A (in)efetividade do Inquérito Policial à luz dos crimes contra a vida na Comarca de Lajeado/RS, em 2015

A presente monografia aborda a (in)efetividade do Inquérito Policial à luz dos crimes contra a vida na Comarca de Lajeado/RS, em 2015. Parte da doutrina denomina o Inquérito Policial como uma peça meramente informativa, sem valor probatório. No entanto, pode-se entender que ele é efetivo e necessário para a elucidação dos homicídios na Comarca de Lajeado/RS. O trabalho inicia descrevendo o Inquérito Policial e seus procedimentos, suas características, prazos e conclusões, arquivamento, valor probatório, os principais princípios e a atuação do advogado no curso do Inquérito Policial. Na sequência, é abordada a instituição do Tribunal do Júri e suas características, princípios, competência e organização do plenário e da sessão de julgamento. Por fim, analisa-se a (in)efetividade do Inquérito Policial com base nos processos que foram submetidos ao Tribunal do Júri na Comarca de Lajeado/RS, no ano de 2015, por meio de pesquisa de campo realizada junto ao Poder Judiciário e à Delegacia de Polícia de Lajeado. Sendo concluído que o Inquérito Policial foi sim efetivo na Comarca de Lajeado/RS, tendo subsidiado todas as ações penais

PLANEJAMENTO TRIBUTÁRIO NA IMPORTAÇÃO: PROCEDIMENTOS E CONTROLE DE IMPORTAÇÃO E EVENTUAL MINORAÇÃO LEGAL NA CARGA TRIBUTÁRIA

O presente trabalho tem por objetivo tecer estudos sobre o planejamento tributário, controle, e a possibilidade de uma minoração da carga tributária nas importações, bem ainda explorar sobre o planejamento tributário no processo de importação, a possibilidade de redução da carga tributária, em razão de benefícios fiscais como isenção, suspensão, redução da base de cálculo de tributos. Explicitar e verificar o conceito, e natureza jurídica e os critérios de aplicação da carga tributária de importação e exportação. O presente trabalho discorre sobre o mercado externo, regimentos internos, as barreiras do Estado para certos produtos e intervenção estatal. Também sobre a mesma alíquota de impostos para empresas com regimes distintos. Trará à tona o planejamento tributário de importação e os regimes de tributação enquadrados as empresas, bem como suas respectivas porcentagens. As particularidades encontradas, relatadas nesta pesquisa são de considerável utilidade, pois ajudam a nortear, agilizar e facilitar os empreendedores nos processos de importação e redução de custos da empresa

Improved graft patency rates and mid-term outcome of diabetic patients undergoing total arterial myocardial revascularization

Objectives: Diabetes negatively affects the outcome of patients undergoing percutaneous transluminal coronary angioplasty (PTCA) or coronary surgery. However, data are lacking with respect to the impact of arterial revascularization in the diabetic population. Methods: Between 1999 and 2003, 100 of 491 diabetics underwent coronary artery bypass graft surgery (CABG) with total arterial grafting (Group 1, G1); these patients were compared with 100 diabetics undergoing conventional CABG with saphenous veins (Group 2, G2), who were matched for Euroscore and other risk factors such as age, obesity, hypertension, left ventricular ejection fraction (LVEF), previous myocardial infarction and chronic obstructive pulmonary disease (COPD). Results: Both groups had a similar number of diseased coronary vessels (G1=2.6 vs G2= 2.7) and received a similar degree of myocardial revascularization (grafted vessels: G1=2.2 vs G2=2.4). Early outcome was comparable between the groups in terms of ventilatory support (G1=10.8±6 vs G2=10.4±5 hours), intensive care unit (ICU) stay (G1=24±12 vs G2=25±14 hours) and major post-operative complications such as atrial fibrillation (G1=26% vs G2=28%), peri-operative myocardial infarction (G1=1% vs G2=2%)and prolonged ventilatory support (G1=6% vs G2=5%). Hospital mortality was 2% in G1 and 3% in G2. Angiography was performed at a mean follow-up of 34 months in 65.9% and 71.1% of hospital survivors of G1 and G2 respectively: patients of G1 showed a significantly higher patency rate (G1=96% vs G2=83.6%, p=0.02). Additionally, patients of G1 showed a significantly lower incidence of recurrent myocardial ischemia (G1=7 pts. vs G2=18 pts., p=0.03), late myocardial infarction (G1=2 pts. vs G2=10 pts., p=0.03) and need for coronary reintervention (G1=1 pt. vs G2=12 pts, p=0.004). Conclusions: Total arterial grafting in diabetic patients significantly improved the benefits of coronary surgery providing at mid term a higher graft patency rate with a lower incidence of cardiac related events. (Heart International 2006; 3-4: 136-40

Safety and usefulness of composite grafts for total arterial myocardial revascularization: A prospective randomized evaluation

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Left atrial fibrosis: an essential hallmark in chronic mitral regurgitation

Abstract Chronic mitral regurgitation (MR) is the second valvular heart disease for incidence, which worsening severity gradually affects all cardiac chambers and leads to poor outcome if untreated. The recent development of minimally invasive surgical techniques and percutaneous intervention has reduced the operative risk, allowing a more confident referral of these patients for intervention. Therefore, there is a growing need of reliable markers to select the best therapeutic strategies and to identify the optimal timing for intervention. Myocardial fibrosis (MF) gradually occurs as a result of left atrial and ventricular (LA and LV) remodeling due to MR pressure and volume overload. It has been identified as an index of clinical outcome and arrhythmic risk in patients with MR. Particularly, the assessment of LA fibrosis not only allows to define different MR etiology, but also was associated with prognosis and atrial fibrillation (AF) burden. Nowadays, noninvasive estimation of MF is possible through the use of advanced imaging modalities, particularly cardiac magnetic resonance and speckle tracking echocardiography. This review discusses the role of LA fibrosis as a diagnostic and prognostic marker in patients with MR and its quantification by noninvasive multimodality cardiac imaging

Left internal thoracic artery−radial artery composite grafts as the technique of choice for myocardial revascularization in elderly patients: a prospective randomized evaluation

AbstractObjectivesThe technique of choice for myocardial revascularization in elderly patients remains a debated issue. We evaluated the potential advantages of the use of left internal thoracic artery-radial artery composite grafts compared with conventional coronary artery bypass grafts in elderly patients.MethodsWe prospectively enrolled 160 patients aged more than 70 years scheduled to undergo isolated myocardial revascularization. Patients were assigned at random to group 1, 80 patients undergoing total arterial revascularization (left internal thoracic artery on left anterior descending coronary artery plus radial artery), or group 2, 80 patients undergoing standard coronary artery bypass graft surgery (left internal thoracic artery on left anterior descending coronary artery plus saphenous veins). The radial artery was used in all cases as a composite Y-graft.ResultsPreoperative characteristics and risk factors (EuroSCORE: group 1 = 7.9 vs group 2 = 8.1), number of grafted coronary vessels (group 1 = 2.4 vs group 2 = 2.5), aortic crossclamping time (group 1 = 37 ± 7 minutes vs group 2 = 38 ± 7 minutes), ventilation time (group 1 = 22 ± 12 hours vs group 2 = 23 ± 11 hours), intensive care unit stay (group 1 = 39 ± 10 hours vs group 2 = 40 ± 9 hours), and hospital mortality (group 1 = 3.8% vs group 2 = 5%) were comparable between the groups. Comparison between the 2 groups in terms of early postoperative complications showed a higher incidence of cerebrovascular accidents in group 2 (group 1 = 0 patients vs group 2 = 4 patients, 5%). At a mean follow-up of 16 ± 3 months, patients in group 1 showed superior clinical results with a lower incidence of graft occlusion (group 1 = 2 vs group 2 = 11; P = .06) and angina recurrence (group 1 = 2 patients vs group 2 = 12 patients; P = .03). Multivariate analysis identified saphenous vein grafts as independent predictors for graft occlusion and angina recurrence.ConclusionsLeft internal thoracic artery-radial artery composite grafts proved to be a safe procedure in elderly patients. It improved the clinical outcome, providing a significantly higher graft patency rate and a lower incidence of late cardiac events

Thoracoscopic epicardial pulmonary vein ablation for lone paroxysmal atrial fibrillation

Abstract Surgical treatment of atrial fibrillation recently gained new popularity since the introduction of different energy sources for ablative therapy as an alternative to the original ''cut-and-sew'' techniques. However, most of the cases have been performed together with other cardiac surgical procedures and mainly through a standard median sternotomy approach. We report here the first European case of closed-chest thoracoscopic pulmonary vein isolation in a patient with lone paroxysmal atrial fibrillation

A multidisciplinary approach for the emergency care of patients with left ventricular assist devices: A practical guide

The use of a left ventricular assist device (LVAD) as a bridge-to-transplantation or destination therapy to support cardiac function in patients with end-stage heart failure (HF) is increasing in all developed countries. However, the expertise needed to implant and manage patients referred for LVAD treatment is limited to a few reference centers, which are often located far from the patient's home. Although patients undergoing LVAD implantation should be permanently referred to the LVAD center for the management and follow-up of the device also after implantation, they would refer to the local healthcare service for routine assistance and urgent health issues related to the device or generic devices. Therefore, every clinician, from a bigger to a smaller center, should be prepared to manage LVAD carriers and the possible risks associated with LVAD management. Particularly, emergency treatment of patients with LVAD differs slightly from conventional emergency protocols and requires specific knowledge and a multidisciplinary approach to avoid ineffective treatment or dangerous consequences. This review aims to provide a standard protocol for managing emergency and urgency in patients with LVAD, elucidating the role of each healthcare professional and emphasizing the importance of collaboration between the emergency department, in-hospital ward, and LVAD reference center, as well as algorithms designed to ensure timely, adequate, and effective treatment to patients with LVAD. Copyright © 2022 Cameli, Pastore, Mandoli, Landra, Lisi, Cavigli, D'Ascenzi, Focardi, Carrucola, Dokollari, Bisleri, Tsioulpas, Bernazzali, Maccherini and Valente

Clinical outcomes after implantation of a sutureless aortic bioprosthesis with concomitant mitral valve surgery: the SURE-AVR registry

Background: Early treatment of aortic valve stenosis is recommended in eligible symptomatic patients with severe aortic valve stenosis who would otherwise have a poor prognosis. The sutureless aortic valve bioprosthesis offers an alternative to standard aortic valve replacement with a sutured valve, but limited data are available in patients who have undergone multiple valve procedures involving the new, sutureless technology. We sought to investigate outcomes in high operative risk patients with previous or concomitant valve surgery who were implanted with a sutureless valve. Methods: SURE-AVR is an ongoing, prospective, multinational registry of patients undergoing aortic valve replacement. In-hospital and post-discharge outcomes up to 5 years were collected. Results: The study population comprised 78 patients (mean \ub1 SD: age 73.6 \ub1 7.6 years, logistic EuroSCORE 18.0 \ub1 17.5) enrolled at 13 sites who presented for concomitant or previous mitral valve repair (n\ua0= 45) or replacement (n\ua0= 33), with or without additional concomitant procedures, and were implanted with a sutureless valve. Mean \ub1 SD overall aortic cross-clamp time was 109 \ub1 41 min and cardiopulmonary bypass time was 152 \ub1 49 min. Mean \ub1 SD aortic pressure gradients decreased from 37.6 \ub1 17.7 mmHg preoperatively to 13.0 \ub1 5.7 mmHg at hospital discharge, and peak aortic pressure gradient from 61.5 \ub1 28.7 to 23.4 \ub1 10.6 mmHg. Early events included 1 death, 1 transient ischaemic attack, and 1 bleed (all 1.3%); a permanent pacemaker implantation was required in 6 patients (7.7%), and 2 reoperations (not valve related) (2.6%) took place. Over a median follow-up of 55.5 months (Q1 13.4, Q3 68.6), 12 patients died (6 cardiovascular and 6 non-cardiovascular, both 2.1% per patient-year). Five-year survival was 81.3%. Late paravalvular leak occurred in 2 patients (0.7% per patient-year) and permanent pacemaker implantation was required in 3 patients (0.1% per patient-year). There was no apparent rise in mean or peak aortic pressure gradient over the study. Conclusions: These results suggest that the sutureless implant is a technically feasible procedure during mitral surgery and is associated with good clinical outcomes