La Vegetazione dell'area Pantaleo-Gutturu Mannu-Punta Maxia-Monte Arcosu nel Sulcis-Iglesiente (Sardegna sud-occidentale)

From the Pantaleo-M. Arcosu district (SW Sardinia) 14 associations are described, 4 of them (Phagnalo-Psoraleetum morisianae, Helichryso-Teucrietum mari, Pistacio-Juniperetum oxycedri and OsmundoAlnetum Glutinosae) for the first time. Prevailing vegetation types in this area are macchia-associations: in lower parts the Pistacio-Juniperetum oxycedri belonging to the Oleo-Ceratonion, in the higher ones the Asplenio-Quercetum ilicis (Quercion ilicis) a transiction belt, between about 400-700 m asI shows the Vibumo-Quercetum ilicis. Up to the last century, the whole study-area was covered by a dense evergreen mediterranean forest which has been modified and partially destroyed by cutting, fire and intense pasture. Nowadays, due also to the protection actions by regional forest authorithies, the woody species show an increasing vigour and are prevailing again. These associations at present can be interpreted as climaxnear vegetation types

La Flora di Pantaleo-Gutturu Mannu-Punta Maxia nel Sulcis (Sardegna sud-occidentale)

This study takes into consideration the floristic eomponent of the area Pantaleo- Gutturu Mannu-Punta Maxia, whieh extends over about 12.000 ha and is situated in the southwestern part of Sardinia. The flora eonsists of 594 taxa belonging to 338 genera and 90 families. The native eomponent is emphatised, particularly the endemie one whieh is 6,2% of the totaI. The analysis of the life forms spectrum reveals the dear dominance of therophytes which points out that the area is a typical plein mediterranean environment; also the ehorological speetrum shows 57% of mediterranean elements. FIoristic correlations with other areas of Sardinia are given

Avaliaçao da fraçao de ejeçao de ventrículo esquerdo no exercício moderado durante estimulaçao cardíaca ventricular e atrioventricular com resposta de freqüência*

O efeito da estimulaçao ventricular e atrioventricular seqüencial, por marca passo de dupla câmara com resposta de freqüência (modelo ERGOS 02, Biotronik), sobre a fraçao de ejeçao de ventrículo esquerdo foi avaliado por ventriculografia isotópica, tendo como radiofármaco hemácias com 99m Te. A fraçao de ejeçao foi determinada em 4 pacientes ao repouso, aos 5 minutos de exercício em bicicleta ergo métrica e aos 5 minutos após interrupçao do exercício, no modo VVIR e DDDR (cuja seleçao inicial foi aleatória), com intervalo de 30 minutos entre a avaliaçao de cada modo de estimulaçao. No modo VVIR a fraçao de ejeçao aumentou de 0,353 para 0,415 durante o exercício, reduzindo-se para 0,373 após sua interrupçao. No modo DDDR foi observado efeito similar, com valores de 0,355, 0,390 e 0,373, respectivamente. Para intervalos comparáveis, nao foi encontrada diferença significativa entre os dois modos de estimulaçao. Respeitadas as limitaçoes da técnica e o reduzido número de pacientes, conclui-se que, durante o exercício moderado, a fraçao de ejeçao do ventrículo esquerdo varia de modo similar, para as modalidades de estimulaçao ventricular e atrioventricular seqüencial

Safety, Effectiveness, and Hemodynamic Performance of the Bovine Pericardium Organic Valvular Bioprosthesis

ABSTRACT Objective: To assess actual data on the safety, effectiveness, and hemodynamic performance of Bovine Pericardium Organic Valvular Bioprosthesis (BVP). Methods: The BIOPRO Trial is an observational, retrospective, non-comparative, non-randomized, and multicenter study. We collected data from 903 patients with symptomatic, moderate, or severe valve disease who underwent BVP implants in the timeframe from 2013 to 2020 at three Brazilian institutions. Death, valve-related adverse events (AEs), functional recovery, and hemodynamic performance were evaluated at the hospital, at discharge, and six months and one year later. Primary analysis compared late (> 30 days after implant) linearized rates of valve-related AEs, such as thromboembolism, valve thrombosis, major hemorrhage, major paravalvular leak, and endocarditis, following objective performance criteria (OPC). Analysis was performed to include at least 400 valve-years for each valve position (aortic and mitral) for complete comparisons to OPC. Kaplan-Meier survival and major adverse cardiovascular and cerebrovascular event analyses were also performed. Results: This retrospective study analyzed follow-up data collected from 903 patients (834.2 late patient-years) who have undergone surgery for 455 isolated aortic valve replacement (50.4%), 382 isolated mitral valve replacement (42.3%), and 66 combined valve replacement or other intervention (7.3%). The linearized rates of valve-related AEs were < 2 × OPC. One-year survival rates were 95.1% and 92.7% for aortic and mitral valve replacement, respectively. This study demonstrated an improvement in the New York Heart Association classification from baseline and hemodynamic performance within an expected range. Conclusion: According to this analysis, BVP meets world standards for safety and clinical efficacy

Rhinophyma: a surgical treatment option

INTRODUCTION: Rhinophyma is a condition involving chronic inflammation of the nose and is characterized by progressive hypertrophy and hyperplasia of sebaceous glands and connective tissue. Rhinophyma leads to an appearance of nasal elephantiasis, which is caused by the congestion of dermis vessels. Its etiology is mostly associated with alcohol abuse. Rhinophyma is considered by some researchers to be an advanced stage of acne rosacea. Here, we report a case of rhinophyma that was surgically treated with decortication and electrocoagulation at the Plastic Surgery Service of the University Hospital of the Federal University of Santa Catarina. METHODS: A review of medical and photographic records of a case of rhinophyma was conducted. RESULTS: The patient was underwent surgical treatment with favorable outcomes. CONCLUSION: There are several treatments for rhinophyma, with decortication and electrocoagulation being an excellent therapeutic option

Estimulaçao cardíaca artificial permanente em pacientes submetidos a cirurgia cardíaca

Desde 1974, cinqüenta pacientes submetidos a cirurgia cardíaca (CC) implantaram um marcapasso cardíaco artificial permanente (MP). A cardiopatia que motivou o implante era congênita em 12 e adquirida em 38 pacientes (valvar em 20, isquêmica em 15, miocardiopática em 3) e a arritmia que motivou o implante do MP foi diagnosticada no pré-operatório em 7, decorreu de trauma cirúrgico em 23 e manifestou-se tardiamente em 20. A técnica de implante do MP foi a transvenosa em 27 e a transtorácica em 23 pacientes. Originalmente foi utilizada a estimulaçao ventricular de demanda em 47 procedimentos e 3 pacientes implantaram MP atrioventricular seqüencial. Nao ocorreram óbitos durante o implante de MP simultâneo (n =13) ou posterior (n =37) a CC, mas posteriormente 5 pacientes faleceram, sendo 4 por insuficiência cardíaca congestiva e um de arritmia ventricular (mortalidade tardia de 10%). Um paciente requereu um marcapasso DDD devido à síndrome do seio carotídeo que nao respondeu à estimulaçao VVI, e outro por insuficiência cardíaca. Diversas intervençoes foram necessárias durante o seguimento tardio, incluindo-se nova CC, reprogramaçao ou reimplante de MP, mas os pacientes sobreviventes estao em condiçoes clínicas satisfatórias. O implante de MP é recurso útil para aumentar a sobrevida de pacientes submetidos a CC e que apresentem bradicardia sintomática. Acompanhamento pós-operatório criterioso é necessário para obtençao de resultados satisfatórios e versatilidade é esperada do marcapassista, pois cada paciente apresenta características anatômicas e hemo dinâmicas peculiares

Incidence of Esophageal Thermal Injury Using a Safety Protocol During Atrial Fibrillation Ablation

Objective: Catheter ablation has been a common procedure used for the management of atrial fibrillation (AF). Atrioesophagel fistula (AEF) is one of the most feared complications of AF ablation. Although it is a rare complication, severe esophageal thermal injury must be avoided. It is important to describe a safe method of preventing esophageal injuries without increasing AF recurrence. Methods: A retrospective cohort study of consecutive patients who underwent radiofrequency AF catheter ablation during 1 year-period wa conducted. One hundred and four patients were enrolled divided in two groups: one with a maximum recorded esophageal temperature (ET) < 38 °C and other with a maximum recorded ET ≥ 38 °C. The primary endpoint was detection of endoscopic esophageal lesions after AF ablation and the secondary endpoint was AF recurrence according to the maximum ET reached during the procedure. Results: The maximum ET was on average 37.3 ± 1.0 °C. Only 4 (3.8%) patients had esophageal lesion diagnosed by upper gastrointestinal endoscopy. There were no cases of esophageal perforation. The AF recurrence rate was 9.6% during the follow-up (10 patients, 3 from the ET max < 38 °C group and 7 from the ET max ≥ 38 °C group; p = 0.181). The maximum ET was not associated with AF recurrence after catheter ablation (OR = 1.65, 95% CI = 0.84-3.24, p = 0.14). Conclusions: A low incidence of esophageal injury after AF ablation with the use of a specific esophageal protection protocol was found. There was no esophageal perforation. The AF recurrence rate was similar to that described in the literature

Incidence of Esophageal Thermal Injury Using a Safety Protocol During Atrial Fibrillation Ablation

Objective: Catheter ablation has been a common procedure used for the management of atrial fibrillation (AF). Atrioesophagel fistula (AEF) is one of the most feared complications of AF ablation. Although it is a rare complication, severe esophageal thermal injury must be avoided. It is important to describe a safe method of preventing esophageal injuries without increasing AF recurrence. Methods: A retrospective cohort study of consecutive patients who underwent radiofrequency AF catheter ablation during 1 year-period wa conducted. One hundred and four patients were enrolled divided in two groups: one with a maximum recorded esophageal temperature (ET) < 38 °C and other with a maximum recorded ET ≥ 38 °C. The primary endpoint was detection of endoscopic esophageal lesions after AF ablation and the secondary endpoint was AF recurrence according to the maximum ET reached during the procedure. Results: The maximum ET was on average 37.3 ± 1.0 °C. Only 4 (3.8%) patients had esophageal lesion diagnosed by upper gastrointestinal endoscopy. There were no cases of esophageal perforation. The AF recurrence rate was 9.6% during the follow-up (10 patients, 3 from the ET max < 38 °C group and 7 from the ET max ≥ 38 °C group; p = 0.181). The maximum ET was not associated with AF recurrence after catheter ablation (OR = 1.65, 95% CI = 0.84-3.24, p = 0.14). Conclusions: A low incidence of esophageal injury after AF ablation with the use of a specific esophageal protection protocol was found. There was no esophageal perforation. The AF recurrence rate was similar to that described in the literature