2,958 research outputs found
Exercise-Induced Intraventricular Obstruction in a Child with Near Syncope and Chest Pain During Exercise
We report the case of a 10-year-old girl with two episodes of light-headedness and chest pain during exercise. She had an unremarkable clinical record, physical examination, ECG, and echocardiogram. Noninvasive ischemia tests were positive, but coronary angiography was normal. Exercise stress echocardiogram revealed an exercise-induced intra-left-ventricular obstruction with a peak gradient of 78 mmHg and replicated her symptoms. After starting beta-blocker therapy her clinical status improved and no residual obstruction was detected. The authors review this unsuspected clinical condition, seldom reported in the adult population and, to our knowledge, never before in a child
Percutaneous Treatment of Pulmonary Atresia with Intact Ventricular Septum: Pulmonary Valve Perforation Using Radiofrequency Energy and Arterial Duct Stenting
A atrésia pulmonar com septo interventricular intacto (AtrP-SI) é uma
cardiopatia congénita rara e de prognóstico
reservado. Apresenta grande variabilidade
anatómica, com diversos graus de hipoplasia do ventrículo direito (VD) o que
condiciona a abordagem terapêutica.
Idealmente, o objectivo é a reconstituição
de uma circulação de tipo biventricular.
Para o efeito, dispomos de técnicas
cirúrgicas e percutâneas. A perfuração da
válvula pulmonar com energia de
radiofrequência (RF) é um método válido
para doentes com atresia de tipo
membranoso, VD sem hipoplasia marcada
(bipartido ou tripartido) e circulação
coronária não dependente do VD. Por
vezes, há necessidade de suplementar a
circulação pulmonar implantando um stent
no canal arterial. Desta forma é possível
tratar alguns doentes com técnicas
exclusivamente percutâneas. Relatamos o
primeiro caso conhecido em Portugal de um
recém-nascido com AtrP-SI submetido a
perfuração com radiofrequência e, num
segundo tempo, implantação de stent no
canal arterial
Percutaneous Closure of Patent Foramen Ovale after Anterior Spinal Cord Infarction
In patients with a patent foramen ovale (PFO) who have had a cryptogenic ischemic stroke, percutaneous closure reduces its recurrence risk. However, its role in spinal cord infarction (SCI) is less well-established. A few case reports describe the putative causative role of PFO in SCI. We present a case of a teenager with cryptogenic anterior SCI in the setting of a deep vein thrombosis and a high risk-PFO who underwent successful percutaneous closure.info:eu-repo/semantics/publishedVersio
Stenosis of the Branches of the Neopulmonary Artery after the Arterial Switch Operation: a Cardiac Magnetic Resonance Imaging Study
Background : The neonatal arterial switch operation (ASO) is now the standard of care for children born with transposition of the great arteries. Stenosis of the neopulmonary artery on long‑term follow up is a known complication.
Methods : We performed a retrospective analysis of eleven patients who underwent a cardiac magnetic resonance imaging (MRI) due to echocardiographic evidence suggestive of
stenosis of the neopulmonary artery or its branches (mean estimated Doppler gradient
48 mmHg, min 30 mmHg, max 70 mmHg). A comprehensive evaluation of anatomy and
perfusion was done by cardiac MRI.
Results : The branches of the neopulmonary artery (neo PA) showed decreased caliber in three patients unilaterally and in two patients, bilaterally. Magnetic resonance (MR) perfusion studies showed concomitant decreased flow, with discrepancy between the two lungs of 35/65% or worse, only in the three patients with unilateral obstruction, by two different MR perfusion methods.
Conclusions : Cardiac MR can be used as a comprehensive non‑invasive imaging technique to diagnose stenosis of the branches of the neopulmonary after the ASO, allowing evaluation of anatomy and function of the neoPA, its branches, and the differential perfusion to each lung, thus facilitating clinical decision making
An Estimation of the Entomological Inoculation Rate for Ifakara: A Semi-Urban Area in a Region of Intense Malaria Transmission in Tanzania.
An entomological study on vectors of malaria and their relative contribution to Plasmodium falciparum transmission in the semi-urban area of Ifakara, south-eastern Tanzania, was conducted. A total of 32 houses were randomly sampled from the area and light trap catches (LTC) performed in one room in each house every 2 weeks for 1 year. A total of 147 448 mosquitoes were caught from 789 LTC; 26 134 Anopheles gambiae s.l., 615 A. funestus, 718 other anophelines and 119 981 culicines. More than 60% of the total A. gambiae s.l. were found in five (0.6%) LTCs, with a maximum of 5889 caught in a single trap. Of 505 A. gambiae s.l. speciated by polymerase chain reaction, 91.5% were found to be A. arabiensis. Plasmodium falciparum sporozoite enzyme-linked immunosorbent assay tests were performed on 10 108 anopheles mosquitoes and 39 (0.38%) were positive. Entomological inoculation rate (EIR) estimates were generated using a standard method and an alternative method that allows the calculation of confidence intervals based on a negative binomial distribution of sporozoite positive mosquitoes. Overall EIR estimates were similar; 31 vs. 29 [95% confidence interval (CI): 19, 44] infectious bites per annum, respectively. The EIR ranged from 4 (95% CI: 1, 17) in the cool season to 108 (95% CI: 69, 170) in the wet season and from 54 (95% CI: 30, 97) in the east of the town to 15 (95% CI: 8, 30) in the town centre. These estimates show large variations over short distances in time and space. They are all markedly lower than those reported from nearby rural areas and for other parts of Tanzania
Patent Foramen Ovale Closure with the BioSTAR Bioabsorbable Implant
Os autores apresentam o caso clínico de
uma doente de 35 anos, sexo feminino, que
recorreu ao hospital da área da residência
por parésia do membro superior direito,
tendo sido diagnosticado AVC isquémico
por Ressonância Magnética Nuclear
Cranio-Encefálica (RMN-CE). A
investigação da fonte embólica levou ao
diagnóstico, por ecocardiograma
transesofágico, de foramen oval patente
(FOP), com shunt direito-esquerdo
espontâneo. Em Maio de 2009 foi efectuado encerramento percutâneo do FOP com dispositivo bioreabsorvível “BioSTAR®”, sob controlo ecocardiográfico. Efectuou ecocardiograma transtorácico após o primeiro, terceiro e sexto mês pós-procedimento e ecocardiograma transesofágico aos nove meses, mostrando sempre adequada
colocação do dispositivo, sem presença de
shunt residual, sem qualquer intercorrência clínica durante este período.
Os autores discutem a importância do
desenvolvimento de dispositivos
bioabsorvíveis para encerramento de FOP,
e as suas vantagens em comparação com os dispositivos sintéticos previamente
utilizados
Validation of a geographic weighted regression analysis as a tool for area-wide integrated pest management programs for Ceratitis capitata Wiedemann (Diptera: Tephritidae) on Terceira Island, Azores
Extrapolation from quantitative sampling to the surrounding areas is an essential feature of many aspects of real world applications in pest management decision-making. However, these decisions are only as good as the accuracy of the methods that provided the information. The problem of estimating Mediterranean fruit fly population densities from trap grids is a specific case. The efficiency of three methods to estimate fruit flies trapped per day values for non-sampled areas in Terceira Island is evaluated, the inverse distance weighted, ordinary Kriging and the geographic weighted regression (GWR). Each method has its own specificities and merits. The results demonstrate that the GWR method is capable of estimating hotspots for the next season and can be used to identify ecological corridors over a non-sampled area. The high spatial heterogeneity and topographical conditions present on Terceira Island may explain why a more mathematically complex method is more reliable than simpler methods for use in possible future wide-area control program for medfly
A fixed point formula for the index of multi-centered N=2 black holes
We propose a formula for computing the (moduli-dependent) contribution of
multi-centered solutions to the total BPS index in terms of the
(moduli-independent) indices associated to single-centered solutions. The main
tool in our analysis is the computation of the refined index Tr(-y)^{2J_3} of
configurational degrees of freedom of multi-centered BPS black hole solutions
in N=2 supergravity by localization methods. When the charges carried by the
centers do not allow for scaling solutions (i.e. solutions where a subset of
the centers can come arbitrarily close to each other), the phase space of
classical BPS solutions is compact and the refined index localizes to a finite
set of isolated fixed points under rotations, corresponding to collinear
solutions. When the charges allow for scaling solutions, the phase space is
non-compact but appears to admit a compactification with finite volume and
additional non-isolated fixed points. We give a prescription for determining
the contributions of these fixed submanifolds by means of a `minimal
modification hypothesis', which we prove in the special case of dipole halo
configurations.Comment: 61 pages, 3 figure
All solutions of the localization equations for N=2 quantum black hole entropy
We find the most general bosonic solution to the localization equations
describing the contributions to the quantum entropy of supersymmetric black
holes in four-dimensional N=2 supergravity coupled to n_v vector multiplets.
This requires the analysis of the BPS equations of the corresponding off-shell
supergravity (including fluctuations of the auxiliary fields) with AdS2 \times
S2 attractor boundary conditions. Our work completes and extends the results of
arXiv:1012.0265 that were obtained for the vector multiplet sector, to include
the fluctuations of all the fields of the off-shell supergravity. We find that,
when the auxiliary SU(2) gauge field strength vanishes, the most general
supersymmetric configuration preserving four supercharges is labelled by n_v+1
real parameters corresponding to the excitations of the conformal mode of the
graviton and the scalars of the n_v vector multiplets. In the general case, the
localization manifold is labelled by an additional SU(2) triplet of one-forms
and a scalar function.Comment: 27 page
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