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Ischemic cardiomyopathy continues to be a major contributor to congestive heart failure, which places a significant burden on our healthcare system. Improving medications and different coronary revascularization strategies are the mainstays in the management of ischemic cardiomyopathy. Although medications and mechanical circulatory support are playing an ever-increasing role, cardiac transplantation remains the gold standard for treating advanced heart failure. Given the small number of available and suitable donor hearts, transplantation is limited for the majority of patients. Surgical ventricular restoration has repeatedly been suggested as a viable alternative in managing heart failure in select patients, as it is believed that surgically returning the ventricle to its original dimensions is possible and associated with favorable outcomes. The purpose of this manuscript is to comprehensively review the current literature on various surgical strategies for ventricular restoration. We also contextualize the published data with respect to ventricular function, volume, structure, arrhythmias, mitral regurgitation, and clinical outcomes.

Introdução: A prevalência de pacientes acometidos por dor neuropática na população em geral pode chegar a 10%. Quando comparado com demais síndromes de dor crônica, os pacientes com dor neuropática descrevem pior estado de saúde mental e física, tornando-se desafiador seu controle. Dado o visível quantitativo de doenças associadas à dor neuropática e as respostas restritas aos manejos atuais, revela-se a busca por novas terapêuticas a serem utilizadas como monoterapia ou em combinação com os tratamentos vigentes. Uma dessas terapêuticas baseia-se na suplementação com vitamina B12, ainda que não seja evidenciado sinais sugestivos de deficiência. Metodologia: Trata-se de estudo exploratório descritivo que emprega o método de revisão integrativa, categoria que consiste em explorar o conhecimento já definido, incluindo pesquisas com diferentes técnicas. Realizou-se em abril de 2020 o levantamento de artigos indexados nas bases de dados eletrônicas PubMed, MedLine, LILACS e BIREM. Resultados e Discussão: Há vários anos, a vitamina B12 tem sido empregada sob forma de monoterapia ou combinadas a demais fármacos para o tratamento de dor em diversas condições clínicas, como dor inflamatória, neuropática, doenças neurodegenerativas, radiculopatia, e etc. demonstrando evidências positivas. Conclusão: Dada as evidências, a vitamina B12 apresenta-se como um candidato potencial para o tratamento da neuropatia periférica com boa segurança e baixa incidência de efeitos colaterais, destacando-se pelos efeitos analgésicos em diferentes síndromes dolorosas e neuropáticas, como adjuvantes ou em monoterapia.

Manometry is the gold standard diagnostic test for achalasia. However, there are incidences where manometry cannot be obtained preoperatively, or the results of manometry is inconsistent with the patient's symptomatology. We aim to determine if intraoperative use of EndoFLIP can provide a diagnosis of achalasia and provide objective information during Heller myotomy and Dor fundoplication. To determine the intraoperative diagnostic EndoFLIP values for patients with achalasia, we determined the optimal cut-off points of the distensibility index (DI) between patients with a diagnosis of achalasia and patients with a diagnosis of hiatal hernia. To evaluate the usefulness of EndoFLIP values during Heller myotomy and Dor fundoplication, we obtained a cohort of patients with EndoFLIP values obtained after Heller myotomy and after Dor fundoplication as well as Eckardt score before and after surgery. Our analysis of 169 patients (133 hiatal hernia and 36 achalasia) showed that patients with DI 99% probability of having achalasia, while DI > 2.3 have a >99% probability of having hiatal hernia. Patients with a DI 0.8–1.3 have a 95% probability of having achalasia, and patients with a DI of 1.4–2.2 have a 94% probability of having a hiatal hernia. There were 40 patients in the cohort to determine objective data during Heller myotomy and Dor fundoplication. The DI increased from a median of 0.7 to 3.2 after myotomy and decreased to 2.2 after Dor fundoplication (p

Objetivo: O objetivo deste estudo foi determinar se o encaminhamento de pacientes com dor musculoesquelética crônica para o reumatologista é realizado corretamente. Método: Foram revistas as fichas de encaminhamento para reumatologia do Centro de Saúde Escola de Sorocaba (CSE). Apuraram-se os dados demográficos, clínicos e terapêuticos, os motivos de encaminhamento e a qualidade dos dados. Foram analisados se houve registro das variáveis mencionadas, o tempo de espera para consulta e a qualidade do preenchimento da ficha de encaminhamento. Resultados: Foram analisados 63 guias de referência e respectivos prontuários. A maioria deles é de pacientes do sexo feminino e da faixa etária entre 50 e 70 anos. Em relação às hipóteses diagnósticas, a maior prevalência nas mulheres foi de osteoartrite seguida de fibromialgia, e fibromialgia e artrite reumatoide entre os homens. Dezesseis pacientes não tinham hipótese registrada. A maior parte queixava-se de dor generalizada. Observou-se que um número importante de fichas de referência e prontuários não registrava os medicamentos nem as medidas não medicamentosas. Chamou a atenção o fato de que não houve nenhuma ficha ou prontuário considerado completo. Conclusão: O encaminhamento de pacientes com dor musculoesquelética crônica do setor primário para a especialidade reumatologia tem falhas importantes.

Objective: Evaluation of the effect of psyllium (Plantago ovata) in pain symptoms in fibromyalgia carriers. Methods: The study included women with fibromyalgia (FM) enrolled in the waiting list of the Clinic School of Physical Therapy of Unisul. Data were collected from March to May 2017. The Visual Analog Scale (EVA) was used to assess the degree of pain, and the pain frequency was assessed through an objective question. Each patient received 300g of Psyllium to use 10g a day for thirty days. Data were expressed as mean and analyzed statically by analysis of variance (ANOVA). Results: A total of 33 FM patients were evaluated, ranging from 31 to 68 years. Before the intervention with psyllium the lowest number in the EVA was 5 (n = 1) and greater 10 (n = 3). After the use of psyllium the smallest number on the scale was 2 (n = 1) and the highest 10 (n = 2). Regarding the frequency ofpain, 75.75% (n = 25) of the patients reported having pain every day before the intervention and 51.51% (n = 17) after. The data from this study showed differences to improve the degree and frequency of pain, but were not statistically significant. Conclusion: Despite not having statistically significant values, it was possible to see improvement in the frequency and degree of pain in some patients. Objetivo: Avaliar o efeito do psyllium (Plantago ovata) nos sintomas de dor em pacientes com fibromialgia. Métodos: Participaram do estudo mulheres com fibromialgia (FM) cadastradas na lista de espera da Clínica Escola de Fisioterapia da Unisul. A coleta de dados foi feita de março a maio de 2017. Para avaliar o grau de dor foi utilizada a Escala Visual Analógica (EVA), e a frequência de dor foi avaliada através de uma pergunta objetiva. Cada paciente recebeu 300g de Psyllium para utilizar 10g ao dia durante trinta dias. Os dados foram expressos em média e analisados estaticamente pela análise de variância (ANOVA). Resultados: Foram avaliadas 33 pacientes com FM, com idade variando entre 31 a 68 anos. Antes da intervenção com o psyllium o menor número na EVA foi 5 (n=1) e maior 10 (n=3). Após o uso do psyllium o menor número na escala foi 2 (n=1) e o maior 10 (n=2). Já com relação à frequência da dor, 75,75% (n=25) das pacientes informaram ter dor todos os dias antes da intervenção e 51,51% (n=17) após. Os dados deste estudo demonstraram diferença para melhora do grau e frequência de dor, porém não foram estatisticamente significantes. Conclusão: Apesar de não se ter obtido valores estatisticamente significativos, foi possível visualizar melhora na frequência e grau de dor em algumas pacientes.

Descrevemos o caso de um paciente jovem com histórico de embolia pulmonar e aborto espontâneo no primeiro trimestre, tendo apresentado dor torácica de início súbito e dispneia. Após revisão retrospectiva sistemática do histórico clínico e avaliação da paciente, ela foi diagnosticada com infarto do miocárdio sem doença coronariana obstrutiva secundário a trombose coronariana. Fundamento: O infarto do miocárdio sem doença coronariana obstrutiva (MINOCA) é um desafio diagnóstico e terapêutico para os médicos, pois um grande espectro de causas pode resultar nessa apresentação clínica, várias entidades podem mimetizá-la e há relativamente poucas recomendações baseadas em evidências para sua avaliação. Discussão: Um diagnóstico preciso da etiologia subjacente à MINOCA requer uma avaliação sistemática e dinâmica do histórico clínico e avaliação de cada paciente, bem como o uso de ferramentas diagnósticas adicionais que permitem uma caracterização mais aprofundada da anatomia cardíaca e da função coronariana, como ressonância magnética cardíaca, imagem vascular coronariana (ultrassom intravascular, tomografia de coerência óptica) e avaliações funcionais coronarianas. O prognóstico dessa entidade depende muito de sua causa subjacente e, portanto, é necessário o diagnóstico preciso de sua etiologia.

BACKGROUND AND OBJECTIVES: In patients with chronic pain, insomnia is reported between 50 and 88% of them. It is essential to recognize sleep disorders to estimate its repercussions on the quality of life and to seek knowledge that supports the necessary interventions. This study aims to identify the possible factors that influence sleep quality, as well as its prevalence in these patients. METHODS: Sample consisting of 68 patients (58 women, 10 men), the mean age of 45.3±10.3 years, with a positive diagnosis of human immunodeficiency virus undergoing antiretroviral and chronic pain treatment in Porto Alegre, RS. The Pittsburgh Sleep Quality Index was used to assess the components of the scale as well as their overall score. For the classification of the type of chronic pain, the Leeds Assessment of Neuropathic Symptoms and Signs scale was used, which differentiates nociceptive and neuropathic pain. RESULTS: Patients classified with no pain, nociceptive pain and neuropathic pain. Overall score divided into good sleep, bad sleep and sleep disorder, where patients without pain accounted for 8.8%, 16.2 and 2.9% respectively. With nociceptive pain 4.4, 11.8 and 5.9%, respectively. With neuropathic pain 4.4, 23.5 and 22.1% respectively. Patients with neuropathic pain had the highest rates of poor sleep and sleep disorder, accounting for 50.0% and using more sleeping pills compared to the control group (p

BACKGROUND AND OBJECTIVES: Parkinson’s disease leads to mandibular movements that affect the masticatory cycle and induce orofacial pain, one of the main clinical alterations found in temporomandibular dysfunction. Thus, the present study aimed to analyze the possible factors associated with temporomandibular dysfunction and to verify the frequency of the dysfunction in this population. METHODS: This was a cross-sectional study in which the participants were evaluated using the Diagnostic Criteria for Temporomandibular Dysfunction research, used to classify the temporomandibular dysfunction and to obtain by physical examination and self-report the variables studied. RESULTS: A total of 139 people with Parkinson’s disease were evaluated. Of these, 77 met the eligibility criteria, with 70% of the sample being male, with an average age of 62±9 years; Parkinson’s disease diagnosis time of 6±4 years and with 71% of the sample in the moderate stage of Parkinson’s disease. No significant associations were found between age, gender, time and stage of the disease with temporomandibular dysfunction. Of the variables analyzed, the significant results showed that the presence of pain (OR=10.92, 95% CI=2.25-59.93, p

The Dor procedure was historically used to restore the geometry of the heart in a patient with a left ventricular (LV) aneurysm via reduction and reshaping of the LV with an aneurysmectomy. Unfortunately, morbidity and mortality remain high with this procedure, with many patients little to no recovery of their ejection fraction while developing severe diastolic failure, often requiring further support; however, the natural history of these patients remains largely unknown. Heart transplant has long been considered the most durable of treatment for patients with end-stage heart failure (HF), but because of the scarcity of donor hearts, the implantation of left ventricular assist devices (LVAD) for mechanical circulatory support has also proven to be an essential tool in the treatment of the advanced heart failure patient. While various techniques for LVAD implantation have been well outlined, there is very limited literature on placement of a VAD in patients with a history of LV aneurysmectomy or Dor procedures, particularly with regard to the challenging aspects of apical cannulation in those with prior apical ventriculotomy and patch placement. In this series, we describe three patients with a history of LV aneurysmectomy procedures who underwent Heartware ventricular assist device (HVAD) implantations for end-stage HF.

Chemotherapy patients have symptoms of pain and fatigue normally used as a justification for not performing physicalactivity during treatment. However, the association of these variables has not yet been conclusively performed inthe studies. The aim of this study was to verify the association between physical activity, levels of pain and fatigue inchemotherapy patients. This was a quantitative, non-experimental and cross-sectional study. For oncological conditionsand levels of physical activity, a semi-structured questionnaire was used; for fatigue the PFS-P was used; for pain, theEORTC-QLQ-C30 was used; and correlations were performed with the R-Spearman test (p

Objectives: In the present study we retrospectively analyzed ventriculographic data from symptomatic patients after myocardial infarction who underwent the Dor procedure (endoventricular circular patch plasty repair) to evaluate left ventricular shape 1 year after the operation and to analyze the geometric correlates of late mitral regurgitation. Methods: Forty-four patients with previous transmural anterior myocardial infarction comprised the study group. Left ventricular volumes, global left ventricular systolic and diastolic sphericity, the extent of wall motion abnormalities, and the presence and degree of mitral regurgitation were analyzed before and 1 year after operation. Results: Comparing preoperative diastole to systole within the cardiac cycle, left ventricular shape becomes more elliptical in systole than it was in diastole (eccentricity index closer to 1). The intervention leads to an increased diastolic sphericity, but for each cardiac cycle, the systolic shape is more elliptical relative to its diastolic counterpart in respect to basal conditions. Mitral regurgitation was detected after operations in 17 patients; 14 of them did not have mitral regurgitation before operations. Patients with late mitral regurgitation had greater preoperative volumes and more spherical chamber than did patients without late mitral regurgitation. Conclusions: Despite a more spherical postoperative left ventricular chamber, systolic pump function improves after the Dor procedure, mainly for the improvement in inferior wall shortening. The presence of late mitral regurgitation is relatively frequent in this series of patients, and this emphasizes the importance of a more accurate quantitative evaluation of preoperative functional mitral regurgitation to repair the valve when appropriate. Geometric correlates of late mitral regurgitation appeared to be greater chamber sphericity and larger ventricular volumes preoperatively. (J Thorac Cardiovasc Surg 2001;121:91-6)

Objective:To identify the prevalence of nonspecific lumbar pain and associated factors among adolescents in Uruguaiana, state of Rio Grande do Sul.Methods:This was a cross-sectional school-based study conducted among adolescents aged 10–17 years who were enrolled in the day shift of the municipal and state educational systems of Uruguaiana. This study evaluated 1455 adolescents. The data-gathering procedures involved two stages. Firstly, a questionnaire on sociodemographic indicators, behavioral patterns and habits of the daily routine and history of nonspecific lumbar pain was applied. Subsequently, height, body mass, flexibility and abdominal strength/resistance measurements were evaluated. To analyze the data, univariate, bivariate and multivariable methods were used and the significance level was taken to be 5% for all the tests.Results:The prevalence of lumbar pain among the adolescents evaluated was 16.1%. Grouped according to sex, the prevalence among males was 10.5% and among females, 21.6%. The variables of sex, body mass index, abdominal strength/resistance and physical activity level presented statistically significant associations with nonspecific lumbar pain. In the adjusted analysis, sex (OR = 2.36; p < 0.001), age (OR=1.14; p < 0.001) and body mass index (OR = 1.44; p = 0.029) maintained significance in the final model.Conclusions:Female adolescents of older age and who presented overweight or obesity had higher chances of developing nonspecific lumbar pain. Objetivo:Identificar a prevalência de dor lombar inespecífica e os fatores associados em adolescentes de Uruguaiana/RS.Métodos:Estudo transversal de base escolar, feito com adolescentes de 10 a 17 anos matriculados no turno diurno das redes municipal e estadual de ensino de Uruguaiana/RS. Foram avaliados 1.455 adolescentes. O procedimento de coleta dos dados ocorreu em duas etapas. Inicialmente foi aplicado um questionário sobre indicadores sociodemográficos, comportamentos e hábitos da rotina diária e histórico de dor lombar inespecífica. Posteriormente foram avaliadas as medidas de estatura, massa corporal, flexibilidade e força/resistência abdominal. Para a análise dos dados foram usados os métodos univariado, bivariado e multivariável e foi considerado nível de significância de 5% para todos os testes.Resultados:A prevalência de dor lombar nos adolescentes avaliados foi de 16,1%. Por sexo, o masculino apresentou uma prevalência de 10,5% e o feminino, de 21,6%. As variáveis sexo, índice de massa corporal, força/resistência abdominal e nível de atividade física apresentaram associação estatisticamente significativa com a dor lombar inespecífica. Na análise ajustada o sexo (OR = 2,36; p < 0,001), a idade (OR = 1,14; p < 0,001) e o índice de massa corporal (OR = 1,44; p = 0,029) mantiveram significância no modelo final.Conclusões:Adolescentes do sexo feminino que apresentaram idades mais elevadas e estavam com sobrepeso ou obesidade têm mais chances de desenvolver dor lombar inespecífica.

Objective: To assess the quantitative serum levels of tropomyosin receptor kinase receptor B, and to estimate its association with serum concentration of brain-derived neurotrophic factor and obesity in patients with painful and painless forms of diabetic polyneuropathy. Methods: We examined 70 patients with diabetic polyneuropathy with confirming peripheral nerve dysfunction by electroneuromyography and measuring of serum levels tropomyosin receptor kinase receptor B and brain-derived neurotrophic factor by enzyme immunoassay. Diabetic polyneuropathy was diagnosed using the modified Toronto Consensus (2011) criteria, while neuropathic pain was assessed using an 11-point Numerical Pain Rating Scale. The patients were divided into two groups according to presence or absence of neuropathic pain. Control Group consisted of 14 healthy persons. Results: The serum levels of tropomyosin receptor kinase receptor B and brain-derived neurotrophic factor in patients with diabetic polyneuropathy are significantly higher than healthy controls (p=0.000). Hyperexpression of brain-derived neurotrophic factor in serum was associated with painful form of diabetic polyneuropathy (R=0.392, p=0.012) and obesity (R=0.412, p=0.001). On the contrary high concentration of tropomyosin receptor kinase receptor B in serum associated with painless diabetic polyneuropathy by Pain DETECT (R=-0.354, p=0.015), low body weight (R=-0.354, p=0.015) and severe demyelization of nerve fibers (R=-0.574, p=0.001), indicated “non-working” receptor detected in serum. Conclusion: Tropomyosin receptor kinase receptor B signaling is involved in the modulation of neuropathic pain and obesity in diabetic polyneuropathy. RESUMO Objetivo: Avaliar os níveis séricos quantitativos do receptor da tropomiosina quinase B, e estimar sua associação com os níveis séricos do fator neurotrófico derivado do cérebro e a obesidade, em pacientes com formas dolorosas e indolores de polineuropatia. Métodos: Examinamos 70 pacientes com polineuropatia diabética, com disfunção de nervo periférico confirmada por eletroneuromiografia e medida de níveis séricos do receptor da tropomiosina quinase B e do fator neurotrófico derivado do cérebro, por imunoensaio enzimático. Polineuropatia diabética foi diagnosticada através dos critérios modificados do Consenso de Toronto (2011), e a dor neuropática foi avaliada pela escala Numerical Pain Rating com 11 pontos. Os pacientes foram divididos em dois grupos, conforme presença ou ausência de dor neuropática. O Grupo Controle tinha 14 indivíduos saudáveis. Resultados: Os níveis séricos do receptor da tropomiosina quinase B e do fator neurotrófico derivado do cérebro em pacientes com polineuropatia diabética são significativamente mais elevados do que controles saudáveis (p=0,000). Hiperexpresssão do fator neurotrófico derivado do cérebro no soro foi associada à forma dolorosa da polineuropatia diabética (R=0,392, p=0,012) e obesidade (R=0,412, p=0,001). Por outro lado, alta concentração sérica de receptor da tropomiosina quinase B, associada à polineuropatia diabética indolor por PainDETECT (R=-0,354, p=0,015), baixo peso corporal (R=-0,354, p=0,015) e grave desmielização de fibras nervosas (R=-0,574, p=0,001), indicaram receptor “não funcionante” detectado no soro. Conclusão: A sinalização do receptor da tropomiosina quinase B está envolvida na modulação da dor neuropática e obesidade na polineuropatia diabética.

BackgroundAntioxidant/oxidant imbalance has been reported to be related to diminished ovarian reserve (DOR). Vitamin A (retinol), a kind of antioxidant, plays a role in restoring ovarian oxidative damage, while C-reactive protein (CRP) is the classical marker of oxidative stress and has recently been identified as an independent variable that is associated with low anti-Mullerian hormone (AMH) levels in young women with DOR. Additionally, retinol binding protein 4 (RBP4) can be considered a substitute for retinol in healthy, nonobese women. The study aim was to determine the relationship between serum RBP4, high sensitivity C-reactive protein (hs-CRP) concentrations and ovarian reserve in nonobese DOR patients.MethodsThis study included 24 DOR women and 48 normal ovarian reserve (NOR) women from the reproductive medical center of Renmin Hospital of Wuhan University. The serum RBP4 and high-sensitivity CRP (hs-CRP) levels were measured with ELISA kits.ResultsRBP4 levels (20,648.36 ± 5475.16 ng/ml vs 23,986.48 ± 5995.64 ng/ml,p = 0.025) were decreased, and hs-CRP levels (695.08 ± 1090.19 ng/ml vs 364.32 ± 786.29 ng/ml,p = 0.012) were increased in the DOR group. Serum RBP4 was positively related to AMH (Pearsonr = 0.518,p = 0.000), while hs-CRP was negatively correlated with AMH (Spearmanr = − 0.345,p = 0.005). after adjustments were made for the covariables, multiple line regression analysis showed that positive association between RBP4 and AMH still existed (β = 0.450,p< 0.001).ConclusionDecreased serum RBP4 levels and increased serum hs-CRP were observed in DOR patients in our study, and the strong correlation between RBP4 and AMH supports the notion that oxidative stress plays a role in DOR, and that appropriate levels of antioxidant vitamin A may be protective against ovarian reserve dysfunction.

JUSTIFICATIVA E OBJETIVOS: A Associação Internacional para o Estudo da Dor recomendou a revisão da definição de dor para "Uma experiência sensorial e emocional desagradável associada com, ou semelhante àquela associada a dano real ou potencial do tecido”. De fato, a dor é uma experiência pessoal influenciada em vários graus por fatores biológicos, psicológicos e sociais1. A pandemia provocada pela (SARS-CoV-2) expôs profissionais de saúde que não estavam preparados para os desafios sem precedentes. Muitos se concentraram em ventiladores, leitos de terapia intensiva, mas outros permaneceram na vanguarda do tratamento da dor. O objetivo deste trabalho foi apresentar uma revisão sobre o impacto da pandemia por COVID-19 no tratamento da dor, além da proposição de uma alternativa frente ao presente contexto, como a telereabilitação. CONTEÚDO: Trata-se de uma revisão integrativa realizada nas bases de dados: LILACS, Scielo, Pubmed, Scopus, Web of Science, PubCovid e bases de dados dedicadas a publicação de Preprints sobre a temática COVID-19, como Psyarxiv e Preprint MedRxiv. Na presente revisão pretendemos evidenciar os prejuízos cognitivos, emocionais e comportamentais relacionadas à dor durante a pandemia causada pela COVID-19. CONCLUSÃO: O contexto pandêmico e isolamento social pode interferir negativamente nas respostas de sensibilidade e no tratamento da dor, seja pelo aumento em eventos de dor na população, impactados pelos prejuízos sociais e psicológicos ou pela interrupção do atendimento presencial durante a pandemia. Neste ponto, recomendamos o avanço gradual na abordagem das limitações atuais do tratamento e propomos um roteiro futuro para enfrentar possíveis desafios que possam se apresentar.

Introduo: A lombalgia se caracteriza como uma dor de origem multifatorial que pode resultar em alteraes no sistema nervoso autnomo. Estas alteraes so identificadas pelo aumento da modulao simptica cardaca levando a diminuio da variabilidade da frequncia cardaca (VFC). Objetivo: Realizar uma reviso literatura acerca do uso da VFC em pacientes com lombalgia. Mtodos: A busca sistemtica desse estudo foi conduzida atravs das bases de dados LILACS, PubMED, CINAHL e SciELO. Resultados: Foram includos na reviso apenas dez estudos que mostravam a relao entre a lombalgia e as respostas dos ndices da VFC. Destes, sete estudos relatam melhora/relao dos ndices da VFC com a lombalgia e outros estudos no mostram alterao das respostas. Concluso: Existem poucas evidncias apresentando a relao entre a lombalgia e as respostas dos ndices da VFC na literatura. Alm disso, os resultados se mostram inconclusivos, fato este que dificulta afirmar se h relao ou melhora dos ndices da VFC aps interveno em pacientes com lombalgia.

Pulmonary atresia with intact ventricular septum and right ventricle-dependent coronary circulation confers a high risk for myocardial infarction and complications of ischaemia, including left ventricle aneurysms. We describe an infant with pulmonary atresia with intact ventricular septum and right ventricle-dependent coronary circulation and a left ventricle apical aneurysm who successfully underwent the Dor procedure and a subsequent Fontan operation. Surgery for postinfarction left ventricle aneurysm can be considered in infants.

The purpose: to study the effectiveness of patch of the left ventricle according to the method of Dor in young people (up to 45 years). Materials and methods: The study was conducted on the basis of the Cardiosurgery Unit No. 2 of the RRCH for 10 years. 38 patients with left ventricular aneurysm and reduced left ventricular function were included in the prospective study. A functional class of heart failure and quality of life before surgery was determined, after surgery before discharge of patients from the hospital and 12-24 months later (on average 20 months later) after discharge from the hospital by questionnaire method. The quality of life was assessed using the Medical Outcomes Study 36 Item Short Form Health Survey (SF-36). The questionnaire consists of 36 questions, the results are presented in the form of scores from 0 to 100 and are distributed over 8 scales, the higher the ball, the better the patient's quality of life. The functional state of the patients was assessed based on the dynamics of the NYHA functional class of heart failure. Results: This study showed that, after the Dor method, left ventricular function increased from 39.3 ± 1.40% to 45 ± 2.2%. According to the SF-36 questionnaire, the overall scores of physical functioning improved significantly 12-24 months after the operation (+ 29% p

Objective: We have retrospectively analyzed the early and the mid-term results of the operations for modified endoventricular circular patch plasty for left ventricular aneurysm (LVA) repair in our clinic. Patients and methods: Sixty-seven cases with anterior LVA were included in the study. Mean age of the patients were 64.8 ± 8.9 (ranged from 51 to 74) years. Fifty-three patients were male and 14 female (M:F = 3.8). Preoperative left ventricular ejection fraction (LVEF) was 30.8%± 4.5%, LV end-diastolic diameter (LVEDD) 6.0 ± 1.9 cm, and end-systolic diameter (LVESD) was 4.6 ± 0.8 cm in average. Coronary revascularization was performed in 61 patients and mitral ring annuloplasty in five patients. Results: Thirty-day mortality was 5.9%. The surviving 63 patients were followed up for 4.3 ± 2.3 years on average (ranged from 0.2 to 8.5 years), adding up to 267.8 patient/years. In the immediate postoperative and long-term follow-up, there was a significant improvement in LVEF, LVESD, LVEDD, and mitral valvular function. Four patients died in the follow-up with only a single patient due to cardiac causes. The five years survival was 87.7%± 4.1% and the freedom from cardiac death was 98.2%± 1.7%. Conclusion: LVA repair with Dor procedure can be performed with low mortality. With appropriate repair of LVA and coronary revascularization, patients may have benefit both for survival and also for clinical status. (J Card Surg 2010;25:147-152)

Background: The aim of this study was to investigate the mid-term changes of left ventricular (LV) geometry and function after Dor, septal anterior ventricular exclusion (SAVE), and Overlapping ventricular remodeling procedures. Methods: Forty-three patients who underwent LV reconstruction for end-stage ischemic heart disease, were divided into three groups, undergoing Dor (n = 15), SAVE (n = 12), and Overlapping procedures (n = 16). Coronary artery bypass grafting and mitral annuloplasty were performed concomitantly when indicated. Left ventricular diastolic and systolic dimensions (LVDd and LVDs), LV end-diastolic and end-systolic volume indexes (LVEDVI and LVESVI), LV ejection fraction (LVEF), deceleration time (DcT), sphericity index (SI), and grade of mitral regurgitation were measured on preoperative and postoperative (immediately and at intermediate-term) echocardiography. Results: In the Dor group, the LVEDVI and LVESVI were significantly reduced immediately after the operation, and increased again at intermediate follow-up. The SI was significantly increased immediately after the operation and increased thereafter in a linear fashion. In the SAVE group, the DcTwas significantly reduced immediately after the operation and was not improved in the later stage. In the Overlapping group, the LVEDVI and LVESVI were significantly reduced, and remained as such at intermediate follow-up. The SI was not increased and remained almost unchanged after the operation. Conclusion: Progression in LV sphericity after the Dor procedure and persistent reduction of the DcTafter the SAVE procedure seem to be procedure-related problems. The Overlapping procedure provided significant LV volume reduction, maintaining the most elliptical LV shape with acceptable early and late mortality. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Background Surgical ventricular restoration (the Dor procedure) is an option in patients with coronary artery disease and postinfarction left ventricular aneurysm. The procedure can be extended to treat ventricular tachycardia (VT). The aim of this study was to evaluate the Dor procedure including VT surgery in our institution. Methods From July 1997 to December 2003, 53 consecutive patients with left ventricular aneurysm and VT underwent surgical ventricular restoration including nonguided endocardiectomy and cryoablation. Twenty-four patients had at least one preoperative episode of spontaneous VT, of which 8 were survivors of sudden cardiac death. Twenty-nine patients had inducible-only VT. In 45 patients, who underwent preoperative programmed stimulation, sustained uniform VT could be initiated. Arrhythmia control was evaluated by programmed stimulation or analysis of events registered by implanted defibrillators and by review of patient's records. Results Early mortality was 2 of 53 (3.8%). Mean follow-up was 3.7 years. At 1, 3, and 5 years overall actuarial survival was 94%, 80%, and 59%, respectively. Surgical success rate in patients with preoperative spontaneous VT was 91%. Inducible VT was found in 5 of 35 patients who underwent postoperative programmed stimulation. There was no arrhythmia-related late death and there was no loss to follow-up. Conclusions The Dor procedure including VT surgery is an effective treatment for postinfarction left ventricular aneurysm and VT and eliminates the need for an implantable defibrillator in most patients. Early and long-term results are good in terms of survival and arrhythmia control.

Objective: Surgical ventricular restoration by means of the Dor procedure is a surgical option in patients with coronary artery disease, postinfarction left ventricular aneurysm or ischemic dilated cardiomyopathy with or without ventricular tachycardia. The aim of this study was to evaluate the 10-year clinical experience of this procedure in our institution. Methods: From May 1994 to June 2004, surgical ventricular restoration was performed in 101 patients (77 males), mean age 63.8 (35‐80) years. All patients presented with angina and/or heart failure and/or ventricular tachycardia. Postinfarction left ventricular aneurysm was present in 97 patients and ischemic dilated cardiomyopathy with a large akinetic left ventricle in 4. The preoperative left ventricular ejection fraction was 27G10 (7‐50) %. Multi-vessel disease was present in 80 patients. Ventricular tachycardia was diagnosed in 53 patients (spontaneous VT in 25). Mitral regurgitation more than grade 2 was found in 13 patients. The mean Euroscore was 7.1G2.9 (3‐17). Results: All patients underwent the Dor procedure, which in 53 patients included a nonguided endocardectomy and cryoablation for treatment of ventricular tachycardia. Coronary artery bypass grafting was performed in 99 patients and a mitral valve procedure was performed in 29. Intra-aortic balloon pumping was used postoperatively in 14 cases and 24 patients needed inotropic support for more than 24 h. Mean time on the ventilator was 16G25 (3‐168) hours and mean stay in the intensive care unit was 2.1G2.2 (0‐13) days. Postoperative stroke occurred in 7 patients. Early mortality was 8/101 (7.9%). Mean follow-up in operative survivors was 4.4G2.8 (0.1‐10.4) years. Actuarial survival at 1, 3 and 5 years was 88, 79 and 65%. Conclusions: The Dor procedure is a reproducible surgical option for treatment of postinfarction left ventricular aneurysm. Early and long-term results are good in terms of survival. Q 2005 Elsevier B.V. All rights reserved.

To reveal morphological factors causing unfavorable follow-up outcome of surgical treatment of patients with ischemic cardiomyopathy (ICMP) and with left ventricle (LV) aneurysm according to the data of intraoperative biopsies of LV myocardium and right atrium (RA) auricle.The object of the study was to examine biopsy material of LV myocardium and RA auricle from 36 patients with ICMP. Clinical criteria of patients' inclusion into the study were: ESI LV80 ml/m(2), EDP LV30 mmHg, LV EF40%, presence of akinetic and dyskinetic areas in LV, angina of II-IV class CCS, heart failure of II-IV class NYHA. The following morphometrical parameters were estimated for revelation of postoperative remodeling risk factors: parenchymal-stromal ratio (PSR), trophic index (TI), pericapillar diffusion zone (PDZ), Kernogan index (KI) and specific volume of granules of natriuretic factor (NUF) in atrial cardiomyocytes.In all the patients LV EF increased significantly (from 36.4+/-4.1% to 46.3+/-4.2%) (P0.05) in the early postoperative period; LV EDI decreased (from 139.3+/-11.2 ml/m(2) to 108.4+/-8.9 ml/m(2)) (P0.05). In the follow-up period (one year) all the patients were divided into two groups: in 28 patients (the 1st group) volume of the cavity, contractile function of LV remained satisfactory. In the other eight patients (the 2nd group) there was significant decrease of LV EF (up to 33.9+/-10.2%) due to increase of LV EDI [up to 129.2+/-10.1 ml/m(2) (P0.05)]. Grade of MR preoperatively was 1.21+/-0.5 and 1.47+/-0.9, correspondingly, for the patients with positive and negative changes in the follow-up postoperative period. Drawing morphological parallels of postoperative heart remodeling in patients with ICMP showed that diffusive, lymphocytic-macrophage inflammatory infiltration of myocardial stroma in combination with severe fibrosis (PSR1.5), low TI (0.015) and greater value of PDZ (1000 microm) and KI (1.6) of LV myocardium are the factors connected with unfavorable follow-up results of surgical treatment. Moreover, we showed an inverse correlative relationship between content of NUF granules in the cardiomyocytes of RA auricle and the outcomes of the Dor procedure.Thus, a combination of the foregoing features is a morphological predictor of postoperative heart remodeling in patients with ICMP.

Background and purpose Significant mitral regurgitation (MR) is frequently associated with coronary artery disease. The precise geometric predictors of significant MR in ischemic cardiomyopathy are not clearly defined. We performed real-time 3D echocardiography (RT3DE) in 48 patients scheduled for infarct exclusion surgery or Dor procedure, 22 of whom had moderate or severe MR (DorMR) and 26 with no or trivial MR (DorNoMR). Methods Two orthogonal apical volumetric planes of LV, commissure–commissure (CC) and antero-posterior (AP) planes, were generated during mid-systole. Mitral valve tenting height (MVTht) and area (MVTa) were measured. The degree of leaflet tethering was estimated by the angles between the annular plane and each leaflet (anterior leaflet: Aα, posterior leaflet: Pα). Results MVTht (1.11±0.14 vs 0.78±0.20cm, P

Background: Complex ventricular reconstruction (CVR) is now being employed increasingly thanks to the pioneering work of Dor. However, little is known about the failure mode of CVR. We present experience from three centres with CVR and an analysis of the failure modes. Methods: Between January 1997 and February 2005, 284 patients underwent CVR in three centres in Australia and USA. All of the procedures were performed as adjuncts to coronary artery surgery and/or valvular surgery. Patients were followed-up clinically and/or echocardiographically. Failure modes were classified as fatal or non-fatal. Non-fatal failure mode (NFM) was defined as either persistent heart failure, recurrence of LV scar, need for ventricular assistance, persistent ventricular arrhythmia, or a combination. Results: Operative mortality rate (OMR) was 8% (23 deaths). This fatal failure mode was most related to urgency of surgery and cardiogenic shock in 15 patients (5.3% of OMR), stroke in 5 patients (1.8%) or postoperative bi-ventricular failure (1%). Non-fatal failure modes accounted for morbidity in 26 patients (9%). This was predominantly due to persistent septal dyskinesis in 7 patients (2.46%), persistent mitral regurgitation in 5 (1.8%), postoperative ventricular tachycardia in 4 (1.4%), sub-optimal myocardial protection in 4 (1.4%) use of a large, stiff patch in 4 (1.4%). One hundred and ninety-nine of the surviving 261 patients(76%) werein NYHAClassI.Conclusions:Complexventricular reconstruction isa robusttechniquethathaslasting benefit.Failuremodes have been identified and could be minimized by appropriate patient and procedure selection.

Insertion of the inflow cannula of an implantable left ventricular assist device (LVAD) is a surgical challenge in patients who have previously undergone a Dor ventriculoplasty procedure. We report a 54-year-old man who had successful LVAD insertion 18 months after a Dor procedure. We also describe the strategy of LVAD insertion in such patients.

See related article on page 863. H eart failure is a major health problem with increasing prevalence due partly to an aged population and more effective treatment of acute myocardial infarction. Postinfarction left ventricular remodeling is characterized by chamber dilatation and abnormal shape leading to systolic and diastolic dysfunction. In advanced form, it leads to the heart failure syndrome and is progressive. Intensive medical management reduces symptoms and improves survival. However, patients who are in functional class III or IV have a poor 3-year prognosis.1-3 Recently, surgical approaches have been designed to abort and reverse remodeling, diminish heart failure, and improve survival. With minor modifications, this surgical approach uses the Dor procedure. Surgical therapy achieves the following: 1. Relieves ischemia by coronary revascularization. 2. Diminishes ventricular volume. 3. Restores the ventricle to more normal geometry. 4. Further diminishes volume overload by mitral valve repair when appropriate.

A influência de fatores pessoais, culturais e afetivos e das caracterísrticas das neoplasias na ocorrência e expressão do sintoma álgico de 92 doentes com doença oncológica avançada foi avaliada através de escalas e inventários adaptados para a língua portuguesa. Havia dor, em geral moderada ou intensa, durante a semana anterior à entrevista em 62,0% dos casos. A duração média do quadro álgico foi 10 meses. Havia maior proporção de doentes com neoplasia do segmento cabeça e pescoço no grupo com dor, do que sem dor. Concepções culturais errôneas sobre o controle da dor no câncer e de que doentes recebiam remédios em demasia se correlacionaram à dor de maior intensidade (p

Perinatal hypoxic-ischemic (HI) brain injury results in death or profound long-term neurologic disability in both children and adults. However, there is no effective pharmacological therapy due to a poor understanding of HI events, especially the initial triggers for hypoxic-ischemic injury such as disrupted ionic homeostasis and the lack of effective intervention strategy. In the present study, we showed that neonatal brains undergo a developmental increase in the disruption of K+ homeostasis during simulated ischemia, oxygen-glucose deprivation (OGD) and neonatal HI cortex has a triple phasic response (earlier attenuation, later enhancement, and then recovery) of disrupted K+ homeostasis to OGD. This response partially involves the activity of the δ-opioid receptor (DOR) since the earlier attenuation of ischemic disruption of K+ homeostasis could be blocked by DOR antagonism, while the later enhancement was reversed by DOR activation. Similar to DOR activation, acupuncture, a strategy to promote DOR activity, could partially reverse the later enhanced ischemic disruption of K+ homeostasis in the neonatal cortex. Since maintaining cellular K+ homeostasis and inhibiting excessive K+ fluxes in the early phase of hypoxic-ischemic insults may be of therapeutic benefit in the treatment of ischemic brain injury and related neurodegenerative conditions, and since many neurons and other cells can be rescued during the "window of opportunity" after HI insults, our first findings regarding the role of acupuncture and DOR in attenuating ischemic disruption of K+ homeostasis in the neonatal HI brain suggest a potential intervention therapy in the treatment of neonatal brain injury, especially hypoxic-ischemic encephalopathy.

e21581 Background: ICI with/without chemotherapy has become the standard of care for the treatment of advanced NSCLC. Little is known about the clinical and molecular predictors of DoR to these agents. We previously reported clinical predictors of DoR to ICI in NSCLC patients (pts). Here we report the correlation of molecular alterations with DoR and clinical/molecular characteristics of super responders (DoR ≥ 2yr) to ICI. Methods: A retrospective chart review of pts with advanced NSCLC treated with ICI based therapy between 2015-2018 at Karmanos Cancer Institute was conducted. Clinical, tumor, and molecular characteristics data were collected. DoR was grouped into: < / = 6 weeks, > 6weeks-6months, > 6mo-1yr, > 1yr, and super responders. Results: Of 147 pts, 68% had adenocarcinoma, 61% received prior radiation, 21% had brain metastasis (mets), 26% developed irAEs, 33% were on statin, 27% were on aspirin, 83% were current or former smokers, 55% had right sided primary tumor, ICI was 1st line treatment (tx) in 20% and 2nd line tx in 52%. Overall median DoR was 168 days (95% CI, 132-231 days). Pts with right sided primary tumors and those who received ICI as 1st line tx had longer DoR (p = 0.012 and p = 0.017; respectively). Other aforementioned covariates, including brain mets, had no significant relationship with DoR. Molecular profile (MP) of 592 genes was available for 57 (38.8%) pts. PD-L1 ≥50%, CDKN2A and NOTCH1 mutations were associated with statistically significant longer DoR. Mutations/alterations in EGFR, ALK, ROS1, MET, RET, HER2, KRAS, STK11 and TP53 did not appears to have an impact on the DoR, although some of the analysis was limited because of very small number of pts. Of the 10 super responders, majority had adenocarcinoma, received prior radiation and were current/former smokers. Two had brain mets. Most did not have concurrent use of anti-inflammatory agents (statin or ASA). Only 2 of the super responders had MP available with negative NOTCH1 and CDKN2A mutations. Conclusions: Receiving ICI as 1st line of therapy and having right sided primary tumors predicted longer DoR. Presence of brain mets did not adversely affect the DoR. Super responders were more likely to have adenocarcinoma, prior radiation therapy, and current/former smoking history. PD-L1 expression ≥ 50%, CDKN2A, and NOTCH1 were associated with longer DoR. Presence of actionable genomic alterations, STK11, KRAS and TP53 did not appear to impact DoR to ICI.

11516 Background: Malignant PEComa is a rare, aggressive sarcoma, with no approved medical treatment. Cytotoxic chemotherapies have limited benefit for patients with advanced disease. The AMPECT trial measured the effects of nab-sirolimus (ABI-009) and is the first prospective study in advanced malignant PEComa. nab-Sirolimus is a nanoparticle albumin-bound mTOR inhibitor with significantly higher intratumoral drug levels, mTOR target suppression, and anti-tumor activity in animal models versus other mTOR inhibitors. This report presents long-term follow-up of DoR after the primary analysis. Methods: Patients (N=34) received nab-sirolimus (100mg/m2 IV, weekly, 2/3 weeks) until progression or unacceptable toxicity. Primary endpoint: ORR by IRR. Key secondary endpoints included DoR, PFS6, OS, and safety. Exploratory endpoints included correlation of tumor genotype and outcome. The sample size of 30 efficacy-evaluable patients was based on an estimated ORR of 30% and the lower bound of the 95%CI of ORR to exclude values less than 14.7%. The primary analysis was conducted when all patients were treated ≥6 months (May 22, 2019). This report updates the primary response analysis and DoR with an additional 8.5-month of follow-up. Results: As of Feb 06, 2020, of the 31 efficacy-evaluable patients, the confirmed ORR by IRR was 39% (12/31, 95%CI: 21.8, 57.8), with 1 complete response (CR) and 11 partial responses (PR), 52% stable disease (SD, 16/31, with 10/16 SD ≥12 weeks), and 10% progressive disease (3/31); the disease control rate (CR+PR+SD ≥12 weeks) was 71%. PFS6 was 71% (95%CI: 47.7, 85.1). The majority of responses (67%) were reached at the first post-baseline scan at week 6, with a median time to response of 1.4 months (95%CI: 1.3 to 2.8). The median DoR by IRR was not yet reached (range 5.6-38.7+ months; calculated median 22.2+ months) with 8/12 (67%) responders still on treatment for >1 year and 5/12 (42%) >2 years. Mutational analysis available for 25 patients identified that TSC2 loss-of-function mutations significantly correlated with response; 8/9 (89%) patients with TSC2 had a confirmed response. Conclusions: Responses of advanced malignant PEComa to nab-sirolimus were highly durable and occurred in 39% of patients based on independent review. The high disease control rate with manageable toxicities suggest that nab-sirolimus is effective and represents an important new treatment option for these patients. NCT02494570. Clinical trial information: NCT02494570 .

There is no consensus regarding the type of anti-reflux procedure to be used as an adjunct to laparoscopic Heller cardiomyotomy (LHCM). The aim of this study was to compare Angle of His accentuation (AOH) with Dor Fundoplication (Dor) as an adjunct to LHCM.A total of 110 patients with achalasia cardia presenting for LHCM from March 2010 to July 2015 were randomized to Dor and AOH. Symptom severity, achalasia-specific quality of life (ASQOL), new onset heartburn, and patient satisfaction were assessed using standardized scores preoperatively, at 3, 6 months, and then yearly. The primary outcome was relief of esophageal symptoms while secondary outcomes were new onset heartburn and ASQOL.Both groups were comparable with respect to the baseline demographic characteristics. There was no conversion to open and no mortality in either group. Median operative time was 128 min in AOH and 144 min in Dor group (p 0.01). Mean follow-up was 36 months and was available in 98% patients. There was significant improvement in esophageal symptoms in both groups with no statistically significant difference between the two groups (p 0.05). There was no difference in cumulative symptom scores between the two groups over the period of follow-up. New onset heartburn was seen in 11% in AOH and 9% in Dor group. Mean ASQOL score improved in both groups with no difference between the two groups (p = 0.83). Patient satisfaction was similar in both groups.AOH is similar to Dor as an adjunct to LHCM in safety and efficacy and can be performed in shorter time.CTRI: REF/2014/06/007146.

We compared the outcomes of Toupet fundoplication with those of Dor fundoplication in patients with achalasia who underwent laparoscopic Heller myotomy. Seventy-two patients with achalasia and dysphagia underwent laparoscopic Heller myotomy with fundoplication performed by a single surgeon. Heller–Toupet fundoplication (HT) was performed in 30 patients, and Heller–Dor fundoplication (HD) was done in 42. The symptoms and esophageal function were retrospectively assessed in both groups. The dysphagia scores significantly decreased after both the HT and HD procedures, and did not differ significantly between them. The incidence of reflux symptoms was significantly higher after HT (26.7 %) than after HD (7.1 %). The lower esophageal sphincter (LES) resting pressure significantly decreased after both HT and HD. Upon endoscopic examination, the incidence of reflux esophagitis was significantly higher after HT (38.5 %) than after HD (8.8 %). During esophageal pH monitoring, the fraction time at pH

A 51-year-old man with a history of ischemic cardiomyopathy who underwent a recent three-vessel coronary artery bypass graft and Dor procedure was admitted to a tertiary care hospital with ventricular tachycardia and congestive heart failure. He underwent a transthoracic echocardiogram, which demonstrated a noticeable aneurysm at the left ventricular apex (A) with patch closure (arrow) in the apical four-chamber view, consistent with a previous Dor procedure (Figure 1). Doppler flow studies suggested a patch leak with communication between the left ventricular cavity and apical aneurysm. A cardiac computed tomography scan demonstrated a communication across the patch closure (arrow in Figure 2), between the left ventricular cavity (LV) and the aneurysm (A). Figure 1 Figure 2 The Dor procedure was first performed in 1984 (1). It is a reasonable surgical ventricular restoration option for patients with severe left ventricular dysfunction and aneurysm. The Dor procedure involves endoventricular patch plasty closure of an apical aneurysm to reduce left ventricular cavity size, resulting in improved left ventricular function and cardiac output (2). The present patient, however, had disruption of the repair procedure, resulting in worsening cardiac function and heart failure without appreciable benefit. He eventually underwent successful cardiac transplantation and remained well two years later.

FUNDAMENTO: A imagem de perfusão miocárdica adquirida durante episódio de dor torácica tem sido utilizada nos pacientes na sala de emergência. OBJETIVO: Avaliar as características operacionais da cintilografia com 99mTc-Tetrofosmin durante episódio de dor torácica para descartar o diagnóstico de infarto agudo do miocárdio. MÉTODOS: 108 pacientes admitidos com dor torácica ou até quatro horas do término dos sintomas e eletrocardiograma não diagnostico realizaram cintilografia em repouso e dosagens de troponina I. Pacientes com passado de infarto do miocárdio (IM) não foram excluídos (24 pacientes). Troponina I foi dosada na admissão e seis horas após. Médicos nucleares realizaram análise cega das imagens. Infarto do miocárdio foi confirmado com elevação da troponina I maior que três vezes o controle. RESULTADOS: A imagem perfusional de repouso foi anormal em todos os seis pacientes com IM. Apenas um paciente apresentou imagem normal e elevação da troponina. Outros 55 pacientes obtiveram imagem positiva sem IM e 46 pacientes com imagens e troponinas normais. A prevalência da doença foi 6,5%. A sensibilidade da imagem de repouso durante dor torácica para a evidência de IM foi 85,7% e especificidade de 45,5%. O valor preditivo negativo foi 97,7%. CONCLUSÃO: Pacientes submetidos ao protocolo de dor torácica com cintilografia de perfusão miocárdica demonstraram um excelente valor preditivo negativo para afastar o diagnóstico de infarto do miocárdio. Estes resultados sugerem que a imagem de perfusão em repouso é uma ferramenta importante na unidade de dor torácica.

Objetivos: A gonartrose é uma patologia articular muito frequente e causa de morbilidade considerável. Esta é muitas vezes secundária à dor, que é o sintoma predominante. Os anti-inflamatórios não esteróides (AINE) orais são uma das opções disponíveis para a analgesia mas estão associados a um importante risco de efeitos adversos. As formulações tópicas poderão representar uma alternativa mais segura. O objetivo deste trabalho é rever a evidência disponível relativa à eficácia do uso de AINE tópicos no tratamento da dor por osteoartrose (OA) do joelho/gonartrose. Fontes de dados: National Clearinghouse, TRIP, The Cochrane Library, DARE, Bandolier, MEDLINE e outros sítios específicos de sociedades científicas internacionais. Métodos de revisão: Pesquisaram-se normas de orientação clínica (NOC), revisões sistemáticas, meta-análises e ensaios clínicos aleatorizados e controlados (ECAC), publicados entre janeiro e dezembro de 2012, nos idiomas português, inglês e espanhol, usando os termos MeSH: “Administration, Topical”/“Administration, Cutaneous”, “Anti-Inflammatory Agents, Non-Steroidal” e “Osteoarthritis”. Para avaliação do nível de evidência e atribuição de força de recomendação foi utilizada a escala Strenght of Recommendation Taxonomy (SORT) da American Academy of Family Physicians. Resultados: Foram encontrados 96 artigos, dos quais 8 cumpriam os critérios de inclusão: 4 NOC e 4 meta-análises. Os estudos suportam que a aplicação tópica de AINE parece ser eficaz no alívio sintomático da dor por gonartrose, a curto prazo, sendo uma alternativa analgésica bem tolerada e com poucos efeitos laterais relatados. Conclusões: A evidência disponível, limitada a ECAC de duração máxima de 12 semanas e com algumas limitações metodológicas, suporta a eficácia da utilização de AINE tópicos na redução da dor por gonartrose (SORT B). Contudo, a heterogeneidade dos compostos testados e da duração dos ensaios limitam as conclusões e a sua extrapolação, pelo que são necessários novos estudos nesta área, nomeadamente com maior duração/seguimento. Aim: Osteoarthritis (OA) is a common form of degenerative joint disease with increasing prevalence. The knee is the most frequently affected joint and pain is an incapacitating symptom. The first line of treatment includes oral analgesics like acetaminophen and oral non-steroidal anti-inflammatory drugs (NSAID). However, the latter are associated with potentially severe side effects, making topical NSAID a possible, safer alternative. The aim of this review is to examine the evidence for the efficacy and safety of topical NSAID in the management of OA of the knee. Data sources: The National Guideline Clearinghouse, TRIP, The Cochrane Library, DARE, Bandolier, MEDLINE and other sites of international scientific associations were searched. Review methods: Databases were searched for guidelines and publications appearing between January and December 2012, in Portuguese, English or Spanish, using the search terms (“Administration, Topical” OR “Administration, Cutaneous”) AND (“Anti-Inflammatory Agents, Non-Steroidal”) AND “Osteoarthritis”. To evaluate the level of evidence and the strength of recommendations, the Strength of Recommendation Taxonomy (SORT) of the American Academy of Family Physicians was used. Results: We found 96 articles, of which 8 fulfilled the inclusion criteria. There were 4 guidelines and 4 meta-analyses selected for inclusion in this review. These studies show the short-term benefits for pain relief in OA of the knee with the use of topical NSAID. They demonstrate its tolerability and safety profile with few adverse effects. Conclusions: The available evidence from Randomized Controlled Trials of up to 12 weeks duration supports the efficacy of topical NSAID for pain control in OA of the knee (SORT B). Studies differed in the drugs investigated, as well as in the duration of treatment. This heterogeneity limits the conclusions that can be drawn and the generalizability of results. Studies with a longer period of follow-up are required.

Objective To estimate the time of decision (TD) to look for medical care and the time of arrival (TA) at the health service for men (M) and women (W) suffering from acute myocardial infarction and to analyze the influence of the interpretation of pain and pain resistance behaviors during these times. Methods This is an exploratory research, performed at the university hospital in Salvador/Bahia. 43 W and 54 M were interviewed. To study the dependence among sociodemographic and gender variables, the Fisher Exact Test was used. To analyze times, a geometric mean (GM) was used. In order to verify the association between the GM of TD and TA and the judgment of pain, and between the GM of TD and TA and the behavior of resistance to pain, as well as to test the time of interaction between the gender variable and other variables of interest, the robust regression model was used. The statistical significance adopted was 5%. Results The GM of the TD for M was 1.13 h; for W, 0.74 h. The GM of the TA was 1.74 h for M and 1.47 h for W. Those who did not recognize the symptoms of AMI and presented behavior of resistance to pain had higher TD and TA, being the associations significant. Gender did not change the associations of interest. Conclusion The findings demonstrate the importance of health education aiming at the benefits of early treatment. Objetivo estimar o tempo de decisão (TD) para a procura de atendimento medico e o tempo de chegada a um serviço de saúde (TC) para homens (H) e mulheres (M) que sofreram infarto do miocárdio e analisar a influência da interpretação da dor e de comportamentos de resistência à dor nesse tempo. Métodos trata-se de pesquisa exploratória, realizada em hospital universitário de Salvador/BA. Foram entrevistados 43 M e 54 H. Para estudar a dependência entre as variáveis sociodemográficas e os sexos, empregou-se o Teste Exato de Fisher. Para analisar os tempos, utilizou-se a média geométrica (MG). Para verificar a associação entre a MG dos TD e TC e o julgamento da dor e entre a MG dos TD e TC e os comportamentos de resistência à dor, bem como para testar o termo de interação entre a variável sexo e as variáveis de interesses, utilizou-se o modelo de regressão robusto. A significância estatística adotada foi de 5%. Resultados a MG do TD para H foi de 1,13 h; para M, de 0,74 h. A MG do TC foi de 1,74 h para H e de 1,47 h para M. Aqueles que não reconheceram os sintomas do IAM e apresentaram comportamentos de resistência à dor apresentaram maior TD e TC, sendo as associações significantes. Os sexos não modificaram as associações de interesse. Conclusão os achados assinalam a importância da educação em saúde visando aos benefícios do tratamento precoce.

Introduction: Osteoarthritis is the leading cause of limitation of functionality and disability in the elderly. The supplementation with chondroitin sulfate is among the pharmacological treatments. Objective: To conduct a systematic review of the influence of chondroitin sulfate on pain and functional aspects associated with osteoarthritis. Methods: The keywords “osteoarthritis” and “chondroitin” were used. The articles were selected independently and blindly by two researchers. Only primary clinical trial, written in Portuguese, English and Spanish in the period between 2005 to 2013 were included. The PEDro scale was used as an evaluation tool. Results: A total of 1.916 studies with appropriate descriptors were found, and nine of these papers remained for analysis. Of these nine studies analyzed, four showed the effectiveness of supplementation of chondroitin sulfate in reducing pain and functional disability, while five studies showed no statistically significant effects. Conclusions: The influence of chondroitin sulfate in pain and functional aspects in osteoarthritis remains questionable.

Since the residual mitral regurgitation after the Dor procedure contributes to increasing postoperative mortality, repair of mitral regurgitation has become one of the essential surgical approaches. We describe two cases of transventricular posterior annuloplasty using a trimmed Duran ring for surgical management of ischemic mitral regurgitation performed with the Dor procedure. This procedure is easy to perform and provides secure annuloplasty because the mitral annulus can be easily exposed through the same ventriculotomy incision.

Several characteristics from Fibromyalgia Syndrome (FMS) suggest alterations in the thermoregulatory activity. There is an overl ap between thermoregulation and nociceptive modulation, consistent with the symptoms of the syndrome. Several studies, addressed in this review , describe common aspects between the regulation of pain and temperature, what may contribute to the generalized and persistent pain of FMS. Several findings, evidenced in the literature, support this idea: the distribution of Brown Fat (BAT) resembles the tender points; stress and cold cause sympathetic hyperactivity stimulating afferent fibers C, innervating BAT and adjacent tissues. They stimulate thermogenesis of BAT, which exacerbates hyperalgesia of FMS in regions corresponding to the tender points; physical activi ty acts in an antagonistic way, avoiding the BAT recruitment and alleviating the symptoms; women may be more susceptible to FMS, because they are less capable of initiating adaptive thermogenesis than men. The activation of the BAT has a peripheral vasoconstriction action, but it increase s the supraclavicular temperature. Infrared thermography may record the activation of BAT in the FMS through the mantle signal. Hands or feet immersion in water at 20oC test evaluates the aforementioned activation. Although not a definitive diagnosis, the phenomenon of the mantle and peripheral vasoconstriction may support the clinical diagnosis, having an important role in monitoring patients with FMS, as markers of autonomic dysfunction, present in this disease.

Surgical cases for myocardial ischemia due to spontaneous coronary artery dissection have rarely been reported. We describe a young male who had a myocardial infarction with left ventricular aneurysm due to spontaneous left anterior descending coronary artery dissection. He was successfully treated with Dor's left ventriculoplasty without coronary artery revascularization. The Dor procedure was a simple and effective treatment. To our knowledge, this is the first report in which the Dor procedure was used to treat spontaneous coronary artery dissection with left ventricular aneurysm. (J Card Surg 2004;19:54-56)

Background Ventricular reconstruction using the Dor technique has been demonstrated to improve outcome in patients with dilated left ventricles. It has been suggested that a beating heart approach improves ventricular function by allowing the surgeon to palpate that part of the ventricle to exclude. Methods We performed a retrospective analysis of patients who underwent an endoventricular circular patch plasty (Dor procedure) between 1998 and 2001. All patients who received ventricular restoration, with or without revascularization or valve repair, were included in the analysis. Discrete left ventricular aneurysms were excluded. Patients were divided into two groups: group 1 (n = 15) underwent ventricular reconstruction with the beating heart technique, whereas group 2 (n = 38) underwent restoration with the aorta cross-clamped. Clinical and hemodynamic data were collected from medical records and computerized databases and compared between the two groups. Results Fifty-three patients underwent endoventricular circular patch plasty. All patients had enlarged ventricles (echocardiogram demonstrating unidimensional end-diastolic diameter ≥ 6.0 cm) and echocardiographic evidence of severe left ventricular dysfunction (mean ejection fraction: group 1=21.4%; group 2=23.4%). No operative mortalities occurred in either group and all patients were discharged home alive (mean postoperative hospital stay 8.3 days [6 to 22 days]). All patients had improvement in left ventricular function with mean postoperative left ventricular ejection fraction of 36.9% (25% to 52%) in group 1 versus 38.1% (31% to 50%) in group 2, p = 0.081. Ventricular arrhythmias occurred in 5 of 15 group 1 patients and in 9 of 38 group 2 patients. Two patients in the entire cohort (1 patient in group 1, and 1 patient in group 2) had at least one readmission within 12 months with evidence of heart failure. The group 1 patient went on to successful transplant 11 months later, whereas the group 2 patient died 10 months later. Conclusions These results demonstrate that the Dor technique of ventricular restoration significantly improves left ventricular function and the beating heart approach provides no additional advantage over continuous aortic cross clamping.