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OBJECTIVE: To describe bypass to perigeniculate vessels for limb salvage. DESIGN: Retrospective cohort study. MATERIAL AND METHODS: Between 1995 and 2009, 47 bypass procedures to perigeniculate collateral arteries were performed in 46 patients (15 women, 31 men; median age, 68 years). All patients presented with critical ischaemia (tissue loss in 87.5%, rest pain in 12.5%). Mean ankle brachial index was 0.27 ± 0.17. The site of distal anastomosis was the descending genicular artery (DGA) in 23 bypasses (1 bilateral) and the medial sural artery (MSA) in 24. Proximal anastomosis was to the external iliac artery in 2 cases, common femoral artery in 23 cases, superficial femoral artery in 8 cases, deep femoral artery in 8 cases, above-knee poplitaeal artery in 2 cases, and previous graft in 4 cases. RESULTS: There were four deaths during the immediate postoperative period. Mean follow-up duration was 27 months. Ten patients required major amputation. Mean ankle brachial index post-operatively was 0.60 ± 0.21. At 3 years, primary patency was 74.7 ± 7%, secondary patency was 83.4 ± 8%, and the limb salvage and survival rates were 73.5 ± 7% and 77.4 ± 7%, respectively. CONCLUSION: Bypass to perigeniculate arteries is a viable treatment option for critical limb ischaemia in selected patients.

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Identificar fatores da linha de base preditores do alcance das metas do programa de intervenção no estilo de vida após 12 meses em população de nipo-brasileiros, empregando-se modelos de regressão logística ajustados. Em 2005, 321 participantes eram portadores de excesso de peso e houve maior chance [OR (IC95 por cento)] de alcance da meta de perda de peso após 12 meses entre mulheres [2,45 (1,33; 4,13)], indivíduos de maior idade [1,03 (1,00; 1,06)] e menor chance entre portadores de morbidades no início do estudo [0,33 (0,14; 0,77)]. Dos 261 indivíduos sedentários, o alcance da meta de atividades físicas foi inversamente relacionado ao exercício de atividades profissionais [0,40 (0,17; 0,95)]. Não se verificou fatores da linha de base associados ao alcance das metas do consumo de legumes, verduras e frutas e gorduras saturadas da dieta após 12 meses. Indivíduos de maior idade, mulheres, não portadores de morbidades e sem exercício de atividades profissionais na linha de base apresentaram maior chance de alcance das metas após 12 meses de intervenção no estilo de vida.

The aim of this study was to identify baseline factors associated with achieving goals after a 12-month lifestyle intervention program in a Japanese-Brazilian population, using adjusted logistic regression models. In 2005, 321 participants were overweight. The odds [OR (IC95 percent)] of reaching the goals after 12 months of intervention were directly related to female gender [2.35 (1.34, 4.13)] and older age [1.03 (1.00, 1.06)] and inversely related to baseline morbidity [0.33 (0.14, 0.77)]. Of the 261 sedentary individuals, achieving the goal for physical activity was inversely related to working [0.44 (0.17, 0.95)]. No baseline predictors were found for reaching the goal of fruit and vegetable consumption or saturated fat intake after 12 months. At baseline, women, older individuals, and individuals without diseases or not working showed increased odds of achieving the goals after 12 months of the lifestyle intervention.

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A proposta deste estudo foi apresentar uma série de pacientes com doença oclusiva da artéria subclávia tratados por procedimento cirúrgico ou angioplastia. Durante um período de cinco anos, nove pacientes com idade média de 54 anos foram submetidos a seis derivaçöes carótidas-subclávias, uma endarterectomia e duas angioplastias. Os resultados clínicos foram inteiramente satisfatórios em quatro pacientes com sintomas cerebrais, em dois com isquemia de membro e em dois dos três com sintomas mistos. Um paciente faleceu e dois foram perdidos para seguimento. As reconstruçöes permaneceram pérvicas em cinco pacientes entre 12 e 28 meses de seguimento de seguimento mas ocluiu em outro. A revascularizaçäo das artérias subclávia é efetiva tanto com procedimentos cirúrgicos como com a angioplastia.

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Efficacy of short atrioventricular (AV) delay and diastolic mitral regurgitation (MR) were studied in 16 patients (70.2 mais ou menos 10.5 SD years old) with implanted DDD pacemakers. AV delay was set at 0.215 and 0.115 sec. In 10 of the 16 patients, diastolic MR was not observed when the AV delay was set at both 0.215 and 0.115 sec. Cardiac output (CO) and pulmonary capilary wedge pressure (PCWP) did not change.In 6 of the 16 patients, diastolic MR was observed when the AV delay was set a 0.215 se However, diastolic MR was not observed when the AV delay was set at 0.115 sec. CO increased from 3.6 mais ou menos 0.7 to 3.9 mais ou menos 0.8 I/min (p menor que 0.05). PCWP was decreased in 5 of the 6 patients (83 por cento, p menor que 0.05 vs. 10 por cento in patients without diastolic MR at 0.215 sec of AV delay). Cardiac function may be improved by shortening AV delay when the diastolic MR was observed. On the other hand, short AV delay may not be effective for patients in whom diastolic MR was ntobserved.

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The immigration of Japanese people to Brazil began in 1908 with two major waves, from 1925 to 1940 and from 1952 to the 1960s. Brazil has the largest population (about 1,288,000) of Japanese origin outside Japan with varying age groups. A mortality study revealed that diabetes as an underlying cause of death was higher in the first-generation Japanese than in Japan (3.4 vs. 1.9 per 100,000 for men, and 7.2 vs. 1.9 for women). The self-reported prevalences of known diabetes in subjects aged 40 years or older were obtained by questionnaires from three sources. In six Japanese cultural associations in Säo Paulo city, the prevalences were 9.7% and 6.9% for the first generation (mean age 61.5 years) and for the second generation (mean age 40.0 years), respectively. Age-adjusted prevalences, according to the Brazilian population in the 1980 national census, were 6.9% and 8.1% for the first and second generations. According to a study carried out as a part of a socioeconomic census of the Japanese population in Brazil, the prevalences of diabetes were 7.4% and 5.2%, and the age-adjusted prevalences were 5.3% and 5.8% in the first and second generations, respectively. Another study carried out for employees of a bank, owned by Japanese-Brazilian community members, revealed crude prevalences of diabetes in the first and second generations of 7.1% and 4.2%, and age-adjusted prevalences of 7.3% and 8.2%, respectively. These data indicate an increased prevalence of diabetes in this population compared to Japan, suggesting the importance of environmental factors in the pathogenesis of diabetes.

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A total of 56 cases of malignant lymphoma presumed to be of peripheral T-cell origin were investigated with regard to histological and immunohistochemical features. The goal of the study was to determine whether virus-associated T-cell lymphomas can be morphologically or immunohistochemically distinguished from presumably virus-negative T-cell lymphomas. The cases came from endemic and non-endemic regions of Japan, the United Kingdom (including 4 Caribbean cases) and the Federal Republic of Germany. Sera of all Japanese and Caribbean patients and 8 German patients were tested for antibodies to adult T-cell leukaemia virus-associated antigen HTLV-A. In all cases sections were examined blind by 5 well-trained histopathologists. In most cases cryostat sections could be prepared from fresh tissue specimens and stained with a large panel of monoclonal antibodies. All HTLV-A-positive cases were morphologically classifiable as the pleomorphic type of T-cell lymphoma. Approximately 70% of the tested cases of pleomorphic T-cell lymphoma, however, showed a positive serum reaction for HTLV-A. All other types of peripheral T-cell lymphoma (T-immunoblastic lymphoma, chronic lymphocytic leukaemia of T type, T-zone lymphoma, "AILD type" and lymphoepithelioid cell lymphoma) were HTLV-A-negative and mostly observed in European patients. Thus virus-associated T-cell lymphomas appear to be invariably of the pleomorphic type; but pleomorphism is not specific to HTLV-A-positive cases. This was also evident from the results of an experiment in which 2 Japanese histopathologists attempted to recognize HTLV-A positivity in a blind study of pleomorphic T-cell lymphomas. A maximum of about 80% of cases were correctly identified, with about 10% false-positive diagnoses (in HTLV-A-negative or presumably negative cases) and 10% false-negative diagnoses. The immunohistochemical analysis revealed not only many common features but also 2 distinct differences between HTLV-A-positive and -negative T-cell lymphomas. All but one of the HTLV-A-positive cases showed reactivity with anti-Tac and all cases in the virus-positive group were negative for TU14. All other cases were Tac-negative and approximately 65% of these cases exhibited reactivity with TU14. Preliminary cytogenetic observations suggest that there are also differences in specific chromosome aberrations.

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