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Citrus black spot (CBS), caused by Guignardia citricarpa, is the most important fungal disease of orange trees in Brazil. The spatial pattern of CBS-symptomatic trees was evaluated using the binomial dispersion index (D), Ripley's K function (K), and a Monte Carlo test for minimum mean distance (d) to understand the distribution of the pathogen. Disease was monitored in 7,790 citrus trees from four commercial groves. In one grove, disease incidence was assessed from 1999 to 2001 and, in the others, disease assessments were conducted only in 2002. Infected trees were aggregated based on the three statistical analyses used (D, K, and d) regardless of the CBS incidence. The binomial index of dispersion (D) indicated aggregation of CBS-affected trees for all groves and for various quadrat sizes (2 by 2, 3 by 3, 4 by 4… up to 10 by 10). According to Ripley's K function, the dependence among symptomatic trees comprised two to three neighboring trees. Disease dispersion occurred at distances below 24.7 m according to the test for d. This suggests that the dispersion of inoculum is highly important over short distances. As a consequence, the required sample size to achieve a level of accuracy of C = 20% increases exponentially with the decrease in incidence of CBS below 15% infected plants.

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Three different approaches were used to assess the kinship structure of two epiphytic bryophytes, Orthotrichum speciosum and O. obtusifolium, that have different dispersal strategies. The two species were sampled in a 200 ha landscape where species occurrence and host trees had been mapped previously. Local environmental conditions at sampled trees were recorded and kinship between individuals was calculated based on amplified fragment length polymorphism (AFLP)-marker data. We did not detect any association between AFLP-markers and investigated environmental conditions. In both species, significant kinship coefficients were found between individuals up to 300-350 m apart which shows that both species have a restricted dispersal range. The spatial kinship structure was detected with both autocorrelation analysis and generalized additive models (GAMs), but linear regression failed to detect any structure in O. speciosum. Although the dioecious O. obtusifolium is currently the more common species it may, none the less, due to its restricted dispersal range and reproduction mode, become threatened in the future by current silvicultural practices which enhance the distance between host trees and decrease their life span. Finally, GAMs seem most appropriate for analysing spatial genetic structure because the effects of local environmental conditions and spatial structure can be analysed simultaneously, no assumption of a parametric form between kinship coefficient and distance is required, and spatial data resolution is not lost in the arbitrary choice of distance classes characterizing autocorrelation analysis.

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Submitral left ventricular aneurysm is a cardiac pathology widely recognized, but relatively unknown, occurred almost exclusively in African black patients. Although still this idea of racial prevalence exists, cases have been described in patients of all the races. Ten Brazilian cases were reported. One of them was presented inside an Italian paper that refers the surgical treatment of a Brazilian patient of black race. We reported one more submitral left ventricular aneurysm case in a brown female patient, with antecedents of peripheral thromboembolism initially not identified as consequence of the cardiac pathology.

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This study is almost an experiment with the objective to verify the effect of the Therapeutic Play on preschool children during blood collect for laboratory tests. The sample consisted of 42 children divided into control and experimental groups. All the children had their behavior observed and only the children of the experimental group were prepared for the Therapeutic Play. The results were analyzed comparing the children's behavior with the groups and showed that arrangement with the Therapeutic Play was effective in the comprehension of the procedure and in the control of their behavioral reactions.

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A case of newborn intrapericardial teratoma is reported. The clinical, echocardiographic, tomographic and histologic features are described, and also, the therapeutic options. The newborn was submitted to surgical excision of the intrapericardial tumor and has a clinical follow-up greater than four years.

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We report a permanent complete heart block, in a 27 year-old female patient, developed during mitral percutaneous valvotomy using a single inflation of the Inoue balloon catheter. After one month, even using corticoids, a Mobitz II second-degree atrioventricular block persisted, the patient became symptomatic to moderate efforts and a cardiac pacemaker was implanted.

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A valvoplastia mitral percutânea (VMP) tem sido utilizada como tratamento näo cirúrgico para pacientes selecionados portadores de estenose mitral, sendo uma laternativa à comissurotomia cirúrgica. Complicaçöes maiorese da VMP incluem: morte durante o procedimento, perfuraçäo cardíaca, embolismo sistêmico (causando acidente vascular cerebral, infarto do miocárdio ou êmbolo periférico), e lesäo valvar grave resultando em regurgitaçäo mitrla. Complicaçöes menores incluem: criaçäo de comunicaçäo interaial, reflexos vaso-vagais, lesäo vascular ou snagramento nos locais de inserçào dos cateteres, taquiarrtimais atriais e ventriculares, e distúrbios de conduçäo temporários. Descreve-se o caso de uma paciente que desenvolveu bloqueio atrioventricular total (BAVT) permanente após valvoplastia mitral percutânea utilizando-se o cateter-baläo de Inoue. Os disturbios da conduçäo cardíaca neste procedimento näo säo infrequentes, sendo em geral transitórios. O levantamento da bibliografia médica, täo extenso quno possível, revelou relatos de apenas dois casos de BAVT permanente como complicaçäo da VMP. Um destes pacientes foi tratado com a técnica do duplo baläo, o outro tratado com o baläo de Inoue, e ambos necessitaram de implante de marcapasso cardíaco.

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A 48-year-old man submitted to surgical excision of a left atrium leiomyosarcoma. The patient had a node close to the right suprarenal gland. The tumor was a casual echocardiographic finding as part of the cardiologic investigation, since the patient had shortness breath. Leiomyosarcomas of the heart are uncommon, and often the diagnosis is performed during postmortem examinations. Methods of diagnosis, specially the echocardiogram, were emphasised. Treatment and prognostic aspects on basis in a wide review of the literature were also emphasised.

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We report a case of congenital coarctation of the lower thoracic aorta. The patient, a 15-year-old man, presenting with the signs of classical coarctation, had the diagnosis confirmed by an aortography. A good surgical result was achieved by means of resection of the internal shelf and aortoplasty using a bovine pericardium patch. One year after the operation the patient has normal blood pressure with good femoral pulses.

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The case of a symptomatic 16-year-old girl, referred with the diagnosis of coarctation of the aorta is presented. Aortography showed a severe coarctation and a huge aneurysm distal to the coarctation. Successful operation was performed with resection of the coarctation and aneurysm and interposition of a tube of bovine pericardium for the anastomosis. Two months after the operation the blood pressure was normal and a 10 mm/Hg gradient was detected by doppler-echocardiography.

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The case of an asymptomatic 6-month-old boy, first seen due to a right arm edema is described. A continuous murmur heard at the right infraclavicular area, cardiomegaly plus increased flow to the lungs on the chest X-ray were associated with an isolated right subclavian artery-to-vein fistula diagnosed at angiography. Successful ligation of the fistula was done at operation with normalization of the arm circumference and heart size on the chest X-ray at 4 years follow up.

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The description of hemolytic anemia after mitral valve repair has been infrequent. The present paper presents this complication, discussing its diagnosis and surgical aspects, such as the association with the use of teflon felt for posterior annuloplasty. This complication happened in two children at our institution, one treated medically with supplementation of folic acid and ferrous sulfate and another requiring surgery for replacement of the teflon felt using a piece of heterologous pericardium for a new annuloplasty and leaflet advancement.

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The authors present a case of massive, nonocclusive intestinal ischemia and necrosis after surgery for correction of interatrial communication with cardiopulmonary bypass in a 22-year-old woman. This is an extremely serious complication that generally occurs in older patients. The literature mentions its occurrence in patients subjected to aortic valve replacement who have low cardiac output and in patients undergoing myocardial revascularization. Its occurrence in a young person with simple congenital cardiopathy is rare.

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The case of a 74 year old woman with pseudo-false aneurysm of the left ventricle after a silent myocardial infarction stimulating left pulmonary neoplasm is presented. Special emphasis in given to the uncommon aspects of the case, its rarity and the association of the pseudo-false aneurysm with a true aneurysm of left ventricle.

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The two techniques usually employed for the surgical treatment of tricuspid valve endocarditis are valve replacement or simple valve excision without valve replacement. A third more conservative procedure consists of resection of the vegetation ("vegetectomy") and leaflet repair, if necessary. Valve excision without valve replacement is described in adult patients especially in addicts of intravenous drugs, with normal ventricular function. Two cases of tricuspid valve endocarditis in children with interventricular communication successfully treated by "vegetectomy" and valve excision without valve replacement are reported. In the first case, surgery was performed during acute infection. Contrarily in the other case there was evidence that cure had been obtained, but still the prosthesis was not implanted due to the excellent hemodynamic status at the moment, and to abbreviate bypass time due to the preoperative conditions of the child. The uncommon approach to these two cases of tricuspid valve endocarditis in childhood motivated this presentation.

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Many studies have demonstrated fairly high incidence of supraventricular arrhythmias after coronary artery bypass surgery, and have tried to identify preoperative, operative and postoperative factors related to their appearance. The present paper analysed 186 patients submitted to coronary artery bypass and reported a incidence of atrial fibrillation of 6.04% (11 cases). The male sex was dominant (81.2%) with ages varying from 49 to 73 (mean 54.58) years. The preoperative incidence of diabetes, smoking and systemic hypertension were, respectively, 18.2%, 54.51% and 36.4%. The mean number of vessels bypassed was 2.42 +/- 1.19 and the left circumflex artery was involved in 81.20% of these cases. Cardiopulmonary bypass time was 100 +/- 39.6 min and ischemic arrest time of 79.6 +/- 37.7 min. Single double stage cannulae for venous drainage were used in 45.5% of the patients and ventricular fibrillation and cardiac overdistention occurred in 63.60% immediately after CPB. Atrial fibrillation presented around 1.66 +/- 2.17 days in the postoperative period and 45.5% of the patients had more than one distinct episode of the arrhythmia. Treatment constituted of cardioversion in 25%, atenolol oral in 18.75% and digitalis associated to quinidine in 56.25%. These numbers permit us to suggest that some of the above factors may contribute to the genesis of arrhythmias, such as single double stage cannulation for venous drainage, inadequate myocardial protection, overdistention and cardiac fibrillation and, mainly, the presence of proximal circumflex artery obstructions responsible for atrial ischemia before and during surgery.

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