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Ants have efficient and well-studied social immunity mechanisms, which prevent the colony contamination. Little is known about how workers keep their outside territory clear of diseases. We investigated the interactions between Azteca chartifex ants, their associated bacteria and bacteria on the phyllosphere of Byrsonima sericea trees, comparing plants patrolled and not by the ants. The hypothesis is that bacteria associated with the worker's exoskeleton may outcompete the leaf bacteria. Culturable bacteria were isolated from ants, from the main and satellite nests, and from phyllosphere of B. sericea taken from trees that had A. chartifex nests and from trees without nests. The isolates were grouped by Gram guilds and identified at the genus level. There was a higher percentage of Gram-negative isolates in the ants and on the leaves patrolled by them. There was a higher growth rate of ant bacteria from the main nest compared to those found in ants from the satellite nests. The most representative genus among ant isolates was Enterobacter, also found on leaves patrolled by ants. Under favourable in vitro conditions, A. chartifex Gram-negative bacteria outcompete leaf bacteria by overgrowth, showing a greater competition capacity over the Gram-positive bacteria from leaves with no previous interaction with ants in the field. It was demonstrated that ants carry bacteria capable of outcompeting exogenous bacteria associated with their outside territory. The leaf microbiota of a patrolled tree could be shaped by the ant microbiota, suggesting that large ant colonies may have a key role in structuring canopy plant-microbe interactions.

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Objetivou-se determinar as possíveis fontes de contaminação de Yersinia enterocolitica em diferentes pontos do processo de ordenha de vacas leiteiras em oito propriedades da região de Pelotas, RS, ao longo de um ano. Foram analisadas amostras de leite cru de conjunto logo após a ordenha, água de estábulo leiteiro, mão de ordenhador, balde de recolhimento do leite e insuflador de teteiras. As amostras de leite cru e água foram coletadas em frascos estéreis, e as amostras de mão, balde e teteiras com zaragatoas estéreis. As amostras de leite cru foram submetidas a um pré-enriquecimento em água peptonada, sendo posteriormente incubadas em caldo PSTA, adicionado de ampicilina. As amostras de água foram filtradas em membrana de éster de celulose e incubadas em caldo TSB. As amostras de leite após incubação em PSTA, as membranas utilizadas na filtragem da água incubadas em TSB, bem como o material de mãos, balde e teteiras coletadas nas zaragatoas, foram semeados em ágar MacConkey e incubados para a obtenção de colônias. Colônias características foram analisadas por meio de duplex PCR para confirmação da espécie. Os perfis moleculares dos isolados de Y. enterocolitica foram comparados utilizando-se a técnica de rep-PCR. Y. enterocolitica foi isolada de 9,37% das amostras de leite, 6,25% das amostras de água e 12,5% das amostras de mão. Não houve similaridade no perfil de bandas dos isolados encontrados, entretanto foi identificada a presença de cepas diferentes na mesma amostra, demonstrando uma variedade grande de cepas distribuídas no ambiente. A presença de Y. enterocolitica em leite cru no Brasil é preocupante, já que uma quantidade considerável do produto ainda é comercializada de forma clandestina, expondo o consumidor ao risco de infecção pela bactéria, ao consumi-lo sem tratamento térmico adequado.(AU)

This work was performed in order to determine the possible Yersinia enterocolitica contamination sources at different points of the dairy cows milking process in eight properties of Pelotas, RS, in a year. Raw milk samples were analyzed immediately after milking, as well as water from milking parlor, milkers' hands, milk collection bucket, and inflator liners. The samples of raw milk and water were collected in sterile bottles and hand samples, and sterile swabs were used for the buckets and liners. The raw milk samples were subjected to a pre-enrichment peptone water buffered and subsequently incubated in PSTA broth with added ampicillin. Water samples were filtered through cellulose ester membrane and incubated in TSB medium. The milk samples after incubation in PSTA, the membranes used in water filtration were incubated in TSB and the material of the hands material, bucket and liners collected in the swabs were plated on MacConkey agar to obtain colonies. Characteristics of colonies were analyzed by duplex PCR to confirm the species. The molecular profiles of Y. enterocolitica isolates were compared using rep-PCR. Y. enterocolitica was isolated from 9,37% of milk samples, 6,25% of water samples and 12,5% of hand samples. There weren't similarities in the band profile of the isolates found; however, the presence of different strains was found in the same sample, demonstrating a variety of strains distributed in the environment. The presence of Y. enterocolitica in raw milk in Brazil is dangerous, considering that the product is sold clandestinely, exposing consumers to the risk of infection by the bacterium, when consuming it without proper heat treatment.(AU)

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Objetivou-se determinar as possíveis fontes de contaminação de Yersinia enterocolitica em diferentes pontos do processo de ordenha de vacas leiteiras em oito propriedades da região de Pelotas, RS, ao longo de um ano. Foram analisadas amostras de leite cru de conjunto logo após a ordenha, água de estábulo leiteiro, mão de ordenhador, balde de recolhimento do leite e insuflador de teteiras. As amostras de leite cru e água foram coletadas em frascos estéreis, e as amostras de mão, balde e teteiras com zaragatoas estéreis. As amostras de leite cru foram submetidas a um pré-enriquecimento em água peptonada, sendo posteriormente incubadas em caldo PSTA, adicionado de ampicilina. As amostras de água foram filtradas em membrana de éster de celulose e incubadas em caldo TSB. As amostras de leite após incubação em PSTA, as membranas utilizadas na filtragem da água incubadas em TSB, bem como o material de mãos, balde e teteiras coletadas nas zaragatoas, foram semeados em ágar MacConkey e incubados para a obtenção de colônias. Colônias características foram analisadas por meio de duplex PCR para confirmação da espécie. Os perfis moleculares dos isolados de Y. enterocolitica foram comparados utilizando-se a técnica de rep-PCR. Y. enterocolitica foi isolada de 9,37% das amostras de leite, 6,25% das amostras de água e 12,5% das amostras de mão. Não houve similaridade no perfil de bandas dos isolados encontrados, entretanto foi identificada a presença de cepas diferentes na mesma amostra, demonstrando uma variedade grande de cepas distribuídas no ambiente. A presença de Y. enterocolitica em leite cru no Brasil é preocupante, já que uma quantidade considerável do produto ainda é comercializada de forma clandestina, expondo o consumidor ao risco de infecção pela bactéria, ao consumi-lo sem tratamento térmico adequado.(AU)

This work was performed in order to determine the possible Yersinia enterocolitica contamination sources at different points of the dairy cows milking process in eight properties of Pelotas, RS, in a year. Raw milk samples were analyzed immediately after milking, as well as water from milking parlor, milkers' hands, milk collection bucket, and inflator liners. The samples of raw milk and water were collected in sterile bottles and hand samples, and sterile swabs were used for the buckets and liners. The raw milk samples were subjected to a pre-enrichment peptone water buffered and subsequently incubated in PSTA broth with added ampicillin. Water samples were filtered through cellulose ester membrane and incubated in TSB medium. The milk samples after incubation in PSTA, the membranes used in water filtration were incubated in TSB and the material of the hands material, bucket and liners collected in the swabs were plated on MacConkey agar to obtain colonies. Characteristics of colonies were analyzed by duplex PCR to confirm the species. The molecular profiles of Y. enterocolitica isolates were compared using rep-PCR. Y. enterocolitica was isolated from 9,37% of milk samples, 6,25% of water samples and 12,5% of hand samples. There weren't similarities in the band profile of the isolates found; however, the presence of different strains was found in the same sample, demonstrating a variety of strains distributed in the environment. The presence of Y. enterocolitica in raw milk in Brazil is dangerous, considering that the product is sold clandestinely, exposing consumers to the risk of infection by the bacterium, when consuming it without proper heat treatment.(AU)

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Photodynamic therapy (PDT) has been proved to be effective against fungi and it may be employed as a coadjutant to conventional antifungal agents, leading to a more effective microbial control minimising side effects. This work evaluates the combined effect of PDT and fluconazole against resistant Candida albicans, Candida glabrata and Candida krusei. The yeasts were submitted to methylene blue-PDT (MB-PDT) in sub-inhibitory concentrations. In the present work, MB-PDT combined with fluconazole was more efficient in the inhibition of the C. albicans and C. glabrata than each treatment alone, being possible to infer that the treatments are synergic.

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Indigenous microbiota plays a crucial role in the development of several intestinal diseases, including mucositis. Gastrointestinal mucositis is a major and serious side effect of cancer therapy, and there is no effective therapy for this clinical condition. However, some probiotics have been shown to attenuate such conditions. To evaluate the effects of Saccharomyces cerevisiae UFMG A-905 (Sc-905), a potential probiotic yeast, we investigated whether pre- or post-treatment with viable or inactivated Sc-905 could prevent weight loss and intestinal lesions, and maintain integrity of the mucosal barrier in a mucositis model induced by irinotecan in mice. Only post-treatment with viable Sc-905 was able to protect mice against the damage caused by chemotherapy, reducing the weight loss, increase of intestinal permeability and jejunal lesions (villous shortening). Besides, this treatment reduced oxidative stress, prevented the decrease of goblet cells and stimulated the replication of cells in the intestinal crypts of mice with experimental mucositis. In conclusion, Sc-905 protects animals against irinotecan-induced mucositis when administered as a post-treatment with viable cells, and this effect seems to be related with the reduction of oxidative stress and preservation of intestinal mucosa.

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OBJECTIVE: The objective of this study was to assess the frequency of early deaths associated with birth asphyxia of very low birth weight infants between 2005 and 2010, in Brazil. STUDY DESIGN: This population study enrolled all live births with birth weight from 400 to 1499 g, gestational age ⩾ 22 weeks, without malformations that died up to 6 days after birth with perinatal asphyxia. Asphyxia was defined if intrauterine hypoxia, asphyxia at birth or meconium aspiration syndrome were written in any line of the death certificate. Active search was carried out in 27 Brazilian federative units. RESULT: For every 1000 live births of very low birth weight infants without congenital malformations, 40.25 and 32.38 died with birth asphyxia in the first week after birth, respectively, in 2005 and 2010 (P<0.001). The contribution of birth asphyxia to early neonatal death of these infants was approximately 10 to 12% all study years. CONCLUSION: Reduction of birth asphyxia in very low birth weight infants is essential to reducing neonatal mortality in Brazil.

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In the present study, the protective potential of Saccharomyces cerevisiae strain UFMG A-905 was evaluated in a murine model of acute ulcerative colitis (UC). Six groups of Balb/c mice were used: not treated with yeast and not challenged with dextran sulphate sodium (DSS) (control); treated with S. cerevisiae UFMG A-905 (905); treated with the non-probiotic S. cerevisiae W303 (W303); challenged with DSS (DSS); treated with S. cerevisiae UFMG A-905 and challenged with DSS (905 + DSS); and treated with S. cerevisiae W303 and challenged with DSS (W303 + DSS). Seven days after induction of UC, mice were euthanised to remove colon for enzymatic, immunological, and histopathological analysis. In vivo intestinal permeability was also evaluated. An improvement of clinical manifestations of experimental UC was observed only in mice of the 905 + DSS group when compared to animals from DSS and W303 + DSS groups. This observation was confirmed by histological and morphometrical data and determination of myeloperoxidase and eosinophil peroxidase activities, intestinal permeability and some pro-inflammatory cytokines. S. cerevisiae UFMG A-905 showed to be a potential alternative treatment for UC when used in an experimental animal model of the disease.

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OBJECTIVES: Congenital adrenal hyperplasia (CAH) is a disease that occurs during fetal development and can lead to virilization in females or death in newborn males if not discovered early in life. Because of this there is a need to seek morphological markers in order to help diagnose the disease. In order to test the hypothesis that prenatal hormones can affect the sexual dimorphic pattern 2D:4D digit ratio in individual with CAH, the aim of this study was to compare the digit ratio in female and male patients with CAH and control subjects. METHODS: The 2D:4D ratios in both hands of 40 patients (31 females-46, XX, and 9 males-46, XY) were compared with the measures of control individuals without CAH (100 males and 100 females). RESULTS: Females with CAH showed 2D:4D ratios typical of male controls (0.950 and 0.947) in both hands (P < 0.001). In CAH males the left hand 2D:4D ratio (0.983) was statistically different from that of male controls (P < 0.05). CONCLUSIONS: These finding support the idea that sexual dimorphism in skeletal development in early fetal life is associated with differences between the exposure to androgens in males and females, and significant differences associated with adrenal hyperplasia. Although the effects of prenatal androgens on skeletal developmental are supported by numerous studies, further investigation is yet required to clarify the disease and establish the digit ratio as a biomarker for CAH.

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O experimento foi realizado em dois anos para avaliar o potencial de produção de bovinos em pastagens de Brachiaria decumbens adubadas com nitrogênio (N). Foram determinadas as massas de forragem total (MFT) e de forragem verde (MFV), a composição morfológica e o valor nutritivo da forragem potencialmente consumível, bem como o desempenho animal e a taxa de lotação (TL) das pastagens. Os tratamentos consistiram de quatro doses de N - 75, 150, 225 e 300kg/ha.ano -, em delineamento de blocos ao acaso, com duas repetições. Nos dois anos, as MFT e MFV aumentaram linearmente em função da aplicação de N. A composição química da forragem potencialmente consumível foi pouco alterada pela aplicação de N. A adubação nitrogenada não influenciou o ganho de peso individual dos novilhos, mas aumentou a TL - de 3,6 para 5,3 e de 3,7 para 5,2UA/ha no primeiro e segundo ano, respectivamente - e a produção animal por área da pastagem - de 404,2 para 737,9 e de 619,7 para 1008,4kg/ha no primeiro e segundo anos, respectivamente.

The experiment which aimed to evaluate the potential of cattle production on nitrogen-fertilized Brachiaria decumbens pastures was carried out in two years. The total forage mass (TFM), green forage mass (GFM), morphological composition and nutritive value of the potentially consumed forage were determined, as well as the animal performance and the stocking rate (SR). The treatments encompassed four doses of N, being 75, 150, 225 and 300kg/ha.year. A randomized block design with two repetitions was used. The chemical composition of the potentially consumable forage was little altered by the N application. N-fertilization did not influence the weight gain of steers, but increased the SR from 3.6 to 5.3 in the first year and from 3.7 to 5.2 animal units per hectare in the second year, and the production by area of pasture from 404.2 to 737.9kg/ha in the first year and from 619.7 to 1008.4kg/ha in the second year. N-fertilization increases forage mass, stocking rate and animal production by area of pasture on B. decumbens cv. Basilisk pastures managed under continuous stocking with varying stocking rate.

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O experimento foi realizado em dois anos para avaliar o potencial de produção de bovinos em pastagens de Brachiaria decumbens adubadas com nitrogênio (N). Foram determinadas as massas de forragem total (MFT) e de forragem verde (MFV), a composição morfológica e o valor nutritivo da forragem potencialmente consumível, bem como o desempenho animal e a taxa de lotação (TL) das pastagens. Os tratamentos consistiram de quatro doses de N - 75, 150, 225 e 300kg/ha.ano -, em delineamento de blocos ao acaso, com duas repetições. Nos dois anos, as MFT e MFV aumentaram linearmente em função da aplicação de N. A composição química da forragem potencialmente consumível foi pouco alterada pela aplicação de N. A adubação nitrogenada não influenciou o ganho de peso individual dos novilhos, mas aumentou a TL - de 3,6 para 5,3 e de 3,7 para 5,2UA/ha no primeiro e segundo ano, respectivamente - e a produção animal por área da pastagem - de 404,2 para 737,9 e de 619,7 para 1008,4kg/ha no primeiro e segundo anos, respectivamente.(AU)

The experiment which aimed to evaluate the potential of cattle production on nitrogen-fertilized Brachiaria decumbens pastures was carried out in two years. The total forage mass (TFM), green forage mass (GFM), morphological composition and nutritive value of the potentially consumed forage were determined, as well as the animal performance and the stocking rate (SR). The treatments encompassed four doses of N, being 75, 150, 225 and 300kg/ha.year. A randomized block design with two repetitions was used. The chemical composition of the potentially consumable forage was little altered by the N application. N-fertilization did not influence the weight gain of steers, but increased the SR from 3.6 to 5.3 in the first year and from 3.7 to 5.2 animal units per hectare in the second year, and the production by area of pasture from 404.2 to 737.9kg/ha in the first year and from 619.7 to 1008.4kg/ha in the second year. N-fertilization increases forage mass, stocking rate and animal production by area of pasture on B. decumbens cv. Basilisk pastures managed under continuous stocking with varying stocking rate.(AU)

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Denture stomatitis is an inflammatory condition that occurs in denture wearers and is frequently associated with Candida yeasts. Antifungal susceptibility profiles have been extensively evaluated for candidiasis patients or immunosupressed individuals, but not for healthy Candida carriers. In the present study, fluconazole, itraconazole, voriconazole, terbinafine and 5-flucytosin were tested against 109 oral Candida spp. isolates. All antifungal agents were effective against the samples tested except for terbinafine. This work might provide epidemiological information about Candida spp. drug susceptibility in oral healthy individuals.

A estomatite protética é uma condição inflamatória que ocorre em usuários de prótese total e está frequentemente associada a leveduras do gênero Candida, Os perfis de suscetibilidade a antifúngicos têm sido extensivamente estudados em pacientes com candidíase ou em indivíduos imunossuprimidos, mas não em portadores sadios de Candida. No presente estudo, fluconazol, itraconazol, voriconazol, terbinafina e 5-flucitosina foram testados contra 109 isolados orais de Candida spp. Todos os agentes antifúngicos mostraram-se eficazes contra as amostras avaliadas, exceto a Terbinafina. O presente trabalho pode fornecer dados epidemiológicos com relação à susceptibilidade a antifúngicos de Candida spp em indivíduos com saúde oral.

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Denture stomatitis is an inflammatory condition that occurs in denture wearers and is frequently associated with Candida yeasts. Antifungal susceptibility profiles have been extensively evaluated for candidiasis patients or immunosupressed individuals, but not for healthy Candida carriers. In the present study, fluconazole, itraconazole, voriconazole, terbinafine and 5-flucytosin were tested against 109 oral Candida spp. isolates. All antifungal agents were effective against the samples tested except for terbinafine. This work might provide epidemiological information about Candida spp. drug susceptibility in oral healthy individuals.

RESUMO

Febrile neutropenia is associated with significant morbidity and mortality. Managing infectious in neutropenic patients remains a dynamic process, making necessary timely and efficient empirical antibiotic therapy. The implementation of critical pathways has been suggested as a strategy to improve clinical effectiveness. This study evaluated the compliance with an institutional critical pathway for the management of febrile neutropenia and the impact on clinical outcomes at Hospital de Clínicas de Porto Alegre, Brazil (HCPA). We performed a cohort study that prospectively included patients hospitalized from January 2004 to December 2005 and presented febrile neutropenia (190 episodes). Historical controls were selected from March 2001 to April 2003 (193 episodes) before the critical pathway was introduced. This study showed a low rate of full compliance (21.6%; 95% CI 15.7-27.5) with the critical pathway. In most cases, there was partial compliance (67.9%; 95% CI 61.3-74.5). Despite the moderate adherence observed, we recorded a decrease in in-hospital all-cause mortality in the sample studied after protocol implementation (from 24.4 to 14.4%; P = 0.017) and reduction in the length of use of cephalosporin and quinolones. In conclusion, implementation of a critical pathway seems to be an effective strategy to improve clinical outcomes in patients hospitalized with febrile neutropenia.

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Denture stomatitis is an inflammatory condition that occurs in denture wearers and is frequently associated with Candida yeasts. Antifungal susceptibility profiles have been extensively evaluated for candidiasis patients or immunosupressed individuals, but not for healthy Candida carriers. In the present study, fluconazole, itraconazole, voriconazole, terbinafine and 5-flucytosin were tested against 109 oral Candida spp. isolates. All antifungal agents were effective against the samples tested except for terbinafine. This work might provide epidemiological information about Candida spp. drug susceptibility in oral healthy individuals.

A estomatite protética é uma condição inflamatória que ocorre em usuários de prótese total e está frequentemente associada a leveduras do gênero Candida, Os perfis de suscetibilidade a antifúngicos têm sido extensivamente estudados em pacientes com candidíase ou em indivíduos imunossuprimidos, mas não em portadores sadios de Candida. No presente estudo, fluconazol, itraconazol, voriconazol, terbinafina e 5-flucitosina foram testados contra 109 isolados orais de Candida spp. Todos os agentes antifúngicos mostraram-se eficazes contra as amostras avaliadas, exceto a Terbinafina. O presente trabalho pode fornecer dados epidemiológicos com relação à susceptibilidade a antifúngicos de Candida spp em indivíduos com saúde oral.

RESUMO

OBJECTIVE: To determine folates, vitamin B12 and total homocysteine levels among neonates from mothers of low or high socioeconomic status. DESIGN: We carried out a cross-sectional transversal study comprising 143 neonates from two maternity hospitals in the city of Salvador, Northeast of Brazil. Cord blood samples were obtained at the time of delivery from newborns from low (group 1, n=77) or high (group 2, n=66) socioeconomic status. The vitamin B12 and folates were analyzed by electrochemiluminescence immunoassay and by a competitive test using a natural folate-binding protein (FBP), respectively. Total homocyteine levels were measured by fluorescence polarization immunoassay. Maternal environmental risk factors for pregnancy complications were obtained from all mothers. RESULTS: Only 2% of women from group 1 received prenatal care/vitamin supplementation, whereas almost all mothers from group 2 (96%) were properly followed. Anemia and/or infections pre- or during pregnancy was more prevalent among mothers of babies from group 1. Folate levels among newborns from group 1 and 2 were 7.38+/-2.71 and 8.83+/-4.06 ng/ml, respectively. No difference in the vitamin B12 levels was determined between groups. In addition, tHcy serum levels were higher among newborns from group 1 compared to those from group 2 (8.54+/-4.06 vs 6.35+/-1.33 micromol/l, respectively; P=0.005). CONCLUSION: These results demonstrate that unprivileged young woman has limited accesses to prenatal care, present high-risk factors that hamper both maternal and newborn health. Maternal and newborn health status could be improved by simply reinforcing the use of folate-enriched diet. The work presented illustrates the challenges that developing countries have to face in order to provide preventive adequate health care to the population at large.

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The genus Xanthomonas is a diverse and economically important group of bacterial phytopathogens, belonging to the gamma-subdivision of the Proteobacteria. Xanthomonas axonopodis pv. citri (Xac) causes citrus canker, which affects most commercial citrus cultivars, resulting in significant losses worldwide. Symptoms include canker lesions, leading to abscission of fruit and leaves and general tree decline. Xanthomonas campestris pv. campestris (Xcc) causes black rot, which affects crucifers such as Brassica and Arabidopsis. Symptoms include marginal leaf chlorosis and darkening of vascular tissue, accompanied by extensive wilting and necrosis. Xanthomonas campestris pv. campestris is grown commercially to produce the exopolysaccharide xanthan gum, which is used as a viscosifying and stabilizing agent in many industries. Here we report and compare the complete genome sequences of Xac and Xcc. Their distinct disease phenotypes and host ranges belie a high degree of similarity at the genomic level. More than 80% of genes are shared, and gene order is conserved along most of their respective chromosomes. We identified several groups of strain-specific genes, and on the basis of these groups we propose mechanisms that may explain the differing host specificities and pathogenic processes.

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Two sibs with duplication of 4q31-->qter due to 3:1 meiotic disjunction and mild phenotype: Clinical and cytogenetic findings in two sibs with partial duplication of 4q31.3-->qter and 21q11.2-->pter are reported. These patients are rare cases of reoccurrence of those partial trisomies due to 3:1 segregation of a maternal balanced translocation. A review of the literature reporting cases of trisomy of the 4q31-->qter segment is also made; previously reported cases mostly in addition have deletions of other chromosomes resulting from adjacent segregation of balanced translocation. The findings of our study confirm the high risk for offspring with unbalanced rearrangements in women with reciprocal translocation involving acrocentric and short chromosome segments. The study also points out that duplication of 4q31-->qter may go along with only mild phenotypic findings if there is no significant additional aneuploidy of the other chromosome involved in the rearrangement.

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The present case study describes an adult male with clinical signs of mild Down's syndrome (DS), who performed well at school and reached university level. A karyotype was done on a lymphocyte culture and mosaic trisomy 21 was found in 3% of the 437 cells analysed. Eleven signs from Jackson's checklist were found in the clinical evaluation, which along with the analysis of the subject's dermatoglyphic traits, confirmed the DS diagnosis. Cognitive evaluation was done with several psychological tests and the results were within the average range. This rare phenotypic association shows that normal intellectual development may be possible in DS. This finding could be explained by the low trisomic cell frequency, which may have little effect on the critical tissues for intellectual development, and it might also reflect the wide phenotypic variation in mosaic trisomy 21. Other factors, such as strong family support, early and continued intervention programmes for both physical and speech therapy, and a thorough educational process, also provided opportunities for the development of the cognitive potential of the subject.

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PURPOSE: To analyze the clinical characteristics, acute and long term results of repeat percutaneous transluminal coronary angioplasty (PTCA) for restenosis of the proximal left anterior descending coronary artery (LDA) METHODS: We studied 113 patients, 79% male, mean age 59 years, 49.5% had stable angina, with single vessel proximal LDA disease undergoing repeat PTCA for a first restenosis from January/88 to December/92. We examined the in hospital outcome (success rate and complications) and long term follow up (angina status, occurrence of myocardial infarction (MI), death and need for repeat PTCA or coronary artery bypass graft (CABG) of this subgroup. RESULTS: Primary success was 96%. Complications included: 1% MI, 1% emergency CABG and 1% procedural death. Follow up data (mean 42 months) was available in 102 (94%) out of 109 patients with successful repeat PTCA: 64 (63%) patients were asymptomatic, 5 (5%) had a MI and 28 (27%) required repeat PTCA or CABG. Actuarial 5 year freedom from death was 94%, freedom from death and MI was 91% and freedom from death, MI and repeat PTCA or CABG was 52%. CONCLUSION: Repeat PTCA is an effective treatment for proximal LAD restenosis with a high success rate, low incidence of procedural complications and provides excellent long term cardiac survival, however repeat revascularization is frequently required.

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The authors describe the morphogenesis and functional alterations of the coronary arterial net in the ectopic coronary arteries: a) with origin in the aorta or its branches and b) with origin in the pulmonary artery. The coronary arteries are developed from: 1) endothelial sprouts localized in the great arteries walls at the level of the sigmoidal values, 2) right and left subepicardial vascular network and 3) the intramyocardial sinusoids. Most of the ectopic coronary arteries result from alterations in the connection between these three embryonic elements. The deviation of one of the subepicardial vascular network in a wrong way (in direction of pulmonary artery or the opposite Valsalva sinus) will stimulate the development of endothelial sprouts which will connect such network originating abnormal connections and anomalous origin of the coronary arteries. The origin of both coronary arteries from the pulmonary artery is in compatible with life. Myocardial ischemia is absent in patients with type I (infant) or type II (adult) anomalous origin of one coronary artery from the pulmonary artery, only in the transitional phase between both types (I and II) there is myocardial ischemia previous to the formation of the collateral coronary circulation. The ectopic origin of the coronary artery from the aortic Valsalva sinus have very little hemodynamic repercussion in the patient. Although there are cases with postexercise sudden dead. These anomalies associated to atherosclerotic coronary stenosis have an impact on the evolution and prognosis of ischemic heart disease.

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