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FUNDAMENTO: A estenose arterial renal (EAR) é uma causa potencialmente reversível de hipertensão arterial sistêmica (HAS) e nefropatia isquêmica. Apesar da revascularização bem sucedida, nem todos os pacientes (pt) apresentam melhora clínica e alguns podem piorar. OBJETIVO: O presente estudo se destina a avaliar o valor do índice de resistividade renal (IR) como preditor dos efeitos da revascularização renal. MÉTODOS: Entre janeiro de 1998 e fevereiro de 2001, 2.933 pacientes foram submetidos ao duplex ultrassom renal. 106 desses pacientes apresentaram EAR significativa e foram submetidos a angiografia e revascularização renal. A pressão arterial (PA) foi medida antes e depois da intervenção, em intervalos de até 2 anos e as medicações prescritas foram registradas. Antes da revascularização, o IR foi medido em 3 locais do rim, sendo obtida uma média dessas medições. RESULTADOS: Dos 106 pacientes, 81 tiveram IR80. A EAR foi corrigida somente por angioplastia (PTA) em 25 pts, PTA + stent em 56 pts e cirurgicamente em 25 pts. Dos pacientes que se beneficiaram da revascularização renal; 57 dos 81 pacientes com IR 80. Usando um modelo de regressão logística múltipla, o IR esteve significativamente associado à evolução da PA (p = 0,001), ajustado de acordo com os efeitos da idade, sexo, PAS, PAD, duração da hipertensão, o tipo de revascularização, número de fármacos em uso, nível de creatinina, presença de diabete melito, hipercolesterolemia, volume sistólico, doença arterial periférica e coronariana e tamanho renal (OR 99,6-95%CI para OR 6,1-1.621,2). CONCLUSÃO: A resistividade intrarrenal arterial, medida por duplex ultrassom, desempenha um papel importante na predição dos efeitos pós revascularização renal para EAR.FUNDAMENTO: La estenosis arterial renal (EAR) es una causa potencialmente reversible de hipertensión arterial sistémica (HAS) y nefropatía isquémica. Pese a que la revascularización sea exitosa, ni todos los pacientes (pt) expresan mejora clínica y algunos pueden empeorar. OBJETIVO: El presente estudio está destinado a evaluar el valor del índice de resistividad renal (IR) como predictor de los efectos de la revascularización renal. MÉTODOS: Entre enero de 1998 y febrero de 2001, 2933 pacientes se sometieron al ultrasonido Doppler dúplex renal. Un total de 106 de estos pacientes expresaron EAR significativa y fueron sometidos a angiografía y revascularización renal. Se midió la presión arterial (PA) antes y después de la intervención, en intervalos de hasta 2 años y las medicaciones prescriptas fueron registradas. Antes de la revascularización, el IR se midió en 3 locales del riñón, con la obtención de un promedio de estas mediciones. RESULTADOS: De los 106 pacientes, 81 tuvieron IR < 80 y 25 RI > 80. La EAR se corrigió solamente por angioplastia (PTA) en 25 pts, PTA + stent en 56 pts y quirúrgicamente en 25 pts. De los pacientes que se beneficiaron de la revascularización renal; 57 de los 81 pacientes con IR 80. Usando un modelo de regresión logística múltiple, el IR estuvo significativamente asociado a la evolución de la PA (p = 0,001), ajustado de acuerdo con los efectos de la edad, sexo, PAS, PAD, duración de la hipertensión, el tipo de revascularização, número de fármacos en uso, nivel de creatinina, presencia de DM, hipercolesterolemia, volumen sistólico, enfermedad arterial periférica y coronaria y tamaño renal (OR 99,6-95%CI para OR 6,1-1.621,2). CONCLUSIÓN: La resistividad intrarrenal arterial, medida por ultrasonido Doppler dúplex, desempeña un rol importante en la predicción de los efectos post revascularização renal para EAR.BACKGROUND: Renal artery stenosis (RAS) is a potentially correctable cause of hypertension and ischemic nephropathy. Despite successful renal revascularization, not all patients (pt) overcome it and some get worse. OBJECTIVE: This study was designed to assess the value of renal resistance index (RI) in predicting the outcome of renal revascularization. METHODS: Between Jan 1998 and Feb 2001, 2,933 pts were referred to renal duplex ultrasound. 106 out of these had significant RAS and underwent angiography and renal revascularization. Arterial blood pressure (BP) was measured before and after the intervention, at intervals of up to 2 years and medications recorded. Prior to revascularization, RI was measured at 3 sites of each kidney and averaged. RESULTS: Out of the 106 patients, 81 had RI80. RAS was corrected with angioplasty (PTA) alone in 25 pts, PTA + stent in 56 pts and corrected by surgery in 25 pts. Of patients who benefited from renal revascularization; 57 of the 81 patients with RI 80. Using a multiple logistic regression model, RI was significantly associated with BP outcome (p=0.001), adjusted for the effects of age, sex, SBP, DBP, duration of hypertension, type of revascularization, number of medication in use, creatinine level, presence of diabetes mellitus, hypercholesterolemia, stroke, peripheral and coronary artery disease and kidney size (OR 99.6 - 95%CI for OR 6.1 to 1,621.2). CONCLUSION: Intrarenal arterial resistance measured by duplex ultrasound plays an important role in predicting BP outcome after renal revascularization for RAS.

FUNDAMENTO: O isolamento das veias pulmonares (IVP) tem sido usado como endpoint para a ablação da fibrilação atrial (FA) com cateter balão. OBJETIVO: Determinar a utilidade do ultrassom intracardíaco (USIC) para guiar o IVP, usando cateter balão a laser. MÉTODOS: 59 VP foram ablacionadas em 27 cães. Imagens de Doppler foram usadas para identificar os vazamentos do fluxo sanguíneo entre a VP e o balão. Após cada liberação de energia, o cateter de mapeamento circular foi reposicionado para verificar se o isolamento tinha sido obtido. A posição de vazamento foi então correlacionada com a posição do gap no estudo patológico. A análise de regressão logística multivariada foi realizada. RESULTADOS: Cinquenta e nove VP foram submetidas à ablação. O tempo médio de energia liberada foi de 279±177 seg., o diâmetro médio do balão era de 23±3 mm, e o comprimento médio do balão era 25±4 mm. O isolamento completo foi obtido em 38/59 (64%), e foi significantemente mais comum sem vazamento: [30/38 (79%) versus 8/23 (35%), pFUNDAMENTO: Se usó el aislamiento de las venas pulmonares (AVP) como endpoint para la ablación de la fibrilación atrial (FA) con catéter-balón. OBJETIVO: Determinar la utilidad del ultrasonido intracardíaco (USIC) para guiar el AVP, usando catéter-balón láser. MÉTODOS: Se ablacionaron 59 VP en 27 perros. Se usaron imágenes de Doppler para identificar los derrames del flujo sanguíneo entre la VP y el balón. Tras cada liberación de energía, se reposicionó el catéter de mapeamiento circular para verificar si se obtuvo el aislamiento. Se correlaccionó, entonces, la posición del derrame con la posición del gap en el estudio patológico. Se realizó el análisis de regresión logística multivariada. RESULTADOS: Se sometieron 59 VP a la ablación. El tiempo promedio de energía liberada fue de 279±177 seg., el diámetro promedio del balón era de 23±3 mm, y la largura promedio del balón era 25±4 mm. Se obtuvo el aislamiento completo en 38/59 (64%), y fue significantemente más común sin derrame: [30/38 (79%) versus 8/23 (35%), pBACKGROUND: Pulmonary vein isolation (PVI) with balloon catheter has been used as the endpoint for AF ablation. OBJECTIVE: To determine the usefulness of intracardiac ultrasound (ICUS) to guide PVI using laser balloon catheter. METHODS: 59 PVs were ablated in 27 dogs. Doppler imaging was used to identify blood flow leaks between PV and balloon. After each energy delivery, the circular mapping catheter was repositioned to check if isolation had been achieved. The leak position was then correlated with the gap position at the pathological study. Multivariate logistic regression analysis was undertaken. RESULTS: 59 PV were ablated. Mean burn time was 279±177 sec, mean balloon diameter was 23±3 mm, and mean balloon length was 25±4 mm. Complete isolation was achieved in 38/59 (64%) cases, and it was significantly more common when there was no leak: [30/38 (79%) versus 8/23 (35%), p

OBJETIVO: Investigar a relação entre consumo de álcool e problemas emocionais em gestantes, verificando se as gestantes com consumo problemático de álcool (uso nocivo ou dependência) tiveram mais problemas emocionais quando comparadas àquelas cujo consumo não era problemático. MÉTODOS: Estudo transversal, observacional, sobre uma amostra clínica de um serviço obstétrico público de Ribeirão Preto, SP. A amostra foi não probabilística, de conveniência, do tipo consecutiva, composta por 450 gestantes. Foram aplicados três questionários: para dados sociodemográficos, o Questionário de Morbidade Psiquiátrica (QMPA) e um questionário padronizado como parte da anamnese para avaliação de problemas relacionados ao uso de álcool (uso nocivo ou síndrome de dependência) de acordo com os critérios da CID-10. Foram utilizados testes univariados (ANOVA) para o exame comparativo entre grupos utilizando medidas de distribuição central e intervalo de confiança de 95%. RESULTADOS: Foram encontradas 172 gestantes (38,2%) problemáticas (escore >7) pelo QMPA. Detectaram-se conforme critérios da CID-10, 41 (9,1%) gestantes com consumo problemático de álcool, sendo 27 (6,0%) com diagnóstico de uso nocivo e 14 (3,1%) com dependência ao álcool. A presença de diagnóstico de uso nocivo ou síndrome de dependência ao álcool relacionou-se à maior intensidade de sofrimento emocional das gestantes, ou seja, maior média de pontuação nas subescalas ansiedade, depressão e álcool do QMPA. CONCLUSÕES: Considerando a prevalência de problemas emocionais, o consumo de álcool durante a gestação e os riscos de problemas à saúde materno-infantil sugere-se que sejam realizadas avaliações mais criteriosas pelos profissionais de saúde.OBJECTIVE: To investigate the relationship between alcohol consumption and emotional distress in pregnant women, and to verify whether women with problematic alcohol consumption (abuse or dependence) have more emotional distress than those with non-problematic alcohol consumption. METHODS: A cross-sectional observational study was carried out in a clinical sample from a public obstetric service in Ribeirão Preto, Brazil. A non-probabilistic convenience sample of patients who were consecutively recruited comprised 450 pregnant women. Three questionnaires were applied: a sociodemographic profile, followed by the Psychiatric Morbidity Questionnaire (QMPA) and a standardized questionnaire for collecting data on alcohol-related problems (abuse or dependence) according to ICD-10 criteria. Univariate analysis (ANOVA) was used for comparison between groups using central distribution measures and 95% confidence intervals. RESULTS: There were found 172 (38.2%) problematic pregnant women with positive score (score >7) in the QMPA. A group of 41 (9.1%) pregnant women with problematic alcohol consumption was detected according to ICD-10 criteria, 27 (6.0%) of them diagnosed as alcohol abuse and 14 (3.1%) as alcohol dependence. Alcohol abuse or dependence syndrome was related to greater emotional distress, i.e. higher mean scoring in anxiety, depression and alcohol QMPA subscales. CONCLUSIONS: Given the prevalence of emotional distress and alcohol consumption during pregnancy and high risk of mother-child health problems, careful evaluations in this population should be conducted by health professionals.

Background: Pulmonary vein isolation (PVI) with balloon catheter has been used as the endpoint for AF ablation., Objective: To determine the usefulness of intracardiac ultrasound (ICUS) to guide PVI using laser balloon catheter., Methods: 59 PVs were ablated in 27 dogs. Doppler imaging was used to identify blood flow leaks between PV and balloon. After each energy delivery, the circular mapping catheter was repositioned to check if isolation had been achieved. The leak position was then correlated with the gap position at the pathological study. Multivariate logistic regression analysis was undertaken., Results: 59 PV were ablated. Mean burn time was 279+/-177 sec, mean balloon diameter was 23+/-3 mm, and mean balloon length was 25+/-4 mm. Complete isolation was achieved in 38/59 (64%) cases, and it was significantly more common when there was no leak: [30/38 (79%) versus 8/23 (35%), p<0.001]. This occurred regardless of time of laser application (302+/-223 sec. vs. 266+/-148 sec., p=ns), laser power (3.5 W/cm, 4.5 W/cm, and 5.5 W/cm), balloon diameter (24+/- 3 mm vs. 22+/- 3 mm, p=ns) and length (27+/-4 mm vs. 24+/-4mm, p=ns). The positive predictive value for predicting incomplete isolation was 65% and the negative predictive value was 83%., Conclusion: An identifiable leak between PV and the LBA device seen at the ICUS is predictive of lower PV isolation rates. ICUS may be useful for leak detection to avoid ineffective energy application during circumferential PV ablation. This could also be helpful when other types of energy are used.

Objective: To investigate the relationship between alcohol consumption and emotional distress in pregnant women, and to verify whether women with problematic alcohol consumption (abuse or dependence) have more emotional distress than those with non-problematic alcohol consumption., Methods: A cross-sectional observational study was carried out in a clinical sample from a public obstetric service in Ribeirão Preto, Brazil. A non-probabilistic convenience sample of patients who were consecutively recruited comprised 450 pregnant women. Three questionnaires were applied: a sociodemographic profile, followed by the Psychiatric Morbidity Questionnaire (QMPA) and a standardized questionnaire for collecting data on alcohol-related problems (abuse or dependence) according to ICD-10 criteria. Univariate analysis (ANOVA) was used for comparison between groups using central distribution measures and 95% confidence intervals., Results: There were found 172 (38.2%) problematic pregnant women with positive score (score >7) in the QMPA. A group of 41 (9.1%) pregnant women with problematic alcohol consumption was detected according to ICD-10 criteria, 27 (6.0%) of them diagnosed as alcohol abuse and 14 (3.1%) as alcohol dependence. Alcohol abuse or dependence syndrome was related to greater emotional distress, i.e. higher mean scoring in anxiety, depression and alcohol QMPA subscales., Conclusions: Given the prevalence of emotional distress and alcohol consumption during pregnancy and high risk of mother-child health problems, careful evaluations in this population should be conducted by health professionals.

Objective: To evaluate the efficacy of three frequently used spacer devices to deliver aerosol to the lung, and to compare radioaerosol deposition with each device in different age groups., Methods: Nine healthy, non-smoking volunteers were recruited: three adults and six children, including three toddlers and three school age children. Qualitative and semi-quantitative analysis of radioaerosol deposition in the lung were carried out. Yet, two small-volume devices (Aerochamber and Inal-Air) and one large-volume device (Flumax) were compared. Each patient inhaled 99mtechnetium-phytate. The device was filled during 30 seconds with radioaerosol. Oxygen was used as the driving gas. During 10 seconds, the patients inhaled the radioaerosol. The radiation emitted at the front and back of the chest was measured. The radiation inside the device was also measured., Results: The quantitative evaluation of lung deposition revealed that the younger the patient, the less aerosol was deposited in the lung with the large-volume spacer device (Flumax). The difference between small-volume devices (Aerochamber and Inal-Air) was not significant., Conclusion: Small-volume spacers are the most appropriate for children. Large-volume devices should only be used by adolescents and adults.