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ObjectiveTo analyze the inflammation resulting from myocardial revascularization techniques with and without cardiopulmonary bypass, based on ultrasensitive C-reactive protein (US-CRP) behavior.MethodsA prospective non-randomized clinical study with 136 patients was performed. Sixty-nine patients were enrolled for Group 1 (on-pump coronary artery bypass - ONCAB) and 67 patients were assigned to Group 2 (off-pump coronary artery bypass - OPCAB). All study participants had blood samples collected for analysis of glucose, triglycerides, creatinine, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and creatinephosphokinase (CPK) in the preoperative period. The samples of creatinephosphokinase MB (CKMB), troponin I (TnI) and US-CRP were collected in the preoperative period and at 6, 12, 24, 36, 48 and 72 hours after surgery. We also analyzed the preoperative biological variables of each patient (age, smoking, diabetes mellitus, left coronary trunk lesion, body mass index, previous myocardial infarction, myocardial fibrosis). All angiographically documented patients with >70% proximal multiarterial stenosis and ischemia, documented by stress test or classification of stable angina (class II or III), according to the Canadian Cardiovascular Society, were included. Reoperations, combined surgeries, recent acute myocardial infarction, recent inflammatory disease, deep venous thrombosis or recent pulmonary thromboembolism, acute kidney injury or chronic kidney injury were not included.ResultsCorrelation values between the US-CRP curve and the ONCAB group, the treatment effect and the analyzed biological variables did not present expressive results. Laboratory variables were evaluated and did not correlate with the applied treatment (P>0.05).ConclusionThe changes in the US-CRP at each moment evaluated from the postoperative period did not show any significance in relation to the surgical technique applied.

Purpose:To study the effects of benzodiazepine midazolam in the coronary flow (Cflo), cardiac frequency (CF) and myocardial contractility in isolated hearts of rats subjected to ischemic preconditioning (IPC). Methods: 30 Wistar rats were used, undistinguished by gender. After anesthesia with ethyl ether, the hearts were put into perfusion (Krebs-Henseleit solution, 95% O 2 and 5% CO 2 , 37°C, 110-120mmHg), in disposable Langendorff type system. Five groups of six animals were constituted: GI-Control; GII-Ischemia; GIII-IPC; GIV-Ischemia + 100mcg of midazolam; GV-IPC + 100mcg of midazolam. After stabilization (t 0 ), and on times t 5 , t 10 , t 15 , t 20 and t 25 , CF, Cflo, systolic pressure (SP) and diastolic pressure (DP) and dP/dt were recorded. DP was maintained at 5 ± 2 mmHg. The statistical method ANOVA and Tukey Test were employed for p < 0.05. Results: No significant variations have occurred between Cflo and CF. On Pd/td, differences have occurred (p<0.05) between groups I and II (respectively 94.7±23.0 and 62.3±12.1%). The preconditioning (GIII), improved significantly the results in the group II (respectively 62.3±12.1 and 87.1±12.4 %). The decrease in dP/dt in group II was not prevented by midazolam (GIV) (62.3±12,1 and 60.5±15.8 %). In group III, dP/dt was 87.1±12.4%, whereas in group V, only 55.5±17.2% (p<0.05) Conclusion: Midazolam, when administered before the ischemia, was unable to prevent the ischemic deterioration of the myocardium. When administered before the preconditioning, it has abolished its protective effect. Key words: Ischemic Preconditioning. Heart. Midazolam. Rats. RESUMOObjetivo: Estudar os efeitos do benzodiazepínico midazolam no fluxo coronariano (Fco), freqüência cardíaca (FC) e contratilidade miocárdica de corações isolados de ratos submetidos ao precondicionamento isquêmico (PCI). Métodos: Foram utilizados 30 ratos Wistar sem distinção de sexo. Após anestesia com éter etílico, os corações foram postos em perfusão (solução de Krebs-Henseleit, 95% de O 2 e 5% de CO 2 , 37°C, 110-120mmHg), em sistema tipo Langendorff descartável. Foram constituídos cinco grupos de seis animais: GI-Controle; GII-Isquemia; GIII-PCI; GIV-Isquemia + 100mcg de midazolam ; GV-PCI + 100mcg de midazolam. Após estabilização (t 0 ), e nos tempos t 5 , t 10, t 15 , t 20 e t 25 , foram registrados a FC, Fco, pressões sistólica (PS) e diastólica (PD) e dP/dt. A PD foi mantida em 5 ± 2 mmHg. Empregou-se método estatístico ANOVA e Teste de Tukey para p < 0,05. Resultados: Não ocorreram variações significantes entre FCo e FC. Na dP/dt, ocorreram diferenças (p<0,05) entre os grupos I e II (respectivamente 94,7±23,0 e 62,3±12,1%). O precondicionamento (GIII), melhorou significantemente os resultados do grupo II (respectivamente 62,3±12,1 e 87,1±12,4 %). A queda da dP/dt no grupo II não foi impedida pelo midazolam (GIV) ( 62,3±12,1 e 60,5±15,8 %). No grupo III a dP/dT foi 87,1±12,4%, sendo que no grupo V, apenas 55,5±17,2% (p<0,05). Conclusão: O midazolan quando administrado antes da isquemia não impediu...

According to the results of the present investigation with the AV node artery derived from the right coronary artery in all cases, complete and permanent AV conduction system blockade occurred after PTSMAA in all types of anatomy regarding the observed LAD.

Tu És a água viva que me motiva a levar a alegria, o bom humor, a esperança e a boa nova aos pacientes todos os dias. Somente o amor pelos doentes pode formar um médico! À Virgem Maria, o meu porto seguro, caminho certo a seguir. Tu que abres portas e portões, sempre esteve à frente como luz em meus caminhos! Confio plenamente a Ti os meus planos e o meu futuro, pois sei que não serei confundido. À Ana Cristina, minha esposa, meu eterno amor, companheira de jornada. Seu carinho e apoio aumentaram as minhas esperanças de chegar ao fim desta jornada. Aos meus amados filhos que nasceram ao longo dessa jornada! À minha filha querida, Laura Maria (Babai), dádiva de Deus! Com você entendi que o amor não possui medidas, arestas e nem peso. Ao meu amado filho Gabriel, tão desejado e amado! Você chegou para deixar ainda mais forte o alicerce de nossa família. Esse esforço e dedicação é também por você filhão! Aos meus pais, José e Tânia, meus amores! Agradeço todo o esforço que tiveram em minha educação como filho e médico. Não foi fácil... Mas sou grato por terem lutado por mim. Se ontem fui filho, hoje sou pai e sei como é importante a educação e o amor da família. Amo vocês! Ao Gustavo, meu único irmão. Você sempre foi para mim um grande exemplo de caráter, perseverança e família. Você merece todas as suas conquistas. Luciana (cunhada) e João (meu afilhado querido), vocês moram em meu coração!

Mediastinum tumors may grow slowly and reach giant proportions without symptoms, hindering surgical removal. Tumor big dimensions difficult surgical maneuvers, with risk of uncontrollable bleeding and prejudice to surrounding structures. It may be necessary the use of exceptional measures such as venous-venous circulatory deviation, pre-operatory embolization and total extracorporeal circulation. We describe the technique of tumor lamination that allows for complete or almost complete resection of such tumors that in many occasions are not resectable. The description is based on the results of four patients treated with mediastinum giant tumors.

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Introduction: Myocardial protection against ischemic injury has been a major focus of studies of cardiovascular sciences worldwide. In 1986, Murry et al. became pioneers by showing a special ischemic preconditioning technique in hearts of dogs which motivated researches for better understanding of endogenous protective mechanisms of the human heart. The aim of this study was to evaluate the effects of omeprazole on protection of functional recovery of isolated rat hearts subjected to ischemia-reperfusion with and without ischemic preconditioning (IP). Methods: In five groups of eight Wistar breed rats, the hearts were removed after anesthesia and perfused with Krebs-Henseleit solution (95% O 2 , 5% CO 2 , 37ºC). The GI was a control group. The GII, GIII, GIV and GV, hearts were submitted to ischemia (20 min) and reperfusion (30 min). In GIV and GV, preconditioning was performed with 5 min of ischemia and 5 min of reperfusion before 20 min of the ischemia period induction. In GIII and GV Omeprazole 200 µg was done before a 20 min-period of ischemia induction. Heart Rate (HR), Coronary Flow (CF), Systolic Pressure (SP), +dP/dt and−dP/dt were registered before (t0) and after reperfusion (t30). Kruskal-Wallisand Mann-Whitney (p<0.05) test were used. Results: The CF analysis showed that the Groups II, III, IV and V, had a similar behavior analyzed over time (p=0.316). Group I presented the averages 18.6, 17.5 and 16.6 at t0, t15' and t30' respectively, with significant changes in the pattern of behavior analyzed over time (p<0.001). There were no significant differences in the HR, SP, +dP/dt max , and −dP/dt max between Groups I, III, IV and V results. Conclusion: Omeprazole conferred preconditioning characteristics to isolated rat hearts subjected to ischemic injury. There was no greater efficacy of protection shown in relation to existing methods of ischemic preconditioning. There was no synergism in the use of omeprazole in conjunction with the methods of IP.