Abstract Background: Transcatheter aortic valve implantation (TAVI) has become a therapeutic option for high-risk or non-operable patients with severe symptomatic aortic stenosis. Atrioventricular conduction disturbances requiring permanent pacemaker (PPM) are a common and clinically important complication. Objectives: To evaluate the incidence of conduction disorders (CDs) after TAVI and the need for subsequent PPM implantation. To identify the predictors of postoperative PPM implantation. Methods: Retrospective study. All patients who underwent TAVI in a public hospital from December/2011 to June/2016 were included. Multivariate analysis was conducted to establish the predictor of permanent pacemaker implantation. Survival curves were constructed by the Kaplan-Meyer method. Statistically significant variables were those with p value < 0.05. Results: 64 patients with AS underwent TAVI. Eleven patients were excluded. TAVI induced a new CD in 40 (77%) of the remaining 53 patients. The most common new CDs were 3rd degree AV block (32%) and left bundle branch block (30%). Sixteen patients (30,2%) underwent PPM implantation during the index hospitalization. On univariate analysis the risk factors for PPM implantation were CoreValve® use (OR: 1,76; P = 0,005), larger prosthesis implantation (P = 0,015), presence of a QRS ≥ 120 ms (OR: 5,62; P = 0,012), and 1st degree AV block (OR: 13; P = 0.008). On multivariate analysis the presence of 1st degree AV block predicted the need for PPM. Conclusion: TAVI induced CDs requiring PPM in 30% of the patients. The presence of 1st degree AV block predicted the need for PPM.

CONTEXTO: A arterite de Takayasu é uma vasculite crônica, geralmente com diagnóstico tardio devido à pouca especificidade dos sintomas durante a fase inicial do acometimento vascular. A terapêutica de eleição é o uso de imunossupressores. O procedimento cirúrgico, quando necessário, é sempre evitado na fase aguda. OBJETIVO: Descrever alterações clínicas, laboratoriais e vasculares de arterite de Takayasu no período de 1977 a 2006. MÉTODO: A amostra compreendeu 36 pacientes - 10 brancos, 35 mulheres, idade média de 31,7 anos (±13,7), com prevalência significante na quarta década (p < 0,005). Evolução de 3 anos e período até o diagnóstico de 7,9 anos. Velocidade de hemossedimentação (VHS) e proteína C reativa (PCR) avaliaram atividade da doença, e o duplex scan aferiu a espessura médio- intimal da artéria carótida. RESULTADOS: Hipertensão arterial sistêmica e claudicação de membros superiores e inferiores foram ressaltados em 85,2, 69,5 e 30,5%, respectivamente. O resultado da VHS foi > 60 mm em 50% da amostra (p < 0,005). PCR mg/dL foi realizado em 18, variando de 0,4-25 na admissão para 0,11-1,9 na evolução. Doença auto-imune, tuberculose e HIV correlacionaram-se em 19,4, 8,3 e 2,7%, respectivamente. Lesões aórticas foram significativas em 22% (quatro oclusões, dois aneurismas infra-renais, um torácico). Em 19,4%, foram acometidas artérias renais e subclávias uma oclusão bilateral de carótidas, e em 25% os membros inferiores. A espessura médio-intimal da carótida comum foi estratificada em: > 3 mm, < 3 e > 1,7, < 1,7 e > 1,2 e < 1,2 mm, representando 41,6, 19,4, 8,37 e 30,50%, respectivamente (p < 0,005). Glicocorticóides foram utilizados em 61,1%, azatioprina em 16.6%, e associada a ciclofosfamida em 8,3%. Procedimento cirúrgico ou endovascular foi realizado em 30,5% com dois óbitos por complicações cardiovasculares. CONCLUSÕES: A VHS, PCR, e a espessura médio-intimal nas carótidas são importantes marcadores de acompanhamento da arterite de Takayasu. O período entre os sintomas e o diagnóstico deve ser abreviado, com redução da morbimortalidade.

BACKGROUND: Takayasu arteritis is a chronic vasculitis often with delayed diagnosis due to the nonspecific presentation of clinical symptoms in its initial phase. Treatment includes imunosuppression drugs. Surgical treatment, when necessary, should be avoided in the acute phase. OBJECTIVE: To describe clinical, laboratory and vascular findings in Takayasu's arteritis from 1977 through 2006. METHODS: The sample was comprised of 36 patients (10 Caucasians, 35 women), mean age of 31.7 (±13.7) years, and significant prevalence in the forth decade (p < 0.005). Disease course was 3 years and time until diagnosis was 7.9 years. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used to assess disease activity, and duplex scan to measure carotid artery intima-media wall thickness. RESULTS: Hypertension was present in 85.2%, and upper and lower limb claudication in 69.5 and 30.5%, respectively. ESR was > 60 mm in 50% of the sample (p < 0.005). PCR mg/dL was performed in 18 cases, ranging from 0.4-25 on admission to 0.11-1.9 during disease course. Autoimmune diseases, tuberculosis and HIV correlated in 19.4, 8.3 and 2.7%, respectively. Major aortic lesions were detected in 22.2% (four occlusions, two infrarenal aneurysms, one thoracic aneurysm). Other arteries involved renal, subclavian and one carotid occlusion (19%), and some level of lower limb occlusion (25%). Intima-media thickness was stratified in > 3 mm (41.6%), < 3 and > 1.7 (19.4%), < 1.7 and > 1.2 (8.37%), and < 1.2 mm (30.50%) (p < 0.005). Glucocorticoids were used in 61%, azathioprine in 16.6%, and azathioprine combined with cyclophosphamide in 8.3%. Surgical and endovascular procedures were performed in 30.5%. Two patients died due to cardiovascular diseases. CONCLUSIONS: Carotid intima-media thickness, PCR, and ESR are important markers for the follow-up of Takayasu's arteritis. Delay in diagnosis is an important issue for Takayasu's progression, since it may reduce morbidity and mortality rates.

Com este trabalho, objetivou-se estimar a produção de leite por meio de ordenha manual usando diferentes doses de ocitocina via intramuscular (1; 2; 3; 4 e 5 UI). Foram utilizadas 10 ovelhas Hampshire Down adultas, distribuídas em um delineamento em quadrado latino repetido 5 x 5 (cinco ovelhas e cinco dias de estimativa de produção de leite). A ordenha foi realizada após uma separação de 4 horas dos cordeiros, sendo a produção corrigida para 24 horas. No último dia de estimação, as ovelhas foram ordenhadas em quatro horários (12h30, 18h30, 24h30 e 06h30), para determinar qual período de ordenha apresentava a maior correlação com a produção total diária. Não foram observadas diferenças significativas entre as doses de ocitocina, de 1; 2; 3; 4 e 5 UI, na produção de leite, sendo, respectivamente, de 1020,80; 936,20; 1028,40; 1235,40 e 1159,80 g. A composição do leite também não foi afetada pelas doses de ocitocina e as médias para porcentagens de sólidos totais, proteína bruta, lactose e gordura foram, respectivamente, de 17,3; 4,3; 3,8 e 7,4%. As correlações entre as estimativas obtidas nos quatro períodos de ordenha e a produção total diária variaram de 0,71 a 0,97. Portanto, para a estimativa de produção de leite diária pode ser recomendada a menor dose de ocitocina (1 UI) e apenas uma ordenha diária, com separação do cordeiro por 4 horas.

The objective of this work was to estimate milk production through hand milking, using different doses (1; 2; 3; 4; and 5 IU) of oxytocin intramuscularly. Ten adult Hampshire Down ewes were assigned to a 5 x 5 repeated Latin square design, with five ewes and five days. Milking was performed after a 4-hour lamb separation period, and then corrected to 24 hours. On the last day of estimation, the ewes were milked at four different times, 12:30 p.m.; 06:30 p.m.; 12:30 a.m. and 06:30 a.m.. This procedure was done to estimate which milking period showed greater correlation with the total daily milk production. No significant differences were observed among oxytocin doses in the milk production. Milk production averages for 1; 2; 3; 4 e 5 IU doses were, respectively, 1020.80; 936.20; 1028.40; 1235.40 and 1159.80 g. Milk composition was not affected by oxytocin doses, either. Averages for total solids, crude protein, lactose and fat were, respectively, 17.3; 4.3; 3.8 and 7.4%. Correlation among the milk production estimates obtained in the four milking periods and the total daily milk production ranged from 0.71 to 0.97. Therefore, for daily milk production estimate, it can be recommended the smallest dose (1 IU) of oxytocin and only one daily milking, with lamb separation of 4 hours.