Rosangela Monteiro

Qualidade de vida em foco

This article aims to discuss aspects concerning Healthrelated to quality of life concepts. This paper presents some piece of information regarding the quality of life instruments.

Critérios de autoria em trabalhos científicos: um assunto polêmico e delicado

Aspects related to the authorship of scientific publications, inherent responsibilities, unethical practices and criteria for definition are discussed in this article. Moreover, the article presents a reflection on the role of editors of scientific journals in respect to inpproper authorship, reinforcing the importance of the issue and suggesting ethical criteria for its determination.

Aortic valve assessment. Anatomical study of 100 healthy human hearts

PURPOSE To assess anatomical characteristics of the aortic valve, so that they may be useful in diagnostic situations and surgical treatment. METHODS The study analyzed 100 healthy fixed human hearts; 84% of them obtained from males, 61% of them from Caucasian individuals. The ages of the individuals ranged from 9 to 86 years (mean 30 +/- 15.5 years). The characteristics assessed related to age, sex, and race were the following: number and height of the cusps, size of the lunulae, internal and external intercommissural distance, position of the coronary ostium in relation to the aortic valve, position of the ventricular septum in relation to the aortic valve, thickness of the cusps. RESULTS All hearts assessed had a tricuspidal aortic valve. In regard to the height of the cusps and size of the lunula, the left coronary cusp was larger, followed by the right coronary cusp and the noncoronary cusp. The internal and external intercommissural distances had mean values of 24.6 +/- 5.7 mm and 19.7 +/- 7 mm, respectively. In regard to the position of the coronary ostia, in one heart two ostia emerged from the left coronary sinus, and in another, the ostium was supracommissural. The mean diameter of the aorta was 21.8 +/- 3.6 mm, and there were no significant sexual or racial differences, but the diameter increased progressively with the increase in age. The thickness of the cusps did not show any significant difference in the 3 points assessed. CONCLUSION The aortic valve annulus did not show a perfect circumference, with some variations in the measurements of the annulus, in the cusps and in the relation with the ventricular septum.

Importância do uso correto dos descritores nos artigos científicos

Endereço para correspondência: Ricardo Brandau. Av. Juscelino Kubitschek de Oliveira, 1505 CEP 15091 450 São José do Rio Preto/SP E-mail: brandau@sbccv.org.br 1 Jornalista, Editor Executivo da Revista Brasileira de Cirurgia Cardiovascular. 2 Doutora pelo Programa de Cirurgia Torácica e Cardiovascular da Faculdade de Medicina da Universidade de São Paulo (FMUSP). Biologista-chefe do Serviço de Cirurgia Torácica do Instituto do Coração do Hospital das Clínicas da FMUSP e membro do NCCC. 3 Cirurgião Cardiovascular, Professor da Faculdade Estadual de Medicina de São José do Rio Preto-SP e da Unicamp e Editor da Revista Brasileira de Cirurgia Cardiovascular. An important item that authors should observe when submitting a work for publication is the definition of descriptors or key works. These terms are of great value in indexation, because many researchers in the health area just to delimit a field in science, utilize them to search for information about diseases, surgical techniques or to write a scientific paper. If descriptors do not follow the nomenclature of databases the article runs the risk of not being found and so, not being cited. Thus, the information is lost. This is very harmful, as the greater the number of citations the more value is placed on the journal and consequently, on the authors who published in the journal. This is what is called the ‘impact factor’, that is, the relationship between the number of times that articles of a magazine are cited and the total number of published articles each year. Thus, the higher the impact factor, the greater is the importance of the journal for reviewers, research agencies and the governmental organs such as CAPES. The author also looses, as the greater number of citations the greater is the recognition of the value of his research and its results. This article has the aim of calling the attention of cardiovascular surgeons who send their works, not just to the Brazilian Journal of Cardiovascular Surgery (BJCVS), but to international journals as well, of the importance of the descriptors and to help them to make the correct choices. Effort has been made so that the BJCVS constantly improves, maintaining a standard compatible to the best journals of its kind, in respect to both its content and its strict observance to the norms. The most important scientific publications usually specify in their norms for authors, the necessity of providing descriptors (or key words) and which databases must be consulted to identify them. The BJCVS, for example, determines in its norms for publication that the manuscript should have from three to five descriptors in the Portuguese and in English versions. A check should be made at the following electronic addresses: http://decs.bvs.br/, for

Robotic versus human camera holding in video-assisted thoracic sympathectomy: a single blind randomized trial of efficacy and safety

Our objective is to compare surgical safety and efficacy between robotic and human camera control in video-assisted thoracic sympathectomy. A randomized-controlled-trial was performed. Surgical operation was VATS sympathectomy for hyperhidrosis. The trial compared a voice-controlled robot for holding the endoscopic camera robotic group (Ro) to human assisted group (Hu). Each group included 19 patients. Sympathectomy was achieved by electrodessication of the third ganglion. Operations were filmed and images stored. Two observers quantified the number of involuntary and inappropriate movements and how many times the camera was cleaned. Safety criteria were surgical accidents, pain and aesthetical results; efficacy criteria were: surgical and camera use duration, anhydrosis, length of hospitalization, compensatory hyperhidrosis and patient satisfaction. There was no difference between groups regarding surgical accidents, number of involuntary movements, pain, aesthetical results, general satisfaction, number of lens cleaning, anhydrosis, length of hospitalization, and compensatory hyperhidrosis. The number of contacts of the laparoscopic lens with mediastinal structures was lower in the Ro group (P<0.001), but the total and surgical length was longer in this group (P<0.001). Camera holding by a robotic arm in VATS sympathectomy for hyperhidrosis is as safe but less efficient when compared to a human camera-holding assistant.

Influence of cyclosporine A on mucociliary system after lung transplantation in rats

OBJETIVO: Investigar a funcao do sistema mucociliar em ratos transplantados sob a influencia de imunossupressores. METODOS: Trinta e seis ratos foram submetidos ao transplante pulmonar unilateral e divididos em dois grupos, onde um grupo foi tratado com ciclosporina e outro foi controle. Administrada ciclosporina por via subcutânea na dose de 10 mg/kg diariamente. Os ratos foram sacrificados 2, 15 e 30 dias apos o transplante pulmonar. O transporte mucociliar bronquico (TMC) in situ e a frequencia de batimento ciliar (FBC) foram analisados na porcao proximal e distal a anastomose bronquica. Realizada correlacao dos achados com parâmetros gasometricos e histologia. RESULTADOS: Foi encontrada melhora progressiva e significante no TMC na regiao proximal e distal a anastomose no grupo que recebeu ciclosporina em 15 e 30 dias (p<0,01). Nao houve diferenca na FBC nos dois grupos estudados. A analise histologica mostrou que a rejeicao foi significantemente maior no grupo controle (p<0,05). A oxigenacao foi melhor nos animais que receberam a ciclosporina. CONCLUSAO: A ciclosporina exerceu influencia positiva no transporte mucociliar bronquico, provavelmente por sua acao imunossupressora.

Tendências em experimentação animal

INTRODUCTION The search of the understanding of etiological factors, mechanisms and treatment of the diseases has been taking to the development of several animal models in the last decades. OBJECTIVE To discuss aspects related to animal models of experimentation, animal choice and current trends in this field in our country. In addition, this study evaluated the frequency of experimental articles in medical journals. METHODS Five Brazilian journals indexed by LILACS, SciELO, MEDLINE, and recently incorporate for Institute for Scientific Information Journal of Citation Reports were analyzed. All the papers published in those journals, between 2007 and 2008, that used animal models, were selected based on the abstracts. RESULTS Of the total of 832 articles published in the period, 92 (11.1%) experimentation papers were selected. The number of experimental articles ranged from 5.2% to 17.9% of the global content of the journal. In the instructions to the authors, four (80%) journals presented explicit reference to the ethical principles in the conduction of studies with animals. The induced animal models represented 100% of the articles analyzed in this study. The rat was the most employed animal in the analyzed articles (78.3%). CONCLUSIONS The present study can contribute, supplying subsidies for adoption of future editorials policies regarding the publication of animal research papers in Brazilian Journal of Cardiovascular Surgery.

Risk Prediction Models: are they Really Necessary?

. Initially created with the aim of analyzing the likelihood of complications and deaths in patients undergoing intervention, these prediction models allow to evaluate the risks and benefits of the procedure. Although no prediction system is comprehensive enough to estimate the specific outcome for each patient, risk stratification allows patients and physicians to know the likely risk of complications or death for the group of individuals with similar risk profile undergoing the proposed procedure collaborating in making decisions. Moreover, these multivariate models of risk assessment have been applied in comparing the performance of institutions or individual professionals, such as setting an objective way to measure the quality of health services, and assisting in the adjustment of resource allocation. Although they are subject to much criticism, the risk assessment models are obviously superior to the comparison of absolute numbers, such as mortality rates, in evaluating the performance of groups or hospitals. Most of the prediction systems developed in cardiac surgery were developed from large populations of patients, resulting often in multicenter studies. From these data, risk scores are established, based on factors identified as predictors of death or complications. The fact is that since the first risk score has become widely known - the Parsonnet index, in the 80s of last century - a wide variety of these instruments has been proposed, including the Cleveland Clinic score, the French score, the Pons score, the Ontario Province score, the Society of Thoracic Surgery (STS) Scoring System, the EuroSCORE and the Bernstein-Parsonnet.Although there is not an ideal risk stratification model, this should have the following characteristics: ease of implementation, objectivity, accuracy in the prediction of mortality and have widespread use. I a recently published meta-analysisCriados inicialmente com o objetivo de analisar a probabilidade de complicações e óbitos de pacientes submetidos a intervenções, esses modelos de predição possibilitam realizar um balanço dos riscos e benefícios do procedimento. Apesar de nenhum sistema de predição ser suficientemente abrangente para estimar o resultado específico para cada paciente, a estratificação de risco possibilita a pacientes e médicos conhecerem o provável risco de complicações ou óbito para o grupo de indivíduos com perfil de risco similar, submetidos ao procedimento proposto, colaborando na tomada de decisões.

Cirurgia de revascularização na fase aguda do infarto do miocárdio: análise dos fatores pré-operatórios preditores de mortalidade

OBJETIVO: Analisar os fatores pre-operatorios preditores de mortalidade, em pacientes submetidos a RM nos primeiros 30 dias apos infarto agudo do miocardio (IAM). METODOS: Entre 3/1998 e 7/2002, foram incluidos, consecutiva e prospectivamente, em um banco de dados, 753 pacientes com IAM, sendo que 135 (17,9%) foram submetidos a revascularizacao miocardica (RM) isolada e incluidos neste estudo. Estudaram-se os seguintes fatores prognosticos, atraves de analise multivariada: idade, sexo, diabete, historia de IAM, RM ou angioplastia (ATC), localizacao do IAM, IAM Q, uso de fibrinolitico, intervalo entre o IAM e a cirurgia, presenca de complicacoes no pre-operatorio. RESULTADOS: A mortalidade hospitalar global foi de 6,7%, variando de 12,5% nos pacientes portadores de complicacoes pre-operatorias a 1,4% naqueles sem complicacoes. Tiveram correlacao estatisticamente significante com a mortalidade pos-operatoria apenas historia previa de angioplastia (p=0,037) e choque cardiogenico (p=0,002). Em contrapartida, o uso de trombolitico na abordagem inicial do IAM apresentou correlacao negativa com a mortalidade (p=0,035). CONCLUSAO: A RM na fase aguda do IAM e um procedimento que apresenta mortalidade cirurgica distinta, na dependencia da condicao clinica pre-operatoria do paciente. Dentre os fatores analisados, a presenca de choque cardiogenico pre-operatorio e historia de angioplastia previa determinaram pior prognostico neste grupo de pacientes.

Importância da anatomia da circulação coronária atrial na operação de Cox para controle da fibrilação atrial

Com o advento de novas tecnicas cirurgicas para o tratamento das arritmias cardiacas, em especial da fibrilacao atrial, como a cirurgia de Cox, o conhecimento das caracteristicas e do trajeto das arterias coronarias atriais assumiu grande importância. O objetivo deste trabalho e o estudo desta circulacao e a definicao dos padroes de irrigacao atrial. Para tanto, utilizamos 30 coracoes a fresco de individuos sem cardiopatia previa, cujas arterias coronarias e ramos foram visibilizados atraves de injecao de resina vinilica corada com tinta laca preta, seguida de cuidadosa disseccao. Apos avaliacao macroscopica das pecas, nao foram encontrados padroes de irrigacao uniforme dos atrios. Porem, a arteria do no sinoatrial (ANSA), quando analisada isoladamente, revelou nao apenas padroes de origem, como tambem padroes de trajeto. Foram descritos 7 padroes de origem e trajeto da ANSA, considerando-se pontos de referencias da estrutura anatomica dos atrios. Os padroes descritos, diferente dos encontrados por outros autores, sao de facil interpretacao e de aplicabilidade direta em tecnicas cirurgicas que abordam os atrios.