Field comparison of broad-spectrum white LED-baited traps with narrow-spectrum green LED-baited traps in the capture of Anopheles mosquitoes (Diptera: Culicidae)

Light-Emitting Diodes (LEDs) have been effective light sources in attracting Anopheles mosquitoes, but the broad-spectrum white light, even with a wide-ranging application in lighting, have not been evaluated yet. In this study, the white light was field evaluated against the green one in the light trapping of anopheline mosquitoes by using two non-suction Silva traps and two CDC-type suction light traps. Anopheline mosquitoes were captured for two 21-night periods of collecting (2022 and 2023). In the first period, two LEDs were used per Silva trap, but three were used in the second one to increase the luminance/illuminance at traps. A CDC-type suction light trap equipped with an incandescent lamp was used in 2022 and a CDC-type suction light trap equipped with a 6 V-white light (higher luminance/illuminance) in 2023. A total of eight species and 3,289 specimens were captured in both periods. The most frequent species were Anopheles triannulatus s.l., An. goeldii, An. evansae and An. argyritarsis. In 2022, white LEDs were less attractive to anopheline mosquitoes than the other light sources, but without statistical difference among treatments (F = 2.703; P = 0.0752; df = 2). In 2023, even with an increased luminance/illuminance at traps, no statistical difference was found between the two LED-baited Silva traps (F = 6.690; P = 0.0024; df = 2), but rather between the 6 V-white-baited CDC-type suction light trap and green-baited Silva traps. Due to some drawbacks and the lower abundance of individuals caught by using white LEDs, the narrow-banded green LEDs is preferable to white ones for attracting anophelines.

Field evaluation of a new suction light trap for the capture of phlebotomine sand flies (Diptera: Psychodidae: Phlebotominae), vectors of leishmaniasis

Phlebotomine sand flies are crepuscular and nocturnal small dipteran insects in the family Psychodidae. Several disease agents, including Leishmania parasites, are transmitted to humans and other vertebrate hosts by the bite of an infected female sand fly. As part of leishmaniasis surveillance programs, light traps have been routinely used in sand fly collections. In this context, new trapping devices are always being required to improve vector monitoring. Here, the efficiency of a new suction light trap, named Silva suction trap or SS trap, was field evaluated in collecting sand flies. Two SS traps, one with green (520 nm, 15,000 mcd) and the other with white (wide spectrum, 18,000 mcd) LEDs, and one CDC-type trap were deployed in a rural forested environment. A total of 4686 phlebotomine sand flies were captured. The most frequent species were females of the Ps. Chagasi series (77.8%) followed by males of Ps. wellcomei (11.6%), Nyssomyia whitmani (3.3%), and Bichromomyia flaviscutellata (2.4%). The CDC-type light trap collected 101.9 ± 20.89 sand flies and 14 species, followed by the white-baited SS trap (87.78 ± 16.36, 14), and the green-baited SS trap (70.61 ± 14.75, 15), but there were no statistically significant differences among traps. A discussion on the considerable advantages of the use of SS traps over CDC traps is included. In this study, the Silva suction trap proved to be efficient and can be an alternative to CDC traps for monitoring adult phlebotomine sand fly populations.

The evening crepuscular host-seeking activity of Anopheles mosquitoes in northeast Brazil

Studies on the timing of anopheline host-seeking are important for understanding mosquito ecology, behaviors, and possible role in disease transmission. To study the evening crepuscular host-seeking activity of anophelines and the effects of moonlight, anopheline mosquitoes were collected with light traps settled in a livestock area in the Brazilian Cerrado region. Traps (Silva traps) were placed next to animal enclosures at 1.5 m asl. The research was divided in 2 experiments: the first experiment (12 nights) comprised 2 trapping periods, one from 6 PM to 7 PM and one from 7 PM to 6 AM, and the second experiment (16 evenings) divided in three 20-min intervals based on the 3 twilight phases (civil: 6-6:20 PM; nautical: 6:20-6:40 PM; and astronomical: 6:40-7 PM). A total of 2,815 anopheline mosquitoes and 9 species were found. The main species were Anopheles triannulatus s.l., An. argyritarsis, An. goeldii, and An. evanse. Host-seeking mosquitoes were more frequently active during the first hour after sunset, with a significant peak in the second 20-min interval. After that, a decrease in the number of individuals was observed from the astronomical twilight onwards. Moonlight did not affect the evening flight activity of anophelines. By using LED-based passive light traps, the evening arrival time of anophelines at blood-feeding sites was demonstrated, and it may be a key time window for malaria vector control interventions.

Effect of ultraviolet LED and trap height on catches of host-seeking anopheline mosquitoes by using a low-cost passive light trap in northeast Brazil

Light traps have been widely used for monitoring malaria vectors, although drawbacks remain. In this context, new tools and attractants are always becoming available to perform monitoring tasks, like the Silva trap, a passive and low-cost LED-light trap for host-seeking anopheline mosquitoes. In this work, the effectiveness of the Silva trap by using UV-LED and at different heights as well as a comparison with the conventional CDC-type (HP) light trap was studied. A total of 9009 mosquitoes and nine species were caught, Anopheles triannulatus, An. argyritarsis, and An. goeldii being the most frequent species. The green (520 nm) and blue (470 nm) LEDs attracted almost equal numbers of anopheline mosquitoes, but UV LEDs (395 nm) attracted a significantly lower number of individuals (Kruskal-Wallis = 19.68, P = 0.0001). Even with the predominance of mosquitoes trapped at the height of 1.5 m, no significant statistical difference was found among the four heights tested (0.5 m; 1.0 m; 1.5 m; 2.0 m). Green-baited Silva traps collected significantly more individuals than incandescent-baited CDC-type traps (U = 60.5; P = 0.0303). LEDs have been useful as light sources for attracting insect vectors and together with a low-cost trap, as the Silva trap, a feasible alternative to conventional trap-based monitoring Anopheles mosquitoes that can be implemented in the field.

The immunomodulatory activity of Chenopodium ambrosioides reduces the parasite burden and hepatic granulomatous inflammation in Schistosoma mansoni-infection

ETHNOPHARMACOLOGICAL RELEVANCE

Folk medicine reports have described the use of Chenopodium ambrosioides as an anti-inflammatory, analgesic, and anthelmintic herb. These effects, including its activity against intestinal worms, are already scientifically observed. However, the immunological mechanisms of this species in the treatment of Schistosoma mansoni infection are unknown.

AIM OF THE STUDY

To evaluate the immunological and anti-Schistosoma mansoni effects of a crude Chenopodium ambrosioides hydro-alcoholic extract (HCE).

MATERIALS AND METHODS

For the in vitro analysis, cercariae and adult worms were exposed to different concentrations (0 to 10,000 μg/mL) of the HCE. For the in vivo evaluation, Swiss mice were infected with 50 cercariae of S. mansoni and separated into groups according to treatment as follows: a negative control (without treatment), a positive control (treated with Praziquantel®), HCE1 Group (treated with HCE during the cutaneous phase), HCE2 Group (treated with HCE during the lung phase), HCE3 Group (treated with HCE during the young worm phase), and HCE4 Group (treated with HCE during the adult worm phase). The animals treated with HCE received daily doses of 50 mg/kg, by gavage, for seven days, corresponding to the different developmental stages of S. mansoni. For comparison, a clean control group (uninfected and untreated) was also included. All animals were euthanized 60 days post-infection to allow the following assessments to be performed: a complete blood cells count, counts of eggs in the feces and liver, the quantification of cytokines and IgE levels, histopathological evaluations of the livers, and the analysis of inflammatory mediators.

RESULTS

HCE treatment increased the mortality of cercariae and adult worms in vitro. The HCE treatment in vivo reduced the eggs in feces and liver. The number and area of liver granulomas, independent of the phase of treatment, were also reduced. The treatment with HCE reduced the percentage of circulating eosinophils, IgE, IFN-γ, TNF-α, and IL-4. In contrast, the treatment with the HCE, dependent on the phase, increased IL-10 levels and the number of peritoneal and bone marrow cells, mainly of T lymphocytes, B lymphocytes, and macrophages. This effect could be due to secondary compounds presents in this extract, such as kaempferol, quercetin and derivatives.

CONCLUSIONS

This study demonstrates that Chenopodium ambrosioides has antiparasitic and immunomodulatory activity against the different phases of schistosomiasis, reducing the granulomatous inflammatory profile caused by the infection and, consequently, improving the disease prognosis.

Centers for Disease Control-type light traps equipped with high-intensity light-emitting diodes as light sources for monitoring Anopheles mosquitoes

In this study the phototactic response of anopheline mosquitoes to different luminous intensity light-emitting diodes (LEDs) was investigated. Centers for Disease Control-type light traps were changed by replacement of the incandescent lamps by 5 mm round type green (520 nm) and blue (470 nm) LEDs of different luminous intensities: green-LED traps with luminous intensities of 10,000, 15,000 and 20,000 millicandela (mcd) and the blue-LED traps with luminous intensities of 4000, 12,000 and 15,000 mcd. Our data showed that increasing luminous intensity has an effect on the attraction of anopheline mosquitoes to light traps, highlighting the importance of taking LEDs and light sources of high luminous intensity into account when using light-trap collections in monitoring populations of Anopheles species.

Light-Emitting Diode (LED) Traps Improve the Light-Trapping of Anopheline Mosquitoes

Numerous advantages over the standard incandescent lamp favor the use of light-emitting diodes (LEDs) as an alternative and inexpensive light source for sampling medically important insects in surveillance studies. Previously published studies examined the response of mosquitoes to different wavelengths, but data on anopheline mosquito LED attraction are limited. Center for Disease Control and Prevention-type light traps were modified by replacing the standard incandescent lamp with 5-mm LEDs, one emitting at 520 nm (green) and the other at 470 nm (blue). To test the influence of moon luminosity on LED catches, the experiments were conducted during the four lunar phases during each month of the study period. A total of 1,845 specimens representing eight anopheline species were collected. Anopheles (Nyssorhynchus) evansae (35.2%) was the most frequently collected, followed by An. (Nys.) triannulatus (21.9%), An. (Nys.) goeldii (12.9%), and An. (Nys.) argyritarsis (11.5%). The green LED was the most attractive light source, accounting for 43.3% of the individuals collected, followed by the blue (31.8%) and control (24.9%) lights. The LED traps were significantly more attractive than the control, independent of the lunar phase. Light trapping of anopheline mosquitoes was more efficient when the standard incandescent lamp was replaced with LEDs, regardless of the moon phase. The efficiency of LEDs improves light trapping results, and it is suggested that the use of LEDs as an attractant for anopheline mosquitoes should be taken into consideration when sampling anopheline mosquitoes.

The effects of urban particulate matter on the nasal epithelium by gender: An experimental study in mice

Nose is the first portion of the respiratory system into contact with air pollution particles, including organic compounds that could act as endocrine releasers. The objective was to identify and quantify estrogenic receptor-β (ERβ), aryl hydrocarbon receptor (AhR), the cytochrome P450 enzymes CYP1A1, 1A2, 1B1, and mucus profile in the nasal epithelium of mice. BALB/c mice male (n = 32) and female (n = 82) in proestrus, estrus and diestrus were divided into two groups: 1) exposed to ambient air; 2) concentrated ambient particles (CAPs) to achieve an accumulated dose (concentration vs. time product) of 600 μg/m(3), the time of the exposure was controlled to ensure the same concentration for all groups (5 days per week for 40-51 days). RT-PCR (Erβ-1, Erβ-2, Ahr, Cyp1a1, Cyp1a2, Cyp1b1), immunohistochemistry and morphometry (ERβ, AhR) were used to analyze. The mucus profiles were examined using acid (Alcian Blue) and neutral (periodic acid Schiff's) stains. Exposed females had significantly lower levels of Erβ-2 mRNA than exposed males (p = 0.036). Cyp1b1 mRNA in diestrus females was significantly lower in the CAP-exposed group compared with the ambient air group (p ≤ 0.05). ERβ expression in the epithelium and submucosa nucleus was lower in estrus exposed to CAPs compared with ambient air. CAPs increases AhR in the epithelium (p = 0.044) and submucosa (p = 0.001) nucleus of female when compared with male mice. Exposure to CAPs, also led to relatively increased acidic content in the mucus of males (p = 0.048), but decreased acidic content in that of females (p = 0.04). This study revealed sex-dependent responses to air pollution in the nasal epithelium that may partially explain the predisposition of females to airway respiratory diseases.

Evaluation of light-emitting diodes as attractant for sandflies (Diptera: Psychodidae: Phlebotominae) in northeastern Brazil

Hoover Pugedo light traps were modified for use with green and blue-light-emitting diodes to trap phlebotomine sandflies in northeastern Brazil. A total of 2,267 specimens belonging to eight genera and 15 species were sampled. The predominant species were Nyssomyia whitmani(34.41%) and Micropygomyia echinatopharynx(17.25%).The green LED trap prevailed over the blue and control lights; however, no statistically significant difference could be detected among the three light sources. Even without statistical significance, we suggest using LEDs as an attractant for the capture of sandflies because of several advantages over the conventional method with incandescent lamps.

The Influence of Weather and Lunar Phases on the Flight Activity of Paederus Rove Beetles (Coleoptera: Staphylinidae)

Despite the medical importance of Paederus beetles, no studies have studied the influence of the abiotic factors on the flight activity and nighttime dispersal of these insects in Brazil. Therefore, the influence of both climatic factors and moon phase on black-light catches of Paederus rove beetles was investigated. Paederus beetles were attracted to a black light source hourly from 1800 to 0600 hours, and data on weather conditions as well as moon phase data were taken for every sampling date. Overall, 543 individuals of Paederus beetles belonging to four species were captured: P. protensus, P. columbinus, P. brasiliensis, and P. mutans. Paederus beetles were mostly active in the warmest parts of the studied nights. Variations in nighttime temperature, relative humidity, wind speed, cloud cover, and moon phases appear not to affect Paederus flight. The diurnal temperature was observed to affect the night hourly dispersal of Paederus rove beetles as well as their distribution pattern during the entire period of study. The true environmental condition responsible for Paederus beetles seasonal pattern and daily night dispersal in northeastern Brazil were the annual moisture and drought cycles and the diurnal maximum temperatures, respectively. Significant trap catches were observed in the earliest hours after sunset (1800-2100), and people must be aware of this fact, as it can notably increase the risk of acquiring linearis dermatitis from the contact with large numbers of active Paederus.

Peritoneal Submesothelial Stromal Cells Support Hematopoiesis and Differentiate into Osteogenic and Adipogenic Cell Lineages

The peritoneum is a thin membrane that covers most of the abdominal organs, composed of a monolayer of mesothelial cells and subjacent submesothelial loose connective tissue. Cells from the peritoneal wall are correlated with peritoneal fibrosis and epithelial-to-mesenchymal transition. However, the distinct involvement of mesothelial or submesothelial cells in such phenomena is still not clear. Here, we propose a new strategy to obtain stromal cells from anterior peritoneal wall explant cultures. These cells migrated from peritoneal tissues and proliferated in vitro for 4 weeks as adherent fibroblast-like cells. Optical and electronic microscopy analyses of the fragments revealed a significant submesothelial disorganization. The obtained cells were characterized as cytokeratin- vimentin+ laminin+ α-smooth muscle actin+, suggesting a connective tissue origin. Moreover, at the third passage, these stromal cells were CD90+CD73+CD29+Flk-1+CD45-, a phenotype normally attributed to cells of mesenchymal origin. These cells were able to support hematopoiesis, expressing genes involved in myelopoiesis (SCF, G-CSF, GM-CSF, IL-7 and CXCL-12), and differentiated into osteogenic and adipogenic cell lineages. The methodology demonstrated in this work can be considered an excellent experimental model to understand the physiology of the peritoneal wall in healthy and pathological processes. Moreover, this work shows for the first time that submesothelial stromal cells have properties similar to those of mesenchymal cells from other origins.

Three-dimensional clustered speckle fields: theory, simulations and experimental verification

Clustered speckle patterns are a particular type of speckles that appear when a coherently illuminated diffuser is imaged through a multiple aperture pupil mask attached to a lens. The cluster formation is the result of the complex speckle modulations of the multiple interferences produced by the apertures. In this paper, a three-dimensional analytical approach to simulate cluster speckles everywhere after the lens is presented. This approach has the possibility of including multiple aperture masks at the lens and at the diffuser, in contrast to previous works which were also limited to the description of the patterns only at the image plane. This model contributes to the development of tailor made speckle patterns that can be used in diverse optical applications, including those lying in the focus region. The approach is validated under different conditions by comparing experimental results with simulations on a statistical basis. Some aspects of possible uses of these clusters are briefly revised, such as optical trapping, manipulation and metrology.

Impact of a multidimensional infection control strategy on central line-associated bloodstream infection rates in pediatric intensive care units of five developing countries: findings of the International Nosocomial Infection Control Consortium (INICC)

PURPOSE

To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control strategy including a practice bundle to reduce the rates of central line-associated bloodstream infection (CLAB) in patients hospitalized in pediatric intensive care units (PICUs) of hospitals, which are members of the INICC, from nine cities of five developing countries: Colombia, India, Mexico, Philippines, and Turkey.

METHODS

CLAB rates were determined by means of a prospective surveillance study conducted on 1,986 patients hospitalized in nine PICUs, over a period of 12,774 bed-days. The study was divided into two phases. During Phase 1 (baseline period), active surveillance was performed without the implementation of the multi-faceted approach. CLAB rates obtained in Phase 1 were compared with CLAB rates obtained in Phase 2 (intervention period), after implementation of the INICC multidimensional infection control program.

RESULTS

During Phase 1, 1,029 central line (CL) days were recorded, and during Phase 2, after implementing the CL care bundle and interventions, we recorded 3,861 CL days. The CLAB rate was 10.7 per 1,000 CL days in Phase 1, and in Phase 2, the CLAB rate decreased to 5.2 per 1,000 CL days (relative risk [RR] 0.48, 95% confidence interval [CI] 0.29-0.94, P = 0.02), showing a reduction of 52% in the CLAB rate.

CONCLUSIONS

This study shows that the implementation of a multidimensional infection control strategy was associated with a significant reduction in the CLAB rates in the PICUs of developing countries.

Subchronic effects of nasally instilled diesel exhaust particulates on the nasal and airway epithelia in mice

Diesel exhaust is the major source of ultrafine particles released during traffic-related pollution. Subjects with chronic respiratory diseases are at greater risk for exacerbations during exposure to air pollution. This study evaluated the effects of subchronic exposure to a low-dose of diesel exhaust particles (DEP). Sixty male BALB/c mice were divided into two groups: (a) Saline: nasal instillation of saline (n = 30); and (b) DEP: nasal instillation of 30 microg of DEP/10 microl of saline (n = 30). Nasal instillations were performed 5 days a week, over 30 and 60 days. Animals were anesthetized with pentobarbital sodium (50 mg/kg intraperitoneal [i.p.]) and sacrificed by exsanguination. Bronchoalveolar lavage (BAL) fluid was performed to evaluate the inflammatory cell count and the concentrations of the interleukin (IL)-4, IL-10, and IL-13 by enzyme-linked immunosorbent assay (ELISA). The gene expression of oligomeric mucus/gel-forming (Muc5ac) was evaluated by real-time polymerase chain reaction (PCR). Histological analysis in the nasal septum and bronchioles was used to evaluate the bronchial and nasal epithelium thickness as well as the acidic and neutral nasal mucus content. The saline group (30 and 60 days) did not show any changes in any of the parameters. However, the instillation of DEP over 60 days increased the expression of Muc5ac in the lungs and the acid mucus content in the nose compared with the 30-day treatment, and it increased the total leukocytes in the BAL and the nasal epithelium thickness compared with saline for 60 days. Cytokines concentrations in the BAL were detectable, with no differences among the groups. Our data suggest that a low-dose of DEP over 60 days induces respiratory tract inflammation.

Mast cells can revert dexamethasone-mediated down-regulation of stem cell factor

Mast cell hyperplasia can be causally related with chronic inflammation and liver fibrosis. Their survival and proliferation is dependent upon locally produced growth factors, the major one being the stem cell factor (SCF). Glucocorticoids can decrease mastocytosis, down-regulating the mast cell production of pro-inflammatory factors or inhibiting the expression of SCF in stroma. We compared dexamethasone effect on SCF expression in co-cultures of mast cells with NIH/3T3 fibroblasts or with primary cultures of activated hepatic stellate cells. Dexamethasone abrogated the NIH/3T3 stroma capacity to sustain mast cell proliferation, but not of hepatic stellate cells, at the post-transcriptional level. Mast cells reverted completely dexamethasone effect on hepatic stellate cells, increasing their SCF synthesis and transport. In both models, dexamethasone inhibited the mast cell spreading on the stroma, which was thus not required for mast cell survival and proliferation. Liver pathologies associated with mast cell hyperplasia are not expected to be sensitive to glucocorticoid treatments.

Liver granulomas in schistosomiasis: mast cell-dependent induction of SCF expression in hepatic stellate cells is mediated by TNF-alpha

Mast cell proliferation, survival, and differentiation are under control of the surrounding stroma and are largely mediated by the stem cell factor (SCF). Mast cells are abundant in liver fibrosis and are proposed to be causally related with its persistence and intensity through secretion of fibrogenic cytokines. In normal adult liver, local connective tissue cells (stellate cells) do not constitutively express SCF. We studied primary cultures of stellate cells obtained from fibrogranulomatous reactions elicited in mouse liver by schistosomal infection. We have shown that the SCF expression can be induced in vitro by co-culture with mast cells and this induction was dependent on the release of tumor necrosis factor alpha (TNF-alpha). Because SCF induces in mast cells proliferation and release of both fibrogenic factors and TNF-alpha, the described interaction between liver stroma and mast cells represents an auto-stimulatory loop, which may explain the progressive and persistent character of liver fibrosis associated with chronic inflammations or infections. Granulomatous reactions in liver elicited by chronic schistosomiasis sustain a local production of inflammatory cells, and this extramedular myelopoiesis is potentially also dependent on the induction of SCF expression in the liver stellate cells.

[The role of the stent in non-coronary cardiopathies]

INTRODUCTION

The stent has demonstrated to be a useful device in the prevention of postangioplasty coronary restenosis and it is expected to have a favourable effect as an alternative or complementary treatment of stenotic lesions in arteries or veins associated with congenital defects. The aim of this study is to analyze our experience in this setting.

MATERIAL AND METHODS

From February 1992 to March 1996, 28 stenting procedures were performed in 26 patients (mean age: 8.6 +/- 0.7 years; mean weight: 26.2 +/- 3 kg). In 12 patients, stenting was single, and a iliac Palmaz stents were always used. Stenting location was: pulmonary artery branches in 17 patients, right ventricular outflow in 2 patients, in the junction of right atrium with pulmonary artery in 2 patients, systemic veins in 2 patients and in post Mustard intratrial channel stenosis in 2 patients. 25 patients had previously undergone at least one surgical procedure.

RESULTS

The stenotic diameter of the treated lesions increased significantly after the procedure (4.4 +/- 0.3 mm before stenting vs 11.6 +/- 0.3 mm after stenting, p < 0.0001) and the transtenotic gradient decreased from 38.1 +/- 5 to 12 +/- 3.8 mmHg. Those changes were associated with a diminution of right ventricular pressure (81.6 +/- 3 vs 56.7 +/- 6 mmHg, p < 0.0001) in patients with pulmonary branch stenosis without septal defects. There was no mortality among the percutaneously treated patients and only one patient needed surgery. Nevertheless, one patient died after bilateral intraoperative stenting.

CONCLUSION

The treatment of proximal or distal stenotic lesions in the pulmonary tree, systemic veins, and obstructed intraatrial channels with stents, can replace or complement conventional balloon angioplasty. It also offers a useful and effective alternative to surgery, when it is impossible or carries a risk.

[The angiographic diagnosis of the connection of the persistent left vena cava superior to the left atrium by the absence of the roof of the coronary sinus in a child with a Holmes' heart]

We describe a patient with angiographic findings of a left superior persistent vena cava draining in the left atrium with absence of the coronary sinus' roof and coexisting with Holmes' heart. The diagnosis can be made by selective angiography in the left atrium, pulmonary vein or at the left superior vena cava. We want to emphasize the importance of knowing this sort of anomaly before surgical treatment.

[Complete atrioventricular canal and tetralogy of Fallot: surgical considerations]

Nine patients with complete atrioventricular canal and tetralogy of Fallot underwent intracardiac repair of both anomalies between 1982 and 1989. The ages of the patients ranged from 6 months to 7 years. Six of the 9 had one or more previous systemic-pulmonary artery shunts. Two-dimensional echocardiography showed diagnostic characteristics of both malformations in all patients. The diagnosis was confirmed by cardiac catheterization and cineangiography. The ventricular septal defect was repaired by a combined right atrial and ventricular approach in every patient. Outflow tract reconstruction was performed with the use of a transannular patch (4), infundibular patch (4), and a valved conduit (1). There were no hospital deaths. Meningitis was responsible for the death of a patient 2 years after repair. We recommend early palliation, complete repair in those older than 4 or 5 years, surgical technique depending on the anatomical findings, combined atrial and ventricular approach, 2 separate patches to close the ventricular septal defect in required cases, adjusted correction of the right ventricular outflow tract, and careful postoperative care.

Complete atrioventricular canal and tetralogy of Fallot: surgical management

Between 1982 and 1989, nine patients with complete atrioventricular (AV) canal and tetralogy of Fallot underwent successful repair of both anomalies. Seven patients had Down's syndrome. One or more previous palliative shunts had been used in six patients. Associated cardiovascular lesions included persistent left superior vena cava (two patients), patent ductus arteriosus with marked stenosis of the left pulmonary artery (one patient). The diagnosis was confirmed by cardiac catheterization and cineangiography. Closure of the ventricular septal defect was performed through a combined right atrial and ventricular approach in each patient. The right ventricular outflow obstruction was relieved with the use of a transannular patch (4), right ventricular infundibular patch (4) or a valved external conduit (1). There were no hospital deaths. One patient died as a result of meningitis 2 years after repair. Progressive left AV valve incompetence developed in one patient requiring valve replacement. A single atrial approach may not provide the best exposure of the subaortic end of the defect. In this regard, we recommend an additional right ventriculotomy in order to ensure safe closure of the septal defect. Although an adequately shaped isolated patch could be sufficient to close the anterior VSD, we favour a separate patch to minimize the possibility of producing subaortic obstruction. A further method to avoid this subaortic stenosis consists of dividing the common anterior leaflet to the right towards the lateral extent of the infundibular septum.

[Surgery of congenital cardiopathies without previous catheterization. Preoperative evaluation and surgical indication using bidimensional echocardiography and Doppler]

With the non-invasive devices available nowadays, many congenital heart diseases may be diagnosed with a definition comparable and even perhaps superior to catheterization and angiography. According to this issue, from January 1983 to December 1987, 239 children underwent operations for palliation or correction of different cardiopathies based on an echo-Doppler assessment without prior catheterization. Preoperative echo-Doppler diagnoses had an adequate correlation with the surgical findings in 234 cases (97.9 percent), so there was no correlation in 5 cases. In general, we consider that echo-Doppler provides a complete and definitive diagnosis in most cases, thus eliminating the need for further invasive procedures, although we still have to rely on catheterization to obtain the necessary information or reassurance in some cases. Progressive increase of reliance in echo-Doppler techniques by the surgeon and self confidence of the cardiologist in his accurate state of the art will considerably increase the performance of cardiac operations without prior catheterization in the future. At present, this is our current policy, as day after day, we are increasing the diagnoses in which we consider unnecessary the catheterization to indicate surgery.

[Atrioventricular septal defect with associated tetralogy of Fallot. Clinico-morphological aspects and surgical considerations]

In this work the clinical features, diagnostic methods, surgical procedures and postoperative follow-up are reviewed in 19 cases of atrioventricular septal defect with associated tetralogy of Fallot. The clinical situation was always related to the degree of pulmonary ischemia, that pointed out the urgency and need for a palliative surgical procedure before corrective surgery. There was no data in the ECG for the differential diagnosis of isolated forms of atrioventricular septal defect. In 50% of the cases the cardio-thoracic index was increased by right atrial enlargement. The diagnosis of the malformation was made in every case by means of 2D echocardiography. In 16 cases palliative surgery was done (aortic-pulmonary shunts), with one death (6.2%) due to facts unrelated to the technique. Of the 6 cases with corrective surgery (5 cases with previous shunts), one needed a mitral valve replacement (St Jude prosthesis). There was no mortality in this group and the functional status in the long-term follow-up was: 3 cases were in the functional class I and 3 cases in class II. The overall mortality for all surgical procedures carried out was 4.3%. In conclusion, we consider the use of the corrective surgery adequate to the clinical stability of the patients with atrioventricular septal defect with associated Fallot's tetralogy.

Phrenic nerve paralysis following pediatric cardiac surgery. Role of diaphragmatic plication

Eighteen children sustained unilateral phrenic nerve paralysis (PNP) after cardiac surgical procedures. Ten (Group I), under 7 months (mean: 2.9 +/- 2.2), required long-term ventilatory assistance (mean: 23.9 +/- 13.0 days); they failed to be weaned from the ventilator. All underwent diaphragmatic plication (DP). DP was performed late in 7 cases (Group Ia) with a mean time of 30.8 days between surgery and DP, and early in 3 others (Group Ib) with a mean time of 10.2 days. Eight children (Group II), older than 1 year, tolerated PNP better and could be extubated early without diaphragmatic plication. In Group Ia severe lung infections were recorded in 5 before or/and after DP, and two died at 3 and 30 days after plication. Five children from Group Ia and all 3 from Group Ib were late survivors. They could be weaned from ventilatory support in a mean time of 3 days after DP, although those with severe lung infection (Group Ia) took the longest time. All from Group II were late survivors. We conclude: PNP is well tolerated without plication in children older than 1 year. However early DP offers excellent and immediate results in infants with PNP. Early DP in these children avoids or reduces severe lung infections and death.

[Systemic-pulmonary fistula. Percentage of children attaining corrective surgery]

Because of the lack of information on definitive long term results of the systemic pulmonary fistulae (SPF) we decided to review our experience. From 1978/1980, SPF was carried out on 91 children with a minimal follow-up period of 53 months, 80 (88%) survive the immediate postoperative period, 65 (71%) the late period, although only 48 (53%) reached corrective surgery. 14 (50%) of the 28 newborn children died and only 9 (32%) had corrective surgery. 12 (19%) of the 63 children of two months or older died and 39 (62 por 100) had definitive surgery. 72% with Fallot syndrome, 58% with TGA and pulmonary stenosis and less than 40% of other pathologies also reached definitive corrective surgery. Frequently the SPF is the only alternative to achieve total correction although there may be a high mortality and morbidity rate. The age (newborn children) and the complex pathology are unfavourable in the end results.

Aortopulmonary window with anomalous origin of the right coronary artery from the pulmonary trunk

A case of aortopulmonary window associated with an anomalous origin of the right coronary artery from the pulmonary artery in a 3-month-old boy is reported. Angiographic diagnosis could be difficult because of the simultaneous filling of both great arteries that obscure the origin of the anomalous vessel; however, a careful evaluation of the angiogram may contribute to an accurate diagnosis. The surgical correction of this association of defects requires the connection of the aorta with the anomalous coronary ostium. An intrapulmonary tunneling procedure by means of a baffle is described.

[Surgical management of aortic coarctation in the newborn infant]

Between 1978 and 1983, 35 neonates with coarctation of the aorta (from a group of 200 cases with the same pathology) underwent coarctation relief. Indications for operation were persistent heart failure and/or hypertension. Three surgical techniques were employed: Aortoplasty with prosthetic patch (politetrafluoroethylen) in 23 cases. Repair with subclavian flap in 11 cases, and resection of coarctate segment with and-to-end anastomosis in only one case. It is an important fact the high incidence of congenital cardiac malformations associated with coarctation of the aorta in neonates. There were 8 deaths (six of them with associated cardiac malformations, and other with miocardiophaty). There were 8 late deaths and 5 cases with restenosis, and no hypertension cases. All others are well in the follow-up. Some of them are waiting for definitive correction of their major cardiac malformation. The high risk of mortality in this group, mark again the importance of adequate medical treatment previous to surgical correction in optimal conditions and as early as possible.

Transposition of the great arteries with ventricular septal defects. Surgical considerations concerning the Rastelli operation

We studied the anatomy of the ventricular septal defect in 20 heart specimens and eight operated patients with transposition of the great arteries regarding the feasibility of the Rastelli operation. They were divided into three groups. In Group I, comprising eight cases, creation of a left ventricle-aorta connection was not prevented by interposition of the atrioventricular valve tissue, and the ventricular septal defect was large or could be enlarged sufficiently. Thus, the Rastelli operation was feasible in all cases. In Group II, comprising 12 cases, interposition of the atrioventricular valves was not present, but the ventricular septal defect was inadequate in size for a good left ventricle-aorta connection. Small or even medium-sized ventricular septal defects were not enlargeable because of surrounding structures or inadequate septum for resection. In all cases, the ventricular septal defect was a tunnellike structure with two orifices; attempted enlargement would be more difficult at the left ventricular end (not obvious to the surgeon's view) than at the right one. The Rastelli operation was judged inadvisable in these cases. In Group III, comprising eight cases, the Rastelli operation was considered inadvisable because of interposition of atrioventricular valve tissue. The size of the ventricular septal defect and the presence of interposed atrioventricular valves can be diagnosed preoperatively. The presence of enough available space for resection, especially at the left ventricular end, should be determined preoperatively and/or intraoperatively in patients with medium-sized ventricular septal defects requiring enlargement. The anatomy of the ventricular septal defect may significantly alter the surgical approach for patients with transposition of the great arteries and ventricular septal defect.

Tetralogy of Fallot associated with total anomalous pulmonary venous drainage

We present a case of tetralogy of Fallot associated with total anomalous pulmonary venous return, with successful surgical correction. This association presents problems as regards surgical indications and technique.

Ventricular septal defect in infancy. Surgical criteria and experience

The optimal surgical management of ventricular septal defects (SVD) in infancy and particularly in small babies, still remains controversial. Seventy-six infants with VSD as the major cardiac lesion were operated upon from March 1978 to December 1981. Forty-three underwent primary repair with a 9.3% mortality rate. Pulmonary artery banding (PAB) was performed in 33 infants without mortality. Sixteen of them had subsequent debanding and VSD closure, also without mortality. Based on our own experience, our current recommendations are as follows: PAB in severely ill infants under 3 months of age, in infants with multiple or "Swiss-cheese type VSD" and in some cases of VSD with associated anomalies. Early debanding and correction, except in cases with multiple VSDs. Primary repair in infants aged more than 3 months and in some selected younger cases, according to the anatomical location of the defect.

New surgical approach to palliate tricuspid atresia in infants

An experimental surgical technique is proposed to increase pulmonary blood flow in tricuspid atresia with normally related great arteries. The method consists of the creation of ventricular septal defect in the infundibular septum by means of a closed surgical procedure. The expected advantage would be the growth of the right ventricular cavity. This would permit performance of a Fontan's procedure later, using the right atrium and the right ventricle. Microscopic sections from the hearts of 4 infants showed no damage in the conduction system. When performed in the beating hearts of dogs, the feasibility of the procedure was tested repeatedly without production of rhythm disturbances.

Rhabdomyoma of the heart: surgical treatment

Rhabdomyoma of the heart may cause severe hemodynamic obstruction specially in infants. Medical treatment carries a 100% mortality, but there are no clear surgical indications for these patients. Accordingly we reviewed the world literature (30 operated patients) adding our own experience (1 successfully operated patient) Based on our data and that of other we conclude: (1) Severely ill patients with rhabdomyoma should be operated upon. Age or associated tuberous sclerosis are not surgical contraindications. (2) Removal of the hemodynamic obstruction should be the main surgical goal. Radical resection of the tumor is not necessary and may be dangerous. (3) Surgical mortality is acceptable and it is becoming lower with time. (4) Long-term outcome for successfully operated patients is unknown.

[Fever of undetermined origin in a case of total correction of persistent truncus arteriosus with agenesis of the left pulmonary artery (author's transl)]

A 19 month-old girl diagnosed of truncus arteriosus with absence of the left pulmonary artery and severe truncal valve insufficiency underwent total correction. A non previously diagnosed severe mitral insufficiency required a new operation to implant a Bjork-Shiley supraanular mitral prosthesis. The postoperative period was hemodynamically normal, except for the presence of persistent fever of unexplained origin. The clinical picture was thought to be an infectious endocarditis due to the late appearance of an aortic prosthetic leak. Because of failure to medical treatment a reoperation was performed to replace aortic prosthesis. Patient died eight hours postoperatively. Autopsy revealed a correct surgical repair, absence of endocarditis and severe miliary disseminated tuberculosis. Authors consider of interest to present this case-report due to the rarity of: a) correction of truncus with a single pulmonary artery under two years of age; b) associated mitral insufficiency; c) the presence of tuberculosis, difficult differential diagnosis with infectious endocarditis in a patient with valvular prosthesis.

[Total transposition of the great vessels: Surgical treatment]

One hundred nine cases of complete transposition of great vessels alone or associated to other abnormalities are presented. In 91 cases a palliative treatment is given and in 18 cases there is a total correction done, depending upon the technique. Surgical indication and the technique used in every case is commented, making special reference to transpositions with ductus arteriosus or associated to coarctation of the aorta. In the 18 cases where we have done a total correction, we comment the surgical procedure of one of them who had a subpulmonary stenosis of the fibromuscular type, which we resolved through left ventriculotomy done on the apex of the ventricle and resecting the stenosis with an electroscalpel, which is a technique we have devised.

[Surgical management of Fallot's syndrome in young children (author's transl)]

The authors report the results in the surgical management of 232 children under two years of age suffering from syndrome of Fallot. Surgical techniques are described, and Waterston's right pulmonary artery to ascending aorta anastomosis advised. The problem of right lung overflow after this operation, its causes and prevention are commented upon. Analysis is made of indications for complete correction under extracorporeal circulation with and without deep hypothermia.