Objective -To assess the incidence of fatal pulmonary embolism (FPE), the accuracy of clinical diagnosis, and the profile of patients who suffered an FPE in a tertiary University Hospital. Methods -Analysis of the records of 3,890 autopsies performed at the Department of General Pathology from January 1980 to December 1990. Results -The scarcity of Brazilian statistics makes us resort to using figures obtained from other countries in order to assess the magnitude of health problems in Brazil. Pulmonary embolism represents one of the best examples of the need for epidemiological investigation in our population.According to the most frequent estimates, pulmonary embolism accounts for 300 thousand hospitalizations and 50 thousand deaths annually in the United States of America 1 . In these studies conducted in the 50's, pulmonary embolism accounted for 3% of the deaths and was a contributing factor to 6% of all deaths. More recent investigations, such as the studies conducted by Morrel and Dunnill, have reported much higher incidences. According to these authors, pulmonary embolism alone accounts for 7% of adult deaths in general hospitals 2 .Autopsy studies have shown that approximately 40% to 60% of the individuals who die as a result of pulmonary embolism are not diagnosed with this condition when alive 3,4 . Approximately 10% of all patients with pulmonary embolism die within the first hour of symptom onset, precluding the use of more sophisticated diagnostic methods. In those who survive after the first hour, the prognosis is closely related to a correct diagnosis and therapy. Mortality is 5 to 6 times higher in those individuals who are not properly diagnosed and in whom the therapy is not instituted 5 .The significance of the figures mentioned above underscores the importance of recognizing the clinical features, the predisposing conditions and the natural history of this disease.We conducted a case-control study at the Department of Pathology of a university hospital to assess the incidence and the accuracy of the clinical diagnosis and the profile of the patients who suffered a fatal pulmonary embolism (FPE). MethodsWe reviewed the records of all autopsies performed on

Introduction Cardiac surgery with cardiopulmonary bypass (CPB) is a recognized trigger of systemic inflammatory response, usually related to postoperative acute lung injury (ALI). As an attempt to dampen inflammatory response, steroids have been perioperatively administered to patients. Macrophage migration inhibitory factor (MIF), a regulator of the endotoxin receptor, is implicated in the pathogenesis of ALI. We have previously detected peak circulating levels of MIF, 6 hours post CPB. Experimental data have shown that steroids may induce MIF secretion by mononuclear cells. This study aims to correlate levels of MIF assayed 6 hours post CPB to the intensity of postoperative pulmonary dysfunction, analysing the impact of perioperative steroid administration. MethodsWe included patients submitted to cardiac surgery with CPB, electively started in the morning, performed by the same team under a standard technique except for the addition of methylprednisolone (15 mg/kg) to the CPB priming solution for patients from group MP (n = 37), but not for the remaining patients -group NS (n = 37). MIF circulating levels were assayed at the anesthesia induction, 3, 6, and 24 hours after CPB. A standard weaning protocol with fast track strategy was adopted, and indicators of organ dysfunction and therapeutic intervention were registered during the first 72 hours postoperative.Results Levels of MIF assayed 6 hours post CPB correlated directly to the postoperative duration of mechanical ventilation (P = 0.014, rho = 0.282) and inversely to PaO 2 /FiO 2 ratio (P = 0.0021, rho = -0.265). No difference in MIF levels was noted between the groups. The duration of mechanical ventilation was higher (P = 0.005) in the group MP (7.92 ± 6.0 hours), compared with the group NS (4.92 ± 3.6 hours). ConclusionCirculating levels of MIF assayed 6 hours post CPB are correlated to postoperative pulmonary performance. Immunosuppressive doses of methylprednisolone did not affect circulating levels of MIF and may be related to prolonged mechanical ventilation. P2Immediate and short-term safety of catheter-based autologous bone marrow-derived mononuclear cell transplantation into myocardium of patients with severe ischemic heart failure Background Bone marrow-derived mononuclear cell (BM-MNC) transplantation into the myocardium has been proposed as a new therapy for ischemic heart failure (HF). Successful cellular therapy for HF using myoblast transplantation has been reported previously but malignant arrhythmias (MA) were an issue. We investigated the safety of BM-MNC transplantation into the myocardium for MA.Methods A prospective study to evaluate the safety of autologous BM-MNC transplantation in patients with severe ischemic HF not amenable to myocardial revascularization was conducted. Bone marrow was harvested from the iliac crest and BM-MNCs were selected by Ficoll gradient. Hibernating myocardium areas were targeted using electromechanical mapping in catheter-based subendocardial injections (MyoStar, Cordis, Miami Lakes, FL, USA). All patien...

Objectives: In the treatment of acute myocardial infarction (MI), the time delay to achieve reperfusion of the infarction-related artery has been linked to survival rates. Primary or direct angioplasty has been found to be an excellent means of achieving reperfusion in acute ST-elevation MI compared to thrombolytic therapy in randomized trials. However, no mortality benefit of primary angioplasty over thrombolysis was observed in several registries, in which delays in performing primary angioplasty were longer. Our objectives were to evaluate the door-to-balloon time (DBT) in our institution and investigate its relationship with clinical and prognostic variables.

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