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Massive hemorrhage from the sacral basivertebral venous plexus during rectal excision can be fatal, and the use of a sterile thumbtack may be a unique effective maneuver to occlude the bleeding site. The control of hemorrhage has been the endpoint of most of reports in the literature, and to our knowledge, there are no detailed descriptions of the "fate" of the thumbtack after its insertion into the sacrum. A case of displacement of a hemostatic sacral thumbtack with extrusion through the anus is presented, highlighting the potential risks related to use of this "last-resort" method for control of sacral life-threatening hemorrhage.

Abstract. Two cases of patent ductus arteriosus are described in 2 Murrah buffalos, a 7.5-month-old heifer calf and a 5-month-old bull calf. The main clinical signs consisted of exercise intolerance, dyspnea, and tachycardia. At necropsy, lesions were consistent with congestive heart failure as indicated by dependent subcutaneous edema, body cavity effusions, and nutmeg liver. The lungs were extensively atelectatic. The heart was enlarged and had a globous shape. The ductus arteriosus, measuring 0.8 cm in length and 0.4 cm in caliber, was patent. The proximal pulmonary artery had an approximately 50-mmlong aneurysm. Eccentric cardiac hypertrophy was evident primarily in the right but to a lesser degree also in the left ventricle. Additionally, there was diffuse subendocardial fibrosis in the left and right ventricle. To the best of the authors' knowledge, patent ductus arteriosus was not previously described in buffalos. Since both calves were sired by the same bull, it is possible that this cardiac anomaly has a hereditary basis.

Summary:There is a limited experience with catheter ablation for treatment of ventricular tachycardia (VT) in Chagasic cardiomyopathy. A 30-year-old woman experienced episodes of palpitations and syncope due to attacks of VT. A diagnosis of Chagas disease was established on a biological basis. Twodimensional echo and contrast ventriculography showed an apical aneurysm with thrombus. Surgery was indicated to resect the aneurysm and ablate the VT. Ventricular tachycardia recurred 1 month later despite therapy, including amiodarone. Two clinical frequent and well-tolerated tachycardias were identified. The site of origin was located in the right ventricular apex and in the apical-lateral wall of the left ventricle, respectively. Catheter ablation was performed at two sites with DC shocks (total energy 600 J) after unsuccessful radiofrequency ablation. Holter recordings performed during the postoperative period showed only infrequent extrasystoles. After follow-up of 24 months the patient remains asymptomatic. Drug-refractory VT in Chagasic cardiomyopathy can be ablated by medium-energy DC shocks after failure of radiofiequency ablation.

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