10,981 research outputs found
Imsejhin ghall-qadi tal-komunita` Nisranija permezz tal-ministeru sacerdotali
No full textThe article focuses upon the call to service through the exercise of the priestly ministry. The point of departure of the study is the Johannine pericope which describes the washing of the disciples' feet by Jesus (Jn 13:1-20). The article describes how the celebration of the liturgy is a fount of vocations to the ordained ministry. The author then studies three documents of the Second Vatican Council -- Optatam Totius, Presbyterorum Ordinis and Christus Dominus -- in order to depict the centrality of service to priestly ministry. A number of evocative texts are referred to, as well as formation documents from the local Church of Malta. Furthermore, the respective contributions of Bishop Tonino Bello, Pope Benedict XVI and Pope Francis are also given pride of place, as more light is thrown on the theme of the article.peer-reviewe
Successful surgical management of ventricular fibromas in children
No full textObjectivesA uniform management strategy has not been established for the treatment of large ventricular fibromas identified in children. The goal of the present study was to review our experience with surgical resection of this uncommon tumor.MethodsWe performed a retrospective review of all patients with a diagnosis of ventricular fibromas who had undergone surgical intervention at our institution from July 1990 to June 2013. The clinical records and pathology reports were reviewed and available follow-up data obtained.ResultsA total of 20 patients had a ventricular fibroma. The median age at presentation was 4 years (range, 5 months to 12 years). Of these, 18 (89%) presented with ventricular tachycardia (n = 15) or frequent ectopy (n = 3), and 1 (6%) with outflow tract obstruction; 1 (6%) was asymptomatic and diagnosed during routine evaluation for a murmur. One patient had undergone previous ablation, and one had had an automated internal cardiac defibrillator implanted for ventricular tachycardia control. Before tumor resection at our institution, 1 patient had been listed for transplantation at an outside institution and 1 had undergone previous extracardiac Fontan without tumor resection. All patients underwent successful tumor excision with no recurrence of ventricular arrhythmia during a median follow-up period of 3.3 years (range, 1 month to 14.7 years). One patient underwent planned staged tumor resection. No patient died.ConclusionsPrimary ventricular fibromas, even when very large, can be managed by surgical resection, with excellent short- and intermediate-term ventricular function and relief of arrhythmic events
Accelerated whole-heart MR angiography using a variable-density poisson-disc undersampling pattern and compressed sensing reconstruction
No full textTo accelerate whole-heart three-dimension MR angiography (MRA) by using a variable-density Poisson-disc undersampling pattern and a compressed sensing (CS) reconstruction algorithm, and compare the results with sensitivity encoding (SENSE)
Myocardial histopathology in late-repaired and unrepaired adults with tetralogy of Fallot
No full textRepaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support
No full textAbstract Surgical management of tetralogy of Fallot (TOF) results in anatomic and functional abnormalities in the majority of patients. Although right ventricular volume load due to severe pulmonary regurgitation can be tolerated for many years, there is now evidence that the compensatory mechanisms of the right ventricular myocardium ultimately fail and that if the volume load is not eliminated or reduced by pulmonary valve replacement the dysfunction might be irreversible. Cardiovascular magnetic resonance (CMR) has evolved during the last 2 decades as the reference standard imaging modality to assess the anatomic and functional sequelae in patients with repaired TOF. This article reviews the pathophysiology of chronic right ventricular volume load after TOF repair and the risks and benefits of pulmonary valve replacement. The CMR techniques used to comprehensively evaluate the patient with repaired TOF are reviewed and the role of CMR in supporting clinical decisions regarding pulmonary valve replacement is discussed.</p
Grajjiet is-Santwarju tal-Madonna tal-Grazzji
No full textContents: Xewqa mitmuma - Mit-tempji pagani ghas-Santwarju tal-lum - Santwarju li jfakkar fil-grajja tal-ordni u ta' missirijietna - Strangieri devoti tal-Madonna - Mir-registru tal-offertiThe Sanctuary of Our Lady of Divine Grace is without doubt the most prominent building in Zabbar. The author gives a detailed description of the history of the Zabbar Sanctuary and illustrates important facts on the history of Zabbar.
Is-Santwarju tal-Madonna tal Grazzji huwa bla dubju l-aktar bini prominenti fiż-Żabbar. L-awtur jagħti deskrizzjoni dettaljata tal-istorja tas-Santwarju u jaghti fatti importanti dwar l-istorja ta’ Zabbar.
Contents: Xewqa mitmuma - Mit-tempji pagani ghas-Santwarju tal-lum - Santwarju li jfakkar fil-grajja tal-ordni u ta' missirijietna - Strangieri devoti tal-Madonna - Mir-registru tal-offertipeer-reviewe
Disfunção vascular nos doentes com coarctação da aorta tratada
No full textRESUMO: As cardiopatias congénitas (CC) afetam aproximadamente 1% dos recémnascidos
e são responsáveis pela maior proporção de mortalidade infantil nos países
desenvolvidos. A coarctação da aorta (CoA), a 6ª CC mais frequente, consiste numa estenose
da aorta descendente proximal. Se não for tratada, tem uma história natural desfavorável.
A cirurgia, dilatação com balão e a implantação de stent são atualmente técnicas que
podem atingir o objetivo de uma remoção eficaz e duradoura da estenose ístmica, sendo
a decisão baseada na idade doente, anatomia da CoA e preferência do operador ou da
instituição. Contudo, um bom resultado anatómico não evita morbilidade e mortalidade
de longo prazo, apresentando cerca de metade dos doentes hipertensão arterial
(HTA), e registando-se mortalidade precoce, maioritariamente devido a complicações
cardiovasculares e acidentes vasculares cerebrais. O perfil tensional anómalo sugere que
os resultados subótimos possam ser secundários a disfunção vascular, cuja existência
foi bem documentada em doentes com CoA tratada. Existem anomalias intrínsecas da
estrutura arterial e função, alterações da sensibilidade neuro-hormonal ou da regulação
endócrina, e fatores adquiridos, como a idade do tratamento, que contribuem para esta
disfunção vascular. Os maus resultados a longo prazo podem resultar igualmente do tipo
de tratamento efetuado, que provavelmente impactam de modo diverso a rigidez do istmo
aórtico e potencialmente comprometem as funções da aorta. Este efeito da modalidade
terapêutica não foi até ao momento estudado. A CoA não é uma simples doença mecânica
que fica resolvida quando é removido o obstáculo.
Objetivos e Hipóteses: O objetivo deste estudo é comparar a função vascular entre diferentes
modalidades terapêuticas de CoA. A hipótese principal é a de que os doentes submetidos
a dilatação com balão têm melhor função vascular que os doentes submetidos a cirurgia
ou implantação de stent, pois aquela modalidade terapêutica tem menor potencial para
danificar a integridade e propriedades biomecânicas da parede da aorta do que estas.
Métodos: Avaliação prospetiva da função vascular usando múltiplas modalidades não
invasivas, de modo a comparar os resultados de três grupos de doentes com CoA, tratados
com dilatação com cirurgia, balão ou implantação de stent, após controle das variáveis de
confusão. Em doentes com CoA tratada com sucesso, comparámos prospectivamente a
rigidez da aorta com tonometria de aplanação e ressonância magnética cardíaca; função
endotelial com tonometria arterial periférica endotelial; analise da onda de pulso com
tonometria de aplanação e tonometria arterial periférica endotelial; massa ventricular
esquerda e anatomia do arco aórtico com ressonância magnética cardíaca; marcadores séricos de função endotelial, inflamação, função da parede arterial e matriz extracelular; e
saúde cardiovascular ideal. A análises estatística incluiu ajuste para as variáveis de confusão.
Resultados: O estudo foi realizado em sete grandes centros, de Portugal e Estados Unidos da
América. Foram incluídos 75 doentes, tratado por cirurgia (n=28), dilatação com balão (n=23)
e implantação de stent (n=24). Os grupos tiveram idade semelhante à data de inclusão,
gravidade da CoA, gradiente residual e perfil metabólico, mas eram diferentes quanto à
idade à data do tratamento. A HTA, rigidez da aorta, função endotelial e massa ventricular
eram semelhantes entre os grupos. Contudo, o grupo da dilatação com balão tinha mais
distensibilidade regional da aorta ascendente, menor tensão arterial (TA) sistólica durante
o exercício, menos alteração da variação noturna da TA, e dose menor de biomarcadores
inflamatórios. Os resultados permaneceram inalterados após ajuste das potenciais variáveis
de confusão, incluindo idade à data do tratamento.
Conclusões: A modalidade terapêutica não estava associada à presença de HTA, rigidez
arterial global e função endotelial. Contudo, os doentes com dilatação com balão tinham um
perfil de função vascular mais favorável, caracterizado por maior distensibilidade da aorta
ascendente, TA noturna mais baixa, menor resposta hipertensiva no esforço e menores
marcadores séricos de inflamação. São necessários mais estudos para confirmar se os nossos
resultados poderão contribuir para o refinamento do paradigma de tratamento da CoA, ao
adicionar ao objetivo de remoção da estenose, a preservação da função vascular, quando
dois ou mais tratamentos são aplicáveis.ABSTRACT: Introduction: Congenital heart disease (CHD) affects approximately 1% of liveborns and
accounts for the largest proportion of infant mortality in developed countries. Coarctation of
the aorta (CoA), the 6th most common CHD, consists of a narrowing of the proximal descending
aorta. If left untreated, it has an unfavorable natural history. Surgery, balloon dilation (BD) or
stent implantation are all current treatments that can achieve a successful long-term removal
of the stenosis, and the choice is based on age, CoA anatomy, and personal or institutional
preference. Coarctation is not a mere mechanical disease that is treated by removing the
increased afterload. In fact, a good anatomic result does not avoid long-term cardiovascular
(CV) morbidity and mortality, with late systemic hypertension (HTN) in approximately half of
the patients, and reduced life expectancy, mostly due to CV complications and stroke. The
abnormal blood pressure (BP) phenotype suggests that the suboptimal results are likely due
to abnormal vascular function, which has been well documented in patients with repaired
CoA. There are inherent changes in the arterial structure and function, impaired neuronal
sensitivity or endocrinal auto-regulation, and acquired features, such as age at treatment,
that contribute to vascular dysfunction in CoA. The poor long-term vascular outcome
may also be impacted by the different types of repair, which likely have differing effects
on the stiffness of the repaired segment and potentially compromise both the conduit and
cushioning functions of the aorta. The effects of treatment modality on long-term vascular
function remain uncharacterized.
Aims and Hypothesis: The goal of this study is to assess vascular function in this patient
population for comparison among the treatment modalities. The central hypothesis of
this study was that patients who have undergone successful BD will have better vascular
function than patients who have undergone successful surgical repair or stenting since
this modality is least likely to damage the integrity and biomechanical properties of the
aortic wall.
Methods: Prospective assessment of vascular function using multiple non-invasive modalities,
and compare the results among the three groups of CoA patients previously treated using
surgery, BD or stent implantation after frequency matching for confounding variables. In
successfully repaired CoA patients, we prospectively compared aortic stiffness by applanation
tonometry and cardiac magnetic resonance (CMR); endothelial function by endothelial pulse
amplitude testing; pulse waveform analysis by applanation tonometry and endothelial pulse
amplitude testing; BP phenotype by office BP, ambulatory BP monitoring, and BP response
to exercise; left ventricular (LV) mass and aortic morphometrics by CMR; blood biomarkers of endothelial function, inflammation, vascular wall function, and extracellular matrix; and
ideal cardiovascular health. In the statistical analysis, we adjusted for potential confounders.
Results: This study was done in seven, large volume centers from Portugal and the United
States of America. Participants included 75 patients treated with surgery (n=28), BD (n=23),
or stent (n=24). Groups had similar age at enrollment, CoA severity, residual gradient, and
metabolic profile but differed by age at treatment. Systemic HTN, aortic stiffness, endothelial
function, and LV mass were similar among groups. However, BD had more distensible
ascending aortas, lower peak systolic BP during exercise, less impairment in diurnal BP
variation, and lower inflammatory biomarkers. The results were unchanged after adjustment
for potential confounders, including age at treatment.
Conclusions: Treatment modality was not associated with major vascular outcomes such
as systemic HTN, global aortic stiffness, and endothelial function. However, BD patients had
a better vascular phenotype profile characterized by higher ascending aorta distensibility,
lower night-time BP, lower peak exercise BP and lower levels of inflammatory markers.
Further studies are required to confirm if our results may contribute to refining the CoA
treatment paradigm by adding to the goals of therapy the preservation of vascular function when two or more treatment techniques are applicable
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