Journal articles on the topic 'Trombone – Histoire'

Introducere. Infiltratele pulmonare şi eozinofilia reprezintă un grup heterogen de afecţiuni determinate de factori intrinseci si extrinseci. Factorii extrinseci reprezentaţi de medicaţie sau agenţi infecţioşi declanşează un răspuns eozinofilic imun. Raportăm cazul unui pacient de 53 ani, bărbat, cu infiltrat pulmonar si eozinofilie, secundare infecţiei cu Toxocara canis, care a fost diagnosticat cu tromboză venoasă profundă şi embolie pulmonară la o lună de la diagnosticul infecţiei cu Toxocara canis. Investigaţiile ulterioare au arătat prezenţa statusului procoagulant. Prezentarea cazului. În martie 2015, pacientul, în vârstă de 53 ani, s-a prezentat la consultaţie pentru durere intensă la nivelul toracelui posterior accentuată de inspir profund. Examenul clinic a fost în limite normale, dar tomografia computerizată fără substanţă de contrast efectuată în urgenţă a arătat infiltrat pulmonar la baza plămânului stâng cu reacţie pleurală. Analizele de sânge au indicat leucocite la limita superioară, eozinofilie (21,5%, 2.050/mm3) şi sindrom inflamator. Investigaţiile pentru eozinofilie au arătat reacţie pozitivăpentru Toxocara canis. Se începe tratamentul cu Albendazol 800 mg/zi cu răspuns favorabil. La interval de o lună, pacientul se prezintă pentru durere la nivelul gambei drepte. Testul pentru D-Dimer a fost intens pozitiv, ecografia Doppler venos confirmă diagnosticul de tromboză venoasă profundă, iar tomografia computerizată cu substanţă de contrast a descris embolie pulmonară. Pacientul a început tratamentul anticoagulant. A efectuat analizele de trombofilie care au fost pozitive pentru MTHFR A 1298C homozigot şi gena PAI1 675. Discuţii. Infecţiile cu helminţi se asociază cu eozinofilie. Helminţii care migrează spre viscere, cum este şi cazul Toxocarei canis, produc răspuns eozinofilic înalt. Întrebarea la care am încercat să răspundem a fost dacă eozinofilia a fost responsabilă pentru tromboze sau a reprezentat doar un factor de risc. Întrucât douăteste genetice pentru trombofilie au fost pozitive (MTHFR A 1298C homozigot şi gena PAI1 675), s-a considerat apariţia trombozei venoase şi a emboliei pulmonare în contextul statusului procoagulant al pacientului. Concluzii. Acest caz clinic subliniază implicarea eozinofiliei ca factor trigger pentru embolia pulmonară şi tromboza venoasă profundă.

The trombone is a popular, versatile, and unique member of the brass family of musical instruments. Yet the musculoskeletal health concerns of trombonists are grossly understudied. The purpose of this study was to develop and apply a novel online research strategy for assessing musical and non-musical demographics along with prevalence, frequency, intensity, quality, timing, and location of site-specific trombone-related pain. Of the 316 trombonist respondents to this open survey, 76.6% (n=242) experienced trombone-related pain in one or more sites over the past year. Lip was the site with the highest prevalence rate for pain (23%). Selected pain sites were outlined in three primary clusters of musculoskeletal sites: 1) the lips and jaw region, 2) left upper extremity, and 3) back region. Over 35% (n=114) reported that trombone-related pain prevented playing their instrument. Site-specific characteristics of pain suggest that future epidemiologic studies seek to better understand location-specific intensity, frequency, quality, and timing of pain. Such details will assist educators, performers, and clinicians understand, prevent, and treat musculoskeletal problems associated with learning and performing musical instruments.

Performing arts health care practitioners need to be familiar with the ergonomic features of various musical instruments, many of which put the performer at increased risk for injury. An informed practitioner can advise regarding improving the fit between the musician and the musical instrument, in order to reduce stresses due to compression of the instrument against the body or to supporting the weight of the instrument. These modifications may alter the instrument itself and/or provide external devices, such as splints, straps, or stands that disperse and minimize stress on the performer. Various thermoplastic orthoses have been designed to reduce static loading on small body parts such as the right thumb in clarinetists and flutists. The purpose of the paper is to discuss the nature of instrumental modifications and present two case studies using a simple moldable splint as well as adaptations to the trombone itself.

Die Quellenlage zu Schütz' Weihnachts-Historie ist komplizierter als bisher angenommen. Die einzige noch erhaltene Quelle mit dem Gesamttext befindet sich in Uppsala. Sie wurde bis jetzt als Frühfassung, SWV 435a, bezeichnet. Nach näherer Untersuchung stellt sich das Manuskript als ein Kompositum verschiedener Fassungen heraus, das sich sowohl aus Teilen der frühesten Version als auch aus der uns heute bekannten letzten Fassung der zehn Konzerte zusammensetzt. Die arbeit bemüht sich, die verschiedenen chronologischen Schichten herauszuarbeiten. Aufgrund von Schreiber- und Papieridentifizierung wird die Überlieferung der Quelle auf Dresden zurückgeführt. Die Korruption zweier Trombone-Stimmen kann an Hand der Quellenuntersuchungen bestätigt werden. Es wird die Hypothese aufgestellt, dass die der Komposition hinzugefügten Stimmen möglicherweise von einer Aufführung stammen, die mit Pohle, und demnach mit einer Aufführung in Halle in Zusammenhang gebracht werden können. Das Manuskript der Universitätsbibliothek Uppsala wirft verschiedene Fragen der Besetzung auf, die im Zusammenhang mit einer Rekonstruktion der Spätfassung diskutiert werden. Eine Neuausgabe der Weihnachts-Historie, die sich um einen korrekten Notentext bemüht und Fragen der Chronologie, Überlieferung und Besetzung einbezieht, wird durch die Verfasserin vorbereitet. (Vorlage)

This study examined the medical problems of musicians who primarily perform on a brass instrument. Data for this study (n = 739) were extracted from the University of North Texas Musician Health Survey data set. Subjects were included if they indicated either trumpet, trombone, French horn, or low brass as their primary instrument. Prevalence rates for one or more musculoskeletal problems were determined for the whole group and by instrument. For those subjects who reported problems at specific sites, average severity levels were derived from responses to a five-point grading scale. Additional prevalence rates for non-musculoskeletal problems were established for the whole group and by instrument. About 60% of the brass musicians reported having one or more musculoskeletal problems. The trombone group reported the highest rate (70%), followed by French horn and low brass (62%), and then trumpet (53%). Results suggest unique physical performance requirements and risks across the four main brass instrument groups and that future studies should examine each brass instrument group individually.

AIMS: Though ergonomic supports are widely used for many groups of instruments, they are rare for brass instruments, despite the instruments’ considerable weight. Musculoskeletal injury and postural problems are common among this group, and so, both adult and young players are likely to benefit from supports that reduce the load placed on the body. This study assessed the effects on postural muscle activity of a recently developed range of supports (Ergobrass) that use a rod to transfer the weight of the instrument to a harness or to the chair or floor. METHODS: Twenty conservatoire students (mean age [SD], 20.9 ± 0.5 yrs) of the trumpet, french horn, or trombone used the supports while playing short brass studies, either sitting or standing. Surface electromyography recordings were made from key postural muscles, and their activity levels were compared with and without the support. RESULTS: Statistically significant reductions (typically 15–30%) were present in many of the muscles when using the supports, though in some players they were much larger. The number of muscles affected was least with the lightest instruments (the trumpet), with the effects mainly in the left deltoid and trapezius muscles. Reductions for the horn were bilateral, principally in biceps, pectoralis major, and deltoid; while in the trombone, they were confined to the left side (pectoralis major, posterior deltoid, and trapezius), as the right arm is in constant use to move the slide. CONCLUSIONS: The supports are effective in reducing postural muscle activity and may be of particular benefit to injured or young players.

Brass instrument players are exposed to unique health risks due to increased pharyngeal pressures necessary for performance. One such risk is development of laryngoceles, or “blowout” of the larynx. This cross-sectional observational study was performed to determine the pressure required to play different frequencies in a variety of brass instruments. The hypothesis tested was that enharmonic frequencies require the same pharyngeal pressure regardless of the instrument. The brass instruments tested were high-pressure, low-flow instruments (trumpet or French horn) or low-pressure, high-flow instruments (tuba or trombone). We were not able to substantiate Jacobs’ theory that enharmonic frequencies resulted in equal pressures regardless of instrument, but we did elicit some high pressures in the hypopharynx when playing the trumpet or horn at higher frequencies.

Aims: Marching band camp injuries were recorded over the course of 1 week (10 field practices) to determine injury rate for preseason. Methods: Members were instructed to self-report any type of injury that occurred. The collected data were coded and analyzed for total injuries and injuries per section. The injury counts, along with total practices and band members per section, were used to calculate injury rate per 1,000 exposures for total injury and injury per section. Results: There were a total of 191 injuries reported in 1,540 practice exposures. The overall injury rate was 124.03/1,000 exposures. The instrument with the highest injury rate was the mellophone (220.0/1,000 exposures), followed by the trombone (190.0/1,000 exposures), and percussion (184.62/ 1,000 exposures). The instrument with the lowest injury rate was the clarinet (43.75/1,000 exposures). Conclusion: The findings demonstrate that marching band is a strenuous activity and deserves to be considered an area of emerging practice for athletic trainers and other health care professionals.

La historia de las terapias hormonales de la menopausia (THM) comienza durante la década de los cuarenta del siglo pasado al reconocerse los beneficios de los estrógenos sobre el síndrome climatérico. Desde entonces las THM han sufrido permanentes altibajos alternando períodos de gran euforia con períodos de profunda depresión. Al cabo de más de treinta años de prescripción de estrógenos no opuestos se demostró un significativo mayor riesgo de cáncer e hiperplasias endometrial. ¡La estrógenoterapia fue proscrita! A poco andar se demostró que el agregado de progestinas ofrecía efectiva protección, evitando los riesgos de hiperplasia y cáncer endometrial. Hacia fines del siglo xx el empleo de THM alcanza su cúspide, al atribuírsele beneficios adicionales sobre el aparato cardiovascular, la memoria y procesos cognitivos, la piel y fanerios y la calidad de vida. Los resultados del estudio WHI, publicados el año 2002 echaron todo por tierra, al señalar un incremento significativo de los riesgos de enfermedad coronaria, accidente cerebro vascular, trombo embolismo venoso y cáncer de mama. Como consecuencia, la THM totalmente execrada. Sin embargo, el reanálisis de los datos demostró, en mujeres menores de 60 años, efectos favorables de la THM sobre el riesgo enfermedad coronaria. Estudios más recientes señalan que estrógenos administrados por vía transdérmica asociados a progestinas no MPA no aumentan los riesgos de accidente cerebro vascular, tromboembolismo venoso y cáncer de mama; y, tienen un fuerte impacto sobre la calidad de vida de las usuarias. Nuevamente las THM estarían encontrando un adecuado cauce.

La obra “Cybeline”, del compositor Norteamericano William Osborne y la trombonista Abbie Conant, nace como reacción a la experiencia discriminatoria sufrida durante trece años por A. Conant en la Orquesta Filarmónica de Munich, en los cuales y debido a su condición de mujer se le negó ocupar el puesto de trombón solista, a pesar de haber merecido dicho puesto tras unas oposiciones. “Cybeline” es una pieza que utiliza la hibridación artística mediante la mezcla de música electroacústica, el teatro musical y la ópera, todo ello unido a las nuevas tecnologías audiovisuales. Su historia nos narra la vida de una mujer que tras ser violada y descuartizada por un psicópata es convertida en cyborg por los médicos y científicos, negándosele todos sus sentimientos y recuerdos. Sin embargo, “Cybeline” intentará demostrarnos que es humana y darnos la visión femenina de un mundo actual dominado por las nuevas tecnologías.

La presencia de un trombo a nivel de una vena superficial y la respuesta inflamatoria que le acompaña, desencadenan el cuadro clínico de la tromboflebitis superficial. Esta patología en un inicio se consideraba un trastorno local, de rápida resolución y curso benévolo, con el mejor conocimiento de la historia natural de la enfermedad, se ha comprobado la alta probabilidad de desarrollar complicaciones tromboembólicas que comprometen la vida. Los hallazgos en la evaluación del paciente crean la sospecha clínica inicial, sin embargo, para la confirmación diagnóstica se requiere del uso del ultrasonido dúplex para determinar la presencia de un coágulo en la circulación superficial, la extensión y la cercanía de este al sistema venoso profundo. El riesgo potencial de desarrollar un tromboembolismo venoso ha llevado a un cambio en el tratamiento, el cual más allá de tratar las molestias del paciente, se encuentra orientado en evitar dichas complicaciones

In a series of 81 brass instrumentalists personally evaluated over the past 16 years, 43 had problems with embouchure. The 31 men and 12 women ranged in age from 16 to 74 years, averaging 35. Twenty-seven were professional performers at the onset of the embouchure problem and 12 others were students, all but one in college or graduate-level music programs. There were 17 who played the French horn, 15 trombone, ten trumpet, and one tuba. Symptom duration varied from as little as one day to as long as 14 years. A diagnosis of dystonia involving the muscles of embouchure was made in 18 cases. Symptoms in this group primarily consisted of impairment in lip control, problems of articulation or tone quality, and loss of seal. Eleven patients were diagnosed as having overuse phenomena and an additional six had evidence of soft-tissue injury. These patients reported predominance of pain, swelling, or discoloration. Four patients had a sensory or motor disturbance of a lip segment, implying focal nerve injury. Treatment generally consisted of a period of rest followed by lip rehabilitation, including buzzing and gradual return to playing. Change in technique was often required to prevent recurrence. In patients with dystonia, technical retraining appeared to be the preferred treatment method but remained unsatisfactory in most cases.

Introducere. Tromboza venoasă cerebrală (TVC) este o afecţiune cerebrovasculară rară cu multiple etiologii. Diagnosticul de TVC este în general obişnuit trecut cu vederea sau întârziat din cauza simptomatologiei extrem de variate, modalităţilor de debut şi semnelor neuroimagistice; mai mult, în peste 15% din cazuri, nu poate fi decelată o cauză, rezultatul individual poate fi greu de prezis, iar boala se poate complica în pofida tratamentului anticoagulant. Material şi metode. Prezentăm un caz tipic de meningită care în ziua 10 de boală asociază o simptomatologie nu foarte tipică ce pledează spre TVC. Rezultate. Examenele imagistice nu pot nici infirma, nici confirma prezenţa trombului. Un caz a cărui evoluţie se agravează progresiv şi pentru care nu există susţinerea imagistică de a aborda o anumită conduită terapeutică îngreunează decizia terapeutică a medicului. Discuţii. Problematica ridicată se concentrează pe ipoteza conform căreia dacă medicaţia anticoagulantăpoate aduce un beneficiu pacientului sau, dimpotrivă, un prejudiciu medicului curant aflat în improbabilitate diagnostică, printr-o evoluţie ulterioară nefavorabilă a stării clinice a pacientului. Concluzii. Raţionamentul creierului uman format în ani de experienţă nu poate fi încă tehnologizat, cu atât mai puţin înlocuit de vreun robot, iar existenţa unor seturi de reguli de tratament, care nu pot acoperi niciodată varietatea de particularităţi ce se poate întâlni în practică, trebuie pusă întotdeauna la îndoială.

<em>Tromba marina</em>, instrument wywodzący się z monochordu, znany od czasów średniowiecza, podobnie jak wiele innych, nie znalazł swojego trwałego miejsca w muzyce profesjonalnej. W niniejszym artykule zwraca się uwagę na pewien „epizod”, który stał się udziałem tego specyficznego chordofonu, a któremu z literaturze muzykologicznej nie poświęcono dostatecznej uwagi.<p>Instrument ten miał swoje pięć minut w muzyce francuskiej około połowy XVII wieku. W 1660 Lully wykorzystał <em>trombae marinae</em> w w ustepach baletowych opery Cavallego <em>Xerxes</em>, wystawionej z okazji ślubu Ludwika XIV z Marią Teresą Habsburg, zaś w 1661 roku na dworze Króla Słońce powołano zespół składający się pięciu z muzyków grających na krumhornach i <em>trombae marinae</em>. Dlatego prawdopodobnie Molierowski Monsieur Jourdain na kartach „Mieszczanina szlachcicem” wyraził pragnienie dołączenia interesującego nas instrumentu do zespołu grającego na organizowanym w jego domu przyjęciu.</p><p>Jedynym znanym z nazwiska wirtuozem tego instrumentu był Jean Baptiste Prin (ok. 1699-1742), który sporządził zachowany do dzisiaj zbiór 216 utworów na <em>tromba marina</em> oraz napisał w roku swojej śmierci traktat <em>Memoire sur la trompette marine, </em>w którym wyraził żal, że ukochany instrument „umiera” wraz z nim.</p><p>Spośród wielu różnych nazw, jakie nadawano temu kuriozalnemu instrumentowi (<em>tuba marina</em>, <em>tuba maritima</em>, <em>Trumscheit</em>, <em>Marientrompette)</em>, najpóźniejsze historycznie, bo pochodzące dopiero z XIX wieku, są nazwy wskazujące na używanie go przez zakonnice. Są to trzy określenia w języku niemieckim bazujące na złożeniach Nonne- (zakonnica) z dodaną nazwą instrumentu lub określeniem jego funkcji w zespole: Nonnengeige, Nonnentrompette, Nonnenbas. Ich istnienie dowodziłoby, iż na niemieckim obszarze językowym jeszcze w tym stuleciu zakonnice posługiwały się w swojej praktyce muzycznej interesującym nas instrumentem.</p><p>Cecil Adkins i Alis Dickonson, autorzy monografii poświęconej historii, budowie i zachowanym egzemplarzom <em>tromba marina</em>, a także związanej z tym instrumentem praktyce wykonawczej i repertuarowi, wskazali 29 ośrodków zakonnych (w tym 26 klasztorów żeńskich), w których kultywowano grę na <em>Nonnengeige</em>, konstatując iż była to specjalność zakonnic (w mniejszym stopniu zakonników) z Europy Środkowej. Do wymienionych przez tych autorów ośrodków, dzięki najnowszym badaniom jesteśmy w stanie obecnie dodać kolejne: klasztor augustianek św. Jakuba auf der Hülben w Wiedniu oraz serwitek w Insbruku oraz trzy kolejne klasztory w niemieckojęzycznej części Szwajcarii. Co więcej, możemy także poszerzyć geograficzny obszar występowania w klasztorach praktyki gry na <em>tromba marina</em> w kierunku północno wschodnim. Mamy bowiem dowody kultywowania jej w klasztorach benedyktynek z Sandomierza i Lwowa oraz klarysek ze Starego Sącza, a także w bursie jezuickiej w Krakowie. Dodatkowo można przypuszczać, iż instrumenty takie posiadał także klasztor cystersów w Obrze.</p><p>W klasztornej praktyce muzycznej instrument mógł pełnić cztery różne funkcje: być wykorzystywany w praktyce śpiewu chorałowego, co jest najsłabiej udokumentowane, służyć jako instrument fundamentalny realizujący wraz z <em>organami basso continuo</em> lub jako substytut trąbek w obsadach wokalno-instrumentalnych, ponadto zespół złożony w trzech lub czterech <em>trombae marinae</em> z towarzyszeniem kotłów mógł wykonywać fanfary.</p><p>Jeśli chodzi o obszar dawnej Rzeczypospolitej, najwięcej informacji na temat kultywowania gry na <em>tromba marina</em> pochodzi z Sandomierza, gdzie grające na tym instrumencie zakonnice są nam znane z nazwiska i gdzie zachowały się rękopisy poświadczające tę zapomnianą praktykę.</p><p> </p>SUMMARY<p><em>Tromba marina</em>(trumpet marine) – the instrument originated from the monochord and known from the Middle Ages – was not widely used in professional music. That special chordophone had, however, its day in French music about the mid-seventeenth century. In 1660 Jean Baptiste Lully used trombae marinae in ballet sections of Francesco Cavalli’s opera Xerxes, and in 1661, at the court of Louis XIV a group of fi ve musicians was formed, who played crumhorns and trombae marinae. The only virtuoso of this instrument, known by name, was Jean Baptiste Prin (ca. 1699-1742), who made a collection of 216 pieces for trumpet marine (tromba marina).</p><p>Out of the many names of the instrument (tuba marina, tuba maritima, Trumscheit, Marientrompette), the historically latest names are the nineteenth-century ones showing that it was used by nuns. There are three names in German, based on the compounds Nonne (nun) with the name of the instrument or with designation of its function in a musical group: Nonnengeige, Nonnentrompette, and Nonnenbas, which would prove that nuns still played the trombae marinae in the German-speaking area as late as in the nineteenth century.</p><p>Cecil Adkins and Alis Dickinson, the authors of the monograph devoted to tromba marina, listed 29 monastic centers (of which 26 were nuns’ convents), in which the playing of Nonnengeige was cultivated, and come to the conclusion that in the eighteenth century this was the specialty of Central European nuns. We can add some more names to those recorded by the two authors: the St. Jakob Augustinian nunnery in Vienna, the Servite Nunnery in Innsbruck, and three convents in the German-speaking part of Switzerland. Furthermore, we can also broaden the geographical range of the practice of playing tromba marina towards North-East because we have evidence that it was cultivated in the convents of Benedictine nuns of Sandomierz and Lvov, the convent of St. Clare in Stary Sącz, as well as in the Jesuit chapel in Krakow.</p><p>The instrument in question exercised different functions in the performing practice in monasteries: it was used in the practice of chorale singing, it served as a fundamental instrument in the basso continuo section, it appeared as a substitute for trumpets in the vocal-instrumental forces, fi nally – as part of a group consisting of three or four trombae marinae and kettledrums, it played fanfares.</p>

Introducción: La parasitosis intestinal por Geohelmintiasis es una de las Enfermedades Infecciosas Desatendidas (OMS), que afecta a poblaciones vulnerables. Existen factores predisponentes como: condiciones precarias de vivienda, bajos ingresos económicos y nivel educativo deficiente. De los helmintos, el Ascaris lumbricoides es el más grande nematodo intestinal en humanos -alcanza hasta 40 centímetros-. La presentación clínica depende del grado de infestación variando desde anemia, astenia, pérdida de peso, hasta invasión interna de órganos blancos como hígado, pulmones, cerebro y corazón en casos extremos. Caso Clínico: Niña de 16 meses de edad, con historia de fiebre prolongada y expulsión espontánea de parásitos por orificio naturales, que llega al servicio de urgencias con síntomas de shock cardiorrespiratorio. Se realiza Ecocardiográfía visualizándose imágenes de cuerpos extraños en forma de cintas y con movimientos espontáneos, compatibles con parásitos de localización cardíaca (2 en aurícula y ventrículo derecho y 1 cabalgando las arterias pulmonares); en el seguimiento ecocardiográfico se constatan múltiples trombos a lo largo del parásito localizado en aurícula derecha y, que dada la gravedad del cuadro se determinó su extracción quirúrgica de urgencia. Se extrajeron 4 parásitos adultos,y, coágulos adherido a uno de ellos. Discusión: El estudio parasitológico y anatomopatológico concluyó que correspondían a hembras adultas de Ascaris lumbricoides. Alta al 8° día post-operatorio en buenas condiciones. Aunque este caso fue exitoso, las complicaciones cardiacas e infecciones sistémicas graves, son de alta morbi-mortalidad, que pueden evitarse con programas de desparasitación y reducción de carga parasitaria mediante mejoras en el saneamiento ambiental y educación sanitaria. A nuestro conocimiento este es el primer caso reportado en el mundo, de extracción de Ascaris Lumbricoides formas adultas del Corazón humano. Correspondencia: Garay Nancy Correo: nancygareche@hotmail.com Conflicto de interés: Los autores declaran no poseer conflicto de interés Recibido: 28/12/2018 Aceptado: 20/06/2019

Streptococcus gallolyticus, membru al grupului Streptococcus bovis (strepococ de grup D) colonizează tubul digestiv al păsărilor, animalelor rumegătoare şi om (2,5-15%). Este descrisă în literatură asocierea bacteriemiei cu Streptococcus gallolyticus cu tumori colonice şi manifestări extracolonice (endocardită bacteriană, osteomielită vertebrală, discită, colangite, tumori pulmonare, ovariene). Raportăm cazul unui pacient în vârstă de 60 ani, sex masculin, caucazian, la care infecţia cu Streptococcus Gallolyticus identificată prin hemocultură a avut ca primă manifestare osteomielită vertebrală. S-au identificat leziuni la nivelul valvei aortice (endocardită bacteriană), arterei politee dreapta (tromboză diagnosticată prin ecografie Doppler artere, angio CT membre pelvine), genunchi drept (artrită). Deşi evoluţia a fost favorabilă din punct de vedere clinic (afebrilitate, ameliorarea durerii lombare) şi biologic (scăderea leucocitozei, a sindromului inflamator, hemoculturile ulterioare au fost negative) repetarea investigaţiilor imagistice la 30 zile şi la 45 zile au arătat insuficienţă aortică severă ce a necesitat intervenţie chirurgicală pentru înlocuire de valvă aortică efectuată la 2 luni de la diagnostic. Leziunile de la nivelul coloanei vetebrale, arterei poplitee s-au ameliorat după 2 luni de tratament antibiotic. Colonoscopia efectuată la 6 săptămîni de la diagnostic a arătat prezenţa polipilor colonici – posibilă poartă de intrare pentru Streptococcus gallolyticus. Cazul prezentat demonstrează debutul silenţios al infecţiei cu Streptococcus gallolyticus, evoluţia ulterioarăseveră din cauza multiplelor determinări septice şi atrage atenţia asupra necesităţii efectuării explorărilor digestive (endoscopie digestivă superioară, colonoscopie) la pacienţii diagnosticaţi cu acest tip de infecţie.

RESUMO Introdução - A miocardiopatia não compactada (MNC) é uma patologia de ocorrência familiar com histórico relevante de morte súbita e insuficiência cardíaca; é considerada como uma miocardiopatia não classificada pela Organização Mundial da Saúde (OMS). Segundo a Associação Americana de Cardiologia, é uma cardiomiopatia primária. Desenvolvimento - A MNC resulta de uma alteração genética que leva a uma parada do processo de compactação miocárdica, caracterizada pela persistência de trabeculações e recessos profundos que se comunicam com a cavidade ventricular. A apresentação clínica inicial varia de assintomático a apresentação de sintomas relacionados à dor torácica, insuficiência cardíaca e arritmias. Os principais métodos de diagnóstico para MNC são estudos ecocardiográficos e ressonância magnética cardíaca, tendo como principais diagnósticos diferenciais a forma apical de cardiomiopatia hipertrófica, a combinação de cardiomiopatia hipertrófica apical e MNC, cardiomiopatia hipertensiva, fibroelastose endocárdica, trombo apical ou tumores entre outros. Considerações finais - A terapêutica disponível inclui tratamento para insuficiência cardíaca, arritmias e eventos tromboembólicos, mas é necessário particularizar a terapêutica relacionada à anticoagulação e prevenção primária de morte súbita cardíaca. Palavras-chave: Cardiomiopatias; insuficiência cardíaca; arritmias cardíacas. ABSTRACT The left ventricular noncompaction (LVNC) is a patology with a familiar occurrence and relevant historic of sudden death and heart failure; it's considered an unclassified cardiomyopathy by World Health Organization (WHO). According to American Heart Association (AHA), it's a primary cardiomyopathy. Development - The LVNC results in a genetic alteration which leads to stop miocardial compaction process, characterized by persistence of trabeculation and deep intertrabecular recesses communicating with the ventricular cavity. The initial clinical findings may vary from asymptomatic to chest pain, heart failure and arrhythmias. The main diagnosis methods for LVNC are echocardiography and cardiac magnetic resonance imaging, having as main differential diagnosis the apical form of hypertrophic cardiomyopathy, a combination of both apical hypertrophic cardiomyopathy and LVNC, hypertensive cardiomyopathy, endocardial fibroelastosis, apical thrombus, or tumours among others. Final considerations - The menagement available includes the treatment for heart failure, arrhythmias and thromboembolic events, but it's neceassary particularize the therapeutics related to anticoagulation and primary prevention of sudden death. Keywords: Cardiomyopathies; heart failure; cardiac arrhythmias.

Nonostante i recenti progressi in tema di wound care, le ulcere varicose degli arti inferiori restano un problema frequente, con un alto tasso di recidiva. In questo lavoro abbiamo esaminato la storia clinica, la storia chirurgica e le patologie associate di 133 pazienti affetti da ulcera varicosa degli arti inferiori, di cui 56 da ulcera recidiva o plurirecidiva. L’analisi dei fattori di rischio potenziale per recidiva ha evidenziato come la presenza di varici recidive, una pregressa trombosi venosa profonda, problemi ortopedici, interventi ortopedici, l’obesità e un’età inferiore a 60 anni siano fattori di rischio potenziale per una recidiva dell’ulcera. La combinazione di uno più fattori di rischio assume significatività per la possibilità di una recidiva; si passa dal 22,7% in assenza di fattori di rischio al 33% per i pazienti che ne presentano due, fino al 57,5% in presenza di tre fattori di rischio e all’81,3% per quattro o più. L’ulcera varicosa richiede un follow-up stretto del paziente e una terapia elastocompressiva continua, che deve vedere una stretta collaborazione del paziente e un’attenzione specifica ai fattori di rischio. Despite recent advances in wound care, varicose ulcers of lower limbs remain frequent and display a high rate of recurrence. In this paper, we examined the clinical, surgical histories and associated diseases of 133 patients with venous ulcers of the lower limbs, which were recurrent in 56 cases. The analysis of potential risk factors for recurrence showed that the presence of recurrent varicose veins, a previous deep venous thrombosis, orthopedic problems, previous orthopedic procedures, obesity and age lower than 60 are potential risk factors for ulcer recurrence. Furthermore, the association of one or more risk factors increased the likelihood of relapse, from 22.7% with no risk factors to 33% with 2 risk factors, up to 57.5% with 3 risk factors, and up to 81.3% with 4 risk factors or more. Venous ulcers require close follow-up and continuous elastic compression, close collaboration by the patient and specific focus on risk factors.