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Pathology of endocarditis

Pathophysiology and causes of endocarditis - Oxford Medicin

Endocarditis is an infection of the heart's valves or its inner lining (endocardium). It is most common in people who have a damaged, diseased, or artificial heart valve, caused by bacterial infection. ETIOLOGY . Endocarditis is caused by bacteria that enter the bloodstream and settle on the inside of the heart, usually on the heart valves Infective endocarditis (IE) is a multisystem disease that results from infection, usually bacterial, of the endocardial surface of the heart. It has been recognized as a pathological entity for hundreds of years and as an infectious process since the 19thcentury1

[Infective endocarditis

Infective endocarditis oftheaorticvalvecharacter- istically occurredon anornal valve in middle-agedmen. In the IOcasesof isolated mitral endocarditis evidence ofprevious abnormality, rheumatic diseaseorendomyocardialfibrosis,wasusuallypresent. Blood cultures in life hadbeenpositive in only3ofthe totalseriesandwererepeatedly negative in8 Infective endocarditis (IE) is an inflammation of the endothelial lining of the heart muscle, valves and great vessels. The valves have a particularly high propensity for infection due to the lack of blood supply and limited access to immune cells DefinitionInfection of the endocardial surface of heart characterized by - Colonization or invasion of the heart valves (native orprosthetic) or the mural endocardium by a microbe, - leading to formation of bulky, friable vegetation composedof thrombotic debris and organisms - often associated with destruction of underlying cardiactissue. 3

Pathology and pathogenesis of infective endocarditis in

Infective endocarditis occurs when a bacterial or fungal pathogen enters the blood and attaches to the inner lining of the heart (the endocardium), usually a heart valve. The organisms that cause the infection can enter blood through the gums or intestines; by health care-related procedures such as intravenous catheter placement, surgery, or hemodialysis; or through the skin because of intravenous drug abuse Cardio-Vascular Disease Dr. Deepak K. Gupta Infective Endocarditis 2. Introduction • It a disease caused by microbial infection - Heart valve (native or prosthetic) - Lining of a cardiac chamber or blood vessel - Congenital anomaly (e.g. septal defect). • Usually a bacterium, but may be a rickettsia, chlamydia or fungu

Histopathology Heart, aortic valve --BacterialDuke Pathology - Cardiovascular Pathology

Infective endocarditis (IE) is an uncommon infection, occurring as a complication in varying percentages of bacteremic episodes. The ability of an organism to cause endocarditis is the result of an interplay between the predisposing structural abnormalities of the cardiac valve for bacterial adherence, the adhesion of circulating bacteria to the valvular surface, and the ability of the. From Libre Pathology. Jump to navigation Jump to search. Infective endocarditis, abbreviated IE, is an uncommon disease of the heart lining/ heart valves . Bacterial endocarditis and subacute bacterial endocarditis (abbreviated SBE) redirect here Pathophysiology Of Endocarditis Pathophysiology Of Endocarditis. Pathophysiology Of Endocarditis is handy for you to explore on this place. This place have 12 Resume pictures about Pathophysiology Of Endocarditis including paper sample, paper example, coloring page pictures, coloring page sample, Resume models, Resume example, Resume pictures, and more

Endocarditis is a life-threatening inflammation of the inner lining of your heart's chambers and valves (endocardium). Endocarditis is usually caused by an infection. Bacteria, fungi or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart The pathophysiology of infective endocarditis comprises at least three critical elements: preparation of the cardiac valve for bacterial adherence, adhesion of circulating bacteria to the prepared valvular surface, and survival of the adherent bacteria on the surface, with propagation of the infected vegetation Endocarditis is an endovascular. Videos (1) Infective endocarditis is infection of the endocardium, usually with bacteria (commonly, streptococci or staphylococci) or fungi. It may cause fever, heart murmurs, petechiae, anemia, embolic phenomena, and endocardial vegetations. Vegetations may result in valvular incompetence or obstruction, myocardial abscess, or mycotic aneurysm View Pathology Endocarditis PPTs online, safely and virus-free! Many are downloadable. Learn new and interesting things. Get ideas for your own presentations. Share yours for free

[Pathology of infective endocarditis]

Hey Gang, it's Nurse Mike, and in Today's video, we're covering Infective Endocarditis pathophysiology, pathology, as well as infective endocarditis. Infecti.. Infective endocarditis (IE) is an uncommon infection, occurring as a complication in varying percentages of bacteremic episodes. The ability of an organism to cause endocarditis is the result of. The pathophysiology of infective endocarditis comprises at least three critical elements: preparation of the cardiac valve for bacterial adherence, adhesion of circulating bacteria to the prepared valvular surface, and survival of the adherent bacteria on the surface, with propagation of the infected vegetatlon.. Study Pathology Of Endocarditis, Myocarditis, Pericarditis flashcards from Scott Mitchell's class online, or in Brainscape's iPhone or Android app. Learn faster with spaced repetition What is endocarditis? Endocarditis means inflammation of the inner layer of the heart. Find our complete video library only on Osmosis Prime: http://osms.i..

Pathology ofinfective endocarditis Apostmortem evaluation Ivo Steiner,' AshvinK. Patel,2 Michael S. R. Hutt,3 andKrishna Somers Fromthe DepartmentsofPathology andMedicine, Makerere University, Kampala, Uganda Areview of28 necropsy cases ofinfective endocarditis seen over the 12-monthperiod ofI969 is presented Articles on Endocarditis pathology in N Eng J Med, Lancet, BMJ. Media Powerpoint slides on Endocarditis pathology. Images of Endocarditis pathology. Photos of Endocarditis pathology. Podcasts & MP3s on Endocarditis pathology. Videos on Endocarditis pathology. Evidence Based Medicine Cochrane Collaboration on Endocarditis pathology

Infective endocarditis is a life-threatening disease whose pathophysiology is based on unique host-pathogen interaction. Pathogenesis includes pre-existing endocardial lesions or inflammation that. This review addresses the pathology of native valve endocarditis, including local (valvular and perivalvular destruction) and distal (embolism, metastatic infection, and septicemia) complications. Old and new cardiac conditions and patients at risk, predisposing to the occurrence of infective endocarditis, are then discussed Abstract. Infective endocarditis is a life-threatening disease whose pathophysiology is based on unique host-pathogen interaction. Pathogenesis includes pre-existing endocardial lesions or inflammation that leads to endothelial cells and platelets activation, coagulation and thrombus formation Study Pathology of Endocarditis flashcards from Devon Stutzman's Philadelphia College of Osteopathic Medicine class online, or in Brainscape's iPhone or Android app. Learn faster with spaced repetition Overview Endocarditis - inflammation inner lining and valves of heart Pericarditis - inflammation outer lining, the pericardial sac around heart Pathophysiology: Endocarditis is inflammation within the heart. The inner lining is inflamed. This is caused by bacteria that enter the bloodstream. This bacteria travels to the hart and causes infection and inflammation. Pericarditis is.

Secondary infective endocarditis. Fever, weight loss, night sweats, lethargy, chest pain. Diagnosis. This website is intended for pathologists and laboratory personnel but not for patients. We welcome suggestions or questions about using the website. However, we cannot answer medical or research questions or give advice.. Infective endocarditis is a fatal disease if left untreated. Heart failure is the leading cause of death in infective endocarditis. This is due to the damage caused to valves. 40-60% of autopsies.

Pathology of Infectious Endocarditis: Overview, Etiology

  1. Endocarditis: Endocarditis, an infection of a heart valve, doesn't usually cause a cough by itself unless there is associated congestive heart failure or embolism t... Read More 160 views Reviewed >2 years ag
  2. Epidemiology of Endocarditis • There has been an increasing incidence ofThere has been an increasing incidence of nosocomial endocarditis - both native and prosthetic valve • There is an increased risk of IE among injecting drug users, patients on long-term hemodialysis, patients with intravenous catheters, diabetics and HIV
  3. If the broad definition of inflammation proposed by Marchand, with the adherence of many other pathologists, is accepted, it may be said that except for congenital anomalies, retrogressive changes such as amyloid, and tumors, the lesions of the human endocardium all have certain features that may be regarded at least in part as inflammatory. ENDOCARDIAL SCLEROSIS Valve leaflets, especially.
  4. Pathology of Infective Endocarditis. STUDY. PLAY. What is the characteristic lesion of IE? Septic vegetations (vegetation colonized by microbes). With bacteremia, bacteria can be trapped in those thrombotic vegetations. - a vegetation is a platelet-fibrin thrombi on surface of a heart valve
  5. Other articles where Bacterial endocarditis is discussed: endocarditis: Traditionally, infective endocarditis has been classified as acute or subacute. Acute infective endocarditis generally is caused by Staphylococcus, Pneumococcus, or Gonococcus bacteria or by fungi. This form of endocarditis develops rapidly, with fever, malaise, and other signs of systemic infection coupled with abnormal.
  6. Pathophysiology The development of infectious endocarditis requires the presence of bacteria or fungi infectious endocarditis (viridans Streptococcus, Streptococcus bovis, gram
  7. ation is often non-spec

Pathology Outlines - Infective endocarditi

  1. Pathology: Endocarditis. STUDY. PLAY. What is the purpose of cardiac valves? Maintain unidirectional blood flow thru the heart. Which valves are connected to papillary muscles? AV valves. What does damage to cardiac valves cause? Regurgitation. Histology of a valve
  2. Infective endocarditis (IE) is an infection involving the endocardial surface of the heart, including the valvular structures, the chordae tendineae, sites of septal defects, or the mural endocardium. Mylonakis E, Calderwood SB. Medical progress: infective endocarditis in adults
  3. Infective endocarditis. Definition - Infective endocarditis is a microbial infection of the heart valves or mural endocardium that leads to the formation of vegetations composed of thrombotic debris and organisms, often associated with destruction of the underlying cardiac tissue ; Infective endocarditis is classified on clinical grounds into acute and subacute forms indicating the severity.

The incidence of endocarditis is approximately 5 to 7.9 cases per 100,000 persons per year in the United States,1 and has been stable over time. Risk factors for infectious endocarditis include. Heart Pathology MCQs 1.Each of the following result in left ventricular hypertrophy except: A. aortic stenosis B. systemic hypertension C. coarctation of the aorta D. mitral stenosis E. severe prolonged anemia 2.Systemic arterial hypertension leads to: A. left ventricular hypertrophy B. an increased incidence of infective endocarditis C. bot

pathology, typical pathogens, and clinical course vary among classes of infective endocarditis, which include . native valve endocarditis . acute subtype . rapid onset and aggressive course of illness ; often highly virulent organisms such as Staphylococcus aureus; subacute subtype . gradual onset and indolent course of illnes Endocarditis is an inflammation of the inner layer of the heart, the endocardium.It usually involves the heart valves.Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or the surfaces of intracardiac devices.Endocarditis is characterized by lesions, known as vegetations, which is a mass of platelets, fibrin, microcolonies.

CVS Pathology 1 - Rheumatic heart disease, infectiveSystemic lupus erythematosus pathophysiology - wikidoc

Endocarditis pathology Britannic

Pathophysiology, Clinical and Imaging Overview1 Myriad infectious organisms can infect the endocardium, myocar- prosthetic valve endocarditis (PVE), infections of prosthetic material, and cryptic manifestations of viral and parasitic This copy is for personal use only ### Learning objectives Endocarditis is defined as inflammation of the endocardium, the lining of the cardiac chambers and valves, and characterised by vegetations, most commonly caused by infection with bacteria or fungi. Non-infective endocarditis, also known as non-bacterial thrombotic endocarditis (NBTE) or aseptic endocarditis, refers to a rare condition characterised by formation of. BACKGROUND Few large studies have documented the clinical and pathologic features of native valve endocarditis (NVE) independently from prosthetic valve endocarditis (PVE). METHODS A retrospective study of medical records of all patients undergoing operation for NVE at Mayo Clinic in Rochester, MN (1985-2004), was performed. Medical records were reviewed from 287 patients for demographics. Currently, the family contains at least 19 members; many of which are emerging human and canine pathogens. 3, 4, 7, 8 Several members of the Bartonella family have become important causes of blood culture-negative infective endocarditis (sterile) in humans. 13, 16 There was no disease associated with Bartonella infection in dogs until.

Eustachian valve infective endocarditis | BMJ Case ReportsEscherichia coli infections

Infective endocarditis (IE) is an infectious and inflammatory process of endothelial lining of the heart structures and valves. It is most commonly caused by bacterial and fungal infections, although non-infective causes of endocarditis occur, this chapter will concentrate on infective causes Abstract. Bouza, Emilio, Meyer, Richard D., and Busch, David F.: Group G streptococcal endocarditis. Am J Clin Pathol 70: 108-111, 1978. The group G streptococcus may be a more common human pathogen than previously recognized. A case of group G streptococcal endocarditis is reported and the 11 cases reported previously are reviewed

Video: ENDOCARDITIS - Etiology, Risk Factors, Pathophysiology

Tests used to confirm or rule out endocarditis include: Blood culture test. A blood culture test is used to identify any germs in your bloodstream. Blood culture test results help your doctor choose the most appropriate antibiotic or combination of antibiotics. Complete blood count. This blood test can tell your doctor if you have a lot of. The systemic pathology consisted of visceral infarcts and abscesses and was particularly common and florid in cases of left-sided endocarditis . Gross infarcts were seen 43 (63.2%) autopsied patients Bacterial endocarditis is a bacterial infection of the inner layer of the heart or the heart valves. The heart has 4 valves. These valves help the blood flow through the heart and out to the body. When a person has bacterial endocarditis, these valves may not be able to work properly. This can force the heart to work harder to get blood out to the body

Antibiotic therapy has decreased the incidence of glomerulonephritis related to subacute bacterial endocarditis (SBE). Kidney involvement may be the initial manifestation of SBE in about 20% of patients. Hematuria and mild proteinuria are commonly present. Hypertension and nephrotic syndrome are rare. Serum complement levels may be low. Gross hematuria may be present in patients with renal. Case 195 (micro case 4) Case 31. Case 286. Review Items for Week 13. Pathology Case Descriptions. CASE NUMBER 25. [ImageScope] [WebScope] Clinical History: A 9-year-old female had two previous attacks of rheumatic fever. She entered the hospital for the third time with painful swollen joints, fever, and pulmonary edema Endocarditis - Atlas of swine pathology. The endocarditis observed in this weaning piglet was caused by Streptococcus suis. In this case, piglets affected during the weaning stage showed high fever, neurological symptoms and joint swelling. This lesion in the endocardium was found during necropsy of one of the pigs

It is usually caused by a form of Viridans group streptococcus bacteria that normally live in the mouth (Streptococcus mutans, mitis, sanguis or milleri).. Other strains of streptococci can cause subacute endocarditis as well. These include streptococcus intermedius, which can cause acute or subacute infection (about 15% of cases pertaining to infective endocarditis) Endocarditis Videos, Flashcards, High Yield Notes, & Practice Questions. Learn and reinforce your understanding of Endocarditis. - Osmosis is an efficient, enjoyable, and social way to learn. Sign up for an account today! Don't study it, Osmose it

370 Vet Pathol 42:370-373 (2005) Pathology of Bartonella Endocarditis in Six Dogs P. A. P ESAVENTO,B.B.CHOMEL,R.W.KASTEN,K.A.MCDONALD, AND F. C. MOHR Abstract. In a 5-year retrospective study of dogs presenting to the Veterinary Medical Teaching Hospital at the University of California, Davis, there were 31 histologic diagnoses of valvular endocarditis Pathology. Which valves cause the most trouble? Mostly those on the left side (subjected to higher pressures), i.e. mitral valve (or left atrioventricular v.) and aortic valve. Zalneraitis, EL.. Marantic endocarditis in children and young adults: clinical and pathological findings.. Stroke 12 (5): 635-9

Marantic endocarditis, Carcinomatosis, Hypoxia, Infective endocarditis 1 Introduction Non-bacterial thrombotic endocarditis (NBTE) is a disease characterised by the presence of vegetations on cardiac valves, which consist of fibrin and platelet aggregates and are devoid of inflammation or bacteria Pathology of Infective Endocarditis. Saved by Dr Sampurna Roy. 37. Medical Surgical Nursing Cardiac Nursing Pharmacology Nursing Pediatric Nursing Nursing School Memes Medical School Funny Nursing Nursing Schools Cardiovascular Nursing

INTRODUCTION — The management of infective endocarditis (IE) includes prompt diagnosis, treatment with antimicrobial therapy, and in some cases of complicated IE, surgical management. Preventive measures including antimicrobial prophylaxis may reduce the risk of initial and recurrent IE for patients with relevant risk factors A locked padlock) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites Endocarditis is a disease with high morbidity and mortality. Signs and symptoms can be very non-specific. Suspect the diagnosis in anyone with a new murmur, bacteremia without a clear focus, peripheral embolic phenomena or IVDU. Diagnosis is usually based off of the Modified Duke criteria Nonbacterial Thrombotic Endocarditis. The exact pathogenesis of nonbacterial thrombotic endocarditis is not completely understood. Nonbacterial thrombotic endocarditis (NBTE), also called marantic endocarditis is most commonly found on previously undamaged valves.; The vegetations in nonbacterial thrombotic endocarditis are sterile and small Pathology of infectious endocarditis 2021-01-28 12:00 AM Infectious endocarditis in injecting drug users: common in young men without heart disease, the skin is often the source of infection, the tricuspid valve is most often damaged

Pathology Outlines - Plasmodium falciparum

This dramatic transformation is not uncommon in the larynx. #entpath #headandneckpathology #pathology #pathologist About The Ottawa Atlas of Pathology is a freely accessible collection of human pathology images brought to you by the pathologists at the Ottawa Hospital dc.contributor.author: Ketchen, William: en: dc.date.accessioned: 2018-09-13T15:47:31Z: dc.date.available: 2018-09-13T15:47:31Z: dc.date.issued: 1862: dc.identifier.ur ### Learning objectives Endocarditis is defined as inflammation of the endocardium, the lining of the cardiac chambers and valves, and characterised by vegetations, most commonly caused by infection with bacteria or fungi. Non-infective endocarditis, also known as non-bacterial thrombotic endocarditis (NBTE) or aseptic endocarditis, refers to a rare condition characterised by formation of. Infective endocarditis (IE), or bacterial endocarditis, is an infection caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel. IE is uncommon, but people with some heart conditions have a greater risk of developing it

Burke, A.P. (2016) Pathology of Infectious Endocarditis. The Heart Org Medscape. has been cited by the following article: TITLE: Isolated Right-Sided Infective Endocarditis—An Infected Right Ventricular Myxoma Masquerading as Tricuspid Vegetation—A Case Report. AUTHORS: Ramachandran Muthia To review the pathohistolgoical context, let's take a quick look at a sample of a cardiac atrioventricular valve: Along the endocardium, label the inflammation and resulting edema; Label the darker-staining vegetation, which, in infective endocarditis, comprises pathogens as well as cellular and extracellular materials. As we discuss elsewhere, these vegetations can lead to emboli, even stroke

Infective endocarditis - PubMed Central (PMC

Media in category Gross pathology of endocarditis The following 8 files are in this category, out of 8 total. Diseases of the chest and the principles of physical diagnosis (1920) (14780651375).jpg 1,794 × 2,182; 415 K David Durack, MD, is an infectious disease specialist who is affiliated with Duke University Hospital and has practiced for 46 years. He received his medical degree from University of Western Australia Faculty of Medicine. Dr. Durack's clinical interests include public health, endocarditis, meningitis, septicemia, MRSA, influenza, and vaccines The true incidence of endocarditis complicating each of the bacterial species causing IE is difficult to estimate. About 20%-30% of individuals with community-acquired staphylococcal bacteremia develop IE, according to a paper published on Springer Science + Business Media. Keyword: endocarditis pathophysiology

Infective Endocarditis - UTM

Pathophysiology of infective endocarditis. Infective endocarditis (IE) is an uncommon infection, Infective endocarditis (IE) is an infection of the endocardium that typically affects one or more heart valves.The condition is usually a result of bacteremia, which is most commonly caused by dental procedures, Mylonakis E, occurring as a. Surgical pathology of native valve endocarditis in 310 specimens from 287 patients (1985-2004) Mathieu C. Castonguay, Kimberly D. Burner, William D. Edwards, Larry M. Baddour, Joseph J. Maleszewski Laboratory Medicine and Pathology Endocarditis Of Pathophysiology. Pathogenesis of Infectious Endocarditis Infectious endocarditis is a disease caused by a bacterial or fungal infection on the hearts endocardial surface. Vegetations may result in valvular incompetence or obstruction myocardial abscess or mycotic aneurysm. Infective endocarditis is infection of the endocardium. The Duke criteria are a set of clinical criteria set forward for the diagnosis of infective endocarditis. For diagnosis the requirement is: 2 major and 1 minor criteria or; 1 major and 3 minor criteria or; 5 minor criteria; For adequate diagnostic sensitivity, transesophageal echocardiography is the preferred modality used in patients designated high-risk or those in whom transthoracic.

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Infective endocarditis - SlideShar

The symptoms of endocarditis can be hard to notice and unclear, developing slowly over weeks or months. In some cases however, they can develop suddenly. The most common symptoms of endocarditis are: flu-like symptoms - these include having a temperature, tiredness, headaches, chills, a cough and sore throat. unexplained weight loss Surgical pathology of nonbacterial thrombotic endocarditis in 30 patients, 1985-2000 Patrick W. Eiken, William D. Edwards, Henry D. Tazelaar, Robert D. McBane Laboratory Medicine and Pathology Tutorial contains images and text for pathology education. Microscopically, the valve in infective endocarditis demonstrates friable vegetations of fibrin and platelets (pink) mixed with inflammatory cells and bacterial colonies (blue). The friability explains how portions of the vegetation can break off and embolize

Kingella kingae: An Unlikely Cause of Meningitis. Madalena Almeida Borges, Sara Silva, Raquel Ferreira, Catarina Martins, Paulo Paixão, Vitória Rodrigues, João Farela Neves, . Kingella kingae is the leading cause of osteoarticular infections between 6 and 48 months, a well-known cause of pediatric bacteremia and endocarditis and has been rarely associated with meningitis Pathology of Bartonella Endocarditis in Six Dog

Study Flashcards On Pathoma - Endocarditis, Cardiomyopathies and Cardiac tumors - Fundamentals of Pathology at Cram.com. Quickly memorize the terms, phrases and much more. Cram.com makes it easy to get the grade you want The broad goal of this proposed research is to determine the underlying molecular mechanisms required for S. aureus endocarditis vegetations to develop and to improve diagnosis of endocarditis by the.. Background. Definition: Infection endocarditis (IE) = Inflammation of the endothelium of the heart, heart valves (or both) (Osman 2013) Epidemiology . Annual incidence = 5-7 cases per 100,000 (Fraimow 2013)40,000 to 50,000 new cases in the US per year. Average hospital charges in excess of $120,000 per patient (Bor 2013)Slightly higher male predominance (1.5:1 - 2:1) (Moreillon 2010 This is an example of coarctation of the aorta and aberrant origin of the right subclavian artery. Subacute bacterial endocarditis was present involving the aortic wall at and immediately distal to the site of the coarctation. (The term endocarditis is a misnomer at this site, but the pathological processes are the same

The broad goal ofthis proposed research is to determine the underlying molecular mechanisms required for S. aureus endocarditis vegetations to develop and to improve diagnosis of endocarditis by the u.. Summary. Infective endocarditis (IE) is an infection of the endocardium that typically affects one or more heart valves.The condition is usually a result of bacteremia, which is most commonly caused by dental procedures, surgery, distant primary infections, and nonsterile injections. IE may be acute (developing over hours or days) or subacute (progressive over weeks to months) Background We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide.. Methods Prospective cohort study of 2781 adults with definite IE who were admitted to 58 hospitals in 25 countries from June 1, 2000, through September 1, 2005 AJKD Atlas of Renal Pathology: Subacute Bacterial Endocarditis-Associated Glomerulonephritis Mark A. Lusco, MD,1 Agnes B. Fogo, MD,1 Behzad Najafian, MD,2 and Charles E. Alpers, MD2 Clinical and Pathologic Features Antibiotic therapy has decreased the incidence of glomerulonephritis related to subacute bacterial endocarditis (SBE) The annual incidence of infective endocarditis (IE) is estimated to be between 15 and 80 cases per million persons in population-based studies. The incidence of IE is markedly increased in. Bartonella endocarditis: a pathology shared by animal reservoirsand patients. Annals of the New York Academy of Sciences, 2009. Ricardo Maggi. Download PDF. Download Full PDF Package. This paper