Anti-Ascaris suum immunoglobulin Y as a novel biotechnological tool for the diagnosis of human ascariasis.

Human ascariasis is a neglected tropical disease of great relevance to public health and is considered the most frequent helminthiasis in poor regions. Accurately diagnosing this parasite has been challenging due to limitations of current diagnostic methods. Immunoglobulin Y (IgY) technology is a very effective alternative for the production of highly specific and profitable antibodies. This study aimed to produce and apply anti-Ascaris suum IgY antibodies in the immunodiagnosis of human ascariasis. Five immunizations comprising total saline extract from A. suum adult life forms were given at 14-day intervals to Gallus gallus domesticus hens of the Isa Brown line. Eggs and blood samples were collected weekly and fortnightly, respectively, to monitor the production of antibodies. The specificity of antibodies was confirmed by dot-blot, kinetic enzyme-linked immunosorbent assay (ELISA), avidity ELISA, immunoblotting and indirect immunofluorescence antibody tests. The application for disease diagnosis was performed through the detection of immune complexes in human serum samples by sandwich ELISA. Peaks of IgY anti-A. suum production occurred at weeks 6 and 8. IgY showed high avidity levels after the second dose of immunization, ranging from 64% to 93%, with a mean avidity index of 78.30%. Purified IgY recognized 12 bands of proteins from A. suum saline extract. Eggs, the uterine portion and cuticles of A. suum female adult are reactive in immunofluorescence. The detection of immune complexes showed diagnostic values of 80% sensitivity and 90% specificity. In conclusion, specific IgY have been shown to be a potential immunodiagnostic tool with promising future applications in human ascariasis.

Diagnosis of the pinworm Syphacia muris in the Wistar rat Rattus norvegicus.

This study aimed to compare three qualitative parasitological methods for the diagnosis of Syphacia muris infection in 30 Wistar rats (Rattus norvegicus) infected naturally. Methods of spontaneous sedimentation (Hoffman, Pons and Janer, or HPJ) and spontaneous flotation (Willis) for faecal samples and a method of taping (Graham) were performed and compared. The Graham and Willis methods were more sensitive than the HPJ method (P< 0.05). The Graham method was able to detect S. muris eggs in 100% of the samples. Eggs were detected in 83% and 60% of the samples using the Willis and HPJ methods, respectively. Method choice is important for screening for parasites of rats kept under laboratory conditions, as accurate diagnosis helps prevent future environmental contamination and infection. We concluded that the Graham method was the most efficient of those tested in this study for detection of S. muris infection in rats. This method is also rapid, inexpensive and practical, and should be implemented as a necessary measure for infection control.

Coronary flow velocity reserve after percutaneous interventions is predictive of periprocedural outcome.

BACKGROUND: Because heterogeneous results have been reported, we assessed coronary flow velocity changes in individuals who underwent percutaneous transluminal coronary angioplasty (PTCA) and examined their impact on clinical outcome. METHODS AND RESULTS: As part of the Doppler Endpoints Balloon Angioplasty Trial Europe (DEBATE) II study, 379 patients underwent Doppler flow-guided angioplasty. All patients were evaluated according to their coronary flow velocity reserve (CFVR) results (> or =2.5 or < 2.5) at the end of the procedure. A CFVR < 2.5 after angioplasty was associated with an elevated baseline blood flow velocity in both the target artery and reference artery. CFVR before PTCA and CFVR in the reference artery were independent predictors of an optimal CFVR after balloon angioplasty (CFVR before PTCA: odds ratio [OR], 2.26; 95% confidence interval [CI], 1.57 to 3.24; CFVR in reference artery: OR, 1.90; 95% CI, 1.21 to 2.98; both P<0.001) and stent implantation (before PTCA: OR, 2.54; 95% CI, 1.47 to 4.36; reference artery: OR, 1.97; 95% CI, 1.07 to 3.87; both P<0.05). A low CFVR at the end of the procedure was an independent predictor of major adverse cardiac events (MACE) at 30 days (OR, 4.71; 95% CI, 1.14 to 25.92; P=0.034) and at 1 year (OR, 2.06; 95% CI, 1.16 to 3.66; P=0.014). After excluding MACE at 30 days, no difference in MACE at 1 year was observed between the patients with and without a CFVR < 2.5 at the end of the procedure. CONCLUSIONS: A low postprocedural CFVR was associated with a worse periprocedural outcome (which was related to microcirculatory disturbances), but there was no significant difference at late follow-up.

Clinical and economic impact of diabetes mellitus on percutaneous and surgical treatment of multivessel coronary disease patients: insights from the Arterial Revascularization Therapy Study (ARTS) trial.

BACKGROUND: Our aims were to compare coronary artery bypass grafting (CABG) and stenting for the treatment of diabetic patients with multivessel coronary disease enrolled in the Arterial Revascularization Therapy Study (ARTS) trial and to determine the costs of these 2 treatment strategies. METHODS AND RESULTS: Patients (n=1205) were randomly assigned to stent implantation (n=600; diabetic, 112) or CABG (n=605; diabetic, 96). Costs per patient were calculated as the product of each patient's use of resources and the corresponding unit costs. Baseline characteristics were similar between the groups. At 1 year, diabetic patients treated with stenting had the lowest event-free survival rate (63.4%) because of a higher incidence of repeat revascularization compared with both diabetic patients treated with CABG (84.4%, P<0.001) and nondiabetic patients treated with stents (76.2%, P=0.04). Conversely, diabetic and nondiabetic patients experienced similar 1-year event-free survival rates when treated with CABG (84.4% and 88.4%). The total 1-year costs for stenting and CABG in diabetic patients were $12 855 and $16 585 (P<0.001) and in the nondiabetic groups, $10 164 for stenting and $13 082 for surgery. CONCLUSIONS: Multivessel diabetic patients treated with stenting had a worse 1-year outcome than patients assigned to CABG or nondiabetics treated with stenting. The strategy of stenting was less costly than CABG, however, regardless of diabetic status.

Randomized comparison of primary stenting and provisional balloon angioplasty guided by flow velocity measurement. Doppler Endpoints Balloon Angioplasty Trial Europe (DEBATE) II Study Group.

BACKGROUND: Coronary stenting improves outcomes compared with balloon angioplasty, but it is costly and may have other disadvantages. Limiting stent use to patients with a suboptimal result after angioplasty (provisional angioplasty) may be as effective and less expensive. METHODS AND RESULTS: To analyze the cost-effectiveness of provisional angioplasty, patients scheduled for single-vessel angioplasty were first randomized to receive primary stenting (97 patients) or balloon angioplasty guided by Doppler flow velocity and angiography (523 patients). Patients in the latter group were further randomized after optimization to either additional stenting or termination of the procedure to further investigate what is "optimal." An optimal result was defined as a flow reserve >2.5 and a diameter stenosis <36%. Bailout stenting was needed in 129 patients (25%) who were randomized to balloon angioplasty, and an optimal result was obtained in 184 of the 523 patients (35%). There was no significant difference in event-free survival at 1 year between primary stenting (86.6%) and provisional angioplasty (85.6%). Costs after 1 year were significantly higher for provisional angioplasty (EUR 6573 versus EUR 5885; P:=0.014). Results after the second randomization showed that stenting was also more effective after optimal balloon angioplasty (1-year event free survival, 93.5% versus 84.1%; P:=0. 066). CONCLUSIONS: After 1 year of follow-up, provisional angioplasty was more expensive and without clinical benefit. The beneficial value of stenting is not limited to patients with a suboptimal result after balloon angioplasty.

Sustained suppression of neointimal proliferation by sirolimus-eluting stents: one-year angiographic and intravascular ultrasound follow-up.

BACKGROUND: We have previously reported a virtual absence of neointimal hyperplasia 4 months after implantation of sirolimus-eluting stents. The aim of the present investigation was to determine whether these results are sustained over a period of 1 year. METHODS AND RESULTS: Forty-five patients with de novo coronary disease were successfully treated with the implantation of a single sirolimus-eluting Bx VELOCITY stent in São Paulo, Brazil (n=30, 15 fast release [group I, GI] and 15 slow release [GII]) and Rotterdam, The Netherlands (15 slow release, GIII). Angiographic and volumetric intravascular ultrasound (IVUS) follow-up was obtained at 4 and 12 months (GI and GII) and 6 months (GIII). In-stent minimal lumen diameter and percent diameter stenosis remained essentially unchanged in all groups (at 12 months, GI and GII; at 6 months, GIII). Follow-up in-lesion minimal lumen diameter was 2.28 mm (GIII), 2.32 mm (GI), and 2.48 mm (GII). No patient approached the >/=50% diameter stenosis at 1 year by angiography or IVUS assessment, and no edge restenosis was observed. Neointimal hyperplasia, as detected by IVUS, was virtually absent at 6 months (2+/-5% obstruction volume, GIII) and at 12 months (GI=2+/-5% and GII=2+/-3%). CONCLUSIONS: This study demonstrates a sustained suppression of neointimal proliferation by sirolimus-eluting Bx VELOCITY stents 1 year after implantation.

Effectiveness of percutaneous balloon mitral valvotomy during pregnancy.

During pregnancy, medically refractory congestive heart failure due to mitral stenosis continues to present a clinical challenge and optimal management remains controversial. Thirteen women underwent balloon mitral valvotomy for control of functional class III or IV congestive heart failure due to mitral stenosis during pregnancy. The mean gestational age at the time of valvotomy was 25 +/- 6 weeks. Percutaneous balloon mitral valvotomy was performed successfully in all patients. No maternal or fetal mortality occurred. The mean mitral valve area assessed by Doppler echocardiography increased from 0.9 +/- 0.3 cm2 before to 2.1 +/- 0.3 cm2 after valvotomy. The mean mitral valve gradient decreased from 20 +/- 7 to 4 +/- 2 mm Hg. This was associated with a decrease in the pulmonary artery systolic pressure from 62 +/- 24 to 32 +/- 14 mm Hg. Currently, 12 of the 13 patients have delivered at an average gestational age of 38 +/- 0.5 weeks. Symptoms of congestive heart failure improved in all women and all were in New York Heart Association functional class I at the time of delivery. One patient is still pregnant and symptom free. Eleven singlet pregnancies resulted in the birth of full-term, healthy infants (mean birth weight 3.2 kg). The woman carrying a twin pregnancy improved from New York Heart Association class IV to class I after balloon mitral valvotomy but delivered prematurely at 32 weeks. The premature twin infants weighed 1.0 and 1.5 kg and died from respiratory failure at 48 hours. Percutaneous balloon mitral valvotomy can be performed safely during pregnancy and is effective in relieving symptoms of severe congestive heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Anatomic correction of transposition of the great vessels.

We present a new approach for anatomic correction of transposition of the great arteries. The two coronary arteries, with a piece of the aortic wall attached, are transposed to the posterior artery. The two aortic openings are closed with a patch. The aorta and pulmonary artery are transected, contraposed, ant then anastomosed. The interventricular septal defect is closed with a patch, through a right ventriculotomy approach, because the right ventricle is no longer part of the systemic circulation. Two patients, aged 3 months and 40 days weighing 4,200 and 3,700 grams, respectively, were operated upon with deep hypothermia and total circulatory arrest. There was good recovery from the operation, with normal cardiocirculatory conditions. Renal failure developed in the first patient, and she died on the third postoperative day. During this time the cardiocirculatory conditions were good. The second patient made an uneventful recovery. Hemodynamic studies 20 days after the operation showed complete correction of the malformation. Five and one-half months after the operation, he weighs 7,500 grams, and his development is very good. We believe that this operation will be reproducible by most cardiovascular septal defect and pulmonary hypertension.

Results of cardiopulmonary resuscitation in a cardiology hospital.

The authors analysed a series of 557 consecutive patients who suffered cardiorespiratory arrest at the Dante Pazzanese Institute of Cardiology (DPIC) during a period of 5 years in order to examine factors predicting successful resuscitation and long-term survival. Cardiopulmonary resuscitation (CPR) maneuvers were tried in 536 patients, with the following results: 284 patients (53%) died immediately, another 102 (19%) died within the first 24 h after the cardiac arrest and 150 patients (28%) survived more than 24 h. Among these, 65 (12.1%) died in the first month after cardiac arrest and other 29 (5.4%) died after that period. There were 43 late survivors (8%). Thirteen patients (2.4%) were lost to follow-up. After 9 years, the accumulative life expectancy was 8.7%. Coronary heart disease, cardiomyopathy and valvular heart disease were the most frequent underlying diseases. None of the 49 patients with cyanotic congenital heart disease survived. The heart arrest was mostly caused by heart failure (55.8%) and primary arrhythmia (17.2%) in the whole group, whereas the survivor group showed primary arrhythmia in 81.7% and heart failure in 7.3%. In those patients where the initial mechanism of cardiac arrest was ventricular fibrillation, 33.2% survived more than 1 month, while among those on ventricular asystole, only 3.4% survived more than 1 month.

Spasm of the left main coronary artery: an indication for surgery?

A patient with severe angina at rest was studied by coronary angiography. A severe spasm in the left main coronary artery was observed; after nifedipine and isosorbide dinitrate a moderate stenosis was still present and surgery was successfully performed.

Coronary angioplasty through an old saphenous vein graft: is it a safe procedure?

A 60-year-old man had myocardial revascularization 13 years ago by means of coronary by-pass surgery. During the described admission, he underwent coronary angioplasty to the marginal branch of the left circumflex artery using the saphenous vein graft as the means of approach. After the procedure, thrombosis occurred within the venous segment with severe reduction of flow despite the atherosclerotic lesion itself being successfully dilated. The patient died one hour later.

Angioplasty for primary treatment of aortic coarctation: immediate results in two adult patients.

Two adult patients with severe aortic coarctation were treated by angioplasty performed percutaneously through the right femoral artery. A 20 mm balloon catheter was used, being inflated several times within the stenosis. The final angiographic result was excellent in both cases. The gradients were 38 and 46 mm Hg before and 5 and 3 mm Hg after angioplasty, respectively. The arterial pulses in the legs were normal after the procedure and no complication was observed.

It is valid to dilate native aortic coarctation with a balloon catheter.

We report our experience in 37 patients with aortic coarctation who underwent balloon aortoplasty. Of the 37, the lesion was native in 34 cases. Clinical re-evaluation was possible in 22 patients, with a mean follow-up period of 13 months and, of these, 21 patients were asymptomatic. Haemodynamic and angiographic studies were performed in 13 patients, with a mean period of follow-up of 12 months, showing excellent results in 11 patients. Aneurysmal formation had occurred in one and recoarctation in the other patient. Our experience has proved that balloon aortoplasty is an effective method for treating patients with aortic coarctation. Adequate selection in terms of the morphology of the coarctation and the size of the balloon catheter are crucial factors in the success of the procedure.

Balloon valvoplasty in calcific aortic stenosis: a therapeutic alternative.

Percutaneous balloon valvoplasty was used to treat calcific aortic stenosis in 3 women aged 73, 67 and 61 years, respectively. We approached through the left brachial artery in the first case and the right femoral artery in the other two. An 18 mm balloon was used in all cases, the systolic gradient being reduced from 50, 180 and 48 to 7, 50 and 35 mm Hg, respectively. A mild and transitory systemic embolization was observed in one case. Aortic regurgitation was not present in two patients either before or after valvoplasty. In the other case, a grade 1/6 murmur indicative of regurgitation prior to the procedure increased to a grade 2/6 afterwards. A small and localized aortic dissection was present in one case but disappeared in the control angiography performed 11 days later.

Pulmonary valvoplasty--experience of 100 cases.

One-hundred patients with pulmonary valve stenosis underwent pulmonary valvoplasty, their ages ranging from 1 to 59 years. The systolic gradient across the valve ranged from 47 to 260 mm Hg (97.67 +/- 41.15) prior to the valvoplasty, and from 0 to 55 mm Hg (14.72 +/- 11.40) immediately after dilatation (P less than 0.0001). The clinical follow-up of 18.2 months of 56 patients showed a tendency for the systolic thrill to disappear, the systolic murmur became softer and there was a tendency to normalization of the electrocardiogram. A hemodynamic restudy was carried out in 54 patients and the systolic gradients across the valve ranged from 21.55 +/- 23.86. Seven patients required redilatation. In patients with hypertrophy of the infundibulum prior to valvoplasty this was observed to regress, indicating that infundibular hypertrophy is reversible.

Use of rapamycin-impregnated stents in coronary arteries.

FIM STUDY: We investigated the 2-year safety and efficacy of sirolimus-eluting stents. Thirty patients had a single 18-mm sirolimus-eluting coronary stent implanted. Twenty-eight patients underwent angiographic and intravascular ultrasound follow-up at 2 years. No death occurred during the study period. No patient developed in-stent restenosis. One patient had a 52% in-lesion stenosis that required repeated revascularization and another patient underwent target vessel revascularization. Neointimal hyperplasia volume was minimal at 2 years in both groups. This study demonstrates the 2-year safety and efficacy of sirolimus-eluting stenting. The slow release formulation showed slight superiority over the fast-release formulation in preventing late lumen loss, which was minimal in both groups. RAVEL TRIAL: This-study was a randomized, double-blind study that included 238 patients at 19 medical centers (15 in Europe, 3 in Brazil, and 1 in Mexico). Patients were eligible for the study if they were between 18 and 85 years of age, and had been given a diagnosis of stable or unstable angina or silent ischemia. Additional eligibility criteria were presence of a single primary target lesion in a native coronary artery that was 2.5 to 3.5 mm in diameter and that could be covered by an 18-mm stent stenosis of 51% to 99% of the luminal diameter and a flow rate of grade 1 or higher according to the Thrombolysis in Myocardial Infarction. RESULTS: One hundred twenty patients were randomly assigned to receive the sirolimus-eluting stent, and 118 were assigned to receive the standard stent. At 6 months, the degree of neointimal proliferation, manifested as the mean (+/-SD) late luminal loss, was significantly lower in the sirolimus-stent group (-0.01 +/- 0.33 mm) than in the standard-stent group (0.80 +/- 0.53 mm, P <.001). None of the patients in the sirolimus-stent group, as compared with 26.6% of those in the standard-stent group, had restenosis of >/=50% of the luminal diameter (P <.001). There were no episodes of stent thrombosis. During a follow-up period of up to 1 year, the overall rate of major cardiac events was 5.8% in the sirolimus-stent group and 28.8% in the standard-stent group (P <.001). The difference was due entirely to the higher rate of revascularization of the target vessel in the standard-stent group. CONCLUSION: Patients with angina who received sirolimus-eluting stents for the treatment of single, primary lesions in native coronary arteries had no angiographic evidence of late luminal loss or in-stent restenosis at 6 months, no episodes of thrombosis, and a very low rate of cardiac events at 1 year.

Coronary angioplasty in Brazil.

In 1979, the first transluminal coronary angioplasty (PTCA) was performed in Brazil, two years after the original contribution of Andreas Gruentzig, in Zurich. In the years which followed, the development of PTCA in the country grew and in the mid eighties several centres had already had the experience of more than 600 cases. In the beginning of the nineties, PTCA underwent an additional promotion with a large number of procedures, now subventioned by the bodies of public health. In addition to this, the introduction of new technologies such as directional atherectomy, rotablator, laser and stents. In 1991, the Brazilian Society of Interventional Cardiology created a national registry (CENIC) to gather data on the coronary procedures performed in the country. The CENIC data for the 1992/1993 and 1996/1997 bienniums were compared and it was observed that there had been a significant increase in the number of cases treated (from 16,429 in 92/93 to 22,025 in 96/97), complex lesions of the B/C type (from 71.4% to 92.3%), patients with previous revascularisation (from 22% to 28.3%), acute myocardial infarction (from 16% to 17.4%) and multiarterial lesions (from 34.4% to 38.8%). However, despite a greater clinical and angiographic complexity, the success of the procedure grew (from 89.7% to 92.8%) and complications reduced: acute occlusion (from 3.2% to 1.5%); acute myocardial infarction (from 2.5% to 1.2%) and death (from 1.8% to 1.4%). Interventional cardiology in Brazil has consequently progressed at the same rate as that of other countries. The incorporation of new technologies, particularly coronary endoprostheses has increased, guaranteeing better success rates, better results and a decrease in complications arising from acute occlusion of the target vessel.

[Antihypertensive effect of urapidil in mild to moderate arterial hypertension. Randomized, double-blind versus placebo study]. / Efeito anti-hipertensivo de urapidil em hipertensão arterial leve a moderada. Estudo randomizado, duplo-cego, contra placebo.

PURPOSE: To evaluate the efficacy and tolerability of urapidil (a new central and peripheral antihypertensive agent) in patients with mild to moderate essential hypertension. METHODS: Thirty-one patients were randomized, double-blindly, to receive either placebo (15 patients) or urapidil (16 patients) for 3 months. The initial dose of urapidil was 30mg twice daily, per oral. The dose was increased progressively till achievement of good blood pressure control or the dose of 60mg three times a day. RESULTS: Seventy percent of the patients on urapidil group responded to therapy against 30% on the placebo group. There were 3 cases of hypertensive crises (2 on urapidil and 1 on placebo) on the early therapy. The adverse events with urapidil were unfrequent and the most common were headache and dizziness. There were no modification on blood sugar and lipids level. CONCLUSION: Urapidil appears to be a safe antihypertensive agent in the treatment of mild to moderate essential hypertension. It also did not demonstrate any clinical effect on the carbohydrates and lipids profile.

[Blood pressure variability and left ventricular hypertrophy in arterial hypertension]. / Variabilidade da pressão arterial e hipertrofia ventricular esquerda na hipertensão arterial.

PURPOSE: To evaluate the left ventricular hypertrophy correlation with blood pressure variability during day and night time as well as throughout the 24h period. METHODS: Fifteen patients with mild to moderate essential hypertension underwent to bi-dimensional echocardiographic study and to 24h ambulatory blood pressure monitorization. Left ventricular mass was calculated according to previous validated formulas. The standard deviation of the mean blood pressures during day-time, night-time and 24h period was taken as blood pressure variability indices. The mean age of the group was 42 years old; 9 patients were male and all were white. RESULTS: This study showed that only the systolic and diastolic blood pressure variability during the 24h period correlated significantly with left ventricular mass, (r = 0.53 and p < 0.05; r = 0.58 and p < 0.05 respectively). There was no significant correlation of the day-time and night-time pressures variability with left ventricular mass. CONCLUSION: The systolic and diastolic blood pressure variability during the 24h period may be one of the many determinants of left ventricular hypertrophy in patients with mild to moderate hypertension.

[Diagnosis using nuclear medicine of anterior descending artery stenosis in patients with left bundle branch block]. / Diagnóstico de lesão obstrutiva da artéria coronária descendente anterior em pacientes com bloqueio de ramo esquerdo através da medicina nuclear.

PURPOSE: To evaluate septal perfusion and contractility in patients with left bundle branch block (LBBB). METHODS: Twenty patients were submitted to myocardial scintigraphy with Tecnecium-99m isontrile after exercise and dipyridamole infusion. The septal contractility was observed during the radionuclide ventriculography. All patients were submitted to coronariography. RESULTS: Twenty patients were studied and 17 (85%) had a normal left anterior descending (LAD) artery. Nine (53%) patients had abnormalities in septal perfusion after the exercise and 2 (12%) after dipyridamole infusion. All patients had abnormalities in septal contractility during the radionuclide ventriculography. CONCLUSION: The myocardial scintigraphy after dipyridamole infusion showed better specificity in the diagnosis of a LAD lesion. The radionuclide ventriculography was an efficient method to evaluate the septal contraction abnormalities in patients with LBBB.