Anti-beta2 glycoprotein I and anticardiolipin antibodies in leptospirosis, syphilis and Kala-azar.

OBJECTIVE: Reports have shown that anticardiolipin (aCL) antibodies present in patients with autoimmune diseases are dependent on the cofactor,beta2 glycoprotein I (beta2 GPI), as opposed to aCL antibodies seen in infectious diseases such as syphilis, HIV hepatitis C, etc. The assay for anti-beta2GPI antibodies has been reported to be more specific for antiphospholipid syndrome (APS). However, the prevalence of these antibodies in diseases such as leishmaniasis and leptospirosis remains unknown. The aim of the present study was determine the prevalence of antibodies to cardiolipin and to beta2GPI in patients with different infectious diseases, including leptospirosis, syphilis and leishmaniasis. METHODS: Samples from patients with Kala-azar (visceral leishmaniasis), syphilis or leptospirosis were tested for IgG and IgM anticardiolipin and IgG anti-beta2GPI antibodies by ELISA. RESULTS: In patients with Kala-azar the prevalence of IgG aCL, IgM aCL and anti-beta2GPI was 6% (2/30), 3% (1/30) and 53% (16/30), respectively. In syphilis the prevalence was 18% (14/74), 13% (10/74) and 10% (8/70), respectively. In leptospirosis the frequency of these antibodies was 23% (9/39), 10% (4/39) and 17% (6/34), respectively. There was no statistical correlation between aCL and anti-beta2GPI antibodies in these diseases. DISCUSSION: This study clearly shows a significant prevalence of anti-beta2GPI antibodies in leptospirosis and leishmaniasis and syphilis. This indicates that the assay for antibeta2GPI antibodies should be thoroughly validated before it is introduced as a definitive tool for the diagnosis of APS, testing a larger number of sera from patients with a wider range of clinical conditions.

[Fungal endocarditis in the neonatal period. Report of a case with large right atrial mass]. / Endocardite por fungos no período neonatal. Relato de um caso com grande massa intra-atrial direita.

OBJECTIVE: To draw pediatricians' attention to diagnoses of Fungal Endocarditis, which may ensue as a result of intravascular catheter use. METHODS: The authors report a case of Fungal Endocarditis during the neonatal period, which was later confirmed through a histopathological exam. They also review literature of the theme - from 1980 on - in MEDLINE and LILACS. RESULTS: A newborn was admitted to the hospital with kernicterus - but no previous cardiopathy - and required the use of an intravascular catheter. During the evolution, the baby developed a recurring fever and systolic murmur. Submitted to exam, the tip of the catheter showed the presence of Candida sp. An ecocardiographic exam showed a great right intra-atrial mass, which was surgically removed. The histopathological exam confirmed the diagnosis of fungal endocarditis. CONCLUSION: Fungal Endocarditis should be thought of as a possible diagnosis when great intra-atrial masses are found in neonates with a history of intravascular catheter use and a non-specific infectious condition.

[Spherical configuration of the aortic valve]. / Configuração esférica do aparelho valvar aórtico.

PURPOSE: To study the normal human aortic valvular ring, and to evaluate the possibility of reproducing its shape artificially. METHODS: The anatomical configuration of six normal aortic valves was studied through the injection of silicone rubber in the ascending aorta. From the resulting casts, epoxi models corresponding to the aortic annulus were obtained. The following parameters were determined: diameter of the base (Db), diameter of the commissures (Dc), height (h) and the Db/Dc and Db/h relationships. The mean value (X) and the standard deviation (SD) of each parameter were studied. RESULTS: The observation of the casts indicate that the aortic valvular ring derives from a sphere. The measures obtained were: Db = 22 +/- 1.67 mm; Dc = mean 19.67 +/- 1.3 mm; h = 16.00 +/- 1.09 mm; Db/Dc = mean = 1.12 +/- 0.04 and Db/h = 1.38 +/- 0.10. Starting from these figures it was possible to define the spheric configuration of the aortic valvular ring, as well as to reproduce it artificially. CONCLUSIONS: The aortic valvular ring has a configuration derived from a sphere or hemisphere. The parameters obtained from the above program, it was possible to reproduce the configuration of the aortic valvular ring and to use it for a bioprosthesis.

[Intermittent myocardial ischemia after surgical angioplasty of left main coronary artery]. / Isquemia miocárdica intermitente após angioplastia cirúrgica do tronco de coronária esquerda.

Two 38 and 53-year old male patients with unstable angina, whose hemodynamic study showed an isolated stenosis of the left coronary artery ostium, were submitted to a surgical angioplasty of the left main coronary artery (LMCA) with saphenous vein patch. At the end of the operation, the patients presented intermitent myocardial isquemia. One of them led to abrupt cardiogenic shock which reversed completely. The postoperative hemodynamic study demonstrated excellent left main coronary artery patency and normal left ventricular of LMCA has been proposed as an alternative technique to the treatment of ostial lesions, the surgical team should be prepared to face severe operative morbidity. The LMCA spasm has been considered as a possible etiology of that event.

Isquemia miocárdica intermitente após angioplastia cirúrgica do tronco de coronária esquerda / Intermittent myocardial isquemia after surgical angioplasty of the left main coronary artery

Dois pacientes do sexo masculino (38 e 53 anos) com angina estável, com estudo hemodinâmico revelando grave lesão de óstio de tronco de coronária esquerda (TCE), foram submetidos a angioplastia cirúrgica do TCE com patch de veia safena. Ao final da operação os pacientes apresentaram isquemia miocárdica intermitente, um deles com choque cardiogênico e, em ambos, reversão completa do quadro. O estudo hemodinâmico pós-operatório revelou adequada ampliação do TCE com função ventricular esquerda preservada nos dois pacientes. Embora a angioplastia cirúrgica do TCE seja uma alternativa técnica para os doentes com lesöes ostiais, chamamos a atenção para esta grave morbidade operatória, tendo como uma das possíveis causas o espasmo do TCE.

Artéria mamaria interna direita em posição retroaórtica para revascularização direta do miocárdio / Right internal mammary artery at retroaortic position for direct myocardial revascularization

Foram submetidos a revascularizacao direta dada arteria circunflexa e seus ramos atraves da anastomose da arteria mamaria interna direita (MID) em posicao retroaortica 26 pacientes, entre julho e novembro de 1983. As idades variaram de 37 a 67 anos (media 53 anos), 92% eram sexo masculino. A revascularizacao foi complementada com a arteria mamaria interna esquerda (MIE) para o ramo descendente anterior ou diagonal e com veia safena (VS) para os outros ramos coronarios. Foram realizados 3,1 pontes/paciente. O estudo cinecoronariografico pos-operatorio, realizado em 8 pacientes, mostrou 100% de perviabilidade das MID e MIE e 91% das VS. A MID fica bem posicionada, suficientemente longa e sem tensao, proporcionando enchimento distal normal ao ramo coronario revascularizado.A revascularizacao direta do ventriculo esquerdo com ambas arterias mamarias talvez possa influenciar favoravelmente os resultados tardios

Calcificacao em bioprotese de dura-mater. / Calcification in dura mater bioprothesis

Dezenove pacientes portadores de bioproteses de dura-mater foram levados a reoperacao devido a disfuncao protetica. Doze pacientes eram mitrais e sete aorticos. Em todos os substitutos valvares recuperados os autores econtraram calcificacao do tecido de que e constituida a bioprotese.Dos pacientes mitrais, em sete casos encontraram estenose da bioprotese, sendo que cinco pacientes tinham menos de quinze anos de idade. Em posicao aortica, estenose foi encontrada em somente um caso. Macroscopicamente, observaram tres tipos de calcificacao: a vegetante, em porcelana e focal