Mapping of SARS-CoV-2 in Waldeyer's lymphatic ring and visceral biopsies: the age and the illness duration's impact

Abstract Objective: To study the impact of age and the interval between disease diagnosis and death on the organotropism of SARS-CoV-2. Method: Patients underwent post-mortem biopsies from lungs, Waldeyer ring, heart, liver, kidneys and bone marrow between 2020-2021. SARS-CoV-2 organotropism was mapped by using molecular RT-PCR analyses for SARS-CoV2 targeting the Envelope gene (E), the RNA Polymerase Gene (RdRp), and the Nucleocapsid gene (N). Statistical and linear regression analysis was performed to study the impact of age and illness duration in SARS-CoV-2 organotropism. Results: We performed 158 postmortem biopsies in 21 patients, with a mean age of 76 years old. The mean interval between the diagnosis of the infection to the death was 23 days. The RNA of the SARS-CoV-2 was detected in 100% of lung biopsies, 76%-82% of Waldeyer's ring biopsies, 55% of heart biopsies, 40% of kidney biopsies, 33% of liver and 25% of bone marrow biopsies. Patients who died before the day 9, presented extensive visceral dissemination of SARS-CoV-2 RNA. Most of the patients older than 80 years (90%) presented visceral dissemination of SARS-CoV-2 RNA, while among younger patients, only 3/11 patients presented visceral dissemination of the virus. The relationship between "age" and "illness duration" and multitropism of the virus was statistically significant (p< 0.001). Conclusion: Disease interval and age were factors that were significantly associated with RT-PCR positive results in multiple organs. Critical COVID-19 patients have multiorganic viral dissemination in early stages. In the critical older patients, multiorganic viral dissemination is the rule. Level of evidence: 4. Case Series.

Enfermedad arterial periférica en pacientes trasplantados renales. Validez del cuestionario de Edimburgo para el diagnóstico de enfermedad / Peripheral arterial disease in renal transplant patients. Validity of the Edinburgh questionnaire for disease diagnosis

RESUMEN Objetivos: Determinar en pacientes trasplantados renales la prevalencia de enfermedad arterial periférica y la validez de las manifestaciones clínicas de claudicación intermitente para su diagnóstico. Material y métodos: Ámbito y período: Servicio de Nefrología del Complejo Hospitalario Universitario A Coruña, 2013-2017. Criterios inclusión: pacientes trasplantados renales con injerto funcionante que consientan participar en el estudio. Justificación del tamaño muestral: n=371 pacientes (seguridad= 95% y precisión= ± 4,25%). Mediciones: edad, edad al trasplante, sexo, dislipemia, índice de masa corporal, tabaquismo, diabetes, signo de Godet, edema perimaleolar, índice tobillo-brazo y cuestionario Edimburgo. El riesgo cardiovascular se midió mediante los scores Framingham-Wilson, Regicor, SCORE y Dorica. Resultados: La edad media al trasplante fue de 47,86 ± 12,62 años, 65,5% hombres. El 8,7% de los pacientes presentan un índice tobillo-brazo <0,90. El 16,2% de los pacientes manifiestan claudicación intermitente según el cuestionario Edimburgo. La concordancia entre ambas pruebas diagnósticas es débil (índice de Kappa=0,34). El cuestionario de Edimburgo mostró sensibilidad del 59,38% para predecir índice tobillo-brazo <0,90 y especificidad del 88,10%. Las variables asociadas a la presencia de arteriopatía son la edad al trasplante (OR=1,07) y el tabaquismo (OR=6,17), encontrándose la dislipemia en el límite de la significación estadística. Conclusiones: Una décima parte de los pacientes presentan arteriopatía periférica. La concordancia entre el cuestionario Edimburgo y el índice tobillo-brazo es débil. Por lo que debería usarse el índice tobillo-brazo como método diagnóstico. Las manifestaciones clínicas infraestiman la prevalencia de arteriopatía. La edad, el tabaquismo y la dislipemia incrementan su riesgo. Los pacientes con arteriopatía presentan riesgo cardiovascular más elevado.

ABSTRACT Objectives: To assess the prevalence of peripheral artery disease in kidney transplant patients and the validity of intermittent claudication for its diagnosis. Methods: Setting and period: Nephrology Department of the University Hospital A. Coruña, 2013-2017. Inclusion criteria: transplant patients with functioning grafts who gave their consent to participate in the study. Sample size rationale: n=371 patients (confidence interval= 95%; precision= ± 4.25%). Measurements: age, age at the time of transplant, sex, dyslipemia, body mass index, smoking, diabetes, sign of Godet, perimalleolar edema, ankle-brachial index and the Edinburgh Questionnaire. Cardiovascular risk was measured with these scores: Framingham-Wilson, Regicore, SCORE and Dorica. Results: The mean age at the time of transplant was 47.86±12.62; 65.5% of patients were men and 8.7% of them had an ankle-brachial index of <0.90. When answering the Edinburgh Questionnaire, 16.2% of subjects reported suffering from intermittent claudication. Concordance between these two diagnostic tests is poor (kappa index= 0.34). The Edinburgh Questionnaire showed a sensitivity of 59.38% in predicting the ankle-brachial index (<0.90) and specificity (88.10%). The variables associated with the presence of artery disease are age at the time of transplant (OR=1.07) and smoking (OR=6.17), dyslipidemia being at the limit of statistical significance. Conclusions: A tenth part of the patients have peripheral artery disease. Concordance between the Edinburgh Questionnaire and the ankle-brachial index is poor; therefore, the latter should be used as diagnostic method. Clinical signs and symptoms underestimate the prevalence of artery disease. Age, smoking and dyslipidemia increase the risk of this disease. Artery disease patients have a higher cardiovascular risk.

Prevalencia de artrosis de rodilla en una muestra aleatoria poblacional en personas de 40 y más años de edad / Prevalence of knee osteoarthritis in a random population sample in people aged 40 and over

Resumen Introducción: La artrosis es la enfermedad osteoarticular con mayor prevalencia en todo el mundo. En los países industrializados, 80 % de la población > 65 años la padece. Objetivos: Determinar la prevalencia de artrosis sintomática en rodilla en una muestra aleatoria poblacional, las variables asociadas y su repercusión en el dolor y funcionalidad. Método: Análisis descriptivo y multivariado de regresión logística realizado en el Centro de Salud de Cambre, A Coruña. Se incluyó una muestra de 707 pacientes. Se estudiaron variables antropométricas, comorbilidad y exploración clínica de rodillas. Para evaluar el dolor y la funcionalidad se utilizaron los cuestionarios validados WOMAC y Lequesne. Resultados: 56.3 % de los pacientes eran mujeres y la media de edad de 61.75 años. La prevalencia de artrosis sintomática en al menos una rodilla fue de 29.3 %. Las personas con artrosis presentaron puntuaciones más altas en las dimensiones dolor, rigidez y capacidad funcional del cuestionario WOMAC (30 ± 35.7, 33.8 ± 40.5 y 25.4 ± 40.1, respectivamente), así como puntuaciones más altas en el cuestionario de Lequesne (9.0 ± 8.8). Conclusiones: Se ha determinado alta prevalencia de personas con artrosis que se modifica con el sexo, la edad y el índice de masa corporal.

Abstract Introduction: Osteoarthritis is the osteoarticular disease with the highest prevalence worldwide. In industrialized countries, 80% of the population > 65 years suffers from it. Objectives: To determine the prevalence of symptomatic osteoarthritis of the knee in a random population sample, its associated variables and its impact on pain and functionality. Methods: Descriptive and multivariate logistic regression analysis carried out at the Cambre Health Center, A Coruña. A sample of 707 patients was included. Anthropometric variables, comorbidity and clinical examination of the knees were assessed. The validated WOMAC and Lequesne questionnaires were used to assess pain and functionality. Results: 56.3% of the patients were females, and mean age was 61.75 years. The prevalence of symptomatic osteoarthritis in at least one knee was 29.3%. People with osteoarthritis had higher scores in the pain, stiffness and functional capacity dimensions of the WOMAC questionnaire (30.0 ± 35.7, 33.8 ± 40.5 and 25.4 ± 40.1, respectively) and had higher scores in the Lequesne questionnaire as well (9.0 ± 8.8). Conclusions: A high prevalence of people with osteoarthritis has been determined, which is modified with gender, age and body mass index.

Variability between Clarke's angle and Chippaux-Smirak index for the diagnosis of flat feet / Variabilidad entre el ángulo de Clarke y el índice de Chippaux- Smirak para el diagnóstico de pie plano

Abstract Background: The measurements used in diagnosing biomechanical pathologies vary greatly. The aim of this study was to determine the concordance between Clarke's angle and Chippaux-Smirak index, and to determine the validity of Clarke's angle using the Chippaux-Smirak index as a reference. Methods: Observational study in a random population sample (n= 1,002) in A Coruña (Spain). After informed patient consent and ethical review approval, a study was conducted of anthropometric variables, Charlson comorbidity score, and podiatric examination (Clarke's angle and Chippaux-Smirak index). Descriptive analysis and multivariate logistic regression were performed. Results: The prevalence of flat feet, using a podoscope, was 19.0% for the left foot and 18.9% for the right foot, increasing with age. The prevalence of flat feet according to the Chippaux-Smirak index or Clarke's angle increases significantly, reaching 62.0% and 29.7% respectively. The concordance (kappa I) between the indices according to age groups varied between 0.25-0.33 (left foot) and 0.21-0.30 (right foot). The intraclass correlation coefficient (ICC) between the Chippaux-Smirak index and Clarke's angle was -0.445 (left foot) and -0.424 (right foot). After adjusting for age, body mass index (BMI), comorbidity score and gender, the only variable with an independent effect to predict discordance was the BMI (OR= 0.969; 95% CI: 0.940-0.998). Conclusion: There is little concordance between the indices studied for the purpose of diagnosing foot arch pathologies. In turn, Clarke's angle has a limited sensitivity in diagnosing flat feet, using the Chippaux-Smirak index as a reference. This discordance decreases with higher BMI values.

Resumen Introducción: Existe una gran variabilidad en las mediciones para el diagnóstico de la patología biomecánica. El objetivo de este estudio fue determinar la concordancia entre el ángulo de Clarke y el índice de Chippaux-Smirak, para determinar la validez del ángulo de Clarke utilizando como referencia el índice de Chippaux-Smirak. Métodos: Se realizó un estudio observacional en una muestra aleatoriamente seleccionada (n= 1,002) en A Coruña (España). Tras el consentimiento informado del paciente y la aprobación del comité de ética, se estudiaron variables, antropométricas, índice de comorbilidad de Charlson y un examen podológico (ángulo de Clarke, índice de Chippaux-Smirak). Se realizó un estudio descriptivo y un análisis multivariado de regresión logística. Resultados: La prevalencia de pie plano utilizando el podoscopio fue de 19.0% (pie izquierdo) y 18.9% (pie derecho), incrementándose con la edad. La prevalencia de pie plano según el índice Chippaux-Smirak o el ángulo de Clarke se incrementan considerablemente llegando a 62.0% y 29.7%. La concordancia (kappa I) entre los índices según grupos de edad oscila entre 0.25-0.33 (pie izquierdo) y 0.21-0.30 (pie derecho). El coeficiente de correlación intraclase (CCI) entre el índice de Chippaux-Smirak y el ángulo de Clarke es -0.445 (pie izquierdo) y 0.424 (pie derecho). Tras ajustar por edad, índice de masa corporal (IMC), score de comorbilidad y sexo la única variable con un efecto independiente para predecir discordancia es el IMC (OR= 0.969; IC 95%: 0.940-0.998). Conclusiones: La concordancia entre los índices estudiados para el diagnóstico de la patología del arco plantar es reducida. Existe a su vez una reducida sensibilidad del ángulo de Clarke para el diagnóstico de pie plano, utilizando como referencia el índice de Chippaux-Smirak. Esta discordancia disminuye con valores más altos de IMC.

Quality of life and anxiety in women with breast cancer before and after treatment / Qualidade de vida e ansiedade em mulheres com câncer de mama antes e depois do tratamento / Calidad de vida, ansiedad antes y después del tratamiento en mujeres con cáncer de mama

ABSTRACT Objectives: to determine the quality of life and anxiety in patients with breast cancer and the changes they experience after treatments. Method: prospective study. Breast cancer statistics (n=339, confidence=95%, accuracy= ± 5.32%). The quality of life questionnaires (QLQ) used were QLQ C-30 and QLQ Br23, and the State-Trait Anxiety Inventory (STAI) was used for anxiety. A multivariate analysis was performed to identify variables associated with baseline quality of life and anxiety as well as pre- and post-treatment differences. Authorization was obtained from the Ethics Committee, and informed consent was provided by all patients. Results: the baseline quality of life dimensions with the lowest score were future prospects (46.0/100) and sexual enjoyment (55.7/100). The dimensions with the highest score were body image (94.2/100) and role (93.3/100). The most disturbing symptoms were insomnia, fatigue and concern about hair loss. After treatment, the dimensions of physical function, role, body image, financial concerns and symptomatology worsened, whereas emotional function and future prospects improved. Severe anxiety presented as a state (48.6%) and as a trait (18.2%). The highest baseline state anxiety was associated with married-widowed status and anxiolytic medication. The greatest trait anxiety was associated with an inactive work situation, anxiolytic medication, breast swelling and advanced stage at diagnosis. After treatment, anxiety significantly decreased. Conclusions: After treatment, the quality of life score was positively modified, while state and trait anxiety decreased.

RESUMO Objetivos: determinar a qualidade de vida e a ansiedade de pacientes com câncer de mama e as mudanças sofridas após os tratamentos. Método: estudo prospectivo. Incidentes de câncer de mama (n = 339, nível de confiança = 95%, precisão = ± 5,32%). Os questionários de qualidade de vida foram o QLQC-30 e o QLQBr23 e o de ansiedade, o Inventário de Ansiedade Traço Estado (IDATE; em inglês: State-Trait Anxiety Inventory - STAI). Foi feita uma análise multivariada para identificar as variáveis associadas à qualidade de vida e à ansiedade iniciais e as diferenças entre os períodos pré e pós tratamento. Foi obtido consentimento informado e uma autorização do Comitê de Ética. Resultados: as dimensões iniciais da qualidade de vida com as menores pontuações foram: perspectivas futuras (46,0/100) e prazer sexual (55,7/100). Dimensões com as pontuações mais altas: imagem corporal (94,2/100) e funcional (93,3/100). Os sintomas mais perturbadores foram: insônia, fadiga e preocupação com a queda de cabelo. Após os tratamentos, pioraram: função física, funcional, imagem corporal, preocupações financeiras e sintomatologia. A função emocional e as perspectivas futuras melhoraram. A ansiedade grave foi apresentada como estado (48,6%) e como traço (18,2%). A maior ansiedade inicial como estado estava associada ao estado civil de casada ou viúva e ao uso de medicamentos ansiolíticos. A maior ansiedade como traço estava associada a: situação inativa no trabalho, medicamentos ansiolíticos, inchaço nas mamas e estágios avançados no momento do diagnóstico. Após os tratamentos, a ansiedade diminui significativamente. Conclusões: após os tratamentos, a pontuação da qualidade de vida é modificada positivamente e a ansiedade como estado e traço diminui.

RESUMEN Objetivos: determinar calidad de vida y ansiedad en pacientes con cáncer de mama y cambios experimentados tras tratamientos. Método: estudio prospectivo. Casos incidentes de cáncer de mama(n=339;seguridad=95%;precisión=±5,32%). Los cuestionarios de calidad de vida fueron: QLQC-30, QLQBr23, y ansiedad: STAI. Se realizó análisis multivariado para identificar variables asociadas a calidad de vida y ansiedad basales y las diferencias pre y post tratamiento. Se obtuvo autorización del comité de ética y consentimiento informado. Resultados: las dimensiones de calidad de vida basales con menor puntuación son: perspectivas de futuro(46,0/100), disfrute sexual(55,7/100). Dimensiones con mayor puntuación: imagen corporal(94,2/100), funcionalidad del rol(93,3/100). Los síntomas más perturbadores fueron: insomnio, fatiga, preocupación por pérdida del cabello. Tras tratamientos, empeoraron: función física, del rol, imagen corporal, dificultades financieras y sintomatología. Mejoraron la función emocional y perspectivas de futuro. Presentaron ansiedad severa como estado 48,6% y como rasgo 18,2%. La mayor ansiedad estado basal se asoció con estado civil casadas-viudas y medicación ansiolítica. La mayor ansiedad rasgo con: situación laboral inactiva, medicación ansiolítica, hinchazón mamaria y estadios avanzados al diagnóstico. Tras los tratamientos, disminuye significativamente la ansiedad. Conclusiones: tras los tratamientos, la puntuación de calidad de vida se modifica positivamente y la ansiedad como estado y como rasgo disminuye.

Caracterización de la anemia durante el embarazo y algunos factores de riesgo asociados, en gestantes del municipio regla / Characterization of anemia during pregnancy and some associated risk factors in pregnant women at Regla municipality

Introducción: la anemia como problema mundial constituye un indicador general de pobre salud. En Latinoamérica la anemia ferripriva afecta a los grupos vulnerables como las embarazadas. Cuba no está exenta de esta carencia nutricional y su prevalencia alcanza el 25 por ciento de las embarazadas. Objetivo: caracterizar la anemia durante la gestación y su relación con posibles factores asociados. Métodos: se realizó un estudio observacional, descriptivo y de corte transversal en 68 gestantes entre 28 y 32 semanas del Policlínico Lidia y Clodomiro, en el período de octubre a noviembre de 2010. Se aplicó una encuesta con datos sociodemográficos, antecedentes obstétricos y del embarazo actual y se determinó la hemoglobina. Resultados: se observó una disminución de los valores medios de hemoglobina entre el primer trimestre 112 g/L y el tercero 108 g/L. También se constató una alta frecuencia de anemia tanto en el primer trimestre 35,3 por ciento como en el tercer trimestre del embarazo 56,0 por ciento, con una anemia moderada más alta. La anemia al inicio del embarazo resultó un factor de riesgo ρ=0,02 de la existencia de anemia al tercer trimestre. Conclusiones: existió una alta frecuencia de anemia, siendo la anemia moderada la más frecuente, tanto en el primer trimestre como en el tercer trimestre de las embarazadas estudiadas. La anemia al inicio del embarazo resultó ser el factor de riesgo más importante encontrado en nuestro estudio a la existencia de anemia en el tercer trimestre, con independencia de otros posibles factores involucrados...

Introduction: anemia as a worlwide problem constitutes a general indicator of poor health. In Latin America anemia ferripriva affects vulnerable groups such as pregnant women. Cuba is not exempt from this lack of nutrition and its prevalence reaches 25 percent of pregnant women. Objective: to characterize anemia during gestation and its relationship with possible associated factors. Method: a study was conducted from September - November 2010, including 68 pregnant women that were in the beginning of their third trimester. Starting from gathering obstetric clinical history and from personal interviews, a survey was conducted to collect sociodemographic data and prior and current obstetric history. Samples of blood were taken to determine the hemoglobin levels. Results: a significant decrease of the hemoglobin mean values was observed during the first trimester 112 g/L and the third 108 g/L and a high frequency of anemia also during the first trimeter 35.3 percent as in the third 56.0 percent, with a relatively higher moderate anemia. Anemia at the begining of the pregnancy resulted to be a risk factor p=0.02 of the existence of anemia in the third trimester. Conclusions: in this study we report to the anemia like a problem of public health in the municipality it Regla. It was evidenced the magnitude and the grade of severity of the anemia in the studied gestantes and that the anemia to the beginning of the pregnancy can constitute a factor of important risk as cause of anemia...

Fibrolipoma de tonsila palatina / Fibrolipoma of palatine tonsil

O lipoma é um tumor muito comum nos tecidos conectivos do corpo. É uma neoplasia de característica benigna composta por células adiposas maduras. Seu surgimento é relativamente comum no trato digestório e raro na orofaringe e especialmente incomum nas tonsilas palatinas. O relato do caso descreve uma rara condição de nódulo amarelado encontrado na tonsila palatina esquerda de um paciente submetido à amigdalectomia. O paciente queixava-se de tosse seca havia três meses, sem relatar outro sintoma otorrinolaringológico. Foi feita a amigdalectomia devido a uma assimetria de volume entre as tonsilas palatinas. O exame anatomopatológico revelou fibrolipoma em tonsila esquerda. Após a cirurgia o sintoma de tosse seca regrediu totalmente.

Lipoma is a very common tumor of the connective tissue of the body. It is a neoplasm of benign characteristics composed of mature adipose cells. It is relatively common in the digestive tract, rare in the oropharynx, and especially uncommon in the palatine tonsil. A case report of a lipoma of the left tonsillar fossa is presented. The patient arrived complaining of dry cough during the last thee months, without other signal or symptom. The tonsillectomy was performed because of the volume asymmetry between the palatine tonsils. The histological findings revealed fibrolipoma in the left tonsil. After the surgery, the dry cough resolved completely.

Pseudo-aneurisma de artéria lingual tratado com embolização / Pseudolingual artery aneurysm treated with embolization

O pseudo-aneurisma traumático da artéria lingual tem ocorrência rara. É ocasionado por traumatismo na artéria lingual, sem o rompimento da mesma, formando um falso aneurisma. O número de complicações relativas à amigdalectomia são grandes, devido o grande número de cirurgias realizadas e sua anatomia (proximidade com grandes vasos). Esse caso é de um paciente do gênero masculino, 54 anos, sem comorbidades que foi submetido a uvulopalatofaringoplastia devido síndrome da apnéia e hipopnéia do sono obstrutiva sob anestesia geral. Durante a realização da amigdalectomia à direita, houve a ruptura de um grande vaso na loja amigdaliana, com intenso sangramento de difícil controle. Queremos, por meio do caso clínico de um pseudo-aneurisma traumático de artéria lingual, analisar as possíveis complicações da cirurgia de amigdalectomia.

The traumatic pseudoaneurism of the lingual artery is rare. It is caused by trauma in the lingual artery, without its disruption, forming a false aneurism. The rate of complications relative to the tonsil surgery is high due to the great number of surgeries carried through and the tonsil anatomy with proximity to the great vessels. We describe the case of a 54-year-old man, without comorbidity who underwent uvulopalatopharyngoplasty because of obstructive sleep apnea and hipopnea syndrome under general anesthesia. During the realization of the right tonsillectomy there was a rupture of a large vessel in the palatine tonsil region with intense bleeding difficulting the control. We wish to analyze the possible complications of tonsil surgery, by means of a clinical case of a traumatic lingual artery pseudoaneurism.

Estudo dos pulmöes, à necrópsia, de 31 pacientes tratados com amiodarona / Study of the lungs, by necropsy, of 31 patients treated with amiodarone

Foi realizado um estudo retrospectivo de 31 pacientes cardiopatas falecidos e necropsiados, com a finalidade de detectar alteraçöes no tecido pulmonar devidas a tratamento com amiodarona. Os resultados foram comparados com os obtidos em grupo-controle com características demográficas e clínicas semelhantes, exceto pela ausência de uso de amiodarona. As alteraçöes anatomopatológicas encontradas foram similares nos dois grupos, näo permitindo caracterizar uma pneumopatia típica atribuível ao medicamento, na casuística estudada

Patogênese do prolapso da valva mitral em chagásicos crônicos: estudo da miocardite dos músculos papilares / Pathogenesis of mitral valve prolapse in chronic chagas' heart disease patients: study of papillary muscle myocarditis

Objetivo - Estudar a valva mitral na cardiopatia chagásica crônica buscando eventual relaçäo entre causa e efeito com o prolapso daquele aparelho. Métodos - Dezessete coraçöes de indivíduos com cardiopatia chagásica crônica, sendo 11 do sexo masculino, idade entre 31 e 84 (média = 54) anos, resultantes de necrópsias realizadas até há um ano. As peças, devidamente conservadas, foram analisadas macro e microscopicamente. Foram retirados fragmentos dos músculos papilares da valva mitral, das regiöes anterior, lateral e posterior do ventrículo esquerdo, septo interventricular, parede livre de ventrículo direito e paredes dos átrios. Resultados - Miocardite crónica foi encontrada nos 17 casos (leve em 6, moderada em 7 e grave em 4). Também em todos os casos os músculos papilares apresentaram miocardite, sendo que, em 15 o grau de intensidade foi igual ou maior do que o observado nas outras regiöes do coraçäo. Conclusäo - Os músculos papilares da valva mitral säo sede muito freqüente de miocardite na cardiopatia chagásica crônica, fato que deve ser lembrado ao se discutir a patogênese do prolapso da mesma

Purpose- Studring the mitral valva in chronic Chagas' heart disease, searching a possible cause effect relationship between this condition and valve prolapse. Methods Seventeen hearts were surveged from individuals exhibiting chronic chagasic cardiopathy, 11 males and 6 females, aged between 31-84 (average 54) years. The hearts came from necropsies carried out until a year before. Properly preserved samples were analyzed macro and microscopicaly. Fragments were excised from the mitral valve papillary muscles, anterior, lateral and posterior regions of the left ventricle, interventricular septum, free wall of right ventricle and atrium walls. Results - Chronic myocarditis was found ill all the samples (mild in 6 of them, moderate in 7 and severe in 4). Also, the papillary muscles exhibited miocarditis in all of the samples, and in 15 of them the degree of severety was equal to or superior than the observed in degree other regions of the heart. Conclusion The chronic chagasic cardiopathy, the papillary muscle constitute afrequent site of myocardites. This fact must be held in mind when one discusses the pathogenesis of the prolapse of the valve

Biópsia endomiocárdica em cardiopatas chagásicos crônicos: um estudo, na necrópsia, para aferiçäo diagnóstica / Endomyocardial biopsy in chronical Chagas heart diseases: a study, in necropsy for diagnosis

Uma média de quatro fragmentos, medindo aproximadamente 3 mm**2, foram retirados do septo ventricular direito em regiöes superior, média e inferior, tomando-se como referencial o sulco interventricular, em pacientes falecidos em conseqüência da cardiopatia chagásica crônica. Os fragmentos foram corados pela hematoxilina-eosina e estudados à microscopatia óptica. Três observadores diferentes analisaram os fragmentos sem conhecimento prévio do diagnóstico. Os dados obtidos foram comparados com os diagnósticos encontrados em fragmentos de tamanho habitual obtidos na necrópsia em cada regiäo do septo onde se "biopsiou" e das paredes livres do ventrículo esquerdo e direito. Obtivemos correlaçäo entre os diagnósticos em 100% dos casos. Analisando-se a miocardite obtivemos que 21,35% dos fragmentos de tamanho equivalente ao obtido pelo método das biópsias näo apresentaram correlaçäo quantitativa com aqueles de tamanho habitualmente a necrópsia. Concluímos que a biópsia endomiocárdica é de grande sensibilidade para o diagnóstico de cardiopatia chagásica, mormente a miocardite, quando forem encontradas alteraçöes no material. Em caso negativo contudo näo é possível negar a existência do processo inflamatório