Pulmonary amoebiasis presenting as superior vena cava syndrome.

Pulmonary amoebiasis without liver involvement occurs sporadically as a result of haematogenous spread from a primary site, the colon. The case history is presented of a patient who developed superior vena cava syndrome due to a pulmonary amoebic abscess without liver involvement. He was initially suspected of having a neoplasm but a combination of tests including histological examination of the H&E stained excised tissue, immunofluorescence using anti-Entamoeba histolytica antibodies, and serology confirmed the diagnosis of amoebiasis. To our knowledge this is the first description of pulmonary amoebiasis presenting as superior vena cava syndrome.

Minimally invasive direct cardiac massage versus closed-chest cardiopulmonary resuscitation in a porcine model of prolonged ventricular fibrillation cardiac arrest.

Open chest cardiac massage has been shown to be superior to closed-chest cardiopulmonary resuscitation for both hemodynamics produced during resuscitation and ultimate resuscitation success. The inexperience of many rescuers with emergency thoracotomy, along with the associated morbidity contributes to the continued reluctance in the use of invasive cardiopulmonary resuscitation techniques. A device has been developed for performing 'minimally invasive' direct cardiac massage. This technique was compared to standard closed-chest CPR for resuscitation results in 20 swine during prolonged ventricular fibrillation cardiac arrest. Minimally invasive direct cardiac massage was superior to closed-chest CPR for return of spontaneous circulation (7/10 vs. 2/10; P<0.02) and coronary perfusion pressure at 30 min of CPR (17+/-9 vs. 6+/-6 mmHg; P<0.05). No significant injuries altering outcome were found with the invasive device. Throughout most of the time course of the study no significant differences in end-tidal expired carbon dioxide levels were noted. Nor were there any differences in 24-h survival. Improvements in assuring proper placement of the device on the epicardium should make this technique a potent advanced cardiac life support adjunct.

[Family with predominance of cardiac involvement in Steinert's disease]. / Família com predominância do comprometimento cardíaco na doença de Steinert.

We report an affected family (mother and two children) with prominent cardiac form as reflected by the mother, 49, with neuromuscular signs (muscular atrophy os face, neck and distally in the extremities) who received an implantable pacemaker after 2 consecutive episodes of syncope and baseline EKG with P-R of 250 ms, QRS of 130 ms (LBBB) and conduction system intervals displaying overt widening (AH of 140 ms with a ERP of junction tissue of 590 ms, and Wenckebach point of 115 bpm; and HV of 80 ms before and 95 ms after pharmacological stress with procainamide). As long as its mode of inheritance is autosomal dominant, the cardiovascular examination of her two affected siblings (F1 and F2) revealed: F1 (male, 31), with P-R of 180 ms and QRS of 100 ms; F2 (female, 27), with P-R of 200 ms and QRS of 100 ms, both with left axis deviation. Echocardiographic studies were normal in both, but Holter studies showed remarkable bradycardia in both and intermittent rate-related (phase 3) LBBB in F2. Also for F1 and F2 conduction system intervals, except for AH (normal in both), displayed severe widening (HV of 70 ms in F1 and of 80 ms in F2, but only in this later with a procainamide stress extra widening to 130 ms). All three patients showed normal NS function, as usual for the disease. F2 is kept under close surveillance for the appearance of any symptom. In conclusion, although rarely symptomatic, the intensity of IV conduction system damage should not be disregarded in this condition.

Econazol no tratamento das otites externas difusas. / Econazole in the treatment of diffuse otitis externa

Estudo terapeutico exclusivamente topico foi efetuado com o uso de econazol, econazol e triamcinolona, triamcinolona ou placebo (propilenoglicol), em 129 casos de otites externas bacterianas ou micoticas. A analise estatistica dos resultados foi efetuada atraves de teste do qui-quadrado e demonstrou a eficiencia de todas essas substancias em comparacao com a atividade do placebo e sem diferencas significantes entre si. Por outro lado, nenhum caso com otomicose deixou de ser sensivel a acao do econazol, isoladamente ou associado a triamcinolona. Nao foram observados quaisquer efeitos colaterais com o emprego de todas as drogas experimentais