[Clinical cross-sectional and epidemiologic study of Chagas disease in a rural area of the Argentinian northeast]. / Estudio transversal clínico y epidemiológico de la enfermedad de Chagas en una área rural del Nordeste Argentino.

The main goal was to know the epidemiologic, clinical, electrocardiographic and radiologic characteristics among a population of seropositives and seronegatives to Trypanosoma cruzi in a rural area of the Department of San Miguel, province of Corrientes, Argentina. One hundred and thirty-two patients of different ages: 2-79 years old were researched (58 males, 74 females). In order to make a thorough assessment clinical evaluation and cardiologic testing were carried out. Signs and symptoms consistent with heart disease, blood pressure, 12-lead ECG registry and chest x-ray (PA view) were registered. In signs and symptoms, abnormal ECG patterns and radiologic abnormalities, non-significant statistic difference were observed. Although we were unable to find a significant relationship between chagasic infection and a higher prevalence for heart disease, it is important to stress the fact that 54.0% of the studied population was largely composed of very young patients whose ages were less than 20 years old, and 45.0% of those older than 41 years showed ECG abnormalities.

Estudio transversal clínico y epidemiológico de la enfermedad de Chagas en una área rural del Nordeste Argentino / Clinical cross-sectional and epidemiologic study of Chagas disease in a rural area of the Argentinian northeast

Esta investigación tiene por objeto analizar las características epidemiológicas, clínicas, electrocardiográficas y radiológicas de una población de seropositivos y seronegativos al Trypanosoma cruzi en una área rural del Departamento San Miguel, provincia de Corrientes, Argentina. Se seleccionaron 132 pobladores (58 hombres y 74 mujeres) de todos los grupos etareos para la realización de un examen clínico y cardiovascular. Se registraron síntomas y signos compatibles con afección cardíaca, tensión arterial, electrocardiograma de 12 derivaciones y radiografía anteroposterior de tórax. En la signo-sintomatología, anomalías electrocardiográficas y en las alteraciones radiográficas detectadas, no se observaron diferencias estadísticamente significativas entre seropositivos y seronegativos. Se concluye que si bien en la población objeto de estudio la infección chagásica no se asoció a mayor prevalencia de cardiopatía, cabe destacar que los pacientes chagásicos pertenecían a un grupo etareo muy joven con un 54,0% de ellos menores de 20 años y que el 45,0% de los pacientes mayores de 41 años tenían alteraciones electrocardiográficas.

The main goal was to know the epidemiologic, clinical, electrocardiographic and radiologic characteristics among a population of seropositives and seronegatives to Trypanosoma cruzi in a rural area of the Department of San Miguel, province of Corrientes, Argentina. One hundred and thirty-two patients of different ages: 2-79 years old were researched (58 males, 74 females). In order to make a thorough assessment clinical evaluation and cardiologic testing were carried out. Signs and symptoms consistent with heart disease, blood pressure, 12-lead ECG registry and chest x-ray (PA view) were registered. In signs and symptoms, abnormal ECG patterns and radiologic abnormalities, non-significant statistic difference were observed. Although we were unable to find a significant relationship between chagasic infection and a higher prevalence for heart disease, it is important to stress the fact that 54.0% of the studied population was largely composed of very young patients whose ages were less than 20 years old, and 45.0% of those older than 41 years showed ECG abnormalities.

[Anatomo-clinical and epidemiologic study of Chagas disease]. / Studio anatomo-clinico ed epidemiologico della malattia di Chagas.

Chagas' disease is a chronic form caused by a parasite, the Trypanosoma Cruzi, endemic of Latin America. The Trypanosoma Cruzi is transmitted by hematophageous bugs, particularly in dilapidated rural areas. Three phases of the disease can be distinguished: 1) acute phase, with high tissue and blood parasitic involvement; 2) undetermined phase, in which the diagnosis requires sophisticated clinical investigations; 3) chronic phase (10-30 years following the infection), characterized particularly by cardiac disease manifestations. The present 120 patients were subdivided into four groups: 1) 43 asymptomatic serum-positive subjects; 2) 25 serum-positive patients with electrocardiographic abnormalities; 3) 14 serum-positive patients with cardiomegaly; 4) 38 with classic chagasic cardiopathy. Comparative studies among these four groups were carried out employing Holter monitoring (24h), ergometric and phonomechanographic tests, M-mode and bidimensional echography and radionuclide ventriculography. A significant difference between the first 3 groups and, respectively, the fourth group (p < 0.001) was found. Deadly-risk (p < 0.001) manifestation were pointed out, such as a third tone, right bundle branch block with left anterior hemiblock and left ventricle's dilation. Autoptic controls were performed and in 4 patients the myocardial biopsy showed C3 and IgG deposition in capillaries and myocardial fibers, at electron microscopic examination, some thickening of capillary and myocytic basal membrane, interstitial collagen proliferation, besides non-specific myocellular abnormalities were detected.

Alteraçöes mitocondriais e subcelulares tempo-dependentes após breve oclusäo coronariana seguida de reperfusäo em coraçäo de rato / Time-dependence of mitochondrial abnormality and subcellular changes after brief coronary occlusion followed by reperfusion in rat heart

Após 15 minutos de isquemia, realizada por oclusäo da artéria coronariana, coraçöes de ratos wistar foram reperfundidos por 0-5 hora, 6-11 horas ou 12-17 horas. Apesar das conhecidas características que ocorrem na anoxia miocárdial tal como eosinofilia (acidofilia - dados näo mostrados), edema celular e extracelular, e ondulaçäo das fibras, a alteraçäo mitocondrial foi nosso mais importante achado. A alteraçäo, evidenciada como um alongamento mitocondrial e um aspecto fusiforme, parece ser específi a estas condiçöes experimentais, ou seja, um curto período de hipóxia e um longo período de reperfusäo sanguínea. A razäo deste aspecto näo foi elucidada, mas pode ser devido às trocas peculiares que sofrem as mitocôndrias de tecidos isquêmicos reperfundidos.

Tripanosomiasis americana (Enfermedad de Chagas) y factor de necrosis tumoral alfa / American trypanosomiasis (Chagas' Disease) and tumor necrosis factor

Objetivo : sobre la base de comprobaciones de la intervención del TNF en enfermedades infecciosas y parasitarias, se planeó determinar si en infectados por el Trypanosoma cruzi se presentan elevaciones de la concentración de tal factor en relación a la afectación cardíaca. La hipótesis a priori es que, teniendo en cuenta lo ya verificado en otras enfermedades, las elevadas concentraciones del TNF alfa se correlacionan con el deterioro cardíaco. Diseño : estudio de comparación de casos por determinación de la concentración de TNF alfa en el suero de infectados chagásicos en fase indeterminada, libres de cardiopatía; pacientes con cardiomiopatía grave letal, en comparación a testigos sanos y otros con cardiopatía congestiva dilatada no parasitaria. Sede operativa : hospitales con centros de anatomía patológica (material de necropsia), bancos de sangre (detección de infectados) y centros de cardiología. Pacientes : Proveyeron sangre para las determinaciones : 4 casos de infección chagásica, 2 de ellos (edades 22 y 28 años) en fase indeterminada, libres de cardiopatía; 2 otros casos (edades 48 y 52 años) muertos por cardiomiopatía chagásica grave (confirmación histopatológica en material de necropsia). Como material comparativo : 16 pacientes sanos, no cardiópatas y 12 pacientes con cardiopatía congestiva dilatada, no infectoparasitaria. Intervención : extracción de 30 ml de sangre y determinación de la concentración de TNF alfa por radioinmunoensayo con el método de Teppo y Maury. Umbral de sensibilidad del método : 40 picogramos de TNF por mililitro. Resultados : los sueros de los 2 pacientes chagásicos indeterminados mostraron concentraciones de TNF alfa de 50 Y 72 picogramos por mililitro. En los pacientes con cardiopatía chagásica crónica mortal : 636 y 459 pg/ml. En 14 sujetos sanos el promedio fue inferior a 40 pg/ml; en dos adicionales 44,5 pg/ml. En 5 pacientes con cardiopatía congestiva dilatada estacionaria valores inferiores a 40 pg/ml; en 7 con evolución descompensada : 61 pg/ml (rango 40-88 pg). Conclusiones : en los dos pacientes que sufrieron cardiomiopatía chagásica crónica mortal se encontraron concentraciones sanguíneas más elevadas (casi 9 veces mayores en promedio) que en los 2 en fase indeterminada sin evidencia cardiopática, e igualmente por encima de los valores hallados en los pacientes con. En virtud del escaso número de casos con infección chagásica analizados, los autores consideran esta presentación sólo como base de orientación para un estudio sobre mayor número de pacientes, dadas las grandes diferencias en los valores hallados.

Tripanosomiasis americana (Enfermedad de Chagas) y factor de necrosis tumoral alfa / American trypanosomiasis (Chagas Disease) and tumor necrosis factor

Objetivo : sobre la base de comprobaciones de la intervención del TNF en enfermedades infecciosas y parasitarias, se planeó determinar si en infectados por el Trypanosoma cruzi se presentan elevaciones de la concentración de tal factor en relación a la afectación cardíaca. La hipótesis a priori es que, teniendo en cuenta lo ya verificado en otras enfermedades, las elevadas concentraciones del TNF alfa se correlacionan con el deterioro cardíaco. Diseño : estudio de comparación de casos por determinación de la concentración de TNF alfa en el suero de infectados chagásicos en fase indeterminada, libres de cardiopatía; pacientes con cardiomiopatía grave letal, en comparación a testigos sanos y otros con cardiopatía congestiva dilatada no parasitaria. Sede operativa : hospitales con centros de anatomía patológica (material de necropsia), bancos de sangre (detección de infectados) y centros de cardiología. Pacientes : Proveyeron sangre para las determinaciones : 4 casos de infección chagásica, 2 de ellos (edades 22 y 28 años) en fase indeterminada, libres de cardiopatía; 2 otros casos (edades 48 y 52 años) muertos por cardiomiopatía chagásica grave (confirmación histopatológica en material de necropsia). Como material comparativo : 16 pacientes sanos, no cardiópatas y 12 pacientes con cardiopatía congestiva dilatada, no infectoparasitaria. Intervención : extracción de 30 ml de sangre y determinación de la concentración de TNF alfa por radioinmunoensayo con el método de Teppo y Maury. Umbral de sensibilidad del método : 40 picogramos de TNF por mililitro. Resultados : los sueros de los 2 pacientes chagásicos indeterminados mostraron concentraciones de TNF alfa de 50 Y 72 picogramos por mililitro. En los pacientes con cardiopatía chagásica crónica mortal : 636 y 459 pg/ml. En 14 sujetos sanos el promedio fue inferior a 40 pg/ml; en dos adicionales 44,5 pg/ml. En 5 pacientes con cardiopatía congestiva dilatada estacionaria valores inferiores a 40 pg/ml; en 7 con evolución descompensada : 61 pg/ml (rango 40-88 pg). Conclusiones : en los dos pacientes que sufrieron cardiomiopatía chagásica crónica mortal se encontraron concentraciones sanguíneas más elevadas (casi 9 veces mayores en promedio) que en los 2 en fase indeterminada sin evidencia cardiopática, e igualmente por encima de los valores hallados en los pacientes con. En virtud del escaso número de casos con infección chagásica analizados, los autores consideran esta presentación sólo como base de orientación para un estudio sobre mayor número de pacientes, dadas las grandes diferencias en los valores hallados.

[Acute myocardial infarction and bronchoalveolar carcinoma. Association or coincidence?]. / Infarto agudo del miocardio y carcinoma bronquioalveolar. Asociación o casualidad?

The aim of this paper is to report for the first time the association between bronchiolo-alveolar carcinoma and acute myocardial infarction (AMI). Two patients suffering from this association were studied. A 59 year old male, diabetic, alcoholic and smoker was admitted because a diaphragmatic AMI. An interventricular septal defect and papillary posterior muscle rupture were confirmed at autopsy. A 0.8 cm diameter friable mass was found in the right lung superior lobe. The second case was a 69 year old male, smoker, who presented with a diaphragmatic and right ventricular posterior wall AMI. A round 1 cm diameter tumor was observed at the right lung superior lobe. It had a caseous aspect lying over a fibrous scar. Both cases had severe right coronary artery narrowings with recent occlusive thrombi. The cardiac valves were free of non-bacterial thrombotic endocarditis. Therefore the possibility of coronary embolization was discarded. As lung carcinomas produce vasospastic and thrombogenic mucins, these substances could have been responsible for the acute coronary thrombosis.

Histopathology of specialized and ordinary myocardium and nerves in chronic Chagas disease, with a morphometric study of inflammation and fibrosis.

Chagas disease, in the chronic phase, is known to be characterized by cardiac failure, and/or arrhythmias. To assess the involvement of the conduction system and of the working myocardium, morphometric and immunohistochemistry studies have been carried out on 4 autoptic hearts of chronic chagasic myocardiopathy. The characterization of interstitial infiltrates was performed by lymphocyte immunophenotyping with immunocytochemical techniques. These infiltrates were more prominent in the working myocardium and in the left branch of the His bundle. The infiltrates consisted of about 50% of macrophages and 50% of T-lymphocytes. Mast cells would not play a role in the chronic stages of the disease. Eosinophils were present in no more than the 5% of the inflammation. The fibrosis, especially of the conducting system seems to be facilitated by an impaired lymphatic outflow, whereas the evidence of neuroganglionic involvement was variable.

Morphometry of skeletal muscle involvement in mice infected or preimmunized with live attenuated Trypanosoma cruzi.

A morphometric study was undertaken in the quadriceps muscle of Swiss mice in order to assess the effects of immunization with attenuated T. cruzi upon tissue lesions. interfascicular lymphocytic infiltration, presence of amastigote nests, vascular lesions, degeneration and fibrosis were evaluated independently. Each of these alterations was drastically prevented in preimmunized animals. These results indicate that immunity against T. cruzi not only reduces circulating parasites but also clears most of the organic damage caused by infection.

Morphometry of skeletal muscle involvement in mice infected or preimmunized with live attenuated Trypanosoma cruzi

A morphometric study was undertaken in the quadriceps muscle of Swiss mice in order to assess the effects of immunization with attenuated T. cruzi upon tissue lesions. interfascicular lymphocytic infiltration, presence of amastigote nests, vascular lesions, degeneration and fibrosis were evaluated independently. Each of these alterations was drastically prevented in preimmunized animals. These results indicate that immunity against T. cruzi not only reduces circulating parasites but also clears most of the organic damage caused by infection.

Morphometry of skeletal muscle involvement in mice infected or preimmunized with live attenuated Trypanosoma cruzi.

A morphometric study was undertaken in the quadriceps muscle of Swiss mice in order to assess the effects of immunization with attenuated T. cruzi upon tissue lesions. interfascicular lymphocytic infiltration, presence of amastigote nests, vascular lesions, degeneration and fibrosis were evaluated independently. Each of these alterations was drastically prevented in preimmunized animals. These results indicate that immunity against T. cruzi not only reduces circulating parasites but also clears most of the organic damage caused by infection.

Morphometry of skeletal muscle involvement in mice infected or preimmunized with live attenuated Trypanosoma cruzi.

A morphometric study was undertaken in the quadriceps muscle of Swiss mice in order to assess the effects of immunization with attenuated T. cruzi upon tissue lesions. interfascicular lymphocytic infiltration, presence of amastigote nests, vascular lesions, degeneration and fibrosis were evaluated independently. Each of these alterations was drastically prevented in preimmunized animals. These results indicate that immunity against T. cruzi not only reduces circulating parasites but also clears most of the organic damage caused by infection.

Hemodynamic effects of chronic 4'epi-adriamycin administration.

Adriamycin (ADM) is an effective antineoplastic drug. However, the amount of ADM that can be administered must be limited because of the risk of developing a severe dose-dependent cardiomyopathy. 4'Epi-adriamycin (4'ADM) is a new anthracycline analog with similar antineoplastic properties as ADM, but with perhaps less cardiac toxicity. To determine myocardial performance after a chronic treatment with 4'ADM, we studied 17 patients (mean age 36.6 years) suffering from lymphomas by means of 24-hour ambulatory ECG, x-ray, M-mode echocardiogram, and rest-exercise gated radionuclide ventriculography (RNV), performed prior to and 2 months after the end of the treatment. Pretreatment and post-treatment shortening fractions, basal pretreatment and post-treatment ejection fractions, and postexercise pretreatment and post-treatment ejection fractions, were tested for correlation with individual 4'ADM doses and pretreatment with ADM. No association was noted among them, showing the lack of correlation between doses and impairment of ventricular performance. 4'ADM doses ranged from 400 to 1100, x 748 +/- 174 mg/m2; all noninvasive studies including RNV were normal. No correlation was found between 4'ADM doses and RNV (Pearson's correlation coefficient, p = ns). No deterioration of ventricular performance could be demonstrated. Conversely, the basal pretreatment ejection fraction changed from 56.17 +/- 7.6% to 61.52 +/- 8.3% in post-treatment (p less than 0.0001). Surprisingly, the post-exercise pretreatment ejection fraction also increased from 55.47 +/- 7.7% to 63.35 +/- 10% in post-treatment (p less than 0.03). The shortening fraction changed from 35.47 +/- 4.8% to 36.47 +/- 4.2% after 4'ADM treatment (ns). No impairment of cardiac function could be shown in patients previously treated with ADM or radiotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Panarteritis precipitating extensive circumferential acute myocardial infarction. A case report.

It is widely known that other causes than recent coronary thrombosis may precipitate acute myocardial infarction in the presence of coronary atherosclerosis. A 48 year old male patient was admitted due to acute coronary insufficiency. The ECG showed anterolateral necrosis and lateral ischemia. Despite medication angina persisted and he died immediately after coronary angiography. At autopsy, established coagulation necrosis was observed in the internal half and the subendocardium of the lateral and posterior walls, of the left ventricle. Early coagulation necrosis occupied the inner half of the anterior, posterior and septal walls. Severe atherosclerotic coronary lesions were found in all major coronary trunks. An extensive panarteritis, involving extra and intramyocardial branches, consisting of mononuclear cells and prominent edema, was observed. A mixed mechanism may be invoked to explain the extensive myocardial necrosis: panarteritic infiltrates and extensive edema and humoral-induced coronary spasm.

Myocardial involvement in Cavia porcellus naturally infected with Trypanosoma cruzi.

This paper describes the myocardial involvement analyzed by histopathological examination in rural Cavia porcellus during natural T. cruzi infection. Four Cavia porcellus of both sexes were bred in a house free of Triatoma infestans. In contrast, four animals were born and lived in a rural yard colonized by T. infestans. Autopsies were performed at 6-9 months of age, in animals weighing 550 to 750 grams. The naturally infected Cavia porcellus presented moderate and severe lymphocyte and plasmocyte infiltrates, focally or diffusedly distributed. Replacement of myocytes both in atria and ventricles was often found and consisted of loose or dense connective tissue infiltration. Regarding the conducting system, polymorphonuclear cell infiltrates were observed in the A-V node and in the left bundle branch. Uninfected Cavia porcellus did not show these lesions. Typical chagasic cysts were not found in the naturally infected Cavia porcellus hearts. Parasitism was not observed in the skeletal muscles. It is concluded that naturally infected Cavia porcellus develop consistent lesions similar to those described in human chronic chagasic myocardiopathy. The high susceptibility of naturally infected Cavia porcellus must be taken into account when these animals are used in studies regarding chronic chagasic myocardiopathy.

Myocardial involvement in cavia porcellus naturally infected with Trypanosoma cruzi

Se describe el compromiso miocárdico en el Cavia porcellus rural por la infección natural con T. cruzi. Se estudiaron ocho animales, 4 crisdos libres de T. infestans y otros 4 animales que habían nacido y vivido en medio rural. Los xenodiagnósticos en el grupo no infectado fueron negativos siendo positivos en el infectado. Entre 6-9 meses de edad se efectuó autopsia completa. Los C. porcellus infectados presentaron infiltrados linfoplasmocitarios moderados y severos, focales o difusos, aún reemplazando el plexo ganglionar auricular. No fue raro observar tejido conectivo laxo en aurículas y ventrículos y polimorfonucleares en el nodo A-V y en la rama izquierda del Haz de His. No se encontraron quistes en el corazón, ni parásitos en el músculo esquelético. Los C. porcellus no infectados presentaron sólo lesiones leves. Los valores fueron: no infectados, 2,2 ñ 1,2 e infectado 9,6 ñ 3,2 ( p<0,001) (Tabla 1). Esto coincidió con la sumatoria de lesiones por animal, y al promediarlos con los otros integrantes del grupo (3,25 vs 14,5). Se demuestra la utilidad de los cavia porcellus para el estudio de la infección crónica al reproducir lesiones semejantes a las del humano