Sex disparities determined by biometric and hematological measurements in Astyanax bimaculatus / [Disparidades sexuais determinadas por medições biométricas e hematológicas em Astyanax bimaculatus]

This study aimed to compare the body indexes and hematological characteristics between Astyanax bimaculatus males and females. Four hundred fish were randomly distributed into four polyethylene tanks (100 fish/unit) in a recirculation system and fed four times a day (3% of biomass). After 90 days, ten fish (five ♀ and five ♂) were removed to perform blood tests and to measure weight, height, total length, height/length ratio, condition factor and index determination: vicerosomatic (VSI), hepatosomatic (HSI), and gonadosomatic (GSI). The results showed a higher average weight (g) in females (12.32±0.71) compared to males (6.98±0.75), the same happened to height (cm) = (3.01±0.07) and (2.40±0.05), total length (cm) = (3.01±0.07) and (2.40±0.05), VSI (%) = (11.43±0.81) and (3.55±1.05), HSI (%) = (0.72±0.08) and (0.30±0.04), respectively. Mean corpuscular hemoglobin (pg) was higher in females (3.72±1.20) than in males (2.99±1.51). Regarding the number of thrombocytes (103.µL-1), there was an increase in males (25.71±3.91) compared to females (17.40±6.40).(AU)

O objetivo deste trabalho foi comparar os índices corporais e as características hematológicas entre machos e fêmeas de Astyanax bimaculatus. Quatrocentos peixes foram distribuídos aleatoriamente em quatro caixas de polietileno (100 peixes/unidade), em sistema de recirculação, e alimentados quatro vezes ao dia (3% da biomassa). Após 90 dias, 10 peixes (cinco ♀ e cinco ♂) foram retirados para realização das análises sanguíneas e para mensuração do peso, da altura, do comprimento total, da relação altura/comprimento, do fator de condição e da determinação dos índices: viscerossomático (IVS), hepatossomático (IHS) e gonadossomático (IGS). Os resultados mostraram um maior peso médio (g) nas fêmeas (12,32±0,71) em relação aos machos (6,98±0,75); o mesmo aconteceu para altura (cm) = (3,01± 0,07) e (2,40± 0,05), comprimento total (cm) = (3,01±0,07) e (2,40±0,05), IVS (%) = (11,43±0,81) e (3,55±1,05), IHS (%) = (0,72±0,08) e (0,30±0,04), respectivamente. Hemoglobina corpuscular média (pg) foi maior nas fêmeas (3,72±1,20) que nos machos (2,99±1,51). Em relação ao número de trombócitos (103/µL), houve um aumento nos machos (25,71± 3,91) em relação às fêmeas (17,40±6,40).(AU)

Supplementation of Curcuma longa hydrolate improves immunomodulatory response in Nile tilapia reared in a recirculation aquaculture system / [Suplementação de extrato aquoso de Curcuma longa aprimorando a resposta imunomoduladora em tilápias cultivadas em sistema de recirculação em aquicultura]

The objective of this study was to evaluate the effects of dietary supplementation with different doses of Curcuma longa hydrolate on the hematological, immunological and zootechnical parameters of Nile tilapia cultivated in a recirculation system (RAS). Nile tilapia (Oreochromis niloticus) were used, distributed in 16 polyethylene boxes, divided into four treatments: 0.0%; 2.5%; 7.5% and 10.0% of Curcuma longa hydrolate, in quadruplicate. After 45 days of treatment, four fish per experimental unit were anesthetized to remove blood aliquot for hematological and immunological analyzes and dissect the liver to evaluate the hepatosomatic index and final biometry. In the haematological analysis, the fish fed with 2.5% had a higher number of leukocytes, monocytes and lymphocytes than control, while the doses of 7.5% and 10.0% did not differ. Antimicrobial activity showed a significant decrease as the dose of C. longa hydrolate increased. The other hematological, immunological, hepatosomatic index and zootechnical data did not differ between treatments. Thus, supplementation of the hydrolate of Curcuma longa at a dosage of 2.5%, improved and maintained blood-immune homeostasis parameters in these animals, being suggested for further studies.(AU)

O objetivo deste estudo foi avaliar os efeitos da suplementação dietética com diferentes doses de hidrolato de Curcuma longa nos parâmetros hematológicos, imunológicos e zootécnicos da tilápia-do-nilo cultivada em sistema de recirculação. Utilizou-se tilápia- do-nilo (Oreochromis niloticus), distribuída em 16 caixas de polietileno, divididas em quatro tratamentos: 0,0%; 2,5%7,5% e 10,0% de hidrolato de Curcuma longa, em quadruplicata. Após 45 dias de tratamento, quatro peixes por unidade experimental foram anestesiados para remover uma alíquota sanguínea para análises hematológicas e imunológicas, e removeu-se o fígado para avaliar o índice hepatossomático e a biometria final. Na análise hematológica, os peixes alimentados com 2,5% apresentaram maior número de leucócitos, monócitos e linfócitos que no controle, enquanto as doses de 7,5% e 10,0% não diferiram. Por outro lado, a atividade antimicrobiana apresentou uma redução significativa à medida que a dose de hidrolato de C. longa aumentou. Os demais dados hematológicos, imunológicos, hepatossomáticos e zootécnicos não diferiram entre os tratamentos. Assim, a suplementação do hidrolato de Curcuma longa, na dose de 2,5%, melhorou os parâmetros hematoimunológicos e manteve a homeostase nesses animais, sendo sugerida para novos estudos.(AU)

Action time and feed frequency of Lactobacillus plantarum for Nile tilapia / Tempo de ação e frequência alimentar do Lactobacillus plantarum para tilápia-do-nilo

O objetivo desta pesquisa foi avaliar o tempo de ação do Lactobacillus plantarum no trato intestinal, assim como em qual frequência esse probiótico deve ser oferecido para tilápia-do-nilo (Oreochomis niloticus). Quarenta e oito tilápias foram alimentadas com ou sem probiótico, durante 14 dias. Após esse período, os peixes foram esviscerados, e amostras do trato intestinal foram semeadas em ágar TCBS, cetrimide e MRS. Esse procedimento foi repetido dois, quatro e seis dias após o 14º dia. Depois disso, 252 tilápias foram divididas em quatro tratamentos, peixes alimentados com probiótico suplementado em 100%, 50%, 25% e 0% (controle) das alimentações. Após nove semanas, os índices zootécnicos foram avaliados. No dia zero, verificou-se maior concentração de bactérias ácido-lácticas e menor concentração de Vibrios spp. e de Pseudomonas spp. no trato intestinal dos alevinos alimentados com probiótico. Peixes alimentados com 100% e 50% das alimentações suplementadas com probiótico apresentaram melhores índices zootécnicos que os peixes alimentados com 25% de suplementação e sem suplementação. O L. plantarum atuou por quatro dias após a última alimentação, e, para obter os melhores índices, essa cepa deve ser suplementada em 50% das alimentações por dia para tilápia-do-nilo (O. niloticus).(AU)

Selection of autochtone probiotic for Astyanax bimaculatus / Seleção de probiótico autóctone para Astyanax bimaculatus

This study aimed to isolate native lactic acid bacteria of yellow tail lambari (Astyanax bimaculatus) and evaluate their effect on host microbiota and gut morphology, as well as survival after experimental challenge. The isolated bacterial strains were evaluated for their inhibition against pathogenic bacterial strains in vitro, and the strain with highest inhibitory ability was molecularly identified as Lactobacillus spp. For in vivo testing, eighty fish were distributed in ten tanks equipped with a recirculation system. The experimental units were divided into two treatments: fish fed with Lactobacillus spp. supplement and fish fed an unsupplemented diet (control). After 30 days, guts from three fish from each experimental unit were pooled for microbiological and histological analysis. The other five fish were inoculated with 2.1x104CFU.mL-1 of Aeromonas hydrophila to evaluate survival after 24h. Lambaris fed with the probiotic diet had a lower count of Vibrios spp., Pseudomonas spp. and Staphylococcus spp., and a higher count of lactic acid bacteria compared to control treatment, as well as, increased length, width and perimeter of intestinal villi, as well as higher survival rate (16.2%) after experimental challenge compared to the unsupplemented group. The results show that the Lactobacillus spp. used has effect probiotic for yellow tail lambari.(AU)

Este estudo objetivou isolar bactéria ácido-láctica nativa do lambari-do-rabo-amarelo (Astyanax bimaculatus) e seu efeito na microbiota e morfologia do trato digestório do hospedeiro, assim como a sobrevivência após um desafio experimental. As bactérias isoladas foram avaliadas quanto a suas inibições in vitro contra bactérias patogênicas; a cepa com maior capacidade de inibição foi identificada como Lactobacillus spp. Para o teste in vivo, 80 peixes foram distribuídos em 10 tanques equipados com sistema de recirculação. As unidades experimentais foram divididas em dois tratamentos: peixes alimentados com Lactobacillus spp. suplementado e peixes alimentados com dieta não suplementada (controle). Após 30 dias, foram coletados o trato intestinal de três peixes, por unidade experimental, para análises microbiológicas e histológicas. Outros cinco peixes foram inoculados com 2,1x104UFCmL-1 de Aeromonas hydrophila para se avaliar a sobrevivência após 24h. Lambaris alimentados com probiótico apresentaram menor contagem de Vibrios spp., Pseudomonas spp. e Staphylococcus spp., e maior de bactérias ácido-lácticas quando comparados com o tratamento controle, assim como aumento do comprimento, da largura e do perímetro das vilosidades intestinais e maior taxa de sobrevivência (16,2%,) após desafio experimental, em comparação com o grupo sem suplementação. Os resultados mostram que o Lactobacillus spp. possui efeito probiótico para o lambari-do-rabo-amarelo.(AU)

Efeito do uso de pentoxifilina no período neonatal sobre a produção espermática em ratos Wistar adultos / Effect of pentoxifylline during neonatal period on spermatic production in adult Wistar rats

Utilizaram-se doses crescentes de pentoxifilina em ratos Wistar neonatos visando aumentar a produção espermática em animais adultos. Trinta e sete animais foram distribuídos de acordo com os tratamentos: não tratados (n=10) e tratados com 1mg/kg (n=10), 5mg/kg (n=9) e 10mg/kg (n=8) de pentoxifilina (IP). Aos 90 dias, os animais foram anestesiados e perfundidos intracardiacamente com solução fixadora. Os testículos foram processados rotineiramente para inclusão em resina plástica à base de glicol metacrilato. Cortes histológicos de 4µm de espessura foram corados em azul de toluidina/borato de sódio a 1 por cento e analisados histometricamente. O número de células de Sertoli por secção transversal diminuiu nos grupos tratados com 5mg/kg e 10mg/kg em relação aos grupos controle e tratado com 1mg/kg. O índice de células de Sertoli aumentou nos animais tratados com 5mg/kg em comparação aos do grupo-controle. A utilização da pentoxifilina não foi capaz de induzir aumento na população das células de Sertoli e produção espermática em ratos adultos.

Increasing doses of pentoxifylline were administrated to newborn Wistar rats in order to augment Sertoli cell number and sperm production in the adult rats. Thirty-seven neonate Wistar rats were distributed in four groups: control (n=10) and treated with 1mg/kg (n=10), 5mg/kg (n=9), and 10mg/kg (n=8) of pentoxifylline. At 90 days, the animals were submitted to anesthesia and intracardiac perfusion. Testes were colleted and routinely processed for inclusion in plastic resin with glycol methacrylate. Histological sections (4µm) were stained in toluidine blue/sodium borate (1 percent) and analyzed. Number of Sertoli cell per transversal section of seminiferous tubule had significant reduction in the groups treated with 5mg/kg and 10mg/kg of pentoxifylline as compared to control and the group that received 1mg/kg (P<0.05). The Sertoli cell index significantly increased in the group treated with 5mg/kg compared to control group. Pentoxifylline did not cause increase in the number of Sertoli cells and daily sperm production in adult male rats.

Desempenho comercial dos medicamentos genéricos, seus medicamentos de referência e similares em Farmácia Universitária, Belo Horizonte, 2000 / Sale performance of generic medicines, their reference and similar medicines in a University Pharmacy, Belo Horizonte, 2000

O estudo comparou o desempenho comercial de medicamentos genéricos com seus respectivos medicamentos de referência e similares, na Farmácia Universitária (F.U.) da UFMG. Utilizando relatório da curva ABC, foram selecionadas as dez apresentações de genéricos mais vendidas em 2000 e seus medicamentos de referência e similares comercializados na F.U. Avaliou-se o volume de vendas e o faturamento obtido para esse grupo de medicamentos. Observou-se aumento progressivo da participação dos genéricos nas vendas desse grupo. Em julho, os genéricos representaram 48 por cento do total dessas vendas e em dezembro, atingiram 70 por cento desse total. Coincidindo com a diminuição das vendas dos medicamentos de referência e similares, detectou-se uma queda de 34 por cento no faturamento para o conjunto de medicamentos estudados. Concluiu-se que essa queda vincula-se ao crescimento nas vendas dos genéricos, considerando o menor custo desses. Por outro lado, à medida que ocorra consolidação do mercado dos medicamentos genéricos essa situação deve mudar, pois se espera uma ampliação progressiva do acesso da população aos medicamentos e um conseqüente aumento nas vendas das farmácias.

Normalization of left ventricular dysfunction in systemic hypertension.

BACKGROUND: In hypertensive heart disease, it is uncertain whether the impairment of left ventricular (LV) systolic function might be reverted by antihypertensive treatment. HYPOTHESIS: This study was undertaken to address the likelihood of recovery of LV dysfunction and to identify factors potentially related. METHODS: Twenty-six patients with primary (n = 16) and renovascular (n = 10) hypertension participated in the study and were classified into Groups A (n = 12) and B (n = 14) according to normalization or persistent left ventricular dysfunction (fractional shortening < 0.30) after 36 weeks of follow-up. All patients received standard medical therapy and appropriate procedures for renovascular disease correction. Logistic regression analysis was used to identify variables associated with recovery. RESULTS: Patients in Group A compared with those in Group B were younger (41 +/- 14 vs. 52 +/- 10 years; p < 0.05), had a greater frequency of renovascular hypertension (8 vs. 2; p < 0.05), showed shorter LV end-diastolic (54 +/- 5 vs. 61 +/- 8 mm; p < 0.05) and end-systolic dimensions (41 +/- 6 vs. 49 +/- 9 mm; p < 0.05), and lower mass index (215 +/- 64 vs. 261 +/- 47 g.m-2; p < 0.05) before treatment, whereas fractional shortening (0.24 +/- 0.4 vs. 0.20 +/- 0.5; p > 0.05) and diastolic blood pressure (116 +/- 12 vs. 122 +/- 19 mmHg; p > 0.05) were similar. On follow-up, Group A patients showed lower diastolic blood pressure (89 +/- 15 vs. 105 +/- 20 mmHg; p < 0.05) and mass index (142 +/- 34 vs. 222 +/- 40 g.m-2; p < 0.05). Logistic regression analysis identified systolic dimension and renovascular hypertension as factors associated with fractional shortening normalization. CONCLUSION: The recovery of LV dysfunction is expected to occur most likely in patients with renovascular hypertension and the shortest systolic dimensions.

L-arginine reduces heart rate and improves hemodynamics in severe congestive heart failure.

BACKGROUND: Stimulated endothelium-derived relaxing factor-mediated vasodilation and conduit artery distensibility are impaired in congestive heart failure (CHF). L-arginine could have a potentially beneficial role in CHF, acting through the nitric oxide (NO)-L-arginine pathway or by growth hormone increment. HYPOTHESIS: This study was undertaken to investigate the effects of L-arginine on heart rate, hemodynamics, and left ventricular (LV) function in CHF. METHODS: In seven patients (aged 39 +/- 8 years) with CHF, we obtained the following parameters using echocardiography and an LV Millar Mikro-Tip catheter simultaneously under four conditions: basal, during NO inhalation (40 ppm), in basal condition before L-arginine infusion, and after L-arginine intravenous infusion (mean dose 30.4 +/- 1.9 g). RESULTS: Nitric oxide inhalation increased pulmonary capillary wedge pressure from 25 +/- 9 to 31 +/- 7 mmHg (p < 0.05), but did not change echocardiographic variables or LV contractility by elastance determination. L-arginine decreased heart rate (from 88 +/- 15 to 80 +/- 16 beats/min, p<0.005), mean systemic arterial pressure (from 84 +/- 17 to 70 +/- 18 mmHg, p < 0.007), and systemic vascular resistance (from 24 +/- 8 to 15 +/- 6 Wood units, p<0.003). L-arginine increased right atrial pressure (from 7 +/- 2 to 10 +/- 3 mmHg, p<0.04), cardiac output (from 3.4 +/- 0.7 to 4.1 +/- 0.8 l/min, p < 0.009), and stroke volume (from 40 +/- 9 to 54 +/- 14 ml, p < 0.008). The ratios of pulmonary vascular resistance to systemic vascular resistance at baseline and during NO inhalation were 0.09 and 0.075, respectively, and with L-arginine this increased from 0.09 to 0.12. CONCLUSION: L-arginine exerted no effect on contractility; however, by acting on systemic vascular resistance it improved cardiac performance. L-arginine showed a negative chronotropic effect. The possible beneficial effect of L-arginine on reversing endothelial dysfunction in CHF without changing LV contractility should be the subject of further investigations.

[Acute effects of ibopamine on left ventricular mechanics and contractility in patients with idiopathic dilated cardiomyopathy]. / Efeitos agudos da ibopamina sobre a mecânica e a contratilidade ventricular esquerda em pacientes com cardiomiopatia dilatada idiopática.

PURPOSE: The effects of ibopamine (IBO) on left ventricular (LV) mechanics and contractility have not been described. The aim of this study was to test the hypothesis that IBO has a contractile effect at a dose of 200 mg. METHODS: Ten male patients (43 +/- 7 years) with refractory heart failure due to idiopathic dilated cardiomyopathy were studied. The patients were submitted to simultaneous echo-Doppler and hemodynamic (microtip catheter) studies, before (B) and after (20, 40 and 60 minutes) a dose of 200 mg of IBO. LV pressure/diameter and stress/strain relations were obtained. Subsequently, heart rate (HR-bpm), cardiac output (CO-L/m), end-diastolic pressure (EDP-mmHg); fractional shortening (FS-%); maximal elastance (Emax-mmHg/cm/s); end systolic (ESS-g/cm2) and end-diastolic (EDS-g/cm2) stress; chamber (Kp-mmHg/cm) and muscle (K(m)-g/cm2) stiffness, and the time of constant relaxation (Tau-ms) were analyzed. RESULTS: Results were presented as mean +/- standard deviation for conditions before and after IBO (20, 40 and 60 minutes) respectively. There was no change in HR (99 +/- 7; 100 +/- 7; 99 +/- 8; 99 +/- 10). Significant increases were observed in CO (4.13 +/- 1.28; 4.95 +/- 1.38; 5.13 +/- 1.86; 5.18 +/- 1.57), FS (13.7 +/- 2.4; 15.4 +/- 2.8; 15.9 +/- 1.8; 16.1 +/- 2.0), and Emax (14.8 +/- 3.2; 16 +/- 3.6; 17.7 +/- 4.2; 17.6 +/- 4.2). A transient (20 minutes) increase followed by a decrease (40 and 60 minutes) occurred in EDP (26.3 +/- 4.2; 30.6 +/- 6.4; 24.6 +/- 5.6; 22.3 +/- 4.6), EDS (79.7 +/- 22.8; 91.7 +/- 29.6; 79 +/- 31; 63 +/- 17.3), and Kp (27.2 +/- 12.6; 60 +/- 26.7; 27.9 +/- 11.7; 28.1 +/- 11). CONCLUSION: IBO has a beneficial effect on LV systolic and diastolic function as well as on contractility in patients with heart failure due to idiopathic dilated cardiomyopathy.

Mid-term results of heart transplantation, cardiomyoplasty, and medical treatment of refractory heart failure caused by idiopathic dilated cardiomyopathy.

BACKGROUND: Heart transplantation is the surgical procedure of choice for treatment of refractory heart failure. However, it benefits a small number of patients because of the limited number of donors and selection criteria of recipients. Cardiomyoplasty is an alternative surgical procedure for heart failure. The aim of this investigation was to report our experience with heart transplantation, cardiomyoplasty, and clinical treatment of heart failure caused by idiopathic dilated cardiomyopathy. METHODS: Ninety patients with refractory heart failure caused by idiopathic dilated cardiomyopathy were observed from May 1988 to March 1993. The patients had New York Heart Association functional class III or IV symptoms. The patients were divided in three groups according to the treatment received: heart transplantation (33 patients), cardiomyoplasty (25 patients), or medical treatment (32 patients). We studied the event-free curve, the New York Heart Association functional class, the left ventricular ejection fraction, and the morbidity of the groups in the follow-up of 19 +/- 16 months. We considered as an event death or crossover to another group because of severe symptoms. RESULTS: The event-free rate in the cardiomyoplasty group was 92%, 88%, 79%, 74%, and 62% at 3, 9, 12, 18, and 24 months of follow-up, respectively. The event-free rate after heart transplantation was 82%, 78%, 82%, 75%, and 69% at 3, 9, 12, 18, and 24 months, respectively. The event-free rate in the medical treatment group was 78%, 65%, 61%, 48%, and 48% at 3, 9, 12, 18, and 24 months, respectively. All surviving patients in the heart transplantation group had functional class I symptoms. After cardiomyoplasty 90% of surviving patients had class I or II symptoms and 10% had class III symptoms. However, in the medical treatment group 27% of surviving patients had class I or II symptoms and 67% had class III or IV symptoms. In the cardiomyoplasty group left ventricular ejection fraction increased from 20% +/- 3% to 24.4% +/- 6.3% at 6 months (p < 0.05). In the heart transplantation group the left ventricular ejection fraction normalized, and the mean value of the left ventricular ejection fraction did not change in the medical treatment group. The need for endomyocardial biopsy and the incidence of rejection and infection were characteristics of the heart transplantation group. CONCLUSIONS: In properly selected patients, cardiomyoplasty and heart transplantation seem to be associated with improvement in survival and functional class at mid-term follow-up. Heart transplantation was more effective than cardiomyoplasty for functional class improvement.

[Effects of rejection on the contractile reserve of the graft after heart transplantation]. / Efeitos da rejeição na reserva de contratilidade do enxerto após o transplante cardíaco.

PURPOSE: To test the hypothesis that rejection could affect the contractility and contractile reserve of left ventricle after heart transplantation. METHODS: Echocardiographic parameters and noninvasive blood pressure end-systolic pressure (ESP), heart rate (HR), end diastolic (EDV) and end-systolic (ESV) volumes, ejection fraction (EF), end-systolic stress (ESS) and the end-systolic relation (ESS/ESV) were recorded in 68 studies in 11 patients, seven days-12 months after heart transplantation. Accordingly with the endomyocardial biopsies results were divided into two groups: group A-with no rejection (53 studies), and group B-with rejection (15 studies). RESULTS: The nitroprusside infusion changed significantly and in the same way, all the parameters except the ESS/ESV ratio (A = 5.5 +/- 1.7 x B = 4.8 +/- 1.5 g/cm2/mL, p = NS); there was a decrease in ESP (A = 107 +/- 15 and B = 109 +/- 12 mmHg, p = NS), EDV (A = 68 +/- 19 and B = 81 +/- 12 mL, p = NS), ESV (A = 12 +/- 5 and B = 18 +/- 12 mL, p = NS) and ESS (A = 59 +/- 13 and B = 82 +/- 20g/cm2, p = NS); there was an increase in HR (A = 94 +/- 9 and B = 93 +/- 16bpm, p = NS) and EF (A = 83 +/- 5 and B = 79 +/- 8%, p = NS). In the dobutamine study it was observed differences for both groups, except for ESP (A = 156 +/- 26 and B = 149 +/- 26mmHg, p = NS). The increase in HR, EF and ESS/ESV ratio was greater in group A (HR-A = 117 +/- 19 and B = 102 +/- 25bpm, p < 0.05; EF-A = 91 +/- 4 and B = 78 +/- 11%, p < 0.05; ESS/ESV-A = 13.1 +/- 6 and B = 6.1 +/- 3.1 g/cm2/mL, p < 0.05). For group A it was smaller the EDV (57 +/- 18 x 94 +/- 35 mL, p < 0.05), ESV (5 +/- 3 x 24 +/- 20 mL, p < 0.05) and ESS (57 +/- 21 x 102 +/- 40 g/cm2, p < 0.05). CONCLUSION: Rejection may not induce changes in resting left ventricular contractility, however, the contractile reserve is depressed during an episode of moderate to severe rejection.

In vivo detection of Trypanosoma cruzi antigens in hearts of patients with chronic Chagas' heart disease.

The heart is the most commonly affected organ in chronic Chagas' disease, and lymphocytic myocarditis is often observed. However, the pathogenesis of chronic Chagas' heart disease is controversial. The purpose of this study was to determine whether in vivo T. cruzi antigens could be detected in hearts from patients with chronic Chagas' disease and to investigate whether a correlation between these antigens and the intensity of myocardial inflammation exists. We studied 16 patients with chronic Chagas' heart disease. Ten patients had severely impaired left ventricular function and refractory heart failure, and six had episodes of sustained ventricular tachycardia without severe left ventricular dysfunction. Eight patients underwent magnetic resonance imaging with gadolinium enhancement to guide endomyocardial and surgical biopsies to sites with more intense inflammatory processes. Myocardial specimens were studied with immunohistochemical techniques by using rabbit anti-T. cruzi immune serum to detect the presence of T. cruzi antigen. All patients had evidence of some myocarditis in at least one myocardial fragment. T. cruzi antigen was detected in 11 (69%) patients. T. cruzi antigens were detected in 10 (71%) of 14 regions with histopathologic evidence of moderate or severe myocarditis. In contrast, T. cruzi antigens were detected in 3 of 18 regions with only mild or absent myocarditis. There was a statistically significant correlation between the presence of T. cruzi antigens and moderate or severe myocarditis (chi-square = 5.169, p = 0.023). The results of this in vivo study demonstrate that T. cruzi antigens are frequently detected in chronic Chagas' heart disease. In addition, there is an association between the intensity of the inflammatory process and the presence of T. cruzi antigens. The presence of the T. cruzi antigen and its correlation with the severity of myocardial inflammatory process provide strong supportive evidence for the role of T. cruzi even in the chronic forms of Chagas' heart disease.

Peak oxygen consumption and resting left ventricular ejection fraction changes after cardiomyoplasty at 6-month follow-up.

BACKGROUND: The effects of cardiomyoplasty on cardiopulmonary exercise test characteristics are not fully known. METHODS AND RESULTS: We determined in 19 patients who underwent cardiomyoplasty for treatment of refractory heart failure (New York Heart Association [NYHA] functional class III) before (pre) and at 6-month follow-up (post) maximum oxygen consumption (peak VO2), NYHA functional class, and resting left ventricular ejection fraction (LVEF) (MUGA). We analyzed the results according to pre peak VO2 < or > 14 mL/kg per minute and the correlation between the changes in absolute values of LVEF and peak VO2. Pre- and post-peak VO2 values were 15.9 +/- 4.4 and 18.6 +/- 6.4 mL/kg per minute, respectively (P = .059). In the subgroup with pre-peak VO2 < 14 mL/kg per minute, the peak VO2 increased from 11.1 +/- 1.9 to 16.4 +/- 6.2 mL/kg per minute (P = .02). The subgroup with peak VO2 > 14 mL/kg per minute showed pre- and post-peak VO2 of 19.2 +/- 2.6 and of 20.1 +/- 7 mL/kg per minute, respectively (P = .06). The pre-total exercise time of the entire group increased from 688.4 +/- 222.1 to 833.7 +/- 241.6 seconds (P < .04). For the subgroup with preoperative peak VO2 < 14 mL/kg per minute, exercise time improved from 585 +/- 76.9 to 825 +/- 186.3 seconds (P < .01). In the subgroup with preoperative VO2 > 14 mL/kg per minute, the preexercise and postexercise time was 763.6 +/- 264.4 and 840 +/- 282 seconds, respectively (P = .4). Pre-LVEF increased from 20.6 +/- 3.3% to 24.2 +/- 7.8% at 6 months of follow-up (P = .02). At 6 months of follow-up, 9 patients were in NYHA functional class I and 10 were in class II. There was no correlation between LVEF values and absolute values of peak VO2 before (r = .123, P = .6) and after (r = .27, P = .2) cardiomyoplasty. A weak correlation was observed between the changes in absolute values of peak VO2 and LVEF from the preoperative to the postoperative period (r = .48, P = .048). CONCLUSIONS: Cardiomyoplasty is a useful method for improving NYHA functional class and LVEF in patients with heart failure. Peak VO2 < 14 mL/kg per minute before cardiomyoplasty may be a selection criterion with which to determine improved exercise capacity after surgery. The effects of cardiomyoplasty on LVEF appear to be partially associated with maximum exercise capacity changes.

Arrhythmias and sudden death after dynamic cardiomyoplasty.

BACKGROUND: The main causes of death in patients with severe cardiomyopathy are progressive heart failure and sudden death. The influence of cardiomyoplasty on the incidence of sudden death and arrhythmias in patients with cardiomyopathy remains unclear. The aim of this study was to investigate the occurrence of arrhythmias and sudden death after cardiomyoplasty. METHODS AND RESULTS: We studied 32 patients (26 male, 6 female; mean age, 48 +/- 12 years) who submitted to cardiomyoplasty for treatment of heart failure in New York Heart Association (NYHA) class III (n = 24) or class IV (n = 8). The etiology was idiopathic dilated cardiomyopathy in 27 patients, ischemic heart disease in 3 patients, and Chagas' heart disease in 2 patients. Patients were routinely studied before and every 6 months after cardiomyoplasty by means of radioisotopic angiography and 24-hour Holter monitor recordings. There were no operative or immediate postoperative deaths. During the postoperative period, 5 patients presented with acute atrial fibrillation and 1 had an episode of sustained ventricular tachycardia. All episodes were successfully treated with intravenous antiarrhythmic drugs or cardioversion. During follow-up (from 2 to 66 months), 15 patients died from sudden death (n = 5) or progressive heart failure (n = 10). Survival rates at 1, 2, and 4 years were 79.9 +/- 7%, 62.5 +/- 9.7% and 35 +/- 12.1%, respectively. At 6-month follow-up, NYHA functional class improved from 3.2 +/- 0.4 to 1.7 +/- 0.6 (P = .001) and left ventricular ejection fraction increased from 19.8 +/- 3.3% to 24 +/- 8.2% (P = .004). The mean values per day of premature ventricular complexes (PVCs) and episodes of nonsustained ventricular tachycardia (NSVT) did not change statistically. The mean number of PVCs per 24 hours before and at 6, 12, 24, 36, and 48 months after surgery were 126 +/- 44, 96 +/- 33, 90 +/- 29, 81 +/- 35, 71 +/- 35, and 59 +/- 48. The mean number of episodes of NSVT per 24 hours before and at 6, 12, 24, 36, and 48 months after surgery were 3.3 +/- 1.3, 1.9 +/- 0.5, 1.3 +/- 0.5, 1 +/- 0.5, 1.5 +/- 1.1, and 0.6 +/- 0.5, respectively. With respect to analysis of the idiopathic dilated cardiomyopathy subgroup, there also were no significant differences in the incidences of pre- and postoperative arrhythmias. CONCLUSIONS: Despite NYHA functional class and left ventricular function improvements observed after cardiomyoplasty, the incidence of arrhythmias did not change, and sudden death was an important finding mainly in late follow-up. The problem of sudden death after cardiomyoplasty, the mechanism that produces it, and the means to prevent it remain critical areas for future research.

[Transesophageal echocardiography in the study of vascular anastomosis in a patient with right lung transplantation]. / Ecocardiografia transesofágica no estudo das anastomoses vasculares em paciente submetido a transplante de pulmão direito.

A 46 years-old man was submitted to right orthotopic lung transplantation due to pulmonary emphysema. The transesophageal echocardiography was important in the evaluation of functional and morphological aspects of pulmonary vessels after this proceeding.

[The role of hypertrophy and left ventricular function on the occurrence of ventricular arrhythmias in arterial hypertension]. / Papel da hipertrofia e da função ventricular esquerda sobre a ocorrência de arritmias ventriculares na hipertensão arterial.

PURPOSE: To evaluate the role of left ventricular hypertrophy (LVH), left ventricular systolic function an other clinical parameters on prevalence and complexity of ventricular arrhythmias in hypertension. METHODS: Ventricular arrhythmias were studied in 39 hypertensives by 24 hours ambulatory electrocardiographic monitoring. Frequency and complexity of ventricular arrhythmias were compared among 3 groups: A and B, respectively without and with LVH, both with normal left ventricular function; and C with LVH and systolic dysfunction. LVH and systolic dysfunction were established echocardiographically. Linear regression analysis was performed in order to identify an independent correlation between clinical parameters and presence of arrhythmias. RESULTS: Group C patients were older and had significantly higher systolic and diastolic blood pressures, greater mass index, diastolic posterior wall thickness and end-systolic stress and increased prevalence of electrocardiographic strain. Left ventricular diastolic diameter in C group patients was increased only when compared to A group. Frequencies of cases with more than 10 ectopic ventricular beats/hour, pairs and nonsustained ventricular tachycardia episodes were all significantly increased in C when compared to B and to A. However, only left ventricular mass index or diastolic posterior wall thickness identified independently patients with ventricular arrhythmias. CONCLUSION: Left ventricular hypertrophy is the main predictor of potential high risk rhythm disturbances in hypertension.

[Role of blood pressure in rest and exercise conditions and importance of clinical factors in left ventricular hypertrophy in arterial hypertension]. / Papel da pressão arterial casual e do exercício e a influência de fatores clínicos sobre a hipertrofia ventricular esquerda na hipertensão arterial.

PURPOSE: To evaluate the role of casual and exercise blood pressure as well as the importance of clinical factors on the presence and degree of left ventricular hypertrophy in hypertension. METHODS: Fifteen normotensives (control group) and 30 hypertensives, 14 of them with and 16 without left ventricular hypertrophy (groups with LVH and without LVH, respectively) were studied. LVH diagnosis was established when mass index was higher than 2 standard-deviations of the mean values calculated for each sex in control group. Resting, casual determined, and bicycle exercise systolic and diastolic blood pressures along with age, body surface area, sex and race distribution were compared between groups. In addiction, their relation with mass index as independent variables were also tested. RESULTS: Hypertensives in group with LVH had higher diastolic septal, posterior wall, and relative wall thicknesses. No significant statistical difference was observed neither in sex and race distribution, nor in age and body surface area between groups. Otherwise, there were significant differences in both resting and exercise blood pressure. In the entire population studied, left ventricular mass index significantly correlated with age (r=0,33, p=0,03) as well as with both casual (systolic - r=0,72, p=0,0001; diastolic - r=0,69, p=0,0001) and exercise (systolic - r=0,62, p=0,0001; diastolic - r=0,66, p=0,0001) blood pressures. However, linear regression analysis demonstrated that only resting systolic (p=0,0001) and exercise diastolic (p=0,0303) blood pressures were significant and independent determinants of mass index. CONCLUSION: Resting and exercising blood pressures are the main determinants of left ventricular hypertrophy in hypertension.

[Hypertension and complex ventricular arrhythmias. Evolution following a long-term blood pressure treatment]. / Hipertensão arterial e arritmias ventriculares complexas. Evolução após tratamento de longo prazo da pressão arterial.

PURPOSE: To evaluate the effects of long-term antihypertensive treatment in the frequency as well as in the complexity of ventricular arrhythmias in arterial hypertension. METHODS: Twenty three patients, 14 males and 11 whites, with mean age of 46 years, were submitted to 24 hours ambulatory electrocardiographic monitoring and echocardiographic studies before and 9 months after antihypertensive treatment. RESULTS: There was no significant serum potassium level alteration, but significant reductions of both systolic (from 192 +/- 29mmHg to 161 +/- 25mmHg) and diastolic (from 122 +/- 17mmHg to 99 +/- 16mmHg) blood pressure. Left ventricular percent of fiber shortening significantly increased, even though only from 26 +/- 9% to 30 +/- 9%, and end-systolic wall stress did not change at all (before 258 +/- 94 10(3) dyn/cm2, after 255 +/- 101 10(3) dyn/cm2). Left ventricular mass index showed significant but also a discrete reduction from 211 +/- 75g/m2 to 196 +/- 70g/m2. Ambulatory electrocardiographic monitoring did not show any significant decrease in neither ventricular ectopic beats nor in couplets. Non-sustained ventricular tachycardia episodes remained unchanged too. Four out of 8 patients with more than 30 ventricular ectopic beats per hour reduced it by more than 70%. On the other hand, the number of patients with couplets was reduced from 10 to 8 whilst those with non-sustained ventricular tachycardia increased from 5 to 7. Furthermore, in 7 patients reevaluated 24 months thereafter results were not expressively dissimilar. CONCLUSION: In hypertensive patients with either severe degree of left ventricular hypertrophy or myocardial dysfunction, long-term blood pressure treatment that produce no impressive changes in these abnormalities also do not modify complex ventricular arrhythmias, in spite of a great reduction in the increase blood pressure.