Lipoma no Septo Interventricular ­ Relato De Caso / Lipoma in the Interventricular Septum ­ Case Report

Tumores cardíacos primários consistem em patologia rara, sendo encontrados em até 0,03% das autópsias e a maioria benigna. Dentre os benignos, os lipomas apresentam incidência de 8,5%, localizando-se mais frequentemente no septo interatrial. Quando localizado no septo interventricular, é considerado patologia ainda mais incomum, com prevalência real desconhecida. Na maioria dos casos, o diagnóstico ocorre de forma incidental, por exame de imagem cardiovascular, e pode ser confirmado por exame histopatológico. Apresentam-se mais comumente de forma assintomática ou com sintomas inespecíficos, mas podem evoluir com arritmias, disfunção valvar, insuficiência cardíaca e óbito, o que ressalta a importância dos métodos de imagem cardiovascular no diagnóstico diferencial e na orientação da terapêutica adequada. O presente trabalho relata o caso de um paciente com achado ecocardiográfico incidental de massa cardíaca localizada no septo interventricular, seguindo da realização de ressonância magnética cardíaca, para melhor caracterização da lesão e demonstração de características compatíveis com lipoma.(AU)

Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block / Perfusão Miocárdica de Estresse com Dipiridamol por Tomografia Computadorizada em Pacientes com Bloqueio de Ramo Esquerdo

Abstract Background: Functional tests have limited accuracy for identifying myocardial ischemia in patients with left bundle branch block (LBBB). Objective: To assess the diagnostic accuracy of dipyridamole-stress myocardial computed tomography perfusion (CTP) by 320-detector CT in patients with LBBB using invasive quantitative coronary angiography (QCA) (stenosis ≥ 70%) as reference; to investigate the advantage of adding CTP to coronary computed tomography angiography (CTA) and compare the results with those of single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy. Methods: Thirty patients with LBBB who had undergone SPECT for the investigation of coronary artery disease were referred for stress tomography. Independent examiners performed per-patient and per-coronary territory assessments. All patients gave written informed consent to participate in the study that was approved by the institution’s ethics committee. Results: The patients’ mean age was 62 ± 10 years. The mean dose of radiation for the tomography protocol was 9.3 ± 4.6 mSv. With regard to CTP, the per-patient values for sensitivity, specificity, positive and negative predictive values, and accuracy were 86%, 81%, 80%, 87%, and 83%, respectively (p = 0.001). The per-territory values were 63%, 86%, 65%, 84%, and 79%, respectively (p < 0.001). In both analyses, the addition of CTP to CTA achieved higher diagnostic accuracy for detecting myocardial ischemia than SPECT (p < 0.001). Conclusion: The use of the stress tomography protocol is feasible and has good diagnostic accuracy for assessing myocardial ischemia in patients with LBBB.

Resumo Fundamentos: Testes funcionais possuem limitada acurácia para identificar isquemia miocárdica em pacientes com bloqueio de ramo esquerdo (BRE). Objetivo: Utilizando tomógrafo com 320 detectores foi avaliado a acurácia diagnóstica da perfusão miocárdica de estresse com dipiridamol pela tomografia (PMT) em pacientes com BRE utilizando a angiografia coronária quantitativa invasiva (QCA) (estenose ≥ 70%) como referência. Procurou-se também investigar o valor adicional da PMT sobre a angiotomografia coronariana (ATC) comparando a acurácia com a cintilografia perfusional miocárdica (SPECT). Métodos: Trinta pacientes com BRE e SPECT prévio em investigação de doença arterial coronariana foram encaminhados para realização do protocolo de estresse na tomografia. Observadores independentes realizaram avaliação por paciente e por território coronariano. Todos os pacientes assinaram um termo de consentimento livre e esclarecido aprovado pelo Comitê de Ética da Instituição. Resultados: A média de idade foi 62 ± 10 anos. A dose média de radiação do protocolo de tomografia foi 9,3 ± 4,6 mSv. Em relação a PMT, na análise por paciente, a sensibilidade, especificidade, valores preditivos positivos e negativos e acurácia foram, respectivamente, 86%, 81%, 80%, 87%, 83% p = 0,001. Na análise por território os valores foram, respectivamente, 63%, 86% a 65%, 84%, 79% p < 0,001. Em ambas as análises, a adição da PMT a ATC determinou maior acurácia diagnóstica para detecção de isquemia miocárdica quando comparado com o SPECT (p < 0,001). Conclusão: O uso do protocolo de estresse na tomografia é viável e tem boa acurácia diagnóstica na pesquisa de isquemia miocárdica nos pacientes com BRE.

Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block.

BACKGROUND: Functional tests have limited accuracy for identifying myocardial ischemia in patients with left bundle branch block (LBBB). OBJECTIVE: To assess the diagnostic accuracy of dipyridamole-stress myocardial computed tomography perfusion (CTP) by 320-detector CT in patients with LBBB using invasive quantitative coronary angiography (QCA) (stenosis ≥ 70%) as reference; to investigate the advantage of adding CTP to coronary computed tomography angiography (CTA) and compare the results with those of single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy. METHODS: Thirty patients with LBBB who had undergone SPECT for the investigation of coronary artery disease were referred for stress tomography. Independent examiners performed per-patient and per-coronary territory assessments. All patients gave written informed consent to participate in the study that was approved by the institution's ethics committee. RESULTS: The patients' mean age was 62 ± 10 years. The mean dose of radiation for the tomography protocol was 9.3 ± 4.6 mSv. With regard to CTP, the per-patient values for sensitivity, specificity, positive and negative predictive values, and accuracy were 86%, 81%, 80%, 87%, and 83%, respectively (p = 0.001). The per-territory values were 63%, 86%, 65%, 84%, and 79%, respectively (p < 0.001). In both analyses, the addition of CTP to CTA achieved higher diagnostic accuracy for detecting myocardial ischemia than SPECT (p < 0.001). CONCLUSION: The use of the stress tomography protocol is feasible and has good diagnostic accuracy for assessing myocardial ischemia in patients with LBBB.

Amiloidose cardíaca: relato de caso / Cardiac amyloidosis: case report

JUSTIFICATIVA E OBJETIVOS: A amiloidose cardíaca é uma doença rara e de difícil diagnóstico ocasionada pela deposição de substância amilóide. Este depósito pode levar a distúrbio da condução cardíaca, cardiomiopatia restritiva, baixo débito cardíaco e comprometimentos atriais isolados. O objetivo deste estudo foi descrever o caso de um paciente portador de insuficiência cardíaca direita há 6 meses. RELATO DO CASO: Paciente do sexo masculino, 51 anos, chegou ao setor de emergência do hospital após episódio de síncope. Após realização do eletrocardiograma (ECG) e ecocardiograma (ECO), levantou-se a hipótese de amiloidose cardíaca a qual foi confirmada através da biópsia do endocárdio e coloração vermelho do congo. CONCLUSÃO: A avaliação clínica complementada por ECG e ECO permitiu caracterizar bem a doença e a forma de manifestação. Pacientes com amiloidose cardíaca possuem poucas opções de tratamento e prognóstico reservado.

BACKGROUND AND OBJECTIVES: The cardiac amyloidosis is a rare disease hard to diagnose, it is caused by the deposit of the amyloid substance. This deposit can lead to trouble in the cardiac conduction, restrictive cardiomyopathy, low cardiac output and atrial damage. We report a case about a male patient with right heart failure for 6 months, admitted in the hospital emergency after syncope episode. CASE REPORT: Male patient, 51 years-old. After accomplishment of electrocardiogram (ECG) and echocardiogram (ECO), it was raised the hypothesis of cardiac amyloidosis which was confirmed through endocardium biopsy and congo red staining. CONCLUSION: The clinical evaluation complemented with ECG and ECO allows characterizing well the disease and its manifestation form. Patients with cardiac amyloidosis have few treatment options and adverse prognosis.

Sepse na unidade de terapia intensiva: etiologias, fatores prognósticos e mortalidade / Sepsis in the intensive care unit: etiologies, prognostic factors and mortality

JUSTIFICATIVA E OBJETIVOS: Sepse é a principal causa de morte em pacientes tratados em unidade de terapia intensiva (UTI). O objetivo deste estudo foi avaliar etiologia, fatores prognósticos e mortalidade de pacientes sépticos tratados nas UTI de Passo Fundo, Brasil. MÉTODO: Foram avaliados 971 pacientes consecutivos prospectivamente, entre agosto de 2005 e fevereiro de 2006, 560 foram selecionados pela presença de síndrome da resposta inflamatória sistêmica (SIRS) e acompanhados por 28 dias ou até a alta ou óbito. Os pacientes foram classificados de acordo com a etiologia da SIRS e adicionalmente classificados como tendo SIRS, sepse, sepse grave e choque séptico. O prognóstico foi avaliado por meio dos escores APACHE II e SOFA. A mortalidade foi comparada em diferentes etiologias de sepse e parâmetros APACHE II e SOFA. RESULTADOS: Dos 971 pacientes admitidos nas UTI, 560 desenvolveram SIRS (58 por cento). A causa mais freqüente de internação foi doença neurológica (28,9 por cento), o mais freqüente local de infecção foi o trato respiratório (71,6 por cento), e os germes mais prevalentes foram os bacilos gram-negativos (53,2 por cento). O escore APACHE II médio foi 18 ± 9 e o escore SOFA médio foi 5 ± 4. O tempo médio de permanência foi 6 (3-11) dias e a taxa de mortalidade foi 31,1 por cento: 6,1 por cento para SIRS não infecciosa, 10,1 por cento para sepse, 22,6 por cento para sepse grave e 64,8 por cento para choque séptico. CONCLUSÕES: Sepse é um importante problema de saúde que leva a uma taxa extremamente alta de mortalidade nas UTI de Passo Fundo, Brasil.

BACKGROUND AND OBJECTIVES: Sepsis is the main cause of death in patients treated in intensive care units (ICU). The aim of this study was to evaluate etiology, prognostic factors and mortality of septic patients treated in ICU of Passo Fundo, Brazil. METHODS: Out of 971 consecutive patients prospectively evaluated from August 2005 to February 2006, 560 were selected due to presence of systemic inflammatory response syndrome (SIRS) and followed for 28 days or until discharge or death. Patients were categorized according with the etiology of SIRS and further classified as having SIRS, sepsis, severe sepsis and septic shock. Prognosis was assessed by means of Apache II and SOFA. Mortality was compared in different etiologies of sepsis, APACHE II and SOFA scores, parameters. RESULTS: Of the 971 patients admitted to the ICU, 560 developed SIRS (58 percent). The most frequent cause of internation was neurological disease (28.9 percent), the most frequent site of infection was the respiratory tract (71.6 percent), and the most prevalent pathogens were gram-negative bacilli (53.2 percent). Mean APACHE II score was 18 ± 9, and mean SOFA score was 5 ± 4. Median ICU stay was 6 (3-11) days and overall mortality rate was 31.1 percent: 6.1 percent for non-infectious SIRS, 10.1 percent for sepsis, 22.6 percent for severe sepsis, and 64.8 percent for septic shock. CONCLUSIONS: Sepsis is an important health problem that leads to an extremely high mortality rate in the ICU of Passo Fundo, Brazil.

Sepsis in the intensive care unit: etiologies, prognostic factors and mortality. / Sepse na unidade de terapia intensiva: etiologias, fatores prognósticos e mortalidade.

BACKGROUND AND OBJECTIVES: Sepsis is the main cause of death in patients treated in intensive care units (ICU). The aim of this study was to evaluate etiology, prognostic factors and mortality of septic patients treated in ICU of Passo Fundo, Brazil. METHODS: Out of 971 consecutive patients prospectively evaluated from August 2005 to February 2006, 560 were selected due to presence of systemic inflammatory response syndrome (SIRS) and followed for 28 days or until discharge or death. Patients were categorized according with the etiology of SIRS and further classified as having SIRS, sepsis, severe sepsis and septic shock. Prognosis was assessed by means of Apache II and SOFA. Mortality was compared in different etiologies of sepsis, APACHE II and SOFA scores, parameters. RESULTS: Of the 971 patients admitted to the ICU, 560 developed SIRS (58%). The most frequent cause of internation was neurological disease (28.9%), the most frequent site of infection was the respiratory tract (71.6%), and the most prevalent pathogens were gram-negative bacilli (53.2%). Mean APACHE II score was 18 ± 9, and mean SOFA score was 5 ± 4. Median ICU stay was 6 (3-11) days and overall mortality rate was 31.1%: 6.1% for non-infectious SIRS, 10.1% for sepsis, 22.6% for severe sepsis, and 64.8% for septic shock. CONCLUSIONS: Sepsis is an important health problem that leads to an extremely high mortality rate in the ICU of Passo Fundo, Brazil.

Câncer de mama e síndrome de Horner / Breast cancer and horner`s syndrome

A síndrome de Claude Bernard-Horner é a combinação clínica de ptose palpebral, miose, anidrose e enolftalmia, sendo resultado de uma interrupção da via simpática cervical. O câncer de mama metastático ocorre em um terço de todos os pacientes, podendo causar complicações neurológicas incluindo síndrome de Horner. Os autores relatam caso de uma paciente de 55 anos com câncer de mama avançado associado à síndrome de Horner devido a metástases cerebrais. Houve regressão parcial da síndrome após uso de corticóide e radioterapia em sistema nervoso central.

The Claude Bernard-Homer's syndrome is a clinical combination of palpebral ptosis, miosis, anhidrosis e enolphtalmos. It results from an interruption of the cervical sympathetic pathway. The metastatic breast cancer occurs in Y3 of all patients and may cause neurologic complications including Homer's syndrome. The authors report a case of a 55-year-old patient with advanced breast cancer associated with Homer's syndrome due to brain metastases. The syndrome partly decreased after the use of corticoids and radiotherapy in the central nervous system.