Liver Metastases in Pancreatic Acinar Cell Carcinoma Treated with Selective Internal Radiation Therapy with Y-90 Resin Microspheres.

BACKGROUND: Pancreatic acinar cell carcinoma (PACC) is a rare tumor. Surgical resection is the treatment of choice when feasible, but there are no clear recommendations for patients with advanced disease. Liver-directed therapy with Y-90 selective internal radiation therapy (SIRT) has been used to treat hepatic metastases from pancreatic tumors. We describe a case of PACC liver metastases treated with SIRT. CASE REPORT: 59-year-old man was admitted with an infiltrative, solid lesion in pancreatic tail diagnosed as PACC. Lymph nodes in the hepatic hilum were enlarged, and many metastatic liver nodules were observed. After partial pancreatectomy, the left and right lobes of the liver were separately treated with Y-90 resin microspheres. Follow-up imaging revealed that all hepatic nodules shrank by at least 50%, and 3 nodules disappeared completely. Lipase concentration was 8407 U/L at baseline, rose to 12,705 U/L after pancreatectomy, and declined to 344 U/L after SIRT. Multiple rounds of chemotherapy in the subsequent year shrank the hepatic tumors further; disease then progressed, but a third line of chemotherapy shrank the tumors again, 16 months after SIRT treatment. CONCLUSION: SIRT had a positive effect on liver metastases from PACC. In conjunction with systemic therapy, SIRT can achieve sustained disease control.

Left ventricular ejection fraction and volumes as measured by 3d echocardiography and ultrafast computed tomography.

BACKGROUND: Real-time three-dimensional echocardiography (RT-3D-Echo) and ultrafast computed tomography (CT) are two novel methods for the analysis of LV ejection fraction and volumes. OBJECTIVE: To compare LVEF and volume measurements as obtained using RT-3D-Echo and ultrafast CT. METHODS: Thirty nine consecutive patients (27 men, mean age of 57+/-12 years) were studied using RT-3D-Echo and 64-slice ultrafast CT. LVEF and LV volumes were analyzed. STATISTICAL ANALYSIS: coefficient of correlation (r: Pearson), Bland-Altman analysis, linear regression analysis, 95% CI, p<0.05. RESULTS: RT-3D-Echo measurements: LVEF ranged from 56.1 to 78.6 (65.5+/-5.58)%; end-diastolic volume ranged from 49.6 to 178.2 (87+/-27.8) ml; end-systolic volume ranged from 11.4 to 78 (33.1+/-13.6) ml. CT scan measurements: LVEF ranged from 53 to 86% (67.8+/-7.78); end-diastolic volume ranged from 51 to 186 (106.5+/-30.3) ml; end-systolic volume ranged from 7 to 72 (35.5+/-13.4)ml. Correlations between RT-3D-Echo and CT were: LVEF (r: 0.7888, p<0.0001, 95% CI 0.6301 to 0.8843); end-diastolic volume (r: 0.7695, p<0.0001, 95% CI 0.5995 to 0.8730); end-systolic volume (r: 0.8119, p<0.0001, 95% CI 0.6673 to 0.8975). CONCLUSION: Good correlation between LVEF and ventricular volume parameters as measured by RT-3D-Echo and 64-slice ultrafast CT was found in the present case series.

Fração de ejeção e volumes do ventrículo esquerdo medidos com eco 3D e com tomografia ultra-rápida / Fracción de eyección y volúmenes del ventrículo izquierdo medidos con eco- 3DTR y con tomografía ultrarrápida / Left ventricular ejection fraction and volumes as measured by 3d echocardiography and ultrafast computed tomography

FUNDAMENTO: O ecocardiograma tridimensional em tempo real (ECO 3D) e a tomografia computadorizada ultra-rápida (CT) são dois novos métodos de análise da fração de ejeção e dos volumes do VE. OBJETIVO: Comparar as medidas da FEVE e dos volumes do VE aferidos pelo ECO 3D e pela CT ultra-rápida. MÉTODOS: Foram estudados pelo ECO 3D e pela CT ultra-rápida de 64 cortes, 39 pacientes consecutivos (27 homens, média etária de 57±12 anos). Foram analisados: FEVE e volumes do VE. Análise estatística: coeficiente de correlação (r: Pearson), teste de Bland & Altman, teste de regressão linear, 95 por cento IC, p<0,05. RESULTADOS: Medidas do ECO 3D: a FEVE variou de 56,1 a 78,6 (65,5±5,58) por cento; volume diastólico final variou de 49,6 a 178,2 (87±27,8)ml; volume sistólico final variou de 11,4 a 78 (33,1±13,6)ml. Medidas da CT: a FEVE variou de 53 a 86 (67,8±7,78) por cento; volume diastólico final variou de 51 a 186 (106,5±30,3) ml; volume sistólico final variou de 7 a 72 (35,5±13,4)ml. As correlações entre ECO 3D e CT foram: FEVE (r: 0,7888, p<0,0001, 95 por cento IC 0,6301 a 0,8843); volume diastólico final (r: 0,7695, p<0,0001, 95 por cento IC 0,5995 a 0,8730); volume sistólico final (r: 0,8119, p<0,0001, 95 por cento IC 0,6673 a 0,8975). CONCLUSÃO: Nesta série, foi observada boa correlação entre as medidas da FEVE e entre os volumes ventriculares aferidos pelo ECO3D e pela CT ultra-rápida de 64 cortes.

BACKGROUND: Real-time three-dimensional echocargiography (RT-3D-Echo) and ultrafast computed tomography (CT) are two novel methods for the analysis of LV ejection fraction and volumes. OBJECTIVE: To compare LVEF and volume measurements as obtained using RT-3D-Echo and ultrafast CT. METHODS: Thirty nine consecutive patients (27 men, mean age of 57±12 years) were studied using RT-3D-Echo and 64-slice ultrafast CT. LVEF and LV volumes were analyzed. Statistical analysis: coefficient of correlation (r: Pearson), Bland-Altman analysis, linear regression analysis, 95 percent CI, p<0.05. RESULTS: RT-3D-Echo measurements: LVEF ranged from 56.1 to 78.6 (65.5±5.58) percent; end-diastolic volume ranged from 49.6 to 178.2 (87±27.8) ml; end-systolic volume ranged from 11.4 to 78 (33.1±13.6) ml. CT scan measurements: LVEF ranged from 53 to 86 percent (67.8±7.78); end-diastolic volume ranged from 51 to 186 (106.5±30.3) ml; end-systolic volume ranged from 7 to 72 (35.5±13.4)ml. Correlations between RT-3D-Echo and CT were: LVEF (r: 0.7888, p<0.0001, 95 percent CI 0.6301 to 0.8843); end-diastolic volume (r: 0.7695, p<0.0001, 95 percent CI 0.5995 to 0.8730); end-systolic volume (r: 0.8119, p<0.0001, 95 percent CI 0.6673 to 0.8975). CONCLUSION: Good correlation between LVEF and ventricular volume parameters as measured by RT-3D-Echo and 64-slice ultrafast CT was found in the present case series.

FUNDAMENTO: La ecocardiografía tridimensional en tiempo real (Eco-3DTR) y la tomografía computarizada ultrarrápida (TC ultrarrápida) son dos nuevos métodos de análisis de la fracción de eyección (FE) y de los volúmenes del ventrículo izquierdo (VI). OBJETIVO: Comparar las mediciones de la fracción de eyección del ventrículo izquierdo (FEVI) y de los volúmenes del VI apurados por la Eco-3DTR y por la TC ultrarrápida. MÉTODOS: Se estudiaron, mediante la Eco-3DTR y la TC ultrarrápida de 64 cortes, a 39 pacientes consecutivos (27 varones, promedio de edad de 57±12 años). Se analizaron: FEVI y volúmenes del VI. Análisis estadístico: coeficiente de correlación (r: Pearson), prueba de Bland & Altman, prueba de regresión lineal, 95 por ciento IC, p<0,05. RESULTADOS: Valores de la Eco-3DTR: variación de la FEVI de 56,1 a 78,6 (65,5±5,58) por ciento; variación del volumen diastólico final de 49,6 a 178,2 (87±27,8)mL; variación del volumen sistólico final de 11,4 a 78 (33,1±13,6)mL. Valores de la TC ultrarrápida: variación de la FEVI de 53 a 86 (67,8±7,78) por ciento; variación del volumen diastólico final de 51 a 186 (106,5±30,3) mL; variación del volumen sistólico final de 7 a 72 (35,5±13,4) mL. Las correlaciones entre la Eco-3DTR y la TC ultrarrápida fueron: FEVI (r: 0,7888, p<0,0001, 95 por ciento IC 0,6301 a 0,8843); volumen diastólico final (r: 0,7695, p<0,0001, 95 por ciento IC 0,5995 a 0,8730); volumen sistólico final (r: 0,8119, p<0,0001, 95 por ciento IC 0,6673 a 0,8975). CONCLUSIÓN: En esta serie, se observó una buena correlación entre las mediciones de la FEVI y entre los volúmenes ventriculares apurados por la Eco-3DTR y por la TC ultrarrápida de 64 cortes.

Comparação entre a aferição da fração de ejeção e dos volumes do ventrículo esquerdo, medidos com ecocardiografia tridimensional em tempo real e com tomografia computadorizada ultra-rápida / Real-time three-dimensional echocardiographic left ventricular ejection fraction and volumes asessment: comparison with cardiac computed tomography

Fundamento e objetivo: O ecocardiograma tridimensional (ECO 3D) e a tomografia computadorizada ultra-rápida (CT) constituem 2 novos métodos de análise da fração de ejeção e dos volumes do ventrículo esquerdo (VE). Existem poucos estudos dirigidos à comparação da análise da fração de ejeção do VE aferidos por ambos os métodos. O objetivo deste estudo foi comparar as medidas da FEVE e dos volumes do VE ECO 3D em tempo real e pela CT ultra rápida. Método: Foram estudados pelo ECO 3D e pela CT ultra rápida de 64 cortes, 41 pacientes (29 homens, média etária de 58 + - 111 anos). Foram analisados com ambas as técnicas: FEVE, volumes sistólico final e diastólico final do VE. Os parâmetros aferidos com o ECO3D e com a CT foram comparados com o emprego do coeficiente de determinação (r:Pearson), do teste de Bland & Altman e do teste de regressão linear, 95 por cento IC, p<0,05. Resultados: Medidas do ECO 3D: a FEVE variou de 56,7 a 78,9 (65,3 + - 5,7) por cento; volume diastólico final variou de 49,6 a 178,2 (88+ - 27,5) mL; volume sistólico final variou de 11,4 a 78 (33,9 + - 13,7) mL. Medidas da CT: a FEVE variou de 7 a 72 (35,1 + - 13,8) mL. As correlações entre ECO 3D e CT foram: FEVE (r: 0,7877, p>0,0001, 95 por cento IC 0,6327 a 0,8853); volume diastólico final (r:0,7671, p< 0,0001, 95 por cento IC 0,5974 a 0,8745); volume sistólico final (r: 0,8121, p< 0,0001, 95 por cento IC 0,6659 a 0,8957). Conclusão: Foi evidenciada boa correlação entre as medidas da FEVE e entre os volumes ventriculares aferidos pelo ECO3D em tempo real e pela CT ultra rápida de 64 cortes.

Papel do acometimento da artéria coronária circunflexa no infarto do miocárdio sem onda Q / The Role of Left Circunflex Coronary Artery Obstruction in Non-Q Ware Acute Myocardial Infarction

PURPOSE--To determine the patency and incidence rates of left circumflex coronary artery (LCX) as the infarct related artery (IRA) in Q-wave and non-Q wave acute myocardial infarction (AMI). METHODS--Two-hundreds and twenty one patients (172 men) with AMI were stratified in Q and non-Q waves groups. All patients were submitted to cinecoronary angiography 72 hours after the beginning of symptoms and the IRA and its patency were evaluated. RESULTS--In non-Q wave AMI, the LCX was considered to be the IRA in 35 of the patients. In Q wave AMI, this incidence was 8 (p < 0.001). Occlusion of LCX was seen in all non-Q wave AMI patients when it was the IRA. CONCLUSION--The incidence of LCX as IRA was significantly higher in non-Q wave AMI patients. This group did not have the previously expected greater patency rates, what could result in different clinical and evolutive characteristics.

Purpose - To determine the patency and incidencerates of left circunflex coronary artery (LCX) as the infarct related artery (IRA) in Q-wave and non-Q wave acute myocardial infarction (AMI). Methods - Two-hundreds and twenty one patients (172 men) with AMI were stratified in Q and non-Q waves groups. All patients were submitted to cinecoronary angiography 72 hours after the beginning of symptoms and the IRA and its patency were evaluated. Results -In non-Q wave AMI, the LCX was considered to be the IRA in 35% of the patients. In Q wave AMI, this incidence was 8% (p<0.001). Occlusion of LCX was seen in all non-Q wave AMI patients when it was the IRA. Conclusion - The incidence of LCX as IRA was significantly higher in non-Q wave AMI patients. This group did not have the previously expected greater patency rates, what could result in different clinical and evolutive characteristics

Evolução hospitalar de pacientes com infarto de ventrículo direito e a importância da perviabilidade da artéria coronária direita / In-Hospital Outcome of Patients with Righ Ventricular Infarction and the Role of Right Coronary Artery Patency

PURPOSE--To evaluate the importance of the right coronary artery (RCA) patency in patients with right ventricular infarction. METHODS--Fifty-two patients with inferior wall myocardial infarction and right ventricular involvement were studied and divided in two groups: group A (GA) included 35 patients in whom the RCA was patent at coronary angiography, and group B (GB), 17 who had an occluded RCA. They were prospectively evaluated for electrical and hemodynamic complications, as well as in-hospital mortality. RESULTS--The mortality in GA was 11 and 29 in GB, p = 0.13; electrical complications were 11 in GA and 35 in GB, p = 0.06; hemodynamic complications were 8 in GA and 41 in GB, p = 0.009. CONCLUSION--These findings suggest a trend towards reduction in mortality and electrical complications, and significant reduction of hemodynamic complications in patients with inferior wall myocardial infarction with involvement of the right ventricle who have the RCA patent. Thus, RCA patency appears to be important in determining in-hospital outcomes of these patients.

Valor da ressonância nuclear magnética na detecção da perviabilidade da artéria coronária após trombólise / Role of the Magnetic Resonance Imaging to Detect Artery Patency After Thrombolysis

PURPOSE--To determine the value of magnetic resonance imaging (MRI) in the noninvasive detection of infarct related coronary artery patency after thrombolysis. METHODS--We studied 26 patients with acute myocardial infarction submitted to thrombolysis underwent MRI studies before and after 0.1mmol/kg gadolinium-DTPA injection within the first 48 h of MI. Signal intensity was assessed by circumferential profile analysis techniques. RESULTS--The average ratio of signal intensity of infarcted tissue over normal myocardium (I/N) was significantly higher in patients with patent arteries (1.3 +/- 0.13 vs 1.12 +/- 0.07, p < 0.02). Compared to coronariography MRI, sensitivity of 81 and specificity of 100 for the diagnosis of coronary patency. CONCLUSION--Gadolinium infusion increased infarcted and normal myocardium differentiation. The study of gadolinium kinetics at MRI is a promising technique for noninvasive diagnosis of coronary patency.

A revascularizaçäo precoce das artérias näo relacionadas ao infarto melhora a funçäo regional e global do ventrículo esquerdo após o infarto agudo do miocárdio / Early Noninfarct Related Arteries Revascularization Improves Regional Wall Motion Post Myocardial Infarction

PURPOSE--To evaluate if early interventions which increase flow in the non-infarct related arteries (NRA) could improve long-term ventricular function in the non-infarct (NI) area after an acute myocardial infarction (MI). METHODS--We studied regional wall motion analyzed by the center-line method in two groups of patients with significant stenoses (> or = 70 per cent ) in the NRA after successful coronary reperfusion (chemical or mechanical thrombolysis). Group I (GI) consisted of 21 patients that were submitted to early (mean 14 days) complete surgical revascularization of both NRA and infarct related artery (IRA); the 12 group II (GII) patients underwent successful revascularization of the IRA only, with percutaneous transluminal coronary angioplasty (mean 6 days). Paired ventriculograms were obtained within 48 hours of the infarction and a mean of 17 months later. RESULTS--NI area contractility in GI patients improved from -0.35 +/- 2.16 to +0.62 +/- 1.6sd/chord (p < 0.05), whereas in GII decreased from +0.54 +/- 1.78 to -0.66 +/- 1.72 sd/chord (p < 0.05), p < 0.05 between the groups at follow-up. Mean infarct area wall motion did not differ between the two groups: from -3.04 +/- 2.43 to 2.61 +/- 2.49 sd/chord in GI (p = NS), and from -2.68 +/- 2.54 to -2.93 +/- 2.35 sd/chord in GII (p = NS). Mean global left ventricular (LV) ejection fraction did not change in GII patients (0.72 +/- 0.09 and 0.67 +/- 0.12, p = NS), but significantly increased from 0.63 +/- 0.12 to 0.72 +/- 0.11 in GI patients (p < 0.01). CONCLUSION--These data suggest that early revascularization of NRA with significant stenoses can improve not only the NI area regional contractility, but also the global LV function in the long-term follow-up of post MI patients treated with thrombolytic therapy

Tratamento trombolítico no tromboembolismo pulmonar em pós-operatório de cirurgia cardíaca complicado por acidente vascular cerebral isquêmico / Thrombolytic Therapy for Pulmonary Embolism Early after Coronary Bypass Surgery Complicated by Ischemic Stroke

A 69 years old man with pulmonary embolism early after coronary bypass surgery complicated by ischemic stroke received thrombolytic therapy. Reperfusion of the pulmonary artery was achieved. Conversion of the ischemic stroke to hemorrhagic infarction was observed at the CT-Scan without neurological impairment

Homem de 69 anos com tromboembolismo pulmonar (TEP) em pós-operatório de revascularização do miocárdio complicado por acidente vascular cerebral isquêmico (AVCI) foi submetido a tratamento trombolítico. Houve reperfusão da artéria pulmonar, estabilização hemodinômica e transformação hemorrágica do AVCI sem deterioração do quadro neurológico

Angioplastia coronária de salvamento em jovem com arterite de Takayasu e infarto do miocárdio / Coronary angioplasty of salvage in young with Takayasu arteritis and myocardial infarction

Adolescente, portador de arterite de Takayasu, com infarto agudo do miocárdio por acometimento da artéria descendente anterior, em seu terço proximal após tentativa, sem sucesso, de trombólise, com estreptoquinase endovenosa, foi submetido a angioplastia coronária de salvamento, resultando em pequena lesão residual

A 16 year old boy with Takayasu's disease was admitted with myocardial infarction. Thrombolytic therapy with intravenous streptokinase showed no sigusof reperfusion. Rescue angioplasty of the left descending coronary artery was periormed with success

Estado lítico sistêmico como marcador do sucesso terapêutico após rt-PA em bolo no infarto do miocárdio / lytic state as marker of therapeutic success after rt-PA in bolus in myocardial infarction

Avaliar o estado lítico sistêmico (ELS) através do nível de fibrinogênio sérico (FS) após tratamento com rt-PA em bolo no infarto do miocárdio (IM) e sua relaçäo com recanalizaçäo coronária. Cinqüenta e um pacientes (38 homens, média de idade de 53 ñ 9,8 anos) com IM submetidos a terapêutica com 70 mg de rt-PA em bolo por via venosa após demonstraçäo de oclusäo da artéria relacionada ao infarto (ARI). Foram feitas dosagens de FS pré-tratamento e após 90 minutos e comparados seus níveis no grupo de pacientes recanalizados (grupo 1) com os do grupo de pacientes com falha terapêutica (grupo 2). Todos os pacientes tinham níveis normais de FS e pré-tratamento. Após 90 minutos a média do FS diminuiu em 35,1% (276,8 ñ 55,5 mg/dl para 168,9 ñ 78,2 mg/dl). Os grupos 1 e 2 aos 90 minutos apresentaram níveis de FS semelhantes (145,1 ñ 96,7 mg/dl contra 187,0 + 53,7 mg/dl). A terapêutica com rt-PA em bolo no IM reduz de maneira significativa o FS, mas o ELS atingido foi semelhante nos grupos com ou sem recanalizaçäo da ARI

Purpose: Evaluate the lytic state (LS) expressed by the level of plasmatic fibrinogen (PF) after rt-PA in bolus tn,fusion for acute myocardial infarction (MI) and its relation to coronary reperfusion. Patients and methods: Fifty-one patients (38 men, mean age of 53.0 ± 9.8 years) with demonstrated occlusion of the infarct related artery (IRA) received an intravenous bolus infusion of 70 mg of rt-PA, PF was assessed before and 90 minutes after the treatment and the levels were compared in patients with (group 1) and without (group 2) reperfusion of the IRA. Results: Basal levels of PF were within the normal range in all patients. There was a decrement of 35.1% in the PF dosed at 90 minutes, from 276.8 ± 55.5 mg/al to 168.0 ± 68.2 mg/dl. Both groups were similar in the levels of PF 90 after treatment (145.1 ± 95.7 mg/dl in group I versus 187.0 ± 53.7 mg/dl in group 2). Conclusion: In bolus rt-PA treatment for MI significantly reduces the PF, but the LS obtained was similar in patients with or without reperfusion of the IRA.

Segmento ST como indicador de recanalizaçäo arterial após terapêutica trombolítica no infarto do miocárdio / ST segment as an arterial recanalization indicator after thrombolytic therapy in acute myocardial infarction

Objetivo: Avaliar a importância do segmento ST como indicador de recanalizaçäo da artéria em pacientes com infarto do miocárdio submetidos a terapêutica trombolítica por via venosa. Casuística e Métodos: Setenta e quatro pacientes (62 homens, média de idade 52,6 ñ 10 anos) com oclusäo da artéria relacionada ao infarto (ARI) antes da infusäo venosa "in bolus" de rt-PA em doses de 50, 60 e 70 mg. Após 90 minutos realizou-se nova angiografia e o estado da ARI foi relacionado ao comportamento do segmento ST antes e após o tratamento. Resultados: Cinqüenta e seis (75,6%) pacientes apresentaram normalizaçäo ou diminuiçäo do segmento ST (grupo I e II). Destes, em 47 notou-se recanalizaçäo da ARI. Dos demais 18 pacientes que näo apresentaram alteraçöes no segmento ST (grupo III), a ARI estava ocluída em 13 e recanalizada em cinco. O comportamento do segmento ST apresentou sensibilidade de 90,3% especificidade de 59,1%, valor preditivo positivo de 83,9% e valor preditivo negativo de 72,9%. Conclusäo: O segmento ST constitui importante indicador de recanalizaçäo ou näo da ARI após terapêutica trombolítica

Purpose: To evaluate the importance of the segment ST in the identification of coronary recanalization in patients submitted to intravenous thrombolysis during acute myocardial infarction (MI). Patients and Methods: Seventy four patients with MI, 62 male with mean age of 52.6 ± 10 years. All patients had angiographically demonstrated occlusion of the infarct-related artery (IRA) before the thrombolytic treatment with intravenous in bolus infusion of 50 mg, 60 mg and 70 mg of rt-PA. The recanalization of the IRA was assessed 90 minutes later. The real status of the IRA in the angiograms was compared with the ST segment changes between the ECGs obtained before and after the thrombolytic therapy. Results: Fifty six (75.6% ) patients presented a significant reduction in the ST segment elevation (groups I and II). Of these, 47 possessed an openned IRA. From the 18 patients who did not show ST segment decrement (group III),13 had an occluded IRA, and 5 an openned one. The method presented sensitivity of 90.3% and a specificity of 59.1%, positive predictive value of 83.9% and negative predictive value of 72.2%. Conclusions: The ST segment is an important marker of coronary recanalization or not following intravenous thrombolytic therapy.

Diagnóstico ecodopplercardiográfico de aneurisma aterosclerótico de artéria coronária / Doppler echocardiographic diagnosis of atherosclerotic aneurysm of the coronary artery

Homem de 74 anos com infarto do miocárdio submetido a terapêutica trombolítica realizou ecoDopplercardiograma que permitiu diagnosticar aneurisma aterosclerótico de artéria coronária direita. Este diagnóstico, raramente conseguido por exames näo invasivos, foi subseqüentemente confirmado por estudo cineangiográfico e biópsia transoperatória

A 74 year-old man with acute myocardial infarction submitted to thrombolytic therapy had the diagnosis of atherosclerotic aneurysm of the coronary artery attained with Doppler echocardiography. Subsequently diagnosis was confirmed by angiography and the atherosclerotic etiology identified in pathology.

Angioplastia de tronco de coronária esquerda no infarto agudo do miocárdio / Percutaneous transluminal angioplasty of left main coronary artery in acute myocardial infarction

A angioplastia transluminal coronária näo é conduta habitual na fase aguda do miocárdio por oclusäo de tronco de coronária esquerda. Aplicamos esta terapêutica em dois casos: o primeiro, homem de 54 anos, foi submetido a desobstruçäo mecânica e angioplastia de tronco de coronária esquerda, após 145 minutos do início dos sintomas, bem como a cirurgia de revascularizaçäo do miocárdio doze horas mais tarde; o segundo, mulher de 77 anos, foi submetida aos dois primeiros procedimentos, nnäo sendo porém operada. No primeiro caso houve boa evoluçäo imediata e tardia, no segundo, a paciente faleceu doze horas após

Percutaneous transluminal coronary angioplastg is unusual in acute myocardial infarction after left main coronary artery occlusion. We applied this therapy in two cases. The first, a 54-year-old man, submitted to mechanical reperfusion and left main coronary artery angioplasty 145 minutes after the beginning of the symptoms and coronary artery surgery 12 hours later; the second, a 77-year-old woman, submitted to both procedures but not to surgery. In the first case there was a satisfactory follow-up but in the second, the patient died twelve hours later

Bloqueio de ramo esquerdo intermitente como complicaçäo na síndrome de Guillain-Barré: relato de caso / Intermittent left branch block as a complication in Guillain-Barré syndrome: report of a case

É apresentado o caso de um paciente de 46 anos, com quadro de síndrome de Guillain-Barré em evoluçäo há 5 dias, e que na ocasiäo da internaçäo apresentava-se com teraparesia flácida de predomínio crural. Internato na Unidade de Terapia Intensiva (UTI) para observaçäo do padräo respiratório, näo se observou progressäo de déficit neurológico com a introduçäo da corticoterapia. Durante evoluçäo foi constatado bloqueio do ramo esquerdo intermitente sem distúrbios hidroeletrolítico ou hemodinâmico concomitante. A reversäo das alteraçöes eletrocardiográficas foi concomitante com a melhora do quadro neurológico. Discute-se a possibilidade de uma miocardite focal durante a fase aguda do processo neurológico, influindo predominantemente sobre o sistema de conduçäo