Ethiologic treatment of acute and chronic Chagas' Disease [corrected].

The uncertainties in the ethiological treatment of Chagas' Disease are consequence of the lack of entire knowledge of its pathogeny and the no existence of a healing criterium. There is a consensus that antiparasite drugs should be in the acute phase of the infection, regardless of the infection route, in new crisis, in patients under immunosuppression and in organs transplantation. There is still controversy regarding subacute, chronic or indetermined phase or cases with mild cardia/digestive forms, not included in the situations listed above neither in a research protocol. The treatment includes oral benzonidazol 5 mg/kg/dat, bid or tid for 60 days. In 71 patients monitored in this fashion, the authors have found 60% of negative xenodiagnostic at the end of treatment It is still necessary, however, to continue to investigate and accomplishing more randomized trials to confirm the efficacy of such method, and also to try to obtain effective and less toxic agents. It is also fundamental to standardize a more reliable healing criterium.

[Prevalence of congestive heart failure after ventriculomectomy in patients with obstructive hypertrophic cardiomyopathy]. / Prevalência de insuficiência cardíaca congestiva após ventriculomiectomia em portadores da cardiomiopatia hipertrófica obstrutiva.

PURPOSE: To assess the prevalence of congestive heart failure in the late post-operative follow-up in patients with hypertrophic obstructive cardiomyopathy (HOCM) submitted to ventriculomectomy (VM). METHODS: Thirty six patients with HOCM, all of them with basal intraventricular systolic pressure gradient (BPG) > or = 50 mmHg, were studied. Sixteen (group I) were submitted to VM and 20 (group II) remained under clinical treatment. At group I the ages were 1 month to 61 years (28.25 +/- 15.39), 10 male (62.5%); BPG ranged from 50 to 192 mmHg (98.09 +/- 42.76) with mean follow-up of 13.06 +/- 7.19 years. At group II the age ranged from 2 months to 58 years (31.01 +/- 18.61); 12 male (60%); BPG ranged from 52 to 185 mmHg (83.47 +/- 35.08) with mean follow-up of 9.6 +/- 4.93 years. RESULTS: At group I the follow-up was good in 4 patients (25%), stable in 2 (12.5%) and poor in 3 (18%). Seven patients (43.75%) developed congestive heart failure at mean time of 7.53 +/- 8.44 years; there was one operative death and the follow-up control was lost in 7 patients. In group II, the follow-up was good in 3 patients (15%), stable in a 6 (30%) and poor in a 9 (45%); no deaths occurred. Two patients had heart failure within 3 years after the onset of the disease. The follow-up control was lost in 8 patients (40%). CONCLUSION: 1) congestive heart failure was more frequent in patients submitted to VM rather than the non-operated ones (p < 0.05); 2) the short-term follow-up was better in operated patients rather than in non-operated ones.

[Chronic phase of Chagas disease. Clinical aspects and course of the disease]. / Fase crônica da doença de Chagas. Aspectos clínicos e evolutivos.

PURPOSE: To evaluate the clinical and evolutive aspects of chronic chagasic patients. METHODS: Three hundred chronic chagasic patients, 180 females, with age ranging from 19 to 81 years (55.6 +/- 13.1) were retrospectively studied. Patients were divided according to the following clinical types: indeterminated, cardiac (with the subtypes: arrhythmogenic, dilated and mixed), digestive isolated and digestive plus cardiac involvement. The following variables were analysed: prevalence of each clinical forms, symptoms, electrocardiographic pattern and clinical outcome. RESULTS: At the start of the study, 73 (24.3%) patients were in indetermined type, 106 (35.3%) in cardiac arrhythmogenic, 95 (31.6%) in mixed, 7 (2.3%) in dilated, 16 (5.3%) in digestive plus cardiac type and 3 (1%) in the pure digestive type. The most prevalent symptoms were dyspnea on efforts (57%), palpitations (41.33%) and chest pain (33%). The most frequent electrocardiographic pattern was right bundle branch block plus antero-superior fascicular block, in 30% of the patients. The average follow-up time was 7.8 +/- 6.1 years and the outcome was considered good in 20 patients (6.6%), stable in 214 (71.3%) and bad in 66 (23%). At the end of the follow-up, 9 patients have evaluated from the indeterminated to the cardiac and digestive types, and 19 (17.92%), from the arrhythmogenic to mixed cardiac subtype. The follow-up was lost in 79 patients (26.3%), most of them, probably dead. CONCLUSION: With a mean time of 7.8 years, 12.3% of the patients in the indeterminated type evolved to the cardiac and/or digestive type; right brundle branch block with antero-superior fascicular block was the most prevalent electrocardiographic pattern; the outcome was stable or good in the majority of these patients.

[Clinical aspects and development of dilated cardiomyopathy in infants and children]. / Aspectos clínicos e evolutivos da miocardiopatia dilatada nos lactentes e na infância.

PURPOSE: The evaluation of the clinical aspects of the dilated cardiomyopathy (DCM) in infants and children regarding, mainly, to the evolution and prognostic of this disease. PATIENTS AND METHODS: 38 patients divided in two groups: A) 22 infants till 22 (11.60 +/- 6.50) months of age, 15 female, and B) 15 children of 2 to 12 years of age (5.23 +/- 3.13) the majority males (10). A retrospective study was carried out based on the data from the patients's records. It was performed, in all the cases, a clinical, electrocardiographic, echocardiographic (M module and two dimensional echocardiography) and radiologic evaluation. RESULTS: The dyspnea on exercise (included sucking) was the predominant symptom in 15 (65.22%) patients of the A group and 10 (66.67%) of the B group followed by perilabial cyanosis in 7 (30.43%) and 6 (40%) patients, respectively. In the A group the clinical diagnostic hypothesis was inspecific myocarditis (IM) in 12 (52.17%), endocardial fibroelastosis (EFE), in 8 (34.79%), and "idiopathic" dilated cardiomyopathy (IDCM) in 3 (13.04%). In the B group to the diagnostic conclusion of myocarditis was made in 10 patients (66.67%)--5 of them IM--EFE in 3 (20%); and IDCM in 2 (13.33%). The average time of evolution was 5.48 months in the A group and 18.56 in the B group. In the A group the evolution was excellent in 3 (3.04%), good in 10 (43.46%), stable in 2 (8.70%) and bad in 1 (4.35%). In the B group, excellent in 8 (53.33%), good in 2 (20%) stable in 1 (6.67%). No bad evolution in this group. There was a decrease in the A group (4.34%); 6 patients in this group (26.09%) and 3 (20%) of the B group interrupt the follow-up. CONCLUSION: 1) The prognosis of infants with DCM including those with the diagnostic hypothesis of EFE seems to be less adverse than it could be supposed to be; 2) the prognostic in children with the diagnosis of DCM established above 2 years of age seems to be good; 3) the differential clinical diagnosis between EFE and IM is difficult and with no accuracy; 4) it is possible that the IM could be more prevalent in infants till 6 months of age than we suppose it was.

Avaliacao da propafenona em pacientes chagasicos com extra-sistolia ventricular. / Evaluation of propafenon in Chagas patients with ventricular extrasystole

Os autores realizaram ensaios terapeuticos com um antiarritmico, a propafenona, em pacientes chagasicos com extrassistolia ventricular estavel, sendo esta considerada como a extrasistolia cujo numero nao sofreu variacao superior a 20% em tres avaliacoes previas ao uso da droga, realizadas a intervalos de uma semana. A casuistica constou de 20 pacientes chagasicos que foram avaliados antes e depois da terapeutica, atraves da eletrocardiografia dianamica e do eletrocardiograma convencional Obteve-se reducao significativa e acentuada no numero de extra-sistoles na 2a. semana de terapeutica em todos os pacientes. Os autores sugerem que o uso da propafenona por via oral nos esquemas propostos, parece ser opcao eficaz na terapeutica da extra-sistolia ventricular de pacientes chagasicos

Insuficiência tricúspide provocada por traumatismo fechado do tórax. Relato de um caso / Tricuspid insufficiency caused by closed trauma of the thorax. Report of a case

E apresentado um caso de insuficiencia tricuspide isolada decorrente de traumatismo fechado do torax, em paciente que se mantem assintomatico e nao operado apos 13 anos do evento