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Após 1989, introduzimos algumas alterações no tratamento cirúrgico dos aneurismas e dissecções da aorta, em nosso Serviço, entre elas maior rapidez no diagnóstico, uso de parada circulatória, hipotermia profunda, parada circulatória total, monitorização hemodinâmica, controle dos distúrbios de coagulação, controle da pressão liquórica, implantação das artérias intercostais. Entre janeiro de 1980 e julho de 1994, 520 pacientes foram submetidos a tratamento cirúrgico de aneurismas ou dissecções da aorta, de forma consecutiva e não selecionados. Os pacientes foram divididos em três grupos, de acordo com o diagnóstico: ? Aneurisma de aorta ascendente (AAAS) ? Aneurisma de arco aórtico (AAAO) ? Dissecção aguda da aorta tipos I e II (DAAO I e II) Nos três grupos, a mortalidade foi significativamente inferior para pacientes operados no período após 1989. Variáveis preditivas de mortalidade para AAAS foram: complicações pulmonares (p = 0,0210), renais (p = 0,0310), neurológicas (p < 0,0001). Para DAAO I e II, a hipertensão arterial (p < 0,0001), complicações cardíacas (p < 0,0001), neurológicas (p < 0,0001), renais (p < 0,0001) e a rotura (p < 0,0001) foram preditivas de óbito, e para AAAO foram as variáveis: idade (p = 0,0001) e complicações renais (p = 0,0015). Os autores concluem que as modificações introduzidas no método de tratamento cirúrgico dos aneurismas e dissecções da aorta contribuíram significativamente para a melhora dos resultados.

Descrevemos um caso de derrame pericárdico idiopático em que, durante investigação diagnóstica, foi constatado ser um quilopericárdio. A linfografia mostrou aplasia parcial do ducto torácico. Realizamos uma breve revisão da etiopatogenia, quadro clínico, métodos diagnósticos complementares e possibilidades terapêuticas do quilopericárdio.

Background: Chagas disease is characterized by intense myocardial fibrosis stimulated by the exacerbated production of inflammatory cytokines, oxidative stress, and apoptosis. Air pollution is a serious public health problem and also follows this same path. Therefore, air pollution might amplify the inflammatory response of Chagas disease and increase myocardial fibrosis. Methods: We studied groups of Trypanosoma cruzi infected Sirius hamsters (Chagas=CH and Chagas exposed to pollution=CH+P) and 2 control groups (control healthy animals=CT and control exposed to pollution=CT+P). We evaluated acute phase (60 days post infection) and chronic phase (10 months). Echocardiograms were performed to assess left ventricular systolic and diastolic diameter, in addition to ejection fraction. Interstitial collagen was measured by morphometry in picrosirius red staining tissue. The evaluation of inflammation was performed by gene and protein expression of cytokines IL10, IFN-g, and TNF; oxidative stress was quantified by gene expression of NOX1, MnSOD, and iNOS and by analysis of reactive oxygen species; and apoptosis was performed by gene expression of BCL2 and Capsase3, in addition to TUNEL analysis. Results: Chagas groups had increased collagen deposition mainly in the acute phase, but air pollution did not increase this deposition. Also, Chagas groups had lower ejection fraction in the acute phase (p = 0.002) and again air pollution did not worsen ventricular function or dilation. The analysis of the inflammation and oxidative stress pathways were also not amplified by air pollution. Apoptosis analysis showed increased expression of BCL2 and Caspase3 genes in chagasic groups in the acute phase, with a marginal p of 0.054 in BCL2 expression among infected groups, and TUNEL technique showed amplified of apoptotic cells by pollution among infected groups. Conclusions: A possible modulation of the apoptotic pathway was observed, inferring interference from air pollution in this pathway. However, it was not enough to promote a greater collagen deposition, or worsening ventricular function or dilation caused by air pollution in this model of Chagas cardiomyopathy. [ABSTRACT FROM AUTHOR]

Extracellular vesicles (EVs) are lipid bilayer envelopes that encase several types of molecules. Their contents mostly reflect their cell origin and possible targets at other locations in the organism and can be modified in pathological conditions to interfere with intercellular communication, thus promoting disease establishment and development. These characteristics, in addition to their presence in virtually all body fluids, make such vesicles ideal for biomarker discovery in human diseases. Here, we describe the effect of different anticoagulants and the combination of two purification methods for isolation and characterization of circulating EVs from blood of chronic Chagas disease (CCD) patients. We illustrated this procedure by studying a population of patients with Chagas disease at the indeterminate chronic stage, in which the Trypanosoma cruzi is very scarce in circulation. EVs were harvested from blood collected without or with different anticoagulants. Protein and nanoparticle tracking analysis was used to measure EVs size and concentration. The EVs were purified by ultracentrifugation, followed by size‐exclusion chromatography and characterized by chemiluminescent enzyme‐linked immunosorbent assay and dot blot using antibodies that recognized parasite‐derived EVs, such as hyperimmune sera, polyclonal and monoclonal antibodies against trans‐sialidase and mucins. In parallel, antibodies against classical human EV markers CD9, CD63, CD81, and CD82, were also analyzed. The results showed that anticoagulants did not interfere with the analyzed parameters and circulating EVs from CCD patients contain T. cruzi antigens and classical human exosomal markers. Overall, our protocol is adequate for the isolation of the total circulating EVs and can serve as an important basis for further studies on biomarker discovery in Chagas' disease. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2005.02.045 Byline: Edmundo Arteaga, Aloir Queiroz Araujo, Paula Buck, Barbara Maria Ianni, Rogerio Rabello, Charles Mady Abstract: Plasma B-type natriuretic peptide (BNP) is a sensitive functional marker in heart disease including hypertrophic cardiomyopathy (HCM). The utility of plasma amino-terminal pro-BNP (NT-proBNP) quantification in heart disease has been investigated, but there are no published data regarding this test in HCM. Author Affiliation: Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil Article History: Received 13 May 2004; Accepted 20 February 2005

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2004.08.021 Byline: Afonso Y. Matsumoto (a)(b), Edmundo Arteaga (a), Barbara M. Ianni (a), Ana M.F.W. Braga (a), Paula C. Buck (a), Charles Mady (a) Abstract: The aim of this study was to analyze the relationships among exercise capacity (EC), hypertrophy, and diastolic function in nonobstructive hypertrophic cardiomyopathy (NOHCM). Author Affiliation: (a) Departmnet of Cardiomyopathy, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil (b) Laboratorio Fleury, Sao Paulo, Brazil Article History: Received 29 January 2004; Accepted 22 August 2004

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2004.09.049 Byline: Edmundo Arteaga, Barbara Maria Ianni, Fabio Fernandes, Charles Mady Abstract: Selected patients with hypertrophic cardiomyopathy (HCM) have 3% to 4% annual mortality as compared to only 0.5% to 1.5% in nonselected patients. Our aim was to evaluate survival and prognostic factors in HCM in patients in a tertiary care center. Author Affiliation: Cardiomyopathy Division, University of Sao Paulo Medical School, Heart Institute (InCor), Sao Paulo, Brazil Article History: Received 13 May 2004; Accepted 20 September 2004