Search

Background: Heart transplantation (HT) as a therapeutic option for end-stage chronic Chagas' heart disease (CCHD) is controversial. Reactivation of Trypanosoma cruzi infection and recurrence of the disease in the allograft are likely to occur. Furthermore, active myocarditis has been reported to predispose patients to an increased incidence and severity of rejection., Methods and Results: We prospectively investigated the long-term follow-up of 10 patients with CCHD who underwent HT. Immunosuppression was based on cyclosporine A and azathioprine. T cruzi reactivation was prevented with benzonidazole. Besides allograft rejection surveillance, T cruzi infection was monitored through blood tests, myocardial biopsies, and serological tests. Over a mean follow-up period of 34 +/- 38 months (range, 73 to 124 months), 7 patients are alive and in NYHA functional class I. Life expectancy was 78% for the second year and 65% for 10 years. Rejection was less frequent in chagasic than in age- and sex-matched control patients (mean +/- SD, 1.60 +/- 1.26 versus 5.70 +/- 1.89 episodes per patient, respectively; P = .0001); decreased severity of rejection was also observed (P = .006). T cruzi parasitemias detected on three occasions were successfully treated with benzonidazole. There were no signs of recurrence of the disease in the allograft., Conclusions: These results suggest an important role of HT in the treatment of CCHD. There was a low frequency of T cruzi infection reactivation and no signs of recurrence of the disease in the allograft. The surprisingly decreased rejection incidence and severity require further studies for elucidation.

Objective: To describe plateau iris syndrome associated with multiple neuroepithelial cysts of the pars plicata., Methods: Case reports of 3 patients with plateau iris syndrome who were found to have multiple bilateral ciliary body cysts on ultrasound biomicroscopic examination., Results: Ultrasound biomicroscopy revealed classic features of plateau iris syndrome in each patient but also showed multiple neuroepithelial cysts of the ciliary body in each eye., Conclusion: Plateau iris syndrome may be associated with multiple ciliary body cysts.

Purpose: The objective of this study is to evaluate the effect of calcium channel blockers (CCB) on the clinical course of glaucoma., Methods: Open-angle glaucoma patients receiving oral CCB for nonophthalmic diseases were sequentially selected from the private practice of the Glaucoma Service of Wills Eye Hospital. The course of visual fields and optic discs and serial intraocular pressures were analyzed in subsequent follow-ups. The findings in these 83 cases were compared with a control group of patients with the same ocular diagnosis, but who were not on CCB. A subset of 43 cases of the study group was compared with an age-matched subset of the control group., Results: There was no apparent difference in the absolute intraocular pressure, stability/change of visual fields or optic discs when we compared patients using CCB with the control group. Among patients with the diagnosis of "low-tension glaucoma," we also could not demonstrate any statistically significant difference between the two groups., Conclusions: In this study, neither a beneficial nor a detrimental effect of CCB on the course of the patients glaucomatous disease was apparent.

We evaluated the influence of apraclonidine on the outcome of filtering surgery. Patients treated with apraclonidine who underwent a guarded filtration procedure were retrospectively evaluated and compared to a control group. Complications were more frequent in patients treated with apraclonidine than in the control group, but the difference was not statistically significant. We encourage further studies regarding the effects of apraclonidine in filtering procedures.

The role of antibodies in the previously demonstrated harmful effect of Trypanosoma cruzi-infected mothers on progeny infection was studied by injecting either serum from chronically infected animals or purified T. cruzi-specific antibodies into uninfected mice during gestation and lactation periods. It was verified that injected antibodies were transferred to offspring. Pregnant or lactating animals exhibited lower circulating antibody levels than nonpregnant or pregnant but nonlactating mice, respectively, suggesting that such antibody transfer occurred in both fetuses and suckling offspring. When infected two months after birth, offspring of mice treated with chronic serum or purified antibodies displayed significantly higher parasitemia than offspring from mothers receiving control serum or immunoglobulins unrelated to T. cruzi. These results indicate that soluble factors contained in sera of infected mice, and particularly antibodies, when transferred from mothers to their young, are able to worsen T. cruzi acquired infection in the offspring.

Purpose: Patients prospectively enrolled in a clinical trial to evaluate the effect of corticosteroid use after guarded filtration procedure (trabeculectomy) were re-evaluated after 10 years to determine whether (1) there were differences in intraocular pressure (IOP) level and stability of glaucoma between treated and nontreated eyes, (2) surgery had altered the clinical course of the patients, and (3) there was any relation between level of IOP and glaucoma control., Methods: Forty-six eyes of 35 patients were evaluated individually. Stabilization/ progression of glaucoma was established based on IOP, clinical evaluation of visual fields, and stereoscopic analysis of disc using ophthalmoscopy and photography., Results: The nonsteroid-treated eyes underwent more additional glaucoma surgeries, were treated with more glaucoma medicines, and had higher IOPs. Glaucoma was stabilized in 82.8% of the steroid-treated eyes and 67% of the nonsteroid-treated eyes. There was a direct correlation between level of IOP and stabilization of optic nerve and visual field in both groups., Conclusion: The use of corticosteroids after guarded filtration procedure was correlated with better glaucoma control. Patients with lower IOPs were more likely to be stabilized than those with higher pressures.

The sequence relations between small bacteriocinogenic plasmids (pRJ6, pRJ9, pRJ10 and pRJ11) of Staphylococcus aureus were investigated by comparing restriction maps and by hybridization. Plasmids pRJ10 and pRJ11 showed identical restriction maps, similar to that of pRJ9. The restriction map of pRJ6 differed from those of pRJ9 and pRJ10/pRJ11. Both groups of plasmids were shown to share a region of homology of at least 2.6 kb. The incompatibility relationships between them were also investigated by using plasmid derivatives tagged with transposon Tn551. Plasmids pRJ6 and pRJ9 proved to belong to different incompatibility groups.

Factors most commonly associated with cervical cancer are early start of sexual activity and papillomavirus infection. PURPOSE--Studying risk factors for cervical condyloma in sexually active adolescents in the region of Campinas, SP, Brazil. METHOD--131 adolescents with condyloma and 131 without disease, controlled by age and pregnancy state, were compared according to social-demographical, sexual-behavioral and gynecological/obstetrical variables. Relative risk evaluation was performed for each variable and multivariate analysis with logistic regression was made to determine confunding factors. RESULTS--Tobacco smoking and nulliparity were identified as independent risk factors for cervical condyloma in this population. More than two sexual partners and low level of schooling were identified as risk factors in the univariate analysis, however, these factors were highly correlated with tobacco smoking and parity, respectively. All other variables were similar in both groups. CONCLUSION--Although tobacco smoking and nulliparity were identified as risk factors for cervical condyloma, it is very difficult to characterize a sexually active adolescent group without risk for infection.

The prevalence of transplacental transfer of microfilariae and structural lesions in the placentas of amicrofilaraemic (n = 10) and Wuchereria bancrofti microfilaraemic (n = 10) pregnant women from the prenatal care unit of the Hospital das Clinicas, Recife, Brazil, was investigated. Study participants were selected by filtration (3 microns/13 mm) of nocturnal (2300-0100 h) venous blood. A detailed histopathological examination was performed to detect abnormalities in the placenta, the cord and the foetal membranes. Both study groups had similar obstetric profiles. Parasitaemia was present during labour in nine of ten microfilaraemic women, but no microfilariae were found by filtration of 5-10 ml cord blood. No macroscopic abnormalities were seen in placentas from microfilaraemic mothers; two placentas from the amicrofilaraemic cases contained, respectively, infarcted areas and cysts at the cut surface. Microscopy failed to detect microfilariae in the intervillous spaces, chorionic and decidual vessels, or the umbilical cord. Thus, transplacental transfer of Wuchereria bancrofti microfilariae seems to be a rare phenomenon, and microfilaraemia does not appear to be a risk factor for placental pathology.