RESUMO
La prevención, el diagnóstico y el tratamiento de la Tuberculosis Infantil (TBI), no ha sido suficientemente reconocida como causa importante de enfermedad y muerte entre los 0 a 14 años. El objetivo del presente trabajo fue analizar la situación epidemiológica de la TBI en la Región Sanitaria V (RSV), provincia de Buenos Aires. Es un estudio observacional longitudinal, realizado entre el 1º de enero del 2000 y el 31 de diciembre de 2014. Se efectuó un análisis de tendencia sobre un total de 2.142 casos de Tuberculosis Infantil, calculada por regresión lineal simple y expresada como variación anual promedio (VAP). Se analizó el número de casos notificados y tasas de incidencia(TI) por 100.000 habitantes de todas las formas de TBI, TBI pulmonar (TBIP) y TBIP confirmada por bacteriología. La TBP se estudió desagregada en dos grupos de edad: 0 a 4 y 5 a 14 años. Resultados: La tasa de incidencia de TBI y la tasa de incidencia de la TBIP presentaron una tendencia neta al descenso, con una declinación mayor al 5% y similar a la TBIP entre los 0 a 4 años y entre los 5 a 14 años. En cambio, la tasa de incidencia de la TBIP confirmada del total de los casos y en los dos subgrupos, la tendencia al descenso fue mínima y no resultó estadísticamente significativa. La TB se mantiene como un riesgo de salud en la RSV, con la mayor afectación en edades jóvenes, hecho que refleja la tendencia de una transmisión reciente y que se asocia cuando no se ha logrado controlar la enfermedad (AU)
Prevention, diagnosis, and treatment of childhood tuberculosis (childhood TB) is underrecognized as an important cause of disease and death between 0 and 14 years of age. The aim of this study was to analyze the epidemiological situation of childhood TB in the Public Health Region V (PHRV), the province of Buenos Aires. In a longitudinal, observational study conducted between January 1, 2000 and December, 2014.A trend analysis was performed in a total of 2,142 cases of childhood TB, calculated by simple linear regression and expressed as average annual rate (AAR). The number of reported cases and incidence rate (IR) were calculated per 100,000 inhabitants of all forms of childhood TB, childhood lung TB, and childhood lung TB confirmed by bacteriological tests. Lung TB was assessed according to age group: 0 to 4 and 5 to 14 years. Results: IR of childhood TB and IR of childhood lung TB showed a net downward trend, with a greater than 5% decrease and similar to childhood lung TB between children between 0 and 4 years and those between 5 and 14 years of age. However, the IR of confirmed childhood lung TB of the total of cases and in the two subgroups showed a minimal downward trend and was not statistically significant. TB remains a health risk in PHRV, with a higher incidence in children, reflecting a trend of recent transmission and associated with a lack of disease control (AU)
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Argentina/epidemiologia , Incidência , Tuberculose Resistente a Múltiplos Medicamentos , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Estudo ObservacionalRESUMO
Granulysin is a human polypeptide produced by cytolytic cells active against a broad range of microbes. Three peptides covering the regions 25-50 (Gr-1 and Gr-2) and 39-62 (Gr-3) of granulysin were synthesized, and their in vitro activity against Mycobacterium tuberculosis was evaluated. The most active peptide was Gr-1C, containing a disulphide bridge, with Minimal Inhibitory Concentration value of 10.1 microM. In concentrations of up to 50 microM, Gr-1 and Gr2 didn't exceed 30% of hemolysis.
Assuntos
Antígenos de Diferenciação de Linfócitos T/química , Antígenos de Diferenciação de Linfócitos T/farmacologia , Peptídeos Catiônicos Antimicrobianos/química , Peptídeos Catiônicos Antimicrobianos/farmacologia , Mycobacterium tuberculosis/efeitos dos fármacos , Fragmentos de Peptídeos/química , Fragmentos de Peptídeos/farmacologia , Sequência de Aminoácidos , Contagem de Colônia Microbiana , Eritrócitos/efeitos dos fármacos , Hemólise , Humanos , Testes de Sensibilidade Microbiana , Dados de Sequência Molecular , Fragmentos de Peptídeos/síntese químicaRESUMO
SETTING: Public health care services in the provinces of Buenos Aires, Santa Fe, Jujuy and Santa Cruz, Argentina. OBJECTIVE: To evaluate delays in tuberculosis (TB) diagnosis and treatment and associated risk factors in departments and administrative areas of four Argentine provinces. DESIGN: Cross-sectional survey including retrospective medical record review and patient interviews. RESULTS: A total of 243 patients with smear-positive pulmonary TB and a mean age of 40 years were included in the study. The mean diagnostic delays were as follows: total delay 92.1 days (median 62.0); patient delay 58.8 days (median 31); health service delay 32.6 days (median 12.5). The mean treatment delay was 0.9 days (median 0). Associations were observed between patient delays of >30 days and residence in Jujuy, age >50 years, dependence on transport to the nearest public health service due to distance and presence of cough. The >60-day total diagnosis delay was associated with age >50 years and need for transport to the nearest public health service. CONCLUSION: Diagnostic delay is an important problem in the areas studied, with patient delay being of most concern. Patient delay was associated with age >50 years, dependence on transport to the nearest public health service due to distance and presence of cough.
Assuntos
Antituberculosos/uso terapêutico , Técnicas Bacteriológicas , Acessibilidade aos Serviços de Saúde , Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Criança , Tosse/microbiologia , Estudos Transversais , Diagnóstico Precoce , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Características de Residência , Estudos Retrospectivos , Fatores de Tempo , Transporte de Pacientes , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/microbiologiaRESUMO
The increase in both Mycobacterium tuberculosis human clinical isolates resistant to the essential drugs and cases of disseminated micobacteriosis due to Mycobacterium avium Complex, underlines the need to investigate new antimicobacterial agents. The antimicrobial peptides are a new group of active antibiotics with a particular mechanism of action. Some of them, like cecropin and melittin, isolated from insects, have demonstrated good in vitro activity against Gram-positive and Gram-negative bacteria. Synthetic hybrids of those peptides have been more active than individual peptides. In this study, the in vitro activity of two hybrid synthetic peptides from melittin and cecropin against M. tuberculosis, M. avium Complex, Mycobacterium fortuitum and Mycobacterium smegmatis has been evaluated. The minimal inhibitory concentration was determined by using the broth macrodilution technique. The minimal bactericide concentration in Lowenstein Jensen medium was then obtained. The peptides studied were active, in vitro, against M. smegmatis, but they did not show any activity against the other mycobacteria analyzed.
Assuntos
Antibacterianos/farmacologia , Peptídeos Catiônicos Antimicrobianos/farmacologia , Meliteno/farmacologia , Mycobacterium/efeitos dos fármacos , Fragmentos de Peptídeos/farmacologia , Antibacterianos/síntese química , Peptídeos Catiônicos Antimicrobianos/síntese química , Avaliação Pré-Clínica de Medicamentos , Meliteno/síntese química , Testes de Sensibilidade Microbiana , Mycobacterium avium/efeitos dos fármacos , Mycobacterium fortuitum/efeitos dos fármacos , Mycobacterium smegmatis/efeitos dos fármacos , Mycobacterium tuberculosis/efeitos dos fármacos , Fragmentos de Peptídeos/síntese químicaRESUMO
OBJECTIVE: To evaluate the usefulness of the recombinant 16-kDa antigen (re-Ag16) of Mycobacterium tuberculosis in the serodiagnosis of tuberculosis (TB) in children. MATERIALS: Seventy-four children with active TB, 49 apparently healthy contact children and 149 children suffering from non-mycobacterial diseases were evaluated. Detection of anti 16-kDa antigen IgG, IgM and IgA was performed by enzyme-immunoassay. RESULTS: An increased mean antibody response to re-Ag16 was observed in contact children compared with non-mycobacterial disease patients (IgG assay: 89.1 enzymatic units [eu] vs. 40.8 eu; IgM assay: 64.7 eu vs. 38.1 eu; IgA assay: 138.2 eu vs. 78.2 eu for contact children and non-mycobacterial disease patients, respectively), indicating that anti-16-kDa antibodies could be elevated in response to infections even without clinically apparent TB. Setting the specificity as the 95th percentile of the contact group's ELISA units, the sensitivity of the IgG, IgA and IgM assays were 34%, 19% and 3% respectively; combining results of the IgG and IgA assays led to 43% positivity in children with active TB. CONCLUSION: The detection of anti 16-kDa IgG and IgA may be useful as a complementary technique for the diagnosis of childhood TB. Recognition of this antigen seems to be heterogeneous; combining responses against other antigens may be a good strategy to improve the performance of this assay.
Assuntos
Anticorpos Antibacterianos/sangue , Antígenos de Bactérias/imunologia , Imunoglobulinas/sangue , Mycobacterium tuberculosis/imunologia , Proteínas Recombinantes/imunologia , Tuberculose/diagnóstico , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Lactente , Masculino , Sensibilidade e Especificidade , Testes SorológicosRESUMO
SETTING: Many authors have shown rising titres of anti-mycobacterial antibodies after a few months of anti-tuberculosis treatment. This humoral response might persist for years, making the discrimination between current and old disease difficult. OBJECTIVE: Characterisation of the humoral response to culture filtrates of Mycobacterium tuberculosis before and after treatment of tuberculous patients in order to identify those antigens that could provide information about disease activity. METHODS: Anti-mycobacterial IgG response was determined during and after treatment of tuberculous patients by ELISA and immunoblot. Serum was taken from 71 active tuberculous patients (59 newly acquired and 12 relapse), 15 old tuberculous patients and 45 nontuberculous control subjects. RESULTS: By ELISA, antibody response increased after 2 months of treatment. After chemotherapy was completed, the estimated number of antibodies remained at the same level. The level of specific antibodies in patients seems to reach the same level as that of control subjects 3 years after initiation of treatment. In Western blot, although each patient serum had its own characteristic banding pattern, differences between tuberculous patients and control subjects were found in the area below 20 kDa. Serum from tuberculous patients showed high levels of antibodies at the 14 kDa region. After the beginning of treatment, the intensity of the 14 kDa region band and the percentage of positive recognition tended to decrease. Therefore, one year after initiation of treatment, only seven of 13 cases who demonstrated anti-mycobacterial antibodies in ELISA revealed a mild but still positive reaction at the 14 kDa region; this reactivity disappeared 2 years after initiation of chemotherapy. CONCLUSIONS: The 14 kDa region antigen seems to induce a humoral response that evolves in relation with the disease activity.
Assuntos
Anticorpos Antibacterianos/análise , Formação de Anticorpos , Antígenos de Bactérias/imunologia , Mycobacterium tuberculosis/imunologia , Tuberculose Pulmonar/tratamento farmacológico , Adulto , Eletroforese em Gel de Poliacrilamida , Ensaio de Imunoadsorção Enzimática , Humanos , Immunoblotting , Peso Molecular , Tuberculose Pulmonar/imunologiaRESUMO
Respiratory Syncytial Virus (RSV) has two major antigenic groups, A and B. The implications of these variants in the epidemiology and pathogenesis of RSV infection are not well defined. This study was undertaken to compare the two RSV subgroups in patients admitted to hospital. Clinical and epidemiologic features of RSV subgroups in children under 30 months of age with proven RSV acute lower respiratory infections were examined during 4 winters from 1993 to 1996 in Santa Fe, Argentina. RSV typing was carried out with monoclonal antibodies in nasopharyngeal cells by indirect immunofluorescence. Of the 177 RSV positive nasopharyngeal aspirates obtained from 1993 to 1996, 85 (48%) were available for typing. Seventy-three (85.9%) specimens were identified as Subgroup A and 12 (14.1%) as Subgroup B. Except in 1993, in which only Subgroup A was detected, both variants circulated throughout the epidemic season. Subgroup A infections produced more severe disease than Subgroup B infections, as assessed by the length of the hospital stay and the use of respiratory support. This difference was age related, being evident in infants 0-6 months old. Patients with Subgroup B infections were also significantly less frequently breast-fed (95% vs. 75% for A and B subgroups, respectively; P = 0.04). It is concluded that the severity of disease in Argentinian patients admitted with acute RSV infections may be associated with Subgroup A strains as determined by a serogrouping method.
Assuntos
Infecções por Vírus Respiratório Sincicial/epidemiologia , Vírus Sincicial Respiratório Humano/patogenicidade , Anticorpos Monoclonais , Argentina/epidemiologia , Aleitamento Materno , Pré-Escolar , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Lactente , Recém-Nascido , Masculino , Líquido da Lavagem Nasal/virologia , Infecções por Vírus Respiratório Sincicial/virologia , Vírus Sincicial Respiratório Humano/classificação , Estudos Retrospectivos , Sorotipagem , VirulênciaRESUMO
The human immunodeficiency virus (HIV) epidemic has altered the epidemiological profile of tuberculosis in both industrialized and developing countries. Serious diseases caused by mycobacteria other than Mycobacterium tuberculosis, mostly belonging to the M. avium-intracellulare complex (MAC), have become very common in association with severe immunosuppression. The increase in mycobacterial disease complexity has stimulated the development of more rapid and efficient methods for diagnosis. In the present study, we investigated and assessed the suitability of a gas-liquid chromatography technique for diagnosis of clinically important mycobacteria in Argentina. An identification scheme was developed from the results obtained in a previous study where we characterized the cellular fatty acids and the mycolic acid cleavage products from most frequent species in Argentina. Of 183 isolates tested, 69% were correctly identified to species level and 5% were incorrectly classified. If we only take into account the isolates that could be identified, 93% were correctly identified. Although all of the isolates of M. tuberculosis were correctly identified, four isolates of MAC incorrectly matched by M. tuberculosis. Gas chromatography provides a rapid technique of highly predictive value for mycobacteria identification; it could be used in reference laboratories as a rapid presumptive identification until the biochemical tests are completed.
Assuntos
Cromatografia Gasosa , Mycobacterium/isolamento & purificação , Humanos , Sensibilidade e EspecificidadeRESUMO
El virus de la inmunodeficiencia humana (HIV) causa un profundo impacto sobre el problema de la tuberculosis tanto en los países industrializados como en los en vías de desarrollo. Enfermedades graves causadas por micobacterias no tuberculosas, la mayoría correspondiente al complejo Mycobacterium avium-intracellulare (MAC), se han vuelto muy comunes en asociación con la inmunosupresión severa. El aumento de la complejidad de las enfermedades micobacterianas ha estimulado el desarrollo de métodos de diagnóstico más rápidos y eficientes. En el presente estudio se caracterizaron los ácidos grasos y los productos de degradación de los ácidos micólicos celulares de las especies micobacterianas más frecuentes en la Argentina empleando cromatografía gaseosa (CG), para luego poder desarrollar una técnica rápida de identificación de especies. Los ácidos grasos y los ácidos micólicos de las células micobacterianas saponificadas fueron analizados como ésteres metílicos por CG capilar. Los principales ácidos grasos detectados en todas las especies estudiadas, con excepción de M. smegmatis, fueron los ácidos octadecenoico (18:1) y hexadecanoico (16:0). Los perfiles cromatográficos presentaron diferencias cuantitativas y no cualitativas entre las distintas especies. El ácido tuberculoesteárico se detectó en todas las micobacteias analizadas. Se observaron diferencias significativas (p<0,01) en las medias de las cantidades relativas de algunos ácidos grasos entre aislamientos clínicos de M. tuberculosis, M. bovis y MAC. Se detectaron trazas de 2-elcosanol en cepas de M. tuberculosis H37Rv. Aunque se estudió un número limitado de cepas y de especies, los resultados preliminares indican que este método podría ser usado para caracterizar cultivos micobacterianos (AU)
Assuntos
Mycobacterium/isolamento & purificação , Cromatografia Gasosa , Ácidos Graxos/isolamento & purificação , Ácidos Micólicos/isolamento & purificação , Tuberculose/diagnósticoRESUMO
El virus de la inmunodeficiencia humana (HIV) causa un profundo impacto sobre el problema de la tuberculosis tanto en los países industrializados como en los en vías de desarrollo. Enfermedades graves causadas por micobacterias no tuberculosas, la mayoría correspondiente al complejo Mycobacterium avium-intracellulare (MAC), se han vuelto muy comunes en asociación con la inmunosupresión severa. El aumento de la complejidad de las enfermedades micobacterianas ha estimulado el desarrollo de métodos de diagnóstico más rápidos y eficientes. En el presente estudio se caracterizaron los ácidos grasos y los productos de degradación de los ácidos micólicos celulares de las especies micobacterianas más frecuentes en la Argentina empleando cromatografía gaseosa (CG), para luego poder desarrollar una técnica rápida de identificación de especies. Los ácidos grasos y los ácidos micólicos de las células micobacterianas saponificadas fueron analizados como ésteres metílicos por CG capilar. Los principales ácidos grasos detectados en todas las especies estudiadas, con excepción de M. smegmatis, fueron los ácidos octadecenoico (18:1) y hexadecanoico (16:0). Los perfiles cromatográficos presentaron diferencias cuantitativas y no cualitativas entre las distintas especies. El ácido tuberculoesteárico se detectó en todas las micobacteias analizadas. Se observaron diferencias significativas (p<0,01) en las medias de las cantidades relativas de algunos ácidos grasos entre aislamientos clínicos de M. tuberculosis, M. bovis y MAC. Se detectaron trazas de 2-elcosanol en cepas de M. tuberculosis H37Rv. Aunque se estudió un número limitado de cepas y de especies, los resultados preliminares indican que este método podría ser usado para caracterizar cultivos micobacterianos
Assuntos
Ácidos Graxos/isolamento & purificação , Ácidos Micólicos/isolamento & purificação , Cromatografia Gasosa , Mycobacterium/isolamento & purificação , Tuberculose/diagnósticoRESUMO
The etiology of acute lower respiratory tract infections (ARI) and nasopharyngeal bacterial carriage in children less than 5 years old living in Santa Fe city, Argentina, was studied. A total of 518 children were included in the study: 450 suffering from ARI and 68 asymptomatic children. Blood samples, pleural effusions and nasopharyngeal secretions (NS) were obtained from children for bacterial isolations. NS was also used for fluorescent antibody techniques, and serum samples were employed for detecting IgM anti Chlamydia trachomatis. A bacterial pathogen was isolated from blood in 6.2% (14/224) of the children with ARI. A total of 11 Streptococcus pneumoniae (five of them oxacillin resistant), two Haemophilus influenzae and one Staphylococcus aureus strains were isolated. The most frequently detected pathogen in the ARI group was respiratory syncytial virus (RSV). It was found in 23.3% (105/450) of the children with ARI. Among children with risk of Chlamydia trachomatis infection, 24% presented high titters of specific IgM antibodies. Main bacteria carried in NS in the ARI group were H.influenzae (31.6%) and S. pneumoniae (23.4%) while viridans streptococci (26.5%), H.influenzae (23.5%) and Moraxella catarrhalis (22.1%) were more frequently isolated from controls. The most common pneumococcal types were 14 and 7 and the main type of H.influenzae was b biotype I. During the period of this study, the susceptibility of the pneumococcal isolates to oxacillin decreased from 60% to 50.8%, and the H.influenzae susceptibility to ampicillin fell from 92.3% to 79%. All the H.influenzae type b isolations were susceptible to ampicillin.
Assuntos
Infecções Respiratórias/microbiologia , Doença Aguda , Argentina , Pré-Escolar , Chlamydia trachomatis/isolamento & purificação , Haemophilus influenzae/isolamento & purificação , Humanos , Lactente , Moraxella catarrhalis/isolamento & purificação , Staphylococcus aureus/isolamento & purificação , Streptococcus pneumoniae/isolamento & purificaçãoRESUMO
The human immunodeficiency virus (HIV) epidemic has altered the epidemiological profile of tuberculosis in both industrialized and developing countries. Serious diseases caused by mycobacteria other that M. tuberculosis, mostly belonging to the M. avium-intracellulare complex (MAC), have become very common in association with severe immunosuppression. The increase in mycobacterial disease complexity has stimulated the development of more rapid and efficient methods of diagnosis. In the present study we characterized the cellular fatty acids and the mycolic acid cleavage product from most frequent mycobacteria species in Argentina using gas chromatography in order to develop a rapid technique for their identification. Fatty acids and mycolic acids extracted from saponified mycobacterial cells were examined as methyl esters by capillary has chromatography. The major constituent fatty acids in all species, with the exception of M. smegmatis, were octadecenoic (18:1) and hexadecanoic (16:1) acids. The fatty acids and mycolic acid cleavage product profiles from the studied species were quantitatively but not qualitatively different. Tuberculostearic acid was found in all species. Significantly different amounts of some fatty acids (p < 0.01) were observed among clinical isolates of M. tuberculosis, M. bovis and MAC. Traces of 2-eicosanol were detected in the M. tuberculosis H37Rv strain. Although a limited number of strains and species were tested, preliminary results indicate that this method could be used to characterize mycobacterial cultures.
Assuntos
Ácidos Graxos/isolamento & purificação , Infecções por Mycobacterium/microbiologia , Mycobacterium/química , Ácidos Micólicos/isolamento & purificação , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Argentina/epidemiologia , Cromatografia Gasosa , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Incidência , Mycobacterium/isolamento & purificação , Infecções por Mycobacterium/epidemiologia , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Complexo Mycobacterium avium/química , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/epidemiologia , Infecção por Mycobacterium avium-intracellulare/microbiologia , Mycobacterium bovis/química , Mycobacterium bovis/isolamento & purificação , Mycobacterium tuberculosis/química , Mycobacterium tuberculosis/isolamento & purificação , Ácidos Micólicos/metabolismo , Micobactérias não Tuberculosas/química , Micobactérias não Tuberculosas/isolamento & purificação , Ácido Palmítico/isolamento & purificação , Especificidade da Espécie , Ácidos Esteáricos/isolamento & purificação , Tuberculose/epidemiologia , Tuberculose/microbiologiaRESUMO
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.
Assuntos
Cardiomiopatia Chagásica/cirurgia , Transplante de Coração , Adulto , Feminino , Seguimentos , Rejeição de Enxerto , Humanos , Infecções , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , RecidivaRESUMO
Three patients were submitted to the Rashkind device technique for closure of a patent ductus arteriosus. The percutaneous transvenous technique was employed in every cases. A 12 mm prosthesis was utilized in one case and 17 mm prostheses in the other two cases. In the first case, after temporary occlusion of the ductus arteriosus, the prostheses was removed due to the technical impossibility of evaluation of the proximal umbrella position. In the second and third cases, the prostheses were duly liberated in the proper position, thus occluding the defects. This technique does not require general anesthesia, is indicated in patients over 6 kgs of body weight, and is a therapeutic alternative to the habitual surgical procedure.
Assuntos
Cateterismo Cardíaco/métodos , Permeabilidade do Canal Arterial/terapia , Adulto , Cateterismo Cardíaco/instrumentação , Criança , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/fisiopatologia , Ecocardiografia Doppler , Eletrocardiografia , Humanos , MasculinoRESUMO
A 54-year-old man with Chagas cardiomyopathy that was submitted to a heart transplantation and five months later presented a progressive increase in liver enzymes. Diagnosis of chronic active hepatitis was confirmed by histopathologic studies. A transitory interruption of treatment with azathioprine and the posterior re-introduction of small doses, as well as the use of lesser amounts of cyclosporin-A improved the clinical and laboratory pictures. Despite several investigations the pathogenesis of hepatitis remained undetermined, although some type of drug injury was presumed to be involved. The eventual role of viruses as the primary inciting event could not be completely ruled out.
Assuntos
Cardiomiopatia Chagásica/cirurgia , Doença Hepática Crônica Induzida por Substâncias e Drogas , Transplante de Coração , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Testes de Função Cardíaca , Hepatite Crônica/enzimologia , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
The authors report two cases of left ventricular aneurysm associated with post-infarction ventricular septal rupture. This rare association, usually aggravated by high mortality, received successful surgical treatment.