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Biomedical subjects

F Pileggi

Publications and source records attributed to F Pileggi.

At least 37 records · Page 2Linked to original sources
PubMed1997

Association of an increase in CD8+ T cells with the presence of Trypanosoma cruzi antigens in chronic, human, chagasic myocarditis.

The role of Trypanosoma cruzi in the pathogenesis of myocarditis in the chronic phase of Chagas' disease is still controversial, with autoimmune mechanisms frequently being proposed. In the present work, we demonstrate that higher numbers of CD8+ T cells are correlated with the presence of parasite antigens, suggesting an important role for the parasite in the development of myocardial inflammation. Quantification of the mean numbers of CD8+ and CD4+ T cells per 400x microscopic field was performed in myocardial specimens from 33 chronic chagasic patients with heart failures (nine biopsies and 24 necropsies), using an immunoperoxidase technique. The cases were grouped according to a semiquantitative score of the relative amounts of T. cruzi antigens: group 1 = absent (14 cases); group 2 = scarce extracellular or intramacrophagic antigens (12 cases); group 3 = many extracellular or intramacrophagic antigens plus T. cruzi intramyocytic pseudocysts (seven cases). The mean numbers of CD8+ and CD4+ T cells in groups 1,2, and 3 were 6.94 and 3.79, 13.89 and 6.24, and 17.91 and 5.97, respectively. The numbers of CD8+ T cells in groups 2 and 3 were significantly higher compared with group 1 (no T. cruzi antigens), but were not different from each other. Scarce, extramyocytic T. cruzi antigens were associated with an intense inflammatory infiltrate, suggesting that delayed-type hypersensitivity immune mechanism is induced by the parasite; intact myocardiocytes containing parasites did not show an inflammatory reaction around them. A poor inflammatory response was frequently associated with many extramyocytic antigens and myocardial parasite pseudocysts, suggesting that active proliferation and dissemination of the parasites occur when the immunologic response is diminished. The number of CD4+ T cells did not vary significantly among the three groups. We conclude that the CD8+ T cell is the main cell type responsible for immune activation in chronic, human, chagasic myocarditis and is probably activated by the presence of T. cruzi antigens associated with internal myocytic host antigens. The absence of a significant member of CD4+ T cells in the presence of T. cruzi antigens suggests inhibition of CD4+ T cell activation or the lack of a class II major histocompatibility complex molecule presentation mechanism.

Antigens, Protozoan↗
PubMed1997

[Persistence of palpitations after successful radiofrequency catheter ablation].

PURPOSE: The aim of this study was to determine prevalence and the underlying mechanism of persistent palpitations after successful radiofrequency ablation of reentrant nodal tachycardia and atrioventricular tachycardia. METHODS: One hundred twenty consecutive patients (mean age of 36 +/- 16 years) who underwent radiofrequency catheter ablation of atrioventricular or reentrant nodal tachycardia constituted the analyzed group. Prevalence of palpitations was investigated during out-clinic visits and telephone interviews. Patients complaining of palpitations were divided in 2 groups: 1) those in whom palpitations lasted more than 30 seconds, and 2) those in whom the paroxysms lasted < 30 seconds (group II). All patients underwent clinical evaluation, ECG and Holter monitoring. Transesophageal atrial pacing and electrophysiologic stimulation were carried out when judged necessary. RESULTS: During a follow up period of 9 +/- 4 months, 52 patients complained of palpitations. In 31 group I patients, palpitations were related to ventricular and atrial premature beats as shown during Holter monitoring. In group II patients, eight had recurrence, five presented a new arrhythmia not recognized previously to the ablative procedure and two patients had their symptoms related to arrhythmias recognized before ablation but taken as asymptomatic. The mechanism of palpitations was not identified in six patients. CONCLUSION: Palpitations may persist in 43% of patients who undergo radiofrequency ablation to treat reentrant nodal tachycardia and atrioventricular tachycardia. Recurrence and treatment are more likely when palpitations last longer than 30 seconds.

Adolescent↗
PubMed1997

[Minimally invasive myocardial bypass surgery using video-assisted thoracoscopy].

PURPOSE: In order to associate the major benefits of the coronary artery bypass graft (CABG) with a less aggressive procedure minimally invasive coronary artery bypass graft (MICABG) has been utilized. The aim of the work is to report our initial experience with this technical approach, using video assisted thoracic surgery (VATS) to facilitate the operation. METHODS: Twenty-six patients, 19 males with ages from 44 to 83 years old, and having isolated lesion of the anterior descending artery were operated upon. Left anterior minithoracotomy of 8-10 cm was performed at the fourth intercostal space. Through this incision the optical device for VATS as well as the surgical instruments were placed in order to provide the complete left internal mammary artery (LIMA) dissection. Bypass circulation was not used and cardiac rate was decreased with the use of intravenous betablockers. For LIMA--anterior descending artery anastomosis, proximal and distal tourniquets were used and 1.5 mg/kg of heparin was intravenously administered. RESULTS: All patients presented satisfactory postoperative evolution, being discharged from the hospital at 72 h after surgery in the majority of the cases. There were delay in two patients healing of incisions and 25 patients have remained asymptomatic, with a mean in postoperative follow-up of four months. One patient died in the second postoperative month due to stroke. CONCLUSION: MICABG makes the surgery possible with better esthetic effect, lower cost and enables faster recovery than the conventional one. The use of VATS through the thoracotomy itself, allows the LIMA dissection without other incisions. It also permitted more ample dissection of the LIMA when compared to minithoracotomy without VATS.

Adult↗
PubMed1997

[Myocardial perfusion study in patients with right bundle branch block].

PURPOSE: To evaluate the sensitivity and specificity of myocardial perfusion scintigraphy in the detection of coronary artery disease in patients with right bundle branch block (RBBB). METHODS: Thirty one patients (24 male, 62.3 +/- 10.5 years) with RBBB, submitted to myocardial perfusion scintigraphy associated with exercise (n = 7) or dipyridamole (n = 24) and previous cinecoronariography were studied retrospectively. Left ventricle scintigraphic image was divided in three segments corresponding to the three main epicardic coronary territories in a total of 93 segments. Cineangiographic and scintigraphic data were then compared according to the different artery territories. RESULTS: Twenty three patients had significant lesions (> or = 60%) in one or more coronary arteries and eight had no obstruction. Forty nine segments were irrigated by normal coronary arteries and 44 were related to arteries that had significant lesions. Twenty out of twenty three patients showed alterations in perfusion (sensitivity = 87%). All patients without coronary obstructions showed normal perfusion scintigraphy (specificity = 100%). One of the segments perfused by normal coronaries showed abnormal scintigraphy. Scintigraphy showed perfusion defects in 29 out of 44 segments with coronary obstructions. Sensitivity and specificity of the method for each arterial territory were 72% and 100% (left descending coronary artery), 67% and 94% (right coronary artery), 55% and 100% (circunflex coronary artery), respectively. CONCLUSION: The presence of RBBB does not modify the sensitivity and specificity of the method in the detection of coronary artery disease.

Bundle-Branch Block↗
PubMed1997

[Gemfibrozil reduces elevated lipoprotein (a) levels in hypercholesterolemic patients].

PURPOSE: To compare the effects of gemfibrozil and lovastatin in patients with hypercholesterolemia and increased lipoprotein(a) [Lp(a)] levels. METHODS: Twenty-seven subjects with total cholesterol (TC) > 240 mg/dL, LDL-C > 160 mg/dL and Lp(a) > 25 mg/dL were studied. Patients were randomized to receive gemfibrozil 1200 mg/day, (n = 14, 54 +/- 7 years) or lovastatin 40-80 mg at night (n = 13, 55 +/- 9 years) for 12 weeks. Lipid profile and Lp(a) were determined at 4 and 12 weeks of treatment. RESULTS: Gemfibrozil reduced TC (-21%), LDL-C (-26%), triglycerides (TG)(-48%) and Lp(a) (-25%), increased HDL-C (+48%)(p < 0.001). Lovastatin reduced TC (-29%), LDL-C (-37%) and TG (-25%) (p < 0.001) however, it did not affect Lp(a). CONCLUSION: Besides reducing plasma LDL-C, TG and increasing HDL-C, gemfibrozil effectively lowers Lp(a) levels. Lovastatin did not affect Lp(a) levels.

Analysis of Variance↗
PubMed1997

[Radiological findings in endomyocardial fibrosis].

PURPOSE: To determine through conventional radiology the type of ventricular involvement in endomyocardial fibrosis (EMF). METHODS: We analyzed 56 cases with EMF confirmed by angiocardiography and 9 by postmortem study, aged between 16 and 56 years (mean 32); there were 42 females. Only one radiologist analyzed X-rays without any knowledge of the cineangiography findings. RESULTS: The right side of the heart was primarily involved in 9 patients and the cardiac silhouette was characteristically globular and had oligemic pulmonary fields (66.66%). The cardiothoracic ratio was 0.62 +/- 0.11. Out of 9 patients, 8 were female. The left side of the heart was established as being primarily involved in 11 cases and simulated rheumatic mitral disease. The cardiothoracic ratio was 0.51 +/- 0.09 and there were increased pulmonary fields in 63.6%. The biventricular disease occurred in 36 cases. There were radiologic findings of right and left side. The cardiothoracic ratio was 0.63 +/- 0.06 and there was oligemic pulmonary fields in 38.8%, increased pulmonary fields in 33.3% and was normal in 27.7%. There were 4:1 females. CONCLUSION: The radiological study is fundamental in the initial diagnosis of EMF. The type of involvement could be done in 66.07% of all cases by chest X-ray.

Adolescent↗
PubMed1996

Plasma kinetics of a chylomicron-like emulsion in patients with coronary artery disease.

Chylomicron catabolism in the bloodstream consists of lipolysis by lipoprotein lipase and uptake of remnants by the liver. In rats, triglyceride-rich emulsions can mimic chylomicron metabolism. To further validate this model in man, the emulsion was injected intravenously into fasting and into subjects previously fed a test fatty meal. The plasma kinetic curves of the emulsion 3H-triglyceride and 14C-cholesteryl ester were determined. The fractional clearance rate (FCR) of both labels was markedly reduced in the fed subjects (triglycerides: fed = 0.018 +/- 0.007; fasting = 0.105 +/- 0.013 min-1, P < 0.001; cholesteryl ester: fed = 0.016 +/- 0.001; fasting = 0.040 +/- 0.006 min-1; P < 0.05) indicating that the emulsion and chylomicrons generated from the testinal lipid absorption compete for the same catabolic processes, confirming the validity of the method. The emulsion was injected into 11 patients with CAD and into 11 controls. All had plasma cholesterol < 240 and triglycerides < 250 mg/dl. FCR of triglycerides was 5-fold smaller in CAD compared to controls (0.028 +/- 0.004 and 0.141 +/- 0.069 min-1, respectively, P < 0.01). FCR of cholesteryl ester was 4-fold smaller in CAD than in controls (0.015 +/- 0.004 and 0.056 +/- 0.067 min-1 respectively, P < 0.05). These results indicate that both chylomicron lipolysis and remnant removal are diminished in CAD.

Adult↗
PubMed1996

Heart transplantation for chronic Chagas' heart disease.

BACKGROUND: Chagas' disease has been considered a contraindication to heart transplantation as Trypanosoma cruzi infection could recur after immunosuppression. METHODS: We report the follow-up of 22 patients who underwent orthotopic heart transplantation for treatment of end-stage chronic Chagas' heart disease, divided in two groups. Group 1 consisted of 9 patients operated on from September 1985 to June 1991, and group 2 patients underwent transplantation from July 1991 to June 1995. After our early experience with group 1, we attempted to use a lower cyclosporine dosage in group 2. RESULTS: Total actuarial survival at 24 months was 60%, and it was better for group 2 (33% for group 1, 80% for group 2, p = 0.008). Parasitemia occurred similarly in both groups, but Chagas' disease reactivation was seen in 5 group 1 patients and in 1 group 2 member (p < 0.002). Neoplasia developed in 5 group 1 patients and 1 group 2 patient, and contributed to death in 3 of them. CONCLUSIONS: These data demonstrate satisfactory outcome of cardiac transplantation in patients with end-stage Chagas' heart disease in the second phase of our experience. Further progress is necessary to improve the results and evaluate its proper role in the management of this disease.

Actuarial Analysis↗
PubMed1996

In vivo detection of Trypanosoma cruzi antigens in hearts of patients with chronic Chagas' heart disease.

The heart is the most commonly affected organ in chronic Chagas' disease, and lymphocytic myocarditis is often observed. However, the pathogenesis of chronic Chagas' heart disease is controversial. The purpose of this study was to determine whether in vivo T. cruzi antigens could be detected in hearts from patients with chronic Chagas' disease and to investigate whether a correlation between these antigens and the intensity of myocardial inflammation exists. We studied 16 patients with chronic Chagas' heart disease. Ten patients had severely impaired left ventricular function and refractory heart failure, and six had episodes of sustained ventricular tachycardia without severe left ventricular dysfunction. Eight patients underwent magnetic resonance imaging with gadolinium enhancement to guide endomyocardial and surgical biopsies to sites with more intense inflammatory processes. Myocardial specimens were studied with immunohistochemical techniques by using rabbit anti-T. cruzi immune serum to detect the presence of T. cruzi antigen. All patients had evidence of some myocarditis in at least one myocardial fragment. T. cruzi antigen was detected in 11 (69%) patients. T. cruzi antigens were detected in 10 (71%) of 14 regions with histopathologic evidence of moderate or severe myocarditis. In contrast, T. cruzi antigens were detected in 3 of 18 regions with only mild or absent myocarditis. There was a statistically significant correlation between the presence of T. cruzi antigens and moderate or severe myocarditis (chi-square = 5.169, p = 0.023). The results of this in vivo study demonstrate that T. cruzi antigens are frequently detected in chronic Chagas' heart disease. In addition, there is an association between the intensity of the inflammatory process and the presence of T. cruzi antigens. The presence of the T. cruzi antigen and its correlation with the severity of myocardial inflammatory process provide strong supportive evidence for the role of T. cruzi even in the chronic forms of Chagas' heart disease.

Adult↗
PubMed1996

Determinants of prognosis in 300 episodes of infective endocarditis.

We studied 300 episodes of infective endocarditis in 287 patients to evaluate clinical and laboratory determinants of prognosis by estimating the probability of in-hospital death. The patients' ages ranged from 2 months to 78 (mean 30.76 +/- 16.06) years; 185 (62%) episodes occurred in male and 115 (38%) in female patients. A total of 386 complications occurred in 223 (74%) episodes of endocarditis. The infecting microorganisms were streptococci in 147 episodes, Staphylococcus aureus in 59, Staphylococcus epidermidis in 14, gram-negative bacteria in 16, other gram-positive bacteria in 8, fungi in 4. The causative microorganism was not identified in 52 episodes (negative blood cultures). The underlying cardiac disease was valvular in 119 episodes, congenital in 37, prosthetic heart valve in 69, and others in 6. No previous heart disease was identified in 69 episodes. Surgical treatment was carried out in 102 (34%) patients. Overall, 78 (26%) patients died. The probability of death was estimated with a logistic regression model (stepwise procedure). The model with best prediction included the cardiac status previous to the endocarditis, the causative microorganism, the occurrence of complications, and the blood leukocyte count. The most important variable in predicting in-hospital death was the occurrence of complications, followed by cardiac status (prosthetic valve endocarditis), the infecting microorganism, and leukocyte count. The model underestimated the severity of the disease in patients with acute endocarditis and overestimated in patients with prosthetic valve endocarditis submitted to surgical treatment.

Adolescent↗
PubMed1996

Failure to demonstrate myocardial ischaemia in patients with angina and normal coronary arteries. Evaluation by continuous coronary sinus pH monitoring and lactate metabolism.

BACKGROUND: Whether myocardial ischaemia is the mechanism underlying chest pain in patients with angina and normal coronary arteriograms is controversial. We sought to detect the presence of transient myocardial ischaemia using continuous monitoring of coronary sinus blood pH during atrial pacing. METHODS AND RESULTS: We studied 14 patients (eight women, six men, mean age 51 +/- 3 years) with typical exertional angina and normal coronary arteriograms and nine patients with coronary artery disease (two men, seven women, mean age 61 +/- 7 years). Of the 14 patients with normal coronary arteries, eight had a reduced coronary blood flow reserve (< 2.5-fold increase), 11 had an ischaemic-appearing response to exercise testing, six had reversible perfusion detects on exercise thallium scans and one had resting left bundle branch block. All patients underwent continuous pH monitoring of coronary sinus blood at rest and during incremental atrial pacing (up to 160 bpm). Coronary sinus oxygen saturation and myocardial lactate extraction ratio were also evaluated at rest and at peak pacing. Eleven patients with angina and normal coronary arteries and eight with coronary artery disease had angina during pacing. Both patients with angina and normal coronary arteries (n = 13) and patients with coronary artery disease (n = 9) showed a fall in coronary sinus pH (-0.02 +/- 0.02 vs -0.11 +/- 0.03 pH units, respectively, P < 0.01). Coronary sinus oxygen saturation expressed as a percentage dropped by 19 +/- 6% in patients with coronary artery disease and by 6 +/- 2% in patients with angina and normal coronary arteriograms (P < 0.05). Myocardial lactate extraction ratio decreased from 33 +/- 6% to -1.4 +/- 4% in patients with coronary artery disease and from 23 +/- 8% to 20 +/- 8% in those with angina and normal coronary arteriograms. Three patients with angina and normal coronary arteries had a drop in coronary sinus pH > 0.02 pH units (-0.043 +/- 0.006 pH units) and in coronary sinus oxygen saturation > 8% (16 +/- 3%) consistent with myocardial ischaemia. CONCLUSION: Despite severe chest pain and reduced coronary flow reserve after pacing, most patients with angina and normal coronary arteriograms do not show metabolic evidence of myocardial ischaemia.

Adult↗
PubMed1996

Prognostic significance of ST-T segment alterations in patients with non-Q wave myocardial infarction.

OBJECTIVE: To determine whether, among patients with non-Q wave myocardial infarction, the characteristics of the segment ST-T shifts at presentation in the diagnostic electrocardiogram can identify those with more severe coronary artery disease and predict a poor clinical outcome. DESIGN: Prospective controlled clinical trial. SETTING: Primary referral medical centre. PATIENTS: 93 patients (mean (SD) 62.0 (7.5) years) were studied: 41 with non-Q wave myocardial infarction and T wave inversion and 52 with ST segment depression. Cardiac events and mortality rates were assessed over 42 months. Age, sex, risk factors, creatinine kinase MB isoenzyme peak, and left ventricular function were comparable. RESULTS: 31 patients with T wave inversion myocardial infarction (94.6%) had total occlusion of the infarct related artery, compared with 12 patients with ST segment depression myocardial infarction (26.7%) (P < 0.05). When compared with patients with T wave inversion, patients with ST segment depression had a higher incidence of cardiac events during the first month and in the 41 subsequent months: 9.6% and 30.8% v 0% (P < 0.01) and 9.8% (P < 0.02), respectively. For the same observation periods, the mortality rates in patients with T wave inversion were 4.9% and 7.3%, and in patients with ST segment depression they were 5.8% and 9.6%, respectively. CONCLUSION: These data suggest that during a non-Q wave myocardial infarction the presence of ST segment depression is related to higher rates of short and long term cardiac events when compared with T wave inversion--possibly because of a higher incidence of residual stenosis of the infarct related artery.

Cardiac Catheterization↗
PubMed1996

Effects of a single heparin bolus on neointimal growth after arterial injury in intact rabbits.

Heparinization is a routine procedure during angioplasty; however, its consequences on the late vascular response to a severe injury are unclear. The authors' objective was to explore the effect of a single heparin bolus at the time of a severe vascular injury on late intimal proliferation and neointimal thickening. The iliac artery of 57 normolipemic rabbits was overdistended with a balloon catheter. Heparin (250 IU/kg i.v.) was given to 29 rabbits ten minutes before angioplasty, whereas 28 rabbits served as untreated controls. Neointimal thickening was prominent at fourteen days after injury and reached near-maximal values at day 28. The intimal/medial area ratio was reduced by an average 28.3% with heparin (at day 28: 2.19 +/- 0.51 vs 1.57 +/- 0.59, control vs heparin, P = 0.02). Neointimal cells stained positively for HHF-35 antibody, directed against smooth muscle cell antigens. Neointimal proliferation, quantified through the number of cell nuclei peroxidase-stained for PCNA/cyclin antigen, was significantly decreased by 43% and 49% with heparin, respectively, at days 7 and 14 after injury. These data suggest that early exposure even to low doses of heparin accounts for much of its inhibitory effect in vascular response to injury; such an effect might prove important in interpreting results of human trials of interventions against restenosis.

Animals↗
PubMed1996

[Infective endocarditis in 100 patients subjected to heart transplantation].

PURPOSE: An analysis of occurence, etiology, clinical aspects and death rate of infectious endocarditis cases involving patients who underwent heart transplantation. METHODS: 100 consecutive heart transplant patients were analysed; follow-up varied from three to 90 (medium of 25.38, SD +/- 27.97) months. Diagnostic criteria for endocarditis were those of the epidemiology and quality control service, Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, that agree with those of the Center for Disease Control. Diagnosis was established mostly by blood cultures, echocardiograms, either transthoracic or esophageal and autopsy. RESULTS: Six cases of endocarditis were recognized, with four deaths; in three of those we found severe systemic compromise. All cases had fever as an important symptom. CONCLUSION: Death risk seems high of infectious endocarditis after heart transplantation. The cause of this high risk appears to be linked to the bacteria themselves, to association with other clinical situations and to the use of immunosuppresive agents. We recommend a high index of suspition when risk factors are present in order to make a rapid diagnosis soon enough in the natural history of the disease; treatment has to be started as soon as possible.

Adolescent↗
PubMed1996

[Analysis of elastic retraction in the 1st 15 minutes after coronary balloon angioplasty].

PURPOSE: To determine the time course of elastic recoil (ER) in the first 15min after successful percutaneous transluminal coronary angioplasty (PTCA). METHODS: One hundred and fifty four patients, with stable or unstable angina were successfully submitted to PTCA. Coronary angiography was undertaken shortly after balloon deflation and repeated 5, 10 and 15 min thereafter. Quantitative coronary angiography was performed with the aid of an eletronic caliper. We calculated the minimal luminal diameter (MLD) and elastic recoil in all angiograms. RESULTS: The average artery's reference diameter was 3.09 +/- 0.61mm and the maximal balloon diameter was 2.95 +/- 0.52mm. MLD before the procedure was 0.65 +/- 0.42mm reaching 2.23 +/- 0.55mm immediately after dilatation (p < 0.0001), and decreasing to 2.09 +/- 0.47mm at 5min (p < 0.0001), 2.01 +/- 0.47 at 10min (p < 0.0001) and to 1.91 +/- 0.56mm at 15min (p < 0.0001). ER increased during the 1st 15min after PTCA, averaging 34.29 +/- 20.40%. In the group of patients whose balloon/artery relationship was < or = 1, the total ER was 0.90 +/- 0.74mm at 15min and 1.20 +/- 0.50mm when the ratio was > 1 (p < 0.0001). We noted that ER in the group of patients with residual stenosis ranging from 30 to 50% at the immediate angiogram after PTCA was greater than in the group whose residual stenosis was less than 30%. CONCLUSION: ER is a dynamic and progressive phenomenon taking place within the 1st 15 min after a successful PTCA. Total ER was 34.29 +/- 20.40% at 15min and was greater when balloon/artery relationship was > 1. Residual stenosis ranging from 30 to 50% in the control immediately after the procedure is a predictive factor of greater ER in the 15min following PTCA.

Angina Pectoris↗
PubMed1996

[Evaluation of ischemic preconditioning on collateral circulation, ventricular function and clinical outcome in acute myocardial infarction].

PURPOSE: To evaluate the influence of ischemic preconditioning (IP) in collateral circulation (CC), early ventricular function and in hospital outcomes after myocardial infarction (MI). METHODS: We studied 97 patients with a 1st anterior MI within 6h of pain and isolated total proximal occlusion of the left anterior descending artery, divided in 2 groups: with (GA) or without (GB) angina before MI. Coronariography and ventriculography were performed prior to reperfusion. The left ventricular (LV) ejection fraction was measured by the area length method and anterior wall motion by the centerline method. RESULTS: There was no difference between the two groups in sex, age, CKMB level, treatment, reperfusion rate. Global LV ejection fraction and anterior wall motion were similar, respectively, 39 +/- 9% and -2.55 +/- 1.17 SD/chord for GA and 37 +/- 8% and -2.75 +/- 0.79 and -2.75 +/- 0.79 SD/chord for GB (p = ns). The incidence of visible CC to the infarct area was also similar (present in 6 GA vs 8 GB patients). However, GA patients fared significantly better during hospitalization: No GA patient presented Killip class > or = 2 compared to 8 GB patients (p = 0.007). CONCLUSION: Although collateral coronary circulation grades, global and regional LV function were similar between the two groups, the presence of angina pectoris preceding an acute myocardial infarction was associated with a better in hospital evolution, what could be partially explained by preconditioning phoenomena.

Collateral Circulation↗
PubMed1996

[Fungal infections in 100 patients subjected to heart transplantation].

PURPOSE: To evaluate prevalence, causes, clinical aspects, topography and deaths due to fungal infections diagnosed in a series of patients submitted to heart transplantation. METHODS: 100 consecutive patients submitted to heart transplantation were studied. Follow-up was three to 90 (mean 25.38 +/- 25.97) months. Fungal infections were diagnosed by the Centers for Disease Control criteria. RESULTS: Forty seven fungal infections were found, with three deaths caused mainly by fungal infection. The most common infection in this series was oral infection by Candida albicans, Acremonium sp, Aspergillus sp, Candida tropicalis, Histoplasma capsulatum and Pneumocystis carinii were also responsible for infections in this patient population. CONCLUSION: Fungal infections caused three deaths in this series, and were responsible for increased morbidity. The authors suggest prophylactic and therapeutic recommendations.

Adolescent↗