Cardiomiopatia dilatada secundária à taquicardia juncional recíproca persistente / Dilated cardiomyopathy secondary to persistentjunctional reciprocating tachycardia

Mulher apresentava taquicardia supraventricular persistente, refratária a tratamento farmacológico, com características eletrocardiográficas compatíveis com a taquicardia juncional recíproca persistente, incluindo ondas P negativas em derivações inferiores e intervalo RP' longo, com relação RP' / P'R>1. A paciente apresentava cardiomiopatia dilatada secundária à taquicardia persistente, com importante redução do diâmetro ventricular e melhora significativa da fração de ejeção do ventrículo esquerdo após ablação de via anômala.

A woman presented persistent supraventricular tachycardia refractory to pharmacological treatment and with electrocardiographic characteristics consistent with persistent junctional reciprocating tachycardia, including inverted P waves in lower leads and long RP’ interval with regard to the RP’/P’R>1. The patient also presented dilated cardiomyopathy secondary to persistent tachycardia, with a significant reduction of the ventricular diameter and important improvement in the ejection fraction of the left ventricle after ablation of the anomalous pathway.

Tissue plasminogen activator and plasminogen activator inhibitor-1 in human choledochal bile

Fibrinolytic properties have been detected in animal and human gallbladder (GB) bile. Plasminogen activator inhibitor-1 (PAI-1) has been reported in greater concentration in GB stone bile and may be a nucleating factor in the pathogenesis of GB stone formation. It is unknown whether or not human choledochal bile has similar properties, which could have a role in choledocholithiasis. The aims of this study were to determine the presence of fibrinolytic properties of human choledochal bile and to compare those properties among normal, acalculous, and calculous-infected choledochal bile. Tissue plasminogen activator (t-PA) and PAI-1 of choledochal bile were measured by enzyme linked immunosorbent assay in patients with cholangitis due to acalculous bile duct obstructions (n = 9), choledocholithiasis with cholangitis (n = 20), and normal bile (n = 7). The t-PA concentration of choledochal bile was no different among the three groups (acalculous-infected bile, median 4.61 ng/ml, and calculous-infected bile, 4.61 ng/ml, versus normal bile, 7.33 ng/ml). PAI-1 was detected in choledochal bile in significantly greater concentrations in patients with acalculous cholangitis due to bile duct obstructions and choledocholithiasis with cholangitis (acalculous-infected bile, median 0.36 ng/ml, and calculous-infected bile, 0.1 ng/ml, versus normal bile, 0.02 ng/ml, p < 0.05), but the bile concentration of PAI-1 was no different between the acalculous and calculous-infected choledochal bile. Human choledochal bile possesses t-PA and PAI-1. PAI-1 was present in greater concentrations in both acalculous and calculous-infected choledochal bile. Increased levels of PAI-1 may be an epiphenomenon of cholangitis rather than a factor in the pathogenesis of choledocholithiasis.

Relationship between tissue plasminogen activator, plasminogen activator inhibitor and CT image in chronic subdural hematoma

The present study was performed to investigate the relationship between the concentrations of tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI) and the CT images in 23 cases of chronic subdural hematomas (SDHs). The concentrations of t-PA and PAI-1 were quantified by enzyme-linked immunosorbent assay (ELISA). Chronic SDHs were divided into five groups according to their appearance on computed tomography: high-density (n = 4), isodensity (n = 8), low-density (n = 5), mixed-density (n = 3), layering (n = 3) types. The volume of hematoma was measured with an image analyzing software program. The concentrations of t-PA were higher in layering (41.2 +/- 0.3 ng/ml, mean +/- standard error of the mean) and high-density (40.0 +/- 1.1 ng/ml) types compared to those of low-density (23.3 +/- 4.1 ng/ml) and iso-density (25.1 +/- 3.7 ng/ml) types. The concentrations of PAI-1 were lower in layering (95.9 +/- 1.0 ng/ml) and high-density (103.4 +/- 34.5 ng/ml) types compared to that of low-density (192.5 +/- 2.6 ng/ml) type. So the ratio between t-PA and PAI-1 (t-PA/PAI) was greater in layering and high-density types. The volume of hematoma was larger in mixed-density and layering types but statistically insignificant. These results presumably suggest that the ratio between t-PA and PAI concentration may contribute to the pathogenesis of the chronic SDH.

Impaired fibrinolysis: another risk for hypertensives

The study comprised 30 hypertensive normoglycemic female patients subdivided into 2 groups according to body mass index [BMI]. Group 1, 15 hypertensive obese females with a BMI above 30 kg/m2. Group 2, 15 non obese hypertensive females with a BMI below 30 kg/m2. The groups were compared to 10 normotensive control subjects. They were subjected to detailed history taking and full clinical examination. Some anthropometric measures including weights and BMI were taken. Finally, they were subjected to laboratory investigations including determination of serum cholesterol, triglycerides and plasma plasminogen activator inhibitor-1. The results concluded a statistically significant elevation of serum cholesterol, triglycerides and plasminogen activator inhibitor-1, in both the obese and non obese hypertensive female patients in comparison with the normal control subjects. Also, there was positive correlation coefficient between PAI-1, cholesterol and TG in both obese and non obese patients. It is suggested that, control of elevated cholesterol, triglycerides, PAI through a diet regimen or otherwise is as important as the control of elevated blood pressure itself

Interrelationship between coagulant activity and tissue-type plasminogen activator activity in hypertensive patients

Tissue plasminogen activator [t-PA] activity, von-Willebrand factor, fibrinogen and lipid pattern were determined in plasma of 49 hypertensive patients as well as 18 healthy subjects. Hypertensive patients compared with controls had significantly decreased t-PA, [P < 0.01], high density lipo-protein [HDL] cholesterol [P < 0.05], and HDL/LDL [low density lipoprotein] cholesterol [P < 0.001], while they had significantly increased plasma levels of von-Willebrand factor [P < 0.001], fibrinogen [P < 0.001], total cholesterol [P < 0.001] LDL cholesterol [P < 0.001], as well as triglycerides [P 0.001]. A significant negative correlation was found between t-PA activity and diastolic blood pressure [BP] indicating that hypofibrinolysis is linked to elevated [BP] which is therefore, considered a cardiovascular risk factor. The effect of antihypertensive drugs on t-PA was studied and we found that propranolol has induced a non significant increase in morning activity of t-PA. Such effect could be contributing to the reported alteration in the circadian pattern of myocardial infarction in patients treated with B-blockers