HTLV-I/II as a common etiology of myelopathies in Bahia, Brazil

Infection by human T-cell lymphotrophic virus type I (HTLV-I) is associated with a myelopathy known as tropical spastic paraparesis (TSP). The prevalence of HTLV-I infection was found to be high in a pilot study in Bahia, Brazil. In the present study, among patients with myleopathy of unclear etiology, 27 per cent (17/62) were immunoblot reactive to HTLV-I/II (serum and CSF), but none of 40 consecutive patients seen at the neurological clinic and having a well-established neurological diagnosis had detectable antibodies against those viruses (discrimination between HTLV-I and HTLV-II was not possible with the tests we used). The clinical syndrome of typical TSP with upper limb hyperreflexia was found to be a significant feature among the HTLV-I/II-seropositive patients compared to seronegative individuals. The 17 HTLV-I/II-reactive individuals had negative tests for syphilis, toxoplasmosis and schistosomiasis. TSP was also associated with female gender (P=0.001). We conclude that TSP is strongly associated with HTLV-I/II infection in women in Bahia.

Lack of association between thyroid function and mitral valve prolapse in Graves' disease

To determine whether the association between mitral valve prolapse and Graves' disease is related to thyroid function, three groups of individuals were studied: 16 patients with Graves' disease and hyperthyroidism (hyperthyroid: T4 > 11.5 microng/100 ml), 16 patients with Graves' disease without hyperthyroidism (euthyroid: T4 < 11.5 microng/100 ml), and 40 healthy individuals. The three groups were similar in age, sex distribution, and anthropometrical characteristics. All apatients were evaluated clinically and by M-mode and two-dimensional echocardiopgraphy to determine the presence of mitral valve prolapse. The frequency of mitral valve prolapse was similar in the hyperthyroid (31%) and euthyroid patients (25%), but was higher than in the normal individuals (5%). The frequency of systolic murmur was in the hyperthyroid patients (75%) than the euthyroid patients (19%) or the normal subjects (0%); however, the presence of a murmur was not associated with mitral valve prolapse. Although patients with Graves' disease have a higher frequency of mitral valve prolapse, this is not associated with thyroid function. The presence of a click but not the presence of a systolic murmur may be a clinical indicator of mitral valve prolapse in Graves' disease

Improvement in wall motion after pindolol: a mechanism for the preservation of left ventricular function in coronary artery disease

In order to evaluate the mechanism by which beta blockers with intrinsic sympathomimetic activity preserve left ventricular systolic function at rest, 46 patients with coronary artery disease were studied by right and left heart catheterization and left ventriculography. Patients were studied using a double-blind, randomized protocol before and after a single intravenous dose of 3 mg propanolol (N = 22) or 0.5 mg pindolol (N = 24). Mean right atrial pressure increased similarly after both drugs. Mean pulmonary artery pressure, left ventricular end-diastolic pressure, mean aortic pressure, and peripheral vascular resistance did not change significantly after either drug. Cardiac index (before: 3.0 + or - 0.7(mean + or - SEM); after: 2.8 + or - 0.2 1 min **-1 m**-2) and heart rate (before: 78 + or - 15; after: 72 + or - 12 bpm) deveased only after propranolol administration. Ejection fraction decreased only after propranolol (48 + or - 16 to 41 + or - 15%). Improvement in segmental wall motion abnormalities was noted (23 of 47 segments) only after pindolo. The total left ventricular wall motion score improved after pindolol and worsened after propranolol (P<0.5). In patients with impaired left ventricular function, pindolol administration resulted in improved resting ejection fraction. Thus, the acute hemodynamic consequences of pindolol administration differ from those of propranolol owing to the preservation of left ventricular systolic function which seem to be related to the...

O ketoconazole por via sistemica em candidiase vulvovaginal: estudo multicentrico. / Ketoconazol by systemic route in vulvovaginal candidiasis: multicenter study

Neste estudo avaliou-se a acao terapeutica de ketoconazole por via sistemica em 105 pacientes com candidiase vulvovaginal, nas formas aguda e cronica. O ketoconazole foi administrado na dose de dois comprimidos de 200 mg por dia, durante cinco dias consecutivos. Realizou-se exame micologico a fresco (microscopia) e cultura em meio de Nickerson, antes do tratamento (para confirmacao diagnostica) e sete e trinta dias apos o termino do mesmo (para comprovacao da cura). Foi observado um percentual de cura micologica da ordem de 75,5%. Ocorreram efeitos colaterais em 19 pacientes (18,1%), tornando necessaria a interrupcao do tratamento em tres pacientes, sendo em um caso por cefaleia, vomitos e astenia moderados, e em dois casos por nausea e mal-estar tambem de grau moderado. Os investigadores consideraram o tratamento da candidiase vulvovaginal entre bom e excelente em 78,4% dos casos, enquanto que para as pacientes tal conceito situou-se em 81,2% dos casos