Diagnóstico de rejeição cardíaca celular em pacientes transplantados: utilidade do estudo regional da função cardíaca com doppler tecidual / Diagnosis of cellular acute cardiac allograft rejection: usefulness of the regional study of heart function using pulsed doppler tissue imaging

Para o diagnóstico de rejeição celular foi utilizado o Doppler tecidual para o estudo da movimentação miocárdica de 14 regiões de 54 pacientes transplantados que realizaram 129 biópsias endomiocárdicas do ventrículo direito. Foram comparadas as médias e desvios padrão das velocidades de movimentação entre os pacientes com e sem rejeição celular = 3A.Verificou-se que a velocidade de movimentação diastólica tardia do anel lateral do ventrículo esquerdo quando menor do que 5,6 cm/s, isoladamente, apresentou sensibilidade de 73,8% e na análise multivariada encontrou-se modelo matemático com um conjunto de seis parâmetros, com sensibilidade de 88,2% para o diagnóstico de rejeição celular = 3A.

For the diagnosis of cellular acute cardiac allograft rejection pulsed tissue Doppler imaging was used for measuring myocardial wall motion of 14 sites of 54 transplant patients who underwent 129 endomyocardial biopsies.The mean and standard deviation of myocardial velocities among patients displaying or not acute rejection = 3A were compared.It was observed that the analysis of late diastolic mitral annular motion at lateral site on its own showed a sensibility of 73.8% (5.6 cm/s was the best cut off value) and in the multivariate analysis a mathematical model was found with a set of 6 parameters with a sensibility of 88.2% for the diagnosis of cellular rejection = 3A.

Embolia múltipla em portadora de endocardite infecciosa: dor lombar e hematúria como manifestações clínicas iniciais / Multiple embolism in a female patient with infective endocarditis: low back pain and hematuria as the initial clinical manifestations

A 59-year-old female patient with mitral valve prolapse and a previous history of lumbosacral spondyloarthrosis and lumbar disk hernia had an episode of infective endocarditis due to Streptococcus viridans, which evolved with peripheral embolism to the left kidney, spleen, and left iliac artery, and intraventricular cerebral hemorrhage. Her clinical manifestations were low back pain and hematuria, which were initially attributed to an osteoarticular condition. Infective endocarditis is a severe polymorphic disease with multiple clinical manifestations and it should always be included in the differential diagnosis by clinicians

Endocardite em bioprótese valvar cardíaca por Cardiobacterium hominis / Cardiobacterium hominis bioprosthetic valve endocarditis

Mulher de 36 anos apresentou endocardite por Cardiobacterium hominis em prótese valvar cardíaca. A identificaçäo do agente etiológico nas hemoculturas foi possível no 7§ dia de incubaçäo. O tratamento etiológico foi feito com a administraçäo diária de 18.10**6 U. I. de penicilina cristalina por via endovenosa, associada a 800 mg/dia de amicacina, por 42 dias. O tratamento cirúrgico foi indicado em razäo de insuficiência cardíaca refratária, procedendo-se a implante de bioprótese de pericárdio bovino. A paciente encontrava-se assintomática em avaliaçäo no 7§ mês após a alta hospitalar

A 36-year-old female patient developed Cardiobacterium hominis endocarditis on a mitral valve prosthesis. The etiologic agent was identified in the seventh day of incubation of the blood cultures specimens. Cristaline penicillin (18.106 UI dayly) and amikacin (800 mg daily) were administered for 42 days. Surgical treatment for heart failure unresponsive to medical treatment was carried on in the eighteenth day of antibiotic therapy. A bovine pericardium prosthesis was inserted. The patient was discharged and is assymptomatic affer seven months