Decreased platelet responsiveness to clopidogrel correlates with CYP2C19 and PON1 polymorphisms in atherosclerotic patients.

Clopidogrel and aspirin are the most commonly used medications worldwide for dual antiplatelet therapy after percutaneous coronary intervention. However, clopidogrel hyporesponsiveness related to gene polymorphisms is a concern. Populations with higher degrees of genetic admixture may have increased prevalence of clopidogrel hyporesponsiveness. To assess this, we genotyped CYP2C19, ABCB1, and PON1 in 187 patients who underwent percutaneous coronary intervention. Race was self-defined by patients. We also performed light transmission aggregometry with adenosine diphosphate (ADP) and arachidonic acid during dual antiplatelet therapy. We found a significant difference for presence of the CYP2C19*2 polymorphism between white and non-white patients. Although 7% of patients had platelet resistance to clopidogrel, this did not correlate with any of the tested genetic polymorphisms. We did not find platelet resistance to aspirin in this cohort. Multivariate analysis showed that patients with PON1 and CYP2C19 polymorphisms had higher light transmission after ADP aggregometry than patients with native alleles. There was no preponderance of any race in patients with higher light transmission aggregometry. In brief, PON1 and CYP2C19 polymorphisms were associated with lower clopidogrel responsiveness in this sample. Despite differences in CYP2C19 polymorphisms across white and non-white patients, genetic admixture by itself was not able to identify clopidogrel hyporesponsiveness.

Predictors of restenosis after percutaneous coronary intervention using bare-metal stents: a comparison between patients with and without dysglycemia.

The objective of this study was to identify intravascular ultrasound (IVUS), angiographic and metabolic parameters related to restenosis in patients with dysglycemia. Seventy consecutive patients (77 lesions) selected according to inclusion and exclusion criteria were evaluated by the oral glucose tolerance test and the determination of insulinemia after a successful percutaneous coronary intervention (PCI) with a bare-metal stent. The degree of insulin resistance was calculated by the homeostasis model assessment of insulin resistance (HOMA-IR). Six-month IVUS and angiogram follow-up were performed. Thirty-nine patients (55.7%) had dysglycemia. The restenosis rate in the dysglycemic group was 37.2 vs 23.5% in the euglycemic group (P = 0.299). The predictors of restenosis using bivariate analysis were reference vessel diameter (RVD): pound2.93 mm (RR = 0.54; 95%CI = 0.05-0.78; P = 0.048), stent area (SA): <8.91 mm(2) (RR = 0.66; 95%CI = 0.24-0.85; P = 0.006), stent volume (SV): <119.75 mm(3) (RR = 0.74; 95%CI = 0.38-0.89; P = 0.0005), HOMA-IR: >2.063 (RR = 0.44; 95%CI = 0.14-0.64; P = 0.027), and fasting plasma glucose (FPG): < or =108.8 mg/dL (RR = 0.53; 95%CI = 0.13-0.75; P = 0.046). SV was an independent predictor of restenosis by multivariable analysis. Dysglycemia is a common clinical condition in patients submitted to PCI. The degree of insulin resistance, FPG, RVD, SA, and SV were correlated with restenosis. SV was inversely correlated with an independent predictor of restenosis in patients treated with a bare-metal stent.

Predictors of restenosis after percutaneous coronary intervention using bare-metal stents: a comparison between patients with and without dysglycemia

The objective of this study was to identify intravascular ultrasound (IVUS), angiographic and metabolic parameters related to restenosis in patients with dysglycemia. Seventy consecutive patients (77 lesions) selected according to inclusion and exclusion criteria were evaluated by the oral glucose tolerance test and the determination of insulinemia after a successful percutaneous coronary intervention (PCI) with a bare-metal stent. The degree of insulin resistance was calculated by the homeostasis model assessment of insulin resistance (HOMA-IR). Six-month IVUS and angiogram follow-up were performed. Thirty-nine patients (55.7 percent) had dysglycemia. The restenosis rate in the dysglycemic group was 37.2 vs 23.5 percent in the euglycemic group (P = 0.299). The predictors of restenosis using bivariate analysis were reference vessel diameter (RVD): £2.93 mm (RR = 0.54; 95 percentCI = 0.05-0.78; P = 0.048), stent area (SA): <8.91 mm² (RR = 0.66; 95 percentCI = 0.24-0.85; P = 0.006), stent volume (SV): <119.75 mm³ (RR = 0.74; 95 percentCI = 0.38-0.89; P = 0.0005), HOMA-IR: >2.063 (RR = 0.44; 95 percentCI = 0.14-0.64; P = 0.027), and fasting plasma glucose (FPG): ≤108.8 mg/dL (RR = 0.53; 95 percentCI = 0.13-0.75; P = 0.046). SV was an independent predictor of restenosis by multivariable analysis. Dysglycemia is a common clinical condition in patients submitted to PCI. The degree of insulin resistance, FPG, RVD, SA, and SV were correlated with restenosis. SV was inversely correlated with an independent predictor of restenosis in patients treated with a bare-metal stent.

Cowpea (Vigna unguiculata) vicilins bind to the peritrophic membrane of larval sugarcane stalk borer (Diatraea saccharalis).

In this work, we show that vicilins from two Vigna unguiculata (cowpea) genotypes, Epace-10 and IT 81D-1045, which are susceptible and resistant to attack by the cowpea weevil Callosobruchus maculatus, respectively, associate with the peritrophic membrane (PM) from larvae of Diatraea saccharalis. Solutions with increasing concentrations of vicilins were incubated with PM of the larvae and subsequently analysed by electrophoresis with SDS. It was observed that the majority of the bands of approximately 50,000 Da (characteristic of vicilins) did not appear in the separating gel and only lower molecular weight polypeptides were seen. When vicilins were incubated with PM, and the solution was then heated after the incubation, the band pattern in the gel appeared completely different. It was observed that the vicilins were being hydrolysed by proteinases associated with the PM. When the incubated samples were heated after the reaction, the major bands reappeared, demonstrating that most of the vicilin molecules had bound to the PM of D. saccharalis. These results suggest that when the vicilins are in contact with the PM they are bound and also digested by the PM of this insect. The major and several minor proteinases from the PM were extracted with Triton X-100 and their activity and the inhibition of this activity were analysed by ingel assays. Based on the effects of proteinase inhibitors, the PM-associated activity is due to serine class proteinases. Larvae of D. saccharalis were fed on artificial diets containing purified vicilins from Epace-10 or IT 81D-1045 seeds. Vicilins from Epace-10 did not affect the larval development, while IT 81D-1045 vicilins reduced significantly the survival rate of the sugar cane borer.

[Hypertrophic cardiomyopathy treated by interventional technique of septal reduction]. / Cardiomiopatia hipertrófica tratada por técnica intervencionista de redução septal.

A 75-year old woman with obstructive hypertrophic cardiomyopathy and class IV dyspnea refractory to medical management had relative contraindications for both pacemaker implantation and surgical approach. Percutaneous intervention was devised to perform the selective injection of absolute alcohol in the first septal branch of the left anterior descending coronary artery. This led to a limited septal infarction documented by ST elevation, enzymatic elevation and the appearance of complete right bundle branch block on the electrocardiogram. A baseline left ventricular outflow tract pressure gradient of 66mmHg was immediately abolished and no unexpected complications supervened. Currently, two months after the procedure, marked symptomatic relief is present and associated with the absence of obstructive outflow gradient, as documented by echocardiography.

Cardiomiopatia hipertrófica tratada por técnica intervencionista de reduçäo septal / Cardiomyopaty hipertrophic treatment through technique interval the reduction septal

Mulher de 75 anos com cardiomiopatia hipertrófica obstrutiva, com dispnéia classe IV, refratária ao tratamento clínico, apresentava contra-indicaçöes relativas para abordagens cirúrgica e de implante de marcapasso. Realizou-se procedimento intervencionista para injeçäo seletiva de álcool absoluto no 1§ ramo septal da artéria interventricular anterior. O infarto septal provocado acompanhou-se de liberaçäo enzimática, elevaçäo de ST e bloqueio de ramo direito do feixe de His. Näo houve complicaçöes inesperadas, e o gradiente da via ejetiva de ventrículo esquerdo, de 66mmHg, foi imediatamente abolido. Controle ecocardiográfico evidencia manutençäo desse resultado, até o momento, dois meses após o procedimento, em correspodência a marcante alívio sintomático.

[Prevalence of residual shunt after closure of patent ductus arteriosus with Rashkind umbrellas]. / Prevalência do shunt residual após fechamento de canal arterial persistente com umbrellas de Rashkind.

PURPOSE: To determine the prevalence of residual left-to-right shunt in patients submitted to closure of patent ductus arteriosus with use of Rashkind double-disc ductal occluding device, analyzing predictive factors that determine short and long-term prevalence of residual shunt. METHODS: Thirteen patients were submitted to percutaneous closure of patent ductus arteriosus with use of Rashkind double-disc device. Ten patients were male with mean age of 5.7 years. A 12mm diameter device was used in 7 cases and a 17mm device in the remaining six patients. All patients had clinical, radiological and echocardiographic follow up, after 24h, 1 month, 6 months and one year after the procedure. Morphology and length of the ductus arteriosus and the presence of residual shunt after 15 min, 24h and one year after the procedure, were correlated. RESULTS: In one case, embolization of the device to the pulmonary artery determined the in success of the procedure. Residual shunt was present in 75% of the patients after 15 min of the procedure, in 33.3% after 24h, in 25% after 1 month and 6 months and in 16.6% after 1 year. The most important and isolated predictive factor leading to a high prevalence of residual shunt after 24h and after 1 year of the procedure was the presence of ductus arteriosus diameter > or = 4.5mm at the site of its insertion in the pulmonary artery. CONCLUSION: Prevalence of residual left-to-right shunt decreases over the time, with a low incidence after one year follow-up. A higher incidence of residual shunt at 24h and 1 year after the procedure occurred in the cases where the diameter of the ductus arteriosus was > or = 4.5mm, at the site of its insertion in the pulmonary artery.

Teste de provocacao bronquica com carbacol no diagnostico de asma. Relato de casos e comentarios. / Bronchial provocation test with carbachol in the diagnosis of asthma. Report of cases and comments

O teste de provocacao bronquica com carbacol e usado para demonstrar a presenca de hiperreatividade bronquica, a qual e universal entre os portadores de asma bronquica. Isto permite o diagnostico ou nao da doenca em diversas situacoes clinicas frequentes. Atraves do relato de casos e revisao bibliografica, e demonstrada a importancia deste teste em casos de:suspeita de asma de inicio recente, com exame clinico-funcional normal; tosse persistente e dispneia como manifestacoes isoladas de asma; diagnostico diferencial da asma bronquica e cardiaca; asma ficticia; e refluxo gastresofagiano simulando asma

Marcadores biologicos em carcinoma bronquico. / Biological markers in bronchial carcinoma

Em um grupo de 27 pacientes de carcinoma bronquico foram estudados, como marcadores biologicos, o antigeno carcinoembrionario, progesterona, hormonio luteinizante, insulina, prolactina, estradiol, hormonio foliculo estimulante, tiroxina, hormonio de crescimento, cortisol, testosterona, tri-iodotironina, hormonio estimulante da tiroide. Em 24 pacientes, um ou mais marcadores biologicos estavam aumentados; o antigeno carcinoembrionario, hormonio luteinizante, progesterona e a insulina apresentaram valores aumentados entre 35 e 50% dos pacientes, enquanto que o hormonio de crescimento, tiroxina, cortisol, testosterona, tri-iodotironina e o hormonio estimulante da tiroide so estavam elevados em menos de 5%; os demais situaram-se entre aqueles valores. Nos pacientes analisados de forma seriada, o unico marcador que apresentou correspondencia com a evolucao do processo tumoral foi o antigeno carcinoembrionario

Nodulo isolado de pulmao: clinica, diagnostico e indicacao cirurgica. / Solitary isolated nodule: clinics, diagnosis and surgical indication

Estudaram-se 42 casos de nodulo isolado de pulmao, todos com diagnostico anatomopatologico. Encontraram-se 27 individuos com neoplasias malignas, todos acima de 40 anos. Os dados radiologicos auxiliaram na identificacao da etiologia do nodulo: em 74% dos casos de nodulos, que ao raio-X mostravam diametro igual ou maior que 3 centimetros, verificou-se malignidade.Surpreendentemente, encontrou-se um caso em que o nodulo era calcificado e revelouse maligno. Sinais radiologicos como umbilicacao, traves perifericas ou corona radiada, isolados ou em associacao, mostraram-se sugestivos de malignidade. Com o diagnostico clinico e armado, pudemos evitar toracotomias desnecessarias ou retardamento na indicacao cirurgica dos nodulos potencialmente malignos

Importancia da cintilografia com galio (67Ga) em pneumologia. / Importance of the scintigraphy with gallium (67Ga) in pneumology

A caracterizacao, a distribuicao pelos varios orgaos e os mecanismos de captacao do galio sao revistos e, atraves de casos clinicos, e discutida sua importancia em pneumologia, com enfase especial em sarcoidose, alveolite fibrosante, berilliose, pneumonia por P. carinii, carcinoma bronquica e linfomas

O comportamento do tecido mamario nas hipertrofias da mama. / Mammary tissue behavior in the breast hypertrophy

Ao estudo histopatologico de 44 casos de hipertrofia mamaria o achado mais importante foi a atrofia lobular com fibrose inter e intralobular, bem assim espessamento da membrana basal dos ductos e acinos. Ha discrepancia entre o aumento macroscopico da glandula mamaria e os achados involutivos histologicos do tecido mamario