Effects of 17ß-Estradiol on Monocyte/Macrophage Response to Staphylococcus aureus: An In Vitro Study.

To describe how 17ß-estradiol (E2) influence in the monocyte/macrophage response induced by S. aureus in in vitro models of murine peritoneal macrophages (MPMs) and human peripheral blood monocytes (HPBM). MPMs (2 x 105/ml) were isolated from sham (n=3) and ovariectomized (OVX) females (n = 3) and males (n = 3) after induction by thioglycolate. The MPMs obtained from OVX females and males were treated for 24 hours with 17ß-estradiol (E2) (10-7 M), and after that, inoculation with S. aureus was carried out for 6 hours. The macrophages were collected and destined to evaluate the relative gene expression of TNF-α, IL-1ß, IL-6, IL-8 and TLR2. For the in vitro model of HPBMs, six men and six women of childbearing age were selected and HPBMs were isolated from samples of the volunteers' peripheral blood. In women, blood was collected both during menstruation and in the periovulatory period. HPBMs were inoculated with S. aureus for 6 hours and the supernatant was collected for analysis of cytokines by Luminex and the HPBMs were removed for analysis of 84 genes involved in the host's response to bacterial infections by RT-PCR array. Previous treatment with E2 decreased the gene expression and production of proinflammatory cytokines, such as TNF-α, IL-1ß and IL-6 and decreased the expression of TLR2 tanto em MPMs quanto em HPBMs. The analysis of gene expression shows that E2 inhibited the NFκB pathway. It is suggested that 17ß-estradiol acts as an immunoprotective in the monocyte/macrophage response induced by S. aureus.

Ovarian hormones influence immune response to Staphylococcus aureus infection

ABSTRACT Objective: Staphylococcus aureus infections remain associated with considerable morbidity and mortality in both hospitals and the community. There is little information regarding the role of ovarian hormones in infections caused by S. aureus. The aim of this study was to evaluate the effects of ovariectomy in the immune response induced by S. aureus. Methods: Female mice BALB/c were ovariectomized (OVX) to significantly reduce the level of ovarian hormones. We also used sham-operated animals. The mice were inoculated intraperitoneally with S. aureus. Blood samples were collected for leukocyte count and bacterial quantification. The uterus and spleen were removed and weighed to calculate the uterine and splenic indexes. Lungs were removed and fractionated for immunohistochemical analysis for macrophage detection (anti-CD68) and relative gene expression of IL-6, IL-1β and TNF-α by RT-PCR. Results: Ovariectomy enlarged spleen size and generally increased circulating lymphocytes. OVX females experienced a continuation of the initial reduction of lymphocytes and a monocyte and neutrophil late response compared to shams (p ≥ 0.05). Moreover, OVX females showed neutropenia after 168 h of infection (p ≥ 0.05). Macrophage response in the lungs were less pronounced in OVX females in the initial hours of infection (p ≥ 0.01). OVX females showed a higher relative gene expression of IL-1β, IL-6 and TNF-α in the lung at the beginning of the infection compared to sham females (p ≥ 0.01). Among the uninfected females, the OVX control females showed a higher expression of IL-6 in the lung compared to the sham control females (p ≥ 0.05). In this model, the lack of ovarian hormones caused a minor increase in circulating leukocytes during the initial stage of infection by S. aureus and increased pulmonary gene expression of IL-1β, IL-6, and TNF-α. Ovariectomy alone enlarged the spleen and increased circulating lymphocytes. Ovarian hormones acted as immunoprotectors against S. aureus infection.

Ovarian hormones influence immune response to Staphylococcus aureus infection.

OBJECTIVE: Staphylococcus aureus infections remain associated with considerable morbidity and mortality in both hospitals and the community. There is little information regarding the role of ovarian hormones in infections caused by S. aureus. The aim of this study was to evaluate the effects of ovariectomy in the immune response induced by S. aureus. METHODS: Female mice BALB/c were ovariectomized (OVX) to significantly reduce the level of ovarian hormones. We also used sham-operated animals. The mice were inoculated intraperitoneally with S. aureus. Blood samples were collected for leukocyte count and bacterial quantification. The uterus and spleen were removed and weighed to calculate the uterine and splenic indexes. Lungs were removed and fractionated for immunohistochemical analysis for macrophage detection (anti-CD68) and relative gene expression of IL-6, IL-1ß and TNF-α by RT-PCR. RESULTS: Ovariectomy enlarged spleen size and generally increased circulating lymphocytes. OVX females experienced a continuation of the initial reduction of lymphocytes and a monocyte and neutrophil late response compared to shams (p≥0.05). Moreover, OVX females showed neutropenia after 168h of infection (p≥0.05). Macrophage response in the lungs were less pronounced in OVX females in the initial hours of infection (p≥0.01). OVX females showed a higher relative gene expression of IL-1ß, IL-6 and TNF-α in the lung at the beginning of the infection compared to sham females (p≥0.01). Among the uninfected females, the OVX control females showed a higher expression of IL-6 in the lung compared to the sham control females (p≥0.05). In this model, the lack of ovarian hormones caused a minor increase in circulating leukocytes during the initial stage of infection by S. aureus and increased pulmonary gene expression of IL-1ß, IL-6, and TNF-α. Ovariectomy alone enlarged the spleen and increased circulating lymphocytes. Ovarian hormones acted as immunoprotectors against S. aureus infection.

Pigment production by Fusarium solani BRM054066 and determination of antioxidant and anti-inflammatory properties.

The fungal kingdom has been widely studied as a source of bioactive compounds of interest to the pharmaceutical and food industry. This paper studies the production of natural red pigments by Fusarium solani BRM054066 in the submerged fermentation system, using Doehlert experimental design to determine optimal cultivation conditions. The chemical composition of the red pigment was determined by Nuclear Magnetic Resonance spectroscopy (NMR) and Ultra-Performance Liquid Chromatography coupled to Mass Spectrometry (UPLC-MS). Antioxidant activity was assessed by the ability to sequester of free radical DPPH. In the analysis of anti-inflammatory activity, murine peritoneal macrophages activated by LPS were used, and the gene expression of TNF-α, IL-1ß, IL-6, IL-10 and IL-17 was determined using qPCR. As a result, it was found that agitation at 200 rpm and glucose concentration ≥ 20 g/L promote the best results in the production of red pigment. The chemical compounds identified were two naphthoquinones, fusarubin and dihydrofusarubin, and an anthraquinone, a bostrycoidin, being fusarubin the majority compound. The red pigment showed antioxidant activity by scavenge 50% of the DPPH radical, in a concentration of 24 µg/mL. The pigment also showed an effective anti-inflammatory capacity by reducing the overexpression of the pro-inflammatory cytokines TNF-α, IL-1ß and IL-6 and promoting the production of anti-inflammatory IL-10 and IL-17, in murine macrophages activated by LPS (p < 0.05). According to the results, the fungus F. solani BRM054066, under optimized conditions of cultivation, proved to be a promising source of biologically active natural pigments with wide industrial applicability.

Multilocus sequence typing characterizes diversity of Ureaplasma diversum strains, and intra-species variability induces different immune response profiles.

BACKGROUND: Ureaplasma diversum is a pathogen found in the genital tract of cattle and associated with genital disorders such as infertility, placentitis, abortion, birth of weak calves, low sperm motility, seminal vesiculitis and epididymitis. There are few studies evaluating the genetic diversity of U. diversum strains and their influence on the immune response in cattle. Therefore, to better understand genetic relationships of the pathogenicity of U. diversum, a multilocus sequence typing (MLST) scheme was performed to characterize the ATCC 49782 strain and another 40 isolates recovered from different Brazilian states. RESULTS: Primers were designed for housekeeping genes ftsH, polC, rpL22, rpoB, valS and ureA and for virulence genes, phospholipase D (pld), triacylglycerol lipase (tgl), hemolysin (hlyA), MIB-MIP system (mib,mip), MBA (mba), VsA (VsA) and ribose transporter (tABC). PCRs were performed and the targeted gene products were purified and sequenced. Sequence types (STs), and clonal complexes (CCs) were assigned and the phylogenetic relationship was also evaluated. Thus, a total of 19 STs and 4 CCs were studied. Following the molecular analysis, six isolates of U. diversum were selected, inoculated into bovine monocyte/macrophage culture and evaluated for gene expression of the cytokines TNF-α, IL-1, IL-6, IL-10 and IL-17. Differences were detected in the induction of cytokines, especially between isolates 198 and BA78, promoted inflammatory and anti-inflammatory profiles, respectively, and they also differed in virulence factors. CONCLUSION: It was observed that intra-species variability between isolates of U. diversum can induce variations of virulent determinants and, consequently, modulate the expression of the triggered immune response.

Ureaplasma diversum and Its Membrane-Associated Lipoproteins Activate Inflammatory Genes Through the NF-κB Pathway via Toll-Like Receptor 4.

Objectives:Ureaplasma diversum is a pathogen of cows that may cause intense inflammatory responses in the reproductive tract and interfere with bovine reproduction. The aims of this study were to evaluate the immune response of bovine blastocysts and macrophages to U. diversum infection and to evaluate the invasion capacity of this microorganism in bovine blastocysts. Methods: Viable and heat-inactivated U. diversum strains ATCC 49782 and CI-GOTA and their extracted membrane lipoproteins were inoculated in macrophages in the presence or absence of signaling blockers of Toll-Like Receptor (TLR) 4, TLR2/4, and Nuclear Factor KB (NF-κB). In addition, the same viable U. diversum strains were used to infect bovine blastocysts. RNA was extracted from infected and lipoprotein-exposed macrophages and infected blastocysts and assayed by qPCR to evaluate the expression of Interleukin 1 beta (IL-1ß), Tumor Necrosis Factor Alpha (TNF-α), TLR2 and TLR4 genes. U. diversum internalization in blastocysts was followed by confocal microscopy. Results: Both Ureaplasma strains and different concentrations of extracted lipoproteins induced a higher gene expression of IL-1ß, TNF-α, TLR2, and TLR4 in macrophages (p < 0.05) when compared to non-infected cells. The used blockers inhibited the expression of IL-1ß and TNF-α in all treatments. Moreover, U. diversum was able to internalize within blastocysts and induce a higher gene expression of IL-1b and TNF- α when compared to non-infected blastocysts (p < 0.05). Conclusion: The obtained results strongly suggest that U. diversum and its lipoproteins interact with TLR4 in a signaling pathway acting via NF-kB signaling to stimulate the inflammatory response. This is the first study to evaluate the in vitro immunological response of macrophages and bovine blastocysts against U. diversum. These results may contribute to a better understanding of the immunomodulatory activity and pathogenicity of this infectious agent.

Resistance training with instability in multiple system atrophy: a case report.

This case report assessed quality of life, activities of daily living, motor symptoms, functional ability, neuromuscular parameters and mRNA expression of selected genes related to muscle protein synthesis and degradation in a patient with Multiple System Atrophy (MSA). The patient underwent resistance training with instability devices (i.e., bosu, dyna disk, balance disk, Swiss ball) for six months twice a week. After the six months training, the patient's left and right quadriceps muscle cross-sectional area and leg press one-repetition maximum increased 6.4%, 6.8%, and 40%, respectively; the patient's timed up and go, sit to stand, dynamic balance, and activities of daily living improved 33.3%, 28.6%, 42.3%, and 40.1%, respectively; the patient's severity of motor symptoms and risk of falls decreased 32% and 128.1%, respectively. Most of the subscales of quality of life demonstrated improvements as well, varying from 13.0% to 100.0%. mRNA expression of mechanogrowth factor and mammalian target of rapamycin increased 12.7-fold and 1.5-fold, respectively. This case report describes likely the first nonpharmacological therapeutic tool that might be able to decrease the severity of motor symptoms and risk of falls, and to improve functional ability, neuromuscular parameters, and quality of the life in a patient with MSA. Key pointsSix months of resistance training with instability alleviate the MSA-related effects and improve the quality of life in a patient with MSA.High complexity exercise intervention (i.e., resistance training with instability) may be very beneficial to individuals with impaired motor control and function as MSA patients.Caution should be exercised when interpreting our findings as they cannot be generalized to the entire MSA population and they do not allow establishing causal conclusions on the effects of this mode of exercise on MSA.

Combined M-FISH and CGH analysis allows comprehensive description of genetic alterations in neuroblastoma cell lines.

Cancer cell lines are essential gene discovery tools and have often served as models in genetic and functional studies of particular tumor types. One of the future challenges is comparison and interpretation of gene expression data with the available knowledge on the genomic abnormalities in these cell lines. In this context, accurate description of these genomic abnormalities is required. Here, we show that a combination of M-FISH with banding analysis, standard FISH, and CGH allowed a detailed description of the genetic alterations in 16 neuroblastoma cell lines. In total, 14 cryptic chromosome rearrangements were detected, including a balanced t(2;4)(p24.3;q34.3) translocation in cell line NBL-S, with the 2p24 breakpoint located at about 40 kb from MYCN. The chromosomal origin of 22 marker chromosomes and 41 cytogenetically undefined translocated segments was determined. Chromosome arm 2 short arm translocations were observed in six cell lines (38%) with and five (31%) without MYCN amplification, leading to partial chromosome arm 2p gain in all but one cell line and loss of material in the various partner chromosomes, including 1p and 11q. These 2p gains were often masked in the GGH profiles due to MYCN amplification. The commonly overrepresented region was chromosome segment 2pter-2p22, which contains the MYCN gene, and five out of eleven 2p breakpoints clustered to the interface of chromosome bands 2p16 and 2p21. In neuroblastoma cell line SJNB-12, with double minutes (dmins) but no MYCN amplification, the dmins were shown to be derived from 16q22-q23 sequences. The ATBF1 gene, an AT-binding transcription factor involved in normal neurogenesis and located at 16q22.2, was shown to be present in the amplicon. This is the first report describing the possible implication of ATBF1 in neuroblastoma cells. We conclude that a combined approach of M-FISH, cytogenetics, and CGH allowed a more complete and accurate description of the genetic alterations occurring in the investigated cell lines.

Angioplastia coronária com uso de duplo baläo em artéria de grande calibre (hugging balloons) / Coronary Angioplasty with the Double Balloon Technique in Large Lumen Artery (Hugging Balloon)

Em paciente do sexo masculino, com 73 anos de idade, foi realizada angioplastia em artéria coronária direita de grande calibre, com lesäo severa associada a trombo, utilizando-se 2 balöes, colocados lado a lado, e insuflados simultaneamente (técnica denominada Hugging Balloons), garantindo a obtençäo de lesäo residual pequena e boa evoluçäo hospitalar

In this case report the transluminal coronary angioplasty was performed in a oversized right coronary artery with a severe lesion with thrombus inside, using the Hugging balloon technique (two dilatation balloon catheters used simultaneously). This technique achieved minimal residual lesion and had a favorable clinical outcome of the patient

Oclusão aguda pós-angioplastia coronária. Manuseio precoce e evolução tardia / Acute Closure After Coronary Angioplasty. Management and Follow-Up

PURPOSE--Assess the efficacy of the different strategies employed in the management of acute closure and verify the late prognosis of patients who develop this complication. METHODS--From january 1987, through December 1990, 2315 consecutive patients underwent percutaneous transluminal coronary angioplasty (PTCA) in our Institution. We analyzed 100 patients who had had acute closure of the dilated vessel determining the total incidence of myocardial infarction and death, the effectiveness of the different treatment strategies and clinical and angiographic predictors of poor in-hospital outcome. Late follow-up was obtained in the hospital survivors. RESULTS--The incidence of acute myocardial infarction in the group of 100 patients was 57; death occurred in 12of the patients. Forty-one individuals were referred to emergency bypass surgery, 35 received clinical treatment and 24 underwent redilatation of the vessel. Those managed clinically had a higher incidence of myocardial infarction compared to the ones who underwent either redilatation or surgery (74.3versus 50and 48.8). The in-hospital mortality rate was significantly higher in patients with left ventricular ejection fraction < 45(44.4, p < 0.001) and in procedures involving the left anterior descending artery (20, p < 0.05); patients undergoing repeat dilatation had the lower death rate (4.2versus 8.6in the clinical group and 17.1in the surgical group). Late follow-up was obtained in 65 of 88 hospital survivors (mean follow-up = 17 months). Patients who underwent repeat dilatation were significantly less symptomatic in the follow-up than those who received medical therapy during the acute phase (89versus 60.9of patients without symptoms respectively, p < 0.05). Patients who were referred to surgery had also a tendency towards having less symptoms (87.5of asymptomatic patients in the late follow-up) although the difference was not statistically significant (0.01 > p > 0.05). CONCLUSION--Acute coronary occlusion is a serious complication of angioplasty and is associated with high rates of major complications (myocardial infarction, death). Low left ventricular ejection fraction and PTCA involving the left anterior descending are predictors of higher in-hospital mortality in patients with acute closure. Late outcome is less favourable in patients submitted to clinical treatment in the acute phase.

Angina instavel: aplicacao da revascularizacao percutanea e da terapeutica adjunta / Unstable angina: role of percutaneous revascularization and adjuntive therapy

Nesta revisao, os autores discorrem acerca do papel da revascularizacao percutanea (angioplastia corornaria, aterectomias e implante de "stent") no manuseio da angina instavel, enfatizando tambem a importancia que uma terapeutica adjunta criteriosamente indicada e conduzida tem nos resultados

Heparina na angioplastia coronária: estudo randomizado em casos com baixo risco para oclusäo aguda / Use of heparin in coronary angioplasty: randomizad trial in low risk patients for abrupt closure

Objetivo - Avaliar prospectivamente a eficácia da heparina em prevenir a oclusäo aguda pós-angioplastia coronária em situaçöes de baixo risco para a ocorrência deste fenômeno. Métodos - Nos últimos 4 anos, 525 pacientes submetidos a dilataçäo coronária com sucesso, foram randomizados para receber (n=264) ou näo (n=261) heparina, após procedimento. Os critérios de oclusäo foram contra-indicaçäo ao uso da droga e risco elevado para oclusäo aguda (angina instável refratária angioplastia direta no infarto do miocárdio, dissecçäo coronária, presença de trombos intracoronários e dilataçäo de oclusöes crônicas). Comparando os que receberam heparina com os que näo receberam, näo se observou qualquer diferença significativa, quanto ao sexo (15% x 17% do sexo feminino, NS), idade acima de 70 anos (7% x 9% NS), infarto prévio (26% x 24% NS), dilataçäo de múltiplos vasos (4% x 7% NS), angina estável (40% x 46X NS), angina instável (52% x 48%NS) e trombólise preliminar (8% x 6% NS). Resultados - No total dos casos, ocorreram 2/525 (0,4%, oclusöes agudas, sendo uma (0,4%) em cada grupo. Houve 1/525 (0,2%) óbito hospitalar, causado por infarto do miocárdio (grupo com heparina. A incidência de infarto foi 0,4% nos dois grupos: ocorreu 1 (0,4%) operaçäo de emergência no grupo sem heparina. Foram observadas complicaçöes hemorrágicas em 7% dos pacientes com heparina e em 2% dos que näo receberam a droga (p=0,02),todas nos locais de punçäo e dissecçäo utilizados para o cateterismo cardíaco. Näo houve hemorragias sistêmicas ou necessidade de transfusäo sanguínea. Conclusäo - Nos pacientes considerados de baixo risco para oclusäo aguda pós-angioplastia coronária, a ocorrência deste fenômeno foi realmente reduzida (0,4%). O emprego da heparina, em dose plena e com ajustes adequados aparentemente, näo influenciou este resultado

Purpose - To assess the efficacy of heparin in preventing the abrupt closure after coronary angioplasty in low risk patients for this phenomenon. Methods - In the last 4 years, 525 patients sucessfully dilated wore randomized to receive intravenous heparin (n=264) or not (n=261) after the angioplasty. The excluding criteria were contraindications for heparin and risifor abrupt closure (reiractory unstable angina, primary coronary angioplasty in acute myocardial inforction, evidence of intracoronary thrombos, intimal tear after the procedure and cases of chronic total oclusions). Both heparin and non heparin groups were similar in respect to female sex (15% x 17%; p=NS), age over 70 years old (7% x 9%; p=NS), previous myocardial infarction (26% x 24%; p=NS), multi-vessel procedures (4%x 7%; p=NS, stable angina (40% x 46%; p=NS), unstable angina (52% x 48%; p=NS) and angioplasty after thrombolitic therapy (8% x 6%; p=NS). Results - The overall incidence of abrupt closure was 2/525 (0.4%), with one case (0.4%) in each group. The in-hospital mortality was 1/525 (0.2%), which occured in a non-heparin patient, due to a anterior myocardial inforction. Major complications occured similary in heparin and non-heparin groups (0.4%). Bleeding complications were observed more frequently in the heparin group (7% x 2%,p=0.002). All of them were in the catheterization site and none required blood transfusion. Severe sistemic bleeding were not observed. Conclusion - In patients regarded as low risk for abrupt closure, the incidence of this complication was really low (0.4%) and heparin probably do not prevent it

Utilidade da angiografia digital na realizaçäo da angioplastia coronária: análise de 100 casos / Utility of Digital Angiography in the Coronary Angioplasty. Analysis of 100 Cases

Objetivo - Analisar a real contribuição da angiografia digital para a realização da angioplastia coronária e como ela ajudaria na otimização dos resultados da dilatação. Métodos - Cem pacientes uniarteriais, sem angioplastia ou cirurgia de revascularização prévias, submetidos à dilatação de estenoses coronárias entre janeiro e dezembro de 1990. Além do registro cinecoronariográfico convencional foram feitas aquisições digitais antes do procedimento, para medir o diâmetro da artéria, escolhendo-se, dessa forma, o cateter balão mais adequado para cada caso, e também para quantificar a importância da estenose coronária a ser tratada. Novas aquisições eram feitas durante o procedimento para medir o diâmetro no local dilatado e, logo após a retirada do sistema dilatador, um novo registro digital permitia a quantificação da lesão residual e o diâmetro final do segmento tratado. Resultados - A estenose média pré-angioplastia era de 78,2%. O diâmetro de referência médio era de 2,8mm e no local estenosado 0,8mm. A relação balão/artéria era 0,9:1. A lesão residual pós-angioplastia foi de 13,6% e o diâmetro no local dilatado aumentou para 2,6mm. Não houve complicações em qualquer paciente. Conclusão - A angiografia digital é um método útil para os laboratórios que se dedicam a intervenções coronárias pois permite a confirmação da severidade anatômica da estenose, otimizar a escolha do cateter-balão a ser utilizado e monitorar os resultados obtidos, quantificando a lesão residual e medindo o diâmetro final atingido

Purpose - To analyse the actual contribution of digital angiography in the angioplasty setting and to assess its utility to optimize angioplasty results. Methods - One hundred patients with single vessel coronary artery disease, without previous angioplasty or coronary artery bypass graft surgery, who underwent angioplasty from January to December 1990. Views were obtained in standard films and also in digitized angiograms. The latter was acquired before angioplasty in order to precisely quantify the stenosis and also to measure the reference diameter of the artery that was used and to choose the balloon catheterfor each case. New acquisitions were done during and after the end of the procedure to confirm the residual stenosis and to measure the final diameter. Results - The mean stenosis pre angioplasty was 78.2%, the mean reference diameter 2.8 mm and the mean diameter at the stenotic site 0.8mm. The balloon artery relation was 0.9:1. After angioplasty the residual stenosis was 13.6% and the dilated segment had a final diameter of 2. 6mm. There were no complications in any patient. Conclusion - Digital angiography is a useful methodfor laboratories devoted to coronary interventions forit allows confirmation of the severity of the stenosis, optimizes the balloon/artery relation, monitors partial results and measures the residual stenosis as well as the final diameter.

Emprego da angioplastia coronária primária no infarto agudo do miocárdio em pacientes acima de 70 anos / Use of primary coronary angioplasty in acute myocardial infarction in patients over 70 years of age

Objetivo - A análise da experiência com a utilizaçäo da angioplastia coronária primária no infarto agudo do miocárdio em pacientes acima de 70 anos, sem o uso prévio de agentes, trombolíticos. Métodos - Quarenta e dois pacientes com diagnóstico de infarto agudo do miocárdio foram submetidos à angioplastia transluminal coronária nas primeiras 12 horas de evoluçäo do episódio agudo dos quais 47% nas 3 horas iniciais de apresentaçäo. As idades variaram de 70 a 86 (m = 76,4) anos; 54,7% eram do sexo masculino e 43% exibiam infarto da parede anterior do ventrículo esquerdo. A angioplastia coronária foi realizada apenas para a artéria responsável pelo evento agudo; a descendente anterior foi tratada em 43% dos pacientes, a coronária direita em 47% e a circunflexa em 10%. Oitenta e um por cento dos casos encontravam-se nas classes funcionais I e II de Killip e os demais nas classes III e IV. Resultados - Sucesso primário foi de 86%. A mortalidade hospitalar ocorreu em 14,2% dos pacientes, sendo significativamente superior nos pacientes do sexo feminino (26,3%), naqueles na classificaçäo de Killip III e IV (37,5%), nos portadores de doença coronária multiarterial (16,6%) e nos casos com insucesso da angioplastia coronária (33%). Ocorreram 8,3% de reinfartos e nenhuma complicaçäo hemorrágica de maior porte. O reestudo angiográfico foi realizado em 50% dos pacientes revelando 72% de permeabilidade arterial tardia com melhora significativa da fraçäo de ejeçäo global e regional, principalmente nos que mantiveram o resultado inicial do procedimento. Conclusäo - A angioplastia coronária primária, sem o uso prévio de agentes trombolíticos, quando empregada em pacientes idosos e infartados, exibe alto percentual de sucesso, baixa taxa de mortalidade e ausência de fenômenos hemorrágicos graves

Purpose - To evaluate the use of primary coronary angioplasty (PTCA) in patients older than 70 years, evolving with acute myocardial infarction, without the previous administration of thrombolitic agents. Methods - Forty-two patients with acute myocardial infarction (AMI) and more than 70 years of age (m = 76.4y). There were 54.7% men and 43% of them had anterior MI. PTCA was carried out during the first 12 hours of evolution and in the first 3 hours of duration in 47% of them. PTCA was done only to the AMI related artery, which was the left descending artery in 43%, the right coronary artery in 47% and the left circunflex in the remaining patients. Nineteen percent of these patients were in Killip class III e IV. Results - Primary success was achieved in 86%. The in hospital mortality was 14.2%, and it was superior in female gender (26,3%), in Killip class III and IV (37.5%), in those with multivessel coronary disease (16.6%) and in those where primary PTCA failed (33%). There were 9.3% of reinfarction, but no major hemorrhagies happened. Late angiography was done in 50% of patients, showing 72% of patency in the AMI related artery, and a significant improval of global ejection fraction and of the wall motion, particularly, in those who maintained arterial patency. Conclusion - Primary PTCA, without former use of thrombolytic agents, when applied early in elderly patients evolving with AMI, has a high success rate and low mortality rate in this subset of high risk patients. It also shows no major hemorrhagic complications

Angioplastia na doença coronária crônica de longevos multiarteriais / Angioplasty of chronic coronary disease in the elderly with multivessel disease

Em nosso serviço, de dezembro de 1979 a maio de 1991, foram tratados através da angioplastia coronária (ATC) 4012 pacientes, dos quais 55 (1,3%)eram longevos (idade > 75 anos) multiarteriais (presença de lesöes > 50%) em 2 ou 3 das grandes coronárias epicárdicas), que se apresentavam com angina crônica. Trinta e dois (58%) eram homens. Antecedentes de infarto do miocárdio (IM) e cirurgia de revascularizaçäo foram observados em 40% dos casos, respectivamente. O quadro clínico foi angina estável em 44% e instável em 56%. A maioria das dilataçöes restringiu-se a um único vaso (76%); dos 13(24%) com ATC multiarterial, em 12 tratou-se 2 vasos e no restante 3 artérias. O sucesso primário foi obtido em 87% dos pacientes, com 92% nos casos estáveis e 84% nos instáveis. A maior parte dos insucessos deveu-se à näo ultrapassagem da lesäo (5/7 casos). Complicaçöes maiores ocorreram em 1 (2%) paciente, o qual evoluiu com IM após a ATC. Näo houve óbitos hospitalares ou necessidade de cirurgia de emergência. Na fase tardia, 66% dos pacientes evoluídos permaneceram assintomáticos; em 14% houve recidiva da angina, ocorreram 5(11%) óbitos (a maioria de causas näo-cardíacas) e em 9% perdeu-se a evoluçäo. Em 10 (22%) reestudos angiográficos, observou-se manutençäo do resultado da ATC em 5 (4 dos quais com progressäo da doença em outros vasos) e reestenose em 5. Sete pacientes (16%) necessitaram de procedimentos adicionais de revascularizaçäo, com 5 ATC e 2 cirurgias de revascularizaçäo. Concluindo, no grupo de longevos multiarteriais, a ATC mostrou-se segura e eficaz, a curto e longo prazo, com elevado índice de sucesso primário, baixo índice de complicaçöes e evoluçäo tardia satisfatória

Angioplastia coronária em uma criança de 12 anos de idade / Coronary angioplasty in a 12-year-old child

Criança do sexo masculino, 12 anos, portadora de hipertensäo arterial sistêmica, apresentou dois episódios de angina típica. Teste de esforço submáximo, realizado em esteira rolante, näo mostrou resposta isquémica do miocárdio. A cinecoronariografia demostrou lesäo concêntica severa (78%, pelo método "caliper") no terço proximal da artéria circunflexa, com extensäo de 3 mm; ventrículo esquerdo com volume e funçäo contratil normais. Foi realizada angioplastia coronária, via femoral, resultando lesäo residual de 12%(caliper). A evoluçäo tardia foi plenamente satisfatória e o reestudo angiográfico 5 meses após evidenciou manutençäo do resultado da dilataçäo

Angioplastia coronária em longevos na 8ª e 9ª décadas de vida: uma opção eficaz de revascularizaçäo? / Transluminal coronary angioplasty in patients 70 years of age and older: an effective technique for myocardial revascularization?

Objetivo Avaliar a eficácia da angioplastia coronária como procedimento de revascularização miocárdica na doença aterosclerótica coronária sintomática, em pacientes na 8a e 9a décadas de vida. Métodos Quatrocentos e cincoenta e dois pacientes idosos (idade média 74,7 anos) foram submetidos à dilatação coronária, entre abril de 1982 e junho de 1990, no Instituto Dante Pazzanese de Cardiologia. Eram 70,4% do sexo masculino, 34,9% hipertensos, 18,8% fumantes e 10,8% diabéticos. Noventa e quatro pacientes (20,7%) exibiam infarto prévio e em cerca de 14% constataram-se doenças sistêmicas severas associadas (insuficiência renal 5,1%; insuficiência respiratória 3,1%; doenças ósseas e reumáticas 1,1%; neoplasias malignas 4,2% e doenças hematológicas—0,4%). Cento e setenta e três pacientes (38,3%) eram multiarteriais e 84 (18,5%) apresentavam moderado a severo comprometimento da função ventricular esquerda. A dilatação coronária foi realizada segundo a metodologia descrita por Grüntzig, utilizando-se em todos os casos os cateteres-balão dirigíveis over the wire (LPS-USCI, Mini Profile-USCI, ACX-ACS) ou on a wire (ProbeUSCI, AXCEL-ACS...

Purpose—To evaluate the efficacy of percutaneous transluminal angioplasty (PTCA), as a revascularization procedure in patients with symptomatic coronary artery disease in the 8th and 9th decades of life. Methods Four hundred and fifty-two elderly patients (mean age 74.7 years) underwent balloon dilation, between April 1982 and June 1990, at the Institute Dante Pazzanese of Cardiology. There were 70.4% male, 34.9% with high blood pressure, 18.8% smoked and 10.8% with diabetes. Ninety-four patients (20.7%) had previous myocardial infarction and systemic disorders were diagnosed in 14% (renal failure 5.1%, respiratory insufficiency 3.1%, rheumatic and bone disorders 1.1%, malignancy 4.2%, haematologic disorders 0.4%). One hundred and seventy-three (38.3%) had multivessel coronary artery disease whereas 84 (18.5%) had moderate to severe dysfunction of the left ventricle. PTCA was done according to the method described by Grüntzig, with the use of a “over the wire (LPS, USCI, Mini Profile USCI, ACX ACS) balloon or a on the wire (Probe USCI, Axcel ACS) System...

Emprego da angioplastia coronária no infarto agudo do miocárdio sem uso prévio de agentes trombolíticos: análise de 201 pacientes / Use of coronary angioplasty in acute myocardial infarction without previous use of trombolytic agents. Analysis of 201 patients

A análise da experiência com o emprego da angioplastia coronária primária no infarto agudo do miocárdio, sem uso prévio de substâncias líticas. Duzentos e um pacientes com infarto do miocárdio, cujas idades variaram de 35 a 86 (média de 57,2 anos), sendo 83,5% do sexo masculino. Viente casos tinham idade acima de 70 anos e em 48,2% o infarto era na parede anterior. A angioplastia foi praticada nas primeiras horas do infarto, com retardo de 12 horas, sendo 79% abaixo de 6 horas. Em 95% dilatou-se apenas a artéria relacionada ao infarto agudo. Setenta por cento dos casos encontravam-se no grupo I da classificaçäo de Killip, 21% no II, 8% nos III e IV (destes, mais de 50% em choque cardiogênico). O sucesso primário foi de 84,5%. A mortalidade hospitalar foi de 5,9%. Ocorreram 7% de reinfartos. Dos 84 casos submetidos a estudo angiográfico tardio, observou-se 19% de reestenoses, 8,3% de reoclusöes. A evoluçäo tardia mostrou 74,8% de assintomáticos, 2% de novos infartos; em 10,8% cirurgia de revascularizaçäo. A mortalidade pós-hospitalar foi de 8,8% em um período médio de evoluçäo de 28 meses (variando de 2 a 72 meses). A angioplastia coronária isolada mostrou-se efetiva como método de reperfusäo, exibindo altas taxas de sucesso, baixo índice de complicaçöes e, praticamente, sem contra-indicaçöes ao seu emprego

Purpose To evaluate the experience with the use of primary PTCA in the set of acute myocardial infarction (AMI) without the previous admnistration of thrombolytic agents. Patients and Methods Two hundred and one patients with AMI, aged 35 to 86 years (mean = 57.2). There were 83.5% men. Twenty patients were older than 70 years and 48.2% had an anterior AMI. PTCA was performed early in the AMI, with a delay no longer than 12 hours. In 95%, it was done solely to the infarct related artery. Seventy percent patients were in Killip class I, 21% in class II, and 8% in classes III and IV (more than 50% of this subset of patients were in cardiogenic shock). Results Primary success was achieved in 84.5%. In hospital mortality was 5.9%, and there were 7% reinfarctions. Among the 84 patients who underwent a late cinecoronariography study, there were 19% restenosis and 8.3% reoclusions. In the long term follow up 75% were asymptomatic. Repeat PTCA was required in 10.2% of the cases, late coronary surgery was performed on 10.8% of the patients, and post-hospital cardiac mortality was 8,8% during an average follow up of 28 months (range 2-72 months). Conclusion Primary PTCA is a effective way of reperfusion in the AMI, with a high primary success, low complications rate and without any major contraindications

Angioplastia da artéria descendente anterior de origem anômala: aplicaçäo de novo cateter-baläo de baixo perfil; relato de caso / Angioplasty of anterior descending artery from anomalous origin: use of a new low profile catheter baloon: report of a case

Atualmente existe a possibilidade de se realizar angioplastia translumina coronaria em artérias de fino calibre e que apresentem lesöes distais graves. Isto se deve, entre outros fatores, à introduçäo de sistemas dilatadores dotados de inovaçöes tecnológicas que favorecem sua realizaçäo nestas e em outras circunstâncias. Nesta paciente o procedimento foi efetivado em uma artéria coronária com origem anômala e fino calibre, variedade anatômica rara e de acesso problemático à angioplastia, utilizando para tanto, cateter-baläo de baixo perfil do tipo Probe**TM, que apresenta características que diferenciam daqueles convencionalmente utilizados

It is possible to perform transluminal coronary angioplasty (TCA) in thin vessels presenting severe obstructions. One of the achievements that made such procedure possible is the development of a new generation of balloon catheters. In this case report the TCA was performed in a very thin left anterior descending artery with an anomalous origin, a quite rare situation that represents a major problem to the traditional dilator system. The catheter used was a ProbeTM (USCI), which differs of the traditional balloons in a number of characteristics. The authors consider the procedure in detail pointing out the advantages of using of the new generations and discuss the impact that newer technological developments will have in enlarging the indications for TCA and improving the results.

Angioplastia coronária: eficácia dos novos cateteres-baläo de baixo perfil / Coronary angioplasty: efficacy of the new low profile balloon catheter

Os novos cateteres-baläo de baixo perfil têm permitido a realizaçäo da angioplastia coronária (ATC) em lesöes mais complexas. O nosso estudo mostra a experiência inicial com estes novos sistemas em 50 (50%) de 101 pacientes submetidos à ATC entre 15 de março e 15 de maio de 1989 no Instituto Dante Pazzanese de Cardiologia. A idade média foi de 58,6 ñ 10,4 anos, com a maioria (75%) dos pacientes do sexo masculino. Cinqüenta e quatro lesöes foram dilatadas, e a doença uniarterial participou com 84% dos casos. Das lesöes nos vasos, 56% se encontravam nos terços médio ou distal e a média do grau de estenose pré-ATC era de 84 ñ 10,2%. A funçäo ventricular esquerda era normal em 60% dos pacientes. O índice de sucesso primário por paciente foi de 95% e a ultrapassagem das obstruçöes coronárias foi possível em todos os casos. O número médio de insuflaçöes foi de 2,7 ñ 0,6. As médias de pressäo máxima de insuflaçäo e de tempo máximo de insuflaçäo foram de 8 ñ 1,15 atm e 86,1 ñ 29,0 segundos, respectivamente. A lesäo residual média correspondeu a 15,2 ñ 10,6%. Em relaçäo às complicaçöes maiores, ocorreu apenas um episódio de infarto lateral. Cirurgias de emergências näo foram necessárias, assim como näo houve óbitos. Em conclusäo, estes novos cateteres-baläo permitiram ampliar o espectro de indicaçäo da ATC para lesöes mais complexas, com elevada taxa (95%) de sucesso primário, e baixo (2,5%) índice de complicaçöes