Doppler echocardiographic study in adolescents and young adults with sickle cell anemia.

OBJECTIVE: Anatomical and functional assessment of the heart through Doppler and echocardiography in patients with cell anemia (SCA). METHODS: Twenty-five patients with SCA and ages ranging from 14 to 45 years were prospectively studied in a comparison with 25 healthy volunteers. All of them underwent clinical and laboratory evaluation and Doppler echocardiography as well. The measurements were converted into body surface indices. RESULTS: There were increases in all chamber diameters and left ventricle (LV) mass of the SCA patients. It was characterised an eccentric hypertrophy of the left ventricle. The preload was increased (left ventricle end-diastolic volume) and the afterload was decreased (diastolic blood pressure, peripheral vascular resistance and end-systolic parietal stress ESPS). The cardiac index was increased due to the stroke volume. The ejection fraction and the percentage of the systolic shortening, as well as the systolic time intervals of the LV were equivalent. The isovolumetric contraction period of the LV was increased. The mitral E-septum distance and the end-systolic volume index (ESVi) were increased. The ESPS/ESVi ratio,a loading independent parameter, was decreased in SCA, suggesting systolic dysfunction. No significant differences in the diastolic function or in the pulmonary pressure occurred. CONCLUSION: Chamber dilations, eccentric hypertrophy and systolic dysfunction confirm the evidence of the literature in characterizing a sickle cell anemia cardiomyopathy.

Fatal pulmonary embolism in hospitalized patients. Clinical diagnosis versus pathological confirmation.

OBJECTIVE: To assess the incidence of fatal pulmonary embolism (FPE), the accuracy of clinical diagnosis, and the profile of patients who suffered an FPE in a tertiary University Hospital. METHODS: Analysis of the records of 3,890 autopsies performed at the Department of General Pathology from January 1980 to December 1990. RESULTS: Among the 3,980 autopsies, 109 were cases of clinically suspected FPE; of these, 28 cases of FPE were confirmed. FPE accounted for 114 deaths, with clinical suspicion in 28 cases. The incidence of FPE was 2.86%. No difference in sex distribution was noted. Patients in the 6th decade of life were most affected. The following conditions-were more commonly related to FPE: neoplasias (20%) and heart failure (18.5%). The conditions most commonly misdiagnosed as FPE were pulmonary edema (16%), pneumonia (15%) and myocardial infarction (10%). The clinical diagnosis of FPE showed a sensitivity of 25.6%, a specificity of 97.9%, and an accuracy of 95.6%. CONCLUSION: The diagnosis of pulmonary embolism made on clinical grounds still has considerable limitations.

Metilprednisolona intravenosa em altas doses (pulsoterapia): possível solução terapêutica para a febre reumática ativa com cardite grave / High-dose intravenous methylprednisolone (pulsetherapy): possible therapeutic solution for active rheumatic fever with severe carditis

Oito pacientes com cardite reumatica ativa a maioria em franca insuficiencia cardiaca foram tratados com esquema de pulsoterapia (lg de metilprednisolona intravenosa). Foram acompanhados por exame clinico,eletrocardiograma, radiografia de torax, provas de atividade reumatica e ecocardiograma. A melhora da insuficiencia cardiaca ocorreu em dias. Esta forma de terapeutica tornou possivel o controle da insuficiencia cardiaca, certamente imunologica em curto periodo de tempo e sem efeitos adversos. Ela permitira, tambem, maior abrangencia em situacoes especiais de insuficiencia cardiaca auto-imune