Criptococose em felino / Cryptococcosis in cat

A case of cryptococcosis in a cat refferred to the Hospital Veterinário da Universidade Federal Rural de Pernambuco is described. The cat was euthanized and the microscopic examination of a firm mass observed in the nasal cavity was accomplished. Cryptococcus sp, and a chronic inflammatory process was observed throughout the tissue

[Evaluation of syncope in patients with chronic Chagas heart disease]. / Avaliação da síncope em pacientes com cardiopatia chagásica crônica.

PURPOSE: To evaluate causes of syncope in patients with Chagas' disease and intraventricular conduction disturbances. METHODS: Nine patients have been studied, being seven males. Average of 49 years. The studied consisted of His Bundle electrogram, determination of Wenckebach period (WP), sinus node recovery time (SNRT), atrial stability and programmed ventricular stimulation (PVS). RESULTS: Monomorphic ventricular tachycardia (VT) was induced in five patients (55.5%), WP depression was observed in three cases, H-V interval prolongation occurred in three cases and the SNRT was normal in hall patients. In one case the electrophysiological study was completely normal. Among five patients with induced VT, with a mean follow-up period of seven months, one died suddenly, three became asymptomatic with antiarrhythmic drugs and one went on a non pharmacological therapy. In the other four patients with a mean follow-up period of 21 months, three are asymptomatic and one presents occasional dizziness (patient with a normal study). Among the patients with VT four presented recurrent syncope while in the group of patients without VT (four patients) all had only one syncopal episode. CONCLUSION: Patients with intraventricular disturbances, Chagas' disease and syncope, VT may be responsible for the symptoms in approximately 44% of cases. The PVS must be considered as a routine in the investigation of these patients.

[Apical lesion of the left ventricle in clinical evolution of chronic Chagas cardiopathy]. / A lesão apical do ventrículo esquerdo na evolução clínica da cardiopatia chagásica crônica.

PURPOSE: Study of clinical evolutionary aspect in patients with apical lesion of chronic Chagas' heart disease diagnosed by left cineventriculography. PATIENTS AND METHODS: 55 patients, 32 female, aged 22 to 69 years with epidemiologic data and positive serological tests, all presenting cardiovascular symptoms, 20 in cardiac failure (10 with left ventricular failure and 10 in congestive heart failure). Heart size was normal in 35 patients and 20 showed cardiomegaly on chest X-ray examinations (slight in 8, moderate in 6 and marked in 6), EKG showed premature beats in all patients and conduction defects in 38 instances with a predominance of right bundle branch block associated with left anterior divisional block in 19 cases. The following morphological aspects of the apical lesions were observed: mammillary--23 (41.82%); digital--18 (32.73%) and semilunar--14 (25.45%). In 8 cases (14.54%) intraventricular thrombi were detected and in 10 (18.18%) there were associated dyskinetic areas. RESULTS: The clinical course of 36 patients (65%) has been followed in the out patient department for 35 to 192 (97.83) months. Seven patients (12.73%) did not return for consultation after having been studied for 22 to 56 (42.83) months, and 12 (22%) died after a follow-up period of 19 to 176 (68.58) months. Detection of 17 thromboembolic episodes occurred in the 14 (25%) patients, 9 pulmonary encephalic and 1 peripheric, very frequent in patients with cardiac failure (11/14-78%). Cardiac pacemakers were implanted in 18 cases due to complete A-V block in 11, to sinus node dysfunction in 6, and to sinus arrest in 1. Among the survivors 29 (80%) maintained a normal heart size. The most frequent cause of death (12) was heart failure in 8, followed by cerebrovascular attacks in 3 and malignancy in 1. The estimated survival in 192 months was of 75.8%, males (74.5%) and females (76.6%). A presence of heart failure however was a limiting factor, with estimates of 96.8% survival in patients without cardiac decompensation, as compared to 36.5% in cases with heart failure. CONCLUSION: The apical lesion is an additional factor of mortality in Chagas' heart disease after the development of congestive heart failure.

[Significance of prolonged PR interval in patients with His bundle branch block, bifascicular type]. / Significado do intervalo PR prolongado em pacientes com bloqueio dos ramos do feixe de His do tipo bifascicular.

PURPOSE: Evaluation of the prolonged PR interval and its predictive value for trifascicular block in individuals with bifascicular His bundle branch block. PATIENTS AND METHODS: 55 patients, 36 male and 19 female aged 57 + 15.8 years with bifascicular bundle branch block type have been studied. 11 cases had complete left bundle branch block and 44 cases had complete right bundle branch block with left anterior and superior division block. His bundle electrogram and atrial stimulation were performed in all patients. The atrial stimulation rate originating the Wenckebach phenomenon (SP) of the A-V conduction, and the A-H and H-V intervals were compared with the PR interval of the surface electrocardiogram. Patients were divided into three groups according to the PR interval: group I, Pr less than 200 ms, group II, PR between 190-280 ms and group III, PR greater than or equal to 280 ms. RESULTS: There was not linear correlation between the PR interval and WP in the three groups. There was a weak linear ascending correlation between the PR and A-H intervals in groups I and II (r + 0.59 and + + 0.43, respectively) and there was a descending correlation in the group III (r. - 0.64, P less than 0.05). In relation to the H-V interval there was not linear correlation with the PR interval in groups I and II, but there was a good ascending linear correlation in the group III (r 0.84, P less than 0.01). The incidence of prolonged A-H and H-V intervals increased as the PR interval was larger. CONCLUSION: The prolonged PR interval with bifascicular bundle branch block means, in the majority of cases, diffuse damage of the conduction system involving the A-V node and the infranodal region; starting from 280 ms, the delayed PR interval suggests involvement predominantly below the A-V node: to a higher PR interval corresponds a higher H-V interval and also, to a relatively shortest A-H interval.

[Intrapericardial lipoma]. / Lipoma intrapericárdico.

A 27 year-old female patient presented with atypical chest pain. 2-D echocardiogram and thorax computed tomography revealed intrapericardial tumor. The patient was operated on for removal of the tumor, which turned out to be two isolated lipomas. The patient had a rapid postoperative recuperation.

[Evaluation of the PR intervals in normal and prolonged maximum limit with short QRS]. / Avaliação dos intervalos PR no limite máximo normal e prolongado com QRS estreito.

PURPOSE: Evaluation of the A-V node function by determining the Wenckebach period (WP) and atropine response in cases of normal PR interval, PR interval at maximum normal range and prolonged PR interval, all with short QRS. PATIENTS AND METHODS: 129 patients, 79 male and 50 female, aged 17 to 84 years (mean 59), asymptomatic or with complaints of palpitations, dizziness, presyncope or syncope has been studied. ECG showed supra-ventricular tachycardia, first degree A-V block or intermittent Mobitz I type A-V block and sick sinus syndrome. Preexcitation (WPW) syndrome and longitudinal A-V dissociation were excluded. Electrical transoesophageal atrial stimulation was performed in all patients for evaluating the PR interval and WP. Atropine test was performed in a group of 16 patients. Based on the values of the WP, patients were divided into three groups: group I, WP greater than or equal to 125 ppm (N = 88); group II, WP ranging 125-110 ppm (N = 16) and group III, WP less than or equal to 110 ppm (N = 25). RESULTS: There was a good decreasing lineal correlation between the PR interval and the WP only in the group III (r = 0.76, p less than 0.01). PR interval greater than 240 ms had greatest and significant incidence in the group III in relation to the other groups in which the number of WP post-atropine normalization was observed. CONCLUSION: There is a strong linear decreasing correlation between the PR interval of the ECG and the WP in individuals with WP less than or equal to 110 ppm. PR interval greatest than 0.24 ms corresponds better to WP below 110 ppm (mean 90 ppm) and the majority of these patients do not normalize the WP with the atropine. We suggest the term "first degree A-V block" for those cases with PR interval greater than 240 ms and "A-V depression" for the cases with PR interval shorter than 240 ms when recorded on the surface electrocardiogram and have been normalized with atropine.

[Thromboembolism in patients with apical lesion caused by chronic chagasic cardiopathy]. / O tromboembolismo em pacientes com lesão apical da cardiopatia chagásica crónica.

The thromboembolism in patients with apical lesion of the chronic Chagas' heart disease diagnosticated by left cineventriculography are present in this study. The series comprises 32 females and 23 males between the ages of 22 and 69 years, all presenting cardiovascular symptoms, 20 in cardiac failure (10 with left ventricular failure and 10 in congestive heart failure). Heart size was normal in 35 instances and 20 showed cardiomegaly on chest X-ray examinations (slight in 8, moderate in 6 and marked in 6). The following morphological aspects of the apical lesions were observed: mammillary-23 (41.82%); digital-18 (32.73%) and semilunar-14 (25.45%). In 8 cases (14.54%) intraventricular thrombi were detected and 10 these were associated with discinetic areas. Seventeen episodes of thromboembolism occurred in 14 (24.45%) patients including 7 to the brain, 9 to the lung and 1 to the iliac right artery, mostly in patients with heart failure. Eight were women and 6 were men, varying between 30 and 62 years of age, the morphological aspects of the apical lesion were semilunar in 8 and mammillary in 6. Cardiac pacemakers were implanted in 8 cases due to complete A-V block in 6, to sinus node disfunction in 1, and to sinus arrest in 1. In 4 cases (28.57%) intraventricular thrombi were detected, in 3 occasioned thromboembolism to the brain. Thrombo-embolic phenomena occurred in the 11 nonsurvivors. The most frequent cause of death was heart failure in 8 followed by cerebro-vascular attacks in 3, after a follow-up period of 19 to 176 months.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prevalence of tricuspid and aortic valve prolapse in patients with mitral valve prolapse]. / Prevalência de prolapso valvar tricúspide e aórtico em portadores de prolapso valvar mitral.

Two-dimensional echocardiograms were performed in 30 patients with mitral valve prolapse (15 females and 15 males, with an average of 33.3). The main objective was to observe the prevalence of involvement of tricuspid and aortic valves. Tricuspid valve prolapse was observed in 43.3% with anterior and septal involvement in 92.3% and posterior involvement in 15.3%. The incidence of aortic prolapse was 10% with involvement of both right coronary and non-coronary leaflets. All patients with aortic valve prolapse showed involvement of both mitral leaflets and at least two tricuspid leaflets. It is concluded that involvement of other valves such as tricuspid (43.3) and aortic (10%) is a common finding in patients with mitral valve prolapse.

[Diabetic cardiac dysautonomia. Clinical and pharmacologic evaluation]. / Disautonomia cardíaca diabética. Avaliação clínica e farmacológica.

Thirty-two insulin-dependent (type I) diabetic patients were studied to detect cardiovascular autonomic nervous system involvement. Half percent (16 cases) were men. Their ages ranged from 6 to 64 years (29.03 years). The average time of diagnosed diabetes was 6.5 years. The group was submitted to several clinical (respiratory, arrhythmia, Valsalva, isometric, orthostatic) and pharmacological tests (propranolol and atropine). The physiological responses were measured as heart beat frequency and blood pressure. Results were analyzed by various statistical methods. Evaluation through a diabetic complication scale showed that ten (31.25%) were uncomplicated), 14 (43.75%) at grade 1, four (12.50%) at grade 2, two (6.25%) at grade 3 and two (6.25%) at grade 4. This scale only correlated to the term of diabetes (p less than 0.01). Results from the autonomic test battery indicated that 12 (37.50%) had isolated parasympathetic damage, five (15.62%) sympathetic lesions, and two (6.25%) had mixed type involvement. We observed, as to cardiovascular autonomic involvement, 13 (40.62%) had no involvement and 19 (59.38%) had some degree of damage; in the latter group, 15 (46.78%) had early lesions and four (12.50%) definite.

[Significance and prognosis of ventricular extrasystole induced by exertion in patients with arterial hypertension with a normal electrocardiogram]. / Significado e prognóstico das extra-sístoles ventriculares induzidas pelo esforço em portadores de hipertensão arterial com electrocardiograma normal.

We studied 13 patients with systemic arterial hypertension and normal electrocardiograms so as to evaluate the significance and prognosis of frequent and complex ventricular premature beats (VPB) induced by exercise testing. After a period of 9 to 33 months of follow-up (mean = 17.6 months), we repeated the exercise testing with the same protocol in all cases. In nine patients (69.2%), the arrhythmia disappeared during exercise, two increased the number of VPB and two others reduced the number of the arrhythmia. Complications, such as sustained ventricular tachycardia, were not seen in any case. The appearance of frequent and complex VPB with stress testing does not seem enhance the risk of sudden death or episodes of spontaneous ventricular tachycardia in patients with arterial hypertension but without electrocardiographic signs of cardiac hypertrophy.

[Apical left ventricular involvement in chronic Chagas' cardiopathy: clinical and ventriculographic aspects]. / Acometimento da ponta do ventrículo esquerdo na cardiopatia chagásica crônica: aspectos clínicos e ventriculográficos.

The present study comprises 62 patients with Chronic Chagas' Heart Disease. In addition to clinical examination, serologic, roentgenologic, hemodynamic, electrocardiographic, left cineventriculographic and cinecoronariographic studies were performed, with subsequent evaluation apical left ventricule. Thirty two patients were women and 30 were men, varying between 21 and 64 years of age, all with positive serological tests, all with cardiovascular symptoms, 26 with myocardial failure (11 with left ventricular failure and 15 with congestive heart failure), heart size was normal on X-ray in 37 patients with cardiomegaly in 25 (slight in 10; moderate in 8 and accentuate in 7). The electrocardiogram revealed in 41 instance of conduction defects. The left ventriculogram showed an apical lesion in 52 patients (83.87%) with: localized hypokicinetic in 4 (6.45%), diffuse hypokicinetic in 6 (9.68%) and, apical lesion in 48 (77.42%). The shaped apical lesion as a nipple in 17 (27.42%), as finger in 17 (27.42%), and half-moon in 14 (22.18%). The apical lesion was observed in 20 of 26 patients with myocardial failure (76.92%). In 9 patients was associated with others aneurysms. In 3 patients apical thrombus was detected.