João Pimenta

Toxocariasis of the central nervous system: with report of two cases

Clinical involvement of the nervous system in visceral larva migrans due to Toxocara is rare, although in experimental animals the larvae frequently migrate to the brain. A review of the literature from the early 50s to date found 29 cases of brain involvement in toxocariasis. In 20 cases, various clinical and laboratory manifestations of eosinophilic meningitis, encephalitis, myelitis or radiculopathy were reported. We report two children with neurological manifestations, in which there was cerebrospinal fluid pleocytosis with marked eosinophilia and a positive serology for Toxocara both in serum and CSF. Serology for Schistosoma mansoni, Cysticercus cellulosae, Toxoplasma and cytomegalovirus were negative in CSF, that was sterile in both cases. Improvement of signs and symptoms after specific treatment (albendazole or thiabendazole) was observed in the two cases. A summary of data described in the 25 cases previously reported is presented and we conclude that in cases of encephalitis and myelitis with cerebrospinal fluid pleocytosis and eosinophilia, parasitic infection of the central nervous system should be suspected and serology should be performed to establish the correct diagnosis and treatment.

Electrocardiographic abnormalities in neurological diseases

OBJECTIVE To evaluate electrocardiographic abnormalities in patients with neurologic diseases. METHODS We studied 161 patients with neurologic disorders by analyzing the 12-lead electrocardiogram during the pathological process. An expert who did not know anything about the patients evaluated the traces. RESULTS Neurological process included brain tumor (41%), stroke (27.3%), cerebral aneurysm (15.5%), subarachnoid hemorrhage (6.8%), subdural hemorrhage (5%), and head injury (4.4%). Electrocardiograms were normal in 61% of cases, and the most frequent abnormality was ventricular repolarization (23.7%). The presence of T waves (4.6%) and prolonged QT intervals (8.8%) was the most characteristic of brain injuries. CONCLUSION We observed a lower incidence of electrocardiographic abnormalities than that described in the literature.

Tachycardia Mediated by an AV Universal (DDD) Pacemaker Triggered by a Ventricular Depolarization

A 44‐year‐old female had Chagas’ disease with right bundle branch block, right axis deviation, and ventricular ectopic beats. An invasive evaluation showed a prolonged HV interval of 100 ms. A Medtronic Versatrax 7000 was implanted, after which a pacemaker‐mediated tachycardia was observed. The esophageal lead ruled out the possibility of an atrial triggered tachycardia. The diagnosis was pacemaker‐mediated tachycardia due to abnormal sensing of the terminal forces of the ventricular activation because of malposition of the atrial lead in the right ventricular out‐flow tract.

Eficácia da atorvastatina sem administração diária

BACKGROUND Statins are widely used because they reduce cardiac events. Although they are indicated for daily use, some doctorsgive prescriptions for every other day, mainly with the purpose of reducing costs. OBJECTIVE To evaluate the efficacy of atorvastatin, when not administered everyday, on LDL-cholesterol (LDL-C) levels, and also to evaluate cost reduction. METHODS A total of 100 patients with hypercholesterolemia in primary (PP) and secondary prevention (SP) were assessed. After a 12-week diet period, atorvastatin was initiated at a dose of 10 mg per day. After six weeks, LDL-C was determined, and if the levels were <80 or <104 mg/dL for SP and PP, respectively, two atorvastatin doses were subtracted per week. If LDL-C remained <80 or <104 mg/dL, a further reduction to three times a week was allowed, and the last determination was performed after six more weeks. The percentage variation in costs was the parameter to evaluate the saving. RESULTS In 47 out of the 52 patients of this group, a reduction by 32% in LDL-C was observed, and daily atorvastatin was maintained. Forty one patients remained throughout the study and had their weekly dosage reduced. In 25 patients the medication was administered three times a week, and in 16, five times a week, with reductions of 42.4% and 46.1% in LDL-C, respectively. As regards costs, one of the groups had their monthly expense reduced from R

Estudos eletrofisiológicos seriados do sistema éxcito-condutor do coração de pacientes com cardiopatia chagásica crônica

106.65 to R

Cardiac electrophysiological assessment in patients with sarcoidosis

74.65, and the other group from R

Avaliação eletrofisiológica cardíaca em pacientes com sarcoidose

106.65 to R

Evolução hospitalar e tardia pós-implante de stent coronariano em paciente com angina instável e síndrome mielodisplásica

53.33. CONCLUSION The results suggest that atorvastatin may be administered on a non-daily basis. A cost reduction between 30% and 50% was also observed.

Slow junctional rhythm during catheter ablation of right posteroseptal accessory pathway causing transient atrioventricular block

OBJECTIVES To study the evolution of lesions in conduction system using invasive electrophysiological studies (EPS), the impact of these alterations on cardiovascular events (CVE), and the frequency of these events in chronic chagasic patients. METHODS Prospective study, initiated in 1979 with clinical follow-up until 2000, with the participation of 28 chronic chagasic patients that were 18 to 65 years old, with bundle branch and/or atrioventricular blocks. The patients were submitted to two EPS with a minimum interval of four years between the studies in order to assess five electrophysiologists parameters that were correlated with CVE. A 24-hour Holter and echocardiogram were performed. RESULTS The average follow-up time after the first EPS was 154.5 months while the interval between EPS was 107.5 months. Ages ranged from 25 to 65 years. Twenty seven patients presented complete right bundle branch block associated with a left anterior hemiblock. The echocardiogram showed alteration in twelve patients. During the 24-hour Holter and ventricular stimulation, only one patient presented sustained ventricular tachycardia (SVT). Nine presented CVE during the study and only the HV interval > or = 70 ms presented a significant statistical relationship with CVE. CONCLUSIONS a) The chronic form of Chagas disease presents different progressive abnormality percentages for the electrophysiological variables and WP alterations are the most common. b) Among the electrophysiological findings, only the HV interval > or = 70 ms was associated with CVE. c) The incidence of CVE was 31.1% during the average follow-up period of 154.5 months.

O coração em portadores do vírus da hepatite C: avaliação Dopplerecocardiográfica

BACKGROUND Sarcoidosis is a multisystem granulomatous disease of unknown origin that can cause sudden death. OBJECTIVE Electrophysiological evaluation of patients with suspected sarcoidosis with cardiac involvement. METHODS We studied 22 patients with mean age of 55.32 ± 13.13 years, diagnosed with sarcoidosis and suspected cardiac involvement. These patients underwent clinical evaluation, laboratory tests, electrocardiogram, echocardiogram, 24-hour Holter, technetium or gallium scintigraphy and electrophysiological study. In selected cases, we performed positron emission tomography or magnetic resonance imaging. Patients were followed up in the outpatient care service with quarterly visits. RESULTS Cardiac involvement was confirmed in four (18.2%) patients. Ventricular extrasystoles with density > 100/24 h were documented in 24-Holter monitoring in 12 (54.5%) patients. Electrophysiological studies revealed an increased HV interval in seven patients (31.8%) and increased Wenckebach point in four (18.2%) patients. There was induction of atrial fibrillation in seven patients (31.8%) and sustained ventricular tachycardia in one patient (4.5%). Four patients with confirmed cardiac sarcoidosis had documented ventricular extrasystoles with density > 100/24 h. Out of these, two had prolonged HV interval and atrial fibrillation was induced in two of them. Sustained ventricular tachycardia was not induced in any of these patients. After mean follow-up period of 20.9 ± 15.7 months, one patient with cardiac sarcoidosis had sudden death. CONCLUSION Patients with sarcoidosis and suspected cardiac involvement have a high prevalence of ventricular extrasystoles (VEs) and conduction system disorders.FUNDAMENTOS: Sarcoidosis es una enfermedad granulomatosa multisistemica de origen desconocido que puede causar la muerte subita. OBJETIVOS:Evaluacion electrofisiologica de los pacientes con sarcoidosis con sospecha de afectacion cardiaca. METODOS:Se estudiaron a 22 pacientes con una media de edad de 55,32 ± 13,13 anos, con diagnostico de sarcoidosis y sospecha de afectacion cardiaca.Se sometieron a evaluacion clinica, examenes de laboratorio, electrocardiograma, ecocardiograma, Holter de 24 h, centellografia con galio o tecnecio y estudio electrofisiologico. En los casos seleccionados se realizo tomografia por emision de positrones o la resonancia magnetica.Los pacientes fueron seguidos en ambulatorio, en consultas trimestrales. RESULTADOS:La afectacion cardiaca se comprobo en cuatro (18,2%) pacientes.Extrasistoles ventriculares con densidad > 100/24 h se documentaron en el Holter de 24 h en 12 (54,5 %) pacientes.Los estudios electrofisiologicos revelaron un aumento del intervalo HV en siete (31,8%) y punto de Wenckebach aumentado en cuatro (18,2%) pacientes. No hubo induccion de fibrilacion auricular en siete (31,8%) y de taquicardia ventricular sostenida en uno (4,5%). En los cuatro pacientes con sarcoidosis cardiaca confirmada, extrasistoles ventriculares (EVs), con densidad > 100/24 h se documentaron en todos, dos presentaban prolongacion del intervalo HV y fibrilacion auricular se indujo en dos. La taquicardia ventricular sostenida no fue inducida en cualquiera de estos pacientes. Despues de un periodo medio de seguimiento de 20,9 ± 15,7 meses, un paciente con sarcoidosis cardiaca tuvo muerte subita. CONCLUSION: Los pacientes con sarcoidosis y sospecha de afectacion cardiaca tienen una alta prevalencia de EVs y trastornos del sistema de conduccion.