Juan Carlos Quintana

Effects of trimetazidine in nonischemic heart failure: a randomized study.

OBJECTIVES Heart failure (HF) is associated with changes in myocardial metabolism that lead to impairment of contractile function. Trimetazidine (TMZ) modulates cardiac energetic efficiency and improves outcomes in ischemic heart disease. We evaluated the effects of TMZ on left ventricular ejection fraction (LVEF), cardiac metabolism, exercise capacity, O2 uptake, and quality of life in patients with nonischemic HF. METHODS AND RESULTS Sixty patients with stable nonischemic HF under optimal medical therapy were included in this randomized double-blind study. Patients were randomized to TMZ (35 mg orally twice a day) or placebo for 6 months. LVEF, 6-minute walk test (6MWT), maximum O2 uptake in cardiopulmonary exercise test, different markers of metabolism, oxidative stress, and endothelial function, and quality of life were assessed at baseline and after TMZ treatment. Left ventricular peak glucose uptake was evaluated with the use of the maximum standardized uptake value (SUV) by 18-fluorodeoxyglucose positron emission tomography ((18)FDG-PET). Etiology was idiopathic in 85% and hypertensive in 15%. Both groups were similar in age, functional class, LVEF, and levels of N-terminal pro-B-type natriuretic peptide at baseline. After 6 months of TMZ treatment, no changes were observed in LVEF (31 ± 10% vs 34 ± 8%; P = .8), 6MWT (443 ± 25 m vs 506 ± 79 m; P = .03), maximum O2 uptake (19.1 ± 5.0 mL kg(-1) min(-1) vs 23.0 ± 7.2 mL kg(-1) min(-1); P = .11), functional class (percentages of patients in functional classes I/II/III/IV 10/3753/0 vs 7/40/50/3; P = .14), or quality of life (32 ± 26 points vs 24 ± 18 points; P = .25) in TMZ versus placebo, respectively. In the subgroup of patients evaluated with (18)FDG-PET, no significant differences were observed in SUV between both groups (7.0 ± 3.6 vs 8.2 ± 3.4 respectively; P = .47). CONCLUSIONS In patients with nonischemic HF, the addition of TMZ to optimal medical treatment does not result in significant changes of LVEF, exercise capacity, O2 uptake, or quality of life.

Cervical metastases of glucagonoma in a patient with multiple endocrine neoplasia type 1: Report of a case

Multiple endocrine neoplasia type 1 (MEN 1) is a syndrome characterized by tumors of the parathyroid glands, pancreatic islet cells, duodenum, and pituitary gland. We report a case of cervical metastases of glucagonoma with MEN 1. The patient was a 34-year-old woman admitted to our hospital with epigastric pain. Her medical history included two resections of prolactinoma and two upper GI hemorrhages secondary to duodenal ulcers. Computed tomography (CT) showed two hypervascular lesions in the tail of the pancreas and cervical ultrasound showed multiple hypoechogenic ovoid images in the neck. A cervical CT scan confirmed two 15-mm lymph nodes in the left cervical region and 111In-DOTATOC imaging showed focal abnormal somatostatin expression in the pancreatic tail and the cervical nodes. The patient had asymptomatic hypoglycemic episodes, with blood sugar levels as low as 30 mg/dl, which raised our suspicion of MEN 1 associated with pancreatic insulinoma. Thus, we performed a distal pancreatectomy with bilateral cervical dissection and parathyroid gland resection. Histopathological examination revealed 12 pancreatic tumors as well as metastases in four cervical lymph nodes. The resected parathyroid glands had normal structure, suggesting parathyroid hyperplasia. A follow-up CT scan, 18 months after surgery, showed new tumors in the head of the pancreas and in the duodenal wall. A pancreatoduodenectomy was performed and histopathological examination revealed nine nonfunctioning endocrine tumors in the pancreas, one tumor in the duodenal wall, and metastases in two peripancreatic lymph nodes. The patient recovered well and remains asymptomatic.

Changes in Regional Cerebral Blood Flow Are Associated With Endothelial Dysfunction Markers in Cocaine-dependent Patients Under Recent Abstinence

Objectives:Cocaine is a known risk factor for several vascular ischemic events. The underlying mechanisms leading to the complications are not fully understood, although thrombus formation and accelerated atherosclerosis are prominent findings. Evidence of endothelial dysfunction (ED), a key phenomenon in the pathogenesis of atherogenesis, has been demonstrated in cocaine-dependent individuals. Abnormal regional cerebral blood flow (rCBF) is a common finding among chronic cocaine users. The aim of this study was to evaluate whether brain perfusion changes were associated with ED markers in cocaine-dependent individuals. Methods:Circulating endothelial cells (CECs), soluble intercellular cell adhesion molecule, and the chemokine regulated on activation normal T cells expressed and secreted were measured in 27 DSM-IV (Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition) cocaine-dependents patients. Regional cerebral blood flow was assessed using single-photon emission computed tomography at baseline (after recent cocaine consumption) and after 4 weeks of strict abstinence under standard benzodiazepine or antipsychotic therapy. We used statistical parametric mapping analysis to evaluate the covariates. Results:Endothelial cell damage/activation markers were significantly higher in cocaine-dependent individuals after recent consumption and were reduced after 1-month abstinence (P < 0.05). Global rCBF exhibited no significant difference between baseline and after abstinence. When regional perfusion was analyzed in association with ED covariates, significant differences were observed in bilateral cortical areas, including the limbic lobes. Conclusions:We demonstrated an association between systemic ED markers and rCBF in cocaine-dependent patients. These findings suggest that vascular injury may play a role in the pathogenesis of abnormal rCBF.

Significado clínico y frecuencia de la alteración genético/molecular 11q23/MLL en lactantes con leucemia aguda en Chile

Clinical significance and frequency of the 11q23/MLL geneticmolecular alteration in Chilean infants with acute leukemia. Background Acute leukemia (AL) ill infants generally shows distinctive biologic features and has a poor prognosis. Aint: To Study the frequency of the cytogenetic alteration of 11q23 chromosome or the recombination of MLL gene ill infants less than 18 months old, with acute leukemia. Patients and methods. We analyzed 37 cases of AL ill infants less than 18 months of age diagnosed ill Chile from 1989 to 1999. The clinical features and cytogenetic/molecular defects of 11q23MLL gene rearrangement and their influence ill prognosis were determined. Results: There were 18 cases of acute Lymphoblastic leukemia (ALL) characterized by female Sex (67%) high presenting leukocyte count (median 99 x109/L), blast cells with a CD10 negative phenotype (50%) and 11q23/MLL rearrangement (39%). Molecular abnormalities Of 11q23 were significantly associated with adverse prognosis, with all event free survival (HF) of only 14 +/- 12%. Interestingly, infants with germ line 11q23 had a very good outcome with all EFS of 73 +/- 11% (P <0.025). There were 19 cases of acute myeloblastic leukemia (AML) characterized ky mate sex (63%) high leukocyte count (median 93 x 109/L), FAB-MS morphology (53%) and 11q23/MLL rearrangement (53%) EFS was very pool; 20 +/-9% and 33 +/-4% for rearranged and germinal group respectively (p=NS), due to a high mortality rate during the first month of diagnosis. Conclusions: These findings demonstrate that Chilean ALL infants with 11q23 abnormalities have a very poor Prognosis, However those with germinal state can enjoy a prolonged disease free survival with the current treatment protocols (Rev Mid Chile2001; 129: 634-642).

Algebraic Reconstruction of Source and Attenuation in SPECT Using First Scattering Measurements

Here we present an Algebraic Reconstruction Technique (ART) for solving the identification problem in Single Photon Emission Computed Tomography (SPECT). Traditional reconstruction for SPECT is done by finding the radiation source, nevertheless the attenuation of the surrounding tissue affects the data. In this context, ballistic and first scattering information are used to recover source and attenuation simultaneously. Both measurements are related with the Attenuated Radon Transform and a Klein-Nishina angular type dependency is considered for the scattering. The proposed ART algorithm allow us to obtain good reconstructions of both objects in a few number of iterations.

Depressive Disorders and Thyroid Function

A. Veronica Araya1, Teresa Massardo2, Jenny Fiedler3, Luis Risco4, Juan C. Quintana5 and Claudio Liberman1 1Endocrinology Section, Clinical Hospital of the University of Chile 2Nuclear Medicine Section, Clinical Hospital of the University of Chile 3Faculty of Chemical and Pharmaceutical Sciences, University of Chile 4Psychiatric Clinic of the Clinical Hospital of the University of Chile 5Department of Radiology, School of Medicine, Pontificia Universidad Catolica de Chile Chile

Metabolismo energético del corazón y sus proyecciones en el tratamiento de la insuficiencia cardíaca

It is unknown why heart failure progresses even when patients are treated with the best therapy available. Evidences suggest that heart failure progression is due to loss of neurohumoral blockade in advanced stages of the disease and to alterations in myocardial metabolism induced, in part, by this neurohumoral activation. Alterations in cardiac energy metabolism, especially those related to substrate utilization and insulin resistance, reduce the efficiency of energy production, causing a heart energy reserve deficit. These events play a basic role in heart failure progression. Therefore, modulation of cardiac metabolism has arisen as a promissory therapy in the treatment of heart failure. This review describes myocardial energy metabolism, evaluates the role of impaired energy metabolism in heart failure progression and describes new therapies for heart failure involving metabolic intervention.

La disincronía cardíaca se correlaciona con el remodelado ventricular izquierdo postinfarto agudo al miocardio

97, p =0.34). At baseline there were significantcorrelations between IAV and LVEF, and between IAV and LVEDV (r =-0.48, p =0.001 and r =-0.41,p =0.004, respectively). These correlations remained significant after 6 months. There was apositive correlation between IAV and LVEDV changes at six months (r =0.403, p =0.04).