Leonardo Celeste Mangili

Favorable effects of ezetimibe alone or in association with simvastatin on the removal from plasma of chylomicrons in coronary heart disease subjects

OBJECTIVE Reductions on the clearance from plasma of chylomicrons are associated with atherosclerosis. Statins improve the removal from plasma of chylomicrons in a dose dependent manner. There is controversy whether ezetimibe modifies the plasma clearance of chylomicrons. Effects of ezetimibe alone or in combination with simvastatin were compared with low and high dose of the latter, upon the kinetics of a chylomicron-like emulsion in coronary heart disease (CHD) patients. METHODS 25 CHD patients were randomized for treatment with ezetimibe 10 mg (group 1) or simvastatin 20 mg (group 2) with progression to ezetimibe + simvastatin 10/20 mg or simvastatin 80 mg, respectively. Kinetic studies were performed at baseline and after each treatment period of 6 weeks. The fractional catabolic rates (FCR) of the emulsion labeled with (14)C-CE and (3)H-TG, that represent respectively chylomicron remnant and triglyceride removal, were calculated. Comparisons were made by ANOVA. RESULTS The (14)CE-FCR in group 1 were 0.005 ± 0.004, 0.011 ± 0.008 and 0.018 ± 0.005 min(-1) and in group 2 were 0.004 ± 0.003, 0.011 ± 0.008 and 0.019 ± 0.007 min(-1) respectively at baseline, after 6 and 12 weeks (p < 0.05 vs. baseline, and 6 vs. 12 weeks). The (3)H-TG-FCR in group 1 were 0.017 ± 0.011, 0.024 ± 0.011 and 0.042 ± 0.013 min(-1) and in group 2 were 0.016 ± 0.009, 0.022 ± 0.009 and 0.037 ± 0.012 min(-1) at baseline, after 6 and 12 weeks (p < 0.05 vs. baseline, and 6 vs. 12 weeks). There were no differences between groups in time. CONCLUSION Both treatments increased similarly the removal from plasma of chylomicron and remnants in CHD patients.

Prevalence of Atherosclerotic Lesions in the Left Internal Thoracic Artery, Evidenced by Selective Angiographic Findings

Background: By observing the high prevalence of failures in the surgical treatment of myocardial revascularization (MR), with the use of the Left Internal Thoracic Artery (LITA) as a graft, evidenced by the international literature, it was sought to demonstrate the prevalence of lesions that would not allow the use of LITA as a graft in myocardial revascularization surgery, with possible alteration in the surgical management performed by the cardiac surgeon, and reduction of the morbimortality of these patients.

Case 1 /2011- seventy-four-year-old female patient with sudden apnea and acute cholecystitis, five days after acute myocardial infarction without critical coronary lesions

At clinical consultation (may 15, 2009), the patient complained of sudden dyspnea and lower-limb pain. At physical examination, the patient presented regular general status, good skin color, was hydrated, acyanotic, anicteric, tachypneic (28 respiratory incursions per minute) and afebrile (BT 35.7°C). HR was 120 bpm and BP was 120/70 mmHg. Lung assessment showed decreased vesicular murmur in both hemithoraces. Heart assessment showed arrhythmic heart sounds, with no murmurs. The abdomen was globular, flaccid, and painful at superficial and deep palpation in the right hypochondriac region (+ Murphy’s sign). The hydro-aerial noise was preserved and there was no visceral megaly. Extremity assessment showed thin distal pulses with ++/4+ edema.

Caso 1/2011 - mulher de 74 anos, com dipneia súbita e colecisitite aguda 5 dias após infarto agudo do miocárdio sem lesões coronárias críticas

At clinical consultation (may 15, 2009), the patient complained of sudden dyspnea and lower-limb pain. At physical examination, the patient presented regular general status, good skin color, was hydrated, acyanotic, anicteric, tachypneic (28 respiratory incursions per minute) and afebrile (BT 35.7°C). HR was 120 bpm and BP was 120/70 mmHg. Lung assessment showed decreased vesicular murmur in both hemithoraces. Heart assessment showed arrhythmic heart sounds, with no murmurs. The abdomen was globular, flaccid, and painful at superficial and deep palpation in the right hypochondriac region (+ Murphy’s sign). The hydro-aerial noise was preserved and there was no visceral megaly. Extremity assessment showed thin distal pulses with ++/4+ edema.

Caso 1/2011 - mujer de 74 años, con disnea súbita y colecistitis aguda, 5 días después de infarto agudo de miocardio sin lesiones coronarias críticas

At clinical consultation (may 15, 2009), the patient complained of sudden dyspnea and lower-limb pain. At physical examination, the patient presented regular general status, good skin color, was hydrated, acyanotic, anicteric, tachypneic (28 respiratory incursions per minute) and afebrile (BT 35.7°C). HR was 120 bpm and BP was 120/70 mmHg. Lung assessment showed decreased vesicular murmur in both hemithoraces. Heart assessment showed arrhythmic heart sounds, with no murmurs. The abdomen was globular, flaccid, and painful at superficial and deep palpation in the right hypochondriac region (+ Murphy’s sign). The hydro-aerial noise was preserved and there was no visceral megaly. Extremity assessment showed thin distal pulses with ++/4+ edema.