Oswaldo Tadeu Greco

Transplante de Células-tronco marcadas para o miocárdio de paciente com doença de chagas

Stem cell transplantation is a new therapy applied to produce cardiac regeneration through differentiation or increase of heart myocytes or neovascular proliferation in patients in the end stage of congestive heart failure secondary to dilated cardiomyopathy, but the results are still unknown.

A terapia celular no tratamento da isquemia crítica dos membros inferiores

The authors review the history of the researches on embryonic and umbilical cord vein stem cells, their advantages and disadvantages. They proceed with comments on adult stem cells, their concept, history, sources and role on tissue regenerative processes, mainly on the endothelium. They stress the importance of factors that mobilize the adult stem cells from the bone marrow: cytokines, angyopoietine and other growth factors. The adult stem cells are mobilized as endothelial progenitor cells, which have a common origin with the endothelial cells from the hemangioblasts. The mobilizing factors are activated under hypoxia and promote the homing of the endothelial progenitor cells on the ischemic sites in order to generate the neovasculogenesis, which is accomplished through three possible mechanisms: angiogenesis (new capillaries from sprouts of the existing ones), arteriogenesis (related to collateral circulation) and vasculogenesis (actual new vessels). An appraisal of the literature is made with regard to animal and clinical sets Finally, they stress that adult stem cells, although bearing an enormous potential, still demand a considerable amount of work to become a current therapeutic method.

Acute myocardial infarction treated with intravenous streptokinase: 6-year follow-up

Our objective was to investigate variables which, although occurring during the acute period, could influence the medium (1st year) and long-term (6th year) survival of infarcted patients. Of a total of 332 patients treated consecutively and prospectively according to the same protocol which included intravenous streptokinase, 305 survived the hospital phase and represent the study population. Mean patient age was 55.6 +/- 10 years and mean follow-up time was 3.33 years, with 1008.59 patient-years. The clinical course of the group was analyzed according to the following variables: left ventricle ejection fraction, hypotension per/peri streptokinase infusion, CK-MB peak, previous myocardial infarction, number of obstructed coronaries, reinfarction, sex, definitive treatment, residual obstruction, age, pain/streptokinase infusion interval, patency of the culprit coronary and infarct location. Overall, patient survival was 93.8 +/- 1.4% during the 1st year and 83.7 +/- 2.6% at the 6th. The following groups showed significantly different (log-rank) survivals: (a) 1st year: 94.6% for absence and 82.6% for presence of reinfarction (P = 0.0451); 97.9% for inferior and 91.4% for anterior infarct location (P = 0.044); 96.4% for ejection fraction > 50% and 90.6% for ejection fraction < or = 50% (P = 0.0187); 96.5% for angioplasty/surgery and 90.1% for clinical treatment (P = 0.0028); 95.5% for absence and 80.6% for presence of previous infarct (P = 0.0001). (b) 6th year: 88.3% for ejection fraction > 50% and 73.9% for ejection fraction < or = 50% (P = 0.028); 87.4% for < or = 65 and 66.4% for > 65 years (P = 0.0114); 89.6% for aggressive and 76.8% for conservative treatment (P = 0.013); 86.6% for absence and 60.7% for presence of previous infarct (P = 0.0009).

Substituição completa da aorta ascendente e da valva aórtica com tubo valvulado de pericárdio bovino

Os autores fazem uma revisao da tecnica cirurgica empregada para o tratamento de aneurismas da aorta ascendente associados a lesoes da valva aortica. Apresentam resultados obtidos com 11 (onze) paciente operados pela tecnica de BENTALL e DE BONO, com enxerto tubular valvulado aberto de pericardio bovino IMC, sem mortalidade devida a tecnica ou ao enxerto utilizado. Desses pacientes, 8 eram do sexo masculino, com idade variando entre 31 e 65 anos, media de 50 anos; 3 eram do sexo feminino, com idade entre 20 e 53 anos, media de 38 anos. Duas cirurgias foram realizadas, em regime de urgencia, e 9 de emergencia. O tubo de pericardio bovino utilizado foi de no 23 em 1 caso, no 25 em 2, no 29 em 6 e no 31 em 2 casos. Dois pacientes tiveram lesao mitral associada com troca valvar (protese biologica IMC). Um paciente necessitou de ponte de veia safena para coronaria direita, por disseccao do ostio coronario. O diagnostico histopatologico mostrou: degeneracao mixomatosa em 4 casos, fibrose em 4 casos, doenca reumatica cicatrizada em 2 casos e pancardite em apenas 1 caso. Apos discorrerem sobre dificuldades e complicacoes do metodo, concluem que a tecnica utilizada e a de escolha no tratamento da referida patologia e que o tubo valvulado de pericardio bovino facilita o ato cirurgico, por sua alta flexibilidade e por ser altamente hemostatico, nao necessitando de medidas pre-coagulativas.

Seguimento de 9 anos da bioprótese valvular cardíaca de pericárdio bovino IMC-Biomédica: estudo multicêntrico

A mitral pericardial bioprosthetic valve IMC-Biomedica was implanted in a consecutive series of 798 patients with mean age of 52 years, from December 1977 to November 1978. The 722 patients who survived operation were observed during a period of 9 years (mean 27036 months or 2253 years). Actuarial studies indicated an expected survived rate at 9 years of 66% for adult patients and 68% for younger patients. The probability of complications were the following: rupture 0.4; perivalvar leak 0.4%; thromboembolysm 2.7%; endocarditis 3.2%; calcification 4.4%. The actuarial freedom from calcification between 1977 to 1982 (Group I) was 94.0% to adults and 12.0% to younger patients. On the other hand, between 1982 to 1986 (Group II) the actuarial analysis of calcification showed that 99.0% adults and 92.0% younger patients were free from this complication. Hence we believe that our option for the pericardial bioprosthetic valve was appropriate because 96.0% patients were free of complications deaths with the valve; this means that in 9 years the bioprosthetic lethal potential was only 4.0%.

MARCAPASSO COM SENSOR DE CONTRATILIDADE REGULADO PELAS VARIACOES DO SISTEMA NERVOSO AUTONOMO NA MIOCARDIOPATIA CHAGASICA CRONICA

OBJETIVO: Analisar o desempenho da estimulacao cardiaca artificial com marcapasso do tipo VVIR cujo sensor e regulado pelas variacoes do sistema nervoso autonomo em pacientes chagasicos com disturbio no sistema de conducao. METODOS: Estudados 47 chagasicos, 28 do sexo masculino, com idades entre 24 e 68 anos, 36 tinham bloqueio atrioventricular (AV) total; 8, bloqueio AV de 2o grau 2; e 3 doenca do nodulo sinusal, e encontravam-se, de acordo com a NYHA, em classe I (4), II (15), III (16) e IV (12). Apos o implante de marcapasso do tipo VVIR os pacientes foram acompanhados durante 12 meses. A resposta de frequencia foi registrada em gravacoes de Holter de 24h e divididos em dois grupos de acordo com a FC em repouso - grupo 1: >65bpm e grupo 2: £65bpm, para estudo comparativo, considerando: 1) FC em exercicio no periodo de pos-implante; 2) PA em repouso apos o implante e 3) avaliacao dos grupos de eletrodos identificados como TIR-60-UP e outros eletrodos. RESULTADOS: O grupo 1 teve em exercicio menor variacao entre seus valores, do que o grupo 2, indicando que esse tipo de sistema de estimulacao permite controlar individualmente cada paciente. Os valores de PA em repouso e em exercicio nao foram diferentes entre os grupos. O eletrodo do tipo TIR-60-UP, comportou-se como os demais eletrodos. CONCLUSAO: O marcapasso do tipo VVIR cujo sensor e regulado pelas variacoes do SNA propicia o restabelecimento dos mecanismos fisiologicos em chagasicos, sendo que 74% deles tiveram melhora de uma ou duas classes funcionais da NYHA.PURPOSEnTo analyse the performance of the artificial cardiac stimulation with the VVIR pacemaker whose sensor is adjusted by the variations of the autonomic nervous system in Chagas disease patients with deficiency of the conduction system.nnnMETHODSnForty-seven Chagas disease patients have been studied, 28 male between 24 and 68 years old, 36 patients had complete AV block, 8 had 2nd degree AV block and the other 3 had sinusnode disease. The patients were in class I (4), II (15), III (16) and IV (12) according to the NYHA. A 12-month-follow-up with constant clinical evaluations was carried out after pacemaker implantation. Patients were divided in 2 different groups according to the HR at rest--group 1: > 65 beats per minute (bpm) and group 2: < or = 65 bpm, for a comparative study considering: 1) HR at stress test after the implantation; 2) arterial blood pressure at rest after the implantation and, 3) evaluation of the identified electrodes such as TIR-60-UP and others.nnnRESULTSnThe group 1 had greater HR at rest, and a smaller variation of values at stress than group 2. This shows that with this type of stimulation system it is possible to control each patient separately. The values of blood pressure at rest and during stress were not different between groups. According to the factors analysed the TIR-60-UP electrode had the same performance as the others.nnnCONCLUSIONnThe VVIR pacemaker with the sensor adjusted by the ANS variations has provided the Chagas patients with a restoration of their physiological mechanisms. 74% of them had the improvement of either one or 2 functional classes.

O G-CSF na terapia do acidente vascular cerebral

The granulocyte colony-stimulating-factor (G-CSF) is a glycoproteina which has been described for decades, and it is commonly utilized in the treatment of neutropenic states and bone marrow transplants. G-CSF stimulates hematopoietic stem-cels e crucially regulates the survival of mature neutrophils through a mechanism of apoptosis inhibition. Beyond its systemic effect, recently it has been shown its surprising activity in the central nervous system (CNS). G-CSF administration mobilizes bone marrow stem cells para systemic blood, and those cells cross the blood-brain-barrier e target brains damaged area. G-CSFs activity in the CNS has been defined as multimodal, because additionally it has been demonstrated a direct neuroprotective action through different mechanisms such as antiapoptotic activity, angiogenesis, anti-inflamatory effect, and stimulation of endogenous neurogenesis. This paper sumarizes G-CSF action in the CNS and approaches its potential para use in stroke.

Uso de células-tronco no tratamento de pacientes com miocardiopatia dilatada de diferentes etiologias, associada à ressincronização cardíaca artificial

In spite of the development of pharmacological strategies, technology and more sophisticated surgical alternatives, incidences of death from cardiopathies remains high throughout the world, in particular in relation to dilated heart disease. Many of these patients benefit from recent strategies of early myocardial perfusion which significantly reduces mortality rates; even so past-infarction heart failure is common. Recent studies have shown that the infusion of autologous stem cells is a possible treatment to reverse ventricular dysfunction. However, frequently there is an associated electrical conduction defect. Thus, an infusion of stem cells may produce a mechanical correction with heart resynchronization correcting the electrical conduction defect thereby improving the left ventricle ejection fraction. Our institution has been combining stem cell transplantation with resynchronization and, when necessary, cardiofibrilation, to treat these patients giving improvements in the Functional Class, ejection fraction and left ventricle and right ventricle-left ventricle synchrony.

O fator estimulador de colônias granulocitárias (G-CSF) para isquemia cerebral: uma nova aplicação terapêutica?

G-CSF is a FDA-approved drug, commonly utilized in neutropenic patients, long knows for its anti-inflammatory and angiogenic properties and also for its capacity to mobilize stem cells, hematopoiethic and endogen precursors and progenitor cells. Recently neuroprotective effects have been shown in animals and humans and there are publications mentioning its potential therapeutic role in focal ischemia (medial cerebral artery territory). We describe a case of a 74-year-old male patient, victim of a subarachnoid hemorrhage and brain ischemia due to bilateral involvement of medial cerebral arteries and vertebrobasilar vasospasms (overall ischemia), who was submitted to G-C5F therapy. G-CSF did not cause adverse effects, mobilized cells (as was seen by the exponential increase in leukocytes) and possibly contributed to a progressive clinical improvement confirmed using GCS and NIHSS scales. Clinical improvements did not reflect in eithrt CT, MNR or SPECT examinations. This initial experience opens the perspective for G-CSF studies in brain ischemia.

Plasma concentrations of D-Dimer predict mortality?

utilizandocitometria de fluxo quantitativa, demonstraram menor quan-tidade de moleculas de TdT e CD19 e maior quantidade demoleculas de CD10 em blastos leucemicos comparados comas celulas linfoides B precursoras.Nos ultimos anos, o desenvolvimento da metodologiade imunofenotipagem por citometria de fluxo multiparametricatornou possivel utilizar tres a quatro cores simultaneamente.O conhecimento adquirido das expressoes antigenicas naontogenese da linhagem linfocitaria B tem auxiliado na dis-tincao entre as celulas linfoides B precursoras e os linfo-blastos residuais leucemicos, como pode ser lido nos artigospublicados por Wells DA,