Suaide Silva

Effect of specific immunotherapy in eosinophil cationic protein release after specific nasal provocation

Abstract Specific immunotherapy (SIT) is effective in the treatment of allergic rhinitis but its mechanisms of action are still not completely understood, particularly in regard to eosinophil activation mechanisms. The purpose of this research was to study if the inhibition of eosinophil activation, demonstrated through the reduction of eosinophil cationic protein [ECP] release, is involved in the therapeutic actions of specific immunotherapy. We analyzed ECP concentrations in nasal lavage fluid of 21 patients with allergic rhinitis, before and after specific nasal provocation. These results were compared to controls, treated without specific immunotherapy. ECP concentrations in nasal lavage fluid were significantly reduced after two years of specific injectable immunotherapy. These reductions were demonstrated both in pre-provocation [basal] values and after specific nasal provocation. Specific immunotherapy can reduce ECP in nasal lavage fluid of in house dust mite allergic rhinitis patients, both before and after allergen nasal challenge, with significant changes in the kinetic of ECP release, a fact which suggests that specific immunotherapy can influence eosinophil activation or its releasability.

Pharmacological Stress Echocardiography in Patients with Anomalous Origin of Left Coronary Artery in Pulmonary Trunk

Pharmacological Stress Echocardiography in Patients with Anomalous Origin of Left Coronary Artery in Pulmonary Trunk Denise Bibiana Masselli1, Manuel Adan Gil1, Claudia Gianini Monaco1, Roberta Longo Machado1, Alfredo Jose Borges da Cunha1, Carlos Eduardo Suaide Silva1,2, Roberto Augusto Vasques Junior1, Felipe Silva Yared1, Guilherme Silva Yared1, Thaiene Martins Miranda2 OMNI-CCNI Medicina Diagnostica de Sao Paulo1; Diagnosticos da America de Sao Paulo (DASA)2, Sao Paulo, SP Brazil

Restrictive Cor Triatriatum in Asymptomatic Adult Patient

Cor Triatriatum (CT), inicialmente descrito em 1868, e uma malformacao congenita resultante da falha na reabsorcao da veia pulmonar comum durante a formacao embrionaria do coracao. Esse erro genetico representa 0,1% das cardiopatias congenitas, com incidencia de obito infantil em 75% das criancas sintomaticas nao tratadas. Na forma classica, caracteriza-se pela presenca de uma membrana fibromuscular no atrio esquerdo, dividindo essa estrutura em duas câmaras: uma proximal, dita acessoria, que recebe as veias pulmonares, e uma distal, correspondendo o verdadeiro atrio esquerdo, onde se encontra o orificio do apendice atrial e a valva mitral1-5. A gravidade e a idade com que manifestam os sintomas da doenca sao determinadas, essencialmente, pelo numero e tamanho das fenestracoes. Doentes com fenestracoes de diâmetro superior a 1 cm sao habitualmente assintomaticos6,7. Os doentes com fenestracoes pequenas desenvolvem, geralmente, sintomas decorrentes da hipertensao pulmonar (dispneia de esforco, ortopneia, hemoptise etc.) com fisiologia semelhante a da estenose valvar mitral. O cor triatriatum esta, frequentemente, associado a outras anomalias congenitas como comunicacao interatrial, persistencia de veia cava superior esquerda, anomalias do retorno venoso pulmonar, comunicacao interventricular ou mesmo cardiopatias mais complexas como tetralogia de Fallot8.