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Assuntos

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OBJECTIVE: To compare the clinical course; laboratory and radiological features of women and men with ankylosing spondylitis (AS). METHODS: Retrospective review of charts of 41 women and 41 men with AS (25 B27+ and 16 B27- in each group) individually matched for age at onset and disease duration. RESULTS: No differences were observed in the clinical picture in either sex, but the disease was less severe in women than in men with lesser duration of uveitis attacks, lower leukocyte counts (p < 0.05), lower levels of gamma-globulins (p < 0.05), and longer asymptomatic periods. At the end of the study, women had less restriction of spinal extension (p = NS), less sequelae of uveitis without significant visual loss (p = NS), required fewer hip replacements, had less frequency of bamboo spine (p < 0.02), and better functional class (p < 0.0027) than men. CONCLUSION: There are no significant clinical or radiographic differences between women and men with AS. However, the disease was more severe in men and these features may be due to sexual dimorphism.

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BACKGROUND: Secondary involvement of the mitral-aortic intervalvular fibrosa and the anterior mitral leaflet (subaortic structures) can occur in patients with aortic valve endocarditis. The secondary involvement of these structures occurs as a result of direct extension of the infection from the aortic valve or as a result of an infected aortic regurgitant jet striking the ventricular surfaces of the mitral-aortic intervalvular fibrosa and the anterior mitral leaflet. The abscess of mitral-aortic intervalvular fibrosa can expand to form an aneurysm. Subsequently, this mitral-aortic intervalvular fibrosa aneurysm can develop a perforation and communicate with the left atrium, resulting in the systolic regurgitation of blood from the left ventricular outflow tract into the left atrium. Secondary infection can also occur on the ventricular surface of the anterior mitral leaflet and result in the formation of an aneurysm or perforation of anterior mitral leaflet. METHODS AND RESULTS: This study examines the utility of transesophageal echocardiography in the detection of these subaortic complications in 55 consecutive patients with aortic valve endocarditis. A total of 24 patients (44%) had involvement of subaortic structures, including four with an abscess in the mitral-aortic intervalvular fibrosa, four with mitral-aortic intervalvular fibrosa aneurysm, seven with perforation of the mitral-aortic intervalvular fibrosa with communication into the left atrium, two with an aneurysm of the anterior mitral leaflet, and seven with perforation of the anterior mitral leaflet. The transesophageal echocardiographic findings were confirmed at surgery in 20 patients and at necropsy in two. By comparison, transthoracic echocardiography visualized these lesions in five of 24 patients (21%), including none of four with mitral-aortic intervalvular fibrosa abscesses, two of four with mitral-aortic intervalvular fibrosa aneurysms, one of seven with mitral-aortic intervalvular fibrosa perforations, one of two with anterior mitral leaflet aneurysms, and one of seven anterior mitral leaflet perforations. Eccentric mitral regurgitation-type systolic jets were noted in eight additional patients by transthoracic color flow imaging, and this finding suggested the possibility of these unusual subaortic complications. If these patients are included, then transthoracic echocardiography suggested the presence of these subaortic complications in 13 of 24 patients (54%). CONCLUSIONS: The results indicate that 1) involvement of the subaortic structures in patients with aortic valve endocarditis may be more common than previously recognized, 2) patients with aortic valve endocarditis and eccentric jets of mitral regurgitation on transthoracic echocardiography should undergo further evaluation by transesophageal echocardiography to exclude these unusual complications, 3) precise recognition of these complications is of value in the optimal medical and surgical management of these patients, and 4) these complications may be responsible for unexplained congestive heart failure and hemodynamic deterioration in some patients with aortic valve endocarditis.

Assuntos

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Testicular function was studied in 22 patients with ankylosing spondylitis (AS) with serum measurements of hormone levels, seminal fluid analysis and testicular reserve test. Results were correlated with disease activity. The abnormal findings were elevated luteinizing hormone (LH), inversion of estradiol/testosterone ratio (E2:T) and diminished testicular reserve for testosterone (T) and slightly increased for estradiol (E2). Nine patients with severe active AS received biweekly 2,500 IU of human chorionic gonadotrophin injections with a resulting increase in E2 serum levels. When the values of E2 reached 40 pg/ml or higher, there was a decrease of the sedimentation rate (p less than 0.05) and a reversal to normal of the E2:T ratio. This was accompanied by an improvement in AS at the 10th week that lasted up to 9 weeks after discontinuation of treatment. Our findings suggest a possible role of sex hormones in the physiopathogenesis of AS and offers a possible therapeutic alternative.

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Assuntos

Assuntos

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Serum glucose, serum immunoreactive insulin and sedimentation rate (ESR) were measured in eighteen male patients with ankylosing spondylitis (AS) and seven male healthy controls. The findings were correlated with the presence or absence of inflammatory activity of the disease. Fourteen patients had active AS with ESR of 47.0 +/- 27.7 mm; they had increased insulin levels measured as area under curve (AUC) of a glucose tolerance test 107.4 +/- 44.1 cm2 vs controls 40.8 +/- 12.6 cm2 (p less than 0.03). In 4 patients with clinically inactive AS and with ESR of 17.0 +/- 4.0 mm the insulin levels as the AUC were 83.2 +/- 38.0 cm2 vs controls (p = ns). In the whole group there was a direct correlation between ESR and serum immunoreactive insulin levels (r = 0.47 p less than 0.05). Our study suggests that AS may be associated with hyperinsulinism, whose role in the physiopathogenesis of the disease remains unknown.

Assuntos

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Doppler echocardiography was performed in 21 patients with hypertrophic cardiomyopathy (HC), in nine patients with no evidence of left ventricular (LV) hypertrophy by two-dimensional echocardiography, and in five patients with systemic hypertension and concentric LV hypertrophy. The LV outflow tract (LVOT) peak velocity was recorded by continuous wave Doppler technique at rest and after amyl nitrite inhalation. The LVOT pressure gradient was calculated by the modified Bernoulli equation. A significant increase in heart rate and a drop in systolic blood pressure were observed in all patients after amyl nitrite inhalation; no adverse effects were encountered. The peak LVOT velocity and pressure gradient increased significantly after provocation in all patients, but the increase was much more pronounced in patients with HC (peak LVOT velocity increased from 2.2 +/- 0.8 to 4.3 +/- 1.0 m/sec and peak gradient increased from 22 +/- 17 to 78 +/- 36 mm Hg). The Doppler spectral signal in patients with HC demonstrated a characteristic contour, with peak velocity occurring in late systole. However, the observed increase in LVOT peak velocity was not statistically different between treated (with beta-blockers and calcium blockers) and untreated patients with HC. We conclude that LVOT peak velocity and pressure gradients in patients with HC can be readily assessed by Doppler echocardiography both at rest and after amyl nitrite inhalation. The dynamic changes in LVOT velocity induced by this provocation have certain characteristic features in obstructive HC but appear to be independent of the medical regimen used, at least in the dosages tested in our study.

Assuntos

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We studied one hundred consecutive patients with rheumatoid arthritis from the cardiological point of view through non invasive methods to detect the frequency of cardiovascular complications. Seventy three (73%) were females and twenty seven (27%) males. Mean age, 48.6 years. Mean age of presentation of the disease, 34.2 years. Mean age of duration of the illness, 21.8 years. Fifty seven per cent had some type of cardiopulmonary complication. Clinically 52 per cent referred some type of cardiopulmonary symptoms. The physical examination was abnormal in 27 per cent. Rheumatoid factor (Waaler-Rose) was positive in 82 per cent. The cardiac X ray series was abnormal in 33 per cent, the resting electrocardiogram in 48 per cent and the M mode echocardiogram in 52 per cent of the cases. The complications detected were: pericardial effusion (21%); pleural effusion (9%); pulmonary fibrosis (6%) which represents a higher incidence of previously reported in the literature; congestive heart failure (10%); valvular lesion (9%) among those are included six patients with valvular heart disease of non detectable etiology; ischemic heart disease (8%); myocarditis (6%); rythm disturbances (22%) and conduction defects (20%) including a 46 year old female patient who developed a complete AV block during an exacerbation of her illness, requiring the insertion of definitive pacemaker. Our results showed that some of the detected lesions are in part more frequent and severe than those reported in the literature, probably due to, that on one hand their search was intentional and on the other, our group was constituted by with severe and long standing rheumatoid arthritis.

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