RESUMO

Blood pulse wave velocity (PWV) is a known index of arterial rigidity and its measurement has proved its usefulness in the study of some cardiovascular pathologies. In this study we describe the design and implementation of a system for noninvasive PWV determination in the aorto-braqui-humero-radial (A-->h), aorto-ileo-femoro-pedial (A-->f) and aorto-carotid (A-->c) regions. This system was examined with 36 normotensives (NT) and 34 hypertensives (HT) patients with (LVH, n = 20) and without (WLVH, n = 14) left ventricular hypertrofy. The equipment consist of a personal computer with an analog to digital converter and hardware and software items adapted to take simultaneously the electrocardiogram (ECG), two photopletismographic pulses and one oscilometric pulse. The Q-pP interval (time between a Q ECG wave and distal blood pulse) and the distance to the register sites are taken into account to calculate the beginning of cardiac prexpulsive period (time zero of pulse trip) which allow the determination of the PWV (in meters/second) from the aortic root to the distal point of the via. PWV was significant higher (p < 0.001) in HT vs. NT (A-->h: 9.3 +/- 2.6 vs. 7.2 +/- 0.8, A-->c: 9.5 +/- 2.8 vs. 6.0 +/- 1.9 and A-->f: 9.5 +/- 1.8 vs. 7.2 +/- 0.9) in each evaluated arterial region. Same thing occurred in cases with LVH vs. WLVH (A-->h: 10.5 +/- 1.6 vs. 8.0 +/- 1.9, A-->c: 10.2 +/- 1.9 vs. 8.0 +/- 1.9 and A-->f: 10.5 +/- 2.0 vs. 8.6 +/- 1.2) (p < 0.025). This is consistent with the relationship more pressure [symbol: see text] more rigidity and with other reports. This method may have clinical application.

Assuntos

RESUMO

UNLABELLED: There are not published incruent methods of provocation and/or measurement of the velocity of the reflexive arterial pulse wave. This phenomenon is implicated in the pathogenesis of arterial hypertension. We describe that during compressive sphygmomanometry (CS) done in the forearm, reflexive waves are provoked that are register in the arm with an equipment developed by us, which measures the velocity of the antegrade (APWV) and the provoked retrograde (RPWV) pulse waves. The procedure consist in: 1) detection, capture and digitalization by pneumatic cuffs of oscillopulses of the arm and the forearm, 2) detection of finger photopulse to control the efficacy of CS, 3) measurement of APWV and RPWV by taking the conduction time travel distance of pulse wave between detectors arm-forearm and forearm-arm respectively. Thirty normal case (group A, GA) and 37 essential systemic hypertensive patients (group B, GB) were studied. Sixteen cases of GB had left ventricular hypertrophy (LVH). RESULTS: A reflexive wave was provoked in 99% of cases. The APWV (m/s) was 6.0 +/- 0.9 vs 7.5 +/- 1.3, p < 0.001 for GA and GB respectively. The RPWV (m/s) of the same groups were 1.8 +/- 0.3 vs 2.5 +/- 0.7, p < 0.001. The hypertensive cases with LVH had more RPWV than the cases without it (2.7 +/- 0.6 vs 2.3 +/- 0.6, p = 0.07). CONCLUSION: Hypertensive cases vs normals had higher antegrade and retrograde pulse wave velocities possible due to the major degree of arterial rigidity of the former. The method may be used in study of chronic arteriopathy.

Assuntos

Assuntos

Assuntos

RESUMO

The usefulness of different radiologic studies in localizing the tumor was evaluated in 26 patients with a firmly established diagnosis of pheochromocytoma. The site of the lesion was correctly identified in 8% of the cases by the plain abdominal x-ray films: in 11% by the plain thoracic films; in 34% by uronephrotomography; in 88% by angiography and in 6 patients (100%) in whom computed tomography scans (CT) were performed. The tumors were intra-adrenal in 19 patients and extra-adrenal in the remaining 7 cases. Of the latter, two were found in the organ of Zuckerkandl, two were abdominal para-aortic, two others in the para-aortic region of thorax, and one with intra an extra-adrenal tumors. It is concluded that CT scans are quite successful in preoperative localization of pheochromocytoma. The non-invasive nature of the technique makes it the method of choice in the anatomical localization of this type of tumors.

Assuntos

Assuntos

RESUMO

With the purpose of learning the usefulness of radiologic and angiographic procedures for the evaluation of Takayasu's arteritis (TA), we studied 64 patients (ratio women: 8.1, average age: 23.5 years, range: 13-52 years) in which we performed arteriographic studies in the clinically affected area. All cases had chest films: 53 had thoracic aortogram, 60 abdominal aortogram, 16 pulmonary arteriography. According to the topography of the lesions we found 8% of the cases with damage exclusive to the supra-aortic trunk, 6% with isolated alteration of the intermediate thoraco-abdominal aorta, 62% with mixed pathology of the two categories above, and 21% with lesions in the pulmonary artery besides systemic arteriopathy. The results were as follows: 1) radiology of the chest: cardiomegaly (48%), irregularities in the ascending aorta (31%), calcification in the aortic wall (29%), calcified granulomas (25%) and signs of pulmonary venous hypertension (21%); 2) thoracic aortogram: irregularities in the descending aorta (56.6%), thickening of the wall of descending aorta (39.6%), dilatation of the ascending aorta (26.4%), of the descending aorta (26.4%); occlusions: of the left subclavian (24 cases), left mammary (16 cases), left carotid (8 cases) and left vertebral (8 cases); 3) abdominal aortogram: irregularities of the outline, stenosis, prominent "supplementary" arteries and aneurysms in 53%, 43.3%, 38% and 13.3 of the studies performed. The arteries most commonly affected were: renal (74.7%), both (31.6%), right (28.2%) and left (14.9%), superior mesenteric (26.6%) and hepatic (21.6%); 4) pulmonary arteriography: arterial occlusions: right superior lobar branch (37.5%), right medial (6.2%), right inferior (12.5%), without predilection by any lobe; 5) coronary arteriography: one case with occlusion of anterior descending artery and circumflex coronary artery (the other 8 cases without significant lesions). We concluded that TA affects independently the arteries of different areas, hence it is necessary to perform multiple angiographic studies for adequate evaluation of the extension of vascular damage.

Assuntos

RESUMO

Study of cellular immune function in 14 patients with Takayasu's arteritis (TKA) revealed markedly decreased active E rosettes and CD4+ cells and slightly diminished CD8 + and autologous rosette-forming T cells. They were also found to have decreased production of interleukin-2 and decreased response to interleukin-1. Patients with active disease were also found to have decreased response to IL-2. Conversely, patients with inactive disease were found to have a normal response to interleukin-2. Patients with TKA, whether active or inactive, had normal production of interleukin-1, normal concanavalin-A-induced and spontaneously expanded suppression, normal NK cell function and normal enhancement of NK cell function by interleukin 2. The findings indicate that the immunoregulatory disturbance of TKA is different from that occurring in connective tissue disorders.

Assuntos

RESUMO

We studied a case of a patent left ductus arteriosus, with a left aortic arch connected to a right descending aorta without an aortic circumflex (retroesophageal) segment. We believe this is the first world-published example of this--so far--hypothetical anomaly, included in Kirkling and Edwards classification of vascular rings. The case was a 27-year-old deaf-mute female patient with a patent left ductus arteriosus, with important left to right shunt and moderate pulmonary arterial hypertension who underwent a successful closing surgical procedure. In the aortographic study a left (normal) aortic arch was seen, which after giving off a large left ductus arteriosus, crossed to the right and connected to a right descending aorta. In the upper part of the thorax the esophagus and trachea were displaced to the right by the left aortic arch. The esophagus in the middle and the upper inferior parts of the thorax was also displaced to the right by the descending right aortic segment. Complete vascular ring was not evident. The case--although without clinical importance--reinforces the pathogenic concept of the Rathke diagram of a complete double aortic primitive arch originating the pulmonary and supraaortic vascular structures which are formed by the obliteration or disappearance of particular segments of the structure. This knowledge explains the embryogenesis of these complex anomalies. Our case is believed to be formed by the very early disappearance of a frontal portion of the primitive left dorsal aorta.

Assuntos

RESUMO

The cause of an abnormal electrocardiographic P wave (AEPW) in systemic arterial hypertension (SAH) has not been delucidated. In order to demonstrate if this sign is related to volume overload of the left atrial cavity -previously we found no correlation between pressure overload of the cavity and the presence of an AEPW- 34 patients with SAH were studied; population were divided in two groups: group A (GA, n = 13), formed by 13 cases with a P wave more than 0.10 s duration (D2 standard lead) and group B integrated by 21 cases with a P wave at 0.10 s or less duration. In each cases phonocardiographic and echocardiographic (Mode M) studies were performed and the following data were obtained: "A" index (AI), left atrial dimension (LAD) and, septal (SD) and left posterior wall dimension (LPWD); besides: Sokolow electrocardiographic index (SI) and systolic (SBP) and diastolic (DBP) blood pressure. Results are shown in the following table: (Table: see text). There were not statistical differences between groups (data of SBP and DBP not shown). Correlation between LAD and AI and duration of P wave were not statistical different (data not shown). An AEPW in SAH does not seem to be cause by a volume left atrial overload. Possible it is related to an interatrial conduction defect.

Assuntos