Endomyocardial fibrosis associated with massive calcification of the left ventricle

This is the report of a rare case of endomyocardial fibrosis associated with massive calcification of the left ventricle in a male patient with dyspnea on great exertion, which began 5 years earlier and rapidly evolved. Due to lack of information and the absence of clinical signs that could characterize impairment of other organs, the case was initially managed as a disease with a pulmonary origin. With the evolution of the disease and in the presence of radiological images of heterogeneous opacification in the projection of the left ventricle, the diagnostic hypothesis of endomyocardial disease was established. This hypothesis was later confirmed on chest computed tomography. The patient died on the 16th day of the hospital stay, probably because of lack of myocardial reserve, with clinical findings of refractory heart failure, possibly aggravated by pulmonary infection. This shows that a rare disease such as endomyocardial fibrosis associated with massive calcification of the left ventricle may be suspected on a simple chest X-ray and confirmed by computed tomography.

End-systolic pressure-diameter relation of the left ventricle during transient and sustained elevations of blood pressure

OBJECTIVE: To assess the effect of transient and sustained variations in cardiac load on the values of the end-systolic pressure-diameter relation (ESPDR) of the left ventricle. METHODS: We studied 13 dogs under general anesthesia and autonomic blockade. Variations of cardiac loads were done by elevation of blood pressure by mechanical constriction of the aorta. Two protocols were used in each animal: gradual peaking and decreasing pressure variation, the "transient arterial hypertension protocol" (TAH), and a quick and 10 min sustained elevation, the "sustained arterial hypertension protocol"(SAH). Then, we compared the ESDR in these two situations. RESULTS: Acute elevation of arterial pressure, being it "transitory" or "sustained", did not alter the heart frequency and increased similarly the preload and after load. However, they acted differently in end systolic pressure-diameter relation. It was greater in the SAH than TAH protocol, 21.0±7.3mmHg/mm vs. 9.2±1.2mmHg/mm (p<0.05). CONCLUSION: The left ventricular ESPDR values determined during sustained pressure elevations were higher than those found during transient pressure elevations. The time-dependent activation of myocardial contractility associated with the Frank-Starling mechanism is the major factor in inotropic stimulation during sustained elevations of blood pressure, determining an increase in the ESPDR values.

Arrhythmogenic cardiomyopathy of the right ventricle. Predictive value of QT interval dispersion to assess arrhythmogenic risk and sudden death

OBJECTIVE: To determine in arrhythmogenic right ventricular cardiomyopathy the value of QT interval dispersion for identifying the induction of sustained ventricular tachycardia in the electrophysiological study or the risk of sudden cardiac death. METHODS: We assessed QT interval dispersion in the 12-lead electrocardiogram of 26 patients with arrhythmogenic right ventricular cardiomyopathy. We analyzed its association with sustained ventricular tachycardia and sudden cardiac death, and in 16 controls similar in age and sex. RESULTS: (mean ± SD). QT interval dispersion: patients = 53.8±14.1ms; control group = 35.0±10.6ms, p=0.001. Patients with induction of ventricular tachycardia: 52.5±13.8ms; without induction of ventricular tachycardia: 57.5±12.8ms, p=0.420. In a mean follow-up period of 41±11 months, five sudden cardiac deaths occurred. QT interval dispersion in this group was 62.0±17.8, and in the others it was 51.9±12.8ms, p=0.852. Using a cutoff > or = 60ms to define an increase in the degree of the QT interval dispersion, we were able to identify patients at risk of sudden cardiac death with a sensitivity of 60%, a specificity of 57%, and positive and negative predictive values of 25% and 85%, respectively. CONCLUSION: Patients with arrhythmogenic right ventricular cardiomyopathy have a significant increase in the degree of QT interval dispersion when compared with the healthy population. However it, did not identify patients with induction of ventricular tachycardia in the electrophysiological study, showing a very low predictive value for defining the risk of sudden cardiac death in the population studied.

Synthesis and biological evaluation of mono and bis-naphthalimide derivatives against SH-SY5Y, human brain cancer cells

Dissertação de mestrado em Medicinal Chemistry

Short-term follow-up of patients after aneurysmectomy of the left ventricle

OBJECTIVE: Left ventricular aneurysm is a complication of myocardial infarction that can best be treated by reconstructive surgeries that can restore ventricular geometry. We analyzed immediate results in a group of consecutive patients who underwent surgical correction of left ventricular aneurysms. METHODS: From January '90 to August '99, 94 patients - mean age 58.4 (ranging from 36 to 73 years), 65 (69.1%) males and 9 ( 30.8%) females - were operated upon. Pre-operative ejection fraction ranged from 0.22 to 0.58 (mean = 0.52), and the aneurysm was located in the antero-lateral area in 90.4% of the cases. Functional class III and IV (NYHA) was present in 82 (87.2%) patients, and 12 (12.7%) were in functional class I and II. Congestive heart failure was the most frequent cause (77.6%), occurring in isolation in 24.4% or associated with coronary artery diseases in 53.2%. RESULTS: Short-term follow-up showed a 7.4% mortality, and low cardiac output was the main cause of death. Coming off pump was uneventful in 73 patients (77.6%), with a 3.2% mortality and with the use of inotropics in 20 (21.3%). One patient (1%) did not come off the pump. CONCLUSION: Surgical correction was adequate in the immediate follow-up of operated patients, and mortality was higher in patients with higher functional class.

Double-outlet left ventricle. Echocardiographic diagnosis

This is a case report of a double-outlet left ventricle associated with tricuspid atresia and hypoplasia of the right ventricle, diagnosed during echocardiography with color-flow imaging, in a three-month-old child who presented with fatigue and cyanosis. The child underwent palliative pulmonary arterial banding without an invasive procedure, and showed sustained improvement during follow-up.

Mitral Valve Replacement and Remodeling of the Left Ventricle in Dilated Cardiomyopathy with Mitral Regurgitation: Initial Results

OBJECTIVE: This study evaluated the effects of a new method of mitral valve replacement on left ventricular (LV) remodeling and heart failure functional class. METHODS: Eight patients (6 men) with severe mitral regurgitation from end-stage dilated cardiomyopathy underwent surgery. Five patients were in functional class (FC) IV, 2 were in FC III and 1 was in FC III/IV. Age ranged from 33 to 63 years. Both the anterior and posterior leaflets of the mitral valve were divided into hemileaflets. The resultant 4 pedicles were displaced under traction toward the left atrium and anchored between the mitral annulus and an implanted valvular prosthesis. The beating heart facilitated ideal chordae tendineae positioning. RESULTS: All patients survived and were discharged from the hospital. After a mean follow-up period of 6.5 months (1-12 m), 5 patients were in FC I; 2 in FC I/II; and 1 in FC II. The preoperative ejection fraction ranged from 19% to 30% (mean: 25.7±3.4 %), and the postoperative ejection fraction ranged from 21% to 40% (mean: 31.1± 5.8%). Doppler echocardiography showed evidence of LV remodeling in 4 patients, including lateral wall changes and a tendency of the LV cavity to return to its elliptical shape. CONCLUSION: This technique of mitral valve replacement, involving new positioning of the chordae tendineae, allowed LV remodeling and improvement in FC during this brief follow-up period.

Treatment of delayed rupture of the left ventricle after mitral valve replacement

Rupture of the left ventricle following mitral valve replacement is a catastrophic complication with deadly consequences. We report here the case of a 75-year-old man who underwent elective mitral valve replacement for severe mitral regurgitation. Delayed type 1 rupture of the left ventricle developed 3 hours postoperatively in the intensive care unit. A salvaging maneuver was used, which gained time, allowing reoperation and successful intraventricular repair.

Acciones tróficas de GABA: implicancias en la diferenciación sexual del cerebro. Trophic actions of GABA: Implications for sexual differentiation of the brain.

En el hipotálamo en desarrollo, el ácido gamma-amino butírico (GABA) produce depolarización neuronal, pudiendo incluso disparar potenciales de acción y causar la apertura de canales de calcio dependientes de voltaje. Esto se debe a que la concentración intracelular de Cl- es alta respecto al medio extracelular, por lo que en reposo el potencial de equilibrio de GABA es más positivo que el potencial de membrana. A medida que el desarrollo transcurre, la concentración intracelular de Cl- disminuye y se produce un cambio en la respuesta de depolarizante (etapa excitatoria) a hiperpolarizante (etapa inhibitoria). Se ha demostrado que este cambio ocurre también en neuronas hipotalámicas in vitro. El dimorfismo sexual del cerebro de los vertebrados es consecuencia de la acción del estrógeno aromatizado a partir de andrógenos segregados por el testículo durante el "periodo crítico" del desarrollo cerebral. Evidencias previas de nuestro y otros laboratorios pusieron de manifiesto diferencias en el crecimiento y diferenciación de neuronas que no podían atribuirse a la acción hormonal, ya que ocurren antes que se inicie el brusco aumento de la secreción gonadal, alrededor del día 18 de desarrollo embrionario en la rata (E18). Además de las diferencias morfológicas, encontramos diferencias sexuales en la forma que las neuronas hipotalámicas responden a muscimol, un agonista específico del receptor GABAA. A los 9 días in vitro (9 DIV) la respuesta a muscimol fue hiperpolarizante (etapa inhibitoria) y además fue de mayor amplitud, área y duración en machos respecto a hembras. Esto nos indica que las neuronas provenientes de embriones machos son intrínsecamente diferentes a las de embriones hembra aún antes de la acción organizadora de los esteroides sexuales. En base a estas evidencias nos propusimos continuar nuestros estudios sobre la participación de GABA en la determinación de diferencias sexuales en el cerebro antes de la acción organizadora de los esteroides gonadales. Para ello, en cultivos de neuronas hipotalámicas de E16 separados por sexos, estudiaremos:- la respuesta a muscimol de las neuronas, en la etapa excitatoria (2 DIV) de la acción de GABA.- las composición de subunidades de los receptores GABAA en la etapa excitatoria/inhibitoria de la acción de GABA.- la participación de los receptores GABAA sobre el crecimiento neurítico.- la activación de la vía de las MAP quinasas por muscimol.- la participación de los receptores GABAA sobre el crecimiento axonal inducido por estradiol in vitro.Toda la metodología propuesta es de uso habitual en nuestro laboratorio e involucra herramientas de la electrofisiología y la biología celular-molecular; como patch-clamp, cultivo de neuronas hipotalámicas, Western blot, RT-PCR, entre otras. Esperamos encontrar diferencias sexuales en la amplitud, área y duración de la respuesta de las neuronas hipotalámicas al muscimol a los 2 DIV, y que éstas se deban a una diferente composición de subunidades del receptor GABAA. En cuanto a la participación del receptor GABAA en la neuritogenesis, esperamos encontrar mayor longitud neurítica en neuronas macho como así también una activación sexualmente dimórfica de la vía de las MAP quinasas. Además esperamosque la acción de un antagonista del receptor GABAA interfiera con la axogénesis inducida por estradiol in vitro, característica que muestra diferencia sexual también a favor de los machos, lo que reforzaría nuestra hipótesis. La importancia y originalidad de este proyecto reside en la evaluación de la participación del sistema GABAérgico en la determinación de características que durante el desarrollo, podrían estar involucradas en la determinación de diferencias sexuales permanentes en el cerebro adulto independientemente de la acción de los esteroides sexuales. Hasta la fecha, no ha sido evaluada la influencia de los receptores GABAA en la diferenciación sexual del cerebro antes de la acción organizadora de los esteroides gonadales.

The Word Brain - A Short Guide to Fast Language Learning

How long does it take to learn another language? How many words do you need to learn? Are languages within the reach of everybody? Which teachers would you choose and which teachers should you avoid? These are some of the questions you ask yourself when you start learning a new language.The Word Brain provides the answers. If you have learned foreign languages in the past, consider reading it. If you or your children need to learn languages in the future, you must read it. What you will discover in two hours will change for ever the way you see languages and language learning. The principles of The Word Brain are timeless. Our children’s grandchildren will follow them when they discover the people of our planet.

Role of mitochondria in ischemia/reperfusion mediated brain injury : mechanisms and pharmacology interventions

Magdeburg, Univ., Fak. für Naturwiss., Diss., 2004

"Differential metabolic recruitment of cognitive, emotional and modulatory brain regions in infant and adolescent rats undergoing two-way active avoidance training"

Magdeburg, Univ., Fak. für Naturwiss., Diss., 2011