Biomedical subjects
Publications and source records attributed to J Agosti.
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We report the case of a male newborn infant with aneurysm of atrial appendage, ascending aorta and sinus of Valsalva associated to ventricular septal defect, fibromuscular subaortic stenosis and single coronary artery. The diagnosis was carried out by means of two-dimensional echocardiography and angiocardiography. This complex cardiac malformation has not been reported before.
The capacity of the tumor necrosis factors, TNF-alpha and TNF-beta, products of activated macrophages and lymphocytes, respectively, to stimulate interleukin 1 (IL-1) release from endothelial cells derived from human umbilical veins was examined in vitro. Recombinant TNF-alpha caused IL-1 release by 4 hr with maximal levels of 17 U/ml by 24 hr; half-maximal stimulation occurred at approximately 80 pM. In contrast, recombinant TNF-beta was a relatively poor stimulus for IL-1 release. Even at concentrations as high as 600 pM, only 3 U of IL-1/ml were recovered; maximal IL-1 release (10 to 12 U/ml) required up to 5 nM TNF-beta. Natural, glycosated human TNF-beta was comparable in activity to recombinant TNF-beta. TNF-beta did not directly inhibit the IL-1 comitogenesis assay, nor was there evidence that TNF-beta induced the release of an IL-1 inhibitor, in that supernatants generated in the presence of TNF-beta did not inhibit thymocyte proliferation to a recombinant IL-1 standard. Binding of the recombinant TNF to endothelial monolayers was assessed by using [125I]TNF-alpha in competition studies with cold TNF-alpha and TNF-beta. Binding of TNF-alpha was half-maximal at 80 pM with an average of 664 receptors/cell and Kd = 0.043 nM. Although TNF-beta was capable of fully competing for [125I]TNF-alpha binding, half-maximal binding occurred at 800 pM TNF-beta. These data suggest that the TNF receptors on human endothelial cells may reflect the structural differences between these two homologous cytokines.
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Escherichia coli serotype O157:H7 is a rarely identified organism that has recently been associated with hemorrhagic colitis in all age groups and with the hemolytic uremic syndrome (HUS) in children. We now report the development of HUS in two young women following enteric infection with E coli O157:H7. Both patients were hospitalized because of the severity of their colitis. They later developed major hemolysis requiring transfusion and significant renal failure requiring, in one case, hemodialysis. One patient underwent laparotomy, where sterile ascites, marked right colonic edema, and intraserosal hemorrhage were noted. Both women survived and are currently improving. Fecal E coli serotype O157:H7 was sought only after routine cultures were negative and features of HUS were recognized. The search for the E coli was facilitated by the continued availability of stool cultures obtained early in the course of the illness. The source of infection was not ascertained, but ingestion of untreated water was a feature of both cases. The HUS is a potential complication of the hemorrhagic colitis associated with E coli serotype O157:H7 and may develop in adults as well as children following enteric infection with this organism.
The valvular lesions caused by rheumatoid arthritis have been known for a long time. The valves may be affected by unspecific inflammatory changes or, specifically, by rheumatoid granulomas identical with subcutaneous nodules that lead to the malfunctioning of the aortic or the mitral valve. We present a patient affected by a classical seropositive rheumatoid arthritis accompanied by a severe aortic insufficiency and a prolapse of the mitral valve with rheumatoid involvement of the histologic granulomatous type, in whom both valves were replaced in two phases. The hemodynamic results were good for a period of time. Replacement of the valve by a prosthesis is the ideal treatment. There is no experience with treatment such a medication with immunosuppressive drugs.
We present 32 cases of dysfunction of the Björk-Shiley valvular prosthesis, representing 3.01% of the 1,063 BS prostheses implanted at this clinic. The complications observed were thrombosis of the prosthesis, suture dehiscence with or without endocarditis and disc-suture interference. In selected, favourable cases, we prefer thrombectomy with generous washing of the prosthesis and rotation of the disc, without removal of the disc from the prosthesis. Furthermore, when the dehiscence does not exceed 1/3 of the circumference of the ring, we have achieved very good results with single sutures supported on Teflon patches. Subsequent failures of this procedure were not of a technique nature, but rather due to the poor condition of the patients. In situations of clinical emergency, the diagnosis of valvular dysfunction may suffice as indication of surgery, further diagnostic measures being postponed in view of the data of the physical exploration.
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Contrapulsation by means of an intra-aortic balloon is an effective and well-known therapeutic measure in the postoperative period after cardiac surgery, mainly when interrupting cardiopulmonary bypass in left ventricular failure situation (3, 4). We present the case of a patient who developed paraplegia 38 hours after surgery, which was attributed to contrapulsation.
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The clinical course of 100 internal arteriovenous fistulas in patients observed over a period of more than 6 months was analyzed. Ninety-six were practiced in the upper extremities as side-to-side anastomoses in the forearm between the radial artery and the nearest vein; three were constructed in the lower limbs as anastomoses between the femoral artery and the internal saphenous vein; and one was an autograft of the saphenous vein in the forearm. The most important complications observed were thrombosis (arising chiefly from scant venous development, surgical procedures, and episodes of arterial hypotension), distal ischemia, distal venous flow, infection of the fistula, and insufficient flow. A blood flow over 350 ml/min was achieved in all except two patients. The actuarial survival of individuals with arteriovenous fistulas is high at the present time, with 86 percent of the fistulas functioning after 3 years. The longest period of satisfactory arteriovenous fistula function is 8 years and 3 months.
Successful treatment of an eight-year-old esophagopleural fistula by means of endoscopic cauterization with an alkaline solution is reported. Previous therapeutic attempts with other more conventional measures had failed. The technique of the successful treatment is described. No complications could be attributed to its use.
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