Apolipoproteins AI, B, and E polymorphisms in severe aortic valve stenosis.

Hypercholesterolemia has been related to aortic valve stenosis (AS). Polymorphisms of apolipoproteins (apo) AI, B, and E are associated with variable levels of plasma lipids, but the association between these polymorphisms and AS is unknown. In a case-control study of groups matched by age, sex, comparable body mass index, hypertension, triglycerides, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol, we analyzed the distribution of apo AI A/G mutation, apo B signal peptide insertion/deletion, apo B XbaI restriction fragment length.

tBID Homooligomerizes in the mitochondrial membrane to induce apoptosis.

Activation of the tumor necrosis factor R1/Fas receptor results in the cleavage of cytosolic BID to truncated tBID. tBID translocates to the mitochondria to induce the oligomerization of BAX or BAK, resulting in the release of cytochrome c (Cyt c). Here we demonstrate that in tumor necrosis factor alpha-activated FL5.

Different familial transmission patterns in bipolar I disorder with onset before and after age 25.

Gene identification in common disorders such as Alzheimer disease and breast cancer has greatly profited from the use of age of onset as criterion to delineate subgroups of disease characterized by different inheritance patterns. In bipolar affective disorder, where the majority of linkage studies have produced conflicting results, studies reporting clinical characteristics and familial occurrence of disease have suggested that age of onset might serve as an indicator for identifying more homogeneous subgroups of disease. Our study was the first to examine this hypothesis by the means of segregation analysis.

SPECT dipyridamole scintigraphy for detecting coronary artery disease in patients with isolated severe aortic stenosis.

Background: The sensitivity and specificity of non-invasive methods--specifically single-photon emission computed tomography (SPECT) dipyridamole-thallium myocardial perfusion--for detecting coronary artery disease (CAD) in patients with severe aortic stenosis remains unclear. Occasionally, these patients present with atypical angina. Therefore, a CAD diagnosis must be excluded to prevent unnecessary cardiac catheterization.

Arterial distensibility as a possible compensatory mechanism in chronic aortic insufficiency.

Objective: To evaluate elastic properties of conduit arteries in asymptomatic patients who have severe chronic aortic regurgitation.

Methods: Twelve healthy volunteers aged 30+/-1 years (control group) and 14 asymptomatic patients with severe aortic regurgitation aged 29+/-2 years and left ventricular ejection fraction of 0.61+/-0.

Mini-sternotomy for the treatment of aortic valve lesions.

Objective: To compare inverted-L mini-sternotomy performed above the sternal furcula with conventional sternotomy in patients with aortic valve diseases who undergo surgical treatment.

Methods: We operated upon 30 patients who had aortic valve lesions that had clinical and hemodynamic findings. All patients underwent inverted-L sternotomy, which extended from above the manubrium of the sternum to the 3rd right intercostal space, without opening the pleural cavity.

Fisics-Incor bovine pericardial bioprostheses: 15 year results.

Background: From March 1982 to December 1995, 2,607 Fisics-Incor bovine pericardial bioprostheses were implanted in 2,259 patients. Mean age was 47.2 +/- 17.

Mitral valve repair in rheumatic patients.

Background: There is controversy regarding the role of reparative techniques for rheumatic-mitral valve disease. We have analyzed the late results of mitral valve repair in a group of patients with rheumatic mitral valve insufficiency.

Methods: From March 1980 to December 1997, 201 patients with rheumatic fever underwent mitral valve repair at the Heart Institute, Hospital das Clínicas, Medical School, University of São Paulo.

Mitral valve repair. Quadrangular resection of the posterior leaflet in patients with myxomatous degeneration.

OBJECTIVE - To analyze the immediate and late results of mitral valve repair with quadrangular resection of the posterior leaflet without the use of a prosthetic ring annuloplasty. METHODS - Using this technique, 118 patients with mitral valve prolapse who underwent mitral repair from January '84 through December '96 were studied. Age ranged from 30 to 86 (mean = 59.

Mitral valve repair. Quadrangular resection of the posterior leaflet in patients with myxomatous degeneration.

Objective: To analyze the immediate and late results of mitral valve repair with quadrangular resection of the posterior leaflet without the use of a prosthetic ring annuloplasty.

Methods: Using this technique, 118 patients with mitral valve prolapse who underwent mitral repair from January '84 through December '96 were studied. Age ranged from 30 to 86 (mean = 59.

Relapses, recurrences, valve replacements, and mortality during the long-term follow-up after infective endocarditis.

Background: Late prognosis after infective endocarditis has not been systematically studied in large series of patients with different underlying heart conditions in recent years.

Methods: We studied an inception cohort study of 420 patients discharged after treatment of endocarditis from a university tertiary care hospital. The patients were aged 34.

Significance of the human immunodeficiency virus infection in patients submitted to cardiac surgery.

Background: To realize if cardiac surgery could interfere with the evolution of HIV infected patients to the acquired immunodeficiency syndrome (AIDS).

Methods: The study group consisted of 30 HIV positive patients (0.21%) among 14,785 who underwent cardiac surgery at the Heart Institute of University of Sao Paulo Medical School (Incor-FMUSP) from November 1988 to December 1994.

Symptoms, left ventricular function, and timing of valve replacement surgery in patients with aortic regurgitation.

Background: Because cardiac decompensation is subtle, the best time to perform aortic valve replacement surgery may be difficult to determine. We investigated the relation of symptoms to left ventricular (LV) function and the timing of valve replacement in patients with aortic regurgitation (AR) of largely rheumatic origin.

Methods: Sixty-eight initially asymptomatic patients (mean age 29 years) with severe chronic AR were monitored for 36 months.

Extraintestinal non-Hodgkin's lymphoma presenting as obstructive jaundice in a patient with Crohn's disease.

We report the case of a 58-yr-old woman, previously diagnosed with Crohn's disease of the duodenum, who presented with jaundice and an epigastric mass. Diagnostic studies revealed an extraintestinal non-Hodgkin's lymphoma located near the head of the pancreas and causing obstructive jaundice. A review of the literature indicates the rarity of this association.

[Comparison between percutaneous balloon valvuloplasty and open commissurotomy for mitral stenosis].

Purpose: To compare immediate and late (12 months) follow-up of clinical and Doppler echocardiographic results between percutaneous mitral balloon valvuloplasty and open commissurotomy in a prospective and randomized trial.

Methods: Eighty eight symptomatic patients with severe mitral stenosis and favorable anatomy were randomized in a prospective trial comparing the two procedures. All patients were submitted to clinical and Doppler echocardiographic evaluation before the procedures and immediate and twelve months thereafter.

[Heart valve surgery during pregnancy. Experience with eight cases].

Purpose: To analyze the results of the valve cardiac surgery in pregnant women and cardiopulmonary bypass consequences to the patients and their fetuses.

Methods: Study of 8 pregnant women who underwent cardiac surgery between January of 1986 and December of 1996. Patients' average age was 31.

Who needs evidence-based health care?

The vast amount of published material in clinical and biomedical sciences, and conflicting results on diagnostic and therapeutic procedures may introduce doubts in decision-making for patient care. Information retrieving skills and the critical appraisal of published literature, together with elaboration of practice guidelines based on epidemiological methodology, form the basis of the trend towards evidence-based health care, which aims to overcome these problems. A survey conducted by questionnaire at the Chaim Sheba Medical Center analyzed which types of information sources are considered most relevant and useful for patient care by a cross-section of physicians with varying degrees of experience.

Cyclic neutropenia in Crohn's ileocolitis: efficacy of granulocyte colony-stimulating factor.

A 40-year-old patient with long-standing Crohn's ileocolitis in remission experienced cyclic neutropenia with a periodicity of 14 days. He was not receiving immunosuppressive or myelosuppressive therapy. The patient had Staphylococcus aureus bacteremia resulting from central catheter infection, which was refractory to antibiotic therapy during the period of severe neutropenia.