topeesp.gif (5672 bytes)

[ Index ]

CHAGAS-PCVC Mailing List

Messages

Go to #: 40
Go to #: 39
Go to #: 38
Go to #: 37
Go to #: 36
Go to #: 35
Go to #: 34
Go to #: 33
Go to #: 32
Go to #: 31
Go to #: 30
Go to #: 29

#29 De:  Goņi Maria Teresa <suteki@ssdnet.com.ar
Enviado: Viernes 18 de Noviembre de 1999 00:09
Asunto: Megavisceras y Chagas/Megaviscera and Chagas
Estimados colegas:
Aprovechando que en el Foro participan distinguidos especialistas de Brasil y de Argentina quisiera hacer las siguientes preguntas:
a) si piensan que la distinta prevalencia de megavisceras en Argentina y Brasil es real o en realidad expresa que en Argentina no se realizan estudios de rutina para descartar el compromiso digestivo.
b) si debieran practicarse de rutina estudios para descartar megas (tan de rutina como se solicita un ECG) y que estudios sugieren.
c) si los megas predominan en los pacientes en fase "indeterminada" o en aquellos que ya tienen compromiso cardiaco.
Los saludo.

Dear colleagues:
Taking advantage of the fact that in the Forum, distinguished specialists from Brazil, and Argentina participate, I would like to ask the following questions:
a) whether you think that different prevalence of megaviscera in Argentina and Brazil is real, or in fact this means that in Argentina routine studies to dismiss digestive involvement are not carried out.
b) Whether studies should be carried out routinely to dismiss megaviscera (as routinely as requesting an ECG), and which studies do you suggest.
c) If megaviscera prevail in patients in "undetermined" stage or in those that already have cardiac involvement.
Greetings,
Dra Maria Teresa Goņi

Top

#30 De: Joao Carlos <jcpdias@cpqrr.fiocruz.br>
Enviado: Lunes 22 de Noviembre de 1999 08:03
Asunto: Re: Megavisceras y Chagas/Re: Megaviscera and Chagas
1) La prevalencia de megas es aun controversa pero hay indudablemente diferencias regionales importantes. Las mas reconocidas son la minima o ausente prevalencia de los megas en en norte de la linea ecuatorial y la significativa predominancia del megacolon sobre el megaesofago en las zonas endemicas de mayor altitud de Bolivia. En Argentina sin duda hay megas chagasicos, asi como esta indudablemente determinada la desnercvacion autonomica del plexo mioenterico intramural y del corazon, por excelentes trabajos. En cuanto a su expresion cuantitativa y proporcional, inegablemente el tema esta aun por ser investigado con la necesaria extension, a traves de encuestas en poblacion general, en doble ciego con la clinica, la serologia y el EKG. Esto valdria la pena hacer tambien en otros paises y en algunas regiones del Brasil. El mas complicado es el megacolon inicial, en donde la clinica es pobre, los sintomas son variables y de restricto valor predictivo en esta fase, y solamente el enema con bario alcanza definir el caso (aqui esta la complicacion para encuestas de terrenos, aun mas con el componente etico de hacerse este examen en persona oligo o asintomatica) .
2) En Brasil, por lo general, 50% de los individuos qui tienen megas tienen tambien una cardiopatia chagasica asociada, especialmente despues de los 30 anos de edad. Al reves, entre los cardiopatas chagasicos, la incidencia de megas esta entre los 10 y 15%. Los megas puros, sin cardiop., estan entre los 5 y 15% de una poblacion chagasica adulta, aumentando con la edad. No existen megas en la formacronica indeterminada, por definicion.
Gran abrazo.

1) Prevalence of megaviscera is still a controversy, but undoubtedly there are important regional differences. The most reckoned ones are the minimal or absent prevalence of megaviscera to the North of equatorial line, and the significant predominance of megacolon over the megaesophagus in the highest endemic areas of Bolivia. In Argentina, positively, there are megaviscera due to Chagas disease, just as undoubtedly, autonomic denervation of the intramural myoenteric plexus and of the heart, is determined by excellent works. Regarding its quantitative and proportional expression, the topic is still undeniably to be researched with the necessary extension, through surveys in the general population, double blind with the clinic, serology and ECG. This would be worthy to be carried out in other countries, and some regions in Brazil. The most complicated is initial megacolon, where clinic is poor, the symptoms are variable and of restricted predictive value in this stage, and only an enema with barium can define the case (here there is a complication to carry out field surveys, even more with the ethic factor of performing this examination in oligo or asymptomatic people).
2) In Brazil, generally, a 50% of people that have megaviscera, also have an associated chagasic heart disease, especially after 30 years of age.  On the contrary, among chagasic patients with heart diseases, incidence of megaviscera is between a 10 and a 15%. Patients with pure megaviscera, and without heart diseases, range between a 5 to a 15% in an adult chagasic population, increasing with age. There are no megaviscera in the undetermined chronic form, by definition.
Hugs,
Joao Carlos Pinto Dias.

Top

#31 De:  Joffre Marcondes de Rezende" <jmrezende@mail.cultura.com.br>
Enviado: Mon, 22 Nov 1999 16:56:28 -0200
Asunto: Megavisceras y Chagas/Megaviscera and Chagas
1.   Sobre as questoes suscitadas pela Dra. Goni, penso que, como preliminar, devemos definir a prevalencia de megavisceras digestivas no Brasil e na Argentina. No Brasil, tomando o esofago como marcador do comprometimento digestivo, em 7 estudos radiologicos realizados em   areas endemicas, do qual participaram 3.073 pacientes chagasicos, 8,8  (ocho coma ocho por cien) apresentavam esofagopatia e, destes, somente 3,0 (tres por cien) tinham dilatacao do esofago (megaesofago). Nao foram feitos estudos semelhantes em relacao ao colon pela maior dificuldade de sua realizacao e de interpretacao dos resultados.   Se considerarmos que a cardiopatia, diagnosticada ao ECG, se encontra em cerca de 30 (trinta por cien) dos pacientes chagasicos das mesmas areas endemicas, vemos que o comprometimento digestivo ocorre em um numero de casos bem inferior ao da cardiopatia. Nao disponho de dados relativos a prevalencia da esofagopatia em areas endemicas da Argentina, para estabelecer uma comparacao.
2.  Penso que pelo menos uma radiografia de esofago deveria ser feita de rotina em todo paciente chagasico. Todavia, a maioria dos pacientes com esofagopatia refere disfagia ao ser feita a anamnese e neste caso a radiografia serve para confirmar o diagnostico.
3.Tanto o megaesofago como o megacolon chagasicos podem ser encontrados em pacientes sem cardiopatia e, neste caso, usamos a denominacao de "forma digestiva" em   lugar de "indeterminada". Quando o paciente apresenta somente cardiopatia dizemos tratar-se de "forma cardiaca" e quando tem ao mesmo tempo cardiopatia e megavíscera chamamos de "forma mista" da enfermedade de Chagas.
Maiores informacoes relativas a forma digestiva em Rezende & Luquetti: "Chagasic megavisceras" In "Chagas disease and the nervous system". Scientific publ. n. 547 - PAHO-WHO, 1994, P.149-171.
Atenciosamente.

1. Regarding the questions asked by Dr. Goni, I think that previously, we should define the prevalence of digestive megaviscera in Brazil and in Argentina. In Brazil, taking the esophagus as marker of digestive involvement, in 7 radiological studies carried out in endemic areas, in which 3,073 chagasic patients participated, 8.8 (eight point eight percent) presented esophagopathy, and from this, only 3.0 (three percent) had esophagus dilatation (megaesophagus). Similar studies were not carried out regarding colon, due to a greater difficulty to do them, or to interpret their results. If we consider that heart disease, diagnosed by ECG, is found in around a 30 (thirty percent), two chagasic patients from the same endemic areas, we see that digestive involvement happens in an amount of cases quite inferior to heart disease. I have not available the relative data on prevalence of esophagopathy in endemic areas of Argentina, to establish a comparison.
2. I think that at least a radiography of esophagus should be carried out routinely in all chagasic patients. Most patients with esophagopathy still mention dysphagia when anamnesis is done, in this case a radiography is useful to confirm diagnosis.
3. Both chagasic megaesophagus, and megacolon can be treated in patients without heart disease, and in this case, we used the label "digestive form" instead of "undetermined". When the patient presents only heart disease, we say we are dealing with "cardiac form", and when there is both heart disease and megaviscera at the same time, we called it a "mixed form" of Chagas disease.  
Further information relative to digestive form at: Rezende & Luquetti: "Chagasic megavisceras"
In "Chagas disease and the nervous system" Scientific publ. No 547 - PAHO-WHO, 1994, P. 149-171.
Sincerely,
J.M.Rezende

Top

#32 De:  Goņi Maria Teresa   <suteki@ssdnet.com.ar
Enviado: Lunes 06 de Diciembre de 1999 00:09
Asunto: Trasplante y Chagas/Chagas and Transplantation
Queria saber si en un paciente chagasico a quien se indica trasplante cardiaco debe recibir rutinariamente tratamiento parasiticida. Cuando - es decir, si antes del transplante, si luego de la operacion en forma concomitante con la inmunosupresion o solo si aparecen manifestaciones de reagudizacion- y con que esquema y dosis. Asimismo, si un corazon de un paciente chagasico sin cardiopatia puede ser admitido como dador.

I would like to know if a chagasic patient, who is indicated heart transplantation, must receive routinely parasiticide treatment. When -that is to   say, if before transplantation, if after the operation in a concomitant way with immunosuppression, or only if manifestations of new worsening appear- and with what schema and doses.  Also, if the heart of a chagasic patient without heart disease can be admitted as donor.
Dra Maria Teresa Goni

Top

#33 De:  Enrique Manzullo
Enviado: Lunes 9 de Noviembre de 1999 17:03
Asunto: Megavisceras y Chagas/Megaviscera and Chagas
He tenido la fortuna de poder asistir pacientes chagasicos en numerosas zonas rurales de latinoamerica. En Mambai (Brasil) los pacientes  expresan espontaneamente dificultades de transito alimentario, regurgitaciones tardias y molestias compatibles con dilatacion de esofago. Un vaso grande de sustancia de contraste y una radigrafia de torax de perfil u oblicua obtenida 3 minutos despues evidencian dilataciones con frecuencia.   Esa misma sintomatologia no la he encontrado en Argentina, Uruguay, Paraguay o Bolivia. La Dra Vanice Macedo (colega Brasilera) realizo a numerosos pacientes chagasicos de Bs. As. el mismo interrogatorio que nos diera positivo en Mambai sin encontrar niguno compatible. La sintomatologia de muchos megaesofagos es florida y resulta improbable que todas pasen desapercibidas. De existir megaesofago deben ser de escasa repercusion clinica y para detectarlos se deberia realizar un estudio siguendo las tecnicas senaladas por el Dr. Rezende.
En cuanto a megacolon, es un tema clinicamente distinto, por lo dificil de correlacionar constipaciones con este cuadro. Sin embargo hace algunos anos, concurrio a verme una colega gastroenterologa de Bs. As. que habia realizado colon por enema con doble contraste a mas de 60 chagasicos asintomaticos, encontrando mas de 10 megas. LLeve al Dr. Rezende las radiografias, quien confirmo por lo menos 8. Sugirio realizar unos pocos estudios en personas sin Chagas, para asegurar el notable valor de este trabajo. Lamentablemente la Dra. Hersilia  Gomez  (autora de este trabajo) no concurrio mas y desconozco donde se encuentra. Si por este medio pudieramos ubicarla le recomendaria que presentara su investigacion aun sin grupo testigo.
Me parece importante inquietar a los gastroenterologos en el tema Chagas porque resulta muy simple en presencia de megavicera realizar serologia para Chagas, investigacion que no siempre se realiza.

I have been fortunate to be able to assist chagasic patients in several rural areas of Latin America. In Mambai (Brazil), the patients present spontaneously difficulties in food passage, late regurgitations, and troubles compatible with esophagus dilatation. A big glass of contrast substance, and an oblique thorax radiography, obtained 3 minutes afterwards, frequently display dilatations. I have not found the same symptomatology in Argentina, Uruguay, Paraguay, or Bolivia. Dr. Vanice Macedo (a Brazilian colleague) performed in several chagasic patients from Bs. As. the same questioning that resulted positive in Mambai, without finding any compatible one. The symptomatology of many megaesophagus is diverse, and it is improbable that all remain unnoticed. If there is megaesophagus, they must be of scant clinical impact, and to detect them a study should be carried out, following the techniques pointed out by Dr. Rezende.
Regarding megacolon, this is a clinically different topic, because it is difficult to correlate constipation with this manifestations. However, some years ago, a gastroenterologist colleague from Bs. As. came to see me: she had done colon by enema with double contrast in more than 60 asymptomatic chagasic patients, finding more than 10 megas. I fetched the radiographs to Dr. Rezende, who confirmed at least 8. He suggested to perform a few studies in people without Chagas, to ensure the remarkable value of this work. Regrettably, Dr. Hersilia Gomez (author of this work) did not come again, and I ignore where she is. If we could find her by this means, I would recommend her to present her investigation even without a witness group.
I think it is important to interest gastroenterologists in the Chagas subject, because it is very simple to do serology for Chagas in the presence of megaviscera, an investigation that is not always performed.
Dr Enrique Manzullo

Top

#34 De:  Marcelo Bassino <marbas@teletel.com.ar>
Enviado: Lunes 6 de Diciembre de 1999 09:02
Asunto: Ergometria y Chagas/Ergometry and Chagas
Estimados colegas :
Me gustaria preguntar a la lista y expertos en general:
1) Que valor predictivo positivo le adjudican a la Prueba Ergometrica en los pacientes portadores de Miocardiopatia Chagasica .
2) Cuales serian los marcadores de mayor relevancia al respecto .
3) Que tipo de apremio utilizan ( biciclo o banda ) y con que protocolo de esfuerzo trabajan .
Muchas gracias

Dear colleagues:
I would like to ask to the list and experts in general:
1) What positive predictive value do you bestow on the Ergometric Test in patients carriers of Chagasic myocardiopathy?
2) Which would be the most relevant markers about this?
3) What kind of pressure do you use (bicycle or band), and with what stress protocol do you work?
Thank you very much,
Marcelo Bassino

Top

#35 De: Cabasco Cristina <ccristina@alternet.com.ar>
Enviado: Lunes 06 de Diciembre de 1999 11:37
Asunto: Positive serology and sterility/Serologia positiva y esterilidad
Estimados colegas :
Desearia saber si la serologia positiva de Chagas esta descripta en la mujer como causa de esterilidad .
Muchas gracias.

Dear colleagues:
I would like to know if positive serology for Chagas is described in the women as a cause for sterility.
Thank you very much,
Dra Cabasco Cristina

Top

#36 De: Sergio Perrone <svperrone@interlink.com.ar>
Enviado: Miercoles 8 de Diciembre de 1999 11:37
Asunto: Chagas y Transplante/Chagas and transplantation
Ante todo debo agradecer la consulta en el tema que los ocupa.
Con respecto a su pregunta sobre si el paciente  transplantado Cardiaco chagasico debe recibir tratamiento parasiticida en forma profilactica en forma rutinaria, existen dos posturas:
1.- Profilaxis parasiticida Si
2.- Profilaxis parasiticida No
Los que apoyan la primer postura (Profilaxis parasiticida Si) se basan en la experiencia de aquellos que previnieron la reactivacion de la enfermedad chagasica en pacientes transplantados que recibieron medicacion inmunosupresora. Esta experiencia constituye la primer y mayor experiencia del grupo de Brasil con mas experiencia en transplante cardiaco en pacienteschagasicos, ellos utilizaron Beznidazol como profilaxis y el inconveniente encontrado fue la mayor incidencia de sindromes linfoproliferativos en ente grupo de pacientes que en los transplantados no chagasicos que no recibieron Beznidazol como profilaxis. La mayor=EDa de estos pacientes (a pesar de la profilaxis parasiticida) presentaron reactivacion de su enfermedad de Chagas en el post transplante. Existe una experiencia mas pequena de otro grupo (tambien de Brasil) que postula la utilizacion de Nifurtimox como profilaxis sin observar esta mayor incidencia de sindrome linfoproliferativo. 
Los que apoyan la segunda postura (Profilaxis parasiticida No) se basan en resultados de supervivencia similares a los observados en pacientes no chagasicos cuando no se utiliza profilaxis parasiticida y solo se tratan los episodios de reactivacion post operatoria de la enfermedad de Chagas, en pacientes transplantados cardiacos utilizando ademas un menor nivel de inmunosupresion post transplante.
Con respecto a la aceptacion o no de un donante portador de serologia positiva para Chagas (sin cardiopatia chagasica) , el tema es aun controvertido, ya que uno estaria transmitiendo la enfermedad al receptor. Uno deberia valorar el riesgo que significa la transmision de la enfermedad de Chagas al receptor vs el riesgo que significa la espera de otro donante.
Me tomo ademas la libertad de recomendarles la consulta con un amigo personal y una de las personas con mas conocimiento y experiencia en el tema Transplante Cardiaco en pacientes Chagasicos, el Dr. Noedir Stolf del Instituto de Cardiologia de la Universidad de San Pablo:
stolf@incor4.incor4.incorusp.br

First and foremost, I must thank the consult on the topic that you deal with.
Regarding your question about if the chagasic patient with heart transplantation, must receive parasiticide treatment in a prophylactic way, routinely, there two stands:
1- Parasiticide prophylaxis Yes
2- Parasiticide prophylaxis No
Those who support the first stand (Parasiticide prophylaxis Yes) are based in the experience of those that prevented reactivation of chagasic disease in transplanted patients that receive immunosuppressive medication. This experience constitutes the first and biggest experience of the group from Brazil with more experience in heart transplantation in chagasic patients. They used Beznidazol as prophylaxis, and the problem they found was the greater incidence of lymphoproliferation symptoms in this group of patients than in those non-chagasic transplanted, that did not receive Beznidazol as prophylaxis. Most of these patients (in spite of parasiticide prophylaxis) presented reactivation of their Chagas disease in post-transplantation. There is a smaller experience from another group (also from Brazil) that poses that use of Nifurtimox as prophylaxis without observing this greater incidence of lymphoproliferative syndrome.
Those who support the second stand (Parasiticide prophylaxis No) are based in results of survival similar to those observed in non-chagasic patients when parasiticide prophylaxis is not used, and only post-operation reactivation episodes of the Chagas disease are treated, in heart transplanted patients using besides, a lower level of immunosuppression post-transplantation.
Regarding acceptance or not of a donor, who is a carrier of positive serology for Chagas (without chagasic heart disease), the topic is still controversial, since one would be transmitting the disease to the receptor. One should estimate the risk that transmission of the Chagas disease to the receptor means, vs. the risk that waiting for another donor means.
I also take the liberty to advise you to consult with a personal friend, and one of the people who knows most, and has more experience in the  topic Heart Transplantation in Chagasic patients, Dr. Noedir Stolf from the Instituto de Cardiologia from the Universidad de San Pablo:
stolf@incor4.incor4.incorusp.br
Sergio Victor Perrone, MD
Director Medico de Transplantes Intratoracicos
ICYCC
Fundacion Favaloro
Belgrano 1746
Buenos Aires (1093)
Argentina
Tel/Fax: 54-11-4378-1350

Top

#37 De:  Harry Acquatella <hacquatella@true.net>
Enviado: Viernes 10 de Diciembre de 1999 08:42 AM
Asunto: Trasplante y Chagas/Chagas and Transplantation
1) No creo debe de aceptarse como donante de ningun organo proveniente de paciente Chagas seropositivo porque se hace correr al receptor un riesgo inaceptable.
2) En cuanto al manejo de tratamiento parasiticida de un receptor chagasico antes o despues de transplante cardiaco consultar los excelentes articulos de Bocchi et al en Ann Thorac Surg 1996,61:1727-1733 y tambien Carvalho et al al Circulation 1996, 94:1815-1817.
Se indica tratamiento ANTES del trasnplante, y tambien DURANTE la aparicion de miocarditis aguda chagasica. Consultar esos articulos.
Atte.

1) I do not think that a chagasic seropositive patient must be accepted as donor of any organ, because the receptor is made to run an unacceptable risk.
2) About the management of parasiticide treatment for a chagasic receptor before or after heart transplantation, consult the excellent articles by Bocchi et al., at Ann Thorac Surg 1996,61:1727-1733, and also Carvalho et al., at Circulation 1996, 94:1815-1817.
Treatment is indicated BEFORE transplantation, and also DURING appearance of chagasic acute myocarditis. Consult these articles.
Sincerely,
Harry Acquatella

Top

#38 De: Fernando Burgos
Enviado: Viernes 10 de Diciembre de 1999 12:56
Asunto: Chagas y Trasplante/Chagas and transplantation
En relacion al aporte del Dr Sergio Perrone y la importancia de tenerlo en esto foro como a la mayoria de los expertos de primer nivel internacional que integran esta lista no quisiera dejar de preguntar tanto al Dr Perrone como a los colegas en gral especialmente a los Brasileros.
1) Que porcentaje de pacientes Chagasicos integran sus listas de pacientes TRASPLANTADOS .
2) Que porcentaje de pacientes Chagasicos integran sus listas de pacientes PARA trasplante .
Es decir cuantos pacientes Chagasicos tienen la real posibilidad de llegar al Trasplante cardiaco , dado que intuyo que pese a ser millones en Latinoamerica los beneficios de la medicina del "Primer Mundo" poco le llegan a esta patologia de la marginacion y la pobreza endemica.

Regarding the contribution by Dr. Sergio Perrone, and the importance of having him in this forum, as most experts of first international level that made up this list, I want to be sure to ask both to Dr. Perrone and the colleagues in general, especially Brazilians:
1) What percentage of chagasic patients make up your lists of TRANSPLANTED patients.
2) What percentage of chagasic patients make up your lists of patients TO BE transplanted.
That is to say, how many chagasic patients have the real possibility of reaching the heart transplantation, since I feel that in spite of benefits of "First World" medicine being millions in Latin-America, few reach this pathology of marginalization, and endemic poverty.
Dr Fernando Burgos

Top

#39 De: Sergio V. Perrone <svperrone@interlink.com.ar>
Enviado: Sabado 11de Diciembre de 1999 23:18
Asunto: Re: Trasplante y Chagas/Chagas and Transplantation
Respeto y apoyo la opinion del Dr. Acquatella, pero debo decirle que se han realizado transplantes renales de donantes portadores de enfermedad de Chagas sin consecuencias para los receptores, incluso creo (deberia confirmar el dato) que se han realizado algunos transplantes hepaticos con donantes seropositivos para Enfermedad de Chagas.
Con respecto a si un receptor cardiaco podria recibir un organo de un donante seropositivo , creo que lo fundamental es evaluar el estado en que se encuentra el receptor y si tendria o no la posibilidad de tener otra oportunidad, y si el grupo de transplante se encuentra en condiciones de manejar una infeccion aguda en un paciente inmunosuprimido.
Actualmente algo similar ocurre con los donantes portadores de serologia
para hepatitis C, en los cuales hay que evaluar en el momento en que aparece el donante el estado del receptor y la posibilidad de llegar a obtener otro organo seronegativo.

I respect and support the opinion by Dr. Acquatella, but I must tell you that renal transplantations have been performed from donors who are carriers of Chagas disease, without consequences for receptors, I even think (I should confirm the information) that some hepatic  transplantations have been performed with donors seropositive for Chagas disease.
About if a heart receptor may receive an organ from a seropositive donor, I think that what is most important is to assess the state in which the receptor is, and if s/he has the possibility of another chance, and if the transplantation group is in conditions to manage an acute infection in an immunosuppressed patient.
Currently something similar happens with donors who are carriers of serology for hepatitis C, in whom we have to assess at the moment in which the donor appears, the state of the receptor, and the possibility of obtaining another seronegative organ.
Dr Sergio Perrone
Director Servicio Trsplantes Intratoracicos
Fundacion Favaloro . Bs As . Argentina

Top

#40 De: Roberto M. Michelson <ramichel@intramed.net.ar>
Enviado: Sabado 11de Diciembre de 1999 16:43
Asunto: Ergometria y Chagas/ Chagas and Exercise Stress Testing
En el caso del paciente portador de miocardiopatia chagasica con compromiso de la funcion contractil ventricular izquierda, la PEG permite determinar la capacidad funcional util y determinar el punto de partida desde el cual se trabajara en el area de rehabilitacion cardiovascular.
En el caso del portador de serologia positiva sin evidencia clinica o instrumental de compromiso cardiaco, empleamos la PEG para intentar llevar al paciente a su capacidad maxima, tratando de demostrar la falta de consecuencias practicas en su capacidad funcional util. Esto tiene gran importancia en el area laboral, ya que en general se trata de personas que realizan tareas de indole preponderantemente fisica, y cualquier duda al respecto puede comprometerlo seriamente en sus posibilidades de insertarse en el mercado laboral regular.
Basandonos en conclusiones extraidas de nuestra propia experiencia (Ver: "Anormalidad especifica de la ergometria en la cardiopatia chagasica" Revista Argentina de Cardiologia, vol 55, supl., p S161, A no P No. 409) creemos que es licito concluir que, a medida que las curvas de anormalidad en general presentan diferencias progresivas estadisticamente significativas segun aumenta la edad de los pacientes, ello se debe a lo que sucede con las arritmias, pues las otras formas de anormalidad consideradas no muestran el tipo de distribucion que sugiere evolutiva con los distintos estadios progresivos del Mal de Chagas.
No considero que existan diferencias teoricas significativas entre la bicicleta y la banda, aunque en lo personal yo prefiero la primera en las evaluaciones de cardiopatas comprobados con baja capacidad funcional y la segunda en pacientes sin evidencias de compromiso contractil y antecedentes que permiten suponer alta capacidad funcional. Pero si esta ultima ha sido correctamente valorada, su medicion debe ser similar y repetible con ambos metodos.
El paciente chagasico en quien se sospecha un compromiso de la capacidad funcional debe ser estudiado mediante un protocolo lentamente progresivo a los fines de determinar su verdadera capacidad funcional util. El portador de serologia positiva sin compromiso miocardico evidente y  nivel elevado de entrenamiento fisico debe ser apremiado mediante un protocolo del tipo Bruce o equivalentes. El paciente en quien quepa la   duda razonable acerca de su capacidad funcional debe ser evaluado inicialmente sobre la base de los criterios empleados en el caso del paciente cardiopata, y solo despues de descartada esta condicion, reevaluado con protocolos mas agresivos en caso de que no haya podido determinarse su real capacidad funcional.
Espero que, en lineas generales, lo que antecede responda a sus preguntas. Y aprovecho para saludar a todos los integrantes de la lista atentamente.

In the case of a patient, who is a carrier of chagasic cardiomyopathy with involvement of left ventricular contractile function, the EST allows to determine the useful functional capacity, and to determine the starting point from where we will work in the area of cardiovascular rehabilitation.
In the case of a carrier of positive serology without clinical or instrumental evidence of heart involvement, we employ the EST to try to take the  patient to his/her maximal capacity, trying to prove the absence of practical consequences in his/her useful functional capacity. This is very important in the labor area, since in general we deal with people that perform tasks mainly of a physical kind, and any doubt about it, may jeopardize seriously his/her possibilities of fitting in the normal labor market.
Basing ourselves in conclusions drawn from our own experience (See: "Anormalidad especifica de la ergometria en la cardiopatia chagasica", Revista Argentina de Cardiologia, vol. 55, suppl., p S161, A no P No. 409), we think that it is right to conclude that, as the abnormality curves in general present progressive differences statistically significant according to the age of the patients, this is due to what happens with arrhythmias, since the other forms of abnormality considered, do not display the type of distribution that suggests evolution with different progressive stages of the Chagas disease.
I do not consider that there are theoretical significant differences between bicycle and band, though personally, I prefer the former in assessment of confirmed heart diseases, with low functional capacity, and the latter in patients without evidences of contractile involvement, and history that let us suppose a high functional capacity. But if the latter has been correctly valued, its measurement should be similar and its repetition should be possible with both methods.
The chagasic patient in whom a compromise of functional capacity is suspected, must be studied through a slowly progressive protocol with the purpose of determining its true useful functional capacity. The carrier of positive serology without evident myocardial involvement, and a high level of physical training, must be pressed through a Bruce type protocol, or equivalents. The patient in whom a reasonable doubt is possible, about his/her functional capacity, must be assessed initially on the basis of criteria applied in the case of patients with heart disease, and only after dismissing this condition, reassessed with more aggressive protocols, if his/her real functional capacity has not yet been determined.
I hope that, broadly speaking, the previous lines answer your questions. And I take advantage of the opportunity to greet all the members of list.
Sincerely,
Dr. Roberto M. Michelson

Top


Š CETIFAC
Bioengineering
UNER

Update
Feb/01/2000