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Newsletter

Electronic publication of the First Virtual Congress of Cardiology,
for purposes of promotion and interchange of topic of interest in
cardiac sciences and news from the Congress.

(Spanish version click here)

Sponsored by
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Newsletter - 1st Virtual Congress of Cardiology
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Year 1, number 12. November 29th, 1999.

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Biweekly electronic publication of the First Virtual Congress of Cardiology, for
purposes of promotion and interchange of topics of interest in cardiac sciences
and news from the Congress. It is distributed free of charge to everyone
subscribed. Those of English speaking origin may subscribe sending an e-mail to:

majordomo@pcvc.sminter.com.ar

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An Spanish version is available for those of Spanish speaking origin.
Contributions are welcomed; also responses to previously published articles, and
commentaries should be send as Letters to:

readers@pcvc.sminter.com.ar

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Previous issues at:

http://www.fac.com.ar/cvirtual/newslett/newseng.htm

or at

http://pcvc.sminter.com.ar/cvirtual/newslett/newseng.htm

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"Eradication of smoking is the most effective means to improve the health in the
population of both developed and developing countries."

From this column, we propose the FVCC to be free of tobacco smoke.

Colleague: if you are still a smoker, we will thank you if you abstain from it
while you participate in the activities of our Congress, and we invite you to
get in touch with us, so that your attempts tostop turn out to be successful.

===============================================================================

CONTENTS

Future of European Cardiology. Commented article
Commentary by Carlos Barrero, M.D.

Discussion Forums

From the Forums

Useful address on the web

HOAX Viruses
FVCC Steering Committee´s member

News Lectures

Space available for Advertisement.

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The Deutsche Bank  (http://www.deutsche-bank.de/congress) supports the
Newsletter of the First Virtual Congress of Cardiology.

===============================================================================

COMMENTED ARTICLE.

FUTURE OF EUROPEAN CARDIOLOGY: CONTINENTALLY ISOLATED OR GLOBALLY INTEGRATED?
"The Lancet", Volumen 354, Numero 9181, 4 Sept. 1999 (por Richard Horton,
editor del Lancet)

The editorial of The Lancet, September, 1999, seems timely. It deals with the
different evolution of cardiovascular disease in different countries of Europe,
so that while Western Europe presents figures of mortality by coronary disease
of around 75/100,000 men with declining rates each year, Eastern Europe displays
rates much higher, and increasing from year to year. Thus, Yugoslavia,
has figures of 215/100,000, Czech Republic: 266, and Russia: 285. Already in
the seventies, differences were evident between the two powers by then. While in
USA a growing tendency was seen, to reduction of mortality by cardiovascular
cause, in the former Soviet Union, the curves remained without declination. This
was attributed to the intense and successful campaign for correction of risk
factors (mostly cholesterol and smoking) in USA and the absence of a counterpart
in the Soviet Union, where there was a high consumption of alcohol and tobacco,
as well as atherogenic diet.
Probably, this causes will persist, and would explain the differences between
the European regions.
The countries of Eastern Europe have features of developing countries, but with
certain peculiarities: they are not, in general sub-fed, but their diets are
atherogenic, and do not seem to have been modified appreciably, probably due to
the lack of diffusion or permeability in community of harms from coronary risk
factors. This reality in Eastern European countries, may not coincide with
other underdeveloped and sub-fed areas, where diets are not atherogenic, and
therefore reality of prevalence of coronary disease may be different.
However, the importance of this editorial lays in that is attracts the attention
towards the need for monitoring what is happening with coronary disease, and by
extension, cardiovascular disease, not only in leader regions in scientific
disease, and in epidemiologic campaigns against cardiovascular disease, but in
the rest of the world as well (and not very far from these areas, as it happens
in Eastern Europe) since otherwise, the goal of the research applied to public
health would be distorted, by constituting as field of action only the developed
areas of the world.
Returning to the example of Eastern Europe, besides the mentioned causes as
probable explanations for the reality of prevalence of cardiovascular disease,
already glimpsed during the sixties, some new causes have been mentioned for
this situation. Bertolasi, in his lecture delivered in the Argentine Congress of
Cardiology, 1998, mentioned "despair" as a possible new factor for
cardiovascular risk, to be considered in these countries (the paradigm of which
is the former Soviet Union): this would be explained by the loss or failure of a
controlling model, and its replacement by other that does not get crystallized,
or does not provide results in the present, as a result the loss of goals or
destiny would constitute the social "despair" that by itself, or by persistence
of harmful habits (diet, smoking) would explain the tendencies observed in
prevalence and mortality of coronary disease.
Regarding our country, there is little published about it, but we can mention
the interesting analysis of data on cardiovascular mortality (on the basis of
data provided by the Secretaria de Salud Publica de la Nacion (Public Health
Department of the Nation) carried out by the Cardiology Service of the
Sanatorio Mitre, of Buenos Aires, and presented in the last Argentine Congress
of Cardiology (Revista Argentina de Cardiologia, vol 67, supl III, pages 35 and
36). There, it is mentioned that mortality by coronary disease was in 1990,
75/100,000 inhabitants, and decreased to a 58/100,000 in 1997 (reduction in a
22%). As it can be observed, in our country, both prevalence of mortality by
ischemic heart disease, as the declining tendency, are similar to those of
countries of Western Europe from the MONICA study, and reason of the editorial
of Lancet.

Dr. Carlos Barrero
Cardiology Head, Clinica Bazterrica, Buenos Aires, Argentina

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DISCUSSION FORUMS

Several thematic moderate mailing lists are available to allow interactivity
between participants, a feature that is very important and distinguishes this
Congress:

Subject                          Name                     Moderator
Arrythmias                       arritmias                Dr. Edgardo Schapachnik
Cardiac Failure                  heartfail-pcvc           Dr. John Bustamante
Cardiovascular Pharmacology     pharma-pcvc              Dr. Alejandro L Coqui
Cardiovascular Risk              epi-pcvc                 Dr. Florencio Garófalo
Cardiovascular Surgery          surgery-pcvc             Dr. Alberto Canestri
Chagas Disease                   chagas-pcvc              Dr. Marcelo Bassino
Chat                             chat-pcvc                Dr. Mario Heñín
Echocardiography                 echo-pcvc                Dr. Jamil Mattar Valente
Exercise Cardiology              exercise-pcvc            Dr. Jorge Sanagua
Hypertension                     hbp-pcvc                 Dr. Edgardo Schapachnik
Informatics in Cardiology       y2k-pcvc                 Dr. Edgardo Schapachnik
Interventional Cardiology       interven-pcvc            Dr. Raul Bretal
Ischemic Heart Disease          coronary-pcvc            Dr. Mario Heñín
Nuclear Cardiology               image-pcvc               Dra. Silvia Eskenazi
Nursing in Cardiology            nursing-pcvc             Lic. Amanda Serrón
Pediatric Cardiology             pediat-pcvc              Dr. Diego Esandi
Technicians in Cardiology       techn-pcvc               Tecn. Mario Blitzman

The messages to each list can be written in any of the official languages of
the Congress: English, Portuguese, and Spanish. The contents will be translated
in the FVCC's Secretariat, thus all subscribers will receive the messages
both in English and Spanish, or English and Portuguese.

The mailing lists are moderated, which means that the messages are previously
read by a Moderator, and only those that have contents related to the goals of
the each list, are sent again.

In order to subscribe (free) to each mailing list, send an e-mail message to:

                  majordomo@pcvc.sminter.com.ar

leaving the subject line empty, and writing:

                  subscribe name-of-the-list

(i.e. subscribe image-pcvc)

as only text in the body of the message.

In order to send messages to the mailing list, address them to:

                  name-of-the-list-pcvc@pcvc.sminter.com.ar

(i.e. image-pcvc@pcvc.sminter.com.ar )

In order tu subscribe to arritmias send an e-mail to:

                  curso@schapachnik.com.ar

write in the subject line:

Inscripcion

write in the body of the message:

name and surname <email-adress>

(i.e. Susan Smith susan@netinter.com )

In case of difficulties to subscription to any mailing list, send a message in
English, Portuguese or Spanish to

rlombard@pcvc.sminter.com.ar ,

writing in the Subject line the word "help", and explaining the problem in the
body of the message.

In order to unsbscribe, send an e-mail message to:

                  majordomo@pcvc.sminter.com.ar

leaving the subject line empty, and writing:

                  unsubscribe name-of-the-list

(i.e. unsubscribe image-pcvc) 

================================================================================

FROM THE FORUMS

This section reflexes the participation of the colleagues in the different
Thematic Forums

CORONARY

From: Dr. Alfredo Espinosa Brito [espinosa@perla.inf.cu]
To: coronary-pcvc@pcvc.sminter.com.ar
Date: Sun 14 Nov 1999 20:07
Tema: Acute Myocardial Infarction. Management.

Dear colleagues:
Since some days ago, the debate that arose on the management to be applied with
a diabetic patient that presents an inferior acute myocardial infarction, has
continued -certainly, almost everything between Argentine colleagues-. If these
opinions would have been read or listened by the patients or their relatives,
they would think that we, physicians have gone crazy with all this information,
Internet, etc., since there are almost not two opinions alike, faced with the
same situation. This a new Babel Tower. It has been said, and with good reasons,
that "clinical practice varies significantly from a physician to another, and
from a community to another. This variability cannot be attributed only to the
differences in occurrence rates, or to severity of diseases. However, not
all work styles could be correct, and the profession is obliged to find which
are the best."
To answer the approach above, nowadays, there is an increasingly growing
interest for promotion, development, and application of guidelines for good
practices for prevention, and treatment in diverse clinical situations. The
passage from making a clinical decision based in scientific evidence, or making
it taking into account consensus and opinions, is the line that divides
protocols from guidelines for clinical practice.
Since they are based in opinions or perceptions founded in experience, the
protocols, carried out mostly to reduce variability in interventions, what they
truly do is to produce a feedback, because they open several therapeutic
options. This is what has happened in the debate promoted by the FVCC. Are we
trying to get a consensus?
However, guidelines make up a group of advices, well systematized, that provide
criteria for, but do not compel, medical behavior in front of a patient with a
determined clinical situation, based in what are considered the best among the
different options for diagnosis and treatment for such clinical manifestations,
based in existing evidence in a given moment.
Elaboration and implementation of clinical practice guidelines have as goal:
"to go from criteria based in subjective validity of clinical procedures, and
methods, used in medical practice, to others that are founded in objective data
using a method that favors making rational decisions, establishing priority
criteria to act."

"To have guidelines for clinical treatment must be a natural result from
applying the scientific method to medicine practice."
However, it has been pointed that more attention must be paid to implementation
and effectiveness in different practice scenarios, taking into consideration
conditions and possibilities of each institution. Due to this, each professional
collective must develop -always check-, apply, and assess their own guidelines.
The latter aspect, will provide the finishing touches, very important, to the
matter.
"The process of obtaining guidelines generally differ from a group to another.
Those who produce guidelines, should not expect everybody to agree with them. In
fact, guidelines stimulate debate, which is not easy sometimes, when ego and
interests from the different parties are at stake, but that it is good for
medicine development."
In our Hospital, since 1998, we have our own modest guidelines devised in a
participatory way, among all physicians, and we are doing well.
It is good to state that a series of disadvantages in application of guidelines
have been also mentioned. Between those that have to do with the example of the
FVCC, it is that information that one has about the best evidences can differ,
and grow "old" quickly,
just as one has to take into account experience and ability of professionals
from each place, and their "adherence" to meet the guidelines.

Fortunately, it seems that the patient-problem has a good prognosis, and will
be "saved", in spite of everything physicians do, with our best intention.
Forgive me for the length of the discourse.

Greetings for everyone from Cuba,

Prof. Dr. Alfredo Espinosa Brito
Hospital "Dr. Gustavo Aldereguia Lima"
Ave 5 de Septiembre y Calle 51A, Cienfuegos, 55100, CUBA
Telef: (53-432) 8945 y 5633
Fax: (53-432) 7387 y 3832
E-mail: espinosa@perla.inf.cu


From: Dr. Marcelo Bassino [marbas@teletel.com.ar]
To: coronary-pcvc@pcvc.sminter.com.ar
Date: Mon 15 Nov 1999 22:15
Subject: Acute Myocardial Infarction. Management.

Dear Mario:

Indeed, the posed case, from its apparent simplicity, has installed a discussion
that displays the lack of homogeneous consensus before a concrete and common
case (inferior AMI-Diabetes) where all of us debate with statistical,
epidemiologic, and cost-benefit arguments, that are valid but express most
different managements, since the debate has flowed from the ideal situation of
Academic Centers (and I am sure that these are not all, instead a few from the
total here in Argentina) that have a proven experience, and the results of which
are comparable to statistics from countries of the First World, that are in
contrast with the great majority of the "real world" as David Faxon mentions in
his editorial commentary about Primary Angioplasty vs. Thrombolysis, in NEJM,
vol. 431, November 4th, 1999, regarding USA reality.
Humbly, I believe that we cannot forget that we live in a country where,
according to a survey by the Sociedad Argentina de Cardiologia (Argentine
Society of Cardiology) from a couple of years ago, in Capital Federal,and
suburbs, only a 40% of the patients received thrombolysis, therefore much more
lives would be saved, allowing that the remaining 60% could receive
Streptokinase without preventing the few Academic Centers that can meet the 1A
premise from the guidelines by the ACC/AHA, about having the balloon inflated
within 90 minutes (timely fashion), from continuing development of advanced
methods that are highly necessary for the development of the specialty, but that
reach only a minority of patients in a few places. Consequently, those who
are in Reference Centers will go on showing us a way to work, that we must know,
but we must not try to extrapolate to all daily activity, that will go on being
ruled by the soundest common sense among resources, and the best scientific
information available.

Dr Marcelo Bassino
Trenque Lauquen
Provincia de Buenos Aires
Argentina


From: Alejandro F. Luque Coqui (alucoq@attglobal.net)
To: coronary-pcvc@pcvc.sminter.com.ar
Date: Wed 17 Nov 1999
Subject: Acute Myocardial Infarction. Management.

Dear Mario:

Sorry for expressing my opinion again, but there is a confusion here.

This confusion arises in the moment in which one thinks that the opinions
expressed on the case you presented, are very heterogeneous. The way I see it,
it is very clear that opinions have splitted in a controversy that is happening
throughout the world, regarding administration of thrombolysis or performing
primary PTCA, that is to say mechanical or pharmacological reperfusion therapy,
but in both cases what is being argued is the form, not the content.
We know, Latin-Americans live in the Third World, in underdeveloped countries,
etc., etc., but in spite of this, we are performing coronary angiography, and
heart surgery, and if this case in particular arrives at a center where I can
perform primary PTCA successfully in the right moment, it would even be a waste
of resources not to do it; it is obvious that no treatment is for everyone, and
here it is the criteria of the doctor in charge which decides the best treatment
for this patient. So, I in particular, with due respect to all opinions
expressed here, do not see in the different opinions such disparity.

Greetings,

Alejandro F. Luque Coqui
Mexico


--------------------------------------------------------------------------------

HYPERTENSION

Date: Sat, 20 Nov 99 10:49:39 EST
From:  <sergio.kuznicki@mail.roche.com.ar>
To: hbp-pcvc@pcvc.sminter.com.ar
Subject: Estratificacion de riesgo / Risk estratification

Dear colleague:
Regarding the work published by Dr. Did Nunez "HTA - Estratificacion del Riesgo"
(BP - Risk Stratification), I would like to ask the colleague two questions.

1) How could you assess the patients recruited between 1996 and 1998 according
to the recommendations from JNC VI, if these were published only in 1997?
2) By what methods have you assessed the "effective performance" of
non-pharmacological treatment, since this is fundamental for assessment of
results?

On the other hand, I would like to make some commentaries on the work:

1) It is interesting that once again, the important conclusion regarding
modification of life style as a base for all anti-hypertensive treatment is
reached. The non-pharmacological treatment, that includes diminishing ingestion
of salt, making exercise regularly, not smoking, keeping a proper weight, among
others, has proven to be enough to normalize BP (blood pressure) in many
patients with normal to high BP, or who are in Stage I.
2) On the other hand, non-pharmacological treatment by itself helps diminishing
the risk of cardiovascular diseases, since it is known that the habit of
smoking, obesity, sedentary way of life, etc., are directly associated to a rise
in cardiovascular morbimortality, independently from values of BP.
3) Regarding risk stratification, this has been a very important contribution
from JNC VI for controlling and following up of hypertensive patients. Nowadays,
BP is considered a plurimetabolic syndrome, in which proper control of glycemia,
insulinemia, cholesterolemia, and uricemia, are as important as control of BP
values. With this criteria, if a patient has the proper pressure values thanks
to the anti-hypertensive treatment, but the above mentioned lab parameters are
not properly controlled, we cannot consider that s/he is well treated.

Cordially,
Dr. Sergio Kuznicki
Buenos Aires, Argentina


From: "Rafael Peleteiro" <peleteir@rpm-net.com.ar>
To: <hbp-pcvc@pcvc.sminter.com.ar>
Date: Sat, 20 Nov 1999 20:00:59 -0300
Subject: Estratificacion de riesgo / Risk estratification

After reading the work by Dr. Jorge P. Did Nunez on risk stratification of BP,
I would like to make some considerations.
Observing distribution of population of hypertensive patients according to
pressure values, it behaves as a normal distribution (Gaussiana), having a 90.2%
in normal to high, and stage I. It is precisely this population the one with the
greatest load of the disease, that is to say most of our patients with
complications due to BP would belong to this group. Therefore they hold the
greatest epidemiologic importance, although in general this datum is not taking
into account, since they hold the least academic importance.
Regarding distribution in risk groups, it is observed that groups B and C
gather a 97.7%. This datum shows us the little usefulness of this classification
in these risk groups just as JNC VI posed it. I think that it is neither useful,
nor practical, nor scientifically proper to have in the same group both stroke
and retinopathy, or an acute myocardial infarction, or a transitory ischemic
attack. I think that they are entities that point to different prognosis and
managements. Likewise, including heart failure, or angina without classification
also adds to the confusion.
I think that we should search for a stratification regarding risk, closer to
the reality we live every day.
Maybe this is one of the causes for not applying the necessary treatment to
each group, and for so many of our patients to lack for instance, a good non
pharmacological treatment.
Rafael Peleteiro


From: Jorge Did Nunez  <jdid@infomed.sld.cu>
To: hbp-pcvc@pcvc.sminter.com.ar
Date: Tue, 23 Nov 1999 23:55:57 -0500
Subject: Estratificacion de Riesgo / Risk estratification

Dear colleagues:

I gladly answer the question asked by Dr. Sergio Kuznicki, to the HBP-PCVC
forum, regarding the work "Hipertension Arterial. Estratificacion de Riesgo"
(Blood Hypertension. Risk Stratification).

How could you assess the patients recruited between 1996 and 1998, according to
the recommendations of JNC VI, if these were only published in 1997?

Of course, it is impossible to assess the patients recruited between 1996, and
1998 according to the recommendations of JNC VI published in 1997.

First, let me remind you that in our work we talked about: "The 1412
hypertensive patients registered in the Basic Work Group No. 2, from the
"Policlinico Hospital Docente Raul Gomez Garcia", from Havannah, who underwent
during the 1996-1998 period, a research protocol...", and not about "...patients
recruited between 1996 and 1998..."

To choose the environment to work in, discharging files from the 17 offices of
familiy medicine that make up the Basic Work Group that I treat as
inter-consultant of Internal Medicine were used. From this moment, the people
who were older than 18 years were identified, with blood hypertension, properly
corroborated. That is why we talked of "...1412 "registered" hypertensive
patients in the Basic Work Group...".

As you may understand, the patients were identified previously to the beginning
of the research, and for this reason, could be included since 1996 in the data
base of hypertensive patients. When designing the structure of this data base we
took therefore, and initially, the JNC V postulates (valid at the time), with
the purpose of registering the general data of the patients, history,
coexistent pathologies, supplementary examinations, and assessment of lesion of
the target organ, etc., aspects that were quite summarized in the "Material and
Method" section.

Second, regarding feasibility of application of JNC VI recommendations in the
research initiated in 1996:

As we all know, in 1997, JNC VI was born, that was different from the previous
one regarding this research, only in two essential items: a) the "nomenclature"
of classification of blood pressure introduced in the previous report changed,
and b) a new system of classification to categorize patients according to Risk
Groups defined in it, is attached.

These reflections point out that the recommendations of JNC VI do not alter,
but instead complement and enhance those of JNC V, improving significantly
preventive and welfare procedures, therefore being ethically unacceptable to
stop applying its new concepts.

As it is evident, only few additional data were necessary to be added by the
end of 1997, and during 1998, to reach wholly the guidelines of JNC VI,
regarding basic analytic data, that were processed automatically with the
support of a system of application programs designed according to the JNC VI
requirements.

Therefore, it is completely justified, when considering the final results of
the extended research up to 1998, for us to say with total responsibility, that
the recommendations of the JNC VI were applied in a prospective research begun
in 1996, even when they were published in 1997.

Next I answer the second of the two questions sent by Dr. Sergio Kuznicki, to
the discussion forum HBP-PCVC, regarding the work "Hipertension Arterial.
Estratificacion de Riesgo" (Blood Hypertension. Risk Stratification).

By what methods have you assessed the "effective compliance" of non
pharmacological treatment, since this is fundamental for assessment of results?

To reach a proper assessment in this matter, just as for the whole development
of research, collaboration from family doctor turned out to be significantly
profitable, since s/he, besides being responsible of the systematic follow up of
the patient, lives nearby the patient's home, and keeps the closest relationship
possible with the patients and all the family.

This way, objectively, through the work of the family doctor, we could assess
the "effective compliance" of non-pharmacological treatment, beyond visits to
the office, i.e., enriching and confirming the criterion by visiting homes,
interrelating with the family, and summarizing, by observing the patient in
his/her social environment, consistently and steadily.

On the other hand, I would like to make common cause with commentaries by Dr.
Sergio Kuznicki about the importance of non-pharmacological treatment as a base
for all anti-hypertensive treatment, since it is one of the goals of this work,
and is part of its conclusions.

Maybe the matter is to obtain a greater effort from the assistant doctor, as
well as more educational capacity, and perseverance to obtain results. Due to
its importance in control of blood hypertension, and prevention of severe
cardiovascular events, low cost, and harmlessness, it is undoubtedly a goal for
practicing the "art" of medicine, without which there is no foundation for our
science.

Warm regards for everyone.

Dr. Jorge P. Did Nunez.
La Habana. Cuba.

--------------------------------------------------------------------------------

CARDIOVASCULAR FARMACOLOGY

From: Dr Alejandro F. Luque Coqui alucoq@attglobal.net
To: pharma-pcvc@pcvc.sminter.com.ar
Subjet: Postmenopausal Women
Date: Nov 10 1999 11:20

In postmenopausal women with hyperlipemia and angina, use of statins could
substitute use of hormone therapy of replacement in a patient with
contraindication of hormones?

Thank you,

Josefina Zaragoza
Mexico
zaragoza@ibm.net


Dear colleagues:
Regarding the case posed by Dr. Josefina Zaragoza, from Mexico: angina patient,
hyperlipemic, and postmenopausal.
This patient must be clearly indicated to normalize lipids to values of LDL-C
under 100mg/dl, since this is a case of "secondary prevention" (she has clear
clinical indications of atherosclerotic disease: chest angina), according to the
NCEP ATP II 1 guidelines. Therefore, independently of her postmenopausal
situation, we must indicate her diet, physical activity, stopping smoking, -if
she smokes- and besides some statin (obviously, also the medication with
B-blockers, and aspirin). She must receive this treatment YES or YES.

The indication for replacement hormone therapy, over and above that this patient
has some contraindication according to Josefina's report, has not yet been
proven if it has to be regarded (as for example aspirin has to, indisputably) as
an obliged therapeutics in secondary prevention, whether as pure estrogenic
therapy, or in combination with some progestagen.

Cordially,

Edgardo Schapachnik


Answer to Dr. Zaragoza from Mexico:

In postmenopausal women, with hyperlipemia and angina, hormone replacement
is not indicated as a treatment for coronary disease.
This is a case of Secondary Prevention, in a postmenopausal woman. The statins
are the drugs that proved to be useful and efficient in long term in these
cases. Particularly in women, there is evidence about the beneficial effects in
the 4S (simvastatin) and CARE (pravastatin) studies. In the latter, the subgroup
of women responded even better than the one of men.
In this women, indication for hormone replacement can have a gynecologic
foundation, but not a cardiologic one. Results from the HERS study have caused a
deep re-evaluation of everything that was believed about hormone replacement, as
a result from positive results from observational studies.
I have discussed this topic largely in the Journal of the Argentine Federation
of Cardiology, in its first issue from 1999, in an article that I titled in a
very thought-provoking fashion: HRT, now what? (as a consequence of results from
HERS study).
My greetings to the Mexican colleague.
Carlos Cuneo

--------------------------------------------------------------------------------

INTERVENTION

From: "Ortiz Baeza" <ortizbaeza@impsat1.com.ar>
To: <interven-pcvc@pcvc.sminter.com.ar>
Subject: AAA
Date: Tue, 9 Nov 1999

I have seen the interesting case presented by Dr. Mendiz, and the commentaries
by Dr. Zvonimir Krajcer regarding the solution of this case. The question I ask
regarding this, and other similar cases is, what management should be carried
out regarding treatment of hypogastrium arteries. In the case exposed, both
hypogastrium arteries appear occluded after the procedure. Specifically, which
is the incidence of complications for occlusion of them, or if there is a
desired effect to avoid a possible endo-leak?
Dr. Oscar Ortiz Baeza
ortizbaeza@impsat1.com.ar


From: Dr. Oscar Mendiz <almendiz@yahoo.com>
Subject: Re: AAA
To: interven-pcvc@pcvc.sminter.com.ar
Date: Fri, 19 Nov 1999

I would like to answer to Dr. Ortiz Baeza, that the patient presented for
discussion had not both hypogastrium arteries occluded.
Maybe the correct appraisal you carried out, arises from a certain degradation
in the passing of images, or from not focusing on the sector of the left
hypogastrium artery that remained patent, and that springs from the anterior
side of the iliac artery, and due to this the submitted angiography cannot be
seen properly.
As a general commentary, I would like to add that we always respected al least
one patent hypogastrium artery to diminish the possibility of ischemic colitis,
that is usually a catastrophic complication.
The need to keep a patent iliac artery is an important limitation for many
patients, because of this we work very hard in developing devices. Thus, there
are already some that allow treatment of primitive iliac arteries of up to 18mm
of diameter, and there are already some models being tested, that would allow to
leave the patent hypogastrium artery (iliac bifurcates).
Oscar A. Mendiz


From: "Dr. Aitor Alberdi" <aisca@arnet.com.ar>
To: <interven-pcvc@pcvc.sminter.com.ar>
Subject: Re: AAA
Date: Sun, 7 Nov 1999

Dear colleagues:
1. Doctors who are invited to comment, receive additional material besides what
we see?
2. Use of Fogarty, was carried out by surgeons or hemodynamics specialists? Is
there a video of this therapeutic action? Can we see it?
3. The Vanguard II prosthesis: in which stage of development of research is
now? According to international experience: was there another disruption in the
mesh of the stent? If there are metallic meshes that are expanded to high
pressures with balloon, can a fogarty cause a disruption of the stent? Is it
possible that this inconvenience may be related to a structural weakness of the
stent (manufacturing), and not exclusively to the action of the fogarty?
Dr. Aitor Alberdi

--------------------------------------------------------------------------------

CHAGAS DISEASE

From: Joao Carlos <jcpdias@cpqrr.fiocruz.br>
To: <chagas-pcvc@pcvc.sminter.com.ar>
Subject: RE: [CHAGAS-PCVC] Megavisceras y Chagas/Megaviscera and Chagas
Date: Mon, 22 Nov 1999 08:03:16 -0200

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.


Mon, 22 Nov 1999 16:56:28 -0200
Message-ID: <001a01bf3512$fcc1b560$e437e6c8@jmr>
From: "Joffre Marcondes de Rezende" <jmrezende@mail.cultura.com.br>
To: <chagas-pcvc@pcvc.sminter.com.ar>
Subject: Megavisceras y Chagas / Megaviscera and Chagas

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

================================================================================

Useful address on the web
=========================

National Stroke Association
http://www.stroke.org

Its an official  Site  from the National Stroke Association. The site includes
information for patients and professionals. In 
the professional Item, professional resources there are guidelines related with
the management of the stroke during the first h
ours, and other interesting and useful tools.

================================================================================

HOAX VIRUSES

One of the most outstanding features that it is possible to see in what it may
be called "the Internet phenomenon", is the bonds established among the members
of the global net.
A sound proof of this are the FVCC's own development, the day by day growth of
its Thematic Forums, and the evolution of the historical Cardiology Lists, such
as Cardio-L, ProCOR, CardioConcert.
Along with this phenomenon, another one is observed, a kind of solidarity that
is established between participants, that in turn is accompanied by a marginal
product.
Thus, as our mailboxes receive periodically moving messages that beg, for
instance, to gather "240 blood donors" for the brother of a scientist, affected
by a strange disease, about which only three cases are known in the whole
world, and invite to go to a real Blood Bank in a near time and date, and ask
to please spread the content of the solidarity request, among acquaintances.
Another frequent visitor in our e-mailboxes, are the messages that warn us
about destructive virus that could reach our computers, using as vehicle other
messages, and the request for us to echo the warning by spreading it in all the
e-mail addresses that we have in our agenda, and their owners to whom we only
wish them "well".
Let's see some examples of this:

Irina HOAX
"There is a computer virus that is being sent across the Internet. If you
receive an e-mail message with the subject line "Irina", DONOT read the
message. DELETE it immediately. Some miscreant is sending people files under
the title "Irina". If you receive this mail or file, do not download it. It has
a virus that rewrites your hard drive, obliterating anything on it. Please be
careful and forward this mail to anyone you care about. (Information received
from the Professor Edward Prideaux, College of Slavonic Studies, London)".

Deeyenda HOAX
"VERY IMPORTANT INFORMATION, PLEASE READ! There is a computer virus that is
being sent across the Internet. If you receive an email message with the
subject line "Deeyenda", DO NOT read the message, DELETE it immediately! Some
miscreant is sending email under the title "Deeyenda" nationwide, if you get
anything like this DON'T DOWNLOAD THE FILE! It has a virus that rewrites your
hard drive, obliterates anything on it. Please be careful and forward this
e-mail to anyone you care about. Please read the message below. Alex"

These messages, written in an appropriate language, therefore they appear
credible (that provides them with credibility to the eyes of those who receive
them), are FALSE and are in fact the "disease itself" about which they
apparently warn, our own feelings of solidarity being the via for spreading,
when we forward their content to all e-mail addresses close at hand.
These Viruses are called mystical, HOAX or False Viruses.
Other examples that we have taken from sites devoted to this problem, and that
are still circulating between us, could be the following:

* Virus KATIUSKA Hoax
* Irina Hoax
* PKZ300 Warning
* Ghost Warning
* NaughtyRobot Warning
* Join the Crew Warning
* AOL4FREE
* A.I.D.S. Virus Hoax
* Win A Holiday
* BUDSAVER.EXE

That is to say, these "viruses" in fact do not exist. The better "vaccine"
against them is to ignore this kind of messages.

How to identify them?
This information comes textually from the Computer Incident Advisory Capability
(CIAC) from the U. S. Department of Energy.

http://ciac.llnl.gov/ciac/CIACHoaxes.html

There are several methods to identify virus hoaxes, but first let us consider
what makes a successful hoax on the Internet. There are two known factors that
make a successful virus hoax, they are: (1) technical sounding language, and
(2) credibility by association. If the warning uses the proper technical
jargon, most individuals, including technologically savy individuals, tend to
believe the warning is real. For example, the Good Times hoax says that "...if
the program is not stopped, the computer's processor will be placed in an
nth-complexity infinite binary loop which can severely damage the processor...".
The first time you read this, it sounds like it might be something real. With a
little research, you find that there is no such thing as an nth-complexity
infinite binary loop and that processors are designed to run loops for weeks at
a time without damage.
When we say credibility by association we are referring to those who sent the
warning. If the janitor at a large technological organization sends a
warning to someone outside of that organization, people on the outside tend to
believe the warning because the company should know about those things. Even
though the person sending the warning may not have a clue what he is talking
about, the prestige of the company backs the warning, making it appear real. If
a manager at the company sends the warning, the message is  double backed by the
company's and the manager's reputations.
Individuals should also be especially alert if the warning urges you to pass it
on to your friends. This should raise a red flag that the warning may be a
hoax. Another flag to watch for is when the warning indicates that it is a
Federal Communication Commission (FCC) warning. According to the FCC, they have
not and never will disseminate warnings on viruses. It is not part of their
job.

Then it is good to remember that no virus can come in the text of a message.
They can, on the other hand, come in an attached file that is received along
with a message, and in these cases, the best protection is to mistrust, and NOT
TO RUN any attached file that we receive from unknown, and even known sources,
when we were not previously informed of the attachment.

The following are addresses on the Internet, where everyone interested can
continue researching the subject:

http://ciac.llnl.gov/ciac/CIACHoaxes.html"
http://www.fcc.gov/Bureaus/Miscellaneous/Public_Notices/pnmc5036.txt

Another useful web site is the "Computer Virus Myths home page"
(http://www.kumite.com/myths/) which contains descriptions of several known
hoaxes. In most cases, common sense would eliminate Internet hoaxes.

==============================================================================

NEWS LECTURES

In Web pages at:

http://www.fac.com.ar/cvirtual
http://pcvc.sminter.com.ar/cvirtual
(All of them are available also by FTPMail)

(Speaker - Title - FTPMail code - Language):

Acute renal failure in ischemic nephropathy
Rodicio Jose L., Alcazar, Jose M.
htm0908i.zip - English

Complicated Endoprosthesis in an AAA: Case presentation
Endoprotesis complicada en A.A.A.: Presentacion del caso
Mendiz, Oscar
iat1p1i.zip - English
iat1p1c.zip - Spanish

Complicated Endoprosthesis in an AAA: 1st Opinion: Krajcer, Zvonimir
Endoprotesis complicada en A.A.A.: 1ra opinion: Krajcer, Zvonimir
iat1o1i.zip - English
iat1o1c.zip - Spanish

Complicated Endoprosthesis in an AAA: Case resolution
Endoprotesis complicada en A.A.A.: Resolucion del caso
iat1o3i.zip - English
iat1o3c.zip - Spanish

Contemporary Cardiac Rehabilitation Services
Franklin, Barry A.
cem3902i - English

Curso de Arritmias: 3ra clase
Gonzalez Zuelgaray, Jorge
Trastornos de conduccion
cla3cuar.zip - Spanish

Curso de Arritmias: 4ta clase
Reyes Caorsi, Walter
Disfunción Sinoauricular. Curso de Arritmias, 4ta clase
cla4cuar.zip - Spanish

Estres y Enfermedad Cardiovascular
Boskis, Bernardo
gac6602c.zip - Spanish

Exercise and the heart: safety of medically supervised outpatient cardiac
rehabilitation exercise therapy. A 16-Year follow-up
Franklin, Barry A.
cem3903i - English

Hipertrofia ventricular izquierda y su regresión en la hipertensión arterial
Villamil, Alberto
htm0910c.zip - Spanish

La actividad fisica en la rehabilitacion de las arteriopatias perifericas
Franchella, Jorge E
cem3902.zip - Spanish

Neuro-spect evaluation of carotid stenosis before and after angioplasty and
stenting
Mena Francisco J.
mnm3007i.zip - English

New concepts and paradigms in cardiovascular medicine: the noninvasive
management of coronary artery disease
Gould, K. Lance
cim0610i - English

Panorama de la practica actual de la medicina y de nuestra sociedad
Favaloro, Rene
chc5704c.zip Spanish

Prevencion de la muerte subita a traves de educacion a la comunidad: Resultados
de una encuesta
Lopez, Carlos A.
tcc5111c.zip - Spanish

Remodeling of Resistance Arteries in Hypertensive Patients: Effects of
Antihypertensive Therapy.
Schiffrin , Ernesto L.
htm0907i.zip - English

Tobacco: Seducing the young II: the assault increases
Lown, Bernard
6301i5b.zip - English

Usefulness of Eco-stress in mitral valvulopathy
Utilidad del estres-eco en la valvulopatia mitral
Sanchez Osella, Oscar Francisco
doc3095i.zip - English
doc3095c.zip - Spanish

================================================================================

The Deutsche Bank (http://www.deutsche-bank.de/congress) supports the
Newsletter of the
First Virtual Congress of Cardiology.

<><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><>

Editor: Alfredo Piombo, M.D. (Argentina)
Chief of the Coronary Care Unit. Cosme Argerich Hospital,
Buenos Aires, Argentina
Associate Editors:
Claudio Gimpelewicz, M.D. (Argentina)
Dante Manyari, M.D. (Canada)
Carlos Basualdo, M.D. (Canada)

Edgardo Schapachnik, M.D.
Vicepresident of the FVCC Steering Committee



--------------------------------------------------------------------------
Letter to Editors:  readers@pcvc.sminter.com.ar
Send commands to majordomo@pcvc.sminter.com.ar
Others: owner-newsletter-fvcc@pcvc.sminter.com.ar

Top

----------------------------------------------------------------
Newsletter - 1st Virtual Congress of Cardiology
----------------------------------------------------------------
Year 1, number 11. Second two weeks, November 1999.

================================================================================

Biweekly electronic publication of the First Virtual Congress of Cardiology, for
purposes of promotion and interchange of topics of interest in cardiac sciences
and news from the Congress. It is distributed free of charge to everyone
subscribed. Those of English speaking origin may subscribe sending an e-mail to:

majordomo@pcvc.sminter.com.ar

with the following message in the body of the e-mail:

subscribe fvcc-newsletter

If you ever want to unsubscribe, you can send the following command in the body
of your email message to

majordomo@pcvc.sminter.com.ar:

unsubscribe fvcc-newsletter

An Spanish version is available for those of Spanish speaking origin.
Contributions are welcomed; also responses to previously published articles, and
commentaries should be send as Letters to:

readers@pcvc.sminter.com.ar

===============================================================================

Cardiovascular colleague: announce in your medical center the First Virtual
Congress of Cardiology to start soon.

===============================================================================

Previous issues at:

http://www.fac.com.ar/cvirtual/newslett/newseng.htm


===============================================================================

"Eradication of smoking is the most effective means to improve the health in the
population of both developed and developing countries."

From this column, we propose the FVCC to be free of tobacco smoke.

Colleague: if you are still a smoker, we will thank you if you abstain from it
while you participate in the activities of our Congress, and we invite you to
get in touch with us, so that your attempts tostop turn out to be successful.

===============================================================================

CONTENTS

Brief Communications
Editorial

From the Forums

Useful address on the web

The Bubbleboy Virus
FVCC Steering Committee´s member

News Lectures and Brief Communications

Space available for Advertisement.

================================================================================

The Deutsche Bank  (http://www.deutsche-bank.de/congress) supports the
Newsletter of the First Virtual Congress of Cardiology.

===============================================================================

BRIEF COMMUNICATIONS

From  a total of 521 brief communications submitted, 422 were accepted by the
reviewers  appointed by the Scientific Committee.
So far, 130 authors and research teams chose to send their complete
publications, many of them in two languages. A large group will compete for the
Prizes to be awarded to the best scientific works.
From November 1st, 1999, and gradually, the authors will see their submissions
published, and the general public, made up by the 6000 current participants who
registered, plus those who are added day by day, will be able to express their
opinion, discuss, disagree, agree with the conclusions presented.
In an unprecedented fashion, several hundred authors and research teams
currently have, and will have the possibility for their scientific ideas to be
exposed and known as never before in a Congress "in person": once published, the
Brief Communications remain in the web, and the FVCC provides the natural
channels, the Thematic Forums, to discuss about them.
The authors have the opportunity to divulge their research throughout the whole
world.
Internet provides this opportunity

The authors have in their hands the possibility of spreading their
contributions. Each published work has a codified web address, and nothing
prevents participants from showing it to their colleagues, at hospitals where
they work, at Institutions to where they belong, in Forums in which they
participate. Nothing prevents them from generating a debate around their
discoveries in the Forums of the FVCC.
Not all authors seem to understand these opportunities, and they do not seem to
realize the potential of the tool they have in their hands: thus, not all
authors and co-authors have registered in the respective Forums where their
presentations will be discussed (or not).
Internet changes the rules of the game: the author is no longer just the person
who signs a publication. Today, s/he is an active and responsible individual
that will have to account for his/her sayings and conclusions if colleagues
request it. Interactivity in the Forums need authors who are alert and well
disposed for debate and controversy. The FVCC provides the channel for
expression.
Since the very moment in which the call was made for authors to publish their
works, it was clear that a distinctive sign in this Congress should be achieved
by providing permanent public galleries for comparing ideas at the highest
level.
Finally, as a third indispensable point, the public: the colleagues registered
in the FVCC, whether they are physicians, nurses, students, technicians in
cardiology, Newsletter readers, must be a committed public.
Owning a powerful instrument, namely being a member of a Forum, provides
unquestionable benefits in the process of continual education, and the exchange
with peers, and also generates responsibilities.
This is not just about receiving in your own computer the opinion of qualified
lecturers. About having at your disposition 422 presentations from all over the
world. Instead, this is most of all, about accounting for the use that this
knowledge will be put to. Expressing your opinion. Turning into an active
individual that questions, asks, interacts, argues, requests.
It is because of this that you must realize that you hold the leading role. To
be the final recipient of this scientific-educational effort provides you with
the tool of participation; it is because of this that you must use it for
collective benefit.
Generating scientific deeds and knowledge -in this case, the process that ends
up in an author writing a Brief Communication-, the channel that allows to
express them and share them - the FVCC-, and the critical analysis by the
public, make up a harmonious whole that can change knowledge itself.
Because of this, Brief Communications will hold the hierarchical place they
deserve, within the framework of the First Virtual Congress of Cardiology.

Dr. Edgardo Schapachnik

==============================================================================

FROM THE FORUMS

This section reflexes the participation of the colleagues in the different
Thematic Forums

CORONARY

Friends of the list:
I want to know the management you would adopt faced with the following case:
Male sex patient, 50 years, diabetic, moderated obesity, dyslipidemia, smoker,
stress, that is admitted in Coronary Unit 20 minutes after a typical inferior
infarction  (D2, D3, and avF) had started, this being his first vascular event,
without previous angina.
The patient is still in pain, hemodynamically stable. That is to say, this is
one of the usual infarctions of diaphragmatic face, without complications until
the moment of admittance.
We have streptokinase available, as well as a trained service of Interventional
Hemodynamics, that can study, and if necessary proceed with angioplasty within
the next hour.
The question is: for you, which is the best management?
-Medical treatment?
-Fibrinolysis?
-Angioplasty?
This question is addressed to interven-pcvc, and also to coronary-pcvc.
Thanks,
Dr Mario A Heñin

Dear Dr. Mario:
Recently I read in New England an interesting work about the subject, that
compares the use of primary angioplasty vs. fibrinolysis (streptokinase) in
management of infarction. It says that in a period of 5 years there was an 87%
of survival in the group that underwent primary angioplasty, while the group
treated with STK had a 76%, besides, rates of readmissions due to new ischemic
events or that evolved into heart failure were also lower. It also says that,
although primary angioplasty seems more expensive at first sight, a longer
follow up reveals that there will be a saving of US$ 3,112 for each patient. The
reference of the text is: Long-term outcome better with primary angioplasty than
thrombolysis for MI - N Engl J Med 1999;341:1413-1419
I also think that what should prevail is the experience of the service. Thus,
if it has a good experience with primary angioplasty, and has a good
hemodynamics service, that would be the best indication; but if not so, thinking
about diminishing risks of the period of time until the patient receives a
definitive treatment, the best choice would be fibrinolysis treatment.
Greetings,

Marcos Aurelio
Brasil - FAMERP

Dear Mario:
In the case you posed, it would be important to know if the ECG presents changes
in other derivations besides DII, DIII, and avF. The presence of subleveling in
the ST segment in precordial derivations and supraleveling of it in V3R or V4R
would point a larger threatened area, and they would clearly lead me to indicate
a reperfusion treatment.
In absence of such changes, what is little frequent, the basal risk is very
low, and because of this the ratio risk/benefit is very close to one, and in
this case I would choose a conventional treatment that included aspirin.
In case of indicating a reperfusion therapy, I would choose thrombolysis, with
only one exception: if the patient presented contraindications or hemodynamic
deterioration. Coronary angioplasty does not seem to be the procedure of choice
in low risk patients, and specifically in inferior infarction, clinical
superiority has not been demonstrated when compared to thrombolysis.

Alfredo C. Piombo.


Hello, Mario:
About your question.
To date, we reinforced evidence that PTCA is better than thrombolysis with STK,
since the interesting article by Dr. Zijlastra that appears in NEJM, Nov 4-99,
bring us the benefits of this strategy (PTCA) over thrombolysis in long term (5
years), because, even though the benefits are very slight in terms of mortality
at 30 days with a 1% vs. 7% (in PTCA vs. STK), interventional therapies look
more appropriate, today even more, with the benefits of other advancements, like
GPIIb/IIIa inhibitors, etc. (that were not considered in the work in NEJM,
because it was performed between 1990 and 1993) but that leads us to consider
the benefits from interventionism in this times.
Consequently, nowadays, the evidence of this article is TYPE I and A
recommendation, to perform PTCA instead of thrombolysis, when the two
possibilities are available.

ATTACHMENT: SEE ARTICLE IN NEJM:
http://www.nejm.org/content/1999/0341/0019/1413.asp

MARISOL BADIEL, MD
Oficina de investigaciones y epidemiologia clinica
Unidad cardiovascular
Fundación Clinica Valle del Lili
www.cardiolili.org


Dear Dr. Henin:

About the patient that you mention in your e-mail message, he is one of the
typical cases that usually show up to debate different strategies faced with an
infarction in the hyperacute stage.
The first option that you propose is medical treatment, I suppose that you mean
to treat him without using reperfusion resources. I think that this topic is
almost no longer debated. As I see it, it is clear that this particular case
will benefit with any reperfusion strategy, and I would not leave him without a
timely and appropriate treatment. About which strategy I would use, whether it
is pharmacological or mechanical, I think that you are more appropriate than I
or anyone else to decide about it. You are faced with a patient within the
first hour, what implies that whatever the strategy used, it will save muscle
(and a lot). If the interventional team that you have can organize quickly, and
does not get delayed due to logistic problems, you can send your patient
immediately to the hemodynamic lab. If instead, you think that the team
might be delayed, I would not waste time, and treat him pharmacologically.

Although your patient is in intermediate or low risk during his hospital stage,
I think that it is not so in the long term, and I would begin now to outline a
proper risk stratification strategy post-AMI, as well as modulating, as much as
possible, his marked risk factors, that in this particular case are numerous,
and surely will determine the future prognosis.

Summarizing, I would not hesitate, and I would try to reperfuse your patient as
soon as possible, with the measures that best fit your practice and center.

It was a pleasure to take part in this exercise with you.

Sincerely,

Rafael Diaz


Dear collegues:
About the case presented by Dr. Henin (inferior AMI, less than 1 hour) I have
observed that most messages state that it would be important to reperfuse it.
And among the proposed options, the most accepted one seems to be the
interventional (if there is a qualified operator, capable of opening the vessel
within an hour).
If this is valid for a patient with inferior AMI not complicated, I think that
all the more, it should be applicable to an inferior AMI with anterior ST
subleveling, anterior AMI, second AMI, AMI non Q, AMI with cardiogenic shock;
since in these cases, either thrombolysis is less effective, or there is
evidence that primary PTCA would be a more effective treatment. If so,
what happens with the controversy: "thrombolysis vs. PTCA in AMI"? Could it be
resumed with the sentence: "In all AMI, primary PTCA is indicated, except when
there is no team of interventionists available, capable of performing PTCA
quickly and efficiently, in which case the second option would be thrombolysis"?

Dr. Raul Bretal
La Plata - Argentina


From:"Carlos Federico Ziehr" <cfziehr@intramed.net.ar>
To: coronary-pcvc@pcvc.sminter.com.ar
Date:Domingo 07/11/1999
Subject: IAM. Tratamiento posterior

Dear friends of the FORUM:
I agree with the different opinions expressed regarding acute treatment of AMI,
but we should not forget that after 50 or 60 days of discharging, is necessary
to give the patient a treatment for Cardiovascular Rehabilitation, along with
the basic medication.
The subject is a complicated patient with several risk factors, consequently
s/he needs a change in habits, both eating as behavioral, performing physical
activity, and psychological support.
I hope that this opinion is shared by you.
Sincerely,

Dr. Carlos Federico Ziehr
Centro de RHCV de la Unidad de Cardiologia del Hospital Dr. Iriarte
Quilmes, Argentina.


My dear colleague, Mario:
About the case that you propose, I would not hesitate to send the patient to
hemodynamics, if I had immediate access to it.
It is a young patient, with high coronary risk, that persists with painful
symptomatology, a fact that would indicate clinically, ischemic myocardium. I
would not label the risk based on the AMI topography, since it is very frequent
to observe in this kind of patients, that begin as an accident of platelet of
only vessel, and in the angiography study present disease of multiple vessels,
and many of them end in surgery.
However, the benefits of angioplasty over thrombolysis are currently
demonstrated. The vessel must be kept open, and therefore faced with the
possibility of hemodynamics of immediate access, I would take the invasive
choice (?).
But I do not dismiss thrombolysis if I have the possibility of accessing it.
Independently from that, the patient would end with an angiography study.
Sincerely,

Dr.Nazar Rodolfo


De:Carlos Enrique Fullone <cef@intramed.net.ar>
Para:coronary-pcvc.sminter.com.ar
Fecha:9 Nov 1999 00:26
Tema: Infarto agudo de miocardio. Conducta

Dear colleague:
This infarction, as you describe it, has an excellent prognosis in acute.
Personally, I would proceed with thrombolysis, based in the following
considerations:
1) It is cheaper
2) It is probably a right coronary, consequently angioplasty has better results.
3) In spite of the absence of previous angina, this is a patient with multiple
risk factors, and especially, diabetic, because of this I would not dismiss that
he had the three vessels disease. Therefore, after his AMI evolution, it would
be very strict in the treatment of all these factors, and in the study, scanning
and possible CAG, since he may be a candidate for revascularization surgery.
4) With this supposition, if in catheterization in acute we observe severe
three vessels disease, we would not be able to perform in acute
arevascularization surgery, and to carry out in this period of time an
angioplasty, could complicate the situation even more. Let us think
of a possible obstruction in acute, what would be, and how it would enlarge the
infarction area, and maybe even involve a vital collateral circulation. On the
other hand, if we perform coronary angiography, and observe this, and decide not
to proceed with angioplasty, we would have missed the chance of fibrinolysis.
5) The lack of previous angina being a diabetic, it is not a hint of previous
coronary health.
A few weeks ago, I did a preoperative test of surgical risk for an elective
cholecystectomy in a diabetic patient, that never suffered angina. He had a
sequel of inferior AMI that of course he ignored, high ischemic risk in the
thallium, and severe three vessels disease. I ended up changing biliary surgery
for a revascularization.
6) On the other hand, as simple cardiologist, in this moment there is a
controversy that is not defined between angioplasty in acute, and
pharmacological fibrinolysis.
Therefore, to me, until a very evident supremacy, and enduring in time is
achieved between both procedures, I will state that both are more or less
equivalent, and that difference in favor of one or another is a statistical
delicacy. Within this context, I choose the cheapest and most accessible for
everyone.
I hope I have somewhat been useful.
Hugs,

Dr. Carlos Enrique Fullone


Dear colleagues:
I think that Dr. Mario Henin's clinic example is extremely appropriate because
it faces us with a real dilemma about what to do. To begin with, let us agree in
that in absence of other risk predictors, strict inferior infarction is of such
good prognosis that not even fibrinolysis seems justified, let alone resisting a
cost/benefit analysis.
Assuming that the patient does not have increased risk predictors (previous
infarction, involvement of LV, diabetes, etc.) my choice, though arguable, would
be based in how early the event is, and probably I would tend to perform a
coronary angiography.
If it was a right coronary artery, not very large, or a ramus of it without
other coronary lesions, this would confirm the low risk, and I would not
hesitate in touching it, even with TIMI 0.
If, on the contrary, and as it frequently happens, the size of the vessel and
its tributary myocardium were large than what is to be expected due to
electrocardiographic involvement, the intervention would be extremely justified.

Dr. Daniel Berrocal
Buenos Aires - Argentina


De:Alfredo C. Piombo [apiombo@intramed.net.ar]
Para:coronary-pcvc@pcvc.sminter.com.ar
Fecha:martes 9/11/99 14:59
Tema: IAM. Conducta

Dear Mario:
Sincerely I did not expect that your question would generate so many different
answers. Obviously, the matter goes beyond the anecdote to present us with a
situation much deeper: information and its handling.
I have noticed in most colleagues that their answers are based in their own
experience, and not in scientific evidence. Otherwise, how can it be posed the
angiography study in a patient that is in evolution of one of the infarctions of
lowest risk? What randomized clinical study supports this management? What
scientific society, national or international recommends this kind of
management?
From where it emerges that all infarctions must be studied by angiography? USA
is carrying out coronary angiographies in AMI in an amount enormously above
other countries like Canada.
However, they have the same mortality. The same happens with unstable angina.
When talking about primary angioplasty, who has the same results as the small
PAMI study?
The study GUSTO II-b would not be more representative, that after 6 months does
not find any difference between thrombolysis and angioplasty, not even in the
triple end-point of death, reinfarction, and stroke?
If the largest meta-analysis carried out on thrombolysis in AMI (the FTT) does
not find differences in patients with inferior AMI (8.4% vs. 7.5%, 2p=0.08), the
reason may be that not all inferior infarctions are equal, since some benefit
and others do not? Least of all has been demonstrated that angioplasty reduces
mortality in inferior infarction.
Therefore, beyond the anecdote, I think that as physicians it is our duty and
our commitment to distinguish the levels of risk in our patients, so that we can
manage rationally the health resources, that are always limited (in any country
of the world).
No treatment in medicine is for everyone, and it is good that it is so,
otherwise our profession would be unbearably boring.

Sincerely,
Alfredo C. Piombo

--------------------------------------------------------------------------------

HYPERTENSION

From: Dr. Pablo Rodriguez <prodriguez@roche.com.ar>
To: <hbp-pcvc@pcvc.sminter.com.ar>
Subject: Aumento del riesgo al disminuir la presion diastolica?
Date: Mon, 1 Nov 1999 16:03:35 -0300

Increase in risk of ischemic events, both at cerebral and coronary level, as a
secondary effect of decrease of diastolic pressure, is not a new finding, taking
into consideration that Cruishank in an article, some years ago, showed the
existence of a curve in J, in which the risk of coronary events increased when
DAP decreased under 70mmHg., which coincides with what is expressed in the
article quoted by Dr. Peleteiro. On the other hand, it is also known that
those patients that present an excessive nightly decrease in blood pressure,
just as it can be demonstrated by a Blood Pressure Ambulatory Monitoring, have
an increase in prevalence of lacunar infarctions at cerebral level. This
analysis of the results from SHEP, supports these previous findings. I agree
with the possible physiopathologic mechanisms mentioned by Dr. Gomez Llambi.
However, I think it is convenient to make some things clear that I consider
important:
1. The SHEP study included patients with isolated systolic blood hypertension,
and therefore, its design and therapeutic aims were based in this condition. To
expect an extrapolation of other results from this study can turn out
inconvenient because it is known that from the statistical point of view, the
aims of each study must be clear from the very beginning, and the design of such
study must be carried out trying to meet those aims.
Sub-analysis of some studies, performed years after it, and studying aims that
were not previously specified, can invalidate the results obtained in this
secondary analysis.
2. One of the aims of the HOT study was to assess the presence of a curve in J
in the patients treated for their blood hypertension, using as target different
values of DAP.
Although the HOT study could not provide an answer to this aim, due to its
results, it proved that the patients in whom decrease of blood pressure was more
intensive, clearly showed a better quality of life.
On the other hand, no tendency to an excess of morbimortality was demonstrated,
in any of the groups compared to others.
There is no doubt that this topic is controversial, and studies with specific
designs are required to prove its truthfulness.

Pablo D. Rodriguez - Buenos Aires - Argentina

--------------------------------------------------------------------------------

CARDIOVASCULAR FARMACOLOGY

Estatines in primary and secondary prevention of atherosclerotic cardiovascular
disease. Facts and controversy.

I answer Dr. Schapachnik statements by telling him that the different clinical
studies (4S, WOSCOPS, CARE, etc.) and that you, as specialists, know more about
clinical management that derive from them, have displayed tolerance in long
term, and proven effectiveness that make statins, the drugs of choice in
hypercholesterolemia. As atorvastatin was the last to be introduced for use, the
available experience is more limited, which is no reason to consider it as an
"object to be careful with", on the contrary, several tests aim to regard
it as the first choice between all statins. Let's see:
1) Statins, regarding reduction of total cholesterol, are equally effective,
behavior is dependent on doses (see fig. 2 in my first message*), therefore any
difference observed between each one of them, is a question of potency (e.g.:
10 mg of atorvastatin produce the same decrease of total cholesterol, and
LDL-cholesterol than 20 mg of simvastatin).
However, regarding reduction of total triglycerides, and circulating Apo B,
atorvastatin is more efficient (reduces significantly its plasmatic values
compared to the rest of statins, even using greater doses of the latter).
2) Statins are usually associated to resins and wrongly combined to fibrates
(see interactions) to obtain heightening of effects in non controlled severe
hypercholesterolemias, type IIa, or accompanied by hypertriglyceridemias type
IIb (although we must take into account that triglycerides are not an evident
risk factor in cardiovascular disease like cholesterol). Atorvastatin, by being
more potent, and having superior effects on triglycerides allows to prevent such
associations, this resulting in a better compliance (above all for patients that
have to receive resins) and in a lower occurrence of adverse effects.
3) Effects of statins on the circulating fibrinogen are controversial; according
to clinical trials this increases, decreases or is not modified due to the
action of these drugs, therefore being difficult to draw conclusions about it,
or to tell which statin is better; even more considering that the fibrinogen is
an independent cardiovascular risk factor.

The explanation of differential behavior of atorvastatin is pharmacodynamics
and pharmacokynetics: Regarding pharmacodynamics, atorvastatin reduces Apo-B
values, which indicates a lower proportion of circulating VLDL (less amount
of triglycerides) with less conversion to LDL; likewise, it is proposed that
this would result in a lower size of LDL (greater clearance of these?). This
explains why is more effective than the rest to reduce triglycerides.

Regarding pharmacokynetics, the larger time of mean residence of atorvastatin
compared to the rest (time that the drug remains in the organism with effective
plasmatic concentrations), the larger mean life, or the activity of its
metabolites, would explain the greater potency observed.

Summarizing, data aim to consider atorvastatin as the best drug of the group,
due to being more potent in reduction of total cholesterol, and LDL-cholesterol,
due to being more effective in reduction of triglycerides, and due to the
possibility of using it as the only drug to obtain the same effects, instead of
obtaining them by use of dangerous associations.
In diabetic, dyslipemic patients there are no preferences to use a particular
statin. However, considering what has been commented, atorvastatin could be the
best choice, since in diabetic patients important hypertriglyceridemias are
observed. The only commentary (recommendation if you wish) that I want to make
to the audience, is about the possible interactions. If the diabetic patient
receives insulin or metformine (that casually also improves the lipid profile,
and reduces obesity in these patients) there is no problem in him/her receiving
a statin. If s/he receives sulfonylureas, carefulness must be maximized, and
properly adjust the doses of 1 glycemia lowering agent because statins can
displace it from its proteic union and cause hypoglycemia. Finally, if s/he
receives troglitazone or other drug from the group, s/he must not receive
statins along with it (consider which one must be removed from the therapeutic
schema) because risk of hepatotoxicity is increased.

Thanks,

Dr. Alejandro Serra

* The images of the discussion by Dr. Alejandro Serra, are published in the
files of the list; for this you should access the web page in Scientific
Activities, from there go to the Discussion Forum, afterwards to the mailing
lists files, and finally to pharma-pcvc images.

================================================================================

NEW SECTION

New Section: Interventional CV Rounds. Several interesting cases will be
published about cardiovascular interventionism, and also opinions from
international experts about them. All participants can take part in it, by
sending their questions, opinions, and commentaries to

interven-pcvc@pcvc.sminter.com.ar

The methodology for presentation will be:
First week: case presentation
Second and third weeks: commentaries made by international experts.
Fourth week: solution of the case
This week: Case number 1: Complicated Endoprosthesis in an AAA, presented by
Dr. Oscar Mendiz

http://pcvc.sminter.com.ar/cvirtual/llave/activ.htm#interv

================================================================================

Registration to the First Virtual Cardiology Congress is free
and everyone registered will get a CD with all material
published at the Congress. All interested may be registered
using an individual or a group e-mail address.
Announce the FVCC at your Center.

================================================================================

Useful address on the web-Cardiology Links
==========================================

HeartWeb
http://www.heartweb.org

Its a Site  with  Cardiology issues. It includes case reports , open forum,
database information and Medline Free. Also it includes also a "Peer- Review
Cardiology Journal". The articles of the  journal, are mainly oriented in
electrophysiology. You can find the Abstract of  PACE (Pacing and clinical
electrophysiology) magazine since 1996. Free Subscription.

================================================================================

BUBBLEBOY VIRUS

A new virus, one of the so-called worms, has been reported very recently, and
it is extremely dangerous, since it is executed when opening the message in
which arrives. This information comes from Jesus de las Heras, one of the people
responsible for RedIRIS, the Computer Net of the Spanish Academic Community.

NAME: Bubbleboy written in V B Script
---------
SUBJECT: Bubbleboy is back!
-------------
To execute itself, it uses some vulnerable points related to MS Outlook and MS
Outlook Express, in systems with Windows Scripts Host (W98, W2000, and W95
systems that have it installed) and Internet Explorer 5.

It is capable of activating itself without the user executing, opening, or even
saving in his disk any kind of attached file received.

Unlike the way Internet worms usually operate, Bubbleboy does not reach the
victim's computer in an attached file, but it is executed when opening the
infected message installing the Update.hta file in the system, so as to be run
in the following booting of the former. In the case of Microsoft Outlook
Express, the infection is carried out only by having the "Preview" option acti
vated.

Because  it is written in V B Script, it runs as soon as the e-mail message
that contains it is opened. When Update.hta is run, it proceeds to modify the
name of the registered user from Outlook to "Bubbleboy" (modifying the register
of Windows: Registered Owner, and Registered Organization) and the name of the
company registered to "Vandelay Industries". Once these changes are carried
out, the worm sends itself to all the addresses contained in all and each one of
Outlook's books of addresses.
After the messages are sent, to avoid sending them again, the worm creates an
entry (key) in the Windows register:

HKLM\Software\OUTLOOK.BubbleBoy\="OUTLOOK.BubbleBoy 1.0 by Zulu"

Finally, the worm displays a window in the screen with the following text:

"System error, delete "UPDATE.HTA" from the startup folder to solve this
problem."

The sender that appears in the message is the name of the affected user.

BubbleBoy will be useless in the computers that:

a) Do not use Outlook products by Microsoft range.
b) Do not have active the execution of ActiveX commands.
c) Have deactivated the recognition of "HTA" files.
d) Do not have its system directories in C: \WINDOWS
e) Run a version of Windows that is not English or Spanish
f) Do not make an active use of the book addresses

This Internet worm does not have any kind of destructive routine.

STEPS FOR PREVENTION
-----------
a) Do not open (= read) any message that reaches the mailbox of your Outlook if
the subject of it is "BubbleBoy is back!", even if the person that sends it to
you is someone known to you, or your friend
b) Install the patch that Microsoft has put at disposal of all users of Windows
from the URL:
http://support.microsoft.com/support/kb/articles/Q240/3/08.ASP

c) If do not usually use HTML applications (HTA files), it is possible to
deactivate its association to Internet Explorer
c1) Double click in "My PC"
c2) Menu "See" -> "Options (from folder)".
c3) Tag "Type of file"
c4) List "Type of registered files"
c5) Select "HTML Application"
c6) "Clear" -> "OK" -> "Close"

d) Move the data contained in your book of addresses to any other support, so
as to prevent "BubbleBoy" from sending itself to any other user from you
computer, and thus stop its expansion.
e) If you have enough knowledge to alter the configuration register, create a
key with the following name and value:
HKLM\Software\OUTLOOK.BubbleBoy\="OUTLOOK.BubbleBoy 1.0 by Zulu"

In this way, "BubbleBoy", by checking in order not to send itself more than
once from a machine, will think that it has already acted in your computer.

HOW TO KNOW IF YOU ARE INFECTED
-----------
a) Unfold the menu "Start" of your computer, and check from the menus "Programs"
and "Start", the contents of this last folder.
If you find the file "UPDATE.HTA" inside, delete it without delay.
b) If by any circumstance you have ignored, or have not paid attention to the
presence of the window that "BubbleBoy" shows after having sent itself by
e-mail to other machines from yours, it is possible to verify some hint of a
past viral activity looking for the following key in the register of
configurations of Windows through the option "Search" (menu "Edition" or Ctrl+B)
of the program "regedit.exe" that you can find in the Windows directory of your
computer: HKLM\Software\OUTLOOK.BubbleBoy\="OUTLOOK.BubbleBoy 1.0 by Zulu"

c) Continuing with the casuistry of the previous example, it is possible to
verify the user name and the company to which his/her copy of windows is
registered, through the option of menu "About Windows" that you will find, for
example, in the menu "Help" of the Windows Explorer.

To clean this worm from the infected systems, it is indispensable to delete the
script Update.hta system. To do this, it is only necessary to search for the
script in Windows (through a simple "search files or folders") and to delete it
once found.

CONSULTED SOURCES
----------------

http://www.mcafee.com/viruses/bubbleboy
http://www.virusbtn.com/VirusInformation/bbpy.html
http://vil.nai.com/vil/vbs10418.asp

==============================================================================

NEW LECTURES

In Web pages at:

http://www.fac.com.ar/cvirtual
http://pcvc.sminter.com.ar/cvirtual
(All of them are available also by FTPMail)

(Speaker - Title - FTPMail code - Language):

de Bold, Adolfo
La sutil diferencia entre el saber y el saber que hacer con el saber. Una tesis
profana sobre como competir en Ciencia y Tecnologia
chc5709c.zip Spanish

de la Serna, Fernando
Clinica de la insuficiencia cardiaca
icm0310c.zip Spanish

Escobar, Edgardo
Historia natural y pronostico de la miocardiopatia dilatada
icm0311c.zip Spanish

IAHF-FIC: Invited Symposium
Challenges for Pediatric Life Support
sfc6306i English
pedisupp.zip (PowerPoint File) English

Londero, Hugo; Bretal, Raul
Interventional Cardiovascular Rounds - Case 1
case1ip.zip English
Ateneos de Cardiologia Intervencionista - Caso 1
case1cp.zip Spanish

Lown, Bernard Tobacco
Seducing the young - I
6301i5a.zip English

Mendiz, Oscar A.
Carotid angioplasty: techniques with and without cerebral protection.
ptc3291i.zip English
Angioplastia carotidea: Tecnicas con y sin proteccion cerebral. Spanish
ptc3291c.zip  Spanish

Serra, Jose Luis
Fibrilacion Auricular e Insuficiencia Cardiaca
icm0311a.zip  Spanish


BRIEF COMMUNICATIONS

The following Brief Communications will be published in Web pages (also
available by FTPMail). Next release: Dec. 6

Title - Language - Authors - FTPMail code:
(i: English; c: Spanish; p: portuguese)
------------------------------------------

Cardiac Resonance. Our Experience.
English.
Alessio Eva; Fortuny M.Eugenia; Cedola Jorge; Ciucci Daniel; Alvarez Carlos;
Corsiglia Daniel.
tnn2591.zip

Surgery for correction of anterior left ventricular aneurysm.
English
Almeida R.M.S.S.A., Lima Jr. J.D., Bastos L.C., Flores E.Q, Loures D.
tnn2342.zip

Registo Nacional de Infarto Agudo de Miocardio Republica Dominicana. (RENIRD
1995/1998)
Spanish
Almonte, Claudio; Arias, Miguel; Ramirez, Wilson; Garcia, Santiago; Mateo,
Braulio; Guzman, Jose Delio;Chang, Marcial; Gonzalez, Ramona; Dominguez,Jeannet;
Lembert, Alexander; Santos, Victor;
tnn2745c.zip

Non-cardioplegic coronary surgery in patients with poor left ventricular
function
English
Antunes Manuel; Antunes Pedro; Ferrao de Oliveira Jose
tnn2383.zip

Staged operations for severe carotid and coronary occlusive disease.
English
Antunes Pedro; Ferrao de Oliveira Jose; Eugenio Luis; Antunes Manuel
tnn2381.zip

Coronary anastomosis with mechanical sutures: the VCS vascular clips. Initial
experience.
English
Aramendi JI, Otero A, Martinez P.
tnn2566.zip

Epidemiological data from the Heart Care Network Argentine. The First Argentine
Multicenter Program on Secondary Prevention in Cardiology.
English
Ballerio Fernando; Cabo Fustaret Marcela; Covelli Guillermo and HCNA
investigators
tnn2718.zip

Effects of Sotalol in reperfusion-induced arrhythmias.
English
Efectos del Sotalol sobre las arritmias de reperfusion.
Spanish
Batiz, L.F.; Ponce Zumino, A.; Baiardi, G.; Carrion, A.; Verdaguer, M.N.
tnn2677i.zip tnn2677c.zip

Major Role of P-wave Signal Averaged Electrocardiography in Predicting the
Occurrence of Atrial Fibrillation in Patients Undergoing Open Heart Surgery
English
Caravelli Paolo, Musumeci Giuseppe, Gherarducci Gherardo, Tartarini Giuseppe,
Mariotti Rita, Bortolotti Umberto, Mariani Mario.
tnn2423.zip

Asociacion del Indice de Masa Corporal y cifras de presion arterial en ninos de
4 a 12 anos de edad de una poblacion rural de Venezuela.
Spanish
Carbonell Di Mola Jose Antonio; Giannoni Delgado Luisana R.
tnn2302.zip

Celsior Cardioplegic Solution in Orthotopic Cardiac Transplantation. A
Comparative Study with Buckberg Solution.
English
Crespo, F.M.; Rodriguez Delgadillo, M.A.; Paladini, G.; Juffe Stein, A.
tnn2736.zip

Acute myocarditis: retrospective analysis in 28 patients.
English
Dallo Matias, Lema Luis, Zelaya Felix, Pacheco Guillermo, Sambuelli Ruben,
Conci Eduardo, Serra Cesar.
tnn2741.zip

Exceptional Patterns of the Wolff-Parkinson-White Syndrome in Rhythm and AV
Nodal Tachycardia that Confirm the Prinzmetal's Theory of Accelerated Conduction
English
Excepcionais Registros da Sindrome de Wolff-Parkinson-White no Ritmo e na
Taquicardia Nodal AV Confirmando a Teoria da Conduçao Acelerada de Prinzmetal.
Portuguese
de Mesquita Quintiliano H.; Baptista Claudio A. S.
tnn2346i.zip tnn2346p.zip

Clinic and pathologic study in 460 patients died with acute myocardial
infarction. Report of two series (1985-1987 and 1991-1993)
English
Estudio clinico-patologico en 460 fallecidos con infarto miocardico agudo.
Informe de dos series (1985-1987 y 1991-1993).
Spanish
Espinosa Brito Alfredo D, Alvarez Li Frank C, Borges Rodriguez Emilio, Quintana
Perez Santiago, Fernandez Turner Manuel
tnn2303i.zip  tnn2303c.zip

The Global Project of Cienfuegos. Ten Years after.
English
El Proyecto Global de Cienfuegos. Diez anos despues.
Spanish
Espinosa Brito Alfredo D; Ordunez Garcia Pedro O;. Alvarez Li Frank C; Diez
Martinez de la Cotera Emiliano; Armas Aguila Yamila; Espinosa Roca Alfredo A;
Vazquez Falcon Luis E; Marrero Perez Raul V
tnn2350i.zip tnn2350c.zip

Cardiotoxicidad en la intoxicacion por cocaina.
Spanish
Ferrer Marrero, Daisy; Sirgo Patino, Irene; Perez Alvarez, Halina; Montalvo
Vidal, Elisa
tnn2325.zip

Evaluation of a program for automatic interpretation of electrocardiograms.
English
Gonzalez Fernandez, Rene; Rivero Varona, Marta M.; Fernandez Nunez, Raisa
tnn2732.zip

Aplicacion de las Redes Neurales Artificiales en la Cancelacion de Ruido.
Spanish
Hernandez Montero Fidel Ernesto; Falcon Urquiaga Wilfredo.
tnn2328.zip

Extraccion y diseccion de la vena safena para su utilizacion como injerto
aorto-coronario con sistema endoscopico vasoview.
Spanish
Lara Juan; Cordera Silvia; Alvarez Miguel; Abdallah Abdul; Moreno Teo;
Lopez-Checa Salvador; Calleja Manuel; Santalla Antonio; Fernandez Rafael;
Telleria Alberto; Palacios Angela; Franco Rafael.
tnn2560.zip

Effects of a Transient Increase in Blood Pressure Upon Cell Injury Markers in
the Hypertensive Rat.
English
Martin Jose F. Vilela; Barbieri Neto Jose; Lachat Joao Jose; Furtado Mozart R.
Fortes.
tnn2801i.zip tnn2801p.zip

Vascular Damage Found in Spontaneously Hypertensive Rats Subjected to Increased
Blood Pressure Variability.
English
Martin Jose F. Vilela; Barbieri Neto Jose; Lachat Joao Jose;Furtado Mozart R.
Fortes.
tnn2690.zip

Validation of a telephone questionnaire for ischemic cardiopathy in Emergency
Health Services.
English
Martin-Castro Carmen
tnn2739.zip

Effect of the application of the new diagnostic criteria of diabetes mellitus
in the prevalence estimates of the disease and diagnostic level in the general
population in Galicia (North West of Spain).
English
Muniz Javier; Cordido Fernando; Lopez Rodriguez Isidro; Castro Beiras Alfonso
tnn2338.zip

Differences in the utilization rate of diagnostic methods after acute myocardial
infarction between hospitals with differing degree of development in cardiology:
RIGA study.
English
Muniz Javier; Freire Evaristo; Perez Martinez Fernando; Juane Rafael; Castro
Beiras Alfonso on behalf of Grupo RIGA.
tnn2339.zip

Differences in blood pressure between Galicia and other parts of Spain, since
childhood.
English
Evidencia de presiones arteriales mas elevadas en ninos y adolescentes gallegos
que en los de otras partes de Espana.
Spanish
Muniz Javier; Lopez Rodriguez Isidro; Gabriel Rafael, Lopez Quintela Alfonso;
Montiel Dolores, Pardo Roibas Consuelo.
tnn2340i.zip

Enhanced detection of reversible myocardial hypoperfusion by technetium
99m-tetrofosmin imaging and first-pass radionuclide angiography after
nitroglycerin administration.
English
Peix Amalia; Lopez Adlin; Ponce Felizardo; Garcia-Barreto David
tnn2400.zip

Enhanced detection of viable myocardium by technetium 99m - tetrofosmin imaging
after nisoldipine administration - English
Peix Amalia; Ponce Felizardo; Lopez Adlin; Llerena Lorenzo; Perez Horacio;
Paredes Angel; Castillo Maritza; Maltas Ana Ma.; Garcia-Barreto David
tnn2402.zip

Ischemic Cardiopathy. Perfusion Scintigraphy vs Coronary Angiography. 1997-1999
English
Cardiopatia Isquemica. Ganmagrafia de perfusion vs coronariografia. 1997-1998 -
Spanish
Quesada Sanchez Lisandra; Borrego Lopez Chavez Martha; Hechavarria Figueras
Cesar.
tnn2458i.zip tnn2458c.zip

Variaciones de los volumenes cardiacos, parametros de funcion ventricular
sistolica y diastolica, y tono del sistema nervioso autonomo cardiaco, en dos
fases del ciclo menstrual de mujeres sanas.
Spanish
Ramirez Z. Leonardo J. ; Fuenmayor A. Abdel J. ; Fuenmayor P. Abdel M.
tnn2556.zip

Autonomic Nervous System in the Patients with Coronary Artery Diseases during
Hyperbaric Oxygenation Therapy.
English
Stepanov Andrey; Stepanova Svetlana.
tnn2324.zip

ANGYCOR: Software for control of procedures in a of Hemodynamical Service.
English
ANGYCOR: Software para control de procedimientos en un Servicio de Hemodinamica
Spanish
Tardio Lopez Maria Antonia; Arie Siguemituzo; Bisbe York Ana Maria.
tnn2358i.zip tnn2358c.zip

Factores causantes de estres en las unidades de cirugia cardiaca.
Spanish
Torne Perez, Enrique; Ossorno Almencija, Maite; Maria del Pino; Paredes Perez,
Pablo; Al-bustani, Ferial; Villanueva Perez, Ferial
tnn2733.zip

3D Dynamics Echocardiography. Workstation for the Acquisition, Reconstruction
and Visualization of 4D Images of the Heart.
English
Torrealba Victor; Bosnjak Antonio; Acuna Manuel; Hernandez Lilia; Roux
Christian; Montilla Guillermo.
tnn2735.zip

Terapeutica fibrinolitica en la trombosis sobre valvula protesica cardiaca.
Spanish
Torres Ruiz Daniel; Estevez Aparicio Eric; Martinez Espinosa Carlos; Acosta
Rodriguez Jose L; Morales Jimeranez Leticia.
tnn2737.zip

Fibrinolisis sistemica en el infarto miocardico y fenomenos hemorragicos.
Spanish
Torres Ruiz Daniel; Morales Jimeranez Leticia; Estevez Aparicio Eric; Cabrera
Gorrin Orlando; Osorio Gomez Carlos.
tnn2738.zip

Low K+-induced subcellular, histochemical and connexin-43 alterations initiate
ventricular fibrillation.
English
Tribulova N; Manoach M1; Varon D1; Sheinberg A2; Okruhlicova L and Stetka R
tnn2700.zip

Fibrilacion auricular y sindrome de Wolf-Parkinson-White en un paciente de 68
anos con Esclerosis Tuberosa.
English
Urbano Galvez J.M., Lopez-Minguez J.R.
tnn2332.zip

Impact of Tricuspid Valve Disease on the Outcome of Pregnancy in Egyptian
Females with Mechanical Valve Prosthesis.
English
Zeinab A. Ashour, M.Hassan Hussein
tnn2409.zip

Rehabilitacion Cardiovascular: Experiencia durante 6 meses con 20 pacientes con
IAM.
Spanish
Ziehr Carlos Federico
tnn2309.zip

================================================================================

The Deutsche Bank (http://www.deutsche-bank.de/congress) supports the
Newsletter of the
First Virtual Congress of Cardiology.

<><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><>

Editor: Alfredo Piombo, M.D. (Argentina)
Chief of the Coronary Care Unit. Cosme Argerich Hospital,
Buenos Aires, Argentina
Associate Editors:
Claudio Gimpelewicz, M.D. (Argentina)
Dante Manyari, M.D. (Canada)
Carlos Basualdo, M.D. (Canada)

Edgardo Schapachnik, M.D.
Vicepresident of the FVCC Steering Committee

--------------------------------------------------------------------------
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----------------------------------------------------------------
Newsletter - 1st Virtual Congress of Cardiology
----------------------------------------------------------------
Year 1, number 10. First two weeks, November 1999.

================================================================================

Biweekly electronic publication of the First Virtual Congress of Cardiology, for
purposes of promotion and interchange of topics of interest in cardiac sciences
and news from the Congress. It is distributed free of charge to everyone
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An Spanish version is available for those of Spanish speaking origin.
Contributions are welcomed; also responses to previously published articles, and
commentaries should be send as Letters to:

readers@pcvc.sminter.com.ar

===============================================================================

Cardiovascular colleague: announce in your medical center the First Virtual
Congress of Cardiology to start soon.

===============================================================================

Previous issues at:

http://www.fac.com.ar/cvirtual/newslett/newseng.htm

or at

http://pcvc.sminter.com.ar/cvirtual/newslett/newseng.htm

===============================================================================

CONTENTS

A challenge for the beginning of the XXI Century
Editorial

Quit and Win
Ms. Laura Cipolla
Contact Person, International Quit and Win - “Abandone y Gane 2000”in Argentina

The clock of death

From the Forums

Useful address on the web

The Pretty Park Virus
Jose Barreto
FVCC Steering Committee´s member

Brief Communications

Space available for Advertisement.

================================================================================

The Deutsche Bank  (http://www.deutsche-bank.de/congress) supports the
Newsletter of the First Virtual Congress of Cardiology.

===============================================================================

A CHALLENGE FOR THE BEGINNING OF THE XXI CENTURY

Cardiovascular disease is the leading cause of mortality in the world. The
implication of this for us, who work in  Cardiology, is to make us medidate.
If our meditations are followed by commitment, commitment for increase our
knowledge, for research, for making proposals that emerge from evidence, the
diseases that we deal with will stop remaining in their sad privileged
position.
The incidence of ischemic heart disease was estimated in around a 3% of the
world population. Each year, 1.5 million people suffer a new myocardial
infarction.
In certain countries from Eastern Europe, ischemic heart disease represents
more than a 30% of all deaths, a figure similar to the one that in Argentina is
attributed to "heart diseases" (according to the nomenclature used in
statistical registers) for the 1980-1994 period.
Thus, mortality figures issued by the MONICA study for coronary disease, point
out for Yugoslavia, 215 per 100,000 inhabitants; 266 in the Czech Republic, 285
in Russia, and 378 in Poland, and most alarmingly yet, than these data, that
are worrisome, is the increase observed in these countries: +0.3% in the Czech
Republic, +2.0% in Russia, and +2.2% in Poland. The figures of death due to
ischemic heart disease in developing countries for all ages was estimated in
1990, in 1,800,000 men and 1,700,000 women. In the year 2020, it is predicted
that these figures will rise to 4,300,000 and 3,500,000 respectively.
One of the most important risk factors, if not the most important, in this
context, is smoking, a true epidemic of the XX century, that afflicts  more
than one third of the global population.
As it will be presented in this Congress, more than a 30% of those who work in
Hospitals in the City of Buenos Aires, more than a 30% of samples of seniors
students of Medicine, more than a 30% of doctors and nurses, smoke.
The WHO points out, each 8 seconds a person dies as a consequence of smoking.
Between 1990 and 2020, the deaths attributed to smoking will rise from 1.9% to
3.8%. 70% of these deaths, -70% of 1,650,000 in 1990 - took place in developing
countries.
Some of these data are analyzed by Richard Horton, editor of The Lancet, in an
incisive article, published in the issue from September 4th, (The Lancet, Volume
354, Number 9181, 4 Sep 1999) reproduced on Saturday, October 23rd, in the Forum
of ProCOR.
Something that should be a rule, hospitals where  no smoking should be
permitted, is a hard goal to achieve, a tragic destiny that will be analyzed by
Dr. Kaczmar Oksana, in her article: Tobacco Free Hospital, published in the
issue No 7 of this Newsletter.

Since the Study of the Seven Countries, and even before, it is known that
mortality attributable to coronary disease follows a parallel curve to
cholesterol levels. However, in our countries, youth is early tempted to join
habits, where consuming hamburgers and potato chips seems a cult linked to
happiness.

In the USA, only  27% of hypertensive patients have proper control of their
arterial, and  54% do not receive treatment.
In our country, Argentina, only a 13% of patients reach those aims.
In the Forum on Epidemiology and Prevention of the FVCC, different colleagues
mentioned the lack of accurate data, in which to base sanitary policies.
We do not know for sure, how many people die of myocardial infarction in our
countries.
At scant 70 days from the end of the millennium, the Century that witnessed the
man reaching the Moon, and in full development of the Internet experience, in
which we are active participants in this Virtual Congress, more than 120 million
people are liable in Latin America, to contract  Chagas disease, according to
the analysis by Dr. Alvaro Moncayo in his Lecture. Our legacy for the new
century, are 16 million people already infected  with  Trypanosoma Cruzii, and
25% of them already present some degree of heart or digestive disease.
This is the reality that frames the beginning of the millennium, and that is
dealt with by Dr. Rene Favaloro in his powerful exposition.
Are we going to be just witnesses of these events?
Undoubtedly, sanitary authorities in our countries must worry. The same must do
our Scientific Societies.
But in the meantime, what will we do?

What will I do - I, who write this, but the one who reads this too-?

The FVCC is already an important scientific event, due to the amount and
quality of the available material. Due to the quality of the lecturers. Due to
the amount of Brief Communications that have been sent. Due to the participation
to date, of almost 6000 colleagues from more than 80 countries.
We expect that after March, 2000, it will become a channel for Continual
Medical Education. And the challenge will be, if the proper use of these
instruments that join us: our Forums, will be just a public gallery where
cardiology advancements will be discussed at the highest level - a goal not
only possible, but necessary- or if besides, they will be an active trench that
we, world cardiologists use, united in the fight against the epidemics that
summons us.
We have things to do, today!
It is necessary that we became conscious of our strength.

Dr. Edgardo Schapachnik

==============================================================================

QUIT AND WIN 

An innovative strategy to encourage adult smokers to quit

It is no news that cardiovascular diseases constitute the major cause of death
in many countries around the world, or that smoking plays one of the leading
roles there.
Finland has historically achieved the greatest success in decreasing the rate of
these diseases in their country. And they did it through the innovative, mostly
community-oriented, strategies of their North Karelia Project, which was later
turned by the World Health Organization into the CINDI (Countrywide Integrated
Non-communicable Disease Intervention)
Programs, in effect in more than 25 European countries nowadays.

One of these strategies is Quit and Win, which the Finnish started in their
country almost a decade ago and are still coordinating. In 1994, 13 European
countries organized the contest with unified rules, and the success achieved
made the number of countries to double in 1996, and to double again two years
later in the third international campaign, where several Asian and African
countries took part and where Argentina again participated, this time taking 5
more Latin American countries with it.
The evaluation of these contests has shown that 15 to 20 percent of the
contestants quit smoking permanently thanks to the contest, something really
hard to achieve in the consulting room.
We are not trying to say that Quit and Win is the only strategy able to reduce
the number of smokers, but it is a truly feasible one, carried out with few
resources in countries like many of ours, mostly by joining the efforts of
physicians, companies, societies, and the community at large. Our data showed
that besides achieving an amazing 30% of quitters in our country, only in 1996 a
total of 6 million cigarettes were unsold due to the contest, representing a
loss of about a quarter of a million dollars for tobacco companies.

All countries registered with the international organizers in Finland to arrange
the contest,* follow the jointly agreed rules and arrange the campaign through
an institution or organization. Argentina arranged the 1996 and 1998 campaigns
through the Program for the Prevention of Infarct in Argentina, PROPIA, of the
University of La Plata.
Contestants (in each country) must be active smokers (smoking from at least a
year prior to the beginning of the contest) and over 18 years of age. They will
have to fill in the registration form before the “quitting date”, May 2nd, and
after 4 weeks of not smoking will be eligible for the prize draw in their
country. To be able to obtain the prize they will have to prove they have
remained smoke-free for a month through a witness plus a biological test.
The registration form includes the following information: personal data; number
of cigarettes, cigars or pipefuls smoked daily; prior attempts to quit (never, 1
or 2, 3 or more); years of smoker; name and address of a witness (over 18 years
old) who can confirm the contestant’s abstinence.
There is also a promise from the contestant to try to remain smoke-free for
the contest period and to tell the truth if asked, validated with his/her
signature.
Every country must give at least one national prize (they can include minor
prizes, or regional prizes), and there’s an international “superprize” of
U$S10,000 to be drawn among all the national-prize winners of each country.
The national prize in Argentina in 1998 was a one-week trip for two to the Machu
Picchu historical ruins in Perú, and it went to a participant of the province of
La Rioja, Mr. Manuel Sosa. The Chilean participant obtained the 1998
international superprize.
The next international campaign will be arranged in 2000, and there are already
100 countries registered to do it. The rules will be the same as before and
efforts are being coordinated for the organization of what will
be a record contest.
Now we invite YOU to participate, in two possible ways:
·       If you are a smoker willing to quit (and you meet the requirements),
you will be able to register in the contest (in your own country).
Registration forms will be available around March of 2000.
·       If you think you can help in the organization of this campaign,
whether through economical support or by contributing some other way, or simply
by referring the particulars of a person or company who could contribute, please
get in touch with PROPIA:
Ms. Laura Cipolla
Contact Person, International Quit and Win - Abandone y Gane 2000”in Argentina
PROPIA Programa de Prevencion del Infarto en Argentina
Universidad Nacional de La Plata
Calles 60 y 120 – 3er. Piso  (1900) La Plata.

Telephone: +54-221-424-0293
            Fax: +54-221-453-5577
E-mail: jtavella@atlas.med.unlp.edu.ar /clatorres@infovia.com.ar
You'll find more information about Quit and Win (Abandone y Gane) in our
Website: http://webs.pccp.com.ar/propia (in Spanish and English)

* Each country can have only one national campaign, or one or more regional
ones. You can consult whether your country/ region is registered (or register it
yourself, if it isn't), and adhere to the campaign. Consult our page in Internet
(information both in Spanish and in English), which links to the international
Quit and Win page (information in English), or send an e-mail to us at
clatorres@infovia.com.ar.
Laura Cipolla
ICQ #18644985

================================================================================

THE CLOCK OF DEATH

From the Clarin Newspaper, Buenos Aires, Tuesday, October 26th, 1999:

The World Health Organization (WHO), started yesterday at the headquarters of
the United Nations in Geneva, Switzerland, the "clock of death", that registers
each eight seconds, the death of a person, victim of the cigarette. 
According to the WHO, until 14:10, yesterday, there were 2,317 deaths registered
due to this cause, therefore by the end of the week, there would be 50,000 more
in the world.
The international organization, put the clock in a room, where a hundred
non-governmental organizations, and member states of the WHO carry out, since
yesterday, meetings to devise the first anti-smoking world treaty.
The clock will work "until an agreement is reached", the WHO announced.

===============================================================================

FROM THE FORUMS

This section reflexes the participation of the colleagues in the different
Thematic Forums

EPIDEMIOLOGY - PREVENTION

From: Beatriz Champagne <beatrizc@ix.netcom.com>
To: "'epi-pcvc@pcvc.sminter.com.ar'"
Subject: Re al Dr.Hurtado
Date: Thu, 14 Oct 1999 15:09:11 -0500

Dear Dr. Hurtado:
As what regards the first part of your question, let me tell you that the
Inter-American Heart Foundation is finishing the second edition of the document
CV and Cerebrovascular Diseases in 2000 America, with contributions by
epidemiologists from each country. This document summarizes data about CV
mortality for each country of our continent, as well as different surveys and
research works related to risk factors. Dr. Andy Wielgosz (Canada) is the
editor, with a very active contribution by Dr. Hernan Schargrodsky (Argentina),
Ricardo Granero (Venezuela) and others. This publication will be available in
English and Spanish before the end of the year.
The data we received from each country can also be found on the following Web:
http://cvdinfobase.ic.gc.ca

As what regards the second part of your message, the IAHF and its 35 member
institutions, have participated very actively in professional and public
education projects, with the purpose of
preventing these diseases. Particularly, primary and secondary prevention
guides have been developed, as well as guides for the use of aspirin for doctors
and health staff. Programs are
being supported in several countries of our continent to promote health in
children and young people. A statement has been published, for children and
young people's health, that specifies the strategy to be followed. The
Foundation has a program as well, called "Guide your patients to a Future Free
of Tobacco", that is being implemented in Chile, Costa Rica, and Uruguay. This
program was chosen by the PAHO as part of the program CARMEN/CINDI.

Kind regards,

Dr. Beatriz M. Champagne, Ph.D.
InterAmerican Heart Foundation
7272 Greenville Ave.
Dallas, TX   75231-4596
Home office phone:  1 972 562 3806
Phone:  1 214 706 1218
Fax:  1 972 562 3807 or 1 214 373 0268
e-mail: beatrizc@ix.netcom.com

From: A. Wielgosz <wielgosz@aix2.uottawa.ca>
To: epi-pcvc@pcvc.sminter.com.ar
Date: Sat 16 Oct 1999 17:58
Subject: Re: Al Dr. Hurtado

In reply to the question from Dr Hurtado, there are no national data on
incidence of acute myocardial infarction or angina for any country in the
Americas, including USA and Canada. However some local data, though not recent
are available from the Dupont and the Minnesota registries in the USA and the
Nova Scotia-Saskatchewan Study in Canada. Mortality data for AMI (ICD-410) are
available for many of the countries and these can be obtained
easily from CVDInfobase on the web at http://cvdinfobase.ic.gc.ca When Heart
and Stroke Disease in the Americas is published at the end of this
year, the data will be available in printed form as well as on the web at the
Interamerican Heart Foundation site.
The prevalence of angina is not a part of routine population surveillance in
any country. Nevertheless some local, typically practice-based studies have
been published.
Regarding campaigns to counteract these problems, several countries have
national programs of heart health promotion and cvd prevention eg Canada.
Again, information on a country by country basis can be obtained from the
CVDInfobase web-site as well as from the publication Heart and Stroke Disease in
the Americas.
Thank you for the questions.

Andreas Wielgosz MD PhD FRCPC


--------------------------------------------------------------------------------

CARDIOVASCULAR SURGERY

Date: Thu, 14 Oct 1999 11:55:16 -0300
To:surgery-pcvc@pcvc.sminter.com.ar
From: Rui Manuel de SousaSequeira Antunes de Almeida <almeidar@certto.com.br>
Subject: Mechanical Prosthesis/ Valvulas Mecanicas

I would like to know, from the participants of the Forum, which are the most
used mechanical prosthesis (the percentage) and if possible, also the
anticoagulation regimen that you prefer.
When choosing the prosthesis, I would like you to tell me, if you use it
because there is no other available, or because the surgeon chooses it, and what
would be an ideal prosthesis.
I thank you in advance,

[] RUI SEQUEIRA DE ALMEIDA, M.Sc., MT-SBCC-V
[] Cirurgiao Responsavel
[] Instituto de Molestias Cardiovasculares de Cascavel
[] Cascavel - Pr - Brasil
[] Professor Assistente de Medicina
[] UNIOESTE - Universidade Estadual do Oeste do Parana
[] Email: almeidar@.com.br

Replying Dr Rui S. De Almeida questions
Answers Dr. Miguel A. Chaippe:
The mechanical prosthesis that we more frequently use are the ones of double
oscillating disc, in almost 100% of the cases. Although each surgeon has his
preference  for a particular trademark, in our context, the health care services
are many times the ones which indicate a determined model according to the
price.
As regards the ideal prosthesis it is known that  it is still being looked for.
As regards the anticoagulation procedures, we use Coumadin (warfarine) or
Sintrom (acenocumarol) till a Rin between 2,5 and 3,5 is reached.

--------------------------------------------------------------------------------

PEDIATRIC CARDIOLOGY

From: "Diana Alvarez" <dalvarez@infovia.com.ar>
To: "Congreso Virtual" <pediat-pcvc@pcvc.sminter.com.ar>
Subject: pregunta
Date: Fri, 15 Oct 1999 18:25:57 -0300

Warm greetings to all of the participants of the list. I am a Pediatric
Cardiologist. My question regards use of carvedilol and aminophylline in dilated
cardiomyopathies in pre-transplantation stage.
If you could provide your experience about this, what doses have you managed?
Thanks. I remain waiting for an answer.
Dra. D. Alvarez.

Date: Tue, 19 Oct 1999 18:57:42 -0300
From: (Sergio Perrone) <Sergio_Perrone@il.com.ar>
To: Pediat-pcvc
Subject: Cardevilol en Miocardiopatias dilatadas en pediatria

The experience with carvedilol in dilated cardiomyopathies is quite broad (in
adults). There is no experience in pediatric patients, but use of B blockers in
cardiomyopathies is being carried out by several years now, and we have been
using B blockers in dilated cardiomyopathies in pediatric patients with good
results.
The doses depend on the patient, age, weight, height, clinical state, but it is
advisable to titrate in doses gradually increasing, and at the beginning of
treatment, when the patient is compensated, and with complete medication for
heart failure treatment (digitalis, diuretics, spironolactone, and inhibitors of
the converter enzyme of angiotensin (ACEI).
It is also very important to try to know the time of evolution of the pathology,
and the extent of damage of ventricular function.
We would be glad to advice our colleague in detail, if she would send to us more
data about her patient.
Regarding use of "aminophylline in patients carriers of terminal heart diseases,
I have no experience on this subject.

Sergio V. Perrone, MD
ICYCC
Fundación Favaloro
E-Mail: svperrone@interlink.com.a

--------------------------------------------------------------------------------

CHAGAS´ DISEASE

Dr. Edgardo Schapachnik:
In answering your question about use of trypanosomicide in chronic phase:
I do not believe that there is solid evidence supporting its routine use with
current drugs. On
the contrary, there is plenty of evidence that they do not alter the current
disease. I think
it is crucial to wait a response from a ransom study, double blind,
multicentric. The later
this study begins, the worst.
Sincerely,

Harry Acquatella

Date: Sat, 23 Oct 1999 11:48:15 -0300 (ART)
From: "Dr. Edgardo Schapacnik" <edgardo@schapachnik.com.ar>
To: chagas-pcvc@pcvc.sminter.com.ar
Subject: Medicin based in evidence

Dear friends:
Harry, in his message from the 20th of this month, said: "I do not think that
there is sound evidence that supports its routinely use with current drugs. On
the contrary, there is a lot evidence that they do not alter the current
disease."
Joao, for his part, in answering Raul's question about pregnant mothers,
pointed out: "After birth, consider the possibility of specific treatment,
according to the last WHO workshops."

I think I read in this statements from these two friends, great researchers
among those that have contributed to my knowledge of the Disease, an friendly
contradiction.

In the case of women that have delivered children with parasites, common sense
would indicate us to treat them with parasiticides after birth, with the
supposed aim of preventing her following children from contracting T Cruzii by
transplacental contagion.
However, sometimes the evidence does not get along with common sense.
Let me do the following mathematical game:
Let us take for example the figure, 3% of connate Chagas (just as example).
This means that for each 100 mothers with chagasic disease, there will be 3
infected children.
Only 3.
How many mothers should I treat so that in their next pregnancy, the impact of
treatment decreases the figures in a significant way?
There are retrospective case-control studies carried out, where the mothers
with history of children with parasites, treated afterwards this delivery,
compared to an equal number of mothers with similar history, but that did not
receive treatment, present a really smaller incidence of new deliveries with
transplacental transmission?
If you let me make a supposition (given that I ignore precise data) that the
treatment reduces incidence of new cases, for example in a 30%, a 1000 mothers
would be required in those conditions so that the expectations of 30 children
with parasites would be reduced to 21. Is this statistically significant?
Is there such a study, in which the WHO workshops are based, to carry out the
recommendation that Joao mentioned?

Hugs,

Edgardo

From: Joao Carlos <jcpdias@cpqrr.fiocruz.br>
To: "'chagas-pcvc@pcvc.sminter.com.ar'" <chagas-pcvc@pcvc.sminter.com.ar>
Subject: RE: [CHAGAS-PCVC] Medicia basada en la evidencia/Medicine based in
evidence
Date: Tue, 26 Oct 1999 08:49:59 -0200

Edgardo, Harry, and the rest of friends: the discussion is very appropriate,
since it suits the goals of our congress. Undoubtedly, Acquatella is right when
he refers to more advanced cases, especially to the level of degree of
myocardial damage, in which the No. and physiological conditions of contractile
elements (including structural disharmony, fibrosis, and problems of
micro-vascularization) are already irreversible. This still corresponds to the
minority of the infected patients. In the rest (majority of undetermined chronic
individuals, or in degrees I (even II)), where there is functional reserve, and
anatomic and functional damage is small, it is there where the axioms discussed
in 1998 by the TDR in Rio, are applied:
The factor of live presence of the parasite follows as the more important as
element of evolution in human and experimental models (Andrade, Andrade,
Higushi); specific treatment depresses dramatically, or eliminates the parasite
among the great majority of chronic patients (Brener, Cancado, Rassi, Viotti);
elements like phlogosis and fibrosis are restrained by specific therapy, in
cases of regression in the experimental model (Andrade, Higushi);
Specific treatment continued for more than 5 years (preferably more than 15
years), reveal slow negativization of serology, permanent negativization of
xeno/hemoculture (or dramatic reduction of pre-treatment positivity), pointing
reduction (majority of the oldest chronic patients) or permanent elimination
(majority of chronic patients under 15 years) (S. Estani, Andrade Sgabatti,
Rassi); The great problems of severe collateral reactions are well known, and
can be perfectly managed by a weekly consult/checking with the assistant doctor.
The great problem of chronic intoxication, was produced by post-therapeutic
lymphomas, detected by Teixeira in rabbits intraperitoneally inoculated,
something that has not happened again in new researches. However, an abnormal
proportion of lymphomas has arisen in transplanted patients (heart) in the
INCOR/SP, due to a high association of immunodepressors in such cases. With
decrease in doses
of these immunodepressors (especially cyclophosphamide), the situation of
cardiac transplanted patients for Chagas in INCOR, has been normalized for three
years, incidence of lymphomas being equal to that of transplanted, non-chagasic
patients.
As a general remark, both drug effectiveness and its secondary effects are far
from ideal, due to this new drugs are quite welcome, that could be more
effective, less toxic and capable of acting in elective metabolic ways on the
parasite, without negative repercussions for the human being (Urbina, Dias,
Coura, Rassi); As final evaluation, there are positive reasons to treat chronic
cases with active and available drugs (Benznidazole, Lampit), in a careful way,
and individually and experimentally .
In other words: give the benefits of doubt to it, with an ethical minimum of
safety.
It would be very opportune for everyone (doctors or medical services) that
comes to practice specific treatment in chronic patients, to organize a good
accompanying of their cases, controlling collateral reactions, bimonthly blood
count, clinical evolution (annually), and serology (annual, quantified, with 2
or 3 techniques), ideally during 10 years or more. If possible (but not
obligatorily), carry out xenodiagnosis or hemoculture (3 times per treatment)
and bymonthly for the next 5 years (stop if serology is permanently
negativized). These protocols are very important and valid. It is suggested that
a copy of them should be sent annually to the PAHO (Dr. Schmunis- HCP/HCT) or to
some of the researchers historically involved in the subject (SUBJECT IN ITS WAY
TO THE PAHO).
Hugs,

JC Pinto Dias

--------------------------------------------------------------------------------

CARDIOVASCULAR FARMACOLOGY

From: Dr Alejandro F. Luque Coqui alucoq@attglobal.net
To: pharma-pcvc@pcvc.sminter.com.ar
Subjet: Estatines in primary and secondary prevention of atherosclerotic
cardiovascular disease. Facts and controversy
Date: Oct 22 1999

Dr. Alejandro Serra answers:
Brief summary: from extracts from fungus of the Aspergillus genus, "lovastatine"
was isolated, that turned out to be a structural analog of
B-hydroxymethylglutaryl_CoA (HMG-CoA), a necessary metabolite for the synthesis
of mevalonic acid, precursor of cholesterol and terpenes.
Lovastatine is a pro-drug, it has a lactone ring (internal ester), that by
hepatic metabolism is opened, giving a derivative hydroxyacid, a true analog to
HMG-CoA; due to this, it inhibits competitively the HMG-CoA reductase enzyme.
From lovastatine, and by chemical modifications, the following were obtained:
"simvastatin" (also a pro-drug lactone) and the "pravastatin" (active
hydroxyacid); more recently, with the accurate knowledge of the chemical
structure-pharmacological activity relation (SAR) of these group of drugs, both
"fluvastatin", and "atorvastatin" were synthetized. To simplify, the inhibitors
of the HMG-CoA reductase are called ESTATINES, and thus we will refer to them
from now on. The therapeutic introduction of estatines, created a landmark in
treatment of hypercholesterolemia, since they reduce in a significant way,
plasmatic figures of LDL-cholesterol, and consequently, the risk of
arteriosclerotic disease almost without important adverse effects.
Mechanism of operation: as it was commented, estatines inhibit competitively
the HMG-CoA reductase (they are more than 5000 times more similar for the
enzyme, than for their natural substrate), an enzyme which is key for metabolism
of cholesterol and terpenes, such action happens mostly in the liver, although
the enzyme is broadly distributed in the whole organism. The inhibited reaction
is fundamental, since it turns out to be the restricting step for biosynthesis
of cholesterol. As a consequence of inhibition in synthesis, the intrahepatic
deposit of cholesterol decreases, what causes an increase in expression and
exposition of receptors for LDL lipoproteins, and an increase in hepatic
uptaking and catabolism of these circulating lipoproteins. Besides, VLDL
(immediate precursor of LDL) are uptaken and catabolized, thus indirectly,
reducing capacity for incorporation of cholesterol to LDL.
Certain factors, some little understood, make hepatic HMG-CoA reductase to be
the enzyme inhibited, while the rest do not undergo such action (especially
suprarenal and gonad steroidogenesis, just as synthesis of cholesterol in the
CNS are not affected); among them I can mention, the great extraction of
estatines by hepatic first pass, the high union of plasmatic proteines, the lack
of penetration through the hematoencephalic barrier of polar metabolites
(hydroxyacids) and compensating phenomena by depression of the gene of the
HMG-CoA reductase.

References:
Brown G, et al. N. Eng. J. Med. (1990) 323:1289-1298.
Hamelin B A, et al. Trends Pharmacol. Sci. (1998) 19:26-37.
Haria M, et al. Drugs (1997) 53:299-336.
Lea A P, et al. Drugs (1997) 53: 828-847.
Lipszyc P S en Zieher L M Colección de Farmacología vol. 6, Ed. Ursino, Buenos
Aires, Argentina
(1997).

================================================================================

Registration to the First Virtual Cardiology Congress is free
and everyone registered will get a CD with all material
published at the Congress. All interested may be registered
using an individual or a group e-mail address.
Announce the FVCC at your Center.

================================================================================

Useful address on the web-Cardiology Links
==========================================

National Guidelines Clearinghouse (NGC)
http://www.guideline.gov/index.asp

A public resource for evidence-based clinical practice guidelines. NGC is
sponsored by the Agency for Health Care Policy and Research in partnership with
the American Medical Association .

================================================================================

THE PRETTY PARK VIRUS

An unwelcome visitor has been present lately in the mailboxes of some
colleagues. It is the Pretty Park Virus. The Technician on Informatics, Jose
Barreto, from Montevideo, Uruguay, member of the Steering Committee of the FVCC,
sends the following report, that we have adapted for the Newsletter.

About the Pretty Park Virus

AKA........................... Trojan Horse, W32.PrettyPark, Trojan.PSW.CHV, CHV
Length of infection........... 37,376
Area of infection............. C:\Windows\System, System Register, E-mail
Attachments
Date of detection..............June 1st, 1999
Characteristics............... Worm, Trojan Horse

The mentioned virus is one of the group of virus known as Worms. These virus
use electronic mail for spreading. It could also be called a Trojan (Trojan
Horse). These (just as the original Trojan Horse) arebased in masking their
code in other program.

The way to spread is simple. An executable file is attached to a message
(originally PrettyPark.exe, although the name can be changed), that travels by
the net, and infects the client system when this is executed.

Once it enters the system, it creates a file with the name FILES32.VXD, adding
it to the system register, to be able to go on being executed.

At 30 minutes intervals, it captures the address book, and sends them a message
with the corresponding attachment, that will infect the addressee's system,
starting the chain over again.
It can also send by IRC (chat channels), important information about the
system, and even the passwords stored on  it.

Dangers for mailing lists:

Basically, the problem consists of the possibility of a message arriving with
an infected attachment through them. In the FVCC lists (Thematic Forums) this
problem does NOT EXIST, because they are moderated; all messages first reach
the moderator, who absolutely does not redistribute messages that contain
attachments. Moreover, even if by mistake the Moderator of the Forum would send
an "infected" message to the List, the Majordomo itself, that is the software
that manages messages' redistribution, would take care of opening the file that
then would lose its destructive capacity.
Likewise, it is prudent that all those who take part in other lists of
distribution, or just  receive e-mail messages from others, should have enough
protection for this type of virus.

How to protect us:

1.- In order to be cautious, all those who use e-mail, must have an active
antivirus, with the possibility of updating it on the Internet (Symantec's
Norton Antivirus is recommended). The active antivirus, seizes everything that
goes through the computer's memory, analyzing it and erasing infections.
One must bare in mind that not all antivirus programs and/or versions,
detect all infections.

2.- It is strongly recommended not to open any file that comes attached to an
e-mail message, from a non-secure source. Usually, the following should be done:
a-  The program of e-mail is forced to put all attachments in a specific
directory (to handle them with confidence, and so that they do not get lost
inside the tangle of information in our disk).
b-  Send an e-mail to the person that sends the attachment, asking him/her
about the characteristics of the mailed attachment (thus, we get to know the
nature of the attachment and whether if it was meant to be sent or not).
c-  Run the antivirus for a double control (heuristic and comparative) to erase
a possible infection.
Most antivirus have both methods of searching. It is understood that
"comparative" mean normal search, that consists of comparing chains of data from
the file that is being analyzed, with others that the antivirus has stored. If
there is a match, the virus is detected.
It is understood that  "heuristic" (or intelligent search) is the method   that
analyzes files searching for possible commands in machine or macro language,
that can damage our system. If a suspicious command is detected it reports
about a "possible virus in...".

Once the infection is detected, you must be sure if the virus can be removed
with the antivirus version that you  have, and most of all, do not send
messages from that machine, until you are sure.

Jose P. Barreto
Technician on Informatics
jbarreto@internet.com.uy

==============================================================================

BRIEF COMMUNICATIONS

Presion de pulso en pacientes hipertensos
Spanish
Musacchio Hector Mario 
Hypertension

Rehabilitacion Cardiovascular: Experiencia durante 6 meses con 20 pacientes con
IAM
Spanish    
Ziehr Carlos Federico  
Coronary Disease

Clinical evidence of Radial Artery spasm immediately after coronary artery
bypass graft surgery
Evidencia clinica de espasmo de la Arteria Radial en el postoperatorio inmediato
de cirugia de revascularizacion miocardica
English - Spanish      
Bonaccorsi Hector; Bauduccio Claudio; Dogliotti Ariel; Ameriso Jose; Sgrosso
Jose
Cardiovascular Surgery

Quantifying Risk in Cardiovascular Surgery
Cuantificacion de riesgo en cirugia cardiovascular
English - Spanish      
Bonaccorsi Hector; Sgrosso Jose, Ameriso Jose, Dogliotti Ariel 
Cardiovascular Surgery

Hypertension. Risk Stratification
Hipertension arterial. Estratificacion de riesgo.
English - Spanish      
Did Nunez  Jorge Pastor.       
Hypertension

Use of Beta-blockers in the Acute Phase of Myocardial Infarction: A Study of 86
Cases.
Uso de Betabloqueador na Fase Aguda do Infarto do Miocardio: Estudo de 86
Casos.
English - Portuguese  
Markman Manuel; Chaves Andrea; Markman Filho Brivaldo
Coronary Disease

Feasibility study of substitution hormonal therapy on cardiovascular diseases
in post-menopausal women. A multicentric international collaboration. (part I).
English
Gutiu Ioan Axente; Dolis Ligia; Peretianu Dan.
Epidemiology and Prevention

Potencial embolico del flutter auricular.
Spanish
Garces Eduardo; Eggers German; Raposo Luis; Riquelme Herminia; Sagardia
Mauricio; Schwencke Ana; Lanas Fernando.       
Arrhythmias

Analisis de la fraccion de eyeccion post trombolisis mediante ventriculografia
nuclear.
Spanish
Torres Ruiz Daniel; Estevez Aparicio Eric; Cabrera Gorrin Orlando; Morales
Jimeranez Leticia; Osorio Gomez Carlos      
Coronary Disease

Open Mitral Commissurotomy. The Golden Standard
English
Antunes M J; Vieira H; Ferrao de Oliveira J
Cardiovascular Surgery
       
Treatment of hyperlipidemia in men with ischemic heart disease.
English
Filippatos G., Anthopoulos P.,Tsilias K., Polychronopoulou O., Karambinos E.,
Efstathiou D.,  Tsekouras V., Anthopoulos L.     
Epidemiology and Prevention

Strategies of cardiovascular prevention: The importance of the massive events.
Estrategias de prevencion cardiovascular: La importancia de los eventos
masivos.
English - Spanish      
Vallejos Julio;  Rasmussen Ricardo; Brizuela Monica; Fernandez Claudia; Starck
Silvia; Maciel Adriana; Cherkasky Susana.       
Epidemiology and Prevention

Enhanced detection of viable myocardium by technetium 99m - tetrofosmin imaging
after nisoldipine administration
English
Peix Amalia; Ponce Felizardo; Lopez Adlin; Llerena Lorenzo; Perez Horacio;
Paredes Angel; Castillo Maritza; Maltas Ana Ma.; Garcia-Barreto David
Nuclear Cardiology

Nonselective b -blockers, Autonomic Regulation and Phases of the Heart Cycle
English
Melezhik Yelena Petrovna; Isaeva Anna Vladimirovna; Yabluchansky Nikolay
Ivanovich.
Cardiovascular Pharmacology

Correlation between the electrocardiogram and the pathological findings in the
autopsies of patients with complete left bundle  branch block and cardiac
failure.
Correlación entre el electrocardiograma y la anatomía patológica en pacientes
con bloqueo completo de rama izquierda e insuficiencia cardiaca.
English - Spanish      
Crudo, Norma; Piombo, Alfredo; Parisi, Coloma; Romeo, Ligia; Ramos, Alberto
Heart Failure

Magnetic Resonance Real Time Imaging for the Evaluation of Left Ventricular
Function
English   
Eike Nagel, Uta Vogel, Simon Schalla, Tareq Ibrahim, Bernhard Schnackenburg,
Axel Bornstedt, Christoph Klein, Hans B. Lehmkuhl, Eckart Fleckuthor
Nuclear Cardiology

Left Ventricle-Like Mechanical Properties of the Right Ventricle Due to an
Acute Afterload Increase.
English
Grignola Juan Carlos; Gines Fernando.  
Heart Failure

Drogadiccion en jovenes de ciudades de menos de 20.000 habitantes. Su posible
incidencia en enfermedades cardiologicas.
Spanish
Fullone Carlos Enrique; Salgado Carlos Maria.
Epidemiology and Prevention

Increased production of oxygen free radicals by phagocytes in hypertensive or
coronary disease subjects.
English
Muniz-Junqueira Imaculada; Mota Licia; Aires Rodrigo; Junqueira Jr Luiz
Hypertension

The Importance of Environmental Charges in Influencing Heart Rate Variability:
Increased Heart Rate Variability on Weekends in Healthy Active Subjects.
English
Frigy  Attila; Zagozdzon Pawel; Malik Marek;
Arrhythmias

Depressed sympathetic and enhanced parasympathetic reflex responses of heart
rate in arterial hypertension.
English
Junqueira Jr., Luiz; Oliveira, Leonardo Capita; Pereira, Flavio; Jesus, Paulo
Cesar; Carvalho, Hervaldo
Hypertension

Increased phagocytic capacity in Chagas' disease patients with heart failure.
English
Muniz-Junqueira Imaculada; Aires Rodrigo; Mota Licia; Junqueira Jr Luiz
Chagas Disease

Technetium-99m tetrofosmin myocardial scintigraphy with adenosine and
nitroglycerin in the evaluation of ischemic heart disease.
English
Peix Amalia; Ponce Felizardo; Lopez Adlin; Llerena Lorenzo; Llerena Luis;
Castillo Antonio; Garcia Raymid; Maltas Ana Ma; Garcia-Barreto David
Nuclear Cardiology

Comparison between mitral regurgitation by radionuclide angiography and Doppler
echocardiography.
English
Peix Amalia; Ponce Felizardo; Lopez Adlin; Prohias Juan.
Nuclear Cardiology

Estudio farmacologico de un digitalico sintetizado a partir de la
digitoxigenina.
Spanish
Zarco Gabriela; Del Valle Leonardo; Pastelin Gustavo
Cardiovascular Pharmacology

Efecto del bloqueo de canales "T" y "L" en la liberacion de oxido nitrico
inducido por el flujo coronario.
Spanish
Gonzalez Amalia Enriqueta; Torres Juan Carlos; Del Valle Leonardo; Suarez
Jorge.; Pastelin Gustavo     
Cardiovascular Pharmacology

Caracteristicas del efecto inhibidor del INCICH-D7 sobre la ATPasa-Na+,K+.
Spanish
Ramirez Margarita; Del Valle Leonardo; Pastelin Gustavo.
Cardiovascular Pharmacology

Tabaquismo en estudiantes de medicina avanzados.
Spanish
Hasper, I.; Feola M.A.; Bruno M.; Cohen Saban I.; D'Amato N.; Donato V.;
Fernandez J.; Giannatasio J.; Macri C.; Meyer E.; Schapachnik E.; Zagalsky P.
Epidemiology and Prevention

Evaluacion del tiempo de conduccion interauricular por ecocardiografia.
Spanish
Fuenmayor A. Abdel J. ; Ramirez Z. Leonardo J. ; Fuenmayor P. Abdel M.
Arrhythmias

Revascularizacion multivaso en cirugia coronaria sin circulacion extracorporea.
Abordaje quirurgico de todas las arterias coronarias.
Spanish
Lara Juan; Cordera Silvia; Moreno Teodoro, Alvarez Miguel; Abdallah Abdul;
Calleja Manuel; Santalla Antonio, Lopez-Checa Salvador.
Cardiovascular Surgery

Pulmonary Embolism, Systemic  and Paradoxical Embolism, and Deep Venous
Thrombosis.
Embolias pulmonar, sistemica paradoxal e trombose venosa profunda.
English - Portuguese   
Del Castillo Jose Maria; Orlandi Fabio;  Capellini Luis Fernando;  Grossmann
Rosana; Nakajima Eliza;  Hublard Ernesto Luiz; Cortese Marcelo.
Echocardiography

Left mamary artery flow in coronary mamary by-pass.
Fluxo da arteria mamaria esquerda em pacientes revascularizados.
English - Portuguese   
Orlandi Fabio; Grossmann Rosana; Hublard Ernesto Luiz; Cortese Marcelo;
Nakajima Eliza; Capellini Luis Fernando; Mangione Jose Armando; Beltrao Pedro;
Cividanes Gil Vicente; Puig Luis Boro; Gebara Otavio; Del Castillo Jose Maria.
Cardiovascular Surgery

Intraortic Ballon Pump - A New Solution for an Old Problem.
English
Almeida R.M.S.S.A.     
Cardiovascular Surgery

Diastolic shunt after ventricular septal perforation following acute myocardial
infarction.
English    
Garcilazo Enrique; McLoughlin Mario; Loredo Stella.
Echocardiography

Marcapasos DDD en la miocardiopatia hipertrofica obstructiva.
Spanish (English Summary)      
Galizio Nestor; Gonzalez Jose ; Favaloro Mariano; Fernandez Mario ; Torino
Augusto ; Valero Elina ; Pesce Ricardo.    
Echocardiography

Comparacion de mortalidad durante seguimiento por 5 anos en sujetos con
Enfermedad de Chagas cronica con y sin tratamiento de Benznidazol.
Spanish
Catalioti  Franco; Acquatella Harry    
Chagas Disease

Analysis of Abnormal Intra-QRS Potentials Associated with Chagasic Myocarditis
using the High-Resolution Electrocardiogram.
English
Gomis Pedro; Garcia Irene; Passariello Gianfranco; Mora Fernando.
Arrhythmias

A study on the mechanism of ventricular arrhythmias induced by adenosine.
English
Gengsheng Yu, Li Zou, Yungru Qian, Wanzhen Li, Xiaomei Li, Jiarong Zhong, Tian
Jie
Arrhythmias

A Study on Endocardial Monophasic Action Potentials and Triggered Arrhythmias
in Rabbit Heart in vivo.
English
Gengsheng Yu;  Li Zou;  Wanzhen Li *; Xiaomei Li*; Jiarong  Zhong.
Arrhythmias

Comparison Between Three Time Series of Rr Intervals Registered in Three
Different Periods Using Heart Rate Variability Analisys.
English
Jesus Paulo C.; Santos Luciano M.; Paula Wagner D.;  Carvalho Hervaldo S.;
Junqueira Jr Luiz.  
Arrhythmias

Control del riesgo no-lipidico en hipercolesterolemicos.
Spanish
Cuneo  Carlos; De Rosa  Jose; Guzman Luis; Linares Casas Juan; Lorenzatti
Alberto; Paterno Carlos; Vita Nestor y los Investigadores del PPPI F.A.C.
Epidemiology and Prevention

Inflammation and infection in acute coronary syndromes. Inflamacion e infeccion
en los sindromes coronarios agudos.
English - Spanish      
Bermejo Jose; Martinez Prudencio; Martin Jose F.; de la Torre Mar; Bustamante
Rosa; Guerrero Ana B.; Ortiz de Lejarazu Raul; Eiros Jose M.; Blanco Santiago;
Fernandez-Aviles Francisco.       
Coronary Disease

El pericardio afecta el volumen paralelo usando cateter conductimetrico.
Spanish
Herrera Myriam C; Olivera Juan M; Martinez Roberto J; Ruiz Estela; Valentinuzzi
Maximo 
Others

Prognostic stratification of patients with congestive heart failure by
cardiopulmonary exercise testing.
English
Sellier P.; Iliou M.C.; Prunier L.; Verdier J.C.; Charon O; Corona P.
Heart Failure

================================================================================

The Deutsche Bank (http://www.deutsche-bank.de/congress) supports the
Newsletter of the
First Virtual Congress of Cardiology.

<><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><>

Editor: Alfredo Piombo, M.D. (Argentina)
Chief of the Coronary Care Unit. Cosme Argerich Hospital,
Buenos Aires, Argentina
Associate Editors:
Claudio Gimpelewicz, M.D. (Argentina)
Dante Manyari, M.D. (Canada)
Carlos Basualdo, M.D. (Canada)

Edgardo Schapachnik, M.D.
Vicepresident of the FVCC Steering Committee


--------------------------------------------------------------------------
Letter to Editors:  readers@pcvc.sminter.com.ar
Send commands to majordomo@pcvc.sminter.com.ar
Others: owner-newsletter-fvcc@pcvc.sminter.com.ar

Top

----------------------------------------------------------------
Newsletter - 1st Virtual Congress of Cardiology
----------------------------------------------------------------
Year 1, number 9. Second two weeks, October 1999.

================================================================================

Biweekly electronic publication of the First Virtual Congress of Cardiology, for
purposes of promotion and interchange of topics of interest in cardiac sciences
and news from the Congress. It is distributed free of charge to everyone
subscribed. Those of English speaking origin may subscribe sending an e-mail to:

majordomo@pcvc.sminter.com.ar

with the following message in the body of the e-mail:

subscribe fvcc-newsletter

If you ever want to unsubscribe, you can send the following command in the body
of your email message to

majordomo@pcvc.sminter.com.ar:

unsubscribe fvcc-newsletter

An Spanish version is available for those of Spanish speaking origin.
Contributions are welcomed; also responses to previously published articles, and
commentaries should be send as Letters to:

readers@pcvc.sminter.com.ar

===============================================================================

Cardiovascular colleague: announce in your medical center the First Virtual
Congress of Cardiology to start soon.

===============================================================================

Previous issues at:

http://www.fac.com.ar/cvirtual/newslett/newseng.htm

or at

http://pcvc.sminter.com.ar/cvirtual/newslett/newseng.htm

===============================================================================

CONTENTS

The FVCC has started
Editorial

Xenotransplantation: a challenge for the beginning of the XXI Century
Dr. Edgardo Schapachnik

From the Forums

Useful address on the web

Computer Viruses (Part 5)
Karel Morlans Hernandez, M. D.
FVCC Steering Committee´s member

First days of the FVCC

Space available for Advertisement.

================================================================================

The Deutsche Bank  (http://www.deutsche-bank.de/congress) supports the
Newsletter of the First Virtual Congress of Cardiology.

===============================================================================

THE FVCC HAS STARTED

Finally the dream has become true and The First Virtual Congress of Cardiology
is at the height of its development.
The symbolic embrace we pretended to give at the end of the millennium with
a trascendent scientific activity that would start before and finish after the
last minute of the 1999, has begun.
Conferences, contributions and communications in Round Tables, are just
available in all the thematic areas that comprise the wide Scientific Program.
The interactivity through the Thematic Forums are just shown in the almost
20 that have been enabled.
This issue of the Newsletter will be a reflex of this beginning.
And from the many challenges that Cardiology of the end of XX century face,
we have chosen a topic to comment about: Dr. Juffe's Conference on
Xenotransplantations. A topic that itself arises questions from the molecular to
the philosophical, from the inmunological to the ethical point of view.
This is the legacy we leave for the future generations.
The First Virtual Congress of Cardiology is today, a reality.

===============================================================================

XENOTRANSPLANTATION: A CHALLENGE FOR THE BEGINNING OF THE XXI CENTURY

Drs. Alberto Juffe Stein, Rafael Manez and Fabian Crespo, from the Pogram of
Cardiac Transplantation  from Complejo Hospitalario Juan Canalejo, Coruña,
España, approachs this complex topic: a challenge on the threshold of the XXI
century.
Are we ready?, the authors ask themselves in the title of their Conference
published in the FVCC.
Imagining an answer should contemplate different sides.
In the strictly medical frame, Juffe et. al introduce a first reflection:
despite the idea of using organs of other animal species is not new, the present
disbalance between organs transplantation supply and demand, could constitute
the stimulus to go deeper in the investigation as this could effectively be the
way of a possible solution.
Other sides, however placed in front of this way: ethical, legal, philosophical
factors, must not be absent at the time of making that answer.
Going on with the analysis of the Conference, Dr. Juffe approaches the Calne's
(1970) concept of concordant and discordant models depending on  the promptness
in which the rejection of the xenotransplanted organ is produced. Hence, he will
say that the presence of the receptor preformed antibodies will originate a
hyperacute rejection in the discordant organs, a phenomena that is seen when the
donor and the receptor are from different zoological orders.
Otherwise, he will analyze, the concordant transplantations use organs of
identical order species: in this case, the primates, organs against which there
is no hyperacute rejection.
This apparent benefit that would be supposed to go deeper in investigations
that take these species as donors, trip on the obstacle that those species are
slowly reproduced and even less in captivity, some of them in danger of
extinction, with the aggravating that its utilization can lead to severe
infections in the receptors.
In other words, to imagine the monkeys being a source of organs to be used in
human transplantations carries a series of considerations, no free of religious,
ethical, moral and philosophical components, to be taken into account by the XXI
century investigator.
These prolegomena are taken by Dr. Juffe's team to point out: "the ideal animal
specie to be used as a source for organs transplantation would be one,
relatively low in the phylogenetic tree, that it were normally used in human
feed  The pig fulfills many of the requisites that would be desirable in an
animal as a potential source of organs. It is tamed, it is reproduced in large
quantities, easy to be fed, grows up quickly and shares many anatomic and
physiological similarities with human beings".
Concepts about rejection in the pig organs, types of involved antibodies, the
role of the complement and the types of preventive strategies (inhibition of
xenoantibodies- endothelium interaction, inhibition of the complement
activation), the acute vascular rejection, the cellular rejection, the risk of
infections, are all titles that invites to read Juffe, Manez and Crespo's
lecture, who are being accompanied by outstanding people.
This that appears to be at the limit of what can be possible, perhaps tomorrow,
will be in our children and grand-children's hands, one of the most important
advances that our generation leaves as a legacy and a challenge for them.

Dr. Edgardo Schapachnik

=============================================================================

FROM THE FORUMS

This section reflexes the participation of the colleagues in the different
Thematic Forums

EPIDEMIOLOGY - PREVENTION

From: Pablo Hurtado  (pacardiol@xerox.com.ni)
To: <epi-pcvc@pcvc.sminter.com.ar>
Subject: Cardiopatia Isquemica:Incidencia
Date: Wed, 6 Oct 1999 10:23:33 -0600

Colleagues:
I would like to know about Incidence and Prevalence of AMI and Angina in
different countries of America.
Which is the magnitude of the problem?
Have campaigns been carried out to counteract these pathologies?
Thanks,
Dr.Pablo Hurtado.
pacardiol@xerox.com.ni

From: Carlos Cuneo <carloscuneo@arnet.com.ar>
To: <epi-pcvc@pcvc.sminter.com.ar>
Date: Thu 7 Oct 7 1999 22:20
Subject: Question by Dr. Hurtado

"I would like to know incidence and prevalence of AMI and Angina in different
countries of America."

Prevalence of AMI in Argentina is not well known, there are data regarding the
WHO codes, that are related to Public Health, the rest are mortality figures
that are obtained from death certificates.

"What is the magnitude of the problem?"

This is a serious problem. One might deduce this commentary, taking into
consideration that the 1st death cause in Argentina is cardiovascular (46.6% in
1996). And among them, the main one is atherosclerotic cardiovascular, standing
out (without accurate figures), coronary.

"Have campaigns been carried out to counteract these pathologies?"

Not serious campaigns, only isolated ones, promoted or sponsored by private
entities, receiving very little support, such as PPPI (Primary Prevention
Program for Infarction) of FAC (Argentine Federation of Cardiology).
Currently, the Ministry of Health is studying and attempting at implementing a
National Program, that has not started yet. I am working on the subject, and
maybe by the end of the year a pilot test might be done in some suitable area of
the country.
Greetings to Dr. Pablo Hurtado

Carlos Cuneo

From: "Marcelo" <mtavella@netverk.com.ar>
To: <epi-pcvc@pcvc.sminter.com.ar>
Subject: Question by Dr. Hurtado
Date: Mon, 11 Oct 1999 20:30:28 -0300

As what regards the second question by Dr. Hurtado, about National Programs, I
can tell you that in the Province of Buenos Aires, Argentina, a "demonstration
area" is being carried out, according to regulations from the Project North
Karelia (Finland). It is to be expected that the first results (3 years approx.)
will permit "doubling" the model in other spots of the country, until it finally
becomes national. These kind of Demonstration Projects have been
highly successful in Europe, where they are sponsored by the WHO, and are called
CINDI (PREVENTION OF NON-COMMUNICABLE DISEASES THROUGH COMMUNITY-BASED
INTEGRATED PROGRMMES).
Any member of the discussion group that wishes a Spanish version of this
Project, will only have to ask it to me.
Greetings to Dr. Hurtado

Dr. Marcelo Tavella

--------------------------------------------------------------------------------

HEART FAILURE

From: Pablo Hurtado <pacardiol@xerox.com.ni>
To: <heartfail-pcvc@pcvc.sminter.com.ar>
Subject: Insuficiencia Cardiaca y VIH
Date: Wed, 6 Oct 1999 10:18:39 -0600

Dear Colleagues:
For several years hypothesis have been made, regarding etiology of heart
failure in patients with HIV/AIDS. There are those who think that this is due to
the virus itself, drugs for opportunistic infections, immunology reactions, etc.
I would like to know which could be the main causes that are discussed nowadays?
Predominant heart failure is Left, Right, or Global?
What other cardiac alterations are most frequent according to your experience?

Thanks,

Date: Thu, 07 Oct 1999 20:42:48 -0300 (ART)
From: "Dr. Edgardo Schapacnik" <edgardo@schapachnik.com.ar>
To: heartfail-pcvc@pcvc.sminter.com.ar
Subject: RE: [HEARTFAIL-PCVC] Insuficiencia cardiaca y VIH/Heart failure

Dear Pablo and all the colleagues of the Forum:

Your question about AIDS and heart failure is really interesting.
This is a good opportunity for us to update a worrying and current topic.
I have an article that is accessible at the Web, and that was published in the
Journal of the Argentine Federation of Cardiology (Revista de la Federacion
Argentina de Cardiologia) No 27: 447-452, 1998, by Drs. Pasca, Pereiro, and
Lastiri, from where I summarize this ideas:
Until now ,there is no accuracy about the causes that originate heart disorders
in HIV infection and, given its complexity, it is possible for multiple factors
to play a role at the same time: direct effect of the virus, autoimmune
mechanisms, opportunistic pathogenic germs, immunologic phenomena generated by
them, consequences of terminal marasmic stage of the nosologic entity
(nutritional deficiencies, meager ingest, state of malabsorption, deficit of
B, C, and E vitamins, selenium, etc.) or drugs used during treatment for the
AIDS patient.
Authors present a huge bibliography about each one of these etiologies, or
contributing causes.
Among infectious agents, the following stand out: Mycobacterium tuberculosis,
Mycobacterium avium-intracellulare, Histoplasma capsulatum, Criptoccocus
neoformans, Toxoplasma gondii, Aspegillus fumigatus, single herpes, Trypanosoma
cruzi, gram-positive and gram-negative cocci, and  gram-negative bacillus.
The severe state of immunosuppression favors in these patients, development of
myocarditis, that can appear as focal or diffuse. In it, cytotoxic T lymphocytes
with specificity to myocyte, originate permanent cell damage during it. Also,
autoantibodies to myocardial fibers have been observed.
Also, the following come into action: hypoalbuminemia, increase of capillary
permeability by cytokines (leak syndrome), or tumoral necrosis factor.
A lot of attention must be paid in detection of Toxoplasma gondii, in patients
with AIDS, since it can precipitate the manifestation of symptomatic congestive
heart failure.
We must not forget as well, as etiologic cause, myocardium infiltration by
Kaposi's sarcoma.

I extracted all these ideas from the mentioned article, that must be read by
anyone who wishes to go any deeper into the subject.
I leave at my colleagues disposal this bibliographical quote.

Cordially,

Edgardo Schapachnik

--------------------------------------------------------------------------------

ARRHYTHMIAS

From=. "Dr. Luis Fiaz E" <ladq1@telcel.net.ve>
To: <ARRITMIAS@listserv.rediris.es>
Subject: Long QT
Date: Wed, 6 Oct 1999 10:48:17 -0400

Dear colleagues, I will describe to you the case of a 33-year-old patient,
whose profession is nursing, that came to the office with hypertension and
syncope in 3 occasions.
Her physical examination is irrelevant, and her ECG in rest shows only one
important finding: a QTc of 540 milliseconds. She has as family history: an aunt
(sister of her father) with sudden death at 32; uncle (brother of her father)
with sudden death at 42; her aunt's daughter with sudden death at 18; her
uncle's son with sudden death at 22; her father with sudden death at 46; a
sister with long-termed QT that arrived at the emergency unit with a ventricular
tachycardia, type "Torsades de pointes", 26 years old, who had multiple
syncopes. Her brother was managed in another city for hypertension and syncope
in several occasions, and her youngest child, 9 years old, has had syncopes in 2
occasions, and has a QTc of 500 milliseconds. When reviewing related texts, I
kept only the idea of management of beta-blockers; and only in some
cases that could be diagnosed by their genetic type, mexilatine besides surgery
for stellar ganglion. Here we lack the means to use ICD. What can you suggest
me? Most of all, for general management of all mentioned relatives.
Thanks,

Dr Luis Díaz E.
Cumana - Venezuela

From=. Dr. Fernando Scazzuso <fscazzuso@intramed.net.ar>
To: <arritmias@listserv.rediris.es>
Subject: QT largo / long QT
Date: Wed, 6 Oct 1999 23:42:49 -0300

First of all, I am amazed at the interesting case presented by Dr. Luis Diaz.
I believe it is of a great importance to carry out a genetic study of this
family, and for this I would send blood samples to Dr. Peter Schwartz' group,
who can perform this kind of analysis, and besides has a world database
regarding diagnosis and follow up of these patients.
Nevertheless, given this patient's family history, I believe left cardiac
denervation is prescribed, besides the beta-blockers' treatment. Before, I would
make a therapeutic test, to verify if QT is corrected with use of xylocaine
bolus at 2 mg/Kg, since in these cases, beta-blockers, far from improving the
symptoms, can worsen them.
Another parameter to take into account, is the electrocardiographic pattern
that can be of help for typifying the different genotypic groups.
Finally, if left cardiac denervation is not possible, I would talk to the
patient about the need of implanting a defibrillator. The rest of the family
present the same risk of arrhythmic sudden death as emerges from questioning.

Dr. Fernando Scazzuso

Date: Thu, 07 Oct 1999 18:40:12 -0300
To: <arritmias@listserv.rediris.es>
From=. "Dr. Daniel Boccardo" <boccardo@agora.com.ar>
Subject: Re: [ARR] QT largo/Long QT

Right tonight we present in the Arrhythmias athenaeums of Cordoba, that are
performed once a month, a 17-year-old patient to whom an ICD was implanted by
"torsades de pointes", that was defibrillated in time, and was diagnosed
sporadic long QT (not familiar, 10% of the cases).
Consequently, we have this subject reviewed and fresh.
It is evident that the patient that you present has a very important family
history; we should know if it is a LQTS1 or a LQTS2 that can be treated with
beta-blockers and potassium orally, since K channels are altered , and are
diagnosed based on the type of T wave of the ECG. The LQTS3 is very virulent,
has a high mortality rate in young people, and presents a plane and long
horizontal ST segment with a normal T wave towards the end. The channel of
Na is altered, and specific medication is Mexitaline that blocks the mentioned
channels (thus shortening QT).
When ICD is not feasible, beta-blockers are the only possibility, besides
avoiding moments of great excitement as rings, alarm clocks, screams, etc., that
can unchain sudden death.
Stellectomy is almost no longer performed, since it produces Horner syndrome,
and it is not always 100% effective. Regarding relatives, all must receive
beta-blockers, and out of these only propranolol, or nadolol in good doses,
since the rest do not diminish sudden death.
Greetings,
Daniel Boccardo

--------------------------------------------------------------------------------

CHAGAS´ DISEASE

From: Marcelo Bassino <marbas@teletel.com.ar>
To: chagas-pcvc@pcvc.sminter.com.ar
Subject: Aportes disponibles
Date: Sun 10 Oct 1999, 23:57:25 -0300

The thematic area of Chagas' disease has started its activities with the
following available Conferences:

1) Acquatella, Harry: Limited Myocardial Contractile Reserve and Chronotropic
Incompetence in Patients With Chronic Chagas' Disease. Assessment by Dobutamine
Stress Echocardiography.
Language: English.

2) Moncayo, Alvaro. Progress in the Interruption of the transmission of Chagas'
Disease in the Southern countries. Language: Spanish.

3) Pinto Días, João. Chagas' Disease: Evolution of the epidemiological knowledge
and present epidemiological situation. Language: Spanish.

Likewise, in the Area Technicians in Cardiology Practice, is published:

4) Mario Blitzman. Chagas-Mazza' Disease. Language: Spanish.

The Forum CHAGAS-FVCC is available in the following address:

CHAGAS-PCVC@PCVC.SMINTER.COM.AR

We invite you to subscribe to the forum and becoming an active participant; all
contributions will be discussed which can lead to contact among the experts
and subscribers increasing the scientific level of the list.
To do that, fill in the Subscription Form available in:

http://pcvc.sminter.com.ar/cvirtual
http://www.fac.com.ar/cvirtual

Moderator of the Forum: Dr. Marcelo Bassino
Coordinator of the Forum: Dr. Haroldo Sgammini

================================================================================

Registration to the First Virtual Cardiology Congress is free
and everyone registered will get a CD with all material
published at the Congress. All interested may be registered
using an individual or a group e-mail address.
Announce the FVCC at your Center.

================================================================================

Useful address on the web-Cardiology Links
==========================================

Atlas of electrocardiography, heart murmurs and echocardiograms

http://www.kumc.edu/instruction/medicine/cont-ed/infotech/car-main.htm

This is the web site of the  University of Kansas Medical Center.
In the above mentioned address  you will be able to find a electrocardiography,
heart murmur and echocardiograph atlas with on line images.

================================================================================

Computer Viruses (5th Part)
Karel Morlans Hernandez, M. D.
FVCC Steering Committee´s member

How to face a virus attack. Antivirus programs.

If your computer is contaminated with a virus, the first thing you must do
is to remain calm and be patient, do not hurry to solve all immediately, instead
do it well. It does not matter the time you spend. Check all disks, tapes, and
storing means. Not doing it, is a common mistake that is usually paid dearly, a
copy of the virus can be laying there waiting.
Follow these steps:
_Disconnect your computer from the net if its linked to one.
_You must not let your computer be used until you are sure that you have
completely eradicated it.
_Verify the presence of viruses with at least two antivirus programs, starting
from a floppy disk checked against viruses and protected against writing, to be
absolutely sure that there is none hidden in the memory.
_If you did not took precautions of having back-up copies of the vital
information contained in your equipment, now is the time to do it. It is  safer
to do it from DOS, using only the dir, cd, and copy commands, without using any
program. Remember: the one responsible for taking care of data is the user, not
the antivirus program. Moreover, even if the latter detects and decontaminates
your computer, the information can be damaged.
_Proceed to decontaminate your computer.
_Viruses modify files or structure of the disk up to a certain extent. Removal
of the evil code in an application is a temporary solution. A complete
cleaning must include re-installment of applications to prevent mistakes in
them.

_Trace the "virus entrance".

Detection and protection against viruses in Nets:
They can be done in three basic levels:
_In a PC: each computer must have installed an antivirus program with the
sentinel activated (monitoring system).
_In the server of a LAN: an antivirus program must also be installed, based
on the server. They allow operation with protocols such as IPX in Netware nets
or in a Windows NT environment, for instance. It has a drawback: that downloaded
files through FTP go straightly to PCs without passing through the LAN server,
therefore they are not checked by its antivirus program. On the contrary, as
each system of electronic mail has its own criptographic system for data, the
trace of virus is blocked.
_Installation of antivirus program in gateway interface and firewalls for
connections to Internet operating under UNIX.
This program, does monitor permanently e-mail and FTP traffic that is done
in the gateway interface of Internet, seizing and isolating viruses before they
reach the net.

Advices to select the antivirus program for your computer or net:
_It must be certified by the ISCA to "cure" a 100% of viruses "in the wild"
(state of savagery, they are the ones running around currently). This
certification is done monthly, and is published in Internet.
_It must have the option to explore or monitor in real time (sentinel) and
be programmed.
_It must allow preventive revision and be programmed with warning alarms,
and options for automatic disinfection or denial of access in systems of e-mail,
fax, broadcast, etc.
_It must have administration tools from a central board, that administers
the heterogeneous global net, groups, or server and computer dominions to
perform a simpler administration.
_It must have protection tools so that the different levels are integrated.
_It must allow automatic updating of the new antivirus signatures and
servers and clients.
_It must include work stations through the installed application in real
time, slowing the less possible the group work.
_It must have a schema "quarantine" type, so that in case that some station
does not have the antivirus application or the last signature loaded, it avoids
entrance to your net server.
_It must have tracing tools for focuses of infection around the net.

==============================================================================

FIRST DAYS OF THE FVCC

Registered participants:
-----------------------

There are 5551 registered participants, from 88 countries.

Thematic lists:
--------------

The following thematic mailing lists are available, all moderated and bilingual
(subject/ name)
Arrhythmias: Arritmias
Sports and Cardiology: exercise-pcvc
Interventional Cardiology: interven-pcvc
Nuclear Cardiology: image-pcvc
Pediatric Cardiology: pediat-pcvc
Chagas Disease: chagas-pcvc
CV surgery: surgery-pcvc
Echocardiography: echo-pcvc
Nursing and Cardiology: nursing-pcvc
Epidemiology and Cardiovascular Prevention: epi-pcvc
Hypertension: hbp-pcvc
Informatics and Cardiology: y2k-pcvc
Heart Failure: heartfail-pcvc
Coronary Insufficiency: coronary-pcvc
Technicians on Cardiology: techn-pcvc
Cardiovascular Therapeutics: pharma-pcvc

Chat Channels:
-------------
The following chat channels are available during the 24hs of day (name/subject):
#ARRITMIA: Arrhythmias - Arritmias
#cafeteria: Lobby - Cafeteria
#cc-pcvc: FVCC Scientific Committee - Comite Cientifico PCVC
#chagas: Chagas Disease - Enfermedad de Chagas
#co-pcvc: FVCC Steering Committee - Comite Organizador PCVC
#coronary-pcvc: Ischemic Heart Disease - Cardiopatia Isquemica
#echo-pcvc: Echocardiography - Ecocardiografia
#epi-pcvc: Cardiov. Risk and Prevention Factors - Epidemiologia y Prevencion
#exercise-pcvc: Sports Cardiology - Cardiologia del Ejercicio
#hbp-pcvc: Hypertension - Hipertension Arterial
#heartfail-pcvc: Heart Failure - Insuficiencia Cardiaca
#image-pcvc: Nuclear Cardiology - Cardiologia Nuclear
#info-pcvc: General information - Informacion general
#interven-pcvc: Interventional Cardiology - Cardiologia Intervencionista
#nursing-pcvc: Nursing in Cardiology - Enfermeria en Cardiologia
#PCVC: 1st Virtual Congress of Cardiology - 1er Congreso Virtual de Cardiologia
#pediat-pcvc: Pediatric Cardiology - Cardiologia Pediatrica
#pharma-pcvc: Cardiovascular Pharmacology - Farmacologia Cardiovascular
#publico: Public - Publico
#surgery-pcvc: Cardiovascular Surgery - Cirugia Cardiovascular
#techn-pcvc: Technicians in Cardiology - Tecnicos en Cardiologia
#y2k-pcvc: Informatics and Cardiology - Informatica y Cardiologia


Brief Communications:
--------------------
Received Brief Communications (abstracts): 521
Approved Brief Communications: 422
Complete received Brief Communications (abstract + presentation): 130
They will be published from 10/31/1999, beginning by the complete works
(abstract + presentation) and according to order of arrival.


FTPMail:
-------
All published lectures will be available by FTPMail (obtaining from Web pages
by e-mail, mainly destined to the participants that do not have access to the
Web).


Lectures:
--------
Received lectures (except those that are already published, and those that will
be published on 10/15/1999; the titles are in the language that will be
published), by alphabetical order of authors:

Achutti Aloysio
Prevention & Socio-Economic impact of Rheumatic Heart Disease in Latin America

Alderman Michael H.
What can be learned from what works!

Baglivo Hugo P.
Medidas generales de tratamiento en el hipertenso diabetico

Boskis Bernardo
Estres y enfermedad cardiovascular

Burlando, Guillermo E
Aspectos epidemiologicos de la  HTA en el paciente diabetico

Chalmers John
The 1999 WHO-ISH Hypertension Guidelines – Stratifiying the risk to treat the
patient

Cometto Maria Cristina
Manejo de drogas mas frecuentemente usadas en la unidad cardiologica

Concha Mauricio
Aspectos Epidemiologicos de la Enfermedad Cerebrovascular

Cunha-Neto Edecio
Immunopathogenic aspects of Chagas' heart disease or Understanding the
pathogenesis of
chagas'disease cardiomyopathy

D'Agosto T. R. Roberto N.
Angiografia digital en laboratorios de hemodinamia

de la Serna, Fernando
Clinica de la insuficiencia cardiaca

DePuey, E. Gordon
Recognition of Soft Tissue Attenuation Artifacts Using Gated Myocardial
Perfusion SPECT

Escobar Eduardo
Historia natural y pronostico de la miocardiopatia dilatada

Forteza Alejandro M.
Diagnostico no invasivo de la enfermedad cvscular extra e intracraneal

Francella Jorge E
La actividad fisica en la rehabilitacion de las arteriopatias perifericas

Franklin Barry A
Safety of medically supervised outpatient cardiac rehabilitation exercise
therapy. A 16-year
follow-up

Franklin Barry A.
Contemporary cardiac rehabilitation services

Garcia del Castilo H.
Pericarditis constrictiva: un reto diagnostico en ecocardiografia

Giraudo Jesus R.
Diabetes and cardiovascular disease

Gonzalez Aldunate Rolando
Taquicardia inducida por taquicardia

Gould Lance
New concepts and paradigms in cardiovascular medicine: the noninvasive
management of coronary
artery disease

Granero Ricardo
Funcion del sistema de salud y del medico en prevenir  la adiccion al tabaco en
ninos y
adolescentes.

Jose M. Alcazar
Acute renal failure in ischemic nephropathy

Juffe Alberto
Trasplante cardiaco. Nuestra experiencia.

Kanter Ronald J.
State of the art in pediatric arrhythmia

Kusuoka Hideo
Detection of Myocardial Ischemia by a Radio-labeled Free Fatty Acid Analog,
BMIPP

Lojero Wheatley,  Luis
Desarrollo de redes de capacitacion con certificacion de la American Heart
Association y
Fundacion Interamericana del Corazon

Lopez Carlos A,
Prevencion de la Muerte subita a traves de educacion  a la comunidad:
Resultados de una encuesta
Lown Bernard
Seducing the young - The assault increases

Lown Bernard
The assault on women - Heart disease and reasons for tobacco power

Lown Bernard
Passive smoking - Overview

Lown Bernard
The power of addiction

Lown Bernard
The assault on women - Cancer and other derangements.

Lown Bernard
Passive smoking - Cardiovascular disease

Lown Bernard
Seducing the young: The crusade against children

Machac Josef
Conventional, Metabolic, and Neuroendocrine Imaging in the Selection of
Patients for Bypass vs.
Transplant Surgery.

Mancia Giuseppe
Sympathetic neural mechanisms in the pathogenesis of human hypertension

Mariani Mario
New trends in myocardial revascularization

Marin-Neto Jose Antonio
Autonomic nervous system derangements

Mena Francisco J
Neuro-Spect Evaluation of Carotid Stenosis before and after Angioplasty and
Stenting

Mendiz Oscar A.
Angioplastia carotidea: Tecnicas con y sin Proteccion Cerebral
Carotid angioplasty: Techniques With and Without Cerebral Protection

Meredith Peter A.
The Importance of Pharmacokinetics in Selection of Antihypertensive Drugs

Michelson Roberto
Hipertension arterial en el anciano
Hypertension in the elderly

Negrao Carlos Eduardo
Exercicio fisico e hipertensao arterial

Negrao Carlos Eduardo
Pathophysiology of Heart Failure-Role of Peripheral Circulatory Mechanisms on
Effort Tolerance

Nordet Porfirio
Rheumatic Fever/Rheumatic Heart Disease. Magnitude and results from some
prevention programmes.

Nordet Porfirio
WHO Global Programme for the Prevention and Control of  Rheumatic  Fever /
Rheumatic  Heart
Disease

Olea G. Enrique
Rol de los radioisotopos en el diagnostico del dolor toracico agudo

Oliveri Nora
Aspectos actuales de la Telemedicina

Pelliccia A. ,Di Paolo  F.M. , De Luca R.
Athlete's Heart and Cardiomyopathy

Pirola Carlos
Susceptibility genes in Essential hypertension

Pitt Bertram
Aldosterone antagonists. A New Hope for Heart Failure Patients.

Raij Leopoldo
Nitric oxide in hypertension: relationship with renal injury and left
ventricular hypertrophy

Rao Syamasundar
Aortic coarctation: Who should be dilated? or operated?

Rasmussen Ricardo
Estrategia en la promocion de la salud cardiovascular

Romero Juan Carlos
The role of angiotensin and oxidative stress in essential hypertension

Reisin Efrain
Treatment of obesity-hypertension

Romano Jose G.
Tratamiento Agudo del Infarto Cerebral Isquemico

Romero Villanueva Horacio
El corazon senil
Senile heart

Ruiz Andres Mariano
Investigacion Biotecnologica en la  y su aplicacion al control de la transmision

Sanchez Osella Oscar Francisco
Utilidad del estres-eco en la valvulopatia mitral
Usefulness of eco-stress in mitral valvulopathy

Sangenis Patricia
Role of exercise in the prevention of coronary heart disease in women.

Schargrodsky Herman E.
Prevencion primaria de las enfermedades cardiovasculares: Una propuesta para
America Latina

Schargrodsky Herman E.
Fundacion InterAmericana del Corazon. La Aspirina y la Enfermedad
Cardiovascular: Una Propuesta
para America Latina

Schargrodsky Herman E.
Prevencion Secundaria de la Enfermedad Coronaria y otras Enfermedades
Vasculares: Una Propuesta
para Latinoamerica

Schiffrin Ernesto L.
Remodeling of resistance arteries in hypertensive patients: effects of
antihypertensive therapy

Serra Jose Luis
Fibrilacion Auricular e

Simoes Marcus V.
Microvascular disturbances in Chagas' heart disease

Simon Alain
Detection of preclinical atherosclerosis: Methods and interest for prevention.

Skinner James S
Actividad fisica y salud cardiovascular

Taddei Stefano
Vasoconstriction to endogenous endothelin-1 is increased in the peripheral
circulation of
essential hypertensive patients

Vilacosta Isidre
Sindrome Aortico Agudo
Acute Aortic Syndrome

Villamil, Alberto S.
Hipertrofia ventricular izquierda y su regresion en la hipertension arterial

Wielgosz Andreas
Situacion epidemiologia CV en nuestro continente

Wilson Elinor
Evidence for Smoking Cessation

Wilson Elinor
Summary of a Presentation on Tobacco Control

Yordi Miriam
Disfuncion organica multiple

Zaman M. Mostafa
Declining Trend of Rheumatic Fever Observed in a Hospital Specialized in
Rheumatic Fever in
Bangladesh

================================================================================

The Deutsche Bank (http://www.deutsche-bank.de/congress) supports the
Newsletter of the
First Virtual Congress of Cardiology.

<><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><>

Editor: Alfredo Piombo, M.D. (Argentina)
Chief of the Coronary Care Unit. Cosme Argerich Hospital,
Buenos Aires, Argentina
Associate Editors:
Claudio Gimpelewicz, M.D. (Argentina)
Dante Manyari, M.D. (Canada)
Carlos Basualdo, M.D. (Canada)

Edgardo Schapachnik, M.D.
Vicepresident of the FVCC Steering Committee


--------------------------------------------------------------------------
Letter to Editors:  readers@pcvc.sminter.com.ar
Send commands to majordomo@pcvc.sminter.com.ar
Others: owner-newsletter-fvcc@pcvc.sminter.com.ar

Top

----------------------------------------------------------------
Newsletter - 1st Virtual Congress of Cardiology
----------------------------------------------------------------
Year 1, number 8. First two weeks, October 1999.
Issue dedicated to FVCC start

================================================================================

Biweekly electronic publication of the First Virtual Congress of Cardiology, for
purposes of promotion and interchange of topics of interest in cardiac sciences
and news from the Congress. It is distributed free of charge to everyone
subscribed. Those of English speaking origin may subscribe sending an e-mail to:

majordomo@pcvc.sminter.com.ar

with the following message in the body of the e-mail:

subscribe fvcc-newsletter

If you ever want to unsubscribe, you can send the following command in the body
of your email message to

majordomo@pcvc.sminter.com.ar:

unsubscribe fvcc-newsletter

An Spanish version is available for those of Spanish speaking origin.
Contributions are welcomed; also responses to previously published articles, and
commentaries should be send as Letters to:

readers@pcvc.sminter.com.ar

===============================================================================

Cardiovascular colleague: announce in your medical center the First Virtual
Congress of Cardiology to start soon.

===============================================================================

Previous issues at:

http://www.fac.com.ar/cvirtual/newslett/newseng.htm

or at

http://pcvc.sminter.com.ar/cvirtual/newslett/newseng.htm

===============================================================================

CONTENTS

Opening speech by the Elected President of the World Heart Federation and member
of the FVCC Honorary Committee.
Professor Mario F. de Camargo Maranhão

Opening speech by the President of the FVCC Steering Committee
Prof. Dr. Armando Pacher
Welcome to the First Virtual Congress of Cardiology

Opening speech by the President of the FVCC Scientific Committee
Prof. Dr. Emilio  Kuschnir

Opening speech by the President of The Argentine Federation of Cardiology
Dr. Eduardo Escudero
1st Virtual Congress of Cardiology

The First Virtual Congress of Cardiology is about to begin...
Alfredo César Piombo; M.D.

Useful address on the web

Computer Viruses (Part 4)
Karel Morlans Hernandez, M. D.
FVCC Steering Committee´s member

Preview of the FVCC

Space available for Advertisement.

================================================================================

The Deutsche Bank  (http://www.deutsche-bank.de/congress) supports the
Newsletter of the First Virtual Congress of Cardiology.

===============================================================================

OPENING SPEECH BY THE ELECTED PRESIDENT OF THE WORLD HEART FEDERATION AND MEMBER
OF THE FVCC HONORARY COMMITEE

To the International Guests

On behalf of the Honorary Committee of the 1st Virtual Congress of Cardiology,
I would like to extend my heartiest greetings to cardiologists all over the
world, plugged in the Internet between October 1st, 1999 -March,31, 2000.
This kind of meeting, planned and organized by the Argentine Federation of
Cardiology (Federación Argentina de Cardiología), will provide access to the
hottest topics in the cardiovascular field, from basic science to the clinical
practice, exploring also the contributions from the modern techniques and
technologies.
Internet, one of the wonders of the world of communications, permits simple,
easy, quick and cheap, effective and interactive information, reporting rapidly
the new advances in diagnosis and therapy of cardiovascular diseases to the  far
away regions of the universe.
I would like to outline the value of Internet as educational tool and
congratulate the organizers, represented by doctors Emilio Kuschnir, Armando
Pacher and Florencio Garafolo, by this worthwhile initiative.
The comprehensive program planned for this meeting will be invaluable for all
participants, not only physicians, but also all professionals concerned with
all aspects of the specialty and healthcare.
I am looking forward, to welcome all of you to the 1st Virtual Congress of
Cardiology.

Professor Mario F. de Camargo Maranhão
Professor of Cardiology at Evangelic School of Medicine and Hospital, and
Professor of Cardiology at Federal University of Parana.

===============================================================================

OPENING SPEECH BY THE PRESIDENT OF THE FVCC STEERING COMMITEE

Welcome to the First Virtual Congress of Cardiology

Being the 2000 so near the First Virtual Congress of Cardiology has started.
Taking the advantages of the communication, frontiers and distances seem to
vanish. Being its aim and the one of the Argentine Federation of Cardiology that
the more than 5000 enrolled people have access to the lattes advances of the
worldwide cardiology, they can interact among each other and with the more than
150 lecturers and with the authors of more than 500 brief communications
presented, and once the congress has finished, then keep on being in touch to
share knowledge constantly through the Discussion Forums.

The Internet facilities being used are those at hand for most of the countries
of the world; Web, E-mail and chat. leaving aside the activities demanding high
velocity of communication, like the video conferences, inaccessible at the end
of the millennium to the fourth-fifth of the population. The discussion forums
are going to be developed using the thematic mailing lists, which have been
conceived for the interactivity between lecturers and participants.

I would like to thank to My wife, with whom I have been sharing projects and
life for 36 years,
To Edgardo Schapachnik, together we give birth to the FVCC and with whom I have
been working since the beginning,
To Roberto Lombardo, partner and close friend, who suffered the burden of the
FVCC Secretary,
To Florencio Garofalo, for his unconditional support and dedication,
To Eliana Bouchet for her never-ending task,
To Maribel Ayala, Corina Espíndola, Mariana Ceballos, Alejandro Alvarez, Carlos
Rodríguez and Lisandro Siviero, for their work in the Secretary,
To Alicia Baetti de Lombardo, for her patience and tolerance, and allowing her
house as the setting of the FVCC Secretary,
To the members of the Steering Committee of the FVCC, whom the 75% we only know
each other virtually,
To the thematic mailing lists Moderators, whom with great effort, dedication and
comprehension, they faced the innumerable difficulties,
To Emilio Kuschnir, for his outstanding work, Polo Friz and the rest of the
members and secretaries of the Scientific Committee,
To the 15 Universities, 58 Scientific Societies, 16 Foundations and other
Institutions that give their support to the FVCC,
To the 12 companies that accepted to participate in an ethical frame and gave
the economical support to make this Congress possible,
To the lecturers, work authors ant the enrolled, who are the ones that "make"
the Congress.

There will be problems and mistakes, which we will try to solve. We are going
along a new path where there are few but deserving models. Let's walk our route,
while building it.

On behalf of the Committees, I wish you can enjoy and take advantage of this
Congress.

Prof. Dr. Armando Pacher
President Steering Commitee

=============================================================================

OPENING SPEECH BY THE PRESIDENT OF THE FVCC SCIENTIFIC COMMITEE

Dear Colleagues,

The Argentine Federation of Cardiology project is completed!

The First Virtual Congress of Cardiology is already a reality.
Learning to learn is our motto.  More than 130 speakers of international
scientific level will participate. Cardiologists, nurses and technicians from 85
countries will have the opportunity of attending the scientific sessions without
moving from their usual workplaces. Lectures, round tables, mailing lists,
virtual institutional athenaeums will be, among others, the tools for promoting
via Internet, maximum interactivity among the participants.

Our intention is to expand scientific knowledge and eliminate frontiers for
professionals from all over the world. At the end of the Congress, in March
2000, a Continuing Medical Education Forum will be set up for the years to come.

I would like to lay special stress on the true protagonists of this event: Our
patients.
If we forget them, most of these activities could become a mere application of
trendy technology. That is why, the Scientific Committee hopes that the Congress
will develop into an usable and used link where each participant will interact
actively, giving and receiving, aiming at improving the care of patients and the
community where they work. Thus, technological advance will become a powerful
tool to democratize knowledge and to create professional and human bonds between
those responsible for watching over their fellows' health.

Dear friends, we hope the Congress beginning today, will become a bridge towards
the future...........

Welcome to the First Virtual Congress of Cardiology!

Prof. Dr. Emilio Kuschnir
President, Scientific Committee

================================================================================

Registration to the First Virtual Cardiology Congress is free
and everyone registered will get a CD with all material
published at the Congress. All interested may be registered
using an individual or a group e-mail address.
Announce the FVCC at your Center.

================================================================================

OPENING SPEECH BY THE PRESIDENT OF THE ARGENTINE FECERATION OF CARDIOLOGY
DR. EDUARDO ESCUDERO

1st Virtual Congress of Cardiology

Dear Colleagues:
It is a true honor for me, and for all members of the Argentine Federation of
Cardiology (FAC) Head Board, to be able to share with you this meaningful moment
in the history of the Institution.

The Argentine Federation of Cardiology has experienced in these almost 35 years
of life, an important growth that determined its expansion to multiple
directions, to find today a wide Institution, booming, contradictory, complex,
and exciting, that we suffer and enjoy daily in the end of this century.

As a part of that growth and that expansion, and thanks to dedication and
creativity from those who, with dedication and hope gave birth to this project,
today we can transcend our limits and project ourselves to a dimension
potentially beyond measure, through this 1st Virtual Congress of Cardiology.

When the project was still in an embryonic stage, when the impulse and
enthusiasm from the main driving force of this idea, Armando Pacher, spread
faith and hope, many of us were not conscious of what we were creating.
Today, with more than 5000 registrations from 86 countries, with a varied,
multifaceted, creative proposal, with high scientific contents, with the
participation of the main figures of national and international cardiology, and
more than 500 scientific communications from different countries, the Argentine
Federation of Cardiology feels a new change of dimension, a new unequivocal sign
of growth.

We are undergoing truly difficult times, not only regarding economy, but as
what regards structure as well, in a society increasingly individualistic,
unfair, and lacking solidarity.
Despite all this, we keep thinking that our Institution must continue its
behavior, trying in its own way to be fair and sympathetic to permit and keep
its development.
Considering as main ideological option that the FAC must act as equalizer of
inequalities, what implies a positive value of equality, we have developed a
plan for educational activities with internal scholarships, courses in person,
and distance courses, as an  answer in someway, to needs from different regions.
It is our permanent concern to keep fostering development of cardiology in
each corner of this wide Argentina and the rest of the world, because we firmly
believe that the growth of many, and not only improvement of a few, is the most
authentic way of placing the Federation in a projection situation increasingly
more solid. Due to its characteristics, the 1st Virtual Congress of Cardiology
will undoubtedly be an important tool to be able to obtain these goals.

Firmly believing that this 1st Virtual Congress of Cardiology will meet fully
its expectations, the Argentine Federation of Cardiology wants to thank most
sincerely and deeply, to those who have provided their time to organize this
event, those who with economical support permitted its realization, and most of
all, to all of you, that by participating actively, will bring life and make
this utopia, definitely, a reality.

Eduardo Escudero, M.D.

===============================================================================

THE FIRST VIRTUAL CONGRESS OF CARDIOLOGY IS ABOUT TO BEGIN....

Dear colleagues:

The First Virtual Congress of Cardiology is about to begin on the Internet,
taking place for the next six months. There is no doubt that this is a
historical fact for cardiology in Argentina and in the world in general. Those
of us who are going to take part in it in some way, to a greater or lesser
degree, must feel honored to be pioneers in a new means of communication. This,
that begins today, and the extent of which is only a dim idea, may be in the
future a part of medicine history.
The globalization phenomenon that everyone is speaking about, that is gradually
affecting several human activities, will also include science, and Internet will
surely be an essential element, although not the only one, of this impossible to
stop phenomenon.
As what regards cardiology in our country, I am convinced that this Congress
will contribute in some way to its future and definite union, an inexorable
fact that will happen in some moment, no matter who gets upset.
Finally, I would like to thank the organizers of this event, and especially to
Dr. Armando Pacher and Dr. Edgardo Schapachnik, for the trust they put in me,
and to take votes for the success of this enterprise, to help us begin with full
energy the new century, without never forgetting that we are the architects of
our own destiny.

Alfredo César Piombo; M.D.

================================================================================

Useful address on the web-Cardiology Links
==========================================

National Institute of Health
http://www.nih.gov

This is the web site of the National Institute of Health of the U.S located in
(Bethesda ,Maryland.) The NIH is one of the most prestigious research institutes
in the world in several areas including cardiovascular one.

In the following address 

http://www.nih.gov/health/trials/index.htm

you will find a database with information about ongoing clinical trials.
Special interest in NHLBI (heart, lung and blood diseases) data base.

--------------------------------------------------------------------------------

Echo-Web
http://www.echo-web.com

Echo-Web has been developed to provide the echocardiographer with career
support, education, conference/seminar information, message and chat areas,
tech news, and echo links.

================================================================================

Computer Viruses (4th Part)
Karel Morlans Hernandez, M. D.
FVCC Steering Committee´s member

Prevention against viruses in Word, Excel, and PowerPoint

Security steps against Macro viruses in Word

_ Extend the list of files recently used: such record is useful, since if
changes were made in "Normal.dot" by a virus, there is a high probability that
the listed documents are infected.
_ Activate the option of asking  if you wish to save changes in Normal.dot: the
user decides if changes are saved or not. These have three drawbacks: it only
warns when the work in Word is concluded. It does not prevent "Normal.dot" in
memory from being infected, that is to say, it is still possible to open an
infected document and made it possible for  the virus to infect the global
template. A virus can deactivate it easily from Word itself.
_ Use the ToolsOptionSave function: this is a Word function that once executed
activates the protective feature to ask if changes made in the "Normal.dot"
template are to be saved. This function can be included in an AutoExec macro,
created by the user in a template also generated by the user, that must be
placed in the folder STARTUP of Microsoft Word for the purpose of activating
this protection each time Word is started. Advantage: this protection is
activated each time Word is started. It has the same drawbacks than the ones
mentioned above, besides you have to create it and know how.
_ DisableAutoMacros Function: this is a function of Word that prevents
automacros from being executed. It can be included in
_ Declare "Normal.dot" as Read Only from Word. It provides the possibility of
preventing infection of the Normal.dot template in the hard drive. Drawback:
each time that Word gets started, an annoying warning message will appear on the
screen for opening the template with the Read Only property.
_ Protect "Normal.dot" against writing, using a password. This protection
relates a password to a document. It allows the template to be modified only if
the correct password is typed in, otherwise, it will be opened in Read Only
mode. Advantage: it prevents "Normal.dot's" global template from being infected
in the hard drive, and can only be deactivated by the computer's owner.
Drawback: after starting  Word, a message is displayed prompting  you to type
the password so that "Normal.dot" could be modified.
_ Use of the Shift key: press the left Shift key without letting go when Word
gets started, or while opening a document. This makes that none of the
automacros is executed. This prevents the spread of viruses that use AutoExec
and AutoOpen macros. If this act is performed when closing a document or when
getting out of Word, the same goal is achieved for the AutoClose macro. Dr
awbacks: it requires a lot of coordination, otherwise macros can be executed
and it prevents only automatic macros from being executed.
_ Use the organizer to check if documents contain MACROS. Drawbacks: the user
has to decide if macros are infected or not. It is uncomfortable to check
documents before opening them.
_ Activate the OpenFile option without Macros: it is only available in Word
8.0. It allows to open  documents created by Word 8.0 and previous versions,
without executing contained macros if the user does not wish so. Drawbacks: the
user is the one who decides if documents will be opened with or without macros.
Users that work with macros will tend to deactivate this protection to be able
to use them.
_ Block project for visualization: only available in Word 8.0. It prevents
modules from being created, seen or copied in a project template. Normal.dot is
a project template, and macros in Visual Basic are
contained in modules.
_ Save a copy of Normal.dot in another folder and compare it to the one you
used with any utility program that allows it. This can be done from the
autoexec.bat.
_ Detect alterations in the STARTUP folder of Microsoft Word, that can be
caused by the inclusion of new templates or alterations in templates contained
there. This process can also be done  from the AUTOEXEC.BAT, and with a DIR.
_ If you have to send by e-mail a text document, do not send it in Word format,
but use RTF format, unless a macro is absolutel
y necessary, or you have been asked to. In RTF format, the text keeps all
features of the original Word format, but no macro will be included. In TXT
format, macros are not included but document's format is lost.

Prevention against Macro viruses in Excel and PowerPoint:

_ Activate the antivirus Protection option in macros: it allows to open
documents of Excel and PowerPoint without opening the macros contained in them.
This method is only available for the 97 version of the product. Drawbacks of
this method are similar to the ones mentioned for MS-Word.
_ Use of the Shift key: same effect and drawbacks as for MS-Word.

==============================================================================

Material to be published on 1999/10/01
In alphabetical order according to author
Author; Title of activity; Thematic area/s; Language

Acquatella Harry
Limited myocardial contractile reserve and chronotropic in competence in
patients with chronic Chagas disease.
Chagas Disease; Heart Failure
English

Agranatti Daniel; Mautner Branco
Sudden Death, Cardiac Arrest and CPR
Heart Failure; Arrhythmias
Spanish

Ariza Olarte Claudia
Can good care produce soon recovery?
Nursing and Cardiology
Spanish

Bayes de Luna A., Bayes-Genis A. y Guindo Soldevila J.
Cardiac Sudden Death
Honorary Committee; Arrhythmias; Cardiovascular Epidemiology and Prevention
Spanish

Bazzino Oscar
Antithrombotic Treatment in Unstable Angina, and Non Q Infarction
Ischemic Heart Disease
Spanish

Bertolasi Carlos
Beyond 2000
Honorary Committee, Ischemic Heart Disease
Spanish/English

Bianco Eduardo
How to Manage the Patient that Smokes in Clinical Practice?
IAHF Symposium, Cardiovascular Epidemiology and Prevention
Spanish

Blitzman Mario
Chagas Disease
Technicians on Cardiology; Chagas Disease
Spanish

Calafiore Antonio Maria
Off or on bypass: what is the safety threshold?
Cardiovascular Surgery, Ischemic Heart Disease
English

Champagne Beatriz Marcet
Summary of Presentation on "The Context for Treating Tobacco Addiction"
IAHF Symposium; Cardiovascular Epidemiology and Prevention
English

De Bold Adolfo
Usefulness of Plasma Levels of the Cardiac Hormones Atrial Natriuretic Factors
(ANF) and Brain Natriuretic Peptide (BNP) in Clinical Cardiology
Honorary Committee; Pharmacology and Therapeutics

Del Rio (h) Alfredo
Long-Term QT Syndrome, and Arrhythmias
Arrhythmias
Spanish

Di Carli, Marcelo
Clinical application of PET
Nuclear Cardiology, Ischemic Heart Disease
English

Doval Hernan
Beta-blockers Drugs
Heart Failure; Pharmacology and Therapeutics
Spanish/English

Favaloro Rene
A Revival of Paul Dudley White. An Overview of Present Medical Practice and of
our Society
Honorary Committee
English/Spanish

Fukuyama Takaya, Imamura Yosihiro
MIBG as an Indicator of the Severity of Heart Failure
Nuclear Cardiology; Heart Failure
English

Gonzalez Zuelgaray Jorge
Course on Arrhythmias
Arrhythmias
Spanish

Gurfinkel Enrique P.
Inflammation & infection in acute coronary syndromes
Ischemic Heart Disease
English

Hijazi Ziyad M., M.D., FACC
Interventional Pediatric Cardiology: What Should we Abandon and Continue to Use
Pediatric Cardiology; Interventional Cardiology
English

Juffe Stein Alberto, Maniez Rafael, Crespo Fabian.
Xenotransplant: Are We Ready?
Cardiovascular Surgery, Heart Failure
Spanish

Kannel W. B.
Epidemiology of atrial fibrillation: risk factors and hazards
Cardiovascular Epidemiology and Prevention, Arrhythmias
English

Levenson Jaime
Rheology, cardiovascular risk factors and silent atherosclerosis
Ischemic Heart Disease; Cardiovascular Epidemiology and Prevention
English

Lown Bernard
Tobacco and cardiovascular health
IAHF Symposium; Cardiovascular Epidemiology and Prevention; Honorary Committee
English

Lown Bernard
Tobacco and the developing world
IAHF Symposium; Cardiovascular Epidemiology and Prevention; Honorary Committee
English

Luciardi Hector
Subendocardial AMI: Diagnostic and Therapeutic Strategy. Should We Intervene?
Ischemic Heart Disease
Spanish

Maranhão Mario F. de Camargo
Women and Heart Disease
Honorary Committee; Cardiovascular Epidemiology and Prevention
English

Matsudo Victor, Matsudo Victor, Araujo Timoteo Leandro, Andrade Erinaldo Luiz,
Andrade Douglas Roque, De Oliveira Luis
Strategies for Physical Activity Promotion in Developing Countries: Experience
from the Agita São Paulo Program
Sports Cardiology; Cardiovascular Epidemiology and Prevention
Spanish

Moncayo Alvaro
Progress towards interruption of transmission of Chagas disease in the Southern
Cone countries
Chagas Disease; Cardiovascular Epidemiology and Prevention
Spanish

Narvaez Perez Galo E
Aerobic-Anaerobic Interactions of Muscular Work
Sports Cardiology
Spanish

Nicolau Juan Carlos
Interventional vs. Conservative Strategies in Myocardial Infarction without
Superior Deviation
(a consultar) of ST Segment
Ischemic Heart Disease; Interventional Cardiology
Portuguese

Oliveri Raul
Autonomous Nervous System Dysfunction in Heart Failure
Heart Failure
Spanish

Pinto Dias João Carlos
Evolution of Epidemiological Knowledge and Current Situation of Epidemiology
Chagas Disease
Spanish

Reckelhoff Jane F.,Juncos Luis A., Romero Carlos
The role of angiotensin and oxidative stress in essential hypertension
Hypertension
English

Rodriguez Jorge Raul
Y2K Syndrome: Year 2000 Situation in the Health Field
Informatics and Cardiology
Spanish/English

Rodriguez Leonardo
Assessment of Diastolic Function Using Tissue Doppler Echocardiography
Echocardiography; Heart Failure
English

Romero Villanueva Horacio
Senile Heart
Physiology and Pathology in the Elderly
Spanish/English

Ronderos Ricardo Ernesto
Advantages and Disadvantages of Echocardiography in Heart Failure Evaluation
Echocardiography; Heart Failure
Spanish

Santoni-Rugiu Francesco
Methods of identifying post-myocardial infarction patients at high risk for
subsequent arrhythmic death
Arrhythmias; Ischemic Heart Disease
English

Sellke Frank W.
Update in techniques of myocardial revascularization: therapeutic angiogenesis
Cardiovascular Surgery; Ischemic Heart Disease
English

Shaffer Elizabeth
Prenatal diagnosis of congenital heart disease: Its impact in pediatric
cardiology
Pediatric Cardiology; Echocardiography
English

Torne Perez Enrique, Alaminos Romero Rosario
Swan-Ganz Catheter. Role of Nurses in Right Heart Catheterization
Nursing and Cardiology
Spanish

Valdes Gloria and Germain Alfredo M.
A pathophysiological approach to the origin of preeclampsia
Hypertension
Spanish

Werba, Jose Pablo
Lowering Blood Cholesterol. When, How and How Much?
Cardiovascular Epidemiology and Prevention; Pharmacology and Therapeutics
English

===============================================================================

MATERIAL TO BE PUBLISHED AFTER 1999/10/01

In alphabetical order according to author
Author; Title of activity; Thematic area/s

Achutti Aloysio
WHO Symposium; Cardiovascular Epidemiology and Prevention

Boskis Bernardo
Stress and Cardiovascular Disease
Cardiovascular Epidemiology and Prevention

Chalmers John
The 1999 WHO-ISH Hypertension Guidelines
Hypertension

Cingolani Horacio
Prevalence of Hypertension in 3154 Youngsters
Honorary Committee; Hypertension

DePuey, E. Gordon MD
Recognition of Soft Tissue Attenuation Artifacts Using Gated Myocardial
Perfusion SPECT
Nuclear Cardiology

Escriba Juan Manuel Pascual
Wide Access and Low Cost Communication. Uninet Experience
Informatics and Cardiology

Garcia del Castilo H.
Constrictive Pericarditis: A Diagnostic Challenge in Echocardiography
Echocardiography

Lojero Wheatley Luis
Development of Training Centers with Certification by the American Heart
Association and the InterAmerican Heart Foundation.
IAHF Symposium; Cardiovascular Epidemiology and Prevention

Lown Bernard
The assault on women - Heart disease and reasons for tobacco power
IAHF Symposium; Cardiovascular Epidemiology and Prevention; Honorary Committee

Lown Bernard
The power of addiction
IAHF Symposium; Cardiovascular Epidemiology and Prevention; Honorary Committee

Lown Bernard
Passive smoking - Overview
IAHF Symposium; Cardiovascular Epidemiology and Prevention; Honorary Committee

Lown Bernard
Passive smoking - Cardiovascular disease
IAHF Symposium; Cardiovascular Epidemiology and Prevention; Honorary Committee

Lown Bernard
Seducing the young: The crusade against children
IAHF Symposium; Cardiovascular Epidemiology and Prevention; Honorary Committee

Lown Bernard
The assault on women - Cancer and other derangements.
IAHF Symposium; Cardiovascular Epidemiology and Prevention; Honorary Committee

Lown Bernard
Seducing the young - The assault increases
IAHF Symposium; Cardiovascular Epidemiology and Prevention; Honorary Committee

Machac Josef
Conventional, Metabolic, and Neuroendocrine Imaging in the Selection of Patients
for Bypass vs. Transplant Surgery.
Heart Failure

Mancia Giuseppe, Seravalle Gino, Grassi Guido
Sympathetic neural mechanisms in the pathogenesis of human hypertension
Heart Failure

Mariani Mario, MD.
New trends in myocardial revascularization
Ischemic Heart Disease

Marin-Neto Jose Antonio
Autonomic nervous system derangements
Chagas Disease

Meredith Peter A.
The Importance of Pharmacokinetics in Selection of Antihypertensive Drugs
Hypertension

Michelson Roberto
Hypertension in the elderly
Physiology and Pathology in the Elderly; Hypertension

Negrão Carlos Eduardo, PhD; de Nazare Nunes Alves Maria Janieire, MD
Pathophysiology of Heart Failure-Role of Peripheral Circulatory Mechanisms on
Effort Tolerance
Heart Failure

Nordet Porfirio
WHO Global Programme for the Prevention and Control of Rheumatic Fever /
Rheumatic Heart Disease
WHO Symposium; Cardiovascular Epidemiology and Prevention

Nordet Porfirio
Rheumatic Fever/Rheumatic Heart Disease. Magnitude and results from some
prevention programmes.
WHO Symposium; Cardiovascular Epidemiology and Prevention

Pelliccia A. , Di Paolo F.M., De Luca R.
Athlete's Heart and Cardiomyopathy
Sports Cardiology

Pichel Ricardo
Biomedical science: an epistemological point of view
Various
      
Pirola Carlos
Susceptibility genes in Essential hypertension
Hypertension
       
Raij Leopoldo
Nitric oxide in hypertension: relationship with renal injury and left
ventricular hypertrophy
Hypertension

Rao Syamasundar
Aortic coarctation: Who should be dilated? or operated?
Pediatric Cardiology; Interventional Cardiology; Cardiovascular Surgery
       
Sanagua Jorge O., Acosta Guillermo, Rasmussen Ricardo
Cardiac Rehabilitation as Secondary Prevention
Sports Cardiology

Sanchez Osella Oscar Francisco
Usefulness of eco-stress in mitral valvulopathy
Echocardiography
       
Sangenis Patricia
Role of exercise in the prevention of coronary heart disease in women.
Sports Cardiology

Schargrodsky Herman E.
InterAmerican Heart Foundation. Aspirin and Cardiovascular Disease: A Proposal
for Latin America
IAHF Symposium
       
Schargrodsky Herman E.
Secondary Prevention of Coronary Disease and other Vascular Diseases: A Proposal
for Latin America
IAHF Symposium
       
Schargrodsky Herman E.
Primary Prevention of Cardiovascular Diseases: A Proposal for Latin America
IAHF Symposium
       
Schiffrin Ernesto L.
Remodeling of resistance arteries in hypertensive patients: effects of
antihypertensive therapy
Hypertension
       
Serra Jose Luis
Atrial Fibrillation and Heart Failure
Heart Failure; Arrhythmias
       
Simões Marcus V.
Microvascular disturbances in Chagas' heart disease
Chagas Disease

Simon Alain
Detection of preclinical atherosclerosis: Methods and interest for prevention.
Ischemic Heart Disease
       
Wielgosz Andreas
Epidemiology of CV Disease in Our Continent
IAHF Symposium
       
Wilson Elinor
Evidence for Smoking Cessation
IAHF Symposium; Cardiovascular Epidemiology and Prevention
       
Wilson Elinor
Summary of a Presentation on Tobacco Control
IAHF Symposium; Cardiovascular Epidemiology and Prevention
       
Zaman M. Mostafa, Yoshiike Nobuo, Rouf Mian Abdur, Haque K.M.H.S. Sirajul, Malik
Abdul, Tanaka Heizo
Declining Trend of Rheumatic Fever Observed in a Hospital Specialized in
Rheumatic Fever in Bangladesh, 1991-1997
WHO Symposium; Epidemiology and Prevention

================================================================================

The Deutsche Bank (http://www.deutsche-bank.de/congress) supports the
Newsletter of the
First Virtual Congress of Cardiology.

<><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><>

Editor: Alfredo Piombo, M.D. (Argentina)
Chief of the Coronary Care Unit. Cosme Argerich Hospital,
Buenos Aires, Argentina
Associate Editors:
Claudio Gimpelewicz, M.D. (Argentina)
Dante Manyari, M.D. (Canada)
Carlos Basualdo, M.D. (Canada)

Edgardo Schapachnik, M.D.
Vicepresident of the FVCC Steering Committee


--------------------------------------------------------------------------
Letter to Editors:  readers@pcvc.sminter.com.ar
Send commands to majordomo@pcvc.sminter.com.ar
Others: owner-newsletter-fvcc@pcvc.sminter.com.ar

Top

----------------------------------------------------------------
Newsletter - 1st Virtual Congress of Cardiology
----------------------------------------------------------------
Year 1, number 7. First two weeks, September 1999.

================================================================

Biweekly electronic publication of the First Virtual Congress of
Cardiology, for purposes of promotion and interchange of topics
of interest in cardiac sciences and news from the Congress. It
is distributed free of charge to everyone subscribed. Those of
English speaking origin may subscribe sending an e-mail to:

majordomo@pcvc.sminter.com.ar

with the following message in the body of the e-mail:

subscribe fvcc-newsletter

If you ever want to unsubscribe, you can send the following
command in the body of your email message to

majordomo@pcvc.sminter.com.ar:

unsubscribe fvcc-newsletter

An Spanish version is available for those of Spanish speaking
origin.
Contributions are welcomed; also responses to previously
published articles, and commentaries should be send as Letters
to:

readers@pcvc.sminter.com.ar

================================================================

Cardiovascular colleague: announce in your medical center the
First Virtual Congress of Cardiology to start soon.

================================================================

Previous issues at:

http://www.fac.com.ar/cvirtual/newslett/newseng.htm

or at

http://pcvc.sminter.com.ar/cvirtual/newslett/newseng.htm

================================================================

CONTENTS

Echoes from the "XVII InterAmerican Congress of Cardiology
Future surgery signaled by biology and robotics

Hospitals Free of Tobacco
Dra Kaczmar Oksana

Useful address on the web

Computer Viruses (Part 3)
Karel Morlans Hernandez, M. D.
FVCC Steering Committee´s member

Activities previous to the Congress

Preview of the FVCC

Space available for Advertisement.

================================================================

This Newsletter will be sponsored by companies that wish to get
involved in the success of the First Virtual Congress of
Cardiology.

================================================================

Transcribed with the authorization of  the editors of the
Electronic Journal of Health in Spanish, "Health I. G. News",
that is distributed by e-mail.
This article was published in its last number, No 8 (year III),
September 2nd, 1999, page 12: "Future surgery signaled by
biology and robotics" Echoes from the "XVII Congreso
Interamericano de Cardiología" (XVII InterAmerican Congress of
Cardiology)

From last August 22nd to 25th, the "XVII Congreso Interamericano
de Cardiología" was held in Buenos Aires, with the auspice of
Argentine Society of Cardiology. One of the famous foreign
guests was, paradoxically, an Argentine man that has been
working in his specialty for almost two decades in France. He is
Juan Carlos Chachques, MD PhD, Director and Associate Professor
of Clinical Research of the Cardiovascular Surgery and Organ
Transplantation Department of Broussais Hospital, Paris, France.
In January, 1985, he created a surgical technique that opened a
new stage in cardiac surgery.
A French woman had a tumor removed from her heart walls.
Chachques, together with his team of the hospital, invented a
novel technique that would save many lives. They wrapped the
weakened heart with part of the dorsal muscle, placed in the
upper part of the back. Thus, the so-called "cardiac shawl" was
born. Last year, Dr Chachques received a subsidy of 200 thousand
dollars for a program on cellular biology. During the Congress,
the scientist presented details of his investigation: "Cellular
Biology and Heart Failure. Myoblast Transplantation."
"Cellular implants" promise to revolutionize cardiovascular
surgery. According to the specialist, "when a person undergoes
an infarct, part of the wall of his/her heart dies. We propose
the following technique: we make a biopsy of heart tissue, and
we carry out a cell culture with lab growth factors. These
"satellite cells" have a great regeneration power. Three weeks
later they are implanted in the heart, and the tissue gets
repaired. It is as if the latter came to life again". Bearing in
mind epidemiological problems in our region, it is worthwhile to
point out that this technique could be used to treat conditions
that damage heart tissue, for example, Chagas disease.
Dr Chachques, who received a prize from the Biblioteca Nacional
(National Library), took the opportunity of his visit to Buenos
Aires to present "Cardiac Bioassist", the 11th volume of the
series published by the Bakken Research Center. For a large
amount of cases, cardiac bioassistance represents a practical
choice. The book is considered a complete guide for that field.
To Chachques, "the future is signaled by biologic surgery and
robotics". By mid-May, 1998, the Argentine specialist was one of
the protagonists in France, of the operation to 6 patients aided
by a robot: a 1,80 meter column that, unlike human beings, has
three arms. In two of them, the different instruments required
for surgery are placed. The third one is a minicamera, through
which the surgeon, sitting three meters apart, watches the
operating zone and handles the robot. The six operations were:
an interatrial communication (performed in a young woman, 25
years old), four reparations of cardiac valves, and a coronary
bypass.
Operations are a lot less invasive, because only three small
incisions are made, through which the arms of the robot enter.
Furthermore, the machine is more accurate in its movements,
because the "wrist" of the robot can rotate 360 degrees,
something impossible for the hand of the surgeon. But there is
still another great advantage: the robot will be handled from a
long range, and the surgeon will be able to give orders to it
through anoptical fiber system. The robot -worth around 700
thousand dollars- could be installed in high complexity centers,
and then, perform operations from there.
Dr Chachques, who was invited to the First Virtual Congress of
Cardiology, will make his contribution to the Congress tackling
on "cellular implants".

In order to subscribe to the "Health I. G. News" Journal, send
an e-mail message to:

healthig@impsat1.com.ar


================================================================

Hospitals Free of Tobacco
Dra Kaczmar Oksana

A hospital free of tobacco is an ambitious goal, that implies
adhesion by all players that take part of it, both people that
work there, and those who go there.

Smoking

Tobacco use is one of the scant elements related to health in
which adverse conditions for the latter are created by human
beings, capable of adjusting their strategies to continue
reassuring a consumption market for this product.

A healthy environment, free of smoke from tobacco is everybody's
responsibility, regardless we are smokers or not. Health
institutions are, in particular, the ones that must perform a
starring role in prevention of smoking habit.
A hospital is not an ordinary place, behaviors observed there
acquire, more than in other places, the value of example in
everything that refers to health conducts.
Sanitary staff, whatever discipline they belong to, are united
by a common goal, to relief their patients' suffering, to
improve physical and mental health state, to prevent health
deterioration that can be avoided. Interventions by health
providers, such as doctors, nurses, sanitary agents, and all
those who make up a health team, have the possibility of
treating a great proportion of smokers due to the high contact
rate that all of them keep with the general public.
Smokers suffer more health alterations, and use health treatment
institutions more frequently than non smokers, therefore there
is a strong opportunity of providing them with preventive and
curative services.
There is a calculation, that around 70-80% of smokers go to
health institutions at least once a year.
In USA, it was detected the fact that annually, the smoker goes
to the doctor an average of 4,3 times.
The hospital as a structure, has special features, both great
size and an important working population. It provides also
accommodation to ill people with different pathologies, and at
the same time it displays an important number of floating
population that come to consult for their own health, or come
accompanying the patients.
The high level of contact that sanitary staff keeps with general
community, shows that an institution free of tobacco is the best
vehicle to offer great possibilities of diminishing smoking
prevalence.
It comes as a paradox that is much harder to find a hospital
free of tobacco smoke, than public transportations or companies
free of tobacco.
A hospital without smoke is a preventive and educational strategy
for health, that sets off a non smoking policy in the hospital
through awareness and commitment from all sanitary staff,
implementing a gradual process, in which feedback mechanisms
hold a fundamental role, as well as human resources action,
committed to obtain hospitals with healthy environments, free of
tobacco smoking.
International precedents back this proposal, such as European
initiative: Programme L Europe contre le Cancer: POUR UN HOSPITAL
SANS TABAC
In year 1991, this program was established as a European
preventive and educational strategy for health that was developed
in the framework of exchanges of the European Net of Hospitals
without Tobacco.
In 1993, the idea for a Net for preventing Smoking arises, along
with the invitation to participate to all European Hospitals and
Sanitary Institutions.

================================================================

Registration to the First Virtual Cardiology Congress is free
and everyone registered will get a CD with all material
published at the Congress. All interested may be registered
using an individual or a group e-mail address.
Announce the FVCC at your Center.

================================================================

Useful address on the web-Cardiology Links
==========================================

On-Line medical Dictionary

http://www.graylab.ac.uk/omd/index.html

OMD is a searchable dictionary and contains terms relating to
biochemistry, cell biology, chemistry, medicine, molecular
biology, physics, plant biology, radiobiology, science and
technology. It includes: acronyms, jargon, theory, conventions,
standards, institutions, projects, eponyms, history, in fact
anything to do with medicine or science in general.

----------------------------------------------------------------

General dictionary of english-spanish language

www.vlekho.be/tt/vakgroep/spaans/diccion.htm
Dictionary on line of spanish language. In the Capital
dictionary section you can find translation from
spanish/english/french/germany to 12 different languages,
including italian and dutch; it also contains definitions in
spanish/french/english/germany/italian.

================================================================

Computer Viruses (3nd Part)
Karel Morlans Hernandez, M. D.
FVCC Steering Committee´s member

Prevention: Basic Steps for Computer Security

"The only system that is really safe is the one that is
disconnected from the electric line, embedded into a concrete
block, hermetically locked up in a lead-covered room, and
protected by armed guards, and even so, I have reservations".
Eugene H. Spanfford.
These words on computer viruses are quite farfetched, but not
unreal. What is important, is to become aware of the problem and
not to ignore it. Believing that such a thing cannot happen to
us, is the same mistake that many people suffering from HIV have
made, though unlike the latter, we will lose time and
information instead of our lives. Just as in medicine, the best
remedy or treatment is PREVENTION.
We can prevent the harmful effects of a computer viral attack
by: basic stepsfor computer security (those are responsibility
of each user and/or net administrator), updated "epidemic"
information about new and running viruses, acquisition,
updating, and systematic use of antivirus programs that perform
the role of computer condoms.
In this article we will deal with basic steps for computer
security, which have two goals: preventing an infection by a
computer virus, and avoiding loss of the largest possible amount
of information. If you believe they are simple and of little
use, you are wrong. If you think they are tiresome and boring,
you are right, but they are useful and necessary for YOU and for
EVERYONE ELSE.
Basic steps for primary prevention:
_In your computer's setup fix starting options as C:, A:
_Prepare a "clean" starting drive (checked against viruses) and
protected against writing
_Do not start you PC with a diskette inside tower A that is not
your starting drive, already checked and protected
_Do not restart with CTRL+ALT+DEL with a diskette inside tower
A. Even though your computer may be configured to get started in
tower C, it will always search first in tower A, and will read
the boot sector of the diskette placed there, this is enough to
get infected by a virus from the boot sector (and these are the
most dangerous)
_Do not use diskettes or CDs that are not yours without
previously checking them
_Check your diskettes if they were used in a computer that is not
yours, the more so if you used them in machines connected in a
net
_Keep in your PC just the programs you use
_Avoid illegal copies of programs, games, and utility programs
_Install at least 1 antivirus program, whether you are or are
not connected to a net
_Keep the TSR (lookout) of the antivirus program always active.
If you have more than one antivirus program, configure them so
that only one of the lookouts works
_Configure the lookout and antivirus programs to check e-mail
messages and zipped files
_Configure the lookout and antivirus programs to automatically
decontaminate infected files or deny access to them
_Check regularly all your system (once a week), apart from the
lookout
_Check all your system if it displays abnormal, or unusual
operation, even if you meet all the previous recommendations
_Make systematically, backup copies of your work files and
applications. In the case of work files, it is ideal to have
three copies of them; two, outside the hard drive in which you
work, and at least one outside your computer
_Do not send attached files by e-mail just because
_Avoid sending attached files to e-mail mailing lists. Instead,
send them to the people that asked for them
_If you receive an attached file that you did NOT requested, or
you do NOT KNOW, do not open it or execute it without checking
it. If you still have doubts, ERASE IT.
_Be careful when playing the CHKDSK command of DOS. When it
checks all subdirectories of the drive and the link chain
between sectors in FAT, it provides viruses a wide opportunity
to contaminate any file, even programs that were not executed.
Certain viruses cause file assignment errors, and take advantage
of the execution of CHKDSK /F to damage beyond repair the files
you try to mend.

Basic steps for secondary prevention: when a virus infection
has already happened.
_Start your computer with a starting diskette checked against
viruses and protected against writing. This will let you access
the hard drive, and copy vital information to diskettes in many
cases
_With the previous option, confine yourself to DOS, and use only
cd, rd, dir, and copy commands.
_Do not execute any program, except an antivirus, until you
decontaminate your PC
_Even after you have decontaminated your applications, and these
work properly, the best is to reinstall them.
_If you detect a virus in some file, check all the means for
storage, there could be copies of the same or other viruses.
_Trace back the way the virus "entered" your computer. Remember
that most infections are unintentional from the human point of
view, it is convenient to know the source to avoid the same
problem, not to punish
_If decontamination of a file is impossible (as with Happy99)
ERASE IT, DO NOT OPEN IT
_If a file is reported as suspicious, DO NOT OPEN IT. Explore it
with another antivirus program, or ask an expert.

Secondary prevention in a Net:
_Disconnect the infected computer from the net, and check it
_Review the server. Firstly, verify that the computer through
which you will make the revision is not contaminated
_While making the revision, sign with the smallest amount of
possible attributes, if there was an infection and you enter as a
supervisor or with your attributes, the virus will take them and
infect every program executed. Rise gradually the authority in
your accesses, in order to decontaminate
_Detect the infection's source. A good NLM will provide you with
a "log file", in which node, time and date of the terrible
episode will be indicated.

================================================================

Activities previous to the Congress

As a functional test, the First Virtual Congress of Cardiology
invites all our colleagues to take part in the "Year 2000
Syndrome - Y2K" Forum, which will be an interactive way to
participate in the lecture by Dr Jorge Rodriguez about this
subject.

The lecture will be available from 9/15/1999 at:
http://pcvc.sminter.com.ar/cvirtual
http://www.fac.com.ar/cvirtual

In order to register to the Forum, send a message with the
following characteristics:

To: majordomo@pcvc.sminter.com.ar
Subject:
=================================
subscribe y2k-pcvc

The Forum will be available until January 10th, 2000.

================================================================

PREVIEW OF THE FVCC

We continue to announce some of the scientific activities that
will be available during the sessions of the Congress.
Dr Bernard Lown will participate with his lectures: "Passive
smoking. Cardiovascular disease"; "Passive smoking. Overview";
"Seducing the young. The assault increases"; "Seducing the young
The crusade against children"; "The assault on women. Cancer and
other deragements"; "The assault on women. Heart disease and
reason for tobacco power"; "The power of addiction" and "Tobacco
and cardiovascular  health".
The contribution by Dr Beatriz Marcet Champagne, will be about
"The Context for Treating Tobacco Addiction".
Dr Wilson Edinor will share the panel, with the topics
"Evidence for Smoking Cessation and "Tobacco Control".
"Prevention and Socio-Economic impact of Rheumatic Heart
Disease", will be the title of the lecture by Dr Achutti Aloyso.
In the Round Table "Risk stratification for sudden arrhytmia
death in Coronary Heart Disease", Dr Francesco Santoni-Rugiu
will deal with "Methods of identifying post-myocardial
infarction patients at high risk for subsequent arrhytmic
death".
Likewise, Dr Franklin Barry, Bonzheim Kimberly, Gordon Seymour,
and Timmis Gerald's contribution on the Cardiac Rehabilitation
Round Table will tackle the topic "Safety of medically
supervised outpatient cardiac rehabilitation exercise therapy. A
16-year follow-up".

================================================================

This space is reserved for companies that wish to sponsor and
support the success of the First Virtual Congress of Cardilogy.

<><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><>

Editor: Alfredo Piombo, M.D. (Argentina)
Chief of the Coronary Care Unit. Cosme Argerich Hospital,
Buenos Aires, Argentina
Associate Editors:
Claudio Gimpelewicz, M.D. (Argentina)
Dante Manyari, M.D. (Canada)
Carlos Basualdo, M.D. (Canada)

Edgardo Schapachnik, M.D.
Vicepresident of the FVCC Steering Committee


--------------------------------------------------------------------------
Letter to Editors:  readers@pcvc.sminter.com.ar
Send commands to majordomo@pcvc.sminter.com.ar
Others: owner-newsletter-fvcc@pcvc.sminter.com.ar

Top

----------------------------------------------------------------
Newsletter - 1st Virtual Congress of Cardiology
----------------------------------------------------------------
http://www.fac.com.ar/cvirtual
http://pcvc.sminter.com.ar/cvirtual

================================================================

Year 1, number 6. August 30, 1999.

================================================================

Biweekly electronic publication of the First Virtual Congress of
Cardiology, for purposes of promotion and interchange of topics
of interest in cardiac sciences and news from the Congress. It
is distributed free of charge to everyone subscribed. Those of
English speaking origin may subscribe sending an e-mail to:

majordomo@pcvc.sminter.com.ar

with the following message in the body of the e-mail:

subscribe fvcc-newsletter

If you ever want to unsubscribe, you can send the following
command in the body of your email message to

majordomo@pcvc.sminter.com.ar:

unsubscribe fvcc-newsletter

An Spanish version is available for those of Spanish speaking
origin.
Contributions are welcomed; also responses to previously
published articles, and commentaries should be send as Letters
to:

readers@pcvc.sminter.com.ar

================================================================

Cardiovascular colleague: announce in your medical center the
First Virtual Congress of Cardiology to start soon.

================================================================

Previous issues at:

http://www.fac.com.ar/cvirtual/newslett/newseng.htm

or at

http://pcvc.sminter.com.ar/cvirtual/newslett/newseng.htm

================================================================

CONTENTS

Editorial:
About trials and registries
Alfredo Piombo, M.D.
Chief of the Coronary Care Unit. Cosme Argerich Hospital,
Buenos Aires, Argentina
FVCC Scientific Committee´s member

Useful address on the web

Computer Viruses (Part 2)
Karel Morlans Hernandez, M. D.
FVCC Steering Committee´s member

Attention!
Announcement for Prizes to the best works presented during the
FVCC.

Preview of the FVCC

Space available for Advertisement.

================================================================

This Newsletter will be sponsored by companies that wish to get
involved in the success of the First Virtual Congress of
Cardiology.

================================================================

"ABOUT TRIALS AND REGISTRIES"

The huge importance that randomized clinical trials (RCT) have,
have had, and will have in the progression of scientific
knowledge, is a topic that does not admit argument. The growth
of "evidence based medicine", that does not replace, but
complements and scientifically supports "experience based
medicine" (true source of medical knowledge) proves so.
RCTs are examples of what is known as intervention analytic
epidemiologic studies, a kind of  prospective cohort studies (1)
The sort of drugs used currently in cardiology require
necessarily this kind of tests to know their efficacy, due to
their small or moderate effect on a certain disease.
There are other kinds of interventions (e. g.: antibiotics,
certain vaccines, electrical cardioversion, etc.), that given
the magnitude of their therapeutic effects, make RCTs
unnecessary.
The avalanche of RCTs that cardiology has withstood in the last
few years, some extraordinarily relevant, others of scant
importance, and many absolutely disposable, have made
researchers to lose sight of other types of studies, certainly
easier and more modest, but from the point of view of
epidemiology, indispensable. They are the so-called registries.
A registry is just an epidemiologic study of a
descriptive-observational type, without controlled therapeutic
interventions (1).
Registries are studies commonly underestimated, considered
"inferior" when compared to intervention studies. This is far
from being true. Comparison between records and RCT is not a
logical one, since the information provided by these two kinds
of studies is different and clearly supplementary.
The effect of a certain therapeutic intervention on survival or
quality of life of a group of people with a given pathology, can
only be recognized with a high degree of certainty by the
implementation of a RCT. Thus, today we know the benefits from
aspirin and thrombolytics in acute myocardial infarction,
results from myocardial revascularization surgery in  patients
with coronary disease, or the contribution of glycoprotein
IIb-IIIa inhibitors in acute ischemic syndromes, mentioning them
just for an example (2-7).
Registries are scientific studies with the purpose of answering
other types of questions, and in that sense can be viewed as
supplementary for the RCT. A registry, among other properties,
assesses the repercussions that a RCT has had in medical
community, and thus in the diseased population. RCT shows us the
effect of a medical intervention on a sample of population
always previously selected (unavoidable bias, not matter how
representative the sample is) according to inclusion criteria.
In this way, extrapolation of the results from a RCT to a group
of patients that were excluded from the study (for reasons of
age, sex, race, history of diseases, etc.), although performed
in medical practice in many cases, is always dangerous.
It is so important to know the effect of a certain intervention,
as the real use of that intervention in medical practice. It is
known that results from the big trials do not get immediately
and directly translated to daily clinical practice. If in some
cases this can be done relatively quickly, in other cases it can
be delayed months or years, and a few of them virtually do not
get incorporated. Multiple factors interpose in the way from a
RCT to large-scale diffusion of its results: publication of
studies (many of them with negative results are not accepted for
publication), the management of results by pharmaceutical
industry ("merchandising"), cost/benefit ratio, interpretation
by physiciens, and prejudices that the latter have, more or less
rooted, on certain drugs or other kind of interventions.
For instance, results from the GUSTO-1 study can be cited,
having proved a certain superiority (small but significant) of
tissue plasminogen activator over streptokinase in acute
myocardial infarction (8).
Its results were massively adopted in the United States, unlike
our country, where cardiologists' behavior regarding indication
of streptokinase almost did not change. A different availability
of resources and a proper use of the cost/benefit ratio explain
the differences.
Results from trials on beta-blockers in patients with heart
failure, also make up an interesting topic regarding this
question. Although evidence favoring this treatment grows day by
day, it is likely that the period until its acceptance by
medical community will be extensive, if we take into
consideration that the presence of heart failure has been
classically considered a counter-indication for  beta- blocking
therapy. 
Complementation between RCTs and epidemiologic registries is
clearly demonstrated by the interaction that has always existed
between both kind of studies. The CASS randomized study and the
CASS registry, the GUSTO study and its corresponding database,
the OASIS-2 study and OASIS registry, are paradigmatic examples
of what was previously stated. In the three mentioned studies,
it is possible to state that volume and quality of information
of registries have largely outgrown the corresponding
intervention studies, giving rise to the publication of an
endless amount of scientific papers (9-18).
Due to space reasons, and because it is the most current
example, we will take for reference the OASIS study (19). The
OASIS-2 study (Organization to Assess Strategies for Ischemic
Syndromes) was a randomized clinic trial that included 10141
patients with acute ischemic syndromes without ST segment
elevation in the admission ECG.
They were randomly assigned to receive unfractionated heparin or
hirudin, both by intravenous way, plus the usual treatment for
these clinical manifestations. The double point of death or
acute myocardial infarction turned out barely more favorable to
hirudin at 72 hours (2% vs. 2.6%; p=0.03), losing statistical
significance at 7 days (3.6% vs. 4.2%; p=0.07). When taking into
consideration a triple end point, results keep being significant
at 7 days, with an absolute difference of 1% between the two
groups. A small excess of hemorrhages, though not cerebral, was
observed in the hirudin group.
The OASIS registry, on the other hand, consisted on the
production of a great database of the patients already
described, grouped according to the countries they belonged to
and to the complexity of the hospital in which they were
admitted (20). The most important conclusions were the
following: a) Countries with higher intervention rates (UA and
Brazil) had similar results regarding infarction and death 
compared to those with very much lower intervention rates
(cineangiography, surgery and angioplasty)(Canada, Australia,
Hungary, Poland); b) Countries with more interventions displayed
an excess of strokes and major bleeding compared to the rest; c)
An inverse relation was observed between basal risk and the
frequency with which invasive procedures were performed; d)
Results were reproduced when comparing hospitals with a
hemodynamics lab and hospitals without it.  Information provided
by the OASIS study and registry is completely different and with
different practical implications in spite of coming from the
same population.
The randomized study, economically much more expensive, has
barely proven a meager difference in favor of hirudin so that
the adoption of this drug by cardiologists seems very difficult.
Instead, the OASIS registry has provided information of great
relevance that, besides, coincides with two studies that
compared an invasive strategy versus a conservative one in
unstable angina and non-Q wave myocardial infarction (21, 22).
The importance of a registry lays (though some use it as a
criticism) in the fact that is not a controlled study, allowing
to "see" reality of medical practice in an environment not
designed or configured beforehand. Surely, no one would design a
randomized study with the goal of low risk patients being the
most intervened, but implementation of a simple epidemiologic
survey shows that this situation happens in medical practice, at
least in hospitals belonging to the countries surveyed. RCTs and
registries are, then, two kinds of epidemiologic studies, both
absolutely valid, that through a different design, provide
answers to different questions. In front of the question: which
is the current mortality of acute myocardial infarction?, a
common mistake is to answer based on intervention studies
results. Thus, it is possible to believe that less than 5% of
the patients suffering a myocardial infarction die. The true
answer, on the contrary, must be looked after in registries or
surveys, of which there are good examples in our area (23, 24).
In this way, it will be understood that the real figure, in
non-selected populations, is close to 10%.
The making of epidemiologic registries should be encouraged at
all levels, but most of all in young researchers, eliminating
the false concept that these are minor studies compared to RCTs,
since they let us access unique information that can be applied
to every region or country in particular,  absolutely necessary
when a rational sanitary planning is meant to be carried out.

Bibliography

1) Hennekens, C. y Buring, J.: Design strategies in
epidemiologic research. En: Epidemiology in  Medicine. Editado
por Little, Brown and Co. 1987.
2) Gruppo Italiano per lo Studio della Streptochinasi nell'
Infarto Miocardico (GISSI): Effectiveness of intravenous
thrombolytic treatment in acute myocardial infarction. Lancet
1986; 1: 397-402.
3) ISIS-2 (Second International Study of Infarct Survival)
Collaborative Group: Randomized trial of intravenous
streptokinase, oral aspirin, both or neither among 17187 cases
of suspected acute myocardial infarction: ISIS-2. Lancet 1988;
2: 349-360.
4) European Coronary Surgery Study Group: Coronary artery bypass
surgery in stable angina pectoris: survival at two years. Lancet
1979; 1: 889.
5) CASS Principal Investigators and their Associates: Myocardial
infarction and mortality in the Coronary Artery Surgery Study
(CASS) randomized trial. N Engl J Med 1984; 310: 750.
6) The EPIC Investigators: Use of a monoclonal antibody directed
against the platelet glycoprotein IIb/IIIa receptor in high-risk
coronary angioplasty. N Engl J Med 1994; 330: 956-961.
7) The Platelet Receptor Inhibition in Ischemic Syndrome
Management in Patients Limited by Unstable Signs and Symptoms
(PRISM-PLUS) Study Investigators: Inhibition of the platelet
glycoprotein IIb/IIIa  receptor with tirofiban in unstable
angina and non-Q wave myocardial infarction. N Engl J Med 1998;
338:1488-1497.
8) The GUSTO Investigators: An international randomized trial
comparing four thrombolytic strategies for acute myocardial
infarction. N Engl J Med 1993; 329: 673-682.
9) Eagle, K.; Rihal, C.; Foster, E. y col.: Log-term survival in
patients with coronary artery disease: importance of peripheral
vascular disease. The Coronary Artery Surgery Study (CASS)
Investigators. J Am Coll Cardiol 1994; 23: 1091-1095.
10) Cameron, A.; Davis, K.; Rogers, W.: Recurrence of angina
after coronary artery bypass surgery: predictors and prognosis
(CASS Registry). J Am Coll Cardiol 1995; 26: 895-899.
11) Weiner, D.; Ryan, T.; Parsons, L. y col.: Long-term
prognostic value of exercise testing in men and women from the
Coronary Artery Surgery Study (CASS) registry. Am J Cardiol
1995; 75: 865-870.
12) Caracciolo, E.; Davis, K.; Sopko, G. y col.: Comparison of
surgical and medical group survival in patients with left main
equivalent coronary artery disease. Long-term CASS experience.
Circulation 1995; 91: 2335-2344.
13) Pilote, L.; Califf, R.; Sapp, S. y col.: Regional variation
across the United States in the management of acute myocardial
infarction. GUSTO-1 Investigators. Global Utilization of
Streptokinase and Tissue Plasminogen Activator for Occluded
Coronary Arteries. N Engl J Med 1995; 333: 565-572.
14) Sgarbossa, E.; Pinski, S.; Barbagelata, A. y col.:
Electrocardiographic diagnosis of evolving acute myocardial
infarction in the presence of left bundle-branch block.
Gusto-1 (Global Utilization of Streptokinase and Tissue
Plasminogen Activator for Occluded Coronary Arteries)
Investigators. N Engl J Med 1996; 334: 481-487.
15) Newby, K.; Califf, R.; Guerci, A. y col.: Early discharge in
the thrombolytic era: an analysis of criteria for uncomplicated
infarction from the Global Utilization of Streptokinase and t-PA
for Occluded Coronary Arteries (GUSTO) trial. J Am Coll Cardiol
1996; 27: 625-632.
16) Goodman, S.; Langer, A.; Ross, A. y col.: Non-Q wave versus
Q wave myocardial infarction after thrombolytic therapy.
Angiographic and prognostic insights from the GUSTO-1
angiographic substudy. Circulation 1998; 97: 444-450.
17) White, H.; Barbash, G.; Califf, R. y col.: Age and outcome
with contemporary thrombolytic therapy. Results from the GUSTO-1
trial. Circulation 1996; 94: 1826-1833.
18) Betriu, A.; Califf, R.; Bosch, X. y col.: Recurrent ischemia
after thrombolysis: importance of associated clinical findings.
J Am Coll Cardiol 1998; 31: 94-102. 
19) Organisation to Assess Strategies for Ischemic Syndromes
(OASIS-2) Investigators: Effects of recombinant hirudin
(lepirudin) compared with heparin on death, myocardial
infarction, refractory angina, and revascularization procedures
in patients with acute myocardial ischemia without ST elevation:
a randomised trial. Lancet 1999; 353: 429-438.
20) Yusuf, S.; Flather, M.; Pogue, J. y col., for the OASIS
Registry Investigators: Variations between countries in invasive
cardiac procedures and outcomes in patients with suspected
unstable angina or myocardial infarction without initial ST
elevation. Lancet 1998; 352: 507-514.
21)  Anderson, V.; Cannon, C.; Stone, P. y col.: One-year
results of the Thrombolysis in Myocardial Ischemia (TIMI) III-B
clinical trial. A randomized comparison of tissue-type
plasminogen activator versus placebo and early invasive versus
early conservative strategies in unstable angina and non-Q wave
myocardial infarction. J Am Coll Cardiol 1995; 26: 1643.
22) Boden, W.; O´Rourke, R.; Crawford, M. y col., for the
Veterans Affairs non-Q wave Infarction Strategies in Hospital
(VANQWISH) Trial Investigators: Outcomes in patients with acute
non-Q-wave myocardial infarction randomly assigned to an
invasive as compared with a conservative management strategy.
New Engl J Med 1998; 338: 1785-1792.
23) Hirschon Prado, A.; Trivi, M.; Tajer, C. y col.: Infarto
agudo de miocardio en la Argentina. Tercera encuesta nacional
SAC 1996. Rev Argent Cardiol 1998; 66: 63-72.
24) Piombo, A.; Salzberg, S.; Lowenberg, T. y col.:
Epidemiologia del infarto agudo de miocardio en los hospitales
publicos de la Capital Federal. Rev Argent Cardiol 1999; 67:
201-207.

Alfredo Piombo, M.D.
Chief of the Coronary Care Unit. Cosme Argerich Hospital,
Buenos Aires, Argentina
FVCC Scientific Committee´s member

================================================================

Registration to the First Virtual Cardiology Congress is free
and everyone registered will get a CD with all material
published at the Congress. All interested may be registered
using an individual or a group e-mail address.
Announce the FVCC at your Center.

================================================================

Useful address on the web-Cardiology Links
==========================================

Prous Science and Timely Topics
http://www.prous.com/ttm

Timely Topics in Medicine is a multimedia continuing medical
training program aimed at health professionals. It is structured
around medical specialties and directed by Spanish and
international editorial committees. Originally created and
developed by Prous Science, it has been serving the medical
community since 1997.
The service's goal is to create multidisciplinary medical
communities and tooffer health professionals a resource that
aims to meet their information and communication needs in a
comprehensive manner, whilst bearing in mind the limited
time available to these people nowadays. Thus, it is
possible to use a single program - Timely Topics in Medicine -
to obtain all the information required to remain up-to-date on
the latest advances in the field of Medicine.

----------------------------------------------------------------

ProCOR
http://www.healthnet.org/programs/procor/index.html

An iniciative of the Lown Cardiovascular Centre and Satel Life

Dialogue:
This moderated discussion forum, open to all subscribers,
provides a mechanism for continuous dialogue and excjange of
information relating to Cardiovascular Health in the developing
wordl.
Commentaries, questions, suggestions and posting can be sent to
ProCOR Moderators who will, if appropiate post and distribute
then after minor editing.
E-mail: procor@usa.healthnet.org

================================================================

Computer Viruses (2nd Part)
Karel Morlans Hernandez, M. D.
FVCC Steering Committee´s member

Signs of Infection by Computer Viruses

Even though you may be a cautious person, and carry out all
preventive, detection and decontamination steps against computer
viruses, you may not be free from the possibility of your
computer suffering an infection because of these viruses. This
is due to the increasing abundance and creation of this kind of
computer monstrosities, together with a more extended use of
resources and information available on the Internet and by
e-mail. Therefore you must know the "symptoms" of these
infections.

Here we will mention some grouped signs, that might be caused by
this kind of infection. If your computer displays some of them,
maximize the measures and make yourself sure that there is not a
computer virus in your system.

In directories and files:
_The space available is increasingly smaller
_The length (in bytes) of the files is larger
_Some files vanish from the hard drive (erased)
_The directory shows files unknown to the user
_The files are replaced by illegible characters
_The time of a file gets altered

In application execution:
_The programs take more time to be loaded, or are no longer
operative
_Some applications work at a slower pace than usual
_When opening a file, errors appear that were not there
previously
_When trying to open a file, some drives appear in the menu that
were not installed

System functioning:
_System output reduced
_The amount of available memory changes or diminishes frequently
_Incomplete starting of the system, or failure in starting
_Unexpected writings in a unit
_Strange or non-standard error messages
_Non-standard screen activity (animations, etc.), screen
fluctuations
_Wrong sectors in diskettes and hard drives
_Any strange operation that your PC did not perform before,
and that in any given moment starts to execute
_Errors without justification in the FAT

Macroviruses symptoms in Word:
_Word documents can only be saved as templates
_Erased files cannot be recovered
_Files display a dialogue box with a number 1
_New macros, called AAAZAQ, AAAZFS and PayLoad, appear in the
Word list of macros
_The Winword6.ini file includes the line ww6=1
_Alterations in the Normal.dot file starting from the comparison
of this template with a previous copy, saved beforehand in a
disk folder, using commands like FC.EXE or the diff from the
AUTOEXEC.BAT
_A lterations in the Microsoft Word STARTUP file, that may be
due to the inclusion of new templates or alterations in the
templates contained there.

================================================================

IMPORTANT INFORMATION FOR AUTHORS OF BRIEF COMMUNICATIONS

Announcement for Prizes to the best works presented during the
FVCC.

The authors of the Brief Communications presented for evaluation
by the Scientific Committee of the FVCC, will be able to choose
to compete for the Prizes to be conferred to the best work in
the following areas:
1- Best scientific work presented at the FVCC (US$2,000)
2- Best work (US$1,000 each):
2.a. in Basic Research.
2.b. in Clinical Research.
2.c. in Epidemiology and Cardiovascular Prevention (auspice:
InterAmerican Heart Foundation).
2.d. performed by Physicians In Training.
2.e. performed at an Iberoamerican Institution.


These are the requirements:
a) The abstract must have been approved by the Scientific
Committee at the proper time.
b) The work must be complete (deadline September 15, 1999)
according to the Instructions for Authors:

http://www.fac.com.ar/cvirtual/cvirteng/normeng/normeng.htm or
http://pcvc.sminter.com.ar/cvirtual/cvirteng/normeng/normeng.htm.

Works presented only as Abstracts will not be included
c) Works must be written in English, or in English and Spanish,
or in English and Portuguese. Works presented only in Spanish or
Portuguese will not be included.
d) All authors must be registered in the FVCC. We remind you the
all can register with the same e-mail address.
e) A e-mail must be sent (deadline September 15, 1999) to:

send-pcvc@pcvc.sminter.com.ar

written in this way:

The work <Title>, the authors of which are <name of all authors
as stated in the work>, applies for competing for the <prize for
which it is presented> Prize.

================================================================

PREVIEW OF THE FVCC

We continue to announce some of the scientific activities that
will be available during the sessions of the Congress.
Dr Rao Syamasundar will participate of the controversy on aortic
coarctation: who should be operated, and who dilated?
The contribution by Dr Elizabeth Shaffer, will be about prenatal
diagnosis of congenital heart disease, and its impact on
pediatric cardiology.
"Assessment of diastolic function using tissue Doppler
echocardiography", will be the title of the lecture by Dr
Leonardo Rodriguez.
In the Round Table "Peripheral vascular changes in essential
Hypertension", Dr Leopoldo Raij will deal with "Nitric Oxide in
Hypertenison: Relation with Renal Injury and Left Ventricular
Hypertrophy".
Dr Ernesto Schiffrin will share the panel, with the topic
"Remodeling of Resistance Arteries in Hypertensive Patients:
Effects of Anti-Hypertensive Therapy".
Likewise, Dr Peter Meredith's contribution on the Therapeutic
Round Table in Hypertension will tackle the topic "Importance of
pharmacokinetics in selection of anti-hypertensive drugs ".
Dr Eduardo Escobar will put forward the subject "Dilated
Myocardiopathy: Natural History and Prognosis", in the Round
Table on Pathophysiologic Aspects of heart failure.

================================================================

This space is reserved for companies that wish to sponsor and
support the success of the First Virtual Congress of Cardilogy.

<><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><>

Editor: Alfredo Piombo, M.D. (Argentina)
Chief of the Coronary Care Unit. Cosme Argerich Hospital,
Buenos Aires, Argentina
Associate Editors:
Claudio Gimpelewicz, M.D. (Argentina)
Dante Manyari, M.D. (Canada)
Carlos Basualdo, M.D. (Canada)

Edgardo Schapachnik, M.D.
Vicepresident of the FVCC Steering Committee


--------------------------------------------------------------------------
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Send commands to majordomo@pcvc.sminter.com.ar
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----------------------------------------------------------------
Newsletter - 1st Virtual Congress of Cardiology
----------------------------------------------------------------
http://www.fac.com.ar/cvirtual
http://pcvc.sminter.com.ar/cvirtual

================================================================

Year 1, number 5. Second two weeks, August 1999.

================================================================

Biweekly electronic publication of the First Virtual Congress of
Cardiology, for purposes of promotion and interchange of topics
of interest in cardiac sciences and news from the Congress. It
is distributed free of charge to everyone subscribed. Those of
English speaking origin may subscribe sending an e-mail to:

majordomo@pcvc.sminter.com.ar

with the following message in the body of the e-mail:

subscribe fvcc-newsletter

If you ever want to unsubscribe, you can send the following
command in the body of your email message to

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unsubscribe fvcc-newsletter

An Spanish version is available for those of Spanish speaking
origin.
Contributions are welcomed; also responses to previously
published articles, and commentaries should be send as Letters
to:

readers@pcvc.sminter.com.ar

================================================================

Cardiovascular colleague: announce in your medical center the
First Virtual Congress of Cardiology to start soon.

================================================================

Previous issues at:

http://www.fac.com.ar/cvirtual/newslett/newseng.htm

or at

http://pcvc.sminter.com.ar/cvirtual/newslett/newseng.htm

================================================================

CONTENTS

Editorial:
Interactive dynamics in the FVCC
Edgardo Schapachnik, M.D.
Vicepresident of the FVCC Steering Committee


The Beta Blockers
Commentary by Hernan Doval, M.D.
Vicepresident of the FVCC Scientific Committee

Useful address on the web

Computer Viruses (Part 1)
Karel Morlans Hernandez, M. D.
FVCC Steering Committee´s member

Attention!

Preview of the FVCC

Space available for Advertisement.

================================================================

This Newsletter will be sponsored by companies that wish to get
involved in the success of the First Virtual Congress of
Cardiology.

================================================================

Editorial

INTERACTIVE DYNAMICS IN THE FVCC
Actively taking part in several activities of the Congress will
be possible in the FVCC. Thus, in the 2nd issue of the
Newsletter we divulged the creation of Thematic Forums as tools
that will make possible and guarantee such interactive sessions.
We will go deeper into the subject here.
In the near future and gradually, the FVCC Steering Committee
will authorize different Forums to which participants will
be able to join according to their preferences.
Therefore, for example, if a colleague is interested in learning
about update on the latest on heart failure, high blood
pressure, echocardiography, and cardiovascular surgery, he or
she may choose to enter any of these four forums, to which he or
she will be able to subscribe just as easily as entering a
Mailing List.
This implies receiving contributions from these four forums.
In due time the corresponding instructions for making
subscriptions will be issued. At the proper time, the Steering
Committee will also send suggestions on how to process all the
information, how to file it in order, so that it can be useful
and to avoid from becoming troublesome messages that crowd the
"entrance mailboxes" of programs of mail.
Every contribution to the Thematic Forums, whether questions,
answers, commentaries, replies, and counterreplies, will be made
in two languages (Spanish and English). Translations will be in
charge of the FVCC Steering Committee.
Each Forum will have a technical team, responsible of granting
smoothness in communication and a Committee of experts in its
specific area from the Scientific Committee, that will guarantee
academic excellence on contributions and will see that each
question, consultation or commentary gets a proper answer. The
Forums' nominations will be according to English. For instance,
the Forum on Coronary Heart Disease will be called CHD, the one
on Heart Failure, HEART-FAILURE, and so on. Our colleagues will
be able to identify the source of a contribution by the presence
of these words in the Subject Line of each message received:
[CHD],[HEART-FAILURE]. Particular attention must be paid to it,
while contributing to simplicity, thus avoiding confusion and
sending messages to the proper Forums.
We hope that these natural channels of interactivity will become
permanent Forums that will gather all those who are interested,
and the most reputed specialists in an area.
More of the "magic" the Internet provides us with.

Edgardo Schapachnik, M.D.
Vicepresident of the FVCC Steering Committee

================================================================

The Beta Blockers

"The evidence that these drugs diminish morbidity and mortality
in patients with heart failure is definite"

Dr. Hernan C. Doval

Introduction
Beta-blockers have been known for years as myocardial
depressants and a cause of worsening heart failure, thus their
use was proscribed. In the last two decades it has been
recognized that the paradigm that the sympathetic activation was
necessary to maintain the cardiac output was false; in fact the
increased adrenergic activity was found deleterious for cardiac
function and survival in the long term.
In 1974, Waagstein (1) published for the first time that
practolol, a selective B1 blocker, was well tolerated by
patients with acute myocardial infarction in spite of having
signs of heart failure. To exclude that the mechanism of the
beneficial effect was due to a decrease of the ischemic burden,
studies in patients with dilated cardiomyopathy were performed,
that also demonstrated improvement that could not be attributed
to a decrease in myocardial ischemia (2).

Possible mechanisms of the beta-blocker effect.
Protection of cardiac myocytes from the direct cardiotoxic
effects of cathecholamines, improvement of baroreflex function,
and also reduction of renin secretion.
Reducing the heart rate they reduce metabolic demands, prolong
the filling phase and in this way time for perfusion, increase
coronary blood flow, and also improve myocardial strength-rate
relationship. In clinical trials they contribute to a decrease
in myocardial infarction.
The reduction of ventricular and supraventricular arrhythmias
due to the diminished sympathetic activity and myocardial
ischemia, the improvement of baroreflex function and the
prevention of hypokalemia, may all contribute to the reduction
of sudden death in chronic heart failure (3).

Effect on left ventricular ejection fraction
It is important to recognize that there may be an acute drop of
the ejection fraction up to one month after initiation of
treatment with beta-blockers. Reduction of ventricular volumes
and improvement of ejection fraction is only apparent after 3
months, and it is known that ventricular function may continue
to improve until 18 months from initial therapy.
In a review of 13 randomized, double-blind, clinical trials of
beta-blockers against placebo (excluding trials of less than
3-month duration or less than 40 patients)(4-16), all showed
statistically significant improvement of the ejection fraction
from 5 to 9%, absolute values; much more significant than those
achieved by angiotensin converting enzyme inhibitors, that was
only of 2%.
It could be that the improved ejection fraction was due to the
reduced heart rate and increased left ventricular end-diastolic
volumes, through the Frank-Starling mechanism, rather than to an
improved left ventricular function. However, contrary to this
hypothesis is the fact that it has been shown in clinical
trials, that ventricular size does not change or diminish during
chronic therapy with beta-blockers.

Effect on exercise tolerance
The effects of long-term beta-blockers on exercise tolerance
have been discordant.
Most of the former studies with metoprolol, a (1 selective
agent, showed improved exercise tolerance over a period longer
than 3-4 months. At the same time the non-selective
beta-blockers such as bucindolol, mebivolol and most of the
studies with carvedilol, did not show improvement in maximal or
sub-maximal exercise tolerance (3).
It is possible that selective blockade of (1 receptors, leaving
untouched (2 receptors, allow an increase of the heart rate
during exercise. The exercise-induced vasodilation is mediated
via (2 receptors, and this fact perhaps is also important in the
beneficial effect seen with selective (1 beta-blockers.
A selection bias can not be excluded. It is possible that
mortality among patients with severe disease in the placebo
groups was higher than in the beta-blocker groups, that resulted
in a better exercise tolerance in the survivors of the placebo
group, thus masking an improved exercise capacity effect of
beta-blockers.

Effect on hospitalization
In this evaluation we will only consider the 6 randomized,
placebo-controlled clinical trials with more than 200 patients.
The first trial with a significant number of patients, the
Metoprolol in Dilated Cardiomyopathy (MDC)(4), showed a decrease
in hospitalizations.
The number of hospitalizations for cardiovascular causes was
also reduced by 32% with bisoprolol, in the Cardiac
Insufficiency Bisoprolol Study (CIBIS)(6). In the studies with
carvedilol, such as the US Multicenter Program (US Trial)(17)
hospitalizations were reduced by 38%, and in the Australia-New
Zeland Trial by 29% (18).
In CIBIS-II (19), hospitalizations for heart failure were
reduced by 36%. The primary endpoint, all cause mortality, was
published from the recent Metoprolol Randomized Intervention
Trial in Congestive Heart Failure (MERIT-HF)(20), but the
secondary endpoint, total mortality plus hospitalizations, has
not yet been published.
Thus, all the large trials, including those that did not show
mortality benefits, have shown a significant reduction in
hospitalizations between 29 to 36%.

Effect on total mortality
Metoprolol in Dilated Cardiomyopathy (MCD)(4).
It randomized 383 patients with idiopathic dilated
cardiomyopathy, mean age of 49 years, and an ejection fraction
of 22%, functional class II-III, followed for an average of 15
months (range 12-18 months).
In this study there was a non-significant reduction of the
combined endpoint of mortality and cardiac transplantation from
20.1 to 12.9% (p=0.058).
But in reality the reduction of this combined endpoint was
entirely due to the reduced rate of cardiac transplantation,
since in fact mortality was non-significantly higher by 19% in
the metoprolol treated group (11.9 vs 10.1%).

The Cardiac Insufficiency Bisoprolol Study (CIBIS) (6)
It included 641 patients with heart failure class III-IV, of
various etiologies (coronary disease in 45%), randomized to
bisoprolol or placebo. The mean age was 60 years, a mean
ejection fraction of 25%, with an average follow up period of 21
months.
Total mortality was decreased by bisoprolol from 20.9 to 16.6%,
with a risk reduction of 20% that was not statistically
significant.
Although mortality in a subgroup of patients without previous
history of myocardial infarction was reduced significantly by
47%, this information should be regarded with caution since no
stratification by etiology was carried out at randomization and
this was not a pre specified endpoint.

US Multicenter Trial Program (US Trial) (17)
Included 1094 patients with a mean age of 59 years, and an
ejection fraction of 23%, with 47% of them having ischemic
cardiomyopathy, functional class II-IV. They were randomized to
carvedilol or placebo and followed for a mean of 6.5 months.
This study is in reality the publication of four clinical trials
in different patient groups, stratified according to the
distance they covered during a six-minute walk test, and was
planned as a study of "efficacy and safety" of carvedilol (17).
This combined analysis found a 65% reduction of total mortality
(p=0.0001).
Analyzing each of the 4 clinical trials, the study of "chronic
mild heart failure" randomized 366 patients (2:1 randomization
in favor of carvedilol), follow up of 12 months, found a
mortality reduction of 78%. The studies in patients with
"moderate" heart failure included 278 patients (133 carvedilol),
and the one in patients with "severe" heart failure, 105
patients (70 carvedilol), followed for 6 months, found a
mortality reduction of 43 and 47%, respectively. The last was a
"dose-response study" in  364 patients (262 on carvedilol), with
6-month follow up, and it found a reduction in mortality of 73%
(p=0.0008). The best effect was obtained with a dose of 25 mg
twice/day.
This is an important study, with the drawbacks noted by the
authors: "This limited experience limit our ability to reach
conclusions about the real magnitude or persistence of any
effect of carvedilol on survival" (17).

Australia-New Zeland Trial (18)
An average of 18 months was the follow up 415 patients, with a
mean ejection fraction of 29%, and an average age of 67 years.
All participants had ischemic cardiomyopathy. They found a non
significant reduction of mortality of 23%.

Cardiac Insufficiency Bisoprolol Study II (CIBIS-II) (19)
This multicenter clinical trial carried out in Europe,
randomized 2,647 patients with class III-IV heart failure,
ejection fraction of <35%, treated with diuretics and an ACE
inhibitor (19).
They were randomized to 1.25 mg/day of bisoprolol (n=1327) or
placebo (n=1320). The initial dose was gradually increased to 10
mg/day. Follow up was 1.3 years.
The CIBIS-II was terminated prematurely because bisoprolol
showed significant benefit in mortality. There were 228 (17.3%)
deaths for any reason in the group assigned to placebo and 156
(11.8%) in those treated with bisoprolol, a risk reduction of
34% (CI 19-46, p<0.0001). There were less sudden deaths in
bisoprolol treated patients than in those treated with placebo,
with a risk reduction of 44% (p=0.0011).
The effects of treatment were independent from etiology
(ischemic or non-ischemic), or the severity of heart failure.
Hospitalizations for heart failure were reduced by 36%
(p=0.0001).

Metoprolol Randomized Intervention Trial in Congestive Heart
failure (MERIT-HF)(20)
This recently published study included 3991 patients with heart
failure class II-IV, ejection fraction equal or less than 40%,
who were randomized to metoprolol (n=1990) or placebo (2001).
After 12 months this study was stopped prematurely after a
significant reduction of mortality was noted, from 11.0% in the
placebo group to 7.2% in the metoprolol group, a risk reduction
of 34% (CI 19-47, p=0.00009).
In patients treated with metoprolol, there were less sudden
deaths (79 vs 132, RR 31%, CI 22-55), and less deaths for
progression of heart failure (30 vs 58, RR 49%, CI 21-67).

Summarizing the results of the three largest controlled clinical
trial with beta-blockers, the US Trial with carvedilol (17), the
CIBIS-II with bisoprolol (19) and the MERIT-HF with metoprolol
(20), all of which showed a decrese in mortality, we can
conclude that the improved mortality and morbidity achieved with
beta blockers is a class effect. These effects are observed with
drugs that are ß1 selectives, such as bisoprolol and metoprolol,
and with non-selective drugs such as carvedilol that blocks both
B1 and B2 adrenoreceptors; but this drug also have other effects
such as blocking the B1 receptors, and a potent antioxidant
effect.

Summary of Mortality Clinical trials with Beta-Blockers
Combining the results of the 6 controlled clinical trials of
more than 200 patients each, there are more than 9,000 patients
with ischemic and non-ischemic etiology, and varied degree of
heart failure severity.

Clinical
Trials

F-U (months)

Placebo
Deaths/total
(%)

Beta-blockers
Deaths/Total
(%)

RR% (95% CI)

P Value

MDC

15

19/189 (10.1%)

23/193 (11.9%)

21%(-36a+129)

0.56

CIBIS-I

21

67/321 (20.9%)

53/320 (16.6%)

-25% (-49a+12)

0.16

ANZ

18

26/208 (12.5%)

20/207 (9.7%)

-25% (-61a+38)

0.36

US trials

6.5

31/398 (7.8%)

22/696 (3.2%)

-63% (-35a-79)

0.0006

CIBIS-II

15.6

228/1320(17.3%)

156/1327(11.8%)

-36% (-20a-48)

0.0001

MERIT

12

217/2001(10.8%)

145/1990(7.3%)

-35% (-19a-48)

0.0001

TOTAL

13.4

588/4437(13.3%)

419/4733(8.9%)

-34% (-25a-43)

0.0001

TABLE I- Metaanalysis using the method of Mantel-Haenszel, modified by Peto
MDC: Metoprolol in Dilated Cardiomyophathy; CIBIS I & II: Cardiac Insufficiency Bisoprolol Study I & II; US trials: US Multicenter Trial Program; ANZ: Australia-New Zealand Heart Failure Research Collaborative Group; MERIT-HF: Metoprolol Randomised Intervention Trial in Heart Failure; F-U : mean follow up period.

In the metanalysis, we find that approximately two thirds of the
total number of patients came from the CIBIS-II and the MERIT-HF
trials, versus one-third of the 4 previous trials. Mortality
decreased from 13.3% in the placebo groups to 8.9% in the
beta-blocker groups, during a follow up period of 13.4 months,
with a mortality risk reduction of 34% (p=0.00001). From these
data, the number needed to treat to prevent one death, are 25
patients per year.

Who, how, and when to use beta-blockers?
Initiation and titration of the doses of beta-blockers in a
patients with heart failure, produce a general uneasiness to the
physician who has not used these drugs. In this situation it is
convenient that those that make the decision to use them follow
these general instructions.
Avoid administration of beta-blockers in patients with asthma,
or chronic obstructive reversible lung disease, and with heart
rates of < 60 beats/minute, or A-V block greater than 1st
degree, without a permanent pacemaker. Also in patients with
severe heart failure, class IV, or decompensated, until this
becomes stable with standard therapy, since a significant number
of patients do not tolerate these medications, they may get
worse or even die in the initial phase of treatment.
Beta-blocker should be started at low doses increasing the dose
slowly. The initial dose in the large clinical trials were:
metoprolol XL 12.5 mg to 25 mg/day (20), carvedilol 3.125-6.25
mg twice/day (17,18), bisoprolol 1.25 mg/day (19); doubling the
dose each week or even better each two weeks according to the
clinical response, until maximal doses used in clinical trials
are achieved.
According to the evidence available to date, we should aim for
metoprolol XL 200 mg/day, carvedilol 50 mg twice/day,
and bisoprolol 10 mg/day.
It is possible that in clinical practice, beta-blockers may not
be tolerated as well as in the clinical trials, where strict
inclusion and exclusion criteria were followed, and careful
follow up existed.
In clinical trials about 5% of patients did not tolerate the
initial doses of beta-blockers due to hypotension or worsening
of cardiac failure; this proportion is greater in patients with
severe heart failure.
In patients who present symptomatic hypotension or bradicardia
while increasing the dose (monitoring these every 2-3 hours is
thus important), it is necessary to go back to the previous dose
and decrease stepwise, first the dose of diuretics and then the
dose of the ACE inhibitor in those with hypotension, or digoxin
and other drugs with bradycardic effects in those with critical
drop of the heart rate, in order to attempt an increase again 2
weeks later.
If heart failure gets worse, on the contrary, these drugs should
be increased in the same sequence.
It must be noted that those patients in whom the dose of
diuretics need to be increased to control worsening of heart
failure during titration, also appear to benefit from
beta-blockers over the long-term.
In those patients who tolerate the starting doses and get
clearly better clinically, occasionally deteriorate later on,
which could be due to the natural evolution of the cardiac
disease, it is not known whether stopping beta-blockers is
associated with improvement or worsening of an already critical
patient.

Bibliography

1) Waagstein F., Hjalmarson A., Varnauskas E., Wasir H.S. Apex
cardiogram and systolic time intervals in acute myocardial
infarction and effect of practolol. Br. Heart J. 1974;
36:1109-21.
2) Swedberg K., Hjalmarson A., Waagstein F., Wallentin I.
Prolongation of survival in congestive cardiomyopathy by
betareceptor blockade. Lancet 1979; i:1364-66.
3)  Cleland J.G.F., Bristow M.R., Erdmann E., Remme W.J.,
Swedberg K., Waagstein F. Eur Heart J. 1996;17:1629-39.
4) Waagstein F., Bristow M.R., Swedberg K. Et al. Beneficial
effects of metoprolol in idiopathic dilated cardiomyopathy.
Lancet 1993; 342:1441-6.
5) Fisher M.L., Gottlieb S.S., Plotnick G. et al. Beneficial
effects of metoprolol in heart failure associated with coronary
artery disease: a randomized trial. J. Am. Cool. Cardiol. 1994;
23:943-50.
6) CIBIS Investigators and Committees. A randomized trial of
beta-blockade in heart failure. The Cardiac Insufficiency
Bisoprolol Study (CIBIS). Circulation 1994; 90:1765-73.
7) Woodley S.L., Gilbert E.M., Anderson J.L. et al.
Beta-blockade with bucindolol in heart failure caused by
ischemic versus idiopathic dilated cardiomyopathy. Circulation
1991; 84:2426-41.
8) Bristow M.R., O'Connell J.B., Gilbert E.M. et al.
Dose-response of chronic beta-blocker treatment in heart failure
from either idiopathic dilated or ischemic cardiomyopathy.
Circulation 1994; 89:1632-42.
9) Krum H., Sackner-Bernstein J.D., Goldsmith R.L. et al.
Double-blind, placebo-controlled study of the long term efficacy
of carvedilol in patients with severe chronic heart failure.
Circulation 1995; 92:1499-1506.
10) Metra M., Nardi M., Giubbini R., Dei Cas L. Effects of
short- and long-term carvedilol administration on rest and
exercise hemodynamic variables, exercise capacity and clinical
conditions in patients with idiopathic dilated cardiomyopathy.
J. Am. Coll. Cardiol. 1994; 24:1678-87.
11) Olsen S.L., Gilbert E.M., Renlund D.G. et al. Carvedilol
improves left ventricular function and symptoms in chronic
heart failure: a double-blind randomised study. J. Am. Coll.
Cardiol. 1995; 25:1225-31.
12) Bristow M.R., Gilbert E.M., Abraham W.T. et al. Multicenter
Oral Carvedilol Heart Failure Assessment (MOCHA): a six-month
dose-response evaluation in class II-IV patients. Circulation
1995; 92(Suppl I):1-142.
13) Packer M., Colucci W.S., Sackner-Bernstein J. Et al.
Prospective Randomized Evaluation of Carvedilol on Symptoms and
Exercise Tolerance in Chronic Heart Failure: Results of the
PRECISE Trial. Circulation 1995; 92(Suppl I):1-143.
14) Colucci W.S., Packer M., Bristow M.R. et al.  Carvedilol
inhibits clinical progression in patients with mild heart
failure. Circulation 1995; (Suppl I):1-395.
15) Cohn J.N., Fowler M.B., Bristow M.R. et al. Effect of
carvedilol in severe chronic heart failure. J Am. Coll. Cardiol.
1996; 27:169A.
16) Australia-New Zealand Heart Failure Research Collaborative
Group. Effects of carvedilol, a vasodilatador beta-blocker, in
patients with congestive heart failure due to ischaemic heart
disease. Circulation 1995; 92:212-18.
17) Packer M., Bristow M.R., Cohn J.N. et al. for the US
carvedilol study group. The effect of carvedilol on morbidity
and mortality in patients with chronic heart failure. N. Engl. J.
Med. 1996; 334:1349-55.
18) Australia-New Zealand Heart Failure Research Collaborative
Group. Randomised, placebo-controlled trial of carvedilol in
patients with congestive heart failure due to ischaemic heart
disease. Lancet. 1997; 349:375-80.
19) CIBIS II Investigators and Committees. The Cardiac
Insufficiency Bisoprolol Study II (CIBIS II): a randomised trial.
Lancet 1999; 353:9-13.
20) MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic
heart failure: Metoprolol CR/XL Randomised Intervention Trial in
Congestive Heart Failure (MERIT-HF). Lancet 1999; 353:2001-07.

================================================================

Registration to the First Virtual Cardiology Congress is free
and everyone registered will get a CD with all material
published at the Congress. All interested may be registered
using an individual or a group e-mail address.
Announce the FVCC at your Center.

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Useful address on the web-Cardiology Links
==========================================

Slack cardiology Internet Directory
http//www.slackinc.com/general/heartnet.htm
A especialized directory in cardiology with links to cardiology
Web sites.
In this site we suggest to visit:
"On line journal of cardiac ultrasound"
http://www2.umdnj.edu/~shindler/echo.html
This site is the  home page of the Echocardiography Laboratory
of the New Jersey University. This web contains medical articles
and cardiac ultrasound images

================================================================

Computer Viruses (Part 1)
Karel Morlans Hernandez, M. D.
FVCC Steering Committee´s member

Definition and History

Up to the 80s, the term "virus" was only used in the fields of
medical and biological sciences to define microorganisms capable
of entering into human beings and destroying or altering their
cellular genetic contents causing specific pathologic
manifestations. Due to similarities in their behavior and their
effects, in informatics, the word virus came to be used for
certain programs that can self-replicate, "transmit" from one
computer to another, and unchain damages in its information
contents (software) and even in the equipment itself (hardware).
Computer viruses are programs created just like any other
program. They are a series of instructions that order computers
what to do, through specific orders to change another program.
Their main feature is that they are hidden files or they write
themselves upon other programs. They are designed to activate
when certain functions
are performed, or at a certain date, or through
more complex mechanisms. They are transmitted by introducing
information to the computer through copying from diskettes that
carry the virus, or by any other system of file copying (hard
drives, CDs, Zips, modems, cable communication, etc.).
In 1949, the first information about a computer program produced
for self-replicating was published in the book "Theory and
Organization of Complicated Automata". Von Neuman proposed in
1959 a method to create programs that self replicated. The
source of computer viruses could not be established exactly,
though it seems it may have lain in USA government's computer
systems. In the fall of 1959, in the AT&T Bell labs, "Core Wars"
was born (a nuclear war simulation), in which adversary
programmers developed a program with the mission of gathering
the maximum possible amount of memory through self-replication,
thus beating its opponent. That is to say, the one with a
largest amount of occupied memory won. In 1981, a virus called
Cloner appeared in Apple computers, and its way of operating was
by displaying a poem in the screen. In 1983, Fred Cohen stated
the following concept of virus: "A program that can infect other
programs by changing them to include a version of itself." In
the same year "Core Wars" became public, after having been kept
within an elite of students and researchers from MIT and the
Xerox's research center in Palo Alto.
Publication of technical articles and wide distribution since
1985 of PCs with DOS Operative System, favored the conditions
for the creation in 1986 of the "Pakistan - Brain" virus. The
second stage in computer viruses evolution has begun, now with
capacity to destroy. Emergence of new computer viruses has grown
almost exponentially. In 1987 12 viruses were reported; 1993
ended with more than 3500, and currently there are several
dozens of thousands. The figure keeps rising with around 350 new
virus by month. In 1995 the first virus of Macros was
discovered, and the sacred rule "a virus cannot exist in a data
file" was broken.
In other machines, such as the Macintosh, more than a 100 are
reported, including those which are no longer operative after
the 32 bits Mac-OS appeared. Unix and its clones already have
their own viruses (Linux, Bliss, Linux Vit. 4096).
Computer viruses can affect partition tables, starting sector,
executable and data files, and even the PCs BIOS.
Some can hide as well (Stealth), and others mutate
(polymorphic).
Initially, they could only affect one type of PC and operative
system. But there are already multi-platform and multi-processor
viruses, such as "Esperanto", which size is only 4.8 Kb. The
latter combines 16 and 32 bits codes. It is compiled in three
different platforms, works on DOS, Windows 3X, Windows 95,
Windows 98, Windows NT and Macintosh. It "runs" in Intel 80X86
processors and its compatibles, Power PC 6XX/750[G3] and
Motorola 680X0.

================================================================

Attention: If you have sent an Abstract to the Congress, you
should have received afterwards an e-mail message confirming our
reception of your work.
If not so, please send the material again, checking that your
e-mail address is correctly written.

================================================================

PREVIEW OF THE FVCC

Continuing with the information that we began to communicate in
our previous issue, we will mention some of the scientific
activities planned for the FVCC.
The Round Table, "Heart and Sports" will have the following
participants:
* Drs Victor Matsudo, Timoteo Araujo, Erinaldo L. Andrade,
Douglas R. Andrade, Luis C. de Oliveira and Aylton Figueira will
be in charge of explaining the theme: "Strategy for Promoting
Sports in Developing Countries: Experience from the Agita Sao
Paulo Program",
* Dr Galo E. Narvaez Perez will explain "Aerobic-Anaerobic
Interactions of Very Short Duration Muscular Work",
* "Athlete's Heart and Cardiomyopathy" will be the topic of Drs
Pellicia, Di Paolo and De Luca,
* Dr Patricia Sangenis will be in charge of explaining the "Role
of Exercise in the Prevention of Coronary Heart Disease in
Women",
* Finally, James Skinner, Ph D will deal with the subject:
"Sports and Cardiovascular Health".

Dr Jeffrey Borer will tackle, in the Nuclear Cardiology area, the
subject "Prediction of Indications for Valve Replacement among
Asymptomatic or Minimally Symptomatic Patients with Chronic
Aortic Regurgitation and Normal Left Ventricular Performance".

In the Pediatric Cardiology area, Hijazi Ziyad M. M.D., FACC,
will contribute with "Interventional Pediatric Cardiology: What
Should We Abandon and Continue to Use?"

The Round Table on "Strategy, Diagnosis, and Therapeutics in
Subendocardial Infarction" will have contributions by Dr Juan
Carlos Nicolau, with the theme "Aggressive vs. conservative
approach to treat acute myocardial infarction without ST.
Segment elevation", and by Dr Hector Luciardi on "Subendocardial
AMI: Strategy, Diagnosis and Treatment. Must We Operate?".

In his lecture, Dr John Chalmers, will deal with the topic: "The
1999 WHO-ISH Hypertension Guidelines - Stratifiying the Risk to
Treat the Patient".

"Autonomic Nervous System Dysfunction in Heart Failure" will be
the subject of Dr Raul Olivieri's talk.

In the next issues of the Newsletter we will continue with
comments about other
titles and authors.

================================================================

This space is reserved for companies that wish to sponsor and
support the success of the First Virtual Congress of Cardilogy.

<><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><>

Editor: Alfredo Piombo, M.D. (Argentina)
Chief of the Coronary Care Unit. Cosme Argerich Hospital,
Buenos Aires, Argentina
Associate Editors:
Claudio Gimpelewicz, M.D. (Argentina)
Dante Manyari, M.D. (Canada)
Carlos Basualdo, M.D. (Canada)

--------------------------------------------------------------------------
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Send commands to majordomo@pcvc.sminter.com.ar
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----------------------------------------------------------------
Newsletter - 1st Virtual Congress of Cardiology
----------------------------------------------------------------
http://www.fac.com.ar/cvirtual
http://pcvc.sminter.com.ar/cvirtual

================================================================

Year 1, number 4. First two weeks, August 1999.

================================================================

Biweekly electronic publication of the First Virtual Congress of
Cardiology, for purposes of promotion and interchange of topics
of interest in cardiac sciences and news from the Congress. It
is distributed free of charge to everyone subscribed. Those of
English speaking origin may subscribe sending an e-mail to:

majordomo@pcvc.sminter.com.ar

with the following message in the body of the e-mail:

subscribe fvcc-newsletter

If you ever want to unsubscribe, you can send the following
command in the body of your email message to

majordomo@pcvc.sminter.com.ar:

unsubscribe fvcc-newsletter

An Spanish version is available for those of Spanish speaking
origin.
Contributions are welcomed; also responses to previously
published articles, and commentaries should be send as Letters
to:

readers@pcvc.sminter.com.ar

================================================================

Cardiovascular colleague: announce in your medical center the
First Virtual Congress of Cardiology to start soon.

================================================================

First, second and third issues at:

http://www.fac.com.ar/cvirtual/newslett/newseng.htm

or at

http://pcvc.sminter.com.ar/cvirtual/newslett/newseng.htm

================================================================

CONTENTS

Editorial: Institutional (virtual) clinical rounds: a Continuous
Medical Education tool
Scientific and Steering Committees of the FVCC

Commented article
Commentary by Carlos Barrero, M.D.

Useful address on the web

FVCC Diffusion
Silvia Eskenazi, MD
FVCC Steering Committee´s member

Attention!

Health Problems in year 2000: Y2K
Jorge Rodriguez, MD
Argentine Society of Intensive Care

Preview of the FVCC

Space available for Advertisement.

================================================================

This Newsletter will be sponsored by companies that wish to get
involved in the success of the First Virtual Congress of
Cardiology.

================================================================

Editorial

INSTITUTIONAL (VIRTUAL) CLINICAL ROUNDS. A Continuous Medical
Education tool.
Scientific and Steering Committees of the FVCC

Convergence of the "virtual" and "presence"

The making of the 1st Virtual Congress of Cardiology (FVCC)
brings about a deep change of paradigm in the area of Cardiology
Continuing Education. The Congress will make possible for any
cardiologist in the world (even those who live in rural or
inhospitable areas), with the sole requirement of having access
to Internet, will be able to take advantage of all the
activities at the FVCC.
Those activities will be the same as those of an ordinary
"presence" congress (Lectures, Round Tables, Courses, etc.). But
they will do it from the comfort of their house, without travel
or accommodation expenses, and with a level of interaction that
will make them protagonists of all events in which they will
take part. Not even the computer, or access to Internet have to
be of their own, since they can share an e-mail account with
other colleagues, or use one belonging to an institution.
Moreover, this Congress will be a landmark since it will become
a Permanent Forums on Cardiology, that will allow its organizing
structure to remain at the disposal of individuals and
institutions interested in making use of it. Thus, it will
become a powerful tool of communication in the area of
cardiology, with an scope only limited by our imagination and
dedication.
With this philosophy, we propose to carry out INSTITUTIONAL
(VIRTUAL) CLINICAL ROUNDS: a Cardiology Division in a Hospital,
a professorship, an institution, etc. will be able to call its
members and perform meetings in which materials presented at the
FVCC will be analyzed. Conclusions that will be reached, ideas
that will be exchanged, all can be projected to the whole world
through the natural interaction of channels provided by the
Congress (mailing lists, chat channels, Web pages). Nets of
institutions will be created, and they will debate
simultaneously major advances and state of the art topics of
cardiology: A REAL NET OF CLINICAL ROUNDS of institutions
interconnected.
We believe that such proposal will greatly enhance the impact of
the FVCC in all the net's institutions. These INSTITUTIONAL
(VIRTUAL) CLINICAL ROUNDS can be conceived as traditional
presence meetings, performed once a week, for instance, just as
clinical rounds.
During these Cardiology sessions or Medical Clinic rounds, new
information presented at the FVCC are discussed and analyzed,
and tasks are distributed (for example, certain lectures,
approaches and/or statements will be printed, for group
discussions first, and later in the networks; or presented as
bibliography).
These group activities carried out "in presence", will be
initially focused on the events of the Congress. But later on
they will allow, on one hand, a growth of these work teams in
each institution, and on the other hand, we will achieve
diffusion among a large number of professionals about a tool
which has already revolutionized the possibilities of
communication all over the world.
We mean, of course, Internet.

================================================================

COMMENTED ARTICLE.

N Engl J Med 1999 Jul 8;341(2):70-6

Aggressive lipid-lowering therapy compared with angioplasty in
stable coronary artery disease. Atorvastatin versus
Revascularization Treatment

Investigators:
Pitt B, Waters D, Brown WV, van Boven AJ, Schwartz L, Title LM,
Eisenberg D, Shurzinske L, McCormick LS. Department of Medicine,
University of Michigan School of Medicine, Ann Arbor, USA.
bpitt@umich.edu

BACKGROUND: Percutaneous coronary revascularization is widely
used in improving symptoms and exercise performance in patients
with ischemic heart disease and stable angina pectoris. In this
study, we compared percutaneous coronary revascularization with
lipid-lowering treatment for reducing the incidence of ischemic
events.
METHODS: We studied 341 patients with stable coronary artery
disease, relatively normal left ventricular function,
asymptomatic or mild-to-moderate angina, and a serum level of
low-density lipoprotein (LDL) cholesterol of at least 115 mg per
deciliter (3.0 mmol per liter) who were referred for
percutaneous revascularization. We randomly assigned the
patients either to receive medical treatment with atorvastatin,
at 80 mg per day (164 patients), or to undergo the recommended
percutaneous revascularization procedure (angioplasty) followed
by usual care, which could include lipid-lowering treatment (177
patients). The follow-up period was 18 months.
RESULTS: Twenty-two (13 percent) of the patients who received
aggressive lipid-lowering treatment with atorvastatin (resulting
in a 46 percent reduction in the mean serum LDL cholesterol
level, to 77 mg per deciliter [2.0 mmol per liter]) had ischemic
events, as compared with 37 (21 percent) of the patients who
underwent angioplasty (who had an 18 percent reduction in the
mean serum LDL cholesterol level, to 119 mg per deciliter [3.0
mmol per liter]). The incidence of ischemic events was thus 36
percent lower in the atorvastatin group over an 18-month period
(P=0.048, which was not statistically significant after
adjustment for interim analyses). This reduction in events was
due to a smaller number of angioplasty procedures,
coronary-artery bypass operations, and hospitalizations for
worse ning angina. As compared with the patients who were
treated with angioplasty and usual care, the patients who
received atorvastatin had a significantly longer time to the
first ischemic event (P=0.03).
CONCLUSIONS:
In low-risk patients with stable coronary artery disease,
aggressive lipid-lowering therapy is at least as effective as
angioplasty and usual care in reducing the incidence of ischemic
events.

-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.

Commentary by Dr Carlos Barrero
Cardiology Head, Clinica Bazterrica, Buenos Aires, Argentina

Commenting this study, it comes to discussion the importance of
correcting the risk factors, in this case hypercholesterolemia,
in the evolution of coronary artery disease. Prior studies have
shown the more favorable long-term evolution after an acute
coronary event by lipid-lowering therapies; it now appears that
similar benefits may be expected from treatment of patients with
stable coronary syndromes compared with elective
revascularization.
It is important to make a critical assessment of this study.
1) The lack of effect of angioplasty may be explained by the low
risk of the population studied. They were patients with one or
two vessel disease, without compromise of the left main, with
normal ventricular function, class I-II angina, and good
exercise tolerance. It is known that in patients with low risk,
the benefit of revascularization is reflected in symptomatic
improvement and thus in quality of life, and not in the
reduction of death or myocardial infarction. Although in this
study, the group treated with angioplasty had less anginal
symptoms on follow up, there were no differences in the quality
of life score among the two groups. This likely means that the
baseline quality of life was acceptable in both groups, thus
explaining the inability of angioplasty to improve it further.
These findings will make us to review the indications for
angioplasty in this type of patients, and not only consider the
benefits of other alternative treatments but also the side
effects of those treatments. If the benefits of angioplasty are
at most modest, then the side effects may make a major
difference, just like in this study where the adverse effects in
the angioplasty group were related to the procedure itself,
while the adverse events in the atorvastatin  group were not
related to the intervention.
2) The incidence of ischemic events were less in the
atorvastatin that the angioplasty group (13 vs 21%), a
difference that was no longer statistically significant after
correction for interim analysis.
The ischemic events included in this study were: myocardial
infarction, death, stroke, surgery for coronary bypass,
angioplasty or worsening of angina reslting in hospitalization.
It can not be excluded that the differences in soft endpoints,
such as by pass surgery, may have been due to differences in
baseline. Although we see that both groups were similar in most
aspects, there were some significant differences: more use of
ASA and anticoagulation in the angioplasty group (reflecting may
be a sicker population) and more females in the atorvastatin
group. It is known that women with coronary artery disease
receive less interventions, such as by-pass surgery than men
with similar conditions. Thus, the less use of by-pass in this
group  (3 vs 9 patients) could reflect the demographic
difference rather that treatment effect. If if take away this
soft endpoint and take into consideration only the other
endpoints, the difference between groups is less (12 % in the
atorvastatin group vs 16% in the angioplasty group) and of
course not significant statistically. One can conclude
therefore, that the outcomes in both groups were similar and no
one intervention was superior to the other.
3) An interesting point in this study is the significant
reduction of angina during follow up in the atorvastatin group
compared with the angioplasty group. Considering events present
in the following 6 months after angioplasty, there was an intent
to eliminate risks for restenosis in the angioplasty group, and
therefore the observed differences reflect beneficial effects of
an aggressive regimen to treat dislipidemia on the progression
of the disease process or in endothelial function. However, 70%
of patients in the angioplasty group was treated with
hypocholesterolemic agents.
Since the results were not statistically significant, these
should be considered hypothesis generating (aggressive treatment
of dislipidemia to reduce events in patients with stable
coronary syndromes) that should be confirmed in future studies
with clarification of what doses or what levels of LDL should
the benefits be maximal.
We conclude that the results of this study suggest the need to
review the indications for angioplasty in patients with stable
coronary disease at low risk, before other alternative
interventions. In this sense, many patients in this study would
not have the indications for angioplasty and therefore could be
treated by conventional medical therapy that includes correction
of risk factors.
 

================================================================

Registration to the First Virtual Cardiology Congress is free
and everyone registered will get a CD with all material
published at the Congress. All interested may be registered
using an individual or a group e-mail address.
Announce the FVCC at your Center.

================================================================

Useful address on the web-Cardiology Links
==========================================

Useful information for clinical investigation in Cardiology

Epi Info's Home Page-Epidemiology Program Office
http://www.cdc.gov/epo/epi/epiinfo.htm

The Centers for Disease Control and Prevention (CDC), located in
Atlanta, Georgia, USA, is an agency of the Department of Health
and Human Services.
Epi Info is a series of microcomputer programs for word
processing, data management and epidemiologic analysis,designed
for public health professionals.
Epi Info is easy to use, but also offers programming languages
for both data input and analysis so that permanent health
information systems can be developed. The last version of the
program can be download by free.

ICD-9-CM  International Classification of Diseases
http://www.Fec.newcastle.edu.au/hsrg/hypertext/icd9cm.html.

Newcastle University Site. In these site  you will be able to
find a clasification of the Code of the International
Classification of Diseases. The information is mainly useful for
the creation of investigation data base and computerized medical
history.

================================================================

FVCC DIFFUSION
Silvia Eskenazi, MD
FVCC Steering Committee´s member

Diffusion of such an important event as this, implies the use of
all possible means in order to make contacts, so that all the
information regarding the Congress reaches every corner of the
world. The only way to achieve this is, apart from having a
Diffusion stable team, having a multiplying team as well, that
is to say, make every one who registers do diffusion
himself/herself. Help from participants of the Congress is truly
positive and encouraging. The Diffusion team´s motto is "let
there be no doctor, nurse, technician in cardiology or medicine
student who misses this First Virtual Congress of Cardiology
because he or she did not get to know about it!"”
That is why everybody’s help is necessary. The database of the
Congress shows that more than 4000 messages have been sent to
different individuals, besides those sent to mailing lists. Work
goes on and is growing bigger as the date of start of the
Congress gets closer.
We will reach our goal for sure!

================================================================

Attention: If you have sent an Abstract to the Congress, you
should have received afterwards an e-mail message confirming our
reception of your work.
If not so, please send the material again, checking that your
e-mail address is correctly written.

The stage of reception of Abstracts has come to an end. All the
material that has been sent is now under evaluation by the
Scientific Committee. Results will be communicated to the
authors on August 15th.

================================================================

Health Problems in year 2000: Y2K
Jorge Rodriguez, MD
Argentine Society of Intensive Care

The problem of date compatibility arises in first computers,
manufacturers and programmers that worked together. In this
stage (the 60's decade), programming and storing data was very
expensive. Each space of memory to be filled cost many dollars,
and be cause of this it was necessary to save. One way of
saving at that time was to represent dates by two digits,
accommodating in computers's memory only information from the XX
Century (the period from 1900 to 1999). Programs were carried
out by pierced cards, and the 2 digits system for dates would
allow entering more information by cards. For instance, January
17th, 1967 wasrepr esented as 01/17/67. This procedure saved
memory and therefore budget. It was mistakenly believed that by
year 1999, current systems would no longer be used, and the
problem of dates would be solved for sure. This problem
potentially affects several computers, nets, PCs and biomedical
equipment.
Is your Institution ready for the eventuality of this problem?
Get more information in the following URLs:
Year 2000 SubCommittee. Argentine Society of Intensive Care)
http://www.y2k.sati.org.ar
2000 Executor Unity. Public Works Secretary. Argentina
http://www.sfp.gov.ar/2000/2000.html
Millenium Project - INSALUD Spain
http://www.msc.es/insalud/milenio
Food & Drug Administration
http://www.fda.gov/y2k
Microsoft Corporation.
http://www.microsoft.com/y2k
Equipment Data Bases . New Wales. Australia.
http://www.y2k.gov.au
Health Services. UK.
http://www.open.gov.uk
Rx2000 Solutions Institute.
http://www.rx2000.org

================================================================

PREVIEW OF THE FVCC

This section will periodically review some of the highlights of
future presentations, conferences, round tables, etc. that will
take place in the FVCC.
For instance, Dr. Joao Carlos Pinto Dias will make an extensive
review of the history and epidemiology of Chagas disease during
his talk "Evolution of epidemiology knowledge and epidemiology
at present".
Dr. Alvaro Moncayo, from the World Health Organization, will
discuss the impact of the program known as the "initiative of
the South Cone", during his talk "Progress in the program to
control the transmission of Chagas Disease in the countries of
the South Cone".
Assessment of coronary blood flow and flow reserve in patients
with coronary artery disease during experimental and clinical
studies using positron emission tomography (PET), will be the
topic of Dr. M. Carli's presentation.
A new disease? A new form of coronary patient? Will be the
questions to answer after Dr. Carlos Bertolasi's presentation
"Beyond the year 2000". He will analyze how coronary artery
disease has changed in light of the new knowledge in the
pathophysiology and therapy of this disease.
"Remodeling of resistance arteries in hypertensive patients:
effects of antihypertensive therapy" is the title of the
conference by Dr. Ernesto L. Schiffrin, from the University of
Montreal, Quebec, Canada. He will analyze the structural and
functional abnormalities observed in small resistance arteries
both in hypertensive patients and in experimental animals.
During the symposium "Tobacco in clinical practice", Dr. Eduardo
Bianco, from the Interamerican Heart Foundation, will discuss
the topic how to approach the patient who smokes.
Dr. Edgardo Escobar will talk about "The natural history and
prognosis of dilated cardiomyopathy".
Dr. Giuseppe Mancia will discuss the topic "neuro-sympathetic
mechanisms" in the pathophysiology of arterial hypertension.
The role of inflamation and infection in acute coronary
syndromes will be the central theme of Dr. Enrique Gurfinkel's
talk.

In the next issues of the Newsletter we will continue with
comments about other titles and authors.

================================================================

This space is reserved for companies that wish to sponsor and
support the success of the First Virtual Congress of Cardilogy.

<><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><>

Editor: Alfredo Piombo, M.D. (Argentina)
Chief of the Coronary Care Unit. Cosme Argerich Hospital ,
Buenos Aires, Argentina
Associate Editors:
Claudio Gimpelewicz, M.D. (Argentina)
Dante Manyari, M.D. (Canada)
Carlos Basualdo, M.D. (Canada)


--------------------------------------------------------------------------
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Send commands to majordomo@pcvc.sminter.com.ar
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----------------------------------------------------------------
Newsletter - 1st Virtual Congress of Cardiology
----------------------------------------------------------------
http://www.fac.com.ar/cvirtual
http://pcvc.sminter.com.ar/cvirtual

================================================================

Year 1, number 3. Second two weeks, July 1999.

================================================================

Biweekly electronic publication of the First Virtual Congress of
Cardiology, for purposes of promotion and interchange of topics
of interest in cardiac sciences and news from the Congress. It
is distributed free of charge to everyone subscribed. Those of
English speaking origin may subscribe sending an e-mail to:

majordomo@pcvc.sminter.com.ar

with the following message in the body of the e-mail:

subscribe fvcc-newsletter

If you ever want to unsubscribe, you can send the following
command in the body of your email message to

majordomo@pcvc.sminter.com.ar:

unsubscribe fvcc-newsletter

An Spanish version is available for those of Spanish speaking
origin.
Contributions are welcomed; also responses to previously
published articles, and commentaries should be send as Letters
to:

readers@pcvc.sminter.com.ar

================================================================

Cardiovascular colleague: announce in your medical center the
First Virtual Congress of Cardiology to start soon.

================================================================

First and second issues at:

http://www.fac.com.ar/cvirtual/newslett/newseng.htm

or at

http://pcvc.sminter.com.ar/cvirtual/newslett/newseng.htm

================================================================

CONTENTS
Editorial: First Virtual Congress of Cardiology
Prof. Dr. Emilio Kuschnir
Chairman of the Scientific Committee of the First Virtual
Congress of Cardiology

Commented article
Commentary by Victor Mauro, M.D.

Useful address on the web

New deadline for Abstract Submission

Attention!

List of Receives auspices

Space available for Advertisement.

================================================================

This Newsletter will be sponsored by companies that wish to get
involved in the success of the First Virtual Congress of
Cardiology.

================================================================

Editorial
First Virtual Congress of Cardiology

Cordoba, Argentine, July 1999.

Dear Friends an Colleagues,

I have great pleasure in sharing with you, as Chairman of the
Scientific Committee of the First Virtual Congress of
Cardiology, a few thoughts on this event.

What is the First Virtual Congress of Cardiology?
The First Virtual Congress of Cardiology is an activity
organized by the Argentine Federation of Cardiology. It will
consist of all the activities of a "conventional personal
attendance" congress but it will take place on Internet from
October, 1 1999 to March 31, 2000.
The Virtual Congress will include Central Lectures, Round
Tables, Symposia, Controversies and Free Communications. After
the Congress the proceedings will appear on the Web pages and
will be edited on CDs.
The Congress has received unusual support at national and
international level and more than 100 figures of great prestige
in the field of international cardiology have confirmed their
participation.
To date and with still a few months to go before the opening of
the Congress there are already more than 3,600 people enrolled
from more than 75 countries and more than 200 free
communications have been received from different research groups
in different countries.

Why a Virtual Congress?
Holding a congress on Internet makes it possible to have a much
higher degree of interactivity between the "speakers" and the
"audience" who will be able to share their experience, knowledge
and ideas in a way never possible at a personal attendance
congress.
The six months the Congress will last will make it possible for
a Lecture, for example, to be available for several months
instead of being a special 30 minute event at a personal
attendance congress which usually last 3 or 4 days.
The organizational costs area markedly lower as there are no
travel and hotel expenses.
Activities will be included not only for physicians, but also
for other members of the health team such as nurses and
technicians in the conviction that a multidisciplinary approach
is the only guarantee of integral care in medicine.
The area of access for the public will make it possible for the
population in general to take part in activities which will make
it an actor in the care of their own health.
The Congress will be the first activity of a Permanent
Cardiology Forum on Internet, thus keeping open the channels of
communication and organizational structure of the Congress
indefinitely.
Modern electronic society is marked by constant change, a change
which involves all the fields of human activity, scientific,
technical, social, political, recreational, etc.
Knowledge acquired today is not enough. Permanent up-dating is
indispensable. Techniques and criteria change at a rate which
implies continuous development. That is why the key to
continuing education does not lie in knowledge as something
static but as its continual evolution.
The challenge is to learn how to learn.
But in this unstable panorama of constant change there are some
permanent values related to man which cannot be set aside. New
technologies, like every type of progress, may have a positive
or a negative impact depending on how they are used. They may
saturate with information and cause "bruits" distancing man from
man or they may become an extraordinary communication bridge.
For all of the above we hope that the First Virtual Congress of
Cardiology will become a link which will make it possible for
cardiologists from all over the world to share knowledge and
friendship and which will motivate all men to achieve scientific
and personal growth.

Prof. Dr. Emilio Kuschnir
Chairman of the Scientific Committee of the First Virtual
Congress of Cardiology

================================================================

COMMENTED ARTICLE.

Commentary by:
Victor Mauro, M.D.
Coronary Unit Head, Clinica Bazterrica, Buenos Aires, Argentina

Lancet 1999 Apr 24;353(9162):1386-9

Acute pulmonary embolism: clinical outcomes in the International
Cooperative Pulmonary Embolism Registry.
Goldhaber SZ, Visani L, De Rosa M.Brigham and Women's Hospital
and Harvard Medical School, Boston, MA 02115, USA.

BACKGROUND: Pulmonary embolism (PE) remains poorly understood.
Rates of clinical outcomes such as death and recurrence vary wid
ely among trials. We therefore established the International
Cooperative Pulmonary Embolism Registry (ICOPER), with the aim
of identifying factors associated with death. METHODS: 2454
consecutive eligible patients with acute PE were registered from
52 hospitals in seven countries in Europe and North America. The
primary outcome measure was all-cause mortality at 3 months. The
prognostic effect of baseline factors on survival was assessed
with multivariate analyses. FINDINGS: 2110 (86.0%) patients had
PE proven by necropsy, high-probability lung scan, pulmonary
angiography, or venous ultrasonography plus high clinical
suspicion; ICOPER accepted without independent review diagnoses
and interpretation of imaging provided by participating centres;
3-month follow-up was completed in 98.0% of patients. The overall
crude mortality rate at 3 months was 17.4% (426 of 2454 deaths,
including 52 patients lost to follow-up): 179 of 397 (45.1%)
deaths were ascribed to PE and 70 of 397 (17.6%) to cancer, and
no information on the cause of death was available for 29
patients. After exclusion of 61 patients in whom PE was first
discovered at necropsy, the mortality rate at 3 months was 15.3%
(365 of 2393 deaths). On multiple-regression modelling, age over
70 years (hazard ratio 1.6 [95% CI 1.1-2.3]), cancer
(2.3 [1.5-3.5]), congestive heart failure (2.4 [1.5-3.7]),
chronic obstructive pulmonary disease (1.8 [1.2-2.7]), systolic
arterial hypotension (2.9 [1.7-5.0]), tachypnoea (2.0 [1.2-3.2]),
and right-ventricular hypokinesis on echocardiography
(2.0 [1.3-2.9]) were identified as significant prognostic
factors. INTERPRETATION: PE remains an important clinical
problem with a high mortality rate. Data from ICOPER provide
rates and highlight adverse prognostic categories that will help
in planning of future trials of high-risk PE patients.

-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.


Commentary by Dr Victor Mauro
Coronary Unit Head, Clinica Bazterrica, Buenos Aires

The role of thrombolytic agents in pulmonary thromboembolism
treatment is still controversial. Even nowadays, there is not
enough evidence to make an absolute conclusion. The UPET study
(1970) randomized 160 patients to treatment with heparin or
heparin-urokinase. Although a 30 % reduction of mixed events
(recurrent embolism and death) was observed in the latter, the
study lacked statistical power because of the small population
included. Even by analyzing patients hemodynamically compromised
(7% of the total population), differences in favor of
thrombolytic agents were marginal, probably because potential
benefit contrasted with a high rate of hemorrhages (60%).
Several observational studies have suggested that the presence
of right ventricular dysfunction increases death risk in
pulmonary thromboembolism. Recently, an International Cooperative
Registry (ICOPER) was published. It analyzed clinical evolution
in 2454 patients admitted because of documented pulmonary
embolism. Mortality rate was 11.4 and 17.4 % at 14 days and 3
months respectively. Half of them were directly related to
pulmonary thromboembolism, while the remaining ones, were due to
the underlying sickness. Only 4 % of patients presented with
hemodynamic instability when admitted, with 58% of mortality,
while in the remaining it was only 15 %. Thirteen per cent
received thrombolytic agents, most of them because of
hemodynamic compromise.
Major bleeding rate was 21 % and the figure for hemorrhagic
stroke was 3 %. Presence of right ventricular dysfunction was a
risk independent variable regarding outcome at 3 months  (20 vs.
14 %, RR 2 (1.3-2.9).
We can conclude in the light of current evidence, that the
indication of thrombolytic agents should be confined to patients
with signs of hemodynamic instability. There is no evidence that
the presence of asymptomatic right ventricular dysfunction,
although it heralds a worse prognosis, can have a higher benefit
with thrombolytic agents treatment; randomized studies at a
greater scale are required to determine its true role in these
patients.

================================================================

Registration to the First Virtual Cardiology Congress is free
and everyone registered will get a CD with all material
published at the Congress. All interested may be registered
using an individual or a group e-mail address.
Announce the FVCC at your Center.

================================================================

Useful address on the web-Cardiology Links
==========================================
Links on Cardiology
www.medscape.com
A site with information in several specialties. You can find the
following topics on cardiology:: news, treatment updates and
guidelines, conferences summary (AHA-ACC),conference schedules,
journal room. It also includes a Data base motor engine on full
articles, medline and others.

================================================================

Change on the deadline for abstract submission.
Due to many requests from colleagues from several countries, the
Steering Committee of the FVCC has resolved to extend the
deadline to receive abstracts submitted for possible publication
in the upcoming FVCC. The new deadline for abstract submission
will be on July 31, 1999.
Instructions for authors may be found at:
http://www.fac.com.ar/cvirtual
http://pcvc.sminter.com.ar/cvirtual

or may be requested by e-mail from:

readers@pcvc.sminter.com.ar

===============================================================

Attention: If you have sent an Abstract to the Congress, you
should have received afterwards an e-mail message confirming our
reception of your work.
If not so, please send the material again, checking that your
e-mail address is correctly written.


Awards to the best Abstracts:

1- Best scientific work presented at the FVCC (US$2,000)
2- Best work  (US$1,000 each)
2a in Basic Research
2b in Clinical Research
2c in epidemiology and cardiovascular prevention (auspice:
InterAmerican Heart Foundation).
2d performed by Physicians In Training.
2e performed at an Iberoamerican Institution.

================================================================

Receives auspices
=================
(up tp now)

Universities
(alphabetical order)

Escuela de Formacion Avanzada, Universidad Pontificia
Bolivariana, Colombia
Facultad de Ciencias Biomedicas, Universidad Favaloro Argentina
Facultad de Ciencias Medicas, Universidad Nacional de La Plata,
Argentina
Facultad de Ciencias Medicas, Universidad Nacional de Rosario,
Argentina
Facultad de Ingenieria, Bioingenieria, Universidad Nacional de
Entre Ríos, Argentina
Facultad de Medicina, Universidad Adventista del Plata Argentina
Facultad de Medicina, Universidad Cayetano Heredia, Peru
Facultad de Medicina, Universidad de Buenos Aires, Argentina
Facultad de Medicina, Universidad de la República, Uruguay
Facultad de Medicina, Universidad del Salvador, Argentina
Facultad de Medicina, Universidad Nacional de Cordoba, Argentina
Facultad de Medicina, Pontificia Universidad Catolica del Peru,
Peru
Instituto Universitario de Ciencias de la Salud, Fundacion
Barcelo, Argentina

Scientific Societies
(alphabetical order)
Belgian Society of Cardiology Belgique
Brazilian Society of Cardiology Brazil
British Cardiac Society United Kingdom
Canadian Cardiovascular Society Canada
Cardiac Society of Australia and New Zealand Australia - New
Zealand
French Society of Cardiology, France
Georgian Association of Cardiology, Georgia
Greek Society of Heart Failure, Greece
Inter-American Society of Hypertension
International Cardiac Doppler Society
Lebanese Society of Cardiology, Lebanon
Italian Federation of Cardiology, Italy
PanAfrican Society of Cardiology
San Marino Society of Cardiology, San Marino
Saudi Heart Association, Saudi Arabia
Singapore Cardiac Society, Singapore
Sociedad Boliviana de Cardiologia, Bolivia
Sociedad Chilena de Cardiologia y Cirugia Cardiovascular, Chile
Sociedad Colombiana de Cardiologia, Colombia
Sociedad Cubana de Cardiologia, Cuba
Sociedad Ecuatoriana de Cardiologia, Ecuador
Sociedad Española de Cirugia Cardiovascular
Sociedad Mexicana de Cardiología, Mexico
Sociedad Peruana de Informatica en Salud, Peru
Sociedad Uruguaya de Cardiologia, Uruguay

Argentine Scientific Societies
(alphabetical order)
Soc. de Cardiologia de Atuel
Soc. de Cardiologia de Catamarca
Soc. de Cardiologia de Comahue
Soc. de Cardiologia de Cordoba
Soc. de Cardiologia de Corrientes
Soc. de Cardiologia de Chaco
Soc. de Cardiologia de Chubut
Soc. de Cardiologia de Entre Ríos
Soc. de Cardiologia de Formosa
Soc. de Cardiologia de Jujuy
Soc. de Cardiologia de La Pampa
Soc. de Cardiologia de La Plata
Soc. de Cardiologia de La Rioja
Soc. de Cardiologia del Atlantico
Soc. de Cardiologia de Mendoza
Soc. de Cardiologia de Misiones
Soc. de Cardiologia de Necochea
Soc. de Cardiologia de Neuquen y Rio Negro
Soc. de Cardiologia del Norte de la Provincia de Buenos Aires
Soc. de Cardiologia del Oeste Bonaerense
Soc. de Cardiologia de Rafaela
Soc. de Cardiologia de Rosario
Soc. de Cardiologia de Salta
Soc. de Cardiologia de San Juan
Soc. de Cardiologia de San Luis
Soc. de Cardiologia de Santa Cruz
Soc. de Cardiologia de Santa Fe
Soc. de Cardiologia de Santiago del Estero
Soc. de Cardiologia del Sur de la Provincia de Cordoba
Soc. de Cardiologia de Tucuman

Foundations and Leagues
(alphabetical order)
Asociacion Peruana del Corazon Peru
Fundacion Barcelo Argentina
Fundacion Cardiologica Correntina Argentina
Fundación Cardiologica de Cordoba para la Asistencia, Docencia e
Investigacion Medica (FUCCADIM), Argentina
Fundacion Cardiologica Ecuatoriana, Ecuador
Fundacion de Ayuda al cardiaco, Paraguay
Fundacion Dr. William Harvey, Argentina
Fundacion F.A.C., Argentina
Fundacion Favaloro, Argentina
Fundacion Santa Maria, Colombia
Fundacion Venezolana del Corazon, Venezuela
Heart Foundation of the Philippines, Philippines
Inter-American Heart Foundation
Liga Colombiana contra la Enfermedad Coronaria y la HTA, Colombia
Taiwan Heart Foundation Taiwan
The National Heart Foundation of New Zealand, New Zealand

Others
Argonauta International, Argentina, Chile, Germany, Italy
Secretary of Health City of Buenos Aires, Argentina
Virtual Hospital, Argentina

================================================================

This space is reserved for companies that wish to sponsor and
support the success of the First Virtual Congress of Cardilogy.

<><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><>

Editor: Alfredo Piombo, M.D. (Argentina)
Chief of the Coronary Care Unit. Cosme Argerich Hospital ,
Buenos Aires, Argentina
Associate Editors:
Claudio Gimpelewicz, M.D. (Argentina)
Dante Manyari, M.D. (Canada)
Carlos Basualdo, M.D. (Canada)



--------------------------------------------------------------------------
Letter to Editors:  readers@pcvc.sminter.com.ar
Send commands to majordomo@pcvc.sminter.com.ar
Others: owner-newsletter-fvcc@pcvc.sminter.com.ar


Top

----------------------------------------------------------------
Newsletter - 1st Virtual Congress of Cardiology
----------------------------------------------------------------
http://www.fac.com.ar/cvirtual  
http://pcvc.sminter.com.ar/cvirtual

================================================================

Year 1, number 2. First two weeks, July 1999.

================================================================

Biweekly electronic publication of the First Virtual Congress of
Cardiology, for purposes of promotion and interchange of topics
of interest in cardiac sciences and news from the Congress. It
is distributed free of charge to everyone subscribed. Those of
English speaking origin may subscribe sending an e-mail to:

majordomo@pcvc.sminter.com.ar

with the following message in the body of the e-mail:

subscribe fvcc-newsletter

If you ever want to unsubscribe, you can send the following
command in the body of your email message to

majordomo@pcvc.sminter.com.ar:

unsubscribe fvcc-newsletter

An Spanish version is available for those of Spanish speaking
origin.
Contributions are welcomed; also responses to previously
published articles, and commentaries should be send as Letters
to:

readers@pcvc.sminter.com.ar

================================================================

Cardiovascular colleague: announce in your medical center the
First Virtual Congress of Cardiology to start soon.

================================================================

First issue at:

http://www.fac.com.ar/cvirtual/newslett/newseng.htm

or at

http://pcvc.sminter.com.ar/cvirtual/newslett/newseng.htm

================================================================

CONTENTS

Forums of Presentation by topics.
Steering Committee of the FVCC

Commented article
Rafael Porcile, M.D.

Useful address on the web

New deadline for Abstract Submission

List of Lecture/Symposia Participants

Space available for Advertisement.

================================================================

This Newsletter will be sponsored by companies that wish to get
involved in the success of the First Virtual Congress of
Cardiology.

================================================================

Forums by subjects:
The First Virtual Congress of Cardiology will allow wide
participation and interaction with world-known liders in
cardiovascular sciences. Everyone, from abstract presenter, the
invited lecturer and members of the audience that wish to
participate actively, to the organized Forums in each topic, will
have all the needed instruments to achieve their goals.
Soon, you will receive information regarding the functioning of
those Forums (Forum of Epidemiology and Prevention; Forum of
Cardiac Failure; Forum of Ischemic Heart Disease; Forum of
Arterial Hypertension; Forum of Pediatric Cardiology; Forum of
Cardiovascular Surgery; Forum of Pharmacology; Forum of
Echocardiography; Forum of Nuclear Cardiology; Forum of MRI, PET;
Forum on Informatics; Forum on Arrhythmias; Forum on Exercise and
Cardiology; Forum on Physiology and Pathology in the Elderly; Forum
on Chagas disease; Forum on Rheumatic Fever; Forum of Technicians in
Cardiology; Forum of Nursing and Cardiology; Forum of the Year
2000 syndrome).
You will also receive information on how to subscribe and
participate in each one of these forums.
These Forums will channel the participation of everyone, and
they will be operational during the Congress. You will be able
to engage in dialogue, ask questions, make comments on the topics
of your interest, to and with specialists from around the world.

Steering Committee of the FVCC.

================================================================

COMMENTED ARTICLE.

Commentary by:
Rafael Porcile, M.D,
Heart Transplantation Coordinator in Cosme Argerich Hospital
Favaloro Foundation Staff Cardiologist
Buenos Aires, Argentina.

Article published in:
J Am Coll Cardiol 1999; 33 (7):1833-40
The multicenter study of enhanced external counterpulsation
(MUST-EECP): effect of EECP on exercise-induced myocardial
ischemia and anginal episodes.
Arora RR, Chou TM, Jain D, Fleishman B, Crawford L, McKiernan T,
Nesto R.  Columbia-Presbyterian Medical Center, Columbia University,
New York, New York, USA.

Mechanical circulatory assistance has always been a therapeutic
resource aimed at treating severe heart failure symptoms. Since
the arrival of external counterpulsation (ECP), a new possibility
of noninvasive use of circulatory assistance arises for the
treatment of chronic conditions in outpatients.
The MUST-EECP study is the first scientific work to achieve a
summary with an important casuistry, of this method benefits in
patients with stable chronic angina.
This multicenter, prospective, randomized, and double blind
study, carried out by seven centers in USA, included 139
patients with stable chronic angina. The trial resulted in a
decrease of weekly frequency of anginal episodes, a rise in
capacity in exercise duration free of  ST segment changes in
strain tests, and a decrease in the required nitrite doses.
These are the expected results from the physiological point of
view, since this method achieves noninvasive effects quite akin
to those largely documented by aortic counterpulsation.
In order to understand the therapeutic mechanism of this device,
it is enough to recall that myocardial perfusion ultimately de
pends on the pressure gradient which exists between coronary
pressure and subendocardial pressure. During systole,
subendocardial pressure equals aortic pressure (and,
consequently, that of coronary arteries, too), being no gradient
between both.
During diastole, coronary pressure is higher than subendocardial
pressure, making perfusion easier.
External counterpulsation causes a pneumatic compression of the
lower limbs during diastole, simultaneously to the
electrocardiogram (insufflates in T wave, and collapses in P
wave).
The hemodynamic  benefits obtained are an increase in arterial
and venous protodiastolic pressure, a decrease in arterial
telediastolic pressure, and a fall in the systolic arterial
tension of the cycle subsequent to the counterpulsed diastole.
The rise on protodiastolic pressure creates an enlargement on
coronary pressure, working particularly in the beginning of
diastole. This protodiastolic augmentation increases the
perfusion gradient through fixed coronary lesions, and makes the
opening of new paths of collateral circulation easier. Parallel
to this, the reduction on telediastolic pressure diminishes
afterload, and, consequently, subendocardial tension. Lower
subendocardial tension enlarges myocardial perfusion gradient,
and reduction on tension during systole, minimizes myocardial
oxygen consumption.
Undoubtedly, this method turns out useful as a support to
pharmacological treatment in this group of patients, but its
therapeutic contribution equals the benefits of a rational
program of cardiovascular rehabilitation. Thus, the method is
really important in stable chronic angina, in patients who,
because of extracardiac reasons (traumatologic, pulmonary, etc)
cannot undergo scheduled training programs.
This method would achieve an ideal cost-benefit ratio when used
in treating other cardiovascular conditions in which physical
retraining is not feasible, as in terminal chronic heart failure
of functional class III / IV, or in angina which is refractory
to pharmacological treatment.
There is no doubt that ECP opens up an interesting choice in
handling cardiac conditions, particularly in patients who,
because of advanced cardiac conditions, or extracardiac reasons,
cannot undergo scheduled and monitored physical training.


================================================================

Registration to the First Virtual Cardiology Congress is free
and everyone registered will get a CD with all material
published at the Congress. All interested may be registered
using an individual or a group e-mail address.
Announce the FVCC at your Center.

================================================================

Useful address on the web-Cardiology Links

Global Cardiology Network
www.globalcardiology.org

A web site for cardiology  that includes links to journals,
Continuing Medical Education, Mettings and conferences, grants
and fellowships. The following organization are members of the
network: Asian Pacific Society of Cardiology, American Heart
Association, American College of Cardiology, Intermerican Society
of Cardiology and World Heart Federation. It is particularly
interesting the easy access to guidelines Treatment of the main
cardiology organizations such as AHA , ACC and europen Society
of Cardiology. Includes a a search engine.

================================================================

Change on the deadline for abstract submission.
Due to many requests from colleagues from several countries, the
Steering Committee of the FVCC has resolved to extend the
deadline to receive abstracts submitted for possible publication
in the upcoming FVCC. The new deadline for abstract submission
will be on July 31, 1999.
Instructions for authors may be found at:
http://www.fac.com.ar/cvirtual
http://pcvc.sminter.com.ar/cvirtual

or may be requested by e-mail from:

readers@pcvc.sminter.com.ar

Awards to the best Abstracts:

1- Best scientific work presented at the FVCC (US$2,000)
2- Best work  (US$1,000 each)
2a in Basic Research
2b in Clinical Research
2c in epidemiology and cardiovascular prevention (auspice:
InterAmerican Heart Foundation).
2d performed by Physicians In Training.
2e performed at an Iberoamerican Institution.

================================================================

Honorary Committe´s members (HC) and List of Lecture/Symposia
Participants.

Argentine      

Acosta, Guillermo; Balestrini, Víctor; Bazzino, Oscar;
Bendersky, Mario; Bertolasi, Carlos (HC) ; Blitzman, Mario;
Boccardo, Daniel; Boskis, Bernardo; Canestri, Alberto; Carbajal,
Horacio; Castro, Ricardo; Chiappe, Miguel; Cingolani, Horacio
(HC); Colombo, Hugo; Conci, Eduardo; Cúneo, Carlos; De la
Fuente, Luis; De la Riva, Julio; De la Serna, Fernando; De Rosa,
José; Delfino, José; Díaz, Rafael; Doval, Hernán; Favaloro, Rene
(HC); González Zuelgaray, Jorge; Gurfinkel, Enrique; Guzmán,
Luis; Laguens, Rubén; Londero, Hugo; López, Carlos; Lorenzatti,
Alberto; Martellotto, Ricardo; Martínez, Felipe; Mastrazzi,
Pablo; Mautner, Branco; Michelson, Roberto; Nota, Carlos;
Oliveri, Raúl; Paolasso, Ernesto; Parodi, Juan Carlos; Paterno,
Carlos; Perrone, Sergio; Perrone, Susana; Pichel, Ricardo;
Piombo, Alfredo; Plastino, Juan; Pramparo, Palmira; Presman,
Carlos; Resk, Jorge; Risler, Norma; Rodríguez Campos, Jorge;
Romero Villanueva, Horacio; Ronderos, Ricardo; Rubio, Carlos;
Sala, José; Sampaolessi, Alberto; Sanagua, Jorge; Scharsgrodsky,
Herman; Serra, César; Sgammini, Haroldo; Sosa, Horacio; Tibaldi,
Miguel; Turri, Domingo; Vigo, César; Werba, Pablo; Zelaya,
Félix.

Australia      

Chalmers John; Kelly, David T.(HC); Morgan, Trevor; Sharpe,
Norman.

Brazil

Almeida de Oliveira, Sergio (HC); Brandao, Ayrton; Buffolo,
Enio; Maranhão, Mario (HC); Costa Guimarães, A.; Dias, Joao
Carlos; Diaz da Silva, Franchini Ramires, Antonio (HC); Marco
A.; Marín Neto, José A.; Nicolau, José; Perez Riera, Andrés;
Ramires José Antonio (HC); Ribeiro, Arthur; Saad, Edson; Soares
Piegas, Leopoldo (HC); Sosa, Eduardo; Timermann Sergio.

Canada 

De Bold Adolfo (HC); Hamet, Pavel; Schiffrin Ernesto; Taillefer
Raymond; Yusuf Salim.

Chile

Corbalan, Eduardo; Escobar Edgardo; Gonzalez, Rolando; Moncayo,
Alvaro; Nordet, Porfidio;

Scotland        
Meredith Peter

Spain

Bayes de Luna, Antonio (HC); Delcan, Juan Luis; Evangelista,
Arturo; Fernandez Cruz, Antonio; Juffe Stein, Alberto; Rivero
Casado, Jose; Rodicio Diaz Jose Luis; Ruilope Luis; Tamargo,
Jose; Zarco Gutierrez, Pedro.

France

Blasco, Antoine; Carpentier, Alain (HC); Chachques, Juan C.
Levenson, Jaime; Rousseau, Herve; Simon, Alain; Vanhoutte, Paul.

Israel 

Reisin, Leonardo; Rosenthal, Thalma.

Italy 

Calafiore, Antonio; Mancia, Giusseppe; Mariani, Mario; Masseri,
Atilio (HC); Salvetti Antonio, Zanchetti, Alberto (HC).

Japan  

Fukuyama Takaya; Kusuoka Hideo; Sasayama Shigetake

United Kingdom    

Camm, John; Kaski, Juan; Poole-Wilson

Uruguay        

Folle, Luis; Reyes, Ariel; Romero Carlos

USA    

Akhtar, Masood; Alderman, Mìchael; Battler, Alexander; Beller,
George; Berman, Daniel; Bommer, William; Borer, Jeffrey (HC);
Borges Neto Salvador; Calkens, Hugh; Carlson, Mark; Cerqueira,
Manuel; Champagne Beatriz; Cohn, Jay; De Puey, Gordon; Di Carli
Marcelo; Dzau, Victor (HC); Feldman, Ted; Forteza Alfredo;
Frohlich Edward (HC); Fuster, Valentín (HC); Garzon, Arthur;
Germano Guido; Gould Lance; Kannel, Williams; Kaplan,  Norman;
Kanter Ronald; Kern, Morton; Knopf, William; Krajcer, Zvonimir;
Laskey, Warren; Lown, Bernard (HC); Machac Joseph; Moller, James
H.(HC); Narula Jagat; Pandian Natesa; Pohost Gery; Port Steven;
Rahimtoola Sabudim; Raij Leopoldo; Rao Syamasundar; Reisin
Efrain; Rodriguez, Leonardo; Romero Juan Carlos; Santoni-Rugiu,
Francesco; Shaffer, Elizabeth; Sorrentino, Robert; Strauss
William; Verani Mario; Waksman, Ron; Wenger, Nannette; Wharton,
Marcus; Williams Roberta.

Venezuela      

Finizola Celli, Bartolomé; Medina Rovell, Víctor.

================================================================

This space is reserved for companies that wish to sponsor and
support the success of the First Virtual Congress of Cardilogy.

<><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><>

Editor: Alfredo Piombo, M.D. (Argentina)
Chief of the Coronary Care Unit. Cosme Argerich Hospital ,
Buenos Aires, Argentina
Associate Editors:
Claudio Gimpelewicz, M.D. (Argentina)
Dante Manyari, M.D. (Canada)
Carlos Basualdo, M.D. (Canada)


--------------------------------------------------------------------------
Letter to Editors:  readers@pcvc.sminter.com.ar
Send commands to majordomo@pcvc.sminter.com.ar
Others: owner-newsletter-fvcc@pcvc.sminter.com.ar

Top

Biweekly electronic publication of the First Virtual Congress of Cardiology, for purposes of promotion and interchange of topic of interest in cardiac sciences and news from the Congress. It is distributed free of charge to everyone subscribed. Those of English speaking origin may subscribe sending an e-mail to:

majordomo@pcvc.sminter.com.ar

with the following message in the body of the e-mail:

subscribe fvcc-newsletter


=======================================================
Newsletter - 1st Virtual Congress of Cardiology
Year 1, number 1. First two weeks, June 1999
=======================================================

If you ever want to unsubscribe, you can send the following
command in the body of your email message to
majordomo@pcvc.sminter.com.ar

unsubscribe fvcc-newsletter


An Spanish version is available for those of Spanish speaking origin.
Contributions are welcomed; also responses to previously
published articles, and commentaries should be send as Letters to:
readers@pcvc.sminter.com.ar

====================================================
Cardiovascular colleague: announce in your medical center the
First Virtual Congress of Cardiology to start soon.
====================================================
CONTENTS

First Virtual Congress of Cardiology
Edgardo Schapachnik, M.D.

Analysis of EPISTENT
Alfredo Piombo, M.D.

Useful address on the web

Instructions for submitting abstracts to the FVCC

Space available for Advertisement.

======================================================
This Newsletter will be sponsored by companies that wish to get
involved in the success of the First Virtual Congress of
Cardiology.

=======================================================

First Virtual Congress of Cardiology

The third millennium is one step away. In the recent past, human
knowledge has duplicated all that has been accumulated since the
be begins of humanity. In the next few years, there will be an
outburst of this accumulated knowledge, such that if we can
imagine sleeping for this period of time, our surprise at
awakening would be similar to that of Adam if he was suddenly
transferred to our days.
Communication has provided the means for this growth of
knowledge, and we the witness of it.
The internet represents the paradigm of communication.
It makes possible the disappearance of frontiers, distant
cultures become closer. We take this tool with an unthinkable
potential as recent as ten years ago, to transmit knowledge.
Medicine - as all other areas- is in convulsions due to this
tool: surgery at a distance, transmission of pictures,
teleconferences on line from home, virtual hospitals.
This is an application we have experience on. The enthusiastic
participation of colleagues in the cardiologist "lists"
(Cardio-L, ProCOR, Cardio-Consul) of discussion, the
organization of the "virtual ateneos", the massive inscription
for the First Course of Arrhythmia in the Internet, all testify
this reality where colleagues from distant countries are united
through the Internet.

The diagnosis of medical knowledge transfer at the turn of the
century, gave us the idea to organize the FIRST VIRTUAL CONGRESS
OF CARDIOLOGY, to take place between October 1999 to March 2000,
surrounding the date that will initiate a new era.
How do we picture this Virtual Congress?
First, as a place for interchange of the most up to date
knowledge in cardiac sciences with the participation of
worldwide professionals, without the limitation of a "real"
presence congress. These are often limited by simultaneous events,
that impinge of the possibility of participation. The Internet
does not have this limitation. The only limitation is the self
discipline required to look for knowledge. Knowledge is there.
Whoever wants it will find it.
The format of the Congress will be standard: Central conferences,
round tables, symposia, courses, short presentations and original
abstracts.
It will be Virtual in place and time. There will not be a
classroom full of participants but the number of participants
will be more than any classroom can accommodate. There will be
no time schedules. Activities will go on every minute of the
180 days the Congress will last.
The official languages will be English, Spanish and Portuguese
The Virtual Congress will be our answer to the fact we are
witnessing this giant step towards the new millennium.


Edgardo Schapachnik, M.D.
Vicepresident of the First Virtual Congress of Cardiology


========================================================
The EPISTENT Trial
========================================================

TITLE
Randomised placebo-controlled and balloon-angioplasty-controlled
trial to assess safety of coronary stenting with use of platelet
glycoprotein-IIb/IIIa blockade.
The EPISTENT Investigators. Evaluation of Platelet IIb/IIIa
Inhibitor for Stenting [see comments]
Address Source Lancet, 1998 Jul, 352:9122, 87-92
Abstract
BACKGROUND: Coronary stenting with use of heparin, aspirin, and
ticlopidine for thromboprophylaxis is performed in more than
500,000 patients per yearworldwide.
We did a randomised controlled trial to assess the role of
platelet glycoprotein-IIb/IIIa blockade for use in elective
stenting.
METHODS:
At 63 hospitals in the USA and Canada, 2399 patients with
ischaemic heart disease and suitable coronary-artery lesions
were randomly assigned stenting plus placebo (n=809), stenting
plus abciximab, a IIb/IIIa inhibitor (n=794), or balloon
angioplasty plus abciximab (n=796).
The primary endpoint was a combination of death, myocardial
infarction, or need for urgent revascularisation in the first 30
days. All patients received heparin, aspirin, and standard
pharmacological therapy.
FINDINGS:
The primary endpoint occurred in 87 (10.8%) of 809 patients in
the stent plus placebo group, 42 (5.3%) of 794 in the stent plus
abciximab group (hazard ratio 0.48 [95% CI 0.33-0.69] p<0.001),
and 55 (6.9%) of 796 in the balloon plus abciximab group (0.63
[0.45-0.88] p=0.007).
The main outcomes that occurred less with abciximab were death
and large myocardial infarction--7.8% in the placebo group, 3.0%
for stent plus abciximab (p<0.001), and 4.7% for balloon
angioplasty plus abciximab (p=0.01).
Major bleeding complications occurred in 2.2% of patients
assigned stent plus placebo, 1.5% assigned stent plus abciximab,
and 1.4% assigned balloon angioplasty plus abciximab (p=0.38).
INTERPRETATION:
Platelet glycoprotein-IIb/IIIa blockade with abciximab
substantially improves the safety of coronary-stenting
procedures. Balloon angioplasty with abciximab is safer than
stenting without abciximab.

*********************************************************

The aim of this important trial was the comparison of three
therapeutic strategies more than three different treatments:
coronary angioplasty with the use of stents, coronary angioplasty
with stents and abciximab infusion, and coronary angioplasty
without stents and abciximab infusion.
Until the performance of this trial, superiority of stents over
balloon angioplasty regarding the incidence of restenosis and
need for new revascularization procedures (but not for major
events) had been conclusively demonstrated. On the other hand,
several trials (EPIC, EPILOG, CAPTURE) had clearly shown the
benefits of the administration of glycoprotein IIb-IIIa receptor
blockers during balloon coronary angioplasty. Therefore, the next
step was to analyze the combination of the different treatments
already shown to be successful.
As it was expected, the addition of glycoprotein receptor
blockers improved the outcomes of interventions both with and
without the use of stents. It not only reduced the incidence of
combined end-points but also that of acute myocardial infarction
taken as an isolated variable. It must be remarked that balloon
angioplasty with abciximab was superior than angioplasty with
stent.
Curiously, in the female patients included in this trial
angioplasty with abciximab was also shown to be better than
angioplasty with both stents and drug infusion.
Although the group of stent plus abciximab globally had the best
results, the difference with the group of balloon plus abciximab
did not reach statistical difference. This means that, if a real
difference between both groups does exist (maybe the size of the
sample was not big enough to show it) it could be probably small,
which would be in favor of the second strategy regarding it is a
less expensive one.
How will these results be incorporated to clinical practice? It
is hard to answer that because not only the efficacy of each
treatment but also the cost-benefit ratio will have to be
carefully evaluated. Cardiologists will have to analyze in
detail from now on the therapeutic strategy to follow in each
single case, taking into account the many options they have in
the present (which will increase in the future). Thus, a
low-risk coronary angioplasty may be performed only with the
classical balloon, adding glycoproteins receptors blockers in
cases of increased risk and stent plus drug infusion in patients
considered at the highest risk.
Massive indication of these kind of drugs and/or stents does not
seem to be justified until now not only because not every patient
needs them but also, and not less important, because it would be
a heavy charge for health systems due to the economic burden they
imply.

Alfredo Piombo, M.D.
Chief of the Coronary Care Unit
Hospital Argerich - Buenos Aires - Argentina


====================================================
Registration to the First Virtual Cardiology Congress is
free and everyone registered will get a CD with all
material published at the Congress. All interested may be
registered using an individual or a group e-mail address.
Announce the FVCC at your Center
.
======================================================


Useful address on the Web-Cardiology Links

Medweb- Electronic Publications
www.medwebplus.com

A list of links to medical journals and medical sites clasified
by specialty.The are more than 350 sites on cardiology including
more than 100 journals. Without images easy to surf in it.

=======================================================

Author Instructions

General Conditions:
Original as well as investigations published within the last two
years will be accepted.

A Selection Board will analyze each submission. All accepted
abstracts will be published in the Journal of the Argentine
Federation of Cardiology.

Abstracts may be submitted from Feb 01, 1999 to July 31, 1999.
Conditions to send abstracts are noted in:

http://www.fac.com.ar/cvirtual
http://pcvc.sminter.com.ar/cvirtual

For those not able to access the web, instructions for abstract
submission may be obtained by sendind an e-mail to:

readers@pcvc.sminter.com.ar

Awards to the best Abstracts:
1- Best scientific work presented at the FVCC (US$2,000)
2- Best work (US$1,000 each)
2a in Basic Research
2b in Clinical Research
2c in epidemiology and cardiovascular prevention (auspice:
InterAmerican Heart Foundation).
2d performed by Physicians In Training.
2e performed at an Iberoamerican Institution.


=======================================================
This space is reserved for companies that wish to sponsor and
support the success of the First Virtual Congress of Cardilogy.
<><><><><><><><><><><><><><><><><><><><><><><>><><><><>

Editor: Alfredo Piombo, MD (Argentina)
Chief, Coronary Care Unit of the Hospital Cosme Argerich,
Buenos Aires, Argentina
Associate Editors:
Claudio Gimpelewicz, MD (Argentina)
Dante Manyari, MD (Canada)
Carlos Basualdo, MD (Canada)


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