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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)

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Number 17
Number 16
Number 15
Number 14
Number 13
Index

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Newsletter - 1st Virtual Congress of Cardiology
----------------------------------------------------------------
The Deutsche Bank (http://www.deutsche-bank.de/congress) supports the
Newsletter of the First Virtual Congress of Cardiology.

================================================================================
Year 2, number 17. Second two weeks, February 2000.
================================================================================

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

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

Previous issues at:

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

or at

http://pcvc.sminter.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.

TAKE PART IN THE INTERNATIONAL PROJECT 'QUIT AND WIN', AND INVITE YOUR PATIENTS
TO DO IT, TOO.

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

CONTENTS

About drive, smoking, and the Public Area of the FVCC
Editorial
By Dr. Edgardo Schapachnik

Reader`s letter
Drugs and something else...
Dr. Carlos Enrique Fullone

Useful address on the web

From the Forums

News lectures

Space available for Advertisement.

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

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

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

EDITORIAL
ABOUT DRIVE, SMOKING, AND THE PUBLIC AREA OF THE FVCC
By Dr. Edgardo Schapachnik

In our Forum on Epidemiology, the dichotomy between what should be the medical
message regarding smoking and the hard facts is currently being discussed: in
many of our countries, most of all those that are called "developing" or "Third
World countries", more than a 30% of the colleagues smoke.
We completely agree with the colleagues that claim not to be surprised that
this is so, or rather, that they are surprised that there are those who are
still surprised. We agree as well with them in laying responsibility for it on
drive, on the unconscious factor; the addiction -the roots of which should be
searched, since drive has been mentioned, in the text by Sigmund Freud
(deep-rooted smoker) from 1920, "Beyond the Principle of Pleasure"- does not
ask profession or courses taken.
However, it is still remarkable that in other countries from the North
Hemisphere, in one of which Freud lived and conceived all his work, and where
also -obviously- drive plays a role, the figures for decrease of smoking in
physicians are as important as the ones observed in the general population from
those countries.
This reality is not at all alien to cardiology. The results from the MONICA
study, commented in the Newsletter's No 12 issue, by Dr. Carlos Barrero, reveal
that the figures of mortality are reduced in the "western" countries, in a
parallel way to the decrease of that scourge, while they increase dramatically
in other countries from Eastern Europe.
That is to say, this "driving", "unconscious" factor may be acted upon. And
when this is done, results are obtained.

Personally, I took part in 1998, in the Quit and Win Contest, interesting
smokers in giving up the addiction; in our Hospital 299 individuals became
interested in trying to quit smoking since May 2, 1998, through the proposal to
participate in a raffle. After 648 days from that date, in the last measurement
that we have done, a 15% of smokers had understood the message, and remained
without smoking. The average of cigarettes smoked by this sample of people was
18 per day. That is to say, 45 individuals did not smoke 11628 cigarettes from
then on.
Following the interesting calculation proposed by M Shaw in the British Medical
Journal (BMJ Jan, 01 2000, 320 [7226] p 53), each smoked cigarette reduces life
in 11 minutes. Making some small calculations, we conclude that these 45
individuals that quitted smoking, moved by the will to take part in a raffle for
a trip to Machu Pichu, and for 10,000 dollars, have gifted themselves with
88 days of life. Almost three months. We see nothing evil in this medical act.
Very much on the contrary.
That is to say, the physician may add quality life with actions different from
prescribing specifics.

This analysis about a highly topical subject, allows me in an indirect way to
introduce a new area of the FVCC: the Public Area that will be available very
soon.
The Public Area is another way of reaching our patients. It is another medical
act.
With information, humor, and recommendations, we hope to reduce the gap that is
sometimes created between scientific knowledge and those who should rightfully
benefit from it.
I fervently invite you to visit the Public Area of the FVCC, and to invite your
relatives, friends, and patients to visit it.

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

READER`S LETTER

DRUGS AND SOMETHING ELSE...
Dr. Carlos Enrique Fullone

We are cardiologists, but we are also physicians, fathers, mothers, sons and
daughters, well, citizens that inhabit a determined country in this globalized
world.
Our scientific organizations, whether Federations, Associations, Councils, or
Societies, are devoted to cardiology, but before that they are civil,
semi-public entities from our Nations, and they are ruled by
physicians-cardiologists-citizens.
And if none of our personal categories, citizen, doctor, cardiologist, can be
left aside, neither should do it our organizations, otherwise they face the risk
of becoming empty structures that are not representative, ignored by the rest of
the community, and even capable of being accused of complicity or non critical
coexistence with the corruption around us.
Our medical organizations cannot adopt in regard to society, a "laissez-faire"
behavior, that is to say, to let it be with no critics or objections, or praise
if it was appropriate, acting as if they were isolated entities, far away from
all external influence, a place that in fact does not exist.
In this globalized world, to adopt a laissez-faire behavior is quite a
definition, certainly on the negative side, but in no way its result is neutral.
Alcohol and drugs have incorporated a new group of consumers: young people. The
latter have been included in a new marketing that links these substances to joy,
health, personal success or in sports, sexual energy, and human encounters.
Drugs (legal and illegal) together with alcohol are incorporated to this death
rites that ensure a brief initial pleasure, to generate later manifestations of
psychic and physical dependency, and end usually in AIDS, jail or death.
I have published in this congress a paper that assesses the voluntary and
anonymous answers from a numerous group of 1690 secondary students (excuse me
for the old-fashioned terms, but as a good old man I still speak about the
system of secondary school from first to fifth year), in regard to drug
consumption.
The figures are alarming, but the best of this work has been the opinions by
students, who did not mince their words to express what is within their minds,
they demanded actions by governors and citizens with power and representation,
they asked for help, and denounced.
Many of them as well, expressed messages of hope, of commitment against drugs
consumption, and without anyone mentioning it, they associate drugs to alcohol
consumption, providing some relief before a future that one supposes is
dangerous.
In the paper there are some messages of example, here as an end for this
article I will provide many others, but after examining all of them, we must
think what can we do for this young people that ask for help and commitment,
from our role as physicians-cardiologists-citizens, and members or authorities
of professional entities.
As the paper proves, there is in drug commerce a very weak link, but in turn,
it is the most necessary link. The final link, the one that finally sells the
drug, the one that almost a 50% of the interviewed students know, and the one
that tries complicity with illegal traffic.
Could our societies, tell this publicly with the weight of institutions?
This last link, that in general is another victim of consumption, that pays for
his/her drug with the profits made with distribution, should be easily arrested,
and should not be released with the excuse that s/he is the last link.
Could our societies promote that this "dealers" got arrested, treated carefully,
and truly rehabilitated, without evolving into scapegoats?
Do our organizations have nothing to say publicly about direct and indirect
marketing for addictions, whether drugs, alcohol, cigarettes, food, or general
consumption?
I think that we owe to our society in general, to our own children and other's,
the commitment to generate structures for protected denouncing, for a better
fight against drug trafficking.
Summarizing, I think that we owe to society a committed attitude, just as our
youngsters demand from us.

Dr. Carlos Enrique Fullone
Cardiologist... And now young people...

- Yes, in Giles* you can get it
- The best way to fight drugs is by family communication and education
- The person who offered it to me was the one who is supposed to fight it
- I would like that there was a penalty for those that sell, instead of
catching them and then letting them go as if nothing had happened
- Where we least think we'll find it, there it is
- In Giles all of us know where to find it. Please, do something to solve this
that is happening in our town
- You have to get them out of the streets
- I think the question should be where drugs are not sold
- Drug trafficking will not end, it is very difficult to eliminate
- I don’t know who sells it, but I do know where to get it
- There is more drug consumption than what is believed. I would never consume it
- There should be awareness that there are not just three or four individuals
that consume, there are plenty in the city
- In San Andres de Giles there are many young people, from 15 years onwards,
that consume drugs and study
- All the ones that consume are my friends
- In Giles it is believed that this is a distant problem, but it is more normal
than you think
- In San Andres de Giles drug is not in the streets, but you know it exists
- Then I think that the police must know who handles it, and who sells it, but
many times they just turn a blind eye, and young, innocent people, who are free
of this addiction is blamed and pointed, just because they want to offer a
helping hand and be a good friend for those who do consume.
- Teenagers are blamed for drug consumption, but it is adults who sell it
- I never tried drugs, although I was offered to do it several times. Sometimes
you feel within yourself the wish to try, or because someone talks you into it.
I had never talked about it, and I chatted about it because I believed it was
just foolishness, but I see many people that want to leave it and can´t
- There should be lectures about addiction to drugs, and on TV there should be
shows at least of one hour, that should speak about drugs, and also by radio,
even if they are publicity
- Thank you for caring about kids that may consume drugs
- In our city one knows who sells. I wonder why there isn't more control
- Addiction to drugs is a consequence of lack of attention by parents
- Teenagers are blamed for consuming drugs. But I wonder: who sell it?
- There are drugs in school and everywhere
- I think that in San Andres de Giles it is very easy to get drug, but each
ones responsible for oneself. Because no one will never force to do what you
don't want to do
- I never took drugs, but if some day I have to (I hope not), I know where to
get it, and I think that I can get it just as if I was going to buy chewing gum
to a kiosk
- If authorities cared, this would be a problem that could be solved
- The great lords are the ones that spoil young people from Giles, and nothing
is done against him because he is the lord.
- I know underage kids who smoke and drink alcohol
- I think that a good deal of people in Carmen de Areco know who consumes and
sells, including authorities, and what upsets me the most, is that the latter do
nothing to stop it.
- I hope that we all become aware, because this is very serious, and you see it
increasingly more, and not only on weekends, even though there are authorities
that know about it, and do nothing. This is a real problem in which all of us
have to help to improve it, all of us.
- Drugs are everywhere, and just by saying you want to consume, you can find
it. Police should prevent illegal commerce of drugs.
- Drug = death. Do not use drugs!
- Do not seek help in the police. They are the main ones.
- I wish there were no more people selling drugs because there are children
with problems, then they find people like these that offer them drugs, and they
seek shelter in drugs, these are the kids that find it more difficult to leave
it.
- In Carmen de Areco** there is a lot of dope, but nothing is done. Everyone
thinks that "here there's none of it", but there's a lot. All of them are
hypocrites.
- The town council and the town itself should work together to end this disease
- I think that we have to help the kids that consume drugs
- I wish this would be prevented as soon as possible, otherwise we are all
going to fall into addiction to drugs
- In Suipacha***, drugs are increasingly spreading. Everyone knows who has
drugs, but no one does anything
- You should try to watch more adults with money, instead of young people

Note by the author: there are plenty of messages left, but these are the most
significant ones. But for the spelling mistakes, the
rest of the messages are written just as the students handed them in.

*Giles: San Andres de Giles. Town in the Province of Buenos Aires, Argentina.
**Carmen de Areco: Idem
***Suipacha: Idem

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FROM THE FORUMS

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

EPIDEMIOLOGY

From: Daniel Flichtentrei <aflichten@intramed.net.ar>
To: epi-pcvc@pcvc.sminter.com.ar
Date: Wednesday, 02 February 2000 02:09 p.m.
Asunto: Smoking

Dear colleagues:
We are devoted readers of the FVCC's publications. We think that the
observations made about smoking among physicians are very interesting.
We think that we must not be surprised by the gap existing between information
and behavior, unless we consider that people act only moved by reason and
traditional logic, without taking into account our driving, unconscious side,
the one that determines our attitudes beyond what is advised by our rational and
scientific-technical knowledge.
In fact, we confess that we are surprised that anyone may still be surprised by
such phenomenon.
We think it is somehow paradoxical that a healthy modification of a habit
clearly linked to an important number of severe pathologies is encouraged by
appealing to the same strategies, often evil, that are used by the international
marketing to encourage its consumption.
It seems that the efforts devoted to fight a calamity for health, are using
instruments authenticated by other none the less catastrophic, such as the
structuring social imagery of our representations of the world, that imposes the
aims of action, the meanings, the desirable and the legitimate, in a cultural
environment in which links between work and remuneration are definitely
broken, and where the models of rewards and punishments lay in their most banal
and insignificant side.
If this is about prizes or rewards:
Do you know any one greater than preservation of life and health?
Is it necessary to supplement this transcendent goal with prizes that are set
up upon a model of existence supported by triviality and insignificance?
In an enterprise riddled with good intentions a methodology is being used, that
far from challenging a social pattern responsible for many of the deeper causes
of the disease, instead confirms it and produces a feedback, isn't it?
I think it is very valuable to incorporate methodologies of qualitative
research, just as it has been mentioned, a fact that would enhance the often
subject to reductionism and simplifying horizons, with which the medical
hegemonic model tackles the complex situations that determine the disease, and
that are deeply embedded in a cultural and historical model, as it could not be
otherwise.
The practice of a profession within a paradigm that ignores the multiple
determinants and the complex interactions, in favor of a simplifying and
unilateral vision of medical facts, creates an amputated and hemiplegic vision
that cannot account for the true dimensions of its object of analysis.
The biological-cultural determinants of the coronary disease have us, physicians
and patients, as propitious victims; I do not find reasonable the implicit
supposition in many messages about a supposed obligation of the doctor to work
as example for his/her patients with his/her own private existence as tool of
diffusion for a desirable pattern for a healthy life. Both, physicians and
patients, share the goals within a society that contains them, and that in many
aspects victimizes them equally. If this presumed moral duty of the doctor was
true, what should be said then, about the patterns of behavior clearly
determined as coronary risk, such as excessive ambition and competitiveness,
profits as the only aim of existence, lack of transcendent goals, often
miserable conditions of professional performance, anguish, and lack of
perspective as agents of the disease. However, we have not heard
campaigns for reducing the brutal impact that these, as well as other aspects
of existence of men, have on the genesis of the disease that scourges the
industrialized world.
How to recommend modifications in behavioral patterns clearly pernicious when
the same features are displayed as virtues, and sanctioned with the success and
prosperity by the world in which we live in?
Who could answer about the impact that living conditions, values, beliefs, and
ruthless and superficial environment in which we live, have upon the genesis of
coronary disease?
Is it maybe that the things that quantitative parameters, aims, and biologists
are not capable of measuring, do not exist?
Is it that healing strategies that are not centered on consumption of medication
or state-of-the-art technology should not be taken into account?
Maybe this will not awaken the noble samaritan vocation of my colleagues.
Thank you for letting us learn from each one of you, for giving us the chance
to disagree and enrich us through the contact with people with whom, if not
through this means, we could not exchange our scant and poor ideas.

Dra Laura Bochatay.
Dr Alberto Brondino.
Dr Daniel Flichtentrei.


From: galcala.vwaisman@interredes.com.ar (Gustavo Alcala)
To: <epi-pcvc@pcvc.sminter.com.ar>
Cc: "Dr. Edgardo Schapachnik" <edgalej@sminter.com.ar>
Subject: Smoking in physicians
Date: Sun, 6 Feb 2000 21:55:48 -0300

The epidemic is moving

Yearly deaths attributed to smoking, and projection (in millions, source WHO
1996)

                    1990     2025

Developed countries    2       3
Underdeveloped         1        7
Total                   3       10

Measurement of prevalence of smoking in health professionals, and what is more
important, their attitude and degree of intervention with patients, constitutes
a fundamental epidemiologic tool. It is much simpler than measuring the
prevalence of general population, and the latter usually follows the same
tendency as the leaders of opinion in the health area some years later. The data
becomes more useful if they are repeated periodically, thus allowing to measure
the efficacy of interventions with the goal of professionals becoming more
involved in a more active way in the treatment of this epidemic.
In Latin-American countries particularly, smoking is still considered more a
private pleasure, than a subject of public health.
Doctors and public in general as well, whisper that if it was really that
important, it would surely be the subject of specific actions by organizations
and institutions with responsibilities in the health field.
To quit smoking may be very hard, but smokers today have a greater number of
effective tools available than a few years ago.
Randomized, controlled clinical trials have proven the efficacy of a variety of
interventions; the evidence seems enough to provide guidelines, such as the case
of BP or dyslipidemia.
A much greater acceptance of guidelines and consensus has been proven among the
specialists, when they are carried out by their own scientific organizations.
The success of guidelines concerning the change of clinical practice depends on
many factors: the way in which it is developed, spread, implemented, and
assessed. It has been verified that for a figure well known both by physicians
and the whole population, to lead a group that works to achieve training and to
assess that the benefits of the proper treatment would reach the patients that
request it, turns out to be a very useful message.
In developed countries, a 75% of patients in primary care, state that they
would try to quit smoking if their doctors would advise them to, only a 20 to
40% reports that in fact, their doctors provided them this advice. And in
underdeveloped countries?

Evolution of smoking in physicians from some developed countries (%)
(Source WHO, 1990)

Finland

       men women

1969    34    28
1973    32    26
1984    19    10
1991    10     6

Sweden

1969    48    35
1972    38    27
1977    32    24
1982    22    14
1988    17    11

Canada

1965    46     -
1975    40     -
1983    37     -
1989     9     8

United States of America

1955    66
1965    24
1975    20
1982    13
1985    10

Japan

1965    68
1975    52
1987    24

New Zealand

1965    35     -
1975    20     -
1982    15    13

I think that in order to go on developing this topic, that logically generates
different opinions, it would be useful to learn the view from European
physicians, taking as example the statute that was supported by the WHO's
European Regional Office.

European statute for health professionals
(European Medical Association Smoking or Health)

1- I know the damaging effects of smoking:
For the smoker
For those who live with him/her
For society in general

2- I know that tobacco is still a legal drug, but a drug that implies
psychological and pharmacological dependency

3- I am ready to help the smokers who whish to quit:
Stimulating them to break this habit
Advising them the proper treatment
Helping them psychologically during the hard period of abstinence

4- I want to act to stop this risk factor in patients that smoke:
By quitting smoking, and showing myself as a non smoker model
By not allowing smoking in the waiting room
By strongly advising not to smoke, not only to patients, but to their families
as well
By taking part in the educational efforts, particularly on young people
By acting to convince people around me that they should take on an anti-smoking
stance

5- I realize that I have a great responsibility, not only to my individual
patient, but to the general public as well

I am urging the government to launch the proper preventive measures

We, European physicians and health professionals, are firmly determined to
support the commitments of this statute, and to join to suppress smoking, that
is the greatest factor of disease and death.

Greetings from San Juan
Gustavo Alcala

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

NEW LECTURES

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

------------------------------------------------------
(Lecturer - Title - Language - FTPMail code):
(Conferencista - Titulo - Idioma - Codigo de FTPMail):
------------------------------------------------------

Boonstra, Piet W.
Myocardial Revascularization with Arterial Conduits
English -
ccm1515i.zip

Blanck, Zalmen
Taquicardia por reentrada entre ramas
Spanish -
arm3612c.zip

Chachques, Juan C.; Carpentier, Alain
Cardiomyoplasty for chronic heart failure
English -
ccc519i.zip

Kanter, Ronald J.
Arritmias en las Cardiopatías Congénitas (Curso de Arritmias, 7ma. clase)
Spanish -
cla7cuar

Maranhao, Mario
Pacemakers, defibrillators and the electromagnetic environment
Marcapasos, cardiodesfibriladores y el ambiente electromagnetico
English-Spanish -
chc5715c.zip

Olea G., Enrique
Rol de los radioisotopos en el diagnostico del dolor toracico agudo
Spanish -
cic0606c.zip

Raij, Leopoldo
Nitric Oxide in Hypertension: Relationship with Renal Injury and Left
Ventricular Hypertrophy
English -
htm0921i.zip

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

Fundamentos de las Recomendaciones de la Federacion Argentina de Cardiología -
============================================================================
FAC '99 - en Prevencion Cardiovascular
======================================

Guzman, Luis
Cuneo, Carlos
Fundamentos de las Recomendaciones FAC '99 en Prevencion Cardiovascular
Spanish -
epc0015c.zip

Waisman, Julio
Hipertension arterial  (Fundamentos de las Recomendaciones FAC '99 en
Prevencion Cardiovascular)
Spanish -
epc0017c.zip

Cuneo, Carlos
Dislipidemias  (Fundamentos de las Recomendaciones FAC '99 en Prevencion
Cardiovascular)
Spanish -
epc0016c.zip

Cuneo, Carlos
Tabaquismo (Fundamentos de las Recomendaciones FAC '99 en Prevencion
Cardiovascular)
Spanish -
epc0018c.zip

Saavedra, Silvia S.
Diabetes mellitus (Fundamentos de las Recomendaciones FAC '99 en Prevencion
Cardiovascular)
Spanish -
epc0019c.zip

Kisen Briger, Oscar
Sedentarismo (Fundamentos de las Recomendaciones FAC '99 en Prevencion
Cardiovascular)
Spanish -
epc0020c.zip

Saavedra, Silvia S.
Obesidad (Fundamentos de las Recomendaciones FAC '99 en Prevencion
Cardiovascular)
Spanish -
epc0021c

de Rosa, Jose
Estado postmenopausico (Fundamentos de las Recomendaciones FAC '99 en Prevencion
Cardiovascular)
Spanish -
epc0022c.zip

Lorenzatti, Alberto
Nuevos factores de riesgo cardiovascular (Fundamentos de las Recomendaciones
FAC '99 en Prevencion Cardiovascular)
Spanish  -
epc0023c.zip

Righetti, Jorge
Factores de riesgo en la ninez y adolescencia (Fundamentos de las
Recomendaciones FAC '99 en Prevencion Cardiovascular)
Spanish -
epc0024c.zip

Vita, Nestor
El estres como factor de riesgo cardiovascular (Fundamentos de las
Recomendaciones FAC '99 en Prevencion Cardiovascular)
Spanish -
epc0025c.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


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

================================================================================
Year 2, number 16. First two weeks, February 2000.
================================================================================
The Deutsche Bank (http://www.deutsche-bank.de/congress) supports the
Newsletter of the First Virtual Congress of Cardiology.

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

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

Previous issues at:

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

or at

http://pcvc.sminter.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.

TAKE PART IN THE INTERNATIONAL PROJECT 'QUIT AND WIN', AND INVITE YOUR PATIENTS
TO DO IT, TOO.

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

CONTENTS

About TIGERS and adversities on cardiology
Editorial
Dr. Edgardo Schapachnik

Reader`s letter
Imaginary meeting between Carlos Chagas and Paul White
Dr. Gonzalo Villamizar A

An international contest to quit smoking: Quit and Win 2000

Poll on smoking

From the Forums

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

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EDITORIAL
About TIGERS, wolfs, and adversities on cardiology

Dr. Edgardo Schapachnik

"The Tiger"
"It was coming and going, delicate and fatal, charged with infinite energy, on
the other side of the solid bars, and all of us were looking at it. It was that
morning's tiger, in Palermo, and the tiger from the East, and Blake's tiger, and
Hugo's, and Shere Khan's, and the tigers that were, and that will be, and the
archetypal tiger as well, since the individual, in this case, was all the
species. We thought it was ferocious and beautiful. Norah, a girl, said: It
is made for love."

Jorge Luis Borges

Since January 10th, the FVCC has reinitiated its activities.
In the period that remains until its end -on March 31st- we will complete the
publication of all the lectures and abstracts of Brief Communications that we
have received.
The Forums are once again, the interactive channel that allows the participation
of anyone who wishes so.
A month after this year 2000's so long-awaited arrival, maybe two topics have
kept public attention's -at least one of them, in the Iberian-American world-
and this was reflected in our Congress: the feared Y2K, that in fact has behaved
until now like a paper tiger, and another tiger, real, fearful, lethal, the
disease of the Argentine soccer player, Diego Armando Maradona. Both topics
awakened opposite opinions that found a channel for expressing themselves in
the FVCC.

The following 100 years that will come after this paradigmatic year 2000, will
mean a challenge for Cardiology. Coronary disease, responsible for the greatest
mortality in the whole world, must retreat if one of the factors that make it
possible, smoking, can be eradicated.
On the other extreme, diseases like the Chagas disease, a true punishment for
Latin-American peoples, will follow the course pointed by its determinant
factor: poverty.

This issue of the Newsletter, the second of year 2000, aims to leave the seeds
for the fight against these two calamities.
The fight against smoking will be present through the call, that we echo, to
take part in the International Contest 'Quit and Win', through the poll about
smoking made up by the Group of Experts of the Committee for Epidemiology and
Prevention of the Federacion Argentina de Cardiologia-Argentine Federation of
Cardiology, and in the opinions expressed in the Forum on Epidemiology.
The letter submitted to our editorial office by Dr. Gonzalo Villamizar A., from
Caracas, Venezuela, is a testimony that invites us to face up to the Chagas
disease.
The FVCC, that has become a cardiac trench against these diseases, summons you!

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READER`S LETTER

IMAGINARY MEETING BETWEEN CARLOS CHAGAS AND PAUL WHITE

Caracas, January 19th, 2000

Dear Dr. Prof. Armando Pacher:

I address this exposition to you because I consider that you are the proper
addressee, because I guess it does not fit in none of the topics about Chagas
disease that are being presented to the FVCC.
The history of this disease presented peculiarities, like having been discovered
and described in opportunities contrary to the usual, because it was clinically
detected in men after having studied the vector and the intermediary hosts, just
like the etiologic agent in human blood, in a process that was fruit of the
inspiration of a true investigator, Dr. Carlos Chagas. During the course of
the investigations about this disease, several generations of distinguished
scientists made their presence be felt, covering the regional geography,
especially Argentina, Brazil, and Venezuela. Because this is my country, I take
advantage of this opportunity to mention two fellow countrymen, who completely
devoted to the crusade against Chagas disease, and may hold the role of beacon
for the legion of scientific men that cleared the secrets of the disease, and
draw the strategies to fight against it. They are known in the circle of masters
against Chagas. They are Dr. Francisco Torrealba, and Dr. Felix Pifano. The
former spent his life in an endemic region of Chagas, working as a rural doctor,
and devoting his time to study the vector, the host animals, the healthy exposed
men, and those that are openly chagasic, with a mission that may be labeled as
apostolic, that he carried out until his death. And the other master, doctor
Felix Pifano, who devoted to the lab work, and to teaching in his anti-chagasic
offensive, that he still performs in his old age.
It seems that the stage of clinical classification and anatomopathology of
Chagas disease is coming to an end. Nowadays we are entertained with the
parasite's characteristics in its attack that damages cells and tissue, and its
self-defensive mechanisms to counteract the immunologic barrier of the host. The
need then arises -that cannot be postponed- for a strong pharmacological
research involving the pharmaceutical industry, in view of the poor results of
the existing medication, and the palliative significance of the technological
resources and the surgery.
Consequently, it is necessary to establish the combat at epidemiological level.
The sanitary work of environmental sanitation has oscillated through time
because the factors that interfere are complex and changing.
It is pleasing to learn about success in some countries. This is a
Latin-American disease, one of the most critical noxas in our population, most
of the disease being located in the poorest social strata, where the breeding
ground to maintain and extend the disease is fermented. Uruguay must be
congratulated, since it claims to have exterminated the vector. This reminds us
of Sweden, a country that some decades ago declared itself free of tuberculosis,
and where just a positive PPD triggered an epidemiological alert. With
globalization, and massive migrations in current Europe, we wonder if that
sanitary paradise will remain. We wish to our Southern brothers that they may
sustain this epidemiological achievement.
Here we ponder, taking as example the case of Venezuela. When the anti-malaria
fight plan was carried out in the forties -in the previous century- the
sanitation measures lead by the sanitation expert, Arnoldo Gabaldon, obtained
amazing achievements that let him sound off internationally; at the same time
other sanitation master, Dr. Jose Ignacio Baldo, created the so called
Anti-Tuberculosis Nets that also sounded off beyond boundaries, working as a
model for the work schema in the fight against cardiovascular diseases,
initiated officially in 1959.
What was applied against malaria was a support to begin the task of eradication
of Rodnius Prolixus. That was a golden age of Venezuelan sanitation,
unfortunately interrupted by political factors with corruption incidence and
neglect of sanitary teachings.
The action of this team of people passionate with their job, has an explanation
in a phenomenon generated when Luis Pasteur's genius created Scientific Medicine
in 1880, that reached Venezuela a decade afterwards. I think that in those times
the world medical family must have experienced the emotion, the renaissance,
that pushed a trend to encourage scientific research, trade unions, a
unanimous disposition to discover and fight microbial germs. Year 1945 was
still a long way to crush the enemy. This mood kept increasing, until it made
possible the creation of the Ministry of Health in 1936 with a group of
sanitation experts, heirs of that tradition, the representatives of which we
have mentioned.
We must stop to make a reference to the Lecture by Dr. Favaloro in this
Congress in regard to the biographical sketch he presented about the eminent
North American cardiologist, Paul White, whose life is a summary of the best
medical tradition; with his strict critic to the materialization of the medical
art, the absence of humanism, that have brought a regrettable decrease in
estimation towards the professional group, and an exaggerated predominance of
healing medicine above the rest of the Health postulates, defined by the WHO:
Promotion, Prevention, Rehabilitation. With the dictatorship of healing
medicine, the machinery, dramatized in the expression by another North American
physician when talking about the "Monster", the hospital, where a great part of
the doctors forgot the doctor-patient relationship, the humanistic essence of
the medical art.
Let us rescue Prevention from among those postulates, and let us apply it in
the fight against Chagas disease. Not only medical pragmatism minimizes the
epidemiological work, that provides scant monetary yield, and does not allow
commercialization of supplies as the hospital does, but there is also lack of
political will from governments to face with decision the field studies; the
alarming degree of poverty in most of our countries is added to this, unhealthy
dwelling, overcrowding and hunger, ingredients for a fertile breeding ground for
Chagas disease.
We add to this factors the rise of Aids, in the widely varied symptomatology of
which, Chagas takes part as an opportunist.
The effect of the causal agent that causes clinical manifestations similar in
men and animals is well known; even the syndrome of oculo-facial entrance may be
observed in rodents, monkeys. There are animal species like the Citemomys
Tucumanuns that suffer a violent invasion and massive multiplication of the
tripanosoma, causing immediate death. In domestic environment, cats, dogs,
monkeys are equal victims, being natural hosts along with the ill man, the best
host for the tripanosoma.
Curiously, there are species like the Armadillo, that develop relatively mild
forms of the disease, this quality being used in the laboratory for research.
This also happens with bats, a phenomenon observed in Argentine. It is important
to respect the boundaries between the species that suffer Chagas, both in the
domestic environment and the wild one, since each one has its own habitat, its
biological circle, its status with the tendency to remain each one in this
position; a circumstance that is worthy to take into account in Sanitation,
since nature has thus ordered it.
We insist, since we have only one group of medications of scant therapeutic
significance for Chagas disease; with palliative devices for the cases with
severe or terminal lesions, obviously, while no excellent medication is found,
the steps for environmental sanitation must be a priority, along with the whole
economical process that will rescue the population exposed from poverty.
We can also imitate nature in its ways to ensure species continuity, like
certain insects, the females of which fill their environment with essences that
attract the males to inseminate their eggs. In the fight against some plagues,
success has been obtained. Maybe it could be attempted with the reduvidii if
feasible. This is only an exercise of the imagination, a fiction that if
materialized would be a triumph: precipitation of tripanosomas in the bottom of
a container filled with the smell of the femme fatale.
Cordially,

Dr. Gonzalo Villamizar A
Cardiologist

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QUIT AND WIN ("ABANDONE Y GANE IN ARGENTINA")

WHAT IS QUIT AND WIN?
Quit and Win is an international contest to quit smoking. World Health
Organization (WHO)'s Quit and Win campaigns encourage people to stop smoking
with a positive stimulus: if they succeed in quitting and it can be
verified, they will be elligible for a prize draw. Frequently prices are of a
high value -and high publicity potential- like exotic vacations, for example.

HOW MANY QUIT AND WIN CAMPAIGNS HAVE THERE BEEN SO FAR?
In 1994 thirteen countries organized the contest in Europe, within the CINDI
(Countrywide Integrated Non-communicable Disease Intervention) Program frame.
About 63,000 smokers entered the contest and a one-year follow-up survey showed
between 15 and 20% of the contestants had quit smoking definitely. The second
international campaign was carried out in 1996. Mostly European countries
participated in this international effort to encourage smokers to quit, though
this time Argentina (first and only country in the Americas to participate) and
China added their efforts. Half the countries arranged the campaign nationally,
and the other half organized it for one or more regions. Argentina arranged a
national contest through PROPIA, the Program for the Prevention of Infarct in
Argentina, from the University of La Plata. The results were very interesting:
in the evaluation carried out one year after the contest about 30% of the
participants still remained non-smokers.

The last campaign was organized in 1998, in 50 countries, and the one-year
evaluation results are still being processed. Argentina not only participated
again in this contest but also helped the international organizers to invite
more Latin American countries to arrange the campaign, so in 1998 Mexico,
Chile, Uruguay, Costa Rica and Paraguay joined this effort.

WHO COORDINATES QUIT AND WIN INTERNATIONALLY?
The National Public Health Institute (KTL) in Helsinki, Finland, is responsible
for the international coordination of the campaign, as well as of the
evaluation carried out one year later (that is the reason why the contest is
carried out every two years).

WHAT ARE THE RULES TO PARTICIPATE?
All countries jointly agree to the rules. The participants must be active
smokers (smoking for at least a year prior to the contest) and over 18 years of
age. Contestants fill in a registration form before the "quit date", that is,
May 2nd, and after a 4-week period of not smoking they are elligible for the
prize draw in their own country. To be considered a "winner" the participant
drawn must prove his/her smoking abstinence through a witness and a biochemical
test.

WHAT IS THE INFORMATION REQUIRED IN THE REGISTRATION FORM?
In the registration form each participant will have to state: name, date of
birth, sex, address, phone number; number of cigarettes/ cigars/ pipes smoked
daily; previous attempts to quit (0, 1 or 2, 3 or more), years of
smoking, plus the name and address of a witness (over 18). The witness should
be able to confirm the participant is a valid candidate for the campaign. The
form also has a promise from the participant to try not to smoke and to say the
truth, if he/she is questioned, validated by his/her signature.

WHAT ARE THE PRIZES?
Each country must grant at least a national prize (there may be minor prizes,
or regional prizes also). Besides, there is an international "superprize" of
10,000 US dollars to be drawn among the winners of the national prize in each
country.

WHAT WAS THE 1998 NATIONAL PRIZE IN ARGENTINA AND WHO GOT IT?
The National Prize was a one-week trip for two to Machu Picchu, Peru, with a
one-week stay, and Mr. Manuel Sosa, from La Rioja, got it. The international
Superprize went for Chile.

HOW CAN I PARTICIPATE IN QUIT AND WIN 2000?
You can take part in this campaign in two different ways:

a) IF YOU ARE A SMOKER WISHING TO QUIT (and you meet the requirements), you
can register in the contest (registration forms will be available sometime in
March 2000). (NOTE: Each country organizes its own campaign. If you are not
from Argentina, consult the International Quit and Win website
www.quitandwin.org or write to Ms. Eeva-Riitta Vartiainen:
eeva.riitta.vartiainen@ktl.fi, to know whether your country is organizing the
contest and how you can register in it.)

b) IF YOU THINK YOU CAN BE OF HELP to the organization of the campaign, be
it with some finantial support or by performing any task, or simply by
referring to us a contact that could be of help, please get in touch with
PROPIA coordinators:

Ms. Laura Cipolla
Contact Person in Argentina, International Quit and Win
PROPIA Program for the Prevention of Infarct in Argentina
Universidad Nacional de La Plata
Calles 60 y 120 - 3er. Piso  (1900) La Plata.

Phone: +54 (0221) 424-0293
Fax: +54 (0221) 453-5577
E-mail: jtavella@atlas.med.unlp.edu.ar /clatorres@infovia.com.ar

WHERE CAN I FIND MORE INFORMATION REGARDING QUIT AND WIN?
In our website: webs.pccp.com.ar/propia (where you can also link to the
international Quit and Win website)

PROPIA - PROGRAM FOR THE PREVENTION OF INFARCT IN ARGENTINA, UNIVERSIDAD
NACIONAL DE LA PLATA,  CIC PROVINCIA DE BUENOS AIRES, MINISTERIO DE SALUD DE LA
PROVINCIA DE BUENOS AIRES
Calles 60 y 120 - 3er. Piso  -  (1900) La Plata, ARGENTINA  --  Phone: + 54
(0221) 424-0293 - Fax: + 54 (0221) 453-5577
E-mail: jtavella@atlas.med.unlp.edu.ar  / clatorres@infovia.com.ar  ---
Website: webs.pccp.com.ar/propia

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POLL ON SMOKING

This questionnaire aims to assess the interest that the topic: SMOKING, awakens
among colleagues and readers, while gathering concrete data about this
addiction.
The arbitrary pattern of measurement for such interest will be given by the
amount of readers that will copy and paste this poll in a new e-mail message,
and will submit it to us with the respective answers to the address:

readers@pcvc.sminter.com.ar

The poll has been taken from the GUIDELINES FOR ORIENTATION for Prevention of
Atherosclerotic Cardiovascular Disease, made up by the Experts of the Work Team
of the Committee on Epidemiology and Prevention of the Federacion Argentina de
Cardiologia-Argentine Federation of Cardiology (Journal of FAC, Vol. 28 No 3,
pg. 399, Jul-Sep 1999)

Likewise, it is useful for surveying data in institutions, colleges, etc.,
wherever you wish to apply it.

1.- Do you smoke cigarettes?
a.- No (go to item 3)
b.- Yes, regularly
c.- Every once in a while (less than a cigarette a day)

2.- In general, how many cigarettes do you smoke daily?
.......cigarettes per day (go to item 5)

3.- Did you ever smoke cigarettes?
a.- No, never (go to item 5)
b.- Yes, I used to do it regularly
c.- Every once in a while (less than one cigarette a day)

4.- When did you quit smoking?
In.... you quitted last year, specify:
a.- Less than a month ago?
b.- From one to six months ago?
c.- From six to twelve months ago?

5.- Did you ever smoke cigars or pipes?
a.- No, never
b.- I used to, but I quitted
c.- Every once in a while, less than once per day
d.- I smoke cigars or pipes habitually

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FROM THE FORUMS

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

EPIDEMIOLOGY

From: Ivonne Bernui <ibernui@uni.edu.pe>
To: epi-pcvc@pcvc.sminter.com.ar
Subject: Prevention and diet

I am not a doctor, I am a biologist, and have a Master's Degree in Nutrition.
My job is to teach at the university (I educate future Nutritionists), and I am
worried about the topic about if knowledge is enough to change a bad habit.
Human behavior is very complex, and the work confirms my hypothesis.

Some years ago, I took part in a team of investigators that gathered information
about "Diet and Health in Peru". And when I had to visit the Society of
Cardiology I was impressed to learn that one of its former presidents had died
of infarction, and that the mentioned person had a problem of overweight.

I think that now, the trend to "educate" must have a high component of
QUALITATIVE investigation, and to learn why people present certain behaviors,
and to attempt to base educational intervention in the finds by the mentioned
research.

Ivonne Bernui


From: "Dr. Edgardo Schapachnik" <edgardo@schapachnik.com.ar>
To: epi-pcvc@pcvc.sminter.com.ar
Subject: RE: [EPI-PCVC] Prevention and diet

Dear colleagues and friends:
I considered that the commentaries by Ivonne Bernui were very interesting.

"I am worried about the topic about if knowledge is enough to change a bad
habit. Human behavior is very complex, and the work confirms my hypothesis"

Let me take Ivonne's reflections about diet, and translate them to another
topic that worries me.

Obviously, knowledge is not enough: otherwise there would be no possible
explanation to justify the figures above a 30% of smokers among physicians, such
as it springs from the works by: Cuneo Carlos; Saavedra Silvia; Lorenzatti
Alberto; Paterno Carlos; Humphreys Juan; Moretti Osvaldo; Guzman Luis; Valeff
Eduardo; Gimenez Juan C, and the researchers from PPPI F.A.C.
"Tabaco y medicos 98 - Resultados finales" (Smoking and Physicians 98 - Final
Results)
and the "Equipo Tabaco o Salud" (Smoking or Health Team) of the Health
Secretariat of the Government of the City of Buenos Aires: Hasper I, Feola MA,
Cohen Saban I, Fernandez J, Garcia L, Giannatasio J, Lombardo V, Macri C, Mella
A, Meyer E, Poliak J, Saenz C, Schapachnik E, Verra F, Zagalsky P, Lado MI.
"Tabaquismo en hospitales de la ciudad de Buenos Aires" (Smoking in hospitals
from the city of Buenos Aires),

both works published among the Brief Communications of the FVCC.

It would be interesting to know how many of the colleagues who are members of
this Forum are still smokers.

Particularly, I would like to know Ivonne's opinion about her statement:
"'educate' must have a high component of QUALITATIVE investigation, and to learn
why people present certain behaviors, and to attempt to base educational
intervention in the finds by the mentioned research"

I extend the question to the colleagues: which would be the necessary
"educational intervention" to eradicate the addiction to tobacco among the
professionals from the Health team?
Do you think that such intervention would have some effect in diminishing the
rates of smoking in the population?
Can we do something from this Forum?

Cordially,

Edgardo Schapachnik


From: "Dr. Alfredo Espinosa Brito" <espinosa@perla.inf.cu>
To: <owner-epi-pcvc@pcvc.sminter.com.ar>
Subject: RE: Smoking in professionals of health
Date: Sat, 15 Jan 2000 19:09:23 +0430

Dear Dr. Edgardo Schapachnik:
I am very satisfied that you have brought up the topic of smoking doctors to be
debated, and that we once again wonder about this "gap" between knowledge and
behavior (or the "lifestyle"), in regard to this topic. I think that the
approach to smoking has to be considered necessarily as an important ADDICTION,
with all the consequences that this implies, both for prevention and control.
This is the most typical example of divorce between knowledge about the negative
consequences of a major risk factor for diseases and damages for health, and the
behavior that is assumed by a large group of physicians.
In our country, we have also checked high rates of smokers between professionals
of health, in spite of several efforts to promote "models" of healthy behavior
in a sector that is key for sanitary education, and health promotion.
In our "Hospital Provincial Clinico Quirurgico Docente 'Dr. Gustavo Aldereguia
Lima'", in Cienfuegos (with 720 beds), we carried out a study of cross section
in 1982, where a sample was selected at random, stratified by job categories,
and 422 were surveyed from a total 1331 workers, with a prevalence of smokers in
a 47% (CI 95%: 42.9-51.0), 6% of former smokers, and 47% that had never smoked.
A 57% of men and 42% of women smoked, in 1982. In 1994, we interviewed again
304 from the 422 workers previously surveyed in 1982, and we recovered the data
of another 7 that died during the 12 years that went by between the two surveys,
and because of this we achieved a 73.7% of retention of the initial sample (that
is to say, of this cohort).
The prevalence of smokers in 1994, descended to 41% (CI 95%: 35.2-46.6),
increasing the prevalence of former smokes to 14%, and a 45% mentioned that they
never had smoked. This time, a 53% of men, and a 34% of women smoked.
Ordered by job categories, the following prevalence of smokers was obtained, in
1994:
Physicians (n=42): 40.5%
Nursing staff (n=54): 44.4%
Technicians (n=22): 36.7%
Auxiliary staff (n=29): 44.8%
Others (n=48): 40.3%
Other interesting results of this study in 1994, were the following: Chronic
coughing and expectoration, as the mentioned symptoms, were significantly more
frequent in smokers than in those that did not smoke [Relative Risks -RR-
respective to: 4.09 (CI 95%: 2.12-7.87) and 12.15 (2.92-50.63)]. The total
incidence of chronic diseases related to smoking was significantly larger in
smokers than in non-smokers (67 diagnosis vs. 51), with a RR of 1.42 (CI
95%: 1.08-1.86). The 7 deaths registered between these workers, during the 12
years of follow up, occurred in the group of smokers, with a mean age at the
time of death of 49.1 years old, and in 6 the basic cause of death was closely
related to the consumption of cigarettes (lung cancer 2, bladder cancer 1, acute
myocardial infarction 2, stroke 1).
The results of this study were spread in the different departments and services
of the Hospital, were discussed with the Board of Directors, and the staff. A
program with active participation was devised, with the purpose of reducing
smoking in the center, that includes educational actions accompanied by others,
of regulation and control.
This balance is not always easy to achieve, and vary in each place and time.
The assessment of the real impact of this program is still pending. Given the
nature of the matter, we do not expect it to be spectacular, but yes that they
constitute an important step in favor of our own health, our economy, and most
of all, of what is expected of the role of professionals of health as those
responsible for sanitary promotion in our communities.
I also agree with my colleague, Ivonne, when she states that: "to "educate"
must have a high component of QUALITATIVE investigation, and to learn why people
present certain behaviors, and to attempt to base educational intervention in
the finds by the mentioned research"
This is what we have attempted to do in our Hospital (the study we have
mentioned includes these aspects that, due to their briefness, we have not
treated here).
You wonder how many of us are smokers. Obviously I am not.
Besides, I believe that we can do a lot in this field of interventions on
prevention and control of smoking among the professionals of health, but I also
think that there are no universal recipes. They have to be planned, and carried
out as "tailor-made suits", according to the diagnosis that is made in each
place.
Likewise, I think that the Forum may promote an exchange of the best experiences
in this sense, and that we could all improve thus the impact of our
intervention, and contribute to the reduction of the rates of smoking in the
population, with special emphasis in the younger groups.
Warm regards to everyone in the New Year.
Best wishes,
--
Prof. Dr. Alfredo Espinosa Brito
Hospital "Dr. Gustavo Aldereguia Lima"
E-mail: espinosa@perla.inf.cu


From: Carlos Enrique Fullone <cef@intramed.net.ar>
To: <owner-epi-pcvc@pcvc.sminter.com.ar>
Sent: Monday, January 17, 2000 11:15 PM
Subject: RE: Smoking in physicians

Dear colleagues:
I express my opinion about this as a humble non-smoker. I believe in Marketing,
tobacco, junk food, drugs have a strongly efficient marketing.
I think this is not a matter of knowledge, though probably to a greater
knowledge of the damage, the rate of use may be lower, this
knowledge will never be able to cancel the effect of powerful marketing in
favor of consumption.
I know I will be too naive, but the only solution would be to banish from a
decent and righteous government all marketing, direct
and indirect, open or subliminal, for consumption of potentially toxic
substances.
And specifically in regard to smoking, I would like that all smokers would tell
us how did they feel with their first experience
with the cigarette, if it was agreeable and tasteful, or rather irritant and
withstood with the power of will.
And then later, that each on would tell when or in what circumstances do they
smoke, and what effect do they believe tobacco
produces on them.
If you wish, I provide my e-mail address to gather and classify the replies,
and then I will tell you the result.
Dr. Carlos E. Fullone


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

NEW LECTURES

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

------------------------------------------------------
(Lecturer - Title - Language - FTPMail code):
(Conferencista - Titulo - Idioma - Codigo de FTPMail):
------------------------------------------------------

Berman, Daniel
Guido Germano
Nuclear Cardiology: Where Do We Stand?
English - mnm3007i.zip (1.1MB)

Chalmers, John
The 1999 WHO-ISH hypertension guidelines stratifiying the risk to treat the
patient
English - htc0904i.zip

Comite de Docencia de FAC - PCVC
Refacin - Recertificacion de FAC por Internet
Spanish - refac1.zip

De Bold, Adolfo
"On being Amused"
Spanish - chc5710c.zip

Garcia del Castillo, H
Pericarditis constrictiva: Un reto diagnostico en ecocardiografia
Spanish - doc3094c.zip

Lown, Bernard
Tobacco: The assault on women II
English - 6301i6b.zip

Mariani, Mario
New Trends in Myocardial Revascularization
English - cic0613i.zip

Negrao, Carlos Eduardo, Forjaz, Claudia
Exercicio fisico e hipertensao arterial
Portuguese - cem3901p.zip

Wilson, Elinor
Summary of a Presentation on Tobacco Control
English - 6302i1

Wilson, Elinor
Evidence for Smoking Cessation
English - 6302i2.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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Year 2, number 15. Second two weeks, January 2000.
The Deutsche Bank ( http://www.deutsche-bank.de/congress ) supports the
Newsletter of the First Virtual Congress of Cardiology.
================================================================================

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

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

Previous issues at:

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

or at

http://pcvc.sminter.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

The challenge: after the FVCC, what happens?
Editorial

Reader`s letter
The Subtle Difference between Knowledge, and Knowing What to Do with Knowledge
Carlos Enrique Fullone, MD
Adolfo J. de Bold, PhD

Useful address on the web

News lectures


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

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

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

EDITORIAL

THE CHALLENGE: AFTER THE FVCC, WHAT HAPPENS?

The FVCC has developed successfully along its first three months. The experience
has demonstrated that it is proper that an academic activity on the Internet may
and must play with its extension through time, with the possibility of using
time in favor of developing a great many options, otherwise incompatible. A
Congress with real attendance would use a dimension we may call "vertical":
multiple simultaneous activities, condensed in scant 5 to 6 days (the time, that
is to say the "horizontal" dimension).
Instead, our FVCC unfolds its activities along intense six months. This makes
easier for those who really wish so, to participate in all and each one of the
activities scheduled.
Although we still have the second half to go, there is already an experience we
have carried out, that let us ponder about that the path we chose is valid, and
consequently must be used again, as well as improved.
Because of this, with a similar structure, this article is useful to announce
the call for the Second Virtual Congress of Cardiology (SVCC), to be held from
October 1st 2001 to March 31st 2002. The way to the Second Congress implies
finishing successfully the one we are carrying out, and above all wonder to
ourselves, recalling the initial question:
Between the FVCC and the SVCC, what happens?

In the previous editorials of the Newsletter we have developed the idea of the
Forum of Continual Education. In fact, after the end of the FVCC, the 16
Thematic Forums will continue active uninterruptedly, and will be again channels
of interactivity during the SVCC.
The chat activities will go on, but now only in Spanish, and we are already
programming activities as symposia, controversies, and Round Tables.

We need and wish to listen to our readers' opinions. This is a channel open
permanently for you to express: after the FVCC, what happens?

Dr. Edgardo Schapachnik

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

READER`S LETTER

Dear Dr. Schapachnik:

I would be grateful if you were to publish this letter in the section Reader's
letters, since I have read Dr. De Bold's letter, with considerations about
neoliberalism, Cuba, Dr. Espindola's expressions, and what surprised me the
most, the comparison between Cuba's and Canada's development.
Cuba has, as many independent people admit, one of the best health and
educational systems.
Of course, in Cuba there is extreme poverty, but no more extreme than in the
rest of the Caribbean, but with more dignity, since they are not slaves of any
imperialism. A short while ago I visited Dominican Republic, and the poverty
observed there, contrasting with super-luxurious hotels, moved me to write an
article that I titled "Lights and Shadows of Tourism".
I quote some paragraphs: "Tourism is the main source of income of this Nation.
In spite of this, rich people's fun does not achieve an acceptable life standard
for the local population...
In what percentage (obviously minimal) the incoming money due to tourism remain
within Dominican Republic in the end, is the main matter of this kind of
treatises.
Tourism, only in the region of Juan Dolio, provides 17,000 jobs, that even so
do not ensure their right to leisure time, just as the President of Dominican
Republic himself stated."
Cuba has been suffering for several decades the commercial war and blockade by
the most powerful country on Earth, and after having aligned with USSR, lost all
support from the latter when communism fell in Russia. Therefore it stands
alone, being no more than an island in the Caribbean, and in spite of this, it
survives. Only for this it deserves respect, and a better analysis before
judging Castro's regime. And a final question: What was the situation of Cuba's
people with the regime previous to Castro, that turned out to be one of the few
triumphant left-wing revolutions?
It is true that I admire the Cuban regime given the considerations made "ut
supra".
Liberalism, or neoliberalism, as Dr. de Bold calls it, with its competitiveness
without limits, does not take into account as the mentioned colleague well says,
the high emotional and human cost for non-competitive individuals, and puts us
close to our genetic ancestor, to our animal origin, to the famous "law of the
jungle", where the strong eats the weak, in a perpetual fight to survive.
Is that in evolution nothing changed with the arrival of Human Beings? Or is it
maybe that the only change is the ability in use of tools, intellect being one
more tool, but with the only goal of competing to be the strongest, regardless
of how many not so strong are left behind, enslaving them thus to become only
instinctive animals (refined, but instinctive after all) who fight continually
to prevail.
Freedom is the possibility of choosing not to compete, without this implying a
hopeless loss, is it not?
Solidarity must be seen only as a means for individual progress of the one who
gives.
In the jungle, any method is valid to win. In current society, too?
When the only aim of research is to obtain economical benefits, to obtain a
private subsidy to search for an advance that can be commercialized afterwards.
Where is the research of that that is not profitable, because it affects areas
of poor income that will not be able to pay for it? To think about the
difference in scientific growth, the difference in interest and number of
researchers, between the coveted human genome and our Chagas disease, provides
us with an accurate answer.
I am, maybe together with Dr. Espindola, one of those who believe that not
everything is used with and for the God money, and that there is poetry in the
smell of a rose.
A warm embrace,
Dr. Carlos Enrique Fullone
Cardiologist M.D.

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

Dear Dr. Schapachnik:

I was very pleased to learn that I have awakened a controversy with my
contribution entitled "The Subtle Difference Between Knowledge, And Knowing
What To Do With Knowledge". The letter by Dr. Fullone seems to be based on
ignoring some facts. To begin with, neither Canada nor I believe in liberalism
without limits. Apparently, Dr. Fullone ignores that Canada is one of the most
socialized countries in the world, and that medical care in Canada is free for
everyone. There are no private hospitals or universities, and even the poorest
of Canadians goes to the same hospital room and receives the same care as the
richest one. The system is better by several orders of magnitude than Cuba's.
Moreover, in Canada there are no poor people of the kind that is seen in many
countries, including Cuba, Dominican Republic, and the United States.
This is because in Canada, each one of us work competitively at the national
and international levels (liberal style) so that
later, we can invest the profits so obtained in social welfare (socialist style)
and in buying the roses that Dr. Fullone enjoys smelling (bourgeois style).
A dictatorship is not required to have a good government. Instead, all that is
required is good administrative skills that are unbiased by ideologies. Many
Argentineans are happy that this is the administrative style that Argentina is
turning to. Canada takes advantage of its proximity to the United States to
obtain the benefits derived from exporting goods to this consumer society
although there are great differences in political and social philosophies
between these two countries. In fact, ninety percent of exports from Canada are
made to the United States. Cuba chose a different style by pretending to dictate
its own conditions to the United States using long speeches on ideological
basis. My dear Doctor, there is a saying in English that is related to the
topic: "If you can't beat them, join them". Of course, one can always pick up
the war afterwards.
The letters by Dr. Espindola, and Dr. Fullone have given me the cue to talk
about a curious subject and they reminded me of one of my many anecdotes. In
fact, this is a personal experience. During a function in the Argentine Embassy
in Ottawa, I had the chance to take part in a conversation between the
Argentine Charge d'Affaires and his Canadian counterpart. At a given moment I
was no longer a participant in the conversation, but an observer because I
wanted to see how the discussion would end. It was interesting to see how our
Argentine compatriot argued a point based in personal and emotional principles,
or maybe pseudo-ethical ones, while the Canadian was interested in how to solve
the problem under consideration.
This is, in general, the course of discussions when an individual trained in a
Latin environment and another trained in an Anglo-Saxon environment, argue
about something. What happens is that for the Anglo-Saxon the ethical and moral
complexities is a given, and his aim is to go beyond these issues and solve the
problem.
Someone with a Latin approach does not realize this, and insists on winning the
argument, that by then she/he considers a matter of honor, with theoretical
concepts. This difference is not a question of mental sharpness, but it reflects
a difference in the individual's upbringing, and each country's tradition. It
is also due to this, that the Anglo-Saxon systems are more effective
administratively.
At the same time this explains why is that many Latin people are outstanding in
Anglo-Saxon societies, and why Castro's speeches result tedious for an
Anglo-Saxon audience. An individual trained in a Latin environment is a very
clever character, an individualist (the Anglo-Saxon is specifically trained to
follow a leader) that requires no more than a proper administration to be
successful. The differences between Latin and Anglo-Saxon approaches are obvious
upon analyzing the commentaries by Drs Espindo la and Fullone.
In my writings it is a given that nothing is completely evil or good. With this
knowledge, how do people compete to maintain their life standard? With a
dictatorship? All dictatorships (or however you call a system in which the
individual or party remains in power for dozens of years) have something good
materially (though not as good as in advanced democracies), whether missiles or
health systems. However, nothing justifies a dictatorship in itself. Not even
the threat of a superpower. Or is it that Dr. Espindola and Dr. Fullone would
rather live permanently in a dictatorship as long as PAMI* operates well? Have
we already for gotten? I know that this is not the case.
Please, let us not confuse how much do we love our fellow men, and other
emotions with what should be done to pay for this love (without printing money
that is "trucho"** or supporting dictatorships).

Cordially,

Adolfo J. de Bold,Ph.D.
Professor of Pathology and
Cellular and Molecular Medicine
University of Ottawa Heart Institute

* PAMI: (Programa de Atencion Medica Integral. -Program for Integral Medical
Assistance for retire people) In Argentine, Social Security for retired and
pensioned people
**Trucho: an Argentine an idiom that means fake, fraudulent, not
convincing.

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

USEFUL ADDRESS ON THE WEB-CARDIOLOGY LINKS
==========================================

http://www.theheart.org
An exclusive site with information of cardiology.  The editor in chief is Dr.
Eric Topol, and among its faculty the site includes Dr Jeffrey Isner, and Eric N
Prystowsky. The site conteins information, case studies, clinical trial, links
on cardiology, Journals. The access is free by subscription.

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

NEW LECTURES

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

------------------------------------------------------
(Lecturer - Title - Language - FTPMail code):
(Conferencista - Titulo - Idioma - Codigo de FTPMail):
------------------------------------------------------

Berman, Daniel
Guido Germano
Nuclear Cardiology: Where Do We Stand?
English - mnm3007i.zip (1.1MB)

Chalmers, John
The 1999 WHO-ISH hypertension guidelines stratifiying the risk to treat the
patient
English - htc0904i.zip

Comite de Docencia de FAC - PCVC
Refacin - Recertificacion de FAC por Internet
Spanish - refac1.zip

De Bold, Adolfo
"On being Amused"
Spanish - chc5710c.zip

Garcia del Castillo, H
Pericarditis constrictiva: Un reto diagnostico en ecocardiografia
Spanish - doc3094c.zip

Lown, Bernard
Tobacco: The assault on women II
English - 6301i6b.zip

Mariani, Mario
New Trends in Myocardial Revascularization
English - cic0613i.zip

Negrao, Carlos Eduardo, Forjaz, Claudia
Exercicio fisico e hipertensao arterial
Portuguese - cem3901p.zip

Wilson, Elinor
Summary of a Presentation on Tobacco Control
English - 6302i1

Wilson, Elinor
Evidence for Smoking Cessation
English - 6302i2.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


--------------------------------------------------------------------------
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 14. Second two weeks, December 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

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

Previous issues at:

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

or at

http://pcvc.sminter.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

Mission: accomplished?
Editorial

Diagnostic update: acute failure of graft in heart transplanted patients with
positive serology for Chagas

Reader`s letter
Adolfo J. de Bold, PhD

From the Forums

News brief communicattions

Space available for Advertisement.

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

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

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

MISSION: ACCOMPLISHED?

In the first issue of our Newsletter, that is with us since the second half of
June, 1999, we said that "in the dawn of the new Millennium this event leads us
to
release the idea of the FIRST VIRTUAL CONGRESS OF CARDIOLOGY, to be carried out
from October, 1999, to March 2000, embracing symbolically this date full of
significance, that will indicate the beginning of a new age"

"How do we imagine the Virtual Congress?", we wondered next.

When this issue reaches the e-mail addresses of our more than 3000 readers, we
will be at only five days of the end of the XX century.

Now we not only imagine the Virtual Congress, but we are living it in full in
the presentations by distinguished specialists published in the web, in the
pounding life of its 16 forums, in the chat experiences carried out, in the
fourteen consecutive issues of the Newsletter, in the more than 500 Brief
Communications received for publication, in the more than 6500 registrations to
the Congress. We are about to fulfill that embrace.

In this century that ends, and that for science meant the discovery of the
relativity theory, the discovery of the unconscious, penicillin and antibiotics,
the eradication of smallpox, the vaccine against poliomyelitis, man reaching the
moon, bases of heredity, of DNA, of insulin, of transistors and microchips, of
monoclonal antibodies, of cloning, and so many others, and that for cardiology
extended almost from the discovery of electrocardiogram, up to the discovery of
the genetic bases of diseases, we leave with this FVCC our very modest
testimony.

As Argentine cardiologists who made this idea be born and develop, we express
our acknowledgement and homage to our teachers, and mentors, and we do it
through the figure of three of them that still throw light, for our luck, on
our Cardiology: Mauricio Rosenbaum, Carlos Bertolasi, and Rene Favaloro.

This issue from the Newsletter, special because it coincides with the end of the
century, may be a pre-announcement, still somehow blurred even for ourselves, of
how the integration to which we aspire in our medical life in the
Institution, in the Hospital, in the research Laboratory, and these pioneer
experiences in Internet will be.

The commentary by Drs. Paola Koslowski, Nestor Jacob, and Gerardo Marambio, from
the Residence on Cardiology, Hospital Cosme Argerich in Buenos Aires, Argentina,
has as its most significant feature, beyond its deserved merits for the effort
on thematic updates, the confluence of an activity carried out in the Hospital,
Wednesday's clinical rounds, and the possibility of sharing the experience with
colleagues from the whole world.

Internet makes it possible, the FVCC handles the means, and the Newsletter is
the integrating vehicle.

Mission accomplished?

We do not think so. We have just put on our dancing shoes. It is time to begin
dancing!

Colleagues: on behalf of the FVCC's Steering Committee and Scientific
Committee, I wish you the greatest success in this enterprise that we begin
together, and that is called XXI century!

Dr. Edgardo Schapachnik

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

DIAGNOSTIC UPDATE: ACUTE FAILURE OF GRAFT IN HEART TRANSPLANTED PATIENTS WITH
POSITIVE SEROLOGY FOR CHAGAS

Dres. Paola Koslowski, Nestor Jacob, and Gerardo Marambio
Residence on Cardiology. Hospital Cosme Argerich. Buenos Aires. Argentina

An interesting and vibrant debate is being carried out currently in the Forum
on CHAGAS DISEASE of our FVCC, and is presented in this issue of the
Newsletter, in the Section "From the Forums".

In turn, an interesting case of chagasic myocarditis contributes to this debate.

The following commentary by Drs. Paola Koslowski, Nestor Jacob, and Gerardo
Marambio from the Residence on Cardiology from the Hospital Cosme Argerich, in
Buenos Aires, Argentina is an updated synthesis of this cardiology
problem/challenge of the end of the Millennium.

In spite of the high incidence of reactivation of Chagas disease in heart
transplanted patients, the administration of lower doses of immunosuppressive
therapies, just as the good response to antiparasite drugs, determine that
currently, parasitosis by Trypanosoma Cruzii does not mean a contraindication
for transplantation.

Early mortality associated to heart transplantation happens in approximately
30% of the cases as a result of infectious complications, or primary failure of
the graft. This fact highlights the importance of immunosuppressive and
prophylactic therapies, for infections more frequently associated to
immunosuppression.

Currently, the protocol most commonly used for immunosuppression includes a
treatment with three drugs: cyclosporine, azathioprine, and prednisone, using
higher doses in the post-transplantation initial period, with afterwards
decrease to lower and less toxic doses. Many centers use routinely, besides,
anti-thymocytic globulins (lymphoglobulin) or anti-T cells antibodies (OKT 3)
for quick induction in the post-operative.

Taking into account the high probability of Chagas disease reactivation, in the
most important work carried out by Bocchi et al., on chagasic transplanted
patients, that compared two groups: one of them had been treated with
conventional immunosuppressive doses, and the other with reduction in the
doses of cyclosporine associated to an increase in the doses of azathioprine; it
was observed that there were no statistically significant differences in regard
to graft rejection, the number of infections and neoplasm, and that besides the
free interval of Chagas disease reactivation with myocarditis was significantly
greater than in those treated with lower doses of immunosuppression, and
survival a year afterwards was significantly greater in the latter group.

Some antiparasite drugs, such as beznidazol and nifurtimox, are quite effective
in treatment of the acute phase of the disease, their benefits as prophylaxis
treatment not having been proved; on the contrary, it has been found in studies
with animals, an increase in incidence of neoplasm associated to these drugs,
and because of this currently, their use as prophylaxis is not recommended.
This led to some authors search for other drug without these adverse effects, as
Dirceau et al., who observed an efficacy of allopurinol for prevention and
treatment for reactivation of Chagas disease; this study was carried out in a
very small population, therefore currently its real usefulness is not clear, as
is  its true tripanosomicide effect.

When a heart transplanted patient that turns up with decompensated heart failure
after four months of transplantation, as the case presented in the Forum on
CHAGAS DISEASE, the diagnosis that must be posed as responsible for graft
dysfunction are: the presence of myocarditis, acute rejection, or
atherosclerosis associated to graft.

Regarding coronary artery  disease, because these are denervated hearts, silent
infarctions are produced that lead to a progressive damage of ventricular
function, and that can manifest as heart failure, but we have to take into
account that this is an entity that happens late, after the first year of
transplantation.

In regard to myocarditis, the two most frequently involved pathogens in its
development, in non chagasic transplanted patients are cytomegalovirus (CMV),
and Toxoplasma gondi, but in patients with positive serology for Chagas, the
Trypanosoma Cruzii would be the most probable pathogen. The incidence of active
infection by symptomatic CMV is a 7 to 45%, associated to a mortality of a 7%.
Although this happens typically within the period of greatest immunosuppression,
its appearance is infrequent, and even in its most severe forms, myocardial
involvement is rare, and besides, the proper prophylaxis with gancyclovir has
proven to diminish significantly the incidence of the disease in seropositive
receptors.

The incidence of myocarditis by Toxoplasma is very low, and happens more
frequently, as secondary to a primary infection. Besides prophylactic with
pirimetamine diminishes the possibility to develop myocarditis by this pathogen
even more.

In the initial experience with chagasic transplanted patients already, a high
frequency of acute reactivation was reported; Bocchi, maybe the author who has
more experience, observed an important incidence of myocarditis during the
episodes of reactivation. Moreover, he found that there is a clear association
with the increase of immunosuppression and use of steroids.

The possibility of acute rejection always exists. In patients that turn up with
heart failure, the presence of rejection grade  IIA or more should be suspected,
and it is only possible to dismiss it after performing endomyocardial biopsy
(EMB). Though Brunner-La Rocca observed in one of their studies, that the only
independent predictor of rejection grade  IIIA, was the find of rejection grade
II in biopsies taken 7 to 10 days prior.

Conclusion: The high frequency of acute reactivation of Chagas disease
associated to immunosuppression, and treatment with corticoids, and  the high
incidence of myocarditis found during these episodes, added to clinical
manifestations, constitute powerful data that allow to suspect the presence of
an acute chagasic myocarditis in transplanted patients, previous carriers of
reactive serology for the parasite.

Such is the case commented in the Forum.

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

READER`S LETTER

Dear Dr. Schapachnik:

Thank you for your message regarding a reader's letter about one of my
contributions to the CVC. I am afraid that I found Dr. Espindola's letter
somehow digressing, and therefore, I do not know how to answer it effectively.
Anyway, if in fact is that  Dr. Espindola is critical to liberal systems
-obviously he admires Cuba- I would point out two things.
Firstly, individuals within liberal systems enjoy the best life standards. This
does not mean more TV sets at home, or other material goods, although that is
true, too. This means that services as electric power, public health, education
and varied nutrition, time to rest, and freedom to express oneself, and to
leave or to enter the country, etc., are within the reach of the individual,
whoever he is. Based in this, for instance, Canada has been chosen number one by
the United Nations during several years in a row. Of course, this is not free.
To achieve it there is hard work to be done, we have to be competitive, and this
is what many people call neoliberalism (I frequently wonder if the word
neoliberalism was not coined by someone who could no longer live from the
State). This competitiveness springs from the individual, and not from the State
or the Companies.
Secondly, social justice depends actually, just as science and education, from
the proper fiscal administration, and competitiveness in the international
field. That is to say, nowadays, money is required to have a fair (and modern)
society, just as money is required to make good science, or obtain a good
education. This is not necessarily ethical or moral. However, given the
circumstances, we have to understand that ideologies, dogmas, and romantic
people have to give an important place to pragmatism, if what it is wanted is
the individual's wellbeing above an ideological concept. Otherwise, this would
surely be inhuman, and would not be either ethical, or moral. Pragmatism is
what systems based on ideologies lack, and that is why infallibly governmen
ts that follow ideologies rigidly, have to turn to dictatorship. This is told
by someone who has no political affiliation, but who was anyway taken to jail
with a 45 caliber gun pointing to the head, just because I was working in the
care unit at the Hospital Clinicas de Cordoba. Is there any doubt about if
being pragmatic is an inhuman reductionism? Let us ask someone who lives in
hunger, or with sewers that do not work, or with a ration of chicken by month,
even though s/he has a vaccine against meningitis.

Cordially,

Adolfo J. de Bold,PhD
Professor of Pathology and
Cellular and Molecular Medicine
University of Ottawa Heart Institute

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

FROM THE FORUMS

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

CHAGAS DISEASE

Clinical case: patient, 57 years old, female, with history of blood
hypertension, positive serology for Chagas, carrier of a necrotic ischemic
dilated cardiomyopathy, with an ejection fraction in 24%, revascularization not
being possible due to bad distal beds, that evolved with heart failure CF II/III
and angina refractory to medical treatment; therefore performing heart
transplantation on 02-17-99. The conventional immunosuppressive schema was used:
azatioprin, ciclosporin (in lower doses), and prednisone; also prophylaxis with
pirimetamine, trimetroprime-sulfametoxazol, ganciclovir, and nistatine. She
evolved with several episodes of acute rejection during the first three months,
together in two times with signs and symptoms of heart failure, requiring
increase in doses of immunosuppressive drugs, glucocorticoids, and
administration of anti-thymocytic globulins. She is admitted on 06-21-99 due to
decompensated heart failure, performing diagnosis by endomyocardial biopsy (EMB)
of chagasic myocarditis (finding nests of leischmanias). In her physical
examination, she presented BP: 130mmHg, HR: 100bpm, left R3, systolic murmur 3/6
in mesocardium, edemas 3/6 in inferior limbs, 1/6 of sacrum edema, bibasal
crepitant rales, and painful hepatomegaly. ECG: rhythm: sinus, HR: 100 x min,
PR: 0.12 sec, QRS: 0.16 sec., axis: -60 degrees. Left anterior hemiblock, non
systematic disorders of intraventricular conduction, hypertrophy, and overload
VI. Echocardiogram: RVDD: 3.17, LVDD: 6.16, RVSD: 3.90, Circumference Shortening
Fraction: 28%, IVS: 1.41, LVPW: 0.90, LA: 6.3, aorta: 4.07. Dilated left
ventricle, with global hypokinesia, and mild to severe systolic dysfunction.
Mild to severe systolic dysfunction of the right ventricle. Left atrial
enlargement. Mild mitral insufficiency. Mild aortic failure.
Mild to moderated tricuspid insufficiency. PASP: 31mmHg.

Dra. Paola Koslowski
Residencia de Cardiologia
Hospital Cosme Argerich
Buenos Aires - Argentina


Date: mon, 06 Dec1999 00:09:35 -0300 (ART)
From: "Dra Goñi Maria Teresa" <suteki@ssdnet.com.ar
To: chagas-pcvc@pcvc.sminter.com.ar
Subject: Trasplante y Chagas

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

Dra Maria Teresa Goni


Date: Wed, 8 Dec 1999 11:37:56 -0300
From: Dr Sergio Perrone
To: chagas-pcvc@pcvc.sminter.com.ar
Subject: Chagas y Trasplante

First and foremost, I must thank the consult on the topic that you deal with.
Regarding your question about if the chagasic patient with heart
transplantation, must receive parasiticide treatment in a prophylactic way,
routinely, there two stands:
1- Parasiticide prophylaxis Yes
2- Parasiticide prophylaxis No
Those who support the first stand (Parasiticide prophylaxis Yes) are based in
the experience of those that prevented reactivation of chagasic disease in
transplanted patients that receive immunosuppressive medication. This experience
constitutes the first and biggest experience of the group from Brazil with more
experience in heart transplantation in chagasic patients. They used Beznidazol
as prophylaxis, and the problem they found was the greater incidence of
lymphoproliferation symptoms in this group of patients than in those
non-chagasic transplanted, that did not receive Beznidazol as prophylaxis. Most
of these patients (in spite of parasiticide prophylaxis) presented reactivation
of their Chagas disease in post-transplantation.
There is a smaller experience from another group (also from Brazil) that poses
that use of Nifurtimox as prophylaxis without observing this greater incidence
of lymphoproliferative syndrome.

Those who support the second stand (Parasiticide prophylaxis No) are based in
results of survival similar to those observed in non-chagasic patients when
parasiticide prophylaxis is not used, and only post-operation reactivation
episodes of the Chagas disease are treated, in heart transplanted patients using
besides, a lower level of immunosuppression post-transplantation.
Regarding acceptance or not of a donor, who is a carrier of positive serology
for Chagas (without chagasic heart disease), the topic is still controversial,
since one would be transmitting the disease to the receptor. One should estimate
the risk that transmission of the Chagas disease to the receptor means, vs. the
risk that waiting for another donor means.

I also take the liberty to advise you to consult with a personal friend, and
one of the people who knows most, and has more experience in the topic Heart
Transplantation in Chagasic patients, Dr. Noedir Stolf from the Instituto de
Cardiologia from the Universidad de San Pablo:

stolf@incor4.incor4.incorusp.br

Sergio Victor Perrone, MD
Director Medico de Transplantes Intratoracicos
ICYCC
Fundacion Favaloro
Belgrano 1746
Buenos Aires (1093)
Argentina
Tel/Fax: 54-11-4378-1350
E-Mail: svperrone@interlink.com.ar


From: Harry Acquatella <hacquatella@true.net>
To: Dr. Marcelo Bassino <marbas@teletel.com.ar>
Date: Friday December 10 1999 08:42 AM
Subject: [CHAGAS-PCVC] Trasplante y Chagas/Chagas and Transplantation

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

Sincerely,
Harry Acquatella


Date: Fri, 10 Dec 1999 12:56 -0300 (ART
From: Dr Fernando Burgos
To: chagas-pcvc@pcvc.sminter.com.ar
Subject: Chagas and transplantation

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

Dr Fernando Burgos


From: Joao Carlos <jcpdias@cpqrr.fiocruz.br>
To: "'chagas-pcvc@pcvc.sminter.com.ar'" <chagas-pcvc@pcvc.sminter.com.ar>
Subject: RE: [CHAGAS-PCVC] Trasplante y Chagas/Chagas and Transplantation
Date: Sat, 11 Dec 1999 10:52:24 -0200

For the first case: the last consensus in scientific community (WHO/Rio, 99),
leaves as option the specific treatment, considering two possibilities: a) to
treat it as a preventive measure with the usual doses, thus preventing the
possible reactivation of parasitosis, or, b) clinical and parasitologic
monitoring of the transplanted patient, beginning treatment if reactivation
appears.
For the second case, the general tendency is not to transplant hearts from
infected patients; however, in cases of extreme necessity and lack of
donors/problems of histocompatibility, the transplantation may be accepted as an
exception, as in the case of kidney transplantation. Here, the same prior
reasoning is applied regarding treatment, but the wisest thing to do (as
published in kidney by Dias & Brener), is to adopt the criteria from
chemoprophylaxis of accidental transmission, treating the receptor during 10 to
15 days immediately after the surgical act.
Sincerely,
JCPDias.
Investigador de Fiocruz, Brasil.


Date: Sat, 11 Dec 1999 23:18:57 -0300
Subject: Re: [CHAGAS-PCVC] Trasplante y Chagas/Chagas and Transplantation
From: "Sergio V. Perrone" <svperrone@interlink.com.ar>
To: <chagas-pcvc@pcvc.sminter.com.ar

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

Dr Sergio Perrone
Director Servicio Trsplantes Intratoracicos
Fundacion Favaloro . Bs As . Argentina


Dear colleagues of the list Chagas-PCVC

Regarding the treatment that a patient with heart transplantation with positive
Chagas must receive, is together with the triple immunosuppressor schema,
receives parasiticide treatment.
Parasitemia was observed, according to what was reported by one of the most
experienced centers in Brazil (Inst. del Corazon from the Univ. of San Pablo) in
a 15% of heart transplanted patients, diagnosed by xenodiagnosis, and in a 20%,
reactivation of Chagas with other skin manifestations, etc. Prophylaxis is
carried out with Beznidazol. What is most important, is to maintain the minimal
immunosuppression necessary so that there is no rejection of the graft, and
parasitemia is not produced.

Dr  Liliana Favaloro
Servicio Trasplante Intratoracico
Fundacion Favaloro .Bs As . Argentina


Date: Sat, 11 Dec 1999 23:18:58 -0300Subject: Re: [CHAGAS-PCVC] Chagas y
Trasplante/Chagas and
transplantation
From: "Sergio V. Perrone" <svperrone@interlink.com.ar>
To: <chagas-pcvc@pcvc.sminter.com.ar>

Just as Dr. Fernando Burgos says, the possibilities that the patients who are
carriers of Chagasic cardiomyopathy, have to access transplantation are very
few, most of them lack health insurance, and their habitat is generally not the
ideal one for an immunosuppressed patient. If one can overcome these difficult,
social problems that not only Chagasic patients present, but a great part of our
population in LatinAmerica, the transplantation could be an option
for some, and I am not saying for all them, because the number of donors is a
fundamental restriction for organ transplantation.
In regard to the question by Dr. F. Burgos, a 2% of our transplanted patients
are Chagasic, and a similar figure makes up the waiting list. I repeat: the
criteria for selection are fundamental before deciding inclusion of any patient
(Chagasic or not) in the waiting list, and the social, and psychological factors
have a fundamental role in post-transplantation survival. Other topic to
take into account in the selection of the Chagasic patient as receptor to
transplantation, is the presence or not of megacolon or megaesophagus, these
being inconveniences that alter significantly the absorption of
immunosuppressive medication, and that besides, may complicate seriously the
post-operative with perforations, and ulcers very hard to treat, to such extent
that the presence of these pathologies, also constitute a contraindication for
transplantation in a patient carrier of Chagas disease.
Now, from the point of view of social economy, I agree with Dr. F. Burgos, in
which it would be so much simpler and economical to eradicate the Chagas disease
from our population, than trying to solve its terminal stage with heart
transplantation.
Once again, thank you very much for letting me contribute with my opinion in
this forum.
Sincerely,

Dr. Sergio V. Perrone


From: "Horacio Romero Villanueva" <ramichel@intramed.net.ar>
To: "Marcelo Bassino" <chagas-pcvc@pcvc.sminter.com.ar>
Subject: Chagas y Transplante/Chagas and Transplantation
Date: Tue, 14 Dec 1999 00:05:10 -0000

I have followed with great interest the answers to the topic of transplantations
in chagasic patients. I would like to contribute with some information. About if
a chagasic patient who is indicated heart transplantation must receive
parasiticide treatment routinely, whether as prophylaxis and/or to treat new
worsening, and which should be the schema to follow, Dr. A Bocchi, from the
Heart Institute, Sao Paulo University, Medical School, is the most experienced
person in transplantation in chagasic patients. In the Ann Thorac Surg 1996,
61:1727-33, he comments two series of patients, one of 9 cases operated between
1985 and the other between 1991 and 1995. After the experience acquired in group
1, lower doses were used in group 2 (33% for group 1, 80% for group 2,
p=3D0.008). The presence of a parasitemia was similar in both groups, but a
reactivation of the Chagas disease was observed in 5 patients in group 1, and
only in one patient in group 2. A parasitemia was detected once in 15 patients
(68%). Five patients from group 1 suffered at least one episode of reactivation
of Chagas disease during follow up. A patient presented four episodes of
reactivation, and other patient 3 episodes, treated with success during follow
up. Three patients had received prophylaxis treatment with benznidazol.
All episodes or reactivation of Chagas disease were successfully treated with
benznidazol with regression of reactivation.
Therefore, in this work only benznidazol was used, both for treatment and
prophylaxis of reactivation of Chagas disease.
Bellotti et al. (Instituto do Coracao, Divisao Clinica, Hospital das Clinicas
de Facultad de Medicina da Universidade de Sao Paulo, Brasil, en Transplantation
Proceedings, vol. 25, No 1, 1993, pp. 1329-1330) analyzed a series of 12
patients, male, between 1986, and 1992. Five patients received benznidazol
(10mg/kg/d) during 60 to 90 days as prophylaxis for reactivation of T. cruzi.
Reactivation of infection by T. cruzi happened in 9 patients with detection of
parasite in blood and/or tissues. A clinical reactivation of Chagas disease with
detection of parasites in blood and tissues was observed in 5 patients. All
episodes of reactivation of Chagas disease were treated successfully with
benznidazol. The attempt to prevent reactivation of T. cruzi with benznidazol
introduced before, or at the time of transplantation, and afterwards during 12
weeks, proved to be ineffective.
De Carvalho, Valeri B., et al. from the "Universidad de Sao Paulo" (Circulation
94: 1815-1817), commented on the experience 10 years after the first
transplantation was performed in chagasic patients. They studied 10 patients, in
8 prevention against reactivation of infection by T. cruzi was carried out,
through administration of benznidazol (10mg/kg/day) during 60 days in the
preoperative period, and in all of them for the same period in the
postoperative. A reactivation of the T. cruzi happened in 3 patients, in whom
the parasite was detected in the blood during the months 2, 17, and 23. There
was no recurrence of infection between months 26 and 124 after operation. Signs
of myocarditis were not confirmed.
In 1995, in the meeting of the "Sociedad Internacional de Transplante Cardiaco
y Cardiopulmonar", the Brazilian experience was presented, a multi-institutional
study, where the results from 55 carriers of Chronic Chagasic Cardiomyopathy
were included. This represented a 10% of the reasons that led to heart
transplantation. They used both double or triple therapy, and they display an
early death in a 14%, related fundamentally to infections, rejection, and
unspecific failure of the graft. And there was a remote modality in a 19%,
related to neoplasm, infections, and rejection, most of them during the first
year. In no case death was related
to the Chagas disease. Approximate survival was in this group of patients, a
73% during the first year, and 67% in four years. All patients by reactivation
were easily treated with benznidazol, and without sequels (44% of patients).
Dr. Almeida et al. (J Heart Lung Transplant, 1996, 15:10, 988-992) under the
title "Ghagas disease reactivation after heart transplantation: efficacy of
allopurinol treatment", describe two cases of patients with Chagas disease that
were transplanted. The first had asthenia, anorexia, and many  painful
subcutaneous nodules in his legs after transplantation. Biopsy showed
subcutaneous infiltrates with many intracytoplasmatic nests of Trypanosoma
cruzi.
Allopurinol (600mg/day) produced a complete regression of
symptoms and nodules with a negative control in the biopsy carried out after
two weeks. The treatment was maintained for two months.
A mild leukopenia developed, that improved after reduction of azathioperine,
and adverse effects were not noticed. The second
patient showed a sudden heart failure, after transplantation. Myocardial biopsy
showed fibers infected with Trypanosoma, and a
concomitant right catheterization showed a low cardiac index, and high final
diastolic pressure. The patient received allopurinol
daily in doses of 900mg/day, and conventional treatment for cardiac
insufficiency. The echo displayed improvement of parietal
motility, and decrease of ventricular dimensions, and control by endomyocardial
biopsy did not displayed any inflammatory activity,
with normalization of pressure of cardiac filling, and cardiac index.
Frazier et al. (Support and Replacement of the Failing Heart - Lippincott-Raven
Publisher), in 1996, commented on the experience
from the Texas Institute, where a South American patient was observed, that
presented a reactivation of Chagas disease two months
after transplantation, with good response to nifurtimox.
The University of Nebraska ("Thoracic Transplantation" Shumway S. et al.
Blackwell Science Inc., 1995), reports the results in one
of their patients, who underwent heart transplantation due to chagasic
myocarditis, who was administered benznidazol as prophylaxis
during a month immediately after surgical intervention, without evidence of
reactivation of the disease, with good evolution in six
years of follow up.
Dibow EF (in an article about "Postcardiac transplant reactivation of Chagas
disease diagnosticated by skin biopsy" Cutis 1991, 48:37-40), reports that in
the University of Columbia four reactivations happened in five patients
tranplanted due to a chagasic cardiomyopathy with totally favorable response to
the treatment.
Blanche et al. reported a work on "Heart Transplantation for Chagas Disease"
(Ann Thorac Surg 1995, 60: 1406-9), in which the experience in Cedars-Sinai from
Los Angeles is told, in two patients without reactivation of Chagas disease
after a follow up from 1 to 6 years, in whom prophylaxis with nifurtimox was
carried out.
During the XXIV Argentine Congress of Cardiology, a Consensus for Heart
Transplantation and Chagas Disease was designed, concluding that a preoperative
anti-parasite treatment should be performed, and in due time postoperative
prophylaxis. This group designed a flux diagram in patients with reactivation
that is the following: treatment, Radanil NR 5mg/kg/day during 60 days.
Secondary prophylaxis: Radanil NR 2.5mg/kg/day for a year.
In the previous summary I have tried to answer the two first required items,
based above all in international bibliography, due to the very scant experience
that there is about the topic in our country.
About if a heart from a chagasic patient without heart disease may be admitted
as donor, in the consulted bibliography, in no case there is such an example
quoted, but kidneys from chagasic donors are used for transplantation.
I want to apologize since, due to urgent obligations that force me to
concentrate in a presentation I have to make immediately in the city of Rosario,
I had literally no time to translate my summary to English, as I see is
customary in the list.
I apologize,

DR. HORACIO ROMERO VILLANUEVA


Date: Fri, 17 Dec 1999 21:14:46 -0300
Subject: Re: [CHAGAS-PCVC] Chagas y Transplante/Chagas and Transplantation
From: "Sergio V. Perrone" <svperrone@interlink.com.ar>
To: <chagas-pcvc@pcvc.sminter.com.ar>


I would like to make clear that in the commentary about the articles by Dr.
Bocchi that Dr. Romero Villanueva expressed, referring to the experience
acquired in group 2, and use of "lower doses" in group 2, Dr. Bocchi means
"lower doses of immunosuppressive medication", and the fact of not using
prophylaxis in group 2 is due to the fact that in group 1 (in which prophylaxis
with Benznidazol was used) the incidence of lymphoproliferation syndromes was
significantly above than in normal population of transplanted patients, then it
was decided to avoid administration of Benznidazol, and to use it only in cases
of reactivation of Chagas disease, thus improving the values of survival in the
follow up of these patients.
Dr. Sergio V. Perrone


Date: Tue, 21 Dec 1999 06:54:24 -0300
Subject: Re: [CHAGAS-PCVC] Chagas y Transplante/Chagas and Transplantation
From: "Sergio V. Perrone" <svperrone@interlink.com.ar>
To: <chagas-pcvc@pcvc.sminter.com.ar>

The bibliographical revision through all publications about Chagas and
transplantation that our colleague is offering to us, is very interesting.
Specifically, in this reference is made to medication with Allopurinol for
treatment of Chagas disease, and I would like to make three commentaries:
1- You must take into account that not all strains respond to treatment with
Allopurinol
2- Allopurinol strengthens significantly the action of azathioprine, therefore
it is necessary to make clear that the undesired effects of the drug are more
evident (leukopenia and even medullar aplasia), and because of this it is
advisable, in the case of its use in patients that receive both drugs, to
diminish the dose to a half, or even better, to a 1/3 of the usual dose. By
default, one can use Micofenolate Mofetil, that has not displayed interaction
with allopurinol
3- Since you are making a quite complete review: how about providing us with
some commentary on treatment of parasitemia with Anfotericine B

Dr. Sergio V. Perrone


From: Dr Enrique Manzullo
To: chagas-pcvc@pcvc.sminter.com.ar
Subject:  [CHAGAS-PCVC] . Chagas and transplantation
Date: Lun, 20 Dic,1999 17:03-0200

I have read the questions about parasiticide therapeutics in heart
transplantations. Also the answers by Joao Carlos Pinto Dias and Romero
Villanueva.
It is clear that an efficient parasiticide therapeutic may be proven because a
treated and cured chagasic donor should not transmit the infection to the
receptor, and a treated and cured chagasic receptor should not infect the organ
received.
The colleagues may draw your own conclusions from the bibliography presented by
Dr. Romero Villanueva.
We can also emphasize that in the presence of new acuteness, the parasiticide
treatment is usually efficient.
In acute Chagas, parasiticides produce parasitologic and serologic healing, in
new acuteness due to immunosuppression (transplantation, HIV, etc.), frequently
healing of clinical manifestations, with maintenance of positive serology. What
happens with evolution of chronic patients? Results constitute the greatest
argument in Chagas since at least thirty years.
I think it is important to emphasize that one cannot lay in parasitic
idetreatment to transplant, whether the chagasic patient is the donor or the
receptor. It must be treated, but we must be very alert as well, to new
acuteness that is frequent.
The most frequent donation-reception act is blood transfusion. I wonder if we
were to research more convinced of the usefulness of parasiticides, this would
allow treated chronic chagasic patients to be blood donors.
Cordially,
Enrique Manzullo

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Spanish - tnn2415.zip

Ramos Neto Aristiliano; Valente Jamil Mattar; Simao Antonio Felipe
Fibroelastoma Papilar de Valva Mitral em Homem de 43 Anos de Idade, com Queixa
de Dor Precordial Desde Ha 4 Anos e Episodio de Sincope Recente
Portuguese - tnn2680.zip

Reggiani Roberto; Negro Ubaldo; Uriarte Marcelo; Carrizo Humberto; Suarez
Fabian; Nitti Nicolas; Larronde Esteban.
Efectos adversos y seguridad del dipiridamol como apremio farmacologico, para
evaluar perfusion miocardica con Talio 201
Spanish - tnn2594.zip

Rizzardi J.L., Concetti C.l; Meletti E, Benetti F.
Abordaje Xifoideo. Primera eleccion...
Spanish - tnn2701.zip

Rosillo Irene; Turco Miryam; Corbera Mirtha; Caferra Digna; Lioi Susana;
Pituelli Norma; Fraix Teresa; Tamagno Beatriz.
Antecedentes familiares y perfil lipidico en una poblacion adolescente
Spanish - 2688

Szot Jorge; Berrios Ximena.
Novel Risk Factors for Coronary Heart Disease: Serum Homocysteine Levels and
its relationship with classic Risk Factors in a school population. Metropolitan
Region. Chile
1999.
English - tnn2684.zip

Valente Jamil Mattar; Ramos Neto Aristiliano; Simao Antonio Felipe.
Perfuracao do Folheto Anterior da Valva Mitral por Endocardite Infecciosa da
Valva Aortica.
Portuguese - tnn2679.zip

Virgili Jimenez Daisy; Ferrer Marrero Daisy; Coro Antich Rosa Maria.
Morfometria del miocardio en funcion de la patologia forense
Spanish - tcc2320

Wisner Jorge; Mendiz Oscar; Telayna Juan; Menendez Marcelo; Valdivieso Leon;
Londero Hugo.
Percutaneous Mitral Valvuloplasty: Predictors of Suboptimal Result and Mitral
Regurgitation and Comparison between Double Balloon and Inoue Techniques
English - tnn2693.zip

Zalazar Carina; Marzano Hernan; Covelli Guillermo; San Martin Eduardo; Rodenas
Pablo; Ravizzini Guillermo; Romero Graciela; Beltran Celina.
Factores de riesgo relacionados al mal pronostico en la angina inestable.
Spanish - tnn2790.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 13. First two weeks, December 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:

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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

From the Forums

New Viruses
FVCC Steering Committee´s member

Reader`s letter

News Lectures and brief communicattions

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.

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FROM THE FORUMS

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

EPIDEMIOLOGY AND PREVENTION

From: biamau@adinet.com.uy
Date: Sun, 28 Nov 1999 21:39:41 -0300
To: epi-pcvc@pcvc.sminter.com.ar
Subject: Question for Dr. Eduardo Bianco/Tabaquismo

Dear organizers of the FVCC
Dear Dr. Beatriz Champagne:
Since 1997 we have developed in Uruguay, four courses for training trainers in
Practical Management of Smoking, based on the Program "GUIE A SUS PACIENTES A UN
FUTURO LIBRE DE HUMO" ("GUIDE YOUR PATIENTS TO A SMOKE-FREE FUTURE"). Near 400
professionals of health attended them: doctors (approximately a 35%), nurses,
psychologists, social workers, administrators, odontologists, etc. Such people
came from all over the country, representing multiple institutions, both public
and private.
We still do not know, because we lack the proper organizational infrastructure,
to what amount of people the trained professionals can reach, and of course, we
ignore quit rates that may have been obtained.
Except for the "Quit and Win" campaign, in our country we do not have reliable
data on the yearly quit rates of population. In our institution, we are trying
to determine the annual quit rate, with a social group of approximately 200,000,
based in a randomized selection in a representative population. In March, 2000,
we will hold a new meeting for training, that will be organized by the "Comision
Honoraria de la Lucha Contra el Cancer" (Honorary Committee of the Fight Against
Cancer), that is open to new people interested in being trained, but that will
also allow those who took part in previous workshops, to strengthen, and
consolidate their knowledge, and will also allow to close ranks and unite
efforts in a campaign that still finds a lot of resistance.
The increase of professionals of health that come, and get motivated by the
proposal the is presented in "Guie a sus pacientes..."
is notorious. Although we do not have official data, we know that Public
Institutions, that have internal Health Services, have developed Programs of
support to Quit, based in work groups. We know that the Health Services of the
Town Council of Montevideo, that have attended training courses, are working in
the topic at the level of Neighborhood Polyclinics that cover a high number of
people from Montevideo. We still could not organize a formal course of training
for Family Doctors from the Ministry of Public Health, that has a population
range of near 500,000 people, although many of them have participated
individually, and even some of its directors as well. Achievement of
participation and commitment from family doctors, could have a high population
impact. We are trying to materialize the mentioned course for next year, if we
manage to convince the authorities.
Another notorious aspect, is that we are invited with increasingly frequency to
present the Program, both in Collective Medical Care Institutions (bases of the
private sanitary structure in our country) and in Medical Congresses. Until 2
years ago, Smoking almost had no room in our congresses or scientific
activities, and currently, both in Cardiology and in Internal Medicine, there
are always activities that include Smoking Management.
Regarding the factors that have supported the greatest awareness and diffusion
of the Program:

1) The effort and dedication "from a few", that always have been convinced that
the fight against smoking is an unavoidable but harsh road, that Medicine must
walk, and that we cannot afford the "luxury" of giving up.

2) Support from Institutions of great prestige, both at national level: as the
"Comision Honoraria para la Salud Cardiovascular" (Honorary Committee for
Cardiovascular Health), and the "Comision Honoraria para la Lucha Contra el
Cancer" (Honorary Committee for the Fight Against Cancer), and international
support, invaluable, from the Interamerican Heart Foundation.

Which are the difficulties that we are still facing?

1) The lack of an administrative structure that provides support and guide to
this movement. To overcome this aspect, we are trying to constitute an
intersocial group or movement, that gathers both health professionals and
educators, industry, commerce, and banking,  journalists, etc. to generate an
elected delegate, and to be able to speak with strong reasoning before several
structures that still resist to face the smoking problem. We are trying to
establish the "Comision Antitabaquica del Uruguay" (Anti-Smoking Committee from
Uruguay) as the base for the mentioned movement. The Committee is currently
headed by Prof. Dr. H. Kassdorf.
Likewise, we are working with the idea of generating a computer net that would
join everyone with this concern, to keep a smooth communication and keep us
updated. About this, we have been talking with Argentine colleagues about the
possibility of achieving an "Interamerican Net" of people who want to foster
anti-smoking fight. The way I see it, if we achieve this ambitious goal, it
would become an invaluable supranational resource to be able to apply pressure
on national structures with which it is not easy to interact.

2) A very important obstacle, is the lack of support, and participation, in
this movement, from Health Administrators, Politicians, and mainly, from our
"Asociacion Medica Nacional" or "Sindicato Medico del Uruguay" (National Medical
Association or Medical Union of Uruguay), that have not expressed their open
will to face the topic of Smoking as a "sanitary priority". I think that a great
part of this lack of involvement, is due to the presence of smokers in
decision-making places. Finally, there is the subject of Medicine School. There
is only one Medicine professorship, between the six that our faculty has, that
teaches its students smoking management. Neither specialties such as cardiology,
pneumology, oncology, and others, have curricular activities that include it.
It is evident that we must revert this situation, and in my opinion, we can
only achieve this by creating this intersocial structure at national level, and
having the support form important Institutions and supranational structures, to
back our work.
I remain at your disposal, to answer other questions, and concerns that may
arise, and I take advantage of this opportunity to greet Dr. B. Champagne, and
the organizers of this excellent initiative: the FVCC.

Dr. Eduardo Bianco

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

CARDIOVASCULAR FARMACOLOGY

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

I would like to know the opinion of the Forum regarding the role of
hypertriglyceridemia as and independent risk factor for
atherosclerotic ischemic heart disease.

Sincerely,

Dra. Martha E. Diaz Cálix.
km780404@gto1.telmex.net.mx
México.

Dr Paterno in Epidemiology List reply Dr Diaz Calix from Mexico

From: Carlos Paterno
To: epi-pcvc@pcvc.sminter.com.ar
Subject: hipertrigliceridemia / hypertriglyceridemia

Dr. Diaz Caliz:
I wish to answer your question regarding hypertriglyceridemia as an independent
risk factor for atherosclerotic ischemic heart disease.
After two decades of management of hypercholesterolemia, the treatment of
hypertriglyceridemia as risk factor, has awaken new interest, the former being
complex due to two factors: heterogeneity of particles rich in triglycerides,
and interaction with HDL-cholesterol (that is another important risk factor).
The big particles that contain triglycerides, such as chylomicrons, are not
atherogenic, but the small remnant particles of the chylomicrons, and the
remnant of VLDL seem to be of very high atherogenicity.
Due to exchange of apoproteins, cholesterol, and phospholipids between VLDL,
and HDL, there is an inverse relation between the levels of these two
lipoproteins.
After several decades of questioning the independent risk of
hypertriglyceridemia perly verified: hypertriglyceridemia is atherogenic because
the association of the remnant particles increase endothelial dysfunction
(possibly in a greater degree than LDL) because they are associated to small and
dense LDL (that increase oxidation), to hypercoagulability (diminishing the
PAI-1, increasing the Factor VIIc, and activating thrombin), and taking part in
the metabolic syndrome of resistance to insulin, trunk obesity, decrease of HDL,
and blood hypertension.
To a greater level of triglycerides, there is a greater amount of small and
dense LDL (and viceversa); with 3-4 grams daily of omega-3 oils, triglycerides
decrease in a 40%, HDL increase in a 20%, but LDL rise a 31%, and because of
this, the aggregate of vastatins is advisable.
Fatty diets (except those that contain omega-3 oils) produce remnant VLDL
that deteriorate endothelial function.
According to the Framingham Study, in women with >250mg/dl of triglycerides,
a great increase in coronary disease was found; in the 4S, hypertriglyceridemias
in treatment with simvastatin had no increase of coronary events, and they did
with placebo. In the Helsinki Heart Study, the hypertriglyceridemias > of
200mg/dl with increase of cholesterol had a greater amount of events.
The National Program of Education for Cholesterol (USA) recommends a
triglyceride level > 200mg/dl, and the observational studies have found that
prognosis improves if the level is < of 100mg/dl.
Secondary causes of hypertriglyceridemia must be dismissed, such as excess
of alcohol, diabetes, hypothyroidism, obesity, and estrogens. The
hypertriglyceridemia must be treated in diabetic patients. We must always begin
treatment with diets, reducing fats and calories. Fibrates may be combined to
vastatins, and fish oil may be used.
Cordially,
Dr. Carlos Alberto Paterno

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

INTERVENTIONAL CARDIOLOGY

From: "Dr. Gustavo R. Bonzón" <bonzon@arnet.com.ar>
To: <interven-pcvc@pcvc.sminter.com.ar>
Subject: RE: reestenosis intrastent
Date: Fri, 19 Nov 1999

Starting from the initial experience of Pichard, and the last news presented by
the same author along with others as Mehran, etc., I would like to know the
strategy used by the colleagues who are members of the list, to solve patterns 2
and 3 of intrastent restenosis, that is to say intrastent diffuse, and
proliferation diffuse varieties.
Pattern 2 is treated by most people with only a balloon, or rotablator plus
balloon: with or without intrastent stent?
Does pattern 3 imply definitely material ablation by rotablator or laser, or
can it be treated with balloon with or without posterior stent, considering that
proliferation exceeds the ends of the stent?
Do you usually see intrastents restenosis type 3 in the follow ups of those
treated with balloon technique, and stent of identical length, or with the focus
technology?
Dr. Gustavo R. Bonzón


From: "Alvarez Iorio" <caiorio@freenet.com.ar>
To: <interven-pcvc@pcvc.sminter.com.ar>
Subject: Reestenosis i/stent
Date: Wed, 24 Nov 1999

I think that for an appropriate treatment for restenosis intra-stent, it would
be fundamental the IVUS, to assess if the stent's apposition to the walls is
proper, i.e. that is not too deformed to make use of rotablator dangerous, but
maybe it is most important to know the true diameter of the artery, and conclude
if the stent used was the suitable one, or was underdimensioned.
In diffuse restenosis (I have no experience with brachytherapy) I always
perform ROTABLATOR (burr/artery relation 0.6/1) and afterwards, balloon with
FOCUS technique if possible overdimensioned, no more than 0.5mm of stent
segment. In order to do this I try to be very careful, and I implement it if
after a good vasodilatation, I think that the segment of reference is 0.1 and/or
0.2mm above the diameter to which the stent was previously expanded (trying to
apply the teachings from IVUS, where in general the real diameter of the vessel
is approximately 0.5mm larger).
Also, following the teachings of the IVUS/ANGIO correlation, I try to "diagnose"
the areas with a lot of atheromatosis, and remodeling, where I try to be
conservative, and I do not overdimension. I do not do it either, with stents,
coil type. I always choose the focal balloon trying to correlate the diameter of
the ends that are smallest, to the reference segment. In proliferating-diffuse
restenosis is so malign, that I think that frequently we have to seriously
consider surgery as first option.
If I had IVUS, my strategy would be different.

Dr. Carlos Alvarez Iorio
Bahia Blanca - Argentina


From: "Daniel Berrocal" <dberrocal@intramed.net.ar>
To: <interven-pcvc@pcvc.sminter.com.ar>
Subject: RE: Reestenosis i/stent/Restenosis intra-stent
Date: Fri, 26 Nov 1999

I agree with the opinion expressed by Dr. Alvarez Iorio. I think it is very
useful, before restenosis intrastent, to carry out a meticulous analysis of the
initial procedure, since from it, details can arise that help planning
reangioplasty.
We use IVUS quite frequently in these cases, though not always. The main
information we try to obtain is what Carlos already mentioned.
Regarding management, we try to carry out an ablation as large as possible.
Since 6 months ago, we have a cold laser, that we are using routinely in
restenosis intra-stent, since thanks to eccentric catheters, we can perform
larger ablations using the same string .014, and pathfinder catheters of 7 to
8F. Apart from that, the rest of the treatment with balloon, we do it just as
what has already been mentioned. If thus we can reduce incidence of a new
restenosis, that we do not know yet. All we can state is that this is a less
complicated procedure than Rotablator, and that the initial result is very good.
Regarding diffuse restenosis, in general, we carry out reangioplasty in them,
though we analyze each particular case, considering if the vessel to be treated
is anterior descending or not, if the lesion involves major rami, if there is
disease in other vessels, etc.
Dr. Daniel Berrocal
Buenos Aires - Argentina


From: "Omar Santaera" <oas20@hotmail.com>
To: interven-pcvc@pcvc.sminter.com.ar
Subject: Re: Reestenosis i/stent/Restenosis intra-stent
Date: Sun, 28 Nov 1999

Dear colleagues:
I think that use of "Cutting Balloon" should also be taken into account to
treat restenosis intra-stent. This is relatively simple procedure, that does not
need a great display of machinery, where two elements are used:
1- the Balloon carrying out the well known crush of the platelet, and
2- the knifes that the device presents, that ensure a regular debulking. There
are already randomized works by Japanese and German groups, with acceptable
results in a pathology that is hard to treat, such as restenosis intra-stent.
Dr. Omar Santaera
Buenos Aires - Argentina


From: "Dr. Gustavo R. Bonzón" <bonzon@arnet.com.ar>
To: <interven-pcvc@pcvc.sminter.com.ar>
Subject: RV: Reestenosis intra-stent
Date: Sat, 27 Nov 1999

I agree with IVUS usefulness, that not all of us have. Many colleagues have
published very interesting works about insufflation pressure, and apposition of
stent controlled by IVUS, that have been very useful. Many colleagues, in the
diffuse variety intra-stent, use rotablator to remove material, and then
balloon. They even seem to prefer the relatively aggressive ablation,
instead of the sequential, faced with a lot of material to be removed; about
this I am interested in knowing the opinion of other participants. I would like
to know opinions regarding use of stent intra-stent.
Do you use it or not, and why? I would also like to know if anyone of the
participants has experience in rotablator in stents coil type. I am interested
in learning the opinion of colleagues on three concrete topics: the role of the
rotablator, and the laser in the diffuse-proliferating variety, in the posterior
stent intra-stent or not (and why). Although I have not seen commentaries on the
observation of restenosis type 3 with balloon of identical length to the stent,
or with focus technology.
Dr. Gustavo R. Bonzon
Corrientes / Chaco, Argentina


From: "Raul Bretal" <rbretal@netverk.com.ar>
To: interven-pcvc@pcvc.sminter.com.ar
Subject: Re: Reestenosis intrastent/In-Stent Restenosis
Date: Wes, 8 Dec 1999

Dear colleagues:

With regards to the management of restenosis intra-stent, in "Cath & Cardiovasc
Interven" of October, 1999, appears: "Clinical and Angiographic Follow-Up After
Balloon Angioplasty With Provisional Stenting for Coronary In-Stent Restenosis",
by S. Elezi et al. Munich, Germany.
The authors analyze restenosis in 373 patients treated with angioplasty with
balloon (group 1: 273) or followed by placement of stents through dissection or
suboptimal result (group 2: 100). The angiographic follow up of the 80% of the
patients after 6 months, displayed a restenosis of a 36% in group 1, and a 48%
in group 2. When they analyzed restenosis in function of the size of the
treated vessel, they observed that the vessels with greatest restenosis in
group 2 were the small ones (less to 2.7mm).
Therefore, the authors conclude that management of restenosis intra-stent with
balloon, is associated to an acceptable evolution in long term, and that the
addition of stents by suboptimal result or dissection is associated to a greater
restenosis (especially in small vessels).
Are there data in treatment literature with other methods (rotablator, laser,
"cutting balloon", brachytherapy, etc.) that can improve these results in an
important number of patients, with angiographic follow up?
Dr Raul Bretal
La Plata, Argentina

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

ARRHYTHMIAS

From=. Residencia de Cardiologia  <cordis@arnet.com.ar>
To: <ARRITMIAS@listserv.rediris.es>
Subject: consulta pte c/marcapasos
Date: Thu, 2 Dec 1999 12:54:29 -0300

Dear colleagues:
I would like to consult with you regarding the management of a 71-year-old
patient, hypertensive heart disease, previous AMI, with permanent pacemaker type
VVI, placed in year 1982 due to AV block with presyncope, the generator is
replaced in 1997; currently consults due to exteriorization of the pacemaker's
wire in implantation location (pectoral), with signs of local phlogosis, without
fever, without positive hemocultures, and without verifying prosthesis
dysfunction.
Gustavo Adolfo Ruffino.


Date: Thu, 2 Dec 1999 23:02:23 -0300
From=. Walter Reyes <wreyes@mednet.org.uy>
To: arritmias@listserv.rediris.es
Subject: RE: Consulta paciente con Marcapasos/ Consult patient with pacemaker

Regarding the consult carried out by Dr. Gustavo Adolfo Ruffino, Dr. Walter
Reyes makes the following commentary:

Regarding the patient with exteriorization of the pacemaker's wire, I think
that the most appropriate management is extraction of the whole system, leaving
an operation scar open and drained, and obviously with antibiotic covering.
There is no generalized infection because the focus is drained, but the system
is infected. If the patient is not pacemaker dependent, I would indicate him
at least 72 hours with antibiotics, before implanting a new system on the other
side. If he was pacemaker dependent, a transitory pacemaker may be considered
for 48 hours, by femoral via, or the new implant in the same action.
The extraction of the original cable, should be carried out by someone with
experience, and with the proper medical equipment.
Greetings,
Dr. W. Reyes F.A.C.C.


Date: Fri, 3 Dec 1999 05:18:57 -0300
From-. "Dr. Fernando A. Scazzuso" <fscazzuso@intramed.net.ar>
To: arritmias@listserv.rediris.es
Subject: RE: Consulta paciente con marcapasos

Dr. Fernando Scazzuso replies regarding Dr. Adolfo Ruffino's patient with
exteriorization of the pacemaker's wire.

The management is removal of the system. Close the pouch with local treatment.
Implantation of the new system after new negative
hemocultures by the opposite access pathway.

Cordially,
Dr. Fernando A. Scazzuso


From.- "Jorge Castilla" <jcastilla@agora.com.ar>
To: <ARRITMIAS@listserv.rediris.es>
Subject: RE: consulta pte c/marcapasos-Consult patient with pacemaker
Date: Fri, 3 Dec 1999 15:59:55 +0200

Reply about Pacemaker with scab of catheter.
Dear colleagues:

There are several questions to be solved:
1- To change the place of contralateral stimulation
2- To assess change in the way of stimulation of VVI to DDD or DDDR (subject to
the clinical and hemodynamic needs of the patient)
3- To confirm the absence of infection through a series of cultures
4- To organize the removal of the old catheter.
I take advantage of the opportunity to greet the medical colleagues in their
day.
Dr. Jorge Castilla


From-. "Arritmias" <arritmias@funcacorr.com.ar>
To: "Lista ARRITMIAS" <arritmias@listserv.rediris.es>
Subject: Respuesta pte con marcapasos / Consult patient with pacemaker
Date: Fri, 3 Dec 1999 17:21:16 -0300

Regarding the consult submitted to the Forum, about a patient 71 years old,
with VVI pacemaker, and scab by decubitus / exteriorization of the wire.
There should be no doubt about its immediate removal, even with negative
hemoculture, and apparent general good state. If possible, I would try to remove
the catheter, although it should be very difficult due to the time of the
implantation; personally, in some few patients in a similar condition with signs
of infection, we had to remove the catheter in surgery by thoracotomy, since we
had no other technique; obviously there are centers that do it, and that would
be the best.
The absence of infectious involvement, may let us consider the possibility of
abandoning the electrode, sectioning the catheter appropriately, even though
this procedure, in this circumstance is not free of complications.
The new implant may be carried out perfectly on the other side, maybe even
immediately, almost simultaneously, or previous transitory, according to the
clinical characteristics.
We had a patient, that presented an exteriorization of electrode in the place
of the pouch, without signs of infection, and with negative cultures, in whom we
removed the generator, sectioned the catheter abandoning it, and prior to
performing a new surgical field, we carried out a contralateral implantation.

Luis Pozzer Corrientes. Argentina


Date: Sat, 4 Dec 1999 18:33:12 -0800 (PST)
From-. Ignacio Perez Galvez <irpg@yahoo.com>
Subject: Re: consulta pte c/marcapasos
To: ARRITMIAS@listserv.rediris.es

Dear colleagues:
Even though late, I give you my opinion regarding this man, 71 years old, that
has an exteriorized pacemaker, and with scabs. In my years of experience, I can
tell you that between 1991, and 1995 in Cuba there was a period in which we had
up to three cases with this problem in a week; at the time, elderly patients
that lost weight because they were anorexic, and their subcutaneous cell
tissue decreased, this favoring pacemakers to become exteriorized; we had cases
with associated sepsis, and others without them, in the latter what we did was
to remove the system and place another on the opposite side, the wire was
removed if possible, and in the cases in which it was not possible, we left it,
and the case was watched closely, but in the cases that had sepsis we removed
everything and the wire, if it did not go out by the normal way, we did it
surgically. The cases in which this type of procedure was not performed, did not
end well in the future. I hope my opinion helps you somehow, but my criterion is
to remove the system, and if the wire does not come out, leave it, and observe
what happens in a time.
Dr.Ignacio R. Perez.


Date: Sun, 05 Dec 1999 11:14:06 -0400
From=. "Dr.Ismael Vergara" <ivergara@med.puc.cl>
To: arritmias@listserv.rediris.es
Subject: Respuesta pte con marcapasos/ Reply patien with pacemaker

Dear Edgardo:
The two most frequent causes for erosion of pouch are infection and atrophy due
to compression due to inappropriate pouches.
Allergic reactions to the materials of the device is quite unusual. In the case
of this patient, it seems obvious that the cause is infection, that might have
been acquired when replacing batteries (1997). When a pacemaker system is
infected, the treatment implies the removal of the whole system. Leaving the
wire behind is technically incorrect. In my experience, when the cable has an
infection, removal is not difficult, but in a cable that has been in situ by 10
years, it is quite possible that the traction fails due to very firm adhesions.
In centers with laser this is not a big problem, but in our area we have to
consider seriously that removal may involve a surgical procedure with
sternotomy.
Regarding assessment and times for procedure, the first thing to do is
hemoculture, control of hemogram, and erythrosedimentation (for controlling
leukocytosis and systemic manifestations), initial covering with antibiotics
that include vancomicine and defining if the patient is pacemaker dependent. If
s/he is not, the interval between removal of the old system, and the
implantation of the new one, is only commanded by the infectious manifestations.
If in removal, the pouch can be debridled, and remains "clean", it may
be closed by first intention. If there are doubts regarding local control, I
would leave it widely open, with daily cures, and closing by second intention.
The time of implantation of the new definitive system is when there is no
evidence of systemic infection, without fever, without leukocytosis, and with
two negative hemocultures of control (usually between 5-7 days), plus a
clean pouch if this is open.
If the patient is pacemaker dependent, s/he would require a transitory probe
pacemaker. As this may be necessary for several days, what I do to avoid
monitoring in intensive coronary unit, and absolute rest in bed, is to implant a
definitive wire screwed from the jugular vein, fixing it to the skin, and
connecting it to a resterilized bipolar pacemaker that remains external. It is
covered in a sterile way, and at the proper time, it is removed just by
unscrewing from the RV.

Ismael Vergara S.

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

NEW VIRUS
From Symantec AntiVirus Research Center

W95.Babylonia

Detected as: W95.Babylonia
Infection Length: 11,036 bytes
Likelihood: Common
Detected on: Dec 7, 1999
Region Reported: Europe, US, Asia-Pacific
Characteristics: MIRC, Y2K, Internet, Windows Help file

Description

W95.Babylonia was discovered on Dec 6, 1999. The virus was originally posted to
an Internet news group as a Windows Help file named serialz.hlp and appeared to
be a list of serial numbers for commercial software. When this Windows help
file is launched, it will introduce the virus into the computer system. Symantec
AntiVirus Research Center has received over 20 submissions of this new virus as
of Dec 6 and believes it is spreading quickly worldwide.
The virus appears to have been written by the same individual who released the
W32.Coke and W95.Fono (a.k.a. El_Inca) viruses.

W95.Babylonia is a complex virus that propagates mainly to other computer users
via MIRC or as regular attachment in an e-mail message. Additionally, all
infected .HLP and .EXE files can cause infection on other systems. This Windows
95 virus employs many proven infection techniques that have been developed by
virus writers for the Windows 9x platforms over the past few years.

Opening a help (.HLP) file

When an infected .HLP file is introduced on a Windows 9x system, the virus code
will be activated. The virus modifies the entry point of .HLP files to a short
script routine. This routine transfers control from the script interpretation
to the binary virus code that is placed at the end of .HLP files in variable
packed form.

When the binary virus code assumes control, the virus attempts to install itself
to kernel memory area on the machine and hooks the file system to its own code.
The virus then creates a 4KB file named c:\babylonia.exe. Finally, this file is
executed.

Execution of babylonia.exe

When babylonia.exe gets control, it copies itself to the Windows system
directory as KERNEL32.EXE and registers this copy in the registry at:

Software\Microsoft\Windows\CurrentVersion\Run.

As a result, this copy will be executed at each system start.

This module is registered as a system service and as a result it cannot be seen
on the Windows 9x task list. The trojan checks if the RNAAPP.EXE application is
running by enumerating the active processes. If it does not find a similar
process, it will sleep for some time and try it again a later.

RNAAPP.EXE is active on Windows 9x machines during dial-up connections. When
the application is loaded, the virus attempts to connect to a virus writer's
website in Japan.

First, the trojan downloads a text file named virus.txt. This text file lists a
few file names (currently 4). The file names are: dropper.dat, greetz.dat,
ircworm.dat and poll.dat. They appear to use a special file format with a header
that begins with 'VMOD'. This stands for "Virus Module". The header of the
virus modules contains an entry point for the module. The trojan then downloads
the files and executes them inside its own process, one by one.

This way the trojan can introduce additional functionality on the already
infected system. If the system is disinfected but the trojan is active, the
virus code will be introduced on the machine again since the dropper virus
module will create a 17KB application (INSTALAR.EXE) and execute it. This file
is infected with the virus.
Finally the file is deleted.

The greetz.dat module modifies the c:\autoexec.bat file in January.
Part of the "marker" for this virus includes the following text in the
c:\autoexec.bat file:

W95/Babylonia by Vecna (c) 1999

The ircworm.dat appears to be an MIRC worm installer. The worm seems to
propagate two files: 2kBug-MircFix.EXE and 2kbugfix.ini to everyone on the
active MIRC channel.

The last module in virus.txt sends messages to babylonia_counter@hotmail.com
with a message

Quando o mestre chegara?

This information was intended by the virus writer to track the number of
infections that W95.Babylonia causes.

Infected .EXE and .HLP files

W95.Babylonia hooks the file system to itself and checks for .EXE and .HLP file
extensions. It infects such files whenever they are accessed. Infected Windows
.HLP files and 32-bit PE .EXE files can introduce the full functionality of the
virus to new systems.

The virus uses an inserting technique (does not modify the entry point of PE
files) when it infects them, probably in an attempt to avoid detection from
heuristic analyzers that could catch the virus more easily. The virus body is
attached to the end of the infected files.

As long as the virus is in memory the virus cannot be easily removed from the
system. This infection mechanism is very similar to the W95.CIH virus.

WSOCK32.DLL Modifications

Another very important detail of the virus infection is that W95.Babylonia will
be able to modify WSOCK32.DLL when the file is not loaded in memory. The virus
adds a very short hook routine to the "Send" API of WSOCK32.DLL similarly to
the Happy99 worm (aka W32.SKA.A). This short hook routine transfers control to
the active part of the virus code when an e-mail is sent. The end result of
this code is that the virus adds a MIME-encoded attachment of itself to all
outgoing e-mail, thus increasing its rate of spread.
W95.Babylonia is technically a worm, as well as a virus.

The possible file names of the e-mail attachment are:

I-WATCH-U.EXE
BABILONIA.EXE
X-MAS.EXE
SURPRISE!.EXE
JESUS.EXE
BUHH.EXE
CHOCOLATE.EXE

It seems the virus has a bug in this routine and therefore only the X-MAS.EXE
file name will be used. This file appears to be the same as the INSTALAR.EXE
that is created by one of the virus modules that has a Santa Claus icon:

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

READER'S LETTER

THE SUBTLE DIFFERENCE BETWEEN X AND SOMEONE DESERVING THE NOBEL PRIZE

Galvez, November - December 1999

Bald, with the glasses halfway down his nose, a sign that he was beyond 45, the
spine somehow bent forward, a sign that he was past the 50s too, there stood
our colleague, we will call him Dr. X, attending his congress number n, in an
attempt (though vain) to keep himself updated in this wonderful specialty he
had chosen, and that grows in such an accelerated way...

Lately, however, his participation in all the courses, real congresses, virtual
discussion lists, placed him repeatedly before a question that he ignored
whether he was able to answer; even today X questions himself over, and over
again:
This gathering of information, knowledge, updates, changes, etc...? in what way
did they modify his performance before his patients, before his peers, before
the different health management organizations, and viceversa?,... is there a
difference between those who do all these  and those who do? wondered X with
skepticism.

This being the situation, he attended once again the congress of the Argentine
Federation of Cardiology, held in May this year, when he found the announcement
of a Lecture, that -he supposed- would answer his questioning: "The Subtle
Difference between Knowledge, and Knowing What to Do with Knowledge".
The title seemed to tell everything; it concentrated all his concerns; he did
not hesitate for a moment to be present to listen to the speaker, who, before a
scant group of colleagues that apparently shared his existential doubts, began
an interesting chat in a pleasant and entertaining way.
Of course, X thought a priori, that Professor de Bold (who was the lecturer),
should be nominated at some time, to be awarded with the Nobel Prize on
Medicine, due to his significant works, and discovery of the atrial natriuretic
hormone, and its functions or actions...and that was another of the reasons
that led him to listen to his speech.
The lecturer had the kindness of descending to the ordinary, making it clear
that his ideas came from a layman in the topic.
This reassured X: the only way and moment -he thought- in which he would be
able to be on the same level with the prestigious scientific and researcher.
The speaker begun by reckoning that his usual reading is related to the subject
he investigates: just as X understood, he was in a similar situation to de Bold:
we live shut away inside a glass bottle, with the label "Cardiology".
X felt better, when he saw that the same thing happened to such a distinguished
colleague, about the time devoted to reading ot her disciplines.
There was not time for Plato, Shakespeare, Goethe...not even Borges, he
comforted himself.

Before the hungry ears of X, the researcher went on expressing...that an article
published in the Clarin newspaper from Buenos  Aires, on September, 1998, had
called his attention due to a sentence that stated: "Our scientific development
has always been more the result of heroism, and individual ability, than of
institutional procedures." "This, of course, was referring to the situation in
Argentina, but the statement caught me somehow by surprise, because I would
never have thought that scientific development depended on anything apart from
heroism and individual ability, -de Bold brooded-. There are hundreds of stories
in dozens of countries that prove this. In fact, every important discovery is
the product of an odyssey. Furthermore, it seemed to me that I saw a hint of
State dependence in that phrase. This incident proved to me that given my
postgraduate upbringing in an Anglo-Saxon environment, I no longer accepted
laying the blame on someone else; something unacceptable in this ambience. Later
in this talk, what I mean now, will be obvious.", thus concluded the illustrious
Argentine researcher, who now lives in Canada.
At this stage of the speech, X felt that he begun to let himself disagree with
such adistinguished speaker.
De Bold then covered in a masterful and enjoyable way, the different "steps"
that make up the Anglo-Saxon scientific production so prolific and of such good
quality: our friend would summarize it in, -taking the case of Canada, that de
Bold used as example-

Socio-economical basis of Canadian Science and Technology
=========================================================

Socio-liberal Canada

- Relative greater role of the State
- Strong presence of the State: e.g.: all Universities and Hospitals belong to
the state. Free health care system.
- Support to private enterprises by research councils
- Geographical advantage in economical and natural terms
- "Advantage" of Northern countries
- No. 1 in life standard (UN)

Social basis

- High academic competitiveness
- Administrative continuity
- Workforce highly qualified

Problem

- High emotional cost for non competitive individuals
- High tax burden

Gross expenditure in research and development = US$ 10,536 millions (1996)
In the item: gross expenditure... etc., -went on Adolfo de Bold- USA invests
193,000 millions, and Japan around 83,000 millions
.
At this stage of the lecture, our observer felt totally depressed, crushed by
these figures, and without having found an answer to satisfy in a minimal way
his initial question, and least of all he found THE ANSWER he was looking for.
He ignored how to demand the greater human value included in an item about
gross expenditure, and the high tax cost... and faced with this, he had another
question: in some of these systems chosen by de Bold to exemplify his thinking,
was there no possibility to include an item that for X was unavoidable, such as
the aspect we might call "humanist" of scientific production?
He rather answered himself such concern with his own ideas: no system -whichever
it is- is good, if it does not result in the wellbeing and happiness of human
beings. The first and final recipients of all human actions..., he said to
himself.
The fact is that the lecture of May 1999, remained fixed to an undetermined
place, between his brain and his epigastrium, going through his auricles and
ventricles of course..., the latter being a passage determined by that bottle
labeled "Cardiology".
And, as X did not give up his eagerness to reach the truth, even if it was
inside the bottle itself, and as he had not enough places to do it, he found
this wonder that for him was the FVCC, a magnificent exponent of what hard work
can achieve, in the hands of people highly qualified, fundamentally sympathetic,
and that generates, among those who receive it and take advantage of it, a
sensation of happiness... of satisfaction...

Hence, as if pierced by a Destiny's whim, X finds again this suggestive title:
"The subtle difference...", but now written.
"The subtle difference..." was announced as a Lecture between the FVCC
activities, and once again X, finds this strange sensation between his brain
and his epigastrium... All the more since, when rereading the lecture, he was
confronted again with a paragraph like this:
Quote:
"Maybe the greatest cost of scientific neo-liberalism, as well as the economical
one, is paid by the individual in his quality of life, and especially, by those
that lack the natural aggressiveness to produce in his work in a way to keep up
with the new times. This is due to the need of increasing competitiveness.
Competitiveness, defined by the dictionary as the "rivalry to attain a goal",
has always been the main ingredient that developed countries have used to become
just as they are in diverse activities, including science and technology. But
there have been differences in style, regarding how different countries have
reached such level of development. In a not so long ago past, many countries
(including most of Europe) were able to compete, while they kept a style of
life balanced between individual's work and indulgence.
The scientific establishment of many of these countries could isolate from
competition thanks to benevolent internal scientific policies. No longer so...
at least not as it used to be. The system of working under high pressure,
favors societies in which daily pleasures are of relative less tenor and
importance, and concentration in work is very high."

And with a sentence like this: "The basic premise is that poor countries cannot
educate their people, or make science and technology."

We must comment, that at this stage of his reunion with de Bold's Lecture, X's
uneasiness was great.

But, on Sunday, November 21st, 1999, Marcelino Cereijido came to help him, in
an article of the "Zona, Debates: ciencia y economia" (Zone, Debates: science
and economy) supplement of the "Clarin" newspaper, the same one of the primitive
reading by de Bold in 1998, titled "La patria bolichera" (1), that X would have
titled "The subtle difference, etc...".
Because, for our troubled Dr. X, this article by Cereijido, answered the
original question; this article -he brooded- puts man first, and exposes our
ignorance regarding what to do with our knowledge...
He found a concept in the article by Cereijido, to whom he adhered dearly:
"To postpone knowledge until our problems are solved, is to accept that
sometimes is better to rely on ignorance". (The economical problems among
others, X supposed, should head Cereijido's list for sure)...
Then, X suggested a careful reading of both articles, since the Canadian system
taken as example by Adolfo de Bold, awakened his admiration, and respect,
though the considerations expressed in "The subtle difference..." filled him
with doubts and questions.

He imagined the need for a policy (with the adjective/noun of your preference),
that would remain in time, and that was carried out by qualified people from an
early age, in towns from any place in the world, that would put human
development, and happiness before any other consideration. He could not help
remembering that in the island of Cuba, in the Caribbean, the meningitis was
eradicated, and now besides, the vaccine is exported.
But, to achieve these goals, -X thought- whether we are rich or poor,
northerners or southerners, or wherever we come from, it is necessary to
discover, for what kind of science we have the knowledge we have..., in
Cereijido's words "that is to say, turn information into knowledge, and the
latter into implementation, and it is there, where research makes sense for
society".
Then, when as a society this becomes important for us, for all of us, and the
life of the common men may become less common thanks to that science, all this
will make sense, and will be worthy for each human being, and will contribute to
make life on Earth happier.

Discussions on the different reasons, and/or all kinds of motivations, that
make our countries ignore what to do with knowledge, are of so complex and
different origins, that our friend preferred to leave them for another
occasion...

Finally, at this stage of his reflections, an e-mail message reached him, from
a colleague and friend, Dr. Q, a cardiologist just as himself, and also
registered to the FVCC. In the message, Q recommended reading the lecture by Dr.
Rene Favaloro, something that X did, luckily for him, immediately, since by
doing so, he finally felt that he could be calm regarding his concerns, since
the illustrious surgeon had identical concerns...

The distinguished master, as I permit myself to call him, quoted in his
Lecture, the teachings that he had been left with, or the "Legacy" as he would
rather called them, by Paul D. White, and to which X adhered dearly, inviting
everyone to share them:

First message: clinical history is above any technological advancement.

Second message: all patients are equal.

Third message: work, in team.

Fourth message: respect to all colleagues, especially to the family doctor.

Fifth message: modest fees

Sixth message: clinical teaching and researching

Seventh message: prevention

Eighth message: humanism

Ninth message: disarmament and peace

Tenth message: optimism

That night, X could go to sleep. He thought to himself that the subtle
difference between knowledge, and knowing what to do with knowledge, depended
on who had the knowledge, and in what it was applied.

Raul E. Espindola
Cardiologist -Recertified
Galvez - Santa Fe - Argentina

(1) "La patria bolichera": "bolichear" is an expression used in Argentina,
referring to the use of one's time in small and unim
portant matters or businesses. "Patria" means homeland. Then, the title alludes
ironically to a way of working in our country.

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

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):

Borer Jeffrey, S.
Clinical, Cellular and Molecular Descriptors of CHF Due to Regurgitant Valvular
Diseases
English - chc5707i.zip
http://pcvc.sminter.com.ar/cvirtual/cvirteng/cienteng/cheng/chc5707i/iborer.htm

González, Rolando; González Zuelgaray, Jorge; Scazzuso, Fernando A.
Curso de Arritmias: 5ta clase - Fibrilacion Auricular
Spanish - cla5cuar.zip
http://pcvc.sminter.com.ar/cvirtual/cvirtesp/cientesp/aresp/cursoesp/clase5/gonz
a1.htm

Kanter, Ronald J.
State of the art in pediatric arrhythmia
English - cpc1205i.zip
http://pcvc.sminter.com.ar/cvirtual/cvirteng/cienteng/cpeng/cpc1205i/ikanter/ika
nter.htm

Kusuoka, Hideo
Detection of Myocardial Ischemia by a Radio-labeled Free Fatty Acid Analog,
BMIPP
English - mnc3006i.zip
http://pcvc.sminter.com.ar/cvirtual/cvirteng/cienteng/mneng/mnc3006i/ikusuok/mnc
3006i.htm

Lown, Bernard
Tobacco: The assault on women 1
English - 6301i6a.zip
http://pcvc.sminter.com.ar/cvirtual/cvirteng/cienteng/sfeng/sfc6301i/ilown/ilown
6a.htm

Mendiz, Oscar
Interventional CV Rounds: Case number 2: Patient with a Carotid Angioplasty
Ateneos de Cardiología Intervencionista: Caso número 2: Paciente con
Angioplastia Carotídea
English - Spanish - iat2pi.zip - iat2pc.zip
http://pcvc.sminter.com.ar/cvirtual/listas/interven/cases/case2/preseng.htm
http://pcvc.sminter.com.ar/cvirtual/listas/interven/cases/case2/presesp.htm

Rasmussen, Ricardo
Estrategia en la promoción de la salud cardiovascular
Spanish - 3901c5.zip
http://pcvc.sminter.com.ar/cvirtual/cvirtesp/cientesp/ceesp/cem3901c/crasmuss/cr
asmuss.htm

Vilacosta, Isidre
Síndrome aórtico agudo. Ecocardiografía.
Spanish - dom3094c.zip
http://pcvc.sminter.com.ar/cvirtual/cvirtesp/cientesp/doesp/dom3094c/ivilac/cvil
aco.htm

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

BRIEF COMMUNICATIONS

Authors - Title - Language -FTPMail code:
Autores -Titulo - Idioma - Codigo de FTPMail:
(i: English; c: Spanish; p: portuguese)


Balbarrey Hector L., Picena Juan C., Guibert Edgardo E.
Alcoholic Dilated Cardiomyophathy, Congestive Heart Failure and Apoptosis
English - tnn2592.zip

Barchetti Marco; Cerioli Giancarla; Cocconcelli Flavio; Asgharnejad Fahim
Nasser; Golinelli Marco; Parravicini Roberto
ATS Open pivot bileaflet prosthesis for aortic valve replacement
English - tnn2443.zip

Brazão Antonio J, Prieto David, Ferrão de Oliveira J, Eugenio Luis, Antunes
Manuel J.
Aortic valve replacement with small-size disc prostheses (Medtronic-Hall)
English - 2379.zip

Cappellin Enrico; Meneghetti Martina; Lancerin Federica; Gatti Rosalba;
Woloszczuk Wolfgang; Teso Enrico; Maragno Ildebrando; De Palo Elio Franco
Plasma Atrial NatriUretic Peptide (ANP) fragments proANP(1-30) proANP(31-67)
Measurements in Heart Chronic Failure
English - tnn2530.zip

De Palo Carlo; Gatti R.; Cappellin E., De Palo E.F. and Spinella P.
Methods for estimating body fat distribution as a risk factor for cardiovascular
disease: agreement of waist-to-hip with truncal reactance-to-resistance ratios.
English - tnn2524.zip

Elias Sierra, Reinaldo; Betancourt Pulsan, Anselma; Armas Lopez, Marisel; Perez
de la Iglesia, Sulay
Characterization of the Blood Presure Values in Children from 5 to 14 years old
living in Guantanamo, Cuba
Caracterizacion de las cifras de presion arterial en niños de 5 a 14 años de
edad residentes en Guantanamo, Cuba
English - tnn2528i.zip - Spanish - tnn2528c.zip

Gavilanes Hernandez Reinaldo; Torres Ruiz Daniel; Estevez Aparicio Eric;
Morales Jimeranez Leticia; Catañeda Casarvilla Luis.
Miocarditis por radiacion. Evaluacion Clinica, electrica y sonografica.
Spanish - tnn2600.zip

Guadarrama Q F; Zinker E E; Rodriguez M C; Lorenzo M A; G R; Martinez S J
Angioplastia en infarto agudo al miocardio
Spanish - tnn2315.zip

Gutiu Ioan Axente, Voicu Victor, Mircioiu Constantin , Jinga Mariana, Gutiu
Laurentiu Ioan
Effects of the slow-releasing oral Lidocaine in suppression of ventricular
arrhytmia in patients after myocardial infarction.
English - tnn2355.zip

Gutiu, Ioan Axente; Dolis Ligia; Abobului Mihai; Gutiu Ioan Laurentiu..
Study of Chlamydia Pneumoniae infection in the patients with coronary
arteriosclerosis (history of old and recent myocardial infarction) in the
Romanian hospitalized subjects.
English - tnn2353.zip

Incze A., Frigy A., Carasca E., Dobreanu D., Cotoi S.
Blunted diurnal variation of ventricular rate in patients with permanent atrial
fibrillation and ventricular tachycardia
English tnn2417.zip

Campos-Toimil Manuel; Lugnier Claire; Takeda Kenneth
Inhibition of agonist-induced rises in internal calcium in human endothelial
cells by Ginkgo biloba extract (EGb 761) and rolipram
English - tnn2606.zip

Kamenskaya Elina; Stepanov Andrey
Enalapril and Heart Rate Variability in Patients with Arterial Hypertension
English - tnn 2396.zip

Macian, Horacio; Rovaletti, Federico; Torfe, Lina; Vivanco, Juan Pablo;
Socolsky, Ricardo
Utilidad de los estudios de perfusion miocardica con Sestamibi Gated-Spect para
identificar pacientes de alto riesgo.
Spanish - tnn2624.zip

Menezes Honorio; Martins Cristiano; Bello Andre; Barra Marinez; Zimmer Lucia;
Zielinsky Paulo.
Morphometric study of myocites in the myocardial septum of the diabetic rat
fetus.
Estudo experimental da morfometria dos nucleos dos miocitos do septo
interventricular em fetos de ratas diabeticas.
English tnn2658i.zip - Portuguese tnn2658p.zip

Obregon Ricardo; Gonzalez Ruben; Gutierrez Patricia; Pelozo Raul; Farias
Eduardo; Alvarenga Pablo; Badaracco Jorge
Perfusion Miocardical with Nuclear Magnetic Resonance: Gadolinium in First-Pass
and Segmental Motility for the Diagnose of the Severe Coronary Disease
Perfusion miocardica con resonancia magnetica nuclear: Gadolinio en primer
pasaje y motilidad segmentaria para el diagnostico de enfermedad coronaria
severa.
English tnn2602i.zip - Spanish tnn2602c.zip

Olivares-Reyes Alexander; Al-Kamme Ahmad; Gonzalez Javier.
Atrial Septal Aneurysm: A Study in Five Hundred Adult Patients
El Aneurisma Septal Atrial: Un Estudio en 500 Pacientes Adultos
English tnn2710i.zip - Spanish tnn2710c.zip

Olivares-Reyes Alexander; Gonzalez Javier; Al-Kamme Ahmad.
Cerebrovascular Embolic Events and Atrial Septal Aneurysm: A Clinical and
Echocardiographic Correlation
Eventos Embolicos Cerebrovasculares y Aneurisma Septal Atrial: Una Correlacion
Clinica y Ecocardiografica
English - tnn2709i.zip - Spanish - tnn2709c.zip

Rodriguez M., Roberto; Castellanos B., Ingrid; Alarcon M., Teresa; (+) Wong N.,
Roberto ; Felipe R., Edgardo and Sanchez C., Leudis.
Elimination of noise via morphological filters and components labeling. Its use
in the study of angiogenesis.
English - tnn2341.zip

Sideris A., Tsilias K., Stamelos N., Filippatos G., Kardara D., Efremidis M.,
Athanasias D., Anthopoulos L., Kardaras F..
False Positive Responses to Head-up Tilt Testing in Patients With Paroxysmal
Lone Atrial Fibrillation.
English - tnn2388.zip

Tsilias K., Zamanis N., Kranidis A., Filippatos G., Sioras E., Anthopoulos P.,
Fokaefs T., Patsilinakos S., Anthopoulos L.
Abnormal Athens QRS score in type II diabetes mellitus patients without
evidence of coronary artery disease
English - tnn2387.zip

Urbano Galvez J.M
Atypical thoracic pain as form of presentation of a pericardial hydatid cyst
English tnn2451.zip

Urbano Galvez J.M
Pulmonary artery aneurysm in a patient with interatrial communication type
ostium secundum
English - tnn2331.zip

Urbano Galvez J.M.
Gemella Haemolisans Endocarditis
English tnn2333.zip

Vazquez Roberto; Muratore Ivana; Abdala Gabriel; Guglieri German; Sosa Osvaldo;
Colque Roberto; Jimenez Kockar Marcelo; Velarde Mariscal Jose Luis; Villegas
Alberto; Pieroni Mario Daniel
Coronary  muscular bridges: incidence and clinic association.
Puentes musculares: incidencia y asociacion clinica.
English tnn2654i.zip - Spanish tnn2654c.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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Update
Feb/18/2000
 

 

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