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A 36 year old woman, with an 18 year history of syncope, became pregnant shortly after a cardiac catheterization demonstrated a high pulmonary arterial pressure and resistance and a low cardiac output. During pregnancy she remained stable at NYHA FC III, on nifedipine, apresoline, isosorbide, aspirin and bed rest. At 28 weeks, catheterization showed a decreased pulmonary pressure and an increased cardiac output. At 38 weeks, she was submitted to an elective caesarean section, and delivered a healthy newborn of 2820 g. After 5 months, her catheterization showed a pulmonary artery pressure similar to the pre-pregnancy study. Her condition deteriorated, leading to death 10 months later. Urinary 6-keto-PGF1[symbol: see text], nitrates/nitrites, kallikrein and angiotensin-(1-7) were increased from 13 to 33 weeks, to drop in week 35 of pregnancy. The safe maternal and fetal outcome, and the intragestational hemodynamic improvement are attributed to a close multidisciplinary surveillance, and to the effects of the endogenous vasodilators of pregnancy on the reversible component of the pulmonary hypertension. Reports in the literature show a decrease in maternal mortality rate, from 56% for the period previous to 1963, to 34 and 30% for those spanning between 1978-1996 y 1997-2001 respectively.

The administration of an angiotensin-converting enzyme (ACE) inhibitor transitorily reduces the GFR in a kidney with renal artery stenosis, effect that can be ascertained with scintigraphic studies using ACE inhibitors. We evaluated the clinical usefulness of captopril renography (CR) in the diagnosis of renovascular hypertension (RVH) in 51 hypertensive patients in which this diagnosis was suspected. All subjects underwent angiography and RVH was diagnosed when renal artery stenosis exceeded 60%, there was lateralization of renal vein renin or there was a concordant clinical outcome. Renography was performed 15 minutes after Lasix administration, using Tc-99m DTPA, before and 60 minutes after the oral administration of 50 mg of captopril. The scintigraphic criteria for a positive test were a decreased split renal function, a delayed peak uptake, a decreased excretion of DTPA and a prolonged transit time. In three of 28 patients in whom angiography discarded RVH, CR was positive. In the 23 patients with confirmed RVH, CR was positive in 10 of 12 with unilateral stenosis, in 3 of 8 with bilateral stenosis and 1 of 3 with stenosis in a transplanted kidney. The overall sensitivity and specificity of the test for RVH was 60.9% and 89.2% respectively. There were no changes in blood pressure or adverse effects after captopril administration. We conclude that CR in RVH is useful to select patients for further studies (angiography) and to perform a functional interpretation of angiographic alterations.

Reports of sexually transmitted diseases in the Vth Region of Chile from 1977 to 1988 were analyzed and compared to nationwide reports and to figures for the Viña del Mar-Quillota area. Overall rates of syphilis decreased during the period. In contrast both number of cases and risk of disease increased for gonorrhoea. Risk of syphilis and gonorrhoea was highest in the Vth Region. HIV infection is increasing, especially in the area covered by the Health Service in Viña del Mar-Quillota. Sexually transmitted diseases not subject to reports were screened along with routine examinations for cancer of the cervix. Infection rates of 9.9% for trichomona and 1.09% for candida were thus detected.

During 1987 and 1988 sexually transmitted diseases affected 87.2 per 100,000 inhabitants of the Viña del Mar-Quillota area. At all ages rates were 3.8 times higher in males compared to females. Gonorrhoea, syphilis and non gonorrheal urethritis accounted for most cases. In males, 82% of cases corresponded to gonorrhoea, in females 50% corresponded to gonorrhoea and 50% to syphilis. Rural and urban figures were not significantly different, except for HIV infection which was predominantly urban. Rates of different infections peaked at different ages: HIV between 30 and 39, gonorrhoea from 15 to 29, syphilis from 40 to 49 and after 60 and non gonorrhoeal urethritis from 15 to 59. In a survey of affected subjects 85% manifested to be heterosexual, 10% omitted a response.

We analyzed the two dimensional echocardiograms (2D echo) of 41 patients with infective endocarditis (IE). The diagnosis of endocarditis was based on typical clinical findings, positive blood cultures or anatomical findings at operation or necropsy. Age ranged from 21 to 73 years. Endocarditis was localized in a native valve in 30 patients (aortic 18, mitral 11 and tricuspid 1), a biologic prosthesis in 9 (mitral 4, aortic 4, unknown 1) and a mechanical valve in 4 (aortic 3, mitral 1). The echocardiogram showed vegetations, valve rupture or abscess in 83% of IE in native valves, 56% of IE in biologic prosthesis and 25% of IE in mechanical valves (p less than 0.05, native vs prosthetic valves). The sensitivity of 2D echo was studied in 27 subjects with known anatomical findings. It was 79% for vegetations (mitral 91%, aortic 72%, NS), 53% for valve rupture (mitral 83%, aortic 33%, p less than 0.05) and 70% for abscess. Specificity was over 89% for all lesions. Systemic embolism occurred in 41% of patients with vegetations and in 25% of those without (p = 0.07).