Possible diaphragmatic ischemia following harvesting of the internal mammary artery.

priorities permit. The comments should not exceed 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Please include a cover letter with a complete list of authors (including full first and last names and highest degree), corresponding author's address, phone number, fax number, and email address (if applicable). An electronic version of the communication should be included on a 3.5-inch diskette. Specific permission to publish should be cited in the cover letter or appended as a postscript. CHEST reserves the right to edit letters for length and clarity. In reference to the very interesting report by Spira and colleagues, 1 which appeared recently in CHEST, I would like to add another illness to Dr. Spira's list: Chagas' disease. This is an infection, endemic in Central and South America, mostly in the central heartlands of Brazil, caused by a protozoan, Trypanosoma cruzi. In its chronic stage, it causes a well-known myocardiopa-thy, as well as often very prominent esophageal and colonic lesions, the " megas. " Its bronchopulmonary manifestations have been recently and extensively reviewed. 2 T cruzi infects wild animals, such as armadillos, racoons, and rodents, as well as humans. Transmission is by the blood sucking beetles of the Triatominae subfamily, which live in the cracks of mud-walled housing; by night, they bite their victims, usually in uncovered areas, mostly the face, originating their vulgar name of " barbei-ros " (barbers). In the United States, the disease may be seen in immigrants 3 or be acquired by congenital or blood transfusion transmission. Chagas' disease may course with an acute phase, seen mostly in children, with fever and inflammation at the inoculation site. Occasionally, there is severe homolateral palpebral inflammation (Romañ a's sign). The chronic stage is usually marked by the myocardial lesions, as well as the esophageal and colonic dilata-tions. These produce severe symptoms (dysphagia, constipation) and typical radiologic and endoscopic findings. The myocardio-pathy is characterized by arrhythmias and bundle-branch blocks, usually with severe and intractable heart failure at the late stages. The anatomic basis for all of these lesions is fundamentally similar. There is a gradual destruction of nerve cells in the digestive tube walls and of myocardial myofibrils by T cruzi Leishmania forms. The lungs may …