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Biomedical subjects

A Andrade

Publications and source records attributed to A Andrade.

At least 19 recordsLinked to original sources
PubMed1992

Antithyroid drug and Graves' hyperthyroidism. Significance of treatment duration and TRAb determination on lasting remission.

OBJECTIVE: To investigate the significance of treatment with antithyroid drugs longer than 12 months on lasting remission in Graves' hyperthyroid patients, and to study clinical and laboratory parameters of prognostic value. PATIENTS: Fifty-two untreated Graves' hyperthyroid patients were assigned at random to two therapeutic groups. They were treated with carbimazole during 12 and 24 months in Group I (n = 28) and Group II (n = 24), respectively. MEASUREMENTS: Serum levels of FT4, T3, sTSH and TSH receptor antibody (TRAb) were measured before starting treatment and at regular intervals during treatment and follow-up after drug withdrawal. We compared the relapse rate in both groups of patients, at short (2-yr) and long-term (5-yr) periods after drug withdrawal. Also, we compared clinical and biochemical parameters between patients who stayed in remission and who had relapse. RESULTS: At the end of the short-term period, relapse had occurred in 13 (46.4%) Group I patients and in 13 (54.1%) Group II patients, p = 0.36. At the end of the long-term period, relapse had occurred in 24 (85.7%) Group I and 20 (83.3%) Group II patients, p = 0.78. No difference could be observed between patients who had stayed in remission and who had suffered relapse, within the 5-yr follow-up period regarding to goiter size, frequency of ophthalmopathy, TSH and TRAb levels. CONCLUSIONS: The high relapse rate observed could be due to high iodine intake in our country. In this study and in a review of the available data, we have been unable to find any rational basis for courses of antithyroid drugs longer than twelve months for the treatment of Graves' hyperthyroidism.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Coronary atherosclerosis in acute myocardial infarct. Anatomic profile of diverse causes of death].

OBJECTIVE: to study the degree of coronary obstruction by atherosclerotic plaques in a population dying with acute myocardial infarction. We defined subgroups by the degree of the obstructive lesion and compared the severity and distribution of coronary atherosclerotic lesions in different groups according to cause. STUDY DESIGN: systematic prospective study in patients dying in the acute phase of myocardial infarction in a University Hospital Coronary Unit during a four years period. POPULATION AND METHODS: we studied 193 patients corresponding 77% of the patients dead in the same period. 24 patients were excluded by technical reasons related to the preparation of necropsic material. The clinical protocol included 64 parameters and were considered the following causes of death: left ventricular failure (shock or acute pulmonary edema), left ventricular free wall rupture, interventricular septum rupture, primary asystole, pulmonary embolism and ventricular fibrillation. To study of the heart we performed the transverse slices technic after fixation; to study the epicardial coronary arteries we isolated the coronaries after fixation and made 5 mm transverse slices. The slices were macroscopic and microscopic evaluated for the degree of coronary obstruction in every 5 mm segment. We classified the degree of coronary obstruction in five grades: less than or equal to 25%; greater than 25% e less than or equal to 50%; greater than 50% e less than or equal to 75%; greater than 75% e less than 100%; and total obstruction. RESULTS: the degree of coronary obstruction in each epicardial segment were: Right ostium--grade I = 21%, grade II = 46%, grade III = 26%, grade IV = 7%, grade V = 0; Right coronary--grade I = 5%, grade II = 10%, grade III = 19%, grade IV = 28%, grade V = 38%; Left ostium--grade I = 27%, grade II = 50%, grade III = 19%, grade IV = 4%, grade V = 0; Left main--grade I = 16%, grade II = 43%, grade III = 28%, grade IV = 10%, grade V = 2%; Anterior descendent--grade I = 1%, grade II = 5%, grade III = 11%, grade IV = 34%, grade V = 49%; Left circumflex--grade I = 2%, grade II = 14%, grade III = 22%, grade IV = 40%, grade V = 22%. The number of coronary arteries with more than 75% obstruction for each group of one, two or three vessel disease were: 1 vessel--41 cases; 2 vessels--56 cases; 3 vessels--68 cases. The number of vessels with more than 75% obstruction for each cause of death were: Wall rupture--1 vessel = 20, 2 vessels = 18, 3 vessels = 11; Septum rupture--1 vessel = 0, 2 vessels = 2, 3 vessels = 2; Shock--1 vessel = 12, 2 vessels = 21, 3 vessels = 30; Acute pulmonary edema--1 vessel = 1, 2 vessels = 9, 3 vessels = 7; Asystole--1 vessel = 4, 2 vessels = 1, 3 vessels = 8; Pulmonary embolism--1 vessel = 2, 2 vessels = 5, 3 vessels = 8; Ventricular fibrillation--1 vessel = 2, 2 vessels = 0, 3 vessels = 2. CONCLUSION: in most patients dying with acute myocardial infarction, the coronary atherosclerotic lesions were present in two or three epicardial coronary arteries. The left anterior descendent artery was the more frequent artery with major lesion (greater than 75%). Major atherosclerotic lesion in just one vessel were more frequent in patients dying by cardiac rupture.

Autopsy↗
PubMed1992

[Association between post-initial remission and HLA phenotype in Type I diabetics].

Our goal was to estimate the occurrence rate of the post-initial remission and its relation with HLA phenotype in type I diabetics (DMI). We studied 50 type I diabetics, 22 women and 28 men, with an average age at the onset of the disease to 15.8 +/- years (range 3-30 years). All patients were conventionally treated with insulin therapy, diet and regular exercise. Six (12%) of the diabetics presented a complete remission during 57.3 +/- 46 weeks, whereas fifteen (30%) patients presented partial remission during 20.1 +/- weeks. No significant differences were observed with regard to age at the onset of the disease, sex, BMI, initial ketoacidosis and stage of gonadal development between those diabetics presenting remission and those who did not presented so. We observed a higher incidence of the HLA-DR4 antigen among diabetics with remission (complete and partial, 61.9%), compared with patients without remission (20%, p less than 0.5). In conclusion, our results support the findings suggesting the presence of a clinical-immunological heterogenicity in DMI, genetically determined and linked to the HLA system.

Adolescent↗
PubMed1991

Altered growth hormone response after growth hormone releasing hormone administration in chronic renal failure.

Eleven chronic renal failure patients and 11 matched controls, received growth hormone GHRH (1 microgram/kg iv) or TRH (400 microgram iv) on separate occasions, immediately before undergoing hemodialysis. GHRH-induced GH peak in uremics (22.7 +/- 5.2 micrograms/l) was not different from that obtained in control subjects (16.0 +/- 4.3 micrograms/l). However, the uremic patients did not show the habitual post-peak fall, remaining GH levels over 10 micrograms/l till the end of the test. Differences between the two groups were significant (p less than 0.05). Uremic patients showed PRL values higher than in controls, however their TRH-induced PRL peak (20.6 +/- 6.6 micrograms/l) was not different from that of controls (26.5 +/- 3.0 micrograms/l). Again chronic renal failure patients showed PRL plasma values abnormally elevated till the end of the test. Differences between the two groups were significant (p less than 0.05). Administration of placebo to a different group of seven uremic patients did not alter GH and PRL plasma levels. This sustained secretion of both GH and PRL in uremia could be attributed to reduced kidney clearance. However, when subjects were examined individually both the GHRH- and the TRH-induced hormonal peaks and the subsequent fall were not different in both groups. Unlike with controls, in uremic patients GHRH-stimulated GH and TRH-stimulated PRL/GH peaks were dispersed throughout the 120 min period. In controls GH and PRL peaks clustered around 15-30 min. The peak dispersion created a false impression of flattened curves or sustained hypersecretion in uremia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Hepatitis by infectious mononucleosis].

Five adult patients presenting with clinical and laboratory manifestations of an acute hepatitis in the course of a hitherto undiagnosed infectious mononucleosis (IM) are reviewed. Chief complaints were intense malaise and prolonged fever (7 to 15 days prior to diagnosis). Serum aminotransferases were moderately raised in all patients; three patients had mild jaundice with a direct-reacting hyperbilirubinemia; 4 patients had an enlarged and tender liver. When making the differential diagnosis of causes of acute hepatitis, blood smear examination was crucial, showing atypical lymphocytes (Downey). The diagnosis of IM was confirmed by the demonstration of high serum titers of antibodies against Epstein-Barr virus, IgM class (4 patients) or heterophil antibodies (1 patient), plus peripheral lymph node enlargement (3 patients), splenomegaly (4 patients) and the time course of the disease. The relevance of blood smear examination as a practical tool in the diagnosis of causes of acute hepatitis is stressed.

Acute Disease↗
PubMed1990

[Mitral valve prolapse associated with Basedow's disease and active hyperthyroidism. Preliminary report].

We performed 2 dimensional echocardiograms to investigate the presence of mitral valve prolapse (MVP) in 21 patients with Graves disease and active hyperthyroidism. 22 healthy subjects were used as a control group. The incidence of MVP was 24% (n = 5) in hyperthyroid patients compared to 5% (n = 1) in normals (NS by Fisher's exact test). Age, T3 and T4 levels were similar in hyperthyroid patients with and without MVP, but the clinical course was longer in the former. A study in a larger group of patients may help establish the increased incidence of MVP in hyperthyroidism.

Adult↗
PubMed1990

Interpretation module for screening normal ECG.

This work concerns the development of a module for automatic recognition of normal ECGs, i.e. those whose waves morphology do not suggest physiopathological or structural heart alterations. Such a unit constitutes the central part of an administrative system under development which will aid in the management of ECG testing in the primary care delivery level in Chile. This system greatly contributes to the optimal allocation of resources in order to increase the test delivery coverage and to reduce the social and private costs involved. A main feature of the system is that it operates through the screening of normal ECG. This process is performed in a computerized unit whose core is the interpretation module. The design of such a module uses concepts and methods previously developed for the general problem of medical diagnosis, based on fuzzy set theory. The interpretation module parameters were adjusted considering hypothetical and real data covering a wide variety of normal and pathological cases. Then its performance was tested using more than one hundred patients' records chosen at random. Results of this test are given and a discussion, including a comparison with similar commercial equipment, is provided.

Diagnosis, Computer-Assisted↗
PubMed1989

[Clinical methods for evaluating infarct size and its anatomic correlations. A study conducted with 193 cases. II. Evaluation of infarct size by determining maximal creatine phosphokinase in serum. Enzimatico-anatomic correlations].

AIMS: To compare the infarct size calculated by the peak serum CK method with the anatomic infarct size in a population dying of acute myocardial infarction. CONCEPT AND PLACE OF THE STUDY: To use the method of peak serum CK in the assessment of infarct size, calculated by a method developed by the authors, in a population dying of acute myocardial infarction in a coronary care unit. METHODS: 193 patients who successively died with acute myocardial infarction entered the study. After establishing the exclusion criteria the anatomical infarct size was measured using the method developed by the authors of myocardial slices after fixation of the heart and by the peak CK method. The two methods were correlated using linear regression curves. RESULTS AND CONCLUSIONS: A global correlation between the two methods was found although wide scattered values were found. After dividing the population in several subgroups, the analysis showed that survival below 48 hours, death in left ventricular failure, inferior infarcts and reinfarction influenced negatively this correlation. The anatomical method showed its value for this kind of evaluation having always in mind its known limitations. The enzyme method looked less discriminating as peak CK, obtained by 12 h sampling will seldom reflect the peaks of CK liberation curve. As the study was applied to a population of patients dying of acute myocardial infarction its results cannot be applied without caution to a population of survivors. We anticipate that in such a population peak CK will have a better correlation with real CK peaks even with 12 hours sampling and therefore reflecting more accurately infarct size.

Autopsy↗
PubMed1989

[Clinical methods for evaluating infarct size and its anatomic correlations. Study carried out in 193 cases. III. Comparison of data on the evaluation of the infarct size using the QRS score and a method of maximal creatine kinase determination in the serum].

AIMS: To compare two methods concerning the clinical evaluation of infarct size--one using a QRS score, the other based on peak Ck values--applied to the same population. CONCEPT AND PLACE OF THE STUDY: to determine--based on previously established correlations between a QRS score and the anatomic total infarct size on one hand, and between the peak CK values and the anatomic recent infarct size on the other hand--which myocardial infarction subgroup constitutes the best indication for each method. The study took place in a Coronary Care Unit of a Central Hospital. MATERIAL AND METHODS: 193 patients who died successively of acute myocardial infarction through out 4 years were studied. After establishing the exclusion critéria, the QRS score was calculated according to the method of Selvester modified by Wagner, and peak CK values were evaluated. Infarct size, either recent or old, was determined by means of an anatomical method developed by the authors and based on Hackel's and Alonso's previous works. Correlations were established between data from each clinical method and those from the anatomical method. Several myocardial infarction subgroups were considered for comparison of the correlations found in each subset. RESULTS AND CONCLUSIONS: As long as QRS score was regarded, significant correlations were found between the evaluation by QRS score and anatomical infarct size in the subgroups of patients with severe pump failure, prior myocardial infarction, or total loss of ventricular muscle mass of at least 20 percent; however, a significant correlation was missing when the whole myocardial infarction group was taken into consideration. When peak CK value were considered, a weak significant correlation was found between the evaluation by enzyme determination and anatomical infarct size in the whole group of patients, but a stronger correlation was present in the subgroups of patients with survival longer than 24 hours, anterior wall myocardial infarction, free wall cardiac rupture, or first acute myocardial infarction. In conclusion the choice of the method to be used in the clinical evaluation of infarct size should take into account the type of population beeing studied, and follow the results obtained in different myocardial infarction subgroups as mentioned above.

Creatine Kinase↗
PubMed1989

[2 cases of acute myocardial infarct complicated by fatal pulmonary embolism].

Two cases of pulmonary embolism with lethal course in the setting of acute myocardial infarction are presented. Both cases are clinically characterized by a late pulmonary embolism occurrence (2nd and 3rd week, respectively), and the presence of a large infarct, heart failure during acute myocardial infarction evolution and the interruption of anticoagulant therapy due to a complication. From the anatomic point of view, both cases had large hearts and very large biventricular infarctions. On the other hand, deep venous plexus constituted the pulmonary embolism origin in one case, and right ventricular thrombosis in the other.

Aged↗
PubMed1989

[Intraventricular thrombi in acute myocardial infarct. Clinicoanatomic study carried out in 193 consecutive cases].

AIMS: To determine the incidence of intraventricular thrombi in patients who died of acute myocardial infarction, as well as to define the clinico-anatomical parameters of the population with thrombi. CONCEPT OF THE STUDY: To apply a clinical as well as an anatomical protocol of prospective study, in patients who died of acute myocardial infarction. The clinical protocol contemplates 64 parameters and the anatomical protocol contemplates 34. in the anatomical study were used very discriminative technics, already presented in previous papers. PLACE OF THE STUDY: The study took place in a CCU and pathological department of an University Hospital. MATERIAL AND METHODS: 193 patients who died successively of acute myocardial infarction in a CCU between 1983 and 1986. The only criteria for the inclusion in the study was the possibility of doing a necropsy study, which was done in 77% of the patients who died in that period. The study was a prospective one, being excluded only the patients in whom the anatomical study didnt confirm recent myocardial infarction. The clinical data were observed during the stay in the CCU using a protocol developed for this study. In the anatomical study a protocol developed by the authors was applied, using very discriminative anatomical quantification technics of the infarct size as well as of the coronary obstruction degree by atherosclerotic plaques. All data were stored and treated in a computer program developed for this study. RESULTS: From the 193 cases that have been studied, 88 (43%) presented thrombus in at least one of the ventricular cavities, 38 (26%) only in left ventricle, 15 (8%) only in right ventricle and 35 (18%) in both ventricles. The set with thrombus has presented a few characteristics which granted it some individuality. Thus, this group presented: a higher delay between the beginning of acute myocardial infarction and the admission in the CCU (and so in the beginning of the anticoagulant therapy), lower prevalence of diabetes, higher prevalence of left ventricular failure (Killip class III or IV), higher prevalence of cardiogenic shock and so a higher need of inotropic therapy, higher heart weight, higher prevalence of auricular thrombi and bigger infarct size when evaluated by a QRS score. In the group with left ventricular thrombi, the anterior infarct was more frequent and in the group with right ventricular thrombi the right ventricular infarct was also more frequent. The systemic embolism was uncommon in this group (1 case in 193 patients). CONCLUSIONS: 1. The intraventricular thrombi occurs in about half of the patients who died of acute myocardial infarction. 2. The group with thrombi has presented some characteristics which makes it different from the group with no thrombi. 3. The delay in the beginning of the anticoagulant therapy seems to be a risk factor of intraventricular thrombosis.

Aged↗
PubMed1987

[Cardiac rupture in acute myocardial infarction. Various clinico-anatomical types in 42 recent cases observed over a period of 30 months].

Forty two cases of complete or incomplete rupture of the free left ventricular wall were reviewed in a group of 136 patients who died of acute myocardial infarction in a Coronary Care Unit and who underwent autopsy examination over a 30 month period. Four groups were distinguished on macro and microscopic features of the rupture based on a previously defined classification established by former studies: type I rupture (13 cases) with an almost direct trajectory with little dissection and bloody infiltration of the myocardium; type II (13 cases) with a multicanalicular trajectory and widespread myocardial dissection and bloody infiltration; type III (9 cases) in which the orifice of rupture is protected by an intraventricular thrombus or a pericardial symphysis; type IV (7 cases) with incomplete epicardial, endocardial or intramyocardial rupture which never was transparietal. The clinical characteristics (age, sex, time interval before admission to the coronary care unit, previous history, ECG location of the myocardial infarcts, clinical course, Killip classification, treatment and ECG changes) and anatomical findings (weight of the heart, presence of haemopericardium, previous infarction or aneurysm, location of the infarct, presence of intraventricular thrombus or ventricular septal defect, number of vessels with over 75 p. 100 obstruction and topographical location of the rupture) were compared. The type I ruptures had smaller infarcts and a quicker terminal illness with rapid evolution to cardiac tamponade. In type II ruptures, the infarcts tended to be bigger, sometimes associated with septal rupture and the terminal illness was longer lasting than in the previous group, reflecting a longer evolution towards cardiac tamponade.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1979

The relationship between disturbed metabolism of vitamin D and bone disease in chronic renal failure.

Following the discovery that the kidney is involved in the metabolism of vitamin D, a causal relationship has been sought between defective production of 1,25-dihydroxy vitamin D3 and bone disease in chronic renal failure. This paper reviews some of the clinical evidence for and against such a relationship, and considers the possible role of other vitamin D metabolites in the pathophysiology of renal bone disease.

Bone Diseases↗
PubMedDate not supplied

[Papillary muscle dysfunction in acute myocardial infarct: a clinical and Doppler echocardiographic study].

The "papillary muscle dysfunction" concept includes a disrupted sequence of one or more structures of the mitral valve complex and not merely a disturbance of a papillary muscle itself. We studied a group of seventeen patients, 14 men and 3 women (mean age 51 and 39 years, respectively). Acute myocardial infarction was the first evidence of heart disease. In all of them, Doppler and M mode echocardiography were performed and correlation clinical features were done. In addition a tricuspid regurgitation flow patterns was scanned on each patient. Mitral regurgitation was found in 29% of them by Doppler echocardiography and only 17% had a mitral systolic murmur suggestive of this entity. In those patients with mitral regurgitation-flow patterns, the infarct site was similar to those with anterior and inferior infarction and serum CPK-level was greater in these patients than the non-mitral regurgitation flow pattern group. The evidence of tricuspid regurgitation by pulsed-Doppler echocardiography was associated with mitral regurgitation in 80% of patients, mainly those with right ventricular extension of acute myocardial infarction, and with the greatest hemodynamic impairment. It seems likely in this study, that mitral regurgitation was due to valve ring dilation with an increase of left ventricular diameter and a decrease on ventricular systolic function.

Adolescent↗
PubMedDate not supplied

[Incidence and forms of clinical presentation of the various morphologic types of myocardial laceration in the acute phase of infarct. A 4 years' caseload at a coronary unit. A clinico-anatomic study of 193 successive cases].

AIMS: To determine the incidence of different morphological type of myocardial laceration (wall rupture) in patients who died of acute myocardial infarction, as well as to study the several clinical forms of presentation of different types of myocardial laceration. CONCEPT OF THE STUDY: To apply a protocol of prospective study, that includes 64 clinical and 34 anatomical parameters, using very discriminative technics in the anatomical study, already presented in previous papers. PLACE OF THE STUDY: The study took place in a CCU and pathological department of a University Hospital. POPULATION: Of 1308 patients successively admitted in a CCU with acute myocardial infarction between 1983-1986, 252 have died. It was possible to perform a necropsy study in 193. The only criterion for inclusion was the family agreement. METHODS: The study was a prospective one, being excluded only the patients in whom the anatomical study didn't confirm recent myocardial infarction. The clinical data were observed during the stay in the CCU, using a protocol developed for this study. In the anatomical study a protocol developed by the authors was applied, using very discriminative anatomical quantification technics of the infarct size as well as of the coronary obstruction degree by atherosclerotic plaques. In the study of the myocardial laceration a fourteen septal perpendicular cuts technic was applied, with a laceration development macroscopic study, and microscopic study of the more interesting cuts. All data were stored and treated in a computer program developed for this study. RESULTS: From the 193 cases that have been studied, 49 presented a complete free wall rupture (25%) and in two others there were an interventricular septal rupture and free wall rupture. The amount of free wall rupture was then 51 cases (26%), with a corrected incidence for the population with AMI of 5.1%. In 7 cases we found an interventricular septal rupture (in two cases associated with complete free wall rupture and in other two cases with an incomplete left ventricular rupture), what represents an incidence in necropsy of 3.6%. Since that in this period five patients with septal rupture have been operated and in three others the hemodynamic diagnosis was made, dying this patients without being performed necropsic study, the amount of septal ruptures was of 15 cases, what represents a corrected incidence of 1.1% in the population with AMI. The clinical forms of presentation of free wall rupture were the following: syncope followed by death (60%), shock (21%), transitory syncope (4%), psycho-motor troubling (4%). Pain persistence or recurrence associated with other clinical symptoms occurred in 63% of the patients. Hypotension, not always evoluting to shock, occurred in 33%, and pericarditis in 21% of the cases. When the different anatomical types of free wall rupture were considered (type I-direct rupture; type II-multicanalicular rupture; type III-rupture covered by an interventricular thrombus), we observed that in type I there was prevalence of syncope (71% and only 50% showed pain persistence or recurrence, when in type II syncope occurred in 67% and shock in 22%, with pain in 56%, and in type III the occurrence of syncope and shock were similar (44% vs 38%), with pain in 81% of the cases. Hypotension was verified in 56% in type III, 21% in type I and 22% in type II. Pericarditis never occurred in type I, happened in 33% in type II and 25% in type III. The terminal accident took an average 44 minutes long in type I, 3.8 hours in type II and 9.2 hours in type III. The delay in admission was nine hours in type I, 19 in type II and 30 in type III, and the time between the onset of symptoms and death was 2.9, 2.7 and 5.4 days respectively in types I, II and III. In what concerns the interventricular septal rupture shock occurred in all cases but one, in which association with free wall rupture determined cardiac tamponade with syncope.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMedDate not supplied

[Pulmonary embolism in acute myocardial infarct. Clinico-anatomic study of 19 cases].

The aim of this study was to evaluate the incidence of pulmonary embolism as the cause of death in acute myocardial infarction; to define the anatomic and clinical profile of a subset of patients deceased by pulmonary embolism; to study the localization and characteristics of pulmonary emboli. An anatomic and clinical protocol was systematically applied to the dying patients with acute myocardial infarction admitted in a CCU of an University Hospital. Therefore, 193 patients consecutively deceased by acute myocardial infarction were studied. Sixty-four clinical parameters were evaluated together with 34 anatomic parameters concerning a very discriminative anatomic study protocol. The sole exclusion criterion for necrotic study was the lack of family consent; necropsy was thus performed in 77% of patients. Therefore, we verified that the incidence of pulmonary embolism as the cause of death was 9.8%. Delay in admission as well as the interval between the onset of symptoms and death, were longer in the deceased by pulmonary embolism than in subjects showing other causes of death. Bradycardia was absent in pulmonary embolism patients, and asystole was the terminal electric accident in the great majority of cases; heart weight was greater, and biventricular infarction and right ventricular thrombosis were also more frequent in this subset of patients. In almost half of cases, pulmonary emboli were located in the main pulmonary artery, being multiple and peripheral in four.

Aged↗