PubMed Health⌕ Search

Biomedical subjects

A Castro Beiras

Publications and source records attributed to A Castro Beiras.

At least 19 recordsLinked to original sources
PubMed2004

Severe cardiac allograft dysfunction without endomyocardial biopsy signs of cellular rejection: incidence and management.

Acute dysfunction of cardiac allograft without evidence of cellular rejection is a potentially fatal complication of heart transplantation that suggests a humoral origin. In clinical practice, humoral rejection (HR) is suspected when there is evidence of severe allograft dysfunction but endomyocardial biopsy (EMB) shows no evidence of cellular rejection. Between April 1991 and August 2003, 12 patients (2.74%) among 438 heart transplants displayed this condition. Time post-heart transplant (HT) was 21.3 +/- 24.7 months (range 2 to 72 months). Immunofluorescence studies using classic markers were negative. All patients were treated with methylprednisolone "bolus" and plasmapheresis until clinical recovery, after which their immunosuppressive regimens were modified. Eleven of the 12 patients recovered satisfactory allograft function. In this series the incidence of suspected HR was low. Unlike other studies, we observed HR not only soon but also even years after HT. Plasmapheresis seems to be an effective treatment.

Adult↗
PubMed2001

[Analysis of the appropriate use of -blockers post-infarction].

INTRODUCTION: The use of ss-blockers in patients with acute myocardial infarction has shown to improve the survival and reduce the risk of a new reinfarction. AIM: To quantify the use of ss-blockers in patients with acute myocardial infarction in Galicia, Spain. METHODS: We used the database of the RIGA study (Registry of Infarctions in Galicia) including 655 consecutive patients admitted to any hospital of Galicia for acute myocardial infarction from February to July, 1995. An extensive review of the literature was previously made to establish therapeutic criteria for the use of ss-blockers in patients with acute myocardial infarction. The survey of the RIGA database was compared with the criteria established to determine the definition of appropriate usage. RESULTS: 210 out of 655 patients (32%) received ss-blockers. Interestingly, treatment (or lack of treatment) with ss-blockers was deemed appropriated in 51.4% of the patients. This inadequacy was related to the use of ACE inhibitors, calcium antagonists and thrombolysis. CONCLUSION: The use of ss-blockers in Galicia in patients admitted with acute myocardial infarction was markedly lower than that established by standard criteria and the use of ACE inhibitors, calcium channel blockers and thrombolysis was related to less appropriate use.

Adrenergic beta-Antagonists↗
PubMed2000

[The clinical practice guidelines of the Sociedad Española de Cardiología on cardiomyopathies and myocarditis].

Myocardial diseases are a extraordinarily heterogeneous group of processes that only have in common the fact that they involve heart muscle and that they cause a wide spectrum of myocardial dysfunction. The approach of the management and treatment of the cardiomyopathies is a continuous matter of discussion because the vast majority of alternatives in this field have not been based on the best scientific possible evidence and, since except for the case of heart failure associated with dilated cardiomyopathy. The majority of different options have not been studied by means of large (or even small) randomized trials. Nevertheless, this chapter has tried to provide the reader with different approaches on how to deal with important clinical problems in dilated, hypertrophic and restrictive cardiomyopathies, and in myocarditis as well. For this, we have utilized the most relevant information found coupled with our best clinical judgment, although we admit that many of the clinical recommendations can be controversial.

Cardiomyopathies↗
PubMed2000

[Guidelines of the Spanish Society of Cardiology on magnetic resonance].

A wide perspective of the cardiac applications of magnetic resonance is presented in this report, including technical aspects of the practice, recommendations on the appropriate training of medical personnel for the practice of examination and also, an extensively commented review of the accepted clinical indications for the practice of a cardiac magnetic resonance imaging study at present.

Heart Diseases↗
PubMed1999

[Acute myocardial infarction after anaphylactic reaction to amoxicillin].

A 62-year-old man was admitted to the hospital in a state of shock with electrocardiographic signs of inferior-wall acute myocardial infarction. He was initially diagnosed of cardiogenic shock. An urgent coronary angiography showed an irregular stenosis of 90% in the right coronary artery. Coronary angioplasty was performed, and a stent was placed in this lesion. In-depth questioning of the family revealed that the patient had taken an oral dose of amoxicillin 15 minutes before the onset of the symptoms. Further tests proved that he was allergic to amoxicillin, and was diagnosed of anaphylactic shock, complicated with acute myocardial infarction. There are several reports of myocardial infarction as a complication of anaphylactic reaction. We have found very few cases related to antibiotics, and none associated with amoxicillin. The most frequently quoted mechanism in these cases is coronary artery spasm due to the mediators of anaphylaxis. In the case reported herein, the irregular lesion suggests that disruption of an atherosclerotic plaque and platelet aggregation have occurred.

Amoxicillin↗
PubMed1999

[The electrocardiogram in apical hypertrophic myocardiopathy. A case report with unique manifestations].

We report the case of a 63-year-old female patient with apical hypertrophic cardiomyopathy, diagnosed by the presence of localized apical hypertrophy in the echocardiogram and a typical "spade like" left ventricular angiographic image, but with unique electrocardiographic features, characterized by chronic ST segment elevation, and T wave inversion, in the anterolateral leads. These changes were initially interpreted as a manifestation of acute ischemic heart disease. Chronic ST segment elevation has been occasionally described in patients with hypertrophic cardiomyopathy complicated with apical necrosis and aneurysm formation, but not in uncomplicated cases of apical hypertrophic cardiomyopathy. Its knowledge by the physician could allow avoidance of problems of differential diagnosis with more frequent heart diseases, especially acute atherosclerotic ischaemic heart disease.

Cardiomyopathy, Hypertrophic↗
PubMed1998

[The value of exercise echocardiography in the diagnosis of coronary disease in patients with left heart branch block in the bundle of His].

OBJECTIVE: To assess the diagnostic value of exercise echocardiography in patients with complete left bundle branch block and clinical suspicion of coronary artery disease. MATERIAL AND METHODS: Among 1,176 exercise echocardiograms performed from May of 1994 to November of 1996, 92 showed complete left bundle branch block in the resting electrocardiogram. We retrospectively analyzed data of 23 patients who had coronary angiography performed within 6 weeks of the exercise echo (19 males and 4 females, age 62 +/- 8, resting ejection fraction 52 +/- 10%). Previous acute myocardial infarction was demonstrated in 8 of them. The development of new or worsening regional dysfunction was considered an ischaemic response on exercise echo; whereas we assumed that there was significant coronary artery disease on the coronariography whether there was > or = 1 vessel disease in patients without previous myocardial infarction or > or = 2 vessel disease in patients with previous infarction. RESULTS: Ten patients showed multivessel disease (> or = 2 vessels, 6 with previous infarction); 5 one-vessel disease; and 8 non significant coronary artery disease. Exercise echocardiography sensitivity for ischaemia detection in the entire group was 86% (95% confidence interval 67-100%); the specificity was 67% (36-98%), predictive value of a positive test was 80% and predictive value of a negative test was 75%. Sensitivity for the detection of > 50% stenosis in the left anterior descending coronary territory was 92% (76%-100%) and specificity 64% (35%-92%); for right coronary artery sensitivity was 80% (55%-100%) and specificity 77% (54%-100%); and for left circumflex artery sensitivity was 70% (42%-98%) and specificity 69% (44%-94%). CONCLUSIONS: Exercise echocardiography may be useful in the evaluation of patients with left bundle branch block and clinical suspicion of coronary artery disease; with good sensitivity and low specificity.

Aged↗
PubMed1998

[Pathology of the heart of noncardiac origin. VIII. Cocaine and the heart].

The marked increase in cocaine consumption observed in recent decades, has led to the identification of previously unknown multiple medical problems. Cardiovascular complications related to cocaine abuse include myocardial ischemia and infarction, myocarditis, cardiomyopathy, rhythm disturbances and sudden death, endocarditis, pneumopericardium and left ventricular hypertrophy. Although the mechanisms involved in cocaine-related cardiac diseases are multiple, many cardiac complications in these patients are caused in part or totally by an increase in adrenergic activity due to the blockade of catecholamine reuptake induced by the drug.

Adult↗
PubMed1998

[The "Heart Area" of Juan Canalejo Hospital Complex. A new approach to clinical management].

The present work describes the process by which the pilot project of clinical management of the Hospital Complex Juan Canalejo, designated as "Heart Area", was implemented. In the first section, the needs and reasons that led to the undertaking of this project are explained. The project's objectives and operative strategies are listed. In the Material and Methods section, three basic aspects of the "Heart Area" are described: selection criteria of the "Area", its structure and function, and its foundation and development. In the Results section, we compare the activity undertaken in the "Area" to the situation present prior to its implementation, in relation to quality and costs. Finally, in the Conclusions, we comment on the important implications that our project can have within the Hospital Complex Juan Canalejo as well as in the health care field in general.

Cardiac Surgical Procedures↗
PubMed1998

[The evidence for higher blood pressures in children and adolescents of the rural interior of Galicia than in other locations in Spain].

AIM: To analyze differences in blood pressure levels in children and adolescents in Galicia with those of peers living in other parts of Spain. DESIGN: Cross-sectional study done in a rural area in Galicia. PARTICIPANTS: 870 boys and girls 6 to 16 years old. They are compared with published data from the RICARDIN study, that includes 10,042 participants selected at the schools in nine centers of Spain (one was the center in Galicia). MEASUREMENTS: Standardized methodology and certification procedures were used in Galicia and Spain to measure weight, height, Quételet index, systolic (SBP) and fifth-phase diastolic blood pressure (DBP5) and sexual maturation. Data are presented by sex and age group (1 year) both in Galicia and Spain. RESULTS: From 11 years and above, girls in Galicia present higher SBP than in Spain. In boys, the difference appears later. Galicia shows higher DBP5 levels than Spain in every age-sex group. In relation to obesity, the differences are of a small magnitude in the Quételet index, again, higher values in Galicia. CONCLUSIONS: This is the first population-based study available that rules out the possibility that the observed differences, previously already suggested, could be attributed to methodological problems. The differences in blood pressure and obesity between Galicia and other areas of Spain, already previously suggested in adults, can be the reflection of differences present from childhood.

Adolescent↗
PubMed1998

[Drug treatment of native valve infective endocarditis in patients not addicted to parenteral drugs].

Infectious endocarditis is an infection that is characterized by the presence of microorganisms in dense populations in vegetating lesions in the endocardium. Because phagocyte penetration to the interior of the vegetation is practically impossible, to cure infectious endocarditis, high doses of bactericidal antibiotics are administered, usually intravenously and for a long duration. In this article, antibiotic treatment is reviewed, depending on the isolated microorganism and in cases where necessary, treatment is initiated in an empirical manner. Once the microorganism was isolated, the recommended guidelines for antibiotic treatment have gone through some variations in recent years, due to the changing pattern of antibiotic sensitivity of some microorganisms, to the point of finding ourselves on occasion without an effective treatment (e.g. multiresistant enterococci). In addition, these variations are due to the introduction of new antibiotics that allow, in special cases, for the treatment to be administered on an outpatient basis. Using anticoagulation in infectious endocarditis is still considered controversial. In general, only patients having cardiac valvular prostheses seem to benefit from its use.

Algorithms↗
PubMed1998

[Informed consent in cardiology. The Committee on Informed Consent of the Commission on Professional Matters of the Sociedad Española de Cardiología].

In the last thirty years, the clinical relationship between physicians and patients has been rather modified. There are several factors that have contributed to this change: a) New ways to execute medical practises, specially referred to the development of new techniques; b) Cultural changes in our western society, mainly in the mediterranean area, where there has been progress in the recognition of patients' autonomy to decide about their own lives, health and their own bodies; c) The increasing number of lawsuits, complaints and judgements about the problems that clinical information involves, particularly the informed consent in clinical practise. We consider it necessary to make an extensive and deep discussion from all of the areas in Medicine and Law, to analyze the different ethical and legal parts of the informed consent. For that reason the Spanish Society of Cardiology offers their members a basic document in order to reflect about these facts, developing arguments, justifications and supports. This document has also considered models, conditions to their applicability according to Spanish law, and the experience we have had. Finally, there is a list of diagnostic procedures and interventional practises in cardiology that might be preceded by a written informed consent document. We considered them by the name of Spanish Society of Cardiology recommendations.

Cardiology↗
PubMed1997

[Research methods in clinical cardiology (VII). Experimental studies in cardiology].

Experimental designs in clinical investigation are discussed in this article. Guideline examples have been used in the area of Cardiology using always the same one only one whenever possible. We have looked for a different perspective from what is generally used in the discussion of the general characteristics of experimental designs, and more specifically of clinical trials and we deal with the aspects of clinical trials which are usually ignored due to their marginal character. We also discuss those characteristics which differentiate clinical trials in respect to other designs and types of questions which are answered by clinical trials. And we finally discuss various aspects such as randomization and its various types (simple, block, stratified, pre-randomized) and variable types of evaluating the answers, masking and the problems in its maintenance, with certain kinds of designs, sample size, etc. There is a brief mention of two particular cases: factorial and cross over designs are both discussed, mentioning their strong and weak points. Likewise, we discuss community trials as another experimental design and examples are provided. Finally, we discuss aspects of criteria: such as, When to stop the trials? or Who are the results applicable to?, and we suggest points to take into consideration when these decisions are made.

Cardiology↗
PubMed1996

Differences in heart transplant physiology according to surgical technique.

A new cardiac transplantation technique that preserves the shape of the left atrium and leaves the right atrium intact has been introduced. To compare the new and the standard techniques, we studied cardiac physiology with Doppler echocardiography and catheterization in 26 patients who underwent operation with the standard technique (group A) and I1 who underwent operation with the new technique (group B). Right atrial dimensions were significantly lower in group B (right atrial area index 8.4 +/- 1.5 vs 14.5 +/- 1.9 cm2/m2, p < 0.001), whereas left atrial dimensions were slightly lower (left atrial area index 10.8 +/- 2.0 vs 16.4 +/- 7.0 cm2/m2, p = 0.07). Right atrial contraction, as reflected by peak late tricuspid velocity, was greater in group B (37 +/- 15 vs 30 +/- 10 cm/sec, p < 0.05). The subsequent systolic vena caval flow-velocity integral was also greater in group B at all respiratory phases (inspiration 10.0 +/- 4.0 vs 5.2 +/- 4.0 cm, p < 0.001; expiration 4.8 +/- 1.9 vs 2.9 +/- 1.4 cm, p < 0.001; apnea 5.3 +/- 2.0 vs 2.9 +/- 1.9 cm, p < 0.001) suggesting better atrial relaxation. Filling pressures on the right side of the heart were lower in group B (mean right atrial pressure 5.5 +/- 2.4 vs 6.6 +/- 2.8 mm Hg, p = 0.1; right atrial A wave 6.0 +/- 3.1 vs 8.3 +/- 3.2 mm Hg, p < 0.01; right atrial V wave 6.8 +/- 3.1 vs 9.2 +/- 3.2 mm Hg, p < 0.01; right ventricular end-diastolic pressure 5.6 +/- 3.2 vs 7.3 +/- 2.9 mm Hg, p < 0.05); however, no significant differences were found in left ventricular end-diastolic pressure or cardiac index. We conclude that patients undergoing the new technique exhibit cardiac physiologic improvements. Follow-up study is indicated to ascertain whether this finding implies improved long-term prognosis.

Adult↗