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Biomedical subjects

A Mesquita

Publications and source records attributed to A Mesquita.

At least 19 recordsLinked to original sources
PubMed2006

[Reconstruction of velopharyngeal sphincter in secondary Cleft Palate: surgical alternative].

There are numerous surgical procedures for the repair of Cleft Palate (CP). Since 1998, in children with CP we use a modified Wardill-Kilner technique, with a large section of the nasal mucous layer at the level of the muscular insertion on the hard palate and lateral nasopharingeal wall, obtaining a push-back and reorientation of the muscular fibres without dissection, diminishing this way the risks of haemorrhages and fibrosis, simplifying the intervention. It allows a lower operative time and a short internment. The aim of our study was to evaluate the results of this operative procedure specially in the development of the speech in 73 children operated on from 1998 until 2000 in our hospital. We verify a competence of the velopharingeal sphincter with ideal results in speech in 88,8% of the cases.

Cleft Palate↗
PubMed1999

[Peripheral revascularization by cardiologists].

OBJECTIVE: To analyse the initial experience in peripheral arterial revascularization, using percutaneous techniques, by interventional cardiologists. DESIGN: Retrospective clinical study. SETTING: Cardiology department of a specialised public non-university hospital. PATIENTS: Twenty patients, 18 male and 2 female, with ages between 37 and 84 years, who underwent peripheral interventions between May 5 1989 and February 20 1998. INTERVENTIONS: Patients were subdivided into two groups: Group I, 9 patients, 8 male, average age of 56 +/- 13 years, undergoing renal artery angioplasty; Group II, 11 patients, 10 male, average age of 63 +/- 10 years, undergoing angioplasty of the distal aorta (1), of the right subclavian artery (1), of the iliac arteries (6) and of the femoral arteries (3). In Group I, 11 arteries were dilated, 6 by balloon angioplasty and 5 with stent implantation (Palmaz-Schatz--4 and Symphony--1). In Group II, 12 arteries were dilated, 5 by balloon angioplasty and 7 with 12 stent implantations (Palmaz-Schatz--6, Symphony--5 and NIRTM--1). In 8 patients, 1 of Group I and 7 of Group II, coronary angioplasty was also performed in 14 arteries and 18 segments, exclusively by balloon (3 patients) or with 10 stent implantations (5 patients). RESULTS: There was angiographic success in all patients (100%) and clinical success in 85% (17/20) of patients. All clinical complications occurred in Group I patients: retroperitoneal bleeding in one; right femoral artery pseudoaneurysm requiring surgery in one patient: acute renal failure in one patient. There were no cardiac complications in patients undergoing peripheral and cardiac angioplasties at the same stage. In the mean follow-up period of 26 months, one patient required reangioplasty of a right iliac artery and another underwent iliac-femoral bypass, both of Group II and before peripheral stents were available. CONCLUSIONS: Percutaneous peripheral arterial revascularization performed by experienced interventional cardiologists seems safe and efficient, being perfectly justified in patients requiring simultaneous coronary angioplasty.

Adult↗
PubMed1998

[Value of exercise test for risk stratification acute myocardial infarction].

OBJECTIVES: To assess the prognostic value of predischarge exercise testing (ET) in patients hospitalized for acute myocardial infarction (AMI). CONTEXT: Department of Cardiology in a reference hospital for Interventional Cardiology METHODS: Between January 1990 and December 1994, 178 patients hospitalized for AMI were discharged and referred to the outpatient clinic (mean follow up, 1049 +/- 612 days). Eighty-two percent of these patients were men, mean age--56 +/- 12 years. Patients that did not perform predischarge ET (Group A, n 77) were retrospectively compared with those who did (Group B, n = 101). In relation to demographic and clinical characteristics; we analysed cardiac events (CE) and death during the first 18 months after discharge in both groups. In group B patients, we studied the relation of ET parameters (duration of exercise, occurrence of exercise-induced ischaemia and arrhythmias, maximum heart rate, blood pressure response, rate pressure product and severity score) to CE and death during the first 18 months after AMI. RESULTS: The proportion of patients aged 70 years or older was greater in group A (23% vs 3%, P < 0.001). In this group, there was a greater prevalence of recurrent ischaemia (51% vs 29%, P < 0.001) and left ventricular dysfunction (42% vs 25%, P < 0.05). Group A patients were also submitted to less thrombolysis (45% vs 62%, P < 0.05) and to revascularization procedures (25% vs 41%, P < 0.05). In group B patients, the incidence of CE did not differ with respect to duration of ET, rate pressure product or maximum heart rate. Incidence of CE was greater in patients with exercise-induced ischaemia (38% vs 15%, P < 0.05), severity score > 2 (45% vs 18%, P < 0.02) and inadequate rise (< 30 mmHg) in systolic blood pressure (39% vs 13%, P < 0.02). The total incidence of CE and revascularization was also greater in patients with exercise-induced ischaemia (88% vs 49%, P < 0.001), severity score > 2 (95% vs 56%, P < 0.02) and inadequate rise in systolic blood pressure (93% vs 45%, P < 0.001). CONCLUSIONS: In patients without indication for ET as part of risk stratification after AMI, clinical characteristics were more severe as defined by age greater than 70 years, residual ischaemia and left ventricular dysfunction. Patients that performed ET had smaller risk, except when presenting exercise-induced ischaemia, severity score > 2 and inadequate rise in systolic blood pressure.

Adult↗
PubMed1998

[Role of auxiliary diagnostic tests in the clarification of the etiology of syncope: experience at an arrhythmia center].

UNLABELLED: Syncope is a syndrome caused by a reversible reduction of blood to the brain. Three hemodynamic abnormalities can cause syncope: an acute decrease in cardiac output, an acute increase in cerebrovascular resistance and a fall in systemic blood pressure due to ineffective control of peripheral vascular resistance. We made a retrospective study of 121 patients with syncope history, 67 males, and 57 females, with mean age 48 +/- 14 years, and at least six months of clinical follow-up. Twelve patients had valvular disease, two patients had hypertrophic cardiomyopathy, eight patients had dilated cardiomyopathy, 14 patients had ischemic disease, three patients had congenital disease; 82 patients did not have cardiac disease. Syncope etiology was arrhythmic in 69 patients: 47 patients had tachyarrhythmia (supraventricular--in 27 patients and ventricular in 20 patients) and 15 patients had bradyarrhythmia (seven patients had sinus node disease and eight patients had atrioventricular block). Non arrhythmic etiology of syncope was identified in 29 patients (neurologic disease--ten patients, metabolic disease--one patient and iatrogenic--two patients; vasodepressor syncope--14 patients, and hypertrophic cardiomyopathy--two patients). It was not possible to determine the syncope etiology in 30 patients. The assessment of patients who present syncope depends on establishing the basis for the symptoms. The initial step is differentiating patients with normal cardiovascular systems from those with heart disease. In the former, tilt-table testing proved to be the most productive from a diagnostic perspective; in the latter group, electrophysiologic evaluation was the most elucidative from a diagnostic perspective. The ultimate goal is to obtain a sufficiently strong correlation between syncopal symptoms and detected abnormalities to permit an accurate assessment of prognosis and to develop an effective treatment plan. CONCLUSIONS: It is very important to establish the etiology of syncope for optimal management of patients and it is therefore possible to control the symptoms in the majority of them. The patients who present syncope require a complete history and a physical examination for an appropriate workup to be initiated. Tilt-table testing was the most accurate for the diagnosis of vasodepressor syncope while electrophysiologic testing provides an accurate method for assessing the etiology of tachyarrhythmic syncope.

Adult↗
PubMed1998

[Revascularization in patients with prior coronary bypass surgery].

UNLABELLED: Increasingly over the past several years, patients have returned after coronary surgery for reintervention procedures. This reflects immediate postsurgical complications and the relentless progression of coronary artery disease in the native circulation and in the bypass grafts. Although there are randomized comparative data for coronary bypass surgery (CABG) versus percutaneous transluminal coronary angioplasty (PTCA) and medical therapy, these trials have always excluded patients with previous (GABG). OBJECTIVES: We attempted to compare the risks and benefits of percutaneous transluminal coronary angioplasty (PTCA) and repeat coronary artery bypass grafting (re-CABG) in patients with previous coronary bypass surgery (CABG). METHODS AND RESULTS: This study examines follow up data (15.4 +/- 11.0 months) from 130 patients with previous CABG, who required either PTCA (Group A, n = 73) or re-CABG (Group B; n = 57) at a single center from 1994 to 1997. Follow up data were obtained from subsequent office visits and telephone calls. The PTCA and re-CABG groups were similar with respect to gender (86% vs 94% males), mean age (62 +/- 9 vs 59 +/- 10 years), angina CCS classes 3 and 4 (73% vs 69%), diminished left ventricular function (23% vs 26%), risk factors such as diabetes (19% vs 17%), hypercolesterolemia (49% vs 45%) and smoking (48% vs 39%) and three-vessel native coronary artery disease (67% vs 72%). The symptomatic status prior to the revascularization procedure was similar in both groups. Complete and functional revascularization was achieved in 85% of the PTCA group and in 92% of those with re-CABG (p = NS). During the hospital stay the complication rates were lower in the PTCA group. Actuarial survival was different at follow up (p = 0.04). Both PTCA and re-CABG groups resulted in equivalent event-free survival (freedom from death, myocardial infarction, unstable angina and urgent revascularization). The need for repeat revascularization at follow up was significantly higher in the PTCA group (PTCA 28% vs re-CABG 10%, p < 0.01). CONCLUSIONS: In this non-randomized study of patients with previous CABG requiring revascularization procedures, PTCA resulted in lower procedural morbidity and mortality risks. At follow up, both PTCA or CABG were similar for event-free survival; PTCA offered lower overall mortality, although it is associated to a greater need for subsequent revascularization procedures.

Aged↗
PubMed1998

[Total occlusion of the left common coronary artery--a case report].

Total chronic occlusion of the left main coronary artery is an unusual finding. After a review of the literature, the authors present a case report of a patient with stable angina and total occlusion of the left main coronary artery, right coronary with atherosclerotic lesions and normal ventricular function.

Aged↗
PubMed1998

[Treatment acute myocardial infarct in the pre-hospital phase].

The authors review and discuss the medical treatment in the prehospital phase of acute myocardial infarction while working at the Referral Centre for Emergency Patients of the National Institute for Medical Emergencies (CODU-INEM). The diagnosis of myocardial infarction should be suspected immediately by the doctor on duty at CODU-INEM in all patients with acute thoracic pain. Then it is essential to send a medical team to the scene as soon as possible after the onset of symptoms in order to treat and to prevent acute fatal complications.

Cardiotonic Agents↗
PubMed1997

Blood flow velocity measurements in the optic nerve of glaucomatous patients by elaboration of a constant to evaluate the evolutive risk.

METHODS: We performed Echo color Doppler examinations on 100 glaucomatous patients (197 eyes). Ophthalmic artery and central retinal artery were particularly considered. The study included eyes in every level and type of glaucoma, and in various types of treatment (topical therapy, Argon laser trabeculoplasty, Argon/YAG/surgical iridectomy, trabeculectomy). The parameters we considered were: ocular tension, anterior chamber angle, optic disc excavation, visual field, refraction and vascular risk factors. We measured the flow values of the ophthalmic artery and of the central retinal artery, i.e. maximal systolic velocity, diastolic velocity and vascular resistance index. RESULTS: We observed that if we divide the value of ocular tension by the systolic velocity and multiply the result by the resistance index, we obtain a number which may be considered as a prognostic factor of evolutive risk. We compared our cases with a population free from glaucomatous and cardiovascular problems.

Adult↗
PubMed1996

[The radiofrequency catheter ablation of ventricular tachycardia].

OBJECTIVE: The aim of this study was to evaluate our results of radiofrequency catheter ablation (RFCA) of ventricular tachycardia. PATIENT SELECTION: We treated with RFCA nine patients, six male and three female, mean age 36 +/- 12 years with ventricular tachycardia (VT), who fulfilled the following criteria; 1) recurrent VT; 2) resistant fo medical therapy despite the use of more than one antiarrhythmic drug; 3) inducible by programmed ventricular stimulation; 4) hemodynamically well tolerated. The VT etiology was coronary artery disease (CAD) in three patients, dilated cardiomyopathy in one, right ventricular dysplasia in one and it was idiopathic in four (being fascicular in three and catecholaminergic right ventricular outflow tract VT in one). METHODS: The RFCA was performed under antiarrhythmic medication. The adequate ablation site was obtained by mapping of the VT, looking for the earliest ventricular activation, identification of isolated mid-diastolic potentials during sinus rhythm or presystolic during VT, good pace mapping (at least 10 of the 12 standard ECG leads), and high frequency short duration spikes, the so called P potentials in fascicular VT. Primary success achieved when occurred termination of VT during application of RF energy and/or VT was no longer inducible by programmed stimulation with the same stimulation protocol. RESULTS: Global primary success rate was 89%, being 100% in idiopathic VT, and 80% in VT associated with structural heart disease. In a follow-up period of 12 +/- 14 months all patients were alive, 75% free of VT in the idiopathic VT group; and 50% in patients with structural heart disease. One of these patients underwent cardioverter defibrillator implantation to treat a fast VT with a new morphology not treated by ablation, and the other two had VT modification with a significant reduction in the number of episodes. CONCLUSIONS: Radiofrequency catheter ablation of VT has shown a good success rate, and it is a valuable alternative in patients with hemodynamically tolerable VT, refractory to drug treatment, highly symptomatic and without surgical indication. In cases of idiopathic VT we had a high rate success and we think that RFCA will probably become the primary indication in symptomatic patients.

Adult↗
PubMed1996

[The maximum heart rate in the exercise test: the 220-age formula or Sheffield's table?].

OBJECTIVE: To determine in the maximum cardiac rate in exercise test of apparently healthy individuals may be more properly estimated through 220-age formula (Astrand) or the Sheffield table. DESIGN: Retrospective analysis of clinical history and exercises test of apparently healthy individuals submitted to cardiac check-up. PARTICIPANTS: Sequential sampling of 170 healthy individuals submitted to cardiac check-up between April 1988 and September 1992. MATERIAL AND METHODS: Comparison of maximum cardiac rate of individuals studied by the protocols of Bruce and modified Bruce, in interrupted exercise test by fatigue, and with the estimated values by the formulae: 220-age versus Sheffield table. RESULTS: The maximum cardiac heart rate is similar with both protocols. This parameter in normal individuals is better predicted by the 220-age formula. CONCLUSIONS: The theoretic maximum cardiac heart rate determined by 220-age formula should be recommended for a healthy, and for this reason the Sheffield table has been excluded from our clinical practice.

Adult↗
PubMed1996

[Predictive value of coronarography in the localization of arterial lesions responsible for future infarcts of the myocardium].

OBJECTIVES: To evaluate the capability of coronary angiography, when performed in stable conditions, to predict which arterial segment will be responsible for future acute myocardial infarction. POPULATION: 17 patients (15 men and 2 woman), mean age 52 +/- 12 years, who suffered a myocardial infarction (AMI), and had been previously submitted to coronary angiography. After the myocardial infarction all the patients had a new angiography. METHODS: The coronary angiographies performed before and after the AMI were compared, by simultaneous visualization of the films, and the segment related to the AMI was determined with the help of ECG and ventriculography. Among the arterial segments with in the coronary angiography performed before the AMI and who were found to be related with it, three Groups were considered: A-with no angiographic lesion; B-with less then 70% lesion; C-with a lesion equal or superior to 70% (angiographically significant). RESULTS: In nine patients the arterial segment related to AMI belonged to group A. In four patients it belonged to group B and in four to C. Segments with angiographically significant lesions were responsible for AMI in less then one fourth of the patients. CONCLUSIONS: Coronary angiography, when performed in stable conditions, has a low predictive value to determine the localization of the arterial segment related to future AMI.

Adult↗
PubMed1996

[Exertion syncopal crisis in the young, associated with idiopathic long QT syndrome].

The cases of two young patients with repetitive syncopal attacks due to idiopathic long QT syndrome (ILQTS) are reported. Both had been primarily misdiagnosed for seizures. In one of the cases the QT interval in the ECG at rest was normal. The same patient had a previous episode of cardiac arrest with ventricular fibrillation. The treadmill stress test was of great value, revealing polymorphic ventricular tachycardia induced by exercise, and evaluating the efficacy of beta-blocking therapy in the follow-up. The ILQTS should be considered a possible etiology in any patient presenting with new onset seizures, especially in the young. The treatments were different in both cases. In the first one, the treatment with nadolol (100 mg od) revealed to be very effective with total remission of symptoms. The treadmill stress test performed 15 days after the beginning of treatment did not show any ventricular arrhythmias, and it was assumed that the patient was effectively protected against ventricular arrhythmias. After 4.5 months of follow up, no syncopal episodes occurred. In the second case due to young age, the frequency, and the severity of the attacks (cardiac arrest with ventricular fibrillation), and the inefficacy of beta-adrenergic-blocking agents, the implantable cardioversor-defibrillator was the treatment chosen, although the beta blocking therapy was maintained to reduce the number of arrhythmic events. The ILQTS is a rare anomaly related to sudden cardiac death. The ILQTS is characterised by the association of several distinctive electrocardiographic features, among which prolongation of the QT interval is the best known. Life-threatening arrhythmia occurs usually under conditions of physical or psychological stress. Relatively effective therapies do exist and are represented by antiadrenergic interventions: beta-adrenergic-blocking agents are the treatment of choice. When they fail, left sympathetic denervation or the automatic implantable cardioversor-defibrillator have also proved to be effective.

Adult↗
PubMed1996

[Coronary disease in women --risk factors, diagnostic and therapeutic approaches].

OBJECTIVE: To characterize and evaluate the prognosis of coronary artery disease in women. SETTING: Hospital with referral for cardiac catheterization, since 1982. PATIENTS: We studied post-menopause patients, not under hormonal replacement therapy, to whom coronary artery disease (CAD) was diagnosed by coronary angiography in the first 5 years of activity of our centre. Patients should have at least five years of follow-up (Group W-84 patients). METHODS: Risk factors for CAD were studied in Group W, and compared with a group of male patients with CAD and a group of women without CAD, that underwent coronary arteriography in the same period of time. RESULTS: Most risk factors for CAD were more prevalent in women with CAD, with special focus on hyperlipidaemia and hypertension. Cigarette smoking was more frequent in men. At the time of coronary arteriography, most patients were in NYHA class I-II and CCS class 3-4. On follow-up 68 patients were revascularized (bypass graft on most). At five years, five patients died and most survivors were a NYHA class I-II and CCS class 1-2. Patients with multivessel disease (MVD), were older, more symptomatic and with more risk factors than patients with single vessel disease (SVD). Follow-up was on medical treatment 17% of the patients and included revascularization procedures in 83% of MVD patient's disease and 77% of patients with SVD patients. Cardiac events (unstable angina, myocardial infarction, admission for cardiac failure) occurred in 49% of MVD and 32% of SVD patients, and distribution of CCS and NYHA classes at 5 years were similar in both subgroups. CONCLUSIONS: The present study characterize the group of women with CAD as having a high prevalence of risk factors, with a large proportion of multivessel disease and high rates of revascularization. Prognosis at five years was favourable in this group. Multivessel disease was associated with presence of more risk factors and increased clinical severity before catheterization, but at five years the prognostic was similar to single disease, therapeutic options, notably the high rate of revascularization, could account for these results.

Coronary Disease↗
PubMed1996

[Acute myocardial infarct in a young cocaine user].

In patients less than 40 years of age, acute myocardial infarction (AMI) has special clinical and pathophysiologic characteristics. Its prevalence varies between 5 and 10%. In such patients, AMI associated with chronic cocaine abuse has a non-negligible prevalence of 6%. The purpose of this report is to describe the case of a 24-year old male patient with smoking habits and chronic abuse of cocaine and hallucinogenic drugs. This patient developed clinical, enzymatic and electrocardiographic criteria of anterior AMI, two hours after the ingestion of an LSD-like hallucinogenic drug. The coronary angiography revealed a critical stenosis of the medium segment of the left anterior descendent artery, and a pre-stenotic aneurysmatic dilatation. In order to determine the etiology of the aneurysm, various laboratory and histologic tests were performed. The results of these were normal. We review the pathophysiology, clinical manifestations and prognosis of cocaine-associated AMI.

Adult↗
PubMed1996

[Experience with dl-sotalol in the treatment of supraventricular arrhythmia].

OBJECTIVES: To review the results of our experience with oral dl-sotalol for preventive treatment of supraventricular tachyarrhythmias (atrial fibrillation and paroxysmal supraventricular tachycardia). POPULATION: 51 patients, 28 female and 23 male, mean age 46.2 +/- 14.4 years, from outpatient arrhythmology clinics of our institution, with recurrent supraventricular tachyarrhythmias (atrial fibrillation in 24 patients and paroxysmal supraventricular tachycardia in 27). All the patients, but one, had normal left ventricular function. Dl-sotalol was first choice medication in only three patients. Previously 2 +/- 1.3 antiarrhythmic drugs had been used. METHODS: Retrospective evaluation of therapeutic response (number of clinical recurrences according to a semi-quantitative scale) and secondary effects of dl-sotalol during a minimum follow-up of 18 months. The mean daily dose was 205 +/- 90 mg (80 to 400 mg). RESULTS: In 37% of the patients there were no clinical recurrences of arrhythmia during follow-up. In 37% of the patients there was a significant reduction in recurrences. In 26% there was no change in the number of recurrences. There were no significant differences in response between patients with atrial fibrillation and those with paroxysmal supraventricular tachycardia. Secondary effects occurred in 16% of the patients: symptomatic bradycardia, asthma or sexual dysfunction. No patient had heart failure, torsades de pointes, syncope or death. CONCLUSIONS: From our experience, DL-sotalol seems to be a good therapeutic alternative for the preventive treatment of supraventricular tachyarrhythmias, with a low risk in patients with good ventricular function.

Adult↗