Biomedical subjects

A Milheiro

Publications and source records attributed to A Milheiro.

8 recordsLinked to original sources

PubMed2001

Phaeohyphomycosis due to Cladosporium cladosporioides.

Phaeohyphomycosis is a clinical entity caused by dematiaceous fungi. We describe a clinical case of phaeohyphomycosis due to Cladosporium cladosporioides in a 45-year-old white male, apparently healthy, human immunodeficiency virus-negative. The patient was treated with terbinafine for 9 months, with regression of a skin lesion. Three months after discontinuation of the therapy, there was a clinical and mycological relapse. After progression of the disease with inadequate treatment, there was no response to amphotericin B and flucytosine. Finally, we obtained a clinical response with itraconazole oral solution at 600 mg day(-1) for a 6-month period.

Adult↗

PubMed1997

[Changes in lung function after cholecystectomy--open versus laparoscopic cholecystectomy].

Impairment of respiratory function after open cholecystectomy may cause atelectasis and hypoxemia. Clinical experience shows evidence for easier recovery after laparoscopic operation. Postoperative respiratory function using spirometric tests was assessed in 50 patients with simple symptomatic cholecystolithiasis submitted either to open or laparoscopic cholecystectomy and revealed less impairment of respiratory function in the laparoscopic group.

Cholecystectomy↗

PubMed1996

Pulmonary function after laparoscopic cholecystectomy in the elderly.

The results of laparoscopic cholecystectomy in a group of 52 patients older than 69 years (group 1) were compared with the results of the same operation in a group of 338 younger patients (group 2). In group 1, 23 per cent of patients had acute cholecystitis and 13 per cent were operated on after an episode of acute pancreatitis. In group 2, 8 per cent of patients had acute cholecystitis and 4 per cent were operated on after acute pancreatitis. Pulmonary function was assessed prospectively before operation, 24 h after surgery and on the seventh day after operation, in 20 patients in group 1 and 30 in group 2. In group 1 there was one death (2 per cent); the morbidity rate was 14 per cent and conversion to laparotomy was required in 15 per cent. In group 2 there were no deaths, the morbidity rate was 11 per cent and the conversion rate 4 per cent. No significant differences were found between the two groups in mortality and morbidity rates. Preoperative values of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were significantly lower in group 1 than in group 2 (P < 0.05); the values of FVC, FEV1 and forced expiratory flow at 50 per cent 24 h after surgery were less depressed in group 1 (P < 0.01) and also recovered more quickly in these patients 7 days after operation. Laparoscopic cholecystectomy gives excellent results in geriatric patients and can be recommended as the treatment of choice for symptomatic cholelithiasis in the elderly.

Aged↗

PubMed1995

[Acute pancreatitis. An analysis of 91 consecutive cases (1988-1991) with a brief review of the literature)].

Acute pancreatitis (AP) remains a subject of great controversy from the standpoint of its aetiology, pathogeny and treatment. We present a study of 91 patients with AP consecutively admitted to a surgical ward. 50 Women and 41 men with a mean age of 59 +/- 19 years were treated. The aetiology of AP was attributed to gallstones in 54 patients, alcohol in 22, ERPC and trauma; in 14 patients the aetiology was considered idiopathic. The most frequent signs and symptoms were pain, vomiting, abdominal tenderness, jaundice and fever. The mean number of Ranson's prognostic criteria was 3 +/- 1.5 and 29 patients (31%) had more than three. Initial management was conservative in 84 patients (92.3%) and seven were operated on admission (acute abdomen in four, septic shock in two and common duct obstruction in another). Mortality rate was 11% (n = 10) and in 24 patients (26.3%) there were complications of AP. Most of the patients (80%) began oral feeding a week after admission. The mean number of Ranson's criteria of patients deceased was 5.4 +/- 1.6 and of those who survived was 2.8 +/- 1.3 (p < 0.001). Follow-up of patients allowed us to see that in five (5.5%) there was a relapse of AP.

Acute Disease↗

PubMed1994

Metabolic responses to cholecystectomy: open vs. laparoscopic approach.

Laparoscopic cholecystectomy is considered a minor surgical procedure. In a prospective, randomized study, we compared the metabolic responses to surgery in two groups of patients submitted to open or laparoscopic cholecystectomy. The aim of the study was to verify if the latter caused less metabolic changes. Blood samples were drawn before the operation (basal), 1 h and 2 h after skin incision, and on the first and second postoperative days. The following parameters were studied: cortisol, renin, and leukocytes, including subpopulations. The mean values for age, weight, height, basal neutrophil and lymphocyte counts, basal values of cortisol and renin of patients, and sex distribution of group 1 patients (open, n = 20) matched with those for group 2 (laparoscopic, n = 20), with the exception of age (p < 0.05). No differences were detected between the two groups in terms of cortisol and renin values. However, the neutrophil count 1 h after skin incision was statistically significantly higher with the laparoscopic approach (p < 0.05). The lymphocyte count on the second postoperative day was also statistically significantly higher in group 2 (p < 0.05). We conclude that when a cholecystectomy is performed, the laparoscopic approach has no advantage over the open approach from the standpoint of the metabolic responses we studied. It appears that leukocytes have a more rapid return to normal values after laparoscopic cholecystectomy. Although pneumoperitoneum is known to be responsible for important cardiorespiratory changes, no worse response was found in the laparoscopic group than in the open group.

Adult↗

PubMed1994

[Esophageal perforations].

The opportunity of having successfully treated a patient with intrathoracic perforation of the Oesophagus and many surgical complications, led us to review the literature on the subject. We then discussed the advantages and disadvantages of the various technical options, concluding that immediate Oesophagectomy is the best solution for this type of perforation, with several hours of evolution and serious mediastinite, to reduce surgical complications and mortality.

Esophageal Perforation↗

PubMedDate not supplied

[Hematuria].

Patients referred for hematuria work-up are frequently seen in the urologic practice. The initial evaluation does not require the participation of a urologist or nephrologist, due to the false sense of security in the evaluation of an asymptomatic and persistent hematuria. In fact, an adequate history and physical followed by urinalysis and radiologic tests, such as IVP and ultrasonography, must be made in the initial evaluation to exclude any serious urologic/nephrologic disease.

Adult↗

PubMedDate not supplied

[Prophylaxis of postoperative thromboembolism. Randomized prospective study].

The difference between a non fractioned heparin (Liquemine) and another of low molecular weight (Fraxiparine) was compared through: hemostasis difficulties, during and after surgery; the use of transfusions; clinical signs of inferior limb vein thrombosis or pulmonary emboli; laboratory results of blood (hemogramme, biochemistry, coagulation) and urine. The results observed in 500 patients, (250 of each heparin) statistically treated, show that no difference was found between the two groups of patients, which lead us to conclude that both heparins have the same effect. Low molecular weight has the advantage of being administrated only once a day.

Adult↗