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A R de Almeida

Publications and source records attributed to A R de Almeida.

13 recordsLinked to original sources
PubMed2001

Improving botulinum toxin therapy for palmar hyperhidrosis: wrist block and technical considerations.

Botulinum A exotoxin has become an excellent therapeutic option to treat focal hyperhidrosis, but when the problem affects the palmar region the technique has some drawbacks. Pain with injection is difficult to tolerate and the large dose needed to treat both hands are two concerns, as well as muscle weakness secondary to botulinum toxin diffusion and the possibility of antibody production. All these problems limit the number of patients treated. The author's suggestion is to treat only the dominant hand, after performing a wrist block. The use of a device adapted from a cartridge rubber may help to control the injection depth and the risk of muscular weakness.

Botulinum Toxins, Type A↗
PubMed1997

[Stress tests in old age. The choice of the stress protocol].

OBJECTIVE: To evaluate, in an elderly Portuguese population, the diagnostic capacities of the most popular treadmill stress test protocols. DESIGN: Retrospective study of an elderly Portuguese population submitted to a stress test. PATIENTS AND METHODS: A population of 45 patients (35 male), aged 65 or more years, consecutively submitted to a stress test. The average age of the group was 67.8 +/- 2.9 years. The three protocols (Bruce, Bruce Modified and Naughton) were comparatively studied in terms of the patients capacity to execute the protocol, capacity to obtain a maximum and a diagnostic stress test, and the complications of the stress test protocol. MAIN RESULTS: The Bruce protocol was used in 19 patients, the Bruce Modified in 13 patients and the Naughton protocol in 13 patients. The three protocols did not lead to any complication. The Bruce protocol led to a larger increment in heart rate (p < 0.001) and to larger maximum rate pressure product (p < 0.05) than the Naughton one. The Bruce protocol obtained a larger number of diagnostic tests (p < 0.01) and a significantly lower number of inconclusive stress tests. The Naughton protocol led to a larger duration of the exercise tests and was not suitable for some of the elderly patients owing to the exhaustion of the protocol. The results obtained with the Bruce Modified protocol were among those of other two protocols. CONCLUSIONS: In the elderly, the stress tests are safe and useful in the diagnosis of exercise induced ischemia and in the stratification of cardiovascular risk. From the protocols studied, the Bruce protocol was the most adequate, globally speaking, for this group of patients. The Bruce protocol presented a better diagnostic capacity with no complications related to the protocol.

Aged↗
PubMed1994

[Significance of the persistence of ST segment elevation in anterior infarction].

OBJECTIVE: Persistent ST segmentary elevation in anterior myocardial infarction was classically attributed to ventricular aneurysm. This association is now considered controversial. We studied the association between this electrocardiographic finding and the left ventricular wall motion abnormalities and global function. DESIGN: Retrospective study. SETTING: Patients admitted to Hospital de Pulido Valente Coronary Care Unit in Lisbon with anterior myocardial infarction who were submitted to angiographic study. PATIENTS: 94 patients were included in the study. METHODS: The global ejection fraction, the regional wall motion abnormalities, the coronary artery disease extension, the patency and the proximal involvement of the left anterior descending artery were investigated. RESULTS: 56 of the 94 patients (60%) had persistent ST segment elevation and 38 (40%) had isoelectric ST segment. The ejection fraction was markedly depressed in the group with elevated ST segment (36.2 SD 17.6) in contrast with the group with isoelectric ST segment (49.3 SD 14.8) (p < 0.001). The group with persistent ST segment elevation had more advanced degrees of left ventricular asynergy (42/58-75%) than the group with isoelectric ST segment (12/38-32%) (p = 0.02). The other studied angiographic variables did not differ between the two groups. CONCLUSIONS: The group with persistent ST segment elevation was associated with advanced degrees of left ventricular asynergy and greater left ventricular function depression. The ventricular aneurysm was exclusive of the first group.

Adult↗