Biomedical subjects
Publications and source records attributed to B Ferreira.
A total of 192 embalmed cadavers were examined in order to present a detailed study of arterial variations in the upper limb and a meta-analysis of them. The variable terminology previously used was unified into a homogenous and complete classification, with 12 categories covering all the previously reported variant patterns of the arm and forearm.
AIMS: This prospective, controlled, randomized crossover trial was conducted to assess the effects of parenteral nutrition, with or without lipids, in cyclosporine (CyA) pharmacokinetics. METHODS: 10 adult patients were randomized on the day of allogeneic bone marrow transplantation to receive isocaloric and isonitrogenous parenteral nutrition admixtures without (regimen A) or with lipids (regimen B). Admixtures were started on average by day + 7.4; 5 patients received regimen A followed by B, 5 in reverse order. Blood samples were collected at day 4 after transplantation, under oral diet, and 4 days after the initiation of each regimen as the sole nutrition support. At each time point, 8 whole blood samples were analysed for CyA to evaluate: area under the curve (AUC), trough concentration and systemic clearance. Clinical/laboratory events were recorded until 31 months of follow-up. RESULTS: There was no evidence of a period or treatment-by period interaction, thus results were combined for further analysis. There were no statistically significant differences between regimens in any CyA pharmacokinetic parameters; there were no significant differences from baseline values, except for a higher systemic clearance of CyA with regimen A (0.40+/-0.09 vs 0.29+/-0.06 L/Kg/h, p=0.03). CONCLUSIONS: The provision of 0.8 g/Kg/d of a 50:50 mixture of medium and long chain triglycerides did not affect CyA parameters, which were closer to baseline. In the short or long term there were no attributable side effects.
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A retrospective study was made of 83 diabetic patients admitted to the Department of Internal Medicine between January 1986 and December 1993, with acute intercurrence of the disease. The authors considered some clinical features (age, type and frequency of complication, form of presentation, causal aetiology, laboratory findings and therapeutic options). Statistical relationships between different populations were made using the unpaired Student's T. method. Results were compared with those in the literature, leading to some significant conclusions.
We examined the antihypertensive efficacy of: (1) sublingual-oral single doses of captopril (25 mg) and nifedipine-capsules (10 mg) in 9 + 9 white patients and in 9 + 8 black patients with hypertensive crisis; and (2) a single oral dose of the slow-acting preparation of nifedipine-retard (20 mg) in another 10 black patients. Blood pressure (BP) was assessed at 10 min intervals for 6 h after administration. After 6 h, the BP falls induced by these drugs were still significantly lower than the baseline placebo values. Hypotensive effect of nifedipine-capsules was established more rapidly than that of captopril in both white and black patients, and of nifedipine-retard in black patients. Considering the area under the curve of BP values during the 6-h treatment, the overall hypotensive effect of nifedipine-capsules was similar to captopril in white patients, but significantly more pronounced than captopril and nifedipine-retard in black patients. In white patients similar maximal drops of BP (mean+/-s.e.m.) were obtained with nifedipine-capsules (71+/-4/52+/-4 mm Hg) and with captopril (69+/-4/50+/-3 mm Hg). In black patients the maximal drop of BP of nifedipine-capsules (70+/-4/52+/-4 mm Hg) was greater (P < 0.02) than that of captopril (48+/-4/32+/-3 mm Hg) but similar to that of nifedipine-retard (71+/-4/49+/-4 mm Hg). However, in contrast to nifedipine-capsules and captopril, nifedipine-retard produced a slower drop in BP. The time of peak drop in BP of both nifedipine-capsules and captopril occurred within the first 2 h whereas with nifedipine-retard it occurred only between 4 and 6 h after administration. Fewer patients reported side effects with nifedipine-retard as compared with the other two preparations. We conclude that single doses of captopril and nifedipine reduces BP for at least 6 h in both white and black patients with hypertensive crisis, but nifedipine is more potent than captopril in black patients. The slow release form of nifedipine-retard effectively and safely lowers BP while achieving a rapid enough effect without the critical rapid falls in BP that occur with nifedipine-capsules.
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OBJECTIVES: This study evaluated the role of preload reserve in the stroke volume response to exercise in patients with left ventricular systolic dysfunction by assessing the relation between stroke volume and late left ventricular diastolic filling during exercise. BACKGROUND: In patients with left ventricular diastolic dysfunction, the absence of left ventricular distension is the fundamental mechanism explaining the nonaugmentation of stroke volume during exercise. METHODS: In 32 patients with left ventricular systolic dysfunction and 16 healthy control subjects, mitral and aortic velocities were recorded by Doppler echocardiography at rest and during submaximal supine bicycle exercise. Stroke volume, peak early (E) and late (A) mitral velocities, A/E ratio and end-diastolic filling were measured at rest and during exercise. RESULTS: Stroke volume increased significantly in control subjects but did not change in patients. Peak early mitral velocity increased significantly and to the same extent in both groups, whereas peak late mitral velocity and end-diastolic filling increased significantly in both groups but more so in control subjects; the A/E ratio increased significantly in control subjects but did not change in patients. In addition, stroke volume correlated significantly with peak late mitral velocity during exercise in patients (r = 0.72, p < 0.001). CONCLUSIONS: Compared with control subjects, patients with left ventricular systolic dysfunction exhibited limited increases in both stroke volume and late left ventricular filling during exercise. Furthermore, their stroke volume response correlated with the capacity of the left ventricle to increase late diastolic filling, that is, preload reserve.
Twenty-three cases with variations in the brachio-antebrachial arterial pattern of the human upper limb are reported. According to the artery which showed a variation, 4 groups were recognised: (1) isolated persistence of the median artery; (2) high origin of the ulnar artery; (3) high origin of the radial artery; and (4) duplication of the brachial artery, either with or without anastomosis at the cubital fossa. In addition, in groups 2, 3 and 4 the median artery may have persisted. Based on these arterial variations an anatomical and embryological correlation was established from a morphogenetic pattern which is proposed as being normal. Thus the terminal branches of the superficial brachial artery take part in the development of the radial, ulnar and median arteries, joining with the trunks of deep origin of these arteries in the primitive axial artery. Regression of the superficial arterial segments located proximal to this anastomosis gives rise to the definitive arterial pattern. Either the total or partial persistence of the superficial arterial segments explains those cases of high origin of either the radial or ulnar arteries as well as the duplications of the brachial artery. We postulate that the persistence of the median artery is independent of the presence or absence of any other variation in the arterial pattern.
In treating facial aging there are three areas that need to be corrected from a deep to a superficial plane. Thus, different techniques need to be used. In this article we describe our experience in correcting these three areas and a possible solution: the three flaps of the SMAS.
An Echinococcus granulosus genomic library has been screened with a mouse beta-actin cDNA probe. Two clones carrying DNA fragments of about 15 kb, possibly derived from the same genome region, have been isolated. This 15-kb genomic region includes 2 actin-related sequences (EgactI and EgactII) separated by about 4 kb. The nucleotide sequences of both genes were determined. The EgactI sequence presents no introns, but an intron of 591 bp was observed in the EgactII sequence. The genes potentially encode 375 and 376 amino-acid-long actins, respectively, with a homology of 85.3%. The deduced amino acid sequences from both genes were compared to the actin sequences from other organisms, showing similarities ranging from 63.5% to 90.6%. The nucleotide sequence of a partial actin cDNA clone has been determined. The deduced amino acids sequence showed a homology of 90.3% and 88.0% in relation to the EgactI and EgactII sequences respectively, suggesting the existence of at least one more actin gene in E. granulosus. This hypothesis is reinforced by the number of bands detected in the Southern blot analysis. Experiments based on the amplification of DNA segments using 3'-specific actin primers indicate that the EgactI gene is transcribed in protoscoleces.
Two cases with anomalous fascicles in abductor digiti minimi, noted in the course of dissecting 62 adult postmortem forearms, are described. Both fascicles arose from the flexor retinaculum and the antebrachial fascia; one was inserted into abductor digiti minimi and the other on the proximal phalanx of the 5th finger. The anomalous muscles crossed the ulnar nerve and in 1 case also the median nerve. In the 2nd case the palmar nerve to the 5th finger was seen to penetrate the anomalous muscle. The ontogeny, morphology and clinical significance of this anomaly are discussed in relation to previously described anomalies of the hypothenar muscles.
Two cases of arterial variation are described in which the obturator, inferior epigastric and medial circumflex femoral arteries arose from a common trunk from the external iliac artery. A possible ontogenetic explanation is provided.
Mitral annular subvalvar Aneurysms are a very uncommon pathology and almost restricted to Blacks Africans. The authors present three cases, describing their clinical presentation, evolution and complications. The complementary exams are also presented and their relevance in the diagnosis is discussed.
Mitral subvalvar aneurysms are a rare clinical entity and not commonly described in the literature. They are almost exclusive of the black population in the subsaharian Africa. The authors, in a bibliographic revision, present the different etiological theories, the pathology, the pathophysiology, the clinical presentation and discuss the relative value of the different diagnostic tools. The differential diagnosis is also discussed and the more recent methods of medical and surgical treatment presented.
The aims of the study were (1) to describe the consequences of aging and hypertension on left ventricular geometry and physical properties of the aorta, (2) to study interactions between some physical properties of the aorta and left ventricular geometry in normal (NT) and hypertensive patients (HT) using Doppler echocardiography. Forty-five healthy normotensive subjects (age range 21 to 84 years) and 20 untreated sustained hypertensive patients (age range 20 to 70 years) were studied. We measured (1) resting arterial blood pressure with a Dinamap, (2) left ventricular radius (r), thickness (th), mass (LVM), th/r ratio and aortic diameter (AD) by M-mode echocardiography with 2D control, and (3) pulse wave velocity (PWV) in the descending thoracic aorta from aortic velocity tracings recorded by pulsed wave Doppler in the isthmus and near the diaphragm. The PWV/AD ratio was derived. In hypertensive patients, blood pressure, PWV, AD, PWV/AD, th, th/r and LVM were significantly increased compared with normal subjects at a similar age. In normal subjects, PWV, AD, PWV/AD, th, r, th/r and LVM correlated significantly to age. In both groups, th/r ratio was significantly related to PWV and PWV/AD. The Doppler echocardiographic method of PWV measurement is feasible, reproducible and gives similar results to other methods, especially the invasive haemodynamic method. Doppler echocardiography is an adequate method to study left ventricular geometry and some physical properties of the aorta. It can be used to assess the consequences of aging and hypertension on both left ventricle (concentric hypertrophy) and aorta (increase of aortic stiffness).
Superficial musculoaponeurotic system (SMAS) has represented a confusing anatomical structure because descriptions of it in classical treatises of anatomy are contradictory. Also, utilization of this system in facial rejuvenation also does not coincide with the true anatomical facts regarding the superficial musculo-aponeurosis. A macroscopic and histological study of the region was carried out in order to determine the areas of fat deposits and the distribution of the true cervical superficial aponeurosis, partly in accordance with the statements by Jost and leaving aside the concept proposed by Mitz and Peyronie. Cervical liposuction was combined with the techniques for cervicofacial rhytidectomy.
This paper shows how one of the flaps of the SMAS, which is normally eliminated during a facelift as excess tissue, can be folded up and used to improve the projection of cheekbone. The improvement of the projection of this facial area enhances the aesthetic result, when the desired aesthetic result is discreet, in rhytidectomy without having to resort to biomedical material or complex surgical techniques. Our technique, which is safe and easy to handle, simplifies this procedure, providing a long-lasting satisfactory result for both the patient and the surgeon. Our report was done following rhytidectomy on 126 female patients and after an approximately 3-year follow-up.
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