PubMed Health⌕ Search

Biomedical subjects

C Machado

Publications and source records attributed to C Machado.

49 records · Page 3Linked to original sources
PubMed1990

[Simvastatin (MK-733), a new HMG-CoA reductase inhibitor, in the treatment of hypercholesterolemia in elderly patients with atherosclerosis].

PURPOSE: To evaluate the efficacy and tolerability of simvastatin, a new and potent HMG-CoA reductase inhibitor, in the treatment of hypercholesterolemia in elderly patients. PATIENTS AND METHODS: Twenty patients, 14 female and 6 male, aged 65 to 72 years (x = 69 +/- 3), with total cholesterol (TC) above 260 mg/dl and triglycerides below 350 mg/dl were studied. All patients presented clinical evidences of atherosclerotic disease and were followed up for 6 months. Monthly visits were required for clinical and laboratory evaluation. The initial dosage of simvastatin was 10 mg/day; dosage was titrated up to 10 mg/day or to a minimum of 5 mg/day in intervals of at least 4 weeks, in order to maintain LDL-cholesterol below 140 mg/dl. To evaluate the changes on plasma lipid levels, the mean value of determinations during the placebo baseline period was compared to the mean value of determinations during the active treatment period. RESULTS: There were significant reductions of total cholesterol (-26.4%), triglycerides (-16.0%), LDL-cholesterol (-35.2%), VLDL-cholesterol (-15.4%), TC/HDL-C (-30.7%), and LDL/HDL-C (-39.5%). There was significant elevation of HDL-cholesterol (+5.2%), although this response was not uniform. The drug was well tolerated: only five patients reported transient clinical adverse experiences that subsided spontaneously. Two patients had elevation of CPK and one of TGP. The drug did not have to be discontinued in any case. Ophthalmological examinations performed before treatment compared to examinations at the end of the study showed no signficant alterations. CONCLUSION: Simvastatin in elderly patients appeared to be a potent TC and LDL-C lowering drug and presented mild but significant effect on the elevation of HDL-C. There was good tolerability, with low incidence of adverse experiences. This fact is important when one considers drug therapy for hypercholesterolemia in this age group.

Aged↗
PubMedDate not supplied

Brain-stem auditory evoked potentials and brain death.

BAEP records were obtained from 30 brain-dead patients. Three BAEP patterns were observed: (1) no identifiable waves (73.34%), (2) an isolated bilateral wave I (16.66%), and (3) an isolated unilateral wave I (10%). When wave I was present, it was always significantly delayed. Significant augmentation of wave I amplitude was present bilaterally in one case and unilaterally in another. On the other hand, in serial records from 3 cases wave I latency tended to increase progressively until this component disappeared. During the same period, wave I amplitude fluctuations were observed. A significant negative correlation was found for wave I latency with heart rate and body temperature in 1 case. Two facts might explain the progressive delay and disappearance of wave I in brain-dead patients: a progressive hypoxic-ischaemic dysfunction of the cochlea and the eighth nerve plus hypothermia, often present in brain-dead patients. Then the incidence of wave I preservation reported by different authors in single BAEP records from brain-dead patients might depend on the moment at which the evoked potential study was done in relation to the onset of the clinical state. It is suggested that, although BAEPs provide an objective electrophysiological assessment of brain-stem function, essential for BD diagnosis, this technique could be of no value for this purpose when used in isolation.

Adolescent↗
PubMedDate not supplied

Hand-assisted laparoscopic nephrectomy in living donors.

Hand-assisted laparoscopic nephrectomy (HLN) in living donors is a minimally invasive surgical modality that uses classic laparoscopic techniques either combined or not with the use of the surgeon's hand as a support tool during renal dissection maneuvers. The purpose of this study was to describe the initial experience with HLN technique in renal donors. Among 58 hand-assisted laparoscopic nephrectomies, the left kidney was removed in 39 donors (67%) and the right in 19 (33%). Surgery time ranged from 55 to 270 minutes (mean 156.9 +/- 49.5). Warm ischemia time ranged from 2 to 11 minutes (mean 4.38 +/- 2.31 min), with an estimated mean blood loss during the intraoperative period of 268 mL. Conversion to open surgery was required for four (6.8%) patients due to a vascular lesion. Upon graft evaluation, we observed immediate diuresis in 56 (96.3%) cases, with a mean serum creatinine on postoperative day 7 of 1.74 +/- 1.61 mg/dL. Renal vein thrombosis requiring graft removal occurred in one (1.7%) patient. Lymphocele was observed in three recipients (5.1%), and urinary leakage due to ureteral necrosis in three cases (5.1%). HLN for living donors is a safe procedure and an effective alternative to open nephrectomy. In this series, the procedure displayed low morbidity after surgery, providing a good morphological and functional quality of the graft for the recipient.

Adult↗
PubMedDate not supplied

[Neuro-cognitive condition of 8 year old children with congenital hypothyroidism treated early].

INTRODUCTION: Congenital hypothyroidism is the most important cause of preventable mental retardation. Since the use of programmes for early detection, mental retardation due to cretinism has been abolished and current investigations seek to detect subtle damage due to foetal hypothyroidism and strategies to minimize such deficits. OBJECTIVE: This study presents the results of neurocognitive assessment of a group of 19 children aged 8 in the Cuban Programme for the early detection of Congenital Hypothyroidism. PATIENTS AND METHODS: The programme is based on the use of umbilical cord serum levels of thyrotropin (TSH), using the Elisa ultramicro method (SUMA) and substitutive treatment with sodium levothyroxine and a programme of neuropsychiatric stimulation until 5 years old. RESULTS: The results showed that the intelligence quotients of children with hypothyroidism were not statistically different from paired controls, and thus demonstrate the efficacy of the programme. On evaluation using computerized techniques for the detection of subtle disorders of the maintenance of attention, deficiencies were found. Analysis of the conventional EEG showed that in 13 cases recordings were normal, 4 had generalized cortical damage, 1 had cortico-subcortical damage and the remainder had signs of focal irritation. On the quantitative EEG, correlation between the attention variables and absolute values (MV2/Hz) were calculated for each derivation and associations found mainly in the right parietal and left frontal regions. CONCLUSION: The effect of stimulating development in these patients is discussed.

Age Factors↗
PubMedDate not supplied

[Subclinical attention changes in transient ischemic attacks in the vertebrobasilar region].

INTRODUCTION: A significant number of patients who have had cerebrovascular illness apparently recover their former abilities completely but return to normal life with subtle cognitive deficits which may affect their daily lives. Such is the situation of patients with transitory ischemic accidents who present with sustained, undiagnosed attention deficits. OBJECTIVES: To identify subclinical alterations due to attention deficits in patients with transitory ischemic accidents, and to contribute to the study of the physiopathological mechanisms involved in the integration of this function. PATIENTS AND METHODS: We examined 44 persons, divided into three groups for this study: one group had vertebro-basilar transitory ischemic accidents, a second group had supratentorial infarct and a third was healthy. All were given a specially designed computerized test of continuous work to evaluate the sustained attention component. RESULTS: Significant differences were found between the transitory ischemic accidents and healthy groups, regarding the variables including correct answers, omissions and indications of attention. This was not seen with the variables involving reaction time and number of errors. This demonstrated the existence of attention disorders involving omission in the group of patients with transitory ischemic accidents. CONCLUSION: These findings suggest the hypothesis that in the vertebro-basilar region there are important mechanisms involved in the process of sustained attention.

Acute Disease↗
PubMedDate not supplied

[Tentorium cerebellum fistula. Diagnosis and treatment].

Among the 17 intracranial dural fistulae treated in the Department of Neuroradiology of the University Hospital of Coimbra (17 patients, 28 embolizations) between 19/10/98 and 20/11/2000, 4 cases (23%) were located on the tentorium cerebelli. Three patients were men aged 45, 53 and 56 years old. The remaining patient was an 85-year-old woman. All 4 patients were treated by embolization. One underwent post embolization surgical interruption of the draining vein. The authors analyse clinical presentation, complementary tests, therapy and outcome.

Aged↗
PubMedDate not supplied

The British version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

We report herein the results of the cross-cultural adaptation and validation into the British language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. A total of 440 subjects were enrolled: 219 patients with JIA (17% systemic onset, 41% polyarticular onset, 33% extended oligoarticular subtype, and 9% persistent oligoarticular subtype) and 221 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the systemic, polyarticular and extended oligoarticular subtypes having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the systemic onset, polyarticular onset and extended oligoarticular subtypes having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the British version of the CHAQ-CHQ is a reliable, and valid tool for the functional, physical and psychosocial assessment of children with JIA.

Adolescent↗
PubMedDate not supplied

[Usefulness of P300 as a tool for diagnosing alterations in sustained attention in ischemic cerebrovascular disease].

INTRODUCTION: Event related potentials, and especially the component P300, can be used to achieve greater precision and sensitivity in the cognitive evaluation of patients. They also enable us to obtain more accurate information about deficiencies in sustained attention, which is a cognitive function associated with the generation of the above mentioned component. Furthermore, the study of disorders triggered off by cerebrovascular disease must be given priority because of the high incidence with which they occur. PATIENTS AND METHODS: We studied four groups of individuals divided according to the localization of the lesion and the etiopatogenic mechanism involved (10 patients with right parietal atherothrombotic infarction, 10 patients with left parietal atherothrombotic infarction, 10 patients with lacunar infarction, 10 paired healthy controls). They were administered a classic test for obtaining P300, which evaluates sustained attention. RESULTS: Patients with cerebral infarction in the right hemisphere presented alterations in the functions evaluated, since they showed more omissions, gave fewer correct answers, the values for latency were significantly increased in Fz derivation and amplitude values were reduced in Pz, as compared to healthy controls. Individuals with left cerebral infarction, however, showed no significant differences with regard to the controls. People with lacunar infarction made less mistakes and omissions, and scored more correct answers than those that had suffered right or left infarction. Their amplitude values were also higher than the values of the individuals with a right lesion in Pz derivation but showed no differences as regards the controls. CONCLUSIONS: These results provide new data on the cognitive mechanisms that are affected during a right parietal lesion and demonstrate the sensitivity of P300 in detecting alterations in sustained attention in individuals that differ as regards not only the localization of the lesion but also the type of etiopathogenic mechanism involved.

Adult↗
PubMedDate not supplied

[Resolution for the determination and certification of death in Cuba].

AIMS: In this paper we report on Public Health Resolution 90, which regulates the determination and certification of death in Cuba. METHOD: Public Health Resolution 90 is of great social importance in our country since it allows the determination and certification of death to be lawfully regulated throughout the whole territory. It is the fruit of over ten years work by a national commission which was set up for that purpose. This resolution includes a series of features that are unprecedented on an international level. By legalising all the aspects linked with the determination and certification of death by means of a ministerial resolution (Ministry of Public Health), and not through a law passed by Parliament, no obstacles are created to prevent it from being reassessed and changed in the future in order to keep up with scientific and technical progress. Unlike most legislation throughout the world, this resolution does not regulate the determination of death, or brain death, linked with organ transplants. In fact, the word transplants does not appear anywhere in the resolution. The clinical and instrumental criteria for determining death were grouped under the heading of the well known true signs of death , but included a true sign based on the irreversible loss of brain functions . Although the irreversible absence of respiratory and circulatory functions, together with the presence of post mortem changes, were included as true signs, the national commission concluded that the death of an individual can only be defined in terms of the irreversible loss of brain functions . The clinical and instrumental criteria for determining death are included in two annexes to the resolution, which must be reviewed from time to time by the National Commission for the Determination of Death, as and when scientific and technical progress makes it necessary to do so. Among the instrumental tests used as a diagnostic aid for the irreversible loss of brain functions and, for perhaps the first time in the world, a battery of tests made up of multimodal evoked potentials and electroretinography has been included. CONCLUSIONS: Public Health Resolution 90 offers the legal framework for regulating the determination and certification of death in Cuba.

Advisory Committees↗
PubMedDate not supplied

[M3 variant leukemia: clinical and diagnostic features].

Acute promyelocytic leukemia represents 5-10% of acute myeloid leukemia cases (AML) recorded in the literature, occurring more frequently in young adults. It has a special clinical and biological behaviour when compared to the other forms of AML, being characterized by a particular morphology of blast cells (M3 in FAB classification), translocation of chromosomes 15;17, and disseminated intravascular coagulation at diagnosis or after the onset of chemotherapy. Within this AML subgroup there are 2 morphological subsets called the hypergranular promyelocytic leukemia and the hypogranular or variant form. We have studied clinical and laboratory aspects of 19 cases of AML M3 out of 217 AML cases, and observed a high incidence of failure to recognize the M3 variant form, although its diagnosis has been mainly based on cytomorphology. Only 4 out of 8 cases of the variant form received in our laboratory were correctly diagnosed, being the other 4 cases wrongly identified as the myelomonocytic subset of AML (M4). Immunophenotyping with monoclonal antibodies using CD2 and CD7 as T cell markers, CD10 and CD19 as B cell markers and CD33, CD13, CD14, CD15 and anti MPO as myeloid markers is a complementary diagnostic tool that permits solving difficult cases. It is important to classify AML correctly because of the special therapeutic and prognostic features of AML M3, which differently from other AML forms, has been successfully treated with cellular differentiating agents.

Adolescent↗
PubMedDate not supplied

[Etiopathogenical and clinical aspects of chronic pancreatitis in San Pablo (Brazil): observations of 80 cases].

The etiopathogeny and clinical aspects of chronic pancreatitis were studied in 80 patients. From the etiological point of view it was observed that 75 out of the 80 patients (93,75%) had had previous intense alcohol ingestion (mean 239.95 +/- 158.34 g of pure ethanol/day) during an average period of 12.5 years. A study of their diet showed that these patients ate significantly more protein than the controls (p less than 0.001). In 2 of the remaining 5 patients, the familiar form of the disease was characterized; in 1 there was a previous history of biliar disease and no etiological factor could be detected. The pathogenic implications of the excessive consumption of alochol associated with a high protein diet, as well as the main clinical characteristics presented by these patients are discussed.

Adolescent↗