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Biomedical subjects

F Pinto

Publications and source records attributed to F Pinto.

At least 91 records · Page 5Linked to original sources
PubMed1995

Radiological findings in a case of Menkes' disease.

Menkes' disease, a neurodegenerative progressive X-linked disorder, was diagnosed in a 4-month-old child. The diagnosis was made on the combination of clinical features with laboratory and radiological findings. The pathogenesis of the skeletal findings in Menkes' disease is as yet unclear. Because of the severity of the prognosis and in order to plan treatment, the correct diagnosis has to be reached quickly. Typical manifestations of the syndrome are likely to develop after 3 months of age, with a pleiotropic appearance. In the present case, on the basis of the clinical investigation the patient underwent retrograde cystourethrography, roentgenographic examination of the skeleton, and magnetic resonance imaging of the brain. On analysis of the magnetic resonance imaging, we detected one-sided involvement of both subcortical and cortical parenchyma resembling a unilateral ischemic lesion such as, to our knowledge, has not yet been reported.

Brain↗
PubMed1995

[The radiological assessment of the knee in the meniscectomy patient].

The increasing number of radiologic examinations performed on patients previously submitted to arthroscopic meniscectomy led us to analyze the types of lesion most frequently found in these patients and the prognostic factors related to meniscectomy. Thus, the radiographs, CT and MR examinations were reviewed of 34 symptomatic patients submitted to arthroscopy at least 1 year earlier and in whom symptoms had appeared no more than 3 months earlier, thus ruling out the symptoms related to surgical complications. Lesions were found in the menisci, in the meniscal stumps and in the articular ends. The lesions involving the menisci not submitted to previous arthroscopy were not studied in detail. As to meniscal stumps, CT and MRI exhibited the same diagnostic accuracy, in detecting lesion recurrence, in 50% of cases. In the remaining cases their results were similar, with some false negatives (CT) and some false positives (MRI). As to osteoarthritis, MRI proved superior in detecting the microscopic evidence of cartilage-bone erosions even though 20% of patients exhibited findings of such entity as to be visible at CT. As regards the macroscopic evidence of articular ends deformity, CT and MRI yielded the same results. To define the prognostic factors of meniscectomy, all patient was asked to define their activity level after meniscectomy, that is before the onset or recurrence of symptoms. A detailed questionnaire was used to this purpose, using the Tapper-Hoover rating scale, expressly developed to derive a functional knee score after meniscectomy. The results indicate that the functional knee score (related to prognosis) was lower in patients older than 40, in meniscectomy performed in older age, in long intervals between trauma and meniscectomy, after complex and horizontal-cleavage lesions and, finally, in sedentary activity.

Adult↗
PubMed1995

[Abnormal origin of left coronary artery from pulmonary artery].

OBJECTIVE: To assess the frequency and severity of the anomalous origin of the left coronary artery (ALCA) from the pulmonary artery (PA). DESIGN OF THE STUDY: Prospective study of case series between March 1991 and December 1994. SETTING: Referral-based Paediatric Cardiology Department of a Tertiary Care Center. PATIENTS AND METHODS: Five consecutive patients (pts) with anomalous origin of the LCA from the PA; there were three infants aged 4 months and two children one 8 year and one 9 year old. There were three girls and two boys. All pts had clinical and 2D-echo and Doppler investigation prior to cardiac catheterization (CC). Indication for CC was based in the association of symptoms and signs of myocarditis or dilated cardiomyopathy of acute or subacute onset and electrocardiographic (ECG) signs of ischemia in infants. In older patients (pts) diagnosis was suspected mainly from ECG. During CC in all pts, aortograms and when necessary selective coronary angiograms were performed. Surgical correction was performed in all children. In two pts stress exercise ECG and stress Thallium studies before and after surgery were performed. RESULTS: two pts had "adult" an three had "infantile" type of ALCA from the PA. CC was performed and diagnosis was confirmed at surgery in all cases. In one child, correct diagnosis was made by ECO prior to CC and in one case LCA to PA fistula was suspected on Colour-Doppler study. No complications were attributed to CC. Several types of surgery were performed: reimplantation of the ALCA from the PA to the aorta (three pts); tunnel connection of the aorta to the ALCA via the PA (one pt) and left internal mammary to LCA anastomosis (one pt). Two infants died intraoperatively due to extensive myocardial infarction and poor left ventricular function. All the three survivors are asymptomatic after a mean follow up of 34 months. Two oldest pts are currently in New York Heart Association functional class I with normal ECG and improved myocardial perfusion on Thallium scan despite almost total occlusion of LCA at the site of implantation in the aorta as diagnosed on coronary angiogram. CONCLUSIONS: ALCA from PA is associated with major morbidity and mortality. Diagnosis should be suspected in pts with unexplained myocardial ischemia on ECG and even more if it is associated to clinical signs of dilated cardiomyopathy or myocarditis. Careful assessment on ECO and pulsed Doppler and colour flow mapping should make the diagnosis in most cases. Although surgery can be performed based only on ECO diagnosis, we strongly advise for angiography in all cases as in our experience there are false negative diagnosis by ECO. Preoperative Thallium studies can be useful for the selection of the type of surgery as pts with very little viable myocardium will not survive the establishment of a direct systemic to coronary blood flow and may be candidates for heart transplantation.

Abnormalities, Multiple↗
PubMed1995

[New antiepileptic medications].

Progress made in the development of new antiepileptics (AEs) is justified by the high percentage of refractory patients to the available medical therapy (25%), although only a minority of cases are deemed suitable for surgical therapy. Yet, the ideal AE, that is, with a well-known mechanism of action, effective in monotherapy for all epileptic fits, with a perfect pharmacokinetic profile, with no adverse or teratogenic effects, with no drug interactions and available under many formulations, is far from being developed. The new AEs arise either from modification of already marked drug molecules or clinical formulations or from the effectiveness on the excitatory/inhibitory balance of the major neurotransmitters involved in the pathogenesis of seizures, the gamma-amino-butyric acid (GABA) as the inhibitory, and the glutamate (GLU) as the excitatory one. However, the mechanism remains unknown in a few of them. Those new AEs already marketed in Portugal (Vigabatrin), soon to be (Lamotrigine, Oxcarbazepine) or available abroad only (Gabapentin, Zonisamide) are review with special emphasis on their pharmacokinetic profile, side effects, interaction with other AEs, and clinical use. In conclusion, these new drugs have brought a very important advancement in the management of refractory patients, but the development of well-designed comparative trials involving both monotherapy and polytherapy has become important in order to develop useful strategies in the drug management of epilepsy.

Acetates↗
PubMed1994

Involvement of alpha-adrenoceptors in the excitatory effect of the A2 adenosine receptors agonist 5'-N-ethylcarboxamidoadenosine (NECA) on cardiac automaticity in the isolated right ventricle of the rat.

The effects of the non-selective A2 adenosine receptor agonist 5'-N-ethyl-carboxamidoadenosine (NECA) were studied on ventricular automaticity induced by a local injury in the isolated right ventricle of the rat. In concentrations ranging from 0.1 to 100 nM, NECA significantly increased ventricular automaticity. This effect was not apparent when the nonselective alpha-adrenoceptor blocker phenoxybenzamine was present at a concentration of 10 microM, which antagonizes both alpha 1- and alpha 2-adrenoceptors, as well as when rats were pretreated with reserpine. In non-reserpinized rats, the excitatory effect of NECA was also abolished in the presence of the selective alpha 1-adrenoceptor antagonist prazosin, but not in the presence of the alpha 2-adrenoceptor antagonist idazoxan. In reserpinized rats, the excitatory effect of NECA was restored in the presence of the non specific alpha-adrenoceptor agonist phenylephrine as well as in the presence of the selective alpha 1-adrenoceptor agonist amidephrine but not in the presence of the selective alpha 2-adrenoceptor agonist clonidine. These results suggest that the excitatory effect of NECA on ectopic ventricular automaticity is dependent on endogenous catecholamines and that alpha-adrenoceptors of type 1 are, in some way, involved in this effect.

Adenosine↗
PubMed1994

Balloon angioplasty results in increased segmental coronary distensibility: a likely mechanism of percutaneous transluminal coronary angioplasty.

OBJECTIVES: The purpose of this study was to evaluate the hypothesis that the increase in lumen area induced by percutaneous transluminal coronary angioplasty is secondary to a change in lesion (segmental) distensibility. BACKGROUND: Despite the widespread use of coronary angioplasty, the precise mechanism (or mechanisms) of lumen area improvement remains poorly understood. METHODS: Quantitative coronary angiography was used to measure the minimal (contrast agent filled) balloon diameters at 1 to 5 atm, inclusive, during the first and final balloon inflations in 24 lesions successfully treated with coronary angioplasty. To rule out possible confounding effects due to changes in balloon material distensibility during repeated inflations, five control balloons were studied ex vivo. In parallel, intravascular ultrasound imaging was utilized to compare the segmental distensibility (change in lumen area during the cardiac cycle) of eight disease-free and seven mildly diseased coronary segments and seven segments after successful balloon angioplasty. RESULTS: Minimal balloon diameters increased significantly between the first and final inflations (46%, 33%, 26%, 14% and 10% at 1, 2, 3, 4 and 5 atm, respectively, all p < 0.0001), demonstrating an increase in arterial distensibility after successful coronary angioplasty. No significant changes in balloon diameters were observed during sequential initial inflations at 1 and 2 atm (n = 5). Minimal increases in balloon diameters were observed during repeated balloon inflations in the ex vivo studies (4.9 +/- 1% [mean +/- SEM]). A distensibility index, derived from the intravascular ultrasound data, was not different between the balloon-dilated and the normal segments but was significantly lower in mildly diseased sites (14.7 +/- 2.2 vs. 12.9 +/- 1.2 vs. 6.9 +/- 1.9, respectively, p < 0.05) despite a smaller plaque area (7.3 +/- 1 vs. 11.3 +/- 1 mm2, proximal/nondilated vs. dilated segments, respectively, p < 0.05). CONCLUSIONS: Coronary distensibility is significantly impaired in atherosclerotically diseased coronary segments and increases significantly after balloon angioplasty. This increase in segmental coronary compliance after coronary angioplasty may create a larger lumen area by allowing the vessel to distend in response to normal intraarterial pressure.

Adult↗
PubMed1994

Abnormal projection of corticospinal tracts in a patient with congenital mirror movements.

A 31 year-old woman with familial congenital mirror movements not associated with other neurological defects underwent a detailed neurophysiological evaluation including: voluntary electromyographic activity recorded from upper limbs in response to acoustic stimuli, motor evoked potentials from the thenar muscles to focal transcranial magnetic stimulation, F waves from upper extremities, scalp somatosensory evoked potentials and long-latency responses from thenar muscles to electric stimulation of the median nerve. The results were consistent with the presence of fast-conducting pathways connecting each hand motor cortex with both contra- and ipsilateral spinal motoneurones.

Adult↗
PubMed1994

Evidence for a cooperation between adenosine A2 receptors and beta 1-adrenoceptors on cardiac automaticity in the isolated right ventricle of the rat.

1. The effects of the adenosine receptor agonists, 5'-N-ethyl-carboxamidoadenosine (NECA) and 2-[4-(2-carboxyethyl)phenethylamino]-5'-N-ethylcarboxamidoadenosin e (CGS-21680) on ventricular automaticity induced by a local injury in the isolated right ventricle of the rat were studied. 2. In concentrations ranging from 0.1 to 100 nM, NECA significantly increased ventricular automaticity. This effect was more reproducible when the adenosine receptor antagonist 1,3-dipropyl-8-cyclopentylxanthine (DPCPX) was present at 5 nM, a concentration that blocks A1 adenosine receptors. 3. The excitatory effect of NECA was not observed when DPCPX was present at a concentration of 10 microM, which antagonizes both A1 and A2 adenosine receptors, as well as when rats were reserpinized. 4. In reserpinized rats, NECA increased ventricular automaticity in the presence of isoprenaline and the beta 2-adrenoceptor antagonist, ICI-118,551, but not in the presence of the beta 1-adrenoceptor antagonists, bisoprolol or atenolol. 5. The A 2s-selective adenosine receptor agonist, CGS-21680 (0.1 nM-10 microM) was devoid of excitatory effect on ventricular automaticity. Binding studies of this compound to the rat ventricular membranes revealed that in the preparation there was no specific binding. 6. These results suggest that the excitatory effect of NECA on ectopic ventricular automaticity is dependent on endogenous catecholamines and is mediated by an A2 adenosine receptor which is in some way 'linked' to the beta 1-adrenoceptor. These A2 receptors do not appear to be of the A2a adenosine receptor subtype.

Adenosine↗
PubMed1994

[The National Workshop on Defecography: anorectal deformities with a functional origin (prolapse, intussusception, rectocele)].

The nonoperative treatment--i.e., rubber band ligation and sclerotherapy--of mucous rectal prolapse, rectocele and intussusception is much less expensive than conventional surgery (Lit. 325,000 vs. 6,500,000, p < 0.0001 on the average). Symptom relief, however, has been reported in 0 to 57% of cases only, according to current literature. A possible cause is represented by improper management from misdiagnosis, relying on clinical findings only, overestimating mucous prolapse in 36.37% of cases and underestimating intussusception in 14.22% of cases (with respect to defecography). Defecography is a cost-effective method (average cost: Lit. 37,000) potentially reducing failure rate after the surgical repair of rectal prolapse.

Ambulatory Surgical Procedures↗
PubMed1994

[The anomalous pulmonary venous connection. A study of 24 children by digital subtraction angiography].

OBJECTIVE: To assess the accuracy of Digital Subtraction Angiography (DSA) in the demonstration of the morphology of Anomalous Pulmonary Venous Connexion (APVC) in children. DESIGN OF THE STUDY: Prospective study of cases series between January 1989 and July 1992. SETTING: Referral-based Paediatric Cardiology Department of a Tertiary Care Center. PATIENTS: Twenty-four consecutive children with anomalous pulmonary venous connection. METHODS: All pts had clinical and 2D-Echo investigation prior to cardiac catheterization. In all cases selective injections of 0.5 to 1 ml/kg undiluted hypo-osmolar contrast were performed in branch pulmonary arteries and high quality DSA images were recorded. Subtracted images were stored in video and cut films for detailed analysis. RESULTS: 16 pts had total APVC: 11 to Superior Vena Cava (SVC), 2 to Coronary Sinus and 3 to Inferior Vena Cava (IVC). Eight pts had partial APVC: 3 to SVC, 1 to Right Atrium, 3 to IVC (scimitar syndrome), and 1 pt had mixed PAVC. In 8 pts of the whole group, DSA contributed significantly to the final morphologic diagnosis and completed or corrected information obtained by 2D-Echo. In all 18 pts submitted to surgery, the DSA diagnosis was confirmed at operation. CONCLUSION: DSA is a very useful technique (and even more informative in video images) for anatomic evaluation of pts with APVC and has clear indication when clinical and 2D-Echo findings are not typical.

Angiography, Digital Subtraction↗
PubMed1993

Electrophysiological study of neurologically asymptomatic HIV1 seropositive patients.

EEGs, brainstem auditory evoked potentials (BAEPs) and auditory event-related potentials (ERPs) were recorded from 33 individuals infected with the human immunodeficiency virus, type 1 (HIV1+ patients: 13 CDC Class II or III; 20 Class IV). All were neurologically asymptomatic, non-demented, and had a past history of intravenous drug abuse. Sixteen age- and sex-matched normals and 10 HIV1- former drug addicts served as controls. Half of the HIV1+ and HIV1- subjects displayed mild EEG anomalies and, except for one HIV1+ patient, BAEPs were normal in both groups. ERPs were normal in all HIV1- subjects but anomalous (longer latencies of components P2, N2, P3; reduced amplitude of P3) in 9 HIV1+ patients (27%), the incidence of such anomalies being higher for Class IV than Class II/III patients. Auditory ERPs proved the most sensitive and specific of these electrophysiological procedures in detecting subclinical central nervous system involvement in HIV1 infection.

Adult↗
PubMed1993

Percutaneous injection of ethanol to treat autonomous thyroid nodules.

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of sonographically guided percutaneous injection of ethanol for treating autonomous thyroid nodules in order to assess that technique's feasibility as an alternative to traditional ablative (radionuclide and surgical) therapies. SUBJECTS AND METHODS: Thirty-two patients with autonomous thyroid nodules were included in the study: seven had thyrotoxicosis, and 25 were in the pretoxic clinical phase. Ethanol was injected percutaneously on an outpatient basis once or twice a week for a total of three to 10 injections per nodule, mainly depending on the nodule's size. Scintigrams obtained 3 months after the end of treatment were used to assess response to this therapy. The follow-up period was from 3 to 30 months. RESULTS: Thyroid scintigraphy 3 months after percutaneous injection of ethanol showed complete recovery of function in extranodular tissue in 26 patients (81%), partial recovery in five patients (16%), and no recovery in one patient (3%). In all patients, the volume of the nodules decreased by more than 50% after treatment. In three of five patients in whom scintigraphy showed only partial recovery of function in extranodular tissue, a second percutaneous injection of ethanol was given after 15 months. The therapy was well tolerated, and after a total of 216 injections, no patient had permanent side effects. CONCLUSIONS: Our experience shows that percutaneous injection of ethanol is a practical alternative to traditional treatments for autonomous thyroid nodules and that it is an option for treating pretoxic adenoma.

Adult↗
PubMed1993

[Abdominal Doppler ultrasonography in the diagnosis of renovascular diseases. Double-blind prospective study].

Our work was aimed at evaluating the sensitivity and specificity and the positive and negative predictive values of abdominal Doppler US in the diagnosis of renovascular disease. Fifty hypertensive patients (23 men and 27 women) with 100 bilaterally single renal arteries (66 of them normal and 34 stenosed) were studied by means of color (26 cases) and duplex (24 cases) Doppler US. The following US variables were considered in the diagnosis of renal artery stenosis: increased peak systolic velocity in the renal artery, increased ratio between peak systolic velocity in the renal artery and in the aorta, increased parenchymal acceleration time and increased resistive index. Feasibility was 100% for all variables. The general multivariate statistic model of discriminate analysis was used to define three calculation levels, according to: a) duplex vs. color Doppler equipment, b) hemodynamic variables and c) optimal cutoff values. US examinations were performed by a single observer in a double-blind study, before angiography, so as to eliminate interobserver variability. On the whole abdominal Doppler US exhibited optimal specificity and fairly good sensitivity. Specificity increased (94% to 97%) with the use of color Doppler according to the different combinations of variables, but sensitivity remained the same. The calculation including all the Doppler variables increased sensitivity from 73% (with true values) to 93% (with threshold values). The positive predictive value demonstrated that 90% of the renal arteries with increased peak systolic velocity and 100% of those with increased parenchymal acceleration time were stenosed. However, the negative predictive value demonstrated that 15% of the renal arteries with no increase in peak systolic velocity is misdiagnosed as normal. In conclusion, abdominal Doppler US can be used to study renovascular disease patients, but the examination must always be based on different hemodynamic variables and true values.

Double-Blind Method↗
PubMed1992

Monitoring of somatosensory evoked potentials during carotid endarterectomy.

Somatosensory evoked potentials (SEPs) were monitored in the course of 368 carotid endarterectomies (CEAs) carried out in 312 patients. In an initial group of 26 patients the shunt was used routinely while in a second group, involving 342 CEAs, it was applied selectively on the basis of modifications which the SEP underwent during clamping. The criterion for shunting was the progressive reduction, up to 50%, of the N20-P25 amplitude. New postoperative neurological deficits appeared in 6 patients, all of whom displayed a transitory SEP flattening. The SEPs of 2 of these returned to normal by the time they awoke and both showed a clinical deficit homolateral to the operated side. In only 2 cases did the deficit fail to regress completely and their postoperative CT scans revealed ischaemic lesions. A positive relationship emerged between SEP changes and back pressure values; nonetheless, as many as 75% of the patients with low residual back pressure values (less than 25 mmHg) tolerated the clamping. SEP monitoring appears to provide a reliable basis for selectively applying a shunt when there is a high risk of haemodynamic ischaemia during clamping.

Adult↗