Biomedical subjects

Fernanda Silva

Publications and source records attributed to Fernanda Silva.

3 recordsLinked to original sources

PubMed2005

Peritoneal fast transport in incident peritoneal dialysis patients is not consistently associated with systemic inflammation.

BACKGROUND: The determinants of peritoneal fast transport status at the beginning of peritoneal dialysis (PD) are still under debate. The relationship between fast transport status and inflammation or co-morbidity, and its impact on patient survival are not fully elucidated. Our objective was to investigate if fast transport status in incident patients is associated with markers of inflammation and atherosclerosis, and its relationship to patient survival. METHODS: Seventy-three incident patients on PD performed a 3.86% peritoneal equilibrium test (PET) at 4.7+/-2.7 months after starting PD. Doppler carotid wall intima-media thickness (IMT) and the presence of carotid plaque were used as markers of atherosclerosis. C-reactive protein (CRP) and serum interleukin-6 (IL-6) were evaluated as markers of systemic inflammation. Baseline plasma levels of albumin, homocysteine, lipoprotein (a) [Lp(a)] and other lipid parameters were measured. Body mass index and residual renal function (RRF) were calculated. Patients were classified with the Davies co-morbidity score. RESULTS: The dialysate-plasma creatinine ratio (D/P creatinine) was 0.75 +/- 0.10; 26% were fast transporters (D/P > or = 0.85). In comparison with other transport categories, these had similar age, body mass index and RRF, and did not present a higher co-morbidity score than non-fast transporters. IMT did not significantly differ between groups. By multiple regression analysis, baseline peritoneal small solute transport was not related to systemic inflammation biomarkers. Fast transporters did not present higher levels of CRP or serum IL-6. Plasma levels of lipids, Lp(a), calcium x phosphorus product and albumin also did not differ between groups. Similar results were obtained when patients were grouped according to mass transfer area coefficient for creatinine. Patients with more than two co-morbidities had lower levels of plasma albumin (3.6 +/- 0.58 vs 3.9 +/- 0.9 g/dl, P = 0.054), significantly higher median levels of serum IL-6 (19.3 vs 9.2 pg/ml, P = 0.003) and wider IMT (0.90 +/- 0.36 vs 0.65 +/- 0.28 mm, P = 0.017). Multivariate analysis confirmed that baseline peritoneal transport was not a significant determinant of patient survival (P = 0.848), while the co-morbidity score remained significant (hazard ratio = 3.48, 95% confidence interval = 1.29-9.38, P = 0.014). CONCLUSION: Initial fast transport was not associated with systemic inflammation and atherosclerosis. In a population with preserved RRF and absence of baseline serious co-morbidity, it was not predictive of worse prognosis. Other determinants of early peritoneal fast transport deserve investigation.

Biological Transport↗

PubMedDate not supplied

[Reoperation in mitral valve reconstructive surgery].

UNLABELLED: In the past few years reconstructive surgery of the mitral valve has experienced a growing popularity. It is now clearly established that restoration of a normal function valve is preferable to valve replacement. The authors report the results of the mitral valve reconstructive surgery in a population of 701 patients with high incidence of restrictive lesions of rheumatic fever. This represents an experience of 14 years. 5.1% of patients who underwent mitral valvuloplasty required late reoperation for recurrent mitral valve dysfunction. Repeat mitral valve repair resulted in successful treatment for 40% of these patients. CONCLUSION: The mitral valve repair failure are: 1--Procedure related: (58.1%); a--surgical technical related--35.8%; b--no ring implantation (in restrictive lesions)--15%; c-rupture of previously chordae shortened--7.4%. 2--Valve related: (41.9%); a--progressive primary valve disease--(25.4%); b--wrong surgical indication--(15%); c--endocarditis--(1.5%).

Adolescent↗

PubMedDate not supplied

[Results of Dor's endoventricular repair in the management of left ventricular aneurysms].

INTRODUCTION: Left ventricular aneurysms are serious long-term complications from acute myocardial infarction that produce hemodynamic alterations in the cardiac function. OBJECTIVE: The aim of this study is to evaluate the chirurgical and clinic results of the endoventricular patch repair of the akinetic or dyskinetic portions of the left ventricle. METHODS: From August 2002 to October 2005, 20 consecutive patients underwent surgical repair of left ventricular aneurysm using the endoventricular patch repair technique. The mean age was 63,6 years, and 80% where male. Every patient have had only one episode of acute myocardial infarction, which resulted in a akinetic or dyskinetic alteration in the motility of the left ventricle. The preoperative functional class of most of the patients was class III or IV and 45% where on angina class II. In 90% of the patients the ventricular aneurysm where antero-septal. Left ventricular dysfunction was present in 65%. RESULTS: All patients underwent the Dor procedure associated with coronary artery bypass grafting. There was no perioperative mortality. One patient died in the immediate postoperative period. Four patients needed inotropic support for more than 24h and intra-aortic balloon pumping was used postoperatively in two cases. Mean hospital stay was 8,6 days. At late follow-up the functional class was I in 20%, class II in 55% and class III in 10%. The angina class was I in 65% of the cases. CONCLUSIONS: The surgical repair of left ventricular aneurysm using the endoventricular patch repair technique proved to be safe, causing significant clinical improvement and an increase in the ejection fraction.

Cardiac Surgical Procedures↗