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G Carvalho

Publications and source records attributed to G Carvalho.

32 records · Page 2Linked to original sources
PubMed1997

Epidemiology of facial injury in blunt assault. Determinants of incidence and outcome in 802 patients.

BACKGROUND: Facial assault trauma has reached epidemic proportions. While the biomechanics of injury, methods of repair, and general demography of blunt facial trauma are well known, statistical associations between epidemiological factors, incidence, and outcome are poorly understood. OBJECTIVES: To provide a comprehensive epidemiological survey of this patient population. To assess factors determining outcome and pattern of injury. DESIGN: Retrospective review of 802 patients admitted with blunt assault facial trauma. Statistical analysis of associations between epidemiological factors, incidence, and outcome with chi 2 test, 2-tailed t test, and Fisher exact test. SETTING: Urban university and county hospital. RESULTS: Statistically significant associations are demonstrated between gender and the context of assault, incidence of armed assault, presence of fracture, and rate of intoxication at injury. Poor prognostic indicators for outcome include use of tobacco and presence of a mandible fracture. Open reduction and internal fixation were found to bear a higher complication rate only in mandible fractures. CONCLUSIONS: While choice of treatment carries a statistically significant association with outcome, social variables, including gender, tobacco use, intoxication, and low socioeconomic status, produce dramatic worsening of both injury incidence and outcome.

Adolescent↗
PubMed1997

Insulin-independent acute restoration of euglycemia normalizes the impaired glucose clearance during exercise in diabetic dogs.

At rest and during exercise, chronic hyperglycemia, high free fatty acid (FFA) oxidation, and insulin deficiency in diabetes are well known to impair glucose clearance (metabolic clearance rate [MCR]). The effect of acute restoration of glycemia per se on MCR has been less well characterized. We therefore studied normal and alloxan-diabetic dogs both at rest and during exercise, as diabetic hyperglycemic or after acutely induced euglycemia (<160 min) generated by infusion of either insulin or phlorizin. Glucose uptake was similar under hyperglycemic and normoglycemic conditions both at rest and during exercise, indicating a precise balance between the mass effect of glucose and decreased MCR. Rest and exercise MCR was fourfold lower under conditions of hyperglycemia, but insulin-independent restoration of euglycemia improved basal MCR threefold and normalized MCR during exercise. High FFA turnover did not affect glucose uptake but was correlated with plasma lactate concentrations (r = 0.72, P < 0.001), suggesting that muscle fuel requirements are controlled by glucose oxidation and not uptake. We conclude that in alloxan-diabetic dogs, the impaired MCR may be an adaptive phenomenon because correction of hyperglycemia corrects MCR despite partial insulin deficiency and high FFA turnover. We speculate that constant glucose uptake despite hyperglycemia in diabetes may protect the muscle from excessive exposure to glucose.

Animals↗
PubMed1996

Meningiomas of the cerebellopontine angle.

Meningiomas of the cerebellopontine angle (CPA) represent a clinically and surgically interesting entity. The opportunity of complete surgical excision and the incidence of impairment of nerval structures largely depend on the tumour biology that either leads to displacement of surrounding structures by an expansive type of growth or to an enveloping of nerval and vascular structures by an en plaque type of growth. As the origin and the direction of growth are very variable, the exact tumour extension in relation to the nerval structures and the tumour origin can be identified sometimes only at the time of surgery. Out of a series of 230 meningiomas of the posterior skull base operated between 1978 and 1993, data of 134 meningiomas involving the cerebellopontine angle are presented. There were 20% male and 80% female patients, age at the time of surgery ranging from 18 to 76 years, on the average 51 years. The clinical presentation was characterized by a predominant disturbance of the cranial nerves V (19%), VII (11%), VIII (67%) and the caudal cranial nerves (6%) and signs of ataxia (28%). 80% of the meningiomas were larger than 30 mm in diameter, 53% led to evident brainstem compression or dislocation and 85% extended anteriorly to the internal auditory canal. Using the lateral suboccipital approach in the majority of cases and a combined presigmoidal or combined suboccipital and subtemporal approaches in either sequence in 5%, complete tumour removal (Simpson I and II) was accomplished in 95% and subtotal tumour removal in 5%. Histologically the meningiotheliomatous type was most common (49%) followed by the mixed type (19%), fibroblastic (16%), psammomatous (7%), hemangioblastic (7%) and anaplastic (2%) types. Major post-operative complications were CSF leakage (8%) requiring surgical revision in 2% and hemorrhage (3%) requiring revision in 2%. While the majority of neurological disturbances showed signs of recovery, facial nerve paresis or paralysis was encountered in 17%, and facial nerve reconstruction was necessary in 7%. Hearing was preserved in 82% with improvement of hearing in 6%. The variability of tumour extension, the implications and limitations for complete surgical excision are discussed along with the experiences from the literature.

Adolescent↗
PubMed1996

Surgical results for meningiomas of the craniocervical junction.

OBJECTIVE: We have undertaken a retrospective analysis of 38 patients who were operated on for 40 meningiomas of the craniocervical junction between September 1977 and August 1995 to determine which factors influenced resectability, complications, and postoperative outcomes. METHODS: Radiological examinations, clinical data, and operation notes were evaluated, and additional follow-up information was obtained from outpatient examinations, telephone calls, and questionnaires. RESULTS: Four groups could be distinguished according to dural attachment as follows: 1) 15 spinocranial meningiomas originated from the spinal canal and extended intracranially; 25 craniocervical meningiomas of intracranial origin were divided into 2) meningiomas of the lower clivus (10 patients with 11 tumors), 3) lateral meningiomas (11 patients with 12 tumors), and 4) posterior meningiomas (2 patients). Standard midline or lateral suboccipital approaches with opening of the foramen magnum and laminectomy of the involved cervical segments were sufficient for the great majority of tumors. In seven instances only, drilling the posterior third of an occipital condyle was needed. Twelve of 15 spinocranial meningiomas and 13 of 25 craniocervical meningiomas could be removed totally. One patient underwent ventriculoperitoneal shunting only. With a rate of 63% of totally removed and 30% of subtotally removed meningiomas in this region, we observed clinical recurrences for two patients only. Complications were encountered in 30% of patients, predominantly with recurrent and/or infiltrative or en plaque meningiomas. Whereas motor weakness and gait ataxia tended to improve postoperatively, cranial nerve deficits usually remained unaltered. CONCLUSION: The relationship of the tumor to neighboring structures, i.e., the vertebral artery in particular, determines its resectability. We recommend using extreme caution with recurrent or en plaque meningiomas and tumors associated with extensive arachnoid scarring.

Adolescent↗
PubMed1988

Transferrin (Tf) polymorphism in wild rabbit, Oryctolagus cuniculus.

Evidence for two new alleles (TfC and TfD) at the transferrin locus (Tf) in wild rabbit, Oryctolagus cuniculus, is presented. Blood samples were collected in Continental Portugal (178 individuals), and in the Azores Islands of Terceira (52) and S. Miguel (59). The frequency of TfA, which is the only allele detected up to now in domestic rabbits, varied from 0.20 +/- 0.13 to 0.95 +/- 0.05 in the populations sampled in Continental Portugal. In the island populations sampled the frequency of TfA was greater than 0.8.

Alleles↗
PubMed1987

Clinical and epidemiological significance of hepatitis delta virus (HDV) infection in chronic HBV carriers in Portugal.

This study demonstrated that in Portugal HDV infection occurs in 17.3% of HBsAg chronic carriers and chronic HDV infection in 8.4%. As in Northern European countries, HDV infection in Portugal is predominantly found in drug-addicts. Our findings also confirm that HDV infection is associated with an active and progressive liver disease. In delta Ag positive CLD serum HBV-DNA was detected in 10 of 19 cases and was present at low levels. In contrast 52 of 84 delta Ag negative were serum HBV-DNA positive and 48.1% of these had high serum HBV-DNA levels. Ninety per cent of delta Ag positive CLD with serum HBV-DNA positive were drug addicts. These findings indicate that in chronic HDV infection synthesis of HBV is reduced and suggest namely that in drug-addicts their disease derived from the cumulative pathogenic effect of both HBV and HDV. In follow-up biopsy a significantly younger mean age and significantly deterioration of carriers with HDV infection was observed, suggesting that HDV infection accelerates the natural history of HBV related liver disease.

Adolescent↗
PubMedDate not supplied

Epidemiology of facial injury in female blunt assault trauma cases.

BACKGROUND: Etiology of trauma in the female population differs from that of the male population. To date, domestic violence has been researched extensively, but little has been published about the epidemiology of facial injury in the female population. OBJECTIVES: To analyze the differences in the circumstances under which males and females are injured, to identify gender-specific patterns of injury, and to assess whether differences in the demographics, health status, and drug-use profile exist between female and male assault cases and whether these factors lead to a difference in outcome. METHODS: A cohort of 91 female assault cases was compared with a control group of 706 males with similar injuries resulting from blunt assault trauma. Information was gathered by retrospective review of 797 consecutive cases requiring admission for facial injuries resulting from blunt assault trauma. Fisher exact, chi 2, and t tests were used to assess statistically significant differences between the male and female cohorts. RESULTS: The female cohort comprised 12% of all cases admitted for blunt assault facial trauma. One third of female blunt assault facial trauma patients were subjects of domestic violence. Statistically significant differences were found between males and females for the type of assault (rape, domestic violence, altercation, etc) with P < .0001. Females were more likely to be admitted with soft tissue injury only but no fracture (P < .05), less likely to be assaulted with a weapon, and unlikely to be involved in an altercation, gang violence, arrest, or robbery. Females were also less likely than males to be injured while intoxicated (P < .05). Incidence of specific injury patterns and outcomes, however, were similar between the 2 groups. CONCLUSION: The present data support the hypothesis that the female blunt assault facial trauma population represents a distinct epidemiological entity, with significant differences in the circumstances of injury, mechanism of assault, and role of intoxication in the incidence of injury. The prevalence of facial trauma in female assault cases makes it critical for the facial plastic surgeon to be vigilant in the evaluation and treatment of these patients.

Adult↗
PubMedDate not supplied

Discharge of frail older people from acute hospitals across Europe.

Over the last few years the number of elderly patients in acute hospitals throughout Europe has risen dramatically. The pressure on hospital beds leads to earlier discharge and the task of sending patients home from hospitals is becoming more complex. The provision of health and social services is organized in different ways all over Europe. Therefore, it would be of interest to know more about how different kinds of systems support the professional carers in their effort to satisfy the needs which older people and their significant others experience in the discharge process. A pilot study was set up mainly to provide information on what kinds of problems are inherent in a multicentre, interprofessional research project involving a large number of countries. The findings serve as an important knowledge base in a future project. Experiences from the pilot study and the benefits of it are presented.

Aged↗
PubMedDate not supplied

Carcinoma in situ and invasive squamous cell carcinoma associated with schistosomiasis of the uterine cervix a report of three cases.

As part of a mass cytologic screening program, cervical scrapings and endocervical/endometrial aspirations were taken from 1,250 women with systemic schistosomiasis. Ova of S. mansoni were found associated with two cases of carcinoma in situ and one case of invasive squamous cell carcinoma of the uterine cervix. In a fourth case, the ova were associated with a benign cervical lesion.

Carcinoma in Situ↗