Biomedical subjects
Publications and source records attributed to H Pereira.
Myocardial abscesses are a serious complication of infectious endocarditis. A 60 years old male patient with subaortic ring abscess is reported. A fistula developed between the left ventricular outflow tract and the left atrium. Doppler echocardiography was of outmost importance for diagnosis. Surgery was successfully performed.
Multiple coronary aneurysms are rare. We report a case of a 56 year-old patient and make a state of the art on this subject, discussing etiologic and pathogenic considerations versus clinical and therapeutic aspects.
STUDY OBJECTIVE: Characterization of the arrhythmic profile of idiopathic dilated cardiomyopathy (DMC); Evaluation of the relation of complex ventricular ectopy and cardiac dysfunction; Clinical outcome. PATIENTS: We studied 20 patients (P) with idiopathic DCM, 15 males P and 5 female P, mean age 51.3 +/- 17.4 years (between 17 and 75 years). MATERIAL AND METHODS: 24-hours Holter study and left cardiac catheterization with ventriculography were performed. Patients were followed at the consults. RESULTS: We detected in the Holter study the presence of ventricular ectopy in 19 P (95%). Nine P had complex ventricular arrhythmias (45%), 10 P had simple ventricular arrhythmias (50%) and 1 P had no ventricular arrhythmia (5%). The mean left ventricular ejection fraction was 28.6 +/- 14.1% (12 to 44%). Two groups were defined based on the severity of left ventricular dysfunction: Group I with 12 P and Group II with 8 P. In Group I, 8 P had complex ventricular ectopy and, in Group II, 1 P had complex ventricular ectopy (p < 0.05). Comparing mean left ventricular ejection fraction in the two groups of arrhythmias (simple and complex), 33.9 +/- 12.5% and 22.1 +/- 13.8%, we found out a statistically significant difference (p < 0.05). After an eight to thirty six months of follow-up, a greater number of cardiac events (mortality, transplant) were detected in the groups of complex arrhythmia and of more severe cardiac dysfunction. CONCLUSIONS: We conclude that there is a high frequency of ventricular arrhythmias in this group of patients with idiopathic DCM. Complex ventricular arrhythmias were more frequently associated to more severe left ventricular dysfunction. The number of cardiac events at follow-up was higher in patients with complex ventricular arrhythmias and in those with more depressed cardiac function.
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Exercise myocardial-thallium scintigraphy plays a fundamental role in the diagnosis of coronary artery disease. Once exercise is not always feasible, pharmacological stress became a possible alternative. The authors review the mechanism of action, administrations protocols, indications and side effects of the drugs used for this purpose: dipyridamole, adenosine and dobutamine. Dipyridamole causes coronary hyperemia by increasing the interstitial levels of endogenous adenosine. Perfusion defects result from the mismatch of coronary reserve in different coronary territories. The drug administration is classically performed with a 0.142 mg/kg/min dosage e.v. for 4 minutes, total of 0.56 mg/kg. It is possible to use a greater dose of 0.84 mg/kg e.v. for 10 minutes, increasing sensitivity without loss of specificity for diagnosis of coronary artery disease. Oral dipyridamole protocols with 300 and 400 mg were used with similar results for sensitivity and specificity. The oral protocol has the disadvantage of delayed onset and longer action. Including several dipyridamole studies, 87% was obtained for sensitivity and 84% for specificity, in the diagnosis of CAD. Dipyridamole scintigraphy has been applied to myocardial infarction risk stratification, cardiac risk evaluation of patients proposed to noncardiac surgery and therapeutic efficacy evaluation of reperfusion techniques (angioplasty and surgery). The secondary effects of dipyridamole are frequent, however mild and well tolerated. They occur in half the patients, the most frequent, facial flushing (2%), dizziness (5%), nausea (4%), vomiting (1%), headaches (11%) and chest pain (26%). Some important complications were reported although rare: myocardial infarction, ventricular fibrillation and bronchospasm.(ABSTRACT TRUNCATED AT 250 WORDS)
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OBJECTIVE: To assess the coronariographic changes and left ventricular function of a group of young patients (pts) (less than 40 years) with myocardial infarction. DESIGN: Retrospective analysis on clinical data and cineangiography. SETTING: Patients studied in the Cardiology Department and Cardiothoracic Department of the Santa Marta Hospital in Lisbon. PATIENTS AND INTERVENTIONS: Sequential sample of 40 pts 39 male and one female submitted to coronariography after an acute myocardial infarction (mean age--34 +/- 3 years). MEASUREMENTS AND RESULTS: Twenty one pts had one vessel disease, 6 pts two vessel disease, 3 pts three vessel disease, 1 left main disease (2.5%) and 9 normal coronary arteries. More than a half (22) had a lesion on the left anterior descending artery (proximal in 12-30%), 13 a lesion on the right coronary artery (proximal in 3) and 8 on the circunflex coronary artery. There were 22 (55%) total occlusions (3 of the circunflex, 9 of the left anterior descending artery and 10 of the right coronary artery). Of these 8 were proximal. We divided the pts according to the regional contractility score in three groups. Most of them had a moderate decrease in contractility. Three pts had an apical aneurysm and 8 pts had apical discinesia. Three of these 11 pts had no significant coronary lesions, six had one vessel disease and 6 had a proximal lesion of the left anterior descending artery. The mean ejection was 53% and none was less than 30%. There was a statistical difference of score and ejection fraction between anterior and inferior myocardial infarctions (6.5 +/- 1.8 versus 7.8 +/- 1.6 e 48 +/- 11.6 versus 55.4 +/- 10.8), p less than 0.05 and between those with and without a proximal lesion of the anterior descending coronary artery (5.5 +/- 1.5 versus 7.9 +/- 1.5 and 41.4 +/- 7.9 versus 56.3 +/- 9.9), p less than 0.0005. Neverthless, when we tried to separate the pts with or without atherosclerotic lesions (6.9 +/- 1.7 versus 7.9 +/- 2.2 and 50.4 +/- 11 versus 54.8 +/- 14.3) or with and without multivessel disease (7.2 +/- 1.8 versus 6.7 +/- 1.9 and 52.9 +/- 12.2 versus 46.6 +/- 8.7), no statistical difference of score and ejection fraction was found. CONCLUSION: Young patients with myocardial infarction are predominantly males; - There is an important number of one vessel disease and in many patients no coronary significant lesions were found; - The functional changes depended more on the proximal location than on the number of diseased vessels.
During a period of three months, 400 patients with normal kidneys were examined by ultrasound. An evaluation of 14 parameters was made including renal volume (RV), the correlation RV-weight, RV-height, and RV-age of the patients, the quantitative measurement of the renal parenchyma, and the influence of hydration and bladder distension on the sonographic diagnosis of hydronephrosis. In 40 cases, comparison with an additional contrast urography study permitted us to obtain the radiographic magnification index. We present 10 figures including measurement of the absolute parenchymal thickness, parenchymo-sinusal ratio, pyelocalyceal distension and we illustrate the four grades of our hydronephrosis classification.
A retrovirus infecting a Brazilian AIDS patient was isolated and characterized in terms of its reactivity with sera from individuals infected with human immunodeficiency viruses 1 and 2 (HIV-1 and HIV-2). The Western blot analysis revealed that the Brazilian isolate is very similar to the well characterized HIV-1 strain. The serum of the patient from whom the virus was isolated did not react with the 140 kDa envelope glycoprotein specific for HIV-2.
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The authors report a case of congestive heart failure as a consequence of traumatic postlumbar laminectomy arteriovenous fistula. A 49 years old female with the diagnosis of atrial septal defect was admitted at the hospital, complaining of dyspnea and peripheral edema. A hemodynamic study was performed and an arteriovenous fistula was detected between the iliac artery and vein, and arterial septal defect was excluded. Surgery for fistula closure was performed with great clinical improvement.
Myotonic dystrophy may have several cardiovascular abnormalities. We report a case in which the cardiac changes that can be found in this disease. Finally, we make a revision of the cardiac changes that can be found in this disease.