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Biomedical subjects

J F Correia

Publications and source records attributed to J F Correia.

At least 19 recordsLinked to original sources
PubMed1999

The natural history of closed mitral commissurotomy--a 20 year follow-up.

AIM: To study the natural history of mitral stenosis in a Portuguese population submitted to closed commissurotomy. METHODS-POPULATION: All the patients submitted to closed mitral commissurotomy in Pulido Valente Hospital. The commisurotomies were performed from 1956 to 1978 and included a total of 1,134 patients (220 males). Based on the clinical records, we studied the baseline characteristics of all the patients (n = 1134) at the time of surgery. An average of 20 years after surgery, we sent a questionnaire to all these patients. The patients who filled out the questionnaire (n = 352) represented the total Population in terms of the principal clinical characteristics. Based on these answers, we studied the long-term results of closed commissurotomy. RESULTS: Closed commissurotomy was performed before the age of 20 in about 10% of the patients and after the age of 49 in only 1.6%. The initial symptoms occurred at 22.0 years and commissurotomy was performed at 30.4 years (averages). The procedure was successful: 99% of patients improved significantly after commissurotomy and two thirds had major or total improvement. CONCLUSIONS: In the natural history of these commissurotomized patients the events were early, with symptoms in their twenties and surgery in their thirties. The events occurred earlier in males than in females. Closed commissurotomy presented, in this study and with these patients, very good results with improvement in 99% of the patients. The positive results the commissurotomies were important and long lasting: there was a low rate of re-intervention (16%) and hospitalization (35%) twenty years after surgery and 53% of the patients are still alive. These good results can be, at least in part, explained by the low age of this population at the time of surgery.

Adolescent↗
PubMed1997

Analysis of the role of nitric oxide in the relaxant effect of the crude extract and fractions from Eugenia uniflora in the rat thoracic aorta.

This study has evaluated the possible role played by the L-arginine-nitric oxide pathway in the vasorelaxant action of the hydroalcoholic extract from Eugenia uniflora, and fractions from the extract, in rings of rat thoracic aorta. The addition of an increasing cumulative concentration of hydroalcoholic extract from E. uniflora (1-300 micrograms mL-1) caused a concentration-dependent relaxation response in intact endothelium-thoracic aorta rings pre-contracted with noradrenaline (30-100 nM). The IC50 value, with its respective confidence limit, and the maximum relaxation (Rmax) were 7.02 (4.77-10.00) micrograms mL-1 and 83.94 +/- 3.04%, respectively. The removal of the endothelium completely abolished these responses. The nitric oxide synthase inhibitors N omega-nitro-L-arginine (L-NOARG, 30 microM) and N omega-nitro-L-arginine methyl ester (L-NAME, 30 microM), inhibited the relaxation (Rmax) to -10.43 +/- 7.81% and -3.69 +/- 2.62%, respectively. In addition, L-arginine (1 mM), but not D-arginine (1 mM), completely reversed inhibition by L-NOARG. Methylene blue (30 microM), a soluble guanylate cyclase inhibitor, reduced the relaxation induced by the extract to 14.60 +/- 7.40%. These data indicate that in the rat thoracic aorta the hydroalcoholic extract, and its fractions, from the leaves of E. uniflora have graded and endothelium-dependent vasorelaxant effects.

Alcohols↗
PubMed1996

[Pharmacological stimulation with dipyridamole in thallium-201 myocardial perfusion scintigraphy: a study of the secondary effects].

To evaluate the safety of intravenous dipyridamole thallium-201 imaging as an alternative to exercise thallium imaging in the evaluation of coronary artery disease, clinical data from 140 patients were retrospectively analyzed. Adverse effects were experienced by 39 patients (27.9%) with a total number of 52 effects: chest pain (23), dizziness (13), headache (7), nausea (7), dyspnea (2). All patients presented complete relief of symptoms. In 15 patients administration of aminophylline was necessary. Major effects (fatal and non fatal myocardial infarction and acute bronchospasm) were not registered. Vital sign data change observed after infusion of dipyridamole was: decreased blood pressure and increased pulse rate. Patient's age and incidence of coronary artery disease did not differ significantly in the subgroup of patients with adverse effects versus the group of patients without it.

Adult↗
PubMed1996

[Amiodarone and the lung].

The pulmonary toxicity induced by amiodarone is one of the major complications that can limit the use of this potent antidysrhythmic agent. The authors perform a bibliographical revision concerning the toxic effects of amiodarone in the lung, pathogenesis, clinical, radiologic and pathologic features, diagnostic problems, risk factors and prognostic data.

Amiodarone↗
PubMed1995

[Acute and chronic sequential atrioventricular pacing in patients with obstructive-type hypertrophic myocardiopathy resistant to medical therapy].

An evaluation was undertaken regarding two female patients suffering from obstructive hypertrophic cardiomyopathy, with high and strongly symptomatic gradients, as well as evidencing a resistance to medication with beta-blockers, verapamil and disopyramide when administered in maximal doses. These patients were provided with the implant of a definitive type DDD pacemaker, with an auricular electrocatheter placed on the right auricular appendix, and with a bipolar ventricular catheter placed on the apex of the right ventricle. The generator was programmed with a short AV so as to ensure that the ventricular stimulation would at any given time be the result of the ventricular contraction would be initiated at the apex portion of the right ventricle. With these therapeutics, we observed not only a reduction or even the gradient, but also the complete elimination of the existing symptoms--angor, dyspnea, dizziness, palpitations and fainting--with the resulting normalcy of the quality of life of the patients. All taken into account we are of the opinion that these therapeutics are, in the case of patients suffering from obstructive hypertrophic cardiomyopathy, a valid alternative for surgical treatment by means of myectomy or myotomy, but without the morbidity and mortality rates presented by such methods.

Adult↗
PubMed1992

[The use of diuretics in heart insufficiency in the elderly].

The kidney function alterations with age and on congestive heart failure, are reviewed as the pharmacocynetic and pharmacodynamic of the diuretics on old patients with this syndrome. The therapeutic importance of hiposodic diet was considered. The reasons for the susceptibility of old people to diuretics and the criteria for the choice of the diuretic on this age, are reviewed. So are the most important adverse effect of diuretics on old people and the contra-indication for the use of these drugs on elderly. The importance of hypocalaemia on old people and how to prevent or correct it are considered. The haemodynamic risks of an excessive diureses are reviewed. Finally, we propose some recommendations about the use of diuretics on the elderly.

Aged↗
PubMed1992

[Treatment of heart insufficiency in the elderly with converting enzyme inhibitors].

The main objectives of the treatment of Congestive Heart Failure are the improvement of quality of life and the reduction of mortality. Both are accomplished by the ACE inhibitors. The most important trials on the effect of ACE inhibitors on the improvement of the quality of life are reviewed. Trials about the reduction of mortality with ACE inhibitors are analysed. The sudden death problem was considered and so the relationship of this with ventricular arrhythmias. The recent evidence of a beneficial effect of captopril was reported. At last we analyse secondary effects of these drugs on the treatment of Heart Failure in old patients.

Aged↗
PubMed1992

[What is the value of myocardial perfusion studies with isotopes in patients with complete left bundle branch block?].

The prognosis of left bundle branch block is determined by associated cardiovascular disease. Exercise electrocardiography is not helpful in detecting ischemia in these patients. Exercise thallium-201 scintigraphy has been widely accepted for that purpose. The authors made an overview of several studies suggesting that exercise thallium-201 scintigraphy has low specificity regarding left anterior descending coronary artery disease. They also review the mechanisms of perfusion defects in patients with left bundle branch block without coronary artery disease. One important question to be clarified is weather small defects are unrelated to coronary artery disease. Finally the authors analyse a few methods to increase diagnostic accuracy of perfusion scintigraphy in left bundle branch block. First the employment of a new criterium that requires the apex to be abnormal to indicate left anterior descendent artery disease. Second Pharmacological Stress with Dipyridamole or Adenosine. Third imaging with Tc-99m-MIBI.

Adenosine↗
PubMed1992

[Effect of converting enzyme inhibitors in cardiac insufficiency mortality in the elderly].

In a retrospective study we analyse two populations of aged patients in congestive heart failure, one treated with ACE inhibitors other not and the other with conventional therapy. Both populations received the same medication (diuretics and digitalis) and are equivalent in age, sex distribution, NYHA functional class and echocardiographic left ventricular parameters. Comparing the mortality of the two populations at the first, second and third year of follow-up, a statistically significant reduction in mortality was found on the ACE inhibitors treated population, at the first year. However, this reduction did not reach statistical significance at second and third years. The results are similar to trials in which the effects of ACE inhibitors are studied on general populations in heart failure.

Aged↗
PubMed1992

[Specifying for the general physician. Digitalis therapy in elderly patients].

The experimental and clinical evidence on the decreased efficacy of digitalis on old age are reviewed. The trials on the efficacy of digitalis on elderly in heart failure and sinus rythm, are analysed and we try to characterize the sub-group of responders. So we try to explain the criteria to choose the therapeutic dose, to avoid intoxication and to interpret the seric concentrations. We describe the pharmacocynetics of digitalis on old people on heart failure which can explain the susceptibility to intoxication. We reviewed the incidence of digitalis intoxication on old age and the difficulties on its recognition.

Aged↗
PubMed1992

[Morpho-functional characteristics of the heart in the elderly].

Alterations in cardiovascular structure and function with advancing age are reviewed. The difficulty to distinguish between aged related alterations and those due to coronary disease are analysed. The results of the studies in which coronary disease are excluded are compared with those in which that situation was present. Cardiac output, systolic volume and peripheral vascular resistence are the differences. The physiological adaptations of the heart to effort are analysed. The adaptation of the heart to effort is quite different according to Coronary Disease have been excluded or not on the population.

Aged↗
PubMed1992

[Heart surgery in the elderly].

The literature of the last five years is reviewd to evaluate the mortality and morbidity of the cardiac surgery (valve replacement and aorto-coronary by-pass, single or combined) in comparison with other patients. There is some slight increase in mortality and morbidity of these patients, depending on of non cardiac causes. Cardiac surgery can improve the quality of live and increase life expectancy of these patients, but the results are influenced by age. On the surgery of valve replacement is important to avoid the funcional deterioration, because the mortality on classe IV is very high. The results of aorto-coronary by-pass on the elderly are not influenced by the coronary anatomy on these ages. The mortality is slightly increased on the majority of the published results. Urgent surgery has a very high mortality on theses ages. The perfection of the surgical techniques and a carefull post-operative care are essencial factors for a good result.

Aged↗
PubMed1991

[Therapy of cardiac insufficiency with angiotensin converting enzyme inhibitors. New concepts-new strategies].

The treatment of heart failure has two main objectives: the improvement of the quality of life and the decrease of cardiac mortality. The first has been proved on several open studies and placebo controlled studies, using converting enzyme inhibitors. Mortality of these patients is very high and half is by sudden death. It has been proved, by several important studies, that these drugs can reduce the cardiac mortality probably acting on the arrhythmogenic mechanisms and on the structural deterioration of the heart.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1991

[Therapy with antiarrhythmic agents in cardiac insufficiency].

The antiarrhythmic drugs characteristics are generally inadequate for the treatment of arrhythmics in heart failure. The pharmacokinetics and pharmaco dynamics of these drugs on heart failure are also altered conditioning its clinical use with a need for tayloring of therapeutics doses. Drug interaction and pro arrhythmic effects are also possible cause of difficulties. That must be considered according with the information about the pro arrhythmic effect of each drug. There is no consensus about how choose these drugs. The published therapeutic antiarrhythmic regimens are variable: monotherapy with amiodarone or propafenone and drug association regimens with type 1 drugs sometimes with beta-blockers. The efficacy of invasive or non invasive oriented drug therapy for the suppression of ventricular arrhythmics and reduction of mortality is generally accepted. When there is a great decrease of ejection fraction mexiletine and amiodarone are generally recommended. More recent information considers that treatment of "potentially malignant arrhythmias" are not justifiable.

Anti-Arrhythmia Agents↗
PubMed1989

[Non-digitalis inotropic agents in the treatment of congestive heart insufficiency].

The action mechanisms of the inotropic agents are reviewed: adrenergic stimulants, dopaminergic agents, phosphodiesterase inhibitors direct adenylcyclase stimulants. The hemodynamic effects of these drugs are compared. According with the items proposed by Braunwald e Colucci the inotropic agents are classified. The therapeutic effect is concluded from the published randomized trials placebo. The value of these drugs on the therapy of Congestive Heart Failure is discussed.

Cardiotonic Agents↗