Biomedical subjects
J Moreira
Publications and source records attributed to J Moreira.
Ebstein's anomaly in neonates.
Ebstein's anomaly is a rare congenital heart disease abnormality in which the tricuspid valve leaflets do not attach normally to the tricuspid valve annulus. The effective tricuspid valve orifice is displaced apically into the right ventricle (RV), near the junction of the inlet and the trabecular parts of the RV. The authors present a retrospective study of the patients with Ebstein's anomaly admitted to a neonatal intensive care unit, in the period between January 1993 and March 2000. There were ten patients, representing 0.24% of total neonates and 1.99% of total congenital heart disease admitted to the institution in the same period. Fifty per cent were male and only one case had prenatal diagnosis. Holosystolic murmur (100%) from tricuspid regurgitation and cyanosis (80%) were the most frequent clinical findings. Chest X-ray was abnormal in 90% of the neonates, with a "balloon-shaped" enlarged heart. The main electrocardiographic findings were right atrial enlargement (70%) and arrhythmias (40%). Apical displacement of the septal leaflet of the tricuspid valve, to a maximum of 20 mm, and leaflets tethering to underlying RV myocardium were found in all patients. Tricuspid valve regurgitation was found in 90% (severe form in four cases). An atrial intracardiac shunt, mostly right-to-left, was also found in 50%. Digoxin was used (40%) to restore sinus rhythm. Fifty per cent of the neonates received intravenous prostaglandins. Two patients required a surgical procedure. Two patients died in the neonatal period. During the follow-up period (range 0.3-74.6 months), only one episode of supraventricular tachycardia was recorded. At present seven patients are clinically stable, three of them on medication.
American tegumentary leishmaniasis (ATL) in Rio de Janeiro State, Brazil: main clinical and epidemiologic characteristics.
BACKGROUND: Rio de Janeiro State in Brazil is an endemic area of American tegumentary leishmaniasis (ATL) induced by Leishmania (Viannia) braziliensis. Objective Our purpose was to describe the main clinical and epidemiologic characteristics of the disease in Rio de Janeiro State. METHODS: Patients from endemic areas of Rio de Janeiro State attending the Evandro Chagas Hospital were included in the study. A general physical, dermatologic, and otorhinolaryngologic examination was performed in all patients, as well as a Leishmanin skin test. Skin biopsy specimens were obtained and utilized for touch preparations (stained with Leishman dye), culture in special media (Nicolle, Nevy and McNeal; NNN), and histopathologic examination after hematoxylin and eosin stain. Positive cultures were identified with regard to species by the isoenzyme technique. Therapy with pentavalent antimonial compounds was employed in all cases. Eco-epidemiologic characteristics were studied through regular field visits to endemic foci. RESULTS: Cutaneous disease was present in 87.2% of patients, and mucosal disease in only 12.7%. A single ulcerative cutaneous lesion was the most common clinical presentation. Demonstration of the parasite was always difficult and culture in special media gave the best results for diagnosis. The species involved in transmission was Leishmania (Viannia) braziliensis. Vectors included phlebotomine sand flies (Diptera: Psychodidae) of the genus Lutzomyia, and the most common species was Lutzomyia intermedia, captured mainly on the external walls of houses. CONCLUSIONS: ATL in Rio de Janeiro is mostly a cutaneous disease. In general, the cases showed great sensitivity to antimony. A pattern of peridomestic transmission seems to be the rule.
[Anomalous origin of the left pulmonary artery (Sling): a case report and review of the literature].
Anomalous left pulmonary artery (vascular sling) is a congenital anomaly in which the vascular structure arises either from the posterior surface of the right pulmonary artery, or from the main pulmonary artery and courses to the left lung between the posterior surface of the trachea and the anterior surface of the esophagus. It may cause compression on the tracheobronchial tree. It is a rare condition leading to death in the first months of life, if it is not corrected. Its diagnosis is quite difficult because it usually presents non specific symptoms frequently associated to diffuse tracheal stenosis. The authors present a clinical case of a newborn with trisomy 21 who had a left pulmonary artery sling associated to tracheal stenosis and congenital heart disease (complete atrioventricular septal defect). They review the literature, particular in what concerns embryopathogenesis, the difficulties in establishing the diagnosis and the surgery which must be performed as soon as possible.
Maternal expectations and experiences of labour pain and analgesia: a multicentre study of nulliparous women.
Six hospitals with large maternity units in five different European countries were involved in this multicentre study. At least 100 primiparae for each country were examined. All mothers received two standardized interviews, one during the last month of pregnancy, and one 24 h after delivery. Maternal expectations and experiences of pain, pain relief, and satisfaction with analgesia and childbirth were assessed by a 100 mm visual analogue scale (VAS). Almost all mothers were seen regularly by an obstetrician or a midwife during pregnancy, had prepared childbirth classes and received antenatal information on labor analgesia techniques. Differences between the five groups were noted in the level of education and socio-economic status. Maternal expectations of labor pain and the answers to the pre-delivery interview varied significantly between the centers, as did maternal knowledge, expectation and ultimate choice of analgesic technique. Generally speaking the level of maternal satisfaction with analgesia and childbirth experience was high; however, epidural analgesia was more effective than other methods of pain relief (P<0.0001). The most satisfied mothers were those who expected more pain, were satisfied with the analgesia received and had good pain relief after analgesia (P<0.001).
The open ring. A new imaging sign in demyelinating disease.
Because demyelinating disease of the brain occasionally presents with large ring-enhancing lesions on computed tomography (CT) scans and magnetic resonance images (MRIs), the authors sought to determine whether the ring pattern differed from that found in other common brain lesions with ring enhancement. Published MRI and CT scans of patients with adrenoleukodystrophy (23), and multiple sclerosis or similar demyelinating disorders (21), as well as a variety of tumors (44) and infections (44) matched to the demyelinating lesions by year of publication, in which ring enhancement was evident, were photographed. Photographs without diagnostic identification were presented randomly to two independent observers. The observers rated the contrast enhancement pattern as (1) open ring, with enhancement in the border of the lesion abutting the white matter; (2) closed ring; or (3) uncertain. For all diagnostically certain cases (n = 112), inter-rater agreement was excellent (kappa = 0.75). As an average of the two reviewers, scans for 11 of 132 cases were read as uncertain; 89% of adrenoleukodystrophy cases, 41% of the multiple sclerosis cases, 3% of tumors, and 9% of infections were classified as having the open-ring pattern. Overall, 66% of demyelinating lesions had an open-ring pattern compared with 7% of the non-demyelinating lesions (chi2 = 41.2, p < 0.0001). An open-ring pattern of enhancement is more likely to be associated with demyelinating lesions than with nondemyelinating lesions.
[Dilated myocardiopathy in children: the doubts persist in 1994].
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[Vascular rings: surgical treatment].
From 1982 to 1992, nine patients underwent correction of vascular rings. The diagnosis was strongly suggested by symptoms of tracheoesophageal obstruction and was confirmed by barium esophagogram and angiography. Endoscopic studies were considered unnecessary and potentially harmful. Seven patients had double aortic arch, one patient right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum and one patient anomalous origin of the left pulmonary artery. The anomaly was approached through a left thoracotomy in every patient. There were no operative or late deaths. When patients are symptomatic, vascular rings should be promptly repaired. The surgical risk is minimal, and the long term results are excellent.
Frequencies of chromosomal aberrations in rodents collected in the coal-field and tobacco culture region of Criciúma, south Brazil.
The present work has been accomplished in the basin of the Sangão River (Criciúma, South Brazil), which receives the rejects from coal washing, mainly heavy metals. In the tobacco cultures at the river banks several agrotoxics are used. We tried to detect and estimate the possible action of this environmental pollution on rodents directly exposed to it through the study of chromosome aberration frequency in the bone marrow. The same methodology was applied to rodents collected from a nonpolluted area of the same state (Florianópolis, 190 km from Criciúma). The results obtained showed significant differences in total chromosome aberrations at the different sites. There is therefore a suggestion that this methodology could be applied to detect the action of environmental pollution on organisms.
[Aorto-left ventricular tunnel arising from the left sinus of Valsalva].
Aortic-left ventricular tunnel (ALVT) is a rare congenital anomaly in which an abnormal communication connects the ascending aorta with the left ventricle, bypassing the aortic valve. Usually the ALVT takes its origin from the right aortic sinus. We report a patient with an ALVT arising from the left sinus of Valsalva who underwent surgery at five months of age. The diagnosis was first established by two-dimensional echocardiography.
Antihypertensive action of calcium blockade in hypertensive patients with chronic renal disease.
The concentration of ionic calcium (Ca2+ in the smooth muscular cells of the resistance vessels is a determining factor of their contraction. It depends on the influx of Ca2+ to the interior of the cells through the calcium channels in the sarcolemma. The effect of a specific Ca2+-channel blocking agent - nifedipine - on arterial hypertension in a group of 18 patients with chronic renal hypertension is reported in this study. The combination of nifedipine and propranolol in the control of hypertension in 6 of these patients in a long-term follow-up was also studied. It was concluded: (1) Ca2+ blockade had a rapid and powerful antihypertensive effect in all patients; (2) the antihypertensive effect was higher with high initial blood pressure levels; this fact was especially evident and appeared particularly useful in hypertensive emergencies; (3) in some patients, the action of nifedipine was dose-dependent; (4) nifedipine had a short-lived action; (5) the combination nifedipine-propranolol was efficient in the long-term control of hypertension.
[Characterization of serum concentrations of thyroid hormones in a healthy infantile Chilean population].
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[Treatment of paraquat poisoning. Plasmapheresis versus hemodialysis].
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[Heart catheterization guided by 2-dimensional echocardiography: its importance in the Rashkind technic].
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