[Late cardiac tamponade after cardiac surgery].
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Adult↗
Biomedical subjects
L F Moreira
Publications and source records attributed to L F Moreira.
Dynamic cardiomyoplasty in the treatment of dilated cardiomyopathy: current results and perspectives.
BACKGROUND: The purpose of this article is to provide an overview of the current indications, results, and perspectives of dynamic cardiomyoplasty in the treatment of patients with dilated cardiomyopathy. Particular emphasis is placed on the clinical experience with 36 patients operated at the São Paulo Heart Institute between 1988 and 1995. METHODS: Based on several clinical reports, the mechanisms of action of dynamic cardiomyoplasty in these patients include the enhancement of left ventricular systolic function, by the direct action of synchronized skeletal muscle flap contraction and the reversion of chamber remodeling. Moreover, both mechanisms seem to be responsible for improved diastolic function properties and for the decrease of ventricular wall stress. Besides the acceptable hospital mortality observed for patients with dilated cardiomyopathy ranging from 0% to 8% with this surgical procedure, clinical improvement after dynamic cardiomyoplasty has been demonstrated as a prevailing and significant outcome. RESULTS: Nevertheless, the 1-year survival for these patients ranges from 82% to 86% and the 5-year survival on the order of 41% to 49%. In addition, the analysis of factors influencing the outcome showed that cardiomyoplasty long-term survival was significantly affected by the severity of preoperative clinical compromise and cardiac function impairment. On the other hand, patients with dilated cardiomyopathy who were operated in functional Class III or intermittent Class IV and with pulmonary vascular resistance below 4 Wood units, present survival rates on the order of 79% at 2 years and of 64% at 5 years of follow-up, which are similar to those reported after cardiac transplantation. CONCLUSIONS: Furthermore, technological advances incorporated in the new cardiomyostimulators may ameliorate skeletal muscle flap performance at long term. Other developments are also discussed in this field.
Cardiomyopathy, Dilated↗
Ischemic preconditioning in myocardial revascularization with intermittent aortic cross-clamping.
BACKGROUND: This study tests the hypothesis that initial brief periods of ischemia can increase the protection obtained by intermittent aortic cross-clamping. METHODS: In the control group (n = 18), the procedure was performed under intermittent aortic cross-clamping at 32 degrees C. Patients in the preconditioned gorup (n = 17) received a stimulus of two 3-minute periods of cross-clamping followed by 2 minutes of reperfusion prior to standard operation. CKMB, troponin 1, adenosine, and lactate were obtained from the great cardiac vein at the onset of cardiopulmonary bypass (CPB), at the end of the first anastomosis, and at the end of CPB. RESULTS: CKMB and troponin I were slightly higher at the end of CPB in the control group, while there was no difference between adenosine and lactate levels. [table: see text]. CONCLUSION: There was no difference between groups in terms of myocardial protection.
Adenosine↗
Myocardial fiber diameter as a good indicator of outcome in Batista's operation.
BACKGROUND: Despite the initial promissory results of partial left ventriculectomy, or Batista's operation, the postoperative mortality associated with the procedure has been too high. We described a histopathologic study performed to identify histological parameters that could help to determine outcomes of patients undergoing this procedure. METHODS AND RESULTS: Myocardial fiber diameter, myocardial fibrosis, thickness of the compact wall, and number of cells presenting from the endocardium to epicardium were analyzed in 32 patients with idiopathic dilated cardiomyopathy who underwent Batista's operation. Data were grouped by patients who died < or = 6 months and patients who survived for > 6 months after the surgical procedure. Additional analyses were performed to compare results according the causes of death and to test the application of these results to biopsy. RESULTS: Myocardial fiber diameter was the only index that could distinguish the two groups. Myocardial fiber diameter < 22 microm distinguished the group of patients who survived the 6-month postoperative period from patients who died during that time with sensitivity of 85.7 and specificity of 72.2. The subendocardial region of the compact wall and the trabecular portion of the wall exhibited comparable results. CONCLUSION: Our results indicate that the myocardial fiber diameter of samples from the trabecular or subendocardial compact wall regions may help predict the outcome of left ventriculectomy. Samples from the trabecular or subendocardial compact wall regions were used for analysis. Further prospective studies involving left ventricular endomyocardial biopsies are necessary to confirm if the use of myocardial fiber diameter in the selection of patients for surgery improves the index of success of Batista's operation. Other factors that are involved remain unclear.
Biopsy↗
[Lymph node metastasis in early rectal tumors].
Sixteen patients with early rectal carcinoma seen between January 1981 and May 1991 have been reviewed to determine the lymph node involvement (histopathological examination of the lymph nodes) and its implications for subsequent treatment. The mean age was 63 years (from 38 to 79; 10 male, six female). The site of the tumor was predominantly in the lower rectum (56.2%). The polypoid and flat-elevated ulcerated (IIa + IIc) subtype were detected in nine and seven lesions respectively. Sphincter-saving techniques were carried out in 62.5% of cases, and only five patients (31.2%) required Miles' operation. Neither postoperative complication nor death were noted. The mean follow-up period was 57 months (6 to 133 months). No recurrence or distal metastasis were found during this follow-up period. The results had shown close relation between the depth of submucosal invasion and IIa+IIc subtype lesions with lymphovascular infiltration. Although this kind of association was not accompanied by an increased number of involved lymph nodes, major surgical resection is suggested in such cases due to the risk of lymph node metastasis when invasion into the submucosa reaches the Sm1c level or deeper.
Adult↗
Biomechanical circulatory assistance. Importance of aerobic capacity of normal and conditioned skeletal muscles.
To define more efficient use of biomechanical circulatory assistance, the contracting and fatigue characteristics of normal and conditioned latissimus dorsi of seven adult mongrel dogs were analyzed. The conditioned muscles underwent vascular adaptation and electrical stimulation with burst frequency of 50 Hz in rates of 60 and 120 contractions per minute for 6 to 8 weeks. They were compared with unconditioned contralateral controls by isometric force measurements. Normal and transformed muscles exhibited the same optimum pacing parameters (burst frequencies from 50 Hz up and train durations from 150 msec) with supramaximal amplitude stimulation. Conditioned muscles showed initial smaller forces (-27%) and longer contraction times (+32%). Fatigue curves of unconditioned muscles for different duty cycles showed marked initial decreases and proportional stable values of force after some minutes, with equal final tension time indexes under these conditions (20 +/- 3 KgF seg/min 100 g). Conditioned muscles maintained stable force for same duty cycles and a greater tension time index during prolonged conditions (68 +/- 6 KgF seg/min 100 g). This study revealed that normal and conditioned skeletal muscles are capable of maintaining steady state work depending upon their aerobic capacity and suggests that these muscles may undergo adaptive transformation while contracting in a synchronous fashion with the heart during variable duty cycles.
Adaptation, Physiological↗
[Thoracic trauma: a rare etiology of total atrioventricular block].
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Adult↗
[Important electrophysiological changes, in subjects with implanted pacemakers, occurring during extracorporeal circulation and with a cardioplegic solution. Experimental study in dogs].
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Animals↗
The De Vega annuloplasty as surgical treatment for tricuspid incompetence.
Seventy-six patients with tricuspid insufficiency associated with other valvular lesions underwent De Vega annuloplasty. There were mitral lesions in 74 patients, aortic valve lesions in eight and atrial septal defects (ASD) in four. The radiographic and electrocardiographic findings and hemodynamic data are reported for 66 patients. Replacement of one or two valves was performed in 56 patients, one or two valves commissurotomy in 21 and closure of the ASD in four. The immediate postoperative mortality was 19.7%. Forty-four patients were followed from six to 59 months. There were three late deaths and clinical conditions were improved in all the survivors except one who presented mitral restenosis. Discrete residual tricuspid incompetence occurred in 11 patients (25%). We conclude that the De Vega annuloplasty is the treatment of choice for functional tricuspid incompetence.
Adolescent↗
[Hamartomas of the lung: surgical considerations in 19 surgically treated cases].
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Adult↗
Assessment of apoptosis in oesophageal carcinoma preoperatively treated by chemotherapy and radiotherapy.
Apoptosis, programmed cell death, was immunohistochemically determined in 55 samples of oesophageal squamous cell carcinoma using the BM1 Mab. Sections from patients not treated (group 1, n = 12) or preoperatively treated by chemotherapy (group 2, n = 11), radiation (group 3, n = 13) or both (group 4, n = 8), and 11 additional cases of high-grade dysplasia or early cancer were examined. Most of the apoptotic cells were BM1-positive and checked by TUNEL proved to be nick end positive. They accounted for 7 (11%), 19 (29%), 21 (32%) and 26 (38%) cells per field in those 4 groups respectively. Chemotherapy and/or radiation significantly increased the number of apoptotic cells as compared to controls (p = 0.029 and p = 0.029, respectively). To assess the implications of the oncogene expression in the apoptotic pathway, additional section stained with bcl2 and p53 were negative for bcl2 and were positive for p53 in 16 samples (37%). Overall, positive cases for p53 mutation showed a significantly decreased incidence of apoptotic cells (p = 0.03). These results suggest that in situ assessment of apoptotic response better correlates to the apoptosis induced by radiation than that by chemotherapy, that abnormalities of the p53 protein decrease the apoptotic response in oesophageal carcinoma, and that immunohistochemical analysis of p53 protein helps to determine the sensitivity to these anticancer agents.
Adult↗
In vivo augmentation of the intratumoral concentration of 5-fluorouracil by cepharanthine--a biscoclaurine alkaloid.
We have investigated the interaction between Cepharanthine (CEP), a multi-functional alkaloid that has the capacity to stabilize the cell membrane, and 5-fluorouracil (5-FU) against a human colon cancer cell line (RPMI 4788) transplanted into nude mice. Their anti-tumor effects were assessed in a group of 7 mice intravenously injected with CEP (5 mg/kg/day) and/or 5-FU (15 mg/kg/day) during a 3-week treatment. The results were compared with a control and a 5-FU group, which received saline solution and 5-FU alone, respectively. The tumors were harvested 2 h after 5-FU administration. On an additional 4 groups of 5 mice, the intratumoral concentration of 5-FU was assessed by a high performance liquid chromatographic (HPLC) method 2, 4, 6 and 12 h following CEP (5 mg/kg) injection 1 h prior to, simultaneously, and 1 h after injection of 5-FU (30 mg/kg). The mean (SD) intratumoral concentration of 5-FU was 0.16 (0.05) mu g/g, 0.32 (0.19) mu g/g, 0.32 (0.16) mu g/g and 0.21 (0.13) mu g/g in the control and the three other groups treated with CEP, respectively. This concentration was about twice as high in mice simultaneously treated with CEP compared to those treated by 5-FU alone. Relatively higher concentrations of 5-FU were noted up to 4 h following 5-FU injection in mice treated with CEP than in those injected only with 5-FU. CEP also enhanced the inhibitory effects of the 5-FU on tumor growth rate.(ABSTRACT TRUNCATED AT 250 WORDS)
Alkaloids↗
Response of adenosquamous carcinoma of the pancreas to interferon-alpha, tumor necrosis factor-alpha and 5-fluorouracil combined treatment.
A 48-year-old woman with a nonresectable pancreatic tumor received combination chemotherapy with cytokines (IFN-a plus TNF-a) and 5-FU. Since partial response was confirmed after seven months, she underwent re-exploration, and received a pancreatico-duodenectomy. Histologically, the tumor was an adenosquamous carcinoma of the pancreas. She recovered uneventfully. However, the tumor rapidly recurred, and she died five months after surgery. Despite the poor result, the survival of the patient with advanced pancreatic cancer for twelve months after the staring of the treatment suggests that combined chemotherapy with cytokines and 5-FU may be a therapeutic modality for advanced pancreatic cancer.
CA-19-9 Antigen↗
Quality of life after cardiomyoplasty.
Cardiomyoplasty has recently been used as a surgical treatment for refractory heart failure, but its results have not been well described in quality-of-life patterns. We studied the quality of life of 14 patients (13 men, with a mean age of 43.3 +/- 7.4 years) submitted to this procedure for treatment of dilated or ischemic cardiomyopathies. They were approached by personal, structured interviews before and 13 +/- 9 months after the procedure, focusing on the following areas: physical activity, food and sleep patterns, working status, social activity, sexual activity, psychologic state, and perceptions and expectations about the treatment. The presence of limitation descriptors (discomfort, disability, and dissatisfaction) was recorded for all patients. The results showed an important decrease in limitation of physical activity, sleep pattern, social activity, and perceptions and expectations about the treatment. These findings suggest that cardiomyoplasty may improve the quality of life of a selected group of patients.
Activities of Daily Living↗
[Synchronous and metachronous tumors of the colon and rectum].
Three hundred and seventy-two patients with colorectal tumours treated by curative resection between January 1982 and January 1992 were reviewed in order to determine the role of colonoscopy and the outcome of patients with multiple tumours. Thirty (8.1%) of them with a mean age of 57 (35-79) years (20 males, 10 females) had synchronous (19 cases) or metachronous (11 cases) lesions. Rectum and sigmoid colon were the most frequent site of multiple lesions, accounting for 73% of all lesions. Accurate pre-operative diagnosis was performed in 14 of the 19 patients with synchronous lesions, and in the remaining 5 cases failure to perform an intra-operative colonoscopy was the cause of missing the lesions. Three of them had over-looked lesions on the previous barium enema. Synchronous lesions has the tendency to be less invasive as compared to metachronous ones. Five-year survival rates (Kaplan-Meier method) were 45% and 58% for patients with multiple and single lesions respectively (not significant). For patients with colorectal carcinoma a thorough examination of the whole colon by intra-operative colonoscopy should be accomplished in order to rule out the possibility of associated lesions as well as to decrease the incidence of "early" metachronous lesions.
Adult↗
[Resection of colonic sessile polyp by strip biopsy].
Sessile polyps of the colon can present difficulties when being resected by the usual method of polypectomy. Strip biopsy has been reported as effective to accomplish the resection of semipedunculated or sessile lesions. In this paper we confirmed the efficacy of strip biopsy to perform the resection of a sessile polyp of the colon.
Biopsy↗
Anti-proliferative and cytokinetic effects of tumor necrosis factor-alpha, interferon-alpha and 5-fluorouracil on a human tumor xenograft.
We have previously reported that interferon-alpha (IFN-alpha) and tumor necrosis factor-alpha (TNF-alpha) blocked the cell cycle progression of cancer cells at the S to G2 transition, causing a synergistic antitumor effect. In this study, the combined effects of both these cytokines and 5-fluorouracil (FUra) on tumor growth and cell cycle progression were investigated in a human colon cancer cell line, RPMI 4788, transplanted in CD-1 nude mice. Daily administration of IFN-alpha and TNF-alpha for 21 days markedly suppressed the tumor growth and induced cytokinetic alterations in which S phase cells were increased and cells in G2/M phase were decreased. FUra added to these cytokines further suppressed tumor development but did not affect the cytokinetics further. Combination of FUra and cytokines in a low dose, either of which alone had no effect, suppressed the tumor growth. These findings demonstrate that IFN-alpha, TNF-alpha and FUra have a distinct antitumor effect in combination.
Animals↗