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Biomedical subjects

L Figueiredo

Publications and source records attributed to L Figueiredo.

At least 19 recordsLinked to original sources
PubMed2001

Use of stents for small coronary arteries. Results of the Multi-Link 2.5 Portuguese Registry.

INTRODUCTION: Stents are being used with increasing frequency in percutaneous transluminal coronary angioplasty (PTCA) but their use in small vessels is still controversial, due to the possibility of excessively high rates of adverse events and restenosis. OBJECTIVE: To assess the safety and clinical efficacy of ACS RX Multi-Link (ML) 2.5 mm stents, in "de novo" coronary stenosis. DESIGN: Prospective Registry, with 6 months clinical follow-up, involving all Portuguese centers of Interventional Cardiology. POPULATION: Between April 7 and November 20 1998, 102 patients were enrolled, 82 male and with ages ranging from 30 to 86 years (average 58 +/- 11). Clinical presentation for PTCA was stable angina in 53%, unstable angina in 36% and silent ischemia in 11%. There was a history of previous myocardial infarction in 29% of patients. The main risk factors were hypertension (58%), hyperlipidemia (57%), smoking (25%) and diabetes (20%). Multivessel coronary artery disease was present in 46% of patients and left ventricular function was normal in 89%. Of the 217 existing lesions, 188 (87%) were treated: 35 with balloon angioplasty and 153 with stent implantation, 114 of which were ML 2.5 mm: 79 of 15 mm in length and 35 of 25 mm. METHODS: Angiographic success with ML stent implantation and major adverse cardiac events (MACE)--myocardial infarction (MI), coronary artery bypass graft (CABG), new target vessel revascularizations and death--were evaluated during hospital stay, and at 1 and 6 months clinical follow-up. RESULTS: Angiographic success was 97.4%. In one patient it was not possible to cross the lesion, in another there was stent migration and in a third distal coronary flow after stenting was TIMI grade 1. Clinical success was 96.1% and there were no cases of death, Q-wave MI or urgent CABG. Two patients had non-Q wave MI and two required urgent repeat angioplasty. Subacute stent thrombosis occurred in 1 patient. There were no additional MACE at 1 month follow-up. At 6-month follow-up (in 97% of patients) MACE had occurred in 14.1%: 2 deaths (one non-cardiac), 3 MI (one non-Q) and 14 new PTCA (one in a non-ML stent). There was no need for CABG in any patient. Six-month survival rate was 97.9%, 94.9% were free of infarction and 84.8% were free of infarction and new revascularization. CONCLUSIONS: Multi-Link 2.5 mm stent implantation appears to be safe and efficient with a low incidence of immediate and 6-month adverse events in the range of centers and operators of the Registry.

Adult↗
PubMed1999

[The use of Abciximab in patients with acute myocardial infarction undergoing direct percutaneous coronary revascularization].

OBJECTIVE: To evaluate the initial experience, in our Centre, with Abciximab in patients with acute myocardial infarction undergoing direct percutaneous transluminal coronary angioplasty (PTCA). METHODS: Between October 1996 and May 1998, 65 patients (51 males, mean age 56.9 +/- 11 years) underwent direct PTCA for acute myocardial infarction. In thirty-seven patients the myocardial infarction was anterior and 40 had multivessels disease. Mainly to compare the incidence of bleeding complications we considered 2 groups: Group A--17 patients submitted to PTCA without the use of Abciximab, and Group B--48 patients submitted to PTCA and to a bolus followed by a 12 hour infusion of Abciximab. All the patients were treated with aspirin and heparin (5,000 to 15,000 U according to ACT) and ticlopidine in case of stent implantation. RESULTS: Percutaneous coronary revascularization was successfully achieved in 92.3% of the patients. The total number of bleeding complications was ten cases (20.8%) in Group B and 1 case (5.8%) in Group A. Most of the bleeding complications in the Abciximab Group were minor and related to the femoral vascular access site (9 cases--18.7%) and were easily resolved with local measures (8 cases). There were also 3 cases of hematemesis and one of oral bleeding, all well tolerated. Major bleeding complications were identified in only one patient of the Abciximab Group related to the vascular access site, however there was an absolutely similar case in Group A (2% versus 5.8%). CONCLUSIONS: Although bleeding complications were more frequent in patients receiving Abciximab, mostly related to the vascular access site, they were transient and well tolerated.

Abciximab↗
PubMed1997

[A review of infectious endocarditis due to Candida].

OBJECTIVE: As fungal endocarditis is a serious disease, frequently requiring cardiac surgery, a review was made of the experience of our Departments in this pathology. DESIGN: A retrospective analysis of clinical, echocardiographic and surgical data. SETTING: Patients studied in a tertiary care Hospital with cardiac surgery available. PATIENTS: Between 1984 and 1994 there were ten cases of candida endocarditis in nine patients, four male and five female, mean age--45 +/- 12 years (31-65). INTERVENTIONS: The following parameters were analysed: clinical (predisposing factors, clinical evolution, complications, therapy and mortality), echocardiographic (presence of vegetations, abscesses, valvular regurgitations). Patients studied in other Centres and referred to our Department only for examination (echocardiograms) were excluded from this analysis. RESULTS: Eight cases in seven patients were prosthetic valve endocarditis and two native valve endocarditis. No patient was drug addicted. Seven cases of prosthetic valve endocarditis developed less than one year after surgery and another had a gynecological fungal infection as the cause of the endocarditis. Four patients had had previous endocarditis. There were four embolic events and three developed heart failure. There were three perivalvular infections, six valvular regurgitations and only one case with huge vegetations on echocardiography. Nine patients were treated with amphotericin B, in five fluocytosin was added and in four ketoconazol, which was replaced by flukonazol in one patient. Therapy was continued for at least eight weeks. Six patients were operated during the acute stage and one died. One patient was operated on late after the infection. Three patients died during the active stage. In a follow up of 5.2 +/- 4.8 years (8 months to 8 years) there was one fatal candida endocarditis relapse, one fatal candida sepsis, one non cardiac death, one patient developed a periprosthetic leak and one had recurrent systemic embolization. Abscesses/pseudoaneurysms were found in five out of seven patients submitted to surgery. CONCLUSION: Candida infective endocarditis has a bad prognosis, specially in those patients not operated early; it develops in patients with predisposing factors, which in our series were a previous infective endocarditis (four patients) and/or a prosthetic valve implantation less than one year before; it has important morbidity with multiple embolic events, perivalvular involvement, valvular regurgitation and heart failure.

Adult↗
PubMed1995

[Emergency catheterization in a coronary intensive care unit. The diagnostic and therapeutic implications].

OBJECTIVE: to evaluate the diagnostic and therapeutic role of emergency hemodynamic studies, in the coronary intensive care (UCI). STUDY DESIGN: Retrospective study of--patients (P) submitted to emergency catheterization. PATIENTS: 183 P (152 M and 31 F), mean age 56 +/- 11.5 years, admitted to UCI of Hospital Santa Marta and who had cardiac catheterization performed, between October 88 and November 92. METHODS: Patient clinical files were reviewed. We considered the reasons for emergency cardiac catheterization; final diagnosis; complications in the first 24 hours; catheterization role in the therapeutic orientation. RESULTS: Reasons for hemodynamic study were: coronary artery disease (CAD) in 127 P (69%); aortic dissection in 33 P (18%); valvular disease in 19 P (10%) and other in 4 P (3%). Clinical diagnosis was confirmed in 92% and changed in 8% by hemodynamic study results. Left main coronary artery disease was diagnosed in 6.5% of CAD patients. Coronary artery disease was excluded in 5 P with previous CAD diagnosis, in 19 P with aortic dissection and in 11 valvular patients. 32% of P were sent to emergent surgery: 93% ascending aortic dissection and 20% of CAD, 76% of valvular disease. The hemodynamic study was decisive in the therapeutic option of myocardial revascularization in 77% of P with CAD: 39 emergent PTCA (31%), 13 primary (33%) and 14 P oriented to elective PTCA (11%); 26 emergent surgery and 19 P oriented to elective surgery (15%). The emergency cardiac catheterization mortality rate was 0.5%, and the morbidity 2.7%. CONCLUSIONS: The contribution of Hemodynamic Department to UCI was decisive in the diagnostic and therapeutic orientation of critical patients.

Adult↗
PubMed1994

[Controversies and progress in the diagnosis and treatment of benign prostatic hypertrophy. Personal experience].

Historically, non surgical procedures awakened little interest among urologists because surgery represented a definite solution with acceptable morbidity and mortality rates. Currently, the diagnosis and management of BPH is pointed towards a greater understanding of those prostate conditions with a trend to obstruction, using more refined methods to assess the severity of the obstruction, identification of predictive parameters of the therapeutical response, and evaluation of the various treatment alternatives based on safety and cost-efficiency parameters.

Humans↗
PubMed1993

[The complications associated with the performance of heart catheterizations (diagnostic and therapeutic). The results in the Hemodynamics Laboratory of Hospital de Santa Marta].

OBJECTIVES: To evaluate the morbidity and mortality with cardiac catheterization (diagnostic and intervention). DESIGN: Retrospective analysis of complications occurring within 24 h of a cardiac catheterization, in three consecutive years (1989-1991). SETTING: Patients admitted to the Haemodynamic Laboratory of Santa Marta Hospital-Lisbon. PATIENTS: 4014 patients submitted to diagnostic and interventional procedures. MATERIALS AND METHODS: Registry analyze in order to obtain the following data: pathology, age, vascular approach and complications of cardiac catheterization. RESULTS: In three years there were 4014 cardiac procedures. 53.6% were performed in patients with coronary artery disease, 20% with valvular heart disease, 8.1% with congenital heart disease, 16.1% with others pathologies and 2.2% revealed normal vessels in coronary angiography. The incidence of ischemic heart disease was progressively higher in the studied years: 51.9% in 1989, 52.4% in 1990 and 55.2% in 1991. Data from population age showed the same tendency: mean age was 51, 53 and 55 years, respectively. Femoral approach was attempted in 95% of the studies, and the axillary in 2.15%. Complications of diagnostic and interventional cardiac procedures occurred in 3% of the patients. Dead occurred in 0.14%; arrhythmia, 0.37%; vascular, 0.14%; vasovagal/pyrogen reactions, 0.73%; myocardial infarction, 0.05%; and others, 1.58%. CONCLUSION: The diagnostic and interventional cardiac catheterization in experienced laboratories are a safe procedure with a reduced incidence of major complications.

Cardiac Catheterization↗
PubMed1993

[The recurrence of an atrial myxoma in a patient with a mechanical mitral prosthesis--apropos a case].

Recurrence of cardiac myxoma after surgery is an uncommon situation, particularly if a wide excision of the tissue under the tumour has been done. The authors report a case of a 54-year-old male presenting with a left atrial myxoma near the mitral valve, which had to be replaced by a mechanical prosthetic valve during the removal of the tumour. One year later, he was admitted to hospital with persistent fever, weight loss, and congestive heart failure. After a positive hemoculture, intravenous antibiotherapy was initiated, and twice modified because of relapsing fever. Six weeks later, he was transferred to our institution, after an episode of severe acute pulmonary edema. 2D-Doppler echocardiography suggested the possibility of prosthesis dysfunction, revealing a transprothetic diastolic flow with a high peak velocity and moderately elevated pressure half-time. No intra-atrial masses were visualized. Computed tomography was also inconclusive, because of multiple artifacts produced by the prosthesis. These results led to the performance of a cardiac catheterization with contrast ventriculography, which revealed the presence of a transprothetic gradient, and mild mitral regurgitation. The patient was submitted to cardiac surgery, which revealed a recurrent pedunculated left atrial myxoma, with mechanical obstruction of the mitral prosthetic valve. No signs of endocarditis were found. Recurrent cardiac myxomas are reviewed and discussed, as well as the specific problems of the present case, namely the presence of a mechanical prosthetic mitral valve and the initial hemoculture results, with consequent diagnostic delay.

Heart Atria↗
PubMed1993

[Nitrates in unstable angina].

Unstable angina is an acute coronary syndrome between stable angina and myocardial infarction, with different clinical and laboratory features. Angiographically, these patients are more likely to have progression of coronary artery disease, vasospastic phenomena and intracoronary thrombus. Sudden plaque rupture, thrombus formation and the occlusion of an epicardial coronary vessel seem to be the underlying pathological mechanism. Patients with unstable angina are at an increased risk of major complications, especially fatal and nonfatal myocardial infarction, justifying an aggressive therapy in an Intensive Coronary Care Unit with beta-blockers, calcium antagonists and, in particular, nitrates, usually in association. The use of antiplatelet agents, namely aspirin, has been proved to be beneficial significantly reducing the risk of death and myocardial infarction. On the other hand, heparin and thrombolytic therapy are still a matter of some controversy, although the former is largely used in the acute phase. Coronary angiography should be done in all patients refractory to medical treatment to allow further management of the underlying coronary lesions by PTCA or coronary bypass surgery. However, some authors have advised a more aggressive attitude, performing the revascularization in an early phase. Randomized studies have shown that, with surgery, only patients with reduced left ventricular function may improve with the procedure, having a better two-year survival rate. Concerning PTCA, although the complication rate is somewhat higher than in the elective procedure, the probability of late infarction and death is significantly reduced in patients in which there was initial success.

Angina, Unstable↗
PubMed1993

[Inverted papilloma of the urethra].

The inverted papilloma of the urethra is an exceptional entity. It occurs as a smooth surface, sessile tumour located in the prostatic urethra. Microscopically, it is lined with transitional epithelium which is projected inside the tumour, creating strands of cells with normal characteristics. All cases reported up to now have occurred in men aged between 49 and 79. None of the cases had additional urothelial injuries associated. Contribution of a new case of inverted papilloma of the prostatic urethra in a 52-year old male. Transurethral resection of the tumour was the procedure chosen. Evolution was good and no relapse nor further urothelial injuries were observed at the controls carried out over an 8-year follow-up period.

Humans↗
PubMed1993

[Renal leiomyosarcoma].

Presentation of one case of a large, rapidly growing and highly aggressive renal leiomyosarcoma. The diagnostic and therapeutical possibilities of this infrequent tumour are analyzed.

Aged↗
PubMed1993

[Cardiovascular syphilis. Report of 2 cases].

We present two cases of cardiovascular syphilis being one of them a curious case of chronic pericardial effusion associated with cardiovascular complications of lues. In this article we will make as well a review of cardiovascular syphilis.

Adult↗
PubMed1992

[Non-chromaffin non-functioning aortosympathetic paraganglioma].

The paraganglia system is the largest component in the construction of the Disseminated Neuroendocrine System, comprising cells derived from the neural crest, with ability to synthesize and secrete catecholamines, hormones and peptides. A general explanation on the subject with a personal contribution is made.

Adult↗
PubMed1992

[Results of treatment with interferon and vinblastine in renal cancer].

Contribution of our experience with Alpha-2a Interferon and Vinblastine, for the treatment of advanced renal cancer in patients formerly not treated with nephrectomy. Pathoanatomical diagnosis was confirmed by puncture biopsy. None of the 4 patients recruited in the protocol showed objective response. In 2 patients no change was observed and in the other 2 the disease progressed. In surviving patients it was impossible to sustain therapy for more than three months. Treatment was discontinued as a result of the Interferon side-effects, such as fever, myalgia, asthenia and neuritis.

Biopsy, Needle↗
PubMed1992

[Floating thrombus in the left atrium. Apropos of a clinical case].

The authors report a case of floating left atrial thrombus, detected by transthoracic echocardiography, in a 63 years old patient with moderate mitral stenosis and atrial fibrillation. He was admitted to hospital, with supraventricular tachyarrhythmia and pulmonary edema. There was no previous syncope or thromboembolism episodes. Apparently the anticoagulant therapy wasn't interrupted. The diagnosis of the free floating left atrial thrombus was made by two-dimensional echocardiography. Predisposing factors, clinical course and echocardiographic diagnosis are discussed. The risk of prolonged engagement of the thrombus in the mitral orifice, causing syncope or sudden death, justifies urgent surgery associating thrombectomy and treatment of mitral stenosis.

Echocardiography↗
PubMed1991

[Hemodynamic assessment after heart transplantation].

OBJECTIVE: Comparative analysis of the results of the hemodynamic evaluations performed at the preoperative period, during the first week and at the end of the first and second years, after orthotopic heart transplantation. DESIGN: Retrospective study of hemodynamic evaluation of patients submitted to orthotopic cardiac transplantation from April 1987 to April 1990. SETTING: Transplanted patients admitted at the cardiology and cardio-toracic surgery departments of the Hospital Santa Marta. PATIENTS: 15 patients (eleven males and four females) aged 21 to 55 years (mean = 33.3 +/- 10.5), with the preoperative diagnosis: dilated cardiomyopathy in 11, ischemic heart disease in three and hypertrophic cardiomyopathy in one patient. All the patients were on triple immunosuppressive therapy (cyclosporine A, azatioprine and prednisolone) at the time of the first week evaluation. Three of the eight patients evaluated at the end of the first year were with double immunosuppressive regimen (without steroids), seven at NYHA functional class I and one patient at class II. The three patients evaluated at the end of the second year were on triple immunosuppressive regimen and in class I. INTERVENTIONS: We considered, preoperatively (PrOp), at the first week (1W), and at the end of the first (1Y) and second (2Y) years: mean right atrial pressure (RA), systolic pulmonary arterial pressure (PAs), mean pulmonary arterial pressure (PAm), pulmonary capillary wedge pressure (PCW), mean systemic arterial pressure (SAm), cardiac index (CI), pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR). At 1Y and 2y there were also considered the left ventricular end-diastolic pressure (LVEDP) and the ejection fraction (Ej). RESULTS: (table; see text) The results found at 2Y were similar to those showed at 1Y. At 1Y and 2Y LVEDP and Ej were normal. CONCLUSIONS: A high prevalence of mild to moderate hemodynamic disturbances characterizes the early post-operative period in cardiac transplantation. Abnormal pressures on right atrium, pulmonary artery, pulmonary capillary wedge pressure, are found on a significant number of patients, and pulmonary and systemic vascular resistances are also elevated. However at the end of the first year there is a significant improvement compared with the first week. Normality is the hallmark of hemodynamic evaluation performed in transplant recipients at the end of the first and second years.

Heart Transplantation↗
PubMed1990

[Influence of recipient auricular contraction on the left ventricle filling pattern of the transplanted heart studied with pulsed Doppler echocardiography].

OBJECTIVES: to evaluate the influence of recipient atrial contraction (RAC) timing on left ventricular filling pattern (LVFP), assessed by Pulsed Doppler, in orthotopic transplant recipients (OTR). STUDY DESIGN: prospective study of OTR. SETTING: patients (pts) submitted to orthotopic heart transplantation at Hospital de Santa Marta, from April/87 to March/89, in routine evaluation. PARTICIPANTS: nine pts, aged 21 to 55 years (mean = 32 +/- 11), 0.5 to 20 (mean = 7.4 +/- 6.9) months post-operatively. METHODS: in each pt 40 to 60 (mean 52) consecutive cardiac cycles were analysed; five groups (Gr.) were considered, according to RAC (P wave) position in the cardiac cycle: Gr. I--Early systole, GR. II--late systole, Gr. III--early diastole, Gr. IV--late diastole and Gr. V--absent. The following parameters were studied: peak early diastolic mitral flow velocity (Evel), peak late diastolic mitral flow velocity (Avel), ratio Evel/Avel, (E/A) and pressure half time (PHT). RESULTS: 1) Evel and E/A were significantly higher, Avel lower, and PHT shorter, in Gr II and III; 2) Avel was higher and E/A smaller in Gr. IV; 3) no statistically significant differences were found betwenn Gr. I and V, for any of the parameters analised. CONCLUSIONS: the timing of RAC significantly influences LVFP and it must be considered on Echo-Doppler analysis of diastolic function in OTR.

Adult↗
PubMed1990

[Biopsy of the right ventricle endomyocardium. Experience at the Santa Marta Hospital].

OBJECTIVE: To review the experience of Santa Marta Hospital in the right ventricle endomyocardial biopsy technique. DESIGN: Retrospective analysis of the results, diagnostic value and complications of the myocardial biopsies performed between April/87 and March/90. PATIENTS AND INTERVENTIONS: 255 biopsies were performed; 221 on 13 patients submitted to orthotopic heart transplantation (nine male and four female, aged between 21 and 55 years old), and the remaining on 34 patients (22 male and 12 female aged between 15 and 64 years old), mainly on cardiomyopathies. RESULTS: In 221 biopsies performed in heart transplant recipients, we found: 109 with no rejection, 21 with moderate rejection, 57 with mild rejection and only one case showed severe rejection. In this group six biopsies were considered inconclusive. In the group of patients not submitted to heart transplantation the histological findings were inespecific in the great majority of the cases. In the 255 procedures four complications were detected (1.56%), with no mortality; two hemopericardium with tamponade (0.78%), one pneumothorax and one atrial fibrillation. CONCLUSIONS: Endomyocardial biopsy essential for histological diagnosis of acute rejection following heart transplantation has revealed to be a save procedure with a small number of complications.

Adolescent↗