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Biomedical subjects

L R Teixeira

Publications and source records attributed to L R Teixeira.

47 records · Page 3Linked to original sources
PubMed1992

Relationship between pleural changes after myocardial revascularization and pulmonary mechanics.

It is known that coronary artery bypass grafting (CABG) results in impairment of postoperative pulmonary function. There is also a high incidence of pleural changes (pleural effusion or pleural thickening) after CABG. We hypothesized that those patients with pleural changes in the postoperative period would have a greater decrease in pulmonary function test (PFTs) results. The present study reports the results of 110 male patients who underwent CABG. The chest films and the PFT results obtained preoperatively and on the sixth postoperative day were reviewed. The relationship between pleural changes and PFTs was analyzed in patients who received saphenous vein graft alone (SVG group: 50 patients) or in combination with internal mammary artery grafting (IMA group: 60 patients). In the IMA group, the patients who had pleural changes had significantly greater decreases in their pulmonary function than did the patients without pleural changes. The decrease in the FVC, TLC and FEV1 in the patients with pleural effusions (37.6, 27.8 and 36.8 percent) was similar to that in patients with pleural thickening (34.6, 28.3 and 35.0 percent) and both were significantly greater (p < 0.05) than the changes in the patients with a normal radiograph (26.1, 17.6 and 26.9 percent). In the SVG group, the presence of pleural changes was not significantly related to the decrement in pulmonary function. The values of RV, FRC, Cst, and blood gases were not affected in the SVG or IMA group by the presence of pleural changes. We conclude that the presence of pleural changes on the chest radiograph is associated with a larger decrement of pulmonary function after CABG in the IMA group. This larger decrease probably reflects added thoracic trauma and is not due to the presence of pleural changes per se.

Coronary Artery Bypass↗
PubMed1992

Arterial blood gases after coronary artery bypass surgery.

Coronary artery bypass graft (CABG) surgery adversely affects arterial blood gas (ABG) determinations. The purposes of this study were to assess serial changes in ABGs following bypass surgery and identify factors that may influence these changes. Room air ABGs were obtained preoperatively and on days 1, 2, 4, 6, and 8 postoperatively on 125 patients undergoing bypass surgery. Fifty-five patients (saphenous vein grafting [SVG] group) had only SVG grafting while 70 (internal mammary artery [IMA] group) received one (60 patients) or two (10 patients) IMA grafts in addition to the SVG grafts and were subjected to pleurotomy. The mean preoperative values (+/- SD) were as follows: PaO2, 75.1 +/- 7.7 mm Hg, P(A-a)O2, 20.9 +/- 7.5 mm Hg; PaCO2, 33.6 +/- 4.1 mm Hg; pH, 7.43 +/- 0.04; hemoglobin, 14.8 +/- 1.4 g/dl; and hematocrit, 44.2 +/- 3.9 percent. There was a large decrease in the PaO2 postoperatively. The nadir for the PaO2 (55.7 +/- 6.6 mm Hg) occurred on the second postoperative day. Eight days postoperatively, there were still significant abnormalities; the PaO2 was 65.7 +/- 7.3 mm Hg, the P(A-a)O2 was 33.2 +/- 8.8 mm Hg; the hemoglobin was 10.5 +/- 1.4 g/dl; and the hematocrit was 31.7 +/- 4.0 percent. The decrease in the PaO2 was particularly noteworthy given the large decrease in the hemoglobin and hematocrit. The changes in the PaO2 were not significantly correlated with the age, number of grafts, pump time, length of anesthesia, or endotracheal intubation or smoking history. Immediately postoperatively, changes were similar in both groups (p > 0.05); on the second postoperative day, the PaO2 had decreased 26.9 percent in the SVG group and 25.5 percent in the IMA group. However, the postoperative abnormalities resolved more slowly in the IMA group (p < 0.05). These observations suggest that the additional trauma to the lungs and chest wall in the IMA group (pleurotomy, the placing of pleural drains, etc) will result in a longer recovery time in the IMA group than in SVG group.

Carbon Dioxide↗
PubMed1990

Pulmonary clearance of technetium 99m diethylene triamine penta-acetic acid aerosol in patients with amiodarone pneumonitis.

Amiodarone pneumonitis is a serious complication that may lead to fatal lung fibrosis. In an attempt to diagnose this condition as early as possible, the technetium-99m-labelled diethylene triamine penta-acetic acid (99mTc-DTPA) aerosol washout rates of 10 non-smoking normal volunteers (group 1), 10 non-smoking patients on a long-term amiodarone regimen with dilated cardiomyopathy but no congestive heart failure (group II) and 10 patients with amiodarone pneumonitis (group III) were compared. Spirometric measurements, as percentage predicted, were higher in group I than in group III (P less than 0.05). The global mean effective half-lives of 99mTc-DTPA aerosol for both lungs together in minutes were 65 +/- 14, 55 +/- 16 and 27 +/- 4 for groups I, II and III, respectively. Group III values were significantly lower than those of groups I and II (P less than 0.05). Our results demonstrated that amiodarone pneumonitis alters the alveolar-capillary membrane permeability to hydrophilic molecules. The pulmonary clearance of 99mTc-DTPA aerosol is a useful test in the differentiation of patients on a long-term amiodarone regimen without side effects from patients with amiodarone pneumonitis. The test is rapid, easy to perform and has the potential for playing an important role in deciding which patients should discontinue therapy.

Aerosols↗
PubMed1989

[Pneumonitis induced by amiodarone].

Fifteen patients, eleven males and four females, with amiodarone induced pulmonary disease were studied. Their ages ranged between 52 and 79 (mean = 64.0) years. 66% of the patients were taking a daily dose of 200 mg of amiodarone. The time elapsed between the initial dose and the diagnosis of the pneumonitis varied from 2 to 84 (mean = 23.3) months. Premature ventricular beats and recurrent episodes of paroxistic supra ventricular tachycardia were the most common indications for the use of the drug. The most frequent clinical complaints were progressive dyspnea and cough. Weight loss was observed in five patients, fever in six and chest pain in two. The most habitual thoracic physical sign was diffuse crepitation. Chest roentgenograms disclosed bilateral interstitial infiltrates in all patients, associated to pleural effusions in two. An increased diffuse uptake of 67 gallium citrate was observed in the nine patients to whom it was done. Lung function tests showed a pattern of restrictive ventilatory respiratory insufficiency and hypoxemia. Lung tissue specimens were obtained in ten patients, bronchoalveolar lavage in one and pleural fluid in one. The material was examined by light and electron microscopy. Amiodarone was discontinued in all patients and corticosteroids were introduced in thirteen. Five patients (33.3%) died, eight improved and two remained with radiographic scars.

Aged↗
PubMedDate not supplied

Low concentration silver nitrate pleurodesis in rabbits: optimal concentration for rapid and complete sclerosing effect.

Pleurodesis is a useful therapeutic tool when local treatment of a recurrent malignant pleural effusion or pneumothorax is needed. We have previously demonstrated that the intrapleural injection of 0.5% silver nitrate (SN) produces a significant pleurodesis, while 0.25% SN has no sclerosing effect in a rabbit model. The objective of this study was to determine the minimum concentration of SN needed to induce pleurodesis in our experimental model. One hundred twenty male New Zealand white rabbits received 0.3, 0.4, or 0.5% SN (40 animals per group) in a total volume of 2 mL instilled intrapleurally. These animals were sacrificed 3, 7, 14 or 28 days after the intrapleural injection (n = 10 animals per group), and the pleural spaces were then assessed grossly for evidence of pleurodesis and microscopically for evidence of fibrosis and inflammation. By 28 days, all concentrations of SN had produced a pleurodesis. There was evidence of a gross pleurodesis 7 days post-injection in animals that received 0.5% SN (score of 2.8 +/- 0.2 on a scale of 0-4). After 14 days, significant pleural adhesions were evident in the groups that received 0.4 or 0.5% SN. We conclude that SN concentrations as low as 0.3% can effectively produce a pleurodesis within 28 days of intrapleural injection. However, the precocious pleurodesis development observed 7 days after the intrapleural injection of 0.5% SN suggests that this concentration may be optimal when a fast result is necessary.

Animals↗
PubMedDate not supplied

Effectiveness of silver nitrate compared to talc slurry as pleural sclerosing agent in rabbits. Influence of concomitant intrapleural lidocaine.

UNLABELLED: The ideal agent for producing pleurodesis has not been identified. Talc, the most commonly used, poses several problems. Another possibility is silver nitrate, which was widely used in the past. PURPOSE: To determine the influence of the intrapleural instillation of lidocaine in producing a pleurodesis with silver nitrate, to define the effect of lidocaine in the maturation of the collagen fibers, and to confirm that the pleurodesis after silver nitrate is stronger than after talc. METHODS: We studied three groups of 8 rabbits. Two groups received 0.5% silver nitrate; in one we had previously injected 0.5 ml of 2% lidocaine. The third group received 400 mg/kg talc (2 ml). The animals were sacrificed 28 days after the injection, and the pleural spaces were assessed grossly for evidence of pleurodesis and microscopically for evidence of inflammation and fibrosis. The total amount of pleural collagen and the distribution of thick and thin collagen fibers were quantified. Collagen was identified using picrosirius red stain. RESULTS: In the two groups that received silver nitrate (without lidocaine: 3.5 + 03 and with lidocaine: 3.2 + 0.3), the macroscopic pleurodesis (scale 0 - 4) was significantly (p = 0.001) better than that resulting from talc (1.6 + 0.2). The mean degree of pleural fibrosis induced by silver nitrate (3.5 + 0.2) was significantly (p = 0.004) higher than that induced by talc (1.9 + 0.1). The previous instillation of lidocaine resulted in a tendency for decreased amounts of fibrosis (3.1 + 0.4). The mean amount (10(3)mm2) of pleural collagen was significantly (p = 0.009) greater in the rabbits that received silver nitrate (116.9 + 22.7) than in those that received talc (10.7 + 3.4). The injection of lidocaine slightly reduced the collagen (80.1 + 30.3). The distribution of collagen fibers did not differ among the groups. CONCLUSION: This rabbit model clearly confirms that intrapleural silver nitrate is more effective than talc for producing pleurodesis. The previous intrapleural instillation of lidocaine results in a decreasing trend in the amount of collagen, but does not change the effectiveness of the pleural fusion or modify the process of collagen maturation.

Anesthetics, Local↗
PubMedDate not supplied

[Influence of the combination of theophylline and beta 2 agonists by oral route on pulmonary function of patients with chronic obstructive lung disease].

The role of the concurrent use of theophylline and beta-adrenergic agents for relief of bronchial obstruction is controversial. For this reason, we studied the lung function of 9 patients with chronic obstructive pulmonary disease, whose ages ranged from 51 to 69 (average 60.6 +/- 6.6) years, after the oral administration of theophylline and theophylline plus salbutamol. After withdrawal of all bronchodilators for 24 hours, the basal values of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were obtained. Oral slow release theophylline (600 mg/day) was then administered for 7 days, followed by 7 days of the concurrent use of the same dose of theophylline plus salbutamol (16 mg/day). Spirometry was reevaluated at the end of each week. Pretreatment FVC ranged from 0.85 to 2.57 (average 1.78 +/- 0.64) liters, FEV1 from 0.70 to 1.64 (average 1.15 +/- 0.30) liters and theophylline serum levels from 0.1 to 3.1 (average 1.81 +/- 1.01) micrograms/ml. At the end of the first week, FVC was 1.38 to 3.26 (average 2.03 +/- 0.65) liters, FEV1 0.85 to 1.73 (average, 1.40 +/- 0.29) liters and theophylline serum levels 8.1 to 21.0 (average 13.40 +/- 4.18) micrograms/ml. With the concurrent use of theophylline and salbutamol FVC ranged from 1.24 to 2.57 (average 1.90 +/- 0.50) liters and FEV1 from 0.96 to 1.90 (average 1.46 +/- 0.33) liters, values not statistically different from theophylline alone.

Administration, Oral↗
PubMedDate not supplied

[Pneumoconiosis in abrasive industry workers].

Occupational lung disease is uncommon in workers of abrasive industries. Twenty-two workers of these industries presenting radiological lung lesions were analysed. All were males with ages ranging from 29 to 59 years. Nineteen worked in the production of silicon carbide, three in the production of aluminum dioxide and one in both for a period of 8 to 27 years. In 20 patients the predominant radiological changes (ILO-80) were small opacities. Association of small and large opacities was observed in one case and isolated large opacities in another one. The small opacities were predominantly round and diffuse. The large opacities in both patients were classified as being of category B. It is concluded that the workers in abrasive industries are at a higher risk of developing occupational lung disease produced by silicon carbide.

Adult↗