PubMed Health⌕ Search

Biomedical subjects

L S Piegas

Publications and source records attributed to L S Piegas.

At least 19 recordsLinked to original sources
PubMed1994

[Infective endocarditis in children and adolescents].

PURPOSE: To assess infective endocarditis (IE) predisposing factors, etiologic agents and hospital course in infants and adolescents. METHODS: We Studied 222 patients admitted under compatible IE diagnosis, from 1985 to 1990. The population of this study is fifty patients (23%) under 16 years of age. RESULTS: Rheumatic valvular disease, as predisposing cardiopathy was proeminent within 9 to 16 years of age, markedly Statistical difference when compared to age range of 0 to 8 years (p < 0.05). Among congenital cardiopathies, the most frequent were: interventricular septal defect (26.0%) and tetralogy of Fallot (21.7%). Blood cultures, surgical material or emboli cultures were positive in 35 (70.0%) assessed patients. Streptococcus viridans (45.7%) and Staphylococcus aureus (42.8%) were the etiologic agents most often isolated. It was found that endocarditis by Staphylococcus aureus had mortality rate of 53.3% [(clinical (66.6%) and surgical (44.4%)], (p < 0.05) when compared to those by Streptococcus viridans; with total mortality of 6.2% (no clinical death and 16.6% in the surgical group). Total in-hospital mortality (clinical and surgical) was 26.0% (13 deaths). CONCLUSION: IE in infants and adolescents in this studied population presented Streptococcus viridans responsible for 46.7% of patients with endocarditis and the Staphylococcus aureus for 42.8% were the etiologic agents most often found. Total, clinical and surgical mortality was greater in patients with endocarditis by Staphylococcus aureus when compared with those by Streptococcus viridans. Among the congenital cardiopathies, whether operated on or not, ventricular septal defect and of Fallot's tetralogy were the most involved ones; rheumatic cardiopathy Still remains a significant predisposing factor to infective IE in our country.

Adolescent↗
PubMed1992

[Surgical management of the aortic valve in patients older than 70 years of age].

PURPOSE: To assess the short and long-term benefits of patients who were submitted to isolated aortic valve replacement or valve replacement (VR) concomitant myocardial revascularization (MR); to evaluate the incidence of postoperative complications, hospital mortality and late mortality. METHODS: From January 1985, through December 1989, 20 consecutive patients underwent surgical intervention, 15 male (75%) and 5 female (25%), the mean age was 74.8% (ranging from 70 to 86 years old), and the aortic valve gradient ranged between 78 and 180 mmHg (mean = 97 mmHg). They presented preoperative diagnosis to have either isolated aortic stenosis (AS) or As and coronary artery disease (CAD). No patient was in NYHA functional class I; 3 patients (15%) were in class II, 14 (70%) in class III and 3 (15%) in class IV. RESULTS: The most frequent post-operative complications found were: extended intubation in 7 patients (35%), bleeding in 4 (20%), acute renal failure in 3 (15%) and ventricular arrhythmia in 3 (15%). Hospital mortality occurred in 2 patients (10%) who had been submitted to VR and concomitant MR. Late mortality occurred in 1 patient (5%). Through December 1989, 11 patients (64%) were in functional class I (NYHA), 3 (18%) in class II, 3 (18%) in class III and none in class IV. CONCLUSION: We concluded that the surgical treatment is indicate to elderly patients with isolated AS os with AS and concomitant CAD. There was a significant post-operative improvement of the functional class (NYHA) to the surviving patients.

Aged↗
PubMed1992

[The importance of the early diagnosis of infectious endocarditis in an aortic prosthesis by transesophageal two-dimensional Doppler echocardiography].

A female patient, 21 years old, was submitted to surgical treatment of severe aortic insufficiency. She was doing well until the 9th postoperative day, when she presented sepsis and an embolic cerebrovascular attack. The transesophageal echo-Doppler-cardiogram showed paraprosthetic abscess and vegetations, that were not seen on the transthoracic echo-Doppler-cardiogram performed one day before. We are convinced that the findings on the echocardiogram were very important for the good results obtained by the prompt surgical procedure.

Adult↗
PubMed1992

[Unstable angina: comparison of the effects of diltiazem and propranolol].

PURPOSE: To evaluate the effects of diltiazem and propranolol in patients with unstable angina. METHODS: Fifty-six patients with unstable angina, mean age of 55.4 +/- 8.5, 41 men and 15 women, were evaluated in a randomized, double-blind study of two groups of patients treated with diltiazem or propranolol at total daily doses of 180 mg and 120 mg respectively during the first 48 hours. After that the total daily doses was adjusted to 240 mg and 160 mg, respectively, until the 7th day. The first 48 hours, four times daily, clinical evaluation, CKMB data, ECG were obtained and two times daily until 7th day. A coronary arteriography was done on study entry. RESULTS: A significative reduction of angina crisis number, duration, intensity and the number of sublingual nitrates doses were observed equally in both groups. The SAP, DAP, HR and RR did not show statistical differences between groups. Individual groups analysis showed significative reductions of SAP, DAP and HR in propranolol group. The CKMB data, ECG alterations and coronary arteriography characteristics were similar. CONCLUSION: Both drugs were effective for the unstable angina treatment.

Angina, Unstable↗
PubMed1990

[Infective endocarditis. Prospective Doppler-echocardiographic study].

PURPOSE: To study of the Doppler-echocardiographic aspects in patients with IE and its correlation with the prognosis and evolution. PATIENTS AND METHODS: One hundred and eight patients with clinical of IE were prospectively studied by Doppler-echocardiography (D-E) in order to determine whether the simple presence of vegetation, its size, mobility and place of attachment could identify high risk groups. Vegetations were classified according to its size (longest axis) into small (veg less than 5 mm), medium (5 mm less than veg less than 10 mm) and large (veg less than 10 mm); according to its kind into "sessible" or "mobile" and according to its appearence into "cotton like" or "calcified". RESULTS: Patients with (84.2%) and without (15.8%) vegetations didn't show any significant difference in the complications incidence (emboli, heart failure or death) and the same happened with its size. However, patients with aortic positioned vegetations showed ligher incidence of HF (Aortic 53.8 x Mitral 31.0% x Tricuspid 3.7%) need for surgery (Aortic 69.2% x Mitral 34.5% x Tricuspid 3.7%) and death (Aortic 30.7% x Mitral 13.7% x Tricuspid 7.4%). Emboli were observed in 81.4% of the patients with tricuspid valve vegetations. Eight patients showed IE on aortic prothesis. Five of them needed surgical treatment and 2 of them died. Among 12 patients with IE on mitral prothesis, 7 needed surgery and 3 died. Pericardial effusion were verified in 51 patients (47.2%), chordal rupture in 14 (12.8%) and valve abcess in 6 (5.5%). All patients with valve abcess were submitted to surgery. CONCLUSION: Doppler-echocardiography is an excellent method in the diagnosis of IE and its aspects may have, sometimes, a positive correlation with the prognosis and patient's evolution.

Adolescent↗
PubMed1990

[Acute myocardial infarction in patients under 40 years of age].

PURPOSE: To evaluate the short and long-term prognosis of a group of patients aged 40 and under, who developed an acute myocardial infarction. PATIENTS AND METHODS: In the last 15 years we studied a group of 73 patients aged 40 and under with a confirmed diagnosis of first acute myocardial infarction. Patients with infarctions caused by coronary embolisms or to revascularization procedures were excluded. RESULTS: Ninety percent were male and mean the age was 35. The most frequent risk factors observed were cigarette smoking in 64 (88%), hypertension in 16 (22%), hypercholesterolemia in 12 (16%) and diabetes in 3 (4%). Seven (9%) patients had no risk factors. The myocardial infarction was anterior em 50 (68%) cases and inferior in the remaining 23 (32%). Severe heart failure (Killip III and IV) was present in 3 (4%). Angiographic studies were performed in 63 (86%). Cineangiography showed critical coronary lesions (obstruction greater than 70%) in one vessel in 38 (60%) patients, multivessel disease in 18 (28%) and 7 (12%) had normal coronary vessels. In-hospital mortality was 5% (3 patients died due to severe heart failure and 1 due to cerebro-vascular accident). The 56 survivors were followed-up to 15 years, with overall survival of 74%. Fourty-nine (71%) were asymptomatic and 7 (10%) had recurrent chest pain. There were 7 (10%) late deaths and follow-up was lost in 6 (9%). Reinfarctions were observed in 5 cases (7%). Revascularization procedures were performed in 12 (17%) patients (bypass-graft surgery in 9 and coronary angioplasty in 3). CONCLUSION: Young patients with acute myocardial infarction have a low mortality rate in the early phase and a favorable outcome after the discharge of the hospital.

Adolescent↗
PubMed1990

[Use of coronary angioplasty in acute myocardial infarction without previous use of thrombolytic agents. Analysis of 201 patients].

PURPOSE: To evaluate the experience with the use of primary PTCA in the set of acute myocardial infarction (AMI) without the previous administration of thrombolytic agents. PATIENTS AND METHODS: Two hundred and one patients with AMI, aged 35 to 86 years (mean = 57.2). There were 83.5% men. Twenty patients were older than 70 years and 48.2% had an anterior AMI. PTCA was performed early in the AMI, with a delay no longer than 12 hours. In 95%, it was done solely to the infarct related artery. Seventy percent patients were in Killip class I, 21% in class II, and 8% in classes III and IV (more than 50% of this subset of patients were in cardiogenic shock). RESULTS: Primary success was achieved in 84.5%. In hospital mortality was 5.9%, and there were 7% reinfarctions. Among the 84 patients who underwent a late cinecoronariography study, there were 19% restenosis and 8.3% reocclusions. In the long term follow up 75% were asymptomatic. Repeat PTCA was required in 10.2% of the cases, late coronary surgery was performed on 10.8% of the patients, and post-hospital cardiac mortality was 8.8% during an average follow up of 28 months (range 2-72 months). CONCLUSION: Primary PTCA is a effective way of reperfusion in the AMI, with a high primary success, low complications rate and without any major contraindications.

Adult↗
PubMed1989

Results of cardiopulmonary resuscitation in a cardiology hospital.

The authors analysed a series of 557 consecutive patients who suffered cardiorespiratory arrest at the Dante Pazzanese Institute of Cardiology (DPIC) during a period of 5 years in order to examine factors predicting successful resuscitation and long-term survival. Cardiopulmonary resuscitation (CPR) maneuvers were tried in 536 patients, with the following results: 284 patients (53%) died immediately, another 102 (19%) died within the first 24 h after the cardiac arrest and 150 patients (28%) survived more than 24 h. Among these, 65 (12.1%) died in the first month after cardiac arrest and other 29 (5.4%) died after that period. There were 43 late survivors (8%). Thirteen patients (2.4%) were lost to follow-up. After 9 years, the accumulative life expectancy was 8.7%. Coronary heart disease, cardiomyopathy and valvular heart disease were the most frequent underlying diseases. None of the 49 patients with cyanotic congenital heart disease survived. The heart arrest was mostly caused by heart failure (55.8%) and primary arrhythmia (17.2%) in the whole group, whereas the survivor group showed primary arrhythmia in 81.7% and heart failure in 7.3%. In those patients where the initial mechanism of cardiac arrest was ventricular fibrillation, 33.2% survived more than 1 month, while among those on ventricular asystole, only 3.4% survived more than 1 month.

Brazil↗
PubMed1989

[Use of isosorbide-5-mononitrate in acute myocardial infarction].

Isosorbide mononitrate in a dose of 20 mg t.i.d. was used in 25 patients admitted few hours after acute myocardial infarction. The following parameters were analysed: systolic and diastolic blood pressure, heart rate, clinical features, and laboratory data. Heart rate and diastolic blood pressure remained unchanged, however systolic blood pressure was slightly reduced (p less than 0.01). There was a reduction in the angina episodes post-AMI. None of the patients included in the study had clinical deterioration or showed infarction extension. There were no changes in laboratory data. After the interruption of the drug, one patient died on the 6th day with acute mitral insufficiency. In conclusion, isosorbide mononitrate can be safely used during an uncomplicated acute myocardial infarction, without the risk of haemodynamic deterioration, and helps to prevent post-infarction angina.

Adult↗
PubMed1988

Transient platelet aggregation as a mechanism of unstable angina. Aggressive treatment with coronary angioplasty.

Decreased oxygen supply rather than increased demand may be the primary pathogenic mechanism of myocardial ischemia in patients with unstable angina. Coronary artery spasm and in vivo platelet aggregation may play an important role in the mechanism by which the magnitude of fixed obstruction secondary to coronary atherosclerosis is transiently exacerbated. In this case report, we describe a patient who developed chest pain accompanied by ischemic ECG changes during coronary arteriography, due to a transient thrombotic aggravation of a fixed, significant coronary stenosis. Percutaneous transluminal coronary angioplasty was performed with relief of the coronary stenosis and of the symptoms.

Angina Pectoris↗
PubMed1988

[Shock lung].

Explore the source record for details and available documents.

Animals↗