Biomedical subjects
Publications and source records attributed to M Carvalho.
Studies show that patients' recall of their CCU stays is extremely limited due to various factors. To monitor patient satisfaction in this area, a team of CCU managers developed a survey and began an "All-Out Recovery Program."
In October 1995 the UK Committee of Safety of Medicine (CSM) issued a warning about the safety (thromboembolic disease) of the third generation oral contraceptive steroids (OCS) recommending a switch to older agents except where women were intolerant of first and second generation OCS. Advice by the Irish regulatory authority (Irish Medicines Board) did not recommend such a switch. This pill scare lead to some UK users stopping OCS mid-cycle and a rise subsequently in abortions and pregnancies was noted. To determine whether local or UK advice was followed we obtained data from the General Medical Service (GMS) Scheme on the use of contraceptive steroids prescribed before and after the CSM's warning. The results show a clear shift from usage of the third generation OCS to the second generation OCS and norgestimate-containing OCS. We have also noted a marked fall in the overall use of the combined OCS, a trend that was noted in the U.K. It is clear that prescribers and pill users were influenced more by advice from the UK than by Irish regulatory authority. There is now a centralised European mechanism to licence drugs in the European Union (EU). We need to develop an EU perspective to issues of drug safety, as constituent nations are no longer isolated islands.
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The purpose of this study was to determine the angiogenic profile of human esophageal carcinomas. The expression of vascular endothelial growth factor (VEGF) was examined in 6 esophageal carcinoma cell lines and 119 human esophageal carcinoma tissues by Northern blot analysis and immunohistochemistry, respectively. Immunohistochemistry using antibodies against CD34 (endothelial cell specific) was carried out on archival specimens, and microvessels were quantitated by counting vessels in a x200 field in the most vascular area of the tumor. All of the cell lines constitutively expressed VEGF mRNA at various levels. A total of 71 of 119 (59.7%) tumors showed intense VEGF immunoreactivity in the cytoplasm of cancer cells. Vessel count was significantly higher in the VEGF-positive tumors than it was in the VEGF-negative tumors. VEGF expression correlated with the depth of tumor invasion, tumor stage, venous invasion, and lymphatic invasion. The survival rate of patients with high vessel density in the tumor was significantly worse than that of patients with low vessel density in the tumor. There was a tendency for poorer prognosis in the group with VEGF-positive tumors compared with that of the group with VEGF-negative tumors. Overall, these results suggest that VEGF is associated with tumor progression by stimulating angiogenesis in human esophageal carcinoma.
The study examines a possible association between increased nuchal translucency thickness at 10-14 weeks of gestation in monochorionic twin pregnancies and the subsequent development of severe twin-to-twin transfusion syndrome (TTS). In 132 monochorionic twin pregnancies, including 16 that developed severe TTS at 15-22 weeks of gestation and 116 that did not develop TTS, crown-rump length, nuchal translucency thickness and fetal heart rate were measured at 10-14 weeks. In those that developed severe TTS, the prevalence of nuchal translucency thickness above the 95th centile of the normal range and the intertwin difference in nuchal translucency thickness and fetal heart rate were significantly higher than in the non-TTS group; there were no significant differences between the groups in the inter-twin difference in crown-rump length. For fetal nuchal translucency above the 95th centile, the positive and negative predictive values for the development of TTS were 38% and 91%, respectively; the likelihood ratios of nuchal translucency above or below the 95th centile for the development of severe TTS were 4.4 (1.8-9.7) and 0.7 (0.4-0.9), respectively. These findings demonstrate that the underlying hemodynamic changes associated with TTS may manifest as increased fetal nuchal translucency thickness at 10-14 weeks of gestation.
In 6644 singleton pregnancies resulting in live births, the fetal heart rate was measured at 10 to 14 weeks of gestation (median 12). There was no significant association between fetal heart rate and birthweight. These findings demonstrate that if there is an association between fetal heart rate, birthweight and subsequent development of cardiovascular disease the responsible intrauterine insult and/or the adaptive fetal response are not present at 10 to 14 weeks of gestation.
Airline passengers, seafarers and islanders are three different examples of people who can benefit from telemedicine. However, the peculiar characteristics of each group require different applications. In 60 years of activity, the CIRM has assisted more than 37,000 patients. In the 10 years from 1986 to 1996 the Centre provided radio medical assistance to 7647 patients, of whom 6981 (91.3%) were sailors, 642 (8.4%) were people living in isolated areas (small italian islands) with few medical facilities, while only 24 patients (0.3%) were airline passengers. In the same period, the telecommunication service received or transmitted almost 80,000 medical messages.
We describe the case of a patient with restrictive cardiomyopathy due to primary amyloidosis associated with aging. The patient had a complex myocardial function. A brief review is made of the etiology, diagnostic procedures and therapy of this clinical entity, which is an important rare cause of cardiac death in elderly patients.
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The high incidence of abortion in Brazil and the increased use of misoprostol among women having clandestine/unsafe abortions has led to an interest in evaluating whether there is an association between the use of misoprostol and the incidence of septic complications post-abortion. To test this association, a retrospective cohort study was conducted with 1840 women treated post-abortion at the Instituto Materno-Infantil de Pernambuco (IMIP) between 1988 and 1992. Incidence of infection (4.2%) was lower in women stating they had used misoprostol than in those stating that the abortion was not induced (7.9%) and twelve times lower than in women stating that they had used other methods (49.4%). These results suggest that misoprostol is a safe, inexpensive method for inducing abortion, and leads to fewer complications and consequently shorter hospital stays. Misoprostol should be considered a viable option in situations where induction of abortion is legal or medically indicated.
We report three patients in whom the initial diagnosis was of possible A myotrophic lateral sclerosis (ALS/MND) according to the 'El Escorial Criteria'. All of them presented with monomelic paresis, atrophy of the paretic muscles and generalised brisk reflexes. The initial electromyograms showed a neurogenic pattern in the limbs with normal sensory and motor conduction velocities. Laboratory evaluation and imagiological investigations were normal in all of them. The previous diagnosis was changed in to demyelinating motor neuropathy with conduction block in 2 patients and tomaculous neuropathy in one after clinical and electromyographic follow-up and nerve biopsy. Patients 1 and 2 were given intravenous immunoglobulin treatment and showed moderate improvement.
Neurocardiogenic syncope seems to be the most common cause of syncope. It is believed to be triggered by paradoxical autonomic reflexes, beginning in the ventricular mechanoreceptors of the heart, modulated by the brain stem and terminating in the autonomic efferent pathways (parasympathetic stimulation with bradycardia or asystole and sympathetic inhibition with severe hypotension). Tilt test has been used recently, as a safety and effective tool to identify subjects prone to syncope. Although the pathophysiology of this syndrome is not completely understood, pharmacological therapeutics seems very effective in resolving symptoms.
OBJECTIVE: To evaluate the reliability of urine carnitine concentrations measured in single postprandial samples, compared with carnitine concentrations measured in 24-hour urine samples. ANIMALS: 19 healthy Beagles. PROCEDURE: After emptying the urinary bladder by catheterization, dogs were fed a canned canine maintenance diet. Approximately 8 hours later, urine, plasma, and serum samples were obtained for determination of urinary carnitine fractional excretion and urine carnitine-to-creatinine concentration ratio. Results were compared with 24-hour urinary carnitine excretion rate. RESULTS: Fractional excretion of carnitine and urine carnitine-to-creatinine ratios correlated poorly with 24-hour urinary carnitine excretion. CONCLUSION: Determination of 24-hour urinary carnitine excretion is recommended to measure urine carnitine concentrations in dogs.
In amyotrophic lateral sclerosis the striated pelvic floor sphincter muscles are functionally uninvolved, and pathological studies have confirmed the relative resistance of the Onuf nucleus motor neurons. We have evaluated the external anal sphincter (EAS) muscle in 16 patients with ALS using single fiber EMG, and compared the results with the findings in the semimembranosus-semitendinosus (SM-ST) muscles that have innervation from the L-5, S-1, and S-2 segments. The results were compared with a group of controls matched for age and sex. None of the patients or controls had symptomatic sphincter involvement and none of the 4 women studied were parous. Eight patients with ALS showed an increased fiber density in the EAS; 6 had an abnormal neuromuscular jitter. In 1 there was fibrillation in the EAS. In the SM-ST muscle 11 patients showed an increased fiber density, and 7 had an abnormal neuromuscular jitter. In 3 patients with ALS in whom there were abnormal findings in the EAS the bulbocavernosus reflex and pudendal nerve evoked potentials were normal. Neurogenic change was more marked in the SM-ST than in the EAS muscle. These findings show that the EAS is not normal in ALS. However, the relative resistance of the EAS to ALS is sufficient to prevent incontinence, even in the longer-surviving older patients.
Noninvasive ventilatory assistance, in ALS patients, with the bilevel intermittent positive air pressure (Bipap) was studied, in a prospective and controlled trial, by the authors. Twenty ALS bulbar patients, fulfilling El Escorial criteria for probable or definite disease, were selected. For the follow-up all patients were submitted to evaluation with the Norris scale, modified Barthel score and an analog scale of life satisfaction, every 3 months. All patients were also submitted to respiratory functional testing (RFT). Ten of these patients were treated with palliative management (group I), the remaining ten patients received Bipap support (group II). Clinical evolution curves and clinical parameters were not statistically different in both groups, except for the percentage of actual predicted value of vital capacity (p < 0.03), showing a more advanced disease in group II patients. Analog scale of life satisfaction showed improvement in the group II, even after the beginning of respiratory insufficiency, though without significance probably due to the small sample size (p < 0.1). Since 6 patients in group II are still alive survival rates were compared with log rank test considering cumulative survivals with Kaplan-Meier estimates. Total survival and survival from diurnal abnormalities in gas exchange (survival 1) were significantly longer for group II (p < 0.006 and p < 0.0004, respectively). In spite of the small number of patients, preliminary results strongly support the importance of BIPAP in ALS patients, though further studies must go on in order to optimize the best time for introducing Bipap.
Respiratory failure accounts for the majority of deaths in amyotrophic lateral sclerosis (ALS). The main cause of respiratory failure is probably diaphragmatic weakness. In order to test the correlation between respiratory impairment and diaphragmatic function we studied the phrenic nerve conduction in 31 ALS patients. Our results showed that patients with respiratory symptoms, and decreased forced vital capacity with arterial PaO2/PaCO2 abnormalities, had more commonly increased phrenic nerve latencies or absent response due to severe diaphragm denervation than ALS patients without respiratory complaints. Diaphragmatic paresis commonly occurs during the course of ALS, and its presence and severity can be assessed by phrenic nerve studies. It is important to recognize the development of impairment in diaphragmatic function in order to prevent life-threatening complications.
The quality of the EMG examination might be improved by standardization. However, knowledge about interlaboratory differences in the performance of the EMG examination is a prerequisite for standardization. The aim of this study was to describe differences in EMG techniques used and number of muscles and nerves examined per patient at 6 European EMG laboratories. The EMG results of 595 patients were prospectively sampled. The average number of muscles examined per patient in different disorders varied from laboratory to laboratory, for example from 3.0 to 10.8 muscles in anterior horn cell disorders and from 2.0 to 5.5 muscles in myopathies. The average number of muscles examined by quantitative EMG varied from 0 to 4.3 in anterior horn cell disorders and from 0.0 to 4.5 in myopathies. Also the average number of nerve segments examined per patient varied from laboratory for example from 2.7 to 17.7 for motor segments and from 3.1 to 9.0 for sensory segments in polyneuropathies. The laboratories that used needle electrodes for nerve conduction studies and quantitative analysis of individual motor unit potentials examined a smaller number of muscles and nerves than laboratories using surface electrodes for nerve conduction studies and qualitative EMG studies. The results of this study may have impact on guidelines and examination protocols as well as on quality assurance.
Tissue factor (TF) is now considered to be the primary physiologic activator of the blood coagulation system. Coupled with recent advances in our understanding of the biochemistry of TF this has heightened interest in measuring aspects of TF activity in disease states. Expression of TF by blood monocytes in various diseases is an established trigger for intravascular coagulation and there is now a considerable body of experience with its measurement. This has considerable clinical potential although more widespread application awaits a consensus on the most appropriate methodologic approach to its measurement. TF can be detected in urine and may reflect the activation state of renal macrophages. Urinary TF is increased in cancer and could have diagnostic and prognostic value in a variety of malignant diseases. Finally, it is now possible to measure soluble TF in plasma. One such assay is commercially available and is technically simple to perform. The clinical value of such assays, however, must await better understanding of the source and function of soluble TF in plasma.