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Biomedical subjects

M De Souza

Publications and source records attributed to M De Souza.

9 recordsLinked to original sources
PubMed2001

[Advantages of video assisted thoracic surgery in the treatment of spontaneous pneumothorax].

Spontaneous pneumothorax (SP) is a disabling condition mostly affecting young, thin and otherwise healthy males. It is usually caused by ruptured pleural blebs. The first treatment is the insertion of a chest tube (ICT) but in a great number of patients there is recurrence of the disease. We believe that the video assisted thoracoscopy (VATS) is the best treatment possible because it allows us to treat the ruptured bleb radically avoiding any recurrence. In order to prove it, 40 patients admitted in a five-year period, with a SP, were randomly assigned to be treated by ICT or VATS. The ICT patients were in the hospital a mean time of 7.5 (4 to 15) days and the VATS patients, 5.3 (2 to 7) days (P < .05). ICT patients required analgesic drugs during 76.8 +/- 31 hours and VATS patients 38.4 +/- 13 hours (p < .05). From the ICT group, 8 (53%) patients had recurrence of the disease and 6 (40%) had a prolonged air leak, while none of the patients of the VATS group had any complication (< .001). Cost of ICT and VATS were $ 850 and $ 1730, respectively. According to these results, VATS should be the treatment of choice in SP patients. It treats the cause of the disease. It also reduces the hospitalization time, the use of analgesic drugs post surgery, decreases recurrence of the disease and the cost of the treatment. Moreover, the patients were back to work in less than 10 days.

Adolescent↗
PubMed1994

Allergies and skin testing: a Nairobi experience.

A prospective study of 72 consecutive patients with symptoms of allergy is presented. Patients aged 20-39 years formed the bulk of the study population (55.6%). Most patients had allergic rhinitis (48.6%); bronchial asthma and atopic dermatitis occurred in 29 patients (40.3%) each. Drug allergies were found in 22 patients (30.6%), urticaria in 15 (20.8%), food allergies in 13 (18.1%), contact dermatitis in 10 (13.9%) and allergic conjuctivitis in 6 patients (8.3%). In many cases more than one allergic condition appeared simultaneously. Skin and prick tests and skin patch tests were done on 46 (63.9%) and 65 (90.3%) patients respectively. Soaps were most frequently implicated in positive reactions (75.0%); D. pteronyssinus, drugs, animal dander and foods gave positive reactions in 40.3%, 30.6%, 19.4% and 18.1% respectively. The need to have a high index of suspicion towards allergic conditions, especially extrinsic bronchial asthma, is stressed.

Adolescent↗
PubMed1992

Allergic conditions in a general practice in Nairobi: a pilot study.

This is a study of 574 randomly selected patients seen in a private practice. The incidence of allergic conditions was found to be 18.8%. The distribution of the allergic conditions was as follows: 35 suffered from bronchial asthma, 33 had dermatological allergic conditions, and 30 were reported as having drug allergies. A significant number of these patients had multiple allergic conditions.

Adolescent↗
PubMed1992

Hepatitis C virus and Hashimoto's thyroiditis.

We report two cases of Hashimoto's thyroiditis associated with chronic active hepatitis C virus (HCV). Our data suggest that HCV infection might be involved in this autoimmune disease.

Adult↗
PubMed1991

Ventricular function during supine bicycle exercise in univentricular connection with absent right atrioventricular connection.

Fourteen patients with univentricular connection, absent right connection (tricuspid valve atresia) and normally related great arteries underwent rest and supine bicycle exercise equilibrium radionuclide blood pool studies. Ejection fraction, heart rate, systemic blood pressure and oxygen saturation (ear oximetry) were measured. There were 6 male and 8 female patients. Mean age +/- standard error of the mean was 14.5 +/- 1.1 years (range 6.3 to 21.1). Eight patients (group 1) had systemic to pulmonary shunts placed as palliation 8.2 +/- 2.2 years before study and 6 patients (group II) had caval to pulmonary shunts placed 11.8 +/- 1.6 years previously. Ejection fraction at rest was 54 +/- 2% and an abnormal response to exercise (failure of ejection fraction to increase greater than or equal to 5% from rest to peak exercise) was found in 9 of 14 patients. When analyzed separately, ejection fraction at rest in group I was higher than in group II; however, this difference disappeared at peak exercise. There was a significant negative correlation between ejection fraction at peak exercise and the interval since palliative surgery, although it was not apparent at rest. These data suggest that ventricular function is compromised during exercise and that abnormal performance is influenced by long-standing volume overload. Importantly, this abnormal state is concealed at rest and the choice of palliative shunting procedure appears to have little effect on normalizing pump performance.

Adolescent↗
PubMed1989

Congenital adrenal hyperplasia family studies using the short ACTH test.

Because of the increasing use of 17-hydroxyprogesterone (17OHP) levels with the short adrenocorticotrophic hormone (ACTH) test in the detection of 21-hydroxylase deficiency, the diagnostic efficiency of the test was evaluated in patient and family studies of congenital adrenal hyperplasia due to 21-hydroxylase deficiency and of congenital adrenal hyperplasia due to 11-hydroxylase (11OH) deficiency (the latter disorder now overlaps basally with the milder non-classical 21-hydroxylase deficiency [NC-CAH]). Stimulated 17-hydroxyprogesterone level (17OHP30), 17-hydroxyprogesterone increase (delta 17 OHP) and the ratio 17-hydroxyprogesterone increase to cortisol increase (delta 17OHP/delta cortisol) were the parameters from the short ACTH test derived for assessment. 17-OHP30 provided complete differentiation of NC-CAH from the controls and heterozygotes, but overlap between NC-CAH and 11-OH occurred. Complete differentiation of NC-CAH from 11-OH was achieved using delta 17OHP. The heterozygotes showed best differentiation from the controls using delta 17OHP/delta cortisol with a diagnostic accuracy of 70%, however marked overlap of heterozygotes and NC-CAH with 11-OH was found. The short ACTH test proved to be a valuable technique with the further detection of homozygotes (n = 3) and heterozygotes (n = 5) in the 13 families studied. However, when interpreting the short ACTH test a careful choice of parameters should be made. It should be kept in mind that mild NC-CAH patients can only be differentiated from 11OH patients by using delta 17OHP.

17-alpha-Hydroxyprogesterone↗
PubMed1987

Noninvasive measurement of blood flow and extraction fraction.

We describe the theory of a technique for the noninvasive measurement of organ blood flow which is based on the principle of fractionation of cardiac output and is applicable with any recirculating gamma emitting tracer. The technique effectively determines the count rate that would be recorded over the organ if the tracer behaved like radiolabelled microspheres and was completely trapped in the organ's vascular bed on first pass. After correction for organ depth, the estimated first pass activity plateau, expressed as a fraction of the injected dose, is equal to the organ's fraction of the cardiac output (CO). By extending the theory, organ extraction fraction of extractable tracers or mean transit time of nonextractable tracers can be measured. Renal blood flow (RBF) to the normal left kidney in 18 subjects without evidence of renal disease was estimated by the technique to be 10.4% CO (S.D. 1.2), for the right kidney 9.0% CO(S.D. 1.1), and for both, 19.4% CO (S.D. 1.5). In a separate series of eight patients, RBF values were highly reproducible when obtained on successive days (standard deviation of change: 0.67% CO for the left kidney, 0.63% CO for the right and 0.78% CO for both). The extraction fraction of DTPA (filtration fraction) was 8.5% (1.7) in the left kidney and 9.7% (2.1) in the right kidney. This parameter was less reproducible than RBF, with standard deviations of the changes equal to 1.17% for the left kidney and 1.31% for the right. Stable, well-functioning, renal allografts in children had a mean blood flow of 20.6% CO (S.D. 3.7). Transplant blood flow in eight patients with rejection was less than 5.2% CO. In patients without splenomegaly, splenic blood flow, splenic extraction fraction of sulphur colloid and splenic red cell mean transit time were 4.3% CO (S.D. 0.9), 41% (S.D. 13.8), and 36.9 s (S.D. 4.6), respectively.

Blood Circulation↗