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Biomedical subjects

M Oliveira

Publications and source records attributed to M Oliveira.

At least 73 records · Page 4Linked to original sources
PubMed1996

[Mitral prosthesis dysfunction--report of 3 clinical cases with unusual ultrasonography features].

Prosthetic valve obstruction is one of the most serious complications of mechanical cardiac valves. Clinicians must be aware of this diagnosis in patients with a worsening of functional NYHA class. Over the past years, echocardiography has imposed itself as the method of choice to diagnose and evaluate patients with suspected prosthetic valve obstruction. We present three clinical reports of prosthetic valve malfunction that have unusual echocardiographic features.

Echocardiography↗
PubMed1995

[Experience of the exclusive use of arteries in myocardial revascularization].

OBJECTIVES: To present the initial experience of a surgical team from Santa Marta Hospital using exclusive arterial grafts on coronary bypass surgery. SETTING: Cardiology and Cardiothoracic Departments. POPULATION AND METHODS: From November 1987 to May 1994, 176 consecutive patients were submitted to surgical myocardial revascularization with the exclusive use of arterial grafts. The patients were operated by one cardiothoracic surgical team. A revision of clinical and angiographic characteristics of the patients was done along with the surgical procedure and intrahospital morbidity. After hospital discharge, follow-up was done by direct evaluation and/or by a questionnaire made using phone or letter on a periodical basis. RESULTS: The medium number of coronary bypasses performed were 2.07 +/- 0.8. The left internal mammary artery was the vessel more frequently used, specially to the myocardial area supplied by the left coronary descending artery. The right internal mammary artery was the second arterial graft more currently used. Gastroepiploic artery was utilized preferentially to coronary arteries supplying the inferior wall of the heart. Hospital mortality was 3.4%-6 patients. One hundred twenty patients have a normal life, without physical restrictions, 25% of the patients have symptoms of angina that is severe in 9. Mean follow-up time was 34 +/- 10 months. IN CONCLUSION: Coronary artery bypass surgery with exclusive use of arterial grafts can be executed with an acceptable mortality and low morbidity rates, even in urgent cases, with relieve of cardiac symptoms and good quality of life.

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↗
PubMed1995

[Acute aortic dissection. Therapeutic strategies and results].

OBJECTIVE: To analyse early and medium-term results of patients (pts) with acute aortic dissection (DAO) regarding the importance of the different therapeutic modalities adopted. DESIGN: Retrospective study of the cases with DAO admitted in the cardiology intensive care unit of Santa Marta Hospital. POPULATION: 46 pts (aged 25 to 80 years) with the diagnosis of DAO from January/1989 throughout December/1993. RESULTS: early mortality rate (30 days) was 36%. DAO type A Two cases were treated only with medical therapy for they suffer from severe associated pathology. Twenty eight pts were treated surgically. In this group mortality concerning time passed from the beginning of the symptoms throughout the surgery was: < 24 h-31%, 24-72 h-40%, > 72 h-63%. Among 17 discharged pts mortality occurred in 7% during the first year. DAO type B In pts with uncomplicated Stanford type B DAO survival was 90%. Emergency surgery was performed in pts who developed complications such as rupture of the aorta, occlusion of major arteries or extension of dissection. In this particular group mortality was 66%. Among 11 discharged pts with type B DAO 9% died within one year. During the follow-up period of 17.4 +/- 14.8 months one third of the pts discharged from hospital had clinical events. CONCLUSION: despite new advances in diagnostic and therapeutic approaches, DAO still's reported as a relatively high hospital mortality situation. Remove pts to an institution with ability to perform quickly the correct diagnosis and treatment becomes essential. Clinical presentation, type of DAO, surgery timing when indicated and major complications were of particular importance in the prognosis of pts with DAO. The frequency of cardiovascular events in pts who left the hospital alive emphasized the need to maintain blood pressure within normal limits.

Acute Disease↗
PubMed1995

[Acute myocardial infarct: apropos a clinical case].

The AA describe a clinical case of acute myocardial infarction (A.M.I.) with prodromal angina and an initial diagnosis based exclusively on clinical criteria; the patient was submitted to thrombolysis and had recurrent angina which led to the performance of rescue percutaneous coronary angioplasty (P.T.C.A.) that was successful. The clinical situations that may precede A.M.I. are discussed and the importance of the clinical presentation in its diagnosis are stressed. The indications and benefits of rescue P.T.C.A. are also discussed and the AA. conclude that the patients with prodromata of A.M.I. must be kept under clinical observation, so that prompt necessary therapeutic measures may be undertaken and that rescue P.T.C.A. is a therapeutic option of proven clinical benefit.

Diagnosis, Differential↗
PubMed1994

The influence of tumor grade, distribution, and extent of carcinomatosis in minimal residual stage III epithelial ovarian cancer after optimal primary cytoreductive surgery.

The purpose of this study was to determine the influence of tumor grade, distribution, and extent of carcinomatosis in minimal residual epithelial ovarian cancer after primary optimal cytoreductive surgery. Between 1978 and 1990, 112 patients with stage III epithelial ovarian cancer underwent primary cytoreductive surgery and had minimal residual disease, i.e., < 5 mm maximum diameter of residual tumor nodules. Seventy-eight patients (70%) had operative reports that contained sufficient detail to be included in this study. We retrospectively reviewed histopathological reports to determine tumor grade, operative and clinical notes to determine one predominant distribution pattern of residual metastases (pelvic/omental, diaphragmatic, or intestinal/mesenteric), and the approximate extent of residual disease (no gross disease, scattered nodules, or extensive carcinomatosis). Standard actuarial survival analysis was performed, and the log-rank chi 2 was used. At the mean follow-up time of 24.4 months, survival was 65% for grade 2 or 3 disease versus 93% for grade 1 (log-rank P < 0.01). Survival was 66% for residual disease in the intestines/mesentery versus 70 and 81% for residual disease in the diaphragm and pelvis/omentum, respectively (log-rank P < 0.03). Survival was 48% for residual extensive carcinomatosis versus 76 and 93% for minimal residual nodules and no gross residual, respectively (log-rank P < 0.001). In conclusion, in women who have minimal residual ovarian cancer after primary cytoreductive surgery, tumor grade and the distribution and extent of carcinomatosis can independently affect survival. The shortest survival correlated with high-grade tumor and extensive carcinomatosis predominantly involving the intestines and mesentery.

Carcinoma↗
PubMed1994

Salmonella typhi meningitis.

Whereas typhoid fever is still an endemic disease in some parts of the world, meningeal involvement in this disease is a rare occurrence. We report a case of Salmonella typhi meningitis in a 70-year-old woman. The patient was treated with ampicillin and the only sequela was right-sided deafness.

Aged↗
PubMed1994

[Holt-Oram syndrome. Review and report of 2 familial cases].

In 1960 Holt and Oram reported a family in which upper extremity malformations were associated with a secundum atrial septal defect. Since then, more than 200 cases have been reported with a wide spectrum of phenotypes. The authors present the cases of one mother and daughter with Holt-Oram Syndrome (SHO).

Adult↗
PubMed1994

[Acute aortic dissection in pregnancy. Report of a clinical case].

Aortic Dissection seldom affects young women. Nevertheless, the structural changes in the arterial wall, that occur during pregnancy, may predispose women to this complication, particularly in the third trimester and peripartum period. Aortic Dissection in gestation is associated specially with the Marfan's syndrome. The authors report a case of a pregnant woman in the 35th week of gestation, without Marfan's disease, admitted to Hospital on suspicious of type A aortic dissection.

Acute Disease↗
PubMed1994

[Acute myocardial infarct: the prognostic significance of complex coronary lesions].

OBJECTIVE: The aim of our study was to analyze the possible influence of coronary lesion morphology on the prognosis of patients (pts) with Acute Myocardial Infarction (AMI) evaluated by coronary angiography before hospital discharge. DESIGN: Retrospective study. SETTING: Study performed at the Cardiology Department of a Central Hospital. MATERIAL AND METHODS: 141 consecutive pts admitted because of AMI were evaluated, with an age average of 53.4 +/- 9.6 years, who had hospital discharge. All pts were submitted to angiography between the 2nd and 3rd week after AMI. The ventriculography was evaluated to determine the ventricular function score, as defined by the CASS protocol. The coronarography was performed to access the number of diseased vessels and to analyze their lesion morphology. Complexity was defined by the presence of one of the following characteristics: irregularity, shoulder, ulcers, filling defects, contrast retention and ecstasy. TWO GROUPS OF PTS WERE CONSIDERED: Group I--n = 64 pts, with complex lesions, and Group II--n = 69 pts with non complex lesions. Seven pts were excluded from the study because they had no significant coronary disease. Mean time of the follow up was 21.4 +/- 8.5 months and was similar in the two groups. The cardiac events considered were angina after AMI; reinfarction; heart failure; new hospital admission, percutaneous transluminal coronary angioplasty; coronary artery bypass grafting and death. RESULTS: In relation to both groups no statistically significant difference was found concerning sex, age, left ventricular function score and number of diseased vessels. In group I a higher incidence was found for cardiac events (p 0.006) and for the occurrence of angina after AMI (p < 0.02). In this group the number of pts with cardiac events was also higher (p < 0.01). No difference was found in relation to each of the morphologic characteristics and a high risk profile could not be found. CONCLUSIONS: Besides left ventricular function and the number of diseased vessels, the analysis of coronary lesion morphology, evaluated 2 to 3 weeks after AMI, could be useful in risk stratification after AMI.

Adult↗
PubMed1993

Iliofemoral bypass: a 10-year review.

Iliofemoral bypass is available to patients with unilateral iliac occlusive disease. Experience with iliofemoral bypass in terms of graft patency and patient outcome is reviewed. From January 1981 to February 1991, iliofemoral grafts were placed in 19 patients. Of these, 16 had medical records available for review; all were men and the mean age was 65 (range 46-72) years. Risk factors associated with peripheral vascular disease included tobacco use (16 patients), hypertension (ten), coronary artery disease (seven) and diabetes mellitus (four). Six patients had undergone previous peripheral vascular procedures. Angiography revealed an ipsilateral iliac artery suitable for bypass. Indications for operation included claudication (five patients), rest pain (six) and non-healing ulcer or gangrene (five). Ten bypasses were placed on the left and six on the right. The mean(s.d.) ankle:brachial pressure index before operation was 0.39(0.24): 0.55(0.19) in patients with claudication and 0.29(0.22) in those treated for threat of limb loss. After surgery patients with claudication demonstrated improvement of this index to a mean(s.d.) of 0.83(0.24); in those with threat of limb loss it improved to 0.60(0.16). One wound infection resolved with antibiotic therapy alone. Two patients had early (< 30 days) graft failure leading to amputation and subsequent perioperative death. Three other grafts failed, one each at 8, 9 and 13 months. All five grafts failed in patients with preoperative threat of limb loss. The cumulative patency rate was 72% at 1 year and 64% at 2-5 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Conformationally restricted analogues of disoxaril: a comparison of the activity against human rhinovirus types 14 and 1A.

A series of conformationally restricted analogs of disoxaril has been synthesized and evaluated against human rhinovirus types (HRV) 14 and 1A. The sensitivity of these serotypes to this series varied and was dependent upon the length of the molecule as well as upon the flexibility of the aliphatic chain. Minimum energy conformations of these compounds were overlaid with the X-ray structure of a closely related analog 9 bound to the capsid protein of both HRV-14 and -1A and then modeled in the compound-binding site of both serotypes. A comparative sweep volume of these compounds about the isoxazole ring revealed an inaccessible region of space for the cis-olefin 8b, which is not the case for either the trans-olefin 8a or the acetylene 5. This region may be important to the binding of the compounds to the HRV-14 site particularly during entry into the pocket.

Antiviral Agents↗
PubMed1991

[Exercise test parameters after acute myocardial infarction. Relationship with coronary angiography].

OBJECTIVE: To analyze the relation between characteristics of symptom-limited treadmill exercise stress test, after acute myocardial infarction (MI) and coronariographic results (number of diseased vessels). Both tests were performed before hospital discharge. DESIGN: Retrospective study with comparative analysis between variable defined groups. POPULATION AND SETTING: From 232 patients interned in the department of Cardiology of Hospital de Santa Marta with a first acute MI, a population of 112 patients submitted to exercise stress test and coronary angiography before discharge were selected (aged 29 to 69 years). METHODS: Symptom-limited treadmill exercise stress tests were performed according to Bruce protocol, with no heart-rate limitation. The following parameters were analyzed: Stress test duration (DUR); Double product variation (varDP); Metabolic equivalent units (METS); Maximal heart rate (FCmax); Percentage of the maximal reached heart rate (% FCmax); Incidence of ST segment depression (InfST); Maximal ST segment depression (Max-InfST); Onset minute of ST segment depression (MinInfST); Heart rate at the onset of ST segment depression (FCInfST); Double product at the onset of ST segment depression (DPInfST); Recovery minute of ST segment depression (MinRInfST); Onset minute of angina (MinAng); Heart rate at the onset of angina (FCAng); Double product at the onset of angina (DPAng). RESULTS: Statistical significant differences were obtained between coronariographic groups concerning the following parameters: DUR: 1-vessel/3-vessel P = 0.02; VarDP: 1-vessel/3-vessel p = 0.008, 2-vessel/3-vessel p = 0.004; METS: 1-vessel/3-vessel p = 0.01. No differences were seen between anterior and inferior myocardial infarctions regarding all the stress test parameters. However in patients with anterior MI significant differences were obtained concerning the following variables: VarDP: 1-vessel/2-vessel p = 0.02; InfraST: 1-vessel/2-vessel p = 0.006, 1-vessel/3-vessel p = 0.03; MaxInfST: 1-vessel/2-vessel p = 0.01, 1-vessel/3-vessel p = 0.0006; Angina: 1-vessel/2-vessel p = 0.0005, 1-vessel/3-vessel p = .001. In inferior myocardial infarctions only the stress duration differed between 1-vessel and 3-vessel groups (p = 0.003). CONCLUSIONS: Symptom-limited treadmill exercise stress tests, safely performed in our institution, were an important method for post MI evaluation and allowed the diagnosis of a great number of patients with residual ischemia. Statistical significant differences were found in ergometric parameters, between coronariographic groups (defined by the number of diseased vessels), emphasising the importance of stress tolerance analysis.

Adult↗
PubMed1990

Regulation of hexose transport in respiration deficient hamster lung fibroblasts.

The transport of [3H]2-deoxy-D-glucose (2DG) and [3H]3-O-methyl-D-glucose (3-OMG) was elevated in a respiration deficient (NADH coenzyme Q [Co Q] reductase deficient) Chinese hamster lung fibroblast cell line (G14). This sugar transport increase was related to an increased Vmax for 2DG transport, 26.9 +/- 4.2 nmoles 2DG/mg protein/30 sec in the G14 cell line vs 9.5 +/- 0.6 nmoles 2DG/mg protein/30 sec in the parental V79 cell line. No differences were observed in their respective Km values for 2DG transport (3.9 +/- .6 vs. 3.0 +/- .13 mM). Factors which increase sugar transport (e.g., glucose deprivation, serum or insulin exposure) or decrease sugar transport (e.g., serum deprivation) in the parental V79 cell line had little effect on sugar transport in the G14 respiration deficient cell lines. Amino acid transport, specific 125I-insulin binding to cells, and insulin-stimulated DNA synthesis, however, were similar in both cell lines. Exposure of both cell lines to varying concentrations of cycloheximide (0.1-50 micrograms/ml) for 4 h resulted in differential effects on 2DG transport. In the parental cell line (V79) low cycloheximide concentrations resulted in decreased 2DG transport, while higher concentrations (greater than or equal to 1 microgram/ml) resulted in elevated 2DG transport. In the G14 cell line, 2DG transport decreased at all concentrations of cycloheximide (up to 50 micrograms/ml). The data indicate that the G14 mutant has been significantly and specifically affected in the expression of sugar transport activity and in the regulatory controls affecting sugar transport activity.

3-O-Methylglucose↗
PubMed1989

Evidence for the autocrine inhibition of glycolysis in human fibroblasts.

We investigated the mechanism by which glucose refeeding can reverse the enhancement of glycolysis caused by glucose starvation. Human fibroblasts were deprived of glucose for 18 hr and then refed for 1 hr with either (a) medium from sister glucose-starved cultures (controls), (b) fresh, glucose-containing medium (fresh medium), or (c) medium conditioned for 18 hr by glucose-fed cells (conditioned medium). Despite a lower glucose content, conditioned medium was significantly more effective at inhibiting the accumulation of radio-labeled glucose than fresh medium (74 vs. 49% inhibition). The uptake of 2-deoxyglucose was not affected by either medium, indicating that the site of control of glycolysis was distal to glucose transport and phosphorylation. The active principle was heat labile, dialyzable (Mr less than 12,000) and unrelated to the lactate content of conditioned medium. Medium conditioned by cells exposed to 3-O-methylglucose did not inhibit glycolysis in glucose-starved cells even though long-term exposure to this hexose, like glucose, results in the repression of transport.

Culture Media↗
PubMed1989

[Diabetes mellitus in the elderly].

The authors discuss the pathogenesis of glucose intolerance occurring in advanced age and the importance of peripheral insulin resistance due to deficiency of post receptor mechanisms. Prevalence of diabetes increases with age and its diagnosis should not be overlooked as it can cause considerable morbidity and mortality in this age group. Acute and chronic complications are discussed as well as the aggravating influence of coexistent pathology and its medication, and of social, environmental and economic factors. Therapeutic measures and desirable therapeutic goals are considered for this specific age group, taking into account the need for an individualised treatment and the priority of well being and safety over too strict control.

Aged↗