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O D Almeida

Publications and source records attributed to O D Almeida.

16 recordsLinked to original sources
PubMed1998

Office microlaparoscopy under local anesthesia in the diagnosis and treatment of chronic pelvic pain.

STUDY OBJECTIVE: To evaluate the safety of diagnostic and operative microlaparoscopy performed in the office under local anesthesia in the diagnosis and treatment of chronic pelvic pain. DESIGN: Prospective study (Canadian Task Force classification II-2). SETTING: Office-based, free-standing private obstetrics and gynecology practice. PATIENTS: Twenty women with chronic pelvic pain. INTERVENTION: Diagnostic and operative microlaparoscopy performed under local anesthesia with conscious sedation. MEASUREMENTS AND MAIN RESULTS: All 20 patients had diagnostic microlaparoscopy and 19 had conscious pain mapping. Nine of 14 patients with endometriosis underwent fulguration of lesions and 7 of 8 with pelvic adhesions had lysis of adhesions. Four women with uterosacral ligament involvement had laparoscopic uterosacral nerve ablation. All patients tolerated office diagnostic and operative procedures without difficulty and had no complications. CONCLUSION: In selected women, several laparoscopic procedures traditionally done in a hospital or ambulatory surgery center under general anesthesia can be performed safely in the office laparoscopy suite under local anesthesia with conscious sedation.

Adolescent↗
PubMed1998

Appendectomy under local anaesthesia following conscious pain mapping with microlaparoscopy.

The appendix is an under-appreciated source of chronic pelvic pain. Laparoscopic evaluation of the appendix is limited without intra-operative patient feedback on the presence and absence of pain. New techniques using local anaesthesia with conscious sedation have enabled us to perform operative laparoscopic surgery while the patient is awake. We report the first two cases of microlaparoscopic appendectomies performed under local anaesthesia with conscious sedation following diagnosis obtained during conscious pain mapping.

Adolescent↗
PubMed1997

Angiographic evolution of intracoronary thrombus and dissection following percutaneous transluminal coronary angioplasty (the Thrombolysis and Angioplasty in Unstable Angina [TAUSA] trial).

The evolution and progression of thrombus and dissection after percutaneous transluminal coronary angioplasty (PTCA) are unknown. As part of the protocol of the Thrombolysis and Angioplasty in Unstable Angina (TAUSA) trial, 1 and 15 minutes post-PTCA angiograms were routinely performed and evaluated by the core laboratory for the presence of thrombus and either minor or major dissection. Thrombus was present at 1 minute in 4.4% of culprit lesions. This increased to 16% at 15 minutes (p < 0.005) and was equally seen in patients receiving both urokinase and placebo. Any dissection was noted in 25.2% at 1 minute versus 30.5% at 15 minutes (p < 0.08), and this trend was mainly related to an increase in major dissection with urokinase at 15 minutes versus 1 minute (10.1% vs 5.9%, respectively, p = 0.10). The in-hospital clinical outcome of patients with lesions that did or did not have thrombus or major dissection at 1 and 15 minutes was retrospectively assessed in the placebo group. The presence of either thrombus or major dissection at 1 minute was associated with a subsequent incidence of acute closure of 14% and an incidence of emergency bypass surgery of 11% (p < 0.01 compared with no thrombus or major dissection at 1 minute). The absence of thrombus and major dissection at 15 minutes (n = 173) was associated with no subsequent acute closure or emergency bypass surgery, (p < 0.05 for acute closure vs thrombus or major dissection at 15 minutes). Thrombus evolves progressively over 15 minutes after PTCA in unstable angina, whereas dissection is usually present immediately after PTCA. The absence of thrombus and major dissection at 15 minutes is associated with very low-acute in-hospital complications. Delayed angiograms following standard balloon angioplasty for unstable angina may be predictive of low complications and our study suggests a possible role for their use.

Acute Disease↗
PubMed1997

Conscious pain mapping.

STUDY OBJECTIVE: To present the technique and usefulness of conscious pain mapping. DESIGN: Prospective, observational study (Canadian Task Force classification II-2). SETTING: Gynecology departments of a university-affiliated hospital and a private community hospital. PATIENTS: Fifty consecutive women undergoing diagnostic microlaparoscopy. INTERVENTIONS: Conscious pain mapping was performed in all 50 women. MEASUREMENTS AND MAIN RESULTS: Conscious pain mapping helped to identify foci of chronic pelvic pain. The appendix and pelvic adhesions accounted for a significant amount of pelvic pain in these women. CONCLUSIONS: Conscious pain mapping helps to uncover sites of pelvic pain that might not be identified during traditional laparoscopy under general anesthesia.

Adolescent↗
PubMed1997

A protocol for conscious sedation in microlaparoscopy.

To establish a protocol for conscious sedation in microlaparoscopy, we conducted a prospective, observational study of 74 women undergoing the procedure under local anesthesia with conscious sedation for the evaluation and treatment of chronic pelvic pain. Our protocol for conscious sedation allowed us to perform diagnostic microlaparoscopy under local anesthesia in all 74 women and operative microlaparoscopy in 52 (70.2%). This procedure is a safe and effective alternative to general anesthesia during microlaparoscopy in selected patients.

Adolescent↗
PubMed1995

Angioplasty of complex lesions in ischemic rest angina: results of the Thrombolysis and Angioplasty in Unstable Angina (TAUSA) trial.

OBJECTIVES: This study sought to analyze the role of complex lesion morphology on the acute results of angioplasty. BACKGROUND: Acute complications of angioplasty are higher in unstable than in stable angina. The unstable culprit lesion is usually complex, indicative of plaque disruption and thrombus formation. Previous nonrandomized studies have shown that the presence of intracoronary thombus increases morbidity after coronary angioplasty. The role of complex morphology in coronary angioplasty outcome was studied in a prespecified subgroup analysis of a large multicenter coronary angioplasty trial. METHODS: The results of coronary angioplasty from the Thrombolysis and Angioplasty in Unstable Angina (TAUSA) trial were analyzed. This large trial randomized 469 patients in double-blinded manner to receive either intracoronary urokinase or placebo during coronary angioplasty of the culprit lesion in ischemic rest angina with or without recent infarction. The study presented here analyzes in detail the results of coronary angioplasty in complex versus simple lesions in the urokinase and placebo groups. Complex lesions were defined before angioplasty by a core laboratory as having one or more of the following: irregular borders, overhanging edges, ulcerations or intraluminal filling defects proximal or distal to the lesion. RESULTS: Of the 469 patients, 458 had identifiable culprit lesions, of which 245 were complex and 213 were simple. Complex lesions were associated with a higher abrupt closure rate than simple lesions (10.6% vs. 3.3%, respectively, p < 0.003). Patients with complex lesions also had higher recurrent in-hospital angina (p < 0.02) and emergent bypass surgery (p < 0.02). Further analysis of complex lesions revealed that abrupt closure was particularly high in the urokinase group (15.0% vs 5.9% for the placebo group, p < 0.03), and most abrupt closures were thrombotic. Composite clinical end points were also significantly higher with complex lesions and urokinase. In the placebo group, complex lesions had a higher abrupt closure rate as well as postcoronary angioplasty filling defects, but clinical end points were not significantly different. CONCLUSIONS: Complex lesions before coronary angioplasty increase acute complication rates after coronary angioplasty. Urokinase as administered in the TAUSA trial had significant adverse effects, especially in complex lesions. However, even in the placebo arm, complex lesions were associated with higher complication rates than simple lesions. Newer antithrombotic measures that particularly target the platelet may eventually decrease complication rates in these lesions.

Angina, Unstable↗
PubMed1994

Adjunctive thrombolytic therapy during angioplasty for ischemic rest angina. Results of the TAUSA Trial. TAUSA Investigators. Thrombolysis and Angioplasty in Unstable Angina trial.

BACKGROUND: Acute closure is increased after angioplasty in unstable angina, and adjunctive intracoronary thrombolytic therapy has been used successfully to increase angiographic success. The role of prophylactic thrombolytic therapy during angioplasty in unstable angina is unknown. METHODS AND RESULTS: Four hundred sixty-nine patients with ischemic rest pain with or without a recent (< 1 month) infarction were randomized in double-blind fashion to intracoronary urokinase or placebo. Randomization was carried out in two sequential phases. In phase I, 257 patients were randomized to 250,000 U of urokinase or placebo given in divided doses at the time of angioplasty. In phase II, 212 patients were randomized to 500,000 U of urokinase or placebo in divided doses. All patients were pretreated with aspirin, and activated clotting times were followed to maintain them at > 300 seconds during angioplasty. Angiographic end points of thrombus after angioplasty were insignificantly decreased by urokinase (30 [13.8%] versus 41 [18.0%] with placebo; P = NS). Acute closure, on the other hand, was increased with urokinase (23 [10.2%] versus 10 [4.3%] with placebo; P < .02). The difference in acute closure between urokinase and placebo was more striking at the higher dose of urokinase (P < .04) than in phase I at the lower urokinase dose (P = NS). Adverse in-hospital clinical end points (ischemia, infarction, or emergency coronary artery bypass surgery) were also increased with urokinase versus placebo (30 [12.9%] versus 15 [6.3%], respectively; P < .02). Angiographic and clinical end points were worse with urokinase in unstable angina without recent infarction than with angioplasty after a recent infarction. CONCLUSIONS: Adjunctive urokinase given prophylactically during angioplasty for ischemic rest angina as administered in this trial is associated with adverse angiographic and clinical events. These detrimental effects may be related to hemorrhagic dissection, lack of intimal sealing, or procoagulant or platelet-activating effects of urokinase.

Angina, Unstable↗
PubMed1989

Maternal Bartter's syndrome and pregnancy.

A case of maternal Bartter's syndrome is reported and prenatal management discussed. Close monitoring of serum potassium levels is essential. Patients with this syndrome may have an increased risk of developing intrauterine growth retardation.

Adult↗
PubMed1988

Amniotic fluid urea nitrogen in the prediction of respiratory distress syndrome.

Amniotic fluid urea nitrogen levels can be used to predict the neonate not at risk for the development of respiratory distress syndrome. A prospective study of 110 pregnancies compared amniotic fluid urea nitrogen concentrations with the lecithin/sphingomyelin ratio and presence of phosphatidylglycerol. After determination of gestational age, amniotic fluid was analyzed for urea nitrogen concentration and an aliquot was sent to the hospital's commercial laboratory for lecithin/sphingomyelin and phosphatidylglycerol measurement. An amniotic fluid urea nitrogen level less than 7.4 mg/dl predicted the presence of neonatal respiratory distress syndrome in 12 of 13 patients independent of gestational age and birth weight. This assay can be performed at the bedside with simple equipment in 70 seconds at approximately one-fortieth the cost of present standard lung maturity studies.

Amniotic Fluid↗
PubMed1988

Asynchronous atrioventricular valve opening as it relates to right to left interatrial shunting in the normal newborn.

The opening of the tricuspid valve and the onset of right ventricular filling precede the opening of the mitral valve and the onset of flow in the normal adult. Sixty-five studies of atrioventricular flow with range-gated pulsed Doppler echocardiography, performed on 32 normal neonates, consistently demonstrated the reverse sequence. Further investigation showed that at the time of mitral valve opening, while the tricuspid valve was still closed, the valve of the foramen ovale began to bow posteriorly into the left atrium and remained posteriorly bowed for most of diastole. The magnitude of posterior bowing varied among the neonates but, concomitant with the more prominent grades of posterior bowing, right to left shunting across the foramen ovale was demonstrated on color flow mapping. Ultrasound studies in the normal fetus also revealed earlier opening of the mitral valve, bowing of the valve of the foramen ovale into the left atrium and right to left shunting across the foramen ovale. These findings indicate that in the normal immature heart isovolumic ventricular relaxation is completed earlier on the left than on the right side and that left ventricular compliance appears to be greater than right ventricular compliance. The relation of left and right ventricular compliance in the adult is different from that in the normal immature heart. Whereas systemic and pulmonary vascular resistance and pressure levels change rapidly in the newborn period, ventricular compliance matures over a longer period of time. As a result of the differential maturity, for a variable period of time in the normal neonate, a left to right ductal shunt coexists with a right to left atrial shunt.

Blood Flow Velocity↗
PubMed1986

Lactation suppression and puerperal fever.

Seventy-five puerperal women who did not wish to breast-feed were treated with bromocriptine mesylate (Parlodel) or placebo in a prospective, randomized, double-blind study. Results revealed a puerperal fever incidence of 18.6%, 13.3% of which was due to breast engorgement and 5.3% to an infectious process. Parlodel prevented puerperal fever in 87.9% of patients. If Parlodel was given within 18 hours of delivery, physiologic puerperal fever was prevented in 100% of cases.

Bromocriptine↗
PubMedDate not supplied

Small trocar perforation of the small bowel: a case report.

Although laparoscopy is one of the most common surgical procedures done today, bowel perforations can and do occur during the initial insertion of the Veress needle and/or trocar. Recent advances in microlaparoscopy have reduced the morbidity of this complication when encountered. We report a case of small bowel perforation following insertion of a Veress needle with its 2 mm trocar and our minimally invasive intra-operative and postoperative management of the patient.

Adult↗