Biomedical subjects

Paulo Pinho

Publications and source records attributed to Paulo Pinho.

5 recordsLinked to original sources

PubMed2005

Etanercept treatment in patients with refractory systemic onset juvenile rheumatoid arthritis.

OBJECTIVE: . To assess the efficacy and safety of etanercept in a large cohort of children with refractory systemic onset juvenile rheumatoid arthritis (SOJRA). METHODS: Standardized questionnaires were sent to US pediatric rheumatologists about patients with SOJRA treated with etanercept. Data were collected at baseline and at the last visit on etanercept. Response to treatment was assessed and compared to baseline as the mean percentage reduction in the following: acute phase reactants, prednisone dose, active joint count, and physician global assessment of disease activity. Response was defined as poor if the mean reduction was < 30%, fair if 30% to < 50%, good if 50% to < 70%, and excellent if > 70%. RESULTS: We analyzed data obtained by survey of 82 SOJRA patients treated with etanercept for a mean of 25 months. Poor response to treatment was observed in 45% of the children, fair response in 9%, good in 13%, and excellent in 33%. Baseline steroid therapy could be discontinued in 27/59 (46%) patients. One or more disease flares occurred in 45% of all patients. Twenty-nine patients (35%) discontinued therapy, mostly due to lack of response or flare. There were 32 adverse event reports, most not considered serious, except for 2 cases of macrophage activation syndrome. CONCLUSION: In this cohort of children with SOJRA, 46% had a good or excellent response, and most were able to reduce concomitant corticosteroid doses. The response to etanercept was fair or poor in more than half our study population, and disease flares were common. Due to the unique cytokine profile of SOJRA, tumor necrosis factor blockade may not be the optimal therapeutic approach for children with treatment-resistant SOJRA.

Adolescent↗

PubMed2002

Pseudoaneurysm of the mitral-aortic fibrosa: myocardial ischemia secondary to left coronary compression.

In the current study we describe the cases of 2 patients operated on for left-sided endocarditis, who later had myocardial ischemia develop secondary to left coronary artery compression from a pseudoaneurysm of the mitral-aortic fibrosa. Because the symptoms of angina persisted despite medical treatment, both patients had second surgeries. Myocardial revascularization was performed in 1 patient; the other patient, who had a severely depressed ventricular function, was given an orthotopic cardiac transplant.

Adult↗

PubMed2002

Modulation of myocardial function by pyruvate.

OBJECTIVES: Pyruvate is an intermediate product of glycolytic metabolism that has a positive inotropic effect in animal models and in failing human hearts. The main objective of the present work was to clarify the mechanisms underlying this inotropic effect. METHODS: Isotonic and isometric twitches were recorded before and after the addition of pyruvate (3, 10 and 15 mM) to rabbit papillary muscles (n = 10) and human atrial trabeculae (n = 6) degrading glucose 9 mM and acetate 5 mM as metabolic substrates. In another protocol, undertaken in rabbit papillary muscles (n = 8), pyruvate was added in the presence of an inhibitor of mitochondrial pyruvate uptake (alpha-cyano-4-hydroxycinnamate [HCm]; 0.5 mM), and using octanoate 5 mM as metabolic substrate. Calculated parameters: active tension (AT); maximum velocity of tension rise (dT/dtmax); maximum velocity of tension decline (dT/dtmin); peak shortening (PS); maximum velocity of shortening (dL/dtmax); maximum velocity of lengthening (dL/dtmin) and time to half relaxation (tHR). Values are presented as means +/- SEM. RESULTS: In rabbit papillary muscles, pyruvate caused an initial transient negative inotropic effect (maximum at 3 min), followed by a sustained increase in myocardial contractility that stabilized 15 min later. The maximum negative inotropic effect was observed with 3 mM of pyruvate, decreasing AT by 13 +/- 4%, dT/dtmax by 14 +/- 5%, dT/dtmin by 9 +/- 3%, PS by 13 +/- 4% and dL/dtmax by 13 +/- 5%. Maximum positive inotropic effect was observed with 10 mM, which increased AT by 45.0 +/- 9.5%, dT/dtmax by 20.5 +/- 7.4%, PS by 33.4 +/- 9.6%, dL/dtmin by 35.5 +/- 12.1, and tHR by 27.8 +/- 3.2%, without significantly altering dL/dtmax or dT/dtmin. In the presence of HCm, the positive inotropic effect was not only observed but even enhanced. In human atrial trabeculae the addition of pyruvate also induced a similar increase in contractility, but the transient negative inotropic effect was absent. CONCLUSIONS: The addition of pyruvate caused a dose dependent positive inotropic effect observed in rabbit papillary muscles as well as in human atrial trabeculae. The effect of pyruvate in rabbit papillary muscles does not depend on its mitochondrial uptake and metabolism. This may be particularly relevant during myocardial ischemia when pyruvate concentration is increased and mitochondrial function is impaired. These characteristics give pyruvate a suitable profile for the metabolic protection of the heart.

Animals↗

PubMedDate not supplied

[Isolated surgery of tricuspid insufficiency in valvular reoperation].

BACKGROUND AND AIMS OF THE STUDY: Development of late tricuspid regurgitation (TR) following prior operation on left heart valves is associated with an important impairement of functional status and adverse prognosis. Indications and outcomes of surgery in this setting are not well defined. Our Department experience in isolated TR in valve reoperation is evaluated. METHODS: Twenty-four patients underwent isolated tricuspid valve surgery because of severe TR following a prior operation on left heart valves between January/1990 and July/2003. Patients with congenital heart disease, traumatic TR, infectious endocarditis or left heart valve disfunction were excluded. The retrospective and observational study of this group of patients included clinical echocardiographic, haemodynamic and surgical data evaluation. RESULTS: Mean follow-up time was 4.4+/-3.5 years and included all patients. There was no operative mortality but actuarial survival at six years was 48%. No risk factors for late death were identified. CONCLUSIONS: Isolated tricuspid surgery for severe TR in patients with previous left heart valve surgery can be done with acceptable hospital mortality. Low operative mortality does not mean medium term good results. High late mortality and unsatisfactory functional results should lead us to consider other options when treating tricuspid valve regurgitation.

Cardiac Surgical Procedures↗

PubMedDate not supplied

[National Registry of Adult's Cardiac Surgery: a time for decision].

In this paper the author makes an analysis on the context and challenges lived presently by the Portuguese Cardiac Surgery and concludes that part of the response lies on the development of registries of surgical activity, either national or supranational. This necessity was felt by the Portuguese Society for Cardio-Thoracic and Vascular Surgery who took the initiative, in the year 2000, of the creation of National Registry dedicated to the Adult's Cardiac Surgery. Six years later, the aim of the project is still far from the expected, for several reasons that are analysed and lead to the conclusion that several urgent decisions are necessary to be undertaken, to save the project as well as the amount of work already done.

Cardiac Surgical Procedures↗