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Biomedical subjects

S Fernandes

Publications and source records attributed to S Fernandes.

34 records · Page 2Linked to original sources
PubMed1997

[Craniocerebral imaging in children with short stature].

OBJECTIVE: To analyse the type and frequency of cranial CT and NMR imaging anomalies in children of short stature. PATIENTS AND INTERVENTIONS: We studied 57 children of short stature with a mean age (+/-SD) of 10.1 +/- 3.8 years, 34 boys and 23 girls, all of them with auxometric criteria of GH deficiency. After studying the pituitary function and determination of karyotype in the girls, the children were classified in to five groups:-Isolated GHD (IGHD) (n = 32), multiple pituitary hormone deficiency (MPHD) (n = 6), neurosecretory dysfunction (NSD) (n = 8), Turner syndrome (n = 7) and idiopathic short stature (ISS) (n = 4). The imaging methods used were cranial CT or NMR. RESULTS: Of the 57 children studied the CT/NMR was abnormal in 37(64.9%) children. We found anomalies in 65.6% of IGHD patients, 62.5% of NSD patients, 100% of MPHD patients and 57.1% and 25% in the Turner s. patients and ISS patients respectively. The most frequent anomaly was hypoplastic pituitary found in 50% of IGHD patients, 37.5% of NSD patients and 33.3% of MPHD patients. None of the cases of Turner s. or ISS had hypoplastic pituitary. An empty sella was the second most frequent anomaly found in 7 patients (IGHD-3, MPHD-3, DNS-1). Of the 25 children in which NMR was performed, 8 had hypoplastic pituitary and stalk and 2 had interruption of the pituitary stalk and ectopic neurohypophysis. CONCLUSION: These results strengthen the necessity for CT/NMR imaging in children of short stature which, besides allowing identification of tumors, also permits the diagnosis of idiopathic GHD because of its frequent association with cranial imaging anomalies, mainly hypoplastic pituitary.

Body Height↗
PubMed1995

Allograft conjunctival transplantation for bilateral ocular surface disorders.

PURPOSE: The purpose of this study is to evaluate the efficacy of allogenic conjunctival transplantation in bilateral surface disorders and to correlate with human leukocyte antigen (HLA) typing and cross-matching. METHODS: A prospective study of allogenic conjunctival transplantation was undertaken in 12 eyes of 10 patients with bilateral surface disorders. Five eyes had Stevens-Johnson syndrome, three had Lyell syndrome, three had bilateral alkali burns, and one had a bilateral thermal burn. Human leukocyte antigen typing and cross-matching were retrospectively performed in eight patients and their respective donors. Stabilization of corneal epithelia, visual acuity, and rejection episodes were examined after the procedure. RESULTS: Eleven (91.6%) of 12 eyes had improved visual acuity, corneal transparency and surface lubrication, stabilization of corneal epithelia, and decreased corneal neovascularization and photophobia after an average follow-up of 17.2 months. Three patients (25%) had rejection episodes, with no disturbance in corneal surface in two. Two of these three patients had 100% incompatible HLA donor-recipient pairs; HLA of the third patient was not available. Patients with favorable evolution were either HLA identical or haplo-identical (50% identity) with their donors. Donor eyes did not present any epithelial problems during the follow-up period. CONCLUSIONS: Human leukocyte antigen-matched allogenic conjunctival transplantation proved to be an adequate method of treating severe bilateral surface disorders, with minimal complications.

Adolescent↗
PubMed1993

Myocardial protection in diffuse coronary artery disease. Intermittent retrograde cold-blood cardioplegia at systemic normothermia versus intermittent antegrade cold-blood cardioplegia at moderate systemic hypothermia.

In order to determine the comparative merits of antegrade cardioplegia at moderate systemic hypothermia versus retrograde cardioplegia at systemic normothermia, we performed coronary artery bypass grafting using intermittent oxygenated blood cardioplegia in 2 sets of 50 consecutive patients with triple-vessel disease (complete occlusion of 1 coronary artery and greater than 90% narrowing of the other 2, with poor distal runoff). Group 1 had antegrade cardioplegia at moderate systemic hypothermia (28 degrees C). Group 2 had retrograde cardioplegia at systemic normothermia. This resulted in no deaths and in no differences in complication rates. Group 2's postoperative need for inotropic agents or vasodilators was significantly less (epinephrine, p < 0.0009; dopamine, p < 0.002; nitroglycerin, p < 0.001). Elevations of CKMB fraction were significantly more common in Group 1: 46% had CKMB levels greater than 9%, versus 16% of Group 2 patients (p < 0.0001). Intraoperative transesophageal echocardiography was performed in 39 Group-1 patients and in 42 Group-2 patients. Development of a new wall-motion abnormality after bypass was significantly only in Group 1 (p < 0.009, by chi 2 analysis). We conclude that retrograde cardioplegia at normothermia provides myocardial protection that equals or surpasses that of antegrade delivery at moderate systemic hypothermia, while avoiding the possible deleterious side effects of hypothermia.

Adult↗
PubMed1992

Epidemiology of sheep myiases in São Paulo State, Brazil.

A survey of Diptera species causing cutaneous myiases on sheep in Botucatu, São Paulo, Brazil was made to determine seasonal incidence, predilection sites and the factors predisposing to infestation. Sheep were checked daily for myiases for one year. At two week intervals larvae from wounds were collected for identification. Only larvae of Dermatobia hominis and Cochliomyia hominivorax were found. Myiases due to C. hominivorax were observed during the whole year with high incidence from January to April. The feet, vulva, tail and scrotum were most frequently infested. Wounds were the commonest predisposing factor.

Animals↗
PubMed1992

Is use of the intraaortic balloon pump in octogenarians justified?

Increasing numbers of octogenarians are seen in the operating room or critical care unit with circumstances for which intraaortic balloon pump (IABP) assistance is appropriate, but it has been suggested that the complication rate for IABP use in octogenarians is excessive. From 1980 to 1990, 25 octogenarians needed an IABP in our institution, as an adjunct to operation in 20 patients (1 had repair of a ventricular rupture and 19 underwent coronary grafting); 5 patients did not have operation. The indications for IABP use were unstable angina, 12 (48%); cardiogenic shock, 10 (40%); and difficulty weaning off cardiopulmonary bypass, 3 (12%)--these 3 were the only ones who had insertion through a femoral cut-down. No serious insertion difficulties were noticed with the percutaneous route in the other 22 patients. Without operation, 4 of 5 patients died in the hospital (80%), and the 5th died 2 years 8 months after discharge. After operation, there were two hospital deaths (10%) and two late deaths, neither from cardiac causes. A fatal outcome occurred in 6 of 9 patients with cardiogenic shock. Intraaortic balloon pump-related complications were rare, minor, and unrelated to IABP assistance duration, which ranged from 24 to 146 hours (mean, 49.9 hours). No long-term vascular complications resulted. Hospital stay averaged 22.2 days. At follow-up from 9 to 81 months (mean, 51.8 months), of the 16 survivors, 12 (75%) were in New York Heart Association class I/II and 2 each were in classes III and IV.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1992

Massive intraoperative pulmonary embolism.

Intraoperative massive pulmonary embolism is extremely rare. We describe such a case in a patient treated for a prolonged period preoperatively with intravenous heparin after an acute myocardial infarction and unsuccessful attempt at angioplasty, emphasizing that the problem should be borne in mind to facilitate expeditious and appropriate management. A clue to the diagnosis is interruption of venous return that is not due to a kink in the cannulae.

Aged↗
PubMed1992

Early detection of coronary artery graft dysfunction with intraoperative 2-dimensional transesophageal echocardiography.

We report 5 cases in which intraoperative transesophageal echocardiography was instrumental in the early detection of a left ventricular wall-motion abnormality caused by acute dysfunction of a coronary artery bypass graft. The appearance of a wall-motion abnormality on transesophageal echocardiography preceded signs of myocardial ischemia when such signs were detectable with routine monitoring. By facilitating prompt, appropriate correction of technical problems, transesophageal echocardiography enabled the blood flow to be restored and the ischemic insult to be resolved without further complication.

Journal Article↗
PubMed1991

Surgical correction of posttraumatic VSD via the right atrium.

We report the cases of four patients seen with ventricular septal defects (VSDs) resulting from penetrating chest trauma; initial surgical management was via left thoracotomy and comprised relief of tamponade and suture of the surface cardiac wound. A VSD was suspected in all four patients postoperatively on the basis of a holosystolic murmur as confirmed with two-dimensional echo and angiography. Elective surgical repair was undertaken on cardiopulmonary bypass with bicaval cannulation and cardioplegic arrest. The interventricular septum was approached through the right atrium (no attempt was made to free the anterior surface of the right ventricle from adhesions). Three defects were closed directly and one was closed with a pericardial patch. The surgical correction of posttraumatic VSD from a penetrating injury can be safely and effectively achieved via a right atrial approach.

Echocardiography↗
PubMedDate not supplied

Immunoglobulin G-positive in B-cell cross-match decreases kidney allograft survival.

We retrospectively studied all 1149 transplants performed at our center between 1993 and 2003 to determine the incidence and clinical effect of pretransplant B-positive cross-match on kidney graft survival. The patients were divided in two groups: B-negative (n = 1102) and B-positive in current sera (n = 47; 4.1%). AB-positive test was more frequent among regrafted patients (14% vs 3%; P = .00). Demographic data were not different between the groups. The overall rate of graft loss was similar (26% vs 24%, respectively; P = .86). However, early nonsurgical graft losses were more frequent among B-positive patients (46% vs 20%, respectively; P = .04). IgM was the most frequent immunoglobulin in the B-positive group (76% IgM and 24% IgG). There was no significant difference between B-negative and B-positive groups in the 1-, 5-, and 10-year graft survival rates (87% vs 83%, 73% vs 78%, 64% vs 66%, respectively; P = .87). The graft survival was significantly reduced comparing an IgG anti-B cell to the B-negative group (P = .03) as well as IgG compared to IgM (P = .004). In conclusion, only B-positive cross-match due to IgG decreased graft survival. Even though it is an uncommon situation (0.9%), this study stressed the clinical value of the B-cell cross-match as a tool to identify patients with a higher immunological risk.

B-Lymphocytes↗
PubMedDate not supplied

Transesophageal echocardiography for the evaluation of mitral valve prostheses in the weanling sheep.

The sheep model has been widely accepted for evaluating the in vivo performance of artificial valves. Introduction of transthoracic echocardiography revolutionized the evaluation of human cardiac valves, but in many cases, resolution of transthoracic studies in sheep is inadequate. The authors used transesophageal echocardiography to follow the performance of chronically implanted mitral prostheses. The technique has proven feasible and safe, requiring sedation only and being done in the spontaneously breathing animal without endotracheal intubation in the left lateral position. The HP 77020A, equipped with a standard HP 5 mHz transesophageal transducer probe, is used. The authors have had to modify the probe to allow for automatic cooling. Standard insertion techniques are used and the probe is positioned in the stomach, close to the gastroesophageal junction. They were able to assess leaflet motion, vegetations, and calcification and use color flow doppler to evaluate stenosis and regurgitation. The technique is convenient and permits a complete assessment of valve function in 10 minutes. Reproducibility has been confirmed. Validation of quantitative data will require further study.

Animals↗