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T Caeiro

Publications and source records attributed to T Caeiro.

At least 19 recordsLinked to original sources
PubMed1997

[Survival of patients with myasthenia gravis after thymectomy. Analysis of 100 cases].

In order to evaluate the survival of patients with myasthenia gravis (MG) after thymectomy (T), 100 patients with MG in which T had been performed between 1967 and 1995 were studied. Patients were divided into different groups for their analysis: patients with thymoma (TI), 22 cases; and patients without thymoma (NTI), 78 cases. In addition those patients belonging to the latter group were further separated according to the date of their surgery into two other subgroups: patients operated before 1980 (A80), 43 cases; and after 1980 (D80), 35 cases; trying to evaluate the prognostic implications of the therapeutical advances achieved over the last 15 years. The population studied was composed mainly of women (78%) but with a slight predominance of men in TI. The mean age was 29.47 years (range 10-70) for the entire population, with a tendency toward older ages in TI (mean 46 years, range 23-70). The mean follow-up period was 4.3 years (range 0.08-23.2) without significant differences between TI and NTI. The results showed that the overall mortality rate was 16/100 (16%) [Fig. 1], with nine of those deaths corresponding to TI (9/22, 40.91%) and only the remaining seven to NTI (7/78, 8.97%). These differences in mortality rate between TI and NTI were statistically significant in all the specific times of follow-up analyzed up to 10 years after surgery (p < 0.05) [Fig. 2]. Notoriously, all deaths in NTI occurred in the A80 subgroup giving a p value < 0.001 when compared with D80 [Fig. 3]. In terms of morbidity, 55/100 (55%) reached complete clinical remission (CCR) defined by the complete absence of symptoms related to MG: 8/22 (36.36%) in TI and 47/78 (60.25%) in NTI [Fig. 4]. Most interestingly the differences were statistically significant (p < 0.01) when the rates of CCR in A80 and D80 were compared for all the times assessed [Fig. 5-6-7-8]. It can be concluded that the best results in survival in MG after T are obtained in patients without thymoma and also that the benefits of the rational use of modern therapeutic modalities, including surgery and immunosuppression with drugs, can offer those patients high possibilities of leading completely normal lives.

Adolescent↗
PubMed1996

[Regional changes of ventricular motility in patients with positive serology for Chagas disease].

The aim of the present study was to carry out a quantitative assessment of the regional left ventricular wall motion and diastolic function of patients with Chagas disease in different clinical stages. Twenty patients with positive immunofluorescence tests for Chagas disease were studied. Eight patients were asymptomatic (class I), 9 patients had electrocardiographic abnormalities (class II) and 3 patients had heart failure (class III). The control group consisted of 10 normal subjects. 2D echocardiographic images from parasternal and apical views were analysed quantitatively using a previously validated method for the assessment of the regional wall motion of the left ventricle. Diastolic flow velocities and times at mitral valve level were analysed using pulsed wave Doppler. Patients with Chagas disease showed marked wall motion abnormalities in the posterobasal segment compared with controls. These abnormalities were evident even in class I patients. The number of affected segments was higher in class II and class III. "A" wave velocity was greater in patients than in controls (0.67 +/- 0.17 and 0.49 +/- 0.08 m/s, p = 0.01 respectively) but the pattern of diastolic flow velocity was non specific. In conclusion, regional left ventricular wall motion abnormalities are common in early stages of Chagas disease suggesting that myocardial activity of the disease is present even during the asymptomatic period.

Adult↗
PubMed1994

Chronic Chagas' disease: possible mechanism of sinus bradycardia.

OBJECTIVE: To determine the cause of sinus bradycardia in patients with chronic Chagas' disease by studying their sinus node function with pharmacological agents. DESIGN: Cohort study. SETTING: Referral tertiary care hospital in Cordoba, Argentina. PATIENTS: Thirty-seven chagasic patients (19 females and 18 males, mean age 41 +/- 12 years) were divided into three groups: group 1, 14 patients with positive serology for Chagas' disease but no evidence of cardiac involvement; group 2, 14 patients with Chagas' disease and electrocardiographic abnormalities but without signs or symptoms of congestive heart failure or cardiomegaly; and group 3, nine patients with Chagas' disease and evidence of cardiomegaly and congestive heart failure. Six healthy volunteers with no evidence of heart disease were used as controls. INTERVENTIONS: All subjects received 0.04 mg/kg intravenous atropine sulphate followed 3 mins later by 0.2 mg/kg intravenous propranolol slowly injected. The resultant heart rate obtained with this total autonomic blockade (TAB) was considered to be the intrinsic heart rate observed (IHRo). MAIN RESULTS: The mean increase of heart rate after atropine was +68 beats/min in controls, +45 beats/min in group 1, +45 beats/min in group 2 and +32 beats/min in group 3. The change from the basal heart rate to the IHRo after TAB with atropine and propranolol was +29 beats/min in controls, +17 beats/min in group 1, +17 beats/min in group 2 and +5 beats/min in group 3. CONCLUSIONS: The observed response to atropine in patients with Chagas' disease suggests abnormality in the innervation of the sinus node. The difference found in the IHRo after TAB indicates involvement of the automaticity of the sinus node. These findings may explain the bradycardia reported in this disease.

Adult↗
PubMed1985

Abnormal left ventricular diastolic function in chronic Chagas' disease: an echocardiographic study.

Simultaneous M-mode echocardiograms and phonocardiograms were recorded in 19 patients with chronic Chagas' disease, and were digitised and compared with normal in order to study systolic and diastolic left ventricular function. Five of the patients were in New York Heart Association class 1, 9 in class 2, and 5 in class 3. Left ventricular cavity dimensions were increased in 3 and shortening fraction reduced in 1. Peak velocity of circumferential fibre shortening was below the 95% confidence limit of normal in 9. In contrast to previous echocardiographic studies, diastolic abnormalities were common, with prolongation of isovolumic relaxation time in 9 patients and reduced rate of dimension increase in 11. However, in spite of regional disease, documented angiographically in 5 of 6 patients, there was no evidence of asynchronous wall motion during relaxation seen in patients with coronary artery disease and comparable segmental abnormalities of wall motion. The relative timing of aortic valve closure and minimum cavity dimension was normal in all but 3 patients, and a significant dimension change during isovolumic relaxation in only one. Thus diastolic disturbances are common at all stages of Chagas' disease, and may represent a fundamental aspect of the pathological process as it affects the left ventricle.

Adolescent↗
PubMed1984

Left ventricular wall motion in patients with Chagas's disease.

The effect of early chronic Chagas's disease on the timing and extent of regional left ventricular wall motion was studied with a frame by frame analysis of left ventriculograms in nine patients and compared with those in 19 normal subjects. In all the patients there was hypokinesis or akinesis in the anteroapical region together with delay in the onset of inward movement. Hypokinesis of the proximal inferior segment was also present, but the time of onset of inward motion here was normal. These differences can be explained on the basis of regional asynchrony within the normal left ventricle, where anteroapical wall motion is delayed with respect to that elsewhere. Thus contraction of the diseased anteroapical segment starts against an appreciable pressure and so may be isometric, whereas the affected proximal inferior segment starts contracting earlier against a lower pressure and so is able to shorten. No abnormalities of wall motion were seen during isovolumic relaxation despite segmental involvement, which is a distinctly different finding from that in patients with coronary artery disease. This may be due partly to the absence of incoordinate relaxation in Chagas's disease and partly to myocardial involvement by Chagas's disease in the mid-anterior segment. This is the site of rapid early diastolic wall thinning, which has been put forward as a major mechanism of normal rapid ventricular filling and whose premature activity causes disturbances in regional wall motion before mitral valve opening when relaxation is incoordinate. Thus quantitative analysis of both the timing and amplitude of wall motion indicates fundamental differences between Chagas's disease and coronary artery disease, when a less complex analysis would have shown a similar pattern of segmental dysfunction in both. Since the effect of the same pathological process on wall motion varies with the site of ventricular involvement, the importance of the disturbances seen in Chagas's disease becomes apparent only when the non-uniformity of normal left ventricular structure and function is taken into account.

Angiocardiography↗