1
|
Respiratory disturbance index as a predictor of atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Obstructive sleep apnea (OSA) is a risk factor for development of atrial fibrillation (AF). Recent pacemakers have specific algorithms for detecting of OSA based on impedance measurement.
Purpose
The aim was to determine the burden of AF in patients with high respiratory disturbance index (RDI). It was also intended to determine if the onset of continuous positive airway pressure (CPAP) reduced the AF burden.
Methods
Retrospective observational study carried out through the analysis of the patient records. It included patients with pacemakers evaluated in an outpatient clinic during the first 8 months of 2018. All had the RDI algorithm. AF burden was assessed according to automatic mode switch (AMS) duration. The percentage of nights with an RDI>20/h was analysed to assess the risk of OSA.
Results
108 patients were included (mean age=70.3±9.0 years; 56.5% men). The most prevalent indication for cardiac pacing was atrioventricular node dysfunction (59.3%). The average percentage of nights with an RDI>20/h was 44.2%. The average follow-up (FU) period was 4.1 years.
Of all cardiovascular risk factors, diabetes mellitus was the only one associated with a higher incidence of AF at FU (p=0.044).
Considering just the patients with an RDI >20/h in more than 20% of nights (RDI20%), male gender was associated with higher rate of major adverse cardiovascular events [(acute myocardial infarction, stroke, acute heart failure and death) (p=0.019)].
Considering patients with AF prior to pacemaker implantation (n=34), 76% of patients had an RDI >20/h in more than 20% of nights (mean of 58.1%). 23 of these patients had long standing persistent AF at the end of FU (vs 17 at the beginnig of FU).
Considering patients who developed AF after pacemaker implantation (n=24), 58% of patients had an RDI>20/h in more than 20% of nights (mean of 45.3%). Most patients had paroxismal AF (83%).
Patients with prior paroxysmal AF or those who developed AF during FU (n=37) had a higher burden of AF at the end of FU when they had RDI >20/h in more than 50% of nights (mean burden of 24.66% vs 14.69%, p=0.005).
There was no statistically significant correlation between the percentage of nights with RDI >20/h and the Apnea Hypopnea Index (AHI) value. Patients who underwent polysomnography (n=30) had a mean AHI of 16/h (which corresponds to moderately severe OSA). 63% of patients who were referred from the pacemaker consultation to pneumology and performed polysomnography started CPAP.
CPAP use was not associated with a statistically significant reduction in any endpoints or AF burden.
Conclusion
A high RDI was associated with onset of de novo AF and higher AF burden in patients with paroxysmal AF. Thus, there is a rationale for early diagnosis and treatment of OSAS to prevent and reduce AF progression.
In this study, CPAP was not shown to significantly reduce this endpoint, probably due to reduced polysomnography and CPAP treatment.
Funding Acknowledgement
Type of funding sources: None.
Collapse
|
2
|
One stent versus two stents for distal LM PCI: insights from the experience of a high volume center. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Distal left main (LM) PCIremains a challenge. One of the most debated issues is whether to use a single vs 2 stent provisional strategy. While most studies and guidelines favour a single stent strategy, the recent DK-CRUSH V trial has shown better results with a 2 stent strategy.
Objective
To evaluate the performance of a single vs dual stent strategy for LM PCI in a real-world population setting.
Methods
Single-center procedural prospective registry of patients (pts) submitted to LM PCI from 2015–2018, with retrospective event analysis. Demographic, clinical data and procedure characteristics were analysed. Results were obtained with χ2 test, T student test, Kaplan-Meier survival analysis, logistic and Cox regression.
Results
100 pts (73 men; 69±11 years) were included. Co-morbidities were very frequent (85 had hypertension, 54 had diabetes, 71 had dyslipidemia and 39 were past smokers). 32 had reduced LVEF (<40%) and 45 previous CABG. The decision to proceed to PCI vs surgery was undertaken individually by the local HeartTeam. Most of the procedures (57) were in an acute coronary syndrome setting (11 in STEMI, 7 with cardiogenic shock). The anatomical distribution of the lesions was: distal in 69 pts (61 involved the LAD and or Cx ostium), mid shaft in 7 pts, ostial in 18 pts and diffuse in 6 pts. Protected left main PCI encompassed 41% of the procedures.
The complication rate was 7%. During a mean follow-up of 866±400 days, there were 4 peri-procedural deaths, 1-year mortality rate of 10% and 22 pts died overall.
In pts submitted to distal LM PCI, a single stent was used in 49 pts (66%) versus a 2 stent approach in 23 pts (31%). The only significant difference between these groups were diabetes (66% in the single stent vs 32% in the 2 stent group, p=0.006) and protected LM (51% in the single stent vs 26.1% in the two stent group, p=0.046).
While a 2 stent strategy was associated with higher mortality by Kaplan Meyer analysis (LogRank = 11.07, p=0.001), it was not an independent predictor of mortality in Cox regression. Cox univariate analysis identified LVEF <40% (OR 2.2, CI 1.01–4.9, p=0.047) and complications (OR 3.1, CI 1.4 – 6.9, p=0.004) as the only predictors of death. In multivariate analysis, only the latter was an independent predictor of mortality (OR 2.6, IC 1.1–5.9, p=0.028). The use of a 2 stent strategy was significantly associated with complications (χ2=5.1 p=0.024)) and was the only independent predictor of it (OR 3.8, IC 1.1–12.8, p=0.03). This was true even in the subgroup of protected LM PCI.
Conclusion
In a real-world setting of challenging LM PCI cases, a single stent strategy for distal LM PCI performed better. The use of 2 stents was an independent predictor of complications, strongly associated with increased risk of death. While a LM PCI must be undertaken on an individual basis, a single stent provisional strategy, whenever feasible, seems to be the best option.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Hospita Santa Maria
Collapse
|
3
|
Mão Reumatóide: revisão de 124 Próteses Mcf de Silicone. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2017. [DOI: 10.1055/s-0037-1606767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objectivos: O tratamento consensual na doença articular avançada da metacarpofalângica é a artroplastia com interposição de prótese. O objectivo deste trabalho foi avaliar o resultado das artroplastias de silicone realizadas em mãos reumatóides, no serviço de Ortopedia do Hospital de Santo António, nos últimos 15 anos.
Material e método: foram revistas 124 próteses de 26 doentes operados nos últimos 15 anos, avaliando-os clínica e radiologicamente, com aplicação de escalas e algoritmos de avaliação de dor, função pré e pós operatória, resultado estético e satisfação global.
Resultados: A maioria dos doentes apresentava artrite reumatóide, atingimento bilateral sendo avaliado o follow-up entre 18 meses e 13 anos. A indicação cirúrgica predominante foi a dor seguida e acompanhada pelo défice de função. Utilizou-se a prótese de Swanson em 82% dos doentes, com correcção do desvio cubital associado em 47%. Houve uma recuperação média de 28 graus do arco de mobilidade articular e 4 graus na escala decimal de dor. Registaram-se 10 complicações (seis fracturas e quatro luxações de prótese). A satisfação global dos doentes foi positiva (67%) com melhoria das actividades da vida diária e deformidade das mãos.
Conclusão: A prótese de silicone demonstrou ser uma boa opção de tratamento para a doença articular reumatóide das MCF com excelentes resultados funcionais, estéticos e dor.
Collapse
|
4
|
P2372Can we rely on iFR for avoiding FFR? Conclusions of a 5-year experience. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
5
|
P2371iFR diagnostic accuracy using FFR as gold standard: insights from a 5-year experience. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
6
|
0745 Dry matter intake, milk yield, and milk composition of dairy cows fed corn silage from corn treated with various application times of foliar fungicide. J Anim Sci 2016. [DOI: 10.2527/jam2016-0745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
7
|
Daily zero-reporting for suspect Ebola using short message service (SMS) in Guinea-Bissau. Public Health 2016; 138:69-73. [PMID: 27106280 DOI: 10.1016/j.puhe.2016.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 11/28/2022]
|
8
|
049 Physiological and molecular mechanisms associated with performance, immunometabolic status, and liver function in transition dairy cows fed rumen-protected methionine or choline. J Anim Sci 2016. [DOI: 10.2527/msasas2016-049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
9
|
|
10
|
Potential distribution and cost estimation of the damage caused by Cryptotermes brevis (Isoptera: Kalotermitidae) in the Azores. JOURNAL OF ECONOMIC ENTOMOLOGY 2014; 107:1554-1562. [PMID: 25195448 DOI: 10.1603/ec13501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In the Azores archipelago, a significant proportion of buildings are infested with the urban exotic drywood termite Cryptotermes brevis (Walker), causing major economical and patrimonial losses. This work aims to understand the potential spread of this termite species in the Azores and estimate the costs for both treatment and reconstruction of infested buildings in the entire archipelago. A maximum entropy niche modeling process was used to determine the potential occurrence of the species on each island. Different scenarios were built using independent global and regional incidence and environmental data. Both projections reveal the same pattern. Generally, the probability of occurrence is higher near the coast line, where, in Azores, the majority of the towns and villages are located. We also predict that the infestation has potential to spread to yet unaffected towns and islands. It is estimated that the cost of treating all currently infested buildings in the archipelago is Euro 51 million, while reconstruction of the same buildings would rise the costs to Euro 175 million. We predict that the absence of a control strategy will cause a further expansion of the pest to more localities in the Azores. An estimate to future scenarios implies higher costs, with treatment and rebuilding values rising up to eight times the current values.
Collapse
|
11
|
On the origin of the electrical response of vapor grown carbon nanofiber + epoxy composites. E-POLYMERS 2012. [DOI: 10.1515/epoly.2012.12.1.892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractThe origin of the electrical response of vapor grown carbon nanofiber (VGCNF) + epoxy composites is investigated by studying the electrical behavior of VGCNF with resin, VGCNF with hardener and cured composites, separately. It is demonstrated that the onset of the conductivity is associated to the emergence of a weak disorder regime. It is also shown that the weak disorder regime is related to a hopping depending on the physical properties of the polymer matrix.
Collapse
|
12
|
|
13
|
Lateral Thoracic Expansion in a Preterm Baby with Asphyxiating Thoracic Dystrophy. Thorac Cardiovasc Surg 2011; 59:56-8. [DOI: 10.1055/s-2008-1038987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
14
|
The Potential Protective Effect of Low Potassium Dextran against Lipid Peroxidation in a Rat Lung Transplantation Model. Thorac Cardiovasc Surg 2009; 57:309-11. [DOI: 10.1055/s-2008-1038634] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
15
|
Synthesis and Characterization of Dicyanovinyl-Substituted Thienylpyrroles as New Nonlinear Optical Chromophores. Org Lett 2006; 8:3681-4. [PMID: 16898791 DOI: 10.1021/ol061277s] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
[structure: see text] New dicyanovinyl-substituted 1-(alkyl)aryl-2-(2'-thienyl)pyrroles 2 were synthesized and characterized. The solvatochromic behavior of the synthesized compounds was investigated. All the derivatives showed reversible oxidation and reduction on the CV time scale. The hyperpolarizabilities (beta) of compounds 2 were measured using hyper-Rayleigh scattering. The results are among the highest beta values reported for donor-acceptor-substituted thienylpyrroles.
Collapse
|
16
|
Enterocytic columnar non-goblet cells of Barrett's esophagus--an immunohistochemical demonstration of association with malignant evolution. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2003; 22:273-8. [PMID: 12866578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Barrett's epithelium (BE), the esophageal columnar-lining with intestinal differentiation, is a premalignant condition predisposing to adenocarcinoma. Columnar cells are the prevalent element of BE, but the hallmark of intestinal differentiation is the goblet population that defines the specialised columnar epithelium (SCE). We have demonstrated that columnar cells adjacent to Barrett's adenocarcinoma (BA) exhibit enterocytic features in areas with and without SCE. Nevertheless, the relationship between malignancy and the presence of these elements is not established. To investigate whether intestinal differentiated cells, other than goblet cells, are associated to neoplasia we compared the prevalence of enterocytic features in columnar elements with and without associated BA through the use of sucrase-isomaltase (SI) immunoreactivity in 31 columnar esophageal segments (CLES) and 12 BA. In metaplasia, SI was only expressed at the columnar cells. Apical staining was exclusive of CLES with SCE. SI was present at the cytoplasm in 22.2% of CLES without SCE. Apical SI occurred in BE with and without carcinoma, similarly in areas with and without SCE (p = 0.11 and p = 0.50, respectively). In areas with SCE, columnar cells with apical SI were more frequent in cases of BE adjacent to carcinoma than in cases without neoplasia but the difference did not reach significance (p = 0.053). In areas without SCE, apical SI was significantly (p = 0.01) more frequent in cases with carcinoma. Apical SI was equally found in neoplastic as in metaplastic areas, with and without SCE, (p = 0.07 and p = 0.40, respectively). In conclusion this study on the frequency of SI on CLES with and without neoplasia demonstrated that additionally to SCE, metaplastic enterocytic cells are also associated with malignancy. It also confirmed that the presence of intestinal features are underestimated if only goblet elements are used for its identification, reinforcing the utility of the immunohistochemical recognition of enterocytic characteristics for establishing the diagnosis of BE.
Collapse
|
17
|
Abstract
Between 1970 and 1998, 90 cases of male breast cancer with available pathological material were retrieved. The disease often presented in aged patients (median--66 years) and as advanced stage (stage III/IV-51%). Excluding stage IV disease, the neoplasia were predominantly ductal invasive carcinomas. NOS (not otherwise specified) (92%), grade 1 and grade 2 (94%), positive for estrogen and progesterone receptors (72% and 74%), negative for androgen receptors (100%), p53 negative (95%), c-erbB-2 negative (88%) and DNA aneuploid (73%). Assessment of disease outcome is determined by stage at time of diagnosis, and axillary lymph node status was the only parameter found to have a statistically significant correlation with either disease-free interval or overall survival (p < 0.001) by multivariate analysis. Clinically useful information on the probability of relapse can be added by determining c-erbB-2 (p = 0.02) and progesterone receptors (p = 0.04) in stage III and tumor ploidy (p = 0.04) in pN1 subgroups of patients.
Collapse
MESH Headings
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Aneuploidy
- Breast Neoplasms, Male/chemistry
- Breast Neoplasms, Male/mortality
- Breast Neoplasms, Male/pathology
- Carcinoma, Ductal, Breast/chemistry
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- DNA, Neoplasm/analysis
- Flow Cytometry
- Follow-Up Studies
- Genetic Predisposition to Disease
- Gonadal Steroid Hormones/analysis
- Humans
- Lymphatic Metastasis
- Male
- Middle Aged
- Neoplasm Proteins/analysis
- Neoplasm Staging
- Portugal/epidemiology
- Prognosis
- Receptor, ErbB-2/analysis
- Receptors, Steroid/analysis
- Survival Analysis
- Tumor Suppressor Protein p53/analysis
Collapse
|
18
|
Abstract
OBJECTIVES To review our experience with thoracoscopy and talc poudrage during the previous 15 years with regards to efficacy, side effects, morbidity, and mortality. METHODS Six hundred fourteen consecutive patients (58.6% female; mean age, 54.5 years) underwent thoracoscopy with talc poudrage from August 1983 to May 1999. Of these, 457 patients had malignant pleural effusions, 108 patients had benign pleural effusions, and 49 patients had spontaneous pneumothorax. RESULTS Sixty-four patients were excluded from evaluation for efficacy: 30 patients (4.9%) because the lung did not expand at the time of the procedure and 34 patients (5.5%) because they died within 30 days of the thoracoscopy. All exclusions were in the malignant group. The overall success rate of the 393 patients with malignant pleural effusions was 93.4%, while the overall success for the 108 patients with benign effusions was 97%, although 7 patients (7%) with benign effusions required a second thoracoscopy. The success rate with pneumothorax was 100%. Major morbidity included empyema in 4%, reexpansion pulmonary edema in 2.2%, and respiratory failure 1.3%. CONCLUSION Thoracoscopy with talc poudrage is effective in producing a pleurodesis in malignant and benign pleural effusion and in spontaneous pneumothorax. However, it should be noted that the insufflation of talc has a systemic distribution associated with a low rate of morbidity and perhaps does induce ARDS, which is sometimes fatal in a small percentage of patients. Because of these side effects, the search for a better agent should be continued.
Collapse
|
19
|
Right atrial thrombus treated with T-PA. Rev Port Cardiol 2000; 19:367-9. [PMID: 10804783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
|
20
|
[Transesophageal echocardiography in electrical cardioversion: Is it possible to predict conversion to sinus rhythm?]. Rev Port Cardiol 1999; 18:1013-6. [PMID: 10608160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Due to its ability to safely exclude thrombi, transesophageal echocardiography (TEE) is now routinely performed in patients proposed for electrical cardioversion. However, what is the value of TEE in predicting conversion to sinus rhythm in patients with atrial fibrillation (AF)? To answer this question, TEE was performed in 21 patients with chronic AF before elective cardioversion. Patients were divided in two groups according to the outcome of cardioversion: Group A--Restoration of sinus rhythm achieved: Group B--atrial fibrillation persisted. The echocardiographic variables used to compare both groups were 1--Left Atrial size; 2--Left Atrial Appendage (LAA) systolic and diastolic dimensions; 3--LAA emptying and filling velocities; 4--LAA emptying fraction; 5--Presence of LAA spontaneous contrast. The clinical variable evaluated was 6--therapy with oral amiodarone for more than 2 weeks (> or = 200 mg/day). The results of this study showed that patients with smaller LA, adequately treated with amiodarone and with higher LAA emptying and filling velocities, have the greatest probability of conversion to sinus rhythm.
Collapse
|
21
|
Abstract
Barrett's esophagus develops with the following 2 distinct types of lining mucosa: with and without specialized intestinal metaplasia (SIM). Goblet cells found only in SIM areas identify an intestinal phenotype, recognized as the histological hallmark diagnosing Barrett's metaplasia, and selecting high-risk patients for endoscopic surveillance. The columnar non-goblet cells are the major component of the heterogeneous Barrett's metaplastic cell population and are present in areas either with or without SIM. Their significance in the differentiation of columnar-lined esophagus, and their relationship to malignancy, is still unclear. This immunohistochemical study used two markers of enterocytic differentiation, to explore the intestinal phenotype of the non-goblet cell population of Barrett's epithelium and Barrett's-associated adenocarcinoma cells. Sucrase-isomaltase (SI) and dipeptidilpeptidase IV (DPP) immunoexpression was assessed in paraffin-embedded samples of 12 surgical specimens containing Barrett's esophageal mucosa in association with adenocarcinoma/high grade dysplasia. Ileal mucosa and mucosa from normal gastric and esophageal segments of the surgical specimen were used as positive and negative controls, respectively. SI and DPP were expressed by the neoplastic cells and the columnar non-goblet, being negative in goblet cells. The localization of the enzymes was predominantly apical for SI and cytoplasmatic for DPP. There was immunoreactivity for SI in 58.3% of the carcinomas and in 66.6% of Barrett's mucosa, with equal frequency in areas with and without SIM. DPP was identified in 66.6% of the carcinomas, in 50% of the cases of Barrett's metaplasia with SIM, and in 75% of those without SIM. The columnar non-goblet cell components of Barrett's metaplasia contain small intestine enzymes in the areas either with or without SIM, which suggests that they identify an "incomplete form" of intestinal metaplasia. The demonstration that the two enzymes, SI and DPP, are produced by the columnar non-goblet cell metaplastic population and by the neoplastic cells of the associated adenocarcinoma, indicates that, in addition to the goblet cells, the non-goblet elements may also be involved in the malignant transformation of Barrett's esophagus.
Collapse
|
22
|
[Isolated left anterior artery disease: angiographic features and clinical evolution of patients submitted to surgical myocardial revascularization or angioplasty]. Rev Port Cardiol 1999; 18:21-6. [PMID: 10091521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
The option for revascularization and the choice of intervention in isolated left anterior descending artery disease may be controversial. We decided to study retrospectively a group of revascularized patients (PTCA or surgery), with previous isolated LAD disease, to evaluate the angiographic features of LAD lesion, its contribution to the persistence of symptoms after revascularization and also to compare the occurrence of cardiac events in the two subgroups (PTCA and surgery). We studied 87 patients (mean age 57 +/- 10 years) submitted to myocardial revascularization (68 PTCA; 19 surgery), whose clinical evolution was followed for a mean period of 49 +/- 10 months (cardiac events: death, myocardial infarction, angina, heart failure, PTCA, surgery). We evaluated in cineangiography angiographic features of LAD lesions (degree of stenosis, lesion length and diameter, ectasia, luminal irregularity, ulcerated plaque, eccentricity, thrombus, calcification, type of lesion). On comparing angiographic features, we noted coronary lesions were longer in operated patients (p < 0.05) and a tendency for more complex lesions in this group (p = 0.08). After revascularization, 65% of PTCA patients and 26% of operated patients maintained angina (p < 0.01). The frequency of events was significantly higher in patients submitted to PTCA (84%) due to the greater occurrence of angina (65%). Sixteen percent PTCA were redilated and 6% operated whereas 11% of the surgical group were reoperated, without statistical difference regarding reintervention between the two groups. In the PTCA group, the greater frequency of angina and the necessity of a new PTCA could reflect restenosis. The disappearance of angina in operated patients may reflect probable patency of coronary bypass.
Collapse
|
23
|
Early destructive spondyloarthropathy from combined beta2-microglobulin and transthyretin Met30 amyloidosis in a dialysed patient. Nephrol Dial Transplant 1998; 13:3223-5. [PMID: 9870498 DOI: 10.1093/ndt/13.12.3223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
24
|
Colonic cancer in a 34-yr-old woman: should it prompt microsatellite instability studies and mismatch repair gene testing? Am J Gastroenterol 1998; 93:1991-2. [PMID: 9772075 DOI: 10.1111/j.1572-0241.1998.00565.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
It remains debatable whether young patients with colorectal tumors should undergo genetic testing with the aim of identifying new hereditary nonpolyposis colorectal cancer families. We describe a case of a young woman with colon cancer with no clinical criteria of hereditary nonpolyposis colorectal cancer, whose genetic analysis showed that the tumor displayed microsatellite instability, and in whom a truncated protein in hMSH2 gene was found, which was also present in two at-risk relatives.
Collapse
|
25
|
4-17-10 Variability and mosaicism on the cortical human map based on data from electrical cortical stimulation in epileptic patients submitted to epilepsy surgery. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)86022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
26
|
Abstract
BACKGROUND Immunoreactivity for p53 tumor suppressor gene product is commonly found in human malignancies and some premalignant lesions, but its role in cancer development and its value as a marker of tumor biologic behavior is still unclear. OBJECTIVES This study was undertaken to assess p53 immunoexpression in esophageal squamous cell carcinoma and attempts to determine its correlation with morphological features associated with tumor behavior. METHODS Immunohistochemical study was performed on archival paraffin-embedded tissue of 37 esophageal squamous cell carcinomas and respective adjacent mucosa. RESULTS Twenty-one tumors (56.8%) demonstrated specific staining for p53. Sixteen areas of dysplasia were present in 14 out of the 35 cases. p53 positivity was found in one low-grade dysplasia and in six high-grade dysplasias. By univariate analysis, p53 immunoexpression correlated positively with local invasion (P = 0.01) and perineural spread (P = 0.04). Multivariate analysis with logistic regression showed that tumor invasion was the only factor that discriminated between p53 positive and p53 negative cases (OR: 15.6, P < 0.02). No relationship was found between p53 expression and tumor grade, DNA nuclear ploidy, and S-phase fraction. CONCLUSIONS These data suggest that p53 dysfunction may be implicated in early, preinvasive, stages of esophageal cancer as well as in the tumor progression related to a more invasive phenotype.
Collapse
|
27
|
[Rupture of the interventricular septum after acute myocardial infarct: the clinical and angiography aspects]. Rev Port Cardiol 1995; 14:905-10. [PMID: 8541074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
|
28
|
[Neurological complications in coronary surgery in patients who have previously undergone carotid endarterectomy]. Rev Port Cardiol 1995; 14:869-72. [PMID: 8541066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
|
29
|
[Isolated disease of the descending anterior artery: the relationship between the angiographic characteristics and the occurrence of angina after myocardial revascularization]. Rev Port Cardiol 1995; 14:881-4. [PMID: 8541069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
|
30
|
[Significance of the persistence of ST segment elevation in anterior infarction]. Rev Port Cardiol 1994; 13:203-6, 191-2. [PMID: 8049087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Persistent ST segmentary elevation in anterior myocardial infarction was classically attributed to ventricular aneurysm. This association is now considered controversial. We studied the association between this electrocardiographic finding and the left ventricular wall motion abnormalities and global function. DESIGN Retrospective study. SETTING Patients admitted to Hospital de Pulido Valente Coronary Care Unit in Lisbon with anterior myocardial infarction who were submitted to angiographic study. PATIENTS 94 patients were included in the study. METHODS The global ejection fraction, the regional wall motion abnormalities, the coronary artery disease extension, the patency and the proximal involvement of the left anterior descending artery were investigated. RESULTS 56 of the 94 patients (60%) had persistent ST segment elevation and 38 (40%) had isoelectric ST segment. The ejection fraction was markedly depressed in the group with elevated ST segment (36.2 SD 17.6) in contrast with the group with isoelectric ST segment (49.3 SD 14.8) (p < 0.001). The group with persistent ST segment elevation had more advanced degrees of left ventricular asynergy (42/58-75%) than the group with isoelectric ST segment (12/38-32%) (p = 0.02). The other studied angiographic variables did not differ between the two groups. CONCLUSIONS The group with persistent ST segment elevation was associated with advanced degrees of left ventricular asynergy and greater left ventricular function depression. The ventricular aneurysm was exclusive of the first group.
Collapse
|
31
|
Abstract
In summary, although I feel that family-centered care has progressed in the last several years, much remains to be done. With improvement in research and technology come new challenges for medical professionals and also new liabilities. I have found individuals who were not interested in working with my son because of the risk in decision making and liability his medical conditions pose. I would like to see the next generation of medical personnel be trained to accept the challenge of multihandicapped and medically fragile children. While our current system puts pressure on physicians and hospitals to protect their business interests, I would like to see this change to allow for more sensitized and comprehensive care for all patients. My child's medical needs will be ongoing, and I know that many more doctors will come and go throughout his lifetime. What I would like to see for him (and others) is a more personalized continuum of quality care. I want him to feel, at whatever his ability to understand, that the medical professionals caring for him want him to thrive, be healthy, and feel food about himself.
Collapse
|
32
|
Abstract
We report 7 cases of severe Peyronie's disease treated with a modified surgical technique of the one described in 1989. This second version consists of making only one I-shaped incision on the dorsal face of the penis, in order to relax and create a defect in the tunica albuginea, which is then covered with a patch of human lyophilized dura mater. The plastic and sexual results were identical to the ones described previously, but the operative time was shortened. This type of surgery is indicated to correct severe angulation and shortening of the penis in men with normal sexual lives.
Collapse
|
33
|
[Methodological considerations in the interpretation of serologic screening for hepatitis B virus among blood donors]. Rev Saude Publica 1991; 25:11-6. [PMID: 1784954 DOI: 10.1590/s0034-89101991000100003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Between October 1988 and February 1989, 1,033 voluntary first-time blood donors were screened for hepatitis B infection in five blood banks in Goiâna, Central Brazil. The survey was part of a major study designed to estimate seroprevalence of HBsAg and anti-HBs and to discuss methodological issues related to prevalence estimation based on data from blood banks. Donors were interviewed and blood samples were collected and tested for HBsAg and anti-HBs by ELISA tests. Prevalences of 1.9% and 10.9% were obtained for HBsAg and anti-HBs, respectively, and no statistical difference was found between the sexes. Prevalence of anti-HBs increased with age (X2 for trend = 7.9 p = 0.004). The positive predictive value and sensitivity of history of jaundice or hepatitis reported in the interview in detecting seropositives were 13.6% and 2.2%, respectively. The methodological issues, including internal and external validity of HBV prevalence estimated among blood donors are discussed. The potential usefulness of blood banks as a source of morbidity information for surveillance for Hepatitis B virus infection is stressed.
Collapse
|
34
|
[Treatment of bronchial diseases using a new derivative of phenothiazine]. HOSPITAL (RIO DE JANEIRO, BRAZIL) 1968; 74:2039-43. [PMID: 5305623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
35
|
[Acute respiratory insufficiency in chronic pulmonary diseases]. Braz J Anesthesiol 1966; 16:151-60. [PMID: 5942217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
|