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1.
Am J Cardiol ; 43(4): 773-7, 1979 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-425914

RESUMO

Acute mitral regurgitation was produced in six open chest dogs by excising a portion of the anterior valve leaflet. Electromagnetic flow probes were placed in the left atrium around the mitral anulus and in the ascending aorta to determine phasic left ventricular filling volume, regurgitant volume and stroke volume. The systolic pressure gradient was calculated from simultaneously measured high fidelity left atrial and left ventricular pressures. The effective mitral regurgitant orifice area was calculated from Gorlin's hydraulic equation. Infusion of nitroprusside resulted in a significant reduction in mitral regurgitation. No significant change occurred in the systolic pressure gradient between the left ventricle and the left atrium because both peak left ventricular pressure and left atrial pressure were reduced. The reduction of mitral regurgitation was largely due to reduction in the size of the mitral regurgitant orifice. Reduction of ventricular volume rather than the traditional concept of reduction of impedance of left ventricular ejection may explain the effects of vasodilators in reducing mitral regurgitation.


Assuntos
Insuficiência da Valva Mitral/tratamento farmacológico , Vasodilatadores/uso terapêutico , Animais , Pressão Sanguínea/efeitos dos fármacos , Débito Cardíaco/efeitos dos fármacos , Cães , Hemodinâmica/efeitos dos fármacos , Nitroprussiato/uso terapêutico
2.
Am J Cardiol ; 46(1): 95-105, 1980 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-7386399

RESUMO

Transesophageal M mode echocardiography was used for continuous monitoring of left ventricular dimensions in 21 patients (11 with valvular and 10 with coronary heart disease) undergoing open heart surgery. Echocardiograms were recorded in six stages of the procedure and simultaneous measurements of cardiac output (with dye dilution) and atrial pressures were made. Measurements of left ventricular diameters with the transesophageal technique correlated excellently with the corresponding measurements obtained with the standard parasternal method. In patients with volume overload, surgical correction was accompanied by a decrease in diastolic dimension, velocity of circumferential fiber shortening, mid wall stress and end-diastolic stiffness, and an increase in cardiac output. Pericardial and chest wall closures generally caused a significant decrease in cardiac output, and correlated with a decrease in diastolic diameter and an increase in the stiffness constant of the left ventricle. Thus, the decrease in cardiac output may have been due to decreased distensibility of the ventricular cavity secondary to mechanical restriction by the pericardium and chest wall. Pericardial opening caused a significant delay in septal motion that was reversed by closing the pericardium. This study confirms the validity of transesophageal echocardiography and its usefulness in monitoring changes in ventricular function during cardiac surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Ecocardiografia , Esôfago , Adulto , Idoso , Débito Cardíaco , Doença das Coronárias/fisiopatologia , Diástole , Feminino , Comunicação Interventricular/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
3.
Chest ; 75(3): 314-9, 1979 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-421572

RESUMO

The records of 20 patients who underwent mitral valve replacement for complications of bacterial endocarditis were reviewed. Although the indications for surgery were the same as those for patients with aortic endocarditis, major emboli (cerebral, coronary or retinal) prompted surgery in 8 of 20 patients, a much higher incidence than reported for surgery in aortic valve endocarditis. Eighteen of the patients had mitral regurgitation; 14 of these had severe congestive heart failure, but the development of congestive failure tended to be more insidious than in patients with aortic endocarditis. Continued septicemia despite appropriate antibiotics was the least common indication for surgery. Sixteen of the 20 patients were salvaged by surgery, although some had major residual deficits, related mainly to preoperative emboli. These results are a marked improvement in the expected 90-100 percent mortality rate for patients with these complications of endocarditis. The main reason for a poor result following surgery was temporization leading to continued deterioration of vital functions preoperatively. Reinfection of the prosthesis did not occur, and we do not consider duration of preoperative antibiotic therapy an important factor in the decision to perform surgery.


Assuntos
Endocardite Bacteriana/cirurgia , Valva Mitral/cirurgia , Adulto , Candidíase/complicações , Candidíase/diagnóstico , Vasos Coronários , Ecocardiografia , Embolia/complicações , Endocardite Bacteriana/diagnóstico , Feminino , Infecções por Haemophilus/complicações , Infecções por Haemophilus/diagnóstico , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/diagnóstico , Trombose/complicações
4.
Chest ; 80(3): 331-3, 1981 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-7273885

RESUMO

A 72-year-old woman presented 12 months postaortic valve replacement with a false aneurysm near the aortic cannulation site. The diagnosis was suspected from clinical findings and confirmed by a nuclear flow study. The patient refused surgery and died shortly afterward. At autopsy, a smooth-walled 1 cm defect adjacent to the cannulation site (presumably related to injury from a partial occlusion clamp) was found; this would have been easily reparable with surgery.


Assuntos
Aorta/lesões , Aneurisma Aórtico/etiologia , Ponte Cardiopulmonar/efeitos adversos , Idoso , Aorta/diagnóstico por imagem , Aorta/patologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/patologia , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Constrição , Feminino , Próteses Valvulares Cardíacas , Humanos , Complicações Intraoperatórias/etiologia , Cintilografia , Tecnécio
5.
Chest ; 81(3): 378-80, 1982 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-6976884

RESUMO

A 65-year-old patient sustained massive air embolism after the needle used for left atrial pressure line insertion punctured the posterior wall of the superior pulmonary vein, entering the middle lobe bronchus and causing a pulmonary venous-bronchus fistula. This is an apparently heretofore unrecognized potential cause of massive air embolism following cardiac surgery.


Assuntos
Fístula Brônquica/etiologia , Embolia Aérea/etiologia , Fístula/etiologia , Veias Pulmonares/lesões , Punções/efeitos adversos , Idoso , Cateterismo/efeitos adversos , Ponte de Artéria Coronária , Feminino , Humanos , Complicações Pós-Operatórias , Pressão
6.
J Thorac Cardiovasc Surg ; 71(4): 631-2, 1976 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-1263547

RESUMO

A rare case of multiple pulmonary leiomyomatous hamartomas is described and seven previously reported cases are reviewed. The pathological and clinical features of this lesion, which is benign and occurs in middle-aged women, are unique; a conservative approach following the establishment of diagnosis is recommended.


Assuntos
Hamartoma/cirurgia , Leiomioma/cirurgia , Neoplasias Pulmonares/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Feminino , Hamartoma/diagnóstico por imagem , Hamartoma/patologia , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Radiografia
7.
Chest ; 69(1): 110-2, 1976 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-1244264

RESUMO

A 62-year-old woman had symptoms of cough provoked by ingestion of liquids and radiologic changes compatible with repeated bouts of aspiration pneumonitis. A left bronchoesophageal fistula was easily demonstrated by barium esophagogram and fiberoptic bronchoscopy. Division of the fistula resulted in immediate disappearance of the symptoms, gradual resolution of the radiologic abnormalities, and marked improvement in the results of pulmonary function tests. The fistula appeared to be of congenital origin, but the reason that symptoms developed so late in life remains obscure.


Assuntos
Fístula Brônquica/congênito , Fístula Esofágica/congênito , Fístula Brônquica/complicações , Fístula Brônquica/diagnóstico , Fístula Esofágica/complicações , Fístula Esofágica/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade
8.
J Thorac Cardiovasc Surg ; 76(6): 771-87, 1978 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-713584

RESUMO

A pulse duplicator system for evaluating the hemodynamic performance of mitral prostheses is described. Under conditions stimulating normal resting physiology, all valves tested had measurable but acceptably small pressure drops. Under conditions simulating exercise, all were moderately to severely stenotic. Valves with nearly equal mounting diameters were compared. The Hancock, Beall, and Starr-Edwards valves (Group A) were found to be significantly more stenotic than the Björk-Shiley, Cutter-Cooley, Ionescu-Shiley, and Lillehei-Kaster valves (Group B). In the 29 to 30 mm. mounting diameter size at cardiac outputs of 5 and 9 L. per minute, Group A had average pressure drops of 3.2 and 10.5 mm. Hg and Group B, pressure drops of 1.6 and 5.3 mm. Hg, respectively. In the 24 to 26 mm. mounting diameter size, at cardiac outputs of 9 L. per minute, all the valves had critically large pressure drops (9 to 17.6 mm. Hg). The standard Gorlin formula is inappropriate for computing the orifice area of prosthetic valves. The discharge coefficient for a valve (a measure of how well the valve uses its primary flow area) and a performance index (a measure of how well the valve uses its mounting area) have been computed from a knowledge of the orifice size, without the necessity of assuming a value for the discharge coefficient required by the Gorlin formula. The biological valves (Hancock and Ionescu-Shiley) provide an efficient orifice for fluid flow at the free leaflet margins and have large discharge coefficients. On the basis of the fluid dynamic equation of motion, steady flow, root mean square (RMS) flow, and peak flow, combined with the appropriate transvalvular gradients, were all shown to yield equally accurate characterizations of valvular hydrodynamic performance. Mean flow, unfortunately the only value obtainable clinically, yielded effective orifice areas 10 percent smaller than either of the other three flow values.


Assuntos
Bioprótese/normas , Próteses Valvulares Cardíacas/normas , Cardiologia/instrumentação , Computadores , Estudos de Avaliação como Assunto , Hemodinâmica , Humanos , Modelos Biológicos
9.
J Thorac Cardiovasc Surg ; 80(4): 613-20, 1980 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-7421295

RESUMO

The hemodynamic performance of the Ionescu-Shiley bovine heterograft valve has been evaluated by intraoperative measurement of transvalvular gradients and cardiac outputs. Effective orifice areas (EOAs) were calculated and the data compared to those obtained by other investigators for other prostheses. In the aortic position, each valve, from 19 to 31 mm external diameter, produced a pressure gradient; mean EOA increased with increasing valve size, so that small (19 to 23 mm) valves were moderately stenotic and larger valves were only mildly stenotic. The presence of a mitral prosthesis produced larger transaortic valve gradients, probably as a result of aortic outflow obstruction by the mitral prosthesis. The Ionescu valve appears to be hemodynamically superior to other biological valves in the aortic position and comparable to most mechanical prostheses, although the data for comparison are scant. Each mitral valve produced a pressure gradient and, on the average, larger (29 mm) valves performed no better than smaller (25 mm). Mean EOAs for each valve size (25 to 29 mm) were adequate to provide satisfactory hemodynamics comparable to other available prosthetic valves. Mild obstruction of the left ventricular outflow by the prosthetic struts was seen to be related to the distance between ventricular septum and the struts. Most currently available prostheses seem to provide similar hemodynamics in the mitral position, and considerations such as thrombogenicity and durability may be relatively more important in the choice of a mitral valve substitute than in the choice of an aortic valve substitute.


Assuntos
Bioprótese , Débito Cardíaco , Próteses Valvulares Cardíacas , Valvas Cardíacas/fisiologia , Valva Aórtica/fisiologia , Valva Aórtica/cirurgia , Valvas Cardíacas/cirurgia , Humanos , Valva Mitral/fisiologia , Valva Mitral/cirurgia
10.
Surgery ; 80(5): 544-9, 1976 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-790620

RESUMO

The experience with 14 patients with infected aortic bifurcation grafts has been reviewed. Factors which appeared to predispose to infection in 11 patients included "re-do" operations, concomitant cholecystectomy or gastrostomy, and ruptured abdominal aneurysm. A mixture of gastrointestinal organisms was responsible for the infections. The pathogenesis, presentation, and treatment varied according to whether the proximal or distal anastomosis was involved or not. Aortoduodenal communications were present in five patients; they presented with gastrointestinal bleeding or septicemia. One patient survived as a result of early, aggressive surgical therapy. Infection presented at the distal anastomosis in nine patients, either as groin abscess or false aneurysm. Conservative therapy failed in the majority of patients but apparently was successful in three of five patients in whom infection did not involve the intra-abdominal portion of the graft. When infection does involve the intra-abdominal portion of the graft, then the graft must be excised also. Revascularization often can be accomplished with extra-anatomic bypasses of prosthesis or autogenous material, depending on the characteristics of the individual patient. Regardless of the mode of presentation or the site of infection, the early institution of judicious surgical management offers the best chance of success in these patients, and temporization usually leads to failure.


Assuntos
Aneurisma Aórtico/cirurgia , Arteriopatias Oclusivas/cirurgia , Infecções Bacterianas/etiologia , Prótese Vascular , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/terapia , Infecções por Bacteroides/etiologia , Candidíase/etiologia , Infecções por Escherichia coli/etiologia , Humanos , Infecções por Proteus/etiologia , Infecções Estreptocócicas/etiologia
11.
J Appl Physiol (1985) ; 83(1): 247-52, 1997 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-9216970

RESUMO

Lungs harvested from cadaveric circulation-arrested donors may increase the donor pool for lung transplantation. To determine the degree and time course of ischemia-reperfusion injury, we evaluated the effect of O2 ventilation on capillary permeability [capillary filtration coefficient (Kfc)], cell viability, and total adenine nucleotide (TAN) levels in in situ circulation-arrested rat lungs. Kfc increased with increasing postmortem ischemic time (r = 0.88). Lungs ventilated with O2 1 h postmortem had similar Kfc and wet-to-dry ratios as controls. Nonventilated lungs had threefold (P < 0.05) and sevenfold (P < 0.0001) increases in Kfc at 30 and 60 min postmortem compared with controls. Cell viability decreased in all groups except for 30-min postmortem O2-ventilated lungs. TAN levels decreased with increasing ischemic time, particularly in nonventilated lungs. Loss of adenine nucleotides correlated with increasing Kfc values (r = 0.76). This study indicates that lungs retrieved 1 h postmortem may have normal Kfc with preharvest O2 ventilation. The relationship between Kfc and TAN suggests that vascular permeability may be related to lung TAN levels.


Assuntos
Nucleotídeos de Adenina/metabolismo , Morte , Parada Cardíaca/metabolismo , Parada Cardíaca/fisiopatologia , Pulmão/metabolismo , Pulmão/fisiopatologia , Animais , Sobrevivência Celular/fisiologia , Parada Cardíaca/patologia , Hemodinâmica/fisiologia , Técnicas In Vitro , Pulmão/patologia , Masculino , Tamanho do Órgão/fisiologia , Consumo de Oxigênio/fisiologia , Mudanças Depois da Morte , Circulação Pulmonar/fisiologia , Pressão Propulsora Pulmonar/fisiologia , Ratos , Ratos Sprague-Dawley , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/fisiopatologia
12.
Ann Thorac Surg ; 36(4): 453-8, 1983 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-6625739

RESUMO

A survey of members of The Society of Thoracic Surgeons was undertaken to obtain information on experiences with cardiac operations in pregnant women. The experiences reported were highly successful, with only 1 maternal death in 68 procedures utilizing cardiopulmonary bypass and more than 80% survival of fetuses. Cardiac operations in pregnant patients probably can be made safer by avoidance of perfusion hypothermia and by use of fetal heart and uterine monitoring. When valve replacement is necessary, use of biological valves is recommended to avoid the necessity for anticoagulation.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Gravidez , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte Cardiopulmonar , Feminino , Insuficiência Cardíaca/cirurgia , Valvas Cardíacas/cirurgia , Humanos , Valva Mitral/cirurgia , Complicações na Gravidez/etiologia
13.
Ann Thorac Surg ; 22(3): 254-9, 1976 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-962410

RESUMO

This report concerns the use of transaxillary thoracotomy for a variety of pulmonary, pleural, and mediastinal conditions in 50 patients. Primary and metastatic carcinomas, pneumothoraces, and benign lesions such as bronchogenic cysts and neurogenic tumors can be identified, evaluated, and treated with confidence. Reduced postoperative pain and morbidity, rapid return of arm and shoulder movements, reduced hospital stay, and excellent cosmetic result are among the advantages of this approach when compared with the usual posterolateral thoracotomy.


Assuntos
Doenças do Mediastino/cirurgia , Doenças Torácicas/cirurgia , Cirurgia Torácica , Tórax/cirurgia , Axila , Humanos , Postura , Procedimentos Cirúrgicos Operatórios
14.
Ann Thorac Surg ; 29(1): 20-5, 1980 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-7356803

RESUMO

Four instances of severe anaphylactoid reaction occurring subsequent to cardiopulmonary bypass are described. These catastrophic reactions, from which 2 patients died, took place approximately an hour following administration of protamine and were characterized by marked peripheral vasodilatation, loss of capillary membrane integrity, and fulminant noncardiogenic pulmonary edema. Primary cardiac depression was not evident. We hypothesize that protamine was the causative agent in these unusually severe reactions. Differential diagnosis from other causes of acute cardiorespiratory dysfunction depended on early assessment of pulmonary artery and left ventricular filling pressures, cardiac output, respiratory mechanics, and arterial blood gases. Therapy was difficult; success in 1 of the patients seemed to have been effected in part by prompt administration of high-dose corticosteroids and maintenance of peripheral vascular tone with an alpha-adrenergic agonist.


Assuntos
Anafilaxia/induzido quimicamente , Ponte Cardiopulmonar , Complicações Pós-Operatórias , Protaminas/efeitos adversos , Edema Pulmonar/induzido quimicamente , Idoso , Anafilaxia/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Edema Pulmonar/terapia
15.
Ann Thorac Surg ; 32(2): 120-6, 1981 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-7259353

RESUMO

Utilizing a questionnaire specifically designed to uncover potential thromboembolic episodes, we personally interviewed 97 patients who underwent valve replacement with the Ionescu-Shiley valve between January, 1977, and June, 1980. In both the aortic and mitral positions, the attrition rate after the first year was low; cumulative survival at 3 to 4 years was 78% (aortic) and 61% (mitral). None of the deaths were attributed to primary valve failure. Patients with aortic prostheses, none of whom were anticoagulated, had a cumulative thromboembolism-free rate of 94% at 3 to 4 years. Patients with mitral prostheses had a thromboembolism-free rate of 71% at 3 to 4 years with 80% of the episodes occurring in patients in atrial fibrillation. Most emboli produced only transient symptoms, and only 1 patient has residual impairment. The Ionescu-Shiley valve performs well in the early years after valve replacement. Anticoagulation should be strongly considered for patients with mitral prostheses who are in atrial fibrillation.


Assuntos
Valva Aórtica/cirurgia , Bioprótese , Próteses Valvulares Cardíacas , Valva Mitral/cirurgia , Adulto , Idoso , Anticoagulantes/uso terapêutico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Inquéritos e Questionários , Tromboembolia/mortalidade , Tromboembolia/prevenção & controle
16.
Ann Thorac Surg ; 67(1): 194-9; discussion 199-200, 1999 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-10086548

RESUMO

BACKGROUND: The perfusion of rat lungs retrieved from cadavers with a solution containing isoproterenol has been shown to ameliorate the ischemia-reperfusion injury seen in lungs retrieved after death, and this protective effect parallels increases in tissue cyclic adenosine monophosphate levels. In this study, we investigated the effect of rolipram, a phosphodiesterase inhibitor, on capillary permeability and lung cyclic adenosine monophosphate levels in lungs retrieved from circulation-arrested rats. METHODS: Using an isolated perfused lung circuit, we retrieved lungs from circulation-arrested donor rats either ventilated with 100% oxygen or not ventilated for varying postmortem times. The lungs were reperfused with or without rolipram (2 micromol/L). The capillary filtration coefficient and wet to dry weight ratio, indicators of pulmonary vascular integrity, were determined, and tissue levels of adenine nucleotides and cyclic adenosine monophosphate were measured by high-performance liquid chromatography. RESULTS: The capillary filtration coefficient was significantly reduced in nonventilated cadaver lungs reperfused with rolipram 120 minutes after death (p<0.05). Oxygen ventilation or reperfusion with rolipram had a similar effect on the capillary filtration coefficient. Cyclic adenosine monophosphate levels were significantly higher in rolipram-reperfused lungs retrieved 120 minutes after death in both oxygen-ventilated (p<0.01) and nonventilated (p<0.01) lungs. CONCLUSIONS: In lungs from nonventilated, circulation-arrested donors, reperfusion with rolipram reduces the ischemia-reperfusion injury that may be due to intracellular cyclic adenosine monophosphate. Alteration of perfusate may have an impact on capillary leak caused by antecedent ischemia. Thus, rolipram may be a useful adjunct in the preservation of donor lungs retrieved after death.


Assuntos
Inibidores de Fosfodiesterase/farmacologia , Pirrolidinonas/farmacologia , Traumatismo por Reperfusão/prevenção & controle , Nucleotídeos de Adenina/metabolismo , Animais , Permeabilidade Capilar/efeitos dos fármacos , Cromatografia Líquida de Alta Pressão , AMP Cíclico/metabolismo , Modelos Animais de Doenças , Parada Cardíaca Induzida , Técnicas In Vitro , Pulmão/química , Transplante de Pulmão , Masculino , Ratos , Ratos Sprague-Dawley , Rolipram
17.
Angiology ; 30(12): 816-9, 1979 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-316976

RESUMO

A high incidence of cardiac arrhythmias and hypertension has been noted after coronary artery bypass surgery in patients previously treated with oral propranolol. Forty-two patients undergoing coronary bypass surgery had propranolol withdrawal 10 hours before surgery and were randomized into a group treated with propranolol immediately postoperatively, and a nontreatment group. Patients treated with prophylactic propranolol had a significantly lower incidence of postoperative supraventricular arrhythmias compared to patints who received no prophylaxis. All the arrhythmias responded rapidly to 1 mg of intravenous propranolol therapy, whether it was used as a primary treatment or as a supplement to prophylactic propranolol. The findings suggest that (1) there is a high incidence of supraventricular arrhythmias and sinus tachycardia after coronary artery bypass which might reflect an abrupt propranolol withdrawal, and (2) that perioperative prophylactic or supplementary propranolol therapy will successfully prevent or treat most of these arrhythmias.


Assuntos
Ponte de Artéria Coronária , Complicações Pós-Operatórias , Propranolol/efeitos adversos , Síndrome de Abstinência a Substâncias/etiologia , Taquicardia/induzido quimicamente , Feminino , Humanos , Masculino , Propranolol/uso terapêutico , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Taquicardia/tratamento farmacológico
18.
Minn Med ; 74(2): 21-4, 1991 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-2017120

RESUMO

We reviewed the records of all 66 cases of tuberculosis in St. Paul between 1986 and 1989. Two-thirds of the patients were foreign born. Some of these patients experienced problems in adherence to therapy because of cultural barriers. Resistance of the organism to antituberculosis medications was also a significant problem.


Assuntos
Tuberculose Pulmonar/epidemiologia , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia
19.
Am J Cardiol ; 45(1): 188-9, 1980 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-7350771
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