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1.
Transplant Proc ; 37(9): 4021-3, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16386615

RESUMO

We report a series of 26 heart transplant recipients with renal impairment in which sirolimus was used as the basic immunosuppresive drug (without associated calcineurin inhibitors) to avoid further nephrotoxicity. Sirolimus (trough levels 10 to 12 ng/mL, average daily dose 3 mg) was used in two settings: de novo in 7 patients with significant preexistent renal impairment and as a chronic conversion in 19 stable patients with established renal failure (creatinine level >2 mg/dL). In all de novo patients (n = 7), the renal function significantly improved. Creatinine fell from 2.95 +/- 0.9 mg/dL to 1.41 +/- 0.4 mg/dL at follow-up (P = .0017). One patient died suddenly of a massive pulmonary embolism. Only one patient experienced histologic but reversible rejection. In one patient, anemia and diarrhea prompted sirolimus withdrawal. Five patients had infectious episodes: three bacterial pneumonias, one mediastinitis, and two CMV infections. In the chronic conversion group (n = 19), the improvement was mostly limited to patients with moderate renal failure (creatinine < or =2.5 mg/dL) in which creatinine fell from 2.24 +/- 0.2 to 1.9 +/- 0.27 mg/dL, P = .009). When basal creatinine was over 2.5 mg/dL, only one third of the patients improved after conversion. Two patients died: terminal renal failure and cerebrovascular accident. There were no clinical episodes of rejection. Secondary effects prompted the discontinuation of sirolimus in five patients: two definite and one possible interstitial pneumonitis and two cases of anemia). The symptoms resolved after sirolimus withdrawal. Six patients had infection: four pneumonias, one sepsis, and one cutaneous abscess. Sirolimus is an interesting alternative to calcineurin inhibitors in selected patients with renal impairment. It prevents renal failure in de novo recipients at high risk of catastrophic renal damage and ameliorates renal dysfunction in chronic patients with moderate renal dysfunction. Given the high incidence of secondary effects, the adequate dosage and the secondary effects profile needs further study.


Assuntos
Inibidores de Calcineurina , Transplante de Coração/imunologia , Imunossupressores/uso terapêutico , Sirolimo/uso terapêutico , Adulto , Idoso , Feminino , Seguimentos , Humanos , Imunossupressores/efeitos adversos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Sirolimo/efeitos adversos , Fatores de Tempo
2.
Rev Esp Cardiol ; 54(4): 522-4, 2001 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-11282060

RESUMO

We report the case of a 44-year-old man with dilated cardiomyocardiopathy, pulmonary hypertension and high pulmonary resistance who underwent orthotopic heart transplant. Following transplantation severe hypoxia was observed after weaning of cardiopulmonary bypass secondary to a patent foramen oval in the donor heart. This situation does not usually lead to problems in the donor, however taking into account the special hemodynamic conditions of the transplanted patient, with high pressure in the right side, an opening occurred producing a significant right-left shunt causing severe receptor hypoxia. Successful closure of the patent foramen oval was performed.


Assuntos
Comunicação Interatrial/complicações , Transplante de Coração/efeitos adversos , Hipóxia/etiologia , Adulto , Humanos , Masculino , Índice de Gravidade de Doença , Fatores de Tempo
3.
Rev Esp Cardiol ; 53(5): 663-83, 2000 May.
Artigo em Espanhol | MEDLINE | ID: mdl-10816174

RESUMO

Doppler echocardiography has become the technique of choice for the diagnosis and follow-up of most heart diseases its main advantages are that it is non-invasive, easy to use, readily available, rapid and has a high cost-benefict ratio. Multiple studies have demonstrated the accuracy of the technique in the diagnosis and severity quantification of the severity of different diseases. Nevertheless, its main limitation lies in the fact that results are operator dependent, and therefore correct training of the echocardiographer is mandatory. In addition, adequate infrastructure and appropriate equipment are a required guarantee quality of the study. Finally, the technique should be used for the indications, in which beneficial information can be yielded. The aim of the present article was to define and update these considerations to enhance the usefulness of echocardiography in clinical practice.


Assuntos
Ecocardiografia , Adolescente , Adulto , Cardiomiopatias , Dor no Peito/diagnóstico por imagem , Ecocardiografia Transesofagiana , Endocardite/diagnóstico por imagem , Teste de Esforço , Cardiopatias/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Hipertensão/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Isquemia Miocárdica/diagnóstico por imagem , Doenças do Sistema Nervoso/diagnóstico por imagem , Pericárdio , Função Ventricular Esquerda
4.
Rev Esp Cardiol ; 53(2): 212-7, 2000 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-10734754

RESUMO

This article presents the program for training in cardiology. The document was elaborated by the National Committee of the Specialty of Cardiology, from the Ministry of Health and Ministry of Education, and describes the theoretical and practical aspects of training in cardiology prevailing at present in Spain.


Assuntos
Cardiologia/educação , Educação Médica , Especialização , Cardiologia/normas , Currículo/normas , Medicina/normas , Espanha
5.
Rev Esp Cardiol ; 53(1): 136-8, 2000 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-10701332

RESUMO

The Brugada syndrome is characterized by in a electrocardiographic pattern of right bundle branch block and ST-segment elevation in the right precordial leads, absence of any structural heart disease and syncope episodes or sudden death. We report the case of a 50 year-old men with Brugada syndrome and manifold changes of the precordial morphology of ST segment.


Assuntos
Fibrilação Ventricular/fisiopatologia , Morte Súbita Cardíaca , Eletrocardiografia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Síncope , Síndrome
7.
Ann Thorac Surg ; 67(5): 1299-303, 1999 May.
Artigo em Inglês | MEDLINE | ID: mdl-10355401

RESUMO

BACKGROUND: The CarboMedics "Top-Hat" supraannular prosthesis was designed to permit the implantation of a larger prosthesis. METHODS: Between June 1993 and November 1996, 127 patients (average age, 61.8+/-10.2 years) received a CarboMedics "Top-Hat" supraannular aortic prosthesis. The average follow-up was 15.7 months, and all surviving patients underwent echocardiographic study. This group is compared with 656 patients in whom a standard CarboMedics prosthesis was implanted and also with 2,927 patients who received other aortic prostheses. RESULTS: Using the standard and the supraannular sizers, there was an average increase of one size in favor of the supraannular prosthesis: 18.9+/-2.8 mm standard versus 20.8+/-2.6 mm supraannular (p < 0.005). For each prosthesis size (19 to 23 mm), the body surface area of the patients in whom a CarboMedics supraannular prosthesis was implanted was significantly smaller than that in those who received a CarboMedics standard prosthesis or any other model. Hospital mortality was 3.9%, and late mortality was 5.5%. The actuarial survival was 86.5%+/-3.9% at 42 months. CONCLUSIONS: Using the CarboMedics supraannular prosthesis allows implantation of a larger prosthesis compared with the standard CarboMedics prosthesis or other models. This advantage is especially important in patients with a small aortic root.


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Adulto , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Ecocardiografia Doppler , Feminino , Doenças das Valvas Cardíacas/cirurgia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Estudos Prospectivos , Desenho de Prótese , Resultado do Tratamento
8.
Rev Esp Cardiol ; 52(12): 1162-4, 1999 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-10659666

RESUMO

We present a case of a 57-year-old man with a giant-cell myocarditis that made its debut as a sustained ventricular polymorphic tachycardia interpreted in the context of old apical myocardium infarct, with a posterior evolution towards refractory heart failure, which finally needed urgent cardiac transplantation. We explain the characteristics of this unusual myocarditis, which has a poor prognosis, and also the results of the laboratory techniques that led to an equivocal diagnosis in this patient.


Assuntos
Infarto do Miocárdio/diagnóstico , Miocardite/diagnóstico , Diagnóstico Diferencial , Emergências , Células Gigantes/patologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/patologia , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/complicações , Miocardite/patologia , Miocardite/cirurgia , Miocárdio/patologia
9.
Rev Port Cardiol ; 17(2): 133-42, 1998 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-9587209

RESUMO

OBJECTIVE: The objective of this study is to analyze the value of the electrocardiogram in the identification of the coronary artery responsible for acute inferior myocardial infarction. MATERIAL AND METHODS: One hundred consecutive patients with acute inferior myocardial infarction were studied, 67 with a lesion in the right coronary artery and 33 in the circumflex artery. The ST segment changes in the inferior, lateral, precordial and right-chest leads were analyzed, as well as the arithmetic sum of the ST segment in the inferior and V2 leads (II + V2, III + V-2 and aVF + V2). We also developed a diagnostic process based on a stepwise approach of three electrocardiographic criteria: a) elevation of the ST segment in DI; b) arithmetic sum of the ST magnitude in DIII + V2 < 0; c) depression of the ST segment in V4R. RESULTS: This study shows that the most useful parameters to predict (with a specificity of 100%) the lesioned coronary artery in acute inferior myocardial infarction are: a) the arithmetic sum of the ST segment: aVF + V2 > 0, for the right coronary artery; b) the arithmetic sum of the ST segment: III + V2 < 0, for the circumflex artery; c) the arithmetic sum of the ST segment: aVF + V2 > 1 mm, for the proximal right coronary artery. CONCLUSIONS: The incorporation of these three criteria in an algorithm diagnostic system allows us to locate the coronary artery responsible for acute myocardial infarction with 100% sensitivity and specificity.


Assuntos
Vasos Coronários/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico por imagem , Algoritmos , Diagnóstico Diferencial , Humanos , Ultrassonografia
10.
Rev Esp Cardiol ; 50(10): 742-4, 1997 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-9417567

RESUMO

A case of a 64-year-old man is described, who was diagnosed as having a false aneurysm of the left ventricle, or pseudoaneurysm, a year following an inferior wall myocardial infarction. The echocardiogram demonstrated the presence of two ways of entry which communicated the inferior wall of the left ventricle to the false aneurysm. The patient was taken to surgery, where the diagnosis was confirmed. Aspects related to the diagnosis, treatment and prognosis of this case are discussed.


Assuntos
Falso Aneurisma/diagnóstico , Aneurisma Cardíaco/diagnóstico , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Aneurisma Cardíaco/etiologia , Aneurisma Cardíaco/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Prognóstico
12.
Neurologia ; 10(7): 283-7, 1995.
Artigo em Inglês | MEDLINE | ID: mdl-7576726

RESUMO

The aim of this prospective study was to determine the etiologic factors leading to stroke in a group of young adults. We studied 95 patients aged 50 years or under who were admitted with the diagnosis of stroke over a 2-year period. These patients underwent complete clinical and laboratory assessment for stroke. The etiology was established in 73 (76.8%) out of 95 cases. Arterial hypertension, embolism and atherosclerosis were found to be the most frequent causes in patients with ischemic stroke, whereas hypertension and aneurysm rupture were the most prevailing etiologies in patients with hemorrhagic stroke. Miscellaneous causes represented one fourth of all cases of the series. Coagulation abnormalities occurred in some patients, but in these cases there were also other well established causes. Paradoxical embolism was not observed. This study corroborates the importance of thorough diagnostic evaluation to establish an accurate diagnosis.


Assuntos
Transtornos Cerebrovasculares/etiologia , Adulto , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/etiologia , Anticorpos Antifosfolipídeos , Arteriosclerose/complicações , Arteriosclerose/fisiopatologia , Encéfalo/fisiopatologia , Angiografia Cerebral , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/fisiopatologia , Feminino , Humanos , Hipertensão/complicações , Embolia e Trombose Intracraniana/complicações , Embolia e Trombose Intracraniana/diagnóstico , Embolia e Trombose Intracraniana/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
13.
J Thorac Cardiovasc Surg ; 110(2): 511-6, 1995 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-7637369

RESUMO

Fifty-one patients with a mean age of 31.2 years underwent aortic valve replacement with glutaraldehyde-treated autologous pericardium. Pure aortic regurgitation was present in 28 (54.9%), stenosis in 9, and mixed disease in 14. Simultaneous mitral valve repair was done in 17 patients and replacement in 1. There were no hospital and two late deaths. Three patients required reoperation because of failure of the pericardial valve as a result of infective endocarditis in two (5 and 31 months after operation) and commissural tear at 8 months in another. One patient underwent reoperation at 24 months because of failure of the mitral valve repair. The pericardial aortic valve, which had 2+ regurgitation since the first operation, was also replaced. Macroscopic and microscopic examination findings in the excised pericardium were excellent. No thromboembolic events have been detected and no patient received anticoagulation therapy except one after mitral valve reoperation and replacement with a mechanical valve. The actuarial survival was 84.53% +/- 12.29% at 60 months, freedom from failure of the aortic reconstruction 83.83% +/- 8.59%, and freedom from any event 72.59% +/- 12.79%. Doppler echocardiographic study at most recent follow-up showed a mean gradient of 12.56 +/- 8.10 mm Hg and mean regurgitation on a scale from 0 to 4+ of 0.80 +/- 0.66. Although the maximum follow-up is only 5 years, the results obtained so far encourage us to continue replacing the aortic valve with stentless autologous pericardium.


Assuntos
Valva Aórtica/cirurgia , Pericárdio/transplante , Adolescente , Adulto , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Insuficiência da Valva Aórtica/cirurgia , Bioprótese , Ecocardiografia Doppler em Cores , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Complicações Pós-Operatórias , Reoperação , Transplante Autólogo/métodos
14.
Ann Thorac Surg ; 58(3): 639-45, 1994 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-7944683

RESUMO

Valve replacement still represents a problem in the very young patient. Between July 1988 and November 1993, 96 CarboMedics mechanical valves were implanted in 75 patients with a mean age of 11.76 years (range, 5 months to 20 years). The mean preoperative New York Heart Association functional class was 3.2, and 89.3% of the patients were in sinus rhythm. The cause was rheumatic in 60%, congenital in 24%, and infective in 12%. Mitral valve replacement was undertaken in 43 patients, aortic in 11, and mitroaortic in 21. Among the 18 patients with congenital defects, 13 required simultaneous repair of their complex lesions. The hospital mortality was 12% (9 patients). Cause and age were significant factors responsible for mortality. The mortality was 27.8% for patients with congenital disease and 6.7% for those with rheumatic defects (p = 0.0365); it was 40% for patients younger than 2 years, 14.3% for those between 3 and 10 years old, and 5.9% for those older than 10 years (p = 0.0108). The maximum follow-up was 54 months (mean, 18 months). There were 10 late deaths (15.15%). No embolic events occurred. All patients were on anticoagulation therapy except 2 who were on antiaggregant therapy. One of them underwent successful reoperation for treatment of mitral prosthetic thrombosis. Three reoperations were performed: one for thrombosis, one for perivalvular leak, and one for endocarditis. The total actuarial survival was 68.19% +/- 7.02%. Freedom from embolism was 100%; from thrombosis, 96.72% +/- 3.22%; from severe hemorrhage, 94.94% +/- 3.67%, and from reoperation, 83.07% +/- 9.51%.


Assuntos
Valva Aórtica/cirurgia , Materiais Biocompatíveis , Bioprótese , Carbono , Próteses Valvulares Cardíacas/instrumentação , Valva Mitral/cirurgia , Análise Atuarial , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Ecocardiografia Doppler , Feminino , Seguimentos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/etiologia , Doenças das Valvas Cardíacas/mortalidade , Doenças das Valvas Cardíacas/cirurgia , Mortalidade Hospitalar , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/cirurgia , Cuidados Pré-Operatórios , Desenho de Prótese , Reoperação , Taxa de Sobrevida
15.
Rev Esp Cardiol ; 47(7): 439-49, 1994 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-8090970

RESUMO

INTRODUCTION AND OBJECTIVES: Regurgitant jet area is to date the most widely accepted color Doppler parameter for quantitation of atrium-ventricular regurgitations. In experimental studies, it has been demonstrated that color regurgitant jet area is greatly influenced by technical settings. The present study was aimed to analyze the effect of gain setting, pulse repetition frequency and echocardiographic plane on color jet area in patients with tricuspid regurgitation. METHODS: We studied 64 patients with nontrivial (more than 1 cm2), rheumatic tricuspid regurgitation. Examinations were performed in apical four-chamber and right ventricle inflow-tract views, at two gain settings (subsaturation gain and 1/3 reduced gain) and at two pulse repetition frequencies (3.1 and 3.8 kHz). Therefore, every regurgitant jet was study under 8 different technical conditions. The remaining technical settings were held unchanged included throughout the studies. The traced area induced central varianced and aliased signals, as well as the immediately contiguous nonturbulent velocities that were moving in the same direction as the jet. Measurements were taken from 5 and 3 representative cycles in patients with atrial fibrillation and sinus rythm, respectively. RESULTS: Globally, reduction in gain setting produced a color area decrease by 50%. This reduction was of greater extent for small jets (less than 5 cm2, 45 +/- 17%) with respect to larger jets (more than 5 cm2, 61 +/- 30%, p = 0.0009). Results were similar for both apical four-chamber and right ventricle inflow views and for the two pulse repetition frequencies. At a given color gain level and echocardiographic view, pulse repetition frequency at 3.1 kHz produced greater color areas (by 3-11%) than frequency at 3.8 kHz, but the difference was not significant. Overall, color jet area was significantly greater in right ventricle inflow view than in apical four-chamber view, but substantial individual variability was observed. Difference between both views was greater than 40% in 28% of patients, with the largest color area in right ventricle inflow view in most, especially in those patients with eccentric jets. CONCLUSIONS: Gain setting and echocardiographic view greatly affect regurgitant jet area by color Doppler in patients with tricuspid regurgitation. Therefore, standardization of technical settings is mandatory in order to avoid diagnostic pitfalls.


Assuntos
Ecocardiografia Doppler/métodos , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Idoso , Análise de Variância , Ecocardiografia Doppler/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/epidemiologia , Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/epidemiologia
16.
Int J Cardiol ; 44(3): 275-83, 1994 May.
Artigo em Inglês | MEDLINE | ID: mdl-8077074

RESUMO

The correlation between data obtained by Doppler color flow imaging and angiographic severity has been investigated in mitral and aortic regurgitation. However, similar studies have not been performed for tricuspid regurgitation (TR). This study was performed to establish the correlation between measurements of regurgitant jet area by Doppler color flow imaging and the angiographic severity of TR. Fifty-four patients with rheumatic heart disease who underwent right ventriculography and transthoracic Doppler color flow imaging were studied. The regurgitant jet area was measured as the largest clearly definable flow disturbance in apical four-chamber and right ventricle inflow views, and expressed in both views as the absolute jet area or as the ratio of maximal jet area to right atrial area. Correlation of all Doppler color flow measurements with angiographic grades of TR were comparable, absolute jet area in apical four-chamber view being closest at r = 0.80. A regurgitant jet area in apical four-chamber view < 5 cm2 predicted minimal or mild TR by angiography with a sensitivity of 78% and a specificity of 100%, whereas a regurgitant jet area > 10 cm2 predicted severe TR with a sensitivity of 92% and a specificity of 91%. Values between 5 and 10 cm2 predicted moderate TR with a sensitivity of 89% and a specificity of 89%. Sensitivity and specificity were not improved with use of the ratio of jet area to right atrial area or with use of right ventricle inflow view. Thus, Doppler color flow jet measurements correlate closely with angiographic results in the evaluation of TR.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Ecocardiografia Doppler , Cardiopatia Reumática/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Análise de Variância , Cateterismo Cardíaco , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Radiografia , Cardiopatia Reumática/epidemiologia , Insuficiência da Valva Tricúspide/epidemiologia
17.
Rev Esp Cardiol ; 46(11): 761-4, 1993 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-8290780

RESUMO

A case of lipomatous hypertrophy of the interatrial septum in a patient with a history of repeated pulmonary embolism is presented. Thickening of the interatrial septum mimicking the presence of a right atrial mass was evidenced by transthoracic and transesophageal echocardiography. Lipomatous hypertrophy was suspected. The diagnostic was confirmed by echo guided (transesophageal) percutaneous transvenous biopsy. To our knowledge, there is no relationship between lipomatous hypertrophy and pulmonary embolism and in this case, it could be associated with smoking habit and oral contraceptives.


Assuntos
Cardiomegalia/diagnóstico por imagem , Ecocardiografia Transesofagiana , Neoplasias Cardíacas/diagnóstico por imagem , Septos Cardíacos/diagnóstico por imagem , Lipoma/diagnóstico por imagem , Adulto , Biópsia , Cardiomegalia/patologia , Diagnóstico Diferencial , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Neoplasias Cardíacas/patologia , Septos Cardíacos/patologia , Humanos , Lipoma/patologia , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/patologia , Recidiva
18.
Rev Esp Cardiol ; 46(10): 633-41, 1993 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-8234998

RESUMO

INTRODUCTION AND OBJECTIVES: To assess the anti-ischemic efficacy of nitroglycerin patches (10 mg/day), we studied, by means of serial exercise testing (Bruce protocol), 10 patients with stable effort angina in a randomized, placebo-controlled, cross-over, double-blind essay. METHODS: Patients were exercised 1, 4, 12 and 24 hours after a single patch, and 4 and 12 hours after a 48 hours therapy course. Chronic therapy was assessed after both continuous and intermittent (intermission of 12 hours) patch application. RESULTS: After single patch, time to angina and time to 1 mm ST depression were significantly increased with respect to placebo at 1-hour test (83 +/- 27 s and 119 +/- 39 s, respectively), 4-hour test (100 +/- 34 s and 87 +/- 29 s, respectively) and 12-hour test (46 +/- 15 s and 64 +/- 20 s, respectively). No effect was demonstrated at 24-hour test. After continuous treatment no differences with respect to placebo were found at any test. After intermittent treatment time to angina was prolonged (75 +/- 23 s) only at 4-hour test, and time to 1 mm ST depression at 4-hour test (61 +/- 19 s) and 12-hour test (41 +/- 14 s). CONCLUSIONS: Nitroglycerin patches improve parameters of exercise ischemia for a 12 hours period. Tolerance is developed very early and provokes absolute lack of efficacy. Tolerance can be avoided with intermittent patch application. No treatment schedule shows 24 hours efficacy.


Assuntos
Angina Pectoris/tratamento farmacológico , Nitroglicerina/administração & dosagem , Esforço Físico/efeitos dos fármacos , Administração Cutânea , Idoso , Angina Pectoris/fisiopatologia , Método Duplo-Cego , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
19.
Chest ; 104(1): 88-93, 1993 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-8325123

RESUMO

OBJECTIVE: To determine the clinical implications of the development of a perivalvular abscess in the course of an infective endocarditis and evaluate the utility of two-dimensional echocardiography in the diagnosis of this complication. DESIGN: Retrospective clinical review. Investigator-blinded comparative echographic case-control study. SETTING: Tertiary referral center. PATIENTS: Forty patients with infective endocarditis and a histologically proved diagnosis of perivalvular abscess. INTERVENTION: Two-dimensional echocardiograms corresponding to 36 of these 40 patients were blindly compared with two-dimensional echocardiograms of 20 randomly chosen patients with infective endocarditis in whom myocardial abscesses had not been demonstrated during surgery. MEASUREMENTS AND MAIN RESULTS: During surgery or at autopsy, 40 patients had a total of 41 definite perivalvular abscesses. Native valve endocarditis was present in 27 patients, and prosthetic valve endocarditis was present in 13 patients. Abscesses were more frequent in aortic-valve endocarditis (57.5 percent) than in infections of other valves, and the infecting organism was more often Staphylococcus (42.5 percent of cases). The hospital mortality rate was 90 percent in the 10 patients who did not receive surgical treatment, as compared with 26.6 percent in the 30 operated-on patient (p < 0.001). Sensitivity and specificity for the detection of abscesses associated with endocarditis were 80.5 percent and 85 percent, respectively, for transthoracic two-dimensional echocardiography. CONCLUSIONS: Our data indicate that transthoracic echocardiography remains an accurate method for the diagnosis of abscesses associated with endocarditis, even in the presence of a prosthetic valve, and it could help to indicate early surgery in these patients.


Assuntos
Abscesso/diagnóstico por imagem , Ecocardiografia , Endocardite Bacteriana/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/microbiologia , Abscesso/patologia , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Estudos de Casos e Controles , Ecocardiografia Doppler , Eletrocardiografia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/patologia , Endocardite Bacteriana/cirurgia , Feminino , Seguimentos , Doenças das Valvas Cardíacas/patologia , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Método Simples-Cego , Infecções Estafilocócicas , Infecções Estreptocócicas , Taxa de Sobrevida , Resultado do Tratamento
20.
Stroke ; 24(6): 792-5, 1993 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-8506549

RESUMO

BACKGROUND AND PURPOSE: The aim of this study was to determine the incidence, type, and prognosis of stroke in young adults in Cantabria, Spain. METHODS: We investigated prospectively all patients aged 50 years or below who were admitted with the diagnosis of a stroke to the University Hospital "Marqués de Valdecilla" from April 1, 1986, to March 31, 1988. This is the main hospital of the region to which all patients with neurological problems are referred. These patients underwent a complete clinical and laboratory assessment for stroke and had 1-year mean follow-up. RESULTS: The total series included 81 patients. The annual age-specific crude incidence rates of stroke were 17.3 and 10.4 per 100,000 for males and females, respectively. Twenty-four patients (30%) were diagnosed as having nonembolic cerebral infarction, 14 (17%) embolic cerebral infarction, 20 (25%) subarachnoid hemorrhage, 22 (27%) spontaneous cerebral hemorrhage, and one case (1%) cerebral venous thrombosis. Eighteen patients (22%) died within 30 days of the cerebrovascular event, and two others died during the follow-up period. Seventy-nine percent of the survivors recovered and were completely self-sufficient. CONCLUSIONS: The incidence of stroke in the young found in Cantabria is comparable with that in previous studies. The initial hospital mortality was not negligible, but the prognosis among the survivors was favorable.


Assuntos
Transtornos Cerebrovasculares/epidemiologia , Adolescente , Adulto , Criança , Atestado de Óbito , Feminino , Seguimentos , Humanos , Incidência , Embolia e Trombose Intracraniana/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Sistema de Registros , Espanha
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