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Biomedical subjects

A Andrade

Publications and source records attributed to A Andrade.

At least 73 records · Page 4Linked to original sources
PubMed1989

[Intraventricular thrombi in acute myocardial infarct. Clinicoanatomic study carried out in 193 consecutive cases].

AIMS: To determine the incidence of intraventricular thrombi in patients who died of acute myocardial infarction, as well as to define the clinico-anatomical parameters of the population with thrombi. CONCEPT OF THE STUDY: To apply a clinical as well as an anatomical protocol of prospective study, in patients who died of acute myocardial infarction. The clinical protocol contemplates 64 parameters and the anatomical protocol contemplates 34. in the anatomical study were used very discriminative technics, already presented in previous papers. PLACE OF THE STUDY: The study took place in a CCU and pathological department of an University Hospital. MATERIAL AND METHODS: 193 patients who died successively of acute myocardial infarction in a CCU between 1983 and 1986. The only criteria for the inclusion in the study was the possibility of doing a necropsy study, which was done in 77% of the patients who died in that period. The study was a prospective one, being excluded only the patients in whom the anatomical study didnt confirm recent myocardial infarction. The clinical data were observed during the stay in the CCU using a protocol developed for this study. In the anatomical study a protocol developed by the authors was applied, using very discriminative anatomical quantification technics of the infarct size as well as of the coronary obstruction degree by atherosclerotic plaques. All data were stored and treated in a computer program developed for this study. RESULTS: From the 193 cases that have been studied, 88 (43%) presented thrombus in at least one of the ventricular cavities, 38 (26%) only in left ventricle, 15 (8%) only in right ventricle and 35 (18%) in both ventricles. The set with thrombus has presented a few characteristics which granted it some individuality. Thus, this group presented: a higher delay between the beginning of acute myocardial infarction and the admission in the CCU (and so in the beginning of the anticoagulant therapy), lower prevalence of diabetes, higher prevalence of left ventricular failure (Killip class III or IV), higher prevalence of cardiogenic shock and so a higher need of inotropic therapy, higher heart weight, higher prevalence of auricular thrombi and bigger infarct size when evaluated by a QRS score. In the group with left ventricular thrombi, the anterior infarct was more frequent and in the group with right ventricular thrombi the right ventricular infarct was also more frequent. The systemic embolism was uncommon in this group (1 case in 193 patients). CONCLUSIONS: 1. The intraventricular thrombi occurs in about half of the patients who died of acute myocardial infarction. 2. The group with thrombi has presented some characteristics which makes it different from the group with no thrombi. 3. The delay in the beginning of the anticoagulant therapy seems to be a risk factor of intraventricular thrombosis.

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PubMed1987

[Cardiac rupture in acute myocardial infarction. Various clinico-anatomical types in 42 recent cases observed over a period of 30 months].

Forty two cases of complete or incomplete rupture of the free left ventricular wall were reviewed in a group of 136 patients who died of acute myocardial infarction in a Coronary Care Unit and who underwent autopsy examination over a 30 month period. Four groups were distinguished on macro and microscopic features of the rupture based on a previously defined classification established by former studies: type I rupture (13 cases) with an almost direct trajectory with little dissection and bloody infiltration of the myocardium; type II (13 cases) with a multicanalicular trajectory and widespread myocardial dissection and bloody infiltration; type III (9 cases) in which the orifice of rupture is protected by an intraventricular thrombus or a pericardial symphysis; type IV (7 cases) with incomplete epicardial, endocardial or intramyocardial rupture which never was transparietal. The clinical characteristics (age, sex, time interval before admission to the coronary care unit, previous history, ECG location of the myocardial infarcts, clinical course, Killip classification, treatment and ECG changes) and anatomical findings (weight of the heart, presence of haemopericardium, previous infarction or aneurysm, location of the infarct, presence of intraventricular thrombus or ventricular septal defect, number of vessels with over 75 p. 100 obstruction and topographical location of the rupture) were compared. The type I ruptures had smaller infarcts and a quicker terminal illness with rapid evolution to cardiac tamponade. In type II ruptures, the infarcts tended to be bigger, sometimes associated with septal rupture and the terminal illness was longer lasting than in the previous group, reflecting a longer evolution towards cardiac tamponade.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1979

The relationship between disturbed metabolism of vitamin D and bone disease in chronic renal failure.

Following the discovery that the kidney is involved in the metabolism of vitamin D, a causal relationship has been sought between defective production of 1,25-dihydroxy vitamin D3 and bone disease in chronic renal failure. This paper reviews some of the clinical evidence for and against such a relationship, and considers the possible role of other vitamin D metabolites in the pathophysiology of renal bone disease.

Bone Diseases↗
PubMedDate not supplied

Hyperplastic changes and receptor status in the breast tissue of bodybuilders under anabolic-androgenic steroid stimulation.

Anabolic androgenic steroids (AAS) are misused by athletes to improve their physical performance. AAS with similar groups and configuration indicate that testosterone is the base of this ability to stimulate anabolic activity. The effect of these compounds on the breast tissue of males that consume them is a confirmation of its metabolic pathway. To confirm its hormonal effects, the status of estradiol and progesterone receptors (ER, PgR) status was determined in cytoplasmic and nuclear fractions (HRc, HRn) of 8 premalignant breast tissues from 8 bodybuilders (aged 21 to 45 years) under AAS stimulation. The control group included 5 males with benign disorders of the breast, but not due to AAS administration. The concentrations of ERc and ERn were significantly higher (p < .05) in males under AAS stimulation than in males without these. The concentrations of PgRc and PgRn do not differ between these two groups (p > .05) The benign breast disease is remarkably similar in female and male patients, suggesting a common origin. In the same way, the measurement of both HRc and HRn is necessary to accurately report receptor concentration.

Adult↗
PubMedDate not supplied

[Papillary muscle dysfunction in acute myocardial infarct: a clinical and Doppler echocardiographic study].

The "papillary muscle dysfunction" concept includes a disrupted sequence of one or more structures of the mitral valve complex and not merely a disturbance of a papillary muscle itself. We studied a group of seventeen patients, 14 men and 3 women (mean age 51 and 39 years, respectively). Acute myocardial infarction was the first evidence of heart disease. In all of them, Doppler and M mode echocardiography were performed and correlation clinical features were done. In addition a tricuspid regurgitation flow patterns was scanned on each patient. Mitral regurgitation was found in 29% of them by Doppler echocardiography and only 17% had a mitral systolic murmur suggestive of this entity. In those patients with mitral regurgitation-flow patterns, the infarct site was similar to those with anterior and inferior infarction and serum CPK-level was greater in these patients than the non-mitral regurgitation flow pattern group. The evidence of tricuspid regurgitation by pulsed-Doppler echocardiography was associated with mitral regurgitation in 80% of patients, mainly those with right ventricular extension of acute myocardial infarction, and with the greatest hemodynamic impairment. It seems likely in this study, that mitral regurgitation was due to valve ring dilation with an increase of left ventricular diameter and a decrease on ventricular systolic function.

Adolescent↗
PubMedDate not supplied

[Incidence and forms of clinical presentation of the various morphologic types of myocardial laceration in the acute phase of infarct. A 4 years' caseload at a coronary unit. A clinico-anatomic study of 193 successive cases].

AIMS: To determine the incidence of different morphological type of myocardial laceration (wall rupture) in patients who died of acute myocardial infarction, as well as to study the several clinical forms of presentation of different types of myocardial laceration. CONCEPT OF THE STUDY: To apply a protocol of prospective study, that includes 64 clinical and 34 anatomical parameters, using very discriminative technics in the anatomical study, already presented in previous papers. PLACE OF THE STUDY: The study took place in a CCU and pathological department of a University Hospital. POPULATION: Of 1308 patients successively admitted in a CCU with acute myocardial infarction between 1983-1986, 252 have died. It was possible to perform a necropsy study in 193. The only criterion for inclusion was the family agreement. METHODS: The study was a prospective one, being excluded only the patients in whom the anatomical study didn't confirm recent myocardial infarction. The clinical data were observed during the stay in the CCU, using a protocol developed for this study. In the anatomical study a protocol developed by the authors was applied, using very discriminative anatomical quantification technics of the infarct size as well as of the coronary obstruction degree by atherosclerotic plaques. In the study of the myocardial laceration a fourteen septal perpendicular cuts technic was applied, with a laceration development macroscopic study, and microscopic study of the more interesting cuts. All data were stored and treated in a computer program developed for this study. RESULTS: From the 193 cases that have been studied, 49 presented a complete free wall rupture (25%) and in two others there were an interventricular septal rupture and free wall rupture. The amount of free wall rupture was then 51 cases (26%), with a corrected incidence for the population with AMI of 5.1%. In 7 cases we found an interventricular septal rupture (in two cases associated with complete free wall rupture and in other two cases with an incomplete left ventricular rupture), what represents an incidence in necropsy of 3.6%. Since that in this period five patients with septal rupture have been operated and in three others the hemodynamic diagnosis was made, dying this patients without being performed necropsic study, the amount of septal ruptures was of 15 cases, what represents a corrected incidence of 1.1% in the population with AMI. The clinical forms of presentation of free wall rupture were the following: syncope followed by death (60%), shock (21%), transitory syncope (4%), psycho-motor troubling (4%). Pain persistence or recurrence associated with other clinical symptoms occurred in 63% of the patients. Hypotension, not always evoluting to shock, occurred in 33%, and pericarditis in 21% of the cases. When the different anatomical types of free wall rupture were considered (type I-direct rupture; type II-multicanalicular rupture; type III-rupture covered by an interventricular thrombus), we observed that in type I there was prevalence of syncope (71% and only 50% showed pain persistence or recurrence, when in type II syncope occurred in 67% and shock in 22%, with pain in 56%, and in type III the occurrence of syncope and shock were similar (44% vs 38%), with pain in 81% of the cases. Hypotension was verified in 56% in type III, 21% in type I and 22% in type II. Pericarditis never occurred in type I, happened in 33% in type II and 25% in type III. The terminal accident took an average 44 minutes long in type I, 3.8 hours in type II and 9.2 hours in type III. The delay in admission was nine hours in type I, 19 in type II and 30 in type III, and the time between the onset of symptoms and death was 2.9, 2.7 and 5.4 days respectively in types I, II and III. In what concerns the interventricular septal rupture shock occurred in all cases but one, in which association with free wall rupture determined cardiac tamponade with syncope.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMedDate not supplied

[Pulmonary embolism in acute myocardial infarct. Clinico-anatomic study of 19 cases].

The aim of this study was to evaluate the incidence of pulmonary embolism as the cause of death in acute myocardial infarction; to define the anatomic and clinical profile of a subset of patients deceased by pulmonary embolism; to study the localization and characteristics of pulmonary emboli. An anatomic and clinical protocol was systematically applied to the dying patients with acute myocardial infarction admitted in a CCU of an University Hospital. Therefore, 193 patients consecutively deceased by acute myocardial infarction were studied. Sixty-four clinical parameters were evaluated together with 34 anatomic parameters concerning a very discriminative anatomic study protocol. The sole exclusion criterion for necrotic study was the lack of family consent; necropsy was thus performed in 77% of patients. Therefore, we verified that the incidence of pulmonary embolism as the cause of death was 9.8%. Delay in admission as well as the interval between the onset of symptoms and death, were longer in the deceased by pulmonary embolism than in subjects showing other causes of death. Bradycardia was absent in pulmonary embolism patients, and asystole was the terminal electric accident in the great majority of cases; heart weight was greater, and biventricular infarction and right ventricular thrombosis were also more frequent in this subset of patients. In almost half of cases, pulmonary emboli were located in the main pulmonary artery, being multiple and peripheral in four.

Aged↗