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Biomedical subjects

A Fernandes

Publications and source records attributed to A Fernandes.

At least 55 records · Page 3Linked to original sources
PubMed1994

Cardiovascular and ventilatory responses to electrically induced cycling with complete epidural anaesthesia in humans.

Cardiovascular and ventilatory responses to electrically induced dynamic exercise were investigated in eight healthy young males with afferent neural influence from the legs blocked by epidural anaesthesia (25 ml 2% lidocaine) at L3-L4. This caused cutaneous sensory anaesthesia below T8-T9 and complete paralysis of the legs. Cycling was performed for 22.7 +/- 2.7 min (mean, SE) (fatigue) and oxygen uptake (VO2) increased to 1.90 +/- 0.13 1 min-1. Compared with voluntary exercise at the same VO2, increases in heart rate (HR) (135 +/- 7 vs. 130 +/- 9 beats min-1) and cardiac output (16.9 +/- 1.1 vs. 17.3 +/- 0.91 min-1) were similar, and ventilation (54 +/- 5 vs. 45 +/- 41 min-1) was higher (P < 0.05). In contrast, the rise in mean arterial blood pressure during voluntary exercise (93 +/- 4 (rest) to 119 +/- 4 mmHg (exercise)) was not manifest during electrically induced exercise with epidural anaesthesia [93 +/- 3 (rest) to 95 +/- 5 mmHg (exercise)]. As there is ample evidence for similar cardiovascular and ventilatory responses to electrically induced and voluntary exercise (Strange et al. 1993), the present results support the fact that the neural input from working muscle is crucial for the normal blood pressure response to exercise. Other haemodynamic and/or humoral mechanisms must operate in a decisive manner in the control of HR, CO and VE during dynamic exercise with large muscle groups.

Adult↗
PubMed1994

Recurrent intracardiac mass in a pregnant woman with antiphospholipid syndrome.

Clinical manifestations of the antiphospholipid syndrome result from thromboembolic phenomena that occur in all vascular territories. Cardiac manifestations frequently associated with this syndrome include valvular and myocardial lesions. We present a case report of primary antiphospholipid syndrome in a pregnant young woman with a right atrial mass detected by echocardiography. Its morphological characteristics presented problems in establishing differential diagnosis within atrial thrombus and atrial myxoma. This case was complicated by pulmonary embolism and recurrence of the mass within four months. Cardiac surgery was performed and two masses excised. Histopathological studies showed them to be thrombotic in nature.

Adult↗
PubMed1993

Regulation of hepatic glucose production during exercise in humans: role of sympathoadrenergic activity.

To investigate the role of sympathoadrenergic activity on glucose production (Ra) during exercise, eight healthy males bicycled 20 min at 41 +/- 2 and 74 +/- 4% maximal O2 uptake (VO2max; mean +/- SE) either without (control; Co) or with blockade of sympathetic nerve activity to liver and adrenal medulla by local anesthesia of the celiac ganglion (Bl). Epinephrine (Epi) was in some experiments infused during blockade to match (normal Epi) or exceed (high Epi) Epi levels during Co. A constant infusion of somatostatin and glucagon was given before and during exercise. At rest, insulin was infused at a rate maintaining euglycemia. During intense exercise, insulin infusion was halved to mimic physiological conditions. During exercise, Ra increased in Co from 14.4 +/- 1.0 to 27.8 +/- 3.0 mumol.min-1.kg-1 (41% VO2max) and to 42.3 +/- 5.2 (74% VO2max; P < 0.05). At 41% VO2max, plasma glucose decreased, whereas it increased during 74% VO2max. Ra was not influenced by Bl. In high Epi, Ra rose more markedly compared with control (P < 0.05), and plasma glucose did not fall during mild exercise and increased more during intense exercise (P < 0.05). Free fatty acid and glycerol concentrations were always lower during exercise with than without celiac blockade. We conclude that high physiological concentrations of Epi can enhance Ra in exercising humans, but normally Epi is not a major stimulus. The study suggests that neither sympathetic liver nerve activity is a major stimulus for Ra during exercise. The Ra response is enhanced by a decrease in insulin and probably by unknown stimuli.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Materno-fetal transmission of pregnancy malaria: an immunoparasitological study on 202 parturients in Maputo.

A total of 202 delivering mothers and their newborns were studied with the intention to follow the materno-fetal transmission of malaria. Malaria infection was encountered in 35 cases (17.3%) in which Plasmodium falciparum predominated in peripheral blood while P. malariae predominated on the placental surface. In cord blood P. falciparum was encountered in 1.5% of the cases. There was slightly more maternal infection in rural (23%) than in suburban areas (19%). Less malaria infection was encountered in primiparas than in multiparas and there was similar antibody response in both mothers and their newborns. Anaemia was encountered in 70% of the mothers and in 93% of the newborns. There was no significant correlation between low birthweight of the newborn and malaria parasitaemia in the mother.

Animals↗
PubMed1993

[Unstable angina. An evaluation of a diagnostic and therapeutic methodology].

The authors describe the diagnostic and therapeutic management of 55 patients with the diagnosis of unstable angina admitted at a medical intensive care unit. According to Braunwald classification, 52 patients had primary angina and the remaining three had post-infarction angina. Risk stratification was based on non invasive procedures such as 2D echocardiogram and exercise test after clinical stabilization. Coronary angiography was performed in all patients. Most of the patients needed revascularization: 62% by percutaneous transluminal coronary angioplasty (PTCA) and 13% were submitted to coronary artery by-pass graft (CABG). None of the patients died during hospitalization.

Adult↗
PubMed1993

[A recurrent intracardiac mass in a pregnant woman with the antiphospholipid antibody syndrome].

Clinical manifestations of the antiphospholipid syndrome result from thromboembolic phenomena that occur in all vascular territories. Cardiac manifestations frequently associated with this syndrome include valvular and myocardial lesions. We present a case report of primary antiphospholipid syndrome in a pregnant young woman with a right atrial mass detected by echocardiography. Its morphological characteristics presented problems in establishing differential diagnosis within atrial thrombus and atrial myxoma. This case was complicated by pulmonary embolism and recurrence of the mass within four months. Cardiac surgery was performed and two masses excised. Histopathological studies showed them to be thrombotic in nature.

Adult↗
PubMed1993

[Carbon monoxide poisoning].

The authors present a case of acute carbon monoxide (CO) poisoning, with associated cerebral, spinal and peripheral nerve lesions. The spinal lesion observed in our patient is a rare condition and, the association between cerebral ischemic lesions and spinal and peripheral nerve lesions has not been previously described. In this case the spinal cord lesion is of hemorrhagic type as shown by MRI. The authors discuss the possible mechanisms implied in each type of lesion.

Adolescent↗
PubMed1993

[Tomodensitometry and radioisotopic methods in the study of unilateral lung hyperlucencies of vascular origin].

Among the causes of the radiological entity known as unilateral or total hyperlucent lung is the decreased blood flow in the lungs. Unilateral and total hyperlucent lung results, among other factors, from the decreased intrapulmonary blood flow. Classically, the diagnosis and haemodynamic evaluation of these situations were usually made through invasive methods: right heart catheterism to perform angiopneumography and pressure evaluations as well as oximetry at several levels of the vascular network, thoracic aortography eventually associated with selective arteriography to detect the abnormalities of the systemic thoracic circulation. In this context, the authors propose for the diagnosis and study of this pathology, a new non-invasive methodology. In order to achieve this propose, we studied 8 patients, all of them performed clinical and laboratory evaluations, chest chi-ray, electrocardiographic and functional respiratory exams, as well angiopneumography, thoracic aortography tomodensitometry including qualitative (to study the lung arterial vasculature) and quantitative (to evaluate CT density of each lung in Hounsefield unit and two radioisotopic tests, including a ventilation/perfusion study with 133 chi e and HAM-99mTc, through an original software--four parameter histograms allowing simultaneous information of ventilation and perfusion at the pixel level and estimation of the V/Q; the other is the pulmonary gating through which it is possible to identify and quantify the arterio-arterial shunts.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1992

Reduced left ventricular diameters at onset of bradycardia during epidural anaesthesia.

Pathophysiologic mechanisms of bradycardia during epidural anaesthesia (L3-L4 with 1% lidocaine, 38 ml) were evaluated by studying changes in selected cardiovascular and hormonal parameters. Six of eight subjects (analgesia to T8-T10) remained circulatory stable with no significant changes in heart rate (HR), mean arterial pressure (MAP) and thoracic impedance (TI). In one of two subjects MAP decreased after 25 min from 85 to 50 mmHg (11.3 to 6.7 kPa), HR from 80 to 45 beats.min-1 while thoracic impedance increased from 25.5 to 26.5 ohm. End-systolic diameter (ESD) and end-diastolic diameter (EDD) of the left ventricle determined with echocardiography were reduced from 3.8 to 3.2 cm (17%) and 5.6 to 5.0 cm (11%), respectively. In the other subject MAP decreased after 25 min from 75 to 50 mmHg (10.0 to 6.7 kPa) and HR from 82 to 60 beats.min-1 while thoracic impedance increased from 28.8 to 29.6 ohm. ESD was reduced from 3.8 to 3.3 cm (13%), and EDD from 5.6 to 5.0 cm (11%). Both subjects recovered after infusion of saline and being placed in the head-down position. There were no consistent changes in plasma catecholamines, whereas pancreatic polypeptide increased from 5 and 3 to 152 and 69 pmol.l-1, vasopressin from 3 and 2 to 152 and 46 pmol.l-1, and aldosterone from 282 and 229 to 383 and 485 pmol.l-1, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Aeromonas hydrophila fulminant pneumonia in a fit young man.

A previously healthy 24 year old athletic man became ill suddenly with pneumonia the day after swimming in the sea. Despite intensive support measures in the intensive care unit he died three hours after admission and 21 hours after his first symptom. Necropsy showed bilateral haemorrhagic necrotising pneumonia. Aeromonas hydrophila was isolated from a blood culture taken at admission and from the lungs at necropsy. The infection may have come from contaminated sea water.

Adult↗
PubMed1992

[Neuroradiology in the physiopathologic diagnosis of subarachnoid hemorrhage--cerebral aneurysm].

The clinical importance of the cerebral aneurismatic lesion in well known. In Portugal we still do not have reliable statistics regarding the occurrence of the subarachnoid hemorrhage, however we can make a comparison through Kassel's and Drake's studies where they refer that annually 28,000 North-Americans suffer from subarachnoid hemorrhage attributed to the rupture of the cerebral aneurysm. This is a clinical situation that needs to be analyzed, more so because if it is not diagnosed and treated in time, it can cause a high level of morbidity and mortality. From 1984 to 1990, the authors studied 208 clinical cases of in-patients at the Santa Maria Hospital who had been diagnosed as having subarachnoid hemorrhage-cerebral aneurysm. They analyzed 172 cranium-encephalic Tomographies and 190 cerebral Angiographies. They found levels that overlapped the series already published with respect to the location of the lesion, dimensions and age groups involved. They tried to relate the presence aneurysm in the willis arterial circle with the occurrence of locoregional anatomic variants that were detected in 51% of the patients with aneurysm of the anterior communicating artery and in 33% of the cases in the posterior communicating artery. The high occurrence of serious forms of tomodensitrometric presentation should also be emphasized. As a matter of fact, 42.6% of the patients studied were grouped in degree IV of the Fisher Scale. This result translates the effort that is still required towards an early clinical and imaging diagnosis of warning hemorrhage to avoid or prevent a catastrophic hemorrhage recurrence.

Adult↗
PubMed1992

Halothane 2% for caesarean section.

During the induction-delivery interval for Caesarean section delivery, 2% halothane in pure oxygen was administered. The technique was compared to a 0.5% halothane in 50% oxygen/50% nitrous oxide anaesthesia. When a continuous infusion of oxytocin was administered, no excessive haemorrhage was seen. No maternal reminiscence was seen using 2% halothane, but awareness was recorded using 0.5% halothane in 50% nitrous oxide in 15% of the mothers. When there were no signs of preoperative fetal distress, the neonates were unaffected by the halothane concentration provided the induction-delivery interval was short. In cases of fetal distress, the administration of 2% halothane further aggravated the condition of the neonates, as indicated by lowered 1-min Apgar scores, umbilical oxygen tensions, pH and base excess values.

Adult↗
PubMed1991

A case of systemic mastocytosis; therapeutic efficacy of ketotifen.

A 68-year-old man presented with a 6-month history of fatigue, rhinorrhoea, pruritic skin lesions, left pleural effusion, ascites, oedema and weight loss of 10 kg. Investigations revealed hepatosplenomegaly, retroperitoneal lymphadenopathy, anaemia, leucocytosis with eosinophilia, hypoprothrombinaemia, hypocholesterolaemia and elevation of both gamma glutamyltransferase and alkaline phosphatase. Biopsies of a skin lesion, bone marrow and liver revealed mast cell infiltration, allowing the diagnosis of systemic mastocytosis (SM). Hydroxyzine plus ranitidine were given without success. Hydroxyzine treatment was stopped, and ketotifen was initiated; substantial symptomatic improvement was observed within 8 d. This case report indicates the effectiveness of ketotifen in the symptomatic treatment of SM.

Aged↗
PubMed1991

Squamous cell carcinoma arising in hidradenitis suppurativa.

The case reported concerns a 57-year-old man with a 35-year history of hidradenitis suppurativa lesions confined to his buttocks and recently complicated by a large, ulcerated, well-differentiated squamous cell carcinoma. Wide surgical excision and grafting, requiring temporary colostomy, were performed with no recurrence or metastasis during the following 12 months. The relevant literature is reviewed and discussed.

Buttocks↗
PubMed1990

Cardiovascular and ventilatory responses to dynamic exercise during epidural anaesthesia in man.

1. In order to evaluate the importance of afferent neural feedback from the working muscles for cardiovascular and ventilatory responses to dynamic exercise, epidural anaesthesia was induced at L3-L4. Six healthy males cycled for 20 min at 57% of maximum oxygen uptake and for 8-12 min at increasing work intensities until exhaustion at 238 +/- 30 W without as well as with epidural anaesthesia. 2. Presence of afferent neural blockade was verified by cutaneous sensory analgesia below T10-T11 and attenuated post-exercise ischaemic pressor response (45 +/- 8-24 +/- 6 mmHg). Efferent sympathetic nerves appear to be intact since basal heart rate and blood pressure as well as the cardiovascular responses to a Valsalva manoeuvre and to a cold pressor test were unchanged. 3. During dynamic exercise with epidural anaesthesia, blood pressure was lower than in control experiments; however, ventilation and heart rate were not affected. 4. The results indicate that afferent neural activity from the working muscles is important for blood pressure regulation during dynamic exercise in man but may not be necessary for eliciting the ventilatory and heart rate responses.

Adult↗