Biomedical subjects
Publications and source records attributed to A Oliveira.
The purpose of this study is to analyse the crossmatched blood units for elective surgery and the real amount of transfused blood, the crossmatch:transfusion rate (C:T) which must be less than 2.5. As in other Blood Banks, the differences are more evident in the situations in which the need for blood is very small, the so called "Type and Screen".
The aim of the present work was to quantify the passage of bovine immunoglobulins into the hemolymph of the tick Boophilus microplus during the feeding process and to determine their antibody activity. The knowledge is of paramount importance when vector control or blocking of disease transmission is attempted by vaccination of cattle. Approximately 2% of bovine immunoglobulin present in the serum as determined by competitive ELISA was demonstrated in hemolymph of B. microplus and antibody activity against an antigen of B. microplus in the hemolymph of ticks fed on bovine immunized with the antigen purified from tick eggs was detected by Western blot assay. The antibody reactivity detected against the B. microplus antigen showed that functional antibodies are present in the hemolymph of fully engorged ticks for at least 48 h after completing the parasitic life cycle.
PURPOSE: To determine the rate of utilization and reasons for exclusion from thrombolytic therapy in acute myocardial infarction (AMI) in the setting of Intensive Care Unit (ICU) Salvador-BA. METHODS: Retrospective cohort study recording patients admitted with suspected AMI in six ICU in Salvador-BA between January/93 and December/94 were reviewed. RESULTS: Three hundred and eighty-eight of confirmed cases of AMI were analysed, 165 (42.0%) were admitted at public hospitals and 225 (58.0%) at private hospitals. Thrombolytic therapy was indicated in 143 (36.8%) patients. The thrombolysis was more frequently performed in men (PR = 1.96 IC 95% 1.39-2.77), in patients less than 60 years of age (PR = 4.46 CI 95% 2.17-9.19) and in those with Killip class I (PR = 2.62 CI 95% 1.60-4.31). The major reasons for excluding from thrombolytic therapy were late arrival, old age and lack of ST elevation. Thirty three percent of patients were excluded for more than one reasons. Multivariate analysis showed that female gender was associated with a reduced indication for thrombolytic therapy, independent of the clinical findings on admission. CONCLUSION: The frequency of the use and reasons for excluding patients from thrombolytic therapy in AMI in Salvador-BA were similar to those of other clinical studies. The recent recommendations of the Thrombolysis Brazilian Consensus will enhance the utilization of this therapy, as it expands its utilization to elderly patients and to those who arrive late to the hospital.
Primary brain lymphoma (PBL) is a rare disease, the study of which is based on small series and case reports. The AA review new cases of PBL not associated to immunodeficiency at the Portuguese Institute of Oncology of Porto since 1978. Five male patients were found with lymphoma primarily located in the brain, with aggressive histology, IE staging, detected by CAT, NMR or brain scintigraphy and with histologic material collected by stereotaxic biopsy (3 cases) or by craniotomy (2 cases). Three patients were in complete remission (25,5 and 1 year) and 2 were dead with a survival of 12 and 17 months. The cases and literature are discussed.
Prevention and early diagnosis are considered the main tools to reduce the incidence and mortality from cancer. The authors studied prospectively 150 oncologic patients admitted to Santa Maria Hospital-Lisbon from April/92 to April/93, by personal interview, to analyze their assistance pathways from the appearance of first symptoms. We tried to define the role of the different medical assistance structures and the most important factors conditioning delay in diagnosis and therapeutics. The results show that primary care physicians were the first medical assistance in 56% of patients; 22% of the patients went to the Emergency Service of the Hospital for the first time. Duration of symptoms was less then 3 months in 74% of the population studied. Primary care physicians diagnosed neoplasia in 32% of the cases and prescribed symptomatic treatment in another 41%. The Emergency Service was the most efficient in diagnosis, providing rapid orientation in 91% of patients. In this population, 43% had their residence more than 30 km from Lisbon. Median age was less than 60 years. These results emphasize the fundamental role of Primary Care Physicians in the initial management of cancer patients and their responsibility in early diagnosis. They also suggest the need for the promotion of graduate education and courses designed for primary care physicians and the population.
A 37 year old woman with duodenal ulcer not responsive to medical treatment was operated. Antrectomy, truncal vagotomy and Bilroth II gastrojejunostomy were performed. The histopathology revealed epithelioid cell granulomas with multinucleated cells and central ceseation, in the gastric side of the pylorus and in three isolated lymph nodes. With Ziehl-Neelsen staining there were multiple acid-fast bacilli. There was no evidence or previous history, personal or familial, or tuberculosis in an other localization. Epidemiology, pathology, diagnosis, and treatment of gastric tuberculosis are discussed according to the literature.
1. The purpose of the present study was to evaluate the intestinal secretory immunity of HIV-infected patients. Jejunal biopsies were obtained with a Watson capsule from 52 HIV-infected patients and compared to a control group consisting of 12 healthy subjects, matched for age and sex. IgA- and IgM-containing plasma cells were studied by immunofluorescence by two independent observers who had no knowledge of the history of the slides. 2. The IgA and IgM plasma cell density was significantly decreased in HIV-infected patients when compared to the controls (31/52 for IgA and 42/52 for IgM in the HIV group and normal density in all controls). The depletion of intestinal plasma cells was an early feature of HIV disease and did not correlate with diarrhea, enteropathogens or mucosal atrophy. Although IgA plasma cell depletion has been described in HIV infection, this is the first report of IgM cell density reduction. 3. A peripheral fluorescence pattern was observed in the intestinal cells of HIV-infected patients, contrasting with the normal cytoplasmic fluorescence pattern seen in controls. The cells presenting a rim of peripheral fluorescence in HIV disease might correspond to immature B lymphocytes. 4. The intestinal plasma cell depletion may result in hampered mucosal defense in HIV disease, and is likely to be a direct consequence of T lymphocyte function impairment. 5. The data indicate that the intestinal secretory immune system is altered in AIDS and also in the early stages of HIV disease.
OBJECTIVE: Comparative analysis of left atrial and left ventricle Doppler inflow patterns in patients with essential systemic mild to moderate hypertension and normal global left ventricular systolic function. PATIENTS: A group of out patients with the diagnosis of hypertension referred to the Echocardiographic Laboratory of Egas Moniz Hospital in Lisbon. SETTING: Echocardiographic Doppler prospective study. MATERIAL AND METHODS: We studied a group of 50 patients with the diagnosis of mild to moderate arterial hypertension (Group H), which was compared with a population of 50 normal subjects (Group N). In each case we analysed the pulsed Doppler flow of the right upper pulmonary vein and the diastolic inflow of the left ventricular cavity. We calculated the peak velocities and time velocity integrals of the systolic, diastolic and atrial contraction waves of the pulmonary venous flow and also the systo-diastolic velocity and time velocity integral ratios. In the transmitral Doppler flow analysis we evaluated the peak velocities and time velocity integrals of the early (E wave) and late (A wave) waves, and their time velocity and velocity ratio. We assessed also the isovolumic relaxation time and left ventricular mass index. RESULTS: In groups N and H the peak velocity of the pulmonary venous flow systolic wave was 0.53 +/- 0.15 cm/sec and 0.75 +/- 0.10 cm/sec (p = 0.01), diastolic wave was 0.50 +/- 0.10 cm/sec and 0.41 +/- 0.09 cm/sec (p = 0.03) and atrial contraction wave was 0.18 +/- 0.03 cm/sec and 0.35 +/- 0.08 (p = 0.001), with a systo-diastolic ratio of 1.06 +/- 0.10 and 1.83 +/- 0.10 (p < 0.001), respectively. In these two groups the time velocity integral of the pulmonary venous flow systolic wave was 14.4 +/- 2.6 cm and 17.8 +/- 1.8 cm (p = 0.001), the diastolic wave was 12.5 +/- 3.2 cm and 9.3 +/- 1.3 cm (p = 0.05) and the atrial contraction wave was 4.4 +/- 0.07 cm (p = 0.001), with a systo-diastolic ratio of 1.1 +/- 0.16 and 1.9 +/- 0.12 (p < 0.001), respectively. For the group H and considering the three subgroups, hypertensive patients without anatomical or functional alterations, with isolated diastolic dysfunction and with left ventricular hypertrophy associated to diastolic dysfunction, the velocity systo-diastolic ratio was 1.08 +/- 0.12, 1.57 +/- 0.08 (p < 0.01) and 2.4 +/- 0.08 (p < 0.01) and 2.4 +/- 0.08 (p < 0.001), the systo-diastolic time velocity integral ratio was 1.22 +/- 0.17, 1.72 +/- 0.13 (p < 0.01) and 2.4 +/- 0.15 (p < 0.001), the peak velocity of the atrial contraction wave was 0.28 +/- 0.07, 0.3 +/- 0.08 (p < 0.01) and 0.43 +/- 0.07 (p < 0.001) and its time velocity integral was 4.6 +/- 0.06 cm, 5.6 +/- 0.07 cm (p < 0.01) and 7.0 +/- 0.08 cm (p < 0.001). CONCLUSIONS: Pulsed Doppler study of pulmonary venous flow is significantly abnormal in patients with arterial hypertension. This abnormal pulmonary venous flow pattern has a close relationship with structural and functional alterations of the left ventricle. Combined analysis of the pulsed Doppler inflow at these two cardiac anatomical levels is fundamental to understand the pathophysiology of hypertensive heart disease.
A sequential analysis of patent and subpatent parasitemias, mortality, and histopathology during acute Chagas' disease experimentally produced by inoculation of 10 or 100 bloodstream forms of Trypanosoma cruzi Y strain in susceptible mice was carried out. Parasites were searched for comparatively using three different methods: direct counting, Ficoll-MI density flotation, and hemoculture. Ficoll-MI density flotation promptly discriminated with high reproducibility subpatent parasitemic states not detected in the blood samples analyzed by direct counting. Despite the high proportion of supposedly uninfected animals and depending on the postinfection time, the majority of the mice had bloodstream parasites at the subpatent level detected by Ficoll-MI, and all of them had muscular lesions during the acute phase. All Ficoll-MI-negative blood samples from infected mice were also negative by hemoculture. Normal mouse blood purposely contaminated with parasite quantities ranging from 200 to 2000/ml was tested comparatively by density flotation and hemoculture and showed frequencies of reisolation varying from 25 to 100%. Overall, these data showed that inoculum as low as 10 infective forms of Y strain is able to induce acute Chagas' disease in susceptible mice and that a subpatent parasitemic state of 600-1000 forms/ml is a common finding. The use of Ficoll-MI to detect subpatent parasitemia is discussed.
Increased titers of anti-sulfatide antibodies were detected by ELISA in 5 of 200 patients and control subjects. All 5 patients had sensory impairment; 4 had neuropathy, and one had multiple sclerosis. Of the patients with neuropathy, 2 had a clinical syndrome of small fiber sensory neuropathy with normal electrophysiological or nerve biopsy studies, 1 had a sensorimotor axonal neuropathy associated with IgM monoclonal gammopathy, and 1 had sensorimotor neuropathy with multifocal motor conduction block and anti-GM1 antibodies. The anti-sulfatide antibodies bound to the surface of unfixed rat dorsal root ganglia neurons and human neuroblastoma cells, and to fixed sections of central and peripheral myelin. No binding was detected following intraneural injection into rat sciatic nerves. Pre-absorption with sulfatide but not with galactocerebroside eliminated the tissue binding activity. These findings indicate that increased titers of anti-sulfatide antibodies are found in patients with sensory impairment but are not restricted to a particular neurological syndrome or type of neuropathy. The significance of anti-sulfatide antibodies is uncertain although sulfatide on dorsal root ganglia neurons may be a target antigen.
The aim of this work is to make a review of the papers about hemorheology and hypertension on the aged. The paucity of the works did not allow any conclusions. However, some of the drugs frequently used have tight links with hemorheology, which must be in our minds when dealing with old people.
OBJECTIVE: To characterize and to quantitate the morphologic changes in left ventricle, in renal transplant patients (Pts) treated with cyclosporine, through sequential echocardiographic examinations. DESIGN: A prospective study of renal transplant patients, between October/88 and May/89, who maintained good function of the renal graft during the follow-up. SETTING: Cardiology and Nephrology departments of Santo António Hospital. MATERIAL AND METHODS: 20 patients, 13 men and 7 women, mean age of 33 +/- 10, ranging from 20 to 56, constitute the final group of the study. These patients have been receiving dialysis during 3.8 +/- 2.3 years (0.4-8). Seven patients were excluded, five by echocardiographic criteria and another two because of chronic renal graft disfunction (creatinine greater than 2.0 mg%). The echocardiographic examinations were performed during the first week, and 1, 2, 3, 6 and 12 months after renal transplantation. The following measurements were performed: left ventricular end-diastole diameter (LVED), interventricular septal thickness (IVST), posterior wall thickness (PWT) and left ventricular mass index (LVMI). The measurements were obtained in M-mode following the conventional recommendations. Average values of at least 3 cardiac cycles were used. Heart rate, blood pressure, creatinine, hematocrit, body surface area and fistula patency, were determined at the time of each echocardiogram. MAIN RESULTS: The LVED decreased progressively until the third month, from 51.9 +/- 7 mm to 47.8 +/- 6 mm (p less than 0.001), remaining stable thereafter. The baseline value of IVST, 13.6 +/- 5 mm, was similar at the twelfth month, 13.8 +/- 2 mm (ns). The baseline value of PWT, 13.7 +/- 4 mm, decreased gradually since the second month, having reached 12.7 +/- 2 mm at the twelfth month (ns). The LVMI (g/m2) reduced progressively, from 243 +/- 82 to 190 +/- 38 at the end of the study (p less than 0.05. A high incidence of arterial hypertension was detected during the follow-up period; at the twelfth month, 18 patients (90%) were on antihypertensive drug therapy, 11 of which had blood pressure greater than or equal to 160/95 mmHg. CONCLUSIONS: We verified, one year after the renal transplantation, a significant decrease of LVMI, that was mainly determined by the LVED reduction. Left ventricular walls thickness had no significant variation; we think that the high incidence of hypertension during the follow-up period, in part due to the pressure effect of cyclosporine, may have been responsible for this fact.
A case of a 42-year-old woman with a right coronary artery fistula into the right ventricle is reported; she was asymptomatic and a continuous precordial murmur was found on physical examination. We discuss the usefulness and limitation of the Echo 2-D/Doppler findings, concerning this diagnosis, which was only definitively established by angiocardiography.
In this study M-mode echocardiograms were performed on 22 top class racing cyclists in order to assess the incidence of structural heart alterations. A normal control group was composed of 20 sedentary men of similar age and surface body area. Statistical analysis was performed using the unpaired Student t-test. A normal LV mass was found in all athletes and normal left Ventricle diastolic diametre (LVDD) in 13 cyclists. Global and regional LV systolic functions were normal in all cyclists. Mitral valve analysis showed normal LV compliance in all athletes. Thus, the cyclists admitted to our study did not present LV hypertrophy and most of them had normal LVDD. Systolic and diastolic functions were normal in all of them.
Experience with 43 duodenoplasties as a complementary procedure of proximal gastric vagotomy used in peptic duodenal stenosis was reviewed. After a rigid protocol aimed at treating the metabolic imbalance, gastric dilation, and activity of the ulcer, the cases were very similar to elective ones. Two types of duodenoplasty were most commonly employed: anterior duodenectomy with a transverse duodenorrhaphy (26 cases) and Finney's duodenoplasty (15 cases). No deaths or serious complications were reported. The only operative accident was a splenic lesion with splenectomy. Two recurrences were observed. The patients were followed up from January 1978.
In a retrospective study the overall survival time of 205 cystinotic patients of six countries was determined. The median survival time was 8.5 years. The median time for 'renal death' (age at death due to uraemia or age at starting renal replacement therapy) was 9.2 years. The youngest patient dying of renal death was 5.2 years. No sex difference in survival time was noticed. Furthermore no difference in survival time was noted between the different countries. The analysis of the overall survival curve indicates no clear differences between the infantile and adolescent types of cystinosis.
Quantitative histological techniques were used to evaluate age-related alterations in the vascularity and thickness of the cerebral cortex in normotensive and hypertensive strains of rats. In both strains, aging was accompanied by a statistically significant increase in mean minimal luminal diameter (MMLD) of capillaries in all cortical laminae. While the overall depth of the cerebral cortex was significantly decreased in aged rats of both strains, the total number of capillaries in a strip of cortex extending from the pia mater to the underlying white matter did not change between 3 months and 23-24 months. The greatest vascularity was seen in the field occupying 41-60% of the depth below the pial surface. Few differences in the laminar variations in capillary density were observed. The number and MMLD of venules were increased in aged WKY, but the aged hypertensive rats exhibited a decrease in number and MMLD of venules. No significant changes in either the number or MMLD of arterioles was observed in aged and/or hypertensive rats. The total brain weight of the hypertensive rats was significantly less than that of normotensive rats at 3 and 12 months of age but no difference was observed between the aged groups. Hypertensive rats demonstrated a significantly decreased relative brain weight (brain weight per 100 g body weight) in all age groups.
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