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Biomedical subjects

D M Braile

Publications and source records attributed to D M Braile.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Fibrinolytic therapy in non-coronary diseases].

Utilization of fibrinolytic drugs in non-coronary diseases has been described since 1949, but despite of that, works about that subject are very rare in the literature. In this paper we discuss the cases of three patients that were treated with such compounds for pulmonary embolism, peripheral arterial embolism, and thrombosis in mechanical aortic prosthesis. All patients had excellent in-hospital outcome, and were totally asymptomatic at the discharge time. It is emphasized the clinical symptoms, sometimes unexpected, and the importance of the complementary tests not only in the disease's diagnosis, but also in some decisions that must be taken during the patient's evolution, where they can help us to decide, for example, about the correct moment to stop the thrombolytic infusion. In conclusion, fibrinolytic drugs can be utilized in the management of many affections that otherwise would be treated by emergency surgery.

Adult↗
PubMed1991

[Survival and predictive factors of late mortality in the surgical treatment of aortic stenosis].

PURPOSE: Study of 161 patients submitted to aortic valve replacement due to aortic stenosis to evaluate survival and predictive factors of late mortality. METHODS: The mean age was 45.8 years +/- 13.2 and 122 patients were men. Surgical mortality was 6.8%. The survival actuarial curve showed 59.28% of the patients alive after 16 years. Among the survival 62.3% +/- 10% were event free, including prosthesis thrombosis, thromboembolism, infective endocarditis and reoperation. Symptoms, age, gradient LV/Ao, ejection fraction (EF) and the compliance (CO) were related to prognosis. Sudden death after surgery was studied, with incidence of the 0.8 events/100 patients year. RESULTS: The asymptomatic patients had better evolution than symptomatic (p less than 0.05). The age above 60 years was not predictive of the prognosis in 10 years of follow-up, but no patients survived after 10 years. The gradient LV/Ao was not an important factor in the survival. The group with EF greater than 50% had 66.4% of survival, while the group with EF less than 50% survival was 39%. Normal or decreased compliance was not important in the survival. All patients with EF less than 50% always has decreased CO. Fifteen patients were dead due to heart failure and the most important predictive factor was the left ventricular dysfunction (p = 0.02). CONCLUSION: In aortic stenosis: a) severe ventricular dysfunction does not preclude the surgical treatment; b) the actuarial analysis suggests that EF less than 50% determines worse prognosis and always occurs with decreased CO; c) the excellent evolution of the asymptomatic patients does not generalize the surgical treatment in this phase; d) the incidence of the sudden death was not high after the surgical treatment; e) patients with pre-operative left ventricular dysfunction had greater mortality due to heart failure, than patients with normal left ventricular function; f) despite of the morbid events our results confirm the real benefit of the surgical treatment in the aortic stenosis.

Actuarial Analysis↗
PubMed1991

[Univentricular heart: angiographic features in 31 patients].

PURPOSE: Evaluation of angiographic features of univentricular heart. METHODS: Thirty-one patients were divided into 3 groups according to morphological type of univentricular heart: left ventricle type, right ventricle type and undetermined. They were studied for atrio-ventricular junction, position of rudimentary chamber in relation to principal chamber, ventricle-arterial junction, the position of the two great arteries in relation to each other and whenever possible, the origin of the coronary arteries. RESULTS: There were 16 cases of left ventricle type with A-V junction through 2 valves in 8 and through single valve in 6. The rudimentary chamber position was superior and to the right in 4 cases of dextrocardia and superior and to the left in 8 of levocardia. The ventricle-arterial junction was discordant in 9 patients and concordant in 4, double outlet of rudimentary chamber in 2 and single outlet in 1. The aorta was anterior to the pulmonary artery in 13 patients. Anomalous origin of the coronary arteries occurred in 5 of 9 cases studied. Right ventricle type occurred in 9 patients with absence of one of the A-V junctions in 5. Trabecular pouch was seen in 6 patients, posterior and inferior positioned in all of them. Double outlet from principal chamber occurred in 8 patients. The aorta was anterior in 66.6%. Undetermined type occurred in 6 patients with A-V junction through single valve in 5. In 3 there was double outlet from principal chamber showing pulmonary stenosis and in the remaining 3 there was pulmonary atresia. CONCLUSION: Discordant ventricle-arterial junction is common for left ventricle type; trabecular pouch is frequent in right ventricle type; single A-V valve is common for undetermined type; obstruction of pulmonary flow happens in all 3 types but it is more frequent in undetermined type; the aorta is anterior to the pulmonary artery in most cases; it is common the anomalous origin of the coronary arteries from the aortic sinus.

Adolescent↗
PubMed1991

[Constrictive pericarditis as differential diagnosis of hepatic disease].

Constrictive chronic pericarditis in a 13-year-old male patient was previously treated as chronic hepatitis for seven years, with the use of furosemide and spironolactone. Investigation for diagnosis included chest radiography, echo-doppler-cardiography, thoracocentesis with pleural biopsy and computerized tomography of chest, and showed ventricular diastolic restriction due to constrictive chronic pericarditis. After eight weeks of tuberculostatic treatment, the patient was submitted to hemodynamic study that confirmed the diagnosis and a pericardiectomy was performed. Long-term follow-up showed regression of diastolic restriction and decrease of hepatosplenomegaly and of jugular stasis. Tuberculostatic drugs were given for 12 months postoperatively, associated to corticosteroids.

Adolescent↗
PubMed1991

[Cardiac rhabdomyomas].

Case report of cardiac rhabdomyoma in one two days old infant with important cyanosis and respiratory insufficiency with evolution to death in few hours. The radiologic feature was a great enlargement of the heart and the electrocardiographic study showed left branch block. The two-dimensional echocardiography study showed multiple intracavitary tumours in both ventricles and in the right atrium. These features were confirmed in the post-mortem study. The microscopic study of the tumors showed proliferation of the spider cells, and vacuolation with the presence glycogen. The diagnosis of cardiac rhabdomyoma was confirmed. The brain and the kidney were not studied for the diagnosis of tuberous sclerosis or kidney tumors. It is very important the early diagnosis by echocardiography, due to the possibility of surgical resection of the intracavitary tumors that cause severe obstruction to the blood flow.

Echocardiography↗
PubMed1990

[Traumatic ventricular septal defect. A case report].

A 34 years old woman, without previous cardiac symptoms, suffered a closed thoracic trauma in a car accident. Three days after presented dyspnea and orthopnea. Physical examination revealed a systolic murmur consistent with ventricular septal defect (VSD). Doppler echocardiography and angiography confirmed the presence of a muscular VSD with severe left-to-right shunt. Surgical intervention was indicated and VSD closure was performed with a patch, through a right atrium approach. Third degree atrioventricular block developed after surgery and a definitive pacemaker was implanted. The patient is asymptomatic and without murmurs in postoperative follow-up.

Accidents, Traffic↗
PubMed1990

Lipid extraction attenuates the calcific degeneration of bovine pericardium used in cardiac valve bioprostheses.

Bovine pericardial bioprostheses frequently fail due to dystrophic calcification. Since (a) recent studies indicate that membrane-associated complexed acidic phospholipids play an important role in the process of both physiologic and pathologic calcification, and (b) cytoplasmic organelles and plasma membrane of interstitial cells seem to serve as initial sites of calcific degeneration of bioprosthetic bovine pericardial tissue, this investigation was undertaken to evaluate whether, and if so, to what extent, the mineralization of valve tissue could be attenuated by previous lipid extraction. Pretreatment of glutaraldehyde-preserved bovine pericardium with acidified sulphuric ether (pH 3.0-4.0) attenuated calcification significantly: 28 days after subcutaneous implantation in young rats the degree of mineral deposition was approximately equal to typical 7 days implants in this model. The mechanism of this beneficial effect is suggested to be due to partial extraction of tissue phospholipids, as demonstrated by electron microscopy, thus reducing the number of available sites for deposition of hydroxyapatite crystals. In addition, and importantly, the present results indicate that any attempt to reduce cardiac valve bioprosthesis mineralization will have to take into account the role of lipids and, particularly, the membranous phospholipids in the calcification mechanism.

Animals↗
PubMed1989

Clinical and laboratory signs of reperfusion: are they reliable?

We studied 101 patients (88 men and 13 women, mean age 54.5 +/- 10 years) who arrived at the hospital during the first 6 hours of acute myocardial infarction evolution. Our objective was to assess the reliability of clinical and laboratory signs of recanalization using intravenous streptokinase as a thrombolytic agent. The mean time between the beginning of infusion and coronary arteriography was 53.83 +/- 43 hours. The positive predictive values for pain, arrhythmia, ST segment and enzymes were 97.9%, 94.2%, 91.8% and 90.8%, respectively; the negative predictive values were 46.8%, 40.8%, 37.2%, and 50% in the same order. Sensitivity was 65.7%, 62.8%, 58.4% and 77.6% and specificity 95.6%, 86.9%, 82.6% and 73.9%, respectively. The positive predictive value, calculated on the basis of the presence of each variable alone or in association showed a probability of recanalization of 76.9% for one sign, 84% for two, 96.3% for three and 100% for all four. When we compared the positive predictive values of each variable according to the interval between the beginning of pain and admission to the hospital (during the first 3 hours or between 3 and 6 hours) our results were 100%/94% for pain (P = NS), 97%/88% for arrhythmia (P = NS), 100%/75% for ST segment (P = 0.004), and 97%/80% for enzymes (P = 0.019). The same analysis applied to negative predictive values showing 22%/62% (P = 0.007), 17%/55% (P = 0.008), 21%/47% (P = NS), 27%/61% (P = NS) for pain, arrhythmia, ST segment and enzymes, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Pulmonary artery aneurysm. Report of 2 cases].

The clinical suspicion of pulmonary artery aneurysm was made in two patients from the clinical signs and radiographic features. The echocardiographic studies showed features concerned with this pathology, and hemodynamic studies confirmed the diagnosis by pulmonary angiography. Both patients presented pulmonary valve insufficiency due to the huge pulmonary artery and dilatation of the valvular annulus. Other congenital malformations of the heart and pulmonary hypertension were not present in these patients. Surgical treatment was indicated in both patients. Surgery in patient no. 2 consisted of resection of the main pulmonary artery aneurysm and replacement with a valved conduit bovine pericardium and anastomosed with a patch of bovine pericardium connecting the left and right pulmonary arteries. The postoperative period was uneventful.

Aneurysm↗
PubMed1989

[Ebstein's anomaly of the mitral valve. A very unusual congenital malformation of the heart. A case report].

Ebstein anomaly of the tricuspid valve is a well known malformation of the heart, but this occurrence in the mitral valve is a very rare congenital heart disease. In this case report a two years and nine months old girl with symptoms of heart failure during the first year of life due to severe mitral regurgitation was studied. The echocardiographic and angiographic features were typical of the Ebstein malformation of the mitral valve. The surgical treatment was made with implantation of pericardial bovine bioprothesis in the mitral position, without ressection of the natural valve tissue. The surgical features confirmed the diagnosis and the postoperative evolvement is excellent.

Bioprosthesis↗
PubMed1986

Calcific degeneration of pericardial valvular xenografts implanted subcutaneously in rats.

Tissue valve dystrophic calcification, resulting in hemodynamic regurgitation and/or stenosis, is the most serious complication when bioprosthetic heart valves are concerned. The objective of this investigation was to define morphologically the sequential development of calcific deposits in pericardial tissue cusps of unimplanted cardiac bioprostheses implanted subcutaneously in rats. Small samples of pericardium were implanted subcutaneously in the dorsal area of young rats weighing 60-80 g. The animals were selected randomly and sacrificed at days 1, 2, 7, 14 and 28 after implantation. The specimens were retrieved and studied morphologically. Calcific deposits were seen grossly as small punctate white masses from day 7 after implantation, progressively becoming more extensive. The light and electron microscopic studies showed that: calcific deposits occurred as early as 24 hours after implantation, the calcific degenerative process was progressive with time, and the mineralization was diffuse, although irregular in degree. The ultrastructural findings revealed that cytoplasmic organelles (mitochondria in particular) and plasma membrane of connective tissue cells appear to serve as initial sites of the process of calcification, which then progresses in the interfibrillar spaces, adjacent to collagen fibrils and elastic fibers.

Animals↗