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Biomedical subjects

F Pileggi

Publications and source records attributed to F Pileggi.

At least 235 records · Page 13Linked to original sources
PubMed1989

[The value of the electrocardiogram in evaluating myocardial function in patients with Chagas' disease].

The authors studied the electrocardiogram of 1004 patients with Chagas' disease. The fit of this observation was the correlation between the electrocardiographic alterations with the cardiac compromise, which was analysed clinically, by thorax X-ray, echocardiogram and stress test. The results show that increased cardiothoracic index, and decreased ejection fraction, decreased difference between systolic blood pressure before the exercise and at the final of the stress test at maximal weight were associated with greater incidence of ventricular premature beat, intraventricular heart block, inactive area, ST-T alteration. chi 2 test shows that these association was significative. The presence of premature ventricular beats and inactive area on the electrocardiographic study seems to determine worse prognosis to the patients since these alterations were more frequent on the patients that died due to Chagas' disease.

Adolescent↗
PubMed1989

[Comparison of histologic changes in Chagas' cardiomyopathy and dilated cardiomyopathy].

In this study the histopathologic features of Chagas' disease and idiopathic dilated cardiomyopathy were compared in 38 patients with congestive heart failure, classes II or III. Biopsy specimens were obtained with the Stanford model needle for right ventricle. Twenty-two patients presented non-chagasic dilated cardiomyopathy, and 16 were carriers of Chagas' disease. Twenty-three were male and 15 were female; their ages varied 18 and 49 years (mean 35.5). Fibrosis was slightly more frequently and intense in Chagas' disease than in dilated cardiomyopathy. Myocarditis aspect also was more frequent in Chagas' disease than in dilated cardiomyopathy (62.4% vs. 50%), with all cases showing a chronic form; acute myocarditis was observed only in dilated myocardiopathy. These differences, however, did not reach statistical significance. In conclusion, the presence of fibrosis, hypertrophy and moderate to severe degrees of chronic inflammatory infiltrate are suggestive of but not pathognomonic of Chagas' disease. On the other hand, dilated myocardiopathies are more frequently associated with less fibrosis or hypertrophy and the presence of mild degree of inflammatory infiltrate. The arrangement of this inflammatory infiltrate tends to be diffuse in dilated cardiomyopathy and in chagasic myocarditis it is multifocal, very similar to the histopathological aspect found in myocardial rejections episodes of transplanted hearts.

Adolescent↗
PubMed1989

[Cardiac thrombosis and embolism in patients having died of chronic Chagas cardiopathy].

The authors studied the files of 111 patients (mean age 47.5 years) with chronic Chagas' disease and severe heart failure who had died between 1978 and 1984; they were 72 men and 39 women. Eighty-one patients (73%) had cardiac thrombosis, 65 times (53%) in right chambers and 56 times (46%) in left ones. Sixty-seven patients (60%) had thromboembolic episodes, 41 (65%) to the lungs, 23 (38%) to other organs (target organs: the kidneys in 21 cases, spleen in four, brain in two, abdominal aorta in one, mesenteric artery in one and iliac artery in one). Right chamber thrombosis occurred 65 times, 35 (53%) with pulmonary thromboembolism. Left chamber thrombosis occurred 56 times, 24 (42%) with systemic thromboembolism. A total of 41 patients had pulmonary thromboembolism, only six (14%) without right chamber thrombosis; of 26 patients with systemic thromboembolism, only two (7%) did not have left chamber thrombosis. The authors concluded that the incidence of thrombosis and thromboembolism was high in the group studied, and that there was a relationship between chamber thrombosis and systemic or pulmonary thromboembolism.

Adolescent↗
PubMed1989

[Mitral valve insufficiency caused by endomyocardial fibrosis of the left ventricle. A case report].

A 38-year old female patient, who had asymptomatic heart disease for seven years, developed progressive and fatal heart failure in eight months. The diagnosis of mitral valve insufficiency was made five months before death. The necropsy revealed that the etiology of mitral insufficiency was isolated left ventricle endomyocardial fibrosis with unusual involvement of the posterior cusp of the mitral valve.

Adult↗
PubMed1989

[Evaluation of aortic insufficiency in aortic dissection. Significance of intraoperative echocardiography on the conservation of the valve. A case report].

A 34-year old man presented with dyspnea and a new murmur of aortic regurgitation (AR). Two months before he had a episode of acute chest pain. The diagnosis of type A chronic aortic dissection was done on the basis of clinical signs and digital angiography. At surgery, intraoperative two-dimensional echocardiography (Iop Echo) showed a large intimal flap prolapsing into the leaflets during diastole causing AR, without primary involvement of the aortic valve. The aorta was transected just above the valve commissures and a 30 mm woven graft was sutured end to end. The false lumen was closed distally and incorporated into the graft-aorta suture line. Valve replacement was not performed. After the surgical procedure, a Iop Echo indicated competence of the aortic valve by means of contrast injection in the aortic root. AR due to the interference of an intimal flap with the aortic leaflets was not yet been reported. To our knowledge, this is the first case of this mechanism and illustrates the potential value of Iop Echo in diagnosis of aortic dissection.

Adult↗
PubMed1989

[Combined surgical treatment of endocarditis of the right atrium by Aspergillus sp and pulmonary fungus ball. Report of a case].

Endocarditis due to Aspergillus is rare and associated with a high mortality. The authors report the case of a 23 year-old patient with Klippel-Trenaunay syndrome who was admitted with dyspnea and loss of weight. The physical examination showed split second sound and presystolic accentuation. In the chest x ray there were cavities in the upper lobe of the right lung and pleural thickening. The echocardiogram and the hemodynamic evaluation demonstrated an image suggesting a right atrial tumor. The patient was operated on under cardiopulmonary bypass, a vegetation in the valve of the inferior vena cava was resected and a lesion of the right lung was also resected. The histologic study showed that the lesions was caused by Aspergillus. The patient had had an uneventful recovery, was discharged on the 13th postoperative day and is well 65 months after the operation.

Adult↗
PubMed1989

[The quality of life of patients with cardiac arrhythmia undergoing surgical treatment].

The handling of patients with malign ventricular arrhythmia, since 1979, can count on intracardiac electrophysiological studies, cardiac mapping and unconventional cardiac surgery. Such service, which requires the use of sophisticated equipment and specialized professionals, is being provided to patients from all over the country and from all social strata. The Hospital, which maintains the costly, infrastructure required to provide such service, is interested in knowing the reach of the therapeutic action, going beyond the mere knowledge of the success in the immediate treatment. In order to situate the patient as well as his family and social relations, a Social Service professional has been appointed, and same, from a group of 37 patients under treatment (there were 15 deaths), has selected for the survey 17 residents in the metroplitan region of São Paulo, because of contact with them was easier. Evaluation of the changes in the quality of life of the patients that have undergone surgery has been structured in such a way to detail the research procedure, treatment of the data and discussion of the results. Thus, an attempt has been made to characterize the extent of the benefits obtained in the surgeries, at the individual, familiar and social level. Basicaly, in the group of patients surveyed, 70% have been identified as males, 70% as married, 65% older than 50 years, 76% associated to the social security system, 70% with primary level schooling and thus a low family income (1.6 minimum wages per capita).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[The biopsy in the diagnosis of pericardial involvement by malignant tumor].

We performed pericardial biopsy by subxiphoid approach in twelve patients (eight men, four women) with cardiac tamponade or pericardial effusion without low cardiac output, in order to search for the underlying disease. Five patients (41%) had pericardial biopsy with malignant neoplastic invasion. In seven patients (59%) the biopsy was nonspecific; in these patients, the diagnosis was made by another methods. We concluded that the pericardial biopsy is a safe method, with high especificity but low sensibility in the diagnosis of malignant pericardial invasion.

Biopsy↗
PubMed1989

[Hemodynamic study at the bedside of patients with acute myocardial infarction over 60 years of age].

Aiming to study the hemodynamic behavior of the aged during the first 36 hours after acute myocardial infarction (AMI), 41 patients of at least 60 years at age (63.3 +/- 3) were submitted to a bedside hemodynamic study, through a Swan-Ganz catheter. The results obtained for the different variables (right atrial pressure, right ventricular pressure, pulmonary-arterial pressure, pulmonary-capillary, cardiac index, systolic index, left and right ventricular performance, and systemic pulmonary-arterial resistance) were compared to those of 39 individuals with age less than 60 years (49.6 +/- 1.5). It was also considered the electrocardiographic localization of the infarcted area. Eventual differences in the distribution of frequency of the individuals were also investigated, considering the four clinical-hemodynamic groups proposed by Forrester. Upon separate analysis of the hemodynamic variables, the results did not reveal significant differences between the younger and the older. However, by Forrester's classification, it was observed a significantly higher number of aged patients in group III (hypovolemic). Therefore, there was a tendency in the aged to present hypovolemia during the first 36 hours after myocardial infarction. The difficulties to recognize this status clinically and its prognostic importance justify the performance of hemodynamic bedside study in elderly with acute myocardial infarction with hemodynamic instability.

Aged↗
PubMed1989

[Acute pulmonary edema due to dysfunction and/or rupture of the papillary muscles in patients with coronary insufficiency. Surgical results].

Acute mitral regurgitation due to severe papillary muscle dysfunction or rupture has a poor clinical outcome and often requires an emergency surgical procedure. Pulmonary venous congestion generally occurs as an end-stage event and in these patients surgery is often postponed or even not considered. We studied 14 consecutive patients with coronary artery disease that suffered acute pulmonary edema soon after mitral regurgitation was diagnosed; they were 8 (57%) male and 6 (43%) female with mean age 60-8 years (49 to 69 years). Five patients had an acute myocardial infarction and 9 had an old infarction or stable angina. Surgical treatment was indicated to all patients: mitral valve replacement or reconstructive procedure (annuloplasty) was the only procedure in 2 patients and was associated to coronary artery revascularization in the other 12. Two patients (14.3%) with acute myocardial infarction died in hospital; the remaining 12 (85.7%) had hospital discharge and did well in the late follow-up period. We concluded that this high-risk group of patients is particularly suitable for surgical management since medical treatment carries a very poor prognosis.

Acute Disease↗
PubMed1989

[Myocardial dysfunction secondary to persistent tachycardia].

This study demonstrates the presence of variable degrees of reversible ventricular dysfunction in five patients with incessant atrioventricular tachycardia (IAVT) submitted to surgical ablation of the anomalous pathway. The patients were three females and two males, with age ranging from four to 39 years (mean 15.2). Preoperative EKG presented persistent tachycardia with narrow QRS and RP greater than PR in every case. The P wave was negative in leads D2, D3, AVF from V2 to V6. The 24 hours Holter monitoring demonstrated IAVT rhythm with few sinus beats. The heart rate variated from 140 to 190 bpm (mean 158 bpm). The echocardiogram ejection fraction ranged from 33% to 59% (mean 49.6%). The left ventricular diastolic diameter varied from 47 to 66 mm (mean 53.8). The chest X-ray showed moderate heart enlargement in two patients and mild enlargement in one. All the patients were refractory to isolated or associated antiarrhythmic drugs. Postero-septal anomalous A-V pathway (with exclusively slow retrograde conduction, was demonstrated by electrophysiologic study. After surgery every patient was asymptomatic without medication. Permanent sinus rhythm with heart rate of 62 to 100 bpm (mean 78.4 bpm) in a four months to two years follow-up. The postoperative echocardiogram ejection fraction ranged from 63% to 81% (mean 71.6%) and the left ventricular diastolic diameter was 42 to 57 mm (mean 48.2 mm). The heart area was normal in four patients and mildly increased in one patient. Thus, persistent increase in heart rate induces variable degrees of reversible myocardial dysfunction.

Adult↗
PubMed1989

[Analysis of the mechanical properties of the left ventricle in patients with aortic valve disease].

The morphological and functional aspects of the left ventricle (LV) were assessed by echocardiography and cardiac catheterization performed simultaneously in 41 patients. Eleven were normal (N), 14 had aortic stenosis (AS) and 16 had aortic regurgitation (AR). Of the 14 patients with AS, eight were in New York Heart Association (NYHA) functional class I and II (ASA group) and six were in NYHA functional class III and IV (ASB group). Of the 16 patients with AR, seven were in NYHA functional class I and II (ARA group) and nine in functional class III and IV (ARB group). In the ASA group normal values of the LV function were obtained because of the development of an adequate hypertrophy that in normalizing the systolic stroke was able to keep a suitable function. In the ASB group there was a reduction of the LV function due to an increase of the systolic stroke and to the reduction of the contractile muscle state. Thus, in the whole AS group we found an inversed relation between the ejection fraction and the systolic stroke. In the ARA group we found a normal cardiac function as consequence of an adequate development of the LV dilation and hypertrophy. Despite the find of reduction of the contractile state, the systolic stroke normalizing was capable to keep the cardiac function at normal values. The ARB group presented an important depression of the cardiac function due the increase of the systolic stroke and to the decrease of the contractile state of the cardiac muscle.

Adolescent↗
PubMed1989

Infarct-sparing effect of propranolol in an occlusion-reperfusion dog model.

1. To test the hypothesis that early pharmacological protection of the ischemic myocardium can enhance the effects of late reperfusion, 32 mongrel dogs were submitted to 6 h of left anterior descending coronary (LAD) occlusion and 18 h of reperfusion. 2. Arterial pressure and ECG were monitored. Area at risk was determined with methylene blue during coronary occlusion. Myocardial infarct size, measured with triphenyl tetrazolium chloride and by planimetry, was reported as percent of the area at risk of necrosis. 3. Ten dogs received no treatment and were used as controls (Group I); Group II (9 dogs) and Group III (13 dogs) received 2.0 and 4.0 mg/kg propranolol, iv, respectively, 30 min after LAD occlusion. 4. The hemodynamic effects of propranolol were not significantly different among groups during ischemia or reperfusion. Area at risk was similar in the 3 groups. 5. Following reperfusion, salvage of ischemic myocardium was 13 +/- 3% of area at risk in Group I, and 18 +/- 8% (Group II) and 25 +/- 5% (Group III) in propranolol-treated animals. The differences between Groups I and II or II and III were not significant. However, preservation was significantly greater in Group III than in Group I (P less than 0.05). 6. Therefore, early propranolol administration during ischemia improves the effects of subsequent reperfusion.

Animals↗
PubMed1989

[Effect of beta blockers with intrinsic sympathomimetic activity on blood pressure and blood lipids in patients with essential hypertension].

The aim of this study was to compare the effects of a beta-blocker (mepindolol) with intrinsic sympathomimetic activity (ISA) to a beta-blocker (metoprolol duriles) without ISA. Hypertensive patients with more than 50 years of age were selected and randomly allocated to receive either 5 mg/day mepindolol (Group A, 10 patients), or 200 mg/day metoprolol duriles (Group B, 9 patients), or placebo (Group C, 10 patients). They were submitted to clinical exam, stress testing and plasma lipids dosage before and after four weeks of treatment. At rest, there were a significant reduction of systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) in all groups. The mean values for SBP, DBP and HR at rest after treatment were respectively: 154.0, 95.5, 73.7 (Group A); 148.8, 94.4, 70.1 (Group B); 153.0, 96.0, 77.8; (Group C). During stress testing, there were a significant reduction of SBP, HR and double product (DP). The DBP remained unchanged. The mean values for SBP, DBP, HR and DP during stress testing after treatment were respectively; 198.0, 115.5, 124.3, 246.9 (Group A); 198.8, 114.4, 144.6, 283.2 (Group B); 202.2, 119.0, 143.5, 283.4 (Group C). Total cholesterol, HDL-cholesterol, and LDL-cholesterol, have not changed with both beta-blockers. There were a significant increase in plasma triglycerides and VLDL-cholesterol levels after treatment with beta-blockers. In conclusion, both mepindolol and metoprolol were similarly effective in reducing arterial blood pressure of hypertensive patients. There were not significant differences between the beta-blocker with or without ISA in regard to their effects on plasma lipids.

Aging↗
PubMed1989

Determinants of survival in endomyocardial fibrosis.

This study describes the clinical course of 108 patients with endomyocardial fibrosis. There were 76 females and 32 males, with a mean age of 35 years. All patients underwent cardiac catheterization. The angiographic data show that 64 (59%) patients had biventricular involvement. From a clinical point of view, 91 (84%) were in New York Heart Association functional classes III and IV. According to the right and left ventricular intensity of fibrosis, the patients were classified as mild (40 [37%]), moderate (36 [33%]), or severe (32 [30%]) for the right ventricle and mild (19 [18%]), moderate (61 [56%]), or severe (28 [26%]) for the left ventricle. Tricuspid regurgitation was observed in 63 (58%) patients and mitral regurgitation in 65 (60%) patients. Fifty patients in functional classes III and IV underwent surgical treatment. Survival curves constructed according to functional classes showed better prognosis for those in classes I and II (p = 0.0452). Survival curves for patients in classes III and IV for clinical and surgical treatment showed a trend toward better results for the surgical group. Analysis of factors that may have influenced the course of endomyocardial fibrosis showed that biventricular involvement (moderate or severe), right ventricular fibrosis, and presence of tricuspid and mitral regurgitation were associated with greater mortality.

Adolescent↗
PubMed1989

[Dental procedures during anticoagulant administration].

Thirty-six patients on chronic anticoagulant therapy were submitted to dental surgery. The ages ranged between 20 and 68 (mean 43.5) years; twenty (55.6%) patients were female and 16 (44.4%) were female. Phenindione was administered to 33 (91.7%) patients, warfarin to one (2.7%) and hydroxycoumarin to two (5.6%). Mechanical heart valve prosthesis occurred in 23 (64%) patients, bioprosthesis in two (5.5%), mitral stenosis submitted to commissurotomy in two (5.5%) and other valvular heart disease occurred in nine patients (25%). Eighty-three elective procedures were performed. Anticoagulant drugs were stopped from two to seven days before, in order to prothrombin time reach 60%. Abnormal bleeding that was easily controlled with local measures occurred in two patients. Sixteen emergency procedures were performed without stopping anticoagulant treatment. Abnormal bleeding was observed in one patient and it subsided after local care. Thus, safe odontologic procedures may be carried on in patients during treatment with oral anticoagulants.

Adult↗
PubMed1988

Reperfusion arrhythmias in acute myocardial infarction--fact or coincidence?

Reperfusion arrhythmias were studied in a group of 20 patients submitted to coronary thrombolysis in the early hours of acute myocardial infarction. Arrhythmias were observed in 15 (75%) patients and consisted of ventricular arrhythmias and/or sinus bradycardia; 11/13 patients with reperfusion ventricular arrhythmias had the same type of arrhythmias before the procedure. This study group was compared to another group of 22 patients with acute myocardial infarction treated conventionally. There was no difference between both groups in regard to the incidence and type of ventricular arrhythmias. Sinus bradycardia only occurred during reperfusion in the study group and was significantly predominant in this group when compared with control group.

Arrhythmias, Cardiac↗