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Biomedical subjects

G Bellotti

Publications and source records attributed to G Bellotti.

At least 199 records · Page 11Linked to original sources
PubMed1990

[Pericardial disease erroneously diagnosed as endomyocardial fibrosis. Report of 2 cases].

Two patients who were sent to operation with diagnosis of endomyocardial fibrosis (EMF) turned out to have pericardial disease. EMF had been suspected on the basis of clinical history, electrocardiographic, radiologic and echocardiographic data. The hemodynamic studies were "typical", and included apex amputation, flat ventricular surface and mitral and tricuspid insufficiencies. Thus, ventriculography should not be considered specific, but rather suggestive of endomyocardial fibrosis.

Adult↗
PubMed1990

[Differences between men and women in fatal cases of myocardial infarction: study of 200 necropsies].

PURPOSE: To compare morphological characteristics from myocardial infarction (IM) in men and women in 200 consecutive necropsies. MATERIAL AND METHODS: Necropsy heart findings from 62 female cases compared with those from 138 male cases, from patients who died from transmural myocardial infarction. Age ranged from 21 to 82 (mean 60) years. RESULTS: Concerning the coronary arteries, the number of 3 major (right, left anterior descending and left circumflex) epicardial coronary arteries narrowed at some point greater than 70% in cross-sectional area by atherosclerotic plaque was not significantly different; on the other hand, there were more severe lesions in the left main coronary artery in men (10.33%) than in women (1.64%) (p = 0.050). 33.33% of men and 43.55% of women had only recent myocardial infarction (1 month or less); 33.33% of men and 14.52% of women had only old myocardial infarction (more than 1 month); 33.33% of men and 41.94% of women had both recent and old myocardial infarction. 12.90% of women and 2.17% of men showed rupture of the left ventricle (p = 0.0220). 15.22% of men and 6.45% of women had left ventricular aneurysms (p = 0.830). CONCLUSION: There are more deaths during the acute phase of MI, in the first infarction and from rupture of the left ventricle in female patients; in men, there are more deaths occurring in chronic phases of the disease and with previous myocardial infarction; and more severe narrowing from the left main coronary artery.

Adult↗
PubMed1990

[Efficacy and tolerance of a new calcium-channel blocking agent (nitrendipine) in the treatment of arterial hypertension].

PURPOSE: Assess the efficacy and tolerability of nitrendipine, 20 mg/day, in mild to moderate essential hypertension (diastolic blood pressure 95 to 114 mmHg). MATERIAL AND METHODS: Twenty patients in an open comparative trial (drug x placebo) during six weeks. Blood pressure and heart rate were measured in orthostatic and supine position and after hand-grip maneuver every two weeks. RESULTS: Systolic and diastolic blood pressure fell significatively in the treated group by the end of the study-supine (161 mmHg +/- 11 to 138 mmHg +/- 13 and 105 +/- 5 to 81 mmHg +/- 7 p less than 0.05) and orthostatic position (153 mmHg +/- 13 to 132 mmHg +/- 13 and 104 mmHg +/- 15 to 81 mmHg +/- 7, p less than 0.05) and after hand grip maneuver (170 mmHg +/- 21 to 148 mmHg +/- 22 and 108 mmHg +/- 5 to 85 mmHg +/- 7 p less than 0.05). Significant modifications were not observed in systolic and diastolic blood pressure in placebo group under the following conditions: supine (168 mmHg +/- 8 to 168 mmHg +/- 17 and 107 mmHg +/- 5 to 107 mmHg +/- 3) and orthostatic positions (167 mmHg +/- 9 to 163 mmHg +/- 14 and 107 mmHg +/- 5 to 107 mmHg +/- 4) and after hand grip maneuver (178 mmHg +/- 17 to 173 mmHg +/- 16 and 107 mmHg +/- 4 to 108 mmHg +/- 6). Significant changes in heart rate did not occur in both groups after treatment. Heart rate elevation observed after hand grip maneuver did not change. Adverse effects like headache, palpitation and dizziness occurred in both groups. Electrocardiogram, x-ray and blood chemistries were not modified during the trial.

Adult↗
PubMed1990

[Empiric therapy with amiodarone in patients with chronic Chagas cardiomyopathy and sustained ventricular tachycardia].

PURPOSE: To evaluate the efficacy and safety of long-term empiric amiodarone therapy in patients with recurrent Sustained Ventricular Tachycardia (SVT) and Chronic Chagasic Myocarditis (CCM). PATIENTS AND METHODS: Thirty-five patients with CCM and SVT, eighteen (51%) of them were refractory to other antiarrhythmic drugs. The Amiodarone loading dose was between 600 and 1200 mg/day, mean of 883 +/- 239 mg/day, from a period of one to four weeks. The maintenance dose was decreasing in the follow-up period, it fell down to 356 +/- 125 mg/day at the end of six to 80 (mean = 27 +/- 20) months. Cumulative, event-free interval curves were generated by the Kaplan-Meier method. Clinical variables were compared with the use of the Student t-test or by means of chi-square tests. RESULTS: The probability to suppress SVT was, 0.62 in 12 months, 0.56 in 24 months and 0.44 in 36 months, with regular use of amiodarone. The probability to the occurrence of sudden death was 0.0 in 12 months, 0.04 in 24 months and 0.11 in 36 months. The stratification of risk to clinical recurrence was significative to the left ventricular disfunction. All patients with functional class III or IV and LV ejection fraction less than 30% at radioisotopic ventriculography had clinical recurrence, while just 30% of patients with functional class I and II have got it (p less than 0.05). Fifteen (42.8%) patients had side effects. The treatment was discontinued in four patients (11.5%). CONCLUSION: The empiric treatment with amiodarone apparently was effective in patients with SVT and CCM and functional class I and II. Patients with functional class III and IV did not get benefits from the treatment. In these cases other therapy must be pointed out.

Adult↗
PubMed1990

[Postoperative jaundice syndrome after mitral valve replacement. A case report].

A 52-year old woman was submitted to mitral valve replacement. The operation proceeded without complications. Jaundice had been noted since the first postoperative (po) day and increased progressively due to conjugated bilirubin. Abdominal examination was normal and no signs of infection or circulatory failure were noted. Conjugated bilirubin levels increased from 6 mg/dl on the second po day to 20.4 mg/dl on the sixth po day and to 32 mg/dl on the tenth po day. Gammaglutamyl transferase levels were 600 U/L (normal up to 18 U/L) and lactate dehydrogenase levels were 396 U/L (normal) up to 240 U/L) on the seventh po day. Alkaline phosphatase levels were 1880 U/L (normal up to 170 U/L) whereas glutamic oxalacetic transaminase levels were 60 U/L (normal up to 15 U/L) and glutamic pyruvic transaminase levels were 66 U/L (normal up to 17 U/L) on the tenth po day. Abdominal ultrasonography did not disclose dilatation of intra and extra-hepatic biliary system. The patient died after a percutaneous hepatic biopsy procedure. The jaundice was attributed to a cholestatic syndrome after cardiac surgery and cardiopulmonary bypass, due to an impairment of the excretory function of the hepatocyte.

Cholestasis↗
PubMed1989

Two- to eight-year survival rates in patients who refused coronary artery bypass grafting.

One hundred and fifty patients with coronary artery disease (CAD) who refused bypass grafting were followed prospectively from 2 to 8 years. Mean age was 57 +/- 8 (standard deviation) years. Ejection fraction averaged 70 +/- 14%. Eight percent of patients had 1-vessel CAD and 92% had multiple-vessel CAD. Medical treatment included propranolol, nifedipine, isosorbide dinitrate, dipyridamole and aspirin. Annual mortality was 0% for 1- and 2-vessel CAD and 1.3% for left main equivalent disease, 3-vessel and left main CAD. Treatment significantly reduced the incidence of stable and unstable angina. Fifty-two patients (34%) had a second hemodynamic study 4.2 +/- 1.3 years after initial evaluation. Stenosis progression or new significant obstructions (greater than or equal to 70%) in previously normal coronary arteries occurred in 61% of 123 arteries studied, whereas new occlusions were observed in 12% of the arteries. Nonfatal acute myocardial infarction incidence was 8%. No significant changes occurred in ejection fraction. In conclusion, proper medical treatment in selected patients with advanced CAD but preserved ventricular function is associated with good long-term survival and remission of symptoms, although progression of coronary atherosclerosis does occur in some patients.

Aged↗
PubMed1989

Postoperative subphrenic abscess after heart-valve replacement.

A 35 year-old male patient developed a subphrenic abscess in the immediate postoperative period after replacement of a calcified mitral bovine pericardium bioprosthesis. He was successfully treated with abdominal percutaneous drainage and antimicrobial therapy.

Adult↗
PubMed1989

Essential hypertension and histocompatibility antigens. A linkage study.

It is well established that genetic and environmental factors are involved in the etiology of essential hypertension. The presence of genes predisposing to essential hypertension in the human leukocyte antigen (HLA) complex is controversial because studies of an association between HLA antigens and essential hypertension have failed to yield consistent results. Our aim in the present study was to further investigate this issue through the method of linkage analysis. Analysis of 96 hypertensive siblings distributed in 31 families indicated a significant distortion (p = 0.0009) of the normal segregation pattern of inheritance of HLA haplotypes. Thus, our data indicate that at least one of the genes responsible for genetic predisposition to essential hypertension is located very near or within the HLA complex.

Adolescent↗
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

[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↗