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Biomedical subjects

G Bellotti

Publications and source records attributed to G Bellotti.

At least 217 records · Page 12Linked to original sources
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

[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↗
PubMed1989

[Histopathologic aspects of hyperacute graft rejection in human cardiac transplantation. A case report].

The first case of a hyperacute rejection of a human cardiac allograft in Brazil is reported. The histopathological aspects of hyperacute cardiac rejection in its earlier moments are described when degenerative and necrotic features of the cardiac fibers are not totally developed. The authors believe that neutrophilic exudation and lesion of the vessel wall are good signs for a correct diagnosis of hyperacute rejection. Furthermore, they observed that the process is diffuse enough to justify the indication of endomyocardial biopsy when there are reasons to suspect this diagnosis. Presence of IgM and complement (C3) are also useful.

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↗
PubMed1988

Infective endocarditis related to acute cholecystitis.

A 30-year-old woman with a homologous dura-mater valve prosthesis developed infective endocarditis related to acute purulent cholecystitis occurring in chronic cholelithiasis. During anti-bacterial treatment refractory heart failure ensued which compelled replacement of the infected prosthesis. She died in the post-operative period. Autopsy revealed endocarditis on the implanted bioprosthesis, purulent cholecystitis and a gallbladder stone. It is warningly concluded that the surgical treatment of endocarditis was unsuccessful because of persistence of purulent cholecystitis that led to reinfection of the inserted prosthesis.

Acute Disease↗
PubMed1988

Difference between the response of the pulmonary and systemic circulation during exercise in congestive heart failure.

Thirty nine patients with cardiomyopathy were evaluated by a hemodynamic study at rest and during isotonic exercise. These patients were divided into two groups on the basis of their left ventricular ejection fraction (LVEF): A, control group (LVEF greater than 40%, N = 19); B, severe congestive heart failure group (LVEF less than or equal to 40%, N = 20). Patients in group A showed adequate cardiovascular responses to exercise, i.e. increased cardiac index (80%) and stroke volume index (17%), decreased systemic vascular resistance (36.8%) but no significant change in pulmonary arteriolar resistance values. In contrast, patients in group B showed a slight and heart rate-dependent increase in cardiac index (38.5%), no improvement of stroke volume index (-3.4%), decreased systemic vascular resistance (21.6%) and increased pulmonary arteriolar resistance (41.2%) with exercise. This group also showed a significant increase in right atrial pressure that might reflect a decrease in right ventricular performance secondary to an abnormal pulmonary vascular response during exercise.

Adult↗