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Biomedical subjects

J Coutinho

Publications and source records attributed to J Coutinho.

At least 19 recordsLinked to original sources
PubMed2002

Philadelphia-positive T-cell acute lymphoblastic leukemia with polymyositis, migratory polyarthritis and hypercalcemia following a chronic myeloid leukemia.

Transformation of chronic myeloid leukemia (CML) often results in acute myeloblastic or, less frequently, in precursor B-cell acute lymphoblastic leukemia (ALL). T-cell blast crisis is rare. Hypercalcemia has also been described as a rare complication of CML, but this usually occurs as a terminal event. Here we report a case of a 35-year-old woman who developed a CD4(+)/CD8(+) T-cell ALL 2 years after the diagnosis of a typical Ph(+) CML. Polymyositis and polyarthritis preceded by 4 months, and symptomatic hypercalcemia occurred just before blastic transformation, probably representing paraneoplastic manifestations of the disease.

Adult↗
PubMed2001

Thermal double donors and quantum dots.

Combined local mode spectroscopy and ab initio modeling are used to demonstrate for the first time that oxygen atoms in thermal double donors (TDD) in Si are in close proximity. The observed vibrational modes in (16)O, (18)O, and mixed isotopic samples are consistent with a model involving [110] aligned oxygen chains made up of an insulating core lying between electrically active ends. The model also explains the minute spin density observed on oxygen in TDD(+) as well as the piezospectroscopic tensors of the donors. The analogy between the thermal donors and quantum dots is emphasized.

Journal Article↗
PubMed2001

[Adrenergic beta inhibitors in heart insufficiency: which and when?].

After briefly reviewing the alterations of sympathetic nervous system in congestive heart failure and the possible ways of its pharmacological management, we review the present data regarding the use of blocking drugs in major trials (USCP, CIBIS and MERIT-HF). beta blocking drugs have a top and unquestionable role in the therapy of congestive heart failure; we conclude with a few practical rules about their use in this syndrome.

Adrenergic beta-Antagonists↗
PubMed1998

Pure red cell aplasia associated to clonal CD8+ T-cell large granular lymphocytosis: dependence on cyclosporin A therapy.

This case report details a single patient with pure red cell aplasia (PRCA) associated with clonal CD3+, TCRalphabeta+, TCR-Vbeta8+, CD8+, CD57+ large granular lymphocytosis whose anaemia did not respond to conventional immunosuppressive therapy but did respond to cyclosporin A (CsA). The patient has become dependent on CsA for 7 years in order to control anaemia due to associated PRCA.

Aged↗
PubMed1998

[Neutropenia].

The authors reviewed the subject of neutropenia in what concern its definition, pathophysiology, clinical features, diagnosis and principles of treatment. A new pathophysiological classification of neutropenia and an evaluation of neutropenic patients are proposed. The extent of laboratory evaluation depends greatly on the duration and severity of the neutropenia. The hematopoietic growth factors controlling the growth, development, differentiation and activation of the hematopoietic progenitor cells have revolutionized the treatment of neutropenia.

Humans↗
PubMed1996

Cytogenetic findings in a patient presenting simultaneously with chronic lymphocytic leukemia and acute myeloid leukemia.

A case of simultaneous presentation of B-chronic lymphocytic leukemia (CLL) and acute myeloid leukemia (AML) is described. CLL was documented by bone marrow and peripheral blood lymphocytosis with a typical B-CLL immunophenotype. The diagnosis of AML was supported by the presence of bone marrow and circulating blast cells positive for myeloperoxidase and myeloid-associated markers. Although the immunophenotyping and morphocytochemical studies indicated two different cell populations (mature B-CLL lymphocytes and myeloblasts), chromosome aberrations commonly associated with CLL and AML were found simultaneously in the same metaphases obtained from unstimulated 24-hour cultures of peripheral blood cells.

Aged↗
PubMed1995

Immunophenotypic characteristics of acute leukaemia after myelodysplastic syndromes.

PURPOSE: To analyse the immunophenotype of acute leukaemia (AL) after myelodysplastic syndromes (MDS) (MDS-AL) and to compare the immunophenotypic profile of acute myeloblastic leukaemia (AML) secondary to MDS (MDS-AML) with that of "de novo"-AML. PATIENTS AND METHODS: Twenty patients with MDS-AL and 29 patients with "de novo"-AML were studied. Morphocytochemical and flow cytometric studies were done in each case. RESULTS: All the MDS-AL studied displayed a myeloid phenotype (MDS-AML). The main difference between MDS-AML and "de novo"-AML was a significantly higher frequency of CD34 expression in the first group. Differences concerning the expression of other non-lineage related or myeloid-associated markers were not statistically significant, although the percentage of cases CD15(+) was lower in MDS-AML. The overall frequency of expression of lymphoid-associated markers was similar in both groups, T-cell markers being more frequently detected. CONCLUSIONS: Our findings support the usefulness of immunophenotyping studies to characterize MDS-AL and suggest some immunophenotyping differences between MDS-AML and "de novo"-AML which might have biological and prognostic significance.

Adult↗
PubMed1995

Diltiazem effects on left ventricular function preliminary results of 12 patients evaluated by calibrated apexcardiogram.

Diltiazem is a calcium channel blocker whose effects on left ventricular function (LVF) are controversial. We studied 12 patients with ischemic heart disease (IHD) before starting and 15 and 30 days after having initiated Diltiazem 60 mg t.i.d. LVF was accessed by means of the normalized indexes of the calibrated apexcardiogram: nS for systolic LVF evaluation and nA for diastolic LVF evaluation. Recent works have shown that these indexes have a good correlation with invasive parameters of LVF. We verified that nS did not change and nA decreased significantly (p < 0.05) after Diltiazem. We preliminary concluded that Diltiazem has no deleterious effect on LV systolic function and improves LV diastolic function, by decreasing nA, a parameter which correlates well with LV end diastolic pressure.

Depression, Chemical↗
PubMed1994

Chronic prolymphocytoid leukaemia with an unusual immature immunophenotype.

A case of a 58 year old woman with a chronic lymphoproliferative disorder of unusual clinical presentation, disease course, and immunophenotype is presented. At diagnosis she had severe anaemia, moderate lymphocytosis with some cells having prolymphocytoid features and a normal platelet count. A clinical examination yielded negative results. Only anaemia related symptoms were found and the patient became blood transfusion dependent. Both the lymphocytosis and the proportion of prolymphocytoid cells rose insidiously and thrombocytopenia developed later during the course of the disease. Three years later, the patient had a white cell count of 269 x 10(9)/l almost exclusively of prolymphocytoid cells and the bone marrow was diffusely infiltrated. She was refractory to chemotherapy and the anaemia did not improve after treatment with cyclosporine. Lymphoid cells were positive for cytoplasmatic CD3, HLA-Dr, CD34, CD38, CD7, CD56, CD13, CD33 and CD65. Membrane alpha beta and gamma delta T cell receptors (TCRs) were not expressed and the beta chain TCR gene was in germline configuration. Other membrane T, B, natural killer, and myelomonocytic markers were negative. Karyotype analysis was tried several times but metaphases were not obtained, even after stimulation with T cell mitogens.

Anemia↗
PubMed1993

[Cytogenetic studies in hematological diseases. Analysis of 185 cases].

PURPOSE: To analyse the chromosomal abnormalities found at diagnosis in patients with malignant blood diseases. PATIENTS AND METHODS: Between june 1988 and january 1992, cytogenetic studies were performed at the Cytogenetics Laboratory of the Abel Salazar Institute for Biomedical Sciences on 185 patients with malignant blood diseases. Bone-marrow and/or peripheral blood cells were used for such studies, two simultaneous cultures being prepared at 24 and 48 hr, plus another one, stimulated with phytohemagglutinin, at 72 hr. Trypsin G-banding techniques were used for chromosome identification. Chromosomes were classified in accordance with the international system, and a clone was judged abnormal whenever two or more metaphases showed identical structural abnormalities or extra chromosome(s) and three or more metaphases lacked the same chromosome(s). RESULTS: Evaluable mitoses were found in 152 of the 185 cytogenetic studies performed (82.2%), pertaining to chronic myelogenous leukaemia (39/42), acute nonlymphoblastic leukaemia (40/43), myelodysplastic syndromes (10/17), acute lymphoblastic leukaemia (30/36), and chronic lymphoproliferative disorders (10/14). Chromosomal alterations, previously described in each diagnostic variety, were found in 69% of the cases with abnormal karyotype. The remaining patients (31%) had chromosomal abnormalities not reported consistently. CONCLUSIONS: The karyotype should be studied regularly in haematologic disorders since, although lacking precise prognostic implications, it may help gain information with regard to the genetic alterations in different blood diseases.

Aneuploidy↗
PubMed1992

Choledochoenterostomy with an anti-reflux mechanism.

A new technique of choledochoenterostomy was devised to solve some of the problems of enterobiliary anastomosis with a normal calibre. The distal extremity of the common bile duct is completely surrounded by the bowel mucosa to a length of 3 cm after seromyectomy of a bowel wall rectangle of 4 x 1 cm. Experimental studies in rats and dogs demonstrated that this procedure prevents the risks of anastomotic disruption and functions like a mechanical unidirectional valve, which has great efficacy in stopping enterobiliary reflux. Studies in ten patients with obstructive jaundice with an extrahepatic biliary dilation less than 1.2 cm diameter submitted to this procedure confirmed the experimental results. All patients were asymptomatic, without jaundice and with normalization of the liver enzymes after 2 months. The permeability of the valvular anastomosis studied by cholangiography, the HIDA 99mTc test and manometry was quite similar to other classical biliary-enteric anastomosis. In contrast, anti-reflux efficacy was only demonstrated in patients with a valvular anastomosis.

Animals↗
PubMed1992

[Variability of heart rate: a perspective].

The present work is an attempt to provide a general overview on the current methods and applications of heart rate variability (HRV), starting from the underlying mechanisms of cardiac rhythmic automaticity and the influence on heart rate of biological modulators, namely autonomous nervous system. Different evaluation methods for HRV are compared in what concerns the duration of the records under analysis and the mathematical approach (spectral/non-spectral). Finally, clinical applications of HRV are mentioned, some of them the Department is particularly interested in, namely coronary heart disease, heart failure and diabetic neuropathy. The authors conclude, minding some aspects susceptible of discussion in the future of this technique.

Autonomic Nervous System↗
PubMed1989

Acute cholangitis. Multivariate analysis of risk factors.

In order to identify risk factors in patients with acute cholangitis, 140 clinical, biochemical, etiologic, and pathologic variables of 449 attacks of acute cholangitis seen in one center over a 20-year period were analyzed. Simple regression revealed 24 factors with prognostic significance, but multivariate analysis detected only seven factors with independent significance in predicting mortality (acute renal failure, cholangitis associated with liver abscesses or liver cirrhosis, cholangitis secondary to high malignant biliary strictures or after percutaneous transhepatic cholangiography, female gender, and age). When the presence of each of these factors is weighted proportional to its coefficient of regression, patients with cholangitis could be scored on a scale of 0-27. A score of seven was clinically the most useful cut off--388 attacks of cholangitis associated with a score of less than 7 had a mortality rate of only 1.8%, whereas 61 attacks associated with a score greater than or equal to 7 had a mortality rate of 49%. The value of this scoring system needs to be confirmed in prospective studies, but it may prove useful, for example, in selecting a group of high-risk patients for urgent biliary decompression in an attempt to reduce the mortality associated with this pathology.

Acute Disease↗
PubMed1988

Influence of sublingual captopril on plasma catecholamine levels during hypertensive emergencies and cold immersion.

Experimental evidence of captopril-induced inhibition of sympathetic activity, mediated by decrease in angiotensin II production, is presented. The blood pressure, plasma catecholamine, plasma renin activity, and plasma aldosterone responses to a single dose of sublingual captopril in 23 patients with hypertensive emergencies were evaluated. The major correlation found was between the captopril-induced decrease in blood pressure and the decrease in plasma norepinephrine levels (r = 0.57, p less than 0.01). In another 11 hypertensive patients with normal or high renin levels, captopril lowered by 65 percent the increase in plasma norepinephrine induced by cold immersion of the forearm. In both circumstances, plasma renin and aldosterone levels changed in accordance with the expected inhibition of angiotensin converting enzyme activity. These data suggest that, in selected circumstances in hypertensive patients, captopril exhibits a depressive influence on sympathetic activity along with the inhibition of the renin-angiotensin system.

Administration, Sublingual↗