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Biomedical subjects

J Cruz

Publications and source records attributed to J Cruz.

At least 181 records · Page 10Linked to original sources
PubMedDate not supplied

[The hemolytic-uremic syndrome].

The microangiopathic thrombotic syndromes--thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS)--are characterized by microangiopathic hemolytic anemia, thrombocytopenia, renal dysfunction, fever and central nervous system abnormalities. Today they are considered as two extremes of a continuous spectrum named TTP--HUS. The syndrome is an uncommon disease with a high mortality rate, despite treatment. The authors describe a case of hemolytic uremic syndrome in a young adult patient. Initially the clinical course and the first biopsy suggested a favourable prognosis, but the early recurrence with severe hypertension was followed by a fatal outcome 6 months later. Concerning this clinical case, the authors present a review of the most recent aspects of the pathogenesis and treatment of this syndrome.

Adolescent↗
PubMedDate not supplied

[Pulmonary arterio-venous fistula: a clinical report].

A 44 years old female was admitted with previous history of several cerebral vascular accident (CVA). A transthoracic echocardiogram showed a patent foramen ovale (PFO) that was closed, under extracorporeal circulation. The patient remained free of symptoms for ten years. In the year 2003 she was admitted to our hospital with paresthesias of the left arm. The clinical evaluation led to the diagnosis of arteriovenous fistula (AVF) of the lung. In November 2003, the patient underwent right inferior lobectomy. This is a rare association of PFO with AVF fistula of the lung with a delayed diagnosis. The differential diagnosis, the surgical treatment and the most frequent complications of this pathology are reported and discussed.

Adult↗
PubMedDate not supplied

[Craniopharyngiomas. Clinicopathological aspects in different age groups].

Craniopharyngiomas are rare brain tumors of the hypothalamo-pituitary region, developing from embryonic remnants of Rathke's pouch and sac. Their overall incidence is 0.13 per 100,000 person years. Most frequently, they are suprasellar, start growing in childhood and originate neurological and hormonal symptoms. We retrospectively studied patients treated in our institution for craniopharyngioma in the last 10 years, in order to evaluate their clinical, imaging and pathological characteristics. Of the 32 patients analysed, 18 were females and 14 males with ages ranging between 6 and 81 years (early onset group--EOG aged 5-14 years: 7 patients; middle age onset group--MAOG aged 15-49 years: 15 patients; late age onset group--LOG aged > or = 50 years: 10 patients). Visual impairment was the most frequent presenting clinical feature in EOG (71.4%) and MAOG (86.6%), while in the LOG personality and cognitive changes including memory loss predominated (60%). Headaches were very frequent in all groups (EOG 42.8%, MAOG 60%, LOG 40%). Meningitis and seizures were presenting features, each in one patient. Regarding endocrine symptoms and signs, growth failure was present in 57.2% of the EOG. Amenorrhea was present in 5 of 10 female patients of the MAOG. Preoperatively, TSH was deficient in 25%, ACTH in 15.6% and gonadotropin in 25% of the patients. There were no cases of diabetes insipidus. Preoperative CT and MR revealed a calcified mass in 12 (37.5%), a partially cystic mass in 20 (62.5%) and a lesion involving or extending into the third ventricle in 7 (21.9%) patients. Twenty seven (84.4%) patients were treated primarily by surgery. In 4 (12.5%) cases the tumour was considered inoperable and 1 (3.1%) patient refused surgery; all were in the LOG. Surgical approach was transsphenoidal in 2/27 (7.4%) (all of them in the LAOG) and by craniotomy in the others. The tumour removable was considered complete in 10 (37%--EOG 2/7, MAOG 6/15, LOG 2/5) and subtotal in 17 (62.9%) patients. Eight (29.6%) patients were reoperated for recurrent tumour. Postoperative radiotherapy was administered in 12 cases with residual tumor, and 3 inoperable tumors were treated primarily by conventional external radiotherapy. Pathological study revealed the adamantinomatous type in 25 (92.6%) and the papillary type in 2 (7.4%--all men in the MAOG) tumors. The average follow-up was longer in the EOG (82.6 +/- 40.7 months) than in MAOG (57.2 +/- 48.5 months) and in LOG (48 +/- 92 months). Four (12.5%) patients died, 1 during the follow-up period due to a radiation-induced astrocytoma and 3 in the postoperative period because of cerebral hemorrhage and hydrocephalus (1 in the EOG and 2 in the LOG). In summary, we found the clinical presentation to be different in the 3 age groups, with a large number of patients in the MAOG. In this group were the only examples of the papillary form. Better prognosis was associated with a total resection at initial surgery.

Adolescent↗
PubMedDate not supplied

[Video-assisted thoracic surgery in the diagnosis of interstitial diffuse pulmonary diseases].

Interstitial lung diseases are best diagnosed by surgical lung biopsy. Videoassisted thoracoscopy (VATS) is less aggressive than open lung thoracotomy and its development is associated with an increased number of lung biopsies. Between July 1994 and July 2004 we performed 70 VATS biopsies for interstitial lung disease patients. Only one biopsy was considered inconclusive (1.4%). The remainder 69 (98.6%) established a final diagnosis. The results in our series show that VATS lung biopsy is a safe method with low mortality and morbidity and an excellent rentability.

Adolescent↗
PubMedDate not supplied

[Pulmonary carcinoid tumors--ten years experience].

Pulmonary carcinoid tumors are rare, accounting for as many as 2% of all pulmonary neoplasms and for 10% of carcinoid tumors overall. Previously classified as bronchial adenomas, actually are classified as neuroendocrine tumors. They have a subclassification into typical classed as low-grade malignant neoplasm and atypical more aggressive, with more potential to cause local invasion. In this paper, the authors report a retrospective study of 25 patients, who had the diagnosis of pulmonary carcinoid tumors and had been operated between January of 1994 and August of 2004. We conclude that this tumors must be considered malignant in the surgical approach.

Adolescent↗
PubMedDate not supplied

[Surgery of mediastinal tumors: 11-years experience].

Between 1993 and 2004, 70 operations on patients with the diagnosis of mediastinal tumors were performed in the Cardiothoracic Surgery Department of Santa Maria Hospital. In this study we did not include diagnostic surgery of mediastinal tumors. In 70 patients treated, 63 p (90%) had the tumor located in the anterior mediastinum, 21 p with thymoma, 6 p with lymphoma, 4 p with carcinoid tumors, 1 p with sarcoma and 1 p with adenocarcinoma. 3 patients had tumors located in the medium and 4 patients in the posterior mediastinum. We analysed the results of the mediastinal tumors surgery during the 11-years period. Also, we evaluated the clinical effects of the thymectomy in myasthenia gravis.

Carcinoid Tumor↗
PubMedDate not supplied

[Surgical diagnosis of mediastinal pathology: eleven-years experience].

Between January 1993 and December 2004, 68 patients with mediastinal pathology were submitted to diagnosis surgery. All the pathological process were located in the anterior mediastinum, and most of them were malignant (64.1%). The most common pathology was limphoma (26.5%), sarcoidosis (23.5%) and thymomas (23.5%). Seven cases consisted in ganglionar tuberculosis (10.3%), six cases were ganglionar metastases of lung adenocarcinoma (8.8%), and three cases were thymic carcinoma (4.4%). One patient had no definite diagnosis (1.5%). In this experience high diagnosis accuracy (98.5%), and low morbidity were demonstrated. Although the present video assisted thoracic surgery progress and development, mediastinoscopy still remains as a reliable, safe and efficient surgical approach for the diagnosis of mediastinal pathology.

Adolescent↗
PubMedDate not supplied

[Arterial hypertension in students of the great São Paulo area].

In 1,000 students from Great São Paulo First Degree Schools, from 6 to 18 years old, we studied: age, sex, race, weight, height, left arm circumference, blood pressure, pulse and family history of hypertension. Of these 550 were female and 450 male, with predominance of caucasians in both sexes (83.7%). The conclusions of this study were: until 9 years old the blood pressure was similar in both sexes. As the school girls grow up earlier, their blood pressure rose first, but after 16 years this fact changed: 126 +/- 3.5 x 76 +/- 2.8 in males and 115 +/- 2.0 x 74 +/- 1.9 in females. Students with a family history of hypertension had higher blood pressure than students without and the prevalence of systolic and diastolic hypertension was higher in the first group: 12.2 and 13.8 to 4.7 and 3.8% respectively. Diastolic blood pressure was dominant in only in males Negros. The prevalence of systolic and diastolic hypertension was 6.9% in these 1,000 students.

Adolescent↗
PubMedDate not supplied

[Cervical lymphadenopathy as first manifestation of a bronchogenic cyst].

A 26-year old woman was admitted with clinical and laboratory signs and symptoms of chronic infection and multiple cervical lymphadenopathy, whose pathological studies disclosed a non-specific inflammatory reaction. Anti-tuberculosis treatment was then started, with no significant improvement. Chest CT scans was compatible with a mediastinial tumor and RMN studies revealed the presence of an infected bronchogenic cyst, which was surgically and successfully removed with complete disappearance of the infection. The authors conclude by enhancing the fact that bronchogenic cysts may course with diverse clinical manifestations and should be included in differential diagnosis of mediastinal tumors.

Adult↗
PubMedDate not supplied

Severe tophaceous gout. Characterization of low socioeconomic level patients from México.

OBJECTIVE: To describe a group of patients with frequent tophaceous gout, the variables associated with severe tophaceous gout and to compare them with other patients with gout described elsewhere. METHODS: We looked for 65 demographic clinical and paraclinical variables from patients with gout who attended our gout clinic from 1995-2000 and were evaluated by the same group of physicians. RESULTS: Three hundred and sixteen patients were included, 98% males, 82% live in México city, the mean age at onset, educational level and disease duration were 37.5 +/- 12.4, 6.3 +/- 3.9 and 12.6 +/- 10.3 years respectively. Tophaceous gout was present in 62% of the patients with a mean tophi number of 4.7 +/- 6.3 and mean HAQ score 0.13 +/- 0.37. Severe tophaceous gout (>or= 5 tophi) was found in 34% and these patients had significantly: earlier age at onset, longer duration of the disease, lesser frequency of obesity and higher frequency of: intradermal tophi, HAQ > 0.5, hospitalizations, radiographic score III/IV, uric acid under-excretion, renal function impairment and previous (oral and parenteral) auto-prescribed chronic glucocorticoid treatment compared with patients with non-severe tophaceous gout. In the multiple logistic regression the significant variables were renal function impairment (p = 0.000) and previous chronic parenteral glucocorticoid treatment (p = 0.011) . CONCLUSION: Our patients compared with those from other countries who have earlier age at onset, very low frequency of gout among females, frequent tophaceous gout and severe tophaceous gout. Severe tophaceous gout in this group is associated with renal function impairment and previous chronic parenteral glucocorticoid treatment.

Adult↗
PubMedDate not supplied

[Treatment of essential hypertension and hypercholesterolemia with or without hypertriglyceridemia, with low dose of bezafibrate (200 mg/day)].

Twenty patients with essential hypertension, 5 with dyslipidemia type IIa and 15 with that of type IIb, were treated with bezafibrate, 200 mg/day. As control group, 20 normo or dislipemic patients with essential hypertension receiving no hypolipidemic drugs, and chosen at random, showed no significant changes of the mean values of serum total cholesterol and triglycerides at three evaluations made in a period of about six months. Six patients were males (60 +/- 4 years) and 14 females (57 +/- 2 years). The levels of cholesterolemia and triglyceridemia were evaluated before the administration of the drug and on the 28th and 56th day of its use. The mean initial value of total cholesterol (n = 20) was 334 +/- 10 mg/dl, lowering significantly (P less than 0.01) to 274 +/- 7 mg/dl and 279 +/- 11 mg/dl. Initial triglyceridemia level (n = 15) was 544 +/- 85 mg/dl, decreasing significantly (P less than 0.01) to 234 +/- 36 and 245 +/- 36. Percentual mean decrease of cholesterolemia was respectively 16 +/- 4% and 14 +/- 5% and that of triglyceridemia was 46 +/- 8% for both evaluations. Side effects of the drug were not seen with the indicated dose. The therapy was useful to lower the dislipemic values of the essential hypertensive patients, in spite of no consistent changes in their diet and physical activity and of its use for a short period.

Aged↗
PubMedDate not supplied

[Histopathologic study of primary glomerulopathies: retrospective analysis of 197 renal biopsies (1985-1987)].

The histopathological prevalence of primary glomerular diseases in patients aged 14 to 70 years (105 males, 92 females) was analysed: 140 (71%) were aged from 14 to 35 years and 57 (29%) were older than 35 years, the difference being significant (p less than 0.001). The following data were found at our Nephrological Unit: the prevalence of focal glomerular sclerosis was 37.1%; of the membranous glomerulonephritis 16.2%; of the IgA nephropathy 8.6%; of the membranoproliferative glomerulonephritis 6.1%; of the minimal change disease 5.1%. The acute diffuse glomerulonephritis, the rapidly progressive glomerulonephritis and the chronic glomerulonephritis showed the same prevalence of 4.6%, and the mesangial proliferative glomerulonephritis and the kidney in Alport's syndrome that of 3.6%. Diagnosis was not defined by renal biopsy in 6.1% of the patients. Failures to achieve diagnosis were due to biopsies with less than 5 glomeruli on optic microscopy or losses affecting the immunofluorescence procedures. It was concluded that the highest prevalence was that of the focal glomerular sclerosis, found in more than one third of the patients. It was followed by the prevalence of the membranous glomerulonephritis which occurred in about one sixth of our cases. The prevalence of IgA nephropathy, minimal change disease, membranoproliferative glomerulonephritis and of other primary glomerulopathies were low. The prevalence of focal glomerular sclerosis was significantly higher (p less than 0.001) in the younger group of patients (14-35 years) than in the older one; the same fact was seen in the prevalence of the proliferative histopathological forms of glomerulonephritis (p less than 0.025), grouping IgA nephropathy, membranoproliferative glomerulonephritis, rapidly progressive glomerulonephritis and mesangial proliferative glomerulonephritis.

Adolescent↗