The state of the contraceptive art.
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Americas↗
Biomedical subjects
J Duarte
Publications and source records attributed to J Duarte.
Overweight and obesity in children and adolescents: relationship with blood pressure, and physical activity.
OBJECTIVE: Using body mass index (BMI) quartiles, the present study's aims were (1) to describe and evaluate the relationship between overweight/obesity with cardiovascular disease (CVD) risk factors, such as systolic blood pressure (SBP), diastolic blood pressure (DBP) and physical activity; (2) to provide information on the prevalence of high blood pressure and physical activity according to BMI quartiles; and (3) to examine the relationship of risk of obesity to adverse levels of high blood pressure and physical activity. METHODS: The sample consisted of 1439 children (758 males and 681 females), 8-16 years old. Participants were classified as being at 'risk of obesity' according to age- and sex-adjusted fourth quartile of BMI values. Blood pressure was measured using the Dinamap monitor. An adapted version of the Weekly Activity Checklist was applied for the diagnosis of physical activity index (PAI). RESULTS: Systolic and diastolic blood pressures were significantly (p < 0.05) and positively related to BMI, whereas no significant associations were reported between BMI and PAI in both genders. Overall, the proportion of subjects with adverse levels of blood pressure (SBP or DBP) ranged from 21.3% in the first BMI quartile (BMI-1Q) to 30.4% in BMI-4Q (p < 0.05). The PAI ranged from 24.5% in BMI-1Q to 20.6 in BMI-4Q and no significant differences were found. Children and adolescents at 'risk of obesity' were 1.5 times as likely to have at least one risk factor (high blood pressure or low level of activity). CONCLUSIONS: Our data suggest that higher BMI is associated with higher values of SBP and DBP. Children and adolescents in the upper quartile of BMI are 1.5 times as likely to have at least one risk factor. Furthermore our data confirmed previous findings that higher levels of BMI are associated with a unfavourable risk profile for CVD risk factors.
Adolescent↗
Oral acyclovir and neurologic adverse effects in endstage renal disease.
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Acyclovir↗
[Epidemiological, clinical and prognostic aspects of subarachnoid hemorrhage in Segovia].
INTRODUCTION: Subarachnoid hemorrhage is a disorder commonly seen as a neurological emergency, with an incidence of 11-19/100,000 persons; 12% of the patients die without seeking medical attention, 63% die during the first year and 72% during the first five years. OBJECTIVE: To describe the epidemiological, clinical and prognostic factors of subarachnoid hemorrhage. PATIENTS AND METHODS: We made a retrospective study of the cases of primary subarachnoid hemorrhage occurring in the province of Segovia between January 1993 and November 1997. The patients presented with a clinical history compatible with subarachnoid hemorrhage which was confirmed by cranial CT and/or lumbar puncture. Angiography of the supra-aortic trunks was done to detect vascular malformations. The patients were classified according to clinical grades on the criteria of Hunt and Hess. RESULTS: There were 54 primary subarachnoid hemorrhages (29 men and 25 women); the average age was 59 years. The average annual incidence was 7/100,000 persons; 59% were at Hunt and Hess stage I-II. Headache was the presenting symptom in 67% of the patients. The patients with normal CT scans (20%) were of lower clinical grade and consulted later; 4% had further bleeding and all these died. There were associated neurological complications in 46% and systemic complications in 28%. Of the 44 arteriographies done, in 14 there were positive findings, 11 aneurysms (five were embolized and five treated surgically), and three arteriovenous malformations (two treated surgically). On discharge 7% had severe neurological sequelae. Mortality during the acute phase was 13%. CONCLUSIONS: Subarachnoid hemorrhage is still a serious condition, with a high rate of mortality during the acute phase (13%) and of sequelae (20%). The clinical grade and cranial CT findings were the main factors in prognosis.
Adult↗
[Epidemiology of primary dystonia].
INTRODUCTION: Dystonia is the most difficult disorder of movement to recognize, and in which errors of diagnosis most often occur. DEVELOPMENT: We review the classification of the dystonias and the most important features of the different subdivisions. With regard to epidemiology, the exact incidence and prevalence of primary dystonia are not known. Figures vary considerably depending on the source, method of study and ethnic group of the population studied. In Europe the only study made of focal dystonias was carried out in Segovia, where the prevalence was about 300 persons per million. Finally we discuss some recent genetic findings related to the dystonias, which should stimulate more detailed studies to clarify the genetic basis of focal dystonias.
Age of Onset↗
[Side effects of antithrombotic treatment in the secondary prevention of cerebrovascular disease].
OBJECTIVE: To determine the incidence of adverse effects of antithrombotic drugs (platelet anti-aggregants and anticoagulants) in patients with transient ischemic attacks (TIA) and mild ischemic strokes (IL). PATIENTS AND METHODS: Clinical follow-up data on the patients with TIA and IL included in a community-based observational study undertaken in the province of Segovia. Adverse effects which led to suspension of treatment or were a potential danger for the patient's life were recorded. RESULTS: The groups studied included 235 patients and the average initial age was 70.8 years. The average follow-up time was 3.6 years. The treatment initially given included: aspirin (75.7%), ticlopidine (12.8%) and acenocumarol (9.4%). Adverse effects led to suspension of treatment in 6% (5% with aspirin and acenocumarol, 17% with ticlopidine). The adverse effects of ticlopidine were mild and patients did not need admission to hospital (cutaneous exanthema, diarrhoea and reversible leucopenia). Aspirin was associated with digestive tract bleeding (2.8%) and cerebral hemorrhage (1.7%) which required hospital admission in most cases. One patient treated with acenocumarol presented with a retroperitoneal hematoma. CONCLUSIONS: In general antithrombotic drugs are well-tolerated by patients with TIA and LI. Hemorrhagic complications, particularly of the digestive tract, associated with aspirin limit tolerance to it.
Acenocoumarol↗
[Behçet's disease. Assessment with magnetic resonance of involvement of the central nervous system].
UNLABELLED: Behçet's disease is a chronic multisystemic inflammatory disease that usually presents in the young adult. Central nervous lesions occur in 5 to 7% of patients and are the most severe manifestations of this disease. METHODS: We retrospectively reviewed the MR images of patients with neurological manifestations of Behçet's disease evaluated in the Neuroradiology Department of Garcia de Orta Hospital and the MRI center of Caselas, Portugal, between 1994 and January 2000. RESULTS: There were 8 cases of Neuro- Behçet. Patients' ages ranged from 24 to 46 years (mean 36.25). There were 4 males and 4 females (male/female ratio = 1:1). In 3 cases (37.5%) there was brainstem involvement, the basal ganglia and thalamus were affected in 2 cases (25%) and the internal capsule and corona radiata in 2 cases (25%). In 3 cases (37.5%) there was telencephalic white matter involvement and in 1 case (12.5%) the spinal cord was involved. CONCLUSION: The topography of the lesions, the absence of a defined arterial territory distribution and the partial or total regression of lesions over time help to distinguish BD from other vasculitic processes and inflammatory/demyelinating diseases.
Adult↗
[Cerebrovascular disease in pregnancy and puerperium].
UNLABELLED: Cerebrovascular diseases are the main causes of neurological events occurring during pregnancy and puerperium. METHODS: We retrospectively reviewed the clinical records and imaging scans of females presenting with stroke during pregnancy or puerperium. We selected the cases with abnormal initial CT and/or MRI and a radiological follow-up until stabilization of the neurological condition. RESULTS: Eleven patients with ages ranging from 21-38 years were found. The hospital admission occurred between the second trimester of pregnancy and the first two weeks after delivery. In six cases there was a clinical setting of preeclampsia/eclampsia (PE/E): five with reversible encephalopathy syndromes (hypertensive-like encephalopathy) and one with a hematoma in a HELLP patient. Three other cases had a clinical setting of hypertension, not fulfilling the PE/E criteria, presented with hemorrhagic infarct in one case and lenticular hematoma in the other two. The other two cases were a subarachnoid hemorrhage in a patient with a middle cerebral aneurysm and a cortical venous infarct in a patient with lateral sinus thrombosis. CONCLUSION: Hypertension is the major underlying factor in peri-partum stroke. PE/E syndrome is the major leading cause of stroke in the peri-partum and maternal morbidity/mortality. MRI is very useful in evaluating this entity and, may have a positive impact on the management protocol.
Adult↗
[Is it possible to have a consensual terminology in disc diseases?].
The large variety of concepts and classifications for disc disease (anatomical, pathological, surgical and radiological) are reflected in the, often ambiguous, terminology of degenerative disc disease used on imaging study reports by neuroradiologists and radiologists. The attempts to standardize the nomenclature, made by some medical societies, lack general acceptance. This work reflects the conviction that morphological characterization of disc disease prevails over the anatomopathological due to the limitations of imaging study techniques, including magnetic resonance imaging.
Humans↗
[Fetal magnetic resonance].
UNLABELLED: The increasing use of magnetic resonance imaging (MRI) in fetal evaluation is due to its excellent structural and morphological resolution. We report nine fetal MRI examinations and discuss some of the technical issues related to this technique. METHODS: We report nine fetal MRI done in the MRI Center in Caselas, Portugal, between January 1999 and March 2000. The fetal ages ranged from 24 and 33 weeks of gestation. RESULTS: The MRI diagnoses were: one normal case, two normal variants, two hydrocephalus due to intraventricular hemorrhage, one corpus callosum agenesis, one corpus callosum hypoplasia, one case with white matter encephaloclastic lesions and one case of torcular and superior sagittal sinus dilatation. In one case the MRI confirmed the ultrasonography (US) diagnosis, in two cases the MRI depicted the etiology of the pathologies found with US, in three cases there was a suspicion of pathology with US but the MRI was normal or had normal variants, and in three cases the MRI diagnoses were different from those made by US. CONCLUSIONS: MRI has the highest sensitivity for fetal imaging and should be used if the US is insufficient to establish the diagnosis.
Female↗
[Clinico-epidemiological study of neurolisteriosis in the province of Segovia].
INTRODUCTION: Listeria monocytogenes is a microorganism with marked tropism towards the central nervous system. One of the commonest forms of presentation is as a meningeal infection. The objective of this study is to describe the epidemiological, clinical and laboratory characteristics and therapeutic implications. PATIENTS AND METHODS: We made a retrospective analysis of four patients, admitted to hospital with the diagnosis of meningeal infection and positive culture for L. monocytogenes in the cerebrospinal fluid (CSF), who were admitted to our centre between 1 January 1996 and 31 December 2000. The overall rate of meningitis due to L. monocytogenes in the province of Segovia is similar to that reported from the USA and Europe (six cases per million inhabitants per year). All the patients were male, aged between 19 and 79 years. The commonest form of presentation was a meningeal syndrome. Analysis of the CSF showed pleocytosis with high protein and low glucose levels. Gram staining was negative in all cases. Initial empirical treatment proved to be correct in two of the four patients. The only predisposing factors observed were alcoholism and diabetes mellitus. All four cases recovered. CONCLUSION: We emphasize the difficulty in diagnosing meningitis due to L. monocytogenes, since the presenting symptoms are relatively non specific, CSF analysis gives variable results and Gram staining is of little use. Clinical suspicion is important so that specific antibiotic treatment may be given to improve the prognosis.
Adult↗
[Radial nerve injury caused by external compression during the dissection of the internal mammary artery in coronary surgery].
Injury of the radial nerve produced by external compression during dissection of the internal mammary artery during surgery of ischemic heart disease, is an infrequent event. The use of sternal retractors with only one rod may be the cause of these lesions. We report two cases of radial nerve paralysis produced as a consequence of external compression induced by a sternal retractor during dissection of the internal mammary artery. In the first case the patient showed loss of power of the external muscles of the left forearm and a clear flexion of the left hand. The second patient presented loss of power of the left hand and impossibility to extend the carpus and fingers. In both cases the lesion was reversible.
Equipment Design↗
[Iatrogenic traumatic lesions of femoral veins during varicose veins surgery].
Traumatic lesions of the femoral veins during varicose veins surgery are very uncommon and they raise several therapeutic difficulties. They occur in 1/1000 cases of varicose veins operated. The authors describe four cases of lesions of this type that were seen and treated for the last six years, probably because there was an increase in the number of varicose veins operated on in the Lisbon area. The authors discuss the surgical options and they concluded that these complications can be minimized with good anatomical and surgical skills, specially of the saphenous-femoral and saphenous-popliteal junctions.
Adult↗
[Reconstruction of thoracolumbar spine instability: clinical and neuroradiological results of a surgical challenge].
INTRODUCTION: Surgical treatment for thoracolumbar union instability represents a challenge, due to the difficult access to this area of the spine, and to the extreme variability of morphological and biomechanical lesions observed. AIM: To describe the indications and clinical and neuroradiological results obtained with procedures of anterior or combined spinal fusion-instrumentation used for the treatment of instable thoracolumbar lesions. PATIENTS AND METHODS: 17 patients with thoracolumbar instability were treated surgically, being followed-up at least for one year. Causes of instability were classified in three groups: (i) fractures or fracture-luxations (n = 7), (ii) pathologic fractures following tumoral invasion (n = 6) and (iii) infectious or degenerative spondylodiscitis (n = 5). In order to carry out the substitution of the injured vertebral body an anterior approach to the thoracolumbar union was performed in all cases, using a modified technique of thoracophrenolaparotomy in which the diaphragmatic dome was not incised. Depending on the number of columns of Denis damaged, the vertebral corpectomy was followed by either an anterolateral or a combined spinal fusion-instrumentation. RESULTS: Pain in standing position was eliminated postoperatively in 83%. Neurological deficits were improved in 50% of cases. Surgical mortality was null and transient postoperative complications occurred in 11.7% of patients, but no lung atelectasis or respiratory infections were observed. CONCLUSIONS: Chronic pain associated to thoracolumbar instability can be treated successfully by substitution of the damaged vertebral body followed by anterior or combined spinal fusion-instrumentation. Thoracophrenolaparotomy without division of the diaphragm is feasible and it reduces the morbidity associated to postoperative respiratory complications.
Adult↗
[Intra-thoracic aneurysm of the right subclavian artery].
The aneurysm of subclavian artery is uncommon, and its differential diagnosis is posed with other mediastinal expansive processes in a conventional RX level. A case of right subclavian aneurysm is presented.
Adult↗
[Surgery of myocardial revascularization after failure of percutaneous transluminal coronary angioplasty].
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Adult↗
Acute renal failure associated with cardiac surgery.
We present the incidence, management and outcome of acute renal failure (ARF) in children who underwent cardiac surgery. Fourteen (9%) from a total of 156 children developed ARF in our hospital in a 3-year period. Patients were aged 2 days to 15 years. Prerenal failure was present in 6 and renal type in the remaining 8 children. Peritoneal dialysis treatment was utilized in 58% of patients. Neurologic and respiratory complications were present. Mortality rate was 58% and related to underlying pathology and to complications in other organs. The management of these patients must be by competent personnel preferably trained in pediatrics.
Acute Kidney Injury↗
[Tear of the right common iliac artery. An infrequent complication in lumbar disk surgery].
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Humans↗