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Biomedical subjects

J Serra

Publications and source records attributed to J Serra.

At least 109 records · Page 6Linked to original sources
PubMed1991

Exteriorized colonic anastomosis.

The risk of anastomotic failure in the unprepared colon is generally high. Therefore, Hartmann's operation is frequently employed in emergencies. We present an alternative technique, the exteriorized anastomosis described until now only for cases of perforation. Exteriorized anastomosis was performed in 14 patients. The preoperative diagnosis was occlusive neoplasm, perforated diverticulitis or traumatic performation of the sigmoid colon. Four patients subsequently developed partial anastomotic dehiscence, but without the consequences of intraperitoneal dehiscence. We think that exteriorized anastomosis is a useful alternative in high risk situations.

Aged↗
PubMed1991

In vivo release of 15-HETE and other arachidonic acid metabolites in nasal secretions during early allergic reactions.

The purpose of this study is to examine the "in vivo" release of 15-HETE and other arachidonic acid metabolites in nasal secretions following a challenge with "Dermatophagoides Pteronyssinus" in patients with allergic rhinitis and non-allergic controls. In addition, we examine the effects of a membrane stabilizer, such as sodium cromoglycate, on these metabolites. Thirteen allergic subjects and seven healthy controls are studied. 15-HETE, peptide leukotrienes, LTB4, PGD2, PGE2 and PGF2 alpha levels are evaluated before and after nasal challenge in sodium cromoglycate treated and untreated subjects. This study provides "in vivo" evidence that the pathophysiological responses to nasal antigen challenge could be related to the release of 15-HETE as well as other arachidonic acid metabolites, mainly arising from the lipoxygenase pathway.

Adolescent↗
PubMed1991

[Exercise test parameters after acute myocardial infarction. Relationship with coronary angiography].

OBJECTIVE: To analyze the relation between characteristics of symptom-limited treadmill exercise stress test, after acute myocardial infarction (MI) and coronariographic results (number of diseased vessels). Both tests were performed before hospital discharge. DESIGN: Retrospective study with comparative analysis between variable defined groups. POPULATION AND SETTING: From 232 patients interned in the department of Cardiology of Hospital de Santa Marta with a first acute MI, a population of 112 patients submitted to exercise stress test and coronary angiography before discharge were selected (aged 29 to 69 years). METHODS: Symptom-limited treadmill exercise stress tests were performed according to Bruce protocol, with no heart-rate limitation. The following parameters were analyzed: Stress test duration (DUR); Double product variation (varDP); Metabolic equivalent units (METS); Maximal heart rate (FCmax); Percentage of the maximal reached heart rate (% FCmax); Incidence of ST segment depression (InfST); Maximal ST segment depression (Max-InfST); Onset minute of ST segment depression (MinInfST); Heart rate at the onset of ST segment depression (FCInfST); Double product at the onset of ST segment depression (DPInfST); Recovery minute of ST segment depression (MinRInfST); Onset minute of angina (MinAng); Heart rate at the onset of angina (FCAng); Double product at the onset of angina (DPAng). RESULTS: Statistical significant differences were obtained between coronariographic groups concerning the following parameters: DUR: 1-vessel/3-vessel P = 0.02; VarDP: 1-vessel/3-vessel p = 0.008, 2-vessel/3-vessel p = 0.004; METS: 1-vessel/3-vessel p = 0.01. No differences were seen between anterior and inferior myocardial infarctions regarding all the stress test parameters. However in patients with anterior MI significant differences were obtained concerning the following variables: VarDP: 1-vessel/2-vessel p = 0.02; InfraST: 1-vessel/2-vessel p = 0.006, 1-vessel/3-vessel p = 0.03; MaxInfST: 1-vessel/2-vessel p = 0.01, 1-vessel/3-vessel p = 0.0006; Angina: 1-vessel/2-vessel p = 0.0005, 1-vessel/3-vessel p = .001. In inferior myocardial infarctions only the stress duration differed between 1-vessel and 3-vessel groups (p = 0.003). CONCLUSIONS: Symptom-limited treadmill exercise stress tests, safely performed in our institution, were an important method for post MI evaluation and allowed the diagnosis of a great number of patients with residual ischemia. Statistical significant differences were found in ergometric parameters, between coronariographic groups (defined by the number of diseased vessels), emphasising the importance of stress tolerance analysis.

Adult↗
PubMed1991

Incidence, characteristics and coronariographic significance of myocardial ischemia during daily life in patients with angina pectoris.

OBJECTIVES: To evaluate the incidence, characteristics and angiographic significance of myocardial ischemia detected on Holter monitoring in a group of patients with stable angina pectoris. SETTING: Department of Cardiology of a Central Terciary Hospital. METHODS: In 24 patients (pts) with stable angina pectoris and proven coronary artery disease (11 pts with left main or three vessel disease; 13 pts with one or two vessel disease), a 24 hour Holter monitoring was performed. Two groups of ischemic episodes were considered: Group I with 65 ischemic episodes detected in pts with left main or three vessel disease and group II constituted by 17 ischemic episodes detected in pts with one or two vessel disease. RESULTS: The incidence of myocardial ischemia was 91% in pts with left main or three vessel disease and 46% in pts with one or two vessel disease. Statistically significant differences were seen between group I and II concerning the mean heart rate variation from two minutes before onset of ST-segment depression to its onset (3.5 bpm vs 7.4 bpm; p less than 0.05) and from the onset of ST-segment depression to its maximal depression (6.5 bpm vs 15 bpm; p less than 0.000001). CONCLUSIONS: The presence of myocardial ischemia and some of its characteristics on Holter monitoring seem to have a relation with the severity of coronary artery disease in patients with stable angina pectoris.

Activities of Daily Living↗
PubMed1991

[Arrhythmic profiles evaluated by Holter's technique in sick sinus syndrome].

OBJECTIVES: The aim of this study was to evaluate in a group of patients with sick sinus syndrome: 1) Characteristics of arrhythmia on Holter monitoring. 2) Value of Holter monitoring to select patients for pacemaker implantation. SETTING: Department of Cardiology in a Central Hospital. METHODS: In 40 patients (27 men and 13 women, aged 37 to 83 years) Holter monitoring during a 24-hour period was performed. According to the arrhythmia profiles four groups of patients were considered: group A--with severe sinus bradycardia; group B--with sinus bradycardia associated to sinoatrial exit block or to sinus pauses; group C--characterized by the bradycardia-tachycardia syndrome and group D--defined by the finding of atrial fibrillation with a slow ventricular response. Symptoms and the presence of structural heart disease were evaluated. RESULTS: In this patients population, 24 patients had coronary artery disease and/or hypertensive heart disease. A severe sinus bradycardia was found in 14 patients (group A) and in other 11 patients it was accompanied by sinoatrial exist block of sinus pauses (group B); 12 patients had the bradycardia-tachycardia syndrome (group C) and periods of atrial fibrillation with a slow ventricular response were found in 3 other patients (Group D). Nonspecific clinical pattern was observed in this population. CONCLUSIONS: Holter monitoring was important to the diagnosis of sick sinus syndrome and for posterior definitive pacemaker implantation. Coronary artery disease and/or hypertensive heart disease were the main pathologies found in this study, being the severe sinus bradycardia and the bradycardia-tachycardia syndrome the principal manifestations of the sick sinus syndrome.

Adult↗
PubMed1991

[Dysrhythmic profile and clinical aspects in a population of 23 patients with hypertrophic cardiomyopathy].

OBJECTIVES: To evaluate: 1. The incidence and characteristics of ventricular arrhythmias on Holter monitoring and their relation to the clinical, functional and morphological aspects. 2. The survival and therapeutical efficiency of amiodarone in a subgroup of patients with ventricular tachycardia. SETTING: Department of Cardiology in a General Hospital. METHODS: 23 patients (pts) aged 19 to 74 years with an echocardiographic diagnosis of cardiomyopathy were studied during a four year period by 24 hours Holter monitoring. Ventricular arrhythmias were defined according the Lown classification. Patients were classified according to: obstructive or nonobstructive hypertrophy (funtional groups, 11 and 12 pts respectively), asymmetric hypertrophy of the septum or ventricular concentric hypertrophy or apical hypertrophy (morphological groups, 18, 3 and 2 pts respectively). They were also classified according medical therapy (pharmacological with B-blockers or calcium antagonists and nonpharmacological groups, 7 and 16 pts respectively). RESULTS: the incidence of severe ventricular arrhythmias was 57.1% and 62.5% in the pharmacological and nonpharmacological groups respectively. In both obstructive and nonobstructive forms, severe ventricular arrhythmias were also found (7/8 pts in each group). 12 pts with asymmetric hypertrophy of the septum and 2 pts with the concentric hypertrophic form also had severe ventricular arrhythmias. Five pts with nonsustained ventricular tachycardia have been submitted to oral amiodarone therapy in a dosage of 200 mg daily. All these pts are alive (follow-up ranged from 15 to 54 months) and in five no significant ventricular arrhythmias have been detected on serial Holter records. CONCLUSIONS: the incidence of ventricular arrhythmias was high in this patients population and no definitive relation could be found between the severity of ventricular arrhythmias and the previous described groups. Meanwhile, classic medical therapy seems not to alter the incidence and the characteristics of ventricular arrhythmias. On other hand, amiodarone therapy seems to abolish ventricular tachycardia in a large percentage of cases and no death occurred during a significant period of time (maximal 54 months).

Adult↗
PubMed1990

[Somatostatin and/or total parenteral nutrition for the treatment of intestinal fistulas].

61 patients with postoperative enterocutaneous fistulas of the small intestine, were admitted to the Intensive Care Unit from 1983 to 1989 and divided in two groups. Group A (n = 46) was treated with Total Parenteral Nutrition (TPN), while B (n = 15) received a combination of TPN and Somatostatin. The reduction of fistula output was significantly greater in group B. Spontaneous closure was observed in 30.4% of the cases in group A and in 53.3% in group B. A significant difference in the time taken to close the fistula between group A and B (29.7 +/- 18 versus 11.1 +/- 1.6 days) was observed.

Adult↗
PubMed1990

[Clinical and hemodynamic efficacy of enalapril in severe congestive heart failure].

OBJECTIVES: Evaluate the clinical and hemodynamic efficacy of enalapril in the treatment of severe congestive heart failure, refractory to the classic therapeutics with diuretics and digitalis. SETTING: Hospitalized patients (pts) of a cardiac department. MATERIAL AND METHODS: 10 pts with a mean age of 57.8 years in whom a Swan-Ganz catheter was placed for 72 hours to monitor the right pressures and cardiac output, with regular control of arterial blood pressure and cardiac frequency. Low doses of enalapril (2.5 mg) were utilized at the start of the treatment and this dose was readjusted depending on the clinic and hemodynamic parameters. RESULTS: the 10 pts had the following characteristics: Basal-mean pulmonary arterial pressure (PAP) 34.1 mmHg, Pulmonary wedge pressure (PWP) 21.1 mmHg, cardiac output (CO) 4.8 l/min, cardiac index (CI) 2.8 l/min/m2. After 72 hours with enalapril treatment, these measurements were: PAP-23.8 mmHg, PWP-12.6 mmHg, CO-5.2 l/min and Cl-3.0 ll/min/m2. These differences were statistically significant. With a follow-up of 18.4 months, there was also a clinical improvement; of the 4 pts in class III, 2 moved to class II and 2 to class I; the 4 pts in class IV 4 moved to class II; two pts had died. CONCLUSIONS: In severe heart failure, the addition of enalapril to the classic therapy has allowed the immediate improvement of the clinical and hemodynamic indexes and this improvement was maintained in the follow-up period.

Aged↗
PubMed1989

Surgical outlook regarding leiomyoma of the rectum. Report of three cases.

The authors report experience with three patients with leiomyomas of the rectum between the years 1979 and 1987. Since Malassez's first description in 1872, approximately 200 cases have been reported. The diagnosis of these rare tumors is difficult. The authors present the ultrasonic characteristics of rectal leiomyoma by means of endorectal ultrasound, a method which, although not definitive, does delimit and orient the diagnosis in regard to the rectal mass and the follow-up of these tumors. A histologic diagnosis constitutes a dilemma between benign and malignant forms. The authors believe that treatment should always be surgical, realizing local extirpation when the histologic study reveals no signs of malignancy; even though it is mandatory to perform regular follow-up checkups (mainly with endorectal ultrasound) and radical treatment in regard to malignant lesions and local relapse of the anterior forms.

Adult↗
PubMed1988

Effect of olfactory bulbectomy and chronic amitryptiline treatment in rats. 3H-imipramine binding and behavioral analysis by swimming and open field tests.

An 'animal model' of depression, based on bulbectomy, followed by chronic treatment with amitryptiline was used in rats. In the synaptosomal membranes of the cerebral cortex plus hippocampus, the number of binding sites for 3H-imipramine increased significantly when bulbectomy was associated with the antidepressant. In the bulbectomized rats the tendency was toward a decrease in binding. The treatment with 0.2% Triton X-100 of the membranes revealed a large increase in postsynaptic sites in the bulbectomized treated rats. The behavioral parameters analyzed by the swimming with a water wheel and the open field test revealed a series of differences in the various groups of rats, with respect to handling, bulbectomy and antidepressant treatment. Handling resulted in an increase in swimming time in controls, while bulbectomy reduced this parameter. In both the swimming and open fields tests, chronic bulbectomy reduces the motility of the rat. In control rats chronic amitryptiline increases locomotion and exploratory activity, a behavioral effect that is even more prominent in bulbectomized treated rats.

Amitriptyline↗
PubMed1988

PGE2 and PGF2 alpha in the nasal lavage fluid from healthy subjects: methodological aspects.

Prostaglandins E2 and F2 alpha were estimated in nasal secretions from ten healthy volunteers by high performance liquid chromatography and radioimmunological assay. Prostaglandin concentrations determined in five consecutive nasal washes with saline at room temperature showed that the nasal mucosa was stimulated after instillation. A substantial increase of basal levels was associated with the second nasal lavage. In all volunteers aspirin treatment inhibited prostaglandin release.

Adult↗
PubMed1988

Surgical gauze pseudotumor.

Gauze forgotten at operations can be potentially life threatening, but such cases are seldom reported because of the medicolegal implications. We have presented a series of seven patients with long-term surgical gauze retention, four after pelvic operations, one after cholecystectomy, one after laryngectomy, and one after mastectomy. The median time interval between operation and gauze removal was 5 years. In three patients this was diagnosed as a tumoral mass, in three as an intestinal occlusion, and in one the gauze was found incidentally. All foreign bodies were removed and no patient died. The clinical and diagnostic aspects of retained surgical gauze have been discussed and the need for radiopaque markers in them have been emphasized.

Bandages↗
PubMed1988

High frequency, high volume ventilation for right ventricular assist.

During ventilation, the lungs may serve as accessory pumps for forward blood flow. We have noted significant hemodynamic improvement in several patients during short periods of vigorous hand ventilation with the Ambu bag and tried to reproduce the hemodynamic improvement in the management of four patients with profound low cardiac output syndrome secondary to right ventricular (RV) failure following open heart surgery. High frequency, high volume (HFHV) ventilation resulted in improved hemodynamics in these patients, as evidenced by pulsatile pulmonary blood flow and increased cardiac output. Right-sided stroke work was present and there was a fall in mean central venous pressure (CVP) and rise in mean pulmonary artery pressure (PAP).

Assisted Circulation↗
PubMed1988

Ability of asthmatics with and without respiratory arrest to detect added resistive loads.

Asthmatics who sometimes experience respiratory arrest during an exacerbation are a particular concern. To date no adequate explanation exists for this phenomenon. Impaired perception of resistive loads is considered a factor in the development of hypercapnic respiratory failure, especially during exacerbation in patients with chronic obstructive pulmonary disease. We analyzed the perception of resistive loads in 10 asthmatics who had suffered two or more respiratory arrests during an acute exacerbation. A group of eight asthmatics (same mean age and basal bronchial obstruction) who had never developed respiratory arrest or acidosis during their exacerbations was also studied. No statistically significant differences were found between the two groups in the perception of resistive loads. This negative result seems to exclude a deficiency in the ability to detect resistive loads as a cause of respiratory arrest in asthmatic patients.

Adult↗