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Biomedical subjects

L Gomes

Publications and source records attributed to L Gomes.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Pancreatic transplantation].

The AA. report on their very limited experience with whole pancreatic transplantation. For the moment this is the only experience in Portugal, the detailed report of the 3 cases may be of some help to other Portuguese groups interested in starting this therapeutical approach for insulin-dependent end-stage renal failure patients. The main comments focus on the third simultaneous pancreas-kidney transplantation, which failed for technical reasons, mainly related to less than good selection of both donor and recipient. In all the three cases the technique preferred was the duodenocystostomy. The 2 first cases are doing very well, free of insulin and with normal glucose metabolism, at 15 and 7 months after grafting. The AA. also make some considerations on the indications, complications and follow-up of patients with pancreas-kidney transplantation.

Adult↗
PubMed1994

Detection of a small proteoglycan present in xiphoid cartilage regions submitted to different biomechanical forces.

1. The effect of biomechanical forces on large proteoglycans and collagen of cartilage has deserved intensive study, enhancing the importance of these molecules to support a better distribution of compressive forces especially in articular cartilage. In the present study, other extracellular matrix components, non-collagenous proteins and small proteoglycans, have been evaluated in terms of biomechanical tension. 2. Different parts of chicken xiphoid cartilage, lateral (R and L) and central (C) portions, which bear different biomechanical tensions, were analyzed. DEAE-cellulose chromatography profiles were similar for R and L portions. SDS-PAGE analyses revealed proteins of 29, 60 and 70 kDa for R and L. The 20- and 70-kDa proteins were not detected in the C portion while the 60-kDa protein was present at a high level. 3. The differences found between lateral (R and L) and central portions of the xiphoid cartilage may be related to the structure of the cartilage which bears higher tension forces than the lateral parts.

Animals↗
PubMed1993

Headaches during intracranial endovascular procedures: a possible model of vascular headache.

We report a series of 11 patients who developed headaches during intracranial endovascular procedures performed for the treatment of arteriovenous malformations (10 cases) or aneurysms (1 case). Headache was precipitated either by balloon inflation (3 cases) or by embolization (8 cases), and had a very constant pattern. In all cases the pain started suddenly, reaching maximum intensity at once. Headache was focal, unilateral, ipsilateral to the occluded artery, nonthrobbing and short-lasting (usually less than 10 minutes). It was not associated with gastrointestinal, autonomic, or aura-like symptoms. Headache localization depended upon the catheterized artery, being constant for each of the major vascular territories. Yet, in all patients pain was felt in the cutaneous territory of the ophthalmic division of the trigeminal nerve. The occurrence of headache was not associated with cortical deficit nor cortical irritation (assessed both clinically and by the EEG) and therefore seems to be directly related to the stimulation of the arterial wall. This type of pain can be used as a model of pure vascular headache. Its study can contribute not only to understand the pattern of intracranial vascular innervation but also to understand or to refute the vascular components of migraine.

Adolescent↗
PubMed1992

[Value of transesophageal echocardiography in the diagnosis of acute aortic dissection].

We describe our experience of six patients with clinical suspicion of acute aortic dissection (AAD) who were studied consecutively by transesophageal echocardiography (TEE) from April to July of 1991. All of them were previously submitted to transthoracic echocardiogram. The diagnosis was correctly established by TEE in five cases, confirmed by aortography and/or surgery (four cases), or by autopsy (one case). In one patient the diagnosis of AAD was excluded by TEE, and posteriorly by nuclear magnetic resonance. Four patients had a Stanford type A, and one patient a type B dissection. The site of entry was identified in three cases; the intimal entry tear of the type B dissection, not observed by TEE, was localized in the aortic arch by aortography. In three of the four type A dissection cases, a thrombus in the false lumen and an aortic regurgitation were found. No other noninvasive methods were used after the diagnosis of AAD by TEE. The surgical repair was successful in three cases, one of which, without previous necessity of aortography. In our experience, TEE increased extraordinarily the diagnosis efficacy of AAD, making possible an earlier therapeutic approach, and probably contributing to the improvement of the prognosis of this pathology.

Acute Disease↗
PubMed1991

[Transcutaneous pacemaker in cardiovascular emergencies].

UNLABELLED: OBJECTIVES AND DESIGN OF THE STUDY: Retrospective study to evaluate the efficacy and tolerance of the transcutaneous cardiac pacemaker in the urgent treatment of asystole or severe bradycardia. SETTING: Coronary Care Unit (CCU) and emergency area of the central reference Hospital. PATIENTS: 24 patients, 20 males and four females, aged between 57 and 84 years (mean 70.4 +/- 7.9). Five pts were in asystole and 19 in severe bradycardia. INTERVENTIONS: The transcutaneous pacemaker used, was the "Cardio Aid Zoll NTP" model. The intensity of the electrical stimulation was increased progressively, until electrical capture or intolerable discomfort by the patients was achieved. We defined by electric efficacy, the visualization of pacing spike followed by a deflection due to ventricular depolarization; and by hemodynamic efficacy, the evidence of myocardial contraction, defined as a palpable pulse, synchronous with the pacing artefact. MAIN RESULTS: Stimulation threshold ranged from 30 to 140 mA (mean 67.7 +/- 23.4). The duration of pacing was from 15 minutes to 13 hours, being more than one hour in only four situations. From the 20 conscious patients, or the ones who got conscious, 15 (75%) tolerated well the stimulation. It was intolerable in five pts (25%). No significative side effects due to the use of transcutaneous pacemaker were observed. CONCLUSIONS: The transcutaneous pacemaker was efficient in the electric and hemodynamic stabilization in the majority of patients. It was generally well tolerated and without important side effects. We think that it may be a valid alternative to transvenous pacing technics in the treatment of asystole and severe bradycardia situations.

Aged↗
PubMed1991

[Indirect criteria of coronary reperfusion and permeability in patients with acute myocardial infarction who have received thrombolytic therapy].

OBJECTIVE: To evaluate the value of some indirect reperfusion signs (IRS) as markers of coronary artery patency in patients (PTS) with acute myocardial infarction (AMI) submitted to intravenous (IV) thrombolytic therapy (TT). DESIGN: Retrospective study, with analysis of the sensibility (S), specificity (SP) and predictive value (PV) of three IRS: 1. Pain and ST resolution in the first three hours; 2. Peak CK in the first 13 hours; 3. accelerated idioventricular rhythm (AIVR) in the first three hours. SETTING: Coronary Care Unit (CCU) of the Santo António Hospital and Hemodynamic Laboratory of the S. João Hospital, Oporto. PATIENTS: Sixty seven PTS (mean age 53.4 +/- 10.6 years) with confirmed AMI, 62 male and five female, 34 with anterior and 33 with inferior infarction, TT started in the first three hours of the beginning of symptoms in 34 PTS and from three to six hours in 33 PTS, all submitted to coronary angiography in the hospital setting (7.6 +/- 5.9 days after AMI). INTERVENTIONS: IV administration of 1,500,000 U of streptokinase (SK) in 47 PTS and 30 U of APSAC in 20 PTS, preceded by 200 mg IV prednisolone and oral 100 mg acetilsalicylic acid, and followed by IV heparin therapy. Continuous electrocardiographic monitoring, and serial 12 leads ECG and enzymatic assays (at start and 1, 3, 7, 13 and 25 hours of TT). Analysis of the correlation of the three IRS (isolated and in association) with coronary artery patency (TIMI 2 or 3). MEASUREMENTS AND RESULTS: The total patency rate was 79.1%; there was no statistically significant difference with regard to AMI location, time of symptoms onset (0-3 vs 3-6 hours) or thrombolytic agent (SK vs APSAC). The first and second IRS had a high S and a low SP; together S = 79.2%, SP = 64.3% and PV = 89.4%. The third IRS with the first and/or the second one had a low S (about 25%) but SP and PV of 100%. The coronary patency rate of PTS without IRS was always greater than 50%. CONCLUSIONS: The analysed IRS although not very reliable are useful when considered in association. It is possible to assess PTA with high probability of reperfusion if AIVR is present. The absence of IRS does not exclude coronary artery patency. There is still missing more reliable no-invasive reperfusion markers.

Adult↗
PubMed1991

[Morphologic course of the left ventricle after renal transplantation. Echocardiographic study].

OBJECTIVE: To characterize and to quantitate the morphologic changes in left ventricle, in renal transplant patients (Pts) treated with cyclosporine, through sequential echocardiographic examinations. DESIGN: A prospective study of renal transplant patients, between October/88 and May/89, who maintained good function of the renal graft during the follow-up. SETTING: Cardiology and Nephrology departments of Santo António Hospital. MATERIAL AND METHODS: 20 patients, 13 men and 7 women, mean age of 33 +/- 10, ranging from 20 to 56, constitute the final group of the study. These patients have been receiving dialysis during 3.8 +/- 2.3 years (0.4-8). Seven patients were excluded, five by echocardiographic criteria and another two because of chronic renal graft disfunction (creatinine greater than 2.0 mg%). The echocardiographic examinations were performed during the first week, and 1, 2, 3, 6 and 12 months after renal transplantation. The following measurements were performed: left ventricular end-diastole diameter (LVED), interventricular septal thickness (IVST), posterior wall thickness (PWT) and left ventricular mass index (LVMI). The measurements were obtained in M-mode following the conventional recommendations. Average values of at least 3 cardiac cycles were used. Heart rate, blood pressure, creatinine, hematocrit, body surface area and fistula patency, were determined at the time of each echocardiogram. MAIN RESULTS: The LVED decreased progressively until the third month, from 51.9 +/- 7 mm to 47.8 +/- 6 mm (p less than 0.001), remaining stable thereafter. The baseline value of IVST, 13.6 +/- 5 mm, was similar at the twelfth month, 13.8 +/- 2 mm (ns). The baseline value of PWT, 13.7 +/- 4 mm, decreased gradually since the second month, having reached 12.7 +/- 2 mm at the twelfth month (ns). The LVMI (g/m2) reduced progressively, from 243 +/- 82 to 190 +/- 38 at the end of the study (p less than 0.05. A high incidence of arterial hypertension was detected during the follow-up period; at the twelfth month, 18 patients (90%) were on antihypertensive drug therapy, 11 of which had blood pressure greater than or equal to 160/95 mmHg. CONCLUSIONS: We verified, one year after the renal transplantation, a significant decrease of LVMI, that was mainly determined by the LVED reduction. Left ventricular walls thickness had no significant variation; we think that the high incidence of hypertension during the follow-up period, in part due to the pressure effect of cyclosporine, may have been responsible for this fact.

Adult↗
PubMed1990

[Ruptured aneurysm of the sinus of Valsalva into the right ventricle--apropos of a case].

A 37 year old man was referred to our institution because of a cardiac murmur, exertional dyspnea and fatigue, symptoms that began since 18 years of age. He reported a cardiac murmur since childhood, with no past history of rheumatic fever or infectious endocarditis. On clinic examination there was a systolic-diastolic murmur louder in the third and fourth left intercostal space, just at the sternal left border. The 2 D-echo revealed a small disruption in the aorto-septal continuity. Right heart catheterisation was performed, showing an increased pressure in the pulmonary artery and right ventricle; an increase in the oxygen saturation on the right heart chambers, suggested the presence of a left-to-right shunt, nevertheless the exact location of the defect was not possible to recognise. The study was complemented with Doppler color flow imaging that revealed a turbulent flow through the defect, with blood flowing from the aortic root into the right ventricular outflow tract. The diagnosis of ruptured aneurysm of sinus of Valsalva was made, being confirmed later by aortic angiography. A rare case is reported in which an aneurysm of the right coronary sinus ruptured into the right ventricle; we emphasize the important contribution of the Doppler color flow imaging to the correct diagnosis, technique rarely described in this type of complication.

Adult↗
PubMed1989

[Pericarditis caused by cholesterol. Apropos of a clinical case].

A case of a 76 year-old woman with a large pericardial effusion is described. The microscopic examination of the scintillating, yellow-greenish fluid obtained by the first pericardiocentesis, showed numerous crystals of cholesterol. In search of the underlying diseases there were found values of T3, T4 and TSH diagnostic of hypothyroidism. Considering the rapid relapse of the effusion and after a second pericardiocentesis, it was decided to open a pleuro-pericardial window. The biopsy of the pericardium showed deposits of cholesterol on electronics microscopy. She was discharged from hospital two weeks after surgery, showing an evident clinical improvement. Six months later she was feeling well, keeping a normal activity for her age. The values of T3, T4 and TSH were normal, and there were no echocardiographic signs of pericardial effusion. It is presented a rare case of cholesterol pericarditis associated to sub-clinical hypothyroidism, showing the presence of cholesterol, as crystals in the pericardial effusion and, we think for the first time in this pathology, in vesicles of pinocytosis, in the pericardial biopsy. The six months period of follow-up showed a good clinical improvement with the selected therapeutic attitude.

Aged↗
PubMed1989

[Behavior of arterial pressure during administration of intravenous streptokinase, in patients with acute myocardial infarct].

OBJECTIVE: To evaluate the effect on blood pressure (BP) of intravenous (IV) streptokinase (SK) in patients (PTS) with acute myocardial infarction (AMI). DESIGN: Retrospective study with analysis of BP registers ten minutes before and during SK infusion. SETTING: PTS admitted to the Coronary Care Unit (CCU) of Santo António Hospital, Oporto. PATIENTS: Thirty-eight male PTS, average ages of 54, ranging from 38 to 67, AMI confirmed, and criteria to thrombolytic therapy. One patient was excluded on account of persistent hypotension since admission. MATERIAL AND METHODS: IV infusion of 1,500,000 U of SK over 60 minutes, preceded by 200 mg IV of prednisolone. BP and heart rate (HR) were evaluated with a Datascope Accutorr 1A set. The lowest value of the systolic BP (SBP) recorded ten minutes before SK infusion was considered the baseline value. We valued the reduction of SBP above 15%, defining its fall as the difference between the baseline value and the minimum value of SBP recorded during the infusion. Hypotension was defined to SBP values below 90 mmHg. MAIN RESULTS: The SBP fall was 40.4 +/- 22.1 mmHg (range 9 to 102), having been recorded the minimum value at 22.9 +/- 10.9 minutes. It was accompanied by diastolic BP (DBP) fall of 30.6 +/- 18.9 mmHg (range -2 to 76) and by a HR increasing from 76.2 +/- 13.7 beats/min. to 80.8 +/- 14.1 beats/min. (p less than 0.01). In 86% of the PTS this fall was transient, lasting 8.9 +/- 6.3 minutes, and was corrected by slowing or stopping the infusion for a few minutes and placing the patient in Trendelenburg position. Two PTS needed sympaticomimetic amines because of persistent BP reduction despite the previous measures. 92% of the PTS had a SBP fall higher than 15% in relation to the baseline value. The SBP was kept over 90 mmHg in 20 PTS (54%); hypotension was recorded in the remaining 14 PTS (38%), and in 10 (27%) of these the SBP fell below 80 mmHg. We couldn't prove that the infarction location and the extension of the ischemic lesion had influenced this BP fall. CONCLUSION: The BP reduction during treatment with high doses of SK deserves some attention because, although transient and easily reversible, it is frequent and sometimes significative. It demands then careful monitoring in order to avoid the hypoperfusion to the ischemic myocardium, that could jeopardize the potential benefits of reperfusion in the reduction of infarction area, the main objective of the thrombolytic treatment.

Adult↗
PubMed1988

Monoclonal antibodies to Staphylococcus aureus laminin-binding proteins cross-react with mammalian cells.

We and others have previously shown that some microorganisms, including bacteria, express on their surfaces receptors that specifically recognize extracellular matrix proteins, such as laminin, fibronectin, or both. The ability of microorganisms to adhere and to invade might depend on the existence of receptors which could, thus, be correlated with pathogenicity. In the present paper, we report the isolation of five stable cell lines that were producers of monoclonal antibodies to Staphylococcus aureus laminin receptors. One of these antibodies, which was of the immunoglobulin M isotype, blocked the binding of laminin to bacteria before and after fixation and recognized the putative 52-kilodalton laminin-binding protein in whole bacterial extracts. Also, purified receptor was isolated by immunoaffinity chromatography and shown to bind laminin. Furthermore, the same antibodies bound the 67-kilodalton putative receptor from mouse melanoma cells and gave positive immunofluorescence reactions against mammalian tumor cells. These data strongly suggest either the evolutionary conservation of at least some sequences in both procaryotic and eucaryotic laminin-binding proteins or convergent evolution and positive selection of epitopes cross-reacting with laminin. Some of these antibodies to the procaryotic protein could therefore become useful markers for the expression of laminin receptors by cancer cells.

Animals↗
PubMed1988

Evolutionary conservation of laminin-binding proteins.

1. The virulence of pathogens and metastatic capacity of cancer cells seems to correlate with the ability to adhere to cells and/or to basement membrane components. A key feature of this mechanism is the expression of specific receptors for the basement membrane protein laminin. Three different receptors have been already described in cells phylogenetically very distant, such as human white blood cells, Trichomonas vaginalis and Staphylococcus aureus, all recognizing laminin with the same range of affinity. 2. We have shown that laminin, which is also found in the circulation, enhances phagocytosis of S. aureus by macrophages in a species-specific fashion. Also, monoclonal antibodies (MAb) raised against the bacterial receptor inhibit the phagocytic enhancement mediated by laminin and recognize laminin-binding proteins in unicellular parasites and mammalian cells. The same Mab 1.H12 elutes a 52-kDa protein from bacterial extracts and a 67-kDa band from cancer cell extracts. Since the MAb is a monospecific reagent, results with 1.H12 strongly suggest an evolutionary conservation of the binding site of phylogenetically different laminin receptors.

Animals↗
PubMedDate not supplied

Orbital Kaposi's sarcoma in acquired immunodeficiency syndrome.

A 28-year-old white male with AIDS-C3 staging, presented with an extensive hemorrhagic dark mass localized in the left orbit. No other ophthalmic findings were disclosed. Ultrasonography and computed axial tomographic scans showed orbital involvement. Orbital Kaposi's sarcoma is a rare finding and only a few cases have been reported. Systemic examination revealed other lesions suggestive of disseminated mucocutaneous Kaposi's sarcoma, oral candidiasis, membranous esophagitis and granulomatous hepatitis. Eyelid incisional biopsy disclosed Kaposi's sarcoma. Despite intensive chemotherapy progression was aggressive with a fatal outcome.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Effect of magnesium chloride and guanidinium chloride on the extraction of components of extracellular matrix from chicken cartilage.

In order to evaluate the effect of chaotropic agents on proteoglycan and non-collagenous proteins, chicken xiphoid cartilage was treated with guanidine-HCl and MgCl2 in different concentrations (1M to 5M), and different periods of time (12, 24, 48 and 72 hr). The maximum yield of uronic acid was obtained with 3M MgCl2 (73.3%). Concentrations of 4M and 5M of MgCl2 showed that much less uronic acid was removed, 55.3% and 38.1% respectively. Extraction with 3M MgCl2 and 3M guanidine-HCl resulted better efficiency when performed for 48 hr. Analysis by SDS-PAGE of the extracts obtained with guanidine-HCl and MgCl2 in different concentrations pointed out that most components are equally removed with the two solvents, showing that the extraction with MgCl2 is an alternative assay to remove non-collagenous proteins from extracellular matrix.

Animals↗
PubMedDate not supplied

[Acute thyroiditis].

We review the pathophysiology, clinical features and therapy of acute thyroiditis. Four cases are reported stressing the role of fine needle aspiration for the diagnosis of this clinical entity.

Acute Disease↗
PubMedDate not supplied

[Beneficial effects of added glicazide in patients with type II diabetes mellitus treated with insulin].

The aim of the study was to assess, in patients with non insulin dependent diabetes mellitus (NIDDM), either with previous failure to sulphonylureas or insulin treated since the disease started, if the combination of gliclazide to insulin therapy might induce a reduction of daily insulin requirement. 30 caucasian type II patients used to self-monitoring (11 female, 19 male, mean age 55.78 +/- 8.07) with residual pancreatic function (glucagon induced C-peptide release = 1.01 +/- 0.70 microgram/ml) entered the study. 8 were excluded for non compliance or for high antiinsulin antibodies levels and 4 are still under study. Each patients was given, for 3 months, 240 mg of gliclazide in addition to usual daily dose of insulin. Data presented as mean +/- s.e.m. were analysed with analysis of variance (p less than 0.05). Mean initial values of main parameters were as follows: glycaemia 192.7 +/- 33.1 mg/100 ml, insulinaemia 9.5 +/- 4.5 microUI/ml, daily insulin requirements 33.11 +/- 10.47 U/d, HbA1 C 7.5 +/- 1.7%. Total cholesterol 240.1 +/- 52.2 mg/10 ml, triglycerides 120.6 +/- 60.3 mg/100 ml. After 3 months treatment significant reduction in mean daily insulin requirements (20.78 +/- 16.15 U/d) was observed. In 13 patients (72.2%) while keeping good metabolic control (HbA1 C 7.46 +/- 1.63), insulin therapy was reduced (9 patients) or even stopped (4 patients). In the other 5, insulin was maintained or slightly increased. The increase in glucagon induced C-peptide release (1.41 +/- 0.99 micrograms/ml) did not reach significance, while glycaemia and insulinaemia were not changed (196.0 +/- 34.1 mg/100 ml, 11.02 +/- 5.05 microUI/ml).(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes Mellitus, Type 2↗