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Biomedical subjects

M Antunes

Publications and source records attributed to M Antunes.

17 recordsLinked to original sources
PubMed2001

Surgery for bronchiectasis.

OBJECTIVE: The incidence of bronchiectasis has declined markedly in developed countries. However, a reasonable number of patients still need surgery, despite aggressive physiotherapy and antibiotic therapy. We have reviewed our patients to clarify the benefits from surgery and to analyse the complications. MATERIAL AND METHODS: Between 1988 and 1999, we have operated on 119 patients with bronchiectasis, 71 female and 48 male, with a mean age of 42.2 years (range 11--77 years). Surgery was indicated because of unsuccessful medical therapy in 66 patients (55%), 31 (26%) had haemoptysis, 11 (9.2%) had lung abscess, 10 (8.4%) had lung masses, and three (2.5%) had pneumothorax. The most common manifestations were cough with sputum in 90 patients (76%), haemoptysis in 45 (38%) and recurrent infections in 57 (48%). The mean duration of the symptoms was 4 years (range 1--40 years). The lower lobes were diseased in 61 patients and bilateral disease was found in ten. The mean number of involved pulmonary segments was five (range 1-15). A lobectomy was performed in 75 patients (62%), a segmentectomy in 12 (10%), a pneumonectomy in nine (7.4%) and a bilobectomy in four (3.3%). Complete resection of the disease was achieved in 108 cases (91%). RESULTS: There was no operative mortality and perioperative morbidity occurred in 15 patients (15%), including temporary broncho-pleural fistulae in 7 (5.8%), and post-operative haemorrhage and atrial arrhythmias in four (3.3%) each. After a mean follow-up was 4.5 years, 73 patients (68%) of this group were asymptomatic, and 31 (29%) had meaningful clinical improvement, while only four (3.7%) maintained or worsened prior symptoms. The best clinical improvement occurred in patients with complete resection of the disease (P=0.008). There were no differences in the respiratory function, comparing pre- and post-operative data, with a 2-year of minimum interval. The VC was 91 and 89% and the FEV1 was 83% and 81% of expected, respectively before and after surgery, (P=NS). CONCLUSION: Surgery of pulmonary bronchiectasis has few complications and markedly improves symptoms in the great majority of patients, especially when complete resection of the disease is achieved. Pulmonary resection of bronchiectasis does not alter respiratory function.

Adult↗
PubMed2000

Quality of life in patients undergoing coronary revascularization.

INTRODUCTION: This study was aimed at the evaluation of the impact of coronary revascularization surgery on the quality of life (QOL) and identification of some variables which may contribute to influence the patients' own perception of their health condition. METHODOLOGY: We prospectively studied 150 consecutive patients subjected to isolated coronary bypass surgery during a 3-month period, with evaluation of their perception of QOL before surgery and 6 months thereafter. The measurement instruments used were the MOS Health Survey (SF-36) and the Nottingham Health Profile (NHP). Additionally, a questionnaire for identification of lifestyles was introduced. RESULTS: The majority of the patients were male (94%), above 50 years of age (81%), with a low educational level (65%), married (90%) and pensioners (44%). About one third (38%) had marked physical limitations (CCS class III/IV), with comorbidity (80%), previous myocardial infarction (49%) and 3-vessel coronary disease (68%). There was no operative mortality, but 29% had postoperative complications, albeit minor in the majority. Admission time was less than 8 days in 88.6% of the cases. Surgery proved beneficial in improving QOL, with better perception after surgery in all dimensions of both measurement instruments (p < 0.001). A higher level of education was related to a better perception of the energy dimension, married patients had a better improvement in the dimensions of physical pain and social isolation. More severe preoperative angina determined less favourable scores in the dimensions of mental health, social function and vitality; comorbidity had a negative impact on vitality and physical mobility; and the number of risk factors and postoperative complications had a negative impact on the dimensions of energy and emotional reactions, and social isolation and physical function, respectively. Six months after surgery, 62% of the patients who were still working before surgery had resumed their professional activity, but about 20% had retired; the majority had adopted healthier lifestyles with a decrease in tobacco and alcohol consumption and a more balanced diet. CONCLUSIONS: Coronary revascularization substantially improves QOL, with a significant impact on the clinical variables of the psycho-social dimensions.

Adult↗
PubMed1999

Excision of pulmonary metastases of osteogenic sarcoma of the limbs.

OBJECTIVE: The combination of surgery and chemotherapy improves the prognosis of patients with osteogenic sarcoma of the limbs without detectable metastases at presentation. However, lung metastases are a frequent complication. To evaluate the role of the resection of pulmonary metastases of osteogenic sarcoma of the limbs, we have reviewed our experience with this type of surgery, combined with a multidrug chemotherapy protocol. PATIENTS AND METHODS: From January 89 to December 97, 198 patients operated on for osteogenic sarcomas of the limbs were followed in our centre. Of these, 31 patients (15.7%), with a mean age of 25 years (range 10-54 years), developed lung metastases and had undergone 45 thoracotomies. All patients received chemotherapy, followed by resection of metastatic lesions and additional chemotherapy. The mean time interval between resection of the primary tumour and the diagnosis of lung metastases was 22 months (4-122 months). Eight patients (25.8%) needed more than one (2-4) thoracotomy. The mean time interval between the first and second thoracic surgeries was 9.2 months (2-14 months). RESULTS: There was no operative mortality or major morbidity. During the 45 thoracotomies, five lobectomies and 40 wedge resections were necessary. The mean number of metastases resected per thoracotomy was 3.4 (range 1-10). The degree of necrosis was evaluated by seriated sections for a histologic study. In the end the mean necrotic volume was calculated. A strong correlation was found between the degree of necrosis of the metastases and the need for reoperation for new metastatic lesions, because all the patients who needed more than one operation had less than 80% of necrosis of metastases. The patients were followed for a mean period of 28 months (6-72 months). Ten patients (32.2%) died of related causes at a mean of 19.4 months after thoracic surgery, three of whom had more than one operation. The 3-year survival after metastasectomy was 61%. Patients without pulmonary metastases had a 3-year survival of 79%. CONCLUSIONS: In patients with lung metastases of an osteogenic sarcoma, the combination of chemotherapy and surgery improves the outcome. In our series the mortality was not influenced by the number or thoracotomies required.

Adolescent↗
PubMed1999

Divided left atrium associated with supravalvar mitral ring.

Reported is a case with a rare association of divided left atrium, supramitral stenosing ring of the left atrium, connection of the left superior caval vein to the roof of the left atrium, unroofed coronary sinus with an interatrial communication at the mouth of the unroofed sinus and ventricular septal defect. The need for a complete echocardiographic examination in the presence of pulmonary venous obstruction is emphasized. Surgery was successful in spite of significant preoperative pulmonary hypertension.

Cor Triatriatum↗
PubMed1998

Brucella endocarditis of the aortic valve.

Brucella endocarditis was diagnosed in two patients with acute renal failure. Both patients had major aortic insufficiency, congestive cardiac failure and clinical and laboratory signs of an active infection, although adequate antibacterial therapy had already been introduced. Replacement of the aortic valve, together with the aortic root in one of the cases, were carried out as emergency procedures, followed by antibacterial treatment with rifampicin, doxycycline and co-trimoxazole. Both patients left the hospital cured and are well 2.5 and 2 years after the surgery, respectively.

Adult↗
PubMed1998

Procedures for developing a simple scoring method based on unsophisticated criteria for screening children for tuberculosis.

OBJECTIVE: To develop a scoring system for screening children for tuberculosis (TB) and for selecting suspects for further investigation in tuberculosis control programmes. Application of the score model, which would not require sophisticated or expensive technology, would be directed towards resource-poor countries with high prevalences of tuberculosis, where health care workers have to deal with diagnostic problems away from district hospitals or diagnostic facilities. DESIGN: Based on contributions from members of an IUATLD task group from 10 countries on the use of diagnostic criteria in childhood tuberculosis, criteria were selected to be used as elements in a score model. Data were collected by standardised questionnaire on 879 subjects aged under 15 years. Of these, 794 were considered probable or confirmed cases of tuberculosis by the diagnosing doctors. From each record, the criteria/procedures used in the diagnosis of probable/confirmed TB and regarded by the doctors as relevant criteria were selected. Bacteriology, histology and chest radiography were used either singly or collectively as the definitive reference (gold standard) against which the more subjective criteria (symptoms, clinical signs, skin test) would be evaluated. The latter criteria cited as relevant were then ranked and further explored for inclusion in the score model. The relative importance of each criterion to every other criterion on the list was expressed as weights, determined by employing a logarithmic least squares method to solve the ratio scale estimation problem which underlies decision-making involving more than one criterion. The resultant values were then assigned to each criterion in the final score model. RESULTS: The five clinical criteria thought to be most relevant as predictors of disease in children were history of contact with a case of tuberculosis, positive skin test, persistent cough, low weight for age, and unexplained/prolonged fever. In selecting the optimal cut-off points for the model at which tuberculosis would be suspected, low sensitivity and specificity (below 70%) but reasonably good positive predictive values (60%-77%) were obtained, depending on age group and epidemiological setting. In low tuberculosis prevalence settings, heavy reliance is placed by the model on a history of contact with a household case of tuberculosis and on a positive skin test, both of which have to be true. For high prevalence settings, more or less equal weighting is assigned to all five elements. Case contact and skin tests are less important, with low body weight, prolonged fever and cough being more indicative of tuberculosis. CONCLUSION: The model provides for epidemiological differences between target populations and should prove successful as a screening tool to select children for further investigation by radiography and bacteriology.

Adolescent↗
PubMed1997

[Left ventricular aneurysm. The surgical results and follow-up].

From May 1988 through October 1994, 44 patients with ischemic left ventricular aneurysm were operated upon. The mean age was 60.5 +/- 7.7 years and 36 patients (81.8%) were male. Thirty-two patients (72.7%) had congestive heart failure in NYHA class II or greater and 26 (59.1%) had moderate or severe left ventricular dysfunction. In 41 cases (93.2%) there was a history or electrocardiographic signs of myocardial infarction and only 3 patients (6.8%) were angina free. The location of the aneurysms was antero-apical or antero-lateral in 37 patients (84.1%) and inferior in 7 (15.9%), and intracavitary clot was present in 9 cases (20.5%). Fifteen patients (34.1%) were operated upon using standard linear repair, 8 (18.2%) by Stoney's technique and in the remaining 21 (47.7%) an endoventricular patch plasty was performed. All patients but one had CABG with a mean of 2.7 grafts per patient. The IMA was used in all patients with graftable LA disease (90.0%). Double IMA grafting was used in 10 patients (22.7%). Three patients (6.8%) had associated valvular surgery. Hospital mortality was 2.3% (1 patient) and morbidity 22.7% (10 patients); intra-aortic balloon counterpulsation was required in two patients. The mean time of hospitalization was 13.5 +/- 9.0 days. In the follow-up period (mean 29.2 +/- 21.5 months), 6 patients had required hospitalization (left ventricular failure -4; supraventricular arrhythmia-2) and two died. The remaining 32 survivors (78.0%) are in functional class I of the NYHA, without angina. Surgery of left ventricular ischaemic aneurysm was possible with low mortality and morbidity, with good functional results.

Adult↗
PubMed1997

[Surgery for acute type-A aortic dissection].

From January 1989 through June 1996, 29 patients underwent surgical repair of type A acute aortic dissection. Mean age was 59 +/- 13.5 years (range 25-76 yrs) and 21 patients (72.4%) were male. Nineteen patients (65.5%) had systemic hypertension and 3 (10.3%) Marfan syndrome. One patient (3.4%) had prior surgical repair of descending aortic dissection and CABG. Six patients (20.7%) were operated on in shock. The dissection was limited to the ascending aorta (DeBakey type II) in 12 patients (41.4%). Eleven patients (37.9%) had severe aortic regurgitation. Replacement of the ascending aorta was performed in all cases and extended to include the transverse arch in one. Twenty-three patients (79.3%) were operated upon using a tubular graft (sacron-21, homograft-2) with aortic valve resuspension. In the remaining 6 (20.7%) the aortic valve and root were replaced using a Bentall procedure, modified with a homograft in 3 cases. Five patients (17.2%) had associated surgery: CABG (4) and closure of aortic-atrial fistula (1). Mean cardiopulmonary bypass time was 134 minutes (range 70 to 285 min) and aortic cross-clamp time was 58 minutes (range 23 to 93 min). Hypothermic circulatory arrest for open distal anastomosis was used in 26 patients (89.7%) (mean time 22 min; range 10 to 32 min), with retrograde cerebral perfusion in the last 4 years (18 cases; 62.1%). Hospital mortality was 17.2% (5 patients). Eight patients (27.6%) had hospital morbidity: reexploration for bleeding (4 cases), CVA (3), A-V block necessitating permanent pacemaker (1). The mean time of hospitalization was 18 days (range 9 to 81 days). In the follow-up period (mean 38 mths; range 4 to 94 mths), 2 patients died (CVA and gastrointestinal bleeding) and 4 required hospitalization (perforated duodenal ulcer, peritonitis, suspected endocarditis, supraventricular tachyarrhythmia-1 patient each). All 22 survivors (75.9%) returned to the functional status they had prior to the dissection and 18 of them (81.8%) are in NYHA functional class I. Type A acute aortic dissection is a complex pathology and the postoperative mortality remains significant, but surgery permits good functional recovery and an active life for the survivors.

Acute Disease↗
PubMed1996

[Homograft replacement of aortic valve and ascending aorta].

From May 1990 through December 1994, integral valved aortic homografts were implanted for replacement of the aortic valve and of part or the whole of the ascending aorta in 24 patients with a mean age of 45.5 years (17-66 years). Ten patients (41.7%) had infective endocarditis of the aortic valve (4 of the native valve and 6 prosthetic). Seven of these had root abscesses (70%), one with a fistula to the right atrium, resulting in a variable degree of discontinuity between the left ventricle and the aorta. Twelve patients (50%) had ascending aortic aneurysms and the remaining two (8.3%) had aortic dissection. Three patients (12.5%) also had mitral pathology, one had triple vessel coronary disease, one had aortic coarctation and another one had a sub-aortic membrane. Two thirds of the patients were in NYHA class III/IV and 10 (41.7%) had moderate or severe left ventricular dysfunction. A modified Bentall technique utilising fresh aortic homografts was used in all patients. The homografts were harvested aseptically from donors with a mean age of 30 years (16-54 years) and preserved at 4 degrees C for a period of 1-43 days (median-13 days). Six patients (25%) had associated surgery: mitral valve replacement; mitral valvuloplasty with a ring; closure of aortic- atrial fistula, resection of sub-aortic membrane; triple coronary artery bypass; and mitral and tricuspid annuloplasty and closure of ASD (one patient each). Postoperatively three patients (12.5%) required reexploration for excessive blood drainage in the first hours and one patient with complete A-V block required a pacemaker (4.2%). Hospital mortality was 4.2% (one patient). At the time of discharge, no patient had significant Doppler or echocardiographic aortic gradient or regurgitation. All patients were followed for a mean period of 31 months (7-62 months). One patient died of a non cardiac death and the remainder are in NYHA class I without thromboembolic or haemorrhagic accidents and with echocardiographic findings similar to those observed at discharge. These results suggest that aortic homografts constitute an effective and safe method of reestablishing the continuity between left ventricle and aorta, especially in the presence of an infective process with root abscesses.

Adolescent↗
PubMed1995

[The Bland-White-Garland syndrome or an anomalous origin of the left coronary from the pulmonary artery. Apropos a case of a continuous murmur in an adult].

The authors report a case of anomalous origin of the left coronary artery from the trunk of pulmonary artery in an adult without significant symptoms, diagnosed by the presence of a continuous thoracic murmur. Because its low incidence and great mortality in the beginning of life, the appearance in the adult is extremely uncommon, especially without symptoms of cardiac failure, angina pectoris or myocardial infarction. In the present case, the patient was asymptomatic and was submitted to various echocardiograms before the diagnosis was suspected and confirmed with angiography. Surgical treatment was performed successfully with reimplantation of the anomalous vessel in the aorta.

Adult↗
PubMed1993

The clinical value of screening chest radiography in the neonate with lung disease.

To examine the role of routine chest radiography in the management of the critically ill neonate with pulmonary disease, 41 term and preterm infants with lung diseases were prospectively evaluated. Seventy radiographs (35%) were obtained for clinical indications and 128 (65%) for prospective screening. Studies were compared with each infant's most recent previous study, if available. Every exam was designated Level I, if the radiograph identified a new finding that required clinical intervention; Level II, if an abnormality or interval change was observed that did not require immediate intervention; or Level III, if there was no interval change since the previous radiograph. Thirty-three (47%) indication radiographs and 63 (49%) screening radiographs showed significant changes since the previous study. Twenty-four (34%) of the indication radiographs and 42 (33%) of the screening radiographs had Level I abnormalities (P = NS). Nine (13%) of the indication radiographs and 21 (16%) of the screening radiographs had Level II abnormalities (P = NS). Results suggest that routine screening chest radiographic studies are an important adjunct of care in critically ill newborns with respiratory disease and may identify potential problems before they are reflected in a change in clinical status.

Diagnostic Tests, Routine↗
PubMed1991

[Aortocoronary bypass. Intermittent clamping of the aorta versus cardioplegia].

STUDY OBJECTIVE: Cardioplegia is the standard method of myocardial protection during aorto-coronary bypass surgery. However, there are other alternatives which the authors intend to test. DESIGN: Forty consecutive, non-selected cases of coronary artery bypass surgery done with intermittent aortic crossclamping (Group A) are compared with the 40 preceding consecutive cases where cardioplegia was used (Group B). PATIENTS: The mean age of the patients of group A was 57.5 years (range 42-69 years) and that of group B was 57.1 years (range 39-76 years). Patients of group A had an incidence of previous myocardial infarct of 42.5% against 65.0% in group B. Chronic angina led to surgery in 33 cases of group A and in 32 of group B. The remainder (18.8%) had unstable angina. INTERVENTIONS: The mean number of grafts per patient was 2.9 in group A and 3.2 in group B. Internal mammary arteries were used in most patients of both groups, with 61 anastomoses in group A (1.5/patient) and 57 in group B (1.4/patient). The mean ischaemic time per graft was 7.4 min (range 5.5-11 min) in group A and 15.6 min (8.5-22 min) for group B. MAIN RESULTS: Serial analysis of myocardium-specific serum enzymes and the CPK-MB/total CPK ratio has not evidenced perioperative infarction in any patient of either group. Although enzyme levels were slightly higher in group A, the difference has not reached statistical significance. However, the electrocardiograms have shown one perioperative infarct in each group. Vasodilators were generally used in the 2 groups, for a mean of 16.8 hours, while inotropic drugs were required in only 4 cases of group A and 3 of group B. There has been no hospital mortality in either group. CONCLUSIONS: These results, in a series of non selected patients, demonstrate that intermittent crossclamping may be an acceptable alternative method of myocardial protection during aorto-coronary bypass surgery thus made simple, quick and secure.

Adult↗
PubMed1991

[Primary heart tumors. Report of a clinical case].

The authors describe the case of a 52-year-old patient with several hospitalizations due to acute pulmonary edema, clarified only during the performance of cardiac surgery for the correction of presumable mitral valvular pathology. A leiomiossarcome of the left auricle was concerned, which involved the posterior ring of the mitral valve, the interauricular septum and the orifices of the pulmonary veins. Due to the impossibility of proceeding with the complete resection of the tumor, the tumoral mass was wasted away in order to liberate the involved structures, this followed by chemotherapy. Two years since, the patient shows a generally deteriorated state, submitted to various hospitalizations due to cardiac insufficiency, having been objectivated hepatic metastization and recurrence of the primary neoplasm.

Female↗
PubMed1990

[Cor triatriatum. Echo/Doppler diagnosis followed by immediate surgical correction. Report of a clinical case].

As Cor Triatriatum is a rare congenital cardiopathy and benign after corrective surgery, decisive means of diagnosis are essential. The AA review some descriptive theoretical concepts and make reference to the difficulties, present at times, in diagnosis by cardiac catheterization. They consider Eco-Doppler to be the means of excellence for its recognition describing all aspects that point to the diagnosis of this pathology. Described is the case of a 12 month old baby, in whom some semiological findings had lead to a wrong diagnosis. In the discussion, additional diagnosis is eliminated due to some anatomic characteristics defined by echocardiography.

Cor Triatriatum↗
PubMed1982

Cardiac operation during active infective endocarditis: results of aortic, mitral, and double valve replacement in 94 patients.

Cardiac valve replacement was performed in 94 patients (95 operations) in the presence of active infective endocarditis. Most of the patients were extremely ill. The operation was performed as an emergency or semiemergency lifesaving procedure in 88% of them, and more than half received little or no antibiotic treatment prior to the operation. The hospital mortality was 16%--14% for aortic valve replacement (AVR) and 11% for double valve replacement (DVR) but 31% for isolated mitral valve replacement (MVR). The mortality was not higher in patients operated on urgently (emergency or semiemergency), nor was it higher in patients who had aortic annular abscesses or aneurysms. Prosthetic valve endocarditis (PVE) (in each case occurring more than 60 days after the previous valve operation) carried a higher mortality (33%) than native valve endocarditis (NVE) (14%). The relatively high early mortality for MVR may have been related to the fact that we operated upon MVR patients after intensive medical treatment had failed. The late results were good: Sixty-six patients are alive and well, 51 of them in Functional Class I. Six patients were reoperated upon for aortic periprosthetic leaks, and five are now well. Eight patients died late (9%), one of them because of a periprosthetic leak and one because of a clotted valve. In seven of the eight deaths, the cause of death was probably not related to the timing of the original operation. We recommend early valve replacement for patients with infective endocarditis. We believe that early operation reduces mortality, prevents emboli, and is associated with excellent long-term results.

Adolescent↗