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Biomedical subjects

M Guerreiro

Publications and source records attributed to M Guerreiro.

At least 19 recordsLinked to original sources
PubMed2006

Cost-minimization analysis for Portugal of five doublet chemotherapy regimens from two phase III trials in the treatment of advanced non-small cell lung cancer.

OBJECTIVES: Economic evaluations of chemotherapy regimens for stage IIIB or IV non-small cell lung cancer (NSCLC) have been conducted for many European countries, but not for Portugal. This study evaluates the total health care costs of five commonly used doublet regimens with similar efficacy results. METHODS: Using the methodology reported by Schiller [Schiller JH, Tilden D, Aristides M, Lees M, Kielhorn A, Maniadakis N, et al. Restropective cost analysis of gemcitabine in combination with cisplatin in non-small cell lung cancer compared to other combination therapies in Europe. Lung Cancer 2004;43:101-12], we conducted a cost-minimization analysis to compare vinorelbine-cisplatin (Vin/Cis), gemcitabine-cisplatin (Gem/Cis), paclitaxel-carboplatin (Pac/Carb), docetaxel-cisplatin (Doc/Cis), and paclitaxel-cisplatin (Pac/Cis). The perspective was that of the Portuguese National Health Service and included only direct medical costs (reimbursed costs plus co-payments): chemotherapy acquisition, chemotherapy administration, hospitalizations due to adverse events, and other medical resources. Unit costs were drawn from official sources (Diagnosis Related Groups and retail/hospital costs) (2003 value [Diagnosis Related Groups (DRG) published at Diário da República; 2003]). Resource use was estimated from two multicenter randomized phase III trials [Comella P, Frasci G, Panza N, Manzione L, De Cataldis G, Cioffi R, et al. Randomized trial comparing cisplatin, gemcitabine, and vinorelbine with either cisplatin and gemcitabine or cisplatin and vinorelbine in advanced non-small-cell lung cancer: interim analysis of a phase III trial of the Southern Italy Cooperative Oncology Group. J Clin Oncol 2000;18:1451-7; Schiller JH, Harrington D, Belani CP, Langer C, Sandler A, Krook J, et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med 2002;346:92-8]. A time horizon of a full course of therapy was adopted. One-way sensitivity analyses were performed. RESULTS: The least and the most costly chemotherapy regimens were Gem/Cis and Pac/Carb, respectively. Total mean cost per patient was estimated at euro7083 for Gem/Cis and euro10,008 for Pac/Carb, a mean cost savings of euro2925 per patient for Gem/Cis. The differences were mainly due to the higher chemotherapy acquisition costs of Pac/Carb than for Gem/Cis. Gem/Cis was less costly in all sensitivity analyses except when 100% inpatient chemotherapy administration was assumed. CONCLUSION: Gem/Cis should be considered as a cost-saving alternative to the other four regimens in treating NSCLC patients in Portugal.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2006

Mild cognitive impairment: deficits in cognitive domains other than memory.

Patients with mild cognitive impairment (MCI) typically present with memory complaints, but may have mild deficits in other cognitive domains. We compared the neuropsychological profiles of a series of consecutive MCI patients (n = 116) with a control group of healthy elderly subjects (n = 63). The presence of a memory deficit on delayed recall was consistent in the MCI sample, as it was an inclusion criterion in the study. Impairment on immediate recall was present in 62.6% of the patients on paragraph recall of the logical memory test and in 63.1% of the patients on the word paired-associate learning test. Remarkably, patients with MCI frequently had deficits in cognitive domains beyond memory. As much as 68.7% of the patients had deficits in temporal orientation, 30.2% had deficits in semantic fluency, 33.7% in the Token test, 23.4% in calculation, and 23.9% in motor initiative. If detailed neuropsychological testing is performed, the majority of MCI patients will have deficits in cognitive domains other than memory.

Aged↗
PubMed2005

Clinical significance of subcortical vascular disease in patients with mild cognitive impairment.

Patients with mild cognitive impairment (MCI) typically present with memory complaints. Some of these patients have subcortical vascular disease on computed tomography (CT) scan, namely white matter changes and lacunar infarcts, however it is not known whether these findings are associated with more pronounced cognitive deficits. In the present study we compare demographic, clinical and neuropsychological characteristics of MCI patients according to the presence or the absence of subcortical vascular disease. Forty consecutive patients with memory complaints, at least one neuropsychological memory test below 1 SD the normal for age and education, and maintained activities of daily living, were included. Patients with dementia, history of stroke or transient ischemic attack, or other brain disorders, were excluded. Twenty-five (62.5%) patients with MCI had no ischemic lesions on CT scan, and 15 (37.5%) were found to have subcortical vascular changes. MCI patients with subcortical vascular changes were older (77.1 +/- 6.8 vs. 70.8 +/- 7.5 years old), and more often males. The number of vascular risk factors, the frequency of neurological signs, the Hachinski score and the neuropsychological tests scores were not significantly different. The presence of subcortical vascular disease on CT scan is frequent in older patients with MCI, but does not appear to be associated with the severity of cognitive deficits.

Aged↗
PubMed2002

Early extubation does not increase complication rates after coronary artery bypass graft surgery with cardiopulmonary bypass.

BACKGROUND: With the evolution of anesthesia and surgical procedures, fast track extubation has gained an increased interest, mainly based on the possibility of reducing health costs seemingly without compromising patient care. AIM: To compare two groups of patients submitted to a non-fast track extubation and a fast track extubation protocol after coronary artery bypass graft surgery with cardiopulmonary bypass, regarding their times of ventilation and intubation and their complication rates in the postoperative period. METHODS: During the year of 1998, 323 sequential patients scheduled for isolated coronary artery bypass graft surgery with cardiopulmonary bypass were enrolled in the study. Fifty-nine patients were excluded due to preoperative use of emergent mechanical and/or inotropic hemodynamic support, low body mass index (< or =18-20 kg/m(2)), reoperations for acute surgical complications, off-pump coronary artery bypass graft surgery, severe respiratory disease, recent myocardial infarction (< or =7 days) and absence of relevant data. Previous myocardial infarction (> or =7 days), prophylactic intraaortic balloon pump and use of postoperative vasoactive drugs were not exclusion criteria. We compared 76 patients sequentially submitted to anesthesia by one of the authors with a fast track extubation protocol and 188 patients sequentially submitted to anesthesia by others in the same period and using a conventional anesthetic protocol. RESULTS: Demographic data, previous medical and cardiac history, preoperative medication and operative data were all similar between the two groups. The mean ventilation and intubation times were significantly shorter in the fast track extubation group than in the non-fast track extubation patients (30 min vs. 7 h and 50 min vs. 8 h, respectively). Forty-two percent of patients in the fast track extubation group were extubated on arrival at the intensive care unit. Morbidity and mortality were similar in both groups. CONCLUSIONS: The study shows that a very fast track extubation protocol may be safely implemented in patients submitted to coronary artery bypass graft surgery with cardiopulmonary bypass.

Cardiopulmonary Bypass↗
PubMed2001

Dementia and cognitive impairment three months after stroke.

To investigate the cognitive capacities of a cohort of ischaemic or haemorrhagic stroke survivors and to identify the clinical determinants of post-stroke cognitive impairment, we evaluated 237 patients admitted to a Stroke Unit (mean age 59; SD=12.7). Three months after stroke, patients were submitted to a neuropsychological evaluation that included the Mini-Mental State Examination (MMSE), a complementary battery to assess specific cognitive domains, the Hamilton Depression Rating Scale (HDRS) and the Blessed Dementia Scale (BDS). Disturbed performance on at least one domain was detected on 131 (55%) patients: 27% had cognitive deficits other than memory, 7% had focal memory deficit, 9% had memory and other cognitive deficits and 6% had dementia. Dementia was associated with female gender (P=0.01), older age (P=0.01) and lower education level (P=0.04). Patients with memory deficits were older (P=0.01) with lower educational level (P=0.08) and more left sided lesions (P=0.02) than patients without memory deficits. In this middle aged stroke survivors cognitive impairment was common 3 months after stroke, while dementia was infrequent.

Age Distribution↗
PubMed2000

Cognitive and emotional consequences of perimesencephalic subarachnoid hemorrhage.

Little is known about the long-term cognitive-functional outcome of patients with perimesencephalic subarachnoid haemorrhage (PM SAH). We investigated the neurological, cognitive and emotional consequences of perimesencephalic subarachnoid haemorrhage in eighteen PM SAH patients admitted between November 1990 and July 1997 to the Neurology/Neurosurgery services of a University Hospital. The follow-up study consisted of a face-to-face interview, a neurological examination, an headache questionnaire, a neuropsychological evaluation (Mini-Mental State and a complementary battery to assess specific cognitive domains), the Hamilton Depression Rating Scale (HDRS) and the Blessed Dementia Scale. Thirteen patients performed below the 10th percentile in at least one cognitive domain. Six patients scored more than 12 points on the HDRS. Mini-Mental State and HDRS scores were moderately correlated (r = 0.55). Only three patients left their previous occupation. Minor cognitive deficits and high scores on a depression scale were frequent findings in this cohort of PM SAH patients. Reassurance and treatment of depressive symptoms could be important to improve the long-term outcome of PM SAH patients.

Adult↗
PubMed1999

A follow-up study of cognitive impairment due to inferior capsular genu infarction.

Abulia, memory loss, other cognitive deficits, and behavioral changes consistent with dementia can follow an inferior capsular genu infarction, but only little is known about the time course of these disturbances. The present study describes the long-term outcome of cognitive defects in four patients with inferior capsular genu infarction who underwent a neuropsychological examination within 3 and 12 months of onset. Three patients had infarcts in the inferior genu of the left internal capsule and had similar symptoms in the acute phase: disorientation, memory loss, language impairment, and behavioral changes. The patient with right-side infarct showed memory impairment and behavioral changes. Three patients had deficits in one or more cognitive domains on the first assessment, but none was demented. By the second evaluation all subjects had improved. In two patients there were a moderate memory defect persisted and a language disturbance. Improvement in these disturbances during long-time follow-up demonstrates that there are alternative pathways that reestablish the functional connections damaged by the strategically located capsular genu infarct. Inferior capsular genu infarction is not a cause of persisting "strategic infarct dementia."

Aged↗
PubMed1998

Headaches in intracerebral hemorrhage survivors.

Few data exist on headache in survivors of acute cerebrovascular disease. During the second year of follow-up of a cohort of intracerebral hemorrhages (ICH), the lifetime history of headache before stroke and 2 years after stroke was characterized through a neurologic interview and a headache questionnaire. Headaches were classified following the International Headache Society classification categories. Disability (Rankin scale) and depression (CERAD depression scale) were also evaluated. Ninety survivors were interviewed. Comparing the distribution of pre- and post-ICH headaches, 24 subjects (27%) never had headaches, 39 subjects (43%) had ongoing headaches, 10 subjects (11%) complained of headaches only after ICH, and 17 subjects' (19%) headaches remitted after ICH. There was usually a delay of weeks or months between ICH and the first headache episode. Poststroke headaches were in general less severe and frequent than prestroke headaches. New-onset headaches after ICH were mainly of the tension type and were significantly associated with depression but not with new intracranial lesions. Headaches in remission after ICH were related to acute alcohol consumption and migraines. Chronic post-ICH headaches are usually tension type and occur in association with depression. Remission of headaches after ICH is related to removal of headache precipitants (alcohol) and possibly to structural or functional changes of the trigeminovascular system secondary to intracranial bleeding.

Adult↗
PubMed1997

Mechanisms underlying degeneration of cryopreserved vascular homografts.

OBJECTIVE: To analyze the mechanism(s) underlying homograft degeneration, we designed an experimental model in which the behavior of cryopreserved autografts and homografts, as well as fresh autografts, implanted in the same animal was compared. METHODS: A cryopreserved homograft was implanted in the aorta of 14 sheep. The excised aortic autologous segment was then subjected to cryopreservation, and 1 to 8 weeks later it was implanted 1 to 2 cm below the cryopreserved homograft. The intermediate segment of the native aorta, the fresh autograft, was dissected at this point. Animals were put to death at different times and the implanted segments were harvested together with a portion of native aorta. Histologic and immunohistochemical analyses, as well as cell viability assessments, were then performed on the explanted segments. Similar studies were also conducted on fragments of cryopreserved autografts and homografts before implantation. RESULTS: With the exception of a partial loss of the endothelium, cryopreserved specimens retained cell viability and morphologic integrity before implantation. Explanted cryopreserved homografts showed profound changes affecting all strata, as well as a decline in cell viability. Lymphocyte infiltrates were found up to 12 months after implantation. Endothelium was always absent in cryopreserved homografts. However, a reendothelialization of the cryopreserved autografts was observed. After an initial period of neuronal degeneration, reenervation of the cryopreserved autograft segment occurred 6 to 12 months after the operation. Findings regarding the fresh autografts were similar to those of the cryopreserved autografts. CONCLUSION: Our results suggest that the immunologic reaction rather than the cryopreservation process is responsible for the degenerative process occurring in cryopreserved homografts.

Animals↗
PubMed1995

Aphasia following right hemisphere lesion in a woman with left hemisphere injury in childhood.

The case of a 56-year-old woman who became aphasic following a right temporoparietal lesion is reported. At the age of 2, this woman had an acute infantile hemiplegia on the right side of the body and it was reported by relatives that a deterioration of language was also noted. There was a slow recovery of these deficits and she was considered as having normal language only at age 7. Although it is difficult to be sure about the hand preference of the patient before the stroke at age 2, the relatives were quite positive saying, that she previously preferred the right hand and that she became left handed. The CT scan showed an old left frontal ischemic lesion and a recent right temporoparietal lesion. This case illustrates the ability of the right hemisphere to take over functions of the left when a left lesion occurs in early stages of language acquisition. Although this is an accepted model for recovery, this is the only case in the literature with a documented early focal lesion of the left hemisphere. Other evidence comes from studies performed in populations where severe epilepsy may contribute to particular functional organization.

Aphasia↗
PubMed1995

Can the location of the large septal artery be predicted?

The aim of this study is to establish anatomical landmarks for the trajectory of the large septal artery. Thirty hearts were dissected, 20 of which had no cardiac pathology and the remaining with different cardiac conditions. One large septal artery was located in 27 of these hearts, two large septal arteries in 2 and three large septal arteries in 1. For all cases there existed one large septal artery in the lower border of the anterior limb of the septomarginal trabecula. When more than one large septal artery was encountered, the first was located within the subendocardial outflow tract of the left ventricle, the second was in the lower border of the anterior limb of the septomarginal trabecula and the third 1.5 cm below the second.

Adolescent↗
PubMed1994

Influence of educational level of non brain-damaged subjects on visual naming capacities.

Educational level of subjects is a variable often neglected in neuropsychological studies. However, there are pieces of evidence to suggest that illiterate subjects may perform worse than literate subjects in some tests. Visual naming is one of the tasks where a poor performance was reported in illiterate populations. The present study addresses this problem of comparing the performance in visual naming tasks of non-brain-damaged patients of different educational levels. The test materials were composed of three subtests: naming real objects, their photographs, and line drawings of the same objects. Results revealed that there is a clear influence of educational level on the ability to name photographs and line drawings of the objects. Naming line drawings is particularly difficult for the lower educated non-brain-damaged subjects. Visual analysis of two dimensional representations is a task that requires special learning. These results have to be taken into consideration in test selection for poorly educated populations.

Aged↗
PubMed1994

[An estimate of the prevalence of dementia and Alzheimer's disease in Portugal].

The authors projected to the Portuguese population the data on prevalence of dementia and Alzheimer's disease obtained respectively by Hofman et al. and Rocca et al through reanalyses of European epidemiological studies conducted or published between 1980 and 1990. The projection relies on the fact that the results of these reanalyses are extensive to all European countries. With this projection which is based on the Portuguese population census of 1991 the numbers of about 92.470 demented patients and about 48.706 Alzheimer's patients are obtained for Portugal. The authors think that, until systematic epidemiological studies of dementia and Alzheimer's disease are available in Portugal, the data now provided are useful for the planning of the care of these patients.

Adult↗
PubMed1992

[Echocardiographic study of 53 patients with rheumatoid mitral stenosis].

In 53 patients with rheumatic mitral stenosis we performed echocardiographic study in order to define anatomic and functional alterations. We used 3.5 MHZ probe and obtained images from apical and parasternal windows. Determinations were performed by standards of the American Society of Echocardiography. Thirteen patients were men and forty women. Men's mean age was 43.5 years and women's mean age 40 years. In the men anatomic mitral valve area was 1.1 cm2 and in the women 1.3 cm2. Correlation anatomic to functional valve area was strong (r = 0.9). Mitral diastolic gradient had correlation with cardiac output, mitral valve area and ejection fraction. Pulmonary artery pressure had strong correlation with valve area and cardiac output. In conclusion, our study showed the usefulness of functional valve area in the graduation of mitral stenosis, the dependence of the mitral diastolic gradient of several cardiac events, the independence of the left atrium dimensions and also the strong dependence of pulmonary artery pressure of cardiac output and valve area.

Adult↗
PubMed1991

[Valve replacement with Macchi prosthesis].

OBJECTIVE: to evaluate the performance of a new ball valve prosthesis. DESIGN: set up of two groups of patients who underwent mitral valve replacement with two different prosthesis: the Macchi prosthesis under evaluation and the well known Starr-Edwards model prosthesis. The chi-square test was used to compare the results. PATIENTS: Patients referred for valvular surgery. INTERVENTIONS: One group of 98 consecutive patients who underwent isolated mitral valve replacement with a Macchi prosthesis from January 1984 to June 30 1986 was compared to a matched group of 49 patients who received a Starr-Edwards prosthesis in the same period of time. Follow-up data were available from 99% patients in the Macchi group 96% in the Starr-Edwards group, with a mean follow-up time of 35.2 (2-57) and 42.9 (4-62) months, respectively. RESULTS: There was no statistical difference in the incidence per 100 patients--month of prosthetic complications--thromboembolism, hemorrhagic events, prosthetic endocarditis, reoperation and mechanical failure. CONCLUSIONS: In our experience and with the available follow-up data the Macchi prosthesis is a good cost effective option when there is indication for a ball valve prosthesis.

Adult↗
PubMed1986

Postsynaptic alpha-adrenoceptor subtypes in the internal carotid, mesenteric, splenic, renal and femoral vascular beds of the dog.

Pressor effects of noradrenaline, phenylephrine and alpha-methylnoradrenaline and the inhibition of these effects by prazosin or yohimbine (or both) were studied in vivo in the renal, splenic, femoral, anterior mesenteric and internal carotid vascular beds of the dog. In all the vascular beds noradrenaline was more potent than alpha-methylnoradrenaline and alpha-methylnoradrenaline was more potent than phenylephrine. However, the ratios between the ED50 for phenylephrine and the ED50 for alpha-methylnoradrenaline in the mesenteric, in the femoral, in the splenic and in the renal circulations was 2.19, 1.89, 1.48, and 1.33, respectively, showing that the relative potency of phenylephrine increased in that order. In the internal carotid vascular bed it was not possible to determine any value. Furthermore, in the renal vascular bed, prazosin (100 micrograms/kg) inhibited pressor responses to all agonists more readily than yohimbine (250 micrograms/kg) and yohimbine was more potent than prazosin against all the agonists in the mesenteric and in the femoral vascular beds. Our results show that: there are both postsynaptic alpha 1- and alpha 2-adrenoceptors in the four vascular beds; the contribution of alpha 2-adrenoceptors to pressor responses to sympathomimetic agents is maximal in the mesenteric followed by the femoral, the splenic and the renal vascular bed, whereas the participation of alpha 1-adrenoceptors is maximal in the renal and progressively smaller in the splenic, in the femoral and in the mesenteric vascular bed, where it reaches the lowest value.

Animals↗
PubMed1984

Transient and persistent right ear extinction in dichotic listening: subcortical lesions.

Nine patients with aphasia had right ear extinction in dichotic listening to words in the first month after an ischemic stroke; they were reassessed after 3 months. Four showed complete recovery from the right ear extinction; in five, the abnormality persisted. In those who recovered, CT revealed a subcortical lesion lateral to the frontal horn of the lateral ventricle without a lesion of Heschl's gyrus or geniculo-temporal pathways; a lesion in those structures was found in patients who did not recover. As reported for subcortical aphasia, a subcortical mechanism may explain contralateral ear extinction in dichotic listening.

Adult↗