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Biomedical subjects

M R Gomes

Publications and source records attributed to M R Gomes.

At least 19 recordsLinked to original sources
PubMed2000

[Risk behavior among Brazilian Military conscripts, 1998: an study of HIV infections following socioeconomic differences].

A study of HIV-related risk behavior was carried out in 1998 among Brazilian military conscripts aged 17-20 years. A sample of 30,318 subjects was selected in three strata, pertaining to counties from: 1) the North and Central-West (N/CW); 2) South (S); and the states of Rio de Janeiro and São Paulo. HIV prevalence rates were estimated in all strata. The objective of this paper was to analyze the results according to differences in socioeconomic status (SES). The statistical analysis used an index of sexual risk behavior and logistic regression models. The N/CW stratum showed the worst indicators for SES, sexual risk behavior, and sexually transmitted infections (STIs), as well as the highest HIV seroprevalence rate. The best indicators for all variables were found in the RJ/SP stratum. The South showed intermediate results. Level of schooling also played a relevant role. In all three strata the conscripts with an incomplete high school education displayed the worst sexual risk behavior index, shown to be a relevant predictor of STI-related problems, including HIV infection.

Adolescent↗
PubMed1999

Tracheobronchial metal stents: effects of covering a bronchial ostium in pigs.

RATIONALE AND OBJECTIVES: The purpose of this study was to examine the effects of placing a metal stent across a bronchial orifice. MATERIALS AND METHODS: Nine pigs were used as test subjects, because the right upper lobe bronchus comes directly off the trachea in these animals. One of three types of metal stents was placed into the trachea of each pig and covered the orifice of the right upper lobe bronchus. Follow-up studies were performed at 1 and 3 months to evaluate the right upper lobe for signs of bronchial obstruction, infection, and atelectasis. The animals were sacrificed at 3 months to study the histopathologic changes of the trachea and lungs. RESULTS: Two upper lobe bronchi remained patent; seven were obstructed by granulation tissue or plugs of mucus and inflammatory cells. Right upper lobe infiltration and atelectasis were seen in eight animals. Interestingly, radiographic opacities were also common in other lung segments. There was a tendency toward fewer and less extensive lung opacities at 3 months compared with that at 1 month. At histopathologic examination, areas of both acute and chronic pneumonia were found in the right upper lobe of all animals. The segment of trachea covered by the stent was lined with a thin layer of granulation tissue containing neutrophils, monocytes, and lymphocytes. The stent luminal surface was covered with columnar, cuboidal, and stratified squamous epithelium. Tracheal stenosis was seen in three animals because of excessive granulation tissue in two and a collapsed stent in one. CONCLUSION: Placement of metal stents in pig trachea covering the orifice of the right upper lobe bronchus resulted in retention of secretions and secondary infection in the right upper lobe and other distant lung segments.

Animals↗
PubMed1998

[Partial pericardectomy using videothoracoscopy].

OBJECTIVE: The aim of this study is to assess the validity of videothoracoscopy in the treatment of chronic pericardial effusions. STUDY PATIENTS: We studied 13 consecutive patients with chronic pericardial effusions and an indication for surgical treatment. The patients, 10 female and 3 male, had a mean age of 48 years (21-72 years). Eleven patients had recurrent pericardial effusion and two patients had anterior mediastinal masses of unknown etiology and a large pericardial effusion. METHODS: A videothoracoscopy was performed in every patient, under general anesthesia with a double-lumen endotracheal tube. The thoracic cavity was inspected, the pericardial effusion was drained and a partial pericardectomy was performed. RESULTS: There was no postoperative mortality or morbidity. Average duration of postoperative thoracic drain and postoperative stay were, 1.2 and 2.4 days respectively. Follow-up ranged from 1 to 48 months (mean 23.3 months). One patient died due to progression of his malignant disease. There were no cases of recurrent pericardial effusions. CONCLUSIONS: Video assisted pericardectomy is a safe technique that should be considered in the treatment of chronic pericardial effusions.

Adult↗
PubMed1997

Transesophageal echocardiography on the presurgical and postsurgical evaluation of a coronary arteriovenous fistula.

A 52-year-old man with a symptomatic condition-a huge left coronary artery fistula simulating a cor triatriatum sinister on transthoracic echocardiography-was referred to our center for surgery. Coronary angiography unequivocally established the diagnosis of a left coronary artery fistula and contrast opacification of the right atrium was observed. However, as a result of the size of the fistula, the entry site could not be defined with certainty. A transesophageal echocardiography (TEE) was then performed, and the opening site was clearly identified in the postero-lateral wall of the right atrium. After the surgical treatment transesophageal echocardiography was repeated, and it was confirmed that the surgical treatment had succeeded.

Arteriovenous Fistula↗
PubMed1997

[The echocardiographic diagnosis of a rare complication of an aneurysm of the sinus of Valsalva].

We report the case of a patient with complete heart block caused by extension of a congenital aneurysm of the sinus of Valsalva into the upper interventricular septum, which was diagnosed by transthoracic and transesophageal echocardiography. We emphasize the rarity of this pathology and the value of transesophageal echocardiography in its assessment, providing a complete anatomicofunctional characterization and allowing surgical repair without previous cardiac catheterization.

Adult↗
PubMed1997

[Systemic vasculitis as the initial presentation of a left atrial myxoma].

Left atrial myxoma remains a diagnostic challenge. The authors briefly review previously reported cases and their individualistic clinical and laboratory features. This report documents an unusual clinical presentation, initially directing attention to the central nervous system as well as bilateral tenderness and weakness of the extremities. The illness was considered to be a vasculitis until thirty-one months later when the diagnosis of left atrial myxoma was made. The tumor was successfully removed.

Diagnosis, Differential↗
PubMed1996

[Surgical repair of free wall rupture after myocardial infarction].

Between August 1992 and July 1995 five patients with cardiac free wall rupture after acute myocardial infarction underwent surgical treatment in Centro de Cirurgia Torácica do Hospital de S. João. The diagnosis was suggested by the hemodynamic changes and in four patients confirmed with echocardiography and pericardiocentesis. All patients survived and were discharged from the hospital. Medical treatment with inotropic drugs, pericardiocentesis and intraaortic balloon counterpulsation allows hemodynamic stabilization but only early surgery may assure survival.

Adult↗
PubMed1996

[Isolated right ventricular myxoma: report of a clinical case].

A clinical case of a 14 years old white female with asthenia and easy fatigue of two months duration is presented. The two-dimensional echocardiography study has identified a tumorous and homogeneous mass filling completely the right ventricle. During the cardiac surgery and with the help of extemporaneous biopsy the real nature of the tumor was confirmed-cardiac myxoma. In this report the authors discuss the incidence of cardiac tumors and particularly cardiac myxomas and point out the rarity of isolated myxomas in the right ventricle.

Adolescent↗
PubMed1996

[Transesophageal echocardiography. A critical appraisal. How to avoid false diagnoses].

In this study the authors make a critical appraisal of transesophageal echocardiography. A retrospective analysis was made of the transesophageal echocardiographic performed in the Thoracic Surgery Center of S. João Hospital, Oporto, over a period of approximately five years. The authors report the limitations and complications of this diagnostic tool with particular emphasis on the leading causes of pitfalls. Between October 1990 and December 1995, 1282 examinations were performed in our echocardiographic laboratory, mean age 49.6 +/- 14 years (5-86), 57% of the patients were female and 43% male. A biplane transducer was used in these examinations. Patient absenteeism was 2% and only one major complication occurred in a patient with an aortic dissection. Pitfalls are of special concern with this technology. The new esophagic window over the heart and the high quality of the cardiac images, depicting structures and anatomic details inaccessible, or difficult to be observed by transthoracic echocardiographic, led to the major causes of transesophageal echocardiographic pitfalls. Once recognized, most of the pitfalls can be avoided. In what concerns our experience, examples of the most common pitfalls are illustrated.

Adolescent↗
PubMed1995

Cardiac myxomas: surgical treatment and long-term results.

Twenty-six patients have undergone a resection of a cardiac myxoma since 1977. There were five males and 21 females, of age range 14-81 years (mean 50 years). Symptoms included congestive heart failure, emboli, palpitations and syncope. The tumours were located in the left atrium (21 patients), right atrium (four) and right ventricle (one). The hospital mortality rate was 3.8%. Late outcome was known for 24 of 25 (96%) patients. The total follow-up is now 2116 months (mean 88 (range 2-204) months per patient). One patient (4%) died of colonic malignancy 4 years after surgery. Long-term results were satisfactory. Echocardiographic information supporting the absence of recurrence was known for all 23 patients, evaluated at an average of 80 (range 2-196) months postoperatively. Surgical resection is the correct treatment for cardiac myxoma and is imperative following the diagnosis.

Adolescent↗
PubMed1995

Transcatheter occlusion of patent ductus arteriosus using a newly developed self-expanding device. Evaluation in a canine model.

RATIONALE AND OBJECTIVES: A new occlusion device designed for use in a patent ductus arteriosus was tested in an animal model. METHODS: The device consists of a self-expanding conical-shaped stainless steel mesh, with hooks encircling the expanding end acting to secure the device within the ductus. A screw thread at the apex allows attachment to a stylet, and a 6 F delivery system is used. Placement of the device was attempted in 20 canines that previously had a vascular graft surgically inserted between the descending thoracic aorta and main pulmonary artery, creating the patent ductus model. Angiographic follow-up at regular intervals was performed over a 3-month period. RESULTS: Early cases resulted in device misplacement and migration because of inaccurate assessment of ductus position and size. In 15 canines the device was placed within the ductus and regularly assessed over the 3-month placement period. Ductus occlusion occurred within 1 week in 12 of 13 dogs (92%) when device placement was considered ideal. In two dogs where significant protrusion of the device from the ductus was evident (either into the aorta or main pulmonary artery) ductus closure was delayed but present by 3 months, resulting in a 93% overall closure rate at this time. In one dog, the ductus remained partially opened. CONCLUSIONS: This self-expanding patent ductus arteriosus occlusion device is promising. The 6 F delivery system is advantageous over other devices currently available, making it more suited for use in the pediatric population. Accurate assessment of the ductus is imperative, however, to enable correct device sizing. The screw thread system allows the device to be repositioned if desired prior to deployment.

Animals↗
PubMed1994

[Vascular rings: surgical treatment].

From 1982 to 1992, nine patients underwent correction of vascular rings. The diagnosis was strongly suggested by symptoms of tracheoesophageal obstruction and was confirmed by barium esophagogram and angiography. Endoscopic studies were considered unnecessary and potentially harmful. Seven patients had double aortic arch, one patient right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum and one patient anomalous origin of the left pulmonary artery. The anomaly was approached through a left thoracotomy in every patient. There were no operative or late deaths. When patients are symptomatic, vascular rings should be promptly repaired. The surgical risk is minimal, and the long term results are excellent.

Angiography↗
PubMed1994

[Diagnostic value of transesophageal echocardiography in the diagnosis of infectious endocarditis. A comparative analysis comparing it with transthoracic echocardiography].

The aim of this study is to compare the performance of Transesophageal Echocardiography (TEE) and the Transthoracic approach (TTE) in the diagnosis of Infectious Endocarditis (IE). Between October/90, the data we started transesophageal ultrasound, till April/92, we performed 33 TTE in inpatients with clinical suspicion of IE. Twenty pts (61%) had one or two prosthesis. All the pts had a previous TTE. The diagnosis of IE determined by non-echocardiographic data was established on 18 pts. The other 15 pts, without clinical criteria of IE, were used as the control group. The Echocardiographic criteria for the diagnosis of IE were for both diagnostic tools the presence of masses suggesting vegetation of abscess. The diagnosis was correctly made by TTE in 8 of the 18 pts (S-44%) and by TEE in 16 of the 18 pts (S-89%) with clinical criteria for IE. Of the 15 patients without clinical criteria for IE 14 were correctly identified by TTE (Sp-93%) and 13 by TEE (Sp-89%). With a similar VPP (89%) for both tools has TEE a significative higher value for NPV than TTE (87% vs 58%). This study suggests that TEE, at a same level of specificity as TTE, is highly more sensitive in the diagnosis of IE (S-89 14 for TEE and S-44 23 for TTE) a figure that recommends that all patients with clinical suspicion of IE and a negative TTE should perform a TEE.

Adult↗
PubMed1993

[Diagnostic value of transesophageal echocardiography in the study of mitral prosthesis dysfunctions].

The aim of this study are to establish the value of transesophageal echocardiography (TEE) in the diagnosis of mitral prostheses dysfunctions and to compare the performance of TEE and the transthoracic approach (TTE) in this context. From October 1990, the data when we started transesophageal ultrasound, till January 1992, we performed 218 TEE's. In 61 patients (pts) there was clinical suspicion of mitral prostheses dysfunction and TEE detected abnormal prostheses function in 22 pts (36%), 12 of which have been reoperated. In this group of 12 pts who underwent surgery, the basis for this study, the results of ETT and TEE were compared with surgeon's information. TEE confirmed the surgical findings in 11 patients (97%) with only one falsely positive (3%). On the other hand, TTE confirmed the surgical findings in only 6 pts (50%), confirmed partially in 3 (25%) and was falsely negative in 3 pts (25%). From these results the authors conclude: in the group of patients with mitral prostheses device dysfunction, that have been submitted to surgical treatment, there is great concordance between surgeon's findings and TEE information. TEE seems to be more accurate than TTE in the diagnosis of mitral prostheses dysfunction. Finally, TEE in conjunction with TTE is highly reliable in the diagnosis of mitral prostheses dysfunctions and spares patients from catheterism.

Adult↗