Twenty-year-old woman with pulmonary hypertension, syncope, and severe headache.
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Adult↗
Biomedical subjects
M R Nobre
Publications and source records attributed to M R Nobre.
Peripheral arterial embolism. Report of hospitalized cases.
OBJECTIVE: We analyzed the frequency of peripheral embolisms, the underlying heart disease,triggering factors, the sites of the emboli, and evolution of the patients. METHODS: We analyzed 29 cases of peripheral arterial embolism out of a total of 20,211 hospitalizations in a cardiology center in the city of São Paulo. The age was 51.89+/-18.66 years, and 15 were males. RESULTS: Embolism in the right lower limb occurred in 18 patients (62.0%),in the left lower 11(37.9%) and right upper 3 (10.3%) limbs, and in the left arm (1). Four patients had embolism in two limbs. The heart disease, mitral valvar heart disease (9 patients - 31.0%); infective endocarditis (7- 24.1%); dilated cardiomyopathy (6 - 20.6%); ischemic coronary heart disease (6 patients - 20.6%); and one patient with cor pulmonale. Atrial fibrillation was observed in 20 patients (68.9%), chronic in 12 patients (41.3% ) and acute in 8 (27. 5%). All patients with mitral valvar heart disease had atrial fibrillation, chronic in 8 patients (88.8%); patients with cardiomyopathy and coronary heart disease, 4 in each group had atrial fibrillation, acute in 60% of the patients. Patients with infective endocarditis, 3 had staphylococcus and 2 Gram-negative bacteria. In the follow-up, 2 patients (6.8%) required limbs amputation, and 5 (17.2%) died due to embolism. CONCLUSION: Most of the time, embolism does not cause permanent complications. Our data highlight the importance of anticoagulation for patients acute atrial fibrillation in myocardial dysfunction and for patients with chronic atrial fibrillation in cases of mitral valvar heart disease to prevent peripheral embolism.
Adolescent↗
[Heart failure at a large tertiary hospital of São Paulo].
PURPOSE: To study the incidence, main causes, aggravating factors and secondary diagnoses of heart failure (HF) during 1995 at the Instituto do Coração of São Paulo. METHODS: Data from hospitalized patients according to the PRODESP data base were analyzed. The following data were studied; age, sex, principal and secondary diagnoses, surgical procedures and mortality. To analyze the data, tables according to sex, age and main cause were built. Analysis of variance and t test were employed to verify differences between groups. RESULTS: In 1995, 903 out of 9620 patients were hospitalized due to HF. The majority were male (60.4%) and the patients' age was between two days and 98 years old (mean 52.6). Ischemic (32.6), dilated (25.8%) and valvar heart disease (22%) were the main causes of HF. 32.1% were submitted to correction of the HF main cause, specially those with valvar heart disease (62.3%). There was greater incidence of multiple diagnoses in aged patients. The mortality was greater in patients younger than 20 and in those older than 80 years old. CONCLUSION: The incidence of HF at INCOR during 1995 was 9.38%. Ischemic myocardiopathy was the most frequent HF cause. The mortality was greater among children, probably because of heart disease complexity and, in the above-80 group due to the greater comorbidity.
Adolescent↗
[Pachydermoperiostosis. Report of a case and diagnostic discussion].
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Adult↗
Polymyositis in Chagas's disease.
Polymyositis marked the clinical onset of Chagas's disease in a patient with rheumatoid arthritis. This is unusual, although clinically unimportant muscle involvement in trypanosomiasis has been described. The plasma cell infiltrate and vascular deposition of IgM and C3 suggest that the humoral immune system may play a role in the pathogenesis of chagasic polymyositis. It is not known whether the rheumatoid diseases predisposed to the polymyositis.
Adult↗
Protein-losing enteropathy in systemic lupus erythematosus.
We describe a 23-year old Brazilian woman with systemic lupus erythematosus and protein-losing enteropathy. Small intestinal biopsy revealed lymphangiectasia. Protein-losing enteropathy responded to corticosteroid therapy and should be suspected in cases of systemic lupus erythematosus with hypoalbuminemia without proteinuria and liver failure. A review of the English literature is presented with comments on pathogenesis.
Adult↗
[Aneurysm of the pulmonary artery in Behçet's syndrome. Report of a case].
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Adult↗
[Anti-beta-2-microglobulin antibodies in systemic lupus erythematosus].
The aim of this work was the study of 88 patients with SLE for clinical, laboratorial and demographical parameters. The patients sera were assayed for the presence of anti-beta-2-microglobulin antibodies by ELISA. These spectrofotometric results were converted in a standard-deviation unity in relation to the average of 29 control individuals values. It was established a cut-off of 2.5 standard-deviation in order to determine the limit of normality as well as the cut-off of 10 standard deviation was chosen in order to defined the higher values. Several statistical significant associations were observed between the anti-beta-2-microgobulin and the clinical and laboratorial parameters. The clinical applications of those associations were determined by the predictive value. It was only considered the values greater then 75%. The negative predictive values found in the lower cut-off were 92% to ANA (homogeneous-peripheral pattern), 89% to high levels CIC, 81% to mucocutaneous vasculitis and 80% to depressed CH50 levels. The positive predictive values found in 88% to high level of mucoprotein, 83% to mucocutaneous vasculitis, 83% to the onset-disease-time lower six years and 78% to limphopenia. Special attention may be paid to the high sensibility and specificity of the anti-beta-2-microglobulin test to some of the parameters in the evaluation of the disease activity, mainly in mucocutaneous vasculitis.
Adult↗