Biomedical subjects

R A Franken

Publications and source records attributed to R A Franken.

At least 19 recordsLinked to original sources

PubMed1992

[Mitral valve replacement with porcine bioprosthesis in children. Evaluation of 29 patients during 12 years].

PURPOSE: To analyze the clinical result of the mitral valve substitution for the porcine bioprostheses, the incidence of dysfunction caused by calcification and its importance related to the durability of bioprostheses and also the patients' survival. METHODS: Twenty-nine children of about seven to sixteen years old were operated on from November 1977 to August 1982 and all of them received porcine bioprostheses of low profile. RESULTS: There were three (10.34%) hospital deaths and nine other late mortalities. The follow-up period varied from 4 to 128 months with average of 58.17 months and with the loss of nine patients. An actuarial survival rate of 46.08% has been observed at 11 years after surgery. Calcification of 21 bioprostheses occurred in 14 out of 17 follow-up patients; 47.6% of them happened until the third year of pos-operative and 85.7% until the fifth year. Eleven patients were reoperated on with 9.09% of hospital mortality. There were no cases of thromboembolism. CONCLUSION: Porcine bioprostheses works well with an evident clinical improvement of patients, with no thromboembolic accidents. However, its durability has been affected by the high incidence of calcification, which is responsible for an increase in late morbidity and mortality. Mitral valve disease treatment in children must be conservative, in an attempt to solve the problem with the different available plastic technics and leave the valve substitution to be a last option. In that case, the preference is given to the homologous bioprostheses.

Actuarial Analysis↗

PubMed1992

[Analysis of fever in 58 cases of infective endocarditis].

PURPOSE: To evaluate if fever is an objective criterion in the assessment of response to antibiotic therapy and in the prognosis of patients undergoing treatment for infective endocarditis (IE). METHODS: Fifty-eight cases of IE, occurring from January 1980 to December 1989 have been analysed retrospectively in this study. Emphasis was given to the clinical history and body temperature changes during the first five weeks of treatment. Patients were divided in three groups according to the number of febrile peaks per week. Temperature was assessed weekly from each patient's highest peak weighed average. RESULTS: At the first exam, 52 patients (86.2%) presented fever. All patients had at least one episode of fever during their hospitalization. There seemed to be a relation between the number of febrile peaks during a one week period and the mean body temperature, so that these patients who presented four or more peaks in a week had a higher mean body temperature than those with two or less febrile peaks during the week. After the second week of treatment, patients with two or less febrile peaks had a 93.1% survival and average of 35.5 days of hospitalization, whereas those with three or more febrile peaks had 63.6% survival and an average of 47.5 days of hospitalization. CONCLUSION: The results of this study show that the intensity of fever is linked to the number of febrile peaks per week, regardless to treatment duration. Should there be three or more febrile peaks weekly after the second week of treatment, therapeutic strategy should be reviewed, considering even surgical treatment. In many cases, the persistence of fever represented the clinical expression of complications which determined a higher mortality rate and a longer hospitalization.

Adult↗

PubMed1992

[The Q wave in the electrocardiogram: necrosis or an electrically inactive area? Myocardial pseudoinfarct].

Six patients with Q-wave myocardial infarction in the ECG, two with coronary disease, two with metabolic alterations, one with acute myocarditis and another with ischemic stroke had an improvement of ECG tracings with disappearance of the Q wave. All had normal plasmatic levels of CPK and CKMB. It is believed that metabolic transitory disturbance of the myocardium increases the rest transmembrane potential turning the cell nonresponsive to electrical stimulus and without mechanical activity (inactive electrical zone, not a necrosis zone, which is an anatomo-pathological diagnosis).

Adolescent↗

PubMed1991

[Cor triatriatum].

A 16-year-old patient was evaluated for congestive heart failure and pulmonary hypertension, suggesting mitral valve stenosis. A left atrial membrane with a 4 mm orifice was seen in echocardiography and angiography, and a diagnosis of cor triatriatum was made. The membrane was successfully removed by surgery.

Adolescent↗

PubMed1991

[Infective endocarditis. Study of 83 cases at the Hospital da Santa Casa de São Paulo].

PURPOSE: To analyse clinical aspects, diagnosis and treatment of infective endocarditis (IE), in order to guide medical procedures and indicate the surgical treatment. PATIENTS AND METHODS: 83 patients were submitted to clinical treatment of IE between January 1980 and December 1987; clinical aspects, laboratory and pathologic-anatomy findings, the site of infection and the entrance of micro-organism were studied. RESULTS: 37 (44.6%) patients were males. Fever was present in 75 (90.4%) cases, cardiac murmur in 76 (91.5%), splenomegaly in 28 (33.7%) and heart failure (III and IV) in 32 (39.8%) patients. Blood culture was positive in 55.5%; staphylococcus 50% of blood cultures; anemia was present in 66 cases (79.5%) and high serum mucoprotein in 58 (92%); echocardiography was 85.7% positive. The mortality was 39.76%; congestive heart failure was the main cause of death; 78.1% of these ones occurred in the first 15 days of antibiotic-therapy. The mitral valve was the one most impaired and the most frequent entrance of micro-organisms in oropharynx. CONCLUSION: Congestive heart failure, sepsis and systemic embolisms were the main complications that led the patient to death in course of IE, usually before 15 days of antibiotic-therapy. In these cases, we may hypothesize that prompt surgical treatment could have diminished the mortality of IE.

Adolescent↗

PubMed1990

[Acute myocardial infarction in patients over 70 years of age. Study of 51 cases].

PURPOSE: To describe the clinic evolution during admission of a group of patients over age 70, who experienced acute myocardial infarction (AMI). PATIENTS AND METHODS: Fifty-one patients, over age 70, with confirmed diagnosis of AMI, were studied. Thirty-six (70.6%) males and 15 (29.4%) females. RESULTS: Near half (49.1%) were admitted before four hours of beginning of pain. The complications were divided into mechanical, electrical, persistent ischemia and others, not related with coronary heart disease. In the coronary care unit (CCU), 84.3% of patients complicated, and 50.0% at the ward. AMI of the anterior wall complicated more frequently with tachiarrhythmia, and inferior wall with atrioventricular block. There were not statistical difference in the incidence of mechanical complications, according to the affected wall. There was statistical significance (p less than 0.05) comparing mortality and the time elapsed between beginning of pain and hospital admission, but not comparing mortality and the wall involved. The patients with congestive heart failure and cardiogenic shock died in 93.3%. Mortality at the CCU was mostly related to complications of AMI, but mortality at ward to other complications not directly related with coronary heart disease. CONCLUSION: Myocardial infarction over age 70 implies high mortality and morbidity, with significantly, better prognosis with earlier arrival of the patient to the hospital.

Aged↗

PubMed1989

[The porcine valve prosthesis and pregnancy].

Anticoagulation is the chief problem during pregnancy of women with mechanical prosthetic valves. Many studies have investigated a nonthrombogenic valve. Since 1978 we have used a biological porcine prosthetic valves in 16 pregnancies, 11 patients with regular clinical electrocardiographic, echocardiographic and chest roentgenographic follow-up. The patients' ages were 19 to 32 years during pregnancy. Nine had mitral, one aortic and one mitro-aortic prosthesis. Two patients dropped out during the study so we completed it with 14 pregnancies. Six patients coursed with grade I heart failure (HYHA), five grade II and three grade IV. All of them were treated clinically. Four valves had dysfunction and calcification during pregnancy and two before pregnancy. The pregnancies resulted in three abortions, seven normal deliveries and four caesarean section with obstetric indication. Fetal distress was not observed during or after delivery. The physiopathology of valve dysfunction during pregnancy was discussed and it was concluded that the biologic porcine prosthetic valve allows hemodynamic stabilization. If dysfunction appears it may be clinically controlled without need of anticoagulation, risk of calcification nor dysfunction during pregnancy. The biologic valves are best indicated for women who wish to become pregnant after valve substitution.

Adult↗

PubMed1988