Browsing by Issue Date, starting with "1998"
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- Ecocardiografia de sobrecarga no enfarte do miocárdioPublication . Mota, PNos doentes com enfarte do miocárdio recente, os principais determinantes de prognóstico são: a extensão da necrose transmural, o estado da artéria relacionada com o enfarte e a presença e extensão de miocárdio em risco. A utilização da ecocardiografia de sobrecarga pressupõe que a sobrecarga farmacológica induz isquemia miocárdica a qual provoca alteração da motilidade segmentar. Esta dissinergia é um marcador precoce, sensível e específico de isquemia miocárdi ca. A infusão de dobutamina permite avaliar a resposta contráctil do miocárdio. Em baixas doses dá-nos informação sobre a reserva contráctil e, inerentemente, viabilidade. Sob doses elevadas de dobutamina a função sistólica torna-se dependente da capacidade da árvore coronária aumen tar o fluxo sanguíneo miocárdico. Quando existem estenoses coronárias significativas, o ter ritório dependente torna-se isquémico, o que se revela como hipo ou acinesia segmentar. O dipiridamol produz vasodilatação coronária provocando, em dose baixa, aumento da perfusão de zonas isquémicas e, em doses elevadas, efeito de roubo nos territórios dependentes de artérias com estenoses significativas. Com qualquer dos métodos, um teste de sobrecarga negativo tem um excelente valor predizente negativo e um teste positivo traduz risco aumentado de eventos.
- Endocardite a streptococcus bovis e envolvimento do colonPublication . Baptista, SB; Duarte, F; Galrinho, A; Dutschmann, LMcNeal and Blevins published the first report of Streptococcus bovis infective endocarditis in 1945. In 1951, McCoy suggested, for the first time, that an association could exist between Group D Streptococcus infective endocarditis and colon carcinoma; this association would be demonstrated later (1977) by Klein and unquestionably confirmed by several posterior works. Due to a clinical case of Streptococcus bovis infective endocarditis, which we had the opportunity of diagnosing, a review is made of the existent literature about the association between infection by this agent and the presence of lesions in the colon. Some recommendations are made in what respects the diagnosis and evaluation of patients with Streptococcus bovis infective endocarditis. Finally, the implications and therapeutic strategies in these patients are discussed
- Diagnosis of stroke by the nonneurologist: a validation study.Publication . Ferro, J; Pinto, A; Falcão, I; Rodrigues, G; Ferreira, J; Falcão, F; Azevedo, E; Canhão, P; Melo, T; Rosas, MJ; Oliveira, V; Salgado, AVBACKGROUND AND PURPOSE: The first medical contact of an acute stroke victim is often a nonneurologist. Validation of stroke diagnosis made by these medical doctors is poorly known. The present study seeks to validate the stroke diagnoses made by general practitioners (GPs) and hospital emergency service physicians (ESPs). METHODS: Validation through direct interview and examination by a neurologist was performed for diagnoses of stroke made by GPs in patients under their care and doctors working at the emergency departments of 3 hospitals. RESULTS: Validation of the GP diagnosis was confirmed in 44 cases (85%); 3 patients (6%) had transient ischemic attacks and 5 (9%) suffered from noncerebrovascular disorders. Validation of the ESP diagnosis was confirmed in 169 patients (91%); 16 (9%) had a noncerebrovascular diagnosis. Overall, the most frequent conditions misdiagnosed as stroke were neurological in nature (cerebral tumor, 3; subdural hematoma, 1; seizure, 1; benign paroxysmal postural vertigo, 1; peripheral facial palsy, 2; psychiatric condition, 6; and other medical disorders, 7). CONCLUSIONS: In the majority of cases, nonneurologists (either GPs or ESPs) can make a correct diagnosis of acute stroke. Treatment of acute stroke with drugs that do not cause serious side effects can be started before evaluation by a neurologist and CT scan.
- Hamartoma of the mitral valve with blood cysts: a rare tumor detected by echocardiographyPublication . Abreu, A; Galrinho, A; Sá, E; Ramos, S; Martins, A; Fragata, J; Ferreira, RA 16-year-old boy was submitted to a cardiac examination after an episode of faintness. A transthoracic echocardiogram was performed, which revealed a very mobile multicystic tumor attached to the mitral valve. A small solid mass adherent to the cysts was better defined by transesophageal echocardiography. The patient was submitted to cardiac surgery consisting of tumor resection and a mitral prosthesis implant. The surgery was successful. The tumor consisted of three bright red tense cysts with hematic content, each 1 to 2 cm in diameter. The cysts were coalescent and adherent to a solid mass attached to the posterior papillary muscle head. Histopathologic examination revealed a hamartoma with a cystic part composed of the proliferation of myofibroblast cells in a stroma with vessels, collagen, and elastin fibers. Valvular hamartoma with blood cysts is a very rare cardiac tumor both for its histopathology and its localization.
- SIDA no idosoPublication . Duarte, F; Dutschmann, L