Browsing by Issue Date, starting with "1992"
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- Reoperations on cardiac valvesPublication . Antunes, MJAs the number of patients undergoing cardiac valve replacement has grown, valve reoperations have become increasingly frequent. The newer generations of mechanical valves are far more efficient and freer from structural failure than the older ones. However, other valve and non-valve related complications still constitute a major cause of morbidity and mortality. On the other hand, bioprostheses, implanted in large numbers in the 1970's and early 1980's, have now gone into the second decade of life since implantation, when biodegradation becomes more frequent. Reoperations are technically more demanding than the original valve procedures because of the mediastinal and pericardial adhesions and the condition of the anulus after removal of the previous prosthesis. Greater awareness of the most dangerous steps and refinements to surgical technique have contributed to the decreased mortality observed in recent years. The risk is higher in certain conditions, such as the presence of prosthetic valve endocarditis and the patient being operated on an emergency basis in NYHA functional class IV. It may also be increased in females and the elderly. Multiple reoperations also carry a higher risk in most surgeon's experience. However, elective reoperations for defective mechanical valves and for replacement of a previously repaired mitral valve carry similar mortality rates to primary valve replacement procedures. The global mortality rates have not been significantly higher in the hands of experienced surgeons working in centers where reoperations are performed frequently. In smaller series high mortality rates are a constant, which underscores the importance of the learning curve. The indications for reoperation must therefore consider all risk factors and, when possible, the procedure must be performed by those who have the most experience. Under these circumstances, elective re-replacement of degenerating bioprostheses and of defective mechanical valves in asymptomatic patients may be advisable.
- Contact dermatitis from a billiard cuePublication . Gonçalo, S; Gonçalo, Margarida; Matos, J; Marques, C
- Photosensitivity to piroxicam: absence of cross-reaction with tenoxicamPublication . Gonçalo, Margarida; Figueiredo, A; Tavares, P; Fontes-Ribeiro, CA; Teixeira, F; Poiares-Baptista, AWe studied 2 groups of patients. One group of 10 patients had a photosensitive eruption to piroxicam. Another group of 24 patients had positive patch test reactions to thimerosal and thiosalicylic acid and had never taken piroxicam or tenoxicam. Patients were patch tested with thimerosal 0.1% pet., thiosalicylic acid 0.1% pet., salicylic acid 2.0% pet., piroxicam 1 and 5% pet. and tenoxicam 1 and 5% pet. Photopatch tests were also performed with piroxicam and tenoxicam. All 10 patients with photosensitivity to piroxicam had positive patch tests to thimerosal and thiosalicylic acid and 9 of them had positive photopatch tests to piroxicam. 20 out of 24 patients with positive patch tests to thiosalicylic acid also had positive photopatch tests to piroxicam. All the patients tested with salicyclic acid were negative. Out of the 29 patients with positive photopatch tests to piroxicam, none reacted to tenoxicam. In countries with a high incidence of contact sensitivity to thimerosal/thiosalicylic acid, the use of piroxicam should be avoided and replaced by tenoxicam, a drug without reported photosensitivity.
- Coronary artery bypass surgery with intermittent aortic cross-clampingPublication . Antunes, MJ; Bernardo, JE; Oliveira, JM; Fernandes, LE; Andrade, CMDespite the generally accepted use of cardioplegia for myocardial protection during cardiac revascularization and other operations, non-cardioplegic methods have been used by many surgeons throughout the world. We have prospectively studied 229 patients consecutively subjected to isolated coronary artery bypass surgery from March 1990 to February 1991 by a single surgeon who used intermittent aortic cross-clamping for construction of the distal anastomoses. The mean age of the patients was 58.9 +/- 8.9 years. One hundred and nine patients (47.6%) with unstable angina were subjected to urgent or emergent surgery and 129 (56.3%) had a previous myocardial infarction. The mean number of grafts per patient was 3.0. The ischaemic time per graft was 6.5 +/- 1.4 min. At least one internal mammary artery was used in 98% of the cases (1.4 internal mammary artery grafts/patient). Hospital mortality was 0.9% (two patients, in neither case related to the procedure). Only nine patients (3.9%) required inotropes and none needed intra-aortic counterpulsation. The analysis of serum enzymes specific of myocardial lesion showed a CPK-MB/CPK ratio of 10.5 +/- 10.2 after surgery, 6.4 +/- 6.6% at 24 h after surgery, and 6.9 +/- 2.6% by the 5th day. Only four patients (1.7%) had ECG criteria of myocardial infarction. These results were compared retrospectively with those of the 40 immediately preceding patients (December 1989 to February 1990), in whom crystalloid cardioplegia had been used. There were no differences between the two groups with regard to age, prevalence of unstable angina and of previous myocardial infarction, and technique used.
- Allergic contact dermatitis in children. A multicenter study of the Portuguese Contact Dermatitis Group (GPEDC)Publication . Gonçalo, S; Gonçalo, Margarida; Azenha, A; Barros, MA; Sousa-Bastos, A; Brandão, FM; Faria, A; Marques, MS; Pecegueiro, M; Rodrigues, JB; Salgueiro, E; Torres, VThe authors report a study of allergic contact dermatitis in 329 Portuguese children of 14 years or younger. 170 children (64 male and 106 female) reacted to 1 or more allergens. Most of these were in the 11-14 years group. The main allergens were nickel, thimerosal, cobalt, mercury, fragrance-mix and potassium dichromate. Nickel reactivity predominated in females over the whole group, but a greater number of males younger than 5 years reacted to nickel. The number of positive reactions increased with age, but this was not accompained by an increase in the % of relevant tests. 12 children, all of them 13 or 14 years-old, had an occupational allergic contact dermatitis.
- Allergic contact dermatitis from minoxidilPublication . Ruas, E; Gonçalo, Margarida; Figueiredo, A; Gonçalo, S
- Kikuchi's disease associated with Epstein-Barr virus infectionPublication . Rabadão, EM; Oliveira, JF; Saraiva da Cunha, JG; Côrte-Real, R; Meliço-Silvestre, AA