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Influence of balloon pressure inflation in patients undergoing primary coronary stent implantation during acute myocardial infarction: a quantitative coronary angiography analysis
Mattos Luiz Alberto,Sousa Amanda G.M.R.,Chaves áurea,Feres Fausto
Arquivos Brasileiros de Cardiologia , 2003,
Abstract: OBJECTIVE:To verify the influence of moderate- or high-pressure balloon inflation during primary coronary stent implantation for acute myocardial infarction. METHODS: After successful coronary stent implantation, 82 patients were divided into 2 groups according to the last balloon inflation pressure: group 1 (superscript three12 to <16 atm) and group 2 (superscript three16 to 20 atm), each with 41 cases. All patients underwent late coronary angiography. RESULTS: In group 1, the mean stent deployment pressure was 13.58±0.92 atm, and in the group 2 it was 18.15±1.66 atm. Stents implanted with moderate pressures (superscript three12 to <16 atm) had a significantly smaller postprocedural minimal lumen diameter, compared to with those with higher pressure, with lesser acute gain (2.7± 0.4 mm vs 2.9±04 mm; p=0.004), but the late lumen loss (0,9±0,8 mm vs 0,9±0,6 mm) and the restenosis (22% vs. 17.1%) and target-vessel revascularization rates (9.8% vs 7.3%) were similar between the groups. CONCLUSION: During AMI stenting, the use of high pressures (superscript three16 atm) did not cause a measurable improvement in late outcome, either in the late loss, its index, and the net gain, or in clinical and angiographic restenosis rates.
Percutaneous handling of coronary lesions >20mm through stents. Is there a first choice strategy?
Tanajura Luiz Fernando L.,Pinto Ibraim M. F.,Mattos Luiz Alberto P.,Feres Fausto
Arquivos Brasileiros de Cardiologia , 1999,
Abstract: OBJECTIVE - This study compared the early and late results of the use of one single stent with those of the use of multiple stents in patients with lesions longer than 20mm. METHODS - Prospective assessment of patients electively treated with stents, with optimal stent deployment and followed-up for more than 3 months. From February '94 to January '98, 215 patients with lesions >20mm were treated. These patients were divided into 2 groups as follows: Group A - 105 patients (49%) with one stent implanted; Group B - 110 patients (51%) with multiple stents implanted. RESULTS - The mean length of the lesions was 26mm in group A (21-48mm) versus 29mm in group B (21-52mm) (p=0.01). Major complications occurred in one patient (0.9%) in group A (subacute thrombosis, myocardial infarctionand death) and in 2 patients (1.8%) in group B (one emergency surgery and one myocardial infarction) (p=NS). The results of the late follow-up period (>6 months) were similar for both groups (group A = 82% vs group B = 76%; p=NS), and we observed an event-free survical in 89% of the patients in group A and in 91% of the patients in group B (p=NS). Angina (group A = 11% vs group B = 7%) and lesion revascularization (group A = 5% vs group B = 6%; p=NS) also occurred in a similar percentage. No infarction or death was observed in the late follow-up period; restenosis was identified in 33% and 29% of the patients in groups A and B, respectively (p=NS). CONCLUSION - The results obtained using one stent and using multiple stents were similar; the greater cost-effectiveness of one stent implantation, however, seems to make this strategy the first choice.
Safety and efficacy of coronary stent implantation. Acute and six month outcomes of 1,126 consecutive patients treated in 1996 and 1997
Mattos, Luiz Alberto;Pinto, Ibraim;Abizaid, Alexandre;Abizaid, Andrea;Chaves, Aurea;Feres, Fausto;Maldonado, Galo;Tanajura, Luiz;Centemero, Marinella;Sousa, Amanda G. M. R.;Sousa, J. Eduardo;
Arquivos Brasileiros de Cardiologia , 1999, DOI: 10.1590/S0066-782X1999000700003
Abstract: purpose: the authors analyzed the 30-day and 6-month outcomes of 1,126 consecutive patients who underwent coronary stent implantation in 1996 and 1997. methods: the 30-day results and 6-month angiographic follow-up were analyzed in patients treated with coronary stents in 1996 and 1997. all patients underwent coronary stenting with high-pressure implantation (>12 atm) and antiplatelet drug regimen (aspirin plus ticlopidine). results: during the study period, 1,390 coronary stents were implanted in 1,200 vessels of 1,126 patients; 477 patients were treated in the year 1996 and 649 in 1997. the number of percutaneous procedures performed using stents increased significantly in 1997 compared to 1996 (64 % vs 48%, p=0.0001). the 30-day results were similar in both years; the success and stent thrombosis rates were equal (97% and 0.8%, respectively). the occurrence of new q wave mi (1.3% vs 1.1%, 1996 vs 1997, p=ns), emergency coronary bypass surgery (1% vs 0.6%, 1996 vs 1997, p=ns) and 30-day death rates (0.2% vs 0.5%, 1996 vs 1997, p=ns) were similar. the 6-month restenosis rate was 25% in 1996 and 27% in 1997 (p= ns); the target vessel revascularization rate was 15% in 1996 and 16% in 1997 (p = ns). conclusions: intracoronary stenting showed a high success rate and a low incidence of 30-day occurrence of new major coronary events in both periods, despite the greater angiographic complexity of the patients treated with in 1997. these adverse variables did not have a negative influence at the 6-month clinical and angiographic follow-up, with similar rates of restenosis and ischemia-driven target lesion revascularization rates.
Avalia??o comparativa do valor prognóstico de quatro marcadores bioquímicos de les?o miocárdica pós interven??es percutaneas utilizando stents coronarianos
Centemero, Marinella;Sousa, Amanda;Staico, Rodolfo;Abizaid, Alexandre;Feres, Fausto;Tanajura, Luiz Fernando;Mattos, Luiz Alberto;Chaves, áurea;Pinto, Ibraim;Sarteschi, Camila;Paes, Angela;Sousa, J. Eduardo;
Arquivos Brasileiros de Cardiologia , 2004, DOI: 10.1590/S0066-782X2004001900010
Abstract: objective: to assess the prognostic effect of the changes in the levels of 4 biochemical markers of myocardial damage (ck-mb activity/mass and troponins t and i) after stent implantation in regard to the occurrence of death, infarction, and new myocardial revascularization procedures in a one-year period. the study also aimed at determining the incidence of their elevations and the existence of predictive variables. methods: those 4 markers were measured in 199 patients treated with stent implantation in native arteries in the following 3 periods: before the procedure, 6-8 hours after the procedure, and 14-18 hours after the procedure. survival curves and cox logistic regression were used to determine the prognostic impact of the changes on the occurrence of cardiac events in one year. results: changes in the levels of the 4 markers after stent implantation are relatively frequent (6.1% to 32.8%), are associated with the degree of complexity of the lesions treated (long lesions and angulations > 45o) and with the development of problems during the procedure (occlusion of the secondary branches, presence of angina, and electrocardiographic changes). the infarction-free survival rate and the need for a new revascularization were significantly lower only in the patients with an elevation in the ck-mb activity after the procedure as compared with those in patients without that alteration (60% x 85.08%; p=0.025). the following variables influenced the event-free survival rate: diabetes mellitus (or: 2.27; p=0.0256), balloon predilation (or: 3.16; p=0.0082), and an elevation in the ck-mb activity after the procedure (or: 3.64; p=0.0162). conclusion: systematic monitoring of ck-mb activity after coronary stenting is justified due to its clinical and laboratory behavior reported in studies relating its elevation after the procedure to a worse late outcome, and due to its low cost.
Arteriografia coronária com cateter de muito baixo perfil. Eficácia e seguran?a do procedimento e da alta hospitalar aos 60 minutos
Berti, Sergio;Feres, Fausto;Castro, Danilo;Gusm?o, Marcos;Staico, Rodolfo;Padilha, Rone;Chaves, Aurea;Centemero, Marinella;Mattos, Luiz A.;Sousa, Amanda;Sousa, J. Eduardo;
Arquivos Brasileiros de Cardiologia , 1998, DOI: 10.1590/S0066-782X1998000100002
Abstract: purpose: to evaluate the feasibility, efficacy and safety of the use of 4f judkins catheters for coronary angiography. methods: from august/95 to january/96, 70 patients with suspected coronary artery disease underwent coronary cineangiography by the judkins technique, with 4f catheters. following punture of the right femoral artery, 4f sheaths were introduced. at the end of the procedure, the sheath was removed and manual compression was applied for 15min. patients were oriented to walk under specialized supervision, 60min after the procedure, and discharged after 4h. results: thirty nine (56%) patients were male, the age ranged from 31 to 83 (mean 57) years and weight from 43 to 101 (mean 69) kg. optimal quality images were obtained in 62 patients (88%). it was necessary to use larger caliber catheters (6 and 8f) in 8 patients, due to femoral tortuosity or inadequate opacification of coronary arteries. there were no vascular complications nor major bleedings. in only 2 cases (3%) there was a minor bleeding, treated by new local compression. sixty (85%) patients walked after 60±5min and were discharged after 4h. conclusion: the use of 4f catheters for coronary angiography by femoral approach allowed early deambulation with no major bleeding. image quality was good, with little contrast used and short hospital stay. this technique may lead to a simpler less traumatic and less invasive coronary angiography,.
Coronary flow reserve in stress-echo lab. From pathophysiologic toy to diagnostic tool
Fausto Rigo
Cardiovascular Ultrasound , 2005, DOI: 10.1186/1476-7120-3-8
Abstract: Normally coronary blood flow can increase approximately four-to-six fold to meet increasing myocardial oxygen demands. This effect is mediated by vasodilation at the arteriolar bed, which reduces vascular resistance, thereby augmenting flow. The coronary reserve (CFR) represents the capacity of the coronary circulation to dilate following an increase in myocardial metabolic demands and can be expressed by the difference between the hyperemic flow and the resting flow curve (figure 1). In 1974, Lance K Gould [1] proposed the relationship between the anatomic condition and behaviour of coronary hyperaemic flow (figure2), whereby an inverse curvilinear relationship exists between the narrowing of lumen of coronary artery and hyperaemic capability, up to a completely abolished coronary reserve for stenosis >90%. This experimental paradigm can be accurately reproduced clinically in highly selected series of patients with single vessel disease, no myocardial infarction, no coronary collateral circulation, normal baseline function, no left ventricular hypertrophy, without evidence of coronary vasospasm, and off therapy at the time of testing. The perfect, predictable relationship found in the experimental animal or in a very selected patient population [2] is not so perfect in clinical practice [3,4], where many variables can modulate the imperfect match between epicardial coronary artery stenosis and coronary flow reserve (figure 2), such as the geometric characteristics of the stenosis, the presence of coronary collateral circulation, the microvascular component of coronary resistance, the presence of left ventricular hypertrophy modulating the myocardial extravascular component of coronary resistance, the viable or necrotic state of the myocardium distal to the stenosis, the presence of coronary macrovascular or microvascular spasm, and, last but not least, the presence of concomitant anti-ischemic therapy.Up to now, coronary flow reserve has been evaluated invasively i
Genetics of SCID
Fausto Cossu
Italian Journal of Pediatrics , 2010, DOI: 10.1186/1824-7288-36-76
Abstract: Over the last years novel genetic defects causing SCID have been discovered, and the molecular and immunological mechanisms of SCID have been better characterized. Distinct forms of SCID show both common and peculiar (e.g., absence or presence of nonimmunological features) aspects, and they are currently classified into six groups according to prevalent pathophysiological mechanisms: impaired cytokine-mediated signaling; pre-T cell receptor defects; increased lymphocyte apoptosis; defects in thymus embryogenesis; impaired calcium flux; other mechanisms.This review is the updated, extended and largely modified translation of the article "Cossu F: Le basi genetiche delle SCID", originally published in Italian language in the journal "Prospettive in Pediatria" 2009, 156:228-238.The initial clinical manifestations of SCID (Severe Combined Immunodeficiency), a heterogeneous group of genetic defects with an overall incidence of about 1 in 40,000 to 75,000 newborns [1-3], are most frequently observed in the first few months of life and the median age at diagnosis is 4-7 months. However, human SCID is a prenatal disorder of T lymphocyte development, already present at birth even if clinically silent in most affected newborns.On January 1, 2008, Wisconsin (USA) became the first state in the world to screen all newborns for SCID through a method based on measurement of T cell receptor excision circles (TRECs) by polymerase chain reaction (PCR), using DNA extracted from newborn dried blood spots (Guthrie cards); TRECs are by-products generated during normal T cell maturation (Figure 1) and are consistently absent or present in very low numbers in newborns with SCID [4]. Recently an infant with SCID has been identified by newborn screening in Massachusetts [5], and the U.S. Department of Health and Human Services recommended the addition of SCID to the uniform screening panel for all newborns [6].Wisconsin SCID screening poster (Figure 2) describes the fundamental features of S
O deslocamento da popula??o brasileira para as metrópoles
Brito, Fausto;
Estudos Avan?ados , 2006, DOI: 10.1590/S0103-40142006000200017
Abstract: the aim of this article is the analysis of the brazilian urbanization process during the second half of the 20th century. for this purpose it is important to take note that the 1970 demographic census indicated that the urban population had surpassed the rural population for the first time. the rapid contemporary urbanization due to intense internal migration concentrated the urban population in the larger brazilian cities and metropolitan areas. during the last two decades, however, the growth rates of the larger cities has declined due to lower fertility rates and, more importantly, decreasing number of immigrants. indeed, the metropolitan area of s?o paulo, for example, presented negative net migration for the 1995-2000 period. although internal migration trends do not point to a process of "hipermetropolitanization", it must be taken into account that as of 2000 40% of the country?s urban population still inhabited the larger metropolitan areas.
Octavio Gouvêa de Bulh?es
Saretta, Fausto;
Estudos Avan?ados , 2001, DOI: 10.1590/S0103-40142001000100010
Abstract: this article is an attempt to synthesize the important role played by octavio gouvêa bulh?es in brazil's economy. considered a model brazilian liberal, bulh?es was a remarkably active civil servant. founder of banco central [brazil's national bank] and sumoc [a superintendency for the local currency and credit] and finance minister from 1964 to 1967, he was outstanding for his constant preoccupation about financial and monetary issues, mainly concerning inflation. in tune with the line of thought which had eugênio gudin as a leader, bulh?es published academic works dealing with economy policy issues focussing mainly on stability, in his view a fundamental factor for economic growth. a university professor and member of the instituto brasileiro de economia, octavio gouvêa bulh?es, both for his life and work, is one of the most important referential names to understand brazilian economy.
Em torno da pré-história intelectual do totalitarismo igualitarista
Fausto, Ruy;
Lua Nova: Revista de Cultura e Política , 2008, DOI: 10.1590/S0102-64452008000300008
Abstract: the article aims at some logical-historical conditions of "left-wing" totalitarianism, or "equalitarist totalitarianism". the first part intends to show that there is a blind spot in marxism - the twentieth-century hegemonic theory on the left - about democracy, and how that same blind spot gave favorable conditions to the rise of totalitarianism and its ideology. the second part traces a genesis of equalitarist totalitarianism. the outstanding reference is bolshevism as pretotalitarian ideology and practice. from that point, the article makes a double logical move: a regressive one, showing how, below marxism, bolshevism rescues the jacobinist politics and how it is going to fuse the jacobinist legacy with the previous traditions blended in marxism itself; and a progressive one, analysing the passage from bolshevik neojacobinism to the ideology and practice of stalinist neodespotism.
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