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Search Results: 1 - 10 of 420 matches for " Jeane Tsutsui "
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The use of microbubbles to target drug delivery
Jeane M Tsutsui, Feng Xie, Richard Porter
Cardiovascular Ultrasound , 2004, DOI: 10.1186/1476-7120-2-23
Abstract: The recent advances in gene therapy and molecular biology have improved the interest in methods of noninvasive delivery of therapeutic agents. Besides the well known application of microbubbles as contrast agents for diagnostic ultrasound, microbubbles have also been demonstrated an effective technique for targeted delivery of drugs and genes [1-6]. Drugs can be incorporated into the microbubbles in a number of different ways, including binding of the drug to the microbubble shell and attachment of site-specific ligands. As perfluorocarbon-filled microbubbles are sufficiently stable for circulating in the vasculature as blood pool agents, they act as carriers of these agents until the site of interest is reached. Ultrasound applied over the skin surface can then be used to burst the microbubbles at this site, causing localized release of the drug [7-10]. This technique then permits using lower concentrations of drugs systemically, and concentration of the drug only where it is needed. This improved therapeutic index may be extremely advantageous in cases of drugs with hazardous systemic side effects, like cytotoxic agents. Albumin-encapsulated microbubbles have also demonstrated to adhere to the vessel walls in the setting of endothelial dysfunction [11]. This also may be a method of targeting delivery with microbubbles but without the application of ultrasound.Two possible strategies for delivering drugs and genes with microbubbles are emerging. The first consists on the ultrasound-mediated microbubble destruction, which is based on the cavitation of microbubbles induced by ultrasound application, and the second is the direct delivery of substances bound to microbubbles in the absence of ultrasound. Different drugs and genes can be incorporated into the ultrasound contrast agents. It has already been demonstrated that perfluorocarbon-filled albumin microbubbles avidly bind proteins and synthetic oligonucleotides [12]. In a similar way, microbubbles can directly tak
Estado atual do tratamento da coronariopatia cr?nica em pacientes diabéticos: evidências e controvérsias baseadas em ensaios clínicos
Lopes, Neuza H.;Tsutsui, Jeane M.;Hueb, Whady A.;
Arquivos Brasileiros de Endocrinologia & Metabologia , 2007, DOI: 10.1590/S0004-27302007000200023
Abstract: diabetes mellitus is a powerful risk factor for coronary artery disease. diabetics demonstrate accelerated coronary atherosclerosis and worst prognosis following cardiac events. although myocardial revascularization procedures result in more effective relieve of symptoms in patients with known coronary artery disease, there is no substantial evidence that this strategy improves outcome, except for specific situations. in addition, the benefit of myocardial revascularization is attenuated by the presence of metabolic abnormalities related to insulin resistance and other significant co-morbidities in diabetic patients. new advances recently developed for the clinical treatment of diabetes, as well as surgical and percutaneous approaches of myocardial revascularization, such as drug-eluting stents, seem to be promising therapeutical strategies for diabetic patients. most importantly, treatment of type 2 diabetics with chronic coronary artery disease should consider the multifactorial pathogenesis of the disease and combine aggressive control of glycemic levels, strict management of all conventional risk factors, and lifestyle modification. the metabolic effects of insulin sensitizers over cardiovascular disease and mortality are under discussion. ongoing clinical multicenter trials will probably define the real impact of new therapeutic modalities over the prognosis of diabetic patients.
Left ventricular free wall impeding rupture in post-myocardial infarction period diagnosed by myocardial contrast echocardiography: Case report
Maria da Trindade, Jeane Tsutsui, Ana Rodrigues, Márcia Caldas, José Ramires, Wilson Mathias
Cardiovascular Ultrasound , 2006, DOI: 10.1186/1476-7120-4-7
Abstract: A 50-year-old man with acute myocardial infarction in the lateral wall underwent myocardial contrast echocardiography for the evaluation of myocardial perfusion in the third day post-infarction. A perfusion defect was detected in lateral and inferior walls as well as the presence of contrast extrusion from the left ventricular cavity into the myocardium, forming a serpiginous duct extending from the endocardium to the epicardial region of the lateral wall, without communication with the pericardial space. Magnetic resonance imaging confirmed the diagnosis of impending rupture of the left ventricular free wall. While waiting for cardiac surgery, patient presented with cardiogenic shock and died. Anatomopathological findings were consistent with acute myocardial infarction in the lateral wall and a left ventricular free wall rupture at the infarct site.This case illustrates the early diagnosis of left ventricular free wall rupture by contrast echocardiography. Due to its ability to be performed at bedside this modality of imaging has the potential to identify this catastrophic condition in patients with acute myocardial infarction and help to treat these patients with emergent surgery.Left ventricular free wall rupture occurs in up to 10% of the in-hospital deaths following acute myocardial infarction (AMI), usually between 3 to 6 days after the infarction. It typically involves the anterior or lateral wall, in the terminal region of the left anterior descending coronary artery distribution. It is associated with transmural infarctions involving at least 20% of the left ventricle, and it rarely occurs in areas with good collateral blood supply [1,2]. The local factors that lead to myocardial rupture are thinness of the apical wall at terminal end of blood supply, poor collateral flow and shearing effect of muscular contraction against an inert and stiffened necrotic area. Rupture of the left ventricular free wall usually leads to hemopericardium and death from cardiac
Papel da ecodopplercardiografia na avalia??o da hipertens?o arterial pulmonar
Sbano, Jo?o Cesar Nunes;Tsutsui, Jeane Mike;Terra-Filho, Mário;Mathias Junior, Wilson;
Jornal Brasileiro de Pneumologia , 2004, DOI: 10.1590/S1806-37132004000100014
Abstract: a precise evaluation of pulmonary pressure is of fundamental importance for the diagnosis and management of patients with hypertension of the pulmonary artery (ph). dopper echodopplercardiography is a low cost, non-invasive method in widespread use for anatomical and functional assessment of the right cardiac chambers and estimation of pulmonary pressures, demonstrating a good correlation with the hemodynamic data obtained by cardiac catheterization. although the most adequate and widely used technique for determination of pulmonary pressure is measurement of the gradient between right ventricle and right atrium through tricuspid regurgitation, it can also be performed by analysis of pulmonary regurgitation or systolic pulmonary flow. transesophageal echocardiography is a very useful procedure when acoustic window is limited by transthoracic approach and allows for high quality imaging of cardiac structures and detection of some disorders related to ph. the role of echocardiography is already established in the literature for the diagnosis of ph, as well as for therapeutic and prognostic evaluation. in patients with pulmonary thromboembolism, detection of right ventricular dysfunction by echocardiography is an important input for adoption of thrombolytic therapy. furthermore, this method is already customary in monitoring the therapeutic response in patients with primary in the assessment of chronic obstructive pulmonary disease and in the follow up of patients submitted to pulmonary transplantation.
Infarto do miocárdio causado por les?o arterial coronariana após trauma torácico fechado
Lima, Márcio Silva Miguel;Tsutsui, Jeane Mike;Issa, Victor Sarli;
Arquivos Brasileiros de Cardiologia , 2009, DOI: 10.1590/S0066-782X2009000700013
Abstract: we report the case of a 29-year-old man, victim of a car accident, who suffered a severe blunt chest trauma, with evolving congestive heart failure. he had previously had a good overall health status, with no symptoms of cardiovascular disease. at the initial assessment, the electrocardiogram showed q waves in the precordial leads and the echocardiogram disclosed severe left ventricular dysfunction. coronary angiogram showed a proximal left anterior descending coronary artery lesion, with anterior wall akinesis on contrast-enhanced ventriculography. a thallium-201 single photon emission computed tomography (spect) showed no viability. he remained on medical treatment with good evolution.
Hand-carried ultrasound performed at bedside in cardiology inpatient setting – a comparative study with comprehensive echocardiography
Jeane M Tsutsui, Raquel R Maciel, Joicely M Costa, Jose L Andrade, Jose F Ramires, Wilson Mathias
Cardiovascular Ultrasound , 2004, DOI: 10.1186/1476-7120-2-24
Abstract: We studied 44 consecutive patients (mean age 54 ± 18 years, 25 men) who underwent bedside echocardiography using HCU and CE. HCU was performed by a cardiologist with level-2 training in the performance and interpretation of echocardiography, using two-dimensional imaging, color Doppler, and simple calliper measurements. CE was performed by an experienced echocardiographer (level-3 training) and considered as the gold standard.There were no significant differences in cardiac chamber dimensions and left ventricular ejection fraction determined by the two techniques. The agreement between HCU and CE for the detection of segmental wall motion abnormalities was 83% (Kappa = 0.58). There was good agreement for detecting significant mitral valve regurgitation (Kappa = 0.85), aortic regurgitation (kappa = 0.89), and tricuspid regurgitation (Kappa = 0.74). A complete evaluation of patients with stenotic and prosthetic dysfunctional valves, as well as pulmonary hypertension, was not possible using HCU due to its technical limitations in determining hemodynamic parameters.Bedside evaluation using HCU is helpful for assessing cardiac chamber dimensions, left ventricular global and segmental function, and significant valvular regurgitation. However, it has limitations regarding hemodynamic assessment, an important issue in the cardiology inpatient setting.Bedside echocardiography can bring important anatomical and hemodynamic information for the management of critically ill patients, and is often required in hospitalized patients for the assessment of left ventricular function. Standard echocardiographic equipments, while optimal, have large size and sometimes are difficult to maneuver in the emergency room or intensive care units. Recently, hand-carried ultrasound (HCU) devices have been demonstrated to broaden the versatility in ultrasound application. Due to their portability and low cost, HCU acts like a stethoscope, providing information beyond physical examination at the p
Teratoma of the mediastinum: a case report
Ricardo D Vieira, Henrique Grimberg, Kiyomi K Uezumi, Lea MM Demarchi, Jeane M Tsutsui, Neuza HM Lopes, Whady Hueb
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-193
Abstract: A 22-year-old Caucasian man with no complaints or comorbid conditions presented to our hospital with obliteration of the right cardiophrenic sinus by a mass. A non-invasive investigation demonstrated a tumoral mass which was continuous to the pericardium and caused extrinsic compression to the right atrium. The clinical suspicion was a pericardial or bronchogenic cyst. Surgical and anatomopathologic findings led to the diagnosis of a mature cystic teratoma with atrophic thymic tissue at the external teratoma surface.We present an original report of a mature teratoma causing obliteration of the right cardiophrenic sinus with extrinsic heart compression. The diagnosis of this tumor is very difficult through non-invasive investigation.A teratoma of the mediastinum is an uncommon germ cell tumor, principally when heart structures are involved [1]. Five percent of germ cell tumors are extragonadally located, and men are affected more than women [2]. Most mediastinal teratomas produce no symptoms, and they are more commonly associated with compression of adjacent structures, predominantly those of the respiratory system. Another signal is bleeding or rupture of the tumor into the bronchial tree, pleura, or pericardium. Digestive enzymes from pancreatic tissue or intestinal mucosa into the tumor produce this phenomenon. A rare finding associated with rupture is hair or sebaceous material expectoration [2,3]. The most common tumors found in the anterior mediastinum are of thymic, thyroid, or lymphoid origin and of pericardium or bronchogenic cyst or fat pad [4,5].A 22-year-old Caucasian man with no complaints or co-morbid conditions presented to our hospital after an abnormal medical check-up before being hired for a job. A chest X-ray revealed an obliteration of the right cardiophrenic sinus by a bosselated mass widening the cardiac shadow (Figure 1). The young man was healthy and had good functional capacity. He denied fever, weight loss, previous disease, or any neoplasm
Study of Coronary Sinus Flow Reserve Through Transesophageal Doppler Echocardiography in Normal Subjects
Ramos Filho, José;Ramires, José A. F.;Turina, Marko;Medeiros, Caio J.;Lachat, Mário;Tsutsui, Jeane;
Arquivos Brasileiros de Cardiologia , 2002, DOI: 10.1590/S0066-782X2002001100001
Abstract: objective - to evaluate the coronary flow reserve in the coronary sinus through transesophageal doppler echocardiography in normal subjects. methods - we obtained technically adequate flow samples for analysis in 10 healthy volunteers (37±8 years, 5 men) with no history of heart or systemic disease and with mean left ventricular mass index by transthoracic echocardiography of 87±18 g/m2. coronary sinus flow velocity was recorded within the coronary sinus with the patient in a resting condition and during intravenous adenosine infusion at a dose of 140 μg/kg/min for 4 minutes. recording of coronary sinus blood flow was possible in all cases with measurement of peak systolic, diastolic, and retrograde velocities (psv, pdv, and prv, cm/sec), mean systolic and diastolic velocities (msv and mdv, cm/sec), and systolic and diastolic velocity time integral (vti s and vti d, cm/sec). results - the coronary flow reserve was calculated as the ratio between the blood flow in the basal state and the maximum measured hyperemic blood flow with adenosine infusion. results are shown as mean and standard deviations. (cfr = psv + pdv ? prv/basal psv): 1st min = 2.2±0.21; 2nd min = 3±0.3; 3rd min = 3.4±0.37; 4th min = 3.6 ± 0.33. conclusion - although coronary sinus flow had significantly increased in the first minute, higher velocities were seen at third and fourth minutes, indicating that these should be the best times to study coronary sinus flow with intravenous adenosine in continuous infusion.
Cardiomiopatia de takotsubo como causa de disfun??o ventricular transitória
Alves, Angele A.;Kowatsch, Ingrid;Tsutsui, Jeane Mike;Nicolau, José C.;Lima, Marta F.;Mathias Junior, Wilson;
Arquivos Brasileiros de Cardiologia , 2008, DOI: 10.1590/S0066-782X2008000300013
Abstract: this is the report of a 74-year-old female patient with a history of systemic hypertension and peripheral vascular disease who presented acute coronary syndrome symptoms. coronary angiography showed coronary arteries with no significant obstructions. ventriculography and echocardiography showed akinesia in mid and apical segments; and hyperkinesia of left ventricle basal segments. two weeks after the onset of symptoms, a new echocardiogram demonstrated normal global and regional systolic function. the uncommon, reversible pattern for systolic dysfunction and segmental compromising that gives left ventricle a takostubo-like shape is known today as stress cardiomyopathy.
Uveitis in Miller Fisher Syndrome—A Case Report and Literature Review  [PDF]
Jia Jeane Ngai
Case Reports in Clinical Medicine (CRCM) , 2017, DOI: 10.4236/crcm.2017.612038
Abstract: Purpose: To report an unusual case of Miller Fisher Syndrome (MFS) in which the patient presented with concurrent right eye uveitis. Case Report: We report a case of a 51-year-old gentleman who presented with typical clinical features of Miller Fisher syndrome including ophthalmoplegia, ataxia, areflexia, ptosis and diplopia following an upper respiratory tract infection. Concurrently, he also had right eye uveitis with raised intraocular pressure. The patient was treated with intravenous immunoglobulin (IVIG), topical steroids and anti-glaucoma eye drops in which he demonstrated good recovery. For diagnostic confirmation, serum antiganglioside antibodies (anti-GQ1b IgG) were later reported to be positive. Conclusion: We described the possible association between MFS and uveitis due to its interrelated pathogenesis. This possible association can lead to early detection and treatment of uveitis.
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