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Search Results: 1 - 10 of 30979 matches for " Altamiro Ribeiro Dias Jr. "
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Fanconi anemia and vaginal squamous cell carcinoma
Altamiro Ribeiro Dias Jr.,Marcela Cavalcante de Andrade Silva,Filomena Marino de Carvalho,Heloisa de Andrade Carvalho
Rare Tumors , 2012, DOI: 10.4081/rt.2012.e4
Abstract: Fanconi Anemia (FA) is an autosomal recessive disease characterized by chromosome instability, cellular hypersensitivity to DNA cross-linking agents, and increased predisposition to malignancies. We describe here a 28 year-old female with FA and vaginal squamous cell carcinoma treated by radiation therapy alone. The patient developed arm phlebitis, pulmonary fungal infection, and severe rectal bleeding, followed by hypocalcaemia, hypokalemia, vaginal bacterial and fungal infection, with subsequent leg and arm phlebitis, perineal abscess, and sepsis. The patient died 12 weeks later.
Aortic root reconstruction through valve-sparing operation: critical analysis of 11 years of follow-up
Dias, Ricardo Ribeiro;Mejia, Omar V;Carvalho JR, Edemir V;Lage, Diogo O. C;Dias, Altamiro Ribeiro;Pomerantzeff, Pablo M. A;Mady, Charles;Stolf, Noedir A. G;
Revista Brasileira de Cirurgia Cardiovascular , 2010, DOI: 10.1590/S0102-76382010000100015
Abstract: introduction: the composite mechanical valve conduit replacement is the standardized operation for aneurysms of the aortic root. the objective of this study is to evaluate the long-term surgical results of aortic valve-preserving procedures to the root reconstruction. methods: from 1996 to 2008, 54 consecutive patients underwent two different techniques of valve-sparing aortic root operation (40 yacoub operations and 14 david operations). mean age was 48 ± 14 years (range 17 to 74). 36 patients (66.7%) were male and 16 (29.6%) experienced marfan's syndrome. the mean euroscore was 4 ± 1.25. the mean follow up time was 4.1 years (from 49 days to 10.9 years). clinical and echocardiographic parameters were analysed. t-student paired test, the mcnemar non parametric test and the kaplan-meyer outcome curves have been used. results: the hospital mortality was 5.6% and the average hospitalization time was 9±4 days. one non related late death (2%) was reported. the actuarial survival and freedom from reoperation were respectively 94.4% and 96% within 11 years of follow-up. there were benefits in reduction of functional class (p=0.002; 78% cf i), in reduction of aortic regurgitation (p<0.001; 78% with or without discrete reflux), in reduction of systolic and diastolic diameters, end-sytolic and end-diastolic volumes of left ventricle (respectively p=0.004; p<0.0001; p=0.036 and p<0.001). two (3.9%) patients required aortic valve replacement due to severe aortic regurgitation during this same period. no thromboembolic, endocarditis or bleeding events were reported during the follow-up. conclusion: the valve-sparing operation for aortic root aneurysms is an effective alternative to the use of a mechanical valve conduit replacement.
Tratamento cirúrgico da les?o isolada de óstio coronário esquerdo
Dias, Ricardo Ribeiro;Dias, Altamiro Ribeiro;Jatene, Marcelo B;Jatene, Adib D;
Revista Brasileira de Cirurgia Cardiovascular , 1995, DOI: 10.1590/S0102-76381995000300007
Abstract: the experience of the heart institute of the university of sao paulo with surgical management of left coronary ostial lesions was made of 11 patients. they were operated on from january 1984 to july 1994. eight of them were female, 3 were male. they were of white race. the ages ranged from 39 to 68 years old (mean 53). two patients were asymptomatic, 2 were with unstable angina and the others with chronic angina. all of them had ostial stenosis of 90% or more. they were operated on with cardio-pulmonary bypass, posterial oblique aortotomy prolonged through the left main coronary artery. the ostioplasty was made with saphenous vein patch in 8 cases and with gluteraldehyde preserved xenopericardial patch in 3 cases. the aortic root biopsies showed inespecif mucoid infiltrations in all studied cases. all patients were angiografically studied 2 weeks after surgery. the ostial angioplasty were opened widely in all cases. one patient died 7 hours after angiografic study, and the necropy revealed a large thrombus of 8 mm inside of the left ostioplasty. one patient died 9 months later, with a diagnosis of hepatitis. the other 9 patients have been followed up from 6 months to 10 years, and are all free of angina and doing well. the results take us to believe that the surgical technique is applicable to this kind of stenosis, with good results
Mini-sternotomy for the treatment of aortic valve lesions
Dias Altamiro Ribeiro,Dias Ricardo Ribeiro,Gaiotto Fábio,O. Júnior José Lima
Arquivos Brasileiros de Cardiologia , 2001,
Abstract: OBJECTIVE: To compare inverted-L mini-sternotomy performed above the sternal furcula with conventional sternotomy in patients with aortic valve diseases who undergo surgical treatment. METHODS: We operated upon 30 patients who had aortic valve lesions that had clinical and hemodynamic findings. All patients underwent inverted-L sternotomy, which extended from above the manubrium of the sternum to the 3rd right intercostal space, without opening the pleural cavity. Their ages ranged from 32 to 76 years, and 18 were males and 12 were females. We used negative pressure in a venous -inch cannula, and the patients were maintained in Trendelemburg's position. Twenty-seven patients received bioprostheses with diameters ranging from 23 to 29mm. Three patients underwent only removal of the calcifications of the aortic valve leaflets and aortic commissurotomy. RESULTS: The mean duration of anoxic cardiac arrest was 63.11min. Access was considered good in all patients. One death was due to pulmonary and renal problems not related to the incision. All patients had a better recovery in the intensive care unit, got out of bed sooner, coughed more easily, and performed prophylactic physiotherapeutic maneuvers for respiratory problems more easily and with less pain in the incision. Early ambulation was more easily carried out by all patients. CONCLUSION: Mini-sternotomy proved to be better than the conventional sternotomy because it provided morecomfort for the patients in the early postoperative period, with less pain and greater desire for early ambulation and all its inherent advantages.
Estudo experimental em c es da a o protetora de solu o cardioplégica de lidocaína e potássio
DIAS Altamiro Ribeiro,GUTIERREZ Paulo Sampaio,HIGUCHI Maria de Lourdes,LOUREN??O Rodrigo
Revista Brasileira de Cirurgia Cardiovascular , 2002,
Abstract: OBJETIVO: Os autores estudam experimentalmente em c es a a o cardioplégica de solu o sangüínea normotérmica contendo lidocaína e potássio. MATERIAL E MéTODO: Foram operados 14 animais, de cerca de 25kg, sob anestesia geral e intuba o traqueal. Os c es foram submetidos a esternotomia mediana, sendo canulados a aorta ascendente e o átrio direito, para coloca o em perfus o extracorpórea. Durante o procedimento, foram feitas dosagens gasométricas e de eletrólitos, visando à manuten o de boas condi es cardiocirculatórias. Em 5 c es, os quais comp em grupo designado n o protegido (NP), foi feita a parada cardíaca anóxica, através de pin amento da raiz da aorta, durante 120 minutos. Nesses animais n o foi tomada nenhuma medida visando à prote o miocárdica. No outro grupo, designado grupo protegido (P), o procedimento foi semelhante, sendo que, após o pin amento da aorta, foi feita prote o cardioplégica. A técnica de cardioplegia consistiu em indu o com inje o de 100 mg de lidocaína e 2,5 mEq de potássio, diluídos em 60 ml de sangue da linha arterial, após o que infundiu-se sangue durante 30 segundos. A parada cardíaca foi imediata. A fase de manuten o consistiu em infus es de sangue da linha arterial, por 30 segundos, de 20 em 20 minutos. RESULTADOS: Todos os animais desse grupo protegido sobreviveram enquanto que no grupo n o protegido, após o restabelecimento da circula o coronariana pelo desclampeamento aórtico, todos vieram a falecer. Em todos os 14 animais foram feitas determina es ecocardiográficas de fra o de eje o e delta D, sendo esses valores normais. Verificamos que, no grupo protegido, houve queda desses valores de cerca de 30% na primeira hora pós suspens o da perfus o. Esses valores foram determinados novamente cerca de 5 horas pós suspens o da perfus o e revelaram-se normais. Após essa segunda avalia o ecocardiográfica, os animais foram sacrificados para estudo anatomopatológico à microscopia óptica e eletr nica. Estes estudos revelaram intensas altera es morfológicas compatíveis com necrose celular no grupo n o protegido. No grupo de animais em que se utilizou a cardioplegia, as altera es microscópicas e utramicroscópicas foram inexpressivas. CONCLUS O: A técnica de cardioplegia apresentada garantiu a sobrevida dos animais, após 120 minutos de parada cardíaca anóxica, com boa performance ecocardiográfica e morfológica, dentro da metodologia utilizada.
Immediate and long term evolution of valve replacement in children less than 12 years old
Atik Fernando Antibas,Dias Altamiro Ribeiro,Pomerantzeff Pablo M. A.,Barbero-Marcial Miguel
Arquivos Brasileiros de Cardiologia , 1999,
Abstract: OBJECTIVE: The aim of this work was the follow-up and evaluation of valve replacement in children under 12 years of age. METHODS: Forty-four children less than 12 years old were underwent valve replacement at INCOR-HCFMUSP between January 1986 and December 1992. Forty (91%) were rheumatic, 39 (88.7%) were in functional classes II or IV, 19 (43.2%) were operated upon on an emergency basis, and 6 (13.6%) had atrial fibrillation. Biological prostheses (BP) were employed in 26 patients (59.1%), and mechanical prostheses (MP) in 18 (40.9%). Mitral valves were replaced in 30 (68.7%), aortic valves in 8 (18.2%), a tricuspid valve in 1 (2.3%), and double (aortic and mitral) valves in 5 (11.4) of the patients. RESULTS: Hospital mortality was of 4.5% (2 cases). The mean follow-up period was 5.8 years. Re-operations occurred in 63.3% of the patients with BP and in 12.5% of those with MP (p=0.002). Infectious endocarditis was present in 26.3% of the BP, but in none of the cases of MP (p=0.049). Thrombosis occurred in 2 (12.5%) and hemorrhage in one (6.5%) of the patients with a MP. Delayed mortality occurred in 5 (11.9%) of the patients over a mean period of 2.6 years; four had had BP and one had a MP (NS). Actuarial survival and re-operation-free curves after 10 years were respectively, 82.5±7.7 (SD)% and 20.6±15.9%. CONCLUSION: Patients with MP required fewer re-operation, had less infectious endocarditis and lower late mortality rates compared with patients with bioprostheses. The former, therefore, appear to be the best valve replacement for pediatric patients.
Análise do tratamento cirúrgico da raiz da aorta com o tubo valvulado e com a preserva??o da valva aórtica
Dias, Ricardo Ribeiro;Mejia, Omar Asdrubal Vilca;Fiorelli, Alfredo Inácio;Pomerantzeff, Pablo Maria Alberto;Dias, Altamiro Ribeiro;Mady, Charles;Stolf, Noedir Antonio Groppo;
Revista Brasileira de Cirurgia Cardiovascular , 2010, DOI: 10.1590/S0102-76382010000400012
Abstract: objective: comparative analysis of early and late results of aortic root reconstruction with aortic valve sparing operations and the composite mechanical valve conduit replacement. methods: from november 2002 to september 2009, 164 consecutive patients with mean age 54 ± 15 years, 115 male, underwent the aortic root reconstruction (125 mechanical valve conduit replacements and 39 valve sparing operations). sixteen percent of patients had marfan syndrome and 4.3% had bicuspid aortic valve. one hundred and forty-four patients (88%) were followed for a mean period of 41.1 ± 20.8 months. results: the hospital mortality was 4.9%, 5.6% in operations with valved conduits and 2.6% in the valve sparing procedures (p <0.05). there was no difference neither in survival (95% ci = 86% - 96%, p= 0.1) nor in reoperation-free survival (95% ci = 85% - 90%, p = 0.29). the survival free of complications such as bleeding, thromboembolism and endocarditis were favorable to the valve sparing operations, respectively (95% ci = 70% - 95%, p = 0.001), (95% ci = 82% - 95% p = 0.03) and (95% ci = 81% - 95%, p = 0.03). multivariate analysis showed that creatinine greater than 1.4 mg/dl, cabrol operation and renal dialysis were predictors of mortality, respectively, with occurrence chance of 6 (95% ci = 1.8 - 19.5, p = 0.003), 12 (95% ci = 3 - 49.7, p = 0.0004) and 16 (95% ci = 3.6 - 71.3, p = 0.0002). conclusions: the aortic root reconstruction has a low early and late mortality, high survival free of complications and low need for reoperation. during the late follow-up, valve sparing aortic root reconstructions presented fewer incidences of bleeding, thromboembolic events and endocarditis.
Surgical treatment of active infectious endocarditis: a study of 361 surgical cases
Dias, Altamiro Ribeiro;Pomerantzeff, Pablo M.;Brand?o, Carlos Manoel A.;Dias, Ricardo Ribeiro;Grinberg, Max;Lahoz, Eliecer Villamizer de;Oliveira, Sérgio Almeida de;
Revista Brasileira de Cirurgia Cardiovascular , 2003, DOI: 10.1590/S0102-76382003000200010
Abstract: objective: to report on the experience achieved with the surgical treatment of 361 patients with acute infectious endocarditis who were operated on in the heart institute of the university of s?o paulo. method: the ages of the patients ranged from 3 to 81 years, with an average age of 38 ± 8.3 years. there were 230 male patients. it was possible to identify the etiologic agent in 311 (86.20%) patients. the diagnosis of acute infectious endocarditis was obtained by clinical, echocardiographic and microbiological evaluations. two hundred and five patients had lesions of heart valves and 156 patients had lesions of cardiac valvular prostheses. ninety had annular abscesses and 11 had fistulae. of the group of diseased native valves, 104 (50.73) were operated on because of severe heart failure and 87 (42.44%) because of progressive sepsis. all natural aortic valves (136) were replaced by artificial valves. there were 107 diseased native mitral valves. in this group partial resections of infected tissue (vegetations) were carried out in 13 patients while maintaining the valvar apparatus. of the 16 infected tricuspid valves, 8 were replaced. all the prostheses were substituted. the abscesses were cleaned and closed when their diameter was less than 10 mm. the larger abscesses were cleaned and closed with a pericardial graft, which was the support for the artificial valve. results: there were 75 (20.78%) hospital deaths, most of which caused by heart problems and their complications. there were 15 cases of postoperative endocarditis, 10 of which were re-operated on. the late follow-up showed good functional and clinical results, with 222 (77.62%) patients as nyha class i. conclusions: when indicated, the surgical treatment must be instituted as early as possible. all diseased and infected tissue must be removed to achieve good results.
Modelo experimental de bandagem ajustável do tronco pulmonar para preparo rápido do ventrículo
DIAS, Carlos A.;ASSAD, Renato S.;CANEO, Luiz F.;ABDUCH, Maria Cristina D.;AIELLO, Vera D.;DIAS, Altamiro Ribeiro;BARBERO-MARCIAL, Miguel;
Revista Brasileira de Cirurgia Cardiovascular , 2000, DOI: 10.1590/S0102-76382000000400007
Abstract: objective: a device for pulmonary trunk (pt) banding with percutaneous adjustment was developed with the aim of inducing rapid hypertrophy of the subpulmonary ventricle. material and methods: it consists of a silicon cuff occluder which holds the pulmonary trunk; an extension tube that connects the cuff to an auto-sealing silicon button, in which water is injected percutaneously to inflate the cuff and adjust the systolic load to the subpulmonary ventricle. the hearts of seven young goats (average wt.: 8.7 kg) were submitted to systolic overload imposed by the device and assessed under hemodynamic, echocardiographic and morphologic aspects. baseline myocardial samples of the right ventricular outflow tract were harvested for microscopic analysis (perimeter and area of the myocyte). the device was then placed on the pt. the pressures in the right ventricle (rv), pt and aorta were monitored. after convalescence, the protocol of insufflation of the banding device was initiated in order to achieve a rv systolic pressure 70% of the left ventricle systolic pressure. the hemodynamic and echocardiographic evaluations were performed every 24 hours. the rv systolic overload was maintained through a 96 hours period, with gradual insufflations of the cuff every 24 hours, according to the tolerance of the animal to the pressure load. after this period, the animals were killed for morphologic evaluation of the heart. another nine goats (average wt.: 7.7 kg) were used as control group to compare the ventricle muscle weight. results: after 96 hours of rv systolic overload, it was observed an increase in systolic gradient rv/pt, from 10.1±4.3 mmhg to 60,0±11,0 mmhg and in the rv systolic pressure, from 22.4±4.1 mmhg to 71.0±10.0 mmhg (p<0.0001). serial echocardiography showed an increase of the rv thickness, from 4.4±0.5 mm to 7.3±1.7 mm (p=0.001). regarding rv weight, there was a 74% increase in the rv submitted to the systolic overload, when compared to the control group (p<0.0001
Immediate and long term evolution of valve replacement in children less than 12 years old
Atik, Fernando Antibas;Dias, Altamiro Ribeiro;Pomerantzeff, Pablo M. A.;Barbero-Marcial, Miguel;Stolf, Noedir Antonio Groppo;Jatene, Adib Domingos;
Arquivos Brasileiros de Cardiologia , 1999, DOI: 10.1590/S0066-782X1999001100002
Abstract: objective: the aim of this work was the follow-up and evaluation of valve replacement in children under 12 years of age. methods: forty-four children less than 12 years old were underwent valve replacement at incor-hcfmusp between january 1986 and december 1992. forty (91%) were rheumatic, 39 (88.7%) were in functional classes ii or iv, 19 (43.2%) were operated upon on an emergency basis, and 6 (13.6%) had atrial fibrillation. biological prostheses (bp) were employed in 26 patients (59.1%), and mechanical prostheses (mp) in 18 (40.9%). mitral valves were replaced in 30 (68.7%), aortic valves in 8 (18.2%), a tricuspid valve in 1 (2.3%), and double (aortic and mitral) valves in 5 (11.4) of the patients. results: hospital mortality was of 4.5% (2 cases). the mean follow-up period was 5.8 years. re-operations occurred in 63.3% of the patients with bp and in 12.5% of those with mp (p=0.002). infectious endocarditis was present in 26.3% of the bp, but in none of the cases of mp (p=0.049). thrombosis occurred in 2 (12.5%) and hemorrhage in one (6.5%) of the patients with a mp. delayed mortality occurred in 5 (11.9%) of the patients over a mean period of 2.6 years; four had had bp and one had a mp (ns). actuarial survival and re-operation-free curves after 10 years were respectively, 82.5±7.7 (sd)% and 20.6±15.9%. conclusion: patients with mp required fewer re-operation, had less infectious endocarditis and lower late mortality rates compared with patients with bioprostheses. the former, therefore, appear to be the best valve replacement for pediatric patients.
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