J P Ribeiro

Hospital Curry Cabral

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Susan Marum

Instituto Português de Oncologia de Coimbra Francisco Gentil

Paulo Marcelino

Hospital de Santa Marta

Raphael Boesche Guimarães

Associação Saúde da Família

Alfonso Alvarado-Lorenzo

Universidad de Salamanca

Joaquim Antônio César Mota

Universidade Federal de Minas Gerais

João Antônio de Queiroz Oliveira

Centro Universitário do Norte

Erikson M. Brum

Mario Sánchez Borges

Centro Médico Docente La Trinidad

José C. Raudales

Universidade Luterana do Brasil

Alexandre Perin

Cooperative Institutions

Hospital de Clínicas de Porto Alegre

Universidade Federal do Rio Grande do Sul

Hospital Curry Cabral

Hospital de Clínicas

Fundação Universitária de Cardiologia

Instituto Português de Oncologia de Coimbra Francisco Gentil

University of Lisbon

Universidade Federal de Minas Gerais

Universidade Federal do Amazonas

Universidade Luterana do Brasil

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[Hybrid or continuous renal replacement techniques for unstable haemodynamic patients in the intensive care unit].

DOAJ (DOAJ: Directory of Open Access Journals) (2007)

Paulo Marcelino Susan Marum Ana Paula Fernandes J P Ribeiro

Comparative study to evaluate the impact of a hybrid renal replacement technique (HRRT) vs a continuous renal replacement technique (haemodiafiltration) on hemodynamic tolerance, azotemic control, and mortality in critical care patients with acute renal failure.a 14-bed Intensive Care Unit (ICU).Two groups of patients were retrospectively compared: patients submitted to continuous renal replacement techniques (CRRT) in 2003 (n = 26) and patients who underwent HRRT in 2004 (n = 27). Both groups had similar severity scores and underlying diseases, and were haemodynamically unstable. Urea and creatinine reduction ratio (URR and CRR) in both groups were evaluated.Patients treated with HRRT presented a lower mortality (62% vs 84%), less heparin use, and a higher URR and CRR. Univariate logistic regression showed that an increase in APACHE II was related to an increase in mortality (CI 95%, 1.03-1.26). Odds for mortality for CRRT group were about 3 times higher (CI 95%, 0.86-12.11), but not statistically significant (p = 0.074).HRRT is a valid alternative to CRRT in haemodynamically unstable critically ill patients.

Renal replacement therapy

Univariate analysis

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Emergency department evaluation of orthotopic liver transplant recipients

Critical Care (2000)

Germano Couto Susan Marum João Antônio de Queiroz Oliveira M Rui Silva J P Ribeiro

The awareness of the diagnostic difficulty and the documented high mortality risk of perioperative myocardial infarction (PMI) has led to the wide use of work up to rule out PMI after major noncardiac operations.This has caused stable postoperative patients to be kept in monitored hospital beds for extended periods of time and to be subjected to additional tests.We hypothesized that the mortality of PMI is high and, therefore, the wide use of postoperative work up to identify these patients is justifiable.We performed the following study to prove our hypothesis.All patients in the recovery room after major noncardiac operations who underwent work up to rule out PMI were identified and followed.The PMI work up included care in an electronically monitored unit, physical assessment, continuous ECG monitoring, and three 12lead electrocardiograms and cardiac enzymes obtained at six to eight hour intervals.Data collection included patient demographics; preoperative cardiac risk factors; incidence of intraoperative hypotension, hemorrhage and ECG changes; type of anesthesia and operative procedures and their durations; postoperative ECG and cardiac enzyme results; the incidence of PMI and patient outcome.Two hundred patients were studied; 85 males and 115 females.Their mean age was 62.9 years.Preexisting conditions included hypertension in 162 patients, peripheral arterial disease in 102, diabetes mellitus in 97, angina in 30, previous myocardial infarction in 41, and smoking in 107.Of 200 patients, 164 had an abnormal preoperative ECG.Vascular operations were performed in 104 patients, nonvascular abdominal operations in 48, and other operations in the remaining 48.Intraoperatively, hypotension occurred in 29 patients, blood loss of >500 ml in 25 and ECG changes in 10.There were no deaths.PMI occurred in 5/200 (2.5%) patients.Four had undergone vascular operations and one had had an abdominal operation.The mean age of the patients with PMI was 64.2 years.The duration of operation and blood loss were similar to those of patients without PMI.None of these patients developed cardiac failure or cardiogenic shock and none of them died. Conclusion:The incidence of PMI among patients undergoing noncardiac surgery is low and its mortality is negligible.Physicians should become more selective in the use of monitored beds and in the ordering of a work up to rule out PMI. P2

10.1186/cc862

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[Acute effects of isosorbide mononitrate on blood circulation and myocardial ischemia in patients with coronary atherosclerosis].

PubMed (1995)

Waldomiro Carlos Manfrói Alcides José Zago J P Ribeiro José C. Raudales Luciane Fanti

To evaluate the acute effects of isosorbide mononitrate on circulation, cardiac function and left ventricular segmental motility in patients with isquemic heart disease due to coronary artery disease.Twenty-four patients with ischemic heart disease, 10 women, with mean age of 58 years, were studied during cardiac catheterization, at baseline condition and 5min after intravenous infusion of 0.3mg/kg of isosorbide mononitrate.After infusion of isosorbide mononitrate there were significant reduction in mean right atrial pressure no mean pulmonary artery pressure (< 0.0001), left ventricular and diastolic pressure (p < 0.004), left ventricular systolic pressure (p < 0.002), maximum (p < 0.002) and mean (p < 0.008) aortic pressure, and left ventricular systolic volume (p < 0.004), as well as significant increase in the left ventricular ejection fraction (p < 0.001) and mean velocity of circunferential fibers shortening (p < 0.001). There was no significant modification of minimum aortic pressure, heart rate, cardiac output nor of left ventricular and diastolic volume. With respect of segmental motility of the left ventricle after medication, 38 kypokinetic segments normalized their motility, 4 akinetic segments remained intact, and of the 21 dyskinetic segments, 6 normalized, 8 became hypokinetic and 7 remained dyskinetic.Isosorbide mononitrate, when used as intravenous infusion, have a rapid and direct effect on systemic and pulmonary circulation, and improving segmental motility and left ventricular performance in patients with impaired left ventricular motility caused by ischemic heart disease.

Isosorbide mononitrate

Ventricular pressure

Aortic pressure

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EXERCISE-INDUCED MYOCARDIAL ISCHEMIA DETECTION: A NEW SCENARIO FOR CARDIOPULMONARY EXERCISE TESTING?

Eva Cantalejo Munhoz J P Ribeiro

Physical exercise

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[Transesophageal echocardiography in patients treated with ventilation at a polyvalent intensive care unit].

PubMed (1997)

Paulo Marcelino M R Silva Raphael Boesche Guimarães J P Ribeiro Joaquim Antônio César Mota

Scope (computer science)

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[Acute myocardial infarction in the thrombolytic era: high mortality in elderly patients].

PubMed (1993)

Carísi Anne Polanczyk K Prado Mario Sánchez Borges J P Ribeiro

Patients with acute myocardial infarction (AMI) admitted to a general hospital are very different from those reported in large multicenter trials.To evaluate the in-hospital mortality in patients with AMI admitted to a general hospital in the thrombolytic era, and to identify factors associated with poor prognosis.113 consecutive patients admitted with AMI in one year at the Hospital de Clínicas of Porto Alegre were studied. Several clinical and laboratory variables related to higher risk were evaluated. According to the hospital routine, 47% of the patients received thrombolytic therapy, and the effects and complications of its use were studied.In-hospital mortality was 19.5%. By univariate analysis, age, female gender and peak creatinephosphokinase level were significantly associated with early mortality. By multiple logistic regression analysis, advanced age was the only predictive variable, even after adjusting for other baseline risk factors. In patients older than 70 years, in-hospital mortality was 41% versus only 8.1% in the younger group. There was no difference in survival with the presence of others factors such as previous myocardial infarction, use of thrombolytic therapy, heart failure, infarcted area, diabetes, and systemic hypertension. Among patients who received thrombolytic therapy, an elevated number of adverse effects was observed, and in 9.4% of the cases the complications were serious.The high in-hospital mortality after AMI in a general hospital is associated with the patients' advanced age. In spite of recent therapeutic advances in the treatment of AMI, older patients have not obtained a comparable benefit as that achieved by the younger group.

Univariate analysis

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Lack of association between thyroid function and mitral valve prolapse in Graves' disease.

PubMed (1990)

Alfonso Alvarado-Lorenzo J P Ribeiro Fernando Freitas J L Gross

1. To determine whether the association between mitral valve prolapse and Graves' disease is related to thyroid function, three groups of individuals were studied: 16 patients with Graves' disease and hyperthyroidism (hyperthyroid: T4 greater than 11.5 micrograms/100 ml), 16 patients with Graves' disease without hyperthyroidism (euthyroid: T4 less than 11.5 micrograms/100 ml), and 40 healthy individuals. The three groups were similar in age, sex distribution, and anthropometrical characteristics. 2. All patients were evaluated clinically and by M-mode and two-dimensional echocardiography to determine the presence of mitral valve prolapse. 3. The frequency of mitral valve prolapse was similar in the hyperthyroid (31%) and euthyroid patients (25%), but was higher than in the normal individuals (5%). The frequency of systolic murmur was higher in the hyperthyroid patients (75%) than the euthyroid patients (19%) or the normal subjects (0%); however, the presence of a murmur was not associated with mitral valve prolapse. Hyperthyroid (13%) and euthyroid (13%) patients had a higher frequency of clicks than the normal individuals (0%), and the presence of click was associated with mitral valve prolapse. 4. Although patients with Graves' disease have a higher frequency of mitral valve prolapse, this is not associated with thyroid function. The presence of a click but not the presence of a systolic murmur may be a clinical indicator of mitral valve prolapse in Graves' disease.

Mitral valve prolapse

Thyroid disease

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