[Júlio Dantas and medical archaeology]. / Júlio Dantas e a arqueologia médica.

Júlio Dantas (1876-1962), was a doctor of very restricted practice. Literature was his great passion, and projected him to a place in the Academy and to an interesting diplomatic career. Dantas, an archaizing and baroque writer who lived in the first times of the modernistic trends, became the object of a vivid controversy. We must, however, recognize he was the most successful of the popular playwrights in Portugal, having sold over two hundred thousand copies of his most known play. In Dantas', somewhat irregular work there are very beautiful pages of prose. The retrospective study of the diseases that afflicted the Portuguese kings is the subject of a collectanea of papers, published by Júlio Dantas in 1909, under the title Medical inquiries to the portuguese royal genealogies-Avis and Bragança. The book is within the limits of the so-called medical archaeology, a mix of history and speculation. Dantas presents a generic thesis of degeneration of the royal dynasties of Portugal, explained as natural consequence of heredity and consanguinity. Between the 13th. century and the beginning of the 1800s, monarchs and princes are implacably flagelatted, because of their physical diseases or moral faults. Isabel of Aragon, the saint-queen; prince Henry the Navigator; even the national hero, the constable Nun'Alvares, as many others, do not escape the severity of an analysis which, in most cases, is not medically accurate.

[Effects of cardiac and renal disease on clinical pharmacokinetics]. / Efeitos da patologia cardíaca e renal em farmacocinética clínica.

In this oral presentation, the author emphasized the need for individualization of drug treatment, reviewing the most known factors of variability in drug response. The importance of studies of clinical pharmacokinetics was focused. The main parameters for a judgement on the efficacy and virtual tolerability of a medicine, on the basis of its sequential concentrations in the blood after administration, were briefly outlined. The influence of congestive heart failure on the volume of distribution, systemic clearance, elimination half-life and bioavailability, was discussed. The changes that renal failure makes in drug elimination were equally presented, having been pointed the modification of protein binding, volume of distribution, and hepatic elimination. A selection of eight clinical cases was summarily presented, to illustrate the important contribute that can be afforded to practice by pharmacokinetics. The dosing of aminoglycosides and of other drugs with narrow therapeutic ranges was evaluated through some of the examples. A case of complex interferences of heart failure, renal failure and therapeutic hemoperfusion on the kinetics of an antibiotic drug was included. Two cases of intoxications (phenytoin and theophylline), whose management has been greatly improved by repeated drug dosing in blood, were discussed, too. A special call of attention was made to the need the currently practicing physician has of being aware of kinetic characteristics of the drugs he prescribes, and of how can disease modify the body fate of those medicines, and their therapeutic and nontherapeutic effects.

[Arterial pressure and race. A study in pauper children attending schools in an urban strip in Lisbon]. / Pressão arterial e raça. Um estudo em crianças pobres de escolas duma franja urbana de Lisboa.

OBJECTIVE: To determine whether race is a factor of blood pressure levels in school-age children of similar social status, and to investigate other potential determinants of the levels of blood pressure. DESIGN: Inquiry in schools of the suburbs of Lisbon. SETTING: Three schools, four medical observers (general practitioners with school-health functions). SUBJECTS: Three hundred ninety seven children, aged 6-14 years, both sexes, 296 being white and 101 non-white. INTERVENTIONS: Inquiry to the following individual characteristics--sex, age, race, birthplace, type of housing, house availability of water, electricity and waste water, type of transportation to school, number of cohabitans, family income, school marks. Individual determination of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), weight and height. MEASUREMENTS AND MAIN RESULTS: Blood pressure values were cross-analyzed with all the determined variables, and the virtual correlations were checked. Main results as follows: Race does not influence either SBP or DBP. In this age group, sex does not influence blood pressure values. The used markers of socioeconomical status have equally no influence on blood pressure. Age has only a significant repercussion on SBP. No significant correlation was found between height and blood pressure. Body weight, however, influence either SBP or DBP. SBP was found to be lower in the second of two successive measurements, and the difference increases with age. CONCLUSIONS: In this school-aged biracial population, body weight seems to be the major factor of blood pressure levels, in the sense-bigger weight, higher SBP and DBP.

[Congenital cardiopathies at an internal medicine service]. / Cardiopatias congénitas num serviço de medicina interna.

STUDY OBJECTIVE: Description of 32 cases of congenital heart disease in the adulthood, admitted in the First Department of Medicine of Hospital Santa Maria, Lisboa between 1980 and 1989. DESIGN: Retrospective study. SETTING: Admission from the Emergency Room and Outpatients Clinic to an Internal Medicine Department of a General Hospital. PATIENTS: Adult patients with congenital heart disease. MATERIAL AND METHODS: All the 32 cases of congenital heart disease admitted between the 1st January 1980 and the 31st December 1989 were studied retrospectively. The clinical findings diagnosis and special examinations were analysed. MAIN RESULTS: The admission age varied between 15 and 83 years old being 21 female (65.6%) and 11 males (34.4%). The 32 cases of congenital heart disease, were distributed as follows: 19 were atrial septal defects (ASD); 4 were bicuspid aortic valves; 3 were coarctations of the aorta; 3 were tetralogy of Fallot; 2 were patent ductus arteriosus; 1 was an Ebstein anomaly with cianosis. From the 19 cases of atrial septal defect (ASD), 15 were female and 4 were male. The mean age of admission was 57.1 +/- 14.9. Congestive heart failure (CHF) was the reason for admission in 11 cases. The EKG findings were atrial fibrillation (AF) in 11 cases and atrial flutter in 1. Pulmonary hypertension was observed in the 17 echocardiographically documented cases. Infeccious endocarditis was diagnosed in 2 of the 4 bicuspid aortic valves. CONCLUSIONS: Congenital heart disease is not a very rare disease. In our 32 cases, 19 (59%) were ASD. CHD and AF were very common in this patology, in relation to the advanced age of this population. The echocardiography was a very useful diagnostic procedure. The 2 infective endocarditis cases between the 4 bicuspid aortic valves, is a way to remember the importance of prophylaxis.

[Hypertensive hypertrophy of the left ventricle: its regression in hypertensive patients with different profiles of plasma renin activity, treated with enalapril]. / Hipertrofia ventricular esquerda hipertensiva: sua regressão em hipertensos com diferentes perfis de actividade da renina plasmática, sob terapêutica com enalapril.

STUDY OBJECTIVE: To determine the action of enalapril maleate in cardiac mass and ventricular performance; to investigate virtual differences of anti-hypertensive action, and regression of left ventricular hypertrophy, between subgroups of patients with different profiles of plasma renin activity (PRA). DESIGN: Randomized, single-blind, placebo-controlled study, along 14 weeks, the last 12 under active treatment with enalapril maleate. SETTING: Outpatient clinics of an university department of Internal Medicine and Cardiology. PATIENTS: Sequential series of twenty patients with mild to moderate essential hypertension. Two patients were lost to follow-up. Eighteen patients completed the study. Seventeen out of them were studied for plasma renin activities, and echocardiographic measurements were performed in ten, during the 2 weeks placebo period, and by the end of active treatment. No patients were excluded because of side-effects. INTERVENTION: After a 2-weeks washout period, enalapril maleate has been given in a single daily dose of 20 mg, at bedtime. In 14 patients the dosage was elevated to 40 mg once daily and, in 5 out of these, 12.5 mg hydrochlorothiazide once a day has been added. MEASUREMENTS AND MAIN RESULTS: The mean of systolic/diastolic sitting blood pressures was reduced from 171.6/112 to 151.6/98.1 mmHg (p less than 0.001). The mean of systolic/diastolic standing blood pressures lowered from 167.8/113.7 to 148.6/99.6 mmHg (p less than 0.001). No significant differences were found between blood pressure reductions in 5 patients with elevated PRA, 5 patients with slightly elevated PRA, and 7 patients with normal or low PRA. The analysis of echocardiographic measurements revealed regression of left ventricular hypertrophy (LVH) and, in one patient who had no criteria of LVH, actually occurred reduction of the thickness of ventricular walls. No unfavourable influence over ventricular function indices, neither systolic nor diastolic, was found. End-systolic stress and inotropic activity remained unchanged. The tolerability of the study drug was very good. CONCLUSIONS: Enalapril maleate appears, in this study, an effective anti-hypertensive compound. Its therapeutic action seems independent of the plasma renin activity profile. The drug induced regression of left ventricular hypertrophy after a period of 12 weeks of treatment, and did not promote any unfavourable influence over ventricular functions indices. Inotropic activity and end-systolic stress were not modified. The tolerability was very good.

[The effectiveness of amiodarone seems to depend highly on the pathology underlying the arrhythmia]. / A eficácia da amiodarona parece depender fortemente da patologia subjacente à arritmia.

STUDY OBJECTIVE: To evaluate the efficacy of amiodarone in tachyarrhythmias occurring acutely, in patients with different nosological entities of the heart. DESIGN: A retrospective study. SETTING: Emergency-room patients and ward-patients, in an Internal Medicine Department of a University Hospital. PATIENTS: Sequential sample of 148 patients with acute tachyarrhythmias, 138 out of them supraventricular (atrial fibrillation--116 cases; paraoxysmal supraventricular tachycardia--14 cases, and atrial flutter--8 cases). INTERVENTIONS: 81 patients had been treated with amiodarone; 67 patients had received several other antiarrhythmic drugs. MEASUREMENTS AND MAIN RESULTS: A favourable result of antiarrhythmic treatment was achieved in 84% of the patients who received amiodarone and in only 57% of those having been treated with the other antiarrhythmic drugs (p less than 0.025). A clearly distinct benefit of amiodorone was seen in the subgroup of patients with mitral stenosis, when compared with the whole of the other treatments (p less than 0.001). Amiodarone results were also better than the other antiarrhythmic ones in hypertensive patients (p less than 0.05). There was no difference between amiodarone and the remaining compounds in patients suffering from ischaemic heart disease, congestive heart failure and chronic obstructive lung disease. No adverse side effects were verified is this short term treated sequence of patients. CONCLUSIONS: Amiodarone seems, in this study, to be a very effective antiarrhythmic drug for the treatment of supraventricular tachyarrhythmias. Its efficacy was superior in cases where the underlying disease was mitral stenosis or arterial hypertension. So, effectiveness of the compound seems to depend on the nature of the subjacente cardiac disease. The short term tolerability has been excellent. However, the small number of patients studied claims for bigger scaled similar investigations.