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1.
J Expo Sci Environ Epidemiol ; 31(4): 753-768, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-32704083

RESUMO

Endocrine disrupting chemicals (EDCs) are exogenous substances that interfere with the endocrine system and cause adverse effects. We aimed to classify the effects of 24 known EDCs, prevalent in certain occupations, according to four modes of action (estrogenic, antiestrogenic, androgenic, and/or antiandrogenic). A literature search, stratified into four types of literature was conducted (namely: national and international agency reports; review articles; primary studies; ToxCastTM). The state of the evidence of each EDC on sex hormone function was summarized and reviewed by an expert panel. For each mode of action, the experts evaluated the likelihood of endocrine disruption in five categories: "No", "Unlikely", "Possibly", "Probably", and "Yes". Seven agents were categorized as "Yes," or having strong evidence for their effects on sex hormone function (antiandrogenic: lead, arsenic, butylbenzyl phthalate, dibutyl phthalate, dicyclohexyl phthalate; estrogenic: nonylphenol, bisphenol A). Nine agents were categorized as "Probable," or having probable evidence (antiandrogenic: bis(2-ethylhexyl)phthalate, nonylphenol, toluene, bisphenol A, diisononyl phthalate; androgenic: cadmium; estrogenic: copper, cadmium and; anti-estrogenic: lead). Two agents (arsenic, polychlorinated biphenyls) had opposing conclusions supporting both "probably" estrogenic and antiestrogenic effects. This synthesis will allow researchers to evaluate the health effects of selected EDCs with an added level of precision related to the mode of action.


Assuntos
Disruptores Endócrinos , Exposição Ocupacional , Dibutilftalato , Hormônios Esteroides Gonadais , Humanos , Julgamento
2.
Herzschrittmacherther Elektrophysiol ; 25(2): 116-20, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24842776

RESUMO

We present a case of a patient who, after correction of tetralogy of Fallot (TOF), experienced runs of ventricular tachycardia (VT). Mapping of the aortic root showed that the critical component of the reentry was located within the noncoronary cusp. The potential explanations of such an unusual isthmus location may be the presence of myocardial extensions in the aortic root or the close vicinity of the right ventricle (RV) to the noncoronary cusp, since in TOF the aorta overrides the RV. Our case highlights the advantage of using electroanatomic mapping systems together with intracardiac echocardiography in such complex cases.


Assuntos
Ablação por Cateter/métodos , Procedimentos de Cirurgia Plástica/efeitos adversos , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/cirurgia , Tetralogia de Fallot/complicações , Tetralogia de Fallot/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
3.
Physiol Res ; 60(6): 877-85, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21995901

RESUMO

Cardiac resynchronization therapy is not commonly used in the early postoperative period in patients undergoing cardiac surgery who have left ventricular (LV) dysfunction and a history of heart failure. We performed a prospective randomized clinical trial to compare atrial synchronous right ventricular (DDD RV) and biventricular (DDD BIV) pacing within 72 hours after cardiac surgery in patients with an EF ≤35 %, a QRS interval longer than 120 msec and who had LV dyssynchrony detected by real-time three-dimensional echocardiography (RT3DE). Epicardial pacing was provided by a modified Medtronic INSYNC III pacemaker. An LV epicardial pacing lead was implanted on the latest activated segment of the LV based on RT3DE. The study included 18 patients with ischemic heart disease, with or without valvular heart disease (14 men, 4 women, average age 71 years). Patients undergoing DDD BIV pacing had a statistically significant greater CO and CI (CO 6.7±1.8 l/min, CI 3.4±0.7 l/min/m(2)) than patients undergoing DDD RV pacing (CO 5.5±1.4 l/min, CI 2.8±0.7 l/min/m(2)), p<0.001. DDD BIV pacing in the early postoperative period after cardiac surgery corrects LV dyssynchrony and has better hemodynamic results than DDD RV pacing.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Doenças das Valvas Cardíacas/fisiopatologia , Isquemia Miocárdica/fisiopatologia , Cirurgia Torácica , Idoso , Ecocardiografia Tridimensional , Feminino , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/cirurgia , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino , Isquemia Miocárdica/complicações , Isquemia Miocárdica/cirurgia , Período Pós-Operatório , Estudos Prospectivos
5.
Europace ; 12(1): 71-7, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19864311

RESUMO

AIMS: Little is known about the incidence of paroxysmal atrial tachycardias (PAT) in patients with heart failure (HF). The availability of cardiac resynchronization therapy (CRT) devices with extended diagnostics for AT enables continuous monitoring of PAT episodes. The aim of the study was to assess the incidence over time of PAT in HF patients treated with CRT. METHODS AND RESULTS: Consecutive patients in NYHA functional class III or IV despite optimal drug therapy, QRS duration > or = 130 ms, left ventricular ejection fraction < or = 35%, and left ventricular end-diastolic dimension > or = 55 mm were eligible for enrolment. Patients with permanent or persistent atrial fibrillation (AF) were not included in the study. The first follow-up examination was performed 2 weeks after implantation, to optimize atrial sensing and CRT. Subsequent follow-up examinations were carried out 15 and 28 weeks after implantation, to collect the telemetric data. A total of 173 patients (67 +/- 11 years, M 116) were enrolled. Complete arrhythmia monitoring data were available from 120 patients over a mean follow-up of 183 +/- 23 days. Atrial tachycardia episodes were detected through telemetry in 25 of 120 patients (21%) during at least one follow-up examination. Atrial tachycardia episodes were recorded in 29 and 17% (P = NS) of patients with and without previous history of AF, respectively. CONCLUSION: More than 20% of the overall HF patient population treated with CRT suffer PAT episodes. Paroxysmal atrial tachycardia may interfere with response to CRT. Therefore, telemetric data may be relevant to drive the appropriate therapy in each patient.


Assuntos
Fibrilação Atrial/epidemiologia , Fibrilação Atrial/prevenção & controle , Estimulação Cardíaca Artificial/estatística & dados numéricos , Eletrocardiografia Ambulatorial/estatística & dados numéricos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/prevenção & controle , Idoso , Fibrilação Atrial/diagnóstico , Comorbidade , Europa (Continente)/epidemiologia , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Incidência , Masculino , Medição de Risco/métodos , Fatores de Risco , Resultado do Tratamento
7.
Clin Anat ; 22(4): 481-8, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19373904

RESUMO

Musculus dorsoepitrochlearis is a typical muscle variation, which, if in full extent, is represented by the muscular or fibromuscular slip detached from the anteroinferior border of the musculus latissimus dorsi. It passes over the axilla under the axillary fascia crossing the medial side of the brachial plexus and continues as a septum intermusculare mediale brachii distally to the medial epicondyle of humerus. Its full extent is rarely developed-the connection into the intermuscular septum being mostly absent. Muscular slips from the musculus latissimus then insert on various structures in the axilla, often on the crest of greater tubercle of humerus or into the musculus pectoralis major (this variation is known as the axillary arch of Langer) or to other neighboring structures (coracoid process, fasciae of muscles). In our observations, 209 patients with traumatic lesions of the brachial plexus underwent surgical procedure. The presence of the musculus dorsoepitrochlearis has been observed. It was found in the form of various slips from the musculus latissimus dorsi in 4 patients. In 3 of those 4 patients, the innervation was derived from the nervus thoracodorsalis. We also presented 2 case reports of patients with clinical symptoms caused by compression of nerves in the axilla by the dorsoepitrochlear strip.


Assuntos
Axila/inervação , Músculo Esquelético/anormalidades , Músculo Esquelético/embriologia , Síndromes de Compressão Nervosa/etiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Úmero/anatomia & histologia , Lactente , Masculino , Pessoa de Meia-Idade , Músculos Peitorais/anatomia & histologia , Nervos Torácicos/fisiopatologia , Parede Torácica/anatomia & histologia , Nervo Ulnar/fisiopatologia , Adulto Jovem
8.
Physiol Meas ; 29(12): 1371-81, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18946155

RESUMO

Complex fractionated atrial electrograms (CFAEs) may represent the electrophysiological substrate for atrial fibrillation (AF). Progress in signal processing algorithms to identify sites of CFAEs is crucial for the development of AF ablation strategies. A novel algorithm for automated description of fractionation of atrial electrograms (A-EGMs) based on the wavelet transform has been proposed. The algorithm was developed and validated using a representative set of 1.5 s A-EGM (n = 113) ranked by three experts into four categories: 1-organized atrial activity; 2-mild; 3-intermediate; 4-high degree of fractionation. A tight relationship between a fractionation index and expert classification of A-EGMs (Spearman correlation rho = 0.87) was documented with a sensitivity of 82% and specificity of 90% for the identification of highly fractionated A-EGMs. This operator-independent description of A-EGM complexity may be easily incorporated into mapping systems to facilitate CFAE identification and to guide AF substrate ablation.


Assuntos
Algoritmos , Fibrilação Atrial/fisiopatologia , Eletrocardiografia/estatística & dados numéricos , Idoso , Automação , Ablação por Cateter , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Processamento de Sinais Assistido por Computador
9.
Vnitr Lek ; 54(1): 36-44, 2008 Jan.
Artigo em Tcheco | MEDLINE | ID: mdl-18390116

RESUMO

OBJECTIVE: The aim of the study was to analyse general health data, diagnostic and therapeutic procedures, pharmacological treatment and hospitalization of patients with atrial fibrillation (AF) who did not undergo AF catheter ablation and were in the care of outpatient cardiologists. METHOD: Data concerning 306 patients (of which 94 women, aged 64 +/- 11 years) for the preceding 2 years were acquired through a questionnaire containing a set of standardized questions on a simple form sent out to outpatient cardiologists. RESULTS: AF was paroxysmal, persistent or permanent in 141 (46%), 77 (25%) or 88 (28%) patients, respectively. The higher the age, the lower the proportion of paroxysmal AF and the higher the proportion of the permanent form of AF. AF was asymptomatic in 122 (39%) of patients. The most frequent among cardiovascular diseases was hypertension, detected in 220 patients (72%), IHD was present in 83 patients (27%). The mean LV EF was 55 +/- 11% and was significantly lower in patients with permanent AF than in patients with paroxysmal AF (phi 51 +/- 13% vs. phi 58 +/- 9%, P < 0,001). The mean left atrium transversal diameter was 47 +/- 7 mm and was significantly higher in patients with permanent AF than in those with paroxysmal AF (50 +/- 8 mm vs. 44 +/- 6 mm, P < 0,001). 230 patients (75%) received anticoagulation treatment and 43 patients (14%) received antiaggregation treatment. 274 patients (90%) were taking antiarrhythmic drugs (AA); 93 patients were taking 1, 168 patients 2 and 13 patients 3 AA drugs. 167 patients (55%) underwent electrical cardioversion in 362 procedures, 106 patients (35%) underwent pharmacological cardioversion in 239 procedures. Coronarography was performed in 79 patients (26%) of which 59 (75%) had normal results for coronary arteries. Pacemaker due to concomitant sinus node dysfunction was implanted to 27 patients (9%). Ablation for concomitant atrial flutter of type I was performed in 42 patients (14%). AF and associated conditions caused 250 hospitalisations in 144 patients (47%). The average length of hospitalisation was 4.2 +/- 3.2 days. Cardioembolic event was the cause of hospitalisation of 25 patients (8%) out of 29 hospitalisations with the mean length of hospital stay 8.2 +/- 2.9 days. CONCLUSION: The study has shown, in the first place, very high standards of anticoagulation and antiarrhythmic treatment. It has also shown a relatively frequent indication for coronarography, pacemaker implant for relative sinus node dysfunction or ablation for concomitant atrial flutter of type I, i.e. intervention procedures with limited benefit for AF patients.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cardiologia , República Tcheca , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade
11.
Europace ; 5(3): 215-20, 2003 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12842630

RESUMO

BACKGROUND: Tachycardia-induced tachycardia appears to be a relatively rare condition. In such cases an important question arises whether catheter ablation of one arrhythmia may prevent the occurrence of another. This paper reviews single-centre experience with coincident idiopathic outflow tract ventricular tachycardia (VT) and atrioventricular (AV) nodal reentry tachycardia (AVNRT), and strategy of treatment. METHODS AND RESULTS: Seven of 46 patients (15%) with clinically documented idiopathic outflow tract VT were found to have reproducibly inducible AVNRT at the time of an electrophysiological study. There were two men and five women (mean age 35+/-9 years, range 20-44) without structural heart disease. During the study, AVNRT spontaneously triggered VT in three cases. Radiofrequency catheter ablation of the slow pathway did not suppress subsequent inducibility of VT in any of them. Successful catheter ablation of VT did not prevent clinical recurrence of AVNRT in one patient, and led to transition of VT into typical AVNRT in another. CONCLUSION: Coincidence of idiopathic outflow tract VT and AVNRT was found in 15% of cases of clinically documented idiopathic VT. Catheter ablation of one arrhythmia substrate did not prevent inducibility or clinical recurrence of the other. These data support the strategy of performing catheter ablation of both arrhythmia substrates during one session.


Assuntos
Ablação por Cateter , Taquicardia por Reentrada no Nó Atrioventricular/complicações , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Taquicardia Ventricular/complicações , Taquicardia Ventricular/cirurgia , Adulto , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Índice de Gravidade de Doença , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento
13.
J Cardiovasc Electrophysiol ; 12(3): 363-6, 2001 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11291813

RESUMO

Optimum strategy for radiofrequency (RF) catheter ablation of ventricular tachycardia (VT) after inferior wall myocardial infarction (MI) that originates from the posteroseptal process of the left ventricle is not known. We describe a case report of a 57-year-old man who developed recurrent post-MI VT with ECG morphology consistent with this type of VT (i.e., left bundle branch block pattern with predominant R waves from V2 to V6 and left-axis deviation). Endocardial mapping and entrainment during VT demonstrated a critical isthmus of the reentrant circuit in the proximal coronary sinus. RF application terminated VT and rendered it noninducible.


Assuntos
Ablação por Cateter/métodos , Vasos Coronários/cirurgia , Infarto do Miocárdio/complicações , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/cirurgia , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/cirurgia , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/fisiopatologia
16.
West J Med ; 172(4): 234, 2000 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-10778371
17.
West J Med ; 171(5-6): 383-4, 1999 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18751203
18.
Head Neck ; 19(6): 549-53, 1997 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-9278765

RESUMO

BACKGROUND: Synovial sarcoma, a rare tumor in the head and neck, has been historically diagnosed by its characteristic biphasic histologic pattern. Monophasic variants exist which can be difficult to diagnose. METHODS: Two cases of synovial sarcoma of the head and neck are presented. Both cases, cytogenetic analysis was performed using standard protocols. RESULTS: Both tumors demonstrated a chromosomal translocation, t(X;18)(p11.2;q11.2), which either made or confirmed the diagnosis. CONCLUSIONS: Synovial sarcoma contains a characteristic chromosomal translocation which is a useful diagnostic tool, especially when histologic studies are equivocal.


Assuntos
Cromossomos Humanos Par 18/genética , Neoplasias de Cabeça e Pescoço/genética , Sarcoma Sinovial/genética , Translocação Genética/genética , Cromossomo X/genética , Adulto , Idoso , Diagnóstico Diferencial , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Leiomiossarcoma/diagnóstico , Masculino , Neoplasias Parotídeas/diagnóstico , Neoplasias Parotídeas/genética , Neoplasias Parotídeas/patologia , Neoplasias Faríngeas/diagnóstico , Neoplasias Faríngeas/genética , Neoplasias Faríngeas/patologia , Sarcoma Sinovial/diagnóstico , Sarcoma Sinovial/patologia , Neoplasias Cranianas/diagnóstico , Neoplasias Cranianas/genética , Neoplasias Cranianas/patologia
19.
Cardiovasc Drugs Ther ; 11(2): 177-85, 1997 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9140694

RESUMO

Chronic hypoxia induces pulmonary hypertension and right ventricular hypertrophy. These changes are completely reversible, except for persistent myocardial fibrosis. The aim of the present study was to determine whether treatment with the angiotensin-converting enzyme (ACE) inhibitor enalapril can reduce the ventricular collagen content in animals recovering from chronic hypoxia. Adult male Wistar rats were exposed to intermittent high-altitude hypoxia simulated in a barochamber (7000 m, 8 hr/day, 5 days a week, 24 exposures), then transferred to normoxia and divided into two groups: (a) treated with enalapril (0.1 g/kg/day for 60 days) and (b) without treatment. The corresponding control groups were kept under normoxic conditions. Enalapril significantly decreased the heart rate, systemic arterial pressure, and absolute left and right ventricular weights in both hypoxic and control rats; on the other hand, the pulmonary blood pressure was unchanged. The content and concentration of collagen was reduced in both ventricles of enalapril-treated hypoxic and control animals by 10-26% compared with the corresponding untreated groups. These data suggest that the partial regression of cardiac fibrosis due to enalapril may be independent of the pressure load.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Enalapril/uso terapêutico , Hipertensão Pulmonar/tratamento farmacológico , Hipertrofia Ventricular Direita/tratamento farmacológico , Hipóxia/complicações , Fibrose Pulmonar/tratamento farmacológico , Doença da Altitude/fisiopatologia , Animais , Peso Corporal/efeitos dos fármacos , Peso Corporal/fisiologia , Doença Crônica , Colágeno/metabolismo , Hemodinâmica/efeitos dos fármacos , Hidroxiprolina/metabolismo , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Hipertrofia Ventricular Direita/fisiopatologia , Hipóxia/fisiopatologia , Masculino , Miocárdio/metabolismo , Tamanho do Órgão/efeitos dos fármacos , Tamanho do Órgão/fisiologia , Fibrose Pulmonar/etiologia , Ratos , Ratos Wistar
20.
Biomed Mater Eng ; 7(3): 159-69, 1997.
Artigo em Inglês | MEDLINE | ID: mdl-9262829

RESUMO

The aim of the present work is to demonstrate of the influence of the adventitia on distribution of residual stresses in the human aorta. The biomaterial increase in media as well as in adventitia in the course of the aorta's growth is formed by an intussusceptive mechanism of growth. In children's aortas, formative elastin lamellae are wavy with high amplitude perpendicular to the aortic surface. In adults' aortas the waves become smoother (stepwise) towards the adventitia. Also introduced is the growth function, which characterizes the biomaterial growth and the interference between the media and adventitial layers. It is possible to expect an extraordinary variability in the formation of the aortic wall tissue in the course of its growth as a result of metabolic and humoral influences and magnitude of the residual stresses in the course of growth.


Assuntos
Aorta Torácica/fisiologia , Aorta/fisiologia , Adulto , Idoso , Aorta/citologia , Aorta Torácica/citologia , Vasos Coronários/fisiologia , Elasticidade , Elastina/análise , Elastina/fisiologia , Endotélio Vascular/citologia , Feminino , Humanos , Técnicas In Vitro , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Modelos Cardiovasculares , Estresse Mecânico
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