Thesis (Ph. D.)--University of Wisconsin--Madison, 1951. / Typescript with manuscript equations. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaf 34).

Thesis (M.Sc. (Med.) (Emergency Medicine))--University of the Witwatersrand, Faculty of Health Sciences, 2014. / INTRODUCTION Cardiac injury following blunt chest trauma (BCT) presents a clinical spectrum of varying severity ranging from asymptomatic to severe and life-threatening. Attempts to diagnose acute cardiac injury may lead to unnecessary investigations and hospitalisation. Conversely, those patients “not at risk” could potentially be discharged from hospital. This research reviewed what methods are utilised by doctors to identify those patients at risk of acute cardiac injury. METHODS An on-line questionnaire was mailed to doctors working in emergency departments (EDs) throughout South Africa to ascertain what history, examination, and special investigations should be performed on patients presenting with blunt chest injury to exclude cardiac injury. RESULTS These revealed varied responses with inappropriate investigations and lacked unanimity in the diagnostic methods. The majority of doctors did not adhere to up-to-date consensus driven and evidenced based up-to-date practice There was not much difference in the respondents responses between specialist emergency physicians (SEPs) and general practitioners (GPs). CONCLUSION A high index of suspicion based on careful history taking and physical examination together with specific diagnostic testing limited to identifying those patients at risk of a cardiac injury (and developing cardiac complications) presenting with BCT should be the cornerstone of this diagnostic challenge. It was evident that the diagnosis of acute cardiac injury remains an elusive challenge and lacks consistent utilisation of diagnostic criteria.

Orientador: Gustavo Pereira Fraga / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T03:18:47Z (GMT). No. of bitstreams: 1 Pereira_BrunoMonteiroTavares_D.pdf: 9308561 bytes, checksum: d9bbcf8aaa7de38fba06e5228f9dccd3 (MD5) Previous issue date: 2014 / Resumo: Introdução: Trauma penetrante é atualmente a principal causa de trauma cardíaco. O objetivo deste estudo é descrever e comparar as variáveis entre os pacientes com trauma cardíaco penetrante nos últimos 20 anos em um hospital universitário identificando fatores de risco para morbidade e mortalidade. Métodos: Revisão de dados de registro de trauma, seguido por análise estatística descritiva comparando os períodos 1990 a 1999 (grupo 1 , 54 casos) e 2000 a 2009 (grupo 2, 39 casos). Foram registrados dados clínicos no momento da internação hospitalar, o Índice de Gravidade da Lesão (ISS), Escala de Coma de Glasgow (GCS), e o Escore de Trauma Revisado (RTS). Resultados: A incidência de ferimentos cardíacos penetrantes foram constantes dentro do período de estudo. Os dois grupos foram semelhantes quanto à idade, mecanismo de trauma (ferimento por projétil de arma de fogo ou branca) e ISS. Grupo 1 apresentou menor pressão arterial sistólica na admissão (média de 87 contra 109 mmHg), menor GCS (12,9 vs. 14,1), RTS mais baixo (6,4 vs. 7,3), maior incidência de lesões cardíacas graus IV e V (74% vs. 48,7%), e foram menos propensos a sobreviver (0,83 contra 0,93). O principal fator de risco para o óbito foi ferimento por projétil de arma de fogo (13 vezes maior do que por arma branca), pressão arterial sistólica <90 mm Hg , GCS <8 , RTS <7,84 , lesões associadas, lesões grau IV e V e ISS >25. Observou-se uma tendência na redução de mortalidade de 20,3% para 10,3% durante o período de observação. Conclusões: Foram identificados vários fatores associados à mortalidade e morbidade. Na última década, os pacientes foram admitidos em melhor condição fisiológica, talvez refletindo uma melhora no tratamento pré-hospitalar. Observou-se uma tendência para uma menor taxa de mortalidade / Abstract: Background: Penetrating traumas, including gunshot and stab wounds, are the major causes of cardiac trauma. Our aim was to describe and compare the variables between patients with penetrating cardiac trauma in the past 20 years in a university hospital, identifying risk factors for morbidity and death. Methods: Review of trauma registry data followed by descriptive statistical analysis comparing the periods 1990 to 1999 (group 1, 54 cases) and 2000 to 2009 (group 2, 39 cases). Clinical data at hospital admission, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), and Revised Trauma Score (RTS) were recorded. Results: The incidences of penetrating cardiac injuries were steady within the period of study in the chosen metropolitan area. The two groups were similar regarding age, mechanism of trauma (gunshot stab), and ISS. Group 1 showed lower systolic blood pressure at admission (mean 87 versus 109 mm Hg), lower GCS (12.9 versus 14.1), lower RTS (6.4 versus 7.3), higher incidence of grade IV and V cardiac lesions (74% versus 48.7%), and were less likely to survive (0.83 versus 0.93). The major risk factor for death was gunshot wound (13 times higher than stab wound), systolic blood pressure <90 mm Hg, GCS <8, RTS <7.84, associated injuries, grade IV and V injury, and ISS >25. We observed a tendency in mortality reduction from 20.3% to 10.3% within the period of observation. Conclusions: Several associated factors for mortality and morbidity were identified. In the last decade, patients were admitted in better physiological condition, perhaps reflecting an improvement on pre-hospital treatment. We observed a trend toward a lower mortality rate / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências

Submitted by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2018-04-11T12:40:06Z No. of bitstreams: 2 Dissertação_Antonio Araujo.pdf: 3932538 bytes, checksum: 332c2dd4e1e40b884f495ce9cf7a0233 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2018-04-11T12:40:21Z (GMT) No. of bitstreams: 2 Dissertação_Antonio Araujo.pdf: 3932538 bytes, checksum: 332c2dd4e1e40b884f495ce9cf7a0233 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-04-11T12:40:21Z (GMT). No. of bitstreams: 2 Dissertação_Antonio Araujo.pdf: 3932538 bytes, checksum: 332c2dd4e1e40b884f495ce9cf7a0233 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-11-08 / JUSTIFICATION: Few studies comment on how fatal heart injuries are implicated in the causes of death and its relation to death mechanisms, such as cardiac exsanguination and tamponade. OBJECTIVES: (1) To verify the frequency of fatal cardiac trauma in the city of Manaus, Amazon, Brazil, between November 2015 and October 2016; (2) to clarify the mechanisms of trauma and death in addition to cases which have or have not received prior hospital treatment, as well as the injuries associated with cardiac trauma. METHODS: This is a retrospective, observational, cross-sectional study which reviewed the necropsy reports of individuals whose causa mortis was cardiac trauma admitted to the city’s Medico-legal Institute (IML) between November 2015 and October 2016, whose death cause was cardiac trauma. RESULTS: During the study period, of the 2,330 necropsies performed at the IML, 138 deaths were caused by cardiac trauma, corresponding to index of 5.98%. Males accounted for 92% of these cases, whereas females corresponded to 8% of them. Median age was 27 years for men and 30 years for women. Regarding the mechanisms of injury used, gunshots accounted for 62.3% and stab wounds for 29.7%. With respect to injury morphology, 47.8 and 42% of the individuals presented perforating and transfixing lesions, respectively. Causa mortis was cardiac exsanguination in 81.9% of cases and cardiac tamponade in 29%. On-site death was described in 86.2% of the cases, and the median time between trauma and death was 50 minutes. The ventricles were the most common site of cardiac injury. Single lesions were observed in 43.5% of the cases, whereas multiple lesions were found in 20.3%. Hemothorax was identified in 90.6% of the individuals. Only 23 (16.7%) of the patients were taken to the Emergency Room (ER); Of these, six (26.2%) were not submitted to thoracotomy for the treatment of the lesions, being the diagnosis made post mortem in the IML. Of the 300 associated injuries, the lung was affected unilaterally in 57% of the cases and bilaterally in 43% of them. CONCLUSIONS: The fatal cardiac trauma represents an index of 5.98% in the city of Manaus. Most patients die on site, usually due to exsanguination, with puncture and transfixing lesions caused by firearms, and especially in cases of on-site death, with lung injury and associated hemothorax. About a quarter of patients who reach the emergency room are not diagnosed with cardiac trauma to justify a thoracotomy. / JUSTIFICATIVA: Poucos estudos comentam a maneira como os ferimentos cardíacos fatais estão implicados nas causas de óbitos e sua relação com os mecanismos de morte, tais como a exsanguinação e o tamponamento cardíaco. OBJETIVOS: (1) Verificar o índice de trauma cardíaco fatal na cidade de Manaus, no período de novembro de 2015 a outubro de 2016; (2) esclarecer os mecanismos de trauma e de morte, além dos casos que receberam ou não tratamento hospitalar prévio, assim como as lesões associadas ao trauma cardíaco. METODOLOGIA: Trata-se de um estudo retrospectivo, observacional, transversal, que revisou os laudos de necrópsias dos indivíduos admitidos no Instituo Médico Legal (IML) entre novembro de 2015 e outubro de 2016, cuja causa mortis tenha sido o trauma cardíaco. RESULTADOS: No período do estudo, foram analisados 138 óbitos por trauma cardíaco dentre 2.306 necrópsias realizadas no IML, correspondendo a um índice de 5,98%. O sexo masculino foi afetado em 92% dos casos, enquanto as mulheres, em 8%. A mediana de idade foi de 27 para os homens e de 30 anos para as mulheres. A arma de fogo foi o mecanismo de trauma em 62,3% e a arma branca em 29,7%. Quanto à morfologia das lesões, 47,8% e 42% dos indivíduos apresentavam lesões perfurantes e transfixantes, respectivamente. O mecanismo de morte foi a exsanguinação em 81,9% dos casos, enquanto o tamponamento em 29%. O óbito no local foi descrito em 86,2% dos casos e a mediana de tempo entre o trauma e o óbito foi de 50 minutos. O local anatômico de lesão cardíaca mais comum foram os ventrículos. Em 43,5% dos casos, as lesões eram únicas, ao passo que em 20,3% eram múltiplas. O hemotórax foi descrito em 90,6%. Apenas 23 (16,7%) dos doentes foram removidos até o pronto-socorro. Destes, seis (26,2%) não foram submetidos à toracotomia para o tratamento das lesões, sendo o diagnóstico realizado post mortem no IML. Das 300 lesões associadas, o pulmão foi acometido em 57% unilateralmente e 43% bilateralmente. CONCLUSÕES: O trauma cardíaco fatal representou um índice de 5,98% na cidade de Manaus. A maioria dos doentes morre na cena do trauma, geralmente devido à exsanguinação, com lesões perfurativas e transfixantes por arma de fogo, principalmente nos casos de óbito na cena do trauma, geralmente com lesão pulmonar e hemotórax associado. Cerca de um quarto dos pacientes que chega ao pronto-socorro e evolui ao óbito, não é diagnosticado com trauma cardíaco para justificar uma toracotomia.

Objetivos: Avaliar a evolução e as complicações dos doentes que sobreviveram a ferimentos cardíacos, atendidos no Pronto-Socorro Municipal 28 de Agosto e Hospital Pronto-Socorro Dr. João Lúcio Pereira Machado, em Manaus, no período de janeiro de 1998 a junho de 2006. Métodos: Foi realizada uma busca de prontuários dos doentes atendidos nos dois prontossocorros, nos quais durante a toracotomia exploradora evidenciou-se o ferimento cardíaco. Os sobreviventes que retornaram ao ambulatório foram avaliados prospectivamente por meio de eletrocardiograma e ecocardiograma, para averiguar a morfologia e a funcionalidade do coração. Foi preenchido um protocolo com registro dos dados dos doentes, tais como: idade, sexo, mecanismo de trauma, complicações intra e pós-operatórias, dentre outras variáveis. Resultados: A população de referência totalizou 100 doentes, dos quais 95% eram homens, 69% entre 20 e 30 anos; 81% das lesões foram por arma branca, sendo que em 78% delas, a entrada se encontrava no precórdio; 41% das lesões acometeram o ventrículo direito (VD) e 38% acometeram o ventrículo esquerdo (VE); em 48% dos casos foi realizada toracotomia ântero-lateral esquerda. A sobrevivência foi de 72%. A população de estudo foi composta por 25 doentes que retornaram ao ambulatório e foram avaliados prospectivamente por meio de eletrocardiograma e ecocardiograma. Das 33 alterações no ecocardiograma (ECO), sete doentes (28%) tinham insuficiência mitral, enquanto nove (36%) não tinham alterações. Das 45 alterações no eletrocardiograma (ECG), oito doentes (32%) tinham taquicardia sinusal, enquanto seis (24%) não tinham alterações. Não houve efeito do tempo no resultado do ECO (p=0,5323) ou do ECG (p=0,6596). Das alterações detectadas no ECO, três (21,4%) foram devidas a lesões grau IV (em VD) e 11 (78,7%) devidas a lesões grau V (em VE) (p=0,048). Das 12 alterações detectadas no ECG, três (25%) relacionaram-se a lesões grau IV e nove (75%) relacionaram-se a lesões grau V (p=0,226). Conclusões: Aproximadamente um terço dos sobreviventes a lesões cardíacas não apresentaram alterações ao eletrocardiograma e ecocardiograma. Ventrículo esquerdo e grau de lesão V da OIS-AAST estiveram relacionados a um maior número de alterações ao eletrocardiograma e ecocardiograma. Taquicardia sinusal e insuficiência mitral foram alterações encontradas em um de cada três doentes que sobreviveram a um ferimento cardíaco. / Objectives: To evaluate the evolution and the complications of the patients that survived cardiac wounds, attended at the Pronto-Socorro Municipal 28 de Agosto and Hospital Pronto-Socorro Dr. João Lúcio Pereira Machado, in Manaus, during the period of January 1998 until June 2006. Methods: A medical records evaluation was made among the patients attended at the two emergency hospitals in which a cardiac wound was found during a exploring thoracotomy. The survivors that returned to the ambulatory were evaluated prospectively through electrocardiogram and echocardiogram, so it was possible to analyze the morphology and the function of the heart. A protocol was filled out with a registry of patients data, such as: age, sex, trauma mechanism, intra-operative and post-operative complications, and other variables. Results: The total reference population in this study was 100 patients, in which 95% were male, the majority (69%) had ages until 30; 81% of the lesions were caused by stab wounds; 78% of the orifice of entry were located at the precordium; 41% of the lesions wounded the right ventricle and 38% wounded the left ventricle; In 48% of the cases a left antero-lateral thoracotomy was executed. The survival rate was 72%. The studied population was of 25 patients that returned to the ambulatory and were prospectively evaluated with electrocardiogram and echocardiogram. Among the 33 echocardiogram alterations (ECO), seven patients (28%) had mitral insufficiency, while nine (36%) didn\'t have any alterations. Among the 45 electrocardiogram alterations (ECG), eight patients (32%) had sinusal tachicardia, while six (24%) had no alterations. Time made no difference in the results of the ECO (p=0,5323) or of the ECG (p=0,6596). Of the 14 detected ECO complications, three (21,4%) were due to IV degree lesions in the right ventricle and eleven (78,7%) were due to V degree lesions (in the left ventricle) (p=0,048). From the 12 left ventricle lesions that complicated (ECG), 9 were V degree. From the 12 alterations detected at the ECG, three (25%) were due to IV degree lesions and nine (75%) were due to V degree lesions (p=0,226). Conclusions: Approximately one third of the cardiac wound survivors did not have alterations in the electrocardiogram and echocardiogram. Left ventricle and V degree lesions from the OIS-AAST were related to a larger number of alterations in the electrocardiogram and echocardiogram. Sinusal Tachicardia and mitral insuficiency were alterations found in one third of the patients that survived a cardiac wound.

by Koo Po Lan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 120-130). / Abstracts in English and Chinese. / Acknowledgement --- p.i / Abstract --- p.ii / Abstract (Chinese version) --- p.iv / Content --- p.vii / List of Abbreviations --- p.xi / List of Figures and Tables --- p.xiii / Chapter Chapter 1 --- Introduction / Chapter 1.1 --- Saponins --- p.1 / Chapter 1.2 --- Structure of Saponin --- p.2 / Chapter 1.2.1 --- Triterpene Class --- p.2 / Chapter 1.2.2 --- Steroid Class --- p.3 / Chapter 1.2.2.1 --- Spirostanol Glycoside --- p.4 / Chapter 1.2.2.2 --- Furostanol Glycoside --- p.4 / Chapter 1.2.3 --- Steroid Alkaloid Class --- p.5 / Chapter 1.3 --- Steroidal Saponin as Anti-Tumor Drug --- p.5 / Chapter 1.4 --- Possible Anti-Tumor Action Mechanisms of Steroid Saponin --- p.6 / Chapter 1.4.1 --- Direct Cytotoxic and Growth Inhibitory Effects --- p.7 / Chapter 1.4.2 --- Immune-Modulatory Effects --- p.8 / Chapter 1.5 --- Possible Anti-Carcinogenicity Action Mechanism of Saponin --- p.9 / Chapter 1.5.1 --- Saponin Binding to Bile Acids --- p.9 / Chapter 1.6 --- Saponin as Cardioactive Drug --- p.9 / Chapter 1.7 --- Liver Cancer --- p.10 / Chapter 1.7.1 --- Prevalence of Hepatocellular Carcinoma (HCC) --- p.11 / Chapter 1.8 --- Coronary Heart Disease (CHD) --- p.12 / Chapter 1.8.1 --- Prevalence and Risk Factors of CHD --- p.12 / Chapter 1.9 --- Diosgenin --- p.14 / Chapter 1.10 --- Hong Kong (HK) Products --- p.15 / Chapter 1.10.1 --- HK-18 (Polyphyllin D) --- p.15 / Chapter 1.11 --- DI AO XIN XUE KANG (DI AO) --- p.17 / Chapter 1.12 --- Aims of My Project --- p.20 / Chapter 1.12.1 --- In Vitro Study of the Effect of HK-18 on Human Hepatocellular Carcinoma Cell Line (HepG2) --- p.21 / Chapter 1.12.2 --- In Vivo Study of the Effect of HK-18 by Human Liver Tumor HepG2 Cells-Bearing Nude Mice Model --- p.21 / Chapter 1.12.3 --- In Vitro Study of the Effect of HK-18 on Multidrug- Resistant Human Hepatocellular Carcinoma Cell Line (R-HepG2) --- p.22 / Chapter 1.12.4 --- Myocardial Ischemia-Reperfusion (IR) Injury in Isolated- Perfused Rat Heart Model --- p.23 / Chapter 1.12.5 --- Effect of DI AO Pretreatment on Global IR Injury --- p.26 / Chapter 1.12.6 --- Effect of DI AO Pretreatment on Isoproterenol-Induced Myocardial Injury in Rats --- p.26 / Chapter Chapter 2 --- Materials and Methods / Chapter 2.1 --- Materials --- p.28 / Chapter 2.1.1 --- Cell Lines and Culture Medium / Chapter 2.1.1.1 --- Cell Lines --- p.28 / Chapter 2.1.1.2 --- Culture Medium --- p.29 / Chapter 2.1.2 --- Chemicals --- p.30 / Chapter 2.1.3 --- Buffers and Reagents --- p.31 / Chapter 2.2 --- Methods / Chapter 2.2.1 --- In Vitro Studies --- p.33 / Chapter 2.2.1.1 --- In Vitro Cytotoxicity --- p.33 / Chapter 2.2.1.2 --- Cell Cycle Analysis by Flow Cytometry --- p.34 / Chapter 2.2.1.3 --- Maintenance of P-glycoprotein in R-HepG2 cells by Doxorubicin and HK-18 --- p.35 / Chapter 2.2.1.4 --- Assessment of DNA Fragmentation --- p.36 / Chapter 2.2.2 --- In Vivo Assessment of the Anti-Tumor Activity of HK-18 --- p.37 / Chapter 2.2.2.1 --- Animals and Tumor Inoculation --- p.37 / Chapter 2.2.2.2 --- Drug Administration --- p.37 / Chapter 2.2.2.3 --- Assessment of the Tumor Size and Tumor Weight --- p.38 / Chapter 2.2.2.4 --- Plasma Preparation --- p.38 / Chapter 2.2.2.5 --- Measurement of the Plasma Enzyme Activity --- p.39 / Chapter 2.2.3 --- Isoproterenol (ISO)-Induced Myocardial Injury (Rat Model) --- p.40 / Chapter 2.2.3.1 --- Animals --- p.40 / Chapter 2.2.3.2 --- Drug Preparations --- p.40 / Chapter 2.2.3.3 --- Animal Treatment --- p.41 / Chapter 2.2.3.4 --- Preparation of Myocardial Tissue Homogenate --- p.41 / Chapter 2.2.3.5 --- Preparation of Cytosolic Fraction of Heart Homogenates --- p.42 / Chapter 2.2.3.6 --- Myocardial Antioxidant Enzyme Activity --- p.42 / Chapter 2.2.3.6.1 --- Glutathione Reductase (GRD) --- p.42 / Chapter 2.2.3.6.2 --- Glutathione S-Transferases (GST) --- p.43 / Chapter 2.2.3.7 --- Myocardial Antioxidant Capacity --- p.43 / Chapter 2.2.3.7.1 --- Myocardial Malondialdehyde (MDA) Content --- p.43 / Chapter 2.2.3.7.2 --- Myocardial Thiol Content --- p.44 / Chapter 2.2.3.7.3 --- Tert-Butylhydroperoxide (tBHP)-Induced Thiol Depletion --- p.45 / Chapter 2.2.3.7.4 --- TBHP-Induced Thiobarbituric Acid-Reactive Substances (TBARS) Formation --- p.45 / Chapter 2.2.4 --- Myocardial Ischemia-Reperfusion (IR) Injury --- p.46 / Chapter 2.2.4.1 --- Langendorff Isolated Perfused Rat Heart --- p.46 / Chapter 2.2.4.1.1 --- Preparation of Perfusion Buffer --- p.46 / Chapter 2.2.4.1.2 --- Preparation of Isolated Rat Heart --- p.47 / Chapter 2.2.4.1.3 --- Myocardial Global Ischemia-Reperfusion Injury --- p.49 / Chapter 2.2.4.1.4 --- Contractile Force Recovery --- p.49 / Chapter 2.2.5 --- Statistical Analysis --- p.50 / Chapter Chapter 3 --- Study of HK-18 on Anti-Tumor Effect / Chapter 3.1 --- In Vitro Study of HK-18 on Human Hepatoma Carcinoma Cell Line (HepG2) --- p.51 / Chapter 3.1.1 --- The Effect of HK-18 on Cell Proliferation of HepG2 Cells by MTT Assay --- p.52 / Chapter 3.1.2 --- DNA Fragmentation Assay --- p.54 / Chapter 3.1.3 --- The Effect of HK-18 on Cell Cycle Phase Distribution --- p.57 / Chapter 3.2 --- In Vivo Study of HK-18 on HepG2-Inoculated Nude Mice --- p.61 / Chapter 3.2.1 --- Assessment of the Anti-Tumor Activity of HK-18 --- p.61 / Chapter 3.2.2 --- The Effect of HK-18 Towards Heart Tissue --- p.65 / Chapter 3.2.3 --- In Vitro Study of HK-18 on Multidrug Resistant Cell Line (R-HepG2) --- p.68 / Chapter 3.2.4 --- The Comparison of the Cytotoxicity of DOX on the Parental Cells and Resistant Cells of HepG2 --- p.69 / Chapter 3.2.5 --- The Effect of HK-18 on Cell Proliferation of R-HepG2 Cells by MTT Assay --- p.72 / Chapter 3.2.6 --- DNA Fragmentation Assay --- p.74 / Chapter 3.2.7 --- The Effect of HK-18 on Cell Cycle Phase Distribution --- p.77 / Chapter 3.2.8 --- The Relationship Between HK-18 and P-glycoprotein --- p.80 / Chapter Chapter 4 --- Study of the Cardioprotective Effect of DI AO / Chapter 4.1 --- Myocardial Ischemia-Reperfusion (IR) Injury in Isolated- Perfused Rat Heart --- p.82 / Chapter 4.1.1 --- Time Course of Global Ischemia-Reperfusion-Induced LDH Leakage --- p.82 / Chapter 4.1.2 --- Effect of DI AO Pretreatment on Global IR Injury --- p.85 / Chapter 4.1.2.1 --- LDH Leakage --- p.85 / Chapter 4.1.2.2 --- Contractile Force --- p.87 / Chapter 4.2 --- Isoproterenol-Induced Myocardial Injury in Rats --- p.89 / Chapter 4.2.1 --- Effect of DI AO Pretreatment --- p.89 / Chapter 4.2.2 --- Alternations in the Activity of Myocardial Antioxidant Enzymes --- p.91 / Chapter 4.2.3 --- Alternations in Myocardial Antioxidant Capacity --- p.94 / Chapter Chapter 5 --- Discussion / Chapter 5.1 --- The Significance of the Study of Saponin in the Treatment of Liver Cancer and Heart Injury --- p.96 / Chapter 5.2 --- Effect of HK-18 on Human Hepatocellular Carcinoma Cell --- p.101 / Chapter 5.3 --- Mechanism Study of Anti-Tumor Effect of HK-18 --- p.102 / Chapter 5.4 --- Cytotoxicity of HK-18 Toward Normal Tissue --- p.105 / Chapter 5.5 --- Effect of HK-18 on Multidrug Resistant Human Hepatocellular Carcinoma / Chapter 5.6 --- Protective Effect of DI AO Against Isoproterenol (ISO)- Induced Myocardial Injury --- p.110 / Chapter 5.7 --- Cardioprotective Effect of DI AO Against Ischemia- Reperfusion (IR) Injury --- p.111 / Chapter 5.8 --- Effect of DI AO Pretreatment on Myocardial Antioxidant Enzymes Activities and Antioxidant Capacity --- p.113 / Chapter 5.9 --- Conclusion and Future Prospect --- p.117 / Chapter Chapter 6 --- References --- p.121

Objetivos: Avaliar a evolução e as complicações dos doentes que sobreviveram a ferimentos cardíacos, atendidos no Pronto-Socorro Municipal 28 de Agosto e Hospital Pronto-Socorro Dr. João Lúcio Pereira Machado, em Manaus, no período de janeiro de 1998 a junho de 2006. Métodos: Foi realizada uma busca de prontuários dos doentes atendidos nos dois prontossocorros, nos quais durante a toracotomia exploradora evidenciou-se o ferimento cardíaco. Os sobreviventes que retornaram ao ambulatório foram avaliados prospectivamente por meio de eletrocardiograma e ecocardiograma, para averiguar a morfologia e a funcionalidade do coração. Foi preenchido um protocolo com registro dos dados dos doentes, tais como: idade, sexo, mecanismo de trauma, complicações intra e pós-operatórias, dentre outras variáveis. Resultados: A população de referência totalizou 100 doentes, dos quais 95% eram homens, 69% entre 20 e 30 anos; 81% das lesões foram por arma branca, sendo que em 78% delas, a entrada se encontrava no precórdio; 41% das lesões acometeram o ventrículo direito (VD) e 38% acometeram o ventrículo esquerdo (VE); em 48% dos casos foi realizada toracotomia ântero-lateral esquerda. A sobrevivência foi de 72%. A população de estudo foi composta por 25 doentes que retornaram ao ambulatório e foram avaliados prospectivamente por meio de eletrocardiograma e ecocardiograma. Das 33 alterações no ecocardiograma (ECO), sete doentes (28%) tinham insuficiência mitral, enquanto nove (36%) não tinham alterações. Das 45 alterações no eletrocardiograma (ECG), oito doentes (32%) tinham taquicardia sinusal, enquanto seis (24%) não tinham alterações. Não houve efeito do tempo no resultado do ECO (p=0,5323) ou do ECG (p=0,6596). Das alterações detectadas no ECO, três (21,4%) foram devidas a lesões grau IV (em VD) e 11 (78,7%) devidas a lesões grau V (em VE) (p=0,048). Das 12 alterações detectadas no ECG, três (25%) relacionaram-se a lesões grau IV e nove (75%) relacionaram-se a lesões grau V (p=0,226). Conclusões: Aproximadamente um terço dos sobreviventes a lesões cardíacas não apresentaram alterações ao eletrocardiograma e ecocardiograma. Ventrículo esquerdo e grau de lesão V da OIS-AAST estiveram relacionados a um maior número de alterações ao eletrocardiograma e ecocardiograma. Taquicardia sinusal e insuficiência mitral foram alterações encontradas em um de cada três doentes que sobreviveram a um ferimento cardíaco. / Objectives: To evaluate the evolution and the complications of the patients that survived cardiac wounds, attended at the Pronto-Socorro Municipal 28 de Agosto and Hospital Pronto-Socorro Dr. João Lúcio Pereira Machado, in Manaus, during the period of January 1998 until June 2006. Methods: A medical records evaluation was made among the patients attended at the two emergency hospitals in which a cardiac wound was found during a exploring thoracotomy. The survivors that returned to the ambulatory were evaluated prospectively through electrocardiogram and echocardiogram, so it was possible to analyze the morphology and the function of the heart. A protocol was filled out with a registry of patients data, such as: age, sex, trauma mechanism, intra-operative and post-operative complications, and other variables. Results: The total reference population in this study was 100 patients, in which 95% were male, the majority (69%) had ages until 30; 81% of the lesions were caused by stab wounds; 78% of the orifice of entry were located at the precordium; 41% of the lesions wounded the right ventricle and 38% wounded the left ventricle; In 48% of the cases a left antero-lateral thoracotomy was executed. The survival rate was 72%. The studied population was of 25 patients that returned to the ambulatory and were prospectively evaluated with electrocardiogram and echocardiogram. Among the 33 echocardiogram alterations (ECO), seven patients (28%) had mitral insufficiency, while nine (36%) didn\'t have any alterations. Among the 45 electrocardiogram alterations (ECG), eight patients (32%) had sinusal tachicardia, while six (24%) had no alterations. Time made no difference in the results of the ECO (p=0,5323) or of the ECG (p=0,6596). Of the 14 detected ECO complications, three (21,4%) were due to IV degree lesions in the right ventricle and eleven (78,7%) were due to V degree lesions (in the left ventricle) (p=0,048). From the 12 left ventricle lesions that complicated (ECG), 9 were V degree. From the 12 alterations detected at the ECG, three (25%) were due to IV degree lesions and nine (75%) were due to V degree lesions (p=0,226). Conclusions: Approximately one third of the cardiac wound survivors did not have alterations in the electrocardiogram and echocardiogram. Left ventricle and V degree lesions from the OIS-AAST were related to a larger number of alterations in the electrocardiogram and echocardiogram. Sinusal Tachicardia and mitral insuficiency were alterations found in one third of the patients that survived a cardiac wound.