Introdução: Vários são os mecanismos envolvidos no desenvolvimento da resposta local e sistêmico na pancreatite aguda. O sistema cardiovascular pode ser afetado durante todo o curso clínico da pancreatite aguda. O objetivo deste estudo foi avaliar a produção local de citocinas pelo miocárdio, assim como, as alterações funcionais e histológicas do miocárdio na pancreatite aguda grave. Métodos: Os animais foram divididos em três grupos: Grupo 1: controle; Grupo 2: controle operado; Grupo 3: pancreatite aguda grave. Foram medidos os níveis séricos de amilase e de citocinas (TNF-alfa IL-6 e IL-10), expressão de RNAm de TNF-alfa, IL-6 e TGF-beta e ecocardiograma com avaliação da função cardíaca. Alterações do tecido cardíaco foram analisadas pelo exame histológico. Resultados: Os níveis séricos de TNF-alfa e IL-10 foram significativamente maiores no grupo pancreatite aguda 2h. Os níveis de RNAm de IL-6 do grupo pancreatite aguda 2h foram estatisticamente superiores. Os níveis de RNAm do TNF-alfa do grupo controle operado e pancreatite aguda 2h foram estatisticamente menores. Mudanças significativas no diâmetro do ventrículo esquerdo foram encontradas nos grupos pancreatite aguda 2h e 12h. Houve alterações estatísticas para a degeneração vacuolar, picnose e perda de núcleo, e os linfócitos. Conclusão: Encontramos alterações cardíacas e histológicas compatíveis com o processo inflamatório desencadeado por pancreatite aguda grave com o incremento da produção de citocinas pelo miocárdio / Background: Several mechanisms are involved in the development of the local and systemic response in acute pancreatitis. Cardiovascular system may be affected throughout the clinical course of acute pancreatitis. The aim was to evaluate local myocardial cytokine production, as well as, functional and histological myocardial alterations in severe acute pancreatitis. Methods: The animals were divided into three groups: Group 1: control; Group 2: sham; Group 3: severe acute pancreatitis. Echocardiographic assessment of cardiac function, serum levels of amylase and cytokines (TNF-alfa, IL-6 and IL-10), and mRNA expression of TNF-alfa, IL-6 and TGF-beta were measured. Myocardial tissue alterations were analysed by histological examination. Results: The serum TNF-alfa, and IL-10 levels were significant higher in acute pancreatitis 2h group. The mRNA IL-6 levels from acute pancreatitis 2h group were statistically higher. The mRNA TNF-alfa levels from sham group and acute pancreatitis 2h group were statistically lower. Significant changes in the left ventricular diameter were found in acute pancreatitis 2h and 12h groups. There were statistical changes for vacuolar degeneration, picnosis and loss of nucleus, and lymphocytes. Conclusion: We found cardiac and histological changes compatible with the inflammatory process triggered by severe acute pancreatitis with the promotion of local myocardial cytokine production

Orientador: Reinaldo Wilson Vieira / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-16T22:33:56Z (GMT). No. of bitstreams: 1 Oliveira_FernandoJosede_D.pdf: 842706 bytes, checksum: c55e580b4ebd9d2c192bd493430bf790 (MD5) Previous issue date: 2010 / Resumo: Objetivo: Processos inflamatórios e infecciosos mediados por bactérias em sítios distantes têm sido descritos como fator de risco à doença coronariana isquêmica aguda (DCIA). Métodos: Cento e oitenta e um pacientes com DCIA, com e sem periodontites crônicas, foram incluídos neste estudo. Os pacientes foram admitidos no HC da UNICAMP e estratificados em três grupos: grupo 1- pacientes com periodontite crônica grave (31 homens e 19 mulheres; média de idade 55,1 ± 11,29 anos); grupo 2- pacientes com periodontite crônica leve (40 homens e 28 mulheres; média de idade 54,8 ± 10,37 anos); grupo 3- pacientes desdentados (43 homens e 20 mulheres; média de idade 67,5 ± 8,55 anos). Amostras sanguíneas foram coletadas para mensurar os perfis lipídico, hematológico e glicêmico. Além disso, biópsias de 17 artérias coronárias com aterosclerose e igual número de artérias torácicas interna sem degeneração aterosclerótica no grupo 1 foram investigadas. Para análise estatística utilizou-se a análise de variância (ANOVA) e o teste de Scheffé para comparações múltiplas. Resultados: Triglicérides e LDL estavam elevados no grupo 1 em relação ao grupo 2. O HDL apresentou-se reduzido em 20% dos pacientes do grupo 1, e em 8% nos desdentados. A glicemia estava elevada no grupo 1. DNA de bactérias periodontais foram detectados em 58,8% das artérias coronárias. Conclusões: Pacientes com DCIA e periodontite crônica grave podem apresentar perfil lipídico alterado, como também microorganismos associados com as periodontites crônicas graves podem permear dentro de vasos coronarianos / Abstract: Objective: Infectious and inflammatory processes mediated by bacteria in distant sites have been described as a risk factor for acute ischemic heart disease (AIHD). Methods: One hundred one patients with AIHD with and without chronic periodontitis (CP) were included in this study. Patients were admitted to the HC-UNICAMP and stratified into three groups: in group 1, we selected patients with severe chronic periodontitis (31 men and 19 women, mean age 55,1 ± 11,29 years old); the group 2 with mild chronic periodontitis (40 men and 28 women, mean age 54,8 ± 10,37 years old) and group 3 represented by the toothless (43 men and 20 women, mean age 67,5 ± 8,55 years old). Blood samples were collected to measure the lipid profiles, hematological and blood glucose levels. In addition, biopsies of seventeen coronary arteries with atherosclerosis and an equal number of internal thoracic artery without atherosclerotic degeneration in group 1 were investigated. Statistical analysis by analysis of variance (ANOVA) and Scheffé test for multiple comparisons was performed. Results: Triglyceride and LDL levels were elevated in group 1 than in group 2. HDL were reduced by 20% in group 1 and remained reduced by 8% in toothless. Blood glucose was higher in group 1. DNA of periodontal bacteria was detected in 58,8% of the coronary arteries / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências

O objetivo desse trabalho foi investigar a atividade sexual dos pacientes submetidos à cirurgia de valvopatia e compreender as repercussões emocionais desses dois eventos. Para sua realização foram convidados funcionários e pacientes dos hospitais Instituto do Coração, localizado na cidade de São Paulo e Cirurgia em Aracaju no Estado de Sergipe. A amostra da pesquisa foi composta por 35 sujeitos portadores de valvopatia de ambos os sexos, entre 20 e 45 anos, que tinham sido submetidos apenas a uma cirurgia de correção dessa enfermidade, alfabetizados e que não tinham apresentado disfunção sexual antes da cirurgia. Foi também realizado um grupo controle com 35 funcionários pertencentes aos hospitais citados e que até o momento da realização da pesquisa não eram portadores de doenças crônicas. Os participantes responderam perguntas sobre atividade sexual e também criaram quatro histórias, a partir da apresentação das imagens contidas nas Pranchas (4, 10, 13HF, 16) do Teste de Apercepção Temática (TAT). Os resultados da pesquisa apontaram, na comparação entre os grupos, para uma presença estatisticamente significante (p<0,05), no grupo de pacientes, da ansiedade como interferência negativa para o desempenho sexual e de medos como não ser aceito e não ter excitação pelo parceiro, além de não satisfazer sexualmente o parceiro. Este grupo também afirmou que houve mudanças nos seus relacionamentos familiares, sociais e amorosos após a cirurgia. O TAT apontou para uma maior intensidade das necessidades emocionais de planejar e manter uma atividade sexual, apoio e afiliação no grupo de pacientes. Sugere-se que, em estudos posteriores, inclua-se o parceiro na amostra a ser pesquisada, uma vez que suas respostas podem complementar os achados do estudo e também se inclua as entrevistas em outros momentos como o pré-cirúrgico, o que contribuirá para uma melhor interpretação na análise da situação-problema. / The objective of this study was to investigate the sexual activity of patients submitted to the surgery of valvopathy and understand the emotional repercussions of these two events. For its realization were invited hospital staff and patients from the hospitals Instituto do Coração do Hospital das Clínicas da Universidade de São Paulo, and Hospital Cirurgia in Aracaju, both located in Brazil. The research sample consisted of 35 citizens of both gender who are affected by a valvopathy, between 20 and 45 years, that had been submitted only to a one surgery of correction of this disease, literate and that they have not presented some sexual dysfunction before the surgery. It also held a control group with 35 employees belonging to the hospitals cited and that until the completion of the research were not carriers of chronic diseases. The participants had answered questions about sexual activity and also created four stories from the presentation of the images contained in plates 4, 10, 13HF and 16 of the Thematic Apperception Test (TAT). The research results had pointed, in the comparison between groups, a statistically significant (p < 0.05) presence, in the group of patients, of the anxiety as a negative interference for the sexual performance, and the presence of sexual fears such as not be accepted by the partner, not be excited about the partner, and not sexually satisfy your partner. This group also affirmed that it had changes in its familiar, social and love relationships after the surgery. The TAT pointed a greater intensity of emotional needs to plan and maintain a sexual activity, support and membership in the group of patients. It is suggested that in further studies the partner should be included in the sample to be investigated, since their responses can complement the findings of the study and also includes interviews at other times as the pre-surgical, which must contribute to a better interpretation and analysis of the situation-problem

Introdução: As doenças cardíacas (DC) representam a principal causa de morte da população brasileira. Evidências epidemiológicas mostram que a alimentação é fator de risco para o desenvolvimento dessas doenças. Objetivo: Verificar a associação da alimentação, com incidência de DC referida, segundo variáveis demográficas e biopsicossociais. Métodos: Foram utilizados dados do Estudo SABE (Saúde, Bem-estar e Envelhecimento), longitudinal, epidemiológico, de base domiciliar, realizado em 2000 (2.143 idosos) e, em 2006 (1.115 idosos), no município de São Paulo Brasil. A população de estudo foi constituída por idosos ( 66 anos), de ambos os sexos, que não referiram DC, em 2000, e que apresentavam todos os dados necessários para este estudo. As variáveis analisadas foram: DC referida, em 2006; alimentação, referida em 2000, incluindo - número de refeições (Nref - < 3 e 3/dia), frequência de ingestão de líquidos (Lq - 5 e > 5 copos/dia), de laticínios (Lat - 1x/dia), de ovos e leguminosas (Leg - 1x/semana), de carnes (Car - 3x/semana), de frutas, legumes e verduras (Flv - 2x/dia); sexo, grupo etário, autopercepção da saúde, escolaridade, companhia no domicílio, tabagismo e hipertensão arterial. Para verificar a associação, utilizou-se teste de Rao & Scott (p<0,05), para amostra complexa, e regressão logística múltipla, calculados pelo programa estatístico STATA 10.1. Resultados: Foram analisados 900 idosos, dos quais, 132 referiram DC (novos casos), em 2006, correspondendo ao coeficiente de incidência (CI) de 14,5/1.000 pessoas-ano (IC95 por cento = 12,12 17,61). Considerando as variáveis demográficas e biopsicossociais, constatou-se que a referência da saúde como rui, segundo a autopercepção e tabagismo para as mulheres, e HAS para os homens constituíram fator de risco. As demais (escolaridade, companhia no domicílio, sexo e grupo etário) não apresentaram diferença estatística em relação à referência de DC. Quanto às variáveis alimentares, verificou que, somente, a referência de não ingerir Lat e Leg, em 2000, apresentou-se associada à DC (Lat - OR: 1,97 IC 95 por cento : 1,11 - 3,47) e (Leg - OR: 2,26 IC95 por cento : 1,11 - 4,60). O CI, em relação a estes alimentos, também apresentou diferença estatística. Conclusão: Constatou-se que a alimentação dos idosos esteve associada à referência de DC. A referência de não ingerir Lat e Leg, constituiu fator de risco para DC em 2006 / Introduction: Heart diseases (HD) are the main cause of death in Brazilian population. Epidemiological evidence shows that diet can be a risk factor for the development of HD. Objective: To investigate the association of food dietary intake, with reported HD incidence, according to demographic and biopsychosocial variables. Methods: The study used data from SABE (Health, Well-being and Ageing): longitudinal, epidemiological, household survey, conducted in 2000 (2,143 elderly individuals) and in 2006 (1,115 elderly individuals), in the city of Sao Paulo - Brazil. The study population was formed by elderly individuals ( 66 y), both sexes, who did not report HD in 2000 and all the necessary data for this study existed. The variables analyzed were referred HD, in 2006; information about dietary intake in 2000, including - number of meals (<3 and 3/day), frequency of fluids intake ( 5 and > 5 cups/day ), dairy (1/day), eggs and legumes (1/week), meat (3/week), fruits and vegetables (2/day), sex, age groups, self-perceived health status, education level, home company, smoking and systemic arterial hypertension. To verify the association Rao & Scott (p <0.05) test was used for complex sample, and multiple logistic regression, calculated by STATA 10.1 statistical program. Results: 900 elderly individuals were analyzed, 132 of them reported HD (new cases) in 2006, corresponding to an incidence rate of 14.5/1,000 person-years (95 per cent CI = 12.12 to 17.61). Considering the demographic and biopsychosocial variables, the association between poor self-perceived health status and smoking for women, and reported hypertension for men, were considered risk factor for HD. The others (educational level, home company, gender and age) showed no statistical difference considering the HD reference. For dietary intake variables, it was found that only the reference of not eating Lat and Leg in 2000, showed to be associated with HD - (Lat - OR: 1.97 - 95 per cent CI: 1.1 1-3, 47) and (Leg - OR: 2.26 - 95 per cent : 1,11 - 4,60). The incidence rate, for these foods also have statistical difference. Conclusion: The elderly dietary intake influences the HD reference. The reference of not eating dairy and legume was a risk factor for HD

Ph.D. / It has become an accepted fact that Coronary Heart Disease is an epidemic of modern civilisation. Coronary Heart Disease is responsible for approximately a third of all deaths in the Western world (Fullard, 1990) and South Africa is no exception. Several risk factors contributing to the development of heart disease have been identified but the extent and exact nature of their contribution is not fully understood. Traditionally accepted risk factors that play a role in the development of Coronary Heart Disease include diet, hypertension, hypercholestrolaemia, smoking, physical inactivity, age, sex and genetic disposition. However the strongest combination of these factors has been unable to predict the majority of heart disease cases. In this regard psychological factors are steadily gaining acceptance as risk factors, one of the most important of these being the Type A behaviour pattern. The far reaching consequences of Coronary Heart Disease have necessitated investigations into methods of decreasing contact with risk factors, particularly psychological ones. The substantial success of the Recurrent Coronary Prevention Project (Friedman et al), coupled with the promising results from other intervention studies, suggests that behaviour change is a viable goal in the prevention of heart disease. Following on from the Recurrent Coronary Prevention Project, Venter (1993) and Viljoen (1993) adapted it for the South African population. Although relatively successful, it did have its flaws. Thus the motivation for redesigning this intervention addressing its shortcomings The revised intervention was administered to a group of 25 Coronary Heart Disease patients. A second group of 22 patients were subjected to the intervention utilised in the original South African Recurrent Coronary Prevention Project. A third group of 18 patients served as a waiting list control group. The results indicated that although the revised intervention produced larger changes in Type A behaviour than the original South African Recurrent Prevention Project intervention, these differences were not significant. Possible reasons for this were the measures utilised, the sample sizes and the nature of the groups themselves. However, the revised version of the SARCPP was found to be more effective in the reduction of the hostility and anger components of the behaviour pattern than the original version. In conclusion it was found that before any further research in this area be conducted, the measures utilised should be modified and the mechanisms of treatment effect be examined.

D.Litt. et Phil. (Psychology) / Over the past four decades we have witnessed the emergence of amazingly sophisticated means of cardiovascular diagnosis and therapy. For the first time in many years, some Western countries could report a decline in cardiovascular deaths. During this same span of years we have witnessed the remarkable development of an array of technological achievements that include the means for invasive diagnostic procedure such as cardiac catherization, and non-invasive methods of echocardiography, magnetic, radio-isotopic and positron imagery which provide detailed diagnostic and prognostic information. This innovations along with synthetic grafts have permitted surgical interventions that would not have been conceivable at the outset of this cardiovascular odyssey. Another major advance has been the appearance of new pharmacological modalities; the diuretics, the beta-adrenergic receptors and angiotension converting enzyme inhibitors, the calcium antagonists and other anti-hypersensitive agents, a spectrum of antiarrhythmic compounds, anticoagulants and fibrinolytic therapy, and the promise of still more innovative and novel modes of therapy which will appear via genetic engineering. Over the past years there has been equally significant development in the area of cardiovascular epidemiology. These advances include the demonstration of validity and the efficacy of various therapeutic programmes by the unique development of complex multi-center trials, as well as long-term population-based studies. Through this endeavours specific risk factors that impart independent risk ofpremature cardiovascular morbidity and mortality has been identified. Some of these risk factors are clearly not modifiable such as advancing years, male gender and race. Others are at least partly modifiable: predisposition to diabetes myelitis and increased body mass. By virtue of multi-center trials we have clear evidence that cigarette smoking, rising systolic and diastolic arterial pressures, serum cholesterol levels, and diabetes are modifiable. It is a known fact that not all individuals with coronary artery disease are cured by medication or by means of a surgical intervention. In addition to this, the reduction of traditional biomedical risk factors have been shown to be insufficient in averting the reocclusion and the further occlusion of coronary arteries in patient populations.

M.Cur. / Coronary stenting as a treatment method for the "in-between" patient with atherosclerosis was instituted in October 1991. It was initially used as secondary treatment to balloon angioplasty as "bail-out", when dissection or secondary closure of the coronary artery occurred. It has now become the primary method of treatment for atherosclerosis. It is apparent that there is a deficit in the information available to patients who have received a coronary stent. The objective of this study was therefore firstly to compile an information booklet for the patient who has received a coronary stent and secondly to set nursing guidelines for use on the implementation of this booklet. A literature study was undertaken on the following topics: atherosclerosis and its associated risk factors; the patient as an adult learner; coronary stents and the function of the nurse. This study showed that the literature covered the procedure of coronary stenting but not patient education. Interviews were conducted with two doctors that do coronary stenting as a method of treatment s as to determine what they see as import ant information to be given to these patients. Further interviews were conducted with patients that have received coronary stents to determine what they wanted and needed to know. From all the information gathered from the literature review and interviews, the information booklet was compiled, as well as the guidelines set for the nurse on how to implement the booklet.

L’altération de la réserve fonctionnelle cardiovasculaire (CV) à l’exercice est un signe précoce d’insuffisance cardiaque (IC). Nous avons étudié l’hypothèse d’une altération de la réserve CV dans deux modèles physiopathologiques : -une étude des pressions de remplissages du ventricule gauche (VG) lors d’un exercice de faible intensité avait pour finalité de démasquer une anomalie cardiaque latente au repos; cette approche a été appliquée à des patients à risque élevé d’IC à fraction d’éjection préservée.-une étude plus approfondie de la réponse CV au cours d’un exercice maximal avait pour double objectif, de démasquer, mais aussi d’analyser en détail les composantes physiopathologiques de l’altération de la fonction cardiaque. Cette approche a été appliquée à l’étude de la drépanocytose, un modèle de cardiopathie à haut débit. Dans la première partie de ce travail, nous avons montré qu’il était possible de démasquer une altération du remplissage VG dès une faible intensité d’exercice. Ces résultats observés initialement en utilisant des outils non-invasifs ont été confirmés en utilisant le cathétérisme cardiaque comme gold standard. Dans la seconde partie de ce travail, l’évaluation de patients drépanocytaires au cours d’un exercice maximal a permis de mettre en évidence une altération de la réserve fonctionnelle CV liée à un défaut de la réserve chronotrope et de la réserve en pré-charge du VG.Nos travaux constituent une contribution à l’étude de la physiopathologie CV. Les différentes modalités d’exploration qui ont été utilisées, et qui ont pour certaines été mises au point pour la réalisation de cette thèse, pourraient servir à l’étude d’autres cardiopathies. / Despite normal investigations at rest, latent heart failure can be observed in a number of patients during exercise. We investigated the hypothesis of an impairment of cardiovascular reserve in two pathophysiological models: - in patients at high risk of heart failure with preserved ejection fraction, we measured left ventricular filling pressures at low exercise level in order to unmask early stages of left ventricular diastolic dysfunction;- moreover, using combined echocardiography and cardiopulmonary exercise testing, a comprehensive study of cardiovascular response to maximal exercise was performed in patients with sickle cell anemia which was chosen as a model of chronic high-output states. We showed that very low exercise level could unmask early stage heart failure with preserved ejection fraction. These results, initially observed using Doppler echocardiography, were confirmed by direct invasive measurement of left ventricular filling pressure during exercise. In patients with sickle cell anemia, we found a decrease of cardiac output response to exercise. This alteration of cardiovascular reserve was characterized by a chronotropic incompetence and a blunted left ventricular preload reserve. The pathophysiological data provided by our studies may help improve and optimize management of patients with heart failure. The stress protocols which have been developed and used in our investigations could be useful to study other models of heart diseases.

No description available.

No description available.