12 results on '"Valeriano C"'
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2. Frequency of clinically unsuspected myocardial injury at a children's hospital
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Karolina M. Zareba, Nader Rifai, Steven E. Lipshultz, Stuart R. Lipsitz, Julia C.L. Wong, Vartouhi Galpechian, and Valeriano C. Simbre
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Cardiomyopathy ,Pilot Projects ,macromolecular substances ,Creatine ,Hospitals, Private ,Immunoenzyme Techniques ,chemistry.chemical_compound ,Troponin T ,Internal medicine ,Troponin I ,Creatine Kinase, MB Form ,Humans ,Medicine ,Myocytes, Cardiac ,Clinical significance ,Myocardial infarction ,Child ,Prospective cohort study ,Creatine Kinase ,Subclinical infection ,Myoglobin ,business.industry ,Unstable angina ,Infant ,medicine.disease ,Surgery ,chemistry ,Child, Preschool ,cardiovascular system ,Cardiology ,Female ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine ,business ,Boston - Abstract
Ill children are at risk but rarely screened for myocardial injury. The frequency of such injury in ill children is unknown. Elevated levels of plasma cardiac troponin I (cTnI) can detect subclinical myocardial injury.We measured cTnI levels from 283 Children's Hospital, Boston patients (median age 2.10 years, range 0.13-22.4 years) seen in an outpatient or emergency clinic without clinically apparent cardiac disease. We tookor = 0.5 ng/mL as an indication of myocardial injury. We also measured plasma creatine kinase-MB, total creatine kinase, and myoglobin, and performed a chart review.Fifteen (7.8%) of the 193 acutely ill children and 4 (4.4%) of the 90 well children had an elevated cTnI level (P = .44). Within the acutely ill group, the children with elevated cTnI were younger and had lower mean hemoglobin and hematocrit levels. Cardiac troponin I levels correlated with creatine kinase-MB (r = 0.22; P.001) but not with creatine kinase or myoglobin. The 4 children with cTnI0.89 ng/mL, who also had plasma cardiac troponin T measured, showed cardiac troponin T elevations that were consistent with unstable angina levels in adults. Four children had high-level cTnI elevations (2 ng/mL) consistent with acute myocardial infarction levels in adults.Elevated cTnI levels occur in children without clinically apparent cardiac disease and can be at adult unstable angina or acute myocardial infarction levels. Prospective studies to determine the clinical significance of these findings and their relationship to the development of cardiomyopathy are warranted. more...
- Published
- 2006
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Catalog
3. Cardiotoxicity of Cancer Chemotherapy
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Tracie L. Miller, Steven E. Lipshultz, Sarah A. Duffy, Gul H. Dadlani, and Valeriano C. Simbre
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Oncology ,Cardiotoxicity ,Chemotherapy ,medicine.medical_specialty ,Myocarditis ,Heart Diseases ,Cyclophosphamide ,business.industry ,medicine.medical_treatment ,Cardiomyopathy ,Antineoplastic Agents ,medicine.disease ,Regimen ,Neoplasms ,Internal medicine ,Heart failure ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Anthracyclines ,Pharmacology (medical) ,Myocardial infarction ,Child ,business ,medicine.drug - Abstract
Many children and adolescents with cancer receive chemotherapeutic agents that are cardiotoxic. Thus, while survival rates in this population have improved for some cancers, many survivors may experience acute or chronic cardiovascular complications that can impair their quality of life years after treatment. In addition, cardiac complications of treatment lead to reductions in dose and duration of chemotherapy regimens, potentially compromising clinical efficacy. Anthracyclines are well known for their cardiotoxicity, and alkylating agents, such as cyclophosphamide, ifosfamide, cisplatin, busulfan, and mitomycin, have also been associated with cardiotoxicity. Other agents with cardiac effects include vinca alkaloids, fluorouracil, cytarabine, amsacrine, and asparaginase and the newer agents, paclitaxel, trastuzumab, etoposide, and teniposide. The heart is relatively vulnerable to oxidative injuries from oxygen radicals generated by chemotherapy. The cardiac effects of these drugs include asymptomatic electrocardiographic abnormalities, blood pressure changes, arrhythmias, myocarditis, pericarditis, cardiac tamponade, acute myocardial infarction, cardiac failure, shock, and long-term cardiomyopathy. These effects may occur during or immediately after treatment or may not be apparent until months or years after treatment. Mild myocardiocyte injury from chemotherapy may be of more concern in children than in adults because of the need for subsequent cardiac growth to match somatic growth and because survival is longer in children. Primary prevention is therefore important. Patients should be educated about the cardiotoxic risks of treatment and the need for long-term cardiac monitoring before chemotherapy is begun. Cardiotoxicity may be prevented by screening for risk factors, monitoring for signs and symptoms during chemotherapy, and continuing follow-up that may include electrocardiographic and echocardiographic studies, angiography, and measurements of biochemical markers of myocardial injury. Secondary prevention should aim to minimize progression of left ventricular dysfunction to overt heart failure. Approaches include altering the dose, schedule, or approach to drug delivery; using analogs or new formulations with fewer or milder cardiotoxic effects; using cardioprotectants and agents that reduce oxidative stress during chemotherapy; correcting for metabolic derangements caused by chemotherapy that can potentiate the cardiotoxic effects of the drug; and cardiac monitoring during and after cancer therapy. Avoiding additional cardiotoxic regimens is also important in managing these patients. Treating the adverse cardiac effects of chemotherapy will usually be dependent on symptoms or will depend on the anticipated cardiovascular effects of each regimen. Treatments include diuresis, afterload reduction, beta-adrenoceptor antagonists, and improving myocardial contractility. more...
- Published
- 2005
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4. Long-Term Enalapril Therapy for Left Ventricular Dysfunction in Doxorubicin-Treated Survivors of Childhood Cancer
- Author
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Richard D. Gelber, Suzanne M. Mone, Seema L. Shaikh, Stuart R. Lipsitz, Valeriano C. Simbre, Steven D. Colan, Stephen E. Sallan, and Steven E. Lipshultz
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Adult ,Risk ,Cancer Research ,medicine.medical_specialty ,Adolescent ,Heart disease ,medicine.medical_treatment ,Angiotensin-Converting Enzyme Inhibitors ,Blood Pressure ,Drug Administration Schedule ,Ventricular Dysfunction, Left ,Enalapril ,Afterload ,Diastole ,Neoplasms ,Internal medicine ,medicine ,Humans ,Survivors ,Child ,Antihypertensive Agents ,Retrospective Studies ,Heart Failure ,Chemotherapy ,Antibiotics, Antineoplastic ,business.industry ,Late effect ,Cancer ,Retrospective cohort study ,medicine.disease ,Surgery ,Death, Sudden, Cardiac ,Oncology ,Doxorubicin ,Echocardiography ,ACE inhibitor ,Cardiology ,Heart Transplantation ,medicine.symptom ,business ,medicine.drug - Abstract
PURPOSE: A common late effect of doxorubicin therapy for childhood cancer is reduced left-ventricular (LV) wall thickness resulting in elevated LV afterload and depressed LV function. Many children are given angiotensin-converting enzyme inhibitors, which have been studied primarily in adults. We document the long-term effects of angiotensin-converting enzyme inhibitors in doxorubicin-treated survivors of childhood cancer. PATIENTS AND METHODS: In this retrospective study, we reviewed records of 18 children who had regular echocardiographic examinations during enalapril therapy (mean age at cancer diagnosis, 8 years; mean time between completion of doxorubicin therapy and start of enalapril, 7 years; median follow-up since the start of enalapril, 10 years). RESULTS: Over the first 6 years of enalapril therapy, there was progressive improvement toward normal values in LV dimension, afterload, fractional shortening, and mass, but all these parameters deteriorated between 6 and 10 years. LV wall thickness deteriorated throughout the study period, as did LV contractility and systolic blood pressure. Diastolic blood pressure fell slightly. By 6 years on enalapril, all six patients who had had congestive heart failure at the start of enalapril therapy had either died or undergone cardiac transplantation, compared with three of the 12 asymptomatic patients. CONCLUSION: In doxorubicin-treated long-term survivors of childhood cancer, enalapril-induced improvement in LV structure and function is transient. The primary defect, which is LV wall thinning, continues to deteriorate, and thus the short-term improvement was mostly related to lowered diastolic blood pressure. more...
- Published
- 2002
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5. Cardiomyopathy caused by antineoplastic therapies
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Valeriano C. Simbre, Sampada S. Deshpande, Steven E. Lipshultz, Sarah A. Duffy, Tracie L. Miller, and M. Jacob Adams
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Cardiotoxicity ,medicine.medical_specialty ,Heart disease ,business.industry ,Cardiomyopathy ,Cancer ,medicine.disease ,Asymptomatic ,Transplantation ,Afterload ,Heart failure ,Internal medicine ,medicine ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
The goals of care for patients at risk for cardiomyopathy induced by cancer treatment should include prevention, early diagnosis, treatment of subclinical cardiac dysfunction, prevention of disease progression, and prolongation of patient survival. Any strategy aimed to minimize the cardiotoxic effects of cancer treatment should maintain the treatment's antineoplastic efficacy. Successful therapy achieves the highest health-related quality of life that is defined by the balance between maximizing the efficacy of oncologic therapy and minimizing the toxicity of this therapy. Doxorubicin-induced cardiotoxicity can be reduced by limiting the overall cumulative dose. There is no specific treatment for cancer therapy-related cardiomyopathy, and symptomatic patients should receive standard treatments for congestive heart failure such as afterload reduction, beta-blockers, diuresis, and digoxin. Afterload reduction with angiotensin-converting enzyme inhibitors such as enalapril and captopril may be indicated in patients with elevated afterload and asymptomatic left ventricular dysfunction diagnosed by echocardiography. Beta-blockers may improve myocardial systolic dysfunction and may be useful in the treatment of cancer treatment-induced cardiomyopathy. Cardiac transplantation remains a viable option in patients with cancer treatment-induced end-stage heart disease. more...
- Published
- 2001
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6. Frequency of elevations in markers of cardiomyocyte damage in otherwise healthy newborns
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Valeriano C. Simbre, Stuart R. Lipsitz, Steven E. Lipshultz, Sema Hart, Nader Rifai, Robert A. Sinkin, and Linda J. Reubens
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Male ,medicine.medical_specialty ,Myocardial Infarction ,Cervix Uteri ,Umbilical cord ,Sampling Studies ,Article ,Sex Factors ,Troponin T ,Pregnancy ,Internal medicine ,Troponin I ,medicine ,Birth Weight ,Creatine Kinase, MB Form ,Humans ,Myocytes, Cardiac ,Myocardial infarction ,Subclinical infection ,biology ,business.industry ,Cesarean Section ,Myoglobin ,C-reactive protein ,Racial Groups ,Infant, Newborn ,Length of Stay ,medicine.disease ,Fetal Blood ,medicine.anatomical_structure ,C-Reactive Protein ,Heart failure ,biology.protein ,Cardiology ,Creatine kinase ,Female ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Myocardial damage in infancy is a risk factor for eventual cardiac disease. Given that myocardial stress is greatest during the perinatal period and that the neonatal period is when most pediatric heart failure occurs, the aim of this study was to determine whether even otherwise healthy neonates might have subclinical myocardial damage and, if so, what characteristics might identify them. Umbilical cord and neonatal serum samples from 32 normal neonates were assayed for biomarkers of myocardial injury. No neonate had clinical evidence of cardiac or other abnormalities. Serum cardiac troponin T was elevated in 19 of 25 cords (76%) and in 16 of 17 neonates (94%); levels indicating myocardial infarction (or =0.2 ng/ml) were found in 2 patients (1 umbilical cord and 1 neonatal sample). Creatine kinase-MB was elevated in 6 of 16 cords (38%) and in 8 of 15 neonates (53%). Cardiac troponin I was elevated in 11% and 17% of samples, myoglobin in 4% and 17%, and high-sensitivity C-reactive protein in 9% and 40%. Measures of myocardial injury were associated with longer hospitalization (r = 0.50, p = 0.04), non-Caucasian race (p = 0.012), lower birth weights (p = 0.014), positive maternal cervical cultures (r = 0.41, p = 0.046), and elevated high-sensitivity C-reactive protein (r = 0.66, p = 0.005). In conclusion, clinically occult myocardial injury appears to occur in some healthy newborns, although whether it is pathologic or not remains to be determined. more...
- Published
- 2008
7. Cardiomyocyte injury to transplant: pediatric management
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William G. Harmon, Steven E. Lipshultz, Valeriano C. Simbre, Svjetlana Tisma-Dupanovic, and Gul H. Dadlani
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medicine.medical_specialty ,medicine.medical_treatment ,Population ,Adrenergic beta-Antagonists ,Angiotensin-Converting Enzyme Inhibitors ,Ventricular Dysfunction, Left ,medicine ,Humans ,education ,Intensive care medicine ,Child ,Heart transplantation ,education.field_of_study ,business.industry ,Immunosuppression ,medicine.disease ,Clinical trial ,Transplantation ,Heart failure ,Child, Preschool ,Heart Transplantation ,Cardiology and Cardiovascular Medicine ,business ,Cardiomyopathies ,Immunosuppressive Agents - Abstract
Cardiomyocyte injury in pediatric patients has a vast number of causes, which are often distinct from the causes of adult heart failure. However, the management of pediatric heart failure and heart transplantation has generally been inferred from adult studies. New therapies show great promise for the neurohormonal regulation of heart failure and the ability to control immunosuppression after heart transplantation. Large, randomized, multicenter, controlled clinical trials are needed to determine the efficacy of these therapies in this population. This article reviews the current recommendations and evidence-based medicine, where available, for the medical management of myopathic dysfunction and transplantation in pediatric patients. more...
- Published
- 2003
8. Occult myocardial injury in otherwise healthy newborns
- Author
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Linda J. Reubens, Robert A. Sinkin, Steven E. Lipshultz, Valeriano C. Simbre, Sema Hart, Tina M. Lipinczyk, Nader Rifai, David B Wilk, and Stuart R. Lipsitz
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medicine.medical_specialty ,business.industry ,Emergency medicine ,Physical therapy ,medicine ,Cardiology and Cardiovascular Medicine ,business ,Occult - Published
- 2003
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9. Field guide in the Continental Area of Alto de Cabo Frio,Guia de campo na Área Continental do Alto de Cabo Frio
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Almeida, J. C. H., Da Costa Pereira Lavalle Heilbron, M., Renata Schmitt, Morisson Valeriano, C., Rubim, I. N., Mohriak, W. U., Lima Machado Júnior, D., and Tetzner, W.
10. Provenance of metasediments from the araxá group in the region of Caldas Novas, Goiás, Central Brazil | Proveniência dos metassedimentos do grupo araxá na região de Caldas Novas, Goiás
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Navarro, G. R. B., Zanardo, A., Cibele Montibeller, Da Conceição, F. T., Valeriano, C. M., Leme, H. G., and Simões, L. S. A.
11. Provenance of metasediments from the araxá group in the region of Caldas Novas, Goiás, Central Brazil,Proveniência dos metassedimentos do grupo araxá na região de Caldas Novas, Goiás
- Author
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Navarro, G. R. B., Zanardo, A., Montibeller, C. C., Da Conceição, F. T., Valeriano, C. M., Leme, H. G., and Luiz Simões
12. Contemporary Management of Stable Coronary Artery Disease
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Dario Tino Bertolone, Emanuele Gallinoro, Giuseppe Esposito, Pasquale Paolisso, Konstantinos Bermpeis, Cristina De Colle, Davide Fabbricatore, Niya Mileva, Chiara Valeriano, Daniel Munhoz, Marta Belmonte, Marc Vanderheyden, Jozef Bartunek, Jeroen Sonck, Eric Wyffels, Carlos Collet, Costantino Mancusi, Carmine Morisco, Nicola De Luca, Bernard De Bruyne, Emanuele Barbato, Bertolone, D. T., Gallinoro, E., Esposito, G., Paolisso, P., Bermpeis, K., De Colle, C., Fabbricatore, D., Mileva, N., Valeriano, C., Munhoz, D., Belmonte, M., Vanderheyden, M., Bartunek, J., Sonck, J., Wyffels, E., Collet, C., Mancusi, C., Morisco, C., De Luca, N., De Bruyne, B., and Barbato, E. more...
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Fractional flow reserve ,Computed Tomography Angiography ,Coronary Stenosis ,Chronic coronary syndrome ,Angina ,Coronary Angiography ,Coronary artery disease ,Percutaneous coronary intervention ,Fractional Flow Reserve, Myocardial ,Predictive Value of Tests ,Internal Medicine ,Humans ,Coronary computed tomography angiography ,Cardiology and Cardiovascular Medicine - Abstract
Coronary artery disease (CAD) continues to be the leading cause of mortality and morbidity in developed countries. Assessment of pre-test probability (PTP) based on patient's characteristics, gender and symptoms, help to identify more accurate patient's clinical likelihood of coronary artery disease. Consequently, non-invasive imaging tests are performed more appropriately to rule in or rule out CAD rather than invasive coronary angiography (ICA). Coronary computed tomography angiography (CCTA) is the first-line non-invasive imaging technique in patients with suspected CAD and could be used to plan and guide coronary intervention. Invasive coronary angiography remains the gold-standard method for the identification and characterization of coronary artery stenosis. However, it is recommended in patients where the imaging tests are non-conclusive, and the clinical likelihood is very high, remembering that in clinical practice, approximately 30 to 70% of patients with symptoms and/or signs of ischemia, referred to coronary angiography, have non obstructive coronary artery disease (INOCA). In this contest, physiology and imaging-guided revascularization represent the cornerstone of contemporary management of chronic coronary syndromes (CCS) patients allowing us to focus specifically on ischemia-inducing stenoses. Finally, we also discuss contemporary medical therapeutic approach for secondary prevention. The aim of this review is to provide an updated diagnostic and therapeutic approach for the management of patients with stable coronary artery disease. more...
- Published
- 2022
- Full Text
- View/download PDF
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