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Resumo Fundamento Apesar da grande proporção de octogenários com embolia pulmonar aguda, há pouca informação indicando a estratégia de manejo ideal, especialmente medidas terapêuticas, como a terapia lítica. Objetivos O número de pacientes idosos diagnosticados com embolia pulmonar aguda aumenta constantemente. Porém, o papel do tratamento trombolítico não está claramente definido entre os octogenários. Nosso objetivo é avaliar a efetividade da terapia lítica em pacientes octogenários diagnosticados com embolia pulmonar. Métodos Cento e quarenta e oito indivíduos (70,3% de mulheres, n=104) com mais de 80 anos foram incluídos no estudo. Os pacientes foram divididos em dois grupos: tratamento trombolítico versus não-trombolítico. As taxas de mortalidade hospitalar e episódios de sangramento foram definidos como desfechos do estudo. Valor de p <0,05 foi considerado como estatisticamente significativo. Resultados A mortalidade hospitalar reduziu significativamente no grupo trombolítico em comparação ao não-trombolítico (10,5% vs. 24,2%; p=0,03). Episódios de sangramento menores foram mais comuns no braço que recebeu o tratamento trombolítico, mas grandes hemorragias não diferiram entre os grupos (35,1% vs. 13,2%, p<0,01; 7% vs. 5,5% p=0,71, respectivamente). O escore de PESI alto (OR: 1,03 IC95%; 1,01-1,04 p<0,01), a terapia trombolítica (OR: 0,15 IC95%; 0,01-0,25, p< 0,01) e níveis altos de troponina (OR: 1,20 IC95%; 1,01-1,43, p=0,03) estiveram independentemente associados a taxas de mortalidade hospitalar na análise de regressão multivariada. Conclusão A terapia trombolítica esteve associada à mortalidade hospitalar reduzida em detrimento do aumento geral das complicações de sangramento em octogenários.
Abstract Background Despite the high proportion of octogenarians with acute pulmonary embolism, there is little information indicating the optimal management strategy, mainly therapeutic measures, such as lytic therapy. Objectives The number of elderly patients diagnosed with acute pulmonary embolism increases constantly. However, the role of thrombolytic treatment is not clearly defined among octogenarians. Our objective is to evaluate the effectiveness of lytic therapy in octogenarian patients diagnosed with pulmonary embolism. Methods One hundred and forty eight subjects (70.3% women, n=104) aged more than eighty years were included in the study. The patients were divided in two groups: thrombolytic versus non-thrombolytic treatment. In-hospital mortality rates and bleeding events were defined as study outcomes. P-value <0.05 was considered as statistical significance. Results In-hospital mortality decreased significantly in the thrombolytic group compared to the non-thrombolytic group (10.5% vs. 24.2% p=0.03). Minor bleeding events were more common in the arm that received thrombolytic treatment, but major hemorrhage did not differ between the groups (35.1% vs. 13.2%, p<0.01; 7% vs. 5.5% p=0.71, respectively). High PESI score (OR: 1.03 95%CI; 1.01-1.04 p<0.01), thrombolytic therapy (OR: 0.15 95%CI; 0.01-0.25, p< 0.01) and high troponin levels (OR: 1.20 95%CI; 1.01-1.43, p=0.03) were independently associated with in-hospital mortality rates in the multivariate regression analysis. Conclusion Thrombolytic therapy was associated with reduced in-hospital mortality at the expense of increased overall bleeding complications in octogenarians.
Subject(s)
Humans , Child , Adolescent , Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Metabolic Syndrome/epidemiology , Pediatric Obesity/therapy , Body Composition , Weight Loss/physiology , Body Mass Index , Atrial Natriuretic Factor/metabolismABSTRACT
Uterine leiomyoma and coronary artery disease are two common diseases in women. However, the association of uterine bleeding caused by leiomyoma with unstable coronary syndrome is not frequent. Here we describe a case of a patient with active vaginal bleeding and unstable angina who underwent a unique approach by performing percutaneous procedures. The report demonstrates that new interventional options can be used to control active bleeding in patients in need of coronary angioplasty
Subject(s)
Humans , Female , Adult , Uterine Hemorrhage/complications , Women , Stents , Angioplasty , Platelet Aggregation Inhibitors/therapeutic use , Angioplasty, Balloon, Coronary/methods , Embolization, Therapeutic/methods , LeiomyomaABSTRACT
Abstract Background: Thrombotic disorders remain one of the leading causes of death in the Western world. Dabigatran appeared as an alternative to warfarin for anticoagulation in the treatment of atrial fibrillation (AF). The risk associated with bleeding due to its use has been documented in several randomized clinical trials, but no large study has examined in detail the risk of bleeding during dental extraction and other dental procedures involving bleeding. Objective: To compare the intensity of bleeding in individuals taking dabigatran or vitamin K antagonist (warfarin) and undergoing dental procedures. Methods: Prospective, single-center, controlled study with one single observer. Patients diagnosed with nonvalvular AF, on warfarin or dabigatran, cared for at a cardiology referral center, and requiring single or multiple dental extractions, were evaluated up to seven days post-extraction. The following outcomes were assessed: bleeding time between the beginning and the end of suture and complete hemostasis; bleeding before the procedure, after 24 hours, 48 hours, 7 days, during and after suture removal (late); p<0.05 was defined as of statistical relevance. Results: We evaluated 37 individuals, 25 in the warfarin group and 12 in the dabigatran group. Age, sex, weight, height, blood pressure, color, schooling, family income and comorbidities were similar between the two groups. Regarding bleeding after 24 hours of the procedure, no one in the dabigatran group had bleeding, whereas 32% in the warfarin group had documented bleeding (p = 0.028). The other variables analyzed did not differ between the groups. Conclusions: This study suggests that, regarding dental extraction, there is no statistically significant difference in the intensity of bleeding of patients taking dabigatran as compared to those taking warfarin. Bleeding 24 hours after the procedure was less frequent among patients on dabigatran.
Resumo Fundamento: Distúrbios trombóticos permanecem como uma das principais causas de morte no mundo ocidental. A dabigatrana surgiu como alternativa à varfarina para a anticoagulação no tratamento da fibrilação atrial (FA). O risco associado a eventos hemorrágicos com a sua utilização foi documentado em vários ensaios clínicos randomizados, mas nenhum grande estudo analisou detalhadamente o risco de hemorragia durante a extração dentária e em outros procedimentos odontológicos que envolvam sangramentos. Objetivo: Em indivíduos submetidos a procedimentos odontológicos, avaliar a intensidade de sangramento com o uso de dabigatrana em comparação ao uso de anticoagulante oral antagonista da vitamina K (varfarina). Métodos: Estudo prospectivo, controlado, unicêntrico, observador único. Pacientes com diagnóstico de FA não valvar atendidos em um centro de referência em cardiologia e com indicação de anticoagulação que necessitavam de tratamento odontológico para exodontia única ou múltipla, estando em uso de varfarina ou dabigatrana e avaliados até sete dias pós-exodontia. Foram avaliados os efeitos sobre: tempo de sangramento entre o início e o fim da sutura e hemostasia completa; sangramento antes do procedimento, após 24 e 48 horas, 7 dias, durante e após a remoção da sutura (tardio), sendo considerado como estatisticamente significativo valor de p < 0,05. Resultados: Foram avaliados 37 indivíduos, sendo 25 no grupo varfarina e 12 no dabigatrana. Idade, sexo, peso, altura, pressão arterial, cor, escolaridade, renda familiar e comorbidades foram semelhantes nos dois grupos. Em relação ao sangramento 24 horas após o procedimento, ninguém do grupo dabigatrana apresentou sangramento, que esteve presente em 32% do grupo varfarina (p = 0,028). Não houve diferenças entre os grupos em relação às outras variáveis analisadas. Conclusões: Os dados deste estudo permitem sugerir que, em indivíduos submetidos a procedimento odontológico de exodontia, não há diferença estatisticamente significante na intensidade de sangramento em uso de dabigatrana em comparação ao uso de varfarina. Há uma menor frequência de sangramento 24 horas após o procedimento nos indivíduos em uso de dabigatrana.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Tooth Extraction/adverse effects , Warfarin/adverse effects , Blood Loss, Surgical , Dabigatran/adverse effects , Anticoagulants/adverse effects , Reference Values , Time Factors , Bleeding Time , Prospective Studies , Risk Factors , Treatment Outcome , Statistics, NonparametricABSTRACT
Objective To investigate the clinical value of inflammation-related factors [white blood cell count,erythrocyte sedimentation rate (ESR),and C-reactive protein] in predicting delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.Methods The aneurysmal subarachnoid hemorrhage in 217 cases according to whether the occurrence of delayed cerebral ischemia were divided into 2 groups:delayed cerebral ischemia (DCI) group (n =69) and non DCI group (n =148).A retrospective analysis of 217 cases of patients was performed with inflammation-related factors,and its relationship with clinical prognosis of patients with DCI was also analyzed.Results The inflammation-related factors (WBC count,erythrocyte sedimentation rate,and C-reactive protein) in DCI group were significantly higher than those in non DCI group with a statistically significant difference (P ＜ 0.05).The follow-up results showed that there were 33 patients died,12 cases of plant survival,and 12 patients with severe disability in DCI group,which had a statistically significant difference relative to non DCI group (P ＜ 0.05).Spearman analysis showed that there was a significantly negative relationship between inflammation-related factors (white blood cell count,ESR,C-reactive protein) and glasgow prognostic score (GOS) in DCI group(r =-0.877,-0.683,-0.841,P ＜0.05).Conclusions The inflammation-related factors can be used as one of method to predict delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.
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Objective: To study the treatment method of apoplectic joint contracture. Method: Fifty-two cases were treated with acupuncture plus cupping and thirty cases were treated with acupuncture alone as the control group. Result and conclusion: The effective rate of the former and later were 100% and 93.3% respectively,combined treatment of acupuncture and cupping was superior to acupuncture alone (P＜0.05).
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Sixty cases of pseudobulbar palsy were treated by puncturing Shuigou (GV 26), Lianquan (GV 23), Fengchi (GB 20), Wangu (GB12), Yifeng (TE 17),Tongli (HT 5), Neiguan (PC 6) and Fenglong (ST 40)with the needling technique to refresh mind and open orifice, and by puncturing the retropharyngeal wall and palatine arch, plus training of swallowing function, the total effective rate reached 95.0%.
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Objective: To observe the therapeutic effect of scalp-acupuncture on post-apoplectic depression.Methods: Twenty-nine patients with depression due to cerebral apoplexy were treated by scalp-acupuncture and compared with 28 cases of medicine group chosen randomly. Results: In scalp-acupuncture group, the total effective rate was 89. 6%. In medicine group (control group), the total effective rate was 71.4%. Conclusion:The result showed that the therapeutic effect in scalp-acupuncture group was obviously better than that in medicine group (P＜0.05).
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According to the method of puncturing the twelve Jing (well) acupoints to treat hemiplegia followYinbai (SP 1), Dadun (LR 1), Shangyang (LI 1) and Guanchong (TE 1), combining with selected acupoints according to the presenting syndromes, to treat 114 cases of hemiplegia following a stroke, the total effective rate was 91.1%.
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Objective: To study the therapeutic effect of treating apoplectic pscudobulbar paralysis with acupunc -ture. Method: Consciousness-restoring & obstruction -clearing needling technique and points Fengchi (GB 20),Yifeng (TE 17), Wangu (GB 12), Neiguan (PC 6),Shuigou (GV 26), Sanyinjiao (SP 6), Shanglianquan (Ex-HN), Jinjin (Ex-HN 12), Yuye (Ex-HN 13) and Baihui (GV 20) were selected to treat 300 cases of apoplectic pseudobulbar paralysis. Result: Cure: 189cases, marked effect: 71 cases, effective: 32 cases, no effect: 8 cases and the whole effective rate is 97.3%.Conclusion: Consciousness-restoring & obstruction-clea ring needling technique is effective in treating apoplectic pscudobulbar paralysis.
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In this research, X-ray photograph and kinescope were applied to observe the whole process of barium swallowing statically and dynamically before and after acupuncture treatment by the radiography of the upper alimentary tract (RART). The observation was made on the objective changes about the functional renovation of contractor muscle of pharynx and epiglottis muscle. Among 36 cases, function of speaking basically recovered in 3 cases, function of swallowing 16 cases,function of expectorating sputum 15 c ases, and for function of water drinking 13 cases. The total effective rate: 75.0% for function of speaking, 97.2% for function of swallowing, 75.0% for function of expectorating sputum, 97.2% for function of water drinking.
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Objective: To discuss the therapeutic method of apoplectic patients with language disorders.Methods: Sixty cases of apoplexy were classified into electroacupuncture group of 30 cases and acupuncture group of 30 cases. In electroacupuncture group, acupoints Lianquan (CV 23), Tongli (HT 5) and lower 2/5 part of motor area and sensory area were selected. In acupunc -ture group, acupoints Lianquan (CV 23) and Tongli (HT 5) were selected. Results and conclusions: After 2 courses of treatment, the total effective rate in electroacu -puncture group was 93.3% and that in acupuncture group was 76.6%. There was a significant difference in the therapeutic effect between the two groups (P＜0.05).