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1.
Rev. colomb. cir ; 39(1): 113-121, 20240102. tab
Article in Spanish | LILACS | ID: biblio-1526857

ABSTRACT

Introducción. Se describe la utilidad del umbral crítico de administración (CAT por su denominación en inglés) como herramienta para la reanimación hemostática en pacientes con trauma severo y oclusión endovascular aórtica. Métodos. Revisión retrospectiva de pacientes adultos con hemorragia por trauma, con o sin oclusión endovascular aórtica (REBOA), atendidos entre enero de 2015 y junio de 2020, en un centro de trauma nivel I en Cali, Colombia. Se registraron variables demográficas, severidad del trauma, estado clínico, requerimiento transfusional, tiempo hasta CAT+ y CAT alcanzado (1, 2 ó 3). Resultados. Se incluyeron 93 pacientes, se utilizó REBOA en 36 y manejo tradicional en 57. El grupo REBOA presentó mayor volumen de sangrado (mediana de 3000 ml, RIC: 1950-3625 ml) frente al grupo control (mediana de1500 ml, RIC: 700-2975ml) (p<0,001) y mayor cantidad de glóbulos rojos transfundidos en las primeras 6 horas (mediana de 5, RIC:4-9); p=0,015 y en las primeras 24 horas (mediana de 6, RIC: 4-11); p=0,005. No hubo diferencias estadísticamente significativas en número de pacientes CAT+ entre grupos o tiempo hasta alcanzarlo. Sin embargo, el estado CAT+ durante los primeros 30 minutos de la cirugía fue mayor en grupo REBOA (24/36, 66,7 %) frente al grupo control (17/57, 29,8 %; p=0,001), teniendo este mayor tasa de mortalidad intrahospitalaria frente a los pacientes CAT-. Conclusión. El umbral crítico de administración es una herramienta útil en la reanimación hemostática de pacientes con trauma y REBOA, que podría predecir mortalidad precoz.


Introduction. The objective is to describe the utility of the Critical Administration Threshold (CAT) as a tool in hemostatic resuscitation in patients with severe trauma and REBOA. Methods. Retrospective review between January 2015 and June 2020 of adult patients with hemorrhage secondary to trauma with or without REBOA in a level I trauma center in Cali, Colombia. Demographic variables, trauma severity, clinical status, transfusion needs, time to CAT+ and number of CAT achieved (1, 2 or 3) were recorded. Results. Ninety-three patients were included, in which REBOA was used in 36 and traditional management in 57. The REBOA group had a higher bleeding volume (3000 ml), IQR: 1950-3625 ml vs the control group (1500 ml, IQR: 700-2975 ml) (p<0.001) and a higher rate of PRBC units transfused in the first 6 hours (median 5, IQR: 4-9); p=0.015 and in the first 24 hours (median 6, IQR: 4-11); p=0.005. There were no statistically significant differences in the number of CAT+ patients between groups or time to CAT+. However, CAT+ status during the first 30 minutes of surgery was higher in the REBOA Group (24/36, 66.7%) vs. the control group (17/57, 29.8%; p=0.001), having this group a higher in-hospital mortality rate vs. CAT- patients. Conclusion. CAT is a useful tool in the hemostatic resuscitation of patients with trauma and REBOA that could predict early mortality.


Subject(s)
Humans , Wounds and Injuries , Cardiopulmonary Resuscitation , Endovascular Procedures , Aorta , Blood Transfusion , Balloon Occlusion , Hemorrhage
2.
Cambios rev. méd ; 22(1): 894, 30 Junio 2023. ilus, tabs
Article in Spanish | LILACS | ID: biblio-1451329

ABSTRACT

La fisura anal es una de las enfermedades más antiguamente descritas, la misma que, ha tenido hasta el momento múltiples tratamientos tanto médicos como quirúrgicos, existiendo controversias en su algoritmo terapéutico. Constituye una de las patologías cuyo diagnóstico y tratamiento corresponde a la Especialidad de Coloproctología, afecta a ambos sexos y a cualquier edad y puede ser aguda o crónica. Proponemos el presente Protocolo para un adecuado manejo de la patología, de manera que sirva de guía en la toma correcta de decisiones basadas en la evidencia y el consenso de quienes integramos la Unidad Técnica de Coloproctología del Hospital de Especialidades Carlos Andrade Marín.


Anal fissure is one of the oldest described diseases, which has so far had multiple medical and surgical treatments, with controversies in its therapeutic algorithm. It is one of the pathologies whose diagnosis and treatment corresponds to the Coloproctology Specialty, it affects both sexes and any age and can be acute or chronic. We propose the present Protocol for an adequate management of the pathology, so that it serves as a guide in the correct decision making based on evidence and consensus of those who integrate the Technical Unit of Coloproctology of the Hospital de Especialidades Carlos Andrade Marín.


Subject(s)
Humans , Male , Adult , Middle Aged , Anal Canal , Anus Diseases , Pruritus Ani , Colorectal Surgery , Fissure in Ano/surgery , Quality of Life , Proctoscopy , Diet , Ecuador , Lateral Internal Sphincterotomy , Hemorrhage , Analgesia
3.
Arch. argent. pediatr ; 121(2): e202202692, abr. 2023. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1418619

ABSTRACT

Las anomalías vasculares de la órbita (AVO) son un grupo heterogéneo de patologías que pueden presentarse con frecuencia en el cono orbitario, la región periorbitaria o dentro de la órbita misma. Las AVO se dividen en tumores y malformaciones. Su presentación clínica más frecuente es el exoftalmos, asociado o no a alteración del eje visual. Además, pueden presentar complicaciones agudas, como hemorragia intralesional o celulitis entre las más frecuentes, y complicaciones crónicas, como ambliopía y afectación de la agudeza visual a largo plazo. La evolución de las técnicas de imágenes, el uso de nuevos fármacos y la utilización de innovadores procedimientos en radiología intervencionista han posibilitado obtener una mejora significativa en los procesos diagnósticos y terapéuticos de estos pacientes, permitiendo un diagnóstico y tratamiento preciso.


Orbital vascular anomalies (OVAs) are a heterogeneous group of disorders frequently found in the orbital cone, the periorbital region, or within the orbit itself. OVAs are divided into tumors and malformations. The most frequent clinical presentation is exophthalmos, associated or not with an alteration of the visual axis. They may also cause acute complications, being intralesional bleeding or cellulitis the most frequent, and chronic complications, such as amblyopia and long-term visual acuity impairment. The development of imaging techniques, the use of new drugs, and the implementation of innovative procedures in interventional radiology have resulted in a significant improvement in the diagnostic and therapeutic approaches to these patients, essential to an accurate diagnosis and management.


Subject(s)
Humans , Child , Exophthalmos , Vascular Malformations/therapy , Vascular Malformations/diagnostic imaging , Orbit/blood supply , Orbit/pathology , Visual Acuity , Hemorrhage/pathology
4.
Article in Chinese | WPRIM | ID: wpr-986838

ABSTRACT

Objective: To assess the effectiveness of transanal drainage tube (TDT) in reducing the incidence of anastomotic leak following anterior resection in patients with rectal cancer. Methods: We conducted a systematic search for relevant studies published from inception to October 2022 across multiple databases, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP. Meta-analysis was performed using Review Manager 5.4 software. The primary outcomes included total incidence of anastomotic leak, grade B and C anastomotic leak rates, reoperation rate, anastomotic bleeding rate, and overall complication rate. Results: Three randomized controlled trials involving 1115 patients (559 patients in the TDT group and 556 in the non-TDT group) were included. Meta-analysis showed that the total incidences of anastomotic leak and of grade B anastomotic leak were 5.5% (31/559) and 4.5% (25/559), respectively, in the TDT group and 7.9% (44/556) and 3.8% (21/556), respectively, in the non-TDT group. These differences are not statistically significant (P=0.120, P=0.560, respectively). Compared with the non-TDT group, the TDT group had a lower incidence of grade C anastomotic leak (1.6% [7/559] vs. 4.5% [25/556]) and reoperation rate (0.9% [5/559] vs. 4.3% [24/556]), but a higher incidence of anastomotic bleeding (8.2% [23/279] vs. 3.6% [10/276]). These differences were statistically significant (P=0.003, P=0.001, P=0.030, respectively). The overall complication rate was 26.5%(74/279) in the TDT group and 27.2% (75/276) in the non-TDT group. These differences are not statistically significant (P=0.860). Conclusions: TDT did not significantly reduce the total incidence of anastomotic leak but may have potential clinical benefits in preventing grade C anastomotic leak. Notably, placement of TDT may increase the anastomotic bleeding rate.


Subject(s)
Humans , Anastomotic Leak/etiology , Rectal Neoplasms/complications , Drainage , Anastomosis, Surgical/adverse effects , Reoperation/adverse effects , Hemorrhage , Retrospective Studies
5.
Chinese Journal of Hepatology ; (12): 614-620, 2023.
Article in Chinese | WPRIM | ID: wpr-986179

ABSTRACT

Objective: To analyze the safety and efficacy of using novel oral anticoagulants (rivaroxaban and others) in patients with cirrhosis accompanied with portal vein thrombosis (PVT). Methods: Clinical research literature published from the establishment of the database to June 20, 2021, was retrieved from PubMed, Web of Science, CNKI, Wanfang, and Weipu databases by combining subject terms and free words. RevMan software was used for the random group meta-analysis model. Results: In terms of PVT recanalization, the novel oral anticoagulants (such as low molecular weight heparin and others) had a higher recanalization rate than traditional anticoagulants (OR = 13.75, 95%CI 3.58-52.9, P = 0.000 1). In terms of bleeding, the novel oral anticoagulants did not increase the risk of bleeding compared with traditional anticoagulants (OR = 2.42, 95%CI 0.62-9.41, P = 0.20). Conclusion: The novel oral anticoagulant drugs are superior to traditional anticoagulants in terms of the occurrence of PVT recanalization; however, there is no statistically significant difference in terms of the occurrence of bleeding between the two groups.


Subject(s)
Humans , Portal Vein/pathology , Treatment Outcome , Venous Thrombosis/complications , Liver Cirrhosis/pathology , Anticoagulants/therapeutic use , Hemorrhage
6.
Chinese Journal of Hepatology ; (12): 551-555, 2023.
Article in Chinese | WPRIM | ID: wpr-986168

ABSTRACT

Relevant research in recent years has demonstrated that the atrial fibrillation occurrence rate is significantly higher in patients with cirrhosis. The most common indication for long-term anticoagulant therapy is chronic atrial fibrillation. The use of anticoagulant therapy greatly reduces the incidence rate of ischemic stroke. Patients with cirrhosis combined with atrial fibrillation have an elevated risk of bleeding and embolism during anticoagulant therapy due to cirrhotic coagulopathy. At the same time, the liver of such patients will go through varying levels of metabolism and elimination while consuming currently approved anticoagulant drugs, thereby increasing the complexity of anticoagulant therapy. This article summarizes the clinical studies on the risks and benefits of anticoagulant therapy in order to provide a reference for patients with cirrhosis combined with atrial fibrillation.


Subject(s)
Humans , Atrial Fibrillation/epidemiology , Stroke/epidemiology , Anticoagulants/therapeutic use , Hemorrhage , Liver Cirrhosis/drug therapy , Risk Factors
9.
Chinese Journal of Traumatology ; (6): 121-124, 2023.
Article in English | WPRIM | ID: wpr-970974

ABSTRACT

Viper bite envenomation represents a significant occupational hazard among agricultural workers in India. The viper bite envenomation is usually suspected when a patient presents with predominant local symptoms at the bitten site, including pain, swelling, and necrosis. Further, systemic findings such as diffuse intravascular coagulation, hypotension, and shock may alert physicians of viper bite envenomation rather than a neurotoxic snake bite. However, cerebral complications are rare in viper bites but may potentially fatal. Central nervous system involvement in a viper bite is either due to neurotoxins or hemorrhagins present in the venom, which may induce cerebral thrombosis, ischemia, infarction, and hemorrhage. Here we present a case of a previously healthy adult male who succumbed to extensive subarachnoid, intracerebral, and intraventricular hemorrhages involving bilateral cerebral hemispheres following viper snake bite envenomation. This report highlights the importance of anticipating cerebral complications in viper bite envenomation, a rare occurrence. It also emphasizes the need for early antisnake venom administration to prevent and control systemic envenomation and its complications.


Subject(s)
Adult , Humans , Male , Snake Bites/complications , Hemorrhage/etiology , Intracranial Hemorrhages , Shock , India
10.
Article in English | WPRIM | ID: wpr-970970

ABSTRACT

PURPOSE@#To develop animal models of penetrating thoracic injuries and to observe the effects of the animal model-based training on improving the trainees' performance for emergent and urgent thoracic surgeries.@*METHODS@#With a homemade machine, animal models of lung injuries and penetrating heart injuries were produced in porcine and used for training of chest tube drainage, urgent sternotomy, and emergent thoracotomy. Coefficient of variation of abbreviated injury scale and blood loss was calculated to judge the reproducibility of animal models. Five operation teams from basic-level hospitals (group A) and five operation teams from level III hospitals (group B) were included to be trained and tested. Testing standards for the operations were established after thorough literature review, and expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Tests were carried out after the training. Pre- and post-training performances were compared. Post-training survey using 7-point Likert scale was taken to evaluate the feelings of the trainees to these training approaches.@*RESULTS@#Animal models of the three kinds of penetrating chest injuries were successfully established and the coefficient of variation of abbreviated injury scale and blood loss were all less than 25%. After literature review, testing standards were established, and expert questionnaire results showed that the scientific score was 7.30 ± 1.49, and the feasibility score was 7.50 ± 0.89. Post-training performance was significantly higher in both group A and group B than pre-training performance. Post-training survey showed that all the trainees felt confident in applying the operations and were generally agreed that the training procedure were very helpful in improving operation skills for thoracic penetrating injury.@*CONCLUSIONS@#Animal model-based simulation training established in the current study could improve the trainees' performance for emergent and urgent thoracic surgeries, especially of the surgical teams from basic-level hospitals.


Subject(s)
Animals , Swine , Reproducibility of Results , Wounds, Penetrating/surgery , Thoracotomy , Thoracic Injuries/surgery , Hemorrhage , Models, Animal
11.
Chinese Journal of Hematology ; (12): 38-42, 2023.
Article in Chinese | WPRIM | ID: wpr-969705

ABSTRACT

Objective: To evaluate the clinical effects of low- and intermediate-dose factor Ⅷ (F Ⅷ) prophylaxis in Chinese adult patients with severe hemophilia A. Methods: Thirty adult patients with severe hemophilia A who received low- (n=20) /intermediate-dose (n=10) F Ⅷ prophylaxis at Nanjing Drum Tower Hospital affiliated with Nanjing University Medical College were included in the study. The annual bleeding rate (ABR), annual joint bleeding rate (AJBR), number of target joints, functional independence score of hemophilia (FISH), quality of life score, and health status score (SF-36) before and after preventive treatment were retrospectively analyzed and compared. Results: The median follow-up was 48 months. Compared with on-demand treatment, low- and intermediate-dose prophylaxis significantly reduced ABR, AJBR, and the number of target joints (P<0.05) ; the improvement in the intermediate-dose prophylaxis group was better than that in the low-dose prophylaxis group (P<0.05). Compared with on-demand treatment, the FISH score, quality of life score, and SF-36 score significantly improved in both groups (P<0.05), but there was no significant difference between the two groups (P>0.05) . Conclusion: In Chinese adults with severe hemophilia A, low- and intermediate-dose prophylaxis can significantly reduce bleeding frequency, delay the progression of joint lesions, and improve the quality of life of patients as compared with on-demand treatment. The improvement in clinical bleeding was better with intermediate-dose prophylaxis than low-dose prophylaxis.


Subject(s)
Humans , Hemophilia A/drug therapy , Factor VIII/therapeutic use , Quality of Life , Retrospective Studies , Hemarthrosis/prevention & control , Hemorrhage/drug therapy
12.
Article in Chinese | WPRIM | ID: wpr-982754

ABSTRACT

A 27-year-old female patient suffering endolymphatic sac tumor with intralabyrinthine hemorrhage was reported. The patient had hearing loss in the left ear with continuous tinnitus, and MRI showed the soft tissue shadow of endolymphatic sac. Considering that the tumor involved semicircular canal and vestibule,endolymphatic cyst tumor resection was performed by labyrinth route. After surgery, there was no cerebrospinal fluid leakage and facial nerve function was normal. More importantly, enhanced MRI of temporal bone showed no tumor recurrence 1 year after surgery.


Subject(s)
Female , Humans , Adult , Endolymphatic Sac/surgery , Neoplasm Recurrence, Local/pathology , Labyrinth Diseases , Tinnitus , Ear Neoplasms/pathology , Bone Neoplasms , Hemorrhage
13.
Article in English | WPRIM | ID: wpr-982349

ABSTRACT

Systemic lupus erythematosus (SLE) complicated with acquired hemophilia A (AHA) is a rare condition with frequently delayed diagnosis and a high mortality rate, so it is necessary to strengthen the understanding of this disease. In this study, the characteristics and treatment in 1 case of SLE complicated by AHA is reported and analyzed, and a literature review is conducted. The patient was a 29-year-old young female with a 10-year history of SLE, the main clinical manifestation was severe abdominal bleeding. Laboratory tests revealed that the activated partial thromboplastin time (APTT) was notably prolonged (118.20 s), and the coagulation factor VIII activity (FVIII꞉C) was extremely decreased (0.20%) with high-titer of factor VIII (FVIII) inhibitor (31.2 BU/mL). After treating with high-dose glucocorticoid, immunoglobulin, cyclophosphamide, rituximab, blood transfusion, and intravenous infusion of human coagulation FVIII, the coagulation function and coagulation FVIII꞉C were improved, and FVIII inhibitor was negative without serious adverse reactions. During the next 5-year follow-up, the patient's condition was stable and no bleeding occurred. In the case of coagulation dysfunction in SLE, especially with isolated APTT prolongation, AHA should be screened. When the therapeutic effects of glucocorticoid combined with immunosuppressants are not desirable, rituximab could be introduced.


Subject(s)
Female , Humans , Adult , Hemophilia A/therapy , Rituximab , Glucocorticoids , Factor VIII , Lupus Erythematosus, Systemic/complications , Hemorrhage/complications
14.
Article in Chinese | WPRIM | ID: wpr-982150

ABSTRACT

Effective haemostatic materials can quickly control bleeding and achieve the purpose of saving patients' lives. In recent years, chitosan-based haemostatic materials have shown good haemostatic effects, but their application is limited because chitosan is almost insoluble in water. Carboxymethyl chitosan-based haemostatic materials can promote hemostasis by activating red blood cells and aggregating platelets. In addition, carboxymethyl chitosan can bind with Ca2+ to activate platelets and coagulation factors, and start endogenous coagulation pathways, which can adsorb fibrinogen in plasma to promote haemostasis. In this paper, the latest research progress of carboxymethyl chitosan-based haemostatic materials and their haemostatic mechanism were reviewed, in order to further strengthen the understanding of the haemostatic mechanism of carboxymethyl chitosan-based haemostatic materials, and provide new idea for the research and clinical application of carboxymethyl chitosan-based haemostatic materials.


Subject(s)
Humans , Hemostatics , Chitosan/pharmacology , Hemostasis , Blood Coagulation/physiology , Hemorrhage
15.
Chinese Journal of Traumatology ; (6): 131-138, 2023.
Article in English | WPRIM | ID: wpr-981930

ABSTRACT

PURPOSE@#SAM junctional tourniquet (SJT) has been applied to control junctional hemorrhage. However, there is limited information about its safety and efficacy when applied in the axilla. This study aims to investigate the effect of SJT on respiration when used in the axilla in a swine model.@*METHODS@#Eighteen male Yorkshire swines, aged 6-month-old and weighing 55 - 72 kg, were randomized into 3 groups, with 6 in each. An axillary hemorrhage model was established by cutting a 2 mm transverse incision in the axillary artery. Hemorrhagic shock was induced by exsanguinating through the left carotid artery to achieve a controlled volume reduction of 30% of total blood volume. Vascular blocking bands were used to temporarily control axillary hemorrhage before SJT was applied. In Group I, the swine spontaneously breathed, while SJT was applied for 2 h with a pressure of 210 mmHg. In Group II, the swine were mechanically ventilated, and SJT was applied for the same duration and pressure as Group I. In Group III, the swine spontaneously breathed, but the axillary hemorrhage was controlled using vascular blocking bands without SJT compression. The amount of free blood loss was calculated in the axillary wound during the 2 h of hemostasis by SJT application or vascular blocking bands. After then, a temporary vascular shunt was performed in the 3 groups to achieve resuscitation. Pathophysiologic state of each swine was monitored for 1 h with an infusion of 400 mL of autologous whole blood and 500 mL of lactated ringer solution. Tb and T0 represent the time points before and immediate after the 30% volume-controlled hemorrhagic shock, respectively. T30, T60, T90 and T120, denote 30, 60, 90, and 120 min after T0 (hemostasis period), while T150, and T180 denote 150 and 180 min after T0 (resuscitation period). The mean arterial pressure and heart rate were monitored through the right carotid artery catheter. Blood samples were collected at each time point for the analysis of blood gas, complete cell count, serum chemistry, standard coagulation tests, etc., and thromboelastography was conducted subsequently. Movement of the left hemidiaphragm was measured by ultrasonography at Tb and T0 to assess respiration. Data were presented as mean ± standard deviation and analyzed using repeated measures of two-way analysis of variance with pairwise comparisons adjusted using the Bonferroni method. All statistical analyses were processed using GraphPad Prism software.@*RESULTS@#Compared to Tb, a statistically significant increase in the left hemidiaphragm movement at T0 was observed in Groups I and II (both p < 0.001). In Group III, the left hemidiaphragm movement remained unchanged (p = 0.660). Compared to Group I, mechanical ventilation in Group II significantly alleviated the effect of SJT application on the left hemidiaphragm movement (p < 0.001). Blood pressure and heart rate rapidly increased at T0 in all three groups. Respiratory arrest suddenly occurred in Group I after T120, which required immediate manual respiratory assistance. PaO2 in Group I decreased significantly at T120, accompanied by an increase in PaCO2 (both p < 0.001 vs. Groups II and III). Other biochemical metabolic changes were similar among groups. However, in all 3 groups, lactate and potassium increased immediately after 1 min of resuscitation concurrent with a drop in pH. The swine in Group I exhibited the most severe hyperkalemia and metabolic acidosis. The coagulation function test did not show statistically significant differences among three groups at any time point. However, D-dimer levels showed a more than 16-fold increase from T120 to T180 in all groups.@*CONCLUSION@#In the swine model, SJT is effective in controlling axillary hemorrhage during both spontaneous breathing and mechanical ventilation. Mechanical ventilation is found to alleviate the restrictive effect of SJT on thoracic movement without affecting hemostatic efficiency. Therefore, mechanical ventilation could be necessary before SJT removal.


Subject(s)
Male , Animals , Swine , Shock, Hemorrhagic/therapy , Tourniquets , Axilla , Hemorrhage/therapy , Vascular Diseases , Respiration
16.
REVISA (Online) ; 12(2): 240-245, 2023.
Article in Portuguese | LILACS | ID: biblio-1437519

ABSTRACT

A "febre de Marburg", "febre hemorrágica de Margurg", o "Marburgvirus", o "Vírus de Marburg", o "Vírus de Marburgo" (MARV), ou ainda, a "doença do vírus Marburg" (DVM), são nomenclaturas relacionadas a mesma complexa enfermidade, que possuir elevada virulência e letalidade, sendo pertencente direta da ordem dos "Mononegavirales", da família "Filoviridae" e do gênero "Marburgvirus". 1,2,3,5,9,10,12,13 Conforme identificado junto a literatura científica, um outro termo alternativo e, diretamente relacionado ao DVM é "Marburgvirus do Lago Vitória", sendo ele possuidor de várias linhagens e, o seu gênero, não mostra reatividade antigênica do tipo cruzada, com o conhecido "Ebolavirus"


Subject(s)
Marburgvirus , Hemorrhagic Fever, Ebola , Hemorrhage
17.
Med. lab ; 27(2): 139-155, 2023. Tabs, Grafs, ilus
Article in Spanish | LILACS | ID: biblio-1435603

ABSTRACT

La enfermedad de von Willebrand (EVW) es el trastorno hemorrágico hereditario más común, y se caracteriza por presentar disminución de la capacidad del factor von Willebrand (FVW) de unirse a las plaquetas y al colágeno de la matriz extracelular durante la hemostasia primaria, debido a defectos cuantitativos o cualitativos. La EVW se clasifica en tres fenotipos principales: el 1 y el 3 que son trastornos cuantitativos, y el 2 que se subclasifica en 2A, 2B, 2M y 2N, y refleja los trastornos cualitativos. Para su diagnóstico son necesarios varios pasos: 1) la evaluación del historial de sangrado personal y familiar del paciente, 2) detección inicial de trastornos hemorrágicos, 3) pruebas para la detección de la EVW, 4) pruebas para la tipificación de la EVW, y 5) el análisis molecular. Tanto la subclasificación de la EVW como su diagnóstico continúan planteando desafíos importantes, motivo por el cual se realiza esta revisión, de manera que los profesionales de la salud tengan una guía que los oriente al momento de tener pacientes con algún trastorno hemorrágico que amerite descartar una EVW e implementar un tratamiento adecuado


von Willebrand disease (VWD) is the most common hereditary bleeding disorder, and is characterized by a decreased ability of the von Willebrand factor (VWF) to bind to platelets and extracellular matrix collagen during primary hemostasis, due to quantitative or qualitative defects. VWD is classified into three main phenotypes: 1 and 3, which are quantitative disorders, and 2 (2A, 2B, 2M and 2N) that reflects qualitative disorders. Several steps are necessary for its diagnosis: 1) evaluation of the patient's personal and family bleeding history, 2) initial screening tests for bleeding disorders, 3) tests for the detection of VWD, 4) tests for the classification of VWD, and 5) molecular analysis. Both the subclassification of VWD and its diagnosis continue to represent important challenges, which we aimed to describe in this review, so that health professionals have a guide to assist them when they have patients with a bleeding disorder that requires exclusion of VWD, and implementation of an appropriate treatment.


Subject(s)
Humans , von Willebrand Diseases , von Willebrand Factor , Ristocetin , Platelet Aggregation , Genetics , Hemorrhage , Hemostasis , Antigens
18.
Rev. Anesth.-Réanim. Med. Urg. Toxicol. ; 15(1): 41-45, 2023. tables
Article in French | AIM | ID: biblio-1438427

ABSTRACT

Introduction : Le choc hypovolémique est une défaillance circulatoire aiguë et critique, mettant rapidement en jeu le pronostic vital. L'objectif de l'étude était de déterminer les aspects épidémio-cliniques et la prise en charge du choc hémorragique periopéraoire au centre hospitalier de Mahajanga. Méthodes : Il s'agit d'une étude rétrospective, descriptive, observationnelle et monocentrique réalisée dans le service de Réanimation Chirurgicale du CHU PZaGa de Mahajanga, sur une période de 52 mois. Les données socio-démographiques, les paramètres cliniques périopératoires, la prise en charge médico-chirurgicale, l'évolution et les retentissements organiques de l'état de choc hémorragique ont été les paramètres étudiés. Résultats : Nous avons collecté 6896 dossiers des patients, dont 70 cas de choc hémorragique ont été recensés (1,02%) pour tout type de chirurgie ; 62 dossiers ont été retenus dans l'étude. La majorité des cas était du genre féminin (87,10%). Les pathologies gynéco-obstétricales étaient la principale source de l'état de choc de (77,4%), dont 59,4% d'hémorragie du post-partum. L'insuffisance rénale aiguë était la principale atteinte viscérale (61%, n=38) suivie de 10% (n=6) des cas des troubles neurologiques. Tous les patients ont bénéficié d'une oxygénothérapie, et d'un remplissage vasculaire par des cristalloïdes et 3,2% ont eu des colloïdes. Les substances vasoactives utilisées étaient l'éphédrine 41,9%, suivie de l'adrénaline 27,4% et de la noradrénaline 17,7%. Vingt-sept virgule quarante pourcent de nos patients étaient décédés, et la cause la plus incriminée était la coagulopathie par défibrination. Conclusion: Les hémorragies obstétricales constituent la première cause de choc hémorragique ; le taux de mortalité reste encore élevé.


Subject(s)
Female , Shock, Hemorrhagic , Disseminated Intravascular Coagulation , Hemorrhage , Shock , Mortality
19.
Ann. afr. méd. (En ligne) ; 16(2): 5074-5081, 2023. tables, figures
Article in French | AIM | ID: biblio-1425850

ABSTRACT

Contexte et objectifs. Les données sur la tendance de la mortalité maternelle sont fragmentaires en Afrique Subsaharienne. La présente étude avait pour objectif de faire une analyse triennale de l'évolution du taux de mortalité maternelle et identifier les causes de décès. Méthodes : Il s'agissait d'une étude observationnelle documentaire, sur la mortalité maternelle enregistrée ; au Centre hospitalo universitaire de Constantine, entre le 1er Janvier 2012 et le 31 Décembre 2017. Résultats. Soixante-dix décès maternels ont été déplorés. Le taux de mortalité maternelle est de 101,3 décès pour 100 000 naissances vivantes. Les hémorragies obstétricales et les complications hypertensives de la grossesse sont les premières causes de mortalité. L'analyse des données triennales met en évidence une baisse importante de la mortalité par hémorragie et par complications de l'anesthésie. Conclusion. Cette étude a permis de dresser un profil des causes de la mortalité maternelle dont les niveaux restent inquiétants et requièrent une action globale.


Subject(s)
Humans , Maternal Mortality , Hemorrhage , Cause of Death , Maternal Death
20.
São Paulo; s.n; 2023. 50 p. tab, ilus.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1451236

ABSTRACT

INTRODUÇÃO: A trombocitopenia é uma complicação comum em pacientes com câncer e nos pacientes críticos. A trombocitopenia está associada a maior mortalidade e sangramento nestas populações, porém não está descrita a associação do nível de plaquetas com sangramentos nos pacientes críticos com câncer. Também é escassa a descrição dos desfechos da trombocitopenia e da transfusão profilática de plaquetas em pacientes críticos com câncer. Finalmente não foi avaliado se o tipo de câncer está associado a sangramento espontâneo em pacientes críticos com câncer. OBJETIVO: Descrever as características e desfechos dos pacientes críticos com câncer e trombocitopenia grave na internação na UTI. Avaliar a associação do nível da trombocitopenia e do tipo de câncer (tumor sólido ou câncer hematológico) com a ocorrência de sangramentos espontâneos nos pacientes críticos com câncer. MATERIAL E MÉTODOS: Estudo observacional com dados coletados prospectivamente que analisou pacientes críticos com câncer em atividade e trombocitopenia grave na internação na UTI. O desfecho primário do estudo foi a ocorrência de sangramentos espontâneos. Para estudar a associação entre nível plaquetário ou tipo de câncer com a ocorrência de sangramentos espontâneo foi usada uma regressão logística ajustada para confundidores reconhecidos por directed acyclic graph. RESULTADOS: As características dos pacientes críticos com câncer na internação e durante a estadia na UTI são majoritariamente similares entre pacientes com e sem sangramento, e entre pacientes com sangramento maior ou menor. Todos os pacientes que tiveram sangramento espontâneo não haviam recebido transfusão profilática de plaquetas nas 24 horas que precederam o sangramento. O tipo de câncer não foi associado ao sangramento espontâneo com razão de chance ajustada de com neoplasias hematológicas de 0,6 (0,4-1,2). Níveis baixos de plaquetas foram associados a maior frequência de sangramentos espontâneos. A razão de chance ajustada para nível de plaquetas entre 20 e 49 x 109 /l foi de 4,5 (1,1-19,1), enquanto a razão de chance ajustada para nível de plaquetas < 20 x 109 /L foi de 17,4 (3,9-77,8). CONCLUSÃO: Mostramos a associação entre menores níveis de contagens de plaquetas com maior incidência de sangramento vii espontâneo em pacientes críticos com câncer. No entanto, não houve associação do tipo de câncer com sangramento espontâneo.


INTRODUCTION: Thrombocytopenia is a common complication in cancer patients and critically ill patients. Thrombocytopenia is associated with higher mortality and bleeding in these populations, but the association of platelet levels with bleeding in critically ill patients with cancer has not been well described. There are also few descriptions of the outcomes of thrombocytopenia and prophylactic platelet transfusion in critically ill patients with cancer. Finally, whether the type of cancer is associated with spontaneous bleeding, in critically ill cancer patients it has not been evaluated. OBJECTIVE: Describe the characteristics and outcomes of critically ill patients with cancer and severe thrombocytopenia when admitted to the ICU and evaluate the association between the level of thrombocytopenia and the type of cancer (solid tumor or hematological cancer) with the occurrence of spontaneous bleeding in critically ill patients with cancer. MATERIAL AND METHODS: Observational study with prospectively collected data that analyzed critically ill patients with active cancer and severe thrombocytopenia during ICU admission. The primary outcome of the study was the occurrence of spontaneous bleeding. To study the association between platelet level or type of cancer with the occurrence of spontaneous bleeding, a logistic regression adjusted for confounders recognized by directed acyclic graph was used. RESULTS: The characteristics of critically ill patients with cancer at admission and during the ICU stay are mostly similar between patients with and without bleeding, and between patients with major or minor bleeding. All patients who had spontaneous bleeding had not received prophylactic platelet transfusions in 24 hours preceding the bleeding. The type of cancer was not associated with spontaneous bleeding with an adjusted odds ratio of with hematologic malignancies of 0.6 (0.4-1.2). Low platelet levels have been associated with a higher frequency of spontaneous bleeding. The adjusted odds ratio for a platelet level between 49 and 20 x 109 /L was 4.5 (1.1- 19.1), while the adjusted odds ratio for a platelet level < 20 x 109 /L was 17.4 (3.9-77.8). CONCLUSION: We showed the association between lower levels of platelet counts and a higher incidence of spontaneous bleeding in critically ill cancer patients. However, there was no association between the type of cancer and spontaneous bleeding.


Subject(s)
Thrombocytopenia , Hemorrhage , Neoplasms
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