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1.
Rev. medica electron ; 41(5): 1192-1204, sept.-oct. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1094122

ABSTRACT

RESUMEN Introducción: la hemorragia digestiva alta ocurre por una lesión sangrante localizada entre el esfínter esofágico superior y el ángulo de Treitz. Objetivo: determinar el comportamiento del tratamiento endoscópico del sangrado digestivo alto por úlcera péptica, en el departamento de Gastroenterología del Hospital Universitario Comandante "Faustino Pérez". Materiales y métodos: se realizó un estudio descriptivo, prospectivo para evaluar el resultado del tratamiento endoscópico en el sangrado digestivo alto por úlcera péptica en el Hospital Universitario Comandante "Faustino Pérez" de Matanzas, de enero del 2016 a febrero del 2018. El tratamiento endoscópico fue la inyectoterapia con epinefrina al 1:10000. Se analizaron las variables: grupo de edades, sexo, resultado del tratamiento endoscópico, estigmas endoscópicos de sangrado, recidiva hemorrágica, mortalidad directa, necesidad de cirugía, estadía hospitalaria y cantidad de unidades transfusionales. Resultados: se constató un predominio de pacientes masculinos (87.5 %), menores de 60 años (70%). Prevalecieron los pacientes con estigmas endoscópicos de sangrado activo venoso (45%). La terapia endoscópica tuvo un resultado satisfactorio (92.5%) en su mayoría. La ocurrencia de resangrado (45%), mortalidad directa por hemorragia digestiva, promedio de estadía hospitalaria, cantidad de unidades transfusionales y necesidad de intervención quirúrgica de urgencia (17.5%), resultó similar a los estudios reportados, demostrando que la inyectoterapia endoscópica aún constituye una opción eficaz si no se cuenta con otras terapias endoscópicas. Conclusiones: la mayoría de los casos tratados con inyectoterapia endoscópica tuvieron un sangrado activo venoso o Forrest IB que fue satisfactoria. La inyectoterapia no satisfactoria fue en pacientes con sangrado activo. La mortalidad directa relacionada con el sangrado fue infrecuente y en relación con el sangrado arterial. Se demostró que la inyectoterapia endoscópica aún constituye una opción eficaz si no se cuenta con otras terapias endoscópicas (AU).


SUMMARY Introduction: high digestive bleeding happens due to a bleeding lesion located between the upper anatomical sphincter of the esophagus and the angle of Treitz. Objective: to determine the endoscopic treatment behavior of high digestive bleeding caused by peptic ulcer, in the department of Gastroenterology of the University Hospital "Comandante Faustino Perez". Materials and methods: a prospective descriptive study was carried out to evaluate the result of the endoscopic treatment in high digestive bleeding caused by peptic ulcer in the University Hospital "Comandante Faustino Perez", of Matanzas, from January 2016 to February 2018. The endoscopic treatment was injecto-therapy with epinephrine at 1:10000. The analyzed variables were: age group, sex, result of the endoscopic treatment, bleeding endoscopic stigma, hemorrhagic relapse, direct mortality, surgery necessity, hospital staying, and quantity of transfusion units. Results: male patients (87.5 %), aged less than 60 years predominated. Patients with endoscopic stigma of venous active bleeding (45 %) prevailed. In most of cases, endoscopic therapy achieved satisfactory results (92.5 %). The authors found that bleeding relapse (45 %), direct mortality by digestive hemorrhage, average hospital staying, quantity of transfusion units and necessity of urgent surgeries (17.5 %) were similar to those reported in other studies. Conclusions: most cases treated with endoscopic injectotherapy had active venous or Forrest IB bleeding and treatment was satisfactory. Therapy was unsatisfactory in patients with active bleeding. The direct mortality related to bleeding was infrequent, and related to arterial bleeding. It was showed that endoscopic injectotherapy is still an efficacious option if other endoscopic therapies are not available (AU).


Subject(s)
Middle Aged , Aged , Peptic Ulcer/diagnosis , Endoscopy/statistics & numerical data , Hemorrhage/therapy , Peptic Ulcer/etiology , Behavior , Epinephrine/therapeutic use , Epidemiology, Descriptive , Prospective Studies , Hemorrhage/complications , Hemorrhage/diagnosis , Hemorrhage/epidemiology
4.
J. vasc. bras ; 17(4): 348-352, out.-dez. 2018. ilus
Article in Portuguese | LILACS | ID: biblio-969242

ABSTRACT

A fístula do tronco arterial braquiocefálico-traqueal é uma complicação pouco frequente da traqueostomia, com incidência entre 0,1 e 1%, porém com alta mortalidade nos casos não tratados. Sinais precoces incluem desde sangramento autolimitado a hemorragia maciça com choque hipovolêmico. A espessura da cânula de traqueostomia, seu posicionamento junto à parede traqueal e a pressão do balonete traqueal podem lesionar a mucosa e precipitar seu desenvolvimento. Descrevemos o caso de paciente do sexo feminino, 14 anos, traqueostomizada aos oito anos após traumatismo craniencefálico. Evoluiu após esse período com estenose subglótica e necessidade de sessões de dilatação por seis anos. No quinto ano das sessões, apresentou hemoptise de repetição, inicialmente tratada por cirurgia com prótese de politetraflouroetileno expandido. Um ano depois, apresentou novo sangramento com repercussão hemodinâmica, controlada pela técnica endovascular, e nova cirurgia foi programada em caráter eletivo. Após a segunda cirurgia, houve seis meses de acompanhamento clínico ambulatorial, sem novas complicações


Tracheo-innominate artery fistula (TIF) is a rare complication of tracheostomy, with incidence ranging from 0.1 to 1%, but mortality is high in untreated cases. Early signs range from self-limited bleeding to massive hemorrhage with hypovolemic shock. The caliber of the tracheostomy cannula, its position in contact with the tracheal wall, and tracheal cuff pressure can traumatize the mucosa and trigger development of a TIF. We describe the case of a 14-year-old female patient who had been tracheostomized at the age of eight because of head trauma. She later developed subglottic stenosis requiring dilation sessions for six years. During the fifth year of these sessions, she presented repetitive hemoptysis, initially treated by surgery to implant an expanded polytetrafluoroethylene graft. One year later, she had an intense hemorrhage, which was controlled using endovascular techniques followed by definitive surgery, performed electively. The patient was followed up for six months, without complications


Subject(s)
Humans , Female , Child , Truncus Arteriosus , Tracheostomy/methods , Endovascular Procedures/methods , Fistula , Hemorrhage/diagnosis , Angiography/methods , Stents , Treatment Outcome , Emergency Treatment/methods , Ambulatory Care , Brain Injuries, Traumatic/complications , Hemorrhage/therapy
5.
Rev. cuba. pediatr ; 90(1): 132-140, ene.-mar. 2018. ilus, graf
Article in Spanish | LILACS | ID: biblio-901472

ABSTRACT

Introducción: la presencia de lágrimas con sangre -o hemolacria- es un hecho infrecuente en la práctica clínica, y ha sido denominada con distintas acepciones en la literatura médica. Las causas que originan este signo son múltiples, y comprenden desde trastornos locales en el globo ocular, hasta enfermedades sistémicas, además de las provocadas en forma artificial y en otras. En ocasiones su etiología no se ha podido demostrar. Presentación del caso: adolescente, mestiza, de 16 años de edad que fue remitida al Hospital Docente Pediátrico del Cerro por el policlínico de su área de salud, porque presentó lágrimas con sangre con epistaxis acompañada de cefaleas y calambres en extremidades inferiores, además de referir un síndrome de inmunodeficiencia adquirida desde los 13 años. Durante su estadía hospitalaria se constató en dos ocasiones hemolacria con epistaxis. Los exámenes complementarios realizados para diagnosticar algún trastorno de la coagulación, enfermedad local o sistémica no transmisible, resultaron normales. Se indicó tratamiento con antirretrovirales para su afección de base. Se explicó la posible fisiopatología de este fenómeno. Conclusiones: la causa de esta entidad en la presente comunicación queda por precisar, y es el primer caso pediátrico reportado en Cuba(AU)


Introduction: the presence of tears with blood -or haemolacria- is an uncommon event in clinical practice which has been defined in several different manners in medical literature. The causes giving rise to this sign are many, ranging from local disorders in the eyeball to systemic diseases, alongside those brought about by artificial agents and others. On occasion it has not been possible to determine its etiology. Case presentation: a mulatto 16-year-old female adolescent was referred by the polyclinic in her health area to the Pediatric University Hospital in the municipality of Cerro with bloody tears and epistaxis accompanied by headaches and cramp in her lower limbs. The patient stated she had suffered from an acquired immunodeficiency syndrome since the age of 13. During her stay in hospital two episodes of haemolacria with epistaxis could be observed. The complementary tests performed to diagnose some other coagulation disorder, local condition or non-communicable systemic disease were all normal. Treatment with antiretrovirals was indicated for her underlying disease. The possible physiopathology of the phenomenon was explained. Conclusions: the cause of the condition discussed in the present communication is still to be determined. This is the first pediatric case of haemolacria reported in Cuba(AU)


Subject(s)
Humans , Female , Adolescent , Hemorrhage/diagnosis
6.
Rev. gaúch. enferm ; 39: e20170131, 2018. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-960793

ABSTRACT

Resumo OBJETIVO Analisar associações entre discriminadores do Sistema de Triagem de Manchester e Diagnósticos de Enfermagem em pacientes adultos, classificados com prioridade clínica I (emergência) e II (muito urgente). MÉTODO Estudo transversal realizado na unidade de emergência do sul do Brasil, entre abril e agosto de 2014. Amostra de 219 pacientes. Os dados foram coletados no prontuário online e analisados estatisticamente, com teste exato de Fisher ou qui-quadrado. RESULTADOS Encontrou-se 16 discriminadores e 14 diagnósticos de enfermagem. Houve associação entre sete discriminadores e cinco diagnósticos de enfermagem do tipo foco no problema, dentre Dor precordial ou cardíaca com o diagnóstico Dor aguda. Também houve associação entre três discriminadores com quatro diagnósticos de enfermagem de risco, dentre Déficit neurológico agudo com o diagnóstico Risco de perfusão tissular cerebral ineficaz. CONCLUSÃO Existem associações significativas entre discriminadores do Sistema de Triagem de Manchester e diagnósticos de enfermagem mais frequentemente estabelecidos na Unidade de Emergência.


Resumen OBJETIVO Analizar asociaciones entre los discernidores del Sistema Triaje de Manchester y los Diagnósticos de Enfermería en pacientes adultos con prioridad clínica I (emergencia) y II (muy urgente). MÉTODO Estudio transversal realizado en la unidad de emergencia del sur de Brasil, entre abril y agosto de 2014, con la muestra de 219 pacientes. La colecta de datos fue realizada en el prontuario online de los pacientes. El análisis estadístico fue realizado con el uso del Test Exacto de Fisher o chi-cuadrado. RESULTADOS Fue identificado el uso de 16 discernidores y 14 diagnósticos de enfermería. Hubo una asociación entre siete discernidores y cinco diagnósticos de enfermería del tipo foco en el problema, entre estos Dolor precordial o cardíaca y Dolor agudo. También hubo asociación entre tres discernidores y cuatro diagnósticos de enfermería de riesgo, entre estos Déficit neurológico agudo con el diagnóstico Riesgo de perfusión tisular cerebral ineficaz. CONCLUSIÓN Existen asociaciones significativas entre los discernidores del Sistema Triaje de Manchester y los diagnósticos de enfermería más frecuente establecidos en la Unidad de Emergencia.


Abstract OBJECTIVE To analyze the association between Manchester Triage System flowchart discriminators and nursing diagnoses in adult patients classified as clinical priority I (emergency) and II (very urgent). METHOD Cross-sectional study conducted in an emergency department in southern Brazil between April and August 2014. The sample included 219 patients. Data were collected from online patient medical records and data analysis was performed using Fisher's exact test or the chi-square test. RESULTS 16 discriminators and 14 nursing diagnoses were identified. Associations were found between seven discriminators and five problem-focused nursing diagnoses, including the discriminator Cardiac pain and the diagnosis Acute pain. Three discriminators were associated with four risk nursing diagnoses, among these Acute neurological deficit with the diagnosis Risk of ineffective cerebral tissue perfusion. CONCLUSION Significant associations were found between Manchester Triage System discriminators and the nursing diagnoses most frequently established in the emergency department.


Subject(s)
Humans , Male , Female , Adult , Aged , Nursing Diagnosis , Triage , Emergency Nursing , Emergencies/nursing , Emergency Service, Hospital/organization & administration , Socioeconomic Factors , Chest Pain/diagnosis , Chest Pain/nursing , Chest Pain/epidemiology , Software Design , Brazil/epidemiology , Cross-Sectional Studies , Diagnosis-Related Groups , Dyspnea/diagnosis , Dyspnea/nursing , Dyspnea/epidemiology , Emergencies/epidemiology , Electronic Health Records , Hemorrhage/diagnosis , Hemorrhage/nursing , Hemorrhage/epidemiology , Hypoxia/diagnosis , Hypoxia/nursing , Hypoxia/epidemiology , Middle Aged , Nursing Care
7.
Arch. argent. pediatr ; 115(6): 432-435, dic. 2017. ilus, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-887408

ABSTRACT

Se reporta un caso de edema agudo hemorrágico de la infancia, en un lactante de 18 meses, después de un episodio de otitis media. El cuadro comenzó con máculas eritematosas en los muslos, seguidas de lesiones purpúricas en los brazos, las piernas y edema en los tobillos. Se interpretó, inicialmente, como urticaria, por lo que recibió esteroides. Sin embargo, las características clínicas fueron de edema agudo hemorrágico de la infancia, una vasculitis leucocitoclástica benigna que se presenta en niños de entre 4 y 24 meses y que se caracteriza por fiebre, máculas y lesiones purpúricas. Estas se ubican, principalmente, en la cara, los lóbulos de las orejas y las extremidades, y se asocian, muchas veces, a edema. Los diagnósticos diferenciales son eritema multiforme, urticaria, vasculitis inducida por droga, enfermedad de Kawasaki, eccema infectado, meningococcemia y maltrato infantil, algunas de ellas, con riesgo de mortalidad. El manejo es conservador, sin embargo, los esteroides podrían ser una opción terapéutica.


We report a case of acute hemorrhagic edema of infancy in an 18-month-old boy after an episode of otitis media. The clinical presentation begins with skin erythematous macules on the thighs, followed by purpuric lesions in arms, legs, and ankle edema. It was initially interpreted as urticaria, whereby steroids were indicated. However, the clinical feature was acute hemorrhagic edema of infancy, a benign leukocytoclastic vasculitis that occurs in children between 4 and 24 months of age and is characterized by fever, large purpuric palpable target-like skin lesions affecting the face, lobes of the ears, limbs and frequently associated with edema. Differential diagnosis includes erythema multiforme, hemorrhagic urticaria, drug-induced vasculitis, Kawasaki disease, infected eczema, sepsis (either meningococcal or non-meningococcal) and child abuse. Some of them have risk of mortality. Management is conservative, however, steroids may be a therapeutic option.


Subject(s)
Humans , Male , Infant , Skin Diseases/diagnosis , Vasculitis, Leukocytoclastic, Cutaneous/diagnosis , Skin Diseases/drug therapy , Urticaria/diagnosis , Hydrocortisone/therapeutic use , Prednisone/therapeutic use , Acute Disease , Vasculitis, Leukocytoclastic, Cutaneous/drug therapy , Diagnosis, Differential , Edema/diagnosis , Hemorrhage/diagnosis , Anti-Inflammatory Agents/therapeutic use
8.
Einstein (Säo Paulo) ; 15(3): 380-385, July-Sept. 2017. tab, graf
Article in English | LILACS | ID: biblio-891407

ABSTRACT

ABSTRACT Severe hemorrhage with necessity of allogeneic blood transfusion is common complication in intensive care unit and is associated with increased morbidity and mortality. Prompt recognition and treatment of bleeding causes becomes essential for the effective control of hemorrhage, rationalizing the use of allogeneic blood components, and in this way, preventing an occurrence of their potential adverse effects. Conventional coagulation tests such as prothrombin time and activated partial thromboplastin time present limitations in predicting bleeding and guiding transfusion therapy in critically ill patients. Viscoelastic tests such as thromboelastography and rotational thromboelastometry allow rapid detection of coagulopathy and goal-directed therapy with specific hemostatic drugs. The new era of thromboelastometry relies on its efficacy, practicality, reproducibility and cost-effectiveness to establish itself as the main diagnostic tool and transfusion guide in patients with severe active bleeding.


RESUMO A hemorragia grave com necessidade de transfusão de sangue e componentes é uma complicação frequente na unidade de terapia intensiva e está associada ao aumento da morbidade e da mortalidade. A identificação adequada e o tratamento precoce da causa específica da coagulopatia tornam-se fundamentais para o controle efetivo da hemorragia, racionalizando a utilização de sangue e componentes, e desta forma, prevenindo a ocorrência de efeitos adversos. Testes convencionais da coagulação (tempo de ativação de protrombina e tempo de tromboplastina parcial ativada) apresentam limitações para prever sangramento e guiar a terapia transfusional em pacientes graves. Testes viscoelásticos como a tromboelastografia e tromboelastometria rotacional permitem a rápida detecção da coagulopatia e orientam a terapia de forma individualizada, alvo dirigida com drogas hemostáticas específicas. A nova era da tromboelastometria confia na sua eficácia, praticidade, reprodutibilidade e custo-eficácia para se firmar como a principal ferramenta diagnóstica e guia transfusional em pacientes com sangramento ativo grave.


Subject(s)
Humans , Thrombelastography/methods , Thrombelastography/standards , Hemorrhage/diagnosis , Severity of Illness Index
9.
Rev. medica electron ; 39(3): 432-442, may.-jun. 2017.
Article in Spanish | LILACS, CUMED | ID: biblio-902183

ABSTRACT

Introducción: la hemorragia digestiva alta constituye un problema frecuente de salud en el mundo; así se comporta en Cuba, en la provincia Matanzas y en el hospital de estudio. Actualmente es considerada como causa mayor de morbimortalidad. Objetivo: determinar el comportamiento de la hemorragia digestiva alta en el Hospital Militar de Matanzas. Materiales y Métodos: se realizó una investigación descriptiva, en un periodo de cinco años que incluyó a todos los pacientes ingresados con ese diagnóstico, y los que durante su ingreso por otra causa presentaron episodios de hemorragia. El índice de Rockall permitió evaluar la necesidad de cirugía, recidiva y mortalidad. Resultados: la mayoría de los pacientes pertenecieron al grupo de riesgo intermedio. Los hombres fueron los más afectados, el grupo de tercera edad presentó mayor incidencia. La gastritis hemorrágica fue la primera causa de sangrado. La hipertensión arterial resultó ser el factor de riesgo relevante y el tabaquismo el hábito tóxico más frecuente. Conclusiones: como beneficio relevante se demostró la importancia de la endoscopia precoz para el diagnóstico de la causa, tratamiento y pronóstico de la hemorragia. Se observó una buena correlación entre el pronóstico del paciente al ingreso y su estado al final del tratamiento (AU).


Introduction: the high digestive hemorrhage is a frequent health problem in the world; it behaves the same in Cuba, in the province of Matanzas and in the hospital where the study was carried out. Currently it is considered a major cause of morbi-mortality. Objective: to determine the behavior of the high digestive bleeding in the Military Hospital of Matanzas. Materials and Methods: a descriptive research was carried out in a five-year period. It included all the patients admitted with that diagnosis and those who presented episodes of hemorrhage even if they were admitted by any other cause. The Rockall index allowed to assess the necessity of surgery, the recidivism and mortality. Results: most of the patients belonged to the intermediate risk group. Male patients were the most affected one; the group of elder people showed higher incidence. Hemorrhagic gastritis was the first cause of bleeding. Arterial hypertension was the relevant risk factor and smoking the most frequent toxic habit. Conclusions: as a relevant benefit it was showed the importance of precocious endoscopy for the diagnosis of the hemorrhage cause, treatment and prognosis. It was observed a good correlation between the patient´s prognosis at the admission and his status at the end of the treatment (AU).


Subject(s)
Humans , Male , Female , Hematemesis/pathology , Digestive System/pathology , Hemorrhage/epidemiology , Hematemesis/complications , Hematemesis/blood , Endoscopy, Digestive System/methods , Gastric Mucosa/injuries , Hemorrhage/complications , Hemorrhage/diagnosis , Hemorrhage/mortality , Hemorrhage/prevention & control , Hemorrhage/blood
10.
J. coloproctol. (Rio J., Impr.) ; 37(1): 44-46, Jan.-Mar. 2017. ilus
Article in English | LILACS | ID: biblio-841308

ABSTRACT

ABSTRACT Anorectal hemangioma is one of the rarest causes of lower gastrointestinal bleeding, but is often neglected and confused in the differential diagnosis. The clinical examination is a turning point for a correct diagnosis and management of patients, thus avoiding unnecessary procedures. The treatment of choice for this condition is surgical and intraoperative bleeding is the main complication of this therapy. The present case reports a 25-year old patient with a history of bleeding from the age of 13, being diagnosed with anorectal hemangioma, and surgically treated with resection of the affected segment and with wound synthesis by marsupialization, with a good progression postoperatively.


RESUMO O Hemangioma Anorretal é uma das mais raras causas de Hemorragia digestiva baixa, sendo muitas vezes negligenciada e confundida no diagnóstico diferencial. O exame clínico representa um ponto decisivo para correto diagnóstico e manejo do paciente, evitando realização de exames desnecessários, e o tratamento de escolha dessa patologia é cirúrgico, sendo o sangramento intraoperatorio a principal complicação dessa terapêutica. O relato de caso a seguir reporta a história de paciente com 25 anos, que apresentava sangramento desde os 13, sendo diagnosticado com Hemangioma Anorretal e tratado cirurgicamente com ressecção do segmento afetado e síntese de ferida com marsupialização, evoluindo bem no pós-operatório.


Subject(s)
Humans , Male , Adult , Rectal Diseases/diagnosis , Hemangioma/diagnosis , Hemorrhage/diagnosis , Neoplasms, Vascular Tissue/diagnosis
11.
Hosp. Aeronáut. Cent ; 12(2)2017. ^c5 100
Article in Spanish | LILACS | ID: biblio-910912

ABSTRACT

Introducción: La hemorragia digestiva es un motivo importante de ingreso a unidades hospitalarias y constituye una verdadera emergencia médica por lo que se hace prioritario reconocer los signos clínicos que hagan sospechar hemorragia grave a fin de realizar precozmente una endoscopia diagnostica-terapéutica. Objetivos: Analizar los diversos parámetros objetivos predictores de hemorragia digestiva grave. Evaluar la correlación existente entre la presentación clínica y la constatación de lesión endoscópica. Demostrar la utilidad del estudio endoscópico tanto para el diagnóstico como para el tratamiento Diseño: Observacional. Descriptivo. Retrospectivo Material y Método: Se tuvieron en cuenta todos los pacientes internados en los que se les ha realizado una endoscopia de urgencia con diagnostico probable de hemorragia digestiva entre Enero a junio de 2017. En base a los datos obtenidos de orden médica, historia clínica, estado del paciente e informe endoscópico. Resultados: El 21,65% se encontraba en unidad cerrada o shock room de la guardia; inestables Hemodinamicamente. La indicación médica que con mayor frecuencia se observo fue la denominada Hemorragia digestiva alta (Melena, vomito porraceo y / o Hematemesis combinada) con el 50,51%. Las UGD y la patología erosiva fue La lesión endoscópica que con mayor frecuencia se hayo con el 25,77%. El 21,65% ha requerido la realización de alguna técnica terapéutica Conclusión: La hemorragia digestiva se asociada a una elevada morbimortalidad. Existe una marcada relación entre la presencia de parámetros de inestabilidad hemodinámica, hallazgo de lesión endoscópica y necesidad de terapéutica


Introduction: Digestive haemorrhage is an important cause of income in hospitals and constitutes a true medical emergency, so it becomes a priority to recognise clinical signs that make us suspect a sever haemorrhage in order to perform an early diagnostic and therapeutic endoscopy. Objectives: To analyse the different severe digestive haemorrhage predictors. To evaluate the correlation between clinical presentation and endoscopic injury. To demonstrate the usefulness of endoscopic study as much as for the diagnosis as the treatment Material and method: Observational, descriptive and retrospective study. They were taken into account all hospitalized patients in whom it has been performed an emergency endoscopy with a probable diagnosis of digestive haemorrhage between January and June 2017. Based on the data obtained from medical order, clinical history, patient ́s status and endoscpic report. Results: 21,65% were in closed unit or shock room, hemodynamically unstable. The medical indication that was most often observed was upper gastrointestinal bleeding with 50,51%. Gastrointestinal ulcers and erosive pathology was the most frequently found lesion with 25,77%. 21,65% has required a therapeutic technique. Conclusions: Digestive haemorrhage is associated with a high morbidity and mortality. There is a strong relationship between the presence of hemodynamic unstable parameters, endoscopic lesion finding and therapeutic need


Subject(s)
Humans , Emergencies , Endoscopy/statistics & numerical data , Hemorrhage , Hemorrhage/diagnosis , Hemodynamics
12.
Neumol. pediátr. (En línea) ; 11(4): 180-184, oct. 2016.
Article in Spanish | LILACS | ID: biblio-835078

ABSTRACT

Diffuse alveolar hemorrhage is a syndrome causing catastrophic respiratory failure, secondary to pathophysiological processes within the natural history of a variety of diseases and clinical conditions. Should be considered a medical emergency due to the significant morbidity and mortality associated. It represents a diagnostic challenge because symptoms and signs are often nonspecific. It requires a highlevel of suspicion to early recognition, essential step towards the establishment of supportive measures and specific therapy for survival.


La hemorragia alveolar difusa es un síndrome causante de falla respiratoria catastrófica, secundario a los procesos fisiopatológicos presentes en la historia natural de varias enfermedades y condiciones clínicas. Debe considerarse como una emergencia médica debido a la significativa morbi-mortalidad asociada. Representa un desafío diagnóstico ya que a menudo los síntomas y signos son inespecíficos, requiere un alto nivel de sospecha para el reconocimiento precoz, paso esencial para la instauración de medidas de soporte vital y terapia específica requerida para la sobrevida.


Subject(s)
Humans , Child , Lung Diseases/diagnosis , Lung Diseases/therapy , Hemorrhage/diagnosis , Hemorrhage/therapy , Lung Diseases/physiopathology , Hemorrhage/physiopathology , Prognosis
13.
Rev. otorrinolaringol. cir. cabeza cuello ; 76(2): 231-235, ago. 2016. ilus
Article in Spanish | LILACS | ID: lil-793973

ABSTRACT

El síndrome de Münchausen por poder es una forma de maltrato infantil, con graves consecuencias para el niño afectado. El diagnóstico de esta afección constituye un desafío para los médicos por su heterogeneidad en los síntomas y signos de presentación. Variadas manifestaciones otorrinolaringológicas están descritas en esta patología. En este artículo se presenta un caso clínico de otitis media crónica con otorragia en un paciente de 2 años, donde se logró establecer el diagnóstico de síndrome de Münchausen por poder a través de la identificación de elementos incongruentes en la historia clínica y finalmente por la detección in fraganti de la agresión por parte de la madre. En esta revisión se concluye que es necesario un alto índice de sospecha para identificar esta patología, la que debe ser una preocupación habitual del equipo de salud para evitar asi consecuencias graves en estos pacientes, tales como secuelas psiquiátricas o incluso la muerte.


Münchausen's syndrome by proxy is a form of child abuse with severe consequences for the affected child. The diagnosis of this condition is a challenge for physicians due to the heterogeneity of the presentation symptoms. A lot of otorhinolaryngological manifestations have been described in this syndrome. We present a case of a 2 year old patient with chronic otitis media and otorrhagia, where we could establish the diagnosis of Münchausen's syndrome by proxy through the identifications of incongruent elements on the clinical history and finally the direct visualization of mother's aggression. In this should be a common concern for health workers to avoid severe consequences in these patients like psychiatric diseases or even death.


Subject(s)
Humans , Male , Child, Preschool , Hemorrhage/diagnosis , Munchausen Syndrome by Proxy/diagnosis , Otitis Media/diagnosis , Chronic Disease
14.
Rev. cuba. hematol. inmunol. hemoter ; 31(4): 0-0, oct.-dic. 2015.
Article in Spanish | LILACS | ID: lil-769403

ABSTRACT

La enfermedad por el virus del Ébola es una dolencia con frecuencia fatal, causada por una de las cinco cepas altamente contagiosas de este virus que afecta, tanto a animales como a seres humanos, cuya tasa de letalidad puede llegar al 90 por ciento. Desde su detección se han producido varios brotes, incluido el último en abril de 2014. Una de las manifestaciones más importantes es el síndrome hemorrágico que suele darse en las últimas etapas de la enfermedad, cuadro que no ocurre en todos los pacientes afectados. Se describen las principales manifestaciones hematológicas presentes en esta entidad, así como algunos aspectos de su etiopatogenia y exámenes de laboratorio útiles en el manejo de estos pacientes(AU)


Ebola virus disease is an often-fatal infection caused by one of the five strains of the Ebola virus that affects both animals and humans. The fatality rate can reach 90 percent and since its detection, there have been several outbreaks, including the last in April 2014. One of the most important manifestations is the hemorrhagic syndrome which usually occurs in the late stages of the disease, condition that is not present in all affected patients. Major hematologic manifestations in this entity, as well as some aspects of its pathogenesis and useful laboratory tests in the management of these patients are described(AU)


Subject(s)
Humans , Male , Female , Hemorrhagic Fever, Ebola/blood , Hemorrhagic Fever, Ebola/etiology , Clinical Laboratory Techniques/methods , Hemorrhage/complications , Hemorrhage/diagnosis
15.
Arq. bras. cardiol ; 105(1): 20-27, July 2015. tab, ilus
Article in English | LILACS | ID: lil-755010

ABSTRACT

Background:

The ACUITY and CRUSADE scores are validated models for prediction of major bleeding events in acute coronary syndrome (ACS). However, the comparative performances of these scores are not known.

Objective:

To compare the accuracy of ACUITY and CRUSADE in predicting major bleeding events during ACS.

Methods:

This study included 519 patients consecutively admitted for unstable angina, non-ST-elevation or ST-elevation myocardial infarction. The scores were calculated based on admission data. We considered major bleeding events during hospitalization and not related to cardiac surgery, according to the Bleeding Academic Research Consortium (BARC) criteria (type 3 or 5: hemodynamic instability, need for transfusion, drop in hemoglobin ≥ 3 g, and intracranial, intraocular or fatal bleeding).

Results:

Major bleeding was observed in 31 patients (23 caused by femoral puncture, 5 digestive, 3 in other sites), an incidence of 6%. While both scores were associated with bleeding, ACUITY demonstrated better C-statistics (0.73, 95% CI = 0.63 - 0.82) as compared with CRUSADE (0.62, 95% CI = 0.53 - 0.71; p = 0.04). The best performance of ACUITY was also reflected by a net reclassification improvement of + 0.19 (p = 0.02) over CRUSADE’s definition of low or high risk. Exploratory analysis suggested that the presence of the variables ‘age’ and ‘type of ACS’ in ACUITY was the main reason for its superiority.

Conclusion:

The ACUITY Score is a better predictor of major bleeding when compared with the CRUSADE Score in patients hospitalized for ACS.

.

Fundamento:

Os escores ACUITY e CRUSADE são modelos validados para a predição de eventos de sangramento maior na síndrome coronariana aguda (SCA). Os desempenhos comparativos desses escores, entretanto, são desconhecidos.

Objetivo:

Comparar a acurácia dos escores ACUITY e CRUSADE para a predição de eventos de sangramento maior nas SCA.

Métodos:

Este estudo incluiu 519 pacientes admitidos consecutivamente por angina instável e infarto do miocárdio com e sem supradesnivelamento do segmento ST. Os escores foram calculados tendo por base dados da admissão. Definiu-se sangramento maior como sendo o tipo 3 ou tipo 5 do Consórcio de Pesquisa Acadêmica de Sangramento (Bleeding Academic Research Consortium - BARC), ocorrido durante a hospitalização e não relacionado com cirurgia cardíaca, a saber: instabilidade hemodinâmica, necessidade de transfusão, queda na hemoglobina ≥ 3 g e sangramento intracraniano, intraocular ou fatal.

Resultados:

Observou-se sangramento maior em 31 pacientes (23 causados por punção femoral, 5 digestivos e 3 em outros locais), sendo a incidência de 6%. Embora os dois escores tenham se associado com sangramento, o ACUITY demonstrou melhor estatística C (0,73, IC 95% = 0,63 – 0,82) do que o CRUSADE (0,62, IC 95% = 0,53 -0,71; p = 0,04). O melhor desempenho do ACUITY foi também evidenciado pela reclassificação líquida de + 0,19 (p = 0,02) em relação à definição de baixo ou alto risco do CRUSADE. A análise exploratória sugeriu que a presença das variáveis ‘idade’ e ‘tipo de SCA’ no ACUITY foi a principal razão para sua superioridade.

Conclusão:

O escore ACUITY mostrou-se superior ao CRUSADE para a predição de sangramento maior em pacientes hospitalizados por SCA.

.


Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Acute Coronary Syndrome/complications , Hemorrhage/diagnosis , Hemorrhage/etiology , Risk Assessment/methods , Age Factors , Angina, Unstable/complications , Hospitalization , Hemorrhage/classification , Myocardial Infarction/complications , Prognosis , Reference Values , Reproducibility of Results , Sensitivity and Specificity , Sex Factors
16.
Arch. argent. pediatr ; 113(3): e161-e163, jun. 2015. ilus
Article in English, Spanish | LILACS, BINACIS | ID: lil-750476

ABSTRACT

La hemorragia suprarrenal neonatal es poco frecuente. Se presenta en el 0,2% de los recién nacidos. El 10% de los casos son bilaterales. Puede estar asociada a un traumatismo al nacimiento, peso alto al nacer o un curso neonatal complicado por hipoxia, asfixia, hipotensión o coagulopatía. El hematoma escrotal es una manifestación extremadamente rara de la hemorragia suprarrenal neonatal. La mayoría de los pacientes presentan tumefacción escrotal con coloración azulada. En los recién nacidos, la tumefacción escrotal, con o sin coloración azulada, puede deberse a diferentes causas. Comunicamos un caso inusual de hemorragia suprarrenal neonatal secundaria a asfixia perinatal, que se manifestó con un hematoma escrotal. El diagnóstico de hemorragia suprarrenal neonatal y hematoma escrotal fue ecográfico; el tratamiento conservador evitó la exploración quirúrgica innecesaria.


Neonatal adrenal hemorrhage is uncommon. It is present in 0,2% of newborns. Ten percent of the cases occur bilaterally. It can be associated with birth trauma, large birth weight, or neonatal course complicated by hypoxia and asphyxia, hypotension, or coagulopathy. Scrotal hematoma is an extremely rare manifestation of NAH. Most patients present scrotal swelling with bluish discolouration. Scrotal swelling with/without bluish discoloration in newborns may result from different causes. We report an unusual case of neonatal adrenal hemorrage secondary to perinatal asphyxia, associated with SH. Neonatal adrenal hemorrhage and scrotal hematoma were diagnosedby ultrasonography and treated by conservative treatment, avoiding unnecessary surgical exploration.


Subject(s)
Humans , Male , Infant, Newborn , Scrotum , Adrenal Gland Diseases/complications , Adrenal Gland Diseases/diagnosis , Genital Diseases, Male , Hematoma , Hemorrhage/complications , Hemorrhage/diagnosis
18.
Salvador; s.n; 2015. 41 p. ilus.
Thesis in Portuguese | LILACS | ID: biblio-1000967

ABSTRACT

A leptospirose é uma zoonose de distribuição mundial, com 1,2 milhões de casos registrados a cada ano. De 1996 a 2013, o grupo de pesquisa de leptospirose do CPqGM, realiza uma vigilância ativa no Hospital Couto Maia em Salvador-Ba, onde foi recrutado 4612 casos suspeitos para leptospirose. Destes 4612 foi confirmado o diagnóstico de 1853 (40%) utilizando pelo menos um dos três métodos de diagnóstico (MAT, Hemocultura, qPCR). Dentre os casos confirmados, 1759 (95%) foram confirmados pelo MAT. A sensibilidade do MAT foi diferente entre as amostras aguda e convalescente, sendo 60% na fase aguda e 97% na fase convalescente. O sorogrupo Icterohaemorrhagiae foi o mais prevalente (90%) dos casos confirmados para MAT. Durante o período do estudo foram coletadas 1133 hemoculturas e destas 203 (18%) foram positivas, sendo possível isolar leptospiras de 93/203 (45%) das hemoculturas, as quais foram soro-agrupadas com soros heterológos de coelho. A concordância entre o sorogrupo encontrado no MAT e na soro-agrupagem foi de 80%. Os achados mostram que existe uma concordância significante entre o sorogrupo encontrado pelos dois métodos, o que indica que o painel de cepas utilizado no MAT apresenta uma ótima cobertura para os sorogrupos prevalentes na região. A predominância de um sorogrupo facilitou quanto a tomadas de decisões para prevenção e controle, assim como facilita para o desenvolvimento de novos testes de diagnóstico e vacinas mais direcionados.


Leptospirosis is a re-emerging zoonotic disease of global importance, with 1,2 million cases reported each year. Diagnosis of leptospirosis is often difficult given the nonspecific disease presentation. In order to compare the performance of the two gold standard diagnostic tests for leptospirosis, the group enrolled 4612 patients with suspected leptospirosis during active surveillance at the state infectious disease reference hospital, Hospital Couto Maia, in Salvador, Bahia between 1996 and 2013. Of these, was confirmed Leptospira infection in 1853 (40%) using at least one of three diagnostic methods (microagglutination (MAT), blood culture, and qPCR). Was confirmed 1759 (95%) cases using only the MAT assay, and identified the serogroup Icterohaemorrhagiae as the infective agent in 90% of MAT positive samples. It was determined the sensitivity of the MAT was 60% for acute phase samples and increased to 97% for convalescent samples. Within this study period, it was possible to collect 1133 blood cultures and was isolated leptospires from 93 of 203 (45%) of blood cultures, and determined the serotype using heterologous rabbit sera. The concordance between the infective serogroup identified using hemoculture and MAT techniques was 80%. This result indicates that the panel of 11 strains used in the MAT represents a majority of the infective serogroups causing disease in our study population. The predominance of a single serogroup in symptomatic cases informs the development of new diagnostic tests and novel vaccines to prevent leptospirosis in Brazil.


Subject(s)
Humans , Hemorrhage/diagnosis , Hemorrhage/blood , Leptospirosis/complications , Leptospirosis/diagnosis , Leptospirosis/immunology , Leptospirosis/mortality , Leptospirosis/pathology , Leptospirosis/prevention & control , Leptospirosis/transmission , Leptospirosis/urine
19.
Salvador; s.n; 2014. 67 p. ilus, tab.
Thesis in Portuguese | LILACS | ID: biblio-1000891

ABSTRACT

A leptospirose é uma zoonose causada por espiroquetas patogênicas pertencentes ao gênero Leptospira. O modelo da doença em camundongos tem vantagens devido à ampla gama de ferramentas genéticas e imunológicas disponíveis para pesquisas básicas. A maior limitação na conduta clínica e na pesquisa experimental da leptospirose é o fraco desempenho dos métodos disponíveis para detecção direta e para quantificação de leptospiras. Foi incluído nesta tese um conjunto de três manuscritos que visam investigar o desfecho da infecção pela cepa virulenta de Leptospira interrogans nas linhagens de camundongos selvagens (A, CBA, BALB/c e C57BL/6)...


Leptospirosis is a zoonosis caused by pathogenic spirochaetes belonging to the genus Leptospira. The mouse disease model is advantagous due to the broad array of immunological and genetic tools available for basic research. A major limitation in the clinical management and experimental research of leptospirosis is the poor performance of the available methods in the direct detection and quantification of leptospires. This thesis includes three manuscripts that investigate the outcome of infection by a virulent strain of Leptospira interrogans in wildtype mice strains: A, CBA, BALB/c and C57BL/6; in iNOS knockout (KO) mice, recombination activating gene 1 (RAG1) KO mice and CB17 severe combined immunodeficiency (SCID) mice. To investigate whether the imprint method (IM) of quantification was reliable we compared it with against real time PCR (qPCR) for the detection and quantification of leptospires in kidney samples from rats and hamsters. As expected, none of the wildtype mice were susceptible to lethal leptospirosis. The A and C57BL/6 strains exhibited high leptospiral loads in the kidney samples and the CBA and C57BL/6...


Subject(s)
Animals , Hemorrhage/diagnosis , Hemorrhage/immunology , Hemorrhage/pathology , Leptospirosis/parasitology , Leptospirosis/pathology
20.
J. coloproctol. (Rio J., Impr.) ; 33(1): 39-41, Mar-Apr/2013. ilus
Article in English | LILACS | ID: lil-679318

ABSTRACT

OBJECTIVE: Postoperative pouch bleeding is a rare but detrimental complication following ileal pouch surgery. It is usually self-limited, however continuous bleeding requires intervention. There is limited published data on its management. DESIGN: Ileoscopy via stoma for loop ileostomy and pouchoscopy via anus for ileal pouch were performed under sedation for the purpose of diagnosis and management of postoperative bleeding. RESULTS: Ileoscopy demonstrated a large, long blood clot in the lumen of efferent limb, but no sign of active bleeding was identified. Pouchoscopy showed that lumen of pouch body as well as afferent limb was filled with maroon-colored liquid stool. Pouch and neo-terminal ileum mucosa was normal. Two dislodged staples at the anastomotic line with sharp tips towards the lumen were found, with activating bleeding at one site. The staples were removed by biopsy forceps, and active bleeding was successfully controlled by the deployment of one endoclip. CONCLUSIONS: We reported the first case that postoperative pouch bleeding, which was caused by dislodged staples, was successfully managed by endoscopic removal of the staples combined with clipping. (AU)


OBJETIVO: O sangramento pós-operatório da bolsa ileal é uma complicação rara, mas prejudicial após abordagem cirúrgica da bolsa ileal. Esse sangramento é geralmente autolimitado, porém, requer intervenção quando contínuo. Não há dados publicados sobre o tratamento. MÉTODO: Ileoscopia através de estoma para ileostomia em alça e endoscopia via ânus para a bolsa ileal foram realizadas sob sedação para diagnóstico e tratamento do sangramento pós-operatório. RESULTADOS: A ileoscopia demonstrou um grande e longo coágulo sanguíneo no lúmen do ramo eferente, mas nenhum sinal de sangramento ativo foi identificado. A endoscopia da bolsa ileal mostrou que os lumens do corpo da bolsa e ramo aferente estavam cheios de fezes líquidas de cor marrom. A bolsa e a mucosa do íleo neoterminal estavam normais. Dois grampos deslocados na linha da anastomose e com pontas afiadas em direção ao lúmen foram encontrados, com sangramento ativo em um dos locais. Os grampos foram removidos com pinça de biópsia e o sangramento ativo controlado com sucesso pela implantação de um endoclipe. CONCLUSÃO: Relatamos o primeiro caso em que o sangramento pós-operatório da bolsa ileal causado por grampos deslocados foi controlado com sucesso pela remoção endoscópica dos grampos combinada com clipagem. (AU)


Subject(s)
Humans , Female , Proctocolectomy, Restorative/adverse effects , Hemorrhage/diagnosis , Anastomosis, Surgical/adverse effects , Ileum/surgery
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