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1.
Medwave ; 22(2): e002118, mar.2022. tab
Article in English, Spanish | LILACS | ID: biblio-1366391

ABSTRACT

Contexto La hemofilia es un trastorno hemorrágico de la coagulación que ocurre en uno de cada 5000 nacimientos masculinos. Los pacientes con hemofilia A grave no tratados tienen complicaciones hemorrágicas, incluyendo sangrados articulares y menor sobrevida. El emicizumab es un anticuerpo monoclonal aprobado por los Estados Unidos para la profilaxis rutinaria de pacientes pediátricos y adultos con hemofilia A grave con inhibidores del factor VIII de coagulación. Objetivos Realizar un estudio de costo-efectividad de la profilaxis con emicizumab para niños y adultos con hemofilia A grave, en comparación con el actual manejo de esos pacientes en el Ministerio de Salud y el Seguro Social de Salud de Perú. Metodología Se modeló la transición del paciente entre estados médicos con la metodología de Markov y se estimó a lo largo de su vida costos y efectos incrementales de emicizumab comparados con el actual manejo. Se estimó el impacto presupuestario de emicizumab proyectando costos netos anuales y su valor presente a cinco años. Resultados Emicizumab generaría ahorros en el Ministerio de Salud entre 14,6 y 16,0 por niño y 11,8 por adulto, en US$ millones actuales, y en el Seguro Social de Salud de 12,8 a 14,9 por niño y 40,1 por adulto. Además, se generan ganancias en efectividad, medidas en años de vida ajustados por calidad, de 0,36 por niño y 0,56 por adulto y de 0,25 por niño y 0,36 por adulto en esas respectivas instituciones. El impacto presupuestario sería un ahorro anual neto, en US$ millones, de 12,8 y 15,0 en esas entidades. Conclusión El actual manejo de la enfermedad es muy costoso y con resultados de salud inferiores a los posibles con emicizumab. Este fármaco produciría grandes ahorros y mejor salud. Ambas entidades debieran implementar protocolos para la profilaxis y tratamiento de la hemofilia y financiarla con presupuesto propio.


Settings Hemophilia is a coagulation disorder that occurs in one in 5000 male births. Patients with untreated severe hemophilia A have hemorrhagic complications, including joint bleeds and decreased survival. Emicizumab is a monoclonal antibody approved by the United States for routine prophylaxis of pediatric and adult patients with severe hemophilia A with factor VIII inhibitors. Objectives To perform a cost-effectiveness study of emicizumab prophylaxis for children and adults with severe hemophilia A compared with the current disease management in the Peruvian Ministry of Health and Social Security Health Insurance. Methods The patient transition between medical states was modeled with Markov methodology, and the lifetime costs and incremental effects of emicizumab compared to current management were estimated. The budgetary impact of emicizumab was estimated by projecting annual net costs and its five-year present value. Results In the Ministry of Health, emicizumab would generate savings between 14.6 and 16.0 per child and 11.8 per adult, in current US$ million. Social Security Health Insurance savings would be 12.8 to 14.9 per child and 40.1 per adult. In addition, this strategy would generate effectiveness gains, measured in quality-adjusted life-years, of 0.36 per child and 0.56 per adult and 0.25 per child, and 0.36 per adult in those respective institutions. The budgetary impact would be a net annual saving of 12.8 and 15.0 US$ million in those entities. Conclusions The current management of hemophilia A is very costly and has health outcomes inferior to those possible with emicizumab. This drug would produce significant savings and better patient health. The Ministry of Health and Social Health Insurance should implement hemophilia prophylaxis and treatment protocols and finance this drug.


Subject(s)
Humans , Male , Child , Adult , Hemophilia A/complications , Hemophilia A/drug therapy , Peru , Factor VIII/therapeutic use , Cost-Benefit Analysis , Antibodies, Bispecific , Antibodies, Monoclonal, Humanized , Hemorrhage/etiology
2.
Rev. Hosp. Clin. Univ. Chile ; 32(3): 187-192, 2021. graf, tab
Article in Spanish | LILACS | ID: biblio-1353082

ABSTRACT

Background: Anaemia and transfusions are frequent in critically ill patients and there are avoidable causes such as routine laboratory tests. Patients and methods: Descriptive study during one continuous week including patients over 18-years old in a medical-surgical ICU. Results: 18 patients were included during a week in 12 beds in our unit, median age 62,5 years, 50% male. Median daily blood loss was 35ml, 45% in laboratory samples and 27% related to renal replacement therapy. 3 patients required 1 transfusion of red blood cells. Conclusions: There is a pattern of continuous blood loss in critically ill patients, primarily in routine laboratory tests. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Hemorrhage/etiology , Intensive Care Units , Blood Transfusion , Hemorrhage/epidemiology , Anemia/complications
3.
Rev. Col. Bras. Cir ; 48: e20202783, 2021. tab, graf
Article in English | LILACS | ID: biblio-1155358

ABSTRACT

ABSTRACT Introduction: extremity tourniquet (TQ) use has increased in the civilian setting; the beneficial results observed in the military has influenced acceptance by EMS and bystanders. This review aimed to analyze extremity TQ types used in the civilian setting, injury site, indications, and complications. Methods: a systematic review was conducted based on original articles published in PubMed, Embase, and Cochrane following PRISMA guidelines from 2010 to 2019. Data extraction focused on extremity TQ use for hemorrhage control in the civilian setting, demographic data, study type and duration, mechanism of injury, indications for use, injury site, TQ type, TQ time, and complications. Results: of the 1384 articles identified, 14 were selected for review with a total of 3912 civilian victims with extremity hemorrhage and 3522 extremity TQ placements analyzed. The majority of TQs were applied to male (79%) patients, with blunt or penetrating trauma. Among the indications for TQ use were hemorrhagic shock, suspicion of vascular injuries, continued bleeding, and partial or complete traumatic amputations. Upper extremity application was the most common TQ application site (56%), nearly all applied to a single extremity (99%), and only 0,6% required both upper and lower extremity applications. 80% of the applied TQs were commercial devices, and 20% improvised. Conclusions: TQ use in the civilian setting is associated with trauma-related injuries. Most are single-site TQs applied for the most part to male adults with upper extremity injury. Commercial TQs are more commonly employed, time in an urban setting is under 1 hour, with few complications described.


RESUMO Introdução: o uso de torniquete em extremidades (TQ) aumentou no ambiente civil; os resultados benéficos observados nas forças armadas influenciaram a aceitação por equipes de pré-hospitalar (PH) assim como pela população leiga. Esta revisão teve como objetivo analisar os tipos de TQ de extremidades usados em ambiente civil, local da lesão, indicações e complicações. Métodos: revisão sistemática foi conduzida com base em artigos originais publicados no PubMed, Embase e Cochrane seguindo as diretrizes do PRISMA de 2010 a 2019. Extração de dados focada no uso de TQ de extremidade para controle de hemorragia em ambiente civil, dados demográficos, tipo de estudo e duração, mecanismo de lesão, indicações de uso, local da lesão, tipo de TQ, tempo de TQ e complicações. Resultados: dos 1.384 artigos identificados, 14 foram selecionados para revisão com total de 3.912 vítimas civis com hemorragia nas extremidades e 3.522 colocações de extremidades TQ analisadas. A maioria foi aplicado em pacientes do sexo masculino (79%), com trauma contuso ou penetrante. Entre as indicações estavam choque hemorrágico, suspeita de lesões vasculares, sangramento contínuo e amputações traumáticas parciais ou completas. A aplicação na extremidade superior foi o local de aplicação mais comum (56%), quase todos aplicados a uma única extremidade (99%), e apenas 0,6% requereram aplicações nas extremidades superior e inferior. 80% dos TQs aplicados eram dispositivos comerciais e 20% improvisados. Conclusões: o uso de TQ em ambientes civis está associado a traumas. Os TQs comerciais são mais utilizados, com tempo menor que uma hora de uso e poucas complicações.


Subject(s)
Humans , Male , Adult , Tourniquets/statistics & numerical data , Vascular System Injuries/therapy , Exsanguination/prevention & control , Hemorrhage/prevention & control , Emergency Medical Services , Emergency Treatment , Extremities/injuries , Vascular System Injuries/complications , Vascular System Injuries/mortality , Exsanguination/etiology , Exsanguination/mortality , Hemorrhage/etiology , Hemorrhage/mortality
5.
Rev. méd. Chile ; 148(7): 1034-1038, jul. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1139407

ABSTRACT

Paroxysmal sympathetic hyperactivity may appear after brain injury. Its clinical manifestations are sporadic and self-limited crisis of arterial hypertension, hyperthermia, tachycardia, hyperhidrosis, muscle tension, sialorrhea and mydriasis. These subside with the administration of morphine and beta-blockers. It may be caused by a dysautonomia leading to increased levels of catecholamines due to the lack of brain regulation. We report a 19 years-old man with a history of illicit drug and alcohol consumption, with a secondary axonal injury due to a cranioencephalic trauma. During hospitalization, he had recurrent, self-limited episodes of dysautonomia. An infectious cause was discarded. When morphine was administrated suspecting the presence of pain, the crisis subsided, which helped to establish the diagnosis of paroxysmal sympathetic hyperactivity.


Subject(s)
Humans , Male , Adult , Sympathetic Nervous System/pathology , Brain/diagnostic imaging , Hemorrhage/etiology , Sympathetic Nervous System/diagnostic imaging , Magnetic Resonance Imaging
6.
Rev. otorrinolaringol. cir. cabeza cuello ; 80(2): 172-177, jun. 2020. graf
Article in Spanish | LILACS | ID: biblio-1115832

ABSTRACT

En este artículo se presenta un paciente que en contexto de un cuadro amigdalino agudo bilateral con un absceso periamigdalino unilateral concomitante presenta sangrado espontáneo proveniente de la amígdala abscedada. Los signos y síntomas observados en este paciente, así como los estudios complementarios son compatibles con la entidad clínica definida como amigdalitis hemorrágica espontánea, una complicación altamente infrecuente de la amigdalitis aguda y/o crónica en nuestra época, la que solía tener una gran tasa de mortalidad y gravedad en la era preantibiótica. A continuación, se reúnen y analizan los antecedentes descritos en la literatura referidos a este cuadro, al igual que su estudio complementario requerido para definir conducta, la cual es fundamentalmente de resorte quirúrgico.


In this article we report a patient who, in the context of a bilateral acute tonsillar condition with a concomitant unilateral peritonsillar abscess presents spontaneous bleeding from the abscessed tonsil. The clinical features observed in our patient, as well as the complementary studies are all compatible with the clinical entity known as spontaneous tonsil hemorrhage, a highly rare complication of acute and/or chronic tonsillitis in our time, which used to have major severity and mortality rate in the pre-antibiotic era. Following next, we gather and analyze the information described in literature referred to this affliction, as well as the complementary tests required to define its fundamentally surgical management.


Subject(s)
Humans , Male , Young Adult , Tonsillitis/complications , Hemorrhage/etiology , Tonsillectomy , Tonsillitis/surgery , Tonsillitis/diagnostic imaging , Tomography, X-Ray Computed , Abscess
7.
Gac. méd. Méx ; 156(1): 67-77, ene.-feb. 2020. tab, graf
Article in English, Spanish | LILACS | ID: biblio-1249872

ABSTRACT

Resumen La hemofilia adquirida (HA) es un trastorno hemostático autoinmune ocasionado por autoanticuerpos dirigidos contra el factor VIII: C. En 52 % de los casos, la causa se desconoce o no se asocia con otra entidad patológica; en el resto, existen factores concomitantes: lupus, artritis reumatoide, cáncer, embarazo y medicamentos. En México no existe registro ni conciencia de la enfermedad entre el personal de salud. Los grupos de mayor incidencia son las mujeres en edad reproductiva y los individuos mayores de 70 años. Se caracteriza por hemorragia grave, sobre todo posterior a traumatismos y parto o cesárea, y equimosis grandes en tronco y extremidades. La sospecha es simple, basta que concurran hemorragia súbita, grave y un TTPa prolongado que no se corrige con plasma. El tratamiento consiste en lograr la hemostasia y erradicar el anticuerpo; lo primero se logra con el factor VII activado recombinante o concentrado del complejo de protrombínico activado. La ciclofosfamida, prednisona o rituximab sirven para erradicar el anticuerpo. La mayoría de los casos no son diagnosticados y la mortalidad es alta. Ya que los médicos desconocen el problema, no se sospecha, no se diagnostica y no se trata. Este documento revisa los datos más recientes de la HA y abunda en el diagnóstico y tratamiento.


Abstract Acquired hemophilia (AH) is an autoimmune hemostatic disorder mediated by autoantibodies directed against factor VIII: C. In 52% of cases, the cause is unknown or is not associated with other pathological entities; in the rest, there are concomitant factors: lupus, rheumatoid arthritis, cancer, pregnancy, and medications. In Mexico, there is not a registry of AH, and awareness of the disease among health personnel is low. The groups with the highest incidence are women of childbearing age and individuals older than 70 years. It is characterized by severe bleeding, especially after trauma and normal childbirth or cesarean delivery, and large ecchymoses in the trunk and extremities. The suspicion is simple, it just takes for sudden, severe hemorrhage and a prolonged activated partial thromboplastin time that is not corrected with plasma to concur in an individual. Treatment involves achieving hemostasis and eradicating the antibody. The former is achieved with recombinant activated factor VII or activated prothrombin complex concentrate. Cyclophosphamide, prednisone or rituximab are used to eradicate the antibody. Most cases of AH are not diagnosed, which translates into a high mortality rate. Given that awareness about the disease among physicians is low, it is not suspected, neither diagnosed, and nor is it treated. This document reviews the most recent data on AH and expands on its diagnosis and treatment.


Subject(s)
Humans , Male , Female , Pregnancy , Adult , Middle Aged , Aged , Young Adult , Autoantibodies/immunology , Factor VIII/immunology , Hemophilia A/immunology , Pregnancy Complications, Hematologic/etiology , Prognosis , Ecchymosis/etiology , Hemophilia A/complications , Hemophilia A/therapy , Hemophilia A/epidemiology , Hemorrhage/etiology , Immunosuppressive Agents/therapeutic use
8.
Rev. colomb. ortop. traumatol ; 34(2): 102-103, 2020. ilus
Article in Spanish | LILACS | ID: biblio-1372344

ABSTRACT

Introducción Las fracturas pélvicas se asocian a sangrado arterial y/o venoso, ocasionando mortalidad elevada. El objetivo del estudio es diseñar, implementar y evaluar un protocolo para el tratamiento de fracturas pélvicas Materiales y métodos estudio prospectivo observacional, de pacientes con fractura pélvica que ingresaron a la clínica Medical. Variables: edad, sexo, arteria comprometida, lesión unilateral o bilateral, tipo de fractura pélvica (clasificación de Tile), indicación de la arteriografía, acceso uni o bilateral, éxito angiográfico, complicaciones del procedimiento, lesiones asociadas, mortalidad a 30 días, mecanismo de trauma, días de estancia en cuidado intensivo. Resultados 56 pacientes con fractura pélvica, 17 pacientes se llevaron a arteriografía pélvica por sospecha de sangrado, 14 pacientes tenían sangrado arterial, promedio de 36 años, las arterias más comúnmente lesionadas fueron la arteria hipogástrica, arteria sacra lateral y la arteria obturatriz. la mayoría de sangrados se asociaron a fracturas tipo C, las lesiones asociadas se encontraron en un 34% de casos, la indicación de la arteriografía fue inestabilidad hemodinámica al momento del ingreso, el control del sangrado se logró en el 86% de casos, la punción fue única en el 100% de casos, se requirió empaquetamiento pélvico 12% de casos. Discusión El trauma pélvico asociado a accidentes de motocicleta es común, el manejo multidisciplinario y la oportuna intervención del cirujano vascular es decisiva para el diagnóstico y tratamiento temprano de las lesiones vasculares pélvicas; la realización de un protocolo de manejo con un algoritmo de embolización mostró ser efectivo y seguro para el control del sangrado pélvico. Nivel de Evidencia: III


Background Pelvic fractures are frequently associated with arterial and / or venous bleeding, leading to high mortality (10 and 50%). Aim of study is to show our experience, based on an institutional protocol developed for the management of the patient with major pelvic trauma. Methods We conducted a prospective observational study for a 3 years period of time. The variables analyzed were: age, sex, artery involved, unilateral or bilateral lesion, type of pelvic fracture (Tile classification), indication of arteriography, unilateral or bilateral access, angiographic success, complications of the procedure, associated injuries, mortality at 30 days, trauma mechanism, days of stay in ICU and floor. Results We found 56 patients with pelvic fracture, 17 patients were taken to pelvic arteriography due to suspected bleeding, 14 patients had arterial bleeding, with an average age of 36 years, the arteries most commonly injured were the hypogastric artery, lateral sacral artery and the obturator artery, 50% of cases the bleeding was bilateral, the majority of bleeds were associated with type C fractures, associated lesions were found in 34% of cases, the indication of arteriography was hemodynamic instability at the time of admission, control of bleeding was achieved in 86% of cases (n: 15), the puncture was unique in 100% of cases (n: N: 14), pelvic packing was required in 2 patients (12%) Discussion Pelvic embolization for pelvic fracture is a safe and feasible procedure. A multidisciplinary approach and a high suspicion of pelvic arterial injury must be always in mind. Mortality in our trial was very low comparative with previous reports. Evidence Level: III


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Pelvis/injuries , Embolization, Therapeutic/methods , Fractures, Bone/complications , Hemorrhage/etiology , Hemorrhage/therapy , Pelvis/surgery , Angiography , Prospective Studies , External Fixators , Fractures, Bone/surgery , Hemorrhage/diagnostic imaging , Iliac Artery/diagnostic imaging
10.
J. bras. nefrol ; 41(1): 89-94, Jan.-Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-1002420

ABSTRACT

Abstract Introduction: Vascular access (VA) in hemodialysis (HD) is essential to end-stage renal disease (ESRD) patients survival. Unfortunately, after some years in HD program, a significant number of patients may develop VA failure for many reasons. In this situation, arterial venous fistula (AVF) confection or catheters placement in traditional vascular sites (jugular, femoral or subclavian) are not feasible. In this scenario, translumbar tunneled dialysis catheter (TLDC) may be a salvage option. Objectives: To describe placement technic, complications, and patency of 12 TLDC. Methods: A retrospective study was performed to analyze 12 TLDC placement in an angiography suite using fluoroscopic guidance at the University Hospital of the Rio Grande do Norte Federal University from January 2016 to October 2017. The data collected of the total procedures performed consisted of demographic characteristics, success rates, observed complications, patient survival, and catheter patency. Results: All 12 TLDC were placed with success; there were only 2 significant periprocedure complications (major bleeding and extubation failure); 41.6% of patients presented a catheter-related first infection after 98 ± 72.1 (6-201) days, but catheter withdrawal was not necessary, mean total access patency was 315.5 (range 65 - 631) catheter-days, and catheter patency at 3, 6 and 12 months was 91 %, 75%, and 45%. Conclusion: TLDC is an option for patients with VA failure, improving survival and acting as a bridge for renal transplantation.


Resumo Introdução: O acesso vascular (AV) para hemodiálise (HD) é crucial para os pacientes portadores de doença renal crônica (DRC) estágio V. Infelizmente, com o passar dos anos, um percentual não desprezível desses enfermos evolui para falência de AV por diversos motivos, o que impossibilita a confecção de novas fístulas arteriovenosas (FAV) ou o implante de cateteres venosos centrais nos sítios de punções tradicionais. Nesse cenário, o implante de cateteres translombares para hemodiálise (CTLHD) em veia cava inferior ganha destaque como medida salvadora. Objetivos: Relatar uma série de 12 casos de implante de CTLHD, sua técnica de implante, patência e complicações. Métodos: Estudo retrospectivo que analisou 12 implantes de CTLHD por radiologista intervencionista no setor de hemodinâmica do Hospital Universitário da Universidade Federal do Rio Grande do Norte (UFRN), no período de janeiro/2016 a outubro/2017. Os dados coletados consistiram em: características demográficas da população estudada, taxa de sucesso, complicações observadas, sobrevida dos pacientes, patência do cateter e desfechos clínicos. Resultados: Todos os 12 CTLHD foram implantados e utilizados com sucesso; ocorreram apenas 2 complicações associadas ao procedimento (sangramento e falha na extubação); 41,6% dos pacientes apresentaram infecção relacionada ao cateter após 98 ± 72,1 dias (6-201 dias), mas não houve necessidade de remoção; e a patência foi de 315,5 cateteres-dia (65-631 dias). Conclusão: O CTLHD é uma opção para pacientes com falência de acesso vascular, prolongando a sobrevida dos pacientes e atuando como ponte para o transplante renal.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Vascular Diseases/etiology , Vena Cava, Inferior/surgery , Catheterization, Central Venous/methods , Catheters, Indwelling/adverse effects , Renal Dialysis , Central Venous Catheters/adverse effects , Kidney Failure, Chronic/therapy , Lumbosacral Region/blood supply , Fluoroscopy , Feasibility Studies , Retrospective Studies , Arteriovenous Fistula/complications , Kidney Transplantation , Treatment Outcome , Hemorrhage/etiology
11.
Article in Spanish | LILACS | ID: biblio-1013825

ABSTRACT

RESUMEN No hay guías específicas para el manejo de pacientes embarazadas con la deficiencia de Factor VII; no hay una correlación entre el nivel de FVII y el riesgo de hemorragia y el nivel del Factor VII aumento durante el embarazo. Presentamos un caso clínico, el manejo y las recomendaciones del consenso.


Subject(s)
Humans , Female , Pregnancy , Young Adult , Pregnancy Complications, Hematologic/diagnosis , Factor VII Deficiency/diagnosis , Pregnancy Complications, Hematologic/therapy , Blood Transfusion , Pregnancy Outcome , Cesarean Section , Factor VII Deficiency/congenital , Factor VII Deficiency/therapy , Hemorrhage/etiology
12.
Braz. j. med. biol. res ; 52(1): e7581, 2019. tab, graf
Article in English | LILACS | ID: biblio-974275

ABSTRACT

Bredemeyera floribunda roots are popularly used to treat snakebites in the semiarid region of Northeast Brazil, and previous studies indicate the anti-ophidian actions of triterpenoid saponins found in its roots. To assess B. floribunda root extract (BFRE) activity against the effects of Bothrops jararacussu venom (BjuV), antiphospholipasic, antiproteolytic, antihemorrhagic, antinecrotic, and anti-edematogenic activities were investigated in mice. Phytochemical analysis revealed the presence of saponins, flavonoids, and sugars, with rutin and saccharose being the major constituents of BFRE. Acute toxicity was determined and BFRE was nontoxic to mice. Phospholipase A2 and proteolytic activities induced by BjuV were inhibited in vitro by BFRE at all concentrations tested herein. BFRE (150 mg/kg) inhibited paw edema induced by BjuV (50 µg/animal), reducing total edema calculated by area under the curve, but carrageenan-induced paw edema was unchanged. Hemorrhagic and necrotizing actions of BjuV (50 µg/animal) were considerably decreased by BFRE treatment. Thus, BFRE blocked the toxic actions of B. jararacussu venom despite having no anti-inflammatory activity, which points to a direct inhibition of venom's toxins, as demonstrated in the in vitro assays. The larger amounts of rutin found in BFRE may play a role in this inhibition, since 3′,4′-OH flavonoids are known inhibitors of phospholipases A2.


Subject(s)
Animals , Male , Rats , Antivenins/pharmacology , Plant Extracts/pharmacology , Plant Roots/chemistry , Crotalid Venoms/antagonists & inhibitors , Edema/drug therapy , Hemorrhage/etiology , Antivenins/isolation & purification , Bothrops , Crotalid Venoms/toxicity , Polygalaceae/chemistry , Disease Models, Animal , Dose-Response Relationship, Drug , Edema/etiology , Hemorrhage/drug therapy
13.
J. bras. pneumol ; 44(4): 307-314, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-975920

ABSTRACT

ABSTRACT Objective: To evaluate the diagnostic accuracy of CT-guided percutaneous core needle biopsy (CT-CNB) of pulmonary nodules ≤ 2 cm, as well as to identify factors influencing the accuracy of the procedure and its morbidity. Methods: This was a retrospective, single-center study of 170 consecutive patients undergoing CT-CNB of small pulmonary nodules (of ≤ 2 cm) between January of 2010 and August of 2015. Results: A total of 156 CT-CNBs yielded a definitive diagnosis, the overall diagnostic accuracy being 92.3%. Larger lesions were associated with a higher overall accuracy (OR = 1.30; p = 0.007). Parenchymal hemorrhage occurring during the procedure led to lower accuracy rates (OR = 0.13; p = 0.022). Pneumothorax was the most common complication. A pleura-to-lesion distance > 3 cm was identified as a risk factor for pneumothorax (OR = 16.94), whereas performing a blood patch after biopsy was a protective factor for pneumothorax (OR = 0.18). Conclusions: Small nodules (of < 2 cm) represent a technical challenge for diagnosis. CT-CNB is an excellent diagnostic tool, its accuracy being high.


RESUMO Objetivo: Avaliar a precisão diagnóstica da biópsia percutânea com agulha grossa, guiada por TC - doravante denominada BAG-TC - de nódulos pulmonares ≤ 2 cm, bem como identificar fatores que influenciam a precisão do procedimento e sua morbidade. Métodos: Estudo retrospectivo, realizado em um único centro, com 170 pacientes consecutivos submetidos a BAG-TC de nódulos pulmonares pequenos (≤ 2 cm) entre janeiro de 2010 e agosto de 2015. Resultados: Do total de biópsias, 156 resultaram em diagnóstico definitivo, com precisão diagnóstica global de 92,3%. Lesões maiores estiveram relacionadas com maior precisão global (OR = 1,30; p = 0,007). A presença de hemorragia parenquimatosa durante o procedimento resultou em menor precisão (OR = 0,13; p = 0,022). Pneumotórax foi a complicação mais comum. Uma distância > 3 cm entre a lesão e a pleura foi identificada como fator de risco de pneumotórax (OR = 16,94), ao passo que a realização de tampão sanguíneo após a biópsia foi um fator de proteção contra o pneumotórax (OR = 0,18). Conclusões: O diagnóstico de nódulos pequenos (< 2 cm) é um desafio do ponto de vista técnico. A BAG-TC é uma excelente ferramenta diagnóstica, cuja precisão é alta.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pneumothorax/etiology , Multiple Pulmonary Nodules/pathology , Biopsy, Large-Core Needle/methods , Image-Guided Biopsy/methods , Lung Neoplasms/pathology , Tomography, X-Ray Computed , Retrospective Studies , Risk Factors , Solitary Pulmonary Nodule/pathology , Biopsy, Large-Core Needle/adverse effects , Image-Guided Biopsy/adverse effects , Hemorrhage/etiology
16.
Dental press j. orthod. (Impr.) ; 23(1): 79-86, Jan.-Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-891120

ABSTRACT

ABSTRACT Introduction: The surgically assisted rapid maxillary expansion is a procedure that reduces the resistance of the sutures correcting the posterior crossbite in adults. Objective: The aim of this study was to evaluate the periodontal status of 17 adults submitted to this procedure. Methods: The clinical attachment level (CAL), gingival recession, attached gingiva and bleeding were evaluated in maxillary first premolars and molars, central and lateral incisors of right and left sides before surgery, 5 days and 6 months after. Means, standard deviation, medians, minimum and maximum values were compared among the evaluations using the Friedman and McNemar tests. Results: There was a statistically significant increase in CAL in the right central incisor, right and left premolars and right and left molars. There was a statistically significant increase in gingival recession in the right and left premolars and molars. The amount of attached gingiva significantly decreased in right premolars and right and left molars. There was increase in bleeding in most of the teeth. Conclusion: Results indicated that the surgically assisted rapid maxillary expansion might cause alterations in periodontal tissue.


RESUMO Introdução: a expansão rápida da maxila assistida cirurgicamente (ERMAC) é um procedimento que reduz a resistência das suturas, corrigindo a mordida cruzada posterior em adultos. Objetivo: o objetivo deste estudo foi avaliar o status periodontal de 17 adultos submetidos a esse procedimento. Métodos: o nível clínico de inserção (NCI), a recessão gengival, gengiva inserida e sangramento foram avaliados nos primeiros pré-molares, molares, incisivos centrais e laterais superiores dos lados direito e esquerdo antes da cirurgia, e depois de 5 dias e 6 meses. Médias, desvios-padrão, medianas, valores mínimos e máximos foram comparados entre as avaliações, usando os testes de Friedman e McNemar. Resultados: houve aumento estatisticamente significativo no NCI no incisivo central direito, pré-molares direito e esquerdo e molares direito e esquerdo. Houve aumento estatisticamente significativo na recessão gengival nos pré-molares e nos molares direito e esquerdo. A quantidade de gengiva inserida diminuiu significativamente nos pré-molares direitos e molares direitos e esquerdos. Houve aumento no sangramento na maioria dos dentes. Conclusão: os resultados indicaram que a ERMAC pode causar alterações no tecido periodontal.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Palatal Expansion Technique/adverse effects , Periodontal Attachment Loss/etiology , Gingival Recession/etiology , Maxilla/surgery , Palatal Expansion Technique/instrumentation , Hemorrhage/etiology
17.
Einstein (Säo Paulo) ; 16(4): eRC4505, 2018. graf
Article in English | LILACS | ID: biblio-975087

ABSTRACT

ABSTRACT Idiopathic pulmonary hemosiderosis is a potentially fatal disease that results from episodes of alveolar hemorrhage of unknown origin. The clinical spectrum is varied, and anemia may constitute the only manifestation of illness, preceding other signs and symptoms by several months. We present the case of a 4 year-old child presenting with fever, vomiting and prostration, associated with pallor. He had microcytic and hypochromic anemia refractory to iron therapy. Gastrointestinal bleeding was ruled out after negative extensive etiological investigation. Subsequently, pulmonary infiltrates suggestive of alveolar hemorrhage were observed in the chest radiography. The cytological exam of the bronchoalveolar lavage showed hemosiderin-laden macrophages. After the etiological study, the diagnosis of idiopathic pulmonary hemosiderosis was made by exclusion. He was initiated on corticosteroid therapy, later associated to an immunosuppressive agent, with subsequent correction of anemia and of the radiological pattern. The patient is currently asymptomatic.


RESUMO A hemossiderose pulmonar idiopática é uma doença potencialmente fatal que cursa com episódios de hemorragia alveolar de etiologia desconhecida. As manifestações clínicas são variadas, e a anemia pode constituir o único sinal de doença, precedendo em vários meses os outros sinais e sintomas. Apresenta-se o caso de criança de 4 anos, com febre, vômitos e prostração, associados à palidez. Apresentava anemia microcítica e hipocrômica, refratária à terapêutica com ferro. A hipótese diagnóstica de sangramento gastrintestinal foi excluída, após investigação etiológica extensa, inconclusiva. Posteriormente, em radiografia torácica, foram observados infiltrados sugestivos de hemorragia alveolar. O exame citológico do lavado broncoalveolar mostrou macrófagos com depósitos de hemossiderina. Após estudo etiológico, assumiu-se, por exclusão, o diagnóstico de hemossiderose pulmonar idiopática. Foi iniciada terapêutica com corticoides, associada posteriormente a imunossupressor, com correção subsequente da anemia e do padrão radiológico, encontrando-se, atualmente, assintomático.


Subject(s)
Humans , Male , Child, Preschool , Anemia, Iron-Deficiency/etiology , Hemorrhage/etiology , Hemosiderosis/complications , Lung Diseases/complications , Hemoglobins/analysis , Bronchoalveolar Lavage Fluid/cytology , Macrophages, Alveolar/cytology , Anemia, Iron-Deficiency/blood , Hemorrhage/diagnostic imaging , Hemosiderosis/blood , Lung Diseases/blood
18.
Rev. gaúch. enferm ; 39: e20170257, 2018. graf
Article in English | LILACS, BDENF | ID: biblio-960827

ABSTRACT

Abstract OBJECTIVE Randomized clinical trial protocol to evaluate the incidence of radial artery occlusion with two different arterial compression devices after transradial procedures. METHODS Barbeau's test will be performed in adults scheduled to undergo transradial interventional procedures. Those with A, B, or C plethysmographic patterns will be selected. At the end of the procedure, patients will be randomly assigned (1:1) to receive patent haemostasis with TR Band™ device or conventional haemostasis with an elastic adhesive bandage. The primary outcome is the incidence of radial artery occlusion. Secondary outcomes are Barbeau's test curve change, additional time to achieve haemostasis, incidence of bleeding at the puncture site, pain severity, development of arteriovenous fistula, radial pseudo aneurysm, any access-site complication requiring vascular surgery intervention and costs between the two devices. DISCUSSION The results of this trial should provide valuable additional information on the best approach for haemostasis after transradial percutaneous cardiovascular interventions.


Resumen OBJETIVO Protocolo de ensayo clínico randomizado para evaluar la incidencia de oclusión de la arteria radial con dos dispositivos de compresión arterial después de pasar por procedimientos transradiales. MÉTODO Se realizará el test de Barbeau en adultos que están esperando una intervención transradial. Se seleccionarán aquellos con padrones pletismográficos A, B o C. Al final del procedimiento, se dividirán a los pacientes de forma aleatoria (1:1) para recibir la hemostasia patente con dispositivo TR Band™ o hemostasia convencional con vendaje elástico adhesivo. El resultado primario es la incidencia de oclusión de la arteria radial. Los resultados secundarios son la alteración de la curva del test de Barbeau, tiempo adicional para alcanzar la hemostasia, incidencia de sangrado en el local de la punción, intensidad del dolor, desarrollo de una fístula arteriovenosa, pseudoaneurisma, cualquier complicación en el lugar de acceso que necesite intervención quirúrgica vascular y costos entre ambos dispositivos. DISCUSIÓN Los resultados de este estudio deben proporcionar informaciones adicionales valiosas sobre un mejor enfoque para la hemostasia luego de intervenciones cardiovasculares percutáneas transradiales.


Resumo OBJETIVO Protocolo de ensaio clínico randomizado para avaliar a incidência de oclusão da artéria radial com dois dispositivos diferentes de compressão arterial após procedimentos transradiais. MÉTODOS O teste de Barbeau será realizado em adultos que serão submetidos a procedimentos de intervenção transradial previamente agendados. Aqueles com padrões pletismográficos A, B ou C serão selecionados. No final do procedimento, os pacientes serão distribuídos aleatoriamente (1:1) para receber hemostasia patente com dispositivo TR Band™ ou hemostasia convencional com bandagem elástica adesiva. O desfecho primário é a incidência da oclusão da artéria radial. Os desfechos secundários são alteração da curva do teste de Barbeau, tempo adicional para atingir a hemostasia, incidência de sangramento no local da punção, intensidade da dor, desenvolvimento de fístula arteriovenosa, pseudoaneurisma, qualquer complicação no local de acesso que necessite intervenção cirúrgica vascular e custos entre os dois dispositivos. DISCUSSÃO: Os resultados deste estudo devem fornecer informações adicionais valiosas sobre a melhor abordagem para a hemostasia após intervenções cardiovasculares percutâneas transradiais.


Subject(s)
Humans , Cardiac Catheterization/adverse effects , Angioplasty, Balloon, Coronary/adverse effects , Randomized Controlled Trials as Topic/methods , Hemostatic Techniques/instrumentation , Compression Bandages , Hemorrhage/therapy , Brazil , Oximetry , Cardiac Catheterization/methods , Punctures , Randomized Controlled Trials as Topic/ethics , Clinical Protocols , Radial Artery/injuries , Collateral Circulation , Patient Selection , Hand/blood supply , Hemorrhage/etiology
19.
GED gastroenterol. endosc. dig ; 36(2): 50-54, Abr.-Jun. 2017. ilus, tab
Article in Portuguese | LILACS | ID: biblio-876737

ABSTRACT

A biópsia hepática percutânea, guiada ou não por ultrassonografia, consiste na retirada de fragmento de tecido hepático. É um procedimento invasivo para estudo histopatológico do órgão, propor terapêutica, avaliar resultados de tratamento e fazer acompanhamento após transplante em várias doenças hepáticas. A taxa de complicações deste procedimento está em torno de 1%, podendo citar dor, hipotensão, hemorragia, pneumotórax, peritonite biliar, bacteremia transitória e morte, e, na sua grande maioria, ocorre dentro das primeiras 48 horas. Relatamos o caso de um paciente do sexo masculino, 62 anos, com história de infecção crônica pelo vírus da hepatite C, submetido à biópsia hepática para estadiamento METAVIR. Após duas semanas, retornou ao serviço de urgência com quadro de abdome agudo hemorrágico, evoluindo a óbito. Com base no relato, os autores discutem as complicações da biópsia hepática, as causas de sangramento abdominal considerando a apresentação tardia do sangramento e a provável causa do óbito do paciente.


Liver biopsy, guided by ultrasonography or not, is an invasive procedure in which a hepatic tissue is removed for histopathological study of the organ, treatment planning, evaluate treatments results and follow-up after liver transplant in several hepatic diseases. Complication rate of the procedure is around 1%, including pain, hypotension, bleeding or hemorrhage, pneumothorax, biliary peritonitis transitory bacteremia and death, and most of them occur within 48 hours after the biopsy. We report a case about a male patient, 62 years old, with previous chronic hepatitis C virus infection, which underwent a liver biopsy for METAVIR staging. After two weeks, patient returns to the hospitals emergency service with hemorrhagic acute abdomen, leading to death. Based on the case report, authors discuss the complications of the liver biopsy, causes of abdominal bleeding considering its late manifestation and the patients probable cause of death.


Subject(s)
Humans , Male , Middle Aged , Carcinoma, Hepatocellular , Hepatitis C, Chronic , Hemorrhage , Hemorrhage/etiology , Liver/pathology , Biopsy
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