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1.
Arq. bras. cardiol ; 118(2): 525-529, 2022. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1364338

ABSTRACT

Resumo A doença de coronavírus 2019 (COVID-19) foi relatada em quase todos os países do mundo desde dezembro de 2019. A infecção por SARS-CoV-2 é frequentemente assintomática ou com sintomas leves, mas também pode levar à hipóxia, um estado hiperinflamatório e coagulopatia. Os parâmetros de coagulação anormais estão associados a complicações trombóticas, incluindo embolia pulmonar na COVID-19, mas pouco se sabe sobre os mecanismos. A semelhança dos sintomas iniciais de ambas as doenças também pode ser confusa, portanto, os médicos devem estar cientes do potencial para condições concomitantes. Apresentamos aqui um caso que não apresentava opacidades em vidro fosco nos pulmões, mas apresentava embolia pulmonar e derrame pleural em associação com infecção por COVID-19.


Abstract Coronavirus disease 2019 (COVID-19) has been reported in almost every country in the world since December 2019. Infection with SARS-CoV-2 is often asymptomatic or with mild symptoms, but it may also lead to hypoxia, a hyperinflammatory state, and coagulopathy. The abnormal coagulation parameters are associated with thrombotic complications, including pulmonary embolism in COVID-19, but little is known about the mechanisms. The similarity of initial symptoms of both diseases can also be confusing, therefore the physicians should be aware of the potential for concurrent conditions. Herein, we present a case who did not have ground-glass opacities in the lungs, yet presented with pulmonary embolism and pleural effusions in association with COVID-19 infection.


Subject(s)
Humans , Pulmonary Embolism/etiology , Pulmonary Embolism/diagnostic imaging , COVID-19/complications , SARS-CoV-2 , Lung
2.
Rev. urug. cardiol ; 36(2): e402, ago. 2021. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1289998

ABSTRACT

El tromboembolismo pulmonar tiene una presentación clínica variada. Es fundamental tener un alto índice de sospecha para arribar al diagnóstico oportuno. El síncope se asocia a casos graves y tiene importancia pronóstica. El tratamiento trombolítico es la piedra angular en el subgrupo de pacientes de alto riesgo. Se presentan tres casos clínicos de tromboembolia pulmonar de alto riesgo con el fin de discutir el escenario clínico de presentación y el tratamiento instaurado.


Pulmonary thromboembolism has a varied clinical presentation. It is essential to have a high index of suspicion to arrive at a timely diagnosis. Syncope is associated with severe cases and is of prognostic significance. Thrombolytic treatment is the cornerstone in the subgroup of high-risk patients. Three clinical cases of high-risk pulmonary thromboembolism are presented in order to discuss the clinical presentation scenario and the established treatment.


O tromboembolismo pulmonar tem a presentação clínica variada. É essencial ter um alto índice de suspeita para chegar a um diagnóstico oportuno. A síncope está associada a casos graves e tem significado prognóstico. O tratamento trombolítico é a pedra angular no subgrupo de pacientes de alto risco. São apresentados três casos clínicos de tromboembolismo pulmonar de alto risco para discutir o quadro clínico e o tratamento instituído.


Subject(s)
Humans , Male , Female , Aged , Pulmonary Embolism/diagnosis , Syncope/complications , Heart Arrest/complications , Pulmonary Embolism/etiology , Pulmonary Embolism/drug therapy , Radiography, Thoracic , Catastrophic Illness , Electrocardiography
4.
Rev. Soc. Bras. Med. Trop ; 54: e01572021, 2021. graf
Article in English | LILACS | ID: biblio-1250835

ABSTRACT

Abstract Approximately one-third of patients with coronavirus disease 2019 (COVID-19) present with coagulation disorders and hematological changes. However, the clinical manifestations of COVID-19 and prognoses of people living with human immunodeficiency virus (HIV) remain controversial. This study reports the case of a 27-year-old HIV-infected man who regularly used antiretroviral medications, had no other comorbidities and was admitted for acute respiratory distress syndrome caused by COVID-19. Complementary examinations during hospitalization revealed a diagnosis of pulmonary thromboembolism in association with an intracavitary thrombus.


Subject(s)
Humans , Male , Adult , Pulmonary Embolism/etiology , Thrombosis , HIV Infections/complications , COVID-19 , HIV , SARS-CoV-2
5.
Rev. habanera cienc. méd ; 19(5): e3067, sept.-oct. 2020. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1144685

ABSTRACT

Introducción: el embolismo tumoral pulmonar es la presencia de acúmulos de células tumorales en las arterias pulmonares arteriolas y capilares pulmonares. Su incidencia en autopsias ha sido descrita entre 3 y 26 por ciento de los pacientes con tumores sólidos, más frecuentemente de mama, estómago, hígado y pulmón. Objetivo: describir los argumentos clínicos que sugieren la sospecha diagnóstica de tromboembolismo tumoral en una paciente atendida en el Hospital Dr. Carlos J Finlay de La Habana, Cuba. Presentación del caso: paciente femenina de 80 años de edad con antecedentes patológicos personales de cirrosis hepática por virus de hepatitis C. Dos meses antes del ingreso comienza con síntomas generales asociados a edemas en miembros inferiores y diarreas. Ingresa en un servicio de Medicina Interna con el diagnóstico de cirrosis hepática descompensada y la sospecha de hepatocarcinoma. Al quinto día de su ingreso comienza de forma súbita con disnea y fallece. Conclusiones: los hallazgos anatomopatológicos informan como causa directa de muerte tromboembolismo tumoral. La embolia pulmonar tumoral debe ser considerada como diagnóstico diferencial en todo paciente con evidencia de neoplasia que presente disnea(AU)


Introduction: Pulmonary tumor thromboembolism is the presence of accumulations of tumor cells in the pulmonary arterioles and pulmonary capillaries. Its incidence in autopsies has been described between 3 percent and 26 percent of patients with solid tumors, most frequently in breast, stomach, liver and lung tumors. Objective: To describe clinical arguments suggesting the suspected diagnosis of tumor thromboembolism in a patient treated at the "Dr. Carlos J. Finlay'' Hospital in Havana, Cuba. Case presentation: Eighty-year-old female patient with personal pathological antecedents of liver cirrhosis due to hepatitis C virus. Two months before admission she started presenting general symptoms associated with edemaof the lower limbs and diarrhea. She was admitted to an Internal Medicine service with the diagnosis of decompensated hepatic cirrhosis and the suspicion of hepatocarcinoma. On the fifth day after admission, he suddenly began with dyspnea and died. Conclusions: Anatomopathological findings report tumor thromboembolism as a direct cause of death. Pulmonary tumor thromboembolism should be considered in the differential diagnosis of all patients with evidence of neoplasia who are presenting dyspnea(AU)


Subject(s)
Humans , Female , Aged, 80 and over , Pulmonary Embolism/etiology , Neoplastic Cells, Circulating
6.
Neumol. pediátr. (En línea) ; 15(1): 267-269, Mar. 2020. ilus
Article in English | LILACS | ID: biblio-1088095

ABSTRACT

Presenting the case of a previously healthy eleven-year-old girl, diagnosed with septic arthritis of the left knee as a result of stabbing trauma, which subsequently develops respiratory distress and fever. Septic pulmonary embolism is diagnosed radiologically and by pathological study. Receive adequate antibiotic treatment, recovering completely. Septic pulmonary embolism, although frequently described in the adult population, is a condition rarely described in pediatric literature.


Se presenta el caso de una niña de once años previamente sana, con diagnóstico de artritis séptica de rodilla izquierda como resultado de un traumatismo punzante, que posteriormente desarrolla dificultad respiratoria y fiebre. Se diagnostica embolia pulmonar séptica documentada radiológicamente y por estudio anatomopatológico. Recibe tratamiento antibiótico adecuado, recuperándose completamente. La embolia pulmonar séptica, aunque frecuentemente descrita en población adulta, es una condición raramente descrita en la literatura pediátrica.


Subject(s)
Humans , Female , Child , Pulmonary Embolism/etiology , Arthritis, Infectious/complications , Pulmonary Embolism/drug therapy , Pulmonary Embolism/diagnostic imaging , Radiography, Thoracic , Tomography, X-Ray Computed , Sepsis , Anti-Bacterial Agents/therapeutic use
7.
Arq. gastroenterol ; 56(1): 99-105, Jan.-Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-1001334

ABSTRACT

ABSTRACT BACKGROUND: One of the most feared complications with the use of cyanoacrylate for treatment of gastric varices is the occurrence of potentially life-threatening systemic embolism. Thus, endoscopists are turning towards new techniques, including endoscopic coiling, as a potentially safer and more effective treatment option. However, no studies have been performed comparing the two techniques. OBJECTIVE: This study aims to compare the safety and efficacy of endoscopic ultrasound guided coil and cyanoacrylate injection versus the conventional technique of injection of cyanoacrylate alone. DESIGN: A pilot randomized controlled trial. METHODS: Patients randomized into group I were treated with coil and cyanoacrylate, and those in group II with cyanoacrylate alone. Flow within the varix was evaluated immediately after the treatment session and one month following initial treatment. If thrombosis was confirmed, additional follow-up was performed 4 and 10 months following initial treatment. All patients underwent a thoracic computerized tomography scan after the procedure. RESULTS: A total of 32 patients, 16 in each group, were followed for an average of 9.9 months (range 1-26 months). Immediately after the procedure, 6 (37.5%) group-I patients and 8 (50%) group-II patients presented total flow reduction in the treated vessel (P=0.476). After 30 days, 11 (73.3%) group-I patients and 12 (75%) group-II patients were found to have varix thrombosis. In both groups, the majority of patients required only one single session for varix obliteration (73.3% in group I versus 80% in group II). Asymptomatic pulmonary embolism occurred in 4 (25%) group-I patients and 8 (50%) group-II patients (P=0.144). No significant difference between the groups was observed. CONCLUSION: There is no statistical difference between endoscopic ultrasound guided coils plus cyanoacrylate versus conventional cyanoacrylate technique in relation to the incidence of embolism. However, a greater tendency towards embolism was observed in the group treated using the conventional technique. Both techniques have similar efficacy in the obliteration of varices. Given the small sample size of our pilot data, our results are insufficient to prove the clinical benefit of the combined technique, and do not yet justify its use, especially in light of higher cost. Further studies with larger sample size are warranted.


RESUMO CONTEXTO: Uma das complicações mais temidas com o uso de cianoacrilato para tratamento de varizes gástricas é a ocorrência de embolia sistêmica potencialmente fatal. Assim, os endoscopistas estão se aprimorando com novas técnicas, incluindo o uso de coils endoscópico, como uma opção de tratamento potencialmente mais segura e eficaz. No entanto, nenhum estudo foi realizado comparando as duas técnicas. OBJETIVO: Este estudo tem como objetivo comparar a segurança e eficácia da injeção de coil com cianoacrilato guiados por ultrassom endoscópico versus a técnica convencional de injeção de cianoacrilato. DESIGN: Um ensaio piloto controlado aleatoriamente. MÉTODOS: Os pacientes randomizados para o grupo I foram tratados com coil + cianoacrilato e os do grupo II apenas com cianoacrilato. O fluxo dentro da variz foi avaliado imediatamente após a sessão de tratamento e um mês após o tratamento inicial. Se a trombose foi confirmada, o acompanhamento adicional era realizado em 4 e 10 meses após o tratamento inicial. Todos os pacientes foram submetidos a uma tomografia computadorizada torácica após o procedimento. RESULTADOS: Um total de 32 pacientes, 16 em cada grupo, foram acompanhados por uma média de 9,9 meses (variação de 1-26 meses). Imediatamente após o procedimento, 6 (37,5%) pacientes do grupo I e 8 (50%) pacientes do grupo II apresentaram redução total do fluxo no vaso tratado (P=0,476). Após 30 dias, 11 (73,3%) pacientes do grupo I e 12 (75%) pacientes do grupo II apresentaram trombose da variz. Em ambos os grupos, a maioria dos pacientes necessitou de apenas uma única sessão para obliteração da variz (73,3% no grupo I versus 80% no grupo II). Embolia pulmonar assintomática ocorreu em 4 (25%) pacientes do grupo I e em 8 (50%) pacientes no grupo II (P=0,144). Nenhuma diferença significativa entre os grupos foi observada. CONCLUSÃO Apesar de não haver diferença estatística entre os dois grupos em relação à incidência de embolia neste estudo piloto, observou-se maior tendência de embolia no grupo tratado pela técnica convencional.


Subject(s)
Humans , Male , Female , Adult , Aged , Esophageal and Gastric Varices/therapy , Cyanoacrylates/administration & dosage , Pulmonary Embolism/etiology , Esophageal and Gastric Varices/diagnostic imaging , Injections, Intralesional/adverse effects , Injections, Intralesional/methods , Pilot Projects , Treatment Outcome , Hemostasis, Endoscopic/methods , Ethiodized Oil/administration & dosage , Endosonography/methods , Middle Aged
8.
Arq. gastroenterol ; 56(1): 51-54, Jan.-Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-1001333

ABSTRACT

ABSTRACT BACKGROUND: The gastroesophageal reflux disease (GERD) is the most common esophageal disease in medical practice, and it is suspected according to patients' symptoms. GERD can be classified in erosive esophagitis (EE) according to the presence of upper gastrointestinal endoscopy findings. OBJECTIVE: To evaluate endoscopic findings in patients with symptoms suggestive of GERD comparing epicemiological and risk factors. METHODS: Upper endoscopy reports were examined retrospectively from patients with symptoms of GERD such as heartburn, regurgitation, cough, throat clearing, globus and chest pain. EE was determined based on Los Angeles classification. Comparisons between risk factors in EE and non-EE groups were done with statistical analysis. RESULTS: A total of 984 endoscopic reports were examined and 676 selected for analysis (281 with EE and 395 with non-EE form). Most were female 381 (56.36%) with a mean age of 44.01±15.40 years. Hiatal hernia was present in 47(6.96%) and smoking in 41(6.07%). Univariate logistic regression showed that male (OR=2.24, CI 95%, 1.63-3.06) and hiatal hernia (OR=4.52, CI 95%, 2.30-8.89) were independent predictors of erosions in the EE group. The presence of hiatal hernia (OR=12.04, CI 95%, 3.57-40.62), smoking (OR=8.46, CI 95%, 3.28-31.32) and aged patients (OR=8.01, CI 95%, 2.42-26.49) were also indicated as a risk factor for severe EE (grades C and D of Los Angeles). CONCLUSION Male gender and hiatal hernia were associated with EE. Aged patients, smoking and hiatal hernia were related to severe EE. It is suggested that the risk factors for EE and non-EE types are different. Cohort studies are necessary to identify the exact mechanisms involved in each disease form.


RESUMO CONTEXTO: A doença do refluxo gastroesofágico (DRGE) é uma das doenças digestivas mais comuns na prática médica e deve ser suspeitada de acordo com os seus sintomas clínicos, podendo ser classificada em esofagite erosiva (EE) de acordo com os achados de endoscopia. OBJETIVO: Avaliar os achados endoscópicos em pacientes com sintomas sugestivos de DGRE comparando fatores de risco e epidemiológicos. MÉTODOS: Resultados de endoscopias digestiva foram examinados retrospectivamente de pacientes com sintomas relacionados com DRGE como pirose, regurgitação, tosse, pigarro, globus e dor torácica. EE foi determinada de acordo com a classificação de Los Angeles. Comparação de fatores de risco entre os grupos EE e não-EE foram feitos com análise estatística. RESULTADOS: Um total de 984 endoscopias foram examinadas e 676 endoscopias selecionadas para análise (281 com EE e 395 sem EE). A maioria dos pacientes era do sexo feminino 381 (56,36%) com uma idade média de 44,01±15,40 anos. Hérnia hiatal esteve presente em 47 (6,96%) e tabagismo em 41 (6,07%). Regressão logística uni variada mostrou que sexo masculino (OR=2,24 - IC 95%: 1,63-3,06) e hérnia hiatal (OR=4,52 - CI 95%: 2,30-8,89) foram fatores de risco independentes de EE. A presença de hérnia hiatal (OR=12,04 - CI 95%: 3,57-40,62), tabagismo (OR=8,46 - CI 95%: 3,28-31,32) e pacientes idosos (OR=8,01 - CI 95%, 2,42-26,49) foram fatores de risco no grupo de EE grave (classes C e D de Los Angeles). CONCLUSÃO: Sexo masculino e hérnia hiatal foram associados com EE. Idade avançada, tabagismo e hérnia hiatal foram relacionados à forma grave de EE. É sugerido que os fatores de risco de pacientes com e sem EE sejam diferentes. Estudos de coorte são necessários para identificar os mecanismos exatos envolvidos em cada forma da doença.


Subject(s)
Humans , Male , Female , Adult , Aged , Esophageal and Gastric Varices/therapy , Cyanoacrylates/administration & dosage , Pulmonary Embolism/etiology , Esophageal and Gastric Varices/diagnostic imaging , Injections, Intralesional/adverse effects , Injections, Intralesional/methods , Pilot Projects , Treatment Outcome , Hemostasis, Endoscopic/methods , Ethiodized Oil/administration & dosage , Endosonography/methods , Middle Aged
9.
Rev. cuba. angiol. cir. vasc ; 19(2)jul.-dic. 2018. ilus, tab
Article in Spanish | LILACS | ID: biblio-960337

ABSTRACT

Introducción: Los filtros de vena cava son dispositivos metálicos diseñados especialmente para ser colocados en la vena cava inferior, ante el riesgo de tromboembolismo pulmonar por trombosis venosa profunda. Objetivo: Mostrar una actualización de las características de los filtros de vena cava y su colocación. Métodos: Revisión bibliográfica realizada entre 2010-2016 en las bases de datos: Medline, Cochrane Library, Lilacs, así como en el metabuscador Google. Se consultaron estudios de cohorte, prospectivos, retrospectivos, clínicos, epidemiológicos, metaanálisis, revisiones bibliográficas y ensayos clínicos. Resultados: se describieron y usaron por primera vez en 1967 en Estados Unidos de Norteamérica. Estos dispositivos se implementan por vía percutánea y producen una interrupción mecánica parcial del flujo sanguíneo de la vena cava inferior. Actualmente, existen filtros de tres tipos: permanentes, temporales y mixtos. El factor más importante de cualquier filtro es el grado de atrapamiento de los coágulos, grado de acceso a la vena cava y de oclusión, riesgo de embolización, grado de integridad mecánica y facilidad para su colocación. Las complicaciones de los filtros pueden ocurrir de modo inmediato o a largo plazo, con un promedio de 0,3 por ciento de complicaciones mayores y menos de 0,2 por ciento de los pacientes fallecen como resultado de la colocación del filtro. Conclusiones: A pesar de su efectividad demostrada, no existen publicaciones en Cuba que avalen su uso. Por su importancia y capacidad resolutiva se sugiere que esta técnica debe comenzarse a aplicar, de manera habitual, en los centros hospitalarios de atención secundaria y terciaria del país(AU)


Introduction: Vena cava filters are special metallic devices designed specially to be placed in the inferior cava vein in view of imminent risk of pulmonary tromboembolism by deep venous thrombosis. Objective: To update the state of vena cava filters and their placement. Methods: A bibliographic review was carried out in the years 2010 to 2016 in Medline, Cochrane Library and Lilacs data bases, as well as in Google search engine. There were consulted cohort, prospective, retrospective, clinical and epidemiological studies, meta-analysis, bibliographic reviews and clinical trials. Results: Vena cava filters were described and used for the first time in 1967 in the United States of America. The filters can be placed percutaneously and produce a partial mechanical disruption of the inferior cava vein flow. There are 3 kinds of filters in the market: permanent, temporal and mixed. The key factors of a filter are clot trapping capacity, access to the vena cava and occlusion capacity; also embolization, mechanical integrity grade, and placement feasibility. Complications by the filter may occur immediately or in a long term, with an average of 0, 3 percent in major complications, and less than 0,2 percent of mortality rate due to the placement of the filter. Conclusion: In spite of its proven benefits, there is not existence in Cuba of publications that guarantee its use. Because of its importance and resolvent capacity, it is suggested that this technique should start to be usually used in secondary and tertiary level hospitals in Cuba(AU)


Subject(s)
Humans , Pulmonary Embolism/prevention & control , Vena Cava Filters , Pulmonary Embolism/etiology , Epidemiology, Descriptive , Prospective Studies , Retrospective Studies , Cohort Studies , Venous Thrombosis/epidemiology
13.
Arch. argent. pediatr ; 115(6): 412-415, dic. 2017. ilus, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-887403

ABSTRACT

Elsíndromeantifosfolipídicoes unaenfermedadautoinmunitaria en la cual se producen de forma persistente autoanticuerpos contra una variedad de fosfolípidos y proteínas transportadoras de estos. Ocurre en el 1, 8% de la población y solo el 2% de los casos son pediátricos. El espectro de manifestaciones clínicas es amplio: desde pacientes asintomáticos hasta una enfermedad amenazante para la vida como es el síndrome antifosfolipídico catastrófico. Cualquier órgano puede verse afectado como consecuencia de la trombosis a nivel de los grandes vasos o la microcirculación. Las manifestaciones más frecuentes en pediatría corresponden a trombosis venosas en el 60% de los pacientes, trombosis arterial en el 32%, alteraciones hematológicas en el 38% (plaquetopenia, leucopenia), alteraciones en la piel en el 18% (livedo reticularis, fenómeno de Raynaud) y alteraciones neurológicas en el 16%. Se presenta el caso clínico de una paciente pediátrica por la baja incidencia a esta edad.


The antiphospholipid syndrome is a multisystem autoimmune disease in which autoantibodies against a variety of phospholipids and phospholipid binding proteins are produced. It occurs in 1.8% of the population and only 2% of the cases are pediatric. The spectrum of clinical manifestations is wide from asymptomatic patients to a life-threatening disease like the catastrophic antiphospholipid syndrome. Any organ can be affected. The most frequent manifestations in pediatrics correspond to venous thrombosis in 60% of patients, arterial thrombosis in 32%, hematological disease in 38% (thrombocytopenia, leucopenia), skin alterations in 18% (livedo reticularis, Raynaud's phenomenon) and neurological signs in 16%. We describe the case of a previously healthy 14-year-old female patient diagnosed with antiphospholipid syndrome.


Subject(s)
Humans , Female , Adolescent , Antiphospholipid Syndrome/diagnosis , Pulmonary Embolism/etiology , Pulmonary Embolism/diagnostic imaging , Antiphospholipid Syndrome/complications
14.
Medicina (B.Aires) ; 76(6): 373-375, dic. 2016. ilus
Article in Spanish | LILACS | ID: biblio-841613

ABSTRACT

Las várices gástricas están presentes en cerca de un tercio de los pacientes con hipertensión portal y el sangrado de las mismas representa una causa significativa de mortalidad. El tratamiento de primera línea es la obturación con N-butil-2-cianoacrilato, que si bien es seguro no está libre de complicaciones. Presentamos el caso de un paciente de 61 años de edad con antecedente de cirrosis criptogénica que se presentó a la consulta febril, taquicárdico e hipoxémico después de la obturación endoscópica con N-butil-2-cianoacrilato. Las imágenes mostraron embolia pulmonar bilateral del material obturante. El objetivo de este trabajo es destacar las manifestaciones clínicas y las imágenes de esta situación para ayudar a su diagnóstico precoz y diferenciarla de otras entidades que requieren un tratamiento específico.


Gastric varices occur in one-third of patients with portal hypertension. Bleeding from gastric varices remains a significant cause of death. Currently the first-line of treatment for gastric varices is endoscopic obliteration with N-butyl-2-cyanoacrylate. Though relatively safe, this option has several well-known complications. We report the case of a 61-year-old male patient with cryptogenic cirrhosis, who presented with fever, tachycardia and hypoxemia after endoscopic obliteration with N-butyl-2-cyanoacrylate. Radiographic findings were consistent with pulmonary embolism of the sclerosing substance. The aim of this case report is to emphasize the clinical and radiological findings of this complication in order to distinguish it from other similar medical conditions and prevent a delay in diagnosis.


Subject(s)
Humans , Male , Middle Aged , Pulmonary Embolism/etiology , Sclerosing Solutions/adverse effects , Esophageal and Gastric Varices/therapy , Enbucrilate/adverse effects , Pulmonary Embolism/diagnostic imaging , Angiography , Tomography, X-Ray Computed , Sclerotherapy/adverse effects , Sclerotherapy/methods , Gastroscopy/adverse effects , Gastroscopy/methods , Injections
16.
Yonsei Medical Journal ; : 1209-1213, 2016.
Article in English | WPRIM | ID: wpr-79772

ABSTRACT

PURPOSE: The aim of this study was to investigate the efficacy of low-molecular-weight heparin (LMWH) for the prevention of venous thromboembolism in Korean patients who underwent hip fracture surgery (HFS). MATERIALS AND METHODS: Prospectively, a total 181 cases were classified into the LMWH user group (116 cases) and LMWH non-user group (65 cases). Each group was sub-classified according to fracture types as follows: 81 cases of intertrochanteric fracture (group A: 49, group B: 32) and 100 cases of neck fracture (group C: 67, group D: 33). We compared the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) according to LMWH use. RESULTS: Of the 181 cases, four DVTs were found in the LMWH user groups (1 in group A, and 3 in group C). One case of PE was found in LMWH non-user group D. The incidences of DVT and PE showed no statistically significant differences between the LMWH user and non-user groups (p=0.298 and 0.359, respectively). In subgroup analysis, no statistically significant differences were found between groups A and B and between groups C and D. CONCLUSION: The administration of LMWH was not effective in the prevention of venous thromboembolism and PE in the Korean patients who underwent HFS.


Subject(s)
Aged , Anticoagulants/therapeutic use , Female , Heparin, Low-Molecular-Weight/therapeutic use , Hip Fractures/classification , Humans , Male , Middle Aged , Postoperative Complications/prevention & control , Pulmonary Embolism/etiology , Republic of Korea , Venous Thromboembolism/prevention & control , Venous Thrombosis/etiology
17.
In. Kalil Filho, Roberto; Fuster, Valetim; Albuquerque, Cícero Piva de. Medicina cardiovascular reduzindo o impacto das doenças / Cardiovascular medicine reducing the impact of diseases. São Paulo, Atheneu, 2016. p.287-306.
Monography in Portuguese | LILACS | ID: biblio-971542
18.
Int. braz. j. urol ; 41(4): 707-713, July-Aug. 2015. tab
Article in English | LILACS | ID: lil-763055

ABSTRACT

ABSTRACTPurpose:The place of oncological cases of upper urinary system in the laparoscopic learning curve was investigated.Materials and Methods:A total of 139 patients from two different centers underwent laparoscopic operations and were included in this retrospective study.Results:Mean operative times for oncological, and non-oncological cases were 101.3 (range 60-450), and 102.7 (45-490) minutes respectively. Fourty-two (31.3 %) patients were oncological cases. In 4 oncological cases, the surgeons switched to open surgery because of massive bleeding and six (14.2 %) oncological cases required blood transfusions during peri/postoperative periods. Pulmonary embolism was observed in one oncological case. In one non-oncological case, the surgeon switched to open surgery because of intestinal perforation and 10 (9.7 %) non-oncological cases needed blood transfusions during peri/postoperative periods. In addition, some complications such as intestinal perforation (n=1), mechanical ileus (n=1), and pulmonary embolism (n=1) were observed during postoperative period. Intestinal perforation was repaired using laparoscopic (n=1) method. Mechanical ileus was approached with open surgical technique. Mean hospital stay of the patients in the oncological and non-oncological series were 4.5 (3-23) and 4.5 (3-30) days respectively.Conclusion:We think that renal oncological cases should be included in the spectrum of laparoscopic indications even at the beginning of the learning curve. Certainly, we still share the opinion that cancer cases which require highly challenging surgeries like radical cystectomy, and prostatectomy should be postponed till to gaining of higher level of experience.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Intestinal Perforation/etiology , Intraoperative Complications/epidemiology , Learning Curve , Laparoscopy/adverse effects , Pulmonary Embolism/etiology , Urologic Neoplasms/surgery , Blood Loss, Surgical/statistics & numerical data , Blood Transfusion/statistics & numerical data , Cystectomy , Conversion to Open Surgery/statistics & numerical data , Ileus/etiology , Length of Stay , Laparoscopy , Nephrectomy , Operative Time , Prostatectomy , Retrospective Studies
19.
Rev. gastroenterol. Perú ; 35(1): 15-24, ene. 2015. ilus, tab
Article in Spanish | LIPECS, LILACS, LIPECS | ID: lil-746990

ABSTRACT

Objetivo: Valorar los puntajes BISAP y APACHE II en predecir severidad según la clasificación Atlanta 2012 y determinar si el factor obesidad añadido a dichos puntajes mejora su predicción. Material y métodos: Se realizó un estudio prospectivo entre enero de 2013 y abril de 2014 de todos los pacientes con pancreatitis aguda según la nueva clasificación Atlanta 2012. Se confeccionó curvas ROC para los puntajes BISAP, BISAP-O, APACHE-II y APACHE-O y se seleccionó puntos de corte apropiados con los que se calculó la sensibilidad, especificidad, VPP, VPN, RPP y la RPN. Resultados: Se estudió a 334 pacientes. El 65,27% presentó sobrepeso u obesidad. La etiología fue biliar en el 86,53%. Sólo 8,38% presentó pancreatitis severa y 1,5% falleció. Las áreas bajo la curva ROC y puntos de corte seleccionados fueron: BISAP: 0,8725, 2; BISAP-O: 0,8246, 3; APACHE-II: 0,8547, 5; APACHE-O: 0,8531, 6. Con dichos puntos de corte la sensibilidad, especificidad, VPP, VPN, RPP y la RPN fueron: BISAP: 60,71%, 91,83%, 40,48%, 96,23%, 7,43, 0,43; BISAP-O: 60,71%, 86,93%, 29,82%, 96,03%, 4,76, 0,45; APACHE-II: 85,71%, 76,14%, 24,74%, 98,31%, 3,6, 0,19; APACHE-O: 82,14%, 79,41%, 26,74%, 97,98%, 4, 0,22. Conclusiones: Los sistemas BISAP, BISAP-O, APACHE-II, y APACHE-O pueden usarse para identificar a los pacientes con bajo riesgo de severidad en razón de su alto VPN, sin embargo su uso debe ser prudente considerando que la RPP y RPN no alcanza niveles óptimos, indicando que su valor en la predicción de severidad es limitado. Por otro lado el añadir el factor obesidad no mejoró su capacidad predictiva.


Objective: To assess the BISAP and APACHE II scores in predicting severity according to the 2012 Atlanta classification and whether the obesity factor added to these scores improves prediction. Material and methods: A prospective study between January 2013 and April 2014 including all patients with acute pancreatitis was performed according to the new Atlanta 2012 classification. ROC curves were fabricated for BISAP, BISAP-O, APACHE-II scores and Apache O and appropriate cutoffs were selected to the sensitivity, specificity, PPV, NPV, RPP and RPN. Results: We studied 334 patients. 65.27% were overweighted or obese. The biliar etiology was 86.53%. Only 8.38% had severe pancreatitis and 1.5% died. Areas under the ROC curve and cut points selected were: BISAP: 0.8725, 2; BISAP-O: 0.8246, 3; APACHE-II: 0.8547, 5; APACHE-O: 0.8531, 6. Using these cutoffs the sensitivity, specificity, PPV, NPV, RPP and RPN were BISAP: 60.71%, 91.83%, 40.48%, 96.23 %, 7.43, 0.43; BISAP-O: 60.71%, 86.93%, 29.82%, 96.03%, 4.76, 0.45; APACHE-II: 85.71%, 76.14%, 24.74%, 98.31%, 3.6, 0.19; APACHE-O: 82.14%, 79.41%, 26.74%, 97.98%, 4, 0.22. Conclusions: BISAP, BISAP-O, APACHE-II and APACHE-O systems can be used to identify patients at low risk of severity because of its high NPV, however their use should be cautious considering that the RPP and RPN do not reach optimal levels indicating that their value in predicting severity is limited. On the other hand adding the obesity factor did not improve their predictive ability.


Subject(s)
Female , Humans , Male , Middle Aged , Pulmonary Embolism/epidemiology , Spinal Cord Injuries/epidemiology , Venous Thrombosis/epidemiology , Cohort Studies , Incidence , Prospective Studies , Pulmonary Embolism/blood , Pulmonary Embolism/etiology , Risk Factors , Spinal Cord Injuries/blood , Spinal Cord Injuries/complications , Taiwan/epidemiology , Venous Thrombosis/blood , Venous Thrombosis/etiology
20.
Article in English | WPRIM | ID: wpr-56487

ABSTRACT

We sought to document the clinical performance of the 1st American Academy of Orthopaedic Surgeons (AAOS) guideline on the prevention of symptomatic pulmonary embolism (PE) after total knee arthroplasty (TKA) in Korean patients, in terms of the proportions of the each risk-stratified group, efficacy and safety. Consecutive 328 patients underwent TKA were preoperatively assessed for the risks of PE and bleeding and categorized into 4 groups: 1) standard risk, 2) high risk for PE, 3) high risk for bleeding, and 4) high risks both for PE and bleeding. One of three options was administered according to the groups (aspirin in group 1 or 4; enoxaparin and following aspirin in group 2; antithrombotic stocking in group 3). Incidences of symptomatic deep vein thrombosis (DVT) and PE, and major or minor bleeding complications were evaluated. Majority of the patients (86%) were assessed to be with standard risks both for PE and bleeding. No patient experienced symptomatic DVT or PE and major bleeding. Eleven percent of the patients discontinued chemoprophylaxis because of bleeding-related wound complication. In conclusion, the 1st AAOS guideline functions successfully in Korean patients undergoing TKA in terms of prevention of symptomatic DVT and PE while avoiding major bleeding complications.


Subject(s)
Aged , Arthroplasty, Replacement, Knee/adverse effects , Aspirin/administration & dosage , Cohort Studies , Enoxaparin/administration & dosage , Female , Fibrinolytic Agents/administration & dosage , Humans , Male , Middle Aged , Orthopedics , Postoperative Complications/etiology , Postoperative Hemorrhage/etiology , Practice Guidelines as Topic , Pulmonary Embolism/etiology , Republic of Korea , Retrospective Studies , Risk Factors , Societies, Medical , Stockings, Compression , Venous Thrombosis/etiology
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