Síndrome autoimune induzida por adjuvantes (ASIA) sinais e sintomas experienciados por mulheres / Implementation of an intravenous therapy team based on convergent-assistance research / Síndrome autoinmune inducido por adyuvante (ASIA) signos y síntomas experimentados por mujeres

Objetivo: Identificar sinais e sintomas experienciados por mulheres com síndrome autoimune induzida por adjuvantes (ASIA) devido ao uso de prótese mamária e os tratamentos realizados. Método: Estudo de campo de abordagem qualitativa realizado por meio de entrevistas online utilizan-do-se a técnica bola de neve. Incluíram-se 13 participantes. Resultados: A partir da análise dos dados, foram elencadas quatro categorias: conhecimento acerca da síndrome; sinais e sintomas; tratamento; e cuidados e implicações de Enfermagem. Identificaram-se mais de 120 sinais e sintomas, e o explante foi mencionado como tratamento definitivo por todas as entrevistadas. Os sinais e sintomas apresentados pelas participantes vão ao encontro do que é descrito pela literatura. Conclusão: Antes da descoberta da doença, as participantes realizaram tratamento com foco no alívio dos sintomas. Após o diag-nóstico, todas as mulheres procederam com o explante

Objective: To identify signs and symptoms experienced by women with autoimmune/inflammatory syndrome induced by adjuvants (ASIA) due to the use of breast implants and the treatments performed. Method: Field study with a qualitative approach carried out through online interviews using the snowball technique. 13 participants were included. Results: Based on data analysis, four categories were listed: knowledge about the syndrome; signs and symptoms; treatment; and nursing care and implications. Over 120 signs and symptoms were identified, and the explant was mentioned as a defi-nitive treatment by all interviewees. The signs and symptoms presented by the participants are in line with what is described in the literature. Conclusion:Before discovering the disease, the participants underwent treatment focused on symptom relief. After diagnosis, all women proceeded with the explant.Keywords: Autoimmune diseases. Prothesis implantation. Breast implantation. Silicones. Perioperative nursing

Objetivo: Identificar los signos y síntomas experimentados por mujeres con síndrome autoinmune inducido por adyuvantes (ASIA) debido al uso de implantes mamarios y los tratamientos realizados. Método: Estudio de campo con enfoque cualitativo realizado a través de entrevistas en línea utilizando la técnica de bola de nieve. Se incluyeron 13 participantes. Resultados: Con base en el análisis de los datos, se enumeraron cuatro categorías: conocimiento sobre el síndrome; signos y síntomas; tratamiento; y cuidados e implicaciones de enfermería. Se identificaron más de 120 signos y sínto-mas, y todos los entrevistados mencionaron el explante como tratamiento definitivo. Los signos y síntomas presentados por los participantes están en línea con lo descrito en la literatura. Conclusión: Antes de descubrir la enfermedad, los participantes realizaban un tratamiento enfocado en el alivio de los síntomas. Después del diagnóstico, todas las mujeres procedieron al explante

Aortic valve replacement via right anterior mini-thoracotomy: the conventional procedure performed through a smaller incision

Abstract Minimally invasive aortic valve replacement has gained consent due to its good results in terms of minimized surgical trauma, faster rehabilitation, pain control and patient compliance. In our experience, we have tried to replicate the conventional and gold standard approach through a smaller incision. Sparing the right internal thoracic artery, avoiding rib fractures and performing total central cannulation is important to make this procedure minimally invasive from a biological point of view too. In addition, the total central cannulation is pivotal to simplify perfusion and drainage. Moreover, a complete step-by-step procedure optimization and-when possible-the use of sutureless prosthesis help to reduce the cross-clamping and perfusion times. After more than 1000 right anterior thoracotomy (RAT) aortic valve replacements, we have found tips and tricks to make our technique more effective.

Reconstrução de sequela facial por prótese interna acrílica / Reconstruction of facial sequela by internal acrylic prothesis

As sequelas faciais decorrentes do trauma representam grande desafio para o cirurgião buco-maxilo-facial e exigem que este tenha em mente o conhecimento anatômico, cirúrgico, do acervo material, bem como do aporte tecnológico que lhe assiste a prática cirúrgica. Frente aos biomateriais utilizados na confecção protética, a resina acrílica aparece como uma possibilidade amplamente vantajosa para o profissional e para o paciente, e, uma vez somada às técnicas de prototipagem, se tornam ainda mais eficientes e eficazes. O presente trabalho objetiva discutir o uso da resina acrílica no tratamento das sequelas faciais após o trauma por meio da apresentação de um caso clínico... (AU)

As the facial sequelae resulting from trauma represent a great challenge for the maxillo-facial surgeon, and require that keep in mind the knowlodge about anatomical, surgical, material assets and the technological support that assists you to surgical practice. In view of the prosthetic biomaterials used in making the acrylic resin appears as a widely advantageous possibility for professional and patient, and once added to the prototyping techniques become more efficient and effective. This paper aims to discuss the use of acrylic resin in the treatment of facial sequelae after trauma by presenting a clinical case... (AU)

Feasibility of anticoagulation therapy after mechanical valve replacement in grass-root health institutions / 中华全科医师杂志

Objective To assess the feasibility of anticoagulation therapy after mechanical valve replacement in grass-root health institutions.Methods One hundred and sixty one patients with mechanical valve replacement received anticoagulation therapy with warfarin,including 79 cases receiving the therapy in grass-root health institutions (test group) and 82 cases in the tertiary hospitals (control group).The patients were followed up for 12 months after operation;the rate of anticoagulation efficacy,the anticoagulationrelated complications,and the anticoagulation-related cost were documented and compared between two groups.Results The international normalized ratio (INR) tests were performed for 1 021 times in test group and 717 times were up to anticoagulation standard (70.2 ％,717/1 021),while INR tests in control group were performed for 965 times and 688 times were up to standard (71.3％,688/965);there were no significantly differences in efficacy rate between two groups (P ＞ 0.05).There were no significant differences in rate of bleeding events and thrombosis between two groups [16.5％ (13/79) vs.12.2％ (10/82),6.3％(5/79) vs.4.9％(4/82),respectively,x2 =0.596,P=0.44,x2 =0.161,P=0.69].The anticoagulation-related cost per month and per patient in test group was significantly lower than those in control group [(63.1 ±.12.8) vs.(176.6 ± 16.4) yuan,t =48.716,P ＜0.05].Conclusion Compared with the tertiary hospital,the anticoagulation therapy in grass-root institutions can accomplish the similar clinical outcomes and significantly reduce the medical cost in patients with mechanical valve replacement.

The protective effects of ulinastatin on cardiac function in heart valve replacements / 中华胸心血管外科杂志

Objective To evaluate the effects of ulinastatin on cardiac function in heart valve replacement patients with cardio-pulmonary bypass (CPB).Methods 120 patients received valve replacements were divided into 4 groups at random.Group U 1,preconditioning group:ulinastatin parenteral solution (20 000 U/kg) was injected into the central veins for 10 min before the ascending aorta was clamped.Group U2,postconditioning group:ulinastatin ( 10 000 U/kg) was injected into the aortic root for 5 min before the aortic clamp was opened.Group U3,combined the treatments of group U1 and group U2.Group C was served as control without using ulinastatin.The ST-T of ECG at different 8 time points was recorded from preanesthesia to the end of operation.The dosage of vasoactive agents in the 4 groups was recorded after the aortic clamp was opened.Blood samples were taken from the radial artery at 4 time points during 1O min before the ascending aorta was clamed to the end of operation for determining the serum concentration of H-FABP,IMA,CK-MB,MDA and SOD.The changes in myocardium were examined by microscope.Results The automatic reheating rate of heart in group U1,group U2,and group U3 were 70％,73％ and 90％ respectively,which were all higher than group C (33％) after the aortic clamp was opened in 3 -5 min.The scores of reperfusion arrhythmia,change of ST segments in ECG ( elevation or depression),the dosage of vasoactive drugs ( dopamine and adrenaline) and their using time,the concentration of MDA,H-FABP,IMA and CK-MB in group U1 and group U2 were ＜ than those of group C ( P ＜0.05 ),but was ＞ than those of group U3 ( P ＜0.05 ).The activity of SOD in group U1 and group U2 were ＞ than those of group C ( P ＜ 0.05 ),but was ＜ than those of group U3 ( P ＜ 0.05 ).There were no significant differences between group U1 and group U2( P ＞0.05 ).The myocardium in group C had focal coagulative necrosis.The damage of myocardium in group U3 was minor,the cytoplasm and nucleus was homogeneous,and the boundaries were distinct.Conclusion Ulinastatin parenteral solution preconditioning and postconditioning could improve heart function after valves replacement on CPB.The protective effects were not significantly different regarding ulinastati was administered into the central veins before the ascending aorta was clamped vs.it was injected into the aortic root before the aortic clamp opening.Combined these 2 administration methods and dosages could produce collaborative protection.

Circulação periférica em pacientes com insuficiência aórtica crônica e indicação de troca valvar / Peripheral circulation in patients with chronic aortic insufficiency and valve replacement indication

Introdução: O recente aperfeiçoamento da ultra-sonografia permitiu a análise estrutural e funcional do vaso. Casuística e Métodos: 36 pacientes com insuficiência aórtica e indicação de troca valvar, divididos em grupos com pressão arterial diastólica (PAD) superior e inferior a 50mmHg, avaliados antes e seis meses após a cirurgia. A função arterial compreendeu a complacência, distensibilidade e a função endotelial pela dilatação fluxo-mediada e nitrato-mediada. Conclusão: A complacência e a distensibilidade foram maiores no grupo com menor PAD e diminuíram após a cirurgia. A disfunção endotelial foi presente em insuficiência aórtica crônica independente do nível da pressão arterial diastólica.

Introduction: The recent improvement of ultrasonography made possible a functional and structural analysis of the vessel. Methods: 36 patients with aortic insufficiency and valve replacement need, divided in 2 groups with diastolic blood pressure (DBP) above and below 50mmHg. Checked twice: before and 6 months after surgery. The arterial function comprised compliance, distensibility and endothelial function through flow-mediated dilatation and nitrate-mediated dilatation. Conclusion: The compliance and distensibility were higher in the group with lower DBP and decreased after surgery. Endothelial dysfunction was present in chronic aortic insufficiency no matter the level of DBP.