Anticoagulantes, Antiplaquetarios y sus implicaciones en cirugía: una revisión de la literatura / Anticoagulants, Anti-platelets, and their implications in Surgery: A Literature review

All health care providers should be aware of the impact of bleeding disorders on their patients during any surgical procedures. The knowledge of the mechanisms of hemostasis and optimized management are very important. Initial recognition of a bleeding disorder, in such patients with a systemic pathologic process, may occur in surgical practice. The surgical treatment of those patients might be complicated during the surgery due to the use of anticoagulant and/or antiplatelet medications raises a challenge in the daily practice of surgical professionals. Adequate hemostasis is critical for the success of any surgical procedure because bleeding problems can give rise to complications associated with important morbidity-mortality. Besides, prophylactic, restorative, and surgical care of patients with any bleeding disorders is handled skillfully by practitioners who are well educated regarding the pathology, complications which could arise, and surgical options associated with these conditions. The purpose of this paper is to review common bleeding disorders and their effects on the surgical aspect. Many authors consider that patient medication indicated for the treatment of background disease should not be altered or suspended unless so indicated by the prescribing physician. Local hemostatic measures have been shown to suffice for controlling possible bleeding problems resulting from surgery.

Hemofilia A adquirida. A propósito de un caso / Acquired hemophilia A. A case report

La hemofilia A adquirida es un trastorno hemorrágico poco frecuente caracterizado por la presencia de autoanticuerpos contra el factor VIII (FVIII) circulante. Se ha observado en un grupo heterogéneo de entidades que incluyen, entre otros, enfermedades malignas; de ellas el 32 por ciento asociada a procesos urológicos, donde el cáncer de próstata tiene la mayor prevalencia. Se presenta un paciente que fue atendido en el servicio de Oncología del Hospital Universitario Celestino Hernández Robau con el diagnóstico de hemofilia A adquirida en la evolución de un adenocarcinoma prostático. Se realizó estudio de coagulación en el Instituto de Hematología e Inmunología donde se comprobó la presencia de inhibidor del factor VIII, lo que confirmó el diagnóstico. Se puso tratamiento inmunosupresor con prednisona 1 mg/kg de peso, con una evolución favorable(AU)

Acquired hemophilia A is a rare bleeding disorder characterized by the presence of autoantibodies against circulating factor VIII (FVIII). It has been observed in a heterogeneous group of entities that include, among others, malignant diseases; 32 percent associated with urological processes, where prostate cancer has the highest prevalence. We present a patient who was treated at the Oncology Service of the Celestino Hernández Robau University Hospital with the diagnosis of acquired hemophilia A in the course of a prostatic adenocarcinoma. A coagulation study was carried out at the Institute of Hematology and Immunology where the presence of factor VIII inhibitor was confirmed, confirming the diagnosis. Immunosuppressive treatment was given with prednisone 1 mg/kg of weight, with a favorable evolution(AU)

Flexible ureteroscopy and Holmium:YAG laser lithotripsy for stone disease in patients with bleeding diathesis: a systematic review of the literature

INTRODUCTION AND OBJECTIVES: The management of urolithiasis in patients on anticoagulants presents a challenge to the endourologist. Due to multiple comorbidities, it may be impossible to safely discontinue the anticoagulant treatment. Other modalities such as shock wave lithotripsy and PCNL are contraindicated in these patients, so ureteroscopic treatment may be the only option. We conducted a systematic review of the literature to look at the safety and efficacy of ureteroscopic management in these patients. METHODS: Systematic review and quantitative meta-analysis was performed using studies identified by a systematic electronic literature search from January 1990 to August 2011. All articles reporting on treatment for stones in patients with a bleeding diathesis using ureteroscopy and a Holmium:YAG laser were included. Two reviewers independently extracted the data from each study. The data was included into a meta-analysis and discussed. RESULTS: Three studies were identified reporting on 70 patients (73 procedures). All patients had stone fragmentation using Holmium laser. The mean stone size was 13.2mm with a range of 5-35mm. The quality of the included studies was modest. Stone free status was achieved in sixty-four patients (87.7%). There were no major complications and only 11% of the patients developed minor complications with only 4% rate of minor bleeding. CONCLUSIONS: Retrograde stone treatment using ureteroscopy and holmium laser lithotripsy can be safely performed in patients with bleeding diathesis with a low complication rate.

Embolia pulmonar no paciente idoso internado / Pulmonary embolism in ederly patients admited into a hospital

Introdução: A prevalência da embolia pulmonar(EP)aumenta com a idade, porém pouco se conhece a respeito dos fatores associados ao óbito no idoso.Objetivo: Identificar as características clínicas e os fatores que se associam com a mortalidade por EP confirmada, internados, entre Março de 2000 a Maio de 2004. A associação com a mortalidade foi analisada pelo teste exato de Fisher e pelo teste t, considerando-se 5 por cento como nível de significância estatística.Resultados: A média de idade foi de 80 anos(máximo 98 anos, mínimo 65 anos) e do Escore APACHE 13, seno 72 por cento do sexo feminino. O seguimento foi de 6 meses. A mortalidade diretamente relacionada à EP foi de 21 por cento. Os demais óbitos foram por choque séptico ou diátese hemorrágica. Houve associação significtiva com mortalidade por EP com: neoplasia (p igual 0,024), acidente vascular encefálico(p igual 0,024), pressão sistólica inferior a 100mmhg(p igual 0,005), e com o intervalo entre o início dos sintomas e a internação(p igual 0,0001).Conclusão: Conclui-se que na EP, fatores associados como a neoplasia, acidente vascular encefálico, hipotensão e intervalo entre o início dos sintomas e a internação correlacionaram-se com a mortalidade

Estudo da mortalidade materna no municipio de Sao Paulo durante o ano de 1998 / Sao Paulo city maternal mortality in 1998

Objetivos: determinar quais as doencas que ocasionaram morte materna por ordem de frequencia, estabelecer as razoes de mortalidade materna para...

Trombofilia / Thrombophilia

La trombofilia es un desorden o trastorno congénito o adquirido del sistema homeostático que predispone a la coagulación intravascular y que debe buscarse en todo paciente joven con o sin factores de riesgo que hace una trombosis venosa profunda. La causa más frecuente de trombofilia congénita es la resistencia a la Proteína C y de trombofilia adquirida es la presencia de anticuerpos antifosfolípidos

Insuficiência renal aguda por acidentes com lagartas / Acute kidney failure by accidents with female lizards

A insuficiência renal aguda (IRA), como complicaçäo de diálise hemorrágica generalizada, por contato com lagartas do gênero (Lonomia (Lepidoptera, Saturniidae), é evento rato. Entretanto, atenderam-se dois pacientes, que, na mesma época e em localidades diferentes, após contato com lagartas, desenvolveram diátese hemorrágica e IRA. A identificaçäo da lagarta, sua toxina, os efeitos desta sobre o sistema de coagulaçäo, bem como a IRA, necessitam de estudos mais completos para melhor entendimento de sua patologia

Bleeding manifestations in megaloblastic anemia.

Ten children with megaloblastic anemia and a hemorrhagic diathesis are reported. Four of them had life-threatening bleeds necessitating an emergency blood transfusion. Seven had platelet counts of less than 30,000/cu mm, and nine had hemoglobin values of less than or equal to 5.2 g/dl at initial presentation. Deficiency of vitamin B12 was more frequently encountered. Response to therapy was excellent and hemostasis was possible within 12 to 24 hours of initiating treatment.