ABSTRACT
BACKGROUND: This study evaluated the association of the ankle-brachial index (ABI) and cardiovascular complications after noncardiac surgery. METHODS: We prospectively evaluated patients referred for noncardiac surgery. The ABI was performed before surgery. Patients with abnormal ABI (≤ 0.9) were included in the peripheral artery disease (PAD) group and the remaining constituted the control group. Cardiac troponin and electrocardiogram were obtained 72 hours after surgery. Patients were followed up to 30 days, and primary end point was the occurrence of any cardiovascular event: cardiovascular death, acute coronary syndrome, isolated troponin elevation (ITE), decompensated heart failure, cardiogenic shock, unstable arrhythmias, nonfatal cardiac arrest, pulmonary edema, stroke, or PAD symptoms increase. RESULTS: We evaluated 124 patients (61.3% male; mean age 65.4 years). During the study, 57.9% of patients in the PAD group had an event versus 25.7% in the control group (P = .011). The ITE was the most observed event (24.2%). After logistic regression, the odds ratio for ITE was 7.4 (95% confidence interval 2.2-25.0, P = .001). CONCLUSIONS: In patients submitted to noncardiac surgery, abnormal ABI is associated with a higher occurrence of a cardiovascular event.
Subject(s)
Ankle Brachial Index , Cardiovascular Diseases/etiology , Peripheral Arterial Disease/diagnosis , Surgical Procedures, Operative/adverse effects , Aged , Biomarkers/blood , Cardiovascular Diseases/blood , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/mortality , Electrocardiography , Female , Humans , Longitudinal Studies , Male , Middle Aged , Peripheral Arterial Disease/complications , Peripheral Arterial Disease/physiopathology , Predictive Value of Tests , Prospective Studies , Risk Assessment , Risk Factors , Surgical Procedures, Operative/mortality , Time Factors , Treatment Outcome , Troponin/blood , Up-RegulationABSTRACT
BACKGROUND: Ankle-brachial index (ABI) is an excellent method for the diagnosis of peripheral arterial disease (PAD) when it is performed with Doppler. However, this device is not always available for primary care physicians. The ABI measured with stethoscope is an easy alternative approach, but have not been proved to be useful. OBJECTIVE: To assess the accuracy of the ABI measured using a stethoscope comparatively to that of the current eligible method for the diagnosis of PAD, the Doppler ABI, and describe the characteristics of this new approach. METHODS: We conducted a diagnostic study of ABI measured with a stethoscope and a Doppler probe and compared the results. Eighty-eight patients were accessed by both methods. RESULTS: Mean stethoscope ABI, 1.01 +/- 0.15, and mean Doppler ABI, 1.03 +/- 0.20, (P = 0.047) displayed a good correlation. Measurements of stethoscope ABI diagnostic accuracy in recognizing a Doppler ABI are described. The comparison of this data with the current gold standard method results gave a sensitivity of 71.4% [95% confidence interval (CI), 41.9-91.6] and specificity of 91.0% (95% CI, 81.5-96.6), with predictive positive value of 62.5% (95% CI, 38.6-81.5) and negative predictive value of 93.8% (95% CI, 85.2-97.6). The study accuracy was 87.7%. The area under the ROC curve was 0.895 (95% CI, 0.804-0.986, P < 0.0001). CONCLUSIONS: According to our study, the stethoscope ABI is a useful method to detect PAD and it may be suitable for its screening in the primary care setting.
Subject(s)
Ankle Brachial Index , Stethoscopes , Aged , Female , Humans , Male , Peripheral Vascular Diseases/diagnosis , Pilot Projects , Ultrasonography, DopplerABSTRACT
Relatamos caso de fasciíte nodular da mama em mulher de 49 anos, que simulava quadro de doença mamária maligna dos pontos de vista clínico, radiológico e citológico. Os autores ressaltam que o diagnóstico diferencial, embora raro, deve ser lembrado, e apresentam revisäo de literatura
Subject(s)
Humans , Female , Middle Aged , Breast Diseases/diagnosis , Breast Diseases/pathology , Breast Diseases , Fasciitis , Fasciitis/diagnosis , Fasciitis/pathology , Diagnosis, Differential , MammographyABSTRACT
Relata-se caso de carcinoma apócrino de mama, em paciente do sexo femino, de 39 anos, que se submeteu a quadrantectomia com linfadenectomia axilar, radioterapia e quimioterapia. Após 24 meses de seguimento näo apresentou recidivas. O carcinoma apocrino é um tipo histológico raro de neoplasia mamária composto de células volumosas com citoplasma eosinofílico
Subject(s)
Adult , Female , Apocrine Glands , Breast Neoplasms/diagnosisABSTRACT
Os autores descrevem um caso incomum de metástase de adenocarcinoma renal, localizado na regiäo petrosa e occiptal da base do crânio, onde o diagnóstico diferencial com tumor do glomus da jugular só foi posível após estudo histológico. Tumores metastáticos chegam comumente ao osso temporal por via hematogênica. Salientam também a dificuldade do diagnóstico pré-operatório. Em geral, o diagnóstico da metástase do osso temporal é baseado na suspeita clínica, confirmada pelos exames por imagem.
Subject(s)
Humans , Male , Middle Aged , Glomus Jugulare Tumor/secondary , Kidney Neoplasms/pathology , Skull Neoplasms/secondary , Diagnosis, Differential , Glomus Jugulare Tumor/diagnosis , Immunohistochemistry , Skull Neoplasms/diagnosisABSTRACT
Os autores apresentam caso de meningoencefalite por herpes simples em paciente portador de leucemia linfóide aguda em remissäo, após quimioterapia. O diagnóstico foi feito pela necrópsia, através da identificaçäo de corpúsculos intranucleares tipo Cowdry A e confirmado pelo método da imunoperoxidase (PAP) anti-herpes simples-sp
Subject(s)
Humans , Male , Child , Leukemia, Lymphoid/radiotherapy , Cerebrum/pathology , Herpes Simplex/complications , Meningoencephalitis/etiologyABSTRACT
Os autores estudam os aspectos anatomopatológicos de sete casos de granuloma maligno mediofacial e concluem que a presença de células atípicas é fundamental para o diagnóstico, sendo a vasculite e os demais elementos secundários. Finalizam acentuando acreditarem ser o granuloma maligno mediofacial a localizaçäo anatômica inicial especial de um linfoma maligno
