ABSTRACT
It is well known that, subsequent to cardiopulmonary bypass, and particularly in children, an inflammatory response within the body can often result in a characteristic syndrome. Recently, it has been suggested that this phenomenon is due to a systemic inflammatory response, with significant involvement of cytokines. With this in mind, we investigated the behavior of tumour necrosis factor-alpha and interleukin-6 during the operative and in the immediate postoperative period in a group of children submitted to open heart surgery. We investigated any possible relation between the levels of these cytokines in the serum and the length of cardiopulmonary bypass, with the serum levels of lactate, and with the extent of use of inotropic drugs in postoperative period. The cytokines were measured in samples withdrawn after induction of anesthesia, after 10 minutes of cardiopulmonary bypass, after re-establishment of circulation, and then 2 and 24 hours after the end of cardiopulmonary bypass. The levels of tumour necrosis factor-alpha and interleukin-6 increased between the beginning and at two hours of the end of cardiopulmonary bypass. There was no correlation between the levels of these cytokines in the serum and the length of cardiopulmonary bypass, although there was a positive relation between levels of interleukin-6 and lactate in samples withdrawn at two hours of the end of bypass, and the measured levels of the cytokines correlated with the extent of inotropic drugs employed in the postoperative period.
Subject(s)
Cardiopulmonary Bypass , Heart Defects, Congenital/immunology , Heart Defects, Congenital/surgery , Interleukin-6/metabolism , Tumor Necrosis Factor-alpha/metabolism , Child , Child, Preschool , Female , Humans , Infant , Intraoperative Period , Male , Postoperative Period , Prospective Studies , Time FactorsABSTRACT
PURPOSE: To study the early and late results of patients treated initially intravenous streptokinase and then with coronary artery bypass surgery. METHODS: One hundred and twenty one patients with acute myocardial infarction less than 6 hours duration were treated initially with intravenous streptokinase, and 1-38 days after (median 8.80 days) coronary artery bypass was undertaken. Ninety six patients were operated with extracorporeal circulation and 25 without it. RESULTS: Overall operative mortality was 3.30% (4/121). Reoperations due to bleeding was necessary in 3.30% (4/121). Late mortality was 5.40% with survival probability of 94.60% after 36 months and 92.30% after 70 months. Late morbidity events in terms of angina and cardiac insufficiency demonstrated that 7 patients had angina, 4 cardiac insufficiency and two angina and cardiac insufficiency; probability to be free from these events was 88.20% after 46 months and 66.40% after 70 months. CONCLUSION: Coronary artery bypass surgery after intravenous streptokinase can be undertaken with security and excellent early and late results.
Subject(s)
Myocardial Infarction/therapy , Myocardial Revascularization , Streptokinase/therapeutic use , Thrombolytic Therapy , Adult , Aged , Female , Follow-Up Studies , Humans , Injections, Intravenous , Male , Middle Aged , Myocardial Infarction/mortalityABSTRACT
Os autores descrevem uma situacao ocorrida em um grupo de estudo da equipe tecnica de um hospital psiquiatrico. Assinalam os dinamismos grupais que surgiram na situacao estudada e mostram a necessidade de identifica-los, compreende-los e maneja-los quando se pretende manter a eficacia do trabalho
Subject(s)
Hospitals, Psychiatric , Patient Care TeamABSTRACT
A equipe de um hospital publico relata suas experiencias no decorrer de sua formacao e a evolucao no seu funcionamento.Ressaltam os avancos e retrocessos ocorridos no periodo de aproximadamente 5 anos
