Assuntos
Ponte de Artéria Coronária , Doença das Coronárias/cirurgia , Obesidade Mórbida/cirurgia , Redução de Peso/fisiologia , Índice de Massa Corporal , Doença das Coronárias/epidemiologia , Doença das Coronárias/fisiopatologia , Humanos , Tempo de Internação , Morbidade , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Resultado do TratamentoRESUMO
OBJECTIVE: Well-defined criteria are needed to provide guidance for the appropriate management of leg wounds following saphenous vein harvest in coronary artery bypass graft surgery (CABG). METHOD: A score named DISINFECT was devised to carefully define the variables to be considered for assessing saphenous vein harvest wounds. RESULTS: This preliminary study included 100 consecutive patients undergoing first-time isolated CABG requiring the saphenous vein as a conduit. Wounds were assessed and the points combined to create a daily score (D) according to the presence of increased C-reactive protein/white blood cells (I), surrounding tissue (S), quality of the incision (I), new skin (N), foreign material (F), exudate (E), positive cultures (C) and temperature (T). CONCLUSION: Taking into account the stages of wound healing, severity of infection and appropriate use of antibiotics, this method of wound management would improve the consistency with which leg wounds are managed, reduce hospital stays and increase resistance to hospital-acquired infection.
Assuntos
Ponte de Artéria Coronária/efeitos adversos , Perna (Membro)/irrigação sanguínea , Avaliação em Enfermagem/métodos , Veia Safena/transplante , Índice de Gravidade de Doença , Infecção da Ferida Cirúrgica , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Exsudatos e Transudatos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação em Enfermagem/normas , Pesquisa em Avaliação de Enfermagem , Registros de Enfermagem/normas , Variações Dependentes do Observador , Valor Preditivo dos Testes , Fatores de Risco , Higiene da Pele/métodos , Higiene da Pele/enfermagem , Supuração , Infecção da Ferida Cirúrgica/classificação , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/terapia , Coleta de Tecidos e Órgãos/efeitos adversos , CicatrizaçãoRESUMO
UNLABELLED: Papillary fibroelastoma is a benign tumour of the cardiac valve apparatus. We present an unusual case of life-threatening pulmonary haemorrhage and disseminated intravascular coagulation in a neonate associated with this benign cardiac tumour. Papillary fibroelastoma of the tricuspid valve rarely presents in children and, to our knowledge, this is only the second reported case in a neonate. The patient was successfully managed by anticoagulation therapy followed by surgical excision of the tumour. This case illustrates the potentially fatal presentation of this benign cardiac tumour among neonates. CONCLUSION: Pulmonary haemorrhage of this degree is unusual in an otherwise healthy term neonate and needs careful investigation for unusual pathology including potential sources of pulmonary emboli in the heart. We emphasize the value of echocardiography in the evaluation of unexpected pulmonary haemorrhage in the newborn.