Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 3 de 3
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
J ECT ; 36(2): 144-146, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32040020

RESUMO

Electroconvulsive therapy (ECT) is a routine treatment for multiple psychiatric disorders including treatment-refractory mood and psychotic disorders. Although ECT is generally a safe and well-tolerated intervention, rare cerebrovascular and cardiovascular complications have been reported. The hemodynamic changes during the ECT seizure are well-recognized, with an initial parasympathetically mediated decrease in heart rate and blood pressure followed by a sympathetically mediated increase in these parameters. Despite intraoperative or postoperative blood pressure fluctuations, the risk of a hypertensive intracerebral bleed during ECT is very low and the risk of ischemic stroke after ECT appears to be even rarer. The authors present a case of a patient who developed an ischemic stroke after ECT treatment. Before stroke, the patient had been undergoing ECT routinely for over 2 years without alarming complications. Ischemic strokes are a rare but serious complication of ECT treatment.


Assuntos
Eletroconvulsoterapia/efeitos adversos , AVC Isquêmico/etiologia , Anestesia , Transtorno Bipolar/terapia , Serviços Médicos de Emergência , Humanos , AVC Isquêmico/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Reabilitação do Acidente Vascular Cerebral , Transtornos Relacionados ao Uso de Substâncias/terapia , Tomografia Computadorizada por Raios X
2.
JAMA ; 312(1): 36-47, 2014 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-25058216

RESUMO

IMPORTANCE: There is limited information about the effect of erythropoietin or a high hemoglobin transfusion threshold after a traumatic brain injury. OBJECTIVE: To compare the effects of erythropoietin and 2 hemoglobin transfusion thresholds (7 and 10 g/dL) on neurological recovery after traumatic brain injury. DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial of 200 patients (erythropoietin, n = 102; placebo, n = 98) with closed head injury who were unable to follow commands and were enrolled within 6 hours of injury at neurosurgical intensive care units in 2 US level I trauma centers between May 2006 and August 2012. The study used a factorial design to test whether erythropoietin would fail to improve favorable outcomes by 20% and whether a hemoglobin transfusion threshold of greater than 10 g/dL would increase favorable outcomes without increasing complications. Erythropoietin or placebo was initially dosed daily for 3 days and then weekly for 2 more weeks (n = 74) and then the 24- and 48-hour doses were stopped for the remainder of the patients (n = 126). There were 99 patients assigned to a hemoglobin transfusion threshold of 7 g/dL and 101 patients assigned to 10 g/dL. INTERVENTIONS: Intravenous erythropoietin (500 IU/kg per dose) or saline. Transfusion threshold maintained with packed red blood cells. MAIN OUTCOMES AND MEASURES: Glasgow Outcome Scale score dichotomized as favorable (good recovery and moderate disability) or unfavorable (severe disability, vegetative, or dead) at 6 months postinjury. RESULTS: There was no interaction between erythropoietin and hemoglobin transfusion threshold. Compared with placebo (favorable outcome rate: 34/89 [38.2%; 95% CI, 28.1% to 49.1%]), both erythropoietin groups were futile (first dosing regimen: 17/35 [48.6%; 95% CI, 31.4% to 66.0%], P = .13; second dosing regimen: 17/57 [29.8%; 95% CI, 18.4% to 43.4%], P < .001). Favorable outcome rates were 37/87 (42.5%) for the hemoglobin transfusion threshold of 7 g/dL and 31/94 (33.0%) for 10 g/dL (95% CI for the difference, -0.06 to 0.25, P = .28). There was a higher incidence of thromboembolic events for the transfusion threshold of 10 g/dL (22/101 [21.8%] vs 8/99 [8.1%] for the threshold of 7 g/dL, odds ratio, 0.32 [95% CI, 0.12 to 0.79], P = .009). CONCLUSIONS AND RELEVANCE: In patients with closed head injury, neither the administration of erythropoietin nor maintaining hemoglobin concentration of greater than 10 g/dL resulted in improved neurological outcome at 6 months. The transfusion threshold of 10 g/dL was associated with a higher incidence of adverse events. These findings do not support either approach in this setting. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00313716.


Assuntos
Anemia/terapia , Lesões Encefálicas/complicações , Transfusão de Eritrócitos/efeitos adversos , Eritropoetina/administração & dosagem , Hemoglobinas/análise , Adulto , Anemia/complicações , Anemia/etiologia , Lesões Encefálicas/terapia , Transfusão de Eritrócitos/métodos , Feminino , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Estado Vegetativo Persistente , Valores de Referência , Índice de Gravidade de Doença , Tromboembolia/induzido quimicamente , Resultado do Tratamento , Adulto Jovem
3.
J Trauma ; 69(5): 1176-81; discussion 1181, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21068620

RESUMO

BACKGROUND: To assess the depressant effects of alcohol on the level of consciousness of patients admitted with head injuries, this study examined the changes that occur in the Glasgow Coma Scale (GCS) of traumatic brain injury patients over time. METHODS: The records of 269 head trauma patients consecutively admitted to the neurosurgery intensive care unit were examined retrospectively. Eighty-one patients were excluded because of incomplete data. The remaining 188 patients were further divided into an intoxicated group (blood alcohol concentration [BAC] ≥ 0.08%, n = 100 [53%]) and a nonintoxicated group (BAC <0.08%, n = 88 [47%]). The GCS in the prehospital setting, in the emergency department, and the highest GCS achieved during the first 24 hours postinjury were compared. RESULTS: The change between emergency department-GCS and the best day 1 GCS in the intoxicated group was greater than the nonintoxicated group and deemed clinically and statistically significant; median change (3 vs. 0) p < 0.001. To assess whether these results were directly related to the BAC%, piecewise regression using a general linear model was used to assess the intercept and slope of alcohol on the changes of GCS with cutting point at BAC% = 0.08. The analysis showed that, in the nonintoxicated range, the effect of alcohol was not significantly related to the changes of GCS. But in the intoxicated range, BAC% was significantly positively related to the changes of GCS. CONCLUSION: This study concludes that the GCS increases significantly over time in alcohol intoxicated patients with traumatic brain injury.


Assuntos
Intoxicação Alcoólica/fisiopatologia , Estado de Consciência/fisiologia , Traumatismos Craniocerebrais/diagnóstico , Escala de Coma de Glasgow/tendências , Adulto , Intoxicação Alcoólica/complicações , Intoxicação Alcoólica/diagnóstico , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Centros de Traumatologia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...