Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 13 de 13
Filtrar
1.
Oral Maxillofac Surg ; 25(3): 411-415, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33151408

RESUMO

BACKGROUND: Septic arthritis of the temporomandibular joint (TMJ) is rare. It usually causes isolated, locoregional symptoms related to the infected intra-articular space but may also cause fever and malaise. CASE REPORT: We present a case of a 72-year-old male with septic arthritis of the TMJ complicated by extensive peri-articular necrosis, septic shock, cerebral abscess, Lemierre's syndrome, and a pathological fracture of the mandibular condyle. CONCLUSION: Case reports describing such a severe course of the disease are few. Moreover, this is the first report of septic arthritis of the TMJ to cause Lemierre's syndrome.


Assuntos
Artrite Infecciosa , Síndrome de Lemierre , Idoso , Artrite Infecciosa/diagnóstico , Humanos , Síndrome de Lemierre/diagnóstico por imagem , Masculino , Necrose , Articulação Temporomandibular/diagnóstico por imagem
2.
Scand Cardiovasc J ; 53(5): 226-234, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31290699

RESUMO

Objective. We aimed to summarize the evidence from observational studies examining the risk factors of the incidence of mediastinitis in open heart surgery. Design. The study was a systematic review and meta-analysis of cohorts and case-control studies. Material and methods. We searched the literature and 74 studies with at least one risk factor were identified. Both fixed and random effects models were used. Heterogeneity between studies was examined by subgroup and meta-regression analysis. Publication bias or small study effects were evaluated and corrected by limit meta-analysis. Results. When correcting for small study effect, presence of obesity as estimated from 43 studies had Odds Ratio OR = 2.26. (95% CI: 2.17-2.36). This risk was increasing with decreasing latitude of study place. Presence of diabetes mellitus from 63 studies carried an OR = 1.90 (95% CI: 1.59-2.27). Presence of Chronic Obstructive Pulmonary Disease (COPD) from 30 studies had an OR = 2.59 (95% CI: 2.22-2.85). Presence of bilateral intramammary graft (BIMA) from 23 studies carried an OR = 2.54 (95% CI: 2.07-3.13). This risk was increasing with increasing frequency of female patients in the study population. Conclusion. Evidence from this study showed the robustness of the risk factors in the pathogenesis of mediastinitis. Preventive measures can be implemented for reducing obesity, especially in lower latitude countries. Furthermore, it is mandatory to monitor perioperative hyperglycemias with continuous insulin infusion. Use of skeletonized BIMA carries higher risk of mediastinitis especially in female patients without evidence of beneficial effect on survival for the time being.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Mediastinite/epidemiologia , Comorbidade , Humanos , Incidência , Mediastinite/diagnóstico , Estudos Observacionais como Assunto , Medição de Risco , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento
3.
BMJ Case Rep ; 20172017 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-28487302

RESUMO

Primary chronic cold agglutinin disease (CAD) is an autoimmune haemolytic anaemia in which a specific bone marrow lymphoproliferative disorder causes production of cold agglutinins (CA). Binding of CA to erythrocyte surface antigens results in a predominantly extravascular haemolysis that is entirely complement dependent. Because of complement activation, exacerbations are common during febrile infections, trauma or major surgery. Involvement of the terminal complement pathway with C5-mediated intravascular haemolysis is probably not prominent in stable disease but is supposed to be of importance in exacerbations following acute phase reaction.We report on a patient with CAD prone to exacerbation of haemolysis during acute phase reactions who was scheduled for cardiac surgery. To prevent her having an exacerbation of haemolysis, we chose to treat her prophylactically with eculizumab along with the usual perioperative precautions. Aortic valve replacement was undertaken with full cardiopulmonary bypass at normothermia. The procedure was successful; no exacerbation of haemolysis was observed, and transfusion requirements did not exceed what could be expected.


Assuntos
Anemia Hemolítica Autoimune/tratamento farmacológico , Anticorpos Monoclonais Humanizados/uso terapêutico , Valva Aórtica , Anuloplastia da Valva Cardíaca , Idoso , Anemia Hemolítica Autoimune/sangue , Anticorpos Monoclonais Humanizados/administração & dosagem , Feminino , Humanos , Cuidados Pré-Operatórios
4.
J Cardiothorac Surg ; 8: 142, 2013 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-23724788

RESUMO

BACKGROUND: Advances in the understanding of mitral valve pathology have laid to mitral valve plasty (MPL) as the procedure of choice of all the mitral intervention as compared to mitral valve replacement (MVR). MATERIAL AND METHODS: A cohort of 355 patients with mitral valve disease operated between January 1993 to January 2007 with closing date first of mars 2011. There were 214 MPL and 141 MVR at the Hospital discharge. This retrospective cohort had the design of exposed (MPL) versus non-exposed (MVR) with outcome total mortality and reoperation during follow up. Also echocardiography follow-up was undertaken to estimate the true long-term failure rate of repair. RESULTS: The mean follow up was 5.3 years SE (3.82) maximum follow up was 14.1 years. Considering the patient time model the association between repair/replacement and total mortality RR = 0.43 95% (0.28-074) p = 0.002 controlling for the confounding effect of 3-vessels disease. Those results were confirmed by propensity score analysis. CONCLUSION: In a cohort of patient with mitral valve disease undergoing MPL/MVR was examined. MPL was associated with better survival, and lower reoperation rate for patients without AF but same rate for patients with AF. We advocate more attention in controlling risk factors of AF in the clinical management of mitral disease. Long-term failure rate of MPL was low during follow up time. A replication of our results by a randomized clinical trial is mandatory.


Assuntos
Fibrilação Atrial/complicações , Valvuloplastia com Balão/métodos , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas , Valva Mitral/cirurgia , Idoso , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/mortalidade , Ecocardiografia , Feminino , Seguimentos , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento
5.
J Thorac Cardiovasc Surg ; 141(4): 995-1001, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20800244

RESUMO

OBJECTIVES: Histidine-tryptophan-ketoglutarate (HTK-Custodiol) cardioplegic solution is administered as one single dose for more than 2 hours of ischemia. No prospective randomized clinical study has compared the effects of HTK and cold blood cardioplegia on myocardial damage in elective mitral valve surgery. Thus, the main aim of the present study was to examine whether one single dose of cold antegrade HTK gives as good myocardial protection as repetitive antegrade cold blood cardioplegia in mitral valve surgery. METHODS: Eighty consecutive patients undergoing elective isolated mitral valve surgery for mitral regurgitation, with or without ablation for atrial fibrillation, were included in the study and randomized to HTK or blood cardioplegia. Markers of myocardial injury (troponin-T and creatine kinase MB) were analyzed at baseline and 7 hours, 1 day, 2 days, and 3 days after surgery. RESULTS: No significant difference in creatine kinase MB and troponin-T between HTK and blood cardioplegia groups was found at any time point. There was a significant correlation between ischemic time and markers of myocardial injury in the HTK group only and significantly more spontaneous ventricular fibrillation after release of crossclamping in the HTK group. CONCLUSIONS: One single dose of antegrade cold HTK cardioplegic solution in elective mitral valve surgery protects the myocardium equally well as repetitive antegrade cold blood cardioplegia.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Soluções Cardioplégicas/administração & dosagem , Parada Cardíaca Induzida , Hipotermia Induzida , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Infarto do Miocárdio/prevenção & controle , Biomarcadores/sangue , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Distribuição de Qui-Quadrado , Creatina Quinase Forma MB/sangue , Procedimentos Cirúrgicos Eletivos , Feminino , Glucose/administração & dosagem , Humanos , Modelos Lineares , Masculino , Manitol/administração & dosagem , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/etiologia , Noruega , Cloreto de Potássio/administração & dosagem , Procaína/administração & dosagem , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Suécia , Fatores de Tempo , Resultado do Tratamento , Troponina T/sangue
6.
Scand Cardiovasc J ; 44(2): 113-8, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19961286

RESUMO

OBJECTIVES: Patients with aortic stenosis (AS) develop left ventricular remodeling characterized by changes in extracellular matrix (ECM) and cardiomyocyte-hypertrophy. Aortic valve replacement (AVR) reverses this process (reverse remodeling). We examined plasma levels of interleukin-18 (IL-18) and its binding protein (IL-18BP) before and after AVR for AS since these mediators have been shown experimentally to exert effects on myocardial remodeling. DESIGN: Plasma levels of IL-18 and IL-18BP were analyzed in 22 patients with AS undergoing AVR, preoperatively, two days, six and 12 months postoperatively. Echocardiography and functional testing were performed. RESULTS: IL-18BP was significantly increased by 28% and 15% at two days and six months after AVR, compared to preoperative values. In contrast, IL-18 showed a later peak (increased by 24% at 12 months postoperatively) when IL-18BP was normalized. IL-18 correlated positively with deceleration time (R = 0.44) at this time-point which might indicate an association with diastolic function. CONCLUSIONS: We report for the first time that plasma IL-18 and IL-18BP are differentially regulated after AVR for AS with an early increase in IL-18BP postoperatively followed by a later peak in IL-18 at 12 months. Given the known effects of these mediators on myocardial remodeling and function, they might play a role in the reverse and remodeling process associated with AVR.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Ventrículos do Coração/fisiopatologia , Peptídeos e Proteínas de Sinalização Intercelular/sangue , Interleucina-18/sangue , Função Ventricular Esquerda , Remodelação Ventricular , Idoso , Estenose da Valva Aórtica/imunologia , Estenose da Valva Aórtica/fisiopatologia , Biomarcadores/sangue , Bioprótese , Estudos de Casos e Controles , Ecocardiografia Doppler em Cores , Teste de Esforço , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Regulação para Cima
7.
J Heart Valve Dis ; 18(3): 345-6, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19557995

RESUMO

The case is reported of a 32-year-old male with an aortic valve injury received in a high-speed traffic accident. Several non-cardiac concomitant injuries were present, none of them life-threatening. Cardiac surgery was performed on day 2 due to a grade III aortic valve insufficiency. The presence of a large tear of the non-coronary cusp, and several concomitant injuries, led to valve replacement being considered the most optimal treatment for this patient.


Assuntos
Acidentes de Trânsito , Valva Aórtica/lesões , Ferimentos não Penetrantes/diagnóstico , Adulto , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Ecocardiografia Transesofagiana , Eletrocardiografia , Humanos , Masculino , Ferimentos não Penetrantes/complicações
8.
J Heart Valve Dis ; 17(5): 586-8, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18980095

RESUMO

The case is reported of a 32-year-old male who sustained an aortic valve injury after a high-speed traffic accident. Several non-cardiac concomitant injuries were present, none of which was life-threatening. Cardiac surgery was performed on day 2 due to a grade III aortic valve insufficiency. As a large tear of the non-coronary cusp was evident, together with several concomitant injuries, valve replacement was considered to be the most optimal treatment in this case.


Assuntos
Acidentes de Trânsito , Insuficiência da Valva Aórtica/diagnóstico , Valva Aórtica/lesões , Traumatismo Múltiplo/diagnóstico , Traumatismos Torácicos/diagnóstico , Ferimentos não Penetrantes/diagnóstico , Adulto , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/patologia , Insuficiência da Valva Aórtica/cirurgia , Ecocardiografia Transesofagiana , Implante de Prótese de Valva Cardíaca , Hemodinâmica/fisiologia , Humanos , Masculino , Traumatismo Múltiplo/cirurgia , Ruptura , Traumatismos Torácicos/patologia , Traumatismos Torácicos/cirurgia , Ferimentos não Penetrantes/patologia , Ferimentos não Penetrantes/cirurgia
9.
Eur J Heart Fail ; 10(12): 1201-7, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18996047

RESUMO

BACKGROUND: Patients with aortic stenosis (AS) develop left ventricular remodelling with cardiomyocyte hypertrophy and increased fibrosis. Following aortic valve replacement (AVR) reverse remodelling usually takes place. AIMS: To examine circulating levels of members of the transforming growth factor (TGF) beta superfamily and matrix metalloproteinases (MMP), known to have important effects on hypertrophy and extracellular matrix, in patients operated for AS. METHODS: Circulating levels of activin A, GDF-15, TGF-beta3, MMP-2, -3, and -9 were measured in twenty-two patients undergoing AVR preoperatively, and 2 days, six months and 12 months postoperatively. Echocardiography and a six minute walking test evaluated reverse remodelling and physical performance. RESULTS: Activin A increased at six (1081.00+/-98.05 pg/ml, p<0.05) and twelve months (1263.09+/-141.43 pg/ml, p<0.05) compared to the preoperative value (855.00+/-76.30 pg/ml) and correlated negatively to physical performance. The preoperative value was also increased compared to controls (639.54+/-63.05 pg/ml, p<0.05). GDF-15, MMP-3 and -9 were all increased at two days postoperatively (p<0.05). MMP-3 correlated with left ventricular end diastolic dimension (p<0.05). MMP-2 did not change during the study period. TGF-beta3 was only slightly reduced at six months postoperatively. CONCLUSION: The observed alteration in circulating levels of members of the TGF-beta superfamily and MMPs might play a role in the reverse remodelling process following AVR for AS.


Assuntos
Ativinas/sangue , Estenose da Valva Aórtica/fisiopatologia , Fator 15 de Diferenciação de Crescimento/sangue , Hipertrofia Ventricular Esquerda/fisiopatologia , Metaloproteinase 2 da Matriz/sangue , Metaloproteinase 3 da Matriz/sangue , Metaloproteinase 9 da Matriz/sangue , Fator de Crescimento Transformador beta3/sangue , Idoso , Estenose da Valva Aórtica/sangue , Estenose da Valva Aórtica/cirurgia , Biomarcadores/sangue , Feminino , Fibrose/fisiopatologia , Próteses Valvulares Cardíacas , Humanos , Hipertrofia Ventricular Esquerda/sangue , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Masculino , Estudos Prospectivos , Fatores de Risco , Ultrassonografia
10.
Scand Cardiovasc J ; 40(6): 368-73, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17118828

RESUMO

OBJECTIVES: Topical cooling of the heart with ice-slush has been widely used for myocardial protection. No prospective, randomized study has evaluated the effect of ice-slush on acknowledged markers (CK-MB, troponin-T) of myocardial damage during aortic valve replacement (AVR). This was the first aim of the present study. A second aim was to examine whether performing a study per se reduced myocardial damage. DESIGN: Sixty patients undergoing AVR were receiving cold crystalloid antegrade cardioplegia every 20 min. Thirty patients were randomized to achieve additional topical cooling with ice-slush. CK-MB and troponin-T were compared between groups as well as to a group of patients undergoing AVR immediately prior to the study. RESULTS: There were no significant differences in myocardial markers between patients with or without ice-slush. However, we found significantly higher levels of troponin-T and CK-MB in patients undergoing AVR prior to start of the study. CONCLUSIONS: Topical cooling with ice-slush does not provide additional cardioprotective effects. Comparison with an historical cohort indicates that administration of crystalloid cardioplegia following a rigid protocol might reduce myocardial damage.


Assuntos
Estenose da Valva Aórtica/cirurgia , Parada Cardíaca Induzida/métodos , Implante de Prótese de Valva Cardíaca , Hipotermia Induzida/métodos , Gelo , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Idoso , Soluções Cardioplégicas , Creatina Quinase Forma MB/sangue , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo por Reperfusão Miocárdica/sangue , Traumatismo por Reperfusão Miocárdica/etiologia , Período Pós-Operatório , Compostos de Potássio , Estudos Prospectivos , Fatores de Tempo , Troponina T/sangue
11.
J Card Surg ; 21(3): 301-3, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16684069

RESUMO

Acute spontaneous coronary artery rupture is rare and the diagnosis might be missed due to high risk of mors subita. We present three patients hospitalized with signs of cardiac tamponade due to acute spontaneous coronary artery rupture. All the three were successfully operated with evacuation of the pericardial hematoma, identification of the bleeding site, and hemostasis. The patients were examined with coronary angiography and computer tomography, and no underlying cause of the rupture was detected. In patients presenting with cardiac tamponade, acute spontaneous coronary artery rupture is a possible diagnosis.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Tamponamento Cardíaco/etiologia , Doença das Coronárias/complicações , Hemostasia Cirúrgica/métodos , Idoso , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/cirurgia , Angiografia Coronária , Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/cirurgia , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ruptura Espontânea , Tomografia Computadorizada por Raios X
12.
Eur J Heart Fail ; 8(3): 257-62, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16466963

RESUMO

BACKGROUND: B-type natriuretic peptide (BNP) is synthesized in cardiac tissue in response to increased wall stress and myocardial hypertrophy. AIMS: In patients with severe aortic stenosis (AS) we examined the effect of aortic valve replacement (AVR) on plasma BNP and association between BNP and left ventricular mass index (LVMI) preoperatively and in the reverse-remodeling phase twelve months postoperatively. We also examined the correlation between BNP and NYHA-class and between BNP and age. METHODS AND RESULTS: Plasma BNP analyses and echocardiographic measurements were performed preoperatively, before discharge after AVR, and at twelve months in twenty-two patients. BNP was additionally measured at six months. Preoperatively, BNP was 283+/-45 pg/ml (mean+/-SEM). Following an immediate postoperative increase (441+/-38 pg/ml), BNP values decreased towards normal values at six and twelve months (139+/-25 and 130+/-18 pg/ml, respectively). LVMI was 206.5+/-15.8 g/m(2) preoperatively and decreased to 119.7+/-7.2 g/m(2) at twelve months with a correlation between LVMI and BNP preoperatively only (r=0.45, p<0.05). There was no correlation between BNP and NYHA-class, whereas BNP correlated to age both pre- and post-operatively. CONCLUSION: We report an increase in plasma BNP in patients with AS. Following a further transient increase postoperatively, BNP levels decreased at six and twelve months after AVR. BNP correlated with LVMI preoperatively, and with age both preoperatively and at twelve months.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Peptídeo Natriurético Encefálico/sangue , Idoso , Estenose da Valva Aórtica/sangue , Feminino , Seguimentos , Humanos , Hipertrofia Ventricular Esquerda/sangue , Masculino
13.
Scand J Infect Dis ; 34(9): 660-3, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12374356

RESUMO

The association of Chlamydia pneumoniae with atherosclerosis is still controversial. Reports from different laboratories have varied widely and "gold standards" for the detection of C. pneumoniae are lacking. In the present study, aortic valves and peripheral blood mononuclear cells from 48 patients undergoing aortic valve replacement were examined for the presence of C. pneumoniae using a nested PCR. C. pneumoniae-specific DNA was not detected in any of the clinical samples. No PCR inhibition was observed by spiking the samples with target C. pneumoniae. A total of 31/46 patients (67%) were seropositive for C. pneumoniae IgG. These results do not support the association of C. pneumoniae with aortic valves and peripheral blood mononuclear cells in patients with atherosclerotic aortic heart valve disease.


Assuntos
Valva Aórtica/microbiologia , Chlamydophila pneumoniae/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Chlamydophila pneumoniae/patogenicidade , Técnicas de Laboratório Clínico , DNA Bacteriano/isolamento & purificação , Erros de Diagnóstico , Feminino , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Reação em Cadeia da Polimerase
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...