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1.
Interact Cardiovasc Thorac Surg ; 25(5): 765-771, 2017 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-29049525

RESUMO

OBJECTIVES: This study prospectively evaluates the impact of the Haga Braincare Strategy (HBS) on the occurrence of haemodynamic and embolic stroke in a cohort of patients who underwent coronay artery bypass grafting (CABG), valve replacement of a combination of both types of surgery between 2012 and 2015 at the Haga Teaching Hospitals. METHODS: The HBS is a dual strategy based on a preoperative vascular work-up of the cerebral circulation by transcranial Doppler and a perioperative monitoring of the cerebral circulation by cerebral oximetry. Duplex of the carotid arteries and/or computed tomography angiography prior to surgery was performed in high-risk patients. Patients with severe carotid artery stenosis were scheduled for carotid angioplasty prior to surgery or waived from surgery. RESULTS: A total of 1065 patients were included. Poor cerebral haemodynamics were identified by transcranial Doppler in 2.1% of patients (n = 22). Based on the HBS, 3 patients were waived from surgery, 4 received preoperative carotid angioplasty followed by cardiac surgery and the remaining patients were operated while being monitored with bilateral cerebral oximetry sensors. In all, 2.2% of the study group experienced a stroke (n = 23), of which none were classified as haemodynamic. Most of the remaining presumed embolic strokes showed a minor to moderate stroke severity. CONCLUSIONS: In this single-centre prospective follow-up study, surveillance of cerebral perfusion by the HBS eliminated the occurrence of haemodynamic stroke while most of the residual strokes had a good to favourable prognosis.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Circulação Cerebrovascular , Embolia Intracraniana/diagnóstico , Oximetria/métodos , Idoso , Angiografia por Tomografia Computadorizada , Feminino , Seguimentos , Humanos , Incidência , Embolia Intracraniana/epidemiologia , Embolia Intracraniana/etiologia , Imageamento por Ressonância Magnética , Masculino , Países Baixos/epidemiologia , Estudos Prospectivos , Índice de Gravidade de Doença , Ultrassonografia Doppler Transcraniana
2.
Eur Radiol ; 13(3): 527-30, 2003 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-12594555

RESUMO

Our objective was to evaluate the safety and diagnostic efficacy of the ultrasound-guided renal biopsy procedure using an automated biopsy device (Biopty gun) with a 14-gauge needle. Five hundred fifteen consecutive ultrasound-guided renal biopsies performed in two large university hospitals were retrospectively reviewed. Three hundred forty-five biopsies were performed on renal allografts and 170 on native kidneys. The tissue specimen was adequate for histological evaluation in 95.3% of the cases (94.8% in the transplanted kidney group, 96.5% in the native kidney group). The overall complication rate was 12.2% and was significantly higher in the native kidney group (19.4%) than in the renal allograft group (8.7%). Major complications occurred in 2.7% of the cases (2.9% of the renal allografts and 2.4% of the native kidney biopsies), including one procedure-related death and the loss of the renal allograft in two other patients. Minor complications were noted in 9.5% of the biopsies and there were significantly more in the group of the native kidneys (17.1%) than in the group of the transplanted kidneys (5.8%). Renal biopsy with an automated device using a 14-gauge needle has a high tissue recovery rate, but it is associated with a small risk of serious complications.


Assuntos
Biópsia por Agulha/efeitos adversos , Hematoma/etiologia , Hematúria/etiologia , Nefropatias/patologia , Transplante de Rim/patologia , Biópsia por Agulha/instrumentação , Estudos de Coortes , Feminino , Hematoma/epidemiologia , Hematúria/epidemiologia , Humanos , Incidência , Nefropatias/diagnóstico por imagem , Nefropatias/mortalidade , Transplante de Rim/diagnóstico por imagem , Transplante de Rim/mortalidade , Masculino , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Transplante Homólogo/patologia , Ultrassonografia
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