Innovative Guide Extension Catheter Trapping Technique to Retrieve a Lost Stent From a Coronary Artery.

A stent that was being implanted in the left circumflex artery, to treat an iatrogenic dissection, became dislodged at the ostial left circumflex artery on a previously deployed stent implanted for the treatment of a distal left main bifurcation stenosis. We describe here a novel technique to retrieve the device safely. (Level of Difficulty: Advanced.).

Questionnaire to avoid transfers to healthcare: a Brazilian experience.

Purpose The purpose of this paper is to test whether training correctional facility (CF) officers in the admission process would identify risk factors for inmates' unscheduled transfers to healthcare units in the first 24 hours. Design/methodology/approach Correctional officers (COs) were trained to use a questionnaire with ten closed questions, which seeks to identify occupational or nosocomial risk, applied upon the admission of inmates to a CF. Findings There were 1,288 admissions in six CFs in Ribeirão Preto and Serra Azul/Brazil from March 2010 to May 2011. Of those admissions, 21.2 percent were in penitentiaries and 78.9 percent in provisional detention centers. Of the questionnaires applied, 580 answered affirmatively (45 percent) for one or more of the questions, with nearly 60 percent related to drug use in the last 12 hours, 37.7 percent use of medications while the most frequently mentioned diseases were respiratory diseases (37 percent) and mental disorders (19 percent).The number of positive responses per evaluation presented an odds ratio of 3.6 (CI 95% - 1.6, 10.5) for unscheduled transfers for external clinical evaluation. Research limitations/implications The lack of a control group and the fact that morbidities described by prisoners could not be confirmed are study limitations. The research does, however, still contribute to the goal of achieving appropriate medical care within CFs. Originality/value The training of COs to identify risk factors that predict the need for unplanned transfers to healthcare units was feasible. These findings have important implications for CFs that do not provide ongoing medical service, a universal reality in Brazil.

Cardiac resynchronization therapy: Femoral approach.

We describe the case of a 62-year-old female patient with bilateral subclavian vein occlusion, in whom a cardiac resynchronization system was implanted via a femoral vein.

The need to improve health care in prisons.

OBJECTIVE: To analyze physical structure, working conditions of health professionals and outline of the procedures established in prisons. METHODS: We analyzed 34 provisional detention centers and 69 male and six female prison units in the state of Sao Paulo, Southeastern Brazil, in 2009. A self-applied instrument was developed to collect quantitative data on the characteristics of health care structure, equipment and personnel in prisons. Analysis of variance (ANOVA) or equivalent non-parametric tests and Chi-square or Fisher's tests were used to compare categorical and continuous variables, respectively, between the groups. RESULTS: The main problems were delays in the results of laboratory tests and imaging. With respect to the teams, it was observed that a large majority were in conditions close to those proposed by the Bipartite Commission 2013 but without improvement being reflected in the indicators. With respect to the process, more than 60.0% of prisons located in small towns do not have the structural conditions to ensure secondary or tertiary health care for the continuity of treatment. CONCLUSIONS: This profile of prisons in the country can be used for planning and monitoring future actions for the continuous improvement of healthcare processes.

Necessidade de aprimoramento do atendimento à saúde no sistema carcerário / The need to improve health care in prisons

OBJETIVO Analisar a estrutura física, as condições de trabalho dos profissionais da saúde e o delineamento de processos estabelecidos em unidades prisionais. MÉTODOS Foram analisados 34 centros de detenção provisória e 69 unidades prisionais masculinas e seis femininas do Estado de São Paulo, Brasil, em 2009. Foi desenvolvido instrumento autoaplicativo para coleta de dados quantitativos sobre as características de estrutura, equipamento e pessoal para atendimento à saúde nas unidades prisionais. A análise de variância (ANOVA) ou equivalente não paramétrico e os testes de Qui-quadrado ou Fisher foram utilizados para comparação de variáveis contínuas ou categóricas, respectivamente, entre os grupos estudados. RESULTADOS Os principais problemas foram o retardo nos resultados de exames laboratoriais e de imagem. Quanto às equipes, grande maioria apresentou condições próximas da proposta pela Comissão InterGestores Bipartite 2013, mas sem que isso se refletisse em melhoria dos indicadores. Com relação ao processo, observou-se que mais de 60,0% das unidades prisionais estão localizadas em cidades pequenas, sem condições estruturais de saúde para garantir o atendimento secundário ou terciário para continuidade do processo de tratamento. CONCLUSÕES O perfil apresentado das unidades prisionais do País poderá ser utilizado para planejamento e acompanhamento de ações futuras para melhoria contínua das condições estruturais de saúde. .

OBJECTIVE To analyze physical structure, working conditions of health professionals and outline of the procedures established in prisons. METHODS We analyzed 34 provisional detention centers and 69 male and six female prison units in the state of Sao Paulo, Southeastern Brazil, in 2009. A self-applied instrument was developed to collect quantitative data on the characteristics of health care structure, equipment and personnel in prisons. Analysis of variance (ANOVA) or equivalent non-parametric tests and Chi-square or Fisher’s tests were used to compare categorical and continuous variables, respectively, between the groups. RESULTS The main problems were delays in the results of laboratory tests and imaging. With respect to the teams, it was observed that a large majority were in conditions close to those proposed by the Bipartite Commission 2013 but without improvement being reflected in the indicators. With respect to the process, more than 60.0% of prisons located in small towns do not have the structural conditions to ensure secondary or tertiary health care for the continuity of treatment. CONCLUSIONS This profile of prisons in the country can be used for planning and monitoring future actions for the continuous improvement of healthcare processes. .

Acute severe mitral regurgitation as an early complication of pacemaker implantation.

A 70-year-old man developed drug refractory acute pulmonary oedema secondary to acute severe mitral regurgitation (MR) immediately after implantation of a dual-chamber pacemaker for complete heart block. Clinical improvement occurred after allowing the patient to resume his native rhythm. A new lead was positioned within the right ventricular outflow tract (RVOT). The echocardiogram during pacing at RVOT showed minimal MR.

Neumomediastino Espontáneo: reporte de un caso y revisión de la literatura / Spontaneous pneumomediastinum: report of a case and literature review

El neumomediastino espontáneo es un trastorno infrecuente que, por lo general, ocurre en personas jóvenes sin un factor o una enfermedad evidente precipitante. El término espontáneo se refiere a la ausencia de trauma u otros procesos patológicos identificables que expliquen el origen del neumomediastino. Se presenta el caso de un paciente masculino de 29 años de edad, ingresado en el Hospital Escuela, quien luego de presentar crisis convulsivas secundarias a síndrome de abstinencia inicia con dolor torácico,disnea y crepitación subcutánea; la radiografía de tórax reveló enfisema subcutáneo y aire libre en la cavidad torácica, se realizó varios exámenes entre ellos una TAC de tórax que confirmó el hallazgo. Se concluyó que presentó neumomediastino espontáneo. La evolución fue satisfactoria.

Tratamiento de pacientes con extrasístoles ventriculares / Treatment of ventricular patients with extrasystoles

Las contracciones ventriculares prematuras son frecuentemente identificadas en la práctica clínica, generalmente son asintomáticas y los pacientes asisten a consulta por otra causa; se encuentran incidentalmete al realizar el examen físico. En la mayoría de veces no con llevan ningún significado clínico y los pacientes nunca presentan síntomas, pero en algunos, sobre todo en aquellos con enfermedad cardiaca de base, estas pueden llegar a ser sintomáticas o ser el desencadenante de una arritmia que ponga en peligro la vida del paciente. Además, se debe tener en consideración el número de extrasístoles ventriculares que ocurren en un minuto, ya que a mayor número (mayor de 7), es mayor el riesgo de desarrollar una arritmia que puede comprometer la vida del paciente. Pueden ser identificadas al realizar un electrocardiograma de 12 derivaciones y en los pacientes que existe la sospecha y no se identifican en este, se puede realizar un Holter de 24 - 48 horas en donde se detectan en un 40 – 75. Debido a la frecuencia con que los pacientes presentan este tipo de alteraciones, que en su mayoría son benignas, es importante que los médicos en atención primaria sean capaces de reconocerlas y en los casos pertinentes referirlos para recibir el tratamiento adecuado, sobre todo en los pacientes con enfermedad cardiaca de base...

Tratamiento de la insuficiencia cardiaca en etapa terminal / Treatment of Heart Failure in terminal stage

La insuficiencia cardiaca es un gran problema de salud pública, con una población de pacientes de por lo menos 10 millones en Europa y aproximadamente 5 millones en Norte América. (1-3) Debido a su aumento en incidencia y prevalencia relacionado a la edad, la insuficiencia cardiaca es una de las causas principales de muerte y hospitalización entre los ancianos.Como consecuencia del aumento en la expectativa de vida en todo el mundo y debido a las mejorías en el tratamiento de la insuficiencia cardiaca en los últimos años, la proporción de pacientes que alcanzan una fase avanzada de la enfermedad, la llamada etapa final, refractaria o insuficiencia cardiaca terminal está creciendo en forma constante. Los pacientes con insuficiencia cardiaca en etapa final caen en la etapa D de la clasificación ABCD del American College of Cardiology(ACC) American Heart Association (AHA), y la clase III-IV de la clasificación funcional de la NewYork Heart Association (NYHA); se caracterizan por enfermedad cardiaca estructural avanzada y síntomas pronunciados de insuficiencia cardiaca al reposo o con un mínimo de esfuerzo físico, a pesar de tratamiento médico máximo de acuerdo a los actuales lineamientos.1-3 Esta población de pacientes tiene un porcentaje de mortalidad en un año de aproximadamente 50% y requiere intervenciones terapéuticas especiales.4 Se debe hacer todo lo posible para identificar y corregirlas causas reversibles de una insuficiencia cardiaca que empeora; tales como: 1) abandono del tratamiento,2) La isquemia miocárdica, 3) Taqui o bradiarritmias,4) regurgitación valvular, 5) embolismo pulmonar, 5) infección o disfunción renal. En este artículo, describimos las actuales estrategias para el tratamiento de la insuficiencia cardiaca en etapa final.