RESUMEN
BACKGROUND: Monosymptomatic enuresis (MNE) results from a pathogenic triad that may include lack of vasopressin secretion during sleep, reduced functional bladder capacity and inability to wake up during sleep. The treatment of MNE can be performed through behavioral therapy, use of alarms or medications such as desmopressin and imipramine. OBJECTIVE: To compare the effectiveness of different treatments of MNE. STUDY DESIGN: Prospective and randomized study comparing different intervention and a control group (receiving only behavior therapy) for MNE. INCLUSION CRITERIA: age between 5 and 16 years old, with MNE, evaluated at the pediatric urology outpatient clinic of Hospital Infantil Menino Jesus. At first visit children were submitted to behavior therapy (urotherapy) for 3 months, children were subsequently characterized according to the ICCS as non-responders, partial responders, or full responders. Those partial responders or non-responders received a patient ID and were randomized to four groups: Alarm Group (G1), Desmopressin Group - DDAVP (G2), Imipramine Group (G3) and Control (G4). All groups were monitored monthly, for a period of 6 months. After 6 months, the children were reevaluated for MNE. RESULTS: 93 patients were enrolled. Mean age was 10.96 years with a standard deviation of 2.28 years, 59,1% were male. All groups had improvement in the number of dry nights (Table). Taking in account success the population full responders and partial responders: Alarm Group (G1) achieve success in 100% of cases, Desmopressin Group - DDAVP (G2) in 63.6% of cases, Imipramine Group (G3) in 73.7% of cases (Table 3). No drugs side effects were observed in both groups (G2 and G3), there was no dropout in patients who used alarms. DISCUSSION: Our data suggests that the use of alarms is the most effective treatment of ENM with superior results when compared to imipramine and DDAVP. The small number of participants is a weakness of the study, as well as the lack of a voiding diary at the end of the study. CONCLUSION: All therapeutics options utilized in the treatment of MNE are safe, effective and has a low rate of abandonment.
Asunto(s)
Enuresis , Enuresis Nocturna , Niño , Humanos , Masculino , Preescolar , Adolescente , Femenino , Enuresis Nocturna/tratamiento farmacológico , Desamino Arginina Vasopresina/uso terapéutico , Imipramina/uso terapéutico , Estudios Prospectivos , Resultado del TratamientoRESUMEN
To evaluate the efficacy and safety of different bulking agents for treating urinary incontinence in women, a systematic review including only randomized controlled trials was performed. The subjects were women with urinary incontinence. The primary outcomes were clinical and urodynamic parameters. The results were presented as a weighted mean difference for non-continuous variables and as relative risk for continuous variables, both with 95% confidence intervals. Initially, 942 studies were identified. However, only fourteen eligible trials fulfilled the prerequisites. Altogether, the review included 1814 patients in trials of eight different types of bulking agents, and all studies were described and analyzed. The measured outcomes were evaluated using a large variety of instruments. The most common complications of the bulking agents were urinary retention and urinary tract infection. Additionally, there were certain major complications, such as one case of death after use of autologous fat. However, the lack of adequate studies, the heterogeneous populations studied, the wide variety of materials used and the lack of long-term follow-up limit guidance of practice. To determine which substance is the most suitable, there is a need for more randomized clinical trials that compare existing bulking agents based on standardized clinical outcomes.
Asunto(s)
Colágeno/administración & dosificación , Siliconas/administración & dosificación , Uretra , Incontinencia Urinaria/tratamiento farmacológico , Resinas Acrílicas/administración & dosificación , Adulto , Dimetilpolisiloxanos/administración & dosificación , Femenino , Glucanos/administración & dosificación , Humanos , Hidrogeles/administración & dosificación , Inyecciones/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento , Circonio/administración & dosificaciónRESUMEN
To evaluate the efficacy and safety of different bulking agents for treating urinary incontinence in women, a systematic review including only randomized controlled trials was performed. The subjects were women with urinary incontinence. The primary outcomes were clinical and urodynamic parameters. The results were presented as a weighted mean difference for non-continuous variables and as relative risk for continuous variables, both with 95% confidence intervals. Initially, 942 studies were identified. However, only fourteen eligible trials fulfilled the prerequisites. Altogether, the review included 1814 patients in trials of eight different types of bulking agents, and all studies were described and analyzed. The measured outcomes were evaluated using a large variety of instruments. The most common complications of the bulking agents were urinary retention and urinary tract infection. Additionally, there were certain major complications, such as one case of death after use of autologous fat. However, the lack of adequate studies, the heterogeneous populations studied, the wide variety of materials used and the lack of long-term follow-up limit guidance of practice. To determine which substance is the most suitable, there is a need for more randomized clinical trials that compare existing bulking agents based on standardized clinical outcomes.
Asunto(s)
Adulto , Femenino , Humanos , Colágeno/administración & dosificación , Siliconas/administración & dosificación , Uretra , Incontinencia Urinaria/tratamiento farmacológico , Resinas Acrílicas/administración & dosificación , Dimetilpolisiloxanos/administración & dosificación , Glucanos/administración & dosificación , Hidrogeles/administración & dosificación , Inyecciones/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento , Circonio/administración & dosificaciónRESUMEN
OBJETIVO: Avaliar repercussões bioquímicas, hormonais e celulares decorrentes do emprego de circulação extracorpórea (CEC) em cirurgia de revascularização miocárdica. MÉTODOS: Dezoito pacientes foram submetidos à cirurgia de revascularização miocárdica com emprego de CEC. A duração média da CEC foi de 80,3 minutos. Dosagens hormonais, bioquímicas e celulares foram realizadas nos seguintes tempos: pré-operatório, logo após a saída de CEC, 24 horas e 48 horas de pós-operatório. Os testes de Friedman e Wilcoxon foram aplicados, considerando-se o nível de significância 5 por cento. RESULTADOS: Houve ativação e elevação significante do número de leucócitos totais e neutrófilos durante o período de CEC, de tal forma que esta condição foi detectada logo após a saída de CEC, mantendo-se assim até 48 horas de pós-operatório. O número total de plaquetas, por sua vez, caracterizou-se por decréscimo relevante logo após a saída de CEC, como também nos dois momentos pós-operatórios de observação. A concentração sérica de proteínas totais e albumina, logo após a saída de CEC e nos dois momentos pós-operatórios de observação, foi significativamente menor em relação aos níveis encontrados no período pré-operatório. Houve decréscimo acentuado dos níveis séricos de T3 total e T3 livre, sobretudo até as primeiras 24 horas de pós-operatório. De forma análoga, notou-se padrão semelhante quanto aos níveis séricos de T4 total. CONCLUSÃO: Em cirurgias de revascularização miocárdica, os efeitos inflamatórios da CEC compreendem ativação de leucócitos, neutrófilos e plaquetas, redução na concentração sérica de proteínas totais e albumina e decréscimo dos níveis séricos de hormônios tireoidianos, sobretudo, nas primeiras 24 horas de pós-operatório.
OBJECTIVE: The authors sought to assess biochemical, hormonal and cellular repercussions from use of cardiopulmonary bypass (CPB) in coronary artery bypass graft (CABG) surgery. METHODS: Eighteen patients underwent on-pump CABG surgery. Mean time of CPB was 80.3 minutes. Hormonal, biochemical and cellular measurements were taken in some time points - preoperatively, immediately after coming off CPB, 24 and 48 hours postoperatively. Friedman and Wilcoxon tests were applied based on significance level of 5 percent. RESULTS: There was activation and significant elevation of total leukocytes and neutrophils count over CPB, remaining this way up to 48 hours postoperatively. Total platelets count, in turn, was marked by relevant reduction immediately after coming off CPB as well as in two postoperative time points. Serum levels of total proteins and albumin, immediately after coming off CPB and also in two postoperative time points, were significantly decreased comparing with preoperative status. There was remarkable reduction of total T3, free T3 and total T4 particularly up to first 24 hours postoperatively. CONCLUSION: In on-pump CABG surgery, inflammatory effects encompass activation of total leukocytes, neutrophils and platelets, reduction of serum level of total proteins and albumin and decreased thyroid hormones levels, especially within first postoperative 24 hours.
Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , Proteínas Sanguíneas/análisis , Puente Cardiopulmonar/efectos adversos , Puente de Arteria Coronaria/efectos adversos , Inflamación/sangre , Hormonas Tiroideas/sangre , Recuento de Leucocitos , Recuento de Plaquetas , Periodo Posoperatorio , Estadísticas no ParamétricasRESUMEN
PURPOSE: To investigate the relevance of the term superficial musculoaponeurotic system (SMAS) and demonstrate that this term is important enough to be added to the MeSH database and listed in International Anatomical Nomenclature. METHODS: Terms related to SMAS were selected from original articles retrieved from the ISI Web of Science and MEDLINE (PubMed) databases. Groups of terms were created to define a search strategy with high-sensitivity and restricted to scientific periodicals devoted to plastic surgery. This study included articles between January 1996 and May 2009, whose titles, abstracts, and keywords were searched for SMAS-related terms and all occurrences were recorded. RESULTS: A total of 126 original articles were retrieved from the main periodicals related to plastic surgery in the referred databases. Of these articles, 51.6 percent had SMAS-related terms in the abstract only, and 25.4 percent had SMAS-related terms in both the title and abstract. The term 'superficial musculoaponeurotic system' was present as a keyword in 19.8 percent of the articles. The most frequent terms were 'SMAS' (71.4 percent) and superficial musculoaponeurotic system (62.7 percent). CONCLUSION: The term SMAS refers to a structure relevant enough to start a discussion about indexing it as a keyword and as an official term in Terminologia Anatomica: International Anatomical Terminology.
OBJETIVO: Investigar a relevância do termo sistema musculoaponeurótico superficial (SMAS) para propor a sua indicação para indexação como palavra-chave e inclusão na Terminologia Anatômica Internacional. MÉTODOS: Termos relacionados ao SMAS foram recuperados de artigos originais identificados por mapeamento automático nas bases ISI Web Of Science e MEDLINE (PubMed). Os termos foram agrupados a fim de formar uma estratégia de busca de alta sensibilidade, limitada a periódicos exclusivos da especialidade de Cirurgia Plástica. Destes periódicos, foram selecionados artigos publicados de janeiro de 1996 a maio de 2009. Avaliou-se o título, resumo e as palavras-chaves, computando-se todas as ocorrências de termos relacionadas ao SMAS. RESULTADOS: Recuperou-se um total de 126 artigos originais de periódicos relevantes, especializados em cirurgia plástica, e indexados nas bases mencionadas. Destes artigos, 51,6 por cento apresentavam termos relacionados com SMAS somente no resumo, e 25,4 por cento apresentavam termos relacionados com SMAS no título e resumo. O termo sistema musculoaponeurótico superficial estava presente como descritor em 19,8 por cento dos artigos. As ocorrências mais freqüentes foram SMAS (71,4 por cento) e sistema musculoaponeurótico superficial (62,7 por cento). CONCLUSÃO: O termo SMAS, referente à estrutura em estudo, apresentou relevância suficiente para ser indexado como palavra-chave e listado na Terminologia Anatômica Internacional.
Asunto(s)
Humanos , Descriptores , Medical Subject Headings , Cirugía Plástica/métodos , Indización y Redacción de ResúmenesRESUMEN
PURPOSE: To investigate the relevance of the term superficial musculoaponeurotic system (SMAS) and demonstrate that this term is important enough to be added to the MeSH database and listed in International Anatomical Nomenclature. METHODS: Terms related to SMAS were selected from original articles retrieved from the ISI Web of Science and MEDLINE (PubMed) databases. Groups of terms were created to define a search strategy with high-sensitivity and restricted to scientific periodicals devoted to plastic surgery. This study included articles between January 1996 and May 2009, whose titles, abstracts, and keywords were searched for SMAS-related terms and all occurrences were recorded. RESULTS: A total of 126 original articles were retrieved from the main periodicals related to plastic surgery in the referred databases. Of these articles, 51.6% had SMAS-related terms in the abstract only, and 25.4% had SMAS-related terms in both the title and abstract. The term 'superficial musculoaponeurotic system' was present as a keyword in 19.8% of the articles. The most frequent terms were 'SMAS' (71.4%) and superficial musculoaponeurotic system (62.7%). CONCLUSION: The term SMAS refers to a structure relevant enough to start a discussion about indexing it as a keyword and as an official term in Terminologia Anatomica: International Anatomical Terminology.
Asunto(s)
Músculos Faciales , Medical Subject Headings , Terminología como Asunto , Bases de Datos como Asunto , HumanosRESUMEN
OBJECTIVE: The authors sought to assess biochemical, hormonal and cellular repercussions from use of cardiopulmonary bypass (CPB) in coronary artery bypass graft (CABG) surgery. METHODS: Eighteen patients underwent on-pump CABG surgery. Mean time of CPB was 80.3 minutes. Hormonal, biochemical and cellular measurements were taken in some time points - preoperatively, immediately after coming off CPB, 24 and 48 hours postoperatively. Friedman and Wilcoxon tests were applied based on significance level of 5%. RESULTS: There was activation and significant elevation of total leukocytes and neutrophils count over CPB, remaining this way up to 48 hours postoperatively. Total platelets count, in turn, was marked by relevant reduction immediately after coming off CPB as well as in two postoperative time points. Serum levels of total proteins and albumin, immediately after coming off CPB and also in two postoperative time points, were significantly decreased comparing with preoperative status. There was remarkable reduction of total T3, free T3 and total T4 particularly up to first 24 hours postoperatively. CONCLUSION: In on-pump CABG surgery, inflammatory effects encompass activation of total leukocytes, neutrophils and platelets, reduction of serum level of total proteins and albumin and decreased thyroid hormones levels, especially within first postoperative 24 hours.
Asunto(s)
Proteínas Sanguíneas/análisis , Puente Cardiopulmonar/efectos adversos , Puente de Arteria Coronaria/efectos adversos , Inflamación/sangre , Hormonas Tiroideas/sangre , Femenino , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Periodo Posoperatorio , Estadísticas no ParamétricasRESUMEN
OBJETIVO: Avaliar se perfusão controlada do tronco pulmonar durante circulação extracorpórea (CEC) modifica os níveis de BNP expressos pelo miocárdio ventricular. MÉTODOS: Estudo experimental com 32 porcos, divididos em dois grupos de acordo com estratégia de CEC - grupo I (cardioplegia) e grupo II (coração batendo). Ambos os grupos foram alocados em três subgrupos, de acordo com a estratégia de perfusão pulmonar - subgrupo A (controle: sem perfusão pulmonar), subgrupo B (perfusão pulmonar com sangue arterial) e subgrupo C (perfusão com sangue venoso). Nos subgrupos B e C, pulmões foram perfundidos por 30 minutos, utilizando pressão arterial média pulmonar (PAPM) préoperatória como pressão de perfusão, a qual foi controlada com manômetro. PAPM e resistência vascular pulmonar (RVP) foram medidas após saída de CEC com cateter de Swan-Ganz. No período pré-operatório e após 30 minutos de perfusão pulmonar, fragmentos de miocárdio ventricular direito foram coletados para avaliar expressão de peptídeo natriurético cerebral (BNP) e padrão histológico tecidual. Técnicas de imunohistoquímica e hematoxilina-eosina foram utilizadas para determinar, respectivamente, expressão de BNP e lesões inflamatórias miocárdicas. RESULTADOS: Nos animais submetidos à perfusão controlada do tronco pulmonar, houve redução pós-operatória da PAPM (P=0,03) e da RVP (P=0,005). Não houve diferenças entre os subgrupos do grupo I (P=0,228) e subgrupos do grupo II (P=0,325) quanto à expressão pós-operatória de BNP. Não houve diferenças entre subgrupos com e sem perfusão pulmonar quanto à intensidade das lesões inflamatórias miocárdicas identificadas no pós-operatório (P>0,05). CONCLUSÃO: Perfusão controlada do tronco pulmonar por 30 minutos não foi suficiente para promover alterações substanciais na expressão de BNP e no padrão histológico miocárdico do ventrículo direito.
OBJECTIVE: Assess if the main pulmonary artery controlled perfusion over cardiopulmonary bypass (CPB) modifies BNP levels expressed by the ventricular myocardium. METHODS: Experimental research involving 32 pigs, divided into two groups according to CPB strategy - group I (cardioplegia) and group II (beating heart). Both groups were allocated into three subgroups according to lung perfusion strategy - subgroup A (control: no lung perfusion), subgroup B (lung perfusion with arterial blood) and subgroup C (lung perfusion with venous blood). In subgroups B and C, lung was perfused for 30 minutes, using preoperative mean pulmonary artery pressure (MPAP) as perfusion pressure, which was monitored through manometer. MPAP and pulmonary vascular resistance (PVR) were measured after coming off CPB using Swan-Ganz catheter. At preoperative time and 30 minutes after lung perfusion, specimens were taken from the right ventricular myocardium aiming to assess brain natriuretic peptide (BNP) and histologic pattern. Immunohistochemical and hematoxylin-eosin techniques were used to determine, respectively, BNP expression and inflammatory myocardial lesions. RESULTS: In animals submitted to controlled lung perfusion, there was a postoperative reduction of MPAP (P=0.03) and PVR (P=0.005).There was no differences among subgroups within the group, I (P=0.228) and subgroups within group II (P=0.325) as to postoperative BNP expression. There were no differences among subgroups with and without lung perfusion as to postoperative inflammatory lesions (P>0.05). CONCLUSION: Main pulmonary artery controlled perfusion for 30 minutes did not yield substantial modifications in BNP expression and histologic pattern of the right ventricular myocardium.
Asunto(s)
Animales , Masculino , Puente Cardiopulmonar/efectos adversos , Miocarditis/patología , Péptido Natriurético Encefálico/biosíntesis , Perfusión/métodos , Arteria Pulmonar/fisiopatología , Ventrículos Cardíacos/patología , Hemodinámica/fisiología , Modelos Animales , Distribución Aleatoria , PorcinosRESUMEN
The outcomes of total and bicaval heart transplantation techniques are better than those of the biatrial technique; however, the latter is still considered the gold-standard. The objective of this study was to determine whether the total and bicaval heart transplantation techniques are, in fact, better than the biatrial technique. A systematic review with meta-analysis was carried out. Studies were retrieved from Pubmed, Lilacs, Web of Science, Scirus, Scopus, Google Scholar, and Scielo databases, identified by sensitive strategy. Randomized, prospective, and retrospective controlled studies were selected for inclusion. Intra and postoperative parameters were assessed. A total of 11,602 studies were identified and 36 were included in our review. The number of atrial arrhythmias, tricuspid valve regurgitation, deaths, and embolic events, as well as bleeding volume; temporary and permanent pacemaker requirement; and length of stay in the intensive care unit are significantly lower for the total and bicaval techniques than for the biatrial technique. Also, hemodynamic variables such as pulmonary capillary pressure, mean pulmonary artery pressure, and right atrial pressure are lower in total and bicaval transplantation. In prognostic terms, total and bicaval orthotopic heart transplantations are better, than the biatrial transplantation. Therefore, indication of the biatrial technique for transplantation should be the exception, not the rule.
Asunto(s)
Trasplante de Corazón/métodos , Anastomosis Quirúrgica/métodos , Atrios Cardíacos/cirugía , Insuficiencia Cardíaca/terapia , Trasplante de Corazón/efectos adversos , Hemodinámica , Humanos , Periodo Posoperatorio , Estudios Prospectivos , Resultado del Tratamiento , Insuficiencia de la Válvula Tricúspide/etiología , Venas Cavas/cirugíaRESUMEN
As técnicas de transplante cardíaco bicaval e total apresentam melhores resultados que a biatrial, porém esta ainda é considerada o padrão-ouro. O objetivo é determinar se as técnicas de transplante cardíaco bicaval e total são, de fato, melhores que a técnica biatrial. Realizou-se a revisão sistemática com metanálise. Os estudos foram provenientes das bases de dados da Pubmed®, Lilacs®, Web of Science®, Scirus®, Scopus®, Google Acadêmico® e Scielo®, identificados por estratégia sensível. Elegeram-se, para a inclusão, estudos aleatórios e estudos prospectivos e retrospectivos controlados. Parâmetros intra e pós-operatórios foram avaliados. Foram identificados 11.602 estudos, e 36 foram incluídos na revisão. O número de arritmias atriais, insuficiência valvar tricúspide, mortalidade, eventos embólicos, volume de sangramento, necessidade de marcapasso temporário e permanente e o tempo de estada em unidade de terapia intensiva são significativamente menores nas técnicas bicaval e total do que na biatrial. Além disso, variáveis hemodinâmicas como a pressão capilar pulmonar, pressão média de artéria pulmonar e pressão de átrio direito são menores nos transplantes bicaval e total. Os transplantes cardíacos ortotópicos bicaval e total são melhores, em termos de prognóstico, que o biatrial. Portanto, a indicação da técnica biatrial para transplante deve ser a exceção e não a regra.
The outcomes of total and bicaval heart transplantation techniques are better than those of the biatrial technique; however, the latter is still considered the gold-standard. The objective of this study was to determine whether the total and bicaval heart transplantation techniques are, in fact, better than the biatrial technique. A systematic review with meta-analysis was carried out. Studies were retrieved from Pubmed, Lilacs, Web of Science, Scirus, Scopus, Google Scholar, and Scielo databases, identified by sensitive strategy. Randomized, prospective, and retrospective controlled studies were selected for inclusion. Intra and postoperative parameters were assessed. A total of 11,602 studies were identified and 36 were included in our review. The number of atrial arrhythmias, tricuspid valve regurgitation, deaths, and embolic events, as well as bleeding volume; temporary and permanent pacemaker requirement; and length of stay in the intensive care unit are significantly lower for the total and bicaval techniques than for the biatrial technique. Also, hemodynamic variables such as pulmonary capillary pressure, mean pulmonary artery pressure, and right atrial pressure are lower in total and bicaval transplantation. In prognostic terms, ...
Asunto(s)
Humanos , Trasplante de Corazón/métodos , Anastomosis Quirúrgica/métodos , Hemodinámica , Atrios Cardíacos/cirugía , Insuficiencia Cardíaca/terapia , Trasplante de Corazón/efectos adversos , Periodo Posoperatorio , Estudios Prospectivos , Resultado del Tratamiento , Insuficiencia de la Válvula Tricúspide/etiología , Venas Cavas/cirugíaRESUMEN
OBJECTIVE: Assess if the main pulmonary artery controlled perfusion over cardiopulmonary bypass (CPB) modifies BNP levels expressed by the ventricular myocardium. METHODS: Experimental research involving 32 pigs, divided into two groups according to CPB strategy--group I (cardioplegia) and group II (beating heart). Both groups were allocated into three subgroups according to lung perfusion strategy--subgroup A (control: no lung perfusion), subgroup B (lung perfusion with arterial blood) and subgroup C (lung perfusion with venous blood). In subgroups B and C, lung was perfused for 30 minutes, using preoperative mean pulmonary artery pressure (MPAP) as perfusion pressure, which was monitored through manometer. MPAP and pulmonary vascular resistance (PVR) were measured after coming off CPB using Swan-Ganz catheter. At preoperative time and 30 minutes after lung perfusion, specimens were taken from the right ventricular myocardium aiming to assess brain natriuretic peptide (BNP) and histologic pattern. Immunohistochemical and hematoxylin-eosin techniques were used to determine, respectively, BNP expression and inflammatory myocardial lesions. RESULTS: In animals submitted to controlled lung perfusion, there was a postoperative reduction of MPAP (P = 0.03) and PVR (P = 0.005).There was no differences among subgroups within the group, I (P = 0.228) and subgroups within group II (P = 0.325) as to postoperative BNP expression. There were no differences among subgroups with and without lung perfusion as to postoperative inflammatory lesions (P > 0.05). CONCLUSION: Main pulmonary artery controlled perfusion for 30 minutes did not yield substantial modifications in BNP expression and histologic pattern of the right ventricular myocardium.
Asunto(s)
Puente Cardiopulmonar/efectos adversos , Miocarditis/patología , Péptido Natriurético Encefálico/biosíntesis , Perfusión/métodos , Arteria Pulmonar/fisiopatología , Animales , Ventrículos Cardíacos/patología , Hemodinámica/fisiología , Masculino , Modelos Animales , Distribución Aleatoria , PorcinosRESUMEN
BACKGROUND: The resection of tumor thrombus of the inferior vena cava (IVC) and right atrium (RA) increases the survival rate of patients with renal/adrenal cancer. OBJECTIVE: To evaluate the surgical procedure in cases of IVC and RA in the treatment of renal and adrenal tumors. METHODS: Fourteen patients undergoing surgical intervention (during the period) between January 1997 and June 2007, for resection of IVC and/or RA thrombus due to renal or adrenal tumors, were retrospectively evaluated. The patients (64.2% male) presented with Wilms' tumor, clear cell carcinoma and adrenal adenocarcinoma, and had mean age of 4.5, 60.5 and 2.5 years, respectively. Epidemiological characteristics and intra- and postoperative parameters were evaluated. RESULTS: Suprahepatic IVC tumor thrombus were observed in all the patients, and in 62.4% of them the thrombus invaded the RA. Thrombectomy was performed with extracorporeal circulation with deep hypothermia and total circulatory arrest in 85.7%, with mild hypothermia in the remaining cases. The inferior vena cava was ligated in 7.1% of the cases, and reconstruction with suture was performed in 92.9% of the patients. The duration of orotracheal intubation and length of hospital stay were different, according to the tumor type. Two deaths, due to intraoperative cardiorespiratory arrest, were seen among patients with adrenal adenocarcinoma. CONCLUSION: IVC and RA tumor thrombi are more frequent in patients with Wilms' tumor. More postoperative complications are seen in patients with adrenal adenocarcinoma, and the postoperative prognosis is better for patients with Wilms' tumor.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/patología , Neoplasias Cardíacas/cirugía , Neoplasias Renales/patología , Trombectomía/métodos , Vena Cava Inferior , Trombosis de la Vena/cirugía , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Adolescente , Adulto , Carcinoma de Células Renales/patología , Carcinoma de Células Renales/cirugía , Niño , Preescolar , Paro Circulatorio Inducido por Hipotermia Profunda/métodos , Circulación Extracorporea/métodos , Femenino , Atrios Cardíacos/cirugía , Neoplasias Cardíacas/patología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estudios Retrospectivos , Trombectomía/efectos adversos , Factores de Tiempo , Tumor de Wilms/patología , Tumor de Wilms/cirugía , Adulto JovenRESUMEN
FUNDAMENTO: A ressecção do trombo tumoral em veia cava inferior (VCI) e átrio direito (AD) aumenta a sobrevida do paciente com câncer renal/supra-renal. OBJETIVO: Avaliar a conduta cirúrgica do trombo da VCI e AD no tratamento dos tumores renais e supra-renais. MÉTODOS:De janeiro de 1997 a junho de 2007 foram avaliados, retrospectivamente, 14 pacientes tratados cirurgicamente para retirada de trombo em VCI e/ou AD decorrente de tumor renal ou supra-renal. Desses, 64,2% eram do sexo masculino, e havia 42,8% de casos de tumor de Wilms (TW), 28,5% de adenocarcinoma de supra-renal (AS) e 28,5% de carcinoma de células claras (CC), com idades médias de 4,5, 60,5 e 2,5 anos, respectivamente. Aspectos epidemiológicos e parâmetros intra e pós-operatórios hospitalar foram avaliados. RESULTADOS: Em todos os casos encontrou-se trombo tumoral em VCI supra-hepática, e em 62,4% o trombo invadiu o AD. A trombectomia foi realizada com o emprego da circulação extracorpórea associada à hipotermia profunda e parada circulatória total em 85,7% dos casos e moderada no restante. Ligou-se a VCI em 7,1% dos pacientes, e reconstruiu-se por rafia em 92,9%. Os tempos de intubação orotraqueal e internação variaram conforme o tipo de tumor. Ocorreram dois óbitos hospitalares no grupo de AS, por parada cardiorrespiratória intra-operatória. CONCLUSÃO: Existe maior número de casos de trombo tumoral em VCI e AD decorrente de TW. Os casos de AS evoluem com mais complicações no pós-operatório, e o prognóstico no pós-operatório hospitalar dos pacientes com TW é melhor.
BACKGROUND: The resection of tumor thrombus of the inferior vena cava (IVC) and right atrium (RA) increases the survival rate of patients with renal/adrenal cancer. OBJECTIVE: To evaluate the surgical procedure in cases of IVC and RA in the treatment of renal and adrenal tumors. METHODS: Fourteen patients undergoing surgical intervention (during the period) between January 1997 and June 2007, for resection of IVC and/or RA thrombus due to renal or adrenal tumors, were retrospectively evaluated. The patients (64.2% male) presented with Wilms' tumor, clear cell carcinoma and adrenal adenocarcinoma, and had mean age of 4.5, 60.5 and 2.5 years, respectively. Epidemiological characteristics and intra- and postoperative parameters were evaluated. RESULTS: Suprahepatic IVC tumor thrombus were observed in all the patients, and in 62.4% of them the thrombus invaded the RA. Thrombectomy was performed with extracorporeal circulation with deep hypothermia and total circulatory arrest in 85.7%, with mild hypothermia in the remaining cases. The inferior vena cava was ligated in 7.1% of the cases, and reconstruction with suture was performed in 92.9% of the patients. The duration of orotracheal intubation and length of hospital stay were different, according to the tumor type. Two deaths, due to intraoperative cardiorespiratory arrest, were seen among patients with adrenal adenocarcinoma. CONCLUSION: IVC and RA tumor thrombi are more frequent in patients with Wilms' tumor. More postoperative complications are seen in patients with adrenal adenocarcinoma, and the postoperative prognosis is better for patients with Wilms' tumor.
FUNDAMENTO: La resección del trombo tumoral en vena cava inferior (VCI) y atrio derecho (AD) aumenta la sobrevida del paciente con cáncer renal/ suprarrenal. OBJETIVO: Evaluar la conducta quirúrgica frente al trombo de la VCI y AD en el tratamiento de los tumores renales y suprarrenales. MÉTODOS: De enero de 1997 a junio de 2007, se evaluaron, retrospectivamente, a 14 pacientes tratados quirúrgicamente para retirada de trombo en VCI y/o AD que transcurre de tumor renal o suprarrenal. De estos, el 64,2% eran del sexo masculino; había el 42,8% de casos de tumor de Wilms (TW), el 28,5% de adenocarcinoma suprarrenal (ACS) y el 28,5% de carcinoma de células claras (CC), con edades promedio de 4,5, 60,5 y 2,5 años, respectivamente. Se evaluaron los aspectos epidemiológicos y también los parámetros hospitalarios intra y postoperatorios. RESULTADOS: En todos los casos se encontró trombo tumoral en VCI suprahepática, y en el 62,4% el trombo invadió el AD. Se realizó la trombectomia con el empleo de la circulación extracorpórea asociada a la hipotermia profunda; se verificó paro circulatorio total en el 85,7% de los casos, mientras que se mantuvo moderada en el restante del grupo. Se procedió a la ligadura de la VCI en el 7,1% de los pacientes, y se la reconstruyó por rafia en el 92,9%. Los tiempos de intubación orotraqueal e internación variaron conforme el tipo de tumor. Ocurrieron dos óbitos hospitalarios en el grupo de ACS, provocados por paro cardiorrespiratorio intraoperatorio. CONCLUSIÓN: Existe mayor número de casos de trombo tumoral en VCI y AD que transcurre de TW. Los casos de ACS evolucionan con más complicaciones en el período postoperatorio, mientras que el pronóstico en el postoperatorio hospitalario de los pacientes con TW resulta mejor.
Asunto(s)
Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Adulto Joven , Neoplasias de las Glándulas Suprarrenales/patología , Neoplasias Cardíacas/cirugía , Neoplasias Renales/patología , Trombectomía/métodos , Vena Cava Inferior , Trombosis de la Vena/cirugía , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Carcinoma de Células Renales/patología , Carcinoma de Células Renales/cirugía , Paro Circulatorio Inducido por Hipotermia Profunda/métodos , Circulación Extracorporea/métodos , Atrios Cardíacos/cirugía , Neoplasias Cardíacas/patología , Invasividad Neoplásica , Estudios Retrospectivos , Factores de Tiempo , Trombectomía/efectos adversos , Tumor de Wilms/patología , Tumor de Wilms/cirugía , Adulto JovenRESUMEN
OBJETIVO: Propor um escore de risco inflamatório para tratamento endovascular dos aneurismas da aorta. MÉTODOS: Vinte e cinco pacientes foram seguidos do período pré-operatório até 3º mês de pós-operatório (1 hora, 6 horas, 24 horas, 48 horas, 7 dias, 1 mês, 2 meses e 3 meses). Variáveis inflamatórias avaliadas foram proteína C reativa, velocidade de hemossedimentação, interleucinas (IL-6, IL8), fator de necrose tumoral alfa, L-selectina, molécula de adesão intercelular (ICAM-1), transfusão de hemáceas, volume de cristalóide, volume de contraste, material da prótese, número de próteses, contagem total de leucócitos e linfócitos. O teste de Spearman apontou as variáveis candidatas ao maior risco inflamatório, segundo P < 20 por cento. A regressão logística apontou variáveis selecionáveis para escore final segundo P < 10 por cento. A análise da curva ROC revelou valores de corte para variáveis selecionadas pela regressão logística. RESULTADOS: Variáveis apresentadas pelo teste de Spearman foram: volume de cristalóide (P = 0,04), material da prótese (P = 0,04), volume de contraste (P=0,02), IL-8 préoperatória (P= 0,10), ICAM-1 1 mês (P=0,03) e L-selectina 1 mês (P = 0,06). A regressão logística revelou que os valores do volume de cristalóide e IL-8 pré-operatória são primordiais para constituição do escore de risco inflamatório para tratamento endovascular dos aneurismas da aorta. O escore de risco seria dividido em três categorias (leve, moderado e grave), com base em intervalos numéricos das duas variáveis selecionadas e as categorias seriam correlacionadas com achados clínicos CONCLUSÃ: Volume de cristalóide e IL-8 pré-operatória são variáveis que poderiam contribuir para categorizar risco inflamatório e, desse modo, ter um papel prognóstico no tratamento endovascular dos aneurismas da aorta.
OBJECTIVE: To purpose an inflammatory risk score for aortic aneurysm endovascular treatment. METHODS: Twenty-five patients were followed-up from preoperative period to third month postoperatively (1-hour, 6-hour, 24-hour, 48-hour, 7-day, 1-month, 2- month and 3month). Inflammatory variables were C-reactive protein, hemosedimentation velocity, interleukins (IL-6, IL-8), tumor necrosis factor-Alpha, L-selectin, intercellular adhesion molecule (ICAM-1), red blood cells transfusion, volume of crystalloid, volume of contrast, type of endoprosthesis, number of endoprostheses, total count of leukocytes and lymphocytes. Spearman test defined the variables considered as candidates to higher inflammatory risk based on P < 20 percent. Logistic regression defined the variables considered as selected for final score based on P < 10 percent. ROC curve analysis revealed the cut-off values for variables selected by logistic regression. RESULTS: Variables defined by Spearman test were: volume of crystalloid (P=0.04), type of endoprosthesis (P=0.04), volume of contrast (P=0.02), preoperative IL-8 (P = 0.10), 1 - month ICAM-1 (P=0.03) and 1-month L-selectin (P=0.06). Logistic regression revealed that volume of crystalloid and preoperative IL-8 values are relevant for composition of inflammatory risk score for aortic aneurysm endovascular treatment. Risk score would be divided into three categories (mild, moderate and severe) based on numeric intervals of these two variables and the categories would be correlated to clinical findings. CONCLUSION: Volume of crystalloid and preoperative IL-8 are variables that might contribute to categorize inflammatory risk and thereby might play a prognostic role for aortic aneurysm endovascular treatment.
Asunto(s)
Femenino , Humanos , Masculino , Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular/efectos adversos , Mediadores de Inflamación/sangre , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Aneurisma de la Aorta/sangre , Aneurisma de la Aorta/fisiopatología , Volumen Sanguíneo/fisiología , Moléculas de Adhesión Celular/sangre , Estudios de Seguimiento , /sangre , Modelos Logísticos , Cuidados Posoperatorios , Cuidados Preoperatorios , Medición de Riesgo , Curva ROCRESUMEN
BACKGROUND: The surgical treatment of patency ductus arteriosus is indicated when the clinical intervention fails. However, this treatment may have some complications. OBJECTIVE: To analyze clinical and surgical aspects involved on the treatment of patency ductus arteriosus in premature newborn. METHODS: Twenty two premature newborns, submitted to surgical treatment for patency ductus arteriosus from January, 2000 to June, 2006, were evaluated. There were 77.3% female patients, the mean birth weight was 952.5 g and the mean gestational age was 27 weeks. The use of vasoactive drugs, indometacin, echocardiograph parameters and complications, in the pre and postoperative periods were evaluated. RESULTS: In this casuistic 59.1% patients needed intratracheal intubation at birth, 77.3% needed surfactants, 59.1% used vasoactive drugs preoperative. The mean doses of indometacin were 3.43, with dose range 0.1 to 0.25 mg/Kg/day. The mean caliber of arterial duct patent was 1,96 mm. The surgical procedure was carried out through extrapleural approach in 59.1% of the patients, the mean time of postoperative intubation was 30.9 days, and 50% of the patients used vasoactive drugs postoperative. There were 18.1% postoperative complications (postoperative non-fatal complications). CONCLUSION: More than the half of the patients needed intratracheal intubation at birth, surfactant use and vasoactive drugs in the preoperative period. There was greater prevalence of the extrapleural approach during the surgery. In the postoperative period, there was less demand of vasoactive use and there was not deaths related to the surgical procedure.
Asunto(s)
Conducto Arterioso Permeable/cirugía , Recien Nacido Prematuro , Brasil/epidemiología , Conducto Arterioso Permeable/mortalidad , Femenino , Edad Gestacional , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Masculino , Mortalidad Perinatal , Complicaciones Posoperatorias , Periodo Posoperatorio , Cuidados Preoperatorios , Estudios RetrospectivosRESUMEN
FUNDAMENTO: O tratamento cirúrgico da persistência de canal arterial é indicado quando a intervenção clínica fracassa. No entanto, esse tratamento não é livre de complicações. OBJETIVO: Analisar aspectos clínicos e cirúrgicos envolvidos no tratamento da persistência do canal arterial, em recém-nascidos prematuros. MÉTODOS: No período de janeiro de 2000 a junho de 2006, foram analisados 22 recém-nascidos prematuros submetidos a tratamento cirúrgico para persistência de canal arterial. Do total de pacientes, 77,3 por cento eram do sexo feminino, com peso médio ao nascimento de 952,5 g e idade gestacional média de 27 semanas. O uso de agentes vasoativos, indometacina, parâmetros ecocardiográficos e complicações, nos períodos pré e pós-operatórios, foi avaliado. RESULTADOS: Na casuística avaliada, 59,1 por cento dos pacientes necessitaram de intubação orotraqueal ao nascimento; 77,3 por cento, de surfactante; e 59,1 por cento usaram agentes vasoativos no pré-operatório. O número médio de aplicações de indometacina foi de 3,4, com dosagem variando de 0,1 a 0,25 mg/kg/dia. O calibre médio do canal arterial foi de 1,96 mm. O procedimento cirúrgico foi realizado por abordagem extrapleural em 59,1 por cento dos casos, e no pós-operatório o tempo médio de intubação foi de 30,9 dias, com emprego de agentes vasoativos em 50 por cento dos pacientes. Observaram-se 18,1 por cento de complicações pós-operatórias não-fatais. CONCLUSÃO: Mais da metade dos pacientes necessitou de intubação orotraqueal ao nascimento, emprego de surfactante e agentes vasoativos no período pré-operatório. Houve maior prevalência de abordagem extrapleural durante o ato operatório. No período pós-operatório, houve menor demanda de agentes vasoativos e não houve óbitos diretamente relacionados ao procedimento cirúrgico.
BACKGROUND: The surgical treatment of patency ductus arteriosus is indicated when the clinical intervention fails. However, this treatment may have some complications. OBJECTIVE: To analyze clinical and surgical aspects involved on the treatment of patency ductus arteriosus in premature newborn. METHODS: Twenty two premature newborns, submitted to surgical treatment for patency ductus arteriosus from January, 2000 to June, 2006, were evaluated. There were 77,3 percent female patients, the mean birth weight was 952,5g and the mean gestational age was 27 weeks. The use of vasoactive drugs, indometacin, echocardiograph parameters and complications, in the pre and postoperative periods were evaluated. RESULTS: In this casuistic 59,1 percent patients needed intratracheal intubation at birth, 77,3 percent needed surfactants, 59,1 percent used vasoactive drugs preoperative. The mean doses of indometacin were 3,43, with dose range 0,1 to 0,25 mg/Kg/day. The mean caliber of arterial duct patent was 1,96 mm. The surgical procedure was carried out through extrapleural approach in 59.1 percent of the patients, the mean time of postoperative intubation was 30,9 days, and 50 percent of the patients used vasoactive drugs postoperative. There were 18,1 percent postoperative complications (postoperative non-fatal complications). CONCLUSION: More than the half of the patients needed intratracheal intubation at birth, surfactant use and vasoactive drugs in the preoperative period. There was greater prevalence of the extrapleural approach during the surgery. In the postoperative period, there was less demand of vasoactive use and there was not deaths related to the surgical procedure.
Asunto(s)
Femenino , Humanos , Recién Nacido , Masculino , Conducto Arterioso Permeable/cirugía , Recien Nacido Prematuro , Brasil/epidemiología , Conducto Arterioso Permeable/mortalidad , Edad Gestacional , Recién Nacido de Bajo Peso , Mortalidad Perinatal , Complicaciones Posoperatorias , Periodo Posoperatorio , Cuidados Preoperatorios , Estudios RetrospectivosRESUMEN
OBJECTIVE: To purpose an inflammatory risk score for aortic aneurysm endovascular treatment. METHODS: Twenty-five patients were followed-up from preoperative period to third month postoperatively (1-hour, 6-hour, 24-hour, 48-hour, 7-day, 1-month, 2- month and 3month). Inflammatory variables were C-reactive protein, hemosedimentation velocity, interleukins (IL-6, IL-8), tumor necrosis factor-Alpha, L-selectin, intercellular adhesion molecule (ICAM-1), red blood cells transfusion, volume of crystalloid, volume of contrast, type of endoprosthesis, number of endoprostheses, total count of leukocytes and lymphocytes. Spearman test defined the variables considered as candidates to higher inflammatory risk based on P < 20%. Logistic regression defined the variables considered as selected for final score based on P < 10%. ROC curve analysis revealed the cut-off values for variables selected by logistic regression. RESULTS: Variables defined by Spearman test were: volume of crystalloid (P=0.04), type of endoprosthesis (P=0.04), volume of contrast (P=0.02), preoperative IL-8 (P = 0.10), 1 - month ICAM-1 (P=0.03) and 1-month L-selectin (P=0.06). Logistic regression revealed that volume of crystalloid and preoperative IL-8 values are relevant for composition of inflammatory risk score for aortic aneurysm endovascular treatment. Risk score would be divided into three categories (mild, moderate and severe) based on numeric intervals of these two variables and the categories would be correlated to clinical findings. CONCLUSION: Volume of crystalloid and preoperative IL-8 are variables that might contribute to categorize inflammatory risk and thereby might play a prognostic role for aortic aneurysm endovascular treatment.
Asunto(s)
Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular/efectos adversos , Mediadores de Inflamación/sangre , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Aneurisma de la Aorta/sangre , Aneurisma de la Aorta/fisiopatología , Volumen Sanguíneo/fisiología , Moléculas de Adhesión Celular/sangre , Femenino , Estudios de Seguimiento , Humanos , Interleucina-8/sangre , Modelos Logísticos , Masculino , Cuidados Posoperatorios , Cuidados Preoperatorios , Curva ROC , Medición de RiesgoRESUMEN
OBJETIVOS: Identificar e caracterizar o principal cuidador dos pacientes candidatos a transplante do coração; comparar as diferenças entre as informações coletadas com os pacientes e cuidadores; e classificar os cuidadores segundo a sua dedicação e eficiência na assistência ao paciente, correlacionando-os aos dados sociodemográficos. MÉTODOS: Estudo descritivo realizado de outubro de 2004 a março de 2005, no ambulatório da UNIFESP, por meio de entrevista estruturada, com amostragem de 21 pacientes e seus cuidadores. RESULTADOS: O principal cuidador era membro da família (95 por cento), na maioria das vezes, o cônjuge, sendo 13 (81 por cento) mulheres e três (19 por cento) homens, com idade variando de 24 a 65 anos (média de 44,3). Declararam-se 56 por cento casados; 43,8 por cento católicos; 29 por cento cursaram o ensino fundamental, 24 por cento completaram o ensino médio e 14 por cento tinham nível superior. Atividade profissional era exercida por 68,8 por cento e 81,4 por cento possuíam renda própria. Todos os cuidadores residiam na mesma casa que o paciente. Estabelecido um escore, classificaram-se os cuidadores em oito (50 por cento) "bons", sete (43,7 por cento) "regulares" e apenas um (6,3 por cento) foi considerado "ruim". Não encontramos correlação estatisticamente significante entre o escore e as variáveis escolaridade, atividade profissional e renda. CONCLUSÃO: É importante determinar os instrumentos para o reconhecimento e caracterização do cuidador. Neste estudo, identificou-se um familiar (cônjuge), do sexo feminino, com idade média de 44,3 anos, renda própria, classificados, na maioria, como "bons" ou "regulares", não havendo correlação com escolaridade, atividade profissional e renda. Novos estudos complementares, com casuística maior, deverão estabelecer a relação entre o papel do cuidador e os resultados do transplante cardíaco.
OBJECTIVES: To identify and describe the main caregiver of the patients on the heart transplant waiting list; to compare relevant information provided by patients and caregivers, and to classify the caregivers according to their dedication and efficiency in assisting the patient by correlating them to sociodemographic data. METHODS: Descriptive study performed from October 2004 to October 2005 at UNIFESP outpatient clinics. The study sample consisted of 21 patients and their caregivers. Data were collected through a structured interview. RESULTS: The main caregiver was a family member (95 percent), usually the spouse. There were 13 women (81 percent) and three men (19 percent). Patient age ranged from 24 to 65 years (mean 44.3). Patients were married (56 percent); catholic (43.8 percent); 29 percent have finished elementary school; 24 percent have finished high school; 14 percent have higher education; 68.8 percent have a regular job; and 81.4 percent had their own income. All caregivers lived in the same house as the patient. Once a score was established, the caregivers were classified as: "good" - 8 (50 percent); "regular" - 7 (43.7 percent); and "bad" 1 - (6.3 percent). The scores were correlated with education, professional activity, and income without any significant statistical correlation. CONCLUSION: It is important to determine the instruments to recognize and describe the caregivers. The caregiver is usually a family member (spouse), female, mean age of 44.3 years; has his/her own income and, most of the time, he/she is classified as "good" or "regular", and no correlation was found with education, professional activity and income. Further studies with a larger sample should establish the relationship between the caregiver's role and the heart transplant outcomes.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidadores/clasificación , Trasplante de Corazón/psicología , Instituciones de Atención Ambulatoria , Cuidadores/estadística & datos numéricos , Escolaridad , Renta/estadística & datos numéricos , Ocupaciones/estadística & datos numéricos , Estudios Prospectivos , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Esposos/estadística & datos numéricos , Listas de EsperaRESUMEN
OBJECTIVE: The objective of this study is to evaluate the inflammatory response caused by endovascular stents in the treatment of aortic aneurysms. METHODS: Twenty-five patients underwent endovascular stent treatment from March through December 2005. The evolution of mediators (sedimentation velocity, C reactive protein, interleukin-6, interleukin-8, tumor necrosis factor-alpha, intercellular adhesion molecule-1, l-selectin), inflammatory cells (leukocytes, lymphocytes, platelets), serum creatinine and body temperature within preoperative period and in the following postoperative periods--1, 6, 24 and 48 h, 7 days, 1-3 months, was analyzed. In order to achieve statistic significance, Friedman test and Wilcoxon test were used, with index of significance of 5% (p<0.05). RESULTS: Peak values of sedimentation velocity, C reactive protein and interleukin-6 were observed at 7 days (p<0.0001), 48 h (p<0.0001) and 24h (p<0.0001), respectively. Tumor necrosis factor-alpha and interleukin-8 did not show statistically significant variability during the entire follow-up. In terms of intercellular adhesion molecule-1 and l-selectin, their expressive values were found in late phase of follow-up, although without statistical significance. Elevation of leukocytes count occurred in premature phase of follow-up (p<0.0001), while lymphocyte and platelet count occurred in a late phase of follow-up (p<0.0001). Serum levels of creatinine did not show significant variability during follow-up. The period between 24 and 48 h corresponded to major frequency for fever (p<0.0001). CONCLUSION: Individual mediators analysis and inflammatory cells demonstrated variability of their values during postoperative follow-up. This could help in the analysis of the inflammatory response evolution caused by endovascular stent treatment for aortic aneurysms in premature and late phases after implantation of the vascular prosthesis.
Asunto(s)
Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular/efectos adversos , Mediadores de Inflamación/sangre , Inflamación/etiología , Adulto , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/cirugía , Femenino , Estudios de Seguimiento , Humanos , Molécula 1 de Adhesión Intercelular/sangre , Interleucina-6/sangre , Interleucina-8/sangre , Selectina L/sangre , Masculino , Persona de Mediana Edad , Stents/efectos adversos , Factor de Necrosis Tumoral alfa/sangreRESUMEN
OBJECTIVES: To identify and describe the main caregiver of the patients on the heart transplant waiting list; to compare relevant information provided by patients and caregivers, and to classify the caregivers according to their dedication and efficiency in assisting the patient by correlating them to sociodemographic data. METHODS: Descriptive study performed from October 2004 to October 2005 at UNIFESP outpatient clinics. The study sample consisted of 21 patients and their caregivers. Data were collected through a structured interview. RESULTS: The main caregiver was a family member (95%), usually the spouse. There were 13 women (81%) and three men (19%). Patient age ranged from 24 to 65 years (mean 44.3). Patients were married (56%); catholic (43.8%); 29% have finished elementary school; 24% have finished high school; 14% have higher education; 68.8% have a regular job; and 81.4% had their own income. All caregivers lived in the same house as the patient. Once a score was established, the caregivers were classified as: "good" - 8 (50%); "regular" - 7 (43.7%); and "bad" 1 - (6.3%). The scores were correlated with education, professional activity, and income without any significant statistical correlation. CONCLUSION: It is important to determine the instruments to recognize and describe the caregivers. The caregiver is usually a family member (spouse), female, mean age of 44.3 years; has his/her own income and, most of the time, he/she is classified as "good" or "regular", and no correlation was found with education, professional activity and income. Further studies with a larger sample should establish the relationship between the caregiver's role and the heart transplant outcomes.