Prontuário eletrônico de pacientes: integrando informações clínicas e imagens médicas / Eletronic patient record: integrating clinical information and image data

O Instituto do Coração tem envidado esforços para integrar todas as informações clínicas dentro da Instituição. Nos últimos anos o InCor implementou com sucesso um sistema para transmissão, arquivamento, recuperação, processamento e visualização de Imagens Médicas e um Sistema de Informações Hospitalares (HIS) que armazena as informações administrativas e clínicas. A integração desses subsistemas forma o Prontuário Eletrônico do Paciente (PEP). O InCor é um dos seis Institutos que compõem o Hospital das Clínicas da Universidade de São Paulo. Como cada um dos Institutos possui o seu próprio sistema de informações, a troca de informações entre os Institutos é também uma questão muito relevante. Este trabalho apresenta a experiência no desenvolvimento de um Prontuário Eletrônico funcional e completo, que inclui controle de acesso, exames laboratoriais, imagens (estáticas, dinâmicas e 3D), laudos, documentos e mesmo sinais vitais de tempo real. Este artigo também discute a modelagem e implantação de um protótipo de um PEP distribuído e homogêneo. Atualmente, um volume superior a 2,5 TB de imagens DICOM já foi armazenado utilizando a arquitetura proposta. Diariamente, o PEP armazena mais de 5GB de dados e tem uma quantidade de acessos superior a 300 usuários. O sistema de armazenamento permite uma visibilidade de seis meses para acesso imediato e mais de dois anos para acesso automático utilizando uma jukebox

The Heart Institute (InCor) of São Paulo has been committed to the goal of integrating all clinical information within the institution. In the last few years, InCor has successfully created a system for transmission, archiving, retrieval, processing and visualization of Medical Images and a Hospital Information System (HIS) that stores the institution administrative and clinical information. These integrated subsystems form InCor's Electronic Patient Record (EPR). Since InCor is one of the six institutes of the University of São Paulo Medical School Hospital (HC) and each institute has its own information system, exchanging information among the institutes is also a very important issue. This work describes the experience in the effort to develop a functional and comprehensive EPR, which includes access control, lab exams, images (static, dynamic and 3D), clinical reports, documents and even real-time vital signals. This paper addresses also the design and prototype for integration of distributed and heterogeneous EPR. Currently, more than 2.5 TB of DICOM images, have been stored using the proposed architecture. The EPR stores more than 5 GB/day of data and presents more than 300 hits per day. The proposed storage subsystem allow six months of visibility for rapid retrieval (online mode) and more than two years for automatic retrieval using the jukebox

Standardization of an isolated pig heart preparation with parabiotic circulation: methodological considerations

In the present study we standardized an experimental model of parabiotic circulation of isolated pig heart. The isolated heart was perfused with arterial blood from a second animal as support and submitted to regional ischemia for 30 min, followed by total ischemia for 90 min and reperfusion for 90 min. Parameters for measurement of ventricular performance using different indices measured directly or indirectly from intraventricular pressure were defined as: maximum peak pressure, final diastolic pressure, pressure developed, first derivative of maximum pressure (dP/dt max), first derivative of minimum pressure (dP/dt min), systolic stress of the left ventricle (sigmas), and maximum elastance of the left ventricle. Isolated hearts subjected to regional and global ischemia presented significant worsening of all measured parameters. Less discriminative parameters were dP/dt max and dP/dt min. Elastance was the most sensitive parameter during the reperfusion period, demonstrating an early loss of ventricular function during reperfusion. The model proved to be stable and reproducible and permitted the study of several variables in the isolated heart, such as ischemia and reperfusion phenomena, the effects of different drugs, surgical interventions, etc. The model introduces an advantage over the classical models which use crystalloid solutions as perfusate, because parabiotic circulation mimics heart surgery with extracorporeal circulation

Standardization of an isolated pig heart preparation with parabiotic circulation: methodological considerations.

In the present study we standardized an experimental model of parabiotic circulation of isolated pig heart. The isolated heart was perfused with arterial blood from a second animal as support and submitted to regional ischemia for 30 min, followed by total ischemia for 90 min and reperfusion for 90 min. Parameters for measurement of ventricular performance using different indices measured directly or indirectly from intraventricular pressure were defined as: maximum peak pressure, final diastolic pressure, pressure developed, first derivative of maximum pressure (dP/dt max), first derivative of minimum pressure (dP/dt min), systolic stress of the left ventricle (sigmas), and maximum elastance of the left ventricle. Isolated hearts subjected to regional and global ischemia presented significant worsening of all measured parameters. Less discriminative parameters were dP/dt max and dP/dt min. Elastance was the most sensitive parameter during the reperfusion period, demonstrating an early loss of ventricular function during reperfusion. The model proved to be stable and reproducible and permitted the study of several variables in the isolated heart, such as ischemia and reperfusion phenomena, the effects of different drugs, surgical interventions, etc. The model introduces an advantage over the classical models which use crystalloid solutions as perfusate, because parabiotic circulation mimics heart surgery with extracorporeal circulation.

Marcapasso responsivo com resposta cronotrópica inesperada / Rate-responsive pacemaker with an unexpected chronotropic response

Os marcapassos responsivos foram um grande avanço na estimulaçäo cardíaca, contudo, a escolha de um biossensor fisiológico adequado é objeto de muito estudo. Mulher de 35 anos com marcapasso responsivo devido a bloqueio atrioventricular total (BAVT) secundário a correçäo de comunicaçäo interventricular deu entrada com insuficiência cardíaca (IC) e estimulaçäo peitoral importante na loja do marcapasso, que levou a interpretaçäo errônea, causando IC. Uma soluçäo paliativa foi tomada até o fim da gestäo, dimunuindo-se a sensibilidade do biossensor.