RESUMO
INTRODUCTION: Patients with heart failure frequently develop renal failure, which increases the mortality rate among patients undergoing cardiac transplantation. PURPOSE: To determine whether preoperative renal function influenced postoperative mortality in cardiac transplantation recipients. MATERIALS AND METHODS: The measurements of plasma urea, plasma creatinine, and 24-hour creatinine clearance in patients who underwent cardiac transplantation were correlated with mortality at 30, 90, and 365 days after the procedure, using Student t test for continuous variables and the chi-square test for categorical variables. RESULTS: All variables correlated with mortality, particularly plasma creatinine at 30, 90, and 365 days (P =.029,.003, and.0029, respectively). CONCLUSION: Preoperative renal failure is a mortality indicator in cardiac transplantation recipients.
Assuntos
Transplante de Coração/mortalidade , Insuficiência Renal/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/mortalidade , Insuficiência Renal/mortalidade , Estudos RetrospectivosRESUMO
The mutilant nature of the mucosal form of leishmaniasis can cause alterations in personal relations. To identify the level of understanding of leishmaniasis and the psychological reaction to it patients and houseowners in an endemic area of Bahia were interviewed. Several false beliefs were identified and there was a strong tendency to reject mutilated patients among the population for a false fear of contagion. Possibly future clarification of the real nature of leishmaniasis could change such a negative attitude among the resident population.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Leishmaniose Mucocutânea/psicologia , Rejeição em Psicologia , Brasil/epidemiologia , Humanos , Leishmaniose Mucocutânea/epidemiologiaRESUMO
Isosorbide mononitrate in a dose of 20 mg t.i.d. was used in 25 patients admitted few hours after acute myocardial infarction. The following parameters were analysed: systolic and diastolic blood pressure, heart rate, clinical features, and laboratory data. Heart rate and diastolic blood pressure remained unchanged, however systolic blood pressure was slightly reduced (p less than 0.01). There was a reduction in the angina episodes post-AMI. None of the patients included in the study had clinical deterioration or showed infarction extension. There were no changes in laboratory data. After the interruption of the drug, one patient died on the 6th day with acute mitral insufficiency. In conclusion, isosorbide mononitrate can be safely used during an uncomplicated acute myocardial infarction, without the risk of haemodynamic deterioration, and helps to prevent post-infarction angina.
Assuntos
Dinitrato de Isossorbida/análogos & derivados , Infarto do Miocárdio/tratamento farmacológico , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Dinitrato de Isossorbida/administração & dosagem , Dinitrato de Isossorbida/uso terapêutico , Masculino , Pessoa de Meia-IdadeRESUMO
A male 54 years-old patient with infective endocarditis through Staphylococcus aureus with prosthesis of Starr-Edwards aortic with clinical and echocardiographic signs compatible with dysfunction classified as severe. The x-ray images presented double silhouette of the prosthesis, thus suggesting its partial dehiscence. This case report points out that the detailed analysis of the X-ray may supply relevant data for the diagnosis of one of this complication thus influencing on management and prognosis.
Assuntos
Endocardite Bacteriana/diagnóstico por imagem , Próteses Valvulares Cardíacas , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Endocardite Bacteriana/fisiopatologia , Endocardite Bacteriana/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , RadiografiaRESUMO
Five patients who had permanent pacemaker and infective endocarditis were analyzed. Diagnose was confirmed by a positive blood cultures in all patients and 2 of them had identifiable vegetation in the echocardiogram too. The etiologic agent was Staphylococcus aureus in 3, Staphylococcus epidermidis in 1 and Staphylococcus viridans in 1. Three patients were treated with antibiotics alone: one had no clinical conditions to be operated, one died before surgery and one had good response to antimicrobial therapy alone. Two patients were submitted to antibiotic therapy and surgical removal of the pacemaker system, without complications. It was concluded that the surgical removal of the pacemaker system, as soon as possible, is the choice's therapy.
Assuntos
Endocardite Bacteriana/microbiologia , Infecções Estafilocócicas/microbiologia , Infecções Estreptocócicas/microbiologia , Adulto , Idoso , Ecocardiografia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/terapia , Staphylococcus aureus , Staphylococcus epidermidis , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/terapia , StreptococcusRESUMO
Two patients with chronic valvular heart disease and myocardial infarction were assisted at our hospital. Both of them were febrile and only one had petechiae associated with signs of valvular involvement led to suspicion of infective endocarditis. Although blood cultures were negative, echocardiographic, surgical and anatomopathologic findings were compatible with infective endocarditis. They required cardiac surgery during the acute phase of the infection because they presented progressive hemodynamic deterioration and no satisfactory response to antimicrobial regimen too. One patient died at late follow-up (two weeks after the hospital discharge) and the other survived, but with signs of cardiac failure (class II of NYHA) one year after the procedure.
Assuntos
Endocardite Bacteriana/complicações , Infarto do Miocárdio/etiologia , Adolescente , Idoso , Trombose Coronária/complicações , Eletrocardiografia , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/fisiopatologia , Feminino , Humanos , Masculino , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/fisiopatologia , CintilografiaRESUMO
A male patient, six years old, with mitral valve endocarditis presented with pseudoaneurysm of the right femoral artery. He was submitted to surgical treatment with reconstruction of the artery with good outcome.
Assuntos
Aneurisma Infectado/etiologia , Endocardite Bacteriana Subaguda/complicações , Artéria Femoral , Valva Mitral , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/cirurgia , Angiografia Digital , Criança , Embolia/etiologia , Artéria Femoral/cirurgia , Humanos , MasculinoRESUMO
PURPOSE: To assess infective endocarditis (IE) predisposing factors, etiologic agents and hospital course in infants and adolescents. METHODS: We Studied 222 patients admitted under compatible IE diagnosis, from 1985 to 1990. The population of this study is fifty patients (23%) under 16 years of age. RESULTS: Rheumatic valvular disease, as predisposing cardiopathy was proeminent within 9 to 16 years of age, markedly Statistical difference when compared to age range of 0 to 8 years (p < 0.05). Among congenital cardiopathies, the most frequent were: interventricular septal defect (26.0%) and tetralogy of Fallot (21.7%). Blood cultures, surgical material or emboli cultures were positive in 35 (70.0%) assessed patients. Streptococcus viridans (45.7%) and Staphylococcus aureus (42.8%) were the etiologic agents most often isolated. It was found that endocarditis by Staphylococcus aureus had mortality rate of 53.3% [(clinical (66.6%) and surgical (44.4%)], (p < 0.05) when compared to those by Streptococcus viridans; with total mortality of 6.2% (no clinical death and 16.6% in the surgical group). Total in-hospital mortality (clinical and surgical) was 26.0% (13 deaths). CONCLUSION: IE in infants and adolescents in this studied population presented Streptococcus viridans responsible for 46.7% of patients with endocarditis and the Staphylococcus aureus for 42.8% were the etiologic agents most often found. Total, clinical and surgical mortality was greater in patients with endocarditis by Staphylococcus aureus when compared with those by Streptococcus viridans. Among the congenital cardiopathies, whether operated on or not, ventricular septal defect and of Fallot's tetralogy were the most involved ones; rheumatic cardiopathy Still remains a significant predisposing factor to infective IE in our country.