RESUMO
Stickler syndrome (SS) is a congenital autosomal dominant condition that affects the formation of collagen. Of primary importance to the anesthesia provider is the propensity for difficulties in managing the airway due to orofacial abnormalities associated with this syndrome. The authors present a two-year-old infant with SS who required anesthetic care for a cleft palate repair. The potential anesthetic implications of this syndrome are discussed and the importance of proper planning and preparation and the usefulness of ultrasound as an airway evaluation tool are highlighted.
RESUMO
Abstract Factor X deficiency ranks among the rarest coagulopathies and has a variable presentation spectrum. We intend to present a proposal for anesthesia protocol for individuals with the coagulopathy. The excision of an ovarian neoplasm was proposed for a 26-year-old, female, ASA II patient, with congenital Factor X deficiency. Physical examination and lab tests were normal, except for Prothrombin Time (PT) 22.1s (VR: 8-14s), International Normalized Ratio (INR) 1.99 (VR: 0.8-1.2) and Activated Partial Thromboplastin Time (aPTT) 41.4s (VR: 25-37s). We concluded that a history of bleeding should always be investigated, along with a pre-anesthetic coagulation study.
Assuntos
Humanos , Feminino , Adulto , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/etnologia , Deficiência do Fator X/complicações , Anestesia/efeitos adversos , Tempo de Tromboplastina Parcial , Tempo de ProtrombinaRESUMO
Factor X deficiency ranks among the rarest coagulopathies and has a variable presentation spectrum. We intend to present a proposal for anesthesia protocol for individuals with the coagulopathy. The excision of an ovarian neoplasm was proposed for a 26-year-old, female, ASA II patient, with congenital Factor X deficiency. Physical examination and lab tests were normal, except for Prothrombin Time (PT) 22.1s (VR: 8-14s), International Normalized Ratio (INR) 1.99 (VR: 0.8-1.2) and Activated Partial Thromboplastin Time (aPTT) 41.4s (VR: 25-37s). We concluded that a history of bleeding should always be investigated, along with a pre-anesthetic coagulation study.
Assuntos
Anestesia , Transtornos da Coagulação Sanguínea , Deficiência do Fator X , Feminino , Humanos , Adulto , Deficiência do Fator X/complicações , Tempo de Protrombina , Tempo de Tromboplastina Parcial , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/etiologia , Anestesia/efeitos adversosRESUMO
Background: Recurrent ascites is a late manifestation of several diseases, including cancer, cirrhosis, and heart failure, invariably associated with very poor prognosis. Hence, every effort must be aimed at reducing discomfort and side effects of its management. Objective: To evaluate if peritoneal catheters (PCs) are a viable alternative treatment approach in palliative patients who fail medical management of ascites. Design: Case study. Results: We report the case of a terminal patient with cirrhosis and hepatocellular carcinoma who presented refractory ascites despite serial large-volume paracentesis. A Tenckhoff percutaneous catheter was inserted, allowing for ascites' control and with no complications noted. Conclusions: PC placement was successful in controlling the patient's symptoms and ultimately improved comfort and well-being during the final stage of his life. This option should be assessed in selected patients to elevate palliative standards of care.
Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Cuidados Paliativos , Ascite/etiologia , Ascite/terapia , Cateteres de Demora , Humanos , ParacenteseRESUMO
Patients requiring renal replacement therapy remain a significant burden on the healthcare system. A substantial amount of hospitalization costs for these patients are related to vascular complications, especially catheter-related thrombosis, which is associated with a significant increase in morbidity and mortality. We report the case of a male patient with multiple myeloma (MM) and dialysis-dependent renal failure due to light-chain cast nephropathy, who presented recurrent early catheter dysfunction. A large thrombus was detected, extending from the superior vena cava (SVC) to the right atrium (RA) and later at the inferior vena cava (IVC), ultimately leading to exhaustion of vascular capital. To this date, there is limited evidence regarding the best approach to catheter-related thrombosis, which frequently leads to treatment dilemmas in clinical practice and demands careful evaluation and individualized decisions. In patients with a highly thrombotic profile, peritoneal dialysis may be considered earlier to prevent further vascular capital damage.
RESUMO
The residual renal function (RRF) in a peritoneal dialysis (PD) patient is clinically important because it contributes to dialytic adequacy, quality of life and mortality. We present the case of a patient in PD with a marked decrease in RRF. Even after the increase of dialysis, the patient maintained asthenia and anorexia, was prostrate and showed no improvement analytically. The study revealed hypothyroidism, iatrogenic due to the use of amiodarone. After suspension of the drug and replacement with levothyroxine, there was a normalization of thyroid function and recovery of RRF to baseline values. A thyroid dysfunction is associated with several changes in renal function, in most cases reversible after obtaining euthyroid state. The association between thyroid dysfunction and loss of RRF continues to be under-recognized. We should consider monitoring thyroid function annually as routine in this group of patients.
Assuntos
Hipotireoidismo/complicações , Falência Renal Crônica/etiologia , Diálise Peritoneal , Amiodarona/efeitos adversos , Progressão da Doença , Taxa de Filtração Glomerular , Humanos , Hipotireoidismo/induzido quimicamente , Hipotireoidismo/diagnóstico , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Bloqueadores dos Canais de Sódio/efeitos adversosRESUMO
Acute kidney injury (AKI) is a global problem which predicts immediate and long-term adverse outcomes. We evaluated the AKI progression to end-stage renal disease, as well as the mortality associated with AKI and the in-hospital readmission rate because of a cardiovascular event in AKI patients admitted in a nephrology ward. A 5-year retrospective study was set in a nephrology department, with a follow-up period of up to 8 years. In a total of 191 patients, mean age was 73.83 ± 12.49 years, and 137 (71.7%) patients had history of chronic kidney disease. One hundred and twenty-four (65%) patients needed RRT and two (1%) needed surgery. Upon discharge, 107 (56%) patients had recovered the renal function, 41 (21.6%) patients had partial recovery, 25 (13%) patients were RRT dependent, 16 (8.4%) died, and two (1%) patients had outcomes unknown to us, because they were transferred to other hospitals. The median survival time free of RRT was 74 months. The median survival time of the followed patients was 34 months (95% CI 23.3-44.7). The mortality rate in the follow-up period in this sample was 18 deaths/100 patients-years, and the incidence of a composite cardiovascular endpoint of heart failure, acute coronary syndrome, and stroke was 6 events/100 patients-years. The mortality rate in the follow-up period was higher than usually described for patients outside intensive care unit, probably because our patients were old and had many comorbidities.
Assuntos
Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/terapia , Doenças Cardiovasculares/epidemiologia , Falência Renal Crônica/etiologia , Nefrologia , Síndrome Coronariana Aguda/epidemiologia , Injúria Renal Aguda/complicações , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Insuficiência Cardíaca/epidemiologia , Unidades Hospitalares , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Terapia de Substituição Renal , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Taxa de Sobrevida , Resultado do TratamentoAssuntos
Humanos , Água Potável , Dieta , Incêndios , Eliminação de Resíduos de Serviços de Saúde , Risco , Gestão da Segurança , Abastecimento de Água , Clima , Fontes Geradoras de Energia , Equipamentos e Provisões Hospitalares , Gases , Gerenciamento de Resíduos/história , Gerenciamento de Resíduos/legislação & jurisprudência , Administração de Materiais no Hospital , Mercúrio/toxicidade , Notificação , Saúde Ocupacional , Fatores de Risco , Resíduos de Serviços de Saúde/classificação , VentilaçãoRESUMO
Objetivo: realizar a adaptação e validação do conteúdo da secção I da escala ôAssessment of PeerRelationsõ û Avaliação das Relações com Pares para o idioma Português. Método: a secção I foi traduzidae retro traduzida por tradutores experientes. A versão de consenso resultante desta tradução foi utilizadaem dois estudos piloto que indicaram a necessidade de melhoramentos linguísticos. Realizadas asalterações necessárias, reuniu-se um painel com oito peritos û investigadores na área da intervençãoprecoce e das interações sociais û que procedeu à discussão aprofundada de cada um dos itens secção I.Resultados: todo o processo inerente a este estudo revelou-se de extrema importância para a exploraçãoaprofundada da secção I e para a realização de todas as alterações consideradas necessárias para quea escala possa ser funcional e aplicável na Língua e Cultura Portuguesas. Conclusões: o processo deinvestigação permitiu atingir o objetivo delineado e, assim, foi possível adaptar e validar, para o idiomaportuguês, o conteúdo da secção I da escala Assessment of Peer Relations û Avaliação das Relações comPares.