Aorta Related and All-cause Mortality in Patients with Aortic Intramural Haematoma.

OBJECTIVES: The prognosis of patients with intramural haematoma (IMH) of the aorta beyond the first year after diagnosis remains largely unknown. In particular, patients that do not undergo interventions are lost to follow-up. The aim was to assess medium-term outcome in IMH patients. METHODS: Post hoc analysis of 63 consecutive patients presenting with IMH between 1999 and 2013 was performed. Patients meeting imaging criteria at the first presentation were included even if follow-up imaging showed evidence of intimal disruption or false lumen flow. RESULTS: Eighteen patients presented with type A and 45 with type B IMH (29% vs. 71%, p < .001). The mean age was 71 ± 9.2 years, range 42-88 years. Follow-up was completed in 97% of patients by May 2017 and represents a mean follow-up of 6.3 ± 3.6 years. Freedom from intervention in patients with type B IMH was 40%. TEVAR was performed in 47% because of development, unmasking of an entry tear (57%), progression to acute type B dissection (24%), or subsequent dilation of the affected aortic segments (19%). Open repair was performed in 13% of type B IMH patients because of dilation of the descending aorta. In type A IMH, 89% underwent open repair. Aorta related 30 day, 6 month, 1 year, and late mortality were 1.6%, 6.3%, 6.3%, and 9.5%, respectively, for all IMH patients. All-cause 30 day, 6 month, 1 year, and late mortality were 1.6%, 6.3%, 6.3%, and 47.6%, respectively, for all IMH patients. Late mortality in type B IMH did not differ whether patients underwent TEVAR, open repair, or received best medical treatment only (26% vs. 22%, p = 1.0). CONCLUSIONS: Late aorta related mortality in IMH was low whereas all-cause mortality was substantial. Aorta related mortality in IMH patients only occurs during the first year after diagnosis. Interventions after the first year are rarely necessary.

Monitorizaçäo da transmissäo neuromuscular / Monitoring neuromuscular transmission

As primeiras tentativas de avaliar o bloqueio neuromuscular residual em seres humanos foram baseadas na observaçäo de sinais clínicos, e na verificaçäo de parâmetros respiratórios como volume-minuto, capacidade vital e força inspiratória máxima. No entanto, o melhor método para monitorizar a transmissäo neuromuscular é a estimulaçäo de um nervo motor periférico e a mensuraçäo da resposta evocada no músculo por ele inervado. As principais características de um estimulador de nervo periférico, tais como freqüência, duraçäo e forma do pulso, voltagem e intensidade da corrente, bem como as características de conexäo entre o paciente e o estimulador como o tipo de polaridade do eletrodo, e o local de sua colocaçäo no paciente säo revistos. Säo discutidas as informaçöes que podem ser obtidas pela estimulaçäo do nervo ulnar ou eventualmente por outro nervo periférico, de modo visual ou táctil, ou através de registros eletromecânicos ou de eletromiografia. As interpretaçöes clínicas dessas informaçöes säo também analisadas

Erros de medida dos esfigmomanômetros / Measurement errors of sphygmometers

O artigo busca despertar a comunidade médica sobre os possíveis problemas envolvendo erros de medidas de pressão arterial nos hospitais brasileiros, provocados pela falta de procedimetos de calibração dos esfignomanômetros. Também apresenta a pesquisa desenvolvida no Hospital São Vicente de Paulo de Passo Fundo (HSVP), e em outros dois hospitais da região, que mostrou dados referentes aos tipos de erros encontrados. Por fim, demonstra que é possível diminuir este problema, adotando-se um procedimento metrologicamente correto para a calibração destes esfigmomanômetros.

Abstract - This article wish to wake up the medical community to beware of troubles about blood presure measure into brazilians hospitais caused by the absence of the sphygmomanometers proceduring calibration. Also shows a research developed into the Hospital São Vicente de Paulo of Passo Fundo, RS (HSVP), as well into the two others hospital around this regions, that showed the types of the errors are founded. Finally, the work demonstrate that is possible to avoid this problem, adopting correct metrological sphygmomanometers proceduring calibration