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Resumen: Los asfaltenos son mezclas ultracomplejas que impactan negativamente la refinación, producción y transporte del petróleo. El interés en su estudio abarca desde su caracterización para definir su estructura molecular, hasta la comprensión de su comportamiento interfacial. Los asfaltenos presentan una gran diversidad de grupos funcionales y diferentes tipos de asociaciones como las de tipo no covalentes, enlaces de hidrógeno, complejo de coordinación e interacciones entre núcleos aromáticos paralelos. El objetivo de este trabajo fue analizar la composición presente en asfaltenos extraídos de crudos pesados y extrapesados mediante espectroscopía derivada. Se prepararon soluciones de asfaltenos en el rango de concentración de 20 mg/L a 100 mg/L y se analizaron con espectroscopía UV-Vis. La selección de los espectros de orden cero para el procesamiento se realizó con base en la nitidez presente. Los espectros fueron procesados con OriginPro 8.5, para la obtención de espectros derivados de primer y segundo orden. El procesamiento de los espectros de orden cero fue realizado con los filtros Savitsky-Golay y transformada rápida de Fourier (FFT). Los espectros derivados obtenidos presentaron señales nítidas con presencia de poco ruido, lo que hizo posible la identificación de grupos funcionales aromáticos, de 1 a 4 anillos en el rango de longitudes onda de 200 nm a 450 nm. El uso de filtros mejoró la calidad de las señales y permitió la identificación de componentes y estructuras presentes en asfaltenos. El filtro de Savitsky-Golay incrementó la resolución de los espectros derivados de asfaltenos extraídos de crudos pesados y el filtro FFT de asfaltenos de crudos extrapesados. Se observaron diferencias morfológicas entre los asfaltenos extraídos de crudos pesados y extrapesados mediante SEM, que pueden ser relacionadas con la composición y estructuras aromáticas presentes en asfaltenos.
Abstract: Asphaltenes are ultra-complex mixtures that negatively impact oil refining, production and transportation. The interest in its study ranges from its characterization to define its molecular structure, to the understanding of its interfacial behavior. Asphaltenes present a great diversity of functional groups and different types of associations such as non-covalent ones, hydrogen bonds, coordination complexes and interactions between parallel aromatic nuclei. The objective of this work was to analyze the composition present in asphaltenes extracted from heavy and extra-heavy crude oils using derivative spectroscopy. Asphaltene solutions were prepared in the concentration range of 20 mg/L to 100 mg/L and analyzed with UV-Vis spectroscopy. The selection of zero-order spectra for processing was made based on the sharpness present. The spectra were subsequently processed with OriginPro 8.5, to obtain first and second-order derived spectra. The processing of the zero order spectra was performed with the Savitsky-Golay and Fast Fourier transform (FFT) filters. The derived spectra obtained presented clear signals with the presence of little noise, which made possible the identification of aromatic functional groups, from 1 to 4 rings in the wavelength range of 200 nm to 450 nm. The use of filters improved the quality of the signals and allowed the identification of components and structures present in asphaltenes. The Savitsky-Golay filter increased the resolution of the spectra derived from asphaltenes extracted from heavy crude oils and the FFT filter increased the asphaltenes extracted from heavy crude oils. Morphological differences between asphaltenes extracted from heavy and extra-heavy crude oils were observed by SEM, which maybe related to the composition and aromatic structures present in asphaltenes.
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Objective:To evaluate the clinical efficacy of individualized thrombolysis-assisted comprehensive intervention for deep vein thrombosis (DVT) in the lower limbs.Methods:This study included 32 patients with acute lower limb DVT diagnosed by angiography who received treatment at the Jianhu Clinical Medical College of Yangzhou University from March 2012 to November 2021. These patients first received implantation of an inferior vena cava filter. Then they were divided into a control group and an observation group based on treatment methods. The control group received thrombolytic catheterization and a routine infusion of urokinase. In the observation group, balloon dilation was performed first, and a large lumen catheter was used to draw blood clots. Subsequently, urokinase at a dose based on fibrinogen measurement was injected through a thrombolytic catheter. Swelling reduction, venous patency, and complications of the affected limbs were monitored.Results:In the control group, the difference in thigh circumference before treatment was (4.65 ± 1.06) cm, and after treatment, it was (2.76 ± 1.25) cm. In the observation group, the difference in thigh circumference before treatment was (4.73 ± 1.03) cm, and it was (1.40 ± 0.83) cm after treatment. In the control group, the difference in calf circumference before treatment was (2.24 ± 0.90) cm, and it was (1.56 ± 0.86) cm after treatment. In the observation group, the difference in calf circumference before treatment was (2.40 ± 0.83) cm, and it was (0.80 ± 0.73) cm after treatment. After treatment, the differences in thigh circumference and calf circumference between the healthy and affected sides were statistically significant ( t = 3.58, 2.67, both P < 0.05). After treatment, there was a significant difference in venous patency between the control and observation groups (34.02% [33/97] vs. 68.18% [60/88], t = 3.44, P < 0.05). After 12 months of follow-up, the Villalta scale score, which was used to evaluate post-thrombotic syndrome, was (9.23 ± 4.07) points in the control group, which was significantly different from (5.73 ± 3.39) points in the observation group ( t = 2.62, P < 0.05). Conclusion:Individualized thrombolysis-assisted comprehensive intervention is highly effective in the treatment of DVT in the lower limbs and results in few complications.
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Resumo Trombose venosa profunda é uma das principais causas de morbidade hospitalar e ambulatorial, seja em pacientes clínicos, seja em pacientes cirúrgicos, impactando significativamente nas estatísticas de mortalidade, exigindo um diagnóstico rápido para que se institua de forma imediata o tratamento. O presente documento foi preparado e revisado por onze especialistas certificados pela Sociedade Brasileira de Angiologia e Cirurgia Vascular, que buscaram nas principais bases de dados as melhores evidências referentes à abordagem diagnóstica (exame físico, exames de imagem) e terapêutica (heparina, cumarínicos, anticoagulantes orais de ação direita, fibrinolíticos) da doença.
Abstract Deep vein thrombosis is one of the main causes of inpatient and outpatient morbidity, both in medical and surgical patients, significantly impacting mortality statistics and requiring prompt diagnosis so that treatment can be initiated immediately. This document was prepared and reviewed by 11 specialists certified by the Brazilian Society of Angiology and Vascular Surgery, who searched the main databases for the best evidence on the diagnostic (physical examination, imaging) and therapeutic approaches (heparin, coumarins, direct oral anticoagulants, fibrinolytics) to the disease.
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En el Centro de Inmunología Molecular se producen el ingrediente farmacéutico activo y la materia prima biológica empleados para la formulación de las vacunas SOBERANAS®. El antígeno de estas vacunas es la proteína del dominio de unión al receptor del coronavirus tipo 2 del síndrome respiratorio agudo severo. La producción de esta proteína recombinante se basa en el cultivo de células de ovario de hámster chino en biorreactores tipo tanque agitado. El proceso tecnológico a escala industrial consta de varias etapas: preparación de medios de cultivo y soluciones, fermentación, clarificación de sobrenadante y purificación. En los procesos biotecnológicos derivados de líneas celulares de origen animal, la contaminación viral endógena o adventicia constituye un riesgo potencial. Por tal motivo, en el proceso de purificación se emplea un paso específico para la remoción viral mediante la nanofiltración. Los nanofiltros empleados son materiales desechables que influyen significativamente en el costo del proceso. Actualmente se desconoce la capacidad de procesamiento de los nanofiltros en el proceso de purificación en cuestión, siendo el objetivo de la presente investigación con vistas a reducir los costos de producción. Se determinó la capacidad de procesamiento de los filtros Virosart CPV, siendo de 239,74 g/m2 (71,67 por ciento de saturación) y 1.259 g/m2 (67,82 por ciento de saturación) para la especie dímero y la mezcla, respectivamente. Se determinó la disminución del costo de producción de la etapa de nanofiltración, que representa una disminución del 54,85 por ciento del costo de filtración de la especie dímero y un 25 por ciento de la mezcla(AU)
The active pharmaceutical ingredient and the biological raw material, used for the formulation of the SOBERANA® vaccines, are produced at the Molecular Immunology Center. The antigen of these vaccines is the receptor-binding domain protein of the severe acute respiratory syndrome type 2 coronavirus. The production of this recombinant protein is based on the culture of Chinese hamster ovary cells in stirred tank bioreactors. The technological process on an industrial scale consists of several stages: preparation of culture media and solutions, fermentation, clarification of supernatant and purification. In biotechnological processes derived from cell lines of animal origin, endogenous or adventitious viral contamination is a potential risk. For this reason, a specific step for viral removal by nanofiltration is used in the purification process. The nanofilters used are disposable materials that significantly influence the cost of the process. The processing capacity of the nanofilters in the purification process in question is currently unknown, being the objective of the present investigation with a view to reducing production costs. The processing capacity of the Virosart CPV filters was determined to be 239.74 g/m2 (71.67percent saturation) and 1,259 g/m2 (67.82percent saturation) for the dimer species and the mixture, respectively. The decrease in the production cost of the nanofiltration stage was determined, representing a 54.85percent decrease in the filtration cost for the dimer species and a 25percent decrease for the mixture(AU)
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Humans , Membrane Filtration , Nanopores/ultrastructure , SARS-CoV-2 , Vaccinesالملخص
Resumen Se presenta el caso de un paciente con enferme dad tromboembólica venosa y contraindicación de anticoagulación en el cual se halló incidentalmente una duplicación de vena cava inferior, situación que determinó la necesidad del implante de dos filtros de protección embólica. Si bien esta anomalía vascular es de escasa presentación, es importante tener presente esta posibilidad para asegurarse de brindar una co rrecta protección a la hora del implante de filtros de vena cava inferior.
Abstract We present the case of a patient with venous throm boembolic disease and contraindication to anticoagu lation, where the incidental finding of a duplication of the inferior vena cava was made. This observation determined the need to implant two embolic protection filters. Although this vascular anomaly is rarely present, it is important to keep this possibility in mind to ensure that proper protection is provided when inferior vena cava filters are implanted.
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ABSTRACT This work is a critical review of the current understanding of the effect of ultraviolet radiation on the eye. It deals with the classification of this radiation, environmental level, and the factors that determine it, along with penetration into the human eye, toxicity to ocular structures, associated morbidities, events that may increase the vulnerability of the eye, and artificial eye filters.
RESUMO Esta é uma revisão crítica do efeito da radiação ul travioleta no olho. Trata da classificação dessa radiação, nível no meio ambiente e os fatores que o determinam, penetração no olho humano, toxicidade às estruturas dos oculares, morbidades associadas, eventos passíveis de aumentar a vulnerabilidade do olho e filtros oculares artificiais. Discute, ainda, o risco real dessas radiações ao olho humano à luz do conhecimento atual.
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ABSTRACT Inferior vena cava filter embolization is not uncommon and can reach 11.8%. However, device migration to the heart is not frequent and occurs in cases after inferior vena cava filter fracture. We present the case of a young woman who was submitted to a routine inferior vena cava filter placement three days before and presented with hemodynamic instability. Since the device was not retrievable, the surgical team opted for an open cardiac surgery under cardiopulmonary bypass to remove the inferior vena cava filter and avoid other further complications.
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Abstract Introduction The isolation of captured peripheral blood mononuclear cells (PBMNCs) from leukoreduction filters (LRFs) can be of great importance in terms of bringing the lost cells back into use. Objective The aim of this study was to evaluate various methods based on their potential to recover the peripheral blood cells from LRFs with a focus on mononuclear cells (MNCs). Method For cell isolation from LRFs, three distinct methods (back-flushing, direct and vacuum pump) were compared through the calculation of the yield of isolated MNCs. The viability of extracted cells was determined by the flow cytometry technique. Moreover, the recovered MNCs were characterized regarding the presence of blood stem cell purification. The cell culture, microscopic observation, and immunophenotyping were employed to characterize the blood stem cells (hematopoietic, mesenchymal and progenitor endothelial stem cells). Results The yield of isolation obtained in the back-flushing, direct and vacuum pump methods were 17.7 ± 1.28, 17.3 ± 0.96 and 21.2 ± 0.90 percent, respectively. Although the highest potential for total blood cell recovery belonged to the vacuum pump method, the lowest cell viability (85.73 ± 4.84%) was observed in this method. However, the isolation process of the back-flushing and direct methods had less effect on cell viability. The characterization of the isolated MNCs displayed that the dominant positive phenotype was for CD34/CD45, indicating hematopoietic stem cells. In addition, the endothelial stem/progenitor cells were significantly detected as CD31/CD133 positive cells. Conclusion According to our results and considering the safety and efficiency potential of each of the applied methods, the back-flushing in comparison with the other methods can be considered a suitable procedure for MNC isolation from LRFs.
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Leukocytes, Mononuclear , Cell Separation , Peripheral Blood Stem Cells , Blood Cell Count , Flow Cytometryالملخص
Objective:To evaluate the effectiveness and safety of the home-made umbrella-shaped Octoparms inferior vena cava filter in the prevention of pulmonary embolism.Methods:A multicenter, randomized, positive parallel controlled, non-inferiority clinical trial was conducted in ten hospitals in China from October 2017 to March 2019. A total of 188 subjects were enrolled according to the same inclusion and exclusion criteria in different institutes. The 188 subjects were randomly divided into the trial group or the control group according to 1∶1 by the central randomization system, with 94 cases in each group. Octoparms inferior vena cava filter was used in the trial group, and the Celect inferior vena cava filter in the control group. The primary effective index was clinical success rate,including the clinical success rate of filter placement and filter retrieval. The secondary index included the rate of manual success of the delivery sheath system,incidence of pulmonary embolism(within 6 months), incidence of filter fracture,migration (>20 mm),tilt(>15°) on insertion/retrieval,and the situation of inferior vena cava flow(within 6 months). Safety evaluation included the incidence of filter related complications and device-related adverse events immediately after surgery and during follow-up.Results:The success rate of implantation was 100% in 188 subjects. Filter retrieval was performed in 87 cases (92.55%) in the trial group and 91 cases (96.81%) in the control group. The clinical success rate of the trial group was 97.87%(92/94) and that of the control group 98.94%(93/94). There was no significant difference between the two groups (χ 2=0.77, P=0.380). The success rate of delivery sheath system was 96.81%(91/94) and 98.94%(93/94) in the trail group and the control group,respectively. There was no significant difference between the two groups( P=0.621). There was 1 case (1.22%) of new asymptomatic pulmonary embolism in the trial group after filter placement and 2 cases (2.44%) in the control group. There was no significant difference between the two groups ( P>0.05). No filter fracture or migration (>20 mm) occurred in either group. The tilting of filter (>15°) was found in 1 case (1.06%) in the test group and 1 case (1.06%) in the control group when the filter was placed. The tilting of filter (>15°) was found in 0 case in the test group and 2 cases (2.44%) in the control group when the filter was retrieved. There was no significant difference between the two groups ( P>0.05). Inferior vena cava thrombosis before filter retrieval was found in 5 cases (5.75%) in trial group and 3 cases (3.30%) in control group. There was no significant difference between the two groups ( P=0.489). There were no immediate serious complications during filter placement/removal in either group. No filter obstruction,migration,deformation,penetration and occlusion of inferior vena cava. The incidence of device-related adverse events was low in both group. There was no significant difference between the two groups ( P>0.05). Conclusion:The home-made umbrella-shaped Octoparms inferior vena cava filter is effective and safe in preventing pulmonary embolism, and is not worse than Celect filter.
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ABSTRACT Introduction: Peripheral blood leukocytes are a suitable cell model for science research. However, blood samples from healthy volunteers are limited in volume and difficult to obtain due to the complexity of volunteer recruitment. Objective: Therefore, it is urgent to find an alternative source of peripheral blood leukocytes. Method: One of the possibilities is the use of leukocyte reduction filters (LRFs) in blood banks that is used for preparation of leukoreduced blood products. More than 90% of the leukocytes are trapped in the leukofilters allowing the desired blood product to pass through. Results: It has been reported that the biological function of leukocytes collected from the filters are no different from those isolated from buffy coats, leukapheresis products and whole blood (WB) cells. Moreover, LRFs are waste products that are discarded after leukoreduction. Conclusion: Thus, leukofilters represent an economic source of human cell populations that can be used for a variety of investigative purposes, with no cost. In the present study, we reviewed the different usage of LRFs in the research, clinical and commercial applications.
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Leukocyte Reduction Procedures , Leukocytesالملخص
Percutaneous procedures through femoral access in patients with inferior vena cava (IVC) filter may be at risk of complications. We evaluated the feasibility and safety of left atrial appendage closure (LAAC) through femoral access in patients previously implanted with IVC filter. We described the WatchmanTM device implantation in two patients with formal contraindication for oral anticoagulation. First patient had a GreenfieldTM filter and the second one an OpteaseTM filter, and in this patient an attempt to withdrawal the filter immediately before the LAAC procedure failed. A femoral approach was performed in both patients using a 14 Fr sheath. Before crossing IVC filters, venographies did not detect any thrombus. All steps of IVC filter crossing were performed under fluoroscopic guidance. No immediate or intrahospital complications related to the procedure occurred. Herein, we presented two cases of successful LAAC closure with Watchman device in patients with two different kinds of IVC filters.
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Atrial Fibrillation , Vena Cava Filters , Heart Atriaالملخص
RESUMO Este artigo apresenta estudos de coagulação, floculação e flotação por ar dissolvido que foram conduzidos com o objetivo de promover a clarificação de águas de lavagens de filtros (ALF) em uma estação de tratamento de água (ETA) com base em experimentos de bancada e piloto. A efetividade da coagulação-floculação foi analisada pela flotabilidade dos agregados obtidos sob diferentes níveis de pH e dosagem de cloreto de polialumínio, enquanto ensaios de flotação foram investigados com base na eficiência de saturação em bancada e na taxa de recirculação. Os resultados indicaram que o pH e a concentração do coagulante representaram condições críticas na etapa de coagulação. A variação do pH da ALF condicionada com 8 mg.L-1 de Al+3 destacou a formação de espécies hidrolisáveis e a elevada atividade das cargas dos coloides indicou a ocorrência de mecanismos diferentes da neutralização de cargas na coagulação. A máxima clarificação da água ocorreu com dosagem de 12 mg.L-1 de Al+3, razão de recirculação de 10%, tempo de floculação de 15 min e pH 6,5. Em configuração otimizada, a técnica alcançou remoção de 88% de turbidez e 86% de sólidos totais, o que pode resultar em mais de 11 quilogramas de sólidos removidos do sistema de tratamento em cada ciclo de lavagem em comparação com a sedimentação, implicando aumento de 33% da carreira de filtração e, consequentemente, redução de custos e melhor desempenho da estação.
ABSTRACT This article presents studies on coagulation, flocculation and dissolved air flotation that were conducted with the aim of promoting the clarification of spent filter backwash water (SFBW) in a Water Treatment Plant (WTP) based on bench and pilot experiments. The effectiveness of coagulation-flocculation was analyzed according to the buoyancy of the aggregates obtained from different levels of pH and dosage of polyaluminium chloride, whereas flotation tests were investigated based on bench saturation efficiency and recirculation rate. According to the results, the pH and the concentration of the coagulant represented critical conditions in the coagulation. The pH variation of the SFBW conditioned with 8 mg.L-1 of Al + 3 highlighted the formation of hydrolyzable species, and the high activity of the colloid indicated the occurrence of different mechanisms for neutralization in the coagulation. The maximum clarification of the SFBW occurred with a dosage of 12 mg.L-1 of Al+3, recirculation rate of 10%, flocculation time of 15 min, and pH 6.5. In an optimized configuration, the technique achieved removal of 88% turbidity and 86% total solids, which can result in more than 11 kilograms of solids removed from the WTP in each backwashing cycle compared with sedimentation. This would imply an increase of 33% in the backwashing interval and, consequently, in the reduction of costs and in the better performance of the WTP.
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RESUMO Os wetlands construídos (WC) são uma ecotecnologia aplicável para o tratamento descentralizado de esgotos notadamente em pequenas comunidades, em razão de sua simplicidade operacional. Existem vários arranjos e combinações de WC possíveis, destacando-se o arranjo tanque séptico (TS), seguido da modalidade de WC de escoamento vertical (WCV) com recirculação do efluente do WCV de volta para o TS, como proposta para possibilitar a remoção de nitrogênio presente no esgoto afluente. Entretanto, no Brasil, essa configuração e suas implicações operacionais e de desempenho são pouco exploradas. Diante disso, o objetivo deste trabalho foi avaliar o desempenho de um sistema de TS seguido de um WCV com recirculação no tratamento descentralizado de esgoto doméstico. O sistema empregado no tratamento de esgoto de um equivalente populacional de dez habitantes é composto de um TS (4,7 m3 de volume útil), seguido de um WCV (24,5 m2 de área superficial) preenchido com brita e plantado com Canna spp. O monitoramento, que compreendeu um período de nove meses, teve início após um ano e cinco meses de operação do sistema. Utilizando taxa de 50% de recirculação, taxa de aplicação hidráulica no WCV de 85 mm d-1 e carga de 47 g DQO m-2.d-1, foram obtidas boas eficiências para remoção conjunta de demanda química de oxigênio — DQO (80%), sólidos em suspensão totais — SST (85%) e nitrogênio total —NT (42%), mesmo com elevadas cargas orgânicas. Além das boas eficiências apresentadas, o sistema demonstrou ser robusto e de operação simples e representa uma alternativa tecnológica com potencial para o tratamento descentralizado de esgotos de empreendimentos habitacionais.
ABSTRACT Constructed wetland (CW) is an applicable eco-technology for decentralized wastewater treatment, notably in small communities, due to its operational simplicity. CW has several possible arrangements and combinations, among which the septic tank (ST) stands out, followed by the vertical flow constructed wetland (VFCW), with treated effluent recirculation back to the ST to enable nitrogen removal. However, in Brazil, this configuration and its operational and performance implications are little explored. Therefore, this study aimed to evaluate the performance of an ST system, followed by a VFCW with recirculation in the decentralized treatment of domestic wastewater. The wastewater treatment system for 10 inhabitants consists of an ST (4.7 m3 of useful volume), followed by a VFCW (24.5 m2 of surface area) planted with Canna spp. The monitoring, which covered a period of nine months, started after one year and five months of system operation. Using a 50% recirculation rate, VFCW hydraulic loading rate of 85 mm d-1, and organic load of 47 g COD m-2 d-1, good efficiencies were obtained for the joint removal of chemical oxygen demand — COD (80%), total suspended solids — TSS (85%), and total nitrogen — TN (42%), even with high organic loads. In addition to the good efficiencies presented, the system proved to be robust and easy to operate, representing a technological alternative with potential for the decentralized wastewater treatment of housing developments.
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AIM: To investigate the necessity of placing inferior vena cava filter in systemic thrombolytic therapy for patients with acute deep vein thrombosis. METHODS: Retrospectively summarized the clinical data of patients who received urokinase for deep vein thrombosis in the Third Xiangya Hospital of Central South University from September 2006 to April 2020, and discussed the necessity of placing inferior vena cava filter. RESULTS: A total of 549 patients were enrolled, including 294 patients in the filter group (154 males, 140 females) and 255 patients in the non-filter group (126 males, 129 females). Among 268 cases of proximal DVT in the filter group, thirty-five cases were complicated with pulmonary embolism before thrombolysis; and there were 218 cases of proximal DVT in the non-filter group and 16 cases of pulmonary embolism before thrombolysis, with statistical difference between the two groups (P=0.038 and 0.023, respectively). The total amount of urokinase in the filter group was (1 636.3±910.0) thousand units, and that in the non-filter group was (1 490.2±777.2) thousand units, with statistical difference between the two groups (P=0.045). However, there were no statistical differences in the days of use of urokinase and the proportion of patients with adequate anticoagulation. In this study, among 255 patients in non-filter group underwent thrombolysis, only 1 patient developed pulmonary embolism after thrombolysis (P=0.282). CONCLUSION: Inferior vena cava filter is not always necessary for patients with acute deep vein thrombosis during systemic thrombolytic therapy.
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Introdução: O tromboembolismo venoso é uma condição potencialmente fatal e frequente no paciente oncológico. Muitas vezes, a anticoagulação é inviável, e a colocação do filtro de veia cava (FVC) torna-se uma opção. A indicação clínica, entretanto, é controversa e gera alto custo. Objetivo: Descrever as características demográficas, clínicas e epidemiológicas dos pacientes com colocação de FVC e seu impacto na sobrevida global. Método: Estudo de coorte retrospectiva com pacientes em tratamento oncológico no INCA, que tiveram FVC implantado de janeiro/2015 até abril/2017. Na análise de sobrevida global em cinco anos, foram considerados o tempo entre o diagnóstico de câncer e o óbito por qualquer causa. Realizaram-se análise descritiva, estimativas de sobrevida (Kaplan-Meier) e regressão de Cox. Resultados: Foram incluídos 74 pacientes com média de idade 54 (+-15) anos. Em sua maioria, apresentavam tumores ginecológicos (52,7%) e digestivos (20,3%). O tempo mediano entre o diagnóstico de câncer e a colocação do FVC foi de 3,48 meses (0-203). No seguimento, foram observados 40 óbitos (54,1%) com mediana de tempo de 25 meses (IC 95%; 1,76-47,32). Na análise ajustada, verificou-se risco 5,63 vezes maior de morrer nos pacientes com colocação do FVC em até seis meses após o diagnóstico de câncer (HR=4,99; IC 95%; 2,20-11,33; p<0,001), e risco 2,47 vezes maior entre aqueles que não fizeram no pré-operatório (HR=2,47; IC 95%; 1,08-5,66; p=0,032). Conclusão: A colocação do FVC foi realizada com maior frequência em pacientes com tumores ginecológicos e em até seis meses após o diagnóstico de câncer foi associada a maior risco de óbito.
Introduction: Venous thromboembolism is a potentially fatal condition and frequent in oncologic patients. Quite often full anticoagulation is unfeasible, and placement of an inferior vena cava (IVC) filter becomes an option. Clinical indication, however, is controversial and expensive. Objective: To describe the demographic, clinical and epidemiological characteristics of oncologic patients submitted to IVC filter placement and their impact on global survival. Method: Retrospective cohort study with patients undergoing cancer treatment at INCA submitted to IVC filter placement from January 2015 to April 2017. Time between cancer diagnoses and death from any cause was considered for the analysis of the global 5-years survival. Descriptive analysis, survival estimates (Kaplan-Meyer) and Cox regression were performed. Results: 74 patients with a mean age of 54 (+15) years were included. Most of them had gynecological (52.7%) and digestive (20.3%) tumors. The median time between cancer diagnosis and IVC filter placement was 3.48 months (0-203). In the follow-up, 40 deaths (54.1%) were observed with a median time of 25 months (95% CI; 1.76 to 47.32). In the adjusted analysis, 5.63 times greater risk of death was verified in patients with IVC filter placement within six months after cancer diagnosis (HR=4.99; 95% CI; 2.20-11.33; p<0.001), and 2.47 times greater risk among those who did not do it at pre-operation (HR=2.47; 95% CI; 1.08-5.66; p=0.032). Conclusion: IVC filter placement was performed more frequently in patients with gynecological tumors and in until six months after cancer diagnosis was associated with increased risk of death.
Introducción: El tromboembolismo venoso es una afección potencialmente mortal y frecuente en pacientes con cáncer. La anticoagulación a menudo no es factible, y la colocación de un filtro de vena cava (FVC) se convierte en una opción. Sin embargo, las indicaciones clínicas son controvertidas y generan un alto costo. Objetivo: Describir las características demográficas, clínicas y epidemiológicas de los pacientes con colocación de CVF y su impacto en la supervivencia general. Método: Estudio de cohorte retrospectivo de pacientes sometidos a tratamiento contra el cáncer en INCA a quienes se les implantó FVC entre enero de 2015 y abril de 2017. En el análisis de la supervivencia general a cinco años, el tiempo transcurrido entre el diagnóstico de cáncer y la muerte cualquier causa Se realizó un análisis descriptivo, estimaciones de supervivencia (Kaplan-Meier) y regresión de Cox. Resultados: Se incluyeron 74 pacientes con una edad media de 54 (+-15) años. La mayoría de ellos tenían tumores ginecológicos (52,7%) y digestivos (20,3%). La mediana del tiempo entre el diagnóstico de cáncer y la colocación de FVC fue de 3,48 meses (0-203). En el período de seguimiento, se observaron 40 muertes (54,1%) con una mediana de tiempo de 25 meses (IC 95%: 1,76 a 47,32). En el análisis ajustado, se observó un riesgo de muerte 5,63 veces mayor en pacientes con colocación de FVC dentro de los seis meses posteriores al diagnóstico de cáncer (HR=4,99; IC 95%: 2,20-11,33; p<0,001) y 2,47 veces mayor riesgo entre aquellos que no lo hicieron antes de la operación (HR=2,47; IC 95%; 1,08-5,66; p=0,032). Conclusión: La colocación de FVC se realizó con mayor frecuencia en pacientes con tumores ginecológicos. La colocación de FVC dentro de los seis meses posteriores al diagnóstico de cáncer se asoció con un mayor riesgo de muerte.
الموضوعات
Humans , Male , Female , Adult , Middle Aged , Aged , Vena Cava Filters/adverse effects , Venous Thromboembolism/mortality , Neoplasms/mortality , Prognosis , Time Factors , Survival Analysis , Retrospective Studies , Venous Thromboembolism/surgery , Venous Thromboembolism/complications , Genital Neoplasms, Female/complications , Genital Neoplasms, Female/mortality , Neoplasms/complicationsالملخص
Abstract The incidence of asymptomatic pulmonary embolism (PE) exceeds 70% in patients with deep venous thrombosis (DVT), even in cases of distal deep vein thrombosis. We report the case of a patient with a diagnosis of DVT in the lower left limb associated with asymptomatic PE who presented late symptoms due to this same PE. The absence of acute symptoms and the late onset of symptoms could have provoked doubts about the most appropriate treatment, resulting in unnecessary interventions, if pulmonary embolism had not already been diagnosed with tomography. In the present case, we demonstrate that computed tomography angiography conducted at the time of DVT diagnosis accurately diagnosed PE and prevented any misinterpretation of recurrent DVT in a patient already being medicated, which could have been mistakenly interpreted as demonstrating failure of anticoagulant therapy. Such a situation could lead to unnecessary intervention to fit an inferior vena cava filter. We cannot suggest that a classic medical conduct should be reformulated simply on the basis of a case report. However, we would be remiss not to suggest that well-designed studies should be carried out in the future to assess the need for this examination in the acute phase.
Resumo A ocorrência de embolia pulmonar assintomática em pacientes com trombose venosa profunda tem uma incidência que excede 70%, mesmo nos casos de trombose venosa profunda distal. Relatamos o caso de um paciente com diagnóstico de trombose venosa profunda no membro inferior esquerdo associado a embolia pulmonar assintomática, que apresentou sintomas tardios devido a essa mesma embolia. A ausência de sintomas agudos e o surgimento de sintomas tardios pode suscitar dúvidas quanto ao tratamento mais adequado e resultar em intervenções desnecessárias, se o diagnóstico tomográfico de embolia pulmonar não tiver sido feito anteriormente. No presente caso, demonstramos que uma angiotomografia realizada no momento do diagnóstico de trombose venosa profunda detectou a embolia pulmonar e evitou uma interpretação incorreta de um evento trombótico recorrente na vigência de anticoagulação, o que por engano demonstraria uma falha na terapia anticoagulante. Essa situação pode levar a intervenções desnecessárias, como o implante de filtro de veia cava inferior. Entendemos que apenas um relato de caso não deve mudar uma conduta médica já estabelecida; no entanto, fomenta a discussão e estimula estudos que avaliem a necessidade de um exame diagnóstico pulmonar no momento do diagnóstico de trombose venosa profunda.
الموضوعات
Humans , Male , Middle Aged , Pulmonary Embolism/complications , Pulmonary Embolism/diagnostic imaging , Venous Thrombosis/complications , Pulmonary Embolism/therapy , Recurrence , Vena Cava, Inferior , Mass Screening , Vena Cava Filters , Venous Thrombosis/therapy , Lower Extremity , Computed Tomography Angiography , Anticoagulants/therapeutic useالملخص
Objective; To evaluate the effect of percutaneous mechanical aspiration thrombectomy (PMT) with AngioJet for treatment of acute deep venous thrombosis (DVT) after surgical operation. Methods: Data of 103 patients with acute lower extremity DVT after surgical operation who underwent AngioJet PMT were retrospectively analyzed. The affected-healthy side diameter differences of thigh and leg, as well as peripheral blood D-dimer levels were compared before and 7 days after AngioJet PMT. The clearance rate of thrombosis for each segment of lower limb veins was detected, the intraoperative and postoperative adverse reactions were counted. Results: Seven days after AngioJet PMT, both the affected-healthy side diameter difference of thigh and leg decreased, so did the peripheral blood D-dimer value (all P<0.05). Effective thrombosis clearance rate (grade Ⅱ, III) of iliac vein, femoral vein and popliteal vein was 97.37% (74/76), 98.06% (101/103) and 94.83% (55/58), respectively, while grade III clearance rate of the above segments was 77.63% (59/76), 70.87% (73/103) and 55.17% (32/58), respectively, of iliac vein and femoral vein were all higher than that of popliteal vein (both P<0.01). Transient arrhythmia occurred in 11 cases (11/103, 10. 68%) during thrombectomy, and returned to normal within 2 min after stopping thrombectomy. Hemorrhage at the puncture site occurred in 3 cases, while 38 cases were found with transient hemoglobinuria, 2 cases with transient creatinine elevation and 3 cases with limb pain. No new pulmonary embolism nor acute renal failure occurred. The filters were failed to be removed in 2 cases, while removed filters were found with obvious thrombi in 6 cases. Conclusion: Percutaneous mechanical aspiration thrombectomy with AngioJet was effective and safe for treatment of acute lower extremity DVT.
الملخص
Objective: To observe the effect of Cook retrieval group set to retrieve super long time window OptEase inferior vena cava (IVC) filter. Methods: Clinical data of 289 patients who underwent retrieval OptEase recoverable IVC filter were retrospectively analyzed. IVC filters were retrieved in normal time window (the time of filter placement ≤14 days) in 242 cases, including 127 using OptEase retrieval sets (group A) and 115 using Cook retrieval sets (group B).Meanwhile, IVC filters of 47 cases were retrieved in the ultra-long time window (the time of filter placement >28 days), including 22 using OptEase retrieval sets (group C) and 25 using Cook retrieval sets (group D). The filter retrieval success rates, retrieval time and complication rates were compared between group A and B, group C and D. Results: IVC filters were successfully retrieved in group A and B. There was no significant difference of retrieval time nor complication rate between group A and B (both P>0.05). The success rate of filter retrieval in group D was higher than that in group C (P<0.05), while the retrieval time and complication rate of group D were both lower than those in group C (both P<0.05).No serious complication occurred. Conclusion: The retrieval effect of Cook filter retrieval set is good for ultra long-term time window OptEase venous filter.
الملخص
Objective: To observe the therapeutic effect of Angiojet thrombosis aspiration of lower extremity deep vein thrombosis (DVT) after ultrasound-guided antegrade vein puncture. Methods: Data of 63 patients with acute or subacute lower extremity DVT were retrospectively analyzed. Angiography of the lower extremity was followed by implantation of inferior vena cava filter. Ultrasound-guided Angiojet thrombosis aspiration and transcatheter thrombolysis were performed, and the effect and safety were observed. Results: Among 63 patients, 54 recycled filters and 9 permanent filters were implanted. The recovery rate of recycled filters was 88.89% (48/54), and the average recovery time was (5.48±2.10) days. The success rate of ultrasound-guided antegrade vein puncture was 100% (66/66) without complication. The excellent and good treatment rate was 84.13% (53/63). There were 9 cases of hemoproteinuria after thrombus aspiration and 7 cases of mucosal hemorrhage during thrombolysis, and the total incidence of complications was 25.40% (16/63). No serious complication occurred. During (22.74±6.21) months' follow-up, 7 cases were lost and 1 case died due to malignant tumor, and post-thrombotic syndrome occurred in 6 cases (6/55, 10.91%). Conclusion: Ultrasound-guided anterograde vein puncture combined with Angiojet thrombosis aspiration is effective and safe for treatment of lower extremity deep vein thrombosis.