Тема - темы
Humans , Male , Female , Pulmonary Embolism/diagnosis , Pulmonary Embolism/surgery , Pulmonary Embolism/drug therapyРеферат
ABSTRACT Objectives Pulmonary endarterectomy (PEA) is the gold standard treatment for chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed at reporting outcomes of CTEPH patients undergoing PEA within 10 years, focusing on advances in anesthetic and surgical techniques. Methods We evaluated 102 patients who underwent PEA between January 2007 and May 2016 at the Instituto do Coração do Hospital das Clínicas da Universidade de São Paulo. Changes in techniques included longer cardiopulmonary bypass, heating, and cooling times and mean time of deep hypothermic circulatory arrest and shortened reperfusion time. Patients were stratified according to temporal changes in anesthetic and surgical techniques: group 1 (January 2007-December 2012), group 2 (January 2013-March 2015), and group 3 (April 2015-May 2016). Clinical outcomes were any occurrence of complications during hospitalization. Results Groups 1, 2, and 3 included 38, 35, and 29 patients, respectively. Overall, 62.8% were women (mean age, 49.1 years), and 65.7% were in New York Heart Association functional class III-IV. Postoperative complications were less frequent in group 3 than in groups 1 and 2: surgical complications (10.3% vs. 34.2% vs. 31.4%, p=0.035), bleeding (10.3% vs. 31.5% vs. 25.7%, p=0.047), and stroke (0 vs. 13.2% vs. 0, p=0.01). Between 3 and 6 months post-discharge, 85% were in NYHA class I-II. Conclusion Improvements in anesthetic and surgical procedures were associated with better outcomes in CTEPH patients undergoing PEA during the 10-year period.
RESUMO Objetivo A endarterectomia pulmonar (EAP) é o tratamento padrão ouro para hipertensão pulmonar tromboembólica crônica (HPTEC). O objetivo deste estudo foi relatar a evolução de pacientes com HPTEC submetidos a EAP em 10 anos, com foco nos avanços nas técnicas anestésicas e cirúrgicas. Métodos Foram avaliados 102 pacientes submetidos à EAP entre janeiro de 2007 e maio de 2016 no Instituto do Coração do Hospital das Clínicas da Universidade de São Paulo. Mudanças nas técnicas incluíram circulação extracorpórea, tempos de aquecimento e resfriamento mais longos e tempo médio de hipotermia profunda com parada circulatória e tempo de reperfusão reduzido. Os pacientes foram estratificados de acordo com as mudanças temporais nas técnicas anestésicas e cirúrgicas: grupo 1 (janeiro de 2007 a dezembro de 2012), grupo 2 (janeiro de 2013 a março de 2015) e grupo 3 (abril de 2015 a maio de 2016). Os desfechos clínicos foram qualquer ocorrência de complicações durante a hospitalização. Resultados Os grupos 1, 2 e 3 incluíram 38, 35 e 29 pacientes, respectivamente. No geral, 62,8% eram mulheres (idade média, 49,1 anos) e 65,7% estavam em classe funcional III-IV da New York Heart Association. As complicações pós-operatórias foram menos frequentes no grupo 3 do que nos grupos 1 e 2: complicações cirúrgicas (10,3% vs. 34,2% vs. 31,4%, p=0,035), sangramento (10,3% vs. 31,5% vs. 25,7%, p=0,047) e acidente vascular cerebral (0 vs. 13,2% vs. 0, p=0,01). Entre 3 e 6 meses após a alta, 85% estavam na classe I-II da NYHA. Conclusão Melhorias nos procedimentos anestésicos e cirúrgicos foram associadas a melhores resultados em pacientes com HPTEC submetidos a EAP durante o período de 10 anos.
Тема - темы
Humans , Female , Middle Aged , Pulmonary Embolism/surgery , Hypertension, Pulmonary/surgery , Patient Discharge , Pulmonary Artery , Brazil , Chronic Disease , Treatment Outcome , Aftercare , EndarterectomyРеферат
A nivel mundial, la tercera causa de muerte por causa cardiovascular es el Tromboembolismo Pulmonar (TEP), después del Infarto agudo de Miocardio y el Accidente cerebrovascular, con una incidencia anual estimada de 40 casos por cada 100.000 habitantes. Se comunica el caso clínico de un paciente de 44 años con diagnóstico de TEP recurrente con Hipertensión pulmonar tromboembólica crónica (CTPH) que fue sometido a tromboendarterectomía pulmonar bilateral (PTE) bajo paro circulatorio con hipotermia profunda. Se informa de los resultados de los medios de diagnóstico y del tratamiento quirúrgico mediante la tromboendarterectomía. Se discute el tema en el contexto de la experiencia internacional y nacional.
Тема - темы
Humans , Male , Adult , Pulmonary Embolism/surgery , Endarterectomy/methods , Hypertension, Pulmonary/surgery , Pulmonary Embolism/diagnosis , Hypertension, Pulmonary/diagnosis , Hypothermia, InducedТема - темы
Humans , Male , Adult , Pulmonary Embolism/surgery , Thromboembolism/surgery , Endarterectomy , Hemoglobinopathies , Hypertension, Pulmonary/surgery , Pulmonary Artery/diagnostic imaging , Blood Coagulation Disorders/complications , Blood Coagulation Disorders/physiopathology , Chronic Disease , Treatment OutcomeРеферат
Abstract Pulmonary endarterectomy is a curative procedure for chronic thromboembolic Pulmonary Hypertension. As usual, cardiopulmonary bypass circuit is required. However, there are several complications attributed to extracorporeal circulation. Hemodilution, systemic inflammatory response syndrome and leukocyte sequestration are circulation related complications. The severe forms include Acute Respiratory Distress Syndrome, Acute Lung Injury, myocardial stunning, dysfunction of the right ventricle, coagulopathy, postoperative stroke or renal dysfunction. In this case report, we aimed to give information about perioperative anesthesia and surgical management of pulmonary endarterectomy which was successfully managed without Cardiopulmonary Bypass.
Тема - темы
Humans , Male , Middle Aged , Pulmonary Embolism/surgery , Endarterectomy , Anesthesia/methods , Pulmonary Embolism/physiopathology , Pulmonary Embolism/diagnostic imaging , Tomography, X-Ray ComputedРеферат
Introdução: A demanda por cirurgia plástica tem aumentado progressivamente, dentre os procedimentos mais frequentes estão as cirurgias de mamas (aumento e redução). Métodos: Estudo retrospectivo de prontuários de pacientes que foram submetidas a mamoplastia redutora e de aumento, no período de janeiro de 2015 a junho de 2018, no Hospital PUC-Campinas. Resultados: Foram realizadas 13 mamoplastias de aumento e 275 mamoplastias redutoras. Das 288 cirurgias realizadas duas (n=2) evoluíram com TEP (tromboembolismo pulmonar). Conclusão: Portanto, a incidência de fenômenos tromboembólicos em mamoplastias de aumento e redutoras mostrou-se baixa no presente estudo, assim como na literatura. Já as pacientes acometidas no estudo eram consideradas de baixo risco para complicação tromboembólica, de acordo com protocolos de profilaxia, devendo-se atentar para tais fenômenos no pós-operatório. Ainda são necessários mais estudos para padronização do uso de medidas de profilaxia do tromboembolismo venoso.
Introduction: The demand for plastic surgery has progressively increased, and breast enlargement and reduction surgeries are among the most frequent procedures. Methods: This retrospective study reviewed the medical records of patients who underwent reduction and augmentation mammoplasty between January 2015 and June 2018 at the PUC-Campinas Hospital. Results: Thirteen augmentation mammoplasties and 275 reduction mammoplasties were performed. Of the 288 patients who underwent surgeries, two patients developed postoperative pulmonary thromboembolism. Conclusion: The incidence of thromboembolic phenomena in augmentation and reduction mammoplasty is low. Patients in this study were considered at low risk for thromboembolic complications. According to prophylaxis protocols, this phenomena should be monitored postoperatively. Further studies are needed to standardize the use of venous thromboembolism prophylaxis measures.
Тема - темы
Humans , Female , Adult , History, 21st Century , Patients , Pulmonary Embolism , Surgery, Plastic , Breast , Medical Records , Retrospective Studies , Embolism and Thrombosis , Venous Thrombosis , Patients/statistics & numerical data , Pulmonary Embolism/surgery , Pulmonary Embolism/complications , Surgery, Plastic/statistics & numerical data , Breast/surgery , Medical Records/statistics & numerical data , Embolism and Thrombosis/surgery , Venous Thrombosis/surgery , Venous Thrombosis/complicationsРеферат
O tromboembolismo pulmonar é um grave problema de saúde pública devido ao subdiagnóstico e às elevadas morbidade e mortalidade. Quando a embolia pulmonar é maciça com repercussão hemodinâmica importante e a terapia adequada não ocorre nas primeiras horas, a mortalidade é superior a 85%. Na suspeita clínica de tromboembolismo pulmonar, a avaliação ecocardiográfica pode ter papel fundamental na avaliação da mobilidade e da estrutura do ventrículo direito, presença de hipertensão pulmonar e documentação da presença de trombo. A detecção ecocardiográfica de trombo móvel nas câmaras cardíacas direitas permite identificar um grupo de pacientes de alto risco, com mortalidade muito elevada, quando comparada ao tromboembolismo pulmonar em geral. Além da terapia clínica clássica, com heparinas e trombolíticos, as terapêuticas endovascular e cirúrgica devem ser consideradas e podem contribuir para o prognóstico desses pacientes. Relata-se um caso de uma paciente de 33 anos de idade admitida em uma unidade de emergência da no 8o dia de pós-operatório de apendicectomia, com queixas de dor torácica e dispneia de início súbito. Ecocardiograma transtorácico evidenciou presença de trombo serpiginoso solto em átrio direito, que ocluía intermitentemente a valva tricúspide durante o ciclo cardíaco. Diante das características ecocardiográficas atípicas do trombo e da significativa chance de embolização maciça, optou-se por intervenção cirúrgica de emergência.
Pulmonary thromboembolism is a serious public health problem due to misdiagnosis and high morbidity and mortality. When pulmonary embolism is massive with important hemodynamic repercussion, and the appropriate therapy does not take place in the early hours, mortality is higher than 85%. If there is clinical suspicion of pulmonary thromboembolism, an echocardiographic evaluation may have a key role in the evaluation of mobility and structure of the right ventricle, presence of pulmonary hypertension, and documentation of the presence of thrombus. Echocardiographic detection of mobile thrombus in right cardiac chambers allows the identification of a group of high-risk patients with very high mortality when compared to pulmonary thromboembolism in general . In addition to the classical clinical therapy with heparins and thrombolytics, endovascular and surgical therapy should be considered and may contribute to these patients' prognosis. A case is reported of a 33-year-old female patient admitted to an Emergency Unit at 8th postoperative day (POD) of appendectomy, with complaints of chest pain and dyspnea of sudden onset. Transthoracic echocardiography showed the presence of a floating serpiginous thrombus in the right atrium, which intermittently occluded the tricuspid valve during the cardiac cycle. Due to the atypical echocardiographic features of the thrombus, and significant chance of massive embolization, an emergency surgery was chosen.
Тема - темы
Humans , Female , Adult , Pulmonary Embolism/diagnostic imaging , Echocardiography , Ventricular Dysfunction, Right/diagnostic imaging , Pulmonary Embolism/surgery , Pulmonary Embolism/complications , Pulmonary Embolism/drug therapy , Tachycardia/etiology , Vasoconstrictor Agents/therapeutic use , Warfarin/therapeutic use , Chest Pain/etiology , Radiography , Norepinephrine/therapeutic use , Enoxaparin/therapeutic use , Ventricular Dysfunction, Right/surgery , Ventricular Dysfunction, Right/complications , Ventricular Dysfunction, Right/drug therapy , Dyspnea/etiology , Electroencephalography , Tachypnea/etiology , Perfusion Index , Hypotension/etiology , Hypoxia/etiology , Anticoagulants/therapeutic useРеферат
Abstract: Objective: Rationale for non-routine use of inferior venous cava filters (IVCF) in pulmonary embolism (PE) patients. Methods: Thrombosis mechanisms involved with IVCF placement and removal, the blood-contacting medical device inducing clotting, and the inorganic polyphosphate in the contact activation pathway were analyzed. In addition, we analyzed clinical evidence from randomized trials, including patients with and without cancer. Furthermore, we estimated the absolute risk reduction (ARR), the relative risk reduction (RRR), and the number needed to treat (NNT) based on the results of each study using a frequency table. Finally, we analyzed the outcome of our PE patients that were submitted to thrombolysis with short and long term follow-up. Results: IVCF induces thrombosis by several mechanisms including placement and removal, rapid protein adsorption, and simultaneous surface-induced activation via the contact activation pathway. Also, inorganic polyphosphate has an important role as a procoagulant, reversing the effect of anticoagulants. Randomized control trials included 904 cancer and non-cancer PE patients. In terms of ARR, RRR, and NNT, there is no evidence for routine use of IVCF. In 290 patients with proved PE, extensive thrombotic burden and right ventricular dysfunction under thrombolysis and oral anticoagulation, we observed a favorable outcome in a short- and long-term follow-up; additionally, IVCF was only used in 5% of these patients. Conclusion: Considering the complex mechanisms of thrombosis related with IVCF, the evidence from randomized control trials and ARR, RRR, and NNT obtained from venous thromboembolism patients with and without cancer, non-routine use of IVCF is recommended.
Resumen: Objetivo: Racionalidad para no utilizar en forma rutinaria filtros de vena cava inferior (FVCI) en pacientes con tromboembolia pulmonar (TEP). Métodos: Analizamos mecanismos de trombosis relacionados con la colocación o retiro de estos dispositivos médicos, incluyendo la importancia del polifosfato inorgánico en la vía de activación de contacto. Analizamos evidencia clínica de estudios aleatorizados controlados en pacientes con y sin cáncer. Mediante tablas de frecuencia estimamos de cada estudio reducción del riesgo absoluto (RRA) y relativo (RRR) y el número necesario a tratar (NNT). Finalmente, examinamos la evolución de nuestros pacientes con TEP llevados a trombolisis con seguimientos a corto y largo plazo. Resultados: FVCI inducen trombosis por diferentes mecanismos: colocación y retiro, adsorción rápida de proteínas y activación de superficie inducida en la vía de activación de contacto. El polifosfato inorgánico es un procoagulante importante para la anticoagulación. Estudios aleatorizados controlados incluyeron 904 pacientes con TEP con y sin cáncer. En términos de RRA, RRR y NNT no existe evidencia para el uso rutinario. En 290 pacientes con TEP probada, importante carga de trombo y disfunción del ventrículo derecho llevados a trombolisis y anticoagulación observamos una evolución favorable en seguimientos a corto y largo plazo. En estos pacientes los FVCI se utilizaron solo en el 5%. Conclusión: Considerando los mecanismos complejos de trombosis relacionados con los FVCI, la evidencia obtenida de los estudios aleatorizados y controlados, así como la RRA, RRR y NNT en pacientes con tromboembolismo venoso con y sin cáncer, no recomendamos el uso rutinario de FVCI.
Тема - темы
Humans , Pulmonary Embolism/surgery , Vena Cava Filters/adverse effects , Pulmonary Embolism/drug therapy , Thrombosis/etiology , Thrombosis/epidemiology , Thrombolytic Therapy , Risk , Practice Guidelines as TopicРеферат
Abstract We present a case of a 41-year-old female with deep vein thrombosis after abdominal surgery. The patient quickly developed severe pulmonary embolism and stroke representative of paradoxical embolism. Echocardiography showed a thrombus straddling a patent foramen ovale, which was confirmed intraoperatively. An accurate diagnosis and rapid treatment decisions are crucial for preventing patient deterioration in the form of new pulmonary embolisms or stroke.
Тема - темы
Humans , Female , Adult , Postoperative Complications/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Venous Thrombosis/diagnostic imaging , Foramen Ovale, Patent/diagnostic imaging , Postoperative Complications/surgery , Pulmonary Embolism/surgery , Venous Thrombosis/surgery , Foramen Ovale, Patent/surgery , Abdomen/surgeryТема - темы
Adult , Humans , Male , Extracorporeal Membrane Oxygenation , Heart Failure/therapy , Endarterectomy/adverse effects , Extracorporeal Membrane Oxygenation/methods , Heart Failure/etiology , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/surgery , Pulmonary Embolism/complications , Pulmonary Embolism/surgeryРеферат
A cirurgia de lipoaspiração é com alguma frequência relacionada a consequências dramáticas ou fatais, causando grande repercussão no meio médico e principalmente na mídia leiga. Esse fato não deve fazer com que o cirurgião plástico evite essa cirurgia, mas sim estimulá-lo a conhecer profundamente a fisiopatologia inerente ao procedimento, buscando meios embasados de realizá-lo da forma mais segura possível, reduzindo ao máximo os riscos de complicações, principalmente as mais graves. Esse artigo teve o objetivo de realizar uma revisão bibliográfica a respeito especificamente da embolia gordurosa causada pela lipoaspiração, relacionada inúmeras vezes a pós-operatórios dramáticos e fatais. Além disso, ressalta alguns cuidados preventivos para uma maior segurança com esse procedimento.
Liposuction surgery is often associated with severe or fatal consequences, causing great repercussions in the medical field, and especially in the lay media . This should not cause the plastic surgeon to avoid the procedure, but rather should promote deeper knowledge of the basic pathophysiology. All means to accomplish the surgery in the safest possible way should be utilized, to minimize the risk of complications, especially the most severe risks. This article reviews the literature on liposuction-induced fat embolism, which is often associated with severe complications in the postoperative period, and even fatal outcomes. In addition, this study highlights several preventive measures that can be adopted to ensure greater safety of this procedure.
Тема - темы
Humans , History, 21st Century , Postoperative Complications , Surgery, Plastic , Lipectomy , Embolism, Fat , Subcutaneous Fat , Postoperative Complications/surgery , Postoperative Complications/therapy , Pulmonary Embolism , Pulmonary Embolism/surgery , Pulmonary Embolism/complications , Pulmonary Embolism/mortality , Pulmonary Embolism/pathology , Surgery, Plastic/methods , Review Literature as Topic , Lipectomy/methods , Lipectomy/mortality , Risk Factors , Embolism, Fat/surgery , Embolism, Fat/complications , Embolism, Fat/mortality , Embolism, Fat/pathology , Subcutaneous Fat/surgeryРеферат
Introdução: A embolia pulmonar é a causa de morte mais previsível em pacientes hospitalizados, sendo isso ainda mais prevalente em pacientes cirúrgicos. 200.000 novos casos ocorrem anualmente, com início súbito e geralmente levando à morte nas primeiras 2 horas. Prevenir é, portanto, mais efetivo que tratar a doença estabelecida. Esse estudo objetiva demonstrar a importância e segurança do protocolo de prevenção do tromboembolismo venoso. Métodos: Conduzimos um estudo retrospectivo no período de maio de 2009 a maio de 2011, quando 2759 pacientes foram submetidos à cirurgia plástica no Instituto Ivo Pitanguy. Todos os pacientes foram submetidos ao protocolo de prevenção e avaliados quanto aos fatores de risco para tromboembolismo venoso. A soma desses fatores gerou um escore que determinou a conduta profilática a ser adotada. Resultados: Houve três casos de tromboembolismo venoso (0,1%), sendo 1 de TEP e 2 de TVP. A quimioprofilaxia com enoxaparina administrada aos 3 pacientes de acordo com o protocolo de prevenção. Nossas taxas permaneceram abaixo das encontradas na literatura, com diferença estatisticamente significativa nos numero total de casos (p < 0,0001). Houve 34 casos de hematoma (1,2%), sendo 55,9% em pacientes submetidos à quimioprofilaxia e 44,1% em pacientes que usaram apenas o dispositivo de compressão pneumática intermitente apenas. As taxas totais de hematoma também permaneceram abaixo das encontradas na literatura, também com diferença estatisticamente significativa (p < 0,001). Conclusão: O protocolo de prevenção do tromboembolismo venoso do Instituto Ivo Pitanguy se provou seguro e importante na prevenção dos casos de TEV, com taxas de hematoma abaixo do descrito na literatura.
Introduction: Pulmonary embolism is the most predictable cause of death in hospitalized patients, even more in surgical patients. 200.000 new cases occur annually, with sudden onset and generally leading to death in the first 2 hours. Preventing is most effective than treating stablished disease. This study aims to show the importance and safety of the venous thromboembolism prevention protocol. Methods: We conducted a retrospective study in the period between May 2009 and May 2011 at The Ivo Pitanguy Institute, where 2759 patients underwent plastic surgery (aesthetic and reconstructive). All patients were assessed for predisposing and exposing risk factors for venous thromboembolism and the sum of those factors generated a score determining the prophylactic procedure to be adopted according to the protocol. Results: There were three cases of venous thromboembolism (0.1%): one case of pulmonary embolism and two cases of deep venous thrombosis. Chemoprophylaxis with heparin was administered in the three patients according to the venous thromboembolism prevention protocol. Our rates remained below those found in the literature, with a statistically significant difference in total cases (p < 0.0001). There were 34 cases of hematoma (1.2%): 55.9% in patients submitted to pharmacological prophylaxis with heparin and 44,1% in patients who used sequential compression devices only. The total rates of hematoma also remained below those found in the literature with a statistically significant difference (p < 0,001). Conclusion: The venous thromboembolism prevention protocol of the Ivo Pitanguy Institute proved to be important and safe, preventing the occurrence of venous thromboembolism cases with low rates of hematoma.
Тема - темы
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , History, 21st Century , Pulmonary Artery , Heparin , Retrospective Studies , Risk Factors , Enoxaparin , Chemoprevention , Guidelines as Topic , Evaluation Study , Pulmonary Artery/surgery , Pulmonary Artery/pathology , Pulmonary Embolism , Pulmonary Embolism/surgery , Pulmonary Embolism/complications , Pulmonary Embolism/mortality , Pulmonary Embolism/pathology , Pulmonary Embolism/prevention & control , Pulmonary Embolism/drug therapy , Surgery, Plastic , Surgery, Plastic/methods , Heparin/adverse effects , Heparin/therapeutic use , Heparin/pharmacology , Enoxaparin/therapeutic use , Enoxaparin/pharmacology , Chemoprevention/methods , Guidelines as Topic/methods , Guidelines as Topic/prevention & controlРеферат
Vertebroplastia por punção é um procedimento realizado para dar sustentação óssea na coluna vertebral. Inúmeras complicações podem ocorrer, dentro elas, a embolia pulmonar de cimento. É descrito um caso de embolia da artéria pulmonar secundária à vertebroplastia, por um fragmento volumoso de cimento, tratada por cirurgia. Discutem-se formas de diagnóstico e estratégias de tratamento (AU)
Puncture vertebroplasty is a procedure for providing bone support in the spine. Various complications may occur, including cement pulmonary embolism. Here we report a case of pulmonary artery embolism secondary to vertebroplasty, by a massive fragment of cement, treated by surgery. Forms of diagnosis and treatment strategies are discussed (AU)
Тема - темы
Humans , Male , Middle Aged , Pulmonary Embolism/chemically induced , Vertebroplasty/adverse effects , Postoperative Complications/surgery , Postoperative Complications/chemically induced , Postoperative Complications/diagnostic imaging , Pulmonary Embolism/surgery , Pulmonary Embolism/diagnostic imaging , EmbolectomyТема - темы
Aged , Female , Humans , Bronchoscopy/adverse effects , Stroke/etiology , Takotsubo Cardiomyopathy/etiology , Pulmonary Embolism/surgeryРеферат
La trombosis venosa profunda es responsable del 25 por ciento de los tromboembolismos pulmonares en pacientes neuroquirúrgicos. Se presenta un estudio descriptivo, retrospectivo realizado en el servicio de Neurocirugía del Hospital Hermanos Ameijeiras de la Ciudad de la Habana en 233 pacientes en los que se determinó la frecuencia de trombosis venosa profunda (TVP) y tromboembolismo pulmonar (TEP) y se constató la presencia de TVP y TEP en 54 pacientes (23,10 por ciento) con tumores intracraneales y raquimedulares, de estas el 74 por ciento de las lesiones eran tumores primarios intracraneales, y el glioma de alto grado de malignidad fue el diagnóstico histológico predominante. Los tumores raquimedulares complicados incluyeron un paciente con un meningioma dorsal y un paciente con metástasis de un coriocarcinoma pineal. Se exponen los factores generales y específicos que incidieron en su presentación y diagnóstico, así como la necesidad de la profilaxis en estos grupos. Hubo un predominio ligero en el sexo masculino, y el 80 por ciento estuvo sometido a un sólo proceder quirúrgico. El 96 por ciento de los casos que desarrollaron TEP superaban los 50 años de edad. Más del 50 por ciento presentaba algún déficit motor asociado, que condicionó encamamiento o limitación de su movilización Se hace una revisión de las medidas preventivas necesarias para la profilaxis de estas complicaciones.
Pulmonary thromboembolism (PTE) is caused by deep venous thrombosis (DVT) in 25 percent of neurosurgical patients. We presented a retrospective and descriptive study with consecutive patients (n = 233) that were operated in Neurosurgery Department in Hermanos Ameijeiras Hospital, Havana City from January 2005 to December 2007. DVT and PTE were diagnosed in 53 patients (23.1 percent) affected by brain and spinal tumors. Malignant primary tumors represented the 74 percent of them. The histological diagnosis most common was malignant brain glioma. We included two spinal tumours: a thoracic memingioma and one metastasic pineal choriocarcinoma .General and specifics factors related to these complications are listed. Prophylaxis treatment is demonstrated like a priority in those patients. Male sex group was mildly more affected and only one procedure was done in the 80 percent. A highest frequency of TEP (96 percent) was observed in patients older than 50 years. Postoperative immobility and paresis were confirmed in more than 50 percent of cases. Thrombosis prophylaxis treatment is also reviewed in the article.
Тема - темы
Humans , Male , Female , Choriocarcinoma , Pulmonary Embolism/surgery , Pulmonary Embolism/diagnosis , Pulmonary Embolism/prevention & control , Glioma , Meningioma , Pineal Gland , Venous Thrombosis/surgery , Venous Thrombosis/diagnosis , Venous Thrombosis/prevention & control , Brain Neoplasms , Cuba , Epidemiology, Descriptive , Retrospective Studies , Spinal NeoplasmsРеферат
La hipertensión pulmonar tromboembólica crónica (HPTEC) es una entidad subdiagnosticada y de alta morbimortalidad si no se accede a un tratamiento adecuado.El centellograma V/Q confirma la naturaleza tromboembólica de la hipertensión pulmonar (HP), pero es la arteriografía convencional el estudio que valora la topografía de los trombos y su accesibilidad a cirugía. El cateterismo cardíacoderecho confirma la HP, su severidad, y brinda parámetros de gran valor pronóstico. La HPTEC es la única etiología de hipertensión pulmonar con posibilidad de un tratamiento quirúrgico potencialmente curativo a través de la tromboendarterectomía pulmonar (TEE).Se reporta el primer caso de nuestro país de HPTEC tratada con TEE y evolución exitosa.
Chronic thromboembolic pulmonary hypertension ( CTEPH) is a delayed diagnosed disease with high morbidity and mortality, especially when untreated. Ventilation/perfusion lung scan confirms the thromboembolic etiology, but pulmonary angiography is still the gold standard diagnostic procedure for defining the extension and location of the disease and surgical indication. Right heart catheterization provides accurate prognostic and disease severity information. Pulmonary endarterectomy represents a potentially curative option in eligible patients.
Тема - темы
Female , Middle Aged , Pulmonary Embolism/surgery , Endarterectomy , Hypertension, Pulmonary/surgery , Hypertension, Pulmonary/ethnology , Risk FactorsРеферат
A trombose venosa profunda (TVP) e o seu desfecho imediato mais grave, o troboembolismo pulmonar (TEP), são complicações de incidência elevada em pacientes hospitalizados e principalmente naqueles submetidos à cirurgia. Objetivo: Apresentar o protocolo de profilaxia de Tromboembolismo (TEV) da Clínica Ivo Pitanguy, mostrando a incidência de TEV no serviço antes e a pós a introdução deste protocolo, assim como a incidência de hematomas, no período de cinco anos. Método: Estudo de revisão dos prontuários dos pacientes operados no período de julho de 2004 a maio de 2009. Comparou-se a incidência de eventos trombóticos antes e após a introdução do protocolo, assim como a incidência de hematomas. Resultados: Foram analisados 1700 prontuários. Desde a introdução do protocolo, não ocorreu nenhum caso de tromboembolismo venoso, em 711 pacientes operados. A incidência de hematomas com necessidade de revisão cirúrgica foi reduzida, provavelmente pelo controle pressórico mais rigoroso após a introdução do protocolo. Conclusão: O protocolo tem se mostrado de utilização simples e efetiva. Houve redução da incidência de TEV e hematomas a partir de sua introdução.
The deep vein thrombosis (DVT) and its most dangerous outcome, the pulmonary embolism (PE), are complications of high incidence in hospitalized patients and in those submitted to surgery. Objective: This study presents the guideline to prevention of thromboembolism at Ivo Pitanguy Clinic and its incidence before and after the introduction of this protocol, in a period of five years. We also relate the incidence of hematoma beforeand after the beginning of the protocol. Methods: The study consists of the revision of the medical records of all patients operated between July 2004 and May 2009. We compared the incidence of thromboembolic events before and after the beginning of the protocol as well as the incidence of hematomas that were submitted to revision at the surgery room. Results: Analyzing 1700 medical records, since the introduction of the guideline of prevention of VTE, there is no case of VTE in 711 operated patients. The incidence of reoperated hematomas at the surgery room was reduced, maybe because there was a more rigorous control of the blood pression after the introduction of the guideline. Conclusion: The guideline has shown itself practical and simple use. There were reduction in cases of VTE and hematomas after its introduction.