RESUMO
We describe a patient who underwent assisted reproduction techniques and was diagnosed with heterotopic cervical pregnancy, and then discuss the management of this entity, which is rare and has no standard protocols. Treatment consisted of intra-arterial methotrexate (50 mg/m(2) body surface area) and simultaneous selective embolization of uterine arteries. The literature is also reviewed to identify other approaches and outcomes.
Assuntos
Preservação da Fertilidade/métodos , Gravidez Ectópica/terapia , Adulto , Colo do Útero/diagnóstico por imagem , Feminino , Fertilização in vitro , Humanos , Metotrexato/administração & dosagem , Metotrexato/uso terapêutico , Metrorragia/diagnóstico por imagem , Metrorragia/etiologia , Metrorragia/terapia , Gravidez , Gravidez Ectópica/diagnóstico por imagem , Gravidez Ectópica/patologia , Fatores de Risco , Fumar , Ultrassonografia , Embolização da Artéria UterinaRESUMO
OBJECTIVE: To report a rare case that supposed an emergency. It is a case of hematuria caused by an arteriovenous fistula. METHODS: We describe the background, clinical exploration, complementary exams and their results, as well as the treatment applied in an adolescent with hematuria. RESULTS: Congenital arteriovenous fistula was diagnosed and treated by percutaneous embolization, with immediate stop of the hematuria. CONCLUSION: Non-traumatic renal arteriovenous fistulae are infrequent and even more if they appear with gross hematuria. We present the case of an emergency caused by one of them which was treated by percutaneous embolization, avoiding surgery.
Assuntos
Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/terapia , Embolização Terapêutica/efeitos adversos , Hematúria/etiologia , Adulto , Angiografia , Malformações Arteriovenosas/complicações , Retração do Coágulo , Humanos , Rim/patologia , Masculino , Circulação Renal/fisiologia , Tomografia Computadorizada por Raios X , UrografiaRESUMO
OBJECTIVE: To report a rare case of hematuria caused by an arteriovenous fistula which may be a urological emergency. METHODS: We describe the medical history, physical examination, complementary tests performed and their results, as well as the treatment applied in an adolescent with hematuria. RESULTS: Congenital arteriovenous fistula was diagnosed and treated by percutaneous embolization with immediate stop of hematuria. CONCLUSION: Non-traumatic renal arteriovenous fistulae are rare, even more if they present with gross hematuria. We present a case of a life-threatening emergency caused by one of them the treatment of which was possible by embolization, avoiding surgery.
Assuntos
Fístula Arteriovenosa/terapia , Embolização Terapêutica , Hematúria/etiologia , Nefropatias/congênito , Nefropatias/terapia , Angiografia , Fístula Arteriovenosa/complicações , Criança , Humanos , Nefropatias/complicações , Masculino , Circulação Renal/fisiologia , Obstrução Ureteral/etiologia , UrografiaAssuntos
Quilotórax , Fístula , Ducto Torácico , Glândula Tireoide/cirurgia , Adulto , Quilotórax/etiologia , Feminino , Fístula/etiologia , Humanos , Linfografia , Ducto Torácico/cirurgiaRESUMO
BACKGROUND AND OBJECTIVES: To determine the use of oral anticoagulants in polypathological patients with atrial fibrillation and its influence on mortality and loss of functionality. PATIENTS AND METHODS: Patients with polypathological patient criteria and atrial fibrillation were included in an observational, prospective and multicenter study. Data on demographic, clinical, functional and sociofamilial characteristics, CHADS2 score, levels of hemoglobin, albumin and creatinine, use of oral anticoagulants and survival and functional status at one year were collected. RESULTS: Five hundred and thirty-two (32.6%) of 1,632 polypathological patients had atrial fibrillation. The stroke risk was high in 505 (94.9%), moderate in 24 (4.5%) and low in 3 (0.6%) patients. Oral anticoagulants were used in 61% of patients with CHADS2 score≥2 and in 37.5% with CHADS2 score=1. Oral anticoagulants were less used in older patients, with more functional and cognitive impairment. Heart failure was associated with more use of oral anticoagulants. There was no difference by the presence of hypertension, diabetes, anemia, renal insufficiency or stroke. In multivariate analysis the use of oral anticoagulants was independently associated with lower age, lower cognitive impairment, absence of hepatic disease and with higher stroke risk. The prescription of oral anticoagulants was independently associated with more survival at one year with no influence on functional status. CONCLUSIONS: Oral anticoagulants are underused in polypathological patients with atrial fibrillation despite being associated with more survival.
Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Índice de Gravidade de Doença , Acidente Vascular Cerebral/prevenção & controle , Trombofilia/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Anemia/epidemiologia , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Transtornos Cognitivos/epidemiologia , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Estimativa de Kaplan-Meier , Nefropatias/epidemiologia , Hepatopatias/epidemiologia , Masculino , Neoplasias/epidemiologia , Prognóstico , Estudos Prospectivos , Risco , Acidente Vascular Cerebral/epidemiologia , Taxa de Sobrevida , Trombofilia/sangue , Trombofilia/etiologia , Resultado do TratamentoAssuntos
Laparoscopia , Melanoma/cirurgia , Neoplasias Retroperitoneais/cirurgia , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X , Idoso , Humanos , Laparoscopia/métodos , Masculino , Melanoma/diagnóstico por imagem , Melanoma/secundário , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/secundárioRESUMO
La nutrición precoz (NEP) postoperatoria por medio de una sonda nasoentérica es un método simple, económico y de poco riesgo para proveer una alimentación adecuada en la mayoría de los pacientes sometidos a cirugía mayor abdominal electiva y/o de emergencia. En este trabajo los autores presentan una serie de 12 pacientes que recibieron nutrición enteral total precoz después de cirugía mayor abdominal. El balance nitrogenado fue mejorado en todos los pacientes antes del trecer día del postoperatorio. La fórmula polimérica utilizada (Fortison) fue bien tolerada y no se observaron complicaciones inherentes al procedimiento