RESUMEN
OBJECTIVE: To evaluate the results of intravenous dobutamine therapy at home for ambulatory patients with severe heart failure. DESIGN: Retrospective. METHOD: Data were retrieved for the 40 patients that had been treated with intravenous dobutamine at home during the period from 1 January 1994 until mid-November 2006 at the Thorax Centre of Groningen University Medical Centre, The Netherlands. The patients were guided by a nurse practitioner. RESULTS: The study group comprised 31 men and 9 women. The 22 patients on the waiting list for a heart transplant had an average age of 49 years. For the other 18 patients, on average 63 years old, it was destination therapy. The mean administered dosage ofdobutamine was 4 microg/kg/ min (range: 2-10). Pre-transplantation and destination therapy were given for an average of 3.5 and 1.5 months, respectively. A successful transplantation was performed in 14 (64%) of the 22 waiting-list candidates; 2 patients were still on the waiting list and 6 died while on the waiting list. Intravenous access complications and ICD shocks each occurred in 6 (15%) patients. The quality of life was reasonable to fair in the waiting-list patients and moderate to reasonable in those given destination therapy. The costs for medication and hire of the infusion pump were Euro 450 per month. CONCLUSION: Dobutamine infusion therapy at home under the guidance of a nurse practitioner, either as a bridge to cardiac transplantation or as destination therapy in patients with severe heart failure, appeared safe, feasible and not expensive.
Asunto(s)
Cardiotónicos/uso terapéutico , Dobutamina/uso terapéutico , Costos de la Atención en Salud , Insuficiencia Cardíaca/terapia , Terapia de Infusión a Domicilio , Enfermería/métodos , Atención Ambulatoria/métodos , Femenino , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/economía , Trasplante de Corazón , Hemodinámica/fisiología , Terapia de Infusión a Domicilio/economía , Terapia de Infusión a Domicilio/métodos , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Estudios Retrospectivos , Resultado del Tratamiento , Listas de EsperaRESUMEN
BACKGROUND: Ten years ago, there was a difference of opinion about the suitability of ventilated patients with end-stage cardiac failure for heart transplantation (HTX). Although guidelines at that time qualified mechanical ventilation as a contraindication, we thought those patients could be candidates for HTX. In the same period a number of other patients received a donor heart in our centre. In this article we describe the clinical course and survival after these procedures. METHODS: We performed a retrospective study using our post HTX database. All patients undergoing transplants in our hospital were selected. Patients underwent echocardiography, scintigraphy (MUGA), ergo-spirometry (VO2 peak), blood tests and completed a quality of life questionnaire (SF-36). All tests were completed in the 1st quarter of 2006. RESULTS: Eight patients were identified; three were mechanically ventilated at the time of HTX. All eight patients were treated according to the standard protocol. Repeated surveillance cardiac biopsies were taken. One patient died 3.5 years after HTX due to an acute myocardial infarction. Seven patients, including the three patients on a ventilator at the time of the HTX, are alive, resulting in a survival rate of 88%. The current median survival time is 126 months (range 55 to 184 months). All patients are in good cardiac condition. The SF-36 domains of social functioning and mental health show high scores, the average score of general health and vitality is moderate. CONCLUSION: Survival of our eight transplanted patients after a median period of ten years was 88%, which is at least comparable with data from larger series. This finding suggests that HTX can be performed effectively and safely in a low volume centre. The finding that all three patients on a ventilator prior to HTX are alive is remarkable. It appears that mechanical ventilation is not always an absolute contraindication for HTX.
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The Morel-Lavallée lesion is a rare condition that was first described by the French physician Maurice Morel-Lavallée in 1853. The lesion is caused by forces of pressure and shear stress at the borders of subcutaneous tissue to the muscle fascia or bone as they are seen in run-over accidents. It leads to a shear of skin and subcutaneous tissue from the neighboring fascia followed by the development of a blood-filled hollow space at predestined regions of the body. If therapy is insufficient, large areas of necrosis can form, which will negatively influence operative measures. We report about three patients with the diagnosis of a Morel-Lavallée lesion. The history and the impressive clinical findings are demonstrated as well as the differential operative therapy performed, partially with osteosynthesis of accompanying bone injuries. According to the recommendations of the literature known to us, an adjusted therapeutic regime suited to the particular findings was carried out and in all three cases uncomplicated healing can be reported. Our results are in line with the existing recommendations, which are to relieve the soft tissue hematoma in time and sufficiently, and secondly to carry out débridements initially as well as planned second-look operations.
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Acetábulo/lesiones , Fijación Interna de Fracturas/métodos , Fracturas de Cadera/cirugía , Ilion/lesiones , Traumatismo Múltiple , Traumatismos de los Tejidos Blandos , Accidentes por Caídas , Accidentes de Trabajo , Adolescente , Adulto , Desbridamiento , Drenaje , Femenino , Fijación Interna de Fracturas/instrumentación , Hematoma/etiología , Hematoma/cirugía , Hematoma/terapia , Humanos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/etiología , Radiografía , Traumatismos de los Tejidos Blandos/diagnóstico , Traumatismos de los Tejidos Blandos/diagnóstico por imagen , Traumatismos de los Tejidos Blandos/etiología , Traumatismos de los Tejidos Blandos/cirugía , Traumatismos de los Tejidos Blandos/terapia , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Fracturas del Cuello Femoral/patología , Fijación Interna de Fracturas/normas , Curación de Fractura , Adulto , Anciano , Anciano de 80 o más Años , Placas Óseas/normas , Tornillos Óseos/normas , Cadáver , Femenino , Fracturas del Cuello Femoral/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Humanos , Inestabilidad de la Articulación/etiología , Masculino , Persona de Mediana Edad , Radiografía , Estrés MecánicoAsunto(s)
Presión Sanguínea , Fracturas del Cuello Femoral/complicaciones , Necrosis de la Cabeza Femoral/etiología , Hemartrosis/complicaciones , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Fracturas del Cuello Femoral/diagnóstico por imagen , Humanos , Cápsula Articular , Persona de Mediana Edad , UltrasonografíaAsunto(s)
Cardiotocografía , Látex/efectos adversos , Urticaria/etiología , Adhesivos , Adulto , Femenino , Humanos , EmbarazoRESUMEN
OBJECTIVES: This study retrospectively assesses the technical aspects of the catheter techniques used to ablate 83 accessory atrioventricular (AV) pathways during 88 procedures in 71 pediatric and adult patients (median age 14 years, range 1 month to 55 years). A number of catheter approaches and techniques evolved that may have improved success and shortened procedure times. BACKGROUND: Radiofrequency catheter ablation of accessory AV pathways can be highly successful. However, the technical difficulty of many of the procedures is masked by the success rate. METHODS: Left free wall, right free wall and septal accessory pathways were ablated with a variety of approaches. RESULTS: Left free wall pathways were ablated successfully by using a standard retrograde approach through the aortic valve in only 10 (24%) of 43 cases. The remaining 33 (76%) required an approach that was either retrograde through the mitral valve (2 of 33), transseptal (21 of 33) or retrograde where the catheter was advanced behind the posterior mitral leaflet at the point of mitral-aortic continuity, so that the catheter course was parallel rather than perpendicular to the mitral anulus (10 of 33). Nineteen of 20 septal pathways were ablated successfully by using either the parallel approach (2 of 29), a transseptal approach (2 of 19), ablation within the coronary sinus or one of its veins (8 of 19) or ablation on the atrial side of the tricuspid valve (7 of 19). Fifteen of 20 right free wall pathways were ablated successfully with a variety of approaches on both the atrial and the ventricular side of the tricuspid valve. Long vascular sheaths were judged to contribute directly to success in 33 (43%) of 77 pathways. The overall success rate has been 93% (77 of 83 pathways), with 100% success for left free wall (43 of 43), 75% for right free wall (15 of 20) and 95% for septal pathways (19 of 20). CONCLUSIONS: Thus, successful ablation of accessory AV pathways in a mixed group of pediatric and adult patients appears to benefit from a wide range of vascular and catheter approaches.