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1.
Medicine (Baltimore) ; 100(14): e25371, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33832122

RESUMEN

INTRODUCTION: Early acute massive pulmonary thrombosis embolism (PTE) after lung cancer surgery is one of the most fatal surgical complications. It is often accompanied by shock and hypotension, with high mortality rate. Due to surgical wounds, patients with early acute massive PTE after lung cancer surgery have a high risk of thrombolytic bleeding, which renders treatment more challenging and there is currently no standard protocol on how to safely and effectively treat these patients in the clinic. PATIENT CONCERNS: A 66-year-old woman after video-assisted thoracoscopic surgery for lung cancer, experienced sudden severe dyspnea, shock and hypotension with high D-Dimer, changed electrocardiogram (ECG), right ventricular dilatation, severe tricuspid regurgitation, and raised pulmonary arterial pressure on ultrasonic cardiogram (UCG), thromboses found on Ultrasonography of lower extremity vein. DIAGNOSIS: Because of her clinical manifestations and results of bedside auxiliary examinations, the patient was finally diagnosed with acute high-risk PTE after lung cancer surgery. INTERVENTIONS: 1.5 hours after onset of symptoms, thrombolysis using a continuous micropump infusion of 20,000 units/kg urokinase into the peripheral vein for 2 hours was initiated for this patient. OUTCOMES: The patient died of massive hemorrhage after thrombolysis. LESSONS: Treatment for patients with early acute PTE after lung cancer surgery is challenging due to a high risk of thrombolytic bleeding at the surgical site. Real-time monitoring of vital signs during thrombolysis and catheter-directed thrombolysis are recommended for these patients, in order to use the minimum drug dosage for quick curative effects and a low risk of bleeding.


Asunto(s)
Neoplasias Pulmonares/cirugía , Embolia Pulmonar/diagnóstico , Terapia Trombolítica/efectos adversos , Trombosis/diagnóstico por imagen , Enfermedad Aguda , Anciano , Resultado Fatal , Femenino , Hemorragia/inducido químicamente , Humanos , Complicaciones Posoperatorias , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/etiología , Cirugía Torácica Asistida por Video/métodos , Terapia Trombolítica/métodos , Trombosis/complicaciones , Ultrasonografía/métodos , Activador de Plasminógeno de Tipo Uroquinasa/administración & dosificación , Activador de Plasminógeno de Tipo Uroquinasa/uso terapéutico
2.
Neurosciences (Riyadh) ; 26(2): 158-162, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33814368

RESUMEN

OBJECTIVES: To assess and quantify the impact COVID-19 has had thus far on ischemic stroke admission rate and severity (National Institutes of Health Stroke Scale (NIHSS) score) at a single tertiary center in Makkah, Saudi Arabia. METHODS: This is a retrospective analysis performed on admitted cases with definitive final diagnoses of transient ischemic attack (TIA) and ischemic stroke at King Abdullah Medical City in Makkah between January 1, 2020 and July 2020. RESULTS: Sixty-nine patients were included in our study, 41 of whom presented at our facility before the pandemic and 29 during the pandemic. No statistical significance was observed between rate of admission, stroke severity, and rate of thrombolysis before the COVID-19 pandemic and after the outbreak. We observed a reduction of mean arrival time after the pandemic began, as well as a reduction of hospital stay days. CONCLUSION: A 29% reduction of admission secondary to acute ischemic stroke was noted during the pandemic. However, COVID-19 did not affect acute stroke care at our institute. The study is limited because of its small sample size, as we assessed just one medical center.


Asunto(s)
Ataque Isquémico Transitorio/epidemiología , /epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Ataque Isquémico Transitorio/terapia , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Arabia Saudita/epidemiología , Índice de Severidad de la Enfermedad , Distribución por Sexo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/terapia , Centros de Atención Terciaria , Terapia Trombolítica/estadística & datos numéricos , Tiempo de Tratamiento/estadística & datos numéricos , Adulto Joven
3.
Rev Port Cir Cardiotorac Vasc ; 28(1): 65-67, 2021 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-33834647

RESUMEN

Catheter directed thrombolysis is a minimally invasive procedure that results in a significant reduction in venous obstruction after deep vein thrombosis. The technique implies the performance of phlebographies to monitor the thrombolysis progression. The objective of this paper is to describe the use of vascular ultrasound to follow the thrombus lysis and to adjust the catheter position according to the progression of the thrombolysis. This is the first case reported describing the application of ultrasound to monitor the thrombolysis. A 36-year woman was admitted ilio-femoral vein. The ipsilateral great saphenous vein was the percutaneous access to perform the anterograde thrombolysis. The procedure, including the control of thrombus lysis, as well as catheter progression was performed under ultrasound guidance. The thrombolysis took 52 hours. The patient has two years of follow-up without any complaint. The use of vascular ultrasound to monitor the thrombolysis has several theoretical advantages in patients with adequate biotopes. It minimizes the number of venograms and can be performed at the bedside. It is effective and inexpensive.


Asunto(s)
Vena Ilíaca , Trombosis de la Vena , Femenino , Vena Femoral/diagnóstico por imagen , Humanos , Vena Ilíaca/diagnóstico por imagen , Terapia Trombolítica , Resultado del Tratamiento , Ultrasonografía Intervencional , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/tratamiento farmacológico
4.
Angiol Sosud Khir ; 27(1): 33-38, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33825726

RESUMEN

PURPOSE: This study was undertaken to investigate efficacy of apixaban in prevention of haemorrhagic complications during treatment of proximal thromboses of deep veins of the lower extremities using endovascular techniques. PATIENTS AND METHODS: We retrospectively studied the results of treating a total of 50 patients presenting with deep vein thromboses at late stages of the pathological process. The patients were subdivided into 2 statistically homogeneous groups. Group One was composed of 30 patients undergoing treatment consisting in a combination of catheter-guided thrombolysis with urokinase and percutaneous mechanical thrombectomy, with rivaroxaban used for prolonged anticoagulation therapy. Group Two comprised 20 patients subjected to similar endovascular treatment with additional venous stenting. Prolonged 6-month anticoagulation therapy was carried out with apixaban. The results of treatment were assessed after 12 months by means of control ultrasonographic and clinical examination in order to determine the degree of restoration of the lumen of deep veins and severity of venous outflow impairments. RESULTS: After 1 year, in Group One patients there was no evidence of impaired venous outflow in 40% of patients, with a mild degree revealed in 40%, moderate degree in 13.3%, and severe degree in 6.7% of patients. In Group Two patients, there were no symptoms of venous insufficiency in 83.4%, with a mild degree revealed in 16.6%. Neither moderate nor severe impairments of venous outflow were observed. In Group One, manifestations of haemorrhagic syndrome on the background of taking rivaroxaban were noted to occur in 10% of patients and in Group Two on the background of taking apixaban also in 10% of patients. CONCLUSION: The use of apixaban in patients with proximal thromboses of deep veins of lower limbs on the background of treatment by endovascular techniques proved effective and safe.


Asunto(s)
Procedimientos Endovasculares , Trombosis de la Vena , Procedimientos Endovasculares/efectos adversos , Humanos , Pirazoles , Piridonas/efectos adversos , Estudios Retrospectivos , Terapia Trombolítica , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/tratamiento farmacológico
5.
Angiol Sosud Khir ; 27(1): 91-95, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33825734

RESUMEN

Demonstrated in the article are the results of catheter-directed thrombolysis in a male patient presenting with bilateral acute iliofemoral venous thrombosis on the background of aplasia of the inferior vena cava. The incidence rate of this pathology is specified, with an emphasis on no recommendations on choosing optimal therapeutic strategy in this cohort of patients. The main causes and complications of the disease are described. The realized policy of revascularization demonstrated its safety and efficacy. The chosen method of correction resulted in a successful outcome of treatment, preventing phlegmasia cerulea dolens. This policy can be recommended as most preferred for patients with acute iliofemoral venous thrombosis on the background of aplasia of the inferior venal cava.


Asunto(s)
Vena Cava Inferior , Trombosis de la Vena , Catéteres , Humanos , Vena Ilíaca/diagnóstico por imagen , Masculino , Terapia Trombolítica , Resultado del Tratamiento , Vena Cava Inferior/diagnóstico por imagen , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/tratamiento farmacológico
6.
Medicine (Baltimore) ; 100(15): e25255, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33847623

RESUMEN

RATIONALE: Fibrinolysis shutdown associated with severe thrombotic complications is a recently recognized syndrome that was previously seldom investigated in patients with severe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. It presents a unique therapeutic dilemma, as anticoagulation with heparin alone is insufficient to address the imbalance in fibrinolysis. And while the use of fibrinolytic agents could limit the disease severity, it is often associated with bleeding complications. There is a need for biomarkers that will guide the timely stratification of patients into those who may benefit from both anticoagulant and fibrinolytic therapies. PATIENT CONCERNS: All 3 patients presented with shortness of breath along with comorbidities predisposing them to severe SARS-CoV-2 infection. One patient (Patient 3) also suffered from bilateral deep venous thrombosis. DIAGNOSES: All 3 patients tested positive for SARS-CoV-2 RNA by reverse transcription polymerase chain reaction (RT-PCR) and were eventually diagnosed with respiratory failure necessitating intubation. INTERVENTIONS: All 3 patients required mechanical ventilation support, 2 of which also required renal replacement therapy. All 3 patients were also placed on anticoagulation therapy. OUTCOMES: In Patients 1 and 2, the initial D-dimer levels of 0.97 µg/ml fibrinogen equivalent units (FEU) and 0.83 µg/ml FEU were only slightly elevated (normal <0.50 µg/ml FEU). They developed rising D-dimer levels to a peak of 13.21 µg/ml FEU and >20.0 µg/ml FEU, respectively, which dropped to 1.34 µg/ml FEU 8 days later in Patient 1 and to 2.94 µg/ml on hospital day 13 in Patient 2. In Patient 3, the D-dimer level on admission was found to be elevated to >20.00 µg/ml FEU together with imaging evidence of thrombosis. And although he received therapeutic heparin infusion, he still developed pulmonary embolism (PE) and his D-dimer level declined to 5.91 µg/ml FEU. Despite "improvement" in their D-dimer levels, all 3 patients succumbed to multi-system organ failure. On postmortem examination, numerous arterial and venous thromboses of varying ages, many consisting primarily of fibrin, were identified in the lungs of all patients. LESSONS: High D-dimer levels, with subsequent downtrend correlating with clinical deterioration, seems to be an indicator of fibrinolysis suppression. These findings can help form a hypothesis, as larger cohorts are necessary to demonstrate their reproducibility.


Asunto(s)
Anticoagulantes/uso terapéutico , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Insuficiencia Multiorgánica , Terapia Trombolítica/métodos , Autopsia/métodos , /complicaciones , /terapia , Deterioro Clínico , Femenino , Fibrinólisis , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/sangre , Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/etiología , Valor Predictivo de las Pruebas , Pronóstico , Terapia de Reemplazo Renal/métodos , Respiración Artificial/métodos , Índice de Severidad de la Enfermedad , Trombosis de la Vena/sangre , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico
7.
Medicine (Baltimore) ; 100(15): e25575, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33847687

RESUMEN

RATIONALE: Hereditary protein C deficiency has a high prevalence in Asian populations, being the important risk factor associated with thrombophilia. Traditionally, conservative medication is the first choice for patients with hereditary protein C deficiency. However, there are few reports on whether aggressive surgical treatment can be performed when patients continue to develop life-threatening ischemic symptoms after adequate anticoagulant and thrombolytic therapy. PATIENT CONCERNS: A 40-year-old male presented with right lower extremity pain for 1 week. DIAGNOSIS: Computed tomography angiography (CTA) of lower extremity indicated arterial embolization of the right superficial femoral artery. Vascular ultrasonography showed old extensive thrombus in the deep vein of the left lower extremity. Electrocardiogram reported old anterior myocardial infarction. Sequencing of the gene encoding protein C (PROC) gene revealed that a heterozygous in-frame deletion mutation (c.577-579delAAG, p.192delK). Based on these findings, the diagnosis of hereditary protein C deficiency was made. INTERVENTIONS: The patient was given low-molecular-weight heparin (LMWH) anticoagulation and urokinase treatment immediately. Then we performed the Fogarty catheter embolectomy with about 18.5 cm thrombus being removed and utilized the balloon catheter to dilate the anterior tibial artery. Despite given adequate anticoagulant and thrombolytic therapy postoperatively, the patient still had new thrombosis, and eventually underwent arterial embolectomy and amputation. OUTCOMES: The patient was discharged with good wound healing and continued rivaroxaban treatment at a dose of 20 mg daily. The patient was followed-up monthly until 1 year: there was no adverse ischemic events occurred. LESSONS: Aggressive surgical treatment may be the effective attempt for life-saving when conservative treatment as the first choice had unsatisfactory results in hereditary protein C deficiency patients. The novel oral anticoagulants (NOACs) could be more suitable than warfarin for the treatment and prevention of recurrence in patients with hereditary protein C deficiency.


Asunto(s)
Embolectomía con Balón/métodos , Deficiencia de Proteína C/terapia , Terapia Trombolítica/métodos , Tromboembolia Venosa/terapia , Adulto , Anticoagulantes/administración & dosificación , Heparina de Bajo-Peso-Molecular/administración & dosificación , Humanos , Masculino , Deficiencia de Proteína C/complicaciones , Resultado del Tratamiento , Activador de Plasminógeno de Tipo Uroquinasa/administración & dosificación , Tromboembolia Venosa/congénito
8.
Am J Case Rep ; 22: e931080, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33883541

RESUMEN

BACKGROUND The novel coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), often manifests a coagulopathy in severely ill patients, which may cause hemorrhage and/or thrombosis of varying severity. This report comprises the cases of 3 patients with COVID-19-associated coagulopathy who were evaluated with thromboelastography (TEG) and activated partial thromboplastin time (aPTT) to enable personalized anticoagulant therapy. CASE REPORT Three patients presented with COVID-19 pneumonia, confirmed by reverse transcription-polymerase chain reaction, who developed thrombohemorrhagic coagulopathy.Case 1: A 72-year-old woman on long-term warfarin therapy for a history of venous thromboembolism developed a right upper lobe pulmonary embolus, despite an international normalized ratio of 6.4 and aPTT of 120.7 s. TEG enabled successful anticoagulation with heparin, and her pulmonary infarct was no longer present 2 weeks later.Case 2: A 55-year-old woman developed a rectus sheath hematoma while on heparin, and TEG demonstrated increased fibrinolysis despite COVID-19 patients more commonly undergoing fibrinolytic shutdown.Case 3: A 43-year-old woman had significant thrombus burden while severely hypocoagulable according to laboratory testing. As the venous thrombi enlarged in a disseminated intravascular coagulopathic-like state, the heparin dose was escalated to achieve a target aPTT of 70 to 80 s, resulting in a flat line TEG tracing. CONCLUSIONS These 3 cases of COVID-19 pneumonia with complex and varied clinical histories demonstrated the clinical value of TEG combined with the measurement of aPTT to facilitate personalized anticoagulation, resulting in good clinical outcomes.


Asunto(s)
Anticoagulantes/uso terapéutico , Hemorragia/tratamiento farmacológico , Tromboelastografía , Terapia Trombolítica , Trombosis/tratamiento farmacológico , Adulto , Anciano , Femenino , Hemorragia/virología , Heparina/uso terapéutico , Humanos , Persona de Mediana Edad , Trombosis/virología
10.
Zh Nevrol Psikhiatr Im S S Korsakova ; 121(3. Vyp. 2): 33-37, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33908230

RESUMEN

OBJECTIVE: To assess the safety and efficacy of Revelisa in patients with ischemic stroke in real-world clinical practice. MATERIAL AND METHODS: The interim analysis of an open-label, prospective, multicenter, non-interventional study IVT-AIS-R included 223 patients (50.2% women and 49.8% men, mean age 66.6 (13.5) years) with ischemic stroke who were admitted to the study sites since July 2019 and who, in the absence of contraindications, underwent thrombolytic therapy (TLT) with Revelisa within the first 4.5 hours from the onset of stroke. Data were collected as a continuous sample. According to the reperfusion therapy protocol for ischemic stroke, all patients included in the study underwent clinical examination, investigations and laboratory tests before TLT and within the first days after it. Symptomatic hemorrhagic transformation was determined in accordance with the ECASS 3 criteria. RESULTS: Most of the patients (96%) had hypertension, 74% of patients had chronic heart failure, 57.4% had coronary artery disease, of which 8.5% were patients with a previous myocardial infarction. Various cardiac arrhythmias were observed in 33.2% of cases, 21.5% of patients had type 2 diabetes, 18.4% had a history of previous acute cerebrovascular accidents. Hemorrhagic transformation (HT) of a cerebral lesion developed in 7.1% of cases, with the frequency of symptomatic HT being 3.1% (7 patients). The hospital mortality rate was 13.9%. The median NIHSS score was 4 points (p<0.0001) on day 7 versus baseline. The proportion of patients with good functional recovery (the modified Rankin scale score 0-2) at discharge was 48.2%. CONCLUSION: The data obtained with the use of Revelisa in patients with ischemic stroke in real-world clinical practice allow drawing conclusions about a comparable safety and efficacy profile to that in previously published registry studies of alteplase.


Asunto(s)
Isquemia Encefálica , Diabetes Mellitus Tipo 2 , Accidente Cerebrovascular , Anciano , Isquemia Encefálica/complicaciones , Isquemia Encefálica/tratamiento farmacológico , Femenino , Fibrinolíticos/uso terapéutico , Humanos , Masculino , Estudios Prospectivos , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Resultado del Tratamiento
11.
JAMA Netw Open ; 4(4): e217498, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33885771

RESUMEN

Importance: Acute ischemic stroke (AIS) is a known neurological complication in patients with respiratory symptoms of COVID-19 infection. However, AIS has not been described as a late sequelae in patients without respiratory symptoms of COVID-19. Objective: To assess AIS experienced by adults 50 years or younger in the convalescent phase of asymptomatic COVID-19 infection. Design, Setting, and Participants: This case series prospectively identified consecutive male patients who received care for AIS from public health hospitals in Singapore between May 21, 2020, and October 14, 2020. All of these patients had laboratory-confirmed asymptomatic COVID-19 infection based on a positive SARS-CoV-2 serological (antibodies) test result. These patients were individuals from South Asian countries (India and Bangladesh) who were working in Singapore and living in dormitories. The total number of COVID-19 cases (54 485) in the worker dormitory population was the population at risk. Patients with ongoing respiratory symptoms or positive SARS-CoV-2 serological test results confirmed through reverse transcriptase-polymerase chain reaction nasopharyngeal swabs were excluded. Main Outcomes and Measures: Clinical course, imaging, and laboratory findings were retrieved from the electronic medical records of each participating hospital. The incidence rate of AIS in the case series was compared with that of a historical age-, sex-, and ethnicity-matched national cohort. Results: A total of 18 male patients, with a median (range) age of 41 (35-50) years and South Asian ethnicity, were included. The median (range) time from a positive serological test result to AIS was 54.5 (0-130) days. The median (range) National Institutes of Health Stroke Scale score was 5 (1-25). Ten patients (56%) presented with a large vessel occlusion, of whom 6 patients underwent intravenous thrombolysis and/or endovascular therapy. Only 3 patients (17%) had a possible cardiac source of embolus. The estimated annual incidence rate of AIS was 82.6 cases per 100 000 people in this study compared with 38.2 cases per 100 000 people in the historical age-, sex-, and ethnicity-matched cohort (rate ratio, 2.16; 95% CI, 1.36-3.48; P < .001). Conclusions and Relevance: This case series suggests that the risk for AIS is higher in adults 50 years or younger during the convalescent period of a COVID-19 infection without respiratory symptoms. Acute ischemic stroke could be part of the next wave of complications of COVID-19, and stroke units should be on alert and use serological testing, especially in younger patients or in the absence of traditional risk factors.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Trombectomía/métodos , Terapia Trombolítica/métodos , Adulto , /diagnóstico , /métodos , Convalecencia , Registros Electrónicos de Salud/estadística & datos numéricos , Procedimientos Endovasculares/métodos , Humanos , Incidencia , /etnología , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Factores de Riesgo , /patogenicidad , Singapur/epidemiología , Migrantes/estadística & datos numéricos
12.
An. Fac. Cienc. Méd. (Asunción) ; 54(1): 77-82, 20210000.
Artículo en Español | LILACS | ID: biblio-1178631

RESUMEN

El empiema es una colección de líquido purulento en el espacio pleural. La causa más común es la neumonía. Las opciones de tratamiento incluyen toracocentesis terapéutica, colocación de catéter de drenaje, terapia fibrinolítica, pleurodesis y cirugía, como la decorticación pleural. El drenaje pleural es eficaz en la etapa I y la cirugía está reservada para casos complicados (estadios II y III). En estos casos, es necesaria la decorticación pulmonar. Actualmente, el enfoque más favorecido para la decorticación es mediante una toracotomía abierta. Este es un estudio observacional, descriptivo, de corte transversal, retrospectivo, con un muestreo no probabilístico de casos consecutivos que tuvo como población accesible a pacientes con el diagnostico de empiema en quienes se realizó una decorticación pleural en el Hospital de Clínicas por el Departamento de Cirugía de Tórax durante el periodo de marzo 2016 a febrero 2019. Un total de 24 pacientes con el diagnóstico de empiema fueron sometidos a una decorticación pleural. La etiología de empiema más frecuente (75%) fue el derrame paraneumónico. Las complicaciones post quirúrgicas estuvieron presentes en 9 (37,5%) pacientes, de estos, 4 (17%) presentaron fuga aérea durante los primeros días postoperatorios. Se constató la resolución completa del cuadro en 21 (87,5%) pacientes y 3 (12,5%) pacientes presentaron colección residual pleural. Se constató recurrencia en 1 (4%) paciente, requiriendo un re intervención quirúrgica. En conclusión, la casuística de nuestro departamento de tórax coincide en cuanto a valores internacionales de complicaciones, resolución y mortalidad.


Empyema is a collection of purulent fluid in the pleural space. The most common cause is pneumonia. Treatment options include therapeutic thoracentesis, drainage catheter placement, fibrinolytic therapy, pleurodesis, and surgery, such as pleural decortication. Pleural drainage is effective in stage I and surgery is reserved for complicated cases (stages II and III). In these cases, pulmonary decortication is necessary. Currently, the most favored approach to decortication is by open thoracotomy. This is an observational, descriptive, cross-sectional, retrospective study, with a non-probabilistic sampling of consecutive cases that had as the accessible population, patients with the diagnosis of empyema in whom pleural decortication was performed at the Clinica´s Hospital of San Lorenzo, by the Department of Thoracic Surgery during the period from March 2016 to February 2019. A total of 24 patients with the diagnosis of empyema underwent pleural decortication. The most frequent aetiology of empyema (75%) was parapneumonic effusion. Post-surgical complications were present in 9 (37.5%) patients, of these, 4 (17%) presented air leakage during the first postoperative days. Complete resolution of the condition was verified in 21 (87.5%) patients and 3 (12.5%) patients presented residual pleural collection. Recurrence was found in 1 (4%) patient, requiring reoperation. In conclusion, the casuistry of our thoracic department coincides in terms of international values of complications, resolution and mortality.


Asunto(s)
Neumonía , Cirugía Torácica , Toracotomía , Drenaje , Pleurodesia , Toracocentesis , Cirugía General , Tórax , Terapia Trombolítica , Estudios Retrospectivos , Catéteres
13.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(2): 155-160, 2021 Feb.
Artículo en Chino | MEDLINE | ID: mdl-33729132

RESUMEN

OBJECTIVE: To determine the effect of andrographolide (AD) on the expression of procoagulant and fibrinolytic inhibitory factors in rat type II alveolar epithelial cells (AEC II) stimulated by lipopolysaccharide (LPS). METHODS: The AEC II cells RLE-6TN in the logarithmic growth phase were divided into 5 groups: the normal control (NC) group, the LPS group, and the 6.25, 12.5, and 25 mg/L AD groups (AD 6.25 group, AD 12.5 group, AD 25 group). The NC group was cultured with RPMI 1640 conventional medium. In the LPS group, 5 mg/L LPS was added to the RPMI 1640 conventional medium for stimulation. Cells in the AD groups were treated with 6.25, 12.5, and 25 mg/L AD in advance for 1 hour and then given LPS to stimulate the culture. The cells and cell culture supernatant were collected 24 hours after LPS stimulation. The protein and mRNA expressions of tissue factor (TF), tissue factor pathway inhibitor (TFPI), and plasminogen activator inhibition-1 (PAI-1) in cells were detected by Western blotting and real-time fluorescent quantitative polymerase chain reaction (RT-qPCR). The levels of procollagen III peptide (PIIIP), thrombin-antithrombin complex (TAT), antithrombin III (AT-III) and activated protein C (APC) in the cell supernatant were detected by enzyme linked immunosorbent assay (ELISA). RESULTS: Compared with the NC group, the protein and mRNA expressions of TF and PAI-1 in the LPS group were significantly increased, and the protein and mRNA expressions of TFPI were significantly reduced. At the same time, the levels of PIIIP and TAT in the cell supernatant were significantly increased, the levels of AT-III, APC were significantly reduced. Compared with the LPS group, the protein and mRNA expressions of TF and PAI-1 in AD 6.25 group, AD 12.5 group, AD 25 group were significantly reduced [TF/GAPDH: 0.86±0.08, 0.45±0.04, 0.44±0.04 vs. 1.32±0.10, TF mRNA (2-ΔΔCt): 2.59±0.25, 2.27±0.05, 1.95±0.04 vs. 4.60±0.26, PAI-1/GAPDH: 2.11±0.07, 1.45±0.04, 0.86±0.09 vs. 2.56±0.09, PAI-1 mRNA (2-ΔΔCt): 3.50±0.22, 2.23±0.29, 1.84±0.09 vs. 6.60±0.27, all P < 0.05], while the protein and mRNA expressions of TFPI were significantly increased [TFPI/GAPDH: 0.78±0.05, 0.81±0.03, 0.84±0.07 vs. 0.36±0.02, TFPI mRNA (2-ΔΔCt): 0.46±0.09, 0.69±0.07, 0.91±0.08 vs. 0.44±0.06, all P < 0.05]. Also the levels of PIIIP and TAT in the cell supernatant were significantly reduced, and the levels of AT-III and APC were significantly increased [PIIIP (µg/L): 13.59±0.23, 12.66±0.23, 10.59±0.30 vs. 15.82±0.29, TAT (ng/L): 211.57±6.41, 205.69±4.04, 200.56±9.85 vs. 288.67±9.84, AT-III (µg/L): 102.95±3.86, 123.92±2.63, 128.67±1.67 vs. 92.93±3.36, APC (µg/L): 1 188.95±14.99, 1 366.12±39.93, 1 451.15±29.69 vs. 1 145.55±21.07, all P < 0.05]. With the increase of the dose of AD, the above-mentioned promotion and inhibition effects became more obvious. In the AD 25 group, TF, PAI-1 protein and mRNA expressions decreased, TFPI mRNA expression increased, PIIIP level in the supernatant decreased and AT-III, APC levels increased compared with AD 6.25 group, the difference was statistically significant, and the decrease of PAI-1 protein expression and PIIIP level in the supernatant were also statistically significant compared with AD 12.5 group. CONCLUSIONS: Andrographolide in the dose range of 6.25-25 mg/L can dose-dependently inhibit the expression and secretion of procoagulant and fibrinolytic inhibitor-related factors in AEC II cells RLE-6TN stimulated by LPS, and promote the secretion of anticoagulant factors. 25 mg/L has the most obvious effect.


Asunto(s)
Células Epiteliales Alveolares , Lipopolisacáridos , Animales , Diterpenos , Ratas , Terapia Trombolítica , Tromboplastina
14.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(2): 207-210, 2021 Feb.
Artículo en Chino | MEDLINE | ID: mdl-33729141

RESUMEN

OBJECTIVE: To investigate the value of quantitative electroencephalography (qEEG) in the evaluation of thrombolytic efficacy in acute cerebral infarction. METHODS: A prospective cohort study was conducted. Ninety-four patients with acute cerebral infarction who received intravenous thrombolysis admitted to the department of emergency of Qinhuangdao First Hospital from October 2019 to September 2020 were enrolled. The relative energy values of δ, θ, α and ß waves in qEEG before and 2 hours, 24 hours and 7 days after intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis were dynamically monitored, and the power ratio index [DTABR, DTABR = (δ+θ)/(α+ß)] was calculated. The National Institutes of Health stroke scale (NIHSS) score was also recorded. The reduction of NIHSS score ≥ 3 or the disappearance of neurological symptoms were regarded as effective thrombolytic therapy. The changes of DTABR before and after thrombolysis in patients with effective and ineffective thrombolysis were analyzed, and the correlation between DTABR and NIHSS score was analyzed by Pearson method. RESULTS: A total of 94 patients were enrolled, including 64 males and 30 females. The average age was (61.71±10.11) years from 36 to 89 years old. Thrombolysis was effective in 57 cases and ineffective in 37 cases. Compared with before thrombolysis, DTABR of the effective group was significantly decreased at 2 hours, 24 hours and 7 days after thrombolysis (left cerebral infarction: 1.87±1.45, 1.59±0.88, 1.58±0.90 vs. 3.82±2.60; right cerebral infarction: 1.55±0.57, 1.41±0.50, 1.35±0.44 vs. 3.20±1.63, all P < 0.05). DTABR did not change or increase significantly at 2 hours, 24 hours and 7 days after thrombolysis compared with before thrombolysis (left cerebral infarction: 3.56±2.57, 3.48±2.19, 3.54±2.50 vs. 3.11±1.62; right cerebral infarction: 5.29±3.93, 5.33±3.94, 5.19±4.52 vs. 4.73±2.43, all P > 0.05). Pearson correlation analysis showed a significant positive correlation between DTABR and NIHSS score in patients with acute cerebral infarction (r = 0.691, P < 0.01). CONCLUSIONS: The quantitative index of qEEG, DTABR, can accurately and quickly monitor the process of thrombolysis in acute cerebral infarction, and can effectively evaluate the effect of thrombolysis in patients.


Asunto(s)
Accidente Cerebrovascular , Activador de Tejido Plasminógeno , Adulto , Anciano , Anciano de 80 o más Años , Infarto Cerebral/tratamiento farmacológico , Electroencefalografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Terapia Trombolítica , Activador de Tejido Plasminógeno/uso terapéutico , Resultado del Tratamiento
15.
Braz J Med Biol Res ; 54(5): e10000, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33729386

RESUMEN

This study aimed to explore the effect of intravenous thrombolysis with alteplase on clinical efficacy, inflammatory factors, and neurological function in patients with acute cerebral infarction. A total of 120 patients with acute cerebral infarction were divided into two groups by the random number table method, with 60 patients in each group: observation group (intravenous thrombolysis with alteplase) and control group (intravenous thrombolysis with batroxobin). The clinical efficacy after a 14-day treatment was observed. Serum C-reactive protein (CRP), tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), CD62p, GMP-140, and neuron-specific enolase (NSE) were measured. Scores of National Institutes of Health Stroke Scale (NIHSS), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA) were determined. The total effective rate in the observation group was 81.67%, which was higher than the 61.67% in the control group (P<0.05). The improvement of inflammatory factors (CRP, TNF-α, IL-6, CD62p, GMP-140, and NSE), NIHSS, MMSE, and MoCA in the observation group was superior to that in the control group (all P<0.05). The modified Rankin scale at three months after hospital discharge in the observation group was lower than that in the control group (P<0.01). Intravenous thrombolysis with alteplase for acute cerebral infarction can enhance the clinical efficacy, alleviate inflammatory response and brain injury, and improve cognitive function, which is worthy of further clinical application and study.


Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular , Isquemia Encefálica/tratamiento farmacológico , Infarto Cerebral/tratamiento farmacológico , Fibrinolíticos/uso terapéutico , Humanos , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Activador de Tejido Plasminógeno , Resultado del Tratamiento
17.
JAMA ; 325(11): 1088-1098, 2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-33724327

RESUMEN

Importance: Stroke is the fifth leading cause of death and a leading cause of disability in the United States, affecting nearly 800 000 individuals annually. Observations: Sudden neurologic dysfunction caused by focal brain ischemia with imaging evidence of acute infarction defines acute ischemic stroke (AIS), while an ischemic episode with neurologic deficits but without acute infarction defines transient ischemic attack (TIA). An estimated 7.5% to 17.4% of patients with TIA will have a stroke in the next 3 months. Patients presenting with nondisabling AIS or high-risk TIA (defined as a score ≥4 on the age, blood pressure, clinical symptoms, duration, diabetes [ABCD2] instrument; range, 0-7 [7 indicating worst stroke risk]), who do not have severe carotid stenosis or atrial fibrillation, should receive dual antiplatelet therapy with aspirin and clopidigrel within 24 hours of presentation. Subsequently, combined aspirin and clopidigrel for 3 weeks followed by single antiplatelet therapy reduces stroke risk from 7.8% to 5.2% (hazard ratio, 0.66 [95% CI, 0.56-0.77]). Patients with symptomatic carotid stenosis should receive carotid revascularization and single antiplatelet therapy, and those with atrial fibrillation should receive anticoagulation. In patients presenting with AIS and disabling deficits interfering with activities of daily living, intravenous alteplase improves the likelihood of minimal or no disability by 39% with intravenous recombinant tissue plasminogen activator (IV rtPA) vs 26% with placebo (odds ratio [OR], 1.6 [95% CI, 1.1-2.6]) when administered within 3 hours of presentation and by 35.3% with IV rtPA vs 30.1% with placebo (OR, 1.3 [95% CI, 1.1-1.5]) when administered within 3 to 4.5 hours of presentation. Patients with disabling AIS due to anterior circulation large-vessel occlusions are more likely to be functionally independent when treated with mechanical thrombectomy within 6 hours of presentation vs medical therapy alone (46.0% vs 26.5%; OR, 2.49 [95% CI, 1.76-3.53]) or when treated within 6 to 24 hours after symptom onset if they have a large ratio of ischemic to infarcted tissue on brain magnetic resonance diffusion or computed tomography perfusion imaging (modified Rankin Scale score 0-2: 53% vs 18%; OR, 4.92 [95% CI, 2.87-8.44]). Conclusions and Relevance: Dual antiplatelet therapy initiated within 24 hours of symptom onset and continued for 3 weeks reduces stroke risk in select patients with high-risk TIA and minor stroke. For select patients with disabling AIS, thrombolysis within 4.5 hours and mechanical thrombectomy within 24 hours after symptom onset improves functional outcomes.


Asunto(s)
Ataque Isquémico Transitorio/terapia , Inhibidores de Agregación Plaquetaria/uso terapéutico , Trombectomía , Terapia Trombolítica , Anticoagulantes/uso terapéutico , Terapia Combinada , Quimioterapia Combinada , Humanos , Ataque Isquémico Transitorio/diagnóstico , Trombectomía/métodos , Terapia Trombolítica/métodos
18.
Acute Med ; 20(1): 15-17, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33749690

RESUMEN

We assessed the efficacy of thrombolysis in avoiding long-term complications. Notes of patients thrombolysed for PE in the 2-year period were reviewed. The initial CTPA and echocardiogram results before thrombolysis were compared to the results of follow up imaging repeated after 6 months. Twenty-two patients were thrombolysed for PE. 14 patients had sub-massive PE and 8 patients had massive PE. The right ventricle (RV) was dilated on pre-thrombolysis echocardiogram in 16 patients. On follow up echocardiography all patients with massive PE (6 studies) had a normal RV size, with pulmonary artery pressures (PAP) of 29mmHg. Follow up echocardiography of patients with submassive PE (13 studies) showed 11 patients with a normal RV, with PAP of 28 mmHg.


Asunto(s)
Embolia Pulmonar , Terapia Trombolítica , Ecocardiografía , Humanos , Embolia Pulmonar/tratamiento farmacológico , Estudios Retrospectivos , Resultado del Tratamiento
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