Assuntos
Transtornos de Deglutição/etiologia , Divertículo de Zenker/diagnóstico , Divertículo de Zenker/cirurgia , Idoso de 80 Anos ou mais , Esofagoscopia , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Masculino , Prognóstico , Encaminhamento e Consulta , Divertículo de Zenker/complicações , Divertículo de Zenker/etiologiaAssuntos
Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/terapia , Adulto , Transtornos de Ansiedade/psicologia , Administração de Caso , Diagnóstico Diferencial , Testes Diagnósticos de Rotina , Feminino , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Relações Médico-Paciente , Terapia Psicanalítica , Encaminhamento e Consulta , Transtornos Somatoformes/psicologiaRESUMO
Ulcerative colitis is an immunologic disorder of the intestine which involves the mucosa and sometimes the submucosa. It has a chronic relapsing course, affects the colon and occasionally the terminal ileum. This so called backwash ileitis is overall very rare and of limited clinical importance. Usually the inflammation starts in the rectum and may extend in a proximal and continuous fashion to the rest of the colon. Symptoms consist of frequent loose bloody stools, cramps and weight loss. It is important and frequently neglected that patients especially (but not exclusively) with a limited degree of colonic involvement up to the splenic flexure are treated topically with mesalamine and budesonid or hydrocortisone by suppository, enema or foam. In case of more severe colitis oral mesalamine, systemic corticosteroids and other immunosupressors should be added to the therapy.
Assuntos
Colite Ulcerativa/diagnóstico , Administração Retal , Corticosteroides/administração & dosagem , Algoritmos , Colite Ulcerativa/classificação , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/patologia , Colonoscopia , Diagnóstico Diferencial , Feminino , Humanos , Imunossupressores/uso terapêutico , Mucosa Intestinal/patologia , Mesalamina/administração & dosagem , Pessoa de Meia-Idade , RecidivaRESUMO
OBJECTIVE: Lung transplantation has become an established treatment option for end-stage pulmonary diseases. However, outcome depends on preoperative condition and co-morbidity. Furthermore, perioperative blood-product use is known to be associated with worse outcome even in transplant surgery. We investigated the impact of poor preoperative right-ventricular function and blood-product use on outcome after lung transplantation. METHODS: The medical records of 169 lung-transplant recipients from 1996 to 2006 were examined. Duration of hospital stay, hours on mechanical ventilation, duration of stay in the intensive care unit, perioperative complications, death during hospital stay, and long-term survival were recorded. These outcome parameters were analyzed regarding coherence with right-ventricular function and the perioperative administration of crystalloids, colloids, allogeneic red blood cells, fresh frozen plasma, and platelets. RESULTS: Patients with poor preoperative right-ventricular function had a significant increase in postoperative hours on ventilation (p=0.005), intensive care stay (p=0.003), and in-hospital death (p=0.012). The hours on ventilation increased also with high intra-operative fluid administration (p=0.026). Blood-product use was associated with prolonged mechanical ventilation and intensive care stay. After multivariate analysis, transfusion of platelets (p=0.022) was an independent prognostic factor for in-hospital death. Hours of mechanical ventilation was the only independent prognostic factor for long-term mortality (p=0.014). CONCLUSIONS: Perioperative transfusion of platelets is an independent prognostic factor for perioperative mortality. Furthermore, the study indicated that poor preoperative right-ventricular function might worsen perioperatively after lung transplantation. Therefore, pre-transplant treatment of pulmonary hypertension to protract right-ventricular failure and a restrictive use of allogeneic blood products may be options to improve outcome.