[Causes of death after revascularization of the lower limbs through surgery and angioplasty in the State of Rio de Janeiro, Brazil, between 2006 and 2011]. / Causas de Morte após Revascularização dos Membros Inferiores por Cirurgia e Angioplastia no Estado do Rio de Janeiro - Brasil, de 2006 a 2011.

INTRODUCTION: The underlying cause of death is the single diagnosis to which the cause of death is attributed. Other diagnostic codes written in the death certificate are the multiple causes. The study of the multiple causes allows the identification of the diseases present in the death. OBJECTIVE: To analyze the underlying and multiple causes of death after revascularization of the lower limbs using open surgery or angioplasty. METHODS: Two databases of the Public Health System of Rio de Janeiro were used: Authorizations for Hospitalizations 2006/10, and Statements of Deaths 2006/11. Probabilistic linkage of records between databases was performed using the Stata program. RESULTS: The most frequent underlying and multiple cause of death was Diabetes mellitus. The second was the systemic atherosclerotic disease represented by peripheral arterial disease, ischemic coronary disease and cerebrovascular disease. The analysis of multiple causes revealed septicemia, iatrogenic and complications after surgery, as well as renal failure after angio- plasty. Patients submitted to lower limb revascularization procedures had a higher overall mortality rate than the population of the State of Rio de Janeiro over 50 years of age, for all causes and specific ones. CONCLUSION: The period of highest risk of death was up to 30 days after hospital discharge, demonstrating the need to improve medical and hospital care before, during and after procedures. The study of multiple causes revealed adverse events and complications that were not chosen as the underlying cause.

Objetivos: A causa básica de morte é o diagnóstico único ao qual se atribui a causa da morte. Outros códigos de diag- nóstico anotados na declaração de óbito, são as causas múltiplas. O estudo das causas múltiplas permite identificar as doenças presentes no óbito. Objetivo: Conhecer as causas básica e múltiplas de morte após revascularização dos membros inferiores por cirurgia aberta ou angioplastia. Métodos: Foram utilizadas duas bases de dados do Sistema Único de Saúde do Estado do Rio de Janeiro: Autorizações de Internação Hospitalar de 2006-10 e as Declarações de Óbito do Sistema de Informação de Mortalidade de 2006-11. Foi realizada vinculação probabilístico de registros entre os bancos de dados, com programa estatístico Stata. Resultados: A causa básica e múltipla de óbito mais freqüente foi o Diabetes mellitus. Em segundo lugar a doença ate- rosclerótica sistêmica representada pela doença arterial periférica, doença isquêmica coronariana e doença cérebro vascular. A análise das causas múltiplas revelou septicemia, iatrogenia e complicações após cirurgia, e insuficiência renal após angioplastia. Os pacientes submetidos aos procedimentos de revascularização de membros inferiores apresentaram mortalidade geral mais elevada do que a população do Estado do Rio de Janeiro acima de 50 anos, por todas as causas e pelas específicas. Conclusão: O período de maior risco de morte foi até 30 dias após a alta hospitalar revelando a necessidade de melhorar os cuidados antes, durante e após os procedimentos. O estudo das causas múltiplas revelou eventos adversos e complicações que não foram escolhidas como causa básica.

[Hospital Lethality Following Lower Limbs Revascularization in the State of Rio de Janeiro, Brasil, 2006/10]. / Letalidade Hospitalar após Revascularização dos Membros Inferiores no Estado Rio de Janeiro - Brasil - 2006/10.

INTRODUCTION: Ischemic peripheral arterial disease is a form of presentation of systemic atherosclerosis and can be treated by angioplasty or open vascular surgery Objective: To find in-hospital lethality after revascularization according to sex, age, procedures and hospitalization conditions. METHOD: The data comes from authorizations to hospitalize from The State of Rio De Janeiro´s Public Healthcare System from the years 2006/10. We performed a search using the International Code of Diseases tenth revision (ICD-10) to identify codes of revascularization by angioplasty or open vascular surgery. The statistical analysis was done with Stata Program of statistics. RESULTS: The procedures were performed in 41 hospitals, public, private and university medical facilities. We identified 1558 registrations, 900 (57.8%) men and 658 women (42.2%). There were 68 hospital deaths and in-hospital mortality was 3.7% for men and 5.1% for women.The lethality was 2.6% under 50 years old, 4.1% between 50-69 years and 5.3% above 70 years. We identified 846 (46.6%) open surgeries and 968 (53.4%) angioplasties with a lethality of 2.0% in angioplasties (16/809) and 7.0% (52/748) with open surgeries. Elective procedures had 4.6 % of lethality and 4.1% in urgent/emergency procedures. Elective angioplasties had a mortality of 2.6%, and 1.4% in urgent/emergency. Open surgeries had the mortality of 6.5% and 7.5%, respectively. CONCLUSION: Hospital lethality showed high levels in open vascular surgery and angioplasties. A very sensitive aspect is the mortality of angioplasties in elective patients. These results are similar to those observed in myocardial revascularization from atherosclerosis. Public hospitals had lower lethality.

[Survival analysis after open vascular surgery and angioplasty in lower limbs vascularization in Rio de Janeiro, Brazil 2006-2013]. / Sobrevida Após Cirurgia Aberta Ou Angioplastia Para Revascularização dos Membros Inferiores No Estado Do Rio De Janeiro - Brasil, 2006-13.

Objective -The aim of this study is survival analysis after lower limb revascularization according to sex, age and procedures. METHOD: Were analysed in-hospital administrative database coming from the Public Health System of Rio de Janeiro (SUS-RJ) from 2006 through 2010 and the Public Registers of death of Rio de Janeiro (SIM-RJ) from 2006 through 2013. Both groups of information had linkaged using the Stata program of statistics. Three groups of age were studied: 50 years old or less, 50 to 79 and over 70 years old. RESULTS: More than half of patients received angioplasty as procedures during the study. In both procedures, men were more frequent, except in angioplasty after 70 years of age. In the period of 30 days after discharge in both procedures the survival had an abrupt reduction and it continue reducing until 180 days after open surgery. After these the survival curves run in parallel until the fourth year and then they had the same performance. CONCLUSION: The greatest reduction in survival was registered in the first thirty days after discharge, mainly in women after open surgery. It is necessary to improve in-hospital care in order to improve the survival index on the first thirty days after discharge..

JAK2V617F mutation in patients with splanchnic vein thrombosis.

BACKGROUND: Splanchnic vein thrombosis can be the presenting manifestation of myeloproliferative neoplasms. However, the diagnosis of a myeloproliferative neoplasm in these patients is often problematic, and more objective criteria are needed. AIM: To determine the frequency of the mutation JAK2V617F in patients with splanchnic vein thromboses. METHODS: A consecutive series of 108 adult patients with portal vein thrombosis (n = 77) and Budd-Chiari syndrome (n = 31) referred for hemostasis evaluation was retrospectively studied, with a median follow-up of 51 months (1-104). RESULTS: One or more prothrombotic risk factors were present in 63% of the patients. Twenty-four (22%) out of the 108 patients presented the JAK2V617F, including 2 cirrhotic patients. Most had a low mutated allele burden (median 16.5%). JAK2V617F was present in all four patients with a previous diagnosis of a myeloproliferative neoplasm. In nine JAK2V617F-positive patients, the diagnosis of a myeloproliferative neoplasm was made at the thrombosis work-up, during follow-up or after JAK2V617F detection. Among the other 11 patients carrying the mutation, 2 patients have died, 4 had no evidence suggesting a myeloproliferative neoplasm, 1 had a normal bone marrow biopsy, and the other 4 could not be persuaded to undergo a biopsy. Among the patients without an overt myeloproliferative neoplasm, 15 out of 99 (15%) presented the JAK2V617F mutation. None of the JAK2V617F-negative patients have developed signs of a myeloproliferative neoplasm during follow-up. CONCLUSIONS: Our findings suggest that JAK2V617F occurs in a high proportion of patients with splanchnic vein thrombosis, and reinforces the diagnostic utility of JAK2V617F testing in this setting.

Avaliaçäo multiprofissional de digitadores do I.B.G.E. com queixas de dores nos membros superiores

O trabalho objetiva o diagnóstico multiprofissional (médico, psicológico, social e institucional) através da avaliaçäo de 51 digitadores que compareceram ao Serviço Médico do IBGE-SEDE (RJ), no período de julho de 1986 a fevereiro de 1987, queixando-se de dores nos membros superiores, relacionando-as as exercício profissional. Estes digitadores foram submetidos a avaliaçäo, psicológica e social, tendo sido analisadas as características do ambiente de trabalho, procurando-se compreender globalmente as diversas situaçöes que interferem no desempenho de sua profissäo