[Thrombolytic therapy in deep venous thrombosis. Initial clinical experience]. / Terapia trombolítica em trombose venosa profunda. Experiência clínica inicial.

Four cases of proximal deep venous thrombosis treated with streptokinase and tissue plasminogen activator are reported. Therapy monitorization was performed by ultrasonography with color Doppler and thrombolytic agents were used by venous infusion. There was complete lysis in two cases, and the mean rate of venous recanalization was 88%. Reversible hemorrhagic complications were observed in two patients, and late ultrasonographic control (after six months) demonstrated venous insufficiency in one case.

[Prolonged mechanical ventilation following heart surgery]. / Ventilação mecânica prolongada após cirurgia cardíaca.

PURPOSE: To study the causes of difficulty or impossible weaning of cardiac surgical patients undergoing mechanical ventilation in the postoperative period and their outcome. METHODS: Three hundred and forty three consecutive adult patients submitted to open heart surgery were retrospectively studied and classified in three groups: I--patients in mechanical ventilation more than 24 hours; II--patients in mechanical ventilation less than 24 hours and reintubated some time after this period; III--patients successfully extubated in the first 24 hours of ventilation. RESULTS: The authors were able to identify the following preoperative factors associated with prolonged postoperative ventilation: cardiac failure, pulmonary hypertension, smoking, chronic obstructive pulmonary disease and previous open heart surgery. Significant factors in the immediate postoperative period (1st 24 hours) were: atelectasis, low output syndrome, perioperative myocardial infarction, reoperation for excessive bleeding, pleural effusion and cardiac arrest. This group of patients had a significant increase in nosocomial pneumonia, multiple organ failure (MOF) and surgical mortality. CONCLUSION: Pre and postoperative factors were identified associated with prolonged mechanical ventilation in the postoperative period and responsible by significant morbidity as such pulmonary infection, MOF and increase in mortality.