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3.
Arq Bras Cardiol ; 109(3 Supl 1): 1-104, 2017 Jan-Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29044300
4.
Arq. bras. cardiol ; 109(3,supl.1): 1-104, Sept. 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-887936
5.
Intern Emerg Med ; 9(2): 133-42, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24057347

RESUMO

Stroke is one of the most important causes of mortality and morbidity worldwide and, for a long time, was the leading cause of death in developed countries. Atherothrombotic carotid stenosis is one of the most important etiologies behind this event. If properly recognized and treated, lives can be saved, as well as long-term disabilities prevented. With population aging and improvements in surgical and clinical care, patients with several comorbidities will be referred for revascularization procedures more frequently, posing a challenge for physicians. The purpose of this review is to provide internists and clinicians with information based on several studies so they can offer to their patients, the best evidence-based care, indicating appropriate medical therapy, as well as referral to a vascular surgeon, or what contraindicates endarterectomy or angioplasty, depending on individual characteristics.


Assuntos
Estenose das Carótidas/diagnóstico , Estenose das Carótidas/cirurgia , Humanos , Medicina Interna , Procedimentos Cirúrgicos Vasculares/métodos
6.
J Vasc Surg ; 58(6): 1593-9, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24280324

RESUMO

INTRODUCTION: Vascular surgeries are related to high cardiac morbidity and mortality, and the maintenance of aspirin in the perioperative period has a protective effect. The purpose of this study was to evaluate the association between preoperative platelet aggregability and perioperative cardiovascular (CV) events. METHODS: A preoperative platelet aggregation test was performed on an impedance aggregometer in response to collagen and to arachidonic acid (AA) for 191 vascular surgery patients under chronic use of aspirin. We analyzed the following CV events: acute myocardial infarction, unstable angina, isolated troponin elevation, acute ischemic stroke, reoperation, and cardiac death. Hemorrhagic events were also evaluated and classified according to the Thrombolysis In Myocardial Infarction criteria. RESULTS: The incidence of CV events was 22% (n = 42). Higher platelet response to AA was associated with CV events, so that patients in the fourth quartile (higher than 11Ω) had almost twice the incidence of CV events when compared with the three lower quartiles: 35% vs 19%; P = .025. The independent predictors of CV events were hemodynamic instability during anesthesia (odds ratio [OR], 4.12; 95% confidence interval [CI], 1.87-9.06; P < .001), dyslipidemia (OR, 3.9; 95% CI, 1.32-11.51; P = .014), preoperative anemia (OR, 2.64; 95% CI, 1.19-5.85; P = .017), and AA platelet aggregability in the upper quartile (OR, 2.48; 95% CI, 1.07-5.76; P = .034). Platelet aggregability was not associated with hemorrhagic events, even when we compared the lowest quartile of AA platelet aggregability (0-1.00 Ω) with the three upper quartiles (>1.00 Ω; OR, 0.77; 95% CI, 0.43-1.37; P = .377). CONCLUSIONS: The degree of aspirin effect on platelet aggregability maybe important in the management of perioperative CV morbidity, without increment in the bleeding toll.


Assuntos
Aspirina/administração & dosagem , Doenças Cardiovasculares/prevenção & controle , Assistência Perioperatória/métodos , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Vasculares , Idoso , Brasil/epidemiologia , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Incidência , Masculino , Agregação Plaquetária/efeitos dos fármacos , Inibidores da Agregação de Plaquetas/administração & dosagem , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências
8.
Arq Bras Cardiol ; 99(5): 1060-7, 2012 Nov.
Artigo em Inglês, Português | MEDLINE | ID: mdl-23138671

RESUMO

Over 230 million surgeries are performed annually worldwide, cardiac complications being the most common causes of postoperative morbidity and mortality. As life expectancy has extended worldwide, a growing number of patients with multiple comorbidities have undergone noncardiac surgeries. Consequently, cardiovascular complications associated with those procedures are expected to increase, and perioperative acute myocardial infarction (AMI) might become a frequent problem. In Brazil, the number of noncardiac surgical procedures has also increased, and approximately three million surgeries are performed annually. Despite advances in surgical and anesthetic techniques, mortality and costs related to those procedures have also increased, thus, requiring the development of strategies to reduce mortality(4). The occurrence of perioperative AMI prolongs the need for intensive care and the hospital length of stay, increases the cost of hospitalization, and reduces long-term survival. This literature review approaches the pathophysiology, incidence, diagnosis and treatment of perioperative AMI based on current evidence.


Assuntos
Complicações Intraoperatórias/fisiopatologia , Infarto do Miocárdio/fisiopatologia , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Fatores de Risco
9.
Arq. bras. cardiol ; 99(5): 1060-1067, nov. 2012. ilus
Artigo em Português | LILACS | ID: lil-656643

RESUMO

Em todo o mundo, são realizadas mais de 230 milhões de operações por ano e as complicações cardíacas são as causas mais comuns de morbidade e mortalidade pós-operatórias. Com o aumento da expectativa de vida da população mundial, um número crescente de pacientes com múltiplas comorbidades tem sido submetido a operações não cardíacas. Em consequência, é esperado um aumento de complicações cardiovasculares associadas a tais procedimentos e o infarto agudo do miocárdio (IAM) perioperatório poderá se tornar um problema frequente. No Brasil, o número de operações não cardíacas também está aumentando, sendo realizadas aproximadamente três milhões de cirurgias por ano. Apesar dos avanços nas técnicas cirúrgicas e anestésicas, a mortalidade e o custo relacionados a estes procedimentos também estão aumentando, sendo fundamental o desenvolvimento de estratégias para a redução da mortalidade. A ocorrência de um IAM perioperatório prolonga a necessidade de terapia intensiva, a estadia hospitalar, aumenta o custo da internação e diminui a sobrevida a longo prazo. Esta revisão aborda a fisiopatologia, a incidência, o diagnóstico e o tratamento do IAM perioperatório, baseado nas evidências atuais.


Over 230 million surgeries are performed annually worldwide, cardiac complications being the most common causes of postoperative morbidity and mortality. As life expectancy has extended worldwide, a growing number of patients with multiple comorbidities have undergone noncardiac surgeries. Consequently, cardiovascular complications associated with those procedures are expected to increase, and perioperative acute myocardial infarction (AMI) might become a frequent problem. In Brazil, the number of noncardiac surgical procedures has also increased, and approximately three million surgeries are performed annually. Despite advances in surgical and anesthetic techniques, mortality and costs related to those procedures have also increased, thus, requiring the development of strategies to reduce mortality4. The occurrence of perioperative AMI prolongs the need for intensive care and the hospital length of stay, increases the cost of hospitalization, and reduces long-term survival. This literature review approaches the pathophysiology, incidence, diagnosis and treatment of perioperative AMI based on current evidence.


Assuntos
Humanos , Complicações Intraoperatórias/fisiopatologia , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Fatores de Risco
10.
Atherosclerosis ; 222(1): 191-5, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22410124

RESUMO

PURPOSE: The pathophysiology of acute coronary syndromes (ACS) after noncardiac surgery is not established yet. Thrombosis over a vulnerable plaque or decreased oxygen supply secondary to anemia or hypotension may be involved. The purpose of this study was to investigate the pathophysiology of ACS complicating noncardiac surgery. METHODS: Clinical and angiographic data were prospectively recorded into a database for 120 consecutive patients that had an ACS after noncardiac surgery (PACS), for 120 patients with spontaneous ACS (SACS), and 240 patients with stable coronary artery disease (CAD). Coronary lesions with obstructions greater than 50% were classified based on two criteria: Ambrose's classification and complex morphology. The presence of Ambrose's type II or complex lesions were compared between the three groups. RESULTS: We analyzed 1470 lesions in 480 patients. In PACS group, 45% of patients had Ambrose's type II lesions vs. 56.7% in SACS group and 16.4% in stable CAD group (P<0.001). Both PACS and SACS patients had more complex lesions than patients in stable CAD group (56.7% vs. 79.2% vs. 31.8%, respectively; P<0.001). Overall, the independent predictors of plaque rupture were being in the group PACS (P<0.001, OR 2.86; CI, 1.82-4.52 for complex lesions and P<0.001, OR 3.43; CI, 2.1-5.6 for Ambrose's type II lesions) or SACS (P<0.001, OR 8.71; CI, 5.15-14.73 for complex lesions and P<0.001, OR 5.99; CI, 3.66-9.81 for Ambrose's type II lesions). CONCLUSIONS: Nearly 50% of patients with perioperative ACS have evidence of coronary plaque rupture, characterizing a type 1 myocardial infarction.


Assuntos
Síndrome Coronariana Aguda/etiologia , Infarto do Miocárdio/complicações , Placa Aterosclerótica/complicações , Ruptura/fisiopatologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Idoso , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Placa Aterosclerótica/fisiopatologia , Estudos Prospectivos , Radiografia , Ruptura/complicações
11.
Arq Bras Cardiol ; 96(3 Suppl 1): 1-68, 2011.
Artigo em Inglês, Português | MEDLINE | ID: mdl-21655875
12.
Arq. bras. cardiol ; 96(3,supl.1): 1-68, 2011. ilus, tab
Artigo em Português | LILACS | ID: lil-588887
14.
PLoS One ; 5(5): e10607, 2010 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-20485549

RESUMO

BACKGROUND: Worldwide distribution of surgical interventions is unequal. Developed countries account for the majority of surgeries and information about non-cardiac operations in developing countries is scarce. The purpose of our study was to describe the epidemiological data of non-cardiac surgeries performed in Brazil in the last years. METHODS AND FINDINGS: This is a retrospective cohort study that investigated the time window from 1995 to 2007. We collected information from DATASUS, a national public health system database. The following variables were studied: number of surgeries, in-hospital expenses, blood transfusion related costs, length of stay and case fatality rates. The results were presented as sum, average and percentage. The trend analysis was performed by linear regression model. There were 32,659,513 non-cardiac surgeries performed in Brazil in thirteen years. An increment of 20.42% was observed in the number of surgeries in this period and nowadays nearly 3 million operations are performed annually. The cost of these procedures has increased tremendously in the last years. The increment of surgical cost was almost 200%. The total expenses related to surgical hospitalizations were more than $10 billion in all these years. The yearly cost of surgical procedures to public health system was more than $1.27 billion for all surgical hospitalizations, and in average, U$445.24 per surgical procedure. The total cost of blood transfusion was near $98 million in all years and annually approximately $10 million were spent in perioperative transfusion. The surgical mortality had an increment of 31.11% in the period. Actually, in 2007, the surgical mortality in Brazil was 1.77%. All the variables had a significant increment along the studied period: r square (r(2)) = 0.447 for the number of surgeries (P = 0.012), r(2) = 0.439 for in-hospital expenses (P = 0.014) and r(2) = 0.907 for surgical mortality (P = 0.0055). CONCLUSION: The volume of surgical procedures has increased substantially in Brazil through the past years. The expenditure related to these procedures and its mortality has also increased as the number of operations. Better planning of public health resource and strategies of investment are needed to supply the crescent demand of surgery in Brazil.


Assuntos
Países em Desenvolvimento/economia , Procedimentos Cirúrgicos Operatórios/economia , Brasil , Procedimentos Cirúrgicos Cardíacos/economia , Procedimentos Cirúrgicos Cardíacos/tendências , Depreciação , Humanos , Assistência Perioperatória , Procedimentos Cirúrgicos Operatórios/tendências , Fatores de Tempo
16.
São Paulo; s.n; 2010. 114 p.
Tese em Português | LILACS | ID: lil-579509

RESUMO

Anualmente são realizadas mais de 234 milhões de cirurgias no mundo com taxas de morbi e mortalidade relativamente elevadas. Os dados nacionais disponíveis de registros de operações não cardíacas são escassos e deficientes. O objetivo do nosso estudo foi avaliar o perfil epidemiológico dos pacientes submetidos a operações não cardíacas e a sua evolução nos últimos anos no Brasil. Selecionamos a partir do banco de dados de DATASUS, as informações de sistema público de saúde em caráter nacional para descrição epidemiológica de operações não cardíacas realizadas no país. As variáveis estudadas foram: número total de internações, gasto total por internação, gasto com transfusões sanguíneas, número de óbitos e tempo de internação hospitalar. O período estudado compreendeu os anos de 1995 a 2007. No período de 13 anos, foram realizadas 32.659.513 operações não cardíacas no país e houve um incremento de 20,42% no número de procedimentos realizados. De forma semelhante, os gastos hospitalares relacionados a estas cirurgias apresentaram aumento importante neste período (~ 200%), com gasto anual superior a 2 bilhões de reais. As despesas relacionadas às transfusões sanguíneas no perioperatório tiveram um aumento superior a 100%, com um gasto anual acima de 17 milhões de reais ao ano. A mortalidade hospitalar encontrada é bastante elevada no nosso país, com média de 1,77% e o aumento registrado foi mais de 30% no período. A única variável que apresentou redução ao longo dos últimos anos foi o tempo de internação hospitalar, com a média de permanência de 3,83 dias. Concluímos que há uma tendência no aumento de intervenções cirúrgicas no país. Apesar do aumento dos gastos hospitalares relacionados a estas cirurgias, a taxa de mortalidade encontrada ainda é bastante elevada. Estudos futuros são necessários para maior investigação e elaboração de estratégias complementares para melhorar os resultados cirúrgicos.


Worldwide, there were performed about 234 millions of surgeries annually with a relatively high surgical morbidity and mortality. Registry and information about non-cardiac operations in Brazil are scarce and deficient. The purpose of our study was to describe the epidemiological data of non-cardiac surgeries performed in Brazil in the last years. This is a retrospective cohort study that investigated the time-window from 1995 to 2007. We collected information from DATASUS, a national public health system database. The variables studied were: number of surgeries, in-hospital expenses, blood transfusion related costs, length of stay and case fatality rates. There were 32.659.513 non-cardiac surgeries performed in Brazil in thirteen years. An increment of 20.42% was observed in the number of surgeries in this period. The cost of these procedures has increased tremendously in the last years. The increment of surgical cost was almost 200% and the yearly cost of surgical procedures to public health system was superior to 1.2 billions of dollars (2 billions of reais). The cost of blood transfusion had an increment superior to 100% and annually approximately 10 millions of dollars (17 millions of reais) were spent in perioperative transfusion. Actually, in 2007, the surgical mortality in Brazil was 1.77% and it had an increment of 31.11% in the period of 1995 to 2007. The length of stay was the unique variable which had a reduction of its numbers in the period. In average, the mean time of surgical hospitalization was 3.83 days. We concluded that the volume of surgical procedures has increased substantially in Brazil through the past years. The expenditure related to these procedures and its mortality has also increased as the number of operations. Better planning of public health resource and strategies of investment are needed to supply the crescent demand of surgery in Brazil.


Assuntos
Humanos , Economia Médica , Epidemiologia , Cirurgia Geral , Morbidade , Mortalidade , Assistência Perioperatória
20.
Int J Cardiol ; 136(1): e14-5, 2009 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-18639945

RESUMO

Acute myocardial infarction may lead to several clinical manifestations and many times this diagnosis is missed. Transient global amnesia (TGA) is a well-defined clinical syndrome of unknown etiology. Several mechanisms have been proposed but only trigger events have been clearly associated with the attack. We describe a case of acute myocardial infarction manifestated by TGA.


Assuntos
Amnésia Global Transitória/diagnóstico , Morte Súbita Cardíaca , Infarto do Miocárdio/diagnóstico , Amnésia Global Transitória/etiologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações
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