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1.
Nephrol Nurs J ; 48(1): 57-63, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33683844

RESUMO

Peritoneal dialysis catheter complications that require nonsurgical or noninvasive correction by peritoneal dialysis (PD) nurses or practitioner are reviewed. Topics reviewed include compromised PD fluid flow, pericatheter fluid leakage, mechanical integrity disruption, catheter extrusion, and exit site/tunnel complications.


Assuntos
Cateteres , Diálise Peritoneal , Cateteres/efeitos adversos , Humanos , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/enfermagem
2.
Medicine (Baltimore) ; 100(1): e24235, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429823

RESUMO

RATIONALE: Catheter-related thrombosis is a serious complication of lung transplantation under venovenous extracorporeal membrane oxygenation (ECMO). Although ECMO-related thrombosis is not uncommon, there are few reports of giant hollow catheter thrombosis in lung transplantation under venovenous ECMO (ECMO). Blood loss and transfusion of coagulation factors may promote ECMO-related thrombosis. Hollow catheter thrombus was not detected on ultrasonography performed after initiation of ECMO. Therefore, it is essential to identify, manage, and reduce or avoid such thrombosis. PATIENT CONCERNS: We report a rare case of a 43-year-old man with advanced silicosis who developed a massive hollow catheter thrombus during lung transplantation. Anticoagulant therapy did not affect the size of the thrombus. DIAGNOSIS: Giant hollow catheter thrombosis was diagnosed by ultrasonography. Thrombosis from the right external iliac vein to the inferior vena cava was found in the shape of the ECMO pipe. INTERVENTIONS: Heparin was prescribed as an anticoagulant. OUTCOMES: Anticoagulant therapy did not affect the size of the thrombus during 2 weeks. The patient developed an infection and died of multiple organ failure. CONCLUSION: It is uncommon for massive hollow thrombus to occur during venovenous-ECMO-assisted lung transplantation. Fibrinogen and prothrombin complexes promote the formation of thrombus, and the measurement of the wall thickness of ECMO catheter may help to detect such thrombus.


Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Transplante de Pulmão , Trombose/diagnóstico , Adulto , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Cateteres/efeitos adversos , Diagnóstico Diferencial , Evolução Fatal , Heparina/administração & dosagem , Heparina/uso terapêutico , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/tratamento farmacológico , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológico
3.
Stroke ; 51(9): 2795-2800, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32772685

RESUMO

BACKGROUND AND PURPOSE: Hemorrhages are a serious complication of brain surgery, and magnesium has shown hemostatic properties in hemorrhagic stroke and non-neurological surgeries. External ventricular drain (EVD) insertion is an advantageous model of emergency neurosurgical hemorrhage risk because it is common, standardized, and the operator is blinded to the outcome during the procedure. We tested the hypothesis that low magnesium is associated with risk of hemorrhagic complications from EVD insertion. METHODS: Patients with spontaneous intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage were enrolled in a prospective, observational study. Demographic and clinical variables were prospectively recorded, including serum magnesium measurements. Catheter tract hemorrhage (CTH) was measured on postoperative head computed tomography within 48 hours of EVD insertion. RESULTS: We observed 50 CTH among 327 EVD procedures (15.3%) distributed similarly among intracerebral hemorrhage (21/116 [18.1%]) and subarachnoid hemorrhage (29/211 [13.7%]). Magnesium was lower in patients with CTH compared with those without (median 1.8 versus 2.0 mg/dL, P<0.0001). Higher magnesium was associated with lower odds of CTH (odds ratio 0.67 per 0.1 mg/dL magnesium [95% CI, 0.56-0.78], P<0.0001) after adjustment for other risk factors, with similar effect in the intracerebral hemorrhage and subarachnoid hemorrhage subgroups. Preprocedural increase in magnesium (odds ratio 0.68 [0.52-0.85]) and dose of preprocedural magnesium sulfate (odds ratio 0.67 [0.40-0.97]) were associated with reduced CTH risk after adjustment for initial magnesium and other risk factors. CONCLUSIONS: Lower magnesium at the time of EVD insertion was an independent predictor of hemorrhagic complications. Baseline risk was attenuated by preprocedural increases in magnesium, suggesting a therapeutic opportunity.


Assuntos
Hemorragia Cerebral/etiologia , Deficiência de Magnésio/complicações , Sulfato de Magnésio/uso terapêutico , Ventriculostomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateteres/efeitos adversos , Hemorragia Cerebral/diagnóstico por imagem , Feminino , Humanos , Deficiência de Magnésio/sangue , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/farmacologia , Complicações Pós-Operatórias , Estudos Prospectivos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X
5.
PLoS One ; 15(6): e0234919, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32559223

RESUMO

BACKGROUND: The ribcage and diaphragm are mechanical barriers for laparoscopic access during hepatectomy. Here, we introduce the varied application of intercostal trans-diaphragmatic ports during laparoscopic hepatectomy, and describe the management of intercostal ports with key technical points. METHODS: From January 2013 to December 2017, 180 patients underwent laparoscopic hepatectomy. In 32 of these patients (17.8%), intercostal ports (31 right and one left) were applied, and we analyzed the feasibility and safety of intercostal ports during laparoscopic hepatectomy. RESULTS: The main tumor location was segment VII and VIII (78%). The major type of laparoscopic hepatectomy was partial hepatectomy (91%). In the majority of cases (66%) the number and size of intercostal trocars was a single 5-mm port. The median operative time and blood loss were 232 min and 50 mL, respectively. A chest drain was placed via the hole of the intercostal port on the chest wall in two cases (6.3%). The median duration of the post-operative hospital stay was 6 days. There was no conversion, and a pure laparoscopic hepatectomy was achieved in all cases. There was no mortality. As for complications due to the application of intercostal ports, an asymptomatic pneumothorax was detected in only one case, and it was cured by conservative treatment. CONCLUSIONS: The ribcage and diaphragm could be overcome as barriers to laparoscopic access by the placement of intercostal ports with minimal access during laparoscopic hepatectomy. The use of an intercostal port and proper management allows for a feasible approach and safe resection during laparoscopic hepatectomy.


Assuntos
Hepatectomia/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Cateteres/efeitos adversos , Diafragma/cirurgia , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/instrumentação , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Costelas/cirurgia
6.
Ulus Travma Acil Cerrahi Derg ; 26(4): 635-638, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32589238

RESUMO

In this study, we report a case of failed angioembolization of a ruptured liver hemangioma complicated by iatrogenic injury of the subclavian vein during catheter insertion. A 30-year-old woman experienced blunt trauma upon falling from her bed. Laceration of a seemingly preexisting hepatic hemangioma was diagnosed. No other injury was detected during a preoperative diagnostic workup. Subclavian vein catheterization was performed, followed by angioembolization to control bleeding due to the ruptured hemangioma. After angioembolization, the patient's systolic blood pressure and hemoglobin levels were 70 mmHg and 5.3 g/dL, respectively. She underwent emergency laparotomy. During the surgery, a large volume of blood in the abdominal cavity due to profuse bleeding from the ruptured hemangioma was observed. Because of a hemothorax found on chest radiography, we performed thoracoscopy, which revealed a large volume of blood in the right thoracic cavity and perforation of the subclavian vein by the catheter. After the damage-control surgery, the patient recovered safely. In this case, ruptured liver hemangioma complicated by subclavian vein catheter-related injury was treated safely using damage-control surgery. The catheter-related injury could be identified and treated using thoracoscopy.


Assuntos
Cateterismo/efeitos adversos , Embolização Terapêutica/efeitos adversos , Hemangioma , Neoplasias Hepáticas , Veia Subclávia/lesões , Adulto , Cateterismo/instrumentação , Cateteres/efeitos adversos , Embolização Terapêutica/instrumentação , Feminino , Hemangioma/fisiopatologia , Hemangioma/terapia , Humanos , Doença Iatrogênica , Neoplasias Hepáticas/fisiopatologia , Neoplasias Hepáticas/terapia , Ruptura Espontânea/fisiopatologia , Ruptura Espontânea/terapia , Falha de Tratamento
7.
Turk Neurosurg ; 30(4): 614-620, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32530486

RESUMO

AIM: To assess the safety and efficacy of distal thrombectomy (DT) using a Catch View mini (CVm) device via a microcatheter with a 0.013-inch inner diameter. MATERIAL AND METHODS: Nine of 246 acute ischemic stroke patients who underwent mechanical thrombectomy developed distal emboli and were included in the study. In all nine subjects (mean age, 64.5 ± 11.6; range, 39?77 years), a combination of CVm and a 0.013-inch microcatheter was used in distal mechanical thrombectomy. Modified Thrombolysis in Cerebral Ischemia scores of 2c and 3 were considered to indicate successful recanalization, and patients with a Modified Rankin Score of ? 2 on the 90th day were considered to have good clinical outcomes. RESULTS: Eleven DT maneuvers were performed using the same stent retriever and microcatheter. The mean National Institutes of Health Stroke Scale score was 13 ± 3.4. Thrombectomy was performed from M3 in six patients, A3 in four, and P3 in one. Successful recanalization was achieved in all of the procedures. The rate of good clinical outcome was 55.5%. CONCLUSION: Advances in technology in the endovascular field enable access to more distal vessels in acute ischemic stroke. As the profile of the instruments used during access decreases, the risk of complications may decrease. The CVm stent retriever could become a useful tool in DT based on its compatibility with a 0.013-inch lumen delivery system.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/cirurgia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Trombectomia/instrumentação , Trombectomia/métodos , Adulto , Idoso , Cateteres/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents/efeitos adversos , Trombectomia/efeitos adversos , Resultado do Tratamento
8.
Enferm. nefrol ; 23(2): 207-210, abr.-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-194139

RESUMO

CASO CLÍNICO: Paciente que inició un Síndrome de Dress tras la colocación del catéter peritoneal. En la literatura se han reportado un número muy escaso de casos de reacción alérgica al catéter peritoneal e inicialmente se sospechó como causa un antibiótico profiláctico utilizado en el quirófano, pero tras sufrir en su domicilio una exacerbación de la sintomatología a la semana de la implantación, se planteó la posibilidad de que el catéter fuera el origen del cuadro, por lo que el paciente ingresó para monitorización y administración de medicación con una mejoría clínica significativa. El Plan de Cuidados se centraba en la resolución aguda del proceso alérgico y asistir al paciente en la técnica hasta que pudo realizarla autónomamente. Finalmente, el cuadro clínico se atribuyó a un Síndrome de Dress provocado por alopurinol. CONCLUSIONES: Tras una revisión bibliográfica y ante la falta de evidencia, se decidió no retirar el catéter y tratar el cuadro, que se solucionó, pudiendo iniciar el paciente la técnica en domicilio de forma autónoma


CLINICAL CASE: Patient suffering from Dress Syndrome after placement of the peritoneal catheter. A very few cases of allergic reaction to the peritoneal catheter have been reported in the literature. Initially, the use of a prophylactic antibiotic used in the operating room was suspected as a cause, but after suffering an exacerbation of symptoms one week after implantation at the patient's home, the possibility that the catheter was the origin of the condition was raised. Then, the patient was admitted for monitoring and administration of medication with significant clinical improvement. The care plan was focused on the acute resolution of the allergic process and on assisting the technique until the patient was able to perform it autonomously. Finally, the clinical picture was attributed to a Dress Syndrome caused by allopurinol. CONCLUSIONS: After a bibliographic review and in the absence of evidence, it was decided not to remove the catheter and treat the clinical picture, which was resolved, and the patient could start the technique at home autonomously


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Diálise Peritoneal/efeitos adversos , Cateteres/efeitos adversos , Hipersensibilidade a Drogas/complicações , Alopurinol/efeitos adversos , Edema/induzido quimicamente , Síndrome de Hipersensibilidade a Medicamentos/enfermagem , Cefazolina/administração & dosagem , Antibioticoprofilaxia , Corticosteroides , Administração Tópica
9.
J Card Surg ; 35(7): 1673-1675, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32365429

RESUMO

There are no consensus guidelines on the management of catheter-related right atrial thrombus. We present the case of a 29-year-old female with end-stage renal disease who was found to have a large right atrial thrombus associated with her tunneled dialysis catheter during preoperative workup for renal transplant. She exhibited signs and symptoms of superior vena cava syndrome and NYHA class III congestive heart failure. She was successfully treated with surgical thrombectomy and demonstrated rapid resolution of her symptoms postoperatively.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cateteres/efeitos adversos , Diálise/efeitos adversos , Diálise/instrumentação , Cardiopatias/etiologia , Cardiopatias/cirurgia , Síndrome da Veia Cava Superior/etiologia , Trombectomia/métodos , Trombose/etiologia , Trombose/cirurgia , Adulto , Feminino , Átrios do Coração , Humanos , Falência Renal Crônica/terapia , Resultado do Tratamento
10.
J Card Surg ; 35(7): 1660-1663, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32369866

RESUMO

Coronary angiography and percutaneous coronary intervention via radial access has been progressively performed over the last three decades and has become standard of care. Even though the radial approach, compared with femoral access, is safe and is also associated with less bleeding in patients with myocardial infarction, it may be problematic in some cases. Here, we describe an 80-year-old woman with brachial artery dissection due to a twisted diagnostic catheter during transradial coronary angiography, who subsequently underwent surgical retrieval of the catheter.


Assuntos
Arteriopatias Oclusivas/cirurgia , Artéria Braquial/cirurgia , Cateteres/efeitos adversos , Angiografia Coronária/efeitos adversos , Angiografia Coronária/instrumentação , Corpos Estranhos/etiologia , Corpos Estranhos/cirurgia , Artéria Radial , Stents , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/etiologia , Feminino , Humanos , Resultado do Tratamento
11.
World Neurosurg ; 140: 369-373, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32294566

RESUMO

BACKGROUND: Endovascular microcatheter adherence and retention is an uncommon complication during brain arteriovenous malformation (AVM) embolization with glue or ethylene-vinyl alcohol copolymer that has previously reported, although there are sparse reports of symptomatic complications thereafter. CASE DESCRIPTION: We present a unique complication 6 years after initial embolization of a cerebral AVM. The patient presented with acute lower limb insufficiency with computed tomography angiogram revealing fragmentation of the microcatheter and associated popliteal aneurysm. The patient underwent an emergency grafting and removal of the retained fragment and recovered without deficit postoperatively. CONCLUSIONS: Fragmentation over retained microcatheters remains a concern that may be worth monitoring in the long term, although there are no recommendations for timing.


Assuntos
Cateteres/efeitos adversos , Embolização Terapêutica/efeitos adversos , Malformações Arteriovenosas Intracranianas/cirurgia , Isquemia/etiologia , Extremidade Inferior/irrigação sanguínea , Adulto , Remoção de Dispositivo , Humanos , Isquemia/cirurgia , Masculino , Resultado do Tratamento
12.
World Neurosurg ; 139: e652-e657, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32339729

RESUMO

BACKGROUND: Intrathecal baclofen (ITB) is an effective treatment for spasticity, and therapeutic levels may be optimized using surgically implanted pumps. Though these devices are effective, complications can pose significant challenges to patients, decreasing the therapeutic effect and potentially requiring reoperation. As such, it is critical that complications associated with ITB be effectively characterized. METHODS: We queried the Manufacturer and User Facility Device Experience (MAUDE) database for cases reported during the past 3 years documenting adverse events specifically related to ITB pumps. We identified 1935 adverse events that were individually analyzed and categorized by type of complication. RESULTS: Out of the 1935 unique adverse events identified from the MAUDE database, 25.7% were device-related complications (n = 497). Of those, 50.3% were catheter-specific (n = 250), 21.3% (n = 106) were pump-specific, and 28.3% (n = 141) were included, more generally, in catheter or device erosion. CONCLUSIONS: The MAUDE database may be a useful resource for evaluating ITB pump complications across a larger data set. By characterizing the complications and providing values for their total occurrences, patients and physicians may have more realistic expectations for the outcomes and morbidity of this device.


Assuntos
Baclofeno/administração & dosagem , Baclofeno/efeitos adversos , Relaxantes Musculares Centrais/administração & dosagem , Relaxantes Musculares Centrais/efeitos adversos , Baclofeno/uso terapêutico , Infecções Relacionadas a Cateter/epidemiologia , Cateteres/efeitos adversos , Bases de Dados Factuais , Falha de Equipamento , Feminino , Migração de Corpo Estranho , Humanos , Bombas de Infusão Implantáveis , Injeções Espinhais , Masculino , Relaxantes Musculares Centrais/uso terapêutico , Espasticidade Muscular/tratamento farmacológico , Estudos Retrospectivos , Resultado do Tratamento
15.
AJNR Am J Neuroradiol ; 41(1): 57-63, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31924603

RESUMO

BACKGROUND AND PURPOSE: Imaging evaluation of ventriculostomy tubes, despite the frequency of malfunction, has remained inadequate due to the absence of a systematic way of assessing the catheter itself. In this retrospective review, we assessed the utility of high-resolution 3D MR imaging techniques, including CISS and volumetric interpolated breath-hold examination sequences, in the evaluation of ventriculostomy catheters. MATERIALS AND METHODS: We performed a retrospective review of 23 clinical MR imaging cases of shunted hydrocephalus spanning a 3-year period, all depicting ventriculostomy catheters. The MR imaging examinations included isotropic CISS and volumetric interpolated breath-hold examination sequences performed with and without contrast. These were independently evaluated by 2 neuroradiologists with respect to the catheter course, side hole position, relationship of the side holes to the ventricles, patency, and the presence or absence of intraluminal debris. RESULTS: The catheter tip was best seen on isotropic CISS sequences reformatted in an oblique plane, and side holes were visualized as CSF signal defects along the catheter wall in 10/23 (43%) cases. The relationship of the catheter side holes to the ventricles was seen in 47% of cases and was best visualized on the coronal CISS sequences. Catheter patency was confirmed in 12/23 (52%) cases, while the other 48% were notable for T2 hypointense filling defects compatible with luminal obstruction. Enhancement of some of these filling defects on imaging is suggestive of choroid plexus ingrowth rather than debris. CONCLUSIONS: High-resolution 3D MR imaging using isotropic CISS sequences allows systematic evaluation of catheter positioning, patency, and potential etiologic differentiation of filling defects when shunt dysfunction is suspected.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Imageamento Tridimensional/métodos , Neuroimagem/métodos , Ventriculostomia/métodos , Adulto , Idoso , Cateteres/efeitos adversos , Falha de Equipamento , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ventriculostomia/efeitos adversos
16.
Int J Colorectal Dis ; 35(1): 109-117, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31792582

RESUMO

PURPOSE: Anastomotic or stump leakage is a common and serious complication of colorectal surgery. The objective of this study was to retrospectively investigate the clinical use and potential benefit of transanal rinsing treatment (TRT) using an innovative rinsing catheter (RC) after treatment with endoscopic vacuum therapy (EVT). METHODS: Patients with leakage after low colorectal surgery who had been treated with EVT were retrospectively analyzed. A subset of patients was trained to perform TRT with a specially developed RC. We investigated the rate of complete healing of the leakage, septic complications, failure of the therapy, surgical revisions, ostomy closure rate, and complications related to endoscopic therapy. RESULTS: Between February 2007 and January 2014, 98 patients with local complications after low colorectal surgery, treated with EVT, were identified. Eighty-nine patients were analyzed (the treatment of nine patients was stopped due to medical or technical problems): 31 patients were treated with EVT only (EVT group) and 58 patients with EVT followed by TRT (EVT/TRT group). Complete healing of the leakage was significantly better in the EVT/TRT group [84% vs. 58% (p < 0.009)], and significantly fewer septic complications needing surgical revision were detected [3% vs. 11% (p = 0.001)]. No significant differences regarding endoscopy-related complications and ostomy closure were found between EVT and EVT/TRT patients. CONCLUSIONS: The use of patient-administered TRT with an innovative, customized RC after EVT is technically feasible and reliable and significantly improves therapeutic results. Further prospective trials with larger patient groups are needed to validate the results of our study.


Assuntos
Canal Anal/cirurgia , Fístula Anastomótica/terapia , Cateteres , Neoplasias Colorretais/cirurgia , Endoscopia , Vácuo , Cicatrização , Idoso , Cateteres/efeitos adversos , Colostomia , Endoscopia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Sepse/etiologia
17.
Am J Perinatol ; 37(6): 557-561, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31756762

RESUMO

OBJECTIVE: This study aimed to determine if intrapartum placement of an intrauterine pressure catheter (IUPC) is associated with an increased rate of surgical site infections in women undergoing a cesarean delivery. STUDY DESIGN: This was a secondary analysis of the prospective observational Maternal-Fetal Medicine Units Network Vaginal Birth after Cesarean Registry. We compared patients with and without IUPC use. A multivariable logistic regression was performed to evaluate for an association between IUPC use and postcesarean surgical site infections. RESULTS: The study included 16,887 women: 7,441 with IUPC use and 9,446 without IUPC use. After adjustment for potential cofounders, IUPC use was associated with an increased risk of postcesarean infections compared with those without IUPC use (adjusted odds ratio: 1.28; 95% confidence interval: 1.10-1.50; p = 0.002). CONCLUSION: IUPC use is associated with an increased risk of postcesarean surgical site infections. This supports the judicious use of IUPC for limited clinical indications and provides a potential area of focus for reduction in postcesarean infections.


Assuntos
Cateteres/efeitos adversos , Recesariana/efeitos adversos , Infecção da Ferida Cirúrgica/etiologia , Adulto , Recesariana/métodos , Feminino , Humanos , Modelos Logísticos , Idade Materna , Gravidez , Pressão , Estudos Prospectivos , Fatores de Risco , Nascimento Vaginal Após Cesárea , Adulto Jovem
18.
Acta Neurochir (Wien) ; 162(1): 15-21, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31713158

RESUMO

BACKGROUND: To compare flow-regulated (FR) and differential pressure (DP) valves for treatment of patients with idiopathic normal hydrocephalus (iNPH) focusing on overdrainage and neurological outcome. METHODS: This is a retrospective study of patients with iNPH treated with FR and DP valves at a single institution between 2008 and 2018. The neurological status was evaluated retrospectively with the Kiefer scale at baseline, after shunt placement and at the 6-month follow-up. Groups were compared using inverse probability of treatment weighting based on propensity scores. RESULTS: The study cohort consisted of 38 patients treated with FR valves and 49 with DP valves. The mean patient age was 72.0 ± 7.6 years. Based on the Kiefer scale score, neurological improvement at the 6-month follow-up was recorded in 79.6% in the DP group and 89.5% in the FR group (p = 0.252). The overdrainage rates were higher among DP valves (10.2%) than among FR valves (2.6%, adjusted p = 0.002). Valve malfunction occurred in 2.0% in the DP group and 5.3% in the FR group (adjusted p = 0.667). CONCLUSIONS: The current study demonstrates a comparable neurological improvement between DP and FR valves, with potentially lower overdrainage rates among FR valves. Long-term studies will be necessary to draw a definite conclusion on FR valves for treatment of iNPH patients.


Assuntos
Cateteres/efeitos adversos , Hidrocefalia de Pressão Normal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Derivação Ventriculoperitoneal/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Derivação Ventriculoperitoneal/efeitos adversos , Derivação Ventriculoperitoneal/instrumentação
19.
Arch Dis Child Fetal Neonatal Ed ; 105(3): 299-303, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31391204

RESUMO

BACKGROUND: Umbilical venous catheters (UVCs) are associated with thrombus formation. Most studies on thrombosis in infants with UVCs focus on only one part of the route, and none assessed a control group of infants without UVCs. OBJECTIVE: To determine the incidence and location of thrombi in infants after umbilical catheterisation and compare this with a control group of infants without umbilical catheters. DESIGN: Prospective observational study with serial ultrasonography of the UVC route from the umbilico-portal confluence to the heart. Ultrasonography was performed until day 14 after catheterisation in cases and day 14 after birth in controls. RESULTS: Thrombi in the UVC route were detected in 75% (30/40) of infants with UVCs in the study group, whereas no thrombi were detected in the control group of infants without UVCs (0/20) (p<0.001). Six thrombi (20%) were located in the right atrium. Most of these were also partly present in the ductus venosus. Six thrombi (20%) were located in the ductus venosus only, and in 12 infants (40%), the thrombus was at least partly located in the umbilico-portal confluence. Thrombi persisted after UVC removal in 25/30 cases. Two infants with thrombotic events were treated with low-molecular-weight heparin and resolution was found. In the other 23 infants managed expectantly, 2 died due to necrotising enterocolitis, 1 was lost to follow-up and in 20 spontaneous regression was seen. CONCLUSIONS: Thrombotic events occur frequently in infants after umbilical catheterisation. Most thrombi were asymptomatic and regressed spontaneously with expectant management. Routine screening for thrombi in UVCs is therefore not advised.


Assuntos
Cateteres/efeitos adversos , Trombose/etiologia , Veias Umbilicais/patologia , Peso ao Nascer , Cateterismo Periférico/efeitos adversos , Idade Gestacional , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Recém-Nascido , Estudos Prospectivos , Trombose/tratamento farmacológico , Ultrassonografia , Veias Umbilicais/diagnóstico por imagem
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