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1.
J Cardiovasc Med (Hagerstown) ; 21(10): 765-771, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32890069

RESUMO

AIMS: The aim of this study was to evaluate the clinical course of COVID-19 in patients who had recently undergone a cardiac procedure and were inpatients in a cardiac rehabilitation department. METHODS: All patients hospitalized from 1 February to 15 March 2020 were included in the study (n = 35; 16 men; mean age 78 years). The overall population was divided into two groups: group 1 included 10 patients who presented with a clinical picture of COVID-19 infection and were isolated, and group 2 included 25 patients who were COVID-19-negative. In group 1, nine patients were on chronic oral anticoagulant therapy and one patient was on acetylsalicylic acid (ASA) and clopidogrel. A chest computed tomography scan revealed interstitial pneumonia in all 10 patients. RESULTS: During hospitalization, COVID-19 patients received azithromycin and hydroxychloroquine in addition to their ongoing therapy. Only the patient on ASA with clopidogrel therapy was transferred to the ICU for mechanical ventilation because of worsening respiratory failure, and subsequently died from cardiorespiratory arrest. All other patients on chronic anticoagulant therapy recovered and were discharged. CONCLUSION: Our study suggests that COVID-19 patients on chronic anticoagulant therapy may have a more favorable and less complicated clinical course. Further prospective studies are warranted to confirm this preliminary observation.


Assuntos
Anticoagulantes/uso terapêutico , Azitromicina/administração & dosagem , Procedimentos Cirúrgicos Cardíacos , Infecções por Coronavirus , Hidroxicloroquina/administração & dosagem , Pandemias , Inibidores da Agregação de Plaquetas/uso terapêutico , Pneumonia Viral , Complicações Pós-Operatórias , Idoso , Anti-Infecciosos/administração & dosagem , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Terapia Combinada/métodos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Feminino , Humanos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico , Pneumonia Viral/etiologia , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/virologia , Tomografia Computadorizada por Raios X/métodos
2.
Medicine (Baltimore) ; 99(33): e20805, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871971

RESUMO

Patients with acute coronary syndrome (ACS) have an increased serum level of calprotectin. The purpose of present study was to analyze the prognostic significance of serum calprotectin levels in elderly diabetic patients underwent percutaneous coronary intervention (PCI) due to ACS.A total of 273 consecutive elderly diabetic patients underwent PCI for primary ACS were enrolled. Serum calprotectin levels were measured before PCI, and baseline clinical characteristics of all patients were collected. All patients were followed up at regular interval for major adverse cardiovascular events (MACEs) during 1 year after PCI. MACEs include cardiovascular death, nonfatal myocardial infarction, and target vessel revascularization (TVR). The predicting value of serum calprotectin for MACEs was analyzed by using univariate and multivariate analysis and receiver-operating characteristic curve (ROC).At the endpoint of this study, 47 patients of all 273 patients had MACEs. According to optimal cutoff value of calprotectin for predicting MACEs by ROC analysis, all patients were stratified into a high calprotectin group and a low calprotectin group. The incidence rate of MACEs and TVR in high calprotectin group was prominently higher than that in low calprotectin group (21.9% vs 11.5%, P = .02). In multivariable COX regression analysis adjusting for potential confounders, serum calprotectin level remains as an independent risk predictor of MACE (hazard ratio, 1.56; 95% confidence interval [CI]: 1.08-4.62; P = .01).In diabetic patients with a comorbidity of ACS, a high serum level of calprotectin is associated to a higher MACE rate after PCI.


Assuntos
Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/cirurgia , Complicações do Diabetes/sangue , Complexo Antígeno L1 Leucocitário/sangue , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/epidemiologia , Idoso , Biomarcadores/sangue , Estudos de Coortes , Comorbidade , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/cirurgia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Prognóstico
3.
BMJ Case Rep ; 13(9)2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32933909

RESUMO

Autoimmune encephalitis is a rare spectrum of disease that can be a complication of chronic immunosuppression. Diagnosis often requires the presence of antineuronal antibodies, but many causative antibodies have not yet been identified. Antibody-negative autoimmune encephalitis (AbNAE) is especially difficult to diagnose and must rely largely on exclusion of other causes. In chronically immune-suppressed transplant recipients, the differential is broad, likely resulting in underdiagnosis and worse outcomes. Here, we present a 58-year-old liver transplant recipient taking tacrolimus for prevention of chronic rejection who presented with 5 days of confusion, lethargy and lightheadedness. He was diagnosed with AbNAE after an extensive workup and recovered fully after high-dose corticosteroids. Our case highlights the importance of recognising the association between chronic immunosuppression and autoimmune encephalitis. Autoimmune encephalitis, even in the absence of characterised antibodies, should be considered when transplant recipients present with central neurologic symptoms.


Assuntos
Encefalite/induzido quimicamente , Doença de Hashimoto/induzido quimicamente , Imunossupressão/efeitos adversos , Imunossupressores/efeitos adversos , Transplante de Fígado , Complicações Pós-Operatórias/induzido quimicamente , Tacrolimo/efeitos adversos , Anticorpos/sangue , Encefalite/sangue , Doença de Hashimoto/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Fatores de Tempo
4.
Int Heart J ; 61(5): 979-983, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921662

RESUMO

The Fontan procedure is a palliative surgery performed for patients with complex congenital heart disease who exhibit functional single ventricular physiology. Although clinical outcomes of the Fontan procedure have improved in recent years and most patients who undergo the procedure reach adulthood, Fontan-associated liver disease (FALD) is a noncardiovascular complication that has become increasingly common; its risk factors remain unknown.A total of 95 patients who underwent the Fontan procedure and who were followed up for at least three years at Gunma Children's Medical Center and Kitasato University Hospital between 1996 and 2015 were retrospectively enrolled in this study.The mean age of the patients at the time of Fontan procedure was 2.3 ± 1.4 years. Overall, 21 patients (23.1%) experienced FALD. All Fontan procedures were performed with extracardiac total cavopulmonary connection using 16-mm expanded polytetrafluoroethylene grafts. The presence of systemic right ventricle, requirement of pulmonary vasodilator, application of a non-fenestrated Fontan procedure, and absence of fenestration flow at the time of follow-up catheter examination were identified as predictors of FALD using univariate analysis. All these factors, except the requirement of pulmonary vasodilator, remained significant predictors of FALD in multivariate logistic regression analysis.Patients with a systemic right ventricle who undergo the Fontan procedure are at a high risk of FALD in the mid-term. Creating fenestration at the time of Fontan and maintaining the fenestration flow may reduce the mid-term risk of FALD.


Assuntos
Técnica de Fontan/métodos , Cardiopatias Congênitas/cirurgia , Hepatopatias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Vasodilatadores/uso terapêutico , Adolescente , Alanina Transaminase/sangue , Anastomose Cirúrgica/métodos , Aspartato Aminotransferases/sangue , Bilirrubina/sangue , Pressão Venosa Central/fisiologia , Criança , Pré-Escolar , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Lactente , Hepatopatias/sangue , Modelos Logísticos , Masculino , Análise Multivariada , Complicações Pós-Operatórias/sangue , Estudos Retrospectivos , Fatores de Risco , Resistência Vascular
5.
S Afr Med J ; 110(4): 320-326, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32657745

RESUMO

BACKGROUND: Patients undergoing arthroplasty may have comorbidities that put them at risk of myocardial injury after non-cardiac surgery (MINS). MINS, a new clinical concept that has a different pathophysiology from conventional myocardial infarction, is related to a supply-demand mismatch ischaemia in the perioperative setting. MINS is often a silent event, and the diagnosis relies on cardiac biomarker testing such as troponin T. The incidence is estimated at 40%, with a fourfold increase in morbidity and mortality risk 1 year post surgery. OBJECTIVES: To determine the prevalence of postoperative troponin leak in a single-centre arthroplasty unit in patients with various cardiac risk factors undergoing hip or knee arthroplasty and investigate the differences in troponin T levels between comorbidities and different types of arthroplasty, i.e. total hip replacement (THR), total knee replacement (TKR) and neck of femur (NoF) fracture hip replacement. METHODS: A prospective, cross-sectional study of patients with one or more cardiac risk factors undergoing replacement surgery was conducted from October 2017 to April 2018. Troponin levels of all included patients were recorded on days 1 and 3 post surgery using a high-sensitivity cardiac troponin T assay (Roche hs-cTnT). A level of >15 ng/L is considered abnormal and termed a positive troponin leak, while >100 ng/L is considered suspected acute coronary syndrome (ACS). RESULTS: One hundred and sixty patients (n=66 THR, n=55 NoF hip replacement, n=39 TKR) were included. Sixty-eight patients (42%) had a positive troponin leak, and in 6 of these cases ACS was suspected. The highest prevalence of troponin leak was recorded in patients undergoing NoF hip replacement (62%), followed by TKR (46%) and then THR (24%). Sixty-two patients (38%) had positive troponin levels on day 1 and 53 patients (33%) had positive levels on day 3. Important patient cardiac risk factors were identified in the presence of a positive troponin leak, with ischaemic heart disease, hypertension, diabetes, renal disease, age >65 years and atrial fibrillation being statistically most likely. CONCLUSIONS: Postoperative troponin surveillance is an inexpensive and reliable way to identify patients at risk of MINS and subsequently enhance early detection, medical optimisation and referral strategies. Simple interventions may improve outcomes and contribute to lower ACS rates and the timeous prevention of other complications. The prevalence of MINS in orthopaedic-specific patients in South Africa (SA) and other resource-constrained developing countries is unknown. Our finding of 42% positive troponin leaks raises awareness of this issue, and we recommend routine postoperative troponin surveillance for all arthroplasty units in SA.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Fraturas do Colo Femoral/cirurgia , Isquemia Miocárdica/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Troponina T/sangue , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/epidemiologia , Fatores Etários , Idoso , Fibrilação Atrial/epidemiologia , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Fraturas do Colo Femoral/epidemiologia , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/sangue , Complicações Pós-Operatórias/sangue , Estudos Prospectivos , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco , África do Sul/epidemiologia
6.
Br J Anaesth ; 125(1): 55-66, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32499013

RESUMO

BACKGROUND: Delirium frequently affects older patients, increasing morbidity and mortality; however, the pathogenesis is poorly understood. Herein, we tested the cognitive disintegration model, which proposes that a breakdown in frontoparietal connectivity, provoked by increased slow-wave activity (SWA), causes delirium. METHODS: We recruited 70 surgical patients to have preoperative and postoperative cognitive testing, EEG, blood biomarkers, and preoperative MRI. To provide evidence for causality, any putative mechanism had to differentiate on the diagnosis of delirium; change proportionally to delirium severity; and correlate with a known precipitant for delirium, inflammation. Analyses were adjusted for multiple corrections (MCs) where appropriate. RESULTS: In the preoperative period, subjects who subsequently incurred postoperative delirium had higher alpha power, increased alpha band connectivity (MC P<0.05), but impaired structural connectivity (increased radial diffusivity; MC P<0.05) on diffusion tensor imaging. These connectivity effects were correlated (r2=0.491; P=0.0012). Postoperatively, local SWA over frontal cortex was insufficient to cause delirium. Rather, delirium was associated with increased SWA involving occipitoparietal and frontal cortex, with an accompanying breakdown in functional connectivity. Changes in connectivity correlated with SWA (r2=0.257; P<0.0001), delirium severity rating (r2=0.195; P<0.001), interleukin 10 (r2=0.152; P=0.008), and monocyte chemoattractant protein 1 (r2=0.253; P<0.001). CONCLUSIONS: Whilst frontal SWA occurs in all postoperative patients, delirium results when SWA progresses to involve posterior brain regions, with an associated reduction in connectivity in most subjects. Modifying SWA and connectivity may offer a novel therapeutic approach for delirium. CLINICAL TRIAL REGISTRATION: NCT03124303, NCT02926417.


Assuntos
Encéfalo/fisiopatologia , Delírio/diagnóstico , Delírio/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Biomarcadores/sangue , Encéfalo/diagnóstico por imagem , Estudos de Coortes , Citocinas/sangue , Delírio/sangue , Imagem de Tensor de Difusão/métodos , Eletroencefalografia/métodos , Humanos , Complicações Pós-Operatórias/sangue
8.
Isr Med Assoc J ; 22(5): 294-298, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32378821

RESUMO

BACKGROUND: Bariatric surgery has become the most common and effective therapeutic option for obesity. However, it is associated with morbidity and complications. Identification of predictors for surgical complications is an unmet need. OBJECTIVES: To determine a simple non-invasive parameter that predicts early postoperative complications following bariatric surgery. METHODS: In this retrospective study of all patients who underwent elective bariatric surgery at Nazareth Hospital EMMS during a 4-year period (2015-2018). We collected clinical and laboratory parameters and determined predictors of complications. RESULTS: A total of 345 patients underwent bariatric surgery during the study period. Of the patients, 51 experienced early post-bariatric surgery complications as compared to 294 patients who had no complications. Univariate analysis revealed that neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR] 1.912, P < 0.0001) and platelet to lymphocyte ratio (OR 1.015, P < 0.0001) were associated with post-bariatric surgery complications. In a multivariate logistic regression analysis, only NLR remained a significant predictor (OR 1.751, 95% confidence interval 1.264-2.425, P = 0.0008) with a receiver operating characteristic curve for NLR of 0.8404. CONCLUSIONS: We found that the NLR predicts post bariatric surgery early complications. Further prospective studies are needed to validate our findings.


Assuntos
Cirurgia Bariátrica , Linfócitos , Neutrófilos , Obesidade/sangue , Obesidade/cirurgia , Complicações Pós-Operatórias/sangue , Adulto , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Retrospectivos
10.
Ann Biol Clin (Paris) ; 78(2): 206-209, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32319951

RESUMO

Factor V deficiency is a rare hemostatic disorder. It may present with a diverse spectrum of symptoms due to a variety of mechanisms including development of autoantibodies associated with a number of conditions. We report a first case of factor V deficiency in Tunisian hemodialysis patient due to an autoantibody most likely secondary to antibiotic exposure responsible for an arteriovenous shunt thrombosis rather than bleeding. We discuss here the clinical and biological features of acquired factor V inhibitor and provide a short review of the current literature.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Autoanticorpos/sangue , Transtornos da Coagulação Sanguínea/etiologia , Fator V/imunologia , Diálise Renal , Trombose/etiologia , Idoso , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/diagnóstico , Fator V/antagonistas & inibidores , Humanos , Masculino , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/diagnóstico , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Trombose/sangue , Trombose/diagnóstico , Tunísia
11.
Medicina (Kaunas) ; 56(3)2020 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-32245061

RESUMO

Background and objectives: Although laparoscopic sleeve gastrectomy (LSG) is effective for obesity management, postoperative vitamin B12 (B12) deficiency is of major concern. In this cross-sectional study, we assessed the levels of B12 and its related functional biomarkers, namely, total homocysteine (tHcy), methylmalonic acid (MMA), folate, methylcitric acid (MCA), and hemoglobin (Hb), in one-year postoperative LSG patients and matched controls. Materials and Methods: Plasma B12, tHcy, MMA, folate, and MCA were measured in matched controls (n = 66) and patients (n = 71) using validated liquid chromatography-tandem mass spectrometry techniques and protocols in the United Arab Emirates (UAE). Results: The median B12 concentration in patients (177 pmol/L) was significantly lower (p < 0.001) than in the controls (334.7 pmol/L). The tHcy and MMA levels were significantly increased (p < 0.001 and p = 0.011, respectively) and folate levels were significantly decreased (p = 0.001) in the LSG patients compared to the controls. Interestingly, no significant difference in MCA levels were observed between the two groups. The levels of tHcy and MMA were concomitantly increased with the decreased folate levels in postoperative LSG patients when compared with the controls. The Hb levels were significantly lower in males and females in the patient group compared with those in the control group, respectively (p = 0.005 and p = 0.043). Conclusions: This is the first report of serum levels of B12 and its functional biomarkers in postoperative LSG patients among a local population from the UAE. Our findings revealed significant alterations of the B12 biomarkers, total B12, MMA, and tHcy in one-year postoperative LSG patients.


Assuntos
Gastrectomia/efeitos adversos , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/diagnóstico , Deficiência de Vitamina B 12/sangue , Deficiência de Vitamina B 12/diagnóstico , Adulto , Biomarcadores/sangue , Cromatografia Líquida , Citratos/sangue , Estudos Transversais , Feminino , Ácido Fólico/sangue , Hemoglobinas , Homocisteína/sangue , Humanos , Masculino , Espectrometria de Massas , Ácido Metilmalônico/sangue , Emirados Árabes Unidos
12.
Clin Interv Aging ; 15: 419-424, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32256056

RESUMO

Introduction: Pneumonia is a serious complication following hip fracture and is the primary risk factor for 30-day mortality after surgery. Modifying several laboratory factors may improve the outcomes of fragile hip fracture patients who are 80 years or older. Purpose: To investigate several adjustable factors for perioperative pneumonia in order to improve patient prognosis and reduce mortality. Patients and Methods: We retrospectively reviewed in-hospital hip fracture data from patients who were 80 years or over between January 1, 2014, and November 31, 2014, from Beijing Jishuitan Hospital. Patients were divided into two groups: perioperative pneumonia (POP) group and non-perioperative pneumonia (non-POP) group. Logistic regression models were used to identify independent risk factors. Statistical significance was set at 5% (p<0.05). Results: The incidence of perioperative pneumonia (POP) in patients 80 years and older was 11.3% (33/293). Male patients had a higher incidence of POP (20/96 cases, 20.83%) compared to females (13/197, 6.6%)(P<0.001). Higher neutrophilic granulocyte percentages (78.148%±9.162% in POP vs 81.959%±6.142% in Non-POP, P=0.033) and lower albumin levels (χ2=2.25, P=0.039) were observed in the POP group at baseline. After multivariate logistic regression, we observed that males (OR=3.402, P=0.048), lower albumin levels (OR=10.16, P=0.001) and PaO2 levels (OR=2.916, P=0.007) were independent risk factors for POP. Conclusion: Low albumin and oxygen levels and the male gender were risk factors for perioperative pneumonia in geriatric hip fracture patients.


Assuntos
Fraturas do Quadril/cirurgia , Pneumonia/epidemiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Albumina Sérica/análise , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Avaliação Geriátrica/métodos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Oxigênio/administração & dosagem , Pneumonia/sangue , Complicações Pós-Operatórias/sangue , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
13.
J Card Surg ; 35(6): 1186-1194, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32349178

RESUMO

BACKGROPUND AND AIM: Postoperative thrombocytopenia after surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) and aggravating causes were the aim of this retrospective study. METHODS: Data of all patients treated with SAVR (n = 1068) and TAVR (n = 816) due to severe aortic valve stenosis was collected at our center from 2010 to 2017. Preprocedural and postprocedural values were collected from electronic patient records. RESULTS: There was a significant drop in platelets in both groups, the TAVR group showed overall superior platelet preservation compared to the AVR group (P < .001). In the SAVR subgroup analysis, a significant difference in platelet preservation was observed between the valve types (P < .001), particularly with the Freedom SOLO valve. In the TAVR subgroup analysis, the valve type did not influence platelet count (PLT) reduction (P = .13). In the SAVR subgroup analyses, PLT was found to be worsened with cardiopulmonary bypass (CPB) duration. CONCLUSION: Thrombocytopenia frequently occurs after implantation of a biological heart valve prosthesis, with a higher frequency observed in patients after cardiac surgery rather than TAVR. Although some surgical bioprosthetic models are more susceptible to this phenomenon, CPB duration seems to be a major determinant for the development of postoperative thrombocytopenia.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Complicações Pós-Operatórias/etiologia , Trombocitopenia/etiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Ponte Cardiopulmonar/efeitos adversos , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Trombocitopenia/sangue , Trombocitopenia/epidemiologia , Fatores de Tempo
14.
J Surg Res ; 252: 63-68, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32234570

RESUMO

BACKGROUND: Postoperative hypocalcemia because of hypoparathyroidism is the most common complication of total thyroidectomy in children. We hypothesized that most children with postoperative hypocalcemia would be eucalcemic by 12 mo and sought to define risk factors for permanent hypoparathyroidism. METHODS: We retrospectively reviewed children who underwent total thyroidectomy at a single children's hospital from 2012 to 2019. Patients with prior neck surgery were excluded. Indication for operation, final pathologic diagnosis, and postoperative serum calcium up to 12 mo were recorded. Permanent hypoparathyroidism was defined as supplemental calcium requirement beyond 1 y postoperatively. RESULTS: Sixty-eight patients underwent total thyroidectomy. Graves' disease was the most common benign indication for surgery (38 patients). Twenty-six patients (38%) had cancer on final pathology. Central lymph node dissection (CLND) was performed in 12 cancer patients. Twenty-eight patients (41%) had postoperative hypocalcemia. Eight patients (12%) had hypocalcemia at 6 mo. Risk factors for hypoparathyroidism at 6 mo were a cancer diagnosis (odds ratio [OR] 6.7; P = 0.02), CLND (OR 12.6; P < 0.01), and parathyroid tissue in the surgical specimen on pathologic analysis (OR 19.5; P < 0.01). Only two patients (3%) developed permanent hypoparathyroidism, both of whom had thyroidectomy for cancer and underwent CLND. CONCLUSIONS: Children with thyroid cancer are at high risk for postoperative hypocalcemia after total thyroidectomy. The risk is further increased by CLND, which should be performed selectively. A majority of patients with hypoparathyroidism at 6 mo postoperatively regain normal parathyroid function by 1 y. Permanent hypoparathyroidism in children after total thyroidectomy at a pediatric endocrine surgery center is rare.


Assuntos
Doença de Graves/cirurgia , Hipocalcemia/epidemiologia , Hipoparatireoidismo/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Adolescente , Cálcio/sangue , Criança , Pré-Escolar , Feminino , Humanos , Hipocalcemia/sangue , Hipocalcemia/diagnóstico , Hipocalcemia/etiologia , Hipoparatireoidismo/sangue , Hipoparatireoidismo/diagnóstico , Hipoparatireoidismo/etiologia , Masculino , Glândulas Paratireoides/lesões , Glândulas Paratireoides/patologia , Hormônio Paratireóideo/sangue , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Adulto Jovem
15.
Medicine (Baltimore) ; 99(14): e19610, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243385

RESUMO

BACKGROUND: Postoperative gastrointestinal dysfunction (PGD) refers to one of the common postoperative complications. Acupuncture can facilitate the recovery of PGD, whereas no therapeutic schedule of acupuncture has been internationally recognized for treating PGD. In the present study, a scientific trial protocol has been proposed to verify the feasibility of acupuncture in treating gastrointestinal dysfunction after laparoscopic cholecystectomy under general anesthesia. We conduct this protocol to investigate whether acupuncture recovery gastrointestinal dysfunction by influencing the expression of gastrointestinal hormone. METHOD: The present study refers to a randomized, evaluator blinded, controlled, multi-center clinical trial; it was designed complying with the Consolidated Standards of Reporting Trials (CONSORT 2010) as well as the Standard for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA). The subjects will be taken from the inpatients having undergone laparoscopic surgery of Mianyang Affiliated Hospital of Chengdu University of traditional Chinese medicine, Mianyang Third Hospital and Mianyang Anzhou Hospital. Based on the random number yielded using SPSS 25.0 software, the qualified subjects will be randomly classified to the experimental group and the control group. Therapies will be performed 30 min once after operation, the experimental group will be treated with acupuncture, while the control group will receive intravenous injection of granisetron. The major outcome will be the time to first flatus, and the secondary outcomes will include the time to first defecation, abdominal pain, dosage of analgesia pump, abdominal distention, nausea, vomiting, gastrointestinal hormone, as well as mental state. The efficacy and safety of acupuncture will be also assessed following the principle of Good Clinical Practice (GCP). DISCUSS: A standardized and scientific clinical trial is conducted to assess the efficacy and safety of acupuncture for gastrointestinal dysfunction after laparoscopic cholecystectomy under general anesthesia. The aim is to objectively evidence and improves the clinical practice of acupoint prescription, as an attempt to promote the clinical application of this technology.


Assuntos
Terapia por Acupuntura/métodos , Anestesia Geral/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Gastroenteropatias/terapia , Hormônios Gastrointestinais/sangue , Complicações Pós-Operatórias/terapia , Adolescente , Adulto , Idoso , Estudos de Viabilidade , Feminino , Gastroenteropatias/sangue , Gastroenteropatias/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
16.
Eur J Endocrinol ; 182(5): 489-498, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32187576

RESUMO

Objective: Cushing's disease (CD) may recur despite corticotropic insufficiency (COI) following pituitary surgery. The predictive value of the desmopressin test (DT) for recurrence in this setting remains controversial. We have evaluated whether the disappearance of the response to DT predicts a low probability recurrence in a large cohort of patients with post-operative COI. Design: Multicentre retrospective study. Methods: Ninety-five patients with CD (women 82%, age 41 ± 14 years), responding preoperatively to DT and with early post-operative COI (08 00 am cortisol: <138 nmol/L), underwent a DT within 3 months post-surgery. Association between DT findings and the prediction of recurrence was tested using regression and ROC analyses. Results: Recurrence occurred in 17/95 patients within 29 to 91 months. The cortisol peak (327, 95% CI (237-417) vs 121 (79-164) nmol/L, P = 0.0001) and absolute increment during DT (208 (136-280) vs 56 (22-90) nmol/L, P = 0.005) were greater in the recurrence vs remission group. Cortisol peak (AUC: 0.786 (0.670-0.902)) and increment (0.793 (0.672-0.914)) yielded a higher prognostic performance for recurrence than did the early post-operative 08 00 am cortisol (0.655 (0.505-0.804)). In the context of COI, cortisol peak >100 nmol/L and increment >30 nmol/L had a high negative predictive value (94, 95% CI (88-100) and 94, (88-100), respectively). Patients with a cortisol peak ≤100 nmol/L (vs >100) or an increment ≤30 nmol/L (vs >30) were less likely to have CD recurrence (odds ratios: 0.12, 95% CI (0.03-0.41) and 0.11 (0.02-0.36), respectively). Conclusion: The disappearance of the response to the post-operative DT was independently associated with a lower odds of CD recurrence and offers an incremental prognostic value, which may help to stratify patients with COI and refine their follow-up according to the risk of recurrence.


Assuntos
Desamino Arginina Vasopressina/uso terapêutico , Hidrocortisona/sangue , Hipersecreção Hipofisária de ACTH/sangue , Hipersecreção Hipofisária de ACTH/tratamento farmacológico , Complicações Pós-Operatórias/sangue , Adulto , Antidiuréticos/uso terapêutico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Hipersecreção Hipofisária de ACTH/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Recidiva , Estudos Retrospectivos
17.
Am Surg ; 86(2): 121-126, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167046

RESUMO

We performed a retrospective study of our large patient cohort aiming to examine the ability to predict postthyroidectomy hypocalcemia. A retrospective review of patients who underwent total or near-total thyroidectomy at our institution between 2008 and 2018 was performed. Postoperative hypocalcemia was defined as Ca level <8.0 mg/dL (reference range: 8.9-10.1 mg/dL) within 30 days of operation. Logistic regression was used to develop models for prediction of the occurrence of postoperative hypocalcemia. Inclusion criteria were met by 1463 patients. Hypocalcemia was documented in 223 patients (15%). Models based on parathyroid hormone (PTH) levels alone had an associated receiver operator characteristic with an areas under the curve (AUC) of 0.79. There was an inverse relationship between time of measurement and PTH levels within the first two hours after thyroidectomy (P < 0.01). When measured two to six hours after closure, the predictive ability of PTH compared favorably (AUC = 0.82) with either earlier (within the first two hours after closure, AUC = 0.79) or later measurement (6-24 hours after closure, AUC = 0.77). When measured between two and six hours postoperatively, PTH < 19 pg/mL had a sensitivity of 90 per cent and negative predictive value of 96 per cent for postoperative hypocalcemia. The model that included the PTH level, concurrently measured total blood calcium level, and time of measurement had an improved predictive ability with an AUC of 0.87. PTH level of 19 pg/mL measured two to six hours after thyroidectomy had a sensitivity of 90 per cent and a negative predictive value of 96 per cent in our cohort. The model including postoperative PTH level, calcium level, and time of measurement may further improve the ability to predict postthyroidectomy hypocalcemia.


Assuntos
Hipocalcemia/etiologia , Hormônio Paratireóideo/sangue , Complicações Pós-Operatórias , Tireoidectomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Biomarcadores/sangue , Cálcio/sangue , Feminino , Humanos , Hipocalcemia/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores de Tempo , Adulto Jovem
18.
Br J Anaesth ; 124(6): 718-725, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32216958

RESUMO

BACKGROUND: Elevated red cell distribution width (RDW) has been associated with worse outcomes in several medical patient populations. The aim of this study was to investigate the association of increased preoperative RDW and short- and long-term mortality after noncardiac surgery. METHODS: This investigation was a retrospective cohort study including all patients undergoing noncardiac surgery between 2005 and 2015 at Landspitali-the National University Hospital in Iceland. Patients were separated into five predefined groups based on preoperative RDW (≤13.3%, 13.4-14.0%, 14.1-14.7%, 14.8-15.8%, and >15.8%). The primary outcome was all-cause long-term mortality and secondary outcomes included 30-day mortality, length of stay, and readmissions within 30 days, compared with propensity score matched (PSM) cohort from patients with RDW ≤13.3%. RESULTS: There was a higher hazard of long-term mortality for patients with RDW between 14.8% and 15.8% (hazard ratio=1.33; 95% confidence interval, 1.15-1.59; P<0.001) and above 15.8% (hazard ratio=1.66; 95% confidence interval, 1.41-1.95; P<0.001), compared with matched controls with RDW ≤13.3%. This association held in multiple patient subgroups. For secondary outcomes, there was no difference in 30-day mortality, length of stay, or risk of readmission within 30 days. CONCLUSIONS: Increased preoperative RDW is associated with increased long-term mortality after noncardiac surgery. RDW could be a composite biomarker of pre-existing chronic inflammation and poor nutritional status. Future studies should clarify if this is a modifiable risk factor for improved surgical outcomes.


Assuntos
Índices de Eritrócitos/fisiologia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/mortalidade , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Operatórios , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
19.
Transplant Proc ; 52(3): 829-835, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32113693

RESUMO

BACKGROUND: Cytomegalovirus (CMV) infection is one of the leading causes of morbidity and mortality in kidney transplantation (KT) recipients. We investigated the association of CMV serostatus and patient outcomes within the first year after KT. METHODS: All KT recipients between January 1, 2007 and December 31, 2017 were identified from the Thai Transplant Registry. The prevalence rates of allograft loss and mortality within the first year after KT were estimated by the Kaplan-Meier method. The CMV serostatus in donors (D) and recipients (R) was assessed as a prognostic factor for allograft loss and mortality within the first year by the Cox proportional hazards model. RESULTS: During the 10-year study period (2007-2017), there were 4556 KT recipients with a mean ± standard deviation age of 43 ± 14 years, and 63% of the recipients were male. Deceased-donor KT and induction therapy were performed in 52% and 58% of the recipients, respectively. Among the 3907 evaluable patients, the rates of cases with D+/R+, D+/R-, D-/R+, and D-/R- as the CMV serostatus were 88.9%, 6.1%, 2.9%, and 1.9%, respectively. The estimated prevalence rates of allograft loss and mortality within the first year were 3.8% and 2.8%, respectively. In univariate analysis, CMV D+/R- serostatus was significantly associated with mortality (hazard ratio [HR], 2.10; 95% confidence interval [CI], 1.18-3.75; P = .01) but not with an allograft loss (HR, 1.51; 95% CI, 0.85-2.66; P = .16) within the first year after KT. In multivariate analysis, CMV D+/R- serostatus of D+/R- was associated with mortality within the first year after KT (HR, 2.04; 95% CI, 1.05-3.95; P = .04). Other independent prognostic factors for mortality were old recipient age, deceased-donor KT, and hemodialysis after KT. CONCLUSIONS: In a national setting with predominant CMV seropositivity in both D and R, CMV seromismatch was associated with poor patient survival within the first year after KT.


Assuntos
Infecções por Citomegalovirus/mortalidade , Citomegalovirus , Transplante de Rim/mortalidade , Complicações Pós-Operatórias/mortalidade , Adulto , Aloenxertos , Infecções por Citomegalovirus/sangue , Infecções por Citomegalovirus/virologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Rim/virologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/virologia , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Tailândia/epidemiologia , Transplante Homólogo
20.
Transplant Proc ; 52(2): 512-514, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32059940

RESUMO

Plasma cell-rich acute rejection (PCAR) is a rare type of allograft rejection in renal transplantation. It is characterized by the presence of mature plasma cells that compromise more than 10% of inflammatory cells infiltrating the renal graft. The pathogenesis of PCAR is unknown, appears late, and has been related mainly to insufficient immunosuppression or infections. The treatment is not clearly defined, and the graft survival is poor. Here, we report a case series of 3 Spanish patients diagnosed with PCAR accompanied by donor-specific antibodies (DSA) after kidney transplantation. Mean to diagnosis was 2-12 years post-transplantation, and they began with abrupt deterioration of renal function. All patients were women and had preceding viral infection. In addition, two of the three patients recognize a doubtful adherence to immunosuppression. About treatment, 2 of the 3 patients, because the biopsy of the renal graft showed signs suggestive of incipient antibody-mediated rejection (ABMR) (glomerulitis, capilaritis, transplant glomerulopathy), were started with corticosteroids, anti-thymoglobulin, plasmapheresis, and intravenous immunoglobulins. The last patient, who only showed PCAR at biopsy, was treated with corticosteroids and anti-thymoglobulin. After treatment, graft function improved in all of them, but one patient developed an ABMR and another required a dialysis program, all of which indicates the difficulty in management and treatment of PCAR.


Assuntos
Rejeição de Enxerto/imunologia , Transplante de Rim/efeitos adversos , Plasmócitos/imunologia , Complicações Pós-Operatórias/imunologia , Adulto , Anticorpos/sangue , Anticorpos/imunologia , Biópsia , Feminino , Rejeição de Enxerto/sangue , Humanos , Rim/imunologia , Rim/patologia , Complicações Pós-Operatórias/sangue , Doadores de Tecidos , Transplantes/imunologia , Transplantes/patologia
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