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2.
Laryngoscope ; 129(10): 2210-2215, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31566760

RESUMO

OBJECTIVES/HYPOTHESIS: The objective of this study was to report for the first time on the results of submucosal injections of bevacizumab used in conjunction with cyanoacrylate glue sclerotherapy in hereditary hemorrhagic telangiectasia (HHT). STUDY DESIGN: Retrospective analytic chart review. METHODS: We performed a chart review that included all patients with HHT treated with intranasal bevacizumab and cyanoacrylate glue for refractory epistaxis at Lariboisiere University Hospital from 2013 with a minimum follow-up of 6 months. We injected 100 mg (25 mg/mL) of bevacizumab diluted in 2 mL of serum at the base of the telangiectasias, and sclerotherapy with an injection of cyanoacrylate glue was used adjunctively. Treatment efficacy was based on changes in Epistaxis Severity Scores (ESS) and the Bergler-Sadick Scale. Quality of life and patient satisfaction were evaluated using the Cantril Self-Anchoring Ladder (CL) and Likert scale, respectively. RESULTS: Thirty-one patients were included, with a mean follow-up of 26.6 months. The average ESS score significantly decreased from 7.82 to 3.89 (P < .05). The Bergler-Sadick score significantly improved (P < .05) following the treatment, including the frequency (from 2.74 to 1.64) and the quantity (from 2.54 to 1.51) scales. Quality of life was significantly improved (P < .05) using the CL score (from 4.16 to 7.22). The Likert satisfaction scale related to the treatment efficacy was high, with an average of 7.03 out of 10. No complications were noted. CONCLUSIONS: Submucosal injections of bevacizumab in conjunction with cyanoacrylate glue sclerotherapy significantly reduced epistaxis and improved the quality of life in HHT. Prospective comparative studies are needed to further evaluate the significance of this treatment modality. LEVEL OF EVIDENCE: 3b Laryngoscope, 129:2210-2215, 2019.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Bevacizumab/administração & dosagem , Cianoacrilatos/administração & dosagem , Epistaxe/tratamento farmacológico , Adesivo Tecidual de Fibrina/administração & dosagem , Telangiectasia Hemorrágica Hereditária/tratamento farmacológico , Administração Intranasal , Adulto , Idoso , Idoso de 80 Anos ou mais , Epistaxe/etiologia , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Telangiectasia Hemorrágica Hereditária/complicações , Resultado do Tratamento
4.
BMC Cancer ; 19(1): 973, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638935

RESUMO

BACKGROUND: Although the dual anti-HER2 therapy, namely, pertuzumab plus trastuzumab and docetaxel, has shown promising results in HER2+ breast cancer patients, whether the dose, efficacy and safety of this treatment differs from those of other pertuzumab-based dual anti-HER2 therapies remain controversial. This systematic review evaluates the efficacy and safety of H (trastuzumab or trastuzumab emtansine ± chemotherapy) + P (pertuzumab) compared with those of H in HER2+ breast cancer patients. METHODS: A comprehensive search was performed to identify eligible studies comparing the efficacy and safety of H + P versus H. The pathologic complete response (pCR), median progression-free survival (PFS) and overall survival (OS) were the primary outcomes, and safety was the secondary outcome. A subgroup analysis of pCR according to hormone receptor (HR) status was performed. All analyses were conducted using STATA 11.0. RESULTS: Twenty-six studies (9872 patients) were identified. In the neoadjuvant setting, H + P significantly improved the pCR [odds ratio (OR) = 1.33; 95% confidence interval (CI), 1.08-1.63; p = 0.006]. In the metastatic setting, H + P significantly improved PFS [hazard ratios (HRs) = 0.75; 95% CI, 0.68-0.84; p < 0.001]. There was a trend towards better OS but that it did not reach statistical significance (HRs = 0.81; 95% CI, 0.64-1.03; p = 0.082). A subgroup analysis revealed that the HER2+/HR- patients who received H + P showed the highest increase in the pCR. Rash, diarrhea, epistaxis, mucosal inflammation, and anemia were significantly more frequently observed with H + P than with H, whereas myalgia was less frequent (OR = 0.91; 95% CI, 0.82-1.01; p = 0.072), and no significant difference in cardiac toxicity was observed between these therapies (OR = 1.26; 95% CI, 0.81-1.95; P = 0.309). CONCLUSIONS: Our study confirms that H + P is superior to H in the (neo)adjuvant treatment of HER2+ breast cancer, and increase the risk of acceptable and tolerable toxicity (rash, diarrhea, epistaxis, mucosal inflammation, and anemia). TRIAL REGISTRATION: A systematic review protocol was registered with PROSPERO (identification number: CRD42018110415 ).


Assuntos
/efeitos adversos , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Receptor ErbB-2/metabolismo , /farmacologia , Antineoplásicos Imunológicos/farmacologia , Diarreia/etiologia , Docetaxel/uso terapêutico , Epistaxe/etiologia , Exantema/etiologia , Feminino , Humanos , Terapia de Alvo Molecular/métodos , Terapia Neoadjuvante , Intervalo Livre de Progressão , Receptor ErbB-2/antagonistas & inibidores , Trastuzumab/efeitos adversos , Trastuzumab/farmacologia , Trastuzumab/uso terapêutico
5.
Acta otorrinolaringol. esp ; 70(5): 279-285, sept.-oct. 2019. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-186371

RESUMO

Introducción y objetivos: El nasoangiofibroma juvenil es una neoplasia benigna sumamente vascularizada de tratamiento complejo, tanto en su preparación quirúrgica como en la cirugía a realizar, los riesgos y las recurrencias. El objetivo es analizar el manejo y tratamiento quirúrgico para el nasoangiofibroma juvenil. Materiales y métodos: Se revisaron las historias clínicas e imágenes de los pacientes intervenidos por la especialidad de cirugía de cabeza, cuello y maxilofacial con resultado de proceso patológico compatible con nasoangiofibroma juvenil, en el periodo comprendido entre enero de 2008 a diciembre de 2016. Resultados: Se intervinieron 61 casos, todos ellos tratados con el mismo acceso quirúrgico por medio de una osteotomía Le Fort I. La totalidad de los pacientes fue de sexo masculino, con un promedio de edad de 13,3 años. Se utilizó la clasificación de Andrew-Fish para la estadificación de los casos, obteniendo los grados ii y i la mayor cantidad de casos. Conclusiones: El abordaje descrito provee un acceso quirúrgico extenso, el cual es adecuado para los diferentes estadios de la tumoración. Requiere de experiencia para poder llevar a cabo la resección de la tumoración con el menor sangrado posible


Introduction and objectives: The juvenile nasopharyngeal angiofibroma is a highly vascularised benign neoplasm of complex treatment in its surgical preparation, surgery to be performed, risks and recurrences. The aim of the study was to analyze the management and surgical treatment for the pathology of juvenile nasoangiofibroma. Materials and methods: We reviewed the clinical histories and images of the patients who underwent surgery with a pathology result of juvenile nasoangiofibroma in the period from January 2008 to December 2016. Results: Sixty-one cases were treated; all of them treated using the same surgical access by means of a Le Fort I osteotomy. All of the patients were male, with an average age of 13.3 years. The Andrew-Fish classification was used for staging the cases, most were staged as grade II and I. Conclusions: The described approach provided extensive surgical access, which was adequate for the different stages of the tumour. It requires experience to be able to resect the tumour with the least possible bleeding


Assuntos
Humanos , Masculino , Criança , Adolescente , Angiofibroma/cirurgia , Neoplasias Nasofaríngeas/cirurgia , Angiofibroma/complicações , Angiofibroma/terapia , Perda Sanguínea Cirúrgica , Transfusão de Sangue , Terapia Combinada , Embolização Terapêutica , Endoscopia , Epistaxe/etiologia , Obstrução Nasal/etiologia , Neoplasias Nasofaríngeas/complicações , Neoplasias Nasofaríngeas/terapia , Terapia Neoadjuvante , Osteotomia de Le Fort , Estudos Retrospectivos , Transtornos da Visão/etiologia
6.
Int J Pediatr Otorhinolaryngol ; 126: 109615, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31416016

RESUMO

Duane's Retraction Syndrome (DRS), a congenital cranial dysinnervation disorder, accounts for 5% of all strabismus. A vascular anomaly in DRS, which became clinically relevant in the context of significant epistaxis, is presented. A 15-year-old girl with DRS underwent a rhinological procedure for traumatic nasal deformity and suffered large volume epistaxis. Using angiography, an anatomical variation was identified, noting the ophthalmic artery was supplied by branches from the sphenopalatine artery, facial artery, and middle meningeal artery; not from the internal carotid artery. Hence epistaxis control was achieved via alternative methods, and unilateral blindness was avoided.


Assuntos
Cegueira/prevenção & controle , Síndrome da Retração Ocular/complicações , Embolização Terapêutica/métodos , Epistaxe/terapia , Obstrução Nasal/cirurgia , Artéria Oftálmica/anormalidades , /terapia , Adolescente , Angiografia , Artéria Carótida Interna/diagnóstico por imagem , Epistaxe/etiologia , Feminino , Humanos , Obstrução Nasal/complicações , Artéria Oftálmica/diagnóstico por imagem , Rinoplastia/efeitos adversos , Estrabismo/etiologia
8.
J Craniofac Surg ; 30(8): 2536-2538, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31261322

RESUMO

Anterior epistaxis is commonly treated with Merocel nasal packing insertion. A 63-year-old male patient showed a cerebrospinal fluid rhinorrhea and pneumocephalus immediately after insertion of a Merocel tampon used for spontaneous right anterior epistaxis. He later developed fever and headache. This clinical report is to highlight how the nasal merocel should be positioned by specialized personnel and to describe how to manage this type of complication.


Assuntos
Epistaxe , Rinorreia de Líquido Cefalorraquidiano/etiologia , Epistaxe/etiologia , Formaldeído , Cefaleia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumocefalia/etiologia , Álcool de Polivinil
9.
BMJ Case Rep ; 12(7)2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31302615

RESUMO

A 43-year-old woman presented with an 8-week history of fatigue and recurrent right sided nasal bleeds progressing to significant pain and swelling on the right side of her face. Clinical examination revealed a friable mass in her right nasal passage. A biopsy and staging positron emission tomography-CT scan confirmed the diagnosis of a T4 N1 M1 BRAF wild type mucosal melanoma. The melanoma had metastasised to the right paranasal sinuses, right and left neck nodes, right submental node, right upper breast, liver, the subcutaneous fat of the left buttock and the right iliac bone as well as cerebral metastasis with further disease progression. Combination immunotherapy was started but initially suspended due to an adverse reaction to nivolumab and restarted in due course. Surgical debulking was carried out for symptomatic relief. This case report explores the delay in diagnosis of mucosal melanoma with its subsequent consequences and the lack of understanding of associated risk factors and optimal treatment.


Assuntos
Epistaxe/etiologia , Melanoma/patologia , Neoplasias Nasais/patologia , Adulto , Antineoplásicos Imunológicos/administração & dosagem , Antineoplásicos Imunológicos/efeitos adversos , Procedimentos Cirúrgicos de Citorredução , Evolução Fatal , Feminino , Humanos , Ipilimumab/administração & dosagem , Ipilimumab/efeitos adversos , Melanoma/diagnóstico por imagem , Melanoma/terapia , Mucosa Nasal/patologia , Nivolumabe/administração & dosagem , Nivolumabe/efeitos adversos , Neoplasias Nasais/diagnóstico por imagem , Neoplasias Nasais/terapia , Tomografia Computadorizada por Raios X
10.
Ann Otol Rhinol Laryngol ; 128(11): 1078-1080, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31204488

RESUMO

OBJECTIVES: Inflammatory myofibroblastic tumor (IMT) is a rare benign lesion, especially in the pediatric age. There are several cases described in pulmonary, digestive and renal localizations, but involvement in head and neck area is infrequent. METHODS: Case report and review of the literature. RESULTS: A 1 year and 11 months old child, during 2 months had clinical signs of nasal respiratory insufficiency and epistaxis subsequently developing a purulent rhinorrhea and a sleep apnea. His pediatrician previously requested a sinus and cavum X-ray with the finding of an image compatible with an intranasal mass. Endoscopic resection was performed of the mass with further immunohistochemical analysis showing the result of a lesion compatible with IMT. CONCLUSIONS: Even though there are very few cases in scientific literature of a tumor with these characteristics in infants, IMT must be present as a differential diagnosis of intranasal masses. The role of the pathologist is essential to reach the definitive diagnosis and the performance of an early surgical treatment decreases aesthetic consequences in this pathology.


Assuntos
Endoscopia/métodos , Epistaxe/etiologia , Cavidade Nasal/patologia , Neoplasias de Tecido Muscular/diagnóstico , Neoplasias dos Seios Paranasais/diagnóstico , Seios Paranasais/diagnóstico por imagem , Diagnóstico Diferencial , Epistaxe/diagnóstico , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Neoplasias de Tecido Muscular/complicações , Neoplasias de Tecido Muscular/cirurgia , Neoplasias dos Seios Paranasais/complicações , Neoplasias dos Seios Paranasais/cirurgia , Tomografia Computadorizada por Raios X
11.
Br J Oral Maxillofac Surg ; 57(6): 597-599, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31155397

RESUMO

Vascular injuries after orthognathic surgery are rare, and mainly occur in young adults after Le Fort I osteotomies. We report the case of a 14-year-old girl who presented with life-threatening epistaxis one week after a surgically-assisted rapid palatal expansion (SARPE) followed by activation of a transpalatal distractor. Definitive treatment was superselective, catheter-directed, glue-embolisation of a bleeding bilobar pseudoaneurysm, which was located at an end branch of the left sphenopalatine artery.


Assuntos
Adesivos , Falso Aneurisma , Embolização Terapêutica , Técnica de Expansão Palatina , Adolescente , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Embolização Terapêutica/métodos , Epistaxe/etiologia , Feminino , Humanos , Maxila , Artéria Maxilar , Osteotomia de Le Fort , Técnica de Expansão Palatina/efeitos adversos , Palato
12.
BMJ Case Rep ; 12(6)2019 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-31229987

RESUMO

The majority of epistaxes are anterior in nature, resolve with simple first aid measures and require no further follow-up. However, some cases pose more of a diagnostic challenge and prove resistant to standard investigation and treatment. We present a case of recurrent epistaxis, refractory to multiple treatment modalities and with CT imaging suggestive of a vascular aetiology which was ultimately disproved. The case highlights the shortcomings of CT imaging and importance of thorough examination technique. Nasal haemangiomas are a rare but recognised cause of epistaxis and should be considered in refractory cases.


Assuntos
Epistaxe/etiologia , Hemangioma/complicações , Nariz/patologia , Idoso , Aneurisma , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/patologia , Angiografia por Tomografia Computadorizada/métodos , Angiografia por Tomografia Computadorizada/estatística & dados numéricos , Diagnóstico Diferencial , Feminino , Hemangioma/diagnóstico por imagem , Hemangioma/cirurgia , Humanos , Nariz/irrigação sanguínea , Nariz/diagnóstico por imagem , Resultado do Tratamento
13.
Ann Afr Med ; 18(2): 75-79, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31070148

RESUMO

Background: Epistaxis, though a mere nuisance can have life-threatening consequences. This first study from Jos on epistaxis aims to determine its sociodemographic characteristics, causes, the treatment modalities and the predictors of patient outcome. Study Design: A retrospective chart review. Methods: Health records of patients that met the inclusion criteria for epistaxis at the Jos University Teaching Hospital, Jos, Nigeria, between February 2011 and December 2015 were retrieved manually using standardized codes in the International Classification of Diseases 10th revision and studied for age, gender, associated comorbidities, treatment modalities offered, and outcome of treatment. Results: We managed 154 patients. Records of 92 patients were retrievable aged between 1 and 85 years (Mean = 37.7; standard deviation ± 16.2) with male to female ratio of 2.3:1. Patients in the third decade were the largest group. The most common cause was idiopathic. Anterior nasal bleeding occurred in 51.1%, posterior nasal bleeding in 34.8%. Conservative management was effective in 84.8%. Etiological factors other than chronic liver disease and otolaryngological malignancies showed statistically significant association with good patient outcomes (P = 0.013, P = 0.044, and P = 0.026, respectively). A mortality rate of 5.4% was recorded. Conclusion: Epistaxis of idiopathic origin occurring mostly in young males is the most common with most resolving on conservative management. Early hospital presentation, normal blood pressure at presentation and all management modalities were positive predictors of outcome in our patients.


Assuntos
Epistaxe/etiologia , Epistaxe/terapia , Hospitais de Ensino/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Epistaxe/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Estudos Retrospectivos , Distribuição por Sexo , Fatores Socioeconômicos , Resultado do Tratamento , Adulto Jovem
14.
Int J Pediatr Otorhinolaryngol ; 123: 75-78, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31077906

RESUMO

Munchausen syndrome by proxy (MSBP) is a condition diagnosed when a caregiver knowingly fabricates or inflicts illness on another for his/her own gain. Typical cases of MSBP detected by otolaryngologists involve facial trauma or otologic injury, while descriptions involving the nose are rare. Destructive nasal lesions have a broad differential diagnosis and may require visits to numerous specialists, placing strain on both the patient and the healthcare system. Early recognition of MSBP in patients with chronic nasal destruction may prevent such unnecessary strain. We present a case of MSBP involving two half-brothers with unexplainable nasal destruction and discuss the literature and current recommendations for managing the diagnosis.


Assuntos
Epistaxe/etiologia , Síndrome de Munchausen Causada por Terceiro/complicações , Síndrome de Munchausen Causada por Terceiro/diagnóstico , Deformidades Adquiridas Nasais/etiologia , Nariz/lesões , Doença Crônica , Diagnóstico Diferencial , Humanos , Lactente , Masculino , Irmãos
15.
Blood Coagul Fibrinolysis ; 30(4): 168-170, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31090598

RESUMO

: Type 2A sub-type of Von Willebrand disease (VWD) is characterized by the loss of high molecular weight multimers. Several plasma-derived Von Willebrand factor concentrates (PD-VWFC) are available for treatment and recently a recombinant VWF concentrate (rVWFC) has been approved for use in VWD for adults in the United States. We describe a patient with Type 2A VWD who had persistent refractory epistaxis despite treatment with PD-VWFC. We describe differences in VWF multimeric composition and Factor VIII (FVIII) levels after plasma-derived and rVWF concentrates. Despite similar VWF levels, VWF multimeric composition after PD-VWFC remained abnormal while it corrected with rVWFC. Post-PD-VWFC, high levels of FVIII were seen, which were not observed after rVWFC. Recombinant VWFC may offer some advantages over PD-VWFC. This finding needs to be confirmed in larger studies.


Assuntos
Doença de von Willebrand Tipo 2/tratamento farmacológico , Fator de von Willebrand/uso terapêutico , Adulto , Proteínas Sanguíneas/uso terapêutico , Epistaxe/etiologia , Fator VIII/análise , Humanos , Multimerização Proteica , Proteínas Recombinantes/uso terapêutico , Estados Unidos , Fator de von Willebrand/isolamento & purificação
16.
Am J Cardiol ; 124(3): 367-372, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31126539

RESUMO

Direct acting oral anticoagulants (DOACs) are increasingly used as off-label alternatives to vitamin K antagonists for the treatment of left ventricular (LV) thrombus. However, efficacy data is limited to small case series and one meta-analysis of case reports. We aimed to determine the efficacy and safety of DOACs in treatment of LV thrombus utilizing transthoracic echocardiography (TTE) and clinical outcomes. We identified 52 patients (mean age = 64 years, 71% men) treated with a DOAC for LV thrombus (n = 26 apixaban, n = 24 rivaroxaban, and n = 2 dabigatran). Thirty-five of the 52 patients had a follow-up TTE after DOAC initiation. The primary end point was defined as resolution of LV thrombus (in patients with a subsequent TTE), or death, major bleeding requiring transfusion, intracranial hemorrhage, ischemic stroke, or peripheral embolization. An experienced echocardiographer (M.L.M.) reviewed all TTEs for presence or absence of LV thrombus without knowledge of time point or clinical data. Twenty-nine of the 35 (83%) patients who underwent follow-up TTE had resolution of LV thrombus, with a mean duration of 264 days. Of the total study population, there was 1 cardioembolic event (transient ischemic attack) 52 days after initiating DOAC, 3 gastrointestinal bleeds requiring transfusion, and 1 patient with epistaxis requiring transfusion. All patients with a hemorrhagic complication were receiving concomitant antiplatelet therapy. DOAC therapy appears promising for the treatment of LV thrombus. A larger, prospective study is warranted to confirm these results.


Assuntos
Inibidores do Fator Xa/uso terapêutico , Trombose/tratamento farmacológico , Disfunção Ventricular Esquerda/tratamento farmacológico , Adulto , Idoso , Transfusão de Sangue/estatística & dados numéricos , Dabigatrana/uso terapêutico , Ecocardiografia , Epistaxe/etiologia , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Estudos Retrospectivos , Rivaroxabana/uso terapêutico , Trombose/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem
17.
JAMA ; 321(17): 1677-1685, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31063573

RESUMO

Importance: Therapeutic hypothermia may increase survival with good neurologic outcome after cardiac arrest. Trans-nasal evaporative cooling is a method used to induce cooling, primarily of the brain, during cardiopulmonary resuscitation (ie, intra-arrest). Objective: To determine whether prehospital trans-nasal evaporative intra-arrest cooling improves survival with good neurologic outcome compared with cooling initiated after hospital arrival. Design, Setting, and Participants: The PRINCESS trial was an investigator-initiated, randomized, clinical, international multicenter study with blinded assessment of the outcome, performed by emergency medical services in 7 European countries from July 2010 to January 2018, with final follow-up on April 29, 2018. In total, 677 patients with bystander-witnessed out-of-hospital cardiac arrest were enrolled. Interventions: Patients were randomly assigned to receive trans-nasal evaporative intra-arrest cooling (n = 343) or standard care (n = 334). Patients admitted to the hospital in both groups received systemic therapeutic hypothermia at 32°C to 34°C for 24 hours. Main Outcomes and Measures: The primary outcome was survival with good neurologic outcome, defined as Cerebral Performance Category (CPC) 1-2, at 90 days. Secondary outcomes were survival at 90 days and time to reach core body temperature less than 34°C. Results: Among the 677 randomized patients (median age, 65 years; 172 [25%] women), 671 completed the trial. Median time to core temperature less than 34°C was 105 minutes in the intervention group vs 182 minutes in the control group (P < .001). The number of patients with CPC 1-2 at 90 days was 56 of 337 (16.6%) in the intervention cooling group vs 45 of 334 (13.5%) in the control group (difference, 3.1% [95% CI, -2.3% to 8.5%]; relative risk [RR], 1.23 [95% CI, 0.86-1.72]; P = .25). In the intervention group, 60 of 337 patients (17.8%) were alive at 90 days vs 52 of 334 (15.6%) in the control group (difference, 2.2% [95% CI, -3.4% to 7.9%]; RR, 1.14 [95% CI, 0.81-1.57]; P = .44). Minor nosebleed was the most common device-related adverse event, reported in 45 of 337 patients (13%) in the intervention group. The adverse event rate within 7 days was similar between groups. Conclusions and Relevance: Among patients with out-of-hospital cardiac arrest, trans-nasal evaporative intra-arrest cooling compared with usual care did not result in a statistically significant improvement in survival with good neurologic outcome at 90 days. Trial Registration: ClinicalTrials.gov Identifier: NCT01400373.


Assuntos
Lesões Encefálicas/prevenção & controle , Serviços Médicos de Emergência , Hipotermia Induzida/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Encéfalo/fisiopatologia , Lesões Encefálicas/etiologia , Reanimação Cardiopulmonar/métodos , Epistaxe/etiologia , Feminino , Humanos , Hipotermia Induzida/efeitos adversos , Hipotermia Induzida/instrumentação , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/mortalidade , Tamanho da Amostra , Método Simples-Cego , Taxa de Sobrevida , Tempo para o Tratamento , Resultado do Tratamento
18.
World Neurosurg ; 128: 23-28, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31054341

RESUMO

BACKGROUND: Epistaxis is a rare presentation of the ruptured cavernous carotid aneurysm, especially the nontraumatic type. Both endovascular therapies and open surgeries have a role in the treatment with various outcomes, but the standard procedure is not well established. We report a successful high-flow bypass with cervical internal carotid artery ligation for aneurysm repair and review the related literature. CASE DESCRIPTION: An 81-year-old man presented with massive epistaxis from the left nostril. The epistaxis was controlled by nasal packing. A saccular aneurysm of the cavernous segment of the left internal carotid artery projecting into the sphenoid sinus was revealed using computed tomography angiography. We treated this patient with high-flow bypass with ligation of the cervical internal carotid artery. Immediate postoperative computed tomography angiography showed complete disappearance of the aneurysm. Nasal packing was removed without further bleeding. No neurological deficit or complications were detected in the postoperative period. CONCLUSIONS: In cases of massive or recurrent epistaxis without coagulopathy or nasal pathology, a cavernous carotid aneurysm should be considered. Immediate cessation of the bleeding is necessary. Flow-preservation bypass with proximal ligation of the parent artery is 1 of the effective procedures for the treatment of this condition with low morbidity.


Assuntos
Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/cirurgia , Epistaxe/etiologia , Epistaxe/terapia , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/cirurgia , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/diagnóstico , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Diagnóstico Diferencial , Epistaxe/diagnóstico , Humanos , Aneurisma Intracraniano/diagnóstico , Ligadura , Masculino , Procedimentos Neurocirúrgicos , Procedimentos Cirúrgicos Vasculares
20.
BMJ Case Rep ; 12(5)2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31142481

RESUMO

Pyogenic granuloma gravidarum is a benign fibrovascular proliferative lesion usually involving the oral gingivae in pregnant patients. While it also occurs, although less frequently, on other oral sites such as lips, tongue and palate, it is relatively unusual to find it in the nasal cavity. Furthermore, lesions normally involute spontaneously after childbirth. For persistent lesions requiring surgical management, imaging has historically been limited to CT. This case is notable not only for its uncommon location but also for its recurrent nature, failure to regress post partum and the use of MRI in the preoperative planning.


Assuntos
Granuloma Piogênico/cirurgia , Cavidade Nasal/cirurgia , Doenças Nasais/cirurgia , Complicações na Gravidez/cirurgia , Adulto , Epistaxe/etiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Planejamento de Assistência ao Paciente , Gravidez , Cuidados Pré-Operatórios/métodos , Recidiva , Tomografia Computadorizada por Raios X
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