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1.
Medicine (Baltimore) ; 99(16): e19699, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311950

RESUMO

This study aimed to identify the correlation of contradiction between DAPT score and PRECISE-DAPT score with the severity of coronary lesion in acute coronary syndromes (ACS).In total, 458 patients with ACS after a percutaneous coronary intervention (PCI) who had tolerated 1-year uneventful dual antiplatelet therapy (DAPT) were enrolled and divided into groups based on the Gensini score, number of stenosed vessels, and left main (LM) disease. Both DAPT score and PRECISE-DAPT score were calculated and the proportion of patients receiving conflicting recommendations from each score was compared among the groups.DAPT score as well as the proportion of patients with DAPT score ≥2 were associated with the Gensini score and the number of stenosed vessels. Similarly, PRECISE-DAPT score as well as the proportion of patients with PRECISE-DAPT score ≥25 were associated with the Gensini score and the number of stenosed vessels. The proportion of patients with DAPT score ≥2 along with PRECISE-DAPT score ≥25 were associated with Gensini score, but they had no significant association with the number of stenosed vessels (P = .006 and P = .075, respectively). None of those aforementioned items were associated with LM disease.The inconsistencies of DAPT scores and PRECISE-DAPT scores are frequent and associated with the severity of coronary disease, represented by the Gensini score. Appropriate clinical decisions should be individualized.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Síndrome Coronariana Aguda/patologia , Idoso , Estenose Coronária/diagnóstico , Terapia Antiplaquetária Dupla , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Hemorragia Pós-Operatória/diagnóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Stents , Resultado do Tratamento
2.
Anticancer Res ; 40(4): 2359-2364, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234938

RESUMO

BACKGROUND: The aim of the present study was to evaluate the clinical impact of the perioperative use of antiplatelet/anticoagulation therapy for postoperative bleeding after esophagectomy for esophageal cancer. PATIENTS AND METHODS: Patients were selected from the medical records of consecutive patients who were diagnosed with primary esophageal adenocarcinoma or squamous cell carcinoma and who underwent complete resection at Yokohama City University from January 2005 to September 2018. The patients were divided into the antiplatelet/anticoagulation treatment group and the non-treatment group. We compared the safety and feasibility of esophagectomy between two groups. RESULTS: One hundred and twenty-two patients underwent esophagectomy for esophageal cancer and were analyzed in the present study. Among them, 18 (14.8%) received anti-thrombotic therapy (anticoagulation group). The incidence of postoperative bleeding in patients overall was 8.2% (10/122). The incidence of postoperative bleeding in the anticoagulation group was 22.2% (4/18), while that in the non-anticoagulation group was 5.8% (6/104). Preoperative anticoagulation therapy was identified as a significant independent risk factor for postoperative bleeding (hazard ratio=4.673, 95% confidence interval=1.170-18.519; p=0.029). CONCLUSION: The perioperative use of anti-thrombotic therapy was a significant risk factor for postoperative bleeding after esophagectomy for esophageal cancer. Thus, when patients receive perioperative antiplatelet/anticoagulation treatment, careful attention is required after esophagectomy due to their increased risk of postoperative bleeding.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Complicações Pós-Operatórias/diagnóstico , Hemorragia Pós-Operatória/diagnóstico , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/cirurgia , Terapia Combinada , Esofagectomia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Agregação de Plaquetas/efeitos adversos , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/etiologia , Fatores de Risco
3.
PLoS One ; 15(2): e0229450, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32092108

RESUMO

BACKGROUND: Accurate prediction of operative transfusions is essential for resource allocation and identifying patients at risk of postoperative adverse events. This research examines the efficacy of using artificial neural networks (ANNs) to predict transfusions for all inpatient operations. METHODS: Over 1.6 million surgical cases over a two year period from the NSQIP-PUF database are used. Data from 2014 (750937 records) are used for model development and data from 2015 (885502 records) are used for model validation. ANN and regression models are developed to predict perioperative transfusions for surgical patients. RESULTS: Various ANN models and logistic regression, using four variable sets, are compared. The best performing ANN models with respect to both sensitivity and area under the receiver operator characteristic curve outperformed all of the regression models (p < .001) and achieved a performance of 70-80% specificity with a corresponding 75-62% sensitivity. CONCLUSION: ANNs can predict >75% of the patients who will require transfusion and 70% of those who will not. Increasing specificity to 80% still enables a sensitivity of almost 67%. The unique contribution of this research is the utilization of a single ANN model to predict transfusions across a broad range of surgical procedures.


Assuntos
Transfusão de Sangue , Simulação por Computador , Redes Neurais de Computação , Assistência Perioperatória , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/terapia , Fatores Etários , Transfusão de Sangue/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Humanos , Aprendizado de Máquina , Masculino , Assistência Perioperatória/métodos , Assistência Perioperatória/estatística & dados numéricos , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Prognóstico , Fatores de Risco , Sensibilidade e Especificidade , Fatores Sexuais
4.
J Cardiovasc Surg (Torino) ; 61(2): 234-242, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31937080

RESUMO

BACKGROUND: Cardiac surgery is associated with perioperative bleeding and carries high risk of allogeneic blood transfusion. Recently new scores for prediction of severe bleeding have been developed. This study aims to compare the WILL-BLEED, CRUSADE, PAPWORTH, TRUST, TRACK and ACTION scores in predicting major bleeding after CABG in patients with low estimated operative risk. METHODS: A multicenter observational study included 1391 patients who underwent isolated CABG from July 2015 to January 2018. We tested the hypothesis that the WILL-BLEED score, specifically designed for CABG, would perform at least as well as the CRUSADE, PAPWORTH, TRUST, TRACK and ACTION scores in predicting postoperative major bleeding in low operative risk patients. The primary endpoint was the performance of known bleeding risk scores after CABG. The secondary endpoint was the evaluation of in-hospital mortality. RESULTS: Mean age was 68.2±9.4 years and median Euroscore II value was 1.69% (IQR 1.15-2.81%). Mean blood losses in the first 12 postoperative hours was 339.75 mL. Seventy-three (5.2%) subjects underwent administration of blood products. The rate of severe-massive bleeding according to UDPB grades 3-4 was 1.5%. WILL-BLEED, TRUST, TRACK and ACTION scores were significantly associated with severe postoperative bleeding. WILL-BLEED presented the best c-index (AUC: 0.658; 95% CI: 0.600,0.716). Reclassification analysis showed a worsening in sensitivity and significant negative reclassification of CRUSADE, PAPWORTH, TRACK and ACTION scores when compared with WILL-BEED. The combination of WILL-BLEED and TRUST scores improved the prediction ability (AUC: 0.673; 95% CI: 0.615-0.732). Overall in-hospital mortality was 1.65%. Early mortality in patients with severe versus no-severe bleeding was found to be 11.8% vs. 1.0% Severe bleeding (OR: 13.26; P value<0.001) was found to be significantly associated with early mortality. CONCLUSIONS: Severe bleeding after CABG is a harmful event associated with adverse outcomes. WILL-BLEED Score has the better performance in predicting severe-massive bleeding after CABG. The TRUST Score, although suboptimal, represents a valuable alternative in this setting.


Assuntos
Transfusão de Sangue/métodos , Ponte de Artéria Coronária/efeitos adversos , Mortalidade Hospitalar/tendências , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/mortalidade , Idoso , Área Sob a Curva , Causas de Morte , Intervalos de Confiança , Angiografia Coronária/métodos , Ponte de Artéria Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/mortalidade , Estenose Coronária/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/terapia , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Resultado do Tratamento
5.
J Surg Res ; 246: 83-92, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31562990

RESUMO

BACKGROUND: Cardiopulmonary bypass (CPB) is essential for the repair of many congenital cardiac defects in infants but is associated with significant derangements in hemostasis and systemic inflammation. As a result, hemorrhagic complications and thrombosis are major challenges in the management of children requiring CPB or extracorporeal membrane oxygenation. Conventional clinical laboratory tests capture individual hemostatic derangements (low platelets, elevated fibrinogen) but fail to describe the complex, overlapping interactions among the various components of coagulation, including cellular interactions, contact activation, fibrinolysis, and inflammation. Given recent advances in analytic tools for identifying protein-protein interactions in the plasma proteome, we hypothesized that an unbiased proteomic analysis would help identify networks of interacting proteins for further investigation in pediatric CPB. MATERIALS AND METHODS: Infants up to 1 y of age were enrolled. Plasma samples were collected at 0, 1, 4, and 24 h after CPB. Mass spectrometry was used to identify proteins undergoing changes in concentration after CPB, and STRING and ToppGene tools were used to identify biological networks. Two-dimensional difference gel electrophoresis identified changes in protein concentrations. Inflammatory markers were assessed by enzyme-linked immunosorbent assay at the same time points. RESULTS: Ten infants with cardiac anomalies requiring surgery and CPB were enrolled; no major complications were recorded (median age, 127.5 d; interquartile range, 181.25 d). Using two-dimensional difference gel electrophoresis, >1400 individual protein spots were observed, and 89 proteins demonstrated change in concentration >30% with P < 0.02 when comparing 1, 4, or 24 h to baseline. Among protein spots with significant changes in concentration after CPB, 29 were identified with mass spectrometry (33%). In our interrogation of functional associations among these differentially expressed proteins, our results were dominated by the acute phase response, coagulation, and cell signaling functional categories. Among cytokines analyzed by enzyme-linked immunosorbent assay, IL-2, IL-8, and IL-10 were elevated at 4 h but normalized by 24 h, whereas IL-6 was persistently elevated. CONCLUSIONS: Infants manifest a robust response to CPB that includes overlapping, complex pathways. Further investigation of interactions among immune, coagulation, and cell signaling systems may lead to novel therapeutics or biomarkers useful in the management of infants requiring CPB.


Assuntos
Ponte Cardiopulmonar/efeitos adversos , Cardiopatias Congênitas/cirurgia , Hemorragia Pós-Operatória/diagnóstico , Proteômica/métodos , Trombose/diagnóstico , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/etiologia , Trombose/sangue , Trombose/etiologia
6.
Cancer Control ; 26(1): 1073274819853831, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31480878

RESUMO

BACKGROUND: This study investigates the effect of body mass index (BMI) on complications and satisfaction in patients who underwent thyroidectomy and lateral neck dissection. METHODS: We retrospectively reviewed 386 patients with papillary thyroid cancer who underwent total thyroidectomy and lateral neck dissection between January 2013 and December 2016. We compared variables including population characteristics, subjective satisfaction, and complications in nonobese (BMI < 28.0 kg/m2) and obese (BMI ≥ 28.0 kg/m2) patients. RESULTS: Obesity was associated with an increased risk of postoperative hemorrhage (POH) (P = .014), accessory nerve injury (P < .001), operative time (P < .001) and infection (P = .013). However, obese patients had higher subjective satisfaction and Vancouver Scar Scale (VSS) scores (P < .05). CONCLUSIONS: Obesity was associated with increased risk of POH, injury of the SAN, and infection. Interestingly, we found that obese patients had higher subjective satisfaction and VSS scores.


Assuntos
Índice de Massa Corporal , Esvaziamento Cervical/métodos , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/efeitos adversos , Obesidade/complicações , Obesidade/psicologia , Satisfação do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Câncer Papilífero da Tireoide/fisiopatologia , Neoplasias da Glândula Tireoide/fisiopatologia , Tireoidectomia/efeitos adversos
7.
Eur Arch Otorhinolaryngol ; 276(11): 3231-3238, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31377901

RESUMO

PURPOSE: Our previous randomized controlled trial (RCT) of children with obstructive sleep apnea (OSA) showed no significant differences between adenotonsillectomy (ATE) and adenotonsillomy (ATE) in improving nocturnal respiration and symptoms after one year. This is the continuous report with the evaluation of postoperative morbidity concerning bleeding and pain. METHODS: A double-blinded RCT including 79 children, aged 2-6 years, with moderate to severe OSA, randomized to either ATE (n = 40) or ATT (n = 39). From one to ten days postoperatively, parents filled in a logbook with six pain-related outcomes (parent and child grading pain at different levels, days of analgesic use and return to normal diet). Peri- and postoperative bleeding were also registered. RESULTS: 63 patients (80%) returned the logbook. There were significant differences between groups in only two of the six pain-related outcomes in favor of the ATT group; first day when the children graded themselves as pain free (p = 0.021, Log Rank Test), and first day the caregiver estimated pain VAS ≤ 5 (p = 0.007, Log Rank Test). Two (5%) cases of postoperative bleeding occurred in the ATE group, one of which needed a return to theatre. No case of postoperative bleeding was seen in the ATT group. CONCLUSIONS: The results from this RCT are in line with previous comparative studies between ATT and ATE. Children operated with ATT had significantly less postoperative pain in one-third of the outcomes, and less bleeding than ATE. However, as the differences in morbidity between the surgical methods were minor the clinical significance is uncertain. TRIAL REGISTRATION: This study was approved by the Swedish Regional Ethics Board in Stockholm, Sweden (Dnr 2011/925-32 and 2013/2274-32) and registered at ClinicalTrials.gov (Trial registration number NCT01676181).


Assuntos
Acetaminofen/administração & dosagem , Adenoidectomia , Dor Pós-Operatória , Hemorragia Pós-Operatória , Tonsilectomia , Adenoidectomia/efeitos adversos , Adenoidectomia/métodos , Analgésicos não Entorpecentes/administração & dosagem , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Masculino , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/etiologia , Apneia Obstrutiva do Sono/fisiopatologia , Tonsilectomia/efeitos adversos , Tonsilectomia/métodos , Resultado do Tratamento
9.
J Card Surg ; 34(10): 1110-1113, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31269305

RESUMO

Mechanical circulatory support is increasingly used and may bring about unique challenges. Most support systems require systemic anticoagulation and the need for anticoagulation must be balanced against the increased risk for bleeding. We report the case of a young man awaiting heart retransplantation, who was supported with a temporary extracorporeal ventricular assist device with the addition of an oxygenator. He developed hemoptysis that forced the cessation of anticoagulation exposing to increased thromboembolic risk. We discuss this distinct clinical scenario with no clearly defined solution and explore the risks and benefits of the different treatment options.


Assuntos
Remoção de Dispositivo/métodos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Coração Auxiliar/efeitos adversos , Hemoptise/etiologia , Hemorragia Pós-Operatória/etiologia , Alvéolos Pulmonares/patologia , Adulto , Biópsia , Hemoptise/diagnóstico , Hemoptise/cirurgia , Humanos , Masculino , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/cirurgia , Alvéolos Pulmonares/irrigação sanguínea , Tomografia Computadorizada por Raios X
10.
Vestn Otorinolaringol ; 84(2): 18-22, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31198210

RESUMO

The analysis (1998-2018) of the causes of early postoperative bleeding in 68 children with chronic lymphoproliferative syndrome and late postoperative bleeding (on the 7-10th day) in 3 children aged 3 to 17 years was performed. It was found the disorder of the platelet functional activity (adrenaline-induced platelet aggregation, adrenaline concentration - 2.5 µmol/l) in 83.8% cases (57 children). Late postoperative bleedings were developed due to the uncontrolled intake of nonsteroidal anti-inflammatory painkillers, which led to the platelet dysfunction. It has been established the decrease in the prothrombin percent by Quick in 73.5% children, and the elongation of the activated partial thromboplastin time (APTT) in the quarter of children amid the bleeding. Half of the children showed the increase of D-dimer concentration to 1.5-2 fold amid the bleeding. We offer preoperative examination: platelet count, prothrombin percent by Quick (prothrombin time), APTT and fibrinogen level. We recommend an extended hemostasis study with the detection of adhesive, aggregative and secretory functions of platelets in the children with chronic lymphoproliferative syndrome if the results of the integral screening tests differ from normal range.


Assuntos
Hemostasia , Hemostáticos , Transtornos Linfoproliferativos , Procedimentos Cirúrgicos Otorrinolaringológicos , Adolescente , Criança , Pré-Escolar , Humanos , Transtornos Linfoproliferativos/complicações , Tempo de Tromboplastina Parcial , Hemorragia Pós-Operatória/diagnóstico , Tempo de Protrombina
11.
Int J Pediatr Otorhinolaryngol ; 124: 210-214, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31229837

RESUMO

OBJECTIVES: There is currently no standard for screening children with post-tonsillectomy bleeds (PTB) for coagulopathy disorders. This study aims to identify children with occult coagulopathy diagnosed at PTB and to identify factors associated with diagnosis. A systematic review of the literature further identified trends in this topic. METHODS: A retrospective chart review of patients returning to the operating room for PTB at a tertiary children's hospital was undertaken from 2012 to 2016. A systematic review using Medline OVID was subsequently performed. RESULTS: Of 12,503 tonsillectomies, 311 children (52% male, mean age 8 years) required surgery for PTB (2.5% rate). Twenty-one patients (7%) had multiple episodes. Only two patients (0.6%) (both with known coagulopathy) underwent pre-tonsillectomy labs and 260 (84%) had labs at PTB. Six patients (2%) were diagnosed with a new coagulopathy, most commonly von Willebrand's Disease (vWD) in five (2%). Three patients (1%) were diagnosed at first PTB and three (1%) at second PTB. Of the three diagnosed at second PTB, two had normal partial thromboplastin time (PTT). In systematic review, 1243 manuscripts were reviewed and 8 papers discussing this topic are presented. CONCLUSION: Occult coagulopathy was rarely diagnosed at PTB, but this may be limited by inconsistent screening. PT and PTT are not sensitive tests for vWD, and normal coagulation labs may lead to delayed diagnosis. The literature reveals occult coagulopathy is rare but often diagnosed after severe or recurrent hemorrhage. In order to provide efficient care and medical management, a standardized algorithm and sensitive labs for screening PTB patients are needed.


Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos Hemorrágicos/diagnóstico , Hemorragia Pós-Operatória/diagnóstico , Tonsilectomia/efeitos adversos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Tempo de Tromboplastina Parcial , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos
12.
World J Surg Oncol ; 17(1): 110, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248419

RESUMO

BACKGROUND: Pharmacological thromboprophylaxis after colorectal cancer (CRC) surgery is internationally recommended for venous thromboembolism (VTE) prevention. The aim of this retrospective study was to evaluate the risk factors of postoperative bleeding after elective surgery for patients with primary CRC receiving pharmacological thromboprophylaxis of fondaparinux or enoxaparin. METHODS: We experienced consecutive 266 patients who underwent elective surgery for CRC during the study period. Finally, the medical records of 218 patients with CRC administrated fondaparinux or enoxaparin following surgery were retrospectively reviewed to evaluate symptomatic VTE until 28 days and postoperative bleeding comparing perioperative D-dimer levels. RESULTS: The significant differences in TNM classification staging and type of thromboprophylaxis were observed between postoperative bleeding-negative and bleeding-positive group. There was no statistical significance among other backgrounds of patients between the two groups. One case (0.46%) of symptomatic VTE and total 11 cases (5%) of postoperative bleeding were observed. In the univariate analysis, fondaparinux thromboprophylaxis and early disease-stage CRC (stages 0 and I) were associated with risk for postoperative bleeding. Multivariate analysis revealed that fondaparinux thromboprophylaxis was identified as an independent risk factor of postoperative bleeding. Moreover, preoperative levels of D-dimer in patients with stage IV CRC were significantly higher than those with the other stages. The significant elevation in preoperative D-dimer was also observed in patients with stage II CRC compared to those with stage I CRC. Perioperative levels of D-dimer in patients with advanced disease-stage CRC (stages II, III, and IV) were significantly higher than those in patients with early disease-stage CRC. CONCLUSIONS: Fondaparinux administration and early disease-stage CRC appeared to be risk factors for postoperative bleeding in patients with pharmacological thromboprophylaxis undergoing surgical treatment for CRC. Patients' hypercoagulative condition depending on disease progression of CRC might be related to the occurrence of postoperative bleeding following CRC surgery.


Assuntos
Anticoagulantes/efeitos adversos , Neoplasias Colorretais/cirurgia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Hemorragia Pós-Operatória/diagnóstico , Tromboembolia Venosa/prevenção & controle , Idoso , Anticoagulantes/administração & dosagem , Neoplasias Colorretais/patologia , Progressão da Doença , Enoxaparina/administração & dosagem , Enoxaparina/efeitos adversos , Feminino , Fondaparinux/administração & dosagem , Fondaparinux/efeitos adversos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
13.
J Neurooncol ; 143(3): 563-571, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31087224

RESUMO

PURPOSE: Intracranial meningiomas are relatively rare in young adults, and their specific clinical features remain unclear. The authors analyzed the clinical characteristics of intracranial meningioma in patients younger than 40 years. METHODS: Consecutive patients younger than 40 years with meningioma (n = 223) who underwent surgical treatment at our hospital from 2010 to 2018 were retrospectively reviewed. The study cases was further divided into a younger group (≤ 30 years old; n = 63) and an older group (31-40 years old; n = 160). The clinical information, radiological characteristics, intraoperative findings, and pathological outcomes were extracted from the patients' records and statistically analyzed. RESULTS: Intracranial meningioma is uncommon in patients younger than 40 years (8.6%). The study group's most common symptoms at presentation were headaches (46.7%), visual impairment (27.8%), limb weakness (20.6%), and epilepsy (13.5%). The mean tumor size was larger (51.47 ± 50.36 cm3) in the younger group than in the older group (22.94 ± 27.20 cm3). According to multivariate analyses, young age was an independent predictor of large tumor size, and large tumor size was significantly associated with peritumoral brain edema and intraoperative blood loss. CONCLUSION: Intracranial meningiomas in younger adult patients may have special complexity and perioperative risk due to large tumor sizes. Therefore, individualized treatment strategy is recommended, and the appropriate caution should be taken during surgery.


Assuntos
Edema Encefálico/diagnóstico , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Hemorragia Pós-Operatória/diagnóstico , Adolescente , Adulto , Fatores Etários , Edema Encefálico/etiologia , Criança , Feminino , Seguimentos , Humanos , Masculino , Neoplasias Meníngeas/patologia , Meningioma/patologia , Hemorragia Pós-Operatória/etiologia , Prognóstico , Estudos Retrospectivos , Adulto Jovem
14.
Eur Arch Otorhinolaryngol ; 276(8): 2251-2257, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31076882

RESUMO

PURPOSE: Nasal packing is frequently used after septoplasty and some complications caused by nasal packing are unavoidable. A nasal septal retainer has recently been developed. We evaluated the safety and clinical efficacy of the retainer in septoplasty, and the subjective symptoms of patients with the retainer were compared with Merocel nasal packing. METHODS: A prospective, randomized, controlled study was performed in patients who had undergone septoplasty. In total, 39 patients were randomized to receive Merocel (n = 17) or the retainer (n = 22) after septoplasty. The deviation of nasal septum and nasal mucosa was evaluated by endoscopy. The clinical efficacy and subjective symptoms were compared using the visual analog scale. RESULTS: During the packing/retaining period, the mean scores of headache, nasal obstruction, epiphora, and facial pressure in the retainer group were significantly lower than in the Merocel group (P < 0.05); the mean scores of nasal pain, nasal itching, rhinorrhea, dysphagia, and sleep disturbance in the retainer group were lower than in the Merocel group, but the difference did not reach statistical significance. On the removal of Merocel/retainer, nasal pain was significantly lower in patients with the retainer (P < 0.05). In the retainer group, the incidence of grade 1 bleeding was 45.5%, and grade 0 bleeding was 54.5%. In the Merocel group, the incidence of grade 2 bleeding was 23.5%, grade 1 was 47.1%, and grade 0 was 29.4%. CONCLUSIONS: The nasal septal retainer is suitable for use after septoplasty with more beneficial effects than nasal packing.


Assuntos
Formaldeído/uso terapêutico , Obstrução Nasal , Septo Nasal/cirurgia , Procedimentos Cirúrgicos Nasais , Álcool de Polivinil/uso terapêutico , Hemorragia Pós-Operatória , Adulto , Endoscopia/métodos , Feminino , Hemostáticos/uso terapêutico , Humanos , Masculino , Cavidade Nasal/diagnóstico por imagem , Obstrução Nasal/diagnóstico , Obstrução Nasal/etiologia , Obstrução Nasal/prevenção & controle , Procedimentos Cirúrgicos Nasais/efeitos adversos , Procedimentos Cirúrgicos Nasais/métodos , Curativos Oclusivos/efeitos adversos , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/prevenção & controle , Resultado do Tratamento
17.
J Thorac Cardiovasc Surg ; 158(5): 1370-1379.e6, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30853233

RESUMO

OBJECTIVE: We sought to characterize the relationship between postoperative blood pressure on the day of surgery and metrics of bleeding. METHODS: In a preplanned secondary analysis of prospectively collected data from the Limiting IV Chloride to Reduce AKI trial (NCT02020538), univariate and multivariable regression analyses explored the association between peak systolic blood pressure, peak mean arterial pressure, and peak central venous pressure recorded postoperatively on the day of surgery and multiple metrics of bleeding. Patients at increased bleeding risk due to specific criteria were excluded from analysis. The primary outcome was chest tube drainage (milliliters per hour) on the day of surgery. Secondary outcomes included red blood cell transfusion, surgical re-exploration for bleeding, and hospital mortality. RESULTS: The study cohort comprised 793 patients. Mean ± standard deviation peak systolic blood pressure, mean arterial pressure, and central venous pressure were 125 ± 15 mm Hg, 83 ± 9 mm Hg, and 12 ± 4 mm Hg, respectively. Median (interquartile range) chest tube drainage on the day of surgery was 33 mL/hour (interquartile range, 23 mL/hour-51 mL/hour). Adjusted for prespecified variables, there was no positive association between peak systolic blood pressure and bleeding outcomes, including chest tube drainage (-2.2 mL/10 mm Hg; 95% confidence interval, -3.9 to -0.5 mL/h/10 mm Hg; P = .01) or volume of transfusion (-15 mL/10 mm Hg; 95% confidence interval, -29 to -1 mL/h/10 mm Hg; P = .04). Results remained broadly consistent across multiple secondary outcomes and regardless of whether systolic blood pressure or mean arterial pressure was the explanatory variable. CONCLUSIONS: The lack of positive association between peak systolic blood pressure or peak mean arterial pressure with metrics of bleeding after cardiac surgery promotes equipoise for testing the influence of higher blood pressure targets during the early postoperative period.


Assuntos
Pressão Arterial , Determinação da Pressão Arterial , Procedimentos Cirúrgicos Cardíacos , Pressão Venosa Central , Drenagem , Transfusão de Eritrócitos , Hemorragia Pós-Operatória , Austrália/epidemiologia , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Tubos Torácicos , Drenagem/instrumentação , Drenagem/métodos , Transfusão de Eritrócitos/métodos , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/fisiopatologia , Hemorragia Pós-Operatória/terapia
18.
Ann Thorac Surg ; 108(2): 517-523, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30851258

RESUMO

BACKGROUND: Few reports have described associations between a bleeding revision and outcomes after implantation of a continuous-flow left ventricular assist device (LVAD). METHODS: We retrospectively analyzed all adult recipients of a continuous-flow LVAD who were operated on between January 2006 and December 2016 at the Division of Cardiac Surgery, Medical University of Vienna (N = 257). LVAD types were HeartWare HVAD (Medtronic, Minneapolis, MN), HeartMate II (Abbott [Thoratec], Abbott Park, IL), and HeartMate 3 (Abbott [Thoratec]). The primary outcome variable was survival during LVAD support. Secondary outcome variables were rates of prolonged ventilation, intensive care unit stay, hospital stay, renal replacement therapy, and stroke. We additionally investigated risk factors for a bleeding revision. RESULTS: Thirty-six patients (14%) underwent surgical revision for bleeding. In a multivariable Cox proportional hazards model, bleeding revision was associated with significantly reduced survival during LVAD support (3 months: hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.20 to 3.48; 6 months: HR, 1.63; 95% CI, 0.95 to 2.82; 12 months: HR, 1.30; 95% CI, 0.69 to 2.46; 24 months: HR, 1.04; 95% CI 0.48 to 2.26; overall p = 0.007). Rates of secondary outcome variables were substantially higher in the revision group compared with patients who survived the hospital stay without a bleeding revision. Concomitant implantation of a temporary right ventricular assist device (p = 0.002) and age (p = 0.028) were independent risk factors for a bleeding revision. CONCLUSIONS: A bleeding revision is associated with significantly reduced survival and substantially increased morbidity during LVAD support. Preoperative, intraoperative, and postoperative prophylactic strategies may help to prevent this life-threatening complication.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Insuficiência Cardíaca/cirurgia , Coração Auxiliar/efeitos adversos , Hematoma/cirurgia , Hemorragia Pós-Operatória/cirurgia , Áustria/epidemiologia , Ecocardiografia , Feminino , Seguimentos , Hematoma/diagnóstico , Humanos , Masculino , Mediastino , Pessoa de Meia-Idade , Morbidade/tendências , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/epidemiologia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
PLoS One ; 14(3): e0213281, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30822318

RESUMO

BACKGROUND: Factors associated with efficacy and safety of cold snare polypectomy (CSP) are not well established. The aim is to elucidate the predictors of R0 resection and immediate bleeding of CSP. METHODS: We retrospectively reviewed a database of patients who underwent CSP for subcentimetric polyps at the University of Tokyo Hospital in Japan. Using the data regarding the characteristics of patients and polyps, such as location, size, and macroscopic appearance; use of narrow band imaging with magnification (NBI-M); and endoscopists' experience, we revealed the predictive factors associated with R0 resection and immediate post-CSP bleeding by univariate and multivariate analyses. RESULTS: In total, 399 polyps, in 200 patients without antithrombotics, were removed. Failure of tissue retrieval was noted in 4% of resected lesions. There was no intramucosal carcinoma observed. The overall rate of R0 resection was 46%. Multivariate analysis elucidated that the observation of the polyp with NBI-M was an independent predictor associated with R0 resection (odds ratio [OR] 1.90; p = 0.024). Although immediate post-CSP bleeding occurred in 19 polyps (4.8%), no delayed bleeding or perforation was observed. Multivariate analysis revealed protruded lesion as an independent risk factor for immediate bleeding (OR 3.54; p = 0.018). CONCLUSIONS: A higher rate of R0 resection with CSP can be achieved by performing colonoscopy with NBI-M, than with white-light imaging. Macroscopic protruding appearance of a polyp is a risk factor for immediate bleeding.


Assuntos
Pólipos do Colo/cirurgia , Colonoscopia , Criocirurgia/efeitos adversos , Hemorragia Pós-Operatória/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pólipos do Colo/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
Br J Surg ; 106(6): 765-773, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30776085

RESUMO

BACKGROUND: Postpancreatectomy haemorrhage (PPH) and venous thromboembolism (VTE) are serious complications following pancreatic surgery. The aim was to assess the timing, occurrence and predictors of PPH and VTE. METHODS: Elective pancreatic resections undertaken in a single university hospital between November 2013 and September 2017 were assessed. Three intervals were reviewed, each with a different routine regimen of nadroparin: 2850 units once daily (single dose) administered in hospital only, or 5700 units once daily (double dose) or 2850 units twice daily (split dose) administered in hospital and continued for 6 weeks after surgery. Clinically relevant PPH (CR-PPH) was classified according to International Study Group of Pancreatic Surgery criteria. VTE was defined according to a number of key diagnostic criteria within 6 weeks of surgery. Cox regression analyses were performed to test the hypotheses that the double-dose group would experience more PPH than the other two groups, the single-dose group would experience more VTE than the other two groups, and the split-dose group would experience the fewest adverse events (PPH or VTE). RESULTS: In total, 240 patients were included, 80 per group. The double-dose group experienced significantly more CR-PPH (hazard ratio (HR) 2·14, 95 per cent c.i. 1·16 to 3·94; P = 0·015). More relaparotomies due to CR-PPH were performed in the double-dose group (16 versus 3·8 per cent; P = 0·002). The single-dose group did not experience more VTE (HR 1·41, 0·43 to 4·62; P = 0·570). The split dose was not associated with fewer adverse events (HR 0·77, 0·41 to 1·46; P = 0·422). Double-dose low molecular weight heparin (LMWH), high BMI and pancreatic fistula were independent predictors of CR-PPH. CONCLUSION: A double dose of LMWH prophylaxis continued for 6 weeks after pancreatic resection was associated with a twofold higher rate of CR-PPH, resulting in four times more relaparotomies. Patients receiving a single daily dose of LMWH in hospital only did not experience a higher rate of VTE.


Assuntos
Anticoagulantes/administração & dosagem , Nadroparina/administração & dosagem , Pancreatectomia , Pancreaticoduodenectomia , Cuidados Pós-Operatórios/métodos , Hemorragia Pós-Operatória/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Idoso , Anticoagulantes/uso terapêutico , Relação Dose-Resposta a Droga , Esquema de Medicação , Procedimentos Cirúrgicos Eletivos , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Nadroparina/uso terapêutico , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/epidemiologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
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