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1.
BMC Oral Health ; 21(1): 96, 2021 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-33663474

RESUMO

BACKGROUND: The aim of this study was to investigate the occurrence of postoperative bleeding following dentoalveolar surgery in patients with either continued vitamin K antagonist medication or perioperative bridging using heparin. METHODS: A retrospective study was performed analyzing patients who underwent tooth extraction between 2012 and 2017. Patients were retrospectively allocated into two comparative groups: un-paused vitamin K antagonist medication versus bridging using heparin. A healthy, non-anticoagulated cohort with equivalent surgery served as a control group. Main outcome measures were: the occurrence and frequency of postoperative bleeding, the number of removed teeth, the surgical technique of tooth removal (extraction/osteotomy/combined extraction and osteotomy) and the prothrombin time. RESULTS: In total, 475 patients were included in the study with 170 patients in the group of un-paused vitamin K antagonist medication VG, 135 patients in the Bridging group BG and 170 patients in the control group CG. Postoperative bleeding was significant: CG versus VG p = 0.004; CG versus BG p < 0.001, BG versus VG p < 0.001. A significant correlation of number of the extracted teeth in the BG (p = 0.014) and no significance in VG (p = 0.298) and CG (p = 0.210) and in the BG versus VG and CG with p < 0.001 in terms of surgical intervention extraction. No difference observed in terms of prothrombin time. CONCLUSIONS: Bridging with heparin increases the risk for bleeding compared to un-paused vitamin K antagonist medication. The perioperative management of anticoagulated patients requires a well-coordinated interdisciplinary teamwork to minimize or at best avoid both: postoperative bleeding and thromboembolic incidences.


Assuntos
Heparina , Vitamina K , Anticoagulantes/efeitos adversos , Humanos , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/prevenção & controle , Estudos Retrospectivos
2.
Medicine (Baltimore) ; 100(10): e25003, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725878

RESUMO

ABSTRACT: The efficacy and safety of bivalirudin in percutaneous coronary intervention (PCI) has always been a hot topic in perioperative antithrombotic therapy, but there are still some controversies. So studies are needed to provide more evidence, especially the real world study which includes patients excluded from previous RCT studys. Our study aimed to investigate these information and analyze the independent predictors of postoperative adverse events.A retrospective study enrolled 1416 patients underwent PCI in Tianjin Chest Hospital from May 2016 to October 2017. The incidence of stent-thrombosis and net clinical adverse events, including all-cause death, myocardial infarction, stroke, urgent target-vessel revascularization and bleeding, were followed up for 30 days and 1 year. Logistic regression and COX regression were respectively used to analyze independent predictors of bleeding events within 30-days, and independent predictors of Major adverse cardiovascular and cerebrovascular events (MACCE) in patients with stent implantation within 1-year.Seven hundred six patients were treated with bivalirudin while 710 with unfractionated heparin (UFH). The proportions of diabetes, hypertension, anemia, myocardial-infarction history, PCI history, moderate-to-severe renal-impairment, gastrointestinal-bleeding history in the bivalirudin group were significantly higher (P < .05). Women, anemia were independent risk factors for bleeding within 30-days (P < .05). Among 682 patients with stent implantation in bivalirudin group, anemia, Body Mass Index (BMI) >25 kg/m2, KILLIP ≥2, ejection fraction (EF) <45%, eGFR <60 ml/minutes were independent risk factors for MACCE, while Statins, proton pump inhibitor (PPI) were independent protective factors for MACCE with-in 1-year (P < .05).Bivalirudin have good anticoagulant effect and lower bleeding risk during PCI, especially in patients with higher bleeding risk. In patients treated with bivalirudin, female, anemia were independent predictors of bleeding within 30-days, BMI >25 kg/m2, anemia, KILLIP ≥2, EF <45%, eGFR <60 ml/minutes were independent risk factors and Statins, PPI were independent protective factors of MACCE within 1-year.


Assuntos
Antitrombinas/administração & dosagem , Doença das Coronárias/cirurgia , Hirudinas/administração & dosagem , Fragmentos de Peptídeos/administração & dosagem , Intervenção Coronária Percutânea/efeitos adversos , Hemorragia Pós-Operatória/epidemiologia , Trombose/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Antitrombinas/efeitos adversos , Feminino , Hirudinas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Fragmentos de Peptídeos/efeitos adversos , Assistência Perioperatória/efeitos adversos , Assistência Perioperatória/métodos , Hemorragia Pós-Operatória/induzido quimicamente , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Stents , Trombose/etiologia , Trombose/prevenção & controle , Resultado do Tratamento
3.
Ann R Coll Surg Engl ; 103(3): 208-217, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645267

RESUMO

INTRODUCTION: Tonsillectomy is a common surgical procedure performed chiefly for recurrent tonsillitis. The Scottish Intercollegiate Guidance Network (SIGN) introduced guidelines in 1998 to improve patient selection for tonsillectomy and reduce the potential harm to patients from surgical complications such as haemorrhage. Since the introduction of the guidance, the number of admissions for tonsillitis and its complications has increased. National Hospital Episode Statistics over a 20-year period were analysed to assess the trends in tonsillectomy, post-tonsillectomy haemorrhage, tonsillitis and its complications with reference to the guidance, procedures of limited clinical value and the associated costs and benefits. MATERIALS AND METHODS: A literature search was conducted via PubMed and the Cochrane Library to identify relevant research. Hospital Episode Statistics data were interrogated and relevant data compared over time to assess trends related to the implementation of national guidance. RESULTS: Over the period analysed, the incidence of deep neck space infections has increased almost five-fold, mediastinitis ten-fold and peritonsillar abscess by 1.7-fold compared with prior to SIGN guidance. Following procedures of limited clinical value implementation, the incidence of deep neck space infections has increased 2.4-fold, mediastinitis 4.1-fold and peritonsillar abscess 1.4-fold compared with immediately prior to clinical commissioning group rationing. The rate of tonsillectomy and associated haemorrhage (1-2%) has remained relatively constant at 46,299 (1999) compared with 49,447 (2009) and 49,141 (2016), despite an increase in the population of England by seven million over the 20-year period. DISCUSSION: The rise in admissions for tonsillitis and its complications appears to correspond closely to the date of SIGN guidance and clinical commissioning group rationing of tonsillectomy and is on the background of a rise in the population of the UK. The move towards daycase tonsillectomy has reduced bed occupancy after surgery but this has been counteracted by an increase in admissions for tonsillitis and deep neck space infections, sometimes requiring lengthy intensive care stays and a protracted course of rehabilitation. The total cost of treating the complications of tonsillitis in England in 2017 is estimated to be around £73 million. The cost of tonsillectomy and treating post-tonsillectomy haemorrhage is £56 million by comparison. The total cost per annum for tonsillectomy prior to the introduction of SIGN guidance was estimated at £71 million with tonsillitis and its complications accounting for a further £8 million.


Assuntos
Hospitalização/tendências , Mediastinite/epidemiologia , Abscesso Peritonsilar/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Abscesso Retrofaríngeo/epidemiologia , Tonsilectomia/tendências , Tonsilite/epidemiologia , Adenoidectomia/tendências , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Inglaterra/epidemiologia , Feminino , Custos de Cuidados de Saúde/tendências , Humanos , Incidência , Lactente , Recém-Nascido , Unidades de Terapia Intensiva , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Medicina Estatal , Tonsilite/cirurgia , Adulto Jovem
4.
J Laryngol Otol ; 135(2): 168-172, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517925

RESUMO

OBJECTIVE: The coronavirus disease 2019 pandemic resulted in the cessation of elective surgery. The continued provision of complex head and neck cancer surgery was extremely variable, with some UK centres not performing any cancer surgery. During the pandemic, Guy's and St Thomas' NHS Foundation Trust received high numbers of coronavirus disease 2019 admissions. This paper presents our experience of elective complex major head and neck cancer surgery throughout the pandemic. METHODS: A head and neck cancer surgery hub was set up that provided a co-ordinated managed care pathway for cancer patients during the pandemic; the Guy's Cancer Centre provided a separate, self-enclosed coronavirus-free environment within the hospital campus. RESULTS: Sixty-nine head and neck cancer patients were operated on in two months, and 13 patients had a microvascular free tissue transfer. Nosocomial infection with coronavirus disease 2019 was detected in two cases (3 per cent), neither required critical care unit admission. Both patients made a complete recovery and were discharged home. There were no deaths. CONCLUSION: Performing major head and neck surgery, including free flap surgery, is possible during the pandemic; however, significant changes to conventional practice are required to achieve desirable patient outcomes.


Assuntos
/epidemiologia , Infecção Hospitalar/epidemiologia , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Retalhos de Tecido Biológico , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Hemorragia Pós-Operatória/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Reino Unido/epidemiologia , Adulto Jovem
6.
Am J Cardiol ; 145: 102-110, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33460604

RESUMO

Most of the trials investigating the role of transcatheter aortic valve implantation (TAVI) across various strata of risk categories have excluded patients with bicuspid aortic stenosis (BAS) due to its anatomical complexities. The aim of this study was to perform a meta-analysis with meta-regression of studies comparing clinical, procedural, and after-procedural echocardiographic outcomes in BAS versus tricuspid aortic stenosis (TAS) patients who underwent TAVI. We searched the PubMed and Cochrane databases for relevant articles from the inception of the database to October 2019. Continuous and categorical variables were pooled using inverse variance and Mantel-Haenszel method, respectively, using the random-effect model. To rate the certainty of evidence for each outcome, we used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. Nineteen articles were included in the final analysis. There was no difference in the risk of 30-day mortality, 1-year mortality, 30-day cardiovascular mortality, major and/or life-threatening bleeding, major vascular complications, acute kidney injury, permanent pacemaker implantation, device success, annular rupture, after-procedural aortic valve area, and mean pressure gradient between the 2 groups. BAS patients who underwent TAVI had a higher risk of 30-day stroke, conversion to surgery, need for second valve implantation, and moderate to severe paravalvular leak. In conclusion, the present meta-analysis supports the feasibility of TAVI in surgically ineligible patients with BAS. However, the incidence of certain procedural complications such as stroke, conversion to surgery, second valve implantation, and paravalvular leak is higher among BAS patients compared with TAS patients, which must be discussed with the patient during the decision-making process.


Assuntos
Estenose da Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter , Lesão Renal Aguda/epidemiologia , Estenose da Valva Aórtica/complicações , Conversão para Cirurgia Aberta/estatística & dados numéricos , Humanos , Mortalidade , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Reoperação , Acidente Vascular Cerebral/epidemiologia
7.
Am J Cardiol ; 145: 143-150, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33460607

RESUMO

It is unknown whether endovascular intervention (EVI) is associated with superior outcomes when compared with surgical revascularization in octogenarian. National Inpatient Sample (NIS) database was used to compare the outcomes of limb revascularization in octogenarians who had surgical revascularization versus EVI. The NIS database's information on PAD patients ≥80-year-old who underwent limb revascularization between 2002 and 2014 included 394,504 octogenarian patients, of which 184,926 underwent surgical revascularization (46.9%) and 209,578 underwent EVI (53.1%). Multivariate analysis was performed to examine in-hospital outcomes. Trend over time in limb revascularization utilization was examined using Cochrane-Armitage test. EVI group had lower odds of in-hospital mortality (adjusted odds ratio [aOR]: 0.61 [95% CI: 0.58 to 0.63], myocardial infarction (aOR: 0.84 [95% CI: 0.81 to 0.87]), stroke (aOR: 0.93 [95% CI: 0.89 to 0.96]), acute kidney injury (aOR: 0.79 [95% CI: 0.77 to 0.81]), and limb amputation (aOR: 0.77 [95% CI: 0.74 to 0.79]) compared with surgical group (p < 0.001 for all). EVI group had higher risk of bleeding (aOR: 1.20 [95% CI: 1.18 to 1.23]) and vascular complications (3.2% vs 2.7%, aOR: 1.25 [95% CI: 1.19 to 1.30]) compared with surgical group (p < 0.001 for all). Within study period, EVI utilization increased in octogenarian patients from 2.6% to 8.9% (ptrend < 0.001); whereas use of surgical revascularization decreased from 11.6% to 5.2% (ptrend < 0.001). In conclusion, the utilization of EVI in octogenarians is increasing, and associated with lower risk of in-hospital mortality and adverse cardiovascular and limb outcomes as compared with surgical revascularization.


Assuntos
Procedimentos Endovasculares/tendências , Mortalidade Hospitalar , Doença Arterial Periférica/cirurgia , Complicações Pós-Operatórias/epidemiologia , Lesão Renal Aguda/epidemiologia , Idoso de 80 Anos ou mais , Amputação/estatística & dados numéricos , Angioplastia/tendências , Aterectomia/tendências , Endarterectomia/tendências , Feminino , Humanos , Masculino , Infarto do Miocárdio/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Risco , Stents , Acidente Vascular Cerebral/epidemiologia , Enxerto Vascular/tendências , Procedimentos Cirúrgicos Vasculares/tendências
8.
Am J Cardiol ; 145: 77-84, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33508268

RESUMO

Scarce data support the prescription of oral anticoagulation in patients with concomitant advanced chronic kidney disease (CKD) and atrial fibrillation, and left atrial appendage closure (LAAC) may provide a favorable risk-benefit ratio in this population. However, outcomes of LAAC in CKD patients are unknown. We aimed to investigate the impact of moderate-to-severe CKD on clinical outcomes following percutaneous LAAC. This was a multicenter study including 1094 patients who underwent LAAC. Moderate-to-severe CKD was defined as an eGFR<45 mL/min. Death, ischemic stroke, severe bleeding (≥BARC 3a) and serious adverse event (SAE; composite of death, stroke or severe bleeding) were recorded. A total of 300 patients (27.4%) had moderate-to-severe CKD. There were no differences between groups in periprocedural complications or device related thrombosis. At a median follow-up of 2 (1 to 3) years, patients with moderate-to-severe CKD did not present an increased risk of ischemic stroke (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.22 to 1.92; p = 0.435) but were at a higher risk of death (HR: 2.84; 95% CI: 2.22 to 3.64; p <0.001), severe bleeding (HR: 1.96; 95% CI: 1.36 to 2.81; p <0.001) and SAE (HR: 2.23; 95% CI: 1.80 to 2.77; p <0.001). By multivariable analysis, an eGFR<45 ml/min (HR: 1.92; 95% CI: 1.34 to 2.76; p <0.001) and previous bleeding (HR: 2.30; 95% CI: 1.27 to 4.17; p = 0.006) were associated with an increased risk of severe bleeding. In conclusion, patients with moderate-to-severe CKD who underwent LAAC had very high thrombotic and bleeding risks. Although the rates of device related thrombosis or ischemic stroke after-LAAC were not influenced by kidney dysfunction, patients with moderate-to-severe CKD remained at higher risk of severe bleeding events.


Assuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Insuficiência Renal Crônica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Procedimentos Cirúrgicos Cardíacos , Tamponamento Cardíaco/epidemiologia , Comorbidade , Embolia/etiologia , Embolia/prevenção & controle , Feminino , Taxa de Filtração Glomerular , Humanos , Ataque Isquêmico Transitório/etiologia , Ataque Isquêmico Transitório/prevenção & controle , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Masculino , Inibidores da Agregação de Plaquetas/uso terapêutico , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Diálise Renal , Índice de Gravidade de Doença , Acidente Vascular Cerebral/epidemiologia
10.
Neurology ; 96(13): e1724-e1731, 2021 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-33495380

RESUMO

OBJECTIVE: To determine whether pretreatment cerebral microbleeds (CMBs) presence and burden are correlated with an increased risk of intracranial hemorrhage (ICH) or poor functional outcome following endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). METHODS: Consecutive patients treated by EVT for anterior circulation AIS were retrospectively analyzed. Experienced neuroradiologists blinded to functional outcomes rated CMBs on T2*-MRI using a validated scale. We investigated associations of CMB presence and burden with ICH and poor clinical outcome at 3 months (modified Rankin Scale score >2). RESULTS: Among 513 patients, 281 (54.8%) had a poor outcome and 89 (17.3%) had ≥1 CMBs. A total of 190 (37%) patients experienced ICH; 66 (12.9%) were symptomatic. CMB burden was associated with poor outcome in a univariable analysis (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.03-1.36 per 1-CMB increase; p = 0.02), but significance was lost after adjustment for sex, age, stroke severity, hypertension, diabetes mellitus, atrial fibrillation, prior antithrombotic medication, IV thrombolysis, and reperfusion status (OR, 1.05; 95% CI, 0.92-1.20 per 1-CMB increase; p = 0.50). Results remained nonsignificant when taking into account CMB location or presumed underlying pathogenesis. CMB presence, burden, location, or presumed pathogenesis were not independently correlated with ICH. CONCLUSIONS: Poor functional outcome or ICH were not correlated with CMB presence or burden on pre-EVT MRI after adjustment for confounding factors. Excluding such patients from reperfusion therapies is unwarranted. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in patients with AIS undergoing EVT, after adjustment for confounding factors, the presence of CMBs is not significantly associated with clinical outcome or the risk of ICH.


Assuntos
Hemorragia Cerebral/epidemiologia , Procedimentos Endovasculares , Hemorragia Pós-Operatória/epidemiologia , Trombectomia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , /fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
AJR Am J Roentgenol ; 216(2): 428-435, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33325737

RESUMO

OBJECTIVE. The purpose of this study was to analyze the timing of major bleeding complications after renal transplant biopsy in the context of a standardized 1-hour postprocedure observation protocol. MATERIALS AND METHODS. We retrospectively reviewed the electronic medical records for consecutive patients who underwent ultrasound-guided renal transplant biopsies between January 1, 2012, and December 31, 2017, and were observed according to a newly implemented 1-hour postprocedure observation protocol. The development of a major bleeding complication (Common Terminology Criteria for Adverse Events class 3 or higher) was recorded along with all available details regarding the time course of patient symptoms and presentation. Complications were grouped into one of four categories according to onset time after biopsy: 2 hours or less (timing category 1), more than 2 hours but 4 hours or less (timing category 2), more than 4 hours but 8 hours or less (timing category 3), and more than 8 hours (timing category 4). RESULTS. In 1824 patients (769 women, 1055 men) who underwent 4519 consecutive ultrasound-guided renal transplant biopsies during the study period, 11 class 3 complications were found (11/4519 [0.2%]). Four of the 11 patients (36.4%) had symptoms during the 1-hour observation period. Of these four patients, three (3/11 [27.3%]) had substantial symptoms related to major bleeding and were classified as timing category 1, and one (1/11 [9.1%]) had initially minor symptoms that increased in severity more than 2 hours but within 4 hours and was classified as timing category 2. Seven of the 11 patients (63.6%) did not have any symptoms at 1 hour of observation and were discharged; three (27.3%) were classified as timing category 3, and four (36.4%) were classified as category 4. CONCLUSION. Major bleeding complications following ultrasound-guided renal transplant biopsy are rare (0.2% of patients in this study). In our study, more than half were not clinically apparent within 4 hours of biopsy. A 1-hour postprocedure recovery period can be safely used after renal transplant biopsy.


Assuntos
Biópsia Guiada por Imagem/efeitos adversos , Transplante de Rim , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/epidemiologia , Ultrassonografia de Intervenção/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Transplantes/patologia
13.
Anaesthesiol Intensive Ther ; 52(5): 366-372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33327694

RESUMO

INTRODUCTION: COVID-19 infection has resulted in thousands of critically ill patients admitted to ICUs and treated with mechanical ventilation. Percutaneous tracheostomy is a well-known technique utilised as a strategy to wean critically ill patients from mechanical ventilation. Worldwide differences exist in terms of methods, operators, and settings, and questions remain regarding timing and indications. If tracheostomy is to be performed in COVID-19 patients, a safe environment is needed for optimal care. MATERIAL AND METHODS: We present a guidewire dilating forceps tracheostomy procedure in COVID-19 patients that was optimised including apnoea-moments, protective clothing, checklists, and clear protocols. We performed a retrospective analysis of the outcome after tracheostomy in COVID-19 patients between March 2020 and May 2020. RESULTS: The follow-up of the first 16 patients, median age 62 years, revealed a median intubation time until tracheostomy of 18 days and median cannulation time of 20 days. The overall perioperative complication rate and complication rate while cannulated was 19%, mainly superficial bleeding. None of the healthcare providers involved in performing the procedure developed any symptoms of the disease. CONCLUSIONS: This COVID-19-centred strategy based on flexibility, preparation, and cooperation between healthcare providers with different backgrounds facilitated percutaneous tracheostomy in COVID-19 patients without an increase in the overall complication rate or evidence of risk to healthcare providers. Our findings provide initial evidence that tracheostomy can be performed safely as a standard of care for COVID-19 patients requiring prolonged mechanical ventilation as was standard practice in ICU patients prior to the COVID-19 pandemic to promote ventilator weaning and patient recovery.


Assuntos
/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Traqueostomia/métodos , Idoso , Anestesia , Broncoscopia , Lista de Checagem , Cuidados Críticos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Equipamento de Proteção Individual , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/terapia , Respiração Artificial , Estudos Retrospectivos , Instrumentos Cirúrgicos , Traqueostomia/instrumentação , Desmame do Respirador
14.
Medicine (Baltimore) ; 99(50): e23651, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327348

RESUMO

Tocolytic agents, commonly used for inhibiting preterm labor, pose the risk of uterine atony, leading to postpartum hemorrhage. This study elucidated the effects of different tocolytic agents on postoperative hemorrhage among women in preterm labor undergoing Cesarean delivery (CD). Data from Taiwan National Health Insurance Research Database were analyzed. The risk (adjusted hazard ratio [aHR] and 95% confidence intervals [CI]) of postoperative hemorrhage in CD women with preterm labor diagnosis using tocolytic agents (Tocolysis group) comparing to CD women not using tocolytic agents (Control group) were determined. Impacts of different tocolytic agents in this regard were also investigated. Our data revealed that the incidence (11.7% vs 2.6%, P < .001) and risk (aHR: 1.21, 95% CI: 1.12-1.31, P < .001) of postoperative hemorrhage were significantly higher in the Tocolysis group (n = 15,317) than in the Control group (n = 244,096). Ritodrine was the most frequently used tocolytic agent (80.5%), followed by combination therapy (using more than one tocolytic agents) (8.5%), magnesium sulfate (MgSO4, 4.6%), calcium channel blockers (3.8%), betamimetics other than ritodrine (1.9%), prostaglandin synthase inhibitors (0.5%), and nitrates (0.1%). Barring those using calcium channel blockers and combination therapy, the use of MgSO4 (aHR: 1.43, P = .001), betamimetics other than ritodrine (aHR: 1.71, P < .001), prostaglandin synthase inhibitors (aHR: 2.67, P < .001) and nitrates (aHR: 3.30, P = .001) was associated with higher risks of postoperative hemorrhage compared with ritodrine. In conclusion, CD women with preterm labor diagnosis using tocolytic agents exhibit an increased risk of postoperative hemorrhage and that this risk varies with the use of different tocolytic agents.


Assuntos
Cesárea/estatística & dados numéricos , Trabalho de Parto Prematuro/tratamento farmacológico , Hemorragia Pós-Operatória/epidemiologia , Tocolíticos/efeitos adversos , Tocolíticos/classificação , Adulto , Fatores Etários , Comorbidade , Feminino , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Taiwan/epidemiologia , Tocolíticos/administração & dosagem
15.
PLoS One ; 15(10): e0239909, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002066

RESUMO

OBJECTIVE: Robotic surgery (RS) has been increasingly used for the resection of rectal cancer, and its advantages over laparoscopic surgery (LS) have been demonstrated. However, few studies focused on the severity of postoperative complications. This study aimed to compared the postoperative complications within 30 days after RS over LS according to the Clavien-Dindo (C-D) classification. METHODS: A literature research of PubMed, Embase, Cochrane Library and Web of Science were systematically performed. The studies comparing the complications of RS and LS for rectal cancer based on the C-D classification were enrolled. Primary outcomes were C-D grade III, IV, V, III-V (severe complications). RESULTS: Seventeen studies (3193 patients) were included in the final analysis: 1554 underwent RS and 1639 underwent LS. The RS group was associated with significantly lower rates of severe complications (OR = 0.69, 95% CI 0.53-0.90, P = 0.005), C-D grade IV (OR = 0.69, 95% CI 0.53-0.90, P = 0.005), and anastomotic leak (OR = 0.66, 95% CI 0.48-0.91, P = 0.01). There was no significant difference in C-D grade III, C-D grade I, II, I-II (minor complications), overall complications, bleeding, wound complications, postoperative ileus, urinary retention, readmission, reoperation between two groups. CONCLUSIONS: Robotic surgery is safe for rectal cancer and may be an effective alternative to laparoscopic surgery, with lower rates of severe complications, C-D grade IV, and anastomotic leak. Further large randomized controlled trials are necessary to confirm this conclusion.


Assuntos
Fístula Anastomótica/epidemiologia , Laparoscopia/efeitos adversos , Hemorragia Pós-Operatória/epidemiologia , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Infecção dos Ferimentos/epidemiologia , Fístula Anastomótica/etiologia , Laparoscopia/métodos , Hemorragia Pós-Operatória/etiologia , Reoperação/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/métodos , Infecção dos Ferimentos/etiologia
17.
Int Heart J ; 61(5): 905-912, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921660

RESUMO

There is little data on management and outcomes of atrial fibrillation (AF) patients on direct oral anticoagulants (DOAC) undergoing general surgery.We retrospectively assessed 98 surgeries in 85 nonvalvular AF patients aged 73 ± 8 (59 men) receiving DOACs. Cardiac, emergency, and minimally invasive surgeries were excluded.The CHA2DS2-VASc score ranged from 0 to 8. The DOACs being given were: dabigatran, 16; rivaroxaban, 25; apixaban, 28; and edoxaban, 16. While the DOACs were not suspended in 11 cases, they were interrupted for a median of 2.0 days before surgery and restarted at a median of 3.0 days after surgery. There were 9 complications (9.2%), 3 instances of thromboembolism and 6 bleeding. Thromboembolism occurred at a mean of 3.0 postoperative days, all of which occurred before resumption of DOACs, while bleeding events occurred at a mean of 4.0 postoperative days. Two of the 3 patients with thromboembolism went into cardiopulmonary arrest during the event, but were resuscitated. There were significantly more patients with congestive heart failure or combined antiplatelets in the patients with complications. The complication group had a significantly higher HAS-BLED score and lower preoperative hemoglobin level. There were no significant differences in the management of DOAC interruption between those with complications and without.The perioperative complication rate in nonvalvular AF patients undergoing elective surgery treating with DOACs was 9.2%. Patients with congestive heart failure, receiving combined therapy with antiplatelets, a higher HAS-BLED score, or lower preoperative hemoglobin level were at higher risk. Further studies evaluating the ideal perioperative DOAC protocol are warranted.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Doenças das Artérias Carótidas/epidemiologia , Infarto Cerebral/epidemiologia , Inibidores do Fator Xa/administração & dosagem , Infarto do Miocárdio/epidemiologia , Assistência Perioperatória/métodos , Hemorragia Pós-Operatória/epidemiologia , Tromboembolia/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Antitrombinas/administração & dosagem , Fibrilação Atrial/complicações , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Dabigatrana/administração & dosagem , Procedimentos Cirúrgicos do Sistema Digestório , Procedimentos Cirúrgicos Eletivos , Embolia/epidemiologia , Endoscopia , Feminino , Humanos , Masculino , Procedimentos Ortopédicos , Complicações Pós-Operatórias/epidemiologia , Pirazóis/administração & dosagem , Piridinas/administração & dosagem , Piridonas/administração & dosagem , Estudos Retrospectivos , Rivaroxabana/administração & dosagem , Tiazóis/administração & dosagem , Tromboembolia/etiologia , Procedimentos Cirúrgicos Urológicos , Procedimentos Cirúrgicos Vasculares
18.
PLoS One ; 15(9): e0239114, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32956379

RESUMO

BACKGROUND: In recent years, transbronchial cryobiopsy (TBCB) has come to be increasingly used in interventional pulmonology units as it obtains larger and better-quality samples than conventional transbronchial lung biopsy (TBLB) with forceps. No multicenter studies have been performed, however, that analyse and compare TBCB and TBLB safety and yield according to the interstitial lung disease (ILD) classification. OBJECTIVES: We compared the diagnostic yield and safety of TBCB with cryoprobe sampling versus conventional TBLB forceps sampling in the same patient. METHOD: Prospective multicenter clinical study of patients with ILD indicated for lung biopsy. Airway management with orotracheal tube, laryngeal mask and rigid bronchoscope was according to the protocol of each centre. All procedures were performed using fluoroscopy and an occlusion balloon. TBLB was followed by TBCB. Complications were recorded after both TBLB and TBCB. RESULTS: Included were 124 patients from 10 hospitals. Airway management was orotracheal intubation in 74% of cases. Diagnostic yield according to multidisciplinary committee results for TBCB was 47.6% and for TBLB was 19.4% (p<0.0001). Diagnostic yield was higher for TBCB compared to TBLB for two groups: idiopathic interstitial pneumonias (IIPs) and ILD of known cause or association (OR 2.5; 95% CI: 1.4-4.2 and OR 5.8; 95% CI: 2.3-14.3, respectively). Grade 3 (moderate) bleeding after TBCB occurred in 6.5% of patients compared to 0.8% after conventional TBLB. CONCLUSIONS: Diagnostic yield for TBCB was higher than for TBLB, especially for two disease groups: IIPs and ILD of known cause or association. The increased risk of bleeding associated with TBCB confirms the need for safe airway management and prophylactic occlusion-balloon use. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT02464592.


Assuntos
Broncoscopia/instrumentação , Criocirurgia/instrumentação , Fluoroscopia/instrumentação , Doenças Pulmonares Intersticiais/diagnóstico , Hemorragia Pós-Operatória/epidemiologia , Idoso , Biópsia/efeitos adversos , Biópsia/instrumentação , Biópsia/métodos , Broncoscopia/efeitos adversos , Broncoscopia/métodos , Broncoscopia/estatística & dados numéricos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Feminino , Fluoroscopia/efeitos adversos , Fluoroscopia/métodos , Humanos , Pulmão/patologia , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Estudos Prospectivos
19.
Am J Cardiol ; 134: 55-61, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32891400

RESUMO

Platelets are crucial in the pathophysiology of coronary artery disease and are a major target of antithrombotic agents in patients receiving percutaneous coronary intervention (PCI). We sought to evaluate the incidence and prognostic impact of thrombocytopenia on clinical outcomes in patients undergoing PCI with drug-eluting stents (DES). We evaluated consecutive patients who received PCI with DES in the IRIS-DES registry between April 2008 and December 2017. Patients were divided into 2 groups based on the presence of thrombocytopenia (platelet count <150 × 109/L) at baseline. The primary outcome was all-cause mortality, and secondary outcomes included the composite outcome of death, myocardial infarction (MI), and stroke, and major bleeding. Complete follow-up data were available for 1 to 5 years (median, 3.1). Among 26,553 eligible patients, 1,823 (6.9%) had thrombocytopenia at baseline. At 5 years, the incidences of all-cause mortality (15.6% vs 8.1%, p <0.001), composite outcome (23.2% vs 15.6%, p <0.001), and major bleeding (3.7% vs 2.2%, p <0.001) were significantly higher in patients with thrombocytopenia than in those without thrombocytopenia. In multivariable Cox proportional-hazards models, thrombocytopenia was significantly associated with increased risks of all-cause mortality (hazard ratio 1.26, 95% confidence interval 1.07 to 1.48, p = 0.01) and major bleeding (hazard ratio 1.41, 95% confidence interval 1.04 to 1.91, P=0.03). In conclusion, among who patients underwent PCI with DES, the incidence of thrombocytopenia was 6.9%. Baseline thrombocytopenia was significantly associated with increased risks of mortality and major bleeding.


Assuntos
Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos , Mortalidade , Infarto do Miocárdio/epidemiologia , Intervenção Coronária Percutânea , Hemorragia Pós-Operatória/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Trombocitopenia/epidemiologia , Idoso , Causas de Morte , Comorbidade , Doença da Artéria Coronariana/epidemiologia , Terapia Antiplaquetária Dupla/estatística & dados numéricos , Duração da Terapia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Inibidores da Agregação de Plaquetas/uso terapêutico , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Modelos de Riscos Proporcionais , Fatores de Risco , Índice de Gravidade de Doença
20.
PLoS One ; 15(9): e0238880, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32913359

RESUMO

BACKGROUND: According to the medical literature, both on-pump and off-pump coronary artery surgery is safe and effective in octogenarians. OBJECTIVES: The aim of our study was to examine the epidemiology, in-hospital outcomes and long-term follow-up results in octogenarians undergoing off-pump and on-pump coronary artery surgery utilizing nationwide registry data. METHODS: All octogenarians (≥ 80 years) enrolled in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry), who underwent isolated coronary surgery between January 2006 and September 2017 were identified. Preoperative data, perioperative complications, hospital mortality and long-term mortality were analyzed. Unadjusted and propensity-matched comparisons were performed between octogenarians undergoing off-pump and on-pump coronary artery bypass surgery. RESULTS: Octogenarians accounted for 4.1% of the total population undergoing coronary artery surgery in Poland during the analyzed period (n = 152,631) and this percentage is increasing. Among 6,006 analyzed patients, 2,744 (45.7%) were operated on-pump and 3,262 (54.3%) were operated off-pump. Propensity-matched analysis revealed that patients operated on-pump were more often reoperated due to postoperative bleeding and their in-hospital mortality was higher (6.6% vs 4.5%, p = 0.006 and 8.7% vs 5.8%, p = 0.001, respectively). Long-term all-cause mortality was lower among patients operated off-pump (p = 0.013). CONCLUSION: On the basis of our findings we suggest that off pump technique should be considered as perfectly acceptable in octogenarians.


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Hemorragia Pós-Operatória/epidemiologia , Reoperação/estatística & dados numéricos , Idoso de 80 Anos ou mais , Ponte de Artéria Coronária sem Circulação Extracorpórea , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Polônia/epidemiologia , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
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