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1.
Europace ; 23(3): 456-463, 2021 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-33595062

RESUMO

AIMS: During the COVID-19 pandemic, concern regarding its effect on the management of non-communicable diseases has been raised. However, there are no data on the impact on cardiac implantable electronic devices (CIED) implantation rates. We aimed to determine the impact of SARS-CoV2 on the monthly incidence rates and type of pacemaker (PM) and implantable cardiac defibrillator (ICD) implantations in Catalonia before and after the declaration of the state of alarm in Spain on 14 March 2020. METHODS AND RESULTS: Data on new CIED implantations for 2017-20 were prospectively collected by nine hospitals in Catalonia. A mixed model with random intercepts corrected for time was used to estimate the change in monthly CIED implantations. Compared to the pre-COVID-19 period, an absolute decrease of 56.5% was observed (54.7% in PM and 63.7% in ICD) in CIED implantation rates. Total CIED implantations for 2017-19 and January and February 2020 was 250/month (>195 PM and >55 ICD), decreasing to 207 (161 PM and 46 ICD) in March and 131 (108 PM and 23 ICD) in April 2020. In April 2020, there was a significant fall of 185.25 CIED implantations compared to 2018 [95% confidence interval (CI) 129.6-240.9; P < 0.001] and of 188 CIED compared to 2019 (95% CI 132.3-243.7; P < 0.001). No significant differences in the type of PM or ICD were observed, nor in the indication for primary or secondary prevention. CONCLUSIONS: During the first wave of the COVID-19 pandemic, a substantial decrease in CIED implantations was observed in Catalonia. Our findings call for measures to avoid long-term social impact.


Assuntos
Desfibriladores Implantáveis/tendências , Marca-Passo Artificial/tendências , Padrões de Prática Médica/tendências , Implantação de Prótese/tendências , Humanos , Segurança do Paciente , Estudos Prospectivos , Implantação de Prótese/instrumentação , Espanha , Fatores de Tempo
2.
Clin Appl Thromb Hemost ; 27: 1076029620982374, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33571008

RESUMO

Mechanically assisted circulation (MAC) sustains the blood circulation in the body of a patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) or on ventricular assistance with a ventricular assist device (VAD) or on extracorporeal membrane oxygenation (ECMO) with a pump-oxygenator system. While MAC provides short-term (days to weeks) support and long-term (months to years) for the heart and/or lungs, the blood is inevitably exposed to non-physiological shear stress (NPSS) due to mechanical pumping action and in contact with artificial surfaces. NPSS is well known to cause blood damage and functional alterations of blood cells. In this review, we discussed shear-induced platelet adhesion, platelet aggregation, platelet receptor shedding, and platelet apoptosis, shear-induced acquired von Willebrand syndrome (AVWS), shear-induced hemolysis and microparticle formation during MAC. These alterations are associated with perioperative bleeding and thrombotic events, morbidity and mortality, and quality of life in MCS patients. Understanding the mechanism of shear-induce hemostatic disorders will help us develop low-shear-stress devices and select more effective treatments for better clinical outcomes.


Assuntos
Plaquetas/metabolismo , Ponte Cardiopulmonar/instrumentação , Oxigenação por Membrana Extracorpórea/instrumentação , Coração Auxiliar , Transtornos Hemostáticos/etiologia , Oxigenadores de Membrana , Implantação de Prótese/instrumentação , Animais , Plaquetas/patologia , Ponte Cardiopulmonar/efeitos adversos , Micropartículas Derivadas de Células/metabolismo , Micropartículas Derivadas de Células/patologia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Hemólise , Transtornos Hemostáticos/sangue , Humanos , Ativação Plaquetária , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Medição de Risco , Fatores de Risco , Estresse Mecânico , Resultado do Tratamento
3.
J Stroke Cerebrovasc Dis ; 30(4): 105610, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33482570

RESUMO

OBJECTIVES: Left ventricular assist device (LVAD) is associated with complications such as cerebrovascular diseases (CEVD) as well as septicemia which is often preventable. With their use increasing in the U.S., identifying patients with LVAD who are at high risk for short-term mortality is essential for targeted effective patient management strategies to prevent adverse outcomes. We investigated the individual and joint association of CEVD and septicemia with the risk of in-hospital mortality in patients with LVAD in the U.S. MATERIALS AND METHODS: We used data from the National Inpatient Sample from 2004 to 2015 to identify patients ≥18 years of age who underwent LVAD implantation by means of International Classification of Disease, 9th Revision, codes. Multivariable hierarchical negative binomial regression models were used to estimate risk ratios (RR) and 95% confidence intervals (CI) for in-hospital mortality by CEVD-septicemia status. RESULTS: The mean age of the 4638 patients was 56 years, and 23% of them were women. Approximately 13% of patients had septicemia; 7% had CEVD and 2% had both conditions. In models adjusted for demographic, lifestyle/behavior factors and comorbid conditions, the risk of in-hospital mortality was almost threefold higher among patients with septicemia alone (RR=2.84, CI:2.24-3.60); two-and-half fold higher among patients with CEVD alone (RR=2.53, CI:1.85-3.48); and almost fourfold among patients with both septicemia and CEVD (RR=3.76, CI: 2.38-5.94, Pinteraction = <0.001) CONCLUSION: The presence of both septicemia and CEVD was associated with a substantially higher risk of in-hospital mortality among LVAD patients when compared to septicemia or CEVD alone.


Assuntos
Transtornos Cerebrovasculares/mortalidade , Insuficiência Cardíaca/terapia , Coração Auxiliar , Mortalidade Hospitalar , Implantação de Prótese/instrumentação , Implantação de Prótese/mortalidade , Sepse/mortalidade , Função Ventricular Esquerda , Transtornos Cerebrovasculares/diagnóstico , Bases de Dados Factuais , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Implantação de Prótese/efeitos adversos , Medição de Risco , Fatores de Risco , Sepse/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
4.
Vasc Endovascular Surg ; 55(4): 419-421, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33375907

RESUMO

The carotid-esophageal fistula is a rare and serious complication of the metallic esophageal prosthesis. A high index of suspicion is required for early diagnosis and treatment, decreasing the morbidity and mortality rate of this severe complication. We report a case of a 4-year-old boy presenting severe upper gastrointestinal bleeding due to a carotid-esophageal fistula, secondary to deployment of an esophageal metallic prosthesis for treatment of a recurrent stenosis. The carotid pseudo-aneurism was successfully treated with stents and coils. Although endovascular treatment is a safe and effective option, arterial stenting in children needs further studies with long-term follow-up.


Assuntos
Artérias Carótidas , Embolização Terapêutica , Procedimentos Endovasculares , Fístula Esofágica/terapia , Estenose Esofágica/terapia , Implantação de Prótese/instrumentação , Stents , Fístula Vascular/terapia , Artérias Carótidas/diagnóstico por imagem , Pré-Escolar , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/etiologia , Estenose Esofágica/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Implantação de Prótese/efeitos adversos , Recidiva , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia
7.
Asian Cardiovasc Thorac Ann ; 28(9): 604-606, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33141596

RESUMO

New short-term devices have been developed to allow percutaneous insertion. However, in some cases, open insertion becomes necessary. Less invasive insertion of short-term devices has been described previously, using two incisions. We present the case of a patient who underwent minimally invasive insertion of a biventricular device, using a single incision.


Assuntos
Coração Auxiliar , Miocardite/terapia , Implantação de Prótese/instrumentação , Função Ventricular Esquerda , Função Ventricular Direita , Feminino , Transplante de Coração , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Miocardite/diagnóstico , Miocardite/fisiopatologia , Desenho de Prótese , Resultado do Tratamento , Adulto Jovem
8.
J Vasc Interv Radiol ; 31(11): 1817-1824, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33008719

RESUMO

PURPOSE: To prospectively evaluate the initial human experience with an absorbable vena cava filter designed for transient protection from pulmonary embolism (PE). MATERIALS AND METHODS: This was a prospective, single-arm, first-in-human study of 8 patients with elevated risk of venous thromboembolism (VTE). Seven absorbable IVC filters (made of polydioxanone that breaks down into H2O and CO2 in 6 mo) were placed prophylactically before orthopedic (n = 5) and gynecologic (n = 2) surgeries, and 1 was placed in a case of deep vein thrombosis. Subjects underwent CT cavography and abdominal radiography before and 5, 11, and 36 weeks after filter placement to assess filter migration, embolization, perforation, and caval thrombosis and/or stenosis. Potential PE was assessed immediately before and 5 weeks after filter placement by pulmonary CT angiography. RESULTS: No symptomatic PE was reported throughout the study or detected at the planned 5-week follow-up. No filter migration was detected based on the fixed location of the radiopaque markers (attached to the stent section of the filter) relative to the vertebral bodies. No filter embolization or caval perforation was detected, and no caval stenosis was observed. Throughout the study, no filter-related adverse events were reported. CONCLUSIONS: Implantation of an absorbable vena cava filter in a limited number of human subjects resulted in 100% clinical success. One planned deployment was aborted as a result of stenotic pelvic veins, resulting in 89% technical success. No PE or filter-related adverse events were observed.


Assuntos
Implantes Absorvíveis , Polidioxanona/química , Implantação de Prótese/instrumentação , Embolia Pulmonar/terapia , Filtros de Veia Cava , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
9.
J Vasc Interv Radiol ; 31(10): 1529-1544, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32919823

RESUMO

PURPOSE: To provide evidence-based recommendations on the use of inferior vena cava (IVC) filters in the treatment of patients with or at substantial risk of venous thromboembolic disease. MATERIALS AND METHODS: A multidisciplinary expert panel developed key questions to address in the guideline, and a systematic review of the literature was conducted. Evidence was graded based on a standard methodology, which was used to inform the development of recommendations. RESULTS: The systematic review identified a total of 34 studies that provided the evidence base for the guideline. The expert panel agreed on 18 recommendations. CONCLUSIONS: Although the evidence on the use of IVC filters in patients with or at risk of venous thromboembolic disease varies in strength and quality, the panel provides recommendations for the use of IVC filters in a variety of clinical scenarios. Additional research is needed to optimize care for this patient population.


Assuntos
Implantação de Prótese/instrumentação , Implantação de Prótese/normas , Radiologia Intervencionista/normas , Filtros de Veia Cava/normas , Tromboembolia Venosa/terapia , Consenso , Humanos , Segurança do Paciente/normas , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Fatores de Risco , Resultado do Tratamento , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/etiologia
10.
Medicine (Baltimore) ; 99(33): e21729, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872056

RESUMO

To evaluate the safety and efficacy [intraocular pressure (IOP)-lowering effect and medication use] of a single trabecular microbypass stent (iStent; Glaukos Corp, San Clemente, CA) for medically controlled open-angle glaucoma.This retrospective case series included 42 eyes of 34 patients with medically controlled open-angle glaucoma with IOP less than 21 mm Hg. Clinical outcomes analyzed were IOP, medication use, corrected distance visual acuity (CDVA), and surgical complications. Surgical success was defined according to 4 criteria: IOP < 21 mm Hg without medication; IOP < 18 mm Hg without medication; IOP < 15 mm Hg without medications; and IOP < 18 mm Hg with or without medication. Patients were followed for a minimum of 6 months postoperatively.Mean IOP was reduced from 15.8 ±â€Š2.8 mm Hg to 14.5 ±â€Š2.8 mm Hg (P < .001), while mean number of medications decreased from 2.2 ±â€Š1.2 to 0.8 ±â€Š1.1 at final visit (P < .001). Surgical success rates were 78.6%, 61.9%, 57.1%, and 97.6% at 6 months and 78.6%, 59.5%, 52.4%, and 95.2% at final visits according to criteria A, B, C, and D. Meanwhile, 59.5% of patients were medication-free at their final visit. The relative risk of surgical failure by Criteria B and C was 4.337 (95% confidence interval: 1.799-10.454) and 3.717 (95% confidence interval: 1.516-9.116) times greater in the higher-medication group (3 or more preoperative medications), respectively. CDVA was significantly improved from 0.41 ±â€Š0.10 to 0.09 ±â€Š0.07 LogMAR in the combined phacoemulsification and iStent implantation group (P < .001). There was no case whose vision was threatened (vision loss of 2 or more lines) or who showed severe complications after surgery.Single trabecular microbypass stent implantation was effective in reducing IOP and medication usage in patients with open-angle glaucoma with a low preoperative IOP. Our results imply that it is more difficult to achieve low target IOP control in eyes with higher numbers of preoperative medications.


Assuntos
Glaucoma de Ângulo Aberto/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/estatística & dados numéricos , Implantação de Prótese/estatística & dados numéricos , Idoso , Glaucoma de Ângulo Aberto/tratamento farmacológico , Humanos , Pressão Intraocular , Procedimentos Cirúrgicos Oftalmológicos/instrumentação , Complicações Pós-Operatórias/epidemiologia , Implantação de Prótese/instrumentação , República da Coreia/epidemiologia , Estudos Retrospectivos , Stents , Acuidade Visual
11.
J Vasc Interv Radiol ; 31(9): 1419-1425, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32792276

RESUMO

PURPOSE: To report device-related adverse events 6 months after placement or conversion of the VenaTech convertible vena cava filter (VTCF). MATERIALS AND METHODS: A review of 6-month follow-up data of an investigational device exemption multicenter, prospective, single-arm study was performed. The VTCF was implanted in 149 patients. Conversion was attempted in 64.4% of those patients (n = 96) and successfully in 96.9% of the patients (n = 93). A total of 76 patients completed imaging evaluation at 6 months after filter conversion. Patients who required continued venous thromboembolism prophylaxis at 6 months did not undergo a conversion attempt and were designated as nonconverted filter subjects. A total of 28 nonconverted filter subjects completed imaging evaluation at 6 months after implantation. RESULTS: Evaluation of patients at 6 months after conversion demonstrated 1 of 76 (1.3%) inferior vena cava (IVC) perforations with a filter strut greater than 3 mm outside of the caval lumen. No cases of recurrent PE, clinically significant filter migration, filter fracture, or IVC thrombosis were reported in the converted subjects. In the nonconverted filter subjects, there was a 14.3% (4 of 28) complete or nearly complete rate of IVC thromboses. There were no cases of recurrent pulmonary embolism, penetration, fracture, or spontaneous conversion in the nonconverted filter subjects. There was a significant reduction in the rate of IVC thrombosis and migration in the converted cohort compared to that in the nonconverted cohort. CONCLUSIONS: At 6 months, the VTCF demonstrated low adverse event rates in the converted configuration, whereas a minority of patients with the nonconverted configuration demonstrated a high risk of IVC thrombosis.


Assuntos
Implantação de Prótese/instrumentação , Filtros de Veia Cava , Veia Cava Inferior , Tromboembolia Venosa/prevenção & controle , Humanos , Estudos Prospectivos , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Recidiva , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Veia Cava Inferior/diagnóstico por imagem
12.
J Interv Cardiol ; 2020: 8413831, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32665769

RESUMO

Aims: To investigate the healing process and nickel release of the Hyperion occluder (Comed BV, Netherlands), as compared to the Amplatzer septal occluder (ASO) (St. Jude Medical Inc., St. Paul, MN, USA) in a chronic swine model. Background: Some long-term complications occurring after percutaneous atrial septal defect (ASD) closure may be partially associated with an inappropriate healing of the device and increased nickel release. There is no direct comparative study of different occluders for healing and nickel release. Methods: After percutaneous ASD creation, 12 pigs were implanted with 15 mm Hyperion (n = 6) and 15 mm ASO (n = 6) devices. After 1 month (n = 3 for each device) and 3 months (n = 3 for each device) of follow-up, device explantation was performed and healing was assessed using histopathological workup. Systemic and tissular nickel release was performed. Results: Implantation was successful in 100% without complications. Device coverage was observed as early as 1 month after implantation and was almost complete after 3 months. A granulation tissue with a predominantly mononuclear inflammatory reaction was observed in contact with nitinol wires while an inflammatory reaction was seen in contact with textile fibers. We found no statistically significant difference between the 2 devices whether for histological grading scores or systemic nickel release, regardless to follow-up duration. Conclusions: In this preclinical study, we demonstrated that Amplatzer septal occluder and Hyperion occluder were not significantly different for device healing and nickel release processes.


Assuntos
Ligas/farmacologia , Comunicação Interatrial/cirurgia , Efeitos Adversos de Longa Duração/induzido quimicamente , Teste de Materiais/métodos , Complicações Pós-Operatórias/induzido quimicamente , Implantação de Prótese , Dispositivo para Oclusão Septal/efeitos adversos , Ligas/efeitos adversos , Animais , Pesquisa Comparativa da Efetividade , Efeitos Adversos de Longa Duração/prevenção & controle , Níquel/efeitos adversos , Níquel/farmacologia , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/prevenção & controle , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Suínos , Oligoelementos/efeitos adversos , Oligoelementos/farmacologia , Resultado do Tratamento
13.
Arch Cardiovasc Dis ; 113(6-7): 461-472, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32653240

RESUMO

Heart failure affects more than 30 million people worldwide and its prevalence is constantly rising. In 2020, heart transplantation is the only curative treatment, but left ventricular assistance devices (LVADs) are fully integrated into the decision algorithm for management of patients with advanced heart failure, with more than 20,000 devices implanted worldwide in the last decade. Intended to support cardiac output, LVADs remove the blood from the left ventricle and eject it into the proximal aorta. Whereas first-generation LVADs were pulsatile, second- and third-generation LVADs are more reliable, but create a laminar flow, with reduced (or absent) blood flow pulsatility. Concomitantly, several new adverse events, some of them lethal, appeared when continuous-flow LVADs started to be implanted, including acquired von Willebrand disease, gastrointestinal bleeding and aortic valve fusion or regurgitation. This review aims to apply models describing pulsatility (such as the Windkessel effect applied by Frank, Guyton's continuity model of venous return and Sunagawa's left ventricular-arterial coupling) to LVADs, to better understand the physiopathology in patients using continuous-flow devices. This review also covers the means of exploring pulsatility and adverse events associated with a reduction in pulsatility, as well as the possible ways for restoring pulsatility in patients implanted with an LVAD.


Assuntos
Insuficiência Cardíaca/terapia , Coração Auxiliar , Hemodinâmica , Implantação de Prótese/instrumentação , Função Ventricular Esquerda , Animais , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Modelos Cardiovasculares , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Implantação de Prótese/mortalidade , Fluxo Pulsátil , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do Tratamento
15.
Ann Thorac Surg ; 110(4): 1412-1416, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32615093

RESUMO

PURPOSE: Currently available techniques and materials for sternal reconstruction are limited in their clinical applicability. We aimed to design a durable prosthetic kit that can be tailored to each patient's sternal anatomy and function intraoperatively. DESCRIPTION: A modularized sternal reconstruction system was designed, containing standardized components of different types and sizes, made of titanium alloy. This technology was applied to patients undergoing sternal resection and reconstruction. EVALUATION: The system was employed in 7 patients undergoing sternal resection and reconstruction for local malignancy. Appropriate modules were chosen and integrated at the time of operation. The sternal prostheses were well integrated into the chest wall, without local infection, effusion, or instability. One patient died of recurrence 4 months after surgery. The remaining 6 patients recovered well, without local recurrence or prosthesis failure. CONCLUSIONS: The most prominent advantage of this system is that there is no need for individualized design and manufacture before surgery. Therefore, this modularized system is potentially widely applicable as an adaptable and effective prosthesis for sternal reconstruction.


Assuntos
Fixadores Internos , Desenho de Prótese , Implantação de Prótese/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Esterno/cirurgia , Adulto , Idoso , Interface Osso-Implante , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esternotomia
16.
J Interv Cardiol ; 2020: 8615410, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32669982

RESUMO

Aim: The feasibility and safety of performing the combined procedure of catheter ablation (CA) and left atrial appendage closure (LAAC) for atrial fibrillation (AF) have been reported by observational studies without controls. The aim of this study was to compare the procedural and long-term outcomes of combined procedures with isolated CA or LAAC. Methods and Results: This study included patients who underwent combined CA and LAAC (combined group), CA alone (CA-only group), or LAAC alone (LAAC-only group). Propensity score matching was used to select controls from the CA-only and LAAC-only groups. Each group contained 76 subjects. The procedures were successfully performed in all the patients. Procedure-related complications of the combined group included one pericardial effusion and two groin haematomas, which did not differ significantly with those of the CA-only group (3.9% vs. 2.6%, P=0.650) or the LAAC-only group (3.9% vs. 2.6%, P=0.650), respectively. The AF-free rate of the combined group was comparable with that of the CA-only group after a mean of 2 years follow-up (67.1% vs. 69.7%, P=0.727). Compared with the LAAC-only group, the combined group achieved similar complete occlusion rate at implant (94.7% vs. 93.4%) and at 45 days (82.9% vs. 85.5%). At the end of follow-up, ischemic stroke and bleeding events of the combined group were low (3.9%) and were comparable with those of the CA-only group (5.3%) and the LAAC-only group (2.6%). Conclusions: The combination of AF-CA and LAAC is safe and efficacious compared with single procedures alone.


Assuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Ablação por Cateter , Complicações Pós-Operatórias , Implantação de Prótese , Dispositivo para Oclusão Septal , Idoso , Fibrilação Atrial/complicações , Estudos de Casos e Controles , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Resultado do Tratamento
17.
J Stroke Cerebrovasc Dis ; 29(8): 104974, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689589
18.
Jt Dis Relat Surg ; 31(2): 201-208, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584715

RESUMO

OBJECTIVES: This study aims to investigate if use of cannulated pedicle screw (CPS) in the dysplastic pedicles in Scheuermann's kyphosis (SK) increases the accuracy rate of the screw and reduces screw-related complications. PATIENTS AND METHODS: This retrospective study included 21 patients (11 males, 10 females; mean age 19.1 years; range, 13 to 22 years) (550 screws) who received correction with pedicle screws due to SK deformity between May 2015 and January 2019. Between 2017 and 2018, classical pedicle screws were used in addition to CPSs in the upper thoracic region (T2, T3, T4) and thin pedicles (group 1). However, during the years 2015 to 2016, only classical pedicle screws were used for the patients who underwent posterior instrumentation for SK (group 2). Computed tomography scanning was used to investigate the accuracy of the screws. RESULTS: There were 12 patients (316 screws) in group 1 and nine patients (234 screws) in group 2. Seventy-four (13.4%) of all screws were inserted incorrectly. Incorrect screw rate in group 1 was significantly lower than group 2; 21 (6.6%) and 53 (22.6%), respectively (p<0.001). There were no complications related to the use of CPSs after a mean follow-up of two-and-a-half years. CONCLUSION: The use of CPS in the surgical treatment of SK does not increase the complication rate; instead it increases the accuracy of the screw. For this reason, we believe that CPS may be an effective and reliable option in the treatment of SK.


Assuntos
Parafusos Pediculares , Implantação de Prótese/instrumentação , Doença de Scheuermann/cirurgia , Fusão Vertebral/instrumentação , Adolescente , Feminino , Humanos , Masculino , Parafusos Pediculares/efeitos adversos , Implantação de Prótese/efeitos adversos , Estudos Retrospectivos , Doença de Scheuermann/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
19.
J Urol ; 204(5): 969-975, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32519913

RESUMO

PURPOSE: American Urological Association (AUA) antibiotic prophylaxis recommendations may be insufficient for covering organisms commonly found in penile prosthesis infections. In this study we assess the difference between AUA recommended antibiotic prophylaxis and nonstandard prophylaxis in preventing device infections in penile prosthesis surgery performed in diabetic patients. MATERIALS AND METHODS: A multicenter, retrospective cohort study of diabetic patients undergoing primary penile prosthesis surgery was performed between April 2003 and August 2018. Eighteen institutions from the United States, Europe and Korea contributed. The association between antibiotic prophylaxis type and postoperative penile prosthesis infections, device explantations and revision surgeries was assessed. RESULTS: Standard AUA antibiotic prophylaxis was followed in 48.6% (391) of cases while nonstandard prophylaxis was used in 51.4% (413). Common nonstandard antibiotic prophylaxis included vancomycin-gentamycin-fluoroquinolone, clindamycin-fluoroquinolone, and vancomycin-fluoroquinolone among other combinations. Patients who received AUA prophylaxis had significantly more postoperative device infections (5.6% vs 1.9%, p <0.01) and explantations (8.3% vs 2.0%, p <0.001) compared to those who received nonstandard prophylaxis. Patients who received AUA prophylaxis had significantly higher odds of a postoperative device infection (OR 2.8, 95% CI 1.1-7.3) and explantation (OR 3.6, 95% CI 1.4-9.1) compared to those who received nonstandard prophylaxis. CONCLUSIONS: Diabetic men with erectile dysfunction who received standard AUA prophylaxis for penile prosthesis surgery had significantly greater odds of experiencing a postoperative device infection and device explantation compared to patients who received nonstandard prophylaxis. Our study provides a strong rationale for a prospective investigation to establish the most appropriate prophylaxis strategy in penile prosthesis surgery.


Assuntos
Antibioticoprofilaxia/normas , Diabetes Mellitus/imunologia , Disfunção Erétil/cirurgia , Prótese de Pênis/efeitos adversos , Guias de Prática Clínica como Assunto , Implantação de Prótese/efeitos adversos , Infecções Relacionadas à Prótese/epidemiologia , Idoso , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Antibioticoprofilaxia/estatística & dados numéricos , Quimioterapia Combinada/métodos , Quimioterapia Combinada/normas , Quimioterapia Combinada/estatística & dados numéricos , Europa (Continente)/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Implantação de Prótese/instrumentação , Infecções Relacionadas à Prótese/imunologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/prevenção & controle , Reoperação/estatística & dados numéricos , República da Coreia/epidemiologia , Estudos Retrospectivos , Sociedades Médicas/normas , Resultado do Tratamento , Estados Unidos/epidemiologia , Urologia/normas
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