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1.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(3): 209-214, 2020 Mar 12.
Artigo em Chinês | MEDLINE | ID: mdl-32164090

RESUMO

Objective: To investigate the clinical characteristics of medical staff with novel coronavirus pneumonia(NCP). Methods: 30 patients infected with novel coronavirus referred to jianghan university hospital between January 11, 2020 and January 3, 2020 were studied. The data reviewed included those of clinical manifestations, laboratory investigation and Radiographic features. Results: The patients consisted of 10 men and 20 women, including 22 doctors and 8 nurses,aged 21~59 years(mean 35±8 years).They were divided to 26 common type and 4 severe cases, all of whom had close(within 1m) contact with patients infected of novel coronavirus pneumonia. The average contact times were 12 (7,16) and the average cumulative contact time was 2 (1.5,2.7) h.Clinical symptoms of these patients were fever in 23 patients (76.67%) , headache in 16 petients (53.33%) , fatigue or myalgia in 21patients (70%) , nausea, vomiting or diarrhea in 9 petients (30%) , cough in 25 petients (83.33%) , and dyspnea in 14 petients (46.67%) .Routine blood test revealed WBC<4.0×10(9)/L in 8 petients (26.67%) , (4-10) ×10(9)/L in 22 petients (73.33%) , and WBC>4.0×10(9)/L in 4 petients (13.33%) during the disease.Lymphocyte count<1.0×10(9)/L occurred in 12 petients (40%),abnormal liver function in 7 petients (23.33%) ,myocardial damage in 5 petients(16.67%), elevated D-dimer (>0.5mg/l) in 5 patients (16.67%). Compared with normal patients, the average exposure times, cumulative exposure time, BMI, Fever time, white blood cell count, liver enzyme, LDH, myoenzyme and D-dimer were significantly increased in severe patients, while the lymphocyte count and albumin levels in peripheral blood were significantly decreased.Chest CT mainly showed patchy shadows and interstitial changes.According to imaging examination, 11 patients (36.67%) showed Unilateral pneumonia and 19 patients (63.33%) showed bilateral pneumonia,4 patients (13.33%) showed bilateral multiple mottling and ground-glass opacity.Compared with the patients infected in the protected period, the proportion of severe infection and bilateral pneumonia were both increased in the patients infected in unprotected period. Conclusion: Medical staffs are at higher risk of infection.Infection rates are associated with contact time, the amount of suction virus. Severe patients had BMI increased, heating time prolonged, white blood cell count, lymphocyte count, D-dimer and albumin level significantly changed and were prone to be complicated with liver damage and myocardial damage.Strict protection measures is important to prevent infection for medical workers.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus , Febre , Pessoal de Saúde , Transmissão de Doença Infecciosa do Paciente para o Profissional , Pneumonia Viral , Adulto , Índice de Massa Corporal , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Tosse/etiologia , Dispneia/etiologia , Feminino , Febre/classificação , Febre/etiologia , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Contagem de Leucócitos , Fígado/patologia , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica , Fatores de Tempo , Adulto Jovem
2.
Lancet Haematol ; 7(3): e247-e258, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32109405

RESUMO

Pregnancy-associated pulmonary embolism is one of the leading causes of maternal mortality. Diagnosis of pulmonary embolism in pregnancy is challenging, with symptoms of pulmonary embolism mimicking those of pregnancy. Several key components such as clinical prediction tools, risk stratification, laboratory tests, and imaging widely used for diagnosis of pulmonary embolism in the non-pregnant population show limitations for diagnosis in pregnancy. Further, because of the difficulty of studying pregnant patients, high-quality research evaluating the performance of these diagnostic components in pregnancy is scarce. Seven international medical society guidelines present clinical diagnostic pathways for evaluation of pulmonary embolism in pregnancy that show conflicting recommendations on the use of these diagnostic components. This Review assesses all key components of diagnostic clinical pathways recommended by guidelines for evaluation of pulmonary embolism in pregnancy, reviews current evidence, compares the guideline recommendations with respect to each key component, and provides our preferred diagnostic pathway. It provides the guidelines and available data needed for informed decision making to diagnose pulmonary embolism in pregnancy.


Assuntos
Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Guias de Prática Clínica como Assunto/normas , Embolia Pulmonar/diagnóstico , Feminino , Humanos , Agências Internacionais , Gravidez , Embolia Pulmonar/metabolismo , Sociedades Médicas
3.
Adv Clin Exp Med ; 29(1): 147-155, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011830

RESUMO

BACKGROUND: Chest pain is one of the most frequent symptoms in patients seeking treatment at emergency departments (ED). These patients differ according to the cause of their reported symptoms and resultant mortality. OBJECTIVES: Evaluation of the influence of hospitalization and biochemical parameters on mortality rates in patients admitted to the ED with chest pain, in whom no cardiovascular emergencies were established. MATERIAL AND METHODS: The study group consisted of 243 patients with chest pain admitted to the ED in the Wroclaw Medical University Clinical Hospital, Poland, between January 1 and March 31, 2015, in whom no specific diagnosis was made at discharge. A retrospective analysis was carried out based on medical documentation, and 60-day and 1-year survival was assessed. RESULTS: In the study group, the 60-day mortality rate was 0.8% (2 persons) while the 1-year mortality rate was 6.6% (16 persons). The stepwise multivariable logistic regression analysis revealed that 1-year mortality was related to increased level of D-dimer (odds ratio (OR) = 8.5, 95% confidence interval (95% CI) = 21.9-37.5, p < 0.005), age (OR (per year) = 1.10, 95% CI = 1.03-1.18, p < 0.03) and lower than 12 g/dL hemoglobin concentration (OR = 18.5, 95% CI = 4.2-80.4, p < 0.001). Troponin I (TNI) levels and hospitalization were not related independently to mortality when other clinical factors were considered. CONCLUSIONS: Hospitalization of patients with chest pain who were not diagnosed with cardiac emergencies is not related with better survival than of those discharged home from the ED. The 60-day mortality is very low and occurs in older patients with numerous comorbidities. In multivariate analysis, survival of the 1-year period depends on the patient's age, hemoglobin levels and D-dimer levels. Risk of death in patients admitted to the ED due to chest pain in whom the cause of the chest pain was not due to cardiovascular emergencies depends on the presence of old age and comorbidities.


Assuntos
Dor no Peito/diagnóstico , Dor no Peito/terapia , Emergências , Serviço Hospitalar de Emergência/estatística & dados numéricos , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Mortalidade Hospitalar , Troponina I/sangue , Idoso , Biomarcadores/sangue , Dor no Peito/sangue , Dor no Peito/mortalidade , Hospitalização/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Polônia/epidemiologia , Estudos Retrospectivos
4.
World Neurosurg ; 133: e774-e783, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605841

RESUMO

BACKGROUND: The use of venous duplex ultrasonography (VDU) for confirmation of deep venous thrombosis in neurosurgical patients is costly and requires experienced personnel. We evaluated a protocol using D-dimer levels to screen for venous thromboembolism (VTE), defined as deep venous thrombosis and asymptomatic pulmonary embolism. METHODS: We used a retrospective bioinformatics analysis to identify neurosurgical inpatients who had undergone a protocol assessing the serum D-dimer levels and had undergone a VDU study to evaluate for the presence of VTE from March 2008 through July 2017. The clinical risk factors and D-dimer levels were evaluated for the prediction of VTE. RESULTS: In the 1918 patient encounters identified, the overall VTE detection rate was 28.7%. Using a receiver operating characteristic curve, an area under the curve of 0.58 was identified for all D-dimer values (P = 0.0001). A D-dimer level of ≥2.5 µg/mL on admission conferred a 30% greater relative risk of VTE (sensitivity, 0.43; specificity, 0.67; positive predictive value, 0.27; negative predictive value, 0.8). A D-dimer value of ≥3.5 µg/mL during hospitalization yielded a 28% greater relative risk of VTE (sensitivity, 0.73; specificity, 0.32; positive predictive value, 0.24; negative predictive value, 0.81). Multivariable logistic regression showed that age, male sex, length of stay, tumor or other neurological disease diagnosis, and D-dimer level ≥3.5 µg/mL during hospitalization were independent predictors of VTE. CONCLUSIONS: The D-dimer protocol was beneficial in identifying VTE in a heterogeneous group of neurosurgical patients by prompting VDU evaluation for patients with a D-dimer values of ≥3.5 µg/mL during hospitalization. Refinement of this screening model is necessary to improve the identification of VTE in a practical and cost-effective manner.


Assuntos
Biomarcadores/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Tromboembolia Venosa/sangue , Tromboembolia Venosa/diagnóstico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Trombose Venosa/sangue
5.
Life Sci ; 240: 117069, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31751582

RESUMO

AIM: Intraluminal thrombus (ILT) is presented in most abdominal aortic aneurysms (AAAs) and is suggested to promote AAA expansion. D-dimer, a breakdown product in the thrombus remodeling, may have prognostic value for AAA. This study investigated the interrelation between plasma D-dimer level, ILT volume, AAA size and progression. MAIN METHODS: This was a retrospective observational study that involved 181 patients with infra-renal AAA. They were divided into small and large AAA groups according to AAA diameter. 24 of them had repeated abdominal computed tomography angiography (CTA) scan and were divided into slow-growing and fast-growing AAA groups according to the median value of AAA growth rate. Baseline and follow-up plasma D-dimer level, maximum diameter of AAA, total infra-renal aortic volume and ILT volume were analyzed. KEY FINDINGS: Plasma D-dimer level was positively correlated with ILT volume (R = 0.382, P < 0.001) and maximum diameter of AAA (R = 0.442, P < 0.001). Increasing value of plasma D-dimer was positively associated with the accelerated growth rate of AAA (R = 0.720, P < 0.01). ILT volume showed positive correlation with maximum diameter (R = 0.859, P < 0.001) and growth rate of AAA (R = 0.490, P < 0.05). After adjusting the baseline ILT volume, the positive correlations remained to be statistically significant between plasma D-dimer level and AAA size (R = 0.200, P < 0.05), as well as increasing value of plasma D-dimer and growth rate of AAA (R = 0.642, P < 0.05). SIGNIFICANCE: Plasma D-dimer level reflected ILT burden in AAAs. Plasma D-dimer level and ILT volume were positively correlated with AAA size. Increasing value of plasma D-dimer and baseline ILT volume could be predictors of AAA progression.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/etiologia , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Trombose/complicações , Trombose/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/sangue , Efeitos Psicossociais da Doença , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fumar/epidemiologia , Trombose/sangue , Tomografia Computadorizada por Raios X
6.
J Stroke Cerebrovasc Dis ; 29(2): 104534, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31810721

RESUMO

BACKGROUND: Differentiating stroke due to Trousseau's syndrome from other types of cerebral embolism is challenging, especially in patients with occult cancer. The current study aimed to determine predicting factors and biomarkers of stroke due to Trousseau's syndrome. METHODS: This retrospective study comprised 496 consecutive patients with acute cerebral embolism, including 19, 85, 310, and, 82 patients with stroke due to Trousseau's syndrome, artery-to-artery embolism, cardioembolic stroke, and embolic stroke with undetermined source, respectively. All patients were evaluated within 72 hours of onset. The clinical characteristics, laboratory findings, and patterns on diffusion-weighted magnetic resonance imaging (DWI) were compared among the groups. RESULTS: Plasma D-dimer and C-reactive protein (CRP) levels were significantly higher in the Trousseau's syndrome than in the other causes of cerebral embolism. Multivariate analyses demonstrated that female sex, multiple lesions on DWI, high D-dimer and CRP levels, and low platelet and low brain natriuretic peptide levels were independent predictors that could distinguish Trousseau's syndrome from the other causes of cerebral embolism. The cutoff values of D-dimer and CRP to identify stroke due to Trousseau's syndrome was 2.68 µg/mL fibrinogen equivalent units and .29 mg/dL, respectively. CONCLUSIONS: The elevated D-dimer and CRP levels on admission in addition to specific clinical features may be useful for diagnosis of Trousseau's syndrome in patients with cerebral embolism.


Assuntos
Proteína C-Reativa/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Embolia Intracraniana/sangue , Neoplasias/sangue , Acidente Vascular Cerebral/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/etiologia , Masculino , Neoplasias/complicações , Neoplasias/diagnóstico , Admissão do Paciente , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Síndrome , Regulação para Cima
7.
Talanta ; 207: 120270, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31594601

RESUMO

Since the disclosure of the fibrinogen degradation mechanism, around half a century ago, a significant number of papers have been published related to the clinical relevance of D-dimer, a molecule immune to additional enzymatic decomposition by plasmin. Due to the obliquity of regulating blood coagulation in pathological events, the number of diseases and conditions associated with abnormal levels of D-dimer includes deep vein thrombosis, pulmonary embolism, sepsis, myocardial infarction, disseminated intravascular coagulation, among many others. D-dimer not only is an important player in medical diagnosis but also its role as a prognosis biomarker is being revealed. However, the number of analytical alternative methods has not accompanied this trend, even though novel simple point-of-care devices would certainly boost the relevance of D-dimer in emergency medicine. Some reasons for that could be related to the fact that D-dimer is a challenging analyte present in complex samples like blood. In this manuscript, subsequent to a fibrinogen degradation process introduction, it is provided a historical overview of the early D-dimer assays, followed by an extended focus on innovative solutions, with a spotlight on the electrochemical bioanalytical devices. The discussion is accompanied with a critical analysis and concluding thoughts concerning future perspectives.


Assuntos
Técnicas Biossensoriais/métodos , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Laboratórios Hospitalares , Pesquisa Médica Translacional/métodos , Humanos
8.
Biochem Med (Zagreb) ; 30(1): 010501, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31839719

RESUMO

The current scenario of in vitro and in vivo diagnostics can be summarized using the "silo metaphor", where laboratory medicine, pathology and radiology are three conceptually separated diagnostic disciplines, which will increasingly share many comparable features. The substantial progresses in our understanding of biochemical-biological interplays that characterize many human diseases, coupled with extraordinary technical advances, are now generating important multidisciplinary convergences, leading the way to a new frontier, called integrated diagnostics. This new discipline, which is currently defined as convergence of imaging, pathology and laboratory tests with advanced information technology, has an enormous potential for revolutionizing diagnosis and therapeutic management of human diseases, including those causing the largest number of worldwide deaths (i.e. cardiovascular disease, cancer and infectious diseases). However, some important drawbacks should be overcome, mostly represented by insufficient information technology infrastructures, costs and enormous volume of different information that will be integrated and delivered. To overcome these hurdles, some specific strategies should be defined and implemented, such as planning major integration of exiting information systems or developing innovative ones, combining bioinformatics and imaging informatics, using health technology assessment for assessing cost and benefits, providing interpretative comments in integrated reports, developing and using expert systems and neural networks, overcoming cultural and political boundaries for generating multidisciplinary teams and integrated diagnostic algorithms.


Assuntos
Doenças Cardiovasculares/diagnóstico , Neoplasias/diagnóstico , Sepse/diagnóstico , Biomarcadores/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Subunidade beta da Proteína Ligante de Cálcio S100/metabolismo , Tomografia , Troponina/análise
9.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(11): 837-842, 2019 Nov 07.
Artigo em Chinês | MEDLINE | ID: mdl-31795545

RESUMO

Objective: To investigate the potential risk factors for the death of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy during perioperative periods. Methods: A total of 71 patients, including 64 males and 7 females, aged from 35 to 72 years old, with hypopharyngeal or cervical esophageal carcinoma, who underwent gastric pull-up reconstruction after pharyngoesophagectomy between October 2008 and October 2017, were reviewed retrospectively. Seventeen factors which may have potential influence on the mortality of patients during perioperative periods were evaluated by single factor Logistic regression analysis, and then those factors with obvious difference in statistics were further analyzed by multi-factor Logistic regression. Results: The rate of perioperative mortality was 9.9% (7/71). Single factor Logistic regression analysis indicated that the age of patients, abnormal electrocardiogram, TNM stages, alanine aminotransferase and D-Dimer changes, postoperative bleeding were risk factors for the death of patients(P values were 0.023, 0.004, 0.026, 0.021, 0.015 and 0.002, respectively). Multi-factor Logistic regression showed that postoperative bleeding and D-Dimer changes were 2 independent risk factors for perioperative death(P=0.021 and 0.047, respectively). Conclusions: Many potential factors may affect the perioperative mortality of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy. Postoperative bleeding and significantly elevated D-Dimer level were independent risk factors for the death of patients, indicating poor prognosis.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/mortalidade , Esôfago/cirurgia , Faringectomia/mortalidade , Faringe/cirurgia , Estômago/cirurgia , Adulto , Idoso , Anastomose Cirúrgica/mortalidade , Neoplasias Esofágicas/sangue , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Estudos Retrospectivos , Fatores de Risco
10.
Medicine (Baltimore) ; 98(52): e18527, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876748

RESUMO

This study aim was to evaluate whether plasma D-dimer levels could serve as a novel prognostic biomarker for 1-month mortality in patients with HBV-related decompensated cirrhosis (HBV-DeCi).This was a retrospective study that enrolled 132 HBV-DeCi patients. Univariate and multivariate regression models were used to identify risk factors for mortality. The area under the receiver operating characteristic curve was calculated to estimate and compare the predictive values of different prognostic markers.In the present study, the plasma D-dimer levels were higher in the nonsurviving group than in the surviving group. Additionally, the D-dimer level was positively correlated with the model for end-stage liver disease (MELD) score. The results of multivariate analysis showed that both the MELD score and D-dimer level are independent predictors of 1-month mortality in HBV-DeCi patients (both P < .01).Plasma D-dimer can be considered a new additional prognostic marker for 1-month mortality in HBV-DeCi patients.


Assuntos
Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hepatite B Crônica/mortalidade , Cirrose Hepática/mortalidade , Adulto , Idoso , Biomarcadores/sangue , Feminino , Hepatite B Crônica/sangue , Hepatite B Crônica/complicações , Hepatite B Crônica/diagnóstico , Humanos , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico , Cirrose Hepática/etiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos
11.
PLoS One ; 14(12): e0222050, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31877562

RESUMO

BACKGROUND: Carcinoma cells often modulate coagulation and fibrinolysis among cancer patients. Plasma dimerized plasmin fragment D (D-dimer) has been reported as a prognostic marker of various types of malignancies, including non-small cell lung cancer (NSCLC). However, the associations between the plasma D-dimer level and peripheral small NSCLC remain unclear. METHODS: Three hundred and sixty-two patients with NSCLC who underwent radical surgery were retrospectively reviewed. Patients who received anticoagulation therapy before surgery or who lacked preoperative D-dimer data were excluded. The other 235 patients were divided into a high D-dimer (over 1.0 µg/mL) group (HDD group, n = 47) and a normal D-dimer group (NDD group, n = 188) and investigated for their clinical characteristics, computed tomography (CT) findings, pathological findings, and clinical outcomes. RESULTS: The mean D-dimer levels was 2.49±2.58 µg/ml in the HDD group and 0.42±0.23 µg/ml in the NDD group. The HDD group was characterized by a predominance of male gender, older age, pure solid appearance on chest CT, vascular invasion in pathology, and a large solid part of the tumor. The HDD group showed a worse overall survival, disease-free survival, and disease-specific survival than the NDD group (p<0.001, <0.001, <0.001, respectively). These survival features were also observed in p-Stage IA disease. There was no marked survival difference when tumors showed ground-glass opacity on CT. CONCLUSION: In NSCLC patients with a solid tumor appearance on CT, high D-dimer levels predict a poor survival and early recurrence.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Produtos de Degradação da Fibrina e do Fibrinogênio/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Carcinoma Pulmonar de Células não Pequenas/patologia , Intervalo Livre de Doença , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Am Surg ; 85(11): 1288-1293, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775973

RESUMO

Portal vein system thrombosis (PVST) is a form of venous thrombosis, which behaves as a common and potentially life-threatening complication after splenectomy. Numerous studies have been made to investigate the mechanism and the risk factors of PVST. However, the research on the prevention and treatment of PVST associated with platelet's (PLT) rule of change is rare. This work mainly investigates the PLT's rule of change and its correlativity with the formation of PVST after splenectomy. The retrospective study included 117 patients who underwent splenectomy from August 2014 to June 2018 and monitored by blood routine, D-dimer (D-D), and portal vein system ultrasound routinely after splenectomy. The changes of PLT and D-D were recorded and compared before and after each operation. We analyzed the changes of PLT and D-D as well as the incidence of PVST postoperatively. Most of the patients' PLT increased significantly after splenectomy. On the first day after operation, there were 80 patients' (68.38%) PLT recovered to normal or above normal. The proportion of patients with abnormally high PLT value on the seventh and fourteenth day were 60.68 per cent and 81.20 per cent, respectively. Thereinto, there were 67 patients' (57.26%) PLT beyond 500 × 109/L on the 14th day. The D-D of all patients exceeded the normal range on the first, seventh, and fourteenth day after operation, and the difference was statistically significant (P < 0.05), which behaved similar like PLT. Meanwhile, our color Doppler ultrasonography showed that the incidence of PVST was 70.79 per cent. Among the patients with PVST, 82 (100%) patients' PLT was increased after operation. The PLT of patients increased obviously after splenectomy. The increased blood viscosity caused by the consecutive elevation of PLT may result in a higher PVST incidence. Early intervention and treatment are needed clinically for PVST after splenectomy.


Assuntos
Sistema Porta , Complicações Pós-Operatórias/sangue , Esplenectomia/efeitos adversos , Trombose Venosa/sangue , Adolescente , Adulto , Idoso , Viscosidade Sanguínea , Criança , Ecocardiografia Doppler em Cores , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Hiperesplenismo/diagnóstico , Hipertensão Portal/diagnóstico , Incidência , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas/estatística & dados numéricos , Sistema Porta/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Ultrassonografia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia , Adulto Jovem
13.
N Engl J Med ; 381(22): 2125-2134, 2019 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-31774957

RESUMO

BACKGROUND: Retrospective analyses suggest that pulmonary embolism is ruled out by a d-dimer level of less than 1000 ng per milliliter in patients with a low clinical pretest probability (C-PTP) and by a d-dimer level of less than 500 ng per milliliter in patients with a moderate C-PTP. METHODS: We performed a prospective study in which pulmonary embolism was considered to be ruled out without further testing in outpatients with a low C-PTP and a d-dimer level of less than 1000 ng per milliliter or with a moderate C-PTP and a d-dimer level of less than 500 ng per milliliter. All other patients underwent chest imaging (usually computed tomographic pulmonary angiography). If pulmonary embolism was not diagnosed, patients did not receive anticoagulant therapy. All patients were followed for 3 months to detect venous thromboembolism. RESULTS: A total of 2017 patients were enrolled and evaluated, of whom 7.4% had pulmonary embolism on initial diagnostic testing. Of the 1325 patients who had a low C-PTP (1285 patients) or moderate C-PTP (40 patients) and a negative d-dimer test (i.e., <1000 or <500 ng per milliliter, respectively), none had venous thromboembolism during follow-up (95% confidence interval [CI], 0.00 to 0.29%). These included 315 patients who had a low C-PTP and a d-dimer level of 500 to 999 ng per milliliter (95% CI, 0.00 to 1.20%). Of all 1863 patients who did not receive a diagnosis of pulmonary embolism initially and did not receive anticoagulant therapy, 1 patient (0.05%; 95% CI, 0.01 to 0.30) had venous thromboembolism. Our diagnostic strategy resulted in the use of chest imaging in 34.3% of patients, whereas a strategy in which pulmonary embolism is considered to be ruled out with a low C-PTP and a d-dimer level of less than 500 ng per milliliter would result in the use of chest imaging in 51.9% (difference, -17.6 percentage points; 95% CI, -19.2 to -15.9). CONCLUSIONS: A combination of a low C-PTP and a d-dimer level of less than 1000 ng per milliliter identified a group of patients at low risk for pulmonary embolism during follow-up. (Funded by the Canadian Institutes of Health Research and others; PEGeD ClinicalTrials.gov number, NCT02483442.).


Assuntos
Angiografia por Tomografia Computadorizada , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Embolia Pulmonar/sangue , Embolia Pulmonar/diagnóstico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Probabilidade , Estudos Prospectivos , Embolia Pulmonar/diagnóstico por imagem
14.
Klin Lab Diagn ; 64(11): 654-658, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31747492

RESUMO

The developing and the testing results of an immunochromatographic test for the D-dimer qualitative determination were presents in the article. The test was approved blood plasma samples in comparison with a quantitative enzyme-linked immunosorbent assay (ELISA). The results of assay with developed test were the same with ELISA results for 87,1% and 100% for samples with increased (more than 400 ng/ml FEU) and normal concentration of D-dimer, respectively. The immunochromatographic test for determination of D-dimer can be included in the diagnostic strategy as a cut test after the assessment of venous thromboembolism risk.


Assuntos
Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Imunoensaio , Tromboembolia Venosa/diagnóstico , Ensaio de Imunoadsorção Enzimática , Humanos , Sensibilidade e Especificidade
15.
Am J Case Rep ; 20: 1497-1499, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31601777

RESUMO

BACKGROUND Radiofrequency ablation is a minimally invasive treatment for arrhythmias, including frequent ventricular premature. As a complication of radiofrequency ablation, pseudoaneurysm can be treated conservatively or by ultrasound-guided thrombin injection. CASE REPORT We report a case that a possible allergic reaction to thrombin injected into pseudoaneurysm after radiofrequency ablation. CONCLUSIONS We hope that the report of successful management of the allergic reaction in this case may be of help to other doctors; we also emphasize the importance of checking the patient's history of allergies to thrombin when considering treating pseudoaneurysm with thrombin injection.


Assuntos
Falso Aneurisma/terapia , Hipersensibilidade a Drogas/diagnóstico , Artéria Femoral , Hemostáticos/efeitos adversos , Trombina/efeitos adversos , Idoso de 80 Anos ou mais , Alanina Transaminase/sangue , Hipersensibilidade a Drogas/etiologia , Eletrocardiografia , Feminino , Febre/etiologia , Fibrina/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hemoglobinas/análise , Hemostáticos/administração & dosagem , Humanos , Hipotensão/etiologia , Injeções Intra-Arteriais , Leucopenia/etiologia , Náusea/etiologia , Ablação por Radiofrequência , Trombina/administração & dosagem , Trombocitopenia/etiologia , Complexos Ventriculares Prematuros/cirurgia
16.
Zhonghua Yi Xue Za Zhi ; 99(35): 2768-2772, 2019 Sep 17.
Artigo em Chinês | MEDLINE | ID: mdl-31550800

RESUMO

Objective: To explore the characteristics of serum D-dimer level before and after delivery in women with advanced maternal age (VTE), and to assess the value of the characteristics for the diagnosis of venous thromboembolic disease. Methods: The objects were 785 puerperae with advanced maternal age (AMA) who experienced delivery in Women's Hospital, Zhejiang University School of Medicine during 1(st) Jan 2017 to 31(st) Dec 2017, and 327 puerperae with appropriate maternal age as controls were randomly selected from puerperae who gave birth in the same period. Their serum D-dimer levels before and after delivery were evaluated, and AMAs with high-level postnatal serum D-dimer were specially observed for the prognosis. Besides, puerperae complicated with VTE were retrieved from the medical database during 2014-2018, and their clinical characteristics and dynamic variation of serum D-dimer levels were analyzed. Result: The significant difference of D-dimer levels neither before nor after delivery was not observed between AMAs and controls (antenatal: 1.64(1.19, 2.29) mg/L vs 1.53(1.04, 2.23) mg/L, and postnatal: 2.70(1.71, 2.97) mg/L vs 2.63(1.17, 4.13) mg/L, P<0.05 for both; None of AMAs with high-level serum D-dimer after delivery were complicated with VTE, and most of their serum D-dimer levels decreasedsharply with in four postnatal days (the average decrease was 9.2(7.69,12.74) mg/L, and 96.2% of the sepuerperae's decrease was more than 50%). Eight puerperae complicated with VTE were found in the database from 2014 to 2018, among which five were AMAs. The eight puerperae all received a B ultrasound because of the discomfort of lower limbs or abnormal variation of serum D-dimer levels (a slow decrease or an increase trend), so that a diagnosis of VTE was established; besides, the diagnosis or symptoms all emerged in the 3(rd) to 5(th) day after caesarean. Conclusions: The factor of advanced maternal age has little influence on the serum D-dimer level before or after delivery among pregnant women. It is not a single detection for serum D-dimer level, but the intensive monitoring of clinical symptoms and dynamic change of serum D-dimer level, that helps early diagnosis of VTE.


Assuntos
Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Idade Materna , Gravidez/sangue , Tromboembolia Venosa/sangue , Estudos de Casos e Controles , Feminino , Humanos , Tromboembolia Venosa/diagnóstico
17.
Pak J Pharm Sci ; 32(3 Special): 1281-1284, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31551204

RESUMO

The aim of this study was to explore the clinical effect of ulinastatin combined with thymosin in patients with sepsis and its influence on cardiopulmonary function and delirium. Sixty-eight sepsis patients were enrolled as study subjects. The patients were randomly divided into a symptomatic treatment group (n=34) and a combined treatment group (n=34) on the basis of random number table. The two groups were first operated and then, the symptomatic treatment group was given symptomatic support treatment, whilst the combined treatment group was treated with ulinastatin and thymosin on the prerequisite of the symptomatic treatment group. After 7 days of treatment, the evaluation of the curative effect was performed, followed by the comparison of the cardiopulmonary function, immune level and safety between the two groups of patients. The cardiac index and oxygenation index of the combined treatment group were higher than those of the symptomatic treatment group 7 days after treatment (P<0.05). Whereas, the levels of plasma D-dimer and cTnI were lower than those of the symptomatic treatment group (P<0.05). In addition, CD3+, CD4+, CD4+/CD8+ levels of the combined treatment group were higher than those of the symptomatic treatment group 7 days after treatment (P<0.05). On the contrary, CD8+ levels of the combined treatment group were lower than those of the symptomatic treatment group 7 days after treatment. There was no significant (P>0.05) difference in drug safety between the two groups during treatment.


Assuntos
Delírio/tratamento farmacológico , Glicoproteínas/uso terapêutico , Sepse/tratamento farmacológico , Timosina/uso terapêutico , Antígenos CD4/sangue , Antígenos CD8/sangue , Constipação Intestinal/induzido quimicamente , Quimioterapia Combinada , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Glicoproteínas/efeitos adversos , Humanos , Oxigênio/sangue , Sepse/imunologia , Sepse/fisiopatologia , Timosina/efeitos adversos , Resultado do Tratamento
18.
Adv Gerontol ; 32(3): 415-421, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31512429

RESUMO

Aged patients with atrial fibrillation (AF) are at high risk of both thromboembolic and haemorrhagic complications of disease and of its treatment. A study was provided to assess the role of D-dimer plasma level as a marker of thrombosis in aged patients with AF having no clinical signs of active thrombosis depending on used treatment strategy and quantitative thrombotic and haemorrhagic risk of AF. The results show that D-dimer plasma levels correlate with scores of thromboembolic and haemorrhagic risks in group on antiplatelet agents but not anticoagulants, with the difference in D-dimer level driven by subgroup on CHA2DS2-VASc score ≥5. High D-dimer level was associated with in-hospital mortality and rhythm of AF at the moment of blood sample collection. Therefore, an accuracy of risk prognosis of fatal complications of AF for elderly patients may be increased by using the laboratory markers of thrombus formation such as D-dimer and by using the obtained results to guide an antithrombotic therapy.


Assuntos
Fibrilação Atrial , Biomarcadores , Produtos de Degradação da Fibrina e do Fibrinogênio , Trombose , Idoso , Fibrilação Atrial/complicações , Biomarcadores/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Fatores de Risco , Trombose/diagnóstico , Trombose/etiologia
19.
Ned Tijdschr Geneeskd ; 1632019 09 16.
Artigo em Holandês | MEDLINE | ID: mdl-31556500

RESUMO

This lab quiz presents some practical case studies on the correct use of D-dimer tests in patients suspected of venous thromboembolism. Elevated D-dimer levels are associated with clotting activation and fibrinolysis and can be used as indirect biomarkers of thrombosis. The D-dimer test is highly sensitive and is used to rule out the presence of venous thromboembolism (VTE) when clinical probability is low, based on Wells scores. However, sensitivity and specificity of cut-off values for D-dimer for ruling out VTE are strongly assay-dependent due to lack of standardisation. Because of low specificity, use of these cut-off values is problematic in cases of sepsis and inflammation, after recent surgery and in cases of trauma and active malignancy as well as during anticoagulant therapy and pregnancy. Agedependent cut-off values for patients > 50 years old might improve specificity and could be safely used if clinically validated assays (latex-agglutination assays) are used as described for the ADJUST-study.


Assuntos
Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Testes Hematológicos/estatística & dados numéricos , Tromboembolia Venosa/diagnóstico , Anticoagulantes/uso terapêutico , Biomarcadores/sangue , Feminino , Testes Hematológicos/métodos , Testes Hematológicos/normas , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Probabilidade , Padrões de Referência , Valores de Referência , Sensibilidade e Especificidade , Tromboembolia Venosa/tratamento farmacológico
20.
Clin Appl Thromb Hemost ; 25: 1076029619868534, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31434499

RESUMO

BACKGROUND: Deep venous thrombosis (DVT) is a common complication after stroke. It is easy to identify the patients with symptomatic DVT; however, the tool for asymptomatic high-risk population needs to be further explored. Our aim was to explore the risk factors of acute stroke patients with asymptomatic DVT. METHODS: We performed a prospective observation study among 452 patients with acute stroke who had a stroke within 14 days. Ultrasound examination of deep veins was repeatedly performed in each patient for DVT every 7 days during his admission. The dynamic rate of DVT in acute stroke was analyzed. Then risk factors were compared between DVT patients and non-DVT patients. The predictive model was explored based on thr cox proportion model. RESULTS: Asymptomatic DVT was detected in 52 (11.5%) patients with stroke and 85.9% of thrombi were identified in their distal veins. Patients with longer length of stay (P = .004), more severe stroke (P = 0.001), higher level of D-dimer (P = .003), and higher blood glucose level were associated with higher risk of DVT, while patients with higher triglyceride level (P = .003) were less likely to have DVT, after adjusting age and sex. With the median of D-dimer (0.38 FEU mg/L) as cutoff value. Patients with higher level of D-dimer might have a higher risk of DVT with a significant statistical difference. Also, the severity of stroke differed DVT risk in Kaplan-Meier model. Using cox-proportion hazard regression model, asymptomatic DVT could be predicted (area under the curve 0.852). CONCLUSION: Our data showed that asymptomatic DVT was common in patients with acute stroke and most of thrombosis occurred in distal veins. Combination of clinical manifestation and laboratory results might be helpful predict DVT. DVT prophylaxis should be condisdered in high risk.


Assuntos
Fatores de Risco , Acidente Vascular Cerebral/complicações , Trombose Venosa/etiologia , Idoso , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hospitalização , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ultrassonografia , Trombose Venosa/diagnóstico por imagem
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