RESUMO
AIM: To describe a simple and useful technique for acute management of massive hemopericardium inside the Electrophysiology (EP) laboratory METHODS AND RESULTS: Five patients from a single center experience were identified, all with blood loss above 1000 ml after initial pericardiocenthesis. Using two long 8.5 F transseptal sheaths inside the pericardium space, with continuous negative pressure, allowed the complete cessation of bleeding or hemodynamic maintenance until definitive surgical repair in all patients CONCLUSION: The use of two long sheaths for blood drainage, instead of conventional pericardiocenthesis, might be helpful to manage massive hemopericardium inside EP lab, avoiding urgent cardiac surgery or maintaining clinical stability until surgical staff is available.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Derrame Pericárdico , Eletrofisiologia Cardíaca , Humanos , Derrame Pericárdico/cirurgia , Pericárdio/cirurgiaRESUMO
BACKGROUND: Cardiac magnetic resonance (CMR) allowed to precisely identify the substrate in scar-related ventricular tachycardia (VT). New software has been developed to define the 3D scar and corridors to help VT ablation by integrating the scar and electroanatomical mapping (EAM). The objective of this study is to evaluate the results of VT ablation aided by the integration of EAM and CMR software processed scar. METHODS: We selected patients that underwent VT ablation with the integration of EAM and CMR processed using ADAS software and imported to the CARTO system using VTK file format. RESULTS: From 2019 to 2021, eight patients (mean age 63 ± 4.4, 62.5% male; EF 47 ± 12%) underwent CMR-aided VT ablation. Mean procedural time was 281 ± 77 min. There was of 9 ± 4.4 epicardial and 7.9 ± 4.3 endocardial bulls eye segments with at least 2 g of border zone or core scar. In a median follow-up time of 532 days (Q1: 284, Q3: 688), three patients (37.5%) presented VT recurrence, all three underwent a second procedure, with no VT recurrence on the follow-up. No patient died in the follow-up. CONCLUSION: CMR aided is ablation is feasible and effective in patients with scar related VT.
Assuntos
Ablação por Cateter , Taquicardia Ventricular , Humanos , Masculino , Feminino , Cicatriz/diagnóstico por imagem , Cicatriz/cirurgia , Cicatriz/patologia , Resultado do Tratamento , Imageamento por Ressonância Magnética/métodos , Taquicardia Ventricular/diagnóstico por imagem , Taquicardia Ventricular/cirurgia , Espectroscopia de Ressonância Magnética , Ablação por Cateter/métodosAssuntos
Doença de Chagas , Taquicardia Ventricular , Humanos , Imageamento por Ressonância Magnética , Endocárdio/diagnóstico por imagem , Endocárdio/cirurgia , Doença de Chagas/complicações , Doença de Chagas/diagnóstico por imagem , Doença de Chagas/cirurgia , Espectroscopia de Ressonância Magnética , Taquicardia Ventricular/diagnóstico por imagem , Taquicardia Ventricular/cirurgiaAssuntos
Cardiomiopatia Chagásica , Doença de Chagas , Taquicardia Ventricular , Humanos , América Latina , Doença de Chagas/complicações , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/radioterapia , Taquicardia Ventricular/cirurgia , Cardiomiopatia Chagásica/radioterapia , Cardiomiopatia Chagásica/cirurgiaRESUMO
The treatment of patients with ST-segment elevation myocardial infarction concomitant with the presence of multivessel disease has been studied in several recent studies with the purpose of defining the need, as well as the best moment to approach residual lesions. However, such studies included only stable patients. The best therapeutic approach to cardiogenic shock secondary to acute coronary syndrome, however, remains controversial, but there are recommendations from specialists for revascularization that include non-event related injuries. Recently published, the CULPRIT-SHOCK study showed benefit of the initial approach only of the injury blamed for the acute event, in view of the multivessel percutaneous intervention, in the context of cardiogenic shock. In this perspective, the authors discuss the work in question, regarding methodological questions, limitations and clinical applicability.
Assuntos
Síndrome Coronariana Aguda/cirurgia , Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Choque Cardiogênico/cirurgia , Síndrome Coronariana Aguda/complicações , Doença da Artéria Coronariana/complicações , Europa (Continente) , Humanos , Revascularização Miocárdica/métodos , Guias de Prática Clínica como Assunto , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Choque Cardiogênico/etiologia , Resultado do TratamentoRESUMO
OBJECTIVE: Hypoparathyroidism is characterized by parathyroid hormone deficiency and hypocalcemia. It has been demonstrated that these patients may also present psychiatric symptoms and decrease of quality of life. The aims of this study were to evaluate the presence of psychopathological symptoms in a cohort of patients with hypoparathyroidism and compare to a control group. SUBJECTS AND METHODS: Patients were submitted to a cross-sectional Symptom Checklist-90-R (SCL-90-R) questionnaire that evaluates psychopathological symptoms by means of the Global Severity Index (GSI), Positive Symptoms Total (PST) and Positive Symptom Distress Index (PSDI). A score based in the positive symptoms was calculated (T-score). The test group was composed of patients with hypoparathyroidism, and control by thyroidectomized patients without hypoparathyroidism. A correlation between the presence of psychological symptoms and clinical features was analyzed. RESULTS: The study included 57 patients with a mean age of 51.1 ± 16.4 years; 20 as a control and 37, test group. There were no differences between groups regarding gender, mean age and age at diagnose. Hypoparathyroidism patients presented higher GSI index than the control group (p = 0.038). Mean T-score of the test group was as elevated as 58.2 ± 5.3 (reference range < 55). No correlation of the number of psychological symptoms to clinical and laboratorial parameters was observed. CONCLUSION: Patients with hypoparathyroidism attending our outpatient clinics presented an increase in the number of self-report of psychological symptoms when compared with a control group. However, no correlation with hypocalcemia and clinical parameters was observed. Future studies are necessary to evaluated if the absence of PTH play a role on it.
Assuntos
Hipoparatireoidismo/psicologia , Qualidade de Vida , Estudos de Casos e Controles , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Hipoparatireoidismo/cirurgia , Masculino , Pessoa de Meia-Idade , Autorrelato , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To identify a clinical profile and laboratory findings of a cohort of hypoparathyroidism patients and determine the prevalence and predictors for renal abnormalities. MATERIALS AND METHODS: Data from medical records of five different visits were obtained, focusing on therapeutic doses of calcium and vitamin D, on laboratory tests and renal ultrasonography (USG). RESULTS: Fifty-five patients were identified, 42 females and 13 males; mean age of 44.5 and average time of the disease of 11.2 years. The most frequent etiology was post-surgical. Levels of serum calcium and creatinine increased between the first and last visits (p < 0.001 and p < 0.05, respectively); and serum levels of phosphate decreased during the same period (p < 0.001). Out of the 55 patients, 40 had USG, and 10 (25%) presented with kidney calcifications. There was no significant difference in the amount of calcium and vitamin D doses among patients with kidney calcifications and others. No correlation between serum and urinary levels of calcium and the presence of calcification was found. Urinary calcium excretion in 24h was significantly higher in patients with kidney calcification (3.3 mg/kg/d) than in those without calcification (1.8 mg/kg/d) (p < 0.05). CONCLUSIONS: The reduction of hypocalcemia and hyperphosphatemia suggest an effectiveness of the treatment, and the increase in serum creatinine demonstrates an impairment of renal function during follow-up. Kidney calcifications were prevalent in this cohort, and higher urinary calcium excretion, even if still within the normal range, was associated with development of calcification. These findings suggest that lower rates of urinary calcium excretion should be aimed for in the management of hypoparathyroidism.
Assuntos
Hipoparatireoidismo/sangue , Pseudo-Hipoparatireoidismo/sangue , Adulto , Calcinose/diagnóstico , Cálcio/sangue , Cálcio/uso terapêutico , Cálcio/urina , Creatinina/sangue , Feminino , Humanos , Hipoparatireoidismo/tratamento farmacológico , Hipoparatireoidismo/etiologia , Nefropatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Nefrocalcinose/complicações , Nefrocalcinose/diagnóstico por imagem , Fosfatos/sangue , Estudos Retrospectivos , Ultrassonografia , Vitamina D/uso terapêuticoRESUMO
BACKGROUND: Capsular contracture is a common occurrence in plastic surgery, with a prevalence varying from 0.5 percent up to 30 percent. Although the standard treatment is capsulectomy, alternative treatments have been studied, such as the use of leukotriene inhibitors. These drugs have recently been evaluated in the prophylaxis of contracture. The authors aimed to assess the efficacy of montelukast (Singulair) in the prevention of capsular contracture in patients undergoing mammaplasty with textured silicone prostheses. METHODS: The authors followed 82 patients (164 breasts) for a minimum of 2 years. Of these, 37 were administered montelukast. RESULTS: The number of affected patients and the severity were higher among the 45 patients who did not use montelukast. CONCLUSION: The prophylactic use of Singulair was, in this sample, shown to be effective in helping to reduce the incidence of capsular contracture. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Assuntos
Acetatos/uso terapêutico , Implantes de Mama/efeitos adversos , Contratura Capsular em Implantes/prevenção & controle , Antagonistas de Leucotrienos/uso terapêutico , Mamoplastia/efeitos adversos , Quinolinas/uso terapêutico , Adolescente , Adulto , Brasil , Estudos de Coortes , Ciclopropanos , Feminino , Seguimentos , Humanos , Modelos Logísticos , Mamoplastia/métodos , Pessoa de Meia-Idade , Análise Multivariada , Prevenção Primária/métodos , Estudos Retrospectivos , Medição de Risco , Sulfetos , Resultado do Tratamento , Adulto JovemAssuntos
Fístula Artério-Arterial/terapia , Doença da Artéria Coronariana/terapia , Fístula Artério-Arterial/diagnóstico por imagem , Doenças Assintomáticas , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Pessoa de Meia-IdadeRESUMO
SUMMARY The treatment of patients with ST-segment elevation myocardial infarction concomitant with the presence of multivessel disease has been studied in several recent studies with the purpose of defining the need, as well as the best moment to approach residual lesions. However, such studies included only stable patients. The best therapeutic approach to cardiogenic shock secondary to acute coronary syndrome, however, remains controversial, but there are recommendations from specialists for revascularization that include non-event related injuries. Recently published, the CULPRIT-SHOCK study showed benefit of the initial approach only of the injury blamed for the acute event, in view of the multivessel percutaneous intervention, in the context of cardiogenic shock. In this perspective, the authors discuss the work in question, regarding methodological questions, limitations and clinical applicability.
RESUMO O tratamento de pacientes com infarto do miocárdio com elevação do segmento ST concomitante à presença de doença multiarterial tem sido estudado em vários estudos recentes com o objetivo de definir a necessidade, bem como o melhor momento, de abordagem das lesões residuais. No entanto, tais estudos incluíam apenas pacientes estáveis. A melhor abordagem terapêutica do choque cardiogênico secundário à síndrome coronariana aguda, no entanto, ainda permanece controversa, havendo porém recomendação de especialistas para uma revascularização que inclua as lesões não relacionadas ao evento. Publicado recentemente, o estudo CULPRIT-SHOCK mostrou benefício da abordagem inicial apenas da lesão culpada pelo evento agudo, perante a intervenção percutânea multiarterial, no contexto do choque cardiogênico. No presente ponto de vista, os autores discutem o trabalho em questão, no que concerne a questões metodológicas, limitações e aplicabilidade clínica.
Assuntos
Humanos , Choque Cardiogênico/cirurgia , Doença da Artéria Coronariana/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Síndrome Coronariana Aguda/cirurgia , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Choque Cardiogênico/etiologia , Doença da Artéria Coronariana/complicações , Resultado do Tratamento , Guias de Prática Clínica como Assunto , Europa (Continente) , Síndrome Coronariana Aguda/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Revascularização Miocárdica/métodosRESUMO
ABSTRACT Objective: Hypoparathyroidism is characterized by parathyroid hormone deficiency and hypocalcemia. It has been demonstrated that these patients may also present psychiatric symptoms and decrease of quality of life. The aims of this study were to evaluate the presence of psychopathological symptoms in a cohort of patients with hypoparathyroidism and compare to a control group. Subjects and methods: Patients were submitted to a cross-sectional Symptom Checklist-90-R (SCL-90-R) questionnaire that evaluates psychopathological symptoms by means of the Global Severity Index (GSI), Positive Symptoms Total (PST) and Positive Symptom Distress Index (PSDI). A score based in the positive symptoms was calculated (T-score). The test group was composed of patients with hypoparathyroidism, and control by thyroidectomized patients without hypoparathyroidism. A correlation between the presence of psychological symptoms and clinical features was analyzed. Results: The study included 57 patients with a mean age of 51.1 ± 16.4 years; 20 as a control and 37, test group. There were no differences between groups regarding gender, mean age and age at diagnose. Hypoparathyroidism patients presented higher GSI index than the control group (p = 0.038). Mean T-score of the test group was as elevated as 58.2 ± 5.3 (reference range < 55). No correlation of the number of psychological symptoms to clinical and laboratorial parameters was observed. Conclusion: Patients with hypoparathyroidism attending our outpatient clinics presented an increase in the number of self-report of psychological symptoms when compared with a control group. However, no correlation with hypocalcemia and clinical parameters was observed. Future studies are necessary to evaluated if the absence of PTH play a role on it.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Qualidade de Vida , Hipoparatireoidismo/psicologia , Estudos de Casos e Controles , Estudos Transversais , Inquéritos e Questionários , Estudos de Coortes , Autorrelato , Hipoparatireoidismo/cirurgiaRESUMO
ABSTRACT Objectives To identify a clinical profile and laboratory findings of a cohort of hypoparathyroidism patients and determine the prevalence and predictors for renal abnormalities. Materials and methods Data from medical records of five different visits were obtained, focusing on therapeutic doses of calcium and vitamin D, on laboratory tests and renal ultrasonography (USG). Results Fifty-five patients were identified, 42 females and 13 males; mean age of 44.5 and average time of the disease of 11.2 years. The most frequent etiology was post-surgical. Levels of serum calcium and creatinine increased between the first and last visits (p < 0.001 and p < 0.05, respectively); and serum levels of phosphate decreased during the same period (p < 0.001). Out of the 55 patients, 40 had USG, and 10 (25%) presented with kidney calcifications. There was no significant difference in the amount of calcium and vitamin D doses among patients with kidney calcifications and others. No correlation between serum and urinary levels of calcium and the presence of calcification was found. Urinary calcium excretion in 24h was significantly higher in patients with kidney calcification (3.3 mg/kg/d) than in those without calcification (1.8 mg/kg/d) (p < 0.05). Conclusions The reduction of hypocalcemia and hyperphosphatemia suggest an effectiveness of the treatment, and the increase in serum creatinine demonstrates an impairment of renal function during follow-up. Kidney calcifications were prevalent in this cohort, and higher urinary calcium excretion, even if still within the normal range, was associated with development of calcification. These findings suggest that lower rates of urinary calcium excretion should be aimed for in the management of hypoparathyroidism.