Assuntos
Encefalopatia Hepática/líquido cefalorraquidiano , Falência Hepática Aguda/líquido cefalorraquidiano , Testes de Função Hepática , Transplante de Fígado , Alanina Transaminase/sangue , Alanina Transaminase/líquido cefalorraquidiano , Aspartato Aminotransferases/sangue , Aspartato Aminotransferases/líquido cefalorraquidiano , Colesterol/sangue , Colesterol/líquido cefalorraquidiano , Encefalopatia Hepática/sangue , Encefalopatia Hepática/fisiopatologia , Humanos , L-Lactato Desidrogenase/sangue , L-Lactato Desidrogenase/líquido cefalorraquidiano , Falência Hepática Aguda/sangue , Falência Hepática Aguda/fisiopatologia , Prognóstico , Triglicerídeos/sangue , Triglicerídeos/líquido cefalorraquidianoAssuntos
Hemodinâmica , Transplante de Fígado , Contração Miocárdica , Volume Sistólico , Função Ventricular Direita , Adulto , Elasticidade , Feminino , Humanos , Transplante de Fígado/métodos , Transplante de Fígado/fisiologia , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Resistência VascularRESUMO
OBJECTIVE: To determine the predictor factors of in-hospital postoperative mortality in patients presenting with symptomatic but not ruptured abdominal aortic aneurysm (AAA) at our institution. PATIENTS AND METHODS: Forty-two patients who underwent urgent open repair for symptomatic, non-ruptured AAA were evaluated retrospectively. RESULTS: Five patients (11.9%) died during the in-hospital stay. History of coronary artery disease (p=0.014), cerebrovascular diseases (p=0.015), renal failure according to Glasgow Aneurysm Score (GAS) criteria (p=0.001), serum creatinine concentration (p=0.026), and the GAS (p=0.008) were predictive of postoperative death. The ROC curve analysis showed that the Glasgow Aneurysm Score had an area under the curve of 0.870 (95%C.I. 0.71-1, S.E. 0.08, p=0.008), and its best cut-off value in predicting postoperative death was 90.0 (specificity 89.2%, sensitivity 80.0%). The postoperative mortality rate of patients with a Glasgow Aneurysm Score below 90 was 2.9%, whereas it was 50% for those with a score >or=90 (p=0.003, O.R. 33.0). CONCLUSION: This study shows that the Glasgow Aneurysm Score is a good predictor of postoperative mortality and morbidity after urgent repair of symptomatic, non-ruptured AAA and can be useful in identifying those patients whose operative risk is prohibitive. Its simplicity makes it a clinically important tool, particularly, in the emergency setting. Patients having a score less than 90 can safely undergo urgent open repair. Thorough evaluation and improvement of preoperative status followed preferably by an endovascular repair is indicated for those with a score >or=90.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Cirúrgicos Vasculares , Idoso , Serviços Médicos de Emergência , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversosRESUMO
We measured the plasma levels of atrial natriuretic factor (ANF) during orthotopic liver transplantation (OLT) in eight adult patients with cirrhosis and ascites. The aim of this study was to determine whether significant differences in ANF concentration may be detected during the individual phases of OLT and to correlate these changes with hemodynamics. In each patient a hemodynamic assessment was achieved using a Swan-Ganz fiber optic catheter for continuous monitoring of cardiac output (CO), systemic vascular resistance index (SVRI), right filling pressure as assessed by central venous pressure (CVP), and left filling pressure by means of pulmonary arterial wedge pressure (PAWP). During reperfusion a clear-cut increase in ANF values was observed (P < 0.05). Concurrently, an increase in CVP (P < 0.05) and a decrease in SVRI were observed without any significant increase in diuresis. These data suggest that ANF might play a role in the development of the reperfusion syndrome.