Assuntos
Circulação Assistida/instrumentação , Circulação Assistida/normas , Oxigenação por Membrana Extracorpórea/instrumentação , Oxigenação por Membrana Extracorpórea/normas , Coração Auxiliar , Circulação Assistida/métodos , Brasil , Oxigenação por Membrana Extracorpórea/métodos , Insuficiência Cardíaca/terapia , Humanos , Fatores de Risco , Sociedades MédicasRESUMO
OBJECTIVE: To determine the risk factors for mortality related to myocardial revascularization when performed in association with coronary endarterectomy. METHODS: We assessed retrospectively 353 patients who underwent 373 coronary endarterectomies between January '89 and November '98, representing 3.73% of the myocardial revascularizations in this period of time. The arteries involved were as follows: right coronary artery in 218 patients (58.45%); left anterior descending in 102 patients (27.35%); circumflex artery in 39 patients (10.46%); and diagonal artery in 14 patients (3.74%). We used 320 (85.79%) venous grafts and 53 (14.21%) arterial grafts. RESULTS: In-hospital mortality among our patients was 9.3% as compared with 5.7% in patients with myocardial revascularizations without endarterectomy (p=0.003). Cause of death was related to acute myocardial infarction in 18 (54.55%) patients. The most significant risk factors for mortality identified were as follows: diabetes mellitus (p=0.001; odds ratio =7.168), left main disease (<0.001; 9.283), female sex (0.01; 3.111), acute myocardial infarction (0.02; 3.546), ejection fraction <35% (<0.001; 5.89), and previous myocardial revascularization (<0.001; 4.295). CONCLUSION: Coronary endarterectomy is related to higher mortality, and the risk factors involved are important elements of a poor outcome.
Assuntos
Vasos Coronários/cirurgia , Endarterectomia/mortalidade , Revascularização Miocárdica/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/mortalidade , Causas de Morte , Endarterectomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/mortalidade , Revascularização Miocárdica/métodos , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Choque Cardiogênico/mortalidadeRESUMO
OBJECTIVE: The aim of this work was the follow-up and evaluation of valve replacement in children under 12 years of age. METHODS: Forty-four children less than 12 years old were underwent valve replacement at INCOR-HCFMUSP between January 1986 and December 1992. Forty (91%) were rheumatic, 39 (88.7%) were in functional classes II or IV, 19 (43.2%) were operated upon on an emergency basis, and 6 (13.6%) had atrial fibrillation. Biological prostheses (BP) were employed in 26 patients (59.1%), and mechanical prostheses (MP) in 18 (40.9%). Mitral valves were replaced in 30 (68.7%), aortic valves in 8 (18.2%), a tricuspid valve in 1 (2.3%), and double (aortic and mitral) valves in 5 (11.4) of the patients. RESULTS: Hospital mortality was of 4.5% (2 cases). The mean follow-up period was 5.8 years. Re-operations occurred in 63.3% of the patients with BP and in 12.5% of those with MP (p=0.002). Infectious endocarditis was present in 26.3% of the BP, but in none of the cases of MP (p=0.049). Thrombosis occurred in 2 (12.5%) and hemorrhage in one (6.5%) of the patients with a MP. Delayed mortality occurred in 5 (11.9%) of the patients over a mean period of 2.6 years; four had had BP and one had a MP (NS). Actuarial survival and re-operation-free curves after 10 years were respectively, 82.5+/-7.7 (SD)% and 20.6+/-15.9%. CONCLUSION: Patients with MP required fewer re-operation, had less infectious endocarditis and lower late mortality rates compared with patients with bioprostheses. The former, therefore, appear to be the best valve replacement for pediatric patients.
Assuntos
Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Fibrilação Atrial/cirurgia , Bioprótese , Criança , Pré-Escolar , Feminino , Seguimentos , Doenças das Valvas Cardíacas/etiologia , Doenças das Valvas Cardíacas/mortalidade , Humanos , Masculino , Reoperação , Estudos Retrospectivos , Febre Reumática/complicações , Resultado do TratamentoRESUMO
Heterotopic gastric mucosa situated in the small bowel distal to the Treitz suspensory ligament is very rare, except in Meckel's diverticulum and in intestinal duplications. There are two forms of this disease, congenital and acquired. The former is secondary to inflammatory bowel disease. The main difference between these forms is histological, although determining diverse physiopathological aspects. A case of a 34 year old man with heterotopic gastric mucosa in the terminal ileum manifested by intestinal obstruction is reported. He was treated surgically by enterectomy of two small bowel segments, both reconstructed by primary suture. His postoperative course was remarkable. The histopathologic study showed a typical pattern of the acquired type because of the presence of antral the antral mucosa and intense fibrosis. That is probably related to intestinal tuberculosis, but was not histologically confirmed. Individual and family recent history of pulmonary tuberculosis corroborates the suspicion. This is a unique report in the literature, among 28 other heterotopic gastric mucosa situated in the jejunum and ileum.
Assuntos
Coristoma/diagnóstico , Mucosa Gástrica/patologia , Doenças do Íleo/diagnóstico , Obstrução Intestinal/diagnóstico , Adulto , Coristoma/etiologia , Humanos , Doenças do Íleo/etiologia , Obstrução Intestinal/etiologia , Masculino , Tuberculose Gastrointestinal/complicaçõesRESUMO
A mucosa gástrica ectópica localizada no intestino delgado, distal ao ligamento de Treitz é muito rara, excetuando-se a encontrada habitualmente no divertículo de Meckel e na duplicaçao intestinal. Existem formas congênita e adquirida, sendo esta última secundária à processos inflamatórios intestinais. As diferenças entre estas formas sao basicamente histológicas, determinando no entanto aspectos fisiopatológicos distintos. Apresentamos caso de mucosa gástrica ectópica em paciente de 34 anos de idade, manifestada por obstruçao do íleo terminal. Submetido a duas enterectomias e anastomoses primárias, apresentou boa evoluçao pós-operatória. O aspecto histopatológico, típico da forma adquirida com mucosa antral e intensa fibrose, foi provavelmente relacionado à quadro recente de tuberculose intestinal, porém nao confirmada histologicamente. O antecedente de tuberculose pulmonar recente na família, aliado à linfoadenomegalia mesentérica encontrada a operaçao, sustentam tal suspeita. Este é fato inédito na literatura dentre as outras 28 publicaçoes de heterotopia gástrica no jejuno e íleo.
Assuntos
Adulto , Humanos , Masculino , Tuberculose Gastrointestinal/complicações , Coristoma/diagnóstico , Mucosa Gástrica/patologia , Doenças do Íleo/diagnóstico , Obstrução Intestinal/diagnóstico , Coristoma/etiologia , Coristoma/patologia , Doenças do Íleo/etiologia , Doenças do Íleo/patologia , Obstrução Intestinal/etiologia , Obstrução Intestinal/patologiaRESUMO
The authors report a case of a 25 year old Brazilian man with a history of crampy abdominal pain in the left iliac fossa for 2 weeks, abdominal distention, mucous diarrhea and anorexia. The patient presented signs of hemodynamic instability and a hard mass palpated in the left iliac fossa presented peritoneal irritation. At laparotomy, fecal peritonitis and a punched-out perforation of the midsigmoid colon were found. A left hemicolectomy was performed with terminal colostomy. Specimen examination revealed a thickened rectosigmoid wall, narrow lumen and multiple mucosal polyps. Microscopically, chronic granulomatous colitis with Schistosoma mansoni eggs confirmed the etiology. To the authors' knowledge, this is the first case of obstruction complicated with perforation due to mansoni schistosomiasis reported in the literature.
Assuntos
Doenças do Colo/complicações , Obstrução Intestinal/complicações , Perfuração Intestinal/etiologia , Esquistossomose mansoni/complicações , Adulto , Animais , Humanos , Obstrução Intestinal/parasitologia , Masculino , Schistosoma mansoni/isolamento & purificação , Doenças do Colo Sigmoide/etiologia , Doenças do Colo Sigmoide/parasitologiaRESUMO
A 4 year old patient with congenital rubella syndrome, confirmed serologically, presents with neurosensorial deafness and a rare association of cardiac anomalies: supravalvar and valvar aortic stenosis and subvalvar pulmonary stenosis. Bidimensional echocardiography and angiography confirmed the diagnosis and the surgical treatment was successful. Due to the presence of somatic characteristics of Williams's syndrome, mental retardation and supraortic stenosis, the authors postulate that there is a coexistence of clinical syndromes responsible for the malformations of this case. This fact is rare on clinical settings, requiring accurate diagnosis and treatment.