RESUMO
The authors made a retrospective study of 72 patients with myelomeningocele treated at a pediatric hospital in Rio de Janeiro, Brazil. 65 (90.2%) lesions involved the inferior segments of the spine and 87.5% of the patients needed shunt procedures for hydrocephalus control. Shunt infections in spina bifida cystica patients were more frequent than in any other group of hydrocephalic patients treated at the institution. There was a great incidence of postoperative complications such as wound infections and skin necrosis. 11 (15.3%) patients developed signs and symptoms related to Chiari II malformation. The overall mortality was 8.3%, and in most of the cases, ascribed to the Chiari malformation.
RESUMO
Myelomeningocele is the most common congenital malformation of the nervous system and despite its complexity and involvement of multiple organs is compatible with long survival. The peculiar characteristics of this malformation expose myelomeningocele patients to acute and chronic care problems with effects in quality of survival. In order to evaluate the quality of the follow-up of spina bifida patients in a pediatric hospital, the authors examined 54 patients attending the neurosurgical outpatient unity of a pediatric hospital. The lack of a multidisciplinary spina bifida clinic in Rio de Janeiro forced the patients to pursuit for complimentary medical and paramedical care outside the hospital with significant effects in the quality of survival. In consequence, only 25% of the patients were able to walk and community ambulation was nearly absent. Only 66.6% had a regular rehabilitation program and nearly 50% had routine orthopedics consultations. Almost half of the patients had no urological referral at all and 75% were incontinent, with recurrent urinary infections ranging 72.2%. The rates of neurosurgical complications were similar to those observed in the literature. We concluded that the quality of survival of patients with neural tube defects is strongly influenced by the adverse socio-economical conditions and the lack of a spina bifida multidisciplinary clinic.
Assuntos
Assistência Ambulatorial , Meningomielocele/terapia , Adolescente , Brasil , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Locomoção , Masculino , Meningomielocele/fisiopatologia , Qualidade de Vida , Ajustamento Social , Fatores Socioeconômicos , Incontinência UrináriaRESUMO
In 12 patients with sinus rhythm (including 5 children and 6 young women), mitral valve replacement was performed with a microporous-surfaced valve similar to the Björk-Shiley Monostrut. After the first 3 months, permitting endothelialization of the suture ring to continue over the groove and adjacent metal valve ring, no long-term anticoagulant treatment was given. There was no thromboembolic complication in this group during follow-up for 6-8 years, during which four women gave birth to a total of seven children. In eight other cases, one mitral case with atrial fibrillation, anti-coagulant was not discontinued, and in the remaining aortic cases it was reinstituted. One of them (with atrial fibrillation) had hematuria during inadequate anticoagulant medication, but no thromboembolism. Of five patients with only aortic valve replacement, two had thromboembolic complications, one without residual symptoms and one with slight hand weakness. Another had a transient ischemic attack while on anticoagulant and acetylsalicylic acid was added. Two patients with aortic and mitral valve replacement died, one from heart tamponade and the other from venous thrombosis with pulmonary embolism.
Assuntos
Anticoagulantes/uso terapêutico , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas , Adolescente , Adulto , Anticoagulantes/administração & dosagem , Criança , Feminino , Seguimentos , Doenças das Valvas Cardíacas/tratamento farmacológico , Próteses Valvulares Cardíacas/métodos , Heparina/uso terapêutico , Humanos , Masculino , Valva Mitral , Projetos Piloto , Complicações Pós-Operatórias/prevenção & controle , Desenho de Prótese , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Resultado do Tratamento , Varfarina/uso terapêuticoRESUMO
An 8-year-old black boy with sickle cell disease and severe hemolytic anemia crisis (95% hemoglobin S) also had mitral incompetence due to rheumatic valve disease. A 27 mm monostrut Björk-Shiley valve prosthesis was implanted after partial exchange transfusions had reduced the hemoglobin S to less than 40%. High-flow normothermic perfusion was used during extracorporeal circulation, with care taken to avoid hypoxia and acidosis. Postoperative recovery was uneventful.
Assuntos
Anemia Falciforme/complicações , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Anemia Falciforme/sangue , Criança , Ecocardiografia Doppler , Transfusão Total , Hemoglobina Falciforme/análise , Humanos , Masculino , Valva Mitral , Insuficiência da Valva Mitral/sangue , Insuficiência da Valva Mitral/complicaçõesRESUMO
A review is presented of 20 patients consecutively operated on for acute valvular endocarditis. The diagnosis was established from at least two of the criteria: (a) typical clinical features, (b) two blood cultures positive for the same causal microorganism, and (c) echocardiographic evidence of vegetations. In all cases there was histologic evidence of active infection in the surgical specimen. Only three of the 20 patients had no previous cardiac disease. The most common causal agent was Staphylococcus aureus. The indications for surgery were refractory cardiac failure or infection (18 and 2 cases, respectively). Aortic valve replacement was performed in 16 of the 20 cases, suggesting that aortic valvulopathy aggravates the course of infective endocarditis and increases the risk of heart failure. The overall mortality rate was 30%. All surviving patients were infection-free at postoperative bacteriologic follow-up. Surgery is considered to be the management of choice in active valvular, therapy-resistant bacterial endocarditis with or without cardiac failure.