RESUMO
INTRODUCTION: Limited information exists on the prevalence and outcomes of patients undergoing surgical aortic valve replacement (SAVR) for aortic stenosis (AS) with reduced left ventricular ejection fraction (LVEF). This study aims to describe the number of AS patients undergoing SAVR with LVEF less than 55 % and quantify LVEF improvement at follow-up. MATERIAL AND METHODS: We analyzed patients undergoing SAVR with LVEF less than 55 % and the number of patients that improved the LVEF at 6 months. We defined 'improved LVEF' as a 10 % increase of LVEF compared to baseline. RESULTS: Out of 685 patients, 11.4 % (n = 78) had SAVR with LVEF <55 %. The median pre-surgery LVEF was 45 % [IQR 37-51]. In-hospital mortality was 5.1 % (n = 4). Follow-up data for 69 patients showed 50.7 % (n = 35) had improved LVEF. CONCLUSIONS: In our cohort, 10 % of severe AS patients underwent SAVR with LVEF <55 %, with half showing LVEF improvement at follow-up.
Assuntos
Estenose da Valva Aórtica , Valva Aórtica , Implante de Prótese de Valva Cardíaca , Volume Sistólico , Humanos , Masculino , Feminino , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/epidemiologia , Volume Sistólico/fisiologia , Idoso , Implante de Prótese de Valva Cardíaca/métodos , Prevalência , Seguimentos , Valva Aórtica/cirurgia , Valva Aórtica/fisiopatologia , Função Ventricular Esquerda/fisiologia , Mortalidade Hospitalar/tendências , Resultado do Tratamento , Estudos Retrospectivos , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/epidemiologia , Pessoa de Meia-Idade , Idoso de 80 Anos ou maisRESUMO
The objectives of this study were to determine: a) the agreement between postmortem endometrial cytology, uterine biopsy and presence of intrauterine fluid in apparently normal genital tracts collected from culled dairy cows; b) the agreement between results obtained from paired uterine horns using the different diagnosis methods; and c) the microorganisms isolated from uteri with cytological endometritis. One hundred grossly normal genital tracts from Holstein cows were collected at a local slaughterhouse. Samples for cytology, histopathology and bacteriology were obtained from both uterine horns, and presence of any intrauterine content was determined after opening the tracts. Cut-off values used for positive cytology were ≥5% PMN (polymorphonuclear neutrophils). Data were analyzed by ROC curve analysis, Cohens Kappa method and Chi-square tests. Presence of inflammatory infiltrate and its endometrial distribution were the only histological parameters significantly correlated with cytology results (AUC: 0.780 and 0.694, respectively). Agreement between histology and cytology was moderately high for presence of infiltrate (kappa = 0.55) and low for infiltrate distribution (kappa = 0.33). Other histological parameters (status of endometrial epithelium, endometrial glands or fibrosis), intrauterine content or bacteriology were not correlated with cytology. Presence of intrauterine content was significantly (P = 0.036) related with biopsy results. Moderately high agreement was observed between paired uterine horns for cytology (kappa = 0.65) and biopsy (kappa = 0.74). Bacteriology was not related with cytology or biopsy, but different bacteria were isolated from cytology negative or positive uteri. It was concluded that endometrial cytology, although less sensitive than biopsy, is a useful tool for diagnosing subclinical endometrial inflammation.
Assuntos
Feminino , Animais , Bovinos , Abate de Animais , Biópsia/veterinária , Bovinos/anatomia & histologia , Bovinos/embriologia , Endométrio/anatomia & histologia , Endométrio/citologiaRESUMO
The objectives of this study were to determine: a) the agreement between postmortem endometrial cytology, uterine biopsy and presence of intrauterine fluid in apparently normal genital tracts collected from culled dairy cows; b) the agreement between results obtained from paired uterine horns using the different diagnosis methods; and c) the microorganisms isolated from uteri with cytological endometritis. One hundred grossly normal genital tracts from Holstein cows were collected at a local slaughterhouse. Samples for cytology, histopathology and bacteriology were obtained from both uterine horns, and presence of any intrauterine content was determined after opening the tracts. Cut-off values used for positive cytology were ≥5% PMN (polymorphonuclear neutrophils). Data were analyzed by ROC curve analysis, Cohens Kappa method and Chi-square tests. Presence of inflammatory infiltrate and its endometrial distribution were the only histological parameters significantly correlated with cytology results (AUC: 0.780 and 0.694, respectively). Agreement between histology and cytology was moderately high for presence of infiltrate (kappa = 0.55) and low for infiltrate distribution (kappa = 0.33). Other histological parameters (status of endometrial epithelium, endometrial glands or fibrosis), intrauterine content or bacteriology were not correlated with cytology. Presence of intrauterine content was significantly (P = 0.036) related with biopsy results. Moderately high agreement was observed between paired uterine horns for cytology (kappa = 0.65) and biopsy (kappa = 0.74). Bacteriology was not related with cytology or biopsy, but different bacteria were isolated from cytology negative or positive uteri. It was concluded that endometrial cytology, although less sensitive than biopsy, is a useful tool for diagnosing subclinical endometrial inflammation.(AU)
Assuntos
Animais , Feminino , Bovinos , Bovinos/anatomia & histologia , Bovinos/embriologia , Endométrio/anatomia & histologia , Endométrio/citologia , Abate de Animais , Biópsia/veterináriaRESUMO
La incidencia de fractura de cadera ha aumentado, por envejecimiento de la población e incremento de su prevalencia en áreas urbanas. Cuando se presenta en pacientes centenarios, resulta un desafío quirúrgico del cual poco se ha reportado. El objetivo del presente trabajo es estudiar una pequeña casuística de ellos. Pacientes y método: se definió como paciente centenario, quien al presentar fractura de cadera tuviera 99 años cumplidos. Ellos fueron operados si su daño orgánico cerebral era leve, si no estaban postrados y no portaban patologías limitantes de su rehabilitación o sobrevida a 1año. Se revisó retrospectivamente la casuística del Servicio de Traumatología, entre 01/04/1999 y 3 1/03/2006. Se comparó sobrevida con datos estadísticos de población centenaria general en periodo estudiado. Resultados: se efectuaron 8 operaciones a seis pacientes, todas mujeres, edad promedio 100.2 años (rango 99-102). La comorbilidad más frecuente fue hipertensión arterial (3 de 6 casos) e infección urinaria ( 3/6). No hubo diabetes mellitus. En todos se usó anestesia raquídea, la cirugía consistió en reducción más inserción de tornillo dinámico de cadera en 5 casos, placa de compresióndinámica en 2 y prótesis parcial en una paciente. El promedio de hospitalización postoperatoria total fue 13,1 días (rango 5- 25), 2 presentaron complicaciones, no hubo mortalidad hospitalaria. La sobrevida fue similar a población general de igual edad sin fractura. Los resultados obtenidos permiten concluir que es posible abordar en nuestro medio, el desafío ético que significa tratar quirúrgicamente fracturas de caderas en pacientes centenarios.
The incidence of hip fracture has increased, due to population aging and augmentation of prevalence in urban areas. Centenarian patients suffering from hip fracture are a surgical challenge, with limited reporting in medical literature. The purpose of this paper is to communicate the results of small groupof them. Patients and method: all patients older than 99 year old were considered as centenarians.They were operated only if they did not suffer from dementia, prostration or limiting severe diseases that could diminish one year survival or full rehabilitation. Their record and chinical folder were studied retrospectively from 01/04/1999 until 31/03/2006 and survival compared with general centenarian population during the same period. Results: six patients underwent 8 operations, all were female, mean age 100,2 years (range 99-102). Three of 6 suffered from hipertensión, 3/6 from urinary infection. No diabetes was found. Surgery was done under regional anaesthesia, in 5 operations a dynamic hip screw was implanted, dynamic compression plate in 2 and parcial prosthesis was used in other. The average total postoperative time in the hospital was 13,1 days (range 5-25), 2 patients suffered from postoperative complications. There were no intrahospital mortality and survival was similar to the general centenarian population with no hip fractures. In view of this results, it is nowadays reasonable to face the ethical challenge to operate hip fractures in centenarian patients.