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La apoplejía hipofisaria es un evento infrecuente, especialmente en el embarazo, con pocos casos reportados en la literatura. Se presenta secundario a infartos hemorrágicos por cambios vasculares en un tumor hipofisario. Se puede manifestar con cambios hormonales cuando es secundario a tumores funcionantes o con síntomas neurológicos cuando ejerce efecto de masa en el caso de los tumores no funcionantes. El diagnóstico es por sospecha clínica, principalmente ante síntomas que sugieren efecto masa con compromiso neurológico y visual. Estudios como pruebas de función hormonal y resonancia magnética del cerebro son herramientas para confirmar la patología. Se describe el caso de una paciente de 30 años con embarazo de 28 semanas que presentó cefalea asociado a síntomas visuales que progresaron durante la gestación, con diagnóstico de apoplejía hipofisaria se presenta el abordaje clínico y opciones de manejo que buscaron preservar la viabilidad fetal e integridad materna. (provisto por Infomedic International)
Pituitary apoplexy is a rare event, especially in pregnancy, with few cases reported in the literature. It occurs secondary to hemorrhagic infarcts due to vascular changes in a pituitary tumor. It may manifest with hormonal changes when secondary to functioning tumors or with neurological symptoms when it exerts mass effect in the case of non-functioning tumors. The diagnosis is based on clinical suspicion, mainly in the presence of symptoms suggesting mass effect with neurological and visual involvement. Studies such as hormone function tests and brain MRI are tools to confirm the pathology. We describe the case of a 30-year-old patient with a 28-week pregnancy who presented headache associated with visual symptoms that progressed during gestation, with a diagnosis of pituitary apoplexy, the clinical approach and management options that sought to preserve fetal viability and maternal integrity are presented. (provided by Infomedic International)
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Las várices gástricas (VG) son un complejo de colaterales vasculares entre la circulación portal y sistémica, condición que se desarrolla como resultado de la presión elevada en el sistema venoso portal. Se encuentran en el 20 % de los pacientes con cirrosis, y son menos frecuentes que las várices esofágicas. Según la clasificación de Sarin, las VG se dividen en cuatro tipos según su ubicación en el estómago y su relación con las várices esofágicas (GOV1, GOV2, IGV1 e IGV2). Entender su hemodinámica con respecto a las rutas de drenaje de las VG es importante para guiar su tratamiento.
Gastric varices (GV) are a complex of vascular collaterals between portal and systemic circulation, a condition that develops as a result of elevated pressure in the portal venous system. They are found in 20% of patients with cirrhosis, and are less common than esophageal varices. According to the Sarin classification, GV are divided into four types based on their location in the stomach and their relationship with esophageal varices (GOV1, GOV2, IGV1, and IGV2). Understanding their hemodynamics with respect to GV drainage routes is important to guide their treatment.
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A hemofilia por deficiência do fator XIII é uma doença que possui inúmeros riscos em cirurgia ou procedimentos invasivos, sendo o maior deles, a hemorragia. Na odontologia, para o profissional realizar procedimentos cirúrgicos em pacientes hemofílicos precisa estar capacitado com conhecimento teórico-prático de como realizar o pré, trans e pós-operatório, a fim de amenizar possíveis riscos e trazer segurança para o paciente e para ele. O presente estudo visa relatar uma exodontia em um paciente portador de hemofilia com deficiência do fator XIII, na Clínica Escola de Odontologia do Instituto Esperança de Ensino Superior (IESPES), objetivando trazer informações relacionadas à essa disfunção sanguínea e a conduta do cirurgião-dentista para um bom manejo odontológico neste grupo de pacientes.
Factor XIII hemophilia is a disease that poses several risks in surgery or invasive procedures, the greatest of which is hemorrhage. In dentistry, for the professional to perform surgical procedures in hemophilia patients need to be trained with theoretical and practical knowledge of how to perform the pre, trans and postoperative, in order to mitigate possible risks and bring safety for the patient and for him. The present study aims to report an exodontia in a patient with hemophilia with factor XIII deficiency in the Clínica Escola de Odontologia do Instituto Esperança de Ensino Superior (IESPES), aiming to bring information related to this blood dysfunction and the dental surgeon's conduct for a good dental management in patients affected by this pathology.
Assuntos
Humanos , Masculino , Adolescente , Cirurgia Bucal , Padrões de Prática Odontológica , Hemofilia A , HemorragiaRESUMO
Coagulation management in the patient with cirrhosis has undergone a significant transformation since the beginning of this century, with the concept of a rebalancing between procoagulant and anticoagulant factors. The paradigm that patients with cirrhosis have a greater bleeding tendency has changed, as a result of this rebalancing. In addition, it has brought to light the presence of complications related to thrombotic events in this group of patients. These guidelines detail aspects related to pathophysiologic mechanisms that intervene in the maintenance of hemostasis in the patient with cirrhosis, the relevance of portal hypertension, mechanical factors for the development of bleeding, modifications in the hepatic synthesis of coagulation factors, and the changes in the reticuloendothelial system in acute hepatic decompensation and acute-on-chronic liver failure. They address new aspects related to the hemorrhagic complications in patients with cirrhosis, considering the risk for bleeding during diagnostic or therapeutic procedures, as well as the usefulness of different tools for diagnosing coagulation and recommendations on the pharmacologic treatment and blood-product transfusion in the context of hemorrhage. These guidelines also update the knowledge regarding hypercoagulability in the patient with cirrhosis, as well as the efficacy and safety of treatment with the different anticoagulation regimens. Lastly, they provide recommendations on coagulation management in the context of acute-on-chronic liver failure, acute liver decompensation, and specific aspects related to the patient undergoing liver transplantation.
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Insuficiência Hepática Crônica Agudizada , Transtornos da Coagulação Sanguínea , Humanos , Insuficiência Hepática Crônica Agudizada/complicações , Transtornos da Coagulação Sanguínea/complicações , Transtornos da Coagulação Sanguínea/terapia , Cirrose Hepática/complicações , Cirrose Hepática/terapia , Coagulação Sanguínea , HemostasiaRESUMO
RESUMEN Objetivo: Evaluar el riesgo de complicaciones maternas en el embarazo adolescente en Latinoamérica y El Caribe durante el periodo 2012 al 2021. Métodos: Se realizó una búsqueda sistemática en 6 bases de datos: PubMed, SCOPUS, Web Of Science, EMBase, LILACS y Scielo. Los artículos incluidos fueron procedentes de paises de Latinoamérica y contaron con cualquiera de las siguientes variables: preeclampsia, eclampsia, hemorragia puerperal y sepsis puerperal publicados desde el 2012 al 2021 y que compararan adolescentes y adultas embarazadas. Se excluyeron artículos que no presentaron hallazgos separados de Latinoamérica y/o El Caribe, que no se encontraban disponibles la versión completa y que estaban enfocados en pacientes con alguna enfermedad en específico. Para el riesgo de sesgo se empleó la Escala de Newcasttle-Ottawa para estudios de casos y controles. La medida de resumen empleada fue el Odds Ratio con un intervalo de confianza al 95% para cada estudio. Resultados: Se incluyeron 4 estudios. No se evidenció el riesgo de preeclampsia en adolescentes embarazadas (OR = 0.93, IC 95% 0.69 - 1.25) ni hemorragia puerperal (OR = 0.86, IC 95% 0.74 - 0.99). Por otro lado, se mostró el riesgo de eclampsia (OR = 2.43, IC 95% 1.29 - 4.58) en adolescentes embarazadas, pero con alta heterogeneidad entre los estudios (I2 = 76%). Conclusiones: Se evidenció un riesgo de eclampsia en adolescentes embarazadas, pero no en preeclampsia ni hemorragia puerperal; sin embargo, estos resultados deben de tomarse con cautela. Registro de protocolo: CRD42021286725 (PROSPERO)
ABSTRACT Objective: To assess whether maternal complications are a risk in adolescent pregnancy in Latin America and the Caribbean during the period 2012 to 2021. Methods: A systematic search was carried out in 6 databases: PubMed, SCOPUS, Web of Science, EMBase, LILACS and Scielo. The articles included were from Latin American countries and had any of the following variables: preeclampsia, eclampsia, puerperal hemorrhage and puerperal sepsis published from 2012 to 2021 and comparing pregnant adolescents and adults. Articles that did not present separate findings from Latin America and/or the Caribbean, that the full version was not available, and that were focused on patients with a specific disease were excluded. For risk of bias, the Newcastle-Ottawa Scale Case-Control Studies was used. The summary measure used was the Odds Ratio with a 95% confidence interval for each study. Results: 4 studies were included. The risk of preeclampsia in pregnant adolescents and postpartum hemorrhage (OR = 0.86, 95% CI 0.74 - 0.99) were not evidenced (OR = 0.93, 95% CI 0.69 - 1.25). On the other hand, the risk of eclampsia (OR = 2.43, 95% CI 1.29 - 4.58) in pregnant adolescents was shown, but with high heterogeneity between studies (I2 = 76%). Conclusions: A risk of eclampsia was evidenced in pregnant adolescents, but not in preeclampsia nor postpartum hemorrhage. However, these results should be taken with caution. Protocol record: CRD42021286725 (PROSPERO)
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RESUMEN Se describe el caso de un varón de 65 años con diarrea crónica, equimosis palpebral y hemolacria. Se realizaron estudios de laboratorio, biopsia y análisis inmunohistoquímico para confirmar el diagnóstico. La variable dependiente fue el diagnóstico confirmado de amiloidosis AL, mientras que las variables independientes incluyeron los síntomas clínicos y los resultados de las pruebas diagnósticas. Se emplearon técnicas descriptivas para analizar los datos clínicos y de laboratorio. El paciente presentó diarrea crónica sin respuesta al tratamiento convencional, equimosis palpebral y hemolacria. Los estudios diagnósticos revelaron depósitos de amiloide en los tejidos. El análisis inmunohistoquímico confirmó amiloidosis sistémica de cadenas ligeras tipo AL. Se inició tratamiento específico, mejorando parcialmente los síntomas y estabilizando la condición del paciente. La amiloidosis sistémica de tipo AL requiere un alto índice de sospecha clínica para su diagnóstico oportuno. La combinación de estudios diagnósticos y tratamiento precoz puede mejorar el pronóstico de estos pacientes.
ABSTRACT The case of a 65-year-old male with chronic diarrhea, periorbital ecchymosis, and hemolacria is described. Laboratory studies, biopsy, and immunohistochemical analysis were performed to confirm the diagnosis. The dependent variable was the confirmed diagnosis of AL amyloidosis, while the independent variables included clinical symptoms and diagnostic test results. Descriptive techniques were used to analyze the clinical and laboratory data. The patient presented with chronic diarrhea unresponsive to conventional treatment, periorbital ecchymosis, and hemolacria. Diagnostic studies revealed amyloid deposits in the tissues. Immunohistochemical analysis confirmed systemic light chain AL amyloidosis. Specific treatment was initiated, partially improving the symptoms and stabilizing the patient's condition. Systemic AL amyloidosis requires a high index of clinical suspicion for timely diagnosis. The combination of diagnostic studies and early treatment can improve the prognosis of these patients.
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RESUMEN Los lipomas yeyunales son tumores gastrointestinales benignos e infrecuentes, de origen mesenquimático, compuestos por adipocitos que suelen estar confinados a la submucosa. Generalmente son asintomáticos y se descubren de manera incidental al realizar estudios por imágenes o endoscópicos. Sin embargo, aquellos mayores de 2 cm pueden presentar síntomas como resultado de complicaciones, como intususcepción intestinal, obstrucción o rara vez, hemorragias. Presentamos un caso infrecuente de intususcepción de un lipoma yeyunal ulcerado en un adulto, diagnosticado en el contexto de un cuadro de hemorragia digestiva.
ABSTRACT Jejunal lipomas are rare benign mesenchymal tumors made up of adipocytes confined to the submucosa layer. They are usually asymptomatic and are incidentally found during imaging or endoscopic tests. Those measuring > 2 cm may become symptomatic as a result of complications as intestinal intussusception, obstruction and bleeding. We herein report a rare case of intussusception of an ulcerated jejunal lipoma in an adult patient, that was diagnosticated in the setting of an intestinal hemorrhage.
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La hemorragia puerperal produce el incremento en el número de ingresos en las unidades de cuidados intensivos, que a su vez requiere de una mayor y mejor atención por parte del personal de enfermería. Este trabajo tiene como objetivo, reflexionar sobre los principales elementos a tener en cuenta para el cuidado de enfermería de puérperas con hemorragia, en el contexto de la unidad de cuidados intensivos. El plan de cuidados en puérperas con hemorragia debe estar basado en los diagnósticos de enfermería, que logren un enfoque más hacia la enfermedad; en el que la planificación de acciones sea más específica a puérperas con hemorragia. Asimismo, combinar lo estandarizado con la individualización, para lograr una mayor efectividad en la atención a esta complicación grave principal causa de la mortalidad materna en el mundo. Por ello el cuidado de enfermería deberá asumir acciones frente a la seguridad de la paciente, desde la promoción del trabajo en equipo, hasta fortalecimiento de competencias para la implementación guías de prácticas que garanticen un accionar más rápido y eficiente.
Puerperal hemorrhage causes an increase in the number of admissions to intensive care units, which in turn requires greater and better care from nursing staff. This work aims to reflect on the main elements to take into account for nursing care of postpartum women with hemorrhage, in the context of the intensive care unit. The care plan for postpartum women with hemorrhage should be based on nursing diagnoses that focus more on the disease; in which action planning is more specific to postpartum women with hemorrhage. Likewise, combine standardization with individualization, to achieve greater effectiveness in the care of this serious complication, the main cause of maternal mortality in the world. Therefore, nursing care must take actions regarding patient safety, from promoting teamwork to strengthening skills for the implementation of practice guides that guarantee faster and more efficient action.
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The main causes of maternal mortality are comorbidities, hypertensive pregnancy syndrome, obstetric haemorrhage, and maternal sepsis. For this reason, uterotonics, magnesium sulphate, and antibiotics are essential tools in the management of obstetric patients during labour and in the peripartum period. These drugs are widely used by anaesthesiologists in all departments, and play a crucial role in treatment and patient safety. For the purpose of this narrative review, we performed a detailed search of medical databases and selected studies describing the use of these drugs in patients during pregnancy, delivery and the pospartum period. Uterotonics, above all oxytocin, play an important role in the prevention and treatment of pospartum haemorrhage, and various studies have shown that in obstetric procedures, such as scheduled and emergency caesarean section, they are effective at lower doses than those hitherto accepted. We also discuss the use of carbetocin as an effective alternative that has a therapeutic advantage in certain clinical circumstances. Magnesium sulphate is the gold standard in the prevention and treatment of eclampsia, and also plays a neuroprotective role in preterm infants. We describe the precautions to be taken during magnesium administration. Finally, we discuss the importance of understanding microbiology and the pharmacology of antibiotics in the management of obstetric infection and endometritis, and draw attention to the latest trends in antibiotic regimens in labour and caesarean section.
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Antibacterianos , Sulfato de Magnésio , Ocitócicos , Humanos , Sulfato de Magnésio/uso terapêutico , Feminino , Gravidez , Antibacterianos/uso terapêutico , Ocitócicos/uso terapêutico , Período Periparto , Anestesia Obstétrica/métodos , Parto Obstétrico , Endometrite/prevenção & controle , Endometrite/tratamento farmacológico , Cesárea , Ocitocina/análogos & derivadosRESUMO
El divertículo de Meckel es la malformación gastrointestinal congènita más frecuente y se produce por la involución parcial o total del conducto onfalomesentérico durante el desarrollo embrionario, resultando en un divertículo verdadero, puesto que contiene todas las capas del intestino delgado. Posee una incidencia de 0,6-4% en la población general y corresponde a la principal causa de hemorragia digestiva baja en pacientes pediátricos. Mayoritariamente, permanece asintomático hasta la adultez, pudiendo presentar cuadros clínicos sugerentes de apendicitis aguda, obstrucción intestinal y hemorragia digestiva baja. El hallazgo del divertículo suele ser incidental y en solo 4-6% de las ocasiones se encuentra como estudio dirigido de esta anormalidad. Existen múltiples estudios diagnósticos disponibles, pasando por la tomografía computarizada (TC), cintigrafía con pertecnetato de Tecnecio-99m (Tc-99m), videocápsula endoscópica y la laparoscopía/laparotomía. El manejo del divertículo de Meckel es quirúrgico, especialmente, debido a sus múltiples complicaciones, siendo detalladas en el presente artículo. El uso de técnicas mínimamente invasivas y las mejores tecnologías y métodos de detección han permitido disminuir la mortalidad de las complicaciones del divertículo de Meckel. Finalmente, esta patología supone un reto para cualquier especialista, puesto que la baja incidencia y el cuadro clínico similar a enfermedades diverticulares significa un mayor reto tanto en el diagnóstico como en el manejo.
Meckel's diverticulum is the most common congenital gastrointestinal malformation and is caused by partial or total involution of the omphalomesenteric duct during embryonic development, resulting in a true diverticulum, since it contains all the layers of the small intestine. It has an incidence of 0.6-4% in the general population and is the main cause of lower gastrointestinal bleeding in pediatric patients. Most of them remain asymptomatic until adulthood, and may present clinical symptoms suggestive of acute appendicitis, intestinal obstruction and lower gastrointestinal bleeding. The finding of the diverticulum is usually incidental and only 4-6% of the time it is found as a directed study of this abnormality. There are multiple diagnostic studies available, including computed tomography (CT), Technetium-99m pertechnetate (Tc-99m) scintigraphy, video capsule endoscopy, and laparoscopy/laparotomy. The management of Meckel's diverticulum is surgical, especially due to its multiple complications, which are detailed in this article. The use of minimally invasive techniques and the best technologies and detection methods have made it possible to reduce the mortality of Meckel's diverticulum complications. Finally, this pathology is a challenge for any specialist, since the low incidence and symptoms similar to diverticular diseases pose a greater challenge both in diagnosis and management.