RESUMO
Background: Inferior vena cava (IVC) filters are used to prevent massive pulmonary embolism in cases where anticoagulation is contraindicated or has failed. It is usually implanted below the renal veins. In a few cases it is necessary to deploy the filter above them, with theoretical rísk of secondary renal failure. Aim: To report the experience with filters located above the renal veins. Patients and Methods: Medical records of all patients with percutaneous suprarenal filters are reviewed. Results: Between May 1993 and May 2007, 361 percutaneous IVC filter procedures were performed. In thirty patients aged 19 to 77 years (average 48years, 50 percent males), they were placed in suprarenalposition (8,3 percent). Suprarenal IVC filters were implanted in patients with extensive caval thrombosis, renal vein thrombosis extending to cava, displacement of previous IVC filters and double IVC system. Jugular vein approach was the access of choice. Technical success was 100 percent, no death or pulmonary embolism occurred. Patients were followed from 1 to 165 months (average 57 months). Eight deaths were recorded, five in patients with cáncer No patient had renal failure on follow up (average creatinine 0.90+0,26 mg/dL). Three patients developed a new deep vein thrombosis (10 percent), without pulmonary embolism. Conclusions: In this retrospective analysis of patients, suprarenal placement of IVC filters was not associated to secondary renal failure, and showed good short and long term results.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Embolia Pulmonar/prevenção & controle , Filtros de Veia Cava , Veia Cava Inferior/cirurgia , Trombose Venosa/terapia , Seguimentos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Veia Cava Inferior , Trombose Venosa , Adulto JovemRESUMO
Background: Dissections that involve the ascending aorta are classified as type A, regardless of the site of the primary intimal tear, and all other dissections as type B. Type B dissections can have fatal ischemic and hemorrhagic complications. In the chronic state, dilatation and rupture can be mortal. Endovascular surgery is a therapeutic alternative, considering the high rate of complications of conventional surgery Aim: To report the results of endovascular treatment of type B aortic dissection. Material and methods: Report of 36 treated patients (30 males) aged 43 to 87 years, with a type B aortic dissection. Seventy eight percent were hypertensive and 39 percent smoked. The diagnosis was conñrmed by CAT sean. Acute patients were treated for complications and chronic patients, for dilatation. In the operating room, an endoprothesis was placed through the femoral artery, to cover the tear. The tear was located and the lumens were differentiated using angiography and transesophageal echocardiography. Results: All procedures were successful. In 16 acute dissections the indications were malperfusion syndrome or unmanageable hypertension in seven patients and imminent rupture or persistent pain in nine. Twenty chronic patients were operated due to dilatation (mean 6 cm). One patient died due to cardiac failure. One patient had a transient paraparesia and two had pulmonary embolism. No patient died in a follow up períod ranging from 2.5 to 74 months. Four patients required a new aortic endovascular procedure due to progressive dilatation or endoleak. Conclusión: Endovascular treatment of type B aortic dissection has good immediate andlong term results.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dissecção Aórtica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Doença Aguda , Doença Crônica , Ecocardiografia Transesofagiana , Seguimentos , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Background: Anticoagulation is the treatment of choice for deep vein thrombosis (DVT) and pulmonary embolism (PE). Occasionally this treatment is contraindicated or fails to prevent PE. In these patients, inferior vena caval (IVC) interruption is indicated and insertion of a filter is the most commonly performed procedure. Aim: To report the experience with IVC filters. Material and methods: Retrospective review of all medical records and operative protocols of patients subjected to IVC filter implantations. Follow up was performed by telephone contact with the patient, relatives or primary physicians, ambulatory consultation or by death certificates. Results: During the period 1993-2005 we implanted IVC filters on 287 patients, 55.4 percent male, average age: 62.1 yrs (17-99). Indications for the procedure were DVT or PE and contraindication of anticoagulation in 141 patients (49.1 percent), DVT or PE and complication of anticoagulation in 65 patients (22.6 percent), prophylaxis in 39 patients (13.6 percent), massive PE or poor respiratory function in 31 patients (10.8 percent), paradoxal emboli in 4 patients (1.4 percent) and other causes in seven patients. All percutaneous devices were successfully inserted. There was no morbidity or mortality related to the procedure. The most frequent access site was the internal jugular vein (66.6 percent). In 24 patients (8.4 percent) the filter was intentionally deployed above the renal veins. Six patients (2.1 percent) were lost to follow up after discharge. A mean follow up of 41.5 months was achieved. Ninety one patients died, with a 5 years survival of 64.7 percent. Symptomatic recurrent PE occurred in 6 patients (2.1 percent) and was the cause of death on 3 of them (1 percent), DVT has been detected in 22 patients (7.7 percent) during the follow up period. Conclusions: IVC filter implantation is a safe and effective short and long term measure to prevent PE and its consequences.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/prevenção & controle , Filtros de Veia Cava , Veia Cava Inferior , Trombose Venosa/prevenção & controle , Anticoagulantes , Chile/epidemiologia , Intervalo Livre de Doença , Seguimentos , Embolia Pulmonar/mortalidade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Trombose Venosa/mortalidadeRESUMO
Within a 14-24 hours lapse after gynecological operative surgery, a 27-year-old woman eliminated with vomit two large taperworm pieces, measuring 3 and 2 meters respectively. At the laboratory they were identified as Taenia saginata strobila with immature, mature and gravid proglottids. The patient informed that she liked to eat raw beef. Treatment consisted in a single dose of praziquantel: 15 mg/kg body weight. Parasitological controls (two series of three fecal samples each), performed three months later, resulted negative for Taenia eggs.
Assuntos
Complicações Pós-Operatórias/parasitologia , Taenia , Vômito/parasitologia , Adulto , Anestesia Geral , Animais , Cisticercose/tratamento farmacológico , Feminino , Humanos , Histerectomia , Praziquantel/uso terapêuticoRESUMO
Durante mayo a agosto de 1983 se estudiaron 180 manipuladores de alimentos de 52 establecimientos comerciales de la ciudad de Arica, realizando a cada uno de ellos, un examen coproparasitológico seriado. 108 (60%0 presentaron infección por parásitos o comensales intestinales. La especie de mayor prevalencia fue ENDOLIMAX NANA (42,2%). Entre los patógenos se encontró GIARDIA LAMBLIA (9,4%), ENTAMOEBA HISTOLYTICA (5%) y los helmintos HYMENOLEPIS NANA (1,1%) y TRICHURIS TRICHIURA (0,6%). Con respecto al tipo de establecimientos, la mayor tasa de infección fue encontrada en los individuos provenientes de panaderías (77,8%) y fuentes de soda (63%)
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Humanos , Enteropatias Parasitárias/epidemiologia , Manipulação de Alimentos , Microbiologia de Alimentos , ChileRESUMO
PIP: Ovarian pregnancy is the rarest of all ectopic pregnancy, occurring in about 0.5% of all cases. This article describes 1 such case, in a 24 year old healthy, multiparous woman. The woman, wearer of a Lippes Loop, was hospitalized for pregnancy with IUD in situ. Diagnosis was done through echography, which clearly showed the IUD, laparoscopy and finally laparotomy, which showed a very much enlarged right ovary. Right oophorectomy was performed and the patient recovered promptly. Histological examination of the resected ovary confirmed the presence of an ovarian pregnancy. The article stresses the importance of correct diagnosis in all cases of ectopic pregnancy.^ieng