Tratamento Endovascular de Aneurismas da Aorta e Transfusão de Sangue. O que Precisamos?

INTRODUCTION: Comparatively to open repair, endovascular aneurysm repair has reduced transfusion rates but thereâs no recommendation about number of red blood cells units to be crossmatched preoperatively. Our aim is contribute to the analysis of red blood cells units needs in endovascular and hybrid aortic aneurysm repair and developing a protocol for maximum surgical blood orders schedule. MATERIAL AND METHODS: We retrospectively analyzed our prospective database of elective endovascular aneurysm repair from 2001 to 2012. We analyzed patients' age, gender, ASA classification, maximum surgical blood orders schedule, red blood cells units transfused and timings, types of endoprosthesis, red blood cells units consumption/endoprosthesis' type ratio, crossmatch to transfusion ratio, conversion to open repair, hemoglobin concentrations before surgery and discharge. RESULTS: We selected 187 patients, 90% men, mean age 73.1, ASA mode III. The endoprosthesis were aorto-bi-iliac in 71%, aorto-uni-iliac in 23% and thoracic in 6%. Of these, 72,6% of the patients did not require blood transfusion. We transfused 171 red blood cells units. Crossmatch to transfusion ratio was 10.1 until 2010 and 7.3 after. The ratio of red blood cells units consumption/endoprosthesis in the first 24 hours was 0.21 red blood cells units/aorto-bi-iliac, 0.46 red blood cells units/aorto-uni-iliac, 0.8 red blood cells units/thoracic, 1.3 red blood cells units/hybrid-thoracic and 2 red blood cells units/hybrid-aorto-bi-iliac. A statistical correlation was observed between red blood cells units transfused postoperatively and type of endoprosthesis (p < 0.001) and between ASA classification and red blood cells units transfused after 24 hours (p < 0.01). DISCUSSION: Guidelines from the British Society of Haematology are based on a crossmatch to transfusion ratio of 2:1. Our crossmatch to transfusion ratio was 10.1 until 2010 and 7.3 from 2011 to 2012. CONCLUSION: These results changed our policy of maximum surgical blood orders schedule for endovascular aneurysm repair. We now type and screen aorto-bi-iliac and aorto-uni-iliac. We crossmatch two red blood cells units for thoracic, three red blood cells units for hybrid thoracic and four red blood cells units for hybrid abdominal procedures. This may lead to financial savings, improved efficiency and reduce workload in hematology department.info:eu-repo/semantics/publishedVersio

Institutional Impact of EVAR's Incorporation in the Treatment of Abdominal Aortic Aneurysm: a 12 Years' Experience Analysis

Introduction: Endovascular aneurysm repair (EVAR) was introduced as a less aggressive treatment of abdominal aortic aneurysms (AAA) for patients ineligible for open repair (OR). Objective: To analyze EVAR's incorporation impact in the treatment of infra-renal abdominal aortic aneurysms in our institution. Methods: A retrospective study of the patients with diagnostic of infra-renal AAA treated between December 2001 and December 2013 was performed. The choice between EVAR and OR was based on surgeon's experience, considering patient clinical risk and aneurysm's anatomical features. Patients treated by EVAR and by OR were analyzed. In each group, patient's and aneurysm's characteristics, surgical and anesthesia times, cost, transfusion rate, intraoperative complications, hospital stay, mortality and re-intervention rates and survival curves were evaluated. Results: The mean age, all forms of heart disease and chronic renal failure were more common in EVAR group. Blood transfusion, surgical and anesthesia times and mean hospital stay were higher for OR. Intraoperative complications rate was higher for endovascular aneurysm repair, overall during hospitalization complication rate was higher for open repair. The average cost in endovascular aneurysm repair was 1448.3€ higher. Re-interventions rates within 30 days and late re-intervention were 4.1% and 11.7% for endovascular aneurysm repair versus 13.7% and 10.6% for open repair. Conclusions: Two different groups were treated by two different techniques. The individualized treatment choice allows to achieve a mortality of 2.7%. Age ≥80 years influences survival curve in OR group and ASA ≥IV in EVAR group. We believe EVAR's incorporation improved the results of OR itself. Patients with more comorbidities were treated by endovascular aneurysm repair, decreasing those excluded from treatment. Late reinterventions were similar for both techniques.info:eu-repo/semantics/publishedVersio

Multifocal Septic Arthritis, Gluteal Abscess and Spondylodiscitis by Streptococcus Dysgalactiae Subspecies Equisimilis After an Intramuscular Injection

We present the case of a 63-year-old man, admitted for hand cellulitis and acute kidney injury. A Streptococcus dysgalactiae subsp equisimilis (SDSE) was isolated in blood cultures and despite directed intravenous antibiotherapy, the patient evolved unfavourably, with dorsolumbar spondylodiscitis, multifocal septic arthritis and abscesses. CT also showed densification of the gluteal muscles, multiple air bubbles in the psoas, paraspinal muscles and spinal canal that were associated with an intramuscular injection administered 1 week earlier for a backache. After escalation of the antibiotherapy and intensive supportive measures, the patient showed improvement and was discharged after 8 weeks of antibiotherapy.The incidence of invasive SDSE infections has been growing, especially in immunosupressed patients. In this case, despite no predisposing factor identified, it evolved to severe sepsis. The intramuscular injection, a trivialised but not harmless procedure, was the assumed port of entry, as previously described in another case report.info:eu-repo/semantics/publishedVersio

Predicting the critical density of topological defects in O(N) scalar field theories

O(N) symmetric $\lambda \phi^4$ field theories describe many critical phenomena in the laboratory and in the early Universe. Given N and $D\leq 3$, the dimension of space, these models exhibit topological defect classical solutions that in some cases fully determine their critical behavior. For N=2, D=3 it has been observed that the defect density is seemingly a universal quantity at T_c. We prove this conjecture and show how to predict its value based on the universal critical exponents of the field theory. Analogously, for general N and D we predict the universal critical densities of domain walls and monopoles, for which no detailed thermodynamic study exists. This procedure can also be inverted, producing an algorithm for generating typical defect networks at criticality, in contrast to the canonical procedure, which applies only in the unphysical limit of infinite temperature.Comment: 4 pages, 3 figures, uses RevTex, typos in Eq.(11) and (14) correcte

Spatio-temporal vulnerability assessment in fractured groundwater systems

Governance reforms are required to demonstrate adaptive and resilient urban water resource management that considers complexity, uncertainty in immediate and long term change. Contamination of groundwater is a complex process and full of uncertainty at local and regional scale. The main objective of this research is the study of vulnerability to pollution in an unconfined karstic aquifer. Mainly it is addressed vulnerability integration, in relation to policy, specifically in risk evaluation and risk–benefit considerations. Development of an integrated vulnerability assessment methodology can be useful to effectively manage and protect this valuable freshwater source. The research insights suggest that the establishment of a pattern of effective governance is mandatory as the future highway, the prison and the airport are overlaying the most vulnerable areas of the aquifer and therefore provide policy makers guidance in overcoming urban water governance challenges.info:eu-repo/semantics/publishedVersio

Toxic Epidermal Necrolysis – Sodium Valproate and Vancomycin?

A prevalência de reacções adversas a medicamentos (RAM) em doentes hospitalizados é estimada em 10 -20% e estas podem ser potencialmente fatais. A necrólise epidérmica tóxica (NET) é uma das apresentações de RAM mais severa, com baixa incidência mas mortalidade elevada. Os autores apresentam o caso de uma mulher de 79 anos, com doença cerebrovascular hemorrágica grave, pós -traumática, com necessidade de internamento em cuidados intensivos que, sob terapêutica com meropenem, vancomicina e valproato de sódio, desenvolveu um quadro de NET. Para identificação do fármaco responsável realizou -se teste de transformação linfoblástica (TTL). Os índices de estimulação obtidos foram 3. Apesar de ser ainda um instrumento de investigação, o TTL foi decisivo na confirmação da base imunológica da reacção. Vancomicina e valproato de sódio estão totalmente contraindicados nesta doente

Manejo de sistemas de produção de centeio visando a produção de forragem e de sementes para a agricultura familiar.

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Indicações técnicas para produção de sementes de plantas recuperadoras de solo para a agricultura familiar.

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Measles outbreak in a tertiary level hospital, Porto, Portugal, 2018: challenges in the post-elimination era

A measles outbreak has been occurring in a healthcare setting in Porto, Portugal, since early March 2018, posing public health challenges for a central hospital and the community. Up to 22 April, 96 cases were confirmed, 67 in vaccinated healthcare workers, mostly between 18-39 years old. Following identification of the first cases, control measures were rapidly implemented. Concomitantly, other measles cases were notified in the Northern Region of the country. No common epidemiological link was identified.info:eu-repo/semantics/publishedVersio