Portal hypertension : a review of literature.

A hipertens?o portal representa a complica??o de v?rias doen?as. Entre as afec??es que podem cursar com hipertens?o do sistema porta, destacam-se a cirrose, a forma hep?tica ou hepatoespl?nica da esquistossomose, neoplasias do f?gado, das vias biliares ou do p?ncreas, fen?menos tromboemb?licos da veia porta e mol?stias supra-hep?ticas. Dentre suas consequ?ncias destacam-se varizes de es?fago e a encefalopatia portossist?mica. A press?o no sistema portal, como em qualquer outro sistema vascular, ? o resultado da intera??o entre o fluxo sangu?neo e a resist?ncia vascular que se op?e a esse fluxo. Assim, a press?o portal pode aumentar, se houver aumento do fluxo sangu?neo portal ou aumento da resist?ncia vascular ou ambos. A resist?ncia aumentada do fluxo pode ser pr?-hep?tica, p?s-hep?tica e intra-hep?tica. O diagn?stico ? baseado em crit?rios cl?nicos, frequentemente com conjunto com exames de imagem e endoscopia.Portal hypertension is a complication of various diseases. Among the diseases that may present with hypertension in the portal system, we highlight cirrhosis, hepatic or hepatosplenic form of schistosomiasis, cancer of the liver, biliary tract or pancreatic cancer, thromboembolic events portal vein and hepatic symptoms. Among its consequences stand out esophageal varices and portosystemic encephalopathy. The pressure in the portal system as in any other vascular system, is the result of the interaction between blood flow and vascular resistance that opposes the flow. Thus, portal pressure may increase, if any increase of portal blood flow or increased vascular resistance, or both. The increased flow resistance can be prehepatic, post-hepatic and intrahepatic. The diagnosis was based on clinical criteria, often together with imaging and endoscopy

O ide?rio republicano e as institui??es escolares em Montes Claros (1916-1918)

Esta disserta??o tem por objetivo compreender como as institui??es escolares da cidade de Montes Claros (MG) representaram um importante instrumento mantenedor do Status Quo do Estado Brasileiro na Primeira Rep?blica (1889-1930). O marco temporal ? o per?odo de 1916 a 1918, e justifica-se pelas fontes utilizadas e que tratam de assuntos referentes ? Escola Normal Norte Mineira e ao Grupo Escolar Gon?alves Chaves. Objetiva-se conceituar e interpretar a hist?ria da educa??o na cidade de Montes Claros, na busca compreender os sujeitos envolvidos nos processos hist?ricos para a constitui??o das sociedades, bem como as suas pr?ticas e adequa??es aos moldes do novo Estado Republicano Brasileiro. Justifica-se a relev?ncia da referida pesquisa devido ao enriquecimento das discuss?es acerca do per?odo trabalhado e das contribui??es para a hist?ria local.Disserta??o (Mestrado Profissional) ? Programa de P?s-Gradua??o em Ci?ncias Humanas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2017.This dissertation aims to understand how school institutions of the town of Montes Claros (MG) represented an important instrument maintaining the Status Quo of Brazilian State in First Republic (1889-1930). The time frame is the period from 1916 to 1918, and it is justified by the sources used and approaches matters related to the Escola Normal Norte Mineira and Grupo Escolar Gon?alves Chaves. It aims to conceptualize and interpret History under the bias of Cultural History, which seeks to understand the subjects involved in the historical processes for the constitution of societies, as well as their practices and adjustments to the molds of the new Republican Brazilian State. The relevance of this research is justified due to the enrichment of the discussions about the period worked and the contributions to the local history

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline