Closure of the nephrosplenic space for treatment of recurring left dorsal displacement of the large colon in standing horses

The article has no abstract

Cisatracurium – A “Safe” Neuromuscular Blocking Agent?

Os agentes anestésicos representam uma causa importante de anafilaxia a fármacos, sendo os relaxantes neuromusculares (RNM) dos principais responsáveis pelos casos de anafilaxia perioperatória. O cisatracúrio é o RNM mais recente, sendo um estereoisómero do atracúrio que se acreditava não ter potencial de libertação de histamina e, consequentemente, causar menos reações alérgicas do que os outros RNM. No entanto, têm sido relatados vários casos de reação anafilática grave após administração de cisatracúrio, não existindo, do nosso conhecimento, registo na literatura de nenhum em Portugal. As autoras apresentam dois casos de anafilaxia perioperatória grave (grau 4 na escala de Ring & Messmer) com paragem cardiorrespiratória. Na investigação alergológica foram realizados testes cutâneos, cujos intradérmicos se revelaram positivos para o cisatracúrio (1:100) em ambos os doentes. É importante alertar que este RNM não será tão desprovido de potencial alergénico como previamente pensado e esse facto deve ser considerado na investigação de uma reação alérgica que ocorra durante a indução anestésica.info:eu-repo/semantics/publishedVersio

The five-point Likert scale for dyspnea can properly assess the degree of pulmonary congestion and predict adverse events in heart failure outpatients

OBJECTIVES: Proper assessment of dyspnea is important in patients with heart failure. Our aim was to evaluate the use of the 5-point Likert scale for dyspnea to assess the degree of pulmonary congestion and to determine the prognostic value of this scale for predicting adverse events in heart failure outpatients. METHODS: We undertook a prospective study of outpatients with moderate to severe heart failure. The 5-point Likert scale was applied during regular outpatient visits, along with clinical assessments. Lung ultrasound with ≥15 B-lines and an amino-terminal portion of pro-B-type natriuretic peptide (NT-proBNP) level >;1000 pg/mL were used as a reference for pulmonary congestion. The patients were then assessed every 30 days during follow-up to identify adverse clinical outcomes. RESULTS: We included 58 patients (65.5% male, age 43.5±11 years) with a mean left ventricular ejection fraction of 27±6%. In total, 29.3% of these patients had heart failure with ischemic etiology. Additionally, pulmonary congestion, as diagnosed by lung ultrasound, was present in 58% of patients. A higher degree of dyspnea (3 or 4 points on the 5-point Likert scale) was significantly correlated with a higher number of B-lines (p = 0.016). Patients stratified into Likert = 3-4 were at increased risk of admission compared with those in class 1-2 after adjusting for age, left ventricular ejection fraction, New York Heart Association functional class and levels of NT-proBNP >;1000 pg/mL (HR = 4.9, 95% CI 1.33-18.64, p = 0.017). CONCLUSION: In our series, higher baseline scores on the 5-point Likert scale were related to pulmonary congestion and were independently associated with adverse events during follow-up. This simple clinical tool can help to identify patients who are more likely to decompensate and whose treatment should be intensified

Sinusite fúngica: uma análise clínica em nosso meio

OBJECTIVE: To report the microbiological, histopathological, radiological, and endoscopic findings associated with clinical observations in patients with fungal sinusitis.MATERIALS AND METHODS: A prospective analysis of 829 cases compatible with chronic sinusitis was carried out. Diagnosis of fungal sinusitis was cofirmed in 33patients through computed tomography and nasal endoscopy associated with clinical, laboratorial, microbiological and histopathological findings. These patients were classified as having one of the following: fungus ball sinusitis, alergic fungal sinusitis , acute invasive sinusitus or indolent or slowly invasive sinusitus.RESULTS: 18 patients presented with fungus ball sinusitis, 13 matched the criteria for AFS and two for slowly invasive fungus sinusitis. There were no occurences of fulminant fungal sinusitis. Clinical cure was obtained in 24 patients. Recidivation took place in four alergic fungal sinusitis patients.CONCLUSIONS: Fungal sinusitis presents itself in many different ways and can be treated with a large variety of therapeutical techniques. Therefore it demands not onlya diagnosis of the etiology of the fungus, but also the identification of the sort of sinusitis, through an association of nasal endoscopy, computed tomography, macroscopic examination of the secretion, direct exam, and culture in appropriate medium.OBJETIVO: Relatar os achados microbiológicos, histopatológicos, radiológicos e endoscópicos associados às observações clínicas de pacientes portadores de sinusite fúngica.MATERIAIS E MÉTODOS: Foi realizada uma análise prospectiva de 829 casos compatíveis com sinusopatia crônica. De acordo com os achados obtidos nos examesde tomografia computadorizada e endoscopia nasal, juntamente com as análises clínicas, laboratoriais, microbiológicas e histopatológicas, atentou-se para o diagnóstico de sinusite fúngica em 33 pacientes da série, os quais foram enquadrados dentro de uma das seguintes classificações: bola fúngica, sinusite fúngica alérgica , sinusite invasiva aguda (fulminante) ou sinusite indolente ou lentamente invasiva.RESULTADOS: 18 pacientes apresentaram-se com bola fúngica, 13 com critérios para sinusite fúngica alérgica. Sinusite lentamente invasiva foi identificada em doiscasos e não houve nenhuma ocorrência de sinusite fúngica fulminante. Cura clínica foi obtida em 24 pacientes. Houve recidiva da sinusite fúngica alérgica em quatro casos.CONCLUSÕES: As várias formas de apresentação e de abordagem terapêutica da sinusite fúngica exigem, além do diagnóstico etiológico fúngico, a identificação dotipo de sinusite fúngica através da associação de endoscopia nasal, tomografia computadorizada, exame macroscópico da secreção, exame direto e cultura em meio adequado

Tliflectomia parcial para tratamento de intussuscepção ceco-cólica em equino

O artigo não apresenta resumo

Osteossíntese de fratura Salter-Harris II em fêmur de pônei

O artigo não apresenta resumo