Múltiplas variações anatômicas nos ramos do arco aórtico e artéria cerebral média: um estudo angiográfico

Introdução: A compreensão dessas variações requer o conhecimento prévio da vasculogênese e da angiogênese do embrião. Relato do caso: Paciente gênero feminino, 32 anos, com história de cefaleia holocraniana e náusea há 24h, que não cedeu aos analgésicos. Foi submetida a exames de imagem que evidenciaram oclusão da artéria vertebral direita e dissecção da artéria vertebral esquerda, arco aórtico apresentando variações anatômicas não patológicas com a origem anômala da artéria subclávia direita e um tronco comum das artérias carótidas, além de variação anatômica não patológica da trifurcação de artéria cerebral média. Comentários: As repercussões clínicas das variações anatômicas são clinicamente importantes para uma análise individual mais adequada e segura na tomada de decisão

Ponte miocárdica

Introdução: A ponte miocárdica constitui um dos diagnósticos diferenciais da doença arterial coronariana que geralmente cursa de forma assintomática, mas pode manifestar-se com angina e mais raramente, infarto agudo do miocárdio ou morte súbita. Relato do caso: Paciente do gênero feminino, 57 anos, assintomática em avaliação clínica inicial, sem precordialgia, hipertensa, foi submetida a teste de esforço cardiopulmonar de rotina o qual apresentou um infradesnivelamento de ST, em CM5 de 1,5 mm em relação ao repouso. Comentários: As repercussões clínicas da ponte miocárdica ocorreram devido ao incremento da tensão durante a sístole em consequência do aumento da pressão diastólica final no ventrículo esquerdo devido a influência da hipertensão arterial o que justifica grau de hipertrofia miocárdica

Padrões de Dominância de Drenagem do Seio Transverso

Objetivo: Investigar o padrão de dominância de drenagem sinusal dural por meio da prevalência de variações anatômicas do ST em exames de angiografias digitais cerebrais. Métodos: Trata-se de um estudo do tipo transversal, observacional e retrospectivo, com amostragem do tipo não probabilístico por conveniência, realizado por meio da análise de 83 exames de angiografia digitais cerebrais em 2D. Resultados: No sexo masculino foi observado um padrão de dominância direito de 32,43%, um padrão de dominância do ST esquerdo de 8,11% e um padrão simétrico de 59,46%. No sexo feminino os percentuais foram de 32,61%, 6,52 e 60,87 para os padrões de dominância direito, esquerdo e simétrico do ST, respectivamente. Para todos os sujeitos o maior percentual foi o de dominância simétrico do ST, cerca de 60,24%. Conclusões: O padrão de drenagem do seio transverso mais prevalente identificado foi o simétrico, independente do sexo do indivíduo. Quando uma dominância foi identificada, o padrão direito foi o mais prevalente. A variação mais prevalente foi a hipoplasia do seio transverso esquerdo. Variações raras como a agenesia do ST foram encontradas. Não foram identificadas diferenças entre o sexo

As particularidades clínicas da otite média: Clinical features of otitis media

A otite média é um processo inflamatório de evolução abrupta, acompanhado pelo quadro clínico típico de inflamação na orelha média, sendo sua incidência prevalente em crianças, culminando em leves repercussões clínicas, mas que deve ser adequadamente diagnosticada e tratada. Este evento clínico pode ser agudo, subagudo ou crônico com aparições típicas, evolução e manejo clínico diferenciados. O seguinte artigo é uma revisão narrativa de literatura que visa analisar a respeito das principais particularidades clínicas da Otite Média. Diante das informações coletadas, pode se elucidar que a otite média é o fator causal para implicações negativas e antibioticoterapia em crianças, logo é essencial medidas para diagnose precoce para evitar repercussões na saúde destes

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis

AbstractBackground and objectivesNeuraxial anesthesia (NA) has been used in association with general anesthesia (GA) for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction.MethodsMortality, arrhythmias, cerebrovascular accident (CVA), myocardial infarction (MI), length of hospital stay (LHS), length of ICU stay (ICUS), reoperations, blood transfusion (BT), quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD) was estimated for continuous variables, and relative risk (RR) and risk difference (RD) for categorical variables.Results17 original articles analyzed. Meta-analysis of mortality (RD=−0.01, 95% CI=−0.03 to 0.01), CVA (RR=0.79, 95% CI=0.32–1.95), MI (RR=0.96, 95% CI=0.52–1.79) and LHS (MD=−1.94, 95% CI=−3.99 to 0.12) were not statistically significant. Arrhythmia was less frequent with NA (RR=0.68, 95% CI=0.50–0.93). ICUS was lower in NA (MD=−2.09, 95% CI=−2.92 to −1.26).ConclusionThere was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS

Cultural adaptation and reproducibility of the Measure Yourself Medical Outcome Profile (Mymop2)

Introduction: The Measure Yourself Medical Outcome Profi le (MYMOP 2) is being used as a generic tool to document its effectiveness, together with the evaluation of health systems and their interventions. Objective: To assess the cultural adaptation and reproducibility of the Measure Yourself Medical Outcome Profile (MYMOP2) questionnaire in a sample of patients undergoing cardiac surgery. Methods: The study sample consisted of 50 patients undergoing cardiac surgery for myocardial and valve revascularization, which were recruited from the cardiac ICU of a private hospital in Maceió, Alagoas. The MYMOP2 questionnaire was initially translated into Brazilian Portuguese. Cultural and conceptual adaptation were performed, so that patients were able to understand questions. All patients answered this instrument twice, on the same day, with two different interviewers, with an interval of 30 minutes between the interviews. After one day, the questionnaire was repeated on a second visit. This process was carried out with MYMOP and MYMOP2 FOLLOW UP. Reproducibility and validity were tested. Results: Cultural adaptations were made, so that the final version was obtained. Spearman correlation coefficient for MYMOP2 was 1 and FOLLOW UP was 0.794, p elt; 0.001. There were moderate correlations with the domains of the EQ-5D. MYMOP2 was validated and supported by a significant correlation between change scores and MYMOP2 change scores and the ability to detect an improvement in acute conditions. Conclusion: MYMOP2 questionnaire is reproducible, easy to understand and quick to apply. It should be included and used in any Brazilian study with the objective to assess disease impact over time

Cultural adaptation and reproducibility of the Measure Yourself Medical Outcome Profile (Mymop2)

Abstract Introduction: The Measure Yourself Medical Outcome Profile (MYMOP 2) is being used as a generic tool to document its effectiveness, together with the evaluation of health systems and their interventions. Objective: To assess the cultural adaptation and reproducibility of the Measure Yourself Medical Outcome Profile (MYMOP2) questionnaire in a sample of patients undergoing cardiac surgery. Methods: The study sample consisted of 50 patients undergoing cardiac surgery for myocardial and valve revascularization, which were recruited from the cardiac ICU of a private hospital in Maceió, Alagoas. The MYMOP2 questionnaire was initially translated into Brazilian Portuguese. Cultural and conceptual adaptation were performed, so that patients were able to understand questions. All patients answered this instrument twice, on the same day, with two different interviewers, with an interval of 30 minutes between the interviews. After one day, the questionnaire was repeated on a second visit. This process was carried out with MYMOP and MYMOP2 FOLLOW UP. Reproducibility and validity were tested. Results: Cultural adaptations were made, so that the final version was obtained. Spearman correlation coefficient for MYMOP2 was 1 and FOLLOW UP was 0.794, p < 0.001. There were moderate correlations with the domains of the EQ-5D. MYMOP2 was validated and supported by a significant correlation between change scores and MYMOP2 change scores and the ability to detect an improvement in acute conditions. Conclusion: MYMOP2 questionnaire is reproducible, easy to understand and quick to apply. It should be included and used in any Brazilian study with the objective to assess disease impact over time