Quality of life after on-pump and off-pump coronary artery bypass grafting surgery

FUNDAMENTO: Técnicas de cirurgia de revascularização miocárdica (RM) sem o uso de circulação extracorpórea (CEC) possibilitou resultados operatórios com menor dano sistêmico, menor ocorrência de complicações clínicas, menor permanência na sala de terapia intensiva e também no tempo de internação, gerando expectativas de melhor qualidade de vida (QV) dos pacientes. OBJETIVO: Avaliar a QV em pacientes submetidos à cirurgia de revascularização com e sem CEC. MÉTODOS: Em pacientes com doença multiarterial coronariana (DAC) estável e função ventricular preservada, aplicou-se o Short-Form Health Survey (SF-36) Questionnaire antes da cirurgia e depois de 6 e 12 meses. RESULTADOS: Entre janeiro de 2002 e dezembro de 2006, foram randomizados 202 pacientes para cirurgia de RM. As características demográficas clínicas laboratoriais e angiográficas foram semelhantes nos dois grupos. Desses pacientes, 105 foram operados sem CEC e 97 com CEC. Na evolução, 22 pacientes sofreram infarto, 29 relataram angina, um reoperou, 3 tiveram AVC e nenhum morreu. A avaliação da QV mostrou similaridade nos dois grupos em relação ao componente físico e mental. Todavia, encontrou-se significativa melhora da capacidade funcional e percepção do aspecto físico nos pacientes do sexo masculino. Além disso, um expressivo número de pacientes dos dois grupos retornou ao trabalho. CONCLUSÃO: Em todos os pacientes estudados, observaram-se melhora progressiva da qualidade de vida e retorno precoce ao trabalho, independentemente da técnica cirúrgica empregada. Exceto pela melhor percepção da capacidade funcional e do aspecto físico experimentado pelos homens, não houve diferença estatística nos resultados dos demais domínios alcançados pelos dois grupos estudados.BACKGROUND: Coronary artery bypass grafting techniques without using cardiopulmonary bypass (off-pump CABG) result in less systemic damage, less clinical complications, less time spent in the intensive care unit, and shorter hospital stays, thereby raising the perspective of improved quality of life (QOL) for patients. OBJECTIVE: To assess quality of life in patients who underwent on-pump and off-pump CABG. METHODS: The Short-Form Health Survey (SF-36) Questionnaire was administered to patients with stable multivessel coronary artery disease (CAD) and preserved ventricular function before and at six and 12 months after surgery. RESULTS: Between January 2002 and December 2006, a total of 202 patients were randomized to either on-pump or off-pump CABG. Demographic, clinical, laboratory, and angiographic characteristics were similar in both groups. One hundred and five patients underwent off-pump CABG and 97 underwent on-pump CABG. In the postoperative course, 22 patients had myocardial infarction, 29 reported angina, one was reoperated, and three experienced stroke. No patient died. Quality of life, as measured by the SF-36 questionnaire, was shown to be similar in both groups regarding physical and mental components. However, male patients showed a significant improvement in physical functioning and role limitations due to physical problems. Also, a large number of patients in both groups returned to work. CONCLUSION: Progressive enhancement in quality of life and early return to work were observed for all patients, regardless of the surgical technique used. Save for a greater improvement in physical functioning and role limitations due to physical problems experienced by male patients, no statistically significant differences were found in the other domains between groups

Wave scattering from discontinuities related to corrosion-like damage in one-dimensional waveguides

Guided waves at high frequency are used in structural health monitoring systems to detect damage. The successful application of the technique, however, requires a deep understanding of wave mode propagation and scattering, as this allows the correct choice of frequency range and wave types to be used to interrogate the structure. Often, this is not the case and systems are developed in an ad hoc way. There is, thus, a greater need to understand the way in which guided waves interact with, and are scattered by, damage. This paper aims to contribute to knowledge in this area. A wave finite element method is applied in a study of wave scattering from symmetric and asymmetric changes of cross-sectional area over a finite length in a waveguide, which are intended to be crude models of corrosion damage. To facilitate analysis of the results, Lamb wave scattering is first investigated in such a system for a point discontinuity involving a change in cross-sectional area. The wave scattering characteristics are evaluated by using the time-averaged kinetic energy of the reflected and transmitted wave fields considering components in the vertical and horizontal directions. This, together with the traditionally used displacement and energy flow coefficients, allows an investigation into the rich wave scattering behaviour due to multi-mode behaviour and wave mode conversion which can complicate the interpretation of the results. In particular, it is shown that care needs to be taken in the interpretation of a sudden increase in the amplitude of a reflected wave from damage. At certain frequencies, this can be due to evanescent waves starting to propagate, rather than an increase in the severity of the damage

Gonadal function in adolescents and young women with juvenile systemic lupus erythematosus

The authors analysed the gonadal function and age of menarche of 23 female adolescents and young women with SLE, and correlated these with clinical, SLEDAI and therapeutic parameters. the presence of one or more clinical and laboratory parameters defined normal gonadal function: normal menstrual cycles with or without dysmenorrhea; elevated cervical mucus length; normal levels of plasma FSH, LH, estradiol, progesterone, prolactin and testosterone; normal urinary hormonal cytology; serial pelvic ultrasound compatible with ovulatory pattern; and present or previous pregnancy. the mean age of menarche (13.5 +/- 1.4 years) was greater than that found among 2578 healthy Brazilian adolescents (12.5 +/- 1.3 years; P = 0.0002). the delay in menarche correlated with an increase in the duration of the disease (P = 0.0085) and the cumulative dose of prednisone (P = 0.0013) used until the appearance of the menarche. the mean phase length in SLE was 31.5 +/- 10.3. Sixteen female (70%) patients showed normal and seven (30%) abnormal gonadal function. Gonadal function was not correlated with parameters of SLE. These results suggest that the patients of this study reach adulthood with a high chance of fertility.Univ São Paulo, Sch Med, Dept Pediat, Pediat Rheumatol Unit,Childrens Inst, São Paulo, BrazilUniv São Paulo, Sch Med, Adolescent Gynaecol Serv, São Paulo, BrazilUniv São Paulo, Sch Med, Dept Pediat, Adolescent Gynecol Serv,Childrens Inst, São Paulo, BrazilWeb of Scienc

Menstrual and hormonal alterations in juvenile systemic lupus erythematosus

Menstrual cycles of 30 patients with juvenile systemic lupus erythematosus (JSLE) were compared with 30 age-matched controls. The mean age of patients with JSLE and controls was similar (17.4 +/- 3.2 vs 17.06 +/- 2.08 years, P = 0.66). The mean menarche age was higher in JSLE than controls (13.13 +/- 1.4 vs 11.56 +/- 1.5 years, P = 0.0008). On the contrary, the mean maternal menarche age was similar in both groups (P = 0.62). Menstrual abnormalities and longer length cycles were more frequently observed in JSLE than controls (63% vs 10%, P = 0.0001; 23% vs 0%, P = 0.0105, respectively). The median of follicle stimulating hormone was significantly higher in patients with JSLE compared with controls (4.6 vs 3.4 IU/L, P = 0.0207), and the median of progesterone was lower (32.5 vs 70 ng/mL, P = 0.0033). The median Of luteinizing hormone was lower in patients with JSLE with menstrual abnormalities versus normal cycles (2.9 vs 5.5 IU/L, P = 0.019) and both had a high percentage of decreased progesterone levels (63% vs 73%, P = 0.70). Our findings support the notion that menstrual disturbances are frequent and may be associated with pituitary dysfunction leading to a decreased progesterone production. We also reported that in spite of premature ovarian failure being a rare event in JSLE the follicular reserve seems to be low regardless of intravenous cyclophosphamide treatment. Lupus (2009) 18, 38-43.Conselho Nacional de Desenvolvimento Clentifico e Tecnologico - CNPQ[305468/2006-5]Conselho Nacional de Desenvolvimento Clentifico e Tecnologico - CNPQ[302469/2005-2]Federico Foundatio

Custos comparativos entre a revascularização miocárdica com e sem circulação extracorpórea Comparative costs between myocardial revascularization with or without extracorporeal circulation

FUNDAMENTO: Técnicas cirúrgicas de revascularização miocárdica sem o uso de circulação extracorpórea (CEC) projetaram esperanças de resultados operatórios com menor dano sistêmico, menor ocorrência de complicações clínicas e menor tempo de internação hospitalar, gerando expectativas de menor custo hospitalar. OBJETIVO: Avaliar o custo hospitalar em pacientes submetidos à cirurgia de revascularização miocárdica com e sem o uso de CEC, e em portadores de doença multiarterial coronariana estável com função ventricular preservada. MÉTODOS: Os custos hospitalares foram baseados na remuneração governamental vigente. Acrescentaram-se aos custos uso de órteses e próteses, complicações e intercorrências clínicas. Consideraram-se o tempo e os custos de permanência na UTI e de internação hospitalar. RESULTADOS: Entre janeiro de 2002 e agosto de 2006, foram randomizados 131 pacientes para cirurgia com CEC (CCEC) e 128 pacientes sem CEC (SCEC). As características basais foram semelhantes para os dois grupos. Os custos das intercorrências cirúrgicas foram significativamente menores (p < 0,001) para pacientes do grupo SCEC comparados ao grupo CCEC (606,00 &plusmn; 525,00 vs. 945,90 &plusmn; 440,00), bem como os custos na UTI: 432,20 &plusmn; 391,70 vs. 717,70 &plusmn; 257,70, respectivamente. Os tempos de permanência na sala cirúrgica foram (4,9 &plusmn; 1,1 h vs. 3,9 &plusmn; 1,0 h), (p < 0,001) na UTI (48,2 &plusmn; 17,2 h vs. 29,2 &plusmn; 26,1h) (p < 0,001), com tempo de entubação (9,2 &plusmn; 4,5 h vs. 6,4 &plusmn; 5,1h) (p < 0,001) para pacientes do grupo com e sem CEC, respectivamente. CONCLUSÃO: Os resultados permitem concluir que a cirurgia de revascularização miocárdica, sem circulação extracorpórea, proporciona diminuição de custos operacionais e de tempo de permanência em cada setor relacionado ao tratamento cirúrgico.<br>BACKGROUND: Surgical techniques of myocardial revascularization without the use of extracorporeal circulation (ECC) have raised hopes of attaining operative results with less systemic damage, lower occurrence of clinical complications and shorter hospital stay duration, generating expectations of lower hospital costs. OBJECTIVE: To evaluate the hospital costs in patients submitted to myocardial revascularization with and without ECC and in those with stable multiarterial coronary disease with preserved ventricular function. METHODS: The hospital costs were based on the existing governmental reimbursement. The costs included that of ortheses and prostheses and clinical complications. The time and costs of ICU stay and hospital stay duration were considered. RESULTS: Between January 2002 and August 2006, 131 patients were randomized to surgery with ECC (SECC), whereas 128 were randomized to surgery without ECC (WECC). The basal characteristics were similar for both groups. The costs of surgical complications were significantly lower (p < 0.001) in patients from the WECC when compared to the SECC group (606.00 &plusmn; 525.00 vs. 945.90 &plusmn; 440.00), as well as ICU costs: 432.20 &plusmn; 391.70 vs. 717.70 &plusmn; 257.70, respectively. The duration of the operating room stay were 4.9 &plusmn; 1.1 h vs. 3.9 &plusmn; 1.0 h, p < 0.001; at the ICU it was 48.2 &plusmn; 17.2 h vs. 29.2 &plusmn; 26.1h) (p < 0.001), with intubation time of 9.2 &plusmn; 4.5 h vs. 6.4 &plusmn; 5.1h, p < 0.001 for patients from the group with and without ECC, respectively. CONCLUSION: The present study allowed us to conclude that the myocardial revascularization surgery without extracorporeal circulation results in the decrease of operational costs and duration of the stay in each section related to the surgical treatment