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[PMID]:29318277
[Au] Autor:Jones PM; Cherry RA; Allen BN; Jenkyn KMB; Shariff SZ; Flier S; Vogt KN; Wijeysundera DN
[Ad] Endereço:Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada.
[Ti] Título:Association Between Handover of Anesthesia Care and Adverse Postoperative Outcomes Among Patients Undergoing Major Surgery.
[So] Source:JAMA;319(2):143-153, 2018 01 09.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Handing over the care of a patient from one anesthesiologist to another occurs during some surgeries and might increase the risk of adverse outcomes. Objective: To assess whether complete handover of intraoperative anesthesia care is associated with higher likelihood of mortality or major complications compared with no handover of care. Design, Setting, and Participants: A retrospective population-based cohort study (April 1, 2009-March 31, 2015 set in the Canadian province of Ontario) of adult patients aged 18 years and older undergoing major surgeries expected to last at least 2 hours and requiring a hospital stay of at least 1 night. Exposure: Complete intraoperative handover of anesthesia care from one physician anesthesiologist to another compared with no handover of anesthesia care. Main Outcomes and Measures: The primary outcome was a composite of all-cause death, hospital readmission, or major postoperative complications, all within 30 postoperative days. Secondary outcomes were the individual components of the primary outcome. Inverse probability of exposure weighting based on the propensity score was used to estimate adjusted exposure effects. Results: Of the 313 066 patients in the cohort, 56% were women; the mean (SD) age was 60 (16) years; 49% of surgeries were performed in academic centers; 72% of surgeries were elective; and the median duration of surgery was 182 minutes (interquartile [IQR] range, 124-255). A total of 5941 (1.9%) patients underwent surgery with complete handover of anesthesia care. The percentage of patients undergoing surgery with a handover of anesthesiology care progressively increased each year of the study, reaching 2.9% in 2015. In the unweighted sample, the primary outcome occurred in 44% of the complete handover group compared with 29% of the no handover group. After adjustment, complete handovers were statistically significantly associated with an increased risk of the primary outcome (adjusted risk difference [aRD], 6.8% [95% CI, 4.5% to 9.1%]; P < .001), all-cause death (aRD, 1.2% [95% CI, 0.5% to 2%]; P = .002), and major complications (aRD, 5.8% [95% CI, 3.6% to 7.9%]; P < .001), but not with hospital readmission within 30 days of surgery (aRD, 1.2% [95% CI, -0.3% to 2.7%]; P = .11). Conclusions and Relevance: Among adults undergoing major surgery, complete handover of intraoperative anesthesia care compared with no handover was associated with a higher risk of adverse postoperative outcomes. These findings may support limiting complete anesthesia handovers.
[Mh] Termos MeSH primário: Anestesiologia/organização & administração
Cuidados Intraoperatórios/efeitos adversos
Transferência da Responsabilidade pelo Paciente
Complicações Pós-Operatórias/etiologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seres Humanos
Masculino
Meia-Idade
Readmissão do Paciente/estatística & dados numéricos
Estudos Retrospectivos
Procedimentos Cirúrgicos Operatórios/mortalidade
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.20040


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[PMID]:28448298
[Au] Autor:Katz JA; Murphy GS
[Ad] Endereço:Northshore University Health System, University of Chicago, Pritzker School of Medicine, Illinois, USA.
[Ti] Título:Anesthetic consideration for neuromuscular diseases.
[So] Source:Curr Opin Anaesthesiol;30(3):435-440, 2017 Jun.
[Is] ISSN:1473-6500
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE OF REVIEW: The aim of this review is to examine data relating to perioperative management of the patient with neuromuscular disorders RECENT FINDINGS: Patients with pre-existing neuromuscular disorders are at risk for a number of postoperative complications that are related to anesthetic drugs that are administered intraoperatively. Careful preoperative assessment is necessary to reduce morbidity and mortality. In particular, the risk of postoperative respiratory failure and need for long-term ventilation should be reviewed with patients. The use of succinylcholine should be avoided in muscular dystrophies, motor neuron diseases, and intrinsic muscle disease due to a risk of malignant hyperthermia, hyperkalemia, rhabdomyolysis, and cardiac arrest. The use of quantitative neuromuscular monitoring should be strongly considered whenever nondepolarizing neuromuscular blocking agents are administered. A number of case series and reports have been recently published demonstrating that sugammadex can be safely used in patients with neuromuscular disease; the risk of residual neuromuscular is nearly eliminated when this agent is administered intraoperatively. SUMMARY: Careful assessment and management of patients with underlying neuromuscular diseases is required to reduce postoperative complications. This article reviews the anesthetic implications of patients undergoing surgery with neuromuscular disorder.
[Mh] Termos MeSH primário: Anestesia/efeitos adversos
Anestésicos/efeitos adversos
Bloqueadores Neuromusculares/efeitos adversos
Doenças Neuromusculares/complicações
Assistência Perioperatória/métodos
Complicações Pós-Operatórias/etiologia
Procedimentos Cirúrgicos Operatórios/efeitos adversos
[Mh] Termos MeSH secundário: Anestesia/métodos
Anestésicos/administração & dosagem
Parada Cardíaca/induzido quimicamente
Parada Cardíaca/prevenção & controle
Seres Humanos
Hiperpotassemia/induzido quimicamente
Complicações Intraoperatórias/induzido quimicamente
Complicações Intraoperatórias/prevenção & controle
Hipertermia Maligna/etiologia
Bloqueadores Neuromusculares/administração & dosagem
Doenças Neuromusculares/epidemiologia
Monitoração Neuromuscular
Complicações Pós-Operatórias/prevenção & controle
Prevalência
Insuficiência Respiratória/prevenção & controle
Rabdomiólise/induzido quimicamente
Rabdomiólise/prevenção & controle
Medição de Risco
Succinilcolina/administração & dosagem
Succinilcolina/efeitos adversos
gama-Ciclodextrinas/administração & dosagem
gama-Ciclodextrinas/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anesthetics); 0 (Neuromuscular Blocking Agents); 0 (gamma-Cyclodextrins); 361LPM2T56 (Sugammadex); J2R869A8YF (Succinylcholine)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.1097/ACO.0000000000000466


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[PMID]:29231667
[Au] Autor:Myrstad M; Vandvik I; Engebretsen EH; Tveit A
[Ti] Título:Hjerneslag etter seponering av nye antikoagulasjonsmidler før kirurgi..
[So] Source:Tidsskr Nor Laegeforen;137(23-24), 2017 12 12.
[Is] ISSN:0807-7096
[Cp] País de publicação:Norway
[La] Idioma:nor
[Mh] Termos MeSH primário: Anticoagulantes/administração & dosagem
Antitrombinas/administração & dosagem
Dabigatrana/administração & dosagem
Inibidores do Fator Xa/administração & dosagem
Cuidados Pré-Operatórios/efeitos adversos
Pirazóis/administração & dosagem
Piridonas/administração & dosagem
Acidente Vascular Cerebral/etiologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Fibrilação Atrial/tratamento farmacológico
Seres Humanos
Masculino
Meia-Idade
Medição de Risco
Fatores de Risco
Acidente Vascular Cerebral/diagnóstico por imagem
Procedimentos Cirúrgicos Operatórios
Fatores de Tempo
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Antithrombins); 0 (Factor Xa Inhibitors); 0 (Pyrazoles); 0 (Pyridones); 3Z9Y7UWC1J (apixaban); I0VM4M70GC (Dabigatran)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE
[do] DOI:10.4045/tidsskr.17.0532


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[PMID]:29390259
[Au] Autor:Wang S; Shi N; You L; Dai M; Zhao Y
[Ad] Endereço:Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
[Ti] Título:Minimally invasive surgical approach versus open procedure for pancreaticoduodenectomy: A systematic review and meta-analysis.
[So] Source:Medicine (Baltimore);96(50):e8619, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Minimally invasive pancreaticoduodenectomy (MIPD) remains one of the most challenging abdominal procedures. Safety and feasibility remain controversial when comparing MIPD with open pancreaticoduodenectomy (OPD). The aim of this systematic review and meta-analysis was to evaluate the feasibility and safety of MIPD versus OPD. METHODS: A systematic review of the literature was performed to identify studies comparing MIPD and OPD. Postoperative complications, intraoperative outcomes and oncologic data, and postoperative recovery were compared. RESULTS: There were 27 studies that matched the selection criteria. Totally 1306 cases of MIPD and 5603 cases of OPD were included. MIPD was associated with a reduction in postoperative hemorrhage (odds ratio [OR] 1.60; 95% confidence interval [CI] 1.03-2.49; P = .04) and wound infection (OR 0.44, 95% CI 0.30-0.66, P < .0001). MIPD was also associated with less estimated blood loss (mean difference [MD] -300.14 mL, 95% CI -400.11 to -200.17 mL, P < .00001), a lower transfusion rate (OR 0.46, 95% CI 0.35-0.61; P < .00001) and a shorter length of hospital stay (MD -2.95 d, 95% CI -3.91 to -2.00 d, P < .00001) than OPD. Meanwhile, the MIPD group had a higher R0 resection rate (OR 1.45, 95% CI 1.18-1.78, P = .0003) and more lymph nodes harvested (MD 1.34, 95% CI 0.14-2.53, P = .03). However, the minimally invasive approach proved to have much longer operative time (MD 71.00 minutes; 95% CI 27.01-115.00 minutes; P = .002) than OPD. Finally, there were no significant differences between the 2 procedures in postoperative pancreatic fistula (P = .30), delayed gastric emptying (P = .07), bile leakage (P = .98), mortality (P = .88), tumor size (P = .15), vascular resection (P = .68), or reoperation rate (P = .11). CONCLUSIONS: Our results suggest that MIPD is currently safe, feasible, and worthwhile. Future large-volume, well-designed randomized controlled trials (RCT) with extensive follow-up are awaited to further clarify this role.
[Mh] Termos MeSH primário: Laparoscopia
Pancreaticoduodenectomia/métodos
[Mh] Termos MeSH secundário: Perda Sanguínea Cirúrgica/estatística & dados numéricos
Transfusão de Sangue/estatística & dados numéricos
Seres Humanos
Tempo de Internação/estatística & dados numéricos
Pancreaticoduodenectomia/efeitos adversos
Complicações Pós-Operatórias
Procedimentos Cirúrgicos Operatórios
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008619


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[PMID]:29357383
[Au] Autor:Ultee KHJ; Tjeertes EKM; Bastos Gonçalves F; Rouwet EV; Hoofwijk AGM; Stolker RJ; Verhagen HJM; Hoeks SE
[Ad] Endereço:Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
[Ti] Título:The relation between household income and surgical outcome in the Dutch setting of equal access to and provision of healthcare.
[So] Source:PLoS One;13(1):e0191464, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The impact of socioeconomic disparities on surgical outcome in the absence of healthcare inequality remains unclear. Therefore, we set out to determine the association between socioeconomic status (SES), reflected by household income, and overall survival after surgery in the Dutch setting of equal access and provision of care. Additionally, we aim to assess whether SES is associated with cause-specific survival and major 30-day complications. METHODS: Patients undergoing surgery between March 2005 and December 2006 in a general teaching hospital in the Netherlands were prospectively included. Adjusted logistic and cox regression analyses were used to assess the independent association of SES-quantified by gross household income-with major 30-day complications and long-term postoperative survival. RESULTS: A total of 3929 patients were included, with a median follow-up of 6.3 years. Low household income was associated with worse survival in continuous analysis (HR: 1.05 per 10.000 euro decrease in income, 95% CI: 1.01-1.10) and in income quartile analysis (HR: 1.58, 95% CI: 1.08-2.31, first [i.e. lowest] quartile relative to the fourth quartile). Similarly, low income patients were at higher risk of cardiovascular death (HR: 1.26 per 10.000 decrease in income, 95% CI: 1.07-1.48, first income quartile: HR: 3.10, 95% CI: 1.04-9.22). Household income was not independently associated with cancer-related mortality and major 30-day complications. CONCLUSIONS: Low SES, quantified by gross household income, is associated with increased overall and cardiovascular mortality risks among surgical patients. Considering the equality of care provided by this study setting, the associated survival hazards can be attributed to patient and provider factors, rather than disparities in healthcare. Increased physician awareness of SES as a risk factor in preoperative decision-making and focus on improving established SES-related risk factors may improve surgical outcome of low SES patients.
[Mh] Termos MeSH primário: Acesso aos Serviços de Saúde/economia
Acesso aos Serviços de Saúde/estatística & dados numéricos
Renda
Classe Social
Procedimentos Cirúrgicos Operatórios
[Mh] Termos MeSH secundário: Feminino
Disparidades em Assistência à Saúde/estatística & dados numéricos
Seres Humanos
Masculino
Meia-Idade
Países Baixos
Análise de Sobrevida
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180123
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191464


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[PMID]:29351327
[Au] Autor:Akbilgic O; Langham MR; Walter AI; Jones TL; Huang EY; Davis RL
[Ad] Endereço:University of Tennessee Health Science Center-Oak Ridge National Laboratory Center for Biomedical Informatics, Memphis, Tennessee, United States of America.
[Ti] Título:A novel risk classification system for 30-day mortality in children undergoing surgery.
[So] Source:PLoS One;13(1):e0191176, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A simple, objective and accurate way of grouping children undergoing surgery into clinically relevant risk groups is needed. The purpose of this study, is to develop and validate a preoperative risk classification system for postsurgical 30-day mortality for children undergoing a wide variety of operations. The National Surgical Quality Improvement Project-Pediatric participant use file data for calendar years 2012-2014 was analyzed to determine preoperative variables most associated with death within 30 days of operation (D30). Risk groups were created using classification tree analysis based on these preoperative variables. The resulting risk groups were validated using 2015 data, and applied to neonates and higher risk CPT codes to determine validity in high-risk subpopulations. A five-level risk classification was found to be most accurate. The preoperative need for ventilation, oxygen support, inotropic support, sepsis, the need for emergent surgery and a do not resuscitate order defined non-overlapping groups with observed rates of D30 that vary from 0.075% (Very Low Risk) to 38.6% (Very High Risk). When CPT codes where death was never observed are eliminated or when the system is applied to neonates, the groupings remained predictive of death in an ordinal manner.
[Mh] Termos MeSH primário: Mortalidade da Criança
Procedimentos Cirúrgicos Operatórios/mortalidade
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Comorbidade
Bases de Dados Factuais
Feminino
Mortalidade Hospitalar
Seres Humanos
Lactente
Mortalidade Infantil
Recém-Nascido
Modelos Logísticos
Masculino
Mortalidade Perinatal
Complicações Pós-Operatórias/mortalidade
Complicações Pós-Operatórias/prevenção & controle
Melhoria de Qualidade
Medição de Risco
Fatores de Risco
Fatores de Tempo
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180120
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191176


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[PMID]:29313371
[Au] Autor:Marquardt M; Anderson C; Ginader T; Parkhurst J; Pagedar N; Bayon R; Clamon G; Hoover A; Buatti J
[Ad] Endereço:1 Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
[Ti] Título:Utility of 3-Month Surveillance F-18 FDG PET/CT in Surgically Resected Oral Squamous Cell Carcinoma.
[So] Source:Ann Otol Rhinol Laryngol;127(3):185-191, 2018 Mar.
[Is] ISSN:1943-572X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To evaluate the performance of surveillance F-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) 1 year after imaging in oral squamous cell carcinoma (OSCC) patients treated with definitive surgery and adjuvant (chemo)radiotherapy (RT). METHODS AND MATERIALS: Surveillance PET/CT accuracy was retrospectively evaluated in OSCC patients receiving surgical resection and (chemo)RT. Pathologic risk factors were assessed for influence on accuracy of the post-RT PET/CT. RESULTS: Fifty-four patients with median follow-up of 3.8 years met inclusion criteria. A PET/CT obtained a median of 3.4 months after RT revealed 11 (20.4%) instances of true disease recurrence: 4 locoregional alone, 6 distant alone, and 1 patient with locoregional and distant disease. Locoregional detection sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 55.6%, 75.0%, 33.3%, and 88.2%, respectively. For distant recurrence, the respective values were 100%, 95.2%, 77.8%, and 100%. Absence of bone invasion, absence of pT4 disease, and disease within the tongue were independently associated with higher sensitivity ( P = .048). Perineural invasion was associated with increased specificity ( P = .027), and tumor location in the tongue was associated with a higher PPV ( P = .007) on surveillance PET/CT. CONCLUSIONS: Post-RT PET/CT accuracy information for surgically managed OSCC patients demonstrates significant associations with pathologic factors.
[Mh] Termos MeSH primário: Carcinoma de Células Escamosas
Fluordesoxiglucose F18/farmacologia
Neoplasias de Cabeça e Pescoço
Recidiva Local de Neoplasia/diagnóstico
Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos
Tomografia Computadorizada por Raios X/métodos
[Mh] Termos MeSH secundário: Idoso
Carcinoma de Células Escamosas/epidemiologia
Carcinoma de Células Escamosas/patologia
Carcinoma de Células Escamosas/terapia
Quimiorradioterapia Adjuvante/métodos
Precisão da Medição Dimensional
Feminino
Neoplasias de Cabeça e Pescoço/epidemiologia
Neoplasias de Cabeça e Pescoço/patologia
Neoplasias de Cabeça e Pescoço/terapia
Seres Humanos
Iowa/epidemiologia
Masculino
Meia-Idade
Imagem Multimodal
Esvaziamento Cervical/métodos
Invasividade Neoplásica
Compostos Radiofarmacêuticos/farmacologia
Estudos Retrospectivos
Procedimentos Cirúrgicos Operatórios/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Radiopharmaceuticals); 0Z5B2CJX4D (Fluorodeoxyglucose F18)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.1177/0003489417751474


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[PMID]:29235093
[Au] Autor:Di Minno MND; Napolitano M; Dolce A; Mariani G; STER Study Group
[Ad] Endereço:Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
[Ti] Título:Role of clinical and laboratory parameters for treatment choice in patients with inherited FVII deficiency undergoing surgical procedures: evidence from the STER registry.
[So] Source:Br J Haematol;180(4):563-570, 2018 02.
[Is] ISSN:1365-2141
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Perioperative bleeding is a major concern in patients with factor VII (FVII) deficiency. Evaluating data of 95 FVII-deficient patients undergoing 110 surgical procedures (61 major, 49 minor), we assessed the impact of type of surgery, bleeding phenotype and FVII coagulant activity (FVII:C) levels on perioperative replacement therapy (RT). Compared to those with higher FVII:C levels, patients with <3% FVII:C received a higher number of RT doses (8 vs. 2, P = 0·003) for a longer RT duration (3 days vs. 1 day, P = 0·001), with no difference in RT dose. Similarly, patients with a history of major bleeds received a higher number of RT doses (8·5 vs. 2-3, P = 0·013) for a longer RT duration (2 days vs. 1 day, P = 0·005) as compared to those with a history of minor bleeds or to asymptomatic patients. No difference in RT was found among major and minor surgical procedures. Overall, multivariate analysis showed that history of major bleeding was the only independent predictor of number of RT doses (ß = 0·352, P = 0·001) and RT duration (ß = 0·405, P = 0·018). Overall, a ≈20 µg/kg perioperative RT was efficacious in 95·5% of cases. The infusion should be repeated ≈8 times in high-risk subsets (i.e. patients with a history of major bleeding).
[Mh] Termos MeSH primário: Deficiência do Fator VII/diagnóstico
Deficiência do Fator VII/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Tomada de Decisão Clínica
Terapia Combinada
Gerenciamento Clínico
Fator VII/administração & dosagem
Deficiência do Fator VII/epidemiologia
Feminino
Hemorragia/etiologia
Hemorragia/cirurgia
Seres Humanos
Masculino
Meia-Idade
Sistema de Registros
Procedimentos Cirúrgicos Operatórios/métodos
Avaliação de Sintomas
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
9001-25-6 (Factor VII)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE
[do] DOI:10.1111/bjh.15055


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[PMID]:27772621
[Au] Autor:Le J
[Ad] Endereço:Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: jade.le@utsouthwestern.edu.
[Ti] Título:Oncogenic γ Herpesviruses EBV and HHV8 in Kidney Transplantation.
[So] Source:Semin Nephrol;36(5):362-371, 2016 09.
[Is] ISSN:1558-4488
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Epstein-Barr virus (EBV) and human herpesvirus-8 (HHV-8) are γ herpesviruses associated with post-transplant malignancies in kidney transplant recipients. EBV is associated with post-transplantation lymphoproliferative disorder (PTLD), with increased risk in EBV-seronegative patients on intensified immunosuppression. Human herpesvirus-8 is associated with Kaposi's sarcoma (KS), with an increased risk in certain patient populations. Diagnosis of PTLD and KS relies on tissue biopsy. The mainstay of therapy for both PTLD and Kaposi's sarcoma is a reduction of immunosuppression, and in the case of PTLD, consideration of rituximab. Chemotherapy, radiation therapy, or surgery is provided for disseminated or recalcitrant disease. The prognoses vary depending on the type of malignancy identified and stage of disease.
[Mh] Termos MeSH primário: Infecções por Vírus Epstein-Barr/induzido quimicamente
Rejeição de Enxerto/prevenção & controle
Imunossupressores/efeitos adversos
Falência Renal Crônica/cirurgia
Transplante de Rim
Transtornos Linfoproliferativos/induzido quimicamente
Sarcoma de Kaposi/induzido quimicamente
[Mh] Termos MeSH secundário: Antineoplásicos/uso terapêutico
Antineoplásicos Imunológicos/uso terapêutico
Infecções por Vírus Epstein-Barr/diagnóstico
Infecções por Vírus Epstein-Barr/tratamento farmacológico
Infecções por Herpesviridae/induzido quimicamente
Infecções por Herpesviridae/diagnóstico
Infecções por Herpesviridae/terapia
Infecções por Herpesviridae/virologia
Herpesvirus Humano 4
Herpesvirus Humano 8
Seres Humanos
Transtornos Linfoproliferativos/diagnóstico
Transtornos Linfoproliferativos/terapia
Transtornos Linfoproliferativos/virologia
Radioterapia
Rituximab/uso terapêutico
Sarcoma de Kaposi/diagnóstico
Sarcoma de Kaposi/terapia
Sarcoma de Kaposi/virologia
Procedimentos Cirúrgicos Operatórios
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Antineoplastic Agents); 0 (Antineoplastic Agents, Immunological); 0 (Immunosuppressive Agents); 4F4X42SYQ6 (Rituximab)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:29300728
[Au] Autor:Biolo G; Massolino B; Di Girolamo FG; Fiotti N; Mearelli F; Mazzucco S; Bertuzzi C; Lazzarini R; Colombatti A; De Cicco M
[Ad] Endereço:Department of Medical, Surgical and Health Sciences, University of Trieste, Clinica Medica, ASUITS, Trieste, Italy.
[Ti] Título:Intensive insulin therapy increases glutathione synthesis rate in surgical ICU patients with stress hyperglycemia.
[So] Source:PLoS One;13(1):e0190291, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The glutathione system plays an essential role in antioxidant defense after surgery. We assessed the effects of intensive insulin treatment (IIT) on glutathione synthesis rate and redox balance in cancer patients, who had developed stress hyperglycemia after major surgery. METHODS: We evaluated 10 non-diabetic cancer patients the day after radical abdominal surgery combined with intra-operative radiation therapy. In each patient, a 24-hr period of IIT, aimed at tight euglycemic control, was preceded, or followed, by a 24-hr period of conventional insulin treatment (CIT) (control regimen). Insulin was administered for 24 hours, during total parenteral nutrition, at a dosage to maintain a moderate hyperglycemia in CIT, and normoglycemic blood glucose levels in IIT (9.3±0.5 vs 6.5±0.3 mmol/L respectively, P<0.001; coefficient of variation, 9.7±1.4 and 10.5±1.1%, P = 0.43). No hypoglycemia (i.e., blood glucose < 3.9 mmol/L) was observed in any of the patients. Insulin treatments were performed on the first and second day after surgery, in randomized order, according to a crossover experimental design. Plasma concentrations of thiobarbituric acid reactive substances (TBARS) and erythrocyte glutathione synthesis rates (EGSR), measured by primed-constant infusion of L-[2H2]cysteine, were assessed at the end of each 24-hr period of either IIT or CIT. RESULTS: Compared to CIT, IIT was associated with higher EGSR (2.70±0.51 versus 1.18±0.29 mmol/L/day, p = 0.01) and lower (p = 0.04) plasma TBARS concentrations (2.2±0.2 versus 2.9±0.4 nmol/L). CONCLUSIONS: In patients developing stress hyperglycemia after major surgery, IIT, in absence of hypoglycemia, stimulates erythrocyte glutathione synthesis, while decreasing oxidative stress.
[Mh] Termos MeSH primário: Glutationa/biossíntese
Hiperglicemia/tratamento farmacológico
Insulina/uso terapêutico
Unidades de Terapia Intensiva
Estresse Fisiológico
Procedimentos Cirúrgicos Operatórios
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seres Humanos
Insulina/administração & dosagem
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Insulin); GAN16C9B8O (Glutathione)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180105
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190291



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