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[PMID]:29292958
[Au] Autor:Lundgren J; Rådegran G
[Ad] Endereço:Sektionen för Hjärtsvikt och klaffsjukdomar - Hjärt- och lungkliniken, SUS Lund, Sweden Hemodynamic Lab - Section for Heart Failure and Valvular Disease Lund, Sweden.
[Ti] Título:Pulmonell hypertension vanligt vid vänstersidig hjärtsjukdom - Kunskapsläget är dåligt ­ fler kliniska studier behövs..
[So] Source:Lakartidningen;114, 2017 Dec 01.
[Is] ISSN:1652-7518
[Cp] País de publicação:Sweden
[La] Idioma:swe
[Ab] Resumo:Pulmonary hypertension (PH) is a serious complication to left heart disease (LHD), affecting a majority of the patients during the course of the disease. Initially, PH-LHD is caused by passive congestion of the pulmonary vessels due to increased left atrial pressures, a condition that is currently denoted as isolated post-capillary PH (Icp-PH). In the majority of patients the increased atrial pressure is a result of elevated left ventricular filling pressures. Furthermore, chronically elevated filling pressures may yield endothelial damage, resulting in structural and functional alterations in the pre-capillary bed with further elevation in pulmonary pressures as well as elevated vascular resistance, defined as combined precapillary and postcapillary PH (Cpc-PH). With previous definitions of PH-LHD it has been difficult to differentiate between the subgroups, so a new classification was presented in the 2015 PH guidelines. Despite PH-LHD being common and serious, specific therapies are lacking for the pulmonary component. Instead, treatments focus on optimizing the underlying cause of PH-LHD and involve medical as well as surgical therapies. In the present review we presents, based on the new guidelines, current knowledge on pathophysiological and pathobiological mechanisms, epidemiology, investigation and treatment of PH-LHD.
[Mh] Termos MeSH primário: Insuficiência Cardíaca/complicações
Hipertensão Pulmonar/etiologia
Disfunção Ventricular Esquerda/complicações
[Mh] Termos MeSH secundário: Procedimentos Clínicos
Insuficiência Cardíaca/diagnóstico
Insuficiência Cardíaca/tratamento farmacológico
Insuficiência Cardíaca/fisiopatologia
Seres Humanos
Hipertensão Pulmonar/diagnóstico
Hipertensão Pulmonar/tratamento farmacológico
Hipertensão Pulmonar/fisiopatologia
Guias de Prática Clínica como Assunto
Prognóstico
Disfunção Ventricular Esquerda/diagnóstico
Disfunção Ventricular Esquerda/tratamento farmacológico
Disfunção Ventricular Esquerda/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[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:180103
[St] Status:MEDLINE


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[PMID]:29384300
[Au] Autor:Martin A; Jego-Sablier M; Prudhomme J; Champsaur L
[Ti] Título:[Care pathway of children managed by the Bouches-du-Rhone Child Welfare Services].
[Ti] Título:Parcours de santé des enfants confiés à l?Aide Sociale à l?Enfance des Bouches-du-Rhône..
[So] Source:Sante Publique;29(5):665-675, 2017 Dec 05.
[Is] ISSN:0995-3914
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:AIM: To describe the care pathway of children managed by the Bouches-du-Rhône Child Welfare Services and to propose ways to improve this care pathway. METHODS: ESSPER-ASE 13 survey is a descriptive and cross-sectional survey carried out between April 2013 and April 2014, which included 1,092 children under the age of 18 years placed in a Bouches-du-Rhône Child Welfare Services children's home or foster care. This survey studied the physical and mental health and the medical follow-up characteristics of these children. This article focuses on care pathway data. RESULTS: 82% of children were followed by general practitioners, while 15% of children, essentially children under the age of 6 years in child care, were followed by Maternal and Infant Protection (Protection Maternelle et Infantile). The care pathway of these children involved multiple actors and was dominated by psychological follow-up. On average, the children were followed by 2 professionals (specialist or paramedical professional) in addition to the medical examiner. In terms of prevention, children's immunization coverage rates were better than national rates. CONCLUSION: Coordination of the numerous actors is essential, including the creation of a referring physician.
[Mh] Termos MeSH primário: Serviços de Proteção Infantil
Bem-Estar da Criança
Procedimentos Clínicos
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Estudos Transversais
Feminino
França
Seres Humanos
Lactente
Recém-Nascido
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.3917/spub.175.0665


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[PMID]:29199436
[Au] Autor:Nagy J; Sági B; Máté J; Vas T; Kovács T
[Ad] Endereço:Klinikai Központ, II. Belgyógyászati Klinika és Nefrológiai Centrum, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs, Pacsirta u. 1., 7624.
[Ti] Título:[Considerations on the treatment of IgA nephropathy on the basis of the results of the latest studies (STOP-IgAN, TESTING, NEFIGAN)].
[Ti] Título:Terápiás megfontolások IgA-nephropathiában a legutolsó vizsgálatok (STOP-IgAN, TESTING, NEFIGAN) eredményei alapján..
[So] Source:Orv Hetil;158(49):1946-1952, 2017 Dec.
[Is] ISSN:0030-6002
[Cp] País de publicação:Hungary
[La] Idioma:hun
[Ab] Resumo:IgA nephropathy is an immune-mediated chronic glomerulonephritis with a great variability in clinical presentation and outcome. The disease can progress to end-stage renal failure in 25% of patients. For this reason we should identify patients with potential to progress. Most important risk factors for progression are persistent proteinuria, hypertension, decreased renal function and some histological lesions. The actually suggested treatment is summarized in KDIGO Clinical Practice Guideline from 2012. They suggest to give firstly non-specific supportive treatment (especially renin-angiotensin system blocking agents). Recommendation about steroid/immunosuppression treatment is based on low level of evidence. Recently three studies were organised concerning benefits and risk of steroid/immunosuppressive treatment added together with specific supportive treatment. In the STOP-IgAN study, systemic steroid/immunosuppressive treatment significantly decreased proteinuria but did not stop progression. In the TESTING study, systemic steroid treatment significantly decreased proteinuria and progression. However, the study was recently discontinued due to several severe side effects of steroid treatment. Involvement of intestinal mucosal immunity in the pathogenesis of IgA nephropathy suggested the NEFIGAN study with budesonide treatment. Budesonide releases corticosteroid in distal small intestine and colon. Proteinuria was significantly decreased and renal function remained stabile. High number of withdrawals owing to adverse effects is a major concern implying a substantial systemic effect of budesonide. We need further information on the characteristics of patients who most likely benefit from steroid/immunosuppressive treatment given after or together with specific supportive treatment. Orv Hetil. 2017; 158(49): 1946-1952.
[Mh] Termos MeSH primário: Glomerulonefrite por IGA/tratamento farmacológico
Imunossupressores/uso terapêutico
Falência Renal Crônica/prevenção & controle
[Mh] Termos MeSH secundário: Budesonida/efeitos adversos
Budesonida/uso terapêutico
Procedimentos Clínicos
Taxa de Filtração Glomerular
Glomerulonefrite por IGA/imunologia
Seres Humanos
Imunossupressão
Falência Renal Crônica/tratamento farmacológico
Proteinúria/tratamento farmacológico
Proteinúria/imunologia
Medição de Risco
Esteroides/efeitos adversos
Esteroides/uso terapêutico
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Immunosuppressive Agents); 0 (Steroids); 51333-22-3 (Budesonide)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE
[do] DOI:10.1556/650.2017.30924


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[PMID]:29305460
[Au] Autor:Broderick C; Hopkins S; Mack DJF; Aston W; Pollock R; Skinner JA; Warren S
[Ad] Endereço:Directorate of Infection, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK.
[Ti] Título:Delays in the diagnosis and treatment of bone and joint tuberculosis in the United Kingdom.
[So] Source:Bone Joint J;100-B(1):119-124, 2018 Jan.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: Tuberculosis (TB) infection of bones and joints accounts for 6.7% of TB cases in England, and is associated with significant morbidity and disability. Public Health England reports that patients with TB experience delays in diagnosis and treatment. Our aims were to determine the demographics, presentation and investigation of patients with a TB infection of bones and joints, to help doctors assessing potential cases and to identify avoidable delays. PATIENTS AND METHODS: This was a retrospective observational study of all adults with positive TB cultures on specimens taken at a tertiary orthopaedic centre between June 2012 and May 2014. A laboratory information system search identified the patients. The demographics, clinical presentation, radiology, histopathology and key clinical dates were obtained from medical records. RESULTS: A total of 31 adult patients were identified. Their median age was 37 years (interquartile range (IQR): 29 to 53); 21 (68%) were male; 89% were migrants. The main sites affected were joints (10, 32%), the spine (8, 26%) and long bones (6, 19%); 8 (26%) had multifocal disease. The most common presenting symptoms were pain (29/31, 94%) and swelling (26/28, 93%). 'Typical' symptoms of TB, such as fever, sweats and weight loss, were uncommon. Patients waited a median of seven months (IQR 3 to 13.5) between the onset of symptoms and referral to the tertiary centre and 2.3 months (IQR 1.6 to 3.4.)) between referral and starting treatment. Radiology suggested TB in 26 (84%), but in seven patients (23%) the initial biopsy specimens were not sent for mycobacterial culture, necessitating a second biopsy. Rapid Polymerase Chain Reaction-based testing for TB using Xpert MTB/RIF was performed in five patients; 4 (80%) tested positive for TB. These patients had a reduced time between the diagnostic biopsy and starting treatment than those whose samples were not tested (median eight days 36 days, p = 0.016). CONCLUSION: Patients with bone and joint TB experience delays in diagnosis and treatment, some of which are avoidable. Maintaining a high index of clinical suspicion and sending specimens for mycobacterial culture are crucial to avoid missing cases. Rapid diagnostic tests reduce delays and should be performed on patients with radiological features of TB. Cite this article: 2018;100-B:119-24.
[Mh] Termos MeSH primário: Tuberculose Osteoarticular/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Antituberculosos/administração & dosagem
Biópsia
Procedimentos Clínicos
Diagnóstico Tardio
Esquema de Medicação
Inglaterra/epidemiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Encaminhamento e Consulta/normas
Encaminhamento e Consulta/estatística & dados numéricos
Estudos Retrospectivos
Fatores de Tempo
Tuberculose Osteoarticular/tratamento farmacológico
Tuberculose Osteoarticular/epidemiologia
Tuberculose Osteoarticular/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Antitubercular Agents)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180107
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.100B1.BJJ-2017-0357.R1


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[PMID]:27771192
[Au] Autor:Citarda S; Galland R; Poux JM; Guerraoui A; Hallonet P; Lino-Daniel M; Thivend P; Caillette-Beaudoin A
[Ad] Endereço:Centre associatif lyonnais de dialyse (Calydial), centre hospitalier Lucien-Hussel, BP 127, 38209 Vienne cedex, France. Electronic address: salvatore.citarda@calydial.org.
[Ti] Título:[Access to kidney transplantation's waiting list: Setting up a clinical pathway].
[Ti] Título:Accès à la liste d'attente de transplantation rénale : mise en place d'un chemin clinique..
[So] Source:Nephrol Ther;12(7):525-529, 2016 Dec.
[Is] ISSN:1872-9177
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:Early information about the kidney transplant is recommended to begin quickly the process of registration on the kidney transplantation waiting list, even for the patients not dialyzed at stage V of the renal insufficiency. It is a strategic choice for the patient care. From the arrival of all the patients in our center of dialysis, a systematic evaluation of the access to the kidney transplant waiting list is organized thanks to a clinical pathway. The impact of this new organization was estimated at 18 months with regard to the information about the kidney transplant transmitted to the patient, of the time required for the assessment of pre-kidney transplant evaluation, and of putting in contraindication. On 78 incident patients, 64 received the information concerning the kidney transplant. After 18 months, 50 clinical pathways are finalized at the time of the analysis among which 25 with a period lower than 6 days and 25 with a median of 169 days. A significant difference of age exists between both groups. The main causes of definitive medical contraindications were estimated. Twenty-two percent of the clinical pathway finalized is awaiting lifting of temporary contraindication. The management of the patient is improved, due to motivation of all the medical teams and a considerable work of coordination between the secretarial department and the department of transplantation in teaching hospital.
[Mh] Termos MeSH primário: Procedimentos Clínicos
Falência Renal Crônica/cirurgia
Transplante de Rim/educação
Educação de Pacientes como Assunto
Listas de Espera
[Mh] Termos MeSH secundário: Idoso
Índice de Massa Corporal
Feminino
Seres Humanos
Comunicação Interdisciplinar
Masculino
Meia-Idade
Seleção de Pacientes
Encaminhamento e Consulta
Reprodutibilidade dos Testes
Fatores de Risco
[Pt] Tipo de publicação:COMPARATIVE STUDY; EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171218
[Lr] Data última revisão:
171218
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:28930953
[Au] Autor:Naik-Mathuria BJ; Rosenfeld EH; Gosain A; Burd R; Falcone RA; Thakkar R; Gaines B; Mooney D; Escobar M; Jafri M; Stallion A; Klinkner DB; Russell R; Campbell B; Burke RV; Upperman J; Juang D; St Peter S; Fenton SJ; Beaudin M; Wills H; Vogel A; Polites S; Pattyn A; Leeper C; Veras LV; Maizlin I; Thaker S; Smith A; Waddell M; Drews J; Gilmore J; Armstrong L; Sandler A; Moody S; Behrens B; Carmant L; and the Pancreatic Trauma Study Group (PTSG) Collaborators:
[Ad] Endereço:From the Texas Children's Hospital (B.J.N-M., E.H.R.); and the Michael E DeBakey Department of Surgery (B.J.N-M., E.H.R.), Houston, TX; Mayo Clinic (D.B.K., S.P.), Rochester, MN; MultiCare Mary Bridge Children's Hospital & Health Center, Tacoma, WA; Children's Hospital of Pittsburgh (B.G., C.L.), Pittsburgh, PA; Le Bonheur Children's Hospital (A.G., L.V.V.), Memphis, TN; Children's Hospital of Alabama (R.R., I.M.), Birmingham, AL; Connecticut Children's Medical Center (B.C., S.T.), Hartford, CT; Hasbro Children's Hospital (H.W., A.S.), Providence, RI; Carolinas HealthCare System (A.S., M.W.), Charlotte, NC; Children's Mercy Hospital (D.J., S.S.P.), Kansas City, MO; Nationwide Children's Hospital (R.T., J.D.), Columbus, OH; Saint Louis Children's Hospital (A.V.), St. Louis, MO; Children's Hospital of Los Angeles (R.V.B., J.U.), Los Angeles, CA; Randall Children's Hospital at Legacy Emanuel (M.J., J.G.), Portland, OR; Boston Children's Hospital (D.M., L.A.), Boston, MA; Children's National Medical Center (R.B.), Washington, DC; University of Utah (S.J.F.), Salt Lake City, UT; Cincinnati Children's (R.A.F.J., S.M.), Cincinnati, OH; Doernbecher Children's Hospital, Oregon Health and Science University (M.J., B.B.), Portland, OR; and Centre Hospitalier Universitaire Sainte-Justine (M.B., L.C.), Montreal, QC, Canada.
[Ti] Título:Proposed clinical pathway for nonoperative management of high-grade pediatric pancreatic injuries based on a multicenter analysis: A pediatric trauma society collaborative.
[So] Source:J Trauma Acute Care Surg;83(4):589-596, 2017 Oct.
[Is] ISSN:2163-0763
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Guidelines for nonoperative management (NOM) of high-grade pancreatic injuries in children have not been established, and wide practice variability exists. The purpose of this study was to evaluate common clinical strategies across multiple pediatric trauma centers to develop a consensus-based standard clinical pathway. METHODS: A multicenter, retrospective review was conducted of children with high-grade (American Association of Surgeons for Trauma grade III-V) pancreatic injuries treated with NOM between 2010 and 2015. Data were collected on demographics, clinical management, and outcomes. RESULTS: Eighty-six patients were treated at 20 pediatric trauma centers. Median age was 9 years (range, 1-18 years). The majority (73%) of injuries were American Association of Surgeons for Trauma grade III, 24% were grade IV, and 3% were grade V. Median time from injury to presentation was 12 hours and median ISS was 16 (range, 4-66). All patients had computed tomography scan and serum pancreatic enzyme levels at presentation, but serial enzyme level monitoring was variable. Pancreatic enzyme levels did not correlate with injury grade or pseudocyst development. Parenteral nutrition was used in 68% and jejunal feeds in 31%. 3Endoscopic retrograde cholangiopancreatogram was obtained in 25%. An organized peripancreatic fluid collection present for at least 7 days after injury was identified in 59% (42 of 71). Initial management of these included: observation 64%, percutaneous drain 24%, and endoscopic drainage 10% and needle aspiration 2%. Clear liquids were started at a median of 6 days (IQR, 3-13 days) and regular diet at a median of 8 days (IQR 4-20 days). Median hospitalization length was 13 days (IQR, 7-24 days). Injury grade did not account for prolonged time to initiating oral diet or hospital length; indicating that the variability in these outcomes was largely due to different surgeon preferences. CONCLUSION: High-grade pancreatic injuries in children are rare and significant variability exists in NOM strategies, which may affect outcomes and effective resource utilization. A standard clinical pathway is proposed. LEVEL OF EVIDENCE: Therapeutic/care management, level V (case series).
[Mh] Termos MeSH primário: Traumatismos Abdominais/terapia
Procedimentos Clínicos
Pâncreas/lesões
[Mh] Termos MeSH secundário: Traumatismos Abdominais/etiologia
Traumatismos Abdominais/patologia
Adolescente
Criança
Pré-Escolar
Consenso
Feminino
Seres Humanos
Lactente
Escala de Gravidade do Ferimento
Masculino
Estudos Retrospectivos
Sociedades Médicas
Centros de Traumatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170921
[St] Status:MEDLINE
[do] DOI:10.1097/TA.0000000000001576


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[PMID]:28882877
[Au] Autor:Rutman L; Klein EJ; Brown JC
[Ad] Endereço:Department of Pediatrics, University of Washington, Seattle, Washington; and lori.rutman@seattlechildrens.org.
[Ti] Título:Clinical Pathway Produces Sustained Improvement in Acute Gastroenteritis Care.
[So] Source:Pediatrics;140(4), 2017 Oct.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVES: Despite widespread use of the rotavirus vaccine in the last decade, dehydrating illnesses impact almost 2 billion children worldwide annually. Evidence supports oral rehydration therapy as a first-line treatment of mild to moderate dehydration. Ondansetron has proven to be a safe and effective adjunct in children with vomiting. We implemented a clinical pathway in our pediatric emergency department (ED) in January 2005 to improve care for this common condition. Our objective in this study was to determine the long-term impact of the pathway for acute gastroenteritis (AGE) on the proportion of patients receiving intravenous (IV) fluids and ED length of stay (LOS) for discharged patients. METHODS: Cases were identified by using diagnosis codes. We used statistical process control to analyze process and outcome measures for 2 years before and 10 years after pathway implementation. RESULTS: We included 30 519 patients. We found special cause variation with a downward shift in patients receiving IV fluids after initiation of the pathway and later with addition of ondansetron to the pathway from 48% to 26%. Mean ED LOS for discharged patients with AGE decreased from 247 to 172 minutes. These improvements were sustained over time. CONCLUSIONS: Implementation of a clinical pathway emphasizing oral rehydration therapy and ondansetron for children with AGE led to decreased IV fluid use and LOS in a pediatric ED. Improvements were sustained over a 10-year period. Our results suggest that quality-improvement interventions for AGE can have long-term impacts on care delivery.
[Mh] Termos MeSH primário: Antieméticos/uso terapêutico
Procedimentos Clínicos
Serviço Hospitalar de Emergência/normas
Hidratação/métodos
Gastroenterite/terapia
Ondansetron/uso terapêutico
Melhoria de Qualidade/estatística & dados numéricos
[Mh] Termos MeSH secundário: Doença Aguda
Adolescente
Criança
Pré-Escolar
Terapia Combinada
Serviço Hospitalar de Emergência/estatística & dados numéricos
Feminino
Hidratação/normas
Hidratação/estatística & dados numéricos
Hidratação/utilização
Seres Humanos
Lactente
Tempo de Internação/estatística & dados numéricos
Masculino
Avaliação de Processos e Resultados (Cuidados de Saúde)
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antiemetics); 4AF302ESOS (Ondansetron)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE


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[PMID]:28842077
[Au] Autor:Schneider PA
[Ad] Endereço:Division of Vascular Therapy, Kaiser Foundation Hospital, Honolulu, Hawaii. Electronic address: peterschneidermd@aol.com.
[Ti] Título:Evolution and current use of technology for superficial femoral and popliteal artery interventions for claudication.
[So] Source:J Vasc Surg;66(3):916-923, 2017 Sep.
[Is] ISSN:1097-6809
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:An important facet in caring for patients with claudication is the development of a plan for managing the technology available for superficial femoral artery (SFA) and popliteal artery interventions. Although this is a field in evolution, clinical experience and data are emerging that assist the clinician in making informed choices as to the best method of endovascular treatment. Algorithms for SFA and popliteal artery interventions are developing. Methods for assessing a wide range of technologies are discussed. This article reviews the evolution of technology for SFA and popliteal artery interventions, describes the recent developments in data and clinical experiences, and discusses some potential methods of device assessment and incorporation into clinical practice.
[Mh] Termos MeSH primário: Angioplastia com Balão
Implante de Prótese Vascular
Artéria Femoral/cirurgia
Claudicação Intermitente/terapia
Doença Arterial Periférica/terapia
Artéria Poplítea/cirurgia
[Mh] Termos MeSH secundário: Algoritmos
Angioplastia com Balão/efeitos adversos
Angioplastia com Balão/instrumentação
Prótese Vascular
Implante de Prótese Vascular/efeitos adversos
Implante de Prótese Vascular/instrumentação
Procedimentos Clínicos
Técnicas de Apoio para a Decisão
Artéria Femoral/fisiopatologia
Seres Humanos
Claudicação Intermitente/diagnóstico
Claudicação Intermitente/fisiopatologia
Seleção de Pacientes
Doença Arterial Periférica/diagnóstico
Doença Arterial Periférica/fisiopatologia
Artéria Poplítea/fisiopatologia
Desenho de Prótese
Fatores de Risco
Stents
Resultado do Tratamento
Dispositivos de Acesso Vascular
Grau de Desobstrução Vascular
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170827
[St] Status:MEDLINE


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[PMID]:28823323
[Au] Autor:Kamman AV; Yang B; Kim KM; Williams DM; Michael Deeb G; Patel HJ
[Ad] Endereço:Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan.
[Ti] Título:Visceral Malperfusion in Aortic Dissection: The Michigan Experience.
[So] Source:Semin Thorac Cardiovasc Surg;29(2):173-178, 2017 Summer.
[Is] ISSN:1532-9488
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:One of the most dreaded complications of acute aortic dissection is end-organ malperfusion. We summarize current evidence and describe our treatment paradigm in the setting of malperfusion in aortic dissection. Given the difficulty with identifying isolated visceral malperfusion in aortic dissection, both in the literature as well as in our practice, we have broadened the discussion to include data examining the presentation complex of malperfusion, particularly if mesenteric ischemia is identified. The approach to treating malperfusion syndrome is different depending on whether the patient presents with type A dissection vs type B dissection with malperfusion. Although thoracic endovascular aortic repair has emerged as the dominant strategy for resolving malperfusion for complicated type B dissection, fenestration may still have a role in its treatment. In contrast, for type A aortic dissection presenting with visceral malperfusion, the concept of operative repair after restoration of end-organ perfusion has been proposed with increasing frequency in recent reports. At the University of Michigan, we apply a patient-specific algorithm, based on the presence of malperfusion with end-organ dysfunction. In those patients presenting with visceral malperfusion, we prefer to first fenestrate, await resolution of the malperfusion syndrome and then perform central aortic repair. We recognize that other groups have implemented similar algorithms to reduce the dismal results of operative procedures in this cohort. However, the most appropriate period of delay remains unknown and there is a persistent risk of rupture before repair is performed. Future studies should be performed to determine whether these various treatment paradigms have merit.
[Mh] Termos MeSH primário: Aneurisma Dissecante/complicações
Aneurisma Aórtico/complicações
Isquemia/etiologia
Isquemia Mesentérica/etiologia
Vísceras/irrigação sanguínea
[Mh] Termos MeSH secundário: Algoritmos
Aneurisma Dissecante/diagnóstico por imagem
Aneurisma Dissecante/fisiopatologia
Aneurisma Dissecante/cirurgia
Aneurisma Aórtico/diagnóstico por imagem
Aneurisma Aórtico/fisiopatologia
Aneurisma Aórtico/cirurgia
Aortografia/métodos
Implante de Prótese Vascular
Angiografia por Tomografia Computadorizada
Procedimentos Clínicos
Procedimentos Endovasculares
Medicina Baseada em Evidências
Seres Humanos
Isquemia/diagnóstico por imagem
Isquemia/fisiopatologia
Isquemia/cirurgia
Isquemia Mesentérica/diagnóstico por imagem
Isquemia Mesentérica/fisiopatologia
Isquemia Mesentérica/cirurgia
Michigan
Fluxo Sanguíneo Regional
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171005
[Lr] Data última revisão:
171005
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170822
[St] Status:MEDLINE


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[PMID]:28822887
[Au] Autor:Jiang T; Ren S; Li X; Su C; Zhou C; O'Brien M
[Ad] Endereço:Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, PR China.
[Ti] Título:The changing diagnostic pathway for lung cancer patients in Shanghai, China.
[So] Source:Eur J Cancer;84:168-172, 2017 Oct.
[Is] ISSN:1879-0852
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Accumulating evidence suggest that patients with advanced non-small-cell lung cancer (NSCLC) and specific genomic alterations including epidermal growth factor receptor and microtubule-associated protein-like 4 anaplastic lymphoma kinase could significantly benefit from molecular-targeted therapies compared with chemotherapy. Recently, immunotherapy based on programmed cell death 1 (PD-1) and its ligand (PD-L1) blockade prolong survival in patients with advanced NSCLC, especially in those patients with positive expression of PD-L1 and when used in the first-line setting. Therefore, the diagnosis, clinical staging and molecular genotyping must be quick and efficient so that we can make a timely and precise decision for treatment strategy. In our department, it takes a median 4 working days (range 3-6) for a new patient from initial respiratory consultation to treatment decision, whereas in many countries, 14 workdays is considered a reasonable timeline. In this article, we will provide detailed information on the diagnostic pathway for a new patient suspected of having lung cancer to the final treatment decisions in our department.
[Mh] Termos MeSH primário: Carcinoma Pulmonar de Células não Pequenas/diagnóstico
Procedimentos Clínicos
Neoplasias Pulmonares/diagnóstico
Encaminhamento e Consulta
Tempo para o Tratamento
[Mh] Termos MeSH secundário: Biomarcadores Tumorais/análise
Biomarcadores Tumorais/genética
Carcinoma Pulmonar de Células não Pequenas/química
Carcinoma Pulmonar de Células não Pequenas/genética
Carcinoma Pulmonar de Células não Pequenas/terapia
China
Tomada de Decisão Clínica
Seres Humanos
Neoplasias Pulmonares/química
Neoplasias Pulmonares/genética
Neoplasias Pulmonares/terapia
Técnicas de Diagnóstico Molecular
Estadiamento de Neoplasias
Valor Preditivo dos Testes
Fatores de Tempo
Fluxo de Trabalho
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Biomarkers, Tumor)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170821
[St] Status:MEDLINE



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