Um Caso Invulgar de Endocardite Fúngica

Apresenta-se um caso de endocardite fúngica numa localização pouco habitual, em doente com hospitalização prolongada por queimaduras extensas. As vegetações localizam-se na veia cava superior (provavelmente aderentes a um trombo), em localização prévia de cateter venoso central. A doente foi tratada apenas com terapêutica médica (voriconazol) e após 5 meses de terapêutica, a doente permanece sem febre, tendo o ecocardiograma transesofágico demonstrado o desaparecimento do trombo e da vegetação.

Follow-Up da Diabetes Gestacional

107 mulheres que tiveram Diabetes Gestacional, vigiadas na consulta de Diabetes da MAC, de 1990 a 1997, foram reclassificadas 1 a 8 anos após o diagnóstico; 14% como diabéticas, 22% como portadoras de Alterações da Homeostase da Glicose e 64% sem alterações, usando os critérios de OMS. O perfil lipídico e a função renal apresentavam-se dentro dos valores de referência para os três grupos, apesar das mulheres com diabetes actual apresentarem algum grau de complicação da doença. A Diabetes Gestacional é factor de risco para alterações do metabolismo da glicose. É função fundamental do clínico que vigia a grávida com Diabetes Gestacional motivá-la para a aderência ao Follow-Up.

Safety and Effectiveness of the Genous Endothelial Progenitor Cell-Capture Stent: Follow-Up to 5 Years

AIMS: To evaluate the long-term clinical outcomes following percutaneous coronary intervention (PCI) with the Genous stent in an unselected population. METHODS: All patients admitted to a single center who underwent PCI using the GS exclusively, between May 2006 and May 2012, were enrolled, and a clinical follow-up of up to 60 months was carried out. The primary endpoint of major adverse cardiac event (MACE) rate was defined as the composite of cardiac death, acute myocardial infarction (AMI), and target lesion revascularization (TLR). RESULTS: Of the 450 patients included (75.1% male; 65.5 ± 11.7 years), 28.4% were diabetic and acute coronary syndrome was the reason for PCI in 76.4%. Angioplasty was performed in 524 lesions using 597 Genous stents, with angiographic success in 97.1%. At a median of 36 months of follow-up (range, 1-75 months), MACE, AMI, TLR, stent restenosis (SR), and stent thrombosis (ST) rates were 15.6%, 8.4%, 4.4%, 3.8%, and 2.2%, respectively. Between 12 and 24 months, the TLR, SR, and ST rates practically stabilized, up to 60 months. Bifurcation lesions were independently associated with MACE, TLR, and SR. CONCLUSION: This is the first study reporting clinical results with the Genous stent up to 60 months. The Genous stent was safe and effective in the long-term, in an unselected population.

Intoxicações numa Unidade de Cuidados Intensivos Polivalente

Apresenta-se aqui um estudo retrospectivo de 1340 admissões por intoxicação numa Unidade de Cuidados Intensivos Polivalente durante um período de quatro anos (1986-1989). Em 666 doentes ocorreram 735 intoxicações medicamentosas e em 674 doentes 691 intoxicações não medicamentosas. Nas intoxicações medicamentosas destacam-se os fármacos com acção principal a nível do sistema nervoso central (82.3%), predominando os insecticidas organofosforados (5 1.2%) nas não medicamentosas. Ao longo dos anos considerados constatou-se uma diminuição absoluta e relativa do número de doentes intoxicados (480 vs 244, 15.1% vs 9.9%). Dos internados, 698 era do sexo masculino (289 nas intoxicações medicamentosas e 409 nas não medicamentosas) e 642 do sexo feminino (377 nas medicamentosas e 265 nas não medicamentosas), existindo uma diferença estatisticamente muito significativa no tipo de intoxicação quanto ao sexo (p

American Society of Anesthesiologists Score: Still Useful After 60 Years? Results of the EuSOS Study

OBJECTIVE: The European Surgical Outcomes Study described mortality following in-patient surgery. Several factors were identified that were able to predict poor outcomes in a multivariate analysis. These included age, procedure urgency, severity and type and the American Association of Anaesthesia score. This study describes in greater detail the relationship between the American Association of Anaesthesia score and postoperative mortality. METHODS: Patients in this 7-day cohort study were enrolled in April 2011. Consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery with a recorded American Association of Anaesthesia score in 498 hospitals across 28 European nations were included and followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Decision tree analysis with the CHAID (SPSS) system was used to delineate nodes associated with mortality. RESULTS: The study enrolled 46,539 patients. Due to missing values, 873 patients were excluded, resulting in the analysis of 45,666 patients. Increasing American Association of Anaesthesia scores were associated with increased admission rates to intensive care and higher mortality rates. Despite a progressive relationship with mortality, discrimination was poor, with an area under the ROC curve of 0.658 (95% CI 0.642 - 0.6775). Using regression trees (CHAID), we identified four discrete American Association of Anaesthesia nodes associated with mortality, with American Association of Anaesthesia 1 and American Association of Anaesthesia 2 compressed into the same node. CONCLUSION: The American Association of Anaesthesia score can be used to determine higher risk groups of surgical patients, but clinicians cannot use the score to discriminate between grades 1 and 2. Overall, the discriminatory power of the model was less than acceptable for widespread use.

Hipotiroidismo Associado a Anticorpos Anti-Receptor da Hormona TSH com Ação Bloqueadora Determinada In Vitro

Thyroid-stimulating hormone-receptor autoantibodies normally causes hyperthyroidism. However, they might have blocking activity causing hypothyroidism. A 11-year-old girl followed due to type 1 diabetes mellitus, celiac disease and euthyroid lymphocytic thyroiditis at diagnosis. Two years after the initial evaluation, thyroid-stimulating hormone was suppressed with normal free T4; nine months later, a biochemical evolution to hypothyroidism with thyroid-stimulating hormone-receptor autoantibodies elevation was seen; the patient remained always asymptomatic. Chinese hamster ovary cells were transfected with the recombinant human thyroid-stimulating hormone -receptor, and then exposed to the patient's serum; it was estimated a 'moderate' blocking activity of these thyroid-stimulating hormone-receptor autoantibodies, and concomitantly excluded stimulating action. In this case, the acknowledgment of the blocking activity of the serum thyroid-stimulating hormone-receptor autoantibodies, supported the hypothesis of a multifactorial aetiology of the hypothyroidism, which in the absence of the in vitro tests, we would consider only as a consequence of the destructive process associated to lymphocytic thyroiditis.