971 resultados para peripheral vascular system


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Pós-graduação em Doenças Tropicais - FMB

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A leptospirose apresenta alta prevalência em nossa região. É uma doença infecciosa, multissistêmica, que acomete vários órgãos e o envolvimento cardíaco é freqüente, constituindo atualmente uma das principais causas de morte dos portadores desta afecção. O objetivo do trabalho foi avaliar o comportamento clínico-epidemiológico, eletrocardiográfico e radiológico do tórax de pacientes com diagnóstico clínico-epidemiológico, eletrocardiográfico e radiológico do tórax de pacientes em diagnóstico clínico-epidemiológico de leptospirose na fase aguda e em ambiente hospitalar. Para este propósito, foi realizado um estudo transversal com 41 pacientes, seis do sexo feminino e 35 do sexo masculino, com idades entre 15 e 78 anos, internados no Hospital Universitário João de Barros Barreto, no período de fevereiro de 2002 a junho de 2003. Os participantes do estudo submeteram-se à anamnese e exame clínico, com ênfase ao aparelho cardiovascular, realizaram de um a três eletrocardiogramas, uma radiografia do tórax e exames laboratoriais de rotina. Analisando-se os achados clínicos, 37 (90,2 %) apresentaram sinais e sintomas compatíveis com envolvimento miocárdico. As anormalidades eletrocardiográficas ocorreram em 20 casos, correspondendo a 48,7 % do total. O nível médio de potássio foi de 3,8 meq/l. A maioria das alterações foram reversíveis e, a principal, correspondeu ao supradesnivelamento de segmento ST, sem diferença estatística significante (p>0,05) entre elas. Nos 37 enfermos que apresentaram sintomas e sinais sugestivos de comprometimento cardíaco, não houve diferença estatística significativa (p> 0,05) entre os eletrocardiogramas normais e os alterados. Em apenas oito indivíduos houve anormalidades radiológicas (19,5 %), sendo que o aumento discreto do ventrículo esquerdo com infiltrado intersticial nas bases pulmonares foi o principal achado, com diferença estatística significante (p<0,05) entre outros tipos de infiltrados pulmonares. Portanto, neste estudo, os principais achados clínicos foram: hepatomegalia e dispnéia; eletrocardiográficos: supradesnível de segmento ST e taquicardia sinusal com reversão na maioria dos caos e radiológicos: aumento ventricular esquerdo discreto com infiltrado pulmonar nas bases.

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BackgroundAcute pulmonary embolism (PE) is a common cause of death, accounting for 50,000 to 200,000 deaths annually. It is the third most common cause of mortality among the cardiovascular diseases, after coronary artery disease and stroke.The advent of multi-detector computed tomographic pulmonary angiography (CTPA) has allowed better assessment of PE regarding visualisation of the peripheral pulmonary arteries, increasing its rate of diagnosis. More cases of peripheral PEs, such as isolated subsegmental PE (SSPE) and incidental PE, have thereby been identified. These two conditions are usually found in patients with few or none of the classic PE symptoms such as haemoptysis or pleuritic pain, acute dyspnoea or circulatory collapse. However, in patients with reduced cardio-pulmonary (C/P) reserve the classic PE symptoms can be found with isolated SSPEs. Incidental SSPE is found casually in asymptomatic patients, usually by diagnostic imaging performed for other reasons (for example routine CT for cancer staging in oncologic patients).Traditionally, all PEs are anticoagulated in a similar manner independent of the location, number and size of the thrombi. It has been suggested that many patients with SSPE may be treated without benefit, increasing adverse events by possible unnecessary use of anticoagulants.Patients with isolated SSPE or incidental PE may have a more benign clinical presentation compared with those with proximal PEs. However, the clinical significance in patients and their prognosis have to be studied to evaluate whether anticoagulation therapy is required.ObjectivesTo assess the effectiveness and safety of anticoagulation therapy versus no intervention in patients with isolated subsegmental pulmonary embolism (SSPE) or incidental SSPE.Search methodsThe Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched October 2013) and CENTRAL (2013, Issue 9). MEDLINE, EMBASE, LILACS and clinical trials databases were also searched (October 2013).Selection criteriaRandomised controlled trials of anticoagulation therapy versus no intervention in patients with SSPE or incidental SSPE.Data collection and analysisTwo review authors inspected all citations to ensure reliable selection. We planned for two review authors to independently extract data and to assess the methodological quality of identified trials using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions.Main resultsNo studies were identified that met the inclusion criteria.Authors' conclusionsThere is no randomised controlled trial evidence for the effectiveness and safety of anticoagulation therapy versus no intervention in patients with isolated subsegmental pulmonary embolism (SSPE) or incidental SSPE, and therefore we can not draw any conclusions. Well-conducted research is required before informed practice decisions can be made.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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Purpose: To study the components of long latency auditory evoked potentials and to compare data from these measures in students with and without learning disabilities. Method: Thirty students, 15 with learning disorder (study group) and 15 typical without learning problems (control group), of both genders, aged 7-14 years, mean age 10 years. They underwent clinical assessment in a clinic belonging to a public university in the state of São Paulo. Following, audiological assessment was performed to determine normal peripheral auditory system and electrophysiological assessment by examining the long latency auditory evoked response. Result: The results showed that there are functional differences between the groups. Increased latency components of long latency auditory evoked potential was observed in the study group compared to the control group. Longer latency values of these components were observed in the left ear when stimulated in the study group. Conclusion: This study contributed to better understanding of the auditory pathway functioning in children with learning disorders and can be a reference for other clinical and experimental studies and thus improve the definition of diagnostic criteria in this population.

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Pós-graduação em Fisioterapia - FCT

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Pós-graduação em Bases Gerais da Cirurgia - FMB

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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Background: Pulmonary embolism (PE) is a common life-threatening cardiovascular condition, with an incidence of 23 to 69 new cases per 100,000 people per year. Outpatient treatment instead of traditional inpatient treatment in selected non-high-risk patients with acute PE might provide several advantages, such as reduction of hospitalizations, substantial cost saving and an improvement in health-related quality of life. Objectives: To compare the efficacy and safety of outpatient versus inpatient treatment for acute PE for the outcomes of all-cause and PE-related mortality; bleeding; and adverse events such as hemodynamic instability, recurrence of PE and patients'satisfaction.Search methodsThe Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (last searched October 2014) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 9). The TSC also searched clinical trials databases. The review authors searched LILACS (last searched November 2014). Selection criteria: Randomized controlled trials of outpatient versus inpatient treatment in people diagnosed with acute PE. Data collection and analysis: Two review authors selected relevant trials, assessed methodological quality, and extracted and analyzed data. Main results: We included one study, involving 339 participants. We ranked the quality of the evidence as very low due to not blinding the outcome assessors, the small number of events with imprecision in the confidential interval (CI), the small sample size and it was not possible to verify publication bias. For all outcomes, the CIs were wide and included clinically significant treatment effects in both directions: short-term mortality (30 days) (RR 0.33, 95% CI 0.01 to 7.98, P = 0.49), long-term mortality (90 days) (RR 0.98, 95% CI 0.06 to 15.58, P = 0.99), major bleeding at 14 days (RR 4.91, 95% CI 0.24 to 101.57, P = 0.30) and 90 days (RR 6.88, 95% CI 0.36 to 134.14, P = 0.20), recurrent PE within 90 days (RR 2.95, 95% CI 0.12 to 71.85, P = 0.51) and participant satisfaction (RR 0.97, 95% CI 0.92 to 1.03, P = 0.30). PE-related mortality, minor bleeding, and adverse course such as hemodynamic instability and compliance were not assessed by the single included study. Authors' conclusions: Current very low quality evidence from one published randomized controlled trial did not provide sufficient evidence to assess the efficacy and safety of outpatient versus inpatient treatment for acute PE in overall mortality, bleeding and recurrence of PE adequately. Further well-conducted research is required before informed practice decisions can be made.

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A heterogeneous group of 159 tumours was studied for the presence of S-100 protein by the immunoperoxidase technique in order to determine whether this marker may be of value in facilitating immunocytochemical diagnosis. Among cases of melanocytic and pigmented lesions, S-100 was widely distributed and demonstrated the strongest degrees of reactivity. S-100 protein was identified in virtually all nerve sheath tumours such as schwannomas, neurofibromas, myxoid sheath nerve tumour and also in some tumours of controversial histogenesis such as granular cell tumours. The great majority of carcinomas did not express S-100, with only two cases of breast carcinoma displaying focal S-100 staining. In a miscellaneous group of tumours S-100 was demonstrated in chordomas, myoepitheliomas and Wilms' tumour with Schwann cell differentiation. Despite its presence in a wide array of cell types, S-100 protein continues to be an extremely useful marker especially for soft tissue and peripheral nervous system tumours.

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Bruxism is the harmful habit of clenching or grinding the teeth during the day and / or night, with unconscious pattern, with particular intensity and frequency, outside the functional movements of chewing and swallowing. It is accepted that bruxism is a response controlled by the neurotransmitters dopamine system associated with emotional component. The proposed of treatment of bruxism with acupuncture aims to stimulate sensory fibers of the peripheral nervous system leading to electrical transmission by neurons sufficient to produce changes in the central nervous system. As a consequence there is the release of substances (cortisol, endorphins, dopamine, noradrenaline and serotonin) that promote wellness and restoration of harmony, be it psychological, biological and / or behavioral.

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Hypertension is characterized by peripheral vascular resistancethat leads to blood pressure increase and severalsystemic changes that may negatively influence one s oralhealth. Thus, the aim of this study was to conduct a literaturereview on the influence of hypertension over oral conditionsand endodontic treatment. Hypertension mainly affects theblood vessels, brain and kidneys. A hypertensive conditioncan lead to increased levels of parathyroid hormones, abnormalvitamin D metabolism, reduction in the concentrationof ionized calcium and decreased calcium absorption.Therefore, hypertension can be closely associated with oralproblems such as periodontal diseases, implant loss, difficultyin bone healing, reduced salivary flow and protein concentrationin saliva, increased number of neutrophils and, as a consequence,favoring of inflammatory processes. It has alsobeen suggested that the success rate of endodontic treatmentin hypertensive patients is lower than in normotensiveones. The response of hypertensive patients to root canaltreatment, intracanal medications and sealers should be furtherstudied in order to provide knowledge on the changes,failures and success of endodontic treatment.