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Association between Hospital Carotid Endarterectomy Procedure Volumes and In-Hospital Mortality in São Paulo State. 圣保罗州医院颈动脉内膜切除手术量与住院死亡率之间的关系。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-09-18 eCollection Date: 2023-01-01 DOI: 10.1590/1677-5449.202201642
Renato Luís Pessôa

Background: Previous studies indicate an inverse relationship between hospital volume and mortality after carotid endarterectomy. However, data at the level of Brazil are lacking.

Objectives: To assess the relationship between hospital carotid endarterectomy procedure volumes and mortality in the state of São Paulo.

Methods: Data from the São Paulo State Hospital Information System on all carotid endarterectomies performed between 2015 and 2019 were analyzed. Hospitals were categorized into clusters by annual volume of surgeries (1-10, 11-25, and ≥26). Multiple logistic regression models were used to determine whether the volume of carotid endarterectomy procedures was an independent predictor of in-hospital mortality among patients undergoing this procedure.

Results: Crude in-hospital mortality was nearly 60 percent lower in patients who underwent carotid endarterectomy at the highest volume hospitals than among those who underwent endarterectomy at the lowest volume hospitals (unadjusted OR of survival to hospital discharge, 2.41; 95% CI, 1.11-5.23; p = 0.027). Although this lower rate represents 1.5 fewer deaths per 100 patients treated, high-volume centers are more likely than low-volume centers to perform elective procedures, thus the analysis did not retain statistical significance when adjusted for admission character (OR, 1.69; 95% CI, 0.74-3.87; p = 0.215).

Conclusions: In a contemporary Brazilian registry, higher volume carotid endarterectomy centers were associated with lower in-hospital mortality than lower volume centers. Further studies are needed to verify this relationship considering the presence of symptoms in patients.

背景:先前的研究表明,颈动脉内膜切除术后住院量与死亡率呈反比。然而,缺乏巴西层面的数据。目的:评估圣保罗州医院颈动脉内膜切除术手术量与死亡率之间的关系。方法:分析圣保罗州立医院信息系统2015年至2019年间进行的所有颈动脉内膜切除术的数据。医院按年度手术量分为集群(1-10、11-25和≥26)。使用多元逻辑回归模型来确定颈动脉内膜切除术的手术量是否是接受该手术的患者住院死亡率的独立预测因素。结果:在容量最大的医院接受颈动脉内膜切除术的患者的粗住院死亡率比在容量最小的医院接受动脉内膜切除手术的患者低近60%(未经调整的存活率与出院率之比为2.41;95%可信区间为1.11-5.23;p=0.027)。尽管这一较低的死亡率意味着每100名接受治疗的患者中死亡人数减少1.5人,高容量中心比低容量中心更有可能进行选择性手术,因此当根据入院特征进行调整时,分析没有保留统计学意义(OR,1.69;95%CI,0.74-3.87;p=0.215)。结论:在当代巴西登记中,与低容量中心相比,高容量颈动脉内膜切除中心的住院死亡率较低。考虑到患者的症状,还需要进一步的研究来验证这种关系。
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引用次数: 0
Shear wave elastography for extracranial carotid atherosclerotic plaques: technical principles and how to do it. 颅外颈动脉粥样硬化斑块的剪切波弹性成像:技术原理和方法。
IF 0.8 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-09-18 eCollection Date: 2023-01-01 DOI: 10.1590/1677-5449.202200822
Pedro Luciano Mellucci, Matheus Bertanha, Rodrigo Gibin Jaldin, Winston Bonetti Yoshida, Marcone Lima Sobreira

In the wake of studies targeting atherosclerotic plaques and searching for quantifiable variables that contribute additional information to therapeutic decision-making, plaque assessment using Shear Wave Elastography (SWE) is emerging as a reproducible and promising alternative. We used a single Logiq S8 device (General Electric, Boston, Massachusetts, United States) with an 8.5-11MHz multifrequency linear transducer at 10MHz in longitudinal section. We considered relevant criteria for image acquisition: adequate longitudinal insonation, differentiation of the intima-media complex, delineation of proximal and distal tunica adventitia and the vascular lumen, good visualization of the atherosclerotic plaque, cardiac cycle in ventricular diastole, and absence of incongruous changes. SWE is an emerging and extremely promising method for assessment of carotid plaques that may contribute to therapeutic decision-making based on characteristics related to the atherosclerotic plaque, with inter-device and inter-examiner reproducibility.

在针对动脉粥样硬化斑块的研究和寻找可量化变量以为治疗决策提供额外信息之后,使用剪切波弹性成像(SWE)进行斑块评估正成为一种可重复且有前景的替代方法。我们使用了一个Logiq S8设备(美国马萨诸塞州波士顿通用电气公司),其纵截面为8.5-11MHz的多频线性换能器,频率为10MHz。我们考虑了图像采集的相关标准:充分的纵向声发射、内膜-中膜复合体的分化、近端和远端外膜和血管腔的描绘、动脉粥样硬化斑块的良好可视化、心室舒张期的心动周期以及没有不协调的变化。SWE是一种新兴的、非常有前景的颈动脉斑块评估方法,它可能有助于根据动脉粥样硬化斑块的相关特征做出治疗决策,具有设备间和检查者间的可重复性。
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引用次数: 0
A aorta no centro 主动脉无中心
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-09-04 DOI: 10.1590/1677-5449.202300891
Andre Brito-Queiroz, Grace Carvajal Mulatti, Vanessa Prado dos Santos
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引用次数: 0
The aorta at the center. 位于中心的主动脉。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-09-04 eCollection Date: 2023-01-01 DOI: 10.1590/1677-5449.202300892
Andre Brito-Queiroz, Grace Carvajal Mulatti, Vanessa Prado Dos Santos
1 Universidade Federal da Bahia, Hospital Ana Nery, Centro de Doenças da Aorta, Salvador, BA, Brasil. 2 Universidade de São Paulo, Hospital das Clínicas, Departamento de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil. 3 Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Departamento de Anestesiologia e Cirurgia, Salvador, BA, Brasil. Financial support: None. Conflicts of interest: ABQ is a consultant at Cook Medical and GCM is a consultant at Cook Medical and Medtronic. Submitted: May 23, 2023. Accepted: June 24, 2023.
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引用次数: 0
Association between platelet lymphocyte ratio and neutrophil lymphocyte ratio and clinical outcomes following carotid endarterectomy. 颈动脉内膜切除术后血小板-淋巴细胞比率和中性粒细胞-淋巴细胞比率与临床结果的关系。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-08-28 eCollection Date: 2023-01-01 DOI: 10.1590/1677-5449.202201222
Vinicius Adorno Gonçalves, Martin Andreas Geiger, Danilo Augusto Sarti, Ana Terezinha Guillaumon

Background: Approximately 30% of stroke cases result from carotid disease. Although several risk factors for complications after carotid endarterectomy have been identified, the existence of a biomarker that can estimate postoperative risk in these patients has not yet been proven.

Objectives: This study aimed to investigate correlations between the platelet-lymphocyte ratio (PLR) and the neutrophil-lymphocyte ratio (NLR) and postoperative clinical outcomes in patients undergoing carotid endarterectomy.

Methods: A retrospective study was conducted, including 374 patients who underwent carotid endarterectomy between 2002 and 2019 due to moderate to high extracranial internal carotid artery stenosis. Their platelet-lymphocyte ratio and neutrophil-lymphocyte ratios were obtained from the same blood samples.

Results: There was a statistically significant correlation between the PLR and the occurrence of restenosis (p < 0.01) and acute myocardial infarction (AMI) after endarterectomy (p = 0.03). Additionally, there was a statistically significant correlation between the PLR and the combined outcomes stroke and/or AMI and/or death (p = 0.03) and stroke and/or AMI and/or death and/or restenosis (p < 0.01). However, there were no significant correlations between NLR and these outcomes (p = 0.05, p = 0.16).

Conclusions: The platelet-lymphocyte ratio proved to be a useful test for predicting occurrence of strokes, acute myocardial infarctions, and deaths during the postoperative period after carotid endarterectomy. It was also associated with the risk of postoperative restenosis.

背景:大约30%的中风病例是由颈动脉疾病引起的。尽管颈动脉内膜切除术后并发症的几个风险因素已经确定,但尚未证明存在可以估计这些患者术后风险的生物标志物。目的:本研究旨在探讨颈动脉内膜切除术患者血小板淋巴细胞比率(PLR)和中性粒细胞淋巴细胞比率(NLR)与术后临床结果之间的相关性。方法:进行回顾性研究,包括2002年至2019年间因中度至高度颅外颈内动脉狭窄而接受颈动脉内膜切除术的374名患者。他们的血小板-淋巴细胞比率和中性粒细胞-淋巴细胞比率是从相同的血液样本中获得的。结果:PLR与动脉内膜切除术后再狭窄(p<0.01)和急性心肌梗死(AMI)的发生率(p=0.03)有显著相关性,PLR与卒中和/或AMI和/或死亡(p=0.03)、卒中和//或AMI、/或死亡和/或再狭窄(p<0.01)的综合转归之间存在统计学显著相关性,NLR与这些结果之间没有显著相关性(p=0.05,p=0.16)。结论:血小板-淋巴细胞比率被证明是预测颈动脉内膜切除术后卒中、急性心肌梗死和死亡的有用测试。它还与术后再狭窄的风险有关。
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引用次数: 0
Endovascular management of bilateral renal angiomyolipoma in a perimenopausal woman. 围绝经期妇女双侧肾血管平滑肌脂肪瘤的血管内治疗。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-08-28 eCollection Date: 2023-01-01 DOI: 10.1590/1677-5449.202000672
Ganesh Govinda Gowda, Maureen Tigga, Ravikumar Banavase Ramesh

Renal angiomyolipoma is a benign and progressive tumor consisting of smooth muscle, fat, and vascular elements and is commonly associated with the tuberous sclerosis complex. Bilateral occurrence is rare and recent evidence suggest strong tumor positivity to female hormones with enlargement during pregnancy and oral contraceptive therapy. Treatment varies from a minimally invasive approach with selective embolization of the renal artery to partial nephrectomy or sometimes even radical nephrectomy. Presented here is a case of bilateral renal angiomyolipoma in 50-year-old lady who was successfully treated with super-selective embolization.

肾血管平滑肌脂肪瘤是一种良性进行性肿瘤,由平滑肌、脂肪和血管成分组成,通常与结节性硬化症有关。双侧肿瘤的发生率很低,最近的证据表明,肿瘤对女性激素呈强烈阳性,妊娠期肿瘤增大,口服避孕药治疗。治疗方法多种多样,从选择性栓塞肾动脉的微创方法到部分肾切除术,有时甚至是根治性肾切除术。本文报告一位50岁女性双侧肾脏血管平滑肌脂肪瘤的病例,她成功地用超选择性栓塞治疗。
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引用次数: 0
Effects of aerobic and combined training on pain-free walking distance and health-related quality of life in patients with peripheral artery disease: a randomized clinical trial. 有氧和联合训练对外周动脉疾病患者无痛步行距离和健康相关生活质量的影响:一项随机临床试验。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-08-28 eCollection Date: 2023-01-01 DOI: 10.1590/1677-5449.202300242
Eduardo Lima Garcia, Adamastor Humberto Pereira, Marcio Garcia Menezes, Alexandre Araújo Pereira, Ricardo Stein, Leandro Tolfo Franzoni, Luiz Claudio Danzmann, Antônio Cardoso Dos Santos

Background: Decreased walking ability in patients with peripheral arterial disease is often a clinical problem and limits the quality of life and daily activities of these subjects. physical exercise is important in this scenario, as it improves both the daily walking distance and the ability to withstand intermittent claudication related to the limitations of the peripheral disease.

Objectives: Our aim was to compare the effects of two types of exercise training (aerobic training and aerobic training combined with resistance exercises) on pain-free walking distance (PFWD) and health-related quality of life (HRQoL) in a sample composed of patients with peripheral artery disease (PAD).

Methods: Twenty patients with claudication symptoms were randomized to either aerobic control (AC) N= 9, or combined training (CT) N= 8, (24 sixty-minute sessions, twice a week). The total walking distance until onset of pain due to claudication was assessed using the 6-minute walk test and HRQoL was measured using the WHOQOL-bref questionnaire (general and specific domains) at baseline and after training. We used generalized estimating equations (GEE) to assess the differences between groups for the PFWD and HRQoL domains, testing the main group and time effects and their respective interaction effects. P values < 0.05 were considered statistically significant.

Results: Seventeen patients (mean age 63±9 years; 53% male) completed the study. Both groups experienced improvement in claudication, as reflected by a significant increase in PFWD: AC, 149 m to 299 m (P<0.001); CT, 156 m to 253 m (P<0.001). HRQoL domains also improved similarly in both groups (physical capacity, psychological aspects, and self-reported quality of life; P=0.001, P=0.003, and P=0.011 respectively).

Conclusions: Both aerobic and combined training similarly improved PFWD and HRQoL in PAD patients. There are no advantages in adding strength training to conventional aerobic training. This study does not support the conclusion that combined training is a good strategy for these patients when compared with classic training.

背景:外周动脉疾病患者的行走能力下降通常是一个临床问题,并限制了这些受试者的生活质量和日常活动。在这种情况下,体育锻炼很重要,因为它既能提高日常步行距离,又能提高抵抗与周围疾病局限性相关的间歇性跛行的能力。目的:我们的目的是在一个由外周动脉疾病(PAD)患者组成的样本中比较两种类型的运动训练(有氧训练和有氧训练结合阻力训练)对无痛步行距离(PFWD)和健康相关生活质量(HRQoL)的影响(AC)N=9,或联合训练(CT)N=8,(24次60分钟的训练,每周两次)。在基线和训练后,使用6分钟步行测试评估直到因跛行而疼痛发作的总步行距离,并使用WHOQOL bref问卷(一般和特定领域)测量HRQoL。我们使用广义估计方程(GEE)来评估PFWD和HRQoL领域的组间差异,测试主要的组和时间效应及其各自的相互作用效应。P值<0.05被认为具有统计学意义。结果:17名患者(平均年龄63±9岁;53%为男性)完成了研究。两组的跛行均有改善,PFWD:AC显著增加,149米至299米(P结论:有氧训练和联合训练同样改善了PAD患者的PFWD和HRQoL。在传统有氧训练基础上增加力量训练没有优势。与经典训练相比,联合训练对这些患者来说是一种好的策略,这项研究不支持这一结论。
{"title":"Effects of aerobic and combined training on pain-free walking distance and health-related quality of life in patients with peripheral artery disease: a randomized clinical trial.","authors":"Eduardo Lima Garcia,&nbsp;Adamastor Humberto Pereira,&nbsp;Marcio Garcia Menezes,&nbsp;Alexandre Araújo Pereira,&nbsp;Ricardo Stein,&nbsp;Leandro Tolfo Franzoni,&nbsp;Luiz Claudio Danzmann,&nbsp;Antônio Cardoso Dos Santos","doi":"10.1590/1677-5449.202300242","DOIUrl":"10.1590/1677-5449.202300242","url":null,"abstract":"<p><strong>Background: </strong>Decreased walking ability in patients with peripheral arterial disease is often a clinical problem and limits the quality of life and daily activities of these subjects. physical exercise is important in this scenario, as it improves both the daily walking distance and the ability to withstand intermittent claudication related to the limitations of the peripheral disease.</p><p><strong>Objectives: </strong>Our aim was to compare the effects of two types of exercise training (aerobic training and aerobic training combined with resistance exercises) on pain-free walking distance (PFWD) and health-related quality of life (HRQoL) in a sample composed of patients with peripheral artery disease (PAD).</p><p><strong>Methods: </strong>Twenty patients with claudication symptoms were randomized to either aerobic control (AC) <b>N= 9,</b> or combined training (CT) N= 8, (24 sixty-minute sessions, twice a week). The total walking distance until onset of pain due to claudication was assessed using the 6-minute walk test and HRQoL was measured using the WHOQOL-bref questionnaire (general and specific domains) at baseline and after training. We used generalized estimating equations (GEE) to assess the differences between groups for the PFWD and HRQoL domains, testing the main group and time effects and their respective interaction effects. P values < 0.05 were considered statistically significant.</p><p><strong>Results: </strong>Seventeen patients (mean age 63±9 years; 53% male) completed the study. Both groups experienced improvement in claudication, as reflected by a significant increase in PFWD: AC, 149 m to 299 m (P<0.001); CT, 156 m to 253 m (P<0.001). HRQoL domains also improved similarly in both groups (physical capacity, psychological aspects, and self-reported quality of life; P=0.001, P=0.003, and P=0.011 respectively).</p><p><strong>Conclusions: </strong>Both aerobic and combined training similarly improved PFWD and HRQoL in PAD patients. There are no advantages in adding strength training to conventional aerobic training. This study does not support the conclusion that combined training is a good strategy for these patients when compared with classic training.</p>","PeriodicalId":14814,"journal":{"name":"Jornal Vascular Brasileiro","volume":"22 ","pages":"e20230024"},"PeriodicalIF":0.0,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10545230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41146180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Management of traumatic superficial palmar arch pseudoaneurysm: a therapeutic challenge. 外伤性掌浅弓假性动脉瘤的治疗:一项治疗挑战。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-08-14 eCollection Date: 2023-01-01 DOI: 10.1590/1677-5449.202300732
Patrick Bastos Metzger, Fernando Antonio Falcão Paixão, Sarah Fernandez Coutinho de Carvalho, Miguel Godeiro Fernandez, Simone Lessa Metzger, Maria Fernanda Lima Brandão, Rafael Borges Monteiro, Fabio Henrique Rossi

Pseudoaneurysm of the palmar arch is a rare entity. Diagnosis is dependent on high clinical suspicion. We present a case referred to the emergency department, with a history of glass penetrating trauma to the palmar surface with a pulsatile mass and jet bleeding. Doppler ultrasound evidenced a partially thrombosed pseudoaneurysm. A CT angiography examination showed a saccular formation arising from the superficial palmar arch. A conventional surgical approach was indicated. A clinical suspicion must be ventured to arrive at the correct diagnosis. Imaging modalities are needed to identify the pseudoaneurysm and plan the treatment course. Nonetheless, the sequence of diagnosis is individual, because further evaluation with different imaging methods may not change the rationale for the intervention. In our experience, conventional surgical removal is preferable, due to its safety and well-established outcomes.

掌弓假性动脉瘤是一种罕见的实体瘤。诊断取决于高度的临床怀疑。我们报告了一个转诊到急诊科的病例,有手掌表面玻璃穿透性创伤史,伴有搏动性肿块和喷射性出血。多普勒超声显示部分血栓形成的假性动脉瘤。CT血管造影术检查显示掌浅弓形成囊状结构。建议采用常规手术入路。必须大胆进行临床怀疑才能得出正确的诊断。需要使用影像学方法来识别假性动脉瘤并计划治疗过程。尽管如此,诊断顺序是个体的,因为用不同的成像方法进行进一步评估可能不会改变干预的基本原理。根据我们的经验,传统的手术切除术更可取,因为它安全且效果良好。
{"title":"Management of traumatic superficial palmar arch pseudoaneurysm: a therapeutic challenge.","authors":"Patrick Bastos Metzger,&nbsp;Fernando Antonio Falcão Paixão,&nbsp;Sarah Fernandez Coutinho de Carvalho,&nbsp;Miguel Godeiro Fernandez,&nbsp;Simone Lessa Metzger,&nbsp;Maria Fernanda Lima Brandão,&nbsp;Rafael Borges Monteiro,&nbsp;Fabio Henrique Rossi","doi":"10.1590/1677-5449.202300732","DOIUrl":"https://doi.org/10.1590/1677-5449.202300732","url":null,"abstract":"<p><p>Pseudoaneurysm of the palmar arch is a rare entity. Diagnosis is dependent on high clinical suspicion. We present a case referred to the emergency department, with a history of glass penetrating trauma to the palmar surface with a pulsatile mass and jet bleeding. Doppler ultrasound evidenced a partially thrombosed pseudoaneurysm. A CT angiography examination showed a saccular formation arising from the superficial palmar arch. A conventional surgical approach was indicated. A clinical suspicion must be ventured to arrive at the correct diagnosis. Imaging modalities are needed to identify the pseudoaneurysm and plan the treatment course. Nonetheless, the sequence of diagnosis is individual, because further evaluation with different imaging methods may not change the rationale for the intervention. In our experience, conventional surgical removal is preferable, due to its safety and well-established outcomes.</p>","PeriodicalId":14814,"journal":{"name":"Jornal Vascular Brasileiro","volume":"22 ","pages":"e20230073"},"PeriodicalIF":0.0,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10545236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41132032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predictive factors of infection in patients with chronic kidney disease using hemodialysis catheters. 使用血液透析导管的慢性肾脏病患者感染的预测因素。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-08-11 eCollection Date: 2023-01-01 DOI: 10.1590/1677-5449.202200982
Juliana da Costa Matos, Laura Lane Menezes Polsin, Karla Cristina Petrucelli Israel, Leonardo Pessoa Cavalcante

Background: Infection is the most frequent complication of central venous catheters used for hemodialysis.

Objectives: The purpose of this study was to the determine the central venous catheter-related infection rate at a dialysis center in the Brazilian state of Amazonas and to identify risk factors and the microbiological profile of the infections.

Methods: This was an observational study with prospective data collection over a 12-month period by chart analysis and face-to-face interviews with patients undergoing hemodialysis using central venous catheters at a dialysis center.

Results: 96 central venous catheters were analyzed in 48 patients. 78 of these were non-tunneled central venous catheters (81.3%) and 18 were tunneled central venous catheters (18.7%), 53.1% of the catheters were exchanged because of infection and blood cultures were obtained from 35.2% of the patients who had catheter-related infections. Gram-negative bacteria were isolated from five of the nine blood cultures in which there was bacterial growth and Gram-positive bacteria were isolated from the other four. The most commonly isolated bacteria was Staphylococcus hominis, found in 22.2% of positive blood cultures.

Conclusion: The overall hemodialysis venous catheter infection rate was 10.1 episodes/1000 catheter days, 15.1 episodes/1000 catheters days in non-tunneled catheters and 3.3 episodes/1000 catheters days in tunneled catheters. The infection predisposing factors identified were use of non-tunneled catheters and having 2 hemodialysis sessions per week. Regarding the microbiological profile, over half of the bacteria isolated were Gram-negative.

背景:感染是血液透析中心静脉导管最常见的并发症。目的:本研究的目的是确定巴西亚马逊州透析中心的中心静脉导管相关感染率,并确定感染的风险因素和微生物特征。方法:这是一项观察性研究,通过图表分析和面对面访谈,对在透析中心使用中心静脉导管进行血液透析的患者进行了为期12个月的前瞻性数据收集。结果:对48例患者的96根中心静脉导管进行了分析。其中78根为非隧道式中心静脉导管(81.3%),18根为隧道式中心血管导管(18.7%),53.1%的导管因感染而更换,35.2%的导管相关感染患者进行了血液培养。从9种有细菌生长的血液培养物中的5种中分离出革兰氏阴性菌,从其他4种中分离到革兰氏阳性菌。最常见的分离细菌是人葡萄球菌,在22.2%的阳性血液培养物中发现。结论:血液透析静脉导管总感染率为10.1次/1000导管天,非隧道导管为15.1次/1000导管日,隧道导管为3.3次/1000导管月。确定的感染易感因素是使用非隧道导管和每周进行2次血液透析。关于微生物特征,超过一半的分离细菌为革兰氏阴性。
{"title":"Predictive factors of infection in patients with chronic kidney disease using hemodialysis catheters.","authors":"Juliana da Costa Matos,&nbsp;Laura Lane Menezes Polsin,&nbsp;Karla Cristina Petrucelli Israel,&nbsp;Leonardo Pessoa Cavalcante","doi":"10.1590/1677-5449.202200982","DOIUrl":"https://doi.org/10.1590/1677-5449.202200982","url":null,"abstract":"<p><strong>Background: </strong>Infection is the most frequent complication of central venous catheters used for hemodialysis.</p><p><strong>Objectives: </strong>The purpose of this study was to the determine the central venous catheter-related infection rate at a dialysis center in the Brazilian state of Amazonas and to identify risk factors and the microbiological profile of the infections.</p><p><strong>Methods: </strong>This was an observational study with prospective data collection over a 12-month period by chart analysis and face-to-face interviews with patients undergoing hemodialysis using central venous catheters at a dialysis center.</p><p><strong>Results: </strong>96 central venous catheters were analyzed in 48 patients. 78 of these were non-tunneled central venous catheters (81.3%) and 18 were tunneled central venous catheters (18.7%), 53.1% of the catheters were exchanged because of infection and blood cultures were obtained from 35.2% of the patients who had catheter-related infections. Gram-negative bacteria were isolated from five of the nine blood cultures in which there was bacterial growth and Gram-positive bacteria were isolated from the other four. The most commonly isolated bacteria was <i>Staphylococcus hominis</i>, found in 22.2% of positive blood cultures.</p><p><strong>Conclusion: </strong>The overall hemodialysis venous catheter infection rate was 10.1 episodes/1000 catheter days, 15.1 episodes/1000 catheters days in non-tunneled catheters and 3.3 episodes/1000 catheters days in tunneled catheters. The infection predisposing factors identified were use of non-tunneled catheters and having 2 hemodialysis sessions per week. Regarding the microbiological profile, over half of the bacteria isolated were Gram-negative.</p>","PeriodicalId":14814,"journal":{"name":"Jornal Vascular Brasileiro","volume":"22 ","pages":"e20220098"},"PeriodicalIF":0.0,"publicationDate":"2023-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10545231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41139284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Gastrite isquêmica grave por isquemia mesentérica crônica 慢性肠系膜缺血引起的严重缺血性胃炎
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-08-11 DOI: 10.1590/1677-5449.202300021
Bruno Moraes Ribas, Eduardo Camargo Rebolho, Guilherme Figueiró Ferronatto, Pedro Henrique Bragato, H. Akahane, E. J. D. Ramos, Thienis Maria da Costa Lima, Bárbara D’Agnoluzzo Moreira
Resumo A gastrite isquêmica é uma doença rara, podendo ocorrer por insuficiência vascular focal ou sistêmica. Essa condição é raramente vista na prática médica devido à vasta rede colateral arterial do estômago pelo tronco celíaco e mesentérica superior. A apresentação clássica da isquemia crônica é formada pela tríade de dor pós-prandial, perda de peso e sopro abdominal. A intervenção está indicada naqueles pacientes sintomáticos, sendo o tratamento endovascular uma alternativa à cirurgia em pacientes com alta comorbidade, tendo bons resultados. Reportamos um caso de gastrite isquêmica grave com úlceras e sangramento que foi causado por isquemia mesentérica crônica, em uma paciente de 71 anos, com oclusão do tronco celíaco e mesentérica inferior, além de estenose crítica da superior. O diagnóstico foi confirmado por exame de imagem, e a paciente foi submetida a tratamento endovascular. Trata-se de uma condição rara de diagnóstico e tratamento desafiadores, a qual requer uma equipe multidisciplinar para o manejo adequado.
缺血性胃炎是一种罕见的疾病,可由局灶性或全身血管功能不全引起。这种情况在医学实践中很少见到,因为胃腔和肠系膜上干有巨大的动脉副侧网。慢性缺血的典型表现是餐后疼痛、体重减轻和腹胀。对于有症状的患者,需要进行干预,对于高合并症患者,血管内治疗是一种替代手术的选择,效果良好。我们报告了一例由慢性肠系膜缺血引起的严重缺血性胃炎,包括溃疡和出血,患者为71岁,腹腔和肠系膜下干闭塞,上肢严重狭窄。经影像学检查证实诊断,患者接受血管内治疗。这是一种罕见的疾病,诊断和治疗具有挑战性,需要多学科团队进行适当的管理。
{"title":"Gastrite isquêmica grave por isquemia mesentérica crônica","authors":"Bruno Moraes Ribas, Eduardo Camargo Rebolho, Guilherme Figueiró Ferronatto, Pedro Henrique Bragato, H. Akahane, E. J. D. Ramos, Thienis Maria da Costa Lima, Bárbara D’Agnoluzzo Moreira","doi":"10.1590/1677-5449.202300021","DOIUrl":"https://doi.org/10.1590/1677-5449.202300021","url":null,"abstract":"Resumo A gastrite isquêmica é uma doença rara, podendo ocorrer por insuficiência vascular focal ou sistêmica. Essa condição é raramente vista na prática médica devido à vasta rede colateral arterial do estômago pelo tronco celíaco e mesentérica superior. A apresentação clássica da isquemia crônica é formada pela tríade de dor pós-prandial, perda de peso e sopro abdominal. A intervenção está indicada naqueles pacientes sintomáticos, sendo o tratamento endovascular uma alternativa à cirurgia em pacientes com alta comorbidade, tendo bons resultados. Reportamos um caso de gastrite isquêmica grave com úlceras e sangramento que foi causado por isquemia mesentérica crônica, em uma paciente de 71 anos, com oclusão do tronco celíaco e mesentérica inferior, além de estenose crítica da superior. O diagnóstico foi confirmado por exame de imagem, e a paciente foi submetida a tratamento endovascular. Trata-se de uma condição rara de diagnóstico e tratamento desafiadores, a qual requer uma equipe multidisciplinar para o manejo adequado.","PeriodicalId":14814,"journal":{"name":"Jornal Vascular Brasileiro","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67419093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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