Introduction Coronary artery bypass grafting (CABG) is the most frequently performed heart surgery in Brazil. Recent international guidelines recommend that national societies establish a database on the practice and results of CABG. In anticipation of the recommendation, the BYPASS Registry was introduced in 2015. Objective To analyze the profile, risk factors and outcomes of patients undergoing CABG in Brazil, as well as to examine the predominant surgical strategy, based on the data included in the BYPASS Registry. Methods A cross-sectional study of 2292 patients undergoing CABG surgery and cataloged in the BYPASS Registry up to November 2018. Demographic data, clinical presentation, operative variables, and postoperative hospital outcomes were analyzed. Results Patients referred to CABG in Brazil are predominantly male (71%), with prior myocardial infarction in 41.1% of cases, diabetes in 42.5%, and ejection fraction lower than 40% in 9.7%. The Heart Team indicated surgery in 32.9% of the cases. Most of the patients underwent cardiopulmonary bypass (87%), and cardioplegia was the strategy of myocardial protection chosen in 95.2% of the cases. The left internal thoracic artery was used as a graft in 91% of the cases; the right internal thoracic artery, in 5.6%; and the radial artery in 1.1%. The saphenous vein graft was used in 84.1% of the patients, being the only graft employed in 7.7% of the patients. The median number of coronary vessels treated was 3. Operative mortality was 2.8%, and the incidence of cerebrovascular accident was 1.2%. Conclusion CABG data in Brazil provided by the BYPASS Registry analysis are representative of our national reality and practice. This database constitutes an important reference for indications and comparisons of therapeutic procedures, as well as to propose subsequent models to improve patient safety and the quality of surgical practice in the country.
ObjectiveTo report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients.MethodsData collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8), Northeast (5), South (3), and Center-West (1). The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG), mitral valve, aortic valve (either conventional or transcatheter), surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults.Results83.1% of patients came from the public health system (SUS), 9.6% from the supplemental (private insurance) healthcare systems; and 7.3% from private (out-of -pocket) clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%; for CABG was 2.6%, and for valve operations, 4.4%.ConclusionThis first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.
Resumo: Os autores relatam caso de paciente feminina de 47 anos, com lesões cutâneas ulceradas, disseminadas, iniciadas sete anos antes do acompanhamento. Os achados histopatológicos de tais lesões, somados aos endoscópicos, permitiram o diagnóstico de uma entidade rara: a doença de Crohn metastática. O valor deste diagnóstico é ainda maior, por não se encontrar na literatura, relato de caso com atividade da doença de Crohn restrita às lesões cutâneas, sem a observação de queixas digestivas expressivas. Palavras-chave: Doença de Crohn; Fístula; Granuloma Abstract: The authors report the case of a 47-year-old female patient with dispersed ulcerated skin lesions that appeared 7 years before medical follow-up. Histopathological and endoscopic findings of such lesions led to the diagnosis of a rare disorder: metastatic Crohn's disease. This diagnosis is even more relevant because there is no case report in the literature of Crohn's disease restricted to cutaneous lesions, without major gastro-intestinal complaints. Keywords: Crohn disease; Fistula; Granuloma Recebido em 17.9.2008. Aprovado pelo Conselho Consultivo e aceito para publicação em 9.07.09. * Trabalho realizado em clínica particular de dermatologia -Campinas (SP), Brasil.Conflito CASO CLÍNICO INTRODUÇÃOAs úlceras cutâneas traduzem perda tecidual circunscrita, geralmente, de epiderme e derme, podendo haver comprometimento eventual da hipoderme. Podem ter etiologia traumática, vascular, infecciosa ou inflamatória. Na propedêutica clínica diagnóstica de lesões ulcerosas dermatológicas, é imperativo que se proceda a avaliação sistêmica do paciente, pois, muitas vezes, estamos diante da manifestação cutânea de patologia com acometimento primário não-cutâneo.Assim acontece em úlceras relacionadas às vasculites, às micoses profundas, às micobacterioses e à doença de Crohn, entidade de lesão primária de trato digestivo, mas que pode determinar manifestações cutâneas, por contiguidade do acometimento intestinal ou não. 1Por vezes, este acometimento sistêmico não se evidencia em sinais e sintomas, é discreto ou está mascarado, mas não deve ser desvalorizado. Na doença de Crohn, é clássico o distúrbio intestinal que cursa, em casos graves, com dor abdominal, diarreia muco-sanguinolenta, emagrecimento e, por vezes, crises de abdômen agudo secundário às aderências intra-abdominais.2 Porém, muitas vezes, o acometimento não atinge tal magnitude clínica e as queixas digestivas podem ser bem menos expressivas. A colonoscopia,
Objective: to report the experience of conducting directed temperature control of a post-cardiopulmonary resuscitation patient, with reduced and basic inputs available at the institution. Method: an experience report of directed temperature control in patient (age 15 years), after four hours of cardiopulmonary resuscitation in an Intensive Care Unit of a hospital in São Paulo State countryside in 2016, according to the protocol suggested by the American Heart Association, in 2015. There were applications of cold compresses, plastic bags with crushed ice and rectal temperature control. Results: after eight hours, temperature had reached 93.2 ºF. Body cooling was maintained for 24 hours. However, bags with crushed ice were used in the first 6 hours. Conclusion: conduct of nurses to obtain the body cooling with reduced and basic inputs was effective during the stay at the Intensive Care Unit.
ObjectiveThe present study refers to a determination of the preoperative B-type natriuretic peptide is a predictor of short-term all-cause mortality in patients undergoing on-pump coronary artery bypass graft surgeries.MethodsTwo hundred and twenty-one patients undergoing on-pump coronary artery bypass graft surgeries were evaluated prospectively during a 30-day postoperative follow-up period. Serum B-type natriuretic peptide concentration was measured without a 24-hour period prior to the surgical procedure and the value obtained was correlated with a short-term all-cause mortality.ResultsData analysis showed that all-cause mortality rates were equal to 9.5% in 30 days. Accuracy analysis by the receiver operating characteristic curve found an ideal cut-off value of B-type natriuretic peptide equal to 150 pg/mL in relation to mortality (AUC=0.82, 95% CI=0.71-0.87, P<0.001). Multivariate analysis showed that B-type natriuretic peptide value greater than or equal to 150 pg/mL (P=0.030, HR=3.99, 95% CI=1.14-13.98) was an independent predictor of all-cause mortality in a 30-day follow-up period.ConclusionPreoperative serum B-type natriuretic peptide concentration is an independent predictor of short-term all-cause mortality in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.
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