2224 research outputs found
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ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI)
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Valor pronóstico de las evaluaciones del crecimiento cerebelar y de los movimientos generales para el neurodesarrollo del gran prematuro entre los 18 y 24 meses de edad corregida
Get PDFIntroducción. La evaluación de los movimientos de ajetreo es sumamente sensible a la hora de predecir el desenlace a
largo plazo o la parálisis cerebral del neonato prematuro, un tipo de paciente en el que se ha descrito el crecimiento anó-
malo del cerebelo.
Objetivo. Comparar el valor pronóstico de la determinación ecográfica del crecimiento anómalo del cerebelo y el de la eva -
luación de los movimientos de ajetreo en el neurodesarrollo de grandes prematuros a los 18-24 meses de edad corregida.
Sujetos y métodos. Estudio prospectivo con una cohorte de 88 neonatos (32 semanas o menos de gestación) en que se
analizó el diámetro transversal del cerebelo por medio de una ecografía semanal hasta las 40 semanas de edad corregi-
da. Los movimientos de ajetreo se evaluaron a los tres meses de edad corregida. El estado de maduración neurológica a
los 18-24 meses de edad corregida se evaluó en 68 neonatos con la escala de evaluación de las competencias en el desa-
rrollo infantil (SGS-II) y la escala de evaluación neurológica de Amiel-Tison (ATNA).
Resultados. En la edad a término, el crecimiento del cerebelo fue inferior al tercer percentil en 11 neonatos (10,3%). Los
movimientos de ajetreo eran normales en 42 (61,8%), y anormales o ausentes, en 7 (10,3%). A los 18-24 meses de edad
corregida, 54 (79,4%) mostraron resultados normales en la SGS-II y 6 (8,8%) fueron calificados como afectados por pará -
lisis cerebral según la ATNA. El diámetro cerebelar inferior al tercer percentil a término estuvo asociado con un desenlace
motor anómalo y los movimientos de ajetreo normales se correlacionaron con el neurodesarrollo normal.
Conclusión. La estimación del tamaño del cerebelo y las exploraciones funcionales (movimientos de ajetreo) poseen un
importante papel complementario en el pronóstico del desarrollo nervioso en el gran prematuro.info:eu-repo/semantics/publishedVersio
Laterality of Pneumonia in Acute Stroke
No full textBACKGROUND/AIMS:
Previous studies demonstrated an alteration of diaphragmatic excursion on the paretic side after stroke; however, it is unclear if this change has clinical repercussions. We aimed to determine if there was an association between the paretic side and the laterality of pneumonia after stroke.
METHODS:
A retrospective analysis of a consecutive cohort of patients admitted to a stroke unit from 2008 to May 2016 was performed. Patients with the diagnosis of acute stroke and pneumonia were included. The laterality of pneumonia was determined through the blinded observation of chest X-rays. Fisher's exact test was applied to study the association between the side of paresis and pneumonia.
RESULTS:
One hundred and five patients were included. Sixty one percent (n = 64) had an ischemic stroke, 39% (n = 41) had brain hemorrhage, and 49.5% (n = 52) had right side paresis. We did not find in general an association between the side of paresis and the side of pneumonia (p = 1.00); however, we found a statistically significant association in patients with severe lower limb paresis (Medical Research Council, MRC ≤2; p = 0.035).
CONCLUSION:
We found an association between severe paresis of the lower limb (MRC ≤2) and ipsilateral pneumonia. We hypothesize that the proximity between the diaphragmatic and inferior limb corticospinal pathways could be the reason for this association.info:eu-repo/semantics/publishedVersio
Percutaneous Catheter Ablation of Epicardial Accessory Pathways.
Get PDFRadiofrequency (RF) catheter ablation is the treatment of choice in patients with accessory pathways (APs) and Wolff-Parkinson-White syndrome. Endocardial catheter ablation has limitations, including the inability to map and ablate intramural or subepicardial APs. Some of these difficulties can be overcome using an epicardial approach performed through the epicardial venous system or by percutaneous catheterisation of the pericardial space. When a suspected left inferior or infero-paraseptal AP is refractory to ablation or no early activation is found at the endocardium, a transvenous approach via the coronary sinus is warranted because such epicardial pathways can be in close proximity to the coronary venous system. Associated congenital abnormalities, such as right atrial appendage, right ventricle diverticulum, coronary sinus diverticulum and absence of coronary sinus ostium, may also hamper a successful outcome. Percutaneous epicardial subxiphoid approach should be considered when endocardial or transvenous mapping and ablation fails. Epicardial mapping may be successful. It can guide and enhance the effectiveness of endocardial ablation. The finding of no epicardial early activation leads to a more persistent new endocardial attempt. When both endocardial and epicardial ablation are unsuccessful, open-chest surgery is the only option to eliminate the AP.info:eu-repo/semantics/publishedVersio
More effective prediction of mortality in Chagas heart disease patients? Importance of cardiopulmonary stress testing
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Systemic Treatment of Metastatic Conjunctival Melanoma.
Get PDFConjunctival melanoma (CM) is an exceptionally rare tumor, with a propensity for local and distant recurrence, with the lungs, skin, liver, and brain being the most common sites of metastasis. Recent progress in systemic treatments, with checkpoint inhibitors and targeted therapies blocking BRAF and MEK, has redefined the standard of care of advanced unresectable and metastatic melanoma. Although most trials did not include patients with conjunctival melanoma, its close molecular and genetic relationship to cutaneous melanoma might suggest a similar response to these novel agents. The authors describe two uncommon cases of metastatic conjunctival melanomas with distinct genetic profiles and, as such, submitted to different systemic treatments.info:eu-repo/semantics/publishedVersio
Carta ao Editor relativa ao artigo “Seroprevalência do Anticorpo do Vírus na Hepatite A em Viajantes Portugueses: Um Novo Paradigma”
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Palliative Stenting for Malignant Large Bowel Obstruction: Stents for All?
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