Browsing by Author "Ferreira, E"
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- Cirurgia de coração aberto sem sangue: simples e seguraPublication . Paiva, P; Ferreira, E; Antunes, MJOBJECTIVES: The use of blood or blood products is routine in cardiac surgery, but is associated with various complications. Aware of this, we have always tried to avoid the use of blood products whenever possible. In this study we sought to evaluate the results of this policy. METHODS: The records of 1505 adult patients who underwent coronary (732) or valve (773) surgery under cardiopulmonary bypass (CPB) in 2002 and 2003 were reviewed retrospectively. Of these, 1058 were male (70.3%) and the mean age was 62.1+/-11.4 years. Mean weight was 68.5+/-10.2 kg and body surface area was 1.7+/-0.2 m2, corresponding to a blood volume of 4119.9+/-593.6 ml. Preoperative hematocrit (Hct) was 40.6+/-4.2% and the prothrombin index was 87.0+/-17.4%. A bloodless prime of the bypass circuit was used for all patients with Hct > or =36%. The prime volume was reduced to the minimum possible. Plasma was used when coagulation was deficient. All blood remaining in the CPB circuit was reinfused at the end of the procedure, either in the operating room or in the ICU. Shed mediastinal blood was retransfused in the first 6 hours in the ICU. RESULTS: Operative mortality was 0.7% for coronary and 0.5% for valve patients. Blood or blood products were not used in 77.3% of the patients (88.7% of coronary and 66.5% of valve patients). Blood and/or plasma was initially added to the prime in 18.2% of cases and during CPB in 11%. Hct was 28.9+/-4.0% after initiation and 28.8+/-3.9% after discontinuation of CPB. The number of units (300 cc) of blood used was 0.25.57 per patient (1.09+/-0.73 per patient transfused). The number of units (300 cc) of plasma used was 0.24+/-0.72. Reoperation for bleeding was required in 2.4% of the patients. CONCLUSIONS: This blood-sparing policy is simple, effective and safe, resulting in low mortality and morbidity rates. More than three quarters of the patients did not require blood or blood products. Additional measures are possible to further decrease the use of blood products.
- Fabry’s disease, an eye-kidney disease reviewPublication . Guedes-Marques, M; Mira, F; Ferreira, E; Pinto, H; Maia, P; Mendes, T; Carreira, A; Campos, MFabry’s disease is a recessive X -linked disorder that results from a deficiency of the hydrolase alpha- -galactosidase A (α -Gal A). The absence of α -Gal A enzyme activity leads to accumulation of glycosphingolipid globotryaosylceramide (GL -3) in the lysosomes of a variety of cell types. It can cause skin and ocular lesions, progressive renal, cardiac or cerebrovascular disorders. The authors report the case of a 39 -year -old female who was referred to a nephrology appointment by her ophthalmologist, after the diagnosis of cornea verticillata and posterior subcapsular cataract. This case illustrates the importance of a multidisciplinary evaluation to an effective clinical screening. In males, most symptoms begin in childhood; in females the onset can be observed later and presentation is more variable. Various manifestations often lead to misdiagnosis or are frequently delayed for many years. Enzyme replacement therapy highlights the importance of early diagnosis so that treatment can be initiated before irreversible organ damage occurs.
- Intoxicação por Paraquat – experiência de 18 anos de um Serviço de MedicinaPublication . Simões, M; Alves, P; Esperto, H; Canha, C; Meira, E; Ferreira, E; Gomes, M; Nascimento-Costa, JMIntroduction: Paraquat is a contact herbicide commercially available since 1962. Paraquat intoxication (PI) is usually voluntary and highly lethal, since there is no effective antidote. Toxicity occurs through cyclic redox reactions, damaging mainly the kidneys and lungs. Aim, material and methods: featuring the clinical presentation, management and outcome of patients with PI over an 18 years period (from the 01st January 1993 to the 31st December 2010) through the retrospective analysis of clinical files and comparing the survivors and the deceased. Results: Thirty-one cases of Paraquat intoxication were included, with a male: female ratio 1:1. Age range from 13 to 80 years, mean age 42.4years (±18.7).All intoxications were voluntary and by oral route. There was statistical difference in the amount ingested (22.1 mL vs. 72.7 mL, p<0.0005). A non-significant trend to a longer delay until getting medical attention in the deceased group (1.6 h vs. 3.2 h, p=0.091). Statistical significance was found between mortality and leukocytosis, hypocapnea, hypoxemia, LDH, alkaline phosphatase and AST. There was no difference between groups according to treatment options, although hemocarboperfusion was used more often in the deceased group (53.9% vs. 66.7%, p=0.471) and corticosteroids in the survivor group (61.5% vs. 44.4%, p=0.350). Mortality rate was 58.1% (66.7% in the first 72 hours), due to respiratory insufficiency and multiple organ failure. Variable levels of pulmonary fibrosis occurred in 38.5% of the survivors. Discussion & Conclusion: Paraquat intoxication has a poor prognosis with limited efficiency of treatment approaches. The relation between Paraquat in the urine and the time elapsed after ingestion is the main determinant factor in the prognosis. In this study the presence of dyspnea, hypocapnea and hypoxemia was linked to a bad prognosis. There was no statistical difference between the available treatment options.
- Polyomavirus Nephropathy: Ten-Year ExperiencePublication . Costa, JS; Ferreira, E; Leal, R; Bota, N; Romãozinho, C; Sousa, V; Marinho, C; Santos, L; Macário, F; Alves, R; Pratas, J; Campos, M; Figueiredo, ABACKGROUND: Polyomavirus nephropathy (BKVN) is an important cause of chronic allograft dysfunction (CAD). Recipient determinants (male sex, white race, and older age), deceased donation, high-dose immunosuppression, diabetes, delayed graft function (DGF), cytomegalovirus infection, and acute rejection (AR) are risk factors. Reducing immunosuppression is the best strategy in BKVN. The objective of our study was to evaluate CAD progression after therapeutic strategies in BKVN and risk factors for graft loss (GL). METHODS: Retrospective analysis of 23 biopsies, from patients with CAD and histological evidence of BKVN, conducted over a period of 10 years. Glomerular filtration rate was <30 mL/min in 16 patients at the time of the BKVN diagnosis. RESULTS: BKVN was histologically diagnosed in 23 recipients (19 men, 4 women). All patients were white, with age of 51.2 ± 12.1 years (6 patients, age >60 years), and 22 had a deceased donor. Diabetes affected 4 patients, DGF occurred in 3, cytomegalovirus infection in 2, and AR in 15. All patients were medicated with calcineurin inhibitors (CNI) (95.7% tacrolimus) and corticoids, and 16 also received an antimetabolite. One year after antimetabolite reduction/discontinuation and/or CNI reduction/switching and/or antiviral agents, graft function was decreased in 11 patients, increased/stabilized in 10, and unknown in 2. GL occurred in 9 patients. Older age (hazard ratio, 1.76; 95% confidence interval, 0.94-3.28) and DGF (hazard ratio, 2.60; 95% confidence interval, 0.54-12.64) were the main risk factors for GL. The lower GFR at the time of the BKVN diagnosis was associated with an increased risk of initiation of dialysis. CONCLUSIONS: GL occurred in 39.1% of patients with BKVN and DGF; older age and lower GFR at the time of diagnosis were important risk factors. Early diagnosis of BKVN is essential to prevent GL.