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Search Results: 1 - 10 of 4395 matches for " Denise Rossato;Gazzana "
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Valor dos achados clínicos e da avalia??o funcional pulmonar pré-operatórios como preditores das complica??es pulmonares pós-operatórias
Silva, Denise Rossato;Gazzana, Marcelo Basso;Knorst, Marli Maria;
Revista da Associa??o Médica Brasileira , 2010, DOI: 10.1590/S0104-42302010000500016
Abstract: objective: to assess the relationship between clinical and preoperative pulmonary functional evaluation and occurrence of postoperative pulmonary complications. methods: we conducted a retrospective cohort study with patients submitted to pulmonary functional evaluation over a period of 5 years. we collected clinical, demographic and spirometric data, also those related to surgical procedures and postoperative pulmonary complications. results: medical records of 521 patients were evaluated. mean age was 59.5 ± 14 years, 65.8% were male, and 93.4% were white. the mean fev1, was 76.6 ± 24.6% of the predicted. clinical comorbidities were present in 73.5% of all patients (copd in 29.8%). the most common surgical sites were thorax (n=122; 23.4%) and upper abdomen (n=117; 22.5%). postoperative pulmonary complications occurred in 99 patients (19.0%), with respiratory insufficiency as the most common (4.6%). forty three patients (8.3%) died. the rates of pulmonary complications were higher after thoracic (28.9%), cardiac (28%) and upper abdomen surgery (24.3%) (p<0.0001). most patients with pulmonary complications (66.7%) were classified as asa iii and iv (p<0.01), and in 70.2% time of anesthesia was > 3.5 hours (p<0.0001). median lenght of hospital stay was statistically different between patients with and without pulmonary complications (23.5 [15.8-34] days vs. 10 [6-18] days; p<0.001). patients who never smoked had fewer complications than those with current or past smoking history (p=0.04). we did not find significant association between postoperative pulmonary complications and presence of copd, fev1, and body mass index (p>0.05). conclusion: the most important factors associated with postoperative pulmonary complications were surgical site, time of anesthesia, and asa classification.
Desfecho de pacientes com cancer de pulm o admitidos em unidades de terapia intensiva Outcomes for patients with lung cancer admitted to intensive care units
Alice Manica Müller,Marcelo Basso Gazzana,Denise Rossato Silva
Revista Brasileira de Terapia Intensiva , 2013,
Abstract: OBJETIVO: Este estudo objetivou avaliar o desfecho de pacientes com cancer de pulm o admitidos na unidade de terapia intensiva e verificar o perfil clínico e demográfico deles. MéTODOS: Estudo analítico observacional, retrospectivo, em que foi avaliado o desfecho de pacientes com diagnóstico de cancer de pulm o que internaram na unidade de terapia intensiva de um hospital universitário de janeiro de 2010 até fevereiro de 2011. RESULTADOS: Foram incluídos 34 prontuários de pacientes. Vinte e seis (76,5%) receberam algum tipo de suporte ventilatório, 21 (61,8%) utilizaram ventila o mecanica invasiva e 11 (32,4%) utilizaram ventila o n o invasiva em algum momento durante a estadia na unidade de terapia intensiva. Considerando a letalidade, 12 (35,3%) foram a óbito durante o período de interna o na unidade de terapia intensiva, totalizando 15 (44,1%) óbitos durante todo o período de hospitaliza o; 19 (55,9%) pacientes obtiveram alta do hospital para casa. A análise das variáveis mostrou que os pacientes que foram a óbito permaneceram um período maior em ventila o mecanica invasiva 5,0 (0,25-15,0) dias do que os sobreviventes (1,0 (0-1,0) dias) (p=0,033) e realizaram diálise durante a estadia na unidade de terapia intensiva (p=0,014). CONCLUS ES: A mortalidade dos pacientes com cancer de pulm o admitidos em unidade de terapia intensiva está associada com o tempo de permanência na ventila o mecanica invasiva e a necessidade de diálise. OBJECTIVE: This study aimed to evaluate the outcomes for patients with lung cancer admitted to intensive care units and assess their clinical and demographic profiles. METHODS: Retrospective, analytical, observational study, wherein the outcomes for patients diagnosed with lung cancer admitted to the intensive care unit of university hospital from January 2010 until February 2011 were evaluated. RESULTS: Thirty-four patients' medical records were included. Twenty-six (76.5%) patients received some type of ventilatory support, of whom 21 (61.8%) used invasive mechanical ventilation and 11 (32.4%) used noninvasive ventilation at some point during their stay at the intensive care unit. Regarding mortality, 12 (35.3%) patients died during hospitalization at the intensive care unit, totaling 15 (44.1%) deaths during the entire hospitalization period; 19 (55.9%) patients were discharged from the hospital. The analysis of the variables showed that the patients who died had remained on invasive mechanical ventilation for a longer period 5.0 (0.25 to 15.0) days than the survivors (1.0 (0 to 1.0) days) (p=0.033) and underwent dialy
Tuberculose grave com necessidade de interna??o em UTI
Silva, Denise Rossato;Gazzana, Marcelo Basso;Dalcin, Paulo de Tarso Roth;
Jornal Brasileiro de Pneumologia , 2012, DOI: 10.1590/S1806-37132012000300015
Abstract: tuberculosis is a curable disease that can evolve to severe forms, requiring the treatment of the patients in an icu, especially if there is a delay in the diagnosis or if it affects elderly patients, those on dialysis, or those with hiv infection or other states of immunosuppression, as well as in cases of multidrug resistant disease. knowledge of the radiological presentation of the cases can help diagnose these severe forms, as can the introduction of new tests, such as the early detection of the etiological agent by pcr and chest ct, which favors the early initiation of treatment. in addition, the use of regimens without isoniazid and rifampin, as well as uncertain enteral absorption and low serum concentrations of antituberculosis drugs, can reduce the efficacy of treatment. for such patients, the prognosis is generally poor and mortality rates are high.
Fibrose pulmonar idiopática simultanea a enfisema em pacientes tabagistas
Silva, Denise Rossato;Gazzana, Marcelo Basso;Barreto, Sérgio Saldanha Menna;Knorst, Marli Maria;
Jornal Brasileiro de Pneumologia , 2008, DOI: 10.1590/S1806-37132008001000005
Abstract: objective: to describe the clinical and functional findings recently reported in the medical literature for patients diagnosed with emphysema involving the upper lobes and idiopathic pulmonary fibrosis (ipf) involving the lower lobes. methods: eleven patients with emphysema and ipf were identified retrospectively. all of the patients underwent high-resolution computed tomography of the lung and pulmonary function tests. results: of the 11 patients, 8 were male and 3 were female. the mean age was 70.7 ± 7.2 years (range, 61-86 years). all of the patients were smokers (mean smoking history, 61.5 ± 43.5 pack-years). the mean values of forced vital capacity (fvc), forced expiratory volume in one second (fev1) and fev1/fvc were 72.1% ± 12.7%, 68.2% ± 11.9% and 74.4 ± 10.8, respectively. lung volumes were normal in 7 patients. a restrictive pattern was observed in 3 patients, and hyperinflation was present in one. the diffusing capacity was moderately-to-severely reduced in all of the patients (mean, 27.7% ± 12.9% of predicted). ten of the 11 patients performed the six-minute walk test. the mean distance covered was 358.4 ± 143.1 m, and 9 of the 10 patients presented desaturation > 4%. echocardiographic findings suggestive of pulmonary hypertension were present in 4 patients (mean systolic pulmonary artery pressure, 61.8 mmhg; range, 36-84 mmhg). conclusions: the concomitant presence of emphysema and ipf causes characteristic changes on pulmonary function tests. the most significant finding is a discrepancy between diffusing capacity and spirometry results.
Embolia pulmonar séptica secundária à tromboflebite jugular: um caso de síndrome de Lemierre
Silva, Denise Rossato;Gazzana, Marcelo Basso;Albaneze, Ricardo;Dalcin, Paulo de Tarso Roth;Vidart, Josi;Gulcó, Nei;
Jornal Brasileiro de Pneumologia , 2008, DOI: 10.1590/S1806-37132008001200015
Abstract: lemierre's syndrome is characterized by acute oropharyngeal infection, complicated by internal jugular venous thrombosis secondary to septic thrombophlebitis, and by metastatic infections in various distant organs-most commonly in the lungs. we report a case of lemierre's syndrome in a 56-year-old female who presented with right-sided neck mass and fever. right internal jugular venous thrombosis was demonstrated on an ultrasound. a computed tomography scan of the chest revealed multiple opacities throughout both lungs. an open surgical biopsy was performed due to suspicion of pulmonary metastases. anatomopathological examination revealed septic emboli in lung parenchyma. retrospectively, the patient reported a history of pharyngitis two weeks prior to hospitalization. after the diagnosis had been made, the patient was treated with broad-spectrum antibiotics (cefuroxime for 7 days and azithromycin for 5 days; subsequently, because fever persisted, cefepime for 7 days). one month later, a computed tomography scan of the chest revealed resolution of the opacities.
Características clínicas e evolu??o de pacientes imunocomprometidos n?o HIV com diagnóstico intra-hospitalar de tuberculose
Silva, Denise Rossato;Menegotto, Diego Millán;Schulz, Luis Fernando;Gazzana, Marcelo Basso;Dalcin, Paulo de Tarso Roth;
Jornal Brasileiro de Pneumologia , 2010, DOI: 10.1590/S1806-37132010000400013
Abstract: objective: to investigate the characteristics of and risk factors for mortality among non-hiv-infected immunocompromised patients with an in-hospital diagnosis of tuberculosis. methods: this was a two-year, retrospective cohort study of patients with an in-hospital diagnosis of tuberculosis. the predictive factors for mortality were evaluated. results: during the study period, 337 hospitalized patients were diagnosed with tuberculosis, and 61 of those patients presented with immunosuppression that was unrelated to hiv infection. extrapulmonary tuberculosis was found in 47.5% of cases. in the latter group, the in-hospital mortality rate was 21.3%, and the mortality rate after discharge was 18.8%. one-year survival was significantly higher among the immunocompetent patients than among the hiv patients (p = 0.008) and the non-hiv-infected immunocompromised patients (p = 0.015), although there was no such difference between the two latter groups (p = 0.848). among the non-hiv-infected immunocompromised patients, the only factor statistically associated with mortality was the need for mechanical ventilation. among the patients over 60 years of age, fibrosis/atelectasis on chest x-rays and dyspnea were more common, whereas fever and consolidations were less common. fever was also less common among the patients with neoplasms. the time from admission to the initiation of treatment was significant longer in patients over 60 years of age, as well as in those with diabetes and those with end-stage renal disease. weight loss was least common in patients with diabetes and in those using corticosteroids. conclusions: the lower prevalence of classic symptoms, the occurrence of extrapulmonary tuberculosis, the delayed initiation of treatment, and the high mortality rate reflect the diagnostic and therapeutic challenges of tuberculosis in non-hiv-infected immunocompromised patients.
Hipertens?o arterial pulmonar e doen?as da tireoide
Silva, Denise Rossato;Gazzana, Marcelo Basso;John, ?ngela Beatriz;Siqueira, Débora Rodrigues;Maia, Ana Luiza Silva;Barreto, Sérgio Saldanha Menna;
Jornal Brasileiro de Pneumologia , 2009, DOI: 10.1590/S1806-37132009000200012
Abstract: recent studies have suggested an association between pulmonary arterial hypertension (pah) and thyroid diseases (hypothyroidism and hyperthyroidism). this combination has a good prognosis, because the increase in the pulmonary artery pressure is usually slight and reverses after the treatment of the thyroid disease. although the exact mechanism involved in the pathogenesis of this combination has not yet been established, it has been hypothesized that thyroid hormones and autoimmunity have a direct influence. due to the high prevalence of thyroid disease in patients with pah, thyroid function tests should be considered in the investigation of every patient with pah. in this review, we describe the prevalence of pah in patients with thyroid diseases and the prevalence of thyroid disease in patients with pah, as well as addressing the principal effects that thyroid diseases have on the respiratory system. in addition, we report the treatment effects in patients with these diseases.
Mortality among patients with tuberculosis requiring intensive care: a retrospective cohort study
Denise R Silva, Diego M Menegotto, Luis F Schulz, Marcelo B Gazzana, Paulo TR Dalcin
BMC Infectious Diseases , 2010, DOI: 10.1186/1471-2334-10-54
Abstract: We conducted a retrospective, cohort study, between November 2005 and November 2007. The patients with TB requiring intensive care were included. Predictors of mortality were assessed. The primary outcome was the in-hospital mortality.During the study period, 67 patients with TB required intensive care. Of them, 62 (92.5%) had acute respiratory failure and required mechanical ventilation. Forty-four (65.7%) patients died. Coinfection with human immunodeficiency virus was present in 46 (68.7%) patients. Early intensive care unit admission and ventilator-associated pneumonia were independently associated with the in-hospital mortality.In this study we found a high mortality rate in TB patients requiring intensive care, especially in those with an early ICU admission.Across the world tuberculosis (TB) remains an important public health problem, especially in developing countries. One third of the world's population is infected with Mycobacterium tuberculosis. Brazil is ranking 15th among the 22 high-burden countries that collectively account for 80% of TB cases globally. The incidence of TB was of 50 cases/100,000 population/yr in 2006, and recently reached approximately 100 cases/100,000 population in the city of Porto Alegre (southern Brazil) [1]. Every year, almost 2 million people die of TB, most of them in low- and middle-income countries. The annual death rate from TB in Brazil was estimated at 4.0/100,000 population/yr in 2006 [2].Despite the availability of curative therapy, a large proportion of patients with TB are being hospitalized. In-hospital mortality rates remain high, particularly among patients with TB requiring intensive care unit (ICU) admission. These cases represent 1-3% of all patients with TB [3]. Acute respiratory failure (ARF) caused by TB necessitating mechanical ventilation (MV) has been associated with mortality rates between 25.9% and 81% [3-6]. Furthermore, such patients have a prognosis significantly worse than patients with nontuberculo
Factors associated with delayed diagnosis of tuberculosis in hospitalized patients in a high TB and HIV burden setting: a cross-sectional study
Denise Rossato Silva, Alice Müller, Paulo de Tarso Roth Dalcin
BMC Infectious Diseases , 2012, DOI: 10.1186/1471-2334-12-57
Abstract: We conducted a cross-sectional study in a general, tertiary care, university-affiliated hospital. Adult patients with TB that were hospitalized were identified retrospectively, and risk factors for delayed diagnosis were collected.The median delay until diagnosis was 6 days (IQR: 2-12 days). One hundred and sixty six (54.4%) patients were diagnosed ≤ 6 days, and 139 (45.6%) > 6 days after admission. The main factors associated with diagnostic delay (> 6 days) were extra-pulmonary TB and negative sputum smear.Although hospitalization permits a rapid management of the patient and favors a faster diagnosis, we found an unacceptable time delay before the diagnosis of pulmonary TB was made. Future studies should focus on attempt to explain the reasons of diagnostic retard in the patients with the characteristics related to delay in this study.Tuberculosis (TB) is a major public health issue worldwide, particularly in low- and middle-income countries. It is estimated that one third of the world population is infected with Mycobacterium tuberculosis [1]. Brazil is ranked 19th among the 22 high-burden countries that collectively account for 80% of TB cases globally, with an incidence of 37.9 cases/100,000 inhabitants/year in 2009 [2]. The city of Porto Alegre, in southern Brazil, has the highest incidence of TB (109.4 cases/100,000 inhabitants/year in 2010) and TB-HIV coinfection (35%) in the country [3].The most essential components of TB control are early diagnosis and adequate treatment. It is estimated that a single infectious person who remains untreated can infect between ten and fifteen people every year, spreading the infection in the community [1,4]. In addition, delay in the diagnosis and treatment of tuberculosis may result in more extensive disease and more complications, increases severity of the disease and is associated with higher risk of mortality [5-7]. According to 2 studies, the main factors associated with diagnostic delay included HIV infection, negati
Doen?a de Kikuchi-Fujimoto
Xavier, Rogério Gastal;Silva, Denise Rossato;Keiserman, Mauro Waldemar;Lopes, Maria Francisca Torres;
Jornal Brasileiro de Pneumologia , 2008, DOI: 10.1590/S1806-37132008001200014
Abstract: kikuchi-fujimoto disease is characterized by fever and lymphadenopathy, usually localized in the cervical region. this disease principally affects young females. it can be confused with lymphoma, adenocarcinoma metastasis and tuberculosis. we report two cases of kikuchi-fujimoto disease. in the first case, a 28-year-old female had been treated for tuberculosis one year prior and presented with a clinical and histological profile compatible with kikuchi-fujimoto disease. the second patient, a 58-year-old female, initially received treatment for wegener's granulomatosis and, subsequently, for tuberculosis. histopathological examination followed by immunohistochemical analysis confirmed the diagnosis of kikuchi-fujimoto disease in both cases. after the definitive diagnosis had been made, both patients were treated symptomatically, and both presented clinical improvement within one month. subsequently, the latter patient developed systemic lupus erythematosus.
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