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Search Results: 1 - 10 of 313730 matches for " Fábio Gon?alves de;Escobar "
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Estudo comparativo entre cirurgia de revasculariza??o miocárdica com e sem circula??o extracorpórea em mulheres
, Michel Pompeu Barros de Oliveira;Lima, Leonardo Pontual;Rueda, Fábio Gonalves de;Escobar, Rodrigo Renda de;Cavalcanti, Paulo Ernando Ferraz;Thé, Emmanuel Callou da Silva;Escobar, Mozart Augusto Soares de;Lima, Ricardo de Carvalho;
Revista Brasileira de Cirurgia Cardiovascular , 2010, DOI: 10.1590/S0102-76382010000200018
Abstract: background: it has been well documented that women have higher morbidity and mortality rates than men following coronary artery bypass graft (cabg) surgery. in view of this evidence, it is necessary to know if there is benefit to off-pump cabg surgery in women in comparison to on-pump cabg. objectives: compare outcomes between off-pump cabg and on-pump cabg in women. methods: retrospective study. our investigation analyzes comparatively clinical profile, thirteen procedure complications and mortality of a population of 941 consecutive women undergoing cabg surgery (549 off-pump and 392 on-pump) at two hospitals for the period january 2000 to december 2005. results: mortality rate for women undergoing off-pump cabg surgery is lower than for women undergoing on-pump surgery, however, not statistically significant (3.1% vs 5.3%; p=0.134). the complication rates analyzed (hemorrhagic shock, neurologic, respiratory, acute renal failure, adult respiratory distress syndrome, septicemia, pneumonia, atrial fibrillation) were lower (significant statistically difference) for women off-pump than women on-pump, with the exception of low cardiac output and wound infection. conclusions: evidence suggests that off-pump cabg surgery may be better for women than on-pump cabg surgery because it appears to reduce morbimortality rates. ten of 13 complications investigated demonstrated an advantage for women undergoing off-pump surgery relative to those receiving on-pump surgery.
Perfil clínico-cirúrgico de pacientes operados por ruptura do septo interventricular pós-infarto do miocárdio
, Michel Pompeu Barros de Oliveira;Sá, Marcus Villander Barros de Oliveira;Barbosa, Caio Henrique;Silva, Niedjon Peixoto de Carvalho;Escobar, Rodrigo Renda de;Rueda, Fábio Gonalves de;Silva, Frederico Pires Vasconcelos;Lima, Ricardo de Carvalho;
Revista Brasileira de Cirurgia Cardiovascular , 2010, DOI: 10.1590/S0102-76382010000300010
Abstract: objectives: to study clinical features, complications and in-hospital outcomes of patients operated for postinfarction ventricular septal rupture. methods: a retrospective study involving 21 patients between january/1996 and june/2009. all operations were performed at the division of cardiovascular surgery of complexo hospitalar huoc/procape. results: mean age of patients was 62.81 years (± 8.21), 61.9% (n = 13) were male. rupture occurred on average 4.8 days after infarction. cardiogenic shock was observed in 57.1% (n = 12), being risk factor for death (100% with shock vs. 22.2% without shock; p<0.001). survivors had a higher mean ejection fraction compared to deaths (66.29% ± 4.61% versus 42.71% ± 4.79%, p <0.001). all were classified as high risk by the euroscore, and the survivors had lower average score compared to deaths (6.57 ± 0.53 versus 10.93 ± 2.23; p <0.001). the majority (76.2%, n = 16) of the patients needed to use vasoactive drugs and 57.1% (n = 12) considered hemodynamically unstable. need for vasoactive drugs was a risk factor for death (81.3% with vasoactive drugs versus 20% without vasoactive drugs, p = 0.025). hemodynamic instability was also a risk factor for death (100% in the unstable group versus 22.2% in the stable group; p <0.001). the rate of in-hospital mortality was 66.7% (n = 14). conclusions: the need for vasoactive drugs, hemodynamic instability and cardiogenic shock were associated with higher rates of mortality. patients who had adverse outcomes had less ventricular function and higher score in the euroscore. mortality remains high
Mediastinite no pós-operatório de cirurgia cardiovascular: análise de 1038 cirurgias consecutivas
, Michel Pompeu Barros de Oliveira;Silva, Débora Oliveira;Lima, érika Nibbering de Souza;Lima, Ricardo de Carvalho;Silva, Frederico Pires Vasconcelos;Rueda, Fábio Gonalves de;Escobar, Rodrigo Renda de;Cavalcanti, Paulo Ernando Ferraz;
Revista Brasileira de Cirurgia Cardiovascular , 2010, DOI: 10.1590/S0102-76382010000100008
Abstract: objective: to report the incidence of mediastinitis in cardiovascular surgery postoperation. methods: the records of all 1038 patients who underwent cardiovascular surgical procedures between may/2007 and june/2009 were reviewed. all operations were performed in division of cardiovascular surgery of pronto socorro cardiológico de pernambuco - procape. results: the complication occurred within, on average, 13 days after operation, in total of 25 (2.4%), eight (32%) deaths occurred. several risk factors mediastinitis were identified: 56% diabetes, 56% smokers, 20% obeses, 16% with chronic obstructive pulmonary disease and 8% of chronic renal failure. mediastinitis were reported in 21 (84%) cases of patients submitted to coronary artery bypass grafting, being associated to major risk of infection development (ic 3.448.30, p=0.0001). high rates of complications were observed: respiratory insufficiency (44%), stroke (16%), cardiogenic shock (12%), acute renal failure (28%), pulmonary infection (36%), multiple organs failure (16%) and esternal deiscence (48%). bacterial cultures of exudates were positive in 84% of patients; staphylococcus aureus was the most responsible pathogen (28.8%). conclusion: mediastinitis stays a serious surgical complication and difficult management in cardiovascular surgery postoperation. the disease stays with low incidence, but still with high lethality. coronary bypass was associated to major risk of infection development.
Validation of MagedanzSCORE as a predictor of mediastinitis after coronary artery bypass graft surgery
, Michel Pompeu Barros de Oliveira;Figueira, Evelyn Soares;Santos, Cecília Andrade;Figueiredo, Omar Jacobina;Lima, Renato Oliveira Albuquerque;Rueda, Fábio Gonalves de;Escobar, Rodrigo Renda de;Soares, Alexandre Magno Macário Nunes;Lima, Ricardo de Carvalho;
Revista Brasileira de Cirurgia Cardiovascular , 2011, DOI: 10.5935/1678-9741.20110013
Abstract: objective: the aim of this study is to evaluate the applicability of a new score for predicting mediastinitis - magedanzscore - in patients undergoing coronary artery bypass graft (cabg) surgery in the division of cardiovascular surgery of pronto socorro cardiológico de pernambuco - procape. methods: retrospective study involving 500 patients operated between may/2007 and april/2010. the registers contained all the information used to calculate the magedanzscore. the outcome of interest was mediastinitis. we calculated sensitivity, specificity, positive predictive value, negative predictive value, concordance and accuracy. the accuracy of the model was evaluated by roc (receiver operating characteristic) curve. results: the incidence of mediastinitis was 5.6%, with a lethality rate of 32.1%. in univariate analysis, the five variables of the magedanzscore were predictors of postoperative mediastinitis: chronic obstructive pulmonary disease (or 6.42; 95.0% ci 2.76-14.96; p<0.001), obesity (or 3.06; 95.0% ci 1.32-7.09; p=0.009), surgical reintervention (or 82.40; 95.0% ci 30.40-223.30; p<0.001), multiple transfusion (or 3.33; 95.0% ci 1.52-7.29; p=0.003) and stable angina class iv or unstable (or 2.59; 95.0% ci 1.19-7.64; p=0.016) according to canadian cardiovascular society. the score had a sensitivity of 96.4%, specificity of 90.0%, positive predictive value of 36.5%, negative predictive value of 99.8% and 90.4% concordance. the accuracy measured by the area under the roc curve was 96.2% (95.0% ci 94.5%-97.9%). conclusions: the magedanzscore proved to be a simple and objective index, revealing a satisfactory predictor of development of postoperative mediastinitis in patients undergoing cabg surgery at our institution
Predictors of transfusion of packed red blood cells in coronary artery bypass grafting surgery
, Michel Pompeu Barros de Oliveira;Soares, Evelyn Figueira;Santos, Cecília Andrade;Figueiredo, Omar Jacobina;Lima, Renato Oliveira Albuquerque;Rueda, Fábio Gonalves de;Escobar, Rodrigo Renda de;Soares, Alexandre Magno Macário Nunes;Lima, Ricardo de Carvalho;
Revista Brasileira de Cirurgia Cardiovascular , 2011, DOI: 10.5935/1678-9741.20110044
Abstract: objectives: finding predictors of blood transfusion may facilitate the most efficient approach for the use of blood bank services in coronary artery bypass grafting procedures. the aim of this retrospective study is to identify preoperative and intraoperative patient characteristics predicting the need for blood transfusion during or after cabg in our local cardiac surgical service. methods: 435 patients undergoing isolated first-time cabg were reviewed for their preoperative and intraoperative variables and analyzed postoperative data. patients were 255 males and 180 females, with mean age 62.01 ± 10.13 years. regression logistic analysis was used for identifying the strongest perioperative predictors of blood transfusion. results: blood transfusion was used in 263 patients (60.5%). the mean number of transfused blood products units per patient was 2.27 ± 3.07 (0-23) units. the total number of transfused units of blood products was 983. univariate analysis identified age >65 years, weight <70 kg, body mass index <25 kg/m2, hemoglobin <13mg/dl, hematocrit < 40% and ejection fraction <50%, use of cardiopulmonary bypass (cpb), not using an internal thoracic artery as a bypass, and multiple bypasses as significant predictors. the strongest predictors using multivariate analysis were hematocrit < 40% (or 2.58; ci 1.62-4.15; p<0.001), cpb use (or 2.00; ci 1.27-3.17; p=0.003) and multiple bypasses (or 2.31; ci 1.31-4.08; p=0.036). conclusions: the identification of these risk factors leads to better identification of patients with a grater probability of using blood, allocation blood bank resources and cost-effectiveness use of blood products.
Risk factors for mediastinitis after coronary artery bypass grafting surgery
, Michel Pompeu Barros de Oliveira;Soares, Evelyn Figueira;Santos, Cecília Andrade;Figueiredo, Omar Jacobina;Lima, Renato Oliveira Albuquerque;Escobar, Rodrigo Renda;Rueda, Fábio Gonalves de;Lima, Ricardo de Carvalho;
Revista Brasileira de Cirurgia Cardiovascular , 2011, DOI: 10.1590/S0102-76382011000100008
Abstract: objective: mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. the aim of this study is to identify risk factors for mediastinitis in patients undergoing coronary artery bypass grafting (cabg), without the use of bilateral internal thoracic artery (ita), at the division of cardiovascular surgery of pronto socorro cardiológico de pernambuco - procape. methods: a retrospective study of 500 consecutive patients operated on between may 2007 and april 2010. ten preoperative variables, seven intraoperative variables and seven postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated. univariate and multivariate logistic regression analyses were performed. results: the incidence of mediastinitis was 5.6% (n=28), with a lethality rate of 32.1% (n=9). in multivariate analysis using logistic regression, five variables remained as independent risk factors: obesity (or 2.60, 95% ci 1.11 to 6.68), diabetes (or 2.71, 95% ci 1.18 to 6.65), smoking (or 2.10, 95% ci 1.12 to 4.67), use of pedicled internal thoracic artery (or 5.17, 95% ci 1.45 to 18.42) and on-pump cabg (or 2.26, 95% ci 1.14 to 5.85). conclusion: this study identified the following independent risk factors for mediastinitis after cabg: obesity, diabetes, smoking, use of pedicled ita and on-pump cabg.
Mortalidade perioperatória em diabéticos submetidos à cirurgia de revasculariza??o miocárdica
, Michel Pompeu Barros de Oliveira;Soares, Evelyn Figueira;Santos, Cecília Andrade;Figueiredo, Omar Jacobina;Lima, Renato Oliveira Albuquerque;Escobar, Rodrigo Renda;Rueda, Fábio Gonalves de;Lima, Ricardo de Carvalho;
Revista do Colégio Brasileiro de Cirurgi?es , 2012, DOI: 10.1590/S0100-69912012000100006
Abstract: objective: to investigate the risk factors for in-hospital death in diabetic patients undergoing isolated coronary artery bypass grafting (cabg). methods: we conducted a retrospective study with 305 consecutive diabetic patients undergoing cabg in the division of cardiovascular surgery of our institution from april 2004 to april 2010. univariate analysis for categorical variables was performed with the chi-square or fisher's exact test, as appropriate. potential risk factors with p <0.05 in the univariate analysis were included in the multivariate analysis, which was performed by backward logistic regression. values of p <0.05 were considered statistically significant. results: the study population had a mean age of 61.44 years (± 9.81) and 65.6% (n=200) were male. the in-hospital mortality rate was 11.8% (n=36). the following independent risk factors for death were identified: on-pump cabg (or 6.15, 95% ci 1.57 to 24.03, p=0.009) and low cardiac output in the postoperative period (or 34.17, 95% ci 10.46 to 111.62, p <0.001). the use of internal thoracic artery (ita) was an independent protective factor for death (or 0.27, 95% ci 0.08 to 0.093, p=0.038). conclusion: this study identified the following independent risk factors for death after cabg: on-pump cabg and low cardiac output syndrome. the use of ita was an independent protective factor.
Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patients
, Michel Pompeu Barros de Oliveira;Soares, Evelyn Figueira;Santos, Cecília Andrade;Figueiredo, Omar Jacobina;Lima, Renato Oliveira Albuquerque;Escobar, Rodrigo Renda;Rueda, Fábio Gonalves de;Ferraz, Paulo Ernando;Lima, Ricardo Carvalho;
Revista Brasileira de Cirurgia Cardiovascular , 2011, DOI: 10.1590/S0102-76382011000200007
Abstract: background: mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. diabetes is a feared risk factor for mediastinitis and viewed with caution by cardiovascular surgeons. objective: to identify risk factors for mediastinitis in diabetics undergoing cabg surgery with use of unilateral ita in the division of cardiovascular surgery of pronto socorro cardiológico de pernambuco - procape. methods: retrospective study of 157 diabetics operated between may 2007 and april 2010. nine preoperative variables, five intraoperative variables and seven postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated. univariate and multivariate logistic regression analyses were applied. results: the incidence of mediastinitis was 7% (n=11), with a lethality rate of 36.1% (n=4). variables associated with increased risk of mediastinitis were: use of pedicled ita (or 8.25, 95% ci 2.03 to 66.10, p=0.016), postoperative renal complications (or 5.10, 95% ci 1.03 to 25.62, p=0.049) and re-operation (or 7.45, 95% ci 1.24 to 42.17, p=0.023). in multivariate analysis using backward logistic regression, only one variable remained as independent risk factor: use of pedicled ita (or 7.64, 95% ci 1.95 to 61.6, p=0.048), in comparison to skeletonized ita. conclusions: we suggest that diabetics should be considered for strategies to minimize risk of infection. in diabetics that undergo unilateral ita, the problem seems to be related to how ita is harvested. diabetics should always be considered for use of skeletonized ita.
A comparative analysis of biotic indices that use macroinvertebrates to assess water quality in a coastal river of Paraná state, southern Brazil
Gonalves, Fábio Bertolini;Menezes, Márcia Santos de;
Biota Neotropica , 2011, DOI: 10.1590/S1676-06032011000400002
Abstract: biotic indices to monitor water quality are helpful tools for evaluating the health of rivers and lakes. in brazil water samples are mainly analyzed using physical and chemical attributes, because most biotic indices were developed in other countries and their effective application to brazilian ecosystems requires significant research. this study compared four biotic indices commonly used to evaluate water quality via benthic macroinvertebrates in order to determine which index best reflects ecosystem health in a coastal river in brazil's paraná state. we also analyzed functional feeding groups. the indices studied were: 1) ept (percent of ephemeroptera, plecoptera and trichoptera); 2) bmwp' (biological monitoring work party system); 3) bmwp'-aspt (average score per taxon); and 4) hfbi (hilsenhoff family biotic index). all indices were calculated from five samples collected from april 2005 to april 2006 at two stations on the coastal do pinto river. the river's headwaters are inside a protected area but impacts increase downriver (e.g., towns, cattle grazing, tourism). the hfbi index did the poorest job of reflecting water quality. no one index performed better than the others, and all indices yielded water quality scores that did not accurately reflect macroinvertebrate community structure because all of them had differences between ordination scores and the structure of assemblage. the functional feeding groups protocol classified the lower stretch of the river as disturbed due to human impacts, suggesting that this method is a good one to evaluate health in environments.
Clinical, radiographic, biochemical and histological findings of florid cemento-osseous dysplasia and report of a case
Gonalves, Marcelo;Píspico, Ronaldo;Alves, Fábio de Abreu;Lug?o, Carlos Eduardo B.;Gonalves, Andréa;
Brazilian Dental Journal , 2005, DOI: 10.1590/S0103-64402005000300014
Abstract: florid cemento-osseous dysplasia has been described as a condition that characteristically affects the jaws of middle-aged black women. it usually manifests as multiple radiopaque cementum-like masses distributed throughout the jaws. this condition has also been classified as gigantiform cementoma, chronic sclerosing osteomyelitis, sclerosing osteitis, multiple estenosis and sclerotic cemental masses. the authors present a case of an uncomplicated florid cemento-osseous dysplasia in a 48-year-old black woman. multiple sclerotic masses with radiolucent border in the mandible were identified radiographically. histopathologic findings revealed formation of calcified dense sclerotic masses similar to cementum. all clinical, radiographic, biochemical and histological features were suggestive of the diagnosis of florid cemento-osseous dysplasia.
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