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Search Results: 1 - 10 of 13322 matches for " GAZZANA MARCELO BASSO "
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Hipertens?o pulmonar: relato de seis casos e atualiza??o do tema
BARRETO, SéRGIO SALDANHA MENNA;GAZZANA, MARCELO BASSO;
Jornal de Pneumologia , 2000, DOI: 10.1590/S0102-35862000000600009
Abstract: pulmonary hypertension occurs when the pressure of the pulmonary artery is disproportionally high for a certain level of pulmonary blood flow. values of mean pulmonary artery pressure of more than 25 mm hg at rest or 30 mm hg during exercise allow the diagnosis of pulmonary hypertension. sustained or chronic pulmonary hypertension may be secondary to known diseases, mainly to those of cardiac or pulmonary nature, or may be a primary abnormality of the pulmonary circulation, with or without identification of associated conditions. advances in the knowledge of the mechanisms of vasoconstriction and vascular remodeling have brought better prospects for the treatment of the disease. the correct use of vasodilators and anticoagulants, the new vasodilators, as epoprostenol and its analogs, and surgical techniques have increased the survival of many patients. pneumologists can view cases of pulmonary hypertension as complications of pulmonary diseases or as a result of dyspnea investigation. despite its etiology, pulmonary hypertension represents a clear abnormality that affects the right ventricle and can be potentially fatal to patients. image methods have made the diagnosis of pulmonary hypertension more accessible and non-invasive. six cases of patients with pulmonary hypertension of different causes are presented and discussed. in conclusion, according to new concepts, idiopathic pulmonary hypertension is no longer an irreversible condition, and the identification of associated conditions with potential treatments can be favorable in the management of the patients with pulmonary hypertension.
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
Hipertens o pulmonar: relato de seis casos e atualiza o do tema
BARRETO SéRGIO SALDANHA MENNA,GAZZANA MARCELO BASSO
Jornal de Pneumologia , 2000,
Abstract: Hipertens o arterial pulmonar (HP) ocorre quando os níveis de press o da artéria pulmonar s o desproporcionalmente elevados para um dado nível de fluxo sanguíneo pulmonar. Valores de press o arterial pulmonar média superiores a 25mmHg em repouso ou 30mmHg em exercício permitem o diagnóstico de HP. A HP sustentada ou cr nica pode ser secundária a doen as conhecidas, principalmente de natureza cardíaca ou pulmonar, ou ser uma anormalidade primária da circula o pulmonar, com ou sem identifica o de condi es associadas. Pneumologistas podem enfrentar casos de HP como conseqüência de pneumopatias ou como achados de investiga es de dispnéia. Independente de sua etiologia, a HP representa uma anormalidade definida que afeta o ventrículo direito e tem conseqüências potencialmente fatais para os pacientes acometidos. Métodos de imagens têm tornado o diagnóstico de HP mais acessível e n o invasivo. Avan os no entendimento dos mecanismos de vasoconstri o e remodelamento vascular têm aberto melhores perspectivas para o tratamento. O uso criterioso de vasodilatadores tradicionais e de anticoagulantes, o surgimento de novos vasodilatadores, como o epoprostenol e seus análogos, e as técnicas cirúrgicas têm melhorado a sobrevida de parcela significativa de pacientes. Seis casos de pacientes com HP, de etiologias variadas, s o apresentados e suas abordagens discutidas. Conclui-se pelo conceito emergente de que a HP idiopática nem sempre é uma condi o irreversível e que a identifica o de condi es associadas potencialmente tratáveis exerce efeito favorável no manejo de pacientes com HP.
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.
Fatores preditores da qualidade de vida relacionada à saúde física e mental em pacientes com doen?a pulmonar intersticial: uma análise multifatorial
Coelho, Ana Cláudia;Knorst, Marli Maria;Gazzana, Marcelo Basso;Barreto, Sérgio Saldanha Menna;
Jornal Brasileiro de Pneumologia , 2010, DOI: 10.1590/S1806-37132010000500007
Abstract: objective: to determine predictors of health-related quality of life (hrqol) in patients with interstitial lung disease (ild). methods: a cross-sectional study comprising 63 patients, all of whom underwent lung function testing and the six-minute walk test. the following instruments were used: the medical outcomes study 36-item shortform survey (sf-36), the saint george's respiratory questionnaire (sgrq), the beck anxiety inventory, the beck depression inventory, and the modified medical research council dyspnea scale. principal component analysis was used in order to reduce the dimensionality of the data, thereby identifying the predictor variables, and multiple linear regression analysis was used in order to identify the explanatory variables. results: of the 63 patients, 34 were female. the mean age was 60.1 ± 13.3 years, the mean fvc was 64.17 ± 15.54% of predicted, and the mean dlco was 44.21 ± 14.47% of predicted. all of the patients evaluated had impaired hrqol, scoring worst for the sf-36 physical functioning and sgrq activity domains. of the patients evaluated, 60.3% and 57.1% showed symptoms of anxiety and depression, respectively. the principal component analysis identified one predictor of physical hrqol and one predictor of mental hrqol. depression had a strong influence on the predictor of mental hrqol, and the degree of dyspnea had a strong influence on both predictors of hrqol in the patients evaluated. variables related to lung function, exercise capacity, and anxiety had no impact on these predictors. conclusions: in our sample of patients with ild, the degree of dyspnea had a major impact on the physical and mental hrqol, and depression had an impact on mental hrqol.
Síndrome hepatopulmonar em paciente com cirrose por vírus C e SIDA
FERREIRA, MARIA ANGéLICA PIRES;GAZZANA, MARCELO BASSO;BARRETO, SéRGIO SALDANHA MENNA;KNORST, MARLI MARIA;
Jornal de Pneumologia , 2001, DOI: 10.1590/S0102-35862001000100009
Abstract: hepatopulmonary syndrome is characterized by a triad consisting of liver disorder, pulmonary vascular dilatation, and hypoxemia. no case of hepatopulmonary syndrome associated with aids has been reported so far. in this study, the authors report the case of a 43-year woman with aids and virus c cirrhosis taking prophylactic cotrimoxazole for pneumocystosis and retroviral therapy. upon admission, the patient presented dyspnea, cyanosis, digital clubbing, vascular spiders, and normal chest examination. chest x-ray revealed bilateral interstitial infiltration and evidenced increased alveolar-arterial gradient and liver function impairment. intrapulmonary shunt was evidenced by contrast-enhanced echocardiography and radionuclide perfusion scanning, thus confirming hepatopulmonary syndrome.
Síndrome hepatopulmonar em paciente com cirrose por vírus C e SIDA
FERREIRA MARIA ANGéLICA PIRES,GAZZANA MARCELO BASSO,BARRETO SéRGIO SALDANHA MENNA,KNORST MARLI MARIA
Jornal de Pneumologia , 2001,
Abstract: A síndrome hepatopulmonar consiste na tríade de doen a hepática, dilata es vasculares intrapulmonares e hipoxemia. N o há relatos de síndrome hepatopulmonar associada com SIDA. Relatamos o caso de uma mulher de 43 anos portadora de SIDA e de cirrose hepática por hepatite C, em uso de cotrimoxazol profilático para pneumocistose e de terapia anti-retroviral, com dispnéia progressiva, cianose, baqueteamento digital, aranhas vasculares e exame do tórax normal. A radiografia do tórax mostrava infiltrado retículo-nodular, o gradiente alvéolo-arterial de oxigênio estava aumentado e a fun o hepática alterada. Shunt intrapulmonar foi evidenciado por ecocardiografia bidimensional transtorácica e por cintilografia pulmonar perfusional, confirmando-se a síndrome hepatopulmonar.
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.
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