Fernanda Martins Gazoni

Complicações cardiovasculares em usuário de cocaína: relato de caso

JUSTIFICATIVA E OBJETIVOS: A cocaina e uma droga ilicita amplamente utilizada e o seu uso tem sido associado a efeitos decorrentes da toxicidade aguda e cronica em praticamente todos os orgaos, particularmente no sistema cardiovascular. Este artigo visou descrever um caso de cardiomiopatia em paciente jovem usuario cronico de cocaina. RELATO DO CASO: Paciente do sexo masculino, 19 anos, usuario de cocaina por inalacao e crack desde os 15 anos de idade. Foi internado em fevereiro de 2006 devido a dispneia progressiva aos minimos esforcos e expectoracao sanguinolenta. Ao exame fisico apresentava edema nos membros inferiores, estase jugular e dispneia em repouso. Foram observados no ecocardiograma: dilatacao das quatro câmaras cardiacas, com hipocinesia difusa de ventriculo esquerdo (VE), trombo mural em VE de 17 mm e fracao de ejecao de 12%. Realizada broncoscopia pulmonar que identificou sangramento em lingula ativo, tratado com embolizacao. Apos 48h do procedimento, o paciente manteve-se assintomatico e sem expectoracao sanguinolenta. Iniciado tratamento antitrombotico com warfarina e enoxaparina. A cineangiocoronariografia nao evidenciou lesoes obstrutivas e o paciente recebeu alta apos melhora clinica. Re-internado em julho de 2006 com dor precordial de forte intensidade e dispneia de repouso. Nova cineangiocoronariografia evidenciou oclusao de terco medio da arteria descendente anterior. CONCLUSOES: Os efeitos agudos da cocaina frequentemente motivam atendimento de emergencia. Ja as suas manifestacoes cronicas, como as doencas cardiovasculares, podem produzir alteracoes de dificil correlacao futura ao seu consumo previo. O uso prolongado da cocaina esta relacionado a alteracao da funcao sistolica ventricular esquerda por hipertrofia ou dilatacao miocardica, aterosclerose, disritmias cardiacas, apoptose de cardiomiocitos e lesao simpatica.

Pain assessment in elderly with dementia: Brazilian validation of the PACSLAC scale

ABSTRACT Objective To validate the Pain Assessment Checklist for Seniors with Limited Ability to Communicate – Portuguese in demented elderly and to analyze its measurement properties. Methods We evaluated 50 elderly with dementia, residing in a nursing home and with limited communication ability, when exposed to potentially painful situations. The tool was applied at two different moments. First, two interviewers applied it simultaneously, and the intensity of pain was asked based on the caregiver’s opinion. After 14 days, with no analgesic intervention, one of the interviewers applied it again. Results The sample comprised more females, aged over 80 years, with dementia due to Alzheimer, presenting musculoskeletal pain of moderate to severe intensity. The psychometric properties of the tool demonstrated appropriate internal consistency (Cronbach’s alpha coefficient of 0.827). The scale had excellent reproducibility, according to the intraclass correlation coefficient, and the tool has been duly validated. Conclusion The Pain Assessment Checklist for Seniors with Limited Ability to Communicate – Portuguese had adequate measuring properties for use with elderly presenting limited communication.

O uso de vitaminas do complexo B em terapêutica analgésica

BACKGROUND AND OBJECTIVES: The B complex vitamins have been used as single therapy or combined to other drugs, such as anti-inflammatory drugs, in different clinical situations, such as degenerative spinal diseases, rheumatologic diseases, polyneuropathies and in different postoperative situations. This study aimed at identifying in the scientific literature most recent evidences of the use of B complex vitamins as analgesic therapy and at describing clinical situations where their analgesic action could be observed. CONTENTS: A search was carried out in Pubmed, Medline, LILACS, Cochrane Library and Scielo databases, contemplating the last 10 years and titles in Portuguese, Spanish and English.

Necrose isquêmica hepática e diabete melito: relato de caso

BACKGROUND AND OBJECTIVES: Hepatic infarction is characterized by parenchyma ischemic necrosis involving at least two acinis. It is extremely uncommon due to the arterial and portal venous blood supply. We report a case of a patient not know to have diabetes who developed massive areas of ischemic infarcts of the liver after episode of acutely diabetes decompensated. CASE REPORT: A 67 year-old hypertensive female who has been presenting, for the last 10 days, polydipsia, high urinary volume, visual and gait impairment, nausea and vomiting was admitted to the emergency room (ER). During the physical examination it was observed dehydration, skin discoloration, peripheral cyanosis, hypothermia, tachycardia, hypotension and mild diffuse abdominal pain. Admissional laboratory exams demonstrated total leukocytes: 16.800, Cr: 3.7, Ur: 167, Na: 133, K: 6.9, glucose: 561; arterial gasometry (O2 catheter: 2 L/min): pH: 6.93, pCO2: 12.1, pO2: 107, B.E.: -28.8, HCO3: 2.4, Sat 91.3%, lactato: 79; urinalysis: pH: 6; leukocytes: 13; density: 1015; erythrocytes: 19; protein: ++; glucose: +++; bilirubin: negative; ketonic bodies: + denote ketonemia. EKG: sharp T wave, right branch block. Patient was treated with intravenous insulin, hydration, sodium bicarbonate and ceftriaxone. After initial treatment, the laboratory exams showed Cr: 2.2, Ur: 122, Na: 162, K: 4.3, Ca: 6.4, glucose: 504, pH: 7.01, HCO3: 7.1, B.E.: -22. One day after admission the patient presented with important abdominal pain and peritoneal irritation, followed by difficulty for talking and somnolence; routine laboratory exams showed arterial gasometry: pH: 7.4, pCO2: 31, pO2: 68, BE: -4.4, HCO3: 19, SatO2: 93.5%; Ur: 95,Cr: 1.4, albumin: 2.4, Ca: 0.95, Na: 166, K:4, bilirubin: 0.5, bilirubin D/I: 0.2/0.3, Amylase: 1157, Gamma-GT: 56, AST 7.210, ALT: 2.470, SR (sedimentation rate): 15, Lipase: 84. Abdominal ultrasound was unremarkable. Patient respiratory function and conscience level worsened, requiring intubation. Despite all resuscitation efforts, she died. Necropsy showed multiple ischemic infarcts of the liver with vascular thrombosis, splenic infarcts, generalized visceral congestion and atherosclerosis of aorta and its branches. Pancreas was normal. CONCLUSIONS: The mechanisms of hepatic and splenic infarctions in this case were unclear. The following factors may have contributed to necrosis: vomiting and fever should be considered to induce dehydration and hypotension, which further decreased portal and hepatic arterial inflows; elevated level of catecholamine in hyperglycemic states might induce vasoconstriction effects; widespread atherosclerosis is commonly seen in diabetic and hypertensive patients. This case underlies the importance of searching for hepatic necrosis or infarction in any diabetic patient with elevated liver enzymes. Anticoagulation therapy should be instituted promptly upon recognition of vascular thromboses.

AS05 Cardiac arrest Outcomes Data Evaluation – CODE registry: Brazilian registry of in-hospital cardiopulmonary resuscitation

INTRODUCTION: In spite of the advances and worldwide standardization for cardiopulmonary resuscitation (CPR), knowledge on the effectiveness of in-hospital CPR is not yet sufficient in Brazil. Meth...

Leucemia mielóide crônica e síndrome de hiper-viscosidade: relato de caso

BACKGROUND AND OBJECTIVES: Hyperleukocytosis (> 100 x 10(9)/L) is an uncommon presentation of chronic leukemias and it can present clinical symptoms of hyperviscosity syndrome. Hearing loss and blindness rarely occurs in patients with leukemia; however, it can be strong association with hyper-viscosity syndrome. The purpose of this paper is to report a case of acute hearing loss as the initial manifestation of acute leukemia and hyper-viscosity syndrome and also mainly aspects of the intensive care treatment. CASE REPORT: A 41 year-old, male patient, who has been complaining about dizziness for six months with no response to symptomatic medications, was admitted to the emergency department with acute hearing loss. The physical examination was normal except for a bilateral hearing loss without an apparent cause. Laboratory exams showed total leukocyte: 645.000 with 66.4% blasts, hemoglobin: 7.0, hematocrit: 20.5, urea: 94, creatinine: 1.59, K: 5.6, Na: 138, INR: 1.38, TTPa: 0.89, troponin lower than 0.2, CK: 218, CKMB: 50, uric acid: 11.1. After a first hypothesis of leukemia with a high risk of hyper-viscosity complications, the patient was admitted to the Intensive Care Unit for monitoring and treatment. A bone marrow biopsy was performed and than started hidratation, hydroxyurea, allopurinol, dexamethasone. According to hematologists the patient had a chronic myeloid leukemia. Leukopheresis was performed one week after admission when total blood leukocytes were around 488.000. Ten days after the procedure the patient had no improvement of the hearing loss but total leukocytes were 10.100. He was discharge to the ward and 2 weeks later went home to continue ambulatory treatment. CONCLUSIONS: The frequency of sensitive manifestations in patients with leukemia include not only visual and hearing loss but also many others manifestations such as conductive vertigo, facial palsy and infections. Hyperviscosity syndrome due to hyperleukocytosis is also a possible cause of sensorial loss, but the syndrome is often dependent on leukocyte counts greater than (>100 x 10(9)/L).This case is a representative of rare cases in which acute sensorineural hearing loss occurred as the initial manifestation of hyper-viscosity syndrome due to leukemia.