Valdir Cesarino de Souza

Mediastinite pós-esternotomia longitudinal para cirurgia cardíaca: 10 anos de análise

INTRODUCTION: Mediastinitis is a rare though potentially fatal complication. The incidence is reported to be between 0.2% and 5.0% and is a major cause of postoperative morbidity. Despite early diagnosis and proper treatment, prognosis is poor because of the chance of mediastinal spread of the infection and poor physical state of these patients. OBJECTIVE: To review the casuistic of mediastinites. METHOD: The records of all 2,272 patients who underwent cardiac surgical procedures between 1991 and 2000 were reviewed. All operations were performed using longitudinal sternotomy and extracorporeal circulation in Joao XXIII Hospital / Institute of Cardiovascular Surgery of Paraiba in Campina Grande, Paraiba. RESULTS: The complication occurred within, on average, 10 days after operation. In total of 37 (1.6%), 8 (21.6%) deaths occurred. Mediastinitis were reported in 19 (51.4%) cases, in patients submitted to coronary artery bypass grafting, 13 (35.1%) in valve diseases, 4 (10.8%) in congenital cardiopathy corrections and 1 (2.7%) in ascending aortic aneurysm. Several risk factors mediastinitis were identified (obesity, prolonged stay in hospital, diabetes mellitus, smoking, reoperation and emergency surgery), especially the prolonged stay in intensive-care unit for more then 72 hours before cardiac operation. Bacterial cultures of exudates were positive in 35 (94.6%) of 37 patients; Staphylococcus aureus was the responsible pathogen in 17 (48.6%) patients. CONCLUSION: The incidence of mediastinitis after longitudinal sternotomy following cardiac surgery do not decreased in the last 10 years and represents a surgical challenge, in spite of the progress added to the diagnostic and therapeutic of this pathology.

AS MUDANÇAS CLIMÁTICAS E A SAÚDE DO IDOSO: UMA APROXIMAÇÃO ENTRE AS FORMAS DE CONHECIMENTOS?

Normal 0 21 The XXI Century has been marked by a meaningful discussion about climate change , its origins and implications for humanity and the environment. In this sense , the contemporary scientific studies indicate the relationships between atmospheric variables and their influence on the health of the elderly population, increasing the understanding of the specific mitigation measures that may be adopted by public health officials and the population at risk, elderly . Which is characterized by aging and provide a gradual degeneration of the tissues and metabolism, energy loss and psychological conditions resulting weaknesses in bodily functions . Given the scenario , the theoretical essay is to analyze the relationship between climatic variations and their effects on health of the elderly . The research methodology was based on theoretical contributions that study the issues , as well as exploratory research from data collected by official bodies such as the Intergovernmental Panel on Climate Change, World Health Organization , the Brazilian Institute of Geography and Statistics. The results point to the emergence of diseases in the elderly resulting from climate change , which serves as a parameter for the planning of health policies and actions for the quality of life of elderly. Keywords: climate change, healt of elderly

Irreversible bilateral amaurosis after heart surgery

Paciente do sexo feminino, 16 anos, portadora de cardiopatia congenita, tipo comunicacao interatrial. Submetida a correcao cirurgica, evoluiu nas primeiras horas com sangramento e instabilidade do quadro hemodinâmico. Corrigidas tais complicacoes, evoluiu com perda progressiva e bilateral da visao. Apos as primeiras horas de pos-operatorio, apresentava acentuado edema de papilas opticas, alem de hipertensao intra-ocular. No transcorrer de 21 dias, evidenciavam-se sinais de atrofia dos nervos opticos com instalacao, bilateral e irreversivel, de amaurose, apesar das condutas terapeuticas instituidas. No seguimento de dois anos, a paciente evoluiu com cegueira bilateral e lesao optica irreversivel.