Revista do Hospital das Clínicas
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Rev Hosp Clin Fac Med Sao Paulo · Jan 2004
ReviewEthical aspects in the management of the terminally ill patient in the pediatric intensive care unit.
To identify the prevalence of management plans and decision-making processes for terminal care patients in pediatric intensive care units. ⋯ Care management was based on ethical principles aiming at improving benefits, avoiding harm, and when possible, respecting the autonomy of the terminally ill patient.
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Rev Hosp Clin Fac Med Sao Paulo · Sep 2003
Prevalence rates of infection in intensive care units of a tertiary teaching hospital.
To determine the prevalence rates of infections among intensive care unit patients, the predominant infecting organisms, and their resistance patterns. To identify the related factors for intensive care unit-acquired infection and mortality rates. ⋯ The rate of nosocomial infection is high in intensive care unit patients, especially for respiratory infections. The predominant bacteria were Enterobacteriaceae, Pseudomonas aeruginosa, and Staphylococcus aureus (resistant organisms). Factors such as nasogastric intubation, postoperative status, and age 60 years were significantly associated with infection. This study documents the clinical impression that prevalence rates of intensive care unit-acquired infections are high and suggests that preventive measures are important for reducing the occurrence of infection in critically ill patients.
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Rev Hosp Clin Fac Med Sao Paulo · Sep 2003
Case ReportsCystic fibrosis with normal sweat chloride concentration--case report.
Cystic fibrosis is a genetic disease usually diagnosed by abnormal sweat testing. We report a case of an 18-year-old female with bronchiectasis, chronic P. aeruginosa infection, and normal sweat chloride concentrations who experienced rapid decrease of lung function and clinical deterioration despite treatment. Given the high suspicion of cystic fibrosis, broad genotyping testing was performed, showing a compound heterozygous with deltaF508 and 3849+10 kb C-->T mutations, therefore confirming cystic fibrosis diagnosis. Although the sweat chloride test remains the gold standard for the diagnosis of cystic fibrosis, alternative diagnostic tests such as genotyping and electrophysiologic measurements must be performed if there is suspicion of cystic fibrosis, despite normal or borderline sweat chloride levels.
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Rev Hosp Clin Fac Med Sao Paulo · Jul 2003
Endovascular techniques for placement of long-term chemotherapy catheters.
To analyze the results from using endovascular techniques to place long-term chemotherapy catheters when advancing the catheter using the external jugular vein is difficult due to obstructions or kinking. ⋯ Venography and endovascular guidance techniques are useful for the placement of long-term catheters in the external jugular vein.
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Rev Hosp Clin Fac Med Sao Paulo · Mar 2003
Case ReportsBlue rubber bleb nevus syndrome: case report.
The case of a patient with blue rubber bleb nevus syndrome who is infected by acquired immunodeficiency syndrome virus due to multiple blood transfusions is presented. This case shows that although it is a rare systemic disorder, blue rubber bleb nevus syndrome has to be considered in the differential diagnosis of chronic anemia or gastrointestinal bleeding. Patients should be investigated by endoscopy, which is the most reliable method for detecting these lesions. ⋯ Minimal resection of the larger lesions and string-purse suture of the smaller ones involving all the layers of the intestine were performed. The string-purse suture of the lesions detected by enteroscopy proved to be an effective technique for handling these lesions, avoiding extensive intestinal resection and stopping the bleeding. Effective management of these patients demands aggressive treatment and should be initiated as soon as possible to avoid risks involved in blood transfusions, as occurred in this case.