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The patients with complicated surgical diseases are relating to the group of high risk of nascence of vein thrombosis and tromboembolism. Aim of the study: to measure of the anticoagulant abilities of bemiparin sodium among women were operated by laparoscopic access in gynecological practices. Materials and methods. 15 women who had been operated for multiple uterine fibroid were examined and enrolled in the basic group. The patients were administered bemiparin sodium 3500 IE (0.2 ml) injected subcutaneously in 6 hours after operative treatment, then once a day during 7 days for prevention of tromboembolic complications in the postoperative period. The control group included 10 healthy women. The following parameters were defined for the control of efficiency of using of bemiparin sodium, his influence on different components of the haemostatic system: D-dimer, thrombocytes quantity and level of fibrinogen. Results. The significant elevation of level of D-dimer and fibrinogen was discovered among patients of the basic group during the preoperative period (p

Objetivo: Describir las complicaciones tromboembólicas y hemorrágicas derivadas de la aplicación de la guía de manejo odontológico del paciente anticoagulado, que se utiliza en el Departamento de Odontología de la Fundación Cardiovascular del Oriente Colombiano.Materiales y Métodos: Mediante un estudio observacional descriptivo se revisaron las historias clínicas médicas y odontológicas de 108 individuos, con un promedio de edad de 54 años, 70% del género masculino.Resultados: La frecuencia más alta de cardiopatías fue la enfermedad coronaria (62.09%) y las valvulopatías (40.74%). En cuanto a la prescripción, previa intervención odontológica, la frecuencia para heparina, 50.92% y warfarina 37.04%. En relación con el protocolo se agruparon cuatro categorías en 2 grupos: alto riesgo de sangrado, que incluyó a las subcategorías: alto riesgo de tromboembolismo y bajo riesgo de tromboembolismo (72.22%); bajo riesgo de sangrado con subcategorías: alto riesgo de tromboembolismo y bajo riesgo de tromboembolismo (27.78%). Del total de la muestra, 13 pacientes (12.04%) requirieron un agente local adicional a maniobras de presión y/o sutura para detener la hemorragia en la cavidad oral. Ningún paciente requirió administración de agentes parenterales. No se presentaron episodios tromboembólicos.Conclusiones: Poseer dos ó más enfermedades cardiovasculares y haber requerido procedimientos odontológicos de alto riesgo de sangrado, confiere un incremento en el riesgo de sangrado posterior al procedimiento odontológico, factores que. se deben considerar para estudios posteriores.[Mesa U, Vargas R, Peñuela L, Sánchez R, Rey S, Pérez A. Descripción de los resultados de la aplicación de la guía de manejo odontológico para pacientes bajo terapia anticoagulante en Cardiodonto, Fundación Cardiovascular del Oriente Colombiano. Ustasalud 2003;1: 7-12]. Purpose: The purpose of this study was to describe the tromboembolic and bleeding complications from a guide for dental management of anticoagulated patients used in the Dental Department of the Fundación Cardiovascular del Oriente Colombiano (FCV) where the patient is classified according to cardiogenic pathology.Material and Methods: Dental and medical histories of 108 individuals were revised using a descriptive observational study, this in order to design the investigation instrument. The mean age group was 54 years old, 70% masculine.Results: The highest prevalence of the cardio pathologies was for coronary disease (62.09%) and valvular pathologies (40.74%). The frequency for previous prescription dental intervention was heparin 50.92% and warfarin, 37.04%. According to the protocol, its four categories were subdivided in 2 groups: high risk of bleeding which included subcategories ARS and BRS (72.22%). Low risk of bleeding with subcategories ART and BRT (27.78%). Thirteen patients (12.04%) required a local agent in addition to excessive pressure and/or sutures to detain bleeding. No patients required application of parenteral agents. No tromboembolic episodes were presented.Conclusions: There were significant associations between some factors and postoperatory bleeding. Those associations will have to be consider for posterior studies.

Background: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared to subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. Objective: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared with subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. The aim of this study was to investigate correlations between D-dimer and serum potassium in acute-onset AF (AAF). Methods: To investigate the potential correlation between the values of serum potassium and D-dimer in patients with AAF, we retrospectively reviewed clinical and laboratory data of all emergency department visits for AAF in 2013. Results: Among 271 consecutive AAF patients with D-dimer assessments, those with hypokalemia (n = 98) had significantly higher D-dimer values than normokalemic patients (139 versus 114 ng/mL, p = 0.004). The rate of patients with D-dimer values exceeding the diagnostic cut-off was higher in the group of patients with hypokalemia than in those with normal serum potassium (26.5% versus 16.2%; p = 0.029). An inverse and highly significant correlation was found between serum potassium and D-dimer (r = −0.21; p < 0.001), even after adjustments for age and sex (beta coefficient −94.8; p = 0.001). The relative risk for a positive D-dimer value attributed to hypokalemia was 1.64 (95% CI, 1.02 to 2.63; p = 0.040). The correlation remained statistically significant in patients free from antihypertensive drugs (r = −0.25; p = 0.018), but not in those taking angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors, or diuretics. Conclusions: The inverse correlation between values of potassium and D-dimer in patients with AAF provides important and complementary information about the thromboembolic risk of these patients.

Triathlon followers increase each year and long-distance events have seen major growth worldwide. In the cycling phase, athletes must maintain an aerodynamic posture on the bike for long periods of time. We report a case of a 38-year-old triathlete with symptoms of an axillary vein thrombosis 48 h after a long triathlon competition. After 3 days of hospitalizationwith a treatment consisted on enoxaparin anticoagulant and acenocumarol, the patient was discharged with instructions to continue treatment under home hospitalization with acetaminophen. Four weeks after the process, the patient was asymptomatic and the diameter of his armwas near normality. Due to the growing popularity of events based on endurance exercise, it is necessary more research to determine the etiopathogeny of deep venous thrombosis in athletes. pre-print 274 KB

A menopausa corresponde à cessação permanente da menstruação, conseqüente à perda da função folicular ovariana ou à remoção cirúrgica dos ovários. A idade média para ocorrência da menopausa natural gira em torno de 50 anos. A deficiência estrogênica decorrente da menopausa está associada com sintomas vasomotores, atrofia urogenital, declínio cognitivo, assim como a um aumento no risco de doenças crônico-degenerativas, aterosclerose e doença cardiovascular, osteoporose e doença de Alzheimer. A estrogenioterapia permanece sendo o tratamento mais efetivo para o manejo dos sintomas vasomotores e atrofia urogenital. Em mulheres com útero presente, a progesterona natural ou os progestogênios devem ser associados ao tratamento com estradiol para antagonizar os efeitos proliferativos deste hormônio sobre o endométrio e anular o risco de hiperplasia/carcinoma endometrial. Por outro lado, em determinadas condições clínicas, a terapia hormonal não é recomendada ou é mesmo contra-indicada. Neste artigo, focalizamos criticamente essas situações clínicas em que não se deve indicar a terapia hormonal na menopausa. Menopause is defined as the permanent cessation of menses, as a result of the loss of ovarian follicular function or of surgical removal of ovaries. The mean age for occurrence of natural menopause is around 50 years. Estrogen deficiency has been associated with vasomotor symptoms, urogenital atrophy, and cognitive impairment, as well as increased risk of chronic degenerative diseases such as osteoporosis and Alzheimer’s disease. Estrogen therapy remains the most effective treatment for the management of vasomotor symptoms and urogenital atrophy. Progesterone or progestins should be added to estrogen treatment in women with uterus, in order to antagonize the estrogen-induced endometrial proliferation. In turn, in specific clinical conditions hormone therapy is not recommended. In the present article, the authors critically focus these clinical conditions in which hormone therapy should not be used.

Background: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared to subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. Objective: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared with subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. The aim of this study was to investigate correlations between D-dimer and serum potassium in acute-onset AF (AAF). Methods: To investigate the potential correlation between the values of serum potassium and D-dimer in patients with AAF, we retrospectively reviewed clinical and laboratory data of all emergency department visits for AAF in 2013. Results: Among 271 consecutive AAF patients with D-dimer assessments, those with hypokalemia (n = 98) had significantly higher D-dimer values than normokalemic patients (139 versus 114 ng/mL, p = 0.004). The rate of patients with D-dimer values exceeding the diagnostic cut-off was higher in the group of patients with hypokalemia than in those with normal serum potassium (26.5% versus 16.2%; p = 0.029). An inverse and highly significant correlation was found between serum potassium and D-dimer (r = −0.21; p < 0.001), even after adjustments for age and sex (beta coefficient −94.8; p = 0.001). The relative risk for a positive D-dimer value attributed to hypokalemia was 1.64 (95% CI, 1.02 to 2.63; p = 0.040). The correlation remained statistically significant in patients free from antihypertensive drugs (r = −0.25; p = 0.018), but not in those taking angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors, or diuretics. Conclusions: The inverse correlation between values of potassium and D-dimer in patients with AAF provides important and complementary information about the thromboembolic risk of these patients. Fundamento: Valores de D-dímero são frequentemente aumentada em pacientes com fibrilação atrial (FA) em comparação com indivíduos em ritmo sinusal. A hipocalemia desempenha um papel em várias doenças cardiovasculares, mas pouco se sabe sobre a associação com FA. Objetivo: As concentrações de D-dímero encontram-se frequentemente aumentadas em pacientes com FA, quando comparados com indivíduos em ritmo sinusal. A hipopotassemia desempenha um papel importante nas doenças cardiovasculares, porém, pouco é conhecido sobre sua associação com a FA. O objetivo deste estudo foi investigar a correlação entre os níveis séricos de D-dímero e potássio na FA aguda (FAA). Métodos: Para investigar a existência de uma potencial correlação entre os níveis séricos de potássio e D-dímero em pacientes com FAA, realizamos uma revisão retrospectiva de dados clínicos e laboratoriais relacionados a todas as visitas ao departamento de emergência devido à FAA, no ano de 2013. Resultados: Entre os 271 pacientes com FAA, aqueles com hipopotassemia (n = 98) mostraram aumento significativo nos níveis de D-dímero, quando comparados com pacientes com concentrações normais de potássio (139 versus 114 ng/mL, p = 0,004). A taxa de pacientes com níveis de D-dímero excedendo o valor limiar de diagnóstico foi maior no grupo de pacientes com hipopotassemia, quando comparado com o grupo de pacientes com concentrações normais de potássio (26,5% versus 16,2%; p = 0,029). Detectamos uma correlação inversa e altamente significativa entre os níveis séricos de potássio e D-dímero (r = -0,21; p < 0,001), até mesmo após ajuste para idade e sexo (coeficiente beta –94,8; p = 0,001). O risco relativo de um valor positivo de D-dímero estar relacionado à hipopotassemia foi de 1,64 (95% CI, 1,02 to 2,63; p = 0,040). A correlação permaneceu estatisticamente significativa em pacientes livres de medicamentos hipertensivos (r = -0,25; p = 0,018), porém não nos pacientes em tratamento com bloqueadores do receptor de angiotensina, inibidores da enzima conversora de angiotensina e diuréticos. Conclusões: A correlação inversa existente entre os níveis séricos de potássio e D-dímero em pacientes com FAA fornece informações importantes sobre o risco de tromboembolismo nestes pacientes.

FUNDAMENTO: A fibrilação atrial (FA) associada à doença valvar mitral reumatismal (DVMR) aumenta a incidência de tromboembolismo (TE), sendo a Varfarina a medicação padrão, apesar das dificuldades na adesão e no controle terapêutico. OBJETIVO: Comparar a eficácia da Aspirina contra a Varfarina na prevenção do TE em pacientes com FA e DVMR. MÉTODOS: Acompanhamos 229 pacientes (pts), portadores de FA e DVMR, em estudo prospectivo e randomizado. 110 pts receberam Aspirina 200 mg/dia, compondo o Grupo A (GA), e 119, a Varfarina, em doses ajustáveis individualmente, compondo o Grupo V (GV). RESULTADOS: Ocorreram 15 eventos embólicos no GA e 24 no GV (p = 0,187), dos quais 21 com o INR menor que 2,0. Assim, excluindo os pacientes com INR inadequado, houve maior número de eventos embólicos no GA (15 vs 3) (p < 0,0061). Houve menor adesão ao tratamento no GV (p = 0,001). Não houve sangramentos maiores em ambos os grupos. Pequenos sangramentos foram mais frequentes no GV (p < 0,01). O nível sérico de colesterol e triglicérides aumentados constituiu fator de risco para maior número de eventos tromboembólicos na população estudada, não havendo diferença entre os grupos. CONCLUSÃO: Na DVMR com FA há menos de um ano e sem embolia prévia, a Aspirina é uma opção pouco eficaz na prevenção do TE. Nos portadores de valvopatia mitral com menor risco (insuficiência mitral e prótese biológica mitral), sobretudo se houver contraindicação ou baixa aderência à Varfarina, a Aspirina pode ter algum benefício na prevenção do TE. BACKGROUND: Atrial fibrillation (AF) associated to rheumatic mitral valve disease (RMVD) increases the incidence of thromboembolism (TE), with warfarin being the standard therapy, in spite of difficulties in treatment adherence and therapeutic control. OBJECTIVE: To compare the effectiveness of Aspirin vs Warfarin in TE prevention in patients with AF and RMVD. METHODS: A total of 229 patients (pts) with AF and RMVD were followed in a prospective and randomized study. The first group consisted of 110 pts receiving Aspirin - 200 mg/day (Group Aspirin - GA) and the second group consisted of 119 pts receiving Warfarin at individually-adjusted doses (Group Warfarin - GW). RESULTS: There were 15 embolic events in GA and 24 in GW (p = 0.187), of which 21 presented INR < 2.0. Thus, after excluding patients with inadequate INR, there was a higher number of embolic events in GA than in GW (15 vs 3) (p < 0.0061). The GW showed lower treatment adherence (p = 0.001). Neither group presented episodes of major bleeding. Small bleeding episodes were more frequent in the GW (p < 0.01). Increased serum levels of cholesterol and triglycerides constituted a risk factor for a higher number of thromboembolic events in the studied population, with no difference between the groups. CONCLUSION: In patients presenting RMVD with AF for less than a year and no previous embolism, Aspirin is little effective in preventing TE. Patients with lower-risk mitral valvulopathy (mitral regurgitation and mitral biological prosthesis), especially in cases presenting contraindication to or low adherence to Warfarin, Aspirin use can present some benefit in TE prevention. FUNDAMENTO: La fibrilación atrial (FA) asociada a la enfermedad valvar mitral reumática (DVMR) aumenta la incidencia de tromboembolismo (TE), siendo la Varfarina la medicación estándar, a pesar de las dificultades en la adhesión y en el control terapéutico. OBJETIVO: Comparar la eficacia de la Aspirina contra la Varfarina en la prevención del TE en pacientes con FA y DVMR. Métodos: Controlamos 229 pacientes (pts), portadores de FA y DVMR, en estudio prospectivo y randomizado. 110 pts recibieron Aspirina 200 mg/día, componiendo el Grupo A (GA), y 119, la Varfarina, en dosis ajustables individualmente, componiendo el Grupo V (GV). RESULTADOS: Ocurrieron 15 eventos embólicos en el GA y 24 en el GV (p = 0,187), de los cuales 21 con el INR menor que 2,0. Así, excluyendo los pacientes con INR inadecuado, hubo mayor número de eventos embólicos en el GA (15 vs. 3) (p < 0,0061). Hubo menor adhesión al tratamiento en el GV (p = 0,001). No hubo sangrados mayores en ambos grupos. Pequeños sangrados fueron más frecuentes en el GV (p < 0,01). El nivel sérico de colesterol y triglicéridos aumentados constituyó factor de riesgo para mayor número de eventos tromboembólicos en la población estudiada, no habiendo diferencia entre los grupos. CONCLUSIÓN: En la DVMR con FA hace menos de un año y sin embolia previa, la Aspirina es una opción poco eficaz en la prevención del TE. En los portadores de valvopatía mitral con menor riesgo (insuficiencia mitral y prótesis biológica mitral), sobre todo se hubiese contraindicación o baja adherencia a la Varfarina, la Aspirina puede tener algún beneficio en la prevención del TE.

A menopausa corresponde à cessação permanente da menstruação, conseqüente à perda da função folicular ovariana ou à remoção cirúrgica dos ovários. A idade média para ocorrência da menopausa natural gira em torno de 50 anos. A deficiência estrogênica decorrente da menopausa está associada com sintomas vasomotores, atrofia urogenital, declínio cognitivo, assim como a um aumento no risco de doenças crônico-degenerativas, aterosclerose e doença cardiovascular, osteoporose e doença de Alzheimer. A estrogenioterapia permanece sendo o tratamento mais efetivo para o manejo dos sintomas vasomotores e atrofia urogenital. Em mulheres com útero presente, a progesterona natural ou os progestogênios devem ser associados ao tratamento com estradiol para antagonizar os efeitos proliferativos deste hormônio sobre o endométrio e anular o risco de hiperplasia/carcinoma endometrial. Por outro lado, em determinadas condições clínicas, a terapia hormonal não é recomendada ou é mesmo contra-indicada. Neste artigo, focalizamos criticamente essas situações clínicas em que não se deve indicar a terapia hormonal na menopausa. Menopause is defined as the permanent cessation of menses, as a result of the loss of ovarian follicular function or of surgical removal of ovaries. The mean age for occurrence of natural menopause is around 50 years. Estrogen deficiency has been associated with vasomotor symptoms, urogenital atrophy, and cognitive impairment, as well as increased risk of chronic degenerative diseases such as osteoporosis and Alzheimer’s disease. Estrogen therapy remains the most effective treatment for the management of vasomotor symptoms and urogenital atrophy. Progesterone or progestins should be added to estrogen treatment in women with uterus, in order to antagonize the estrogen-induced endometrial proliferation. In turn, in specific clinical conditions hormone therapy is not recommended. In the present article, the authors critically focus these clinical conditions in which hormone therapy should not be used.

Endocardite Bacteriana (EB) é a inflamação séptica do endocárdio valvular e/ou mural. É uma doença de diagnóstico ante-mortem difícil devido ao quadro clínico inespecífico. A partir da consulta dos arquivos do Setor de Patologia Veterinária da Universidade Federal do Rio Grande do Sul, foi realizado um estudo retrospectivo sobre a EB canina em um período de 6 anos. De 2000 a 2005, 54 casos da doença foram diagnosticados à necropsia correspondendo a 1,72% do total de cães necropsiados nesse período. A idade média dos animais afetados foi de 8,2 anos. Machos (32/54) foram mais afetados do que fêmeas (22/54). A doença foi observada principalmente em cães de raça (37/54) sendo Pastor Alemão (9/54) e Fila Brasileiro (8/54) as raças mais acometidas. A válvula mitral foi a mais afetada (50/54). Na maior parte dos casos (42/54), uma possível porta de entrada para as bactérias foi identificada. A origem da infeccção bacteriana usualmente eram lesões cutâneas ulceradas e inflamadas (31/42). Em parte dos casos (10/31), essas feridas de pele estavam infestadas por larvas da mosca Cochliomyia hominivorax (miíases) e apresentavam evidente contaminação bacteriana. Streptococcus beta-hemolítico foi a bactéria mais freqüentemente cultivada de amostras de sangue colhidas à necropsia (6/17). Tromboembolismo arterial, evidenciado pela presença de infartos em múltiplos órgãos e tecidos, foi observado na maioria dos cães (46/54) sendo o rim (38/46) e o baço (24/46) os órgãos mais afetados. Os dados epidemiológicos e achados patológicos apresentados nesse estudo visam auxiliar no diagnóstico clínico da EB. Bacterial Endocarditis (BE) is a septic inflammation of the valvular and/or mural endocardium. Because of nonspecific clinical signs, the antemortem diagnosis of BE in dogs is difficult. Based on a 6-year review of the records of the Section of Veterinary Pathology, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil, this disease was studied retrospectively. From 2000 to 2005, 54 cases of EB were diagnosed in dogs at necropsy corresponding to 1.72% of the total number of dogs necropsied during this period. The median age of the affected animals was 8.2 years. Males were more frequently affected than females (32/54 versus 22/54). The disease was most commonly observed in purebred dogs (37/54), the German Shepherd Dog and the Fila Brasileiro being the two canine breeds most frequently affected. The mitral valve was the most commonly affected valve (50/54). In 42 out of 54 cases, a potential portal of entry of bacteria was identified. Ulcerated/inflamed skin lesions were the most common portal of entry for these microorganisms (31/42). In some cases (10/31), skin wounds were infested by screwworm fly (Cochliomyia hominivorax) larvae (myiases), and there was frank bacterial contamination of these lesions. Betahemolytic streptococci were the most frequent bacterium cultured from blood samples collected at necropsy (6/17). Infarcts in multiple organs and tissues (arterial tromboembolism) were present in 46 dogs (46/54), the kidney and spleen being the most frequently affected (38/46 and 24/46, respectively). The epidemiological data and pathological findings presented in this study would help local veterinary practitioners in the clinical diagnosis of EB.

Background: Thromboembolism is the most important complication of cancers.The aim of this study was to determine D-dimer levels in benign and malignant tumors of the uterus, ovary and cervix. Subjects and Methods: This was a cross sectional study and it was conducted on 90 female patients referred to Imam Khomeini and Arash Hospitals because of uterine, cervical and ovarian tumors in 2013-2014. After surgical resection or tissue biopsy, 2 cc of each patient’s blood was taken to be sent to laboratory of hospitals. “Nycocard” kit was chosen to measure D-dimer levels in Mg/Lit by neflumetry method. Data were analyzed in SPSS-16 by T-test and One-Way ANOVA test. Results: The highest mean of D-dimer was 3.9 (± 2.9SD) in malignant cervical tumors. The mean plasma levels of D-dimer in malignant uterine cancers (P = 0.008), ovarian cancers (P = 0.007) and cervical cancers (P = 0.006) was significantly higher than benign tumors. In all three types of uterine, ovarian and cervical cancers, D-dimer was significantly higher in advanced stages than lower stages. Conclusion: The plasma D-dimer levels in patients with malignant tumors of the uterus, cervix and ovary were higher than benign types. By increasing the stage of gynecologic malignant tumors, the levels of plasma D-dimer were increased.