Browsing by Author "Freitas, S."
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- Cateteres epicutâneocavas em recém-nascidos: estudo retrospectivoPublication . Hernández, T.; Fonseca, F.; Freitas, S.; Carrapato, M.RESUMO Introdução: A possibilidade de ter um acesso venoso de longa duração é muito importante em Neonatologia, principalmente se os doentes são recémnascidos (RN) prematuros ou de baixo peso. Objectivos: Conhecer as complicações mecânicas e infecciosas relacionadas com a utilização de cateteres epicutâneos (EPC) na Unidade de Cuidados Intensivos Neonatais (UCIN) do Hospital São Sebastião (HSS) e identificar alguns factores de risco. Material e métodos: Estudo retrospectivo por análise dos processos clínicos de RN internados entre 1 Janeiro de 2000 até 31 Março de 2003 e que tiveram pelo menos um EPC. Os dados foram tratados por análise estatística simples. Resultados: Foram estudados um total de 91 EPC, o que corresponde a 1.306 dias-cateter. Peso ao nascimento (PN) médio: 1536 gr; idade gestacional média: 31,4 semanas. Dos 91 EPC 53 (58%) foram colocados em RN com PN < 1500 gr. Idade média de colocação: 9,9 dias; Duração do EPC média: 13,5 dias (min.: 1 dias; máx.: 41 dias). Sessenta e seis cateteres (72%) colocaramse através de veias dos membros superiores. Foram retirados electivamente cateteres 49 (53%), por complicações 33 (36%). Das suspeitas de sépsis apenas se confirmaram 6, (50% por Candida spp e 50% por Estafilococo coagulase-negativo) como sendo relacionadas com o cateter. Foram enviados para estudo bacteriológico 88 (95%). Verificamos que ocorreram 4,6 sépsis /1000 dias-cateter e 24,8 contaminações / 1000 dias-cateter, com predomínio de Estafilococo coagulase-negativo (20 / 23%). Observamos que foi no grupo de RN com peso < 1500 gr e nos que tiveram o cateter numa localização não habitual que as complicações ocorreram em maior percentagem (< 1500 gr vs > 1500 gr: 36% vs 13% e local correcto vs incorrecto: 18% vs 57%). Conclusão: A utilização destes cateteres demonstrou-se segura, mesmo nos pequenos prematuros. O número de complicações infecciosas foi inferior ao esperado e as complicações mecânicas podem ser minoradas pelo correcto posicionamento e manipulação do cateter. ABSTRACT Introduction: It is vital for prematures and very low birth weight newborns (VLBW) to keep a venous line for long periods of time while they are in the neonatal units, in order to initiate an adequate parenteral nutrition, antibiotic treatment and other medications. Objective: To evaluate the complications related to the percutaneous central venous catheters (PCVC) in newborns in the São Sebastião Hospital (HSS) neonatal intensive care unit (NICU) and try to recognize some risk factors involved in this complications. Methods: Retrospective clinical records study of all the newborns admitted in the HSS NICU who had at least one PCVC from January 2000 to March 2003 Results: A total of 91 PCVC that means 1.306 catheter-days. Mean Birth weight: 1536 gr; mean gestational age: 31,4 weeks;53/91 (58%) were inserted in newborns with less than 1500 gr. Mean age at insertion: 9,9 days; mean catheter duration: 13,5 days (min: 1 day; max: 41 days). 72% were inserted in upper limbs veins. Most were electively removed (53%), 36% were removed because of several complications. Catheter-related sepsis suspicion was only confirmed in 6 cases. A total of 88 (95%) catheter tips were sent for microbiological examination and we found 4,6 catheter-related sepsis /1000catheter-days and 24,8 catheter contamination/1000 catheter-days, the most common organism isolated was coagulase negative staphylococcus. We found a higher rate of complications when inserted in less common vessels and in patients with less than 1500 gr of weight. Conclusion: The placement of percutaneous venous catheters seems to be safe, even in VLBW newborns and extreme prematures. The incidence of infectious complications was lower than expected. The mechanical complications can be reduced with the correct position and manipulation of the catheter.
- Dysgenetic male pseudohermaphroditismPublication . Proença, E.; Freitas, S.; Fonseca, M.; Figueiredo, S.; Rodrigues, C.Acta Med Port. 2001 Sep-Dec;14(5-6):511-4. [Dysgenetic male pseudohermaphroditism] [Article in Portuguese] Proença E, Freitas S, Fonseca M, Figueiredo S, Rodrigues C. Serviço de Cirurgia Pediátrica, Hospital Maria Pia, Porto. Abstract Dysgenetic male pseudohermaphroditism is the result of a defect of testis development that encompasses a large clinical heterogeneity. It is characterized by bilateral dysgenetic testis, absence of mullerian regression, ambiguous genitalia and/or stigmata of Turner's syndrome in the majority of the cases. Typically, these individuals have either a 46,XY or 45,X/46,XY karyotype. The authors present four cases of dysgenetic male psudohermaphroditism, with ages of diagnosis between 1 month and 17 years old. The first had a male phenotype with stigmata of Turner's syndrome and the others ambiguous genitalia. Two patients were 45,X/46,XY and 45X/47,XYY mosaics and the other two were 46,XY. Gonadal karyotyping showed mosaicism (45,X/46,XY) in all four cases. In the first case was programed orquidectomy; all the others assigned a male gender, with regular follow-up until the puberty. PMID: 11878163 [PubMed - indexed for MEDLINE]