Tromboangeíte obliterante ou Doença de Buerger.

 

Sobre imagem do post   Uma doença vascular. do dia 2 de junho.

 

 

A  tromboangeíte obliterante  também conhecida como Doença de Buerger, em homenagem a Leo Buerger que publicou uma descrição dos achados patológicos de membros amputados em pacientes com esta doença em 1908.É uma vasculite de grandes  e media artérias  e veias das extremidades, mas comumente de MMII.O que a caracteriza é a  formação trombo oclusivo  inflamatório, poupando  a perede dos vasos.

Mais comum em homens( quase 90%),  jovens( antes dos 45 anos), fumantes com alta carga tabágica.Quase dois terços dos pacientes tem periodontal grave e  pode representar um fator de risco adicional. Isquemia digital (dedo do pé)é a forma mais comum de tromboangeíte obliterante. Começa com  dor e, posteriormente, a descoloração dos dedos, que evolui para ulcerações isquêmicas.O fenómeno de Raynaud pode  ocorre em até 40 % , podendo ser assimétrico.

Os sintomas de claudicação devido a tromboangeíte obliterante pode ser indistinguíveis daqueles devido a outras doenças vasculares oclusivas.O exame físico não consegue distinguir a doença oclusiva arterial devido à tromboangeite de outras etiologias. Deve ser feito o teste de Allen, que pode ser positivo em outras doenças arteriais oclusivas.

Não existem testes laboratoriais específicos para diagnosticar tromboangeíte obliterante. O objetivo dos estudos de laboratório é de excluir outras entidades que causam doenças vasculares oclusivas tais como a diabetes, as vasculites e trombofilias .É um diagnóstico eminentemente clínico que deve ser suspeitada em pacientes jovens do sexo masculino que fumam e que se apresentam com isquemia das mãos e / ou pés. Mas devemos fazer  alguns exames:

  • Hemograma e bioquímica completa
  • Glicemia
  • Marcadores inflamatórios- VHS, PCR
  • Crioglobulinas
  • Sorologia para doenças auto-imunes=anticorpo antinuclear, anticorpo anticentrômero ,anti-SCL-70, que devem ser todos negativos.
  • Anticoagulante lúpico e anticardiolipina= são detectados em alguns pacientes
  • Ecocardiografia no caso de oclusão arterial aguda
  • Angiografia pode ser realizada para excluir um fonte de embolia arterial proximal e definir a anatomia e a extensão da doença

No entanto, o diagnóstico de tromboangeíte obliterante pode ser de exclusão

  • Os critérios clínicos – O diagnóstico clínico pode ser estabelecida com os seguintes critérios comumente utilizados
  • Idade inferior a 45 anos
  • História atual ou recente de tabagismo
  • Isquemia extremidade distal
  • Achados da arteriografia típicos de tromboangeíte obliterante
  • Exclusão de doença auto-imune, trombofilia, diabetes e fontes embólicas proximais.

O tratamento é parar de fumar,  única terapia definitiva para pacientes com tromboangeíte obliterante. Embora um certo número de outras terapias têm sido investigadas, estes devem ser considerados paliativos.Ulcerações dígitos são gerenciados como com outras feridas isquêmicas, debridamento e curativo úmido.

 

 

FacebookTwitterGoogle+

Monitoring in Anesthesia and Perioperative Care

Monitoring in Anesthesia and Perioperative Care

David L. Reich

DOWNLOAD
Monitoring in Anesthesia and Perioperative Care is a practical and comprehensive resource documenting the current art and science of perioperative patient monitoring, addressing the systems-based practice issues that drive the highly regulated health care industry of the early twenty-first century. Initial chapters cover the history, medicolegal implications, validity of measurement, and education issues relating to monitoring. The core of the book addresses the many monitoring modalities, with the majority of the chapters organized in a systematic fashion to describe technical concepts, parameters monitored, evidence of utility complications, credentialing and monitoring standards, and practice guidelines. Describing each device, technique, and principle of clinical monitoring in an accessible style, Monitoring in Anesthesia and Perioperative Care is full of invaluable advice from the leading experts in the field, making it an essential tool for every anesthesiologist.

FacebookTwitterGoogle+

Clinical Practice of Emergency Medicine

 

1. Very easy read textbook with good information. Not quite as much detail as Tintinelli, but nice layout with presenting complaint, disease, discussion, pitfalls and patient disposition. Would recommend this as a reference/study guide for EM residents.

2. this is an excellent general er text. it covers most everything well.

3. An outstanding reference text in Emergency Medicine. Logically organized, well written, easy to read. If you only buy one book, this should be it.
.
GET IT HERE
.
http://filepost.com/files/87b7eea5/078175125X.CHM/

FacebookTwitterGoogle+

International Neurology


This unique textbook deals with the differences in etiology, genetics, age of onset and clinical presentations of neurological disease internationally. This is the first book to take a truly global approach to neurological illness.

Consisting of 22 sections and 173 chapters with contributions from experts in many countries, it serves as an invaluable guide for physicians to expand their knowledge of different neurological disorders around the world. More importantly it is a definitive source of practical information to aid diagnosis and treatment.
.
GET IT HERE
.
http://filepost.com/files/cdca8f8b/international_neurology.pdf/

FacebookTwitterGoogle+

Principles of Pulmonary Medicine

Concise and easy to read, this completely updated new edition correlates basic pathophysiologic principles with the radiologic, pathologic, and clinical aspects of disease to provide an integrated, user-friendly approach to the study of pulmonary medicine. In addition to detailed text, case-based questions cover topics including interpretation of pulmonary function tests, physiologic data, and results of arterial blood gas testing. More than 120 high-quality images complement the discussion of specific diseases and provide a clear framework for understanding difficult pulmonary concepts. The text provides updated coverage of diagnostic modalities in pulmonary disease, as well as management of asthma, lung cancer, respiratory failure, pulmonary hypertension, and other important pulmonary diseases. A new, web-based interactive learning tool box offers additional radiographic images, audio clips of lung sounds, and self-assessment questions modeled after the questions found on the USMLE exams. In print and online, this is an essential resource for mastering the foundations of pulmonary medicine.

 

GET IT HERE
.
http://filepost.com/files/e893646b/1416050345.pdf/

 
FacebookTwitterGoogle+

Monitoring the Critically ill Patient – 3rd Edition (2012)

Monitoring the Critically Ill Patient is an essential, accessible guide to caring for critically ill patients on the general ward. Now fully updated and improved throughout, this well established and handy referenced text assumes no prior knowledge and equips students and newly-qualified staff with the clinical skills and knowledge they need to confidently monitor patients at risk, identify key priorities, and provide prompt and effective care

Book Description

Monitoring the critically ill patient is a practical guide to monitoring acutely ill patients on the general ward. Critically ill patients are increasingly cared for outside intensive care units and all nurses need to be able to accurately monitor critically ill patients in their care. Monitoring the critically ill patient assumes no prior knowledge and equips students and newly qualified staff with the clinical skills and knowledge they need in order to confidently monitor patients at risk, identify key priorities, and provide prompt and effective care. It was developed in response to NHS policies relating to critical care and adopts a system-by-system approach, exploring respiratory function, cardiovascular function, neurological function, renal function, gastrointestinal function, hepatic function, endocrine function, nutritional status, and temperature in turn. This revised and updated second edition includes an additional chapter on outreach, medical emergency teams and early warning scoring systems. A final chapter explores monitoring during transport.
.
GET IT HERE
.
http://filepost.com/files/f7c73928/1444337475.pdf/

FacebookTwitterGoogle+