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    Hemorragia pós-operatória em 397 adenotonsilectomias realizadas nos Hospitais Geral de Pirajussara (HGP) e Hospital Estadual de Diadema (HED) / UNIFESP-EPM
    (ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2004-12-01) Dib, Gabriel Cesar [UNIFESP]; Kosugi, Eduardo Macoto [UNIFESP]; M. Neto, Júlio [UNIFESP]; Antunes, Marcos L. [UNIFESP]; Morales, Douglas S. R. [UNIFESP]; Guilherme, Arnaldo [UNIFESP]; Fukuda, Yotaka [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Adenotonsillectomy is a common procedure in otorhinolaryngology, and it is recommended for tonsil and adenoid hypertrophy. Hemorrhage is the most common complication of this procedure. In this study, we present the incidence of postoperative hemorrhage following adenotonsillectomy carried out at Hospital Geral de Pirajussara (HGP) and Hospital Estadual de Diadema (HED), whose purpose was to identify cases of bleeding. STUDY DESIGN: Historic transversal cohort. MATERIAL AND METHOD: We analyzed 397 patients who underwent adenoidectomy, tonsillectomy and adenotonsillectomy. Adenotonsillectomy represented 91.7% of all surgeries. Patients were aged 2 to 39 years. Preoperative tests were conducted in all patients, with weekly follow-up up to the first month after surgery. RESULTS: 397 surgeries were performed in the hospitals (HGP and HED), 364 adenotonsillectomies (91.7%), 16 tonsillectomies (4.03%) and 17 adenoidectomies (4.28%). There were 5 cases of postoperative bleeding, 3 of which occurred in the early postoperative period and 2 in the middle postoperative period. There were no reports of bleeding in late postoperative period. The incidence of hemorrhage was 1.37% (5 out of 364 cases). CONCLUSION: Postoperative hemorrhage possibly results from poor surgical technique and blood clotting disorder in some patients.
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    Tratamento da superdosagem de anticoagulantes orais
    (Sociedade Brasileira de Cardiologia - SBC, 1998-01-01) Lourenco, Dayse Maria [UNIFESP]; Morelli, Vânia Maria [UNIFESP]; Vignal, Carla Valadares [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE: To evaluate the response of 73 patients with antivitamin K (AVK) overdose to 3 different therapeutic regimens. METHODS: Seventy three patients were evaluated in 94 occasions: group A (N=32), consisted of drug withdrawal for 2 days followed by reduced dosage; group B (N=37), drug withdrawal and reassessment within 4 days; group C (N=25), oral administration of vitamin K. Therapeutic range was set between INR-values of 2 and 4. RESULTS: Reversal regimens did not result in differences among 61 patients who had initial INR <8 (chi²=2.352, p=0.671). There were more patients bellow therapeutic range in group C (N=14) than group B (N=19) (chi² =9.998, p=0.007). After intervention, 7 patients in group B still had INR >4, but 5 of them were bellow 4.5, without increased bleeding risk. There were 10 patients in group C bellow therapeutic range, 6 of them with INR < 1.6, with risk of thromboembolism. Thirteen patients bled, but none required transfusion. CONCLUSION: Reversal of excessive oral anticoagulation can be safely performed by initial withdrawal of the drug, followed by lower doses. Vitamin K administration may lead to INR bellow the therapeutic range. This should be reserved for patients with high INR or in the presence of bleeding.