Stela Braun - Academia.edu (original) (raw)
Papers by Stela Braun
Purpose This study aimed to determine whether the administration of statins before, during or aft... more Purpose This study aimed to determine whether the administration of statins before, during or after lower-limb arterial angioplasty was associated with improved primary patency, mortality, and limb loss through a meta-analysis. Methods All studies on statin administration in patients undergoing lower-limb arterial angioplasty that reported the outcomes of interest (primary patency, mortality and limb loss) were included in a meta-analysis. Results Nine studies were included in this meta-analysis. Statin use in patients undergoing lower-limb arterial angioplasty was associated with improved primary patency at 12 (12.57, 95% confidence interval [CI]: 6.86–18.28, p < 0.0001) and 24 months (7.19, 95% CI: 1.02–13.37, p = 0.02), decreased mortality in 39% at 12 months (relative risk (RR): 0.61, 95% CI: 0.55–0.74, p < 0.00001) and improved amputation-free survival (AFS) in 35% (Hazard ratio: 0.65, 95% CI: 0.46–0.793, p = 0.0198). However, statin use was not associated with decreased ...
Carbapenem-resistant bacteria are a major cause of diabetic foot (DF) infection. They are resista... more Carbapenem-resistant bacteria are a major cause of diabetic foot (DF) infection. They are resistant to almost all available antimicrobial agents and lead to increased hospital costs. The clinical and microbiological characteristics of DF infection due to these microorganisms and the association of DF with outcomes such as mortality and amputation are not yet well established. This was a retrospective cohort study involving 60 vascular surgery patients who were admitted to Nossa Senhora da Conceição Hospital due to DF infection caused by carbapenem-resistant bacteria and who underwent debridement or amputation, and a control group with 60 randomly selected patients. The analyzed parameters were mortality and amputation rates and patients’ epidemiological and microbiological profiles. A significant association was observed between bacterial resistance and previous amputation, previous hospitalizations, and DF ulcer classification into ischemic and neuroischemic; however, there were no...
Takayasu’s arteritis and Crohn’s disease are chronic inflammatory diseases with unknown etiology.... more Takayasu’s arteritis and Crohn’s disease are chronic inflammatory diseases with unknown etiology. They rarely occur together in the same individual, with less than 30 cases reported in the literature. This case report describes this association in a 36-year-old woman with Crohn’s disease and weak pulses in her left arm with blood pressure of 60/40 mmHg. Angiotomography showed segmental stenosis in the left subclavian artery and circumferential thickening of the aortic wall between T10 and L1, establishing the diagnosis of Takayasu’s arteritis. Both are organspecific and immune-mediated diseases and exhibit granulomas and granulomatous vasculitis, which contribute to reinforce the hypothesis of a common immunologic origin. We believe that this is the first case of concomitant presence of these two diseases reported in the Brazilian literature.
Aneurysms of the supra-aortic trunks are rare conditions that can cause peripheral neurological c... more Aneurysms of the supra-aortic trunks are rare conditions that can cause peripheral neurological conditions or embolization resulting in stroke. The upper airways can even be affected and rupture is potentially fatal. We present a case of a patient with an aneurysm of the carotid bifurcation who was treated conventionally with reconstruction of the carotid bifurcation using a venous patch. Surgical treatment enabled accurate histopathological diagnosis and anatomic correction of the carotid bifurcation.
Carbapenem-resistant bacteria are a major cause of diabetic foot (DF) infection. They are resista... more Carbapenem-resistant bacteria are a major cause of diabetic foot (DF) infection. They are resistant to almost all available antimicrobial agents and lead to increased hospital costs. The clinical and microbiological characteristics of DF infection due to these microorganisms and the association of DF with outcomes such as mortality and amputation are not yet well established. This was a retrospective cohort study involving 60 vascular surgery patients who were admitted to Nossa Senhora da Conceição Hospital due to DF infection caused by carbapenem-resistant bacteria and who underwent debridement or amputation, and a control group with 60 randomly selected patients. The analyzed parameters were mortality and amputation rates and patients’ epidemiological and microbiological profiles. A significant association was observed between bacterial resistance and previous amputation, previous hospitalizations, and DF ulcer classification into ischemic and neuroischemic; however, there were no...
The presence of a hemodynamic significant stenosis in renal arteries can lead to two distinct and... more The presence of a hemodynamic significant stenosis in renal arteries can lead to two distinct and independent clinical conditions: renovascular hypertension (RH) and ischemic nephropathy (IN). The first results from a progressive stimulation of the renin–angiotensin– aldosterone system (RAAS), while the second is a consequence of the progressive reduction in the effective renal plasma flow. This flow reduction impacts the kidney excretory function leading to development of chronic renal failure (CRF). Traditionally, the majority of the clinical studies in atherosclerotic renal artery disease or renovascular disease (RVD) focused in the physiopathology and in the management of the resulting systemic hypertension (SHT), due to the considerable clinical interest aiming a cure for secondary SHT1,2. However, in more recent years, attention has also been given to the role of the ischemia resulting from the renovascular involvement in the progressive loss of renal function. Renovascular in...
Jornal Vascular Brasileiro, 2009
A arterite de Takayasu e a doença de Crohn são doenças inflamatórias com etiologia desconhecida. ... more A arterite de Takayasu e a doença de Crohn são doenças inflamatórias com etiologia desconhecida. Raramente ocorrem de modo concomitante em um mesmo indivíduo, havendo menos de 30 casos relatados na literatura. Este trabalho descreve essa associação em uma paciente de 36 anos de idade portadora de doença de Crohn, que apresentou redução dos pulsos no membro superior esquerdo e pressão arterial de 60/40 mmHg. A angiotomografia evidenciou estenose segmentar de artéria subclávia esquerda e espessamento parietal circunferencial da aorta na transição toracoabdominal entre T10 e L1, estabelecendo o diagnóstico de arterite de Takayasu. Ambas as patologias são mediadas imunologicamente e apresentam granulomas e vasculite granulomatosa, o que contribui para reforçar a hipótese de uma origem imunológica comum no seu desenvolvimento. Acreditamos que este seja o primeiro caso relatado na literatura brasileira da presença concomitante destas duas enfermidades.
Jornal Vascular Brasileiro, 2012
A doença renal isquêmica ou nefropatia isquêmica relacionada à doença renovascular pode evoluir d... more A doença renal isquêmica ou nefropatia isquêmica relacionada à doença renovascular pode evoluir de forma rápida e progressiva para a insuficiência renal crônica. É fundamental a identificação e o tratamento precoces desta condição clínica, prevenindo a ocorrência de doença renal em estágio terminal, com consequente necessidade de terapia de substituição renal. Há uma década, o controle da hipertensão renovascular era o objetivo primário no manejo de pacientes com doença renovascular. Atualmente, a meta está dirigida principalmente para a estabilização e a melhora da função renal, além do controle dos níveis pressóricos.
Jornal Vascular Brasileiro, 2009
Takayasu's arteritis and Crohn's disease are chronic inflammatory diseases with unknown... more Takayasu's arteritis and Crohn's disease are chronic inflammatory diseases with unknown etiology. They rarely occur together in the same individual, with less than 30 cases reported in the literature. This case report describes this association in a 36-year-old woman with ...
Jornal Vascular Brasileiro
The ductus arteriosus is a fetal structure that spontaneously closes in 90% of newborns. Patency ... more The ductus arteriosus is a fetal structure that spontaneously closes in 90% of newborns. Patency 3 months after birth is considered a congenital heart disease that, if untreated, can progress to serious cardiovascular complications. This report aims to review an alternative treatment with an aortic endoprosthesis in a 49-year-old man who presented with dyspnea on moderate exertion associated with a heart murmur. He was diagnosed with persistent ductus arteriosus (PDA) with cardiac complications. Clinical management was unsuccessful and surgical treatment was indicated. Endovascular treatment with a thoracic endoprosthesis was indicated and performed successfully. Percutaneous closure is the preferred method in adult patients. Endovascular intervention using an endoprosthesis is a safe and effective option, in addition to being applicable regardless of the anatomy of the PDA. This case demonstrates the natural history of the pathology and presents a safe and effective alternative for...
Jornal Vascular Brasileiro, 2015
Aneurysms of the supra-aortic trunks are rare conditions that can cause peripheral neurological c... more Aneurysms of the supra-aortic trunks are rare conditions that can cause peripheral neurological conditions or embolization resulting in stroke. The upper airways can even be affected and rupture is potentially fatal. We present a case of a patient with an aneurysm of the carotid bifurcation who was treated conventionally with reconstruction of the carotid bifurcation using a venous patch. Surgical treatment enabled accurate histopathological diagnosis and anatomic correction of the carotid bifurcation.
Purpose This study aimed to determine whether the administration of statins before, during or aft... more Purpose This study aimed to determine whether the administration of statins before, during or after lower-limb arterial angioplasty was associated with improved primary patency, mortality, and limb loss through a meta-analysis. Methods All studies on statin administration in patients undergoing lower-limb arterial angioplasty that reported the outcomes of interest (primary patency, mortality and limb loss) were included in a meta-analysis. Results Nine studies were included in this meta-analysis. Statin use in patients undergoing lower-limb arterial angioplasty was associated with improved primary patency at 12 (12.57, 95% confidence interval [CI]: 6.86–18.28, p < 0.0001) and 24 months (7.19, 95% CI: 1.02–13.37, p = 0.02), decreased mortality in 39% at 12 months (relative risk (RR): 0.61, 95% CI: 0.55–0.74, p < 0.00001) and improved amputation-free survival (AFS) in 35% (Hazard ratio: 0.65, 95% CI: 0.46–0.793, p = 0.0198). However, statin use was not associated with decreased ...
Carbapenem-resistant bacteria are a major cause of diabetic foot (DF) infection. They are resista... more Carbapenem-resistant bacteria are a major cause of diabetic foot (DF) infection. They are resistant to almost all available antimicrobial agents and lead to increased hospital costs. The clinical and microbiological characteristics of DF infection due to these microorganisms and the association of DF with outcomes such as mortality and amputation are not yet well established. This was a retrospective cohort study involving 60 vascular surgery patients who were admitted to Nossa Senhora da Conceição Hospital due to DF infection caused by carbapenem-resistant bacteria and who underwent debridement or amputation, and a control group with 60 randomly selected patients. The analyzed parameters were mortality and amputation rates and patients’ epidemiological and microbiological profiles. A significant association was observed between bacterial resistance and previous amputation, previous hospitalizations, and DF ulcer classification into ischemic and neuroischemic; however, there were no...
Takayasu’s arteritis and Crohn’s disease are chronic inflammatory diseases with unknown etiology.... more Takayasu’s arteritis and Crohn’s disease are chronic inflammatory diseases with unknown etiology. They rarely occur together in the same individual, with less than 30 cases reported in the literature. This case report describes this association in a 36-year-old woman with Crohn’s disease and weak pulses in her left arm with blood pressure of 60/40 mmHg. Angiotomography showed segmental stenosis in the left subclavian artery and circumferential thickening of the aortic wall between T10 and L1, establishing the diagnosis of Takayasu’s arteritis. Both are organspecific and immune-mediated diseases and exhibit granulomas and granulomatous vasculitis, which contribute to reinforce the hypothesis of a common immunologic origin. We believe that this is the first case of concomitant presence of these two diseases reported in the Brazilian literature.
Aneurysms of the supra-aortic trunks are rare conditions that can cause peripheral neurological c... more Aneurysms of the supra-aortic trunks are rare conditions that can cause peripheral neurological conditions or embolization resulting in stroke. The upper airways can even be affected and rupture is potentially fatal. We present a case of a patient with an aneurysm of the carotid bifurcation who was treated conventionally with reconstruction of the carotid bifurcation using a venous patch. Surgical treatment enabled accurate histopathological diagnosis and anatomic correction of the carotid bifurcation.
Carbapenem-resistant bacteria are a major cause of diabetic foot (DF) infection. They are resista... more Carbapenem-resistant bacteria are a major cause of diabetic foot (DF) infection. They are resistant to almost all available antimicrobial agents and lead to increased hospital costs. The clinical and microbiological characteristics of DF infection due to these microorganisms and the association of DF with outcomes such as mortality and amputation are not yet well established. This was a retrospective cohort study involving 60 vascular surgery patients who were admitted to Nossa Senhora da Conceição Hospital due to DF infection caused by carbapenem-resistant bacteria and who underwent debridement or amputation, and a control group with 60 randomly selected patients. The analyzed parameters were mortality and amputation rates and patients’ epidemiological and microbiological profiles. A significant association was observed between bacterial resistance and previous amputation, previous hospitalizations, and DF ulcer classification into ischemic and neuroischemic; however, there were no...
The presence of a hemodynamic significant stenosis in renal arteries can lead to two distinct and... more The presence of a hemodynamic significant stenosis in renal arteries can lead to two distinct and independent clinical conditions: renovascular hypertension (RH) and ischemic nephropathy (IN). The first results from a progressive stimulation of the renin–angiotensin– aldosterone system (RAAS), while the second is a consequence of the progressive reduction in the effective renal plasma flow. This flow reduction impacts the kidney excretory function leading to development of chronic renal failure (CRF). Traditionally, the majority of the clinical studies in atherosclerotic renal artery disease or renovascular disease (RVD) focused in the physiopathology and in the management of the resulting systemic hypertension (SHT), due to the considerable clinical interest aiming a cure for secondary SHT1,2. However, in more recent years, attention has also been given to the role of the ischemia resulting from the renovascular involvement in the progressive loss of renal function. Renovascular in...
Jornal Vascular Brasileiro, 2009
A arterite de Takayasu e a doença de Crohn são doenças inflamatórias com etiologia desconhecida. ... more A arterite de Takayasu e a doença de Crohn são doenças inflamatórias com etiologia desconhecida. Raramente ocorrem de modo concomitante em um mesmo indivíduo, havendo menos de 30 casos relatados na literatura. Este trabalho descreve essa associação em uma paciente de 36 anos de idade portadora de doença de Crohn, que apresentou redução dos pulsos no membro superior esquerdo e pressão arterial de 60/40 mmHg. A angiotomografia evidenciou estenose segmentar de artéria subclávia esquerda e espessamento parietal circunferencial da aorta na transição toracoabdominal entre T10 e L1, estabelecendo o diagnóstico de arterite de Takayasu. Ambas as patologias são mediadas imunologicamente e apresentam granulomas e vasculite granulomatosa, o que contribui para reforçar a hipótese de uma origem imunológica comum no seu desenvolvimento. Acreditamos que este seja o primeiro caso relatado na literatura brasileira da presença concomitante destas duas enfermidades.
Jornal Vascular Brasileiro, 2012
A doença renal isquêmica ou nefropatia isquêmica relacionada à doença renovascular pode evoluir d... more A doença renal isquêmica ou nefropatia isquêmica relacionada à doença renovascular pode evoluir de forma rápida e progressiva para a insuficiência renal crônica. É fundamental a identificação e o tratamento precoces desta condição clínica, prevenindo a ocorrência de doença renal em estágio terminal, com consequente necessidade de terapia de substituição renal. Há uma década, o controle da hipertensão renovascular era o objetivo primário no manejo de pacientes com doença renovascular. Atualmente, a meta está dirigida principalmente para a estabilização e a melhora da função renal, além do controle dos níveis pressóricos.
Jornal Vascular Brasileiro, 2009
Takayasu's arteritis and Crohn's disease are chronic inflammatory diseases with unknown... more Takayasu's arteritis and Crohn's disease are chronic inflammatory diseases with unknown etiology. They rarely occur together in the same individual, with less than 30 cases reported in the literature. This case report describes this association in a 36-year-old woman with ...
Jornal Vascular Brasileiro
The ductus arteriosus is a fetal structure that spontaneously closes in 90% of newborns. Patency ... more The ductus arteriosus is a fetal structure that spontaneously closes in 90% of newborns. Patency 3 months after birth is considered a congenital heart disease that, if untreated, can progress to serious cardiovascular complications. This report aims to review an alternative treatment with an aortic endoprosthesis in a 49-year-old man who presented with dyspnea on moderate exertion associated with a heart murmur. He was diagnosed with persistent ductus arteriosus (PDA) with cardiac complications. Clinical management was unsuccessful and surgical treatment was indicated. Endovascular treatment with a thoracic endoprosthesis was indicated and performed successfully. Percutaneous closure is the preferred method in adult patients. Endovascular intervention using an endoprosthesis is a safe and effective option, in addition to being applicable regardless of the anatomy of the PDA. This case demonstrates the natural history of the pathology and presents a safe and effective alternative for...
Jornal Vascular Brasileiro, 2015
Aneurysms of the supra-aortic trunks are rare conditions that can cause peripheral neurological c... more Aneurysms of the supra-aortic trunks are rare conditions that can cause peripheral neurological conditions or embolization resulting in stroke. The upper airways can even be affected and rupture is potentially fatal. We present a case of a patient with an aneurysm of the carotid bifurcation who was treated conventionally with reconstruction of the carotid bifurcation using a venous patch. Surgical treatment enabled accurate histopathological diagnosis and anatomic correction of the carotid bifurcation.