RESUMEN
Invasive pulmonary aspergillosis (IPA) is an emerging and life-threatening infectious disease in patients admitted to the intensive care unit (ICU). Most diagnostic studies are conducted in hematological patients and results cannot readily be transferred to ICU patients lacking classical host factors. In a multicenter, prospective clinical trial including 44 ICU patients, hematological (nâ¯=â¯14) and non-hematological patients (nâ¯=â¯30), concurrent serum and bronchoalveolar lavage (BAL) samples were analyzed by conventional culture, galactomannan (GM), 1-3-beta-D-glucan (BDG) as well as an Aspergillus specific nested polymerase chain reaction (PCR). Nine patients (20%) had putative IPA according to AspICU classification. GM and PCR showed superior performance in BAL with sensitivity/specificity of 56%/94% and 44%/94% compared to 33%/97% and 11%/94% in serum. Despite better sensitivity of 89%, BDG showed poor specificity of only 31% (BAL) and 26% (serum). Combination of GM and PCR (BAL) with BDG (serum) resulted in 100% sensitivity, but also reduced specificity to 23%. Whereas mean GM levels were significantly higher in hematological patients BDG and PCR did not differ between hematological and non-hematological patients. Under present clinical conditions test combinations integrating both BAL and blood samples are advantageous. BDG might best serve as possible indicator for ruling out IPA. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01695499. First posted: September 28, 2012, last update posted: May 8, 2017.
Asunto(s)
Aspergillus/aislamiento & purificación , Líquido del Lavado Bronquioalveolar/microbiología , Enfermedad Crítica , Aspergilosis Pulmonar Invasiva/microbiología , Reacción en Cadena de la Polimerasa , Adulto , Anciano , Anciano de 80 o más Años , Pruebas Diagnósticas de Rutina , Galactosa/análogos & derivados , Humanos , Masculino , Mananos/análisis , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Adulto Joven , beta-Glucanos/análisisRESUMEN
BACKGROUND: Pulmonary embolism (PE) is a frequently occurring complication in critically ill patients, and the simultaneous occurrence of PE and life-threatening bleeding is a therapeutic dilemma. Inferior vena cava filters (IVCF) may represent an important therapeutic alternative in these cases. The Angel® catheter (Bio2 Medical Inc., San Antonio, TX, USA) is a novel IVCF that provides temporary protection from PE and is implanted at bedside without fluoroscopy. MATERIAL AND METHODS: The European Angel® Catheter Registry is an observational, multicenter study. In our German substudy, we investigated patients from three German hospitals and four intensive care units, who underwent Angel® catheter implantation between February 2016 and December 2016. RESULTS: A total of 23 critically ill patients (68 ± 9 years, 43% male) were included. The main indication for implantation was a high risk for or an established PE, combined with contraindications for prophylactic or therapeutic anticoagulation due to either an increased risk of bleeding (81%) or active bleeding (13%). The Angel® catheter was successfully inserted in all patients at bedside. No PE occurred in patients with an indwelling Angel® catheter. Clots with a diameter larger the 20 mm, indicating clot migration, were detected in 5% of the patients by cavography before filter retrieval. Filter retrieval was uneventful in all of our cases, while filter dislocation occurred in 3% of the patients. CONCLUSION: The German data from the multicenter European Angel® Catheter Registry show that the Angel® catheter is a safe and effective approach for critically ill patients with a high risk for the development of PE or an established PE, when an anticoagulation therapy is contraindicated.
Asunto(s)
Embolia Pulmonar , Sistema de Registros , Filtros de Vena Cava , Enfermedad Crítica , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Embolia Pulmonar/prevención & control , Resultado del Tratamiento , Vena Cava InferiorRESUMEN
Pulmonary embolism (PE), mostly caused by deep vein thrombosis, is a life-threatening complication in critically ill patients in the intensive care unit. A potential strategy to prevent PE in patients with contraindication for anticoagulant therapy is the implantation of a vena cava filter (VCF), to provide fast and safe PE protection against ascending thrombi. We report the case of a 56-year-old woman with an intracranial hemorrhage, who developed a PE. Because of acute contraindications for anticoagulant therapy, bedside implantation of a new VCF was performed to overcome the period of absolute contraindications for anticoagulation. After explanation, several thrombi were found on the filter.
Asunto(s)
Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Contraindicaciones de los Medicamentos , Unidades de Cuidados Intensivos , Sistemas de Atención de Punto , Embolia Pulmonar/prevención & control , Filtros de Vena Cava , Angiografía por Tomografía Computarizada , Diseño de Equipo , Femenino , Heparina de Bajo-Peso-Molecular/efectos adversos , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Hemorragias Intracraneales/complicaciones , Persona de Mediana Edad , Embolia Pulmonar/diagnóstico por imagen , Trombosis de la Vena/complicacionesRESUMEN
We report on the case of a 49-year-old man who presented with increasing dyspnea and a skin rash. The community-acquired pneumonia was initially treated with broad spectrum antibiotics. The patient's respiratory condition rapidly worsened and the clinical picture of Waterhouse-Friderichsen syndrome developed with disseminated intravasal coagulopathy and necrosis of the toes. An infection with Capnocytophaga canimorsus, which had been caused by an initially unmentioned dog bite was confirmed. In view of the fulminant course and the high risk of operative treatment of the ubiquitous necroses in all limbs, a joint decision for deescalation of therapy was made together with relatives. The patient died 14 days after admission to hospital.
Asunto(s)
Mordeduras y Picaduras/microbiología , Capnocytophaga , Disnea/etiología , Exantema/etiología , Infecciones por Bacterias Gramnegativas/microbiología , Animales , Mordeduras y Picaduras/complicaciones , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Necrosis , Dedos del Pie/patología , Síndrome de Waterhouse-Friderichsen/etiologíaRESUMEN
A trial was conducted to study the influence of CP and fat content of the diet on performance and egg quality traits of brown egg-laying hens from 22 to 50 wk of age. The experiment was conducted as a completely randomized design with 8 treatments arranged factorially with 4 diets and 2 initial BW of the hens (1,592 vs. 1,860 g). Three of these diets differed in the CP content (16.5, 17.5, and 18.5%) and included 1.8% added fat. The fourth diet also had 18.5% CP but was supplemented with 3.6% fat instead of 1.8% fat. Each treatment was replicated 4 times, and the experimental unit consisted of 21 hens allocated into groups of 7 in 3 adjacent cages. All diets were isocaloric (2,750 kcal of AME/kg) and met the recommendations of brown egg-laying hens for digestible Arg, Ile, Lys, Met, Thr, Trp, TSAA, and Val. Productive performance and egg quality were recorded by replicate every 28 d. For the entire experimental period, diet did not affect any of the productive performance traits studied, but the heavier hens had higher ADFI (120.6 vs. 113.9 g; P < 0.001), egg production (92.5 vs. 89.8%; P < 0.01), and egg weight (64.9 vs. 62.4 g; P < 0.001) than the lighter hens. Initial BW did not affect feed conversion per kilogram of eggs or hen mortality, but BW gain was higher (289 vs. 233 g; P < 0.01) and feed conversion ratio per dozen of eggs was better (1.52 vs. 1.57; P < 0.01) for the lighter than for the heavier hens. None of the egg quality variables studied was affected by dietary treatment or initial BW of the hens. It is concluded that brown egg-laying hens, irrespective of their initial BW, do not need more than 16.5% CP to maximize egg production, provided that the diet meets the requirements for key indispensable amino acids. Heavier hens produce more eggs that are larger than lighter hens but feed efficiency per kilogram of eggs is not affected.
Asunto(s)
Alimentación Animal/análisis , Crianza de Animales Domésticos , Pollos/fisiología , Grasas de la Dieta/administración & dosificación , Proteínas en la Dieta/administración & dosificación , Fenómenos Fisiológicos Nutricionales de los Animales , Animales , Peso Corporal , Pollos/crecimiento & desarrollo , Huevos , Femenino , Distribución AleatoriaRESUMEN
In patients with hypertrophic cardiomyopathy (HOCM), the decision for an implantable cardioverter-defibrillator (ICD) depends highly on the exact identification of the etiology of syncope. In this article, the case of a patient with HOCM and syncope is reported. Invasive pressure measurement was used to diagnose a typical case of cough syncope as the cause of the syncope.