RESUMO
A 15-year-old adolescent sustained a left tuberositas tibiae avulsion fracture after a jump.
Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos do Joelho/diagnóstico , Fraturas da Tíbia/diagnóstico , Adolescente , Traumatismos em Atletas/cirurgia , Pinos Ortopédicos , Fixação Interna de Fraturas/métodos , Humanos , Traumatismos do Joelho/cirurgia , Masculino , Fraturas da Tíbia/cirurgia , Resultado do TratamentoRESUMO
A 79-year-old man had a complication of gastric surgery after 45 years: afferent-loop syndrome after a Billroth II partial gastrectomy.
Assuntos
Dor Abdominal/etiologia , Síndrome da Alça Aferente/etiologia , Gastroenterostomia/efeitos adversos , Dor Abdominal/diagnóstico , Dor Abdominal/cirurgia , Síndrome da Alça Aferente/diagnóstico , Síndrome da Alça Aferente/cirurgia , Idoso , Humanos , Masculino , Resultado do TratamentoRESUMO
A 29-year-old woman presented with peracute pain in the right lower quadrant of her abdomen, which at diagnostic laparoscopy appeared to be related to hematoperitoneum caused by bleeding ofa corpus rubrum.
Assuntos
Abdome Agudo/etiologia , Dor Abdominal/etiologia , Corpo Lúteo , Hemoperitônio/etiologia , Hemorragia/diagnóstico , Abdome Agudo/cirurgia , Dor Abdominal/cirurgia , Adulto , Corpo Lúteo/patologia , Diagnóstico Diferencial , Feminino , Hemoperitônio/complicações , Hemorragia/complicações , Humanos , Laparoscopia/métodos , Resultado do TratamentoRESUMO
A 64-year-old man of Hindustan origin presented at the Emergency Department with symptoms which suggested stomach perforation. A chest X-ray taken with the patient in the upright position showed gas between the liver and the right hemidiaphragm. After 30 minutes the pain subsided spontaneously. The gas seen on the chest X-ray was diagnosed as Chilaiditi's sign, caused by interposition of the colon between the liver and the diaphragm. This interposition is usually asymptomatic and does not require surgical treatment.
Assuntos
Dor Abdominal/etiologia , Doenças do Colo/diagnóstico por imagem , Flatulência/diagnóstico por imagem , Doenças do Colo/complicações , Diagnóstico Diferencial , Diafragma/diagnóstico por imagem , Flatulência/complicações , Humanos , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , SíndromeRESUMO
BACKGROUND: Babesiosis can be life-threatening in immunocompromised individuals. Although the disease is usually transmitted by tick bite, more than 20 cases have been reported of infection transmitted by transfusion of blood or blood components obtained from apparently healthy donors from endemic areas in the United States. This report describes several recent cases of transfusion-transmitted babesiosis in New York State. STUDY DESIGN AND METHODS: Transfusion-associated incidents of babesiosis infection were identified and investigated. Seroprevalence of babesiosis in healthy blood donors in a highly endemic area was ascertained. RESULTS: In three incidents, babesiosis was diagnosed in five of eight patients given infected blood: two premature infants, an elderly patient with gastrointestinal bleeding, and two patients with thalassemia. Seroprevalence in blood donors on Shelter Island (Suffolk County, eastern Long Island), a highly endemic area, was 4.3 percent in May 1998. CONCLUSIONS: Infected donors lived in endemic areas and were asymptomatic with no history of tick bite. Blood collected in January 1997 from one donor was infectious. Those transfusion recipients who were infected were neonatal, elderly, or chronically transfused patients. Babesiosis should be included in the differential diagnosis of febrile illness in immunocompromised recipients of blood transfusion, particularly in the Northeastern United States.
Assuntos
Babesiose/transmissão , Reação Transfusional , Adulto , Idoso , Animais , Babesiose/sangue , Babesiose/epidemiologia , Doadores de Sangue , Humanos , Imunoglobulina M/sangue , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , New York/epidemiologia , Reação em Cadeia da PolimeraseRESUMO
OBJECTIVE: New York State must provide effective oversight for more than 400 facilities that provide blood services, ensuring the safety of transfusion recipients. PROGRAM STRUCTURE: Oversight is based on educated, trained program staff; a council of transfusion medicine experts; regulations governing laboratories and blood banking services; proficiency testing; requirements for reporting transfusion-related errors and incidents; tracking collection, testing, and disposition of all blood; inspections; partnership with the Food and Drug Administration; and investigation of incident reports. Policy letters and guidelines (eg, umbilical cord blood, transfusion-associated infections, intraoperative blood recovery) supplement regulations. OBSERVATIONS: Standards are maintained through education by a responsive, proactive oversight program. Areas warranting stricter regulation or supplemental educational guidelines are identified by periodic assessment of standards of practice and review of reported information. CONCLUSION: The multifaceted oversight program contributes to efforts to improve transfusion medicine.
Assuntos
Transfusão de Sangue/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Governo Estadual , Bancos de Sangue/legislação & jurisprudência , Bancos de Sangue/organização & administração , Bancos de Sangue/normas , Transfusão de Sangue/legislação & jurisprudência , Controle de Doenças Transmissíveis/métodos , Doenças Transmissíveis/transmissão , Humanos , New YorkRESUMO
Constitutive phycocyanin from cyanobacterium Fremyella diplosiphon (Calothrix sp. PCC 7601) grown in green light, has been isolated and crystallized. The crystals belong to the space group R3 with cell constants a = b = 180.26 A, c = 61.24 A, alpha = beta = 90 degrees, gamma = 120 degrees. The crystal structure has been determined by Patterson search techniques using the molecular model of C-phycocyanin from the cyanobacterium Agmenellum quadruplicatum. The asymmetric unit of the crystal cell consists of two (alpha beta)-monomers related by a local dyad. Three asymmetric units are arranged around a crystallographic triad and form an (alpha beta)6-hexamer, the functional unit in the native antenna rod. The initial structure has been refined in a cyclic manner by energy-restrained crystallographic refinement and modelling until the conventional crystallographic R-factor converged at 18.1% with data to a resolution of 1.66 A. The molecular structure resembles closely the C-phycocyanins of Mastigocladus laminosus and A. quadruplicatum. The conformation and configuration of the alpha-84 and beta-84 chromophores is very similar to the corresponding chromophores in the trimeric C-phycocyanin of M. laminosus, whereas the beta-155 chromophore differs in configuration with C(4)-Z, C(10)-Z and C(15)-Z compared to C(4)-Z, C(10)-Z, C(15)-Z,E. The stereochemistry of the beta-155 chiral centres is C(2)-RC(3)-R and C(31)-S, respectively, whereas alpha-84 and beta-84 have C(2)-RC(3)-R and C(31)-R. The amino acid sequences of constitutive and inducible phycocyanin differ mainly in residues located on the surface of the beta-subunits that mediate the inter-hexameric contacts.
Assuntos
Ficocianina/ultraestrutura , Sequência de Aminoácidos , Simulação por Computador , Cristalização , Cristalografia , Cianobactérias/análise , Cianobactérias/metabolismo , Transferência de Energia , Substâncias Macromoleculares , Modelos Moleculares , Dados de Sequência Molecular , Ficocianina/metabolismo , Análise Espectral , Difração de Raios XRESUMO
The early institution of end expiratory pressure has been demonstrated frequently to be beneficial in acute respiratory failure. EPAP without intubation allows early therapy while avoiding the complications associated with the high flow rates utilized with CPAP. Three patients are described, illustrating the administration of EPAP for mild ARDS, aspiration penumonia, and postoperative atelectasis.
Assuntos
Respiração com Pressão Positiva/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pneumonia Aspirativa/terapia , Síndrome do Desconforto Respiratório/terapiaAssuntos
Relaxantes Musculares Centrais/farmacologia , Miastenia Gravis/complicações , Compostos de Mostarda Nitrogenada/efeitos adversos , Pancurônio/efeitos adversos , Tiotepa/efeitos adversos , Interações Medicamentosas , Feminino , Humanos , Pessoa de Meia-Idade , Miastenia Gravis/tratamento farmacológico , Tiotepa/farmacologiaAssuntos
Abdome/cirurgia , Pneumopatias/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Atelectasia Pulmonar/prevenção & controle , Embolia Pulmonar/prevenção & controle , Síndrome do Desconforto Respiratório/prevenção & controle , Fatores Etários , Anestesia , Humanos , Respiração com Pressão Positiva Intermitente , Pulmão/fisiopatologia , Obesidade/complicações , Oxigenoterapia , Respiração com Pressão Positiva , Cuidados Pós-Operatórios , Postura , Cuidados Pré-Operatórios , Doenças Respiratórias/complicações , Infecções Respiratórias/complicações , Risco , Sepse/complicações , Fatores de TempoRESUMO
After an operation upon the abdomen, certain patients have a high risk of developing acute respiratory failure or the adult respiratory distress syndrome. These patients at high risk have been mechanically ventilated during the postoperative period in an attempt to prevent the onset of respiratory insufficiency. As a method of prophylaxis, continuous positive airway pressure has the advantages of increasing the functional residual capacity with minimal effects on the cardiac output, low potential for barotrauma and simplicity of equipment. Alternate patients at risk following an operation on the upper part of the abdomen were placed on 8 centimeters of water continuous positive airway pressure for the first 24 hours postoperatively. Fifty-six controls and 56 patients receiving continuous positive airway pressure were studied. In ten controls, adult respiratory distress syndrome developed, and three died in respiratory failure. Only one of the group receiving continuous positive airway pressure met standard criteria for the diagnosis of adult respiratory distress syndrome. In addition, in 25 patients serving as controls, respiratory complications other than adult respiratory distress syndrome developed compared with the development in only 11 receiving continuous positive airway pressure9
Assuntos
Respiração com Pressão Positiva , Complicações Pós-Operatórias/prevenção & controle , Insuficiência Respiratória/prevenção & controle , Abdome/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Cuidados Pós-Operatórios , Insuficiência Respiratória/sangue , Infecções Respiratórias/etiologiaRESUMO
Alternate patients believed to be at risk for developing ARDS were placed on CPAP for the first twenty-four hours post upper abdominal surgery. Ten of the 58 controls developed ARDS, requiring prolonged mechanical ventilation with a 30% mortality rate. Only one of the 59 CPAP patients developed evidence of ARDS. This patient, however, is believed to have had fluid overload, and responded quickly to diuretics and was extubated within two days. Thus, prophylactic CPAP has greatly decreased our postoperative morbidity and mortality related to respiratory causes.
Assuntos
Respiração com Pressão Positiva , Complicações Pós-Operatórias/prevenção & controle , Insuficiência Respiratória/prevenção & controle , Abdome/cirurgia , Idoso , Humanos , Illinois , Respiração com Pressão Positiva/instrumentação , Complicações Pós-Operatórias/mortalidade , Insuficiência Respiratória/mortalidadeAssuntos
Enfisema Mediastínico/cirurgia , Traqueotomia/efeitos adversos , Acidentes Domésticos , Autopsia , Detergentes/efeitos adversos , Afogamento , Humanos , Lactente , Intubação Intratraqueal/efeitos adversos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/patologia , Complicações Pós-Operatórias , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/patologia , RadiografiaAssuntos
Fraturas Ósseas/cirurgia , Laringe/lesões , Anestesia Local , Pré-Escolar , Humanos , Intubação Intratraqueal , Lidocaína , MasculinoAssuntos
Anemia Falciforme/complicações , Doenças do Sistema Nervoso Central/etiologia , Complicações Pós-Operatórias/etiologia , Traço Falciforme/complicações , Procedimentos Cirúrgicos Operatórios , Afasia/etiologia , Transtornos Cerebrovasculares/etiologia , Criança , Hemiplegia/etiologia , Humanos , Infarto , MasculinoAssuntos
Arritmias Cardíacas/induzido quimicamente , Dexametasona/efeitos adversos , Adulto , Insuficiência da Valva Aórtica/cirurgia , Arritmias Cardíacas/tratamento farmacológico , Dexametasona/administração & dosagem , Eletrocardiografia , Feminino , Humanos , Injeções Intravenosas , Lidocaína/uso terapêutico , Insuficiência da Valva Mitral/cirurgia , Fosfatos/administração & dosagem , Fosfatos/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Sódio/administração & dosagem , Sódio/efeitos adversosRESUMO
Unlike Escherichia coli, Bacillus cereus T appears to accumulate Mg(2+) in its cell sap against a concentration gradient. Over a range of Mg(2+) in the growth medium from 5 x 10(-5) to 1.35 x 10(-2)m, the concentration of Mg(2+) in the cell sap of B. cereus T was maintained at about 6 x 10(-3)m, and ribosome-bound Mg(2+) and spermidine, as well as the spermidine concentration in the cell sap, appear to be unaffected by the concentration of Mg(2+) in the growth medium. Inhibition of growth of E. coli by streptomycin is progressively reversed by increasing the concentration of Mg(2+) in the growth medium above 5 mm. The finding that similar increases of Mg(2+) in the growth medium did not reverse the inhibition of B. cereus T is also consistent with the conclusion that B. cereus T, unlike E. coli, accumulates Mg(2+) to a constant concentration in its cell sap.