Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 25
Filtrar
1.
Transplant Proc ; 56(5): 1192-1195, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38806313

RESUMO

Pneumonia is a common nosocomial complication in transplant patients. Stenotrophomonas maltophilia is recognized as a common cause and is typically seen in immunocompromised and critically ill patients. S. maltophilia, a nonfermenting gram-negative rod, ranks as the third most common nosocomial pathogen, following Pseudomonas aeruginosa and Acinetobacter. The bacteria are frequently found in environmental sources and are prevalent in healthcare facilities, including in tap water faucets, shower outlets, air-cooling systems, intravenous fluids, catheters, dialysis machines, and oxygen humidifiers. This bacterium possesses the ability to rapidly form biofilms, enabling it to colonize new surfaces in less than 24 hours. While S. maltophilia generally exhibits low virulence, there remains uncertainty among many clinicians regarding whether it is merely a colonizer or the primary cause of infection. Although S. maltophilia infections are rare in immunocompetent individuals, the species is increasingly recognized as an opportunistic pathogen in vulnerable populations such as those with cystic fibrosis, cancer, and other conditions leading to immunosuppression. S. maltophilia now recognized as a causative agent in various clinical syndromes, primarily affecting the lungs and bloodstream. We present a case of S. maltophilia-associated lung infection in a kidney transplant recipient, emphasizing the significance of underlying diseases and associated signs and symptoms.


Assuntos
Infecções por Bactérias Gram-Negativas , Transplante de Rim , Stenotrophomonas maltophilia , Humanos , Stenotrophomonas maltophilia/isolamento & purificação , Transplante de Rim/efeitos adversos , Infecções por Bactérias Gram-Negativas/microbiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/diagnóstico , Hemorragia/etiologia
2.
J Clin Anesth ; 95: 111465, 2024 08.
Artigo em Inglês | MEDLINE | ID: mdl-38581926

RESUMO

OBJECTIVE: Test the hypothesis that one-lung ventilation with variable tidal volume improves intraoperative oxygenation and reduces postoperative pulmonary complications after lung resection. BACKGROUND: Constant tidal volume and respiratory rate ventilation can lead to atelectasis. Animal and human ARDS studies indicate that oxygenation improves with variable tidal volumes. Since one-lung ventilation shares characteristics with ARDS, we tested the hypothesis that one-lung ventilation with variable tidal volume improves intraoperative oxygenation and reduces postoperative pulmonary complications after lung resection. DESIGN: Randomized trial. SETTING: Operating rooms and a post-anesthesia care unit. PATIENTS: Adults having elective open or video-assisted thoracoscopic lung resection surgery with general anesthesia were randomly assigned to intraoperative ventilation with fixed (n = 70) or with variable (n = 70) tidal volumes. INTERVENTIONS: Patients assigned to fixed ventilation had a tidal volume of 6 ml/kgPBW, whereas those assigned to variable ventilation had tidal volumes ranging from 6 ml/kg PBW ± 33% which varied randomly at 5-min intervals. MEASUREMENTS: The primary outcome was intraoperative oxygenation; secondary outcomes were postoperative pulmonary complications, mortality within 90 days of surgery, heart rate, and SpO2/FiO2 ratio. RESULTS: Data from 128 patients were analyzed with 65 assigned to fixed-tidal volume ventilation and 63 to variable-tidal volume ventilation. The time-weighted average PaO2 during one-lung ventilation was 176 (86) mmHg in patients ventilated with fixed-tidal volume and 147 (72) mmHg in the patients ventilated with variable-tidal volume, a difference that was statistically significant (p < 0.01) but less than our pre-defined clinically meaningful threshold of 50 mmHg. At least one composite complication occurred in 11 (17%) of patients ventilated with variable-tidal volume and in 17 (26%) of patients assigned to fixed-tidal volume ventilation, with a relative risk of 0.67 (95% CI 0.34-1.31, p = 0.24). Atelectasis in the ventilated lung was less common with variable-tidal volumes (4.7%) than fixed-tidal volumes (20%) in the initial three postoperative days, with a relative risk of 0.24 (95% CI 0.01-0.8, p = 0.02), but there were no significant late postoperative differences. No other secondary outcomes were both statistically significant and clinically meaningful. CONCLUSION: One-lung ventilation with variable tidal volume does not meaningfully improve intraoperative oxygenation, and does not reduce postoperative pulmonary complications.


Assuntos
Anestesia Geral , Ventilação Monopulmonar , Complicações Pós-Operatórias , Volume de Ventilação Pulmonar , Humanos , Ventilação Monopulmonar/métodos , Ventilação Monopulmonar/efeitos adversos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Anestesia Geral/métodos , Oxigênio/sangue , Cirurgia Torácica Vídeoassistida/métodos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Resultado do Tratamento , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Pulmão/cirurgia , Frequência Cardíaca , Atelectasia Pulmonar/prevenção & controle , Atelectasia Pulmonar/etiologia , Atelectasia Pulmonar/epidemiologia
3.
Transl Neurosci ; 14(1): 20220293, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-37465373

RESUMO

Background: The role of the willisian collaterals during carotid endarterectomies (CEAs) is a debated issue. The aim of the present work was to test whether an incomplete or non-functional circle of Willis (CoW) is a risk factor for ischemic events during CEA. Patients and methods: CEAs were performed under local anesthesia. Patients were considered symptomatic (SY) if neurological signs appeared after the cross-clamping phase. In SY patients shunt insertion was performed. CoW on CT angiograms (CTa) were analyzed offline and categorized as non-functional (missing or hypoplastic collaterals) or functional collaterals by three neuroradiologists. Near-infrared spectroscopy (NIRS) was performed throughout the procedure. Results: Based on CTa, 67 incomplete circles were found, 54 were asymptomatic (ASY) and 13 were SY. No complete CoW was found among the SY patients. Significant differences could be detected between incomplete and complete circles between ASY and SY groups (Chi-square: 6.08; p = 0.013). The anterior communicating artery was missing or hypoplastic in 5/13 SY cases. There were no cases of the non-functional anterior communicating arteries in the ASY group (Chi-square: 32.9; p = 10-8). A missing or non-functional bilateral posterior communicating artery was observed in 9/13 SY and in 9/81 ASY patients (Chi-square: 24.4; p = 10-7). NIRS had a sensitivity of 76.9% and a specificity of 74.5% in detecting neurological symptoms. Conclusions: Collateral ability of the CoW may be a risk factor for ischemic events during CEAs. Further studies should delineate whether the preoperative assessment of collateral capacity may be useful in decision-making about shunt use during CEA.

4.
Transl Neurosci ; 13(1): 476-482, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36578287

RESUMO

Recent evidence suggests no difference between patient outcomes when carotid endarterectomies (CEAs) are performed under general or regional anesthesia. However, for detecting the need for a shunt, general anesthesia has the drawback of monitoring needs in the intraoperative setting. In the present study, we attempted to perform intraoperative transcranial Doppler (TCD) monitoring for CEAs performed under intermediate plexus block to describe cerebral hemodynamic changes during different phases of the procedure. Patients and methods: Patients with unilateral hemodynamically significant carotid stenosis scheduled for elective CEAs were included. Ultrasound-guided intermediate plexus block was used for regional anesthesia. TCD monitoring of the middle cerebral artery mean blood flow velocity (MCAV) was performed throughout the procedure. MCAVs were offline analyzed during different phases of CEA: (1) resting state, before regional block, (2) after block, before incision, (3) before cross-clamp, (4) after cross-clamp, (5) 5 min after cross-clamp, (6) 10 min after cross-clamp, (7) after declamping, and (8) during the postoperative period (4-6 h). Results: Shunt insertion based on the deterioration of neurological symptoms after cross-clamping was necessary for 11/66 patients (16.6%). In these symptomatic patients, the ipsilateral percent decrease of the MCAV was more than 70% in 8 out of 11 cases (72.7%). In asymptomatic patients, without shunt insertion, the average decrease of MCAV was less than 50%. Conclusions: Neurological symptoms referring to cerebral ischemia may be superior to TCD monitoring of cerebral blood flow for detecting the necessity of a shunt. Regional anesthesia enables reliable, symptom-based monitoring of CEAs.

5.
Orv Hetil ; 163(18): 695-701, 2022 May 01.
Artigo em Húngaro | MEDLINE | ID: mdl-35490385

RESUMO

The timing of elective surgery is very important in patients, who suffered SARS-CoV-2 virus infection. According to a study of more than 100,000 patients, it takes approximately seven weeks to be safely admitted to elective surgery. In the case of emergency surgeries, the date of the surgery should be considered based on the patient's general condition and the expected improvement from the surgery. Surgery with a vital indication takes the greatest risk, as there is very little time and opportunity for preoperative examination in these cases. SARS-CoV-2 virus infection does not go away without a trace. Complications may include cardiopulmonary, coagulation, central nervous system, locomotor problems, acute renal failure, ionic and diabetic disorders, and gastrointestinal abnormalities, which may be short-term or long-term, and in some cases permanent. The preoperative examination strategy, the method of anesthesia (general or regional) and the intraoperative monitoring should be chosen according to the severity of these complications and the type of surgery. In the postoperative period, patients suffered with SARS-CoV-2 virus infection may require more frequent monitoring or intensive ward monitoring.


Assuntos
COVID-19 , SARS-CoV-2 , Humanos
6.
J Cardiothorac Vasc Anesth ; 35(12): 3528-3546, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34479782

RESUMO

The novel coronavirus pandemic has radically changed the landscape of normal surgical practice. Lifesaving cancer surgery, however, remains a clinical priority, and there is an increasing need to fully define the optimal oncologic management of patients with varying stages of lung cancer, allowing prioritization of which thoracic procedures should be performed in the current era. Healthcare providers and managers should not ignore the risk of a bimodal peak of mortality in patients with lung cancer; an imminent spike due to mortality from acute coronavirus disease 2019 (COVID-19) infection, and a secondary peak reflecting an excess of cancer-related mortality among patients whose treatments were deemed less urgent, delayed, or cancelled. The European Association of Cardiothoracic Anaesthesiology and Intensive Care Thoracic Anesthesia Subspecialty group has considered these challenges and developed an updated set of expert recommendations concerning the infectious period, timing of surgery, vaccination, preoperative screening and evaluation, airway management, and ventilation of thoracic surgical patients during the COVID-19 pandemic.


Assuntos
Anestesia , Anestesiologia , COVID-19 , Cuidados Críticos , Humanos , Pandemias , SARS-CoV-2
7.
Braz J Anesthesiol ; 71(5): 558-564, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33901551

RESUMO

BACKGROUND AND OBJECTIVES: The aim of our study was to assess systemic and cerebral hemodynamic changes as well as cerebral CO2-reactivity during propofol anesthesia. METHODS: 27 patients undergoing general anesthesia were enrolled. Anesthesia was maintained using the Target-Controlled Infusion (TCI) method according to the Schnider model, effect site propofol concentration of 4 µg.mL-1. Ventilatory settings (respiratory rate and tidal volume) were adjusted to reach and maintain 40, 35, and 30 mmHg EtCO2 for 5 minutes, respectively. At the end of each period, transcranial Doppler and hemodynamic parameters using applanation tonometry were recorded. RESULTS: Systemic mean arterial pressure significantly decreased during anesthetic induction and remained unchanged during the entire study period. Central aortic and peripherial pulse pressure did not change significantly during anesthetic induction and maintenance, whereas augmentation index as marker of arterial stiffness significantly decreased during the anesthetic induction and remained stable at the time points when target CO2 levels were reached. Both cerebral autoregulation and cerebral CO2-reactivity was maintained during propofol anesthesia. CONCLUSIONS: Propofol at clinically administered doses using the Total Intravenous Anesthesia (TIVA/TCI) technique decreases systemic blood pressure, but does not affect static cerebral autoregulation, flow-metabolism coupling and cerebrovascular CO2 reactivity. According to our measurements, propofol may exert its systemic hemodynamic effect through venodilation. TRIAL REGISTRATION: The study was registered at http://www.clinicaltrials.gov, identifier: NCT02203097, registration date: July 29, 2014.


Assuntos
Propofol , Anestesia Geral , Anestesia Intravenosa , Anestésicos Intravenosos/farmacologia , Dióxido de Carbono , Circulação Cerebrovascular , Homeostase , Humanos , Propofol/farmacologia , Sufentanil/farmacologia
8.
J Cardiothorac Vasc Anesth ; 34(9): 2315-2327, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32414544

RESUMO

The novel coronavirus has caused a pandemic around the world. Management of patients with suspected or confirmed coronavirus infection who have to undergo thoracic surgery will be a challenge for the anesthesiologists. The thoracic subspecialty committee of European Association of Cardiothoracic Anaesthesiology (EACTA) has conducted a survey of opinion in order to create recommendations for the anesthetic approach to these challenging patients. It should be emphasized that both the management of the infected patient with COVID-19 and the self-protection of the anesthesia team constitute a complicated challenge. The text focuses therefore on both important topics.


Assuntos
Comitês Consultivos/normas , Manuseio das Vias Aéreas/normas , Anestesia em Procedimentos Cardíacos/normas , Betacoronavirus , Infecções por Coronavirus/cirurgia , Pneumonia Viral/cirurgia , Guias de Prática Clínica como Assunto/normas , Manuseio das Vias Aéreas/métodos , Anestesia em Procedimentos Cardíacos/métodos , Anestesiologia/métodos , Anestesiologia/normas , COVID-19 , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , SARS-CoV-2
9.
Orv Hetil ; 161(17): 685-688, 2020 04 01.
Artigo em Húngaro | MEDLINE | ID: mdl-32324361

RESUMO

There is currently no proven effective therapy for COVID-19. Here we discuss the drugs most investigated for the treatment of the disease. All the listed therapies are experimental at this stage. However, due to the severe healthcare effects of the pandemic and the potentially fatal outcome of COVID-19 patients treated in the intensive care units, their off-label use should none-the-less be considered. Orv Hetil. 2020; 161(17): 685­688.


Assuntos
Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , COVID-19 , Humanos , Unidades de Terapia Intensiva , Uso Off-Label , Pandemias , SARS-CoV-2 , Tratamento Farmacológico da COVID-19
10.
Orv Hetil ; 161(17): 678-684, 2020 04 01.
Artigo em Húngaro | MEDLINE | ID: mdl-32324362

RESUMO

In December 2019, a novel outbreak of pneumonia was reported in Wuhan city, China. Initially, the zoonitic infection spread from human to human, causing a pandemic. This viral disease (COVID-19) can appear in a variety of forms, from asymptomatic through the spectrum of mild symptoms to severe respiratory failure, requiring intensive care. Caring for this latter group of patients puts a significant burden on health care. The purpose of this summary is to present the practical aspects of intensive care for patients requiring respiratory support and mechanical ventilation. Orv Hetil. 2020; 161(17): 678­684.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Cuidados Críticos , Pandemias , Pneumonia Viral , Respiração Artificial , Animais , COVID-19 , Infecções por Coronavirus/terapia , Cuidados Críticos/normas , Estado Terminal , Humanos , Pneumonia Viral/terapia , SARS-CoV-2
11.
Orv Hetil ; 161(17): 692-695, 2020 04 01.
Artigo em Húngaro | MEDLINE | ID: mdl-32324364

RESUMO

Caring for those affected by the coronavirus outbreak of December 2019 imposed a heavy burden on healthcare systems. Not only because some patients require intensive care, but because patients with any form of the disease may need surgical intervention. Managing these cases is a major challenge for anesthesiologists. The purpose of this summary is to present the practical aspects of anesthetic and perioperative care for patients requiring surgical treatment. Orv Hetil. 2020; 161(17): 692­695.


Assuntos
Anestesia , Betacoronavirus , Infecções por Coronavirus , Pandemias , Assistência Perioperatória , Pneumonia Viral , Anestesia/métodos , Anestesiologia/normas , COVID-19 , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , SARS-CoV-2
12.
Orv Hetil ; 161(17): 696-703, 2020 04 01.
Artigo em Húngaro | MEDLINE | ID: mdl-32324365

RESUMO

The coronavirus pandemic is a serious challenge for healthcare workers worldwide. The virus is spread through the air by droplets of moisture when people cough or sneeze and it has a very high virulence. Procedures generating airway aerosols are dangerous for every participant of patient care. The serious form of coronavirus infection can cause progressive respiratory failure. The best treatment is early endotracheal intubation and invasive mechanical ventilation. Intubation is an aerosol-generating process and thus carries the risk of contamination. Additionally the airway management of this patient population is usually difficult. The goal of this article is to give a practice-based overview of the peculiarities of airway management in coronavirus-infected patients with special regard to infection control and patient safety considerations. Orv Hetil. 2020; 161(17): 696­703.


Assuntos
Manuseio das Vias Aéreas , Infecções por Coronavirus/terapia , Pandemias , Infecções por Coronavirus/epidemiologia , Humanos
13.
Orv Hetil ; 161(17): 704-709, 2020 04 01.
Artigo em Húngaro | MEDLINE | ID: mdl-32324366

RESUMO

In critically ill COVID-19 patients, the failure of the cardiorespiratory system can be due to one of the following: (1) cytokine storm, haemophagocytosis ­ septic shock, (2) unmanageable hypoxemia, (3) isolated organ failure or as part of multi-organ failure. Herein we give an overview of the therapeutic options for treating or preventing these disease states. In recent years, CytoSorb-haemoperfusion to remove cytokines has shown promising results in the treatment of septic shock. Inhalational nitric oxide (iNO), inhalational epoprostenol and veno-venous extracorporeal membrane oxygenation (ECMO) are options in severe hypoxemia that is unresponsive to conventional mechanical ventilation. Renal failure is a frequent component of the multi-organ failure usually seen with disease progression and necessitates starting one of the available continuous renal replacement modalities. Orv Hetil. 2020; 161(17): 704­709.


Assuntos
Injúria Renal Aguda , Infecções por Coronavirus/terapia , Cuidados Críticos , Oxigenação por Membrana Extracorpórea , Hipóxia , Pneumonia Viral/terapia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Betacoronavirus , COVID-19 , Infecções por Coronavirus/complicações , Estado Terminal , Citocinas/metabolismo , Hemoperfusão , Humanos , Hipóxia/etiologia , Hipóxia/terapia , Óxido Nítrico/administração & dosagem , Pandemias , Pneumonia Viral/complicações , Terapia de Substituição Renal , SARS-CoV-2
14.
Orv Hetil ; 161(17): 710-712, 2020 04 01.
Artigo em Húngaro | MEDLINE | ID: mdl-32324367

RESUMO

The coronavirus pandemic is a serious challenge for healthcare workers worldwide. The virus is spread through the air by droplets of moisture when people cough or sneeze and it has a very high virulence. Procedures generating airway aerosols are dangerous for every participant of patient care. Mortality of COVID-19 is above 10%, thus cardiopulmonary resuscitation is an often needed intervention in this patient group. Resuscitation is an aerosol-generating process and thus carries the risk of contamination. The goal of this article is to give a practice-based overview of the specialities of cardiopulmonary resuscitation in coronavirus-infected patients. Orv Hetil. 2020. 161(17): 710­712.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Coronavirus , Pandemias , Pneumonia Viral , Ressuscitação/métodos , COVID-19 , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Humanos , Pneumonia Viral/complicações , Pneumonia Viral/terapia , SARS-CoV-2
15.
BMC Anesthesiol ; 19(1): 109, 2019 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-31215448

RESUMO

BACKGROUND: Sevoflurane is one of the most frequently used inhaled anesthetics for general anesthesia. Previously it has been reported that at clinically used doses of sevoflurane, cerebral vasoreactivity is maintained. However, there are no data how sevoflurane influences systemic and cerebral circulation in parallel. The aim of our study was to assess systemic and cerebral hemodynamic changes as well as cerebral CO2-reactivity during sevoflurane anesthesia. METHODS: Twenty nine patients undergoing general anesthesia were enrolled. Anesthesia was maintained with 1 MAC sevoflurane in 40% oxygen. Ventilatory settings (respiratory rate and tidal volume) were adjusted to reach and maintain 40, 35 and 30 mmHg EtCO2 for 5 min respectively. At the end of each period, transcranial Doppler and hemodynamic parameters using applanation tonometry were recorded. RESULTS: Systemic mean arterial pressure significantly decreased during anesthetic induction and remained unchanged during the entire study period. Central aortic and peripherial pulse pressure and augmentation index as markers of arterial stiffness significantly increased during the anesthetic induction and remained stable at the time points when target CO2 levels were reached. Both cerebral autoregulation and cerebral CO2-reactivity was maintained at 1 MAC sevoflurane. DISCUSSION: Cerebral autoregulation and CO2-reactivity is preserved at 1 MAC sevoflurane. Cerebrovascular effects of anesthetic compounds have to be assessed together with systemic circulatory effects. TRIAL REGISTRATION: The study was registered at http://www.clinicaltrials.gov , identifier: NCT02054143, retrospectively registered. Date of registration: February 4, 2014.


Assuntos
Encéfalo/efeitos dos fármacos , Dióxido de Carbono/farmacologia , Circulação Cerebrovascular/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Sevoflurano/farmacologia , Adulto , Anestésicos Inalatórios/farmacologia , Encéfalo/irrigação sanguínea , Encéfalo/fisiologia , Dióxido de Carbono/sangue , Circulação Cerebrovascular/fisiologia , Feminino , Hemodinâmica/fisiologia , Humanos , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Ultrassonografia Doppler Transcraniana , Adulto Jovem
16.
Clin Chem Lab Med ; 56(7): 1117-1125, 2018 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-29425104

RESUMO

BACKGROUND: Serum angiotensin-converting enzyme (ACE) activity determination can aid the early diagnosis of sarcoidosis. We aimed to optimize a fluorescent kinetic assay for ACE activity by screening the confounding effects of endogenous ACE inhibitors and interfering factors. Genotype-dependent and genotype-independent reference values of ACE activity were established, and their diagnostic accuracies were validated in a clinical study. METHODS: Internally quenched fluorescent substrate, Abz-FRK(Dnp)P-OH was used for ACE-activity measurements. A total of 201 healthy individuals and 59 presumably sarcoidotic patients were enrolled into this study. ACE activity and insertion/deletion (I/D) genotype of the ACE gene were determined. RESULTS: Here we report that serum samples should be diluted at least 35-fold to eliminate the endogenous inhibitor effect of albumin. No significant interferences were detected: up to a triglyceride concentration of 16 mM, a hemoglobin concentration of 0.71 g/L and a bilirubin concentration of 150 µM. Genotype-dependent reference intervals were considered as 3.76-11.25 U/L, 5.22-11.59 U/L, 7.19-14.84 U/L for II, ID and DD genotypes, respectively. I/D genotype-independent reference interval was established as 4.85-13.79 U/L. An ACE activity value was considered positive for sarcoidosis when it exceeded the upper limit of the reference interval. The optimized assay with genotype-dependent reference ranges resulted in 42.5% sensitivity, 100% specificity, 100% positive predictive value and 32.4% negative predictive value in the clinical study, whereas the genotype-independent reference range proved to have inferior diagnostic efficiency. CONCLUSIONS: An optimized fluorescent kinetic assay of serum ACE activity combined with ACE I/D genotype determination is an alternative to invasive biopsy for confirming the diagnosis of sarcoidosis in a significant percentage of patients.


Assuntos
Ensaios Enzimáticos/métodos , Peptidil Dipeptidase A/sangue , Peptidil Dipeptidase A/normas , Sarcoidose/diagnóstico , Adulto , Idoso , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Peptidil Dipeptidase A/genética , Polimorfismo Genético , Valores de Referência
17.
Turk J Anaesthesiol Reanim ; 44(5): 247-249, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27909605
18.
Acta Physiol Hung ; 100(2): 163-72, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23524179

RESUMO

BACKGROUND: Previously a report has suggested that administration of lung protective strategy for one-lung ventilation(OLV) results in oxygen desaturation of the brain parenchyma. The aim of our work was to confirm that the maintenance of normocapnia during protective OLV strategy results in alteration of cerebral blood fl ow and cerebral oxygen saturation as compared to double-lung ventilation. METHODS: Data were obtained from 24 patients undergoing thoracic surgery. Cerebral oxygen saturation (rSO2) was continuously monitored by INVOS 5100C Cerebral Oxymeter System along with measurement of cerebral blood fl ow velocity (MCAV) by transcranial Doppler sonography. Arterial blood samples were taken for blood gas analysis in the awake state, in the supine and lateral decubitus position during double-lung ventilation (DLV), and during OLV. RESULTS: When ventilation was changed from DLV to OLV, no significant change was observed in rSO2. A significant decrease of rSO2 was found compared to the value observed during DLV in lateral decubitus at the time point 60 minutes after the start of OLV. No clinically significant changes in the MCAV was observed throughout the course of the thoracic surgical procedure. CONCLUSIONS: OLV does not result in clinically relevant decreases in cerebral blood fl ow and cerebral oxygen saturation during application of lung protective ventilation if normocapnia is maintained.


Assuntos
Ventilação Monopulmonar/métodos , Adulto , Idoso , Velocidade do Fluxo Sanguíneo , Dióxido de Carbono/sangue , Circulação Cerebrovascular , Feminino , Humanos , Hipóxia/prevenção & controle , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Volume de Ventilação Pulmonar
19.
J Anesth ; 26(3): 375-80, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22278374

RESUMO

PURPOSE: In some thoracic surgical procedures, the insertion of a double-lumen tube (DLT) is not feasible, or the altered use of a DLT and a single-lumen tube (SLT) is justified during the surgery. In the present article we report our experience with a new bronchial blocker, the EZ-blocker, in clinical use. METHODS: Data were obtained from ten patients undergoing thoracic surgery necessitating one-lung ventilation. For lung isolation, a combination of an SLT and an EZ-blocker was used. The time of insertion and positioning of the EZ-blocker, the lung deflation time with the EZ-blocker cuff inflated and deflated, and the cuff's minimal occlusion volume were recorded. Based on the CT scan, the diameter of the main bronchi and the angle of the bifurcation were measured offline. RESULTS: The insertion duration of the EZ-blocker was 76 ± 15 s. Two malpositionings were caused by the too-deep positioning of the SLT used for introducing the EZ-blocker, which could be corrected within 65 ± 7 s. The use of the EZ-blocker allowed a short deflation time of the lung without (9.4 ± 0.7 s) and with (4.1 ± 0.7 s) administration of suctioning. The proper block was only dependent on the diameter of the main bronchi and was independent of the bifurcation angle. CONCLUSIONS: Use of the EZ-blocker is easy and safe. The short insertion time and short lung deflation time through the lumen of the SLT allows its use in emergency situations or in cases of a difficult airway.


Assuntos
Intubação Intratraqueal/instrumentação , Respiração Artificial/instrumentação , Adulto , Idoso , Humanos , Pessoa de Meia-Idade
20.
Orv Hetil ; 151(41): 1708-11, 2010 Oct 10.
Artigo em Húngaro | MEDLINE | ID: mdl-20880806

RESUMO

Reexpansion pulmonary edema (RPE) is a rare entity that develops after reexpansion in a chronically collapsed lung. There is a broad clinical spectrum of the disease ranging from asymptomatic appearance to lethal form that occurs in approximately 20% of the cases. The pathophysiological background is complex and not clarified in all details. RPE may be prevented by knowing and treating potential risk factors. This review summarizes the updated knowledge on the pathophysiological background, clinical picture and treatment modalities of RPE.


Assuntos
Atelectasia Pulmonar/terapia , Edema Pulmonar/fisiopatologia , Edema Pulmonar/terapia , Humanos , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA