RESUMO
Jeune's Syndrome or asphyxiating thoracic dystrophy (ATD) is a rare autosomal recessive skeletal dysplasia syndrome characterized by a small and narrow chest, short extremities, and often polydactyly associated with multiple organ manifestations. The severity of complications ranges from mild to lethal. This is a report of two cases of ATD diagnosed in successive pregnancies of a nonconsanguineous couple. The contribution of sonography in prenatal diagnosis of the syndrome is highlighted.
Assuntos
Síndrome de Ellis-Van Creveld/diagnóstico por imagem , Feminino , Humanos , Masculino , Gravidez , Recidiva , Ultrassonografia Pré-Natal , Adulto JovemRESUMO
The authors report a diamniotic dichorionic twin pregnancy after in vitro fertilization (IVF) in mid-second trimester. The dead fetuses were delivered by cesarean section at the 20th week of gestation. The authors discuss management aspects and review of the literature.
Assuntos
Doenças em Gêmeos , Fertilização in vitro , Morte Fetal/diagnóstico , Gravidez de Gêmeos , Gêmeos Dizigóticos , Feminino , Morte Fetal/cirurgia , Idade Gestacional , Humanos , Histerotomia , Pessoa de Meia-Idade , GravidezRESUMO
In acute respiratory distress syndrome (ARDS), recruitment sessions of high-frequency oscillation (HFO) and tracheal gas insufflation (TGI) with short-lasting recruitment manoeuvres (RMs) may improve oxygenation and enable reduction of subsequent conventional mechanical ventilation (CMV) pressures. We determined the effect of adding HFO-TGI sessions to lung-protective CMV on early/severe ARDS outcome. We conducted a prospective clinical trial, subdivided into a first single-centre period and a second two-centre period. We enrolled 125 (first period, n = 54) patients with arterial oxygen tension (P(a,O(2)))/inspiratory oxygen fraction (F(I,O(2))) of <150 mmHg for >12 consecutive hours at an end-expiratory pressure of ≥ 8 cmH(2)O. Patients were randomly assigned to an HFO-TGI group (receiving HFO-TGI sessions with RMs, interspersed with lung-protective CMV; n = 61) or CMV group (receiving lung-protective CMV and RMs; n = 64). The primary outcome was survival to hospital discharge. Pre-enrolment ventilation duration was variable. During days 1-10 post-randomisation, P(a,O(2))/F(I,O(2))), oxygenation index, plateau pressure and respiratory compliance were improved in the HFO-TGI group versus the CMV group (p < 0.001 for group × time). Within days 1-60, the HFO-TGI group had more ventilator-free days versus the CMV group (median (interquartile range) 31.0 (0.0-42.0) versus 0.0 (0.0-23.0) days; p < 0.001), and more days without respiratory, circulatory, renal, coagulation and liver failure (p ≤ 0.003). Survival to hospital discharge was higher in the HFO-TGI group versus the CMV group (38 (62.3%) out of 61 versus 23 (35.9%) out of 64 subjects; p = 0.004). Intermittent recruitment with HFO-TGI and RMs may improve survival in early/severe ARDS.
Assuntos
Ventilação de Alta Frequência/métodos , Insuflação/métodos , Síndrome do Desconforto Respiratório/terapia , Adulto , Idoso , Feminino , Ventilação de Alta Frequência/instrumentação , Humanos , Insuflação/instrumentação , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Síndrome do Desconforto Respiratório/mortalidade , Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: The ductus venosus is a short vessel, present in the newborn infant on the dorsal surface of the liver, connecting the portal and umbilical circulation with the inferior vena cava. Agenesis of the duct is a rare anomaly. CASE: A 28-year-old woman was referred to our department for the first trimester ultrasound evaluation. Detailed scanning revealed agenesis of the duct. Fetal echocardiography showed cardiac disproportion at the level of the ventricles. CONCLUSION: Agenesis of the duct can be related to either cardiac or congenital abnormalities.
Assuntos
Coração Fetal/diagnóstico por imagem , Feto/irrigação sanguínea , Veia Porta/embriologia , Ultrassonografia Pré-Natal , Veias Umbilicais/embriologia , Veia Cava Inferior/embriologia , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Veia Porta/anormalidades , Veia Porta/diagnóstico por imagem , Gravidez , Veias Umbilicais/anormalidades , Veias Umbilicais/diagnóstico por imagem , Veia Cava Inferior/anormalidades , Veia Cava Inferior/diagnóstico por imagemAssuntos
Bacteriemia/diagnóstico , COVID-19/complicações , Candidemia/diagnóstico , Infecção Hospitalar/diagnóstico , Unidades de Terapia Intensiva/estatística & dados numéricos , Bacteriemia/microbiologia , COVID-19/fisiopatologia , Candidemia/microbiologia , Estado Terminal , Infecção Hospitalar/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Sistemas de Infusão de Insulina , Papel do Médico , Médicos de Família , Adulto , Continuidade da Assistência ao Paciente , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Grécia/epidemiologia , Humanos , Masculino , População Rural , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
A 55-year-old HIV-infected patient on antiretroviral treatment with Ritonavir-boosted Tipranavir as part of HAART developed intracranial haemorrhage during the acute phase of cryptococcal meningitis. CT scan and MRI confirmed the intracranial haemorrhage. Positive cryptococcal antigen and cultures of both blood and CSF confirmed the diagnosis of meningitis caused by Cryptococcus neoformans. There was no evidence of any bleeding disorder, use of aspirin or antiplatelet agents. The patient was treated with Liposomal Amphotericin B for cryptococcal meningitis. No special treatment was needed for the intracranial haemorrhage, but Tipranavir was discontinued and replaced by Kaletra and Saquinavir. Intracranial haemorrhage could be related to Tipranavir and cryptococcal meningitis was a predisposing factor. Headache stopped 3 days after starting antifungal treatment. To the best of our knowledge, this is the first reported case of intracranial haemorrhage related to Tipranavir treatment after the end of the "RESIST" studies and the only one related to meningitis.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Fármacos Anti-HIV/efeitos adversos , Infecções por HIV/complicações , Hemorragias Intracranianas/induzido quimicamente , Meningite Criptocócica/complicações , Piridinas/efeitos adversos , Pironas/efeitos adversos , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Causalidade , Cryptococcus neoformans/isolamento & purificação , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Inibidores da Protease de HIV/efeitos adversos , HIV-1 , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Meningite Criptocócica/microbiologia , Pessoa de Meia-Idade , Sulfonamidas , Tomografia Computadorizada por Raios XRESUMO
Stroke represents a leading cause of morbidity and mortality especially among the elderly people, and therefore the need for effective preventive strategies is imperative. The value of physical activity for stroke prevention is not as well established as for other cardiovascular diseases. Despite some conflicting results, the majority of published studies have demonstrated a negative association between physical activity and stroke risk. In this article, we provide a concise overview of the epidemiological studies that investigate this association as well as a comprehensive analysis of the most relevant underlying pathophysiological mechanisms.