RESUMO
Cerebral ischaemia is reported in a 33 year-old woman at 34 weeks gestation during an infusion of ritodrine to stop premature labour. CT Scan revealed multiple ischemic bilateral lesions. These lesions disappeared completely under artificial ventilation and thiopental infusion. The authors discuss the other possible causes of cerebral ischaemia in pregnant patients.
Assuntos
Isquemia Encefálica/etiologia , Trabalho de Parto Prematuro/tratamento farmacológico , Ritodrina/efeitos adversos , Doença Aguda , Adulto , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Cesárea , Feminino , Humanos , Recém-Nascido , Trabalho de Parto Prematuro/complicações , Gravidez , Ritodrina/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
The efficacy of antimicrobial agents against pulmonary infections depends on their local concentrations in the lung. The aims of the present study were to: 1) compare technetium-99m diethylenetriaminepenta-acetic acid (99mTc-DTPA) and urea as markers of epithelial lining fluid (ELF) dilution for measuring ELF concentrations of pharmaceuticals; 2) quantify ELF cefepime concentrations in normal and injured lung; and 3) measure the increase in permeability to cefepime following oleic acid-induced acute lung injury. A modified bronchoalveolar lavage technique, based on equilibration of infused 99mTc-DTPA, was used to measure ELF volume. Cefepime was administered intravenously at steady plasma levels. Six serial bronchoalveolar lavages were performed 5 h after the beginning of infusion. ELF to plasma cefepime concentration ratios were 95 +/- 17 and 100 +/- 14.5% in normal and injured lung respectively. When urea was used as marker, cefepime concentration ratios were underestimated at 16.4 +/- 2.7 and 73.9 +/- 8.4% respectively. Cefepime blood/ airspace clearance increased from 3.8 +/- 0.7 micro x min(-1) in controls to 39.8 +/- 4.9 microL x min(-1) in acute lung injury. It was concluded that: 1) cefepime concentrations in epithelial lining fluid were in equilibrium with those in plasma in both normal and injured lung after 5 h at steady plasma concentrations; 2) epithelial lining fluid cefepime concentration by the urea method was much less underestimated in injured versus normal lung; and 3) acute lung injury induces a 10-fold elevation of cefepime blood/airspace clearance.