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OBJECTIVE: To make a comprehensive assessment of a pacient who has a thoracoscopy or thoracic window that needs wound care. Through the functional patterns of Marjory Gordon and the NANDA taxonomy (North American Nursing Diagnosis Association), NIC (Nursing Interventions Classification), and NOC (Nursing Outcomes Classification). As well as helping the healing and closing time of the wound to be shorter, reducing the risk of infection and improving the quality of life of the patient. CASE PRESENTATION: The clinical case of the patient with thoracic window is described. The real and potential diagnoses were established, some objectives or NOC were set and the necessary activities or NIC were carried out to reach them. RESULTS: On a Likert scale (1 to 5), a wound healing was obtained, from 1 to 3, a level of anxiety, from 3 to 4, a problem coping, from 3 to 4, a level of self-care, from 2 to 4, the promotion of health, from 2 to 4, and the therapeutic regimen, from 2 to 4, after one year of follow-up. CONCLUSIONS: The comprehensive approach that should be performed to the patient, not focused only on the reason for the consultation, but assessing the different functional patterns to know which are altered and take into account the evolution of the process and better care and quality improvement of the patient's life.
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Prisões , Toracostomia/enfermagem , Adulto , Humanos , Masculino , EspanhaRESUMO
BACKGROUND AND PURPOSE: The pulvinar sign refers to exclusive T1WI hyperintensity of the lateral pulvinar. Long considered a common sign of Fabry disease, the pulvinar sign has been reported in many pathologic conditions. The exact incidence of the pulvinar sign has never been tested in representative cohorts of patients with Fabry disease. The aim of this study was to assess the prevalence of the pulvinar sign in Fabry disease by analyzing T1WI in a large Fabry disease cohort, determining whether relaxometry changes could be detected in this region independent of the pulvinar sign positivity. MATERIALS AND METHODS: We retrospectively analyzed brain MR imaging of 133 patients with Fabry disease recruited through specialized care clinics. A subgroup of 26 patients underwent a scan including 2 FLASH sequences for relaxometry that were compared with MRI scans of 34 healthy controls. RESULTS: The pulvinar sign was detected in 4 of 133 patients with Fabry disease (3.0%). These 4 subjects were all adult men (4 of 53, 7.5% of the entire male population) with renal failure and under enzyme replacement therapy. When we tested for discrepancies between Fabry disease and healthy controls in quantitative susceptibility mapping and relaxometry maps, no significant difference emerged for any of the tested variables. CONCLUSIONS: The pulvinar sign has a significantly lower incidence in Fabry disease than previously described. This finding, coupled with a lack of significant differences in quantitative MR imaging, allows hypothesizing that selective involvement of the pulvinar is a rare neuroradiologic sign of Fabry disease.
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Doença de Fabry/patologia , Pulvinar/patologia , Adolescente , Adulto , Idoso , Doença de Fabry/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pulvinar/diagnóstico por imagem , Estudos Retrospectivos , Adulto JovemRESUMO
We investigated five methylation markers recently linked to body mass index, for their role in the neuropathology of obesity. In neuroimaging experiments, our analysis involving 23 participants showed that methylation levels for the cg07814318 site, which lies within the KLF13 gene, correlated with brain activity in the claustrum, putamen, cingulate gyrus and frontal gyri, some of which have been previously associated to food signaling, obesity or reward. Methylation levels at cg07814318 also positively correlated with ghrelin levels. Moreover, expression of KLF13 was augmented in the brains of obese and starved mice. Our results suggest the cg07814318 site could be involved in orexigenic processes, and also implicate KLF13 in obesity. Our findings are the first to associate methylation levels in blood with brain activity in obesity-related regions, and further support previous findings between ghrelin, brain activity and genetic differences.
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Proteínas de Ciclo Celular/genética , Metilação de DNA , Grelina/metabolismo , Fatores de Transcrição Kruppel-Like/genética , Neurônios/metabolismo , Obesidade/genética , Obesidade/metabolismo , Orexinas/metabolismo , Proteínas Repressoras/genética , Animais , Regulação do Apetite , Encéfalo/citologia , Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Proteínas de Ciclo Celular/metabolismo , Comportamento Alimentar/fisiologia , Neuroimagem Funcional , Regulação da Expressão Gênica , Humanos , Fatores de Transcrição Kruppel-Like/metabolismo , Masculino , Camundongos , Obesidade/fisiopatologia , Receptores de Grelina/metabolismo , Proteínas Repressoras/metabolismo , RecompensaRESUMO
Irritable bowel syndrome (IBS) is characterized by visceral hypersensitivity likely related to altered processing of sensory stimuli along the brain-gut axis. Previous neuroimaging studies demonstrated structural and functional alteration of several brain areas involved in bodily representation, e.g. the insula, in patients with IBS. By means of resting-state functional magnetic resonance imaging (rs-fMRI) we searched for alteration of functional connectivity within the network involved in self-bodily consciousness. We found significant inverse correlation between hypochondriasis assessed through a clinical questionnaire and connectivity between posterior cingulate cortex and left supramarginal gyrus, extending into the adjacent superior temporal gyrus. Moreover, we observed a significant and positive correlation between a clinical questionnaire assessing interoception and connectivity between left anterior ventral insula and two clusters located in supramarginal gyrus bilaterally.Our findings highlight an "abnormal network synchrony" reflecting functional alteration, in the absence of structural and micro-structural changes, which might represent a possible therapeutic target for Irritable Bowel Syndrome.
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Encéfalo/fisiopatologia , Interocepção , Síndrome do Intestino Irritável/fisiopatologia , Síndrome do Intestino Irritável/psicologia , Adulto , Idoso , Conscientização , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico , Feminino , Humanos , Síndrome do Intestino Irritável/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Vias Neurais/diagnóstico por imagem , Vias Neurais/fisiopatologia , Testes Neuropsicológicos , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: In response to food cues, obese vs normal-weight individuals show greater activation in brain regions involved in the regulation of food intake under both fasted and sated conditions. Putative effects of obesity on task-independent low-frequency blood-oxygenation-level-dependent signals-that is, resting-state brain activity-in the context of food intake are, however, less well studied. OBJECTIVE: To compare eyes closed, whole-brain low-frequency BOLD signals between severely obese and normal-weight females, as assessed by functional magnetic resonance imaging (fMRI). METHODS: Fractional amplitude of low-frequency fluctuations were measured in the morning following an overnight fast in 17 obese (age: 39±11 years, body mass index (BMI): 42.3±4.8 kg m-2) and 12 normal-weight females (age: 36±12 years, BMI: 22.7±1.8 kg m-2), both before and 30 min after consumption of a standardized meal (~260 kcal). RESULTS: Compared with normal-weight controls, obese females had increased low-frequency activity in clusters located in the putamen, claustrum and insula (P<0.05). This group difference was not altered by food intake. Self-reported hunger dropped and plasma glucose concentrations increased after food intake (P<0.05); however, these changes did not differ between the BMI groups. CONCLUSION: Reward-related brain regions are more active under resting-state conditions in obese than in normal-weight females. This difference was independent of food intake under the experimental settings applied in the current study. Future studies involving males and females, as well as utilizing repeated post-prandial resting-state fMRI scans and various types of meals are needed to further investigate how food intake alters resting-state brain activity in obese humans.
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Peso Corporal/fisiologia , Encéfalo/fisiopatologia , Ingestão de Alimentos , Comportamento Alimentar , Obesidade/fisiopatologia , Descanso/fisiologia , Recompensa , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Estudos de Casos e Controles , Sinais (Psicologia) , Ingestão de Alimentos/psicologia , Potenciais Evocados/fisiologia , Jejum/fisiologia , Jejum/psicologia , Feminino , Alimentos , Humanos , Imageamento por Ressonância Magnética , Obesidade/diagnóstico por imagem , Obesidade/psicologia , Período Pós-Prandial/fisiologia , Saciação/fisiologiaRESUMO
A placa aural é uma dermatopatia associada à quatro Equus caballus papillomavirus (EcPVs). Até o momento, o DNA de EcPVs não foi identificado em amostras de placa aural fixadas em formalina e embebidas em parafina (FFPE). O objetivo deste estudo foi otimizar um método para a detecção dos quatro tipos de EcPVs em 21 amostras FFPE usando a PCR. O DNA dos EcPVs foram detectados em 11 amostras (52.4%). O DNA do EcPV4 foi detectado em 38.1% (8/21) e do EcPV3 em 4.8% (1/21) das amostras. Coinfecção foi identificada em duas amostras (9.5%); EcPV4 e 5 foram detectados simultaneamente em uma amostra, enquanto o DNA dos EcPV4 e 6 foi detectado em outra. A especificidade do DNA dos papilomavírus equinos foi avaliada por sequenciamento gênico direto, que confirmou a especificidade dos produtos. A metodologia de PCR proposta possibilita o diagnóstico dos EcPV3, 4, 5 e 6 em amostras FFPE de placa aural equina.(AU)
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Animais , Métodos Analíticos de Preparação de Amostras/veterinária , Testes de DNA para Papilomavírus Humano/veterinária , Cavalos/virologia , Parafina , Reação em Cadeia da Polimerase/veterináriaRESUMO
Colletotrichum truncatum is an extremely important fungal pathogen. It can cause diseases both in humans and in over 460 plant species. However, little is known about its genetic diversity within and among populations. One of the major plant hosts of C. truncatum is pepper, and China is one of the main pepper-producing countries in the world. Here, we propose the hypotheses that geography has a major influence on the relationships among populations of C. truncatum in China and that infections in different populations need to be managed differently. To test these hypotheses, we obtained and analyzed 266 C. truncatum isolates from 13 regions representing the main pepper-growing areas throughout China. The analysis based on nine microsatellite markers identified high intrapopulation genetic diversity, evidence of sexual recombination, and geographic differentiation. The genetic differentiation was positively correlated with geographic distance, with the southern and northern China populations grouped in two distinct clusters. Interestingly, isolates collected from the pepper-breeding center harbored the most private alleles. The results suggest that the geographic populations of C. truncatum on peppers in China are genetically differentiated and should be managed accordingly. Our study also provides a solid foundation from which to further explore the global genetic epidemiology of C. truncatum in both plants and humans.
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REASONS FOR PERFORMING THE STUDY: Toxin detection and screening could contribute to knowledge of the transmission patterns, risk factors and epidemiology of Clostridium difficile and Clostridium perfringens. OBJECTIVE: To isolate C. difficile and C. perfringens and to detect A/B toxins in faecal samples from diarrhoeic and nondiarrhoeic foals. STUDY DESIGN: Cross-sectional observational study. METHODS: A total of 153 samples from foals were collected: 139 samples from farms and 14 samples from diarrhoeic foals admitted to a veterinary hospital. The A/B toxins were detected by cytotoxicity assay. All suspected colonies of C. perfringens were subjected to polymerase chain reaction for detection of the major toxin genes (α, ß, ε and ι) and for detection of ß2-, NetB- and enterotoxin-encoding genes. Furthermore, C. difficile and C. perfringens isolates were evaluated for in vitro antimicrobial susceptibility. RESULTS: Seven of 153 (4.6%) samples, all from diarrhoeic foals, were positive for C. difficile A/B toxin. Of these, 5 of 14 (35.7%) were from hospitalised foals, and only 2 of 63 (3.2%) diarrhoeic foal samples were from farms (P = 0.002). Clostridium perfringens was isolated from 31 (20.3%) foals, of which 21 of 76 (27.6%) were diarrhoeic and 10 of 76 (13.2%) were nondiarrhoeic, demonstrating a difference between these 2 groups (P = 0.045). Only 4 strains were positive for the ß2-encoding gene (cpb2). All C. difficile and C. perfringens isolates were susceptible to metronidazole and vancomycin. CONCLUSIONS: The present report highlights the need for laboratory diagnostics to differentiate C. difficile-associated infection in foals from other causes of diarrhoea to facilitate adequate antimicrobial therapy. POTENTIAL RELEVANCE: More studies are needed to clarify the role of C. perfringens as a primary agent of diarrhoea in foals.
Assuntos
Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/veterinária , Clostridium perfringens/isolamento & purificação , Doenças dos Cavalos/microbiologia , Animais , Toxinas Bacterianas , Infecções por Clostridium/microbiologia , Clostridium perfringens/genética , Clostridium perfringens/metabolismo , Estudos Transversais , Diarreia/microbiologia , Diarreia/veterinária , Regulação Bacteriana da Expressão Gênica/fisiologia , Cavalos , Reação em Cadeia da Polimerase/veterináriaRESUMO
BACKGROUND: Stratification of the severity of heart failure has major prognostic and therapeutic implications. AIMS: To prospectively compare different methods of assessment of functional capacity in patients with chronic heart failure (CHF). METHODS AND RESULTS: We studied 143 patients (78 male and 65 female) with CHF aged less than 70 years (mean 57.3 years). Functional assessment was made clinically according to NYHA classification and according to the Goldman Activity Scale Classification (GASC). Cardiovascular performance was measured by peak O(2) consumption (pVO(2)) and anaerobic threshold (AT) at cardiopulmonary exercise test and by the distance walked during a 6-min walk test (6-MWT). Clinical scales resulted significantly related. Peak VO(2) and AT showed a mild relation with distance covered at 6-MWT (r=0.56 and r=0.46, respectively). Concordance between NYHA classification and levels of performance at cardiopulmonary exercise test or at 6-MWT was less than 50%. CONCLUSION: Our results suggest that none of the usually employed methods give a definitive assessment of functional capacity of cardiovascular system and a high degree of discordance exists among the results of different tests in the same patient. Although NYHA classification maintains its value in clinical evaluation of patients with CHF, the 6-min walk test is recommended in patients with mild-to-moderate CHF (II-III NYHA classes) as a simple and useful screening test to select patients for further diagnostic evaluation.
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Insuficiência Cardíaca/fisiopatologia , Função Ventricular Esquerda/fisiologia , Adulto , Idoso , Limiar Anaeróbio , Gasometria , Doença Crônica , Ecocardiografia , Teste de Esforço , Feminino , Insuficiência Cardíaca/classificação , Insuficiência Cardíaca/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Pico do Fluxo Expiratório , Estudos Prospectivos , Radiografia , Índice de Gravidade de Doença , Volume SistólicoRESUMO
Decreased sensitivity of cardiopulmonary and arterial baroreceptors has been hypothesized to sustain sympathetic activation in patients with heart failure. In the present investigation the relationship between the impairment of baroreflex sensitivity and clinical severity of congestive heart failure was investigated. The authors studied 58 patients with heart failure (14 in NYHA class I, 22 in NYHA class II, and 22 in NYHA class III), 38 women and 20 men, age range 28-65 years. Thirty-two patients suffered from idiopathic dilated cardiomyopathy and 26 from coronary heart disease. As control group they examined 21 age-matched subjects. Baroreceptor sensitivity was studied by using the Valsalva maneuver as stimulus. Arterial pressure and heart rate were measured noninvasively by Finapres instrument (Ohmeda) and signals were recorded and elaborated with a personal computer. A decrease of baroreflex sensitivity was already demonstrable in NYHA class I patients (4.72 +/- 3.31 vs 9.25 +/- 5.05 msec/mm Hg in control group) (p < 0.005). A further impairment of baroreceptor response was found in patients in NYHA class II (1.94 +/- 2.88 msec/mm Hg, p < 0.001) and class III (1.78 +/- 1.52 msec/mm Hg, p < 0.001). Baroreceptor response showed a significant correlation with functional NYHA class (r = 0.61, p < 0.001) and anaerobic threshold (r = 0.57, p < 0.001) while the correlation was less tight with left ventricular end-diastolic diameter, fractional shortening, left ventricular ejection fraction, pulmonary mean arterial blood pressure, cardiac index, distance at 6 minutes walk corridor test, and maximal oxygen consumption (VO2max). These results suggest that baroreceptor function may be impaired early in the clinical course of heart failure and may contribute to sympathetic activation.
Assuntos
Barorreflexo/fisiologia , Insuficiência Cardíaca/fisiopatologia , Pressorreceptores/fisiopatologia , Manobra de Valsalva , Adulto , Idoso , Pressão Sanguínea , Ecocardiografia Doppler , Teste de Esforço , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/metabolismo , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Prognóstico , Índice de Gravidade de Doença , Volume SistólicoRESUMO
To evaluate the physiological basis for suboptimal peak exercise oxygen consumption (VO2p) observed in the early stage of hypertension, 25 WHO Stage I hypertensive men with normal left ventricular mass and 10 healthy control subjects of equivalent age underwent the maximal cardiopulmonary exercise test with contemporary measurement of cardiac output with Tc99m angiocardiography. At peak exercise hypertensive patients had lower VO2p (p < 0.045) and cardiac output (p < 0.014) and higher vascular resistance (p < 0.010) than controls. At multiple regression analysis VO2 was positively related to cardiac output in controls (r = 0.80, p < 0.02), whereas in hypertensives the best (negative) correlation was observed with peripheral vascular resistance (r = -0.72, p < 0.04). Thus reduced cardiopulmonary function during physical exercise in hypertensives seems to be mainly related to impaired peripheral vascular autoregulation.
Assuntos
Exercício Físico/fisiologia , Hipertensão/fisiopatologia , Resistência Vascular/fisiologia , Adulto , Idoso , Limiar Anaeróbio/fisiologia , Pressão Sanguínea/fisiologia , Dióxido de Carbono/metabolismo , Débito Cardíaco/fisiologia , Ecocardiografia , Teste de Esforço , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Homeostase/fisiologia , Humanos , Hipertensão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Consumo de Oxigênio/fisiologia , Ventriculografia com Radionuclídeos , Compostos Radiofarmacêuticos , Análise de Regressão , TecnécioRESUMO
Echocardiography is frequently required in patients with atrial fibrillation (AF) to exclude underlying heart disease. In the present investigation the authors evaluated 56 patients with paroxysmal AF (PAF) (27 men, 29 women, mean age 54+/-11.3 years) in whom lone AF was suspected on clinical grounds. M-mode, B-mode, and Doppler examination were performed and measurements taken according to American Society of Echocardiography criteria. Left atrial diameter, left and right atrial volumes, left ventricular (LV) diameters, LV fractional shortening, and Doppler indexes of LV diastolic function were not different in patients with PAF in comparison with those of a control group of 56 age-matched subjects free from cardiovascular diseases. Echocardiographic examination results were entirely normal in 32/56 patients (57%) vs 39/56 of the control group (69%). Mitral valve prolapse was found in five patients (9%), but only one showed mild mitral regurgitation. Doppler examination disclosed a mild (+/++) mitral regurgitation in eight patients and a small aortic or pulmonary diastolic flow in four and two patients, respectively, in the absence of significant morphologic valvular abnormalities. In these patients the sizes of heart chambers were entirely normal. Aneurysm of the interatrial septum was found in one patient and an increased thickness of the epipericardial junction in another two patients. Finally two patients had a small increase of right atrial volume without demonstrable causes. The results suggest that lone AF can be correctly suspected on the basis of clinical findings (history, physical examination, and ECG) and that in these patients echocardiography rarely discloses organic heart disease.
Assuntos
Fibrilação Atrial/diagnóstico por imagem , Ecocardiografia Doppler , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Estudos de Casos e Controles , Eletrocardiografia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
The relationship between impaired baroreflex sensitivity (BS) and the degree of sympathetic activation during exercise in patients with heart failure (HF) has not been studied in detail. For this purpose, we studied BS and measured plasma norepinephrine (NE) at rest, and during and after treadmill exercise in 15 patients and 10 controls. HF patients showed lower BS in comparison to controls (3. 51 +/- 3.62 vs. 9.74 +/- 4.56 ms/mm Hg; p < 0.001), and higher levels of plasma NE at rest (449.3 +/- 147.1 vs. 261.1 +/- 82.48 pg/ml; p < 0.001) and during exercise (1,542 +/- 361.2 vs. 524.6 +/- 92.61 pg/ml; p < 0.001). BS was directly related to pVO2 (r = 0.62; p = 0.0008) and inversely related to NE at peak exercise and to the increase in NE during exercise (r = 0.59, p = 0.005, and r = 0.53; p = 0.0058). Thus, during exercise, a marked sympathetic activation exists in patients with moderate HF. The relationship between increased plasma NE during exercise and decreased BS suggests that impaired baroreceptor function may be present in sympathetic activation in HF patients.
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Barorreflexo/fisiologia , Cardiomiopatia Dilatada/fisiopatologia , Sistema Nervoso Simpático/fisiopatologia , Adulto , Pressão Sanguínea/fisiologia , Cardiomiopatia Dilatada/sangue , Teste de Esforço , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Norepinefrina/sangue , Consumo de Oxigênio/fisiologia , Manobra de Valsalva/fisiologiaRESUMO
Left atrial enlargement has been demonstrated to occur as a consequence of the arrhythmia in patients with chronic atrial fibrillation (AF) in the absence of organic heart disease, whereas contrasting results have been reported in patients with paroxysmal lone AF. In the present investigation the behavior of left atrial size was followed up for an average period of 30.3 months in 20 patients with paroxysmal lone AF since their first arrhythmic episode. No significant changes in left atrial size were found at the end of the follow-up period. In 65% of patients the arrhythmia recurred at least once yearly. Left atrial size at enrollment was not significantly different in these patients from those without recurrences and did not change in either group during follow-up. The results suggest that in patients with lone AF left atrial dilatation occurs only after the arrhythmia becomes chronic. Early restoration of sinus rhythm may interrupt the vicious circle leading to atrial enlargement.
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Fibrilação Atrial/complicações , Cardiomegalia/complicações , Adulto , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Cardiomegalia/diagnóstico por imagem , Cardiomegalia/fisiopatologia , Doença Crônica , Ecocardiografia , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Função Ventricular EsquerdaRESUMO
To differentiate bacterial from viral infections the level of C-reactive protein in serum samples was studied in three groups of children under 5 years of age with gastroenteritis. Of the 53 children with bacterial infection, 41 (77%) had C-reactive protein levels > or = 12 mg1 -1, 32 (66%) > or = 20 mgl-1 and 24 (45%) > or = 35 mgl-1. Of the 35 patients with viral infection, 4 (11%) had C-reactive protein levels > or = 12 mgl-1, 3 (9%) > or = 20 mgl-1 and 1 (3%) > or = 35 mgl-1. The best balance between sensitivity and specificity of C-reactive protein was obtained for a cut-off level > or = 12 mgl-1 (sensitivity 77%, specificity 89%) as compared to > or = 20 mgl-1 (sensitivity 58%, specificity 97%) and > or = 35 mgl-1 (sensitivity 44%, specificity 97%). Our results suggest that the determination of C-reactive protein values may be a useful tool for predicting bacterial gastroenteritis in children.
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Infecções Bacterianas/complicações , Proteína C-Reativa/metabolismo , Gastroenterite/imunologia , Gastroenterite/microbiologia , Viroses/complicações , Doença Aguda , Sedimentação Sanguínea , Diagnóstico Diferencial , Gastroenterite/sangue , Gastroenterite/diagnóstico , Humanos , Lactente , Recém-Nascido , Contagem de Leucócitos , Programas de Rastreamento , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Progressive systemic sclerosis (PSS) is characterized in its first phases by vascular damage. Lungs are involved in two thirds of patients with initial progressive destruction of the capillary bed and consequent reduction of the functional reserve, which may lead to hypertension of the pulmonary circulation. For these reasons it is of great interest to have early information about the pressure of the pulmonary circulation, both at rest and during exercise, to follow the progression and the evolution of the illness independently from subjective symptoms. The aim of the study was to evaluate by a noninvasive method, saline-enhanced Doppler echocardiography, the behavior of the right ventricular systolic pressure in patients with PSS, at rest and during exercise, without clear instrumental or clinical signs of pulmonary involvement at rest. Nine patients (7 women and 2 men) with PSS, aged 55.7 +/- 8.7 years, and 9 control subjects were evaluated. All patients had normal pulmonary pressure at rest and negative history for effort dyspnea. Subjects underwent Doppler echocardiographic examination at rest and during exercise. Right ventricular systolic pressure was evaluated by saline-enhanced Doppler technique, at rest and throughout exercise. At rest the right ventricular systolic pressure was normal in all patients and controls. At the end of exercise, in 4 patients, values were still normal (40.7 +/- 2.2 mmHg); in the others pathologic values were recorded (59.8 +/- 3.9 mmHg). In the control group values were always normal (35.6 +/- 4.6 mmHg). In our study the saline-enhanced Doppler echocardiography has been demonstrated to be an important diagnostic tool for the noninvasive evaluation of right ventricular systolic pressure, both at rest and during exercise; it could be useful in monitoring the pulmonary vascular damage in patients with PSS.
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Ecocardiografia Doppler , Exercício Físico/fisiologia , Escleroderma Sistêmico/fisiopatologia , Função Ventricular Direita/fisiologia , Pressão Ventricular/fisiologia , Adulto , Teste de Esforço , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Cloreto de Sódio , Função VentricularRESUMO
Pulmonary hypertension has a negative prognostic value in the progression of chronic obstructive lung disease. The hypoxic vasoconstriction and subsequent morphological alterations that occur in the small arteries and in the pre-capillary arterioles may contribute to the reduction of the pulmonary vascular bed. The evolution of pulmonary hypertension in patients with chronic obstructive lung disease is not rapid except during relapses of the disease. Oxygen therapy reduces pulmonary arterial pressure values not only via a reduction in the functional abnormalities of the vessels but also via a regression in the anatomic changes induced by hypoxemia. Thus, long-term oxygen therapy may slow the progression of pulmonary hypertension in the course of chronic obstructive lung disease and the longer is oxygen administration the better haemodynamic results are obtained. The Medical Research Council (MRC) Study and the Nocturnal Oxygen Therapy Trial (NOTT) have clearly demonstrated that mortality among hypoxiemic patients treated with low-flow oxygen therapy is reduced; the NOTT also reported a reduction of about 10% in the levels of pulmonary vascular resistances in patients treated with long-term oxygen therapy, while an increase of about 7% has been observed in patients treated with oxygen therapy only during the night. Nevertheless, the reduction of mortality observed during long-term oxygen therapy not always is accompanied by an haemodynamic improvement; in particular a reduction in the pulmonary arterial pressure seems not to reduce mortality. In conclusion long term oxygen therapy may slow the progression of pulmonary hypertension during chronic obstructive lung disease while the improvement in pulmonary haemodynamic due to oxygen therapy is not strictly correlated with a reduction of mortality.
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Hipertensão Pulmonar/terapia , Pneumopatias Obstrutivas/terapia , Oxigenoterapia , Hemodinâmica , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Hipóxia/etiologia , Hipóxia/fisiopatologia , Hipóxia/terapia , Pneumopatias Obstrutivas/complicações , Pneumopatias Obstrutivas/fisiopatologia , Prognóstico , Fatores de TempoRESUMO
The case of a 68-year-old woman with lung adenocarcinoma complicated by apparently isolated widespread meningeal metastasis is described. Meningeal carcinomatosis is a rare complication of solid neoplasms. In fact, it occurs in less than 2% of lung carcinoma which is the most frequent cause of this syndrome. Although computed tomography and nuclear magnetic resonance may aid the diagnosis of this condition, only the cytological demonstration of neoplastic cells in the cerebrospinal fluid directly establishes it. In this patient, the onset of symptoms due to meningeal carcinomatosis complicated the course of a diagnosed lung adenocarcinoma with the acute onset of a confusional state and extended meningeal dissemination without clinical or instrumental findings of metastasis in other areas of the body. Acute confusional state is seldom the initial symptom of meningeal carcinomatosis. Nevertheless, in the neoplastic patient, this possibility must be taken into account after the most common causes of acute confusion have been excluded. Even when modern diagnostic imaging techniques are utilized, diagnosis must be confirmed by cytological examination of the cerebrospinal fluid.
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Adenocarcinoma/secundário , Neoplasias Pulmonares/patologia , Neoplasias Meníngeas/secundário , Adenocarcinoma/diagnóstico , Adenocarcinoma/psicologia , Idoso , Confusão/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/psicologiaRESUMO
Aplasia cutis congenita is a heterogeneous group of disorders characterized by focal absence of skin at birth. In the majority of cases, the involved area is limited to the scalp. These disorders are relatively rare. As a result of misinterpretation, medicolegal advice can be sought by parents who believed that their child's scalp had been injured during surgical induction of labour or fetal monitoring. We report four additional patients (two familiar and two sporadic cases) and discuss, in the light of a comprehensive review of the literature, the probable pathogenesis, the clinical variability and the treatment.
Assuntos
Couro Cabeludo/anormalidades , Anormalidades da Pele , Fatores Etários , Alopecia/congênito , Feminino , Seguimentos , Humanos , Recém-Nascido , Masculino , Linhagem , Fatores de TempoRESUMO
An impaired maximal vasodilating capacity has been reported in hypertensives. This study aimed to assess whether mild hypertensives depend on anaerobic metabolism more than do normal subjects during the exercise stress test. The oxygen uptake (VO2) and carbon dioxide output (VCO2) were measured at the anaerobic threshold (AT) and at peak exercise (VO2p and VCO2p) during the cardiopulmonary exercise test by breath-by-breath expiratory gas analysis in 21 mild hypertensives and 19 age-matched normotensives. AT was reached earlier in hypertensives than in normotensives, but with similar VO2 uptake, VCO2 output, and VCO2/VO2 ratio. At peak exercise, however, hypertensives showed lower VO2p than controls (29 +/- 5 v 33 +/- 5 mL VO2/kg/min, (P < .03) but similar VCO2p (36 +/- 6 v 39 +/- 6 mL VCO2/kg/min, P = .19). As a result, the slope of carbon dioxide output increase versus oxygen uptake after anaerobic threshold was steeper in hypertensives than in controls (P < .002). The higher CO2 production per unit of O2 in hypertensives as compared with controls seems to reflect a greater involvement of the anaerobic metabolism to supplement energy output.