RESUMO
Hypopyon usually corresponds to the sedimentation of white blood cells, and it signifies severe intraocular inflammation. This key clinical sign may occur in association with a wide variety of infectious, inflammatory, and neoplastic conditions that may be sight- and, occasionally, life-threatening. A careful history and thorough clinical examination are the cornerstones for orienting the differential diagnosis, identifying the causative agent, and initiating prompt and appropriate treatment. This review outlines the clinical characteristics and management of hypopyon in relation with the underlying causative infectious or noninfectious ocular or systemic diseases.
Assuntos
Endoftalmite/fisiopatologia , Infecções Oculares Bacterianas/fisiopatologia , Uveíte Supurativa/fisiopatologia , Endoftalmite/microbiologia , Infecções Oculares Bacterianas/microbiologia , Humanos , Supuração/fisiopatologia , Uveíte Supurativa/microbiologiaRESUMO
BACKGROUND: Pain is a common, important symptom negatively affecting the well-being and quality of life of patients with hidradenitis suppurativa (HS). The aim of this study was to examine self-reported pain alleviating methods among outpatients attending a tertiary referral center. METHODS: Consecutive patients with HS were invited to complete a questionnaire regarding their self-reported pain alleviating methods for HS associated pain. Additionally, the patients filled out the Dermatology Life Quality Index questionnaire and a visual analog scale for overall distress related to HS and for boil-associated pain in the past month. Information on disease severity and onset was obtained by interview and clinical examination. RESULTS: A total of 134 patients with a mean age of 38.3 years (SD 12.8) participated; 32% (n=43) had Hurley stage i, 52% (n=70) had Hurley stage ii, and 16% (n=21) had Hurley stage iii. Overall, to achieve pain relief, 82% (n=110) of the patients had previously drained pus from the lesions by manual pressure. Compared to patients who did not alleviate pain, patients who attempted to alleviate pain had a higher mean overall disease related distress score (7.43 [SD 2.81] vs. 5.47 [SD 3.37], P<.003), and a higher boil-associated pain score in the past month (6.56 [SD 3.07] vs. 4.39 [SD 3.88], P=.007). CONCLUSION: This study demonstrates that a large proportion of HS patients attempt to alleviate pain through various alternative and homespun methods. These results may reflect a major role of pain in HS and its potential insufficient management by dermatologists.
Assuntos
Furunculose/terapia , Hidradenite Supurativa/terapia , Manejo da Dor/métodos , Dor/etiologia , Autocuidado/métodos , Adulto , Estudos Transversais , Drenagem , Feminino , Furunculose/fisiopatologia , Hidradenite Supurativa/fisiopatologia , Temperatura Alta/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Qualidade de Vida , Comportamento Autodestrutivo , Índice de Gravidade de Doença , Supuração/fisiopatologia , Supuração/terapia , Inquéritos e Questionários , Escala Visual AnalógicaRESUMO
AIM: To assess the impact of local treatment of donor sites wounds in patients with deep burns on the frequency of complications and to identify the main risk factors of complications of donor sites wounds. MATERIAL AND METHODS: There were 486 patients with deep burns who underwent split-thickness skin grafting. Treatment of donor sites wounds was carried by using of moisture-controlled dressings DDB-M in the main group (n=56). Conventional approach including once imposed wet-to-dry gauze bandages was applied in the control group. RESULTS: We identified the structure of complications of the donor sites wounds and the main risk factors of suppuration.
Assuntos
Queimaduras/cirurgia , Transplante de Pele/efeitos adversos , Sítio Doador de Transplante/fisiopatologia , Ferimentos e Lesões/terapia , Bandagens , Queimaduras/fisiopatologia , Humanos , Fatores de Risco , Supuração/etiologia , Supuração/fisiopatologia , Supuração/prevenção & controle , Cicatrização/fisiologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/fisiopatologiaRESUMO
Three Florida pumas ( Puma concolor coryi) that had spent time in captivity prior to being released in the wild were found exhibiting respiratory signs and reluctance to move. All 3 pumas died shortly after immobilization, despite supportive veterinary care. Significant autopsy findings included necrotizing interstitial pneumonia, with pulmonary edema and hyaline membranes, and suppurative myocarditis. Organisms morphologically consistent with Bartonella henselae were identified in intravascular histiocytes in the lung of one of the pumas on histopathology and confirmed via transmission electron microscopy. B. henselae was detected in fresh lung tissue and confirmed by PCR and sequence analysis (16S-23S spacer region, pap31, and rpoB genes) from one of the affected pumas. In all affected pumas, B. henselae was detected by PCR in formalin-fixed, paraffin-embedded lung tissue, and positively staining organisms were identified in sections of lung by immunohistochemistry for B. henselae. In situ hybridization detected B. henselae DNA in lung tissue from 2 of 3 affected pumas. Our case series suggests that B. henselae can be associated with a fatal disease syndrome in Florida pumas. The cause of susceptibility to fatal disease associated with B. henselae infection in these pumas remains unknown.
Assuntos
Infecções por Bartonella/veterinária , Bartonella henselae/isolamento & purificação , Doenças Pulmonares Intersticiais/veterinária , Miocardite/veterinária , Puma , Animais , Infecções por Bartonella/microbiologia , Infecções por Bartonella/fisiopatologia , Florida , Doenças Pulmonares Intersticiais/microbiologia , Doenças Pulmonares Intersticiais/fisiopatologia , Miocardite/microbiologia , Miocardite/fisiopatologia , Pneumonia Necrosante/microbiologia , Pneumonia Necrosante/fisiopatologia , Pneumonia Necrosante/veterinária , Supuração/microbiologia , Supuração/fisiopatologia , Supuração/veterináriaRESUMO
Bronchiectasis is a structural airway disease characterized by dilated bronchi and bronchioles due to severe or recurrent lower airways inflammation. Bronchiectasis can occur as a result of chronic pulmonary aspiration. Bronchiectasis may also be associated with a wide variety of systemic diseases, which should be considered in the differential diagnosis. Children with bronchiectasis typically have a chronic or recurrent productive cough and carry a significant burden of disease with a considerable impact on quality of life. The diagnosis of bronchiectasis is made by high-resolution chest computerized tomography. Aggressive management of bronchiectasis is necessary to reduce the daily symptom burden and frequency of exacerbations. Chronic suppurative lung disease may be a precursor to bronchiectasis, only lacking the defining radiographic features of bronchiectasis. Children with chronic suppurative lung disease may have the same symptoms as children with bronchiectasis and should be treated similarly. Protracted bacterial bronchitis is defined as a cough lasting at least four weeks that responds to antibiotic therapy. Protracted bacterial bronchitis may occur following a viral respiratory tract infection. Protracted bacterial bronchitis can be treated with a prolonged course of empiric antibiotics. Further evaluation is necessary if a child with suspected protracted bacterial bronchitis does not adequately respond to antibiotics as chronic suppurative lung disease or bronchiectasis must be considered.
Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/diagnóstico , Bronquiectasia/diagnóstico , Bronquite/diagnóstico , Pneumopatias/diagnóstico , Supuração/diagnóstico , Infecções Bacterianas/complicações , Bronquiectasia/tratamento farmacológico , Bronquiectasia/fisiopatologia , Bronquite/tratamento farmacológico , Bronquite/fisiopatologia , Broncoscopia , Criança , Doença Crônica , Tosse/etiologia , Humanos , Pneumopatias/tratamento farmacológico , Pneumopatias/fisiopatologia , Guias de Prática Clínica como Assunto , Supuração/tratamento farmacológico , Supuração/fisiopatologiaRESUMO
The objective of the present work was to analyze the current concept of the genetically predetermined condition Zivert-Kartagener's syndrome with special reference to the pathogenetic mechanisms underlying the development of this condition, its clinical picture and methods of treatment. The authors' original observations of the patients presenting with Zivert-Kartagener's syndrome are reported.
Assuntos
Dextrocardia/diagnóstico por imagem , Infertilidade , Síndrome de Kartagener , Depuração Mucociliar/genética , Rinite , Sinusite , Doença Crônica , Gerenciamento Clínico , Dineínas/genética , Feminino , Humanos , Infertilidade/diagnóstico , Infertilidade/etiologia , Síndrome de Kartagener/diagnóstico , Síndrome de Kartagener/fisiopatologia , Síndrome de Kartagener/terapia , Mutação , Prognóstico , Rinite/diagnóstico , Rinite/etiologia , Rinite/fisiopatologia , Rinite/terapia , Sinusite/diagnóstico , Sinusite/etiologia , Sinusite/fisiopatologia , Sinusite/terapia , Supuração/fisiopatologia , Adulto JovemRESUMO
The authors assessed efficacy of regional intraosseous administration of urokinase medac in comprehensive treatment of patients with complicated forms of diabetic foot syndrome by means of analysing therapeutic results in a total of 65 patients presenting with pyonecrotic complications of diabetic foot. The patients were subdivided into 2 groups. The control group was composed of 35 patients receiving basic therapy. The study group comprised 30 patients subjected to comprehensive treatment including regional intraosseous (into the heel bone of the affected limb) administration of urokinase medac at a dose of 100 thousand IU for 5 days. Efficacy of treatment was evaluated by the course of the wound process, indices of haemostasis, free radical oxidation, results of surgical treatment. In patients of the Study Group the terms of wound purification from pyonecrotic masses amounted to 9.8±0.3 days, which was by 4.7 days less than in the Control Group patients (p<0.01), marginal epithelialization of wounds also occurred averagely by 6.4 days faster. On day 22 of using the basic therapy alone, the haemostasis system preserved the condition of coagulation activity. The Study Group patients as early as on day 5 of treatment demonstrated shifts towards normocoagulation. In the Control Group by day 22 of treatment, the level of malonic dialdehyde decreased by 18.5%, the index of catalase activity increased by 24.6% (p<0.05); in the Study Group the level of malonic dialdehyde decreased by 42.6% and catalase activity increased by 69.4% (p<0.01). On the background of using urokinase the number of high amputations decreased by 18% and the number of operations with the supporting function preserved decreased by 12% as compared with basic therapy alone. A conclusion was made that additional use of regional intraosseous administration of urokinase medac as compared with basic therapy alone promoted a more significant decrease in the coagulation activity of blood and the level of free-radical lipid oxidation, stimulation of regenerative processes, as well as improvement of outcomes of surgical treatment.
Assuntos
Amputação Cirúrgica , Pé Diabético , Necrose , Supuração , Ativador de Plasminogênio Tipo Uroquinase , Amputação Cirúrgica/métodos , Amputação Cirúrgica/estatística & dados numéricos , Pé Diabético/complicações , Pé Diabético/diagnóstico , Pé Diabético/metabolismo , Pé Diabético/fisiopatologia , Pé Diabético/terapia , Feminino , Fibrinolíticos/administração & dosagem , Fibrinolíticos/efeitos adversos , Hemostasia/efeitos dos fármacos , Humanos , Infusões Intraósseas/métodos , Extremidade Inferior/patologia , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Necrose/tratamento farmacológico , Necrose/etiologia , Necrose/fisiopatologia , Oxirredução/efeitos dos fármacos , Estudos Retrospectivos , Federação Russa , Supuração/tratamento farmacológico , Supuração/etiologia , Supuração/fisiopatologia , Resultado do Tratamento , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagem , Ativador de Plasminogênio Tipo Uroquinase/efeitos adversos , Cicatrização/efeitos dos fármacosRESUMO
AIM: To study serum and bile cytokines dynamics in patients with non-tumoral obstructive jaundice and suppurative cholangitis. MATERIAL AND METHODS: Comparative study of serum and bile cytokines in 49 operated patients with biliary pathology was performed. Patients were divided into 3 groups. The first group included 24 patients with acute calculous cholecystitis (ACCh), the second group consisted of 12 patients with chronic calculous cholecystitis (CCCh) and the third group included 13 patients with choledocholithiasis complicated by obstructive jaundice and suppurative cholangitis. RESULTS AND DISCUSSION: All patients had increased level of TNF-α, IL-4 и IL-6. There was augmentation of biliary cytokines in patients with obstructive jaundice compared with those with acute and chronic calculous cholecystitis. In patients with obstructive jaundice and suppurative cholangitis the highest levels of cytokines were observed. Patients with obstructive jaundice (OJ), suppurative cholangitis (SCh) and chronic calculous cholecystitis had higher levels of cytokines in both blood and bile than in those with OJ, SCh and acute calculous cholecystitis that is explained by development of purulent inflammation on background of previous cytokines imbalance and chronic inflammation. In general, patients with acute calculous cholecystitis had higher levels of TNF-α and IL-6 in blood serum and IL-4 in bile. Patients with chronic calculous cholecystitis had higher concentration of TNF-α and IL-4 in bile and IL-6 - in blood serum. CONCLUSION: Both forms of cholecystitis and their complications are associated with increased cytokines in serum and bile. The level of augmentation depends on the type of inflammation and complications. Comparative study of cytokines can be the most informative criterion to monitor the postoperative period.
Assuntos
Colangite , Interleucina-4/metabolismo , Interleucina-6/metabolismo , Icterícia Obstrutiva , Supuração/sangue , Fator de Necrose Tumoral alfa/metabolismo , Bile/metabolismo , Colangite/sangue , Colangite/diagnóstico , Feminino , Humanos , Icterícia Obstrutiva/sangue , Icterícia Obstrutiva/diagnóstico , Masculino , Pessoa de Meia-Idade , Estatística como Assunto , Supuração/fisiopatologiaRESUMO
A 91 year old patient presented with constipation, abdominal distension, weakness and anorexia lasting for two days. Computed tomography revealed multiple peritoneal masses with significant growth within days and local invasiveness without regard to anatomical boundaries. No lymphadenopathy or hepatosplenomegaly were found. Abdominal paracentesis showed 60,000 cells/mm3 presumed to be neutrophils. During follow-up, there were no clinical or radiographic signs of peritonitis. Trans-abdominal true-cut biopsy from the peritoneal masses was consistent with diffuse large B cell lymphoma germinal center B cell type, clinically presenting as peritoneal lymphomatosis. FISH cytogenetic study identified single BLC-6 gene in the tumor infiltrating lymphocytes. We speculated that this aberration in the patient's immune system cells contributed to this rare, unusual and aggressive lymphoma presentation in an otherwise non-immune compromised patient.
Assuntos
Ascite/etiologia , Linfoma Difuso de Grandes Células B , Neoplasias Peritoneais , Supuração/etiologia , Idoso de 80 Anos ou mais , Ascite/diagnóstico , Ascite/fisiopatologia , Líquido Ascítico/patologia , Biópsia , Diagnóstico Diferencial , Rearranjo Gênico do Linfócito B , Humanos , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/genética , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/fisiopatologia , Masculino , Invasividade Neoplásica , Cavidade Peritoneal/diagnóstico por imagem , Cavidade Peritoneal/fisiopatologia , Neoplasias Peritoneais/complicações , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/fisiopatologia , Supuração/patologia , Supuração/fisiopatologia , Tomografia Computadorizada por Raios XAssuntos
Câmara Anterior/patologia , Oftalmopatias/induzido quimicamente , Glucocorticoides/efeitos adversos , Facoemulsificação/efeitos adversos , Ruptura da Cápsula Posterior do Olho/diagnóstico , Supuração/induzido quimicamente , Triancinolona Acetonida/efeitos adversos , Câmara Anterior/efeitos dos fármacos , Oftalmopatias/fisiopatologia , Feminino , Glucocorticoides/administração & dosagem , Humanos , Injeções Intraoculares , Implante de Lente Intraocular , Pessoa de Meia-Idade , Ruptura da Cápsula Posterior do Olho/etiologia , Prolapso , Supuração/fisiopatologia , Triancinolona Acetonida/administração & dosagem , Vitrectomia , Corpo VítreoRESUMO
An analysis of treatment results was made in 474 patients with a diffuse purulent peritonitis. It was shown, that a dynamics of indices of computer phonoenterography (preservation and aggravation of disturbed intestinal motility pattern) and gas-liquid chromatography (the invariable or increased level of acetic, propionic, butyric acid in blood and exudate) significantly supported an evidence objectification to staged sanitization of the abdominal cavity. Recurrent peritoneal lavage was performed in a case of polyorgan dysfunction evidence in the stage of subcompensation in 36, 7 patients. It could be carried out by endovideosurgical method in 82.2% of medical supervisions. The lethality consisted of 4.9% in a case of the application of staged laparoscopic sanitization of the abdominal cavity in complex treatment of patients with diffuse purulent peritonitis.
Assuntos
Laparoscopia/métodos , Insuficiência de Múltiplos Órgãos , Lavagem Peritoneal/métodos , Peritonite , Supuração/fisiopatologia , Cirurgia Vídeoassistida/métodos , Cavidade Abdominal/fisiopatologia , Cavidade Abdominal/cirurgia , Cromatografia Gasosa/métodos , Feminino , Motilidade Gastrointestinal , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/fisiopatologia , Insuficiência de Múltiplos Órgãos/cirurgia , Peritonite/diagnóstico , Peritonite/fisiopatologia , Peritonite/cirurgia , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do TratamentoAssuntos
Abscesso Abdominal , Drenagem , Espaço Retroperitoneal , Supuração/cirurgia , Procedimentos Cirúrgicos Operatórios , Abscesso Abdominal/complicações , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/fisiopatologia , Abscesso Abdominal/cirurgia , Infecções por Acinetobacter/complicações , Infecções por Acinetobacter/fisiopatologia , Infecções por Acinetobacter/cirurgia , Antibacterianos/uso terapêutico , Terapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Proctite/complicações , Proctite/fisiopatologia , Proctite/cirurgia , Radiografia , Espaço Retroperitoneal/diagnóstico por imagem , Espaço Retroperitoneal/fisiopatologia , Espaço Retroperitoneal/cirurgia , Índice de Gravidade de Doença , Supuração/complicações , Supuração/diagnóstico , Supuração/fisiopatologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/terapia , Resultado do TratamentoRESUMO
BACKGROUND: There are no any systemized studies of relationship between the coagulative haemostasis' disorders and metabolic and cytokine status in patients with septic tuboovarial formations. OBJECTIVE: The aim of the present work was to study the mechanisms of blood coagulation disorders and their relationships with changes of cytokine status and acute phase of inflammatory response in septic tubo-ovarian formations in women. METHODS: 32 patients with purulent tubovarial formations and 30 healthy women were examined. RESULTS: Shortening of activated partial thromboplastin, prothrombin and thrombin clotting time, increasing the duration of XIIa-kallikrehin-dependent fibrinolysis, as well as the elevation of paracoagulation products in blood plasma were observed. IL-1ß (p =0.000023), TNF-α (p <0.001), C-reactive protein (p <0.001), haptoglobin (p <0.001) and fibrinogen (p <0.001) levels were higher in peripheral blood of patients in comparison with healthy women. Accumulation of lipid hydroperoxides (p <0. 001) and malonic dialdehyde (p <0.001) occurred in the blood plasma of patients. Serum albumin (p <0.001) and transferring (p <0.001) levels were lesser in patients with purulent tubo ovarial formations in comparison with healthy women. CONCLUSION: The obtained results showing an initiating role of cytokine and oxidative metabolic status changes in blood coagulation potential's and fibrinolysis activity's disorders developing. This biochemical signs may be used as objective criteria which may serve to determine the risk of thrombosis in case of acute inflammatory response in women with purulent inflammation.
Assuntos
Citocinas/sangue , Estresse Oxidativo , Infecções do Sistema Genital/complicações , Síndrome de Resposta Inflamatória Sistêmica , Trombose , Adulto , Coagulação Sanguínea , Feminino , Fibrinogênio/metabolismo , Humanos , Estudos Prospectivos , Infecções do Sistema Genital/diagnóstico , Infecções do Sistema Genital/fisiopatologia , Supuração/metabolismo , Supuração/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/metabolismo , Tromboplastina/metabolismo , Trombose/sangue , Trombose/etiologiaRESUMO
The results of laparoscopic cholecystectomy, conducted in 71 patients, suffering cholelithiasis, were analyzed. In early postoperative period an acute cholangitis have occurred in 2 (2.8%) patients, an acute pancreatitis--in 1 (1.4%), postoperative infiltrate--in 14(19.7%), suppuration of postoperative cicatrix--in 6 (8.4%); late compli- cations as a kind of postcholecystectomy syndrome was observed in 29 (40.8%) patients, and abdominal hernia--in 3 (4.2%).
Assuntos
Colangite/reabilitação , Colecistectomia Laparoscópica/efeitos adversos , Hérnia Abdominal/reabilitação , Pancreatite/reabilitação , Síndrome Pós-Colecistectomia/reabilitação , Complicações Pós-Operatórias , Supuração/reabilitação , Doença Aguda , Adulto , Idoso , Colangite/etiologia , Colangite/fisiopatologia , Colelitíase/patologia , Colelitíase/cirurgia , Feminino , Vesícula Biliar/patologia , Vesícula Biliar/cirurgia , Hérnia Abdominal/etiologia , Hérnia Abdominal/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/etiologia , Pancreatite/fisiopatologia , Síndrome Pós-Colecistectomia/etiologia , Síndrome Pós-Colecistectomia/fisiopatologia , Licença Médica , Supuração/etiologia , Supuração/fisiopatologiaRESUMO
Pyogenic spinal epidural abscess Is an uncommon Infectious occurrence. Clinical prospects of pyogenic spinal epidural abscess are graver if not promptly diagnosed and treated appropriately. A case of spinal epidural abscess has been presented with sinus tract formation at L4-L5 level, of pyogenic aetiology that progressed to paraplegia over the course of the disease. MRI pointed towards an epidural abscess extending from T12 vertebral level to S1 vertebral level. Surgical decompression in the form of laminectomy and evacuation of pus was done and antibiotics were given according to culture and sensitivity. Histopathological analysis revealed the acute suppurative nature of the abscess. Citrobacter kasori was isolated on pus culture. Pyogenic epidural abscess with causative organism being Citrobacter kasori has least been documented.
Assuntos
Antibacterianos/administração & dosagem , Citrobacter koseri/isolamento & purificação , Descompressão Cirúrgica/métodos , Abscesso Epidural , Compressão da Medula Espinal/etiologia , Supuração/fisiopatologia , Adolescente , Abscesso Epidural/complicações , Abscesso Epidural/microbiologia , Abscesso Epidural/fisiopatologia , Abscesso Epidural/terapia , Feminino , Humanos , Laminectomia , Vértebras Lombares/patologia , Imageamento por Ressonância Magnética , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/fisiopatologia , Resultado do TratamentoRESUMO
Bone and soft tissue infection in the foot of diabetic patients is a well-described issue in the literature. A sound anatomical knowledge of the foot anatomy and compartments is mandatory to understand the mechanisms of infection spread. We describe four cases of diabetic foot infection complicated by long ascending infection. All did not respond initially to antibiotic treatment and the usual surgical debridement and were cured only after excision of the infected tendons. We highlight a rare but serious complication of the diabetic foot disease not commonly seen by the surgical community. We hope that this report raises the awareness of this condition so that a prompt diagnosis is made and appropriate treatment started, thereby reducing the risk of major lower limb amputations.
Assuntos
Antibacterianos/administração & dosagem , Desbridamento/métodos , Diabetes Mellitus Tipo 2/complicações , Pé Diabético , Pé , Infecções dos Tecidos Moles , Supuração , Tendões/cirurgia , Idoso , Pé Diabético/diagnóstico , Pé Diabético/tratamento farmacológico , Pé Diabético/fisiopatologia , Pé Diabético/cirurgia , Dissecação , Drenagem , Humanos , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Infecções dos Tecidos Moles/etiologia , Infecções dos Tecidos Moles/fisiopatologia , Infecções dos Tecidos Moles/cirurgia , Supuração/etiologia , Supuração/fisiopatologia , Tendões/patologia , Resultado do Tratamento , Ultrassonografia Doppler , CicatrizaçãoRESUMO
BACKGROUND: Individuals with bronchiectasis exhibit colonization and infection of the respiratory system, with a consequent alteration of the macroscopic appearance of secretions, which ranges from mucoid to purulent. Purulence is related to the structural conformation, rheological profile, and transport indexes of mucus. We analyzed and compared the transport properties of respiratory secretions with mucoid appearance versus those with purulent appearance in patients with bronchiectasis and in subjects without lung disease. METHODS: In a simulated cough machine we assessed the mucociliary transport and contact angle of 32 mucoid and 19 purulent samples from subjects with bronchiectasis, and 21 samples from subjects without lung disease. RESULTS: Mucociliary transport was lower in the mucoid samples (0.78 ± 0.22) and in the purulent samples (0.73 ± 0.22) than in the samples from subjects without lung disease (1 ± 0.19). The purulent samples had less displacement in the simulated cough machine (7.57 ± 3 cm) than did the mucoid samples (23 ± 15 cm) or the samples from subjects without lung disease (34 ± 8.4 cm), as did the mucoid samples compared to the samples from subjects without lung disease. The purulent samples had a higher contact angle (25 ± 6.1°) than the mucoid samples (17 ± 7.8°) or the samples from subjects without lung disease (10 ± 2.5°), as did the mucoid samples compared to the samples from subjects without lung disease. CONCLUSIONS: Respiratory secretions in individuals with bronchiectasis have poor transport properties, which manifest as reduced mucociliary transport, reduced mucus transport by cough, and higher contact angle. These features were more accentuated in the purulent samples. This simple classification can be used by therapists to plan treatments, and by researchers to obtain more homogeneity between groups of subjects.
Assuntos
Bronquiectasia , Depuração Mucociliar , Muco/metabolismo , Infecções Respiratórias , Escarro/metabolismo , Supuração , Adulto , Idoso , Bronquiectasia/complicações , Bronquiectasia/diagnóstico , Bronquiectasia/fisiopatologia , Tosse/fisiopatologia , Feminino , Humanos , Masculino , Seleção de Pacientes , Sistema Respiratório/fisiopatologia , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/etiologia , Infecções Respiratórias/fisiopatologia , Manejo de Espécimes/métodos , Supuração/complicações , Supuração/diagnóstico , Supuração/fisiopatologiaRESUMO
A 37-year-old man presented with fever, decreased vision in the left eye, a partial left cranial nerve III paresis, and a left cranial nerve VI paresis. Neuro-imaging showed an opacification of a left pneumatised anterior clinoid process. After failing a course of intravenous antibiotics, a craniotomy was performed with exenteration of the cavity and resolution of symptoms. Although rare, a pyocele of a pneumatised anterior clinoid process may cause ocular morbidity and require surgical intervention.
Assuntos
Doenças do Nervo Abducente/etiologia , Antibacterianos/administração & dosagem , Craniotomia/métodos , Mucocele , Doenças do Nervo Oculomotor/etiologia , Osso Esfenoide , Supuração/fisiopatologia , Doenças do Nervo Abducente/fisiopatologia , Adulto , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Mucocele/complicações , Mucocele/diagnóstico , Mucocele/fisiopatologia , Doenças do Nervo Oculomotor/fisiopatologia , Osso Esfenoide/patologia , Osso Esfenoide/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
The 1st group consisted of 68 patients with the diffuse peritonitis, who were treated with the use of traditional approach, i.e., laparotomy, elimination of the peritonitis source, nasointestinal intubation, abdominal cavity sanation and drainage. Within 24--48 hours all these patients had videoendoscopic abdominal sanation with the injection of 200 ml 0.03% water solution of sodium hypochlorite. The 2nd group, consisted of 41 patients. The first treatment stage was the same, but during the videoendoscopic stage the pulsing stream of the antiseptic was used and the procedure ended with intraabdominal injection of 200 ml 0.03% water solution of sodium hypochlorite immobilized in gel. All patients of the 2nd group showed better recovery results.