ABSTRACT
Heart and left lung (en bloc) transplantation was used as an approach to end-stage cardiomyopathy with very high pulmonary vascular resistance. This surgical method was applied to a 13-year-old girl who did very well initially, but died 5 months later of severe pulmonary and cardiac rejection. The pulmonary perfusion scintigraphy showed equalization of the blood flow in both lungs after 42 days, and complete reversal of the pulmonary vascular changes in the opposite lung was observed at autopsy.
Subject(s)
Cardiomyopathy, Dilated/surgery , Heart-Lung Transplantation , Pulmonary Artery/physiopathology , Vascular Resistance , Adolescent , Blood Pressure/physiology , Cardiac Output , Cardiomyopathy, Dilated/physiopathology , Female , Heart-Lung Transplantation/methods , Heart-Lung Transplantation/physiology , Humans , Pulmonary Circulation/physiology , Vascular Resistance/physiologyABSTRACT
Myasthenic gravis may affect both inspiratory and expiratory muscles. Respiratory involvement occurred in almost all patients with myasthenia gravis in all clinical forms of the disease: 332 lung function tests done in 324 myasthenic patients without respiratory symptoms (age 34.6 +/- 18.3 years) were examined. Lung volumes analysis showed that all the patients of both sexes with generalized or ocular myasthenia gravis showed "myasthenic pattern". Male patients with "ocular" form only presented the "myasthenic pattern" with lung impairment and had, from the lung function point of view, a more benign behaviour. Female patients with the "ocular" form exhibited a behaviour of respiratory variables similar to that of the generalized form. It was not observed modification of the variables that suggested obstruction of the higher airways. The "myasthenic pattern" was rarely observed in other neuromuscular diseases, except in patients with laryngeal stenosis.
Subject(s)
Myasthenia Gravis/diagnosis , Myasthenia Gravis/physiopathology , Respiration , Adult , Female , Forced Expiratory Flow Rates , Humans , Lung Volume Measurements , Male , Pulmonary Ventilation , Residual Volume , Vital CapacityABSTRACT
A case of a 10-year-old patient with a benign congenital myopathy, suddenly aggravated because of an accentuated deficit in respiratory muscles is reported. The institution of assisted respiration at night allowed the patient to return to her daily activities. Examination of muscular biopsy with ultra-microscope permitted the diagnosis of mitochondrial myopathy.
Subject(s)
Diaphragm/physiopathology , Mitochondria, Muscle/ultrastructure , Muscular Diseases/congenital , Child , Female , Forced Expiratory Volume , Humans , Respiration, Artificial , Vital CapacitySubject(s)
Anesthesia, General , Benzamides , Ketamine , Myasthenia Gravis/therapy , Thymectomy , Tiapamil Hydrochloride , Adolescent , Adult , Child , Female , Humans , Male , SternumSubject(s)
Measles/complications , Respiratory Tract Infections/surgery , Tracheotomy , Female , Humans , Infant , Male , Respiratory Tract Infections/etiologyABSTRACT
Twenty-seven patients with generalized myasthenia gravis (moderate, severe and acute fulminating forms) who underwent thymectomy were studied. The effects of several anesthetic agents were analyzed with special attention being given to immunologic considerations. The authors conclude that the association of ketamine, tiapride, droperidol, fentanil and nitrous oxide allowed fast recovery of consciousness and spontaneous respiration, and made safe extubation possible before leaving the operating room.
Subject(s)
Anesthetics , Myasthenia Gravis/therapy , Thymectomy/methods , Adolescent , Adult , Female , Humans , Male , Preanesthetic MedicationSubject(s)
Age Determination by Skeleton , Carpal Bones/diagnostic imaging , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Sex FactorsSubject(s)
Anesthesia/mortality , Age Factors , Anesthetics/adverse effects , Clinical Competence , Female , Humans , Male , RiskSubject(s)
Analgesics/pharmacology , Phenylbutazone/pharmacology , Pyrazoles/pharmacology , Animals , Drug Synergism , Humans , Pain/prevention & control , RatsSubject(s)
Bites and Stings/complications , Communicable Diseases/epidemiology , Rat-Bite Fever , Brazil , HumansABSTRACT
Os autores determinaram o consumo de 02, produçäo de CO2 e gasto energético num grupo de RNTAIG, através da técnica de calorimetria indireta, empregando colorímetro nacional de circuito fechado. O objetivo do trabalho foi a determinaçäo da açäo dinâmico-específica (ADE) do leite materno no metabolismo energético dentro de um ciclo de mamadas em situaçäo de termoneutralidade e atividade física basal. A avaliaçäo da ADE pela análise da variável múltipla "VO2, VCO2 e GE" mostrou-se mais sensível do que através das variáveis isoladas, e a apresentaçäo dos resultados utilizando o referencial "superfície corpórea" foi mais discriminativo do que o "quilograma de peso". O aumento da atividade metabólica devido a ADE foi da ordem de 10 a 15%, aumento esse que persistiu até 90 min após a mamada, retornando a seguir aos valores da pré-mamada
Subject(s)
Infant, Newborn , Humans , Basal Metabolism , Milk, Human , Infant, Newborn/metabolism , Brazil , Calorimetry, IndirectABSTRACT
Determinaram-se o gasto de energia em repouso (GER) e o quociente respiratorio (QR) de 8 lactentes desnutridos e infectados, apos a admissao hospitalar (Adm) e durante a recuperacao (Rec), que durou em media 37 dias. As idades variam de 3 a 12 meses e apresentavam um deficit medio de peso para a idade superior a 35%. Utilizou-se a tecnica de calorimetria indireta, empregando-se um calorimetro de circuito fechado. As determinacoes de VO2 e VCO2 foram efetuadas por cromatografia gasosa. A atividade fisica foi avaliada pelo score de Scopes e Ahmed. Os dados pareados mostraram que o GER, calculado pelo peso real foi semelhante entre a Adm = 70,4+/-17,4kcal/kg/dia e Rec = 79,4+/-14,7 kcal/kg/dia. Quando o GER foi calculado pelo peso/altura houve diferenca significativa entre Adm = 44,5+/-7,3 kcal/kg/dia e Rec = 55,3+/-9,5 (p<0,05).O aumento da atividade fisica na Adm como na Rec proporcionou aumento semelhante (20%) e significativo (p<0,05) do GE (tanto por peso real como por peso/altura). O QR sa Adm=0,76+/-0,09 foi significativamente menor do que na Rec = 0,83+/-0,16 p<0,05).Os AA especulam que a admissao, o GER diminuido (calculado pelo peso/altura) traduz a menor massa celular ativa dos lactentes desnutridos infectados. Conclui-se que o QR e um bom parametro para avaliar a normalizacao da atividade metabolica desses desnutridos em recuperacao nutricional .