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Gamma-ray bursts (GRBs) are produced by rare types of massive stellar explosion. Their rapidly fading afterglows are often bright enough at optical wavelengths that they are detectable at cosmological distances. Hitherto, the highest known redshift for a GRB was z = 6.7 (ref. 1), for GRB 080913, and for a galaxy was z = 6.96 (ref. 2). Here we report observations of GRB 090423 and the near-infrared spectroscopic measurement of its redshift, z = 8.1(-0.3)(+0.1). This burst happened when the Universe was only about 4 per cent of its current age. Its properties are similar to those of GRBs observed at low/intermediate redshifts, suggesting that the mechanisms and progenitors that gave rise to this burst about 600,000,000 years after the Big Bang are not markedly different from those producing GRBs about 10,000,000,000 years later.
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Pseudomonas aeruginosa is a well-known cause of severe and potentially life-threatening infections among hematological patients. A prospective epidemiological surveillance program ongoing at our Hematology Unit revealed an increase over time of P. aeruginosa bloodstream infections (BSI). Their impact on outcome and antibiotic susceptibility was analyzed. BSI which consecutively occurred at our institution during a 70-month period were evaluated and correlated with type of pathogen, status of underlying disease, neutropenia, previous antibiotic therapy, resistance to antibiotics, and outcome. During the observation period, 441 BSI were recorded. Frequency of Gram-negative BSI was higher than that of other pathogens (57.3%). Overall, 66 P. aeruginosa BSI were recorded; 22 out of 66 were multiresistant (MR P. aeruginosa). Thirty-day mortality for all BSI was 11.3%; it was 27.3% for P. aeruginosa BSI and 36.4% for MR P. aeruginosa. At multivariate analysis, only active hematological disease and P. aeruginosa BSI were associated to an increased risk of death. For MR P. aeruginosa, BSI mortality was 83.3% vs. 18.8% when empiric therapy included or not an antibiotic with in vitro activity against P. aeruginosa (p=0.011). Together with active disease, the emergence of P. aeruginosa BSI, particularly if multiresistant, was responsible for an increased risk of death among hematological patients at our institution. In this scenario, reconsidering the type of combination antibiotic therapy to be used as empiric treatment of neutropenic fever was worthwhile.
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Enfermedades Hematológicas/epidemiología , Hematología/tendencias , Infecciones por Pseudomonas/epidemiología , Pseudomonas aeruginosa/aislamiento & purificación , Antibacterianos/uso terapéutico , Bacteriemia/diagnóstico , Bacteriemia/tratamiento farmacológico , Bacteriemia/epidemiología , Bacteriemia/mortalidad , Causas de Muerte , Enfermedades Transmisibles/diagnóstico , Enfermedades Transmisibles/tratamiento farmacológico , Enfermedades Transmisibles/epidemiología , Enfermedades Hematológicas/complicaciones , Enfermedades Hematológicas/diagnóstico , Enfermedades Hematológicas/tratamiento farmacológico , Hematología/métodos , Hematología/estadística & datos numéricos , Humanos , Pruebas de Sensibilidad Microbiana , Vigilancia de la Población , Pronóstico , Infecciones por Pseudomonas/complicaciones , Infecciones por Pseudomonas/diagnóstico , Infecciones por Pseudomonas/tratamiento farmacológico , Análisis de SupervivenciaRESUMEN
'Long' gamma-ray bursts (GRBs) are commonly accepted to originate in the explosion of particularly massive stars, which give rise to highly relativistic jets. Inhomogeneities in the expanding flow result in internal shock waves that are believed to produce the gamma-rays we see. As the jet travels further outward into the surrounding circumstellar medium, 'external' shocks create the afterglow emission seen in the X-ray, optical and radio bands. Here we report observations of the early phases of the X-ray emission of five GRBs. Their X-ray light curves are characterised by a surprisingly rapid fall-off for the first few hundred seconds, followed by a less rapid decline lasting several hours. This steep decline, together with detailed spectral properties of two particular bursts, shows that violent shock interactions take place in the early jet outflows.
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An apparatus allowing continuous acquisition of thickness measurements during electropolishing of superconducting cavities is described. The instrument is based on the ultrasound thickness measurement technique and allows the connection of up to six probes. The apparatus has been employed to monitor the surface treatment of PIP-II low beta single cell prototypes developed and manufactured by LASA-INFN and specifically to measure surface removal at different points of interest on the cavity surface. The apparatus facilitated the development and optimization of electropolishing parameters for incorporation into the cavity manufacturing process.
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The ability of patients with hematologic malignancies (HM) to develop an effective humoral immune response after COVID-19 is unknown. A prospective study was performed to monitor the immune response to SARS-CoV-2 of patients with follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), chronic lymphoproliferative disorders (CLD), multiple myeloma (MM), or myelodysplastic/myeloproliferative syndromes (MDS/MPN). Antibody (Ab) levels to the SARS-CoV-2 nucleocapsid (N) and spike (S) protein were measured at +1, +3, +6 months after nasal swabs became PCR-negative. Forty-five patients (9 FL, 8 DLBCL, 8 CLD, 10 MM, 10 MDS/MPS) and 18 controls were studied. Mean anti-N and anti-S-Ab levels were similar between HM patients and controls, and shared the same behavior, with anti-N Ab levels declining at +6 months and anti-S-Ab remaining stable. Seroconversion rates were lower in HM patients than in controls. In lymphoma patients mean Ab levels and seroconversion rates were lower than in other HM patients, primarily because all nine patients who had received rituximab within 6 months before COVID-19 failed to produce anti-N and anti-S-Ab. Only one patient requiring hematological treatment after COVID-19 lost seropositivity after 6 months. No reinfections were observed. These results may inform vaccination policies and clinical management of HM patients.
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COVID-19/inmunología , Neoplasias Hematológicas/inmunología , Inmunidad Humoral/efectos de los fármacos , Rituximab/farmacología , SARS-CoV-2/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antivirales/efectos de los fármacos , Anticuerpos Antivirales/metabolismo , Formación de Anticuerpos/efectos de los fármacos , Formación de Anticuerpos/fisiología , Especificidad de Anticuerpos/efectos de los fármacos , COVID-19/complicaciones , COVID-19/epidemiología , COVID-19/terapia , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Neoplasias Hematológicas/complicaciones , Neoplasias Hematológicas/tratamiento farmacológico , Neoplasias Hematológicas/epidemiología , Hospitalización , Humanos , Italia/epidemiología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Rituximab/uso terapéuticoRESUMEN
As the SARS-CoV-2 pandemic continues to rage worldwide, the emergence of numerous variants of concern (VOC) represents a challenge for the vaccinal protective efficacy and the reliability of commercially available high-throughput immunoassays. Our study demonstrates the administration of two doses of the BNT162b2 vaccine that elicited a robust SARS-CoV-2-specific immune response which was assessed up to 3 months after full vaccination in a cohort of 37 health care workers (HCWs). SARS-CoV-2-specific antibody response, evaluated by four commercially available chemiluminescence immunoassays (CLIA), was qualitatively consistent with the results provided by the gold-standard in vitro neutralization assay (NTA). However, we could not observe a correlation between the quantity of the antibody detected by CLIA assays and their neutralizing activity tested by NTA. Almost all subjects developed a SARS-CoV-2-specific T-cell response. Moreover, vaccinated HCWs developed a similar protective neutralizing antibodies response against the EU (B.1), Alpha (B.1.1.7), Gamma (P.1), and Eta (B.1.525) SARS-CoV-2 variants, while Beta (B.1.351) and Delta (B.1.617.2) strains displayed a consistent partial immune evasion. These results underline the importance of a solid vaccine-elicited immune response and a robust antibody titre. We believe that these relevant results should be taken into consideration in the definition of future vaccinal strategies.
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Vacuna BNT162/inmunología , Vacunas contra la COVID-19/inmunología , COVID-19/inmunología , COVID-19/prevención & control , SARS-CoV-2/inmunología , Adulto , Anciano , Anticuerpos Neutralizantes/sangre , Anticuerpos Neutralizantes/inmunología , Anticuerpos Antivirales/sangre , Anticuerpos Antivirales/inmunología , Vacuna BNT162/administración & dosificación , Vacuna BNT162/genética , COVID-19/sangre , COVID-19/virología , Vacunas contra la COVID-19/administración & dosificación , Vacunas contra la COVID-19/genética , Femenino , Humanos , Inmunidad Celular , Inmunidad Humoral , Inmunoensayo , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , SARS-CoV-2/genética , Linfocitos T/inmunología , Vacunación , Adulto JovenRESUMEN
AIM: This study evaluated the temperature rise of the adhesive system Single Bond (SB) and the composite resins Filtek Z350 flow (Z) and Filtek Supreme (S), when polymerized by light-emitting diode (LED XL 3000) and quartz-tungsten halogen (QTH Biolux). METHODS: Class V cavities (3 yen2 mm) were prepared in 80 bovine incisors under standardized conditions. The patients were divided as follows: G1: Control; G2: SB; G3: SB + Z; G4: SB + S. The groups were subdivided into two groups for polymerization (A: QTH, B: LED). Light curing was performed for 40 s and measurement of temperature changes during polymerization was performed with a thermocouple positioned inside the pulp chamber. Data were statistically analyzed using ANOVA and Tukey tests. RESULTS: The factors material (P<0.00001) and curing unit (P<0.00001) had significant influence on temperature rise. The lowest temperature increase (0.15 degrees C) was recorded in G2 B and the highest was induced in G1 A (0.75 degrees C, P<0.05). In all groups, lower pulp chamber temperature measurements were obtained when using LED compared to QTH (P<0.05). CONCLUSION: QTH caused greater increases in tooth temperature than LED. However, both sources did not increase pulpal temperature above the critical value that may cause pulpal damage.
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Resinas Compuestas , Luces de Curación Dental , Curación por Luz de Adhesivos Dentales , Temperatura , Animales , Bovinos , PolímerosRESUMEN
With the first direct detection of merging black holes in 2015, the era of gravitational wave (GW) astrophysics began. A complete picture of compact object mergers, however, requires the detection of an electromagnetic (EM) counterpart. We report ultraviolet (UV) and x-ray observations by Swift and the Nuclear Spectroscopic Telescope Array of the EM counterpart of the binary neutron star merger GW170817. The bright, rapidly fading UV emission indicates a high mass (≈0.03 solar masses) wind-driven outflow with moderate electron fraction (Ye ≈ 0.27). Combined with the x-ray limits, we favor an observer viewing angle of ≈30° away from the orbital rotation axis, which avoids both obscuration from the heaviest elements in the orbital plane and a direct view of any ultrarelativistic, highly collimated ejecta (a γ-ray burst afterglow).
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X-ray fluorescence probe for detection of foreign material inclusions on the inner surface of superconducting cavities has been developed and tested. The setup detects trace element content such as a few micrograms of impurities responsible for thermal breakdown phenomena limiting the cavity performance. The setup has been customized for the geometry of 1.3 GHz TESLA-type niobium cavities and focuses on the surface of equator area at around 103 mm from the centre axis of the cavities with around 20 mm detection spot. More precise localization of inclusions can be reconstructed by means of angular or lateral displacement of the cavity. Preliminary tests confirmed a very low detection limit for elements laying in the high efficiency spectrum zone (from 5 to 10 keV), and a high angular resolution allowing an accurate localization of defects within the equator surface.
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BACKGROUND: Motion analysis with optoelectronic systems is a frequently used method to analyze the patient's gait as well as further relevant activities of daily living before and after knee arthroplasty. The aim of this systematic review was to identify the investigated activities of daily living and to show an extensive presentation of gait analysis studies with patients after knee arthroplasty surgery. METHODS: The articles were searched in electronic databases: MEDPILOT, EMBASE. To identify articles that potentially met the inclusion criteria the titles and abstracts were screened. The level of evidence was analyzed for the included articles. RESULTS: Overall 3989 abstracts were reviewed and 87 full text articles were included. Ten activities of daily living were identified. Level walking was the most frequently investigated activity (78.2%). In 94.6% the sagittal plane kinematics were analyzed and 5.3% presented the results in all three planes. Knee adduction moments were determined in 33.3% of the included articles. At least two joints were investigated in 40.2%, including the impaired knee and further body parts (ankle, hip, pelvis, trunk). Unicondylar knee arthroplasty was addressed in 14.1%. CONCLUSIONS: Besides level walking, it is necessary to examine physical more demanding activities of daily living to detect potential kinematic and kinetic abnormalities. Further research should imply the evaluation of sagittal, frontal and transverse plane joint and muscle function based on accurate inverse-dynamic techniques. More motion analysis studies are necessary that address unicondylar knee arthroplasty in comparison to total knee arthroplasty and healthy controls.
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Actividades Cotidianas , Artroplastia de Reemplazo de Rodilla , Articulación de la Rodilla/fisiología , Movimiento/fisiología , Caminata/fisiología , Fenómenos Biomecánicos/fisiología , Humanos , Rango del Movimiento Articular/fisiologíaRESUMEN
OBJECTIVE: Gastroenteritis caused by a single pathogen or multiple pathogens remains a major diagnostic challenge for the laboratory. The treatment of diarrhoea is based on microbiological results. Diagnosis is achieved using different laboratory techniques that have variable sensitivity and specificity. xTAG GPP is a new multiplex PCR assay that simultaneously detects 15 different pathogens responsible for diarrhoea. The results of the first multicentre study in Italy to evaluate the potential clinical application of the GPP assay in the laboratory diagnosis of diarrhoea are reported here. METHODS: Faeces specimens (N=664) from hospitalized patients were tested with the GPP assay using a Luminex 200 instrument. All specimens were run using comparator methods following a routine algorithm: culture for bacteria, enzyme immunoassay and PCR for viruses, and microscopy for parasites. RESULTS: Of the samples tested with the GPP, 53.61% (356/664) gave positive results, as compared to 45.33% by routine testing. Of the positive specimens, 34.55% showed the presence of genomic DNA from multiple pathogens. The Luminex method showed an increase in the percentage of positivity of 8.28%. CONCLUSIONS: The GPP assay can be considered a helpful tool for the detection of gastrointestinal pathogens, with a hands-on time of 5h; it provides accurate data for the clinical management of hospitalized patients and for epidemiological surveillance.
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Bacterias/aislamiento & purificación , Diarrea/diagnóstico , Gastroenteritis/diagnóstico , Técnicas de Diagnóstico Molecular , Reacción en Cadena de la Polimerasa Multiplex/métodos , Parásitos/aislamiento & purificación , Virus/aislamiento & purificación , Adulto , Animales , Diarrea/microbiología , Diarrea/parasitología , Heces/microbiología , Heces/parasitología , Femenino , Gastroenteritis/microbiología , Gastroenteritis/parasitología , Humanos , Técnicas para Inmunoenzimas , Italia , Masculino , Persona de Mediana Edad , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: This study compares perfluorocarbon broncho-alveolar lavage (PFC-BAL) with isotonic saline broncho-alveolar lavage (saline-BAL) in an experimental model of meconium aspiration in adult guinea pigs. DESIGN: Prospective controlled experimental study. PATIENTS AND METHODS: Ten male guinea pigs were given 1 ml of human meconium, diluted to 10% in isotonic saline, via tracheostomy and then artificially ventilated. After stabilization, five animals (control group) underwent BAL with 10 ml/ kg isotonic saline solution. After bronchial suctioning, a further BAL with 2 ml/kg saline was performed. The other five animals (study group) underwent BAL with 100 ml/kg of PFC (RIMAR 101). Bronchosuction was effected at 5 min and then a BAL with PFC 2 ml/kg was performed. Both groups received conventional mechanical ventilation during the lavage procedures. Within 20 min all the saline-BAL treated animals died, whereas the PFC-BAL treated animals survived and were then treated with total liquid ventilation (TLV) by gravity. MEASUREMENTS AND RESULTS: After meconium inhalation in both groups, a large alveolar-arterial oxygen difference, hypercarbia, severe acidosis and tachycardia were noticed. In PFC treated animals, an improvement in blood gases was noted and acid-base balance remained stable compared to saline-BAL treated animals. No haemodynamic change was observed during or after PFC-BAL, while during saline-BAL there was evidence of bradycardia, hypotension and respiratory failure, which led to the death of the animals. The histological lung sections in the PFC-BAL group showed evidence of normal alveolar expansion with a minimal presence of meconium debris in the small bronchioles. In saline-BAL treated animals, the lung structure appeared severely compromised with the presence of meconium in bronchioles and alveoli, intra-alveolar oedema and haemorrhagic areas. CONCLUSIONS: This study confirms the detrimental effects of meconium aspiration and the impairment of lung function following saline-BAL. By contrast, PFC-BAL and TLV by gravity seemed to prevent absorption of meconium, facilitate its removal, improve gas exchange and reduce lung barotrauma.
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Lavado Broncoalveolar/métodos , Modelos Animales de Enfermedad , Fluorocarburos/administración & dosificación , Síndrome de Aspiración de Meconio/terapia , Respiración Artificial/métodos , Cloruro de Sodio/administración & dosificación , Enfermedad Aguda , Análisis de Varianza , Animales , Lavado Broncoalveolar/estadística & datos numéricos , Estudios de Evaluación como Asunto , Cobayas , Humanos , Recién Nacido , Pulmón/patología , Masculino , Síndrome de Aspiración de Meconio/patología , Estudios Prospectivos , Distribución Aleatoria , Respiración Artificial/estadística & datos numéricosRESUMEN
The role of persistently high serum aluminum levels (sAl) in the pathogenesis of dialysis encephalopathy (DE) was evaluated in two groups selected from 170 patients dialyzed with low Al fluids. Group 1 (G1) consisted of 24 patients showing two or more sAl below 50 micrograms/l and group 2 (G2) consisted of 27 patients with sAl above 100 micrograms/l in at least 2 of 3 determinations. The two groups did not show any significant difference for age, sex, education or duration of the dialysis treatment. All G1 patients were treated by hemodialysis. In G2, 24 patients underwent hemodialysis and 3 were on continuous ambulatory peritoneal dialysis (CAPD). We evaluated body loads of Al in 25 of 27 G2 patients with the desferrioxamine (DFO) infusion test. All 51 patients underwent a neurological examination and a waking EEG. Intelligence was assessed by Raven's Progressive Matrices 47 test in 19 of the G1 patients and in 20 of the G2 patients; short-term memory was measured by digit span and by word span and long-term memory by a short story in 10 G1 patients and 17 G2 patients. We diagnosed DE only in the presence of the typical EEG changes, with or without manifest clinical symptoms. DE was diagnosed in none of the G1 patients and in 8 of the G2 patients (0 vs 29.6%, chi 2 = 6.34; p less than 0.025). Five of the patients with DE showed both clinical and EEG signs, while the remaining three showed only EEG signs.(ABSTRACT TRUNCATED AT 250 WORDS)
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Aluminio/sangre , Encefalopatías/inducido químicamente , Diálisis Renal/efectos adversos , Aluminio/efectos adversos , Encefalopatías/diagnóstico , Deferoxamina , Electroencefalografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Examen Neurológico , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Pruebas Psicológicas , Factores de Riesgo , SíndromeRESUMEN
Twenty neurophysiological parameters were employed to evaluate the presence and the degree of peripheral neuropathy (PNP) in a cohort of 135 patients (pts) on regular dialysis treatment (RDT) for 2 to 184 months. The 135 pts were divided into 3 groups according to the duration of RDT (group I: 52 pts with less than 5 yrs; group II: 46 pts 5 to 10 yrs; group III: 37 pts 10 to 15 yrs). Each group was then divided into two subgroups according to age (less or more than 47 yrs) to evaluate the influence of age on PNP. Correlations of electrophysiological parameters with some biochemical parameters (urea, creatinine, PTH) were looked for. The presence of clinical PNP was evaluated according to the Bolton classification: in group I, 50% of pts have mild PNP; in group II, 45.7% of pts have mild PNP; in group III, 81.1% have mild, 10.8% have moderate and 2.7% of pts have severe PNP. In as many as 84.4% of the 135 pts at least one of the 20 parameters studied had abnormal values and in 63% two or more parameters were abnormal. Of 20 parameters evaluated separately in the 3 groups only three showed abnormal mean values: sural nerve latency in all 3 groups; sural nerve Sensory Conduction Velocity (SCV) and peroneal nerve Max. Motor Conduction Velocity (MCV) in group III. Five parameters referring to ulnar nerves and two referring to the sural nerve were significantly more impaired in the group of pts with the longest duration of RDT and in this group the impairment was more severe in older patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Enfermedades del Sistema Nervioso Periférico/fisiopatología , Diálisis Renal/efectos adversos , Uremia/fisiopatología , Adulto , Anciano , Electrofisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
The Authors, after a review of the latest reports on ethiology, pathology and clinical aspects of acquired immunodeficiency syndrome (AIDS) and of linphadenopathyc syndrome (LAS or pre-AIDS), describe a case of pre-AIDS syndrome in a heroin addict characterized by typical symptoms, histological, serological and immunological patterns.
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Síndrome de Inmunodeficiencia Adquirida , Dependencia de Heroína/complicaciones , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/etiología , Síndrome de Inmunodeficiencia Adquirida/inmunología , Síndrome de Inmunodeficiencia Adquirida/patología , Adulto , Anticuerpos Antivirales/análisis , Deltaretrovirus/inmunología , Diagnóstico Diferencial , Estudios de Seguimiento , Antígenos HLA/análisis , Humanos , Ganglios Linfáticos/patología , MasculinoRESUMEN
A case of familial hypercholesterolaemia detected in a homozygous subject following the investigation of two large families with a high incidence of the disease, is presented. The genetic background of this form is discussed. Reference is made to the difficulty of identifying heterozygotes and homozygotes and the mode of transmission followed in the two families. The results of 45 months' treatment with cholestiramine and clofibrate and a dietary regimen are described.
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Hiperlipidemias , Hiperlipidemias/genética , Adulto , Anciano , Niño , Resina de Colestiramina/uso terapéutico , Clofibrato/uso terapéutico , Femenino , Humanos , Hiperlipidemias/diagnóstico , Hiperlipidemias/terapia , Masculino , Persona de Mediana Edad , Ácidos Nicotínicos/uso terapéutico , LinajeRESUMEN
BACKGROUND: In the surgical strategy of lower limb varicose veins, the fundamental objective is to prevent relapses. For this purpose, after having examined the international literature on the most frequent relapse causes, the authors emphasize that erroneous diagnosis, varicose disease natural development and incorrect surgical treatment are very important. METHODS: They report their experience about the sapheno-femoral junction anatomic variants that have been verified at the surgical table on 532 consecutive patients operated on for lower limb varicose veins. Of 532 patients 449 (84.4%) patients were women and 83 (15.6%) were men; all of them were, on average 49+/-26 years old. They were all with derivative from sapheno-femoral junction incontinence varicose veins that can be classified according to CEAP (C2-3-4/Ep/As 2-3/Pr). On these patients, 430 (80.8%) patients have had an operation of internal saphena long stripping; 65 (12.3%) patients have had an operation of saphena short stripping and 37 (6.9%) patients have had an operation of internal simple rossectomy. RESULTS: The authors have inspected all collateral veins of the sapheno-femoral junction and they have noticed 135 variants (25.2%) that are very important for the surgeon and, among these variants, they have discovered some collaterals, that flow under the sapheno-femoral junction (about 4%), are particularly insidious and they are the cause of sure relapse if they are ignored. CONCLUSIONS: The purpose of the work is to emphasize the importance of knowing sapheno-femoral junction changeability that is often the cause of relapse after surgical treatment.
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Vena Femoral/anatomía & histología , Vena Femoral/cirugía , Vena Safena/anatomía & histología , Vena Safena/cirugía , Várices/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
The effectiveness of a new alpha-blocking agent with additional mechanism of action was evaluated during intraoperative hypertensive crises. Urapidil was administered both in bolus form and as a continuous infusion in order to compare the two routes of delivery. During the study systolic, diastolic, mean pressure and heart rate were measured, and results were evaluated using statistical methods. The study showed that urapidil clearly possesses a rapid (bolus route) and long-lasting (continuous infusion) hypotensive function. In conclusion, given its efficacy in hypertensive crises and the absence of side-effects in this study. Urapidil may be considered one of the best choices during intraoperative hypertension crises.
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Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Complicaciones Intraoperatorias/tratamiento farmacológico , Piperazinas/uso terapéutico , Procedimientos Quirúrgicos Vasculares , Anciano , Urgencias Médicas , Femenino , Humanos , Infusiones Intravenosas , Inyecciones Intravenosas , Masculino , Persona de Mediana EdadRESUMEN
A young caucasian man (16 years old) underwent laparatomy after a diagnosis of acute appendicitis. After anesthetic induction, the patient experienced hypotension and tachycardia. The surgical approach discovered a massive haemoperitoneum subsequent to necrosis of the ileum due to internal herniation. The haemoperitoneum was probable responsible for hypovolemia which justified hypotension and tachycardia, which were reversed by aggressive intraoperative volume infusion. The importance of adequate preoperative diagnosis, in order to treat hypovolemia associated with a massive haemoperitoneum, is stressed.