RESUMO
INTRODUCTION: Rupture of the spleen can be secondary to abdominal traumas (usually closed trauma) or spontaneous, can interest an organ normal or with morphological alterations secondary to various pathologies. Among the diseases responsible of occult rupture, infectious diseases are the most frequent and, among these, infectious mononucleosis, that is complicated with splenic rupture in 0.5% of the cases, with 30% of mortality. CASE REPORT: P.M., 16 years old female, admitted with acute abdomen, progressive anaemia and incipient cardiovascular instability, associated with suggestive clinical diagnosis of infectious mononucleosis, confirmed by serological findings and histological examination. Because of the imaging of subcapsular splenic haematoma, probably ruptured and with peritoneal bleeding we opt for emergency laparotomy intraoperative findings allows to splenectomy. DISCUSSION: Splenic rupture in infectious mononucleosis often presents as left hypochondrial pain, rare in uncomplicated cases; its occurrence in a patient with a recent diagnosis of infectious mononucleosis or with clinical or laboratory features suggestive of acute EBV infection, should always be investigated with an urgent abdominal ultrasound scan or CT. This approach is mandatory when hypochondrial pain is associated with pain referred to the left shoulder (Kehr's sign), peritoneal irritation and haemodynamic instability. Patients with splenic rupture in infectious mononucleosis generally undergo emergency splenectomy.
Assuntos
Mononucleose Infecciosa/complicações , Mononucleose Infecciosa/cirurgia , Esplenectomia , Ruptura Esplênica/cirurgia , Ruptura Esplênica/virologia , Adolescente , Diagnóstico Diferencial , Emergências , Feminino , Herpesvirus Humano 4/isolamento & purificação , Humanos , Mononucleose Infecciosa/diagnóstico , Ruptura Espontânea , Ruptura Esplênica/diagnóstico , Resultado do TratamentoRESUMO
INTRODUCTION: GISTs, a new nosological entity recently described, represent a peculiar model of solid tumor: the identification of the molecular mechanism responsible for the oncogenesis led to the development of a new drug (imatinib) active on the specific molecular target, represented by the product of the mutated proto-oncogene c-kit which is a tyrosine kinase receptor that becomes constitutively active by mutation. Surgical resection, nevertheless, is still the primary treatment and it has to be as complete as possible. These two treatments can be integrated. GISTs are not uniformly kit-positive, and they can be alternatively due to mutations of the PDGFRA gene or, in patients with neurofibromatosis type 1 (NF-1), to generally isolated mutations of the NF-1 gene. PATIENTS AND METHODS: We describe 3 cases of kit-positive GISTs of the small intestine (SISTs), complicated and emergency surgically treated: case 1--53 years, female, with small bowel obstruction and concomitant acute intestinal bleeding; case 2--71 years, male, with NF-1 and acute intestinal bleeding; case 3--47 years, male, with perforation of the Treitz tract. The first two cases have been treated with intestinal resection and immediate mechanical anastomosis; the third one with resection of the pedunculated tumor at its base, where is situated the perforation too. CONCLUSIONS: SISTs (20-30%), with little or no symptoms in the initial phases, show notable diagnostic difficulties. Their aspecific and late clinical presentation--typical of this site and of the pathology that we are talking about--and the difficult physical-instrumental approach to small bowel limit the possibility of an accurate diagnosis and expose the patient to potentially fatal acute complications and to risks related to emergency surgery treatment that decreases the possibility of a radical resection.
Assuntos
Neoplasias Duodenais/cirurgia , Tratamento de Emergência , Tumores do Estroma Gastrointestinal/cirurgia , Neoplasias do Íleo/cirurgia , Neoplasias do Jejuno/cirurgia , Idoso , Neoplasias Duodenais/diagnóstico , Feminino , Tumores do Estroma Gastrointestinal/diagnóstico , Humanos , Neoplasias do Íleo/diagnóstico , Neoplasias do Jejuno/diagnóstico , Masculino , Pessoa de Meia-Idade , Proto-Oncogene MasRESUMO
BACKGROUND: Minimally invasive cardiac surgery (MICS) is a safe and satisfactory approach used mainly in mitral valve surgery with excellent results in many centers. Cardioplegia administration can be still a problem, especially when an endoaortic clamp is used. We retrospectively analyzed our early results with histidine-triptophane-ketoglutarate (HTK) solution used for myocardial protection in MICS. METHODS: Between February 2003 and February 2004, 8 patients underwent mitral valve surgery using an endo- cardiopulmonary bypass (CPB) system and HTK solution as myocardial protection. The mean patient age was 67.7 +/- 9.2 years, and the preoperative ejection fraction was normal in all patients. Three patients had valve repair and 5 had valve replacement. Mean CPB time was 129.2 +/- 19.4 minutes, and aortic cross-clamp duration was 88.5 +/- 15.4 minutes. RESULTS: In every case HTK solution was used for only a single dose for cardioplegia at the beginning of the procedure, without any recalls. The heart restarted spontaneously at reperfusion in 6 of 8 cases (75%), and there were no significant modifications in electrocardiogram results or myocardial cytonecrosis enzymes (creatine kinase and its MB fraction) during the postoperative period. CONCLUSIONS: HTK solution is a cold crystalloid cardioplegia solution that has demonstrated its utility in MICS because it provides a safe long cardioplegic arrest time and it reduces the risk of inadequate coronary perfusion due to dislodgement of the endoaortic clamp.
Assuntos
Soluções Cardioplégicas/uso terapêutico , Ponte Cardiopulmonar , Doenças das Valvas Cardíacas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Valva Mitral/cirurgia , Idoso , Constrição , Creatina Quinase/sangue , Creatina Quinase Forma MB/sangue , Cardioversão Elétrica , Eletrocardiografia , Feminino , Glucose/uso terapêutico , Doenças das Valvas Cardíacas/enzimologia , Doenças das Valvas Cardíacas/fisiopatologia , Próteses Valvulares Cardíacas , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Manitol/uso terapêutico , Pessoa de Meia-Idade , Cloreto de Potássio/uso terapêutico , Procaína/uso terapêutico , Respiração Artificial , Estudos Retrospectivos , Fatores de TempoRESUMO
BACKGROUND: The outcome of patients with acute traumatic rupture of the thoracic aorta after motor vehicle accidents is strongly conditioned by injuries to other districts. The timing of repair is controversial when the patients arrive alive to the hospital. METHODS: A series of 42 patients with acute traumatic rupture of the thoracic aorta observed between January 1980 and June 1996 was divided into two groups: group I underwent immediate repair (21 patients) and in group II operation was performed after intensive medical treatment and management of the associated lesions and monitoring of the aortic tear. RESULTS: The mortality in group I patients was 19% and the morbidity was more significant than in group II where no deaths were reported and complications were minor. CONCLUSIONS: Patients with acute traumatic rupture of the thoracic aorta may have a better fighting chance if aortic operation is postponed to the most favorable moment after undergoing life-sustaining measures and management of the major associated lesions. Needless to say, evolution should be closely monitored by computed tomographic scans and magnetic resonance imaging.
Assuntos
Aorta Torácica/lesões , Ruptura Aórtica/cirurgia , Acidentes de Trânsito , Doença Aguda , Adolescente , Adulto , Idoso , Ruptura Aórtica/etiologia , Ruptura Aórtica/mortalidade , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo , Fatores de TempoRESUMO
BACKGROUND: Heparin-coated circuits (HCCs) in low-risk cardiac patients who have coronary revascularization have a limited impact on postoperative outcome. In this prospective, randomized investigation, we studied high-risk patients who had cardiac operations with or without HCCs. METHODS: A total of 886 patients who had cardiac operations with cardiopulmonary bypass and at least one patient-related or procedure-related risk factor were enrolled in a multicenter study. They were randomly allocated to have cardiopulmonary bypass with Duraflo II HCCs (HCC group, n = 442) or conventional circuits (control group, n = 444). Postoperative outcome was investigated with respect to the occurrence of organ dysfunction. RESULTS: HCCs are associated with a shorter intensive care unit and postoperative hospital stay and with a lower rate of patients having a severely impaired clinical outcome (stay in intensive care unit for more than 5 days or death) (relative risk 0.66, p = 0.045). Lung dysfunction rate was significantly lower for the patients in HCC group affected by chronic obstructive pulmonary disease or who had mitral procedure (relative risk, respectively, 0.31, p = 0.018 and 0.05, p = 0.02). Renal dysfunction rate was significantly (p = 0.05) lower for diabetics in the HCC group (relative risk 0.28). CONCLUSIONS: When HCCs were used postoperative times decreased and they had a protective effect on lung and kidney function in high-risk patients.
Assuntos
Ponte Cardiopulmonar/instrumentação , Heparina/administração & dosagem , Idoso , Diabetes Mellitus/fisiopatologia , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Pneumopatias Obstrutivas/fisiopatologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
PURPOSE: To compare lesion-to-background contrast with and without magnetization transfer (MT) in lesions of the head and neck. METHODS: Twenty lesions (16 malignant, 4 benign) were evaluated in 17 patients (11 men, 6 women; mean age, 58 years; age range, 39-76 years). In 13 patients, MR imaging was performed at 0.1 T with continuous-wave, off-resonance MT; in 4 patients, MR imaging was performed at 1.5 T with on-resonance, binomial MT prepulses. Fifteen sequences were conducted before the administration of gadopentetate dimeglumine; 13 were conducted after the administration of that contrast material. The ratio of signal intensity with the MT pulses (Ms) to signal intensity without the MT pulses (Mo) was calculated, as were the lesion-to-background contrast and the contrast-to-noise ratios. RESULTS: Ms/Mo showed both wide variability and considerable overlap among different lesion types. Images from MT sequences showed better contrast than those from non-MT sequences in 23 of 28 lesions (12 of 15 before and 11 of 13 after the administration of contrast material). The mean contrast improvement percentages (+/- standard deviation) were 165.5% (+/- 58%) on unenhanced images and 186.6% (+/- 84.8%) on contrast-enhanced images. The mean improvements in contrast-to-noise ratios were 156% (+/- 60%) on unenhanced images and 171.6% (+/- 98.1%) on contrast-enhanced images. CONCLUSION: MT improved contrast between nodes or tumors showing an MT effect and background tissue (usually fat) not showing an MT effect. MT also improved contrast between contrast-enhanced neoplastic lesions and background tissue that showed an MT effect.
Assuntos
Meios de Contraste , Neoplasias de Cabeça e Pescoço/diagnóstico , Imageamento por Ressonância Magnética/métodos , Meglumina , Compostos Organometálicos , Ácido Pentético/análogos & derivados , Adulto , Idoso , Diagnóstico Diferencial , Combinação de Medicamentos , Feminino , Gadolínio DTPA , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Aumento da Imagem , Masculino , Pessoa de Meia-IdadeRESUMO
Adductor laryngeal breathing dystonia (ALBD) is a rare disorder in which patients have persistent inspiratory stridor, usually normal voice, and cough. Physical exam is characterized by paradoxical movement of the vocal cords on inspiration. These patients have involuntary action-induced spasms of the adductor laryngeal muscles on inspiration. There has been no uniformly satisfactory treatment for the disease. Speech therapy, psychotherapy, and pharmacotherapy have all had limited success. We report the successful use of botulinum toxin type A in seven patients with adductor laryngeal breathing dystonia. All patients received bilateral thyroarytenoid injections. All patients had toxin effect within 72 hours, reaching maximal effect within 2 weeks with sustained improvement for an average of 13.8 weeks. Adverse effects included breathy voice and mild choking on liquids. Both resolved, on average, within 2 weeks. This retrospective study supports the safe and effective use of botulinum toxin type A in the treatment of adductor laryngeal breathing dystonia.
Assuntos
Toxinas Botulínicas/uso terapêutico , Músculos Laríngeos/fisiopatologia , Laringismo/terapia , Respiração/fisiologia , Prega Vocal/fisiopatologia , Distúrbios da Voz/terapia , Feminino , Humanos , Laringismo/epidemiologia , Laringismo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Sons Respiratórios/efeitos dos fármacos , Estudos Retrospectivos , Fatores de Tempo , Distúrbios da Voz/epidemiologia , Distúrbios da Voz/fisiopatologiaRESUMO
The authors have investigated whether genetic abnormalities in two genes, loss of heterozygosity (LOH) of p53 and amplification of the cyclin D1 gene, correlate with clinical outcome in 56 matched pairs of blood and tumor from patients with squamous cell carcinoma of the head and neck (SCCHN). Frequency of p53 LOH was 47.4%, of cyclin D1 amplification 33.9%, and of both abnormalities together 23.7%. p53 LOH was associated with T4 (P = 0.003) and stage IV (P = 0.015) tumors. Cyclin D1 amplification was associated with recurrences and/or metachronous tumors (P = 0.007). The total number of p53 and cyclin D1 abnormalities (scored as zero, one, and two) show a pattern that seems to be additive; the increase in the number of these abnormalities is associated with a proportional increase in the frequency of T4, stage IV, presence of recurrences and/or metachronous tumors, and possibly a proportional decrease in the disease-free interval in the sample. The association of the markers with recurrences and/or metachronous tumors persists if the tumor stage effect is mathematically removed. The combined analysis of the p53 and cyclin D1 abnormalities seems to be more informative than either of them individually and may have predictive value in SCCHN.
Assuntos
Carcinoma de Células Escamosas/genética , Amplificação de Genes , Genes bcl-1 , Genes p53 , Neoplasias de Cabeça e Pescoço/genética , Perda de Heterozigosidade , Carcinoma de Células Escamosas/patologia , Intervalo Livre de Doença , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/genética , Estadiamento de Neoplasias , Segunda Neoplasia Primária , Prognóstico , Resultado do TratamentoRESUMO
OBJECTIVE: To determine whether selective 5-lipoxygenase (5-LO) inhibition decreases expression of adhesion molecules (beta2 integrins) on systemic neutrophils, decreases neutrophil infiltration in ischemic flap tissue, and improves flap survival. DESIGN: A randomized, controlled study of 91 adult female Hartley guinea pigs divided into 3 survival groups, 4 neutrophil assay groups, 1 sham group, and 1 control group. Ischemia of varying duration and reperfusion was induced in island flank skin flaps. The treated groups received zileuton, a 5-LO inhibitor, orally during flap ischemia. After reperfusion, systemic neutrophil receptor expression, neutrophil infiltration, and flap survival were measured. Surface receptor molecules on neutrophils from whole blood samples obtained via transcardiac puncture were analyzed using monoclonal antibodies and cell-associated fluorescence. Neutrophil infiltration into a distal 1 cm2 of flap tissue was assessed using myeloperoxidase antibodies. Flap survival was determined within 7 days of surgery. RESULTS: Untreated flaps with 10 hours of ischemia underwent total necrosis. Treated 2- and 10-hour ischemic flaps survived intact. A significant main effect of the drug treatment was detected using analysis of variance (P<.001). Neutrophil receptor detection in the untreated groups undergoing 2 and 10 hours of ischemia was significantly increased compared with that in the treated groups with the same ischemia times. Skin neutrophil infiltration was significantly decreased in the treated groups. CONCLUSIONS: Systemic administration of a 5-LO inhibitor is effective in reducing ischemia-reperfusion injury in flap tissue. Our data indicate that there is a significant reduction in neutrophil receptor expression with administration of 5-LO, reducing the priming of systemic neutrophils from circulating cytokines.
Assuntos
Antígenos CD18/metabolismo , Hidroxiureia/análogos & derivados , Inibidores de Lipoxigenase , Inibidores de Lipoxigenase/farmacologia , Neutrófilos/efeitos dos fármacos , Receptores de Superfície Celular/efeitos dos fármacos , Traumatismo por Reperfusão/prevenção & controle , Animais , Feminino , Cobaias , Hidroxiureia/farmacologia , Hidroxiureia/uso terapêutico , Inibidores de Lipoxigenase/uso terapêutico , Ativação de Neutrófilo/efeitos dos fármacos , Neutrófilos/metabolismo , Receptores de Superfície Celular/metabolismo , Pele/efeitos dos fármacos , Pele/lesões , Pele/metabolismo , Cicatrização/efeitos dos fármacosRESUMO
Surgeons have been creating tracheotomies since at least 124 AD, when first reported by Asclepiades (Price HC, Postma DS. Ear Nose Throat J 1983;62:44-59). Intraoperative and postoperative complications specifically associated with this procedure have been well established. The incidence of pneumothorax ranges from 0% to 17%, depending on the age group studied. To evaluate this complication, it is generally accepted that a postoperative chest film should routinely be obtained after a tracheotomy in adult patients. In adult nonemergent tracheotomies, the routine use of a postoperative chest film has a low yield for detecting a pneumothorax in patients without clinical findings of pneumothorax. To evaluate the use of postoperative chest x-ray in adult tracheotomy patients, a retrospective review of tracheotomies performed at the Boston Medical Center from January 1994 to June 1996 was undertaken. Data examined consisted of age, sex, surgical indication, urgency, operating service, intraoperative and postoperative complications, difficulty of procedure, anesthetic technique, findings on postoperative chest film, signs and symptoms of pneumothorax, and specific treatment of pneumothorax if present. In total, 250 patients were identified. The main indication for tracheostomy in this study was ventilator dependence, accounting for 77% of the procedures. A complication rate of 11.6% was encountered, with no deaths. Postoperative hemorrhage was the most common complication (3.6%). Pneumothorax was documented by chest x-ray in 3 (1.2%) patients, 1 of whom had bilateral pneumothoraces. The most common symptom of a pneumothorax was tachycardia, with 8.8% of the patients exhibiting at least 1 episode. Of the 3 cases of pneumothorax in this study, only 1 was clinically relevant and required treatment. Furthermore, the clinical signs and symptoms in this patient clearly supported the diagnosis of pneumothorax before a postoperative chest film was obtained. Thus postoperative chest radiographs did not change the treatment or outcome of any of the patients undergoing a tracheotomy. This suggests that postoperative chest x-ray after adult tracheotomy is not required in routine cases. Chest radiographs should be obtained after emergent procedures, after difficult procedures, or in patients exhibiting signs or symptoms of pneumothorax.
Assuntos
Complicações Pós-Operatórias/diagnóstico , Doenças Respiratórias/diagnóstico , Traqueotomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Masculino , Pneumotórax/diagnóstico , Período Pós-Operatório , Estudos RetrospectivosRESUMO
We implemented screening for squamous cell carcinomas of the oral cavity, pharynx, and larynx with symptom assessment and systematic inspection of the oral mucosa by primary care practitioners at health care sites serving inner-city residents of Boston; 4611 tobacco users older than 40 years were screened, and 313 with specific criteria were referred to otolaryngology for diagnostic evaluations. In these screened patients, the prevalence of oral mucosal lesions was almost 13% and prevalence of persistent hoarseness was more than 11%. Although the identification of these cancers was rare (nearly 3%), abnormal findings were seen in more than 70% of referred patients. These clinical and histologic diagnoses are described. We have documented the range of pathologic conditions in high-risk patients screened for upper aerodigestive tract malignancy.
Assuntos
Carcinoma de Células Escamosas/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Atenção Primária à Saúde , Fumar/efeitos adversos , Adulto , Fatores Etários , Biópsia , Carcinoma de Células Escamosas/epidemiologia , Neoplasias Esofágicas/diagnóstico , Feminino , Neoplasias de Cabeça e Pescoço/epidemiologia , Inquéritos Epidemiológicos , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Masculino , Pessoa de Meia-Idade , Neoplasias Orofaríngeas/diagnóstico , Neoplasias Faríngeas/diagnóstico , Prevalência , Estudos Retrospectivos , Fatores de RiscoRESUMO
Angioedema is an immunologically mediated, anatomically limited, nonpitting edema that can lead to life-threatening airway obstruction. To predict the risk of airway compromise in angioedema, we retrospectively reviewed 93 episodes in 80 patients from 1985 to 1995. Intubation or tracheotomy was necessary in 9 (9.7%) cases. Angiotensin-converting enzyme inhibitor use in 36 cases (39%) was associated with intensive care unit (ICU) admission (P = 0.05). ICU stay correlated significantly with presentation with voice change, hoarseness, dyspnea, and rash (P < 0.05). Voice change, hoarseness, dyspnea, and stridor were present in patients requiring airway intervention (P < 0.05). On the basis of our data, we propose a staging system by which airway risk may be predicted from the anatomic site of presentation. Patients with facial rash, facial edema, lip edema (stage I), and soft palate edema (stage II) were treated as outpatients and on the hospital ward. Patients with lingual edema (stage III) usually required ICU admission. All patients with laryngeal edema (stage IV) were admitted to the ICU. Airway intervention was necessary in 7% of stage III patients and in 24% of stage IV cases. No deaths were caused by angioedema. Airway risk in angioedema may be predicted by anatomic site of presentation, allowing appropriate triage with preparation for airway intervention in selected cases.
Assuntos
Obstrução das Vias Respiratórias/etiologia , Angioedema/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/terapia , Algoritmos , Assistência Ambulatorial , Angioedema/classificação , Angioedema/diagnóstico , Angioedema/terapia , Feminino , Humanos , Unidades de Terapia Intensiva , Intubação Intratraqueal , Edema Laríngeo/complicações , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Estudos Retrospectivos , Fatores de Risco , TraqueotomiaRESUMO
We report the biochemical characterization of amyloid fibrils from a patient with localized amyloidosis of the epiglottis and larynx. Biopsy specimens showed amorphous material consistent with amyloid deposits with a plasmacytic infiltrate. Both plasma cells and amyloid deposits stained positively by immunohistochemistry for kappa light chains. Amyloid fibrils were isolated. The major constituent resolved as a 13 kd band was sequenced and found to be consistent with a kappa 1 light chain. A tryptic digest was carried out and 3 tryptic peptides were sequenced defining the first 45 residues of the protein and residues 110 through 119. Four amino acid substitutions were found, 3 of which have not been described previously. This study defines the immunoglobulin origin of amyloid deposits in localized amyloidosis. The benign nature of localized amyloidosis suggests that a localized clone of plasma cells producing an amyloidogenic light chain may represent the pathogenetic mechanism of this disease, which appears to be a form of plasma cell dyscrasia.
Assuntos
Amiloidose/imunologia , Cadeias kappa de Imunoglobulina/análise , Doenças da Laringe/imunologia , Sequência de Aminoácidos , Amiloide/análise , Amiloidose/diagnóstico por imagem , Amiloidose/metabolismo , Amiloidose/patologia , Eletroforese em Gel de Poliacrilamida , Feminino , Humanos , Doenças da Laringe/diagnóstico por imagem , Doenças da Laringe/metabolismo , Doenças da Laringe/patologia , Laringe/imunologia , Pessoa de Meia-Idade , Dados de Sequência Molecular , Tomografia Computadorizada por Raios XRESUMO
The haemodynamic indices proposed by Buckberg et al. have been used to evaluate total coronary flow and its distribution to the subendocardial tissue. The following conclusions were drawn from the data obtained in humans and in experimental pathology: 1) in regional ischaemia (angina, myocardial infarction), the DPTI/TTI ratio expresses the degree of subendocardial hypoperfusion with fair approximation, although it has some theoretical limitations, 2) in total myocardial ischaemia, as occurs during ECC, the index provides an accurate picture of the subendocardium and a useful idea of the real effectiveness of the means of myocardial protection.
Assuntos
Angina Pectoris/metabolismo , Ponte de Artéria Coronária , Doença das Coronárias/metabolismo , Glicogênio/metabolismo , Lactatos/metabolismo , Miocárdio/metabolismo , Animais , Circulação Coronária , Doença das Coronárias/cirurgia , SuínosRESUMO
DPH may result in protean head and neck manifestations (Table 1). In some cases these effects are dose related and in others they appear to be idiosyncratic; some occur only at toxic levels (Table 2). Many of the conditions are reversible and withdrawal of DPH or re-establishment of therapeutic levels is the only treatment necessary. Failure to recognize this fact can result in expensive workups or, worse, in aggressive treatment, both of which are unnecessary. The otolaryngologist should therefore be aware of these conditions and consider them in the differential diagnosis.
Assuntos
Otorrinolaringopatias/induzido quimicamente , Fenitoína/efeitos adversos , Animais , Diagnóstico Diferencial , HumanosRESUMO
The report has been divided in two parts. In the first part, the authors review the chief features of the alveolar-capillary membrane permeability. In the second part, are described the early ultrastructural changes observed in the sheep lung, three and twenty-four hours after the haemorragic shock indication. At third hour, the lesions showed a very heterogeneous distributive pattern. The interstitial oedema was the most striking feature at this time, but some important morphological lesions within endothelial and epithelial layers could be also observed. A large amount of neutrophyls on the way to degranulation or already degranulated were observed in the interstitium especially in the most damaged areas. The morphological status of the junctional complex was normal. After twenty-four hours, typical hyaline membranes and areas of well developed alveolar oedema could be seen.
Assuntos
Pulmão/ultraestrutura , Edema Pulmonar/patologia , Animais , Cães , Endotélio/ultraestrutura , Epitélio/ultraestrutura , Neutrófilos/ultraestrutura , Alvéolos Pulmonares/fisiopatologia , Alvéolos Pulmonares/ultraestrutura , Edema Pulmonar/sangue , Ovinos , Choque Hemorrágico/patologiaRESUMO
High incidence of postoperative arterial hypertension, confined to the first 24-48 hours and independent of the preoperative pressure situation, has been noted in patients following vascular surgery. The phenomenon is more frequent in patients whose angiosclerotic symptomatology goes back more than 2 years, and in those in whom preoperative investigation showed high daily variability in measured values, always however within non-pathological limits. Analysis of possible intraoperative pathogenetic factors in postoperative hypertension reveals a significant relationship between this phenomenon and inhalatory anesthesia, particularly with fluothane and curarization with D-tubocurarine. Co-responsibility of respiratory factors, particularly hypercapnia, has never been documented by haemogasanalysis. As for the pathogenetic mechanisms responsible for this type of hypertension, measurement of urinary catecholamines has revealed a close relationship between the two phenomena. The same investigation, extended to a wider group of patients, showed that by comparison with patients submitted to balanced anaesthesia, those who had received inhalatory anaesthesia with fluothane show, with much greater frequency, increased urinary elimination of catecholamines during the operation and for 24-48 hours afterwards. Catecholaminic hyperincretion, more frequent in fluothane anaesthesia, thus seems to be an important pathogenetic factor in these hypertensive manifestations in which the angiosclerotic medium presumably acts as an amplifier.