ABSTRACT
The purpose of this study was to correlate the preoperative level of antioxidant defenses, measured by the plasma total antioxidant capacity (TAC), to the degree of postoperative systemic inflammatory response, measured by the severity of pulmonary injury following elective aortic surgery. Twenty-four patients had TAC measured preoperatively and 24 hr postoperatively. Chest radiography and arterial blood gases were obtained preoperatively and serially during the first 24 hr after surgery. Using objective radiologic criteria and blood gas analysis, the degree of pulmonary edema and pulmonary dysfunction were quantified. All patients showed evidence of pulmonary dysfunction in the first 24 hr following surgery. Fifteen of the 24 patients showed radiographic evidence of noncardiogenic pulmonary edema in the immediate postoperative period. In this group, the TAC was lower than in those without pulmonary edema immediately following surgery (p = 0.03). Preoperative TAC was associated with the degree of pulmonary edema in the postoperative period (r = -0.372, p = 0.067). These results suggest that preoperative antioxidant supplementation may favorably impact the severity of systemic inflammatory response following ischemia and reperfusion injury.
Subject(s)
Antioxidants/analysis , Aortic Aneurysm/blood , Aortic Diseases/blood , Oxidative Stress , Systemic Inflammatory Response Syndrome/blood , Aged , Aortic Aneurysm/surgery , Aortic Diseases/surgery , Blood Vessel Prosthesis Implantation , Female , Humans , Male , Middle Aged , Postoperative Period , Prospective Studies , Pulmonary Edema/physiopathology , Reperfusion Injury/bloodABSTRACT
BACKGROUND: We report the use of retroperitoneal aortic aneurysm repair utilizing exclusive regional anesthesia (no intubation or inhalation anesthetic) in high pulmonary risk patients. METHODS: Six patients were retrospectively reviewed. Pulmonary disease was diagnosed by clinical history and pulmonary function tests. Patients received intravenous sedation and regional anesthesia. Retroperitoneal aortoiliac aneurysm repair was performed. RESULTS: All patients used inhaled steroids and albuterol. Three required theophylline and home oxygen. FEV1 = 23% +/- 5% predicted, FVC = 34% +/- 5% predicted, and PO2 = 62 +/- 2 mm Hg. Operative time was 247 +/- 25 minutes. Blood loss was 840 +/- 479 mL. Five of six patients (83%) tolerated awake aneurysm repair and had intensive care unit stays of 2.4 +/- 0.6 days, and postoperative hospital stays of 8.2 +/- 1.8 days. One patient was converted to general anesthesia and had a prolonged hospital stay. CONCLUSIONS: With thorough patient communication, awake retroperitoneal aortic aneurysm repair can be safely performed in select patients with severe pulmonary disease.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Consciousness , Iliac Aneurysm/surgery , Lung Diseases/complications , Administration, Inhalation , Aged , Albuterol/administration & dosage , Albuterol/therapeutic use , Anesthesia, Epidural , Anesthesia, General , Anesthesia, Intravenous , Blood Loss, Surgical , Bronchodilator Agents/administration & dosage , Bronchodilator Agents/therapeutic use , Critical Care , Forced Expiratory Volume/physiology , Home Care Services , Hospitalization , Humans , Hypnotics and Sedatives/administration & dosage , Length of Stay , Lung Diseases/drug therapy , Lung Diseases/therapy , Oxygen Inhalation Therapy , Retroperitoneal Space , Retrospective Studies , Risk Factors , Safety , Steroids/administration & dosage , Steroids/therapeutic use , Theophylline/administration & dosage , Theophylline/therapeutic use , Time Factors , Vital Capacity/physiologyABSTRACT
Perforation from a solitary metastatic lesion of the small bowel is rare. We report a case of acute perforation with no evidence of metastatic disease within the abdomen. Resection of the small bowel was performed.
Subject(s)
Breast Neoplasms/pathology , Carcinoma, Intraductal, Noninfiltrating/secondary , Intestinal Perforation/etiology , Intestine, Small , Jejunal Neoplasms/secondary , Abdomen, Acute/etiology , Adult , Carcinoma, Intraductal, Noninfiltrating/complications , Carcinoma, Intraductal, Noninfiltrating/surgery , Fatal Outcome , Female , Humans , Jejunal Neoplasms/complications , Jejunal Neoplasms/surgery , Peritonitis/etiologyABSTRACT
This article presents a case of acute mesenteric vein thrombosis with small bowel infarction associated with pancreatitis. Although a rare occurrence, the authors suggest this diagnosis should be considered as a possible complication of pancreatic inflammation.
Subject(s)
Infarction/complications , Intestine, Small/blood supply , Mesenteric Veins , Pancreatitis/complications , Thrombosis/complications , Acute Disease , Adult , Humans , Male , Tomography, X-Ray ComputedABSTRACT
Some original water-soluble metalloporphyrins/KHSO5 systems were developed to mimic the metabolic biooxidation of drugs. Oxidation of acetaminophen and various ellipticine derivatives were used as model reactions. Oxidative products (mainly quinone-imine structures) were obtained in good yield after 2 min of reaction, for a catalyst/substrate ratio of 0.04. Iron(III) derivative of tetrasodium meso-tetrakis(p-sulfonatophenyl)porphyrin and manganese(III) derivative of tetraacetate meso-tetrakis(4-N-methyl-pyridiniumyl)-porphyrin were the best catalysts for the oxidation of acetaminophen and ellipticine compounds, respectively. At low catalyst concentration, initial turnover rates could rise up to 8 catalytic cycles/sec. In some conditions, these catalytic systems are nearly as efficient as horseradish peroxidase/H2O2. They might have a real future as oxidation catalysts, in complement to the use of purified monooxygenase and peroxidases, to predict the possible in vivo oxidative metabolite pathways.