ABSTRACT
Oculopharyngeal muscular dystrophy (OPMD) is an uncommon autosomal dominant disorder characterized by late onset and slow progression. Complications of OPMD include ptosis and progressive dysphagia leading to eventual malnutrition and aspiration. We report a rare case of OPMD complicating mechanical ventilator management following emergent surgery. OPMD and the resulting dysphagia contributed to multiple intubations, tracheostomy, aspiration pneumonia, and a prolonged hospital course. Awareness of the possibility of OPMD in intubated patients with a history of dysphagia is crucial for avoidance of complications.
Subject(s)
Foot/blood supply , Ischemia/surgery , Muscular Dystrophies/complications , Pneumonia, Aspiration/etiology , Postoperative Complications/etiology , Respiration, Artificial , Aged , Aged, 80 and over , Diagnosis, Differential , Humans , Male , Muscular Dystrophies/diagnosis , Muscular Dystrophies/genetics , Pneumonia, Aspiration/diagnosis , Postoperative Complications/diagnosis , Ventilator Weaning/adverse effectsABSTRACT
Decreases in effective capillary blood flow during septic shock may be related to changes in neutrophil rheology which contribute to microvascular occlusion. The purpose of this study was to examine neutrophil deformability, adherence, and aggregation in patients with severe sepsis and septic shock. Neutrophils were isolated from six patients with septic shock (SS), 12 patients with severe sepsis (S), six noninfected critically ill patients (CINS), and nine normal volunteers (N). Neutrophil deformability was determined by examining filtration through 5-microm filters. Neutrophil aggregation was measured by aggregometry and leukergy. Neutrophil adherence was examined by assessing the binding of latex beads to neutrophils. Patients with S and SS demonstrated decreased neutrophil filterability of 27 +/- 2% and 16 +/- 5%, respectively (p < 0.01), in comparison with N subjects, 55 +/- 4% and CINS patients, 58 +/- 2%. Preincubation of neutrophils from S and SS patients with cytochalasin D significantly increased the percent filtration of neutrophils. Neutrophil aggregation, measured by aggregometry, was increased in SS patients, 16 +/- 4% (p < 0.01) compared with N subjects, 1 +/- 0.2% and CINS patients, 1 +/- 0.2%. Incubation of neutrophils of SS patients with anti-CD11/CD18 significantly increased the filtration of isolated neutrophils to 46 +/- 3% (p < 0.01) and decreased aggregation to 7 +/- 2%. Neutrophil adherence was not increased in S or SS patients. These observations suggest that neutrophil deformability is decreased in patients with S and SS. Increased leukoaggregation may also contribute to decreased filterability of neutrophils in SS patients. These mechanisms may play a role in impaired microvascular flow in septic shock.
Subject(s)
Hemorheology , Neutrophils/physiology , Shock, Septic/blood , Aged , Cell Adhesion , Cell Aggregation , Filtration , Humans , Sepsis/bloodABSTRACT
A comprehensive review of the biochemical organization of the malignant astrocytoma is presented. The review is intended for neurosurgeons. It outlines the metabolic flow of events beginning with energy and substrate utilization, followed by structural components (protein, lipids, etc.) and tumor cell secretory products, and ending with nucleic acid synthesis. Cellular pH, tumor-induced cerebral edema, tumor blood flow, and tumor necrosis are also considered.