RESUMO
A 67-year-old man presented with fever, night sweat and abdominal complaints for about 4 weeks. Ultrasound and a computed tomography scan showed distinct ascites as the main finding, presenting as exsudate with predominating lymphoid cells. Because of long-term immunosuppressive therapy with the tumor necrosis factor (TNF)-α inhibitor golimumab for psoriasis, the suspicion for a possible tuberculous peritonitis arose. This was confirmed with an enzyme-linked immunospot assay, a high level of adenosine deaminase in the ascites and a peritoneum which was studded with multiple whitish nodules, corresponding to granulomas with giant cells. With a standard antituberculous regimen the symptoms were quickly relieved and finally complete restitution was achieved.
Assuntos
Anticorpos Monoclonais/efeitos adversos , Ascite/etiologia , Febre de Causa Desconhecida/etiologia , Peritonite Tuberculosa/induzido quimicamente , Psoríase/tratamento farmacológico , Sudorese , Adenosina Desaminase/metabolismo , Idoso , Anticorpos Monoclonais/uso terapêutico , Ritmo Circadiano , Diagnóstico Diferencial , ELISPOT , Humanos , Masculino , Peritonite Tuberculosa/diagnósticoRESUMO
Meteorites provide a sample of Solar System bodies and so constrain the types of objects that have collided with Earth over time. Meteorites analysed to date, however, are unlikely to be representative of the entire population and it is also possible that changes in their nature have occurred with time. Large objects are widely believed to be completely melted or vaporized during high-angle impact with the Earth. Consequently, identification of large impactors relies on indirect chemical tracers, notably the platinum-group elements. Here we report the discovery of a large (25-cm), unaltered, fossil meteorite, and several smaller fragments within the impact melt of the giant (> 70 km diameter), 145-Myr-old Morokweng crater, South Africa. The large fragment (clast) resembles an LL6 chondrite breccia, but contains anomalously iron-rich silicates, Fe-Ni sulphides, and no troilite or metal. It has chondritic chromium isotope ratios and identical platinum-group element ratios to the bulk impact melt. These features allow the unambiguous characterization of an impactor at a large crater. Furthermore, the unusual composition of the meteorite suggests that the Morokweng asteroid incorporated part of the LL chondrite parent body not represented by objects at present reaching the Earth.
RESUMO
Hemodynamic effects of the beta-receptor-blocking agent metoprolol (100 mg orally) and the calcium antagonist verapamil (160 mg orally) were analyzed in 24 patients with atrial fibrillation of different etiology (idiopathic atrial fibrillation, 6 cases; congestive cardiomyopathy, 6 cases; mitral stenosis, 5 cases; mitral regurgitation, 6 cases). 2 h after the administration of either metoprolol or verapamil heart rate was reduced significantly both at rest and during exercise. Cardiac output during exercise was significantly diminished under metoprolol in all groups of patients, whereas no effects were noted under verapamil. Peripheral vascular resistance was significantly decreased by verapamil both at rest and during exercise. No change in total peripheral resistance was noted after metoprolol at rest, but an increase occurred during exercise. Different effects on peripheral circulation may explain the different patterns of cardiac performance observed after heart rate reduction in atrial fibrillation by a calcium antagonist and a beta-blocking agent.
Assuntos
Fibrilação Atrial/tratamento farmacológico , Hemodinâmica/efeitos dos fármacos , Metoprolol/uso terapêutico , Taquicardia/tratamento farmacológico , Verapamil/uso terapêutico , Débito Cardíaco/efeitos dos fármacos , Cardiomiopatia Dilatada/tratamento farmacológico , Frequência Cardíaca/efeitos dos fármacos , Humanos , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/tratamento farmacológico , Estenose da Valva Mitral/tratamento farmacológico , Pressão Propulsora Pulmonar/efeitos dos fármacos , Resistência Vascular/efeitos dos fármacosRESUMO
Eleven mongrel dogs were observed for 72 h following a standardized traumatic hemorrhagic shock. The decrease of plasma albumin concentration and blood 125-I-albumin activity with a concomitant increase in lung I-albumin content is possibly caused by capillary leakage. A rise in the extravascular lung water content was measured by a gravimetric postmortem method. An in vivo double indicator technique, however, failed to document these findings.
Assuntos
Permeabilidade Capilar , Síndrome do Desconforto Respiratório/metabolismo , Choque Hemorrágico/metabolismo , Choque Traumático/metabolismo , Animais , Proteínas Sanguíneas/metabolismo , Cães , Espaço Extracelular/metabolismoRESUMO
In polytraumatized patients, pulmonary contusion complicated by pneumonia is associated with a high risk of fatality. The effects of both contusion and bacterial infection on pulmonary function can be estimated early by measuring the parameters PAPd-PCWP, pulmonary shunt volume and maximal PaO2 following FiO2 = 1.0 for 20 min.