RESUMO
Patients with complications of chemotherapy, either acute or chronic, are frequently encountered in the emergency department (ED). Some patients present with complaints immediately after chemotherapy administration, whereas others may show subtle, secondary signs or may have no signs or symptoms of chemotoxicity. An increased index of suspicion prompts early recognition, diagnosis, and prevention of further iatrogenic injury. This article reviews characteristic hypersensitivity reactions, typical organ system dysfunction, and treatment strategies for adult patients who present to the ED with complications after chemotherapy.
Assuntos
Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/terapia , Serviços Médicos de Emergência/métodos , Adulto , Serviço Hospitalar de Emergência , HumanosRESUMO
Cardiac arrest is a common cause of global hypoxic-ischemic brain injury. Poor neurologic outcome among cardiac arrest survivors results not only from direct cellular injury but also from subsequent long-term dysfunction of neuronal circuits. Here, we investigated the long-term impact of cardiac arrest during development on the function of cortical layer IV (L4) barrel circuits in the rat primary somatosensory cortex. We used multielectrode single-neuron recordings to examine responses of presumed excitatory L4 barrel neurons to controlled whisker stimuli in adult (8 ± 2-mo-old) rats that had undergone 9 min of asphyxial cardiac arrest and resuscitation during the third postnatal week. Results indicate that responses to deflections of the topographically appropriate principal whisker (PW) are smaller in magnitude in cardiac arrest survivors than in control rats. Responses to adjacent whisker (AW) deflections are similar in magnitude between the two groups. Because of a disproportionate decrease in PW-evoked responses, receptive fields of L4 barrel neurons are less spatially focused in cardiac arrest survivors than in control rats. In addition, spiking activity among L4 barrel neurons is more correlated in cardiac arrest survivors than in controls. Computational modeling demonstrates that experimentally observed disruptions in barrel circuit function after cardiac arrest can emerge from a balanced increase in background excitatory and inhibitory conductances in L4 neurons. Experimental and modeling data together suggest that after a hypoxic-ischemic insult, cortical sensory circuits are less responsive and less spatially tuned. Modulation of these deficits may represent a therapeutic approach to improving neurologic outcome after cardiac arrest.
Assuntos
Potenciais de Ação/fisiologia , Parada Cardíaca/patologia , Parada Cardíaca/terapia , Neurônios/fisiologia , Córtex Somatossensorial , Vibrissas/inervação , Vias Aferentes/fisiologia , Animais , Animais Recém-Nascidos , Simulação por Computador , Modelos Animais de Doenças , Eletrocardiografia , Complexo IV da Cadeia de Transporte de Elétrons/metabolismo , Feminino , Parada Cardíaca/etiologia , Hipóxia-Isquemia Encefálica/complicações , Modelos Neurológicos , Inibição Neural/fisiologia , Estimulação Física , Ratos , Ratos Sprague-Dawley , Córtex Somatossensorial/crescimento & desenvolvimento , Córtex Somatossensorial/patologia , Córtex Somatossensorial/fisiopatologia , Tálamo/fisiologiaRESUMO
Patients with complications of chemotherapy, either acute or chronic, are frequently encountered in the emergency department (ED). Some patients present with complaints immediately after chemotherapy administration, whereas others may show subtle, secondary signs or may have no signs or symptoms of chemotoxicity. An increased index of suspicion prompts early recognition, diagnosis, and prevention of further iatrogenic injury. This article reviews characteristic hypersensitivity reactions, typical organ system dysfunction, and treatment strategies for adult patients who present to the ED with complications after chemotherapy.
