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Mar Pollut Bull ; 73(2): 452-62, 2013 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-23473095


Extensive CO2 vents have been discovered in the Wagner Basin, northern Gulf of California, where they create large areas with lowered seawater pH. Such areas are suitable for investigations of long-term biological effects of ocean acidification and effects of CO2 leakage from subsea carbon capture storage. Here, we show responses of benthic foraminifera to seawater pH gradients at 74-207m water depth. Living (rose Bengal stained) benthic foraminifera included Nonionella basispinata, Epistominella bradyana and Bulimina marginata. Studies on foraminifera at CO2 vents in the Mediterranean and off Papua New Guinea have shown dramatic long-term effects of acidified seawater. We found living calcareous benthic foraminifera in low pH conditions in the northern Gulf of California, although there was an impoverished species assemblage and evidence of post-mortem test dissolution.

Adaptação Fisiológica , Dióxido de Carbono/toxicidade , Foraminíferos/fisiologia , Água do Mar/química , Poluentes Químicos da Água/toxicidade , Ecossistema , Concentração de Íons de Hidrogênio , México
South Med J ; 86(6): 651-3, 1993 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-8506486


Bioimpedance technology is being used increasingly to determine drug volume of distribution, body water status, and nutrition repletion. Its accuracy in patients experiencing large volume flux is not established. To address this, we undertook this prospective study in 54 consecutive seriously injured adults who had emergency celiotomy soon after arrival in the emergency department. Bioimpedance measurements were obtained in the emergency department before the patient was transported to the operating room, on completion of celiotomy, and 24 hours and 48 hours after celiotomy. Bioimpedance measurements of body water were compared with measured fluid balance. If insensible losses are subtracted from measured fluid balance, the percentage of body weight, which is body water determined by bioimpedance, closely follows fluid flux. This study supports the use of bioimpedance measurements in determining total body water even during periods of surgery, blood loss, and vigorous resuscitation.

Traumatismos Abdominais/fisiopatologia , Água Corporal , Impedância Elétrica , Equilíbrio Hidroeletrolítico , Abdome/cirurgia , Traumatismos Abdominais/cirurgia , Adulto , Emergências , Feminino , Humanos , Masculino , Estudos Prospectivos
J Surg Res ; 53(1): 17-9, 1992 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-1405584


High costs and a paucity of available operating time have led us to seek alternatives to operatively placed vascular access systems. This prospective study is the initial report of a peripheral port system (P.A.S. PORT System, Pharmacia Deltec, Inc.) placed at the bedside. Seventy-nine patients (52 male, 27 female), ages 3-92 years, had ports implanted by surgical residents with attending supervision. Sixty-eight (86%) received the P.A.S. PORT for long-term antibiotics, antifungal, or antiviral therapy; four (5%) for TPN infusion; three (4%) for blood products; two (3%) for chemotherapy; and two (3%) for iv narcotics. Ports were placed in 10 (13%) HIV(+) patients, three (4%) who were fully anticoagulated, and one who was a hemophiliac with a platelet count of zero. Eight patients (10%) developed superficial phlebitis, all of which resolved with nonsteroidal anti-inflammatory agents within 48 hr without port removal. Seven patients (9%) had their port removed due to infection. The average hospital charge to place the P.A.S. PORT System was $1488.00 vs $2811.00 for a tunneled external chest catheter and $3729.00 for the placement of a chest port. Bedside insertion of vascular access devices can be safely performed with acceptable infection rates allowing more efficient use of hospital operating rooms and with substantial cost savings.

Cateterismo Periférico/instrumentação , Adolescente , Adulto , Idoso , Anti-Infecciosos/administração & dosagem , Cateterismo Periférico/economia , Criança , Pré-Escolar , Análise Custo-Benefício , Tratamento Farmacológico/métodos , Feminino , Soropositividade para HIV , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral Total/economia , Estados Unidos
Am Surg ; 58(2): 104-7, 1992 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-1550300


This study was undertaken to evaluate the association between red blood cell transfusions and infections in an easily stratified, homogenous group of injured adults. All received their initial transfusions upon arrival to the emergency department. Over 5 years, 390 uncross-matched trauma patients received type "O" red blood cells (RBCs) during initial resuscitation. One hundred fifty-four (39%) died within 7 days because of injuries sustained: 236 (61%) survived at least 7 days. Of these 236, clear differences could be seen between those receiving 6 or fewer or 7 or more units of RBCs. When adjusted for age, sex, and severity of injury (Champion Trauma Score, Injury Severity Score, TRISS), the risk of infection was higher in those receiving 7 or more units of RBCs. Similarly, risk of infection was related to units of RBCs transfused in a dose-related fashion. Blood transfusions should be avoided, if possible. Arbitrary "trigger points" for transfusions should be abandoned.

Infecções Bacterianas/etiologia , Reação Transfusional , Ferimentos e Lesões/complicações , Sistema ABO de Grupos Sanguíneos , Adulto , Transfusão de Eritrócitos , Feminino , Humanos , Escala de Gravidade do Ferimento , Intestinos/lesões , Masculino , Modelos de Riscos Proporcionais , Análise de Regressão , Fatores de Risco , Taxa de Sobrevida , Índices de Gravidade do Trauma
Am Surg ; 56(1): 43-6, 1990 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-2294811


This study was undertaken to ascertain the role of colonoscopy and surgery in patients with pseudo-obstruction of the cecum. Twenty-eight patients developed cecal pseudo-obstruction (cecal diameter ave., 13.6 cm +/- 2.0; range, 10-18 cm) and 25 of these 28 (89%) were hospitalized for nonabdominal problems. Significant comorbidities existed in all patients. Multimodal therapy was used in most: nasogastric (NG) suction (100%), rectal tube (64%), laxatives (64%), enemas (57%), Colonoscopy (57%), and surgery (25%). Twelve of 18 patients receiving rectal tubes, 14 of 18 receiving laxatives, 11 of 16 receiving enemas, and 12 of 16 (75%) undergoing colonoscopy avoided surgery; colonoscopy cured 44 per cent of the patients, was useless in 38 per cent, was detrimental in 6 per cent, and was temporizing in 12 per cent. Seven of the 28 patients (5 cecostomy, 2 right hemicolectomy) underwent surgery. Four of the seven patients (57%) had significant surgical complications such as wound infection, incisional hernia, cecal prolapse with infarction/death, and evisceration/death. Twenty-four patients of the 28 (86%) survived the index admission; Two of four patients died of the systemic problems that brought on cecal pseudo-obstruction and two of four patients died as a result of cecostomy complications. Pseudo-obstruction occurs in older, debilitated patients generally hospitalized because of nonabdominal problems. Treatment should be aimed at correcting the underlying cause; multimodalities often temporize until underlying problems are corrected and pseudo-obstruction resolves. Colonoscopy is often curative, occasionally helpful, and rarely harmful. Surgery is curative but carries significant risks. Uncomplicated cecal dilatation to 10-18 cm is tolerated; early operative intervention should not be dictated by cecal size alone.

Doenças do Ceco/terapia , Pseudo-Obstrução Intestinal/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Ceco/mortalidade , Doenças do Ceco/patologia , Cecostomia , Colectomia , Colonoscopia , Terapia Combinada , Comorbidade , Estudos de Avaliação como Assunto , Feminino , Humanos , Pseudo-Obstrução Intestinal/mortalidade , Pseudo-Obstrução Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Recidiva
J Bone Joint Surg Am ; 67(4): 598-605, 1985 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-3980506


In this study we compared the effects of compression on the maturity and pattern of osseous healing in canine tibial osteotomies that were fixed with an external fixation system at a single time-period, ninety days after osteotomy. The in vitro model demonstrated that compression increased rigidity of fixation. Relative to the rigidity of the intact tibia, this increase was small. Estimation of osteotomy-site bone blood flow at ninety days by 85Sr clearance and torsional testing to failure of the healed osteotomies were used to compare the maturity of bone union in each group. The pattern of healing of the osteotomy was evaluated by quantitative histological determination of new-bone formation and porosity. All of the osteotomies healed by the ninetieth day. We found no significant difference at that time in osteotomy-site bone blood flow or strength of healing of the osteotomy, although the compression-treated osteotomies healed with higher torsional stiffness. No differences were demonstrated between the two groups in the pattern of healing of the osteotomy. In both groups there was a significantly greater amount of periosteal new-bone formation in the relatively less rigidly fixed antero-posterior plane when compared with the mediolateral plane. Primary bone-healing of both the contact type and the gap type was seen in both groups. There were no significant complications and the pin-loosening rate was similar in both groups.

Dispositivos de Fixação Ortopédica , Osteotomia , Tíbia/cirurgia , Animais , Fenômenos Biomecânicos , Desenvolvimento Ósseo , Cães , Pressão , Fluxo Sanguíneo Regional , Radioisótopos de Estrôncio , Tíbia/irrigação sanguínea , Tíbia/fisiologia , Cicatrização