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1.
Medicine (Baltimore) ; 99(9): e19364, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118780

RESUMO

To establish a clinical prediction rule for acute bilirubin encephalopathy (ABE) in term/near-term neonates with extreme hyperbilirubinemia.A retrospective cohort study was conducted between January 2015 and December 2018. Six hundred seventy-three out of 26,369 consecutive neonates with extreme hyperbilirubinemia were enrolled in this study. Data included demographic characteristics, total serum bilirubin (TSB), albumin, bilirubin/albumin ratio (B/A), direct antiglobulin test, glucose-6-phosphate deficiency, asphyxia, sepsis, acidosis. ABE was defined as a bilirubin induced neurological dysfunction score of 4 to 9. We used stepwise logistic regression to select predictors of ABE and devised a prediction score.Of the 673 eligible infants, 10.8% suffered from ABE. Our prediction score consisted of 3 variables: TSB (as a continuous variable; odds ratio [OR] 1.16; 95% confidence interval [CI], 1.02-1.31; logistic coefficient 0.15), B/A (as a continuous variable; OR 1.88; 95% CI, 1.19-2.97; logistic coefficient 0.67), and sepsis (OR 3.78; 95% CI, 1.40-10.21; logistic coefficient 1.19). Multiplying the logistic coefficients by 10 and subtracting 75, resulted in the following equation for the score: Score = 12 × (if sepsis) + 1.5 × (TSB) + 7 × (B/A) - 75. The model performed well with an area under the curve of 0.871.The risk of ABE can be quantified according to TSB, B/A, and sepsis in term/near-term neonates with extreme hyperbilirubinemia.


Assuntos
Hiperbilirrubinemia/complicações , Kernicterus/etiologia , Bilirrubina/análise , Bilirrubina/sangue , China/epidemiologia , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Hiperbilirrubinemia/diagnóstico , Hiperbilirrubinemia/epidemiologia , Recém-Nascido , Kernicterus/diagnóstico , Kernicterus/epidemiologia , Masculino , Estudos Retrospectivos
2.
Transplant Proc ; 51(7): 2420-2424, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31405742

RESUMO

Sepsis causes life-threatening organ dysfunction and is the leading cause of morbidity and mortality in critically ill patients worldwide. Mortality rate of sepsis is close to 30% to 50% despite better understanding of the pathophysiology of sepsis, and advances in antimicrobial therapy, resuscitation strategies, and mechanical ventilation. Liver failure is characterized by accumulation of potentially toxic substances in the systemic circulation of the patient. Toxic effects of these molecules can induce cellular injuries leading to multiorgan dysfunction. Hydrophobic unconjugated bilirubin and bile acids, hydrophilic conjugated bilirubin, and ammonium are the main toxins accumulated in liver failure. We carried out cytokine adsorbtion (CytoSorb) procedure with continuous venovenous hemodialysis in 12-hour sessions. The biochemical values of the patients before and after the use of the filter were recorded. The parameters compared were as follows: total bilirubin, direct bilirubin, C-reactive protein, leukocyte, neutrophil, alanine aminotransferase, aspartate aminotransferase, creatinine, colloid oncotic pressure, ammonia, gamma-glutamyl transferase, alkaline phosphatase, procalcitonin, hematocrit, hemoglobin, pH, albumin, international normalized ratio, fibrinogen, lactate dehydrogenase, platelet, temperature, changes in vasoactive medication requirement, temperature. According to these results, cytokine adsorption systems can be considered as an option to lower bilirubin levels in cases of liver failure. Its inability to lower ammonia level is considered a disadvantage compared with other bilirubin-lowering methods. Although further studies are needed to compare different methods, cytokine adsorption systems may be considered in treatment planning as it contributes to the treatment of sepsis and hyperbilirubinemia in liver failure patients with sepsis.


Assuntos
/métodos , Citocinas/sangue , Hiperbilirrubinemia/sangue , Falência Hepática/terapia , Sepse/sangue , Adsorção , Amônia/sangue , Bilirrubina/sangue , Feminino , Humanos , Hiperbilirrubinemia/complicações , Falência Hepática/sangue , Falência Hepática/etiologia , Testes de Função Hepática/métodos , Masculino , Pessoa de Meia-Idade , Sepse/complicações , Resultado do Tratamento
3.
Artigo em Chinês | MEDLINE | ID: mdl-31446717

RESUMO

SummaryNeonatal hyperbilirubinemia is the most common clinical symptom in neonates. When the concentration of free bilirubin in blood is too high, it crosses through the blood-brain barrier and selectively deposits in specific brain nuclei to cause neurotoxicity and bilirubin neurological dysfunction. The auditory nervous system is highly sensitive to bilirubin. Therefore, auditory neuropathy is the most important or even the only clinical symptom of bilirubin neurological dysfunction. Chronic bilirubin encephalopathy can be classified to three types as mild, moderate and severe,according to the audiological manifestations and other neurological sequelae. Early recognition and intervention of bilirubin-induced hearing impairment is of great significance to improve the speech recognition rate of the referred children. This article reviews the most important studies about the clinical characteristics, pathogenesis and treatment of bilirubin-induced hearing impairment.


Assuntos
Perda Auditiva/etiologia , Perda Auditiva/terapia , Hiperbilirrubinemia/complicações , Bilirrubina , Humanos , Kernicterus/complicações
5.
BMJ Case Rep ; 12(6)2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31171533

RESUMO

Thyrotoxicosis rarely presents as cholestatic hyperbilirubinaemia, and severe bilirubin elevation may lead to bile cast nephropathy. We present a case of a young woman with newly diagnosed Graves' disease with thyrotoxicosis who developed severe hyperbilirubinaemia and bile cast nephropathy. Serial plasma exchange and temporary haemodialysis led to full renal recovery. After treatment of her thyrotoxicosis with antithyroid medication and radioactive iodine ablation, her bilirubin normalised.


Assuntos
Doença de Graves/radioterapia , Hiperbilirrubinemia/complicações , Icterícia Obstrutiva/etiologia , Tireotoxicose/complicações , Adulto , Bile , Feminino , Doença de Graves/tratamento farmacológico , Humanos , Radioisótopos do Iodo/uso terapêutico , Nefropatias/etiologia , Nefropatias/terapia , Diálise Renal/métodos , Resultado do Tratamento
6.
Int J Mol Sci ; 20(9)2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31075981

RESUMO

Decreased inflammatory status has been reported in subjects with mild unconjugated hyperbilirubinemia. However, mechanisms of the anti-inflammatory actions of bilirubin (BR) are not fully understood. The aim of this study is to assess the role of BR in systemic inflammation using hyperbilirubinemic Gunn rats as well as their normobilirubinemic littermates and further in primary hepatocytes. The rats were treated with lipopolysaccharide (LPS, 6 mg/kg intraperitoneally) for 12 h, their blood and liver were collected for analyses of inflammatory and hepatic injury markers. Primary hepatocytes were treated with BR and TNF-α. LPS-treated Gunn rats had a significantly decreased inflammatory response, as evidenced by the anti-inflammatory profile of white blood cell subsets, and lower hepatic and systemic expressions of IL-6, TNF-α, IL-1ß, and IL-10. Hepatic mRNA expression of LPS-binding protein was upregulated in Gunn rats before and after LPS treatment. In addition, liver injury markers were lower in Gunn rats as compared to in LPS-treated controls. The exposure of primary hepatocytes to TNF-α with BR led to a milder decrease in phosphorylation of the NF-κB p65 subunit compared to in cells without BR. In conclusion, hyperbilirubinemia in Gunn rats is associated with an attenuated systemic inflammatory response and decreased liver damage upon exposure to LPS.


Assuntos
Hiperbilirrubinemia/complicações , Inflamação/complicações , Animais , Apoptose/efeitos dos fármacos , Bilirrubina/farmacologia , Biomarcadores/sangue , Células Cultivadas , Citocinas/sangue , Citocinas/genética , Citocinas/metabolismo , Citoproteção/efeitos dos fármacos , Feminino , Hepatócitos/metabolismo , Hiperbilirrubinemia/sangue , Leucócitos/metabolismo , Lipopolissacarídeos , Fígado/metabolismo , NF-kappa B/metabolismo , Fosforilação/efeitos dos fármacos , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Ratos Gunn , Transdução de Sinais
7.
J Matern Fetal Neonatal Med ; 32(11): 1813-1819, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29295636

RESUMO

OBJECTIVE: Unconjugated bilirubin (UCB) may cause neurotoxicity in preterm neonates due to immaturity of UGT1A1 leading to bilirubin accumulation in the brain. Caffeine used in the treatment of apnea of prematurity was reported to decrease mechanical ventilation requirement, the frequencies of bronchopulmonary dysplasia, patent ductus arteriosus, cerebral palsy and neurodevelopmental disorders in very low birth weight infants. However, the effect of caffeine on hyperbilirubinemia was not yet clarified. METHODS: We used astrocyte cell cultures obtained from 2-day-old Wistar albino rats via modified Cole and de Vellis method. UCB concentration toxic to 50% of astrocytes, and caffeine concentration increasing cell viability 100% were used in experiments. While no medication was applied to the control group, UCB (50 µM) and caffeine (100 µM) were applied to the bilirubin and caffeine groups for 24 h. Prophylactic and therapeutic caffeine groups were treated with caffeine 4 h before and after UCB exposure. The effects of caffeine were investigated in rat astrocytes exposed to UCB in terms of cell viability, apoptosis, antioxidant defense, proinflammatory cytokines, and Toll-like receptor (TLR)s. RESULTS: Compared to the control group, UCB increased apoptosis, malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), interleukin (IL)-1ß, IL-6, total nitrate/nitrite, and TLR4 levels, and decreased cell viability, catalase (CAT), glutathione peroxidase (GPx), superoxide dismutase (SOD) activities, glutathione, and TLR9 levels (for all p < .001). Conversely, prophylactic and therapeutic caffeine improved the detrimental effects of UCB. CONCLUSIONS: Caffeine seems encouraging for the prevention and treatment of bilirubin neurotoxicity in rats by means of its antiapoptotic, antioxidant, anti-inflammatory, anti-nitrosative, and anti-TLR-4 properties.


Assuntos
Astrócitos/efeitos dos fármacos , Cafeína/uso terapêutico , Hiperbilirrubinemia/complicações , Síndromes Neurotóxicas/prevenção & controle , Antagonistas de Receptores Purinérgicos P1/uso terapêutico , Animais , Animais Recém-Nascidos , Células Cultivadas , Avaliação Pré-Clínica de Medicamentos , Síndromes Neurotóxicas/etiologia , Ratos Wistar
9.
J Vasc Interv Radiol ; 30(1): 31-37, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30527653

RESUMO

PURPOSE: To retrospectively investigate the impact of hyperbilirubinemia on future liver remnant (FLR) volume after percutaneous transhepatic portal vein embolization (PVE) and incidence of post-hepatectomy liver failure in primary biliary malignancy. MATERIALS AND METHODS: Eighty-seven patients (62 men, overall mean age 66.9 y) who underwent PVE, using Gelfoam and coils before major hepatectomy between January 2004 and June 2016, were included in this study and divided into a hyperbilirubinemia (serum total bilirubin level at PVE 5.80 ± 2.44 mg/dL; n = 41) group and a control group (1.09 ± 0.73 mg/dL; n = 46). Liver volume was measured from computerized tomographic data before and 18.5 days, on average, after PVE. Correlation between FLR hypertrophy (degree of hypertrophy and percentage increase in future liver remnant [%FLR]) and total bilirubin were analyzed. FLR hypertrophy and incidence of post-hepatectomy liver failure were compared. Simple and multiple regressions were used for univariable and multivariable analyses, respectively. RESULTS: Mean FLR volumes before and after PVE were 529.1 cm3 and 640.5 cm3, respectively. Degree of hypertrophy and %FLR were 7.64 ± 4.22 and 21.77 ± 13.34, respectively. There was no significant correlation between FLR hypertrophy and total bilirubin (P > .5). FLR hypertrophy was not significantly different between the 2 groups. Planned major hepatectomy was performed in 73 patients (83.9%). Grade 3 post-hepatectomy liver failure occurred in 6 patients (8.2%; 2 in the hyperbilirubinemia group and 4 in the control group), and its incidence was not significantly different between the groups (P = .354). CONCLUSIONS: Hyperbilirubinemia at the time of PVE seems to have no effect on FLR hypertrophy. The incidence of grade 3 post-hepatectomy liver failure is not likely to be influenced, either.


Assuntos
Neoplasias do Sistema Biliar/cirurgia , Bilirrubina/sangue , Embolização Terapêutica , Hepatectomia/efeitos adversos , Hiperbilirrubinemia/sangue , Falência Hepática/etiologia , Regeneração Hepática , Veia Porta , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Sistema Biliar/sangue , Neoplasias do Sistema Biliar/complicações , Neoplasias do Sistema Biliar/patologia , Proliferação de Células , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Embolização Terapêutica/métodos , Feminino , Esponja de Gelatina Absorvível/administração & dosagem , Humanos , Hiperbilirrubinemia/complicações , Hiperbilirrubinemia/diagnóstico , Infusões Intravenosas , Falência Hepática/diagnóstico , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
10.
Ir Med J ; 111(4): 739, 2018 04 19.
Artigo em Inglês | MEDLINE | ID: mdl-30488686

RESUMO

Kernicterus is a relatively rare consequence of hyperbilirubinemia. There is an important role for MRI imaging for this entity in the appropriate clinical context as there are distinct signal changes in the globus pallidus. A case report and image findings are presented


Assuntos
Imagem de Difusão por Ressonância Magnética , Globo Pálido/diagnóstico por imagem , Globo Pálido/patologia , Kernicterus/diagnóstico por imagem , Kernicterus/patologia , Neuroimagem , Feminino , Humanos , Hiperbilirrubinemia/complicações , Lactente , Kernicterus/etiologia
11.
J Acquir Immune Defic Syndr ; 79(5): 617-623, 2018 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-30204718

RESUMO

OBJECTIVE: To investigate the association between total, direct, and indirect bilirubin and the presence of carotid lesions in a large sample of HIV-1-infected patients on virological suppression. DESIGN: Retrospective study on adult HIV-1-infected patients, with a carotid ultrasound (CUS) examination performed between January 2008 and August 2016, with HIV-RNA <50 copies per milliliter at CUS and without previous cardiovascular events. METHODS: Intima media thickness was measured in 4 segments: carotid common artery and bifurcation on the left and right sides. Carotid lesion was defined as an intima media thickness ≥1.5 mm in ≥1 region at CUS. Patients were classified as: normal if all bilirubin values before CUS were below the upper normal limit and with hyperbilirubinemia if ≥1 bilirubin value above upper normal limit before CUS was recorded. Multivariate logistic regression was used to determine whether hyperbilirubinemia showed association with the presence of ≥1 carotid lesion, after adjusting for confounding factors. RESULTS: Overall, 903 patients were evaluated, 511 with ≥1 and 392 without carotid lesions. At multivariate analysis, total [adjusted odds ratio (95% confidence interval) 0.57 (0.36 to 0.90), P = 0.016] and indirect hyperbilirubinemia before CUS [adjusted odds ratio (95% confidence interval) 0.62 (0.40 to 0.97), P = 0.036] were associated with a lower risk of carotid lesions in addition to younger age, negative hepatitis C virus antibodies, higher nadir CD4, lower low-density lipoprotein cholesterol, higher high-density lipoprotein cholesterol, lower triglycerides, and no use of statin; no effect of atazanavir treatment on carotid lesions was detected. CONCLUSIONS: In HIV-1-treated patients, total or indirect hyperbilirubinemia was likely associated with the absence of carotid lesions.


Assuntos
Doenças das Artérias Carótidas/epidemiologia , Infecções por HIV/complicações , Hiperbilirrubinemia/complicações , Adulto , Idoso , Fármacos Anti-HIV/uso terapêutico , Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Resposta Viral Sustentada , Ultrassonografia , Adulto Jovem
13.
PLoS One ; 13(8): e0201022, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30106954

RESUMO

Hyperbilirubinemia (jaundice) is caused by raised levels of unconjugated bilirubin in the blood. When severe, susceptible brain regions including the cerebellum and auditory brainstem are damaged causing neurological sequelae such as ataxia, hearing loss and kernicterus. The mechanism(s) by which bilirubin exerts its toxic effect have not been completely understood to date. In this study we investigated the acute mechanisms by which bilirubin causes the neurotoxicity that contributes to hearing loss. We developed a novel mouse model that exhibits the neurological features seen in human Bilirubin-Induced Neurological Dysfunction (BIND) syndrome that we assessed with a behavioural score and auditory brainstem responses (ABR). Guided by initial experiments applying bilirubin to cultured cells in vitro, we performed whole genome gene expression measurements on mouse brain tissue (cerebellum and auditory brainstem) following bilirubin exposure to gain mechanistic insights into biochemical processes affected, and investigated further using immunoblotting. We then compared the gene changes induced by bilirubin to bacterial lipopolysaccharide (LPS), a well characterized inducer of neuroinflammation, to assess the degree of similarity between them. Finally, we examined the extent to which genetic perturbation of inflammation and both known and novel anti-inflammatory drugs could protect hearing from bilirubin-induced toxicity. The in vitro results indicated that bilirubin induces changes in gene expression consistent with endoplasmic reticulum (ER) stress and activation of the unfolded protein response (UPR). These gene changes were similar to the gene expression signature of thapsigargin-a known ER stress inducer. It also induced gene expression changes associated with inflammation and NF-κB activation. The in vivo model showed behavioural impairment and a raised auditory threshold. Whole genome gene expression analysis confirmed inflammation as a key mechanism of bilirubin neurotoxicity in the auditory pathway and shared gene expression hallmarks induced by exposure to bacterial lipopolysaccharide (LPS) a well-characterized inducer of neuroinflammation. Interestingly, bilirubin caused more severe damage to the auditory system than LPS in this model, but consistent with our hypothesis of neuroinflammation being a primary part of bilirubin toxicity, the hearing loss was protected by perturbing the inflammatory response. This was carried out genetically using lipocalin-2 (LCN2)-null mice, which is an inflammatory cytokine highly upregulated in response to bilirubin. Finally, we tested known and novel anti-inflammatory compounds (interfering with NF-κB and TNFα signalling), and also demonstrated protection of the auditory system from bilirubin toxicity. We have developed a novel, reversible, model for jaundice that shows movement impairment and auditory loss consistent with human symptoms. We used this model to establish ER-stress and inflammation as major contributors to bilirubin toxicity. Because of the rapid and reversible onset of toxicity in this novel model it represents a system to screen therapeutic compounds. We have demonstrated this by targeting inflammation genetically and with anti-inflammatory small molecules that offered protection against bilirubin toxicity. This also suggests that anti-inflammatory drugs could be of therapeutic use in hyperbilirubinemia.


Assuntos
Bilirrubina/toxicidade , Estresse do Retículo Endoplasmático/efeitos dos fármacos , Perda Auditiva/etiologia , Kernicterus/etiologia , Síndromes Neurotóxicas/etiologia , Doença Aguda , Animais , Anti-Inflamatórios/farmacologia , Ataxia/etiologia , Ataxia/metabolismo , Bilirrubina/metabolismo , Linhagem Celular , Modelos Animais de Doenças , Potenciais Evocados Auditivos do Tronco Encefálico/efeitos dos fármacos , Feminino , Perda Auditiva/metabolismo , Perda Auditiva/prevenção & controle , Humanos , Hiperbilirrubinemia/complicações , Hiperbilirrubinemia/metabolismo , Inflamação/etiologia , Inflamação/metabolismo , Kernicterus/metabolismo , Lipocalina-2/deficiência , Lipocalina-2/genética , Lipopolissacarídeos/toxicidade , Masculino , Camundongos , Camundongos Endogâmicos CBA , Camundongos Knockout , NF-kappa B/metabolismo , Síndromes Neurotóxicas/metabolismo
14.
BMJ Case Rep ; 20182018 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-30093463

RESUMO

We report a case of a term baby presenting with neonatal cholestasis and upper limb flexion deformity on day 4 of life. On further evaluation, high gamma glutamyl transpeptidase (GGT) levels and absent left kidney were found. A diagnosis of arthrogryposis, renal dysfunction and cholestasis (ARC) syndrome was made which is a rare autosomal recessive disorder with primarily clinical diagnosis. Outcome of this condition is dismal. It has a large spectrum of clinical manifestations, but association with high GGT levels and absent kidney is quite rare. No single case report has observed such an association, and this is the first case of ARC syndrome reported from India to the best of our knowledge.


Assuntos
Artrogripose/diagnóstico , Colestase/diagnóstico , Rim/anormalidades , Insuficiência Renal/diagnóstico , Artrogripose/complicações , Colestase/complicações , Feminino , Humanos , Hiperbilirrubinemia/sangue , Hiperbilirrubinemia/complicações , Índia , Recém-Nascido , Doenças do Recém-Nascido , Insuficiência Renal/complicações , Deformidades Congênitas das Extremidades Superiores/complicações , gama-Glutamiltransferase/sangue
15.
Pancreatology ; 18(6): 666-670, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30153902

RESUMO

BACKGROUND: Surgical resection remains the only curative option for pancreatic adenocarcinoma. Despite recent improvements in medical imaging, unresectability is still often discovered at the time of surgery. It is essential to identify unresectable patients preoperatively to avoid unnecessary surgery. High serum CA 19-9 levels have been suggested as a marker of unresectability but considered inaccurate in patients with hyperbilirubinemia. AIM OF THE STUDY: To evaluate CA 19-9 serum levels as a predictor of unresectability of pancreatic adenocarcinomas with a special focus on jaundiced patients. METHODS: All patients presenting with histologically-confirmed pancreatic adenocarcinoma and having serum CA 19-9 levels available prior to any treatment were included in this retrospective study. The relationship between serum concentrations of CA 19-9 and resectability was studied by regression analysis and theROC curves obtained. A cut-off value of CA 19-9 was calculated. In jaundiced patients, a CA 19-9 adjusted for bilirubinemia was also evaluated. RESULTS: Of the 171 patients included, 49 (29%) were deemed resectable and 122 (71%) unresectable. Altogether, 93 patients (54%) had jaundice. The area under the ROC curve for CA 19-9 as a predictor of resectability was 0.886 (95%CI:[0.832-0.932]); in jaundiced patients it was 0.880 (95% CI [0.798-0.934]. A cut-off in CA 19-9 at 178 UI/mlyielded 85% sensitivity, 81% specificity and 91% positive predictive value for resectability. There was no correlation between the levels of bilirubin and CA 19-9 (r = 0.149). CONCLUSION: Serum CA 19-9 is a good predictive marker of unresectability of pancreatic adenocarcinoma, even in jaundiced patients. CA 19-9 levels over 178 UI/ml strongly suggest unresectable disease.


Assuntos
Adenocarcinoma/sangue , Adenocarcinoma/cirurgia , Antígeno CA-19-9/sangue , Icterícia/complicações , Pancreatectomia , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/cirurgia , Adenocarcinoma/complicações , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Feminino , Humanos , Hiperbilirrubinemia/complicações , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/complicações , Valor Preditivo dos Testes , Estudos Retrospectivos , Resultado do Tratamento
16.
J Artif Organs ; 21(4): 475-478, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29860680

RESUMO

Extracorporeal membrane oxygenation (ECMO) is an emerging tool for supporting cardiopulmonary function in patients with cardiorespiratory failure or arrest. The oxygenator of the ECMO circuit requires effective oxygenation and removal of carbon dioxide from the blood. Major problems that can occur with the oxygenator include plasma leakage, one of the late-onset serious complications necessitating device replacement. However, the rapid onset of plasma leakage is rare. We present a 1-year-old boy with acute respiratory failure due to Pneumocystis and Aspergillus pneumonia. He presented with tachypnea, tachycardia, and hypoxemia despite the ventilatory support, and was therefore placed on venoarterial ECMO with a drainage catheter from the right internal jugular vein (12 Fr) and a return catheter to the right internal carotid artery (10 Fr). Extracorporeal circulation was initiated at a blood flow of 1 L/min (145 mL/kg/min) and a sweep gas flow of 1 L/min with FiO2 of 0.7. Although he was successfully weaned from the venoarterial ECMO on day 15 with an improvement of cardiopulmonary function, he was later placed on venoarterial ECMO again because of the progression of pulmonary hypertension. Laboratory tests showed increased concentrations of hepatic enzymes and hyperbilirubinemia (total bilirubin 31.6 mg/dL). Six hours after starting ECMO circulation, plasma leakage from the oxygenator occurred. Although we replaced the oxygenator with a new one, the replacement showed plasma leakage after 6 h. Disassembly of the oxygenator revealed congestion from bilirubin in the membrane fibers. We described a case of repeated, rapid-onset plasma leakage after implementation of ECMO. Hyperbilirubinemia was likely associated with the plasma leakage of this patient.


Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Hiperbilirrubinemia/complicações , Insuficiência Respiratória/etiologia , Falha de Equipamento , Humanos , Lactente , Masculino
17.
Emerg Med Pract ; 20(Suppl 4): 1-2, 2018 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-29634896

RESUMO

There are approximately 52,000 visits a year to emergency departments for patients presenting with jaundice. While many of these patients will not have immediately life-threatening pathology, it is essential that the emergency clinician understands the pathophysiology of jaundice, as this will guide the appropriate workup to detect critical diagnoses. Patients who present with jaundice could require intravenous antibiotics, emergent surgery, and, in severe cases, organ transplantation. This issue will focus on the challenge of evaluating and treating the jaundiced patient in the ED using the best available evidence from the literature. [Points & Pearls is a digest of Emergency Medicine Practice.].


Assuntos
Icterícia/complicações , Icterícia/diagnóstico , Icterícia/fisiopatologia , Colestase Extra-Hepática/complicações , Colestase Extra-Hepática/fisiopatologia , Colestase Extra-Hepática/terapia , Medicina de Emergência/métodos , Serviço Hospitalar de Emergência/organização & administração , Hemólise/fisiologia , Humanos , Hiperbilirrubinemia/complicações , Hiperbilirrubinemia/fisiopatologia , Hiperbilirrubinemia/terapia
18.
Med Glas (Zenica) ; 15(1): 29-36, 2018 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29549688

RESUMO

Aim To identify risk factors for hearing impairment presented in neonates born in Cantonal Hospital Zenica (CHZ) and to estimate their influence on outcome of hearing tests in Newborn Hearing Screening (NHS). Methods Retrospective-prospective study was done at the Department of Gynaecology and Maternity. The NHS was performed with transitory evoked otoacoustic emissions (TEOAE) during a six-month period using "Titan" device (Interacoustics, Denmark). The questionnaire was written for the purpose of getting more structured basic information about every newborn and to identify risk factors for hearing impairment. Chi-square test was used to investigate the difference between experimental and control group refer incidence. Results A total of 1217 newborns was screened for hearing impairment of which 259 (21.28%) with one or more known risk factors for hearing impairment. The following risk factors for hearing impairment were identified during the study period: family history of permanent childhood hearing impairment in 42 (3.45%) newborns, prematurity in 39 (3.21%), low APGAR scores in 29 (2.40%), asphyxia in 31 (2.55%), hyperbilirubinemia in 41 (3.37%), admission of ototoxic medication (aminoglycosides) after birth in 155 (12.74%). Conclusion There were many serious risk factors for hearing loss identified in this study. Identification of risk factors for hearing impairment in neonates is necessary because a follow up of the children with risk factors is very important.


Assuntos
Aminoglicosídeos/toxicidade , Índice de Apgar , Asfixia/complicações , Família , Perda Auditiva/etiologia , Hiperbilirrubinemia/complicações , Nascimento Prematuro , Aminoglicosídeos/administração & dosagem , Aminoglicosídeos/uso terapêutico , Feminino , Perda Auditiva/induzido quimicamente , Testes Auditivos , Humanos , Recém-Nascido , Doenças do Recém-Nascido , Masculino , Programas de Rastreamento , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários
19.
Emerg Med Pract ; 20(4): 1-24, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29565526

RESUMO

There are approximately 52,000 visits a year to emergency departments for patients presenting with jaundice. While many of these patients will not have immediately life-threatening pathology, it is essential that the emergency clinician understands the pathophysiology of jaundice, as this will guide the appropriate workup to detect critical diagnoses. Patients who present with jaundice could require intravenous antibiotics, emergent surgery, and, in severe cases, organ transplantation. This issue will focus on the challenge of evaluating and treating the jaundiced patient in the ED using the best available evidence from the literature.


Assuntos
Icterícia/diagnóstico , Icterícia/terapia , Colestase Extra-Hepática/complicações , Colestase Extra-Hepática/fisiopatologia , Colestase Extra-Hepática/terapia , Serviço Hospitalar de Emergência/organização & administração , Hemólise/fisiologia , Humanos , Hiperbilirrubinemia/complicações , Hiperbilirrubinemia/fisiopatologia , Hiperbilirrubinemia/terapia , Icterícia/fisiopatologia
20.
BMJ Case Rep ; 20182018 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-29420242

RESUMO

A 52-year-old man presented to our hospital for further workup of fever of unknown origin after an extensive workup at an outside hospital had failed to reveal a diagnosis. At the outside hospital, he underwent excisional biopsy of the left supraclavicular lymph node, which showed non-necrotising granulomatous changes, and a bone marrow biopsy which showed a normocellular marrow. He was discharged without a diagnosis with recommendations to present to a tertiary hospital. During his admission, his hospital course was complicated by new direct hyperbilirubinaemia and eosinophilia, prompting liver and skin biopsies which showed CD30+ and CD3+ cells. He subsequently underwent left axillary lymph node biopsy, which was reported as 'classic Hodgkin's lymphoma'. With worsening lab values and T cells noted on liver and skin biopsies, excisional lymph node biopsy was sent to the National Institute of Health, where it was confirmed patient had peripheral T cell lymphoma.


Assuntos
Febre de Causa Desconhecida/etiologia , Doença de Hodgkin/diagnóstico , Linfoma de Células T Periférico/diagnóstico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/análise , Biópsia , Diagnóstico Diferencial , Eosinofilia/complicações , Eosinofilia/tratamento farmacológico , Humanos , Hiperbilirrubinemia/complicações , Hiperbilirrubinemia/tratamento farmacológico , Antígeno Ki-1 , Linfonodos/patologia , Linfoma de Células T Periférico/complicações , Linfoma de Células T Periférico/tratamento farmacológico , Linfoma de Células T Periférico/patologia , Masculino , Células de Reed-Sternberg/patologia
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