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1.
Isr Med Assoc J ; 21(11): 743-746, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31713363

RESUMO

BACKGROUND: The use of oral midazolam as premedication to induce anxiolysis before surgical procedures under local anesthesia is widely accepted in plastic surgery. Rhinoplasty performed under local anesthesia is known to generate high levels of perioperative anxiety, thus the use of appropriate premedication is important. Oral midazolam has been shown to be safe in various procedures. However, the safety of oral midazolam before rhinoplasty has not been evaluated. OBJECTIVES: To evaluate the safety of premedication with oral midazolam prior to rhinoplasty by analyzing the intraoperative blood oxygen saturation levels as predictors of adverse respiratory events. METHODS: We retrospectively reviewed the anesthesia records of 62 patients who underwent rhinoplasty under local anesthesia and received premedication with oral midazolam for anxiolysis between March 2017 and December 2017. The median age of the patients was 25.4 years, and they were all classified as American Society of Anesthesiologists class 1. The patients received 10 mg midazolam hydrochloride orally 1 hour prior to the procedure. Oxygen blood saturation was monitored using a pulse oximeter and recorded every 15 minutes. RESULTS: All the patients maintained blood oxygen saturation levels above 95% (median peripheral capillary oxygen saturation 99%) on room air, and they did not require supplemental intraoperative oxygen. There were no transient hypoxemic events during and following the procedure. CONCLUSIONS: Our study confirmed the safety of oral midazolam premedication to reduce perioperative anxiety when performing rhinoplasty under local anesthesia.


Assuntos
Hipnóticos e Sedativos/administração & dosagem , Midazolam/administração & dosagem , Oxigênio/sangue , Rinoplastia , Administração Oral , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oximetria , Pré-Medicação , Estudos Retrospectivos
3.
N Engl J Med ; 381(10): 923-932, 2019 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-31483963

RESUMO

BACKGROUND: Pulmonary alveolar proteinosis is a disease characterized by abnormal accumulation of surfactant in the alveoli. Most cases are autoimmune and are associated with an autoantibody against granulocyte-macrophage colony-stimulating factor (GM-CSF) that prevents clearing of pulmonary surfactant by alveolar macrophages. An open-label, phase 2 study showed some therapeutic efficacy of inhaled recombinant human GM-CSF in patients with severe pulmonary alveolar proteinosis; however, the efficacy in patients with mild-to-moderate disease remains unclear. METHODS: We conducted a double-blind, placebo-controlled trial of daily inhaled recombinant human GM-CSF (sargramostim), at a dose of 125 µg twice daily for 7 days, every other week for 24 weeks, or placebo in 64 patients with autoimmune pulmonary alveolar proteinosis who had a partial pressure of arterial oxygen (Pao2) while breathing ambient air of less than 70 mm Hg (or <75 mm Hg in symptomatic patients). Patients with severe pulmonary alveolar proteinosis (Pao2 <50 mm Hg) were excluded to avoid possible exacerbation of the disease in patients who were assigned to receive placebo. The primary end point was the change in the alveolar-arterial oxygen gradient between baseline and week 25. RESULTS: The change in the mean (±SD) alveolar-arterial oxygen gradient was significantly better in the GM-CSF group (33 patients) than in the placebo group (30 patients) (mean change from baseline, -4.50±9.03 mm Hg vs. 0.17±10.50 mm Hg; P = 0.02). The change between baseline and week 25 in the density of the lung field on computed tomography was also better in the GM-CSF group (between-group difference, -36.08 Hounsfield units; 95% confidence interval, -61.58 to -6.99, calculated with the use of the Mann-Whitney U test and the Hodges-Lehmann estimate of confidence intervals for pseudo-medians). Serious adverse events developed in 6 patients in the GM-CSF group and in 3 patients in the placebo group. CONCLUSIONS: In this randomized, controlled trial, inhaled recombinant human GM-CSF was associated with a modest salutary effect on the laboratory outcome of arterial oxygen tension, and no clinical benefits were noted. (Funded by the Japan Agency for Medical Research and Development and the Ministry of Health, Labor, and Welfare of Japan; PAGE ClinicalTrials.gov number, NCT02835742; Japan Medical Association Center for Clinical Trials number, JMA-IIA00205.).


Assuntos
Doenças Autoimunes/tratamento farmacológico , Fator Estimulador de Colônias de Granulócitos e Macrófagos/uso terapêutico , Fatores Imunológicos/uso terapêutico , Proteinose Alveolar Pulmonar/tratamento farmacológico , Administração por Inalação , Adulto , Idoso , Autoanticorpos/sangue , Doenças Autoimunes/diagnóstico por imagem , Método Duplo-Cego , Esquema de Medicação , Feminino , Fator Estimulador de Colônias de Granulócitos e Macrófagos/administração & dosagem , Fator Estimulador de Colônias de Granulócitos e Macrófagos/efeitos adversos , Fator Estimulador de Colônias de Granulócitos e Macrófagos/imunologia , Humanos , Fatores Imunológicos/administração & dosagem , Fatores Imunológicos/efeitos adversos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Proteinose Alveolar Pulmonar/diagnóstico por imagem , Proteinose Alveolar Pulmonar/imunologia , Capacidade de Difusão Pulmonar , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêutico , Fumar/efeitos adversos , Tomografia Computadorizada por Raios X , Teste de Caminhada
4.
Top Magn Reson Imaging ; 28(4): 205-212, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31385900

RESUMO

Blood oxygenation level-dependent (BOLD) imaging is gaining traction in the clinical realm as a measure for quantifying changes in regional blood flow in response to external stimuli. Through the evoked signal changes that are a consequence of hemoglobin's intrinsic paramagnetic properties, this technique allows for the statistical mapping of brain regions associated with a given task, which has broad applications in preneurosurgical planning for tumor resection. From an acquisition perspective, collection of BOLD data most commonly requires the use of echo planar imaging readout schemes. These sequences are currently widely available on most clinical scanners and at various field strengths. However, while the BOLD acquisition protocol is relatively straightforward, additional hardware and rigorous image processing are needed to correlate the time-dependent signal changes associated with a specific and well defined task. This manuscript will provide the necessary information to detail the physiologic underpinning of acquiring BOLD sensitized images and the important technical aspects of processing the data for use in a surgical environment.


Assuntos
Mapeamento Encefálico/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Neoplasias Encefálicas/cirurgia , Imagem Ecoplanar/métodos , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Oxigênio/sangue , Cuidados Pré-Operatórios/métodos
5.
Top Magn Reson Imaging ; 28(4): 225-233, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31385902

RESUMO

Clinical use of blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) is a relatively new phenomenon, with only about 3 decades of collective experience. Nevertheless, task-based BOLD fMRI has been widely accepted for presurgical planning, over traditional methods, which are invasive and at times perilous. Many studies have demonstrated the ability of BOLD fMRI to make substantial clinical impact with respect to surgical planning and preoperative risk assessment, especially to localize the eloquent motor and visual areas. Reproducibility and repeatability of language fMRI are important in the assessment of its clinical usefulness. There are national efforts currently underway to standardize language fMRI. The American Society of Functional Neuroradiology (ASFNR) has recently provided guidelines on fMRI paradigm algorithms for presurgical language assessment for language lateralization and localization. In this review article, we provide a comprehensive overview of current standards of language fMRI mapping and its reproducibility.


Assuntos
Encefalopatias/diagnóstico por imagem , Linguagem , Imagem por Ressonância Magnética/métodos , Algoritmos , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Encéfalo/cirurgia , Encefalopatias/sangue , Encefalopatias/fisiopatologia , Encefalopatias/cirurgia , Mapeamento Encefálico/métodos , Humanos , Oxigênio/sangue , Cuidados Pré-Operatórios/métodos , Reprodutibilidade dos Testes
6.
Medicine (Baltimore) ; 98(35): e17011, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464959

RESUMO

Aim was to compare the impact of bedside percutaneous dilational tracheostomy (PDT) and open surgical technique (ST) on intracranial pressure (ICP), pulmonary gas exchange and hemodynamics.We retrospectively analyzed data of 92 neurocritical care patients with invasive ICP monitoring during either PDT (43 patients) or ST (49 patients).Peak ICP levels were higher during PDT (22 [17-38] mm Hg vs 19 [13-27] mm Hg, P = .029). Mean oxygen saturation (SpO2) and end-tidal carbon dioxide partial pressure (etCO2) did not differ. Episodes with relevant desaturation (SpO2 < 90%) or hypercapnia (etCO2 > 50 mm Hg) occurred rarely (5/49 during ST vs 3/43 during PDT for SpO2 < 90%; 2/49 during ST vs 5/43 during PDT for hypercapnia). Drops in mean arterial pressure (MAP) below 60 mm Hg were seen more often during PDT (8/43 vs 2/49, P = .026). Mean infusion rate of norepinephrine did not differ (0.52 mg/h during ST vs 0.45 mg/h during PDT). No fatal complications were observed.Tracheostomy can be performed as ST and PDT safely in neurocritical care patients. The impact on ICP, pulmonary gas exchange and hemodynamics remains within an unproblematic range.


Assuntos
Transtornos Cerebrovasculares/terapia , Hemodinâmica/fisiologia , Pressão Intracraniana/fisiologia , Troca Gasosa Pulmonar/fisiologia , Traqueostomia/métodos , Estado Terminal , Dilatação , Feminino , Humanos , Tempo de Internação , Masculino , Oxigênio/sangue , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Retrospectivos
7.
Medicine (Baltimore) ; 98(29): e16554, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335738

RESUMO

BACKGROUND: The benefits of fenestration for patients undergoing Fontan procedure seem controversial at early and late postoperative stages. OBJECTIVE: We aimed to compare the outcomes between the fenestrated and non-fenestrated Fontan procedures. METHODS: Studies comparing the fenestrated and non-fenestrated Fontan procedures were identified by searching the PubMed, EMBASE, and Cochrane Library databases until July 2018. The assessed variables included postoperative oxygen saturation (SaO2), pulmonary artery pressure, mortality, cardiopulmonary bypass (CPB) time, ventilation time, intensive care unit stay, hospital stay, chest tube duration, protein-losing enteropathy, arrhythmia, and other follow-up outcomes including reintervention, stroke/thrombosis, and peak oxygen consumption. A random-effect/fixed-effect model was used to summarize the estimates of the mean difference (MD)/odds ratio (OR) with 95% confidence interval (CI). Subgroup analysis stratified by early and late outcomes was performed. RESULTS: A total of 1929 Fontan patients from 14 studies were included. The early postoperative SaO2 was lower with fenestration than without fenestration (MD -2.52, 95% CI -4.16 to -0.87, P <.05); however, the late postoperative SaO2 showed no difference between the 2 approaches. The CPB time was shorter without fenestration than with fenestration (MD 10.72, 95% CI 2.54-18.9, P <.05); however, the incidence of arrhythmia was lower with fenestration than without fenestration (OR 0.43, 95% CI 0.25-0.75, P <.05). Other variables showed no significant differences between the 2 approaches in Fontan patients. CONCLUSION: Fenestration appears to result in a lower incidence of arrhythmia but with a longer CPB time and lower early SaO2. Other outcomes are comparable between the 2 approaches.


Assuntos
Técnica de Fontan/métodos , Arritmias Cardíacas/etiologia , Ponte Cardiopulmonar , Cuidados Críticos , Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/cirurgia , Humanos , Tempo de Internação , Oxigênio/sangue , Consumo de Oxigênio , Cuidados Pós-Operatórios , Complicações Pós-Operatórias , Respiração Artificial
8.
J Comput Assist Tomogr ; 43(4): 539-546, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31268874

RESUMO

OBJECTIVE: The objective of this study was to investigate the changes in the blood oxygen level-dependent (BOLD) response in the ipsilateral primary somatosensory cortex (SI) and thalamus of patients with moyamoya disease (MMD) during sensory stimulation. METHODS: Sixty-four MMD patients, and 15 healthy volunteers were enrolled. Thirty-three MMD patients exhibited paroxysmal numbness or hypoesthesia in the unilateral limbs. Fifteen patients with acroparesthesia underwent unilateral encephaloduroarteriosynangiosis (EDAS). All volunteers underwent BOLD functional magnetic resonance imaging (BOLD-fMRI) under median nerve electrical stimulation (MNES). Blood oxygen level-dependent fMRI data were processed to obtain time-signal intensity curves in the activation areas of the bilateral SI and thalamus. Processed dynamic susceptibility contrast-enhanced magnetic resonance imaging data were used to measure the time to peak of the BOLD response in the regions of interest, including the bilateral SI, thalamus, and cerebellum. Changes in the time-signal intensity curve-related hemodynamic parameters in the ipsilateral SI and thalamus were examined between healthy controls, nonacroparesthesia patients, and asymptomatic and symptomatic sides of unilateral acroparesthesia patients during MNES. Changes in these parameters in MMD patients before and after EDAS were examined. RESULTS: Compared with healthy volunteers, 3 groups of MMD patients exhibited an increased peak of the positive BOLD response in the ipsilateral thalamus during MNES (0.65 ± 0.24 vs 0.79 ± 0.35, 0.94 ± 0.57, and 0.89 ± 0.50; P = 0.0335). The positive response peak in the ipsilateral SI markedly increased in MMD patients with acroparesthesia during MNES on the asymptomatic side (0.56 ± 0.37 vs 0.38 ± 0.27, P = 0.0243). The time to peak negative response in the ipsilateral SI was prolonged during MNES on the symptomatic side after EDAS (12.14 ± 8.90 seconds vs 18.86 ± 9.20 seconds, P = 0.0201). CONCLUSIONS: During sensory stimulation treatment, BOLD response changes occurred in the ipsilateral SI and thalamus of MMD patients. These changes enabled the contralateral hemisphere of the brain to better deal with sensory stimuli.


Assuntos
Estimulação Elétrica/métodos , Imagem por Ressonância Magnética/métodos , Doença de Moyamoya/diagnóstico por imagem , Oxigênio/sangue , Córtex Somatossensorial , Tálamo , Adulto , Feminino , Humanos , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/fisiologia , Plasticidade Neuronal , Córtex Somatossensorial/irrigação sanguínea , Córtex Somatossensorial/diagnóstico por imagem , Tálamo/irrigação sanguínea , Tálamo/diagnóstico por imagem
9.
Emerg Med Clin North Am ; 37(3): 395-408, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262411

RESUMO

Patients in shock present frequently to the emergency department. The emergency physician must be skilled in the resuscitation of both differentiated and undifferentiated shock. Early, aggressive resuscitation of patients in shock is essential, using macrocirculatory, microcirculatory, and clinical end points to guide interventions. Therapy should focus on the restoration of oxygen delivery to match tissue demand. This article reviews the evidence supporting common end points of resuscitation for common etiologies of shock and limitations to their use.


Assuntos
Ressuscitação , Choque/terapia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/prevenção & controle , Pressão Arterial/fisiologia , Biomarcadores , Circulação Sanguínea/fisiologia , Dióxido de Carbono/sangue , Débito Cardíaco/fisiologia , Medicina de Emergência , Homeostase/fisiologia , Humanos , Hipotensão/prevenção & controle , Ácido Láctico/sangue , Oxigênio/sangue , Sepse/fisiopatologia , Choque/sangue , Urina
10.
Emerg Med Clin North Am ; 37(3): 557-568, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262421

RESUMO

A subset of intubated patients can safely be extubated in the emergency department (ED). The emergency medicine provider should be prepared for both common and life-threatening complications if considering ED extubation. Patients selected for extubation in the ED should have a low or near zero risk of reintubation or extubation failure. Intensive nursing care, close monitoring, and the ability to reintubate are minimum requirements for EDs considering ED extubation. This article provides a framework for determining appropriate patients for extubation and a practical approach on how to safely perform the procedure.


Assuntos
Extubação/métodos , Serviço Hospitalar de Emergência , Pressão Sanguínea , Delírio/complicações , Frequência Cardíaca , Hemodinâmica , Humanos , Hipóxia/etiologia , Hipóxia/prevenção & controle , Exame Neurológico , Oxigênio/sangue , Cuidados Paliativos , Seleção de Pacientes , Agitação Psicomotora/complicações , Taxa Respiratória , Sons Respiratórios , Medição de Risco , Desmame do Respirador
11.
J Vet Emerg Crit Care (San Antonio) ; 29(4): 373-384, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31231948

RESUMO

OBJECTIVE: To determine the association between thoracic injuries evaluated by computed tomography (CT) and arterial blood gas and acid-base status in dogs with blunt thoracic trauma caused by motor vehicle accidents. DESIGN: Prospective observational clinical study. SETTING: University teaching hospital. ANIMALS: Thirty-one client owned traumatized dogs and 15 healthy dogs. PROCEDURES: All trauma group dogs underwent a CT scan and simultaneous arterial blood gas analysis within 24 hours, but not before 4 hours, after the traumatic incident within a 45-month enrollment period. MEASUREMENTS AND MAIN RESULTS: Thorax injuries were classified as pulmonary, pleural space, or rib cage and each of these components was scored for severity using a CT composite pulmonary, pleural, and rib score. The trauma group arterial blood gas and acid-base status were evaluated for statistical difference from the control group. The pulmonary-arterial oxygen pressure was significantly lower in the trauma group compared to the control group that was supported by significant differences in the calculated variables of arterial blood oxygenation as well. There was also a significant correlation between the composite lung score and pleural score and the variables of arterial oxygen status. The pulmonary-arterial carbon dioxide pressure was not significantly different to any of the thoracic injury variables indicating normal alveolar ventilation. Acid-base imbalances were generally mild, insignificant, and variable. CONCLUSIONS AND CLINICAL RELEVANCE: Blunt thoracic trauma causes significant pulmonary and pleural injury and the blood oxygen economy is significantly affected by this. The functional measures of arterial blood oxygenation were well correlated with thoracic CT pathology. Alveolar ventilation was mostly spared but a clinically significant ventilation perfusion mismatch was present.


Assuntos
Equilíbrio Ácido-Base/fisiologia , Gasometria/veterinária , Traumatismos Torácicos/veterinária , Tomografia Computadorizada por Raios X/veterinária , Ferimentos não Penetrantes/veterinária , Animais , Cães , Feminino , Pulmão/patologia , Masculino , Oxigênio/sangue , Estudos Prospectivos , Traumatismos Torácicos/sangue , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/patologia , Ferimentos não Penetrantes/sangue , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/patologia
12.
Diving Hyperb Med ; 49(2): 112-118, 2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31177517

RESUMO

BACKGROUND: Aircrew training often includes an hypoxic experience aimed at improving symptom recognition and self-rescue in a subsequent hypoxic event. Similar training has been advocated for rebreather divers. We investigated the effect of a prior hypoxic experience on actual and perceived cognitive function during subsequent hypoxia and measured the physiological responses to severe progressive hypoxia. METHODS: Twenty-five subjects underwent two hypoxic hypoxia experiences (trials one and two) approximately five weeks apart. Subjects breathed 5.5% oxygen whilst performing a playing card recognition test. The primary endpoint was the time taken to make three consecutive errors in the card recognition test (time of useful consciousness, TUC). Secondary endpoints were the total number of errors made, accuracy of error recollection and physiological variables. RESULTS: Mean (SD) TUC was 166 seconds (37) and 169 s (35), and subjects made 8.9 (2.4) and 7.8 (2.0) errors in trials one and two respectively. Error recall was identical between trials with participants failing to recall 6 (3) and 6 (2) errors made in trials one and two respectively. Across both trials mean nadir arterial blood and cerebral oxygen saturations were 52% and 49% respectively. The mean (SD) increase in heart rate was 42 (16) beats·min⁻¹. CONCLUSION: An hypoxic experience did not improve cognitive performance or subject insight into performance in a second exposure five weeks later. Hypoxia imposes a significant physiological stress which may be hazardous in unscreened, non-medically supervised subjects. Hypoxia experience training is not recommended for rebreather divers at this time.


Assuntos
Mergulho/fisiologia , Hipóxia , Oxigênio , Frequência Cardíaca , Humanos , Oxigênio/sangue
13.
Undersea Hyperb Med ; 46(1): 1-6, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31154680

RESUMO

Hypoxia is one of the main problems an underwater diver may have to face. The probability of experiencing hypoxia is related to the type of dive and the equipment used. Hypoxia in diving is a potentially fatal event for the diver, as it can lead to the loss of brain functions and consequently to the loss of breathing control, all in the absence of specific premonitory symptoms. It is a risk that may be encountered more frequently by divers who use a closed-circuit rebreather (CCR). For those who use this type of equipment, hypoxia is usually the most frequent cause of death [1]. Our study was aimed at the detection of peripheral oxygen saturation in order to identify, in the future, a preclinical hypoxic condition. We combined the use of pulse oximetry with two forehead sensors on an underwater diver subject who was using an electronic closed-circuit rebreather (ECCR). Despite the known limits of this method and the preliminary status of these findings [2], the recorded data show a clear validity in the use of pulse oximetry in immersion for the detection of peripheral oxygen saturation. In the future, the pulse oximeter could become part of the instrumentation of the diver who uses CCR gear. The device could easily be implemented in these rebreathers. The possibility of being able to perform a basic instrumental analysis means that the diver can become more quickly aware of imminent hypoxia, characterized by the absence of clearly identifiable warning symptoms, and can put in place all the correct procedures for an emergency ascent, avoiding serious consequences.


Assuntos
Mergulho/efeitos adversos , Desenho de Equipamento , Hipóxia/diagnóstico , Oximetria , Oxigênio/sangue , Adulto , Gasometria/instrumentação , Gasometria/métodos , Equipamentos para Diagnóstico , Humanos , Hipóxia/sangue , Hipóxia/etiologia , Imersão , Masculino , Oximetria/instrumentação , Oximetria/métodos , Sintomas Prodrômicos , Água do Mar , Avaliação de Sintomas/instrumentação , Temperatura Ambiente
14.
J Comput Assist Tomogr ; 43(4): 634-640, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31162241

RESUMO

BACKGROUND: Noninvasive blood oxygen level-dependent imaging and intravoxel incoherent motion sequences were used to assess bilateral renal oxygenation, hemodynamics, and proton diffusion in iodixanol renal artery first-pass in rabbit model. METHODS: Forty-two rabbits were divided into 2 groups. Saline and iodixanol (1 g iodine/kg, left renal artery) were administered. Magnetic resonance imaging scans were acquired longitudinally at 24 hours prior to and 1, 24, 48, and 72 hours after administration to assess apparent diffusion coefficient, pure molecular diffusion (D), perfusion-related diffusion (D*), volume fraction (f), and relative spin-spin relaxation rate (R2*) values, respectively. The experiment evaluated serum creatinine, histological, and hypoxia-inducible factor 1α immunoexpression. RESULTS: During 1 to 48 hours, the values of D, f, and D* significantly decreased (P < 0.05), but R2* values significantly increased (P < 0.05) in cortex, outer medulla, and inner medulla after administration of iodixanol through left renal artery, which showed in the 72 hours. The change of the left kidney is noteworthy. Significant negative correlations were observed between apparent diffusion coefficient, D, f, and R2* in cortex, outer medulla, and inner medulla (all P < 0.001, r = -0.635-0.697). CONCLUSIONS: The first-pass effect of the contrast agent significantly reduces ipsilateral renal perfusion and renal oxygenation, and noninvasive monitoring can be performed by using blood oxygen level-dependent magnetic resonance imaging and intravoxel incoherent motion.


Assuntos
Lesão Renal Aguda , Meios de Contraste/efeitos adversos , Imagem por Ressonância Magnética/métodos , Oxigênio/sangue , Ácidos Tri-Iodobenzoicos/efeitos adversos , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/diagnóstico por imagem , Animais , Meios de Contraste/administração & dosagem , Interpretação de Imagem Assistida por Computador/métodos , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Rim/efeitos dos fármacos , Masculino , Coelhos , Artéria Renal/diagnóstico por imagem , Ácidos Tri-Iodobenzoicos/administração & dosagem
15.
Rinsho Ketsueki ; 60(3): 213-217, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31068518

RESUMO

More than 1,200 hemoglobin variants are identified worldwide, and approximately 200 variants are detected in one of 3,000 Japanese people. Most of these patients are asymptomatic; however, some patients had hemolytic anemia or cyanosis. Herein, we report a case of a 49-year-old woman with prolonged fatigability after experiencing symptoms of common cold and intermittent brown urine. Her clinical data showed mild hemolysis, a disparity between SpO2 (93%) and pO2 (85.2 mmHg), and abnormally low HbA1c levels (3.7%). These findings lead to the diagnosis of unstable hemoglobin variant, Hb Hirosaki. A simple series of tests using pulse oximetry, an arterial blood gas analysis, measurement of HbA1c levels, or identifying the HPLC chromatogram of HbA1c can be the factors associated with the diagnosis of hemoglobinopathy.


Assuntos
Hemoglobina A Glicada/análise , Hemoglobinopatias/diagnóstico , Hemoglobinas Anormais/análise , Oxigênio/sangue , Feminino , Humanos , Pessoa de Meia-Idade , Oximetria
16.
World J Pediatr Congenit Heart Surg ; 10(4): 485-491, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31142197

RESUMO

BACKGROUND: Infants with cyanotic congenital heart disease demonstrate wide fluctuations in hemoglobin (Hb), oxygen saturation, and cardiac output following palliation. Methemoglobin (Met-Hb), the product of Hb oxidation, may represent a compensatory mechanism during hypoxia and may be utilized as a biomarker. METHODS: Arterial and venous Met-Hb levels were obtained from infants requiring palliation. The primary outcome was to describe the relationship between Met-Hb and other indices of tissue oxygenation (venous saturation, estimated arteriovenous oxygen difference [Est AV-Diff], and lactate). Secondary outcomes were to determine the impact of elevated Met-Hb levels ≥1.0% and the effect of red blood cell (RBC) transfusion on Met-Hb levels. RESULTS: Fifty infants and 465 Met-Hb values were studied. Venous Met-Hb levels were significantly higher than arterial levels (venous: 0.84% ± 0.36% vs arterial: 0.45% ± 0.18%; P < .001). Venous Met-Hb demonstrated a significant inverse relationship with venous oxygen saturation (R = -0.6; P < .001) and Hb (R = -0.3, P < .001) and a direct relationship with the Est AV-Diff (R = 0.3, P < .001). A total of 129 (29.6%) venous Met-Hb values were elevated (≥1.0%) and were associated with significantly lower Hb and venous saturation levels and higher Est AV-Diff and lactate levels. Methemoglobin levels decreased significantly following 65 RBC transfusions (0.94 ± 0.40 vs 0.77 ± 0.34; P < .001). Linear mixed models demonstrated that higher venous Met-Hb levels were associated with lower measures of tissue oxygenation and not related to any preoperative clinical differences. CONCLUSION: Methemoglobin may be a clinically useful marker of tissue oxygenation in infants following surgical palliation.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias Congênitas/sangue , Metemoglobina/metabolismo , Oxigênio/sangue , Cuidados Paliativos/métodos , Biomarcadores/sangue , Feminino , Cardiopatias Congênitas/cirurgia , Hemoglobinas/metabolismo , Humanos , Lactente , Recém-Nascido , Masculino , Oximetria , Período Pós-Operatório , Prognóstico
17.
Arch Dis Child Fetal Neonatal Ed ; 104(6): F648-F653, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31085677

RESUMO

OBJECTIVES: A new device that combines, for the first time, two photonic technologies (time-resolved near-infrared spectroscopy and diffuse correlation spectroscopy) was provided and tested within the BabyLux project. Aim was to validate the expected changes in cerebral oxygenation and blood flow. METHODS: A pulse oximeter and the BabyLux device were held in place (right hand/wrist and frontoparietal region, respectively) for 10 min after birth in healthy term infants delivered by elective caesarean section. Pulse oximeter saturation (SpO2), cerebral tissue oxygen saturation (StO2) and blood flow index (BFI) were measured over time. Tissue oxygen extraction (TOE) and cerebral metabolic rate of oxygen index (CMRO2I) were calculated. RESULTS: Thirty infants were enrolled in two centres. After validity check of data, 23% of infants were excluded from TOE and CMRO2I calculation due to missing data. As expected, SpO2 (estimate 3.05 %/min; 95% CI 2.78 to 3.31 %/min) and StO2 (estimate 3.95 %/min; 95% CI 3.63 to 4.27 %/min) increased in the first 10 min after birth, whereas BFI (estimate -2.84×10-9 cm2/s/min; 95% CI -2.50×10-9 to -3.24×10-9 cm2/s/min) and TOE (estimate -0.78 %/min; 95% CI -1.12 to -0.45 %/min) decreased. Surprisingly, CMRO2I decreased (estimate -7.94×10-8/min; 95% CI -6.26×10-8 to -9.62×10-8/min). CONCLUSIONS: Brain oxygenation and BFI during transition were successfully and simultaneously obtained by the BabyLux device; no adverse effects were recorded, and the BabyLux device did not limit the standard care. The preliminary results from clinical application of the BabyLux device are encouraging in terms of safety and feasibility; they are consistent with previous reports on brain oxygenation during transition, although the interpretation of the decreasing CMRO2I remains open. TRIAL REGISTRATION NUMBER: NCT02815618.


Assuntos
Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Circulação Cerebrovascular/fisiologia , Oxigênio/sangue , Análise Espectral/instrumentação , Encéfalo/metabolismo , Cesárea , Feminino , Hemodinâmica , Humanos , Recém-Nascido , Masculino , Oximetria , Espectroscopia de Luz Próxima ao Infravermelho
18.
J Cardiothorac Surg ; 14(1): 89, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060627

RESUMO

BACKGROUND: One lung ventilation (OLV) is the technique used during lung resection surgery in order to facilitate optimal surgical conditions. OLV may result in hypoxemia due to the shunt created. Several techniques are used to overcome the hypoxemia, one of which is continuous positive airway pressure (CPAP) to the non-dependent lung. Another technique is ventilating the non-dependent lung with a minimal volume, thus creating differential lung ventilation (DLV). In this study we compared the efficacy of CPAP to DLV during video assisted thoracoscopic lung resection. PATIENTS AND METHOD: This is a prospective study of 30 adult patients undergoing elective video assisted thoracoscopic lung lobectomy. Each patient was ventilated in four modes: two lung ventilation, OLV, OLV + CPAP and OLV + DLV. Fifteen patients were ventilated with CPAP first and DLV next, and the other 15 were ventilated with DLV first and then CPAP. Five minutes separated each mode, during which the non-dependent lung was open to room air. We measured the patient's arterial blood gas during each mode of ventilation. The surgeons, who were blinded to the ventilation technique, were asked to assess the surgical conditions at each stage. RESULTS: Oxygenation during OLV+ CPAP was significantly lower that OLV + DLV (p = 0.018). There were insignificant alterations of pH, PCO2 and HCO3 during the different ventilating modes. The surgeons' assessments of interference in the field exposure between OLV + CPAP or OLV + DLV was found to be insignificant (p = 0.073). CONCLUSIONS: During OLV, DLV is superior to CPAP in improving patient's oxygenation, and may be used where CPAP failed. TRIAL REGISTRATION: ClinicalTrials.gov NCT03563612 . Registered 9 June 2018, retrospectively (due to clerical error).


Assuntos
Hipóxia/terapia , Ventilação Monopulmonar/métodos , Oxigênio/sangue , Procedimentos Cirúrgicos Pulmonares/métodos , Idoso , Gasometria , Pressão Positiva Contínua nas Vias Aéreas , Estudos Cross-Over , Feminino , Humanos , Hipóxia/sangue , Hipóxia/etiologia , Masculino , Pessoa de Meia-Idade , Pneumonectomia , Estudos Prospectivos , Método Simples-Cego , Cirurgia Torácica Vídeoassistida
19.
Medicine (Baltimore) ; 98(20): e15632, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096477

RESUMO

BACKGROUND: It is commonly reported a limitation of therapeutic strategy in Eisenmenger syndrome (ES) historically. This qualitative systematic review is conducted to evaluate the safety and efficacy of pulmonary arterial hypertension-specific drug therapy (PAH-SDT) for ES patients for a clinical therapeutic strategy based on evidence. METHODS: PubMed, EMBASE, and the Cochrane Library databases have been systematically reviewed up to January 2019. Two reviewers independently conducted a literature search, quality evaluation, and data extraction. The occurrence of death, deterioration, and adverse events (AEs) has respectively been described as a count or percentage. Meta-analysis was conducted by Stata 15.1, and weighted mean differences (WMD) with 95% confidence intervals (CI) were recorded for continuous data. Randomized-effect model or fixed-effect model was applied according to the heterogeneity test. RESULTS: Fifteen citations recruiting 456 patients associated with ES were eventually pooled, which involved 4 RCTs, 6 prospective studies, and 5 retrospective studies. Within the first year, it indicated PAH-SDT significantly ameliorated exercise capacity in 6-minute walk distance (6MWD) (I = 60.5%; WMD: 53.86 m, 95% CI [36.59, 71.13], P < .001), functional class (FC) (WMD = -0.71, 95% CI [-0.98, -0.44], P < .001) and Borg dyspnea index (WMD = -1.28, 95% CI [-1.86, -0.70], P < .001), in addition to hemodynamics, especially mean pulmonary arterial pressure by 5.70 mmHg (WMD = -5.70 mmHg, 95% CI [-8.19, -3.22], P < .001) and pulmonary vascular resistance by 4.20 wood U (WMD: -4.20, 95% CI [-7.32, -1.09], P = .008), but unsatisfactory effects in oxygen saturation at exercise (P = .747). In a prolonged medication, bosentan, a dual ERA, has been proved acting an important role in improving exercise tolerance of patients with ES (6MWD: I = 47.5%; WMD: 88.68 m, 95% CI [54.05, 123.3], P < .001; FC: I = 0.0%; WMD = -0.65, 95% CI [-1.10, -0.19], P = .006). While a nonsignificant change of 6MWD was noted in a long-term therapy of ambrisentan (P = .385). There existed rare evidence about the efficacy and safety of macitentan, phosphodiesterase-5 inhibitors (PDE5i), and prostanoids in a prolonged medication. Most AEs were recorded as mild to moderate with PAH-SDT, but about 4.3% individuals treated with endothelin receptor antagonists (ERAs) suffered from serious ones, and 3.9% suffered from death. CONCLUSIONS: This systematic review and meta-analysis proved PAH-SDT as a safe and effective role in ES in an early stage. However, in a long-term treatment, bosentan has been supported for a lasting effect on exercise tolerance. A further multicenter research with a large sample about pharmacotherapy of ES is necessary.


Assuntos
Anti-Hipertensivos/uso terapêutico , Complexo de Eisenmenger/tratamento farmacológico , Antagonistas dos Receptores de Endotelina/uso terapêutico , Inibidores da Fosfodiesterase 5/uso terapêutico , Prostaglandinas/uso terapêutico , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/efeitos adversos , Bosentana/uso terapêutico , Antagonistas dos Receptores de Endotelina/administração & dosagem , Antagonistas dos Receptores de Endotelina/efeitos adversos , Tolerância ao Exercício/efeitos dos fármacos , Hemodinâmica , Humanos , Hipertensão Pulmonar/tratamento farmacológico , Oxigênio/sangue , Fenilpropionatos/uso terapêutico , Inibidores da Fosfodiesterase 5/administração & dosagem , Inibidores da Fosfodiesterase 5/efeitos adversos , Prostaglandinas/administração & dosagem , Prostaglandinas/efeitos adversos , Piridazinas/uso terapêutico , Pirimidinas/uso terapêutico , Sulfonamidas/uso terapêutico
20.
Orv Hetil ; 160(20): 780-783, 2019 May.
Artigo em Húngaro | MEDLINE | ID: mdl-31081357

RESUMO

Introduction: Numerous data suggest that episodes of breathing disorder during sleep are closely related to chronic cardiovascular and mental illnesses. Aim: In this study, we sought to find out how the decrease in oxygen saturation level and its duration during sleep are affected by the degree of depression and its extent. Method: Data of 76 persons were processed in the study. The oxygen saturation measured during sleep was obtained from data from a polysomnographic filter device. Data collection for depression symptoms was done with a validated questionnaire. The decrease of night oxygen saturation on the effect of the disease was illustrated by the odds ratio calculation. Results: The value below 90% of the average oxygen saturation during sleep time will more than double the risk of developing depression. It is also a risk factor for the severity of depression. Examining the duration of sleep time at reduced saturation, it mainly increases the chance of severe depression. Conclusions: Hypoxia during sleep and duration of hypoxic periods are a risk factor for the development of depression with therapeutic and diagnostic consequences. Orv Hetil. 2019; 160(20): 780-783.


Assuntos
Depressão/complicações , Oxigênio/sangue , Síndromes da Apneia do Sono/diagnóstico , Apneia Obstrutiva do Sono/complicações , Sono/fisiologia , Depressão/psicologia , Humanos , Consumo de Oxigênio/fisiologia , Polissonografia/métodos
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