RESUMEN
The adult respiratory distress syndrome seen after pneumonectomy is an uncommon but usually lethal complication. Its etiology remains unknown, although several factors such as fluid overload, endothelial damage, lymphatic interruption, and hyperinflation are thought to be involved in its pathogenesis.
Asunto(s)
Neumonectomía , Complicaciones Posoperatorias , Edema Pulmonar/etiología , Síndrome de Dificultad Respiratoria/etiología , Anciano , Diagnóstico Diferencial , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Edema Pulmonar/fisiopatología , Síndrome de Dificultad Respiratoria/fisiopatología , Factores de RiesgoRESUMEN
Therapeutic laparoscopy has substantially simplified the postoperative course of patients suffering from hepatobiliary, gastric, or colonic disease. One important advantage of this modality is the decrease in postoperative pain, which diminishes the potential for cardiopulmonary problems. Patients with aortoiliac atherosclerotic disease are at high risk for postoperative complications, and a minimally invasive procedure may favorably affect their postoperative recovery. We describe here the first patient on whom we performed a laparoscopy-assisted aortobifemoral bypass. Under the pneumoperitoneum, seven 10-mm trocars were inserted to permit aortic dissection and creation of retroperitoneal tunnels to the femoral regions. After evacuation of the pneumoperitoneum, an 8-cm midline incision was made to allow a side-to-end aortic anastomosis. The patient's postoperative period was uncomplicated by any cardiopulmonary problems despite his history of three myocardial infarctions; the patient had minimal pain that allowed for a quick return to ambulation. This procedure is minimally invasive and appeared to simplify the postoperative period in our patient. It could become the procedure of choice for certain patients with aortoiliac disease.
Asunto(s)
Aorta/cirugía , Arteria Femoral/cirugía , Claudicación Intermitente/cirugía , Laparoscopía , Anastomosis Quirúrgica , Arteriopatías Oclusivas/cirugía , Humanos , Arteria Ilíaca/cirugía , Masculino , Persona de Mediana EdadRESUMEN
Four monoclonal anti-DNA antibodies derived from a single autoimmune MRL/lpr mouse were studied. Three of these antibodies showed similarities in DNA binding; the fourth had a much higher specific activity for single-stranded DNA and, in addition, was unique in binding double-stranded DNA and cardiolipin. Complete nucleotide sequences of heavy- and light-chain variable regions demonstrated that all four antibodies are clonally related. The sequences also showed numerous somatic mutations, the distribution of which suggests that positive selection by antigen operated on these clonally related autoantibodies.