RESUMO
BACKGROUND: As 6% hydroxyethyl starch (HES) 130/0.40 or 130/0.42 can originate from different vegetable sources, they might have different clinical effects. The purpose of this prospective, randomized, double-blind controlled trial was to compare two balanced tetrastarch solutions, one maize-derived and one potato-derived, on perioperative blood loss in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). METHODS: We randomly assigned 118 patients undergoing elective cardiac surgery into two groups, to receive either a maize- or a potato-derived HES solution. Study fluids were administered perioperatively (including priming of CPB) until the second postoperative day (POD#2) using a goal directed algorithm. The primary outcome was calculated postoperative blood loss up to POD#2. Secondary outcomes included short-term incidence of acute kidney injury (AKI), and long-term effect (up to one yr) on renal function. RESULTS: Preoperative and intraoperative characteristics of the subjects were similar between groups. Similar volumes of HES were administered (1950 ml [1250-2325] for maize-HES and 2000 ml [1500-2700] for potato-HES; P=0.204). Calculated blood loss (504 ml [413-672] for maize-HES vs 530 ml [468-705] for potato-HES; P=0.107) and the need for blood components were not different between groups. The incidence of AKI was similar in both groups (P=0.111). Plasma creatinine concentration and glomerular filtration rates did vary over time, although changes were minimal. CONCLUSIONS: Under our study conditions, HES 130/0.4 or 130/0.42 raw material did not have a significant influence on perioperative blood loss. Moreover, we did not find any effect of tetrastarch raw material composition on short and long-term renal function. CLINICAL TRIAL REGISTRATION: EudraCT number: 2011-005920-16.
Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Derivados de Hidroxietil Amido/farmacologia , Hemorragia Pós-Operatória/epidemiologia , Injúria Renal Aguda/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ponte Cardiopulmonar , Creatinina/sangue , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
OBJECTIVE: Platypnea-orthodeoxia is a rare syndrome characterized by dyspnea induced by the upright position and relieved by supine position and an arterial deoxygenation increased by the upright position which improves during recumbency. Several anatomical factors that can alter the atrial anatomy and facilitate shunting through an interatrial defect have been related to this syndrome. In many cases, this syndrome has been associated with patent foramen ovale (PFO) and right-to-left shunt. Rarely platypnea-orthodeoxia syndrome has been described associated with an aortic and with an interauricular septal aneurysm too. CASE PRESENTATION: We present a case of platypnea-orthodeoxia syndrome in a 85-year-old woman with patent foramen ovale, interauricular septal aneurysm and ascending aortic aneurysms who was admitted for an acute coronary syndrome which could be of embolic origin and was responsible for ventricular fibrillation during the transfer to the hospital. PFO closure was performed by percutaneous device and right coronary artery obstruction was treated by transluminal angioplasty and stenting.
Assuntos
Síndrome Coronariana Aguda/fisiopatologia , Aneurisma Aórtico/fisiopatologia , Septo Interatrial/fisiopatologia , Dispneia/fisiopatologia , Aneurisma Cardíaco/fisiopatologia , Idoso de 80 Anos ou mais , Aorta/fisiopatologia , Feminino , Forame Oval Patente , Humanos , PosturaRESUMO
Carditis can complicate Lyme disease in an estimated <5% of cases, and cardiogenic shock and severe cardiac arrhythmias are described with electrocardiographic abnormalities that could be suggestive of coronary manifestations. We report a case of severe persistent biventricular heart failure complicated by cardiac arrhythmias as initial manifestation of a Lyme disease developing peroperatively electrocardiographic abnormalities suggesting acute transmural myocardial infarction.
Assuntos
Síndrome Coronariana Aguda , Doença de Lyme/complicações , Miocardite/complicações , Miocardite/microbiologia , Choque Cardiogênico/complicações , Choque Cardiogênico/microbiologia , Arritmias Cardíacas/complicações , Arritmias Cardíacas/microbiologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Período PerioperatórioRESUMO
A 34-year-old man with primary pulmonary hypertension developed acute nonhemodynamic pulmonary edema after a loading dose of nifedipine. Changes of the vascular permeability induced by the drug acting on the arteriolar wall of the capillary system could be an explanation.
Assuntos
Hipertensão Pulmonar/tratamento farmacológico , Nifedipino/efeitos adversos , Edema Pulmonar/induzido quimicamente , Doença Aguda , Adulto , Pressão Sanguínea/efeitos dos fármacos , Humanos , Hipertensão Pulmonar/fisiopatologia , Masculino , Nifedipino/administração & dosagem , Artéria Pulmonar/fisiopatologia , Pressão Propulsora Pulmonar/efeitos dos fármacos , Resistência Vascular/efeitos dos fármacosRESUMO
A case is presented in which a venous mesenteric thrombosis necessitated an extended small bowel resection. The postoperative follow-up with its complications is presented. Review of the literature.
Assuntos
Oclusão Vascular Mesentérica/diagnóstico , Trombose/diagnóstico , Feminino , Humanos , Intestino Delgado/irrigação sanguínea , Intestino Delgado/cirurgia , Oclusão Vascular Mesentérica/cirurgia , Veias Mesentéricas , Pessoa de Meia-Idade , Trombose/cirurgiaRESUMO
The case of a 21-yr-old man, who died in cachexia after 2 yr of intermittent abdominal pain, bouts of diarrhea, and anorexia, is reported. Laboratory tests performed shortly before death disclosed signs of malabsorption. Radiologic examination of the gastrointestinal tract showed a coarse mucosal relief in the upper jejunum and a tubular aspect in the rest of the small bowel. There was no dilatation of the loops. Autopsy revealed severe to complete atrophy with fibrosis of the outer muscle layer of the entire small bowel, extending from the pylorus to the ileocecal valve. The only other lesion discovered was a moderate portoportal fibrosis of the liver. The patient's brother had died a few months earlier after 2.5 yr of similar symptoms. An upper gastrointestinal series had shown dilatation of the stomach with fluid retention and a tubular aspect of the small bowel with generalized widening of the loops. No autopsy was performed. There was a high degree of consanguinity on the mother's side. Family history revealed no other evidence of possible genetic factors in the disease.
Assuntos
Obstrução Intestinal/genética , Músculo Liso , Doenças Musculares/genética , Adulto , Motilidade Gastrointestinal , Humanos , Obstrução Intestinal/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/patologia , Masculino , Músculo Liso/diagnóstico por imagem , Músculo Liso/patologia , Atrofia Muscular/diagnóstico por imagem , Atrofia Muscular/genética , Doenças Musculares/diagnóstico por imagem , Radiografia , EscleroseAssuntos
Infecções por HIV/patologia , Neoplasias Cardíacas/diagnóstico , Hipertrofia Ventricular Esquerda/diagnóstico , Linfoma/diagnóstico , Diagnóstico Diferencial , Evolução Fatal , Feminino , Infecções por HIV/complicações , Neoplasias Cardíacas/microbiologia , Humanos , Hipertrofia Ventricular Esquerda/microbiologia , Achados Incidentais , Linfoma/microbiologia , Pessoa de Meia-Idade , Septo Interventricular/patologiaRESUMO
The staphylococcal form of toxic epidermal necrolysis or staphylococcal scalded skin syndrome (SSSS) is exceptionally seen in an adult patient. We report a case of SSSS in a 21-year-old male who suffered from a fulminant pneumopathia due to a phage group II Staphylococcus aureus. The onset of that clinical picture in an adult patient is unusual and could be due to a deficient immunity, as previous case reports have emphasized. Unfortunately, the sudden death of our patient did not allow us to investigate his immunological defences.
Assuntos
Dermatite Esfoliativa , Infecções Estafilocócicas , Adulto , Dermatite Esfoliativa/patologia , Humanos , Masculino , Necrose , Pele/patologia , Infecções Estafilocócicas/patologiaRESUMO
Cardiopulmonary abnormalities are frequently encountered in myotonic dystrophy. We present five patients with myotonic dystrophy who entered the intensive care unit in acute respiratory failure. The possible etiologic factors of pulmonary complications are reviewed. The most important is probably aspiration pneumonia. The difficulties in the treatment of the respiratory failure are emphasezed. Myotonia of the chest muscles and diaphragm make artificial ventilation difficult. Recovery is delayed chiefly by swallowing disturbances. General anaesthesia is hazardous. Four patients presented cardiac arrhythmias and/or conduction abnormalities which were transient.