RESUMO
A patient presenting a relapsing polychondritis with ruptured iliac arterial aneurysm and lower limbs arteritis is described. The analysis of the results compared with the literature's cases confirm the no response for surgical and medical treatments.
Assuntos
Aneurisma/etiologia , Arterite/etiologia , Artéria Femoral , Artéria Ilíaca , Policondrite Recidivante/complicações , Adulto , Feminino , Humanos , Policondrite Recidivante/terapiaRESUMO
To maintain good cellular oxygenation during bronchopulmonary lavage for alveolar proteinosis is often a difficult problem to solve. A case is reported of alveolar proteinosis in whom four lavages were performed. Details of the technique are discussed, as are the problems with expedients used to improve PaO2. The use of a 10 cmH2O positive end-expiratory pressure was useful only during the "in-phase"; in the "out-phase", it worsened the PaO2. PaO2 during lavage in patients with alveolar proteinosis can only be improved by three ways: cancellation of the shunt during lung filling and, during the "out-phase", an increase in FIO2 or pulmonary artery occlusion by a balloon.
Assuntos
Oxigênio/sangue , Respiração com Pressão Positiva , Proteinose Alveolar Pulmonar/terapia , Alvéolos Pulmonares , Adulto , Anestesia Geral/métodos , Feminino , Humanos , Troca Gasosa Pulmonar , Testes de Função Respiratória , Irrigação TerapêuticaRESUMO
Transoesophageal atrial pacing was used in 10 patients to interrupt post-operative atrial flutter after cardio-thoracic surgery. The method was successful in all cases. The arrhythmia was converted directly into sinus rhythm in 8 patients and into atrial fibrillation followed by spontaneous reversion to sinus rhythm in 2 patients. The results differed according to the underlying disease. Return to sinus rhythm was the rule in all patients who underwent coronary artery bypass grafting and pneumonectomy, whereas transient atrial fibrillation seemed to be more frequent (and should be considered a satisfactory result) in patients with heart valve surgery. Relapses of arrhythmias seemed to be more resistant to transoesophageal stimulation irrespective of the operation performed. The method is non-invasive, easy to carry out and safe in patients receiving digitalis. The risk of ventricular pacing is very low. The burning sensation and chest pain experienced during stimulation are well tolerated. Transoesophageal pacing is as effective as epicardial atrial stimulation and more effective in such patients than temporary transvenous atrial pacing.