RESUMO
In contrast to other series purporting advantages of routine lavage [20], our data support the position that, in patients with blunt abdominal trauma, certain criteria eliminate the need for peritoneal lavage and make this procedure an unwise investment of valuable time on a routine basis. Criteria such as evidence of hollow organ rupture on radiologic studies, gross abdominal wall defects (excluding simple lacerations), rapidly increasing abdominal distention, uncorrectable hypotension and isolated rigidity on abdominal examination in an otherwise intact and cooperative patient, should be considered indications for laparotomy. In a stable patient with associated injuries or altered central nervous system status, abdominal examination should be viewed as suspect and peritoneal lavage considered mandatory. However, in over one fourth of cases, positive lavage may fail to correlate with intraabdominal injury of a degree that necessitates operative repair. In patients admitted for observation of abdominal injuries with concurrent alterations in central nervous system status or associated injuries that hinder accurate abdominal examination when no urgency exists, we support the opinion that selective use of peritoneal lavage will save unnecessary delay in diagnosis and operative treatment. The highly lethal nature of multiple injuries and central nervous system damage is confirmed by our data, veryfying reports by Davis et al [6] of a 70 percent or greater mortality rate among comatose patients hospitalized with multiple trauma.
Assuntos
Traumatismos Abdominais/diagnóstico , Laparotomia , Cavidade Peritoneal , Irrigação Terapêutica , Ferimentos não Penetrantes/diagnóstico , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos RetrospectivosAssuntos
Glucagon/efeitos adversos , Isoproterenol/efeitos adversos , Lanatosídeos/efeitos adversos , Choque Hemorrágico/tratamento farmacológico , Animais , Antiarrítmicos/sangue , Pressão Sanguínea/efeitos dos fármacos , Catepsinas/sangue , Cães , Glucuronidase/sangue , Lisossomos/efeitos dos fármacos , Lisossomos/enzimologia , Fluxo Sanguíneo Regional/efeitos dos fármacos , Baço/irrigação sanguínea , Baço/efeitos dos fármacos , Baço/patologia , Fatores de TempoAssuntos
Catepsinas/biossíntese , Glucuronidase/biossíntese , Lisossomos/enzimologia , Metilprednisolona/uso terapêutico , Choque Séptico/tratamento farmacológico , Animais , Velocidade do Fluxo Sanguíneo , Gasometria , Pressão Sanguínea , Débito Cardíaco , Pressão Venosa Central , Cães , Endotoxinas , Escherichia coli , Frequência Cardíaca , Hemodinâmica/efeitos dos fármacos , Hepatectomia , Fígado/citologia , Artérias Mesentéricas/fisiologia , Metilprednisolona/administração & dosagem , Fluxo Sanguíneo Regional , Choque Séptico/etiologia , Choque Séptico/fisiopatologia , Resistência VascularRESUMO
A patient with acquired, isolated, chronic, severe neutropenia, minimal splenomegaly, and myeloid hyperplasia in the bone marrow is described. Splenectomy resulted in a rise into the normal range of the absolute neutrophil count within 18 hours after ligation of the splenic artery. No other underlying disorders were found, and efforts to demonstrate antineutrophilic autoantibodies before and after splenectomy were unsuccessful. Although this case might be referred to as "primary splenic neutropenia," it is likely that the basic abnormality was intrinsic to the neutrophil. Such cases should be designated "idiopathic neutropenia," since no primary disorder of the spleen can be demonstrated.
Assuntos
Agranulocitose/etiologia , Neutropenia/etiologia , Esplenopatias/complicações , Anticorpos/imunologia , Medula Óssea/patologia , Feminino , Humanos , Hiperplasia , Contagem de Leucócitos , Pessoa de Meia-Idade , Neutropenia/cirurgia , Baço/patologia , Esplenectomia , Esplenopatias/imunologia , Esplenopatias/patologia , Esplenopatias/cirurgiaRESUMO
For the patient with hematobilia, a serious complication of liver injury, angiography is the definitive diagnostic procedure. In addition to localizing precisely the source of the hemorrhage, angiography also provides an effective alternative to surgery for the control of hemorrhage. In two cases of iatrogenic hematobilia discussed, the bleeding sites were identified by angiography, and the bleeding was controlled by transcatheter embolization.
Assuntos
Embolização Terapêutica , Hemobilia/terapia , Doença Iatrogênica , Adulto , Biópsia por Agulha/efeitos adversos , Feminino , Hemobilia/diagnóstico por imagem , Hemobilia/etiologia , Humanos , Fígado/lesões , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
The human mucin, MUC-1, is a transmembrane glycoprotein that is produced by both normal an malignant epithelium. The MUC-1 produced by malignant epithelium is underglycosylated, which leads to the expression by tumors of novel T and B cell epitopes on the mucin polypeptide core. Similar underglycosylation occurs in the lactating breast. In this report, we describe a long-term survivor of breast cancer whose tumor strongly expressed the T- and B-cell-stimulatory epitopes. Five years after presenting with the tumor, the patient had her first pregnancy, at which time she developed fulminant lymphocytic mastitis. We demonstrate that the lactating breast produced mucin expressing the same "tumor-specific" epitopes as the original cancer. The patient had circulating anti-mucin antibodies of both the IgM and IgG isotypes (these are not found in normal controls), and mucin-specific cytotoxic T lymphocytes in the peripheral blood. Limiting-dilution analysis for mucin-specific cytotoxic T lymphocytes in three different experiments yielded frequencies of 1 in 3086, 1 in 673, and 1 in 583, compared to approximately 1 in 10(6) in normal controls. The patient remains clinically free of carcinoma after 5 additional years of follow-up. We propose that the original tumor primed the patient's immune response against the mucin epitopes, and that the re-expression of these epitopes on the lactating breast evoked a secondary immune response. It is tempting to speculate that the vigor of her anti-mucin immunity may have helped protect this patient against recurrent tumor.