ABSTRACT
Currently the compartmental abdominal syndrome is recognized as a relevant clinical picture in the context of the critical surgical patient. For an adequate diagnosis and handling of the picture, measurement of the pressure in the mentioned compartment, the abdomen is fundamental. Several methods have been applied with this objetive, where the most utilized is that of intra-vesical measurement. The objetive of our study is the validation of the technique of intra-vesical measure of pressure in humans. Patients that are to undergo laparoscopic surgery were included. Intra-abdominal pressure was measured via intra-peritoneal de Veres needle technique associated to a CO2 insufflator performing increasing pressure curve up to tha safe limit of (18 mmHg. Parallely the intra-vesical pressure was measured with a three-way N°18 Foley probe (latex, Kendall), adjusting the secondary way to a pressure transducer. 20 patients were evaluated, with a total of 220 measurements. Through linear regression method a strong positive correlation was observed between de Veres needle and Foley probe with r = 0.713, P=0,00001. The method seems valid with a projected line of y = 4.77 + 0.69x, for a 95 per cent confidence interval. There were two cases where, clearly for the observer, there was no correlation, in one of them due to multiple previous surgeries (it was even necessary to change to open surgery) and in another case it was an obese patient (IMC 29.56). We come to the conclusion that measurement of intravesical pressure as a method for evaluating the intra-abdominal pressure is adequate on humans, considering a lower sensitivity to the changes in abdominal pressure, therefore the clinical conduct in the particular case must be taken with several measurements and associated to the relevant symptomatology described for the abdominal compartmental syndrome. We also recommend precaution on obese patients and those with multiple previous surgeries.
Subject(s)
Humans , Male , Female , Compartment Syndromes , Abdominal Cavity/physiology , Abdominal Cavity/blood supply , Hypertension , Urinary Bladder/physiology , Blood PressureABSTRACT
La reconstrucción microquirúrgica de los grandes defectos posteriores a terapia resectiva en cáncer de cabeza y cuello ha sido un gran aporte que ha permitido mejorar resultados funcionales, estéticos y quirúrgicos de estos pacientes. Presentamos un caso clínico de reconstrucción microquirúrgica cervical en el cual no habían vasos receptores en el cuello, mostrando la solución mediante la utilización de un vaso recipiente que se encontraba fuera del territorio cervical: la vena cefálica
Subject(s)
Humans , Male , Aged , Head and Neck Neoplasms , Microsurgery , Plastic Surgery Procedures/methodsABSTRACT
Background. The pathophysiology of renal impairments occurring in obstructive jaundice has been extensively studied, but underlying mechanism of these derangements remains unclear. The aim of the present study was to investigate the time-related morphological and functional changes occurring in the kidneys of rats undergoing obstructive jaundice. Methods. Histological examination, renal function assessment and determination of (Na + K)-ATPase activity were performed in the kidneys of rats 7, 14, and 21 days following bile duct ligation (BDL) or sham operation (sham). Results. Glomerular filtration rate was unaffected by BDL throughout the period of the study. Tubular effects occurred at days 7 ant 14, being more marked at day 7, and consisted of an increase of about twice in the fractional excretion of sodium and chloride, paralleled by a decreased proximal and distal tubular reabsorption of sodium of about 50 and 40 percent, respectively. Natriuresis was consistent with augmentation of osmolar clearance but it was not associated with changes in the acivity of renal (Na+ + K+)-ATPase. The ability to dilute urine was imparied at days 14 and 21 after BDL. Additionally, these effects were accompanied by decreased tubulointerstitial fibrosis and vasodilation of inner medullary capillaries. At day 21, the parameters of tubular function in BDL and sham groups were not significantly different. Conclusions. These data support the view that rasied natriuresis taking place in the initial 2 weeks following BDL is due mainly to tubular effects. The contribution of hemodynamic, paracrine and humoral mediators is discussed