ABSTRACT
A gestação heterotópica é uma entidade rara, principalmente se resultante de concepção natural. O diagnóstico é ultrassonográfico, porém a gestação intrauterina concomitante contribui para a dificuldade propedêutica. Neste relato de caso, a detecção foi tardia, a ultrassonografia não identificou a gestação heterotópica e apenas durante a avaliação intraoperatória, por meio de uma cirurgia de emergência devido a choque hemorrágico, houve o reconhecimento. A suspeita de uma gestação heterotópica deve ser sempre aventada quando sinais clínicos típicos (sangramento, dor abdominal) estão presentes, mesmo na ausência de fatores de risco ou imagens anômalas na ecografia. Assim, uma intervenção precoce menos invasiva pode ser realizada, reduzindo a morbimortalidade materna e do feto intrauterino. Este relato de caso destaca uma situação incomum dentro dessa patologia rara: diagnóstico tardio, apenas no segundo trimestre de gestação, sem evidência prévia ultrassonográfica, certificada apenas durante o intraoperatório. O manejo cirúrgico preciso permitiu a manutenção da gravidez intrauterina.(AU)
Heterotopic pregnancy is a rare entity, especially if it is resulted from natural conception. The diagnosis is ultrasonographic, but the concomitant intrauterine pregnancy contributes to the propaedeutic difficulty. In this case report, the detection was late, the ultrasonography did not identify heterotopic pregnancy and, only during intraoperative evaluation through emergency surgery, exploratory laparotomy, there was recognition. The suspicion of a heterotopic pregnancy should always be raised when typical clinical signs (bleeding, abdominal pain) are present, even in absentia of risk factors or anomalous images on ultrasound. Thus, a less invasive early intervention can be performed, reducing maternal and intrauterine fetus morbimortality. This case report highlights an unusual situation within this rare pathology: late diagnosis, only in the second trimester of pregnancy, without previous ultrasound evidence, certified only during the intraoperative period. Precise surgical management allowed the maintenance of intrauterine pregnancy.(AU)
Subject(s)
Humans , Female , Pregnancy , Pregnancy, Tubal , Pregnancy, High-Risk , Pregnancy, Heterotopic , Pregnancy Maintenance , Pregnancy Trimester, Second , Shock, Hemorrhagic/surgery , Risk Factors , Adnexal Diseases , Delayed DiagnosisABSTRACT
Resumen ANTECEDENTES: El dengue es una enfermedad infecciosa causada por el virus del dengue, género Flavivirus, familia Flaviviridae y el mosquito Aedes aegypti es el vector principal. El diagnóstico se establece con la determinación de componentes virales o pruebas serológicas. La fluidoterapia y la identificación de la fase crítica son decisivas en el tratamiento de la enfermedad. CASO CLÍNICO: Pacientes de 31 años, embarazada, acudió al servicio médico por fiebre no cuantificada, cefalea, dolor retroorbitario, mialgias y artralgias de tres días de evolución. El tratamiento inicial consistió en la administración de líquidos intravenosos y antipiréticos sin reacción favorable. Al ingreso a la unidad médica de alta especialidad se confirmó el diagnóstico de dengue no grave por NS1 positivo. Durante su estancia hospitalaria persistió con fiebre de 38.5 ºC, deterioro del estado hemodinámico, colapso circulatorio, afectación vascular placentaria y, como consecuencia, óbito. Ingresó a la unidad de cuidados intensivos por choque hemorrágico y posterior insuficiencia orgánica múltiple; manifestó asistolia, se iniciaron maniobras de reanimación, sin lograr revertir el paro cardiaco, por lo que se declaró el fallecimiento de la paciente. CONCLUSIÓN: Es importante conocer las manifestaciones clínicas y evolución del dengue. La infección puede cursar por un periodo de evolución crítico, en el que se manifiestan coagulopatías severas y pérdida de plasma. El tratamiento, además de oportuno, debe dirigirse al control de los signos de hemorragia.
Abstract BACKGROUND: Dengue is an infectious disease transmitted for Aedes aegypti. The diagnosis is made by viral components in serum or serological tests. Fluid therapy and identification of the critical phase are essential in the treatment and need to be addressed as a single disease. CLINICAL CASE: A 31-year-old pregnant patient attended in medical service due to a non-quantified fever, headache, retro-orbital pain, myalgias and arthralgias of three days of evolution. The initial treatment consisted in the administration of intravenous and antipyretic fluids without favorable reaction. Upon admission to the medical specialty unit, the diagnosis of non-severe dengue due to NS1 positive was confirmed. During the hospital stay he persisted with fever of 38.5ºC, deterioration of the hemodynamic state, circulatory collapse, vascular placental involvement and, as a result, death. He was admitted to the intensive care unit for hemorrhagic shock and subsequent multiple organ failure; manifested asystole, resuscitation maneuvers were initiated, without reversing the cardiac arrest, for which the death of the patient was declared. CONCLUSION: It is important the knowledge of the clinical manifestations and evolution. Being aware that secondary infections due to dengue may manifest a critical period marked by severe coagulopathies and plasma loss. In this case, we consider it essential to known the treatment when signs of haemorrhage appear.
ABSTRACT
Objective To investigate the dynamic changes of MDA, NO, SOD and pathologic changes of the lung and kidneyduring repefusion after haemorrhagic shock in rabbits, and to study the protective effects of edaravone during thecourse.Method Totally 29 beparinized (3 mg/kg) rabbits were randomly divided into three groups:tho sham-operatedcontrol group (group C, n = 7), the haemorrhagic shock group (group I/R, n = 10), and the haemorrhagicshock group with edaravone infusion (group I/R-edaravone, n = 12). Rabbits in the latter two groups were bledfrom left arteria cmralis in 10 minutes with MAP maintained at 40 mmHg for 60 minutes, and then group I/R-edar-avone was given edaravone intravenously. After that, resuscitation began:all blood loss was replaced with normalsaline within 60 minutes with MAP at the end ≥ 70% MAP before haemorrhagic shock. Edaravone was reinjectedat 10 hours after shock.All rabbits were killed at 20 h after reperfusion.Plasma nitric oxide(NO), malonyldialde-hyde (MDA) and superoxide dismutase(SOD) in every group were measured before shock,60 minutes after shockaad 1 h, 5 h and 20 h after reperfusien. Part of the right lung and the right kidney tissues were taken from everyrabbit for pathologic examnation after sacrifice.Results There was no significant difference in MDA,NO aad SOD among three groups before shock. A higherlevel of MDA (5.35±0.29 μmol/L), NO(27.75 ±2.88 μmol/L)and lower serum concentration of SOD(194.58±14.42U/ml)could be found in group I/R during haemorrhagic shock,as compared to group C(4.44±0.59 μmol/L,25.01±4.95μmol/L,210.86±24.54U/ml,respectively,P<0.01).At 20 hours after resuscitation,MDA and NO contents continued to increase(5.69±0.24 μmol/L and 28.01±3.10 μmol/L respectively,P<0.05)while SOD contents kept decreasing(151.83±9.36 U/ml,P<0.05)in group I/R.Comparing to group I/R,group I/R-edaravone had significant lower level of MDA(3.48±0.23 μmol/L,P<0.01)and higher concentration of SOD(195.10±11.87U/ml,P<0.01).Edaravone attenuated the pathologic changes in the lung and kidney.Conclusions Edaravone could effectively protect vital organs from reperfusion injury caused by free radicals following haemorrhagic shock by reducing plasma levels of MDA,NO and increasing levels of SOD.
ABSTRACT
In order to assess the effect of opioid receptor antagonists, naloxone and noradrenaline, on renal cortical microcirculation, India ink infusion was made through the renal artery, one hour after treatment with each drug, in dogs subjected to haemorrhagic shock. Naloxone (1 mg/kg) treatment showed a dual beneficial effect of significant improvement (P < 0·001) in the mean arterial pressure without increasing the renal resistance as indicated by the presence of ink particles in about 75% of the cortical glomeruli. However, in the case of noradrenaline (2 μg/kg/min)-treated animals, although mean arterial pressure increased significantly (P < 0·001) only very few glomeruli (25%) in the cortical region showed ink particles, demonstrating severe vasoconstriction. In the control group infused only with saline, although most of the glomeruli (92%) were filled with ink particles, there was a significant decline in the mean arterial pressure (P < 0·001).
ABSTRACT
Effect of haemorrhagic shock on somatostatin (ss)-immunoreactive cells in rat pancreas was studied with the immunohistochemical PAP method. The results showed that at different time from 30 mins to 6 hours after haemorrhagic shock the number of SS-immunoreactive cells in pancreas was decreased significant. It is suggested that after haemorrhagic shock the releasing rate of somatostatin from the pancreatic D cells is increased. Therefore, the pancreatic D cells may play a role in the regulation of the pathological process of haemorrhagic shock.