ABSTRACT
O objetivo do presente trabalho é revisar o uso da tomografia computadorizada (TC) na insuficiência respiratória aguda (IRA) - lesão pulmonar aguda ou acute lung injury (ALI) e síndrome da angústia respiratória aguda (SARA). Foram revisados os principais trabalhos publicados na literatura em língua inglesa e localizados por pesquisa na Medline, que estudaram o uso da TC na IRA. A TC permite, num primeiro momento, uma avaliação qualitativa da morfologia pulmonar buscando a presença de hiperdensidades difusas e/ou localizadas e de outras anormalidades concomitantes (como derrame pleural e pneumotórax). Além disso, permite avaliar os histogramas de densidade pulmonares a partir dos quais podem ser efetuados o cálculo dos volumes pulmonares totais e regionais (volume das regiões ventiladas, parcialmente ventiladas, não ventiladas e de hiperdistensão). Isso possibilita quantificar recrutamento alveolar e hiperdistensão decorrentes de estratégias ventilatórias, como por exemplo do uso de diferentes níveis de pressão expiratória final positiva (PEEP).
The goal of this paper is to review the use of CT scan in acute respiratory failure (ARF), acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The most important papers studying CT in ARF, published in English language literature, were found in Medline. The use of CT in patients with ARF let allowed the authors to proceed to a qualitative evaluation of lung morphology looking for diffuse an/or localized hyperdensities, and for other concomitant abnormalities (pleural effusion, pneumothorax). It is also possible to evaluate lung density histograms and calculate the gas-tissue ratio within the lungs. Likewise, one can also calculate total and regional lung volumes (aerated, poorly-aerated, non-aerated, and overdistension volumes). Knowing those volumes it is possible to quantify alveolar recruitment and overdistension due to ventilatory strategies as the use of different positive end expiratory pressure (PEEP) levels.
ABSTRACT
Incomplete bladder emptying even after prostatectomy were not uncommonly anticipated in patients with benign prostate hypertrophy (BPH) who had episodes of acute urinary retention. This may be related h impaired contractility of detrusor muscle secondary to decreased blood flow to the bladder and over-stretching of detrusor muscle caused by overdistension of bladder. We measured detrusor contractility in 41 patients with BPH who had episodes of urine retention (Group A) and 77 patients with BPH without urine retention. Also, follow up uroflowmetry were taken for 25 patients of group A and 40 patients of group B in 30-50 days after prostatectomy. Results were as follows; I. On filling cystometry. first sense of fill, urge sense to void, maximum cystometric capacity and compliance were not significantly different between 2 groups and detrusor instability were 23 cases (56%) in group A, 38 cases (49%) in group B. 2. On pressure-flow study, maximum detrusor voiding pressure was 32.5+/-4.13 cmH2O in group A and 50.27+/-2.4 cmH2O in group B (P<0.01). Peak flow rate (Qmax) and voided volume were 4.1 to 0.7 ml/sec, 76.1+/-12.7 ml in group A and 8.6+/-0.65 ml/sec, 176.1+/-16.7 ml in group B respectively (P<0.01, P<0.01). Residual urine was 256.5 1:24.3 ml in group A and 111.6 t 14.7 ml in group B (P<0.01). 3. On postoperative follow up uroflowmetry, voided volume and Qmax were increased compared to preoperative value in group A but still lower than those in group B (P<0.05, P<0.05). 4. The number of patients who didn't show any improvement of voiding symptoms after surgery were 17 on group A and 11 on group B. Impaired detrusor contractility was present in 25 of 41 cases (61%) of group A and 10 of 71 cases (13%) of group B on urodynamic diagnosis. Conclusively, in patients with BPH who had episodes of urine retention, preoperative pressure-flow study to recognize impaired detrusor contractility would be helpful in anticipating incomplete bladder emptying after prostate surgery and considering other forms of ancillary therapy.