ABSTRACT
Os autores apresentam um caso raro de choque em doente sem antecedentes pessoais significativos, admitido na unidade de terapia intensiva por suspeita de choque séptico. Inicialmente, foi tratado com fluidoterapia sem melhoria, tendo sido aventada a hipótese de síndrome de hiperpermeabilidade capilar, após confirmação de hipoalbulinemia paradoxal grave, hipotensão e hemoconcentração exuberante - tríade característica da doença. Os autores discutiram o diagnóstico diferencial e ainda realizaram uma revisão do diagnóstico e do tratamento da doença.
The authors report a rare case of shock in a patient without significant clinical history, admitted to the intensive care unit for suspected septic shock. The patient was initially treated with fluid therapy without improvement. A hypothesis of systemic capillary leak syndrome was postulated following the confirmation of severe hypoalbuminemia, hypotension, and hemoconcentration - a combination of three symptoms typical of the disease. The authors discussed the differential diagnosis and also conducted a review of the diagnosis and treatment of the disease.
Subject(s)
Female , Humans , Middle Aged , Capillary Leak Syndrome/diagnosis , Shock, Septic/diagnosis , Capillary Leak Syndrome/physiopathology , Capillary Leak Syndrome/therapy , Diagnosis, Differential , Fluid Therapy/methodsABSTRACT
Systemic capillary leak syndrome (SCLS), also called Clarkson's disease is rare and life-threatening disorder of unknown etiology, which is a characteristic triad of hypovolemic shock, hemoconcentration, and hypoalbuminemia. Unexplained capillary leakage from the intravascular to the interstitial space, which has been estimated up to 70% of the intravascular volume, is the proposed mechanism. Because the pathogenesis is unknown, it is diagnosed clinically after exclusion of other diseases that cause systemic capillary leak and no efficacious pharmacological treatment has been clearly established. The mortality rate ranges from 30% to 76%. In Korea, four cases of SCLS (5 cases in adult and 1 case in child) were reported by 2012. We describe a case of severe SCLS that suddenly occurred and rapidly progressed during pylorus preserving pancreaticoduodenectomy and review the literature.
Subject(s)
Adult , Humans , Capillaries , Capillary Leak Syndrome , Hypoalbuminemia , Korea , Mortality , Pancreaticoduodenectomy , Pylorus , ShockABSTRACT
OBJETIVO: Comparar hemoconcentración y sistemas de puntuación APACHE II y Ranson como predictores tempranos de severidad determinada por criterios de Atlanta en pacientes con diagnóstico de Pancreatitis Aguda en el Hospital Nacional Cayetano Heredia. MATERIALES Y MÉTODOS: Estudio descriptivo retrospectivo entre diciembre del 2009 a noviembre del 2010 con una ficha de recolección de datos para obtener la información relevante. Se clasificó los cuadros de pancreatitis aguda en leve y severa en base a los criterios de falla orgánica y/o complicaciones locales según el Simposio de Atlanta. Para la comparación del valor de hematocrito se realizó la prueba t de Student para evaluar una diferencia significativa y se elaboró la curva ROC para las áreas bajo la curva. RESULTADOS: Ingresaron al estudio 151 pacientes, 103 mujeres (68.2%), edad promedio de 45.5 ± 19.17 años, 112 pancreatitis leves (74.2%) y 39 severas (25.8%). El hematocrito promedio en los casos leves fue de 38.40 ± 4.77%, y 39.78 ± 7.35% en los severos con p igual a 0.182. Se encontró un área bajo la curva de 0.89 y 0.68 para score APACHE II y Ranson, respectivamente. CONCLUSIÓN: Hemoconcentración y Ranson no son buenos predictores de severidad comparados con el APACHE II en Pancreatitis Aguda.
OBJECTIVE: Compare hemoconcetration, APACHE II and Ranson scores as early predictors of severity defined by Atlanta criteria in patients with acute pancreatitis at Hospital Nacional Cayetano Heredia. MATERIALS AND METHODS: Retrospective descriptive study between December 2009 to November 2010 done using a data collection sheet to gather study relevant information. We classified acute pancreatitis into mild or severe according to Atlanta symposium criteria for organ failure and/or local complications. Comparison of hematocrit values was made using a t Student test to detect a significant difference and the area below the ROC curve was analyzed. RESULTS: Counting with 151 patients, 103 women (68.2%), with mean age of 45.5 ± 19.17 years, 112 mild pancreatitis (74.2%) and 39 severe (25.8%). Mean hematocrit in mild cases was 38.40 ± 4.77% and 39.78 ± 7.35% in severe group with p equal to 0.182. Area below the ROC curve of 0.89 y 0.68 for APACHE II and Ranson scores respectively. CONCLUSION: Hemoconcentration and Ranson proved not to be as useful as APACHE II score in predicting severity in acute pancreatitis.
Subject(s)
Humans , Male , Female , APACHE , Hematocrit , Pancreatitis/diagnosis , Predictive Value of Tests , Epidemiology, Descriptive , Retrospective StudiesABSTRACT
To study the effects of prolonged kendo practice in a hot environment on cardiovascular function, certain hemodynamic parameters were measured in 5 male college kendo fencers before and after 1 hour of kendo practice performed at a dry bulb temperature of 30.4t and wet bulb temperature of 26.2°C After kendo practice, body weight was significantly decreased and both hematocrit and blood viscosity were significantly increased. The left ventricular end-diastolic dimension and the left atrial dimension, measured by echocardiography, were significantly reduced after kendo practice, and stroke volume, ejection fraction, and fractional shortening were also significantly decreased after practice. The same fencers were subjected to lower body negative pressure testing designed to reduce the left ventricular end-diastolic dimension to the same degree as kendo practice, and comparable decreases in stroke volume, ejection fraction, and fractional shortening were observed. The ratio of end-systolic wall stress to end-systolic volume index was significantly increased during both kendo practice and lower body negative pressure testing. We conclude that prolonged kendo practice in a hot environment impairs cardiac pump function by reducing preload in parallel with the decrease in venous return, that myocardial contractility may not deteriorate despite marked hemoconcentration, and that fluid intake during practice may prevent deterioration of cardiovascular function.