Problema de pele em paciente estomizada: relato de caso / Skin problems in a stomized patient: a case report

Objetivo: Relatar o caso vivenciado na prática de enfermagem, no manejo de complicações de pele periestoma,e avaliar as mudanças clínicas obtidas após a utilização de protetores cutâneos. Relato de caso: O estudo foi desenvolvido em uma paciente estomizada de 57 anos, cuja pele periestoma apresentava extensa dermatite periestomal com aspecto brilhante, altamente exsudativa, irritativa e dolorosa, em que o dispositivo para estomia mantinha-se adaptado por menos de 24 horas. Conclusão: Após o manejo dos protetores cutâneos, houve evolução satisfatória em relação à lesão periestomal e no emocional, o que resultou no fechamento da ileostomia.

Objective: To report a case experienced in nursing practice regarding the management of peristomal skin complications, as well as to evaluate the clinical changes obtained after the use of skin protectors. Case report: this study was developed in a patient with stoma 57, whose skin had extensive peristomal dermatitis, glossy, highly exudative, irritating and painful, who had a device installed for ostomy adapted forless than 24 hours. Conclusion: After the management of skin protectors, there was satisfactory progress in relation to peristomal and emotional injury, which resulted in the closure of the ileostomy.

Effects of nitric oxide on peritoneal lymphatic stomata and lymph drainage via NO-cGMP-Ca2+ pathway / 生理学报

To study the cell signal transduction mechanism of nitric oxide (NO) on the peritoneal lymphatic stomata and lymph drainage in the rat, cGMP content were measured by a commercially available radioimmunoassay kit, and the [Ca(2+)](i) were observed by a confocal laser scanning microscope in the cultured peritoneal mesothelial cell. Animal experiment was practiced to study the effect of NO-cGMP-Ca(2+) pathway on the lymphatic stomata and lymph absorption. The results showed that: (1) Sper/NO increased cGMP of the rat peritoneal mesothelial cell (RPMC) in a dose-dependent manner (P<0.01) compared to the control group. This effect was blocked by 1H-[1,2,4] oxadiazolo [4,3-a] quinoxalin-1-one (ODQ) (P<0.05), a specific inhibitor of soluble guanylyl cyclase (sGC). The level of [Ca(2+)](i) in single RPMC decreased by adding Sper/NO (P<0.05). Pretreatment with ODQ for 10 min blocked the Sper/NO-induced decrease in [Ca(2+)](i). L-typed calcium channel blocker nifedipine induced an immediate and marked decrease in [Ca(2+)](i) (P<0.05).. After [Ca(2+)](i) reached a balance again, adding Sper/NO could not change [Ca(2+)](i) (P>0.05). (2) Sper/NO increased the area of the stomata (P<0.01) and the quantity of the tracer in a dose-dependent manner (P<0.05) compared to the control group. Pretreatment with ODQ significantly inhibited Sper/NO-induced change of lymphatic stomata and lymph drainage (P<0.01). Nifedipine increased the opening area of the lymphatic stomata (P< 0.01) and the concentration of absorbed trypan blue of the diaphragm (P<0.05). Sper/NO could not make a further change in the samples pretreated by nifedipine (P> 0.05). The results indicate that NO can decrease [Ca(2+)](i) in the RPMC through the NO-cGMP pathway. This procession is related with the L- type voltage-gated Ca(2+) channel. NO enlarges the opening area of the lymphatic stomata and enhances the lymph drainage of tracer by NO-cGMP-[Ca(2+)](i) pathway.

Effects of nitric oxide on pleural lymphatic stomata and lymphatic drainage in the rat / 生理学报

To investigate the effects of nitric oxide (NO) on the pleural lymphatic stomata and lymph absorption from the pleural cavity, the NOS (nitric oxide synthase) inhibitor N(omega)-nitro-L-arginine-methyl-ester (L-NAME) and the NO donor isosorbide dinitrate (ISDN) were injected into the peritoneal cavity of the rats respectively. Trypan blue was used as a tracer. Then the concentrations of NO and trypan blue in the blood serum were measured, and the ultrastructural changes in pleural lymphatic stomata were observed under a scanning electron microscope (SEM) and studied by a computer image processing system attached to SEM. It turned out that the concentration of NO in the serum was 49.34+/-18.47 micromol/L, and the area and density of the pleural lymphatic stomata were 6.80+/-1.13 microm(2) and 170.24+/-66.60 /0.1 mm(2) respectively in the NO donor group. The concentration of NO reduced to 17.72+/-6.58 micromol/L, and the area and density of the pleural lymphatic stomata were 5.72+/-1.54 microm(2) and 61.71+/-12.73/0.1 mm(2) in the NOS inhibitor group. We found that the area and density of the pleural lymphatic stomata were positively correlated with the NO quantity. After the tracer was injected into the pleural cavity, the NO donor group exhibited a higher trypan blue concentration than the control group. The ability of the pleura to absorb trypan blue was enhanced because of the large opening of the stomata. It is suggested that NO can increase lymph absorption of the pleura by relaxing pleural lymphatic stomata.

Pneumotórax catamenial: uma revisão da literatura a respeito da etiologia, patogênese, terapêutica e relato de um caso / Catamenial pneumothorax: a literature rewiew of etiology, pathogenesis, managmenty and a case report

Introdução: O pneumotórax espontâneo catamenial é uma entidade clínica definida com a presença de ar no espaço pleural, durante as primeiras 48 a 72 horas após o início do fluxo menstrual. Ocorre, preferencialmente, no hemitórax direito, com maior incidência nas terceiras e quartas décadas de vida. Apesar de constituir uma entidade pouco conhecida pela literatura mundial, dada a raridade do quadro, acredita-se que possa estar relacionado à existência de pertuitos diafragmáticos associado ou não à presença de implantes de células endometriais na cavidade torácica. Objetivos: Fazer a revisão da literatura e relatar um caso de pneumotórax catamenial. Material e métodos: Apresentamos um caso de paciente de 28 anos, sexo feminino, admitida no Hospital Monte Sinai com quadro de dispnéia de instalação súbita, tosse persistente e dor no hemitórax direito do tipo pleurítica, irradiada para a região escapular homolateral. Era a quinta vez que apresentava essa sintomatologia. A radiografia do tórax foi realizada com objetivo de se confirmar a presença de pneumotórax. Posteriormente, a paciente foi submetida a videopleuroscopia, com inventário minuncioso do espaço pleural, incluindo a visualização do diafragma e de toda a pleura. Resultados: À videopleuroscopia detectaram-se vários pertuitos diafragmáticos. Enviado material para estudo anatomopatológico, pudemos descartar endometriose pleural. A terapêutica consistiu em pleurectomia, com o objetivo de prevenir novos episódios. Conclusão: Em função da raridade do caso, o pneumotórax catamenial tem seu diagnóstico após vários episódios. Nesse caso específico, o achado de orifícios diafragmáticos permitiu optar pelo tratamento cirúrgico. A paciente encontra-se assintomática.

Introduction: Catamenial pneumothorax is characterized by recurrent accumulation of air in the thoracic space appeared within 48 to 72 hours from the menstrual flow. In most cases, catamenial pneumothorax is right-sided, and most of the affected women are in the third to fourth decades of life. Although it is a rare entity of unknown etiology, there are some possible cause for pnemothorax catamenial have been proposed: 1) rupture of pulmonary bleb; 2) diaphragmatic fenestration; 3) thoracic endometriosis. Objectives: 1) To make a review of the literature about pneumothorax catamenial. 2) To present a case of pneumothorax catamenial caused by diaphragmatic fenestration. Methods: A 28-year-old woman suffered 5 episodes of right-sided pneumothorax, which appeared during menstruation. She had undergone thoracic radiography to confirm the diagnosis. Then she had undergone video-assisted thoracoscopy, with histological examination of diaphragm specimen. Results: We identified diaphragm defects of different extension. Endometriosis could not be found. The patient undergone pleurectomy to prevent further occurrences. Conclusion: Because of its rarity, the diagnosis of catamenial pneumothorax could be difficult. In this present case the patient is assymptomatic before thoracocirurgical intervention, without using anovulatory therapy.