Ressuscitação cardiopulmonar de adultos com parada cardíaca intra-hospitalar utilizando o estilo Utstein / Cardiopulmonary resuscitation of adults with in-hospital cardiac arrest using the Utstein style

RESUMO Objetivo: Analisar o perfil clínico de pacientes com parada cardiorrespiratória intra-hospitalar, seu atendimento e evolução, com registro baseado no estilo Utstein. Métodos: Estudo observacional, prospectivo e longitudinal em ambiente de terapia intensiva de pacientes com parada cardiorrespiratória incluídos durante 1 ano. Resultados: Foram 89 pacientes, com média de idade de 59,0 anos, 51,6% homens, submetidos às manobras de ressuscitação cardiopulmonar. Os episódios ocorreram no período diurno em 64,6% dos casos. A assistolia/bradiarritmia foi o ritmo inicial mais frequente (42,7%). A maior parte dos que apresentaram retorno à circulação espontânea evoluiu com parada cardiorrespiratória recorrente, principalmente nas primeiras 24 horas (61,4%). As médias dos tempos foram de 10,3 dias entre a internação e ocorrência de parada cardiorrespiratória; 0,68 minutos entre a parada cardiorrespiratória e ressuscitação cardiopulmonar; 7,1 minutos entre a parada cardiorrespiratória e a desfibrilação; 16,3 minutos de duração da ressuscitação cardiopulmonar. Houve associação entre sexo e duração da ressuscitação cardiopulmonar (19,2 minutos nas mulheres versus 13,5 minutos nos homens; p = 0,02), duração da ressuscitação cardiopulmonar e retorno à circulação espontânea (10,8 minutos versus 30,7 minutos; p < 0,001), entre cardiopatia e a idade (60,6 anos versus 53,6; p < 0,001). A sobrevida imediata após a parada cardiorrespiratória foi de 71% e, até a alta hospitalar e no sexto mês após a alta, de 9% e de 6%, respectivamente. Conclusão: O principal ritmo inicial detectado foi a assistolia/bradiarritmia com curto intervalo entre a parada cardiorrespiratória e a reanimação, porém com desfibrilação tardia. Mulheres apresentaram maior tempo de reanimação. Houve baixa taxa de sobrevida hospitalar.

ABSTRACT Objective: The objective of this study was to analyze the clinical profile of patients with in-hospital cardiac arrest using the Utstein style. Methods: This study is an observational, prospective, longitudinal study of patients with cardiac arrest treated in intensive care units over a period of 1 year. Results: The study included 89 patients who underwent cardiopulmonary resuscitation maneuvers. The cohort was 51.6% male with a mean age 59.0 years. The episodes occurred during the daytime in 64.6% of cases. Asystole/bradyarrhythmia was the most frequent initial rhythm (42.7%). Most patients who exhibited a spontaneous return of circulation experienced recurrent cardiac arrest, especially within the first 24 hours (61.4%). The mean time elapsed between hospital admission and the occurrence of cardiac arrest was 10.3 days, the mean time between cardiac arrest and cardiopulmonary resuscitation was 0.68 min, the mean time between cardiac arrest and defibrillation was 7.1 min, and the mean duration of cardiopulmonary resuscitation was 16.3 min. Associations between gender and the duration of cardiopulmonary resuscitation (19.2 min in women versus 13.5 min in men, p = 0.02), the duration of cardiopulmonary resuscitation and the return of spontaneous circulation (10.8 min versus 30.7 min, p < 0.001) and heart disease and age (60.6 years versus 53.6, p < 0.001) were identified. The immediate survival rates after cardiac arrest, until hospital discharge and 6 months after discharge were 71%, 9% and 6%, respectively. Conclusions: The main initial rhythm detected was asystole/bradyarrhythmia; the interval between cardiac arrest and cardiopulmonary resuscitation was short, but defibrillation was delayed. Women received cardiopulmonary resuscitation for longer periods than men. The in-hospital survival rate was low.

Hemangiopericitoma benigno del mediastino en un adulto / Benign mediastinal hemangiopericytoma in an adult

Se describe el caso clínico de un paciente de 49 años de edad, quien ingresó en el Servicio de Medicina Interna con el diagnóstico de tumor del mediastino, considerado inicialmente como un posible linfoma o teratoma, por lo cual fue trasladado al Servicio de Cirugía General. En la toracotomía programada, a través de una incisión de estereotomía media, se encontró un gran tumor del mediastino, muy adherido a estructuras vecinas, pero que pudo ser extirpado totalmente. El estudio histopatológico del espécimen quirúrgico reveló un hemangiopericitoma benigno, inusual en esta localización. El período posoperatorio transcurrió satisfactoriamente y egresó de la consulta de seguimiento médico para reincorporarse a su vida normal a las 4 semanas de intervenido.

The clinical case of a patient aged 49, who was hospitalized at the Internal Medicine Service and referred to General Surgery Service, having a mediastinal tumor diagnosis, which was initially considered as a possible lymphoma or teratoma, is described. In the scheduled thoracotomy, done through an incision of mean stereotomy, a big mediastinal tumor, well-attached to surrounding structures, was found but it could be totally removed. A histopathological study of the surgical specimen showed a benign hemangiopericytoma with an uncommon location. No complication was observed in the postoperative time period. The patient was discharged from the medical follow-up room so he could return to his normal lifestyle after 4 weeks of being surgically treated.

Inclusão de silagem de rama de mandioca em substituição à pastagem na alimentação de vacas em lactação: produção, qualidade do leite e da gordura / Substitution of pasture by cassava foliage silage in the diet of dairy cows: production and quality of milk and milkfat

Avaliou-se o efeito da substituição da pastagem pela silagem de rama de mandioca (SRM) sobre a produção e constituintes do leite e sobre a qualidade da gordura do leite de vacas da raça Holandesa. O delineamento experimental utilizado foi um duplo quadrado latino 4x4, e para o fator níveis de suplementação, foi usado regressão. A dieta-controle foi 50 por cento concentrado e 50 por cento volumoso, e as proporções de substituição do volumoso foram 0, 20, 40 e 60 por cento com base na matéria seca. Todas as dietas eram isoprotéicas. Foram analisados: produção de leite (PL), PL corrigida a 4 por cento (PLC), acidez, gordura ( por cento), densidade, proteína, lactose, sólidos totais, contagem de células somáticas (CCS), ureia e perfil dos ácidos graxos da gordura do leite. Houve efeito linear decrescente da substituição do volumoso pela SRM sobre a PL, PLC e ureia no leite, e efeito (P<0,05) linear crescente sobre a concentração de ácido gama linolênico e ácido palmítico. A acidez, densidade, proteína, gordura, lactose, sólidos totais, CCS e demais ácidos graxos da gordura do leite permaneceram inalterados com a incorporação da SRM na dieta.

The effect of a partial substitution of pasture for cassava foliage silage (CFS) on milk production and composition on fat quality of Holstein cow milk was studied using a replicated 4 X 4 Latin square design with four treatments. Regression was used for the comparison of nutrition levels. The control diet contained 50 percent pasture and 50 percent concentrate on a dry matter basis. The substitution levels of pasture for CFS were 0, 20, 40, or 60 percent of the forage dry matter. All diets were isonitrogenous. The analyzed parameters were: milk production (MP); 4 percent fat-corrected milk production (FCM); acidity; density; concentrations of fat, protein, lactose, urea, and total solids; somatic cell counts (SCC), and milk fatty acids profile. There was a linear decrease effect (P<0.05) in MP, FCM, and urea content with increasing levels of CFS in the diet. Concentrations of gamma linolenic and palmitic acids in milk fat linearly increased (P<0.05) with higher proportions of CFS in the diet. Other contents of milk fatty acids remained similar among treatments as well as acidity; density; concentrations of protein, fat, lactose, and total solids; and SCC.

Manejo anestésico de las emergencias de oftalmología / Anaesthesic treatment of the ophtalmologic emergencies

Se realizó un estudio prospectivo sobre el manejo anestésico de los pacientes intervenidos bajo anestesia general por traumas oculares agudos durante un período de tres meses en el Hospital Dr. Luis E. Aybar, con la intención de evaluar la calidad de la anestesia, sobretodo por la forma del paciente recobrar su estado de conciencia. Por su condición de emergencia los pacientes no fueron premedicados, se les administró anestesia general endotraqueal con Tiopental o Ketamina o anestesia general endovenosa con Diazepam o Ketamina. El criterio que prevaleció para determinar la técnica anestésica fue de la edad del paciente, duración del procedimiento, carácter intra o extraocular de la intervención y status hemático. La técnica anestésica general endotraqueal se empleó en 60 pacientes para un 83.3//y la general endovenosa en 12 para un 16.///. En 56 de los pacientes (77.7//) el diagnóstico prequirurgico fue herida de cornea. Todos los pacientes en este estudio fueron menores de 15 años de edad. Ningún paciente tuvo una mala recuperación de la anestesia, 16.7//tuvo una recuperación regular y 83.3//una recuperación buena

MIP 28 forms channels in planar lipid bilayers

Fiber cells, which constitute most the lens tissue, have large amounts of a protein named the main intrinsic protein (MIP) in their plasma membrane, MIP seems to vary among species. On SDS-PAGE, MIP from bovine lens (MIP 26) migrates faster than MIP from chicken lens (MIP 28), which runs as a 28-KDa protein. Recently a number of laboratories have shown that MIP 26 forms channels in lipid bilayers. We have isolated membrane fractions highy enriched in MIP 28 from chicken lens and incorporated channel activity into planar bilayers from these membrane fractions before and after treatment with the detergent Triton X-100. Detergent treatment does not seem to affect channel properties. We have attempted to block channel activity with polyclonal antivodies against bovine and chicken MIP but failed to detect blockade using either detergent-free or detergent-treated membranes. Single channel size in symmetric solutions of 300 m§K2SO4(3-00-400pS) agrees well with published results one allows for corrections in ionic strenght. Preliminary experiments indicate that the incorporated channels display voltage dependence. The channel activity recorded from MIP 28-enriched membrane fractions ins qualitatively similar to that described for MIP 26 membrane fractions incorporated into bilayers. In contrast to previous reports, we do not find it necessary to add the membrane fractions to both sides of the bilayer to obtain channel incorporation. This may reflect the fact that MIP does not span two bilayers