RESUMO
BACKGROUND: Tourniquet is associated with tourniquet induced hypertension (T-HTN) and with occasional circulatory collapse. These changes can be well tolerated by young healthy patients; however, in elderly patients with reduced physiologic cardiovascular reserve and blunted baroreflex, these alterations could be significantly detrimental. So we studied that whether there was any difference in hemodynamic changes in elderly patients receiving general or epidural anesthesia. METHODS: One hundred twenty patients underwent total knee arthroplasty were classified into four groups; general anesthesia in control ( or = 65 years, group II, n=30), epidural anesthesia in control (group III, n=30), epidural anesthesia in elderly (group IV, n=30). Mean blood pressure (MAP), heart rate (HR) and PETCO2 were recorded throughout the experiments. RESULTS: MAP in the general anesthesia was higher than that in the epidural anesthesia after tourniquet inflation and there was pronounced occurrence of T-HTN in the group II (43.3%). After tourniquet deflation, MAP was more reduction in the group II than that in the group IV (23.3+/-10.9% vs 17.4+/-9.4%, p<0.05), and heart rate was increased in all groups except group II. Tourniquet time did not correlate with the magnitude of the changes in MAP and HR associated with tourniquet application. CONCLUSIONS: In elderly patients associated with general anesthesia, occurrence of "tourniquet hypertension" is more frequent and reduction in MAP after deflation is more marked without compensatory increasing of HR than epidural.
Assuntos
Idoso , Humanos , Anestesia Epidural , Anestesia Geral , Artroplastia , Barorreflexo , Pressão Sanguínea , Frequência Cardíaca , Hemodinâmica , Hipertensão , Inflação , Joelho , Choque , Torniquetes , Sinais VitaisRESUMO
Hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is a variant presentation of severe preeclampsia/eclampsia. A 24-year old woman presented herself at 34 wk of pregnancy. Based on the clinical and laboratory assessment, HELLP syndrome was diagnosed. Cesarean section was performed under general anesthesia without invasive monitoring due to stable blood pressure. The course of anesthesia and surgery was uneventful and she delivered female neonate weighing 1770 gram. After the operation, the patient was transferred to the intensive care unit immediately. During the intensive care bleeding started and signs of disseminated intravascular coagulopathy showed up. Any improvement was not made after transfusion and every other supportive therapy. By the request of guardian, she was transferred to tertiary hospital, where she died.
Assuntos
Feminino , Humanos , Recém-Nascido , Gravidez , Adulto Jovem , Anestesia , Anestesia Geral , Anestesia Obstétrica , Pressão Sanguínea , Cesárea , Síndrome HELLP , Hemólise , Hemorragia , Cuidados Críticos , Unidades de Terapia Intensiva , Fígado , Centros de Atenção TerciáriaRESUMO
Pulmonary eosinophilic granuloma, a rare form of Langerhans cell histiocytosis confined to lung, has no known etiology and variable natural history. It is characterized by discrete proliferation of Langerhans cells. It is known that over 90% of the patients are cigarette smokers, and it is rarely reported in non- or passive-smoking patients, especially female. Here we describe a case of pulmonary eosinophilic granuloma in a passive-smoking, reproductive female patient presented with spontaneous pneumothorax. We identified S-100 and CDla positive histiocytes on immunohistochemical stain of the lung tissue obtained by open lung biopsy.
Assuntos
Feminino , Humanos , Biópsia , Granuloma Eosinófilo , Eosinófilos , Histiócitos , Histiocitose de Células de Langerhans , Células de Langerhans , Pulmão , História Natural , Pneumotórax , Produtos do TabacoRESUMO
Pulmonary actinomycosis is a chronic suppurative disease usually caused by Actinomyces israelii, characterized by suppuration, sinus tract formation, and purulent discharge containing yellowish "sulfur granules". It is usually caused by aspiration of contaminated material from mouth or oropharynx. The diagnosis of pulmonary actinomycosis is difficult and its initial clinical manifestations mimic tuberculosis or neoplasm. We experienced a case of thoracic actinomycosis in a 47-year old male patient who had complained of cough, chest pain and fever for 2 months. The diagnosis was confirmed pathologically by ultrasonography guided gun-biopsy of pleural mass and thoracoscopic wedge biopsy of parenchymal lung lesion.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Actinomyces , Actinomicose , Biópsia , Dor no Peito , Tosse , Diagnóstico , Febre , Pulmão , Boca , Orofaringe , Supuração , Tuberculose , UltrassonografiaRESUMO
No abstract available.