Thrombectomia reolitica (angiojet) en embolismo pulmonar masivo: a propósito de dos casos / Rheolityc trombectomy (angiojet) in mass pulmonary embolism

Presentamos un nuevo sistema de carácter de trombectomía reolítica en dos pacientes jóvenes, de 27 y 34 años con embolismo pulmonar severo, sin antecedentes previos de cuagulopatía, cardiopatía o traumatismo. Fueron llevados al laboratorio de hemodinamia y se les realizó angiografía pulmonar, documentádose en el primer caso embolismo pulmonar bilateral y en el segundo embolismo pulmonar de la rama izquierda de la fragmentación mecánica de trombos y remoción del mismo, con catéter 5fr angiojet con resultados exitosos

Effects of anti-CD18 monoclonal antibody, R15.7, on the cardiopulmonary manifestations of group B streptococcal sepsis in piglets.

We hypothesized that anti-CD18 monoclonal antibody, R15.7, a murine IgG(1) antibody which blocks leukocyte-endothelial cell adherence, might ameliorate the cardiopulmonary manifestations of sepsis secondary to group B streptococci (GBS). Twenty-six anesthetized, mechanically ventilated newborn piglets received a continuous infusion of GBS (7.5 x 10(9) cfu/kg/min) and were randomly assigned to a treatment group receiving R15.7 (1 mg/kg i.v.) 15 min prior to GBS infusion or to a control group. Cardiopulmonary measurements, arterial blood gases and peripheral blood leukocytes were obtained over 120 min of R15.7 infusion. GBS infusion caused significant increases in pulmonary artery and systemic arterial blood (Psa) pressures, pulmonary vascular (PVR) and systemic vascular (SVR) resistances, and PVR/SVR ratio with decreases in cardiac output and stroke volume. R15.7-treated piglets maintained significantly higher Psa (p < 0.003), dynamic lung compliance (p < 0.04), PaO2 and pH (p < 0.05), and lower total lung resistance (p < 0.01) and PaCO2 (p < 0.04). A longer median survival time was observed in the treatment group (p < 0.01). These data suggest that administration of a CD18-blocking agent prolongs survival in a young animal model of GBS sepsis, possibly secondary to improved tissue perfusion, lung mechanics and acid-base status.

Development of a multiple regression model to identify multi-family residential buildings with a high prevalence of sick building syndrome (SBS).

The aim was to develop a multiple logistic regression model to identify multi-family houses with an increase of sick building syndrome (SBS). In Stockholm, 609 multi-family buildings with 14,235 dwellings were selected by stratified random sampling. The response rate was 77%. Multiple logistic regression analysis was applied, adjusting for ownership of the building, building age and size, age, gender, and atopy. Females, subjects with allergy, those above 65 yr, and those in new buildings reported significantly more SBS. Subjects owning their own building reported less SBS, but the relationship between ownership and building age was strong. A regression model, including factors with a high explanatory value was developed. According to the model, 5% of all buildings built before 1961, 13% of those built 1976-1984, and 15% of those built 1985-1990 would have significantly more SBS than expected. In conclusion, SBS is related to personal factors, building age, and ownership of the building. To identify multi-family buildings with more SBS than expected, it is necessary to adjust for ownership and population characteristics.

[Experiences with intraoperative autotransfusion in the replacement of hip endoprostheses]. / Erfahrungen mit der intraoperativen Autotransfusion bei Hüftendoprothesenwechseln.

This is a report about the use of the Haemonetic Cell Saver for intraoperative retransfusion of blood in replacement of total hip prostheses. The amount of donor blood used was compared in two groups of patients: group II, using the Cell Saver, group I without it. In group II, there was an average of 1000 ml less donor blood used; in certain individual cases, more blood was used. Using the patient's own blood reduces the postoperative reduction of hemoglobin content in the blood by 0.5 g%.

[Long-term experience with brachial plexus anesthesia]. / Langzeiterfahrung mit der Plexusanästhesie.

In this work we report on our experience of more than 11 000 cases of plexus anaesthesia in the eight years 1976-1983. Particular care is taken to show how both the increase in experience and the amelioration in technology have led to an increase in the success rate. Our initial and current methods of axillary plexus block are described in detail, as are the most important signs relevant to the placing of the needle. Finally we discuss indications and contraindications, as well as possible complications and their prevention.

[Delirium tremens in accident surgery]. / Delirium tremens in der Unfallchirurgie.

The case histories of 49 patients suffering from delirium tremens in a trauma hospital are described. Particular attention is devoted to two questions: 1. Is delirium tremens always coupled with a low serum K+? It was shown that a low serum K+ in this illness is frequent but not obligatory. 2. Is there a danger that a relapse could ensue by another operation carried out within a relatively short interval after delirium tremens? It was found that as a rule there is no relapse.

[A contribution to differential diagnosis between acute respiratory distress syndrome and central fatty embolism illustrated by examples from traumatology (author's transl)]. / Ein Beitrag zur Differentialdiagnose zwischen akutem Atemnotsyndrom und zerebraler Fettembolie anhand von Beispielen aus der Traumatologie.

The article reports on 5 patients with polytrauma or who had undergone major surgery of the long bones. In all 5 patients there was acute respiratory insufficiency, and, in addition, a comatose condition lasting for a shorter or greater length of time. In 4 out of these 5 patients, tachypnea occurred despite normalisation of the pO2. Petechial hemorrhages occurred in 3 patients at the trunk. All patients rapidly overcame the acute respiratory insufficiency; no pulmonary shock syndrome developed. In case of acute respiratory insufficiency, especially if associated with comatose conditions, central fatty embolism should always be considered a differential diagnostic possibility.