ABSTRACT
OBJECTIVE: A study is made of the influence of preemptive hemodynamic intervention restricting fluid administration upon the development of oleic acid-induced lung injury. DESIGN: A randomized in vivo study in rabbits was carried out. SETTING: University research laboratory. Subjects: Sixteen anesthetized, mechanically ventilated rabbits. VARIABLES: Hemodynamic measurements obtained by transesophageal Doppler signal. Respiratory mechanics computed by a least square fitting method. Lung edema assessed by the ratio of wet weight to dry weight of the right lung. Histological examination of the left lung. INTERVENTIONS: Animals were randomly assigned to either the early protective lung strategy (EPLS) (n=8) or the early protective hemodynamic strategy (EPHS) (n=8). In both groups, lung injury was induced by the intravenous infusion of oleic acid (OA) (0.133mlkg−1h−1 for 2h). At the same time, the EPLS group received 15mlkg−1h−1 of Ringer lactate solution, while the EPHS group received 30mlkg−1h−1. Measurements were obtained at baseline and 1 and 2h after starting OA infusion. RESULTS: After 2h, the cardiac index decreased in the EPLS group (p < 0.05), whereas in the EPHS group it remained unchanged. Lung compliance decreased significantly only in the EPHS group (p < 0.05). Lung edema was greater in the EPHS group (p < 0.05). Histological damage proved similar in both groups (p = 0.4). CONCLUSIONS: In this experimental model of early lung injury, lung edema progression was attenuated by preemptively restricting the administration of fluids
OBJETIVO: Conocer cómo influye una intervención hemodinámica preventiva basada en la restricción de fluidos sobre el desarrollo de la lesión pulmonar inducida por la administración de ácido oleico. DISEÑO: Estudio aleatorizado en animales vivos. Lugar: Laboratorio universitario de investigación experimental. VARIABLES: Mecánica respiratoria (método de los mínimos cuadrados), medidas hemodinámicas (doppler esofágico), estimación del edema pulmonar (relación peso húmedo/seco del pulmón derecho) y daño histológico del pulmón izquierdo. INTERVENCIONES: Ocho animales fueron asignados a un grupo con una estrategia protectora pulmonar (EPP), y otros 8 a otro grupo con una estrategia protectora hemodinámica (EPH). En ambos grupos la lesión pulmonar se desencadenó mediante la administración intravenosa de ácido oleico (0,133mL/kg−1/h−1 durante 2h), recibiendo simultáneamente los animales del grupo EPP 15mL/kg−1/h−1 de Ringer Lactato y los del grupo EPH 30mLKg−1h−1. Se obtuvieron medidas basales, a la hora y a las 2h. RESULTADOS: Transcurridas las 2h de experimento el índice cardiaco permaneció estable en el grupo EPH, pero disminuyó en el grupo EPP (p < 0,05). Por el contrario, la distensibilidad pulmonar disminuyó significativamente solo en el grupo EPH (p < 0,05), en el cual el edema pulmonar estimado mediante la relación peso húmedo/seco del pulmón derecho fue mayor (p < 0,05). El daño histológico fue similar en ambos grupos (p = 0,4). CONCLUSIONES: En este modelo experimental de lesión pulmonar aguda en fase inicial, la formación del edema pulmonar fue atenuada por la restricción preventiva en la administración de fluidos
Subject(s)
Animals , Rabbits , Acute Lung Injury/physiopathology , Drinking/physiology , Pulmonary Edema/prevention & control , Respiratory Distress Syndrome/prevention & control , Oleic Acid/adverse effects , Beverages/adverse effects , Disease Models, AnimalABSTRACT
OBJECTIVE: A study is made of the influence of preemptive hemodynamic intervention restricting fluid administration upon the development of oleic acid-induced lung injury. DESIGN: A randomized in vivo study in rabbits was carried out. SETTING: University research laboratory. SUBJECTS: Sixteen anesthetized, mechanically ventilated rabbits. VARIABLES: Hemodynamic measurements obtained by transesophageal Doppler signal. Respiratory mechanics computed by a least square fitting method. Lung edema assessed by the ratio of wet weight to dry weight of the right lung. Histological examination of the left lung. INTERVENTIONS: Animals were randomly assigned to either the early protective lung strategy (EPLS) (n=8) or the early protective hemodynamic strategy (EPHS) (n=8). In both groups, lung injury was induced by the intravenous infusion of oleic acid (OA) (0.133mlkg-1h-1 for 2h). At the same time, the EPLS group received 15mlkg-1h-1 of Ringer lactate solution, while the EPHS group received 30mlkg-1h-1. Measurements were obtained at baseline and 1 and 2h after starting OA infusion. RESULTS: After 2h, the cardiac index decreased in the EPLS group (p<0.05), whereas in the EPHS group it remained unchanged. Lung compliance decreased significantly only in the EPHS group (p<0.05). Lung edema was greater in the EPHS group (p<0.05). Histological damage proved similar in both groups (p=0.4). CONCLUSIONS: In this experimental model of early lung injury, lung edema progression was attenuated by preemptively restricting the administration of fluids.
Subject(s)
Fluid Therapy/methods , Lung Injury/etiology , Lung Injury/prevention & control , Pulmonary Edema/complications , Respiration, Artificial , Animals , Disease Progression , Hemodynamics , Oleic Acid/administration & dosage , Pulmonary Edema/chemically induced , Pulmonary Edema/physiopathology , Rabbits , Random AllocationABSTRACT
Acute necrotizing esophagitis is a rare disease. Its pathogenesis is influenced by situations of low systemic perfusion, such as hypertension, heart failure or sepsis, in which other factors, such as the application of a nasal tube, infections or drugs also play a role. We present a case of acute necrotizing esophagitis in a patient with copious vomiting, renal failure, gastric hemorrhage due to Mallory-Weiss syndrome and esophageal infection due to Actinomyces. The patient was undergoing coadjuvant chemotherapy for a surgically-treated colonic neoplasia. Maintenance therapy produced favorable evolution with restoration of esophageal epithelium and no stenotic complications.
Subject(s)
Esophagitis/diagnosis , Acute Disease , Adenocarcinoma/complications , Adenocarcinoma/therapy , Adult , Combined Modality Therapy , Esophagitis/therapy , Esophagus/pathology , Humans , Male , Necrosis , Sigmoid Neoplasms/complications , Sigmoid Neoplasms/therapyABSTRACT
The clinical case of a 21-year-old patient diagnosed with a variant of intrahepatic biliary ductopenia or Alagille syndrome, a dominant inherited disorder associated with a chronic cholestatic syndrome and abnormalities in different organs and systems. The present article discusses the main clinical abnormalities found in this syndrome and we describe a persistent arterial ductus as an isolated cardiovascular manifestation not previously reported in association to this syndrome.
Subject(s)
Alagille Syndrome/complications , Ductus Arteriosus, Patent/complications , Adult , Alagille Syndrome/pathology , Bile Ducts, Intrahepatic/pathology , Biopsy , Ductus Arteriosus, Patent/diagnosis , Ductus Arteriosus, Patent/diagnostic imaging , Echocardiography , Female , Humans , Radiography, ThoracicABSTRACT
The clinical case of a 45-years old patient with previous diagnosis of alcoholic cirrhosis who was admitted to study the appearance of a picture consisting in erythematoviolescent lesions in the lower limbs and advanced renal failure is presented. Anatomopathologic study of the cutaneous lesions suggested the diagnosis of leukocytoclastic vasculitis. This fact was of special clinical interest on having taken into consideration the cytologic demonstration of hepatocarcinoma superimposed to the established chronic liver disease of the patient. The rarity of leukocytoclastic vasculitis as the initial clinical manifestation of a hepatocarcinoma versus the most common forms of presentation is herein discussed.
Subject(s)
Carcinoma, Hepatocellular/diagnosis , Liver Neoplasms/diagnosis , Vasculitis, Leukocytoclastic, Cutaneous/diagnosis , Carcinoma, Hepatocellular/pathology , Chronic Disease , Diagnosis, Differential , Fatal Outcome , Humans , Liver Cirrhosis, Alcoholic/diagnosis , Liver Cirrhosis, Alcoholic/pathology , Liver Neoplasms/pathology , Male , Middle Aged , Vasculitis, Leukocytoclastic, Cutaneous/pathologyABSTRACT
The association of systemic lupus erythematosus (SLE) with amyloidosis is exceptional. We present a 37-year-old patient who was diagnosed five months earlier for SLE. She developed an acute episode of chest pain, cough and dyspnoea. Hypoxemia and obstructive changes in respiratory tests were present. The chest X-ray was repeatedly normal. Open lung biopsy revealed lupus pneumonitis with positive stain for immunoglobulins and complement, bronchiolitis obliterans, and pulmonary amyloidosis.
