ABSTRACT
SUMMARY: Following thoraco-abdominal oesophagogastrectomy for an adenocarcinoma of the lower oesophagus, an 81-year-old female with no pre-existing respiratory disease could not be weaned from mechanical ventilation. Right upper and middle lobe torsion were found at thoracotomy on the 14th postoperative day. Both lobes were resected. The patient was discharged from hospital after several postoperative complications. Pulmonary torsion is a rare, potentially life-threatening complication of thoraco-abdominal oesophagogastrectomy. Differentiation from the more common postoesophagectomy pulmonary complications can be difficult. Early post-thoracotomy lung opacification, in the absence of the expected degree of hypoxaemia, should trigger a suspicion of pulmonary torsion.
Subject(s)
Esophagectomy/adverse effects , Gastrectomy/adverse effects , Lung Diseases/etiology , Torsion Abnormality/etiology , Adenocarcinoma/surgery , Aged, 80 and over , Esophageal Neoplasms/surgery , Female , Humans , Lung Diseases/diagnostic imaging , Tomography, X-Ray Computed , Torsion Abnormality/diagnostic imaging , Ventilator WeaningABSTRACT
Elastosis perforans serpiginosa (EPS) é afecçäo rara do tecido elástico, caracterizada por pápulas hiperceratósicas, de etiologia desconhecida, havendo associaçäo com certas doenças geneticamente determinadas, especialmente síndrome de Down, e iatrogenia em alguns casos. Relata-se o caso de um paciente de 10 anos de idade, do sexo masculino, que apresenta elastosis peerforans serpiginosa associada à síndrome de Down
Subject(s)
Humans , Male , Child , Down Syndrome , Skin DiseasesABSTRACT
OBJECTIVE: To demonstrate if daily Multiple Organ Dysfunction scoring could describe outcome groups in septic shock better than daily Acute Physiology and Chronic Health Evaluation (APACHE) II and Organ Failure scores. DESIGN: A prospective cohort study. SETTING: A medical and surgical adult intensive care unit (ICU) at a tertiary referral center. MEASUREMENTS AND MAIN RESULTS: Daily data collection over a 14-month period was performed on 368 ICU patients, 39 of whom developed septic shock while in the ICU. These data were entered into a computer programmed to calculate APACHE II, Organ Failure, and Multiple Organ Dysfunction scores. The admission Multiple Organ Dysfunction scores for nonsurvivors and survivors of septic shock in the ICU was 6.5 +/- 2.7 and 6.6 +/- 2.8 (SD), respectively. These patients deteriorated due to the development of septic shock during their ICU stay resulting in a maximum Multiple Organ Dysfunction score of 12.2 +/- 3.7 in nonsurvivors and 9.4 +/- 2.7 in survivors (p < .05). The difference between the maximum and initial Multiple Organ Dysfunction scores (delta score) was also significantly greater in nonsurvivors than in survivors (5.6 +/- 4.7 vs. 2.8 +/- 3.0) (p < .05). There were no significant differences between the maximum and delta scores in the outcome groups using the APACHE II and Organ Failure scoring systems. These results were mirrored by 2.3 +/- 0.7 and 1.7 +/- 0.5 organ failures in nonsurvivors and survivors, respectively (p < .01). For all 368 patients, the initial and maximum Multiple Organ Dysfunction scores were 3.5 +/- 2.5 and 10.5 +/- 3.6, respectively. CONCLUSION: Maximum and delta Multiple Organ Dysfunction scores mirrored organ dysfunction and could accurately describe the outcome groups, whereas daily APACHE II and Organ Failure scores could not.
Subject(s)
Multiple Organ Failure/etiology , Severity of Illness Index , Shock, Septic/complications , Shock, Septic/diagnosis , APACHE , Adult , Aged , Critical Care , Female , Hospital Mortality , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity , Shock, Septic/classification , Shock, Septic/mortality , Shock, Septic/therapy , Survival Analysis , Treatment OutcomeABSTRACT
Durante o tratamento da hanseníase, o uso da dapsona e da rifampicina pode levar a transtornos cutâneos e hepáticos significativos. Relata-se o caso de paciente leucodérmica, com 12 anos de idade, portadora de hanseníase indeterminada, que desenvolveu eritrodermia, hepatite e colecistite no curso da segunda semana de tratamento com esquema para paucibacilar (600mg/mês de rifampicina e 100mg/dia de dapsona). O quadro foi diagnosticado como síndrome sulfônica
Subject(s)
Humans , Female , Child , Cholecystitis/complications , Dapsone/adverse effects , Dapsone/therapeutic use , Dermatitis, Exfoliative/etiology , Leprosy/drug therapy , Hepatitis/complications , Rifampin/adverse effects , Rifampin/therapeutic use , Drug HypersensitivitySubject(s)
Laryngeal Masks , Tracheostomy/methods , Humans , Intensive Care Units , Treatment OutcomeSubject(s)
Burns/therapy , Intubation, Intratracheal/adverse effects , Tracheostomy , Adult , Contraindications , Critical Care , Hoarseness/etiology , Humans , Male , Time FactorsABSTRACT
Os autores apresentam caso de tétano pós-cirurgico com evoluçäo benigna a atençäo para a possibilidade de, em determinadas situaçöes, este tipo de tétano dever-se à contaminaçäo por fontes diferentes daquelas relacionadas à intrvençäo cirúrgica
Subject(s)
Humans , Male , Adult , Postoperative Complications , Tetanus/etiology , Diazepam/administration & dosage , Diazepam/therapeutic use , Metronidazole/administration & dosage , Metronidazole/therapeutic use , Tetanus/drug therapyABSTRACT
Records of 165 patients who underwent total correction for Tetralogy of Fallot were analysed for early postoperative morbidity and mortality in the Intensive Care Unit. Eighty three patients (50.3%) had one or more pulmonary complications; 18 (10.9%) developed an infection; 10 (6%) developed acute renal failure requiring peritoneal dialysis; 9 (5.5%) required Total Parenteral Nutrition; there was no intraoperative death, but 6 patients (3.5%) died in the Intensive Care Unit, 4 of them aged < = 24 months. Patients aged < = 24 months at surgery (Group I) showed a significant increase in the incidence of pulmonary complications, infection and longer length of ICU stay compared to those aged > 24 months (Group II). Patients with a bypass time > 120 minutes had significantly more pulmonary complications (63.8%), compared to those < = 120 minutes (34.4%); the longer bypass time group had significantly more pulmonary complications (78%) in patients aged < = 24 months at surgery compared to those aged > 24 months (50%).
Subject(s)
Tetralogy of Fallot/surgery , Age Factors , Child , Child, Preschool , Female , Humans , Infant , Male , Morbidity , Retrospective Studies , Saudi Arabia/epidemiology , Tetralogy of Fallot/epidemiology , Tetralogy of Fallot/mortality , Time FactorsABSTRACT
O objetivo deste trabalho foi identificar a influência da orientaçäo pré-operatória na recuperaçäo pós-operatória. O estudo limitou-se a pacientes adultos que se submeteram à gastrictomia por serem portadores de úlcera péptica. Vinte pacientes do grupo experimental, na véspera da cirúrgia, receberam a uma orientaçäo pré-operatória planejada e a vinte pacientes do grupo controle foi omitida a mesma orientaçäo. Os principais dados obtidos demonstraram que o número de complicaçöes pós-operatórias foi menor no grupo experimental do que no grupo controle, assim como foi menor a média dos dias de permanência no hospital após a cirúrgia.
