RESUMEN
Vecuronium is a curaric agent, largely used in anesthesia. Indications as to its employ in uremic patients appear to be debated because of partial renal elimination of the drug. A 52-year-old hemodialyzed woman required transplantectomy for rejection. At awakeness after general anesthesia (induced with fentanyl, propofol, and 6 mg of vecuronium, repeated with a single 2 mg dose 30 min later), she presented diafragmatic and muscular limb weakeness that lasted 180 min in spite of prostigmine administration. A 2 h 30 min predilutional hemofiltration was then performed, which induced rapid disappearance of neuromuscular blockade. Even if vecuronium can be used in dialysis patients, one should remember its possible side effects, especially with repeated doses, in determining prolonged neuromuscular blockade. Cautious use of this drug in renal failure is mandatory. Low dosage must be employed and repeated administration avoided. Neuromuscular blockade seems to be rapidly reversible with dialytic treatment.
Asunto(s)
Debilidad Muscular/terapia , Fármacos Neuromusculares no Despolarizantes/efectos adversos , Diálisis Renal , Bromuro de Vecuronio/efectos adversos , Inhibidores de la Colinesterasa/uso terapéutico , Femenino , Rechazo de Injerto/cirugía , Humanos , Trasplante de Riñón , Persona de Mediana Edad , Debilidad Muscular/inducido químicamente , Neostigmina/uso terapéutico , Fármacos Neuromusculares no Despolarizantes/administración & dosificación , Respiración Artificial , Parálisis Respiratoria/inducido químicamente , Parálisis Respiratoria/terapia , Bromuro de Vecuronio/administración & dosificaciónRESUMEN
A case of severe accidental hypothermia (core temperature 20 degrees C) in an elderly woman successfully treated by warmed lavage of peritoneal cavity is reported. The various available rewarming techniques and some observations about the differential diagnosis between the severe hypothermic patient with cardiac arrest and the hypothermic dead person are briefly reviewed on the basis of current literature.
Asunto(s)
Hipotermia/terapia , Lavado Peritoneal , Recalentamiento/métodos , Anciano , Anciano de 80 o más Años , Temperatura Corporal/fisiología , Femenino , Hemodinámica/fisiología , Humanos , Hipotermia/fisiopatologíaRESUMEN
A 57-year old male uremic patient developed a sudden cardiac arrest due to severe hyperkalemia. The cardiac arrest lasted 135 minutes and was initially unresponsive to conventional therapy. It was successfully treated by prolonged external cardiac massage, assisted ventilation and double simultaneous arteriovenous hemodialysis to rapidly decrease the high potassium level.
Asunto(s)
Reanimación Cardiopulmonar , Paro Cardíaco/terapia , Hiperpotasemia/complicaciones , Diálisis Renal/métodos , Paro Cardíaco/etiología , Humanos , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
The authors report a life-threatening, acute asthmatic attack in a young man, which was followed by rhabdomyolysis and acute myoglobinuria. A discussion of the possible rôle of the pharmacological treatment of asthma in initiating muscle damage is included, based on a review of the current literature.
Asunto(s)
Asma/complicaciones , Rabdomiólisis/etiología , Enfermedad Aguda , Adulto , Aminofilina/efectos adversos , Humanos , Masculino , Terbutalina/efectos adversosRESUMEN
The treatment of traumatic ruptures of the duodenum is one of the greatest controversies in surgery. The injury mechanisms, diagnostic criteria and factors underlying the prognosis are analysed and indications suggested for the various types of intervention. The problem relating to the operating technique are specified.
Asunto(s)
Duodeno/lesiones , Duodeno/cirugía , Humanos , Rotura , Procedimientos Quirúrgicos Operativos/métodos , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/cirugíaRESUMEN
The results of surgery in 5 cases of traumatic rupture of the duodenum are presented. The site of the laceration, the time between trauma and operation, associated lesions, diagnostic routine and type of operation are specified. The mortality encountered (40%) should be related to the seriousness of the lesions.
Asunto(s)
Duodeno/lesiones , Duodeno/cirugía , Adolescente , Adulto , Humanos , Masculino , Persona de Mediana Edad , RoturaRESUMEN
Seventeen cases of segmental portal hypertension due to splenic vein thrombosis are reported. This syndrome may be asymptomatic for a long time and then present suddenly in the form of a serious picture of high digestive haemorrhage due to rupture of gastric fundus varices as a result of hypertrophied submucous collateral drainage circulation. Useful for diagnosis are oesophagogastroduodenoscopy, which points to stomach varices, and splenoportography or splenic artery angiography with venous phase, which highlight pathognomonic dilatation and tortuosity of the gastroepiploic veins. Surgical exploration typically shows: presence of large epiploic vessels, splenomegaly, absence of changes in the liver and in the portal and mesenteric circulation. Curative treatment of choice is splenectomy.
Asunto(s)
Hipertensión Portal/etiología , Vena Esplénica , Trombosis/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Hipertensión Portal/diagnóstico , Hipertensión Portal/cirugía , Masculino , Persona de Mediana Edad , Esplenectomía , Trombosis/diagnósticoRESUMEN
1,354 deaths due to traumatic causes arising in 1976-1985 among patients admitted to the Molinette Hospital, Turin were analysed. The causes were divided into 5 major groups with to monitoring the course of the pathologies concerned over time. The results confirm an increase in deaths from septic shock that reflects increased recourse to surgery and the application of resuscitation manoeuvres and equipment, but a decrease in death due to haemorrhagic shock. These two pathologies represent the major lines for future research aimed at improving the prognosis in traumatic lesions.
Asunto(s)
Heridas y Lesiones/patología , Adulto , Autopsia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Heridas y Lesiones/mortalidadAsunto(s)
Infecciones Bacterianas/etiología , Transfusión de Sangre Autóloga/efectos adversos , Infección Hospitalaria/etiología , Adolescente , Adulto , Anciano , Bacterias/aislamiento & purificación , Transfusión de Sangre Autóloga/instrumentación , Contaminación de Equipos , Femenino , Humanos , Cuidados Intraoperatorios , Masculino , Persona de Mediana Edad , Factores de RiesgoAsunto(s)
Diagnóstico por Computador , Traumatismo Múltiple/cirugía , Terapia Asistida por Computador , Cuidados Críticos , Urgencias Médicas , Corazón/fisiología , Humanos , Pulmón/fisiología , Monitoreo Fisiológico , Traumatismo Múltiple/fisiopatología , Pronóstico , Pruebas de Función RespiratoriaRESUMEN
We have examined the aneurysmal dilatations in the wall of abdominal aorta after microsurgical experimental operation of end-to-end anastomosis. We observed this alteration both by macroscopic examination and by optical light microscopy. The wall presents various damages, particularly in the media, that seems thick, disarranged and often necrotic.