RESUMO
Inguinal and scrotal Wilms' tumors are extremely rare; only 15 cases have been reported to date. The authors report a case of inguinal Wilms' tumor (stage III), which occurred in a previously healthy 3 1/2-year-old boy who was staged and treated according to currently accepted National Wilms' Tumor Study III criteria. The exact embryological origin of this tumor has not been determined. However, there is evidence that the origin is more primitive than that of intrarenal Wilms' tumor.
Assuntos
Neoplasias Abdominais/patologia , Canal Inguinal/patologia , Tumor de Wilms/patologia , Neoplasias Abdominais/terapia , Pré-Escolar , Terapia Combinada , Criptorquidismo/patologia , Seguimentos , Hérnia Inguinal/patologia , Humanos , Masculino , Estadiamento de Neoplasias , Tumor de Wilms/embriologia , Tumor de Wilms/terapiaRESUMO
The most virulent pneumococcal serotype (type 3) has not to date been associated with multiple antimicrobial resistance. We report an unusual gastrointestinal presentation of fatal septicemia caused by a multiply resistant type 3 pneumococcus in a setting of increasing prevalence of multiple resistance, including resistance to erythromycin, clindamycin, and tetracycline.
Assuntos
Gastroenterite/microbiologia , Infecções Pneumocócicas/microbiologia , Sepse/microbiologia , Streptococcus pneumoniae/efeitos dos fármacos , Adolescente , Clindamicina/farmacologia , Resistência Microbiana a Medicamentos , Eritromicina/farmacologia , Humanos , Masculino , Penicilinas/farmacologia , Tetraciclina/farmacologia , Resistência a TetraciclinaRESUMO
Although there has been a proliferation of catheter related infection literature there is still little consensus regarding infection statistics and optimal catheter management techniques. This paper analyses the various factors that have contributed to these inconsistencies and thereby attempts to provide a standardised framework for future research and communication on the subject. An attempt has also been made from available data to provide management guidelines that are practicable in the intensive care environment.
Assuntos
Infecções Bacterianas/etiologia , Cateterismo/efeitos adversos , Cateterismo/normas , Humanos , Fatores de RiscoRESUMO
We studied the use of continuous iv magnesium (Mg) infusion to control the sympathetic crises in a patient with severe tetanus characterized by pronounced autonomic nervous system instability. Our results suggested that Mg is a useful adjunct to the CNS depressants traditionally used. This therapy controlled the sympathetic crises and also suppressed the release of catecholamines, although Mg infusions alone appeared to be inadequate therapy.
Assuntos
Sulfato de Magnésio/uso terapêutico , Tétano/tratamento farmacológico , Adulto , Pressão Sanguínea , Diazepam/uso terapêutico , Epinefrina/sangue , Humanos , Infusões Intravenosas , Masculino , Norepinefrina/sangue , Tétano/fisiopatologiaRESUMO
The type of poisoning which inhibits acetylcholinesterase (AChE) most often encountered in an intensive care unit is that of organophosphates (OP). Carbamates also inhibit AChE but for a much shorter duration and they do not cause the same degree of central nervous system effects as OP. A case of carbamate poisoning is described, in which the pharmacological differences between carbamates and OP are stressed. The therapeutic and diagnostic differences between the two are also discussed.
Assuntos
Aldicarb/intoxicação , Inseticidas/intoxicação , Compostos Organofosforados , Adulto , Feminino , Humanos , Tentativa de SuicídioRESUMO
In order to identify potential problems and thereby minimise the risk of invasive vascular catheterisation, we conducted an analysis of these procedures in our medical intensive care unit with the aid of a computer database. During the 9-month study period 114 patients underwent 247 invasive vascular catheterisations, including pulmonary arterial (PA), central venous (CV) and arterial catheter insertions. Complications unique to PA catheterisation included burst catheter balloons (6%) and one serious episode of arrhythmia. The incidence of pneumothorax (2.8%) and inadvertent arterial puncture (2.2%) with PA and CV lines and our sepsis rate of 3.6% for all types of catheters are consistent with other studies. Arterial catheterisation proved to be relatively free of complications. Our study confirmed the safety of invasive vascular catheterisation. However, we review the precautions needed to limit potential complications.
Assuntos
Cateterismo/efeitos adversos , Cuidados Críticos/métodos , Artérias/cirurgia , Feminino , Humanos , Masculino , Monitorização Fisiológica/efeitos adversos , Complicações Pós-Operatórias , Artéria Pulmonar/cirurgia , Veias/cirurgiaRESUMO
Two patients admitted to the medical intensive care unit with subarachnoid haemorrhage, one with the provisional diagnosis of 'sick sinus syndrome' the other as having an acute myocardial infarction complicated by ventricular tachycardia, are described and the arrhythmias associated with this condition are reviewed.
Assuntos
Hemorragia Subaracnóidea/diagnóstico , Adulto , Idoso , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Humanos , Hipotálamo/fisiopatologia , Masculino , Infarto do Miocárdio/diagnóstico , Síndrome do Nó Sinusal/diagnóstico , Hemorragia Subaracnóidea/líquido cefalorraquidianoRESUMO
Oxygen tensions of 50 simultaneously withdrawn blood samples from the right atrial orifice of a triple-lumen pulmonary artery catheter and from the pulmonary artery lumen were compared. Mixed venous oxygen tensions ranged from 21 mmHg to 44.9 mmHg. The correlation coefficient was 0.96 (t = 2.09; P = 0.01). The benefits and drawbacks of intermittent right atrial oxygen tension monitoring are discussed.
Assuntos
Oxigênio/sangue , Cateterismo Cardíaco , Átrios do Coração , Humanos , Pressão Parcial , Artéria PulmonarRESUMO
Long-term (greater than 48 h) sodium nitroprusside (SNP) infusion significantly reduced cobalamin (vitamin B12) levels in 23 patients treated in a CCU after myocardial infarction. There was no evidence of vitamin B12 deficiency or SNP toxicity. Low vitamin B12 levels should not limit the use of SNP, because prolonged infusion of SNP at maximum doses of 2.5 micrograms/kg X min did not adversely affect hemodynamic stability.