RESUMO
Umbilical cord blood transplant (UCBT) has emerged as an alternate source of stem cells for transplantation in patients with hematologic malignancies. However, outcomes of adult UCBT patients requiring ICU admission remain unknown. In order to identify predictors of ICU transfer and mortality in UCBT patients, the course and outcome of all adult (> or = 16 years old) patients who underwent UCBT between 1 January 1998 and 31 December 2003 at University Hospitals of Cleveland were analyzed. Forty-four patients underwent UCBT during the study period and 25 (57%) required ICU transfer. Use of a myeloablative preparative regimen was a significant predictor of ICU transfer (P = 0.03). An infusion of higher numbers of nucleated cells was protective from ICU transfer (P = 0.05). For those patients transferred to the ICU, mortality was 72%. The univariate predictors of mortality, at the time of ICU admission were a high APACHE III score (P = 0.0004), use of vasopressors (P = 0.03), and a low platelet count (P = 0.03). We conclude that transfer of UCBT patients to an ICU may be predicted by their preparative regimen, while ICU mortality may be predicted by physiologic parameters upon admission.
Assuntos
Transplante de Células-Tronco de Sangue do Cordão Umbilical/efeitos adversos , Neoplasias Hematológicas/terapia , Unidades de Terapia Intensiva , APACHE , Adolescente , Adulto , Idoso , Transplante de Células-Tronco de Sangue do Cordão Umbilical/mortalidade , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Agonistas Mieloablativos/efeitos adversos , Admissão do Paciente/estatística & dados numéricos , Contagem de Plaquetas , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Trombocitopenia , Transplante Homólogo , Resultado do Tratamento , Vasoconstritores/uso terapêuticoRESUMO
OBJECTIVE. The objective of our study was to evaluate the role of dynamic inspiratory-expiratory imaging with multidetector CT in patients with suspected tracheobronchomalacia. CONCLUSION. Multidetector CT with inspiratory-expiratory imaging is a promising method in the evaluation of patients with dynamic airway collapse. In our study, the degree of dynamic collapse correlated well with bronchoscopic results. Dynamic expiratory multidetector CT may offer a feasible alternative to bronchoscopy in patients with suspected tracheobronchomalacia.
Assuntos
Broncopatias/diagnóstico por imagem , Doenças das Cartilagens/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Doenças da Traqueia/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Broncografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Respiração , Traqueia/diagnóstico por imagemRESUMO
Acute bronchial asthma is a common problem with immense medical and economic impacts. It is estimated that this disease affects 12 to 14 million people in the United States with costs in excess of $6 billion per year. Most of the morbidity and all of the mortality of asthma tends to be associated with acute exacerbations, and treatment of these events accounts for the majority of expenditures in money and health care resources. Unfortunately, the factors that contribute to the destabilization of asthma are rarely studied and much of the pathogenesis and pathobiology of acute asthma remains unknown. This article examines these issues and suggests treatment for acute asthma.