Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/prevenção & controle , Infecção Hospitalar/prevenção & controle , Unidades de Terapia Intensiva , Antibacterianos/farmacologia , Escherichia coli/efeitos dos fármacos , Humanos , Klebsiella/efeitos dos fármacos , Proteus/efeitos dos fármacos , Pseudomonas/efeitos dos fármacos , Sepse/prevenção & controleRESUMO
118 patients of a non specialized intensive care unit have been studied, all of them under high dose bactericidal cover (10 MIU of Na-Penicillin G and 2,0 Ciclacillin q 12 hrs.) for a period of days to 4 weeks. In 17 (14,4%) a skin rash was observed. 10 of these could be studied using special techniques (radial immunodiffusion, passive hemagglutination, RIST and RAST), however in none of these cases there was a hint of the existence of penicillin specific antibodies. In 6 patients also skin tests were performed. There was no immediate type reaction, only twice delayed type reactions occured to Na Pencillin G.6 patients had continuing treatment on spite of the rash and without further steps the effluorescences vanished within 3-6 days. Therefore continuation of the antibiotic therapy in spite of rash along with strict clinical and laboratory monitoring seems to be preferable to a hastened change of antibiotic regime
Assuntos
Cuidados Críticos , Toxidermias/diagnóstico , Penicilinas/efeitos adversos , Adolescente , Adulto , Idoso , Criança , Complemento C3/análise , Ciclacilina/efeitos adversos , Feminino , Humanos , Hipersensibilidade Tardia , Hipersensibilidade Imediata , Imunoglobulinas/análise , Lactente , Masculino , Pessoa de Meia-Idade , Penicilina G/efeitos adversos , Penicilinas/imunologiaRESUMO
Urinary catecholamine excretion and thyroid hormone blood level were studied in 16 patients following severe cerebral trauma. Increased excretion rates of epinephrine and norepinephrine were found. There was no significant difference in the catecholamine excretion when compared with generally traumatized patients. The relationships between catecholamine excretion, increased metabolic rates, and negative nitrogen balance indicate that in patients with a midbrain syndrome there exists an additional diencephalic metabolic factor, which leads to a rise in fat oxidation and perpetuation of catabolism. Early high caloric parenteral nutrition seems to inhibit the initial increase of catecholamine excretion and thus protects the body from an unnecessary breakdown of its own reserves. If the course is classified according to neurological stages, it can be shown that patients with a traumatic apallic syndrome in poor condition have a high increase of catecholamine excretion. Secretion of thyroid hormones is not influenced significantly by cerebral trauma.
