RESUMO
Preoperative fasting is a currently adopted measure since Mendelson's report pertaining to aspiration pneumonia as a cause of death following general anesthesia. From a metabolic point of view fasting is detrimental because surgery in itself causes a state of hypercatabolism and hyperglycemia as a result of insulinresistance. Preoperative fasting has become almost obsolete in certain elective surgical procedures. In these cases the use of clear liquids is now well established and this paper focuses on the safe use of clear fluids, postoperative insulinresistance, patient comfort and postoperative outcome as well as its effect on the length of stay.
Assuntos
Carboidratos da Dieta/administração & dosagem , Jejum , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Procedimentos Cirúrgicos Eletivos , Jejum/efeitos adversos , Humanos , Resistência à Insulina , Pneumonia Aspirativa/prevenção & controle , Aspiração Respiratória/prevenção & controleAssuntos
Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Intestinos/irrigação sanguínea , Isquemia/diagnóstico por imagem , Artérias Mesentéricas/diagnóstico por imagem , Oclusão Vascular Mesentérica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Feminino , Humanos , Pessoa de Meia-Idade , Sensibilidade e EspecificidadeRESUMO
Computed tomography (CT) plays a major role as the initial diagnostic tool in adult blunt abdominal trauma. Indications of CT are hemodynamical instability, abdominal defense and high-speed deceleration. We present the case of a 22 year-old man involved in a motor-vehicle accident admitted in our emergency department with headache but without clinical signs of intraabdominal trauma. The abdominal CT was asked because of the high-speed deceleration and because the patient had to come to the CT room for a head CT. The abdominal multislice helical CT performed with contrast bolus injection showed a massive intraperitoneal extravasation from a hepatic laceration and avulsion. The patient died during operation despite immediate management of the abdominal traumatic lesions detected by CT.
Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Extravasamento de Materiais Terapêuticos e Diagnósticos , Hemoperitônio/diagnóstico por imagem , Artéria Hepática/lesões , Fígado/lesões , Acidentes de Trânsito , Adulto , Meios de Contraste , Evolução Fatal , Artéria Hepática/diagnóstico por imagem , Humanos , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Masculino , Ruptura/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
We report on a patient with febrile illness, right unilateral paratracheal widening, pulmonary infiltrates, pleural effusions, exanthema and diarrhea. The right paratracheal widening was due to lymph node enlargement confirmed by CT scan. Symptoms disappeared subsequently without specific treatment. On the basis of serological tests, we are able to diagnose a coxsackie B3 virus infection. No previous case report of unilateral mediastinal nodal enlargement contemporary to a coxsackie B3 virus infection was found in our review of the literature.
