RESUMO
Venous thrombosis of the upper extremities is becoming increasingly prevalent in the intensive care unit as a result of chronic in-dwelling central venous catheters. We report two rare cases in which combined transoesophageal echocardiography and vascular ultrasound examination aided in the identification of catheter-related thrombosis in two patients suffering from splenectomy-induced thrombocytosis and antiphospholipid syndrome respectively.
Assuntos
Síndrome Antifosfolipídica/complicações , Cateterismo Venoso Central/efeitos adversos , Ecocardiografia Transesofagiana/métodos , Esplenectomia/efeitos adversos , Trombose Venosa Profunda de Membros Superiores/diagnóstico por imagem , Adulto , Humanos , Unidades de Terapia Intensiva , MasculinoAssuntos
Ecocardiografia Transesofagiana/métodos , Hematoma/diagnóstico por imagem , Esplenopatias/diagnóstico por imagem , Adulto , Hematoma/etiologia , Humanos , Unidades de Terapia Intensiva , Masculino , Esplenopatias/etiologia , Ruptura Esplênica/complicações , Ruptura Esplênica/diagnóstico por imagemAssuntos
Anestesia/métodos , Cuidados Críticos/métodos , Veia Femoral/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Doenças Linfáticas/diagnóstico , Bloqueio Nervoso/métodos , Adulto , Cateterismo Venoso Central/métodos , Feminino , Humanos , Achados Incidentais , Masculino , Ultrassonografia Doppler/métodosAssuntos
Aorta Torácica/diagnóstico por imagem , Aorta Torácica/lesões , Esôfago/diagnóstico por imagem , Unidades de Terapia Intensiva , Stents , Ferimentos e Lesões/diagnóstico por imagem , Ferimentos e Lesões/cirurgia , Adulto , Humanos , Masculino , Procedimentos de Cirurgia Plástica , UltrassonografiaAssuntos
Cateterismo Cardíaco/efeitos adversos , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/etiologia , Filtros de Veia Cava , Adulto , Cuidados Críticos , Feminino , Escala de Coma de Glasgow , Traumatismos Cranianos Fechados/complicações , Humanos , Monitorização Fisiológica , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/diagnóstico por imagem , Síndrome da Veia Cava Superior/terapia , UltrassonografiaAssuntos
Anestesia Intravenosa/efeitos adversos , Traumatismos Craniocerebrais/complicações , Hipnóticos e Sedativos/efeitos adversos , Propofol/efeitos adversos , Adulto , Traumatismos Craniocerebrais/cirurgia , Feminino , Testes Genéticos/normas , Hemofiltração/métodos , Humanos , Hipnóticos e Sedativos/administração & dosagem , Propofol/administração & dosagem , SíndromeRESUMO
OBJECTIVE: We investigated whether alterations in the optic nerve diameter (OND) correlated with brain computed tomography (CT) imaging results among patients with brain injury and whether monitoring of OND could predict brain death. PATIENTS AND METHODS: We enrolled 54 patients with brain injury (Glasgow Coma Scale < 8) and 53 controls. OND measurements were performed 3 mm posterior to the papillae by means of transorbital sonography. The severity of the injury was classified according to a semiquantitative CT neuroimaging scale (1 to 4). All patients underwent 3 repeated evaluations of OND combined with synchronous CT scans. RESULTS: Twenty-two patients progressed to brain death, while 32 patients showed gradual clinical improvement. Upon admission, the patients showed significantly increased OND (4.84 +/- 1.2 mm) compared with the controls (3.49 +/- 1.1 mm; P < .001). The median intraobserver variation of OND was 0.2 mm (95% confidence intervals [CI]: 0.1-0.7). The median interobserver variation of OND was 0.3 mm (95% CI: 0.1-0.9). Alterations in the OND were significantly correlated with the neuroimaging scale on 3 repeated evaluations: r = .65, r = .70, and r = .73 (all P < .001). An OND greater than 5.9 mm (specificity = 65% and sensitivity = 74%; P < .01) and a 2.5 mm increased OND between repeated measurements (specificity = 70% and sensitivity = 81%; P < .01) were associated with a poor prognosis. CONCLUSIONS: Alterations in OND strongly correlated with neuroimaging results among patients with brain injury. However, monitoring of OND exhibited a low predictive value for brain death.
Assuntos
Lesões Encefálicas/diagnóstico por imagem , Nervo Óptico/anatomia & histologia , APACHE , Adulto , Morte Encefálica/diagnóstico por imagem , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Lesões Encefálicas/mortalidade , Progressão da Doença , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Variações Dependentes do Observador , Traumatismos do Nervo Óptico/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia/métodosRESUMO
OBJECTIVE: Cerebral blood flow tests have increasingly been advocated for the confirmation of brain death (BD). Angiography has been considered the gold standard in the diagnosis of BD but is invasive. We validated transcranial color Doppler ultrasonography (TCD) to confirm BD by comparing it to angiography. PATIENTS AND METHODS: Forty patients experienced the clinical diagnosis of brain death due to head injury in 19 cases (47.5%), cerebral hemorrhage in 11 (27.5%), subarachnoid hemorrhage in 7 (17.5%), and cerebral infarction in 3 (7.5%). Blood pressure, heart rate, SPO2, and PCO2 were monitored throughout the study. Patients were excluded if episodes of hypoxia, arrhythmia, and hypotension occurred during examinations, or if the TCD was not technically feasible. RESULTS: Both angiography and TCD confirmed BD in all patients. The agreement between the above methods to confirm BD was 100%. Angiography showed the absence of filling of intracranial arteries, while TCD revealed: (1) brief systolic forward flow or systolic spikes and diastolic reversed flow (50%); (2) brief systolic forward flow or systolic spikes and no diastolic flow (25%); (3) no demonstrable flow in a patient in whom flow had been clearly documented on a previous TCD examination (12.5%). Five patients required repeated TCD examinations, because of initial detection of a diastolic to-and-fro flow pattern. BD was confirmed by TCD in the above patients after 30 hours of clinical BD. CONCLUSION: TCD was a sensitive tool to diagnose BD, affording a reliable alternative examination to standard angiography.
Assuntos
Morte Encefálica/diagnóstico por imagem , Adulto , Angiografia , Morte Encefálica/diagnóstico , Hemorragia Cerebral , Infarto Cerebral , Traumatismos Craniocerebrais , Escala de Coma de Glasgow , Humanos , Pessoa de Meia-Idade , Seleção de Pacientes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Hemorragia Subaracnóidea , Ultrassonografia Doppler TranscranianaRESUMO
Traumatic tricuspid insufficiency, a rare complication of blunt chest trauma, has been reported with increasing frequency during the last 40 years. Automobile accidents are the leading cause of traumatic tricuspid valve regurgitation. The most frequently reported injury is chordal rupture, followed by rupture of the anterior papillary muscle and leaflet tear, primarily of the anterior leaflet. In the acute phase of the injury, the traumatic lesion may go undetected. In the chronic phase many patients remain asymptomatic and others exhibit symptoms and signs of moderate to severe right heart failure. Clinically overt right heart failure has been the traditional indication for surgery, which usually consisted of tricuspid valve replacement. More recently, a more aggressive strategy, with surgical repair of the valve performed before deterioration of the right ventricular function occurs, has been advocated.
Assuntos
Acidentes de Trânsito , Insuficiência da Valva Tricúspide/etiologia , Ferimentos não Penetrantes/etiologia , Adulto , Humanos , Masculino , Resultado do Tratamento , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/cirurgia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgiaAssuntos
Infecções Bacterianas/tratamento farmacológico , Cefotetan/uso terapêutico , Clindamicina/uso terapêutico , Doenças dos Genitais Femininos/tratamento farmacológico , Doenças dos Genitais Femininos/microbiologia , Netilmicina/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Cefotetan/administração & dosagem , Clindamicina/administração & dosagem , Ensaios Clínicos como Assunto , Quimioterapia Combinada , Feminino , Humanos , Infusões Intravenosas , Netilmicina/administração & dosagem , Resultado do TratamentoRESUMO
In a prospective randomised study 60 patients with gynaecological or intra-abdominal infections were given either 2g iv every 12 hours of cefotetan or a combination of netilmicin (150mg iv every 12 hours) and clindamycin (600mg iv every 8 hours). The clinical condition of nearly half the patients (26 of 60) was characterized as serious and surgical manipulation and drainage were performed in 57 of the 60 patients. The clinical response was similar in both groups with 21 of 29 patients in the cefotetan group and 29 of 33 patients in the netilmicin plus clindamycin group. Side effects were few and mild in nature with no significant differences between the two groups. This work is continuing but the results to date suggest that cefotetan monotherapy is a safe and effective alternative to a combination of netilmicin and clindamycin in the treatment of gynaecological and intra-abdominal infections.