RESUMO
This study aims to investigate if histamine induces electrochemical alterations in the normal and post-traumatic peritoneum. Peritoneal rabbit specimens were obtained before surgery and 10 days post-operatively and were mounted in Ussing chambers. Histamine solutions were added facing the intra-peritoneal and outer-peritoneal surface. Dimetindene maleate-, cetirizine-, and ranitidine-pretreated specimens were used to investigate histamine receptor involvement, whereas amiloride- and ouabain-pretreated specimens were used to investigate ion transportation blockage involvement. Trans-mesothelial resistance (R(TM)) was determined. Histamine-increased R(TM) intra-peritoneally and decreased it outer-peritoneally. A less intense effect was induced in post-traumatic specimens. Dimetindene maleate, cetirizine, amiloride, and ouabain totally inhibited this effect, whereas ranitidine only had a partial effect. Histamine induces electrochemical alterations in the normal and post-operative peritoneum. This effect is mediated by interaction with histamine receptors, hindering the normal process of ion trans-mesothelial transportation.
Assuntos
Deslocamentos de Líquidos Corporais/efeitos dos fármacos , Histamina/farmacologia , Peritônio/efeitos dos fármacos , Animais , Relação Dose-Resposta a Droga , Impedância Elétrica , Feminino , Antagonistas dos Receptores Histamínicos/farmacologia , Transporte de Íons , Peritônio/metabolismo , Peritônio/cirurgia , Permeabilidade , Coelhos , Receptores Histamínicos/efeitos dos fármacos , Receptores Histamínicos/metabolismo , Fatores de TempoRESUMO
Blunt diaphragmatic injuries are usually caused by blunt trauma or penetrating injuries. The diagnosis may be delayed or missed because of the confusing clinical and radiographic findings and the presence of multiple associated injuries. We report the case of an isolated right diaphragm rupture in a 56-year-old man who sustained blunt thoracic trauma after car accident 2 weeks before presentation. No other injuries were detected, and he was subjected to laparotomy. Diaphragmatic rupture is perceived as an emergency entity. The late appearance of such an injury, without other accompanying injuries, is rare and should be in mind by clinicians treating trauma patients who have a delayed presentation after the injury.
Assuntos
Acidentes de Trânsito , Hérnia Diafragmática Traumática/etiologia , Traumatismos Torácicos/etiologia , Ferimentos não Penetrantes/etiologia , Diagnóstico Tardio , Hérnia Diafragmática Traumática/diagnóstico , Hérnia Diafragmática Traumática/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgiaRESUMO
Jejunal perforation is extremely rare in trauma especially without initial involvement of the abdomen. We present the case of a delayed jejunal perforation after thoracic trauma with no initial indication of abdominal trauma in a 55-year-old man who was admitted to our department after a road traffic accident. The patient sustained thoracic trauma with rib fractures of the left hemithorax and hemopneumothorax and a mild head injury. On the fourth day of his in-hospital stay, he complained of severe abdominal pain and signs of acute abdomen were observed. He underwent emergency laparotomy where a perforation of the jejunum near the ligament of Treitz was noticed and sutured. His postoperative recovery was uneventful. Physicians treating trauma should always have a high degree of suspicion regarding rare abdominal injuries, with delayed presentation, even if no abdominal involvement is noticed during the initial survey.
