RESUMEN
A 26-y-old patient with end-stage renal disease and recent dual transplantation of cadaveric kidneys en bloc presented with increasing abdominal pain and a rising level of serum creatinine. An anterior-view (99m)Tc-mercaptoacetyltriglycine renogram demonstrated the typical overlap of the lower pole of the superior kidney and the upper pole of the inferior kidney. The renogram was consistent with vasomotor nephropathy. Subsequent imaging 1 wk later for worsening symptoms demonstrated a single reniform structure in the expected location of the inferior transplanted kidney, which was interpreted as a loss of perfusion to the superior kidney. Correlation with subsequent CT and sonography showed normal perfusion to both transplanted kidneys and that the superior kidney had wandered inferiorly, completely overlapping the inferior kidney on the anterior projection. The increasing prevalence of dual kidney transplantation warrants special attention to the potential for a wandering kidney.
Asunto(s)
Interpretación de Imagen Asistida por Computador , Trasplante de Riñón , Riñón/diagnóstico por imagen , Riñón/fisiología , Movimiento , Adulto , Humanos , Fallo Renal Crónico/diagnóstico por imagen , Fallo Renal Crónico/cirugía , Trasplante de Riñón/efectos adversos , Renografía por Radioisótopo , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: The deleterious effects of positive pressure ventilation may be prevented by substituting passive oxygen insufflation during advanced cardiac life support (ACLS) cardiopulmonary resuscitation (CPR). METHODS: We compared 24-h neurologically normal survival among three different ventilation scenarios for ACLS in a realistic swine model of out-of-hospital prolonged ventricular fibrillation (VF) cardiac arrest. No bystander CPR was provided during the first 8 min of untreated VF before the simulated arrival of an emergency medical system (EMS). Thirty-six swine were randomly assigned to one of three experimental groups. Group I (standard ventilation) was mechanically ventilated at 10 respirations per minute (RPM) at a tidal volume (TV) of 10 ml/kg with 100% oxygen. Group II (hyperventilation) was ventilated at 35 RPM at a TV of 20 ml/kg with 100% oxygen. In Group III (insufflation) animals, a nasal cannula was placed in the oropharynx to administer oxygen continuously at 10 l/min. RESULTS: There was no significant difference in the 24h neurologically normal survival among groups (standard: 2/12, hyperventilation: 2/12, insufflation: 4/12; p=.53). CONCLUSIONS: Passive insufflation may be an acceptable alternative to the currently recommended positive pressure ventilation during resuscitation efforts for out-of-hospital VF cardiac arrest. Potential advantages of this technique include: (1) easier to teach, (2) easier to administer, (3) prevention of the adverse effects of positive pressure ventilation and (4) allows EMS personnel to concentrate upon other critically important duties.
Asunto(s)
Reanimación Cardiopulmonar/métodos , Terapia por Inhalación de Oxígeno/métodos , Respiración con Presión Positiva , Fibrilación Ventricular/terapia , Animales , Distribución de Chi-Cuadrado , Modelos Animales de Enfermedad , Femenino , Curva ROC , Distribución Aleatoria , Tasa de Supervivencia , Porcinos , Volumen de Ventilación Pulmonar , Fibrilación Ventricular/fisiopatologíaRESUMEN
Green tea and green tea catechins have been shown to possess potent cancer-preventive activities in rodent cancer models. At present, epidemiological evidence of the protective effect of green tea consumption against the development of human cancers is not conclusive. Oral bioavailability of green tea catechins has been shown to be low in animals and possibly in humans. This study is designed to determine the contribution of first-pass hepatic elimination to the low oral bioavailability of green tea catechins. Green tea catechin mixture was dosed to rats by intravenous or intraportal infusion. Blood samples were collected after dosing and analyzed using high-performance liquid chromatography with the coulometric electrode array detection system. The systemic clearance of epigallocatechin gallate (EGCG), epigallocatechin (EGC), and epicatechin (EC) was 8.9, 6.3, and 9.4 ml/min, respectively. The steady state volume of distribution (V(ss)) of EGCG, EGC, and EC was 432, 220, and 187 ml, respectively. We found that high percentage of green tea catechins escaped first-pass hepatic elimination, with 87.0, 108.3, and 94.9% of EGCG, EGC, and EC, respectively, available in the systemic blood following intraportal infusion. Our results suggest that factors within the gastrointestinal tract such as limited membrane permeability, transporter mediated intestinal secretion, or gut wall metabolism may contribute more significantly to the low oral bioavailability of green tea catechins.