RESUMEN
The goal of the present study was to compare pulmonary function test (PFT) and cardiopulmonary exercise test (CPET) performance in COVID-19 survivors with a control group (CG). This was a cross-sectional study. Patients diagnosed with COVID-19, without severe signs and symptoms, were evaluated one month after the infection. Healthy volunteers matched for sex and age constituted the control group. All volunteers underwent the following assessments: i) clinical evaluation, ii) PTF; and iii) CPET on a cycle ergometer. Metabolic variables were measured by the CareFusion Oxycon Mobile device. In addition, heart rate responses, peak systolic and diastolic blood pressure, and perceived exertion were recorded. Twenty-nine patients with COVID-19 and 18 healthy control subjects were evaluated. Surviving patients of COVID-19 had a mean age of 40 years and had higher body mass index and persistent symptoms compared to the CG (P<0.05), but patients with COVID-19 had more comorbidities, number of medications, and greater impairment of lung function (P<0.05). Regarding CPET, patients surviving COVID-19 had reduced peak workload, oxygen uptake (VÌO2), carbon dioxide output (VÌCO2), circulatory power (CP), and end-tidal pressure for carbon dioxide (PETCO2) (P<0.05). Additionally, survivors had depressed chronotropic and ventilatory responses, low peak oxygen saturation, and greater muscle fatigue (P<0.05) compared to CG. Despite not showing signs and symptoms of severe disease during infection, adult survivors had losses of lung function and cardiorespiratory capacity one month after recovery from COVID-19. In addition, cardiovascular, ventilatory, and lower limb fatigue responses were the main exercise limitations.
Asunto(s)
COVID-19 , Capacidad Cardiovascular , Adulto , Dióxido de Carbono/metabolismo , Estudios Transversales , Prueba de Esfuerzo , Tolerancia al Ejercicio/fisiología , Humanos , Persona de Mediana Edad , Consumo de Oxígeno/fisiologíaRESUMEN
The goal of the present study was to compare pulmonary function test (PFT) and cardiopulmonary exercise test (CPET) performance in COVID-19 survivors with a control group (CG). This was a cross-sectional study. Patients diagnosed with COVID-19, without severe signs and symptoms, were evaluated one month after the infection. Healthy volunteers matched for sex and age constituted the control group. All volunteers underwent the following assessments: i) clinical evaluation, ii) PTF; and iii) CPET on a cycle ergometer. Metabolic variables were measured by the CareFusion Oxycon Mobile device. In addition, heart rate responses, peak systolic and diastolic blood pressure, and perceived exertion were recorded. Twenty-nine patients with COVID-19 and 18 healthy control subjects were evaluated. Surviving patients of COVID-19 had a mean age of 40 years and had higher body mass index and persistent symptoms compared to the CG (P<0.05), but patients with COVID-19 had more comorbidities, number of medications, and greater impairment of lung function (P<0.05). Regarding CPET, patients surviving COVID-19 had reduced peak workload, oxygen uptake (V̇O2), carbon dioxide output (V̇CO2), circulatory power (CP), and end-tidal pressure for carbon dioxide (PETCO2) (P<0.05). Additionally, survivors had depressed chronotropic and ventilatory responses, low peak oxygen saturation, and greater muscle fatigue (P<0.05) compared to CG. Despite not showing signs and symptoms of severe disease during infection, adult survivors had losses of lung function and cardiorespiratory capacity one month after recovery from COVID-19. In addition, cardiovascular, ventilatory, and lower limb fatigue responses were the main exercise limitations.
RESUMEN
This study examined the features of 16 complications from 51 distraction lengthenings in the hands of 43 patients. From 1996 to 2006, 24 metacarpals and 27 phalanges were lengthened at a rate of 0.5 and 0.25 mm/day, respectively, using a callus distraction technique. The indications were congenital (33 cases in 27 patients) and traumatic (18 cases in 16 patients) deformities. The average percentage lengthening in the phalanges and metacarpals was 62% (16 mm) and 63% (34 mm), respectively. The distraction rates in the phalanges and metacarpals were 69 and 52 days/cm, respectively. The overall complication rate was 31%. Major complications requiring secondary procedures were non-union (one case), fracture (one case), premature union (one case), angulations (two cases) and dislodgment of pins (two cases). The minor complications encountered were delayed callus formation (four cases), joint stiffness (four cases) and soft tissue thinning (one case). Traumatic deformities had more complications than the congenital ones (nine of 18 cases and seven of 33 cases, respectively). The phalanges had a higher rate of complication than the metacarpals (11 of 27 cases and four of 24 cases, respectively). Most patients with complications except for two children with dislodgment were as satisfied with the final results as those without complications. Although callus distraction in the hand requires a long treatment period and has a relatively high rate of complication, it appears to be effective in achieving adequate bone length. A high level of patient compliance and prompt management of complications by an experienced surgeon are essential for achieving good results.
Asunto(s)
Fijadores Externos/efectos adversos , Falanges de los Dedos de la Mano/cirugía , Deformidades Adquiridas de la Mano/cirugía , Deformidades Congénitas de la Mano/cirugía , Huesos del Metacarpo/cirugía , Osteogénesis por Distracción/efectos adversos , Adolescente , Adulto , Niño , Preescolar , Estudios de Cohortes , Femenino , Deformidades Adquiridas de la Mano/diagnóstico , Deformidades Adquiridas de la Mano/etiología , Deformidades Congénitas de la Mano/diagnóstico por imagen , Deformidades Congénitas de la Mano/patología , Humanos , Masculino , Osteogénesis por Distracción/instrumentación , Radiografía , Reoperación , Estudios Retrospectivos , Insuficiencia del TratamientoRESUMEN
The sensation of a foreign body in the throat when swallowing is a common and very discomforting symptom for those who experience it. Common causes are gastroesophageal reflux disease and possibly upper oesophageal dysmotility. This complaint may be dismissed as psychogenic when a cause for the problem is not readily apparent. We present two cases in which the patient had a foreign body sensation in the throat, associated with a dry swallow. The most helpful diagnostic procedure was careful examination of the hypopharynx and neck and flexible fibre-optic rhinolaryngoscopy. One case was treated with surgery of the neck and larynx to trim the medially projecting superior cornu of the thyroid cartilage. Surgery was successful in eliminating the symptoms. Although an uncommon finding, our experience is that symptoms due to a medially displaced thyroid cornu should be considered in the differential diagnosis as an important and surgically correctable cause of persistent foreign body sensation at the hyoid level in the neck.
Asunto(s)
Cuerpos Extraños/diagnóstico , Enfermedades de la Laringe/diagnóstico , Cartílago Tiroides , Trastornos de Deglución/etiología , Trastornos de Deglución/cirugía , Diagnóstico Diferencial , Esofagoscopía , Humanos , Enfermedades de la Laringe/cirugía , Masculino , Persona de Mediana Edad , Cartílago Tiroides/cirugía , Resultado del TratamientoRESUMEN
OBJECTIVE: To compare the efficacy of 5% NaHCO3, 3% H2O2, Sofradex (dexamethasone sodium metasulphobenzoate 0.05%, framycetin sulphate 0.5%, gramicidin 0.005%), 0.33% acetic acid and 0.9% NaCl eardrops in clearing grommets blocked with harvested thick middle ear effusion fluid. STUDY DESIGN: A blinded in-vitro study. SETTING: District general hospital. PARTICIPANTS: A total of 473 grommets were blocked with freshly harvested unpooled thick middle ear effusion fluid obtained from 68 patients. MAIN OUTCOME MEASURES: Patency of the grommets before and 7 days after intervention was ascertained by tympanometry and close visual inspection. RESULTS: Instillation of eardrops leads to a statistically significant increase in the clearance of grommets as compared with not using any drops (chi2 = 14.3, d.f. = 5, P = 0.006). The numbers needed to treat were 2.8 for NaHCO3, 3.2 for 0.9% NaCl, 3.9 for 0.33% acetic Acid, 4.4 for Sofradex and 9.5 for H2O2 eardrops. Pair-wise comparison was only significant for comparison between 5% NaHCO3 and 3% H2O2 eardrops (Bonferroni corrected P = 0.01, odds ratio = 4.3, CI = 1.9-9.9). CONCLUSIONS: Use of eardrops leads to a clinically and statistically significant increase in the clearance of blocked grommets. Of the five drops used, 5% NaHCO3 was the most efficacious and 3% H2O2 the least efficacious. Limitations of this in-vitro study are recognized and a prospective in-vivo double blind randomized controlled trial is planned.
Asunto(s)
Otitis Media con Derrame/tratamiento farmacológico , Soluciones Farmacéuticas/uso terapéutico , Ácido Acético/administración & dosificación , Ácido Acético/uso terapéutico , Pruebas de Impedancia Acústica , Administración Tópica , Adolescente , Adulto , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Niño , Preescolar , Dexametasona/administración & dosificación , Dexametasona/uso terapéutico , Combinación de Medicamentos , Femenino , Framicetina/administración & dosificación , Framicetina/uso terapéutico , Gramicidina/administración & dosificación , Gramicidina/uso terapéutico , Humanos , Técnicas In Vitro , Lactante , Masculino , Persona de Mediana Edad , Ventilación del Oído Medio/instrumentación , Otitis Media con Derrame/terapia , Soluciones Farmacéuticas/administración & dosificación , Bicarbonato de Sodio/administración & dosificación , Bicarbonato de Sodio/uso terapéutico , Cloruro de Sodio/administración & dosificación , Cloruro de Sodio/uso terapéuticoRESUMEN
From ancient times up to the present day many different functions and conditions have been attributed to the uvula, many speculative and some with a more scientific basis. The uvula has been shown to have the ability to produce and secrete large quantities of thin saliva. A common complication of surgery involving removal of the uvula is pharyngeal dryness. We have observed that on phonation and swallowing the uvula swings back and forth in the oropharynx. We present a review of the literature on the uvula and propose a theory that the uvula bastes the throat and thereby helps keep it moist and well lubricated.
Asunto(s)
Úvula/anatomía & histología , Úvula/fisiología , Deglución/fisiología , Humanos , Orofaringe/fisiología , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Paladar Blando/cirugía , Fonación/fisiología , Saliva/metabolismo , Saliva/fisiología , Úvula/cirugíaRESUMEN
The objective of this blinded randomized trial was to compare five sets of bipolar forceps, both single use and reusable, and discuss their potential role in postoperative complications. An animal tissue experiment was set up with standardized parameters. Results indicate larger tips give larger burns. We also found that some forceps gave suboptimal burns.
Asunto(s)
Electrocoagulación/instrumentación , Instrumentos Quirúrgicos , Tonsilectomía/instrumentación , Adenoidectomía/instrumentación , Animales , Quemaduras/etiología , Pollos , Método Doble Ciego , Electrocoagulación/efectos adversos , Diseño de Equipo , Falla de Equipo , Equipo Reutilizado , Humanos , Complicaciones Posoperatorias/etiologíaRESUMEN
We present a case of osseous haemangioma arising within the inferior turbinate.
Asunto(s)
Hemangioma Cavernoso/complicaciones , Obstrucción Nasal/etiología , Neoplasias Nasales/complicaciones , Cornetes Nasales , Adulto , Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/cirugía , Humanos , Masculino , Obstrucción Nasal/diagnóstico , Obstrucción Nasal/cirugía , Neoplasias Nasales/diagnóstico , Neoplasias Nasales/cirugíaRESUMEN
The clinical and radiological differential diagnosis of cystic lesions of the submandibular region can be difficult. We report an unusual case of a submandibular salivary duct cyst mimicking an external laryngocele on presentation by appearing to expand on Valsalva manoeuvre, and where computed tomography (CT) scanning was unhelpful in reaching a diagnosis. We present the case, discuss the theories of pathogenesis, and review the literature on the differential diagnosis of cystic lesions in the submandibular region.
Asunto(s)
Quistes/diagnóstico , Laringe/anomalías , Enfermedades de la Glándula Submandibular/diagnóstico , Adulto , Diagnóstico Diferencial , Hernia/diagnóstico , Humanos , Enfermedades de la Laringe/diagnóstico , MasculinoRESUMEN
Globus pharyngeus as a possible presenting symptom of a pharyngeal or upper oesophageal neoplasm is the main reason why barium swallows are requested, although it is essentially a benign disorder that in many cases requires reassurance only. We therefore retrospectively reviewed all barium swallows done in our department for globus pharyngeus during a one-year period to assess their value in the investigation of this condition. Ninety-two patients were identified. All had a normal ENT examination, and symptoms suggestive of acid reflux was the most common associated complaint, at 11 per cent. Acid reflux (18.5 per cent) and hiatus hernia (12 per cent) were the commonest findings of a barium swallow. Three cases of suspicious findings on barium swallow had a normal examination under general anaesthetic. Statistical analysis showed no significant relationship between the symptoms of globus and the barium swallow results. A barium swallow does not seem to add any further useful information to the investigation of globus pharyngeus. But most globus patients will continue to undergo a barium swallow, because although alternative investigations have been extensively assessed, it is still not clear which is the most appropriate mode of investigation for this condition.
Asunto(s)
Sulfato de Bario , Trastornos de Conversión/diagnóstico por imagen , Enfermedades Faríngeas/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Niño , Trastornos de Conversión/complicaciones , Femenino , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Faríngeas/complicaciones , Valor Predictivo de las Pruebas , Radiografía , Estudios Retrospectivos , Procedimientos InnecesariosRESUMEN
Largyngotracheal and pharyngoesophageal tears following minor blunt trauma to the neck are uncommon. A child with such an injury is reported and the modes of diagnosis and management are discussed. Patients may initially present with minimal signs and symptoms, but their condition may deteriorate rapidly or insidiously. In the absence of respiratory compromise, conservative management is appropriate, but all patients with significant blunt neck trauma should undergo early direct laryngoscopy under a general anaesthetic.
Asunto(s)
Enfisema/etiología , Traumatismos del Cuello/complicaciones , Heridas no Penetrantes/complicaciones , Preescolar , Enfisema/diagnóstico por imagen , Femenino , Humanos , Enfisema Mediastínico/diagnóstico por imagen , Enfisema Mediastínico/etiología , Traumatismos del Cuello/diagnóstico por imagen , Radiografía , Factores de Tiempo , Heridas no Penetrantes/diagnóstico por imagenRESUMEN
The important task of obtaining informed consent is often left to the most junior member of the surgical team, whose understanding of the surgical procedures involved may be limited. Little is known about patients' and junior doctors' satisfaction with the consent procedure, which was studied with the use of questionnaires. The vast majority of patients (95%) were satisfied with the explanation given to them prior to obtaining consent although 45% thought that the doctor who signed the consent form would be performing the surgery. Thirty-seven per cent of the junior doctors questioned admitted to obtaining consent for procedures of which they had little understanding. The majority of both junior doctors and patients felt that the surgeon performing surgery should sign the consent form. Junior doctors cannot be expected to obtain informed consent for procedures they do not fully understand and patients's; expectations must be taken into consideration if the seemingly inexorable rise in medico-legal litigation is to be halted.
Asunto(s)
Actitud del Personal de Salud , Consentimiento Informado , Cuerpo Médico de Hospitales/psicología , Pacientes/psicología , Formularios de Consentimiento , Revelación , Ética Médica , Humanos , Satisfacción del Paciente , Medición de Riesgo , Encuestas y CuestionariosRESUMEN
In rats with lymphostatic encephalopathy the duration of harmine tremor was lengthened, and the brain concentrations of harmine decreased more slowly than in sham-operated controls. The tremor began simultaneously in both rat groups at coinciding brain concentrations of harmine. In rats with lymphostatic encephalopathy harmine concentrations in brain at the termination of tremor lay in the same range as in sham-operated controls. The plasma concentrations of harmine were not changed by the disease. It is concluded that during lymphostatic encephalopathy the lymphatic drug elimination from brain is impaired whereas--at least for harmine--the blood-brain barrier functions as normal.
Asunto(s)
Alcaloides/farmacología , Barrera Hematoencefálica , Encefalopatías/fisiopatología , Encéfalo/metabolismo , Harmina/farmacología , Sistema Linfático , Animales , Sistema Linfático/fisiopatología , Masculino , Ratas , Temblor/inducido químicamenteRESUMEN
In rats, pretreatment with caffeine or ethanol shortens the duration of the harmine tremor and decreases the brain concentrations of this alkaloid. Caffeine and ethanol do not influence the plasma concentration of harmine, its plasma protein binding and its cerebral concentration at the termination of the tremor. The findings are regarded as indicative of a reduction by caffeine and ethanol of the blood-brain barrier permeability to harmine.
Asunto(s)
Barrera Hematoencefálica/efectos de los fármacos , Cafeína/farmacología , Etanol/farmacología , Animales , Encéfalo/metabolismo , Harmina/sangre , Harmina/metabolismo , Masculino , Unión Proteica , Ratas , Temblor/inducido químicamenteRESUMEN
Cardiac output of rats shows seasonal variations with low values in spring and summer and high ones in autumn and winter. The stroke volume was much more implicated in these changes than the heart rate. The seasonal changes of cardiac output are probably due to changes of thyroid function.
Asunto(s)
Gasto Cardíaco , Animales , Presión Sanguínea , Resistencia Capilar , Ritmo Circadiano , Frecuencia Cardíaca , Masculino , Ratas , Estaciones del AñoRESUMEN
In normal and lymphostatic encephalopathic rats, aprotinin pretreatment alters the duration of the harmine tremor and the cerebral concentration of the alkaloid; low doses shorten the tremor and decrease the concentration, a high dose causes the opposite. Aprotinin may decrease or increase the blood-brain barrier permeability of harmine. Because the findings are similar in both groups of rats the blood-brain barrier for harmine is assumed to be intact in lymphostatic encephalopathy. However, sick rats possibly suffer from an impaired cerebral elimination of harmine.
Asunto(s)
Alcaloides/farmacología , Aprotinina/farmacología , Encefalopatías/fisiopatología , Harmina/farmacología , Temblor/inducido químicamente , Animales , Proteínas Sanguíneas/metabolismo , Química Encefálica/efectos de los fármacos , Ganglios Linfáticos/fisiología , Masculino , Unión Proteica , Ratas , Factores de TiempoRESUMEN
Injection of the tremorigenic alkaloid harmine into lymphostatic encephalopathic rats leads to a longer duration of tremor and higher brain concentrations than in sham-operated controls. In lymphostatic encephalopathic as well as in normal rats different antiphlogistics shorten the tremor duration and decrease harmine concentration in brain. The antiphlogistics do not influence the plasma concentration of harmine, its protein binding and its tremorend concentration in brain. The effect of antiphlogistics in lymphostatic encephalopathic rats is considered as a consequence of the reduced blood-brain barrier permeability. Obviously in sick animals the blood-brain barrier permeability for harmine is not increased; the prolonged harmine tremor and the increased alkaloid concentration in the brain are consequences of the impaired cerebral lymphatic drainage only.