RESUMEN

Multiple small intestinal stromal tumors were removed from mother and natural daughter within 15 months of each other. Both had long histories of recurrent iron deficiency anemia and upper gastrointestinal bleeding. Light microscopy revealed that the tumors had arisen in conjunction with diffuse hyperplasia/ dysplasia of Auerbach's myenteric plexus. Immunohistochemistry generally did not show myogenic or paraganglionic phenotypes; CD34 was positive in most tumors. Electron microscopy confirmed the association with the abnormal Auerbach's plexus and showed the structure of gastrointestinal autonomic nerve tumors (GANTs). These findings provide information as to the origin and evolution of GANTs, and also have implications for the clinical management of these tumors which appear to occur more frequently than previously thought.

Asunto(s)

Neoplasias Gastrointestinales/patología , Intestino Delgado/inervación , Intestino Delgado/patología , Neoplasias del Sistema Nervioso Periférico/patología , Sarcoma/patología , Anciano , Antígenos CD34/análisis , Biomarcadores de Tumor/análisis , Femenino , Neoplasias Gastrointestinales/química , Neoplasias Gastrointestinales/diagnóstico por imagen , Neoplasias Gastrointestinales/cirugía , Humanos , Hiperplasia/patología , Técnicas para Inmunoenzimas , Intestino Delgado/diagnóstico por imagen , Intestino Delgado/cirugía , Persona de Mediana Edad , Plexo Mientérico/patología , Orgánulos/ultraestructura , Linaje , Neoplasias del Sistema Nervioso Periférico/química , Neoplasias del Sistema Nervioso Periférico/diagnóstico por imagen , Neoplasias del Sistema Nervioso Periférico/cirugía , Fosfopiruvato Hidratasa/análisis , Sarcoma/química , Sarcoma/diagnóstico por imagen , Sarcoma/cirugía , Tomografía Computarizada por Rayos X

RESUMEN

Changes in organ blood flow (Q) produced by 20 cm H2O positive end-expiratory pressure (PEEP) were measured before and after the induction of hyperdynamic sepsis in nine unanesthetized sheep. During the baseline nonseptic study, PEEP was associated with a 9% fall in thermodilution-measured systemic Q, although arterial perfusing pressures were unaffected. Concurrently, microsphere-derived Q was maintained to the brain and heart, but fell to liver, spleen, pancreas, kidney, large intestine, and gastrocnemius. Twenty-four to 36 h after cecal ligation and perforation, a pre-PEEP septic study demonstrated an increase in all of the cardiac index (CI) (+43%) and systemic O2 delivery (+54%) when compared with the nonseptic study, whereas whole-body O2 extraction (-30%) was depressed. Although PEEP depressed systemic Q (-17%) during the septic study to a greater extent than during the nonseptic study (p less than 0.02), absolute organ Q fell only to pancreas, liver, and spleen. Relative to the simultaneous fall in the CI, Q to some splanchnic organs was not depressed by PEEP to the same magnitude in the septic as in the nonseptic study. When an infusion of Ringer's lactate (993 +/- 295 ml) subsequently restored systemic Q to pre-PEEP septic levels, individual flows that had been depressed by PEEP were not restored. Furthermore, Q-kidney continued to fall, such that the postfluid Q-kidney (-19%) was significantly less than was demonstrated in the pre-PEEP septic study. We postulate that differences noted in the distribution of organ Q between the nonseptic and hyperdynamic septic studies after the application of PEEP were secondary to the vasculopathy of sepsis and/or an alteration in the function of specific organ microcirculations. However, these data do not address whether the changes in organ Q distribution after a PEEP-mediated depression in systemic Q during sepsis significantly restricted tissue DO2. The inability to acutely reverse the PEEP-mediated changes in organ Q after restoring systemic Q by a fluid infusion also suggests the need to evaluate alternative methods of support to organ Q in acute respiratory failure secondary to sepsis when the addition of PEEP acutely depresses systemic DO2.

Asunto(s)

Respiración con Presión Positiva , Flujo Sanguíneo Regional , Sepsis/fisiopatología , Animales , Hemodinámica , Microesferas , Radioisótopos , Ovinos

RESUMEN

Previous studies describing the histologic elements of multi-system organ failure caused by bacterial sepsis may have been complicated by a significant interaction on tissue injury from either a preterminal low-flow state or the effects of therapy immediately before death. Therefore we evaluated the nonpulmonary histologic findings of sepsis during a 3-day period that followed cecal ligation and perforation. In this septic model, mean arterial perfusion pressures remained unchanged from baseline, systemic flows rose by 54%, and laboratory evidence of organ dysfunction including an elevation of the serum bilirubin levels and a depression of the serum total protein values was considered mild. Concurrently, development of the hyperdynamic central circulatory septic state was associated with widespread histologic changes in myocardium, striated muscle, liver, gut, and pancreas. Lesions common to these organs included high-protein interstitial and intracellular edema, mitochondrial destruction, and patchy cell necrosis. Lesions within the pancreas were exaggerated over those noted in other organs. Of all organs examined, only the liver demonstrated microvascular neutrophil accumulation. Unlike models of shock caused by sepsis, fibrin thrombi were not seen in the microvasculature of any organ. We conclude that tissue injury characterized by the accumulation of protein-rich extravascular fluid and the development of reversible and irreversible cell injury antedated significant multiple-system organ failure in this animal model of normotensive sepsis.

Asunto(s)

Infecciones Bacterianas/patología , Animales , Infecciones Bacterianas/metabolismo , Infecciones Bacterianas/fisiopatología , Vesícula Biliar/patología , Hemodinámica , Intestino Delgado/patología , Hígado/patología , Microscopía Electrónica , Músculos/patología , Miocardio/patología , Oxígeno/sangre , Páncreas/patología , Presión Parcial , Alveolos Pulmonares , Ovinos

RESUMEN

Since severity of acute lung injury (ALI) is reduced by pretreatment with non-steroidal agents, we hypothesized that ibuprofen would ameliorate ALI when administered after the onset of septic lung injury. Twenty-four hours after cecal ligation and perforation (CLP) in 23 sheep during a 4 h study period (period S), pulmonary lymph flow (QL) increased 16.2 +/- 12.1 ml/min (P less than 0.01) from base line, whereas lymph-to-plasma total protein concentration ratios ([L/P]TP) remained unchanged. During the subsequent 24 h of study (period D), 10 sheep received parenteral ibuprofen, 12.5 mg/kg every 6 h, and 13 sheep served as untreated septic controls. Throughout period D, a progressive increase in QL (16.2 +/- 16.3 ml/60 min) from period S was greater in the untreated than in the ibuprofen (2.5 +/- 9.0 ml/60 min, P less than 0.02) group. Between base line and period D, increase in lung wet-to-dry weight ratios was greater in the untreated group than in the ibuprofen group (P less than 0.05). Concurrently mean pulmonary arterial pressure increased 4.7 +/- 7.3 mmHg in the untreated group (P less than 0.05) during period D vs. 0.0 +/- 5.2 mmHg in the ibuprofen group (NS). When administered after septic ALI had been established by CLP, ibuprofen reduced an otherwise progressive increase in both fluid flux and extravascular lung water.

Asunto(s)

Ibuprofeno/uso terapéutico , Peritonitis/tratamiento farmacológico , Síndrome de Dificultad Respiratoria/prevención & control , Animales , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/fisiopatología , Modelos Animales de Enfermedad , Hemodinámica/efectos de los fármacos , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/fisiopatología , Hipertensión Pulmonar/prevención & control , Peritonitis/complicaciones , Peritonitis/fisiopatología , Circulación Pulmonar/efectos de los fármacos , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/fisiopatología , Ovinos , Equilibrio Hidroelectrolítico/efectos de los fármacos

RESUMEN

The effect on pulmonary fluid balance of adrenergic receptor agonist agents commonly employed in clinical sepsis has not been well characterized. Therefore, we tested the hypothesis that dobutamine would increase pulmonary microvasular fluid flux in experimental sepsis-induced lung injury. To define the effects of this synthetic catecholamine on pulmonary lymph flow (QL), we infused dobutamine in sheep at two doses in sequence (5 micrograms/kg/min and 10 micrograms/kg/min) before and after the induction of intraperitoneal sepsis which resulted in the development of lung microvascular injury. In the nonseptic state, cardiac output increased at both 5 micrograms/kg/min and 10 micrograms/kg/min (22 and 36 percent, respectively), while QL was unchanged from baseline (for 5 micrograms, delta QL = +0.44 +/- 1.35 ml/15 min; not significant) (for 10 micrograms, delta QL = -0.20 +/- 1.0 ml/15 min; not significant). Values for the ratio of lymph/plasma total protein levels [( L/P]TP) fell modestly in the nonseptic study at both doses (p less than 0.05). With established sepsis syndrome, QL increased from the nonseptic baseline study (2.99 +/- 1.8 to 7.01 +/- 3.95 ml/15 min; p less than 0.05), without change in [L/P]TP ratios or the calculated microvascular hydrostatic pressure. (Pmv) During sepsis, dobutamine infusion was again associated with an increase in cardiac output at both the 5 micrograms/kg/min (+29 percent) and 10 micrograms/kg/min (+33 percent) doses, while QL increased modestly only with the lower dose of dobutamine infused (5 micrograms/kg/min, delta QL = 1.80 +/- 2.2 ml/15 min; p less than 0.05). In this model of sepsis-induced lung injury, dobutamine increased systemic flow without substantially augmenting QL.

Asunto(s)

Agua Corporal/fisiología , Permeabilidad Capilar , Dobutamina/farmacología , Pulmón/fisiopatología , Peritonitis/fisiopatología , Síndrome de Dificultad Respiratoria/fisiopatología , Animales , Presión Sanguínea/efectos de los fármacos , Gasto Cardíaco/efectos de los fármacos , Presión Hidrostática , Pulmón/irrigación sanguínea , Linfa/fisiología , Peritonitis/complicaciones , Síndrome de Dificultad Respiratoria/etiología , Ovinos , Síndrome

RESUMEN

Morphologic studies were undertaken in a sheep model of pulmonary permeability edema (PPE) induced by cecal ligation and perforation. Biopsies taken every 24 hours through 96 hours following induction of sepsis showed, at 24 hours, interstitial edema accompanied by widespread aggregation of polymorphonuclear leukocytes. This was confirmed by electron microscopy, which also demonstrated endothelial cell swelling, platelet aggregation, and fibrin deposition. By 48 hours, a "thromboangiitis" had developed that persisted through 96 hours. In vitro pulmonary angiograms done at 60 and 96 hours showed multiple filling defects; it was possible to demonstrate that these defects corresponded to the "thromboangiitis." These thrombotic lesions, which were not the result of embolization from indwelling lines, closely resembled vascular changes described in the adult respiratory distress syndrome. It is believed that this is the first time that such lesions have been described in a model of PPE resulting from nonpulmonary sepsis.

Asunto(s)

Pulmón/patología , Edema Pulmonar/patología , Sepsis/complicaciones , Animales , Permeabilidad Capilar , Agregación Celular , Modelos Animales de Enfermedad , Hemodinámica , Pulmón/ultraestructura , Microscopía Electrónica , Neutrófilos/patología , Edema Pulmonar/etiología , Edema Pulmonar/fisiopatología , Síndrome de Dificultad Respiratoria/patología , Ovinos

RESUMEN

Here reported is an 11-week-old female infant with an incarcerated left direct inguinal hernia containing uterus, both ovaries, and fallopian tubes. An excision of the sac and back wall repair through the external ring was done.

Asunto(s)

Hernia Inguinal/cirugía , Trompas Uterinas , Femenino , Humanos , Lactante , Ovario , Útero