RESUMEN
An operationally available diagnostic imaging capability augments spaceflight medical support by facilitating the diagnosis, monitoring and treatment of medical or surgical conditions, by improving medical outcomes and, thereby, by lowering medical mission impacts and the probability of crew evacuation due to medical causes. Microgravity-related physiological changes occurring during spaceflight can affect the genitourinary system and potentially cause conditions such as urinary retention or nephrolithiasis for which ultrasonography (U/S) would be a useful diagnostic tool. This study describes the first genitourinary ultrasound examination conducted in space, and evaluates image quality, frame rate, resolution requirements, real-time remote guidance of nonphysician crew medical officers and evaluation of on-orbit tools that can augment image acquisition. A nonphysician crew medical officer (CMO) astronaut, with minimal training in U/S, performed a self-examination of the genitourinary system onboard the International Space Station, using a Philips/ATL Model HDI-5000 ultrasound imaging unit located in the International Space Station Human Research Facility. The CMO was remotely guided by voice commands from experienced, earth-based sonographers stationed in Mission Control Center in Houston. The crewmember, with guidance, was able to acquire all of the target images. Real-time and still U/S images received at Mission Control Center in Houston were of sufficient quality for the images to be diagnostic for multiple potential genitourinary applications. Microgravity-based ultrasound imaging can provide diagnostic quality images of the retroperitoneum and pelvis, offering improved diagnosis and treatment for onboard medical contingencies. Successful completion of complex sonographic examinations can be obtained even with minimally trained nonphysician ultrasound operators, with the assistance of ground-based real-time guidance.
Asunto(s)
Pelvis/diagnóstico por imagen , Espacio Retroperitoneal/diagnóstico por imagen , Vuelo Espacial , Ingravidez , Técnicos Medios en Salud/educación , Astronautas , Estudios de Factibilidad , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Radiología/educación , Consulta Remota/métodos , Ultrasonografía , Grabación en Video/métodosRESUMEN
INTRODUCTION: The diagnosis of endotracheal tube (ETT) mal-position may be delayed in extreme environments. Several methods are utilized to confirm proper ETT placement, but these methods can be unreliable or unavailable in certain settings. Thoracic sonography, previously utilized to detect pneumothoraces, has not been tested to assess ETT placement. HYPOTHESIS: Thoracic sonography could correlate with pulmonary ventilation, and thereby, help to confirm proper ETT placement. METHODS: Thirteen patients requiring elective intubation under general anesthesia, and data from two trauma patients were evaluated. Using a portable, hand-held, ultrasound (PHHU) machine, sonographic recordings of the chest wall visceral-parietal pleural interface (VPPI) were recorded bilaterally in each patient during all phases of airway management: (1) pre-oxygenation; (2) induction; (3) paralysis; (4) intubation; and (5) ventilation. RESULTS: The VPPI could be well-imaged for all of the patients. In the two trauma patients, right mainstem intubations were noted in which specific pleural signals were not seen in the left chest wall VPPI after tube placement. These signs returned after correct repositioning of the ETT tube. In all of the elective surgery patients, signs correlating with bilateral ventilation in each patient were imaged and correlated with confirmation of ETT placement by anesthesiology. CONCLUSIONS: This report raises the possibility that thoracic sonography may be another tool that could be used to confirm proper ETT placement. This technique may have merit in extreme environments, such as in remote, pre-hospital settings or during aerospace medical transports, in which auscultation is impossible due to noise, or capnography is not available, and thus, requires further scientific evaluation.
Asunto(s)
Servicios Médicos de Urgencia , Intubación Intratraqueal/métodos , Tráquea/diagnóstico por imagen , Ultrasonografía Doppler en Color , Tratamiento de Urgencia/métodos , Diseño de Equipo , Seguridad de Equipos , Femenino , Humanos , Intubación Intratraqueal/instrumentación , Masculino , Muestreo , Sensibilidad y Especificidad , Tórax/diagnóstico por imagenRESUMEN
BACKGROUND: As a medical emergency that can affect even well-screened, healthy individuals, peritonitis developing during a long-duration space exploration mission may dictate deviation from traditional clinical practice due to the absence of otherwise indicated surgical capabilities. Medical management can treat many intra-abdominal processes, but treatment failures are inevitable. In these circumstances, percutaneous aspiration under sonographic guidance could provide a "rescue" strategy. HYPOTHESIS: Sonographically guided percutaneous aspiration of intra-peritoneal fluid can be performed in microgravity. METHODS: Investigations were conducted in the microgravity environment of NASA's KC-135 research aircraft (0 G). The subjects were anesthetized female Yorkshire pigs weighing 50 kg. The procedures were rehearsed in a terrestrial animal lab (1 G). Colored saline (500 mL) was introduced through an intra-peritoneal catheter during flight. A high-definition ultrasound system (HDI-5000, ATL, Bothell, WA) was used to guide a 16-gauge needle into the peritoneal cavity to aspirate fluid. RESULTS: Intra-peritoneal fluid collections were easily identified, distinct from surrounding viscera, and on occasion became more obvious during weightless conditions. Subjectively, with adequate restraint of the subject and operators, the procedure was no more demanding than during the 1-G rehearsals. CONCLUSIONS: Sonographically guided percutaneous aspiration of intra-peritoneal fluid collections is feasible in weightlessness. Treatment of intra-abdominal inflammatory conditions in spaceflight might rely on pharmacological options, backed by sonographically guided percutaneous aspiration for the "rescue" of treatment failures. While this risk mitigation strategy cannot guarantee success, it may be the most practical option given severe resource limitations.
Asunto(s)
Drenaje , Peritonitis/cirugía , Vuelo Espacial , Animales , Estudios de Factibilidad , Femenino , Porcinos , Ultrasonografía , Ingravidez , Simulación de IngravidezRESUMEN
The results of traditional (incision) and risk-based (visual) postmortem inspection procedures were compared on groups of approximately 30,000 pigs. The performance characteristics used as a basis for comparison included the non-detection rates of grossly detectable abnormalities, the microbiological contamination rates of carcases and boned product, the association of reactive lymph nodes with carcase condemnation and the achievement of 'finished product standards' for 'wholesomeness'. It was estimated that 6 per cent of all cases of abscessation and 28 per cent of all cases of arthritis were undetected by the traditional method, and the comparable figures for the risk-based procedure were 19 per cent and 39 per cent. However, when the rates of contamination of undetected abnormalities with foodborne hazards and other carcase contamination parameters were taken into account, it was concluded that both inspection systems were likely to result in a very similar level of consumer protection. Any increase in potential exposure to foodborne hazards in the abnormalities undetected by risk-based inspection would be insignificant in comparison with the potential exposure to foodborne hazards resulting from contaminated 'normal' lymph nodes and carcase surfaces. There were no statistically significant differences between the two procedures in the contamination rates of pre-chill carcases or boned retail products with Salmonella and Yersinia species.
Asunto(s)
Contaminación de Alimentos , Inspección de Alimentos/métodos , Carne , Porcinos , Animales , Australia , Medición de Riesgo , Salmonella , YersiniaRESUMEN
To determine whether pericardial liquid pressure accurately measures pericardial constraint, we developed a technique in which a catheter was positioned perpendicular to the epicardial surface. This device, which occupies little or no pericardial space, couples the thin film of liquid to a transducer. In six open-chest dogs, we also measured left ventricular (LV) end-diastolic pressure (LVEDP) and anteroposterior and septum-to-free wall diameters. LVEDP was raised incrementally to approximately 25 mmHg by saline infusion. With the use of the product of the two diameters as an index of area (A(LV)), LVEDP-A(LV) relationships were obtained with the pericardium closed and again after the pericardium had been widely opened to obtain the isovolumic difference in LVEDP (DeltaLVEDP). In all dogs, the technique yielded values of pericardial pressure equal to DeltaLVEDP as well as equal to that measured using a previously placed balloon transducer in the same location and at the same A(LV). We conclude that, when the pressure of the pericardial liquid is appropriately measured, it (in addition to the balloon-measured contact stress) defines the diastolic constraining effect of the pericardium. Furthermore, we suggest that earlier measurements of pericardial "liquid pressure" were low, due to an artifact of measurement.
Asunto(s)
Cateterismo Cardíaco/instrumentación , Manometría/métodos , Contracción Miocárdica/fisiología , Pericardio/fisiología , Animales , Presión Sanguínea/fisiología , Diástole/fisiología , Perros , Técnicas In Vitro , Manometría/instrumentación , Presión , Reproducibilidad de los Resultados , Función Ventricular Izquierda/fisiologíaAsunto(s)
Medicina Aeroespacial , Sustitutos Sanguíneos , Medio Ambiente Extraterrestre , Fluidoterapia , Soluciones para Rehidratación , Solución Salina Hipertónica , Choque Hemorrágico/terapia , Animales , Fenómenos Fisiológicos Cardiovasculares , Hemoglobinas , Humanos , Neurotransmisores/fisiología , Vuelo Espacial , Heridas y Lesiones/terapiaRESUMEN
BACKGROUND: Thoracic ultrasound may rapidly diagnose pneumothorax when radiographs are unobtainable; the accuracy is not known. METHODS: We prospectively evaluated thoracic ultrasound detection of pneumothorax in patients at high suspicion of pneumothorax. The presence of "lung sliding" or "comet tail" artifacts were determined in patients by ultrasound before radiologic verification of pneumothorax by residents instructed in thoracic ultrasound. Results were compared with standard radiography. RESULTS: There were 382 patients enrolled; the cause of injury was blunt (281 of 382), gunshot wound (22 of 382), stab wound (61 of 382), and spontaneous (18 of 382). Pneumothorax was demonstrated on chest radiograph in 39 patients and confirmed by ultrasound in 37 of 39 patients (95% sensitivity); two pneumothoraces could not be diagnosed because of subcutaneous air; the true-negative rate was 100%. CONCLUSION: Thoracic ultrasound reliably diagnoses pneumothorax. Expansion of the focused abdominal sonography for trauma (FAST) examination to include the thorax should be investigated for terrestrial and space medical applications.
Asunto(s)
Neumotórax/diagnóstico por imagen , Traumatismos Torácicos/diagnóstico por imagen , Heridas no Penetrantes/diagnóstico por imagen , Humanos , Estudios Prospectivos , Sensibilidad y Especificidad , Ultrasonografía , Heridas por Arma de Fuego/diagnóstico por imagen , Heridas Punzantes/diagnóstico por imagenRESUMEN
Pneumothorax is commonly seen in trauma patients; the diagnosis is confirmed by radiography. The use of ultrasound where radiographic capabilities are absent, is being investigated by the National Aeronautics and Space Administration. We investigated the ability of ultrasound to assess the magnitude of pneumothorax in a porcine model. Sonography was performed on anesthetized pigs in both ground-based laboratory (n = 5) and microgravity conditions (0 x g) aboard the KC-135 aircraft during parabolic flight (n = 4). Aliquots of air (50-100 cm3) were introduced into the chest to simulate pneumothorax. Results were videorecorded and digitized for later interpretation. Several distinct sonographic patterns of partial lung sliding were noted including the combination of a sliding zone with a still zone and a "segmented" sliding zone. These "partial lung sliding" patterns exclude massive pneumothorax manifested by a complete separation of the lung from the parietal pleura. In 0 x g, the sonographic picture is more diverse; one x g differences between posterior and anterior aspects are diminished. Modest pneumothorax can be inferred by the ultrasound sign of "partial lung sliding." This finding, which increases the negative predictive value of thoracic ultrasound, may be attributed to intermittent pleural contact, small air spaces, or alterations in pleural lubricant. Further studies of these phenomena are warranted.
Asunto(s)
Modelos Animales de Enfermedad , Neumotórax/clasificación , Neumotórax/diagnóstico por imagen , Índice de Severidad de la Enfermedad , Ingravidez , Animales , Artefactos , Femenino , Neumotórax/patología , Neumotórax Artificial/instrumentación , Neumotórax Artificial/métodos , Valor Predictivo de las Pruebas , Porcinos , Ultrasonografía/instrumentación , Ultrasonografía/métodos , Ultrasonografía/normas , Grabación de Cinta de Video , Ingravidez/efectos adversosRESUMEN
Previously, we developed a balloon transducer to measure the constraint of the pericardium (i.e., pericardial pressure) on the surface of the heart. It was validated physiologically in that it was shown to measure a pressure equal to the difference between the left ventricular end-diastolic pressure measured before and after pericardiectomy at the same left ventricular volume. To define its static operating characteristics, we loaded the balloon nonuniformly with weights that covered fractions of the balloon surface and found that the balloon accurately recorded the average stress if the stress was applied over at least 23% of its surface. To test its performance when curved, we placed it in large and small cylinders (minimum diameter 31 mm) and found that the balloon accurately recorded the stress. To define its dynamic operating characteristics, we applied sinusoidal stresses and found that its frequency response was limited only by that of the connecting catheter. When better dynamic response is required, we introduce a micromanometer-tipped catheter to obtain a unity-gain frequency response that is flat to 200 Hz.
Asunto(s)
Cateterismo/instrumentación , Pericardio , Artefactos , Calibración , Cateterismo/métodos , Manometría , Estrés Mecánico , Transductores de PresiónAsunto(s)
Neumotórax/diagnóstico por imagen , Traumatismos Torácicos/diagnóstico por imagen , Heridas Punzantes/diagnóstico por imagen , Adulto , Tubos Torácicos , Humanos , Masculino , Pleura/diagnóstico por imagen , Neumotórax/terapia , Traumatismos Torácicos/terapia , Ultrasonografía , Heridas Punzantes/terapiaRESUMEN
The quantitative expression of complement receptor type 1 (CR1) on erythrocytes is regulated by two CR1 alleles that differ in having genomic HindIII fragments of either 7.4 or 6.9 kb and that determine high (H allele) or low (L allele) CR1 expression, respectively, across a 10-fold range. To investigate whether the product of the L allele may contain amino acid substitutions that make it more susceptible to proteolysis, cDNA sequence spanning the CR1 coding region was analyzed in two donors who were homozygous for the H and L alleles and differed by 7-fold in their mean numbers of CR1 per erythrocyte. Sequence differences were detected at 10 nucleotide positions, including 6 that would cause amino acid substitutions. The HindIII RFLP and 3 of the latter 6 sites were analyzed in genomic DNA of 85 Caucasians and 75 African Americans; sites encoding the other amino acid substitutions were analyzed less extensively. Two major haplotypes defined prototypic H and L alleles in both ethnic groups, suggesting that these alleles existed before the African and European populations diverged. Decreased erythrocyte CR1 expression is associated with impaired clearance of immune complexes from blood. Persistence of the L allele in all populations that have been analyzed may suggest a compensatory survival advantage, perhaps related to malaria or another infectious disease.
Asunto(s)
Alelos , Población Negra/genética , Haplotipos/inmunología , Receptores de Complemento 3b/química , Receptores de Complemento 3b/genética , Población Blanca/genética , Sustitución de Aminoácidos/genética , Sustitución de Aminoácidos/inmunología , Humanos , Polimorfismo de Longitud del Fragmento de Restricción , Receptores de Complemento 3b/aislamiento & purificación , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Análisis de Secuencia de ADNRESUMEN
We suggest a mechanism by which blood volume changes might explain the hypotension that, after space flight, often accompanies the return to normal gravity. Upon entering microgravity, peripheral veins may collapse and, because of volume redistribution, raise the pressure in the central venous compartment. After some time in space, homeostatic mechanisms may cause volume excretion and reduce the pressure in the central venous compartment to normal values. Upon return to normal gravity, peripheral veins may re-expand and distribute a reduced blood volume into an enlarged space, thus lowering pressure in the central venous compartment. This would reduce cardiac preload, output, and arterial pressure. To prevent this sequence of events, leg cuffs might be inflated before the end of the space flight to allow homeostatic mechanisms to increase blood volume to normal levels.
Asunto(s)
Hipotensión Ortostática/fisiopatología , Vuelo Espacial , Capacitancia Vascular , Ingravidez , Circulación Sanguínea , Volumen Sanguíneo , Humanos , Pierna/irrigación sanguínea , Venas/fisiologíaRESUMEN
We wished to determine whether the number of central nervous system (CNS) white matter lesions on magnetic resonance imaging (MRI) is increased in patients with nonarteritic ischemic optic neuropathy (NAION). T2-Weighted axial images of the brain in 13 patients with acute NAION and 16 age-matched controls were used to tabulate the number of subcortical and periventricular white matter lesions. Groups were compared by t test for means, the Wilcoxon-Mann-Whitney rank-sum test, and chi-square test for proportions with at least one lesion. The mean number of CNS white matter ischemic lesions in the NAION group was 4.0 (range 0-20) as compared to 1.4 (range 0-7) in the control group. The difference in these samples suggested a significant increase in NAION (p = 0.069, rank-sum test). The proportions of patients with at least one lesion were not significantly different (53.8% NAION vs. 56.3% controls). The data suggest an increased number of CNS white matter lesions in patients with NAION.
Asunto(s)
Arteritis , Encéfalo/patología , Neuropatía Óptica Isquémica/diagnóstico , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana EdadRESUMEN
Many modern surgical techniques have been developed to provide exposure or visualization of the surgical field to perform definitive treatment. The actual therapeutic part of surgery is often a small fraction of the procedure. In obtaining exposure, however, morbidity can ensue. This has led to newer techniques that use minimally invasive treatments, thus substantially decreasing overall morbidity and patient costs. By providing physicians with visualization alternatives, MR imaging and computed tomography, when combined with a therapeutic procedure, can reduce the morbidity of surgery.
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Neoplasias de Cabeza y Cuello/cirugía , Cabeza/patología , Imagen por Resonancia Magnética , Cuello/patología , Tomografía Computarizada por Rayos X , Biopsia con Aguja/métodos , Ablación por Catéter , Cabeza/cirugía , Neoplasias de Cabeza y Cuello/diagnóstico , Humanos , Terapia por Láser , Cuello/cirugíaRESUMEN
PURPOSE: To evaluate the feasibility of a technique of MR-guided stereotactic radio frequency ablation, which was developed as a minimally invasive treatment for brain tumors, and to determine MR characteristics and sequential evolution of radio frequency lesions created to ablate brain tumors. METHODS: Fourteen lesions in 12 patients with primary and metastatic brain tumors were treated with this technique and followed for up to 10 months. The stereotactic coordinates of the tumor and the angle of the radio frequency probe were calculated on MR imaging. The radio frequency lesion was generated in the awake patient by increasing the temperature to 80 degrees C within the tumor for 1 minute. This was repeated until the entire tumor volume was destroyed. MR imaging was performed before, during, and immediately after the radio frequency procedure, and sequential MR was obtained during clinical follow-up. RESULTS: MR imaging clearly showed well-defined radio frequency lesions and provided feedback for treatment planning. The radio frequency lesion boundary was well identified as a dark signal rim on T2-weighted images and showed ring enhancement on contrast-enhanced T1-weighted images. The sequential MR imaging showed the radio frequency lesions decreased in volume in all cases, suggesting focal control. CONCLUSION: Stereotactic MR-guided radio frequency brain tumor ablation is a feasible and promising technique that can be an attractive brain tumor treatment alternative. MR provided not only accurate tumor location but also visualization of feedback of thermal tissue changes that reflected therapeutic effect.
Asunto(s)
Neoplasias Encefálicas/cirugía , Imagen por Resonancia Magnética , Radiología Intervencionista , Radiocirugia , Adenocarcinoma/patología , Adenocarcinoma/secundario , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/secundario , Medios de Contraste , Estudios de Factibilidad , Retroalimentación , Estudios de Seguimiento , Gadolinio , Glioblastoma/patología , Glioblastoma/cirugía , Humanos , Aumento de la Imagen , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Oligodendroglioma/patología , Oligodendroglioma/cirugía , Planificación de Atención al Paciente , Radiocirugia/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: To determine the transmural pressure-dimension relations of the right atrium (RA) and right ventricle (RV) before and after pericardiectomy, six open-chest dogs were instrumented with pericardial balloons placed over the RA and RV free walls. METHODS AND RESULTS: PA appendage dimensions and RV free-wall segment lengths were measured using sonomicrometry. Intact-pericardium RA and RV transmural pressures were calculated by subtracting the pericardial pressures (measured using balloons) from the cavitary pressures. Pooled data from six animals with pericardium intact indicate that at RA and RV cavitary pressures of 5, 10, and 15 mm Hg, RV pericardial pressure was 4.3 +/- 0.3, 8.6 +/- 1.0, and 13.3 +/- 1.5 mm Hg, respectively, and RA pericardial pressure was 4.8 +/- 0.3, 9.6 +/- 0.6, and 14.6 +/- 0.6 mm Hg, respectively (mean +/- SD). With calculated unstressed dimensions, the cavity dimension data were normalized to strain (in percent). We determined that in the dog, RV strain would increase by 14% and RA by 68% to maintain cavitary pressure at 10 mm Hg on pericardiectomy. To compare these results with clinical data, RV (n = 7) and RA (n = 6) transmural pressures were measured using balloons in patients (age, 19 to 76 years) undergoing cardiac surgery. RA transmural pressure of six patients was 1.0 +/- 1.5 mm Hg when central venous pressures (CVPs) ranged from 3 to 16 mm Hg. RV transmural pressure equaled 1.2 +/- 1.9, 2.3 +/- 1.9, and 3.4 +/- 2.0 mm Hg when CVP was 5, 10, and 15 mm Hg, respectively. CONCLUSIONS: Pericardial constraint (as evaluated by the ratio of pericardial to intracavitary pressures when CVP is 10 mm Hg) accounted for 96% of RA cavitary pressure in the dog and 89% in humans and at least 86% of RV cavitary pressure in the dog and 77% in humans.
Asunto(s)
Función del Atrio Derecho , Pericardio/fisiología , Función Ventricular Derecha , Adulto , Anciano , Animales , Perros , Femenino , Humanos , Masculino , Persona de Mediana Edad , PresiónRESUMEN
The response of signal intensity to transient (on-off) motor and sensory stimulation has been well studied; however, the dependence of signal response on the duration of stimulus requires further characterization. The objective of this study was to determine the time course of signal response in the human visual cortex to prolonged, sustained stimulation and to examine possible contributory physiologic mechanisms. Nine healthy volunteers underwent magnetic resonance (MR) imaging during sustained visual stimulation with light-proof binocular goggles. With photic stimulation, activation was observed in all subjects as an increase in signal intensity of the visual cortex. With sustained stimulation, a gradual decrease in signal intensity was subsequently observed, with progression toward an apparent steady state. Correlation with positron emission tomographic, MR spectroscopic, and visual evoked-potential data suggests that the initial uncoupling of cerebral blood flow and oxidative metabolism with a neuronal activation burst may represent a transient phenomenon. This quick-response phase may proceed to an equilibrium coupling of flow and oxidative metabolism, with a gradual normalization of venous deoxyhemoglobin levels and signal intensity.
Asunto(s)
Imagen por Resonancia Magnética , Estimulación Luminosa , Corteza Visual/fisiología , Adulto , Circulación Cerebrovascular/fisiología , Potenciales Evocados Visuales/fisiología , Hemoglobinas/metabolismo , Humanos , Procesamiento de Imagen Asistido por Computador , Espectroscopía de Resonancia Magnética , Masculino , Neuronas/metabolismo , Neuronas/fisiología , Consumo de Oxígeno/fisiología , Técnica de Sustracción , Factores de Tiempo , Tomografía Computarizada de Emisión , Corteza Visual/metabolismoRESUMEN
To determine the optimal method of applying abdominal compressions during cardiopulmonary resuscitation (CPR), 3 levels of pressure (25, 50, and 100 torr) were applied to the abdomen a) continuously and b) as 500 msec pulses at 10 different phases during the CPR cycle in 8 anesthetized dogs. Thoracic aortic (Ao) and right atrial (RA) pressures were measured and PAo-PRA was calculated as the coronary perfusion gradient. A pneumatic piston device provided external chest compression (60/min, 120 lbs, for 50% of the cycle) and ventilation (80% O2, 12/min, at 20cm, H2O). Another identical device provided abdominal compression (AC) via an air-filled bladder. High-pressure (100 torr) AC applied for 500 msec commencing 200 msec prior to chest compression demonstrated the best overall profile, raising mean aortic pressure 26 torr (P less than 0.001) and peak coronary perfusion gradient pressure 17 torr (P less than 0.02) from control values during standard CPR of 58 and 41 torr, respectively. We conclude that applying high-pressure, 500-msec pulses of AC 200 msec before chest compressions significantly improves CPR hemodynamics.
Asunto(s)
Abdomen/fisiología , Aorta Torácica/fisiología , Presión Sanguínea , Circulación Coronaria , Resucitación , Animales , Perros , Masaje Cardíaco/métodos , Presión , Factores de TiempoRESUMEN
Life-threatening bleeding oesophageal varices due to idiopathic portal vein thrombosis occurred in a five-year-old male. Diagnosis was made by endoscopy and ultrasonography and decompression of the portal system performed by splenorenal shunt using the end renal vein to side splenic vein. This avoided the difficult mobilization of the splenic vein from the pancreatic bed in the conventional distal splenorenal shunt.