RESUMEN
BACKGROUND: A key element in enhanced postoperative recovery is early mobilization which, however, may be hindered by orthostatic intolerance, that is, an inability to sit or stand because of symptoms of cerebral hypoperfusion as intolerable dizziness, nausea and vomiting, feeling of heat, or blurred vision. We assessed orthostatic tolerance in relation to the postural cardiovascular responses before and shortly after open radical prostatectomy. METHODS: Orthostatic tolerance and the cardiovascular response to sitting and standing were evaluated on the day before surgery and 6 and 22 h after operation in 16 patients. Non-invasive systolic (SAP) and diastolic arterial pressure (DAP) (Finometer), heart rate, cardiac output (CO, Modelflow), total peripheral resistance (TPR), and central venous oxygen saturation (Scv(O2)) were monitored. RESULTS: Before surgery, no patients had symptoms of orthostatic intolerance. In contrast, 8 (50%) and 2 (12%) patients were orthostatic intolerant at 6 and approximately 22 h after surgery, respectively. Before surgery, SAP, DAP, and TPR increased (P<0.05), whereas CO did not change (P>0.05) and Scv(O2) decreased (P<0.05) upon mobilization. At 6 h after operation, SAP and DAP declined with mobilization (P<0.05) and the arterial pressure response differed from the preoperative response both upon sitting (P<0.05) and standing (P<0.05) due to both impaired TPR and CO. At approximately 22 h, the SAP and DAP responses to mobilization did not differ from the preoperative evaluation (P>0.05). CONCLUSIONS: The early postoperative postural cardiovascular response is impaired after radical prostatectomy with a risk of orthostatic intolerance, limiting early postoperative mobilization. The pathogenic mechanisms include both impaired TPR and CO responses.
Asunto(s)
Ambulación Precoz , Intolerancia Ortostática/fisiopatología , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/fisiopatología , Anciano , Analgésicos Opioides/administración & dosificación , Anestesia General/métodos , Presión Sanguínea/fisiología , Esquema de Medicación , Fluidoterapia/métodos , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/fisiopatología , Dolor Postoperatorio/prevención & control , Atención Perioperativa/métodos , ProstatectomíaRESUMEN
Air embolism is a rare and potentially severe complication of surgical and invasive procedures. Emboli large enough to produce symptoms require immediate treatment because of the risk of 'gas lock' in the right side of the heart and subsequent circulatory failure. If air is transmitted to the arterial circulation through a shunt, it may cause cerebral emboli with neurological symptoms. We present two cases with venous air emboli and concurrent cerebral arterial emboli. Both patients were successfully treated with hyperbaric oxygen therapy.
Asunto(s)
Embolia Aérea/terapia , Oxigenoterapia Hiperbárica/métodos , Enfermedad Iatrogénica , Adulto , Anciano , Cerebro/diagnóstico por imagen , Ecocardiografía Transesofágica , Embolia Aérea/diagnóstico , Embolia Aérea/etiología , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Vena Porta/anomalías , Radiografía Abdominal , Enfermedades Raras , Convulsiones/etiología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
This study investigated if prior eccentric contractions, and thus mechanical strain and muscle damage, exert an effect on the muscle membrane phospholipid fatty acid composition in rats, and whether a possible effect could be attenuated by dietary supplements. Twenty-three rats were randomised to three groups who received chow with added fish oil (n = 8), vitamin C (n = 8) or no supplement (n = 7). After 3 weeks of feeding, calf muscles on one side were stimulated electrically during anaesthesia causing eccentric contractions. Two days later the white gastrocnemius, a part of the stimulated calf muscle, was excised from both legs. In the muscles stimulated to contract eccentrically, compared to the control muscles, the proportion of arachidonic acid, C20:4,n-6 (17.7 +/- 0.6; 16.4 +/- 0.4% of total fatty acids, respectively) and docosapentanoeic acid, C22:5,n-3 (2.9 +/- 0.1 and 2.7 +/- 0.1% of total fatty acids, respectively) was uniformly higher across groups (P < 0.02) with no differences between diet groups. The proportion of long chain polyunsaturates was also significantly higher in the eccentrically contracted (39.9 +/- 0.6% of total fatty acids) compared to the control leg (38.2 +/- 0.6% of total fatty acids; P < 0.01). In contrast no differences were observed in the fatty acid composition of the triacylglycerols stored within the muscle. Thus one severe bout of eccentric contractions modulates the fatty acid composition of the muscle membrane phospholipids when compared to a control leg, and supplemental intake of fish oil or vitamin C did not attenuate this effect.
Asunto(s)
Ácidos Grasos/metabolismo , Contracción Muscular/fisiología , Músculo Esquelético/metabolismo , Fosfolípidos/metabolismo , Triglicéridos/metabolismo , Animales , Antioxidantes/administración & dosificación , Antioxidantes/farmacología , Ácido Ascórbico/administración & dosificación , Ácido Ascórbico/farmacología , Glucemia , Grasas de la Dieta/administración & dosificación , Estimulación Eléctrica , Aceites de Pescado/administración & dosificación , Aceites de Pescado/farmacología , Ácido Láctico/sangre , Masculino , Músculo Esquelético/citología , Músculo Esquelético/efectos de los fármacos , Distribución Aleatoria , Ratas , Ratas Wistar , Estrés MecánicoRESUMEN
Recombinant activated coagulation factor VII (rFVIIa) (NovoSeven) was developed for treatment of bleeding in hemophilia patients with inhibitors (antibodies) against factors VIII or IX. rFVIIa initiates the coagulation cascade by binding to tissue factor at the site of injury and causes the formation of sufficient amounts of thrombin to trigger coagulation. Patients with a variety of other coagulation deficiencies than hemophilia characterized by an impaired thrombin generation and life-threatening bleeding have been reported as successfully treated with rFVIIa. Data are now entered into clinical registries established to further monitor this experimental treatment with NovoSeven. rFVIIa is produced free of any added human protein. The amino acid sequence of rFVIIa is identical to plasma-derived FVIIa (pdFVIIa). Posttranslational modifications (i.e., gamma-carboxylations, N- and O-glycosylations) are qualitatively identical in pdFVIIa and rFVIIa although some quantitative differences exist. The activities of rFVIIa and pdFVIIa are indistinguishable. Manufacturing of rFVIIa involves expression in baby hamster kidney (BHK) cells followed by purification, including three ion-exchange and one immunoaffinity chromatography steps. The last anion-exchange chromatography step ensures completion of the autoactivation of recombinant factor VII (rFVII) to rFVIIa. This review describes the mechanism of action, characterization, manufacturing, and preclinical and current clinical evidence for the efficacy and safety of rFVIIa.
Asunto(s)
Factor VII/química , Factor VII/farmacología , Microbiología Industrial/métodos , Proteínas Recombinantes/química , Proteínas Recombinantes/farmacología , Animales , Ensayos Clínicos como Asunto , Clonación Molecular , Factor VII/uso terapéutico , Factor VIIa , Humanos , Estructura Molecular , Proteínas Recombinantes/uso terapéutico , Transformación GenéticaRESUMEN
OBJECTIVE: To investigate the long-term predictive value of urodynamics for the outcome of patients undergoing prostatic surgery for lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO) and to determine the long-term effectiveness on symptoms, maximum flow rate and the rate of re-operation. PATIENTS AND METHODS: Of 139 elderly men who had undergone prostatic surgery, selected without reference to urodynamic assessment but having extensive (blinded) urodynamic testing included in their evaluation, 79 were followed for 8 years using a history, symptom score analysis, uroflowmetry and review of their records. RESULTS: Comparing the results in groups of men with a pre-operative maximum flow rate < or > or = 15 mL/s, there was a similar difference in the rate of success to that noted 6 months post-operatively. Similar results were obtained when comparing those with BOO or a normal bladder outlet function. However, although the tendency was clear it was not statistically significant because of the small sample size (type-2 error). There was a significant reduction in all symptom scores from those assessed pre-operatively and during the 8 years (P < 0.001). The median pre-operative maximum flow rate was 8.5 mL/s, compared with 12.5 mL/s after 8 years (P < 0.001). Of the 79 patients, 14 (18%) had 28 re-operations during the 8-year follow-up, 12 being repeat resections of the prostate, giving a repeat resection rate of 1.8% per year and a success rate of 71%. During the 8 years, 82% of the patients had an unchanged overall evaluation of the post-operative outcome. In general, those having an unsatisfactory outcome were slightly younger than the whole group. CONCLUSION: Uroflowmetry and pressure-flow studies can predict to some degree the long-term result after prostatic surgery. There was a durable effect on symptom scores and maximum flow rates after the operation. The annual rate of repeat resection (1.8%) was relatively low.