RESUMEN
We examined the incidence and mortality of adult respiratory distress syndrome (ARDS) in patients receiving emergency medical care at a large metropolitan medical center. The patients were classified into eight high-risk categories and monitored prospectively until discharge or death. Over a period of 12 months, 11,112 such patients entered the emergency room. Of 4926 who were admitted to the hospital acutely ill, 90 (2%) developed ARDS. Thirty-six percent of these survived. ARDS occurred in 25% of patients admitted with acquired immune deficiency syndrome and Pneumocystis carinii pneumonia, and mortality in these patients was 86%. Aspiration pneumonia was the primary cause of ARDS in 37% of the patients, who also had a similar mortality rate (85%). Mortality was also high in patients with multisystem organ failure or with ARDS and disseminated intravascular coagulation. These results indicate that there probably is a relatively low incidence of ARDS among hospital patients admitted with high-risk diagnoses.
Asunto(s)
Síndrome de Dificultad Respiratoria/epidemiología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adulto , Anciano , California , Coagulación Intravascular Diseminada/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía por Aspiración/complicaciones , Neumonía por Pneumocystis/complicaciones , Estudios Prospectivos , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/mortalidadRESUMEN
The utility of predicting theophylline clearance (CL) from two serum concentrations obtained during continuous intravenous aminophylline infusion was examined in 16 stable, adult patients. Blood for theophylline measurement was obtained 0, 6, and 12 h after starting infusions and, thereafter, at 12-h intervals. EMIT was used to assay samples in multiple runs as they were obtained. Later, each sample was reassayed by EMIT within a single run. Bayesian least-squares regression and the algebraic method of Chiou were used to predict CL using the 0,6 and 0,12 h concentrations. "Actual" CL was measured by nonlinear least-squares regression of all concentrations obtained during prolonged infusions. Prediction bias and precision were assessed by calculating mean percent error (PCE) and mean absolute percent error (APCE), respectively. A three-way repeated-measures ANOVA was used to examine the effect of the method of CL prediction, assay procedure, and time interval between samples on PCE and APCE. Bayesian predictions were less biased and slightly more precise than Chiou predictions. The assay procedure had no effect on bias but precision was improved using a single-assay run. Predictions were less biased and more precise with 0,12 h versus 0,6 h data. Serum samples for theophylline measurement should be obtained after initiating constant intravenous aminophylline and again 8-12 h later in stable, adult patients. Prediction of CL with either of the concentration-based methods studied will then allow safe and rapid adjustment of dosage to achieve therapeutic serum concentrations.
Asunto(s)
Aminofilina/metabolismo , Teofilina/metabolismo , Adulto , Anciano , Aminofilina/administración & dosificación , Femenino , Humanos , Infusiones Parenterales , Cinética , Masculino , Persona de Mediana EdadRESUMEN
Evaluation of a series of 12 chordoid sarcomas suggests that there is a wider range of histological features in this entity then previously appreciated. Six of the lesions had a typical tumor cell organization and a mixture of cellular and myxoid stromal components, while the remaining cases were atypical because of a more solid growth pattern. Four of the 12 cases, that included both typically myxoid and more cellular examples, had small foci with hyalinized stroma segragating individual or small groups of tumor cells with and without lacunar spaces. Two atypical cases revealed more extensive and obvious chondrocytic differentiation in recurrent or metastatic lesions and in one of these, the histological pattern was that of mesenchymal chondrosarcoma. Ultrastructural examination of three cases revealed fine structural features of both the tumor cell population and extracellular matrix compatible with chondrocytic differentiation. Results of light and electron microscopy of this series of chordoid sarcoma add further support for categorizing this tumor with other malignant chondrocytic neoplasms. It is probable that chordoid sarcoma and extraskeletal myxoid chondrosarcoma represent the same entity and that this lesion has a close histogenetic relationship to mesenchymal chondrosarcoma.
Asunto(s)
Condrosarcoma/patología , Neoplasias de los Tejidos Blandos/patología , Adulto , Anciano , Condrosarcoma/ultraestructura , Femenino , Humanos , Masculino , Microscopía Electrónica , Persona de Mediana Edad , Neoplasias de los Tejidos Blandos/ultraestructuraAsunto(s)
Hipoxia/prevención & control , Intubación Intratraqueal/instrumentación , Succión/métodos , Irrigación Terapéutica/métodos , Adulto , Humanos , Hipoxia/etiología , Recién Nacido , Intubación Intratraqueal/efectos adversos , Terapia por Inhalación de Oxígeno , Respiración con Presión Positiva/métodos , Insuficiencia Respiratoria/terapiaAsunto(s)
Traumatismos Craneocerebrales/complicaciones , Trastornos Respiratorios/terapia , Arterias , Dióxido de Carbono/sangre , Humanos , Hiperventilación/fisiopatología , Presión Parcial , Penicilinas/uso terapéutico , Neumonía por Aspiración/tratamiento farmacológico , Neumonía por Aspiración/etiología , Edema Pulmonar/diagnóstico , Trastornos Respiratorios/etiología , Trastornos Respiratorios/fisiopatología , Respiración ArtificialRESUMEN
A case of invasion of the brain of a 48-year-old man, a native of Louisiana, by a larval tapeworm is described. Inasmuch as there were no scolices or rostellar hooks present the parasite was identified as a racemose cysticercus which could be either a sterile coenurus of Taenia multiceps (= Multiceps multiceps), Taenia serialis (= Multiceps serialis), or an aberrant cysticercus of Taenia solium or of a different species of Taenia. Most of the parasite was removed surgically with a preoperative diagnosis of brain tumor. After operation the patient improved, and 32 months after onset of his illness he was working and showed no evidence of a recurrence.
Asunto(s)
Encefalopatías/parasitología , Cisticercosis/parasitología , Encéfalo/parasitología , Cysticercus/anatomía & histología , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
A 70-year-old man had the superior vena cava syndrome. At thoracotomy a retained central venous pressure line was found to be the cause of venous thrombosis at the outlet of the superior vena cava into the right atrium. A retained central venous pressure catheter and catheter-induced venous thrombosis should be added to the list of causes of the benign form of the superior vena cava syndrome.