RESUMEN
In recent years, it has been our practice to treat persistent hypotension in the cardiac intensive care unit with glucocorticoids. We undertook a retrospective review in an attempt to identify predictors of a hemodynamic response to steroids and of survival in these patients. Patients who had received glucocorticoids for hypotension over a 2-year period were identified retrospectively. Summary measures of blood pressure, heart rate, urine output, inotrope score, and volume of infused fluid were calculated for the 12 hours before and the 24 hours following initiation of glucocorticoid therapy. A hemodynamic response was defined as a > or =20% increase in mean blood pressure without an increase in inotrope score following initiation of steroid therapy. Fifty-one patients were included, of whom 6 (11.8%) died. Serum cortisol was measured in 43 patients (84.3%) and was below the lower limit of normal (<5 microg/dl) in 20 of these (46.5%). Following initiation of steroid therapy, blood pressure and urine output increased, whereas heart rate, inotrope score, and infused volume decreased. There were 21 (41.1%) hemodynamic responders, all of whom survived, whereas 6 of 30 (20%) nonresponders died (p = 0.036). No predictors of a hemodynamic response to steroid were identified. Some critically ill children with cardiac disease and inotrope refractory hypotension demonstrated hemodynamic improvement following glucocorticoid administration. An improvement in blood pressure following administration of glucocorticoid was associated with survival, but we were unable to identify predictors of that response.
Asunto(s)
Cardiotónicos/uso terapéutico , Glucocorticoides/uso terapéutico , Hipotensión/tratamiento farmacológico , Factores de Edad , Presión Sanguínea/efectos de los fármacos , Niño , Preescolar , Dopamina/uso terapéutico , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Hidrocortisona/sangre , Hipotensión/mortalidad , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Pediátrico , Modelos Logísticos , Estudios Retrospectivos , Estadísticas no Paramétricas , Micción/efectos de los fármacosAsunto(s)
Puente Cardiopulmonar , Cardiopatías Congénitas/cirugía , Enfermedades Pulmonares/metabolismo , Pulmón/metabolismo , Surfactantes Pulmonares/metabolismo , Biomarcadores , Humanos , Lactante , Pulmón/fisiopatología , Enfermedades Pulmonares/fisiopatología , Fosfolípidos/metabolismo , Complicaciones Posoperatorias , Proteínas/metabolismoRESUMEN
The protein sequence of ATP/CTP:tRNA nucleotidyltransferase (cca) from Sulfolobus shibatae was used to search open reading frames in the genome of Methanococcus jannaschii. Translations of two unidentified open reading frames showed significant sequence similarity to portions of the Sulfolobus cca protein. When the two open reading frames were joined together, the expanded open reading frame was similar in sequence to the entire Sulfolobus cca protein and displayed features of the active site signature sequence proposed for members of class I enzymes within the superfamily of nucleotidyltransferases (Yue et al., 1996, RNA 2, 895-908). A possible UUG start codon was identified based on significant sequence similarity of the resulting amino-terminal region to that of Sulfolobus, and on a six-base complementarity between an adjacent upstream sequence and Methanococcus 16S rRNA.
Asunto(s)
Archaea/genética , Genes Bacterianos , Genoma Bacteriano , Methanococcus/genética , ARN Nucleotidiltransferasas/genética , Secuencia de Aminoácidos , Datos de Secuencia Molecular , Sistemas de Lectura Abierta/genética , Alineación de SecuenciaRESUMEN
Early cytological diagnosis in a patient presenting with acute abdominal pain averted laparotomy and expedited successful management. The place of cytological diagnosis in patient management is discussed.
Asunto(s)
Citodiagnóstico , Linfoma no Hodgkin/diagnóstico , Abdomen/cirugía , Adulto , Antineoplásicos/administración & dosificación , Biopsia , Líquidos Corporales/citología , Diagnóstico Diferencial , Quimioterapia Combinada , Humanos , Ganglios Linfáticos/patología , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/patología , Masculino , Dolor/diagnóstico , Neoplasias Retroperitoneales/diagnóstico , Neoplasias Retroperitoneales/patologíaRESUMEN
A primary aortoduodenal fistula is usually associated with an atherosclerotic aortic aneurysm, and a secondary fistula with a leaking anastomotic aortic suture line. Two examples of each are reported. The typical features of a primary fistula are haematemesis or melaena, pain, and a pulsatile abdominal mass; the features of a secondary fistula are haematemesis and melaena with a past history of aortic resection. The initial haemorrhage is rarely fatal: a lag period allows urgent laparotomy. The fistula is diagnosed by dissection of the fourth part of the duodenum from the aorta. The treatment is closure of the duodenum, and resection of an aneurysm if present. Reconstruction is by a graft anastomosed to the aorta proximal to the fistula, if the area is clean, or by an extra anatomical bypass, if the area is heavily contaminated.