Assuntos
Serviço Hospitalar de Oncologia , Centro Cirúrgico Hospitalar , Cirurgia Torácica , Educação Médica Continuada , Hospitais de Ensino/organização & administração , Humanos , México , Serviço Hospitalar de Oncologia/organização & administração , Editoração , Previdência Social , Centro Cirúrgico Hospitalar/organização & administração , Cirurgia Torácica/educação , Cirurgia Torácica/organização & administração , Recursos HumanosAssuntos
Adenocarcinoma/diagnóstico por imagem , Asma/diagnóstico , Neoplasias Pulmonares/diagnóstico por imagem , Sons Respiratórios/etiologia , Adenocarcinoma/complicações , Adenocarcinoma/secundário , Asma/diagnóstico por imagem , Espasmo Brônquico/etiologia , Broncoscopia , Feminino , Humanos , Neoplasias Renais , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/secundário , Pessoa de Meia-Idade , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
A study was conducted in 14 patients with pericardial syndrome after pulmonary embolism. The role of right ventricular myocardial injury and noncardiogenic pulmonary edema in this syndrome is considered and its existence is established.
Assuntos
Pericardite/etiologia , Embolia Pulmonar/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pericardite/diagnóstico , Pericardite/tratamento farmacológico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamento farmacológico , SíndromeRESUMO
To test the efficacy of intrapleural fibrinolytic therapy in patients with loculated pleural effusions, we conducted an open, prospective, and multicenter trial among five hospitals in Mexico. We enrolled patients with hemothorax or empyema, clotted and/or loculated, that was not resolved through conventional pleural drainage with chest tube and antibiotics in patients with empyema. All patients received repeated doses of 250,000 IU of streptokinase through chest tube. Effectiveness criteria were before and after intrapleural streptokinase (IPSK) drainage, and poststreptokinase radiographic and respiratory function test improvement. Forty-eight patients were studied; there were 30 patients with empyemas, 14 with hemothorax, and 4 patients with malignant pleural effusions without lung trapping. Successful fibrinolysis was obtained in 44 patients, with complete resolution of the pleural collection and adequate radiologic and spirometric improvement. In three of four patients with multiloculated malignant hemothorax with high-yielding pleural drainage, IPSK allowed successful lysis of loci and an adequate pleurodesis was achieved. Only four patients required surgical treatment. The overall success rate in our series was 92%, similar to previous reports. The results in this first prospective and multicentric trial suggest that intrapleural fibrinolysis is an effective and safe adjunctive treatment in patients with heterogeneous pleural coagulated and loculated collections to restore the pulmonary function assessed by respiratory function tests and can obviate surgery in most cases.
Assuntos
Empiema Pleural/tratamento farmacológico , Hemotórax/tratamento farmacológico , Estreptoquinase/uso terapêutico , Terapia Trombolítica , Adolescente , Adulto , Idoso , Tubos Torácicos , Terapia Combinada , Drenagem , Empiema Pleural/diagnóstico por imagem , Feminino , Hemotórax/diagnóstico por imagem , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Derrame Pleural Maligno/diagnóstico por imagem , Derrame Pleural Maligno/tratamento farmacológico , Estudos Prospectivos , Estreptoquinase/administração & dosagem , Estreptoquinase/efeitos adversos , Terapia Trombolítica/efeitos adversos , Tomografia Computadorizada por Raios XRESUMO
A 68 year old male with multisystemic disease, mainly lungs and heart, was treated with a cuffed endotracheal tube, mechanical ventilation and a 16 Fr Levin nasogastric tube for feeding; it was substituted 13 days later by a 2.3 mm, 8 Fr O'Brien KMI polyurethane small bore enteral feeding tube introduced with a guide wire. The feeding tube perforated his right lung and passed into the pleural cavity, either through the larynx or through a nonconfirmed tracheoesophageal fistula; signs for the supposedly correct position of the tube were positive. In patients with depressed sensoria, abnormalities of gag or cough reflexes, esophageal strictures, significant cardiomegaly or tracheoesophageal fistula, small bore enteral feeding tubes should be passed under direct vision by laryngoscopy or preferably by flexible endoscopy; adequate confirmation of the correct position requires a chest and an upper abdominal roentgenogram.
Assuntos
Nutrição Enteral/instrumentação , Intubação Gastrointestinal/efeitos adversos , Lesão Pulmonar , Idoso , Humanos , Doença Iatrogênica , Pulmão/diagnóstico por imagem , Masculino , Pneumotórax/etiologia , RadiografiaRESUMO
Even pediatricians and cardiologists the complex congenital heart disease is considered to be difficult chapter. The purpose of this review is to show that complex congenital heart disease is not difficult to understand it two avenues are followed: First, a detailed explanation of the methodology used for the segmental analysis is given; all possible segmental combinations are reviewed. Second, 5 basic rules for this analysis are proposed: symmetry of the first segment, a discordant intersegmentary connection, two discordant intersegmentary connections, absence or hypoplasia of one the elements of the ventricular or arterial segment and both components of the arterial segment join one instead of the two ventricles. If these concepts are mastered, the basis for a correct diagnosis and suitable treatment are established.
Assuntos
Cardiopatias Congênitas/diagnóstico , Coração/anatomia & histologia , HumanosRESUMO
We report our experience with five children with pulmonary embolism and infarction. Two with congenital heart disease, one with rheumatic cardiopathy and two with a previously healthy cardiopulmonary system. The risk factors, clinical behavior and ECG were similar to those in adults. In chest roentgenogram we found pulmonary infarction with cavitations in three patients because of a delayed diagnosis. All patients had hypoxemia and hypocapnia, and diagnosis was made on the basis of segmentary or larger defects in perfusion gammagraphy. In just one case we obtained V/Q gammagraphy and pulmonary angiography. In one case we confirmed the clinical diagnosis by autopsy. We conclude that it is very important to keep this diagnosis in mind in all children with respiratory failure.
Assuntos
Embolia Pulmonar/diagnóstico , Adolescente , Criança , Pré-Escolar , Feminino , Heparina/administração & dosagem , Humanos , Masculino , Embolia Pulmonar/tratamento farmacológico , RecidivaAssuntos
Carcinoma Broncogênico/diagnóstico , Neoplasias Pulmonares/diagnóstico , Biópsia , Carcinoma Broncogênico/patologia , Carcinoma Broncogênico/cirurgia , Terapia Combinada , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , RadiografiaRESUMO
Forty patients with overt pulmonary edema secondary to ischemic heart disease were treated in the emergency room with iv ouabain and furosemide; 20 patients in Group A received sublingual nifedipine before undergoing early tracheal intubation and mechanical ventilation with 100% FiO2 during 15 min. and then 50% FiO2; 20 patients in Group B received iv aminophylline, rotating tourniquets and IPPB by mask with 60% FiO2. All patients in Group A were extubated after 66 +/- 10.8 min. in the emergency room; 7 in Group B improved but 13 had to undergo tracheal intubation and mechanical ventilation. Upon arrival at the ICCU all had a Swan-Ganz catheter installed and received comparable therapy for ischemic heart disease. Statistically significant differences in favor of patients in Group A as compared to the 7 improved in B were seen in heart rate, arrhythmias, diastolic blood pressure, mean and wedge pulmonary pressures, systemic resistances, arterial pH and PaO2; when compared to the 13 patients undergoing late tracheal intubation and mechanical ventilation, parameters were more or less similar but improvement appeared later and extubation took place after 1.94 +/- 1.24 days (P less than 0.05). Three patients in Group B died in the emergency room, 3 in Group A and 4 in B died in the ICCU (P less than 0.01). Early tracheal intubation and mechanical ventilation in patients with overt pulmonary edema secondary to ischemic heart disease produce better results due to early improvement in pulmonary and systemic hemodynamics and should be considered in all such patients arriving at the emergency room.
Assuntos
Doença das Coronárias/complicações , Intubação Intratraqueal , Edema Pulmonar/etiologia , Respiração Artificial , Adulto , Feminino , Hemodinâmica , Humanos , Respiração com Pressão Positiva Intermitente , Masculino , Pessoa de Meia-Idade , Edema Pulmonar/fisiopatologia , Edema Pulmonar/terapiaRESUMO
Se comunica el caso de una enferma de 19 anos con telangiectasia hemorragica hereditaria acompanada de fistula arteriovenosa pulmonar macroscopica unica del lobulo superior derecho, con suplemento arterial proveniente de la circulacion pulmonar y drenaje anormal de las venas del lobulo medio en la vena pulmonar inferior.Se identificaron cinco pacientes conseguineos con epistaxis (dos fallecidos a consecuencia de ellas); los tres vivos tenian telangiectasias en piel y mucosas y ninguno fistula arteriovenosa pulmonar. Los estudios para identificar sindrome de coagulacion intravascular y enfermedad de Von Willebrand acompanantes fueron negativos.La reseccion del lobulo superior derecho fue seguida por desaparicion de las manifestaciones clinicas y normalizacion de las pruebas de la funcion pulmonar
Assuntos
Adulto , Humanos , Feminino , Artéria Pulmonar , Fístula Arteriovenosa , Telangiectasia Hemorrágica Hereditária , Medidas de Volume PulmonarRESUMO
Se presenta un caso de sindrome de inmunodeficiencia adquirida (SIDA) de un homosexual masculino en Mexico, correspondiente a un sujeto de 27 anos, previamente sano, quien tres meses antes de iniciar su padecimiento visito San Francisco, California, USA. El SIDA se caracterizo por amibiasis intestinal y gran ataque al estado general seguidos por enfermedad pulmonar alveolar e intersticial bilateral difusa; la biopsia pulmonar pulmonar a cielo abierto permitio elaborar el diagnostico de neumonitis por citomegalovirus y neumonia por Pneumocystis carinii; el enfermo fallecio con manifestaciones de sindrome de insuficiencia respiratoria progresiva del adulto y de toxiinfeccion. En la necropsia se encontraron, ademas de las lesiones pulmonares, candidiasis esofagogastrica empiema y bacteremia multibacterianos, colilis amibiana y linfadenopatia inmunoblastica con eritrofagocitosis y leucofagocitosis graves; en el estudio ultraestructural se observaron rosetas vesiculares en el citoplasma de celulas linfoides, inclusiones tubulorreticulares en el citoplasma de linfocitos, monocitos y celulas endoteliales de los sinusoides ganglionares, y particulares virales en el citoplasma de los linfocitos
Assuntos
Adulto , Humanos , Masculino , Síndrome da Imunodeficiência AdquiridaRESUMO
Se presenta una casuistica de 704 pacientes en quienes se practico cierre de comunicacion interauricular com ayuda de circulacion extracorporea. Su edad vario de 13 meses a 53 anos. Se describen sus caracteristicas clinicas, manejo medico y quirurgico y evolucion. Hubo cinco muertes didato ideal parece ser uno de 5 a 16 anos de edad, corto circuito de mas de 1.9 a 1.0 y presion en arterial pulmonar no mayor de 40 mmHg sistolica a 20 mmHg media.postoperatorias inmeditas (0,71%). El candidato ideal parece ser uno de 5 a 16 anos didato ideal parece ser uno de 5 a 16 anos de edad, corto circuito de mas de 1.9 a 1.0 y presion en arteria pulmonar no mayor de 40 mmHg sistolica a 20 mmHg media