RESUMO
We have studied the swallowing apnea in 66 persons. Five were laryngectomized. We analysed 1916 breathing/swallowing correlation charts, 109 in laryngectomized and 1807 in not laryngectomized persons. The correlation charts were done using a piezoelectric and thermistor register coupled to a manometric system developed by Synetics Medical interfaced to a microcomputer running software Polygram upper 4.21. Our observation allows us to conclude that: 1. the swallowing apnea has not the same reflex path of the breathing interruption that occurs when a foreign body stimulates the laryngeal receptors; 2. the swallowing apnea installation is not dependent on the laryngeal structures; 3. the swallowing apnea and rima glottidis closure, that occur in the same moment, are correlated phenomena, but are a distinct part of the airway protective mechanisms; and 4. even though the swallowing apnea can occur in every moment of the breathing cycle, it occurs more frequently at the end of expiratory and beginning of the inspiratory phase of breathing cycle; it is usually continued by a complementary expiration. We believe that the less lung volume is the basic condition to the establishment of the more frequent kind of swallowing apnea reflex.
Assuntos
Apneia/fisiopatologia , Transtornos de Deglutição/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Laringectomia/efeitos adversos , Masculino , Manometria , Pessoa de Meia-Idade , Periodicidade , RespiraçãoRESUMO
The mother's perception of signs and symptoms of dehydration in children under three years of age was studied and compared with the medical classification. The study was carried out in a children's hospital in the city of Rio de Janeiro, among children hospitalized with diarrhoea between January, 1987 and February, 1988. The number of excretions and of vomitings, thirst and condition of eyes constituted the signs and symptoms most frequently reported by mothers. However, they had difficulty in judging the amount of urine, humidity of mouth and tongue and turgidity of the skin. These signs were almost always regarded as normal or, at most, as indicating only slight alteration. Those mothers who tended to underestimate the severity of the dehydration indicated by the physician were of a lower educational level and had more severely undernourished children and greater difficulty of access to the hospital. On the other hand, those who tended to overestimate it belonged to a higher educational level, had better-nourished children, greater ease of access to the hospital and were attended to by a smaller number of health care services before reaching the hospital surveyed. Those who agreed with the medical diagnosis were in an intermediate situation, although they tended to be closer to those who underestimated the gravity of the dehydration. Those mothers whose children had already gone through a dehydration episode did not present a more intense agreement with the physician's diagnosis, thus evidencing that the information afforded at the health care service was either non-existent or inadequate.
Assuntos
Desidratação/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Mães , Pré-Escolar , Diarreia Infantil/complicações , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Fatores SocioeconômicosRESUMO
Severe hemorrhage in pentobarbital-anesthetized dogs (25 mg/kg) is reversed by intravenous NaCl (4 ml/kg, 2,400 mosmol/l, 98% long-term survival). This paper compares survival rates and hemodynamic and metabolic effects of hypertonic NaCl with sodium salts (acetate, bicarbonate, and nitrate), chlorides [lithium and tris(hydroxymethyl)aminomethane (Tris)], and nonelectrolytes (glucose, mannitol, and urea) after severe hemorrhage (44.5 +/- 2.3 ml/kg blood loss). Sodium salts had higher survival rates (chloride, 100%; acetate, 72%; bicarbonate, 61%; nitrate, 55%) with normal stable arterial pressure after chloride and nitrate; near normal cardiac output after sodium chloride; normal acid-base equilibrium after all sodium salts; and normal mean circulatory filling pressure after chloride, acetate, and bicarbonate. Chlorides and nonelectrolytes produced low survival rates (glucose and lithium, 5%; mannitol, 11%; Tris, 22%; urea, 33%) with low cardiac output, low mean circulatory filling pressure, and severe metabolic acidosis. Plasma sodium, plasma bicarbonate, mean circulatory filling pressure, cardiac output, and arterial pressure correlated significantly with survival; other parameters, including plasma volume expansion or plasma osmolarity, did not. It is proposed that high plasma sodium is essential for survival.