Medicina
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Non compact of the left ventricular myocardium is a rare congenital cardiomyopathy characterized by the presence of multiple and prominent deep trabeculations in the ventricular wall, that define recesses communicated with the main ventricular chamber. This is a condition with low incidence and prevalence, diagnosed through imaging techniques such as Doppler echocardiogram (DE), multi-slice computed tomography (MSCT) or magnetic resonance imaging (MRI). Clinically, it may be asymptomatic or manifested by cardiac arrhythmias, heart failure or thromboembolism. ⋯ A DE obtained initially, did not show any significant abnormality, but another DE, a MSCT and a RMN obtained after discharge, certified isolated non-compacted myocardium, ruling out coronary artery disease. He received beta blocker and antiplatelet therapy and the placement of an automatic cardioverter defibrillator was considered. The pathophysiology of the association of these two infrequent and potentially lethal conditions is discussed.
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Comparative Study
[Quinolone resistant Campylobacter jejuni strains isolated from humans and from poultry].
Eight quinolone resistant Campylobacter jejuni strains isolated from humans with diarrheal disease were compared with 23 isolates from chicken and from laying hens. Samples were cultured on selective agar in microaerophilia, identified by conventional tests, and conserved in 17% glycerol at -70 C. Clones were determined by RAPD-PCR employing the 1254 primer (Stern NJ). ⋯ Pattern III was only obtained from humans whereas pattern IV was only obtained from poultry. A 95.3% of clones were found in both, humans and poultry. According to these results colonization by quinolone resistant strains could be the origin of this human infection, acquired by ingestion.
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There is not consensus about the true influence of age on mortality associated to mechanical ventilation (MV). We performed a prospective study in order to determine if age is an independent factor to predict mortality in patients under MV. Two hundred patients requiring MV at the intensive care unit were included and clinical variables at admission, co-morbidities, complications and outcome at the hospital and after 6 months were registered. ⋯ Multivariate analysis showed that only an APACHE II score > 20 (p = 0.0077) or the absence of an autonomous life (p = 0.0028) were independent predictive factors of mortality. Elderly patients under mechanical ventilation do not show a higher mortality because of the advance age in itself. Restriction of mechanical ventilation and invasive care does not seem to be justified based on the advanced age.
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Medical technology applied to acute and severely ill patients allowed for the emergence of a differentiated area of care and the development of intensive care units. The means available to replace or assist vital organs' functions determined this crucial advance of high technology medicine in the last forty years. ⋯ This pervasive influence adversely affects the chances to permanently remember the ends of medicine, which are not to avoid death or to consider life as the supreme value irrespectively of the patients' preferences. Final decisions in irreversible situations, where only a life in vegetative condition is possible, are to be taken by doctors and family members.
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Metabolic activity can be down-regulated throughout the reduction of mitochondrial population. Lowering O2 demand in cardiogenic, hemorrhagic and septic shock is here examined through clinical observations and trials. A decrease in the availability of O will be followed by reductions in mitochondrial population and, therefore, in a decrease in O2 demand. ⋯ Decoupling of mitochondrial oxidative phosphorylation occurs in both experimental models and in clinical septic shock. In critical patients this phenomenon may be detected by an inordinate increase in VO2 in response to a therapeutically increased DO. This hipermetabolic stage can be mistakenly interpreted as the repayment phase of an O2 debt.