Medicina
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The aim of the present study was to evaluate the hemodynamic and respiratory variations in patients with acute respiratory distress syndrome (ARDS) under two conditions: volume controlled ventilation (VCV) and pressure controlled inverse ratio ventilation (PCIRV). Seventeen patients with ARDS and the following criteria were included: lung injury score > 2.5 and peak inspiratory pressure > or = 40 cm H2O under VCV, constant flow and I/E ratio of 1/2. Measurements were obtained in VCV and after one hour in PCIRV with I/E ratio 2/1 using a similar PEEP value than VCV. ⋯ Our results show that PCIRV allow to ventilate patients with lower peak inspiratory and plateau pressures without significant changes in hemodynamic and oxygenation parameters. The conventional tidal volumes are excessive for lungs with SDRA, which is shown with the improvement in the static compliance and the airway pressures in PCIRV. PCIRV mode at the same PEEPt level as VCV, with normal I/E ratio does not improve the oxygenation, despite the higher level of the mean airway pressure.
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A case of polymyalgia rheumatica with atypical manifestations, including carpal tunnel syndrome, distal myalgias and a low eritro sedimentation is reported. The association of polymyalgia rheumatica and carpal tunnel syndrome is controversial. ⋯ This form of presentation and its response to treatment suggest that the symptoms of carpal tunnel syndrome are caused by the inflammation of the carpal synovial, which is an unfrequent manifestation of polymyalgia rheumatica. We report this case for the purpose of altering to an unusual form of presentation of polymyalgia rheumatica in order to avoid unnecessary surgery for the carpal tunnel syndrome.
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We report the case of a 45-year old man who presented a common hepatic artery aneurysm. He had alcoholic habits and after an episode of upper gastrointestinal tract bleeding underwent an abdominal ultrasound study. This showed a large fluid-filled upper abdominal mass related to the pancreatic head. ⋯ The patient was discharged a week after surgery. Most of the hepatic artery aneurysms are free of symptoms and difficult to palpate and only a few patients can be operated before the occurrence of aneurysmal fissure. Broad use of ultrasound and selective angiography has increased the number of cases diagnosed before complications, reducing the mortality rate, which, in the past, has been reported up to 59%.
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Using a flagellated (052) and an aflagellated (T-1) strains we studied the participation of flagellar epitopes of C. jejuni in the adhesion to HEp-2 cells in vitro. Strain 052 was significantly more adherent than strain T-1. ⋯ With an ELISA test it was demonstrated that those monoclonal antibodies were specific and directed exclusively against flagellar epitopes of strain 052 being unreactive with strain T-1. Our results show that flagellar epitopes could participate in the adhesion process suggesting that flagella could be involved in the installation of the infectious process.
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Case Reports
[Native-valve endocarditis produced by Lactobacillus casei sub. rhamnosus refractory to antimicrobial therapy].
Lactobacillus endocarditis is a rare infection. In fact, only 42 cases have been described in the literature from 1938 up to date. In only 17 previously reported cases have patients been cured with medical therapy alone. ⋯ The patient displayed a successful clinical outcome, with no evidence of recurrence along the subsequent 2 years. We point out the need to accurately identify Lactobacillus spp. in isolates from blood cultures of patients with endocarditis, since these bacteria may often be mistaken for other species more frequently associated to this infection, which usually respond to conventional antimicrobial therapy. Furthermore, we suggest that early surgical replacement should be considered when lactobacillus endocarditis is diagnosed.