Postgraduate medical journal
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Systemic and renal haemodynamic and functional indices were measured in 15 anaesthetised pigs during systemic sepsis induced by faecal peritonitis. Five animals were assigned to maintenance of cardiac output (CO) at baseline, pre-infection values throughout the study (controls n = 5). In the remaining 10 animals, CO was increased by 25% prior to induction of sepsis and maintained at this level for the duration of the study using volume expansion with intravenous colloid and an infusion of either 20 micrograms/kg/min dobutamine (n = 5) or placebo (n = 5). ⋯ In the dobutamine group systemic oxygen uptake (VO2) increased from 173 +/- 30 to 277 +/- 73 ml/min (P less than 0.05), however this resulted in a decrease in renal DO2 (20 +/- 9 to 10 +/- 2 ml/min P less than 0.05) and there was no equivalent rise in renal VO2 (3.3 +/- 1.6 to 3.2 +/- 1.5 ml/min). There was however no significant difference in the effect on renal function of the three management protocols. Agents used to increase cardiac output during systemic sepsis may result in significantly different effects on the renal vascular bed which are not revealed by the measurement of systemic indices alone.
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A 77 year old woman, with chronic immobility, developed bed sores which became infested with maggots. This progressed to cutaneous myiasis which is an uncommon complication of this particular phenomenon.
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Case Reports
Diagnostic aspiration of an iatrogenic hydrothorax following subclavian catheterization.
Central venous catheterization is not without hazard. Inadvertent placement in the pleural space can occur without the development of a pneumothorax and pressure measurements may appear misleadingly normal. This case report illustrates an effective method of diagnosing and draining an iatrogenic hydrothorax which resulted in this way.