Medicina
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Case Reports Comparative Study
Pulmonary edema and hemorrhage as complications of acute airway obstruction following anesthesia.
Airway obstruction is a quite common complication while its conditioned pulmonary edema--rare. Causes associated with anesthesia are various. Forced inspiratory efforts against an obstructed upper airway generate peak negative intrathoracic pressure. ⋯ Early diagnosis of negative-pressure pulmonary edema or pulmonary hemorrhage is very important, because this affects postoperative morbidity and mortality of the patients. Two cases of pulmonary edema and hemorrhage after upper airway obstruction as well as literature overview are presented in this article. Pulmonary hemorrhage developed during anesthesia with ketamine, conditioned by increment of hydrostatic pressure, hypoxia, and effects of ketamine on hemodynamics.
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Comparative Study
A volume loading test for the detection of hypovolemia and dehydration.
There is a need for simple method allowing detection of dehydration and hypovolemia. Based on a new theory of homeostatic blood states, we hypothesized that hemodilution following standardized crystalloid fluid bolus can be used to discriminate between baseline normohydration and dehydration, also normovolemia and hypovolemia. ⋯ In response to fluid load, the baseline dehydration exaggerates the lowering of residual hemoglobin in respect to baseline. Meanwhile, baseline hypovolemia exaggerates the lowering of peak hemoglobin concentration. The volume loading test that deploys interpretation of hemoglobin dynamics in response to the test volume load could possibly serve as an easily available guide to indicate an individual patient's baseline hydration state and volemia. The introduction of continuous noninvasive monitoring of hemoglobin concentration would expand the applicability of the new method.
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Relevance of platelet transfusion is related to an increasing number of indications due to conditions with an increased risk for hemorrhage and a lack of standard protocols both for treatment and prophylaxis of thrombocytopenia, in the presence of high costs of this procedure. The appropriate use of platelet transfusion is associated with reduction of thrombocytopenia, which actually in a critically ill patient is associated with increased length of stay both in intensive care unit and hospital. In 2003, the Professional Consensus was established to define the main recommendations for platelet transfusion. ⋯ It is recommended that the platelet count in one dose of platelets transfused would be not lower than 55 x 10(9)/L in order to increase the platelet count by 5-10 x 10(9)/L. The effectiveness of platelet transfusion is evaluated 10-60 min, 18 hours, and 24 hours after transfusion. Advantages of platelet transfusion of small and large doses are presented.
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Comparative Study
The influence of fluid balance on intra-abdominal pressure after major abdominal surgery.
The objectives of this study were to determine the incidence of intra-abdominal hypertension in patients after major abdominal surgery and to evaluate the correlation of intra-abdominal pressure with fluid balance and systemic inflammatory response syndrome. ⋯ Intra-abdominal hypertension occurs commonly in patients after major abdominal surgery, and patients with positive 24-hour fluid balance and/or systemic inflammatory response syndrome are at risk of having higher intra-abdominal hypertension.
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To evaluate efficacy of diagnostic procedures, results of surgery, and complications in malignant pleural diseases. ⋯ In noninvasive methods, the highest sensitivity was achieved for chest computed tomography and magnetic resonance imaging (97%); the specificity of chest magnetic resonance imaging was 100%, and the specificity chest computed tomography and magnetic resonance imaging--98%. The accuracy of chest x-ray plus computed tomography was 98%. In invasive methods, accuracies of pleural biopsy, video-assisted thoracoscopic pleural biopsy, and pleurectomy were 100%, 90%, and 100%, respectively. In case of primary pleural tumors, the main surgery was extended pleuropulmonectomy (45.2%) with or without mediastinal resection. Mortality rate was 6.5%. In case of metastatic pleural disease, the main surgery was video-assisted thoracoscopic pleurectomy (19.7%). Mortality was rate 5%. In cases of pleural invasion by other thoracic malignancies, the main surgeries were chest wall and pleural resection (13.2%) and lung and pleural resection (15.8%). Mortality rate was 2.8%. After 169 operations due to malignant pleural diseases, the rate of postoperative complications ranged from 1.3% to 7.8%.