Medicina
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Heart failure impairs the heart's pumping ability and triggers catecholamine production as an adaptive mechanism. Uterine leiomyomas are common tumors of the female reproductive tract. Their growth is promoted by dysregulated angiogenesis and gonadal steroid hormones. ⋯ Growth factors and the compression effect of uterine leiomyomas may predispose patients to heart failure and exacerbate its deterioration. Although reports of fibroid-related heart failure are rare, uterine leiomyomas should be considered a potential cause of refractory heart failure. Nevertheless, a direct association requires a longer follow-up period.
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Advanced hemodynamic monitoring is fundamental in the management of the critically ill. Blood pressure and cardiac function are key markers of cardiovascular system function;, thus, having accurate measurements of these parameters in critically ill patients is essential. Currently, there are various methods available to choose from, as well as a greater understanding of the methods and criteria to be able to compare devices and select the best option for our patients' needs. ⋯ Pulse index contour continuous cardiac output (PiCCO) is a minimally invasive hemodynamic monitoring technique, integrating various static and hemodynamic parameters through a combination of trans-cardiopulmonary thermodilution and pulse contour analysis. The PiCCO method provides guidance to fluid and vasoactive therapy in critically ill patients and is also used for intraoperative and postoperative fluid management and monitoring in cardiac surgery. While invasive methods such as PiCCO are recommended for hemodynamic monitoring and can provide accurate information, they are not always necessary and are contraindicated in some cases.
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Background and Objectives: Patients with primary Sjögren's disease (pSjD) show contradictory results regarding the activity of the hypothalamic-pituitary-adrenal (HPA) axis. The aim of this study was to determine the salivary cortisol concentration to evaluate the function of the HPA axis (hypoactive/hyperactive) between patients with pSjD and control subjects. Materials and Methods: A total of 34 subjects participated in the cross-sectional study: 17 patients with pSjD and 17 control subjects. ⋯ The patients with pSjD had four times higher scores for depression and stress and six times higher scores for anxiety compared to the control subjects (p = 0.048, p < 0.001, p = 0.038; Mann-Whitney U test). The patients with pSjD had a statistically significantly higher total Oral Health Impact Profile (OHIP) score compared to the control subjects (p < 0.001, Mann-Whitney U test). Conclusions: The patients with pSjD showed short-term hyperactivity of the HPA axis compared to the control subjects.
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Transient Elevation of Liver Function Tests and Bilirubin Levels After Laparoscopic Cholecystectomy.
Background and Objectives: Laparoscopic cholecystectomy constitutes the current "gold standard" treatment of symptomatic gallstone disease. In order to avoid intraoperative vasculobiliary injuries, it is mandatory to establish the "critical view of safety". In cases of poor identification of the cystic duct and artery leading to a missed intraoperative injury, patients present with elevated liver function tests (LFTs) or increased bilirubin postoperatively. ⋯ Conclusions: In select cases, a transient increase in LFTs and/or bilirubin may be observed in the early postoperative period after elective laparoscopic cholecystectomy in the absence of an obvious etiology. A possible interpretation of these findings could involve the pneumoperitoneum or the anesthesia regimens used intra- or perioperatively. The specific cause, however, remains undetermined and yet to be examined by future studies.
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Background and Objectives: This study aimed to investigate the risk and mechanisms of air entry into the extracorporeal membrane oxygenation (ECMO) circuit through the central venous catheter (CVC) in a veno-venous configuration. The primary goal was to assess the impact of different air volumes on ECMO circuit performance at varying pump speeds. Material and Methods: The study utilized a circuit model to simulate ECMO conditions and evaluate the potential entry points of air, specifically through the unprotected lumen of the CVC. ⋯ The use of a closed three-way stopcock or one-way valve was found to be a reliable protective measure against air infiltration. Early detection through the observation of a hissing sound in the circuit provided a valuable warning sign. These findings contribute to enhancing the safety and performance of ECMO systems by minimizing the risk of air embolism.