Cir Cir
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Paraneoplastic syndromes are disorders of host organ function occurring at a site remote from the primary tumor and its metastases. Paraneoplastic syndromes associated with primary lung cancer are not uncommon, have diverse initial manifestations, and epitomize the systemic nature of human malignant disease. ⋯ Although diagnosis is often one of exclusion, improved understanding of the pathogenesis involved in some of these syndromes has provided another means of recognizing these disorders and perhaps treating affected patients. In this update, we review paraneoplastic syndromes associated with lung cancer, potential mechanisms, clinical manifestations, diagnosis, and treatment.
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Vasodilatory refractory shock is common in patients with severe burns. It is defined by resistance to high doses of volume and vasopressor therapy. ⋯ After administration of vasopressin, systemic vascular resistance index (SVRI) and pre-arrest morbidity (PAM) were significantly increased (p < 0.05). We observed a significant decrease in dopamine and norepinephrine requirements (p < 0.005). Norepinephrine was discontinued at 72 h and dopamine infusion was continued at low dose. Urine output, urinary sodium, and serum bicarbonate were significantly increased. deltaCO2 was increased and this finding was associated to decrease in norepinephrine and dopamine requirements; this effect translated in to better splachnic perfusion. Left ventricular function indexes were normal. Patients did not develop evidence of myocardial, splachnic, or limb ischemia during vasopressin infusion. In all patients vasopressin was weaned at 24 h and removed. In five patients, it was necessary to reinitiate vasopressin infusion for another 96 h without complications. Low-dose vasopressin infusions (0.04 IU/min), are a useful therapy to severely burned patients with vasodilatory refractary shock and who are devoid of adverse effects.