Int Surg
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Umbilical metastases from primary ovarian cancer are rare. Metastases to the umbilicus are most commonly from primary gastrointestinal malignancies. The second most common metastases are of gynecologic origin. This is the nineteenth well-documented case reported of a primary ovarian cancer with umbilical metastasis.
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Case Reports
Respiratory distress syndrome and its treatment with high positive end-expiratory pressure ventilation.
In a 25-month period, nine patients developed a severe, rapidly progressive respiratory distress syndrome (RDS) and did not respond adequately to conventional respiratory therapy despite the application of positive end-expiratory pressure ventilation (PEEP) up to an upper limit of 15 cm H2O. Treatment with high PEEP was instituted up to 35 cm H2O, in order to achieve a PaO2 higher than 70 mmHg. Massive infusion of electrolyte solutions, colloids and red blood cells were necessary to maintain an adequate circulation that could be monitored by simple parameters such as arterial blood pressure, peripheral skin temperature and urine production. ⋯ There were no pulmonary functional or radiological abnormalities, one to 14 months after discharge from the hospital. The upper limit for PEEP should be abandoned and PEEP should be administered according to the needs of each individual patient. As an adequate oxygenation can always be achieved with high-PEEP ventilation, in surgical patients there is hardly, if ever, an indication for ECMO.
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Out of 17 mongrel dogs, 3 were subjected on one and two hours of hemorrhagic shock, while the remaining four served as controls. In five of the thirteen dogs, 30 mg/kg of methylprednisolone sodium succinate were administered intravenously one hour after hemorrhage. All animals were sacrificed at the end of the experiment, their lungs were removed and the sodium and water content was measured. ⋯ This increase was prevented significantly by the administration of pharmacological doses of methylprednisolone given at one hour of hemorrhagic shock. No significant change in total lung water was noted, even after two hours of hemorrhagic shock. The results of this study suggest that early intravenous administration of large doses of methylprednisolone may be beneficial to patients in protracted hemorrhagic shock, who are at high risk of developing pulmonary complications.
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The authors used the scanning electron microscope to study the surface ultrastructure of the ependyma in six control rabbits and six rabbits subjected to bilateral jugular vein ligation four to five days previously. Whereas in the control rabbits the mean CSF pressure was 27 mm H2O, it rose to 71.5 mm H2O in the experimental animals. The ependymal lining of the fourth ventricle, third ventricle and the inferior horn of the lateral ventricle was examined. ⋯ While a marked reduction in ciliary density and appearance of pits were noticeable in the former, almost total replacement of globular excrescences by pleomorphic microvilli was noted in the infundibular region. The morphological alterations in the ependyma that occurred in experimental animals suggested a modification in its function from a surface capable of propelling cerebrospinal fluid by ciliary movement to one capable of increased ependymoabsorption. Increased incidence of macrophage-like supraependymal cells was noted in the experimental rabbits.