Vasopressor-induced peripheral skin necrosis after shock Arnáiz-García, María Elena; Arnáiz-García, Ana María; Gutiérrez-Diez, José Francisco ...
Revista portuguesa de cardiologia,
July-August 2017, 2017 Jul - Aug, 2017-07-00, 20170701, 2017-07-01, Letnik:
36, Številka:
7-8
Journal Article
Set of resident microorganisms in our body that are responsible for the absorption of nutrients and the maintenance of health is named microbiota. The microbiota´s role is protective, trophic and ...metabolic. Different groups of microbiota intestinal name enterotypes, each one of them are in relation to specific dietary habits. The absence of enteral stimulation affects both epithelial and GALT and the development of the microbiota. This situation modifies the immune system´s interaction, with a less competitive exclusion of more pathogenic bacteria, which can promote infections. These changes are likely reversible when supplementation with enteral nutrition is used. Dietary fibre and probiotics, to be fermented by colonic microbiota produce gases and short-chain fatty acids causing an acid pH in the large intestine which hinders the growth of pathogenic microorganisms. The administration of probiotic with enteral nutrition in critically ill patients was associated with lower rates of infection with no effect on mortality, average stay, or diarrhea. Also proposed as a strategy to reduce infectious complications in elective surgery and to reduce the time of tolerance of enteral feeding in preterm or low birth weight. In acute pancreatitis, it has been suggested a possible role of probiotics to restore intestinal integrity, but more safety studies are needed. There are isolated cases of bacteremia, sepsis or endocarditis usually in immunocompromised patients. Yet the benefits appear to be greater than the risks.
Resumen El conjunto de microorganismos residentes en nuestro organismo que se encarga de la absorción de los nutrientes y del mantenimiento de la salud se denomina microbiota. Sus principales ...funciones son protectoras, tróficas y metabólicas. Las distintas agrupaciones de microbiota intestinal se denominan enterotipos, cada uno de los cuales están relacionados con hábitos dietéticos específicos. La ausencia de estímulo enteral afecta tanto al epitelio y GALT (gut-associated lymphoid tissue) como al desarrollo de la microbiota. Altera la interacción con el sistema inmune, con una menor exclusión competitiva de bacterias más patógenas, lo que puede favorecer infecciones. Estos cambios son probablemente reversibles cuando se emplea suplementación con nutrición enteral. La fibra dietética y los prebióticos, al ser fermentados por la microbiota colónica, producen ácidos grasos de cadena corta y gases, generando un pH ácido en el intestino grueso que dificulta el crecimiento de microorganismos patógenos. La administración de probióticos asociados a la nutrición enteral en pacientes críticos se ha relacionado con menores tasas de infección sin evidenciarse efectos en la mortalidad, estancia media o diarrea. También se ha propuesto como estrategia para reducir las complicaciones infecciosas en cirugía programada y para reducir el tiempo de tolerancia de la alimentación enteral en neonatos pretérmino o de bajo peso. En pancreatitis aguda, se ha propuesto un posible papel de los probióticos para restablecer la integridad intestinal, pero son necesarios más estudios en materia de seguridad. Hay descritos casos aislados de bacteriemia, sepsis o endocarditis, habitualmente en pacientes inmunodeprimidos. Aun así, los beneficios parecen ser superiores frente a los riesgos.
A 52-year-old male patient, who underwent mitral replacement with a mechanical prosthesis as a child, sustained a cardiac arrest which was successfully resuscitated. Further investigation showed ...prosthesis malfunction with significant regurgitation in the context of multi-organ failure. In such a life-threatening condition, veno-arterial extracorporeal membrane oxygenation was considered as a rescue procedure to achieve optimisation of clinical status to allow definitive surgical treatment. An unusual complete fracture of the prosthesis was subsequently identified as the cause of acute dysfunction.
A bovine aortic arch in humans Arnáiz-García, María Elena; González-Santos, Jose María; López-Rodriguez, Javier ...
Indian heart journal,
05/2014, Letnik:
66, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Abstract We describe a curious congenital variation of human aortic arch (AA) branching pattern termed the “bovine aortic arch”. Rather than arising directly from the AA as a separate branch as ...occurs in the most common AA branching pattern, the left common carotid artery moves to the right and merges from the brachiocephalic trunk. It is the normal AA branching pattern presented in a number of animals (canines, felines or Macaque monkeys) but it has nothing to do with anatomy of AA in ruminant animals, including cattle and buffalo. That is why it is one of the most widely misnomers used in medical literature whose origin is nowadays unknown.
A young male presented with a right parasternal stab wound. The chest radiography was normal and transthoracic echocardiography ruled out pericardial tamponade. He remained hemodynamically stable ...until three hours later when signs of progressive anemia were observed. Chest computed tomography showed massive right-sided hemothorax. The patient underwent surgery, which revealed an active bleeding atriopleural fistula connecting the right atrium and draining into the right pleura resulting from the negative pressure generated during respiration. This mechanism prevented cardiac tamponade and maintained initial hemodynamically stability.
Um jovem foi transferido para o serviço de emergência da nossa instituição com uma facada paraesternal direita. A radiografia de tórax foi normal. A ecocardiografia transtorácica descartou a presença de derrame pericárdico. Manteve-se hemodinamicamente estável até ao fim de três horas, após o que o paciente começou a apresentar sinais de anemia progressiva. Foi realizada tomografia computadorizada de tórax que mostrou hemotórax maciço. O paciente foi encaminhado urgentemente para cirurgia cardíaca. Observou-se hemorragia ativa através de uma fístula corte pleural ligando o átrio direito/a aurícula direita e drenagem pleural direita, resultado da pressão negativa da pleura durante a respiração. Este mecanismo impediu o tamponamento cardíaco e explica a estabilidade hemodinâmica inicial.
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