14 research outputs found
Left Ventricle to Right Atrium Shunt Secondary to Blunt Chest Trauma. A Case Report
Intracardiac shunts are rarely encountered as sequelae of non-penetrating heart trauma and their clinical manifestations may often be unrecognized in the multi-injured patient. However, they are serious complications and their diagnostic approach is not always feasible.
Kinetics of progenitor hemopoetic stem cells in sepsis: Correlation with patients survival?
BACKGROUND: Current theories underline the crucial role of pro-inflammatory mediators produced by monocytes for the pathogenesis of sepsis. Since monocytes derive from progenitor hemopoetic cells, the kinetics of stem cells was studied in peripheral blood of patients with sepsis. METHODS: Blood was sampled from 44 patients with septic syndrome due to ventilator-associated pneumonia on days 1, 3, 5 and 7 upon initiation of symptoms. Concentrations of tumour necrosis factor-alpha (TNFα), interleukin (IL)-6, IL-8 and G-CSF were estimated by ELISA. CD34/CD45 cells were determined after incubation with anti-CD45 FITC and anti-CD34 PE monocloncal antibodies and flow cytometric analysis. Samples from eight healthy volunteers served as controls. RESULTS: Median of CD34/CD45 absolute count of controls was 1.0/μl. Respective values of the total study population were 123.4, 112.4, 121.5 and 120.9/μl on days 1, 3, 5 and 7 (p < 0.0001 compared to controls). Positive correlations were found between the absolute CD34/CD45 count and the absolute monocyte count on days 1, 5 and 7. Survival was prolonged among patients with less than 310/μl CD34/CD45 cells on day 1 compared to those with more than 310/μl of CD34/CD45 cells (p: 0.022). Hazard ratio for death due to sepsis was 5.47 (p: 0.039) for CD34/CD45 cells more than 310/μl. Median IL-6 on day 1 was 56.78 and 233.85 pg/ml respectively for patients with less than 310/μl and more than 310/μl CD34/CD45 cells (p: 0.021). CONCLUSION: Stem cells are increased in peripheral blood over all days of follow-up compared to healthy volunteers. Patients with counts on day 1 less than 310/μl are accompanied by increased survival compared to patients with more than 310/μl
Abnormal Right Ventricular Free Wall Strain Prior to Prone Ventilation May Be Associated With Worse Outcome of Patients With COVID-19-Associated Acute Respiratory Distress Syndrome.
We investigated the effect of prone ventilation on right ventricular (RV) function of intubated patients with COVID-19-associated acute respiratory distress syndrome by measuring both conventional RV functional variables (namely, tricuspid annular peak systolic velocity, tricuspid annular plane systolic excursion, and fractional area change) and right ventricular free wall strain (RVFWS) using transthoracic speckle-tracking echocardiography at baseline (before prone positioning), 18 hours after prone positioning, and 1 hour after supine repositioning. We found that transthoracic echocardiography was feasible in a considerable proportion (nine patients, 75% of our cohort) of patients undergoing prone ventilation. Also, abnormal as opposed to normal RVFWS values (in the absence of conventional variables of RV dysfunction) at baseline were associated with higher mortality (100% vs 20%; p = 0.048). Finally, we found that, among patients without acute cor pulmonale or conventional markers of RV dysfunction, one session of prone ventilation may not affect right myocardial strain
Right atrial strain during prone ventilation in acute respiratory distress syndrome
Although prone ventilation is widely used in acute respiratory distress syndrome
(ARDS), its effects on right heart function, assessed by state-of-the-art
echocardiography, are not well studied. We report the effect of prone ventilation
on right atrial strain in severe ARDS after optimization of lung recruitment
and hemodynamics using esophageal pressure and pulmonary artery catheter
measurements, respectively. A 66-year-old obese man with ischemic heart
failure was intubated due to ARDS. Before, during and after his first prone
session, pulmonary, hemodynamic and echocardiographic (using twodimensional
transthoracic speckle tracking echocardiography) parameters were
measured. Prone ventilation sustainably improved lung recruitment and right
atrial strain. Combining detailed physiological and advanced echocardiographic
assessment provides insights into the effect of prone ventilation in ARDS
Successful resuscitation with thrombolysis of a patient suffering fulminant pulmonary embolism after recent intracerebral haemorrhage
We report the life-saving administration of thrombolysis during
cardiopulmonary resuscitation in a patient with recent intracerebral
haemorrhage. A 53-year-old mate with intracerebral. haemorrhage was
admitted to the intensive care unit. On the 24th day of treatment he
suffered cardiac arrest with pulseless electrical activity.
Transoesophageal echocardiography was performed during ongoing
cardiopulmonary resuscitation. Thrombi in the right heart cavities with
excessive right ventricular dysfunction confirmed the diagnosis of
fulminant pulmonary embolism. Permanent restoration of a spontaneous
rhythm was feasible only after administration of systemic thrombolysis
with recombinant tissue plasminogen activator. Neurological examination
and a computed tomogram of the brain did not show rebleeding.
We conclude that under extreme circumstances absolute contraindications
to thrombolysis should be weighed against the potential benefit. (c)
2006 Elsevier Ireland Ltd. All rights reserved
Fatal post-traumatic zygomycosis in an immunocompetent young patient
Zygomycosis, a relatively uncommon infection, usually occurs among
immunocompromised individuals. It has been reported only rarely in
trauma patients. A fatal case is reported of pulmonary and rapidly
progressive cutaneous zygomycosis in a young, otherwise healthy farmer,
with multiple bone fractures, wounds and soft tissue injuries after an
accident with an agricultural machine in the field. Rhizopus spp. was
isolated from both cultures of bronchial washings and wound samples. The
diagnosis was confirmed by histopathological examination of tissue
specimens from a large wound. Despite systemic antifungal therapy and
surgical debridement, the patient’s condition deteriorated and he died
from refractory septic shock