39 research outputs found
Nitrosative and Oxidative Stresses Contribute to Post-Ischemic Liver Injury Following Severe Hemorrhagic Shock: The Role of Hypoxemic Resuscitation
Purpose: Hemorrhagic shock and resuscitation is frequently associated with liver ischemia-reperfusion injury. The aim of the study was to investigate whether hypoxemic resuscitation attenuates liver injury. Methods: Anesthetized, mechanically ventilated New Zealand white rabbits were exsanguinated to a mean arterial pressure of 30 mmHg for 60 minutes. Resuscitation under normoxemia (Normox-Res group, n = 16, PaO2 = 95–105 mmHg) or hypoxemia (Hypox-Res group, n = 15, PaO 2 = 35–40 mmHg) followed, modifying the FiO 2. Animals not subjected to shock constituted the sham group (n = 11, PaO 2 = 95–105 mmHg). Indices of the inflammatory, oxidative and nitrosative response were measured and histopathological and immunohistochemical studies of the liver were performed. Results: Normox-Res group animals exhibited increased serum alanine aminotransferase, tumor necrosis factor- alpha, interleukin (IL)-1b and IL-6 levels compared with Hypox-Res and sham groups. Reactive oxygen species generation, malondialdehyde formation and myeloperoxidase activity were all elevated in Normox-Res rabbits compared with Hypox-Res and sham groups. Similarly, endothelial NO synthase and inducible NO synthase mRNA expression was up-regulated and nitrotyrosine immunostaining increased in animals resuscitated normoxemically, indicating a more intense nitrosative stress. Hypox-Res animals demonstrated a less prominent histopathologic injury which was similar to sham animals. Conclusions: Hypoxemic resuscitation prevents liver reperfusion injury through attenuation of the inflammatory respons
Year in review in Intensive Care Medicine, 2008: II. Experimental, acute respiratory failure and ARDS, mechanical ventilation and endotracheal intubation
SCOPUS: re.jinfo:eu-repo/semantics/publishe
Drainage tube endoscopy: a contribution to the management of severe acute pancreatitis?
Peritoneal lavage is one of the interventional approaches that have
gained some attention in the early, toxaemic phase of acute
pancreatitis. Additionally some kind of drainage is necessary for
suppurative collections that characterize the late phase of the disease.
In both the above situations tube plugging is a common problem and it is
usually associated with a relapse of the patient’s septic state and
newly formed collection(s) on abdominal CT. Two cases are presented, in
early and in late phases respectively, in which drainage tube adoscopy
(DTE) re-established tube patency and ensured drainage. DTE may
represent an alternative to surgery or to CT-guided paracentesis and
evacuation of newly formed intra-abdominal collections secondary to tube
obstruction
EARLY PLASMAPHERESIS IN PATIENTS WITH THROMBOTIC THROMBOCYTOPENIC PURPURA
Objectives: To investigate the relationship of thrombotic
thrombocytopenic purpura to adult respiratory distress syndrome (ARDS)
and study the responses of thrombotic thrombocytopenic purpura patients
to early plasmapheresis.
Design: Case series.
Setting: ICU of a university hospital.
Patients: Twenty-four consecutive patients with thrombotic
thrombocytopenic purpura, with various periods of time (1 to 18 days)
having elapsed since the onset of this condition. Patients ranged in
age from 17 to 66 yrs.
Interventions: Plasmapheresis, using intermittent flow separators, was
instituted soon after the patients’ ICU admission. The retinoscopic
findings on admission and the relationship of Pao2 to platelet counts
before and after plasmapheresis therapy were recorded. Antiplatelet
agents were given to the survivors to prevent relapses.
Measurements and Main Results: Eighteen patients survived and six died.
Plasmapheresis was administered for a range of 1 to 5 days (mean 3) and
3 to 18 days (mean 9.8) in survivors and nonsurvivors, respectively (p <
.001). Four patients with confluent fundus hemorrhages died and seven
without these fundoscopic findings had easily controlled disease.
Increases in Pao2 paralleled increases in platelet counts after
plasmapheresis (p < .001) in this small series of patients. Three of 18
discharged survivors relapsed over a period of 3 to 56 months of
follow-up.
Conclusions: Early introduction of plasmapheresis in thrombotic
thrombocytopenic purpura seems to increase the survival rate and to halt
the development of ARDS. Fundus findings may be a prognostic factor in
thrombotic thrombocytopenic purpura. The antiplatelet agents seem to be
efficacious in the prevention of relapses
Adenoid cystic carcinoma of the head and neck. Clinicopathological analysis of 23 patients and review of the literature
Adenoid cystic carcinoma (ACC) is a rare epithelial tumor with a
distinct natural history characterized by an indolent but persistent
growth, late onset of distant metastases and eventual death of patients.
Between 1991 and 2003, 23 patients with ACC were treated in our
Department. Surgery with a curative intent followed by radiotherapy (RT)
was applied in 22 patients. Complete resection was achieved in 72.73%
of patients. Local recurrence occurred in 26% of patients. Positive
margins emerged as the only statistically significant parameter (p <
0.0001) influencing the development of local recurrence. Distant
metastasis (DM) occurred in 47.8% of patients. In 54.5% of the
patients developing DM, this occurred between 5 and 10 years after the
initial treatment. DM was influenced by perineural invasion (p = 0.04)
and was disassociated from local control of the tumor. The mean overall
survival of our patients was 70.58 months and the mean disease free
survival 61.85 months. Perineural invasion (p = 0.048) and DM (p =
0.001) had a statistically significant impact on final patients’
outcome.
The most important factor influencing survival was DM. Its late onset,
irrespectively of local control, supports the hypothesis that ACC has a
potential to develop DM in the very early phases of tumor growth. (c)
2005 Elsevier Ltd. All rights reserved
Sarcomas of the head and neck. Results from the treatment of 25 patients
Aims. Head and neck sarcomas comprise a heterogenous and biologically
diverse group of rare neoplasms. In an effort to clarify some of the
obscure clinical. behavior of head and neck sarcomas, we present our
experience and review the relevant Literature.
Methods. Retrospective analysis of patients with histologically proven
head and neck sarcomas treated in a tertiary Hospital, Department
between 1992 and 2002.
Results. During this period, 25 patients with head and neck sarcomas
were registered. Follow-up ranged from 8 to 144 months. Twenty-three.
patients were treated with surgery as the primary modality; 14 were
treated by surgery alone. Clear margins were obtained in all. of them
and local control was achieved in 12/13. The 2-and 5-year survival rates
for the entire group were 80 and 40%, respectively. Mean overall
survival time of our patients was 62 months (median 52 months).
Conclusions. Surgical, treatment remains the cornerstone of therapeutic
management of head and neck sarcomas. (C) 2004 Elsevier Ltd. ALL rights
reserved