Hyperkalemia Accompanies Hemorrhagic Shock and Correlates with Mortality

OBJECTIVE: This study was designed to evaluate the effects of terlipressin versus fluid resuscitation with normal saline, hypertonic saline or hypertonic-hyperoncotic hydroxyethyl starch, on hemodynamics, metabolics, blood loss and short-term survival in hemorrhagic shock. METHOD: Twenty-nine pigs were subjected to severe liver injury and treated 30 min later with either: (1) 2 mg terlipressin in a bolus, (2) placebo-treated controls, (3) 4 mL/kg 7.5% hypertonic NaCl, (4) 4 mL/kg 7.2% hypertonic-hyperoncotic hydroxyethyl starch 200/0.5, or (5) normal saline at three times lost blood volume. RESULTS: The overall mortality rate was 69%. Blood loss was significantly higher in the hypertonic-hyperoncotic hydroxyethyl starch and normal saline groups than in the terlipressin, hypertonic NaCl and placebo-treated controls groups (p<0.005). Hyperkalemia (K>5 mmol/L) before any treatment occurred in 66% of the patients (80% among non-survivors vs. 22% among survivors, p=0.019). Post-resuscitation hyperkalemia occurred in 86.66% of non-survivors vs. 0% of survivors (p<0.001). Hyperkalemia was the first sign of an unsuccessful outcome for the usual resuscitative procedure and was not related to arterial acidemia. Successfully resuscitated animals showed a significant decrease in serum potassium levels relative to the baseline value. CONCLUSION: Hyperkalemia accompanies hemorrhagic shock and, in addition to providing an early sign of the acute ischemic insult severity, may be responsible for cardiac arrest related to hemorrhagic shock

Projeto doenças orificiais experiência do HCFMUSP em hospital-dia e doenças anorretais

The treatment of malignant or benign colorectal pathologies that require more complex management are priorities in tertiary hospitals such as "Hospital das Clínicas" University of São Paulo Medical Center (HCFMUSP). Therefore, benign, uncomplicated orifice conditions are relegated to second place. The number of patients with hemorrhoids, perianal fistulas, fissures, condylomas and pilonidal cysts who seek treatment at the HFMUSP is very great, resulting in over-crowding in the outpatient clinics and a long waiting list for recommended surgical treatment (at times over 18 months). The authors describe the experience of the HCFMUSP over an eight-day period with day-hospital surgery in which 140 patients underwent surgery. Data was prospectively taken on the patients undergoing surgery for benign orifice pathologies including age, sex, diagnosis, surgery performed, immediate and late postoperative complications, and follow-up. 140 patients operated on over eight days were studied. 68 were males (48.75%) with ages ranging from 25 to 62 (mean 35.2 yrs.). Hemorrhoids was the most frequent condition encountered (82 hemorrhoidectomies, 58.6%), followed by perineal fistula (28 fistula repairs, 20.0%). The most common complication was headache secondary to rachianesthesia occurring in 9 patients (6.4%). One patient (0.7%) developed bleeding immediately PO that required reoperation. Mean follow-up was 104 days. Day-surgery characterized by quality care and low morbidity is feasible in tertiary public hospitals, permitting surgery for benign orifice pathologies on many patients within a short period of time.O tratamento das patologias colorretais malignas ou benignas, que necessitam tratamento com maior grau de complexidade são prioridades em hospitais terciários, como é o Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), permanecendo assim as patologias orificiais benignas em um segundo plano. Todavia devido à sua característica assistencial, o número de pacientes que procuram o HCFMUSP por doença hemorroidária, fístulas perianais, fissuras, condilomas e cistos pilonidais é muito grande, resultando na hipertrofia dos ambulatórios e lentidão para o tratamento cirúrgico preconizado (às vezes um ano e meio). Os autores descrevem a experiência do HCFMUSP durante oito dias com o atendimento tipo hospital-dia em que 140 pacientes foram atendidos e submetidos a intervenções cirúrgicas. Foram anotados prospectivamente os dados de paciente submetidos a tratamento cirúrgico para patologias orificiais benignas quanto a idade, sexo, diagnóstico, tratamento cirúrgico realizado, e complicações pós operatórias imediatas e tardias e tempo de seguimento ambulatorial. Foram estudados 140 pacientes, operados em oito dias, sendo 68(48,75%) homens e a idade variando entre 25 e 62 anos (média de 35,2 anos). A doença hemorroidária foi a patologia mais freqüente, com 82 doentes operados (58,57%), seguido pela fístula perineal com 20,0% dos casos operados. A complicação mais freqüente foram as anestésicas com a cefaléia pós raquianestesia ocorrendo em nove pacientes (6,42%). Um paciente (0,71%) apresentou hemorragia no PO necessitando reoperação para hemostasia. O tempo médio de seguimento foi de 104 dias. O uso do conceito hospital-dia em serviços públicos terciários é factível, com a possibilidade de atendimento de grande quantidade de pacientes com patologias orificiais benignas, em curto espaço de tempo, com qualidade e baixas taxas de complicações

Solução salina hipertônica aumenta a pressão de perfusão cerebral no transplante do fígado para hepatite fulminante: resultados preliminares

During orthotopic liver transplantation for fulminant hepatic failure, some patients may develop sudden deterioration of cerebral perfusion and oxygenation, mainly due to increased intracranial pressure and hypotension, which are likely responsible for postoperative neurological morbidity and mortality. In the present study, we hypothesized that the favorable effects of hypertonic saline solution (NaCl 7.5%, 4 mL/kg) infusion on both systemic and cerebral hemodynamics, demonstrated in laboratory and clinical settings of intracranial hypertension and hemorrhagic shock resuscitation, may attenuate the decrease in cerebral perfusion pressure that often occurs during orthotopic liver transplantation for fulminant hepatic failure. METHODS: 10 patients with fulminant hepatic failure in grade IV encephalopathy undergoing orthotopic liver transplantation with intracranial pressure monitoring were included in this study. The effect on cerebral and systemic hemodynamics in 3 patients who received hypertonic saline solution during anhepatic phase (HSS group) was examined, comparing their data with historical controls obtained from surgical procedure recordings in 7 patients (Control group). The maximal intracranial pressure and the corresponding mean arterial pressure values were collected in 4 time periods: (T1) the last 10 min of the dissection phase, (T2) the first 10 minutes at the beginning of anhepatic phase, (T3) at the end of the anhepatic phase, and (T4) the first 5 minutes after graft reperfusion. RESULTS: Immediately after hypertonic saline solution infusion, intracranial pressure decreased 50.4%. During the first 5 min of reperfusion, the intracranial pressure remained stable in the HSS group, and all these patients presented an intracranial pressure lower than 20 mm Hg, while in the Control group, the intracranial pressure increased 46.5% (P < 0.001). The HSS group was the most hemodynamically stable; the mean arterial pressure during the first 5 min of reperfusion increased 21.1% in the HSS group and decreased 11.1% in the Control group (P < 0.001). During the first 5 min of reperfusion, cerebral perfusion pressure increased 28.3% in the HSS group while in the Control group the cerebral perfusion pressure decreased 28.5% (P < 0.001). Serum sodium at the end of the anhepatic phase and 3 hours after reperfusion was significantly higher in the HSS group (153.00 &plusmn; 2.66 and 149.00 &plusmn; 1.73 mEq/L) than in the Control group (143.71 &plusmn; 3.30 and 142.43 &plusmn; 1.72 mEq/L), P = 0.003 and P < 0.001 respectively. CONCLUSION: Hypertonic saline solution can be successfully used as an adjunct in the neuroprotective strategy during orthotopic liver transplantation for fulminant hepatic failure, reducing intracranial pressure while restoring arterial blood pressure, promoting sustained increase in the cerebral perfusion pressure.Neste estudo testamos a hipótese de que os efeitos benéficos decorrentes da administração da solução salina hipertônica (NaCl 7,5%, 4 mL/kg) sobre a hemodinâmica sistêmica e cerebral na hipertensão intracraniana e no choque hemorrágico, possam atenuar a diminuição da pressão de perfusão cerebral que freqüentemente acompanha o transplante do fígado para hepatite fulminante. MÉTODO: Foram estudados 10 pacientes com hepatite fulminante em encefalopatia grau IV e monitorização de pressão intracraniana submetidos ao transplante do fígado. A hemodinâmica sistêmica e cerebral de 3 pacientes que receberam solução salina hipertônica durante a fase anepática (Grupo SSH) foi analisada comparando com os dados obtidos de 7 pacientes transplantados anteriormente nas mesmas condições (Grupo Controle). Os valores de pressão intracraniana máxima e a correspondente pressão arterial média foram coletados em quatro tempos: (T1) nos últimos 10 min da fase de disseccão, (T2) nos primeiros 10 minutos da fase anepática, (T3) no final da fase anepática e (T4) nos primeiros 5 min da reperfusão RESULTADO: Imediatamente após a infusão da solução salina hipertônica a pressão intracraniana diminuiu 50,4%. Nos primeiros 5 min da reperfusão a pressão intracraniana no Grupo SSH se manteve estável e todos os pacientes apresentavam pressão intracraniana menor que 20 mmHg enquanto no Grupo Controle a pressão intracraniana aumentou 46,5% (

Enxofre elementar adicionado em resíduo de mineração e sua influência no crescimento de arbóreas nativas / Influence of elemental sulfur added to mining residue on the growth of native trees

 A exploração do mineral vermiculita tem gerado grande volume de resíduos no entorno das mineradoras, se tornado um passivo ambiental significativo, com potencial poluente. Uma importante alternativa para minimizar os impactos provenientes desta atividade é o aproveitamento do resíduo para o cultivo de arbóreas de ocorrência na Caatinga. Objetivou-se avaliar a influência de proporções de enxofre elementar (S°) adicionado ao resíduo de vermiculita sobre o crescimento inicial de duas espécies arbóreas. Foram realizados dois experimentos, sendo um com a espécie Tabebuia aurea e outro para o Caesalpinea ferrea. Em cada experimento, os tratamentos foram constituídos por cinco proporções de enxofre elementar (0, 50, 100, 150 e 200g/kg) adicionado ao resíduo de vermiculita e um tratamento adicional correspondente ao solo sem resíduo e adubado de forma convencional. Realizou-se medições do diâmetro do caule e altura de planta a cada quinze dias, durante 105 dias de cultivo. Após este período, foram avaliados o número de folhas, índice de área foliar, massa seca da parte aérea e raiz, índice de qualidade de Dickson e a eficiência dos tratamentos. O resíduo de vermiculita, tem potencial para ser utilizado no cultivo da Tabebuia aurea e Caesalpinea ferrea, com eficiência superior a 60% e 100% respectivamente. Entretanto, a produção de massa seca da Tabebuia aurea é afetada de forma negativa com a adição de S° em proporção superior a 50g/kg. Para o Caesalpinea ferrea, a eficiência do tratamento é maximizada com a adição de 87 g/kg de enxofre elementar ao resíduo.

Statement of Second Brazilian Congress of Mechanical Ventilarion : part I

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Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio