Petco(2), Vco2 and corpp values in the successful prediction of the return of spontaneous circulation: an experimental study on unassisted induced cardiopulmonary arrest

During cardiac arrest, end-tidal CO2 (PetCO(2)), VCO2 and coronary perfusion pressure fall abruptly and tend to return to normal levels after an effective return of spontaneous circulation. Therefore, the monitoring of PetCO(2) and VCO2 by capnography is a useful tool during clinical management of cardiac arrest patients. To assess if PetCO(2), VCO2 and coronary perfusion pressure are useful for the prediction of return of spontaneous circulation in an animal model of cardiac arrest/cardiopulmonary resuscitation treated with vasopressor agents. 42 swine were mechanically ventilated (FiO(2)=0.21). Ventricular fibrillation was induced and, after 10 min, unassisted cardiac arrest was initiated, followed by compressions. After 2 min of basic cardiopulmonary resuscitation, each group received: Adrenaline, Saline-Placebo, Terlipressin or Terlipressin + Adrenaline. Two minutes later (4th min of cardiopulmonary resuscitation), the animals were defibrillated and the ones that survived were observed for an additional 30 min period. The variables of interest were recorded at the baseline period, 10 min of ventricular fibrillation, 2nd min of cardiopulmonary resuscitation, 4th min of cardiopulmonary resuscitation, and 30 min after return of spontaneous circulation. PetCO(2) and VCO2 values, both recorded at 2 min and 4 min of cardiopulmonary resuscitation, have no correlation with the return of spontaneous circulation rates in any group. On the other hand, higher values of coronary perfusion pressure at the 4th min of cardiopulmonary resuscitation have been associated with increased return of spontaneous circulation rates in the adrenaline and adrenaline + terlipressin groups. Although higher values of coronary perfusion pressure at the 4th min of cardiopulmonary resuscitation have been associated with increased return of spontaneous circulation rates in the animals that received adrenaline or adrenaline + terlipressin, PetCO(2) and VCO2 have not been shown to be useful for predicting return of spontaneous circulation rates in this porcine model316468473FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP07/08315-0Fundo de Apoio ao Ensino, Pesquisa e Extensao (Faepex)-Unicam

Evaluation of respiratory impairment in patients with systemic lupus erythematosus with the six-minute walk test

AbstractObjectiveEvaluate SLE stable patients, without overt respiratory compromise, by means of 6MWT.Casuistic and methodsForty-five stable SLE patients were enrolled. The ATS/ERS protocol for 6MWT, was used and two parameters with cut-off points were chosen.ResultsForty-two patients were women. The mean age was 39 ± 11.4 years; mean duration of disease, 121 ± 93.1 months; mean value of MRC, 2 ± 0; mean FVC, 85.9 ± 34.2%; mean FEV1, 67.5 ± 21.6%; mean MIP, 82 ± 58.4%; mean MEP, 78 ± 37.3%; mean heart rate at rest, 75 ± 12.8 bpm; mean respiratory rate at rest, 19 ± 5.3 bpm; mean 6MWD, 478 ± 82 m; mean SpO2 at rest was 98 ± 0.8%; mean fall in SpO2, 4 ± 6 points. When the study population was divided according to the 400-m walk distance cut-off value, the heart rate immediately before the test was significant lower in those participants who walked less than 400 m (p = 0.0043), just like the value of Borg scale (p = 0.0036); according to the presence of saturation ≥ 4, heart rate at the end of the test was significantly higher in those participants who were showing desaturation (p = 0.0170); MEP (p = 0.0282) and 6MWD (p = 0.0291) were signifi- cantly lower, and MIP showed a tendency towards being smaller (p = 0.0504). FVC < normal inferior limit was significantly associated with the group with desaturation (p = 0.0274).ConclusionCompared to 6MWD, desaturation was better suited to find the patients with the most compromised indexes in respiratory function tests

[acute Respiratory Failure As A Manifestation Of Eosinophilia-myalgia Syndrome Associated With L-tryptophan Intake].

Eosinophilia-myalgia syndrome was described in 1989 in patients who presented progressive and incapacitating myalgia and eosinophilia in blood, fluids and secretions. Most patients report previous L-tryptophan intake. Respiratory manifestations are found in up to 80% of the cases, occasionally as the only manifestation. Treatment includes drug discontinuation and administration of corticosteroids. Here, we describe the case of a 61-year-old female admitted with acute respiratory failure after using L-tryptophan, hydroxytryptophan and other drugs. The patient presented eosinophilia, together with elevated eosinophil counts in the bronchoalveolar lavage and pleural effusion. After discontinuation of the drugs previously used, corticosteroids were administered, resulting in clinical and radiological improvement within just a few days.33747-5

Volumetric capnography as a noninvasive diagnostic procedure in acute pulmonary thromboembolism

Pulmonary thromboembolism is a common condition. Its diagnosis usually requires pulmonary scintigraphy, computed angiotomography, pulmonary arteriography and, in order to rule out other diagnoses, the measurement of D-dimer levels. Due to the fact that these diagnostic methods are not available in most Brazilian hospitals, the validation of other diagnostic techniques is of fundamental importance. We describe a case of a woman with chronic pulmonary hypertension who experienced a pulmonary thromboembolism event. Pulmonary scintigraphy, computed angiotomography and pulmonary arteriography were used in the diagnosis. The D-dimer test result was positive. Volumetric capnography was performed at admission and after treatment. The values obtained were compared with the imaging test results.O tromboembolismo pulmonar é uma situação freqüente que pode ser diagnosticada pela cintilografia pulmonar, angiotomografia computadorizada, arteriografia pulmonar e, como método de exclusão, dosagem do dímero-D. Como estes exames nem sempre estão disponíveis, a validação de outros métodos diagnósticos é fundamental. Relata-se o caso de uma paciente com hipertensão pulmonar crônica, agudizada por tromboembolismo pulmonar. Confirmou-se o diagnóstico por cintilografia, angiotomografia computadorizada, arteriografia pulmonar; a dosagem do dímero-D resultou positiva. A capnografia volumétrica associada à gasometria arterial foi realizada na admissão e após o tratamento. As variáveis obtidas foram comparadas com os resultados dos exames de imagem.32833

Saliva as a potential tool for cystic fibrosis diagnosis

BACKGROUND: Saliva and sweat are modified by cystic fibrosis (CF). In both cases the chloride and sodium ion concentrations for healthy subjects and CF patients differ, this representing a possible alternative tool for CF diagnosis. In this context, the aim of this study was to compare the concentrations of these ions in saliva samples taken from CF patients and healthy subjects. METHODS: A case–control study was carried out at a university CF center, in which the saliva samples were analyzed on an ABL 835 Radiometer(®) to determine the ion concentration. RESULTS: For the CF patients (n = 80) the values for the biochemical parameters of chloride, potassium and sodium ion concentration were higher (p < 0.009) and the volume and pH of the saliva were lower than in the case of healthy subjects (p < 0.009). For the healthy subjects group (n = 84) versus CF patients, according to the ROC curve, the values for sodium were: cutoff: 13.5 mmol/L, sensitivity: 73.4%, specificity: 70.6%; and for chloride: cutoff: 20 mmol/L, sensitivity: 68.1%, specificity: 72.9%. CONCLUSIONS: The chloride and sodium concentrations in the saliva samples were higher for CF patients in comparison with healthy subjects. Thus, saliva as a tool for CF diagnosis can be considered a new challenge, and a population study including patients in all age classes needs to be performed, in different countries over the world, to extend the database to include a broad spectrum of information in order to identify normal ion concentration ranges for CF patients according to age, genotype and environment. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/261423314875014

[thrombolysis In Massive Pulmonary Embolism Based On The Volumetric Capnography].

This is the first report of a patient submitted to chemical thrombolysis due to massive pulmonary embolism (PE) during the postoperative period of neurosurgery, in whom due to the lack of adequate clinical conditions, no imaging assessment was performed. Clinical, gasometric and capnographic data allowed the decision to perform the thrombolysis with safety. The P(a-et)CO2 gradient decreased from 46.4 mmHg to 11.8 mmHg (normal < 5 mmHg) and the end-tidal alveolar dead space fraction decreased from 0.85 to 0.37 (normal < 0.15) from the pre-thrombolysis period to the 7th day post-thrombolysis. We conclude that the volumetric capnography (VC) was useful in the patient's diagnosis and clinical follow-up.95e97-e9

Idiopathic Bilateral Diaphragmatic Paresis.

We report the case of a patient with severe dyspnea upon reclining. Lung disease, neuromuscular disorders and heart disease were ruled out. However, during the course of the investigation, bilateral diaphragmatic paresis was discovered. A key sign leading to the diagnosis was evidence of paradoxical respiration in the dorsal decubitus position. When the patient was moved from the orthostatic position to the dorsal decubitus position, oxygenation and forced vital capacity worsened. The orthostatic fluoroscopy was normal. Maximal inspiratory pressure was severely reduced. The responses to transcutaneous electric stimulation of the diaphragm were normal. However, electric stimulation of the phrenic nerve produced no response, leading to the diagnosis of bilateral diaphragmatic paresis.32481-

Ultraestrutura ciliar a microscopia eletronica de transmissão : comparação da prevalencia de anomalias ciliares entre pacientes portadores da sindrome da discinesia ciliar e individuos normais

Orientador : Albina Messias AltamaniTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: A sindrome da discinesia ciliar é uma das hipóteses diagnósticas que devem ser consideradas em indivíduos com sintomatologia cronica pulmonar e de vias aéreas superiores...Observação: O resumo, na integra, podera ser visualizado no texto completo da tese digitalAbstract: The complete abstract is available with the full electronic digital thesis or dissertationsDoutoradoDoutor em Medicin