Effect of saline infusion for the maintenance of blood volume on pulmonary gas exchange during temporary abdominal aortic occlusion

We analyzed the effects of saline infusion for the maintenance of blood volume on pulmonary gas exchange in ischemia-reperfusion syndrome during temporary abdominal aortic occlusion in dogs. We studied 20 adult mongrel dogs weighing 12 to 23 kg divided into two groups: ischemia-reperfusion group (IRG, N = 10) and IRG submitted to saline infusion for the maintenance of mean pulmonary arterial wedge pressure between 10 and 20 mmHg (IRG-SS, N = 10). All animals were anesthetized and maintained on spontaneous ventilation. After obtaining baseline measurements, occlusion of the supraceliac aorta was performed by the inflation of a Fogarty catheter. After 60 min of ischemia, the balloon was deflated and the animals were observed for another 60 min of reperfusion. The measurements were made at 10 and 45 min of ischemia, and 5, 30, and 60 min of reperfusion. Pulmonary gas exchange was impaired in the IRG-SS group as demonstrated by the increase of the alveolar-arterial oxygen difference (21 ± 14 in IRG-SS vs 11 ± 8 in IRG after 60 min of reperfusion, P = 0.004 in IRG-SS in relation to baseline values) and the decrease of oxygen partial pressure in arterial blood (58 ± 15 in IRG-SS vs 76 ± 15 in IRG after 60 min of reperfusion, P = 0.001 in IRG-SS in relation to baseline values), which was correlated with the highest degree of pulmonary edema in morphometric analysis (0.16 ± 0.06 in IRG-SS vs 0.09 ± 0.04 in IRG, P = 0.03 between groups). There was also a smaller ventilatory compensation of metabolic acidosis after the reperfusion. We conclude that infusion of normal saline worsened the gas exchange induced by pulmonary reperfusion injury in this experimental model

CENTRAL VENOUS-BLOOD COMPOSITION and the PULMONARY VENTILATION DURING HEMODIALYSIS

ESCOLA PAULISTA MED,DEPT MED,PULM SECT,BR-04023 São Paulo,SP,BRAZILESCOLA PAULISTA MED,DEPT MED,NEPHROL SECT,BR-04023 São Paulo,SP,BRAZILESCOLA PAULISTA MED,DEPT MED,PULM SECT,BR-04023 São Paulo,SP,BRAZILESCOLA PAULISTA MED,DEPT MED,NEPHROL SECT,BR-04023 São Paulo,SP,BRAZILWeb of Scienc

LUNG INHALATION SCINTIGRAPHY - DEVELOPMENT of A NEW AEROSOL SYSTEM

ESCOLA PAULISTA MED,DISCIPLINA PNEUMOL,BR-04023 São Paulo,SP,BRAZILESCOLA PAULISTA MED,DISCIPLINA PNEUMOL,BR-04023 São Paulo,SP,BRAZILWeb of Scienc

Outcomes in relapsed graves' disease patients following radioiodine or prolonged low dose of methimazole treatment

Low doses of antithyroid drugs (ATD) for extended periods may be an alternative for Graves' disease (GD) patients who relapse after a course of ATD. Patients with GD relapse (n = 238) after discontinuation of ATD therapy for 12–24 months were retrospectively analyzed in a nonrandomized study. Radioiodine (RAI) treatment and L-thyroxine replacement was used in 114 patients, and a low dose of methimazole (MMI; 2.5–7 mg/daily) was used in 124 patients. Thyroid dysfunction, Graves' ophthalmopathy (GO) evolution, quality of life (QoL), and body weight were evaluated during the follow-up. The mean follow-up was 80.8 ± 35.3 months for the RAI group, and 71.3 ± 40.3 months for the low-dose MMI group. No notable side effects were observed in either group. Thyroid dysfunction was predominant in the RAI group (p < 0.001), and euthyroidism was more common in the MMI group (p < 0.001). GO deterioration was mainly evaluated by clinical activity score (CAS)—it was higher in the RAI group (p < 0.0005) over all periods of follow-up. Multivariate logistic analysis showed that RAI treatment was associated with no improvement in CAS during follow-up (24 months: OR = 3.51 [CI 1.02–12.03], p < 0.05; 36 months: OR = 8.46 [CI 1.47–48.58], p < 0.05; 48 months: OR = 19.52 [CI 1.70–223.10], p < 0.05; 60 months: OR = 21.1 [CI 1.5–298], p < 0.05). Kaplan–Meier survival analysis confirmed this finding (p < 0.0003). Assessment of QoL using the Short Form Health Survey's 36 parameters in stable euthyroid patients (at least six months) was similar in both groups. The RAI group patients gained more weight (p < 0.005), particularly after 24 months of follow-up. The use of low doses of MMI is efficient and safe, and offers better outcomes for GO than RAI treatment. Prolonged low doses of MMI may be an alternative choice for relapsed GD patients, particularly for GO patients or for patients who refuse a definitive treatment25121282129