Sympathectomy provided excellent patient satisfaction and a low incidence of complications. There was no significant difference between the levels of ablation in terms of reflex sweating, although the intensity of this complication decreased when lower levels of blockage, principally at the T4 level, were employed.
Brazilian spotted fever, caused by Rickettsia rickettsii, has been increasingly reported in Brazil especially in the southeastern states. The severe and fulminant forms of the disease are not unusual but most of the reported fatal cases have shown some typical clinical clue, which leads the attending physician to a correct diagnosis. We report a probable case of atypical fulminant Brazilian spotted fever that presented full-blown septic shock associated with Adult Respiratory Distress Syndrome (ARDS) and delayed uncharacteristic rash with an over four-fold increase in reciprocal IgM, but not IgG titer against Rickettsia rickettsii. Brazilian practitioners should be aware of the possibility of Brazilian spotted fever as a cause of fulminant primary sepsis with ARDS; improved laboratory methods are necessary for the rapid diagnosis of such cases
Transtracheal puncture has long been known as a safe, low-cost procedure. However,
with the advent of bronchoscopy, it has largely been forgotten. Two researchers have
suggested the use of α-amylase activity to diagnose salivary aspiration, but the
normal values of this enzyme in tracheobronchial secretions are unknown. We aimed to
define the normal values of α-amylase activity in tracheobronchial secretions and
verify the rate of major complications of transtracheal puncture. From October 2009
to June 2011, we prospectively evaluated 118 patients without clinical or
radiological signs of salivary aspiration who underwent transtracheal puncture before
bronchoscopy. The patients were sedated with a solution of lidocaine and diazepam
until they reached a Ramsay sedation score of 2 or 3. We then cleaned the cervical
region and anesthetized the superficial planes with lidocaine. Next, we injected 10
mL of 2% lidocaine into the tracheobronchial tree. Finally, we injected 10 mL of
normal saline into the tracheobronchial tree and immediately aspirated the saline
with maximum vacuum pressure to collect samples for measurement of the α-amylase
level. The α-amylase level mean ± SE, median, and range were 1914 ± 240, 1056, and
24-10,000 IU/L, respectively. No major complications (peripheral desaturation,
subcutaneous emphysema, cardiac arrhythmia, or hemoptysis) occurred among 118
patients who underwent this procedure. Transtracheal aspiration is a safe, low-cost
procedure. We herein define for the first time the normal α-amylase levels in the
tracheobronchial secretions of humans.
Pulmonary amyloidosis is a rare disease, characterized by extracellular deposition of fibrillary protein in the lungs. Amyloidosis is a generic term for a heterogeneous group of diseases, including Alzheimer's disease and type 2 diabetes mellitus. In the respiratory system, it appears in various forms: tracheobronchial; nodular pulmonary; and alveolar septal (diffuse parenchymal). We present the case of a woman who was a 20 pack-year smoker and had nodular pulmonary amyloidosis, as diagnosed through tests performed prior to laparoscopic cholecystectomy.
Objective: To conduct a longitudinal investigation of cardiac vagal activity (CVA) by measuring resting HR and calculating the cardiac vagal index (CVI) in individuals undergoing sympathectomy for the treatment of primary hyperhidrosis. Methods: This was a descriptive longitudinal study involving 22 patients, 13 of whom were female. The mean age was 22.5 ± 8.8 years. The palms, soles, and axillae were the most commonly affected sites. Resting HR was measured by an electrocardiogram performed 20 min before the 4-second exercise test (4sET), which was used in order to evaluate CVA at three different time points: before surgery, one month after surgery, and four years after surgery. Results: Resting HR (expressed as mean ± SE) was found to have decreased significantly at 1 month after surgery (73.1 ± 1.6 bpm before surgery vs. 69.7 ± 1.2 bpm at one month after surgery; p = 0.01). However, the HR values obtained at four years after surgery tended to be similar to those obtained before surgery (p = 0.31). The CVI (expressed as mean ± SE) was found to have increased significantly at one month after surgery (1.44 ± 0.04 before surgery vs. 1.53 ± 0.03 at one month after surgery; p = 0.02). However, the CVI obtained at four years after surgery tended to be similar to that obtained before surgery (p = 0.10). Conclusions: At one month after sympathectomy for primary hyperhidrosis, patients present with changes in resting HR and CVA, both of which tend to return to baseline at four years after surgery.
A embolia pulmonar por líquido amniótico é uma complicação obstétrica rara, freqüentemente fatal, de fi siopatologia ainda não totalmente esclarecida e pouco conhecida pelo intensivista e obstetra. O objetivo deste relato foi enfatizar a necessidade de conhecimento desta entidade clínica e discutir a literatura pertinente de maior relevância. RELATO DO CASO: Paciente com 15 anos, primigesta, 34 semanas de gestação, foi admitida no serviço de emergência para tratamento de início de parto prematu
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