RESUMO
Blunt rupture of the pericardium is a rare injury. Strangulated cardiac hernia following blunt trauma is one cause of reversible cardiac arrest. Traumatic pericardial tears usually have delayed diagnoses and carry high mortality rates (64%). Clinical signs mimic cardiac tamponade during the primary survey. We report here two cases of blunt trauma. Both patients arrived alive in the emergency room and presented signs of cardiac tamponade caused by pericardial rupture.
Assuntos
Ruptura Cardíaca/cirurgia , Pericárdio/lesões , Ferimentos não Penetrantes/cirurgia , Acidentes de Trânsito , Adulto , Tamponamento Cardíaco/diagnóstico , Diagnóstico Diferencial , Evolução Fatal , Ruptura Cardíaca/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Ferimentos não Penetrantes/diagnósticoRESUMO
The use of laparoscopy in generalized peritonitis has become increasingly frequent in recent years. However, CO2 pneumoperitoneum in association with increased intraperitoneal pressure may have deleterious effects in patients with hemodynamic or metabolic disturbances caused by bacterial peritonitis. The purpose of this study was to investigate the effect of CO2 pneumoperitoneum on bacteremia, mean arterial pressure, and blood gas disturbances in an animal model of bacterial peritonitis. Dogs were anesthetized, orally intubated, and subjected to experimental peritonitis by intraperitoneal inoculation of a suspension containing Escherichia coli and sterile dog feces. The animals were randomly assigned to two groups: control animals were maintained under anesthesia, and the insufflated animals were subjected to intraperitoneal CO2 insufflation. Bacterial peritonitis provoked the appearance of bacteremia and a significant decrease in mean arterial pressure, pH, bicarbonate, and base deficit. The induction of bacterial peritonitis did not significantly influence pH in the control group and partial pressure of arterial CO2 in either group. Thirty minutes of CO2 pneumoperitoneum did not influence the effect of bacterial peritonitis on the analyzed variables. These results suggest that laparoscopic CO2 pneumoperitoneum does not aggravate bacteremia or metabolic and hemodynamic disturbances induced by bacterial peritonitis.
Assuntos
Bacteriemia/etiologia , Peritonite/cirurgia , Pneumoperitônio Artificial , Animais , Dióxido de Carbono , Modelos Animais de Doenças , Cães , Hemodinâmica , Masculino , Peritonite/metabolismo , Peritonite/fisiopatologia , Distribuição AleatóriaRESUMO
BACKGROUND: Tracheostomy in children remains controversial regarding the risk of complications. METHODS: Forty-six trauma patients (35 male and 11 female, mean age = 6.8 years) were admitted to the intensive care unit between 1987 and 1991 with severe head injury plus coma. Tracheostomy was performed with standard technique after 5.9 days (range, 2-12 days) of intubation. RESULTS: There were no deaths from tracheostomy, but six deaths resulted from severe head injury. One child was discharged with tracheostomy. The 39 survivors remained with tracheostomy 16.14 days (range, 4-71 days) in the intensive care unit. After cannula removal, 31 remained asymptomatic; 8 had respiratory distress: 2 were normal, 5 had endoscopic treatment for subglottic granulomas/stenosis from intubation, and 1 had tracheomalacia from tracheostomy. In 1997, the 18 patients located for follow-up were asymptomatic. At endoscopy, 8 were normal, 9 had subglottal granulomas from intubation, and 1 had 20% tracheal stenosis from tracheostomy. CONCLUSION: Most complications after tracheostomy result from intubation. Tracheostomy has an acceptable risk in children with severe head injury who need prolonged ventilatory support.
Assuntos
Coma Pós-Traumatismo da Cabeça/terapia , Traumatismos Craniocerebrais/terapia , Serviços Médicos de Emergência , Complicações Pós-Operatórias , Traqueostomia/efeitos adversos , Adolescente , Criança , Pré-Escolar , Coma Pós-Traumatismo da Cabeça/complicações , Traumatismos Craniocerebrais/complicações , Feminino , Seguimentos , Humanos , Masculino , Fatores de RiscoRESUMO
BACKGROUND: Gut ischemia followed by reperfusion (I/R) is implicated as a prime initiating event in the mechanism of multiple organ failure after trauma and hemorrhagic shock. Several lines of evidence indicate that macrophages are involved in this prime event. Our purpose was to evaluate hydrogen peroxide (H2O2) and tumor necrosis factor (TNF) production and phagocytosis by lung macrophages in a gut I/R model of multiple organ failure in rats. METHODS: In the experimental group (I/R), Wistar rats (n = 35) were anesthetized and subjected to a median laparotomy, and the superior mesenteric artery was clamped for 45 minutes followed by 60 minutes of reperfusion. In the control group (LAP) (n = 37), animals underwent sham laparotomy. After the period of reperfusion, bronchoalveolar lavage (BAL) was performed and the resulting BAL cells were assayed for H2O2 production using the horseradish peroxidase-mediated red phenol oxidation method. TNF release was determined using the L929 cells bioassay. Zymosan phagocytosis by BAL macrophages was quantitated using phase microscopy. RESULTS: H2O2 release in BAL cells of I/R rats (19.90 +/- 7.98 nmol/L/2 x 10(5) cells) is statistically higher than in the LAP group (10.92 +/- 5.01 nmol/L per 2 x 10(5) cells) (p = 0.0155), and the TNF production by BAL cells of the I/R group (38.09 +/- 20.79 units per 10(6) cells) was significantly higher than that of LAP rats (17.16 +/- 13.35 units per 10(6) cells) (p = 0.0281). Phagocytic activity of BAL mac. Macrophages of I/R rats was not statistically different from LAP animals. CONCLUSION: These results suggest that BAL macrophage play a role in the mechanism of acute lung injury after trauma and hemorrhagic shock.
Assuntos
Peróxido de Hidrogênio/metabolismo , Intestinos/irrigação sanguínea , Ativação de Macrófagos , Macrófagos Alveolares/metabolismo , Insuficiência de Múltiplos Órgãos/fisiopatologia , Traumatismo por Reperfusão/fisiopatologia , Fator de Necrose Tumoral alfa/biossíntese , Animais , Líquido da Lavagem Broncoalveolar/citologia , Contagem de Células , Modelos Animais de Doenças , Pulmão/citologia , Macrófagos Alveolares/imunologia , Masculino , Insuficiência de Múltiplos Órgãos/etiologia , Fagocitose , Distribuição Aleatória , Ratos , Ratos Wistar , Traumatismo por Reperfusão/complicaçõesRESUMO
Occlusion of the thoracic aorta is meant to improve cerebral and cardiac perfusion in the moribund, exsanguinating trauma patient. Yet clinical and experimental experience shows no evident benefit from this critical maneuver, and hind limb paralysis (HLP) is a feared complication. Our study is intended to verify whether aortic occlusion can decrease further blood loss and therefore be useful during treatment of hemorrhagic shock. Four groups of 10 dogs were submitted to hemorrhagic shock and treated with blood (40 mL/kg) and saline (35 mL/kg). Group I was then submitted to intermittent intra-aortic occlusion (IIAO), Groups II and III to IIAO and to a second bleeding (rebleeding), and Group IV to rebleeding only, without IIAO. All dogs received volume replacement during this rebleeding phase and were kept alive for 8 days. Five dogs died and seven had HLP in the three groups submitted to IIAO. Death and HLP occurred even in the dogs of Group I, which were not submitted to a second bleeding. IIAO reduced blood loss from 139 mL/kg to 48 mL/kg. There were no complications or deaths among the 10 dogs in Group IV. Although efficient in reducing blood loss, IIAO was associated with a 16% mortality and 23% of HLP, whereas volume replacement alone was tolerated without complications or death. We conclude that IIAO is dangerous while treating severe hemorrhagic shock even after volume replacement and hemodynamic stabilization.
Assuntos
Aorta Torácica , Choque Hemorrágico/terapia , Animais , Aorta Torácica/fisiologia , Aorta Torácica/fisiopatologia , Pressão Sanguínea , Transfusão de Sangue , Cães , Membro Posterior , Concentração de Íons de Hidrogênio , Masculino , Paralisia/prevenção & controle , Choque Hemorrágico/sangueRESUMO
Duodenal diverticulum is a common anatomic abnormality. Its inflammatory perforation is a rare complication, with less than 100 cases reported in the available literature. Traumatic perforation is exceedingly rare (only 3 cases reported). In this report one more case of traumatic perforation is presented, and the literature is reviewed focusing on the pathogenic, diagnostic and therapeutic aspects of this severe disease.
Assuntos
Traumatismos Abdominais/complicações , Divertículo/complicações , Duodeno/lesões , Duodeno/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , RupturaRESUMO
Traumatic injuries of the extrahepatic biliary tract are infrequent, occurring in approximately 0.5% of all patients with blunt and penetrating abdominal trauma. The incidence of this injury due to blunt abdominal trauma is rare. This study reviewed patients with injuries of the extrahepatic biliary tract due to abdominal trauma over a 6-year period to determine the incidence, trauma scores, associated injuries, surgical treatment performed, complications and mortality rate. We report our experience with 14 patients with extrahepatic biliary tract trauma. A review of the literature and the discussion about the management are presented.
Assuntos
Ductos Biliares Extra-Hepáticos/lesões , Traumatismos Abdominais/complicações , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/cirurgia , Adolescente , Adulto , Ductos Biliares Extra-Hepáticos/cirurgia , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Índices de Gravidade do TraumaRESUMO
Gallstone ileus, a mechanical intestinal obstruction caused by the passage of a gallstone into the intestinal lumen through a fistula, although not common, deserves to more carefully studied due to its morbidity and mortality. Its incidence among older-age groups explains its association with chronic and degenerative diseases, which increase the complexity of the treatment choice. The need and appropriateness of a surgical approach to a cholecystenteric fistula to solve the obstructive emergency, in a one or two stage procedure, has been discussed in the literature. It has also been reported that gallstone ileus is an uncommon cause of upper intestinal obstruction. Intestinal obstruction is seen more frequently after a gallstone impacts at the ileocecal valve. The authors report a case of gallstone ileus as a cause of upper intestinal obstruction and discuss its diagnosis and treatment.
Assuntos
Colelitíase/complicações , Obstrução Intestinal/etiologia , Idoso , Idoso de 80 Anos ou mais , Colelitíase/diagnóstico , Colelitíase/cirurgia , Feminino , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgiaRESUMO
Multiple organ failure (MOF) is a major cause of death of ICU trauma patients. Despite intensive clinical and experimental investigation, the exact physiopathology of this syndrome is unclear. Although diverse cellular and humoral mediators have been identified, their mechanistic role is still debated. In this article the authors discuss recent results of this investigation. They present recently published criteria for MOF quantification, and focus on the mechanisms and mediators of MOF syndrome, emphasizing the role of sepsis, the intestinal ischemia/reperfusion MOF model, the role of polymorphonuclear neutrophil, and the relationship between adult respiratory distress syndrome (ARDS) and the development of MOF syndrome.