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Seminars in Respiratory and Critical... Jun 2022Among mechanically ventilated patients, asymmetrical lung injury is probably extremely frequent in the intensive care unit but the lack of standardized measurements does...
Among mechanically ventilated patients, asymmetrical lung injury is probably extremely frequent in the intensive care unit but the lack of standardized measurements does not allow to describe any prevalence among mechanically ventilated patients. Many past studies have focused only on unilateral injury and have mostly described the effect of lateral positioning. The good lung put downward might receive more perfusion while the sick lung placed upward receive more ventilation than supine. This usually results in better oxygenation but can also promote atelectasis in the healthy lung and no consensus has emerged on the clinical indication of this posture. Recently, electrical impedance tomography (EIT) has allowed for the first time to precisely describe the distribution of ventilation in each lung and to better study asymmetrical lung injury. At low positive-end-expiratory pressure (PEEP), a very heterogeneous ventilation exists between the two lungs and the initial increase in PEEP first helps to recruit the sick lung and protect the healthier lung. However, further increasing PEEP distends the less injured lung and must be avoided. The right level can be found using EIT and transpulmonary pressure. In addition, EIT can show that in the two lungs, airway closure is present but with very different airway opening pressures (AOPs) which cannot be identified on a global assessment. This may suggest a very different PEEP level than on a global assessment. Lastly, epidemiological studies suggest that in hypoxemic patients, the number of quadrants involved has a strong prognostic value. The number of quadrants is more important than the location of the unilateral or bilateral nature of the involvement for the prognosis, and hypoxemic patients with unilateral lung injury should probably be considered as requiring lung protective ventilation as classical acute respiratory distress syndrome.
Topics: Electric Impedance; Humans; Lung; Lung Injury; Positive-Pressure Respiration; Respiration, Artificial; Respiratory Distress Syndrome
PubMed: 35785812
DOI: 10.1055/s-0042-1744303 -
Revista Espanola de Enfermedades... Apr 2022A 4-month-old girl was admitted to the Emergency Department with gastric vomiting and bloody diarrhea. On physical examination, the abdomen was distended, painful, with...
A 4-month-old girl was admitted to the Emergency Department with gastric vomiting and bloody diarrhea. On physical examination, the abdomen was distended, painful, with evidence of peritoneal irritation. The abdominal X-ray showed the presence of intraluminal gas in the ascending colon, sigmoid and rectum.
Topics: Child; Female; Humans; Infant; Pneumatosis Cystoides Intestinalis; Radiography, Abdominal; Rectum; Tomography, X-Ray Computed
PubMed: 34856808
DOI: 10.17235/reed.2021.8482/2021 -
Tierarztliche Praxis. Ausgabe K,... Jun 2023An intact male Labrador Retriever was presented with signs of an acute abdomen and generalized weakness. Abdominal ultrasonography revealed a distended, horizontally...
An intact male Labrador Retriever was presented with signs of an acute abdomen and generalized weakness. Abdominal ultrasonography revealed a distended, horizontally orientated and caudally displaced gallbladder with a thickened wall. Computed tomography (CT) showed an abrupt tapering of the cystic duct in addition to the displacement of the gallbladder.On laparotomy a complete gallbladder torsion was diagnosed. After cholecystectomy the dog made a full recovery. Gallbladder torsion should be considered as a rare, potential differential diagnosis in dogs with an acute abdomen.
PubMed: 37567181
DOI: 10.1055/a-2110-0036 -
ACG Case Reports Journal Mar 2021Pancreatic ganglioneuromas occur mostly in children and rarely in young adults, with no cases reported in adults older than 60 years. An 86-year-old-woman, with active...
Pancreatic ganglioneuromas occur mostly in children and rarely in young adults, with no cases reported in adults older than 60 years. An 86-year-old-woman, with active advanced multiple myeloma, presented with epigastric pain for 2 days. Abdominal and pelvic computed tomography demonstrated a distended gallbladder, mildly dilated biliary tree, and a 13 × 8-mm hypodense mass in pancreatic body, without extrapancreatic invasion at endoscopic ultrasound. Fine-needle endoscopic ultrasound-guided core biopsy revealed characteristic histopathology of ganglioneuroma, as confirmed by immunohistochemical positivity for S100, SOX-10, and synaptophysin. This demonstrates novel finding of pancreatic ganglioneuroma occurring in the elderly. Lesion inclusion in the differential diagnosis may mandate tissue for pathologic diagnosis and complete lesion resection.
PubMed: 33763500
DOI: 10.14309/crj.0000000000000546 -
Cureus Oct 2023Intrauterine volvulus is an extremely rare disorder. Its diagnosis is difficult to make antenatally, unless typical pictures are obtained. Owing to its high morbidity...
Intrauterine volvulus is an extremely rare disorder. Its diagnosis is difficult to make antenatally, unless typical pictures are obtained. Owing to its high morbidity and mortality, intensive monitoring of the fetal condition is mandatory. Here, we report a patient, gravida 4, para 1 (G4P1), who had suffered from preterm labor and diminishing fetal movement and was brought to the emergency unit after her 35th week of pregnancy. Ultrasonography was performed to reveal a fetus with a markedly distended bowel (18 mm in width). Intestinal obstruction related to intrauterine volvulus was highly suspected. The fetus was delivered via Cesarean section because of its deteriorated abdominal condition. Urgent exploratory laparotomy was done by a pediatric surgeon to relieve the bowel obstruction on the second day after birth, on the account of poor improvement of the newborn. The newborn did well after segmental resection and was subsequently followed up at the pediatric outpatient clinic. In conclusion, early detection, intensive monitoring, prompt delivery, and urgent surgical intervention are the key to save the fetal life and neonatal health.
PubMed: 38021592
DOI: 10.7759/cureus.47712 -
Annals of Translational Medicine Oct 2018Mechanical ventilation is a life-saving procedure, which takes over the function of the respiratory muscles while buying time for healing to take place. However, it can... (Review)
Review
Mechanical ventilation is a life-saving procedure, which takes over the function of the respiratory muscles while buying time for healing to take place. However, it can also promote or worsen lung injury, so that careful monitoring of respiratory mechanics is suggested to titrate the level of support and avoid injurious pressures and volumes to develop. Standard monitoring includes flow, volume and airway pressure (Paw). However, Paw represents the pressure acting on the respiratory system as a whole, and does not allow to differentiate the part of pressure that is spent di distend the chest wall. Moreover, if spontaneous breathing efforts are allowed, the Paw is the sum of that applied by the ventilator and that generated by the patient. As a consequence, monitoring of Paw has significant shortcomings. Assessment of esophageal pressure (Pes), as a surrogate for pleural pressure (Ppl), may allow the clinicians to discriminate between the elastic behaviour of the lung and the chest wall, and to calculate the degree of spontaneous respiratory effort. In the present review, the characteristics and limitations of airway and transpulmonary pressure monitoring will be presented; we will highlight the different assumptions underlying the various methods for measuring transpulmonary pressure (i.e., the elastance-derived and the release-derived method, and the direct measurement), as well as the potential application of transpulmonary pressure assessment during both controlled and spontaneous/assisted mechanical ventilation in critically ill patients.
PubMed: 30460257
DOI: 10.21037/atm.2018.05.31 -
Minimally Invasive Therapy & Allied... Jan 2022To examine the uterine cavity and/or to perform hysteroscopic surgery, one has to access the uterine cavity through the cervix, distend the cavity with a fluid (liquid... (Review)
Review
To examine the uterine cavity and/or to perform hysteroscopic surgery, one has to access the uterine cavity through the cervix, distend the cavity with a fluid (liquid or gas) to visualize it with a telescope and/or a camera system and use energy (mechanical or thermal) to affect and/or remove tissue. Distension of the uterine cavity then is an important component of hysteroscopy, and during the last century, numerous attempts have been made to achieve an undistorted and unobstructed panoramic view of the uterine cavity. In order to achieve this goal, the uterine cavity has been distended with fluids using a variety of techniques, including gravity-assisted systems, pressure cuffed systems, and electronic pumps. Excessive fluid intravasation during hysteroscopy can lead to significant complications, and hence, automated fluid delivery systems have been developed recently to provide a safe and more efficient method of fluid delivery. This review aims to describe the evolution of distension media delivery systems chronologically from the 1900s to the present day.
Topics: Cervix Uteri; Female; Humans; Hysteroscopy; Pregnancy; Uterus
PubMed: 32410478
DOI: 10.1080/13645706.2020.1763402 -
JBRA Assisted Reproduction Oct 2021To evaluate the newly formed epithelium that develops following a neovaginoplasty performed with Amniotic Membrane.
OBJECTIVE
To evaluate the newly formed epithelium that develops following a neovaginoplasty performed with Amniotic Membrane.
METHODS
A retrospective study conducted at the University Hospital of the Federal University, in Curitiba, Paraná, Brazil. A group of 33 patients with Vaginal Agenesis, most of them amenorrhoeic, either incapable of or having difficulty to perform sexual activity, were separated in Subgroup A (27 patients) with Mayer-Rokitansky-Kuster-Hauser Syndrome, and Subgroup B (six patients) with Androgenic Insensitivity Syndrome (Morris Syndrome). Intervention: Banister-McIndoe neovaginoplasty was performed using amniotic membrane graft in 33 patients of Subgroups A and B and evaluated 60-90 days later by vaginal epithelium biopsies. Main Outcome Measure(s): Transmission Electronic Microscopy (TEM) performed Biopsies of neovaginal epithelium in 10 patients. In 20 patients, we analyzed the levels of intensity and presence of Estrogenic Receptors.
RESULTS
Vaginal length was measured (vaginometry) before and after surgery. Before surgery, the vagina was absent in 5 patients (15.15%), vaginal length was 1 cm in 19 patients (57.58%) and in 9 patients (27.27%), it was between 2-3 cm. After surgery, all patients had a vaginal length greater or equal to 5 cm and, in 26 patients (78.8%), vaginal length was 7-8 cm. Seven to eight centimeters average neovagina length allowed patients to have a satisfactory sexual activity after all the surgical procedures to dilate, widen and distend the neomucosa lining. The ERs presented different levels of intensity in the three layers of the neovaginal mucosa. TEM analysis of the vaginal neoepithelium obtained from the amniotic membrane graft revealed all the characteristics of a trophic vaginal epithelium.
CONCLUSIONS
In a developing country like Brazil, neovaginoplasty with amniotic membrane graft is considered a great option, being an inexpensive, safe, and easy technique, not requiring any special materials. After a few days (60-90 days), or months, a new epithelium and vagina are obtained allowing patients to have proper sexual activity.
Topics: 46, XX Disorders of Sex Development; Epithelium; Female; Humans; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome; Vagina
PubMed: 34061487
DOI: 10.5935/1518-0557.20210016 -
Frontiers in Cell and Developmental... 2020Paraptosis is a type of programmed cell death that is characterized by dilation of the endoplasmic reticulum (ER) and/or mitochondria. Since paraptosis is... (Review)
Review
Paraptosis is a type of programmed cell death that is characterized by dilation of the endoplasmic reticulum (ER) and/or mitochondria. Since paraptosis is morphologically and biochemically different from apoptosis, understanding its regulatory mechanisms may provide a novel therapeutic strategy in malignant cancer cells that have proven resistant to conventional pro-apoptotic treatments. Relatively little is known about the molecular basis of paraptosis, but perturbations of cellular proteostasis and ion homeostasis appear to critically contribute to the process. Ca transport has been shown to be important in the paraptosis induced by several natural products, metal complexes, and co-treatment with proteasome inhibitors and certain Ca-modulating agents. In particular, the Ca-mediated communication between the ER and mitochondria plays a crucial role in paraptosis. Mitochondrial Ca overload from the intracellular Ca-flux system located at the ER-mitochondrial axis can induce mitochondrial dilation during paraptosis, while the accumulation of misfolded proteins within the ER lumen is believed to exert an osmotic force and draw water from the cytoplasm to distend the ER lumen. In this process, Ca release from the ER also critically contributes to aggravating ER stress and ER dilation. This review focuses on the role of Ca transport in paraptosis by summarizing the recent findings related to the actions of Ca-modulating paraptosis-inducing agents and discussing the potential cancer therapeutic strategies that may effectively induce paraptosis Ca signaling.
PubMed: 33585447
DOI: 10.3389/fcell.2020.607844