Lung ultrasound in acute respiratory distress syndrome and acute lung injury

Purpose of reviewLung ultrasound at the bedside can provide accurate information on lung status in critically ill patients with acute respiratory distress syndrome.Recent findingsLung ultrasound can replace bedside chest radiography and lung computed tomography for assessment of pleural effusion, pneumothorax, alveolar- interstitial syndrome, lung consolidation, pulmonary abscess and lung recruitment/de-recruitment. It can also accurately determine the type of lung morphology at the bedside (focal or diffuse aeration loss), and therefore it is useful for optimizing positive end-expiratory pressure. The learning curve is brief, so most intensive care physicians will be able to use it after a few weeks of training.SummaryLung ultrasound is noninvasive, easily repeatable and allows assessment of changes in lung aeration induced by the various therapies. It is among the most promising bedside techniques for monitoring patients with acute respiratory distress syndrome.

Persistent Pleuropulmonary Air Leak Treated with Autologous Blood: Results from a University Hospital and Review of Literature

Background: Persistent air leak after pulmonary resection is a difficult complication for thoracic surgeons to manage. Objectives: To show the results of our experience treating persistent pleuropulmonary air leak with autologous blood and review the literature on this specific method of treatment. Methods: Retrospective study of patients with persistent aerial pleuropulmonary fistula treated with autologous blood. The patient's own blood was collected from a peripheral vein and directly introduced through the pleural drain. An inverted siphon was located in the drainage system to avoid prolonged clamping of the drain. This siphon impeded blood return but not air escape. Results: Between January 2001 and August 2008, 27 patients were treated by the above method. Patient age ranged from 2 to 74 years, and 78% were male. Each procedure used a mean quantity of 92 ml blood. Mean persistent air leak time before pleurodesis was 10.6 days and mean time to fistula resolution after pleurodesis was 1.5 days. Twenty-three (85%) patients had persistent pleuropulmonary air leak closed with the above procedure. Conclusion: Treating persistent pleuropulmonary air leak with autologous blood is promising, but further studies are required to quantify its real effectiveness. Copyright (C) 2009 S. Karger AG, Basel

Cardiac trauma confirmed by cardiac markers in dogs: two case reports

Relatam-se dois casos de miocardite em cães. A avaliação radiográfica mostrou pneumotórax e padrão alveolar no lobo diafragmático pulmonar em um cão e arritmia em ambos os cães. As análises das proteínas cardíacas altamente sensíveis, como a CK-MB e a troponina I cardíaca, associadas ao histórico clínico e aos achados eletrocardiográficos, indicaram, com acurácia, a extensão da injúria miocárdica secundária ao trauma.

Ultrassonografia torácica extracardíaca em pequenos animais

Until recently, ultrasonography was not considered one of the prevailing imaging methods for thoracic evaluation due to its limitations in evaluating lesions located below thoracic gas collections in individuals with normal lung tissue as well as in those with pneumothorax. Nevertheless, ultrasound has an advantage over other imaging techniques. It allows not only differentiating pleural from pulmonary lesions, but also identifying and assessing peripheral pulmonary lesions. Thus, thoracic ultrasound has become more popular in Veterinary Medicine as an ancillary method in the diagnosis and treatment of several diseases of the thoracic cavity, especially in emergency settings. This review aims at providing information on the main alterations found in the chest wall, mediastinum, pleura, lung and diaphragm by means of ultrasonography.

Enfisema lobar congênito: série de casos de 30 anos em dois hospitais universitários

Objetivo: Revisar os casos de enfisema lobar congênito (ELC) operados nos últimos 30 anos em dois hospitais universitários. Métodos: Foram revistos os prontuários médicos das crianças com ELC operadas no Hospital das Clínicas da Faculdade de Medicina de Botucatu e no Hospital da Universidade de Mogi das Cruzes entre 1979 e 2009. Dados sobre sintomas, exame físico, achados radiológicos, diagnóstico, tratamento cirúrgico e seguimento pós-operatório mediato e tardio foram analisados. Resultados: Durante o período estudado, 20 crianças com ELC foram submetidas a tratamento cirúrgico. A média de idade dos pacientes no momento da cirurgia foi 6,9 meses (variação, 9 dias a 4 anos). Todos os casos apresentaram sintomas ao nascimento ou nos primeiros meses de vida. Em todos os casos, a radiografia simples de tórax foi importante na definição do diagnóstico. Em casos de dificuldade respiratória moderada, a TC de tórax auxiliou no diagnóstico. Um paciente com desconforto respiratório grave foi diagnosticado erroneamente com pneumotórax hipertensivo e submetido a drenagem torácica. A broncoscopia só foi realizada nos pacientes com dificuldade respiratória moderada e não foram encontrados sinais de anomalias traqueobrônquicas. A abordagem cirúrgica foi realizada através de toracotomia lateral poupadora de músculo. O lobo superior esquerdo e o lobo médio foram os mais afetados, seguidos pelo lobo superior direito. A lobectomia foi realizada em 18 casos, enquanto a bilobectomia foi realizada em 2 casos (com ressecção de cisto broncogênico em 1 desses). Complicações pós-operatórias não foram observadas. O acompanhamento pós-operatório foi de pelo menos 24 meses (média, 60 meses) e não foram observadas complicações tardias nesta série. Conclusões: O ELC é uma doença pouco comum, ainda negligenciada, de etiologia incerta, mas de fácil diagnóstico radiológico e tratamento cirúrgico eficaz.

Pneumotórax experimental em equinos: efeitos clínicos e sobre as pressões pleural e intra-abdominal

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Segurança e eficácia da analgesia interpleural com ropivacaína em simpatectomia torácica videoassistida

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Mensuração e análise do ph salivar em pacientes com hiperidrose submetidos a cirurgia de simpatectomia videotoracoscópica

The study was performed to verify if there are changes in salivary pH in patients with hyperhidrosis who were treated by Videothoracoscopic Sympathectomy. Twelve patients underwent sympathectomy with clamping the sympathetic chain along the vertebrae T2, T3 and T4, under inhalation and intravenous general anesthesia and with drainage of pneumothorax through probe N° 16. These patients had their saliva collected 1 day before and 7 days after surgery for measurement of pH by the colorimetric method with indicator paper. All patients showed no sign or symptom of hyperhidrosis in the immediate postoperative period, which demonstrates the success of sympathetic denervation on these levels. No patient had compensatory sweating and there was no post-operatively surgical complication. No drug or substance has been administered to patients for the study. The pH results obtained were analyzed using test ´´t´´ Student. Although the average pH in samples obtained after surgery was lower than the preoperative, the test revealed no statistically significant difference (p = 0.181). It is concluded that sympathectomy, an excellent therapeutic and definitive method for hyperhidrosis, does not alter the salivary pH, and so, did not influence the cariogenic process