Pulmonary hypertension due to acute respiratory distress syndrome

Our aims were to describe the prevalence of pulmonary hypertension in patients with acute respiratory distress syndrome (ARDS), to characterize their hemodynamic cardiopulmonary profiles, and to correlate these parameters with outcome. All consecutive patients over 16 years of age who were in the intensive care unit with a diagnosis of ARDS and an in situ pulmonary artery catheter for hemodynamic monitoring were studied. Pulmonary hypertension was diagnosed when the mean pulmonary artery pressure was >25 mmHg at rest with a pulmonary artery occlusion pressure or left atrial pressure <15 mmHg. During the study period, 30 of 402 critically ill patients (7.46%) who were admitted to the ICU fulfilled the criteria for ARDS. Of the 30 patients with ARDS, 14 met the criteria for pulmonary hypertension, a prevalence of 46.6% (95% CI; 28-66%). The most common cause of ARDS was pneumonia (56.3%). The overall mortality was 36.6% and was similar in patients with and without pulmonary hypertension. Differences in patients' hemodynamic profiles were influenced by the presence of pulmonary hypertension. The levels of positive end-expiratory pressure and peak pressure were higher in patients with pulmonary hypertension, and the PaCO2 was higher in those who died. The level of airway pressure seemed to influence the onset of pulmonary hypertension. Survival was determined by the severity of organ failure at admission to the intensive care unit.

Comparison of totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for kidney stones: a randomized, clinical trial

This study aimed to compare the totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy techniques regarding their rates of success and complications in patients with kidney stones. Patients were randomly assigned to two groups. Forty-four patients (24 men; mean age: 50.40±2.02 years) received totally tubeless percutaneous nephrolithotomy (PCNL; no nephrostomy catheter or ureteral catheter after PCNL) and 40 patients (18 men; mean age: 49.95±13.38 years) underwent standard PCNL (a nephrostomy catheter and ureteral catheter were used after PCNL). All surgeries were performed by one surgeon. Postoperative changes in hemoglobin, the blood transfusion rate, changes in creatinine levels, operation time, analgesic need, hospitalization time, and complication rate were compared between the groups. No significant differences were observed in age, gender, stone size, and surgery side between the groups (P<0.05). The operation time was significantly lower in the totally tubeless PCNL group than in the standard PCNL group (P=0.005). Pethidine requirements were significantly higher in the standard PCNL group than the totally tubeless PCNL group (P=0.007). Hospitalization time was significantly higher in the standard PCNL group than in the totally tubeless PCNL group (P<0.0001). The complication rate was 15% in the standard PCNL group and 9.1% in the totally tubeless PCNL group (P=0.73). The totally tubeless PCNL technique is safe and effective, even for patients with staghorn stones. This technique is associated with decreased pain, analgesic needs, and operative and hospitalization time. We believe that a normal peristaltic ureter is the best drainage tube.

Tratamentos de pré-resfriamento e resfriamento sobre a qualidade de carne de peito de frango

O total de 402 frangos foi processado em abatedouro comercial e submetido a seis tratamentos de resfriamento. Inicialmente as carcaças foram pré-resfriadas (PR) por imersão em água e gelo, seguido de resfriamento (R) a -35°C e estocagem a 4°C por 20 horas. Os tratamentos foram: a (0°C/30min, -35°C/3h e 15min), b (10°C/30min, 0°C/30min, -35°C/2h e 45 min), c (10°C/30min, -35°C/3h e 15min), d (20°C/30min, 0°C/30min, -35°C/2h e 45min), e (20°C/30min, -35°C/3h e 15min) e F (20°C/30min, 0°C/3h e 15min). Temperaturas baixas utilizadas após a evisceração aceleraram a instalação do rigor em músculos pectoralis major (PM). Aos 45min post mortem carcaças sem PR (A) ou PR a 10°C (B) tiveram músculo PM com menor (P<0,001) pH (5,75 e 5,81) do que carcaças PR a 20°C (D) (5,95). Às 4h p.m, nos tratamentos A e B as médias de valor R* foram (P<0,05) mais elevadas (1,51 e 1,44) que o no tratamento D (1,32). O teor de luminosidade foi influenciado (P<0,001) pelas temperaturas de R (nos tratamentos A, B e C as médias foram de 48,2; 47,7 e 47,6 e nos tratamentos D e E de 45,5 e 45,7, respectivamente). Os teores de luminosidade mais elevados coincidiram com tratamentos com rápida glicólise post mortem. A perda de peso por cozimento e a força de cisalhamento não revelaram efeito dos tratamentos. * razão entre as absorbâncias de 250nm e 260nm, que avalia a quantidade de monofosfato de inosina (IMP) para trifosfato de adenosina (ATP)