Abstract
Rev Bras Ter Intensiva. 2010;22(4):403-412
DOI 10.1590/S0103-507X2010000400015
Gene expression is disrupted by sepsis. Genetic markers can only reveal a patient's genotype, and they are not affected by environmental biological processes. These processes are expressed by proteins. This study was aimed to advance the insight into the molecular foundations of sepsis. It employed proteomic techniques to identify and analyze differential serum protein expressions taken from a patient throughout the stages of sepsis (sepsis, severe sepsis and septic shock). Serum samples were collected at each stage of sepsis and submitted to one-dimensional electrophoresis, on gradient strips of immobilized pH, followed by two-dimensional 12.5% polyacrylamide gel electrophoresis. The gels obtained were stained, scanned and analyzed by the ImageMasterPlatinum program. Proteins that were differentially expressed in the gels were excised, digested with trypsin and identified through mass spectrometry. Fourteen differentially expressed proteins were identified throughout the stages of sepsis, as well as a protein that was not expressed in all stages, suggesting the potential existence of a biomarker. The differentially expressed proteins identified were: serum amyloid A, apolipoprotein A-1 (2 isoforms), zinc finger protein 222, human albumin, PRO 2619, immunoglobulin kappa light chain VLJ region, monoclonal immunoglobulin M cold agglutinin, 7 proteinase inhibitors - alpha-1 antitrypsin. The findings of this pilot study demonstrate the involvement of the complement and coagulation pathways, of the lipid metabolism and of genetic information in sepsis. The vast majority of proteins identified are involved in the immune system and the proteinase inhibitor proteins are predominant.
Abstract
Rev Bras Ter Intensiva. 2010;22(1):96-98
DOI 10.1590/S0103-507X2010000100016
A case of Chryseobacterium indologenes infection is reported, identified in an invasive mechanic ventilation patient's tracheal aspiration material. Epidemiological, microbiological, and intensive care unit therapy aspects are discussed. The patient was a 30 years-old male, admitted with idiopathic medullary aplasia and febrile neutropenia, referred to the intensive care unit with severe bronchopneumonia and sepsis of pulmonary origin. Most of the previously reported Chryseobacterium indologenes infection cases were associated with severe diseases and polymicrobial infections which could make difficult interpreting antimicrobial therapy options against this agent.
Abstract
Rev Bras Ter Intensiva. 2009;21(4):461-464
DOI 10.1590/S0103-507X2009000400018
Patients with chronic Schistosoma mansoni infection may feature a range of pulmonary symptoms and radiological findings. Eggs, and rarely adult worms, may passively enter the pulmonary circulation, usually via the portal system, where they may cause pulmonary inflammation, fibrosis, hypertension and cor pulmonale. A 25-year-old patient who lived in a schistosomiasis endemic area with a pulmonary mass suggestive of malignancy underwent exploratory thoracotomy. The mass was adherent, with no resection possibility. The lung-biopsy specimen evaluation showed several granulomas with Schistosoma mansoni eggs and hyperplasic connective tissue with no sign of malignancy. The patient had respiratory failure and hypotension immediately post-surgery. Specific treatment (praziquantel) and prednisone were given. The patient had pneumonia and septic shock. The patient was given antibiotics, vasopressors, mechanical ventilation and hemodialysis with no improvement, and subsequently died 28 days after the surgery.
Abstract
Rev Bras Ter Intensiva. 2009;21(3):332-335
DOI 10.1590/S0103-507X2009000300015
This case report relates out-of-hospital care to a patient with risk factors treated in the out-of-hospital services after cardiac arrest and ventricular fibrillation. The patient was treated according to the standards of basic life support and advanced cardiovascular life support; by applying an automated external defibrillator (AED) with favorable outcome and successful recovery of the patient from his risk of life condition. This is the first documented report with a favorable outcome in Peru, in out-of-hospital services and stresses the desirability of adopting policies for public access to early defibrillation.
Abstract
Rev Bras Ter Intensiva. 2009;21(3):336-339
DOI 10.1590/S0103-507X2009000300016
Case report of a patient with 37-week gestational age admitted to an obstetric intensive care unit with an altered level of consciousness, related primarily to the pregnancy-induced hypertension. The patient presented a worsening clinical course characterized by, anemia and severe thrombocytopenia, Investigation led to a diagnostic of thrombotic thrombocytopenic purpura after the hematological profile was assessed. The authors emphasize the importance of the disease recognition as a prognostic marker for obstetric patients, in view of the similarity with other common morbidities during pregnancy and the importance of timely diagnosis and early treatment as determinant factors for the outcome.
Abstract
Rev Bras Ter Intensiva. 2009;21(2):226-230
DOI 10.1590/S0103-507X2009000200017
Pulmonary artery catheter is frequently used to monitor patients during liver transplantation. Recently developed less invasive methods for estimating cardiac output and pulmonary capillary wedge pressure together with the failure of randomized studies to demonstrate reduced mortality in pulmonary artery catheter-monitored patients, has restricted its applicability. Pulmonary artery rupture by pulmonary artery catheter is a rare, but dangerous complication. The purpose of this report is to describe a pulmonary artery rupture caused by monitorization with a pulmonary artery catheter, reviewing the clinical approach and discussing hemodynamic monitoring with the pulmonary artery catheter during liver transplantation. A 56 year old female patient, with cirrhosis caused by hepatitis C virus (MELD score 26) presented with acute hepatic encephalopathy. She was medicated and received a liver transplantation with invasive monitoring with a pulmonary artery catheter. In the first 24 hours after surgery, the patient presented with hemodynamic instability, low hematocrit, and cardiorespiratory arrest. After cardiopulmonary resuscitation, hemopericardium was diagnosed by transthoracic echocardiography and even after pericardiocentesis the patient developed recurrent hemopericardium. Pulmonary angiography did not disclose large vessellesions. The pulmonary artery rupture diagnosis was only made after sternotomy and direct lesion observation. Complications from use of pulmonary artery catheter are infrequent, however, due to their clinical severity, can cause high morbidity and mortality. A decreased use of pulmonary artery catheter reduced the number of complications observed. New clinical studies comparing pulmonary artery catheter with non-invasive methods for pulmonary capillary wedge pressure measurement must be conducted in liver transplantation.
Abstract
Rev Bras Ter Intensiva. 2008;20(3):318-320
DOI 10.1590/S0103-507X2008000300016
Pulmonary thromboembolism is a major cause of morbidity and mortality of patients undergoing neurosurgical procedures. The purpose of this study was to present a case of intra-arterial pulmonary thrombolysis in recent neurosurgery postoperative period. Male patient, undergoing neurosurgery, presented as a complication on the seventh day of postoperative massive pulmonary embolism with hemodynamic instability and intraarterial pulmonary thrombolysis with alteplase was indicated. Evolution was satisfactory without bleeding complications and patient was discharged. Pulmonary thromboembolism is a high morbidity and mortality condition at neurosurgical postoperative period and thrombolysis should be an alternative therapy in cases refractory to clinical treatment.
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