Archive for February, 2012

PULSUS ALTERNANS

Saturday, February 18th, 2012

Alternating pulse (pulsus alternans) (Figure 227.2) is characterized by regular rhythm of the pulse waves with alternating high and low amplitude and is caused by the alternation of different strength of heart contractions with severe left ventricular dysfunction. Usually alternating pulse is combined with a loud voice III heart. It occurs in the absence of organic lesions of the heart: paroxysms of tachycardia during and immediately after their termination, as well as for several cardiac cycles after the extrasystole.

Alternating pulse alternation of the heart - a special form of arrhythmia, which is clinically manifested in the correct succession of full-systoles systolic weak heartbeat. This is a rare rhythm disturbance caused by a decrease in cardiac contractile function in severe myocardial injury, especially when combined with hypertension and tachycardia. Accordingly, the power of the systolic contractions of the heart varies the intensity of heart sounds: the case of strong muscle contraction - normal tones, with the weak - the deaf.

Alternating pulse may be confused with bigeminy, but after the second bigeminy (extrasystolic) wave is a compensatory pause.

With the disappearance of the causal factors that lower the contractile force of cardiac muscle, intermittent pulse disappears.

Continuous alternating pulses - the terrible symptom of heart failure. Treat the underlying disease, heart funds are used.

PSYCHOGENIC POLYDIPSIA

Saturday, February 18th, 2012

Abstract Congenital renal dysplasia WAS Diagnosed tentatively, based on ultrasound and year
intravenous urogram, in a 5-month-old female with polyuria and polydipsia. creatinine clearance
measurement the renal dysplasia Revealed That Was Not the cause of the polyuria. A modified
water deprivation test Eliminated Other differential diagnoses and psychogenic polydipsia Confirmed.
Renal dysplasia and congenital Resume psychogenic polydipsia in a Bernese mountain dog.
A tentative diagnosis of congenital renal dysplasia was subsequently raised has an ultrasound examination
and has an intravenous urogram in a bitch 5 months presenting polyuria and polydipsia.
An analysis of the creatinine clearance has revealed that renal dysplasia was not the cause
polyuria. A modified ordeal of water deprivation resulted in eliminating diagnoses diffdrentiels
psychogenic polydipsia and confirmed.

Thirst is the desire to drink. This is a feeling of dry mouth and mucous membranes due to a need for the body water.

Some terms are used in connection with the thirst it comes to (not exhaustive):

The oligodipsie (from the Greek oligos: dipsa little and thirst, in English oligodipsia) reflects the reduction or almost complete absence of thirst. The oligodipsie is observed in some individuals who show no disturbance of a medical nature.

Polydipsia (Greek palus: many dipsa: thirst, polydipsia in English) translated excessive thirst.

The dipsomania (Greek dipsa: thirst and so: Madness) is the impulse that drives some individuals (dipsomaniacs) with psychiatric disorders to absorb excess toxic liquids, most often alcohol. Trelat said: “Drunks are people who get drunk when they find an opportunity to drink the dipsomaniacs are patients who get drunk every time they access the taking.”

The term dipsogenic means something that causes thirst. Such term also includes substances with this property.

Knowing that the hypothalamus regulates the sensation of thirst, a lesion of the central gray nucleus disrupt it. Thus, lack of thirst may be the result of a breach of the hypothalamus (the hypothalamus) that occur between other following a head injury, an illness, injury etc. .. If no correction is made hydropower that is to say if the individual absorbs, from that moment, no liquid, there is a risk of dehydration.

Renal failure or taking medications such as phenothiazines or severe bleeding can result in a significant sense of thirst.

Potomania the contrary, is an unquenchable thirst and permanent. This symptom can reflect the occurrence of diabetes insipidus or diabetes mellitus. More rarely potomania may be the result of a psychiatric or psychological disturbance. It is in this case of psychogenic polydipsia with excessive thirst due to a psychiatric condition.

Cellular dehydration syndrome also called cellular dehydration or intracellular dehydration syndrome denotes the set of symptoms due to an increase in the osmotic tonicity (osmotic pressure) outside the body cells as occurs among others in the hypertension syndrome osmotic plasma.

Syndrome extracellular dehydration that occurs during Darrow’s syndrome, among others, is a collection of symptoms characterized by a decrease in the amount of sodium within the extracellular compartment with a proportionally water loss (water ). The patient suffers from haemoconcentration but the quantity of sodium in the blood (serum sodium) and the osmotic pressure of plasma is normal. The symptoms are fatigue, dry skin and mucous membranes, tachycardia (increased heart rate) and hypotension. It can be seen by other oliguria with a high amount of nitrogen in the urine. This syndrome may be due to loss of water and salt through the digestive tract because of vomiting, diarrhea or gastrointestinal fistula. It may also be the result of water loss through the skin or kidney due to chronic adrenal insufficiency. Diabetic coma and nephritis may also be the origin.
Treatment requires the administration of water and salt.

Syndrome or complete dehydration is a comprehensive set of symptoms resulting extracellular dehydration associated with intracellular dehydration. Extracellular dehydration affects all body compartments outside the cells that compose it. The intracellular dehydration for the interior of all cells in the body. There is other hemoconcentration (blood concentration) and increased the amount of sodium (salt) in the blood. This is a syndrome that is caused by a deficiency of water and salt resulting from loss of water and salt in large quantities. Sodium losses (or sodium salt) are the result of a leak in the gut but also in sweat. These losses must be compensated, especially among the elderly, infants and the topic coma. Syndrome overall dehydration results in the appearance of a thirst, a fall in blood pressure, a dry skin and mucous membranes (cell layer covering the inside of a hollow organ in touch with air) of the mouth, agitation and psychological disorders. It is necessary to administer simultaneously water and salt.

Fever of thirst (dehydration fever in English) also called dehydration fever. means a rise in temperature, occurring suddenly and transiently in a newborn aged 3 to 4 days. In general this syndrome occurs most often during the warm season. It is the result of fluid absorption in short supply. Fever of thirst is also observed in adults who are exposed, including the sun or other heat sources, which results in significant evaporation loss of water resulting in very intense, which is not offset by a fluid intake (water) enough.

Polyuridipsique syndrome also called syndrome-dipsique polyuria or polydipsia-polyuria is a symptom complex resulting in the combination of excessive thirst and a superabundant secretion (in large amounts) of urine, as occurs among other in diabetes insipidus.

polyuria

Saturday, February 18th, 2012

poliuria

poliuria

The polyuria (Greek πολυουρία, poliuría, “a lot of urine”) is the medical term for an abnormally increased urinary excretion (significantly more than 2 liters in 24 hours).

contents

1 Causes
2 Symptoms
3 Diagnostics
4 Differential Diagnosis

Causes

Diabetes mellitus: In a poorly controlled diabetes mellitus or possibly undetected because it is a so-called osmotic diuresis with polyuria to excretion of glucose (glucosuria)
Polyurische phase after acute renal failure
Renal and central diabetes insipidus
Medications (diuretics)
Alcohol (centrally inhibits the ADH secretion)
possibly in chronic renal failure with Isosthenurie
Nocturia (nocturnal polyuria) in heart failure (Ödemausschwemmung)
Bartter’s syndrome
Conn’s syndrome

Symptoms

As a rule, in addition to the increased urinary excretion (more than 2 liters in 24 hours) also came by way of increased thirst (polydipsia) to compensate for fluid losses. Often there is still a so-called dehydration (drying out).

Diagnostics

Search for the above underlying diseases
blood sugar
Electrolytes is important to check the electrolyte, since it at a loss to polyuria especially of sodium, potassium and calcium may
Drug and alcohol history
hematocrit
creatinine
Urine and Blutosmolarität

Differential diagnosis

In psychogenic polydipsia patients drink because of a mental illness too much. Of course, secondarily, the amount of urine increased. When pollakiuria the urinary frequency without changing the Gesamtharnmenge is increased.

(SIADH) SYNDROME OF INNAPROPRIATE ADH SECRETION

Saturday, February 18th, 2012

SYNDROME OF INNAPROPRIATE ADH SECRETION (SIADH)

SYNDROME OF INNAPROPRIATE ADH SECRETION (SIADH)

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a syndrome frequently encountered in hospitals, particularly in patients hospitalized for problems in central nervous system (CNS). As the name suggests, is a syndrome characterized by an excessive release of antidiuretic hormone (ADH or vasopressin) from the posterior pituitary. This results in hyponatremia, and sometimes fluid overload.

The antidiuretic hormone (ADH) is synthesized by neurons of the hypothalamus and stored in the pituitary. It exerts its action in the kidneys by allowing water reabsorption by the collecting duct and thus the concentration of urine.

Antidiuretic hormone secretion is stimulated by two factors: the increase in plasma osmotic pressure (force exerted on both sides of the cell membrane of capillary blood vessels) and the drop in pressure of the blood volume circulating (hypovolemia).

Antidiuretic hormone deficiency is responsible for diabetes insipidus, condition characterized by polyuria (emission of large amounts of urine) and polydipsia (increased thirst and compelling). This deficit can be offset by the administration of oral desmopressin.

Hypersecretion inappropriate antidiuretic hormone, or Schwartz-Bartter syndrome, is characterized by lower levels of sodium in the blood and reducing urine; this syndrome is often linked to the existence of a tumor (most often cerebral and pulmonary) and is called paraneoplastic syndromes. Drugs ADH antagonists, by blocking its receptors, treat this syndrome and edema associated with congestive heart failure.

Summary

1 Pathophysiology
2 Clinic
3 Survey etiological
4 Treatment
5 Differential Diagnosis
Part 6

Pathophysiology

Normally, the antidiuretic hormone (ADH) controls the osmolar concentration of the organism. It maintains a stable concentration osmolar through the volume of water contained in the human body. DHA induces the retention of “pure” water at the distal convoluted tubule in the kidney. The retained water dilutes the excess osmoles that stimulated the secretion of antidiuretic hormone.

The mechanisms of secretion of ADH outside its usual controls are imperfectly understood. Tissues become capable of secreting a hormone similar to ADH in large quantities; is the case of cancer and bronchopulmonary infections.

Clinical

There is no specific sign of this syndrome. The major signs are those of the intracellular overhydration or hyponatremia, nausea, vomiting, confusion and behavioral problems. In cases of severe hyponatremia, coma and convulsions are common.
Etiology
Head injury
Cancers
Lung cancer (including small cell lung cancer)
Lymphoma, Hodgkin’s disease
Infections
Brain abscess
Pneumonia
Lung abscess
Bronchopulmonary aspergillosis
Malignant pertussis
Endocrine causes
adrenal insufficiency
Drugs
Chlorpropamide
Cyclophosphamide
Carbamazepine
Idiopathic

Treatment

fluid restriction
loop diuretic
infusion of hypertonic sodium chloride
dedemeclocycline administration or lithium or urea
ADH V2 receptor antagonist
etiological treatment

Differential diagnosis

Addison’s disease
dilutional hyponatremia on congestive heart / liver
myxedema
pseudo-hyponatremia

talc pleurodesis recovery

Friday, February 17th, 2012
  1. Surgery.com – Read Information on the Pleurodesis Procedure

    www.surgery.com/article/pleurodesis

    31 Jan 2010 – Scarring agents commonly used in pleurodesis include talc, certain The same thing occurs in the chest during pleurodesis recovery except it

  2. Talc Procedure recovery – moviefan’s journal – Inspire

    www.inspire.com/…/talc-procedure-recover -

    10 Aug 2010 – The effect of the procedure, called medical thoracoscopy with talc pleurodesis, are immediate and last a lifetime. The talc has added benefits

  3. Chronic pain due to talc pleurodesis for spontaneous pneumothorax

    ats.ctsnetjournals.org/cgi/content/full/…/174… -

    We present a case of previous talc pleurodesis that resulted in chronic pain and The patient made an uneventful postoperative recovery and was discharged 7

  4. Pleurodesis | Mesothelioma Treatment.net

    www.mesotheliomatreatment.net/pleurodesis -

    Pleurodesis, also known as chemical pleurodesis, is a specialized surgical procedure that The talc acts as an irritant within the pleural space and causes swelling and The completion of the surgery is followed by a painful recovery period.

  5. SPONTANEOUS PNEUMOTHORAX :: View topic – pleurodesis

    www.blebinfo.co.uk/…/viewtopic.php?p=93… -
    Сообщений: 8 - Авторов: 7 - 28 сен 2006

    My specialist likes to reserve chemical pleurodesis for older persons that have in the experiences forum which discuss surgery and recovery.

  6. Pleurodesis in the treatment and care of mesothelioma patients

    www.mesotheliomaweb.org/…/pleuro

    Pleurodesis works to counter this fluid build up by causing the pleurae to stick together, The most common agent is talc, while nitrogen mustard, quinacrine, to both guard again infection and to manage any pain felt during their recovery.

  7. VAT – Pleurodesis

    www.bostonthoracicsurgery.com/handler.cf…

    How to Prepare. What to Expect. Recovery Pleurodesis is a therapy that we offer for lung cancer patients to remove excess fluid — called pleural effusion

  8. Talc pleurodesis? – Yahoo!7 Answers

    au.answers.yahoo.com/…/index?…

    Talc pleurodesis? I have been informed by doctor after various speculatory guesses by a couple of doctors (pinched nerve/scarring/etc), i have had 3

  9. The LAM Foundation :: Pleurodesis

    www.thelamfoundation.org/pleurodesis -

    Talc pleurodesis: One of the most common methods of chemical pleurodesis is in the hospital after a thoracotomy, but full recovery can take several months.

  10. The Spontaneous Pneumothorax Patient Network :: View topic – Talc

    www.blebbusters.com/…/viewtopic.php?t…

    IF so, is the recovery time, pain after surgery, and long term recovery about the same? Also, has anyone had the talc pleurodesis and had a

talc pleurodesis procedure

Friday, February 17th, 2012

The procedure of talc pleurodesis can be performed successfully by nurses as well as doctors.

A comparison of thoracoscopic talc insufflation, slurry, and mechanical abrasion pleurodesis.
AU
Colt HG, Russack V, Chiu Y, Konopka RG, Chiles PG, Pedersen CA, Kapelanski D
SO
Chest. 1997;111(2):442.
The purpose of this study was to compare the anatomic and histopathologic results of four different methods of pleurodesis in 10 dogs. Each animal was randomly assigned to receive two of the following methods of pleurodesis: thoracoscopic talc insufflation (poudrage), talc slurry administration, focal gauze abrasion by limited thoracotomy, and mechanical abrasion by thoracoscopy using a commercially available pleural abrader. Animals were killed 30 days after pleurodesis. At autopsy, the efficacy of pleurodesis was graded by evaluating the gross appearance of each pleural cavity and lung (pleurodesis score), and by determining the extent of adhesion formation (obliteration grade). Pleural and lung biopsy specimens were obtained from the areas most representative of adhesion formation for histopathologic evaluation. Pleurodesis scores (on a scale of 0 to 4) were 3.0 +/- 0.7 for talc poudrage (p<0.05 when compared with talc slurry), 2.2 +/- 1.7 for thoracotomy, and 1.6 +/- 1.1 for talc slurry. Adhesions produced by gauze abrasion during thoracotomy were mostly peri-incisional. Thoracoscopic pleural abrasion using the pleural abrader was uniformly unsatisfactory. Granulation tissue formation was greatest in both talc models. The degree of parietal pleural thickening was greatest in the talc slurry model, but fibrosis and inflammation occurred mostly in gravity-dependent areas within the pleural cavity. Although differences were not statistically significant, thoracoscopic talc insufflation consistently produced the most widespread, firm fibrotic adhesions as evidenced by higher obliteration grades.

talc pleurodesis

Friday, February 17th, 2012
talc pleurodesisTalc preparations used for pleurodesis vary markedly from one preparation to another.
AU
Ferrer J, Villarino MA, Tura JM, Traveria A, Light RW
SO
Chest. 2001;119(6):1901.
BACKGROUND: At the present time, talc is the one of the agents most commonly used for the production of a pleurodesis. However, there have been several recent reports of acute pneumonitis developing after the intrapleural administration of talc. The incidence of pneumonitis has varied markedly from center to center.
OBJECTIVE: To compare the physical characteristics of talc used for the production of pleurodesis in various localities.
DESIGN: Eight talc preparations (four from the United States, and one each from Brazil, France, Spain, and Taiwan) were analyzed for the distribution of the particle size and the type and amount of impurities.
MEASUREMENTS: The physical characteristics of the talc specimens were determined using radiograph diffraction and scanning electron microscopy.
RESULTS: The mean and median particle size varied by more than a factor of three among the eight different talc preparations. In addition, the impurities of the different talc preparations were quite varied.
CONCLUSIONS: We conclude that there is marked variation in the physical characteristics of the talc preparations used intrapleurally for the production of a pleurodesis. We speculate that different incidences of acute pneumonitis at various centers after intrapleural administration of talc may be due to differences in the physical characteristics of the talc preparations used for pleurodesis.alcage by medical thoracoscopy for primary spontaneous pneumothorax is more cost-effective than drainage: a randomised study.

AU
Tschopp JM, Boutin C, Astoul P, Janssen JP, Grandin S, Bolliger CT, Delaunois L, Driesen P, Tassi G, Perruchoud AP, ESMEVAT team. (European Study on Medical Video-Assisted Thoracoscopy)
SO
Eur Respir J. 2002;20(4):1003.
Simple thoracoscopic talcage (TT) is a safe and effective treatment of primary spontaneous pneumothorax (PSP). However, its efficacy has not previously been estimated in comparison with standard conservative therapy (pleural drainage (PD)). In this prospective randomised comparison of two well-established procedures of treating PSP requiring at least a chest tube, cost-effectiveness, safety and pain control was evaluated in 108 patients with PSP (61 TT and 47 PD). Patients in both groups had comparable clinical characteristics. Drainage and hospitalisation duration were similar in TT and PD patients. There were no complications in either group. The immediate success rate was different: after prolonged drainage (>7 days), 10 out of 47 PD patients, but only 1 out of 61 TT patients required a TT as a second procedure. Total costs of hospitalisation including any treatment procedure were not significantly different between TT and PD patients. Pain, measured daily by visual analogue scales, was statistically higher during the first 3 days in TT patients but not in those patients receiving opiates. One month after leaving hospital, there was no significant difference in residual pain or full working ability: 20 out of 58 (34%) versus 10 out of 47 (21%) and 36 out of 61 (59%) versus 26 out of 39 (67%) in TT versus PD groups, respectively. After 5 yrs of follow-up, there had been only three out of 59 (5%) recurrences of pneumothorax after TT, but 16 out of 47 (34%) after conservative treatment by PD. Cost calculation favoured TT pleurodesis especially with regard to recurrences. In conclusion, thoracoscopic talc pleurodesis under local anaesthesia is superior to conservative treatment by chest tube drainage in cases of primary spontaneous pneumothorax that fail simple aspiration, provided there is efficient control of pain by opioids.
AD
Centre Valaisan de Pneumologie, Montana, Switzerland. Elisabeth.voland@admin.vs.ch
PMID