Adenocarcinoma intestinal en un perro

Descripción del caso: perro de nueve años de edad, macho, mestizo (Terranova/chow chow) con historia de diarrea crónica, vómito y sin respuesta a diferentes tratamientos; fue recibido en el Hospital Veterinario de Especialidades de la Universidad Nacional Autónoma de México para continuar con el proceso diagnóstico de una probable neoplasia intestinal.Hallazgos clínicos: condición corporal 2/5, 6 % de deshidratación, depresión, vómito, diarrea, dolor abdominal y anorexia. El diagnóstico fue pancreatitis aguda y un proceso infiltrativo (neoplásico o inflamatorio). En los estudios sanguíneos se observó anemia ligera a moderada relacionada con inflamación crónica y posible pérdida entérica; hipoproteinemia por pérdidas entéricas (diarrea) y anorexia prolongada, y en el leucograma hubo inflamación activa de forma persistente.Pruebas de laboratorio: ultrasonido que mostró cambios en el páncreas y el duodeno. Se realizaron varios estudios sanguíneos y una gasometría arterial, las alteraciones fueron asociadas a dolor.Tratamiento y evolución: el paciente fue hospitalizado para realizar biopsia quirúrgica y colocarle una sonda de yeyunostomía; tres días después mostró dolor, melena, empeoramiento del estado mental y efusión abdominal. El perro fue diagnosticado con peritonitis séptica. Debido a la condición y riesgo del paciente, se le practicó la eutanasia.Relevancia clínica: las neoplasias intestinales en perros son raras, el adenocarcinoma es el segundo más común. Como factores de pobre pronóstico se mencionan, la localización, el tamaño y la pobre diferenciación histológica. Este reporte es relevante por la limitada información e incidencia de este tipo de neoplasia, principalmente por la localización y manejo médico y quirúrgico. Duodenal adenocarcinoma in a dog: diagnostic approach and complications Abstract Case description: nine-year-old male dog, mix breed (Terranova/chow chow) with a history of chronic diarrhea and vomiting without response to different treatments. It continues in diagnosis process due to probable intestinal neoplasia.Clinical findings: body condition 2/5, 6 % dehydration, depression, vomiting, diarrhea, abdominal pain and anorexia. The diagnosis was acute pancreatitis and infiltrative intestinal process (neoplastic or inflammatory). The blood counts observed mild to moderate anemia related to chronic inflammation and possible enteric losses, hypoproteinemia due to enteric losses (diarrhea) and prolonged anorexia, and in the leukogram it had active inflammation persistently.Lab test: ultrasound showed changes in the pancreas and duodenum. Several blood counts were performed, and an arterial blood gas, the alterations were associated with pain.Treatment and evolution: the patient was hospitalized for surgical biopsy and placement of a jejunostomy tube; three days later there was pain, mane, worsening mental state and abdominal effusion. The dog was diagnosed with septic peritonitis was. Due to the patient´s risk, euthanasia was practiced.Clinical relevance: intestinal neoplasm in dogs are rare, the adenocarcinoma is the second most common. As factors of poor prognosis, the location, size and poor histological differentiation are mentioned. It is important to know the available tools to make a proper diagnosis, establish the prognosis and take therapeutic decisions. The relevance of this case report is the limited information and incidence of this type of neoplasm, mainly the location, which implies a medical-surgical management different from others tumours.Key words: duodenal adenocarcinoma, effusion citology, lactate, glucose, intestinal neoplasia.

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Beyond PaO2: Relationships between Indices of Pulmonary Oxygen Transfer in Hospitalized Adults Undergoing Blood Gas Testing

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol04-i03/600 ◽

2019 ◽

Vol 4 (03) ◽

Author(s):

Mark Feldman, MD ◽

Denise Rebel, BS, RRT

Keyword(s):

Oxygen Transfer ◽

Supplemental Oxygen ◽

Blood Gas ◽

Limited Information ◽

Partial Pressure Of Oxygen ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Wide Range ◽

Breathing Room ◽

Supplemental Oxygen Therapy

The arterial partial pressure of oxygen in the arterial blood reveals limited information about pulmonary oxygen transfer. In 989 hospitalized patients undergoing arterial blood gas testing, we compared conventional indices of oxygen transfer: (1) P(A-a) O2 (A-a); (2) PaO2/PAO2 (a/A); and (3) the P/F ratio Nine hundred twenty-five of the patients were receiving supplemental oxygen therapy (FIO2 .24-1.00) and 65 were breathing room air. In patients receiving supplemental O2, the a/A ratio closely correlated with the P/F ratio (r = .98 to .99); the A-a O2 difference did not correlate as closely with the a/A ratio (r = -.77 to -.85) or with the P/F ratio (r = -.72 to -.80). In those breathing room air (FIO2 .21), the a/A ratio was closely and inversely correlated with the A-a difference (r= -.97 to -.98); correlations between the a/A and P/F ratios (r=.88 to .89) and between the P/F ratio and A-a O2 difference (r = -.78 to -.79) were less robust. We conclude that the a/A ratio is the preferred oxygen transfer parameter over the wide range of FIO2 levels encountered clinically.

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Atrial fibrillation associated with carbon monoxide poisoning

Undersea and Hyperbaric Medicine ◽

10.22462/04.06.2019.14 ◽

2019 ◽

pp. 203-206

Author(s):

Mevlut Demir ◽

◽

Muslum Sahin ◽

Ahmet Korkmaz ◽

◽

...

Keyword(s):

Atrial Fibrillation ◽

Carbon Monoxide ◽

Sinus Rhythm ◽

Partial Pressure ◽

Motor Vehicle ◽

Carbon Monoxide Poisoning ◽

Venous Blood ◽

Blood Gas ◽

Arterial Blood Gas ◽

Arterial Blood

Carbon monoxide intoxication occurs usually via inhalation of carbon monoxide that is emitted as a result of a fire, furnace, space heater, generator, motor vehicle. A 37-year-old male patient was admitted to the emergency department at about 5:00 a.m., with complaints of nausea, vomiting and headache. He was accompanied by his wife and children. His venous blood gas measures were: pH was 7.29, partial pressure of carbon dioxide (pCO2) was 42 mmHg, partial pressure of oxygen (pO2) was 28 mmHg, carboxyhemoglobin (COHb) was 12.7% (reference interval: 0.5%-2.5%) and oxygen saturation was 52.4%. Electrocardiogram (ECG) examination showed that the patient was not in sinus rhythm but had atrial fibrillation. After three hours the laboratory examination was repeated: Troponin was 1.2 pg/ml and in the arterial blood gas COHb was 3%. The examination of the findings on the monitor showed that the sinus rhythm was re-established. The repeated ECG examination confirmed the conversion to the sinus rhythm. He was monitored with the normobaric oxygen administration.

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Popliteal artery cannulation as a saviour during prone positioning

BMJ Case Reports ◽

10.1136/bcr-2020-234370 ◽

2020 ◽

Vol 13 (6) ◽

pp. e234370

Author(s):

Narayan Bala ◽

Vinay Pathak ◽

Shilpa Goyal ◽

Nikhil Kothari

Keyword(s):

Prone Position ◽

Popliteal Artery ◽

Blood Pressure Monitoring ◽

Arterial Cannulation ◽

Invasive Blood Pressure ◽

Arterial Blood Gas ◽

Artery Cannulation ◽

Arterial Blood ◽

Arterial Cannula ◽

Invasive Blood Pressure Monitoring

The cannulation of the peripheral artery is a prerequisite for invasive blood pressure monitoring and repeated arterial blood gas sampling. Radial artery is commonly used site for inserting an arterial cannula. Many times, either during the change of posture or during prone ventilation, the arterial cannula gets displaced, and it is challenging to reinsert the arterial cannula in the lateral or prone position. In such circumstances, an alternative site of arterial cannulation needs to be looked into; we report a case in which the popliteal artery was used for arterial cannulation while the patient was in a prone position.

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Evaluation of percutaneous transcatheter embolization for pulmonary arteriovenous malformations

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01448-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

ZhengZhong Wu ◽

JunQing Lin ◽

WeiZhu Yang ◽

Na Jiang ◽

Ning Huang ◽

...

Keyword(s):

New York ◽

Success Rate ◽

Arteriovenous Malformations ◽

Heart Association ◽

Transcatheter Embolization ◽

Pulmonary Arteriovenous Malformations ◽

Technical Success ◽

Arterial Blood Gas ◽

Technical Success Rate ◽

Arterial Blood

Abstract Background The purpose of this study was to assess the safety and efficacy of percutaneous transcatheter embolization (TCE) for the treatment of pulmonary arteriovenous malformations (PAVMs). Methods Forty-three consecutive patients (n = 17 males; n = 26 females) with 72 untreated PAVMs underwent coil and/or plug embolization between January 2010 and February 2018. The mean patient age was 42 ± 14 years (range 19–71 years). The median size of the feeding artery was 7.9 ± 2.9 mm (range 3.5–14.0 mm). The arterial blood gas level and cardiac function of all patients were analysed. The technical success rate, recanalization rate, and complications were evaluated. Computed tomography angiography (CTA) examinations were scheduled for 12 months after treatment and every 2–4 years thereafter. Results Twenty-five PAVMs were treated with coils alone, twenty-one were treated with plugs alone, and twenty-six were treated with both coils and plugs. The technical success rate was 100%. There were no complications during operation. However, one patient (2.3%) had pulmonary thrombosis and embolism post-operation. The patients’ pre-operative and post-operative PaO2 and SaO2 levels were significantly different (p < 0.01). A comparison of the New York Heart Association (NYHA) grade before and after embolization in all patients showed a significant decrease in the post-operative grade (p < 0.01). The 72 PAVMs were divided into three groups (coils only group [n = 25], plugs only group [n = 21], and coils/plugs combined group [n = 26]). After 12 months of follow-up, there were seven reperfusion PAVMs in the coil group, seven reperfusion PAVMs in the plug group, and 1 reperfusion PAVM in the combined group. There were significant differences between the two groups and the combined group. Conclusion Percutaneous TCE is safe and effective for the treatment of PAVMs. A combination of coils and vascular plugs may be useful for preventing recanalization after the embolization of PAVMs.

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d-Cystine di(m)ethyl ester reverses the deleterious effects of morphine on ventilation and arterial blood gas chemistry while promoting antinociception

Scientific Reports ◽

10.1038/s41598-021-89455-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Benjamin Gaston ◽

Santhosh M. Baby ◽

Walter J. May ◽

Alex P. Young ◽

Alan Grossfield ◽

...

Keyword(s):

Gas Exchange ◽

Intracellular Signaling ◽

Dimethyl Ester ◽

Diethyl Ester ◽

Blood Gas ◽

Negative Effects ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Gas Chemistry ◽

Ventilatory Drive

AbstractWe have identified thiolesters that reverse the negative effects of opioids on breathing without compromising antinociception. Here we report the effects of d-cystine diethyl ester (d-cystine diEE) or d-cystine dimethyl ester (d-cystine diME) on morphine-induced changes in ventilation, arterial-blood gas chemistry, A-a gradient (index of gas-exchange in the lungs) and antinociception in freely moving rats. Injection of morphine (10 mg/kg, IV) elicited negative effects on breathing (e.g., depression of tidal volume, minute ventilation, peak inspiratory flow, and inspiratory drive). Subsequent injection of d-cystine diEE (500 μmol/kg, IV) elicited an immediate and sustained reversal of these effects of morphine. Injection of morphine (10 mg/kg, IV) also elicited pronounced decreases in arterial blood pH, pO2 and sO2 accompanied by pronounced increases in pCO2 (all indicative of a decrease in ventilatory drive) and A-a gradient (mismatch in ventilation-perfusion in the lungs). These effects of morphine were reversed in an immediate and sustained fashion by d-cystine diME (500 μmol/kg, IV). Finally, the duration of morphine (5 and 10 mg/kg, IV) antinociception was augmented by d-cystine diEE. d-cystine diEE and d-cystine diME may be clinically useful agents that can effectively reverse the negative effects of morphine on breathing and gas-exchange in the lungs while promoting antinociception. Our study suggests that the d-cystine thiolesters are able to differentially modulate the intracellular signaling cascades that mediate morphine-induced ventilatory depression as opposed to those that mediate morphine-induced antinociception and sedation.

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Prehospital Diagnosis of Shortness of Breath Caused by Profound Metformin-Associated Metabolic Acidosis

Healthcare ◽

10.3390/healthcare9010074 ◽

2021 ◽

Vol 9 (1) ◽

pp. 74

Author(s):

Pietro Elias Fubini ◽

Laurent Suppan

Keyword(s):

Metabolic Acidosis ◽

Hospital Setting ◽

Blood Gases ◽

Shortness Of Breath ◽

Potential Harm ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Common Causes ◽

Prehospital Diagnosis ◽

Gas Measurement

Shortness of breath is a common complaint among patients in emergency medicine. While most common causes are usually promptly identified, less frequent aetiologies might be challenging to diagnose, especially in the pre-hospital setting. We report a case of prehospital dyspnoea initially ascribed to pulmonary oedema which turned out to be the result of profound metformin-associated metabolic acidosis. This diagnosis was already made during the prehospital phase by virtue of arterial blood gas measurement. Pre-hospital measurement of arterial blood gases is therefore feasible and can improve diagnostic accuracy in the field, thus avoiding unnecessary delay and potential harm to the patient before initiating the appropriate therapeutic actions.

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Accuracy of two pulse-oximetry measurements for INTELLiVENT-ASV in mechanically ventilated patients: a prospective observational study

Scientific Reports ◽

10.1038/s41598-021-88608-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shinshu Katayama ◽

Jun Shima ◽

Ken Tonai ◽

Kansuke Koyama ◽

Shin Nunomiya

Keyword(s):

Oxygen Saturation ◽

Pulse Oximetry ◽

Prospective Observational Study ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen ◽

Arterial Blood Gas ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Arterial Blood ◽

Ventilated Patients

AbstractRecently, maintaining a certain oxygen saturation measured by pulse oximetry (SpO2) range in mechanically ventilated patients was recommended; attaching the INTELLiVENT-ASV to ventilators might be beneficial. We evaluated the SpO2 measurement accuracy of a Nihon Kohden and a Masimo monitor compared to actual arterial oxygen saturation (SaO2). SpO2 was simultaneously measured by a Nihon Kohden and Masimo monitor in patients consecutively admitted to a general intensive care unit and mechanically ventilated. Bland–Altman plots were used to compare measured SpO2 with actual SaO2. One hundred mechanically ventilated patients and 1497 arterial blood gas results were reviewed. Mean SaO2 values, Nihon Kohden SpO2 measurements, and Masimo SpO2 measurements were 95.7%, 96.4%, and 96.9%, respectively. The Nihon Kohden SpO2 measurements were less biased than Masimo measurements; their precision was not significantly different. Nihon Kohden and Masimo SpO2 measurements were not significantly different in the “SaO2 < 94%” group (P = 0.083). In the “94% ≤ SaO2 < 98%” and “SaO2 ≥ 98%” groups, there were significant differences between the Nihon Kohden and Masimo SpO2 measurements (P < 0.0001; P = 0.006; respectively). Therefore, when using automatically controlling oxygenation with INTELLiVENT-ASV in mechanically ventilated patients, the Nihon Kohden SpO2 sensor is preferable.Trial registration UMIN000027671. Registered 7 June 2017.

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Can Alveolar-Arterial Difference and Lung Ultrasound Help the Clinical Decision Making in Patients with COVID-19?

Diagnostics ◽

10.3390/diagnostics11050761 ◽

2021 ◽

Vol 11 (5) ◽

pp. 761

Author(s):

Gianmarco Secco ◽

Francesco Salinaro ◽

Carlo Bellazzi ◽

Marco La Salvia ◽

Marzia Delorenzo ◽

...

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Lung Ultrasound ◽

Signs And Symptoms ◽

Clinical Decision ◽

Arterial Oxygen ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Lung Dysfunction ◽

Close Relationship

Background: COVID-19 is an emerging infectious disease, that is heavily challenging health systems worldwide. Admission Arterial Blood Gas (ABG) and Lung Ultrasound (LUS) can be of great help in clinical decision making, especially during the current pandemic and the consequent overcrowding of the Emergency Department (ED). The aim of the study was to demonstrate the capability of alveolar-to-arterial oxygen difference (AaDO2) in predicting the need for subsequent oxygen support and survival in patients with COVID-19 infection, especially in the presence of baseline normal PaO2/FiO2 ratio (P/F) values. Methods: A cohort of 223 swab-confirmed COVID-19 patients underwent clinical evaluation, blood tests, ABG and LUS in the ED. LUS score was derived from 12 ultrasound lung windows. AaDO2 was derived as AaDO2 = ((FiO2) (Atmospheric pressure − H2O pressure) − (PaCO2/R)) − PaO2. Endpoints were subsequent oxygen support need and survival. Results: A close relationship between AaDO2 and P/F and between AaDO2 and LUS score was observed (R2 = 0.88 and R2 = 0.67, respectively; p < 0.001 for both). In the subgroup of patients with P/F between 300 and 400, 94.7% (n = 107) had high AaDO2 values, and 51.4% (n = 55) received oxygen support, with 2 ICU admissions and 10 deaths. According to ROC analysis, AaDO2 > 39.4 had 83.6% sensitivity and 90.5% specificity (AUC 0.936; p < 0.001) in predicting subsequent oxygen support, whereas a LUS score > 6 showed 89.7% sensitivity and 75.0% specificity (AUC 0.896; p < 0.001). Kaplan–Meier curves showed different mortality in the AaDO2 subgroups (p = 0.0025). Conclusions: LUS and AaDO2 are easy and effective tools, which allow bedside risk stratification in patients with COVID-19, especially when P/F values, signs, and symptoms are not indicative of severe lung dysfunction.

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Analysis of Arterial Blood Gas Values Based on Storage Time Since Sampling: An Observational Study

Nursing Reports ◽

10.3390/nursrep11030048 ◽

2021 ◽

Vol 11 (3) ◽

pp. 517-521

Author(s):

Alejandro Montero-Salinas ◽

Marta Pérez-Ramos ◽

Fernando Toba-Alonso ◽

Leticia Quintana-DelRío ◽

Jorge Suanzes-Hernández ◽

...

Keyword(s):

Lactic Acid ◽

Observational Study ◽

Partial Pressure ◽

Group Analysis ◽

Initial Time ◽

Blood Gas ◽

Initial Sample ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Prospective Longitudinal

Aim. To evaluate the influence of time on arterial blood gas values after artery puncture is performed. Method. Prospective longitudinal observational study carried out with gasometric samples from 86 patients, taken at different time intervals (0 (T0), 15 (T15), 30 (T30) and 60 (T60) min), from 21 October 2019 to 21 October 2020. The study variables were: partial pressure of carbon dioxide, bicarbonate, hematocrit, hemoglobin, potassium, lactic acid, pH, partial pressure of oxygen, saturation of oxygen, sodium and glucose. Results. The initial sample consisted of a total of 90 patients. Out of all the participants, four were discarded as they did not understand the purpose of the study; therefore, the total number of participants was 86, 51% of whom were men aged 72.59 on average (SD: 16.23). In the intra-group analysis, differences in PCO2, HCO3, hematocrit, Hb, K+ and and lactic acid were observed between the initial time of the test and the 15, 30 and 60 min intervals. In addition, changes in pH, pO2, SO2, Na and glucose were noted 30 min after the initial sample had been taken. Conclusions. The variation in the values, despite being significant, has no clinical relevance. Consequently, the recommendation continues to be the analysis of the GSA at the earliest point to ensure the highest reliability of the data and to provide the patient with the most appropriate treatment based on those results.

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Causes, Effects and Methods of Monitoring Gas Exchange Disturbances during Equine General Anaesthesia

Animals ◽

10.3390/ani11072049 ◽

2021 ◽

Vol 11 (7) ◽

pp. 2049

Author(s):

Elżbieta Stefanik ◽

Olga Drewnowska ◽

Barbara Lisowska ◽

Bernard Turek

Keyword(s):

Gas Exchange ◽

General Anaesthesia ◽

Near Infrared ◽

Respiratory Acidosis ◽

Monitoring Methods ◽

Arterial Blood Gas ◽

Complementary Method ◽

Arterial Blood ◽

Operative Complications ◽

Post Operative Complications

Horses, due to their unique anatomy and physiology, are particularly prone to intraoperative cardiopulmonary disorders. In dorsally recumbent horses, chest wall movement is restricted and the lungs are compressed by the abdominal organs, leading to the collapse of the alveoli. This results in hypoventilation, leading to hypercapnia and respiratory acidosis as well as impaired tissue oxygen supply (hypoxia). The most common mechanisms disturbing gas exchange are hypoventilation, atelectasis, ventilation–perfusion (V/Q) mismatch and shunt. Gas exchange disturbances are considered to be an important factor contributing to the high anaesthetic mortality rate and numerous post-anaesthetic side effects. Current monitoring methods, such as a pulse oximetry, capnography, arterial blood gas measurements and spirometry, may not be sufficient by themselves, and only in combination with each other can they provide extensive information about the condition of the patient. A new, promising, complementary method is near-infrared spectroscopy (NIRS). The purpose of this article is to review the negative effect of general anaesthesia on the gas exchange in horses and describe the post-operative complications resulting from it. Understanding the changes that occur during general anaesthesia and the factors that affect them, as well as improving gas monitoring techniques, can improve the post-aesthetic survival rate and minimize post-operative complications.

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