[Psoas abscess].
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Diabetes Mellitus, Type 2↗
Biomedical subjects
Raúl Carrillo-Esper
Publications and source records attributed to Raúl Carrillo-Esper.
[Persistent left superior vena cava: infrequent localization of central venous catheter].
OBJECTIVE: Our objective was to report a Persistent Left Superior Vena Cava in a critically ill patient. DESIGN: Case report. PLACE: Intensive care unit of a referral center. PATIENT: A 52 years-old male without previous cardiovascular disease was admitted to the intensive care unit due to cranial trauma. A central left subclavian vein catheter was placed at his arrival at the center chest X-ray showed the catheter in the left of the cardiac silhohuete without hemo-pneumothorax. A angiographic evaluation through central venous catheter showed persistent left superior vena cava draining to the coronary sinus and right atrium with normal permeability of right superior vena cava. Other congenital alterations were excluded. Chest computed tomography confirmed the diagnosis. Persistent left superior vena cava is a congenital vascular abnormality. The intensive care unit staff must be aware of this vascular abnormality because it can complicate central venous catheterization.
Angiography↗
[Knotting Swan-Ganz catheter in right pulmonary artery].
Knotting Swan-Ganz catheter is a rare complication of hemodynamic monitoring. This is the second case reported in Mexico in over 20 years. Identified risk factors that increase likelihood of loop formation knotting of the catheter are blind introduction and small diameter of catheter, incomplete balloon inflation before advancing it, several tries to wedge it, bending of the catheter by heat, and enlarged right heart chambers. More frequent sites of knotting are right atrium and ventricle, subclavian vein, and pulmonary artery and its branches. Diagnostic confirmation is made by chest radiography, fluoroscopy, and echocardiography. Therapeutic approach depends on knot characteristics, either non-surgical or surgical.
Catheterization, Swan-Ganz↗
[Innate immunity, Toll receptor and sepsis].
The innate immune response is the first line of defense against infection. Toll-like receptors (TLRs) recognize bacterial lipopolysaccharide and other pathogen-associated molecular patterns (PAMPs). Intracellular signals initiated by interaction between Toll receptors and specific PAMPs results in inflammatory response. Sepsis and septic shock are the result of an exaggerated inflammatory systemic response induced by innate immune dysregulation.
Animals↗
[Vasopressin use in shock].
Arginine-vasopressin (VP), also known as the antidiuretic hormone, is essential for water homeostasis. Its synthesis and liberation depends on regulation of osmotic, hypovolemic, hormonal, and nonosmotic stimuli. It has been demonstrated that it is key for maintenance of cardiovascular homeostasis through vasomotor regulation, the determinant of systemic vascular resistance and mean arterial pressure, a process acting through V1 receptors. Shock state with refractory vasodilation seen in sepsis, systemic inflammatory response, hypovolemia, cardiac arrest, polytrauma, etc., is characterized by an initial phase of liberation and increased levels of VP followed by a second phase characterized by inappropriately low levels of this hormone that are associated with refractoriness to management with volume, inotropics, and vasopressors. It has been demonstrated in clinical and experimental studies that exogenous VP treatment under this condition increases systemic vascular resistance, perfusion pressure, and oxygen supply to peripheral tissues, which makes it possible to decrease and to suspend vasopressors and also to increase survival.
Clinical Trials as Topic↗
[Non-hypothermic J wave in subarachnoid hemorrhage].
Incidence of electrocardiographic abnormalities in subarachnoid hemorrhage secondary to aneurysm rupture is 50-100%. The most frequent electrocardiographic abnormalities described include acuminated, inverted or flat T waves, inverted T waves associated with prolonged QT interval, positive or negative ST segment levels, prominent U waves, PR segment enlargement, acuminated P waves, and pathologic Q waves. J point is the isoelectric union of QRS complex with ST segment. It represents the end of depolarization and the beginning of repolarization. Prominent and positive J point level is named J wave, considered pathognomonic of severe hypothermia, although it has also been described in other clinical entities not associated with hypothermia, such as hypercalcemia, Brugada syndrome, acute brain injury, cardiac arrest, and dysfunction of cervical sympathetic system. Non-hypothermic J wave is an infrequent electrocardiographic manifestation of subarachnoid hemorrhage. We describe a clinical case of non-hypothermic J wave in a patient with subarachnoid hemorrhage.
Aged↗
[Pseudothrombocytopenia induced by ethylenediaminetetraacetic acid in burned patients].
The EDTA-dependent pseudothrombocytopenia is a false decrease in the number of platelets below the normal value when analyzed with automated devices. There is an incidence of 0.09 to 0.21% in hospitalized patients. Pseudothrombocytopenia is secondary to platelet clumping induced by antibodies in the presence of EDTA and has been associated with sepsis, cancer, cardiac surgery and drugs. We report the first case of pseudothrombocytopenia induced by EDTA in a burn patient.
Adult↗
[All-trans retinoic acid syndrome. Case report and a review of the literature].
We described a patient with acute promyelocytic leukemia (APL) who developed all-trans retinoic acid syndrome (ATRAS) and reviewed the literature. ATRAS presents in patients with APL treated with all-trans retinoic acid (ATRA). It has an incidence from 5%-27% with mortality of 29%. It is secondary to ATRA effect on promyelocyte differentiation, which causes systemic inflammatory response syndrome, endothelium damage with increase in capillary permeability, microcirculation obstruction, and tissue infiltration. ATRAS clinical manifestations are fever, hypotension, respiratory, renal and hepatic insufficiency, lung infiltrates, pleural and pericardic effusion, and generalized edema. Treatment is based on ATRA suspension, support measures, and steroids.
Adult↗
[Practice guidelines for the management of acute perioperative pain].
The inadequacy of perioperative management causes a severe adverse outcome, a prolonged time of hospitalization and unnecessary suffering. Therefore, it is important to provide an effective management approach to the patient with perioperative pain. A task force with experience in this field systematically develops practice guidelines and the primary goal is to facilitate, to health care professionals, decision-making regarding pain relief. The well-known concept of "administer as needed" is inaccurate and must be eliminated from hospital's management protocols in order to facilitate the staff education to decrease the painful experience. A method to evaluate and document pain in an objective and periodic way shall be implemented. Also, analgesic therapy shall be individualized and chosen regarding pain intensity in every surgical procedure. The treatment options include the use of non-opiate and opiate drugs, regional analgesia and nonpharmacological techniques. The best analgesic will be the one that shall provide the highest relief of pain with the fewest side effects. In the pediatric and obstetric populations, special considerations for the ambulatory patient must be taken. Finally, these practice guidelines could be the reference for future practice guidelines on pain management in Mexico.
Acute Disease↗
[Dyslipidemia in the critically ill patient].
Dyslipidemia seen in the critically ill patient is a common disturbance, poorly recognized by physicians in this setting. Shock states, sepsis, multifactorial systemic inflammatory response syndrome and ischemia-reperfusion injury are associated with important metabolic changes that contribute to this disturbance. As a result, the lipid concentration, including cholesterol, high-density lipoproteins and apo-lipoprotein A-I, diminishes. Previous reports correlate the disturbance in lipids with a higher risk of infection, systemic inflammatory response syndrome, multiple organic dysfunction syndrome, and raised mortality. The use of reconstituted high-density lipoprotein may be a therapeutic alternative for the management of this entity.
Animals↗
[Myocardial depression in the burn patient].
Myocardial depression and heart failure are frequent complications in critically ill burn patients. The physiopathology is complex and involves the activation of inflammatory pathways, ischemia-reperfusion, oxidative stress and endothelial lesion. Diagnosis should be made early by means of hemodynamic monitoring. Treatment is accomplished by inotropics that act on different pathways of the contractile function and immune response associated with antioxidants and allopurinol.
Adult↗
[Toxic epidermal necrolysis].
Toxic epidermal necrolysis is the prototype of a proapoptotic disease characterized by system CD95 dysrregulation. Drugs constitute the main antigenic triggers. Hystopatologically it is characterized by epidermis detachment and necrosis with apoptotic keratinocytes. Clinical presentation includes erithematous-ampullous lesions in the skin and mucous membranes. It is associated with serious complications such as severe sepsis and septic shock. The management in the intensive care unit includes support treatment and specific treatment with immunoglobulins that alter disease course. Recombinant activated Factor VII is effective to control the associated microvascular haemorraghe.
Adult↗
[Recombinant factor VII activated in non-hemophiliac patients with acute severe hemorrhage in the intensive care unit].
BACKGROUND: Severe hemorrhage is a frequent complication with multiple etiologies and high morbi-mortality observed among critically ill patients. Recombinant Factor VIla (rFVlla) constitutes a new therapeutic alternative. OBJECTIVE: Analyze the evolution in a non-hemophiliac patient group with severe hemorrhage treated with rFVlla. MATERIAL AND METHODS: Ten non-hemophiliac patients with severe hemorrhage, five men and five women between 18 and 74 years, were included and treated with rFVIIa. We used a t test for statistic analyses. Significance was set at p < 0.001. RESULTS: Among patients treated with rFVlla, hemorrhage was controlled and the use of blood products was significantly diminished (p < 0.001). Coagulation tests, fibrinogen levels, platelet count and perfusion parameters increased significantly (p < 0.001). CONCLUSIONS: rFVIIa is a therapeutic alternative for the treatment of severe hemorrhage not controlled by conventional management.
Acute Disease↗
[Isolated renal mucormicosis].
Mucormycosis is an infection caused by a class Zygomycetes fungi. The rhinocerebral and pulmonary are the most common clinical presentations. Renal mucormycosis is a very rare form. To date, only 25 cases have been reported in the literature. We describe the case of a patient with leukemia who developed isolated renal mucormycosis and review the literature.
Adult↗