Revista médica de Chile
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Revista médica de Chile · May 1990
Review Case Reports[Lymphomatoid granulomatosis: a clinical case].
A 49 year old woman with a fluctuating painful ophthalmoplegia and a history of polyarthralgia is reported. On examination, additional findings included a maxillary subcutaneous infiltration, sphenoidal sinusitis and pulmonary nodes. Lung and sinus biopsy demonstrated findings compatible with lymphomatoid granulomatosis. The patient was treated with prednisone and cyclophosphamide, with good response of neurological and dermatological findings.
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In spite of advances in our understanding of the pathophysiology of cardiogenic shock, and the introduction of potent vasoactive pharmacological agents in its management, prognosis continued to be dismal with hospital mortalities over 85%. It has been only through additional and aggressive interventions--including intraaortic balloon counterpulsation (IABC), percutaneous transluminal coronary angioplasty (PTCA) and surgical revascularization--that improved survival can be achieved. Today's management of cardiogenic shock requires an early and integrated approach including physiological monitoring, vasoactive drugs, IABC, coronary angiography and PTCA, with the expectation of improving prognosis.
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Revista médica de Chile · Mar 1989
Review[Cardiopulmonary resuscitation: acid-base alterations and alkalizing therapy].
It is generally believed that metabolic acidosis prevails during cardiac arrest. However, recent experimental and clinical studies have demonstrated that respiratory acidosis in mixed venous blood and respiratory alkalosis in arterial blood with only minor increases in lactic acid characterize the early acid-base changes that follow cardiac arrest and cardiopulmonary resuscitation (CPR). While continued CO2 production with critical reduction in systemic perfusion explains the accumulation of CO2 in the venous side, the reduction of pulmonary blood flow with maintenance of constant minute ventilation explains the decreases in expired CO2 and therefore arterial PCO2. ⋯ Moreover, adverse effects stemming from increases in plasma osmolality, increases in hemoglobin-O2 affinity, induction of alkalemia and generation of CO2 are potentially deleterious for myocardial and cerebral function. Consequently, the American Heart Association has recently discouraged the routine administration of bicarbonate during the initial 10 minutes of CPR in which interventions with proven efficacy such as artificial ventilation, precordial compression, electric defibrillation and epinephrine administration take place. Alternative experimental buffer therapy with agents that consume CO2 have also failed to alter the outcome of cardiac arrest.