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Kanchana Ngaosuwan, Kanit Ounchokdee, Thep Chalermchai
BACKGROUND: The current international guideline recommended 200 mg per day of hydrocortisone intravenously to treat septic shock. However, a subsequent study on cortisol metabolism actually showed an increase in cortisol level during sepsis. Hence, the smaller hydrocortisone dose of 100 mg per day might be sufficient and reduce steroid-associated complications. We aimed to compare the clinical outcomes of minimized hydrocortisone dose of 100 mg to the currently recommended dose in the treatment of septic shock patients...
November 15, 2017: Shock
Eddie Copelin, Rosann Cholankeril, Ponnandai Somasundar, George Cholankeril
Portomesenteric venous thrombosis is a rare complication reported in only a few cases involving laparoscopic bariatric surgery. We report a case of a 44-year-old woman who presented 14 days after recent laparoscopic sleeve gastrectomy with the chief complaint of abdominal pain and associated nausea. Abdominal CT demonstrated thrombi in her superior mesenteric, portal and splenic veins. She was initiated on therapeutic heparin but developed haemorrhagic shock shortly afterwards. Subsequent CT angiogram failed to localise the source of her haemorrhage...
May 29, 2017: BMJ Case Reports
Jingyuan Xu, Xiao Peng, Chun Pan, Shixia Cai, Xiwen Zhang, Ming Xue, Yi Yang, Haibo Qiu
BACKGROUND: Significant effort has been devoted to defining parameters for predicting fluid responsiveness. Our goal was to study the feasibility of predicting fluid responsiveness by transcutaneous partial pressure of oxygen (PtcO2 ) in the critically ill patients. METHODS: This was a single-center prospective study conducted in the intensive care unit of a tertiary care teaching hospital. Shock patients who presented with at least one clinical sign of inadequate tissue perfusion, defined as systolic blood pressure <90 mmHg or a decrease >40 mmHg in previously hypertensive patients or the need for vasopressive drugs; urine output <0...
December 2017: Annals of Intensive Care
Pei-Ling Chen, Jie-Yang Jhuang, Ho-Hsiung Lin, Sheng-Mou Hsiao
OBJECTIVE: Management of cornual gestational trophoblastic neoplasia (GTN) has never been reported. Here, we describe the first case of cornual GTN. CASE REPORT: A 32-year-old woman was diagnosed with left cornual GTN after evacuation of a complete mole. Laparoscopic cornuostomy was performed with intramural vasopression injection and barbed sutures. Histopathology revealed hydropic chorionic villi. Complete hydatidiform mole was diagnosed, and treated with adjuvant methotrexate, to address the poor decline of β-human chorionic gonadotropin levels during follow-up...
April 2017: Taiwanese Journal of Obstetrics & Gynecology
Pauline Devauchelle, Zoé Schmitt, Aurélie Bonnet, Serge Duperret, Jean-Paul Viale, Jean-Yves Mabrut, Frédéric Aubrun, Mathieu Gazon
INTRODUCTION: The peroperative management of liver transplantation is still associated with many cardiocirculatory complications in which diastolic dysfunction may play a contributive role. Transoesophageal echocardiography is a monitoring device commonly used in liver transplantation allowing diastolic function assessment. METHODS: We prospectively analysed the peroperative transoesophageal echocardiography recordings of 40 patients undergoing liver transplantation in order to describe changes in diastolic function at different steps of the surgery...
December 24, 2016: Anaesthesia, Critical Care & Pain Medicine
S L Cohen, S Senapati, A R Gargiulo, S S Srouji, F F Tu, J Solnik, H-C Hur, A Vitonis, G M Jonsdottir, K C Wang, J I Einarsson
OBJECTIVE: To determine if higher-volume, fixed-dose administration of vasopressin further reduces blood loss at the time of minimally invasive myomectomy. DESIGN: Randomised multicentre clinical trial. SETTING: Tertiary-care academic centres in the USA. POPULATION: Women undergoing conventional laparoscopic or robot-assisted laparoscopic myomectomy. METHODS: All participants received the same 10-unit (U) dose of vasopressin, but were randomly assigned to one of two groups: (i) received 200 ml of diluted vasopressin solution (20 U in 400 ml normal saline), and (ii) received 30 ml of concentrated vasopressin solution (20 U in 60 ml normal saline)...
January 2017: BJOG: An International Journal of Obstetrics and Gynaecology
Patrick M Honore, Rita Jacobs, Elisabeth De Waele, Marc Diltoer, Herbert D Spapen
Sepsis-induced acute kidney injury (SAKI) is traditionally viewed as a process driven by a reduced blood flow and prone to benefit from vasopressive support. In ovine hyperdynamic septic shock, Lankadeva et al. report a significant and flow-independent intrarenal perfusion and oxygenation "mismatch" jeopardizing the renal medulla that was aggravated by norepinephrine. Medullary and urinary oxygenation changed in parallel, suggesting that urinary oxygenation may act as a biomarker to predict SAKI...
July 2016: Kidney International
S Abdalla, A Brouquet, T Lazure, B Costaglioli, C Penna, S Benoist
AIM: The study evaluated the outcome of severe acute antipsychotic (neuroleptic) drug related colitis requiring emergency surgery. METHOD: From 2009 to 2014, 20 patients underwent emergency surgery for acute and severe neuroleptic-related ischaemic colitis. Neuroleptic-induced colitis was defined as another cause besides inflammatory, infectious or ischaemic colitis with a relationship to treatment by antipsychotic drugs. RESULTS: The main drugs involved were cyamemazine (n = 9, 45%), loxapine (n = 5, 25%), haloperidol (n = 4, 20%) and alimemazine (n = 4, 20%)...
December 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Uberto Fumagalli, Alessandra Melis, Jana Balazova, Valeria Lascari, Emanuela Morenghi, Riccardo Rosati
This study aims to report the hypotensive episodes (HEs) during esophagectomy and their influence on the occurrence of anastomotic leak. Eighty-four patients underwent esophagectomy with gastric pull-up. Pre-, intra-, and post-operative data were prospectively collected. HEs were defined by systolic pressure decreasing more than 30 % of the basal value for more than 5 min. Nineteen patients had intra-operative HEs (22.6 %). HEs were significantly more frequent in patients undergoing prone esophagectomy (P = 0...
June 2016: Updates in Surgery
Satoshi Kawatsu, Shingo Takahara, Kou Sakatsume, Keisuke Kanda, Tomoyuki Suzuki, Shintaro Katahira, Hidenori Fujiwara, Osamu Adachi, Masatoshi Akiyama, Kiichiro Kumagai, Shunsuke Kawamoto, Yoshikatsu Saiki
Tolvaptan is a new selective vasopression V2-receptor antagonist. We report our experience with a use of tolvaptan for preoperative fluid management in a patient with severe constrictive pericarditis. A 66-year-old man presented with heart failure symptoms derived from constrictive pericarditis. Chest X-ray showed right pleural effusion and chest computed tomography demonstrated severe pericardial calcification. Despite that he received optimal conventional medical treatments, his hemodynamic condition further exacerbated during hospitalization...
February 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Patricia Wiesen, Paul B Massion, Jean Joris, Olivier Detry, Pierre Damas
AIM: To determine renal dysfunction post liver transplantation, its incidence and risk factors in patients from a Belgian University Hospital. METHODS: Orthotopic liver transplantations performed from January 2006 until September 2012 were retrospectively reviewed (n = 187). Patients with no renal replacement therapy (RRT) before transplantation were classified into four groups according to their highest creatinine plasma level during the first postoperative week...
March 24, 2016: World Journal of Transplantation
Sylvain Malfroy, Florent Wallet, Delphine Maucort-Boulch, Laurent Chardonnal, Nicolas Sens, Arnaud Friggeri, Guillaume Passot, Olivier Glehen, Vincent Piriou
BACKGROUND AND OBJECTIVES: For patients suffering from peritoneal carcinomatosis, cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is the only curative option. We focused on severe complications in the postoperative course of HIPEC. METHODS: We studied perioperative data from patients who underwent HIPEC between January 2010 and August 2011. Our primary objective was to identify perioperative risk factors for ICU admission. Our secondary objective was to identify patient that may be re-admitted to the ICU thanks to a prognostic score...
March 2016: Surgical Oncology
D Batouche, K Elhalimi, N Chaib, K Gaid, M A Negadi, Z Mentouri
OBJECTIFS: Le maintien d'une pression de perfusion cérébrale (PPC) entre 65-70mmHg chez l'enfant traumatisé crânien est un de nos objectifs de surveillance par le doppler transcrânien (DTC), mais peut céder la place à une personnalisation des objectifs hémodynamiques, cérébraux reposant sur un faisceau des paramètres qui sont « dépendants de chaque opérateur de garde ». À travers une observation nous allons pointer sur un effet iatrogène ayant conduit à un syndrome d'encéphalopathie postérieure réversible (SEPR)...
December 2015: Annales de Cardiologie et D'angéiologie
Tran Doan Ngoc Tran, Jeffrey M Gimble, Henrique Cheng
Intracellular Ca(2+) signals are essential for stem cell differentiation due to their ability to control signaling pathways involved in this process. Arginine vasopression (AVP) is a neurohypophyseal hormone that increases intracellular Ca(2+) concentration during adipogenesis via V1a receptors, Gq-proteins and the PLC-IP3 pathway in human adipose-derived stromal/stem cells (hASCs). These Ca(2+) signals originate through calcium release from pools within the endoplasmic reticulum and the extracellular space...
March 2016: Cell Calcium
Axel Andres, Tatsuya Kin, Doug O'Gorman, Scott Livingstone, David Bigam, Norman Kneteman, Peter Senior, A M James Shapiro
In islet transplantation, deceased cardiac death (DCD) donation has been identified as a potential extended source. There are currently no studies comparing outcomes between these categories, and our goal was to compare islet isolation success rates and transplantation outcomes between DCD and neurological determination of death (NDD) donors. Islet isolations from 15 DCD and 418 NDD were performed in our centre between September 2008 and September 2014. Donor variables, islet yields, metabolic function of isolated isled and insulin requirements at 1-month post-transplant were compared...
January 2016: Transplant International: Official Journal of the European Society for Organ Transplantation
Frederic Vanden Eynden, Gilles Mets, Filip De Somer, Stefaan Bouchez, Thierry Bove
BACKGROUND: Most therapeutic strategies for acute right ventricular failure (RVF) by pressure-overload are directed to improve cardiac output and coronary perfusion pressure by vasopressive agents. The eventual role of intra-aortic balloon counterpulsation (IABP) support remains questionable. This study investigates the contribution of IABP for acute RVF by pressure-overload, in comparison with phenylephrine (PE) and norepinephrine (NOR). METHODS: Acute RVF is induced by fixed pulmonary artery constriction in 6 pigs, pursuing a 50% reduction of cardiac output...
October 15, 2015: International Journal of Cardiology
Maria Vittoria Modica, Fabrizio Lombardo, Paolo Franchini, Marco Oliverio
BACKGROUND: Hematophagy arose independently multiple times during metazoan evolution, with several lineages of vampire animals particularly diversified in invertebrates. However, the biochemistry of hematophagy has been studied in a few species of direct medical interest and is still underdeveloped in most invertebrates, as in general is the study of venom toxins. In cone snails, leeches, arthropods and snakes, the strong target specificity of venom toxins uniquely aligns them to industrial and academic pursuits (pharmacological applications, pest control etc...
2015: BMC Genomics
Manassawee Korwutthikulrangsri, Pat Mahachoklertwattana, Rojjanee Lertbunrian, La-Or Chailurkit, Preamrudee Poomthavorn
BACKGROUND: Data on interrelationship between vitamin D deficiency (VDD) and adrenal insufficiency in critically ill children are limited. OBJECTIVE: To determine vitamin D status in critically ill children and its relationship with adrenal function. MATERIAL AND METHOD: Thirty-two patients and 36 controls were included. Serum 25-hydroxyvitamin D (25-OHD) levels were measured. Pediatric Risk of Mortality (PRISM) III score, outcome and adrenal function assessed by 1-microgram adrenocorticotropic hormone test were collected...
April 2015: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
A Lemaignen, G Birgand, W Ghodhbane, S Alkhoder, I Lolom, S Belorgey, F-X Lescure, L Armand-Lefevre, R Raffoul, M-P Dilly, P Nataf, J C Lucet
The incidence of surgical site infection (SSI) after cardiac surgery depends on the definition used. A distinction is generally made between mediastinitis, as defined by the US Centers for Disease Control and Prevention (CDC), and superficial SSI. Our objective was to decipher these entities in terms of presentation and risk factors. We performed a 7-year single centre analysis of prospective surveillance of patients with cardiac surgery via median sternotomy. SSI was defined as the need for reoperation due to infection...
July 2015: Clinical Microbiology and Infection
Anne Mossdorf, Florian Ulmer, Karsten Junge, Christoph Heidenhain, Marc Hein, Ilknur Temizel, Ulf Peter Neumann, Wenzel Schöning, Maximilian Schmeding
Introduction. The venovenous/portal venous (VVP) bypass technique has generally become obsolete in liver transplantation (LT) today. We evaluated our experience with 163 consecutive LTs that used a VVP bypass. Patients and Methods. The liver transplant program was started in our center in 2010. LTs were performed using an extracorporal bypass device. Results. Mean operative time was 269 minutes and warm ischemic time 43 minutes. The median number of transfusion of packed cells and plasma was 7 and 14. There was no intraoperative death, and the 30-day mortality was 3%...
2015: Gastroenterology Research and Practice
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