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https://www.readbyqxmd.com/read/28543041/the-added-value-of-cardiac-index-and-pulse-pressure-variation-monitoring-to-mean-arterial-pressure-guided-volume-therapy-in-moderate-risk-abdominal-surgery-coguide-a-pragmatic-multicentre-randomised-controlled-trial
#1
J Stens, J-P Hering, C W P van der Hoeven, A Boom, H S Traast, L E Garmers, S A Loer, C Boer
There is disagreement regarding the benefits of goal-directed therapy in moderate-risk abdominal surgery. Therefore, we tested the hypothesis that the addition of non-invasive cardiac index and pulse pressure variation monitoring to mean arterial pressure-based goal-directed therapy would reduce the incidence of postoperative complications in patients having moderate-risk abdominal surgery. In this pragmatic multicentre randomised controlled trial, we randomly allocated 244 patients by envelope drawing in a 1:1 fashion, stratified per centre...
May 25, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28542743/neuroimaging-cardiovascular-physiology-and-functional-outcomes-in-infants-with-congenital-heart-disease
#2
REVIEW
Nathalie H P Claessens, Christopher J Kelly, Serena J Counsell, Manon J N L Benders
This review integrates data on brain dysmaturation and acquired brain injury using fetal and neonatal magnetic resonance imaging (MRI), including the contribution of cardiovascular physiology to differences in brain development, and the relationship between brain abnormalities and subsequent neurological impairments in infants with congenital heart disease (CHD). The antenatal and neonatal period are critical for optimal brain development; the developing brain is particularly vulnerable to haemodynamic disturbances during this time...
May 19, 2017: Developmental Medicine and Child Neurology
https://www.readbyqxmd.com/read/28541443/the-impact-of-multidisciplinary-care-on-early-morbidity-and-mortality-after-heart-transplantation
#3
Marie Schmidhauser, Julien Regamey, Nathalie Pilon, Manuel Pascual, Sam Rotman, Carlo Banfi, René Prêtre, Philippe Meyer, Jean-Philippe Antonietti, Roger Hullin
OBJECTIVES: The impact of multidisciplinary care on outcome after heart transplantation (HTx) remains unclear. METHODS: This retrospective study investigates the impact of multidisciplinary care on the primary end point 1-year all-cause mortality (ACM) and the secondary end point mean acute cellular rejection (ACR) grade within the first postoperative year. RESULTS: This study includes a total 140 HTx recipients (median age: 53.5 years; males: 80%; donor/recipient gender mismatch: 38...
May 24, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28541428/dissociable-roles-of-cerebral-%C3%AE-opioid-and-type-2-dopamine-receptors-in-vicarious-pain-a-combined-pet-fmri-study
#4
Tomi Karjalainen, Henry K Karlsson, Juha M Lahnakoski, Enrico Glerean, Pirjo Nuutila, Iiro P Jääskeläinen, Riitta Hari, Mikko Sams, Lauri Nummenmaa
Neuroimaging studies have shown that seeing others in pain activates brain regions that are involved in first-hand pain, suggesting that shared neuromolecular pathways support processing of first-hand and vicarious pain. We tested whether the dopamine and opioid neurotransmitter systems involved in nociceptive processing also contribute to vicarious pain experience. We used in vivo positron emission tomography to quantify type 2 dopamine and μ-opioid receptor (D2R and MOR, respectively) availabilities in brains of 35 subjects...
May 24, 2017: Cerebral Cortex
https://www.readbyqxmd.com/read/28540790/hyperthermic-chemotherapy-intra-abdominal-laparoscopic-approach-development-of-a-laparoscopic-model-using-co2-recirculation-system-and-clinical-translation-in-peritoneal-carcinomatosis
#5
Susana Sánchez-García, David Padilla-Valverde, Pedro Villarejo-Campos, Esther P García-Santos, Jesús Martín-Fernández
INTRODUCTION: Hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment for peritoneal carcinomatosis (PC). Laparoscopic surgery is performed in the treatment of colorectal and appendiceal cancer, and PC from diverse origin in selected patients. HIPEC management by laparoscopic approach after cytoreductive surgery (CRS) completed locoregional treatment of PC, and may be feasible and safe after appropriate patient selection. OBJECTIVE: Development of an experimental model of HIPEC by laparoscopic approach, with CO2 recirculation...
April 2, 2017: International Journal of Hyperthermia
https://www.readbyqxmd.com/read/28540781/haemodynamic-changes-during-hyperthermic-intra-thoracic-chemotherapy-for-pseudomyxoma-peritonei
#6
Nina Ashraf-Kashani, John Bell
PURPOSE: Hyperthermic intra-thoracic chemotherapy (HITOC) combined with cytoreductive surgery (CRS) is a novel approach in the management of pseuodmyxoma peritonei with thoracic extension. The haemodynamic effects of hyperthermic chemotherapy present an anaesthetic challenge. Here, we describe the haemodynamic changes seen during HITOC. MATERIALS AND METHODS: A retrospective case note review of adult patients undergoing CRS with HITOC from 2009 to 2016. Intra-operative haemodynamics were measured using the LIDCOrapid(TM) brand of invasive cardiac output (CO) monitor...
March 19, 2017: International Journal of Hyperthermia
https://www.readbyqxmd.com/read/28539480/identification-of-vortex-structures-in-a-cohort-of-204-intracranial-aneurysms
#7
Nicole Varble, Gabriel Trylesinski, Jianping Xiang, Kenneth Snyder, Hui Meng
An intracranial aneurysm (IA) is a cerebrovascular pathology that can lead to death or disability if ruptured. Abnormal wall shear stress (WSS) has been associated with IA growth and rupture, but little is known about the underlying flow physics related to rupture-prone IAs. Previous studies, based on analysis of a few aneurysms or partial views of three-dimensional vortex structures, suggest that rupture is associated with complex vortical flow inside IAs. To further elucidate the relevance of vortical flow in aneurysm pathophysiology, we studied 204 patient IAs (56 ruptured and 148 unruptured)...
May 2017: Journal of the Royal Society, Interface
https://www.readbyqxmd.com/read/28539007/videolaryngoscopy-versus-direct-laryngoscopy-for-tracheal-intubation-in-children-excluding-neonates
#8
REVIEW
Ibtihal S Abdelgadir, Robert S Phillips, Davinder Singh, Michael P Moncreiff, Joanne L Lumsden
BACKGROUND: Direct laryngoscopy is the method currently used for tracheal intubation in children. It occasionally offers unexpectedly poor laryngeal views. Indirect laryngoscopy involves visualizing the vocal cords by means other than obtaining a direct sight, with the potential to improve outcomes. We reviewed the current available literature and performed a meta-analysis to compare direct versus indirect laryngoscopy, or videolaryngoscopy, with regards to efficacy and adverse effects...
May 24, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28538248/minimally-invasive-cardiac-output-technologies-in-the-icu-putting-it-all-together
#9
Ramon P Clement, Jaap J Vos, Thomas W L Scheeren
PURPOSE OF REVIEW: Haemodynamic monitoring is a cornerstone in the diagnosis and evaluation of treatment in critically ill patients in circulatory distress. The interest in using minimally invasive cardiac output monitors is growing. The purpose of this review is to discuss the currently available devices to provide an overview of their validation studies in order to answer the question whether these devices are ready for implementation in clinical practice. RECENT FINDINGS: Current evidence shows that minimally invasive cardiac output monitoring devices are not yet interchangeable with (trans)pulmonary thermodilution in measuring cardiac output...
May 19, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28538086/sphingosine-1-phosphate-receptor-1-agonist-sew2871-causes-severe-cardiac-side-effects-and-does-not-improve-microvascular-barrier-breakdown-in-sepsis
#10
Sven Flemming, Natalie Burkard, Michael Meir, Martin Alexander Schick, Christoph-Thomas Germer, Nicolas Schlegel
BACKGROUND: Endothelial barrier dysfunction is a hallmark in the pathogenesis of sepsis. Sphingosine-1-phosphate (S1P) has been proposed to be critically involved in the maintenance of endothelial barrier function predominately by activating S1P receptor-1 (S1P1). Previous studies have shown that the specific S1P1 agonist SEW2871 improves endothelial barrier function under inflammatory conditions. However, the effectiveness of SEW2871 and potential side effects remained largely unexplored in a clinically relevant model of sepsis...
May 23, 2017: Shock
https://www.readbyqxmd.com/read/28537037/abdominal-paragangliomas-a-quantitative-prognostic-score-as-predictive-factor-of-the-feasibility-of-the-laparoscopic-approach
#11
Giovanni Alemanno, Carlo Bergamini, Riccardo Somigli, Paolo Prosperi, Alessandro Bruscino, Andrea Valeri
The gold standard treatment for abdominal paraganglioma is the complete surgical excision. The surgical approach may be either open or laparoscopic. The aim of this study is to identify clinical-pathological predictive factors for the failure of the laparoscopic approach in the treatment of abdominal paragangliomas, with the aim of reducing the rate of conversion to the open technique. A retrospective review was conducted on the medical records of patients who underwent laparoscopic surgery for suspected abdominal paraganglioma...
May 23, 2017: Updates in Surgery
https://www.readbyqxmd.com/read/28536728/neonatologist-performed-point-of-care-functional-echocardiography-in-the-neonatal-intensive-care-unit
#12
Woei Bing Poon, Keng Yean Wong
Functional echocardiography (fECHO) refers to a bedside, limited assessment of the ductus arteriosus, myocardial performance and pulmonary or systemic haemodynamics that is brief in nature and addresses a specific clinical question or management dilemma. This point-of-care ultrasonography is increasingly used internationally and locally among neonatal units to assist with management of neonatal haemodynamic conditions. This article intends to explain the modality, its indications, interpretation and implications for management, and how it impacts long-term outcomes, particularly in chronic lung disease for premature infants born before 32 weeks of gestation...
May 2017: Singapore Medical Journal
https://www.readbyqxmd.com/read/28536224/impella-percutaneous-left-ventricular-assist-device-for-severe-acute-ischaemic-mitral-regurgitation-as-a-bridge-to-surgery
#13
Bilal Jalil, Karim El-Kersh, Jarrod Frizzell, Shozab Ahmed
Ischaemic papillary muscle rupture causing acute severe mitral regurgitation (MR) has a dramatic presentation and a very high mortality. Emergent surgical repair improves outcomes, which necessitates robust preoperative stabilisation. Here we discuss a patient with cardiogenic shock with an acute severe MR that was deemed very high risk for emergent valve replacement due to haemodynamic instability and respiratory failure. A percutaneous left ventricular assist device Impella 2.5 (Abiomed, Danvers, MA) drastically improved clinical status, and the patient underwent a successful surgical mitral valve replacement soon after placement of the temporary assist device...
May 22, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28532189/non-selective-beta-blocker-treatment-does-not-impact-on-kidney-function-in-cirrhotic-patients-with-varices
#14
Bernhard Scheiner, Diego Parada-Rodriguez, Theresa Bucsics, Philipp Schwabl, Mattias Mandorfer, Nikolaus Pfisterer, Florian Riedl, Wolfgang Sieghart, Arnulf Ferlitsch, Michael Trauner, Markus Peck-Radosavljevic, Thomas Reiberger
GOALS AND BACKGROUND: Non-selective beta-blockers (NSBBs) are used for bleeding prophylaxis in cirrhotic patients with gastroesophageal varices (GEVs). Recent data suggested that NSBB treatment might increase the risk of renal dysfunction in patients with refractory ascites due to an impaired response to acute haemodynamic stress. STUDY: Retrospective longitudinal assessment of kidney function in a cohort of cirrhotic patients with GEVs with vs. without NSBB therapy...
May 22, 2017: Scandinavian Journal of Gastroenterology
https://www.readbyqxmd.com/read/28531295/right-ventricular-vascular-coupling-in-heart-failure-with-preserved-ejection-fraction-and-pre-vs-post-capillary-pulmonary-hypertension
#15
Thomas M Gorter, Dirk J van Veldhuisen, Adriaan A Voors, Yoran M Hummel, Carolyn S P Lam, Rolf M F Berger, Joost P van Melle, Elke S Hoendermis
Aims: Many patients with heart failure with preserved ejection fraction (HFpEF) develop post-capillary pulmonary hypertension (PH) due to increased left-sided filling pressures. However, a subset of patients develops combined post- and pre-capillary PH. We studied the value of echocardiographic right-sided characterization for the discrimination between pre- vs. post-capillary PH in HFpEF, using invasive haemodynamics as gold standard. Methods and results: 102 consecutive HFpEF patients with simultaneous right heart catheterization and echocardiography were identified...
May 22, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/28530658/endoglin-controls-blood-vessel-diameter-through-endothelial-cell-shape-changes-in-response-to-haemodynamic-cues
#16
Wade W Sugden, Robert Meissner, Tinri Aegerter-Wilmsen, Roman Tsaryk, Elvin V Leonard, Jeroen Bussmann, Mailin J Hamm, Wiebke Herzog, Yi Jin, Lars Jakobsson, Cornelia Denz, Arndt F Siekmann
The hierarchical organization of properly sized blood vessels ensures the correct distribution of blood to all organs of the body, and is controlled via haemodynamic cues. In current concepts, an endothelium-dependent shear stress set point causes blood vessel enlargement in response to higher flow rates, while lower flow would lead to blood vessel narrowing, thereby establishing homeostasis. We show that during zebrafish embryonic development increases in flow, after an initial expansion of blood vessel diameters, eventually lead to vessel contraction...
May 22, 2017: Nature Cell Biology
https://www.readbyqxmd.com/read/28529193/laparoscopy-has-a-therapeutic-role-in-the-management-of-abdominal-trauma-a-matched-pair-analysis
#17
Saurav Chakravartty, Ameet Patel, Diwakar R Sarma, Muhammad Noor, Spyros Panagiotopoulos, Ameet G Patel
INTRODUCTION: Laparoscopy is increasingly utilised as a diagnostic tool in management of abdominal trauma; however its role in therapeutic intervention remains unexplored. The aim of this study is to compare laparoscopy with laparotomy in the treatment of abdominal trauma in haemodynamically stable patients. METHODS: A review of patients undergoing surgery for abdominal trauma between January 2004-2014 identified 25 patients who underwent laparoscopy for therapeutic intervention (TL)...
May 18, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28526597/slow-ventricular-tachycardia-in-a-91-year-old-man-with-implantable-cardioverter-defibrillator-and-acute-respiratory-failure
#18
Nicola Vargas, Loredana Tibullo, Cesare A E Landi, Giovanni Carifi, Emanuela Landi, Elisa Salsano, Francesco Di Grezia, Fiore Candelmo
Slow ventricular tachycardia (VT) in patients with devices such as an implantable cardioverter - defibrillator (ICD) is more common than in the rest of the population. The incidence in elderly patients with an ICD remains largely unknown. In younger patients, slow VT is generally asymptomatic or associated with limited clinical relevance. It may be efficiently and safely terminated by anti-tachycardia pacing. We present a case of slow VT in a 91-year-old man with ICD with type 1 acute respiratory failure and drowsiness...
May 11, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28525624/early-and-asymptomatic-cardiac-dysfunction-in-chronic-kidney-disease
#19
Shanmugakumar Chinnappa, Edward White, Nigel Lewis, Omer Baldo, Yu-Kang Tu, Griet Glorieux, Raymond Vanholder, Meguid El Nahas, Andrew Mooney
Background: . Heart failure (HF) is highly prevalent and associated with high mortality in chronic kidney disease (CKD). However, the pathophysiology of cardiac dysfunction in CKD, especially in the early asymptomatic stage, is not well understood. We studied subclinical cardiac dysfunction in asymptomatic CKD patients without comorbid cardiac disease or diabetes mellitus by evaluating peak cardiac performance. Methods.: In a cross-sectional study ( n  = 130) we investigated 70 male non-diabetic CKD patients (21 CKD stage 2-3a, 27 CKD stage 3b-4 and 22 CKD stage 5) employing specialized cardiopulmonary exercise testing to measure peak cardiac output and cardiac power output non-invasively...
May 19, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28525548/computational-fluid-dynamics-characterization-of-pulsatile-flow-in-central-and-sano-shunts-connected-to-the-pulmonary-arteries-importance-of-graft-angulation-on-shear-stress-induced-platelet-mediated-thrombosis
#20
Robert Ascuitto, Nancy Ross-Ascuitto, Martin Guillot, Carey Celestin
OBJECTIVES: Central (aorta) and Sano (right ventricle)-to-pulmonary artery (PA) shunts, palliative operations for infants with complex heart defects, can develop life-threatening thrombosis. We employed computational fluid dynamics (CFD) to study pulsatile flow in these shunts, with the goal to identify haemodynamic characteristics conducive to thrombus formation. METHODS: CFD, using the finite volume method with cardiac catheterization data, and computer simulations, based on angiography, were employed to determine flow-velocity field, wall shear stress (WSS) profile and oscillatory shear index (OSI)...
May 19, 2017: Interactive Cardiovascular and Thoracic Surgery
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