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https://www.readbyqxmd.com/read/28422408/prevention-of-the-osmotic-demyelination-syndrome-after-liver-transplantation-a-multidisciplinary-perspective
#1
J F Crismale, K A Meliambro, S DeMaria, D B Bronster, S Florman, T D Schiano
The osmotic demyelination syndrome (ODS) is a serious neurologic condition that occurs in the setting of rapid correction of hyponatremia. It presents with protean manifestations, from encephalopathy to the "locked-in" syndrome. ODS can complicate liver transplantation (LT), and its incidence may increase with the inclusion of serum sodium as a factor in the Model for End-Stage Liver Disease score. A comprehensive understanding of risk factors for the development of ODS in the setting of LT, along with recommendations to mitigate the risk of ODS, are necessary...
April 19, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28420865/a-novel-variant-t-1-22-translocation-ins-22-1-q13-p13p31-in-a-child-with-acute-megakaryoblastic-leukemia
#2
Elizabeth Margolskee, Jad Saab, Julia T Geyer, Alexander Aledo, Susan Mathew
BACKGROUND The reciprocal translocation t(1;22)(p13;q13) involving the RBM15 and MKL1 genes is an uncommon abnormality that occurs in a subset of acute myeloid leukemia with megakaryocytic differentiation (AMKL). Variant translocations have been infrequently described in this subtype of leukemia. CASE REPORT We describe the case of a 3-month-old girl who presented with progressive abdominal distension, vomiting, and fever. Although there was no morphologic evidence of leukemia in the bone marrow, cytogenetic and metaphase fluorescence in situ hybridization analysis identified an insertion of p13p31 bands of chromosome 1 onto the long arm of chromosome 22, resulting in the karyotype: 46,XX,ins(22;1)(q13;p13p31)...
April 19, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28413683/obtaining-accurate-glucose-measurements-from-wild-animals-under-field-conditions-comparing-a-hand-held-glucometer-with-a-standard-laboratory-technique-in-grey-seals
#3
Kimberley A Bennett, Lucy M Turner, Sebastian Millward, Simon E W Moss, Ailsa J Hall
Glucose is an important metabolic fuel and circulating levels are tightly regulated in most mammals, but can drop when body fuel reserves become critically low. Glucose is mobilized rapidly from liver and muscle during stress in response to increased circulating cortisol. Blood glucose levels can thus be of value in conservation as an indicator of nutritional status and may be a useful, rapid assessment marker for acute or chronic stress. However, seals show unusual glucose regulation: circulating levels are high and insulin sensitivity is limited...
2017: Conservation Physiology
https://www.readbyqxmd.com/read/28412028/-effectiveness-of-erlotinib-in-critical-care-unit-in-patients-with-non-small-cell-lung-cancer-with-egfr-mutation
#4
M Dewolf, C Dayen, C Garoute, W Khamis, M Fourrier, F Rousselle, M Sadki, F Le Meunier, R Suguenot, E Lecuyer, H Bentayeb, Y Douadi, P Berna
INTRODUCTION: The search for mutations epidermal growth factor receptor (EGFR) has changed the therapeutic approach and prognosis of non-small cell lung cancer (NSCLC). The effectiveness of tyrosine kinase inhibitors (TKI) has been demonstrated orally in patients with EGFR mutation. We report the case of a patient for whom treatment with TKI was started effectively in a Critical Care Unit. OBSERVATION: A patient of 59 years is followed for a stage IV lung adenocarcinoma with metastases in liver, brain, adrenal, lung and pleura...
April 12, 2017: Revue de Pneumologie Clinique
https://www.readbyqxmd.com/read/28410274/three-hypothetical-inflammation-pathobiology-phenotypes-and-pediatric-sepsis-induced-multiple-organ-failure-outcome
#5
Joseph A Carcillo, E Scott Halstead, Mark W Hall, Trung C Nguyen, Ron Reeder, Rajesh Aneja, Bita Shakoory, Dennis Simon
OBJECTIVES: We hypothesize that three inflammation pathobiology phenotypes are associated with increased inflammation, proclivity to develop features of macrophage activation syndrome, and multiple organ failure-related death in pediatric severe sepsis. DESIGN: Prospective cohort study comparing children with severe sepsis and any of three phenotypes: 1) immunoparalysis-associated multiple organ failure (whole blood ex vivo tumor necrosis factor response to endotoxin < 200 pg/mL), 2) thrombocytopenia-associated multiple organ failure (new onset thrombocytopenia with acute kidney injury and a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 activity < 57%), and/or 3) sequential multiple organ failure with hepatobiliary dysfunction (respiratory distress followed by liver dysfunction with soluble Fas ligand > 200 pg/mL), to those without any of these phenotypes...
April 13, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28402551/a-risk-prediction-score-for-acute-kidney-injury-in-the-intensive-care-unit
#6
Rakesh Malhotra, Kianoush B Kashani, Etienne Macedo, Jihoon Kim, Josee Bouchard, Susan Wynn, Guangxi Li, Lucila Ohno-Machado, Ravindra Mehta
Background.: Acute kidney injury (AKI) is common in critically ill patients and is associated with high morbidity and mortality. Early identification of high-risk patients provides an opportunity to develop strategies for prevention, early diagnosis and treatment of AKI. Methods.: We undertook this multicenter prospective cohort study to develop and validate a risk score for predicting AKI in patients admitted to an intensive care unit (ICU). Patients were screened for predictor variables within 48 h of ICU admission...
April 10, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28399882/liver-necrosis-shortly-after-pancreaticoduodenectomy-with-resection-of-the-replaced-left-hepatic-artery
#7
Michihiro Yamamoto, Masazumi Zaima, Hidekazu Yamamoto, Hideki Harada, Junichiro Kawamura, Masahiro Yamada, Tekefumi Yazawa, Junya Kawasoe
BACKGROUND: Surgeons, in general, underestimate the replaced left hepatic artery (rLHA) that arises from the left gastric artery (LGA), compared with the replaced right hepatic artery (rRHA), especially in standard gastric cancer surgery. During pancreaticoduodenectomy (PD), preservation of the rRHA arising from the superior mesenteric artery (SMA) is widely accepted to prevent critical postoperative complications, such as liver necrosis, bile duct ischemia, and biliary anastomotic leakage...
April 11, 2017: World Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28396854/a-hepatitis-c-educational-needs-assessment-of-canadian-healthcare-providers
#8
Reza Naghdi, Karen Seto, Carolyn Klassen, Didi Emokpare, Brian Conway, Melissa Kelley, Eric Yoshida, Hemant A Shah
Background and Aim. Despite advances in the treatment of chronic hepatitis C infection (CHC), it remains a major public health problem in Canada and globally. The knowledge of healthcare providers (HCPs) is critical to improve the care of CHC in Canada. To assess the current knowledge and educational needs of healthcare providers (HCPs) in the area of CHC management a national online survey was conducted. Method. An interprofessional steering committee designed a 29-question survey distributed through various direct and electronic routes...
2017: Canadian Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28388373/protein-kinetics-and-metabolic-effects-related-to-disease-states-in-the-intensive-care-unit
#9
Robert G Martindale, Daren K Heyland, Saúl J Rugeles, Jan Wernerman, Peter J M Weijs, Jayshil J Patel, Stephen A McClave
Evaluating protein kinetics in the critically ill population remains a very difficult task. Heterogeneity in the intensive care unit (ICU) population and wide spectrum of disease processes creates complexity in assessing protein kinetics. Traditionally, protein has been delivered in the context of total energy. Focus on energy delivery has recently come into question, as the importance of supplemental protein in patient outcomes has been shown in several recent trials. The ICU patient is prone to catabolism, immobilization, and impaired immunity, which is a perfect storm for massive loss of lean body tissue with a unidirectional flow of amino acids from muscle to immune tissue for immunoglobulin production, as well as liver for gluconeogenesis and acute phase protein synthesis...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28381377/current-technical-aspects-of-oncological-hepatic-surgery
#10
Ahmed I Salem, Emily R Winslow
BACKGROUND: With the recent advances in oncological hepatic surgery, major liver resections became more widely utilized procedures. The era of modern hepatic surgery witnessed improvements in patients care in preoperative, intraoperative and postoperative aspects. This significantly improved surgical outcomes regarding morbidity and mortality. This review article focuses on the recent advances in oncological hepatic surgery. DATA SOURCES: This review includes only data from peer-reviewed articles and journals...
April 2017: Hepatobiliary & Pancreatic Diseases International: HBPD INT
https://www.readbyqxmd.com/read/28377772/treatment-of-pediatric-acute-graft-versus-host-disease-lessons-from-primary-immunodeficiency
#11
REVIEW
Aisling M Flinn, Andrew R Gennery
Allogeneic hematopoietic stem cell transplant (HSCT) is used to treat increasing numbers of malignant and non-malignant disorders. Despite significant advances in improved human leukocyte antigens-typing techniques, less toxic conditioning regimens and better supportive care, resulting in improved clinical outcomes, acute graft-versus-host disease (aGvHD) continues to be a major obstacle and, although it principally involves the skin, gastrointestinal tract, and liver, the thymus is also a primary target. An important aim following HSCT is to achieve complete and durable immunoreconstitution with a diverse T-cell receptor (TCR) repertoire to recognize a broad range of pathogens providing adequate long-term adaptive T-lymphocyte immunity, essential to reduce the risk of infection, disease relapse, and secondary malignancies...
2017: Frontiers in Immunology
https://www.readbyqxmd.com/read/28374334/long-term-outcome-of-patients-with-liver-cirrhosis-admitted-to-a-general-intensive-care-unit
#12
Alex Warren, Charlotte R Soulsby, Alex Puxty, Joseph Campbell, Martin Shaw, Tara Quasim, John Kinsella, Joanne McPeake
OBJECTIVES: The prevalence of liver cirrhosis is increasing, and many patients have acute conditions requiring consideration of intensive care. This study aims to: (a) report the outcome at 12 months of patients with cirrhosis admitted to ICU, (b) identify factors predictive of long-term mortality and (c) evaluate the ability of scoring systems to predict long-term outcome. DESIGN: Observational cohort study. SETTING: General adult critical care unit in a UK teaching hospital...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28370502/the-impact-of-real-life-treatment-strategies-for-candida-peritonitis-a-retrospective-analysis
#13
S Dubler, M Laun, C Koch, A Hecker, S Weiterer, B H Siegler, R Röhrig, M A Weigand, C Lichtenstern
Candida species are commonly detected isolates from abdominal foci. The question remains as to who would benefit from early empiric treatment in cases of Candida peritonitis. This study collected real-life data on critically ill patients with Candida peritonitis to estimate the relevance of the chosen treatment strategy on the outcome of these patients. One hundred and thirty-seven surgical intensive care unit (ICU) patients with intra-abdominal invasive Candidiasis were included in the study. Fifty-six patients did not get any antifungal agent...
April 3, 2017: Mycoses
https://www.readbyqxmd.com/read/28355466/invasive-mould-infections-in-the-icu-setting-complexities-and-solutions
#14
Matteo Bassetti, Emilio Bouza
Infections caused by filamentous fungi represent a major burden in the ICU. Invasive aspergillosis is emerging in non-neutropenic individuals with predisposing conditions, e.g. corticosteroid treatment, chronic obstructive pulmonary disease, liver cirrhosis, solid organ cancer, HIV infection and transplantation. Diagnosis is challenging because the signs and symptoms are non-specific, and initiation of additional diagnostic examinations is often delayed because clinical suspicion is low. Isolation of an Aspergillus species from the respiratory tract in critically ill patients, and tests such as serum galactomannan, bronchoalveolar lavage 1-3-β-d-glucan and specific PCR should be interpreted with caution...
March 1, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/28331622/c-terminal-proendothelin-1-ct-proet-1-is-associated-with-organ-failure-and-predicts-mortality-in-critically-ill-patients
#15
Lukas Buendgens, Eray Yagmur, Jan Bruensing, Ulf Herbers, Christer Baeck, Christian Trautwein, Alexander Koch, Frank Tacke
BACKGROUND: Endothelin 1 (ET-1) is a strong vasoconstrictor, which is involved in inflammation and reduced tissue perfusion. C-terminal proendothelin-1 (CT-proET-1) is the stable circulating precursor protein of ET-1. We hypothesized that CT-proET-1, reflecting ET-1 activation, is involved in the pathogenesis of critical illness and associated with its prognosis. METHODS: Two hundred seventeen critically ill patients (144 with sepsis, 73 without sepsis) were included prospectively upon admission to the medical intensive care unit (ICU), in comparison to 65 healthy controls...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28306680/anaesthesia-in-patients-with-liver-disease
#16
Malgorzata H Starczewska, Wint Mon, Peter Shirley
PURPOSE OF REVIEW: The purpose of this review is to summarize the most recent up to date research data and recommendations regarding anaesthetic management of patients with liver disease undergoing surgery. The incidence of chronic liver disease (CLD) continues to rise and perioperative mortality and morbidity remains unacceptably high in this group. Meticulous preoperative assessment and carefully planned anaesthetic management are vital in improving outcomes in patients with liver disease undergoing surgery...
March 16, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28297813/-clinical-application-and-evaluation-of-an-early-non-sedation-protocol-for-critically-ill-respiratory-patients
#17
J B Huang, C Q Lan, H Y Li, L Chen, J G Pan, L L Chen, H Weng, Y M Zeng
Objective: To study the value of an early (mechanical ventilation after 24 h) non-sedation protocol for intubated, mechanically ventilated patients in the respiratory intensive care unit (RICU). Methods: Seventy intubated, mechanically ventilated patients were prospectively enrolled and randomly assigned to management with early non-sedation (intervention group; n=35) or with daily interruption of sedation (DIS) (control group; n=35). The duration of mechanical ventilation, length of the RICU and hospital stay, RICU and hospital mortality, drug consumption, RICU and hospitalization expenses, incidence of complications and adverse events and serum levels of vital organ damage and inflammatory markers after mechanical ventilation for 48 h were recorded and compared...
March 12, 2017: Chinese Journal of Tuberculosis and Respiratory Diseases
https://www.readbyqxmd.com/read/28289273/metastatic-colonic-adenocarcinoma-to-the-extrahepatic-common-bile-duct-the-critical-role-of-the-pathologist-and-immunohistochemistry-in-guiding-patient-care-decisions
#18
Kurt J Knowles, Shoujun Chen, Gillermo A Herrera
BACKGROUND Adenocarcinoma of the colon frequently invades adjacent organs, spreads intraperitoneal, and metastasizes to intestinal lymph nodes, lungs, and the liver. Metastasis solely to the extrahepatic bile duct is extremely rare and has only been previously reported on 15 occasions. The accurate determination that an extrahepatic common bile duct lesion is of colonic origin has critical therapeutic implications. CASE REPORT The patient was a 50-year-old male with a history of colon cancer S/P surgical resection in September 2014...
March 14, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28275294/anatomical-resection-of-hepatocellular-carcinoma-a-critical-review-of-the-procedure-and-its-benefits-on-survival
#19
REVIEW
Koo Jeong Kang, Keun Soo Ahn
Hepatocellular carcinoma (HCC) is the sixth most common type of cancer and the third most frequent cause of cancer-related death. Advances in preoperative assessment of HCC (e.g., imaging studies and liver function tests), surgical techniques, and postoperative care have improved the surgical outcomes and survival of patients who undergo hepatic resection for HCC. However, in the last 20 years, the long-term survival after hepatectomy has remained unsatisfactory owing to the high rates of local recurrence and multicentric occurrence...
February 21, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28257538/multidisciplinary-approach-to-complicated-pregnancy
#20
Josip Andelo Borovac, Josko Bozic, Tina Ticinovic Kurir, Nikola Zaja, Kresimir Kolic, Vedran Hrboka
A nulliparous pregnant woman in her mid-20s and in the 32nd week of gestation presented to the emergency department with severe headache and vomiting. She had an uneventful medical history; however, the physical examination upon hospital admission revealed a hypertensive emergency, papilledema, and 2+ dipstick proteinuria. Upon establishing the diagnosis of preeclampsia, aggressive therapy with corticosteroids, antihypertensive medication, and seizure prophylaxis was initiated. Hemodynamic stability was achieved within 24 hours and the patient remained in the observation unit located within the gynecology clinic...
March 2017: Southern Medical Journal
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