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Chetna Shamshery, Ashish Kannaujia, Rajashree Madabushi, Dinesh Singh, Divya Srivastava, Shobhana Jafa
BACKGROUND: Central neuraxial blockade (CNB) is an established technique of providing anesthesia for surgeries of the lower limb and abdomen. Hypotension is the most common side effect of CNB. It was hypothesized that by supplementing the initial burst of vasopressin following hypovolemia, hypotension following combined spinal epidural anesthesia (CSEA) could be avoided. MATERIALS AND METHODS: A total of 122 patients undergoing lower limb and abdomen surgeries were included in the study, with 61 patients randomized into two groups - I and II...
September 2016: Anesthesia, Essays and Researches
Kiran Imran, Mirza Naqi Zafar, Uzma Ozair, Sadia Khan, Syed Adibul Hasan Rizvi
The goal of this study was to investigate metabolic risk factors in pediatric stone formers in an emerging economy. A prospective, data collection enrolled 250 children age <1-15 years at our center. Risk factors were evaluated by gender and in age groups <1-5, 6-10 and 11-15 years. Patients were evaluated for demographics, blood and 24 h urine for calcium, magnesium, phosphate, uric acid, electrolytes and additional protein, citrate, ammonia and oxalate in urine. All reported values were two sided and statistical significance was considered at p value ≤0...
October 15, 2016: Urolithiasis
Patricia Huelin, Salvatore Piano, Elsa Solà, Marialuisa Stanco, Cristina Solé, Rebeca Moreira, Elisa Pose, Silvano Fasolato, Nuria Fabrellas, Glòria de Prada, Chiara Pilutti, Isabel Graupera, Xavier Ariza, Antonietta Romano, Chiara Elia, Andrés Cárdenas, Javier Fernández, Paolo Angeli, Pere Ginès
BACKGROUND & AIMS: In patients with cirrhosis of the liver, acute kidney injury (AKI) is classified into 3 stages. Recent studies indicate that there are 2 subgroups of stage 1 disease, associated with different outcomes and serum levels of creatinine (sCr): stage 1A (sCr <1.5 mg/dL) and stage 1B (SCr ≥1.5 mg/dL). We performed a prospective study to validate, in a large series of patients with cirrhosis, the association between this new description and patient outcomes, as well as assess the relationship between AKI stage and the presence of acute-on-chronic liver failure (ACLF)...
October 5, 2016: Clinical Gastroenterology and Hepatology
Janelle Rekman, Christopher Wherrett, Sean Bennett, Miso Gostimir, Sara Saeed, Kristina Lemon, Richard Mimeault, Fady K Balaa, Guillaume Martel
BACKGROUND: Liver resection can be associated with significant blood loss and transfusion. Whole blood phlebotomy is an under-reported technique, distinct from acute normovolemic hemodilution, the goal of which is to minimize blood loss in liver operation. This work sought to report on its safety and feasibility and to describe technical considerations. METHODS: Consecutive patients who had an elective liver resection and concurrent phlebotomy between 2013 and 2016 were examined prospectively...
October 3, 2016: Surgery
Maria Skytioti, Signe Søvik, Maja Elstad
Intact cerebral blood flow (CBF) is essential for cerebral metabolism and function, whereas hypoperfusion in relation to hypovolemia and hypocapnia can lead to severe cerebral damage. This study was designed to assess internal carotid artery blood flow (ICA-BF) during simulated hypovolemia and noninvasive positive pressure ventilation (PPV) in young healthy humans. Beat-by-beat blood velocity (ICA and aorta) were measured by Doppler ultrasound during normovolemia and simulated hypovolemia (lower body negative pressure), with or without PPV in 15 awake subjects...
October 2016: Physiological Reports
Xiaoping Lin, Zhijun Xu, Pengfei Wang, Yan Xu, Gensheng Zhang
Neurogenic pulmonary edema (NPE) is occasionally observed in patients with traumatic brain injury (TBI); however, this condition is often underappreciated. NPE is frequently misdiagnosed due to its atypical clinical performance, thus delaying appropriate treatment. A comprehensive management protocol of NPE in patients with TBI has yet to be established. The current study reported the case of a 67-year-old man with severe TBI who was transferred to our intensive care unit (ICU). On day 7 after hospitalization, the patient suddenly suffered tachypnea, tachycardia, systemic hypertension and hypoxemia during lumbar cistern drainage...
October 2016: Experimental and Therapeutic Medicine
Kwadwo Kyeremanteng, Gianni D'Egidio, Cynthia Wan, Alan Baxter, Hans Rosenberg
Objective. To describe a single case of Systemic Capillary Leak Syndrome (SCLS) with a rare complication of compartment syndrome. Patient. Our patient is a 57-year-old male, referred to our hospital due to polycythemia (hemoglobin (Hgb) of 220 g/L), hypotension, acute renal failure, and bilateral calf pain. Measurements and Main Results. The patient required bilateral forearm, thigh, and calf fasciotomies during his ICU stay and continuous renal replacement therapy was instituted following onset of acute renal failure and oliguria...
2016: Case Reports in Critical Care
Joana Feiteiro, Melissa Mariana, Ignacio Verde, Elisa Cairrão
Mifepristone (RU 486) is a compound that is structurally related to steroid hormones, which is derived from the estrane progestins. This compound strongly binds the progesterone and glucocorticoid receptor and, to a lesser extent, the androgen receptor. This compound has its effects through different signaling pathways, related to genomic and nongenomic effects. The genomic effect involves the activation or blockage of nuclear or intracellular receptor, that in this case the progesterone, glucocorticoid, and androgen receptors...
September 27, 2016: Reproductive Sciences
Catherine L Oberg, Robert J Hiensch, Hooman D Poor
OBJECTIVE: To report a case series of three patients with hepatitis C virus infection who all presented with severe type B lactic acidosis shortly after starting treatment with ombitasvir-paritaprevir-ritonavir-dasabuvir. DESIGN: Case series. SETTING: ICU. PATIENTS: Three patients, all who had HCV cirrhosis with mild hepatic impairment (Child-Pugh A) and had started taking ombitasvir-paritaprevir-ritonavir-dasabuvir within the preceding 2 weeks, presented with similar nonspecific symptoms of lethargy, fatigue, and nausea...
September 22, 2016: Critical Care Medicine
F Dufour-Gaume, D Delaune, C Martinaud, A Sailliol
In December 2013, the most widespread epidemic of Ebola virus disease began in Guinea and continued for over 2 years. At the request of the Guinean state, France deployed a military field hospital to treat Ebola infected healthcare workers. From January to July 2015, our center supported 26 healthcare workers suffering from Ebola virus disease. Despite an individualized care and optimal treatment, the fatality rate remained high at 30.7%. Improved therapies are required to reduce mortality risk in Ebola virus disease...
September 14, 2016: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
K Hammes, J Novo Matos, M Baron Toaldo, T Glaus
Systolic anterior (septal) motion of the mitral valve (SAM) is a common secondary phenomenon in hypertrophic cardiomyopathy (HCM) in people and cats. In humans, it is increasingly recognized that SAM may be found in other cardiac and non-cardiac disease states. In small animal cardiology, SAM unassociated with HCM has been described in dogs with mitral valve dysplasia and right ventricular pressure overload. In this report, we describe two cases of dogs where transient SAM was caused by hypovolemia. When SAM was present both dogs showed pseudohypertrophy and tachycardia...
September 14, 2016: Journal of Veterinary Cardiology: the Official Journal of the European Society of Veterinary Cardiology
Wen-Rui Xu, Hong-Fang Jin, Jun-Bao Du
OBJECTIVE: Postural tachycardia syndrome (POTS) is one of the major causes of orthostatic intolerance in children. We systematically reviewed the pathogenesis and the progress of individualized treatment for POTS in children. DATA SOURCES: The data analyzed in this review are mainly from articles included in PubMed and EMBASE. STUDY SELECTION: The original articles and critical reviews about POTS were selected for this review. RESULTS: Studies have shown that POTS might be related to several factors including hypovolemia, high catecholamine status, abnormal local vascular tension, and decreased skeletal muscle pump activity...
2016: Chinese Medical Journal
Nathalie Linn Anikken Holme, Erling Bekkestad Rein, Maja Elstad
PURPOSE: Hypovolemia decreases preload and cardiac stroke volume. Cardiac stroke volume (SV) and its variability (cardiac stroke volume variability, SVV) have been proposed as clinical tools for detection of acute hemorrhage. We compared three non-invasive SV measurements and investigated if respiration-induced fluctuations in SV may detect mild and moderate hypovolemia in spontaneously breathing humans. METHODS: Ten healthy subjects underwent experimental central hypovolemia induced by lower body negative pressure to -60 mmHg or onset of presyncopal symptoms...
September 10, 2016: European Journal of Applied Physiology
Edoardo Picetti, Franco Servadei, Cristiana Reverberi, Francesca De Carlo, Ilaria Rossi, Marta Velia Antonini, Maria Luisa Caspani
BACKGROUND: The aim of this prospective clinical study was to evaluate the cerebral and hemodynamic effects of low dose intramuscular DCFS administered for fever control in ICU patients with ABI. METHODS: Inclusion criteria were: 1) age ≥ 18 years, 2) the ability to monitor intra-arterial blood pressure, Tc, and ICP, 3) the placement of an indwelling jugular venous catheter for intermittent SjVO2 measurements, and 4) a Tc ≥ 37.5 °C. Exclusion criteria were: hypovolemia, administration of drugs with hemodynamic effects during the study period, administration of antipyretics within 6 hours prior to the start of the study, acute heart failure, cerebral vasospasm, pregnancy, renal and gastric diseases and allergy to DCFS...
August 17, 2016: World Neurosurgery
Anthony S McLean
Echocardiography is pivotal in the diagnosis and management of the shocked patient. Important characteristics in the setting of shock are that it is non-invasive and can be rapidly applied.In the acute situation a basic study often yields immediate results allowing for the initiation of therapy, while a follow-up advanced study brings the advantage of further refining the diagnosis and providing an in-depth hemodynamic assessment. Competency in basic critical care echocardiography is now regarded as a mandatory part of critical care training with clear guidelines available...
2016: Critical Care: the Official Journal of the Critical Care Forum
Kinza Sentissi, Mandeep S Sawhney, Douglas Pleskow, Paul Sepe, Jose M Mella, Benjamin Kwittken, Gyanprakash Ketwaroo, Balachundhar Subramaniam
In this prospective observational study, conducted at an academic medical center, we evaluated the feasibility of performing a basic transesophageal echocardiography (TEE) examination using endoscopic ultrasound (EUS) technology to determine what cardiac structures could be assessed. This may be potentially beneficial during hemodynamic emergencies in the endoscopy suite resulting from hypovolemia, depressed ventricular function, aortic dissection, pericardial effusions, or aortic stenosis. Of the 20 patients enrolled, 18 underwent EUS with a linear echoendoscope for standard clinical indications followed by a cardiac assessment performed under the guidance of a TEE-certified cardiac anesthesiologist...
September 2016: Anesthesia and Analgesia
Noud van Helmond, Blair D Johnson, Timothy B Curry, Andrew P Cap, Victor A Convertino, Michael J Joyner
What is the central question of this study? Is lower body negative pressure a useful surrogate to study white blood cell responses to haemorrhage in humans? What is the main finding and its importance? We found that lower body negative pressure appears to be a useful surrogate to study the early white blood cell mobilization response during blood loss. Hypovolaemia has been associated with an immune response that might be secondary to sympathoexcitation. We tested the hypothesis that simulated hypovolaemia using lower body negative pressure (LBNP) and real hypovolaemia induced via experimental blood loss (BL) cause similar increases in the white blood cell concentration ([WBC])...
October 1, 2016: Experimental Physiology
Michael Dahl, Chris Hayes, Bodil Steen Rasmussen, Anders Larsson, Niels H Secher
BACKGROUND: Whether during spontaneous breathing arterial pressure variations (APV) can detect a volume deficit is not established. We hypothesized that amplification of intra-thoracic pressure oscillations by breathing through resistors would enhance APV to allow identification of a reduced cardiac output (CO). This study tested that hypothesis in healthy volunteers exposed to central hypovolemia by head-up tilt. METHODS: Thirteen healthy volunteers were exposed to central hypovolemia by 45° head-up tilt while breathing through a facemask with 7...
2016: BMC Anesthesiology
Kavita Yadav, Akanksha Singh, Ashok Kumar Jaryal, Poonam Coshic, Kabita Chatterjee, K K Deepak
Non-hypotensive hypovolemia, observed during mild haemorrhage or blood donation leads to reflex readjustment of the cardiac autonomic tone. In the present study, the cardiac autonomic tone was quantified using heart rate and blood pressure variability during and after non-hypotensive hypovolemia of blood donation. 86 voluntary healthy male blood donors were recruited for the study (age 35 ± 9 years; weight 78 ± 12 kg; height 174 ± 6 cms). Continuous lead II ECG and beat-to-beat blood pressure was recorded before, during and after blood donation followed by offline time and frequency domain analysis of HRV and BPV...
August 2, 2016: Journal of Clinical Monitoring and Computing
Tanja Radovanović, Slobodan Spasojević, Vesna Stojanović, Aleksandra Doronjski
INTRODUCTION: Subgaleal hemorrhage is a rare but potentially fatal birth trauma. It is caused by rupture of the emissary veins (connections between the dural sinuses and scalp veins), followed by the accumulation of blood between the epicranial aponeurosis and the periosteum. Usually, it is associated with instrumental delivery (vacuum extraction, forceps delivery), but it may also occur spontaneously, suggesting the possibility of congenital bleeding disorder. CASE OUTLINE: A full term male neonate was born at 40 weeks gestation by spontaneous vaginal delivery, with birth weight of 3,700 g...
March 2016: Srpski Arhiv za Celokupno Lekarstvo
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