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fluid therapy

Ramiro Marinho, Mara Sousa, Filipa Machado, Sara Fonseca, Luísa Guedes
Cerebrospinal fluid cutaneous fistula is a rare but potentially serious complication of epidural analgesia. We report the case of a patient submitted to total knee arthroplasty under subarachnoid block and placement of lumbar epidural catheter for post-operative analgesia. The epidural catheter was found exteriorised on the fourth post-operative day, and the patient presented with a moderate fluid leak from the puncture site that was confirmed to be cerebrospinal fluid by cytological and chemical analysis. The initial therapeutic approach consisted of bed rest, hydration and prophylactic antibiotic therapy for 3 days, but it was ineffective as the leak persisted...
June 22, 2018: Scandinavian Journal of Pain
Sunil K Arya, Pedro Estrela
Electrochemical enzyme-linked immunosorbent assay (ELISA)-based immunoassays for cancer biomarker detection have recently attracted much interest owing to their higher sensitivity, amplification of signal, ease of handling, potential for automation and combination with miniaturized analytical systems, low cost and comparative simplicity for mass production. Their developments have considerably improved the sensitivity required for detection of low concentrations of cancer biomarkers present in bodily fluids in the early stages of the disease...
June 22, 2018: Sensors
Silvia Scabini, Mattia Trunfio, Veronica Pirriatore, Daniele Imperiale, Sabrina Audagnotto, Roberto Bertucci, Valeria Ghisetti, Giacoma Cinnirella, Angelina Cistaro, Mariaelena Perna, Andrea Calcagno, Giovanni Di Perri
A case of progressive multifocal leukoencephalopathy (PML) is described in an HIV-negative patient with mixed connective-tissue disease (MCTD) on a minimally immunosuppressive treatment with hydroxychloroquine. The patient presented with right-sided weakness, episodes of disorientation and loss of short-term memory and of vision in her right eye. PML was diagnosed by JCV DNA on cerebrospinal fluid and radiological criteria. She was treated with off-label maraviroc and mirtazapine but died two months after hospital admission, despite a surprising decrease in the viral load of cerebrospinal fluid three weeks after starting therapy...
June 1, 2018: Le Infezioni in Medicina
Taek Hwan Shin, Sung Hyun Im, Min Su Goh, Eun Seok Lee, Myoung Jin Ho, Chang Hyun Kim, Myung Joo Kang, Young Wook Choi
The objective of this study was to formulate once-a-day extended-release (ER) pellet system of imidafenacin (IDN), a recently approved urinary antispasmodic agent with twice-a-day dosing regimen. The sugar sphere pellets were firstly layered with IDN and hypromellose and then coated with Eudragit RS (copolymers of acrylic and methacrylic acid esters), employed as a release modifier, using a fluid-bed coater. Solid-state characterizations using solid-state X-ray diffraction and differential scanning calorimeter indicated that the antispasmodic agent was homogeneously layered onto the pellets in an amorphous state...
June 21, 2018: AAPS PharmSciTech
Nuria Martín, Patricia Guilabert, Luis Abarca, Gemma Mª Usua, Jordi Serracanta, Maria J Colomina
Patients with major burn injury undergo a series of pathophysiologic changes that begin with a systemic inflammatory response and coagulation abnormalities, similar to those experienced by patients with sepsis or severe trauma. Coagulation changes in patients with burns are generally characterized by procoagulant abnormalities, but alterations in fibrinolysis and anticoagulation factors have also been observed. Around 40% of patients with major burn show changes on standard coagulation tests, and these have been related to the severity of the lesions, smoke inhalation, and administration of intensive fluid resuscitation therapy...
December 6, 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
Mozhgan Karimifar
Thyroid follicular cancers are one of the thyroid gland cancers. This cancer can lead to metastases to various areas of the body. We describe a patient with thyroid follicular carcinoma who after total thyroidectomy had severe hypercalcemia, increased creatinine, and thyrotoxicosis due to extensive bone metastases. The patient was a 52-year-old man who had femoral neck fracture as the first manifestation of thyroid cancer. He was hospitalized for some time after orthopedic measures because of thyrotoxicosis and deep-venous thrombosis...
2018: Advanced Biomedical Research
Nadina Tinsley, Nikitha Yemula, Satheesh Ramalingam, Shyam Madathil
A 72-year-old man was brought to the emergency department with acute onset confusion and haemoptysis. Chest X-ray showed a possible lung mass, while CT head showed a fluid-filled, space-occupying lesion (SOL) in the right frontal lobe of the brain. MRI head indicated that this SOL had spilt its contents into the subarachnoid and intraventricular spaces. Due to a fluctuating Glasgow Coma Scale (GCS), the patient underwent emergency debulking. Macroscopically, a frail-walled cystic tumour filled with straw-coloured fluid was noted; histology confirmed metastasis from a primary lung adenocarcinoma...
June 21, 2018: BMJ Case Reports
Guillaume Hékimian, Tamara Jovanovic, Nicolas Bréchot, Guillaume Lebreton, Pascal Leprince, Jean-Louis Trouillet, Matthieu Schmidt, Ania Nieszkowska, Sébastien Besset, Jean Chastre, Alain Combes, Charles-Edouard Luyt
PURPOSE: To describe patients with refractory cardiogenic shock related to influenza B virus myocarditis rescued by venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO). MATERIAL AND METHODS: Consecutive patients hospitalized in our unit for influenza-associated myocarditis were prospectively included. We also conducted a systematic MEDLINE database literature review through the PubMed search engine, between 1946 and 2017. RESULTS: We report the cases of 4 young patients with fulminant myocarditis requiring VA-ECMO for 6 [5-8] days...
June 9, 2018: Journal of Critical Care
Athanasios Charalampopoulos, Robert Lewis, Peter Hickey, Charlotte Durrington, Charlie Elliot, Robin Condliffe, Ian Sabroe, David G Kiely
Pulmonary hypertension due to left heart disease (PH-LHD) is the most common type of pulmonary hypertension, although an accurate prevalence is challenging. PH-LHD includes PH due to systolic or diastolic left ventricular dysfunction, mitral or aortic valve disease and congenital left heart disease. In recent years a new and distinct phenotype of "combined post-capillary and pre-capillary PH," based on diastolic pulmonary gradient and pulmonary vascular resistance, has been recognized. The roles of right ventricular dysfunction and pulmonary vascular compliance in PH-LHD have also been elucidated recently and they appear to have significant clinical implications...
2018: Frontiers in Medicine
Eun Hyun Seo, Hae Jung Yang, Sang Hoon Kim, Jung Hyun Park, Hyung-Jun Yoon
Background: Neurosyphilis remains a diagnostic challenge in current psychiatric practice because of its pleomorphic psychiatric manifestations. Although neurosyphilis can present with a wide range of psychiatric symptoms, psychotic mania as its solitary manifestation is an unusual phenomenon. Case presentation: A 46-year-old man, with no history of any psychiatric disorder, exhibited abruptly developed symptoms of psychotic mania. He was admitted to a psychiatric ward for further evaluation and treatment...
2018: Annals of General Psychiatry
Douglas A Simonetto, Hala Fatima, Folkert Zijlstra, Michael K Zijlstra
Ascites is an abnormal accumulation of fluid within the peritoneal cavity. The most common cause of ascites in the United States population is portal hypertension secondary to cirrhosis, accounting for about 80% of the cases. Other etiologies include malignancy, heart failure, tuberculosis, and pancreatic disease. After an extensive literature review, it is to our best knowledge that there have been no cases reported on autoimmune ascites. We present an interesting case of ascites in a 67-year-old Caucasian male with symptoms of recurrent abdominal distention and significant weight gain, refractory to standard therapies...
May 2018: Case Reports in Gastroenterology
Katarzyna Niemirowicz-Laskowska, Katarzyna Głuszek, Ewelina Piktel, Karlis Pajuste, Bonita Durnaś, Grzegorz Król, Agnieszka Z Wilczewska, Paul A Janmey, Aiva Plotniece, Robert Bucki
Background: 1,4-Dihydropyridine (1,4-DHP) and its derivatives are well-known calcium channel blockers with antiarrhythmic and antihypertensive activities. These compounds exhibit pleiotropic effects including antimicrobial activities that rely on their positive charge and amphipathic nature. Use of magnetic nanoparticles (MNPs) as carriers of 1,4-DHP modulates their properties and enables improved formulations with higher efficacy and less toxicity. Methods: In this study, the antimicrobial and immunomodulatory activities of novel 1,4-DHP derivatives in free form and immobilized on MNPs were determined by evaluating pathogen outgrowth and proinflammatory cytokine release in experimental settings that involve incubation of various 1,4-DHPs with clinical isolates of bacteria or fungi as well as mammalian cell culture models...
2018: International Journal of Nanomedicine
Bongjin Lee, Soo Jung Kim, June Dong Park, Jiun Park, Ae Hee Jung, Sun Hoi Jung, Yu Hyeon Choi, Hee Gyung Kang, Il Soo Ha, Hae Il Cheong
Vancomycin is known to be unintentionally eliminated by continuous renal replacement therapy, and the protein bound fraction of vancomycin is also known to be different in adults and children. However, there are only a few studies investigating the relationship between the dose of continuous venovenous hemodiafiltration (CVVHDF) parameters and serum concentration of vancomycin in pediatric patients. The aim of this study was to determine clinical and demographic parameters that significantly affect serum vancomycin concentrations...
2018: PloS One
Katie Park, Lindsay C Trout, Cong Xu, Ming Wang, Robert F Tamburro, E Scott Halstead
OBJECTIVES: To determine the relationship between theophylline trough levels and urine output in critically ill children administered aminophylline as adjunctive diuretic therapy. DESIGN: Retrospective cohort study. SETTING: The PICU of a tertiary care children's hospital. PATIENTS: A mixed population of medical/surgical including postoperative cardiothoracic surgery patients less than 18 years old. INTERVENTIONS: Electronic medical records of all PICU patients admitted from July 2010 to June 2015 were reviewed, and patients who received aminophylline as diuretic therapy were identified...
June 20, 2018: Pediatric Critical Care Medicine
Ron R Neyens, George E Gaskill, Julio A Chalela
OBJECTIVES: Anti-N-methyl-D-asparate receptor encephalitis is considered an immune-mediated form of encephalitis with paraneoplastic and nonparaneoplastic forms. Delay in recognition is common and patients typically present to the ICU without a diagnosis or with complications following a delayed diagnosis. The aim of this review is to provide a focused overview for the ICU clinician regarding presentation, diagnosis, and critical care management. DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION: PubMed database search with manual review of articles involving anti-N-methyl-D-asparate receptor encephalitis...
June 20, 2018: Critical Care Medicine
Thierry Conrozier, Jordi Monfort, Xavier Chevalier, Raghu Raman, Pascal Richette, Demirhan Diraçoglù, Hervé Bard, Dominique Baron, Jörg Jerosch, Alberto Migliore, Yves Henrotin
Objectives The 3 aims of the work were to identify population subgroups that can benefit the most from viscosupplementation (VS), to provide recommendations on injection techniques, and to discuss VS appropriateness in clinical situations that are commonplace in daily practice. Methods The task force members voted on their degree of agreement on 27 statements, 36 recommendations, and 22 clinical scenarios using a 9-point scale. The strength of agreement/appropriateness/recommendation (SOA/SOR) was classified as strong if the median agreement score was ≥8...
June 1, 2018: Cartilage
Marije Wijnberge, Daniko P Sindhunata, Michael R Pinsky, Alexander P Vlaar, Else Ouweneel, Jos R Jansen, Denise P Veelo, Bart F Geerts
The bedside hemodynamic assessment of the critically ill remains challenging since blood volume, arterial-venous interaction and compliance are not measured directly. Mean circulatory filling pressure (Pmcf ) is the blood pressure throughout the vascular system at zero flow. Animal studies have shown Pmcf provides information on vascular compliance, volume responsiveness and enables the calculation of stressed volume. It is now possible to measure Pmcf at the bedside. We performed a systematic review of the current Pmcf measurement techniques and compared their clinical applicability, precision, accuracy and limitations...
June 20, 2018: Annals of Intensive Care
Sang-Ho Jo, Sung-Ji Park, Eung Ju Kim, Soo-Joong Kim, Hyun-Jae Cho, Jong-Min Song, Jinho Shin, Jin Joo Park, Joon-Han Shin, Kyoo-Rok Han, Dong-Ju Choi
BACKGROUND: The efficacy of a combination of a calcium channel blocker (CCB) plus chlorthalidone (diuretic) versus a CCB plus an angiotensin receptor blocker (ARB) in patients not responding to CCB monotherapy has not been evaluated previously. We plan to compare the efficacy and safety of S-amlodipine (CCB) plus chlorthalidone versus S-amlodipine plus telmisartan (ARB) combinations among hypertension patients unresponsive to amlodipine monotherapy. METHODS/DESIGN: This study is a prospective, randomized, double-blind, multicenter, parallel, non-inferiority phase 4 study...
June 20, 2018: Trials
X Huang, F F Xu, H R Qian, X Lei, X K Qi, D Y Xia
Objective: To analyze the clinical presentations of neuromyelitis optica spectrum disorders (NMOSD) with ultra-longitudinally extensive transverse myelitis (uLETM), in order to improve the diagnostic accuracy of this disorder. Methods: Twenty-two uLETM patients was recruited and retrospectively analyzed for general clinical characteristics, laboratory tests and MRI characteristics, as well as therapeutic. Results: (1)The Male-to-female ratio was 1∶6. The median onset age was 31 years old. The duration from the first relapse to the onset was 5...
June 5, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
H Liu, F Gong, Y H Ai, M L Ai, Q Feng, S Y Deng, Z Y Liu, L N Zhang
To explore the present status of fluid therapy and clinical outcome in critically ill patients in intensive care units (ICU). ICU patients consecutively admitted to our ICU were prospectively enrolled. Patients' demographics, laboratory data, fluid record and clinical outcome were collected. Fluid intake quantity of all patients was at peak on the fifth day which was 2 806 (1 997, 3 582) ml. From the fourth day in ICU, fluid balance started to benegative as -84 (-1 127, 612) ml and gradually increased. Crystalloid solution was the main components...
June 1, 2018: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
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