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https://www.readbyqxmd.com/read/28331645/propylene-glycol-toxicity-in-adolescent-with-refractory-myoclonic-status-epilepticus
#1
Kara A Bjur, Bryan C Cannon, Anthony L Fine, Matthew J Ritter, Kerry E Schueler, Michael E Nemergut
Propylene glycol (PG) is a solvent commonly used in medications that, while benign at low doses, may cause toxicity in adults and children at high doses. We describe a case and the physiologic sequelae of propylene glycol toxicity manifested in a critically ill adolescent male with refractory myoclonic status epilepticus aggressively treated with multiple PG-containing medications (lorazepam, phenobarbital, and pentobarbital)-all within accepted dosing guidelines and a total daily PG exposure previously recognized to be safe...
2017: Case Reports in Pediatrics
https://www.readbyqxmd.com/read/28331629/congenital-diaphragmatic-hernia-a-review
#2
REVIEW
Praveen Kumar Chandrasekharan, Munmun Rawat, Rajeshwari Madappa, David H Rothstein, Satyan Lakshminrusimha
Congenital Diaphragmatic hernia (CDH) is a condition characterized by a defect in the diaphragm leading to protrusion of abdominal contents into the thoracic cavity interfering with normal development of the lungs. The defect may range from a small aperture in the posterior muscle rim to complete absence of diaphragm. The pathophysiology of CDH is a combination of lung hypoplasia and immaturity associated with persistent pulmonary hypertension of newborn (PPHN) and cardiac dysfunction. Prenatal assessment of lung to head ratio (LHR) and position of the liver by ultrasound are used to diagnose and predict outcomes...
2017: Maternal Health, Neonatology and Perinatology
https://www.readbyqxmd.com/read/28331446/lung-transplantation-and-the-routine-use-of-cardiopulmonary-bypass-and-median-sternotomy-experience-at-the-ochsner-multi-organ-transplant-institute
#3
Michael Bates, Matthew Factor, P Eugene Parrino, Aditya Bansal, Reinaldo Rampolla, Leonardo Seoane, Jose Mena, Matthew Gaudet, William Smith, P Michael McFadden
BACKGROUND: From 1990-2005 at Ochsner Medical Center in New Orleans, LA, cardiopulmonary bypass (CPB) was used only when necessary during lung transplantation surgeries. Ochsner's lung transplant program was closed for more than 4 years after Hurricane Katrina, and since the program's reestablishment in 2010, the majority of lung transplantation surgeries have been performed with the patient on CPB and with a median sternotomy incision. The purpose of this study was to compare the outcomes of the CPB and non-CPB groups...
2017: Ochsner Journal
https://www.readbyqxmd.com/read/28327144/computational-medical-imaging-and-hemodynamics-framework-for-functional-analysis-and-assessment-of-cardiovascular-structures
#4
REVIEW
Kelvin K L Wong, Defeng Wang, Jacky K L Ko, Jagannath Mazumdar, Thu-Thao Le, Dhanjoo Ghista
Cardiac dysfunction constitutes common cardiovascular health issues in the society, and has been an investigation topic of strong focus by researchers in the medical imaging community. Diagnostic modalities based on echocardiography, magnetic resonance imaging, chest radiography and computed tomography are common techniques that provide cardiovascular structural information to diagnose heart defects. However, functional information of cardiovascular flow, which can in fact be used to support the diagnosis of many cardiovascular diseases with a myriad of hemodynamics performance indicators, remains unexplored to its full potential...
March 21, 2017: Biomedical Engineering Online
https://www.readbyqxmd.com/read/28327093/continuous-non-invasive-finger-cuff-caretaker%C3%A2-comparable-to-invasive-intra-arterial-pressure-in-patients-undergoing-major-intra-abdominal-surgery
#5
Irwin Gratz, Edward Deal, Francis Spitz, Martin Baruch, I Elaine Allen, Julia E Seaman, Erin Pukenas, Smith Jean
BACKGROUND: Despite increased interest in non-invasive arterial pressure monitoring, the majority of commercially available technologies have failed to satisfy the limits established for the validation of automatic arterial pressure monitoring by the Association for the Advancement of Medical Instrumentation (AAMI). According to the ANSI/AAMI/ISO 81060-2:2013 standards, the group-average accuracy and precision are defined as acceptable if bias is not greater than 5 mmHg and standard deviation is not greater than 8 mmHg...
March 21, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28325648/role-of-bromocriptine-in-multi-spectral-manifestations-of-traumatic-brain-injury
#6
Sunil Munakomi, Binod Bhattarai, Bijoy Mohan Kumar
PURPOSE: Despite the prevalence and cost of traumatic brain injury related disabilities, there is paucity in the literature on modern approaches to pharmacotherapy. Medications may promote recovery by enhancing some neurological functions without impacting others. Herein we discussed the role of bromocriptine in neurorehabilitation for patients with traumatic brain injury. METHODS: A cohort comprising of 36 selective nonsurgical cases of traumatic brain injury in minimally conscious state were enrolled in the study...
February 21, 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/28324671/dose-de-escalation-of-intrapleural-tissue-plasminogen-activator-therapy-for-pleural-infection-the-adapt-project
#7
Natalia Popowicz, Oliver Bintcliffe, Duneesha De Fonseka, Kevin G Blyth, Nicola A Smith, Francesco Piccolo, Geoffrey Martin, Donny Wong, Anthony Edey, Nick Maskell, Y C Gary Lee
RATIONALE: Intrapleural therapy with a combination of tissue plasminogen activator (tPA) 10mg and deoxyribonuclease (DNase) 5mg administered twice daily has been shown in randomized and open-label studies to enable adequate drainage of over 90% of infected pleural effusions without surgery. Potential bleeding risks associated with intrapleural tPA and the drug costs remain important concerns. The ongoing ADAPT (Alteplase Dose Assessment for Pleural infection Therapy) project aims to investigate the efficacy and safety of dose de-escalation for intrapleural tPA...
March 21, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28323662/hvad-flow-waveform-morphologies-theoretical-foundation-and-implications-for-clinical-practice
#8
Jonathan D Rich, Daniel Burkhoff
Continuous flow ventricular assist device (cfVAD) performance and patient hemodynamic conditions are intimately interrelated and dynamic, changing frequently with alterations in physiologic conditions, particularly pre- and after-loading conditions. The Heartware cfVAD (HVAD) provides a unique feature among currently approved VADs of providing an estimated instantaneous flow waveform, the characteristics of which can provide significant insights into patient and device properties. Despite being readily available, HVAD waveforms are poorly understood, underutilized and insufficiently leveraged, even by clinicians who regularly manage HVAD patients...
March 16, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28319954/comparison-of-initial-vasopressors-used-for-delayed-cerebral-ischemia-after-aneurysmal-subarachnoid-hemorrhage
#9
Bhaskar Roy, Louise D McCullough, Rajat Dhar, James Grady, Yu-Bo Wang, Robert J Brown
BACKGROUND: The main reason for morbidity after aneurysmal subarachnoid hemorrhage (aSAH) is delayed cerebral ischemia (DCI). The mainstay of medical therapy for treating DCI is induced hypertension with vasopressors to restore cerebral perfusion. Both phenylephrine (PE) and norepinephrine (NE) are commonly used for induced hypertension, but the impact of the initial choice of vasopressor on the efficacy, adverse effects, or outcome after hemodynamic therapy for DCI is unknown. METHODS: Sixty-three patients with aSAH between January 2012 and October 2014, who developed DCI (defined as new focal deficit or decline in Glasgow Coma Score) and in which PE (n = 45) or NE (n = 18) treatment was initiated were evaluated in this retrospective study...
March 21, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28319467/effects-of-iv-acetaminophen-on-core-body-temperature-and-hemodynamic-responses-in-febrile-critically-ill-adults-a-randomized-controlled-trial
#10
Hildy M Schell-Chaple, Kathleen D Liu, Michael A Matthay, Daniel I Sessler, Kathleen A Puntillo
OBJECTIVE: To determine the effects of IV acetaminophen on core body temperature, blood pressure, and heart rate in febrile critically ill patients. DESIGN: Randomized, double-blind, placebo-controlled clinical trial. SETTING: Three adult ICUs at a large, urban, academic medical center. PATIENTS: Forty critically ill adults with fever (core temperature, ≥ 38.3°C). INTERVENTION: An infusion of acetaminophen 1 g or saline placebo over 15 minutes...
March 17, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28318811/st-elevation-myocardial-infarction-after-penetrating-thoracic-trauma
#11
Kiran Faryar, Michael P Flaherty, Martin Huecker
BACKGROUND: ST-segment elevation myocardial infarction (STEMI) may complicate penetrating thoracic trauma. CASE REPORT: This report describes a 42-year-old man who sustained a self-inflicted gunshot wound to the left chest. Electrocardiogram showed ST elevation in the inferior leads. Emergent catheterization was not recommended and conservative management was initiated. Cardiac catheterization 4 days later showed no perturbation of the coronary arteries, neither atherosclerotic nor traumatic...
March 17, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28318517/-intracardiac-myxoma-complicated-by-acute-aortic-occlusion-case-report
#12
O Zizi, B Benfor, H Jiber, A Bouarhroum, S Benlamkaddem, N Kanjaa
We report the case for a 44-year-old patient without medical history, admitted in our department for bilateral acute limb ischemia (H6). The patient was hemodynamically stable and the physical examination shows limb sever ischemia (no femoral arterial pulses, coldness, cyanosis and paralysis). Abdominal CT angiography showed a complete occlusion of the infra renal abdominal aorta compatible with embolus. An embolectomy with Fogarty catheters was performed. Echocardiography showed a mass in the left atrium. Pathological examination of the material embolic confirmed the diagnosis of the cardiac myxoma...
March 16, 2017: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/28316963/the-results-of-proximal-femoral-nail-for-intertrochanteric-fracture-in-hemodialysis-patient
#13
Kyung Sub Song, Sang Phil Yoon, Su Keon Lee, Seung Hwan Lee, Bong Seok Yang, Byeong Mun Park, Ick Hwan Yang, Beom Seok Lee, Ji Ung Yeom
PURPOSE: Hip fractures in hemodialysis patients are accompanied by high rates of complications and morbidities. Previous studies have mainly reported on nonunion and avascular necrosis of femoral neck fractures in this patient group. In this study the complication and clinical results of hemodialysis patients with intertrochanteric fractures treated with proximal femoral intramedullary nailing have been investigated through comparison with patients with normal kidney function. MATERIALS AND METHODS: Forty-seven patients were included; the hemodialysis group (n=17) and the control group with normal kidney function (n=30)...
March 2017: Hip & Pelvis
https://www.readbyqxmd.com/read/28303688/patient-level-meta-analysis-of-999-claudicants-undergoing-primary-femoropopliteal-nitinol-stent-implantation
#14
Krishna J Rocha-Singh, Joshua A Beckman, Gary Ansel, Sean P Lyden, Peter Schneider, Manish Mehta, Michael Dake, Christopher M Mullin, Michael R Jaff
CONDENSED ABSTRACT: The factors that impact the clinical effectiveness of bare nitinol stents in claudicants with symptomatic femoropopliteal atherosclerosis are incompletely known. The authors analyzed variables that may influence stent durability and provide a benchmark for their effectiveness. Data analyzed from six studies (999 patients) included baseline noninvasive hemodynamic tests, angiographic characteristics, ultrasound defined stent patency and target lesion revascularization through 12-months...
March 17, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28302247/symptomatic-fetal-type-cardiac-rhabdomyoma
#15
Seyma Kayali, Vehbi Dogan, Ilker Ertugrul, Senem Ouml Zg Uuml R, Utku Arman Ouml R Uuml N, Selmin Karademir, Nil Uuml Fer Arda, Murat Ko Ccedil
Rhabdomyomas are the most common primary cardiac tumors, especially seen during early periods of childhood. Fetaltype rhabdomyoma is a benign tumor described almost always in extracardiac locations. Although the natural history of the cardiac rhabdomyoma is to regress, the behaviour of the fetal-type rhabdomyomas when present in the heart is unknown with respect to its infrequency. Herein, we report a hemodynamically unstable female neonate with a single large intra-cardiac mass unresponsive to medical treatment, who underwent surgery...
March 2017: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
https://www.readbyqxmd.com/read/28301228/the-evolving-classification-of-pulmonary-hypertension
#16
Michelle Foshat, Nahal Boroumand
CONTEXT: - An explosion of information on pulmonary hypertension has occurred during the past few decades. The perception of this disease has shifted from purely clinical to incorporate new knowledge of the underlying pathology. This transfer has occurred in light of advancements in pathophysiology, histology, and molecular medical diagnostics. OBJECTIVES: - To update readers about the evolving understanding of the etiology and pathogenesis of pulmonary hypertension and to demonstrate how pathology has shaped the current classification...
March 16, 2017: Archives of Pathology & Laboratory Medicine
https://www.readbyqxmd.com/read/28299615/remote-monitoring-in-heart-failure-the-current-state
#17
REVIEW
Rajeev C Mohan, J Thomas Heywood, Roy S Small
The treatment of congestive heart failure is an expensive undertaking with much of this cost occurring as a result of hospitalization. It is not surprising that many remote monitoring strategies have been developed to help patients maintain clinical stability by avoiding congestion. Most of these have failed. It seems very unlikely that these failures were the result of any one underlying false assumption but rather from the fact that heart failure is a progressive, deadly disease and that human behavior is hard to modify...
March 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28299212/hemorrhagic-shock-as-complication-of-intramural-intestinal-bleeding
#18
Asma Ben Ali, Mohamed Ali Cherif, Walid Mhajba, Hamdi Hamdène Doghri, Malek Hassouna, Youssef Zied El Hechmi, Zouheir Jerbi, Ines Ben Hassen, Mohamed Habib Daghfous
Introduction. Mural intestinal hematoma (MIH) is an uncommon complication of anticoagulant therapy. Hemorrhagic shock has been rarely reported as a revealing modality. Results. We report two cases of shock induced by mural intestinal hematoma in patients under oral anticoagulant for aortic prosthetic valve and atrial fibrillation. Patients were admitted to the ICU for gastrointestinal tract bleeding associated with hemodynamic instability. After resuscitation, an abdominal CT scan has confirmed the diagnosis showing an extensive hematoma...
2017: Case Reports in Gastrointestinal Medicine
https://www.readbyqxmd.com/read/28298764/postoperative-sore-throat-prevention-in-ambulatory-surgery-a-comparison-between-preoperative-aspirin-and-magnesium-sulfate-gargle-a-prospective-randomized-double-blind-study
#19
Surajit Chattopadhyay, Anjan Das, Sabyasachi Nandy, Sandip RoyBasunia, Tapobrata Mitra, Partha Sarathi Halder, Subinay Chhaule, Subrata Kumar Mandal
BACKGROUND: Postoperative sore throat (POST) frequently hampers the positive feedback of ambulatory surgery in spite of so many measures. This study was carried out to compare the efficacy of preoperative magnesium sulfate and aspirin gargle in preventing POST after ambulatory surgery. MATERIALS AND METHODS: It was a prospective, randomized, and double-blinded study. Fifty-six adult patients of either sex, aged 25-50, of American Society of Anesthesiologists physical status I-II, scheduled for day care surgery, were randomly allocated to Group A ([n = 28] receiving aspirin gargle [325 mg tablet]) and Group M ([n = 28] receiving magnesium sulfate [20 mg/kg] gargle)...
January 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28296657/neuroendocrine-derangements-in-early-septic-shock-pharmacotherapy-for-relative-adrenal-and-vasopressin-insufficiency
#20
James W Schurr, Paul M Szumita, Jeremy R DeGrado
Septic shock is a leading cause of mortality in intensive care units throughout the world. While this disease state represents a highly complex pathophysiology involving numerous organ systems, the early approach to care includes adequate hemodynamic support traditionally achieved via infusions of vasoactive medications after adequate fluid resuscitation. Relative adrenal and vasopressin deficiencies are a common feature of septic shock that contribute to impaired hemodynamics. Hydrocortisone and vasopressin are endocrine system hormone analogues that target the acute neuroendocrine imbalance associated with septic shock...
March 14, 2017: Shock
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