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Outstanding Clinical Review

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683 papers 1000+ followers Topics related to cardiac anesthesia & critical care
Akhil Narang, Karima Addetia, Lynn Weinert, Megan Yamat, Atman P Shah, John E Blair, Victor Mor-Avi, Roberto M Lang
BACKGROUND: The prevalence of isolated cleft mitral valve (MV; no concomitant congenital heart disease or degenerative MV disease) with significant mitral regurgitation (MR) diagnosed using two-dimensional echocardiography (2DE) has been reported to be very low. Three-dimensional echocardiography (3DE) has enabled a more comprehensive visualization of the MV and detailed understanding of the mechanisms of MR and can potentially reveal isolated cleft MV that is not recognized with 2DE...
August 7, 2018: Journal of the American Society of Echocardiography
Piero Amodio
Hepatic encephalopathy (HE) is a peculiar kind of brain dysfunction caused by liver insufficiency and/or portal-systemic shunting. It is related to gut-derived substances. It is a relevant cause of morbidity and hospitalisation for patients with cirrhosis. The prognosis of HE is important in terms of survival and re-hospitalisation. It is related to impaired quality of life, falls and poor driving; presents a relevant burden for caregivers and health services; and may negatively impact on patient's job and income...
June 2018: Liver International: Official Journal of the International Association for the Study of the Liver
Mary M Quien, Muhamed Saric
Echocardiography has become a critical tool in clinical cardiology in evaluating cardiac physiology and diagnosing cardiac disease states. However, imaging artifacts are commonly encountered and often lead to misdiagnoses of life-threatening diseases, such as aortic dissection and ventricular thrombus. It is, thus, critical for clinicians to understand these artifacts to avoid these misdiagnoses and protect patients from undue intervention. Artifacts can be broken down into two categories: those from violation of ultrasound system assumptions and those from interference by external equipment and devices...
August 6, 2018: Echocardiography
Jeffrey DellaVolpe, Ali Al-Khafaji
The development of acute kidney injury in the setting of liver disease is a significant event both before and after liver transplant. Whether acute kidney injury is the cause of or merely associated with worse outcomes, the development of renal failure is significant from a prognostic as well as from a diagnostic and therapeutic standpoint. Although not every etiology is reversible, there are number of etiologies that are correctable, to include hypovolemia, nephrotoxic medications, and acute tubular necrosis...
July 30, 2018: Journal of Intensive Care Medicine
Gunnar Lachmann, Claudia Spies, Thomas Schenk, Frank M Brunkhorst, Felix Balzer, Paul La Rosée
BACKGROUND: Hemophagocytic lymphohistiocytosis in adults (aHLH) is a rare life-threatening hyperinflammatory syndrome caused by excessive activation of macrophages and CD8+ T-cells. Due to the clinical overlap with severe sepsis, aHLH often remains undiagnosed resulting in poor outcome. Here, we present a retrospective study of incidence, clinical findings, and the outcome of aHLH in intensive care units (ICUs). METHODS: This retrospective analysis was performed at the university hospital Charité - Universitätsmedizin Berlin...
August 2018: Shock
Harpreet Singh Grewal, Neha S Dangayach, Usman Ahmad, Subha Ghosh, Thomas Gildea, Atul C Mehta
No abstract text is available yet for this article.
July 27, 2018: Chest
Michael A Borger, Paul W M Fedak, Elizabeth H Stephens, Thomas G Gleason, Evaldas Girdauskas, John S Ikonomidis, Ali Khoynezhad, Samuel C Siu, Subodh Verma, Michael D Hope, Duke E Cameron, Donald F Hammer, Joseph S Coselli, Marc R Moon, Thoralf M Sundt, Alex J Barker, Michael Markl, Alessandro Della Corte, Hector I Michelena, John A Elefteriades
Bicuspid aortic valve disease is the most common congenital cardiac disorder, being present in 1% to 2% of the general population. Associated aortopathy is a common finding in patients with bicuspid aortic valve disease, with thoracic aortic dilation noted in approximately 40% of patients in referral centers. Several previous consensus statements and guidelines have addressed the management of bicuspid aortic valve-associated aortopathy, but none focused entirely on this disease process. The current guidelines cover all major aspects of bicuspid aortic valve aortopathy, including natural history, phenotypic expression, histology and molecular pathomechanisms, imaging, indications for surgery, surveillance, and follow-up, and recommendations for future research...
August 2018: Journal of Thoracic and Cardiovascular Surgery
Yu-Min Shen, Srikanth Nagalla
No abstract text is available yet for this article.
July 17, 2018: Circulation
Salia Farrokh, Pouya Tahsili-Fahadan, Eva K Ritzl, John J Lewin, Marek A Mirski
BACKGROUND: The incidence of seizures in intensive care units ranges from 3.3% to 34%. It is therefore often necessary to initiate or continue anticonvulsant drugs in this setting. When a new anticonvulsant is initiated, drug factors, such as onset of action and side effects, and patient factors, such as age, renal, and hepatic function, should be taken into account. It is important to note that the altered physiology of critically ill patients as well as pharmacological and nonpharmacological interventions such as renal replacement therapy, extracorporeal membrane oxygenation, and target temperature management may lead to therapeutic failure or toxicity...
June 7, 2018: Critical Care: the Official Journal of the Critical Care Forum
Brit Long, Alex Koyfman, Eric J Chin
INTRODUCTION: Acute heart failure (AHF) accounts for a significant number of emergency department (ED) visits, and the disease may present along a spectrum with a variety of syndromes. OBJECTIVE: This review evaluates several misconceptions concerning heart failure evaluation and management in the ED, followed by several pearls. DISCUSSION: AHF is a heterogeneous syndrome with a variety of presentations. Physicians often rely on natriuretic peptides, but the evidence behind their use is controversial, and these should not be used in isolation...
June 1, 2018: American Journal of Emergency Medicine
Lowie M R Van Assche, Mark J Ricciardi
Functional mitral regurgitation (FMR) is common in patients with heart failure and portends a poor prognosis. The etiology is secondary to non-ischemic or ischemic (post myocardial infarction) adverse remodeling. Treatment includes guideline-directed medical therapy, cardiac resynchronization therapy, and in some cases, surgical repair or replacement. Transcatheter mitral valve repair with the MitraClip device is approved in patients with degenerative MR and is currently under investigation for use in FMR; as are several transcatheter mitral valve repair devices...
June 22, 2018: Cardiology in Review
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
C P M Hayward
INTRODUCTION: Laboratory investigations for bleeding disorders are warranted when an individual has a personal and/or family history of bleeding, and/or laboratory findings that suggest the possibility of an inherited or acquired bleeding disorder. METHODS: This review summarizes author's experience with ordering and reporting on diagnostic investigations for common and rare bleeding disorders, with consideration of recent articles on diagnosing bleeding disorders...
May 2018: International Journal of Laboratory Hematology
Rebecca T Hahn, Jonathon Leipsic, Pamela S Douglas, Wael A Jaber, Neil J Weissman, Philippe Pibarot, Philipp Blanke, Jae K Oh
OBJECTIVES: This study aims to establish parameters for identifying normal function for each of the 3 iterations of balloon-expandable valves and 2 iterations of self-expanding valves. BACKGROUND: Expected transthoracic echocardiographic Doppler-derived hemodynamic data for transcatheter aortic valves inform pre-implant decision-making and post-implanted monitoring of longitudinal valve function. METHODS: We collected the Echocardiography Core Lab measured mean gradients and effective orifice area (EOA) from discharge or 30-day echocardiograms from randomized trials; the PARTNER (Placement of Aortic Transcatheter Valves) trials for the balloon-expandable valves and the Medtronic CoreValve US Pivotal trial and Medtronic CoreValve Evolut R United States IDE Clinical Study for the self-expanding valves...
June 8, 2018: JACC. Cardiovascular Imaging
B Frenckner, M Broman, M Broomé
Extracorporeal membrane oxygenation (ECMO) is used in critically ill patients with severe pulmonary and/or cardiac failure. Blood is drained from the venous system and pumped through a membrane oxygenator where it is oxygenated. For pulmonary support, the blood is returned to the patient via a vein (veno-venous ECMO) and for pulmonary/circulatory support it is returned via an artery (veno-arterial ECMO).Veno-venous ECMO can be performed either with a single dual-lumen cannula or with two separate single-lumen cannulas...
June 15, 2018: Critical Care: the Official Journal of the Critical Care Forum
James M Walter, Richard G Wunderink
Viral pathogens are a common cause of severe lower respiratory tract infection in adults. Our ability to rapidly and accurately identify viral infections has dramatically improved as slow culture-based techniques have been largely replaced by multiplex high-throughput systems. Given these advances, reevaluation of the role of respiratory viral testing in adults presenting with lower respiratory tract infection is important. This article reviews the potential benefits of testing, provides an overview of the most commonly used diagnostic techniques, and considers whether current evidence supports routine testing...
June 14, 2018: Chest
Anne S Chin, Martin J Willemink, Aya Kino, Virginia Hinostroza, Anna M Sailer, Michael P Fischbein, R Scott Mitchell, Gerald J Berry, D Craig Miller, Dominik Fleischmann
BACKGROUND: Limited intimal tears (LITs) of the aorta (Class 3 dissection variant) are the least common form of aortic pathology in patients presenting with acute aortic syndrome (AAS). LITs are difficult to detect on imaging and may be underappreciated. OBJECTIVES: This study sought to describe the frequency, pathology, treatment, and outcome of LITs compared with other AAS, and to demonstrate that LITs can be detected pre-operatively by contemporary imaging. METHODS: The authors retrospectively reviewed 497 patients admitted for 513 AAS events at a single academic aortic center between 2003 and 2012...
June 19, 2018: Journal of the American College of Cardiology
Jean-Louis Vincent, Pedro Castro, Beverley J Hunt, Achim Jörres, Manuel Praga, Jose Rojas-Suarez, Eizo Watanabe
No abstract text is available yet for this article.
June 13, 2018: Critical Care: the Official Journal of the Critical Care Forum
Cian P McCarthy, Muthiah Vaduganathan, James L Januzzi
No abstract text is available yet for this article.
June 11, 2018: JAMA: the Journal of the American Medical Association
Ari Garber, Catherine Frakes, Zubin Arora, Prabhleen Chahal
Acute pancreatitis represents a disorder characterized by acute necroinflammatory changes of the pancreas and is histologically characterized by acinar cell destruction. Diagnosed clinically with the Revised Atlanta Criteria, and with alcohol and cholelithiasis/choledocholithiasis as the two most prominent antecedents, acute pancreatitis ranks first amongst gastrointestinal diagnoses requiring admission and 21st amongst all diagnoses requiring hospitalization with estimated costs approximating 2.6 billion dollars annually...
2018: Gastroenterology Research and Practice
2018-06-11 14:01:26
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