Thromboelastography as a method for preoperative assessment of hemostasis state in neurosurgical patients on long term aspirin therapy

The hemostasis state was assessed by routine tests and TEG in 169 patients on long term aspirin therapy. According to TEG results all the patients were divided into three groups: normo-, hypo- and hypercoagulation. The aspirin therapy was interrupted in normo- and hypercoagulation groups, but the surgery was not postponed. In cases of hypocoagulation the aspirin therapy was also interrupted and the surgery was postponed for 3-5 days until TEG results normalized. Also the frequency of intracranial hemorrhagic complications was analyzed in every group. The results showed that despite the method used the hypocoagulation group had the highest rate of postoperative hemorrhage complications. Thromboelastography enables to assess hemostasis state in neurosurgical patients on long term aspirin therapy promptly and effectively.     

Treatment of acute stroke -- an overview

This paper provides an overview on the actual state of acute therapy in patients with ischemic stroke. The discussion focusses on intravenous and intraarterial thrombolysis, antithrombotic therapy, and the treatment of medical and neurological complications, and therapy recommendations are presented. Finally ongoing studies, particularly those concerning thrombolysis with glycoprotein IIb/IIIa receptor blockers and ultrasound-assisted thrombolysis, are presented.     

饮食疗法对改善慢性肾衰竭病人透析前症状的观察

[目的]观察以优质低蛋白饮食为主的综合治疗,对改善慢性肾衰竭(CRF)病人透析前临床状态的意义。[方法]将慢性肾衰竭非透析治疗住院病人90例随机分为治疗组(A组)和对照组(B组),A组实施以优质低蛋白饮食为主的综合内科治疗,B组不限制饮食;同时治疗18个月,观察两组肾功能、营养状态和并发症情况。[结果]A组肾功能较B组明显改善,血尿素氮(BUN)、血肌酐(Cr)较B组有明显下降,内生肌酐清除率(Ccr)较B组明显升高;A组血浆白蛋白(ALB)、血红蛋白(Hb)均较B组明显升高;急性心力衰竭、酸中毒、严重水电解质紊乱、高血钾等并发症发生率较B组明显下降。[结论]以优质低蛋白饮食为主的综合治疗,能改善CRF病人透析前的肾功能、营养状态及临床症状,延缓CRF的进展。     

Cancer therapy-related complications in the bowel and mesentery: an imaging perspective

Cancer therapy-induced complications in the bowel and mesentery are fairly common. It is important for clinicians to be aware of these complications and the agents most frequently implicated. Cancer therapy is rapidly evolving and often encompasses both classic cytotoxic drugs and newer molecular targeted agents. Drugs from both broad classes can have numerous adverse effects on the bowel and mesentery that can be detected on imaging. These adverse effects include ileus, various forms of enterocolitis, gastrointestinal perforation, pneumatosis intestinalis, secretory diarrhea, and sclerosing mesenteritis. These complications are diverse and range from relatively benign to life threatening. The management is also variable, but many of these conditions are easily controlled and reversed with supportive care and cessation of the particular cancer therapy. The objective of this pictorial essay is to demonstrate some of the more common cancer therapy-induced complications of the bowel and mesentery, with a focus on the radiographic findings.     

Hypertension: endothelial dysfunction, the prothrombotic state and antithrombotic therapy

The pathophysiology of essential hypertension and its complications has been a focus of much research and clinical interest. More recent attention has been directed towards inflammation and endothelial dysfunction, especially since inflammation can promote endothelial dysfunction and the latter has been intimately related to thrombogenesis and atherogenesis. Hypertension is also associated with a prothrombotic or hypercoagulable state, and this may contribute to the observation that despite the blood vessels being exposed to high pressures in hypertension the common complications of the latter are paradoxically thrombotic rather than hemorrhagic--the so-called 'thrombotic paradox of hypertension' (or 'Birmingham paradox'). Despite these thrombotic complications, the role of antithrombotic therapy for primary prevention in hypertension is less defined, unless the patient is at significant risk of cardiovascular events or has renal impairment. Antithrombotic therapy for secondary prevention in hypertension is recommended, but unanswered questions regarding the interactions between aspirin and angiotensin-converting enzyme inhibitors remain.     

Prevention and treatment of NSAIDs-induced gastrointestinal complications by prostaglandin derivatives

Non-steroidal anti-inflammatory drugs(NSAIDs) are widely used for the treatment of many rheumatic diseases. Gastrointestinal ulcers are the most important complication during long-term NSAIDs therapy and sometimes, serious complications, such as perforation, stenosis, and bleeding occurs. Recently, use of COX-2 selective NSAIDs reduced such complications, however the increase of cardiovascular risks has been reported. Administration of misoprostol, one of the prostaglandin derivatives has been proven to be effective for both prevention and treatment of gastrointestinal ulcers associated with NSAIDs therapy and is recommended by the Japanese guidelines. In addition, the reduction of NSAIDs-related serious complications, such as perforation, stenosis, and bleeding have been reported with misoprostol therapy. The important side effects include abdominal pain, flatulence, and diarrhea.     

Parenteral nutrition in the cancer patient.

The nutritional state of patients with malignant disease must be assessed at the beginning of treatment. Nutritional supplements, given either orally or intravenously, enable patients to tolerate larger doses of chemotherapy and radiotherapy and the clinical response may be enhanced by nutritional support. Crystalline L aminoacids and glucose are the main nutrients used intravenously and fat emulsions are required in prolonged parenteral nutrition. Hypophosphataemia related to glucose administration and infection related to access to the circulation are the main complications, both of which are preventable. Total parenteral nutrition alone will not improve the results of cancer treatment significantly but its careful use in association with surgery, radiation therapy and chemotherapy can be most valuable.     

Paraplegia after aortic aneurysm repair versus traumatic spinal cord injury: functional outcome, complications, and therapy intensity of inpatient rehabilitation

Yokoyama O, Sakuma F, Itoh R, Sashika H. Paraplegia after aortic aneurysm repair versus traumatic spinal cord injury: functional outcome, complications, and therapy intensity of inpatient rehabilitation.

Objective

To compare outcomes, complications, and therapy intensity of inpatient rehabilitation in patients with paraplegia caused by spinal cord injury associated with aortic aneurysm repair (SCI-AA) versus patients with traumatic spinal cord injury (SCI).

Design

Case-controlled study.

Setting

SCI unit in a rehabilitation center.

Participants

Seventeen patients with SCI-AA and 17 patients with traumatic SCI.

Intervention

Standard rehabilitation therapy for SCI.

Main Outcome Measures

Length of stay (LOS) in acute and rehabilitation hospitals; FIM instrument scores; FIM change; FIM efficiency; complications; therapy intensity; and ambulatory state and return to community at discharge.

Results

No significant differences were noted in acute and rehabilitation LOS and admission FIM scores. Discharge FIM scores, FIM change, and FIM efficiencies were significantly lower in the SCI-AA group, which had many complications related to AA and SCI. Intensity of rehabilitation sports therapy in the SCI-AA group was significantly lower than that of the traumatic SCI group, but total therapy intensity did not differ significantly. Both had similar rates of return to ambulatory state and discharge to the community.

Conclusions

SCI-AA patients had many complications that interfered with rehabilitation therapy, and could not achieve functional gains comparable to those with traumatic SCI. However, both groups achieved comparable success with return to ambulatory state and discharge to the community.     

Therapy of human immunodeficiency virus infections

Although therapy is currently available for many of the infections and neoplastic complications of AIDS, there is no effective therapy for the underlying immunodeficiency state. The authors review various attempts at treatment to date, and conclude that a major decrease in HIV-associated morbidity will require a combined approach, making use of our knowledge of the epidemiology, as well as the molecular and cellular biology, of the virus.     

Diabetes update: injectable therapies for type 2 diabetes: practical applications for older adults with pancreatic failure

The goal of therapy for older adults who have type 2 diabetes and pancreatic failure is to provide the best management program that meets his/her individual needs and lifestyle. The goals are to maintain blood sugar control, but more importantly, to prevent complications and to provide the patient with a better quality of life through a more natural metabolic state. Decisions about when to add insulin to the regimen, the goals of therapy, what types of insulin to use, and how to monitor response are based on the pathophysiologic mechanisms, which ensures overall treatment success. The information that patients gather and record will assist in decisions about therapy that maximize the benefits and eliminate the problems that patients often experience when therapies are modified without a careful plan.     

冠心病介入术后舒适护理的实践进展

分析引起冠心病介入术后舒适感下降的相关因素,阐述舒适护理在冠心病介入术后患者中的应用,为提高冠心病介入术后患者舒适度,减少并发症提供依据.     

探讨5例布-加氏综合症介入围手术期护理重点

目的：探讨布-加氏综合症介入围手术期的护理重点,以保证介入治疗护理的有效性和安全性。方法：对5例布-加氏综合症患者介入围手术期实施重点护理,如：饮食护理,对患者、家属心理支持,准确评估病情,有效控制腹水、出血等并发症及防治复发。结果：5例布-加氏综合症介入术后2-3 d腹壁静脉及双下肢静脉曲张基本消失,X片显示支架位置正常,扩张良好;进食及生命体征正常,无心累,双下肢水肿减退,无并发症发生。住院时间10-13 d,患者满意。结论：通过对布-加氏综合症介入围手术期实施重点护理,提高了护理质量,防治了并发症,保证了介入治疗效果。     

Heart and heart-lung transplantation.

The fields of heart and combined heart-lung transplantation are in a constant state of evolution. As greater experience is gained in posttransplant management, more patients with end-stage heart and lung disease can be treated. Because the postoperative course and rehabilitation phase may be extremely difficult, only candidates who meet specific medical and psychosocial criteria are selected. During the waiting period, critical care nurses along with the transplant team are instrumental in stabilizing the emotional and physical condition of the transplant candidate. Postoperative complications requiring intensive therapy include decreased cardiac output, respiratory dysfunction, rejection, and infection. Graft atherosclerosis, obliterative bronchiolitis, and malignancy are long-term complications that may limit survival. Life-long immunosuppression and careful long-term medical surveillance are crucial to the health of the recipient. Although there are numerous emotional and physical challenges related to potentially life-threatening complications and other disturbances in daily living, the quality of life for most recipients has greatly improved.     

Management of gynecologic oncology emergencies

Gynecologic malignancies are the third most common cancer among women in the United States. Because of often subtle early findings, the diagnosis may not be made before the widespread dissemination of the disease. The Emergency Department physician will commonly encounter a woman with vaginal bleeding, pelvic pain, or a symptomatic abdominal mass. In this article, we have described the epidemiology, recognized patterns of spread, and associated findings of gynecologic tumors. The proper Emergency Department evaluation and management of these problems is emphasized with guidelines for the timing of referrals and consultation with the gynecologic oncologist. The treatment of gynecologic malignancies is often complicated and responsible for Emergency Department visits. The various modalities are addressed according to the organ systems affected and include sections on postoperative problems, gastrointestinal complaints, urologic complications of therapy, radiation therapy and its complications, with an emphasis on the most serious complications necessitating either careful outpatient management or hospital admission. As cost-containment pressure grows, we have included sections on chemotherapy and total parenteral nutrition, both of which are becoming common outpatient events for the cancer patient.     

肝癌微创治疗并发低血糖反应的观察及护理

通过对2006年4月—2007年3月在我科行肝癌微创治疗的68例病人低血糖反应的观察及护理。结果由于严密观察,发现及时,处理得当,未发生严重并发症。提示对于肝癌微创治疗病人由于纳差、呕吐、禁食等原因,容易出现低血糖反应,需加强低血糖反应的观察及护理,并做好预防措施,避免严重并发症发生。     

Complications of central venous catheters: nursing care

There are increasing numbers of patients, both at home and in the hospital, receiving intravenous therapy via long-term central venous catheters. Although fairly commonplace, there are many potential complications associated with the insertion and use of these catheters. This article describes the insertion and postinsertion-related complications of these devices. The article will give the nurse the information and confidence required for observing, detecting, preventing and/or treating promptly any complication to ensure the best possible nursing care.     

Hepatic and gastrointestinal disorders in pregnancy.

The presentation, nonradiologic diagnostic evaluation, and course (including complications and outcome) of gastrointestinal disorders in pregnancy are not substantially different than for the nonpregnant patient. The possible exception is the higher mortality for pancreatitis when it occurs during pregnancy. With the exception of nausea/vomiting and hyperemesis gravidarum, there does not appear to be a gastrointestinal tract disorder that is peculiar to the pregnant state. Hepatic disorders are somewhat different in that the excretory defect-pruritus gravidarum-cholestatic jaundice spectrum and perhaps part of what presents as acute hepatic failure are intimately associated with pregnancy and have an onset and course that are tied to the gestational period. Otherwise, hepatic diseases that occur during pregnancy share the characteristic of gastrointestinal diseases, that their manifestations are not clearly different from the nonpregnant state. As is true for the diagnostic approach to all medical diseases that occur during pregnancy, radiographic procedures are prohibited. Furthermore, therapy must be reconsidered with concern for its effect on the fetus. This leads to elimination of many or all measures used for purely symptomatic or nonspecific benefit. If no harm or potential harm will accrue for the fetus, therapy for hepatic and gastrointestinal disorders preceeds in pregnancy very much as it does in the nongravid individual.     

Vasculitis: Wegener granulomatosis,Churg-Strauss syndrome,microscopic polyangiitis,polyarteritis nodosa,and Takayasu arteritis

Identification, diagnosis, and management of the primary vasculitides and their attendant complications is a challenging task for the critical care physician. However, with appropriate therapy, the morbidity and mortality of these diseases can be markedly improved and allow the individual patient to return to their previous functional state.     

脑卒中与短暂性脑缺血发作后焦虑抑郁障碍发生及相关因素的对比研究

目的探讨脑卒中及短暂性脑缺血发作(TIA)焦虑抑郁情感障碍的发生及影响因素。方法TIA组76例及卒中组70例患者采用汉密顿抑郁量表(HAMD)和汉密顿焦虑量表(HAMA)进行测查。结果TIA和卒中后患者都会产生焦虑抑郁症状,焦虑发生率两组无显著性差异,抑郁发生率两组有显著性差异。结论焦虑抑郁障碍也是TIA发作后和各种卒中危险因素相关疾病常见的并发症状。     

Common complications in critically ill patients

Patients in intensive care units (ICUs) are subject to many complications connected with the advanced therapy required for their serious illnesses. Complications of ventilatory support include problems associated with short-term and long-term intubation, barotrauma, gastrointestinal tract bleeding, and weaning errors. Cardiac tachyarrhythmias can arise from a patient's intrinsic cardiac disease, as well as from drug therapy itself. Hemodynamic monitoring is crucial to careful patient management, but it is associated with technical complications during insertion such as pneumothorax, as well as interpretive errors such as those caused by positive end-inspiratory pressure. Acute renal failure can develop as a result both of therapy with drugs such as aminoglycosides and hypotension of many etiologies, as well as the use of contrast media. Nosocomial infection, which is a dreaded complication in ICU patients, usually arises from sources in the urinary tract, bloodstream, or lung. Complications frequently can arise if the interactions of drugs commonly used in the ICU are not recognized. Further, the ICU patient is subject to nutritional complications, acid base problems, and psychological disturbances. This monograph deals with the frequency, etiology, and prevention of these common ICU complications.