Pneumopericardium and pneumomediastinum after polypectomy

A case of colonic perforation followed by the development of pneumopericardium, pneumomediastinum and subcutaneous emphysema as complications of colonoscopic polypectomy is described. Surgical intervention with primary closure was successfully performed 24 hours after perforation.     

Malnutrition and dehydration after stroke

By identifying malnutrition and dehydration in patients who have had a stroke, nurses can intervene to prevent significant complications developing and so improve patient outcomes. Poor intake of fluid and food may result from difficulties in swallowing, as well as other physical and functional problems that occur as a result of a stroke. The aim of this article is to encourage nurses to identify the frequency and causes of malnutrition and dehydration, to consider the complications this can cause and to be aware of optimum feeding strategies for stroke patients.     

Long-term survival and health status after prolonged mechanical ventilation after cardiac surgery

OBJECTIVE: To determine hospital mortality, weaning from mechanical ventilation, long-term survival, and functional health status in patients receiving > or =7 days of mechanical ventilation after cardiac surgery. DESIGN: Retrospective chart review and prospective patient interviews. SETTING: A university-affiliated, tertiary care medical center. PATIENTS: A total of 124 patients that received > or =7 days of mechanical ventilation after cardiac surgery. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Hospital and long-term death, liberation from mechanical ventilation, and functional health status. MEASUREMENTS AND MAIN RESULTS: A total of 19 (15%) patients died in hospital. Of the 105 survivors, 104 (99%) were completely weaned from mechanical ventilation. Patients who died in the hospital were more likely to have had a preoperative stroke or to have a new postoperative stroke, more likely to have postoperative renal failure, and less likely to have chronic obstructive pulmonary disease. Kaplan-Meier survival was 59% at 5 yrs and expected median survival was 6.2 yrs. Patients who died anytime after discharge were more likely to have preoperative renal dysfunction or stroke, took longer to be weaned from mechanical ventilation and to be discharged, and were more likely to have postoperative complications such as stroke or renal dysfunction. Also, they were more likely to be too debilitated to walk or eat. By multivariate analysis, admitting creatinine, aortic valve surgery, number of ventilator days, and discharged on tube feedings remained significant predictors of mortality. A total of 40 of 53 survivors were interviewed. Participants were similar to nonparticipants (p > .10 for all characteristics). A few (16%) had limitations of their activities of daily living (eating, dressing, bathing), and most had limitations of moderate activity (60%) and vigorous activity (94%). Only 36% could climb stairs or walk uphill without limitations, 54% could walk a block, and 41% had no limitations in house or job work. Half the participants had no body pain; 38% had moderate and 4% severe pain. Most (59%) described their general health as good to excellent. Only 10% said it was poor. CONCLUSION: Patients' chances of being liberated from mechanical ventilation are excellent. Their long-term survival and health status are good.     

Severe cardiovascular changes associated with pancuronium after cardiopulmonary resuscitation and after brain injury

Severe hypertension, tachycardia or ECG changes have been reported following i.v. administration of pancuronium to patients with pheochromocytoma or bronchial asthma. These cardiovascular changes were explained by an interaction between autonomic effects of pancuronium and elevated serum catecholamines or aminophylline. We noted similar cardiovascular changes associated with i.v. administration of pancuronium in two patients after successful cardiopulmonary resuscitation and in two with midbrain hemorrhage and epidural hematoma. In these patients, pancuronium produced no abnormal cardiovascular changes when given during elective surgery or before the occurrence of midbrain hemorrhage. Thus, ischemic brain damage may play a role in producing the severe cardiovascular changes associated with pancuronium.     

Gastrointestinal blood loss after diflunisal and after aspirin: effect of ethanol.

Fecal blood loss was evaluated in normal subjects with 51Cr-labeled red cells. In a double-blind parallel study in 10 subjects, 250 mg diflunisal twice daily did not significantly increase blood loss in two consecutive treatment periods, while 750 mg acetylsalicylic acid (ASA) 4 times daily did so. In a double-blind crossover study in 2 subjects, diflunisal, 250 mg twice daily again did not significantly affect fecal blood loss during a 4-day treatment period, and there also was no significant effth diflunisal during two additional treatment days. ASA, 600 mg 4 times daily, induced an increase in blood loss and this effect was significantly enhanced by the addition of alcohol. The difference between treatments in the way they interact with alcohol was also statistically significant.