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111.
Alexandre N. Cavalcante Yvette N. Martin Juraj Sprung Jasmin Imsirovic Toby N. Weingarten 《Journal of clinical monitoring and computing》2018,32(5):929-935
An electrical impedance-based noninvasive respiratory volume monitor (RVM) accurately reports minute volume, tidal volume and respiratory rate. Here we used the RVM to quantify the occurrence of and evaluate the ability of clinical factors to predict respiratory depression in the post-anesthesia care unit (PACU). RVM generated respiratory data were collected from spontaneously breathing patients following intraperitoneal surgeries under general anesthesia admitted to the PACU. Respiratory depression was defined as low minute ventilation episode (LMVe, <?40% predicted minute ventilation for at least 2 min). We evaluated for associations between clinical variables including minute ventilation prior to opioid administration and LMVe following the first PACU administration of opioid. Also assessed was a low respiratory rate (<?8 breaths per minute) as a proxy for LMVe. Of 107 patients, 38 (36%) had LMVe. Affected patients had greater intraoperative opioid dose, P?=?0.05. PACU opioids were administered to 45 (42.1%) subjects, of which 27 (25.2%) had LMVe (P?=?0.42) within 30 min following opioid. Pre-opioid minute ventilation <?70% of predicted normal value was associated with LMVe, P?<?0.01, (sensitivity?=?100%, specificity?=?81%).Low respiratory rate was a poor predictor of LMVe (sensitivity?=?11.8%). Other clinical variables (e.g., obstructive sleep apnea) were not found to be predictors of LMVe. Using RVM we identified that mild, clinically nondetectable, respiratory depression prior to opioid administration in the PACU was associated with the development of substantial subsequent respiratory depression during the PACU stay. 相似文献
112.
Kayode O. Kuku Hector M. Garcia-Garcia Edward Koifman Alexandre H. Kajita Sameer Desale Viana Azizi Gebremedhin Melaku Anh Bui Yael F. Meirovich Solomon Beyene Aaphtaab Dheendsa Blaine Schneider Ron Waksman On behalf of the CELLO study investigators 《The international journal of cardiovascular imaging》2018,34(3):345-352
The CliRpath Excimer Laser System to Enlarge Lumen Openings (CELLO) registry included patients treated with modified excimer laser catheters for the endovascular treatment of peripheral artery disease affecting the superficial femoral artery (SFA) and proximal popliteal artery. The aim of this study was to assess, via intravascular ultrasound (IVUS) the dissections in the vessel wall following treatment with the laser catheters. IVUS grayscale images from the CELLO registry were systematically reviewed for dissections in the treated vessel segments by two investigators. Images from 33 patients; 66 pullbacks (1867 IVUS frames in 2 phases), were successfully matched frame-to-frame to evaluate identical segments of the treated vessels in the two phases; post-2 mm Turbo-Elite laser pilot channel creation and post Turbo-Booster laser atherectomy. Dissections were categorized as; (1) intimal, (2) medial, (3) intramural hematoma, and (4) adventitial according to the ACC Clinical Expert Consensus Document classification of dissections. An average of 57 frames was evaluated per pullback, giving a total of 3734 frames (1867 matched for pre-ablation (post channel creation) and post-ablation phases). Treatments with the modified Excimer laser catheters resulted in a significant increase in lumen area of 5.5?±?3.2-mm2 (95% CI 4.3–6.8, p?<?0.0001) and reduction in plaque plus media volume of ?10.6?±?36.0 mm3 (95% CI ?25.8 to 4.6, p?=?0.1619) whilst giving rise to mainly intramural hematoma formations post Turbo-Booster laser treatment in 55% of frames assessed and 24% medial dissections with less than 1% adventitial disruption. The Excimer laser based Turbo-Booster treatment of peripheral artery lesions resulted in significant plaque debulking and increased lumen diameter with negligible degree of adventitial layer injury. 相似文献
113.
114.
Romain Jouffroy Anastasia Saade Alexandre Muret Pascal Philippe Maud Michaloux Pierre Carli Benoit Vivien 《The American journal of emergency medicine》2018,36(10):1754-1758
Background
Septic shock is associated with hypovolemia resulting in organs failure and poor prognosis. The first step in hemodynamic resuscitation relies on early fluid expansion. In this study, we describe qualitative and quantitative fluid resuscitation of septic shock initially managed in a pre-hospital setting by a mobile intensive care unit.Methods
Patients with septic shock who received pre-hospital medical care were retrospectively analysed. Qualitative and quantitative fluid resuscitation performed in the pre-hospital setting were analysed. Applying the "grey zone" concept, we define 3 categories of fluid expansion indexed on ideal body weight (IBW): >20ml/kg, 10-20ml/kg and ?<?10ml/kg. The relationship between the pre-specified categories and mortality at day 28 were analyzed.Results
Ninety-five patients were included. The origin of sepsis was mainly pulmonary (68%). Mortality reached 34%. Pre-hospital fluid expansion was performed using serum saline (98%) with a mean of 1158±559ml. An inversed linear relationship between pre-specified categories and mortality was observed. Using logistic regression model, significant association with mortality remained for fluid expansion indexed on IBW: p=0.02, ORa [CI95] = 0.93 [0.89-0.98]. For fluid expansion indexed on IBW?<?10ml/kg, the OR [CI95] was 4.03 [1.78-9.41] (p=0.005) whereas for fluid expansion indexed on IBW?>?20ml/kg, the OR [CI95] was 0.30 [0.13-0.66] (p=0.01).Discussion
Pre-hospital fluid resuscitation in septic shock is mainly performed using crystalloids with quantitative fluid expansion lower than recommended. Low pre-hospital fluid expansion was associated with increased mortality. Further prospective studies are needed to evaluate the impact of optimized early fluid expansion on mortality in the prehospital management of septic shock. 相似文献115.
116.
117.
New insights on IgA vasculitis with underlying solid tumor: a nationwide French study of 30 patients
Hankard Antoine Michot Jean-Marie Terrier Benjamin Brihaye Benoît Chanal Johan Combe Christian Karras Alexandre Urbanski Geoffrey Amoura Zahir Darrigade Anne-Sophie Deroux Alban Guerville Florent Burel Le Sébastien Maigné Gwénola Mekinian Arsène Moulis Guillaume Riviere Etienne Vandamme-Giard Carole Maillot Francois De Boysson Hubert Aouba Achille Audemard-Verger Alexandra 《Clinical rheumatology》2021,40(5):1933-1940
Clinical Rheumatology - IgA vasculitis (IgAV) frequently occurs during or after a mucosal infection; it also rarely occurs in patients with cancer. We hypothesized that cancer could impact the... 相似文献
118.
Legallois Damien Hodzic Amir Alexandre Joachim Dolladille Charles Saloux Eric Manrique Alain Roule Vincent Labombarda Fabien Milliez Paul Beygui Farzin 《Heart failure reviews》2022,27(1):37-48
Heart Failure Reviews - An increase in left ventricular volumes between baseline and follow-up imaging is the main criteria for the quantification of left ventricular remodelling (LVR) after... 相似文献
119.
Martin RM Lin CJ Costa EM de Oliveira ML Carrilho A Villar H Longui CA Mendonca BB 《The Journal of clinical endocrinology and metabolism》2003,88(12):5739-5746
P450c17 deficiency is an autosomal recessive disorder and a rare cause of congenital adrenal hyperplasia characterized by hypertension, hypokalemia, and impaired production of sex hormones. We performed a clinical, hormonal, and molecular study of 11 patients from 6 Brazilian families with the combined 17alpha-hydroxylase/17,20-lyase deficiency phenotype. All patients had elevated basal serum levels of progesterone (1.8-38 ng/ml; 0.57-12 pmol/liter) and suppressed plasma renin activity. CYP17 genotyping identified 5 missense mutations. The compound heterozygous mutation R362C/W406R was found in 1 family, whereas the homozygous mutations R96W, Y329D, and P428L were seen in the other 5 families. The R96W mutation has been described as the cause of p450c17 deficiency in Caucasian patients. The other mutations were not found in 50 normal subjects screened by allele-specific oligonucleotide hybridization (Y329D, R362C, and W406R) or digestion with HphI (P428L) and were recently found in other Brazilian patients. Therefore, we elucidated the genotype of 11 individuals with p450c17 deficiency and concluded that basal progesterone measurement is a useful marker of p450c17 deficiency and that its use should reduce the misdiagnosis of this deficiency in patients presenting with male pseudohermaphroditism, primary or secondary amenorrhea, and mineralocorticoid excess syndrome. 相似文献
120.