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161.
Introduction
Critically ill patients with sepsis are prone to develop cardiac dysrhythmias, most commonly atrial fibrillation (AF). Systemic inflammation, circulating stress hormones, autonomic dysfunction, and volume shifts are all possible triggers for AF in this setting. We conducted a systematic review to describe the incidence, risk factors and outcomes of new-onset AF in patients with sepsis.Methods
MEDLINE, EMBASE and Web Of Science were searched for studies reporting the incidence of new-onset AF, atrial flutter or supraventricular tachycardia in patients with sepsis admitted to an intensive care unit, excluding studies that primarily focused on postcardiotomy patients. Studies were assessed for methodological quality using the GRADE system. Risk factors were considered to have a high level of evidence if they were reported in ≥2 studies using multivariable analyses at a P value <0.05. Subsequently, the strength of association was classified as strong, moderate or weak, based on the reported odds ratios.Results
Eleven studies were included. Overall quality was low to moderate. The weighted mean incidence of new-onset AF was 8% (range 0 to 14%), 10% (4 to 23%) and 23% (6 to 46%) in critically ill patients with sepsis, severe sepsis and septic shock, respectively. Independent risk factors with a high level of evidence included advanced age (weak strength of association), white race (moderate association), presence of a respiratory tract infection (weak association), organ failure (moderate association), and pulmonary artery catheter use (moderate association). Protective factors were a history of diabetes mellitus (weak association) and the presence of a urinary tract infection (weak association). New-onset AF was associated with increased short-term mortality in five studies (crude relative effect estimates ranging from 1.96 to 3.32; adjusted effects 1.07 to 3.28). Three studies reported a significantly increased length of stay in the ICU (weighted mean difference 9 days, range 5 to 13 days), whereas an increased risk of ischemic stroke was reported in the single study that looked at this outcome.Conclusions
New-onset AF is a common consequence of sepsis and is independently associated with poor outcome. Early risk stratification of patients may allow for pharmacological interventions to prevent this complication.Electronic supplementary material
The online version of this article (doi:10.1186/s13054-014-0688-5) contains supplementary material, which is available to authorized users. 相似文献162.
Surgical management of bleeding stomal varices 总被引:1,自引:1,他引:1
David E. Beck Maj MC USAF Victor W. Fazio M.B.B.S. F.A.C.S. F.R.A.C.S. Sharon Grundfest-Broniatowski M.D. 《Diseases of the colon and rectum》1988,31(5):343-346
A retrospective chart review of nine patients with stomal varices and portal hypertension who required surgical management
of bleeding varices from 1978 to 1986 was performed. The patient's mean age at stoma formation was 46 years (range, 36 to
70 years). Three were female, six were male, and all were Caucasian. Three patients had colostomies and six had ileostomies.
Indications for creation of the ostomies included inflammatory bowel disease in six patients and carcinoma in three patients.
The time from creation of the stoma to the first bleed was 11 to 196 months (mean, 82 months). The average time between this
bleed and surgical treatment was six months. The operative procedures performed included nine mucocutaneous disconnections
(MCD) in seven patients (one for recurrent bleeding) and two stoma relocations (one for recurrence). MCD is simple, quick,
and associated with a lower morbidity and intraoperative blood loss than stomal relocation. Post-operative follow-up has ranged
from 4 months to 4.6 years (mean, 2.5 years). During this period there were two episodes of recurrent varices that required
surgery. In the select group of patients that cannot be managed conservatively, MCD is favored and relocation considered only
if MCD is technically impossible.
Read at the meeting of the American Society of Colon and Rectal Surgeons, Washington, D.C., April 5 to 10, 1987.
The opinions expressed are those of the authors and do not reflect the opinions of the United States Air Force or the Department
of Defense. 相似文献
163.
164.
165.
Previous reports indicate that metronidazole is highly effective in the therapy of colonic amebiasis and in the treatment of hepatic amebic abscesses when combined with aspiration. A retrospective review of 15 cases of intestinal amebiasis and 12 patients with amebic liver abscesses treated with metronidazole alone is reported. Based on the literature and the clinical response of the patients reported herein, metronidazole is the initial drug of choice in the therapy of amebic colitis because of its ease of administration, efficacy, and low toxicity. In the treatment of hepatic amebic abscesses, metronidazole alone is adequate therapy for most cases, but occasionally there will be progression of the disease despite standard dosages of the drug. 相似文献
166.
P. H. Sebrechts CAPT MC USN J. P. Anderson Jr. LCDR MC USN 《Diseases of the colon and rectum》1971,14(1):57-61
Summary The management of pilonidal cyst disease in a large military hospital is described. Of special interest to the military practice
is the “buddy” system, in which patients help one another to keep their wounds clean and dry. The specific objectives of our
technic are: 1) obtaining excellent hemostasis by the use of zinc peroxide paste; 2) avoiding recurrences by an open-wound
method of treatment; 3) preservation of a pad of subcutaneous tissue over the postsacral fascia, thus reducing long-term morbidity
by insuring a mobile scar; 4) decreasing the duration of hospitalization, achieved by frequently drying the wounds with warm
air.
Read at the meeting of the American Proctologic Society, Hollywood, Florida, April 12 to 16, 1970.
The opinions or assertions contained herein are those of the authors and are not to be construed as official or as reflecting
the views of the Navy Department. 相似文献
167.
Crohn''s Disease of the Appendix Presenting as Lower Intestinal Hemorrhage and Cecal Mass 总被引:1,自引:0,他引:1
WILLIAM K. BROWN COL. USAF MC RICHARD W. PETERS MAJ. USAF MC † 《The American journal of gastroenterology》1976,65(4):349-351
A rare case of Crohn's disease confined to the appendix and presenting with bright rectal bleeding is documented. 相似文献
168.
A second BamHI DNA polymorphism has been identified in the factor IX gene in an American black population at an allelic frequency of 0.13. This site has been localized within 500 basepairs (bp) 5' to the XmnI intron 3 polymorphic site and increases the heterozygosity of black females at the factor IX gene locus. In addition, haplotype analysis of factor IX genes at five polymorphic loci indicates that although there is conservation of sequences between the races, factor IX genes show more heterogeneity in an American black population and thus more heterozygosity is observed in black females compared with whites. This increased heterogeneity is due to DNA polymorphisms unique to black populations and to linkage equilibrium between the most 5' and 3' polymorphic sites in factor IX genes in blacks. 相似文献
169.
170.
MDJeff A. Alloway Major USAF MC Section of Rheumatology Stephen M. Evangelisti Major USAF MC Jeffrey S. Sartin Major USAF MC Section of Infectious Disease 《Seminars in arthritis and rheumatism》1995,24(6)
Mycobacterium marinum is an atypical acid-fast organism that is rarelyassociated with septic arthritis. Most often this is seen in patients with monarticular synovitis of the hands or wrists, especially in association with a history of periarticular trauma or exposure to marine environments. From tissue obtained by aspiration or synovectomy, Mycobacterium marinum can be identified by Ziehl-Nielson stain and has optimal growth in Lowenstein-Jenson medium. Therapy should consist of at least two anti mycobacterial agents for a minimum 6 months. Surgical debridement also may be beneficial. The clinician must have a high index of suspicion that exposure to Mycobacterium marinum has occurred so appropriate stains and cultures can be obtained and antimycobacterial therapy initiated. 相似文献