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A 72-year-old woman without cardiovascular history presented with acute substernal chest pain and dyspnoea. The electrocardiogram was normal, but the blood test analyses showed an elevated troponin T level. Emergency coronary angiography revealed normal epicardial coronary arteries, but the left ventriculogram demonstrated midventricular dilatation and akinesis with well-preserved contractility of the apex and base. The patient was diagnosed as having an atypical presentation of takotsubo cardiomyopathy. She was treated with a beta blocker and an ACE inhibitor and recovered well. A follow-up echocardiogram at 2 months showed normalization of the wall motion abnormality. 相似文献
33.
Severe sepsis is a major challenge for clinicians caring for acutely ill patients. For many years, several biomarkers have
been tested and proposed to improve the ability not only to diagnose but also to anticipate clinical response to antibiotics.
Despite the availability of many sophisticated and novel biomarkers, current evidence demonstrates that C-reactive protein
(CRP), a well-known and relatively inexpensive biomarker, is useful in the clinical setting. The sequential evaluation of
plasma CRP concentrations in patients with severe sepsis and the interpretation of its patterns may allow assessments of individual
prognosis and response to treatment. 相似文献
34.
Lokien X. van Nunen Marcel van t Veer Frederik M. Zimmermann Inge Wijnbergen Guus R. G. Brueren Pim A. L. Tonino Wilbert A. Aarnoudse Nico H. J. Pijls 《Catheterization and cardiovascular interventions》2020,95(1):128-135
- Carotid stenting results show equivalence to carotid endarterectomy.
- Most patients undergoing carotid intervention are asymptomatic.
- Using embolic protection with a covered mesh stent shows promise in this first large multicenter study.
35.
PRD Humphrey IF Moseley RW Ross Russell 《Journal of neurology, neurosurgery, and psychiatry》1982,45(7):591-597
Four cases are described in which visual field defects followed enlargement of the third ventricle. Three were due to aqueduct stenosis while in one case a left cerebellar hemisphere tumour was discovered. The visual field defects comprised a unilateral scotoma, bilateral scotomata and, in two patients, incongruous bitemporal hemianopia. 相似文献
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Luciano CP Azevedo Marcelo Park Jorge IF Salluh Alvaro Rea-Neto Vicente C Souza-Dantas Pedro Varaschin Mirella C Oliveira Paulo Fernando GMM Tierno Felipe dal-Pizzol Ulysses VA Silva Marcos Knibel Antonio P Nassar Jr Rossine A Alves Juliana C Ferreira Cassiano Teixeira Valeria Rezende Amadeu Martinez Paula M Luciano Guilherme Schettino Marcio Soares 《Critical care (London, England)》2013,17(2):R63
Introduction
Contemporary information on mechanical ventilation (MV) use in emerging countries is limited. Moreover, most epidemiological studies on ventilatory support were carried out before significant developments, such as lung protective ventilation or broader application of non-invasive ventilation (NIV). We aimed to evaluate the clinical characteristics, outcomes and risk factors for hospital mortality and failure of NIV in patients requiring ventilatory support in Brazilian intensive care units (ICU).Methods
In a multicenter, prospective, cohort study, a total of 773 adult patients admitted to 45 ICUs over a two-month period requiring invasive ventilation or NIV for more than 24 hours were evaluated. Causes of ventilatory support, prior chronic health status and physiological data were assessed. Multivariate analysis was used to identifiy variables associated with hospital mortality and NIV failure.Results
Invasive MV and NIV were used as initial ventilatory support in 622 (80%) and 151 (20%) patients. Failure with subsequent intubation occurred in 54% of NIV patients. The main reasons for ventilatory support were pneumonia (27%), neurologic disorders (19%) and non-pulmonary sepsis (12%). ICU and hospital mortality rates were 34% and 42%. Using the Berlin definition, acute respiratory distress syndrome (ARDS) was diagnosed in 31% of the patients with a hospital mortality of 52%. In the multivariate analysis, age (odds ratio (OR), 1.03; 95% confidence interval (CI), 1.01 to 1.03), comorbidities (OR, 2.30; 95% CI, 1.28 to 3.17), associated organ failures (OR, 1.12; 95% CI, 1.05 to 1.20), moderate (OR, 1.92; 95% CI, 1.10 to 3.35) to severe ARDS (OR, 2.12; 95% CI, 1.01 to 4.41), cumulative fluid balance over the first 72 h of ICU (OR, 2.44; 95% CI, 1.39 to 4.28), higher lactate (OR, 1.78; 95% CI, 1.27 to 2.50), invasive MV (OR, 2.67; 95% CI, 1.32 to 5.39) and NIV failure (OR, 3.95; 95% CI, 1.74 to 8.99) were independently associated with hospital mortality. The predictors of NIV failure were the severity of associated organ dysfunctions (OR, 1.20; 95% CI, 1.05 to 1.34), ARDS (OR, 2.31; 95% CI, 1.10 to 4.82) and positive fluid balance (OR, 2.09; 95% CI, 1.02 to 4.30).Conclusions
Current mortality of ventilated patients in Brazil is elevated. Implementation of judicious fluid therapy and a watchful use and monitoring of NIV patients are potential targets to improve outcomes in this setting.Trial registration
ClinicalTrials.gov . NCT01268410相似文献39.
Otavio T Ranzani Fernando G Zampieri Marcelo Park Jorge IF Salluh 《Critical care (London, England)》2013,17(5):191
Mortality is still the most assessed outcome in the critically ill patient and is
routinely used as the primary end-point in intervention trials, cohort studies, and
benchmarking analysis. Despite this, interest in patient-centered prognosis after ICU
discharge is increasing, and several studies report quality of life and long-term
outcomes after critical illness. In a recent issue of Critical Care,
Cuthbertson and colleagues reported interesting results from a cohort of 439 patients
with sepsis, who showed high ongoing long-term mortality rates after severe sepsis,
reaching 61% at 5 years (from a starting point of ICU admission). Follow-up may start
at ICU admission, after ICU discharge, or after hospital discharge. Using ICU
admission as a starting point will include patients with a wide range of illness
severities and reasons for ICU admission. As a result, important consequences of the
ICU, such as rehabilitation and reduced quality of life, may be diluted in an
unselected population. ICU discharge is another frequently used starting point. ICU
discharge is a marker of better outcome and reduced risk for acute deterioration,
making this an interesting starting point for studying long-term mortality, need for
ICU readmission, and critical illness rehabilitation. Finally, using hospital
discharge as the starting point will include patients with the minimal requirements
to sustain an adequate condition in a non-monitored environment but will add a
?survivors bias?; that is, patients who survive critical illness are a special group
among the critically ill. In this commentary, we discuss the heterogeneity in
long-term mortality from recent studies in critical care medicine ? heterogeneity
that may be a consequence simply of changing the follow-up starting point ? and
propose a standardized follow-up starting point for future studies according to the
outcome of interest. 相似文献
40.