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Archives of Disease in Childhood.... Jun 2021The association between hyperlactataemia and poorer outcomes in acutely unwell adults and children is well recognised. Blood lactate testing has become readily available...
The association between hyperlactataemia and poorer outcomes in acutely unwell adults and children is well recognised. Blood lactate testing has become readily available in acute settings and is considered a first-line investigation in international guidelines for the management of sepsis. However, while healthcare professionals do appreciate the value of measuring blood lactate in acute severe illness, its clinical significance and interpretation remain less well understood. In this paper, we present the evidence for the use of lactate as a diagnostic test and prognostic marker in acutely unwell children.
Topics: Diagnostic Tests, Routine; Humans; Lactic Acid; Sepsis
PubMed: 32887681
DOI: 10.1136/archdischild-2020-319601 -
Somatosensory & Motor Research Mar 2018The acutely dissociated neurons from the dorsal root ganglia (DRGs) are extensively used. The effects of acute dissociation on the properties of these neurons are,...
The acutely dissociated neurons from the dorsal root ganglia (DRGs) are extensively used. The effects of acute dissociation on the properties of these neurons are, however, not clear. In this study, the action potentials (APs) were recorded from both acutely dissociated and in vivo identified DRG neurons with patch clamp and sharp electrode recording techniques, respectively. We found that acute dissociation slowed both the depolarizing and repolarizing rate of APs, and elongated the AP duration (APD). The lower recording temperature presented in the acutely dissociated neurons contributed to about 10% of these differences. The major contributor of these differences was possibly modulation of the mRNA expression especially those of the ion channels, as suggested by our observation that acute dissociation significantly reduced the mRNA abundance of Nav1.6-1.9. In conclusion, acute dissociation altered the electrophysiological properties of the DRG neurons; the disrupted gene-expression pattern may contribute to this effect.
Topics: Action Potentials; Animals; Evoked Potentials; Female; Ganglia, Spinal; Neurons; Patch-Clamp Techniques; Rats; Rats, Wistar
PubMed: 29471715
DOI: 10.1080/08990220.2018.1439000 -
Annals of the Royal College of Surgeons... Nov 2004Small bowel intussusception, presenting acutely in adults is an extremely rare event. We present an exceptional case, previously unreported in the English language, of a...
Small bowel intussusception, presenting acutely in adults is an extremely rare event. We present an exceptional case, previously unreported in the English language, of a lipoma within a Meckel's diverticulum giving rise to this clinical scenario.
Topics: Abdomen, Acute; Adult; Humans; Intussusception; Male; Meckel Diverticulum; Tomography, X-Ray Computed
PubMed: 16749951
DOI: 10.1308/147870804173 -
British Journal of Hospital Medicine... Nov 2010As a result of developments in portable and hand-held devices, transthoracic echocardiography can now be brought to the patient. There is the opportunity for acute...
As a result of developments in portable and hand-held devices, transthoracic echocardiography can now be brought to the patient. There is the opportunity for acute physicians to exploit the benefits of echo in the assessment and management of acutely unwell patients in a variety of settings.
Topics: Acute Disease; Echocardiography; Humans; Medical Staff, Hospital
PubMed: 21063255
DOI: 10.12968/hmed.2010.71.11.79661 -
Current Treatment Options in Neurology Nov 2010Hypertensive intracerebral hemorrhage remains an entity in search of definitive treatment. It requires management in a specialized unit, where hypertension,...
Hypertensive intracerebral hemorrhage remains an entity in search of definitive treatment. It requires management in a specialized unit, where hypertension, hyperglycemia, seizures, and elevated intracranial pressure can be expertly managed. However, the exact target range of hypertensive therapy is uncertain. Extraventricular drainage and surgery for cerebellar hemorrhage can both be life-saving. The role of craniotomy for hematoma resection remains unclear. Surgery for deep or pontine hemorrhages has questionable value. The reduction of clot expansion acutely may lead to improved outcomes. One option to this end, the tight control of hypertension acutely, may be difficult to prove effective. Another, the use of factor VIIa, eluded validation in one trial. Efforts are under way to reduce intraventricular hemorrhage, and with it, hydrocephalus. The role of clot evacuation in the subset of individuals with lobar hemorrhage is also being studied. In all likelihood, the key to acute treatment of this condition will be early intervention, with implementation of blood pressure control, administration of clotting factors in the emergency department, or both. This treatment will be followed by transfer to a specialized unit, with appropriate interventions in selected patients. However, morbidity and mortality will remain high, pointing out the importance of prevention through management of hypertension.
PubMed: 20848325
DOI: 10.1007/s11940-010-0096-3 -
Resuscitation Jul 2023A minority of out-of-hospital cardiac arrest patients have an acutely occluded coronary artery without manifesting ST-segment elevation on their post-resuscitation ECG....
BACKGROUND
A minority of out-of-hospital cardiac arrest patients have an acutely occluded coronary artery without manifesting ST-segment elevation on their post-resuscitation ECG. Identifying such patients is an issue to providing timely reperfusion therapy. We aimed to evaluate the usefulness of the initial post-resuscitation electrocardiogram in out-of-hospital-cardiac-arrest patients for selection to perform early coronary angiography.
METHODS
The study population consisted of 74 of the 99 randomized patients from the PEARL clinical trial with both ECG and angiographic data. The purpose of this study was to investigate initial post-resuscitation electrocardiogram findings from out-of-hospital cardiac arrest patients without ST-segment elevation for any association with the presence of acute coronary occlusions. Secondarily, we aimed to observe the distribution of abnormal electrocardiogram findings and survival to hospital discharge of subjects.
RESULTS
Initial post-resuscitation electrocardiogram findings, including ST-depression, T-wave inversion, bundle branch block, non-specific changes, were not associated with the presence of an acutely occluded coronary. Normal post-resuscitation electrocardiogram findings were associated with patient survival to hospital discharge but were not associated with the presence or absence of an acute coronary occlusion.
CONCLUSIONS
Electrocardiogram findings cannot exclude or identify the presence of an acutely occluded coronary in out-of-hospital-cardiac-arrest patients without ST-segment elevation. An acutely occluded coronary may be present regardless of normal electrocardiogram findings.
Topics: Humans; Coronary Occlusion; Out-of-Hospital Cardiac Arrest; Cardiopulmonary Resuscitation; Electrocardiography; Coronary Angiography; Hospitals
PubMed: 37178897
DOI: 10.1016/j.resuscitation.2023.109826 -
Schizophrenia Research Nov 1996Changes in the concentration of some serum acute phase proteins (alpha 1-antitrypsin, alpha 2-macroglobulin, complement C3, haptoglobin, ceruloplasmin, transferrin,...
Changes in the concentration of some serum acute phase proteins (alpha 1-antitrypsin, alpha 2-macroglobulin, complement C3, haptoglobin, ceruloplasmin, transferrin, albumin and hemopexin), thyroxine-binding globulin, retinol-binding globulin, plasminogen and Gc-globulin are reported in two separate series of Chinese, male schizophrenic patients and healthy controls. In the first series, 41 healthy blood donors and 98 schizophrenic patients in different stages of the disease were investigated. The second series consists of a random sample of 50 acutely ill schizophrenic patients and a second group of healthy subjects. The concentrations of these serum proteins were measured by rocket immunoelectrophoresis in agarose gel. Increased levels of serum alpha 1-antitrypsin, alpha 2-macroglobulin, haptoglobin, ceruloplasmin, and thyroxine-binding globulin were observed in both series of patients when compared to their respective controls. Albumin, transferrin and retinol-binding protein levels were reduced in patients in both series. Hemopexin levels were increased only in the acutely ill patients while complement C3 was decreased in the chronically ill patients. No changes were observed in the Gc-globulin levels of all groups of patients. With the exception of complement C3, the changes observed in the levels of these serum proteins were appropriate for that of an acute phase response.
Topics: Acute Disease; Acute-Phase Proteins; Adult; Autoimmune Diseases; China; Humans; Male; Middle Aged; Reference Values; Risk Factors; Schizophrenia; Schizophrenic Psychology; Singapore
PubMed: 8958601
DOI: 10.1016/s0920-9964(96)00037-0 -
European Heart Journal. Acute... Apr 2016Acutely decompensated heart failure (HF), one of the most common reasons for hospitalization, places an intense economic pressure on the health care system and adversely... (Review)
Review
Acutely decompensated heart failure (HF), one of the most common reasons for hospitalization, places an intense economic pressure on the health care system and adversely affects outcome of HF patients. Due to lack of reliable clinical tools to assess and monitor hemodynamics, accurate judgment on cardiac preload remains a challenge and complicates current inpatient HF management. In this review, we discuss the emerging role of real-time quantitative Doppler echocardiography (DE) in identifying inappropriate cardiac preload, monitoring volume status during the management, and improving quality of care in patients with acute HF. We illustrate the utilization of DE in common clinical scenarios, propose stepwise algorithms to effectively utilize serial quantitative DE in the bedside care, and discuss obstacles and prospects of quantitative DE utilization in HF management. These efforts will further prompt the development of multi-center prospective studies to define and validate the specific roles of quantitative DE in reducing hospitalization time and improving outcome of HF patients.
Topics: Acute Disease; Aged; Algorithms; Echocardiography, Doppler; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Prospective Studies; Stroke Volume; Ventricular Pressure
PubMed: 25694508
DOI: 10.1177/2048872615573517 -
Pediatric Surgery International Apr 1998Nine patients with sickle cell disease (SCD) were operated upon at our hospital for acute appendicitis, comprising only 0.43% of the total appendicectomies performed at...
Nine patients with sickle cell disease (SCD) were operated upon at our hospital for acute appendicitis, comprising only 0.43% of the total appendicectomies performed at our institution. Three appendices were acutely inflamed and six (66.7%) were perforated. Histologic evaluation of the six perforated specimens revealed congestion and haemorrhage by sickled erythrocytes (RBCs) in addition to acute transmural inflammatory cell infiltrates. The mucosa was extensively ulcerated, with haemorrhage both within the lumen and in the appendiceal wall. The blood vessels were dilated and packed with sickled RBCs. Two of the three acutely inflamed appendices showed features of acute transmural appendicitis, with marked congestion and haemorrhage by sickled RBCs. The third did not show any acute inflammatory cell infiltrate, however, the mucosa was partly ulcerated with both mucosal and intraluminal haemorrhage. These findings suggest that acute appendicitis is different in patients with SCD: while it is not common, when it does develop it has a rapid course with a high incidence of perforation due to blockage of appendiceal vessels by sickled RBCs, leading to transmural necrosis.
Topics: Adolescent; Appendicitis; Child; Child, Preschool; Female; Humans; Male; Sickle Cell Trait
PubMed: 9553185
DOI: 10.1007/s003830050312 -
Urologic Radiology 1991Computed tomography (CT) of acutely obstructed kidneys secondary to stone disease demonstrated that approximately two thirds of these patients showed a mottled... (Comparative Study)
Comparative Study
Computed tomography (CT) of acutely obstructed kidneys secondary to stone disease demonstrated that approximately two thirds of these patients showed a mottled nephrogram in contrast to 6% at urography, where the nephrogram was seen as the previously reported striated nephrogram. Mottled nephrograms are better and more frequently shown at CT than at urographic imaging.
Topics: Acute Disease; Contrast Media; Female; Humans; Kidney; Male; Ureteral Obstruction; Urography
PubMed: 2042267
DOI: 10.1007/BF02924002