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Muscle & Nerve Feb 2010Up to 16% of chronic inflammatory demyelinating polyneuropathy (CIDP) patients may present acutely. We performed a retrospective chart review on 30 acute inflammatory...
Clinical and electrophysiological parameters distinguishing acute-onset chronic inflammatory demyelinating polyneuropathy from acute inflammatory demyelinating polyneuropathy.
Up to 16% of chronic inflammatory demyelinating polyneuropathy (CIDP) patients may present acutely. We performed a retrospective chart review on 30 acute inflammatory demyelinating polyneuropathy (AIDP) and 15 acute-onset CIDP (A-CIDP) patients looking for any clinical or electrophysiological parameters that might differentiate AIDP from acutely presenting CIDP. A-CIDP patients were significantly more likely to have prominent sensory signs. They were significantly less likely to have autonomic nervous system involvement, facial weakness, a preceding infectious illness, or need for mechanical ventilation. With regard to electrophysiological features, neither sural-sparing pattern, sensory ratio >1, nor the presence of A-waves was different between the two groups. This study suggests that patients presenting acutely with a demyelinating polyneuropathy and the aforementioned clinical features should be closely monitored as they may be more likely to have CIDP at follow-up.
Topics: Action Potentials; Adult; Autonomic Nervous System; Diagnosis, Differential; Electrophysiological Phenomena; Facial Muscles; Female; Guillain-Barre Syndrome; Humans; Infections; Male; Middle Aged; Muscle Weakness; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating; Respiration, Artificial; Retrospective Studies
PubMed: 19882646
DOI: 10.1002/mus.21480 -
Environmental Science & Technology Oct 2003We present evidence that Mg2+ antagonism is one mechanism for acute toxicity of waterborne Ni to Daphnia magna. Acutely, adult D. magna were exposed to either control or...
We present evidence that Mg2+ antagonism is one mechanism for acute toxicity of waterborne Ni to Daphnia magna. Acutely, adult D. magna were exposed to either control or 694 microg Ni L(-1) as NiSO4 in moderately soft water (45 mg L(-1) as CaCO3; background Ni approximately 1 microg Ni L(-1)) for 48 h without feeding. Chronically, adults were exposed to either control or 131 microg Ni L(-1) for 14 days (fed exposure). These concentrations were approximately 65% and 12%, respectively, of the measured 48-h LC50 (1068 microg Ni L(-1)) for daphnid neonates in this water quality. The clearest effect of Ni exposure was on Mg2+ homeostasis, as whole-body [Mg2+] was significantly decreased both acutely and chronically by 18%. Additionally, unidirectional Mg2+ uptake rate (measured with the stable isotope 26Mg) was significantly decreased both acutely and chronically by 49 and 47%, respectively, strongly suggesting that Ni is toxic to D. magna due at least in part to Mg2+ antagonism. No impact was observed on the whole-body concentrations or unidirectional uptake rates of Ca2+ during either acute or chronic Ni exposure, while only minor effects were seen on Na+ and Cl- balance. No acute toxic effect was seen on respiratory parameters, as both oxygen consumption rate (MO2) and whole-body hemoglobin concentration ([Hb]) were conserved. Chronically, however, Ni impaired respiratory function, as both MO2 and [Hb] were significantly reduced by 31 and 68%, respectively. Acutely, Ni accumulation was substantial, rising to a plateau between 24 and 48 h of approximately 15 microg g(-1) wet weight--an increase of approximately 25-fold over control concentrations. Mechanisms of acute toxicity of Ni in D. magna differ from those in fish; it is likely that such mechanistic differences also exist for other metals.
Topics: Animals; Daphnia; Female; Ion Exchange; Lethal Dose 50; Magnesium; Nickel; Water; Water Pollutants
PubMed: 14572089
DOI: 10.1021/es034317l -
Blood Jun 1995The process of acute release of tissue-type plasminogen activator (tPA) is important in locally speeding up fibrinolysis. Using a sensitive enzyme-linked immunosorbent...
The process of acute release of tissue-type plasminogen activator (tPA) is important in locally speeding up fibrinolysis. Using a sensitive enzyme-linked immunosorbent assay for tPA, we investigated the acute release of tPA from cultured human umbilical vein endothelial cells. The addition of thrombin (0.003 to 3 NIH U/mL) caused the dose-dependent release of noncomplexed, enzymatically active tPA into the medium. The amount of tPA released into the medium by thrombin was similar to the difference in the amounts of tPA present in extracts from thrombin-treated cells and control cells. The process of acute release of tPA was complete in 1 minute, whereas the concomitant release of von Willebrand factor into the medium was slightly slower (maximum after 3 minutes). By increasing (c.q. decreasing) tPA synthesis, it was found that the amount of tPA constitutively secreted, the amount acutely released, and the amount in cell extracts were increased (c.q. decreased) to the same extent. The same relation was found in vivo. When rats were pretreated with cholera toxin or retinoic acid to increase tPA synthesis, plasma levels of tPA were increased, whereas acute release of tPA, as induced by bradykinin, was increased to the same extent. Acutely released tPA and constitutively secreted tPA were liberated from different pathways in human umbilical vein endothelial cells; tPA had, relative to the in vivo situation, a short residence time in the acutely releasable pathway.
Topics: Animals; Cholera Toxin; Endothelium, Vascular; Humans; Rats; Thrombin; Tissue Plasminogen Activator; Tretinoin; Umbilical Veins
PubMed: 7780137
DOI: No ID Found -
American Journal of Critical Care : An... Jul 1996The acute care nurse practitioner, an emerging role in acute healthcare settings, is responsible for managing acutely ill patients with multiple acute and chronic health...
The acute care nurse practitioner, an emerging role in acute healthcare settings, is responsible for managing acutely ill patients with multiple acute and chronic health problems. There are variations in acute care nurse practitioner specialty practices but the complexity and potential progression of the acutely ill patient's status require the use of a multidisciplinary approach to patient care to include knowledge of common health problems. The acute care nurse practitioner curriculum should include course content on common health problems and/or physiological alterations, which should be prerequisites for specialty courses.
Topics: Acute Disease; Clinical Competence; Credentialing; Curriculum; Humans; Nurse Practitioners; Professional Practice
PubMed: 8811152
DOI: No ID Found -
Chest Dec 2020Lung ultrasonography (LUS), an imaging modality quickly performed, interpreted, and integrated by the treating physician at the bedside, is a particularly useful tool... (Review)
Review
Lung ultrasonography (LUS), an imaging modality quickly performed, interpreted, and integrated by the treating physician at the bedside, is a particularly useful tool for acutely ill patients. In the evaluation of a patient with respiratory failure in the ICU or ED, LUS is superior to chest radiograph and generally comparable with CT imaging and reduces the need for patient transport and radiation exposure. This article will provide a concise review of LUS as it pertains to respiratory failure in general and will include examples of relevant ultrasound images and video clips from critically ill patients.
Topics: Acute Disease; Comparative Effectiveness Research; Critical Illness; Humans; Lung; Point-of-Care Testing; Respiratory Insufficiency; Ultrasonography
PubMed: 32835706
DOI: 10.1016/j.chest.2020.08.2052 -
Pflugers Archiv : European Journal of... 1977Since arginine is a precursor of urea and other guanidino derivatives, we have evaluated its metabolism in acute uremia using the isolated perfused rat liver. Female...
Since arginine is a precursor of urea and other guanidino derivatives, we have evaluated its metabolism in acute uremia using the isolated perfused rat liver. Female Sprague-Dawley rats underwent bilateral nephrectomy (n = 5) or sham operation (n = 5) 48 h prior to liver perfusion. Fifty microCi of L-[guanidino 14C] arginine and unlabelled arginine and aspartic acid were added to the recycling perfusate 15 min prior to liver perfusion. Perfusate concentrations of urea and other guanidino derivatives were measured with high-pressure liquid chromatography. After the initial 30 min of perfusion, net uptake of arginine was lower, and net release of guanidino-succinic acid (GSA) was higher in the livers of acutely uremic rats. Net release of urea was also higher in uremia but the results did not achieve statistical significance. In uremia, the percent conversion of 14C arginine to 14C urea was significantly higher (79 +/- 5 [SE]%) than in controls (58 +/- 7%). These results demonstrate increased GSA production by livers of acutely uremic rats and suggest that acute uremia may be associated with increased arginine utilization and increased production of urea.
Topics: Acute Kidney Injury; Animals; Arginine; Female; Guanidines; Liver; Rats; Urea; Uremia
PubMed: 564051
DOI: 10.1007/BF01063863 -
Stroke Jun 1998The aim of this study was to determine whether acutely psychotic first-episode schizophrenics show an increased cerebral blood flow velocity and whether this condition...
BACKGROUND AND PURPOSE
The aim of this study was to determine whether acutely psychotic first-episode schizophrenics show an increased cerebral blood flow velocity and whether this condition is reversible on psychopathological improvement.
METHODS
In the first of two examinations, transcranial Doppler ultrasonography and assessment with the Positive and Negative Syndrome Scale (PANSS) were performed on 28 acutely psychotic, neuroleptically naive, first-episode schizophrenics. In the second examination, the same patients were assessed psychometrically (PANSS) as well as with Doppler ultrasonography after psychopathological improvement.
RESULTS
Acutely psychotic first-episode schizophrenics showed a significant increase of the mean velocity on both sides in the middle and anterior cerebral arteries and in the right posterior cerebral artery. Blood flow showed significant correlations with productive psychotic symptoms. After psychopathological improvement there was a bilateral normalization of the mean velocity in the middle, anterior, and posterior cerebral arteries.
CONCLUSIONS
Acutely psychotic first-episode schizophrenics show a significantly increased bilateral cerebral blood flow velocity, which normalizes on psychopathological improvement. There were significant correlations of cerebral blood flow velocity with psychopathology.
Topics: Acute Disease; Adolescent; Adult; Aged; Blood Flow Velocity; Cerebrovascular Circulation; Female; Humans; Male; Middle Aged; Schizophrenia; Ultrasonography, Doppler, Transcranial
PubMed: 9626287
DOI: 10.1161/01.str.29.6.1149 -
American Journal of Nephrology 1988Acute and chronic renal failure are associated with a marked reduction in the serum levels of testosterone. The mechanisms underlying this abnormality are unknown....
Acute and chronic renal failure are associated with a marked reduction in the serum levels of testosterone. The mechanisms underlying this abnormality are unknown. Certain data have implicated the high blood levels of parathyroid hormone (PTH) of uremia in the genesis of the hypotestosteronemia. The effects of 3 days of acute uremia in dogs with intact parathyroid glands and in thyroparathyroidectomized animals on serum testosterone levels and on the calcium content of the hypothalamus, pituitary gland, and the testes were examined. Similar studies were performed in normal dogs treated with parathyroid extract for 3 days. The serum levels of testosterone were significantly (p less than 0.01) reduced, and the calcium levels of hypothalamus, pituitary gland, and testes were significantly (p less than 0.01) increased in the acutely uremic dogs with intact parathyroid glands and in the normal dogs treated with parathyroid extract. Prior parathyroidectomy in the acutely uremic dogs prevented these abnormalities. The results of our study assign an important role for the excess blood levels of PTH in uremia in the genesis of the hypotestosteronemia. The data suggest that the effect of excess PTH on serum testosterone levels may be mediated through the accumulation of calcium in the organs which participate in synthesis and/or release of testosterone.
Topics: Acute Kidney Injury; Animals; Calcium; Dogs; Hyperparathyroidism, Secondary; Hypothalamus; Male; Parathyroid Hormone; Pituitary Gland; Testis; Testosterone
PubMed: 3394723
DOI: 10.1159/000167576 -
Biochemia Medica Jun 2017In health, an efficient negative feedback mechanism maintains serum thyroid hormone concentrations within an exquisitely controlled narrow range. Therefore any change... (Review)
Review
In health, an efficient negative feedback mechanism maintains serum thyroid hormone concentrations within an exquisitely controlled narrow range. Therefore any change that occurs to thyroid hormones in intrinsic thyroid disease is concordant and easy to interpret. Optimal functioning of the many tissues they influence is thereby facilitated. The situation in acute illnesses is different. Mechanisms that operate in these circumstances influence the hypothalamic-pituitary-thyroid axis and its components producing thyroid test results, which are discordant, do not fit recognizable patterns and are difficult to interpret. The yield of abnormalities is also low (about 7%). As many studies indicate, thyroid tests are expensive and consume large amounts of the hospital budget and resources of hospital laboratories. Other studies have shown that when abnormalities are detected, clinicians do not intervene or follow up these subjects. Therefore the clinical utility of thyroid testing in acutely ill patients is debatable. Interventions to change requestor behaviour with regard to thyroid testing in acutely ill subjects and the success of some audit and educational interventions are worthy of note. Thyroid testing in acutely ill patients is often an expensive distraction and is of limited clinical value. Targeted thyroid testing should be offered in this group only to those with: (a) symptoms or signs of thyroid disease goiter or orbitopathy; (b) risk factors for thyroid disease, previous or family history of thyroid disease;
Topics: Acute Disease; Humans; Hypothalamo-Hypophyseal System; Pituitary-Adrenal System; Practice Guidelines as Topic; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland; Thyroid Hormones
PubMed: 28694722
DOI: 10.11613/BM.2017.033 -
The American Review of Respiratory... Aug 1980Control of breathing was studied in patients with chronic obstructive pulmonary disease, both in the chronic state and during acute respiratory failure. The results were...
Control of breathing was studied in patients with chronic obstructive pulmonary disease, both in the chronic state and during acute respiratory failure. The results were compared to those in a group of age-matched normal subjects. In patients breathing air, minute ventilation was not different during acute and chronic states, and was similar to that in normal subjects. The pattern of breathing, however, was different: acutely ill patients took shorter and smaller breaths, with a breathing frequency higher than that of normal subjects. The pattern of the chronic group was intermediate between that of acutely ill patients and that of normal subjects. Mouth occlusion pressure, an index of neuromuscular respiratory drive, was 5 times greater in acutely ill patients than in normal subjects. Administration of O2 at a flow of 5 L/min caused a small (14%), bus significant, decrease in minute ventilation due to decreased respiratory frequency. The tidal volume did not change, so the decrease in minute ventilation was the result of decreased inspiratory flow. This was associated with a decreased mouth occlusion pressure that was still 3 times greater than that of normal subjects. The increase in arterial PCO2, observed after administration of O2 was not correlated with the decrease in ventilation, indicating that other factors must be responsible for the increase in arterial PCO2. We concluded that (1) despite the poor mechanical advantage of the respiratory muscles in acute respiratory failure, the increased drive to breathe results in high mouth occlusion pressure and inspiratory flow, and (2) the increase in arterial PCO2, observed during administration of O2 is not related solely to changes in respiratory drive.
Topics: Aged; Carbon Dioxide; Female; Humans; Lung Diseases, Obstructive; Male; Oxygen; Respiration; Respiratory Insufficiency; Tidal Volume
PubMed: 6774639
DOI: 10.1164/arrd.1980.122.2.191