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Ugeskrift For Laeger Jul 2021This review summarises the present knowledge of acute compartment syndrome, which is a time-critical diagnosis threatening both life and limb of the affected patients.... (Review)
Review
This review summarises the present knowledge of acute compartment syndrome, which is a time-critical diagnosis threatening both life and limb of the affected patients. Acute compartment syndrome is a clinical diagnosis, which in equivocal cases can be supported by direct intra-compartmental pressure measurement and laboratory values. Imaging can detect fractures; and non-invasive monitoring is under investigation but has not yet found clinical use. The treatment is a surgical fasciotomy, and this should be performed acutely. If diagnosis is made more than 24-48 hours after onset of symptoms, non-operative treatment should be considered.
Topics: Compartment Syndromes; Extremities; Fasciotomy; Humans
PubMed: 34219642
DOI: No ID Found -
Acta Gastro-enterologica Belgica 2022We hereby describe a case of an acutely ill 41-year-old male without any medical history who presented with an acute abdomen in the emergency department. An abdominal CT...
We hereby describe a case of an acutely ill 41-year-old male without any medical history who presented with an acute abdomen in the emergency department. An abdominal CT showed a dissection of the coeliac trunk and infarction of the spleen. Because of a presumed diagnosis of vasculitis he was started on high dose IV steroids. However, after additional testing the diagnosis of segmental arteriolar Mediolysis (SAM) was made. In this case report we describe the presentation, diagnosis, treatment and follow-up of this patient and provide the readers with background about common differential diagnosis and criteria for diagnosing SAM.
Topics: Male; Humans; Adult; Abdomen, Acute; Abdominal Pain; Abdomen; Vasculitis; Celiac Artery
PubMed: 35770291
DOI: 10.51821/85.4.9860 -
The European Respiratory Journal.... Nov 2003Respiratory failure occurs due mainly either to lung failure resulting in hypoxaemia or pump failure resulting in alveolar hypoventilation and hypercapnia. Hypercapnic... (Comparative Study)
Comparative Study Review
Respiratory failure occurs due mainly either to lung failure resulting in hypoxaemia or pump failure resulting in alveolar hypoventilation and hypercapnia. Hypercapnic respiratory failure may be the result of mechanical defects, central nervous system depression, imbalance of energy demands and supplies and/or adaptation of central controllers. Hypercapnic respiratory failure may occur either acutely, insidiously or acutely upon chronic carbon dioxide retention. In all these conditions, pathophysiologically, the common denominator is reduced alveolar ventilation for a given carbon dioxide production. Acute hypercapnic respiratory failure is usually caused by defects in the central nervous system, impairment of neuromuscular transmission, mechanical defect of the ribcage and fatigue of the respiratory muscles. The pathophysiological mechanisms responsible for chronic carbon dioxide retention are not yet clear. The most attractive hypothesis for this disorder is the theory of "natural wisdom". Patients facing a load have two options, either to push hard in order to maintain normal arterial carbon dioxide and oxygen tensions at the cost of eventually becoming fatigued and exhausted or to breathe at a lower minute ventilation, avoiding dyspnoea, fatigue and exhaustion but at the expense of reduced alveolar ventilation. Based on most recent work, the favoured hypothesis is that a threshold inspiratory load may exist, which, when exceeded, results in injury to the muscles and, consequently, an adaptive response is elicited to prevent and/or reduce this damage. This consists of cytokine production, which, in turn, modulates the respiratory controllers, either directly through the blood or probably the small afferents or via the hypothalamic-pituitary-adrenal axis. Modulation of the pattern of breathing, however, ultimately results in alveolar hypoventilation and carbon dioxide retention.
Topics: Acute Disease; Chronic Disease; Cytokines; Female; Humans; Hypercapnia; Male; Muscle Fatigue; Prognosis; Pulmonary Gas Exchange; Respiratory Function Tests; Respiratory Insufficiency; Respiratory Muscles; Risk Assessment
PubMed: 14621112
DOI: 10.1183/09031936.03.00038503 -
La Clinica Terapeutica Nov 2021Haemorrhoids are considered among the most frequent proctologi-cal condition at a general practitioner (GP) practice. Acute prolapse of internal haemorrhoids is...
Haemorrhoids are considered among the most frequent proctologi-cal condition at a general practitioner (GP) practice. Acute prolapse of internal haemorrhoids is presented with oedema, inflammation and acute pain. The application of granulated sugar on swollen hae-morrhoids leads to an immediate reduction of their edema and to the patient's relief. After the topical application of sugar, haemorrhoids begin to shrink immediately and edema is drastically reduced, while haemorrhoidal tissue can easily retracted back into the anal canal. The method is a cheap, quick and painless way to control the worsening symptoms such as swelling, bleeding and irritation. In addition, this method can easily be applied in the GP practice without the necessity of any form of anaesthesia.
Topics: Anal Canal; Hemorrhoids; Humans; Ligation; Pain; Sugars
PubMed: 34821343
DOI: 10.7417/CT.2021.2369 -
American Journal of Physiology. Heart... Sep 2020Tobacco cigarette (TC) smoking has never been lower in the United States, but electronic cigarette (EC) vaping has reached epidemic proportions among our youth.... (Comparative Study)
Comparative Study
Tobacco cigarette (TC) smoking has never been lower in the United States, but electronic cigarette (EC) vaping has reached epidemic proportions among our youth. Endothelial dysfunction, as measured by flow-mediated vasodilation (FMD) is a predictor of future atherosclerosis and adverse cardiovascular events and is impaired in young TC smokers, but whether FMD is also reduced in young EC vapers is uncertain. The aim of this study in otherwise healthy young people was to compare the effects of acute and chronic tobacco cigarette (TC) smoking and electronic cigarette (EC) vaping on FMD. FMD was compared in 47 nonsmokers (NS), 49 chronic EC vapers, and 40 chronic TC smokers at baseline and then after EC vapers ( = 31) and nonsmokers ( = 47) acutely used an EC with nicotine (ECN), EC without nicotine (EC0), and nicotine inhaler (NI) at ~4-wk intervals and after TC smokers ( = 33) acutely smoked a TC, compared with sham control. Mean age (NS, 26.3 ± 5.2 vs. EC, 27.4 ± 5.45 vs. TC, 27.1 ± 5.51 yr, = 0.53) was similar among the groups, but there were more female nonsmokers. Baseline FMD was not different among the groups (NS, 7.7 ± 4.5 vs. EC:6.6 ± 3.6 vs. TC, 7.9 ± 3.7%∆, = 0.35), even when compared by group and sex. Acute TC smoking versus control impaired FMD (FMD pre-/postsmoking, -2.52 ± 0.92 vs. 0.65 ± 0.93%∆, = 0.02). Although the increase in plasma nicotine was similar after EC vapers used the ECN versus TC smokers smoked the TC (5.75 ± 0.74 vs. 5.88 ± 0.69 ng/mL, = 0.47), acute EC vaping did not impair FMD. In otherwise healthy young people who regularly smoke TCs or ECs, impaired FMD compared with that in nonsmokers was not present at baseline. However, FMD was significantly impaired after smoking one TC, but not after vaping an equivalent "dose" (estimated by change in plasma nicotine) of an EC, consistent with the notion that non-nicotine constituents in TC smoke mediate the impairment. Although it is reassuring that acute EC vaping did not acutely impair FMD, it would be dangerous and premature to conclude that ECs do not lead to atherosclerosis. In our study of otherwise healthy young people, baseline flow-mediated dilation (FMD), a predictor of atherosclerosis and increased cardiovascular risk, was not different among tobacco cigarette (TC) smokers or electronic cigarette (EC) vapers who had refrained from smoking, compared with nonsmokers. However, acutely smoking one TC impaired FMD in smokers, whereas vaping a similar EC "dose" (as estimated by change in plasma nicotine levels) did not. Finally, although it is reassuring that acute EC vaping did not acutely impair FMD, it would be premature and dangerous to conclude that ECs do not lead to atherosclerosis or increase cardiovascular risk.
Topics: Adult; Atherosclerosis; Brachial Artery; Cigarette Smoking; Consumer Product Safety; Cross-Over Studies; E-Cigarette Vapor; Electronic Nicotine Delivery Systems; Endothelium, Vascular; Female; Healthy Volunteers; Humans; Male; Middle Aged; Random Allocation; Risk Assessment; Risk Factors; Vaping; Vasodilation; Young Adult
PubMed: 32734819
DOI: 10.1152/ajpheart.00307.2020 -
Australian Family Physician Nov 2013Acute scrotal pain, once diagnosed, can be treated appropriately with either conservative or surgical measures. The complexity lies in the use of history, clinical... (Review)
Review
BACKGROUND
Acute scrotal pain, once diagnosed, can be treated appropriately with either conservative or surgical measures. The complexity lies in the use of history, clinical examination and investigations in a restricted time frame, to identify the appropriate management path.
OBJECTIVE
To evaluate the literature regarding important and common differentials of acute scrotal pain with the intent to enable primary care doctors to appropriately assess and manage the acutely painful scrotum.
DISCUSSION
Since there is no single feature in the history, examination or investigation that is pathognomonic in diagnosing acute scrotal pain, the triad together is pivotal in its clinical evaluation. If there is any suspicion of testicular torsion, a prompt referral to a surgeon with relevant experience or to the emergency department may salvage the testis. Epididymitis and torsion of the appendix testis may be managed conservatively once testicular torsion has been ruled out.
Topics: Acute Pain; Epididymitis; Humans; Male; Pelvic Pain; Physical Examination; Scrotum; Spermatic Cord Torsion
PubMed: 24217099
DOI: No ID Found -
JHEP Reports : Innovation in Hepatology Sep 2023Acute-on-chronic liver failure (ACLF) is the most severe form of acutely decompensated cirrhosis and is characterised by the presence of one or more organ failures,... (Review)
Review
Acute-on-chronic liver failure (ACLF) is the most severe form of acutely decompensated cirrhosis and is characterised by the presence of one or more organ failures, intense systemic inflammation, peripheral blood lymphopenia, and a high risk of death without liver transplantation within 28 days. Herein, we propose the hypothesis that intense systemic inflammation may lead to organ failures through five different non-mutually exclusive mechanisms. First, pathogen-associated molecular patterns and inflammatory mediators ( cytokines and lipid mediators) stimulate the production of the vasorelaxant nitric oxide in the walls of splanchnic arterioles, leading to enhanced splanchnic and systemic vasodilation which, in turn, induces enhanced activity of endogenous vasoconstrictor systems causing renal vasoconstriction and acute kidney injury. Second, neutrophils that reach the systemic circulation are prone to adhere to the vascular endothelium. Cytokines and lipid mediators act on the endothelium in microvessels of vital organs, an effect that favours the migration of neutrophils (and probably other leukocytes) to surrounding tissues where neutrophils can cause tissue damage and thereby contribute to organ failure. Third, cytokines and lipid mediators promote the formation of microthrombi that impair microcirculation and tissue oxygenation. Fourth, acute inflammation stimulates intense peripheral catabolism of amino acids whose products may be metabotoxins that contribute to hepatic encephalopathy. Fifth, acute inflammatory responses, which include the production of a broad variety of biomolecules (proteins and lipids), and an increase in biomass (., granulopoiesis requiring nucleotide synthesis), among others, are energetically expensive processes that require large amounts of nutrients. Therefore, immunity competes with other maintenance programmes for energy. The brain stem integrates the energy demand of each organ system, with immunity considered a top priority. The brain stem may "decide" to make a trade-off which involves the induction of a dormancy programme that permits the shutdown of mitochondrial respiration and oxidative phosphorylation in peripheral organs. In the context of acutely decompensated cirrhosis, the consequence of a shutdown of mitochondrial respiration and ATP production would be a dramatic decrease in organ function.
PubMed: 37600957
DOI: 10.1016/j.jhepr.2023.100807