Medicine
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Observational Study
Could dysnatremias play a role as independent factors to predict mortality in surgical critically ill patients?
Several studies have demonstrated the impact of dysnatremias on mortality of intensive care unit (ICU) patients. The objective of this study was to assess whether dysnatremia is an independent factor to predict mortality in surgical critically ill patients admitted to ICU in postoperative phase. One thousand five hundred and ninety-nine surgical patients (58.8% males; mean age of 60.6 ± 14.4 years) admitted to the ICU in the postoperative period were retrospectively studied. ⋯ The comparison among the prognostic indexes was not statistically significant. Only SOFA score had a statistic difference compared with hypernatremia (P < .02). The serum sodium levels at admission, especially hypernatremia, may be used as an independent predictor of outcome in the surgical critically ill patients.
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Randomized Controlled Trial
Intensive insulin therapy for preventing postoperative infection in patients with traumatic brain injury: A randomized controlled trial.
To assess the effect of intensive insulin therapy (IIT) for preventing postoperative infection in patients with traumatic brain injury (TBI). ⋯ IIT leads to a reduced infection rate, shorter stays in ICU, and improved neurological outcome.
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Case Reports
Pseudohypoparathyroidism with basal ganglia calcification: A case report of rare cause of reversible parkinsonism.
Parkinsonism can be secondary to many internal diseases, in some certain conditions, it seems that the clinical manifestations of parkinsonism presenting reversible. We report a case of patient with parkinsonism secondary to pseudohypoparathyroidism, who improved markedly after the supplement of serum calcium. ⋯ This study reported a patient presenting as acute reversible parkinsonism, who was finally diagnosed as pseudohypoparathyroidism. It indicated us that secondary parkinsonism should be carefully differentiated for its dramatic treatment effect. And the family history of seizures might be an indicator for the consideration of pseudohypoparathyroidism.
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Observational Study
Prediction of the mid-tracheal level using surface anatomical landmarks in adults: Clinical implication of endotracheal tube insertion depth.
Endotracheal tube (ETT) should be placed at the optimal level to avoid single lung ventilation or accidental extubation. This study was performed to estimate the mid-tracheal level by using surface anatomical landmarks in adult patients. Neck computed tomography images of 329 adult patients between the ages of 16 and 79 years were reviewed. ⋯ The difference between the extCC-SSN and the mid-tracheal level was -6.6 (12.5) mm, and the difference between the extSSN-MSJ and the mid-tracheal level was -19.2 (6.1) mm. The difference between the extCC-SSN and the mid-tracheal level was smaller in females compared with males [-1.7 (11.7) mm vs -12.8 (10.7) mm; P < 0.001]. The mid-tracheal level, which is helpful in planning the insertion depth of an ETT, can be predicted by the surface distance between the cricoid cartilage and suprasternal notch in adults, especially in females.
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Observational Study
Liver function in alpha-1-antitrypsin deficient individuals at 37 to 40 years of age.
Severe alpha-1-antitrypsin (AAT) deficiency (PiZZ) is a risk factor for liver disease, but the prevalence of liver cirrhosis and hepatocellular cancer in PiZZ adults is unknown. The risk of liver disease in adults with moderate AAT deficiency (PiSZ) is also unknown. A cohort of 127 PiZZ, 2 PiZnull, 54 PiSZ, and 1 PiSnull individuals were identified by the Swedish national neonatal AAT screening program between 1972 and 1974, when all 200,000 newborn infants in Sweden were screened for AAT deficiency. ⋯ The PiZZ women taking medication influencing liver enzymes had significantly higher GGT than the PiMM women on the corresponding treatment (P = 0.023). These AAT-deficient individuals identified by neonatal screening have normal plasma levels of liver function tests, and no clinical signs indicating liver disease at the age of 37 to 40 years. However, bilirubin, GGT, and liver stiffness are significantly higher in PiZZ men than PiMM men.