Medical hypotheses
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Acute coagulopathy of trauma predicts a poor clinical outcome. Tissue trauma activates the sympathoadrenal system resulting in high circulating levels of catecholamines that influence hemostasis dose-dependently through immediate effects on the two major compartments of hemostasis, i.e., the circulating blood and the vascular endothelium. There appears to be a dose-dependency with regards to injury severity and the hemostatic response to trauma evaluated in whole blood by viscoelastic assays like thrombelastography (TEG), changing from normal to hypercoagulable, to hypocoagulable and finally hyperfibrinolytic in severely injured patients. ⋯ Given this, the rise in circulating catecholamines in trauma patients may favor a switch from hyper- to hypocoagulability in the blood to keep the progressively more procoagulant microvasculature open. The hypothesis delineated in the present paper thus infers that the state of the fluid phase, including its cellular elements, is a consequence of the degree of the tissue injury and importantly, critically related to the degree of endothelial damage, with a progressively more procoagulant endothelium inducing a gradient of increasing anticoagulation towards the fluid phase. The implications of this hypothesis may include targeted treatment strategies according to the degree of sympathoadrenal response as evaluated by whole blood viscoelastical hemostatic assays in trauma patients.
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Awareness under anaesthesia is an uncommon but serious phenomenon, which continues to occur despite the use of commercially available depth-of-anaesthesia (DOA) monitors. Many of these monitors use processed electroencephalographic (EEG) data to give an indication of anaesthetic depth. ⋯ I hypothesise that an audio signal derived from the raw EEG waveform could form the basis of a DOA monitor, enabling humans to directly determine whether a patient is awake or anaesthetised from sound alone. I propose to call the sounds derived from amplification of the EEG trace the 'audio EEG'.
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One of the unsolved problems of septic shock is the poor responsiveness, or reduced vascular reactivity, to vasopressors used to increase blood pressure (BP). Attempts to restore vascular reactivity with NO inhibitors or low dose steroids have met with little success. Low vascular reactivity, which may lead to refractory shock and death, is linked to desensitization or down-regulation of alpha-1 adrenergic receptors. ⋯ Our preliminary observations in the setting of septic shock again suggest such increased vascular reactivity. Improved outcome was also observed. Rigorous work is warranted to verify reduced vasopressor requirement and improved outcome, when an alpha-2 agonist is combined with state-of -the-art treatment of septic shock.
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Hepatic inflow occlusion during the liver surgery may result in a transient ischemia period followed by reperfusion, and may initiate liver injury and lead to postoperative liver dysfunction. Especially in cirrhotic patients, the tolerance time of ischemia is much shorter and the outcome would be worse. ⋯ However, there is still lack of trials to compare the postoperative outcomes such as liver function in cirrhotic patients undergoing liver surgery with inflow occlusion between volatile anesthetics and propofol anesthesia. Hence we hypothesize that with its anti-IR injury characteristics, volatile anesthetics might be the more appropriate choice in cirrhotic patients undergoing liver surgery with occlusion.
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Although Spurling test, a foraminal compression test, is commonly used in clinical practice in patients with a suspected cervical radiculopathy, its protocol is still obscure. In undergoing this test, patients extend, laterally flex and slightly rotate neck to the symptomatic side, and then a pressure is applied on the top of patient's head by examiner. The test is scored as positive if it causes pain or tingling that starts in the shoulder and radiates distally to the elbow. ⋯ Here we hypothesize that vertical weight-bearing MRI provides an innovative method for researching and standardizing the protocols of Spurling test. The result will provide better knowledge of the mechanism of Spurling test. Standardization of the test will improve its sensitivity and rate of reproducibility.