J Formos Med Assoc
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Hemodialysis, which leads to negative fluid balance, is often required in mechanically ventilated patients with renal failure. We conducted a prospective study on the influence of hemodialysis on the respiratory mechanics in 14 mechanically ventilated patients (10 men, 4 women, mean age 70.1 +/- 8.1 yr) with various causes of renal failure requiring hemodialysis in an intensive care unit. Respiratory mechanics were measured before and after hemodialysis using the interrupter technique under constant flow and constant volume. ⋯ Minimal respiratory resistance and maximal respiratory resistance were significantly decreased after hemodialysis (4.38 +/- 1.26 vs 2.99 +/- 1.00 cmH2O/L/s and 9.93 +/- 2.50 vs 8.39 +/- 2.43 cmH2O/L/s, respectively), but effective additional respiratory resistance and static respiratory compliance were not. Significant correlations were found between body weight reduction by hemodialysis and changes in minimal respiratory resistance (r = 0.758, p < 0.01), maximal respiratory resistance (r = 0.544, p < 0.05), and static respiratory compliance (r = 0.703, p < 0.01). We conclude that hemodialysis significantly alters the respiratory mechanics in mechanically ventilated renal failure patients and that the alteration may be related to the negative fluid balance caused by hemodialysis.
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A 42-year-old-women with sigmoid colon adenocarcinoma was found to have isolated prolonged activated partial thromboplastin time (aPTT 102.5 s, normal range 24-36 s) preoperatively. Her medical history included an episode of prolonged postdelivery uterine bleeding 16 years previously. A mixed aPTT test showed immediate correction of the prolonged aPTT, indicating a coagulation factor deficiency in the intrinsic pathway. ⋯ The patient recovered smoothly and is currently undergoing adjuvant chemotherapy. This is the first formal report of a patient with factor XI deficiency undergoing major surgery in Taiwan. Careful monitoring of aPTT, with fresh frozen plasma transfusion, when needed, may safely overcome bleeding problems during surgery.
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We investigated the influence of local administration of anti-nerve growth factor (NGF) serum on collateral nerve fiber sprouting caused by chronic constriction injury (CCI) of the sciatic nerve in rats. CCI was induced in adult Sprague-Dawley rats (six per group) by constriction of the sciatic nerve of the right hind limb. Control rats received no further manipulation. ⋯ High-dose anti-NGF serum did not block collateral sprouting when injected into the contralateral (unoperated) hind limb, indicating that the inhibition of sprouting was not caused by a systemic effect. In conclusion, local administration of anti-NGF serum can block sprouting of collateral fibers after nerve injury. Our findings suggest that collateral sprouting is dependent on the local availability of NGF to nearby intact cutaneous nerve fibers.