Journal of medicine
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Journal of medicine · Jan 2003
Tracheal intubation without neuromuscular relaxants for thymectomy in myasthenic patients.
The purpose of the present study was to evaluate in detail the suitability of the combined use of fentanyl and propofol for endotracheal oral intubation without non-depolarizing muscle relaxants (NDMRs) for myasthenic patients. We evaluated orotracheal intubation, without using an NDMR, having induced anesthesia with 2 microg x kg(-1) fentanyl and 2.5 mg x kg(-1) propofol in myasthenic (Osserman's classification: I-IIb) and non-myasthenic patients. Using this technique, intubation was easily performed, the vocal cords remained opened, and any increase in blood pressure was satisfactorily suppressed in both myasthenic and non-myasthenic patients. ⋯ In myasthenic patients, no or only a slight cough occurred if the ratio was less than 75%, and a cough of moderate intensity occurred if the ratio was more than 90%. All of th coughing reflexes observed in myasthenic patients were considered to be clinically acceptable. The results indicate that the combined fentanyl and propofol technique, without NDMR, provides satisfactory intubatin conditions in myasthenic patients.
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Journal of medicine · Jan 2002
ReviewRespiratory distress syndrome: principles and current therapy.
Acute respiratory distress syndrome (ARDS) describes a clinicopathologic disease process that occurs in association with a variety of clinical situations. The severity and outcome of this syndrome varies. ⋯ Oxygen therapy and PEEP, though dramatically improve lung mechanics and oxygenation, are not innocuous and may adversely affect cardiovascular function and even induce pulmonary parenchymal injury. Over the years a variety of "lung protective" treatment modalities have been introduced and proved as effective and safe in the treatment of this syndrome
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Journal of medicine · Jan 1999
Comparative Study Clinical Trial Controlled Clinical TrialSerum thrombomodulin as a prognostic marker of disseminated intravascular coagulation.
Disseminated intra-vascular coagulation (DIC) is associated with severe bleeding tendency and organ failure, the extent of which is thought to be related to the prognosis of DIC patients. Thrombomodulin (TM) is a high-affinity thrombin receptor on vascular endothelial cells. ⋯ The significant elevation of circulating TM in nonsurvivors with DIC compared with survived patients with DIC(TM 3.1+/-1.52 vs 8.1+/-3.89 FU/ml), as well as FDP (12.9+/-12.12 vs 49.8+/-55.42 microg/ml) but the levels of FDP were not different between the two groups. The measurement of circulating TM was a relatively good prognostic marker of patients with DIC.
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Journal of medicine · Jan 1999
Assessment of inflammatory mediators in patients with generalized peritonitis.
We investigated the pathology and the involvement of type II phospholipase A2 (type II PLA2), inflammatory cytokines, nitrite/nitrate (NOx), and endotoxin in generalized peritonitis. All of the factors except endotoxin were higher in the non-surviving group, the shock group, and the multiple organ dysfunction syndrome (MODS) group than in the surviving group, the shock-free group, and the MODS-free group, respectively. Significant differences were not found in endotoxin or other factors at sites of gastrointestinal (GI) perforation. These findings suggest that inflammatory cytokines, type II PLA2, and NO are highly involved in the evolution of the pathology of generalized peritonitis.
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Journal of medicine · Jan 1996
Plasma levels of interleukin-1 receptor antagonist (IL-1ra) and severity of illness in patients with burns.
The present study was conducted to determine whether a plasma interleukin-1 receptor antagonist (IL-1ra) would reflect the severity of burn injury and to examine the relation between IL-1ra and the cytokines. We studied 24 burn patients in whom the total burn surface area (TBSA) accounted for at least 20% of the body surface, and in whom serial blood samples could be obtained beginning immediately after the burn injury. Plasma levels of IL-1ra were determined by enzyme-linked immunosorbent assay (ELISA). ⋯ No correlation was found between IL-1ra and endotoxin. The plasma IL-1ra level was closely correlated with the severity of inflammation and the clinical status of the burn patients, regardless of the infection. Results suggest that IL-1ra can serve as an index of the systemic inflammatory response syndrome (SIRS).