Journal of medicine
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Journal of medicine · Jan 1996
Comparative StudyThe pattern of inflammation in rat sepsis due to enterotoxin-producing Staphylococcus aureus: a comparison with ischemia-reperfusion injury.
Sepsis and trauma have similarities in their immunopathologic profiles. Both conditions can result in multi-system organ failure which is sometimes associated with cytokine generation and inflammatory cell activation. Furthermore, decreases in peripheral blood monocyte expression of HLA-DR have been noted in both human sepsis and trauma. ⋯ In analogy to the findings of monocyte decreases in DR expression observed in human trauma and sepsis, rat B-cell I-A expression showed decreases in sublethal sepsis as well as in ischemia-reperfusion injury. However, this was not observed in lethal sepsis. These findings have implications in understanding the immunologic/inflammatory changes observed in human sepsis and trauma.
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Journal of medicine · Jan 1995
Case ReportsFetal blood sampling in the assessment of acute nonimmune hydrops fetalis.
Nonimmune hydrops fetalis can be associated with many fetal conditions. A fetal blood sample obtained from ultrasound-guided cordocentesis can offer vital information about the underlying cause of the nonimmune hydrops fetalis, and perinatal management can be planned accordingly. We attempted to evaluate a case of nonimmune hydrops fetalis conveying poor perinatal outcome through serial fetal blood sampling. Although we could establish no apparent reason for this acute case, fetal blood sampling in addition to ultrasonographic screening can play a key role in the management of the 'perplexing' nonimmune hydrops fetalis.
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Journal of medicine · Jan 1993
Case ReportsSuccessful pregnancy in a patient with heart failure secondary to aortic and mitral regurgitation.
In this report, maternal and fetal risks were evaluated in a pregnant patient who had no previously established heart valvular disease. A 41-old-year patient with aortic and mitral regurgitations suffered from progressive congestive heart failure during 20 weeks of gestation. ⋯ During this time, sudden deterioration in the symptoms occurred, but both the fetal and maternal outcomes were uneventful. This experience of a good outcome may contribute to the future management of pregnancies associated with heart disease.
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The frequency, causes, and outcome of hyponatremia (plasma sodium less than 125 mmol/L), and the value of some routine investigations were studied during a six month period in a hospital population. The incidence and prevalence of hyponatremia were 1.5 and 2.6 per 100 patients per day, respectively. A majority of patients (75%) developed hyponatremia in the hospital. ⋯ Hypovolemic and hypervolemic hyponatremia were seen in 63 and 21 patients, respectively. Urine osmolality did not differ between the three groups, and was of little diagnostic value. The mortality in the hyponatremic patients was 41.7%.
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In order to identify factors that influence the outcome from cardiopulmonary resuscitation (CPR) in children, we studied 69 children (mean age 2.5 +/- 0.4 years) who were apneic and pulseless prior to resuscitation, and treated in the Pediatric Intensive Care Unit (PICU) following CPR. Immediate success (restoration of spontaneous circulation and normal sinus rhythm) was noted in 54 (78%) patients. Forty-one (59%) were short-term survivors (greater than 24 h), and ten (14.5%) became long-term survivors (five recovered well, three moderately disabled, and two severely disabled). ⋯ Outcome was positively influenced by: 1) CPR duration; when less than five min., 54% were long-term survivors compared to 5% of patients resuscitated for more than five min (p less than 0.001). 2) Number of epinephrine doses: 38% of 24 patients receiving one dose became long-term survivors versus 0% of 26 receiving more than one dose (p less than 0.001). 3) Location of arrest; Fifty percent of patients resuscitated in the operation suite or catherization laboratory survived long-term compared to only 8% resuscitated in the PICU (p less than 0.03). Age, sex, cardiac rhythm, as well as metabolic and acid-base variables during resuscitation, did not significantly affect the outcome. Overall good neurologic survival was rare.