Articles: adult.
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The Medical Advisory Secretariat undertook a review of the evidence on the effectiveness and cost-effectiveness of small bowel transplant in the treatment of intestinal failure. ⋯ There is evidence that small bowel transplant can prolong the life of some patients with irreversible intestinal failure who can no longer continue to be managed by parenteral nutrition therapy. Both patient survival and graft survival rates have improved with time. However, small bowel transplant is still associated with significant mortality and morbidity. The outcomes are inferior to those of total parenteral nutrition. Evidence suggests that this procedure should only be used when total parenteral nutrition is no longer feasible.
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The present overview describes recent contributions to the literature with regard to choice of anesthetic techniques, approaches to anesthetic management of elderly outpatients undergoing arthroscopy and other procedures, reconsideration of the problem of postoperative delirium in the elderly patient, and a general summary of perioperative management and assessment of anesthetic risk in older adults. ⋯ The efficiency and speed with which outpatient surgery and anesthetic recovery can be conducted in older adults continue to improve. Monitors of depth of anesthesia, ultra-short-acting agents, and combined techniques have minimized minor complications such as nausea and vomiting, and have improved the speed with which these patients recover from anesthesia. A small proportion of elderly surgical outpatients remain at risk for residual postoperative cognitive dysfunction.
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Tissue ice content and post-freeze survival were documented for caterpillars of the arctiid moth Pyrrharctia isabella. Tissue ice content was inversely dependent on freeze temperature (-3 degrees C=24.4%, -6 degrees C=40.2%, -10 degrees C=48.7%) but values were substantially less than expected given hemolymph osmolality. Accumulation of glycerol (200-300 mM) in the hemolymph helped to colligatively reduce the amount of freezable water. ⋯ Pupation rates ranged between 45.7 to 52.4% of caterpillars in a test group. Adult emergence exceeded 60% of the pupae in the -3 and -6 degrees C test groups. Hence, P. isabella caterpillars survived ecologically relevant freezes and continued their life cycles to adulthood.
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Jornal de pediatria · Nov 2002
[Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock].
The Institute of Medicine has called for the development of clinical guidelines and practice parameters to develop "best practice" and potentially improve patient outcome. ⋯ American College of Critical Care Medicine adult guide lines for hemodynamic support of septic shock have little application to the management of pediatric or neonatal septic shock. Studies are required to determine whether American College of Critical Care Medicine guidelines for hemodynamic support of pediatric and neonatal septic shock will be implemented and associated with improved outcome.