Articles: function.
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To present an overview of the principles of renal replacement therapy, its application in the critically ill patient, and an update of recent research in this area. ⋯ Continuous renal replacement therapy has become commonplace in the management of critically ill patients with acute renal failure. It has the advantage of causing less hypotension and a more gradual return of the fluid and electrolyte status, when compared with intermittent haemodialysis. Recent evidence suggests that it may also be a useful immunomodulator and may be beneficial in the management of patients with multiple organ failure.
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Spinal subdural haematoma is a rare entity. Only a few cases have been reported, mainly in patients with coagulopathies or bleeding diathesis, and also in patients undergoing anticoagulant therapy following surgery, trauma, or lumbar puncture. Symptoms of spinal cord compression produced by spinal subdural haematoma may progress rapidly causing complete and irreversible deficits. ⋯ She was discharged to an inpatient rehabilitation facility. Follow-up at 1 year showed significant improvement in motor function, but absence of posterior column function. A follow-up magnetic resonance study demonstrated widening of the spinal cord, advanced myelomalacia and a large, central, multi-loculated syrinx.
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The relation of procalcitonin (PCT) plasma concentrations compared with C-reactive protein (CRP) was analyzed in patients with different severity of multiple organ dysfunction syndrome (MODS) and systemic inflammation. PATIENTS AND ⋯ Measurement of PCT concentrations during multiple organ dysfunction syndrome provides more information about the severity and the course of the disease than that of CRP. Regarding the strong association of PCT and the respective score systems in future studies we recommend evaluation also of the severity of inflammation and MODS when PCT concentrations were compared between different types of disease.
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Neuropathic pain syndromes may be treated by intervention at the sympathetic nervous system. The pain in these syndromes is therefore called sympathetically maintained pain (SMP). Typical disorders with a SMP component are complex regional pain syndromes (reflex sympathetic dystrophy and causalgia), traumatic neuralgias and herpes zoster. ⋯ Open questions are how the efferent sympathetic nervous system is capable of influencing pain sensation and which mechanisms underly the autonomic dysregulation often observed in these syndromes.(1) Somatic afferents that project through the sympathetic trunk do not exist. Therefore, a pure sympathetic block does not block afferent information arising from the affected extremity. What alternatives are possible? Under pathophysiological conditions a functional interaction of efferent sympathetic fibers and afferent nociceptive fibers could be demonstrated in patients and animal studies. The intensity of this coupling varies considerably between individual patients and is not necessary for the diagnosis of the disorder. (2) Sympathetically maintained pain and signs of autonomic dysfunction are independent clinical and pathophysiological phenomena without any causal relation. However, it is possible to treat both the SMP and the autonomic dysfunction with sympathetic blocks.
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The number of required hidden units is statistically estimated for feedforward neural networks that are constructed by adding hidden units one by one. The output error decreases with the number of hidden units by an almost constant rate, if each appropriate hidden unit is selected out of a great number of candidate units. The expected value of the maximum decrease per hidden unit is estimated theoretically as a function of the number of learning data sets in relation to the number of candidates that are obtained by random search. ⋯ Therefore the number of candidates can be regarded as a parameter that represents the efficiency of the search. Computer simulation shows that estimating this parameter experimentally from the actual decrease in output error is useful for demonstrating the efficiency of the gradient search. It also shows the influence, on the number of hidden units, of the hidden unit's nonlinearity.