Home About us Contact
|
Home About us Contact | ||
|
|
||
Full Recovery (full + recovery)
Selected AbstractsComa and respiratory failure due to moxidectin intoxication in a dogJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 1 2008Alexander E. Gallagher DVM Abstract Objective: To describe the clinical consequences following ingestion by a dog of a moxidectin-containing equine deworming product. Few reports exist concerning the treatment and outcome of severe moxidectin toxicity. Treatment, known factors influencing intoxication, and prognosis are reviewed. Case summary: A 10-month-old female Border Collie ingested an unknown quantity of a moxidectin-containing equine deworming product several hours before presentation. Severe neurological signs subsequently developed and included: ataxia, seizures, coma, and respiratory failure. The dog was treated with supportive care including intravenous fluids, activated charcoal, and positive pressure ventilation. Normal spontaneous respiration returned in 34 hours and the patient was discharged 58 hours after ingestion. Full recovery occurred within 1 week of intoxication. New information provided: This report describes moxidectin intoxication and associated respiratory failure in a dog that required mechanical ventilation. The dog's recovery was rapid. Despite severity of signs, the prognosis for patients with moxidectin intoxication is good with appropriate supportive care. [source] 65 Multi-resistant Escherichia coli septicaemia following transrectal ultrasound guided prostate biopsy , an emerging riskBJU INTERNATIONAL, Issue 2006A.-J. DAVIDSON Introduction:, Transrectal ultrasound (TRUS) guided biopsy of the prostate is the standard procedure for diagnosing prostate carcinoma. Complications range from discomfort and bleeding to asymptomatic bacteruria and sepsis. Rarely, sepsis is fatal. E. coli is the most common pathogen causing infection and although no international standard for the use of prophylactic antibiotics exists their use has decreased the incidence of infection to around 2%. Worldwide the incidence of multi-resistant E. coli (MREC) is increasing, and we report two cases of septicaemia secondary to MREC infection postprostate biopsy. Methods:, We performed a review of case records involving postprostate biopsy MREC infection. A comprehensive literature review of TRUS guided biopsy of the prostate was also performed. Results:, All patients in our series had MREC cultured following TRUS guided biopsy of the prostate. All received the same prophylactic antibiotic regime (norfloxacin and gentamicin). They required admission to hospital for intravenous antibiotics and in two cases inotropic support, eventually making full recoveries. All had a history of recent travel to a developing country whilst two had self-limiting diarrhoea and this is the first report in the English literature of MREC following prostate biopsy. Other risk factors for acquiring multi-resistant urinary tract infections have been identified including age and previous quinolone therapy. Conclusion:, Antibiotic prophylaxis for biopsy of the prostate, being predominantly quinolones, will continue to aid in reducing morbidity. However, with the prevalence of MREC increasing current regimens will not cover such organisms potentially leading to sepsis. In our cases travel to developing countries appeared to be a risk factor for being colonised with MREC. We believe through careful history risk factors for multi-resistant urinary tract infection including travel may alert doctors to the potential risk of MREC at the time of biopsy leading to the addition of a broader spectrum antibiotic such as intravenous meropenem. [source] CO2 laser treatment of Zenker's diverticulaCLINICAL OTOLARYNGOLOGY, Issue 4 2001H.H.W. De Gier Introduction. Evaluation of the results of endoscopic CO2 laser treatment of Zenker's diverticula. Methods. The records of all patients treated in the University Hospital Rotterdam between 1990 and 1996 using CO2 laser surgery or electrocautery (when CO2 laser was impossible because of technical reasons) for a Zenker's diverticulum were studied. Results. One hundred and eighty-three patients were treated for a Zenker's diverticulum, 179 times using CO2 laser and 42 times using electrocautery. In 29 patients, two or more treatments were needed. Twenty-five complications occurred, five severe and 20 mild. One patient died and in one patient the recurrent laryngeal nerve was damaged; the other patients made full recoveries. Conclusion. CO2 laser surgery is a safe and effective method of treatment for Zenker's diverticula. [source] Neurological complications in two children with Lemierre syndromeDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 8 2010BASHEER PEER MOHAMED Lemierre syndrome is a distinct clinical syndrome comprising oropharyngeal sepsis and fever, internal jugular vein thrombosis and remote septic metastases caused by Fusobacterium species. The mortality rate was historically high and although use of antibiotics led to a dramatic fall in incidence, a resurgence has been seen recently. A 14-year-old male developed Lemierre syndrome after tonsillitis. There was extensive leptomeningitis, especially over the clivus, causing 6th and 12th cranial nerve palsies, a clinical feature termed the ,clival syndrome'. He also developed an epidural abscess in the cervical spine, which was unsafe for surgical drainage. Conservative treatment with an extended course of antibiotics and anticoagulation for jugular vein thrombosis led to a good recovery. A 15-year-old female developed Lemierre syndrome after a persistent sore throat lasting 7 weeks. She had palsy of the 12th cranial nerve from clival osteomyelitis. She was treated with a 6-week course of antibiotics and anticoagulants leading to almost full recovery at 3-month review. Awareness of the potential neurological complications of Lemierre syndrome and prompt management are crucial in reducing morbidity and mortality in this ,forgotten disease'. [source] Stream geomorphology in a mountain lake district: hydraulic geometry, sediment sources and sinks, and downstream lake effectsEARTH SURFACE PROCESSES AND LANDFORMS, Issue 4 2007C. D. Arp Abstract Lakes are common in glaciated mountain regions and geomorphic principles suggest that lake modifications to water and sediment fluxes should affect downstream channels. Lakes in the Sawtooth Mountains, Idaho, USA, were created during glaciation and we sought to understand how and to what extent glacial morphology and lake disruption of fluxes control stream physical form and functions. First, we described downstream patterns in channel form including analyses of sediment entrainment and hydraulic geometry in one catchment with a lake. To expand on these observations and understand the role of glacial legacy, we collected data from 33 stream reaches throughout the region to compare channel form and functions among catchments with lakes, meadows (filled lakes), and no past or present lakes. Downstream hydraulic geometry relationships were weak for both the single catchment and regionally. Our data show that downstream patterns in sediment size, channel shape, sediment entrainment and channel hydraulic adjustment are explained by locations of sediment sources (hillslopes and tributaries) and sediment sinks (lakes). Stream reaches throughout the region are best differentiated by landscape position relative to lakes and meadows according to channel shape and sediment size, where outlets are wide and shallow with coarse sediment, and inlets are narrow and deep with finer sediment. Meadow outlets and lake outlets show similarities in the coarse-sediment fraction and channel capacity, but meadow outlets have a smaller fine-sediment fraction and nearly mobile sediment. Estimates of downstream recovery from lake effects on streams suggest 50 per cent recovery within 2,4 km downstream, but full recovery may not be reached within 20 km downstream. These results suggest that sediment sinks, such as lakes, in addition to sources, such as tributaries, are important local controls on mountain drainage networks. Copyright © 2006 John Wiley & Sons, Ltd. [source] Use of Chronic Epilepsy Models in Antiepileptic Drug Discovery: The Effect of Topiramate on Spontaneous Motor Seizures in Rats with Kainate-induced EpilepsyEPILEPSIA, Issue 1 2005Heidi L. Grabenstatter Summary:,Purpose: Potential antiepileptic drugs (AEDs) are typically screened on acute seizures in normal animals, such as those induced in the maximal electroshock and pentylenetet-razole models. As a proof-of-principle test, the present experiments used spontaneous epileptic seizures in kainate-treated rats to examine the efficacy of topiramate (TPM) with a repeated-measures, crossover protocol. Methods: Kainic acid was administered in repeated low doses (5 mg/kg) every hour until each Sprague,Dawley rat experienced convulsive status epilepticus for >3 h. Six 1-month trials (n = 6,10 rats) assessed the effects of 0.3,100 mg/kg TPM on spontaneous seizures. Each trial involved six pairs of TPM and saline-control treatments administered as intraperitoneal injections on alternate days with a recovery day between each treatment day. Data analysis included a log transformation to compensate for the asymmetric distribution of values and the heterogeneous variances, which appeared to arise from clustering of seizures. Results: A significant effect of TPM was observed for 12 h (i.e., two 6-h periods) after a 30-mg/kg injection, and full recovery from the drug effect was complete within 43 h. TPM exerted a significant effect at doses of 10, 30, and 100 mg/kg, and the effects of TPM (0.3,100 mg/kg) were dose dependent. Conclusions: These data suggest that animal models with spontaneous seizures, such as kainate- and pilocarpine-treated rats, can be used efficiently for rapid testing of AEDs with a repeated-measures, crossover protocol. Furthermore, the results indicate that this design allows both dose,effect and time-course-of-recovery studies. [source] Nanoindentation of a Pseudoelastic NiTiFe Shape Memory Alloy,ADVANCED ENGINEERING MATERIALS, Issue 1-2 2010Janine Pfetzing-Micklich Nanoindentation is a suitable tool for characterizing the local mechanical properties of shape memory alloys (SMA) and to study their pseudoelastic behavior. There is a special interest in indenting with different indenter tips (as not all tips are associated with strain states that predominantly induce the martensitic transformation) and in indenting at different temperatures, where different phases are present. In this study, we perform nanoindentation on a ternary NiTiFe SMA with different indenter tips and at various testing temperatures. For nanoindentation with spherical tips, load,displacement hystereses clearly indicate pseudoelastic behavior, whereas indentation with Berkovich tips results in more pronounced plastic deformation. Testing at different temperatures is associated with different volume fractions of austenite, martensite, and R-phase. The corresponding nanoindentation responses differ considerably in terms of pseudoelastic behavior. Best pseudoelastic recovery is found at testing temperatures close to the R-phase start temperature, even though this temperature is below the austenite finish temperature, which is a well-known lower temperature bound for full recovery in macroscopic tests. Our results are discussed considering micromechanical aspects and the interaction between stress-induced phase transformation and dislocation plasticity. [source] In vivo morphological and antifungal study of the activity of a bergamot essential oil by-productFLAVOUR AND FRAGRANCE JOURNAL, Issue 4 2006Francesco Carmelo Pizzimenti Abstract The in vivo antifungal activity of a bergamot processing by-product, named ,Peratoner', was evaluated through applications to male Wistar rats' back skin, previously infected with Candida albicans. Following the treatment, samples were taken to evaluate the fungal load and punch biopsies were carried out for morphological studies. In infected rats without Peratoner treatment, skin detachment with infiltrating cells was observed. The presence of C. albicans cells was evident on the surface strata of the epidermis, which was detached from the basal cells. After 24 h, in the case of Peratoner treatment, the epidermic strata were still few in number, while the infiltrating elements in the dermis were fewer in quantity and a small cluster of C. albicans cells, above the stratum corneous, was also visible. After 48 h of treatment, the skin revealed proliferation of the strata, while in the dermis infiltrating cells were still evident. Following this period and up to a week after treatment, a full recovery of the cutaneous structure was observed. Copyright © 2006 John Wiley & Sons, Ltd. [source] Successful administration of aggressive chemotherapy concomitant to tuberculostatic and highly active antiretroviral therapy in a patient with AIDS-related Burkitt's lymphomaHIV MEDICINE, Issue 1 2005C Lehmann Treatment of AIDS-related malignant lymphoma (ARL) remains a therapeutic challenge. There are concerns not only about infectious and haematological complications in HIV-infected patients during intensive chemotherapy, but also about potential interactions between chemotherapy and highly active antiretroviral therapy (HAART). Current data on patients treated concomitantly with intensive chemotherapy and HAART are limited, and no data exist on patients with ARL suffering from active opportunistic infections. We report the case of a 38-year-old man with advanced HIV-1 infection, pulmonary tuberculosis and Burkitt's lymphoma. Intensive chemotherapy was administered in parallel with tuberculostatic therapy and HAART. Six months later, the patient achieved not only a complete remission of Burkitt's lymphoma and sustained viral suppression, but also a full recovery from tuberculosis. This case report provides some useful observations on the successful application of intensive chemotherapy in addition to tuberculostatic therapy and HAART in HIV-infected patients. [source] Assessing the influence of scanner background noise on auditory processing.HUMAN BRAIN MAPPING, Issue 8 2007Abstract We compared two experimental designs aimed at minimizing the influence of scanner background noise (SBN) on functional MRI (fMRI) of auditory processes with one conventional fMRI design. Ten subjects listened to a series of four one-syllable words and had to decide whether two of the words were identical. This was contrasted with a no-stimulus control condition. All three experimental designs had a duration of ,17 min: 1) a behavior interleaved gradients (BIG; Eden et al. [1999] J Magn Reson Imaging 41:13,20) design (repetition time, TR, = 6 s), where stimuli were presented during the SBN-free periods between clustered volume acquisitions (CVA); 2) a sparse temporal sampling technique (STsamp; e.g., Gaab et al., [2003] Neuroimage 19:1417,1426) acquiring only one set of slices following each of the stimulations with a 16-s TR and jittered delay times between stimulus offset and image acquisition; and 3) an event-related design with continuous scanning (ERcont) using the stimulation design of STsamp but with a 2-s TR. The results demonstrated increased signal within Heschl's gyrus for the STsamp and BIG-CVA design in comparison to ERcont as well as differences in the overall functional anatomy among the designs. The possibility to obtain a time course of activation as well as the full recovery of the stimulus- and SBN-induced hemodynamic response function signal and lack of signal suppression from SBN during the STsamp design makes this technique a powerful approach for conducting auditory experiments using fMRI. Practical strengths and limitations of the three auditory acquisition paradigms are discussed. Hum Brain Mapp, 2006. © 2006 Wiley-Liss, Inc. [source] Should bulimia nervosa be subtyped by historyof anorexia nervosa?INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue S3 2007A longitudinal validation Abstract Objective: To determine whether a past diagnosis of anorexia nervosa (AN) predicts longitudinal course and outcome among women with bulimia nervosa (BN). Method: A subset (n = 176) of participants in the Longitudinal Study of Anorexia and Bulimia Nervosa who met DSM-IV criteria for BN either at study intake (n = 144) or during follow-up (n = 32; 4 had restricting AN at intake, 28 had binge/purge AN at intake) were included in this report. Over a median of 9 years, weekly eating disorder symptom data were collected from participants using the Longitudinal Interview Follow-up Examination, Eating Disorders Version. Results: While there were no between-group differences in likelihood of partial recovery, women with BN who had a history of AN were more likely to have a protracted illness, relapsing into AN during follow-up, compared to those with no AN history who were more likely to move from partial to full recovery. Conclusion: Lifetime AN is an important prognostic indicator among women with BN and these longitudinal data would support the subtyping of BN on the basis of AN history. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007 [source] Infectious discitis in adults: 9 years experience from Al-Yarmouk Teaching Hospital in Baghdad, IraqINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2 2008Riyadh A. SAKENI Abstract Aim:, The objective of this study was to analyse the presentation, aetiology, diagnosis, management, and outcome of infectious discitis. Methods:, A screening prospective case-finding study was carried out at Al-Yarmouk teaching hospital in Baghdad, Iraq from 1997 to 2006. Fifty adult patients (12 men and 38 women) were diagnosed with infectious discitis from different referral sources. The diagnosis was based on laboratory biochemical tests, isolation of micro-organisms from blood and needle aspiration tissue, and radiological investigations including magnetic resonance images (MRI). Results:, Of the 50 cases, 32 (64%) patients presenting within 4 weeks, 94% had pelvic and abdominal surgical interventions, 70% presented with severe neck pain and 36% had neurological deficits. Marked elevation of erythrocyte sedimentation rate and high serum C-reactive protein levels were observed in all patients. Positive blood, percutaneous disc aspiration and surgical exploration samples for Staphylococcus aureus, Streptococcus viridans, E. coli, Pseudomonas aureginosa and Candida albicans were found. Radiological images showed that disc involvement did not exceed more than one intervertebrate disc with two adjacent vertebrae. The clinical outcome was full recovery (86%), residual neurological deficits (10%) and death (4%). Conclusions:, Infectious discitis in adults should be suspected in every case presenting with severe neck or back pain, followed by pelvic or abdominal surgical interventions. Therefore, MRI techniques should be performed on every case and an early empirical antibiotic therapy is advised. [source] Mitigating stress effects during transportation of matrinxă (Brycon amazonicus Günther, 1869; Characidae) through the application of calcium sulfateJOURNAL OF APPLIED ICHTHYOLOGY, Issue 2 2009F. Bendhack Summary This study verified the effects of CaSO4 on physiological responses of the tropical fish matrinxăBrycon amazonicus (200.2 ± 51.1 g) in water containing CaSO4 after a 4-h transportation at concentrations of: 0, 75, 150, and 300 mg L,1. Blood samples were collected prior to transportation (initial levels), immediately after packaging, at arrival, and 24 h and 96 h after transportation (recovery). Cortisol levels increased after packaging (118.2 ± 14.2 ng ml,1), and decreased slightly after transportation in water containing CaSO4 (106.8 ± 14.1), but remained higher than initial levels (21.0 ± 2.6 ng ml,1). Fish kept at 150 mg L,1 CaSO4 reached the pre-transportation levels at 24 h of recovery. Blood glucose increased after transportation in all treatments (8.2 ± 0.2 mmol L,1) and declined after full recovery to values below initial levels (4.8 ± 0.1 mmol L,1). Chloride levels did not change in CaSO4 treatments; serum sodium concentrations decreased after packaging and after transportation. Serum calcium levels did not differ among treatments, but decreased after packaging and increased at 96 h of recovery. Hematocrit and the number of red blood cells were higher in all treatments after packaging and arrival, except in fish exposed to 300 mg L,1 CaSO4. Mean corpuscular volume increased in 75 mg L,1 CaSO4, which reached the higher VCM after transportation. Hemoglobin levels increased only after transportation, regardless of calcium sulfate levels. Handling before transportation and transportation itself were both stressful to fish; calcium sulfate at concentrations tested in the present work had a moderate influence in the reduction of stress responses. [source] Restoration of Bone Mass and Strength in Glucocorticoid-Treated Mice by Systemic Transplantation of CXCR4 and Cbfa-1 Co-Expressing Mesenchymal Stem Cells,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 5 2009Chun-Yang Lien Abstract Transplantation of gene-modified mesenchymal stem cells (MSCs) in animals for bone regeneration therapy has been evaluated extensively in recent years. However, increased endosteal bone formation by intravenous injection of MSCs ectopically expressing a foreign gene has not yet been shown. Aside from the clearance by lung and other tissues, the surface compositions of MSCs may not favor their bone marrow (BM) migration and engraftment. To overcome these hurdles, a gene encoding the chemokine receptor largely responsible for stromal-derived factor-1 (SDF-1)-mediated BM homing and engraftment of hematopoietic stem cells (HSCs), CXCR4, was transduced into mouse C3H10T1/2 cells by adenovirus infection. A dose-dependent increase of CXCR4 surface expression with a parallel enhanced chemotaxis toward SDF-1 in these cells after virus infection was clearly observed. Higher BM retention and homing of CXCR4-expressing MSCs were also found after they were transplanted by intramedullary and tail vein injections, respectively, into immunocompetent C3H/HeN mice. Interestingly, a full recovery of bone mass and a partial restoration of bone formation in glucocorticoid-induced osteoporotic mice were observed 4 wk after a single intravenous infusion of one million CXCR4-expressing C3H10T1/2 cells. In the meantime, complete recovery of bone stiffness and strength in these animals was consistently detected only after a systemic transplantation of CXCR4 and Cbfa-1 co-transduced MSCs. To our knowledge, this is the first report to show unequivocally the feasibility of ameliorating glucocorticoid-induced osteoporosis by systemic transplantation of genetically manipulated MSCs. [source] Bilateral Femoral Head Osteonecrosis After Septic Shock and Multiorgan Failure,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 3 2004Mark J Bolland Abstract A case of bilateral femoral head osteonecrosis after septic shock is presented. We suggest that the osteonecrosis was caused by ischemic insults to the proximal femora. The association between septic shock and osteonecrosis has not been previously reported. Introduction: Osteonecrosis is an uncommon disorder characterized by the in situ death of bone. A diverse range of conditions has been associated with osteonecrosis. We present a case of bilateral femoral head osteonecrosis that occurred after an episode of septic shock. Materials and Methods: A 66-year-old woman presented with a left-sided renal stone and a urinary tract infection. Her condition rapidly progressed to a life-threatening illness with septic shock complicated by multiorgan failure, which necessitated prolonged intensive care and inotropic support. She made a full recovery but 3 months later developed bilateral osteonecrosis of the femoral heads requiring bilateral total hip joint replacement. Results and Conclusions: We propose that the osteonecrosis was caused by ischemic insults to the femoral heads as a result of the widespread systemic ischemia that occurred during her initial illness. To our knowledge, septic shock has not been previously described as a cause of osteonecrosis. Clinicians should be aware of this association, particularly in patients presenting with bone pain after episodes of sepsis. [source] Treatment of Trauma- and Abuse-Related Dissociative Symptom Disorders in Children and AdolescentsJOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 1 2009Scott Weber EdD TOPIC:,Dissociation is believed to be one of the most common underlying psychological processes among children and adolescents receiving mental health treatment, but most of the dissemination of information about dissociation has occurred among psychiatrists and psychologists. PURPOSE:,Modes of treatment for dissociation as it affects children and adolescents are described. SOURCES USED:,Current research and practice scholarly articles on treatment of children and adolescents for dissociation and dissociative symptom disorders were accessed and critically reviewed. CONCLUSIONS:,Prognosis in children and adolescents can vary widely among patients and between the specific types of dissociation disorder; however, expert clinicians and researchers agree that early, intense treatment offers the greatest possibility of full recovery. [source] Erythrocytapheresis for Plasmodium falciparum infection complicated by cerebral malaria and hyperparasitemiaJOURNAL OF CLINICAL APHERESIS, Issue 1 2001Y. Zhang Abstract In malaria due to Plasmodium falciparum, life-threatening complications are in part related to the degree of parasitemia. Whole blood exchange and red blood cell exchange (RCE) have been used for the rapid removal of parasites from the circulation of patients with a high parasite load complicated by cerebral, pulmonary, and renal dysfunction. We have treated three 5,45-year-old patients with hyperparasitemia and end-organ dysfunction with red cell exchange by automated apheresis as an adjunct to specific anti-malarial chemotherapy. Parasitemia dropped more than 80% in all three patients immediately after the exchange, and all patients had an uneventful and full recovery. In combination with effective anti-malarial chemotherapy, apheresis RCE is a safe and rapid approach to treat complicated malaria due to P. falciparum. J. Clin. Apheresis. 16:15-18, 2001. © 2001 Wiley-Liss, Inc. [source] Conservative management of an extensive renal graft subcapsular hematoma arising during living donor nephrectomy.JOURNAL OF CLINICAL ULTRASOUND, Issue 3 2010Role of Doppler sonographic posttransplant follow-up Abstract We report a case of subcapsular hematoma (SH) of a kidney graft arising during minimal-incision living-donor nephrectomy. SH covered at least two-thirds of the cortical surface. Capsulotomy was not done because it was deemed too risky. In the immediate postoperative period, a rapid deterioration of graft function was observed associated with Doppler sonographic evidence of graft compression. However, in the following days, spontaneous resolution of SH and progressive improvement of Doppler findings was observed, which preceded full recovery of graft function. Conservative management seemed a valid approach of this complication in this case where Doppler sonography proved essential for the follow-up. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010 [source] Solifenacin-induced small bowel pseudo-obstructionJOURNAL OF HOSPITAL MEDICINE, Issue 2 2008Naveen Pemmaraju MD Abstract An 89-year-old woman was admitted to Johns Hopkins Hospital with a small bowel obstruction and symptoms of urinary retention. She had been started on solfenacin for bladder overactivity 10 days prior to her presentation. Withdrawal of the solfenacin resulted in a full recovery, which has persisted for greater than 6 months without surgical intervention. This is the first reported case report of small bowel pseudo-obstruction due to solifenacin. Journal of Hospital Medicine 2008;3:176,178. © 2008 Society of Hospital Medicine. [source] Postoperative taste and smell deficit after upper gastrointestinal cancer surgery,an unreported complicationJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2003Adrian M. Harris FRCS(Ed) Abstract Background and Objectives Patients undergoing upper gastrointestinal cancer surgery were noted to suffer loss of taste and/or smell, a previously unreported problem. Our aim was to investigate the extent of this phenomenon, quantify recovery time, and identify potentially associated factors. Methods In this retrospective study, a postal questionnaire was sent to all patients still alive after oesophagectomy or gastrectomy, with a minimum 1-year follow-up and no clinical or radiological evidence of recurrence. Data were analysed for prevalence of deficit in relation to operation, age, sex, respiratory complications, and disease stage. Results A total of 109/119 (92%) patients completed the questionnaire: 50 gastrectomies and 69 oesophagectomies. Ten patients were excluded with prior sensory deficit. Overall, 45/99 patients (45%) suffered deficit (M:F,=,1.6:1). No association was found with type of surgery: deficits for subtotal gastrectomy, total gastrectomy, and oesophagectomy were 44, 46 and 46% respectively (,2,=,0.355, 2 df P,>,0.5). No other parameter was associated, and full recovery occurred in 30 patients (67%) within a mean of 6 months. Conclusions Loss of taste and smell occurs in nearly one-half of all cases after upper gastrointestinal surgery. The pathophysiology is unknown, but it resolves in most patients within 6,12 months. This complication should be discussed as part of informed consent for patients undergoing oesophagogastric cancer surgery. J. Surg. Oncol. 2003;82:147,150. © 2003 Wiley-Liss, Inc. [source] Successful use of short-term mechanical ventilation to manage respiratory failure secondary to profound hypokalemia in a cat with hyperaldosteronismJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 5 2008Tara N. Hammond DVM Abstract Objective , To report successful management of respiratory failure due to severe hypokalemia in a cat with hyperaldosteronism, including short-term mechanical ventilation strategies and aspects of medical and surgical treatment. Case Summary , A cat presented with bilateral pelvic limb weakness that rapidly progressed to tetraparesis and respiratory muscle failure. Point-of-care testing revealed severe hypokalemia (1.9 mmol/L) and mild azotemia. Initial management included endotracheal intubation, mechanical ventilation, and aggressive potassium supplementation. Spironolactone was started due to a high index of suspicion for hyperaldosteronism. A right adrenal mass visualized during abdominal ultrasonographic examination and a serum aldosterone level greater than 3329 pmol/L confirmed the diagnosis. The cat made a full recovery following surgical removal of a right adrenal adenoma. New or Unique Information Provided , We report successful management of respiratory failure in a cat with hyperaldosteronism using short-term mechanical ventilation. Respiratory failure due to severe hypokalemia should be considered a complication of hyperaldosteronism in cats and may require mechanical ventilation. However, full recovery is possible. [source] SOMA (carisoprodol) toxicity in a dogJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 1 2005Stephen G. Lane DVM Abstract Objective: To describe a case of SOMA intoxication in a dog. Case summary: A 13-year-old, 25 kg, female spayed Australian shepherd presented to the emergency service after ingestion of ten to fifteen 350 mg tablets of SOMA (carisoprodol), a muscle relaxant used for back pain in humans. Toxic effects of the drug in this dog included mild sinus tachycardia, respiratory depression, seizures, and ataxia. The dog's mentation progressively deteriorated from depressed to comatose within 1 hour after admission. Treatment on initial presentation consisted of induction of emesis while the dog still had a gag reflex, administration of activated charcoal, oxygen therapy, and supportive care. The dog was discharged to the owner prior to full recovery (4 days later). New or unique information provided: This is the first known report of carisoprodol intoxication in the dog. [source] CLOSTRIDIUM TETANUS INFECTION IN 13 DOGS AND ONE CATJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue S1 2004C Bandt Clostridium tetani infection is uncommon in dogs and cats. Up to this point in time just single case reports have been published in veterinary medicine. The goal of this retrospective study was to describe the clinical features and outcome of 13 dogs and one cat affected with Clostridium tetani. The medical records of the last ten year were reviewed. Dogs and cats that were identified as being infected with Clostridium tetani on the basis of characteristic clinical signs and/or bacterial culture from infected wounds were eligible for study inclusion. Thirteen dogs and one cat met the criteria for study inclusion. Six different breeds and mix-breed dogs were affected, German Shepherd dogs (n=4, 29%) and Labrador retriever (n=3, 21%) were the most frequently affected breeds. Observed clinical complications were ventricular aspiration pneumonia (n=7), laryngeal spasm (n=6), hypersalivation (n=4), ventricular tachycardia (n=3), and third degree AV block (n=1). Median days from onset of clinical signs until first signs of improvement were 10 days (range: 9,12 days). Median hospitalisation time was 18 days (range: 14,22 days). Six animals showed full recovery and 8 animals died or were euthanized. Death was associated with acute onset of ventricular tachycardia in 2 dogs, 1 dog died with non-responsive third degree AV-block, 3 dogs died after developing aspiration pneumonia, and 1 dog died of unknown causes. [source] Treatment of a Myasthenic Dog with Mycophenolate MofetilJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 3 2000C.W. Dewey DVM, DACVIM (Neurology), DACVS Summary A ten-year-old, male castrated Springer Spaniel was presented for dysphagia, ptyalism, and regurgitation. Evidence of megaesophagus and mild aspiration pneumonia were apparent on thoracic radiographs. A diagnosis of focal acquired myasthenia gravis was suspected and subsequently confirmed with a positive serum acetylcholine (ACh) receptor antibody concentration (3.87 nM/L). A gastrostomy tube was placed shortly after presentation; food and drugs (including azathioprine) were administered through the tube. After transient improvement, the dog suddenly deteriorated clinically, experiencing frequent episodes of regurgitation and developing severe aspiration pneumonia. Mycophenolate mofetil (MMF), a novel immunosuppressive drug with relative specificity for lymphocytes, was instituted every twelve hours via the gastrostomy tube. Within four days of beginning MMF therapy, both clinical evidence of pharyngeal/esophageal dysfunction and radiographic evidence of megaesophagus had resolved. Initially, clinical side-effects of combined MMF/AZA administration were not apparent, but the patient experienced several vomiting episodes during the third week of treatment. The vomiting resolved after decreasing the dose of both drugs. The patient made a full recovery, and a one-month follow-up ACh receptor antibody concentration was normal (0.26 nM/L). After one month of combination therapy, the patient was weaned off of AZA and maintained on MMF as the sole immunosuppressive drug. The dog was subsequently weaned off of MMF on two occasions. Mycophenolate mofetil was reinstituted after the first discontinuation due to the development of profound appendicular muscle weakness two days after stopping MMF; the weakness resolved within 24 hours of reinstituting MMF. A positive ACh receptor antibody concentration (0.89 nM/L) after the second MMF weaning prompted the second reinstitution of MMF. Two months following this second MMF reinstitution, the dog was again serologically negative (0.51 nM/L) for myasthenia gravis. At the time of last followup, the dog remained in clinical remission eight months after initial presentation. The use of MMF to treat acquired myasthenia gravis in dogs has not been reported previously. The literature concerning MMF and its potential use in treating patients with autoimmune diseases is discussed. [source] Cross-Linked Poly(, -caprolactone/D,L -lactide) Copolymers with Elastic PropertiesMACROMOLECULAR CHEMISTRY AND PHYSICS, Issue 18 2002Antti O. Helminen Abstract Cross-linked , -caprolactone (CL) and D,L -lactide (DLLA) copolymers with elastic properties were synthesized in three steps. First, the monomers were copolymerized in ring-opening polymerization to obtain telechelic star-shaped oligomers with almost completely random monomer distribution. The oligomers were methacrylated with methacrylic anhydride in the second step and cured in a third. Molar CL/DLLA compositions of 30/70, 50/50, 70/30, 90/10, and 100/0 were used to obtain elastic structures with a wide range of properties. The effect of the average length of the copolymer block on the properties of the networks was evaluated with three different co-initiator contents (0.5, 1.0, and 2.0/100) in the oligomer synthesis. The oligomers were characterized by 13C NMR spectroscopy, size-exclusion chromatography (SEC), and differential-scanning calorimetry (DSC). The formation of elastic networks was confirmed by the absence of a flow region in dynamic mechanical analysis (DMA), the increase in Tg in DSC, and the full recovery of the sample dimensions after tensile testing. In addition, gel contents were high and the samples swelled in CH2Cl2. The networks possessed break stresses from 0.7,9.7 MPa with elongations from 80,350%. Networks with 100 or 90% of , -caprolactone retained their form in vitro for 12 weeks, but an increase in lactide content made the networks more vulnerable to hydrolysis. Water absorption of the polymers during hydrolysis. [source] Restored Atrial Excitability After Late Recanalization in a Patient with Atrial Standstill and Acute Myocardial InfarctionPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2002TAKA-AKI KOSHIMIZU KOSHIMIZU, T-A., et al.: Restored Atrial Excitability After Late Recanalization in a Patient with Atrial Standstill and Acute Myocardial Infarction. Atrial standstill is electrophysiologically characterized by the loss of spontaneous excitation in atrial muscle and the inability to cause action potential firing upon electrical stimulation. Clinical diagnosis of transient standstill of the right atrium was made in a patient with acute occlusion of the right coronary artery and acute renal failure. Percutaneous coronary intervention, performed 5 days after the onset, restored the coronary blood flow and resulted in full recovery of electrical activity and regular sinus rhythm. [source] APA national audit of pediatric opioid infusionsPEDIATRIC ANESTHESIA, Issue 2 2010FFPMRCA, FRCPCH, NEIL S. MORTON MD Summary Introduction:, A prospective audit of neonates, infants, and children receiving opioid infusion techniques managed by pediatric acute pain teams from across the United Kingdom and Eire was undertaken over a period of 17 months. The aim was to determine the incidence, nature, and severity of serious clinical incidents (SCIs) associated with the techniques of continuous opioid infusion, patient-controlled analgesia, and nurse-controlled analgesia in patients aged 0,18. Methods:, The audit was funded by the Association of Paediatric Anaesthetists (APA) and performed by the acute pain services of 18 centers throughout the United Kingdom. Data were submitted weekly via a web-based return form designed by the Document Capture Company that documented data on all patients receiving opioid infusions and any SCIs. Eight categories of SCI were identified in advance, and the reported SCIs were graded in terms of severity (Grade 1 (death/permanent harm); Grade 2 (harm but full recovery and resulting in termination of the technique or needing significant intervention); Grade 3 (potential but no actual harm). Data were collected over a period of 17 months (25/06/07-25/11/08) and stored on a secure server for analysis. Results:, Forty-six SCIs were reported in 10 726 opioid infusion techniques. One Grade 1 incident (1 : 10 726) of cardiac arrest occurred and was associated with aspiration pneumonitis and the underlying neurological condition, neurocutaneous melanosis. Twenty-eight Grade 2 incidents (1 : 383) were reported of which half were respiratory depression. The seventeen Grade 3 incidents (1 : 631) were all drug errors because of programming or prescribing errors and were all reported by one center. Conclusions:, The overall incidence of 1 : 10 000 of serious harm with opioid infusion techniques in children is comparable to the risks with pediatric epidural infusions and central blocks identified by two recent UK national audits (1,2). Avoidable factors were identified including prescription and pump programming errors, use of concurrent sedatives or opioids by different routes and overgenerous dosing in infants. Early respiratory depression in patients with specific risk factors, such as young age, neurodevelopmental, respiratory, or cardiac comorbidities, who are receiving nurse-controlled analgesia or continuous opioid infusion suggests that closer monitoring for at least 2 h is needed for these cases. As a result of this audit, we can provide parents with better information on relative risks to help the process of informed consent. [source] Impact of acute cellular rejection on coagulation and fibrinolysis biomarkers within the immediate post-operative period in pediatric liver transplantationPEDIATRIC TRANSPLANTATION, Issue 3 2010Jun Mimuro Mimuro J, Mizuta K, Kawano Y, Hishikawa S, Hamano A, Kashiwakura Y, Ishiwata A, Ohmori T, Madoiwa S, Kawarasaki H, Sakata Y. Impact of acute cellular rejection on coagulation and fibrinolysis biomarkers within the immediate post-operative period in pediatric liver transplantation. Pediatr Transplantation 2010:14: 396,376. © 2009 John Wiley & Sons A/S. Abstract:, We studied restoration of the coagulation and fibrinolysis system in pediatric patients following liver transplantation and biomarkers of blood coagulation and fibrinolysis for suspecting the occurrence of acute cellular rejection. Coagulation activity recovered rapidly within two days following transplantation, but it took approximately 21,28 days for full recovery of the coagulation and fibrinolysis factors synthesized in the liver. PAI-1 levels were significantly higher in patients at the time of acute cellular rejection compared with levels after control of AR, and levels on days 14 and 28 in patients without AR. Plasma protein C and plasminogen levels at the time of rejection were significantly lower than those on day 14 in patients without AR. Statistical analysis suggested that an increase in plasma PAI-1 at a single time point in the post-operative period is a reliable marker among the coagulation and fibrinolysis factors for suspecting the occurrence of acute cellular rejection. These data suggested that appropriate anticoagulation may be required for 14 days after liver transplantation in order to avoid vascular complications and measurement of plasma PAI-1 levels may be useful for suspecting the occurrence of acute cellular rejection in pediatric patients following liver transplantation. [source] Sub-lethal responses of the large pine weevil, Hylobius abietis, to the pyrethroid insecticide lambda-cyhalothrinPHYSIOLOGICAL ENTOMOLOGY, Issue 4 2006D. ROSE Abstract The response of the large pine weevil (Hylobius abietis) to the pesticide lambda-cyhalothrin, a pyrethroid, is investigated. Both behavioural (feeding preferences) and nutritional and physiological (lipid content) responses are recorded. Hylobius abietis shows both a significant avoidance of pesticide-treated food sources and a decrease in lipid content after exposure, but a full recovery after feeding on untreated food. It is proposed that the mechanism for the pesticide avoidance and altered lipid levels is due to an anti-feedant effect of the pesticide. Implications for pest management programmes are described. [source] Case Report: Extracorporeal Membrane Oxygenation in Nonintubated Patients as Bridge to Lung TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010K. M. Olsson We report on the use of veno-arterial extracorporeal membrane oxygenation (ECMO) as a bridging strategy to lung transplantation in awake and spontaneously breathing patients. All five patients described in this series presented with cardiopulmonary failure due to pulmonary hypertension with or without concomitant lung disease. ECMO insertion was performed under local anesthesia without sedation and resulted in immediate stabilization of hemodynamics and gas exchange as well as recovery from secondary organ dysfunction. Two patients later required endotracheal intubation because of bleeding complications and both of them eventually died. The other three patients remained awake on ECMO support for 18,35 days until the time of transplantation. These patients were able to breathe spontaneously, to eat and drink, and they received passive and active physiotherapy as well as psychological support. All of them made a full recovery after transplantation, which demonstrates the feasibility of using ECMO support in nonintubated patients with cardiopulmonary failure as a bridging strategy to lung transplantation. [source] | ||||||||||||||||||||||||||||||||||||||||