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High Possibility (high + possibility)
Selected AbstractsIncidence, management and mortality of acute hypoxemic respiratory failure and acute respiratory distress syndrome from a prospective study of Chinese paediatric intensive care networkACTA PAEDIATRICA, Issue 5 2010X Hu Abstract Aim:, To investigate the incidence, clinical management, mortality and its risk factors, major outcome and costs of acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) in a Chinese network of 26 paediatric intensive care unit (PICU). Methods: In a consecutive 12-month period, AHRF and ARDS were identified and followed up for 90 days or until death or discharge. Results:, From a total of 11 521 critically ill patients, 461 AHRF were identified in which 306 developed ARDS (66.4%), resulting in incidences of 4% and 2.7%, respectively, with pneumonia (75.1%) and sepsis (14.7%) as main underlying diseases and 83% were 5 years and 1 month-old. In-hospital mortality of AHRF was 41.6% (44.8% for ARDS), accounted for 15.5% of all PICU deaths. For those of pneumonia or sepsis with AHRF and ARDS, mortality and its relative risk were significantly higher than those without. Relatively lower tidal volume and total fluid balance, adequate upper limit of PaCO2 in the early PICU days, and family affordability, tended to result in better outcome. Conclusion:, In this prospective study, AHRF had high possibilities to develop ARDS and death risk, as impacted by ventilation settings and fluid intake in the early treatment, as well as socioeconomic factors, which should be considered for implementation of standard of care in respiratory therapy. [source] Hepatectomy of living donors with a left-sided gallbladder and multiple combined anomalies for adult-to-adult living donor liver transplantationLIVER TRANSPLANTATION, Issue 1 2004Shin Hwang The left-sided gallbladder is very rare, but it is often accompanied by multiple anomalies of the liver, by which living donor hepatectomy cannot be feasible or becomes difficult. We have experienced 3 donors with a left-sided gallbladder out of 642 living donors. The first case was a male donor showing bifurcating portal anomaly with intrahepatic right portal vein confluence and extremely low bifurcation of the bile ducts. The right lobe was retrieved and implanted to his father. The second case was a male donor revealing trifurcating portal anomaly with separate right posterior portal branch and replacing right posterior hepatic artery. The right posterior segment graft was retrieved and implanted to his uncle. The third case was a male volunteer in whom the anterior portion of the medial segment was fed by an aberrant branch of the right anterior segment glisson. The small left lobe was retrieved and implanted simultaneously with another living donor's left lobe graft in the form of a dual living donor liver transplantation. There was no donor morbidity or recipient complication. Although there is a high possibility of diverse liver anomalies in living donors with a left-sided gallbladder, complete preoperative evaluation and mapping of the multiple anatomical variations may make certain types of living donor hepatectomy feasible. (Liver Transpl 2004;10:141,146.) [source] Evaluation of the Impeller Shroud Performance of an Axial Flow Ventricular Assist Device Using Computational Fluid DynamicsARTIFICIAL ORGANS, Issue 9 2010Boyang Su Abstract Generally, there are two types of impeller design used in the axial flow blood pumps. For the first type, which can be found in most of the axial flow blood pumps, the magnet is embedded inside the impeller hub or blades. For the second type, the magnet is embedded inside the cylindrical impeller shroud, and this design has not only increased the rotating stability of the impeller but has also avoided the flow interaction between the impeller blade tip and the pump casing. Although the axial flow blood pumps with either impeller design have been studied individually, the comparisons between these two designs have not been conducted in the literature. Therefore, in this study, two axial flow blood pumps with and without impeller shrouds were numerically simulated with computational fluid dynamics and compared with each other in terms of hydraulic and hematologic performances. For the ease of comparison, these two models have the same inner components, which include a three-blade straightener, a two-blade impeller, and a three-blade diffuser. The simulation results showed that the model with impeller shroud had a lower static pressure head with a lower hydraulic efficiency than its counterpart. It was also found that the blood had a high possibility to deposit on the impeller shroud inner surface, which greatly enhanced the possibility of thrombus formation. The blood damage indices in both models were around 1%, which was much lower than the 13.1% of the axial flow blood pump of Yano et al. with the corresponding experimental hemolysis of 0.033 g/100 L. [source] Management of congenital nasolacrimal duct obstructionACTA OPHTHALMOLOGICA, Issue 5 2010Yasuhiro Takahashi Abstract. Our review aims to provide an update of management protocols for congenital nasolacrimal duct obstruction (CNDO). Although early probing performed before the age of 1 year was traditionally recommended, many reports have since confirmed high frequencies of spontaneous resolution during the first year of life. Accordingly, a ,wait-and-see' approach, combined with conservative therapies, is judged to be the best option in infants aged < 1 year. By contrast, persistent obstruction beyond 1 year of age warrants probing as a first-line interventional therapy. However, the optimal timing for probing remains controversial. Although there remains a high possibility of spontaneous resolution after the first year of age, this must be balanced against the decrease in success rates for probing that accompanies advancing age. If conservative management fails, persistent CNDO beyond 1 year of age should be managed either by further observation or by primary probing according to the severity of symptoms. In patients in whom probing fails, advanced treatment such as balloon catheter dilation, silicone tube intubation or dacryocystorhinostomy may be considered. [source] Ventricular tachyarrhythmia associated with cardiac sarcoidosis: Its mechanisms and outcomeCLINICAL CARDIOLOGY, Issue 4 2004Hiroshi Furushima M.D. Abstract Background: Cardiac sarcoidosis is increasingly recognized and is associated with poor prognosis. Ventricular tachycardia (VT) associated with cardiac sarcoidosis is the most likely cause of sudden death in most patients, but the mechanism has not been well established. Hypothesis: This study investigated the mechanisms and outcome of VT associated with cardiac sarcoidosis. Methods: The study included eight consecutive patients (five men, three women, aged 54 ± 19 years) who had sustained monomorphic VT associated with cardiac sarcoidosis in our hospital. Results: The average ejection fraction was 43 ± 11%. Twenty-two VTs were observed in these patients, and mean heart rate during VT was 192 ± 29 beats/min (range 144,259). The phenomenon of transient entrainment was documented in 10 of 22 (45%) VTs by ventricular pacing (eight in the active phase). Another five (23%) VTs could not be entrained, but could be initiated by programmed stimulation and terminated by rapid pacing, reproducibly. In 3 of the 22 (14%) VTs, cardioversion was required urgently because of the fast rate, while the remaining 4 (18%) could be induced during electrophysiologic study. Conclusions: In this study, there was a high possibility that the mechanism of 15 (68%) VTs was reentry. Reentrant substrate is formed not only in association with the healing of cardiac granulomas in the inactive phase of cardiac sarcoidosis but also in the active phase. Ventricular tachycardia with cardiac sarcoidosis, even if this mechanism is reentry, has different inducibility between the active and inactive phases in an electrophysiologic study. This makes the therapy for cardiac sarcoidosis (e.g., corticosteroids, antiarrhythmic agents, and catheter ablation) difficult. The implantable cardioverter-defibrillator is an effective treatment for ventricular tachyarrythmia with cardiac sarcoidosis. [source] | ||||||||||