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Sample records for intra-operative intravenous fluid

  1. Evaluation of the effect of intra-operative intravenous fluid on post-operative pain and pulmonary function: a randomized trial comparing 10 and 30 ml kg(-1) of crystalloid.

    LENUS (Irish Health Repository)

    Straub, B D

    2013-12-10

    Existing evidence suggests that administration of intravenous fluids has been shown to improve outcomes including pain in gynecological laparoscopic surgery but the optimum fluid dose has not been determined.

  2. Intra-Operative Amylase Concentration in Peri-Pancreatic Fluid Predicts Pancreatic Fistula After Distal Pancreatectomy

    NARCIS (Netherlands)

    Nahm, C.B.; Reuver, P.R.; Hugh, T.J.; Pearson, A.; Gill, A.J.; Samra, J.S.; Mittal, A.

    2017-01-01

    Post-operative pancreatic fistula (POPF) is a potentially severe complication following distal pancreatectomy. The aim of this study was to assess the predictive value of intra-operative amylase concentration (IOAC) in peri-pancreatic fluid after distal pancreatectomy for the diagnosis of POPF.

  3. Intra-Operative Amylase Concentration in Peri-Pancreatic Fluid Predicts Pancreatic Fistula After Distal Pancreatectomy.

    Science.gov (United States)

    Nahm, Christopher B; de Reuver, Philip R; Hugh, Thomas J; Pearson, Andrew; Gill, Anthony J; Samra, Jaswinder S; Mittal, Anubhav

    2017-06-01

    Post-operative pancreatic fistula (POPF) is a potentially severe complication following distal pancreatectomy. The aim of this study was to assess the predictive value of intra-operative amylase concentration (IOAC) in peri-pancreatic fluid after distal pancreatectomy for the diagnosis of POPF. Consecutive patients who underwent a distal pancreatectomy between November 2014 and September 2016 were included in the analysis. IOAC was measured, followed by drain fluid analysis for amylase on post-operative days (PODs) 1, 3, and 5. Receiver operator characteristic (ROC) analysis was performed to evaluate the discriminative capacity of IOAC as a predictor of POPF. IOAC was measured after distal pancreatectomy in 26 patients. The IOAC correlated significantly with (i) PODs 1, 3, and 5 drain amylase (p  1000 experienced a post-operative complication (OR 18.3, 95% CI 2.51-103, p pancreatectomy.

  4. Intravenous fluids: balancing solutions.

    Science.gov (United States)

    Hoorn, Ewout J

    2017-08-01

    The topic of intravenous (IV) fluids may be regarded as "reverse nephrology", because nephrologists usually treat to remove fluids rather than to infuse them. However, because nephrology is deeply rooted in fluid, electrolyte, and acid-base balance, IV fluids belong in the realm of our specialty. The field of IV fluid therapy is in motion due to the increasing use of balanced crystalloids, partly fueled by the advent of new solutions. This review aims to capture these recent developments by critically evaluating the current evidence base. It will review both indications and complications of IV fluid therapy, including the characteristics of the currently available solutions. It will also cover the use of IV fluids in specific settings such as kidney transplantation and pediatrics. Finally, this review will address the pathogenesis of saline-induced hyperchloremic acidosis, its potential effect on outcomes, and the question if this should lead to a definitive switch to balanced solutions.

  5. Sublingual misoprostol is as effective as intravenous oxytocin to reduce intra-operative blood loss during cesarean delivery in women living at high altitude.

    Science.gov (United States)

    Gavilanes, Patricio; Morales, Maria Fernanda; Velasco, Stiward; Teran, Enrique

    2016-01-01

    To assess the effect of sublingual misoprostol compared to intravenous oxytocin for blood loss during cesarean delivery in women living at high altitude. In a randomized trial, conducted in Quito, Ecuador (2800 m above sea level), 100 women received either sublingual misoprostol (400 µg) or intravenous oxytocin (10 IU). Bleeding in the misoprostol was no different than in the oxytocin group. Shivering was reported in 66% of women in the misoprostol group. Sublingual misoprostol might be a valid alternative to oxytocin reduce intra-operative blood loss during cesarean section in women living at high altitude.

  6. Intravenous fluids in acute decompensated heart failure.

    Science.gov (United States)

    Bikdeli, Behnood; Strait, Kelly M; Dharmarajan, Kumar; Li, Shu-Xia; Mody, Purav; Partovian, Chohreh; Coca, Steven G; Kim, Nancy; Horwitz, Leora I; Testani, Jeffrey M; Krumholz, Harlan M

    2015-02-01

    This study sought to determine the use of intravenous fluids in the early care of patients with acute decompensated heart failure (HF) who are treated with loop diuretics. Intravenous fluids are routinely provided to many hospitalized patients. We conducted a retrospective cohort study of patients admitted with HF to 346 hospitals from 2009 to 2010. We assessed the use of intravenous fluids during the first 2 days of hospitalization. We determined the frequency of adverse in-hospital outcomes. We assessed variation in the use of intravenous fluids across hospitals and patient groups. Among 131,430 hospitalizations for HF, 13,806 (11%) were in patients treated with intravenous fluids during the first 2 days. The median volume of administered fluid was 1,000 ml (interquartile range: 1,000 to 2,000 ml), and the most commonly used fluids were normal saline (80%) and half-normal saline (12%). Demographic characteristics and comorbidities were similar in hospitalizations in which patients did and did not receive fluids. Patients who were treated with intravenous fluids had higher rates of subsequent critical care admission (5.7% vs. 3.8%; p fluid treatment varied widely across hospitals (range: 0% to 71%; median: 12.5%). Many patients who are hospitalized with HF and receive diuretics also receive intravenous fluids during their early inpatient care, and the proportion varies among hospitals. Such practice is associated with worse outcomes and warrants further investigation. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  7. Intra-operative on-line discrimination of kidney cancer from normal tissue by IR ATR spectroscopy of extracellular fluid

    Science.gov (United States)

    Urboniene, V.; Velicka, M.; Ceponkus, J.; Pucetaite, M.; Jankevicius, F.; Sablinskas, V.; Steiner, G.

    2016-03-01

    Determination of cancerous and normal kidney tissues during partial, simple or radical nephrectomy surgery was performed by using differences in the IR absorption spectra of extracellular fluid taken from the corresponding tissue areas. The samples were prepared by stamping of the kidney tissue on ATR diamond crystal. The spectral measurements were performed directly in the OR during surgery for 58 patients. It was found that intensities of characteristic spectral bands of glycogen (880-1200 cm-1) in extracellular fluid are sensitive to the type of the tissue and can be used as spectral markers of tumours. Characteristic spectral band of lactic acid (1730 cm-1) - product of the anaerobic glycolysis, taking place in the cancer cells is not suitable for use as a spectral marker of cancerous tissue, since it overlaps with the band of carbonyl stretch in phospholipids and fatty acids. Results of hierarchical cluster analysis of the spectra show that the spectra of healthy and tumour tissue films can be reliably separated into two groups. On the other hand, possibility to differentiate between tumours of different types and grades remains in question. While the fluid from highly malignant G3 tumour tissue contains highly pronounced glycogen spectral bands and can be well separated from benign and G1 tumours by principal component analysis, the variations between spectra from sample to sample prevent from obtaining conclusive results about the grouping between different tumour types and grades. The proposed method is instant and can be used in situ and even in vivo.

  8. Microbiological quality of some brands of intravenous fluids ...

    African Journals Online (AJOL)

    Microbiological quality of some brands of intravenous fluids produced by some pharmaceutical companies in Nigeria was investigated. Membrane filtration method was used for concentration of contaminating organisms in the intravenous fluids. Thioglycollate medium, Tryptone Soya broth, Brilliant Green Agar ...

  9. Portable Intravenous Fluid Production Device for Ground Use

    Data.gov (United States)

    National Aeronautics and Space Administration — There are several medical conditions require the administration of intravenous (IV) fluids, but limitations of mass, volume, shelf-life, transportation, and local...

  10. Intra-operative cholangiography for the diagnosis of choledocholithiasis

    International Nuclear Information System (INIS)

    Raab, M.; Schroeder, A.

    1987-01-01

    521 patients with benign disorders of the extrahepatic bile duct system were examined retrospectively. Bile duct stones suspected by pre-operative intravenous cholangiography could be verified by surgery in but 41,6% of the cases. Routine intra-operative cholangiography was not performed in those cases with pre-operative indication of choledocus revision and with rare failure of cystic duct cannulation. Evaluation of 448 intra-operative cholangiographies revealed the diagnosis of choledocholithiasis to be false positive in 3,3% and false negative in 1,1%. Intra-operative X-ray examination allowed to diagnose 45 cases of choledocholithiasis subsequently verified by surgery. Most of these patients exhibited clinical signs (transient jaundice, changes in blood chemistry). Follow-up identified two patients whose bile duct stones had been overlooked. (orig.) [de

  11. Intra-operative cholangiography for the diagnosis of choledocholithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Raab, M.; Schroeder, A.

    1987-01-01

    521 patients with benign disorders of the extrahepatic bile duct system were examined retrospectively. Bile duct stones suspected by pre-operative intravenous cholangiography could be verified by surgery in but 41,6% of the cases. Routine intra-operative cholangiography was not performed in those cases with pre-operative indication of choledocus revision and with rare failure of cystic duct cannulation. Evaluation of 448 intra-operative cholangiographies revealed the diagnosis of choledocholithiasis to be false positive in 3,3% and false negative in 1,1%. Intra-operative X-ray examination allowed to diagnose 45 cases of choledocholithiasis subsequently verified by surgery. Most of these patients exhibited clinical signs (transient jaundice, changes in blood chemistry). Follow-up identified two patients whose bile duct stones had been overlooked.

  12. Microbiological quality of some brands of intravenous fluids ...

    African Journals Online (AJOL)

    SERVER

    2007-10-04

    Oct 4, 2007 ... cases of circulation of contaminated intravenous fluids in hospitals in Nigeria. Some deaths and diseases condi- tions have been attributed to use of these microbiolo- gically unfit fluids. The Nigerian National Agency for. Food, Drug Administration and Control (NAFDAC), have on many occasions ordered ...

  13. Early feeding and discontinuation of intravenous fluid after laparoscopic cholecystectomy.

    Science.gov (United States)

    Shah, J N; Maharjan, S B; Manandhar, K; Paudyal, S; Shrestha, S; Shah, S; Lamichhane, D

    2012-01-01

    Common practice at most centers in the country is to continue intravenous (i.v.) fluid till morning round next day following laparoscopic cholecystectomy (LC), assess patient and gradually allow oral diet. However this seems unnecessary in view of fast recovery after minimal invasive LC. The aim of this study was to observe the prospects and assess the acceptability, safety and benefit of early oral feeding and discontinuing i.v. fluid after LC. This cross-sectional observational study was carried out prospectively from Oct 1, 2009 to Sep 31, 2010 at Patan Hospital, a university teaching hospital. All elective LC patients were included. Oral liquid was introduced after four hours and i.v. fluid was stopped after six hr of LC. I.v. cannula was kept locked in situ. Vomiting, abdomen distension and reasons for continuation or resumption of i.v. fluids were recorded. During one year period 294 LC patients fulfilled study criteria. Average age was 40.8 years. Female accounted for 78.2%. Oral fluid was started in average of 5.5 hrs in 97%. In 3% (9/294) i.v. was continued. Postoperative nausea and vomiting was observed in 25.9% (76/294), of which 6.6% (5/76) required i.v.. There was no untoward affect after i.v. fluid was stopped. Early oral feeding and discontinuing of intravenous fluid in laparoscopic cholecystectomy is safe, economic and well accepted by patients, family and nursing staff in Patan hospital.

  14. Intravenous fluid restriction after major abdominal surgery: A randomized blinded clinical trial

    NARCIS (Netherlands)

    H. Vermeulen (Hester); J. Hofland (Johannes); D.A. Legemate (Dink); D.T. Ubbink (Dirk)

    2009-01-01

    textabstractBackground: Intravenous (IV) fluid administration is an essential part of postoperative care. Some studies suggest that a restricted post-operative fluid regime reduces complications and postoperative hospital stay after surgery. We investigated the effects of postoperative fluid

  15. Final Report for Intravenous Fluid Generation (IVGEN) Spaceflight Experiment

    Science.gov (United States)

    McQuillen, John B.; McKay, Terri L.; Griffin, DeVon W.; Brown, Dan F.; Zoldak, John T.

    2011-01-01

    NASA designed and operated the Intravenous Fluid Generation (IVGEN) experiment onboard the International Space Station (ISS), Increment 23/24, during May 2010. This hardware was a demonstration experiment to generate intravenous (IV) fluid from ISS Water Processing Assembly (WPA) potable water using a water purification technique and pharmaceutical mixing system. The IVGEN experiment utilizes a deionizing resin bed to remove contaminants from feedstock water to a purity level that meets the standards of the United States Pharmacopeia (USP), the governing body for pharmaceuticals in the United States. The water was then introduced into an IV bag where the fluid was mixed with USP-grade crystalline salt to produce USP normal saline (NS). Inline conductivity sensors quantified the feedstock water quality, output water purity, and NS mixing uniformity. Six 1.5-L bags of purified water were produced. Two of these bags were mixed with sodium chloride to make 0.9 percent NS solution. These two bags were returned to Earth to test for compliance with USP requirements. On-orbit results indicated that all of the experimental success criteria were met with the exception of the salt concentration. Problems with a large air bubble in the first bag of purified water resulted in a slightly concentrated saline solution of 117 percent of the target value of 0.9 g/L. The second bag had an inadequate amount of salt premeasured into the mixing bag resulting in a slightly deficient salt concentration of 93.8 percent of the target value. The USP permits a range from 95 to 105 percent of the target value. The testing plans for improvements for an operational system are also presented.

  16. Conceptual design of intravenous fluids level monitoring system - a review

    Science.gov (United States)

    Verma, Prikshit; Padmani, Aniket; Boopathi, M.

    2017-11-01

    In today’s world of automation, there are advancements going on in all the fields. Each work is being automated day by day. However, if we see our current medical care system, some areas require manual caretaker and are loaded with heavy jobs, which consumes a lot of time. Nevertheless, since the work is related to human health, it should be properly done and that too with accuracy. An example of such a particular work is injecting saline or Intravenous (IV) fluids in a patient. The monitoring of such fluids needs utter attention as if the bottle of the fluid is not changed on time, it may lead to various problems for the patients like backflow of blood, blood loss etc. Various researches have been performed to overcome such critical situation. Different monitoring and alerting techniques are described in different researches. So, in our study, we will go through the researches done in this particular field and will see how different ideas are implemented.

  17. Portable Intravenous Fluid Production Device For Ground Use Project

    Science.gov (United States)

    Oliva-Buisson, Yvette J.

    2014-01-01

    Several medical conditions require the administration of intravenous (IV) fluids,but limitations of mass, volume, shelf-life, transportation, and local resources can restrict the availability of these important fluids. Such limitations are expected in long-duration space exploration missions and in remote or austere places on Earth. This design uses regular drinking water that is pumped through two filters to produce, in minutes, sterile, ultrapure water that meets the stringent quality standards of the United States Pharmacopeia for Water for Injection (Total Bacteria, Conductivity, Endo - toxins, Total Organic Carbon). The device weighs 2.2 lb (1 kg) and is 10 in. long, 5 in. wide, and 3 in. high (˜25, 13, and 7.5 cm, respectively) in its storage configuration. This handheld device produces one liter of medical-grade water in 21 minutes. Total production capacity for this innovation is expected to be in the hundreds of liters. The device contains one battery powered electric mini-pump. Alternatively, a manually powered pump can be attached and used. Drinking water enters the device from a source water bag, flows through two filters, and final sterile production water exits into a sealed, medical-grade collection bag. The collection bag contains pre-placed crystalline salts to mix with product water to form isotonic intravenous medical solutions. Alternatively, a hypertonic salt solution can be injected into a filled bag. The filled collection bag is detached from the device and is ready for use or storage. This device currently contains one collection bag, but a manifold of several pre-attached bags or replacement of single collection bags under sterile needle technique is possible for the production of multiple liters. The entire system will be flushed, sealed, and radiation-sterilized. Operation of the device is easy and requires minimal training. Drinking water is placed into the collection bag. Inline stopcock flow valves at the source and collection bags

  18. Intravenous fluids: should we go with the flow?

    Science.gov (United States)

    Kozek-Langenecker, Sibylle A

    2015-01-01

    Sensitive monitoring should be used when prescribing intravenous fluids for volume resuscitation. The extent and duration of tissue hypoperfusion determine the severity of cellular damage, which should be kept to a minimum with timely volume substitution. Optimizing the filling status to normovolaemia may boost the resuscitation success. Macrocirculatory pressure values are not sensitive in this indication. While the Surviving Sepsis Campaign guidelines focus on these conventional pressure parameters, the guidelines from the European Society of Anaesthesiology (ESA) on perioperative bleeding management recommend individualized care by monitoring the actual volume status and correcting hypovolaemia promptly if present. The motto is: 'give what is missing'. The credo of the ESA guidelines is to use management algorithms with predefined intervention triggers. Stop signals should help in avoiding hyper-resuscitation. The high-quality evidence-based S3 guidelines on volume therapy in adults have recently been prepared by 14 German scientific societies. Statements include, for example, repeated clinical inspection including turgor of the skin and mucosa. Adjunctive laboratory parameters such as central venous oxygen saturation, lactate, base excess and haematocrit should be considered. The S3 guidelines propose the use of flow-based and/or dynamic preload parameters for guiding volume therapy. Fluid challenges and/or the leg-raising test (autotransfusion) should be performed. The statement from the Co-ordination group for Mutual Recognition and Decentralized Procedures-Human informs healthcare professionals to consider applying individualized medicine and using sensitive monitoring to assess hypovolaemia. The authorities encourage a personalized goal-directed volume resuscitation technique.

  19. Intra-operative radiation treatment of cancers

    International Nuclear Information System (INIS)

    Dubois, J.B.; Joyeux, H.; Solassol, C.; Pujol, H.

    1986-01-01

    Intra-operative radiation treatment (I.O.R.T.) is concerning the treatment either of an unresectable tumor or of tumor bed after complete excision of a primary tumor and its first draining lymph nodes. We describe X-ray and electrons techniques and we discuss the delivered doses according to experimental and clinical data. According to the residual disease (macroscopic or microscopic), to the healthy tissues in the target volume, and the histological type, single doses from 20 Gy to 40 Gy can be delivered. Our preliminary results are reported: 25 patients with resectable tumors of the cardia, the stomach and the pancreas, 5 patients with pelvic recurrences of colon and rectum carcinomas. Therapeutic results of the I.O.R.T. providing from the literature are discussed. The I.O.R.T. indications are defined as palliative (unresectable tumors) and curative (irradiation of tumor bed after complete excision of the tumor) [fr

  20. Maternal intravenous fluids and postpartum breast changes: a pilot observational study.

    Science.gov (United States)

    Kujawa-Myles, Sonya; Noel-Weiss, Joy; Dunn, Sandra; Peterson, Wendy E; Cotterman, Kermaline Jean

    2015-01-01

    The current breastfeeding initiation rate in Canada is approximately 87%. By one month, about 21% of women have stopped breastfeeding. Engorgement and edema in breast tissue can lead to breastfeeding challenges which may contribute to early weaning. The aims of this pilot research study were to explore the relationship between intrapartum intravenous fluids given to mothers and postpartum breast swelling in the first 10 days postpartum and to determine if a larger study was warranted and feasible. A prospective, longitudinal, observational cohort pilot study with repeated measures and a within-subjects design was completed. Participants were first time mothers who have a single, healthy newborn and had a spontaneous vaginal birth. Daily data collection from admission into the study until postpartum day 10 took place. Descriptive statistics are reported and linear regression analysis was used to model the relationship between IV therapy and postpartum breast edema. Women who received intravenous fluids during labour had higher levels of breast edema postpartum and rated their breasts as firmer and more tender than women who did not receive intravenous fluids. Participants who had intravenous fluids described patterns of fullness that appeared to be related to edema as opposed to fullness associated with engorgement and lactogenesis II. The findings demonstrate that mothers in this pilot study who received intravenous fluids in labour and postpartum had higher levels of breast edema. These results suggest a larger study is warranted to more fully examine the effects of intravenous fluids on postpartum breast swelling.

  1. Intra-operative complications in sagittal and vertical ramus osteotomies

    NARCIS (Netherlands)

    van Merkesteyn, J. P.; Groot, R. H.; van Leeuwaarden, R.; Kroon, F. H.

    1987-01-01

    In orthognatic surgery of the mandibular ramus, intra-operative complications as a lesion of the inferior alveolar nerve, fractures of the osteotomised segments, incomplete sectioning, malpositioning of segments and haemorrhage may occur. In this report, intra-operative complications in 124 sagittal

  2. Perception of Nigerian anaesthetists on intra-operative death ...

    African Journals Online (AJOL)

    Perception of Nigerian anaesthetists on intra-operative death. SOA Olateju, AT Adenekan, BB Osinaike, OM Fatungase, ON Akanmu, AA Adebayo. Abstract. Background: Intra-operative death is an unusual devastating occurrence in anaesthetic practice, and it is of serious concern when it happens. Objectives: To assess the ...

  3. The incidence and risk factors for intra-operative hypothermia ...

    African Journals Online (AJOL)

    ... at the Kenyatta National Hospital is 30%. Gender (male), lower body temperature at induction, use of caudal block and the volume of intravenous fluids infused were significant independent predictors of core hypothermia. The most significant predictor was body temperature at the time of induction of general anaesthesia.

  4. Physiologic effects of intravenous fluid administration in healthy volunteers

    DEFF Research Database (Denmark)

    Holte, Kathrine; Jensen, Peter; Kehlet, Henrik

    2003-01-01

    Dose regimens in perioperative fluid management are rarely evidence based. Therefore, we investigated responses to an IV fluid infusion in healthy volunteers to assess basic physiologic effects of a fluid infusion per se. In a prospective, double-blinded, cross-randomized study, 12 healthy...... volunteers with a median age of 63 yr (range, 59-67 yr) received an infusion of lactated Ringer's solution 40 mL/kg (median, 2820 mL) or 5 mL/kg (median, 353 mL; background infusion) in random order on two separate occasions. The study was designed to mimic the perioperative course with preoperative fasting...... by fluid administration. These findings may serve as a basis for clinical studies applying the same type of fluid in different amounts to determine the optimal amount of perioperative fluid in various surgical procedures. IMPLICATIONS: Infusion of 40 mL/kg of lactated Ringer's solution in volunteers led...

  5. Physiologic effects of intravenous fluid administration in healthy volunteers

    DEFF Research Database (Denmark)

    Holte, Kathrine; Jensen, Peter; Kehlet, Henrik

    2003-01-01

    , infusion of the fluid over 3 h in the morning, and additionally 24-h hospitalization under standardized conditions. Primary outcome assessments were pulmonary function (spirometry), exercise capacity (submaximal treadmill test), balance function (BalanceMaster), and weight. Infusion of 40 mL/kg of lactated...... by fluid administration. These findings may serve as a basis for clinical studies applying the same type of fluid in different amounts to determine the optimal amount of perioperative fluid in various surgical procedures. IMPLICATIONS: Infusion of 40 mL/kg of lactated Ringer's solution in volunteers led...

  6. A Retrospective Evaluation of Intravenous Fluid Usage in Animal ...

    African Journals Online (AJOL)

    Anorexia, lethargy, salivation, cornea opacity, haematuria and convulsion were observed in 20, 8, 2, 4, 1 and 3 of the patients respectively. Vulval discharge was noted in 1 surgical case while 2 patients had skin wound. The proportion of cases presented with indication for fluid therapy varied significantly (P<0.05) between ...

  7. Physiologic effects of intravenous fluid administration in healthy volunteers

    DEFF Research Database (Denmark)

    Holte, Kathrine; Jensen, Peter; Kehlet, Henrik

    2003-01-01

    , infusion of the fluid over 3 h in the morning, and additionally 24-h hospitalization under standardized conditions. Primary outcome assessments were pulmonary function (spirometry), exercise capacity (submaximal treadmill test), balance function (BalanceMaster), and weight. Infusion of 40 mL/kg of lactated...

  8. Warming of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia.

    Science.gov (United States)

    Campbell, Gillian; Alderson, Phil; Smith, Andrew F; Warttig, Sheryl

    2015-04-13

    Inadvertent perioperative hypothermia (a drop in core temperature to below 36°C) occurs because of interference with normal temperature regulation by anaesthetic drugs, exposure of skin for prolonged periods and receipt of large volumes of intravenous and irrigation fluids. If the temperature of these fluids is below core body temperature, they can cause significant heat loss. Warming intravenous and irrigation fluids to core body temperature or above might prevent some of this heat loss and subsequent hypothermia. To estimate the effectiveness of preoperative or intraoperative warming, or both, of intravenous and irrigation fluids in preventing perioperative hypothermia and its complications during surgery in adults. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 2), MEDLINE Ovid SP (1956 to 4 February 2014), EMBASE Ovid SP (1982 to 4 February 2014), the Institute for Scientific Information (ISI) Web of Science (1950 to 4 February 2014), Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCOhost (1980 to 4 February 2014) and reference lists of identified articles. We also searched the Current Controlled Trials website and ClinicalTrials.gov. We included randomized controlled trials or quasi-randomized controlled trials comparing fluid warming methods versus standard care or versus other warming methods used to maintain normothermia. Two review authors independently extracted data from eligible trials and settled disputes with a third review author. We contacted study authors to ask for additional details when needed. We collected data on adverse events only if they were reported in the trials. We included in this review 24 studies with a total of 1250 participants. The trials included various numbers and types of participants. Investigators used a range of methods to warm fluids to temperatures between 37°C and 41°C. We found that evidence was of moderate quality because descriptions of trial design were

  9. Cefodizime in serum and skin blister fluid after single intravenous and intramuscular doses in healthy volunteers.

    OpenAIRE

    Korting, H C; Schäfer-Korting, M; Maass, L; Klesel, N; Mutschler, E

    1987-01-01

    In gonorrhea therapy, cephalosporins are conventionally administered by intramuscular (i.m.) injection, which rather frequently leads to local side effects. To investigate whether the well-tolerated intravenous (i.v.) injection of cephalosporins may be of comparable gonocidal effect, levels of cefodizime, a new broad-spectrum cephalosporin, in serum and tissue fluid (suction blister and cantharides blister fluid) were determined in six healthy men. Single doses of 1 g of cefodizime were injec...

  10. Pattern of intravenous fluid use at the accident and emergency unit ...

    African Journals Online (AJOL)

    Introduction: The location of University of Benin Teaching Hospital along the Nigerian part of the Trans-Sahara highway, makes it a favourable center, for classical emergencies. The pattern of utilization of intravenous fluid would provide a template for procurement and donation for the institution. Objective: To assess the ...

  11. Effect of warm intravenous and irrigating fluids on body temperature during transurethral resection of the prostate gland

    Directory of Open Access Journals (Sweden)

    Okeke LI

    2007-09-01

    Full Text Available Abstract Background Transurethral resection of the prostate gland with irrigation fluid at room temperature leads to perioperative hypothermia which could give rise to adverse cardiovascular events in the perioperative period. The use of isothermic irrigation fluid reduces but does not eliminate this risk. Routine use of warm intravenous fluids along with isothermic irrigation had not been documented. This study set out to investigate the effect of the use of warm intravenous fluid together with isothermic irrigation fluid on the body temperature in patients undergoing transurethral resection of the prostate gland. Methods One hundred and twenty consented patients with obstructing benign prostatic hyperplasia were randomly assigned to one of 3 groups. Group 1 received irrigation and intravenous fluids at room temperature, group 2 received warmed irrigation fluid at 38°C along with intravenous fluid at room temperature while group 3 patients received warmed irrigation fluid and warmed intravenous fluids at 38°C. Their perioperative body temperature changes were monitored, analyzed and compared. Results The mean decrease in body temperature at the end of the procedure was significantly greater in group 1 (0.98 ± 0.56°C than in group 2 (0.42 ± .21°C (p 0.05 and none of them felt cold or shivered. Conclusion It is concluded that the use of isothermic irrigation fluid together with warm intravenous fluids during TURP prevents the occurrence of perioperative hypothermia. Trial registration number CCT-NAPN-15944

  12. Are postoperative intravenous fluids in patients undergoing elective laparoscopic cholecystectomy a necessity? A randomized clinical trial.

    Science.gov (United States)

    Henriques, Jessimara Ribeiro; Correia, Maria Isabel Toulson Davisson

    2018-04-01

    Intravenous (IV) fluid therapy should be individualized according to each patient's weight, disease, and comorbidities, as well as the type and duration of the operative procedure. Laparoscopic cholecystectomy represents one of the most common, short-duration operations; thus, the aim of this study was to assess the necessity of postoperative administration of IV fluids. A randomized clinical trial with patients undergoing elective laparoscopic cholecystectomy was performed. Patients were randomly assigned to control group (IV fluids at the surgeon's discretion) and study group (no IV fluids after the operation). Body weight and composition, total intravenous fluids, urinary output, creatinine levels, and the presence of thirst and hunger were assessed. Costs related to the administration of postoperative IV fluids were measured. The study and control groups were similar with regard to sex distribution, age, and general characteristics. There was a significant difference in the amount of infused IV fluids (1,600 mL vs 3,000 mL), directly related to the amount offered postoperatively to the control group. Weight, extracellular water, and urinary output (1,257 ± 736 mL vs 888 ± 392 mL; P fluids (r = 0.333). There were no differences in creatinine levels, thirst, hunger, and well-being features. An average of 10.7 minutes per patient of nursing time was required for IV administration. Cost related to IV fluids was increased in the control group. Postoperative intravenous fluids are not necessary in patients undergoing laparoscopic cholecystectomy, and their use is associated with increased nursing time and costs. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Capturing intra-operative safety information using surgical wikis.

    Science.gov (United States)

    Edwards, Michael; Agha, Riaz; Coughlan, Jane

    2013-03-01

    Expert surgeons use a mass of intra-operative information, as well as pre- and post-operative information to complete operations safely. Trainees acquired this intra-operative knowledge at the operating table, now largely diminished by the working time directive. Wikis offer unexplored approaches to capturing and disseminating expert knowledge to further promote safer surgery for the trainee. Grafting an abdominal aortic aneurysm represents a potentially high-risk operation demanding extreme safety measures. Operative details, presented on a surgical wiki in the form of a script and content analysed to classify types of safety information. The intra-operative part of the script contained 2,743 items of essential surgical information, comprising 21 sections, 405 steps and 2,317 items of back-up information; 155 (5.7%) of them were also specific intra-operative safety checks. Best case scenarios consisted of 1,077 items of intra-operative information, 69 of which were safety checks. Worse case and rare scenarios required a further 1,666 items of information, including 86 safety checks. Wikis are relevant to surgical practice specifically as a platform for knowledge sharing and optimising the available operating time of trainees, as a very large amount of minutely detailed information essential for a safe major operation can be captured.

  14. A randomized controlled trial of isotonic versus hypotonic maintenance intravenous fluids in hospitalized children

    Directory of Open Access Journals (Sweden)

    Laforte Diane

    2011-09-01

    Full Text Available Abstract Background Isotonic saline has been proposed as a safer alternative to traditional hypotonic solutions for intravenous (IV maintenance fluids to prevent hyponatremia. However, the optimal tonicity of maintenance intravenous fluids in hospitalized children has not been determined. The objective of this study was to estimate and compare the rates of change in serum sodium ([Na] for patients administered either hypotonic or isotonic IV fluids for maintenance needs. Methods This was a masked controlled trial. Randomization was stratified by admission type: medical patients and post-operative surgical patients, aged 3 months to 18 years, who required IV fluids for at least 8 hours. Patients were randomized to receive either 0.45% or 0.9% saline in 5.0% dextrose. Treating physicians used the study fluid for maintenance; infusion rate and the use of additional fluids were left to their discretion. Results Sixteen children were randomized to 0.9% saline and 21 to 0.45% saline. Baseline characteristics, duration (average of 12 hours and rate of study fluid infusion, and the volume of additional isotonic fluids given were similar for the two groups. [Na] increased significantly in the 0.9% group (+0.20 mmol/L/h [IQR +0.03, +0.4]; P = 0.02 and increased, but not significantly, in the 0.45% group (+0.08 mmol/L/h [IQR -0.15, +0.16]; P = 0.07. The rate of change and absolute change in serum [Na] did not differ significantly between groups. Conclusions When administered at the appropriate maintenance rate and accompanied by adequate volume expansion with isotonic fluids, 0.45% saline did not result in a drop in serum sodium during the first 12 hours of fluid therapy in children without severe baseline hyponatremia. Confirmation in a larger study is strongly recommended. Clinical Trial Registration Number NCT00457873 (http://www.clinicaltrials.gov/

  15. Quality Control of Compounded Crystalloid Fluids for Intravenous Delivery to Horses.

    Science.gov (United States)

    Magnusson, C B; Poulsen, K P; Budde, J A; Hartmann, F A; Aulik, N A; Raabis, S M; Moreira, A S D; Darien, B J; Peek, S F

    2018-01-01

    Periodic lack of availability and high cost of commercially produced isotonic fluids for intravenous (IV) use in horses have increasingly led to use of home-made or commercially compound fluids by veterinarians. Data regarding the quality control and safety of compounded fluids would be of benefit to equine veterinarians. To compare electrolyte concentrations, sterility, and endotoxin contamination of commercially available fluids to 2 forms of compounded isotonic crystalloid fluids intended for IV use in horses. Prospective study. Two methods of preparing compounded crystalloids formulated to replicate commercial Plasma-Lyte A (Abbott, Chicago, IL) were compared. One formulation was prepared by a hand-mixed method involving chlorinated drinking water commonly employed by equine practitioners, and the other was prepared by means of ingredients obtained from a commercial compounding pharmacy. The variables for comparison were electrolyte concentrations, sterility, and presence of endotoxin contamination. Electrolyte concentrations were consistent within each product but different between types of fluids (P fluids had significantly more bacterial contamination compared to commercial Plasma-Lyte A (P = 0.0014). One of the hand-mixed fluid samples had detectable endotoxin contamination. Chlorinated drinking water is not an acceptable source of water to compound isotonic fluids for IV administration. Equine practitioners should be aware of this risk and obtain the informed consent of their clients. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  16. Changes from 2012 to 2015 in intravenous fluid solutions issued to hospital departments

    DEFF Research Database (Denmark)

    Jonsson, A B; Perner, A

    2017-01-01

    BACKGROUND: In recent years, large trials have increased the level of evidence for intravenous (IV) fluid therapy, at least in the intensive care setting. It is less clear whether this change in the evidence base has been associated with changes in IV fluid use in different hospital departments....... METHODS: We obtained details from the regional pharmacy regarding IV fluids issued to hospital departments in the Danish Capitol Region from January 2012 to May 2015. We used paired Wilcoxon's signed-rank test to analyse changes in the issuing in different departments. RESULTS: Total regional issuing...... issued to anaesthesia departments (63%; P = 0.005) and was rarely issued to general surgery and orthopaedic departments. CONCLUSIONS: The issuing of IV fluid solutions to hospital departments has changed markedly over the last years to less colloid, in particular the synthetic solutions, and relatively...

  17. Appropriateness of Intra-Operative Blood Transfusion In Children at ...

    African Journals Online (AJOL)

    Background: The decision to transfuse intra-operatively is based on preoperative haemoglobin (Hb), estimated blood loss and physiological variables. The visual estimate of blood loss is notoriously unreliable especially with small volumes of blood losses in children. Objectives :We sought therefore to determine the ...

  18. Unexpected intra-operative diagnosis of a large cystic ...

    African Journals Online (AJOL)

    draining directly into the inferior vena cava. The patient became. Unexpected intra-operative diagnosis of a large cystic phaeochromocytoma and secondary nifedipine pharmacobezoar. D N Ginther, MD, BSc. Division of General Surgery, Royal University Hospital, Saskatoon, SK, Canada. S Kriegler, MD, MB ChB, MMed, ...

  19. Comparative Study Of Intra-Operative Pelvimetry With Calipers And ...

    African Journals Online (AJOL)

    The pelvic measurement of patients who have had a caesarean section was done using Pelvic Calipers (intra-operative) and x-ray methods. In the former method, during Caesarean sections and after closure of the lower uterine segment incision, a pair of pelvic calipers was used to measure the true conjugate of the pelvis.

  20. perception of nigerian anaesthetists on intra-operative death

    African Journals Online (AJOL)

    2012-10-01

    Oct 1, 2012 ... East African Medical Journal Vol. 89 No. 10 October 2012. PERCEPTION OF NIGERIAN ANAESTHETISTS ON INTRA-OPERATIVE DEATH. S. O. A. Olateju, MBChB, DA, MPH, FMCA, FICS, Consultant Anaesthetist/Lecturer, A. T. Adenekan, MBBS, DA,. FWACS, Consultant Anaesthetist/Lecturer, ...

  1. Intra-operative parathyroid hormone measurements – experience of ...

    African Journals Online (AJOL)

    Background. Surgery is the treatment of choice for symptomatic primary hyperparathyroidism. The majority of research concerning intra-operative parathyroid hormone (ioPTH) measurements is conducted in university hospitals. Whether ioPTH measurements are feasible and useful in predicting the presence of remaining ...

  2. Efficacy of florfenicol and intravenous fluid therapy for treatment of experimental salmonellosis in newborn calves

    OpenAIRE

    Silva,D.G.; Silva,P.R.L.; Fagliari,J.J.

    2010-01-01

    The efficacy of florfenicol associated or not to intravenous fluid therapy for treatment of Salmonella Dublin-infected calves was determined. Twenty-four healthy 10 to 15-day-old Holstein calves were randomly allotted into four groups, with six animals each: control (group 1); infected with 10(8)CFU Salmonella Dublin and not treated (group 2); infected with 10(8)CFU Salmonella Dublin and treated with florfenicol (group 3); and infected with 10(8)CFU Salmonella Dublin and treated with florfeni...

  3. No bacterial growth found in spiked intravenous fluids over an 8-hour period.

    Science.gov (United States)

    Haas, Richard E; Beitz, Edwin; Reed, Amy; Burtnett, Howard; Lowe, Jason; Crist, Arthur E; Stierer, Kevin A; Birenberg, Allan M

    2017-04-01

    Protocol changes prompted by the Joint Commission mandating intravenous (IV) fluid bags to be used within 1 hour of spiking because of possible bacterial contamination have sparked clinical and economic concerns. This study investigated the degree of bacterial growth in which samples were obtained from spiked IV fluid bags at the time of spiking and 1, 2, 4, and 8 hours after spiking. No bacterial growth occurred in any of the 80 bags of Lactated Ringer's (LR) IV solutions sampled. This study demonstrated that LR IV bags do not support any bacterial growth for up to 8 hours after spiking. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  4. Pressurized Intravenous Fluid Administration in the Professional Football Player: A Unique Setting for Venous Air Embolism.

    Science.gov (United States)

    Fibel, Kenton H; Barnes, Ronnie P; Kinderknecht, James J

    2015-07-01

    Venous air embolism (VAE) is a potentially life-threatening event that is most commonly associated with certain surgical procedures, although this theoretical complication of pressurized rapid infusion of intravenous (IV) fluids has been described. This series of cases describes 4 athletes who presented with continuous coughing and other chest complaints after peripheral IV infusion of normal saline through manual pressurized infusion. Symptoms resolved within 20 minutes, and these incidences did not interfere with resuming athletic competition with no recurrence of symptoms or complications. These cases are most consistent with varying degrees of VAE and reveal the risk of VAE associated with pressurized peripheral IV fluid administration along with the unique clinical presentation of more modest forms of VAE in an awake patient. Becoming more knowledgeable about IV infusion technique and understanding potential pitfalls can be helpful in reducing future incidences of VAE.

  5. Outbreak of Serratia marcescens postsurgical bloodstream infection due to contaminated intravenous pain control fluids.

    Science.gov (United States)

    Chiang, Ping-Cherng; Wu, Tsu-Lan; Kuo, An-Jing; Huang, Yhu-Chering; Chung, Ting-Ying; Lin, Chun-Sui; Leu, Hsieh-Shong; Su, Lin-Hui

    2013-09-01

    Serratia marcescens is an important nosocomial pathogen causing significant outbreaks. Here we report an outbreak of bloodstream infection caused by S. marcescens at a 3500-bed hospital in Taiwan. The effective cooperative efforts of both laboratory personnel and infection control practitioners (ICPs) jointly contributed to the total control of the outbreak. A sudden increase in the isolation of S. marcescens from blood cultures was noted in the Clinical Microbiology Laboratory. The information was passed to the ICPs and an investigation was initiated. Pulsed-field gel electrophoresis was used to study the relationships among the isolates. Pulsotype A was identified in 43 (82.7%) of the 52 blood isolates studied. They were isolated from 52 patients distributed across 22 wards that were surveyed by seven ICPs. All patients had undergone surgery before the infection, and fentanyl-containing intravenous fluids were used for pain control in 43 of them. Isolates from 42 belonged to pulsotype A. Three S. marcescens isolates, all from fentanyl-containing fluids and demonstrating pulsotype A, were identified from 251 environmental cultures. All fentanyl-containing fluids that were in use were withdrawn and the outbreak was stopped. The outbreak of S. marcescens bloodstream infection apparently occurred through the use of fentanyl-containing fluids contaminated by a pulsotype A S. marcescens. Copyright © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  6. Pediatric awake craniotomy and intra-operative stimulation mapping.

    Science.gov (United States)

    Balogun, James A; Khan, Osaama H; Taylor, Michael; Dirks, Peter; Der, Tara; Carter Snead Iii, O; Weiss, Shelly; Ochi, Ayako; Drake, James; Rutka, James T

    2014-11-01

    The indications for operating on lesions in or near areas of cortical eloquence balance the benefit of resection with the risk of permanent neurological deficit. In adults, awake craniotomy has become a versatile tool in tumor, epilepsy and functional neurosurgery, permitting intra-operative stimulation mapping particularly for language, sensory and motor cortical pathways. This allows for maximal tumor resection with considerable reduction in the risk of post-operative speech and motor deficits. We report our experience of awake craniotomy and cortical stimulation for epilepsy and supratentorial tumors located in and around eloquent areas in a pediatric population (n=10, five females). The presenting symptom was mainly seizures and all children had normal neurological examinations. Neuroimaging showed lesions in the left opercular (n=4) and precentral or peri-sylvian regions (n=6). Three right-sided and seven left-sided awake craniotomies were performed. Two patients had a history of prior craniotomy. All patients had intra-operative mapping for either speech or motor or both using cortical stimulation. The surgical goal for tumor patients was gross total resection, while for all epilepsy procedures, focal cortical resections were completed without any difficulty. None of the patients had permanent post-operative neurologic deficits. The patient with an epileptic focus over the speech area in the left frontal lobe had a mild word finding difficulty post-operatively but this improved progressively. Follow-up ranged from 6 to 27 months. Pediatric awake craniotomy with intra-operative mapping is a precise, safe and reliable method allowing for resection of lesions in eloquent areas. Further validations on larger number of patients will be needed to verify the utility of this technique in the pediatric population. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Tissue-engineered heart valves: intra-operative protocol.

    Science.gov (United States)

    Gallo, Michele; Bianco, Roberto; Bottio, Tomaso; Naso, Filippo; Franci, Paolo; Zanella, Fabio; Perona, Giovanni; Busetto, Roberto; Spina, Michele; Gandaglia, Alessandro; Gerosa, Gino

    2013-08-01

    Tissue engineering of heart valves investigates the possibility to create a fully compatible and biomimetic graft able to provide host cell repopulation like the native living valve. Decellularized aortic and pulmonary valves and synthetic polymers have been used to promote the creation of a native-like scaffold suitable to be colonized by cells either in vitro, in dynamic bioreactors or in vivo using different animal models. The herein presented research provides the intra-operative protocol and details of surgical technique. Porcine aortic valve conduits were decellularized and implanted in the right ventricular outflow tract of Vietnamese pigs.

  8. A randomized, double-blinded, controlled trial of the effects of fluid rate and/or presence of dextrose in intravenous fluids on the labor course of nulliparas.

    Science.gov (United States)

    Fong, Alex; Serra, Allison E; Caballero, Deysi; Garite, Thomas J; Shrivastava, Vineet K

    2017-08-01

    Prolonged labor has been demonstrated to increase adverse maternal and neonatal outcome. A practice that may decrease the risk of prolonged labor is the modification of fluid intake during labor. Several studies demonstrated that increased hydration in labor as well as addition of dextrose-containing fluids may be associated with a decrease in length of labor. The purpose of our study was to characterize whether high-dose intravenous fluids, standard-dose fluids with dextrose, or high-dose fluids with dextrose show a difference in the duration of labor in nulliparas. Nulliparous subjects with singletons who presented in active labor were randomized to 1 of 3 groups of intravenous fluids: 250 mL/h of normal saline, 125 mL/h of 5% dextrose in normal saline, or 250 mL/h of 2.5% dextrose in normal saline. The primary outcome was total length of labor from initiation of intravenous fluid in vaginally delivered subjects. Secondary outcomes included cesarean delivery rate and length of second stage of labor, among other maternal and neonatal outcomes. In all, 274 subjects who met inclusion criteria were enrolled. There were no differences in baseline characteristics among the 3 groups. There was no difference in the primary outcome of total length of labor in vaginally delivered subjects among the 3 groups. First stage of labor duration, second stage of labor duration, and cesarean delivery rates were also equivalent. There were no differences identified in other secondary outcomes including clinical chorioamnionitis, postpartum hemorrhage, blood loss, Apgar scores, or neonatal intensive care admission. There is no difference in length of labor or delivery outcomes when comparing high-dose intravenous fluids, addition of dextrose, or use of high-dose intravenous fluids with dextrose in nulliparous women who present in active labor. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Intravenous fluid restriction after major abdominal surgery: a randomized blinded clinical trial

    Directory of Open Access Journals (Sweden)

    Legemate Dink A

    2009-07-01

    Full Text Available Abstract Background Intravenous (IV fluid administration is an essential part of postoperative care. Some studies suggest that a restricted post-operative fluid regime reduces complications and postoperative hospital stay after surgery. We investigated the effects of postoperative fluid restriction in surgical patients undergoing major abdominal surgery. Methods In a blinded randomized trial, 62 patients (ASA I-III undergoing elective major abdominal surgical procedures in a university hospital were allocated either to a restricted (1.5 L/24 h or a standard postoperative IV fluid regime (2.5 L/24 h. Primary endpoint was length of postoperative hospital stay (PHS. Secondary endpoints included postoperative complications and time to restore gastric functions. Results After a 1-year inclusion period, an unplanned interim analysis was made because of many protocol violations due to patient deterioration. In the group with the restricted regime we found a significantly increased PHS (12.3 vs. 8.3 days; p = 0.049 and significantly more major complications: 12 in 30 (40% vs. 5 in 32 (16% patients (Absolute Risk Increase: 0.24 [95%CI: 0.03 to 0.46], i.e. a number needed to harm of 4 [95%CI: 2–33]. Therefore, the trial was stopped prematurely. Intention to treat analysis showed no differences in time to restore gastric functions between the groups. Conclusion Restricted postoperative IV fluid management, as performed in this trial, in patients undergoing major abdominal surgery appears harmful as it is accompanied by an increased risk of major postoperative complications and a prolonged postoperative hospital stay. Trial registration Current Controlled Trials ISRCTN16719551

  10. Evaluation of the stability of linezolid in aqueous solution and commonly used intravenous fluids

    Directory of Open Access Journals (Sweden)

    Taylor R

    2017-07-01

    Full Text Available Rachel Taylor, Bruce Sunderland, Giuseppe Luna, Petra Czarniak School of Pharmacy, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia Purpose: The aim was to evaluate the stability of linezolid in commonly used intravenous fluids and in aqueous solution to determine the kinetics of degradation and shelf-life values at alkaline pH values. Methods: Forced degradation studies were performed on linezolid in solution to develop a validated high-performance liquid chromatography analysis. Sodium chloride 0.9%, sodium lactate, and glucose 5% and glucose 10% solution containing 2.0 mg/mL linezolid were stored at 25.0°C (±0.1°C for 34 days. The effect of temperature on the stability of linezolid in 0.1 M sodium hydroxide solution was investigated to determine the activation energy. The degradation rates of linezolid at selected pH values at 70.0°C and the influence of ionic strength were also examined. Activation energy data were applied to determine the shelf-life values at selected pH values, and a pH rate profile was constructed over the pH range of 8.7–11.4. The stability of intravenous linezolid (Zyvox® solution was evaluated by storing at 70.0°C for 72 hours. Results: Linezolid was found to maintain >95.0% of its initial concentration after storage at 25.0°C for 34 days in sodium lactate, 0.9% in sodium chloride, and 5% and 10% in glucose solutions. Linezolid was degraded at alkaline pH values by first-order kinetics. Activation energy data showed that temperature, but not ionic strength, influenced the degradation rate significantly. An activation energy of 58.22 kJ/mol was determined for linezolid in 0.1 M sodium hydroxide solution. Linezolid was least stable at high pH values and at elevated temperatures. It was determined that linezolid has adequate stability for the preparation of intravenous fluids for clinical administration. Conclusion: Linezolid was found to have a shelf life of 34 days at 25°C when added to

  11. Stability studies of lincomycin hydrochloride in aqueous solution and intravenous infusion fluids

    Directory of Open Access Journals (Sweden)

    Czarniak P

    2016-03-01

    Full Text Available Petra Czarniak, Michael Boddy, Bruce Sunderland, Jeff D Hughes School of Pharmacy, Curtin University, Perth, WA, Australia Purpose: The purpose of this study was to evaluate the chemical stability of Lincocin® (lincomycin hydrochloride in commonly used intravenous fluids at room temperature (25°C, at accelerated-degradation temperatures and in selected buffer solutions.Materials and methods: The stability of Lincocin® injection (containing lincomycin 600 mg/2 mL as the hydrochloride stored at 25°C±0.1°C in sodium lactate (Hartmann’s, 0.9% sodium chloride, 5% glucose, and 10% glucose solutions was investigated over 31 days. Forced degradation of Lincocin® in hydrochloric acid, sodium hydroxide, and hydrogen peroxide was performed at 60°C. The effect of pH on the degradation rate of lincomycin hydrochloride stored at 80°C was determined.Results: Lincomycin hydrochloride was found to maintain its shelf life at 25°C in sodium lactate (Hartmann’s solution, 0.9% sodium chloride solution, 5% glucose solution, and 10% glucose solution, with less than 5% lincomycin degradation occurring in all intravenous solutions over a 31-day period. Lincomycin hydrochloride showed less rapid degradation at 60°C in acid than in basic solution, but degraded rapidly in hydrogen peroxide. At all pH values tested, lincomycin followed first-order kinetics. It had the greatest stability near pH 4 when stored at 80°C (calculated shelf life of 4.59 days, and was least stable at pH 2 (calculated shelf life of 0.38 days.Conclusion: Lincocin® injection was chemically found to have a shelf life of at least 31 days at 25°C when added to sodium lactate (Hartmann’s solution, 0.9% sodium chloride solution, 5% glucose solution, and 10% glucose solution. Solutions prepared at approximately pH 4 are likely to have optimum stability. Keywords: lincomycin, stability, pH, intravenous fluids, IV additives

  12. Cerebrospinal fluid changes after intravenous injection of gadolinium chelate: assessment by FLAIR MR imaging

    International Nuclear Information System (INIS)

    Bozzao, Alessandro; Floris, Roberto; Fasoli, Fabrizio; Simonetti, Giovanni; Fantozzi, Luigi Maria; Colonnese, Claudio

    2003-01-01

    Fluid-attenuated inversion recovery (FLAIR) sequence is currently used in clinical practice. Some reports emphasize the possibility that, in pathologic conditions, intravenous injection of gadolinium chelates may lead to an increased signal inside the cerebrospinal fluid (CSF). The aim of this study was to evaluate the presence of CSF signal changes in pathologic conditions causing blood-brain barrier disruption or neovascularization when imaging is performed after intravenous injection of gadolinium. We obtained FLAIR sequences after gadolinium injection from 33 patients affected by different intracranial pathologies and 10 control subjects. Patients were affected by ischemic stroke in the subacute phase, from 2 to 7 days from onset of symptoms (12 patients), meningiomas (8 patients), high-grade gliomas (5 patients), previous surgical procedures for intra-axial neoplasms (5 patients), and multiple sclerosis with active plaques (3 patients). Magnetic resonance imaging was performed in patients and controls using a 1.5-T magnet, using T2- and T1-weighted FLAIR sequences. The FLAIR sequence was acquired before and 1-3 h after injection of a standard dose of gadolinium. In those patients affected by ischemic lesions, FLAIR sequences were repeated the next days and 3-4 days later. The CSF signal was visually evaluated by two readers and scored from 0 to 3 depending by the degree of enhancement. The location of CSF signal changes (close to the lesion, hemispheric, or diffuse) was also considered. The CSF signal was markedly increased after 3 h from intravenous injection of gadolinium in all the patients with stroke, in those with previous surgery, and in those with high-grade gliomas whose neoplasm's surface was in contact with the subarachnoid spaces (SAS) or ventricles; a strong enhancement was also evident inside the necrotic component of the tumor. The CSF changes were more evident close to the pathology and/or in the hemisphere involved by the pathology. Moderate

  13. Intravenous S-Ketamine Does Not Inhibit Alveolar Fluid Clearance in a Septic Rat Model

    Science.gov (United States)

    Weber, Nina C.; van der Sluijs, Koen; Hackl, Florian; Hotz, Lorenz; Dahan, Albert; Hollmann, Markus W.; Berger, Marc M.

    2014-01-01

    We previously demonstrated that intratracheally administered S-ketamine inhibits alveolar fluid clearance (AFC), whereas an intravenous (IV) bolus injection had no effect. The aim of the present study was to characterize whether continuous IV infusion of S-ketamine, yielding clinically relevant plasma concentrations, inhibits AFC and whether its effect is enhanced in acute lung injury (ALI) which might favor the appearance of IV S-ketamine at the alveolar surface. AFC was measured in fluid-instilled rat lungs. S-ketamine was administered IV over 6 h (loading dose: 20 mg/kg, followed by 20 mg/kg/h), or intratracheally by addition to the instillate (75 µg/ml). ALI was induced by IV lipopolysaccharide (LPS; 7 mg/kg). Interleukin (IL)-6 and cytokine-induced neutrophil chemoattractant (CINC)-3 were measured by ELISA in plasma and bronchoalveolar lavage fluid. Isolated rat alveolar type-II cells were exposed to S-ketamine (75 µg/ml) and/or LPS (1 mg/ml) for 6 h, and transepithelial ion transport was measured as short circuit current (ISC). AFC was 27±5% (mean±SD) over 60 min in control rats and was unaffected by IV S-ketamine. Tracheal S-ketamine reduced AFC to 18±9%. In LPS-treated rats, AFC decreased to 16±6%. This effect was not enhanced by IV S-ketamine. LPS increased IL-6 and CINC-3 in plasma and bronchoalveolar lavage fluid. In alveolar type-II cells, S-ketamine reduced ISC by 37% via a decrease in amiloride-inhibitable sodium transport. Continuous administration of IV S-ketamine does not affect rat AFC even in endotoxin-induced ALI. Tracheal application with direct exposure of alveolar epithelial cells to S-ketamine decreases AFC by inhibition of amiloride-inhibitable sodium transport. PMID:25386677

  14. Factors predictive of intravenous fluid administration errors in Australian surgical care wards

    Science.gov (United States)

    Han, P; Coombes, I; Green, B

    2005-01-01

    Background: Intravenous (IV) fluid administration is an integral component of clinical care. Errors in administration can cause detrimental patient outcomes and increase healthcare costs, although little is known about medication administration errors associated with continuous IV infusions. Objectives: (1) To ascertain the prevalence of medication administration errors for continuous IV infusions and identify the variables that caused them. (2) To quantify the probability of errors by fitting a logistic regression model to the data. Methods: A prospective study was conducted on three surgical wards at a teaching hospital in Australia. All study participants received continuous infusions of IV fluids. Parenteral nutrition and non-electrolyte containing intermittent drug infusions (such as antibiotics) were excluded. Medication administration errors and contributing variables were documented using a direct observational approach. Results: Six hundred and eighty seven observations were made, with 124 (18.0%) having at least one medication administration error. The most common error observed was wrong administration rate. The median deviation from the prescribed rate was –47 ml/h (interquartile range –75 to +33.8 ml/h). Errors were more likely to occur if an IV infusion control device was not used and as the duration of the infusion increased. Conclusions: Administration errors involving continuous IV infusions occur frequently. They could be reduced by more common use of IV infusion control devices and regular checking of administration rates. PMID:15933314

  15. Risk of Phthalate Exposure among Hospitalized Patient via Intravenous Fluids Receiving

    Directory of Open Access Journals (Sweden)

    Forouz Rastegari

    2017-03-01

    Full Text Available Background: Phthalates are widely used as plasticizers in polyethylene terephthalate (PET products. Several pharmaceutical products have been stored in PET containers, and due to serious health effects of phthalates, migration levels of them into pharmaceutical products must be determined. In the present study, leaching levels of four common phthalate esters including di-n-butyl phthalate (DBP, diethyl phthalate (DEP, benzyl butyl phthalate (BBP and Di-(2-ethylhexyl phthalate (DEHP into various types of infusion fluids form four different commercial brand were investigated. Methods: Trace levels of phthalate esters were successfully extracted by a dispersive liquid-liquid microextraction (DLLME method using acetonitrile as dispersive and CCL4 as an extraction solvent and analyzed by gas chromatography-mass spectrometry (GC-MS. Results: Different levels DEHP were detected in all samples (mean=10.55±6.88 and maximum=19.7 ppb. While no levels of other phthalates were detected in some samples, some other contained up to 25.1±17.7, 15.4±8.3, 8.1 ppb DEP, DBP, and BBP respectively. Mean total phthalate ester (TPE levels in infusion fluids were 7.92±5.68 ppb. Phthalate leaching into normal saline was significantly lower than other types of serums and brand ID#3’ products contain minimum phthalate levels compared to other brands. Conclusions: Hospitalized patient particularly those who regularly take serum-therapy and children are at significant risk of phthalate exposure via intravenous fluids receiving.

  16. Intravenous fluid rate for reduction of cesarean delivery rate in nulliparous women: a systematic review and meta-analysis.

    Science.gov (United States)

    Ehsanipoor, Robert M; Saccone, Gabriele; Seligman, Neil S; Pierce-Williams, Rebecca A M; Ciardulli, Andrea; Berghella, Vincenzo

    2017-07-01

    The National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine have emphasized the need to promote vaginal delivery and have offered recommendations to safely prevent primary cesarean delivery. However, there has been limited discussion regarding management of intravenous fluids and other aspects of labor management that may influence mode of delivery. Therefore the aim of our study was to determine whether an intravenous fluid rate of 250 vs. 125 mL/h is associated with a difference in cesarean delivery rate. Searches were performed in MEDLINE, OVID, Scopus, ClinicalTrials.gov, the PROSPERO International Prospective Register of Systematic Reviews, Embase, Web of Science, and the Cochrane Library for randomized controlled trials. We included all randomized controlled trials comparing intravenous fluid rates of 250 vs. 125 mL/h in nulliparous women in spontaneous labor at term with singleton pregnancies at ≥36 weeks. Studies were included regardless of the type of intravenous fluids used and regardless of whether oral intake was restricted during labor. Studies including multiparous women or women whose labor was induced were excluded. The primary outcome was the incidence of cesarean delivery. We planned to assess a subgroup analysis according to type of fluids used and according to restriction of oral fluid intake. Seven trials including 1215 nulliparous women in spontaneous labor at term were analyzed; 593 (48.8%) in the 250 mL/h group, and 622 (51.2%) in the 125 mL/h group. Five studies used lactated Ringer's solution, one used normal saline in dextrose water, and in one study it was unclear which intravenous fluid was used. Women who received intravenous fluids at 250 mL/h had a significantly lower incidence of cesarean delivery for any indication (12.5 vs. 18.1%; RR 0.70, 95% CI 0.53-0.92; seven studies, 1215 participants; I 2 = 0%) and for dystocia (4.9 vs. 7.7%; RR

  17. Stability studies of lincomycin hydrochloride in aqueous solution and intravenous infusion fluids.

    Science.gov (United States)

    Czarniak, Petra; Boddy, Michael; Sunderland, Bruce; Hughes, Jeff D

    2016-01-01

    The purpose of this study was to evaluate the chemical stability of Lincocin(®) (lincomycin hydrochloride) in commonly used intravenous fluids at room temperature (25°C), at accelerated-degradation temperatures and in selected buffer solutions. The stability of Lincocin(®) injection (containing lincomycin 600 mg/2 mL as the hydrochloride) stored at 25°C±0.1°C in sodium lactate (Hartmann's), 0.9% sodium chloride, 5% glucose, and 10% glucose solutions was investigated over 31 days. Forced degradation of Lincocin(®) in hydrochloric acid, sodium hydroxide, and hydrogen peroxide was performed at 60°C. The effect of pH on the degradation rate of lincomycin hydrochloride stored at 80°C was determined. Lincomycin hydrochloride w as found to maintain its shelf life at 25°C in sodium lactate (Hartmann's) solution, 0.9% sodium chloride solution, 5% glucose solution, and 10% glucose solution, with less than 5% lincomycin degradation occurring in all intravenous solutions over a 31-day period. Lincomycin hydrochloride showed less rapid degradation at 60°C in acid than in basic solution, but degraded rapidly in hydrogen peroxide. At all pH values tested, lincomycin followed first-order kinetics. It had the greatest stability near pH 4 when stored at 80°C (calculated shelf life of 4.59 days), and was least stable at pH 2 (calculated shelf life of 0.38 days). Lincocin(®) injection was chemically found to have a shelf life of at least 31 days at 25°C when added to sodium lactate (Hartmann's) solution, 0.9% sodium chloride solution, 5% glucose solution, and 10% glucose solution. Solutions prepared at approximately pH 4 are likely to have optimum stability.

  18. Intra-operative radiation therapy in cancer of the pancreas

    International Nuclear Information System (INIS)

    Dubois, J.B.; Gu, S.D.; Saint-Aubert, B.; Joyeux, H.; Solassol, C.; Pujol, H.

    1991-01-01

    We report our experience concerning 22 pancreatic carcinoma bearing patients treated with intra-operative radiation therapy (IORT) after complete surgical excision: duodenopancreatectomy: 15 patients; isthmic and caudal pancreatectomy: 2 patients; total pancreatectomy: 5 patients. The dose delivered to the tumor bed was 20 Gy in 12 patients, 18 Gy in 3 patients and 15 Gy in 7 patients. Three patients died within the 1st month post-surgery from intercurrent diseases. Post-operative morbidity was not significantly modified by IORT as compared to purely surgical treated patients. Out of 19 evaluable patients, we observed local control in 16 patients (79.4%). Causes of death (15/19 patients) were: distant metastases with local control: 7 patients; in situ local failure: 3 patients; regional recurrence outside of the IORT fields: 2 patients; intercurrent diseases: 3 patients. Four patients are still alive without evolutive disease. The median overall survival is 6 months. The mean overall survival is 10.56 months. Excluding patients who died from complications and intercurrent diseases, the median survival is 10 mths and the mean survival 14.5 mths. These results emphasize the improvement in local control with IORT, but without significant improvement in survival which is dependent on local evolution and also systemic disease [fr

  19. Longitudinal Analysis of Novel Alzheimer’s Disease Proteomic Cerebrospinal Fluid Biomarkers During Intravenous Immunoglobulin Therapy

    Science.gov (United States)

    Shayan, Gilda; Adamiak, Basia; Relkin, Norman R.; Lee, Kelvin H.

    2018-01-01

    Intravenous immunoglobulin (IVIg) therapy has shown promising results in treating Alzheimer’s disease (AD). In this study, a Random Forest classification model was used to identify possible effects of IVIg on a group of eight subjects who underwent immunotherapy. Cerebrospinal fluid (CSF) samples from eight AD subjects who underwent IVIg therapy were collected before the therapy, after six months of therapy, and after a three-month drug washout period. Samples were analyzed using two-dimensional gel electrophoresis and further studied using a Random Forest classification model to identify effects of IVIg on a panel of 23 putative diagnostic AD biomarkers previously identified. Six of the eight subjects showed improvements with respect to the 23 AD diagnostic biomarkers after six months of therapy compared to the samples taken at the outset of the trial. All subjects reverted back to baseline during drug washout. These results are also consistent with clinical observations. The observed improvements in subjects during six months of IVIg therapy and the reversion back to baseline during drug washout provides preliminary evidence regarding the potential use of IVIg as an AD immunotherapy. PMID:22806462

  20. Systemic pharmacokinetics and cerebrospinal fluid uptake of intravenous ceftriaxone in patients with amyotrophic lateral sclerosis.

    Science.gov (United States)

    Zhao, Yanli; Cudkowicz, Merit E; Shefner, Jeremy M; Krivickas, Lisa; David, William S; Vriesendorp, Francine; Pestronk, Alan; Caress, James B; Katz, Jonathan; Simpson, Ericka; Rosenfeld, Jeffrey; Pascuzzi, Robert; Glass, Jonathan; Rezania, Kourosh; Harmatz, Jerold S; Schoenfeld, David; Greenblatt, David J

    2014-10-01

    The cephalosporin antibiotic ceftriaxone was evaluated as a potential therapeutic agent for the treatment of amyotrophic lateral sclerosis (ALS). The pharmacokinetics (PK) of ceftriaxone in plasma and cerebrospinal fluid (CSF) were investigated in 66 participants in a previously reported clinical trial. Their mean age was 51 years, and 65% were male. Participants were randomly assigned to 1 of 3 treatment groups receiving intravenous infusions (mean duration: 25 minutes) every 12 hours of either: placebo and placebo; 2 g ceftriaxone and placebo; or 2 g ceftriaxone twice. Mean steady-state plasma PK variables were: volume of distribution, 14 L (0.17 L/kg); elimination half-life, 8-9 h; total clearance, 17-21 mL/min (0.22-0.25 mL/min/kg). Values were not different between dosage groups. CSF PK analysis, determined through sparse CSF sampling, indicated apparent entry and elimination half-life values of 1.0 and 34 hours, respectively. With both dosage regimens, CSF concentrations were maintained above the target threshold of 1.0 µM (0.55 µg/mL) as determined from in vitro models. The plasma and CSF PK profiles of ceftriaxone were used as a basis for planning the Phase 3 clinical trial of ceftriaxone in ALS. © 2014, The American College of Clinical Pharmacology.

  1. Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement.

    Science.gov (United States)

    Powell, Arfon G M T; Paterson-Brown, Simon; Drummond, Gordon B

    2014-02-20

    Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications. Fluid prescription is often left to junior medical staff and is frequently poorly managed. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used. We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information, because there is no consensus on these topics. The maximum score that a book could achieve was 52. Three of the topics we chose were not considered by any of the books. Discounting these topics as "too esoteric", the maximum possible score became 46. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). In particular, coverage of routine postoperative management was inadequate. Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field. Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and "fitness for purpose", and avoid omission of vital knowledge.

  2. Intra-operative blood transfusion among adult surgical patients in a ...

    African Journals Online (AJOL)

    This retrospective study was designed to audit the pattern of intra-operative whole blood transfusion among adult surgical patients over a two-year period. Data were collected on the rate of intra-operative transfusion, estimated blood loss, units of donor blood transfused, pattern of use of autologous blood and circumstances ...

  3. Intra-operative removal of chest tube in video-assisted thoracoscopic procedures

    Directory of Open Access Journals (Sweden)

    Moustafa M. El-Badry

    2017-12-01

    Conclusions: Intra-operative removal of chest tube during VATS procedures was a safe technique in well selected patients with an intra-operative successful air-leak test with radiological and clinical follow-up. This technique provided lesser post-operative pain with shorter hospital stay.

  4. The incidence of intra-operative awareness during general anesthesia in China: a multi-center observational study.

    Science.gov (United States)

    Xu, L; Wu, A-S; Yue, Y

    2009-08-01

    The incidence of awareness in patients undergoing general anesthesia is 0.1-0.2% in Western countries. The medical literatures about awareness during general anesthesia are still rare in China, but some previous studies have reported a higher incidence (1.4-6%) of intra-operative awareness. To find out the reason why the incidence reported in China is much higher than that in Western countries, we performed a prospective, multicenter, non-randomized observational study to determine the true incidence of intra-operative awareness in China. This is a prospective, non-randomized descriptive cohort study that was conducted at 25 academic medical centers in China. Eleven thousand one hundred and eighty-five patients were interviewed by research staff for evaluation of awareness at the first and fourth day after general anesthesia with muscle relaxation. An independent blinded committee evaluated the responses and determined whether awareness occurred. Necessary data were collected for a binary logistic regression analysis. Data from 11,101 patients were presented. Forty-six cases (0.41%) were reported as definite awareness and 47 additional cases (0.41%) as possible awareness. Three hundred and fifty-five patients (3.19%) had dreams during general anesthesia. Awareness was associated with increased American Society of Anesthesiologists (ASA) physical status, a previous anesthesia, and anesthesia methods of total intravenous anesthesia. The incidence of intra-operative awareness in China is approximately 0.41%, two to three times higher than that widely cited in Western countries. Inappropriately light anesthesia, and the population proportion of surgery and general anesthesia in China may account for the difference. (ClinicalTrials.gov Identifier, NCT00693875.).

  5. The contamination of intravenous fluids by writing on the infusion bag: Fact or fiction?

    OpenAIRE

    James Daniel Langston; William Patrick Monaghan; Mellissa Bush

    2013-01-01

    Introduction -Laboratory experiments were conducted to ascertain whether Sharpie® brand black permanent marker ink will permeate through intravenous infusion bags. The practice of writing directly on infusion bags is a frequent yet controversial practice. There are no known written standards that exist which pertain to this practice. Methods – Five types of intravenous bags containing different solutions marked with black ink from a fine point felt tipped Sharpie® marker. Sample extraction oc...

  6. Inadvertent venous air embolism during cesarean section: Collapsible intravenous fluid bags without self-sealing outlet have risks. Case report.

    Science.gov (United States)

    Bakan, Mefkur; Topuz, Ufuk; Esen, Asim; Basaranoglu, Gokcen; Ozturk, Erdogan

    2013-01-01

    The anesthesiologist must be aware of the causes, diagnosis and treatment of venous air embolism and adopt the practice patterns to prevent its occurrence. Although venous air embolism is a known complication of cesarean section, we describe an unusual inattention that causes iatrogenic near fatal venous air embolism during a cesarean section under spinal anesthesia. One of the reasons for using self-collapsible intravenous (IV) infusion bags instead of conventional glass or plastic bottles is to take precaution against air embolism. We also demonstrated the risk of air embolism for two kinds of plastic collapsible intravenous fluid bags: polyvinyl chloride (PVC) and polypropylene-based. Fluid bags without self-sealing outlets pose a risk for air embolism if the closed system is broken down, while the flexibility of the bag limits the amount of air entry. PVC-based bags, which have more flexibility, have significantly less risk of air entry when IV administration set is disconnected from the outlet. Using a pressure bag for rapid infusion can be dangerous without checking and emptying all air from the IV bag. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  7. Patterns of intravenous fluid resuscitation use in adult intensive care patients between 2007 and 2014

    DEFF Research Database (Denmark)

    Hammond, Naomi E; Taylor, Colman; Finfer, Simon

    2017-01-01

    BACKGROUND: In 2007, the Saline versus Albumin Fluid Evaluation-Translation of Research Into Practice Study (SAFE-TRIPS) reported that 0.9% sodium chloride (saline) and hydroxyethyl starch (HES) were the most commonly used resuscitation fluids in intensive care unit (ICU) patients. Evidence has e...

  8. Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy.

    Science.gov (United States)

    Woodcock, T E; Woodcock, T M

    2012-03-01

    I.V. fluid therapy does not result in the extracellular volume distribution expected from Starling's original model of semi-permeable capillaries subject to hydrostatic and oncotic pressure gradients within the extracellular fluid. Fluid therapy to support the circulation relies on applying a physiological paradigm that better explains clinical and research observations. The revised Starling equation based on recent research considers the contributions of the endothelial glycocalyx layer (EGL), the endothelial basement membrane, and the extracellular matrix. The characteristics of capillaries in various tissues are reviewed and some clinical corollaries considered. The oncotic pressure difference across the EGL opposes, but does not reverse, the filtration rate (the 'no absorption' rule) and is an important feature of the revised paradigm and highlights the limitations of attempting to prevent or treat oedema by transfusing colloids. Filtered fluid returns to the circulation as lymph. The EGL excludes larger molecules and occupies a substantial volume of the intravascular space and therefore requires a new interpretation of dilution studies of blood volume and the speculation that protection or restoration of the EGL might be an important therapeutic goal. An explanation for the phenomenon of context sensitivity of fluid volume kinetics is offered, and the proposal that crystalloid resuscitation from low capillary pressures is rational. Any potential advantage of plasma or plasma substitutes over crystalloids for volume expansion only manifests itself at higher capillary pressures.

  9. A dedicated intravenous cannula for postoperative use effect on incidence and severity of phlebitis.

    LENUS (Irish Health Repository)

    Panadero, A

    2012-02-03

    A prospective, randomised, controlled clinical study was performed to compare the incidence and severity of postoperative peripheral venous thrombophlebitis associated with a single intravenous cannula used for both intra-operative and postoperative purposes, and two cannulae, one used intra-operatively and the other postoperatively. Sixty American Society of Anaesthesiologists (ASA) physical status I or II patients aged 18-65 years undergoing elective surgery were studied. The technique of cannula insertion was standardised. After surgery, the cannulation sites were examined daily by a blinded investigator for the presence and severity of thrombophlebitis using the Baxter Scale. The two groups were similar in terms of age, gender, weight, type and duration of surgical procedures, and drugs and fluids administered both intra-operatively and postoperatively. The proportion of patients that developed phlebitis was significantly less in the two cannulae group (26.1%) than in the single cannula group (63.3%) (p < 0.0001). The severity of phlebitis was greater in the single cannula group than in the two cannulae group. These results indicate that the use of a dedicated cannula for postoperative use decreases the incidence and severity of postoperative, peripheral, cannula-related phlebitis.

  10. Warming intravenous fluids reduces perioperative hypothermia in women undergoing ambulatory gynecological surgery.

    Science.gov (United States)

    Smith, C E; Gerdes, E; Sweda, S; Myles, C; Punjabi, A; Pinchak, A C; Hagen, J F

    1998-07-01

    We evaluated whether warming i.v. fluids resulted in less hypothermia (core temperature 30 min were randomized to two groups: fluid warming at 42 degrees C or control (room temperature fluids at approximately 21 degrees C). All patients received general anesthesia with isoflurane, tracheal intubation, standard operating room blankets and surgical drapes, and passive humidification of inspired gases. Tympanic membrane (core) temperatures were measured at baseline and at 15-min intervals after induction. The incidence of shivering and postoperative requirement for meperidine and/or radiant heat were evaluated. Core temperatures were lower in the control compared with the warm fluid group at the end of surgery (35.6 +/- 0.1 degrees C vs 36.2 +/- 0.1 degrees C; P unit or the incidence of shivering between the groups. We conclude that fluid warming, in conjunction with standard heat conservation measures, was effective in maintaining normothermia during outpatient gynecological surgery; however, there was no improvement in patient outcome. Women who received i.v. fluid at body temperature had significantly higher core temperatures during and after outpatient gynecological surgery compared with women who received i.v. fluids at the temperature of the operating room.

  11. The effects of warmed intravenous fluids, combined warming (warmed intravenous fluids with humid-warm oxygen, and pethidine on the severity of shivering in general anesthesia patients in the recovery room

    Directory of Open Access Journals (Sweden)

    Ahmad Nasiri

    2015-01-01

    Full Text Available Background: Shivering is a common complication of general and epidural anesthesia. Warming methods and many drugs are used for control of shivering in the recovery room. The present study is a randomized clinical trial aimed to investigate the effects of two interventions in comparison with pethidine which is the routine treatment on shivering in patients undergoing abdominal surgery with general anesthesia. Materials and Methods: Eighty-seven patients undergoing abdominal surgery by general anesthesia were randomly assigned to three groups (two intervention groups in comparison with pethidine as routine. Patients in warmed intravenous fluids group received pre-warmed Ringer serum (38°C, patients in combined warming group received pre-warmed Ringer serum (38°C accompanied by humid-warm oxygen, and patients in pethidine group received intravenous pethidine routinely. The elapsed time of shivering and some hemodynamic parameters of the participants were assessed for 20 min postoperatively in the recovery room. Then the collected data were analyzed by software SPSS (v. 16 with the significance level being P < 0.05. Results: The mean of elapsed time in the warmed intravenous serum group, the combined warming group, and the pethidine group were 7 (1.5 min, 6 (1.5 min, and 2.8 (0.7 min, respectively, which was statistically significant (P < 0.05. The body temperatures in both combined warming and pethidine groups were increased significantly (P < 0.05. Conclusions: Combined warming can be effective in controlling postoperative shivering and body temperature increase.

  12. Use of Hypotonic Maintenance Intravenous Fluids and Hospital-Acquired Hyponatremia Remain Common in Children Admitted to a General Pediatric Ward.

    Science.gov (United States)

    Shukla, Shikha; Basu, Srikanta; Moritz, Michael L

    2016-01-01

    To evaluate maintenance intravenous fluid-prescribing practices and the incidence of hospital-acquired hyponatremia in children admitted to a general pediatric ward. This is a prospective observational study conducted over a 2-month period in children ages 2 months to 5 years who were admitted to a general pediatric ward and who were receiving maintenance intravenous fluids. The composition, rate, and duration of intravenous fluids were chosen at the discretion of the treating physician. Serum biochemistries were obtained at baseline and 24 h following admission. Patients who were at high risk for developing hyponatremia or hypernatremia or had underlying chronic diseases or were receiving medications associated with a disorder in sodium and water homeostasis were excluded. Intravenous fluid composition and the incidence of hyponatremia (sodium fluids; 87.5% received 0.18% sodium chloride (NaCl) and 14.3% received 0.45% NaCl. Forty percent of patients (17/42) with a serum sodium (SNa) less than 140 mEq/L experienced a fall in SNa with 12.5% of all patients (7/56) developing hospital-acquired or aggravated hyponatremia (126-134 mEq/L) with fall in SNa between 2 and 10 mEq/L. Administration of hypotonic fluids was a prevalent practice in children admitted to a general pediatric ward and is associated with acute hospital-acquired hyponatremia.

  13. Effect of pre-warmed intravenous fluids on perioperative hypothermia and shivering after ambulatory surgery under monitored anesthesia care.

    Science.gov (United States)

    Kim, Gahyun; Kim, Myung Hee; Lee, Sangmin M; Choi, Soo Joo; Shin, Young Hee; Jeong, Hee Joon

    2014-12-01

    The aim of this study was to evaluate the effects of pre-warmed (approximately 41 °C) intravenous fluids (IV) on perioperative hypothermia and postoperative shivering in female patients undergoing short, ambulatory urological surgery under monitored anesthesia care (MAC). Patients between the ages of 35 and 80 years were randomly assigned to either the pre-warmed (n = 27) or the room temperature (n = 26) group. According to group allocation, either pre-warmed IV fluids that had been stored in a warming cabinet for at least 8 h or room temperature IV fluids were administered intraoperatively up to approximately 600-700 ml, including a bolus infusion of 10 ml/kg within 20 min. Perioperative core temperatures at the tympanic membrane, postoperative shivering, subjective thermal comfort, and the use of forced-air warming interventions in the post-anesthesia care unit (PACU) were recorded. Mean core temperatures were significantly higher in the pre-warmed group than they were in the room temperature group after 10 ml/kg preload fluid was administered, at the end of the operation, and on admission to the PACU (p = 0.004, p = 0.02, and p = 0.008, respectively). The incidence of hypothermia (shivering incidence was also significantly lower in the pre-warmed group (n = 2) than in the room temperature group (n = 8, p = 0.039). Infusion of pre-warmed IV fluid improved the postoperative recovery profile by decreasing hypothermia and shivering in female patients undergoing short, ambulatory urological surgery under MAC.

  14. [Therapeutic hypothermia after cardiac arrest. A cold intravenous fluid, a cooling helmet and a cooling blanket efficiently reduce body temperature].

    Science.gov (United States)

    Friberg, Hans; Nielsen, Niklas; Karlsson, Torbjörn; Cronberg, Tobias; Widner, Håkan; Englund, Elisabet; Ersson, Anders

    2004-07-22

    Two controlled randomized trials have shown that mild systemic hypothermia after cardiac arrest is beneficial for neurological outcome and one of the studies shows an improved survival rate. A pilot study was performed to evaluate a model of induced hypothermia after cardiac arrest, using cold intravenous fluids and surface cooling with a cold helmet and a coldwater blanket (Thermowrap). The main purpose was to evaluate our cooling method regarding efficacy, safety and usability. Five unconscious patients after cardiac arrest were treated with induced hypothermia of whom three survived with good recovery to six-month follow up. Two patients died in the ICU without regaining consciousness. There were no adverse events during treatment. We conclude that our method is reasonably fast compared to other published methods, it is easy to perform and it offers a good temperature control during cooling and rewarming. Routines for evaluating prognosis and neurological outcome after cardiac arrest and hypothermia treatment need to be revised.

  15. The Association of Prehospital Intravenous Fluids and Mortality in Patients with Penetrating Trauma.

    Science.gov (United States)

    Bores, Sam A; Pajerowski, William; Carr, Brendan G; Holena, Daniel; Meisel, Zachary F; Mechem, C Crawford; Band, Roger A

    2018-02-28

    The optimal approach to prehospital care of trauma patients is controversial, and thought to require balancing advanced field interventions with rapid transport to definitive care. We sought principally to examine any association between the amount of prehospital IV fluid (IVF) administered and mortality. We conducted a retrospective cohort analysis of trauma registry data patients who sustained penetrating trauma between January 2008 and February 2011, as identified in the Pennsylvania Trauma Systems Foundation registry with corresponding prehospital records from the Philadelphia Fire Department. Analyses were conducted with logistic regression models and instrumental variable analysis, adjusted for injury severity using scene vital signs before the intervention was delivered. There were 1966 patients identified. Overall mortality was 22.60%. Approximately two-thirds received fluids and one-third did not. Both cohorts had similar Trauma and Injury Severity Score-predicted mortality. Mortality was similar in those who received IVF (23.43%) and those who did not (21.30%) (p = 0.212). Patients who received IVF had longer mean scene times (10.82 min) than those who did not (9.18 min) (p < 0.0001), although call times were similar in those who received IVF (24.14 min) and those who did not (23.83 min) (p = 0.637). Adjusted analysis of 1722 patients demonstrated no benefit or harm associated with prehospital fluid (odds ratio [OR] 0.905, 95% confidence interval [CI] 0.47-1.75). Instrumental variable analysis utilizing variations in use of IVF across different Emergency Medical Services (EMS) units also found no association between the unit's percentage of patients that were provided fluids and mortality (OR 1.02, 95% CI 0.96-1.08). We found no significant difference in mortality or EMS call time between patients who did or did not receive prehospital IVF after penetrating trauma. Published by Elsevier Inc.

  16. Comparison of Intravenous Ranitidine with Pantoprazole in Decreasing Gastric Fluid Acidity in Emergency Cesarean Section

    Directory of Open Access Journals (Sweden)

    Alipour M

    2013-10-01

    Full Text Available Objectives: Peri-operative aspiration of gastric contents is a problem that causes certain respiratory problems including ARDS. Prophylaxis against aspiration of gastric contents is performed routinely in elective surgeries, but there is rare evidence on the efficacy of this method in emergency cesarean section. Materials and Methods: This is a randomized, controlled, double-blinded clinical trial. 60 parturients undergoing emergency cesarean section were randomly assigned into three groups of 20 each. They were allocated into two study and one placebo groups. The study group one and two received intravenous ranitidine (IV 50 mg or IV pantoprazole 40 mg, half an hour before induction of GA, respectively. The placebo group was administered just 5 ml of isotonic saline half an hour before GA induction. After intubation and confirmation of endotracheal tube insertion, the gastric contents were aspirated through a nasogastric tube for evaluation of acidity and volume. Results: A statistical difference between group one and two with the control group was observed in the acidity of gastric contents, but there was no difference in volume. Also, the PH level of gastric contents in patients receiving pantoprazole was significantly higher than the isotonic saline (p

  17. Workflow Driven Decision Support Systems : A case of an intra-operative visualization system for surgeons

    NARCIS (Netherlands)

    Jalote-Parmar, A.

    2009-01-01

    Inadequate visualization during Minimally Invasive Surgeries (MIS) has led several technology research labs to develop decision support systems such as Intra-operative Visualization Systems (IVS). IVS focuses on providing surgeons with real-time imaging support to improve task visualization and

  18. Photoacoustic intra-operative nodal staging using clinically approved superparamagnetic iron oxide nanoparticles

    NARCIS (Netherlands)

    Grootendorst, Diederik; Fratila, R.M.; Visscher, M.; ten Haken, Bernard; van Wezel, Richard Jack Anton; Steenbergen, Wiendelt; Manohar, Srirang; Ruers, Theo J.M.; Oraevsky, Alexander A.; Wang, Lihong V.

    2013-01-01

    Detection of tumor metastases in the lymphatic system is essential for accurate staging of various malignancies, however fast, accurate and cost-effective intra-operative evaluation of the nodal status remains difficult to perform with common available medical imaging techniques. In recent years,

  19. l-Arginine Pathway Metabolites Predict Need for Intra-operative Shunt During Carotid Endarterectomy

    DEFF Research Database (Denmark)

    Szabo, P; Lantos, J; Nagy, L

    2016-01-01

    lactate levels were increased during reperfusion (p = .02). The median pre-operative concentration of l-arginine was lower in patients requiring an intra-operative shunt than in patients without need of shunt (median: 30.3 μmol/L [interquartile range 24.4-34.4 μmol/L] vs. 57.6 μmol/L [interquartile range...

  20. Evaluation of measures to decrease intra-operative bacterial contamination in orthopaedic implant surgery

    NARCIS (Netherlands)

    Knobben, BAS; van Horn, [No Value; van der Mei, HC; Busscher, HJ

    The aim of this study was to evaluate whether behavioural and systemic measures wilt decrease intra-operative contamination during total hip or knee replacements. The influence of these measures on subsequent prolonged wound discharge, superficial surgical site infection and deep periprosthetic

  1. Intra-operative measurement of applied forces during anterior scoliosis correction.

    Science.gov (United States)

    Fairhurst, H; Little, J P; Adam, C J

    2016-12-01

    Spinal instrumentation and fusion for the treatment of scoliosis is primarily a mechanical intervention to correct the deformity and halt further progression. While implant-related complications remain a concern, little is known about the magnitudes of the forces applied to the spine during surgery, which may affect post-surgical outcomes. In this study, the compressive forces applied to each spinal segment during anterior instrumentation were measured in a series of patients with Adolescent Idiopathic Scoliosis. A force transducer was designed and retrofit to a routinely used surgical tool, and compressive forces applied to each segment during surgery were measured for 15 scoliosis patients. Cobb angle correction achieved by each force was measured on intra-operative fluoroscope images. Relative changes in orientation of the screw within the vertebra were also measured to detect intra-operative screw plough. Intra-operative forces were measured for a total of 95 spinal segments. The mean applied compressive force was 540N (SD 230N, range 88N-1019N). There was a clear trend for higher forces to be applied at segments toward the apex of the scoliosis. Fluoroscopic evidence of screw plough was detected at 10 segments (10.5%). The magnitude of forces applied during anterior scoliosis correction vary over a broad range. These forces do reach magnitudes capable of causing intra-operative vertebral body screw plough. Surgeons should be aware there is a risk for tissue overload during correction, however the clinical implications of intra-operative screw plough remain unclear. The dataset presented here is valuable for providing realistic input parameters for in silico surgical simulations. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Use of virtual slide system for quick frozen intra-operative telepathology diagnosis in Kyoto, Japan.

    Science.gov (United States)

    Tsuchihashi, Yasunari; Takamatsu, Terumasa; Hashimoto, Yukimasa; Takashima, Tooru; Nakano, Kooji; Fujita, Setsuya

    2008-07-15

    We started to use virtual slide (VS) and virtual microscopy (VM) systems for quick frozen intra-operative telepathology diagnosis in Kyoto, Japan. In the system we used a digital slide scanner, VASSALO by CLARO Inc., and a broadband optic fibre provided by NTT West Japan Inc. with the best effort capacity of 100 Mbps. The client is the pathology laboratory of Yamashiro Public Hospital, one of the local centre hospitals located in the south of Kyoto Prefecture, where a full-time pathologist is not present. The client is connected by VPN to the telepathology centre of our institute located in central Kyoto. As a result of the recent 15 test cases of VS telepathology diagnosis, including cases judging negative or positive surgical margins, we could estimate the usefulness of VS in intra-operative remote diagnosis. The time required for the frozen section VS file making was found to be around 10 min when we use x10 objective and if the maximal dimension of the frozen sample is less than 20 mm. Good correct focus of VS images was attained in all cases and all the fields of each tissue specimen. Up to now the capacity of best effort B-band appears to be sufficient to attain diagnosis on time in intra-operation. Telepathology diagnosis was achieved within 5 minutes in most cases using VS viewer provided by CLARO Inc. The VS telepathology system was found to be superior to the conventional still image telepathology system using a robotic microscope since in the former we can observe much greater image information than in the latter in a certain limited time of intra-operation and in the much more efficient ways. In the near future VS telepathology will replace conventional still image telepathology with a robotic microscope even in quick frozen intra-operative diagnosis.

  3. Outcome of renal transplantation with and without intra-operative diuretics.

    Science.gov (United States)

    Hanif, F; Macrae, A N; Littlejohn, M G; Clancy, M J; Murio, E

    2011-01-01

    This paper presents an e-survey of current clinical practice of use of intra-operative diuretics during renal transplantation in the United Kingdom and a study to compare outcome of renal transplants carried out with or without intra-operative diuretics in our centre. An e-mail questionnaire to renal transplant surgeons exploring their practice of renal transplantation with or without intra-operative diuretics, the type of a diuretic/s if used and the relevant doses. An observational study comparing the outcome of renal transplant recipients, group no-diuretics (GND, n = 80) carried out from 2004 to 2008 versus group diuretics (GD n = 69) renal transplant recipients who received intra-operative diuretics over a one year period is presented. Outcome measures were incidence of delayed graft function and a comparison of graft survival in both groups. Forty surgeons answered from 18 transplant centres with a response rate of 67%. 13 surgeons do not use diuretics. Mannitol is used by 10/40, Furosemide 6/40 and 11 surgeons use a combination of both. In comparative study there was no significant overall difference in one year graft survival of GD versus GND (N = 65/69, 94% and 75/80, 94% respectively, p = 0.08) and the incidence of delayed graft function was also comparable (16/69, 23% and 21/80, 26% respectively, p = 0.07). The donor characteristics in both groups were comparable. The study showed variation in clinical practice on the use of intra-operative diuretics in renal transplantation and it did not demonstrate that the use of diuretics can improve renal graft survival. Copyright © 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  4. High-dose rate intra-operative radiation therapy for pediatric solid tumors

    International Nuclear Information System (INIS)

    Merchant, T.E.; Zelefsky, M.J.; Sheldon, J.M.; LaQuaglia, M.B.; Harrison, L.B.

    1996-01-01

    Fifteen pediatric patients with solid tumors received treatment on a phase I protocol designed to test the feasibility and safety of high-dose rate intra-operative radiation therapy (IORT) via a remote afterloader. Patients with Ewing's sarcoma (n=5), rhabdomyosarcoma (n=3), soft-tissue sarcoma (n=3), Wilm's tumor (n=2), osteosarcoma, and immature teratoma were included. IORT was used in the initial management of nine patients and at the time of recurrence in six. Indications for treatment included gross residual disease in four and suspected microscopic disease in eleven. The general sites treated were the abdomen (n=3), chest-wall (n=7), and pelvis (n=5). All patients were pre-treated with chemotherapy, four received prior external beam radiation therapy at the IORT site, and eight underwent an attempt at resection prior to the procedure during which IORT was performed. A minimum dose of 1200 cGy was prescribed to a depth of 0.5 cm from a multi-channel tissue-equivalent applicator. Complications ascribed to IORT included an abscess, delayed wound healing, cytopenia, and fluid loculations. Five patients received supplemental external beam radiation therapy to the IORT site without complication. At the time of IORT, three patients were known to have locally disseminated disease within the pleural cavity and one had pulmonary metastases. With a median follow-up of 18 months, the actuarial rate of local control, metastases-free and overall survival were 60%, 75%, and 50%. The patterns of failure were local (n=1), distant (n=1), and local + distant (n=1). Four patients are alive with active disease, six are alive with no evidence of disease, and the remaining five are dead from disease (n=2), other causes (n=1), or treatment (n=2). Although local failure remains a common problem in the treatment of pediatric solid tumors, the potential to improve local control with high doses of radiation must be balanced against the risk of late effects. The ability to confine the

  5. Use of hypotonic maintenance intravenous fluids and hospital-acquired hyponatremia remain common in children admitted to a general pediatric ward

    Directory of Open Access Journals (Sweden)

    Michael L Moritz

    2016-08-01

    Full Text Available Aim: To evaluate maintenance intravenous fluid prescribing practices and the incidence of hospital-acquired hyponatremia in children admitted to a general pediatric ward.Methods: This is a prospective observational study conducted over a 2-month period in children ages 2 months to 5 years who were admitted to a general pediatric ward and who were receiving maintenance intravenous fluids. The composition, rate and duration of intravenous fluids was chosen at the discretion of the treating physician. Serum biochemistries were obtained at baseline and 24 hours following admission. Patients who were at high risk for developing hyponatremia or hypernatremia or had underlying chronic diseases or were receiving medications associated with a disorder in sodium and water homeostasis were excluded. Intravenous fluid composition and the incidence of hyponatremia (sodium < 135 mEq/L were assessed. Results: Fifty-six children were enrolled. All received hypotonic fluids; 87.5% received 0.18% sodium chloride (NaCl and 14.3% received 0.45% NaCl. Forty percent of patients (17/42 with a serum sodium less than 140 mEq/L experienced a fall in serum sodium with 12.5% of all patients (7/56 developing hospital-acquired or aggravated hyponatremia (126 – 134 mEq/L with fall in serum sodium between 2 – 10 mEq/L.Conclusions: Administration of hypotonic fluids was a prevalent practice in children admitted to a general pediatric ward and is associated with acute hospital-acquired hyponatremia.

  6. Intra-operative colloid administration increases the clearance of a post-operative fluid load

    DEFF Research Database (Denmark)

    Borup, Tine; Hahn, Robert; Holte, K

    2009-01-01

    using volume kinetics based on the plasma dilution alone. The pre-operative plasma clearance was compared with the post-operative plasma clearance and patients served as their own control. RESULTS: The urinary excretion averaged 350 ml for the pre-operative infusion and 612 ml post-operatively, which...

  7. The use of pregame hyperhydration with intravenous fluids in National Collegiate Athletic Association Football Bowl Subdivision teams.

    Science.gov (United States)

    Gesik, Nicole Y; Tan, Sabrina K G; Prentiss, Gale T; Fitzsimmons, Sean; Nichols, Andrew W

    2013-11-01

    To determine the frequency of pregame intravenous fluid hyperhydration (PIVFH) usage, administration protocols, indications, complications, and perceived efficacy by National Collegiate Athletic Association Football Bowl Subdivision (NCAA-FBS) teams. Cross-sectional survey study. National Collegiate Athletic Association Football Bowl Subdivision. Head athletic trainers from NCAA-FBS institutions. Voluntary, anonymous 15-item validated online survey instrument. Number of teams reporting use of PIVFH. The survey response rate was 64% (77 of 120). Thirty percent of respondents reported the utilization of PIVFH, administered to an average of 2 to 3 players. The most common reasons cited for using PIVFH were to prevent muscle cramps (95%), heat illness (79%), and dehydration (68%). Additionally, 47% of programs used PIVFH to improve player exercise tolerance and 47% per player request. Twenty-four percent of programs that used PIVFH reported the occurrence of associated complications. Only 15% of respondents believed that PIVFH improved their teams' overall performance. PIVFH is a common practice among NCAA-FBS teams. PIVFH is used most often to prevent muscle cramps, dehydration, and heat illness. The relatively few numbers of players per team who receive PIVFH suggest that higher risk individuals were targeted for administration.

  8. Touch imprint and crash preparation intra operative cytology versus frozen section in thyroid nodule

    Directory of Open Access Journals (Sweden)

    Ali Chehrei

    2012-01-01

    Full Text Available Background: Intra operative cytology (IC, including touch imprint (TI and crash preparations (CP, in general has been demonstrated to be a diagnostic tool for many organs but its validity and reliability for diagnosis of thyroid nodules remain controversial. We evaluate the diagnostic value of frozen section, touch imprint, crash preparation and the combination of touch imprint and crash preparation and the combination of frozen section, touch imprint and crash preparation. Materials ans Methods : 55 intra operative specimens from patients with thyroid nodules who underwent thyroidectomy were evaluated at Alzahra and vali-Asr hospital laboratories. For all of the patients frozen section (FS, touch imprint (TI and crash preparation (CP was obtained and reviewed by two pathologists at the same time. Serial TI and CP, and FS, TI and CP were reviewed by the same pathologists. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and accuracy were calculated according to the permanent section as the gold standard test. Results: In our study sensitivity, specificity and accuracy for FS was 100%, 97.6% and 98.1% respectively; for TI they were 78.6%, 95% and 92.4%; for CP they were 78.6%, 92.7% and 89.9%; for serial TI and CP they were 85.7%, 92.7% and 90.9%; and for the combination of FS and TI and CP they were 100%, 97.6% and 98.18% respectively. Conclusions: Intra operative cytology (including TI and CP seems to be a useful, valuable and inexpensive method in clinics, which do not have equipment for frozen sections. Intra operative cytology combined with FS increased the overall accuracy of diagnosis. Further studies are needed to validate the obtained results of this study.

  9. Studies on the reliability of high-field intra-operative MRI in brain glioma resection

    Directory of Open Access Journals (Sweden)

    Zhi-jun SONG

    2011-07-01

    Full Text Available Objective To evaluate the reliability of high-field intra-operative magnetic resonance imaging(iMRI in detecting the residual tumors during glioma resection.Method One hundred and thirty-one cases of brain glioma(69 males and 62 females,aged from 7 to 79 years with mean of 39.6 years hospitalized from Nov.2009 to Aug.2010 were involved in present study.All the patients were evaluated using magnetic resonance imaging(MRI before the operation.The tumors were resected under conventional navigation microscope,and the high-field iMRI was used for all the patients when the operators considered the tumor was satisfactorily resected,while the residual tumor was difficult to detect under the microscope,but resected after being revealed by high-field iMRI.Histopathological examination was performed.The patients without residual tumors recieved high-field MRI scan at day 4 or 5 after operation to evaluate the accuracy of high-field iMRI during operation.Results High quality intra-operative images were obtained by using high-field iMRI.Twenty-eight cases were excluded because their residual tumors were not resected due to their location too close to functional area.Combined with the results of intra-operative histopathological examination and post-operative MRI at the early recovery stage,the sensitivity of high-field iMRI in residual tumor diagnosis was 98.0%(49/50,the specificity was 94.3%(50/53,and the accuracy was 96.1%(99/103.Conclusion High-quality intra-operative imaging could be acquired by high-field iMRI,which maybe used as a safe and reliable method in detecting the residual tumors during glioma resection.

  10. The Effects of Intravenous Hydration on Amniotic Fluid Volume and Pregnancy Outcomes in Women with Term Pregnancy and Oligohydramnios: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Mahnaz Shahnazi

    2012-08-01

    Full Text Available Introduction: Amniotic fluid is an important factor in the prediction of fetal survival. The aim of this research was to evaluate the effects of intravenous hydration of mothers on amniotic fluid volume and in turn on pregnancy outcomes. Methods: The current single blind controlled clinical trial was conducted on 20 pregnant mothers with amniot-ic fluid index of lower or equal to 5 cm and gestational age of 37-41 weeks. The subjects were divided into two groups of case and control through simple random sampling. Am-niotic fluid index was measured in all participants. The case group received one liter of isotonic saline during 30 minutes by the bolus method. Reevaluations of amniotic fluid index in both groups were made 90 minutes after baseline measurement. Independent t-test and paired t-test were used to compare the two groups and mean amniotic fluid in-dex before and after treatment, respectively. Results: Hydration of mothers significantly increased the amniotic fluid index in the case group (mean change: 1.5 cm; 95%CI: 0.46 - 2.64; P = 0.01. The mean change of amniotic fluid index in the control group did not significantly increase (P = 0.06. The elevation of amniotic fluid index in the hydra-tion group (32% was significantly higher than the control group (1% (P = 0.03. Conclusion: In this study intravenous hydration increased amniotic fluid index of mothers with term pregnancy and oligohydramnios. Since it caused no complications for the moth-er and the fetus, it can be used as an effective method in management of oligohydramnios.

  11. Intra-operative mapping of the atria: the first step towards individualization of atrial fibrillation therapy?

    Science.gov (United States)

    Kik, Charles; Mouws, Elisabeth M J P; Bogers, Ad J J C; de Groot, Natasja M S

    2017-07-01

    Atrial fibrillation (AF), an age-related progressive disease, is becoming a worldwide epidemic with a prevalence rate of 33 million. Areas covered: In this expert review, an overview of important results obtained from previous intra-operative mapping studies is provided. In addition, our novel intra-operative high resolution mapping studies, its surgical considerations and data analyses are discussed. Furthermore, the importance of high resolution mapping studies of both sinus rhythm and AF for the development of future AF therapy is underlined by our most recent results. Expert commentary: Progression of AF is determined by the extensiveness of electropathology which is defined as conduction disorders caused by structural damage of atrial tissue. The severity of electropathology is a major determinant of therapy failure. At present, we do not have any diagnostic tool to determine the degree of electropathology in the individual patient and we can thus not select the most optimal treatment modality for the individual patient. An intra-operative, high resolution scale, epicardial mapping approach combined with quantification of electrical parameters may serve as a diagnostic tool to stage AF in the individual patient and to provide patient tailored therapy.

  12. Bimanual, intra-operative, fluoroscopy-guided removal of nasopharyngeal migratory fish bone from carotid space.

    Science.gov (United States)

    Al-Abduwani, J A; Bhargava, D; Sawhney, S; Al-Abri, R

    2010-07-01

    We report a rare and unusual case of a patient with an ingested fishbone which migrated from the oropharynx to the anterior compartment of the retropharyngeal space and then to the deep neck space in the nasopharynx (i.e. the carotid space). This report aims to describe a successful, minimally invasive method of foreign body removal which avoided both major skull base surgery and any potential life-threatening complications. A secondary aim is to highlight the role of intra-operative fluoroscopy, an under-used tool. We present a 67-year-old man with a history of fish bone impaction but no fish bone visible on plain X-ray or flexible endoscopy. The diagnosis of fish bone lodged in the retropharyngeal space was confirmed by computed tomography. Surgical exploration of the anterior retropharyngeal space failed to locate the fish bone, as it had migrated to a new, unknown location. Intra-operative fluoroscopy was vital for the removal of the fish bone, as it was impossible to see with the naked eye and had migrated from its previously imaged position. The fish bone was finally retrieved bimanually using external pressure on the submandibular region, which displaced the fish bone, and fluoroscopic guidance, which assisted its removal from the nasopharyngeal lumen. To the best of our knowledge, this is the first reported case of bimanual, intra-operative, fluoroscopy-guided, intra-luminal removal of a migratory fish bone from the deep neck space in this region of the nasopharynx.

  13. Clinical evaluation of intra-operative radiotherapy combined with subtotal cystectomy for invasive bladder carcinoma

    International Nuclear Information System (INIS)

    Ozawa, Kazunori; Nakagomi, Kazuaki; Yonese, Junzi

    1996-01-01

    From 1981 to 1994, intra-operative radiotherapy after subtotal cystectomy was performed on 22 patients with invasive bladder carcinoma on whom radical cystectomy could not be recommended because of old age or condition. All the patients received 25 to 30 Gy of radiotherapy focused on trigonum and internal urethral orifice after subtotal cystectomy with uretero-cutaneostomy. Of 22 patients, 15 patients died. Five patients died of bladder cancer, one died of gastic cancer, one died of rectal cancer and the others died of pneumonia, heart failure, sepsis and senility. The five-year survival rate was 41% and the cause-specific five-year survival rate was 75%. Local recurrence was seen only in one patient, who received second intra-operative radiotherapy and recovered well in complete remission. We believe that intra-operative radiotherapy after subtotal cystectomy is useful for patients with invasive bladder carcinoma on whom radical cystectomy could not be recommended because of old age or condition. (author)

  14. Safe surgery: how accurate are we at predicting intra-operative blood loss?

    LENUS (Irish Health Repository)

    2012-02-01

    Introduction Preoperative estimation of intra-operative blood loss by both anaesthetist and operating surgeon is a criterion of the World Health Organization\\'s surgical safety checklist. The checklist requires specific preoperative planning when anticipated blood loss is greater than 500 mL. The aim of this study was to assess the accuracy of surgeons and anaesthetists at predicting intra-operative blood loss. Methods A 6-week prospective study of intermediate and major operations in an academic medical centre was performed. An independent observer interviewed surgical and anaesthetic consultants and registrars, preoperatively asking each to predict expected blood loss in millilitre. Intra-operative blood loss was measured and compared with these predictions. Parameters including the use of anticoagulation and anti-platelet therapy as well as intra-operative hypothermia and hypotension were recorded. Results One hundred sixty-eight operations were included in the study, including 142 elective and 26 emergency operations. Blood loss was predicted to within 500 mL of measured blood loss in 89% of cases. Consultant surgeons tended to underestimate blood loss, doing so in 43% of all cases, while consultant anaesthetists were more likely to overestimate (60% of all operations). Twelve patients (7%) had underestimation of blood loss of more than 500 mL by both surgeon and anaesthetist. Thirty per cent (n = 6\\/20) of patients requiring transfusion of a blood product within 24 hours of surgery had blood loss underestimated by more than 500 mL by both surgeon and anaesthetist. There was no significant difference in prediction between patients on anti-platelet or anticoagulation therapy preoperatively and those not on the said therapies. Conclusion Predicted intra-operative blood loss was within 500 mL of measured blood loss in 89% of operations. In 30% of patients who ultimately receive a blood transfusion, both the surgeon and anaesthetist significantly underestimate

  15. The Effects of Intravenous Hydration on Amniotic Fluid Index in Pregnant Women with Preterm premature Rupture of Membranes: A Randomized Clinical Trial

    Science.gov (United States)

    Shahnazi, Mahnaz; Tagavi, Simin; Hajizadeh, Khadije; Farshbaf Khalili, Azize

    2013-01-01

    Introduction: Preterm premature rupture of membranes (PPROM) can result in fetal complications such as oligohydramnios. This study aimed to determine the effects of intravenous (IV) fluid bolus on amniotic fluid index (AFI) in pregnant women with PPROM. Methods: 24 women with PPROM during singleton live pregnancy of 28 to 34 weeks whose baseline AFI was ≤ 5cm were randomized into two groups. The study group received one liter intravenous fluid bolus of isotonic Ringer serum during 30-minute period. Reevaluations of amniotic fluid index in both groups were made 90 minutes and 48 hours after baseline measurement. Independent t-test and paired t-test were used to compare the two groups and mean amniotic fluid index before and after treatment, respectively. Results: The results of this study demonstrate that AFI decreased statistically significant in both the control and study groups. AFI decreased in both groups at 48 hours later. This decrease was not statistically significant in any group. The mean change in AFI (90 minutes and baseline) and (48 hours and baseline) between the two groups were not significant. The time between mean baseline measurements and delivery were 196.41 and 140.58 hours in the study and control groups, respectively. This difference was not statistically significant. Conclusion: This study did not find significant impact of hydration On AFI as a prophylactic method on oligohydramnios in pregnant women with PPROM. PMID:25276709

  16. Intravenous fluid administration may improve post-operative course of patients with chronic subdural hematoma: a retrospective study.

    Directory of Open Access Journals (Sweden)

    Miroslaw Janowski

    Full Text Available BACKGROUND: The treatment of chronic subdural hematoma (cSDH is still charged of significant risk of hematoma recurrence. Patient-related predictors and the surgical procedures themselves have been addressed in many studies. In contrast, postoperative management has infrequently been subjected to detailed analysis. Moreover variable intravenous fluid administration (IFA was not reported in literature till now in the context of cSDH treatment. METHODOLOGY/PRINCIPAL FINDINGS: A total of 45 patients with cSDH were operated in our department via two burr hole craniostomy within one calendar year. Downward drainage was routinely left in hematoma cavity for a one day. Independent variables selected for the analysis were related to various aspects of patient management, including IFA. Two dependent variables were chosen as measure of clinical course: the rate of hematoma recurrence (RHR and neurological status at discharge from hospital expressed in points of Glasgow Outcome Scale (GOS. Univariate and multivariate regression analyses were performed. Hematoma recurrence with subsequent evacuation occurred in 7 (15% patients. Univariate regression analysis revealed that length of IFA after surgery influenced both dependent variables: RHR (p = 0.045 and GOS (p = 0.023. Multivariate regression performed by backward elimination method confirmed that IFA is a sole independent factor influencing RHR. Post hoc dichotomous division of patients revealed that those receiving at least 2000 ml/day over 3 day period revealed lower RHR than the group with less intensive IFA. (p = 0.031. CONCLUSIONS/SIGNIFICANCE: IFA has been found to be a sole factor influencing both: RHR and GOS. Based on those results we may recommend administration of at least 2000 ml per 3 days post-operatively to decrease the risk of hematoma recurrence.

  17. [Intra-operative myelography in treatment of fractures of thoracolumbar spine].

    Science.gov (United States)

    Tomčovčík, L; Cuha, R; Raši, R

    2010-08-01

    The aim of this retrospective study was to evaluate the results of intra-operative myelography as the method used to assess the reduction of bone fragments from the posterior margin of the vertebral body. Forty patients with 42 comminuted fractures of the thoracolumbar spine were included in the study. The pre-operative spinal stenosis caused by bone fragments from the posterior margin of the vertebral body, as detected by CT scanning, ranged from 25 % to 85 %. Neurological deficit was due to injury in 19 patients and in one it developed post-operatively after the patient stood and walked. After ligamentotaxis and internal fixation, intra-operative myelography was used to show decompression of the spinal canal. A spinal block or severe constriction of contrast flow was an indication for hemilaminectomy (laminectomy) and direct decompression of the spinal canal. In the patients with neurological deficit and severe spinal stenosis persisting after ligamentotaxis and detectable by skiascopy, hemilaminectomy (laminectomy) and direct spinal decompression followed by intra-operative myelography were carried out. Intra-operative myelography was used 46 -times (20-times in 20 patients free from neurological deficit and 26-times in 20 patients with neurological deficit). In 38 cases (82.6 %) dural sac compression was not present (patients with neurological deficit, 13-times after ligamentotaxis, eight-times after ligamentotaxis and hemilaminectomy with direct decompression, twi- ce at repeat surgeryúúú patients without neurological deficit, 15-times). On two occasions (4.4 %) the contrast agent injected into the dural sac did not make the interior body part visible, on three occasions (6.5 %) contrast medium was injected extradurally, and dural sac compression following ligamentotaxis requiring hemilaminectomy (laminectomy) and direct decompression occurred in three cases (6.5 %). In the patients without neurological deficit, dural sac compression was not recorded. No

  18. Intra-operative maternal complications of emergency cesarean section done in advanced labor

    International Nuclear Information System (INIS)

    Nisa, M.U.

    2013-01-01

    Background: Emergency cesarean section done in advanced labor is a big challenge in obstetrics due to increased risk of intraoperative complications. In the last decade, a rapid increase in cesarean section done in advanced labor has been observed. Difficult deli-very of the fetal head during cesarean section carries a high risk of intraoperative complications like cervical and uterine tears, intra operative hemorrhage and trauma to the baby. Objectives: The purpose of this study is to find out the frequency and risk factors for intra-operative complications in emergency cesarean section done in advanced labor, so that appropriate management protocols can be planned to reduce these complications. Study Design: Prospective cohort study. Materials and Methods: This prospective study was carried out in Obstetrics and Gynecology Unit - 2 of Services Institute of Medical Sciences, Services Hospital, Lahore; from 1st January 2007 to 31st December 2007. All patients undergoing emergency cesarean sections done on laboring mothers were included in the study. The sample was divided into two groups; emergency C-section done in advanced labor as the study group and emergency C-section in early labor as the control group. Data were collected regarding age, parity, booked or unbooked status, indications for cesarean section, level of competence of operating surgeon, intra-operative complications and the risk factors for these complications. Data were recorded on a structured proforma and compared between the two groups. Statistical Analysis: Data were analyzed using computer programme SPSS Version 14 for windows applying student t-test for quantitative and chai square test for qualitative parameters. A p-value < 0.05 was used as statistically significant. Results: Out of 2064 total deliveries in the year 2007, 1290 (62.5%) were vaginal deliveries and 774 (37.5%) were C-Sections. Out of 774 C-Section, 174 (23%) were elective and 600 (77%) were emergency. Out of 600 emergency C

  19. The impact of intra-operative interruptions on surgeons' perceived workload: an observational study in elective general and orthopedic surgery.

    Science.gov (United States)

    Weigl, Matthias; Antoniadis, Sophia; Chiapponi, Costanza; Bruns, Christiane; Sevdalis, Nick

    2015-01-01

    Surgeons' intra-operative workload is critical for effective and safe surgical performance. Detrimental conditions in the operating room (OR) environment may add to perceived workload and jeopardize surgical performance and outcomes. This study aims to evaluate the impact of different intra-operative workflow interruptions on surgeons' capacity to manage their workload safely and efficiently. This was an observational study of intra-operative interruptions and self-rated workload in two surgical specialties (general, orthopedic/trauma surgery). Intra-operative interruptions were assessed via expert observation using a well-validated observation tool. Surgeons, nurses, and anesthesiologists assessed their intra-operative workload directly after case completion based on three items of the validated Surgery Task Load Index (mental demand, situational stress, distraction). A total of 56 elective cases (35 open, 21 laparoscopic) with 94 workload ratings were included. Mean intra-operative duration was 1 h 37 min. Intra-operative interruptions were on average observed 9.78 times per hour. People who entered/exited the OR (30.6 %) as well as telephone-/beeper-related disruptions (23.6 %) occurred most often. Equipment and OR environment-related interruptions were associated with highest interference with team functioning particularly in laparoscopic procedures. After identifying task and procedural influences, partial correlational analyses revealed that case-irrelevant communications were negatively associated with surgeons' mental fatigue and situational stress, whereas surgeons' reported distraction was increased by case-irrelevant communication and procedural disruptions. OR nurses' and anesthesiologists' perceived workload was also related to intra-operative interruption events. Our study documents the unique contribution of different interruptions on surgeons' workload; whereas case-irrelevant communications may be beneficial for mental fatigue and stress in routine

  20. Achieving Adequate Margins in Ameloblastoma Resection: The Role for Intra-Operative Specimen Imaging. Clinical Report and Systematic Review

    Science.gov (United States)

    Ramakrishnan, Anand; Mirkazemi, Mansoor; Baillieu, Charles; Ptasznik, Ronnie; Leong, James

    2012-01-01

    Background Ameloblastoma is a locally aggressive odontogenic neoplasm. With local recurrence rates reaching 90%, only completeness of excision can facilitate cure. Surgical clearance has widely been based on pre-operative imaging to guide operative excision margins, however use of intra-operative specimen x-ray or frozen-section has been sought to improve clearance rates, and advanced imaging technologies in this role have been proposed. This manuscript aims to quantify the evidence for evaluating intra-operative resection margins and present the current standard in this role. Method The current study comprises the first reported comparison of imaging modalities for assessing ameloblastoma margins. A case is presented in which margins are assessed with each of clinical assessment based on preoperative imaging, intra-operative specimen x-ray, intra-operative specimen computed tomography (CT) and definitive histology. Each modality is compared quantitatively. These results are compared to the literature through means of systematic review of current evidence. Results A comparative study highlights the role for CT imaging over plain radiography. With no other comparative studies and a paucity of high level evidence establishing a role for intra-operative margin assessment in ameloblastoma in the literature, only level 4 evidence supporting the use of frozen section and specimen x-ray, and only one level 4 study assesses intra-operative CT. Conclusion The current study suggests that intra-operative specimen CT offers an improvement over existing techniques in this role. While establishing a gold-standard will require higher level comparative studies, the use of intra-operative CT can facilitate accurate single-stage resection. PMID:23094099

  1. Achieving adequate margins in ameloblastoma resection: the role for intra-operative specimen imaging. Clinical report and systematic review.

    Directory of Open Access Journals (Sweden)

    Inoka De Silva

    Full Text Available BACKGROUND: Ameloblastoma is a locally aggressive odontogenic neoplasm. With local recurrence rates reaching 90%, only completeness of excision can facilitate cure. Surgical clearance has widely been based on pre-operative imaging to guide operative excision margins, however use of intra-operative specimen x-ray or frozen-section has been sought to improve clearance rates, and advanced imaging technologies in this role have been proposed. This manuscript aims to quantify the evidence for evaluating intra-operative resection margins and present the current standard in this role. METHOD: The current study comprises the first reported comparison of imaging modalities for assessing ameloblastoma margins. A case is presented in which margins are assessed with each of clinical assessment based on preoperative imaging, intra-operative specimen x-ray, intra-operative specimen computed tomography (CT and definitive histology. Each modality is compared quantitatively. These results are compared to the literature through means of systematic review of current evidence. RESULTS: A comparative study highlights the role for CT imaging over plain radiography. With no other comparative studies and a paucity of high level evidence establishing a role for intra-operative margin assessment in ameloblastoma in the literature, only level 4 evidence supporting the use of frozen section and specimen x-ray, and only one level 4 study assesses intra-operative CT. CONCLUSION: The current study suggests that intra-operative specimen CT offers an improvement over existing techniques in this role. While establishing a gold-standard will require higher level comparative studies, the use of intra-operative CT can facilitate accurate single-stage resection.

  2. Impact of intra-operative intraperitoneal chemotherapy on organ/space surgical site infection in patients with gastric cancer.

    Science.gov (United States)

    Liu, X; Duan, X; Xu, J; Jin, Q; Chen, F; Wang, P; Yang, Y; Tang, X

    2015-11-01

    Various risk factors for surgical site infection (SSI) have been identified such as age, overweight, duration of surgery, blood loss, etc. Intraperitoneal chemotherapy during surgery is a common procedure in patients with gastric cancer, yet its impact on SSI has not been evaluated. To evaluate whether intra-operative intraperitoneal chemotherapy is a key risk factor for organ/space SSI in patients with gastric cancer. All patients with gastric cancer who underwent surgery at the Department of Gastrointestinal Surgery between January 2008 and December 2013 were studied. The organ/space SSI rates were compared between patients who received intra-operative intraperitoneal chemotherapy and patients who did not receive intra-operative intraperitoneal chemotherapy, and the risk factors for organ/space SSI were analysed by univariate and multi-variate regression analyses. The microbial causes of organ/space SSI were also identified. Of the eligible 845 patients, 356 received intra-operative intraperitoneal chemotherapy, and the organ/space SSI rate was higher in these patients compared with patients who did not receive intra-operative intraperitoneal chemotherapy (9.01% vs 3.88%; P = 0.002). Univariate analysis confirmed the significance of this finding (odds ratio 2.443; P = 0.003). As a result, hospital stay was increased in patients who received intra-operative intraperitoneal chemotherapy {mean 20.91 days [95% confidence interval (CI) 19.76-22.06] vs 29.72 days (95% CI 25.46-33.99); P = 0.000}. The results also suggested that intra-operative intraperitoneal chemotherapy may be associated with more Gram-negative bacterial infections. Intra-operative intraperitoneal chemotherapy is a significant risk factor for organ/space SSI in patients with gastric cancer. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  3. Intra-operative neurophysiological mapping and monitoring during brain tumour surgery in children: an update.

    Science.gov (United States)

    Coppola, Angela; Tramontano, Vincenzo; Basaldella, Federica; Arcaro, Chiara; Squintani, Giovanna; Sala, Francesco

    2016-10-01

    Over the past decade, the reluctance to operate in eloquent brain areas has been reconsidered in the light of the advent of new peri-operative functional neuroimaging techniques and new evidence from neuro-oncology. To maximise tumour resection while minimising morbidity should be the goal of brain surgery in children as much as it is in adults, and preservation of brain functions is critical in the light of the increased survival and the expectations in terms of quality of life. Intra-operative neurophysiology is the gold standard to localise and preserve brain functions during surgery and is increasingly used in paediatric neurosurgery. Yet, the developing nervous system has peculiar characteristics in terms of anatomical and physiological maturation, and some technical aspects need to be tailored for its use in children, especially in infants. This paper will review the most recent advances in the field of intra-operative neurophysiology (ION) techniques during brain surgery, focussing on those aspects that are relevant to the paediatric neurosurgery practice.

  4. Minimizing shoulder syndrome with intra-operative spinal accessory nerve monitoring for neck dissection.

    Science.gov (United States)

    Lee, C-H; Huang, N-C; Chen, H-C; Chen, M-K

    2013-04-01

    The objective of this study was to analyze the safety and results of intra-operative SAN (spinal accessary nerve) monitoring during selective neck dissection, with emphasis on shoulder syndrome. Twenty-five consecutive patients with head and neck cancer were studied. Selective neck dissection was performed by a single clinical fellow under the supervision of the department chief using an intra-operative SAN monitor. Electrophysiological data were recorded after initial identification of the SAN and continued until just before closure. Electromyographic evaluation was carried out to assess SAN function one month postoperatively. Shoulder disability was also evaluated at this time using a questionnaire for shoulder syndrome (shrug, flexion, abduction, winging, and pain). No patients had postoperative shoulder syndrome involving shrug, flexion, abduction, or winging. Twenty-two of the 25 (88%) patients had shoulder pain, but the average pain score was low (2.3 ± 1.3). No patients had neck recurrence during at least 1 year of follow up. By using nerve monitoring during selective neck dissection, no patient developed significant "shoulder syndrome", with the exception of slight pain.

  5. The effect of intra-operative transcutaneous electrical nerve stimulation on posterior neck pain following thyroidectomy.

    Science.gov (United States)

    Park, C; Choi, J B; Lee, Y-S; Chang, H-S; Shin, C S; Kim, S; Han, D W

    2015-04-01

    Posterior neck pain following thyroidectomy is common because full neck extension is required during the procedure. We evaluated the effect of intra-operative transcutaneous electrical nerve stimulation on postoperative neck pain in patients undergoing total thyroidectomy under general anaesthesia. One hundred patients were randomly assigned to one of two groups; 50 patients received transcutaneous electrical nerve stimulation applied to the trapezius muscle and 50 patients acted as controls. Postoperative posterior neck pain and anterior wound pain were evaluated using an 11-point numerical rating scale at 30 min, 6 h, 24 h and 48 h following surgery. The numerical rating scale for posterior neck pain was significantly lower in the transcutaneous electrical nerve stimulation group compared with the control group at all time points (p < 0.05). There were no significant differences in the numerical rating scale for anterior wound pain at any time point. No adverse effects related to transcutaneous electrical nerve stimulation were observed. We conclude that intra-operative transcutaneous electrical nerve stimulation applied to the trapezius muscle reduced posterior neck pain following thyroidectomy. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

  6. Intra-operative 3-T MRI for paediatric brain tumours: challenges and perspectives

    International Nuclear Information System (INIS)

    Abernethy, L.J.; Avula, S.; Hughes, G.M.; Wright, E.J.; Mallucci, C.L.

    2012-01-01

    MRI is the ideal modality for imaging intracranial tumours. Intraoperative MRI (ioMRI) makes it possible to obtain scans during a neurosurgical operation that can aid complete macroscopic tumour resection - a major prognostic factor in the majority of brain tumours in children. Intra-operative MRI can also help limit damage to normal brain tissue. It therefore has the potential to improve the survival of children with brain tumours and to minimise morbidity, including neurological deficits. The use of ioMRI is also likely to reduce the need for second look surgery, and may reduce the need for chemotherapy and radiotherapy. High-field MRI systems provide better anatomical information and also enable effective utilisation of advanced MRI techniques such as perfusion imaging, diffusion tensor imaging, and magnetic resonance spectroscopy. However, high-field ioMRI facilities require substantial capital investment, and careful planning is required for optimal benefit. Safe ioMRI requires meticulous attention to detail and rigorous application of magnetic field safety precautions. Interpretation of ioMRI can be challenging and requires experience and understanding of artefacts that are common in the intra-operative setting. (orig.)

  7. Intra-operative application of optical coherence tomography with an operating microscope.

    Science.gov (United States)

    Just, T; Lankenau, E; Hüttmann, G; Pau, H W

    2009-09-01

    To introduce the use of optical coherence tomography with an operating microscope for intra-operative evaluation of the human larynx. A specially equipped operating microscope with integrated spectral domain optical coherence tomography apparatus was used during microlaryngoscopy. Technical improvements in optical coherence tomography equipment (e.g. pilot beam, variable focal distance, improved image quality and integration into an operating microscope) have enabled greater sensitivity and imaging speed and a non-contact approach. Spectral domain optical coherence tomography now enables a better correlation between optical coherence tomography images and histological findings. With this new technology, the precision of biopsy can be improved during microlaryngoscopy. Use of this new optical coherence tomography technology, integrated into an operating microscope, enables the surgeon to define the biopsy site location and resection plane precisely, while the optical zoom of the operating microscope can be used over the complete range.

  8. A standardized and safe method of sterile field maintenance during intra-operative horizontal plane fluoroscopy

    Directory of Open Access Journals (Sweden)

    Kaska Serge C

    2010-12-01

    Full Text Available Abstract Background Intra-operative fluoroscopy for orthopaedic procedures frequently involves imaging in the horizontal plane, which requires the lower portion of the C-arm (x-ray tube to be rotated from an unsterile zone (beneath the table into the sterile field. To protect the integrity of the sterile field the C-arm must be draped repeatedly throughout the surgical case. The current, un-standardized, practice employs draping procedures which violate the Association of peri-Operative Registered Nurses (AORN Standards and Recommended Practices, waste time and material, and pose an increased risk for surgical site infection. Presentation of the hypothesis Use of a novel sterile C-arm drape (C-armor that maintains the integrity of the sterile field, will improve operating room efficiency and reduce surgical site infection risk factors. This reduction in risk factors may potentially reduce surgical site infections in orthopaedic surgical cases requiring repeated horizontal x-ray imaging. Testing the Hypothesis Savings in time and material and the reduction in surgical site infection risk factors afforded by using C-armor are intuitive to those skilled in the practice of orthopaedic surgery. Testing for a reduction in the number of microorganisms introduced to the surgical site by improved C-arm draping would be challenging due to the multiple confounding factors during a surgical operation. Determination of an absolute reduction in surgical site infections may be possible, but will require accounting for many confounding variables and a large study sample in order to achieve statistical significance. Implications of the Hypothesis Improved intraoperative workflow, healthcare savings and a reduction in surgical site infection risk factors will be achieved by utilizing a standardized and safe method of sterile field maintenance during intra-operative horizontal plane fluoroscopy.

  9. Effect of External Pressure and Catheter Gauge on Flow Rate, Kinetic Energy, and Endothelial Injury During Intravenous Fluid Administration in a Rabbit Model.

    Science.gov (United States)

    Hu, Mei-Hua; Chan, Wei-Hung; Chen, Yao-Chang; Cherng, Chen-Hwan; Lin, Chih-Kung; Tsai, Chien-Sung; Chou, Yu-Ching; Huang, Go-Shine

    2016-01-01

    The effects of intravenous (IV) catheter gauge and pressurization of IV fluid (IVF) bags on fluid flow rate have been studied. However, the pressure needed to achieve a flow rate equivalent to that of a 16 gauge (G) catheter through smaller G catheters and the potential for endothelial damage from the increased kinetic energy produced by higher pressurization are unclear. Constant pressure on an IVF bag was maintained by an automatic adjustable pneumatic pressure regulator of our own design. Fluids running through 16 G, 18 G, 20 G, and 22 G catheters were assessed while using IV bag pressurization to achieve the flow rate equivalent to that of a 16 G catheter. We assessed flow rates, kinetic energy, and flow injury to rabbit inferior vena cava endothelium. By applying sufficient external constant pressure to an IVF bag, all fluids could be run through smaller (G) catheters at the flow rate in a 16 G catheter. However, the kinetic energy increased significantly as the catheter G increased. Damage to the venous endothelium was negligible or minimal/patchy cell loss. We designed a new rapid infusion system, which provides a constant pressure that compresses the fluid volume until it is free from visible residual fluid. When large-bore venous access cannot be obtained, multiple smaller catheters, external pressure, or both should be considered. However, caution should be exercised when fluid pressurized to reach a flow rate equivalent to that in a 16 G catheter is run through a smaller G catheter because of the profound increase in kinetic energy that can lead to venous endothelium injury.

  10. Intra-operative Ultrasound as a Tool to Assess Free Borders of Primary Vascular Aortic Tumors During Resection

    Directory of Open Access Journals (Sweden)

    R.M. Andersen

    Full Text Available : Introduction: Primary vascular tumors are rare and, in general, have a poor prognosis. Complete resection is associated with a better prognosis. Radical resection depends on safe discrimination of tumor borders. Technical summary: A 54 year old woman presented with abdominal pain. Imaging revealed a mass in the thoracic aorta, highly suspicious of angiosarcoma which was confirmed post-operatively by histological analysis. Open surgery was performed. Prior to clamping of the aorta, intra-operative ultrasound established clear delineation of the tumor borders. Conclusion: Intra-operative ultrasound was, in this case, a safe and easy method to determine the tumor borders, providing a simple guide to in toto tumor removal. Keywords: Angiosarcoma, Intra-operative ultrasound, In toto tumor removal, Fludeoxyglucose positron emission tomography/computed tomography, Magnetic resonance imaging

  11. Comparison of the Concentrations of Lidocaine in Different Body Fluids/Tissues after Subarachnoid Space and Intravenous Administration of a Lethal Dose of Lidocaine

    Directory of Open Access Journals (Sweden)

    Nan Zhang

    2015-01-01

    Full Text Available The objective of the study was to compare the concentration of lidocaine in different body fluids/tissues after subarachnoid space and intravenous administrations of a lethal dose of lidocaine. Totally 18 dogs were used in the experiment. Six dogs were given subarachnoid anesthesia, another were given an intravenous injection of a dose of 75 mg/kg weight of lidocaine hydrochloride in 5 min and the last 6 dogs were used as the blank control dogs and given a subarachnoid space injection or a femoral artery injection of the same volume of sodium chloride. As soon as its vital signs disappeared, each dog was dissected and the specimen, such as brain, cerebrospinal fluid (CSF in lateral ventricle, CSF in subarachnoid space, spinal cord (cervical spinal cord, thoracic spinal cord, lumbar spinal cord, and waist spinal cord, heart, lung, liver, spleen, kidney, bile, urine, heart blood, peripheral blood, muscle in injection location, and muscle in no injection location, were collected for analysis of lidocaine immediately. Analysis was performed with gas chromatography-mass spectrometry (GC-MS. From the maximum to the minimum, the order of lidocaine concentration detected in the subarachnoid space-administered dogs was as follows: CSF in subarachnoid space, waist spinal cord, thoracic spinal cord, CSF in lateral ventricle, lumbar spinal cord, cervical spinal cord, lung, kidney, muscle in injection location, heart, brain, spleen, heart blood, liver, peripheral blood, bile, muscle in no injection location, and urine. The order of lidocaine concentration detected in the intravenously administered dogs was as followed: Kidney, heart, lung, spleen, brain, liver, peripheral blood, bile, heart blood, cervical spinal cord, thoracic spinal cord, muscle in injection location, lumbar spinal cord, muscle in no injection location, CSF in subarachnoid space, urine, and CSF in lateral ventricle. The maximum concentration of lidocaine was detected in the subarachnoid

  12. Intra-operative nuclear imaging based on positron-emitting radiotracers

    International Nuclear Information System (INIS)

    Shakir, Dzhoshkun Ismail

    2014-01-01

    Positron-emitting radiotracers are an important part of nuclear medical imaging processes. Besides the very famous glucose analog [ 18 F]FDG, many not so well known ones exist, among them the particularly interesting amino acid-based tracers like [ 18 F]FET. Although peri-operative imaging with positron-emitting radiotracers has become state-of- the-art in cases of many types of cancer, their capability is not fully exploited in the operating room yet. In this thesis we explore two intra-operative nuclear imaging modalities exploiting different aspects of positron radiation towards quality assurance in challenging surgical treatment scenarios. The first modality freehand PET provides a tomographic image of a volume of interest and aims at minimizing invasiveness by assisting the surgeon in pinpointing target structures marked with a radiotracer. The second imaging modality epiphanography generates an image of the radiotracer distribution on a surface of interest and aims at providing a means for improving the control of tumor resection margins. The word epiphanography is a compound of the Greek words επιφανεια (epiphaneia) for surface and ζωγραφια (ographia) for image, and hence means the image of the surface similar to the compound τομοζ (tomos) for slice/volume and ζωγραφια (ographia) for image, meaning the image of the volume, i.e. tomography. To our knowledge this is the first use of the word epiphanography in the context of nuclear medical imaging. In this thesis we present our approach to modeling, developing and calibrating these two novel imaging modalities. In addition, we present our work towards their clinical integration. In the case of freehand PET, we have already acquired the first intra-operative datasets of a patient. We present this first experience in the operating room together with our phantom studies. In the case of epiphanography, we present our phantom studies with neurosurgeons towards the integration of this

  13. Lymphoscintigraphy and intra-operative gamma probe in detection of sentinel lymph node for breast cancer surgery

    International Nuclear Information System (INIS)

    Le Ngoc Ha; Le Manh Ha; Bui Quang Bieu

    2011-01-01

    Sentinel lymph node biopsy (SLNB) has been emerged as a highly accurate method of axillary staging in management of breast cancer patients. Sentinel lymph node detection (SLND) by lymphoscintigraphy and intra-operative gamma probe for SLNB have been widely used in the world. Objectives: the purpose of our study was to evaluate the result of techniques using lymphoscintigraphy and intra-operative gamma probe for SLND in breast carcinoma patients. Materials and Methods: 102 patients with early breast carcinoma were enrolled in the study. Lymphoscintigraphy using Tc-99m-human serum albumin colloid, intra-operative gamma probe were undergone for localization and SLNB. Total axillary lymph node was dissected in breast cancer surgery. Results: The success rate of lymphoscintigraphy and SLND was 98.0% (100/102 patients), mean number of sentinel lymph node (SLN)/patient was 1.56 ± 0.79 (ranged 1 - 3), number of lymphatic vessel/SLN was 1.5 ± 0.69 (ranged 1 - 4) and mean time for SLND on lymphoscintigraphy was 4.21 ± 13.4 minutes (2 - 15 minutes). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of radio-guided SLNB for axillary staging was 100%, 70.6%, 41.2%, 100% and 75.6 % respectively. Conclusions: radio-guided SLNB by lymphoscintigraphy and intra-operative gamma probe is feasible and reliable for axillary staging in early breast carcinoma patients. (author)

  14. The ultrastructure of tumor cells in patients with rectal cancer after pre-operative irradiation and intra-operative cryotherapy

    International Nuclear Information System (INIS)

    Vyinnik, Yu.O.; Kotenko, O.Je.; Nevzorov, V.P.; Chyibyisov, L.P.

    2000-01-01

    Electronic microscopy of the tumor cells was performed to confirm the efficacy of combined pre-operative gamma-therapy and intraoperative cryotherapy (CT). Pre-operative irradiation at the dose of 20 Gy accompanied by intra-operative cryotherapy caused the changes in the ultrastructure, the depth and degree of which allow to consider them destructive and irreversible

  15. Intra-operative warming with a forced-air warmer in preventing hypothermia after tourniquet deflation in elderly patients.

    Science.gov (United States)

    Kim, Y-S; Jeon, Y-S; Lee, J-A; Park, W-K; Koh, H-S; Joo, J-D; In, J-H; Seo, K-W

    2009-01-01

    This randomized, single-blind study aimed to explore the effects of intra-operative warming with a forced-air warmer in the prevention of hypothermia after tourniquet deflation in elderly patients undergoing unilateral total knee replacement arthroplasty under general anaesthesia. Patients were randomized to receive either intra-operative warming using a forced-air warmer with an upper body blanket (warming group; n = 12) or no intra-operative warming (nonwarming group; n = 12). Oesophageal temperature was measured as core body temperature. At 30 min following tourniquet inflation, the core body temperature started to increase in the warming group whereas it continued to drop in the non-warming group. This difference was statistically significant. The final core body temperature after tourniquet deflation was significantly higher in the warming group (mean +/- SD 36.1 +/- 0.2 degrees C) than in the non-warming group (35.4 +/- 0.3 degrees C). Intra-operative forced-air warming increased the core body temperature before tourniquet deflation and prevented subsequent hypothermia in elderly patients under general anaesthesia.

  16. Effects of intra-operative fluoroscopic 3D-imaging on peri-operative imaging strategy in calcaneal fracture surgery

    NARCIS (Netherlands)

    M.S.H. Beerekamp (Suzan); Backes, M. (M.); N.W.L. Schep (Niels); D.T. Ubbink (Dirk); J.S.K. Luitse; T. Schepers (Tim); J.C. Goslings (Carel)

    2017-01-01

    textabstractIntroduction: Previous studies demonstrated that intra-operative fluoroscopic 3D-imaging (3D-imaging) in calcaneal fracture surgery is promising to prevent revision surgery and save costs. However, these studies limited their focus to corrections performed after 3D-imaging, thereby

  17. Intra-operative ex vivo photoacoustic nodal staging in a rat model using a clinical superparamagnetic iron oxide nanoparticle dispersion

    NARCIS (Netherlands)

    Grootendorst, D.J.; Fratila, R.M.; Visscher, M.; Haken, B.T.; Wezel, R.J.A. van; Rottenberg, S.; Steenbergen, W. van; Manohar, S.; Ruers, T.J.M.

    2013-01-01

    The ability to accurately detect tumor metastases in lymph nodes is essential for intra-operative staging of various malignancies. Histopathological assessment of nodes has the drawback of a time delay before results are available to the surgeon and a likelihood of missing metastases. Photoacoustic

  18. Intra-operative ex vivo photoacoustic nodal staging in a rat model using a clinical superparamagnetic iron oxide nanoparticle dispersion

    NARCIS (Netherlands)

    Grootendorst, Diederik; Fratila, R.M.; Visscher, M.; ten Haken, Bernard; van Wezel, Richard Jack Anton; Rottenberg, S.; Steenbergen, Wiendelt; Manohar, Srirang; Ruers, Theo J.M.

    The ability to accurately detect tumor metastases in lymph nodes is essential for intra-operative staging of various malignancies. Histopathological assessment of nodes has the drawback of a time delay before results are available to the surgeon and a likelihood of missing metastases. Photoacoustic

  19. Intra-operative ultrasound-based augmented reality guidance for laparoscopic surgery.

    Science.gov (United States)

    Singla, Rohit; Edgcumbe, Philip; Pratt, Philip; Nguan, Christopher; Rohling, Robert

    2017-10-01

    In laparoscopic surgery, the surgeon must operate with a limited field of view and reduced depth perception. This makes spatial understanding of critical structures difficult, such as an endophytic tumour in a partial nephrectomy. Such tumours yield a high complication rate of 47%, and excising them increases the risk of cutting into the kidney's collecting system. To overcome these challenges, an augmented reality guidance system is proposed. Using intra-operative ultrasound, a single navigation aid, and surgical instrument tracking, four augmentations of guidance information are provided during tumour excision. Qualitative and quantitative system benefits are measured in simulated robot-assisted partial nephrectomies. Robot-to-camera calibration achieved a total registration error of 1.0 ± 0.4 mm while the total system error is 2.5 ± 0.5 mm. The system significantly reduced healthy tissue excised from an average (±standard deviation) of 30.6 ± 5.5 to 17.5 ± 2.4 cm 3 ( p < 0.05) and reduced the depth from the tumor underside to cut from an average (±standard deviation) of 10.2 ± 4.1 to 3.3 ± 2.3 mm ( p < 0.05). Further evaluation is required in vivo, but the system has promising potential to reduce the amount of healthy parenchymal tissue excised.

  20. Automatic Adjustments of a Trans-oesophageal Ultrasound Robot for Monitoring Intra-operative Catheters

    Science.gov (United States)

    Wang, Shuangyi; Housden, James; Singh, Davinder; Rhode, Kawal

    2017-12-01

    3D trans-oesophageal echocardiography (TOE) has become a powerful tool for monitoring intra-operative catheters used during cardiac procedures in recent years. However, the control of the TOE probe remains as a manual task and therefore the operator has to hold the probe for a long period of time and sometimes in a radiation environment. To solve this problem, an add-on robotic system has been developed for holding and manipulating a commercial TOE probe. This paper focuses on the application of making automatic adjustments to the probe pose in order to accurately monitor the moving catheters. The positioning strategy is divided into an initialization step based on a pre-planning method and a localized adjustments step based on the robotic differential kinematics and related image servoing techniques. Both steps are described in the paper along with simulation experiments performed to validate the concept. The results indicate an error less than 0.5 mm for the initialization step and an error less than 2 mm for the localized adjustments step. Compared to the much bigger live 3D image volume, it is concluded that the methods are promising. Future work will focus on evaluating the method in the real TOE scanning scenario.

  1. Scintigraphic techniques in primary hyperparathyroidism: from pre-operative localisation to intra-operative imaging

    Energy Technology Data Exchange (ETDEWEB)

    Rubello, Domenico [S. Maria della Misericordia Hospital, Service of Nuclear Medicine, Rovigo (Italy); Gross, Milton D. [Department of Veterans Affairs Health System, Nuclear Medicine Service, Ann Arbor, MI (United States); Mariani, Giuliano [University of Pisa, Regional Center of Nuclear Medicine, Pisa (Italy); Al-Nahhas, Adil [Hammersmith Hospital, Department of Nuclear Medicine, London (United Kingdom)

    2007-06-15

    Primary hyperparathyroidism (PHPT) is an increasingly diagnosed disease worldwide. In most cases, PHPT is related to the presence of a solitary parathyroid adenoma (PA). Fifty percent or more of newly diagnosed PHPT patients are asymptomatic, and there is debate among endocrinologists and endocrine surgeons about whether or not such patients should be treated. Usually, in a PHPT patient with a solitary PA that is well localised pre-operatively, a parathyroidectomy with limited or minimally invasive neck exploration is offered. The diffusion of minimally invasive neck exploration procedures is a consequence of the significant improvement in the accuracy of pre-operative imaging (mainly scintigraphic) techniques; these techniques have changed the surgical strategy to PHPT, from the wide traditional bilateral neck exploration to limited neck exploration. The present review considers developments during the past 10-15 years with regard to both the accuracy of pre-operative localising imaging techniques and intra-operative minimally invasive procedures in order to provide endocrinologists and endocrine surgeons with further information about the newly available diagnostic and therapeutic tools for use in PHPT patients with a solitary PA. (orig.)

  2. Photo-acoustic imaging of blue nanoparticle targeted brain tumor for intra-operative glioma delineation

    Science.gov (United States)

    Ray, Aniruddha; Wang, Xueding; Koo Lee, Yong-Eun; Hah, HoeJin; Kim, Gwangseong; Chen, Thomas; Orrienger, Daniel; Sagher, Oren; Kopelman, Raoul

    2011-07-01

    Distinguishing the tumor from the background neo-plastic tissue is challenging for cancer surgery such as surgical resection of glioma. Attempts have been made to use visible or fluorescent markers to delineate the tumors during surgery. However, the systemic injection of the dyes requires high dose, resulting in negative side effects. A novel method to delineate rat brain tumors intra-operatively, as well as post-operatively, using a highly sensitive photoacoustic imaging technique enhanced by tumor targeting blue nanoparticle as contrast agent is demonstrated. The nanoparticles are made of polyacrylamide (PAA) matrix with covalently linked Coomassie-Blue dye. They contain 7.0% dye and the average size is 80nm. Their surface was conjugated with F3 peptide for active tumor targeting. These nanoparticles are nontoxic, chemically inert and have long plasma circulation lifetime, making them suitable as nanodevices for imaging using photoacoustics. Experiments on phantoms and rat brains tumors ex-vivo demonstrate the high sensitivity of photoacoustic imaging in delineating the tumor, containing contrast agent at concentrations too low to be visualized by eye. The control tumors without nanoparticles did not show any enhanced signal. This study shows that photoacoustic imaging facilitated with the nanoparticle contrast agent could contribute to future surgical procedures for glioma.

  3. [Inflammatory pseudotumour of the liver. Importance of intra-operative histopathology].

    Science.gov (United States)

    Onieva-González, Francisco Gabriel; Galeano-Díaz, Francisco; Matito-Díaz, María José; López-Guerra, Diego; Fernández-Pérez, Juana; Blanco-Fernández, Gerardo

    2015-01-01

    Inflammatory pseudotumour is a rare entity, considered benign, and characterised by inflammatory cell mesenchymal proliferation. The case is presented 70 year-old man with fever of unknown origin syndrome. He was diagnosed with liver abscesses (one segment IV, adjacent to gallbladder fundus and segment VI), who progressed slowly after antibiotic treatment. In the absence of a diagnosis, although fine needle puncture-aspiration and different imaging tests were performed, elective surgery was decided. The intra-operative histopathology reported the existence of an inflammatory pseudotumour. Inflammatory pseudotumours are clinically classified into different types according to their aetiology, varying therapeutic management based on the same. It is very difficult to diagnose because of the absence of symptoms, blood disorders, or specific radiological findings. Definitive diagnosis often requires histopathological confirmation, in most cases by percutaneous liver puncture, but sometimes exploratory laparotomy or even performing a hepatectomy for confirmation is necessary. The natural history of inflammatory pseudotumour is its regression; thus conservative management may be used through regular checks until resolution, or can be treated with antibiotics, anti-inflammatories and even corticosteroids. Surgical resection is indicated for persistent unresolved systemic symptoms despite medical treatment, in those situations where growth is evident, with or without symptoms, when involving the hepatic hilum, and finally, in case where the possibility of malignancy cannot be ruled out. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  4. Intra-operative radiation therapy with laser-accelerated carbon ions

    Science.gov (United States)

    Mur, P.; Bellido, P.; Seimetz, M.; Lera, R.; Ruiz-de la Cruz, A.; Galán, M.; Roso, L.; Sánchez, F.; Benlloch, J. M.

    2017-03-01

    Laser accelerators have long been proposed as beam source for hadron therapy. However, the high energies necessary for the treatment of deep-lying tumours, combined with stringent requirements on the beam quality, are still a severe challenge. In the present work, we discuss the applicability of laser-accelerated carbon ions at moderate energies (100-480 MeV) to the irradiation of superficial lesions. We propose a new therapeutic modality which combines the versatility of Intra-Operative Radiation Therapy with the advantages of carbon ions as compared to photon and electron radiation. To justify this idea a feasibility study has been carried out, focused on the uniformity of dose deposition inside the treatment volume. Physical and biological aspects characteristic to laser-accelerated carbon ion beams are considered. A GATE simulation has been performed, showing an approximately uniform depth-dose profile up to a maximum penetration depth of 5 mm for a single radiation boost of 10 GyE.

  5. Can I Hang? Ideal Time to Replace Isotonic Crystalloid Intravenous Fluids and Sets to Prevent Fluid Contamination and Blood Stream Infection: a Knowledge Summary

    Directory of Open Access Journals (Sweden)

    Erik Davis Fausak

    2016-11-01

    Full Text Available Clinical bottom lineBased on very poor veterinary and human evidence, fluid bags and IV sets should be changed every 96 hours whether on one or multiple patients. Additionally, supportive evidence suggests that creating a routine of wiping ports with alcohol prior to injection or withdrawal may significantly decrease the likelihood of fluid contamination. This certainly seems to be an area that needs more research. 

  6. Effect of intra-operative glove changing during cesarean section on post-operative complications: a randomized controlled trial.

    Science.gov (United States)

    Scrafford, Jonathan D; Reddy, Buvana; Rivard, Colleen; Vogel, Rachel Isaksson

    2018-03-19

    To compare the rates of wound-related complications among women undergoing a cesarean section when the surgical team used intra-operative glove changing versus usual care. All women undergoing a cesarean section at a single, county hospital were randomized to usual care or intra-operative glove changing prior to abdominal closure. Participants were randomized at the time of decision for cesarean section; surgeons were not blinded to the randomization arm. The primary outcome was any wound-related complication, including wound hematoma, seroma, skin separation of at least 1 cm, wound infection, or other incisional abnormality requiring treatment within 8 weeks of surgery. To detect a reduction in the primary outcome from 17% in the control group to 9% in the intervention group with 80% power, a total of 554 women (277 per group) were required. Secondary outcomes included other infectious complications including endometritis and other superficial or deep soft tissue infections. From August 2015 to November 2016, 277 women were randomized to usual care and 276 women were randomized to intra-operative glove changing. The two groups were well balanced in terms of demographic data, comorbid conditions and surgical characteristics. Intra-operative glove changing led to a significant decrease in composite wound complications from 13.6% in the control group to 6.4% in the intervention group (p = 0.008). Intra-operative glove changing prior to abdominal closure during cesarean section significantly reduced the incidence of post-operative wound complications.

  7. Agreement between pre-operative and intra-operative bacteriological samples in 85 chronic peri-prosthetic infections.

    Science.gov (United States)

    Matter-Parrat, V; Ronde-Oustau, C; Boéri, C; Gaudias, J; Jenny, J-Y

    2017-04-01

    Whether pre-operative microbiological sampling contributes to the management of chronic peri-prosthetic infection remains controversial. We assessed agreement between the results of pre-operative and intra-operative samples in patients undergoing single-stage prosthesis exchange to treat chronic peri-prosthetic infection. Agreement between pre-operative and intra-operative samples exceeds 75% in patients undergoing single-stage exchange of a hip or knee prosthesis to treat chronic peri-prosthetic infection. This single-centre retrospective study included 85 single-stage prosthesis exchange procedures in 82 patients with chronic peri-prosthetic infection at the hip or knee. Agreement between pre-operative and intra-operative sample results was evaluated. Changes to the initial antibiotic regimen made based on the intra-operative sample results were recorded. Of 149 pre-operative samples, 109 yielded positive cultures, in 75/85 cases. Of 452 intra-operative samples, 354 yielded positive cultures, in 85/85 cases. Agreement was complete in 54 (63%) cases and partial in 9 (11%) cases; there was no agreement in the remaining 22 (26%) cases. The complete agreement rate was significantly lower than 75% (P=0.01). The initial antibiotic regimen was inadequate in a single case. Pre-operative sampling may contribute to the diagnosis of peri-prosthetic infection but is neither necessary nor sufficient to confirm the diagnosis and identify the causative agent. The spectrum of the initial antibiotic regimen cannot be safely narrowed based on the pre-operative sample results. We suggest the routine prescription of a probabilistic broad-spectrum antibiotic regimen immediately after the prosthesis exchange, even when a pathogen was identified before surgery. IV, retrospective study. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  8. Independence From Parenteral Nutrition and Intravenous Fluid Support During Treatment With Teduglutide Among Patients With Intestinal Failure Associated With Short Bowel Syndrome

    DEFF Research Database (Denmark)

    Iyer, Kishore R; Kunecki, Marek; Boullata, Joseph I

    2017-01-01

    BACKGROUND: In phase III clinical studies, treatment with teduglutide was associated with clinically meaningful reductions (≥20% from baseline) in parenteral support (PS; parenteral nutrition and/or intravenous fluids) requirements in adult patients with intestinal failure associated with short...... sample size and lack of comparator. RESULTS: Of 134 patients, 16 gained oral or enteral autonomy after a median of 5 years of PS dependence and 89 weeks of teduglutide treatment. Demographic and baseline disease characteristics varied among patients (median age, 55 years; 50% men; median baseline PS......: Findings from this post hoc analysis suggest that oral or enteral autonomy is possible for some patients with SBS-IF who are treated with teduglutide, regardless of baseline characteristics and despite long-term PS dependence....

  9. Significant air embolism: A possibility even with collapsible intravenous fluid containers when used with rapid infuser system

    Directory of Open Access Journals (Sweden)

    Deepanjali Pant

    2010-01-01

    Full Text Available Significant venous air embolism may develop acutely during the perioperative period due to a number of causes such as during head and neck surgery, spinal surgery, improper central venous and haemodialysis catheter handling, etc. The current trend of using self collapsible intravenous (IV infusion bags instead of the conventional glass or plastic bottles has several advantages, one of thaem being protection against air embolism. We present a 56-year-old man undergoing kidney transplantation, who developed a near fatal venous air embolism during volume resuscitation with normal saline in collapsible IV bags used with rapid infuser system. To our knowledge, this problem with collapsible infusion bags has not been reported earlier.

  10. Protecting Patients from an Unsafe System: The Etiology & Recovery of Intra-Operative Deviations in Care

    Science.gov (United States)

    Hu, Yue-Yung; Arriaga, Alexander F.; Roth, Emilie M.; Peyre, Sarah E.; Corso, Katherine A.; Swanson, Richard S.; Osteen, Robert T.; Schmitt, Pamela; Bader, Angela M.; Zinner, Michael J.; Greenberg, Caprice C.

    2012-01-01

    Objective To understand the etiology and resolution of unanticipated events in the operating room (OR). Background The majority of surgical adverse events occur intra-operatively. The OR represents a complex, high-risk system. The influence of different human, team, and organizational/environmental factors on safety and performance is unknown. Methods We video-recorded and transcribed 10 high-acuity operations, representing 43.7 hours of patient care. Deviations, defined as delays and/or episodes of decreased patient safety, were identified by majority consensus of a multidisciplinary team. Factors that contributed to each event and/or mitigated its impact were determined and attributed to the patient, providers, or environment/organization. Results Thirty-three deviations (10 delays, 17 safety compromises, 6 both) occurred – with a mean of one every 79.4 minutes. These deviations were multifactorial (mean 3.1 factors). Problems with communication and organizational structure appeared repeatedly at the root of both types of deviations. Delays tended to be resolved with vigilance, communication, coordination, and cooperation, while mediation of safety compromises was most frequently accomplished with vigilance, leadership, communication, and/or coordination. The organization/environment was not found to play a direct role in compensation. Conclusions Unanticipated events are common in the OR. Deviations result from poor organizational/environmental design and suboptimal team dynamics, with caregivers compensating to avoid patient harm. While recognized in other high risk domains, such human resilience has not yet been described in surgery and has major implications for the design of safety interventions. PMID:22750753

  11. Radiation protection for an intra-operative X-ray device.

    Science.gov (United States)

    Eaton, D J; Gonzalez, R; Duck, S; Keshtgar, M

    2011-11-01

    Therapeutic partial breast irradiation can be delivered intra-operatively using the Intrabeam 50 kVp compact X-ray device. Spherical applicators are added to the source to give an isotropic radiation dose. The low energy of this unit leads to rapid attenuation with distance, but dose rates are much greater than for diagnostic procedures. To investigate the shielding requirements for this unit, attenuation measurements were carried out with manufacturer-provided tungsten-rubber sheets, lead, plasterboard and bricks. A prospective environmental dose rate survey was also conducted in the designated theatre. As a result of isotropic geometry, the scattered dose around shielding can be 1% of primary and thus often dominates measured dose rates compared with transmission. The absorbed dose rate of the unshielded source at 1 m was 11.6 mGy h(-1) but this was reduced by 95% with the shielding sheets. Measured values for the common shielding materials were similar to reference data for the attenuation of a 50 kVp diagnostic X-ray beam. Two lead screens were constructed to shield operators remaining in the theatre and an air vent into a service corridor. A lead apron would also provide suitable attenuation, although a screen allows greater flexibility for treatment operators. With these measures, staff doses were reduced to negligible quantities. Survey measurements taken during patient treatments confirmed no additional measures were required, but the theatre should be a controlled area and access restricted. Results from this study and reference data can be used for planning other facilities.

  12. High-dose rate intra-operative radiation therapy for local advanced and recurrent colorectal cancer

    International Nuclear Information System (INIS)

    Harrison, L.B.; Mychalczak, B.; Enker, W.; Anderson, L.; Cohen, A.E.; Minsky, B.

    1996-01-01

    In an effort to improve the local control for advanced and recurrent cancers of the rectum, we have integrated high-dose rate intra-operative radiation therapy (HDR-IORT) into the treatment program. Between 11/92 and 10/95, 47 patients (pts) were treated. There were 26 males and 21 females whose ages ranged from 30-80 (median = 62) years. There were 19 pts with primary unresectable rectal cancer, and 28 pts who were treated for recurrent rectal cancer. Histology was adenocarcinoma - 45 pts, squamous cancer - 2 pts. The range of follow-up is 1-34 months (median = 14 months). The majority of primary unresectable pts received pre-operative radiation therapy (4500-5040 cGy) with chemotherapy (5-FU with Leucovorin) 4-6 weeks later, they underwent resection + HDR-IORT (1200 cGy). For the 28 pts with recurrent cancer, the majority received surgery and HDR-IORT alone because they had received prior RT. For the pts with primary unresectable disease, actuarial 2-year local control was 77%, actuarial distant metastasis-free survival was 71%, disease free survival was 66%, and overall survival was 84%. For those pts with recurrent disease, actuarial 2-year local control rate was 65%, distant metastasis-free survival was 65%, disease free survival was 47%, and overall survival was 61%. Complications occurred in 36%. There were no cases where the anatomical distribution of disease, or technical limitations prevented the adequate delivery of HDR-IORT. We conclude that this technique was most versatile, and enabled all appropriate pts to receive IORT. The preliminary data in terms of local control are encouraging, even for the poor prognostic sub-group of pts with recurrent cancer

  13. A novel intra-operative positron imager for rapid localization of tumor margins

    Science.gov (United States)

    Sabet, Hamid; Stack, Brendan C.; Nagarkar, Vivek V.

    2014-03-01

    We have developed an intra-operative and compact imaging tool for surgeons to detect PET- positive lesions. Currently, most such probes on the market are non-imaging, and provide no ancillary information of surveyed areas, such as clear delineations of malignant tissues. Our probe consists of a novel hybrid scintillator coupled to a compact silicon photomultiplier (SiPM) array with associated front-end electronics encapsulated in an ergonomic housing. Pulse shape discrimination electronics has been implemented and integrated into the downstream data acquisition system. The hybrid scintillator consists of a 0.4 mm thick layer of CsI:Tl scintillator coupled to a 1 mm thick LYSO crystal. To achieve high spatial resolution, CsI:Tl is pixelated to 0.5×0.5 mm2 pixels using laser ablation technique. While CsI:Tl act as beta-sensitive scintillator, LYSO senses the gamma radiation and can be used to navigate the probe to the locations of interest. The gamma response is also subtracted from the beta image for improved SNR and contrast. To achieve accurate centroid position estimation and uniform beta sensitivity over the entire imaging area, the LYSO thickness is optimized such that it acts as scintillation light diffuser by spreading CsI:Tl light over multiple SiPM pixels. The results show that the response of the two scintillators exposed to radiation could be easily distinguished based on their pulse shapes. The probe's spatial resolution is beta radiation even in presence of strong gamma background.

  14. Dose optimization of intra-operative high dose rate interstitial brachytherapy implants for soft tissue sarcoma

    Directory of Open Access Journals (Sweden)

    Jamema Swamidas

    2009-01-01

    Full Text Available Objective : A three dimensional (3D image-based dosimetric study to quantitatively compare geometric vs. dose-point optimization in combination with graphical optimization for interstitial brachytherapy of soft tissue sarcoma (STS. Materials and Methods : Fifteen consecutive STS patients, treated with intra-operative, interstitial Brachytherapy, were enrolled in this dosimetric study. Treatment plans were generated using dose points situated at the "central plane between the catheters", "between the catheters throughout the implanted volume", at "distances perpendicular to the implant axis" and "on the surface of the target volume" Geometrically optimized plans had dose points defined between the catheters, while dose-point optimized plans had dose points defined at a plane perpendicular to the implant axis and on the target surface. Each plan was graphically optimized and compared using dose volume indices. Results : Target coverage was suboptimal with coverage index (CI = 0.67 when dose points were defined at the central plane while it was superior when the dose points were defined at the target surface (CI=0.93. The coverage of graphically optimized plans (GrO was similar to non-GrO with dose points defined on surface or perpendicular to the implant axis. A similar pattern was noticed with conformity index (0.61 vs. 0.82. GrO were more conformal and less homogeneous compared to non-GrO. Sum index was superior for dose points defined on the surface of the target and relatively inferior for plans with dose points at other locations (1.35 vs. 1.27. Conclusions : Optimization with dose points defined away from the implant plane and on target results in superior target coverage with optimal values of other indices. GrO offer better target coverage for implants with non-uniform geometry and target volume.

  15. Relevance of intra operative radiotherapy in the treatment of uterine carcinoma - Lyon preliminary experience

    International Nuclear Information System (INIS)

    Gerard, J.P.; Braillon, G.; Gilly, F.N.; Romestaing, P.; Sentenac, I.; Rocher, F.P.; Berger, C.; Chipier, V.; Dargent, D.; Chabert, P.; Raudrant, D.; Adeleine, P.

    1994-01-01

    Aim: Retrospective analysis of Intra operative Radiotherapy (IORT) in recurrent uterine carcinoma (RUC) and prospective pilot study of IORT in advanced cervix cancer (ACC) with high risk of local failure. Patients-Treatments: (1) RUC: from 1988 to 1991, 34 patients with RUC have been treated. Primary cancer was: cervix uterus: 28, endometrium: six. Site of recurrence: centro pelvis: four, latero pelvis: 25, lombo aortic: five. Total gross resection was only possible in 12 patients. A dose of 15 to 22 Gy was given by IORT according to the residual tumour size. External beam irradiation was added in 16 patients; (2) ACC: January 1991 to November 1992, 20 patients were included in this pilot study, stage IIB: seven, stage III: 12, stage IV: 1. Preoperative retroperitoneal pelviscopy showed 13 pN1 patients and NMR imaging ten tumours of 6 cm or larger in diameter. Treatment started with concomitant pelvic irradiation (44 Gy) and one concomitant cycle of 5 Fu-CDDP, followed by a short course of high dose rate upper vagina brachytherapy (4Gy). Four weeks later a radical Wertheim operation was performed together with IORT on the lateral pelvis. Results: (1) RUC: overall survival (Kaplan Meier) at 4 years is 32% (±8). Local relapse in the field of IORT was observed in six patients. Grade 2-3 complications: six patients (radiation proctitis, neuritis, vertebral collapse, ureteral stenosis); (2) ACC: the median follow up is short (18 months). Four cases of pelvic relapse, no postoperative death. The first line radio chemotherapy was associated with two G3 early complications. Postoperative radiation complication was less than 10% G3. Discussion: promising results of IORT in RUC have been observed especially if no irradiation is given during the primary treatment. Good feasibility of the pilot study of IORT in ACC was also observed. It could be followed by a multicentric feasibility trial. (authors). 38 refs., 4 tabs., 1 fig

  16. Intra-operative parathyroid hormone monitoring through central laboratory is accurate in renal secondary hyperparathyroidism.

    Science.gov (United States)

    Vulpio, Carlo; Bossola, Maurizio; Di Stasio, Enrico; Pepe, Gilda; Nure, Eda; Magalini, Sabina; Agnes, Salvatore

    2016-05-01

    The usefulness, the methods and the criteria of intra-operative monitoring of the parathyroid hormone (ioPTH) during parathyroidectomy (PTX) for renal secondary hyperparathyroidism (rSHPT) in patients on chronic hemodialysis remain still matter of debate. The present study aimed to evaluate the ability of a low cost central-laboratory second generation PTH assay to predict an incomplete resection of parathyroid glands (PTG). The ioPTH decay was determined In 42 consecutive patients undergoing PTX (15 subtotal and 27 total without auto-transplant of PTG) for rSHPT. The ioPTH monitoring included five samples: pre-intubation, post-manipulation of PTG and at 10, 20 and 30min post-PTG excision. The patients with PTH exceeding the normal value (65pg/ml) at the first postoperative week, 6 and 12months were classified as persistent rSHPT. The concentrations of ioPTH declined significantly over time in patients who received total or subtotal PTX; however, no difference was found between the two types of PTX. Irrespective of the type of PTX and the number of PTG removed, combining the absolute and percentage of ioPTH decay at 30min after PTG excision, we found high sensitivity (100%), specificity (92%), negative predictive value (100%) and accuracy (93%) in predicting the persistence of rSHPT. The monitoring of the ioPTH decline by a low cost central-laboratory second generation assay is extremely accurate in predicting the persistence of disease in patients on maintenance hemodialysis undergoing surgery for rSHPT. Copyright © 2016 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  17. Using the transverse acetabular ligament as a landmark for acetabular anteversion: an intra-operative measurement.

    Science.gov (United States)

    Inoue, Masahiro; Majima, Tokifumi; Abe, Satomi; Nakamura, Takayuki; Kanno, Taiki; Masuda, Takeshi; Minami, Akio

    2013-08-01

    PURPOSE. To measure the transverse acetabular ligament (TAL) anteversion in hips with severe deformity, using fluoroscopy-computed tomographic navigation. METHODS. 31 hips in 10 men and 19 women aged 40 to 78 (mean, 58.7) years who underwent total hip arthroplasty for primary osteoarthritis (n=6) or osteoarthritis secondary to developmental hip dysplasia (n=19) or congenital hip dislocation (n=6) were included. The severity of hip dislocation was classified according to the Crowe classification; 15 hips were grade 1, 7 were grade 2, 3 were grade 3, and 6 were grade 4. The TAL anteversion was measured using fluoroscopy-computed tomographic navigation. The difference in TAL anteversion between non-dislocated hips (Crowe grade 1, n=15) and dislocated hips (Crowe grades 2-4, n=16) was compared. RESULTS. In all 31 hips, the TAL could be visualised intra-operatively. No patient reported severe pain, early wear, loosening, or dislocation after 2 years. The mean TAL anteversion and inclination angles measured by the navigation system were 26.5 (SD, 8.9; range, 8-42) degrees and 41.5 (SD, 4.6; range, 32-49) degrees, respectively. 22 of the 31 hips were in the safe zone. TAL anteversion in non-dislocated and dislocated hips was not significantly different. Inter- and intra-observer mean absolute differences in TAL anteversion were 0.3 and 0.4 degree, respectively. CONCLUSION. The TAL is a useful anatomic landmark for total hip arthroplasty in dislocated hips.

  18. Hemodynamic effects of dexmedetomidine during intra-operative electrocorticography for epilepsy surgery

    Directory of Open Access Journals (Sweden)

    G Chaitanya

    2014-01-01

    Full Text Available Background: Dexmedetomidine, a predominant alpha-2-adrenergic agonist has been used in anesthetic practice to provide good sedation. The drug is being recently used in neuroanesthesia during awake surgery for brain tumors and in functional neurosurgery. Materials and Methods: This prospective study analyzed the hemodynamic effects of dexmedetomidine infusion during electrocorticography in patients undergoing surgery for mesial temporal sclerosis. Dexmedetomidine infusion was administered during intra-operative electrocorticography recording, 15 minutes after the end tidal MAC of N 2 O and isoflurane were decreased to zero. Anesthesia was maintained with O 2 :air mixture = 50:50, vecuronium and fentanyl. Heart rate (HR, mean arterial pressure (MAP and end tidal carbon dioxide (ETCO 2 were recorded across at induction, 2 min prior to dexmedetomidine (PreDEX, 5 min during dexmedetomidine infusion (DEX; 1 μg/kg, 5 min after stopping dexmedetomidine and 10 minutes after stopping dexmedetomidine. Results: Forty patients with mesial temporal sclerosis (M: F = 27:13, mean age = 28.15 ± 10.9 years; duration of epilepsy = 12.0 ± 7.9 years underwent anterior temporal lobe resection with amygdalohippocampectomy for drug-resistant epilepsy. Infusion of dexmedetomidine caused a transient fall in HR in 87.5% of patients and an increase in MAP in 62.5% of patients, which showed a tendency to revert back towards PreDEX values within 10 min after stopping the infusion. Sixty-five percent of the patients showed ≤25% reduction and 10% of them showed >25% reduction in HR. 47.5% of the patients showed ≤25% increase and 15% of them showed >25% increase in MAP. These changes were over a narrow range and within physiological limits. Conclusion: The infusion of dexmedetomidine for a short period causes reduction of HR and increase in MAP in patients, however the variations are within acceptable range.

  19. Imaging of spatially extended hot spots with coded apertures for intra-operative nuclear medicine applications

    Science.gov (United States)

    Kaissas, I.; Papadimitropoulos, C.; Potiriadis, C.; Karafasoulis, K.; Loukas, D.; Lambropoulos, C. P.

    2017-01-01

    Coded aperture imaging transcends planar imaging with conventional collimators in efficiency and Field of View (FOV). We present experimental results for the detection of 141 keV and 122 keV γ-photons emitted by uniformly extended 99mTc and 57Co hot-spots along with simulations of uniformly and normally extended 99mTc hot-spots. These results prove that the method can be used for intra-operative imaging of radio-traced sentinel nodes and thyroid remnants. The study is performed using a setup of two gamma cameras, each consisting of a coded-aperture (or mask) of Modified Uniformly Redundant Array (MURA) of rank 19 positioned on top of a CdTe detector. The detector pixel pitch is 350 μm and its active area is 4.4 × 4.4 cm2, while the mask element size is 1.7 mm. The detectable photon energy ranges from 15 keV up to 200 keV with an energy resolution of 3-4 keV FWHM. Triangulation is exploited to estimate the 3D spatial coordinates of the radioactive spots within the system FOV. Two extended sources, with uniform distributed activity (11 and 24 mm in diameter, respectively), positioned at 16 cm from the system and with 3 cm distance between their centers, can be resolved and localized with accuracy better than 5%. The results indicate that the estimated positions of spatially extended sources lay within their volume size and that neighboring sources, even with a low level of radioactivity, such as 30 MBq, can be clearly distinguished with an acquisition time about 3 seconds.

  20. A rapid infusion pump driven by micro electromagnetic linear actuation for pre-hospital intravenous fluid administration.

    Science.gov (United States)

    Zhao, Peng; Chong, Yinbao; Zhao, An; Lang, Lang; Wang, Qing; Liu, Jiuling

    2015-02-01

    A rapid infusion pump with a maximum flow rate of 6 L/h was designed experimentally using a micro electromagnetic linear actuator, and its effectiveness was evaluated by comparing with that of a commercial Power Infuser under preset flow rates of 0.2, 2, and 6 L/h. The flow rate, air detection sensitivity, occlusion response time, quantitative determination of hemolysis, and power consumption of the infusion devices were extensively investigated using statistical analysis methods (p fluid administration. © IMechE 2015.

  1. Effects of enteral and intravenous fluid therapy, magnesium sulfate, and sodium sulfate on colonic contents and feces in horses.

    Science.gov (United States)

    Lopes, Marco A F; White, Nathaniel A; Donaldson, Lydia; Crisman, Mark V; Ward, Daniel L

    2004-05-01

    To assess changes in systemic hydration, concentrations of electrolytes in plasma, hydration of colonic contents and feces, and gastrointestinal transit in horses treated with IV fluid therapy or enteral administration of magnesium sulfate (MgSO4), sodium sulfate (NaSO4), water, or a balanced electrolyte solution. 7 horses with fistulas in the right dorsal colon (RDC). In a crossover design, horses alternately received 1 of 6 treatments: no treatment (control); IV fluid therapy with lactated Ringer's solution; or enteral administration of MgSO4, Na2SO4, water, or a balanced electrolyte solution via nasogastric intubation. Physical examinations were performed and samples of blood, RDC contents, and feces were collected every 6 hours during the 48 hour-observation period. Horses were muzzled for the initial 24 hours but had access to water ad libitum. Horses had access to hay, salt, and water ad libitum for the last 24 hours. Enteral administration of a balanced electrolyte solution and Na2SO4 were the best treatments for promoting hydration of RDC contents, followed by water. Sodium sulfate was the best treatment for promoting fecal hydration, followed by MgSO4 and the balanced electrolyte solution. Sodium sulfate caused hypocalcemia and hypernatremia, and water caused hyponatremia. Enteral administration of a balanced electrolyte solution promoted hydration of RDC contents and may be useful in horses with large colon impactions. Enteral administration of either Na2SO4 or water may promote hydration of RDC contents but can cause severe electrolyte imbalances.

  2. Intra-operative assessment of femoral antetorsion using ISO-C 3D: a cadaver study.

    Science.gov (United States)

    Hawi, Nael; Suero, Eduardo M; Liodakis, Emmanouil; Decker, Sebastian; Krettek, Christian; Citak, Musa

    2014-03-01

    The aim of this study was to check the feasibility and accuracy of measuring antetorsion during surgery using a mobile image intensifier (IF) with computed tomography (CT) function (ISO-C 3D; Siemens, Erlangen, Germany) in comparison to a conventional multi-slice CT scanner (LightSpeed QX/I CT; GE Healthcare, VA, USA). A total of 10 intact femora with intact soft tissue of five fresh frozen cadavers were used. After fixation on a surgical table, IF CT scans of the hip and knee were performed at both 190° and 120° of scanning rotation. Afterwards, a conventional CT scan was performed. Antetorsion was calculated according to the method of Jend et al. Analysis of variance (ANOVA) and Lin's concordance correlation coefficient (LCC) were used to test the agreement between the three measurement techniques. There was no significant difference in femoral antetorsion angle measurements between the different techniques (P>0.05). The mean time required to perform a scan using the ISO-C 3D was 9±3 min. The mean time required to measure antetorsion was 8±2 min. We found a high positive correlation between CT-based measurements and measurements performed using both the ISO-C 3D at 190° (LCC=0.99; mean difference=0.02°±1.8°) and the ISO-C 3D at 120° (LCC=0.99; mean difference=0.6°±1.5°), and a high positive correlation was also seen between both ISO-C 3D methods (LCC=0.99; mean difference=0.6°±1.7°). Measuring femoral antetorsion using an intra-operative IF with CT function is a feasible and accurate method. This technique could be used when there is doubt about the antetorsion angle in the operated femur and it could help decrease the need for a separate revision surgery. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. l-Arginine Pathway Metabolites Predict Need for Intra-operative Shunt During Carotid Endarterectomy.

    Science.gov (United States)

    Szabo, P; Lantos, J; Nagy, L; Keki, S; Volgyi, E; Menyhei, G; Illes, Z; Molnar, T

    2016-12-01

    Asymmetric dimethylarginine (ADMA) inhibits nitric oxide (NO) synthesis and is a marker of atherosclerosis. This study examined the correlation between pre-operative l-arginine and ADMA concentration during carotid endarterectomy (CEA), and jugular lactate indicating anaerobic cerebral metabolism, jugular S100B reflecting blood-brain barrier integrity, and with factors of surgical intervention. The concentration of l-arginine, ADMA, and symmetric dimethylarginine was measured in blood taken under regional anaesthesia from the radial artery of 55 patients prior to CEA. Blood gas parameters, concentration of lactate, and S100B were also serially measured in blood taken from both the radial artery and the jugular bulb before and after carotid clamping, and after release of the clamp. To estimate anaerobic metabolism, the jugulo-arterial ratio of CO 2 gap/oxygen extraction was calculated. Positive correlation was found between pre-operative ADMA levels and the ratio of jugulo-arterial CO 2 gap/oxygen extraction during clamp and reperfusion (p = .005 and p = .01, respectively). An inverse correlation was found between the pre-operative l-arginine concentration and jugular lactate at each time point (both p = .002). The critical pre-operative level of l-arginine was determined by receiver operator curve analysis. If l-arginine was below the cutoff value of 35 μmol/L, jugular S100B concentration was higher 24 h post-operatively (p = .03), and jugular lactate levels were increased during reperfusion (p = .02). The median pre-operative concentration of l-arginine was lower in patients requiring an intra-operative shunt than in patients without need of shunt (median: 30.3 μmol/L [interquartile range 24.4-34.4 μmol/L] vs. 57.6 μmol/L [interquartile range 42.3-74.5 μmol/L]; p = .002). High pre-operative ADMA concentration predicts poor cerebral perfusion indicated by elevated jugulo-arterial CO 2 gap/oxygen extraction. Low pre-operative l

  4. Middle cerebral artery aneurysms: aneurysm angiographic morphology and its relation to pre-operative and intra-operative rupture

    Directory of Open Access Journals (Sweden)

    Iracema Araújo Estevão

    Full Text Available ABSTRACT Objective Correlate the middle cerebral artery bifurcation aneurysm morphology with the pre-operative and intra-operative risk of rupture. Methods Forty patients with 46 middle cerebral artery bifurcation aneurysms were treated microsurgically by the same surgeon. Aneurysms were classified according to shape and the Fisher test was applied to analyze the effect of morphology on the pre-operative and intra-operative rupture. Results Pre-operative and intra-operative ruptures were observed in 8/46 patients (17.4% and 14/46 patients (30.4% respectively. Thirty-two cases (69.6% had no symptoms postoperatively, modified Rankin score (MRS of 0; 6.5% had MRS of 1 (no significant disability; 13% had MRS of 2 (slight disability; 4.3% had moderately severe disability (MRS of 4; and there were 3 deaths (6.5% post-operatively. The morphology was not directly related to the rupture rate. Conclusion In general, ruptures are not affected by the morphology or the studied variables. Larger series are needed to validate these outcomes.

  5. Intravenous grafts of amniotic fluid-derived stem cells induce endogenous cell proliferation and attenuate behavioral deficits in ischemic stroke rats.

    Directory of Open Access Journals (Sweden)

    Naoki Tajiri

    Full Text Available We recently reported isolation of viable rat amniotic fluid-derived stem (AFS cells [1]. Here, we tested the therapeutic benefits of AFS cells in a rodent model of ischemic stroke. Adult male Sprague-Dawley rats received a 60-minute middle cerebral artery occlusion (MCAo. Thirty-five days later, animals exhibiting significant motor deficits received intravenous transplants of rat AFS cells or vehicle. At days 60-63 post-MCAo, significant recovery of motor and cognitive function was seen in stroke animals transplanted with AFS cells compared to vehicle-infused stroke animals. Infarct volume, as revealed by hematoxylin and eosin (H&E staining, was significantly reduced, coupled with significant increments in the cell proliferation marker, Ki67, and the neuronal marker, MAP2, in the dentate gyrus (DG [2] and the subventricular zone (SVZ of AFS cell-transplanted stroke animals compared to vehicle-infused stroke animals. A significantly higher number of double-labeled Ki67/MAP2-positive cells and a similar trend towards increased Ki67/MAP2 double-labeling were observed in the DG and SVZ of AFS cell-transplanted stroke animals, respectively, compared to vehicle-infused stroke animals. This study reports the therapeutic potential of AFS cell transplantation in stroke animals, possibly via enhancement of endogenous repair mechanisms.

  6. The plasma and cerebrospinal fluid pharmacokinetics of erlotinib and its active metabolite (OSI-420) after intravenous administration of erlotinib in non-human primates.

    Science.gov (United States)

    Meany, Holly J; Fox, Elizabeth; McCully, Cynthia; Tucker, Chris; Balis, Frank M

    2008-08-01

    Erlotinib hydrochloride is a small molecule inhibitor of epidermal growth factor receptor (EGFR). EGFR is over-expressed in primary brain tumors and solid tumors that metastasize to the central nervous system. We evaluated the plasma and cerebrospinal fluid (CSF) pharmacokinetics of erlotinib and its active metabolite OSI-420 after an intravenous (IV) dose in a non-human primate model. Erlotinib was administered as a 1 h IV infusion to four adult rhesus monkeys. Serial blood and CSF samples were drawn over 48 h and erlotinib and OSI-420 were quantified with an HPLC/tandem mass spectroscopic assay. Pharmacokinetic parameters were estimated using non-compartmental and compartmental methods. CSF penetration was calculated from the AUC(CSF):AUC(plasma). Erlotinib disappearance from plasma after a short IV infusion was biexponential with a mean terminal half-life of 5.2 h and a mean clearance of 128 ml/min per m(2). OSI-420 exposure (AUC) in plasma was 30% (range 12-59%) of erlotinib, and OSI-420 clearance was more than 5-fold higher than erlotinib. Erlotinib and OSI-420 were detectable in CSF. The CSF penetration (AUC(CSF):AUC(plasma)) of erlotinib and OSI-420 was OSI-420 are measurable in CSF after an IV dose. The drug exposure (AUC) in the CSF is limited relative to total plasma concentrations but is substantial relative the free drug exposure in plasma.

  7. Beliefs and values about intra-operative teaching and learning: a case study of surgical teachers and trainees.

    Science.gov (United States)

    Ong, Caroline C P; Dodds, Agnes; Nestel, Debra

    2016-08-01

    Surgeons require advanced psychomotor skills, critical decision-making and teamwork skills. Much of surgical skills training involve progressive trainee participation in supervised operations where case variability, operating team interaction and environment affect learning, while surgical teachers face the key challenge of ensuring patient safety. Using a theoretical framework of situated learning including cognitive apprenticeship, we explored teachers' and trainees' beliefs and values about intra-operative training and reasons for any differences. A qualitative case study method was used where five teacher-trainee pairs participating in an observed teaching operation were separately interviewed about the same operation. Thematic analysis of transcribed interviews and observations was performed with iterative refinement and a reflexive approach was adopted throughout the study. We found that in all cases, teachers and trainees had shared recognition of learning about technical skills whereas they differed in three cases regarding non-technical skills such as surgical reasoning and team management. Factors contributing to teacher and trainee satisfaction with the process were successful trainee completion of operation without need for surgeon take-over, a positive learning environment and learning new things. Teaching-learning behaviours observed and discussed were modeling, coaching and scaffolding, while exploration, reflection and articulation were less common. Our study reveals differing teacher and trainee perspectives of some aspects of intra-operative training and surfaces new reasons other than amount of feedback and autonomy given. Factors contributing to different perspectives include teacher and trainee abilities, values and situational influences. Targeted teaching-learning strategies could enhance intra-operative learning.

  8. Use of auditory evoked potentials for intra-operative awareness in anesthesia: a consciousness-based conceptual model.

    Science.gov (United States)

    Dong, Xuebao; Suo, Puxia; Yuan, Xin; Yao, Xuefeng

    2015-01-01

    Auditory evoked potentials (AEPs) have been used as a measure of the depth of anesthesia during the intra-operative process. AEPs are classically divided, on the basis of their latency, into first, fast, middle, slow, and late components. The use of auditory evoked potential has been advocated for the assessment of Intra-operative awareness (IOA), but has not been considered seriously enough to universalize it. It is because we have not explored enough the impact of auditory perception and auditory processing on the IOA phenomena as well as on the subsequent psychological impact of IOA on the patient. More importantly, we have seldom tried to look at the phenomena of IOP from the perspective of consciousness itself. This perspective is especially important because many of IOA phenomena exist in the subconscious domain than they do in the conscious domain of explicit recall. Two important forms of these subconscious manifestations of IOA are the implicit recall phenomena and post-operative dreams related to the operation. Here, we present an integrated auditory consciousness-based model of IOA. We start with a brief description of auditory awareness and the factors affecting it. Further, we proceed to the evaluation of conscious and subconscious information processing by auditory modality and how they interact during and after intra-operative period. Further, we show that both conscious and subconscious auditory processing affect the IOA experience and both have serious psychological implications on the patient subsequently. These effects could be prevented by using auditory evoked potential during monitoring of anesthesia, especially the mid-latency auditory evoked potentials (MLAERs). To conclude our model with present hypothesis, we propose that the use of auditory evoked potential should be universal with general anesthesia use in order to prevent the occurrences of distressing outcomes resulting from both conscious and subconscious auditory processing during

  9. The use of high-field intra-operative magnetic resonance imaging combined with language functional neuronavigation in glioma surgery

    OpenAIRE

    Yan ZHAO; Xiao-lei CHEN; Fei WANG; Guo-chen SUN; Yu-bo WANG; Zhi-jun SONG; Bai-nan XU

    2011-01-01

    Objective To explore the effect of high-field intra-operative magnetic resonance imaging(iMRI) combined with language functional neuronavigation in resection of glioma in language area of dominant hemisphere of the brain.Methods Twenty right handed patients(12 males and 8 females,aged from 20 to 61 years with mean of 43.6 years) with glioma close to arcuate fasciculus were involved in present study,and they were stratified into normal group(n=9) and aphasia group(n=11) according to the preope...

  10. Online signal processing of internal anal sphincter activity during pelvic autonomic nerve stimulation: a new method to improve the reliability of intra-operative neuromonitoring signals.

    Science.gov (United States)

    Kauff, D W; Koch, K P; Somerlik, K H; Heimann, A; Hoffmann, K P; Lang, H; Kneist, W

    2011-12-01

    Intra-operative neuromonitoring is increasingly applied in several surgical disciplines and has been introduced to facilitate pelvic autonomic nerve preservation. Nevertheless, it has been considered a questionable tool for the minimization of risk, as the results are variable and might be misleading. The aim of the present experimental study was to develop an intra-operative neuromonitoring system with improved reliability for monitoring pelvic autonomic nerve function. Fifteen pigs underwent low anterior rectal resection with pelvic autonomic nerve preservation. Intra-operative neuromonitoring was performed under autonomic nerve stimulation with observation of electromyographic signals of the internal anal sphincter and bladder manometry. As the internal anal sphincter frequency spectrum during stimulation was found to be mainly in the range of 5-20 Hz, intra-operative neuromonitoring signals were postoperatively processed by implementation of matching band pass filters. In 10 preliminary experiments, signal processing was performed offline in the postoperative analysis. Of 163 stimulations intra-operatively assessed by the surgeon as positive responses, 135 (83%) were confirmed after signal processing. In the following five consecutive experiments intra-operative online signal processing was realized and demonstrated reliable intra-operative neuromonitoring signals of internal anal sphincter activity with significant increase during pelvic autonomic nerve stimulation [0.5 μV (interquartile range = 0.3-0.7) vs 4.8 μV (interquartile range = 2.5-7.5); P signal processing of internal anal sphincter activity aids reliable identification of pelvic autonomic nerves with potential for improvement of intra-operative neuromonitoring in pelvic surgery. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

  11. Validation of intra-operative parathyroid hormone and its decline as early predictors of hypoparathyroidism after total thyroidectomy: A prospective cohort study.

    Science.gov (United States)

    Gupta, Shailesh; Chaudhary, Poras; Durga, Chikkala K; Naskar, Dipankar

    2015-06-01

    Total thyroidectomy is a preferred surgical technique for benign as well as malignant thyroid pathologies, but many a times can cause hypoparathyroidism. The aim of this study is to evaluate the intra-operative parathyroid hormone (ioPTH) level and its decline as predictors for post-operative hypoparathyroidism after total thyroidectomy. In this single-centre prospective cohort study, 90 patients who underwent total thyroidectomy for benign as well as malignant pathologies of thyroid gland were studied. Intra-operative parathyroid levels and at different time intervals parathyroid hormone and serum calcium levels were measured to predict hypoparathyroidism. The data was analysed using independent sample t test and p value hypoparathyroidism. Intra-operative PTH was found to be most accurate predictor for diagnosing post-operative hypoparathyroidism (cut off was (11.3 pg/ml, calculated using ROC curves) and has maximum sum of sensitivity (91.7%) and specificity (97%). On taking cut off values of intra-operative PTH and PTH decline together, they were found to be most accurate predictor for permanent hypoparathyroidism. Early and accurate predictor of hypoparathyroidism is very important and always sought. Very early prediction during intra-operative periods can be used for auto transplantation of parathyroid gland. Intra-operative parathyroid hormone and its decline are accurate, reliable, and early predictor of hypoparathyroidism after total thyroidectomy. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  12. Accuracy of intra-operative frozen section and its role in the diagnostic evaluation of ovarian tumors.

    Science.gov (United States)

    Abudukadeer, A; Azam, S; Zunong, B; Mutailipu, A Zuoremu; Huijun, B; Qun, L

    2016-01-01

    Summary This retrospective study was undertaken to evaluate the accuracy and role of intra-operative frozen section in the diagnosis of ovarian tumors. Retrospective study of 804 ovarian frozen section results between June 2010 and June 2014 was examined to determine the accuracy of frozen section diagnosis. The intra-operative frozen section diagnosis was compared with the permanent (paraffin) section and the overall accuracy, sensitivity, specificity, and positive and negative predictive values of the frozen section were studied. The overall accuracy to determine the status of malignancy was 92.6%. There were 38 (7.4%) false negative and no false positive frozen section diagnoses.The sensitivity, specificity, and positive predictive and negative predictive values for benign ovarian tumors were 100.0%, 97.0%, 91.3%, and 100.0%, respectively; for borderline tumors they were 64.3%, 97.0%, 91.5%, and 94.0%, respectively, and for malignant tumors they were 90.0%, 100.0%, 100.0%, and 85.5%, respectively. This study concluded that frozen section appears to be an adequate technique for the histopathological diagnosis of ovarian tumors, with some limitations observed among borderline and mucinous tumors.

  13. Maternal intravenous treatment with either azithromycin or solithromycin clears Ureaplasma parvum from the amniotic fluid in an ovine model of intrauterine infection.

    Science.gov (United States)

    Miura, Yuichiro; Payne, Matthew S; Keelan, Jeffrey A; Noe, Andres; Carter, Sean; Watts, Rory; Spiller, Owen B; Jobe, Alan H; Kallapur, Suhas G; Saito, Masatoshi; Stock, Sarah J; Newnham, John P; Kemp, Matthew W

    2014-09-01

    Intrauterine infection with Ureaplasma spp. is strongly associated with preterm birth and adverse neonatal outcomes. We assessed whether combined intraamniotic (IA) and maternal intravenous (IV) treatment with one of two candidate antibiotics, azithromycin (AZ) or solithromycin (SOLI), would eradicate intrauterine Ureaplasma parvum infection in a sheep model of pregnancy. Sheep with singleton pregnancies received an IA injection of U. parvum serovar 3 at 85 days of gestational age (GA). At 120 days of GA, animals (n=5 to 8/group) received one of the following treatments: (i) maternal IV SOLI with a single IA injection of vehicle (IV SOLI only); (ii) maternal IV SOLI with a single IA injection of SOLI (IV+IA SOLI); (iii) maternal IV AZ and a single IA injection of vehicle (IV AZ only); (iv) maternal IV AZ and a single IA injection of AZ (IV+IA AZ); or (v) maternal IV and single IA injection of vehicle (control). Lambs were surgically delivered at 125 days of GA. Treatment efficacies were assessed by U. parvum culture, quantitative PCR, enzyme-linked immunosorbent assay, and histopathology. Amniotic fluid (AF) from all control animals contained culturable U. parvum. AF, lung, and chorioamnion from all AZ- or SOLI-treated animals (IV only or IV plus IA) were negative for culturable U. parvum. Relative to the results for the control, the levels of expression of interleukin 1β (IL-1β), IL-6, IL-8, and monocyte chemoattractant protein 2 (MCP-2) in fetal skin were significantly decreased in the IV SOLI-only group, the MCP-1 protein concentration in the amniotic fluid was significantly increased in the IV+IA SOLI group, and there was no significant difference in the histological inflammation scoring of lung or chorioamnion among the five groups. In the present study, treatment with either AZ or SOLI (IV only or IV+IA) effectively eradicated macrolide-sensitive U. parvum from the AF. There was no discernible difference in antibiotic therapy efficacy between IV-only and IV

  14. A Novel Stress-Diathesis Model to Predict Risk of Post-operative Delirium: Implications for Intra-operative Management

    Directory of Open Access Journals (Sweden)

    Renée El-Gabalawy

    2017-08-01

    Full Text Available Introduction: Risk assessment for post-operative delirium (POD is poorly developed. Improved metrics could greatly facilitate peri-operative care as costs associated with POD are staggering. In this preliminary study, we develop a novel stress-diathesis model based on comprehensive pre-operative psychiatric and neuropsychological testing, a blood oxygenation level-dependent (BOLD magnetic resonance imaging (MRI carbon dioxide (CO2 stress test, and high fidelity measures of intra-operative parameters that may interact facilitating POD.Methods: The study was approved by the ethics board at the University of Manitoba and registered at clinicaltrials.gov as NCT02126215. Twelve patients were studied. Pre-operative psychiatric symptom measures and neuropsychological testing preceded MRI featuring a BOLD MRI CO2 stress test whereby BOLD scans were conducted while exposing participants to a rigorously controlled CO2 stimulus. During surgery the patient had hemodynamics and end-tidal gases downloaded at 0.5 hz. Post-operatively, the presence of POD and POD severity was comprehensively assessed using the Confusion Assessment Measure –Severity (CAM-S scoring instrument on days 0 (surgery through post-operative day 5, and patients were followed up at least 1 month post-operatively.Results: Six of 12 patients had no evidence of POD (non-POD. Three patients had POD and 3 had clinically significant confusional states (referred as subthreshold POD; ST-POD (score ≥ 5/19 on the CAM-S. Average severity for delirium was 1.3 in the non-POD group, 3.2 in ST-POD, and 6.1 in POD (F-statistic = 15.4, p < 0.001. Depressive symptoms, and cognitive measures of semantic fluency and executive functioning/processing speed were significantly associated with POD. Second level analysis revealed an increased inverse BOLD responsiveness to CO2 pre-operatively in ST-POD and marked increase in the POD groups when compared to the non-POD group. An association was also noted for

  15. Intra-operative techniques to reduce the risk of capsular contracture in patients undergoing aesthetic breast augmentation - A review.

    Science.gov (United States)

    Horsnell, J D; Searle, A E; Harris, P A

    2017-10-01

    Capsular contracture is a significant complication following aesthetic breast augmentation. Efforts to reduce this incidence have focused on the surgical approach, implant selection and IV antibiotics. Intra-operative methods to reduce the risk have had less investigation. This review focuses on these interventions and will document evidence to support pocket irrigation, nipple shields, drains and the use of an implant insertion funnel. A comprehensive review of Pubmed, Scopus and Embase was performed to identify relevant papers published since 2000. These were reviewed and pertinent papers selected. Data regarding the intervention and its impact were recorded and compared. Ten relevant studies were identified. A total of 11,772 patients were included in the studies, with a pooled capsular contracture rate of 2.54%. Six papers reported the use of antibiotic irrigation, two papers reported the use of drains, two the use of an insertion funnel, two the use of povidone-iodine and one the use of nipple shields. Antibiotic irrigation was shown to reduce capsular contracture 10 fold in two papers, have no effect in one and increase it in a further paper. However these changes did not persist after multivariate analysis. There was limited evidence to support intra-operative techniques to reduce capsular contracture rate. Where available the literature tends to support the use of antibiotic and povidone-iodine irrigation, the use of insertion funnels and nipple shields and the avoidance of drains. However due to the poor quality of the evidence these findings should be treated cautiously. Copyright © 2017 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  16. Intravenous Leiomyomatosis

    African Journals Online (AJOL)

    Hemostasis was well achieved. The tumor weighed 6.7 kg. The postoperative course. Intravenous Leiomyomatosis. Narayanaswamy Mariyappa, Uday Kumar Manikyam1, Dinesh Krishnamurthy2, Preeti K,. Yamini Agarwal, Prakar U. Departments of Obstetrics and Gynaecology, 1Pathology and 2Anaesthesia, Sri Devaraj ...

  17. Focused parathyroidectomy without intra-operative parathormone monitoring: The value of PTH assay in preoperative ultrasound guided fine needle aspiration washout.

    Science.gov (United States)

    Kuzu, Fatih; Arpaci, Dilek; Cakmak, Guldeniz Karadeniz; Emre, Ali Ugur; Elri, Tarik; Ilikhan, Sevil Uygun; Bahadir, Burak; Bayraktaoglu, Taner

    2016-03-01

    The accurate identification of hyperfunctioning parathyroid (HP) gland is the only issue for definitive surgical treatment in primary hyperparathyroidism (pHPT). Various imaging and operative techniques have been proposed to confirm the localization of the diseased gland. Nevertheless, none of these methods proved to be the gold standard. The presented study aimed to assess the value of parathyroid hormone assay in preoperative ultrasound guided fine needle aspiration (FNA)-PTH washout fluid to verify the correct localisation for focused parathyroidectomy without intra-operative PTH monitoring. The retrospective analysis of 57 patients with pHPT who underwent FNA-PTH was conducted from a prospective database. Biochemical assessment together with radiological (ultrasonography) and nuclear (MIBI scan) imaging was reviewed. Associations between FNA-PTH washout values and localization technics were evaluated and compared in terms of operative findings. Focused parathyroidectomy without intraoperative PTH monitoring was performed to 45 patients with high FNA-PTH values. The median largest diameter of the target parathyroid lesion identified by ultrasonography was 13 mm (range, 6 to 36). The median serum PTH level was 190 pg/mL (range, 78 to 1709; reference range, 15 to 65) whereas the median washout PTH was 2500 pg/mL (range, 480 to 3389). According to operative findings high FNA-PTH levels correctly identified parathyroid adenoma in 40 cases (89% of sensitivity and 100% of specificity and positive predictive value) whereas MIBI scan localized the lesion in 36 of these cases (80% of sensitivity). The higher level of PTH in preoperative ultrasound guided FNA washout is a considerable data to predict the correct localization of HP, particularly in circumstances of greater values than the serum PTH level. However, although its specificity is high, in cases of coexisting nodular thyroid disease, associated additional HP might be missed at focused parathyroidectomy

  18. Observation of behavioural markers of non-technical skills in the operating room and their relationship to intra-operative incidents.

    Science.gov (United States)

    Siu, Joey; Maran, Nikki; Paterson-Brown, Simon

    2016-06-01

    The importance of non-technical skills in improving surgical safety and performance is now well recognised. Better understanding is needed of the impact that non-technical skills of the multi-disciplinary theatre team have on intra-operative incidents in the operating room (OR) using structured theatre-based assessment. The interaction of non-technical skills that influence surgical safety of the OR team will be explored and made more transparent. Between May-August 2013, a range of procedures in general and vascular surgery in the Royal Infirmary of Edinburgh were performed. Non-technical skills behavioural markers and associated intra-operative incidents were recorded using established behavioural marking systems (NOTSS, ANTS and SPLINTS). Adherence to the surgical safety checklist was also observed. A total of 51 procedures were observed, with 90 recorded incidents - 57 of which were considered avoidable. Poor situational awareness was a common area for surgeons and anaesthetists leading to most intra-operative incidents. Poor communication and teamwork across the whole OR team had a generally large impact on intra-operative incidents. Leadership was shown to be an essential set of skills for the surgeons as demonstrated by the high correlation of poor leadership with intra-operative incidents. Team-working and management skills appeared to be especially important for anaesthetists in the recovery from an intra-operative incident. A significant number of avoidable incidents occur during operative procedures. These can all be linked to failures in non-technical skills. Better training of both individual and team in non-technical skills is needed in order to improve patient safety in the operating room. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  19. Screening and confirmatory analyses of flunixin in tissues and bodily fluids after intravenous or intramuscular administration to cull dairy cows with or without lipopolysaccharide challenge

    Science.gov (United States)

    Twenty cull dairy cows (645 ± 83 kg) were treated with 2.2 mg/kg bw flunixin by intravenous (IV) or intramuscular (IM) administration with, or without, exposure to lipopolysaccharide in a two factor balanced design. The usefulness of screening assays to identify violative flunixin levels in a varie...

  20. The use of high-field intra-operative magnetic resonance imaging combined with language functional neuronavigation in glioma surgery

    Directory of Open Access Journals (Sweden)

    Yan ZHAO

    2011-07-01

    Full Text Available Objective To explore the effect of high-field intra-operative magnetic resonance imaging(iMRI combined with language functional neuronavigation in resection of glioma in language area of dominant hemisphere of the brain.Methods Twenty right handed patients(12 males and 8 females,aged from 20 to 61 years with mean of 43.6 years with glioma close to arcuate fasciculus were involved in present study,and they were stratified into normal group(n=9 and aphasia group(n=11 according to the preoperative aphasia quotient(AQ.All the patients underwent surgical operation assisted by arcuate fasciculus navigator,and the high-field iMRI was performed with a 1.5-T magnetic resonance scanner.The 3D reconstructed arcuate fasciculus images were integrated into neuronavigation system before the operation,and used by combining with functional neuronavigation under microscope during the surgical procedure.Pre-operatirely,and 2-4 weeks,3-6 months postoperative,the patients were examined with magnetic resonance scanning and aphasia quotients examination.Results Pre-operative and intra-operative arcuate fasciculus reconstruction was completed in all the 20 patients,and neuronavigation under microscope were performed after the 3D images integrated into neuronavigation system.Patients of normal AQ(94.5±5.5 retained the normal level,except one patients who developed new conduction aphasia syndrome(AQ=81.8 2-4 weeks after operation.The AQ of aphasia group(89.4±5.8 was significantly improved than that before operation(84.9±8.7,P < 0.05,except 2 patients whose language deficit was exacerbated due to tumor recurrence.The AQ of normal group(98.3±0.5 remained at normal level,while that of aphasia group(95.2±2.6 was significantly improved 3-6 months after operation compared with that at 2-4 weeks after operation(P < 0.05.There were no other new neurologic deficits and death in both groups.Conclusion High-field iMRI combined with functional neuronavigation is a safe and

  1. Fluorocholangiography: reincarnation in the laparoscopic era-evaluation of intra-operative cholangiography in 3635 laparoscopic cholecystectomies.

    Science.gov (United States)

    Nassar, Ahmad H M; Mirza, Ahmad; Qandeel, Haitham; Ahmed, Zubir; Zino, Samer

    2016-05-01

    The introduction of laparoscopic cholecystectomy (LC) resulted in the decline of routine intra-operative cholangiography (IOC). Common bile duct stones are being diagnosed preoperatively using magnetic resonance cholangiopancreatography (MRCP). We aim to evaluate the use and benefits of IOC during laparoscopic biliary surgery at a high-volume biliary surgery unit. Prospective data from 4088 patients undergoing LC over 22 years were analysed. Referral protocols allow one firm to receive the great majority of biliary emergencies and all suspected ductal stones. All patients with gall stones on ultrasound scanning, fit for surgery, will undergo LC during the index admission. MRCP and ERCP are not part of preoperative investigation. A four-port LC is performed with a size 5Fr ureteric catheter within an open cannula to obtain an IOC through right sub-costal port. Of 4088 patients, IOC was attempted in 3691 (90.2 %) and 3635 had a successful IOC (98.4 %). 75 % were females. The mean age was 59 years. Patients presented with one or more of the following: chronic biliary pain in 60 %, acute pain 26.7 %, acute cholecystitis 8.4 %, gallstone pancreatitis 7.8 % and jaundice with or without cholangitis in 19.2 %. A total of 1328 patients (36.5 %) had risk factors for CBD stones. The IOC was abnormal in 975 cases (26.8 %), recording 1599 abnormalities. IOC identified 774 patients with CBD stones (21.3 %), including previously unsuspected CBD stones in 4.7 %. IOC was false negative in 20 cases (0.5 %) found to have stones on basket exploration. A decision not to perform IOC in 453 cases (11 %) was made preoperatively in 74.2 % and intra-operatively in 12.3 %. IOC can be safely and routinely performed in LC. It helps to identify CBD stones, even in patients with no known risk factors, delineate bile duct anatomy and facilitate single-stage management of CBD stones.

  2. Intra-operator and inter-operator reliability of manual and semiautomated measurement of fetal nuchal translucency : a cross sectional study

    NARCIS (Netherlands)

    Bakker, M.; Mulder, P.; Birnie, E.; Bilardo, C. M.

    2013-01-01

    ObjectiveThe goal of this study was to examine the intra-operator and inter-operator differences of the manual and semiautomated nuchal translucency (NT) measurements and to evaluate if these differences alter women's risk status. MethodsA cross sectional study was performed. Two operators obtained

  3. Intra-operative rapid diagnostic method based on CK19 mRNA expression for the detection of lymph node metastases in breast cancer

    NARCIS (Netherlands)

    Visser, Mike; Jiwa, Mehdi; Horstman, Anja; Brink, Antoinette A. T. P.; Pol, Rene P.; van Diest, Paul; Snijders, Peter J. F.; Meijer, Chris J. L. M.

    2008-01-01

    Staging by sentinel node (SN) biopsy is the standard procedure for clinically node-negative breast cancer patients. Intra-operative analysis of the SN allows immediate axillary lymph node (ALN) dissection in SN positive patients, but a quick, reliable and reproducible method is lacking. We tested

  4. Extended endoscopic endonasal surgery using three-dimensional endoscopy in the intra-operative MRI suite for supra-diaphragmatic ectopic pituitary adenoma.

    Science.gov (United States)

    Fuminari, Komatsu; Hideki, Atsumi; Manabu, Osakabe; Mitsunori, Matsumae

    2015-01-01

    We describe a supra-diaphragmatic ectopic pituitary adenoma that was safely removed using the extended endoscopic endonasal approach, and discuss the value of three-dimensional (3D) endoscopy and intra-operative magnetic resonance imaging (MRI) to this type of procedure. A 61-year-old-man with bitemporal hemianopsia was referred to our hospital, where MRI revealed an enhanced suprasellar tumor compressing the optic chiasma. The tumor extended on the planum sphenoidale and partially encased the right internal carotid artery. An endocrinological assessment indicated normal pituitary function. The extended endoscopic endonasal approach was taken using a 3D endoscope in the intraoperative MRI suite. The tumor was located above the diaphragma sellae and separated from the normal pituitary gland. The pathological findings indicated non-functioning pituitary adenoma and thus the tumor was diagnosed as a supra-diaphragmatic ectopic pituitary adenoma. Intra-operative MRI provided useful information to minimize dural opening and the supra-diaphragmatic ectopic pituitary adenoma was removed from the complex neurovascular structure via the extended endoscopic endonasal approach under 3D endoscopic guidance in the intra-operative suite. Safe and effective removal of a supra-diaphragmatic ectopic pituitary adenoma was accomplished via the extended endoscopic endonasal approach with visual information provided by 3D endoscopy and intra-operative MRI.

  5. Systematic Review and Meta-Analysis of Randomized Controlled Trials Evaluating Prophylactic Intra-Operative Wound Irrigation for the Prevention of Surgical Site Infections

    NARCIS (Netherlands)

    de Jonge, Stijn W.; Boldingh, Quirine J. J.; Solomkin, Joseph S.; Allegranzi, Benedetta; Egger, Matthias; Dellinger, E. Patchen; Boermeester, Marja A.

    2017-01-01

    Surgical site infections (SSIs) are one of the most common hospital-acquired infections. To reduce SSIs, prophylactic intra-operative wound irrigation (pIOWI) has been advocated, although the results to date are equivocal. To develop recommendations for the new World Health Organization (WHO) SSI

  6. Direct evidence of the left caudate's role in bilingual control: an intra-operative electrical stimulation study.

    Science.gov (United States)

    Wang, Xin; Wang, Yin-Yan; Jiang, Tao; Wang, Yong-Zhi; Wu, Chen-Xing

    2013-01-01

    Bilinguals need control mechanisms in order to switch between languages in different communication contexts (Green, 1998, Bilingualism: Language and Cognition, 1; Price, Green, & von Studnitz, 1999, Brain, 122). There has been neural evidence showing competition to control output in L2 vs. L1 in both cortical and sub-cortical areas, when language selection is carried out (Abutalebi & Green, 2007, Journal of Neurolinguistics, 20). Here we use intra-operative direct electrical stimulation to demonstrate that the head of the left caudate is critical not only in language switching tasks but other control tasks. A bilingual Chinese-English patient was instructed to perform both language switching and switching in color-shape naming tasks during awake glioma surgery. When stimulation was applied on the left caudate, failures or difficulties in both language switching and color-shape naming were observed, with the effects greater on language switching. Stimulation to neighboring brain regions either did not affect performance or generated mild problems specific to language switching. The results provide direct evidence of the necessary role of the left caudate in language control.

  7. In vivo intra-operative breast tumor margin detection using a portable OCT system with a handheld surgical imaging probe

    Science.gov (United States)

    Erickson-Bhatt, Sarah J.; Nolan, Ryan; Shemonski, Nathan D.; Adie, Steven G.; Putney, Jeffrey; Darga, Donald; McCormick, Daniel T.; Cittadine, Andrew; Marjanovic, Marina; Chaney, Eric J.; Monroy, Guillermo L.; South, Fredrick; Carney, P. Scott; Cradock, Kimberly A.; Liu, Z. George; Ray, Partha S.; Boppart, Stephen A.

    2014-02-01

    Breast-conserving surgery is a frequent option for women with stage I and II breast cancer, and with radiation treatment, can be as effective as a mastectomy. However, adequate margin detection remains a challenge, and too often additional surgeries are required. Optical coherence tomography (OCT) provides a potential method for real-time, high-resolution imaging of breast tissue during surgery. Intra-operative OCT imaging of excised breast tissues has been previously demonstrated by several groups. In this study, a novel handheld surgical probe-based OCT system is introduced, which was used by the surgeon to image in vivo, within the tumor cavity, and immediately following tumor removal in order to detect the presence of any remaining cancer. Following resection, study investigators imaged the excised tissue with the same probe for comparison. We present OCT images obtained from over 15 patients during lumpectomy and mastectomy surgeries. Images were compared to post-operative histopathology for diagnosis. OCT images with micron scale resolution show areas of heterogeneity and disorganized features indicative of malignancy, compared to more uniform regions of normal tissue. Video-rate acquisition shows the inside of the tumor cavity as the surgeon sweeps the probe along the walls of the surgical cavity. This demonstrates the potential of OCT for real-time assessment of surgical tumor margins and for reducing the unacceptably high re-operation rate for breast cancer patients.

  8. Evaluation of Pediatric Liver Transplantation-Related Artery Complications Using Intra-Operative Multi-Parameter Ultrasonography.

    Science.gov (United States)

    Ren, Xiuyun; Guan, Junhui; Gao, Nong; Niu, Hong; Tang, Jie

    2016-11-21

    BACKGROUND This article discusses the value of using multi-parameter evaluation of intra-operative ultrasonography in evaluating pediatric liver transplantation-related arterial complications. MATERIAL AND METHODS Sixty-eight children receiving a liver transplant underwent intraoperative ultrasonography for monitoring of artery hemodynamics. The ultrasonic measurement parameters included the diameters of the hepatic artery (HA) of the donor and anastomotic stoma, peak systolic velocity (PSV), resistance index (RI), acceleration time (SAT), and blood flow volume. RESULTS After being treated immediately using surgery or other means, blood flow returned to normal in 8 cases, and did not in 3 cases, of whom 2 experienced postoperative HAT. There was a significant difference in HA diameter of the donor, anastomotic stoma diameter, PSV, RI, SAT, and blood flow volume before and after treatment of the donor in the complications group. Postoperative complications occurred in 7 of 68 recipients, including the 2 cases exhibiting complications during the surgery (complication group) and 5 without complications during the surgery (no complication group). There was a statistically significant difference (Pultrasonography parameters of HA diameter, anastomotic stoma diameter, RI, and blood flow volume. CONCLUSIONS Through intraoperative multi-parameter ultrasonic measurement, a definite diagnosis of hepatic artery complications can be made in liver transplantation patients. HA diameter of the donor, anastomotic stoma diameter, PSV, RI, SAT, and blood flow volume are important in assessing intraoperative artery complications.

  9. Intra-operative radiation therapy in cancer of the pancreas. La radiotherapie peroperatoire dans les cancers du pancreas

    Energy Technology Data Exchange (ETDEWEB)

    Dubois, J.B.; Gu, S.D.; Saint-Aubert, B.; Joyeux, H.; Solassol, C.; Pujol, H. (Centre Regional de Lutte contre le Cancer, 34 - Montpellier (FR))

    1991-03-01

    We report our experience concerning 22 pancreatic carcinoma bearing patients treated with intra-operative radiation therapy (IORT) after complete surgical excision: duodenopancreatectomy: 15 patients; isthmic and caudal pancreatectomy: 2 patients; total pancreatectomy: 5 patients. The dose delivered to the tumor bed was 20 Gy in 12 patients, 18 Gy in 3 patients and 15 Gy in 7 patients. Three patients died within the 1st month post-surgery from intercurrent diseases. Post-operative morbidity was not significantly modified by IORT as compared to purely surgical treated patients. Out of 19 evaluable patients, we observed local control in 16 patients (79.4%). Causes of death (15/19 patients) were: distant metastases with local control: 7 patients; in situ local failure: 3 patients; regional recurrence outside of the IORT fields: 2 patients; intercurrent diseases: 3 patients. Four patients are still alive without evolutive disease. The median overall survival is 6 months. The mean overall survival is 10.56 months. Excluding patients who died from complications and intercurrent diseases, the median survival is 10 mths and the mean survival 14.5 mths. These results emphasize the improvement in local control with IORT, but without significant improvement in survival which is dependent on local evolution and also systemic disease.

  10. Intra-operative radiation therapy for malignant brain tumours: rationale, method, and treatment results of cerebral glioblastomas

    International Nuclear Information System (INIS)

    Matsutani, M.; Nakamura, O.; Nagashima, T.

    1994-01-01

    In radiation therapy for malignant brain tumours, the dose of radiation that can be safely delivered to a tumour is limited by the radiation tolerance of the adjacent normal brain tissue. Among various radiation modalities to produce local tumour eradication without unacceptable complications, we chose a large, single irradiation dose during the operation (intra-operative radiation therapy, IORT). In contrast to X-ray or Cobalt-60 gamma ray irradiation, IORT with a high-energy electron beam delivered by the Shimadzu 20 MeV betatron provides acceptable dose homogeneity with rapid fall-off of the radiation dose beyond the treatment volume. Thus, IORT has the advantage of precise demarcation of the target volume, minimum damage to surrounding normal tissues, and a high absorbed target dose (15-25 Gy in 5-10 min). On the basis of our experience with 170 patients treated by IORT, we established the treatment indications and method in patients with malignant brain tumours. IORT with a dose of 15-25 Gy was delivered to widely resected tumours followed by external radiation therapy. No acute or subacute complications were observed. Treatment results of 30 patients with glioblastoma treated by IORT (mean 18.3 Gy) combined with external radiation therapy (mean 58.5 Gy) resulted in a median survival of 119 weeks and a 2-year survival rate of 61 %. (authors)

  11. Feasibility of integrating a multi-camera optical tracking system in intra-operative electron radiation therapy scenarios

    International Nuclear Information System (INIS)

    García-Vázquez, V; Marinetto, E; Santos-Miranda, J A; Calvo, F A; Desco, M; Pascau, J

    2013-01-01

    Intra-operative electron radiation therapy (IOERT) combines surgery and ionizing radiation applied directly to an exposed unresected tumour mass or to a post-resection tumour bed. The radiation is collimated and conducted by a specific applicator docked to the linear accelerator. The dose distribution in tissues to be irradiated and in organs at risk can be planned through a pre-operative computed tomography (CT) study. However, surgical retraction of structures and resection of a tumour affecting normal tissues significantly modify the patient's geometry. Therefore, the treatment parameters (applicator dimension, pose (position and orientation), bevel angle, and beam energy) may require the original IOERT treatment plan to be modified depending on the actual surgical scenario. We propose the use of a multi-camera optical tracking system to reliably record the actual pose of the IOERT applicator in relation to the patient's anatomy in an environment prone to occlusion problems. This information can be integrated in the radio-surgical treatment planning system in order to generate a real-time accurate description of the IOERT scenario. We assessed the accuracy of the applicator pose by performing a phantom-based study that resembled three real clinical IOERT scenarios. The error obtained (2 mm) was below the acceptance threshold for external radiotherapy practice, thus encouraging future implementation of this approach in real clinical IOERT scenarios. (paper)

  12. Rapid intra-operative diagnosis of kidney cancer by attenuated total reflection infrared spectroscopy of tissue smears.

    Science.gov (United States)

    Pucetaite, Milda; Velicka, Martynas; Urboniene, Vidita; Ceponkus, Justinas; Bandzeviciute, Rimante; Jankevicius, Feliksas; Zelvys, Arunas; Sablinskas, Valdas; Steiner, Gerald

    2018-01-09

    Herein, a technique to analyze air-dried kidney tissue impression smears by means of attenuated total reflection infrared (ATR-IR) spectroscopy is presented. Spectral tumor markers-absorption bands of glycogen-are identified in the ATR-IR spectra of the kidney tissue smear samples. Thin kidney tissue cryo-sections currently used for IR spectroscopic analysis lack such spectral markers as the sample preparation causes irreversible molecular changes in the tissue. In particular, freeze-thaw cycle results in degradation of the glycogen and reduction or complete dissolution of its content. Supervised spectral classification was applied to the recorded spectra of the smears and the test spectra were classified with a high accuracy of 92% for normal tissue and 94% for tumor tissue, respectively. For further development, we propose that combination of the method with optical fiber ATR probes could potentially be used for rapid real-time intra-operative tissue analysis without interfering with either the established protocols of pathological examination or the ordinary workflow of operating surgeon. Such approach could ensure easier transition of the method to clinical applications where it may complement the results of gold standard histopathology examination and aid in more precise resection of kidney tumors. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  13. Pain and intra-operative amnesia evaluation with local anesthesia and sedation in patients subjected to rhinosseptoplasties

    Directory of Open Access Journals (Sweden)

    Weber, Raimar

    2010-03-01

    Full Text Available Introduction: The local anesthesia practice and sedation to rhinoplasty and others aesthetics procedures of the face are each time more frequents. In the Brazil, the Federal Council of Medicine defines it and regulate its practice. Objective: To analyze the analgesia' effectiveness and of the intro operative amnesia through analogous visual and subjective scales in the rhinosseptoplasties performed under local anesthesia and sedation, looking for associations with the medium quantities of medication utilized. Method: A retrospective study based in reports relatives to 158 aesthetic-functional rhinoplasties. The surgeon recorded in a protocol the data relatives to the use of local anesthetics and sedatives (including concentration and quantities utilized as well as the side effects. In the first return post surgery the patient quantifies the pain that he felt in the intra operative utilizing a analogous visual scale as described by Hasen and collaborators. The Amnesia considered ideal when the patient referred to remind "nothing" or "a few of the procedure. Results: The sample constituted of 80 (73,4% women and 29 26,6% men, average of age of 29,3 ± 9,5 years. The median of the pain by the analogous visual scale was 0,05; 80% under 3,35. The amnesia was ideal in 51 (46,8% surgeries. The midazolam was utilized in all the surgeries. Fentanyl in 32 (29,4% and, pethidine in 77 (70,6%. Had not statistically significants differences between the quantities of medication utilized between the groups of patients with ideal amnesia when compared with those that do not obtained satisfactory amnesia. Conclusion: Local anesthesia and sedation in rhinoplasties are comfortable and secures in the majority of the cases, even without have a satisfactory amnesia.

  14. Is intra-operative cholangiography necessary during laparoscopic cholecystectomy? A multicentre rural experience from a developing world country.

    Science.gov (United States)

    Mir, Iqbal Saleem; Mohsin, Mir; Kirmani, Omar; Majid, Tafazul; Wani, Khurshid; Hassan, Mehmood-Ul; Naqshbandi, Javed; Maqbool, Mohammed

    2007-09-07

    To evaluate the feasibility and safety of performing laparoscopic cholecystectomy (LC) in non-teaching rural hospitals of a developing country without intra-operative cholangiography (IOC). To evaluate the possibility of reduction of costs and hospital stay for patients undergoing LC. A prospective analysis of patients with symptomatic benign diseases of gall bladder undergoing LC in three non-teaching rural hospitals of Kashmir Valley from Jan 2001 to Jan 2007. The cohort represented a sample of patients requiring LC, aged 13 to 78 (mean 47.2) years. Main outcome parameters included mortality, complications, re-operation, conversion to open procedure without resorting to IOC, reduction in costs borne by the hospital, and the duration of hospital stay. Twelve hundred and sixty-seven patients (976 females/291 males) underwent laparoscopic cholecystectomy. Twenty-three cases were converted to open procedures; 12 patients developed port site infection, nobody died because of the procedure. One patient had common bile duct (CBD) injury, 4 patients had biliary leak, and 4 patients had subcutaneous emphysema. One cholecystohepatic duct was detected and managed intraoperatively, 1 patient had retained CBD stones, while 1 patient had retained cystic duct stones. Incidental gallbladder malignancy was detected in 2 cases. No long-term complications were detected up to now. LC can be performed safely even in non-teaching rural hospitals of a developing country provided proper equipment is available and the surgeons and other team members are well trained in the procedure. It is stressed that IOC is not essential to prevent biliary tract injuries and missed CBD stones. The costs to the patient and the hospital can be minimized by using reusable instruments, intracorporeal sutures, and condoms instead of titanium clips and endobags.

  15. Intra-operative wound irrigation to reduce surgical site infections after abdominal surgery: a systematic review and meta-analysis.

    Science.gov (United States)

    Mueller, Tara C; Loos, Martin; Haller, Bernhard; Mihaljevic, André L; Nitsche, Ulrich; Wilhelm, Dirk; Friess, Helmut; Kleeff, Jörg; Bader, Franz G

    2015-02-01

    Surgical site infection (SSI) remains to be one of the most frequent infectious complications following abdominal surgery. Prophylactic intra-operative wound irrigation (IOWI) before skin closure has been proposed to reduce bacterial wound contamination and the risk of SSI. However, current recommendations on its use are conflicting especially concerning antibiotic and antiseptic solutions because of their potential tissue toxicity and enhancement of bacterial drug resistances. To analyze the existing evidence for the effect of IOWI with topical antibiotics, povidone-iodine (PVP-I) solutions or saline on the incidence of SSI following open abdominal surgery, a systematic review and meta-analysis of randomized controlled trials (RCTs) was carried out according to the recommendations of the Cochrane Collaboration. Forty-one RCTs reporting primary data of over 9000 patients were analyzed. Meta-analysis on the effect of IOWI with any solution compared to no irrigation revealed a significant benefit in the reduction of SSI rates (OR = 0.54, 95 % confidence Interval (CI) [0.42; 0.69], p < 0.0001). Subgroup analyses showed that this effect was strongest in colorectal surgery and that IOWI with antibiotic solutions had a stronger effect than irrigation with PVP-I or saline. However, all of the included trials were at considerable risk of bias according to the quality assessment. These results suggest that IOWI before skin closure represents a pragmatic and economical approach to reduce postoperative SSI after abdominal surgery and that antibiotic solutions seem to be more effective than PVP-I solutions or simple saline, and it might be worth to re-evaluate their use for specific indications.

  16. Characterization of a microDiamond detector in high-dose-per-pulse electron beams for intra operative radiation therapy.

    Science.gov (United States)

    Di Venanzio, C; Marinelli, Marco; Tonnetti, A; Verona-Rinati, G; Falco, M D; Pimpinella, M; Ciccotelli, A; De Stefano, S; Felici, G; Marangoni, F

    2015-12-01

    To characterize a synthetic diamond dosimeter (PTW Freiburg microDiamond 60019) in high dose-per-pulse electron beams produced by an Intra Operative Radiation Therapy (IORT) dedicated accelerator. The dosimetric properties of the microDiamond were assessed under 6, 8 and 9 MeV electron beams by a NOVAC11 mobile accelerator (Sordina IORT Technologies S.p.A.). The characterization was carried out with dose-per-pulse ranging from 26 to 105 mGy per pulse. The microDiamond performance was compared with an Advanced Markus ionization chamber and a PTW silicon diode E in terms of dose linearity, percentage depth dose (PDD) curves, beam profiles and output factors. A good linearity of the microDiamond response was verified in the dose range from 0.2 Gy to 28 Gy. A sensitivity of 1.29 nC/Gy was measured under IORT electron beams, resulting within 1% with respect to the one obtained in reference condition under (60)Co gamma irradiation. PDD measurements were found in agreement with the ones by the reference dosimeters, with differences in R50 values below 0.3 mm. Profile measurements evidenced a high spatial resolution of the microDiamond, slightly worse than the one of the silicon diode. The penumbra widths measured by the microDiamond resulted approximately 0.5 mm larger than the ones by the Silicon diode. Output factors measured by the microDiamond were found within 2% with those obtained by the Advanced Markus down to 3 cm diameter field sizes. The microDiamond dosimeter was demonstrated to be suitable for precise dosimetry in IORT applications under high dose-per-pulse conditions. Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  17. Reproducibility of a Digital Method to Evaluate Soft Tissue Modifications: A study of Inter and Intra-Operative Measurement Concordance

    Science.gov (United States)

    Rancitelli, Davide; Cicciù, Marco; Lini, Francesco; Fumagalli, Davide; Frigo, Anna Chiara; Maiorana, Carlo

    2017-01-01

    Background: The soft tissue healing and quality around dental implant is a current debated topic in the recent literature. The free gingival margin and the quantity and quality of the mucosa around teeth and surrounding dental implants still determine the hard and soft tissue healing status. Objective: The aim of this study is to assess inter and intra-operative measurement concordance of a method aimed at evaluating the apico-coronal migration of free gingival margin, using intra-oral photography. Methods: The method was tested on peri-implant tissues that were treated with a connective tissue graft on the second stage surgery. Thirty-eight measurements on 13 implants in 8 patients were recorded. An intra-oral photograph was taken for the graft and the provisional crown, which enclosed a circular landmark with a previously determined diameter. The landmark was prepared with a red-resin by the same technician. Before crown cementation, the landmark was calibrated with a digital calibrator by the main investigator, to determine the precise diameter up to two decimal numbers. Results: On the intra-oral photograph, the distance was measured from the most apical point of the determined landmark to the zenith of the gingiva, using an image-processing program designed for scientific multidimensional images (Image J). Three independent examiners took these measurements. Conclusion: The main advantage of the present non-invasive technique is that the spatial plane of the prosthetic landmarks is the same of the tooth unlike the utilization of periodontal probe, which is generally positioned on different plans in the space (generally more vestibular). PMID:28567141

  18. Frozen section is superior to imprint cytology for the intra-operative assessment of sentinel lymph node metastasis in Stage I Breast cancer patients

    Directory of Open Access Journals (Sweden)

    Makita Masujiro

    2006-05-01

    Full Text Available Abstract Background A standard intra-operative procedure for assessing sentinel lymph node metastasis in breast cancer patients has not yet been established. Patients and methods One hundred and thirty-eight patients with stage I breast cancer who underwent sentinel node biopsy using both imprint cytology and frozen section were analyzed. Results Seventeen of the 138 patients had sentinel node involvement. Results of imprint cytology included nine false negative cases (sensitivity, 47.1%. In contrast, only two cases of false negatives were found on frozen section (sensitivity, 88.2%. There were two false positive cases identified by imprint cytology (specificity, 98.3%. On the other hand, frozen section had 100% specificity. Conclusion These findings suggest that frozen section is superior to imprint cytology for the intra-operative determination of sentinel lymph node metastasis in stage I breast cancer patients.

  19. Intra-Operative Surgical Irrigation of the Surgical Incision: What Does the Future Hold-Saline, Antibiotic Agents, or Antiseptic Agents?

    Science.gov (United States)

    Edmiston, Charles E; Leaper, David J

    2016-12-01

    Intra-operative surgical site irrigation (lavage) is common practice in surgical procedures in general, with all disciplines advocating some form of irrigation before incision closure. This practice, however, has been neither standardized nor is there compelling evidence that it effectively reduces the risk of surgical site infection (SSI). This narrative review addresses the laboratory and clinical evidence that is available to support the practice of irrigation of the abdominal cavity and superficial/deep incisional tissues, using specific irrigation solutions at the end of an operative procedure to reduce the microbial burden at wound closure. Review of PubMed and OVID for pertinent, scientific, and clinical publications in the English language was performed. Incision irrigation was found to afford a three-fold benefit: First, to hydrate the bed; second, to assist in allowing better examination of the area immediately before closure; and finally, by removing superficial and deep incisional contamination and lowering the bioburden, expedite the healing process. The clinical practice of intra-operative peritoneal lavage is highly variable and is dependent solely on surgeon preference. By contrast, intra-operative irrigation after device-related procedures has become a standard of care for the prophylaxis of acute peri-prosthetic infection. The clinical evidence that supports the use of antibiotic irrigation is limited and based on retrospective analysis and few acceptable randomized controlled trials. The results of laboratory and animal studies using aqueous 0.05% chlorhexidine gluconate are favorable, suggesting that further studies are justified to determine its clinical efficacy. The adoption of appropriate and standardized intra-operative irrigation practices into peri-operative care bundles, which include other evidence-based strategies (weight-based antimicrobial prophylaxis, antimicrobial sutures, maintenance of normothermia, and glycemic control), offers

  20. Rotational X-ray angiography: a method for intra-operative volume imaging of the left-atrium and pulmonary veins for atrial fibrillation ablation guidance

    Science.gov (United States)

    Manzke, R.; Zagorchev, L.; d'Avila, A.; Thiagalingam, A.; Reddy, V. Y.; Chan, R. C.

    2007-03-01

    Catheter-based ablation in the left atrium and pulmonary veins (LAPV) for treatment of atrial fibrillation in cardiac electrophysiology (EP) are complex and require knowledge of heart chamber anatomy. Electroanatomical mapping (EAM) is typically used to define cardiac structures by combining electromagnetic spatial catheter localization with surface models which interpolate the anatomy between EAM point locations in 3D. Recently, the incorporation of pre-operative volumetric CT or MR data sets has allowed for more detailed maps of LAPV anatomy to be used intra-operatively. Preoperative data sets are however a rough guide since they can be acquired several days to weeks prior to EP intervention. Due to positional and physiological changes, the intra-operative cardiac anatomy can be different from that depicted in the pre-operative data. We present an application of contrast-enhanced rotational X-ray imaging for CT-like reconstruction of 3D LAPV anatomy during the intervention itself. Depending on the heart size a single or two selective contrastenhanced rotational acquisitions are performed and CT-like volumes are reconstructed with 3D filtered back projection. In case of dual injection, the two volumes depicting the left and right portions of the LAPV are registered and fused. The data sets are visualized and segmented intra-procedurally to provide anatomical data and surface models for intervention guidance. Our results from animal and human experiments indicate that the anatomical information from intra-operative CT-like reconstructions compares favorably with preacquired imaging data and can be of sufficient quality for intra-operative guidance.

  1. Does pre-operative sampling predict intra-operative cultures and antibiotic sensitivities in knee replacements revised for infection?: a study using the NJR dataset.

    Science.gov (United States)

    Holleyman, Richard J; Deehan, David J; Charlett, Andre; Gould, Kate; Baker, Paul N

    2016-10-01

    This study examined a cohort of primary knee arthroplasties revised for peri-prosthetic infection to (1) determine whether the microorganisms isolated by sampling (up to 6 months pre-operatively) are representative of the microorganisms encountered at the time of knee revision, (2) determine whether the antibiotic sensitivity profiles of matching organisms correlate and (3) determine whether the proportion of organism and antibiotic sensitivity matches is influenced by the type of infection, timing of sample collection and the type of microorganism isolated. From the National Joint Registry database for England and Wales, a consecutive series of primary knee arthroplasties performed between 2003 and 2014 that went on to have a revision for peri-prosthetic infection were identified. Each case was then linked to a national microbiology database held by Public Health England. Following data linkage, intra-operative and pre-operative cultures were identified and compared in a group of 75 patients. Pre-operative genus matched intra-operative genus in 56 of 75 cases (75 %). Of those 56, the corresponding antimicrobial sensitivities matched in 37 (66 % of cases). Overall, 37 of 75 cases (49 %) matched for both microorganism and antimicrobial sensitivity. The proportion of matches was highest in the pure Staphylococcal genus infections (genus match 88 %, sensitivity match 62 %, genus and sensitivity match 55 %) and lowest in those patients with mixed organism infections (genus match 29 %, sensitivity match 14 %). Pre-operative joint sampling obtained by either aspiration or tissue biopsy is advocated in cases where peri-prosthetic infection is suspected and provides the only means of determining infecting organism prior to revision. Overall, only half of all pre-operative cultures matched completely the findings of intra-operative samples in terms of both the microorganism(s) encountered and their corresponding antimicrobial sensitivity profile. Clinicians should

  2. Fracture Surgery of the extremities with the intra-operative use of 3D-RX: A randomized multicenter trial (EF3X-trial

    Directory of Open Access Journals (Sweden)

    Marmor Meir

    2011-07-01

    Full Text Available Abstract Background Posttraumatic osteoarthritis can develop after an intra-articular extremity fracture, leading to pain and loss of function. According to international guidelines, anatomical reduction and fixation are the basis for an optimal functional result. In order to achieve this during fracture surgery, an optimal view on the position of the bone fragments and fixation material is a necessity. The currently used 2D-fluoroscopy does not provide sufficient insight, in particular in cases with complex anatomy or subtle injury, and even an 18-26% suboptimal fracture reduction is reported for the ankle and foot. More intra-operative information is therefore needed. Recently the 3D-RX-system was developed, which provides conventional 2D-fluoroscopic images as well as a 3D-reconstruction of bony structures. This modality provides more information, which consequently leads to extra corrections in 18-30% of the fracture operations. However, the effect of the extra corrections on the quality of the anatomical fracture reduction and fixation as well as on patient relevant outcomes has never been investigated. The objective of this study protocol is to investigate the effectiveness of the intra-operative use of the 3D-RX-system as compared to the conventional 2D-fluoroscopy in patients with traumatic intra-articular fractures of the wrist, ankle and calcaneus. The effectiveness will be assessed in two different areas: 1 the quality of fracture reduction and fixation, based on the current golden standard, Computed Tomography. 2 The patient-relevant outcomes like functional outcome range of motion and pain. In addition, the diagnostic accuracy of the 3D-RX-scan will be determined in a clinical setting and a cost-effectiveness as well as a cost-utility analysis will be performed. Methods/design In this protocol for an international multicenter randomized clinical trial, adult patients (age > 17 years with a traumatic intra-articular fracture of the

  3. Intra-operative Vector Flow Imaging Using Ultrasound of the Ascending Aorta among 40 Patients with Normal, Stenotic and Replaced Aortic Valves

    DEFF Research Database (Denmark)

    Hansen, Kristoffer Lindskov; Møller-Sørensen, Hasse; Kjaergaard, Jesper

    2016-01-01

    Stenosis of the aortic valve gives rise to more complex blood flows with increased velocities. The angleindependent vector flow ultrasound technique transverse oscillation was employed intra-operatively on the ascending aorta of (I) 20 patients with a healthy aortic valve and 20 patients with aor...... replacement corrects some of these changes. Transverse oscillation may be useful for assessment of aortic stenosis and optimization of valve surgery. (E-mail: lindskov@gmail.com) 2016 World Federation for Ultrasound in Medicine & Biology...... with aortic stenosis before (IIa) and after (IIb) valve replacement. The results indicate that aortic stenosis increased flow complexity (p , 0.0001), induced systolic backflow (p , 0.003) and reduced systolic jet width (p , 0.0001). After valve replacement, the systolic backflow and jet width were normalized...

  4. Analysis of radiation risk to patients from intra-operative use of the mobile X-ray system (C-arm

    Directory of Open Access Journals (Sweden)

    Yang-Sub Lee

    2015-01-01

    Full Text Available Background: The aim of this study was to investigate clinical applications of mobile C-arms and consequent radiation risk, to increase medical attention on radiation protection, and to provide basic data for safe radiation use in the operating room. Materials and Methods: In this study, a total of 374 surgical operations, conducted using a portable fluoroscopic X-ray system from January to March of 2013, were analyzed. Dose summaries produced by the General Electric C-arm and data elements in digital imaging and communications in the medicine header of Ziehm C-arm, fluoroscopy time were used to obtain dose-area product (DAP and effective dose. Corresponding mean and maximum values were calculated, and the resulting data on the frequency of application, fluoroscopy time, DAP, and effective dose were compared and analyzed in terms of surgical specialty and operation types. Results: Orthopedic surgery was the most frequent with 165 cases (44.1%. The highest DAP value and effective dose were found in liver transplant among surgical specialty fields, with mean values of 2.90 ± 3.76 mGy∙m 2 and 58 ± 75.2 mSv, respectively (P = 0.0001. The highest DAP value and effective dose were observed in intra-operative mesenteric portography among types of surgery, showing mean values of 2.90 ± 3.81 mGy∙m 2 and 58.03 ± 76.24 mSv, respectively (P = 0.0001. Conclusion: Because DAP varies significantly across surgical specialties and types of operation, aggressive efforts to understand the effects of radiation dose is critical for radiation protection from intra-operative use of mobile C-arms.

  5. Assessment of the learning curves for photoselective vaporization of the prostate using GreenLight™ 180-Watt-XPS laser therapy: defining the intra-operative parameters within a prospective cohort.

    Science.gov (United States)

    Misraï, Vincent; Faron, Matthieu; Guillotreau, Julien; Bruguière, Eric; Bordier, Benoit; Shariat, Shahrokh F; Rouprêt, Morgan

    2014-04-01

    To assess the learning curves for the intra-operative parameters of the GreenLight™ 180-W XPS for photoselective vaporization of the prostate (PVP). A prospective study was conducted on 200 men who underwent PVP using the GreenLight™ 180-W XPS over 20 months. The population was divided into four consecutive equal groups. Evolution of lasing parameters was the main endpoint to reach an average energy of 5 kJ per prostate volume and to reach a lasing time/operative time (LT/OT) ratio of 66-80 %. Changes in the IPSS and prostate volume were also evaluated 12 weeks later. Total energy delivered (energy/ml of prostate) and the LT/OT ratio significantly increased over time (p learning curves within multiple intra-operative parameters. The PVP learning curves required at least 120 procedures until it met all intra-operative parameters of experts in this field.

  6. Intentional intravenous mercury injection

    African Journals Online (AJOL)

    In this case report, intravenous complications, treatment strategies and possible ... Mercury toxicity is commonly associated with vapour inhalation or oral ingestion, for which there exist definite treatment options. Intravenous mercury ... personality, anxiousness, irritability, insomnia, depression and drowsi- ness.[1] However ...

  7. Efficacy of florfenicol and intravenous fluid therapy for treatment of experimental salmonellosis in newborn calves Eficácia do florfenicol e da fluidoterapia parenteral no tratamento da salmonelose experimental em bezerros neonatos

    Directory of Open Access Journals (Sweden)

    D.G. Silva

    2010-06-01

    Full Text Available The efficacy of florfenicol associated or not to intravenous fluid therapy for treatment of Salmonella Dublin-infected calves was determined. Twenty-four healthy 10 to 15-day-old Holstein calves were randomly allotted into four groups, with six animals each: control (group 1; infected with 10(8CFU Salmonella Dublin and not treated (group 2; infected with 10(8CFU Salmonella Dublin and treated with florfenicol (group 3; and infected with 10(8CFU Salmonella Dublin and treated with florfenicol associated to fluid therapy (group 4. All animals were submitted to physical examination just before inoculation and every 24 hours, during seven days after experimental infection. Rectal swabs and blood samples were collected for Salmonella Dublin isolation and pH and blood electrolytes determination. The experimental infection with Salmonella Dublin induced clinical signs of salmonellosis, such as diarrhea and fever, and caused reduction in blood concentrations of pH, sodium, potassium and chlorides. The treated calves showed good clinical recovery, and the group treated with antibiotic in combination to fluid therapy presented a faster and more efficient correction of the hydro-electrolyte balance.Avaliou-se a eficácia terapêutica do florfenicol associado ou não à fluidoterapia intravenosa no tratamento de bezerros infectados experimentalmente com Salmonella Dublin. Foram utilizados 24 bezerros sadios da raça Holandesa com 10 a 15 dias de idade, distribuídos aleatoriamente em quatro grupos experimentais, constituídos por seis animais cada: controle (grupo 1; infectado com 10(8UFC de Salmonella Dublin e não tratado (grupo 2; infectado com 10(8UFC de Salmonella Dublin e tratado com florfenicol (grupo 3; e infectado com 10(8UFC de Salmonella Dublin (grupo 4 e tratado com florfenicol associado à fluidoterapia. Todos os animais foram submetidos ao exame físico logo antes da inoculação e a cada 24 horas, durante sete dias após a infec

  8. Concentrations in plasma, epithelial lining fluid, alveolar macrophages and bronchial mucosa after a single intravenous dose of 1.6 mg/kg of iclaprim (AR-100) in healthy men.

    Science.gov (United States)

    Andrews, J; Honeybourne, D; Ashby, J; Jevons, G; Fraise, A; Fry, P; Warrington, S; Hawser, S; Wise, R

    2007-09-01

    A validated microbiological assay was used to measure concentrations of iclaprim (AR-100) in plasma, bronchial mucosa (BM), alveolar macrophages (AM) and epithelial lining fluid (ELF) after a single 1.6 mg/kg intravenous 60 min iv infusion of iclaprim. Male volunteers were randomly allocated to three nominal sampling time intervals 1-2 h (Group A), 3-4 h (Group B) and 5.5-7.0 h (Group C) after the start of the drug infusion. Mean iclaprim concentrations in plasma, BM, AM and ELF, respectively, were for Group A 0.59 mg/L (SD 0.18), 0.51 mg/kg (SD 0.17), 24.51 mg/L (SD 21.22) and 12.61 mg/L (SD 7.33); Group B 0.24 mg/L (SD 0.05), 0.35 mg/kg (SD 0.17), 7.16 mg/L (SD 1.91) and 6.38 mg/L (SD 5.17); and Group C 0.14 mg/L (SD 0.05), no detectable level in BM, 5.28 mg/L (SD 2.30) and 2.66 mg/L (SD 2.08). Iclaprim concentrations in ELF and AM exceeded the MIC(90) for penicillin-susceptible Streptococcus pneumoniae (MIC90 0.06 mg/L), penicillin-intermediate S. pneumoniae (MIC90 2 mg/L), penicillin-resistant S. pneumoniae (MIC90 4 mg/L) for 7, 7 and 4 h, respectively, and Chlamydia pneumoniae (MIC90 0.5 mg/L) for 7 h. Mean iclaprim concentrations in ELF exceeded the MIC90 for Haemophilus influenzae (MIC90 4 mg/L) and Moraxella catarrhalis (MIC90 8 mg/L) for up to 4 and 2 h, respectively; in AM the MIC90 was exceeded for up to 7 h. Furthermore, the MIC90 for methicillin-resistant Staphylococcus aureus of 0.12 mg/L was exceeded at all sites for up to 7 h. These data suggest that iclaprim reaches lung concentrations that should be effective in the treatment of community-acquired pneumonia.

  9. The efficacy, safety and cost-effectiveness of intra-operative cell salvage in high-bleeding-risk cardiac surgery with cardiopulmonary bypass: a prospective randomized and controlled trial.

    Science.gov (United States)

    Xie, Yihong; Shen, Sheliang; Zhang, Jun; Wang, Wenyuan; Zheng, Jiayin

    2015-01-01

    Intra-operative cell salvage (CS) was reported to be ineffective, safe and not cost-effective in low-bleeding-risk cardiac surgery with cardiopulmonary bypass (CPB), but studies in high-bleeding-risk cardiac surgery are limited. The objective of this study is to evaluate the efficacy, safety and cost-effectiveness of intra-operative CS in high-bleeding-risk cardiac surgery with CPB. One hundred and fifty patients were randomly assigned to either with intra-operative CS group (Group CS) or without intra-operative CS group (Group C). Study endpoints were defined as perioperative allogeneic red blood cell (RBC) transfusion, perioperative impairment of blood coagulative function, postoperative adverse events and costs of transfusion-related. Both the proportion and quantity of perioperative allogeneic RBC transfusion were significantly lower in Group CS than that in Group C (p=0.0002, operative CS in high-bleeding-risk cardiac surgery with CPB is effective, generally safe, and cost-effective in developed countries but not in China.

  10. Intra-operative defibrillation testing and clinical shock efficacy in patients with implantable cardioverter-defibrillators: the NORDIC ICD randomized clinical trial.

    Science.gov (United States)

    Bänsch, Dietmar; Bonnemeier, Hendrik; Brandt, Johan; Bode, Frank; Svendsen, Jesper Hastrup; Táborský, Miloš; Kuster, Stefan; Blomström-Lundqvist, Carina; Felk, Angelika; Hauser, Tino; Suling, Anna; Wegscheider, Karl

    2015-10-01

    This trial was designed to test the hypothesis that shock efficacy during follow-up is not impaired in patients implanted without defibrillation (DF) testing during first implantable cardioverter-defibrillator (ICD) implantation. Between February 2011 and July 2013, 1077 patients were randomly assigned (1 : 1) to first time ICD implantation with (n = 540) or without (n = 537) DF testing. The intra-operative DF testing was standardized across all participating centres, and all ICD shocks were programmed to 40 J irrespective of DF test results. The primary end point was the average first shock efficacy (FSE) for all true ventricular tachycardia and fibrillation (VT/VF) episodes during follow-up. The secondary end points included procedural data, serious adverse events, and mortality. During a median follow-up of 22.8 months, the model-based FSE was found to be non-inferior in patients with an ICD implanted without a DF test, with a difference in FSE of 3.0% in favour of the no DF test [confidence interval (CI) -3.0 to 9.0%, Pnon-inferiority Defibrillation efficacy during follow-up is not inferior in patients with a 40 J ICD implanted without DF testing. Defibrillation testing during first time ICD implantation should no longer be recommended for routine left-sided ICD implantation. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

  11. Anti-tumor effects of cold atmospheric pressure plasma on vestibular schwannoma demonstrate its feasibility as an intra-operative adjuvant treatment.

    Science.gov (United States)

    Yoon, Yeo Jun; Suh, Michelle J; Lee, Hyun Young; Lee, Hae June; Choi, Eun Ha; Moon, In Seok; Song, Kiwon

    2018-02-01

    Vestibular schwannoma (VS), although a benign intracranial tumor, causes morbidities by brainstem compression. Since chemotherapy is not very effective in most Nf2-negative schwannomas, surgical removal or radiation therapy is required. However, depending on the size and site of the tumor, these approaches may cause loss of auditory or vestibular functions, and severely decrease the post-surgical wellbeing. Here, we examined the feasibility of cold atmospheric pressure plasma (CAP) as an intra-operative adjuvant treatment for VS after surgery. Cell death was efficiently induced in both human HEI-193 and mouse SC4 VS cell lines upon exposure to CAP for seven minutes. Interestingly, both apoptosis and necroptosis were simultaneously induced by CAP treatment, and cell death was not completely inhibited by pan-caspase and receptor-interacting serine/threonine-protein kinase 1 (RIK1) inhibitors. Upon CAP exposure, cell death phenotype was similarly observed in patient-derived primary VS cells and tumor mass. In addition, CAP exposure after the surgical removal of primary tumor efficiently inhibited tumor recurrence in SC4-grafted mouse models. Collectively, these results strongly suggest that CAP should be developed as an efficient adjuvant treatment for VS after surgery to eliminate the possible remnant tumor cells, and to minimize the surgical area in the brain for post-surgical wellbeing. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Simulated versus realistic intra operative radiation therapy (I.O.R.T.) treatment in operating room: from knowledge of stray radiation to action

    International Nuclear Information System (INIS)

    Andreoli, S.; Moretti, R.; Catalano, M.; Locatelli, F.

    2006-01-01

    Intra-Operative Radiation Therapy (I.O.R.T.) is carried out with electron beams produced by a Linac (Linear Accelerator) generally used for conventional radiotherapy with external beam, or by dedicated accelerators that can be employed directly into an operating room. I.O.R.T. refers to the application of radiation during a surgical intervention, after the removal of a neoplastic mass. I.O.R.T. uses on the tumour area a direct irradiation, for the possible localisation of sub-clinic illness or macroscopic residue in the case of non-radical resection. Intra-Operative Radiotherapy foresees a single session only, generally preceded or followed by radiotherapy with external beam. It allows the achievement of a selective radiation boost on the tumour volume. In some cases, it can also be used as a one-time/stand alone treatment in initial cancer of small volume, or in unresectable malignancies for palliative purpose. The technical advantages of I.O.R.T. consist in the direct visual control of the target volume, and in the possibility to protect the healthy tissues by moving them away from the path of the radiation beam. The use of electron beams allows the administration of a homogeneous dose to a selected layer of tissues surrounding the tumour. The following professional staff forms the Operative Group: radiation oncologist, surgeon, anaesthetist, medical physicist, radiation technologist, nurse.The choice of a simulation geometry very similar to the clinical situation allows to evaluate radioprotection data very close to the real situation. For a fixed layout, an anthropomorphic phantom was positioned on the operating bed and a breast I.O.R.T. treatment was simulated positioning all the accessories of the operating room in their typical positions. A detailed dose mapping was performed with a Victoreen 450P ionisation chamber and with environment film-dosimeter on the walls of the operating room during the simulation of the clinical treatment. The simulation appears

  13. Pre-operative and intra-operative detection of axillary lymph node metastases in 108 patients with invasive lobular breast cancer undergoing mastectomy.

    Science.gov (United States)

    Novak, Jerica; Besic, Nikola; Dzodic, Radan; Gazic, Barbara; Vogrin, Andrej

    2018-02-05

    Despite the recent changes in the treatment of the axilla in selected breast cancer patient, positive sentinel lymph node (SLN) in patients undergoing mastectomy still necessitates axillary lymph node dissection (ALND). In invasive lobular carcinoma (ILC), pre-operative detection of the lymph node metastasis may be demanding due to its unique morphology. The aim of this study was to examine the benefit of preoperative axillary ultrasound (AUS), ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and intra-operative imprint cytology (IIC), in order to avoid two-stage axillary surgery in patients with ILC undergoing mastectomy. The object of this study were 102 patients (median age 52, range 34-73 years) with clinically non-suspicious axilla in whom 108 mastectomies were performed after a pre-operative AUS investigation. Whenever a metastasis was detected in a sentinel lymph node, ALND was done. Reports of the pre-operative AUS investigation, US-FNAB, and IIC were compared with definitive histopathological reports of surgical specimens. In 46 cases lymph node metastases were diagnosed. AUS suspicious lymph nodes were found in 29/108 cases and histopathology confirmed metastases in 22/30 cases. US-FNAB was performed in 29 cases with AUS suspicious lymph nodes. Cytology proved metastases in 11/29 cases. Histopathology confirmed metastases in 10/11 cases with only isolated tumor cells found in one case. IIC investigation was performed in 63 cases and in 10/27 cases metastases were confirmed by histopathology. Pre-operative AUS, US-FNAB, and/or IIC investigation enabled ALND during a single surgical procedure in 20/46 patients with metastases in lymph nodes. Pre-operative AUS, US-FNAB, and/or IIC are/is beneficial in patients with ILC planned for mastectomy in order to decrease the number of two stage axillary procedures.

  14. Dual phase helical CT versus portal venous phase CT for the detection of colorectal liver metastases: Correlation with intra-operative sonography, surgical and pathological findings

    Energy Technology Data Exchange (ETDEWEB)

    Scott, D. John; Guthrie, J. Ashley; Arnold, Paul; Ward, Janice; Atchley, Julian; Wilson, Daniel; Robinson, Philip J

    2001-03-01

    AIM: To assess whether dual phase helical computed tomography (DPCT) of the liver improves the detection of colorectal liver metastases compared with portal venous phase (PVP) imaging alone. MATERIALS AND METHODS: DPCT was performed in 33 consecutive patients before laparotomy for resection of colorectal liver metastases. CT comprised 8-mm slice collimation with a pitch of 1 to 1.25; imaging was commenced 20-25 and 65-70 s after the start of injection of 150 ml of contrast medium at 5 ml/s to coincide with hepatic arterial phase (HAP) and PVP contrast enhancement, respectively. Four blinded observers independently reviewed the HAP, PVP and DPCT images recording the site and size of all lesions. Alternative-free response receiver operating characteristic (AFROC) methodology was used to analyse the results, which were correlated with surgery, intra-operative ultrasound and histology. RESULTS: The mean observer sensitivities for malignant lesion detection were 75.3% for DPCT, 69.7% for PVP imaging and 66.7% for HAP imaging alone. There was a statistically significant improvement in malignant lesion detection using DPCT when compared with PVP imaging alone (P < 0.05). The mean areas under the AFROC curves were 0.84 for DPCT and 0.82 for PVP (P < 0.03) imaging alone. CONCLUSION: The detection of colorectal liver metastases was marginally better with DPCT than with PVP imaging alone, but the discovery of additional lesions did not affect the management of any of the patients in this study. Scott, D.J. et al. (2001)

  15. Intra-Operative Inspired Fraction of Oxygen and the Risk of Surgical Site Infections in Patients with Type 1 Surgical Incisions.

    Science.gov (United States)

    Wanta, Brendan T; Hanson, Kristine T; Hyder, Joseph A; Stewart, Thomas M; Curry, Timothy B; Berbari, Elie F; Habermann, Elizabeth B; Kor, Daryl J; Brown, Michael J

    2018-04-02

    Whether the fraction of inspired oxygen (F I O 2 ) influences the risk of surgical site infection (SSI) is controversial. The World Health Organization and the World Federation of Societies of Anesthesiologists offer conflicting recommendations. In this study, we evaluate simultaneously three different definitions of F I O 2 exposure and the risk of SSI in a large surgical population. Patients with clean (type 1) surgical incisions who developed superficial and deep organ/space SSI within 30 days after surgery from January 2003 through December 2012 in five surgical specialties were matched to specialty-specific controls. Fraction of inspired oxygen exposure was defined as (1) nadir F I O 2 , (2) percentage of operative time with F I O 2 greater than 50%, and (3) cumulative hyperoxia exposure, calculated as the area under the curve (AUC) of F I O 2 by time for the duration in which F I O 2 greater than 50%. Stratified univariable and multivariable logistic regression models tested associations between F I O 2 and SSI. One thousand two hundred fifty cases of SSI were matched to 3,248 controls. Increased oxygen exposure, by any of the three measures, was not associated with the outcome of any SSI in a multivariable logistic regression model. Elevated body mass index (BMI; 35+ vs. operative oxygen exposure was associated with higher odds of SSI in the neurosurgical and spine populations. Increased intra-operative inspired fraction of oxygen was not associated with a reduction in SSI. These findings do not support the practice of increasing F I O 2 for the purpose of SSI reduction in patients with clean surgical incisions.

  16. Systematic Review and Meta-Analysis of Randomized Controlled Trials Evaluating Prophylactic Intra-Operative Wound Irrigation for the Prevention of Surgical Site Infections.

    Science.gov (United States)

    de Jonge, Stijn W; Boldingh, Quirine J J; Solomkin, Joseph S; Allegranzi, Benedetta; Egger, Matthias; Dellinger, E Patchen; Boermeester, Marja A

    Surgical site infections (SSIs) are one of the most common hospital-acquired infections. To reduce SSIs, prophylactic intra-operative wound irrigation (pIOWI) has been advocated, although the results to date are equivocal. To develop recommendations for the new World Health Organization (WHO) SSI prevention guidelines, a systematic literature review and a meta-analysis were conducted on the effectiveness of pIOWI using different agents as a means of reducing SSI. The PUBMED, Embase, CENTRAL, CINAHL, and WHO databases were searched. Randomized controlled trials (RCTs) comparing either pIOWI with no pIOWI or with pIOWI using different solutions and techniques were retrieved with SSI as the primary outcome. Meta-analyses were performed, and odds ratios (OR) and the mean difference with 95% confidence intervals (CI) were extracted and pooled with a random effects model. Twenty-one studies were suitable for analysis, and a distinction was made between intra-peritoneal, mediastinal, and incisional wound irrigation. A low quality of evidence demonstrated a statistically significant benefit for incisional wound irrigation with an aqueous povidone-iodine (PVP-I) solution in clean and clean contaminated wounds (OR 0.31; 95% CI 0.13-0.73; p = 0.007); 50 fewer SSIs per 1,000 procedures (from 19 fewer to 64 fewer)). Antibiotic irrigation had no significant effect in reducing SSIs (OR 1.16; 95% CI 0.64-2.12; p = 0.63). Low-quality evidence suggests considering the use of prophylactic incisional wound irrigation to prevent SSI with an aqueous povidone-iodine solution. Antibiotic irrigation does not show a benefit and therefore is discouraged.

  17. Comparison of surgical outcomes after anterior cervical discectomy and fusion: does the intra-operative use of a microscope improve surgical outcomes.

    Science.gov (United States)

    Adogwa, Owoicho; Elsamadicy, Aladine; Reiser, Elizabeth; Ziegler, Cole; Freischlag, Kyle; Cheng, Joseph; Bagley, Carlos A

    2016-03-01

    The primary aim of this study was to assess and compare the complications profile as well as long-term clinical outcomes between patients undergoing an Anterior Cervical Discectomy and Fusion (ACDF) procedure with and without the use of an intra-operative microscope. One hundred and forty adult patients (non-microscope cohort: 81; microscope cohort: 59) undergoing ACDF at a major academic medical center were included in this study. Enrollment criteria included available demographic, surgical and clinical outcome data. All patients had prospectively collected patient-reported outcomes measures and a minimum 2-year follow-up. Patients completed the neck disability index (NDI), short-form 12 (SF-12) and visual analog pain scale (VAS) before surgery, then at 3, 6, 12, and 24 months after surgery. Clinical outcomes and complication rates were compared between both patient cohorts. Baseline characteristics were similar between both cohorts. The mean ± standard deviation duration of surgery was longer in the microscope cohort (microscope: 169±34 minutes vs. non-microscope: 98±42 minutes, Pmicroscope and non-microscope cohorts demonstrated similar improvement from base line in NDI (microscope: 13.52±25.77 vs. non-microscope: 19.51±27.47, Pmicroscope: 4.15±26.39 vs. non-microscope: 11.98±22.96, Pmicroscope: 9.47±32.38 vs. non-microscope: 16.19±30.44, Pmicroscope: 2.22±4.00 vs. non-microscope: 3.69±3.61, Pmicroscope does not improve overall surgery-related outcomes, nor does it lead to superior long-term outcomes in pain and functional disability, 2 years after index surgery.

  18. Dual phase helical CT versus portal venous phase CT for the detection of colorectal liver metastases: Correlation with intra-operative sonography, surgical and pathological findings

    International Nuclear Information System (INIS)

    Scott, D. John; Guthrie, J. Ashley; Arnold, Paul; Ward, Janice; Atchley, Julian; Wilson, Daniel; Robinson, Philip J.

    2001-01-01

    AIM: To assess whether dual phase helical computed tomography (DPCT) of the liver improves the detection of colorectal liver metastases compared with portal venous phase (PVP) imaging alone. MATERIALS AND METHODS: DPCT was performed in 33 consecutive patients before laparotomy for resection of colorectal liver metastases. CT comprised 8-mm slice collimation with a pitch of 1 to 1.25; imaging was commenced 20-25 and 65-70 s after the start of injection of 150 ml of contrast medium at 5 ml/s to coincide with hepatic arterial phase (HAP) and PVP contrast enhancement, respectively. Four blinded observers independently reviewed the HAP, PVP and DPCT images recording the site and size of all lesions. Alternative-free response receiver operating characteristic (AFROC) methodology was used to analyse the results, which were correlated with surgery, intra-operative ultrasound and histology. RESULTS: The mean observer sensitivities for malignant lesion detection were 75.3% for DPCT, 69.7% for PVP imaging and 66.7% for HAP imaging alone. There was a statistically significant improvement in malignant lesion detection using DPCT when compared with PVP imaging alone (P < 0.05). The mean areas under the AFROC curves were 0.84 for DPCT and 0.82 for PVP (P < 0.03) imaging alone. CONCLUSION: The detection of colorectal liver metastases was marginally better with DPCT than with PVP imaging alone, but the discovery of additional lesions did not affect the management of any of the patients in this study. Scott, D.J. et al. (2001)

  19. Simultaneous multi-scale microscopy as a potential dedicated tool for intra-operative parathyroid identification during thyroid surgery (Conference Presentation)

    Science.gov (United States)

    De Montigny, Étienne; Goulamhoussen, Nadir; Madore, Wendy-Julie; Strupler, Mathias; Maniakas, Anastasios; Ayad, Tareck; Boudoux, Caroline

    2016-02-01

    While thyroidectomy is considered a safe surgery, dedicated tools facilitating tissue identification during surgery could improve its outcome. The most common complication following surgery is hypocalcaemia, which results from iatrogenic removal or damage to parathyroid glands. This research project aims at developing and validating an instrument based on optical microscopy modalities to identify tissues in real time during surgery. Our approach is based on a combination of reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) to obtain multi-scale morphological contrast images. The orthogonal field of views provide information to navigate through the sample. To allow simultaneous, synchronized video-rate imaging in both modalities, we designed and built a dual-band wavelength-swept laser which scans a 30 nm band centered at 780 nm and a 90 nm band centered at 1310 nm. We built an imaging setup integrating a custom-made objective lens and a double-clad fibre coupler optimized for confocal microscopy. It features high resolutions in RCM (2µm lateral and 20 µm axial) in a 500 µm x 500 µm field-of-view and a larger field-of-view of 2 mm (lateral) x 5 mm (axial) with 20 µm lateral and axial resolutions in OCT. Imaging of ex vivo animal samples is demonstrated on a bench-top system. Tissues that are visually difficult to distinguish from each other intra-operatively such as parathyroid gland, lymph nodes and adipose tissue are imaged to show the potential of this approach in differentiating neck tissues. We will also provide an update on our ongoing clinical pilot study on patients undergoing thyroidectomy.

  20. The effect of post-traumatic-stress-disorder on intra-operative analgesia in a veteran population during cataract procedures carried out using retrobulbar or topical anesthesia: a retrospective study.

    Science.gov (United States)

    Rapoport, Yuna; Wayman, Laura L; Chomsky, Amy S

    2017-06-07

    A growing proportion of veterans treated at the Veterans Health Administration (VA) have a history of post-traumatic-stress-disorder (PTSD), and there exists a higher rate of PTSD amongst veterans than the general population. The purpose of this study is to determine the correlation between PTSD and intra-operative analgesia, intra-operative time, and anesthesia type for cataract surgery in a veteran population. Secondary objectives are to determine if patient age, and first or second eye surgery affect intra-operative pain control or are correlated with type of anesthesia modality. A retrospective study of 330 cataract surgeries performed by resident physicians between January and September 2012 at the Veterans Affairs Medical Center Tennessee Valley Healthcare System, Nashville and Murfreesboro Campuses was completed. Three hundred and thirty veteran patients were selected if their cataract surgery was performed between January and September 2012. Combined cases were excluded. The primary outcome evaluated was intra-operative analgesia. Secondary outcomes included history of post-traumatic-stress-disorder, anesthesia type, first or second eye, pain control, intra-operative heart rate and blood pressure, age, and case complexity. Data was analyzed using an unpaired two-sample Welch's t-test assuming unequal variance and Z test of comparison of proportions. Patients with post-traumatic-stress-disorder reported higher pain scores, had longer operative times, and were more likely to have received a retrobulbar block. Operative time was not associated with an increased pain score, irrespective of anesthesia type, when controlled for PTSD. Complex cases had longer operative times, more sedation, and higher pain scores. P Post-traumatic stress disorder and anxiety are more prevalent in the veteran population. Our data suggests that a history of post-traumatic-stress-disorder was correlated with higher pain scores, longer operative times, and with having received a

  1. Pain management in emergency department: intravenous morphine vs. intravenous acetaminophen

    Directory of Open Access Journals (Sweden)

    Morteza Talebi Doluee

    2015-01-01

    Full Text Available Pain is the most common complaint in emergency department and there are several methods for its control. Among them, pharmaceutical methods are the most effective. Although intravenous morphine has been the most common choice for several years, it has some adverse effects. There are many researches about intravenous acetaminophen as an analgesic agent and it appears that it has good analgesic effects for various types of pain. We searched some electronic resources for clinical trials comparing analgesic effects of intravenous acetaminophen vs. intravenous morphine for acute pain treatment in emergency setting.In two clinical trials, the analgesic effect of intravenous acetaminophen has been compared with intravenous morphine for renal colic. The results revealed no significant difference between analgesic effects of two medications. Another clinical trial revealed that intravenous acetaminophen has acceptable analgesic effects on the post-cesarean section pain when combined with other analgesic medications. One study revealed that administration of intravenous acetaminophen compared to placebo before hysterectomy decreased consumption of morphine via patient-controlled analgesia pump and decreased the side effects. Similarly, another study revealed that the infusion of intravenous acetaminophen vs. placebo after orthopedic surgery decreased the consumption of morphine after the surgery. A clinical trial revealed intravenous acetaminophen provided a level of analgesia comparable to intravenous morphine in isolated limb trauma, while causing less side effects than morphine.It appears that intravenous acetaminophen has good analgesic effects for visceral, traumatic and postoperative pains compare with intravenous morphine.

  2. Incremental value of combined 99MTc tetrofosmin parathyroid scintigraphy, rapid intra operative PTH assays and minimally invasive radio-guided surgery (MIRS) in optimizing parathyroidectomies

    International Nuclear Information System (INIS)

    Padma, S.; Kumar, S.; Babu, T.; Kumar, H.; Nair, V.; Nair, G.K.

    2004-01-01

    Objective: Aim of our study was to evaluate incremental diagnostic value of 99mTc Tetrofosmin parathyroid SPECT (TPSPECT), rapid intra operative quick parathyroid hormone measurement (QPTH) combined with radio guidance provided by scintillation probe (Minimally Invasive Radio guided Surgery MIRS) in parathyroid surgeries. While TPSPECT is an established investigation in preoperative workup of hyperparathyroidism patients , MIRS is a relatively new concept in Indian subcontinent. Methods: 29 pts (M: F = 18: 11), age range 16- 65 yrs (mean 41+ 9 yrs) having clinical and biochemical hyperparathyroidism underwent TPSPECT between Jan 02 -04, using 20 mci IV 99mTc Tetrofosmin. Pts with familial hyperparathyroidism , previous nodular goiters and previous neck irradiation were excluded from study. Scintigraphy comprised of immediate, delayed planar and SPECT imaging of neck and chest. Imagewise abnormal, persistent tracer uptake was considered positive for adenoma and diffuse uptake for hyperplasia. 26 pts underwent exploration (22 adenomas and 4 hyperplasias).18 pts had benefit of intraoperative QPTH. A select group (after Dec 2003) i.e. 9 pts got the assistance of radioguided probing. Peroperatively NM physician used cordless handheld gamma probe (Gamma Finder, World of Medicine, Germany) in neck and mediastinum to detect parathyroid adenoma / hyperplasias. A five fold increase in radioactive counts perceived by probe when compared to background was considered positive for parathyroid adenoma / hyperplasia. If PTH levels fell from baseline by at least 50%, the surgery was concluded as complete. Results: In all 22 pts suspected to have primary hyperparathyroidism TPSPECT identified adenomas (100 % sensitivity). While planar imaging had a sensitivity of 90.1% (20/22 pts), SPECT identified the adenoma in all pts. Interestingly only 3/22 pts had ectopic glands while 5 had more than one adenomas. The most commonly involved gland was left inferior. In secondary

  3. Intravenous clonidine as a part of balanced anaesthesia for controlled hypotension in functional endoscopic sinus surgery: A randomised controled trial.

    Science.gov (United States)

    Jiwanmall, Meghna; Joselyn, Anita Shirley; Kandasamy, Subramani

    2017-05-01

    Controlled hypotension with balanced anaesthesia minimises blood loss. This study was done to evaluate the effectiveness of intravenous clonidine as a single bolus dose to establish controlled hypotension during functional endoscopic sinus surgery (FESS). This randomised, double-blind, placebo-controlled study was done in a tertiary hospital in India. Sixty American Society of Anesthesiologists physical status I and II patients (18-65 years) undergoing FESS were randomly allocated to one of the two groups. Placebo group (group A, n = 30) received sterile water whereas the clonidine group (group B, n = 30) received 3μg/kg of clonidine intravenously, 30 min prior to induction of anaesthesia. The primary outcome was to achieve a target mean arterial blood pressure (MAP) of 55-65 mmHg intraoperatively. The secondary outcomes measured were requirement of additional fentanyl and metoprolol, intra-operative blood loss, surgeon's opinion on the surgical field, pain, sedation score and complications requiring treatment. Target MAP was easily achieved in clonidine group as against the placebo group ( P hypotensive drugs and good analgesia ( P = 0.01) were seen in clonidine group. The complication rates were similar in both the groups. Clonidine is effective in achieving controlled hypotension in patients undergoing FESS. It reduces intra-operative blood loss, requirement of additional hypotensive drugs, improves the surgical field and offers good analgesia without significant side effects.

  4. Computed tomography intravenous cholangiography

    International Nuclear Information System (INIS)

    Nascimento, S.; Murray, W.; Wilson, P.

    1997-01-01

    Indications for direct visualization of the bile ducts include bile duct dilatation demonstrated by ultrasound or computed tomography (CT) scanning, where the cause of the bile duct dilatation is uncertain or where the anatomy of bile duct obstruction needs further clarification. Another indication is right upper quadrant pain, particularly in a post-cholecystectomy patient, where choledocholithiasis is suspected. A possible new indication is pre-operative evaluation prior to laparoscopic cholecystectomy. The bile ducts are usually studied by endoscopic retrograde cholangiopancreatography (ERCP), or, less commonly, trans-hepatic cholangiography. The old technique of intravenous cholangiography has fallen into disrepute because of inconsistent bile-duct opacification. The advent of spiral CT scanning has renewed interest in intravenous cholangiography. The CT technique is very sensitive to the contrast agent in the bile ducts, and angiographic and three-dimensional reconstructions of the biliary tree can readily be obtained using the CT intravenous cholangiogram technique (CT IVC). Seven patients have been studied using this CT IVC technique, between February 1995 and June 1996, and are the subject of the present report. Eight further studies have since been performed. The results suggest that CT IVC could replace ERCP as the primary means of direct cholangiography, where pancreatic duct visualization is not required. (authors)

  5. Computed tomography intravenous cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Nascimento, S.; Murray, W.; Wilson, P. [Pittwater Radiology, Dee Why, NSW, (Australia)

    1997-08-01

    Indications for direct visualization of the bile ducts include bile duct dilatation demonstrated by ultrasound or computed tomography (CT) scanning, where the cause of the bile duct dilatation is uncertain or where the anatomy of bile duct obstruction needs further clarification. Another indication is right upper quadrant pain, particularly in a post-cholecystectomy patient, where choledocholithiasis is suspected. A possible new indication is pre-operative evaluation prior to laparoscopic cholecystectomy. The bile ducts are usually studied by endoscopic retrograde cholangiopancreatography (ERCP), or, less commonly, trans-hepatic cholangiography. The old technique of intravenous cholangiography has fallen into disrepute because of inconsistent bile-duct opacification. The advent of spiral CT scanning has renewed interest in intravenous cholangiography. The CT technique is very sensitive to the contrast agent in the bile ducts, and angiographic and three-dimensional reconstructions of the biliary tree can readily be obtained using the CT intravenous cholangiogram technique (CT IVC). Seven patients have been studied using this CT IVC technique, between February 1995 and June 1996, and are the subject of the present report. Eight further studies have since been performed. The results suggest that CT IVC could replace ERCP as the primary means of direct cholangiography, where pancreatic duct visualization is not required. (authors). 11 refs., 6 figs.

  6. Methods of preparing and using intravenous nutrient compositions

    International Nuclear Information System (INIS)

    Beigler, M.A.; Koury, A.J.

    1983-01-01

    A method for preparing a stable, dry-packaged, sterile, nutrient composition which upon addition of sterile, pyrogen-free water is suitable for intravenous administration to a mammal, including a human, is described. The method comprises providing the nutrients in a specific dry form and state of physical purity acceptable for intravenous administration, sealing the nutrients in a particular type of container adapted to receive and dispense sterile fluids and subjecting the container and its sealed contents to a sterilizing, nondestructive dose of ionizing radiation. The method results in a packaged, sterile nutrient composition which may be dissolved by the addition of sterile pyrogen-free water. The resulting aqueous intravenous solution may be safely administered to a mammal in need of nutrient therapy. The packaged nutrient compositions of the invention exhibit greatly extended storage life and provide an economical method of providing intravenous solutions which are safe and efficacious for use. (author)

  7. Tight intra-operative blood pressure control versus standard care for patients undergoing hip fracture repair - Hip Fracture Intervention Study for Prevention of Hypotension (HIP-HOP) trial: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Moppett, Iain Keith; White, Stuart; Griffiths, Richard; Buggy, Donal

    2017-07-25

    Hypotension during anaesthesia for hip fracture surgery is common. Recent data suggest that there is an association between the lowest intra-operative blood pressure and mortality, even when adjusted for co-morbidities. This is consistent with data derived from the wider surgical population, where magnitude and duration of hypotension are associated with mortality and peri-operative complications. However, there are no trial to data to support more aggressive blood pressure control. We are conducting a three-centre, randomised, double-blinded pilot study in three hospitals in the United Kingdom. The sample size will be 75 patients (25 from each centre). Randomisation will be done using computer-generated concealed tables. Both participants and investigators will be blinded to group allocation. Participants will be aged >70 years, cognitively intact (Abbreviated Mental Test Score 7 or greater), able to give informed consent and admitted directly through the emergency department with a fractured neck of the femur requiring operative repair. Patients randomised to tight blood pressure control or avoidance of intra-operative hypotension will receive active treatment as required to maintain both of the following: systolic arterial blood pressure >80% of baseline pre-operative value and mean arterial pressure >75 mmHg throughout. All participants will receive standard hospital care, including spinal or general anaesthesia, at the discretion of the clinical team. The primary outcome is a composite of the presence or absence of defined cardiovascular, renal and delirium morbidity within 7 days of surgery (myocardial injury, stroke, acute kidney injury, delirium). Secondary endpoints will include the defined individual morbidities, mortality, early mobility and discharge to usual residence. This is a small-scale pilot study investigating the feasibility of a trial of tight intra-operative blood pressure control in a frail elderly patient group with known high morbidity

  8. Effects of intra-operative end-tidal carbon dioxide levels on the rates of post-operative complications in adults undergoing general anesthesia for percutaneous nephrolithotomy: A clinical trial

    Directory of Open Access Journals (Sweden)

    Mahmoud Saghaei

    2014-01-01

    Full Text Available Background: A retrospective study has shown lesser days of hospital stay in patients with increased levels of intra-operative end-tidal carbon dioxide (ETCO 2 . It is probable that hypercapnia may exert its beneficial effects on patients′ outcome through optimization of global hemodynamic and tissue oxygenation, leading to a lower rate of post-operative complications. This study was designed to test the hypothesis that higher values of intra-operative ETCO 2 decrease the rate of post-operative complications. Materials and Methods: In this randomized, double-blind clinical trial, 78 adult patients scheduled for percutaneous nephrolithotomy (PCNL were prospectively enrolled and randomly divided into three groups. ETCO 2 was set and maintained throughout the procedure at 31-33, 37-39 and 43-45 mmHg in the hypocapnia, normocapnia and hypercapnia groups, respectively. The rates of post-operative complications were compared among the three groups. Results: Seventy-five patients completed the study (52 male and 23 female. Ten (38.5%, four (16% and two (8.3% patients developed post-operative vomiting in the hypocapnia, normocapnia and hypercapnia groups, respectively (P = 0.025. The nausea score was significantly lower in the hypercapnic group compared with the other groups (3.9 ± 1.8, 3.2 ± 2.1 and 1.3 ± 1.8 in the hypocapnia, normocapnia and hypercapnia groups, respectively; P = 0.000. Time to return of spontaneous respiration and awakening were significantly decreased in the hypercapnia group compared with the other groups (P < 0.01. Conclusion: Mild intra-operative hypercapnia has a protecting effect against the development of post-operative nausea and vomiting and decreases the duration of emergence and recovery from general anesthesia.

  9. Intravenous lipid emulsion and dexmedetomidine for treatment of ...

    African Journals Online (AJOL)

    tulyasys

    2015-08-19

    Aug 19, 2015 ... include intravenous fluid support to maintain electrolyte balance and hydration and to promote diuresis, dermal decontamination with a mild detergent and .... GABAA receptor complex and its activation increases chloride conductance and generates slow inhibitory postsynaptic potentials. This is one of the ...

  10. Intravenous lidocaine infusion.

    Science.gov (United States)

    Soto, G; Naranjo González, M; Calero, F

    2018-02-26

    Systemic lidocaine used in continuous infusion during the peri-operative period has analgesic, anti-hyperalgesic, as well as anti-inflammatory properties. This makes it capable of reducing the use of opioids and inhalational anaesthetics, and the early return of bowel function, and patient hospital stay. The aim of this narrative review was to highlight the pharmacology and indications for clinical application, along with new and interesting research areas. The clinical applications of peri-operative lidocaine infusion have been reviewed in several recent systematic reviews and meta-analyses in patients undergoing open and laparoscopic abdominal procedures, ambulatory procedures, and other types of surgery. Peri-operative lidocaine infusion may be a useful analgesic adjunct in enhanced recovery protocols. Potential benefits of intravenous lidocaine in chronic post-surgical pain, post-operative cognitive dysfunction, and cancer recurrence are under investigation. Due to its immunomodulation properties over surgical stress, current evidence suggests that intravenous lidocaine could be used in the context of multimodal analgesia. Copyright © 2018 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. A comparison of intravenous ketoprofen versus pethidine on peri-operative analgesia and post-operative nausea and vomiting in paediatric vitreoretinal surgery.

    Directory of Open Access Journals (Sweden)

    Subramaniam R

    2003-01-01

    Full Text Available AIM: To compare the efficacy of ketoprofen and pethidine for peri-operative analgesia and post-operative nausea and vomiting in children undergoing vitreoretinal surgery and surgery for retinal detachment. MATERIAL AND METHODS: Children aged 7 to 16 years and ASA I status, undergoing vitreo-retinal surgery were randomly allocated to receive either ketoprofen 2mg/kg or pethidine 1mg/kg intravenously for peri-operative analgesia. In all patients, general anaesthesia was induced with thiopentone and intubation was facilitated with vecuronium bromide and maintained with 33% oxygen in nitrous oxide and isoflurane. Intra-operative and post-operative monitoring was done by an observer blinded to the technique. Intra-operative rescue analgesia was used if heart rate and/or blood pressure increased by 25% from pre-incision values. Post-operative pain and episodes of nausea and vomiting were evaluated at recovery (0 hour, 2, 6 and 24 hours intervals. Standard rescue analgesia and anti-emetic agents were administered if required. RESULTS: Eighty-six children were enrolled in the study. Forty-four received ketoprofen while 42 received pethidine. Intra-operative analgesia was comparable in both the groups and no significant difference was found in the requirement of intra-operative rescue analgesia, as well. Postoperatively 6/44 (13.6% children in ketoprofen group had pain at recovery compared to 17/42 (40.4% in pethidine group. Pain at 2, 6 and 24 hours, and postoperative analgesic requirement were not significantly different among the two groups. Post-operative nausea, vomiting, and antiemetic requirement were significantly less in the ketoprofen group at all time intervals. CONCLUSION: Ketoprofen is a satisfactory alternative analgesic to pethidine for vitreoretinal surgery and results in a lower incidence of postoperative nausea and vomiting.

  12. Intravenous versus oral etoposide

    DEFF Research Database (Denmark)

    Ali, Abir Salwa; Grönberg, Malin; Langer, Seppo W.

    2018-01-01

    High-grade gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs, G3) are aggressive cancers of the digestive system with poor prognosis and survival. Platinum-based chemotherapy (cisplatin/carboplatin + etoposide) is considered the first-line palliative treatment. Etoposide is frequently...... administered intravenously; however, oral etoposide may be used as an alternative. Concerns for oral etoposide include decreased bioavailability, inter- and intra-patient variability and patient compliance. We aimed to evaluate possible differences in progression-free survival (PFS) and overall survival (OS......) in patients treated with oral etoposide compared to etoposide given as infusion. Patients (n = 236) from the Nordic NEC study were divided into three groups receiving etoposide as a long infusion (24 h, n = 170), short infusion (≤ 5 h, n = 33) or oral etoposide (n = 33) according to hospital tradition. PFS...

  13. Ultrasonography versus intravenous urography

    International Nuclear Information System (INIS)

    Aslaksen, A.

    1991-01-01

    The present study was performed to compare the clinical value of urography and ultrasonography in a non-selected group of patients referred for urography to a university hospital. The conslusions and clinical implications of the study are as follows: Intravenous urography remains the cornerstone imaging examination in the evaluation of ureteral calculi. Ultrasonography is a valuable adjunct in cases of non- visualization of the kidneys, in distal obstruction and known contrast media allergy. When women with recurrent urinary tract infection are referred for imaging of the urinary tract, ultrasonography should be used. Ultrasonography should replace urography for screening of non-acute hydronephrosis like in female genital cancer and benign prostate hyperplasia. There is good correlation between urography and ultrasonography in assessing the degree of hydronephrosis. However, more researh on the relationship between hydronephrosis and obstruction is necessary. Ultrasonography should be used as the only imaging method of the upper urinary tract in patients with microscopic hematuria. In patients less than 50 years with macroscopic hematuria, ultrasonography should be used as the only imaging of the upper urinary tract, and an examination of the urinary bladder should be included. In patients over 50 years, urography supplied with ultrasonography should be used, but more research is necessary on the subject of imaging method and age. 158 refs

  14. Randomised study on single stage laparo-endoscopic rendezvous (intra-operative ERCP procedure versus two stage approach (Pre-operative ERCP followed by laparoscopic cholecystectomy for the management of cholelithiasis with choledocholithiasis

    Directory of Open Access Journals (Sweden)

    Manash Ranjan Sahoo

    2014-01-01

    Full Text Available Introduction : The ′Rendezvous′ technique consists of laparoscopic cholecystectomy (LC standards with intra-operative cholangiography followed by endoscopic sphincterotomy. The sphincterotome is driven across the papilla through a guidewire inserted by the transcystic route. In this study, we intended to compare the two methods in a prospective randomised trial. Materials And Methods: From 2005 to 2012, we enrolled 83 patients with a diagnosis of cholecysto-choledocolithiasis. They were randomised into two groups. In ′group-A′,41 patients were treated with two stages management, first by pre-operative endoscopic retrograde cholangiopancreatography (ERCP and common bile duct (CBD clearance and second by LC. In ′group-B′, 42 patients were treated with LC and intra-operative cholangiography; and when diagnosis of choledocholithiasis was confirmed, patients had undergone one stage management of by Laparo-endoscopic Rendezvous technique. Results: In arm-A and arm-B groups, complete CBD clearance was achieved in 29 and 38 patients, respectively. Failure of the treatment in arm-A was 29% and in arm-B was 9.5%. In arm-A, selective CBD cannulation was achieved in 33 cases (80.5% and in arm-B in 39 cases (93%. In arm-Agroup, post-ERCP hyperamylasia was presented in nine patients (22% and severe pancreatitis in five patients (12% versus none of the patients (0% in arm-B group, respectively. Mean post-operative hospital stay in arm-A and arm-B groups are 10.9 and 6.8 days, respectively. Conclusion: One stage laparo-endoscopic rendezvous approach increases selective cannulation of CBD, reduces post-ERCP pancreatitis, reduces days of hospital stay, increases patient′s compliance and prevents unnecessary intervention to CBD.

  15. Intravenous methylene blue venography during laparoscopic paediatric varicocelectomy.

    Science.gov (United States)

    Keene, David J B; Cervellione, Raimondo M

    2014-02-01

    One of the challenges of varicocele surgery is to prevent hydrocele formation while still ensuring success. Methylene blue has been used to identify and preserve lymphatic vessels, and venography has been a standard component of sclerotherapy and percutaneous retrograde techniques. The authors have combined both approaches during laparoscopic varicocelectomy and report their experience. A prospective study was performed of adolescents with idiopathic varicocele and spontaneous venous reflux on Doppler ultrasound. A pampiniform plexus vein was cannulated via scrotal incision before creating the pneumoperitoneum. A mixture of methylene blue and Omnipaque™ was injected into the pampiniform plexus with fluoroscopic screening. Laparoscopic selective vein ligation was then performed using 5mm endoscopic clips or a bipolar vessel sealing device such as Plasmakinetic™ or Ligasure™. Venography was repeated to confirm complete ligation of the internal testicular veins. Patients were followed-up at 3, 6, and 9 months post-surgery with clinical examination and Doppler ultrasound. Data are presented as median (interquartile range). Twenty-four patients underwent laparoscopic selective vein ligation with venography and methylene blue injection. The median age was 14.7 (14.6-15.7) years. The recurrence rate was 12%. No patients developed a hydrocele. The length of surgery was 120 (100-126) minutes. Intra-operative intra-venous methylene blue injection and venography helps to identify venous duplications of the internal testicular veins and enhances the success rate of laparoscopic selective vein ligation. This approach prevents hydrocele formation but has a 12% recurrence rate, which appears to be higher than some techniques described in the literature. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Intravenous pyogenic granuloma or intravenous lobular capillary hemangioma

    Energy Technology Data Exchange (ETDEWEB)

    Ghekiere, Olivier; Galant, Christine; Berg, Bruno Vande [Cliniques Universitaires St. Luc, Department of Radiology, Brussels (Belgium)

    2005-06-01

    Lobular capillary hemangioma is a vascular neoplasm that commonly occurs as a cutaneous tumor. When it involves the skin and mucosal surfaces, ulceration and suppuration may occur, hence the classic term of pyogenic granuloma. Intravenous pyogenic granuloma is a rare solitary form of lobular capillary hemangioma that usually occurs in the veins of the neck and upper extremities. We report the ultrasonographic and magnetic resonance imaging findings of a pyogenic intravenous granuloma localized in the right cephalic vein. The imaging and pathological findings and the differential diagnoses are discussed. (orig.)

  17. Effect of Intravenous Infusion Solutions on Bioelectrical Impedance Spectroscopy.

    Science.gov (United States)

    Yap, Jason; Rafii, Mahroukh; Azcue, Maria; Pencharz, Paul

    2017-05-01

    Bioelectrical impedance (BIA) is often used to measure body fluid spaces and thereby body composition. However, in acute animal studies, we found that impedance was driven by the saline content of intravenous (IV) fluids and not by the volume. The aim of the study was to investigate the effect of 3 different fluids acutely administered on the change in impedance, specifically resistance (R). Nine healthy adults participated in 3 treatment (0.9% saline, 5% dextrose, and a mixture of 0.3% saline + 3.3% dextrose) experiments on nonconsecutive days. They all received 1 L of one of the treatments intravenously over a 1-hour period. Repeated BIA measurements were performed prior to IV infusion and then every 5 minutes for the 1-hour infusion period, plus 3 more measurements up to 15 minutes after the completion of the infusion. The change in R in the 0.9% saline infusion experiment was significantly lower than that of the glucose and mixture treatment ( P Bioelectrical impedance spectroscopy and BIA measure salt rather than the volume changes over the infusion period. Hence, in patients receiving IV fluids, BIA of any kind (single frequency or multifrequency) cannot be used to measure body fluid spaces or body composition.

  18. Orthostatic stability with intravenous levodopa

    Directory of Open Access Journals (Sweden)

    Shan H. Siddiqi

    2015-08-01

    Full Text Available Intravenous levodopa has been used in a multitude of research studies due to its more predictable pharmacokinetics compared to the oral form, which is used frequently as a treatment for Parkinson’s disease (PD. Levodopa is the precursor for dopamine, and intravenous dopamine would strongly affect vascular tone, but peripheral decarboxylase inhibitors are intended to block such effects. Pulse and blood pressure, with orthostatic changes, were recorded before and after intravenous levodopa or placebo—after oral carbidopa—in 13 adults with a chronic tic disorder and 16 tic-free adult control subjects. Levodopa caused no statistically or clinically significant changes in blood pressure or pulse. These data add to previous data that support the safety of i.v. levodopa when given with adequate peripheral inhibition of DOPA decarboxylase.

  19. Pre- and/or Intra-Operative Prescription of Diuretics, but Not Renin-Angiotensin-System Inhibitors, Is Significantly Associated with Acute Kidney Injury after Non-Cardiac Surgery: A Retrospective Cohort Study.

    Science.gov (United States)

    Tagawa, Miho; Ogata, Ai; Hamano, Takayuki

    2015-01-01

    Pre- and/or intra-operative use of diuretics, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARB) constitutes a potentially modifiable risk factor for postoperative acute kidney injury (AKI). It has been studied whether use of these drugs predicts AKI after cardiac surgery. The objective of this study was to examine whether administration of these agents was independently associated with AKI after non-cardiac surgery. This was a retrospective observational study. Inclusion criteria were adult patients (age ≥ 18) who underwent non-cardiac surgery under general anesthesia from 2007 to 2009 at Kyoto Katsura Hospital. Exclusion criteria were urological surgery, missing creatinine values, and preoperative dialysis. The exposures of interest were pre- and/or intra-operative use of diuretics or ACE-I/ARB. Outcome variables were postoperative AKI as defined by the AKI Network (increase in creatinine ≥ 0.3 mg/dL or 150% within 48 hours, or urine output 6 hours). Multivariable logistic regression analyses were conducted and adjusted for potential confounders. Propensity scores (PS) for receiving diuretics or ACE-I/ARB therapy were estimated and PS adjustment, PS matching, and inverse probability weighting were performed. There were 137 AKI cases (5.0%) among 2,725 subjects. After statistical adjustment for patient and surgical characteristics, odds (95% CI) of postoperative AKI were 2.07 (1.10-3.89) (p = 0.02) and 0.89 (0.56-1.42) (p = 0.63) in users of diuretics and ACE-I/ARB, respectively, compared with non-users. PS adjustment, PS matching, and inverse probability weighting yielded similar results. The effect size of diuretics was significantly greater in the patients with lower propensity for diuretic use (p for interaction diuretics, but not ACE-I/ARB, was independently associated with postoperative AKI after non-cardiac surgery, especially in patients with low propensity for diuretic use. It might be reasonable to withhold

  20. Intravenous urography and childhood trauma

    OpenAIRE

    Okorie, N. M.; MacKinnon, A. E.

    1982-01-01

    Results of intravenous urography (IVU) in 33 patients suspected of suffering from renal trauma were reviewed. It was concluded that when haematuria is only detected microscopically and clears within 24 hr then an IVU is not necessary, in the absence of other evidence of significant urinary tract injury.

  1. Aspectos clínicos e hematológicos em cães submetidos à fluidoterapia intravenosa, nutrição enteral e parenteral Clinical and hematological aspects in dogs allotted to intravenous fluid therapy, enteral and parenteral nutrition

    Directory of Open Access Journals (Sweden)

    R.C. Valadares

    2006-08-01

    Full Text Available Avaliaram-se peso vivo, temperatura retal, comportamento, escore fecal e hemograma em 20 cães, sem raça definida, distribuídos aleatoriamente em quatro grupos experimentais com cinco animais cada, duas fêmeas e três machos, submetidos ao arraçoamento padrão (grupo I - controle, à fluidoterapia intravenosa (grupo II, à nutrição enteral por gastrostomia (grupo III e à nutrição parenteral total (grupo IV. Os tratamentos duraram sete dias, precedidos por dois dias de jejum alimentar. Os animais do grupo II apresentaram a maior perda de peso (P0,05. Os animais do grupo II apresentaram valores abaixo dos de referência para hemácias, hemoglobina e hematócrito, sugerindo anemia normocítica normocrômica. A fixação da sonda gástrica, via endoscopia, levou a alterações no número total de leucócito (PBody weight, rectal temperature, behavior, fecal score and hemogram were evaluated in 20 crossbred dogs, randomly alloted in four experimental groups, being five animals in each group, two females and three males. Those animals were alloted to standard feeding (group I - control, intravenous fluid therapy (group II, enteral nutrition through gastrotomy (group III and total parenteral nutrition (group IV. The treatments lasted seven days, preceded by two days of fasting. The animals of group II showed the highest weigth loss (P0.05, however, the animals of group II showed lower values of erythrocytes, hemoglobin and hematocrit, suggesting normocytic normochromic anemia. The gastric tube placement, through endoscopy, led to alteration of the total number of leukocytes (P<0.05, causing a regenerative left shift in the animals of group II. The administration rate of the parenteral nutrition solution must be monitored when a peripheral venous access is used.

  2. [Ultrafiltration versus intravenous diuretics in decompensated heart failure: a meta-analysis of randomized controlled trials].

    Science.gov (United States)

    Zhao, Yu-liang; Zhang, Ling; Yang, Ying-ying; Tang, Yi; Liu, Fang; Fu, Ping

    2013-08-13

    To explore whether ultrafiltration is superior to intravenous diuretics in ameliorating fluid overload and preserving renal functions in decompensated heart failure patients. By searching in Pubmed, Cochrane Library, Embase, Springer, WanFang, CQVIP, CNKI and CBM database as well as related Chinese journals, qualified randomized controlled trials (RCTs) were included for meta-analysis by Revman 5.0 and STATA 10.0. Six RCTs were included with 241 patients in ultrafiltration group and 240 patients in intravenous diuretics group. Pooled analyses demonstrated ultrafiltration was superior to intravenous diuretics in the aspects of weight loss (WMD = 1.44 kg, 95%CI:0.33-2.55 kg, P = 0.01) and fluid removal (WMD = 1.23 kg, 95%CI:0.63-1.82 kg, P diuretics in mitigating fluid overload. No intergroup difference was observed in renal function preservation, mortality or rehospitalization.

  3. The feasibility of 12-gauge intravenous catheter use in the prehospital setting.

    Science.gov (United States)

    Guisto, J A; Iserson, K V

    1990-01-01

    Intravenous fluid therapy is a mainstay in the treatment of trauma and hypovolemia. However, controversy exists as to its effective use by prehospital personnel. We reasoned that 12-gauge catheters, shown to have significantly greater fluid flow than 14- or 16-gauge catheters, might allow prehospital care providers to have a more significant role in patient resuscitation. This study was designed to see if 12-gauge intravenous catheters can successfully be placed and used in the prehospital care arena. During a six-month period, commercial peripheral 12-gauge catheter-over-needle intravenous units were placed in any hypovolemic or potentially hypovolemic patient in whom paramedics thought that rapid fluid therapy was, or might become, necessary. They experienced an overall success rate of 84% and a success-per-attempt rate of 74%. The catheters were placed under normal field conditions. Per preexisting protocols, departure from the scene and transport to the hospital were not delayed for any paramedic interventions, including starting intravenous lines. The 12-gauge catheters can be successfully used by paramedics, both to establish large bore intravenous access prior to arrival at the emergency department and to institute effective fluid therapy where time and circumstances allow.

  4. Intra-Operative Dosimetry in Prostate Brachytherapy

    Science.gov (United States)

    2006-11-01

    insufficient to correctly match the seeds, while a third image renders the matching problem to be of nonpolynomial complexity. We utilize the special... subpixel precision. Projected point features have a high segmentation error25 1–2 pixel but make the pose estimation problem very well constrained.27...in Eq. 2 uniquely. In this framework, the exact solution is rendered nonlin- ear and we use the iterative Newton’s optimization method to solve it

  5. Intravenous Fluids in AKI: A Mechanistically Guided Approach

    NARCIS (Netherlands)

    Legrand, Matthieu; Ince, Can

    2016-01-01

    Acute kidney injury (AKI) has been associated with an increased risk of death and morbidity in many clinical scenarios. The prevention and treatment of AKI therefore has been advocated as a high-priority research focus. However, nearly all strategies tested in this setting have failed to prevent or

  6. Effect of delayed sterilization on the production of intravenous fluids ...

    African Journals Online (AJOL)

    % (w/v) dextrose solution was studied. The 5% (w/v) dextrose was prepared with distilled water. The solution was inoculated with a laboratory isolate of Escherichia coli and thereafter divided into two: Solutions A and B. Sample A was sterilized ...

  7. Effect of delayed sterilization on the production of intravenous fluids ...

    African Journals Online (AJOL)

    Jane

    2010-08-27

    Aug 27, 2010 ... of a Seminar held in Oslo from June 6 -8, 1978. Salawu et al. 6951. Netea MG, van Deuren M, Kullberg BJ, Cavaillon JM, Van der Meer. JW (2002). Does the shape of lipid A determine the interaction of. LPS with Toll-like receptors? Trends Immunol. 23(3): 135-139. The British Pharmacopoeia, (BP) (2002).

  8. Physiologic effects of intravenous fluid administration in healthy volunteers

    DEFF Research Database (Denmark)

    Holte, Kathrine; Jensen, Peter; Kehlet, Henrik

    2003-01-01

    volunteers with a median age of 63 yr (range, 59-67 yr) received an infusion of lactated Ringer's solution 40 mL/kg (median, 2820 mL) or 5 mL/kg (median, 353 mL; background infusion) in random order on two separate occasions. The study was designed to mimic the perioperative course with preoperative fasting...... Ringer's solution compared with the background infusion (5 mL/kg) resulted in a significant decrease in pulmonary function and a significant weight gain of median 0.85 kg (range, -0.2-1.6 kg; P = 0.003) persisting 24 h after the infusion. Exercise capacity and balance function were not influenced...

  9. In vitro comparison of output fluid temperatures for room temperature and prewarmed fluids.

    Science.gov (United States)

    Soto, N; Towle Millard, H A; Lee, R A; Weng, H Y

    2014-08-01

    To determine if prewarmed intravenous fluids produce superior fluid output temperatures compared with room temperature fluids at common anaesthetic fluid rates for small animal patients. A prospective, randomised, in vitro fluid line test-vein study was performed. Nine flow rates were analysed (10, 20, 60, 100, 140, 180, 220, 260 and 300 mL/hour) for room temperature fluids (21°C) and for five prewarmed fluids (40, 45, 50, 55 and 60°C). For each flow rate tested, room temperature fluids never exceeded 25°C at any time point for each trial (range 18 to 25°C). For each flow rate tested, prewarmed fluids never exceeded 25 · 5°C at any time point for each trial (range 18 to 25 · 5°C). The mean output fluid temperature of prewarmed fluids was significantly warmer than room temperature fluids only at 300 mL/hour for 40°C (P = 0 · 0012), 45°C (P = 0 · 004), 50°C (P = 0 · 0002), 55°C (P = 0 · 0001) and 60°C (P fluids (up to 60°C) compared with room temperature intravenous fluids at common anaesthetic fluid rates for small animals. © 2014 British Small Animal Veterinary Association.

  10. Pediatric Acute Respiratory Distress Sydnrome : Fluid Management in the PICU

    NARCIS (Netherlands)

    Ingelse, SA; Wösten-van Asperen, RM; Lemson, J; Daams, JG; Bem, R.A.; van Woensel, JB

    2016-01-01

    The administration of an appropriate volume of intravenous fluids, while avoiding fluid overload, is a major challenge in the pediatric intensive care unit. Despite our efforts, fluid overload is a very common clinical observation in critically ill children, in particular in those with pediatric

  11. Pediatric Acute Respiratory Distress Syndrome: Fluid Management in the PICU

    NARCIS (Netherlands)

    Ingelse, Sarah A.; Wösten-van Asperen, Roelie M.; Lemson, Joris; Daams, Joost G.; Bem, Reinout A.; van Woensel, Job B.

    2016-01-01

    The administration of an appropriate volume of intravenous fluids, while avoiding fluid overload, is a major challenge in the pediatric intensive care unit. Despite our efforts, fluid overload is a very common clinical observation in critically ill children, in particular in those with pediatric

  12. Intravenous Antiepileptic Drugs in Russia

    Directory of Open Access Journals (Sweden)

    P. N. Vlasov

    2014-01-01

    Full Text Available Launching four intravenous antiepileptic drugs: valproate (Depakene and Convulex, lacosamide (Vimpat, and levetiracetam (Keppra – into the Russian market has significantly broadened the possibilities of rendering care to patients in seizure emergency situations. The chemi- cal structure, mechanisms of action, indications/contraindications, clinical effectiveness and tolerability, advantages/disadvantages, and adverse events of using these drugs in urgent and elective neurology are discussed. 

  13. Seizures after intravenous tramadol given as premedication

    Directory of Open Access Journals (Sweden)

    Lalit Kumar Raiger

    2012-01-01

    Full Text Available A 35-year-old, 50-kg female with a history of epilepsy was scheduled for elective breast surgery (fibroadenoma under general anaesthesia. She was given glycopyrrolate 0.2 mg, ondansetron 4 mg and tramadol 100 mg i.v. as premedication. Within 5 min, she had an acute episode of generalised tonic-clonic seizure that was successfully treated with 75 mg thiopentone i.v. and after 30 min, she was given general anaesthesia with endotracheal intubation. Surgery, intra-operative period, extubation and post-operative period were uneventful. We conclude that tramadol may provoke seizures in patients with epilepsy even within the recommended dose range.

  14. Muscle power during intravenous sedation

    Directory of Open Access Journals (Sweden)

    Nobuyuki Matsuura

    2017-11-01

    Full Text Available Intravenous sedation is effective to reduce fear and anxiety in dental treatment. It also has been used for behavior modification technique in dental patients with special needs. Midazolam and propofol are commonly used for intravenous sedation. Although there have been many researches on the effects of midazolam and propofol on vital function and the recovery profile, little is known about muscle power. This review discusses the effects of intravenous sedation using midazolam and propofol on both grip strength and bite force. During light propofol sedation, grip strength increases slightly and bite force increases in a dose-dependent manner. Grip strength decreases while bite force increases during light midazolam sedation, and also during light sedation using a combination of midazolam and propofol. Flumazenil did not antagonise the increase in bite force by midazolam. These results may suggest following possibilities; (1 Activation of peripheral benzodiazepine receptors located within the temporomandibular joint region and masticatory muscles may be the cause of increasing bite force. (2 Propofol limited the long-latency exteroceptive suppression (ES2 period during jaw-opening reflex. Thus, control of masticatory muscle contraction, which is thought to have a negative feedback effect on excessive bite force, may be depressed by propofol.

  15. Proximal translation of > 1 mm within the first two years of revision total hip arthroplasty correctly predicts whether or not an acetabular component is loose in 80% of cases: a case-control study with confirmed intra-operative outcomes.

    Science.gov (United States)

    Kim, Y S; Abrahams, J M; Callary, S A; De Ieso, C; Costi, K; Howie, D W; Solomon, L B

    2017-04-01

    The purpose of this study was to determine the sensitivity, specificity and predictive values of previously reported thresholds of proximal translation and sagittal rotation of cementless acetabular components used for revision total hip arthroplasty (THA) at various times during early follow-up. Migration of cementless acetabular components was measured retrospectively in 84 patients (94 components) using Ein-Bild-Rontgen-Analyse (EBRA-Cup) in two groups of patients. In Group A, components were recorded as not being loose intra-operatively at re-revision THA (52 components/48 patients) and Group B components were recorded to be loose at re-revision (42 components/36 patients). The mean proximal translation and sagittal rotation were significantly higher in Group B than in Group A from three months onwards (p 1.0 mm within 24 months had a positive predictive value (PPV) of 90% and a specificity of 94%, but a sensitivity of 64%. Proximal translation > 1.0 mm within the first 24 months correctly identified 76 of 94 (81%) of components to be either loose or not loose. However, ten components in Group B (24%) did not migrate proximally above 1.0 mm within the first 60 months. The high PPV of EBRA-Cup measurements of proximal translation (90%) shows that this can be used in early follow-up to identify patients at risk of aseptic loosening. The absence of proximal translation within the first 60 months indicates a component is not likely to be loose at re-revision THA although it does not exclude late aseptic loosening as a cause of failure. Cite this article: Bone Joint J 2017;99-B:465-74. ©2017 The British Editorial Society of Bone & Joint Surgery.

  16. Attenuation measurements show that the presence of a TachoSil surgical patch will not compromise target irradiation in intra-operative electron radiation therapy or high-dose-rate brachytherapy.

    Science.gov (United States)

    Sarmento, Sandra; Costa, Filipa; Pereira, Alexandre; Lencart, Joana; Dias, Anabela; Cunha, Luís; Sousa, Olga; Silva, José Pedro; Santos, Lúcio

    2015-01-09

    Surgery of locally advanced and/or recurrent rectal cancer can be complemented with intra-operative electron radiation therapy (IOERT) to deliver a single dose of radiation directly to the unresectable margins, while sparing nearby sensitive organs/structures. Haemorrhages may occur and can affect the dose distribution, leading to an incorrect target irradiation. The TachoSil (TS) surgical patch, when activated, creates a fibrin clot at the surgical site to achieve haemostasis. The aim of this work was to determine the effect of TS on the dose distribution, and ascertain whether it could be used in combination with IOERT. This characterization was extended to include high dose rate (HDR) intraoperative brachytherapy, which is sometimes used at other institutions instead of IOERT. CT images of the TS patch were acquired for initial characterization. Dosimetric measurements were performed in a water tank phantom, using a conventional LINAC with a hard-docking system of cylindrical applicators. Percentage Depth Dose (PDD) curves were obtained, and measurements made at the depth of dose maximum for the three clinically used electron energies (6, 9 and 12MeV), first without any attenuator and then with the activated patch of TS completely covering the tip of the IOERT applicator. For HDR brachytherapy, a measurement setup was improvised using a solid water phantom and a Farmer ionization chamber. Our measurements show that the attenuation of a TachoSil patch is negligible, both for high energy electron beams (6 to 12MeV), and for a HDR (192)Ir brachytherapy source. Our results cannot be extrapolated to lower beam energies such as 50 kVp X-rays, which are sometimes used for breast IORT. The TachoSil surgical patch can be used in IORT procedures using 6MeV electron energies or higher, or HDR (192)Ir brachytherapy.

  17. Management of Anaphylactic Shock During Intravenous Fluorescein Angiography at an Outpatient Clinic

    Directory of Open Access Journals (Sweden)

    Chang-Sue Yang

    2007-08-01

    Full Text Available We report the proper management of a severe adverse reaction of anaphylactic shock during intravenous fluorescein angiography at an outpatient clinic. A 72-year-old male developed the severe, life-threatening complication after intravenous injection of sodium fluorescein dye for retinal angiography. Three minutes after receiving an intravenous injection of fluorescein, the patient developed syncope, apnea and circulatory shock. Fortunately, he recovered without any neurologic sequelae after immediate intensive resuscitation with fluid and inotropic support. We highlight the occurrence of anaphylactic shock as a potentially fatal complication during intravenous fluorescein angiography. Thus, one should be alert to the possibility of this adverse event and be prepared to deal with it when fluorescein angiography is performed. When it happens, immediate intensive medical resuscitation is essential to minimize morbidity and to avoid mortality.

  18. The mechanistic causes of peripheral intravenous catheter failure based on a parametric computational study

    OpenAIRE

    Piper, Russell; Carr, Peter J.; Kelsey, Lachlan J.; Bulmer, Andrew C.; Keogh, Samantha; Doyle, Barry J.

    2018-01-01

    Peripheral intravenous catheters (PIVCs) are the most commonly used invasive medical device, yet up to 50% fail. Many pathways to failure are mechanistic and related to fluid mechanics, thus can be investigated using computational fluid dynamics (CFD). Here we used CFD to investigate typical PIVC parameters (infusion rate, catheter size, insertion angle and tip position) and report the hemodynamic environment (wall shear stress (WSS), blood damage, particle residence time and venous stasis vo...

  19. Randomized controlled trial of oral vs intravenous therapy for the clinically diagnosed acute uncomplicated diverticulitis.

    LENUS (Irish Health Repository)

    Ridgway, P F

    2009-11-01

    Despite the high prevalence of hospitalization for left iliac fossa tenderness, there is a striking lack of randomized data available to guide therapy. The authors hypothesize that an oral antibiotic and fluids are not inferior to intravenous (IV) antibiotics and \\'bowel rest\\' in clinically diagnosed acute uncomplicated diverticulitis.

  20. Plasma Volume Expansion Resulting from Intravenous Glucose Tolerance Test

    Directory of Open Access Journals (Sweden)

    Robert G. Hahn

    2011-01-01

    Full Text Available Objective. To quantify the degree of plasma volume expansion that occurs during an intravenous glucose tolerance test (IVGTT. Methods. Twenty healthy volunteers (mean age, 28 years underwent IVGTTs in which 0.3 g/kg of glucose 30% was injected as a bolus over 1 min. Twelve blood samples were collected over 75 min. The plasma glucose and blood hemoglobin concentrations were used to calculate the volume distribution (Vd and the clearance (CL of both the exogenous glucose and the injected fluid volume. Results. The IVGTT caused a virtually instant plasma volume expansion of 10%. The half-life of the glucose averaged 15 min and the plasma volume expansion 16 min. Correction of the fluid kinetic model for osmotic effects after injection reduced CL for the infused volume by 85%, which illustrates the strength of osmosis in allocating fluid back to the intracellular fluid space. Simulations indicated that plasma volume expansion can be reduced to 60% by increasing the injection time from 1 to 5 min and reducing the glucose load from 0.3 to 0.2 g/kg. Conclusion. A regular IVGTT induced an acute plasma volume expansion that peaked at 10% despite the fact that only 50–80 mL of fluid were administered.

  1. Predicting and measuring fluid responsiveness with echocardiography

    Directory of Open Access Journals (Sweden)

    Ashley Miller

    2016-06-01

    Full Text Available Echocardiography is ideally suited to guide fluid resuscitation in critically ill patients. It can be used to assess fluid responsiveness by looking at the left ventricle, aortic outflow, inferior vena cava and right ventricle. Static measurements and dynamic variables based on heart–lung interactions all combine to predict and measure fluid responsiveness and assess response to intravenous fluid esuscitation. Thorough knowledge of these variables, the physiology behind them and the pitfalls in their use allows the echocardiographer to confidently assess these patients and in combination with clinical judgement manage them appropriately.

  2. Intravenous amino acids in third trimester isolated oligohydramnios

    International Nuclear Information System (INIS)

    Qureshi, F.U.

    2011-01-01

    To determine the efficacy of maternal administration of intravenous amino acid solution in improving amniotic fluid volume in cases of isolated oligohydramnios and to observe its impact on mode of delivery and neonatal outcome. Study Design: A prospective case series. Methodology: Forty two women with singleton pregnancy, well established gestational age and clinically and sonographically proven isolated oligohydramnios in the third trimester before 36 weeks were administered amino acid solution intravenously after excluding cases of premature rupture of membranes, congenital anomaly of fetus, maternal pulmonary, cardiovascular and hypertensive disorders, and severe placental insufficiency (raised S/D ratio). Pre-infusion and postinfusion Amniotic fluid Index (AFI) was measured and repeated weekly. Women were followed till delivery. Results: According to repeated measurement analysis of variance, mean pre-infusion AFI was 4.7 cm, mean one week postinfusion AFI was 5.8 cm, mean two week post-infusion AFI was 6.2 cm and mean three week AFI was 6.3 cm (p-value 0.029, significant). Cesarean section became a predominant mode of delivery in this group without a firm evidence of associated fetal compromise. Conclusion: Amino acid infusion is an effective therapy for raising AFI in isolated oligohydramnios in this case series. Liberal use of cesarean section in this selected group should be carefully re-evaluated. (author)

  3. Rationale and design of the Aquapheresis Versus Intravenous Diuretics and Hospitalization for Heart Failure (AVOID-HF) trial.

    Science.gov (United States)

    Costanzo, Maria Rosa; Negoianu, Daniel; Fonarow, Gregg C; Jaski, Brian E; Bart, Bradley A; Heywood, J Thomas; Nabut, Jose L; Schollmeyer, Michael P

    2015-09-01

    In patients hospitalized with acutely decompensated heart failure, unresolved signs and symptoms of fluid overload have been consistently associated with poor outcomes. Regardless of dosing and type of administration, intravenous loop diuretics have not reduced heart failure events or mortality in patients with acutely decompensated heart failure. The results of trials comparing intravenous loop diuretics to mechanical fluid removal by isolated venovenous ultrafiltration have yielded conflicting results. Studies evaluating early decongestive strategies have shown that ultrafiltration removed more fluid and was associated with fewer heart failure-related rehospitalization than intravenous loop diuretics. In contrast, when used in the setting of worsening renal function, ultrafiltration was associated with poorer renal outcomes and no reduction in heart failure events. The AVOID-HF trial seeks to determine if an early strategy of ultrafiltration in patients with acutely decompensated heart failure is associated with fewer heart failure events at 90 days compared with a strategy based on intravenous loop diuretics. Study subjects from 40 highly experienced institutions are randomized to either early ultrafiltration or intravenous loop diuretics. In both treatment arms, fluid removal therapies are adjusted according to the patients' hemodynamic condition and renal function. The study was unilaterally terminated by the sponsor in the absence of futility and safety concerns after the enrollment of 221 subjects, or 27% of the originally planned sample size of 810 patients. The AVOID-HF trial's principal aim is to compare the safety and efficacy of ultrafiltration vs that of intravenous loop diuretics in patients hospitalized with acutely decompensated heart failure. Because stepped treatment approaches are applied in both ultrafiltration and intravenous loop diuretics groups and the primary end point is time to first heart failure event within 90 days, it is hoped that

  4. Intravenous Therapy: Hazards, Complications and Their Prevention ...

    African Journals Online (AJOL)

    In this review article, the local and systemic complications of intravenous therapy are highlighted and their preventive measures are discussed. Intravenous therapy exposes the patient to numerous hazards and many of them are avoidable, if the health care provider understands the risks involved and acts appropriately and ...

  5. Intentional intravenous mercury injection | Yudelowitz | South African ...

    African Journals Online (AJOL)

    Intravenous mercury injection is rarely seen, with few documented cases. Treatment strategies are not clearly defined for such cases, although a few options do show benefit. This case report describes a 29-year-old man suffering from bipolar disorder, who presented following self-inflicted intravenous injection of mercury.

  6. Intravenous immunoglobulin prophylaxis in neonates on artificial ...

    African Journals Online (AJOL)

    The efficacy of the prophylactic use of intravenous immunoglobulin (Ig) was evaluated in a double-blind placebo-controlled trial of 21 pairs of ventilated neonates weighing more than 1 500 g, Each infant received 0.4 g/kglday of intravenous Ig or a similar volume of placebo daily for 5 days. Criteria used to assess the ...

  7. Fluid therapy in the emergency unit

    African Journals Online (AJOL)

    Senior Specialist Paediatrician, Department of Ambulatory and Emergency Paediatrics, Red Cross War Memorial Children's Hospital, Cape. Town. Dr Diedericks is currently head of the Paediatric Emergency Service at Red Cross Hospital. He has previous experience ... intravenous fluid administration. Choosing the correct ...

  8. Gone fishing in a fluid trial

    DEFF Research Database (Denmark)

    Hjortrup, Peter B; Haase, Nicolai; Wetterslev, Jørn

    2016-01-01

    OBJECTIVE: To maximise the yield of existing data by assessing the effect on mortality of being born under the zodiac sign Pisces in a trial of intravenous (IV) fluids. DESIGN, SETTING AND PARTICIPANTS: A retrospective observational study, with no predefined hypothesis or statistical analysis pla...

  9. Effects of intravenous solutions on acid-base equilibrium: from crystalloids to colloids and blood components.

    Science.gov (United States)

    Langer, Thomas; Ferrari, Michele; Zazzeron, Luca; Gattinoni, Luciano; Caironi, Pietro

    2014-01-01

    Intravenous fluid administration is a medical intervention performed worldwide on a daily basis. Nevertheless, only a few physicians are aware of the characteristics of intravenous fluids and their possible effects on plasma acid-base equilibrium. According to Stewart's theory, pH is independently regulated by three variables: partial pressure of carbon dioxide, strong ion difference (SID), and total amount of weak acids (ATOT). When fluids are infused, plasma SID and ATOT tend toward the SID and ATOT of the administered fluid. Depending on their composition, fluids can therefore lower, increase, or leave pH unchanged. As a general rule, crystalloids having a SID greater than plasma bicarbonate concentration (HCO₃-) cause an increase in plasma pH (alkalosis), those having a SID lower than HCO₃- cause a decrease in plasma pH (acidosis), while crystalloids with a SID equal to HCO₃- leave pH unchanged, regardless of the extent of the dilution. Colloids and blood components are composed of a crystalloid solution as solvent, and the abovementioned rules partially hold true also for these fluids. The scenario is however complicated by the possible presence of weak anions (albumin, phosphates and gelatins) and their effect on plasma pH. The present manuscript summarises the characteristics of crystalloids, colloids, buffer solutions and blood components and reviews their effect on acid-base equilibrium. Understanding the composition of intravenous fluids, along with the application of simple physicochemical rules best described by Stewart's approach, are pivotal steps to fully elucidate and predict alterations of plasma acid-base equilibrium induced by fluid therapy.

  10. Intravenous adenosine SPECT thallium imaging

    International Nuclear Information System (INIS)

    Joyce, J.M.; Grossman, S.J.; Garrett, J.S.; Sharma, B.; Geller, M.; Sweeney, P.J.

    1991-01-01

    This paper determines the safety and efficacy of intravenous (IV) adenosine in females for the evaluation of coronary artery disease, since only limited data are available. Eighty consecutive studies of 78 female subjects (aged 43-83 years) using IV adenosine (0.14 mg/kg per minute) with T1-201 SPECT imaging were reviewed. Fifty-eight (73%) had mild symptoms; mild dyspnea (24%), flushing (23%), chest pain (23%), headache (11%), dizziness (11%), weakness (9%), nausea (8%), abdominal pain (8%), arm pain (6%), chest tightness (4%), neck tightness (4%), dry mouth (4%), and dropped P waves (4%). Four had moderate symptoms: dyspnea requiring Proventil or aminophylline (2%), significant hypotension (1%), and third-degree atrioventicular heart block (1%). Two had severe symptoms (ventricular tachycardia requiring cardioversion (1%) and severe dyspnea requiring epinephrine (1%). Twenty-two (28%) underwent cardiac catheterization that demonstrated coronary artery disease or postangioplasty results. The thallium SPECT images were 94% sensitive and 100% specific in detecting significant disease. The one false-negative result was in a subject who experienced no symptoms for ECG changes during adenosine infusion. Ischemic ECG changes were 35% sensitive and 100% specific. Chest pain was 53% sensitive and 60% specific

  11. Fluid Mechanics.

    Science.gov (United States)

    Drazin, Philip

    1987-01-01

    Outlines the contents of Volume II of "Principia" by Sir Isaac Newton. Reviews the contributions of subsequent scientists to the physics of fluid dynamics. Discusses the treatment of fluid mechanics in physics curricula. Highlights a few of the problems of modern research in fluid dynamics. Shows that problems still remain. (CW)

  12. Fluid Interfaces

    DEFF Research Database (Denmark)

    Hansen, Klaus Marius

    2001-01-01

    Fluid interaction, interaction by the user with the system that causes few breakdowns, is essential to many user interfaces. We present two concrete software systems that try to support fluid interaction for different work practices. Furthermore, we present specificity, generality, and minimality...... as design goals for fluid interfaces....

  13. Pharmacokinetics and pulmonary distribution of gamithromycin after intravenous administration in foals.

    Science.gov (United States)

    Berlin, S; Randow, T; Scheuch, E; Grube, M; Venner, M; Siegmund, W

    2017-08-01

    The long-acting azalide antibiotic gamithromycin is marketed for intramuscular treatment of bovine and swine infections. Off-label use in foals leads to severe local lesions likely caused by hyperosmolality of the injected solution. We provide evidence from a pharmacokinetic study in 10 warm-blooded healthy foals for intravenous bolus injection of gamithromycin diluted in distilled water to be a safe and well tolerated alternative. By intravenous dosing, markedly higher plasma exposure and better penetration into bronchoalveolar lavage cells but lower distribution into epithelial lining fluid are achieved as after intramuscular or subcutaneous administration. Intravenously injected gamithromycin was tolerated without any adverse drug reactions. The protocols for treatment of equine pulmonary infections caused by Rhodococcus equi should be revised accordingly. © 2017 John Wiley & Sons Ltd.

  14. INFECTIVE ENDOCARDITIS IN INTRAVENOUS DRUGS ABUSED PATIENT

    Directory of Open Access Journals (Sweden)

    E. Y. Ponomareva

    2011-01-01

    Full Text Available Three-year observation of acute tricuspid infective endocarditis in intravenous drug abused patient: diagnosis, clinical features, visceral lesions, the possibility of cardiac surgery and conservative treatment, outcome.

  15. Intravenous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy

    NARCIS (Netherlands)

    Eftimov, Filip; Winer, John B.; Vermeulen, Marinus; de Haan, Rob; van Schaik, Ivo N.

    2013-01-01

    Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) causes progressive or relapsing weakness and numbness of the limbs, developing over at least two months. Uncontrolled studies suggest that intravenous immunoglobulin (IVIg) helps. This review was first published in 2002 and has since

  16. Intravenous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy

    NARCIS (Netherlands)

    Eftimov, Filip; Winer, John B.; Vermeulen, Marinus; de Haan, Rob; van Schaik, Ivo N.

    2009-01-01

    Background Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) causes progressive or relapsing weakness and numbness of the limbs, developing over at least two months. Uncontrolled studies suggest that intravenous immunoglobulin (IVIg) helps. Objectives To review systematically the

  17. Intravenous iron-containing products: EMA procrastination.

    Science.gov (United States)

    2014-07-01

    A European reassessment has led to identical changes in the summaries of product characteristics (SPCs) for all intravenous iron-containing products: the risk of serious adverse effects is now highlighted, underlining the fact that intravenous iron-containing products should only be used when the benefits clearly outweigh the harms. Unfortunately, iron dextran still remains on the market despite a higher risk of hypersensitivity reactions than with iron sucrose.

  18. Contrast medium extravasation in intravenous urography

    International Nuclear Information System (INIS)

    Tosch, U.; Becker-Gaab, C.; Hahn, D.

    1984-01-01

    Aetiology and diagnostic procedure of calyceal fornix rupture during intravenous urography are discussed. In the literature the fornix rupture is discribed as a spontaneous event - not so in the four cases presented. In two cases a sudden increase in intrapelvic pressure was due to an ureteric calculus, in the other cases an obstruction of the ureter was secondary to neoplasm. It is recommended to perform a CT as soon as a contrastmedium extravasation in intravenous urography is diagnosed. (orig.) [de

  19. Contrast medium extravasation in intravenous urography

    Energy Technology Data Exchange (ETDEWEB)

    Tosch, U.; Becker-Gaab, C.; Hahn, D.

    1984-09-01

    Aetiology and diagnostic procedure of calyceal fornix rupture during intravenous urography are discussed. In the literature the fornix rupture is discribed as a spontaneous event - not so in the four cases presented. In two cases a sudden increase in intrapelvic pressure was due to an ureteric calculus, in the other cases an obstruction of the ureter was secondary to neoplasm. It is recommended to perform a CT as soon as a contrast medium extravasation in intravenous urography is diagnosed.

  20. Rapid correction of metabolic alkalosis in hypertrophic pyloric stenosis with intravenous cimetidine: preliminary results.

    Science.gov (United States)

    Banieghbal, Behrouz

    2009-03-01

    Pyloromyotomy has been the treatment of choice for hypertrophic pyloric stenosis (HPS) for the past century. In most HPS cases, there is mild metabolic alkalosis, which requires intravenous fluid resuscitation with 5% dextrose/normal saline for 1-2 days. However, in some cases, due to a delay in diagnosis, alkalosis becomes severe and a much longer resuscitation period (5-10 days) is required to normalize serum pH. Metabolic alkalosis of HPS results from excessive vomiting of hydrochloric acid; and therefore if its production is reduced, serum pH can be normalized faster. In this study, the use of intravenous cimetidine (CM) in a small number of infants with HPS is presented. Over a 28-month period, 32 HPS cases, including a sub-group of 17 infants (aged 7-9 weeks) with arterial pH >7.60, were admitted to a tertiary referral unit. Four infants in this sub-group were treated with standard resuscitation fluids for 4 days prior to intravenous CM, while 12 infants received CM immediately. Intravenous CM (10 mg/kg) was given at twice daily until arterial pH was less than 7.50. In one case, intravenous omeprazole at 0.1 mg/kg was given instead of CM. In all 17 cases, CM treatment or omeprazole therapy (for 12-48 h) reduced pH to less than 7.50, thus allowing for Ramstedt pyloromyotomy the same day. These patients were allowed oral feeding on the following day and were discharged at 1-3 post-operative days. No complications due to CM (or omperazole) treatment were observed. Intravenous CM administration can rapidly normalize severe metabolic alkalosis in HPS patients. As a result, pyloromyotomy can be performed sooner reducing both hospital stay and costs.

  1. Fluid dynamics of dilatant fluid

    DEFF Research Database (Denmark)

    Nakanishi, Hiizu; Nagahiro, Shin-ichiro; Mitarai, Namiko

    2012-01-01

    A dense mixture of granules and liquid often shows a severe shear thickening and is called a dilatant fluid. We construct a fluid dynamics model for the dilatant fluid by introducing a phenomenological state variable for a local state of dispersed particles. With simple assumptions for an equation...

  2. Role of Pre-incision, Intravenous Prophylactic Amiodarone to Control Arrhythmias in Patients with Rheumatic Valvular Heart Disease undergoing Mitral Valve Replacement

    International Nuclear Information System (INIS)

    Ahmad, K.; Naqvi, S.

    2013-01-01

    Objective: To evaluate the effect of intra-operative single intra venous dose of amiodarone on post operative cardiac arrhythmias in patients undergoing valvular heart surgery. Study Design: Randomized controlled trials. Place and Duration of surgery: This study was performed at Armed forces Institute of Cardiology Rawalpindi from Jan 01, 2011 to Dec 31, 2011. Patients and Methods: In this study 80 patients with rheumatic valvular heart disease and undergoing elective mitral valve replacement were randomly divided into two groups. Group I, n = 40 (Amiodarone group) was given single intravenous dose of amiodarone (5 mg/kg in 100 ml of saline over 30 min) before sternotomy incision. Group II, n = 40(control / placebo group) was given 100 ml of saline over 30 min. Result: In the amiodarone group, after removal of aortic cross clamp 75% patients had sinus rhythm compared to 47.5% in control group. p=0.045. Similarly 15% had AF, 5% JR and 5% VT/VF in amiodarone group in contrast to 32.5% with AF, 12.5% JR and 7.5% Vt/VF in control group. (p=0.045). Response to cardioversion was positive in 75% of the patients requiring shocks in amiodarone group as against 43.75% in the control group. (p=0.044). Conclusion: A single intravenous bolus dose of amiodarone is effective in decreasing the incidence of cardiac arrhythmias after mitral valve replacement in patients with rheumatic MVD. (author)

  3. Monitoring hyperhydration during high-dose chemotherapy: Body weight or fluid balance?

    NARCIS (Netherlands)

    Mank, A.; Semin-Goossens, A.; van der Lelie, J.; Bakker, P.; Vos, R.

    2003-01-01

    Body weight and fluid input/output are usually monitored for checking fluid balance in case of intravenous hyperhydration during nephrotoxic chemotherapy. The reliability of measuring fluid input/output is uncertain. Moreover, this measurement is redundant, complex, labour-intensive and represents

  4. Fluids engineering

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    Fluids engineering has played an important role in many applications, from ancient flood control to the design of high-speed compact turbomachinery. New applications of fluids engineering, such as in high-technology materials processing, biotechnology, and advanced combustion systems, have kept up unwaining interest in the subject. More accurate and sophisticated computational and measurement techniques are also constantly being developed and refined. On a more fundamental level, nonlinear dynamics and chaotic behavior of fluid flow are no longer an intellectual curiosity and fluid engineers are increasingly interested in finding practical applications for these emerging sciences. Applications of fluid technology to new areas, as well as the need to improve the design and to enhance the flexibility and reliability of flow-related machines and devices will continue to spur interest in fluids engineering. The objectives of the present seminar were: to exchange current information on arts, science, and technology of fluids engineering; to promote scientific cooperation between the fluids engineering communities of both nations, and to provide an opportunity for the participants and their colleagues to explore possible joint research programs in topics of high priority and mutual interest to both countries. The Seminar provided an excellent forum for reviewing the current state and future needs of fluids engineering for the two nations. With the Seminar ear-marking the first formal scientific exchange between Korea and the United States in the area of fluids engineering, the scope was deliberately left broad and general

  5. Fluid machinery

    International Nuclear Information System (INIS)

    Ha, Jae Hyeon; Son, Byeong Jin

    2001-04-01

    This book tells of definition and classification of fluid machinery, energy equation of incompressible fluid, principle of momentum, classification and structure of pump, size, safety of centrifugal pump, theory and operation of contraction pump, reciprocating pump, rotary pump, special pump, using of water power, classification of water turbine, impulse water turbine, reaction water turbine, pump water turbine, liquid movement apparatus, fluid type control machinery and solid and gas type pneumatic machine.

  6. Effect of Intravenously Administered Crystalloid Solutions on Acid?Base Balance in Domestic Animals

    OpenAIRE

    Muir, W.

    2017-01-01

    Intravenous fluid therapy can alter plasma acid?base balance. The Stewart approach to acid?base balance is uniquely suited to identify and quantify the effects of the cationic and anionic constituents of crystalloid solutions on plasma pH. The plasma strong ion difference (SID) and weak acid concentrations are similar to those of the administered fluid, more so at higher administration rates and with larger volumes. A crystalloid's in vivo effects on plasma pH are described by 3 general rules...

  7. Contrast enhancement of the cerebrospinal fluid on MRI in two cases of spirochaetal meningitis

    International Nuclear Information System (INIS)

    Good, C.D.; Jaeger, H.R.

    2000-01-01

    We report two patients with meningitis due to spirochaetal infection, both of whom showed diffusely enhancing meninges around the brain and spinal cord. In addition, there was enhancement of the cerebrospinal fluid after intravenous administration of Gd-DTPA. (orig.)

  8. What´s cheapest, intravenous iron sucrose- or intravenous iron carboxymaltose treatment in IBD patients?

    DEFF Research Database (Denmark)

    Bager, Palle; Dahlerup, Jens Frederik

      What´s cheapest, intravenous iron sucrose- or intravenous iron carboxymaltose treatment in IBD patients? It dependent on the economic evaluation perspective!   Aim: To evaluate the health care cost for intravenous iron sucrose (Venofer®, Vifor) and intravenous iron carboxymaltose (Ferinject......-cost per mg iron is for iron carboxymaltose approximately double the cost of iron sucrose.   Patients and Methods: Data related to 111 IBD-patients treated with intravenous iron at Aarhus University Hospital from August 2005 until October 2009 was used for the economic evaluation. Analysis included......, utensils and ½ hour spend by a nurse per visit; showed approximately 150€ extra cost per 1000 mg Fe++ administrated, if iron carboxymaltose was chosen. In contrast the CEA including both BIA-values and patient-related costs (transportation and lost income) showed iron carboxymaltose to be more cost...

  9. Oxytetracycline hydrochloride in the horse: serum, synovial, peritoneal and urine concentrations after single dose intravenous administration.

    Science.gov (United States)

    Brown, M P; Stover, S M; Kelly, R H; Farver, T B; Knight, H D

    1981-03-01

    Six adult mares were given a single intravenous injection of oxytetracycline HCl (50 mg/ml) at a dosage of 5 mg/kg. Serum, synovial fluid, peritoneal fluid, and urine oxytetracycline concentrations were measured serially over a 48-h period. The highest measured serum oxytetracycline concentration was 8.01 mcg/ml at 1/2 h. Oxytetracycline was detected in synovial fluid and peritoneal fluid, which obtained mean peak oxytetracycline concentrations of 4.43 mcg/ml and 4.20 mcg/ml, at 1/2 h and 1 h, respectively. These concentrations steadily declined in parallel with serum concentrations and were not measurable at 48 h. Urine oxytetracycline concentration was relatively high, with a peak concentration of 1565.2 mcg/ml at 1/2 h after drug administration.

  10. Schroedinger fluid

    International Nuclear Information System (INIS)

    Kan, K.K.

    1983-01-01

    The relationship of nuclear internal flow and collective inertia, the difference of this flow from that of a classical fluid, and the approach of this flow to rigid flow in independent-particle model rotation are elucidated by reviewing the theory of Schroedinger fluid and its implications for collective vibration and rotation. (author)

  11. Fluid Dynamics

    DEFF Research Database (Denmark)

    Brorsen, Michael

    These lecture notes are intended mainly for the 7th semester course "Fluid Dynamics" offered by the Study Committee on Civil Engineering, Aalborg University.......These lecture notes are intended mainly for the 7th semester course "Fluid Dynamics" offered by the Study Committee on Civil Engineering, Aalborg University....

  12. A phase I trial of intravenous catumaxomab

    DEFF Research Database (Denmark)

    Mau-Sørensen, Morten; Dittrich, Christian; Dienstmann, Rodrigo

    2015-01-01

    design in epithelial cancers with known EpCAM expression. The dose-limiting toxicity (DLT) period consisted of 4 weeks, with weekly intravenous administration of catumaxomab. Key DLTs were ≥grade 3 optimally treated non-hematological toxicity; ≥grade 3 infusion-related reactions refractory to supportive....... A reversible decrease in liver function test (prothrombin time) at the 7-µg dose level was considered a DLT. The first patient at 10 µg experienced a fatal hepatic failure related to catumaxomab that led to the termination of the study. CONCLUSIONS: The MTD of weekly intravenous catumaxomab was 7 µg. Major...

  13. Intravenous polyclonal human immunoglobulins in multiple sclerosis

    DEFF Research Database (Denmark)

    Sørensen, Per Soelberg

    2008-01-01

    Intravenous immunoglobulin (IVIG) is an established therapy for demyelinating diseases of the peripheral nervous system. IVIG exerts a number of effects that may be beneficial in multiple sclerosis (MS). Four double-blind IVIG trials have been performed in relapsing-remitting MS. A meta-analysis ......Intravenous immunoglobulin (IVIG) is an established therapy for demyelinating diseases of the peripheral nervous system. IVIG exerts a number of effects that may be beneficial in multiple sclerosis (MS). Four double-blind IVIG trials have been performed in relapsing-remitting MS. A meta...

  14. Restricted Crystalloid Fluid Therapy during Orthotopic Liver Transplant Surgery and its Effect on Respiratory and Renal Insufficiency in the Early Post-operative Period: A Randomized Clinical Trial.

    Science.gov (United States)

    Sahmeddini, M A; Janatmakan, F; Khosravi, M B; Ghaffaripour, S; Eghbal, M H; Nickeghbalian, S; Malek-Hosseini, S A

    2014-01-01

    Respiratory and renal insufficiencies are common dysfunctions during post-liver transplantation period that increase post-operative mortality and morbidity rates. Intra-operative fluid therapy is an important factor associated with pulmonary and renal insufficiency. To evaluate the relation between intra-operative fluid therapy and early renal and respiratory insufficiency after liver transplantation. In this randomized clinical study, 67 adult patients with end-stage liver disease who underwent orthotopic deceased donor liver transplantation were randomly allocated into two groups. The restricted fluid group, which received a controlled fluid administration of normal saline, 5 mL/kg/hr during anesthesia, and non-restricted fluid group received a controlled infusion of normal saline 10 mL/kg/hr during anesthesia. Early post-operative respiratory and renal insufficiency in both groups were assessed. The patients were monitored during the three stages of liver transplantation for their hemodynamic indices. The trial is registered with the Iranian Randomized Clinical Trial Registry, number IRCT2013101811662N4. The baseline demographic and clinical characteristics were similar in both studied groups. The prevalence of respiratory insufficiency in the non-restricted fluid group (15%) significantly (p=0.01) higher than that in the restricted fluid group (0%). The post-operative mean±SD serum creatinine was 1.0±0.1 mg/dL in the non-restricted fluid group and 1.1±0.2 in the restricted fluid group (p=0.43). No patients in the studied groups required post-operative continuous renal replacement therapy. Restricted crystalloid fluid administration during orthotropic liver transplantation though decreased post-operative chance of pulmonary insufficiency, did not increase renal dysfunction.

  15. Administration and monitoring of intravenous anesthetics

    NARCIS (Netherlands)

    Sahinovic, Marko M.; Absalom, Anthony R.; Struys, Michel M. R. F.

    2010-01-01

    Purpose of review The importance of accuracy in controlling the dose-response relation for intravenous anesthetics is directly related to the importance of optimizing the efficacy and quality of anesthesia while minimizing adverse drug effects. Therefore, it is important to measure and control all

  16. Intravenous immunoglobulin treatment for secondary recurrent miscarriage

    DEFF Research Database (Denmark)

    Christiansen, O B; Larsen, E C; Egerup, P

    2015-01-01

    OBJECTIVE: To determine whether infusions with intravenous immunoglobulin (IVIg) during early pregnancy increase live birth rate in women with secondary recurrent miscarriage compared with placebo. DESIGN: A single-centre, randomised, double-blind, placebo-controlled trial. SETTING: A tertiary...

  17. Intravenous iron supplementation in children on hemodialysis.

    NARCIS (Netherlands)

    Leijn, E.; Monnens, L.A.H.; Cornelissen, E.A.M.

    2004-01-01

    BACKGROUND: Children with end-stage renal disease (ESRD) on hemodialysis (HD) are often absolute or functional iron deficient. There is little experience in treating these children with intravenous (i.v.) iron-sucrose. In this prospective study, different i.v. iron-sucrose doses were tested in

  18. Intravenous and intramuscular magnesium sulphate regimens in ...

    African Journals Online (AJOL)

    1993-09-03

    Sep 3, 1993 ... parenterally, usually according to one of two popular regimens: the intramuscular (IM) regimen introduced by. Pritchard' and a continuous intravenous (IV) infusion described by Zuspan! Sibai et a/.3 have reported that lower serum magnesium values are achieved with Zuspan's regimen (maintenance dose ...

  19. Clinical Evaluation of Ciprofloxacin Intravenous Preparation ...

    African Journals Online (AJOL)

    The most common site of bacteria infection in humans is the urinary tract. For nosocomial infections it is the catheterized urinary tract. Compromised immune responses in hospitalized patients contribute to the difficulties encountered in treating their infections. In these patients, administration of intravenous antibiotic is ...

  20. A Comparison of Prophylactic Intravenous Glycopyrrolate and ...

    African Journals Online (AJOL)

    Ephedrine is gradually falling out of favour because of the associated tachyarrhythmia and foetal acidosis. This study compared the effect of preoperative administration of intravenous glycopyrrolate and ephedrine on spinal induced maternal hypotension. Patients and Methods: Fifty patients scheduled for elective C/S were ...

  1. Comparative Evaluation of Ultrasonography and Intravenous ...

    African Journals Online (AJOL)

    Background: Renal ultrasonography an easily available procedure was compared to intravenous urogram (IVU) to determine its suitability as an alternative to the latter, which is a relatively invasive test for demonstrating hydronephrosis/ or ureteric obstruction in cervical cancer staging. Study design: Thirty five histologically ...

  2. Intravenous voriconazole after toxic oral administration

    NARCIS (Netherlands)

    Alffenaar, J.W.C.; Van Assen, S.; De Monchy, J.G.R.; Uges, D.R.A.; Kosterink, J.G.W.; Van Der Werf, T.S.

    In a male patient with rhinocerebral invasive aspergillosis, prolonged high-dosage oral administration of voriconazole led to hepatotoxicity combined with a severe cutaneous reaction while intravenous administration in the same patient did not. High concentrations in the portal blood precipitate

  3. Intravenous paracetamol overdose in a paediatric patient

    NARCIS (Netherlands)

    Broeks, Ilse J.; Van Roon, Eric N.; Van Pinxteren-Nagler, Evelyn; De Vries, Tjalling W.

    2013-01-01

    BACKGROUND: Paracetamol is a widely used drug in children. In therapeutic doses, paracetamol has an excellent safety profile. Since the introduction of the intravenous form in 2004, only three reports of accidental overdose in children have been published. The low number probably is due to

  4. Intramuscular compared to intravenous midazolam for paediatric ...

    African Journals Online (AJOL)

    Background: Sedation in children remains a controversial issue in emergency departments (ED). Midazolam, as a benzodiazepine is widely used for procedural sedation among paediatrics. We compared the effectiveness and safety of two forms of midazolam prescription; intramuscular (IM) and intravenous (IV). Patients ...

  5. Intravenous platelet blockade with cangrelor during PCI

    NARCIS (Netherlands)

    Bhatt, Deepak L.; Lincoff, A. Michael; Gibson, C. Michael; Stone, Gregg W.; McNulty, Steven; Montalescot, Gilles; Kleiman, Neal S.; Goodman, Shaun G.; White, Harvey D.; Mahaffey, Kenneth W.; Pollack, Charles V.; Manoukian, Steven V.; Widimsky, Petr; Chew, Derek P.; Cura, Fernando; Manukov, Ivan; Tousek, Frantisek; Jafar, M. Zubair; Arneja, Jaspal; Skerjanec, Simona; Harrington, Robert A.; Bhatt, D. L.; Harrington, R. A.; Lincoff, A. M.; Pollack, C. V.; Gibson, C. M.; Stone, G. W.; Mahaffey, K. W.; Kleiman, N. S.; Montalescot, G.; White, H. D.; Goodman, S. G.; Greenbaum, A.; Simon, D.; Lee, D.; Feit, F.; Dauerman, H.; Gurbel, P.; Berger, P.; Makkar, R.; Becker, R. C.; Manoukian, S.; Jorgova, J.; Chew, D. P.; Storey, R.; Desmet, W.; Cura, F.; Herrmann, H.; Rizik, D.; DeServi, S.; Huber, K.; Jukema, W. J.; Knopf, W.; Steg, P. G.; Schunkert, H.; Widimsky, P.; Betriu, A.; Aylward, P.; Polonestsky, L.; Lima, V.; Kobulia, B.; Navickas, R.; Gasior, Z.; Vasilieva, E.; Bennett, J. M.; Kraiz, I.; Van de Werf, F.; Faxon, D.; Ohman, E. M.; Tijssen, J. G. P.; Verheugt, F.; Weaver, W. D.; Califf, R. M.; Mehta, C.; Hamm, C. W.; Pepine, C. J.; Ware, J.; Wilson, M.; Gorham, C.; Maran, A.; McNulty, S.; Fasteson, D.; Ryan, G.; Bradsher, J.; Connolly, P.; Mehta, R.; Leonardi, S.; Brennan, M.; Patel, M.; Petersen, J.; Bushnel, C.; Jolicoeur, M.; Chan, M.; Dowd, L.; Skinner, P.; Lawrence, G.; Jordon, M.; Dickerson, S.; Meyer, M.; Hartford, S.; Garcia Escudero, Alejandro; Poy, Carlos; Miceli, Miguel; Pocovi, Antonio; Londero, Hugo; Baccaro, Jorge; Polonetsky, Leonid; Karotkin, Aliaksey; Shubau, Leanid; Maffini, Eduardo; Machado, Bruno; Airton, José; Lima, Valter; Martinez Filho, Eulogio; Herdy, Arthur; Tumelero, Rogerio; Precoma, Dalton; Botelho, Roberto; Saad, Jamil; Jatene, Jose; Vilas-Boas, Fabio; Godinho, Antonio; Perin, Marco; Caramori, Paulo; Castro, Iran; Grigorov, Mladen; Milkov, Plamen; Jorgova, Julia; Georgiev, Svetoslav; Rifai, Nizar; Doganov, Alexander; Petrov, Ivo; Hui, William; Lazzam, Charles; Reeves, Francois; Tanguay, Jean-Francois; Richter, Marek; Klimsa, Zdenek; Padour, Michal; Mrozek, Jan; Branny, Marian; Coufal, Zdenek; Simek, Stanislav; Rozsival, Vladimir; Pleva, Leos; Stasek, Josef; Kala, Petr; Groch, Ladislav; Kocka, Viktor; Shaburishvili, Tamaz; Khintibidze, Irakli; Chapidze, Gulnara; Mamatsashvili, Merab; Mohanan, Padinhare; Jain, Rajesh; Parikh, Keyur; Patel, Tejas; Kumar, Sampath; Mehta, Ashwani; Banker, Darshan; Krishna, Lanka; Gadkari, Milind; Joshi, Hasit; Hiremath, Shirish; Grinius, Virgilijus; Norkiene, Sigute; Petrauskiene, Birute; Michels, Rolf; Tjon, Melvin; de Swart, Hans; de Winter, Robbert; White, Harvey; Devlin, Gerard; Abernethey, Malcolm; Osiev, Alexander; Linev, Kirill; Kalinina, Svetlana; Baum, Svetlana; Kosmachova, Elena; Shogenov, Zaur; Markov, Valentin; Boldueva, Svetlana; Barbarash, Olga; Kostenko, Victor; Vasilieva, Elena; Gruzdev, Aleksey; Lusov, Victor; Dovgalevsky, Pavel; Azarin, Oleg; Chernov, Sergey; Smolenskaya, Olga; Duda, Alexey; Fridrich, Viliam; Hranai, Marian; Studencan, Martin; Kurray, Peter; Bennett, John; Blomerus, Pieter; Disler, Laurence; Engelbrecht, Johannes; Klug, Eric; Routier, Robert; Venter, Tjaart; van der Merwe, Nico; Becker, Anthony; Cha, Kwang-Soo; Lee, Seung-Hwan; Han, Sang-Jin; Youn, Tae Jin; Hur, Seung-Ho; Seo, Hong Seog; Park, Hun-Sik; Rhim, Chong-Yun; Pyun, Wook-Bum; Choe, Hyunmin; Jeong, Myung-Ho; Park, Jong-Seon; Shin, Eak-Kyun; Hernández, Felipe; Figueras, Jaume; Hernández, Rosana; López-Minguez, José Ramón; González Juanatey, José Ramón; Palop, Ramón López; Galeote, Guillermo; Chamnarnphol, Noppadol; Buddhari, Wacin; Sansanayudh, Nakarin; Kuanprasert, Srun; Penny, William; Lui, Charles; Grimmett, Garfield; Srinivasan, Venkatraman; Ariani, Kevin; Khan, Waqor; Blankenship, James; Cannon, Louis; Eisenberg, Steven; McLaurin, Brent; Mahoney, Paul; Greenberg, Jerry; Breall, Jeffrey; Chandna, Harish; Hockstad, Eric; Tolerico, Paul; Kao, John; Shroff, Adhir; Nseir, Georges; Greenbaum, Adam; Cohn, Joel; Gogia, Harinder; Nahhas, Ahed; Istfan, Pierre; Orlow, Steve; Spriggs, Douglas; Sklar, Joel; Paulus, Richard; Cochran, David; Smith, Robert; Ferrier, L. Norman; Scott, J. Christopher; Xenopoulos, Nicholaos; Mulumudi, Mahesh; Hoback, James; Ginete, Wilson; Ballard, William; Stella, Joseph; Voeltz, Michele; Staniloae, Cezar; Eaton, Gregory; Griffin, John; Kumar, Krishna; Ebrahimi, Ramin; O'Shaughnessy, Charles; Lundstrom, Lundstrom; Temizer, Dogan; Tam, Kenneth; Suarez, Jose; Raval, Amish; Kaufman, Jay; Brilakis, Emmanouil; Stillabower, Michael; Quealy, Kathleen; Nunez, Boris; Pow, Thomas; Samuels, Bruce; Argenal, Agustin; Srinivas, Vankeepuram; Rosenthal, Andrew; Tummala, Pradyumna; Myers, Paul; LaMarche, Nelson; Chan, Michael; Bach, Richard; Simon, Daniel; Kettelkamp, Richard; Helmy, Tarek; Schaer, Gary; Kosinski, Edward; Buchbinder, Maurice; Sharma, Mukesh; Goodwin, Mark; Horwitz, Phillip; Mann, J. Tift; Holmes, David; Angiolillo, Dominick; Rao, Sunil; Azrin, Michael; Gammon, Roger; Mavromatis, Kreton; Ahmed, Abdel; Kent, Kenneth; Zughaib, Marcel; Westcott, R. Jeffrey; Jain, Ash; Gruberg, Luis; LeGalley, Thomas

    2009-01-01

    BACKGROUND: Intravenous cangrelor, a rapid-acting, reversible adenosine diphosphate (ADP) receptor antagonist, might reduce ischemic events during percutaneous coronary intervention (PCI). METHODS: In this double-blind, placebo-controlled study, we randomly assigned 5362 patients who had not been

  6. Effect of intravenous dexmedetomidine infusion on some ...

    African Journals Online (AJOL)

    Background: This study was designed to evaluate the effect of intravenous dexmedetomidine infusion in patients undergoing major abdominal surgery on stress response markers as plasma interleukin-6, cortisol and blood glucose level. It also assessed its effect on recovery profile and postoperative pain. Methods: Thirty ...

  7. Cost-effectiveness of oral phenytoin, intravenous phenytoin, and intravenous fosphenytoin in the emergency department.

    Science.gov (United States)

    Rudis, Maria I; Touchette, Daniel R; Swadron, Stuart P; Chiu, Amy P; Orlinsky, Michael

    2004-03-01

    Oral phenytoin, intravenous phenytoin, and intravenous fosphenytoin are all commonly used for loading phenytoin in the emergency department (ED). The cost-effectiveness of each was compared for patients presenting with seizures and subtherapeutic phenytoin concentrations. A simple decision tree was developed to determine the treatment costs associated with each of 3 loading techniques. We determined effectiveness by comparing adverse event rates and by calculating the time to safe ED discharge. Time to safe ED discharge was defined as the time at which therapeutic concentrations of phenytoin (>or=10 mg/L) were achieved with an absence of any adverse events that precluded discharge. The comparative cost-effectiveness of alternatives to oral phenytoin was determined by combining net costs and number of adverse events, expressed as cost per adverse events avoided. Cost-effectiveness was also determined by comparing the net costs of each loading technique required to achieve the time to safe ED discharge, expressed as cost per hour of ED time saved. The outcomes and costs were primarily derived from a prospective, randomized controlled trial, augmented by time-motion studies and alternate-cost sources. Costs included the cost of drugs, supplies, and personnel. Analyses were also performed in scenarios incorporating labor costs and savings from using a lower-urgency area of the ED. The mean number of adverse events per patient for oral phenytoin, intravenous phenytoin, and intravenous fosphenytoin was 1.06, 1.93, and 2.13, respectively. Mean time to safe ED discharge in the 3 groups was 6.4 hours, 1.7 hours, and 1.3 hours. Cost per patient was 2.83 dollars, 21.16 dollars, and 175.19 dollars, respectively, and did not differ substantially in the Labor and Triage (lower-urgency area of ED) scenarios. When the measure of effectiveness was adverse events, oral phenytoin dominated intravenous phenytoin and intravenous fosphenytoin, with a lower cost and number of adverse

  8. Intravenous/oral ciprofloxacin therapy versus intravenous ceftazidime therapy for selected bacterial infections.

    Science.gov (United States)

    Gaut, P L; Carron, W C; Ching, W T; Meyer, R D

    1989-11-30

    The efficacy and toxicity of sequential intravenous and oral ciprofloxacin therapy was compared with intravenously administered ceftazidime in a prospective, randomized, controlled, non-blinded trial. Thirty-two patients (16 patients receiving ciprofloxacin and 16 patients receiving ceftazidime) with 38 infections caused by susceptible Pseudomonas aeruginosa, enteric gram-negative rods, Salmonella group B, Serratia marcescens, Pseudomonas cepacia, and Xanthomonas maltophilia at various sites were evaluable for determination of efficacy. Length of therapy varied from seven to 25 days. Concomitant antimicrobials included intravenously administered beta-lactams for gram-positive organisms, intravenous/oral metronidazole and clindamycin for anaerobes, and intravenous/local amphotericin B for Candida albicans. Intravenous administration of 200 mg ciprofloxacin every 12 hours to 11 patients produced peak serum levels between 1.15 and 3.12 micrograms/ml; trough levels ranged between 0.08 and 0.86 micrograms/ml. Overall response rates were similar for patients receiving ciprofloxacin and ceftazidime. Emergence of resistance was similar in both groups--one Enterobacter cloacae and two P. aeruginosa became resistant after ciprofloxacin therapy and two P. aeruginosa became resistant after ceftazidime therapy. The frequency of superinfection with a variety of organisms was also similar in both groups. Adverse events related to ciprofloxacin included transient pruritus at the infusion site and generalized rash leading to drug discontinuation (one patient each), and with ceftazidime adverse effects included pain at the site of infusion and the development of allergic interstitial nephritis (one patient each). Overall, intravenous/oral ciprofloxin therapy appears to be as safe and effective as intravenous ceftazidime therapy in the treatment of a variety of infections due to susceptible aerobic gram-negative organisms.

  9. Effect of intravenous immunoglobulin on pain in patients with post-polio syndrome.

    Science.gov (United States)

    Werhagen, Lars; Borg, Kristian

    2011-11-01

    Pain is a common symptom that affects quality of life in patients with post-polio syndrome. An increase in cytokine in the cerebrospinal fluid suggests that inflammation is pathophysiologically important in post-polio syndrome. Intravenous immunoglobulin might therefore be a therapeutic option. The aim of this study was to analyse the effect of intravenous immunoglobulin treatment on pain in post-polio syndrome. An uncontrolled clinical study. Patients with post-polio syndrome and pain (n = 45) underwent a neurological examination and were interviewed about pain before and 6 months after treatment with intravenous immunoglobulin. Pain intensity was measured on a visual analogue scale. The pain was classified according to the International Association for the Study of Pain criteria as neuropathic when it occurred in an area with decreased sensibility, or nociceptive when signs of inflammation and/or painful joints movements were present. After treatment 31/45 (69%) patients were improved, with a mean visual analogue scale decrease from 53 to 42 (p = 0.001). Eighteen patients (40%) had a decrease of 20 or more points on the visual analogue scale. The effect of treatment did not differ regarding age, gender and severity of disability. Two-thirds of 45 patients with post-polio syndrome and pain reported a decrease on the visual analogue scale for pain after treatment with intravenous immunoglobulin, and 40% reported a decrease of 20 or more points on the visual analogue scale.

  10. Evaluation of the effects of intravenous anaesthesia using a ...

    African Journals Online (AJOL)

    medetomidine for total intravenous anaesthesia were evaluated in six sahel goats. The goats were administered a combination of ketamine (5mg/kg) and medetomidine (0.01mg/kg) intravenously. Baseline measurements of heart rate, respiratory ...

  11. Optimal timing for intravenous administration set replacement.

    Science.gov (United States)

    Gillies, D; O'Riordan, L; Wallen, M; Morrison, A; Rankin, K; Nagy, S

    2005-10-19

    Administration of intravenous therapy is a common occurrence within the hospital setting. Routine replacement of administration sets has been advocated to reduce intravenous infusion contamination. If decreasing the frequency of changing intravenous administration sets does not increase infection rates, a change in practice could result in considerable cost savings. The objective of this review was to identify the optimal interval for the routine replacement of intravenous administration sets when infusate or parenteral nutrition (lipid and non-lipid) solutions are administered to people in hospital via central or peripheral venous catheters. We searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE: all from inception to February 2004; reference lists of identified trials, and bibliographies of published reviews. We also contacted researchers in the field. We did not have a language restriction. We included all randomized or quasi-randomized controlled trials addressing the frequency of replacing intravenous administration sets when parenteral nutrition (lipid and non-lipid containing solutions) or infusions (excluding blood) were administered to people in hospital via a central or peripheral catheter. Two authors assessed all potentially relevant studies. We resolved disagreements between the two authors by discussion with a third author. We collected data for the outcomes; infusate contamination; infusate-related bloodstream infection; catheter contamination; catheter-related bloodstream infection; all-cause bloodstream infection and all-cause mortality. We identified 23 references for review. We excluded eight of these studies; five because they did not fit the inclusion criteria and three because of inadequate data. We extracted data from the remaining 15 references (13 studies) with 4783 participants. We conclude that there is no evidence that changing intravenous administration sets more often than every 96 hours

  12. Patient preparation for intravenous urography: are we practising evidence-based medicine?

    International Nuclear Information System (INIS)

    Singh, S.; Reddicliffe, N.; Parker, D.A.

    2008-01-01

    Aim: To identify the current practice of patient preparation prior to intravenous urography (IVU) in England and Wales. Methods: Seventy-two hospitals were contacted to request details regarding the duration of fluid restriction, adherence to a low-residue diet, or use of laxatives for patient preparation before IVU examinations. Results: Results showed that out of 45 hospitals that still use IVU, only six (13.3%) did not follow a patient-preparation regime. The vast majority of the hospitals contacted (87.6%), implemented either fluid and/or food restriction, or prescribed laxatives. The duration of fluid and food restriction varied from 2-12 h duration, and some departments advocated 48 h of laxatives. Conclusion: A large proportion of hospitals are not practising evidence-based medicine in relation to IVU, and we suggest that the practice of patient preparation should be abandoned

  13. Patient preparation for intravenous urography: are we practising evidence-based medicine?

    Science.gov (United States)

    Singh, S; Reddicliffe, N; Parker, D A

    2008-02-01

    To identify the current practice of patient preparation prior to intravenous urography (IVU) in England and Wales. Seventy-two hospitals were contacted to request details regarding the duration of fluid restriction, adherence to a low-residue diet, or use of laxatives for patient preparation before IVU examinations. Results showed that out of 45 hospitals that still use IVU, only six (13.3%) did not follow a patient-preparation regime. The vast majority of the hospitals contacted (87.6%), implemented either fluid and/or food restriction, or prescribed laxatives. The duration of fluid and food restriction varied from 2-12 h duration, and some departments advocated 48 h of laxatives. A large proportion of hospitals are not practising evidence-based medicine in relation to IVU, and we suggest that the practice of patient preparation should be abandoned.

  14. Intravenous immunoglobulin therapy for refractory recurrent pericarditis.

    Science.gov (United States)

    del Fresno, M Rosa; Peralta, Julio E; Granados, Miguel Ángel; Enríquez, Eugenia; Domínguez-Pinilla, Nerea; de Inocencio, Jaime

    2014-11-01

    Recurrent pericarditis is a troublesome complication of idiopathic acute pericarditis and occurs more frequently in pediatric patients after cardiac surgery (postpericardiotomy syndrome). Conventional treatment with nonsteroidal antiinflammatory drugs, corticosteroids, and colchicine is not always effective or may cause serious adverse effects. There is no consensus, however, on how to proceed in those patients whose disease is refractory to conventional therapy. In such cases, human intravenous immunoglobulin, immunosuppressive drugs, and biological agents have been used. In this report we describe 2 patients with refractory recurrent pericarditis after cardiac surgery who were successfully treated with 3 and 5 monthly high-dose (2 g/kg) intravenous immunoglobulin until resolution of the effusion. Our experience supports the effectiveness and safety of this therapy. Copyright © 2014 by the American Academy of Pediatrics.

  15. Retroperitoneal fibrosis with normal intravenous urogram.

    OpenAIRE

    Creagh, F. M.; Stone, T.; Stephenson, T. P.; Lazarus, J. H.

    1985-01-01

    A 58 year old male presented with a two week history of low back pain and malaise. The intravenous urogram (IVU) at presentation was normal but within three months he had developed renal failure with bilateral ureteric obstruction on repeat IVU. Primary retroperitoneal fibrosis was confirmed at operation. This case demonstrates that retroperitoneal fibrosis may progress rapidly to renal failure within a few months of the first symptoms. In addition, the IVU may be normal in the early stages o...

  16. Total intravenous anesthesia for major burn surgery

    OpenAIRE

    Cancio, Leopoldo C; Cuenca, Phillip B; Walker, Stephen C; Shepherd, John M

    2013-01-01

    Total intravenous anesthesia (TIVA) is frequently used for major operations requiring general anesthesia in critically ill burn patients. We reviewed our experience with this approach. Methods: During a 22-month period, 547 major burn surgeries were performed in this center’s operating room and were staffed by full-time burn anesthesiologists. The records of all 123 TIVA cases were reviewed; 112 records were complete and were included. For comparison, 75 cases were selected at random from a t...

  17. Fluid therapy in the perioperative setting-a clinical review

    DEFF Research Database (Denmark)

    Voldby, Anders Winther; Brandstrup, Birgitte

    2016-01-01

    aims to analyze the literature concerning perioperative fluid therapy in abdominal surgery and to provide evidence-based recommendations for clinical practice. RESULTS: Preoperative oral or intravenous administration of carbohydrate containing fluids has been shown to improve postoperative well...... for most patients. It is less expensive and simpler than the zero-balance GDT approach and therefore recommended in this review. In outpatient surgery, 1-2 L of balanced crystalloids reduces postoperative nausea and vomiting and improves well-being....

  18. Contrast agent choice for intravenous coronary angiography

    International Nuclear Information System (INIS)

    Zeman, H.D.; Siddons, D.P.

    1989-01-01

    The screening of the general population for coronary artery disease would be practical if a method existed for visualizing the extent of occlusion after an intravenous injection of contrast agent. Measurements performed with monochromatic synchrotron radiation x-rays and an iodine containing contrast agent at the Stanford Synchrotron Radiation Laboratory have shown that such an intravenous angiography procedure would be possible with an adequately intense monochromatic x-ray source. Because of the size and cost of synchrotron radiation facilities it would be desirable to make the most efficient use of the intensity available, while reducing as much as possible the radiation dose experienced by the patient. By choosing contrast agents containing elements with a higher atomic number than iodine, it is possible to both improve the image quality and reduce the patient radiation dose, while using the same synchrotron source. By using Si monochromator crystals with a small mosaic spread, it is possible to increase the x-ray flux available for imaging by over an order of magnitude, without any changes in the storage ring or wiggler magnet. The most critical imaging task for intravenous coronary angiography utilizing synchrotron radiation x-rays is visualizing a coronary artery through the left ventricle or aorta which also contains a contrast agent. Calculations have been made of the signal to noise ratio expected for this imaging task for various contrast agents with atomic numbers between that of iodine and bismuth

  19. Intravenous Lipids for Preterm Infants: A Review

    Directory of Open Access Journals (Sweden)

    Ghassan S. A. Salama

    2015-01-01

    Full Text Available Extremely low birth weight infants (ELBW are born at a time when the fetus is undergoing rapid intrauterine brain and body growth. Continuation of this growth in the first several weeks postnatally during the time these infants are on ventilator support and receiving critical care is often a challenge. These infants are usually highly stressed and at risk for catabolism. Parenteral nutrition is needed in these infants because most cannot meet the majority of their nutritional needs using the enteral route. Despite adoption of a more aggressive approach with amino acid infusions, there still appears to be a reluctance to use early intravenous lipids. This is based on several dogmas that suggest that lipid infusions may be associated with the development or exacerbation of lung disease, displace bilirubin from albumin, exacerbate sepsis, and cause CNS injury and thrombocytopena. Several recent reviews have focused on intravenous nutrition for premature neonate, but very little exists that provides a comprehensive review of intravenous lipid for very low birth and other critically ill neonates. Here, we would like to provide a brief basic overview, of lipid biochemistry and metabolism of lipids, especially as they pertain to the preterm infant, discuss the origin of some of the current clinical practices, and provide a review of the literature, that can be used as a basis for revising clinical care, and provide some clarity in this controversial area, where clinical care is often based more on tradition and dogma than science.

  20. Fluid Shifts

    Science.gov (United States)

    Stenger, M. B.; Hargens, A. R.; Dulchavsky, S. A.; Arbeille, P.; Danielson, R. W.; Ebert, D. J.; Garcia, K. M.; Johnston, S. L.; Laurie, S. S.; Lee, S. M. C.; hide

    2017-01-01

    Introduction. NASA's Human Research Program is focused on addressing health risks associated with long-duration missions on the International Space Station (ISS) and future exploration-class missions beyond low Earth orbit. Visual acuity changes observed after short-duration missions were largely transient, but now more than 50 percent of ISS astronauts have experienced more profound, chronic changes with objective structural findings such as optic disc edema, globe flattening and choroidal folds. These structural and functional changes are referred to as the visual impairment and intracranial pressure (VIIP) syndrome. Development of VIIP symptoms may be related to elevated intracranial pressure (ICP) secondary to spaceflight-induced cephalad fluid shifts, but this hypothesis has not been tested. The purpose of this study is to characterize fluid distribution and compartmentalization associated with long-duration spaceflight and to determine if a relation exists with vision changes and other elements of the VIIP syndrome. We also seek to determine whether the magnitude of fluid shifts during spaceflight, as well as any VIIP-related effects of those shifts, are predicted by the crewmember's pre-flight status and responses to acute hemodynamic manipulations, specifically posture changes and lower body negative pressure. Methods. We will examine a variety of physiologic variables in 10 long-duration ISS crewmembers using the test conditions and timeline presented in the figure below. Measures include: (1) fluid compartmentalization (total body water by D2O, extracellular fluid by NaBr, intracellular fluid by calculation, plasma volume by CO rebreathe, interstitial fluid by calculation); (2) forehead/eyelids, tibia, and calcaneus tissue thickness (by ultrasound); (3) vascular dimensions by ultrasound (jugular veins, cerebral and carotid arteries, vertebral arteries and veins, portal vein); (4) vascular dynamics by MRI (head/neck blood flow, cerebrospinal fluid

  1. Intravenous contrast enhanced computed tomography colonoscopy in children with suspected colonic polyps.

    Science.gov (United States)

    Bhatia, Anmol; Saxena, Akshay K; Kalra, Naveen; Sodhi, Kushaljit S; Thapa, Babu R; Rao, Katragadda L N; Khandelwal, Niranjan

    2013-06-01

    The purpose of this study was to evaluate the diagnostic performance of intravenous contrast enhanced computed tomographic colonoscopy (IVCTC) in the diagnosis of clinically suspected colorectal polyps in children, using conventional colonoscopy (CC) as the gold standard. This was a prospective study conducted between July 2008 and June 2010. 30 pediatric patients with history of rectal bleeding and clinically suspected to have colorectal polyps were enrolled. All of the patients underwent IVCTC followed by CC. 30 IVCTC and 31 CC were performed in 30 patients. The findings of IVCTC were compared with those of CC. Statistical analysis was performed to obtain diagnostic performance values of IVCTC on per polyp (sensitivity and positive predictive value) and per patient (sensitivity, specificity, positive predictive value and negative predictive value) basis. By IVCTC, 63 polyps were detected in 28 patients of which 53 polyps were eligible for inclusion in the statistical analysis. 60 polyps were detected by CC in 28 patients of which 50 polyps were eligible for inclusion in the statistical analysis. The per polyp sensitivity and positive predictive values were 94% and 88.6% respectively. The per patient sensitivity, specificity, positive predictive value, and negative predictive values were 96.4, 50, 96.4, and 50% respectively. Twenty polyps, in 10 patients, were visualized only after intravenous contrast administration of which 5 polyps, in 5 patients, were likely to have been missed in the absence of the intravenous contrast injection as these polyps were submerged in fluid. Four patients would have had a false negative CTC examination if the intravenous contrast had not been injected; while in another patient, the number of polyps would have been underestimated. CTC is capable of serving as a safe and efficient non-invasive tool for evaluating children with clinically suspected colorectal polyps. Administration of intravenous contrast improves the sensitivity of

  2. Intravenous contrast enhanced computed tomography colonoscopy in children with suspected colonic polyps

    International Nuclear Information System (INIS)

    Bhatia, Anmol; Saxena, Akshay K.; Kalra, Naveen; Sodhi, Kushaljit S.; Thapa, Babu R.; Rao, Katragadda L.N.; Khandelwal, Niranjan

    2013-01-01

    Objective: The purpose of this study was to evaluate the diagnostic performance of intravenous contrast enhanced computed tomographic colonoscopy (IVCTC) in the diagnosis of clinically suspected colorectal polyps in children, using conventional colonoscopy (CC) as the gold standard. Methods: This was a prospective study conducted between July 2008 and June 2010. 30 pediatric patients with history of rectal bleeding and clinically suspected to have colorectal polyps were enrolled. All of the patients underwent IVCTC followed by CC. 30 IVCTC and 31 CC were performed in 30 patients. The findings of IVCTC were compared with those of CC. Statistical analysis was performed to obtain diagnostic performance values of IVCTC on per polyp (sensitivity and positive predictive value) and per patient (sensitivity, specificity, positive predictive value and negative predictive value) basis. Results: By IVCTC, 63 polyps were detected in 28 patients of which 53 polyps were eligible for inclusion in the statistical analysis. 60 polyps were detected by CC in 28 patients of which 50 polyps were eligible for inclusion in the statistical analysis. The per polyp sensitivity and positive predictive values were 94% and 88.6% respectively. The per patient sensitivity, specificity, positive predictive value, and negative predictive values were 96.4, 50, 96.4, and 50% respectively. Twenty polyps, in 10 patients, were visualized only after intravenous contrast administration of which 5 polyps, in 5 patients, were likely to have been missed in the absence of the intravenous contrast injection as these polyps were submerged in fluid. Four patients would have had a false negative CTC examination if the intravenous contrast had not been injected; while in another patient, the number of polyps would have been underestimated. Conclusion: CTC is capable of serving as a safe and efficient non-invasive tool for evaluating children with clinically suspected colorectal polyps. Administration of

  3. Mycotic aneurysms in intravenous drug abusers: the utility of intravenous digital subtraction angiography

    International Nuclear Information System (INIS)

    Shetty, P.C.; Krasicky, G.A.; Sharma, R.P.; Vemuri, B.R.; Burke, M.M.

    1985-01-01

    Two-hundred thirteen intravenous digital subtraction angiographic (DSA) examinations were performed on 195 intravenous drug abusers to rule out the possibility of a mycotic aneurysm in a groin, neck, or upper extremity infection. Twenty-three surgically proved cases of mycotic aneurysm were correctly identified with no false positive results. In addition, six cases of major venous occlusion were documented. The authors present the results of their experience and conclude that DSA is an effective and cost-efficient method of examining this high risk patient population

  4. Fluid Mechanics

    Science.gov (United States)

    Pnueli, David; Gutfinger, Chaim

    1997-01-01

    This text is intended for the study of fluid mechanics at an intermediate level. The presentation starts with basic concepts, in order to form a sound conceptual structure that can support engineering applications and encourage further learning. The presentation is exact, incorporating both the mathematics involved and the physics needed to understand the various phenomena in fluid mechanics. Where a didactical choice must be made between the two, the physics prevails. Throughout the book the authors have tried to reach a balance between exact presentation, intuitive grasp of new ideas, and creative applications of concepts. This approach is reflected in the examples presented in the text and in the exercises given at the end of each chapter. Subjects treated are hydrostatics, viscous flow, similitude and order of magnitude, creeping flow, potential flow, boundary layer flow, turbulent flow, compressible flow, and non-Newtonian flows. This book is ideal for advanced undergraduate students in mechanical, chemical, aerospace, and civil engineering. Solutions manual available.

  5. Intravenous drugs infusion safety through smart pumps

    Directory of Open Access Journals (Sweden)

    C. Gómez-Baraza

    2014-07-01

    Full Text Available Objective: To analyze the role of smart infusion pumps in reducing errors related with the administration of intravenous medications. Method: Retrospective, observational study analyzing the implementation of a system with smart intravenous infusion pumps (Hospira MedNetTM and the role of the safety system for the detection of errors during the administration of drugs, sera, and blood. We included infusions administered at the day-care hospitals of hematology, oncology, rheumatology, and oncopediatrics. We analyzed adherence to the safety system, the number of programming errors detected, the commonly implicated drugs in these errors, and improvement actions. Results: During the study period, 120 smart pumps were implemented and data on 70,028 infusions were gathered. The rate of adherence to the safety program was 62.30% in hematology (6,887 infusions, 60,30% in oncology (28,127 infusions, 46,50% in rheumatology (1,950 infusions and 1.8% in oncopediatrics (139 infusions. 3,481 out of the established limits programming alerts were generated by the pumps: 2,716 of relative limit and 765 of absolute limit. En 807 infusions (2.17%, errors that could have had consequences for the patients could be prevented. These findings allowed implementing a series of strategies aimed at minimizing these errors in the future. Conclusions: The Hospira MedNetTM system detects deviations from the established protocols of intravenous infusion, preventing in this way potential adverse events for the patients. It also allows establishing correction measures and implementing the improvement strategies.

  6. Effect of intravenous lipid on human pancreatic secretion.

    Science.gov (United States)

    Edelman, K; Valenzuela, J E

    1983-11-01

    Parenteral alimentation, including intravenous fat, is sometimes used in the treatment of patients with pancreatitis, although the effect of intravenous fat on human pancreatic secretion has not been systematically studied. Intravenous fat, however, has been shown to stimulate pancreatic protein secretion in the dog. The purpose of these studies was to clarify the effect of intravenous fat on human pancreatic secretion. Pancreatic secretion was assessed by measurement of enzymes and bicarbonate in duodenal aspirate collected via a double-lumen tube from 6 healthy volunteers. Four studies were randomly conducted on different days. On day 1, graded concentrations of Intralipid (5%, 10%, and 20%) were given intravenously for 1 h each, while secretin (8.2 pmol . kg-1 . h-1) was given as a background. On day 2, the same doses of Intralipid were infused intravenously without secretin. On day 3, the same doses of Intralipid were perfused into the intestine, and, finally, on day 4, 20% Intralipid was given by intestinal infusion for 2 h while 10% Intralipid was infused intravenously during the second hour. Significant stimulation of enzyme secretion was observed only during the infusion of fat into the intestine, not after intravenous infusion at any concentration. Pancreatic enzyme secretion, stimulated by intraintestinal fat, was not significantly modified by simultaneous intravenous lipid infusion. We conclude that since intravenous fat does not stimulate pancreatic secretion, its use in conditions where pancreatic stimulation is undesirable appears safe.

  7. Retroperitoneal fibrosis with normal intravenous urogram.

    Science.gov (United States)

    Creagh, F. M.; Stone, T.; Stephenson, T. P.; Lazarus, J. H.

    1985-01-01

    A 58 year old male presented with a two week history of low back pain and malaise. The intravenous urogram (IVU) at presentation was normal but within three months he had developed renal failure with bilateral ureteric obstruction on repeat IVU. Primary retroperitoneal fibrosis was confirmed at operation. This case demonstrates that retroperitoneal fibrosis may progress rapidly to renal failure within a few months of the first symptoms. In addition, the IVU may be normal in the early stages of the illness. Images Figure 1 Figure 2 PMID:3983053

  8. Pyeloureteral visualization using glucagon during intravenous urography

    International Nuclear Information System (INIS)

    Nepper-Rasmussen, J.; Nielsen, P.H.; Kruse, V.

    1983-01-01

    194 adult patients were subjected to intravenous urography. In order to study the effect of glucagon on the visualization of the pyeloureteral system, IVU's were performed in four different ways: I. with abdominal compression, II. with glucagon 1 mg.i.v., III. without abdominal compression and without glucagon, and IV. with abdominal compression and glucagon 1 mg.i.v. Coded objective and subjective analyses showed significant worsened visualization of the pyelocalyceal systems, when IVU was performed with glucagon alone. Ureteral visualization was equal in all four groups. Glucagon fails as a pharmacological alternative to abdominal compression in adult human subjects. (orig.) [de

  9. Switching between intravenous and subcutaneous trastuzumab

    DEFF Research Database (Denmark)

    Gligorov, Joseph; Curigliano, Giuseppe; Müller, Volkmar

    2017-01-01

    AIM: To assess the safety and tolerability of switching between subcutaneous (SC) and intravenous (IV) trastuzumab in the PrefHer study (NCT01401166). PATIENTS AND METHODS: Patients with HER2-positive early breast cancer completed (neo)adjuvant chemotherapy and were randomised to receive four....... Rates of clinically important events, including grade ≥3 AEs, serious AEs, AEs leading to study drug discontinuation and cardiac AEs, were low and similar between treatment arms (safety signals for trastuzumab were observed. CONCLUSIONS: PrefHer revealed...... that switching from IV to SC trastuzumab (hand-held syringe or SID) or vice versa did not impact the known safety profile of trastuzumab....

  10. Fluid dynamics

    CERN Document Server

    Ruban, Anatoly I

    This is the first book in a four-part series designed to give a comprehensive and coherent description of Fluid Dynamics, starting with chapters on classical theory suitable for an introductory undergraduate lecture course, and then progressing through more advanced material up to the level of modern research in the field. The present Part 1 consists of four chapters. Chapter 1 begins with a discussion of Continuum Hypothesis, which is followed by an introduction to macroscopic functions, the velocity vector, pressure, density, and enthalpy. We then analyse the forces acting inside a fluid, and deduce the Navier-Stokes equations for incompressible and compressible fluids in Cartesian and curvilinear coordinates. In Chapter 2 we study the properties of a number of flows that are presented by the so-called exact solutions of the Navier-Stokes equations, including the Couette flow between two parallel plates, Hagen-Poiseuille flow through a pipe, and Karman flow above an infinite rotating disk. Chapter 3 is d...

  11. Association between fluid balance and mortality in patients with septic shock

    DEFF Research Database (Denmark)

    Cronhjort, M; Hjortrup, P B; Holst, L B

    2016-01-01

    BACKGROUND: Several studies have shown an association between a positive fluid balance and increased mortality in patients with septic shock. This may have led to a more restrictive use of intravenous fluids. The association between fluid accumulation and mortality in the setting of a more...... restrictive use of intravenous fluids, however, is uncertain. We therefore aimed to investigate the association between a cumulative fluid balance 3 days after randomization and 90-day mortality in a recent Nordic multicentre cohort of patients with septic shock. METHODS: A post hoc analysis of patients from...... the Transfusion Requirements in Septic Shock (TRISS) trial treated for 3 days or more in the ICU after randomization. The patients were categorized into four groups depending on their weight-adjusted cumulative fluid balance after 3 days. We performed multivariable Cox regression analysis, adjusting for important...

  12. Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access.

    Science.gov (United States)

    Costantino, Thomas G; Parikh, Aman K; Satz, Wayne A; Fojtik, John P

    2005-11-01

    We assess the success rate of emergency physicians in placing peripheral intravenous catheters in difficult-access patients who were unsuccessfully cannulated by emergency nurses. A technique using real-time ultrasonographic guidance by 2 physicians was compared with traditional approaches using palpation and landmark guidance. This was a prospective, systematically allocated study of all patients requiring intravenous access who presented to 2 university hospitals between October 2003 and March 2004. Inclusion criterion was the inability of any available nurse to obtain intravenous access after at least 3 attempts on a subgroup of patients who had a history of difficult intravenous access because of obesity, history of intravenous drug abuse, or chronic medical problems. Exclusion criterion was the need for central venous access. Patients presenting on odd days were allocated to the ultrasonographic-guided group, and those presenting on even days were allocated to the traditional-approach group. Endpoints were successful cannulation, number of sticks, time, and patient satisfaction. Sixty patients were enrolled, 39 on odd days and 21 on even days. Success rate was greater for the ultrasonographic group (97%) versus control (33%), difference in proportions of 64% (95% confidence interval [CI] 39% to 71%). The ultrasonographic group required less overall time (13 minutes versus 30 minutes, for a difference of 17 [95% CI 0.8 to 25.6]), less time to successful cannulation from first percutaneous puncture (4 minutes versus 15 minutes, for a difference of 11 [95% CI 8.2 to 19.4]), and fewer percutaneous punctures (1.7 versus 3.7, for a difference of 2.0 [95% CI 1.27 to 2.82]) and had greater patient satisfaction (8.7 versus 5.7, for a difference of 3.0 [95% CI 1.82 to 4.29]) than the traditional landmark approach. Ultrasonographic-guided peripheral intravenous access is more successful than traditional "blind" techniques, requires less time, decreases the number of

  13. Intravenous Carbamazepine for Adults With Seizures.

    Science.gov (United States)

    Vickery, P Brittany; Tillery, Erika E; DeFalco, Alicia Potter

    2018-03-01

    To review the pharmacology, pharmacokinetics, efficacy, safety, dosage and administration, potential drug-drug interactions, and place in therapy of the intravenous (IV) formulation of carbamazepine (Carnexiv) for the treatment of seizures in adult patients. A comprehensive PubMed and EBSCOhost search (1945 to August 2017) was performed utilizing the keywords carbamazepine, Carnexiv, carbamazepine intravenous, IV carbamazepine, seizures, epilepsy, and seizure disorder. Additional data were obtained from literature review citations, manufacturer's product labeling, and Lundbeck website as well as Clinicaltrials.gov and governmental sources. All English-language trials evaluating IV carbamazepine were analyzed for this review. IV carbamazepine is FDA approved as temporary replacement therapy for treatment of adult seizures. Based on a phase I trial and pooled data from 2 open-label bioavailability studies comparing oral with IV dosing, there was no noted indication of loss of seizure control in patients switched to short-term replacement antiepileptic drug therapy with IV carbamazepine. The recommended dose of IV carbamazepine is 70% of the patient's oral dose, given every 6 hours via 30-minute infusions. The adverse effect profile of IV carbamazepine is similar to that of the oral formulation, with the exception of added infusion-site reactions. IV carbamazepine is a reasonable option for adults with generalized tonic-clonic or focal seizures, previously stabilized on oral carbamazepine, who are unable to tolerate oral medications for up to 7 days. Unknown acquisition cost and lack of availability in the United States limit its use currently.

  14. The human experience with intravenous levodopa

    Directory of Open Access Journals (Sweden)

    Shan H Siddiqi

    2016-01-01

    Full Text Available Objective: To compile a comprehensive summary of published human experience with levodopa given intravenously, with a focus on information required by regulatory agencies.Background: While safe intravenous (IV use of levodopa has been documented for over 50 years, regulatory supervision for pharmaceuticals given by a route other than that approved by the U.S. Food and Drug Administration (FDA has become increasingly cautious. If delivering a drug by an alternate route raises the risk of adverse events, an investigational new drug (IND application is required, including a comprehensive review of toxicity data.Methods: Over 200 articles referring to IV levodopa were examined for details of administration, pharmacokinetics, benefit and side effects.Results: We identified 142 original reports describing IVLD use in humans, beginning with psychiatric research in 1959-1960 before the development of peripheral decarboxylase inhibitors. Over 2750 subjects have received IV levodopa, and reported outcomes include parkinsonian signs, sleep variables, hormone levels, hemodynamics, CSF amino acid composition, regional cerebral blood flow, cognition, perception and complex behavior. Mean pharmacokinetic variables were summarized for 49 healthy subjects and 190 with Parkinson’s disease. Side effects were those expected from clinical experience with oral levodopa and dopamine agonists. No articles reported deaths or induction of psychosis.Conclusion: Over 2750 patients have received IV levodopa with a safety profile comparable to that seen with oral administration.

  15. Flank pain: is Intravenous Urogram necessary?

    Science.gov (United States)

    Teh, H S; Lin, M B; Khoo, T K

    2001-09-01

    To determine the diagnostic yield of Intravenous Urogram (IVU) and the values of plain radiograph of kidney, ureter and bladder (KUB) and urinalysis as screening tests, with the objective to improve the cost effectiveness, in the management of patients presenting with flank pain due to urinary lithiasis. All Intravenous Urogram (IVU) request forms and reports for the month of February 1998 were audited. The case notes, urinalysis, KUB and IVU films were traced and reviewed. There were 110 patients investigated, 61.8% (68) had normal IVU, 38.2% (42) had abnormal IVU. The sensitivity and specificity of KUB alone was 79.4% and 90%. The sensitivity using urinalysis alone was 90.9% and its specificity 33.8%. The sensitivity of combined KUB and urinalysis was 100% and its specificity 26%, with a negative predictive value of 100%. All the patients with both negative KUB and urinalysis in our study were found to have negative IVU. Our study shows that in patients with both negative KUB and urinalysis, the yield of IVU is very low and may not be necessary. This is important, as an IVU examination is not without risk. A combination of KUB with urinary analysis and careful evaluation of clinical symptoms will improve the cost-effectiveness of patient management.

  16. Intravenous dynamic nucleography of the brain

    International Nuclear Information System (INIS)

    Rosenthall, L.

    1972-01-01

    The advent of stationary imaging devices has created interest in studying cerebral blood flows and transits with diffusible and nondiffusible radioactive indicators. Much of this has disclosed interesting pathophysiology, but not necessarily of significant diagnostic import to include in routine patient workup. The conventional static brain scan is one of the more useful tests in the nuclear medicine armamentarium for uncovering and localizing intracranial disease. Unfortunately, it does not as a rule clearly distinguish cerebral vascular accidents, neoplasms, arteriovenous malformations, and so forth, which is important from the standpoint of patient management. Aside from clinical impressions a diagnosis is often based on the appearance of the radiocontrast angiogram, which is not always desirable because of the implicit hazards. Thus it is incumbent upon investigators to search for innocuous intravenous methods of identifying the various intracranial afflictions. Intravenous 99 /sup m/Tc-pertechnetate comparisons of brain hemisphere perfusion as a routine complement to static brain imaging are useful. Estimations of disparate radioactive transits are made qualitatively from serial 4 to 5 sec exposure scintiphotographs. (U.S.)

  17. Intravenous polyclonal human immunoglobulins in multiple sclerosis

    DEFF Research Database (Denmark)

    Sørensen, Per Soelberg

    2008-01-01

    Intravenous immunoglobulin (IVIG) is an established therapy for demyelinating diseases of the peripheral nervous system. IVIG exerts a number of effects that may be beneficial in multiple sclerosis (MS). Four double-blind IVIG trials have been performed in relapsing-remitting MS. A meta-analysis ......Intravenous immunoglobulin (IVIG) is an established therapy for demyelinating diseases of the peripheral nervous system. IVIG exerts a number of effects that may be beneficial in multiple sclerosis (MS). Four double-blind IVIG trials have been performed in relapsing-remitting MS. A meta......-analysis of the four trials has shown that IVIG reduces the relapse rate and, possibly, disease progression. In patients with a first episode of demyelinating disease, IVIG delays the time to the second relapse and thereby to the diagnosis of definite MS. In patients with an acute MS relapse, IVIG as add-on therapy...... to methylprednisolone does not make remission of symptoms faster or more complete. IVIG does not seem to be of any benefit to chronic visual or motor symptoms in MS. In secondary progressive MS, IVIG has not shown any effect on disease progression, relapses or new magnetic resonance imaging lesions. Experimental...

  18. Adverse reactions to iotroxate at intravenous cholangiography

    International Nuclear Information System (INIS)

    Nilsson, U.

    1987-01-01

    The number and type of adverse reactions to meglumine iotroxate at intravenous infusion cholangiography, performed one day prior to elective cholecystectomy, were recorded in a prospective investigation of 196 asymptomatic, anicteric patients. One hundred ml (50 mg I/ml) of contrast medium was infused over a period of 30 minutes. Only 2 minor (1%) and no severe or fatal reactions were noted. A review of the literature on the use of iotroxate in 2492 patients, including those in the present investigation, revealed a complication rate of 3.5% (3.0% minor, 0.3% moderate and 0.2% severe reactions) at infusion of iotroxate (5.0-8.0 g I) over a period of 30 to 120 minutes. This compared favourably with the 5% complication rate (4% minor, 0.5% moderate and 0.5% severe reactions) at infusion of iodoxamate and the 9% complication rate (5% minor, 1% moderate and 3% severe reactions) at infusion of ioglycamide. Irrespective of the contrast agent used, the frequency of adverse reactions at infusion was found to be 3 times lower than when equal amounts (5.0-5.6 g I) of the same medium were injected. It is concluded that, at present, infusion of iotroxate in an amount which approximates to the transportation maximum of the liver is the least toxic way of performing intravenous cholangiography with an optimum filling of the bile ducts. (orig.)

  19. A tomographic approach to intravenous coronary arteriography

    International Nuclear Information System (INIS)

    Ritman, E.L.; Bove, A.A.

    1986-01-01

    Coronary artery anatomy can be visualized using high speed, volume scanning X-ray CT. A single scan during a bolus injection of contrast medium provides image data for display of all angles of view of the opacified coronary arterial tree. Due to the tomographic nature of volume image data the superposition of contrast filled cardiac chambers, such as would occur in the levophase of an intravenous injection of contrast agent, can be eliminated. Data are presented which support these statements. The Dynamic Spatial Reconstructor (DSR) was used to scan a life-like radiologic phantom of an adult human thorax in which the left atrial and ventricular chambers and the major epicardial coronary arteries were opacified so as to simulate the levophase of an intravenous injection of contrast agent. A catheter filled with diluted contrast agent and with regions of luminal narrowing (i.e. 'stenoses') was advanced along a tract equivalent to a right ventricular catheterization. Ease of visualization of the catheter 'stenoses' and the accuracy with which they can be measured are presented. (Auth.)

  20. Panlobular emphysema in young intravenous Ritalin abusers

    International Nuclear Information System (INIS)

    Schmidt, R.A.; Glenny, R.W.; Godwin, J.D.; Hampson, N.B.; Cantino, M.E.; Reichenbach, D.D.

    1991-01-01

    We studied a distinctive group of young intravenous Ritalin abusers with profound obstructive lung disease. Clinically, they seemed to have severe emphysema, but the pathologic basis of their symptoms had not been investigated previously. Seven patients have died and been autopsied: in four, the lungs were fixed, inflated, dried, and examined in detail radiologically, grossly, microscopically, and by electron probe X-ray microanalysis. All seven patients had severe panlobular (panacinar) emphysema that tended to be more severe in the lower lung zones and that was associated with microscopic talc granulomas. Vascular involvement by talc granulomas was variable, but significant interstitial fibrosis was not present. Five patients were tested for alpha-1-antitrypsin deficiency and found to be normal, as were six similar living patients. These findings indicate that some intravenous drug abusers develop emphysema that clinically, radiologically, and pathologically resembles that caused by alpha-1-antitrypsin deficiency but which must have a different pathogenesis. Talc from the Ritalin tablets may be important, but the mechanism remains to be elucidated

  1. Intravenous immunoglobulin therapy and systemic lupus erythematosus.

    Science.gov (United States)

    Zandman-Goddard, Gisele; Levy, Yair; Shoenfeld, Yehuda

    2005-12-01

    Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with diverse manifestations. We suggest that intravenous immunoglobulin (IVIg) therapy may be beneficial and safe for various manifestations in SLE. A structured literature search of articles published on the efficacy of IVIg in the treatment of SLE between 1983 and 2005 was conducted. We searched the terms "IVIg," "intravenous immunoglobulin," "lupus," "SLE," and "systemic lupus erythematosus." The various clinical manifestations of SLE that were reported to be successfully treated by IVIg in case reports include autoimmune hemolytic anemia, acquired factor VIII inhibitors, acquired von Willebrand disease, pure red cell aplasia, thrombocytopenia, pancytopenia, myelofibrosis, pneumonitis, pleural effusion, pericarditis, myocarditis, cardiogenic shock, nephritis, end-stage renal disease, encephalitis, neuropsychiatric lupus, psychosis, peripheral neuropathy, polyradiculoneuropathy, and vasculitis. The most extensive experience is with lupus nephritis. There are only a few case series of IVIg use in patients with SLE with various manifestations, in which the response rate to IVIg therapy ranged from 33 to 100%. We suggest that IVIg devoid of sucrose, at a dose of 2 g/kg over a 5-d period given uniformly and at a slow infusion rate in patients without an increased risk for thromboembolic events or renal failure, is a safe and beneficial adjunct therapy for cases of SLE that are resistant to or refuse conventional treatment. The duration of therapy is yet to be established. Controlled trials are warranted.

  2. Intravenous saline administration in patients with severe acquired brain injury and orthostatic intolerance for tilt-table mobilization

    DEFF Research Database (Denmark)

    Riberholt, Christian; Olesen, Niels; Hovind, Peter

    2018-01-01

    Primary objective: This study aimed to investigate the effect of intravenous saline administration on orthostatic hypotension (OH) during head up tilt (HUT) and the change in the renin–angiotensin–aldosterone system before and after HUT in patients with severe acquired brain injury (ABI). Research...... artery blood flow velocity. Blood samples were collected before and after two HUT sessions separated by 1 hour and saline was administered in between. Main outcomes and results: Patients’ ability to stand upright did not change after saline administration due to OH. The patients showed signs of reduced...... fluid administration. Research focusing on the ability to retain fluid after bed rest is warranted....

  3. Association between intravenous chloride load during resuscitation and in-hospital mortality among patients with SIRS.

    Science.gov (United States)

    Shaw, Andrew D; Raghunathan, Karthik; Peyerl, Fred W; Munson, Sibyl H; Paluszkiewicz, Scott M; Schermer, Carol R

    2014-12-01

    Recent data suggest that both elevated serum chloride levels and volume overload may be harmful during fluid resuscitation. The purpose of this study was to examine the relationship between the intravenous chloride load and in-hospital mortality among patients with systemic inflammatory response syndrome (SIRS), with and without adjustment for the crystalloid volume administered. We conducted a retrospective analysis of 109,836 patients ≥ 18 years old that met criteria for SIRS and received fluid resuscitation with crystalloids. We examined the association between changes in serum chloride concentration, the administered chloride load and fluid volume, and the 'volume-adjusted chloride load' and in-hospital mortality. In general, increases in the serum chloride concentration were associated with increased mortality. Mortality was lowest (3.7%) among patients with minimal increases in serum chloride concentration (0-10 mmol/L) and when the total administered chloride load was low (3.5% among patients receiving 100-200 mmol; P SIRS, a fluid resuscitation strategy employing lower chloride loads was associated with lower in-hospital mortality. This association was independent of the total fluid volume administered and remained significant after adjustment for severity of illness, supporting the hypothesis that crystalloids with lower chloride content may be preferable for managing patients with SIRS.

  4. Effect of Intravenously Administered Crystalloid Solutions on Acid-Base Balance in Domestic Animals.

    Science.gov (United States)

    Muir, W

    2017-09-01

    Intravenous fluid therapy can alter plasma acid-base balance. The Stewart approach to acid-base balance is uniquely suited to identify and quantify the effects of the cationic and anionic constituents of crystalloid solutions on plasma pH. The plasma strong ion difference (SID) and weak acid concentrations are similar to those of the administered fluid, more so at higher administration rates and with larger volumes. A crystalloid's in vivo effects on plasma pH are described by 3 general rules: SID > [HCO3-] increases plasma pH (alkalosis); SID solutions has little to no effect on plasma pH because of their low titratable acidity. Appreciation of IV fluid composition and an understanding of basic physicochemical principles provide therapeutically valuable insights about how and why fluid therapy can produce and correct alterations of plasma acid-base equilibrium. The ideal balanced crystalloid should (1) contain species-specific concentrations of key electrolytes (Na + , Cl - , K + , Ca ++ , Mg ++ ), particularly Na + and Cl - ; (2) maintain or normalize acid-base balance (provide an appropriate SID); and (3) be isosmotic and isotonic (not induce inappropriate fluid shifts) with normal plasma. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  5. [Pure subacute pandysautonomia: an assessment of treatment with intravenous polyvalent immunoglobulins].

    Science.gov (United States)

    Ramirez, C; de Sèze, J; Stojkovic, T; Ferriby, D; Delalande, S; Defoort-Dhellemmes, S; Vermersch, P

    2004-10-01

    Acute or sub-acute pure dysautonomia is uncommon. We report a case of sub-acute pure pandysautonomia with favorable outcome after intravenous immunoglobulin therapy. A 29-year-old right-handed student, with an uneventful medical history presented, for one month, bilateral loss of visual acuity and digestive disorders, associating diarrhea, vomiting and anorexia. Physical examination revealed bilateral intrinsec oculomotor nerve palsy, a dryness syndrome and severe orthostatic hypotension. Ophthalmologic examination showed bilateral diffuse parasympathic impairment associating an Argyll Robertson pupil and full pupil light reflex abolition. Elevated protein level (0.93g/l) was the only cerebrospinal fluid anomaly. Serum tests were negative for anti-gangliosides antibodies. The patient improved slowly after two series of intravenous immunoglobulin infusions. Clinical course and laboratory findings suggest that acute or sub-acute pure pandysautonomia events are likely to be related to acute polyradiculoneuritis. Therefore intravenous polyvalent immunoglobulin infusions should be attempted, even if their efficacy needs to be confirmed.

  6. Central venous catheter insertion problem solving using intravenous catheter: technical communication

    Directory of Open Access Journals (Sweden)

    Alemohammad M

    2013-02-01

    Full Text Available Insertion of central venous catheter is an accepted method for hemodynamic monitor-ring, drug and fluid administration, intravenous access, hemodialysis and applying cardiac pace-maker in hospitalized patients. This procedure can be associated with severe complications. The aim of this article is to provide a practical approach to prevent catheter malposition in states that the guide wire will not pass freely.During central venous insertion in internal jugular vein using modified seldinger technique, when after venous insertion, the passage of the guide wire shows difficulties and don’t pass freely, insertion of an intravenous cannula over the wire and re-insertion of the wire can help to prevent malposition of the wire and the catheter. Use of an intravenous cannula over the guide, in situations that the guide wire cannot pass freely among the needle inserted in internal jugular vein, and re-insertion of the guide can probably prevent or reduce the tissue or vascular trauma and the associated complica-tions. This simple maneuver can be helpful in difficult cases especially in cardiac surgery patients who receive high dose heparin and it is necessary to avoid traumatize-tion of carotid artery.

  7. Fluid mechanics

    International Nuclear Information System (INIS)

    Paraschivoiu, I.; Prud'homme, M.; Robillard, L.; Vasseur, P.

    2003-01-01

    This book constitutes at the same time theoretical and practical base relating to the phenomena associated with fluid mechanics. The concept of continuum is at the base of the approach developed in this work. The general advance proceeds of simple balances of forces as into hydrostatic to more complex situations or inertias, the internal stresses and the constraints of Reynolds are taken into account. This advance is not only theoretical but contains many applications in the form of solved problems, each chapter ending in a series of suggested problems. The major part of the applications relates to the incompressible flows

  8. Fluid Sounds

    DEFF Research Database (Denmark)

    and in architectural design. Aesthetics, psychoacoustics, perception, and cognition are all present in this expanding field embracing such categories as soundscape composition, sound art, sonic art, sound design, sound studies and auditory culture. Of greatest significance to the overall field is the investigation...... of sound, site and the social, and how the spatial, the visual, and the bodily interact in sonic environments, how they are constructed and how they are entangled in other practices. With the Seismograf special issue Fluid Sounds, we bring this knowledge into the dissemination of audio research itself...

  9. Principles of fluid mechanics

    International Nuclear Information System (INIS)

    Kreider, J.F.

    1985-01-01

    This book is an introduction on fluid mechanics incorporating computer applications. Topics covered are as follows: brief history; what is a fluid; two classes of fluids: liquids and gases; the continuum model of a fluid; methods of analyzing fluid flows; important characteristics of fluids; fundamentals and equations of motion; fluid statics; dimensional analysis and the similarity principle; laminar internal flows; ideal flow; external laminar and channel flows; turbulent flow; compressible flow; fluid flow measurements

  10. Maintenance fluid therapy and fluid creep impose more significant fluid, sodium, and chloride burdens than resuscitation fluids in critically ill patients: a retrospective study in a tertiary mixed ICU population.

    Science.gov (United States)

    Van Regenmortel, Niels; Verbrugghe, Walter; Roelant, Ella; Van den Wyngaert, Tim; Jorens, Philippe G

    2018-03-27

    Research on intravenous fluid therapy and its side effects, volume, sodium, and chloride overload, has focused almost exclusively on the resuscitation setting. We aimed to quantify all fluid sources in the ICU and assess fluid creep, the hidden and unintentional volume administered as a vehicle for medication or electrolytes. We precisely recorded the volume, sodium, and chloride burdens imposed by every fluid source administered to 14,654 patients during the cumulative 103,098 days they resided in our 45-bed tertiary ICU and simulated the impact of important strategic fluid choices on patients' chloride burdens. In septic patients, we assessed the impact of the different fluid sources on cumulative fluid balance, an established marker of morbidity. Maintenance and replacement fluids accounted for 24.7% of the mean daily total fluid volume, thereby far exceeding resuscitation fluids (6.5%) and were the most important sources of sodium and chloride. Fluid creep represented a striking 32.6% of the mean daily total fluid volume [median 645 mL (IQR 308-1039 mL)]. Chloride levels can be more effectively reduced by adopting a hypotonic maintenance strategy [a daily difference in chloride burden of 30.8 mmol (95% CI 30.5-31.1)] than a balanced resuscitation strategy [daily difference 3.0 mmol (95% CI 2.9-3.1)]. In septic patients, non-resuscitation fluids had a larger absolute impact on cumulative fluid balance than did resuscitation fluids. Inadvertent daily volume, sodium, and chloride loading should be avoided when prescribing maintenance fluids in view of the vast amounts of fluid creep. This is especially important when adopting an isotonic maintenance strategy.

  11. Effects of intravenous diclofenac on postoperative sore throat in ...

    African Journals Online (AJOL)

    Effects of intravenous diclofenac on postoperative sore throat in patients undergoing laparoscopic surgery at Aga Khan University Hospital, Nairobi: A prospective, randomized, double blind controlled trial.

  12. Intravenous methylprednisolone pulse therapy for children with epileptic encephalopathy

    OpenAIRE

    Pera, Maria Carmela; Randazzo, Giovanna; Masnada, Silvia; Dontin, Serena Donetti; De Giorgis, Valentina; Balottin, Umberto; Veggiotti, Pierangelo

    2015-01-01

    The aim of this retrospective study of children affected by epileptic encephalopathy was to evaluate seizure frequency, electroencephalographic pattern and neuropsychological status, before and after intravenous methylprednisolone therapy.

  13. Unexpected intra-operative diagnosis of a large cystic ...

    African Journals Online (AJOL)

    crampy abdominal pain, hypercalcaemia, and postprandial nausea and vomiting suggestive of intermittent bowel obstruction. Her medical history included hypothyroidism and hypertension. There was no prior surgical history of note. Her medications included nifedipine XL, losartan, hydrochlorothiazide and levothyroxine.

  14. Intra-operative RF ablation in the atria.

    Science.gov (United States)

    Swanson, David; Panescu, Dorin

    2004-01-01

    We examined two methods of creating atrial linear transmural lesions for an epicardial approach. In a monopolar approach, radiofrequency (RF) ablation was applied to a multiple coil electrode probe with internal cooling to create linear and transmural lesions from the epicardium. Compared to no cooling, internal cooling enables faster and deeper lesion formation. In vitro experiments showed that with internal cooling epicardial RF energy applications time requirements could be reduced from longer than 3 min to 45 seconds to achieve transmural lesions despite convective endocardial cooling produced by blood flow. In vivo experimentation in five sheep confirmed atrial transmural lesions were achieved using 120 seconds of RF application times at set temperatures of 80 degrees C. In a bipolar clamp approach, RF ablation was applied from multiple coil electrodes mounted on one jaw of the clamp to coil electrodes mounted on the opposing jaw of the clamp. In vitro experiments showed that lesions could be made reliably through tissues up to 1-cm thick using RF energy applied for 30 seconds with a set temperature of 80 degrees C. Animal experiments confirmed that pulmonary veins (PV) could be isolated in an electrophysiological (EP) sense from the left atrium by creating an encircling lesion in a cuff of tissue surrounding the PV using the bipolar ablating clamp technique.

  15. aging hypotension and intra-operative cardiac arres

    African Journals Online (AJOL)

    Initiate CPR. Call for defibrillator. Instruct surgeon to deliver foetus. All to follow instructions. Can ask: “what must I do?” *Times given are approximate values for ..... Functioning of operating table. 4. 4. 4. Neonatal equipment. Indicate that neonatal equipment must be checked. 0. 3. 4. Preoperative assessment. Medical and ...

  16. Broken Heart Syndrome – An intra operative complication

    Directory of Open Access Journals (Sweden)

    Zara Wani

    2018-03-01

    Full Text Available We report a case of Broken Heart Syndrome in a 56 year old Postmenopausal woman suffered while undergoing simple biopsy procedure for vocal cord polyp that lead to physical, mental and financial burden both for the patient as well as the doctors. A team of cardiologists based on clinical and echocardiographic findings made the diagnosis of this case.

  17. Intra-Operational Area Coordination: The Zone EOC Concept

    Science.gov (United States)

    2015-09-01

    critical infrastructure, including regional mass transportation corridors, as well as gas, electric , fuel, and water utility lines.5 Any earthquakes ...more effective alternate model and offers an alternative, multilateral collaborative model solution—the zone EOC concept. Designed to enable...Operations Center (DOC), operational area, emergency response coordination, mutual aid, catastrophic disasters, earthquake , geographic regions, emergency

  18. aging hypotension and intra-operative cardiac arres

    African Journals Online (AJOL)

    class correlation coefficient of 0.983. Conclusions: The scoring tool was shown to be valid and reliable. It offers a standardised assessment process and may be used to refine institutional intern training programmes, with a view to improving ...

  19. Intra-operative pneumatic tourniquet - perceptions of use and ...

    African Journals Online (AJOL)

    Fifty-four per cent of respondents personally checked the calibration of the pneumatic tourniquet, although 76% of respondents believe that the apparatus needs to be checked at least once per month. More respondents who did not check the tourniquet apparatus than respondents who did check it believe that applied ...

  20. Intra-operative pneumatic tourniquet - perceptions of use and ...

    African Journals Online (AJOL)

    applied pressure alone or excessive applied pressure caused by use of faulty equipment. It needs to be emphasised to these surgeons that regular checking of the pneumatic tourniquet apparatus is necessary in order. MRC/UCT Bioenergetics of Exercise Research Unit, Department of. Physiology. University of Cape Town.

  1. Intra-operative hearing monitoring methods in middle ear surgeries

    Directory of Open Access Journals (Sweden)

    Wei Ren

    2016-12-01

    Full Text Available Hearing loss is a condition affecting millions of people worldwide. Conductive hearing loss (CHL is mainly caused by middle ear diseases. The low frequency area is the pivotal part of speech frequencies and most frequently impaired in patients with CHL. Among various treatments of CHL, middle ear surgery is efficient to improve hearing. However, variable success rates and possible needs for prolonged revision surgery still frustrate both surgeons and patients. Nowadays, increasing numbers of researchers explore various methods to monitor the efficacy of ossicular reconstruction intraoperatively, including electrocochleography (ECochG, auditory brainstem response (ABR, auditory steady state response (ASSR, distortion product otoacoustic emissions (DPOAE, subjective whisper test, and optical coherence tomography (OCT. Here, we illustrate several methods used clinically by reviewing the literature.

  2. Intra-operative parathyroid hormone measurements – experience of ...

    African Journals Online (AJOL)

    These patients remained normocalcaemic during follow-up. The 'uncured' patient was operated on by means of a targeted approach to the left lower parathyroid, based on the result of the sestamibi scan. His medical history comprised previous thy- roid gland surgery. After removal of what appeared to be thyroid tissue, the ...

  3. Anaphylaxis after intravenous infusion of dexketoprofen trometamol

    Directory of Open Access Journals (Sweden)

    Sertac Guler

    2016-09-01

    Full Text Available Dexketoprofen trometamol (DT, a nonsteroidal anti-inflammatory drug, is a highly water-soluble salt and active enantiomer of rac-ketoprofen. Its parenteral form is commonly used for acute pain management in emergency departments of our country. Side effects such as diarrhea, indigestion, nausea, stomach pain, and vomiting may be seen after the use of DT. Anaphylactic shock (AS secondary to infusion of DT is very rare and, to our knowledge, it is the first case report describing this side effect. This case report was presented to emphasize that AS may be seen after the use of DT. Keywords: Anaphylactic shock, Dexketoprofen trometamol, Intravenous infusion (MeSH database

  4. Intravenous urography in children and youth

    Energy Technology Data Exchange (ETDEWEB)

    Pedersen, H.K.; Gudmundsen, T.E.; Oestensen, H.; Pape, J.F.

    1987-10-01

    This report derives from Tromsoe in northern Norway. In a retrospective study of the indications for intravenous urography (IU) and the findings at IU in 740 patients (451 girls and 289 boys) aged 0-19 years, we found that urinary tract infections accounted for 69.4% of the IU in females and 30.1% of the IU in males, most often seen in the youngest patients. The pathological findings most frequently seen were anomalies (17 females and 10 males) and urinary tract obstruction (3 females and 15 males). The present study indicates the following: first, that the yield of IU in the primary investigation of children and youth suffering from enuresis and non-specific abdominal disturbancies is small; and second, that the use of IU in children and youth with urinary tract infection and haematuria should be questioned and reconsidered.

  5. Renal trauma and the intravenous urogram.

    Science.gov (United States)

    Oakland, C D; Britton, J M; Charlton, C A

    1987-01-01

    A retrospective analysis of all patients with blunt abdominal trauma associated with haematuria admitted to one hospital (Royal United, Bath) in a 10-year period was conducted to establish the contribution of the intravenous urogram (IVU) in their management. Eighty-one case records were analysed. Of 35 IVUs performed in patients with microscopic (reagentstrip positive) haematuria, only one was abnormal. In contrast, 27 IVUs performed in patients with macroscopic (naked eye) haematuria revealed 17 major injuries and 5 previously unrecognized congenital abnormalities. It is concluded that an IVU is an unnecessary and non-contributory investigation in patients with microscopic haematuria and guidelines are suggested for the role of IVU in patients with blunt abdominal trauma associated with haematuria. PMID:3560121

  6. Retrocaval ureter: the importance of intravenous urography.

    Science.gov (United States)

    Hassan, Radhiana; Aziz, Azian Abd; Mohamed, Siti Kamariah Che

    2011-10-01

    Retrocaval ureter is a rare cause of hydronephrosis. Its rarity and non-specific presentation pose a challenge to surgeons and radiologists in making the correct diagnosis. Differentiation from other causes of urinary tract obstruction, especially the more common urolithiasis, is important for successful surgical management. Current practice has seen multislice computed tomography (MSCT) rapidly replaces intravenous urography (IVU) in the assessment of patients with hydronephrosis due to suspected urolithiasis, especially ureterolithiasis. However, MSCT, without adequate opacification of the entire ureter, may allow the physician to overlook a retrocaval ureter as the cause of hydronephrosis. High-resolution IVU images can demonstrate the typical appearance that leads to the accurate diagnosis of a retrocaval ureter. We reported a case that illustrates this scenario and highlights the importance of IVU in the assessment of a complex congenital disorder involving the urinary tract.

  7. Intravenous immunoglobulin, pharmacogenomics, and Kawasaki disease.

    Science.gov (United States)

    Kuo, Ho-Chang; Hsu, Yu-Wen; Wu, Mei-Shin; Chien, Shu-Chen; Liu, Shih-Feng; Chang, Wei-Chiao

    2016-02-01

    Kawasaki disease (KD) is a systemic vasculitis of unknown etiology and it is therefore worth examining the multifactorial interaction of genes and environmental factors. Targeted genetic association and genome-wide association studies have helped to provide a better understanding of KD from infection to the immune-related response. Findings in the past decade have contributed to a major breakthrough in the genetics of KD, with the identification of several genomic regions linked to the pathogenesis of KD, including ITPKC, CD40, BLK, and FCGR2A. This review focuses on the factors associated with the genetic polymorphisms of KD and the pharmacogenomics of the response to treatment in patients with intravenous immunoglobulin resistance. Copyright © 2014. Published by Elsevier B.V.

  8. [Use of intravenous immunoglobulins in pediatrics].

    Science.gov (United States)

    Duse, M; Plebani, A; Crispino, P; Ugazio, A G

    1991-01-01

    Intramuscular Immunoglobulin (IMIG) have been used for 40 years in substitution therapy for antibody deficiencies and as prophylaxis for and treatment of several infectious diseases. Modified and intact intravenous immunoglobulin preparations (IVIG) have now been available for more than 10 years: only the intact product express full Fc- mediated functions with a biological half-life of IgG (3-4 weeks). These preparations have constituted an important achievement in the treatment of humoral immunodeficiencies also resulting in a dramatic improvement of the prognosis. The use of IVIG has also modified the therapeutic approach to several secondary and acquired immunodeficiencies. Treatment with IVIG for immune modulation in several diseases is investigated: substantial data indicate a useful role in selected cases of idiopathic thrombocytopenic purpura, Kawasaky disease and in some neurologic diseases. IVIG are substantially safe and severe side effects have been rarely reported.

  9. Intravenous urography in children and youth

    International Nuclear Information System (INIS)

    Pedersen, H.K.; Gudmundsen, T.E.; Oestensen, H.; Pape, J.F.

    1987-01-01

    This report derives from Tromsoe in northern Norway. In a retrospective study of the indications for intravenous urography (IU) and the findings at IU in 740 patients (451 girls and 289 boys) aged 0-19 years, we found that urinary tract infections accounted for 69.4% of the IU in females and 30.1% of the IU in males, most often seen in the youngest patients. The pathological findings most frequently seen were anomalies (17 females and 10 males) and urinary tract obstruction (3 females and 15 males). The present study indicates the following: first, that the yield of IU in the primary investigation of children and youth suffering from enuresis and non-specific abdominal disturbancies is small; and second, that the use of IU in children and youth with urinary tract infection and haematuria should be questioned and reconsidered. (orig.)

  10. Solar urticaria successfully treated with intravenous immunoglobulin.

    LENUS (Irish Health Repository)

    Hughes, R

    2012-02-01

    Idiopathic solar urticaria (SU) is a rare, debilitating photodermatosis, which may be difficult to treat. First-line treatment with antihistamines is effective in mild cases, but remission after phototherapeutic induction of tolerance is often short-lived. Other treatment options include plasma exchange, photopheresis and cyclosporin. We present two cases of severe, idiopathic SU, which were resistant to conventional treatment. Both patients achieved remission after administration of intravenous immunoglobulin (IVIg) and have remained in remission at 13 months and 4 years, respectively. There are only two case reports of successful treatment of solar urticaria with IVIg. In our experience IVIg given at a total dose of 2 g\\/kg over several 5-day courses about a month apart is an effective treatment option for severe idiopathic SU. It is also generally safe, even if certainly subject to significant theoretical risks, such as induction of viral infection or anaphylaxis.

  11. Does Intravenous Midazolam Dose Influence the Duration of Recovery Room Stay Following Outpatient Third Molar Surgery?

    Science.gov (United States)

    Ettinger, Kyle S; Jacob, Adam K; Viozzi, Christopher F; Van Ess, James M; Fillmore, W Jonathan; Arce, Kevin

    2015-12-01

    To evaluate the impact of intravenous midazolam dose on the duration of recovery room stay for patients undergoing outpatient third molar surgery. Using a retrospective cohort study design, a sample of patients undergoing outpatient third molar surgery under intravenous sedation at Mayo Clinic from 2010 to 2014 was identified. All patients underwent extraction of all 4 third molars during a single operative procedure and the age range was limited to 14 to 29 years. The primary predictor variable was the total dose of intravenous midazolam administered during sedation. The primary outcome variable was recovery room length of stay (LOS) after completion of surgery. Multiple covariates also abstracted included patient age, gender, American Society of Anesthesiologists (ASA) score, duration of surgical procedure, complexity of surgical procedure, types and dosages of all intravenous medications administered during sedation, and volume of crystalloid fluid administered perioperatively. Univariable and multivariable models were developed to evaluate associations between the primary predictor variable and covariates relative to the primary outcome variable. The study sample was composed of 2,610 patients. Mean age was 18.3 years (SD, 3.0 yr; range, 14 to 29 yr) and gender distribution was 52% female. Mean dosage of midazolam administered was 4.1 mg (SD, 1.1 mg; range, 0.5 to 10.0 mg). Variables predicting shorter LOS at multivariable analysis included older age (P third molar surgery. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Ceftaroline fosamil: just another intravenous antibiotic.

    Science.gov (United States)

    2013-12-01

    Various antibiotics, especially cephalosporins, are used for empirical treatment of community-acquired pneumonia requiring hospitalisation and intravenous treatment, and for serious infections of the skin and soft tissues. When the infection is caused by bacteria that are resistant to common antibiotics, some antibiotics such as vancomycin are available. Ceftaroline (Zinforo, AstraZeneca) is a new cephalosporin intended for intravenous administration (as ceftaroline fosamil). It is authorised for the treatment of community-acquired pneumonia and for serious infections of the skin and soft tissues. In two double-blind, randomised trials of ceftaroline versus ceftriaxone (a cephalosporin), ceftaroline showed no advantage in patients with community-acquired pneumonia. Note that the results of these trials are undermined by the use of a suboptimal dose of ceftriaxone. Ceftaroline has not been evaluated versus a first-line treatment for serious skin infections. It has been compared with second-line antibiotics in patients with serious skin infections in four randomised trials. None of these trials showed that ceftaroline has superior efficacy. The known adverse effect profile of ceftaroline is similar to that of all cephalosporins, and comprises hypersensitivity reactions (including anaphylaxis) and gastrointestinal disorders (including rare cases of pseudomembranous colitis). A possible excess of haematological and renal adverse effects has also been raised. Given the absence of relevant data, it is best to avoid using ceftaroline during pregnancy. In practice, there is no proof that ceftaroline represents a therapeutic advance for patients with community-acquired pneumonia warranting hospitalisation or with serious skin or soft-tissue infections. It is best to stick with better-known antibiotics.

  13. Phytonadione Content in Branded Intravenous Fat Emulsions.

    Science.gov (United States)

    Forchielli, Maria Luisa; Conti, Matteo; Motta, Roberto; Puggioli, Cristina; Bersani, Germana

    2017-03-01

    Intravenous fat emulsions (IVFE) with different fatty acid compositions contain vitamin E as a by-product of vegetable and animal oil during the refining processes. Likewise, other lipid-soluble vitamins may be present in IVFE. No data, however, exist about phytonadione (vitamin K1) concentration in IVFE information leaflets. Therefore, our aim was to evaluate the phytonadione content in different IVFE. Analyses were carried out in triplicate on 6 branded IVFE as follows: 30% soybean oil (100%), 20% olive-soybean oil (80%-20%), 20% soybean-medium-chain triglycerides (MCT) coconut oil (50%-50%), 20% soybean-olive-MCT-fish oil (30%-25%-30%-15%), 20% soybean-MCT-fish oil (40%-50%-10%), and 10% pure fish oil (100%). Phytonadione was analyzed and quantified by a quali-quantitative liquid chromatography-mass spectrometry (LC-MS) method after its extraction from the IVFE by an isopropyl alcohol-hexane mixture, reverse phase-liquid chromatography, and specific multiple-reaction monitoring for phytonadione and vitamin d3 (as internal standard). This method was validated through specificity, linearity, and accuracy. Average vitamin K1 content was 500, 100, 90, 100, 95, and 70 µg/L in soybean oil, olive-soybean oil, soybean-MCT coconut oil, soybean-olive-MCT-fish oil, soybean-MCT-fish oil, and pure fish oil intravenous lipid emulsions (ILEs), respectively. The analytical LC-MS method was extremely effective in terms of specificity, linearity ( r = 0.99), and accuracy (coefficient of variation <5%). Phytonadione is present in IVFE, and its intake varies according to IVFE type and the volume administered. It can contribute to daily requirements and become clinically relevant when simultaneously infused with multivitamins during long-term parenteral nutrition. LC-MS seems adequate in assessing vitamin K1 intake in IVFE.

  14. Intravenous volume tomographic pulmonary angiography imaging

    Science.gov (United States)

    Ning, Ruola; Strang, John G.; Chen, Biao; Conover, David L.; Yu, Rongfeng

    1999-05-01

    This study presents a new intravenous (IV) tomographic angiography imaging technique, called intravenous volume tomographic digital angiography (VTDA) for cross sectional pulmonary angiography. While the advantages of IV-VTDA over spiral CT in terms of volume scanning time and resolution have been validated and reported in our previous papers for head and neck vascular imaging, the superiority of IV-VTDA over spiral CT for cross sectional pulmonary angiography has not been explored yet. The purpose of this study is to demonstrate the advantage of isotropic resolution of IV-VTDA in the x, y and z directions through phantom and animal studies, and to explore its clinical application for detecting clots in pulmonary angiography. A prototype image intensifier-based VTDA imaging system has been designed and constructed by modifying a GE 8800 CT scanner. This system was used for a series of phantom and dog studies. A pulmonary vascular phantom was designed and constructed. The phantom was scanned using the prototype VTDA system for direct 3D reconstruction. Then the same phantom was scanned using a GE CT/i spiral CT scanner using the routine pulmonary CT angiography protocols. IV contrast injection and volume scanning protocols were developed during the dog studies. Both VTDA reconstructed images and spiral CT images of the specially designed phantom were analyzed and compared. The detectability of simulated vessels and clots was assessed as the function of iodine concentration levels, oriented angles, and diameters of the vessels and clots. A set of 3D VTDA reconstruction images of dog pulmonary arteries was obtained with different IV injection rates and isotropic resolution in the x, y and z directions. The results of clot detection studies in dog pulmonary arteries have also been shown. This study presents a new tomographic IV angiography imaging technique for cross sectional pulmonary angiography. The results of phantom and animal studies indicate that IV-VTDA is

  15. Forced fluid removal versus usual care in intensive care patients with high-risk acute kidney injury and severe fluid overload (FFAKI)

    DEFF Research Database (Denmark)

    Berthelsen, Rasmus E.; Itenov, Theis; Perner, Anders

    2017-01-01

    Background: Intravenous administration of fluids is an essential part of critical care. While some fluid administration is likely beneficial, there is increasing observational evidence that the development of fluid overload is associated with increased mortality. There are no randomised trials...... to confirm this association in patients with acute kidney injury. We aim to perform a pilot trial to test the feasibility of forced fluid removal compared to standard care in patients with acute kidney injury and severe fluid overload, the FFAKI trial. Methods: Then FFAKI trial is a pilot, multicentre......, randomised clinical trial recruiting adult intensive care patients with acute kidney injury and fluid overload, defined as more than 10% of ideal bodyweight. Patients are randomised with concealed allocation to either standard care or forced fluid removal with a therapeutic target of negative net fluid...

  16. Intraperitoneal delivery of monoclonal antibodies: enhanced regional delivery advantage using intravenous unlabeled anti-mouse antibody

    International Nuclear Information System (INIS)

    Wahl, R.L.; Fisher, S.

    1987-01-01

    Radiolabeled monoclonal antibodies (MAb) delivered intraperitoneally expose cells in contact with peritoneal fluid to considerably higher levels of MAb than if the MAb dose were given intravenously. This regional delivery advantage for intact MAb is present mainly due to the relatively slow exit of MAb from the peritoneal fluid to the blood. Eventually, following i.p. injection, blood levels of MAb rise resulting in exposure of the animal to high systemic MAb levels and potential toxicity. In this series of experiments, systemic exposure was minimized by the administration of unlabeled goat polyclonal anti-mouse antibody intravenously from 1 1/2 to 6 h following i.p. MAb injection. This maneuver results in the formation of immune complexes with their subsequent clearance and dehalogenation by the reticuloendothelial system, thus minimizing systemic MAb exposure. This approach, of increasing systemic clearance of MAb, did not alter intraperitoneal MAb levels and thus significantly increased the regional delivery advantage to the peritoneal cavity by 70-100%. This approach provides an immunologic rationale for the further enhancement of MAb delivery to i.p. foci of malignant disease and may have diagnostic and therapeutic utility. (author)

  17. Extended stability of intravenous 0.9% sodium chloride solution after prolonged heating or cooling.

    Science.gov (United States)

    Puertos, Enrique

    2014-03-01

    The primary objective of this study was to evaluate the stability and sterility of an intravenous 0.9% sodium chloride solution that had been cooled or heated for an extended period of time. Fifteen sterile 1 L bags of 0.9% sodium chloride solution were randomly selected for this experiment. Five bags were refrigerated at an average temperature of 5.2°C, 5 bags were heated at an average temperature of 39.2°C, and 5 bags were stored at an average room temperature of 21.8°C to serve as controls. All samples were protected from light and stored for a period of 199 days prior to being assayed and analyzed for microbial and fungal growth. There was no clinically significant difference in the mean sodium values between the refrigerated samples, the heated samples, and the control group. There were no signs of microbial or fungal growth for the duration of the study. A sterile intravenous solution of 0.9% sodium chloride that was heated or cooled remained stable and showed no signs of microbial or fungal growth for a period of 199 days. This finding will allow hospitals and emergency medical technicians to significantly extend the expiration date assigned to these fluids and therefore obviate the need to change out these fluids every 28 days as recommended by the manufacturer.

  18. Turkish Validity Reliability of the Pediatric Peripheral Intravenous Infiltration Scale and Its Adaptation to Newborns

    Directory of Open Access Journals (Sweden)

    Ebru Temizsoy

    2017-12-01

    Full Text Available Aim: The aim of this study is to determine the Turkish validity reliability and newborns’ adaptation to Pediatric Peripheral Intravenous Infiltration Scale. Materials and Methods: This study is methodological and was conducted on 54 newborns with the simultaneous evaluation of two observers. Each infant was monitored 8 times with hourly observations from when the vein path was changed, and a total of 864 observational outcomes were assessed with scale. SPSS program was used for statistical evaluations. Results: A total of 54 newborns were taken into the study and the proportions of cases at each care level in neonatal intensive care unit were similar (level 1: 16 patients, level 2: 23 patients, level 3: 15 patients (p=0.348. The most commonly used fluid was found to be dextrose 10% in 63%, and total parenteral nutritional fluid in 26%. The newborns’ postnatal age was median 3 days (minimum: 1, maximum: 27. A total of 864 observations were made for 8 hours and in the 35% (n=19 of 54 babies, the vein pathway was changed after the first observation. 69% of the infants whose vascular accesses were changed, were identified in the first stage (1 point, 25% in the second stage (2 points, and vascular accesses were renewed. The Krippendorff’s alpha reliability coefficient showing the integration between the two evaluators was 1.00 (p<0.001. This result shows “full agreement” between the two evaluators. Intra-class correlation coefficient showing reliability between measurements was r=0.99 (p<0.001. This coefficient also indicates that the measurements are highly reliable. Conclusion: Intravenous infiltration and extravasations are preventable complications in neonates and should be assessed with the aid of a scale at regular intervals. Pediatric Peripheral Intravenous Infiltration Scale can be used in newborns and also in Turkish.

  19. Gyroelastic fluids

    Energy Technology Data Exchange (ETDEWEB)

    Kerbel, G.D.

    1981-01-20

    A study is made of a scale model in three dimensions of a guiding center plasma within the purview of gyroelastic (also known as finite gyroradius-near theta pinch) magnetohydrodynamics. The (nonlinear) system sustains a particular symmetry called isorrhopy which permits the decoupling of fluid modes from drift modes. Isorrhopic equilibria are analyzed within the framework of geometrical optics resulting in (local) dispersion relations and ray constants. A general scheme is developed to evolve an arbitrary linear perturbation of a screwpinch equilibrium as an invertible integral transform (over the complete set of generalized eigenfunctions defined naturally by the equilibrium). Details of the structure of the function space and the associated spectra are elucidated. Features of the (global) dispersion relation owing to the presence of gyroelastic stabilization are revealed. An energy principle is developed to study the stability of the tubular screwpinch.

  20. Gyroelastic fluids

    International Nuclear Information System (INIS)

    Kerbel, G.D.

    1981-01-01

    A study is made of a scale model in three dimensions of a guiding center plasma within the purview of gyroelastic (also known as finite gyroradius-near theta pinch) magnetohydrodynamics. The (nonlinear) system sustains a particular symmetry called isorrhopy which permits the decoupling of fluid modes from drift modes. Isorrhopic equilibria are analyzed within the framework of geometrical optics resulting in (local) dispersion relations and ray constants. A general scheme is developed to evolve an arbitrary linear perturbation of a screwpinch equilibrium as an invertible integral transform (over the complete set of generalized eigenfunctions defined naturally by the equilibrium). Details of the structure of the function space and the associated spectra are elucidated. Features of the (global) dispersion relation owing to the presence of gyroelastic stabilization are revealed. An energy principle is developed to study the stability of the tubular screwpinch

  1. Hydrothorax, hydromediastinum and pericardial effusion: a complication of intravenous alimentation.

    Science.gov (United States)

    Damtew, B; Lewandowski, B

    1984-01-01

    Complications secondary to intravenous alimentation are rare but potentially lethal. Massive bilateral pleural effusions and a pericardial effusion developed in a patient receiving prolonged intravenous alimentation. Severe respiratory distress and renal failure ensued. He recovered with appropriate treatment. Images Fig. 1 Fig. 2 Fig. 3 PMID:6428731

  2. Intravenous lipid emulsion and dexmedetomidine for treatment of ...

    African Journals Online (AJOL)

    All cats presented in this study, were treated with intravenous lipid emulsion (ILE) at variable dosages, and dexmedetomidine was also administered by intravenous way. No adverse reaction such as thrombophlebitis, overload circulation or others was noticed during and after administration of ILE. Dexmedetomidine was ...

  3. Clinical effect of intravenous thrombolysis combined with nicorandil ...

    African Journals Online (AJOL)

    Purpose: To evaluate the effectiveness of intravenous thrombolysis in combination with nicorandil in the treatment of acute ST-segment elevation myocardial infarction (STEMI). Methods: Patients who developed acute STEMI and underwent intravenous thrombolysis in the hospital were selected and divided into observation ...

  4. Effects of intravenous diclofenac on postoperative sore throat in ...

    African Journals Online (AJOL)

    EB

    Objective: To evaluate the effect of intravenous diclofenac sodium on the occurrence and severity of postoperative sore throat. Methods: ... Conclusion: Intravenous diclofenac sodium does not reduce the occurrence or severity of postoperative sore throat. .... 8.4% sodium bicarbonate-also a colourless liquid- was added to ...

  5. Cost-minimization of mabthera intravenous versus subcutaneous administration

    NARCIS (Netherlands)

    Bax, P.; Postma, M.J.

    2013-01-01

    Objectives: To identify and compare all costs related to preparing and administrating MabThera for the intravenous and subcutaneous formulations in Dutch hematological patients. The a priori notion is that the costs of subcutaneous MabThera injections are lower compared to intravenous infusion due

  6. The reliability of the physical examination to guide fluid therapy in adults with severe falciparum malaria: an observational study

    NARCIS (Netherlands)

    Hanson, Josh; Lam, Sophia W. K.; Alam, Shamsul; Pattnaik, Rajyabardhan; Mahanta, Kishore C.; Uddin Hasan, Mahatab; Mohanty, Sanjib; Mishra, Saroj; Cohen, Sophie; Day, Nicholas; White, Nicholas; Dondorp, Arjen

    2013-01-01

    Adults with severe malaria frequently require intravenous fluid therapy to restore their circulating volume. However, fluid must be delivered judiciously as both under- and over-hydration increase the risk of complications and, potentially, death. As most patients will be cared for in a

  7. Thermophysical Properties of Fluids and Fluid Mixtures

    Energy Technology Data Exchange (ETDEWEB)

    Sengers, Jan V.; Anisimov, Mikhail A.

    2004-05-03

    The major goal of the project was to study the effect of critical fluctuations on the thermophysical properties and phase behavior of fluids and fluid mixtures. Long-range fluctuations appear because of the presence of critical phase transitions. A global theory of critical fluctuations was developed and applied to represent thermodynamic properties and transport properties of molecular fluids and fluid mixtures. In the second phase of the project, the theory was extended to deal with critical fluctuations in complex fluids such as polymer solutions and electrolyte solutions. The theoretical predictions have been confirmed by computer simulations and by light-scattering experiments. Fluctuations in fluids in nonequilibrium states have also been investigated.

  8. Automatic fluid dispenser

    Science.gov (United States)

    Sakellaris, P. C. (Inventor)

    1977-01-01

    Fluid automatically flows to individual dispensing units at predetermined times from a fluid supply and is available only for a predetermined interval of time after which an automatic control causes the fluid to drain from the individual dispensing units. Fluid deprivation continues until the beginning of a new cycle when the fluid is once again automatically made available at the individual dispensing units.

  9. Responses of Preterm Pigs to an Oral Fluid Supplement During Parenteral Nutrition

    DEFF Research Database (Denmark)

    Berding, Kirsten; Makarem, Patty; Hance, Brittany

    2016-01-01

    Background: Nutrients and electrolytes in amniotic fluid swallowed by fetuses are important for growth and development. Yet, preterm infants requiring parenteral nutrition (PN) receive minimal or no oral inputs. With the limited availability of amniotic fluid, we evaluated the responses of preterm...... enterally (n = 10) or intravenously (n = 8). Outcome measures after 96 hours were weight gain, blood chemistry, organ weights, and small intestine mass and brush-border membrane carbohydrases. Results: The OFS did not improve weight gain compared with providing lactated Ringer’s orally or intravenously...

  10. Fluid Mechanics and Fluid Power (FMFP)

    Indian Academy of Sciences (India)

    Amitabh Bhattacharya

    decades, mainly due to the rapid improvement in computational efficiency, cameras, optics and instrumentation, both computational and experimental techniques have improved significantly, allowing researchers in Fluid Mechanics to build better mechanistic and analytical models for processes involving dynamics of fluids.

  11. Potential intravenous drug interactions in intensive care

    Directory of Open Access Journals (Sweden)

    Maiara Benevides Moreira

    Full Text Available Abstract OBJECTIVE To analyze potential intravenous drug interactions, and their level of severity associated with the administration of these drugs based on the prescriptions of an intensive care unit. METHOD Quantitative study, with aretrospective exploratory design, and descriptive statistical analysis of the ICU prescriptions of a teaching hospital from March to June 2014. RESULTS The sample consisted of 319 prescriptions and subsamples of 50 prescriptions. The mean number of drugs per patient was 9.3 records, and a higher probability of drug interaction inherent to polypharmacy was evidenced. The study identified severe drug interactions, such as concomitant administration of Tramadol with selective serotonin reuptake inhibitor drugs (e.g., Metoclopramide and Fluconazole, increasing the risk of seizures due to their epileptogenic actions, as well as the simultaneous use of Ranitidine-Fentanyl®, which can lead to respiratory depression. CONCLUSION A previous mapping of prescriptions enables the characterization of the drug therapy, contributing to prevent potential drug interactions and their clinical consequences.

  12. Intravenous injection of ioxilan, iohexol and diatrizoate

    Energy Technology Data Exchange (ETDEWEB)

    Thomsen, H.S.; Dorph, S.; Mygind, T.; Sovak, M.; Nielsen, H.; Rygaard, H.; Larsen, S.; Skaarup, P.; Hemmingsen, L.; Holm, J.

    Effects of intravenous ioxilan, a new third generation non-ionic contrast medium, diatrizoate, iohexol and saline on urine profiles were compared. Albumin, glucose, sodium, phosphate, and the enzymes NAG, LDH and GGT were followed in 24 normal rats over 7 days. Diatrizoate significantly affected all profile components during the first two hours. Albuminuria was significantly greater after diatrizoate than after iohexol or ioxilan, and excretion of glucose, LDH and GGT was significantly higher than after ioxilan. Both iohexol and ioxilan increased the excretion of albumin, LDH and GGT, while iohexol also significantly increased excretion of glucose and sodium. There was a greater excretion of glucose and GGT after iohexol than after ioxilan. Saline did not induce any changes. At day 7, serum sodium, urea, creatinine, and albumin were normal for all test substances, and kidney histology revealed no difference between the groups of animals. It is thus concluded that both high osmolar ionic and low osmolar non-ionic contrast media may cause temporary glomerular and tubular dysfunction in rats. In this model, the kidney is affected most by diatrizoate, less by iohexol, and least by ioxilan.

  13. Radiation dose measurements in intravenous pyelography

    International Nuclear Information System (INIS)

    Egeblad, M.; Gottlieb, E.

    1975-01-01

    Intravenous pyelography (IVP) and micturition cystourethrography (MCU) are the standard procedures in the radiological examination of children with urinary tract infections and in the control of these children. Gonad protection against radiation is not possible in MCU, but concerning the girls partly possible in IVP. It is of major importance to know the radiation dose in these procedures, especially since the examination is often repeated in the same patients. All IVP were done by means of the usual technique including possible gonad protection. The thermoluminescence dosimeter was placed rectally in the girls and fixed on the scrota in the boys. A total of 50 children was studied. Gonad dose ranged from 140 to 200mR in the girls and from 20 to 70mR in the boys (mean values). The radiation dose in IVP is very low compared to that of MCU, and from this point of view IVP is a dose saving examination in the control of children with urinary tract infections [fr

  14. Intravenous buprenorphine and norbuprenorphine pharmacokinetics in humans

    Science.gov (United States)

    Huestis, M.A.; Cone, E.J.; Pirnay, S.O.; Umbricht, A.; Preston, K.L.

    2013-01-01

    Background Prescribed sublingual (SL) buprenorphine is sometimes diverted for intravenous (IV) abuse, but no human pharmacokinetic data are available following high-dose IV buprenorphine. Methods Plasma was collected for 72 h after administration of placebo or 2, 4, 8, 12, or 16 mg IV buprenorphine in escalating order (single-blind, double-dummy) in 5 healthy male non-dependent opioid users. Buprenorphine and its primary active metabolite, norbuprenorphine, were quantified by liquid chromatography tandem mass spectrometry with limits of quantitation of 0.1 μg/L. Results Maximum buprenorphine concentrations (mean ± SE) were detected 10 min after 2, 4, 8, 12, 16 mg IV: 19.3±1.0, 44.5±4.8, 85.2±7.7, 124.6±16.6, and 137.7±18.8 μg/L, respectively. Maximum norbuprenorphine concentrations occurred 10–15 min (3.7±0.7 μg/L) after 16 mg IV administration. Conclusions Buprenorphine concentrations increased in a significantly linear dose-dependent manner up to 12 mg IV buprenorphine. Thus, previously demonstrated pharmacodynamic ceiling effects (over 2–16 mg) are not due to pharmacokinetic adaptations within this range, although they may play a role at doses higher than 12 mg. PMID:23246635

  15. Total intravenous anesthesia: advantages for intracranial surgery.

    Science.gov (United States)

    Cole, Chad D; Gottfried, Oren N; Gupta, Dhanesh K; Couldwell, William T

    2007-11-01

    Although volatile anesthetics have been widely accepted in anesthetic management for neurosurgery, they reduce vascular resistance, resulting in increased cerebral blood flow and increased intracranial pressure (ICP). In patients with elevated ICP who undergo craniotomy, the increase in ICP during surgery from inhaled anesthetics can make the surgery more difficult, thereby increasing the risk of ischemic cerebral insults. Total intravenous anesthesia (TIVA) using propofol and analgesic drugs (remifentanil or fentanyl) and excluding simultaneous administration of any inhaled drugs is being used in patients undergoing craniotomy because of its potential to reduce ICP and ease access to the operative site. We reviewed the literature and describe our experience with TIVA, with emphasis on hemodynamic stability, effects on ICP, emergence from anesthesia, extubation times, and return of cognitive function in patients undergoing craniotomy for space-occupying lesions. TIVA with propofol is similar to inhaled anesthetics with regard to hemodynamic stability, emergence times, extubation times, early cognitive function, and adverse events. In several prospective, randomized clinical trials, evidence suggests that ICP is decreased and cerebral perfusion pressure is increased in patients receiving TIVA when compared with those receiving volatile anesthetics during elective craniotomy procedures. The impact of TIVA on ICP, brain swelling, and access to the operative site in patients with severely elevated ICP has yet to be evaluated and is the subject of a future study at our institution.

  16. Infantile Spasms Treated with Intravenous Methypredinsolone Pulse.

    Science.gov (United States)

    Hassanzadeh Rad, Afagh; Aminzadeh, Vahid

    2017-01-01

    Infantile spasms is diagnosed late even by expert pediatricians. Late diagnosis (later than 3 weeks) can have a negative effect on the long-term prognosis. We aimed to investigate infantile spasms treated with intravenous methylprednisolone pulse. In this case series study, 20 infants with infantile spasms in 17-Shahrivar Hospital, Rasht, Iran were enrolled. Drugs were administered based on Mytinger protocol that included 3 days of methylprednisolone pulse and 56 days of oral prednisolone. The control of spasms and the omission of hypsarrhythmia in infants follow-up were the primary and secondary outcomes, respectively. Remission was indicated if the caregivers mentioned no spasms or >50% decrease regarding drug initiation for at least 5 consecutive days and the electroencephalography during sleep period noted the omission of hypsarrhythmia. Eleven female (55%) and 9 male (45%) patients with the mean age of 4.95±1.39 months were enrolled. Mean rapid remission was noted as 4.41±1.50 days. Twelve patients (60%) noted early remission. seizure was controlled in 3(15%) patients completely after 24 months. Five (25%) occasional seizures were noted controlled by routine anticonvulsant drugs after 24 months and 12 (60%) no response was mentioned. Most of the patients (65%) had cryptogenic etiology for infantile spasms. Uncontrolled seizure was mentioned after initial remission. Methyl prednisolone is an appropriate drug based on easy administering, low cost, and its accessibility.

  17. Rapid Intravenous Rehydration to Correct Dehydration and Resolve Vomiting in Children with Acute Gastroenteritis

    Directory of Open Access Journals (Sweden)

    Anoush AZARFAR

    2014-09-01

    Full Text Available SUMMARY: Objectives: The objective of this study is to evaluate the effect of rapid intravenous rehydration to resolve vomiting in children with acute gastroenteritis. Methods: This randomized control trial was conducted in the pediatric emergency department in a tertiary care center in Tabriz, North-West of Iran. The study participants' were 150 children with acute gastroenteritis and vomiting who were moderately dehydrated, had not responded to oral rehydration therapy and without any electrolyte abnormalities. 20–30 cc/kg of a crystalloid solution was given intravenously over 2 hours and the control group was admitted in the emergency department (ED for a standard 24 hour hydration. Effectiveness of rapid intravenous rehydration in the resolution of vomiting in children with acute gastroenteritis was evaluated. Results: In 63 children of the intervention group (out of 75 vomiting was resolved after rapid IV rehydration and they were discharged. Among them, 12 that did not tolerate oral fluids were admitted. In the control group, 62 patients' vomiting was resolved in the first 4 hours after admission, and there was no significant difference between the two groups regarding resolution of vomiting. Conclusions: Rapid intravenous rehydration in children with moderate dehydration and vomiting due to gastroenteritis is effective in reducing admission rates in the ED. ÖZET: Amaç: Bu çalışmanın amacı, akut gastroenteritli çocuklarda, hızlı intravenöz rehidratasyon tedavisinin kusma üzerine etkisini değerlendirmektir. Gereç ve Yöntem: Bu randomize kontrollü çalışma İran'ın Kuzeybatısındaki Tebriz ilinde üçüncü basamak çocuk acil servisinde gerçekleştirildi. Çalışmaya orta derecede dehidrate, elektrolit anormalliği olmayan ve oral rehidrasyon tedavisine yanıt vermemiş akut gastroenteritli 150 çocuk katıldı. İki saat içinde intravenöz yolla 20–30 cc/kg kristaloid çözelti verildi ve kontrol grubu standart

  18. Fluid Mechanics and Fluid Power (FMFP)

    Indian Academy of Sciences (India)

    Amitabh Bhattacharya

    of renewable energy (e.g., via wind, hydrokinetic generators), creating low-cost healthcare (e.g., via point-of-care medical testing) and improvement of energy efficiency of fluid power systems, depends on improving our understanding of Fluid. Mechanics. Fluids are ubiquitous in both nature and technological applications, ...

  19. Comparison of analgesic efficacy of intravenous Paracetamol and intravenous dexketoprofen trometamol in multimodal analgesia after hysterectomy.

    Science.gov (United States)

    Unal, Ciğdem; Cakan, Türkay; Baltaci, Bülent; Başar, Hülya

    2013-10-01

    [corrected] We aimed to evaluate analgesic efficacy, opioid-sparing, and opioid-related adverse effects of intravenous paracetamol and intravenous dexketoprofen trometamol in combination with iv morphine after total abdominal hysterectomy. Sixty American Society of Anesthesiologist Physical Status Classification I-II patients scheduled for total abdominal hysterectomy were enrolled to this double-blinded, randomized, placebo controlled, and prospective study. Patients were divided into three groups as paracetamol, dexketoprofen trometamol, and placebo (0.9% NaCl) due to their post-operative analgesic usage. Intravenous patient controlled analgesia morphine was used as a rescue analgesic in all groups. Pain scores, hemodynamic parameters, morphine consumption, patient satisfaction, and side-effects were evaluated. Visual Analog Scale (VAS) scores were not statistically significantly different among the groups in all evaluation times, but decrease in VAS scores was statistically significant after the evaluation at 12(th) h in all groups. Total morphine consumption (morphine concentration = 0.2 mg/ml) in group paracetamol (72.3 ± 38.0 ml) and dexketoprofen trometamol (69.3 ± 24.1 ml) was significantly lower than group placebo (129.3 ± 22.6 ml) (P dexketoprofen trometamol after surgery and the increase in global satisfaction score was significant only in group placebo. Dexketoprofen trometamol and Paracetamol didn't cause significant change on pain scores, but increased patients' comfort. Although total morphine consumption was significantly decreased by both drugs, the incidence of nausea and vomiting were similar among the groups. According to results of the present study routine addition of dexketoprofen trometamol and paracetamol to patient controlled analgesia morphine after hysterectomies is not recommended.

  20. Comparison of analgesic efficacy of intravenous Paracetamol and intravenous dexketoprofen trometamol in multimodal analgesia after hysterectomy

    Directory of Open Access Journals (Sweden)

    Çiğdem Ünal

    2013-01-01

    Full Text Available Backround: We aimed to evaluate analgesic efficacy, opioid-sparing, and opioid-related adverse effects of intravenous paracetamol and intravenous dexketoprofen trometamol in combination with iv morphine after total abdominal hysterectomy. Materials and Methods: Sixty American Society of Anesthesiologist Physical Status Classification I-II patients scheduled for total abdominal hysterectomy were enrolled to this double-blinded, randomized, placebo controlled, and prospective study. Patients were divided into three groups as paracetamol, dexketoprofen trometamol, and placebo (0.9% NaCl due to their post-operative analgesic usage. Intravenous patient controlled analgesia morphine was used as a rescue analgesic in all groups. Pain scores, hemodynamic parameters, morphine consumption, patient satisfaction, and side-effects were evaluated. Results: Visual Analog Scale (VAS scores were not statistically significantly different among the groups in all evaluation times, but decrease in VAS scores was statistically significant after the evaluation at 12 th h in all groups. Total morphine consumption (morphine concentration = 0.2 mg/ml in group paracetamol (72.3 ± 38.0 ml and dexketoprofen trometamol (69.3 ± 24.1 ml was significantly lower than group placebo (129.3 ± 22.6 ml (P < 0.001. Global satisfaction scores of the patients in group placebo was significantly lower than group dexketoprofen trometamol after surgery and the increase in global satisfaction score was significant only in group placebo. Conclusion: Dexketoprofen trometamol and Paracetamol didn′t cause significant change on pain scores, but increased patients′ comfort. Although total morphine consumption was significantly decreased by both drugs, the incidence of nausea and vomiting were similar among the groups. According to results of the present study routine addition of dexketoprofen trometamol and paracetamol to patient controlled analgesia morphine after hysterectomies is not

  1. Pediatric Acute Respiratory Distress Syndrome: Fluid Management in the PICU.

    Science.gov (United States)

    Ingelse, Sarah A; Wösten-van Asperen, Roelie M; Lemson, Joris; Daams, Joost G; Bem, Reinout A; van Woensel, Job B

    2016-01-01

    The administration of an appropriate volume of intravenous fluids, while avoiding fluid overload, is a major challenge in the pediatric intensive care unit. Despite our efforts, fluid overload is a very common clinical observation in critically ill children, in particular in those with pediatric acute respiratory distress syndrome (PARDS). Patients with ARDS have widespread damage of the alveolar-capillary barrier, potentially making them vulnerable to fluid overload with the development of pulmonary edema leading to prolonged course of disease. Indeed, studies in adults with ARDS have shown that an increased cumulative fluid balance is associated with adverse outcome. However, age-related differences in the development and consequences of fluid overload in ARDS may exist due to disparities in immunologic response and body water distribution. This systematic review summarizes the current literature on fluid imbalance and management in PARDS, with special emphasis on potential differences with adult patients. It discusses the adverse effects associated with fluid overload and the corresponding possible pathophysiological mechanisms of its development. Our intent is to provide an incentive to develop age-specific fluid management protocols to improve PARDS outcomes.

  2. Pediatric acute respiratory distress syndrome: fluid management in the PICU

    Directory of Open Access Journals (Sweden)

    Sarah A Ingelse

    2016-03-01

    Full Text Available The administration of an appropriate volume of intravenous fluids, while avoiding fluid overload, is a major challenge in the pediatric intensive care unit. Despite our efforts, fluid overload is a very common clinical observation in critically ill children, in particular in those with pediatric acute respiratory distress syndrome (PARDS. Patients with ARDS have widespread damage of the alveolar capillary barrier, potentially making them vulnerable to fluid overload with the development of pulmonary edema leading to prolonged course of disease. Indeed, studies in adults with ARDS have shown that an increased cumulative fluid balance is associated with adverse outcome. However, age-related differences in the development and consequences of fluid overload in ARDS may exist due to disparities in immunologic response and body water distribution. This systematic review summarizes the current literature on fluid imbalance and management in PARDS, with special emphasis on potential differences with adult patients. It discusses the adverse effects associated with fluid overload and the corresponding possible pathophysiological mechanisms of its development. Our intent is to provide an incentive to develop age-specific fluid management protocols to improve PARDS outcomes.

  3. Fluid dispersal from safety cannulas: an in vitro comparative test.

    Science.gov (United States)

    Rosenthal, Victor D; Hughes, Gavin

    2015-03-01

    We report a comparative laboratory study between 2 peripheral intravenous catheters equipped with a passive fully automatic safety mechanism to assess generation of blood droplets during withdrawal. One presented no fluid droplets, whereas the other presented droplets in 48% and 60% for the best and worst case, with analysis of variance showing positive effects on the number of droplets generated (P blood splatter. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  4. Characterization of immunoglobulin G fragments in liquid intravenous immunoglobulin products

    NARCIS (Netherlands)

    Diemel, Robert V.; ter Hart, Hendricus G. J.; Derksen, Gerardus J. A.; Koenderman, Anky H. L.; Aalberse, Rob C.

    2005-01-01

    Intravenous immunoglobulin (IVIG) products formulated as a liquid instead of a powder have become commercially available. Preferably, such liquid products should not alter after storage outside the refrigerator. Therefore, a thorough characterization of immunoglobulin G (IgG) fragmentation at

  5. Outcomes of cancer surgery after inhalational and intravenous anesthesia

    DEFF Research Database (Denmark)

    Soltanizadeh, Sinor; Degett, Thea H; Gögenur, Ismail

    2017-01-01

    Perioperative factors are probably essential for different oncological outcomes. This systematic review investigates the literature concerning overall mortality and postoperative complications after cancer surgery with inhalational (INHA) and intravenous anesthesia (TIVA). A search was conducted...

  6. Distinct in vitro Complement Activation by Various Intravenous Iron Preparations

    NARCIS (Netherlands)

    Hempel, Julia Cordelia; Poppelaars, Felix; da Costa, Mariana Gaya; Franssen, Casper F. M.; de Vlaam, Thomas P G; Daha, Mohamed R.; Berger, Stefan P.; Seelen, Marc A. J.; Gaillard, Carlo A. J. M.

    2017-01-01

    Background: Intravenous (IV) iron preparations are widely used in the treatment of anemia in patients undergoing hemodialysis (HD). All IV iron preparations carry a risk of causing hypersensitivity reactions. However, the pathophysiological mechanism is poorly understood. We hypothesize that a

  7. Intravenous glutathione for skin lightening: Inadequate safety data ...

    African Journals Online (AJOL)

    protein thiol that protects mammalian cells from oxidative stress. Intravenous (IV) GSH for skin lightening is advertised by clinics in South Africa and internationally online, yet to date no published review on the subject exists. Methods.

  8. Glucagon in intravenous cholangiography - an experimental study on dogs

    International Nuclear Information System (INIS)

    Toetterman, S.; Santavirta, S.; Antila, H.

    1980-01-01

    The present study reports on the effect of glucagon on the excretion of ioglycamate in experimental intravenous cholangiography on dogs. Glucagon increased the bile flow rate highly significantly (p [de

  9. Ultrasound Guidance as a Rescue Technique for Peripheral Intravenous Cannulation

    National Research Council Canada - National Science Library

    Pappas, Nancy L; Michaud, Terese E; Wolbers, Russell M; Steward, James C; Fevurly, Thomas A; Samolitis, Timothy J; Shoneboom, Bruce A; Watts, Dorraine D

    2006-01-01

    Peripheral intravenous (W) cannulation can be difficult to perform using the traditional landmark or visual/palpation technique in patients with access difficulties such as deep, sclerotic, small, or fragile veins...

  10. Plasma kinetics of intravenously administered lactose- in-saline in ...

    African Journals Online (AJOL)

    USER

    2010-05-17

    ) the rapid sequestration of homologous desialylated erythrocytes from the blood stream of rabbits has been considerably inhibited by intravenously administered lactose (Muller et al., 1981). More recently, infusion of lactose ...

  11. Advances in the use of intravenous techniques in ambulatory anesthesia

    Directory of Open Access Journals (Sweden)

    Eng MR

    2015-07-01

    Full Text Available Matthew R Eng,1 Paul F White1,2 1Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 2White Mountain Institute, The Sea Ranch, CA, USA Summary statement: Advances in the use of intravenous techniques in ambulatory anesthesia has become important for the anesthesiologist as the key perioperative physician in outpatient surgery. Key techniques and choices of anesthetics are important in accomplishing fast track goals of ambulatory surgery. Purpose of review: The anesthesiologist in the outpatient environment must focus on improving perioperative efficiency and reducing recovery times while accounting for patients' well-being and safety. This review article focuses on recent intravenous anesthetic techniques to accomplish these goals. Recent findings: This review is an overview of techniques in intravenous anesthesia for ambulatory anesthesia. Intravenous techniques may be tailored to accomplish outpatient surgery goals for the type of surgical procedure and individual patient needs. Careful anesthetic planning and the application of the plans are critical to an anesthesiologist's success with fast-track ambulatory surgery. Conclusion: Careful planning and application of intravenous techniques are critical to an anesthesiologist's success with fast-track ambulatory surgery. Keywords: intravenous anesthesia, outpatient anesthesia, fast-track surgery

  12. Process fluid cooling system

    International Nuclear Information System (INIS)

    Farquhar, N.G.; Schwab, J.A.

    1977-01-01

    A system of heat exchangers is disclosed for cooling process fluids. The system is particularly applicable to cooling steam generator blowdown fluid in a nuclear plant prior to chemical purification of the fluid in which it minimizes the potential of boiling of the plant cooling water which cools the blowdown fluid

  13. Fluid mechanics in fluids at rest.

    Science.gov (United States)

    Brenner, Howard

    2012-07-01

    Using readily available experimental thermophoretic particle-velocity data it is shown, contrary to current teachings, that for the case of compressible flows independent dye- and particle-tracer velocity measurements of the local fluid velocity at a point in a flowing fluid do not generally result in the same fluid velocity measure. Rather, tracer-velocity equality holds only for incompressible flows. For compressible fluids, each type of tracer is shown to monitor a fundamentally different fluid velocity, with (i) a dye (or any other such molecular-tagging scheme) measuring the fluid's mass velocity v appearing in the continuity equation and (ii) a small, physicochemically and thermally inert, macroscopic (i.e., non-Brownian), solid particle measuring the fluid's volume velocity v(v). The term "compressibility" as used here includes not only pressure effects on density, but also temperature effects thereon. (For example, owing to a liquid's generally nonzero isobaric coefficient of thermal expansion, nonisothermal liquid flows are to be regarded as compressible despite the general perception of liquids as being incompressible.) Recognition of the fact that two independent fluid velocities, mass- and volume-based, are formally required to model continuum fluid behavior impacts on the foundations of contemporary (monovelocity) fluid mechanics. Included therein are the Navier-Stokes-Fourier equations, which are now seen to apply only to incompressible fluids (a fact well-known, empirically, to experimental gas kineticists). The findings of a difference in tracer velocities heralds the introduction into fluid mechanics of a general bipartite theory of fluid mechanics, bivelocity hydrodynamics [Brenner, Int. J. Eng. Sci. 54, 67 (2012)], differing from conventional hydrodynamics in situations entailing compressible flows and reducing to conventional hydrodynamics when the flow is incompressible, while being applicable to both liquids and gases.

  14. Videotapes and Movies on Fluid Dynamics and Fluid Machines

    OpenAIRE

    Carr, Bobbie; Young, Virginia E.

    1996-01-01

    Chapter 17 of Handbook of Fluid Dynamics and Fluid Machinery: Experimental and Computational Fluid Dynamics, Volume 11. A list of videorecordings and 16mm motion pictures about Fluid Dynamics and Fluid Machines.

  15. Potential intravenous drug interactions in intensive care.

    Science.gov (United States)

    Moreira, Maiara Benevides; Mesquita, Maria Gefé da Rosa; Stipp, Marluci Andrade Conceição; Paes, Graciele Oroski

    2017-07-20

    To analyze potential intravenous drug interactions, and their level of severity associated with the administration of these drugs based on the prescriptions of an intensive care unit. Quantitative study, with aretrospective exploratory design, and descriptive statistical analysis of the ICU prescriptions of a teaching hospital from March to June 2014. The sample consisted of 319 prescriptions and subsamples of 50 prescriptions. The mean number of drugs per patient was 9.3 records, and a higher probability of drug interaction inherent to polypharmacy was evidenced. The study identified severe drug interactions, such as concomitant administration of Tramadol with selective serotonin reuptake inhibitor drugs (e.g., Metoclopramide and Fluconazole), increasing the risk of seizures due to their epileptogenic actions, as well as the simultaneous use of Ranitidine-Fentanyl®, which can lead to respiratory depression. A previous mapping of prescriptions enables the characterization of the drug therapy, contributing to prevent potential drug interactions and their clinical consequences. Analisar as potenciais interações medicamentosas intravenosas e seu grau de severidade associadas à administração desses medicamentos a partir das prescrições do Centro de Terapia Intensiva. Estudo quantitativo, tipologia retrospectiva exploratória, com análise estatística descritiva das prescrições medicamentosas do Centro de Terapia Intensiva de um Hospital Universitário, no período de março-junho/2014. A amostra foi composta de 319 prescrições e subamostras de 50 prescrições. Constatou-se que a média de medicamentos por paciente foi de 9,3 registros, e evidenciou-se maior probabilidade para ocorrência de interação medicamentosa inerente à polifarmácia. O estudo identificou interações medicamentosas graves, como a administração concomitante de Tramadol com medicamentos inibidores seletivos da recaptação da serotonina, (exemplo: Metoclopramida e Fluconazol

  16. A NOSOCOMIAL INFECTION MANIFESTED AS ERYSIPELAS IN PEMPHIGUS FOLIACEUS PATIENT UNDER INTRAVENOUS DEXAMETHASONE TREATMENT

    Directory of Open Access Journals (Sweden)

    Achmad Yudha Pranata

    2016-05-01

    Full Text Available Introduction: Puncture wound in diagnostic interventions permits the entry of bacteria into the skin or soft tissue, thus precipitating nosocomial infection, such as erysipelas. There are other risk factors of nosocomial infections including old age, immunosuppressive drugs, and underlying diseases. Pemphigus foliaceus (PF is an autoimmune disease with corticosteroid treatment as the mainstay therapy, which could cause immunosuppression and predispose patients to infection. The objective of this paper was to report erysipelas as one of the manifestations of nosocomial infection in patients under immunosuppressive therapy. Case: A case of erysipelas acquired on the 9th day of hospitalization in a PF patient underwent intravenous dexamethasone injection, with history of puncture wounds on the previous day on the site of erysipelas was reported. The clinical findings of erysipelas were well defined, painful erythema and edema that felt firm and warm on palpation, with blisters and pustules on top. Gram staining from the pustules and blisters fluid revealed Gram (+ cocci. Patient was given 2 grams intravenous ceftriaxone for 7 days and saline wet compress. Improvement on the erysipelas was seen the day after ceftriaxone injection. The patient was discharged after 12 days of hospitalization with improvement both on the PF and the erysipelas. On the next visit 7 days later, the erysipelas lesion disappeared. Conclusion: Puncture wound and immunosuppresive treatment are the factors that could cause erysipelas as a nosocomial infection, and an appropriate treatment of the infection would decrease the functional disability of the patient.

  17. [Successful treatment with intravenous steroid pulse therapy of a boy with recurrent idiopathic sixth nerve palsy].

    Science.gov (United States)

    Yamada, Keitaro; Kimizu, Tomokazu; Kimura, Sadami; Ikeda, Tae; Mogami, Yukiko; Yanagihara, Keiko; Suzuki, Yasuhiro

    2014-07-01

    A 3-year-old boy developed left-sided convergent strabismus one week after upper respiratory infection. All examinations, including analysis of cerebrospinal fluid, a tensilon test, and brain MRI, were negative. He was diagnosed with idiopathic sixth nerve palsy. His symptom resolved gradually with vitamin B12, and remitted completely three months after onset. At the age of 6 years, he experienced recurrence of left-sided sixth nerve palsy. After vitamin B12 failed, his symptom responded markedly to intravenous steroid pulse therapy starting on day 26 after relapse. He has been symptom-free for three years since the second remission. Steroid therapy might be effective, and should be considered in children with idiopathic sixth nerve palsy who do not show spontaneous remission.

  18. Influence of hang time and location on bacterial contamination of intravenous bags in a veterinary emergency and critical care setting.

    Science.gov (United States)

    Guillaumin, Julien; Olp, Nichole M; Magnusson, Karissa D; Butler, Amy L; Daniels, Joshua B

    2017-09-01

    To assess the rate of bacterial contamination of fluid and ports in intravenous bags in a veterinary emergency room (ER) and intensive care unit (ICU). Experimental model. Ninety intravenous fluid bags of lactated balanced-electrolytes solution (1 L) hung in a university hospital. Bags were hung in 2 different locations in the ER (sink and bins) and one location in the ICU (sink) for 11 days. Bags were punctured 3 times daily with a sterile needle to simulate clinical use. Injection ports were swabbed and 50 mL of fluid were collected in duplicates on days 0, 2, 4, 7, and 10. Aerobic bacterial cultures were performed on the fluid and injection port. Contamination was defined as bacterial growth of a similar phenotype across 2 consecutive times. Increase in the fluid contamination rate from day 0 was tested using an exact binomial test. Port contamination rate between locations was tested using Fisher's exact test. Combined bacterial growth on injection ports reached a mean (95% confidence interval) of 8.1 (0.005-16.2) cfu/port on day 10. The combined port contamination was 3.3%, 11.1%, 17.8%, and 31.1% on days 0, 2, 4, and 7, respectively. Port contamination was similar between ER and ICU. However, port contamination was higher in the sink versus the bins area (38.3% vs 16.7%, P = 0.032). No fluid bag was contaminated at days 0 and 2. The contamination rate of fluid bag was 1.1% and 4.4% on days 4 and 7, respectively. All bags with contaminated fluid were in the ER (6.7%, 95% exact binomial confidence interval 1.9-16.2%). Injection port contamination reached 31.1% on day 7. Contamination was more likely when the bags were hung next to a sink. In our model of bag puncture, fluid contamination occurred between days 2 and 4. © Veterinary Emergency and Critical Care Society 2017.

  19. Effect of Intravenous Ondansetron on the QT Interval of Patients' Electrocardiograms.

    Science.gov (United States)

    Krammes, Sarah Kline; Jacobs, Todd; Clark, John M; Lutes, R Esther

    2018-01-01

    Ondansetron improves the success of oral rehydration in children with gastroenteritis. In postoperative adults, ondansetron has been shown to prolong the corrected QT (QTc). The aim of the study was to evaluate the effect of ondansetron on the QT at peak effect and at 1-hour postpeak effect in pediatric patients. This was an observational study looking at patients aged 6 months to 18 years receiving intravenous ondansetron for nausea, vomiting, or the inability to take fluids in the emergency department. Patients had electrocardiogram performed at baseline, at ondansetron's peak effect, and 1 hour postpeak effect. A paired samples Student t test compared QTc change at peak effect to zero. Peak effect of intravenous ondansetron is 3 minutes. One hundred patients were included. Fifty-five percent of patients were female with a mean age of 8.3 years. The mean (range) baseline QTc was 435 (388 to 501) milliseconds. The mean (range) change in QTc at peak effect of ondansetron was 3 (-40 to 65) milliseconds (P = 0.072). The change in QTc 1-hour postpeak effect of ondansetron was 3 (-43 to 45) milliseconds (P = 0.082). No change at peak effect or 1-hour postpeak effect was clinically significant. Ondansetron does not affect the QTc of pediatric patients receiving the medication for nausea, vomiting, or inability to take fluids in the emergency department. No changes in the QTc are clinically significant. To date, there have been no studies evaluating the effect of ondansetron in this acutely ill population; therefore, a larger study should be completed to confirm these data.

  20. Morbimortality associated with intravenous boarding in very ill pediatrics’ patients

    Directory of Open Access Journals (Sweden)

    Darelys Baños Sánchez

    2018-05-01

    Full Text Available The insertion of intravenous catheters has converted itself in an indispensable procedure in Pediatric Intensive Care Units. The objective is caracterizing the morbimortality associated with intravenous boarding in very ill pediatrics’ patients. Descriptive, longitudinal prospective study, during 2016, in the Intensive Care Unit of the Pepe Portilla Pediatric Hospital, Pinar of the Río, The Universe: It got constituted for 182 patients admitted in the period of study and they required intravenous boarding. The information got from patient's charts and the unit's record of continuous morbility itself, and it was processed with SPSS statistical parcel for Windows, the test of hypothesis of proportions and the percentages were utilized. The intravenous boarding was accomplished to the 51.12% of the admitted patients, 31.46% for femoral road and 60.83% to patients under one year old. Principal use was the administration of medications (100%, the 56.59% had the boarding over 10 days, the 12.08% of patients presented complications, infection was more frequent. The conclusions are high incidence of the application of intravenous boarding exists; infection for catheter is the correlated complication more frequent.

  1. FOREWORD Fluid Mechanics and Fluid Power (FMFP)

    Indian Academy of Sciences (India)

    This section of the Special Issue carries selected articles from the Fluid Mechanics and Fluid. Power Conference held during 12–14 December 2013 at the National Institute of Technology,. Hamirpur (HP). The section includes three review articles and nine original research articles. These were selected on the basis of their ...

  2. Efficacy and safety of intravenous fentanyl administered by ambulance personnel

    DEFF Research Database (Denmark)

    Friesgaard, Kristian Dahl; Nikolajsen, Lone; Giebner, Matthias

    2016-01-01

    BACKGROUND: Management of pain in the pre-hospital setting is often inadequate. In 2011, ambulance personnel were authorized to administer intravenous fentanyl in the Central Denmark Region. The aim of this study was to evaluate the efficacy and safety of intravenous fentanyl administered...... by ambulance personnel. METHODS: Pre-hospital medical charts from 2348 adults treated with intravenous fentanyl by ambulance personnel during a 6-month period were reviewed. The primary outcome was the change in pain intensity on a numeric rating scale (NRS) from before fentanyl treatment to hospital arrival....... Secondary outcomes included the number of patients with reduction in pain intensity during transport (NRS ≥ 2), the number of patients with NRS > 3 at hospital arrival, and potential fentanyl-related side effects. RESULTS: Fentanyl reduced pain from before treatment (8, IQR 7-9) to hospital arrival (4, IQR...

  3. Acute Forefoot Phlegmon - A Complication of Intravenous Heroin-Addiction.

    Science.gov (United States)

    Wollina, Uwe; Lotti, Torello; Tchernev, Georgi

    2018-01-25

    Infections of the skin and soft tissues (SSTI) are clinical entities with variable presentations, causes, and levels of clinical severity. They are frequent in emergency departments. The most common pathogen in the Western World is Staphylococcus aureus . SSTI may provide a hint to underlying pathologies such as diabetes and other states of immune compromise. Here we present a 41-year-old non-diabetic male patient with pain and swelling of the left forefoot but not any recent trauma. Microbiology identified streptococci. The medical history was positive for intravenous heroin abuse. The diagnosis of forefoot phlegm due to drug addition was confirmed. Treatment was realised by a combination of intravenous antibiosis and drainage. Intravenous drug addiction is a significant risk factor for SSTI.

  4. An ischemic diabetic eye treated with intravenous prostaglandin E1.

    Science.gov (United States)

    Steigerwalt, Robert D; Belcaro, Gianni; Nebbioso, Marcella; Pascarella, Antonella; De Angelis, Mauro; Cesarone, M Rosaria

    2014-01-01

    To present the use of intravenous prostaglandin E1 (PGE1), a powerful vasodilator of the microcirculation, in the treatment of an ischemic diabetic eye. A 27-year-old diabetic man with ischemic diabetic retinopathy and glaucoma had a decreased visual acuity of no light perception in his right eye and hand motions in his left eye. He was started on intravenous PGE1 and has been treated for over 4.5 years. The visual acuity in his right eye remained unchanged and in his left eye improved gradually to 1.5/30. He has been stable for 4.5 years. Intravenous PGE1 may be useful in ischemic diabetic eyes to improve the ocular blood flow and visual acuity. It is safe and tolerated well.

  5. Intravenous methylprednisolone pulse therapy for children with epileptic encephalopathy.

    Science.gov (United States)

    Pera, Maria Carmela; Randazzo, Giovanna; Masnada, Silvia; Dontin, Serena Donetti; De Giorgis, Valentina; Balottin, Umberto; Veggiotti, Pierangelo

    2015-01-01

    The aim of this retrospective study of children affected by epileptic encephalopathy was to evaluate seizure frequency, electroencephalographic pattern and neuropsychological status, before and after intravenous methylprednisolone therapy. Eleven children with epileptic encephalopathy were administered one cycle of intravenous methylprednisolone (15-30 mg/kg/day for three consecutive days, once a month for four months) in addition to constant dosages of their regular antiepileptic drugs. The treatment resulted in statistically significant reductions of generalized slow spike-and-wave discharges (ptreatment regimen did not cause significant or persistent adverse effects. We suggest that children with epileptic encephalopathy without an underlying structural lesion could be the best candidates for intravenous methylprednisolone pulse therapy.

  6. Electric fluid pump

    Science.gov (United States)

    Van Dam, Jeremy Daniel; Turnquist, Norman Arnold; Raminosoa, Tsarafidy; Shah, Manoj Ramprasad; Shen, Xiaochun

    2015-09-29

    An electric machine is presented. The electric machine includes a hollow rotor; and a stator disposed within the hollow rotor, the stator defining a flow channel. The hollow rotor includes a first end portion defining a fluid inlet, a second end portion defining a fluid outlet; the fluid inlet, the fluid outlet, and the flow channel of the stator being configured to allow passage of a fluid from the fluid inlet to the fluid outlet via the flow channel; and wherein the hollow rotor is characterized by a largest cross-sectional area of hollow rotor, and wherein the flow channel is characterized by a smallest cross-sectional area of the flow channel, wherein the smallest cross-sectional area of the flow channel is at least about 25% of the largest cross-sectional area of the hollow rotor. An electric fluid pump and a power generation system are also presented.

  7. Hydraulic Brake Fluid,

    Science.gov (United States)

    A hydraulic brake fluid consisting of diethylene glycol , monoethyl ether of diethylene glycol , and castor oil has been improved as described in the patent by adding the fluid tributyl ether of orthophosphoric acid.

  8. Lectures on fluid mechanics

    CERN Document Server

    Shinbrot, Marvin

    2012-01-01

    Readable and user-friendly, this high-level introduction explores the derivation of the equations of fluid motion from statistical mechanics, classical theory, and a portion of the modern mathematical theory of viscous, incompressible fluids. 1973 edition.

  9. Pleural fluid Gram stain

    Science.gov (United States)

    Gram stain of pleural fluid ... mixing it with a violet stain (called a Gram stain). A laboratory specialist uses a microscope to ... reveals an abnormal collection of pleural fluid. The Gram stain can help identify the bacteria that might ...

  10. Clinical Applications of Intravenous Immunoglobulins in Child Neurology.

    Science.gov (United States)

    Gogou, Maria; Papadopoulou-Alataki, Efimia; Spilioti, Martha; Alataki, Sofia; Evangeliou, Athanasios

    2017-11-10

    While there are guidelines for the use of intravenous immunoglobulins in children with Guillain-Barre syndrome and myasthenia gravis based on high-level evidence studies, data are scarce for the majority of neurologic disorders in this age group. Neuronal antibodies are detected in children with seizures of autoimmune etiology. Intravenous immunoglobulins with their broad immunomodulatory mechanism of action could be ideally effective in different forms of immunedysregulated intractable epilepsies such as autoimmune epilepsy and autoimmune Rasmussen encephalitis. We conducted a systematic review of the literature for evidence of the use of intravenous immunoglobulins in a variety of neurologic diseases in childhood. A comprehensive literature search was conducted using Pubmed as the medical database source without date range. Prospective studies in pediatric groups including objective measures of clinical outcomes were systematically selected. A total of 11 prospective studies were identified in the literature demonstrating a favorable effect of this therapeutic option in children with drug-resistant epilepsy and in cases of encephalitis. No serious adverse effects were reported. No prospective studies about the use of intravenous immunoglobulins in children with demyelinating disorders or neurologic paraneoplasmatic syndromes were found. In this review, we summarize the recent advances in the field of intravenous immunoglobulins used in pediatric neurological diseases. Literature data supports a beneficial effect in this age group. Whilst awaiting the results of large scale studies, administration of intravenous immunoglobulins could be justified in refractory child epilepsy. Otherwise, its use should be guided by the individual needs of each child, depending on the underlying neurological disease. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  11. Computational Fluid Dynamics

    International Nuclear Information System (INIS)

    Myeong, Hyeon Guk

    1999-06-01

    This book deals with computational fluid dynamics with basic and history of numerical fluid dynamics, introduction of finite volume method using one-dimensional heat conduction equation, solution of two-dimensional heat conduction equation, solution of Navier-Stokes equation, fluid with heat transport, turbulent flow and turbulent model, Navier-Stokes solution by generalized coordinate system such as coordinate conversion, conversion of basic equation, program and example of calculation, application of abnormal problem and high speed solution of numerical fluid dynamics.

  12. Fluid overload and changes in serum creatinine after cardiac surgery: predictors of mortality and longer intensive care stay. A prospective cohort study

    Science.gov (United States)

    2012-01-01

    Introduction Fluid overload is a clinical problem frequently related to cardiac and renal dysfunction. The aim of this study was to evaluate fluid overload and changes in serum creatinine as predictors of cardiovascular mortality and morbidity after cardiac surgery. Methods Patients submitted to heart surgery were prospectively enrolled in this study from September 2010 through August 2011. Clinical and laboratory data were collected from each patient at preoperative and trans-operative moments and fluid overload and creatinine levels were recorded daily after cardiac surgery during their ICU stay. Fluid overload was calculated according to the following formula: (Sum of daily fluid received (L) - total amount of fluid eliminated (L)/preoperative weight (kg) × 100). Preoperative demographic and risk indicators, intra-operative parameters and postoperative information were obtained from medical records. Patients were monitored from surgery until death or discharge from the ICU. We also evaluated the survival status at discharge from the ICU and the length of ICU stay (days) of each patient. Results A total of 502 patients were enrolled in this study. Both fluid overload and changes in serum creatinine correlated with mortality (odds ratio (OR) 1.59; confidence interval (CI): 95% 1.18 to 2.14, P = 0.002 and OR 2.91; CI: 95% 1.92 to 4.40, P serum creatinine. Fluid overload (%): b coefficient = 0.17; beta coefficient = 0.55, P creatinine (mg/dL): b coefficient = 0.01; beta coefficient = 0.11, P = 0.003). Conclusions Although both fluid overload and changes in serum creatinine are prognostic markers after cardiac surgery, it seems that progressive fluid overload may be an earlier and more sensitive marker of renal dysfunction affecting heart function and, as such, it would allow earlier intervention and more effective control in post cardiac surgery patients. PMID:22651844

  13. Subcutaneous versus intravenous immunoglobulin in multifocal motor neuropathy

    DEFF Research Database (Denmark)

    Harbo, T; Andersen, Henning; Hess, A

    2009-01-01

    Background and purpose: For treatment of multifocal motor neuropathy (MMN), we hypothesized that (i) infusion of equivalent dosages of subcutaneous immunoglobulin (SCIG) is as effective as intravenous immunoglobulin (IVIG) and that (ii) subcutaneous infusion at home is associated with a better...... at the injection sites for a few weeks. All other adverse effects during SCIG were mild and transient. No differences between treatments of health-related quality of life occurred. Conclusion: In MMN, short-term subcutaneous infusion of immunoglobulin is feasible, safe and as effective as intravenous infusion...

  14. Intravenous adenosine for surgical management of penetrating heart wounds.

    Science.gov (United States)

    Kokotsakis, John; Hountis, Panagiotis; Antonopoulos, Nikolaos; Skouteli, Elian; Athanasiou, Thanos; Lioulias, Achilleas

    2007-01-01

    Accurate suturing of penetrating cardiac injuries is difficult. Heart motion, ongoing blood loss, arrhythmias due to heart manipulation, and the near-death condition of the patient can all affect the outcome. Rapid intravenous injection of adenosine induces temporary asystole that enables placement of sutures in a motionless surgical field. Use of this technique improves surgical conditions, and it is faster than other methods. Herein, we describe our experience with the use of intravenous adenosine to successfully treat 3 patients who had penetrating heart wounds.

  15. Recurrence of Intravenous Talc Granulomatosis following Single Lung Transplantation

    Directory of Open Access Journals (Sweden)

    Richard C Cook

    1998-01-01

    Full Text Available Advanced pulmonary disease is an unusual consequence of the intravenous injection of oral medications, usually developing over a period of several years. A number of patients with this condition have undergone lung transplantation for respiratory failure. However, a history of drug abuse is often considered to be a contraindication to transplantation in the context of limited donor resources. A patient with pulmonary talc granulomatosis secondary to intravenous methylphenidate injection who underwent successful lung transplantation and subsequently presented with recurrence of the underlying disease in the transplanted lung 18 months after transplantation is reported.

  16. Fluid dynamic transient analysis

    International Nuclear Information System (INIS)

    Vilhena Reigosa, R. de

    1992-01-01

    This paper describes the methodology adopted at NUCLEN for the fluid dynamic analyses for ANGRA 2. The fluid dynamic analysis allows, through computer codes to simulate and quantify the loads resulting from fluid dynamic transients caused by postulated ruptures or operational transients, in the piping of the safety systems and of the important operational systems. (author)

  17. Amniotic fluid water dynamics

    NARCIS (Netherlands)

    Beall, M. H.; van den Wijngaard, J. P. H. M.; van Gemert, M. J. C.; Ross, M. G.

    2007-01-01

    Water arrives in the mammalian gestation from the maternal circulation across the placenta. It then circulates between the fetal water compartments, including the fetal body compartments, the placenta and the amniotic fluid. Amniotic fluid is created by the flow of fluid from the fetal lung and

  18. Fundamental Fluid Mechanics

    Indian Academy of Sciences (India)

    BOOK I REVIEW. Fundamental Fluid. Mechanics. Good Text Book Material. V H Arakeri. Fluid Mechanics for Engineers. P N Chatterjee. MacMillan India Limited. Vol. 1, pp. 367. RS.143. Vo1.2, pp.306. RS.130. Fluid Mechanics for Engineers in two vol- umes by P N Chatterjee contains standard material for a first level ...

  19. Short-lasting systemic and regional benefits of early crystalloid infusion after intravenous inoculation of dogs with live Escherichia coli

    Directory of Open Access Journals (Sweden)

    Garrido A.G.

    2005-01-01

    Full Text Available We investigated the systemic and regional hemodynamic effects of early crystalloid infusion in an experimental model of septic shock induced by intravenous inoculation with live Escherichia coli. Anesthetized dogs received an intravenous infusion of 1.2 x 10(10 cfu/kg live E. coli in 30 min. After 30 min of observation, they were randomized to controls (no fluids; N = 7, or fluid resuscitation with lactated Ringer's solution, 16 ml/kg (N = 7 or 32 ml/kg (N = 7 over 30 min and followed for 120 min. Cardiac index, portal blood flow, mean arterial pressure, systemic and regional oxygen-derived variables, blood lactate, and gastric PCO2 were assessed. Rapid and progressive cardiovascular deterioration with reduction in cardiac output, mean arterial pressure and portal blood flow (~50, ~25 and ~70%, respectively was induced by the live bacteria challenge. Systemic and regional territories showed significant increases in oxygen extraction and in lactate levels. Significant increases in venous-arterial (~9.6 mmHg, portal-arterial (~12.1 mmHg and gastric mucosal-arterial (~18.4 mmHg PCO2 gradients were also observed. Early fluid replacement, especially with 32 ml/kg volumes of crystalloids, promoted only partial and transient benefits such as increases of ~76% in cardiac index, of ~50% in portal vein blood flow and decreases in venous-arterial, portal-arterial, gastric mucosal-arterial PCO2 gradients (7.2 ± 1.0, 7.2 ± 1.3 and 9.7 ± 2.5 mmHg, respectively. The fluid infusion promoted only modest and transient benefits, unable to restore the systemic and regional perfusional and metabolic changes in this hypodynamic septic shock model.

  20. Fluid and particle mechanics

    CERN Document Server

    Michell, S J

    2013-01-01

    Fluid and Particle Mechanics provides information pertinent to hydraulics or fluid mechanics. This book discusses the properties and behavior of liquids and gases in motion and at rest. Organized into nine chapters, this book begins with an overview of the science of fluid mechanics that is subdivided accordingly into two main branches, namely, fluid statics and fluid dynamics. This text then examines the flowmeter devices used for the measurement of flow of liquids and gases. Other chapters consider the principle of resistance in open channel flow, which is based on improper application of th

  1. Fluid inclusion geothermometry

    Science.gov (United States)

    Cunningham, C.G.

    1977-01-01

    Fluid inclusions trapped within crystals either during growth or at a later time provide many clues to the histories of rocks and ores. Estimates of fluid-inclusion homogenization temperature and density can be obtained using a petrographic microscope with thin sections, and they can be refined using heating and freezing stages. Fluid inclusion studies, used in conjunction with paragenetic studies, can provide direct data on the time and space variations of parameters such as temperature, pressure, density, and composition of fluids in geologic environments. Changes in these parameters directly affect the fugacity, composition, and pH of fluids, thus directly influencing localization of ore metals. ?? 1977 Ferdinand Enke Verlag Stuttgart.

  2. Spinning fluids reactor

    Science.gov (United States)

    Miller, Jan D; Hupka, Jan; Aranowski, Robert

    2012-11-20

    A spinning fluids reactor, includes a reactor body (24) having a circular cross-section and a fluid contactor screen (26) within the reactor body (24). The fluid contactor screen (26) having a plurality of apertures and a circular cross-section concentric with the reactor body (24) for a length thus forming an inner volume (28) bound by the fluid contactor screen (26) and an outer volume (30) bound by the reactor body (24) and the fluid contactor screen (26). A primary inlet (20) can be operatively connected to the reactor body (24) and can be configured to produce flow-through first spinning flow of a first fluid within the inner volume (28). A secondary inlet (22) can similarly be operatively connected to the reactor body (24) and can be configured to produce a second flow of a second fluid within the outer volume (30) which is optionally spinning.

  3. Design of Dual Mode RFID Antenna for Inventory Management and IV Fluid Level Warning System

    Directory of Open Access Journals (Sweden)

    Ssu-Han Ting

    2017-01-01

    Full Text Available Radio frequency identification (RFID readers are powered RF devices that communicate with an RFID tag to read necessary information. Using this capability, a dual use system for short distance inventory management and moderate distance automatic warning system for low intravenous (IV fluid levels is designed. The RFID is affixed on the IV drip bag; the fluid in bag affects the antenna transmission distance by fluid dielectric conditions. This allows for two different operational modes (moderate and short distance. For pharmaceutical management, a handheld RFID reader can be used for short distance application. Another stationary RFID system can serve as a warning system for long distance application such as hospital care.

  4. Postarthroscopy analgesia using intraarticular levobupivacaine and intravenous dexketoprofen trometamol.

    Science.gov (United States)

    Sahin, Sevtap Hekimoglu; Memiş, Dilek; Celik, Erkan; Sut, Necdet

    2015-12-01

    The aim of this prospective study was to determine the efficacy of intraarticular levobupivacaine with and without intravenous dexketoprofen trometamol for postarthroscopy analgesia. Sixty patients who underwent arthroscopic knee surgery were randomly assigned to three treatment groups. When the surgical procedure was completed, patients received the following treatments: group I (n = 20) patients received 20 mL intraarticular normal saline and 2 mL intravenous dexketoprofen trometamol (50 mg); group II (n = 20) patients received 20 mL intraarticular 0.5 % levobupivacaine (100 mg) and 2 mL intravenous normal saline; and group III (n = 20) patients received 20 mL intraarticular 0.5 % levobupivacaine (100 mg) and 2 mL intravenous dexketoprofen trometamol (50 mg). The visual analogue scale (VAS) was used, and the total analgesic consumption was assessed at 1, 2, 4, 6, 12, and 24 h post-operatively. The VAS scores at 1, 2, 4, 6, 12, and 24 h post-operatively were significantly increased in group I and group II compared with group III (p dexketoprofen trometamol administration provided better pain relief and less analgesic requirement after arthroscopic knee surgery during the first 24 h than that induced by dexketoprofen alone or levobupivacaine intraarticular alone. II.

  5. Causes of intravenous medication errors: an ethnographic study

    OpenAIRE

    Taxis, K; Barber, N

    2003-01-01

    Background: Intravenous (IV) medication errors are frequent events. They are associated with considerable harm, but little is known about their causes. Human error theory is increasingly used to understand adverse events in medicine, but has not yet been applied to study IV errors. Our aim was to investigate causes of errors in IV drug preparation and administration using a framework of human error theory.

  6. High dose intravenous immunoglobulin in Rh and ABO hemolytic ...

    African Journals Online (AJOL)

    Ehab

    High dose intravenous immunoglobulin in Rh and ABO hemolytic disease of Egyptian neonates. INTRODUCTION. Hemolytic disease of the newborn (HDN) due to red cell alloimmunisation is an important cause of hyperbilirubinemia with significant morbidity in the neonatal period.1,2. Hemolytic disease of the newborn has ...

  7. Intravenous Sedation for Dental Patients with Intellectual Disability

    Science.gov (United States)

    Miyawaki, T.; Kohjitani, A.; Maeda, S.; Egusa, M.; Mori, T.; Higuchi, H.; Kita, F.; Shimada, M.

    2004-01-01

    The poor quality of oral health care for people with intellectual disability (ID) has been recognized, and the strong fears about dental treatment suggested as a major reason for disturbances of visits to dentists by such patients. Intravenous sedation is a useful method for relieving the anxiety and fear of such patients about dental treatment,…

  8. Splenic lipidosis after administration of intravenous fat emulsions.

    Science.gov (United States)

    Forbes, G B

    1978-01-01

    Spleens showing fatty infiltration and necrosis of the pulp were found at necropsy on several patients who had received intravenous fat emulsions during their terminal illnesses. The postmortem findings are described and the clinicopathological correlation is discussed with special reference to the phenomenon of creaming of the emulsion. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 PMID:690241

  9. Pattern of intravenous immunoglobulins (IVIG) use in a pediatric ...

    African Journals Online (AJOL)

    EB

    Abstract. Background: Intravenous Immunoglobulin (IVIG) preparations are scarce biological products used for replacement or immunomodulatory effects. Guidelines have been issued by regulatory health authorities to ensure provision of the products for patients who are in severe need. Objectives: The study aimed at ...

  10. AIthesin (eT 1341) - A New Intravenous Anaesthetic Agent*

    African Journals Online (AJOL)

    1973-01-06

    Jan 6, 1973 ... Althesin (CT 1341), a new intravenous steroid anaes':he- tic agent without steroid activity, was given as ... by competent nursing staff who immediately reported any unfavourable side-effects. The time when the ..... A.) (ply) Ltd, for their expert advice, and for the liberal supplies of Althesin. REFERENCES. 1.

  11. Intravenous immunoglobulin in the prevention of recurrent miscarriage

    DEFF Research Database (Denmark)

    Christiansen, Ole B; Nielsen, Henriette Svarre

    2005-01-01

    Immunological disturbances play a role in the majority of patients with recurrent miscarriage (RM) and therefore treatment with intravenous immunoglobulin (IvIg) has been tested in patients with RM in several trials. Seven placebo-controlled trials that were extremely heterogeneous with respect...

  12. Carotid endarterectomy after intravenous thrombolysis for acute cerebral ischaemic attack

    DEFF Research Database (Denmark)

    Rathenborg, Lisbet Knudsen; Jensen, L P; Baekgaard, N

    2013-01-01

    Intravenous thrombolysis (IVT) has proven effective in the treatment of acute cerebral ischaemic attack in selected cases. In the presence of a carotid artery stenosis, such patients may be candidates for carotid endarterectomy (CEA). Few studies have been made on the safety of CEA performed after...

  13. Comparison of Caudal Analgesia and Intravenous Diclofenac for ...

    African Journals Online (AJOL)

    Background: Effective postoperative pain management is a vital determinant to when a child can be safely discharged from the hospital after day case surgery. This study compared the effect of caudal bupivacaine block with intravenous diclofenac for postoperative pain relief in children aged 1-7years undergoing ...

  14. Ultrastructural Changes in the Liver of Intravenous Heroin Addicts

    Directory of Open Access Journals (Sweden)

    Goran Ilić

    2010-02-01

    Full Text Available The ultrastructural research has a decisive role in gathering the knowledge on the liver’s response to the influence of some drugs. The aim of the study was to perform an ultrastructurai analysis of the liver in chronic intravenous heroin addicts.The study involved the autopsy conducted on 40 bodies of intravenous heroin addicts and 10 control autopsies. The liver tissue was fixed in glutaraldehyde and moulded with epon for investigation purposes of ultrastructural changes. The analysis was performed using the method of transmission electron microscopy.In the group of intravenous heroin addicts, the liver autopsy samples showed degenerative vesicular and fat changes, chronic active and persistent hepatitis, cirrhosis, reduction in the amount of glycogen in hepatocytes, as well as the Kupffer cell’s dominant hypertrophy. Various changes occur in organelles, plasma membrane of hepatocytes and biliary channels as well as in the nucleus.The most important ultrastructural findings include: hyperplasia and hypertrophy of the smooth endoplasmic reticulum, which is histologically proven vesicular degeneration of hepatocyte occurring as a result of the increased synthesis of enzymes of smooth endoplasmic reticulum due to chronic intravenous heroin intake, and the presence of continuous basal membrane followed by transformation of the sinusoids into capillaries (in the cases of chronic active hepatitis and cirrhosis which leads to a disorder of microcirculation and further progress of cirrhosis.

  15. Comparison of intramuscular artemether and intravenous quinine in ...

    African Journals Online (AJOL)

    Objectives: To compare the efficacy of intramuscular artemether and intravenous quinine in the treatment of severe falciparum malaria. Design: An open randomized controlled clinical trial. Setting: New Halfa Teaching Hospital, Eastern Sudan, in the period November 2001-January 2002. Subjects: Forty one male and ...

  16. Pharmacokinetics of Single Dose Intravenous Paracetamol in Children

    African Journals Online (AJOL)

    A new intravenous formulation containing paracetamol is now available and widely used in chil-dren, but with limited paediatric pharmacokinetic data. This study was aimed at determining the effects of age on the pharmacokinetics (PK) of this formulation of paracetamol in children. Blood samples were obtained from 24 ...

  17. The effect of intravenous preemptive paracetamol on postoperative ...

    African Journals Online (AJOL)

    Aim: We investigated the efficacy of intravenous (IV) preemptive paracetamol on postoperative total fentanyl consumption and fentanyl.related side effects in patients undergoing open nephrectomy. Materials and Methods: A total of 60 patients scheduled for elective open nephrectomy under general anesthesia were ...

  18. Optimal composition of intravenous lipids | Kreymann | South African ...

    African Journals Online (AJOL)

    The provision of energy from a lipid source is an essential component of any parenteral nutrition (PN) therapeutic regimen in the appropriate clinical setting. All available sources of intravenous lipid emulsions have a low osmolarity but they strongly differ in their immunologic effects and their effects on oxidative stress, liver ...

  19. Training requirements for the administration of intravenous contrast ...

    African Journals Online (AJOL)

    Background. The administration of intravenous contrast media (IVCM) is one of the key areas currently under investigation for inclusion in the South African (SA) radiographers' scope of practice. However, for the radiographers to legally administer IVCM, training guidelines must first be identified, developed and accredited ...

  20. X-ray diagnostics. Oral and intravenous cholegraphy

    International Nuclear Information System (INIS)

    1981-04-01

    The standard deals with oral and intravenous cholegraphy. It includes information on indications, contraindications, prerequisites and preparations as well as on application and appropriate dosage of contrast media. Parameters on focussing, imaging conditions and on the program of taking radiographies are outlined. The necessity of special examinations according to findings as well as measures concerning radiation protection and hygiene are presented

  1. Enzymuria in neonates receiving continuous intravenous infusion of gentamicin

    DEFF Research Database (Denmark)

    Colding, H; Brygge, K; Brendstrup, L

    1992-01-01

    with non-treatment periods in the same newborn infant (33 infants). The same tendency applied to AAP. Newborn infants receiving continuous intravenous infusion of gentamicin were not found to be at greater risk of nephrotoxicity than those receiving intermittent gentamicin treatment, using NAG and AAP...

  2. Oxalic acid excretion after intravenous ascorbic acid administration

    Science.gov (United States)

    Robitaille, Line; Mamer, Orval A.; Miller, Wilson H.; Levine, Mark; Assouline, Sarit; Melnychuk, David; Rousseau, Caroline; Hoffer, L. John

    2012-01-01

    Ascorbic acid is frequently administered intravenously by alternative health practitioners and, occasionally, by mainstream physicians. Intravenous administration can greatly increase the amount of ascorbic acid that reaches the circulation, potentially increasing the risk of oxalate crystallization in the urinary space. To investigate this possibility, we developed gas chromatography mass spectrometry methodology and sampling and storage procedures for oxalic acid analysis without interference from ascorbic acid and measured urinary oxalic acid excretion in people administered intravenous ascorbic acid in doses ranging from 0.2 to 1.5 g/kg body weight. In vitro oxidation of ascorbic acid to oxalic acid did not occur when urine samples were brought immediately to pH less than 2 and stored at –30°C within 6 hours. Even very high ascorbic acid concentrations did not interfere with the analysis when oxalic acid extraction was carried out at pH 1. As measured during and over the 6 hours after ascorbic acid infusions, urinary oxalic acid excretion increased with increasing doses, reaching approximately 80 mg at a dose of approximately 100 g. We conclude that, when studied using correct procedures for sample handling, storage, and analysis, less than 0.5% of a very large intravenous dose of ascorbic acid is recovered as urinary oxalic acid in people with normal renal function. PMID:19154961

  3. Imaging of chest disease due to intravenous heroin abuse

    International Nuclear Information System (INIS)

    Lian Xuhui; Chen Zhong; Ye Wenqin

    2002-01-01

    Objective: To study the imaging findings of the chest disease due to intravenous heroin abuse. Methods: Twenty-five cases of clinically confirmed chest disease due to intravenous heroin abuse were retrospectively analyzed. 25 cases had conventional X-ray film, 6 cases had CT scanning, and 6 cases had echocardiography scanning. Results: On X-ray and CT, the following signs were found: lung making manifold (n = 5), small patchy shadow (n = 15), pneumatocele (n = 16), small cavity (n = 16), small node (n = 7), pleural effusion (n = 8 ), pneumothorax (n = 2), hydropneumothorax (n = 6), pulmonary edema (n = 2), megacardia (n = 11), multiple-shaped lesion (n = 20). On echocardiography, tricuspid vegetation (n = 4) and tricuspid insufficiency (n = 4) were found. Conclusion: The X-ray and CT manifestations of chest inflammation due to intravenous heroin abuse are multiple. The multiple small cavities and pneumatoceles sign are of some value in the diagnosis of lung inflammation due to intravenous heroin abuse among young patients

  4. ORAL IBOPAMINE SUBSTITUTION IN PATIENTS WITH INTRAVENOUS DOPAMINE DEPENDENCE

    NARCIS (Netherlands)

    GIRBES, ARJ; MILNER, AR; MCCLOSKEY, BV; ZWAVELING, JH; VANVELDHUISEN, DJ; ZIJLSTRA, JG; LIE, KI

    1995-01-01

    In a prospective open study we evaluated whether intravenous dopamine infusions can be safely switched to enterally administered ibopamine in dopamine-dependent patients. Six patients defined as being clinically stable, normovolaemic, but dopamine dependent, i.e. with repeated inability to stop

  5. Usefulness of MR cholangiopancreatography after intravenous morphine administration

    International Nuclear Information System (INIS)

    Lee, So Jung; Ko, Ji Ho; Cho, Young Duk; Jung, Mi Hee; Yoon, Byung Chull

    2007-01-01

    We wanted to assess the usefulness of MRCP after intravenous morphine administration in the evaluation of the hepatopancreatic pancreatico-biliary ductal system. We studied 15 patients who were suspected of having disease of hepatopancreatic ductal system and they did not have any obstructive lesion on ultrasonography and/or CT. MRCP was acquired before and after morphine administration (0.04 mg/kg, intravenously). Three radiologists scored the quality of the images of the anatomic structures in the hepatopancreatic ductal system. We directly compared the quality of the images obtained with using the two methods and the improvement of the artifacts by pulsatile vascular compression. The MRCP images obtained after intravenous morphine administration were better than those obtained before morphine administration for visualizing the hepatopancreatic ductal system. On direct comparison, the MRCP images obtained after morphine administration were better in 12 cases, equivocal in two cases, and the images before morphine administration were better in only one case. In three patients, MRCP before morphine injection showed signal loss at the duct across the pulsatile hepatic artery. In two of three patients, MRCP after morphine injection showed no signal loss in this ductal area. MRCP after intravenous morphine administration enables physicians to see the hepatopancreatic ductal system significantly better and the artifacts caused by pulsation of the hepatic artery can be avoided

  6. Classification of chronic orofacial pain using an intravenous diagnostic test

    NARCIS (Netherlands)

    Tjakkes, G. -H. E.; De Bont, L. G. M.; van Wijhe, M.; Stegenga, B.

    The aim of this study was to evaluate the ability of a preliminary intravenous diagnostic test to classify chronic orofacial pain patients into different subgroups. Patients with chronic orofacial pain conditions that could not be unambiguously diagnosed. A retrospective evaluation of series of

  7. Illicit intravenous drug use in Johannesburg medical complications ...

    African Journals Online (AJOL)

    Illicit intravenous drug use in Johannesburg medical complications and prevalence of HIV infection. P.G. Williams, S.M. Ansell, F.J. Milne. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. Article Metrics. Metrics Loading ... Metrics ...

  8. Intravenous glutamine enhances COX-2 activity giving cardioprotection.

    LENUS (Irish Health Repository)

    McGuinness, Jonathan

    2009-03-01

    Preconditioning, a highly evolutionary conserved endogenous protective response, provides the most powerful form of anti-infarct protection known. We investigated whether acute intravenous glutamine, through an effect on cyclooxygenase (COX)-2 and heat shock protein (HSP) 72, might induce preconditioning.

  9. [Stump pain relieved by continuous intravenous ketamine infusion therapy].

    Science.gov (United States)

    Mizuno, J; Sugimoto, S; Ohmori, T; Itadera, E; Ichikawa, N; Machida, K

    2001-07-01

    We experienced a case of stump pain relieved by continuous intravenous ketamine infusion therapy. A 59-year-old male had his left first through fourth toes amputated because a giant iron plate at work fell on his left foot fifteen years ago. Thereafter he had refractory spontaneous burning pain and night pain on his stump. On examination, we found his left foot skin hard, lustrous, and with sweating disturbance, allodynia and hyperpathia. As intravenous administrations of ketamine 10 mg and thiamylal 50 mg were positive as a drug challenge test, we performed intravenous ketamine infusion at 1 mg.kg-1.hr-1 for 1 hour and a half. After this treatment, his visual analogue scale (VAS) improved dramatically to 0 mm, and night pain, allodynia and hyperpathia disappeared for three days. Thereafter stump pain was relieved to the level of VAS 20 mm. Therefore we diagnosed his stump pain as central pain of neuropathic origin. We suspect that continuous intravenous infusion of ketamine, a noncompetitive blocker of N-methyl-D-aspartic acid receptor, might be an effective and useful alternative treatment in a patient with refractory stump pain.

  10. Treatment of neonatal sepsis with intravenous immune globulin

    DEFF Research Database (Denmark)

    Brocklehurst, Peter; Farrell, Barbara; King, Andrew

    2011-01-01

    Neonatal sepsis is a major cause of death and complications despite antibiotic treatment. Effective adjunctive treatments are needed. Newborn infants are relatively deficient in endogenous immunoglobulin. Meta-analyses of trials of intravenous immune globulin for suspected or proven neonatal sepsis...... suggest a reduced rate of death from any cause, but the trials have been small and have varied in quality....

  11. Intravenous carbon dioxide as an echocardiographic contrast agent

    NARCIS (Netherlands)

    R.S. Meltzer (Richard); P.W.J.C. Serruys (Patrick); P.G. Hugenholtz (Paul); J.R.T.C. Roelandt (Jos)

    1981-01-01

    textabstractIntravenous carbon dioxide (CO2) was employed to cause echocardiographic contrast in 40 patients. One to 3 cc of medically pure CO2 were agitated with 5 to 8 cc of 5% dextrose in water and rapidly injected into an upper extremity vein. Contrast was obtained in all patients. In 33

  12. Intravenous analgesics for pain management in postoperative patients

    African Journals Online (AJOL)

    Purpose: To compare the effectiveness of post-operative pain management and associated adverse effects of ketamine and nefopam. Methods: In total, 78 American Society of Anesthesiologists (ASA) grade 1 and 2 patients who had undergone abdominal surgery were given 3 mg of intravenous (IV) morphine as ...

  13. Time to treatment with intravenous alteplase and outcome in stroke

    DEFF Research Database (Denmark)

    Lees, Kennedy R; Bluhmki, Erich; von Kummer, Rüdiger

    2010-01-01

    BACKGROUND: Early administration of intravenous recombinant tissue plasminogen activator (rt-PA) after ischaemic stroke improves outcome. Previous analysis of combined data from individual patients suggested potential benefit beyond 3 h from stroke onset. We re-examined the effect of time to trea...

  14. Treatment of neonatal sepsis with intravenous immune globulin

    DEFF Research Database (Denmark)

    Brocklehurst, Peter; Farrell, Barbara; King, Andrew

    2011-01-01

    Neonatal sepsis is a major cause of death and complications despite antibiotic treatment. Effective adjunctive treatments are needed. Newborn infants are relatively deficient in endogenous immunoglobulin. Meta-analyses of trials of intravenous immune globulin for suspected or proven neonatal sepsis...

  15. Pattern of intravenous immunoglobulins (IVIG) use in a pediatric ...

    African Journals Online (AJOL)

    Background: Intravenous Immunoglobulin (IVIG) preparations are scarce biological products used for replacement or immunomodulatory effects. Guidelines have been issued by regulatory health authorities to ensure provision of the products for patients who are in severe need. Objectives: The study aimed at description of ...

  16. Microcosting Study of Rituximab Subcutaneous Injection Versus Intravenous Infusion

    NARCIS (Netherlands)

    Mihajloviç, Jovan; Bax, Pieter; van Breugel, Erwin; Blommestein, Hedwig M.; Hoogendoorn, Mels; Hospes, Wobbe; Postma, Maarten J.

    Purpose: The goal of this study is to identify and compare all direct costs of intravenous and subcutaneous rituximab given to patients with diffuse large B-cell lymphoma in the Netherlands.  Methods: Using a prospective, observational, bottom-up microcosting study, we collected primary data on the

  17. Intravenous Laser Therapy in Young Children with Thermal Injuries

    Directory of Open Access Journals (Sweden)

    R. V. Bocharov

    2014-01-01

    Full Text Available Objective: to evaluate the laboratory and clinical effects of combined intravenous laser therapy in young children with thermalinjuries in the acute period of burn disease.Subjects and methods. Forty children whose mean age was 2.67±0.35 years were examined; thermal injuries accounted for 25.05±1.01% of the total body surface area; of them degrees IIIaIIIb was 19.04±0.85%. A comparison group (n=15 received conventional therapy without taking into account and correcting baseline and current hemostasiological disorders. On day 1, a study group (n=25 had programmed anticoagulant therapy and intravenous laser therapy at different radiation frequencies with a Mustang 20002+ laser therapy apparatus (patent for invention No. 2482894 in addition to the conventional therapy. The laser therapy cycle was 6 to 16 sessions. The investigators estimated and compared the following examined parameters: white blood cell count; leukocytic index of intoxication; plasma average mass molecules at a wavelength of 254 nm; toxogenic granularity of neutrophils; wound exudate discharge time; surgical plasty area; and hospitalization time.Results. The positive laboratory and clinical effects of the performed combined intravenous laser therapy in the combined therapy of burn disease in young children were comparatively shown in the study group patients. The significant decrease in the level of an inflammatory response and endogenous intoxication led to a rapider burn wound cleansing, active epithelization, and reduced surgical plasty volumes.Conclusion. Combined intravenous laser therapy signif icantly exerts antiinflammatory and detoxifying effects in young children with 40% thermal injuries in the acute period of burn disease. Abolishing a systemic inflammatory response by combined intravenous laser therapy initiated early regenerative processes in the burn wound and caused reductions in surgical plasty volumes and hospitalization time, which optimizes ther

  18. Dexamethasone, Intravenous Immunoglobulin, and Rituximab Combination Immunotherapy for Pediatric Opsoclonus-Myoclonus Syndrome.

    Science.gov (United States)

    Pranzatelli, Michael R; Tate, Elizabeth D

    2017-08-01

    Although pulse-dose dexamethasone is increasingly favored for treating pediatric opsoclonus-myoclonus syndrome (OMS), and multimodal immunotherapy is associated with improved clinical response, there have been no neuroimmunologic studies of dexamethasone-based multimodal disease-modifying therapy. In this observational retrospective study, 19 children with OMS (with or without associated neuroblastoma) underwent multibiomarker evaluation for neuroinflammation. Nine children of varying OMS severity, duration, and treatment status were treated empirically with pulse dexamethasone, intravenous immunoglobulin (IVIg), and rituximab combination immunotherapy (DEXIR-CI). Another 10 children on dexamethasone alone or with IVIg at initial evaluation only provided a comparison group. Motor severity (total score) was scored rater-blinded via videotapes using the validated OMS Evaluation Scale. DEXIR-CI was associated with a 69% reduction in group total score (P = 0.004) and was clinically well tolerated. Patients given the dexamethasone combination exhibited significantly lowered B cell frequencies in cerebrospinal fluid (-94%) and blood (-76%), normalizing the cerebrospinal fluid B cell percentage. The number of patients with positive inflammatory markers dropped 87% (P = 0.002) as did the number of markers. Cerebrospinal fluid oligoclonal bands were positive in four of nine pretreatment patients but zero of six post-treatment patients. In the comparison group, partial response to dexamethasone alone or with IVIg was associated with multiple positive markers for neuroinflammation despite an average of seven months of treatment. Multimechanistic dexamethasone-based combination immunotherapy increases the therapeutic armamentarium for OMS, providing a viable option for less severely affected individuals. Partial response to dexamethasone with or without IVIg is indicative of ongoing neuroinflammation and should be treated promptly and accordingly. Copyright © 2017

  19. Fiber optic fluid detector

    Science.gov (United States)

    Angel, S. Michael

    1989-01-01

    Particular gases or liquids are detected with a fiber optic element (11, 11a to 11j) having a cladding or coating of a material (23, 23a to 23j) which absorbs the fluid or fluids and which exhibits a change of an optical property, such as index of refraction, light transmissiveness or fluoresence emission, for example, in response to absorption of the fluid. The fluid is sensed by directing light into the fiber optic element and detecting changes in the light, such as exit angle changes for example, that result from the changed optical property of the coating material. The fluid detector (24, 24a to 24j) may be used for such purposes as sensing toxic or explosive gases in the atmosphere, measuring ground water contamination or monitoring fluid flows in industrial processes, among other uses.

  20. Safest light in a combat area while performing intravenous access in the dark.

    Science.gov (United States)

    Aydin, Attila; Bilge, S; Eryilmaz, M

    2018-04-06

    Cannulation for the administration of intravenous fluids is integral to the prehospital management of injured military patients. However, this may be technically challenging to undertake during night-time conditions where the use of light to aid cannulation may give the tactical situation away to opponents. The aim of this study was to investigate the success and tactical safety of venepuncture under battlefield conditions with different colour light sources. The procedure was carried out with naked eye in a bright room in the absence of a separate light source, with a naked eye in a dark room under red, white, blue and green light sources and under an infrared light source while wearing night vision goggles (NVGs). The success, safety, degree of difficulty and completion time for each procedure were then explored. All interventions made in daylight and in a dark room were found to be 100% successful. Interventions performed under infrared light while wearing NVGs took longer than under other light sources or in daylight. Interventions performed under blue light were tactically safer when compared with interventions performed under different light sources. Blue light offered the best tactical safety during intravenous cannulation under night-time conditions and is recommended for future use in tactical casualty care. The use of NVGs using infrared light cannot be recommended if there is the possibility of opponents having access to the technology. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Metalworking and machining fluids

    Science.gov (United States)

    Erdemir, Ali; Sykora, Frank; Dorbeck, Mark

    2010-10-12

    Improved boron-based metal working and machining fluids. Boric acid and boron-based additives that, when mixed with certain carrier fluids, such as water, cellulose and/or cellulose derivatives, polyhydric alcohol, polyalkylene glycol, polyvinyl alcohol, starch, dextrin, in solid and/or solvated forms result in improved metalworking and machining of metallic work pieces. Fluids manufactured with boric acid or boron-based additives effectively reduce friction, prevent galling and severe wear problems on cutting and forming tools.

  2. Fluid supplementation for neonatal unconjugated hyperbilirubinaemia.

    Science.gov (United States)

    Lai, Nai Ming; Ahmad Kamar, Azanna; Choo, Yao Mun; Kong, Juin Yee; Ngim, Chin Fang

    2017-08-01

    Neonatal hyperbilirubinaemia is a common problem which carries a risk of neurotoxicity. Certain infants who have hyperbilirubinaemia develop bilirubin encephalopathy and kernicterus which may lead to long-term disability. Phototherapy is currently the mainstay of treatment for neonatal hyperbilirubinaemia. Among the adjunctive measures to compliment the effects of phototherapy, fluid supplementation has been proposed to reduce serum bilirubin levels. The mechanism of action proposed includes direct dilutional effects of intravenous (IV) fluids, or enhancement of peristalsis to reduce enterohepatic circulation by oral fluid supplementation. To assess the risks and benefits of fluid supplementation compared to standard fluid management in term and preterm newborn infants with unconjugated hyperbilirubinaemia who require phototherapy. We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 5), MEDLINE via PubMed (1966 to 7 June 2017), Embase (1980 to 7 June 2017), and CINAHL (1982 to 7 June 2017). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. We included randomised controlled trials that compared fluid supplementation against no fluid supplementation, or one form of fluid supplementation against another. We extracted data using the standard methods of the Cochrane Neonatal Review Group using the Covidence platform. Two review authors independently assessed the eligibility and risk of bias of the retrieved records. We expressed our results using mean difference (MD), risk difference (RD), and risk ratio (RR) with 95% confidence intervals (CIs). Out of 1449 articles screened, seven studies were included. Three articles were awaiting classification, among them, two completed trials identified from the trial registry appeared to be unpublished so far.There were

  3. Pharmacokinetics of escin Ia in rats after intravenous administration.

    Science.gov (United States)

    Wu, Xiu-Jun; Cui, Xiang-Yong; Tian, Lian-tian; Gao, Feng; Guan, Xin; Gu, Jing-Kai

    2014-10-28

    Escin, a natural mixture of triterpene saponins, is commonly utilized for the treatment of chronic venous insufficiency, hemorrhoids, inflammation and edema. Escin Ia is the chief active ingredient in escin and plays key role in mediating its pharmacological effects. Adequate pharmacokinetic data are essential for proper application of escin agent in clinical practice. However, pharmacokinetic properties of escin Ia are still poorly understood and this conflicts with the growing use of escin agent over the years. The goal of this study is to investigate the pharmacokinetic behavior of escin Ia in rats after low, medium and high-dose intravenous administration. Wistar rats were divided into 3 groups (n=6 per group) and escin Ia was administered via the caudal vein at doses of 0.5, 1.0 and 2.0 mg/kg, respectively. Subsequently, the concentrations of escin Ia and its metabolite isoescin Ia, a positional isomer of escin Ia, in rats׳ plasma were measured by an established liquid chromatography tandem mass spectrometry (LC-MS/MS) method at various time points following the administration of the drug. Main pharmacokinetic parameters were calculated by non-compartmental analysis using the TopFit 2.0 software package (Thomae GmbH, Germany). After intravenous administration, the Cmax and AUC of escin Ia increased in a dose-proportional manner at the dose of 0.5 mg/kg and 1.0 mg/kg, while increased in a more than dose-proportional manner at the doses of 1.0 mg/kg and 2.0 mg/kg. The t₁/₂ was significantly longer with increased intravenous doses, while other parameters such as CL and Vd also exhibit disagreement among three doses. Taken together, our data showed dose-dependent pharmacokinetic profile of escin Ia in rats after intravenous administration at the doses of 0.5-2.0 mg/kg. After intravenous administration, escin Ia was rapidly and extensively converted to isoescin Ia. The results suggested dose-dependent pharmacokinetics of escin Ia at the doses of 0.5-2.0 mg

  4. Intravenous antibiotics for pulmonary exacerbations in people with cystic fibrosis.

    Science.gov (United States)

    Hurley, Matthew N; Prayle, Andrew P; Flume, Patrick

    2015-07-30

    Cystic fibrosis is a multi-system disease characterised by the production of thick secretions causing recurrent pulmonary infection, often with unusual bacteria. Intravenous antibiotics are commonly used in the treatment of acute deteriorations in symptoms (pulmonary exacerbations); however, recently the assumption that exacerbations are due to increases in bacterial burden has been questioned. To establish if intravenous antibiotics for the treatment of pulmonary exacerbations in people with cystic fibrosis improve short- and long-term clinical outcomes. We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews and ongoing trials registers.Date of last search of Cochrane trials register: 27 July 2015. Randomised controlled trials and the first treatment cycle of cross-over studies comparing intravenous antibiotics (given alone or in an antibiotic combination) with placebo, inhaled or oral antibiotics for people with cystic fibrosis experiencing a pulmonary exacerbation. The authors assessed studies for eligibility and risk of bias and extracted data. We included 40 studies involving 1717 participants. The quality of the included studies was largely poor and, with a few exceptions, these comprised of mainly small, inadequately reported studies.When comparing treatment with a single antibiotic to a combined antibiotic regimen, those participants receiving a combination of antibiotics experienced a greater improvement in lung function when considered as a whole group across a number of different measurements of lung function, but with very low quality evidence. When limited to the four placebo-controlled studies (n = 214), no difference was observed, again with very low quality evidence. With regard to the review's remaining primary outcomes, there was no effect upon time to next exacerbation and

  5. Electrorheological fluids and methods

    Science.gov (United States)

    Green, Peter F.; McIntyre, Ernest C.

    2015-06-02

    Electrorheological fluids and methods include changes in liquid-like materials that can flow like milk and subsequently form solid-like structures under applied electric fields; e.g., about 1 kV/mm. Such fluids can be used in various ways as smart suspensions, including uses in automotive, defense, and civil engineering applications. Electrorheological fluids and methods include one or more polar molecule substituted polyhedral silsesquioxanes (e.g., sulfonated polyhedral silsesquioxanes) and one or more oils (e.g., silicone oil), where the fluid can be subjected to an electric field.

  6. Plasmas and fluids

    International Nuclear Information System (INIS)

    Anon.

    1986-01-01

    Plasma and fluid physics includes the fields of fusion research and space investigation. This book discusses the most important advances in these areas over the past decade and recommends a stronger commitment to basic research in plasma and fluid physics. The book recommends that plasma and fluid physics be included in physics curriculums because of their increasing importance in energy and defense. The book also lists recent accomplishments in the fields of general plasma physics, fusion plasma confinement and heating, space and astrophysical plasmas, and fluid physics and lists research opportunities in these areas. A funding summary explains how research monies are allocated and suggests ways to improve their effectiveness

  7. The Fluids RAP

    Science.gov (United States)

    Nedyalkov, Ivaylo

    2016-11-01

    After fifteen years of experience in rap, and ten in fluid mechanics, "I am coming here with high-Reynolds-number stamina; I can beat these rap folks whose flows are... laminar." The rap relates fluid flows to rap flows. The fluid concepts presented in the song have varying complexity and the listeners/viewers will be encouraged to read the explanations on a site dedicated to the rap. The music video will provide an opportunity to share high-quality fluid visualizations with a general audience. This talk will present the rap lyrics, the vision for the video, and the strategy for outreach. Suggestions and comments will be welcomed.

  8. Fluid dynamics transactions

    CERN Document Server

    Fiszdon, W

    1965-01-01

    Fluid Dynamics Transactions, Volume 2 compiles 46 papers on fluid dynamics, a subdiscipline of fluid mechanics that deals with fluid flow. The topics discussed in this book include developments in interference theory for aeronautical applications; diffusion from sources in a turbulent boundary layer; unsteady motion of a finite wing span in a compressible medium; and wall pressure covariance and comparison with experiment. The certain classes of non-stationary axially symmetric flows in magneto-gas-dynamics; description of the phenomenon of secondary flows in curved channels by means of co

  9. Sphere based fluid systems

    Science.gov (United States)

    Elleman, Daniel D. (Inventor); Wang, Taylor G. (Inventor)

    1989-01-01

    Systems are described for using multiple closely-packed spheres. In one system for passing fluid, a multiplicity of spheres lie within a container, with all of the spheres having the same outside diameter and with the spheres being closely nested in one another to create multiple interstitial passages of a known size and configuration and smooth walls. The container has an inlet and outlet for passing fluid through the interstitial passages formed between the nested spheres. The small interstitial passages can be used to filter out material, especially biological material such as cells in a fluid, where the cells can be easily destroyed if passed across sharp edges. The outer surface of the spheres can contain a material that absorbs a constitutent in the flowing fluid, such as a particular contamination gas, or can contain a catalyst to chemically react the fluid passing therethrough, the use of multiple small spheres assuring a large area of contact of these surfaces of the spheres with the fluid. In a system for storing and releasing a fluid such as hydrogen as a fuel, the spheres can include a hollow shell containing the fluid to be stored, and located within a compressable container that can be compressed to break the shells and release the stored fluid.

  10. Theoretical Fluid Dynamics

    CERN Document Server

    Shivamoggi, Bhimsen K

    1998-01-01

    "Although there are many texts and monographs on fluid dynamics, I do not know of any which is as comprehensive as the present book. It surveys nearly the entire field of classical fluid dynamics in an advanced, compact, and clear manner, and discusses the various conceptual and analytical models of fluid flow." - Foundations of Physics on the first edition. Theoretical Fluid Dynamics functions equally well as a graduate-level text and a professional reference. Steering a middle course between the empiricism of engineering and the abstractions of pure mathematics, the author focuses

  11. Complexity in fluids

    International Nuclear Information System (INIS)

    Bayly, B.

    1991-01-01

    Fluids are basically very simple things. The fluids encountered all the time - air, water, milk, coffee, etc. - are undramatic. One blob of a given fluid looks much like any other, except for such gross properties as volume or mass. Of course, blobs of fluid come in different shapes. However, it's easy to change the shape of a blob of fluid, with the result that we rarely think of the shape of a fluid blob as a defining property. In fact, a blob that starts with one shape can be deformed into almost any other shape, with arbitrarily small input of energy. When one talks about lumps of a solid, in contrast, shape is important. This is because it takes work, i.e., energy, to change the shape of a solid. Making a small deformation from some rest configuration takes a small amount of energy, and a large deformation takes a lot of energy. Sometimes, as in idealized elastic systems, the required energy goes to infinity as the deformation becomes unbounded. Real solids usually break if you deform them enough; all subsequent deformations cost no energy. Basically, a finite deformation requires finite energy. Complexity arises in fluid systems because the shape of a blob of fluid is indeterminate. Nothing prevents an initially simple fluid blob from deforming into the weirdest shape imaginable. It is the absence of any kind of blob-shape constraint that allows complexity to enter fluid science. During these lectures the author briefly describes a few areas in which complexity arises and has to be dealt with. These lectures will be roughly divided as follows: (1) physical and mathematical description of fluids and flows; (2) flow transport and ergodic theory; (3) magnetic dynamos and related problems; (4) flow instabilities; (5) turbulence

  12. Intravenous digital subtraction angiography in patients with cerebral ischaemia

    International Nuclear Information System (INIS)

    Mantoni, M.; Neergaard, K.

    1989-01-01

    Over a two-year period, 167 patients with symptoms of transient ischaemic attacks or suspected minor stroke underwent intravenous digital subtraction angiography (DSA) of the carotid arteries. There were no major complications. Ninety-six patients had abnormal angiograms, 60 normal studies, and in 11 patients (7%) the examination was not of diagnostic quality, mostly because of motion artifacts. In 86 patients no therapeutic consequences resulted from the DSA examination. Twenty-six patients were referred for vascular surgery, and 34 patients had either anticoagulation or aspirin therapy. In 10 patients a primary medical cause was found for their cerebral vascular symptoms. It is concluded that intravenous DSA of the carotid arteries in patients with transient ischaemic attack is a safe, diagnostically useful procedure, that can also be used on an outpatient basis. (orig.)

  13. Pharmacokinetics of oral and intravenous melatonin in healthy volunteers

    DEFF Research Database (Denmark)

    Andersen, Lars Peter Holst; Werner, Mads Utke; Rosenkilde, Mette Marie

    2016-01-01

    BACKGROUND: The aim was to investigate the pharmacokinetics of oral and iv melatonin in healthy volunteers. METHODS: The study was performed as a cohort crossover study. The volunteers received either 10 mg oral melatonin or 10 mg intravenous melatonin on two separate study days. Blood samples were...... collected at different time points following oral administration and short iv infusion, respectively. Plasma melatonin concentrations were determined by RIA technique. Pharmacokinetic analyses were performed by "the method of residuals" and compartmental analysis. The pharmacokinetic variables: k a, t 1....../2 absorption, t max, C max, t 1/2 elimination, AUC 0-∞, and bioavailability were determined for oral melatonin. C max, t 1/2 elimination, V d, CL and AUC 0-∞ were determined for intravenous melatonin. RESULTS: Twelve male volunteers completed the study. Baseline melatonin plasma levels did not differ...

  14. Pharmacokinetics of high-dose intravenous melatonin in humans

    DEFF Research Database (Denmark)

    Andersen, Lars P H; Werner, Mads U; Rosenkilde, Mette Marie

    2016-01-01

    This crossover study investigated the pharmacokinetics and adverse effects of high-dose intravenous melatonin. Volunteers participated in 3 identical study sessions, receiving an intravenous bolus of 10 mg melatonin, 100 mg melatonin, and placebo. Blood samples were collected at baseline and 0, 60......, 120, 180, 240, 300, 360, and 420 minutes after the bolus. Quantitative determination of plasma melatonin concentrations was performed using a radioimmunoassay technique. Pharmacokinetic parameters were estimated by a compartmental pharmacokinetic analysis. Adverse effects included assessments...... of sedation and registration of other symptoms. Sedation, evaluated as simple reaction times, was measured at baseline and 120, 180, 300, and 420 minutes after the bolus. Twelve male volunteers completed the study. Median (IQR) Cmax after the bolus injections of 10 mg and 100 mg of melatonin were 221...

  15. Candida glabrata olecranon bursitis treated with bursectomy and intravenous caspofungin.

    Science.gov (United States)

    Skedros, John G; Keenan, Kendra E; Trachtenberg, Joel D

    2013-01-01

    Orthopedic surgeons are becoming more involved in the care of patients with septic arthritis and bursitis caused by yeast species. This case report involves a middle-aged immunocompromised female who developed a Candida glabrata septic olecranon bursitis that developed after she received a corticosteroid injection in the olecranon bursa for presumed aseptic bursitis. Candida (Torulopsis) glabrata is the second most frequently isolated Candida species from the bloodstream in the United States. Increased use of fluconazole and other azole antifungal agents as a prophylactic treatment for recurrent Candida albicans infections in immunocompromised individuals is one reason why there appears to be increased resistance of C. glabrata and other nonalbicans Candida (NAC) species to fluconazole. In this patient, this infection was treated with surgery (bursectomy) and intravenous caspofungin, an echinocandin. This rare infectious etiology coupled with this intravenous antifungal treatment makes this case novel among cases of olecranon bursitis caused by yeasts.

  16. Diagnostic value of intravenous cholangiography with regard to laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Shoghi, Y.; Georgi, M.

    1996-01-01

    In a retrospective study the accuracy of sonography and intravenous cholangiography (IVC) in respect of pre-operative diagnostics before laparoscopic cholecystectomy was determined. Altogether 267 patients were examined by comparing sonography and IVC results with those under both surgical and histopathological examinations. Ultrasound proved to be superior to IVC detecting cholecystolithiasis in 99.4% versus 94.6%. The choledochus could be perceived in 81.0% by using ultrasound but in 93.6% by using IVC. In diagnosis of choledocholithiasis (CDL) IVC proved to be more suitable. With this method 100% could be recognised whereas sonography showed CDL in 33.3%. Serious side effects caused by intravenous contrast media could not be observed during any IVC examination. In our opinion IVC is a valid and reliable method to detect CDL and should be used in addition to ultrasound in pre-operative diagnostics before laparoscopic cholecystectomy. (orig.) [de

  17. Symptomatic sinus bradycardia: A rare adverse effect of intravenous ondansetron

    Directory of Open Access Journals (Sweden)

    Md Shahnawaz Moazzam

    2011-01-01

    Full Text Available Ondansetron is a serotonin receptor antagonist which has been used frequently to reduce the incidence of post-operative nausea and vomiting in laparoscopic surgery. It has become very popular drug for the prevention of post-operative nausea and vomiting due to its superiority in-terms of efficacy as well as lack of side effects and drug interactions. Although cardiovascular adverse effects of this drug are rare, we found a case of symptomatic sinus bradycardia in a 43-year-old female patient, going for laparoscopic cholecystectomy, who developed the same after she was given intravenous ondansetron in operation theater during premedication. Hence, we report this case, as the rare possibility of encountering bradycardia effect after intravenous administration of ondansetron should be born in mind.

  18. Anaphylactic Shock After Intravenous Fluorescein Administration for Intraoperative Cystoscopy.

    Science.gov (United States)

    Lee, Toy; Sanderson, Derrick; Doyle, Paula; Buchsbaum, Gunhilde

    2018-04-01

    Rates of administration of intravenous sodium fluorescein during cystoscopy have increased since indigotindisulfonate sodium was removed from the market in 2014. Although sodium fluorescein has been extensively evaluated and found to be safe, side effects including anaphylaxis have been observed, with an incidence between 0.05% and 1.0%. We present a case of anaphylactic shock after administration of intravenous sodium fluorescein for the assessment of ureteral efflux in a patient with a history of frequent severe allergic reactions undergoing urethral lysis and cystoscopy for urinary retention. Cardiopulmonary structure and function were evaluated and found to be normal. An elevated serum tryptase level was identified, indicating an anaphylactoid reaction. Timely recognition of symptoms associated with a severe allergic reaction in the setting of hemodynamic instability with prompt supportive and pharmacologic therapy was vital in the patient's recovery. Health care providers must be aware of this potential complication, especially in patients with a history of severe allergic reactions.

  19. Intravenous tranexamic acid for hyperacute primary intracerebral hemorrhage

    DEFF Research Database (Denmark)

    Sprigg, Nikola; Robson, Katie; Bath, Philip

    2016-01-01

    RATIONALE: Outcome after intracerebral hemorrhage remains poor. Tranexamic acid is easy to administer, readily available, inexpensive, and effective in other hemorrhagic conditions. AIM: This randomized trial aims to test the hypothesis that intravenous tranexamic acid given within 8 h...... of spontaneous intracerebral hemorrhage reduces death or dependency. DESIGN: Phase III prospective double-blind randomized placebo-controlled trial. Participants within 8 h of spontaneous intracerebral hemorrhage are randomized to receive either intravenous tranexamic acid 1 g 10 min bolus followed by 1 g 8 h......, and institutionalization. DISCUSSION: This pragmatic trial is assessing efficacy of tranexamic acid after spontaneous intracerebral hemorrhage. Recruitment started in 2013; as of 15th January 2016 1355 participants have been enrolled, from 95 centers in seven countries. Recruitment is due to end in 2017. TICH-2 Trial...

  20. Safety of Intravenous Methamphetamine Administration During Ibudilast Treatment.

    Science.gov (United States)

    DeYoung, Dustin Z; Heinzerling, Keith G; Swanson, Aimee-Noelle; Tsuang, John; Furst, Benjamin A; Yi, Yi; Wu, Ying Nian; Moody, David E; Andrenyak, David M; Shoptaw, Steven J

    2016-08-01

    Methamphetamine dependence is a significant public health concern without any approved medications for treatment. We evaluated ibudilast, a nonselective phosphodiesterase inhibitor, to assess the safety and tolerability during intravenous methamphetamine administration. We conducted a randomized, double-blind, placebo-controlled, within-subjects crossover clinical trial. Participants received ibudilast (20 mg twice daily followed by 50 mg twice daily) and placebo, with order determined by randomization, and then underwent intravenous methamphetamine challenges (15 and 30 mg). We monitored cardiovascular effects, methamphetamine pharmacokinetics, and reported adverse events. Ibudilast treatment had similar rates of adverse events compared with placebo, and there was no significant augmentation of cardiovascular effects of methamphetamine. Pharmacokinetic analysis revealed no clinically significant change in maximum concentration or half-life of methamphetamine with ibudilast. Methamphetamine administration during ibudilast treatment was well tolerated without additive cardiovascular effects or serious adverse events, providing initial safety data to pursue ibudilast's effectiveness for the treatment of methamphetamine dependence.

  1. Accidental intravenous infusion of air: a concise review.

    Science.gov (United States)

    Wilkins, Robert G; Unverdorben, Martin

    2012-01-01

    The unintended intravenous infusion of small volumes of air is common in clinical practice. International Electrotechnical Commission guidelines for infusion pumps permit infusion of up to 1 mL in 15 minutes and discount bubbles smaller than 50 μL. A review of the literature, however, suggests that these limits may be too generous. Neonates and patients with right-to-left cardiac shunts (eg, patent foramen ovale [PFO]) are at risk from lower volumes. Because PFO is prevalent in 20% to 27% of healthy adults and generally asymptomatic, all patients are at risk from small air bubbles, although clinically significant air embolism from intravenous infusion is rare. Attention to good clinical practice and use of an inline air filter should be considered to reduce any risk.

  2. [Intravenous immunoglobulin therapy for kidney diseases in children].

    Science.gov (United States)

    Zwolińska, Danuta

    2011-06-01

    Intravenous immunoglobulin (IVIG) for the treatment of primary immunodeficiency disorders have been administrated for more than 25 years. However, the recognition of the anti-inflammatory and immune-modulatory actions of IVIG resulted broader applications to autoimmunity and systemic inflammatory conditions. The major focus of this review is the usefulness of IVIG therapy in children kidney disease, particularly in severe, atypical hemolytic-uremic syndrome and thrombotic thrombocytopenic purpura, refractory to standard therapy, including plasmaferesis. The role of intravenous immunoglobulins in the treatment and prevention of infection, the most common complication in nephrotic syndrome is also discussed. Probably, in the future, similarly to adults, IVIG will be used for the therapy of some forms of glomerulopathies.

  3. Enucleation following treatment with intravenous pentamidine for Acanthamoeba sclerokeratitis

    Directory of Open Access Journals (Sweden)

    Rebecca A Kuennen

    2010-09-01

    Full Text Available Rebecca A Kuennen, Reynell Harder Smith, Thomas F Mauger, Elson CraigDepartment of Ophthalmology, The Ohio State University, Columbus, Ohio, USAPurpose: To describe the course and outcome of treatment of advanced Acanthamoeba sclerokeratitis with intravenous pentamidine.Methods: A case of advanced Acanthamoeba sclerokeratitis was resistant to conventional therapy and was treated with intravenous pentamidine. The eye was later removed due to incapacitating pain.Results: The eye showed Acanthamoeba organisms within the cornea and evidence of acute and chronic inflammation throughout the remainder of the eye. The patient has survived without orbital recurrence for 2 years.Conclusions: This case demonstrates late inflammation with active Acanthameoba keratitis following systemic pentamidine therapy.Keywords: keratitis, scleritis

  4. Today and tomorrow of intravenous coronary angiography programme in Japan

    International Nuclear Information System (INIS)

    Ando, Masami; Hyodo, Kazuyuki

    1994-01-01

    Development of an intravenous coronary angiography system using monochromated synchrotron radiation at the Photon Factory is described. This comprises an asymmetric cut silicon monochromator crystal to get a larger exposure area, a two dimensional imaging system using an imaging intensifier coupled to a CCD TV camera and a fast video data acquisition system. The whole system is under development using alive dogs. A future system including a dedicated insertion device applicable to alive humans is also proposed. (author)

  5. Total Intravenous Anesthesia (TIVA) in pediatric cardiac anesthesia

    OpenAIRE

    Wong , Grace Lai Sze

    2011-01-01

    Abstract Inhalational anesthesia with moderate to high-dose opioid analgesia has been the mainstay of pediatric cardiac anesthesia but the advances in understanding of pharmacology and availability of new fast-acting drugs coupled with the advanced concepts in pharmacokinetic modeling and computer technology have made total intravenous anesthesia (TIVA) an attractive option. In this article, we review some of the TIVA techniques used in pediatric cardiac anesthesia. gracewong531...

  6. Intravenous ferric carboxymaltose accelerates erythropoietic recovery from experimental malarial anemia

    DEFF Research Database (Denmark)

    Maretty, Lasse; Sharp, Rebecca Emilie; Andersson, Mikael

    2012-01-01

    Iron restriction has been proposed as a cause of erythropoietic suppression in malarial anemia; however, the role of iron in malaria remains controversial, because it may increase parasitemia. To investigate the role of iron-restricted erythropoiesis, A/J mice were infected with Plasmodium chabaudi...... use of iron therapy in malaria and show the need for trials of intravenous ferric carboxymaltose as an adjunctive treatment for severe malarial anemia....

  7. Postoperative analgesic efficacy of intravenous dexketoprofen in lumbar disc surgery.

    Science.gov (United States)

    Yazar, Mehmet Akif; Inan, Nurten; Ceyhan, Aysegul; Sut, Esra; Dikmen, Bayazit

    2011-07-01

    We investigated the postoperative analgesic efficacy and effect on total tramadol consumption of intravenous dexketoprofen trometamol, a new nonsteroidal anti-inflammatory drug, in patients that had undergone lumbar disc surgery. Sixty patients were included in this placebo-controlled, randomized, double-blind study. General anesthesia was applied to both groups. Group D (n=30) received dexketoprofen (50 mg) intravenously 30 minutes before the end of surgery and at the postoperative 12th hour, whereas group C (n=30) received 2 mL of 0.9% NaCL intravenously at the same time points. All patients received a patient controlled analgesia device with a tramadol, 25 mg bolus, 15 minutes lockout protocol, and were followed with visual analog scale, verbal rating scale, modified Aldrete recovery scoring system, and Ramsay sedation scale in the postoperative period. There was no significant difference between the groups for demographic data, duration of surgery, mean arterial pressure, and heart rate. The time to first postoperative analgesic requirement was significantly longer in group D (151.33±81.98 min) than group C (19±5.78 min) (Pdexketoprofen was an effective analgesic for postdiscectomy pain when used alone or in addition to opioids. It is easy to administer and decreases tramadol consumption and opioid-related side effects.

  8. Rhabdomyolysis associated with single-dose intravenous esomeprazole administration

    Science.gov (United States)

    Jeon, Dae-Hong; Kim, Yire; Kim, Min Jeong; Cho, Hyun Seop; Bae, Eun Jin; Chang, Se-Ho; Park, Dong Jun

    2016-01-01

    Abstract Background: Proton pump inhibitors are usually safe, although serious adverse effects can occur. We report the first case of rhabdomyolysis associated with single-dose intravenous esomeprozole administration. Methods: A 45-year-old Korean male visited our emergency room because of persistent lower chest discomfort that started 10 hours before. He had been diagnosed with diabetes and coronary heart disease, but discontinued oral hypoglycemic agents 1 month earlier. He continued to take medications for coronary heart disease. There was no abnormality on an electrocardiogram or in cardiac enzymes. Initial laboratory findings did not show abnormalities for muscle enzymes. Esomeprozole 40 mg was administrated intravenously for the control of his ambiguous chest discomfort. Then, 12 hours later, he complained of abrupt severe right buttock pain. An area of tender muscle swelling 8 cm in diameter was seen on his right buttock area. Creatine kinase and lactate dehydrogenase were elevated to 40,538 and 1326 U/L, respectively. A bone scan using 20 mCi of 99mTc-hydroxymethylene diphosphonate was compatible with rhabdomyolysis. Results: His muscular symptoms, signs, and laboratory findings improved markedly with conservative management, including hydration and urine alkalinization. He is being followed in the outpatient department with no evidence of recurrence. Conclusion: We should keep in mind that single-dose intravenous administration of esomeprazole can induce rhabdomyolysis. PMID:27442680

  9. Intravenous Thrombolysis for Embolic Stroke due to Cardiac Myxoma

    Directory of Open Access Journals (Sweden)

    Mu-Chien Sun

    2011-01-01

    Full Text Available Cardiac myxoma is a rare but curable cause of ischemic stroke. Current guidelines do not address the use of intravenous thrombolysis for embolic stroke caused by cardiac myxoma. The risk of hemorrhage due to occult tumor emboli or microaneurysms is a major concern. We describe a 45-year-old man who had an embolic stroke in the left middle cerebral artery. The initial National Institutes of Health Stroke Scale (NIHSS score was 16. He received intravenous thrombolysis 2 h and 52 min after stroke onset. No intracranial hemorrhage developed. A cardiac mass was found in the left atrium and removed surgically 84 h after stroke. Pathological study showed a myxoma with extensive hemorrhage and thrombus over the surface. At the 3-month follow-up, the NIHSS score was 9 and the modified Rankin scale score was 3. Our experience with this patient supports the hypothesis that intravenous thrombolysis may be safely used in the treatment of embolic stroke due to cardiac myxoma.

  10. A History of Intravenous Anesthesia in War (1656-1988).

    Science.gov (United States)

    Roberts, Matthew; Jagdish, S

    2016-01-01

    The practice of anesthesia in war places significant restraints on the choice of anesthetic technique used; these include, but are not limited to, safety, simplicity, and portability. Ever since intravenous anesthesia became a practical alternative, there have been military doctors who felt that this technique was particularly suited to this environment. The challenge, as in civilian practice, has been to find the appropriate drugs as well as simple and safe delivery systems. The urgency of war has always stimulated innovation in medicine to counteract the ongoing development of weapons of war and their effects on the human body and to achieve improved survival as public expectations rise. This article traces the development of and the use of intravenous anesthesia by military physicians for battle casualties. The story starts long before the era of modern anesthesia, and the discussion concludes in the dog days of the cold war. The rapidly increasing interest in intravenous anesthesia in both civilian and military practice since the early 1990s is left for other authors to examine. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. Errors in the administration of intravenous medication in Brazilian hospitals.

    Science.gov (United States)

    Anselmi, Maria Luiza; Peduzzi, Marina; Dos Santos, Claudia Benedita

    2007-10-01

    To verify the frequency of errors in the preparation and administration of intravenous medication in three Brazilian hospitals in the State of Bahia. The administration of intravenous medications constitutes a central activity in Brazilian nursing. Errors in performing this activity may result in irreparable damage to patients and may compromise the quality of care. Cross-sectional study, conducted in three hospitals in the State of Bahia, Brazil. Direct observation of the nursing staff (nurse technicians, auxiliary nurses and nurse attendants), preparing and administering intravenous medication. When preparing medication, wrong patient error did not occur in any of the three hospitals, whereas omission dose was the most frequent error in all study sites. When administering medication, the most frequent errors in the three hospitals were wrong dose and omission dose. The rates of error found are considered low compared with similar studies. The most frequent types of errors were wrong dose and omission dose. The hospitals studied showed different results with the smallest rates of errors occurring in hospital 1 that presented the best working conditions. Relevance to clinical practice. Studies such as this one have the potential to improve the quality of care.

  12. Pharmacokinetics of butafosfan after intravenous and intramuscular administration in piglets.

    Science.gov (United States)

    Sun, F; Wang, J; Yang, S; Zhang, S; Shen, J; Xingyuan, C

    2017-04-01

    The pharmacokinetics and bioavailability of butafosfan in piglets were investigated following intravenous and intramuscular administration at a single dose of 10 mg/kg body weight. Plasma concentration-time data and relevant parameters were best described by noncompartmental analysis after intravenous and intramuscular injection. The data were analyzed through WinNolin 6.3 software. After intravenous administration, the mean pharmacokinetic parameters were determined as T 1/2λz of 3.30 h, Cl of 0.16 L kg/h, AUC of 64.49 ± 15.07 μg h/mL, V ss of 0.81 ± 0.44/kg, and MRT of 1.51 ± 0.27 h. Following intramuscular administration, the C max (28.11 μg/mL) was achieved at T max (0.31 h) with an absolute availability of 74.69%. Other major parameters including AUC and MRT were 48.29 ± 21.67 μg h/mL and 1.74 ± 0.29 h, respectively. © 2016 John Wiley & Sons Ltd.

  13. Efficacy and Tolerability of Intravenous Levetiracetam in Children

    Directory of Open Access Journals (Sweden)

    Jose eAceves

    2013-08-01

    Full Text Available Intractable epilepsy in children poses a serious medical challenge. Acute repetitive seizures and status epilepticus leads to frequent emergency room visits and hospital admissions. Permanent neurological damage can occur if there is delay in treatment. It has been shown that these children continue to remain intractable even after acute seizure management with approved FDA agents. Intravenous levetiracetam, a second-generation anticonvulsant was approved by the FDA in 2006 in patients 16 years and older as an alternative when oral treatment is not an option. It has been shown that oral levetiracetam can be used in the treatment of status epilepticus and acute repetitive seizures. Data have been published showing that intravenous levetiracetam is safe and efficacious, and can be used in an acute inpatient setting. This current review will discuss the recent data about the safety and tolerability of intravenous levetiracetam in children and neonates, and emphasize the need for a larger prospective multicenter trial to prove the efficacy of this agent in acute seizure management.

  14. Clinical and biochemical features of some intravenous iron complexes

    Directory of Open Access Journals (Sweden)

    S. Yu. Abashin

    2013-01-01

    Full Text Available Most anemia cases associated with iron deficiency. There are various therapeutic approaches to compensate iron deficiency. In some cases,a rapid restore of body iron is required, which is only possible with intravenous administration. Now a number of intravenous iron preparations are available, and each of them has not only advantages. Considering the drugs side effects, there was a need for drugs with high efficiency, low immunogenicity, and minimal toxicity. One of the decisions was to create preparations based on maltose and isomaltose. Such new intravenous iron preparations are ferric carboxymaltose and iron isomaltoside. Currently, there are no available clinical data that isomaltose and maltose preparations differ significantly with respect to adverse reactions associated with their immunogenicity. Based on study results isomaltose preparations in patients with dextran sensibilization should be used with caution. This is not completely exclude the possibility that both of these drugs can be an immune response trigger with a different specificity than the one on dextran develops. Preparations based on maltose, sucrose and gluconate were neutral in immunoprecipitation assay with dextran-reactive antibodies that determines their preference for patients with dextran sensibilisation. Other important properties of ferric carboxymaltose are: convenience of application and lack of oxidative stress that are determined by the slow iron release.

  15. Clinical and biochemical features of some intravenous iron complexes

    Directory of Open Access Journals (Sweden)

    S. Yu. Abashin

    2014-07-01

    Full Text Available Most anemia cases associated with iron deficiency. There are various therapeutic approaches to compensate iron deficiency. In some cases,a rapid restore of body iron is required, which is only possible with intravenous administration. Now a number of intravenous iron preparations are available, and each of them has not only advantages. Considering the drugs side effects, there was a need for drugs with high efficiency, low immunogenicity, and minimal toxicity. One of the decisions was to create preparations based on maltose and isomaltose. Such new intravenous iron preparations are ferric carboxymaltose and iron isomaltoside. Currently, there are no available clinical data that isomaltose and maltose preparations differ significantly with respect to adverse reactions associated with their immunogenicity. Based on study results isomaltose preparations in patients with dextran sensibilization should be used with caution. This is not completely exclude the possibility that both of these drugs can be an immune response trigger with a different specificity than the one on dextran develops. Preparations based on maltose, sucrose and gluconate were neutral in immunoprecipitation assay with dextran-reactive antibodies that determines their preference for patients with dextran sensibilisation. Other important properties of ferric carboxymaltose are: convenience of application and lack of oxidative stress that are determined by the slow iron release.

  16. Fluid loading responsiveness

    NARCIS (Netherlands)

    Geerts, Bart

    2011-01-01

    Patients in the intensive care unit (ICU) and in the peri-operative phase are dependent on physicians and nurses for their fluid intake. Volume status optimization is required to maximize oxygen delivery to vital organs. Unnecessary fluid administration can, however, lead to general and pulmonary

  17. Fluid Statics and Archimedes

    Indian Academy of Sciences (India)

    stationary fluid only normal stress (pressure) is present and tangential stresses are absent. In this article we ... delayed the discovery of the principle by a few centuries! Archimedes formulated his laws on buoyancy ... stress in the study of mechanics of solids and fluids (see Boxl). Just as temperature and density, stress can ...

  18. Applications of fluid dynamics

    International Nuclear Information System (INIS)

    Round, G.R.; Garg, V.K.

    1986-01-01

    This book describes flexible and practical approach to learning the basics of fluid dynamics. Each chapter is a self-contained work session and includes a fluid dynamics concept, an explanation of the principles involved, an illustration of their application and references on where more detailed discussions can be found

  19. Tumor interstitial fluid

    DEFF Research Database (Denmark)

    Gromov, Pavel; Gromova, Irina; Olsen, Charlotta J.

    2013-01-01

    Tumor interstitial fluid (TIF) is a proximal fluid that, in addition to the set of blood soluble phase-borne proteins, holds a subset of aberrantly externalized components, mainly proteins, released by tumor cells and tumor microenvironment through various mechanisms, which include classical secr...

  20. Peritoneal fluid culture

    Science.gov (United States)

    Culture - peritoneal fluid ... sent to the laboratory for Gram stain and culture. The sample is checked to see if bacteria ... The peritoneal fluid culture may be negative, even if you have ... diagnosis of peritonitis is based on other factors, in addition ...