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Sample records for temporary extracorporeal circulatory

  1. Extracorporeal Circulatory Factors and Cerebral Functions in Operated Patients

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    V. G. Postnov

    2009-01-01

    Full Text Available Objective: to establish a relationship between the influence of extracorporeal circulation (EC factors — its duration, mean blood pressure, and the magnitude of cerebral dysfunction. Subjects and methods. Thirty patients who had undergone above 120-min EC with surface (34—33°C hypothermia of the body due to cardiosurgical intervention were examined by neurological and neuropsychological methods as described by A. R. Luriya. Results. Acute global brain ischemia (AGBI, as a consequence of negative EC factors, was shown to have impact on cerebral, specifically, higher psychic functions. There was a heterogeneous susceptibility of cerebral structures to AGBI, particularly the structures of the left hemisphere and cerebellum. Conclusion. The duration of perfusion is a determinant in the development of AGBI when extracorporeal circulation is applied. Arterial hypotensive episodes and critically low mean blood pressure are an important concomitant. Key words: extracorporeal (artificial circulation, higher psychic functions, neurology, neuropsychology, neurodynamics, acute global brain ischemia.

  2. Automation of a portable extracorporeal circulatory support system with adaptive fuzzy controllers.

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    Mendoza García, A; Krane, M; Baumgartner, B; Sprunk, N; Schreiber, U; Eichhorn, S; Lange, R; Knoll, A

    2014-08-01

    The presented work relates to the procedure followed for the automation of a portable extracorporeal circulatory support system. Such a device may help increase the chances of survival after suffering from cardiogenic shock outside the hospital, additionally a controller can provide of optimal organ perfusion, while reducing the workload of the operator. Animal experiments were carried out for the acquisition of haemodynamic behaviour of the body under extracorporeal circulation. A mathematical model was constructed based on the experimental data, including a cardiovascular model, gas exchange and the administration of medication. As the base of the controller fuzzy logic was used allowing the easy integration of knowledge from trained perfusionists, an adaptive mechanism was included to adapt to the patient's individual response. Initial simulations show the effectiveness of the controller and the improvements of perfusion after adaptation. Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.

  3. Factors influencing the outcome of paediatric cardiac surgical patients during extracorporeal circulatory support

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    Peek Giles J

    2007-01-01

    Full Text Available Abstract Background Veno-arterial extracorporeal membrane oxygenation (ECMO is a common modality of circulatory assist device used in children. We assessed the outcome of children who had ECMO following repair of congenital cardiac defects (CCD and identified the risk factors associated with hospital mortality. Methods From April 1990 to December 2003, 53 patients required ECMO following surgical correction of CCD. Retrospectively collected data was analyzed with univariate and multivariate logistic regression analysis. Results Median age and weight of the patients were 150 days and 5.4 kgs respectively. The indications for ECMO were low cardiac output in 16, failure to wean cardiopulmonary bypass in 13, cardiac arrest in 10 and cardio-respiratory failure in 14 patients. The mean duration of ECMO was 143 hours. Weaning off from ECMO was successful in 66% and of these 83% were survival to hospital-discharge. 37.7% of patients were alive for the mean follow-up period of 75 months. On univariate analysis, arrhythmias, ECMO duration >168 hours, bleeding complications, renal replacement therapy on ECMO, arrhythmias and cardiac arrest after ECMO were associated with hospital mortality. On multivariate analysis, abnormal neurology, bleeding complications and arrhythmias after ECMO were associated with hospital mortality. Extra and intra-thoracic cannulations were used in 79% and 21% of patients respectively and extra-thoracic cannulation had significantly less bleeding complications (p = 0.031. Conclusion ECMO provides an effective circulatory support following surgical repair of CCD in children. Extra-thoracic cannulation is associated with less bleeding complications. Abnormal neurology, bleeding complications on ECMO and arrhythmias after ECMO are poor prognostic indicators for hospital survival.

  4. Extracorporeal membrane oxygenation in circulatory and respiratory failure - A single-center experience.

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    Passos Silva, Marisa; Caeiro, Daniel; Fernandes, Paula; Guerreiro, Cláudio; Vilela, Eduardo; Ponte, Marta; Dias, Adelaide; Alves, Fernando; Morais, Jorge; Mello, Andreza; Santos, Lino; Castelões, Paula; Gama, Vasco

    2017-11-07

    Extracorporeal membrane oxygenation (ECMO) provides mechanical pulmonary and circulatory support for patients with shock refractory to conventional medical therapy. In this study we aim to describe the indications, clinical characteristics, complications and mortality associated with use of ECMO in a single tertiary hospital. We conducted a retrospective observational cohort study of all patients supported with ECMO in two different intensive care units (general and cardiac), from the first patient cannulated in April 2011 up to October 2016. Overall, 48 patients underwent ECMO: 29 venoarterial ECMO (VA-ECMO) and 19 venovenous ECMO (VV-ECMO). In VA-ECMO, acute myocardial infarction was the main reason for placement. The most frequent complication was lower limb ischemia and the most common organ dysfunction was acute renal failure. In VV-ECMO, acute respiratory distress syndrome after viral infection was the leading reason for device placement. Access site bleeding and hematologic dysfunction were the most prevalent complication and organ dysfunction, respectively. Almost 70% of ECMO episodes were successfully weaned in each group. Survival to discharge was 37.9% for VA-ECMO and 63.2% for VV-ECMO. In VA-ECMO, the number of inotropic agents was a predictor of mortality. Patients with respiratory indications for ECMO experienced better survival than cardiac patients. The need for more inotropic drugs was a predictor of mortality in VA-ECMO. This is the first published record of the overall experience with ECMO in a Portuguese tertiary hospital. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. The organ preservation and enhancement of donation success ratio effect of extracorporeal membrane oxygenation in circulatory unstable brain death donor.

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    Fan, Xiaoli; Chen, Zhiquan; Nasralla, David; Zeng, Xianpeng; Yang, Jing; Ye, Shaojun; Zhang, Yi; Peng, Guizhu; Wang, Yanfeng; Ye, Qifa

    2016-10-01

    Between 2010 and 2013, we recorded 66 cases of failed organ donation after brain death (DBD) due to the excessive use of the vasoactive drugs resulting in impaired hepatic and/or renal function. To investigate the effect of extracorporeal membrane oxygenation (ECMO) in donor management, ECMO was used to provide support for DBD donors with circulatory and/or respiratory failure from 2013 to 2015. A retrospective cohort study between circulatory non-stable DBD with vasoactive drugs (DBD-drug) and circulatory non-stable DBD with ECMO (DBD-ECMO) was designed to compare the transplant outcomes. A total of 19 brain death donors were supported by ECMO. The incidence rate of post-transplant liver primary non-function (PNF) was 10% (two of 20) in DBD-drug group and zero in DBD-ECMO group. Kidney function indicators, including creatinine clearance and urine production, were significantly better in DBD-ECMO group, as well as the kidney delayed graft function (DGF) rate was found to be decreased by the use of ECMO in our study. Donation success rate increased steadily from 47.8% in 2011 to 84.6% in 2014 after the ECMO intervention. The use of ECMO in assisting circulatory and respiratory function of DBD can reduce liver and kidney injury from vasoactive drugs, thereby improving organ quality and reducing the organ discard rates. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Optical Dynamic Analysis of Thrombus Inside a Centrifugal Blood Pump During Extracorporeal Mechanical Circulatory Support in a Porcine Model.

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    Fujiwara, Tatsuki; Sakota, Daisuke; Ohuchi, Katsuhiro; Endo, Shu; Tahara, Tomoki; Murashige, Tomotaka; Kosaka, Ryo; Oi, Keiji; Mizuno, Tomohiro; Maruyama, Osamu; Arai, Hirokuni

    2017-10-01

    Complications due to pump thrombus remain the weak point of mechanical circulatory support (MCS), such as the use of a left ventricular assist device (LVAD) or extracorporeal membrane oxygenation, leading to poor outcomes. Hyperspectral imaging (HSI) is an effective imaging method using a hyperspectral (HS) camera, which comprises a spectrophotometer and a charge-coupled device camera to discriminate thrombus from whole blood. Animal experiments were conducted to analyze dynamic imaging of thrombus inside a prototype of a hydrodynamically levitated centrifugal blood pump using an HSI system. Six pigs were divided into a venous circulation group (n = 3) and an arterial circulation group (n = 3). Inflow and outflow cannulae were inserted into the jugular veins in the venous circulation group. The latter simulated an LVAD application. To create thrombogenic conditions, pump flow was maintained at 1 L/min without anticoagulation. An image of the bottom surface of the pump was captured by the HS camera every 4 nm over the wavelength range of 608-752 nm. Real-time dynamic images of the inside of the pump were displayed on the monitor. Appearance of an area displaying thrombus was detected within 24 h after the start of the circulation in every experiment. This imaging system also succeeded in determining the origins of pump thrombus: from inside the pump in two cases, and from outside in four cases. Two main possible sources of pump thrombus originating outside the pump were identified on autopsy: wedge thrombus around the inflow cannula; and string-like thrombus at the junction between the pump inlet and circuit tube. The results of this study from close observation of the changing appearance of pump thrombus may contribute to improvements in the safety of extracorporeal MCS. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  7. FIVE-YEAR EXPERIENCE IN PERIPHERAL VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION AS A METHOD OF MECHANICAL CIRCULATORY SUPPORT IN POTENTIAL HEART TRANSPLANT RECIPIENTS

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    S. V. Gautier

    2016-01-01

    Full Text Available Introduction. Venoarterial extracorporeal membrane oxygenation (VA ECMO is one of the most widely used methods of temporary mechanical circulatory support (MCS during the preparation and performance of heart transplant surgery (HT [Barth E. et al., 2012; Kittleson M.M. et al., 2011].Aim of this study was to assess the effectiveness of using peripheral VA ECMO as a method of mechanical circulatory support in potential heart transplant recipients that urgently required transplantation.Materials and methods. The study included 125 potential heart transplant recipients (107 (86% men and 18 (14% women aged from 12 to 72 (43 ± 1.2 years with a peripheral VA ECMO system installed within the period from April 01, 2011 till August 12, 2016. The indication for the start of its use was rapidly progressing congestive heart failure (CHF of level 1 or 2 by the INTERMACS scale. Femoral blood vessel cannulation was performed using both open (surgical and closed (puncture methods. 23 and 25 F venous cannulae were utilized for femoral vein cannulation, and 15 and 17 F arterial cannulae were utilized for femoral artery cannulation. In all cases superfi cial femoral artery catheterization (14 F single-lumen catheter or cannulation (8 or 10 F arterial cannula was performed in the descending (anterograde direction for the prevention of lower limb ischemia on the side of the femoral artery cannulation.Results. The peripheral cannulation method was used to perform VA ECMO in 100% (n = 125 observations. In 69 (55.2% patients the severity of progressive CHF corresponded to INTERMACS level 1; in 51 (40.8% cases it corresponded to INTERMACS level 2. During VA ECMO the average volumetric extracorporeal circulation fl ow rate ranged from 2.2 to 4.5 (3.2 ± 0.4 l/min or 1.6 ± 0.2 l/min/m2 with the average rotation speed of the centrifugal pump of 3.216 ± 105 rpm. 113 (90.4% of 125 potential recipients underwent HT. The duration of VA ECMO prior to HT (n

  8. Recovery of donor hearts after circulatory death with normothermic extracorporeal machine perfusion.

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    Tolboom, Herman; Makhro, Asya; Rosser, Barbara A; Wilhelm, Markus J; Bogdanova, Anna; Falk, Volkmar

    2015-01-01

    A severe donor organ shortage leads to the death of a substantial number of patients who are listed for transplantation. The use of hearts from donors after circulatory death could significantly expand the donor organ pool, but due to concerns about their viability, these are currently not used for transplantation. We propose short-term ex vivo normothermic machine perfusion (MP) to improve the viability of these ischaemic donor hearts. Hearts from male Lewis rats were subjected to 25 min of global in situ warm ischaemia (WI) (37°C), explanted, reconditioned for 60 min with normothermic (37°C) MP with diluted autologous blood and then stored for 4 h at 0-4°C in Custodiol cold preservation solution. Fresh and ischaemic hearts stored for 4 h in Custodiol were used as controls. Graft function was assessed in a blood-perfused Langendorff circuit. During reconditioning, both the electrical activity and contractility of the ischaemic hearts recovered rapidly. Throughout the Langendorff reperfusion, the reconditioned ischaemic hearts had a higher average heart rate and better contractility compared with untreated ischaemic controls. Moreover, the reconditioned ischaemic hearts had higher tissue adenosine triphosphate levels and a trend towards improved tissue redox state. Perfusate levels of troponin T, creatine kinase and lactate dehydrogenase were not significantly lower than those of untreated ischaemic controls. The micro- and macroscopic appearance of the reconditioned ischaemic hearts were improved compared with ischaemic controls, but in both groups myocardial damage and oedema were evident. Our results indicate that functional recovery from global WI is possible during short-term ex vivo reperfusion, allowing subsequent cold storage without compromising organ viability. We expect that once refined and validated, this approach may enable safe transplantation of hearts obtained from donation after circulatory death. © The Author 2014. Published by Oxford

  9. Ethical dilemma: offering short-term extracorporeal membrane oxygenation support for terminally ill children who are not candidates for long-term mechanical circulatory support or heart transplantation.

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    Shankar, Venkat; Costello, John P; Peer, Syed M; Klugman, Darren; Nath, Dilip S

    2014-04-01

    The use of extracorporeal membrane oxygenation (ECMO) in terminally ill pediatric patients who are not candidates for long-term mechanical circulatory support or heart transplantation requires careful deliberation. We present the case of a 16-year-old female with a relapse of acute lymphoid leukemia and acute-on-chronic cardiomyopathy who received short-term ECMO therapy. In addition, we highlight several ethical considerations that were crucial to this patient's family-centered care and demonstrate that this therapy can be accomplished in a manner that respects patient autonomy and family wishes.

  10. Usefulness of extracorporeal membrane oxygenation using double roller pumps in a low body weight newborn: A novel strategy for mechanical circulatory support in an infant

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    Keisuke Nakanishi

    2016-01-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO with a centrifugal pump requires a certain flow rate; therefore, its application for low body weight infants is frequently accompanied by oxygenator membrane malfunction and/or inadequate perfusion. To prevent low-flow associated complications, we report a case in which a novel system of dual roller pumps was used. A baby girl with a body mass index 0.25 m 2 , who experienced difficulty weaning from cardiopulmonary bypass after a Norwood-like operation, required an ECMO. Concerns for the tube lifespan reduction due to roller pump friction led to the use of a double roller pump circulation. The termination of ECMO during tube exchange is not needed, because circulation is maintained by another roller pump. The novel strategy of ECMO with double roller pumps will allow low perfusion rate to provide adequate circulatory support for low body weight patients.

  11. MedTech Mag-Lev, single-use, extracorporeal magnetically levitated centrifugal blood pump for mid-term circulatory support.

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    Nagaoka, Eiki; Fujiwara, Tatsuki; Kitao, Takashi; Sakota, Daisuke; Shinshi, Tadahiko; Arai, Hirokuni; Takatani, Setsuo

    2013-01-01

    Short- to mid-term extracorporeal ventricular assist devices (VADs) are recommended for critical cardiogenic shock patients. We have designed a preclinical, single-use MedTech Mag-Lev VAD for one-month extracorporeal use. The impeller-rotor of the pump was suspended by a two degree-of-freedom active magnetic bearing in a 300 μm fluid gap, where the computational fluid dynamics analysis predicted a secondary flow of about 400-500 ml/min at a pump speed of 1800-2200 rpm. Three eddy current sensors were employed to implement noise- and drift-free magnetic levitation. The pump components were injection molded using polycarbonate for smooth surfaces as well as improved reproducibility, followed by coating with a biocompatible 2-methacryloyl-oxyethyl phosphorylcholine polymer. Chronic animal experiments were performed in nine calves. Three of the nine calves were excluded from analysis for problems with the circuit. Five of the six (83.3%) completed the 60 day duration of the study, while one prematurely died of massive bleeding due to inflow port detachment. The pump did not stop due to magnetic-levitation malfunction. Neither pump thrombosis nor major organ infarction was observed at autopsy. In comparison to machined surfaces, the injection-molded pump surfaces were thrombus-free after 60 day implantation. This study demonstrates the feasibility of MedTech Mag-Lev VAD for 60 day circulatory support.

  12. Mechanical circulatory support for bridge to decision: which device and when to decide.

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    Ziemba, Elizabeth A; John, Ranjit

    2010-07-01

    Despite the many advances in the management of patients with acute heart failure, the outcome for patients with refractory acute cardiogenic shock remains disproportionately poor. Clearly, there is a definitive role for wider application of temporary circulatory support in such patients. Questions remain as to the ideal device, the optimal duration of temporary support, and the ideal timing to bridge these patients to a long-term device. There are currently several options available for circulatory support and include surgically implanted ventricular assist devices, percutaneous assist devices, and extracorporeal membrane oxygenation. This review includes a brief summary of the current assist devices available along with the University of Minnesota's experience with the Levitronix CentriMag system.

  13. Cardiovascular devices; reclassification of nonroller-type cardiopulmonary bypass blood pumps for cardiopulmonary and circulatory bypass; effective date of requirement for premarket approval for nonroller-type cardiopulmonary bypass blood pumps for temporary ventricular support. Final order.

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    2015-06-08

    The Food and Drug Administration (FDA) is issuing a final order to reclassify nonroller-type cardiopulmonary bypass blood pump (NRP) devices for cardiopulmonary and circulatory bypass, a preamendments class III device, into class II (special controls), and to require the filing of a premarket approval application (PMA) for NRP devices for temporary ventricular support. FDA is also revising the title and identification of the regulation for NRP devices in this order.

  14. Use of extracorporeal membrane oxygenation in adults.

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    Lafç, Gökhan; Budak, Ali Baran; Yener, Ali Ümit; Cicek, Omer Faruk

    2014-01-01

    Since the first successful application of the heart-lung machine in 1953 by John Gibbon [1], great efforts have been made to modify the bypass techniques and devices in order to allow prolonged extracorporeal circulation in the intensive care unit (ICU), commonly referred to as extracorporeal membrane oxygenation (ECMO). ECMO uses classic cardiopulmonary bypass technology to support circulation. It provides continuous, non-pulsatile cardiac output and extracorporeal oxygenation [2]. Veno-venous ECMO (VV ECMO) provides respiratory support, while veno-arterial ECMO (VA ECMO) provides cardio-respiratory support to patients with severe but potentially reversible cardiac or respiratory deterioration refractory to standard therapeutic modalities. ECMO is a temporary form of life support providing a prolonged biventricular circulatory and pulmonary support for patients experiencing both pulmonary and cardiac failure unresponsive to conventional therapy. Despite the advent of newer ventricular assist devices that are more suitable for long term support, ECMO is simple to establish, cost-effective to operate. Copyright © 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  15. Extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation or uncontrolled donation after the circulatory determination of death following out-of-hospital refractory cardiac arrest-An ethical analysis of an unresolved clinical dilemma.

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    Dalle Ave, Anne L; Shaw, David M; Gardiner, Dale

    2016-11-01

    The availability of extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation (E-CPR), for use in refractory out-of hospital cardiac arrest (OHCA), is increasing. In parallel, some countries have developed uncontrolled donation after circulatory determination of death (uDCDD) programs using ECMO to preserve organs for transplantation purposes. When facing a refractory OHCA, how does the medical team choose between initiating ECMO as part of an E-CPR protocol or ECMO as part of a uDCDD protocol? To answer these questions we conducted a literature review on E-CPR compared to uDCDD protocols using ECMO and analyzed the raised ethical issues. Our analysis reveals that the inclusion criteria in E-CPR and uDCDD protocols are similar. There may be a non-negligible risk of including patients in a uDCDD protocol, when the patient might have been saved by the use of E-CPR. In order to avoid the fatal error of letting a saveable patient die, safeguards are necessary. We recommend: (1) the development of internationally accepted termination of resuscitation guidelines that would have to be satisfied prior to inclusion of patients in any uDCDD protocol, (2) the choice regarding modalities of ongoing resuscitation during transfer should be focused on the primary priority of attempting to save the life of patients, (3) only centers of excellence in life-saving resuscitation should initiate or maintain uDCDD programs, (4) E-CPR should be clinically considered first before the initiation of any uDCDD protocol, and (5) there should be no discrimination in the availability of access to E-CPR. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. Mechanical circulatory support in pediatrics.

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    Steffen, Robert J; Miletic, Kyle G; Schraufnagel, Dean P; Vargo, Patrick R; Fukamachi, Kiyotaka; Stewart, Robert D; Moazami, Nader

    2016-05-01

    End-stage heart failure affects thousands of children yearly and mechanical circulatory support is used at many points in their care. Extracorporeal membrane oxygenation supports both the failing heart and lungs, which has led to its use as an adjunct to cardiopulmonary resuscitation as well as in post-operative cardiogenic shock. Continuous-flow ventricular assist devices (VAD) have replaced pulsatile-flow devices in adults and early studies have shown promising results in children. The Berlin paracorporeal pulsatile VAD recently gained U.S. Food and Drug Administration approval and remains the only VAD approved in pediatrics. Failing univentricular hearts and other congenitally corrected lesions are new areas for mechanical support. Finding novel uses, improving durability, and minimizing complications are areas of growth in pediatric mechanical circulatory support.

  17. Extracorporeal life support devices and strategies for management of acute cardiorespiratory failure in adult patients: a comprehensive review.

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    Shekar, Kiran; Mullany, Daniel V; Thomson, Bruce; Ziegenfuss, Marc; Platts, David G; Fraser, John F

    2014-05-09

    Evolution of extracorporeal life support (ECLS) technology has added a new dimension to the intensive care management of acute cardiac and/or respiratory failure in adult patients who fail conventional treatment. ECLS also complements cardiac surgical and cardiology procedures, implantation of long-term mechanical cardiac assist devices, heart and lung transplantation and cardiopulmonary resuscitation. Available ECLS therapies provide a range of options to the multidisciplinary teams who are involved in the time-critical care of these complex patients. While venovenous extracorporeal membrane oxygenation (ECMO) can provide complete respiratory support, extracorporeal carbon dioxide removal facilitates protective lung ventilation and provides only partial respiratory support. Mechanical circulatory support with venoarterial (VA) ECMO employed in a traditional central/peripheral fashion or in a temporary ventricular assist device configuration may stabilise patients with decompensated cardiac failure who have evidence of end-organ dysfunction, allowing time for recovery, decision-making, and bridging to implantation of a long-term mechanical circulatory support device and occasionally heart transplantation. In highly selected patients with combined severe cardiac and respiratory failure, advanced ECLS can be provided with central VA ECMO, peripheral VA ECMO with timely transition to venovenous ECMO or VA-venous ECMO upon myocardial recovery to avoid upper body hypoxia or by addition of an oxygenator to the temporary ventricular assist device circuit. This article summarises the available ECLS options and provides insights into the principles and practice of these techniques. One should emphasise that, as is common with many emerging therapies, their optimal use is currently not backed by quality evidence. This deficiency needs to be addressed to ensure that the full potential of ECLS can be achieved.

  18. Recurrent or prolonged mechanical circulatory support: bridge to recovery or road to nowhere?

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    d'Udekem, Yves; Shime, Nobuaki; Lou, Song; MacLaren, Graeme

    2013-06-01

    Remarkable outcomes have been reported after prolonged mechanical circulatory support in the pediatric population, but there is yet no clear delineation of the duration beyond which supporting a child becomes futile. The likelihood of survival in patients supported on extracorporeal membrane oxygenation for respiratory failure decreases with the length of support. However, extracorporeal membrane oxygenation can be successfully used in these patients for long periods (weeks to months) provided adequate support is maintained without complications. This is not the case with cardiac failure and mechanical circulatory support.Extracorporeal membrane oxygenation is usually the initial form of mechanical circulatory support used in patients with primary refractory myocardial dysfunction. There is evidence and consensus that if the patient shows no signs of recovery after a maximum duration of 2 weeks, he or she should be transitioned to a ventricular assist device, which allows prolonged support. In post-cardiac surgery patients, survival is only anecdotal beyond 12 days of extracorporeal membrane oxygenation support, and myocardial recovery is exceptionally rare after this time period unless new diagnoses and management strategies are formulated.Repeat extracorporeal membrane oxygenation should generally not be offered to patients unless it is established that support was withdrawn prematurely or a new intervention is planned. Repeat extracorporeal membrane oxygenation may achieve some improvement in early survival, but the long-term outcomes of survivors are so poor that these attempts cannot be generally recommended unless organ transplantation is an option.

  19. Mechanical Circulatory Support for High-Risk Pulmonary Embolism.

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    Elder, Mahir; Blank, Nimrod; Shemesh, Adi; Pahuja, Mohit; Kaki, Amir; Mohamad, Tamam; Schreiber, Theodore; Giri, Jay

    2018-01-01

    Temporary mechanical circulatory support (MCS) devices have a role in treating high-risk patients with pulmonary embolism with cardiogenic shock. Mechanical circulatory device selection should be made based on center experience and device-specific features. All current devices are effective in decreasing right arterial pressure and providing circulatory support of 4 to 5 L/min. The pulmonary artery pulsatility index may prove to be an unreliable method to assess right ventricular function. Careful clinical evaluation on an individual patient basis should determine the need for MCS. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Hemodynamic changes in patients with extracorporeal membrane oxygenation (ECMO) demonstrated by contrast-enhanced CT examinations - implications for image acquisition technique.

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    Lambert, Lukas; Grus, Tomas; Balik, Martin; Fichtl, Jaromir; Kavan, Jan; Belohlavek, Jan

    2017-04-01

    Extracorporeal membrane oxygenation (ECMO) is an established tool for respiratory and circulatory support. In computed tomography, altered hemodynamics in ECMO patients requires special considerations and handling in contrast injection and its timing. In this article, we demonstrate changes in hemodynamics in ECMO patients captured on contrast-enhanced CT examinations and pitfalls in strategies for contrast injection in relation to the ECMO flow, cardiac function and the placement of ECMO cannulas. Contrast-enhanced CT of patients with ECMO requires prior knowledge of the ECMO cannulas, central venous lines, changes of hemodynamics induced by low cardiac output and the influence of adjustment of ECMO on blood flow in order to optimize injection of the contrast material and timing of the scan. Special considerations include temporary reduction of the ECMO flow, selection of the injection site and increasing volume or flow rate of the contrast material.

  1. Advancements in mechanical circulatory support for patients in acute and chronic heart failure

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    Csepe, Thomas A.

    2017-01-01

    Cardiogenic shock (CS) continues to have high mortality and morbidity despite advances in pharmacological, mechanical, and reperfusion approaches to treatment. When CS is refractory to medical therapy, percutaneous mechanical circulatory support (MCS) should be considered. Acute MCS devices, ranging from intra-aortic balloon pumps (IABPs) to percutaneous temporary ventricular assist devices (VAD) to extracorporeal membrane oxygenation (ECMO), can aid, restore, or maintain appropriate tissue perfusion before the development of irreversible end-organ damage. Technology has improved patient survival to recovery from CS, but in patients whom cardiac recovery does not occur, acute MCS can be effectively utilized as a bridge to long-term MCS devices and/or heart transplantation. Heart transplantation has been limited by donor heart availability, leading to a greater role of left ventricular assist device (LVAD) support. In patients with biventricular failure that are ineligible for LVAD implantation, further advancements in the total artificial heart (TAH) may allow for improved survival compared to medical therapy alone. In this review, we discuss the current state of acute and durable MCS, ongoing advances in LVADs and TAH devices, improved methods of durable MCS implantation and patient selection, and future MCS developments in this dynamic field that may allow for optimization of HF treatment. PMID:29268418

  2. Population pharmacokinetics of intravenous clonidine for sedation during paediatric extracorporeal membrane oxygenation and continuous venovenous hemofiltration

    NARCIS (Netherlands)

    Kleiber, Niina; Mathôt, Ron A. A.; Ahsman, Maurice J.; Wildschut, Enno D.; Tibboel, Dick; de Wildt, Saskia N.

    2017-01-01

    AIMS Clonidine is used for sedation in the paediatric intensive care unit. Extracorporeal membrane oxygenation (ECMO) provides temporary support if respiratory and cardiac function is threatened. ECMO influences the pharmacokinetics of drugs. Clonidine during paediatric ECMO cannot be effectively

  3. Population pharmacokinetics of intravenous clonidine for sedation during paediatric extracorporeal membrane oxygenation and continuous venovenous hemofiltration

    NARCIS (Netherlands)

    Kleiber, N.; Mathot, R.A.A.; Ahsman, M.J.; Wildschut, E.D.; Tibboel, D.; Wildt, S.N. de

    2017-01-01

    AIMS: Clonidine is used for sedation in the paediatric intensive care unit. Extracorporeal membrane oxygenation (ECMO) provides temporary support if respiratory and cardiac function is threatened. ECMO influences the pharmacokinetics of drugs. Clonidine during paediatric ECMO cannot be effectively

  4. Vertebrobasilar circulatory disorders

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    ... will keep improving for months or years. Possible Complications Complications of vertebrobasilar circulatory disorders are stroke and ... FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, ...

  5. Circulatory shock in horses

    OpenAIRE

    José Monteira da Silva Filho; Maristela Silveira Palhares; Cíntia Ferreira; Ubiratan Pereira de Melo

    2010-01-01

    Circulatory shock can be defined as an acute circulatory failure with an inadequate tissue delivery of oxygen and nutritive substrates to the tissues, resulting in generalised cellular hypoxia. Shock can be classified as cardiogenic, obstructive, hypovolaemic, or distributive. The pathophysiologic consequences of inadequate tissue perfusion are directly related to cell ischemia, inadequate O2 delivery, and the production of proinflammatory mediators. If abnormalities of tissue perfusion are a...

  6. Extracorporeal membrane oxygenation in the treatment of poisoned patients.

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    de Lange, D W; Sikma, M A; Meulenbelt, J

    2013-06-01

    Although extracorporeal membrane oxygenation (ECMO) was used in many patients following its introduction in 1972, most hospitals had abandoned this experimental treatment for adult patients. Recently, improvements in the ECMO circuitry rendered it more biocompatible. The surprisingly low mortality in patients with severe acute respiratory distress syndrome who were treated with ECMO in the influenza A/H1N1 pandemic of 2009 resurrected interest in ECMO in many intensive care units around the world. This article reviews the different techniques of ECMO, the indications, contraindications and complications of its use, its role in poisoned patients and the ethics of its use. We searched Pubmed, Toxnet, Cochrane database and Embase from 1966 to September 2012 using the search terms (''extracorporeal membrane oxygenation'', 'extracorporeal life support', 'ECMO', 'ECLS', 'assist-device', and 'intox*' or 'poison*'). These searches identified 242 papers of which 116 described ECMO in conditions other than intoxications or were reviews. In total 46 publications selected for this manuscript were case reports or case series involving poisoned patients. ECMO TECHNIQUES: Two types of ECMO are used: veno-venous ECMO (VV-ECMO) or veno-arterial ECMO (VA-ECMO). VV-ECMO is used for patients with severe ARDS to secure adequate oxygenation of the organs while protecting the lungs from harmful ventilation pressures or prolonged inspiratory fraction of oxygen. VA-ECMO can be used whenever the patient remains in shock despite adequate fluid resuscitation and is refractory to administration of inotropes and vasopressors. The organ support that can be applied with ECMO makes it especially useful in patients with severe poisoning as the clinical impact of the intoxication is often temporary; ECMO can be used as a 'bridge to recovery'. Absolute contraindications are uncontrolled coagulopathy and severe intracranial bleeding, which precludes the use of anticoagulation therapy. Relative

  7. [Extracorporeal kidney surgery].

    Science.gov (United States)

    Lopatkin, N A

    1983-12-01

    A report is given on the correlation between 50 planned extracorporal kidney operations and the 20 operations actually performed. The reasons for this relation, indications for the operations and operative techniques are discussed. Extracorporal kidney surgery is relatively seldom necessary with strict indication.

  8. Extracorporeal membrane oxygenation

    Science.gov (United States)

    ECMO; Heart-lung bypass - infants; Bypass - infants; Neonatal hypoxia - ECMO; PPHN - ECMO; Meconium aspiration - ECMO; MAS - ECMO ... Extracorporeal membrane oxygenation (ECMO) is a treatment that uses a pump to circulate blood through an artificial lung back ...

  9. Extracorporeal treatment for thallium poisoning

    DEFF Research Database (Denmark)

    Ghannoum, Marc; Nolin, Thomas D; Goldfarb, David S

    2012-01-01

    The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning. To test and validate its methods, the workgroup reviewed data for thallium (Tl)....

  10. Extracorporeal Membrane Oxygenation (ECMO) for Hypothermic Cardiac Deterioration: A Case Series.

    Science.gov (United States)

    Niehaus, Matthew T; Pechulis, Rita M; Wu, James K; Frei, Steven; Hong, John J; Sandhu, Rovinder S; Greenberg, Marna Rayl

    2016-10-01

    Accidental hypothermia can lead to untoward cardiac manifestations and arrest. This report presents a case series of severe accidental hypothermia with cardiac complications in three emergency patients who were treated with extracorporeal membrane oxygenation (ECMO) and survived after re-warming. The aim of this discussion was to encourage more clinicians to consider ECMO as a re-warming therapy for severe hypothermia with circulatory collapse and to prompt discussion about decreasing the barriers to its use. Niehaus MT , Pechulis RM , Wu JK , Frei S , Hong JJ , Sandhu RS , Greenberg MR . Extracorporeal membrane oxygenation (ECMO) for hypothermic cardiac deterioration: a case series. Prehosp Disaster Med. 2016;31(5):570-571.

  11. Pediatric Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Jenks, Christopher Loren; Raman, Lakshmi; Dalton, Heidi J

    2017-10-01

    Extracorporeal life support is a modified form of cardiopulmonary bypass. Experience in extracorporeal membrane oxygenation (ECMO) has come largely from the neonatal population. Most centers have transitioned the ECMO pumps from roller pumps to centrifugal technology. Modes of support include venovenous for respiratory support and venoarterial for cardiac support. "Awake" ECMO is the trend with extubation and tracheostomy on the rise. Fluid overload is common and managed with diuretics or hemofiltration. Nutrition is important and provided enterally or via total parenteral nutrition. Overall survival for pediatric cardiac and respiratory ECMO has remained at approximately 50% to 60%. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Stress Cardiomyopathy Managed with Extracorporeal Support after Self-Injection of Epinephrine

    Directory of Open Access Journals (Sweden)

    Bourenne Jeremy

    2017-01-01

    Full Text Available A 28-year-old man was admitted to the ICU for self-injection of Epinephrine. This injection resulted in the rapid development of a catecholamine-induced cardiomyopathy (inverted Takotsubo with a severe cardiogenic shock. The importance of ventricular dysfunction required the implementation of a temporary arteriovenous circulatory support until the recovery of myocardial stunning. This case allows redefining the role of circulatory assistance during cardiotropic agents intoxication.

  13. The abdominal circulatory pump.

    Directory of Open Access Journals (Sweden)

    Andrea Aliverti

    Full Text Available Blood in the splanchnic vasculature can be transferred to the extremities. We quantified such blood shifts in normal subjects by measuring trunk volume by optoelectronic plethysmography, simultaneously with changes in body volume by whole body plethysmography during contractions of the diaphragm and abdominal muscles. Trunk volume changes with blood shifts, but body volume does not so that the blood volume shifted between trunk and extremities (Vbs is the difference between changes in trunk and body volume. This is so because both trunk and body volume change identically with breathing and gas expansion or compression. During tidal breathing Vbs was 50-75 ml with an ejection fraction of 4-6% and an output of 750-1500 ml/min. Step increases in abdominal pressure resulted in rapid emptying presumably from the liver with a time constant of 0.61+/-0.1SE sec. followed by slower flow from non-hepatic viscera. The filling time constant was 0.57+/-0.09SE sec. Splanchnic emptying shifted up to 650 ml blood. With emptying, the increased hepatic vein flow increases the blood pressure at its entry into the inferior vena cava (IVC and abolishes the pressure gradient producing flow between the femoral vein and the IVC inducing blood pooling in the legs. The findings are important for exercise because the larger the Vbs the greater the perfusion of locomotor muscles. During asystolic cardiac arrest we calculate that appropriate timing of abdominal compression could produce an output of 6 L/min. so that the abdominal circulatory pump might act as an auxiliary heart.

  14. Perspective of clinical application of pumpless extracorporeal lung assist (ECMO in newborn

    Directory of Open Access Journals (Sweden)

    Gandolfi José Francisco

    2003-01-01

    Full Text Available Extracorporeal lung assist (ECLA has been proposed as an invasive alternative to conventional treatment when oxygenation is not possible by rigorous mechanical ventilation alone. Usually, ECLA is carried out by establishing a venovenous or venoarterial shunt consisting of a roller or centrifugal pump, a membrane oxygenator, and a heat exchanger. However, the extracorporeal membrane oxygenation (ECMO with circulatory support lead hemolysis, coagulation disorders, inflammatory response, and specific technical complications inherent to a procedure of high risk and cost. To reduce the drawbacks of mechanical blood trauma during prolonged ECLA, the patient´s arteriovenous pressure gradient as the driving force for the blood flow through for the extracorporeal circuit can be used. In this article are analysed the main contributions of pumpless ECMO, used experimentally and in children and adults with respiratory failure, with perspective of clinical application in newborn.

  15. Assistência circulatória com oxigenação por membrana extracorpórea (ECMO no adulto: um conceito falido ou esquecido? Adult extracorporeal life support: a failed or forgotten concept?

    Directory of Open Access Journals (Sweden)

    Alexandre Siciliano Colafranceschi

    2008-07-01

    oxygenation for temporary mechanical circulatory support of adults that present with acute refractory cardiogenic shock in our institution. There is no other published experience of the use of this system in this scenario in Brazil. OBJECTIVE: To describe our experience with the use of the extracorporeal membrane oxygenation for circulatory support in adults. METHODS: Retrospective analysis of the medical files of patients submitted to the implant of extracorporeal membrane oxygenation system for circulatory assistance in acute and refractory cardiogenic shock. RESULTS: Eleven patients (63,5yo; 45,5%male were considered for analysis from 2005 to 2007. Median support time was 77 hours (10-240h and 5 patients have survived 30 days (45,5%. Two patients were subsequently submitted to prolonged paracorporeal circulatory assistance. Mortality on ECMO (6 patients was due to multiple organ failure (66,6% and refractory bleeding (33,4%. CONCLUSION: ECMO system is an option to be used in acute refractory cardiogenic shock as a bridge to recovery or selecting patients that might benefit from prolonged paracorporeal assist devices (bridge to bridge.

  16. Long-term Follow-up of Children Treated with Neonatal Extracorporeal Membrane Oxygenation: neuropsychological outcome

    NARCIS (Netherlands)

    M.J. Madderom (Marlous)

    2013-01-01

    textabstractThis thesis aims to describe the long-term neuropsychological outcome of children and adolescents treated with neonatal extracorporeal membrane oxygenation (ECMO). ECMO is a pulmonary bypass technique providing temporary life support in potentially acute reversible (cardio)respiratory

  17. EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY AS

    African Journals Online (AJOL)

    2, 2002. 87-93. EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY AS. MONOTHERAPY FOR STONES IN SOLITARY KIDNEY. K. MADBOULY, E. ELSOBKY, K.Z. SHEIR, l. ERAKY AND M. KENAWY. Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. Objective To evaluate extracorporeal shock.

  18. Extracorporeal treatment for acetaminophen poisoning

    DEFF Research Database (Denmark)

    Gosselin, S; Juurlink, D N; Kielstein, J T

    2014-01-01

    BACKGROUND: The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments (ECTR) in poisoning and the results are presented here for acetaminophen (APAP). METHODS: After a systematic review of the litera...

  19. Extracorporeal Treatment for Lithium Poisoning

    DEFF Research Database (Denmark)

    Decker, Brian S; Goldfarb, David S; Dargan, Paul I

    2015-01-01

    treatment (1D), but continuous RRT is an acceptable alternative (1D). The workgroup supported the use of extracorporeal treatment in severe lithium poisoning. Clinical decisions on when to use extracorporeal treatment should take into account the [Li(+)], kidney function, pattern of lithium toxicity...

  20. Mechanical circulatory treatment of advanced heart failure

    DEFF Research Database (Denmark)

    Løgstrup, Brian B; Vase, Henrik; Gjedsted, Jakob

    2016-01-01

    Heart failure is one of the most common causes of morbidity and mortality worldwide. When patients cease to respond adequately to optimal medical therapy mechanical circulatory support has been promising. The advent of mechanical circulatory support devices has allowed significant improvements...... in patient survival and quality of life for those with advanced or end-stage heart failure. We provide a general overview of current mechanical circulatory support devices encompassing options for both short- and long-term ventricular support....

  1. Short-term mechanical circulatory support as a bridge to durable left ventricular assist device implantation in refractory cardiogenic shock: a systematic review and meta-analysis.

    Science.gov (United States)

    den Uil, Corstiaan A; Akin, Sakir; Jewbali, Lucia S; Dos Reis Miranda, Dinis; Brugts, Jasper J; Constantinescu, Alina A; Kappetein, Arie Pieter; Caliskan, Kadir

    2017-07-01

    Short-term mechanical circulatory support (MCS) is increasingly used as a bridge to decision in patients with refractory cardiogenic shock. Subsequently, these patients might be bridged to durable MCS either as a bridge to candidacy/transplantation, or as destination therapy. The aim of this study was to review support duration and clinical outcome of short-term MCS in cardiogenic shock, and to analyse application of this technology as a bridge to long-term cardiac support (left ventricular assist device, LVAD) from 2006 till June 2016. Using Cochrane Register of Trials, Embase and Medline, a systematic review was performed on patients with cardiogenic shock from acute myocardial infarction, end-stage cardiomyopathy, or acute myocarditis, receiving short-term MCS. Studies on periprocedural, post-cardiotomy and cardiopulmonary resuscitation support were excluded. Thirty-nine studies, mainly registries of heterogeneous patient populations (n = 4151 patients), were identified. Depending on the device used (intra-aortic balloon pump, TandemHeart, Impella 2.5, Impella 5.0, CentriMag and peripheral veno-arterial extracorporeal membrane oxygenation), mean support duration was (range) 1.6-25 days and the mean proportion of short-term MCS patients discharged was (range) 45-66%. The mean proportion of bridge to durable LVAD was (range) 3-30%. Bridge to durable LVAD was most frequently performed in patients with end-stage cardiomyopathy (22 [12-35]%). We conclude that temporary MCS can be used to bridge patients with cardiogenic shock towards durable LVAD. Clinicians are encouraged to share their results in a large multicentre registry in order to investigate optimal device selection and best duration of support. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  2. A 95 year-old suffering circulatory arrest after accidental hypothermia: a case report

    Directory of Open Access Journals (Sweden)

    Anders Wetting Carlsen

    2017-10-01

    Full Text Available Abstract Background The elderly are vulnerable to cold and prone to accidental hypothermia, both because of environmental and endogenous factors. The incidence of severe accidental hypothermia among the elderly is poorly described, but many cases probably go unrecorded. Going through literature one finds few publications on severe hypothermia among the elderly, and, to our knowledge, nothing about extracorporeal re-warming of geriatric hypothermia victims. Case presentation We present a case were a 95 year-old man with severe accidental hypothermia and circulatory arrest was brought to our hospital under on-going CPR, and was successfully resuscitated with extracorporeal circulation. He was discharged to his home without physical sequelae a few weeks later. Conclusion The decision whether or not to continue resuscitation of a nonagenarian can be difficult in many respects. Knowing that resuscitation with extracorporeal circulation is resource intensive may complicate the discussion. In light of our experience with this case we discuss medical and ethical aspects of modern treatment of severe accidental hypothermia.

  3. Extracorporeal membrane oxygenation (ECMO) | Richards ...

    African Journals Online (AJOL)

    Extracorporeal membrane oxygenation (ECMO) is increasingly being employed in South African intensive care units for the management of patients with refractory hypoxaemia and for haemodynamic support, particularly following cardiothoracic procedures. ECMO is expensive, however, and there is a danger that this ...

  4. [Pain evaluation during extracorporeal lithotropsy].

    Science.gov (United States)

    Schoenig, A; Vedrine, N; Costilles, T; Boiteux, J-P; Guy, L

    2014-10-01

    The aim of this study was to demonstrate the feasibility of extracorporeal lithotripsy using lithotripter Sortz MODULITH SLK(®) without analgesics. An anonymous self-administered questionnaire was sent to 854 patients post-shock wave lithotripsy for urinary lithiasis. No patient had pain medication. The questionnaire included seven questions to assess the pain symptoms due to treatment. After 15 days, a reminder letter was sent. The response rate was 69% (591/854). The extracorporeal lithotripsy without analgesic treatment was generally well tolerated. About 70% of patients felt just a few or no pain and average pain assessment was 3.6/10 on VAS. The pain was often considered to be multifactorial, related to the treatment itself, the duration of the session and the position on the table. Anxiety seemed to play an equally important role in pain relief with an average VAS 4.5 against 2.9 for non-anxious patients. If a new session of extracorporeal lithotripsy was necessary, 53% of patients would require no pain medication. The extracorporeal lithotripsy could easily be done without systematic analgesics allowing for outpatient care. In contrast, anxiety seemed to be an important predictor of poor tolerance of sessions so the idea of a prophylactic anxiolytic treatment based on psychological profile of the patient should allow less aggressive and less costly management of urolithiasis. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  5. Uncontrolled organ donation after circulatory determination of death: US policy failures and call to action.

    Science.gov (United States)

    Wall, Stephen P; Munjal, Kevin G; Dubler, Nancy N; Goldfrank, Lewis R

    2014-04-01

    In the United States, more than 115,000 patients are wait-listed for organ transplants despite that there are 12,000 patients each year who die or become too ill for transplantation. One reason for the organ shortage is that candidates for donation must die in the hospital, not the emergency department (ED), either from neurologic or circulatory-respiratory death under controlled circumstances. Evidence from Spain and France suggests that a substantial number of deaths from cardiac arrest may qualify for organ donation using uncontrolled donation after circulatory determination of death (uDCDD) protocols that rapidly initiate organ preservation in out-of-hospital and ED settings. Despite its potential, uDCDD has been criticized by panels of experts that included neurologists, intensivists, attorneys, and ethicists who suggest that organ preservation strategies that reestablish oxygenated circulation to the brain retroactively negate previous death determination based on circulatory-respiratory criteria and hence violate the dead donor rule. In this article, we assert that in uDCDD, all efforts at saving lives are exhausted before organ donation is considered, and death is determined according to "irreversible cessation of circulatory and respiratory functions" evidenced by "persistent cessation of functions during an appropriate period of observation and/or trial of therapy." Therefore, postmortem in vivo organ preservation with chest compressions, mechanical ventilation, and extracorporeal membrane oxygenation is legally and ethically appropriate. As frontline providers for patients presenting with unexpected cardiac arrest, emergency medicine practitioners need be included in the uDCDD debate to advocate for patients and honor the wishes of the deceased. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  6. [Organ donation after circulatory death].

    Science.gov (United States)

    de Jonge, J; Kalisvaart, M; van der Hoeven, M; Epker, J; de Haan, J; IJzermans, J N M; Grüne, F

    2016-02-01

    Approximately 17 million inhabitants live in the Netherlands. The number of potential organ donors in 1999 was the lowest in Europe with only 10 donors per million inhabitants. Medical associations, public health services, health insurance companies and the government had to find common solutions in order to improve organ allocation, logistics of donations and to increase the number of transplantations. After a prolonged debate on medical ethical issues of organ transplantation, all participants were able to agree on socio-medico-legal regulations for organ donation and transplantation. In addition to improving the procedure for organ donation after brain death (DBD) the most important step was the introduction of organ donation after circulatory death (DCD). Measures such as the introduction of a national organ donor database, improved information to the public, further education on intensive care units (ICU), guidelines for end of life care on the ICU, establishment of transplantation coordinators on site, introduction of autonomous explantation teams and strict procedures on the course of organ donations, answered many practical issues about logistics and responsibilities for DBD and DCD. In 2014 the number of postmortem organ donations rose to 16.4 per million inhabitants. Meanwhile, up to 60 % of organ donations in the Netherlands originate from a DCD procedure compared to approximately 10 % in the USA. This overview article discusses the developments and processes of deceased donation in the Netherlands after 15 years of experience with DCD.

  7. Extracorporeal Treatment in Phenytoin Poisoning

    DEFF Research Database (Denmark)

    Anseeuw, Kurt; Mowry, James B; Burdmann, Emmanuel A

    2016-01-01

    The Extracorporeal Treatments in Poisoning (EXTRIP) Workgroup conducted a systematic literature review using a standardized process to develop evidence-based recommendations on the use of extracorporeal treatment (ECTR) in patients with phenytoin poisoning. The authors reviewed all articles...... criteria. Only case reports, case series, and pharmacokinetic studies were identified, yielding a very low quality of evidence. Clinical data from 31 patients and toxicokinetic grading from 46 patients were abstracted. The workgroup concluded that phenytoin is moderately dialyzable (level of evidence = C......) despite its high protein binding and made the following recommendations. ECTR would be reasonable in select cases of severe phenytoin poisoning (neutral recommendation, 3D). ECTR is suggested if prolonged coma is present or expected (graded 2D) and it would be reasonable if prolonged incapacitating ataxia...

  8. Regional tissue oximetry reflects changes in arterial flow in porcine chronic heart failure treated with venoarterial extracorporeal membrane oxygenation.

    Science.gov (United States)

    Hála, P; Mlček, M; Ošťádal, P; Janák, D; Popková, M; Bouček, T; Lacko, S; Kudlička, J; NeuŽil, P; Kittnar, O

    2016-12-22

    Venoarterial extracorporeal membrane oxygenation (VA ECMO) is widely used in treatment of decompensated heart failure. Our aim was to investigate its effects on regional perfusion and tissue oxygenation with respect to extracorporeal blood flow (EBF). In five swine, decompensated low-output chronic heart failure was induced by long-term rapid ventricular pacing. Subsequently, VA ECMO was introduced and left ventricular (LV) volume, aortic blood pressure, regional arterial flow and tissue oxygenation were continuously recorded at different levels of EBF. With increasing EBF from minimal to 5 l/min, mean arterial pressure increased from 47+/-22 to 84+/-12 mm Hg (Pheart support. Regional arterial flow and tissue oxygenation suggest that partial circulatory support may be sufficient to supply brain and peripheral tissue by oxygen.

  9. Organ donation after circulatory death: vital partnerships.

    Science.gov (United States)

    Ringos Beach, Patricia; Hallett, Annette M; Zaruca, Kim

    2011-05-01

    The authors present the case of a woman in her mid-50s who sustained extensive brain injury in an accident but wasn't declared brain dead. The case highlights some of the clinical and ethical considerations of organ donation after circulatory death (also known as non-heart-beating donation and donation after cardiac death). It also illustrates the interdisciplinary teamwork necessary for organ donation in such cases, involving nurses and other clinicians in the ICU, palliative care, and the local organ procurement organization, among others. cardiac death, circulatory death, donation after cardiac death, end-of-life care, ethics, non-heart-beating donation, organ donation, organ donation after circulatory death, organ transplantation, palliative care.

  10. PAEDIATRIC URETERIC CALCULIZ IN-SITU EXTRACORPOREAL

    African Journals Online (AJOL)

    Vandeursen H, Devos P, Baert L. Electromagnetic extracorporeal shock wave lithotripsy in children. J. UroI1991, 14511229. Marberger M, Turk C, Steinkogler l. Piezoelectric extracorporeal shock wave in children. J Urol. 1989, 142349. Newman DM, Kaefer M. Pediatric ESWL: Suitability hinges on long-term renal effects.

  11. Hospital Costs Of Extracorporeal Life Support Therapy

    NARCIS (Netherlands)

    Oude Lansink-Hartgring, Annemieke; van den Hengel, Berber; van der Bij, Wim; Erasmus, Michiel E; Mariani, Massimo A; Rienstra, Michiel; Cernak, Vladimir; Vermeulen, Karin M; van den Bergh, Walter M; van Dijk, D; Donker, DW

    OBJECTIVES: To conduct an exploration of the hospital costs of extracorporeal life support therapy. Extracorporeal life support seems an efficient therapy for acute, potentially reversible cardiac or respiratory failure, when conventional therapy has been inadequate, or as bridge to transplant, but

  12. Hospital Costs Of Extracorporeal Life Support Therapy

    NARCIS (Netherlands)

    Oude Lansink-Hartgring, Annemieke; van den Hengel, Berber; van der Bij, Wim; Erasmus, Michiel E.; Mariani, Massimo A.; Rienstra, Michiel; Cernak, Vladimir; Vermeulen, Karin M.; van den Bergh, Walter M.

    Objectives: To conduct an exploration of the hospital costs of extracorporeal life support therapy. Extracorporeal life support seems an efficient therapy for acute, potentially reversible cardiac or respiratory failure, when conventional therapy has been inadequate, or as bridge to transplant, but

  13. Stent Placement in a Neonate with Sano Modification of the Norwood using Semi-Elective Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Mustafa Gulgun

    Full Text Available Abstract Extracorporeal membrane oxygenation (ECMO is a well-established tool of cardiopulmonary circulatory support for cardiopulmonary failure in children and adults. It has been used as a supportive strategy during interventional procedures in neonates with congenital heart disease. Herein, we describe a neonate with hypoplastic left heart syndrome who underwent stenting of the Sano shunt and left pulmonary artery after Norwood Sano operation using intra-procedural ECMO support. The use of ECMO as a bridge to recovery might be a feasible and reasonably safe adjunctive approach in the treatment of complications in selective case of neonates having undergone the Norwood Sano procedure.

  14. [Oxygen-transporting function of the blood circulation system in sevoflurane anesthesia during myocardial revascularization under extracorporeal circulation].

    Science.gov (United States)

    Skopets, A A; Lomivorotov, V V; Karakhalis, N B; Makarov, A A; Duman'ian, E S; Lomivorotova, L V

    2009-01-01

    The purpose of the study was to evaluate the efficiency of oxygen-transporting function of the circulatory system under sevoflurane anesthesia during myocardial revascularization operations under extracorporeal circulation. Twenty-five patients with coronary heart disease were examined. Mean blood pressure, heart rate, cardiac index, total peripheral vascular resistance index, pulmonary pressure, pulmonary wedge pressure, and central venous pressure were measured. Arterial and mixed venous blood oxygen levels, oxygen delivery and consumption index, arteriovenous oxygen difference, and glucose and lactate concentrations were calculated. The study has demonstrated that sevoflurane is an effective and safe anesthetic for myocardial revascularization operations in patients with coronary heart disease. The use of sevoflurane contributes to steady-state oxygen-transporting function of the circulatory system at all surgical stages.

  15. SECURING DIGITIZED LIBRARY CIRCULATORY SYSTEM | Olaniyi ...

    African Journals Online (AJOL)

    Current model of operation carries along with it challenges of insecurity of library books, errors in task execution, laborious routines with over dependency of human involvement in Library operations. In this paper, circulatory operations of the library were digitized and secured using a 125- KHz Radio Frequency ...

  16. Representations of the Human Circulatory System

    Science.gov (United States)

    Lopez-Manjon, Asuncion; Angon, Yolanda Postigo

    2009-01-01

    There is no agreement about the robustness of intuitive representations of the circulatory system and their susceptibility to change by instruction. In this paper, we analyse to what extent students with varying degrees of biology instruction and different ages (High School Health Science and Social Science students and first and final year…

  17. obtunding the circulatory response to intubation

    African Journals Online (AJOL)

    Lidocaine. ' before endotracheal intubation, intravenous or laryngotracheal. Anesthesiology 1981', 55: 578—581. 2. Tam S, Chung F, Campbell JM. Attenuation of circulatory responses to endotracheal intubation using intravenous lidocaine: a determination of the optimal time of injection. Can J. Anaesth. 1985; 32: 565-569.

  18. Critical care ultrasonography in circulatory shock

    NARCIS (Netherlands)

    Koster, Geert; van der Horst, Iwan C. C.

    Purpose of review The objective was to define the role of ultrasound in the diagnosis and the management of circulatory shock by critical appraisal of the literature.Recent findings Assessment of any patient's hemodynamic profile based on clinical examination can be sufficient in several cases, but

  19. [New techniques for the treatment of salivary lithiasis: sialoendoscopy and extracorporal lithotripsy: 1773 cases].

    Science.gov (United States)

    Katz, Ph

    2004-06-01

    Salivary lithiasis is a relatively common medical problem. Treatment by invasive endoscopy, intracorporeal lithotripsy, and extracorporeal lithotripsy has been developing worldwide as an alternative to open surgical procedures. We hypothesized that treatment of salivary gland duct stones with endoscopic ductal intervention and extracorporeal lithotripsy could eliminate ductal stones while exposing the patient to less morbidity. In the current study, we analyzed a large clinical series to determine the success of the new techniques and develop an algorithm for comprehensive treatment of salivary stones. Retrospective chart study of 1773 treated salivary ductal pathology cases. Treatment of salivary lithiasis using either duct endoscopy with instrumentation and/or intracorporeal laser lithotripsy or electromagnetic extracorporeal shock wave lithotripsy was undertaken for 1773 lithitic glands between 1988 and 2002. A total of 1105 endoscopies were performed on pathologic glands. 668 therapeutic extracorporeal lithotripsies were conducted. Stones were eliminated endoscopically in 96% of patients. Lithotripsy completely destroyed the stones in 63% of the lithotriptor cases; and an additional 35% of these procedures resulted in stone fragmentation with spontaneous expulsion or ancillary endoscopic removal. There were no major complications such as nerve or tooth damage. Early in the endoscopic series, one patient required surgical removal of a lodged wire-basket snare. TIssue effects such as edema, swelling bleeding or infection were temporary and treated as necessary. Four percent of the endoscopic cases and 2% of the lithotriptor cases ultimately required gland excision to remove the stone. The treatment algorithm for salivary stones, which once contained only conventional open surgery, may now include endoscopic instrumentation and extracorporeal lithotripsy. Both techniques are particularly valuable for stones located in the major salivary ducts. This series

  20. Extracorporeal Pregnancy as a Feminist Issue

    Directory of Open Access Journals (Sweden)

    Iskra Krstić

    2015-10-01

    Full Text Available Extracorporeal pregnancy (ectogenesis presents perhaps the culmination of reproductive technology (NRT. Second wave feminism welcomed the use of NRT (including extracorporeal pregnancy as a means of women’s liberation. Later on, theories belonging to the third wave pointed out the negative implications of NRT and reclaimed the power of unassisted reproduction. This paper will try to point out some remaining productive potentials of NRT and extracorporeal pregnancy. The author wishes to explore the changes in the conceptualisation of the integrity of the individual in the context of the feminist critique of ectogenesis.

  1. A comprehensive elementary model of the mammalian circulatory system.

    Science.gov (United States)

    Sandquist, G M; Olsen, D B; Kolff, W J

    1982-01-01

    Beginning with a set of simplifying assumptions and the statements for the hydrodynamic and thermodynamic processes involved, a comprehensive mathematical model for the mammalian circulatory system is developed and evaluated. Analytical relationships are derived and examined for the circulatory component pressures, flow rates, blood volumes, flow resistances, pumping power and pumping rate. The essential circulatory model parameters are identified and inspected for their influence upon circulatory behavior. A complete and consistent set of circulatory model parameters is given for the adult human male and the model response is examined. In general, agreement of the model predictions for man with experimental data is good.

  2. Pathophysiological roles of peroxynitrite in circulatory shock.

    Science.gov (United States)

    Szabó, Csaba; Módis, Katalin

    2010-09-01

    Peroxynitrite is a reactive oxidant produced from nitric oxide and superoxide, which reacts with proteins, lipids, and DNA, and promotes cytotoxic and proinflammatory responses. Here, we overview the role of peroxynitrite in various forms of circulatory shock. Immunohistochemical and biochemical evidences demonstrate the production of peroxynitrite in various experimental models of endotoxic and hemorrhagic shock both in rodents and in large animals. In addition, biological markers of peroxynitrite have been identified in human tissues after circulatory shock. Peroxynitrite can initiate toxic oxidative reactions in vitro and in vivo. Initiation of lipid peroxidation, direct inhibition of mitochondrial respiratory chain enzymes, inactivation of glyceraldehyde-3-phosphate dehydrogenase, inhibition of membrane Na+/K+ ATPase activity, inactivation of membrane sodium channels, and other oxidative protein modifications contribute to the cytotoxic effect of peroxynitrite. In addition, peroxynitrite is a potent trigger of DNA strand breakage, with subsequent activation of the nuclear enzyme poly(ADP-ribose) polymerase, which promotes cellular energetic collapse and cellular necrosis. Additional actions of peroxynitrite that contribute to the pathogenesis of shock include inactivation of catecholamines and catecholamine receptors (leading to vascular failure) and endothelial and epithelial injury (leading to endothelial and epithelial hyperpermeability and barrier dysfunction), as well as myocyte injury (contributing to loss of cardiac contractile function). Neutralization of peroxynitrite with potent peroxynitrite decomposition catalysts provides cytoprotective and beneficial effects in rodent and large-animal models of circulatory shock.

  3. Pediatric Donation After Circulatory Determination of Death: A Scoping Review.

    Science.gov (United States)

    Weiss, Matthew J; Hornby, Laura; Witteman, William; Shemie, Sam D

    2016-03-01

    Although pediatric donation after circulatory determination of death is increasing in frequency, there are no national or international donation after circulatory determination of death guidelines specific to pediatrics. This scoping review was performed to map the pediatric donation after circulatory determination of death literature, identify pediatric donation after circulatory determination of death knowledge gaps, and inform the development of national or regional pediatric donation after circulatory determination of death guidelines. Terms related to pediatric donation after circulatory determination of death were searched in Embase and MEDLINE, as well as the non-MEDLINE sources in PubMed from 1980 to May 2014. Seven thousand five hundred ninety-seven references were discovered and 85 retained for analysis. All references addressing pediatric donation after circulatory determination of death were considered. Exclusion criteria were articles that did not address pediatric patients, animal or laboratory studies, surgical techniques, and local pediatric donation after circulatory determination of death protocols. Narrative reviews and opinion articles were the most frequently discovered reference (25/85) and the few discovered studies were observational or qualitative and almost exclusively retrospective. Retained references were divided into themes and analyzed using qualitative methodology. The main discovered themes were 1) studies estimating the number of potential pediatric donation after circulatory determination of death donors and their impact on donation; 2) ethical issues in pediatric donation after circulatory determination of death; 3) physiology of the dying process after withdrawal of life-sustaining therapy; 4) cardiac pediatric donation after circulatory determination of death; and 5) neonatal pediatric donation after circulatory determination of death. Donor estimates suggest that pediatric donation after circulatory determination of death will

  4. The Temporary Leave Dilemma -

    DEFF Research Database (Denmark)

    Amilon, Anna

    2010-01-01

    Lone mothers have to take care of a sick child with little or no help from the child’s other parent and have to carry all costs connected to leave-taking. This paper empirically tests whether lone mothers take more temporary parental leave to care for sick children than partnered mothers...... and whether parental leave is associated with a signaling cost. The results from this study of Swedish mothers show that lone mothers use more temporary parental leave than partnered mothers. Further, within the group of lone mothers, those with higher socioeconomic status take less temporary parental leave...... than those with lower socioeconomic status, whereas no such differences are found within the group of partnered mothers. One possible interpretation is that signaling costs negatively influence the utilization of temporary parental leave for lone mothers....

  5. Temporary internal pacing.

    Science.gov (United States)

    Ortiz Díaz-Miguel, R; Gómez Grande, M L

    2014-12-01

    Technology and insertion techniques for cardiac temporary internal pacing have experienced a remarkable development over the last few years. Despite this fact, the procedure continues to have potentially fatal associated complications. Temporary internal pacing is indicated for the treatment of bradyarrhythmias or tachyarrhythmias refractory to conventional treatment, or arrhythmias causing cardiovascular or clinical instability of the patient. On the other hand, the indications of temporary cardiac pacing are far less well defined than those of permanent pacing. Since the decision of implementing temporary pacing is complex and delicate, it should always be carefully considered, and over-indication should be avoided. We must base these decisions on robust knowledge of the arrhythmias that may benefit from temporary internal pacing, and should also acquire the habit of considering external temporary pacing among other less aggressive treatments, and to make the best use of new technologies such as echocardiography that add accuracy to the procedure. Copyright © 2013 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  6. Apnea test in the determination of brain death in patients treated with extracorporeal membrane oxygenation (ECMO).

    Science.gov (United States)

    Saucha, Wojciech; Sołek-Pastuszka, Joanna; Bohatyrewicz, Romuald; Knapik, Piotr

    2015-01-01

    Extracorporeal Membrane Oxygenation (ECMO) is a well-established method of support in patients with severe respiratory and/or circulatory failure. Unfortunately, this invasive method of treatment is associated with a high risk of neurological complications including brain death. Proper diagnosis of brain death is crucial for the termination of futile medical care. Currently, the legal system in Poland does not provide an accepted protocol for apnea tests for patients on ECMO support. Veno-arterial ECMO is particularly problematic in this regard because it provides both gas exchange and circulatory support. CO₂ elimination by ECMO prevents hypercapnia, which is required to perform an apnea test. Several authors have described a safe apnea test procedure in patients on ECMO. Maximal reduction of the sweep gas flow to the oxygenator should maintain an acceptable haemoglobin oxygenation level and reduce elimination of carbon dioxide. Hypercapnia achieved via this method should allow an apnea test to be conducted in the typical manner. In the case of profound desaturation and an inadequate increase in the arterial CO₂ concentration, the sweep gas flow rate may be increased to obtain the desired oxygenation level, and exogenous carbon dioxide may be added to achieve a target carbon dioxide level. Incorporation of an apnea test for ECMO patients is planned in the next edition of the Polish guidelines on the determination of brain death.

  7. Clinical outcomes in patients after extracorporeal membrane oxygenation support for post-cardiotomy cardiogenic shock: a single-centre experience of 92 cases.

    Science.gov (United States)

    Guihaire, Julien; Dang Van, Simon; Rouze, Simon; Rosier, Sébastien; Roisne, Antoine; Langanay, Thierry; Corbineau, Hervé; Verhoye, Jean-Philippe; Flécher, Erwan

    2017-09-01

    Post-cardiotomy cardiogenic shock is a major concern in cardiac surgery. We reviewed our experience of extracorporeal membrane oxygenation (ECMO) as temporary circulatory support in post-cardiotomy cardiogenic shock. Between January 2005 and December 2014, adult patients implanted with ECMO after cardiac surgical procedures were included. Indications for ECMO were failure to be withdrawn from cardiopulmonary bypass or refractory cardiogenic shock occurring during postoperative Days 1 and 2. Patients' characteristics and outcomes were prospectively collected in a local ECMO database. Ninety-two patients, median age of 63 years (17-83 years), were supported by ECMO following valvular surgery (66%), acute aortic dissection (10%) and coronary artery bypass grafting (9%). A total of 37% were combined surgical procedures, 24% were redo procedures and 33% were emergent procedures. The median duration of ECMO support was 6 days (1-28 days). The weaning rate from mechanical support was 48%. Overall 1-month and 6-month survival rates were, respectively, 42% and 39%. Survivors were younger (57 vs 63 years old, P = 0.02) and had a higher preoperative left ventricular ejection fraction (52.5 vs 44.1%, P = 0.017). There was a trend for lower serum creatinine levels and total bilirubin rates in the survivors' group 24 h after initiation of ECMO (respectively, 162 vs 212 µmol/l, P = 0.06; 25.3 vs 54.2 mg/dl, P = 0.08). Valvular surgery and peak lactic acid serum level were associated with poor outcomes. The mean health-related quality of life EuroQoL scale was 68 ± 16/100 at 2 years. Refractory cardiogenic shock requiring ECMO was most frequently observed after redo valvular surgery in the present study. The overall 6-month survival rate was 39% after ECMO support for post-cardiotomy cardiogenic shock with acceptable health-related quality of life. Improved kidney and liver functions after 24 h of support were associated with favourable outcomes.

  8. [Pulmonary complications after extracorporeal circulation. ECC lung syndrome].

    Science.gov (United States)

    Foliguet, B

    1977-01-01

    Pulmonary complications after cardiac surgery under extracorporeal circulation remain frequent and sometimes grave, in spite of the great progress which has been made over the past 20 years in the methods of cardiorespiratory assistance. The authors analyse the clinical and radiological repercussions of perfusion on the lung, in 40 patients operated under ECC for coronary revascularisation. The simutaneous study of the arterial, and mixed venous blood gasses and of the alveolar gases, in 20 of these patients showed the constant occurrence of a shunt syndrome, without alveolar hypoventilation or disorders in peripheral circulatory flow. Ventilatory alcalosis, hypocapnia, hypoxemia and the rise in the alveolar arterial oxygen gradient is increased during the second post-operative day. Among the variables studied (duration of ECC, degree of hypothermia, duration of the intervention, duration of anesthesia, pleurotomy) only the latter intervened in a statistically significant manner in this study, in the increase in hypoxemia. 46 pulmonary biopsies carried out before and after ECC in 23 coronary patients were examined with the electron microscope. The initial alveolar involvement affects the septal microcirculation with signs of an increase in capillary permeability leading to an interstitial and epithelial destruction. The use of a membrane oxygenator prevents some of the alveolar lesions, as has been proved by the study of five pulmonary biopsies carried out in dogs submitted to ECC of long duration. Catherterization of the pulmonary artery carried out in 35 patients by means of a SWAN-GANZ catheter, before the intervention enabled supervision of the degree of importance and speed of the hemodynamic variations in the pulmonary circulation during the different phases of ECC (during the phase of ventricular fibrillation). The rise in the flow of left output can lead to the occurrence of negative pulmonary intravascular pressures which can be prejudicial for capillary

  9. Temporary labour contracts

    CERN Document Server

    1999-01-01

    The five contracts for Temporary Labour assignments on the CERN site (L020/PE, L021/PE, L022/PE, L023/PE and L024/PE) approved by the Finance Committee in March 1996 (CERN/FC/3857) will reach the end of their initial three-year contractual period at the end of December 1999. Following the satisfactory execution of these contracts during this period, CERN requests approval to extend them from January 2000 for the first of the two years foreseen in the original adjudication. The Finance Committee is invited: - to take note that the three-year expenditure for Temporary Labour contracts from 1997 to 1999 will not exceed 19 100 000 Swiss francs, compared to the 18 900 000 Swiss francs estimated at the time of the adjudication in March 1996; - to approve an extension of the present Temporary Labour contracts for the year 2000 for a total amount not exceeding 6 000 000 Swiss francs.

  10. [Kidney paired donation. Combination with extracorporeal desensitization].

    Science.gov (United States)

    Bond, G; Böhmig, G A

    2014-09-01

    Live kidney donation represents the gold standard for renal replacement therapy. Due to ABO and HLA incompatibility between donor and recipient pairs, one third of possible transplantations cannot be performed. Kidney exchange programs in combination with extracorporeal desensitization have been introduced to enable successful kidney transplantation in such circumstances. This review discusses the current indications, methods, ethical problems and results within such programs. Relevant Medline articles were analyzed and personal experiences of the authors are included in this article. Kidney exchange programs in combination with extracorporeal desensitization enable successful transplantation for most patients. The best combinations of existing strategies have to be defined and newly arisen ethical questions have to be answered.

  11. Oxidative Stress and Methods for Its Correction in Patients with Acute Coronary Circulatory Disorders During Perioperative Direct Myocardial Revascularization

    Directory of Open Access Journals (Sweden)

    M. V. Chumakov

    2008-01-01

    Full Text Available Objective: to study the effect of the antioxidant and cardioprotector mexicor on oxidative stress in patients with acute coronary circulatory disorders (ACCD during perioperative direct myocardial revascularization. Subjects and methods. The study included 33 patients with ACCD who had undergone coronary bypass surgery. Two groups (a study group and a control one were formed. Prior to surgery, all the patients received the maximum doses of antianginal and antihypertensive drugs. The study group patients additionally took mexicor. All patients were operated on under extracorporeal circulation and moderate hypothermia. Lipid peroxidation (LPO indices were estimated via measurements of the serum levels of dienic conjugates, malonic dialdehyde, and the degree of serum lipid oxidability. The serum antioxidative system (AOS was judged from the concentration of а-tocopherol and cerulo-plasmin. The oxidative stress coefficient K, an integral index, was calculated to evaluate LPO-AOS imbalance. Results. High oxidative stress was found to be detectable in patients with ACCD. Mexicor lowers oxidative stress, diminishes LPO-AOS imbalance, improves oxygen balance and cardiac contractility, and reduces the number of life-threatening cardiac arrhythmias. Conclusion. Mexicor diminishes oxidative stress in patients with ACCD in the perioperative period of coronary bypass surgery. Mexicor-induced stabilization of LPO positively affects better oxygen balance and cardiac contractility, thus reducing the number of perioperative complications. Key words: oxidative stress, dienic conjugates, malonic dialdehyde, а-tocopherol, ceruloplasmin, coronary bypass, acute coronary circulatory disorder, hemodynamics.

  12. Brain-Dead Donors on Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Bronchard, Régis; Durand, Louise; Legeai, Camille; Cohen, Johana; Guerrini, Patrice; Bastien, Olivier

    2017-10-01

    To describe donors after brain death with ongoing extracorporeal membrane oxygenation and to analyze the outcome of organs transplanted from these donors. Retrospective analysis of the national information system run by the French Biomedicine Agency (CRISTAL database). National registry data of all donors after brain death in France and their organ recipients between 2007 and 2013. Donors after brain death and their organ recipients. None. During the study period, there were 22,270 brain-dead patients diagnosed in France, of whom 161 with extracorporeal membrane oxygenation. Among these patients, 64 donors on extracorporeal membrane oxygenation and 10,805 donors without extracorporeal membrane oxygenation had at least one organ retrieved. Donors on extracorporeal membrane oxygenation were significantly younger and had more severe intensive care medical conditions (hemodynamic, biological, renal, and liver insults) than donors without extracorporeal membrane oxygenation. One hundred nine kidneys, 37 livers, seven hearts, and one lung were successfully transplanted from donors on extracorporeal membrane oxygenation. We found no significant difference in 1-year kidney graft survival (p = 0.24) and function between recipients from donors on extracorporeal membrane oxygenation (92.7% [85.9-96.3%]) and matching recipients from donors without extracorporeal membrane oxygenation (95.4% [93.0-97.0%]). We also found no significant difference in 1-year liver recipient survival (p = 0.91): 86.5% (70.5-94.1) from donors on extracorporeal membrane oxygenation versus 80.7% (79.8-81.6) from donors without extracorporeal membrane oxygenation. Brain-dead patients with ongoing extracorporeal membrane oxygenation have more severe medical conditions than those without extracorporeal membrane oxygenation. However, kidney graft survival and function were no different than usual. Brain-dead patients with ongoing extracorporeal membrane oxygenation are suitable for organ procurement.

  13. Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support

    Directory of Open Access Journals (Sweden)

    Liane Brescovici Nunes

    2014-03-01

    Full Text Available OBJECTIVE: Veno-venous extracorporeal oxygenation for respiratory support has emerged as a rescue alternative for patients with hypoxemia. However, in some patients with more severe lung injury, extracorporeal support fails to restore arterial oxygenation. Based on four clinical vignettes, the aims of this article were to describe the pathophysiology of this concerning problem and to discuss possibilities for hypoxemia resolution. METHODS: Considering the main reasons and rationale for hypoxemia during veno-venous extracorporeal membrane oxygenation, some possible bedside solutions must be considered: 1 optimization of extracorporeal membrane oxygenation blood flow; 2 identification of recirculation and cannula repositioning if necessary; 3 optimization of residual lung function and consideration of blood transfusion; 4 diagnosis of oxygenator dysfunction and consideration of its replacement; and finally 5 optimization of the ratio of extracorporeal membrane oxygenation blood flow to cardiac output, based on the reduction of cardiac output. CONCLUSION: Therefore, based on the pathophysiology of hypoxemia during veno-venous extracorporeal oxygenation support, we propose a stepwise approach to help guide specific interventions.

  14. Extending normothermic regional perfusion to the thorax in donors after circulatory death.

    Science.gov (United States)

    Tsui, Steven S L; Oniscu, Gabriel C

    2017-06-01

    Despite a significant increase in the utilization of donors after circulatory death (DCD), the number of organs recovered and their function are largely inferior to those from donors after brain death. This review summarizes recent advances in in-situ normothermic regional perfusion of DCD organs prior to procurement. The combination of warm and cold ischemia in DCD donation are detrimental to organ function. As a consequence, the acceptance criteria are far more restrictive and many organs are discarded.The application of extracorporeal circulation technology to DCD organ retrieval in the form of abdominal normothermic regional perfusion (NRP) made a significant impact on organ procurement. DCD heart transplantation has been made possible by technological developments of ex-situ preservation. Extending NRP to include cardio-thoracic organs is a recent development enabling conversion from a DCD to a donor after brain death-type procurement.NRP offers the opportunity for a dynamic assessment of function and may lead to expansion of acceptance criteria as well as allowing for early interventions to modulate organ function. Thoraco-abdominal NRP may become the new gold standard for DCD organ retrieval. Further research and education are required to streamline logistics, define organ function markers and increase acceptance and utilization.

  15. Bilateral extracorporeal testicular ectopia: An extremely rare ...

    African Journals Online (AJOL)

    B.M. Abubakar

    2015 Pan African Urological Surgeons' Association. Production and hosting by Elsevier B.V. All rights reserved. Introduction. Extracorporeal testicular ectopia is very rare. It is also referred to as scrotoschisis [1]. The few cases described in the literature mostly refertounilateralscrotoschisis.Theactualetiologyoftheanomalyis.

  16. Catastrophic complication following injection and extracorporeal ...

    African Journals Online (AJOL)

    ... in lameness was noted 14 days post-operatively. Imaging revealed catastrophic fracture of the left MFC. Possible mechanisms leading to failure of the MFC secondary to the described treatment are discussed. Keywords: Equine, Extracorporeal shock wave therapy, Intra-lesional injection, Stifle, Subchondral cystic lesion.

  17. Guidelines on the use of extracorporeal photopheresis

    DEFF Research Database (Denmark)

    Knobler, R; Berlin, G; Calzavara-Pinton, P

    2014-01-01

    BACKGROUND: After the first investigational study on the use of extracorporeal photopheresis for the treatment of cutaneous T-cell lymphoma was published in 1983 with its subsequent recognition by the FDA for its refractory forms, the technology has shown significant promise in the treatment...

  18. Extracorporeal membrane oxygenation for refractory cardiac arrest

    Directory of Open Access Journals (Sweden)

    Steven A Conrad

    2017-01-01

    Full Text Available Extracorporeal cardiopulmonary resuscitation (ECPR is the use of rapid deployment venoarterial (VA extracorporeal membrane oxygenation to support systemic circulation and vital organ perfusion in patients in refractory cardiac arrest not responding to conventional cardiopulmonary resuscitation (CPR. Although prospective controlled studies are lacking, observational studies suggest improved outcomes compared with conventional CPR when ECPR is instituted within 30-60 min following cardiac arrest. Adult and pediatric patients with witnessed in-hospital and out-of-hospital cardiac arrest and good quality CPR, failure of at least 15 min of conventional resuscitation, and a potentially reversible cause for arrest are candidates. Percutaneous cannulation where feasible is rapid and can be performed by nonsurgeons (emergency physicians, intensivists, cardiologists, and interventional radiologists. Modern extracorporeal systems are easy to prime and manage and are technically easy to manage with proper training and experience. ECPR can be deployed in the emergency department for out-of-hospital arrest or in various inpatient units for in-hospital arrest. ECPR should be considered for patients with refractory cardiac arrest in hospitals with an existing extracorporeal life support program, able to provide rapid deployment of support, and with resources to provide postresuscitation evaluation and management.

  19. Extracorporeal total artificial heart as bailout surgery.

    Science.gov (United States)

    Perrodin, Stéphanie F; Muller, Olivier; Gronchi, Fabrizio; Liaudet, Lucas; Hullin, Roger; Kirsch, Matthias

    2017-03-01

    We report the use of a total extracorporeal heart for uncontrolled bleeding following a proximal left anterior descending artery perforation, using two centrifugal ventricular assist devices after heart explantation. The literature describing similar techniques and patient outcomes for this "bailout" technique are reviewed. © 2017 Wiley Periodicals, Inc.

  20. Ex vivo MRI in extracorporeal liver surgery

    NARCIS (Netherlands)

    Wolf, RFE; Slooff, MJH; Peeters, PMJG; deJong, KP; Kamman, RL; Mooyaart, EL

    1995-01-01

    Extracorporeal resection of hepatic tumors that were considered inoperable in the past is now possible in selected cases, Such procedures require high-quality preoperative images for the exact delineation of the tumor extent and for an optimal planning of the line of parenchymal division, In-vivo CT

  1. Frequency of stone clearance after extracorporeal shockwave ...

    African Journals Online (AJOL)

    A. Khalique

    2017-02-24

    Feb 24, 2017 ... Abstract. Objective: To determine the rate of stone clearance after extracorporeal shockwave lithotripsy (ESWL) for renal stones in adult patients with renal insufficiency. Subjects and methods: This is a cross-sectional descriptive study of 117 adult patients who underwent. ESWL. The indications for ESWL ...

  2. Ethical Aspects of Organ Donation After Circulatory Death.

    Science.gov (United States)

    St Louis, Erik K; Sharp, Richard R

    2015-10-01

    Neurologists should be familiar with the process and ethical aspects of organ donation. While most neurologists understand the steps involved in organ procurement following brain death, the controversial practice of organ donation after circulatory death (also referred to as non-heart-beating organ donation) is less familiar but increasingly frequent. This article presents a hypothetical case of a patient with a devastating neurologic injury and a poor prognosis for meaningful recovery and discusses the ethical considerations underlying donation after circulatory death, the general procedure of donation after circulatory death, and ethical controversies associated with this practice.

  3. Essays on temporary migration

    OpenAIRE

    Mestres Domenech, J.

    2012-01-01

    My thesis dissertation focuses on the temporariness of migration, its diverse effects as well as on migration selection. The first paper, A Dynamic Model of Return Migration analyzes the decision process underlying return migration using a dynamic model. We explain how migrants decide whether to stay or to go back to their home country together with their savings and consumption decisions. We simulate our model with return intentions and perform policy simulations. The se...

  4. Extracorporeal Membrane Oxygenation for Complex Multiorgan System Trauma

    Directory of Open Access Journals (Sweden)

    Michael S. Firstenberg

    2012-01-01

    Full Text Available With growing experience, the indications for salvage extracorporeal membrane oxygenation continue to expand. We describe a successful application of extracorporeal support in a polytrauma patient presenting with profound hypothermia, respiratory failure, and whom was later found to have an intracranial hemorrhage. We advocate the role of salvage therapy even in patients with complex pathophysiology despite perceived relative or absolute contraindications to extracorporeal support.

  5. Cardiogenic shock induced by a voluminous phaeochromocytoma rescued by concomitant extracorporeal life support and open left adrenalectomy.

    Science.gov (United States)

    Dang Van, Simon; Hamy, Antoine; Hubert, Noémie; Fouquet, Olivier

    2016-10-01

    Phaeochromocytoma is a rare catecholamine-secreting tumour involved in 0.1-0.2% cases of hypertension in the general population. Headache, palpitation and paroxystic sweating are the most commonly described symptoms. A few published cases report an acute adrenergic cardiomyopathy, leading to severe cardiogenic shock requiring mechanical circulatory support. We report the case of a 57-year old patient presenting a voluminous phaeochromocytoma of the left adrenal gland revealed by cardiogenic shock and rescued by peripheral extracorporeal life support device (ECLS). Left surrenalectomy has been performed under protective ECLS during the same surgical procedure. The patient was successfully weaned from ECLS on Day 7 after surgery and myocardial function completely recovered when the patient was discharged from the hospital. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  6. Early outcome of liver transplantation performed with organs procured from brain death donors with transient or sustained cardio-circulatory collapse.

    Science.gov (United States)

    Valenza, F; Villa, A; Froio, S; Coppola, S; Barretta, F; Melada, E; Gatti, S; Avalli, L; Citerio, G; Rossi, G E; Gattinoni, L

    2015-05-01

    Aim of this study was to compare early graft function after transplantation of recipients transplanted with livers procured from donors after brain death who experienced transient or sustained cardio-circulatory collapse. We retrospectively analysed patients who underwent liver transplantation (LTx) at our Institution from January 2010 to May 2012. Recipients were divided into 3 groups: those who received livers from brain death donors who experienced reversible cardio-circulatory arrest before organ procurement (RCA); those who experienced sustained cardio-circulatory collapse, treated with extra-corporeal membrane oxygenation support as rescue therapy of refractory cardiogenic shock (ECMO). Standard donors were considered as reference group (REF). Postoperative graft function, Primary Non-Function (PNF), and complications during the first 30 days were analysed. 102 LTx were analysed (76 REF, 22 RCA and 4 ECMO). The main cause of donor's death was post-anoxic coma in RCA and ECMO, cerebrovascular accident in REF. SGOT in REF, RCA, and ECMO donors were 27 [17-43], 54 [34-92], 716 [190-962] respectively, SGPT 17 [12-34], 46 [27-73], 84 [51-175] UI/L respectively, both P<0.01. All recipients had similar SGOT (P=0.48), SGPT (P=0.75) and Model for End-Stage Liver Disease scores (P=0.98) before LTx; similar graft cold and warm ischemia time and serum lactate levels at the end of surgery. After LTx, Intensive Care Unit stay and the incidence of PNF were similar. The use of livers procured from donors after brain death that experienced transient or sustained cardio-circulatory collapse was associated with early graft function comparable to that of standard donors.

  7. Transplantation of Hearts Donated after Circulatory Death

    Directory of Open Access Journals (Sweden)

    Christopher W. White

    2018-02-01

    Full Text Available Cardiac transplantation has become limited by a critical shortage of suitable organs from brain-dead donors. Reports describing the successful clinical transplantation of hearts donated after circulatory death (DCD have recently emerged. Hearts from DCD donors suffer significant ischemic injury prior to organ procurement; therefore, the traditional approach to the transplantation of hearts from brain-dead donors is not applicable to the DCD context. Advances in our understanding of ischemic post-conditioning have facilitated the development of DCD heart resuscitation strategies that can be used to minimize ischemia-reperfusion injury at the time of organ procurement. The availability of a clinically approved ex situ heart perfusion device now allows DCD heart preservation in a normothermic beating state and minimizes exposure to incremental cold ischemia. This technology also facilitates assessments of organ viability to be undertaken prior to transplantation, thereby minimizing the risk of primary graft dysfunction. The application of a tailored approach to DCD heart transplantation that focuses on organ resuscitation at the time of procurement, ex situ preservation, and pre-transplant assessments of organ viability has facilitated the successful clinical application of DCD heart transplantation. The transplantation of hearts from DCD donors is now a clinical reality. Investigating ways to optimize the resuscitation, preservation, evaluation, and long-term outcomes is vital to ensure a broader application of DCD heart transplantation in the future.

  8. Early Extracorporeal Detoxification after Cardiosurgical Interventions

    Directory of Open Access Journals (Sweden)

    G. P. Plotnikov

    2009-01-01

    Full Text Available Objective: to substantiate a need for early use of extracorporeal homeostatic correction techniques during cardiosurgical intensive care. Subjects and methods: A non-randomized study was conducted in 63 cardiosurgical patients with postoperatively evolving multiple organ dysfunction. The clinical efficiency and economic expediency of the early initiation of homeostatic correction were estimated by continuous low-flow venovenous hemofiltration on a Prisma apparatus. Results. The study has demonstrated the advantages of early (within the 36-hour postoperative period initiation of a procedure by the time of organ dysfunction recovery, the length of stay on a resuscitation bed, and pharmacoeconomic indices. Conclusion. The early (at the stage of dysfunction, until hemostasis becomes stable and in the absence of drainage volume losses initiation of hemofiltration in the development of multiple organ dysfunction after surgical interventions has been clinically and economically warranted. Key words: extracorporeal homeostatic correction, multiple organ dysfunction, cardiac surgery.

  9. Extracorporeal life support in pediatric cardiac patients

    Directory of Open Access Journals (Sweden)

    Matteo Di NARDO

    2016-10-01

    Full Text Available Extracorporeal Life Support (ECLS is a valuable tool in the management of neonates and older children with severe cardiac or respiratory failure. In this review, we focus on ECLS when used for neonatal and pediatric cardiac disease. Strict selection of patients and timely deployment are necessary to optimize outcomes. Although every attempt should be made to deploy ECLS urgently rather than emergently, extracorporeal cardiopulmonary resuscitation (ECPR is being increasingly used and reasonable survival rates have been achieved after initiation of ECLS during active compressions of the chest following in-hospital cardiac arrest. Contraindications to ECLS are falling over time, although lethal chromosomal abnormalities, severe irreversible brain injury, and extremely low gestational age and weight (<32 weeks gestation or <1.5 kg remain firm contraindications.

  10. Extracorporeal treatment for valproic acid poisoning

    DEFF Research Database (Denmark)

    Ghannoum, Marc; Laliberté, Martin; Nolin, Thomas D

    2015-01-01

    BACKGROUND: The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup presents its systematic review and clinical recommendations on the use of extracorporeal treatment (ECTR) in valproic acid (VPA) poisoning. METHODS: The lead authors reviewed all of the articles from a systematic literature....... The workgroup concluded that VPA is moderately dialyzable (level of evidence = B) and made the following recommendations: ECTR is recommended in severe VPA poisoning (1D); recommendations for ECTR include a VPA concentration > 1300 mg/L (9000 μmol/L)(1D), the presence of cerebral edema (1D) or shock (1D...... 50 and 100 mg/L (350-700 μmol/L)(2D). Intermittent hemodialysis is the preferred ECTR in VPA poisoning (1D). If hemodialysis is not available, then intermittent hemoperfusion (1D) or continuous renal replacement therapy (2D) is an acceptable alternative. CONCLUSIONS: VPA is moderately dialyzable...

  11. Renal mucormycosis complicating extracorporeal membrane oxygenation.

    Science.gov (United States)

    Charles, Pierre; Kahn, Jean-Emmanuel; Ackermann, Felix; Honderlick, Patrick; Lortholary, Olivier

    2013-02-01

    Zygomycosis can manifest as severe infections, particularly in immunocompromised patients, which can be nosocomial in nature resulting from complications of invasive procedures. We report the case of a 65-year-old woman with a medical history of unclassified inflammatory rheumatism who underwent arteriovenous extracorporeal membrane oxygenation because of a myocardial failure following the drainage of a tuberculous tamponade. This procedure was complicated by a superinfection of the scarpa which revealed a disseminated zygomycosis with renal involvement. A favorable outcome was achieved after 15 months of antifungal therapy involving the use of liposomal amphotericin B followed with posaconazole which involved the close monitoring of the concentrations of this antifungal. Extracorporeal membrane oxygenation is a frequent procedure which could be complicated with severe fungal nosocomial infections such as zygomycosis. The outcome of such complication can be favorable with the utilization of new antifungal therapies.

  12. Physiotherapy for Patients on Awake Extracorporeal Membrane Oxygenation: A Systematic Review.

    Science.gov (United States)

    Polastri, Massimiliano; Loforte, Antonino; Dell'Amore, Andrea; Nava, Stefano

    2016-12-01

    Extracorporeal membrane oxygenation (ECMO) is used as temporary life support in subjects with potentially reversible respiratory/cardiac failure. The principal purpose of this review was to assess the characteristics and potential advantages of physiotherapeutic interventions in subjects on awake ECMO support. Seven databases were interrogated: we searched titles, abstracts and keywords using the Medical Subject Headings terms 'extracorporeal membrane oxygenation' and 'rehabilitation' linked with the Boolean operator 'AND'. In total, 216 citations were retrieved. Nine citations satisfied our inclusion criteria and were subjected to full-text analysis. The numbers of patients enrolled in the included studies (most of which were case series) were low (n = 52). We found no prospective studies or randomized controlled trials. Overall, subjects on awake ECMO usually received a combination of passive and active physiotherapy, and most achieved an acceptable degree of autonomy after treatment. Emerging research in the field affords preliminary evidence supporting the safety of early mobilization and ambulation in patients on awake veno-venous ECMO support. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  13. A temporary face support

    Energy Technology Data Exchange (ETDEWEB)

    Popov, V.I.; Bakhtin, V.N.; Tolkachev, N.I.

    1980-03-30

    A temporary face support is proposed. It includes a beam supported by hydraulic jacks on the housing of the cutter-loader with a working tool and rotary pressure regulator. It differs in that to decrease the volume of unsecured roofing in the face space between the leading edge of the beam and the cutting tool of the cutter-loader, the beam is hinged onto the housing of the rotary pressure regulator by a fastened connecting rod, and the hydraulic jacks are provided with additional powered elements with a mechanism that regulates the length of the cut-off plate of the hydraulic pump when the seam pressure changes.

  14. Circulatory CNP Rescues Craniofacial Hypoplasia in Achondroplasia.

    Science.gov (United States)

    Yamanaka, S; Nakao, Kazumasa; Koyama, N; Isobe, Y; Ueda, Y; Kanai, Y; Kondo, E; Fujii, T; Miura, M; Yasoda, A; Nakao, Kazuwa; Bessho, K

    2017-12-01

    Achondroplasia is the most common genetic form of human dwarfism, characterized by midfacial hypoplasia resulting in occlusal abnormality and foramen magnum stenosis, leading to serious neurologic complications and hydrocephalus. Currently, surgery is the only way to manage jaw deformity, neurologic complications, and hydrocephalus in patients with achondroplasia. We previously showed that C-type natriuretic peptide (CNP) is a potent stimulator of endochondral bone growth of long bones and vertebrae and is also a potent stimulator in the craniofacial region, which is crucial for midfacial skeletogenesis. In this study, we analyzed craniofacial morphology in a mouse model of achondroplasia, in which fibroblast growth factor receptor 3 (FGFR3) is specifically activated in cartilage ( Fgfr3ach mice), and investigated the mechanisms of jaw deformities caused by this mutation. Furthermore, we analyzed the effect of CNP on the maxillofacial area in these animals. Fgfr3ach mice exhibited midfacial hypoplasia, especially in the sagittal direction, caused by impaired endochondral ossification in craniofacial cartilage and by premature closure of the spheno-occipital synchondrosis, an important growth center in craniomaxillofacial skeletogenesis. We crossed Fgfr3ach mice with transgenic mice in which CNP is expressed in the liver under the control of the human serum amyloid-P component promoter, resulting in elevated levels of circulatory CNP ( Fgfr3ach/SAP-Nppc-Tg mice). In the progeny, midfacial hypoplasia in the sagittal direction observed in Fgfr3ach mice was improved significantly by restoring the thickness of synchondrosis and promoting proliferation of chondrocytes in the craniofacial cartilage. In addition, the foramen magnum stenosis observed in Fgfr3ach mice was significantly ameliorated in Fgfr3ach/SAP-Nppc-Tg mice due to enhanced endochondral bone growth of the anterior intraoccipital synchondrosis. These results clearly demonstrate the therapeutic potential of

  15. Unfocused Extracorporeal Shock Waves Induce Anabolic Effects in Rat Bone

    NARCIS (Netherlands)

    O.P. van der Jagt (Olav); T.M. Piscaer (Tom); W. Schaden (Wolfgang); J. Li; N. Kops (Nicole); H. Jahr (Holger); J.C. van der Linden (Jacqueline); J.H. Waarsing (Jan); J.A.N. Verhaar (Jan); M. de Jong (Marion); H.H. Weinans (Harrie)

    2011-01-01

    textabstractAbstract. BACKGROUND: Extracorporeal shock waves are known to stimulate the differentiation of mesenchymal stem cells toward osteoprogenitors and induce the expression of osteogenic-related growth hormones. The aim of this study was to investigate if and how extracorporeal shock waves

  16. Can low-intensity extracorporeal shockwave therapy improve erectile dysfunction?

    DEFF Research Database (Denmark)

    Olsen, Anne B; Persiani, Marie; Boie, Sidsel

    2015-01-01

    OBJECTIVE: The aim of this study was to investigate whether low-intensity extracorporeal shockwave therapy (LI-ESWT) can be used as a treatment for men with erectile dysfunction of organic origin. MATERIALS AND METHODS: This prospective, randomized, blinded, placebo-controlled study included 112 ...... are needed. KEYWORDS: Erectile dysfunction; extracorporeal shockwave; penis...

  17. THE MORBIDITY WITH TEMPORARY DISABILITY OF WORKING MILITARY RETIREES

    Directory of Open Access Journals (Sweden)

    A. V. Popov

    2017-01-01

    Full Text Available The purpose of the study. The study of morbidity with temporary disability of working officers of the Navy, retired and resigned, as well as affecting the level of certain factors.Materials and methods. A sociological survey of 574 officers of the Navy, who were dismissed from the Armed Forces to the reserve (resignation, was held. 32.7% of them at the time of the survey have been working.Results. 48.8% of respondents rated their health at the time of the survey as a good for their age. The level of morbidity with temporary disability (MWTD in 100 operating reserve (retired officers amounted to 94 cases. The number of days of temporary disability was equal to 867 days per 100 employed military pensioners. Most long-term treatment (up to 47 days were required for patients with blood diseases. Analysis of the structure of diseases of reserve (retired officers leading to temporary disability, showed that the bulk of the cases (63.7 per cent were diseases of the respiratory organs, in second place were diseases of the circulatory system (24,5%, the third — diseases of the genitourinary system (4.3%. The average number of existing diseases to working military retirees less than idle: 1.9 vs 2.1. The average number of diseases at the single soldiers discharged was significantly more than that of living in family.Conclusion. The features of level and structure, as well as risk factors of MWTD should be considered in the development and adoption of administrative decisions directed on preservation and strengthening of health of reserve (retired officers. 

  18. Early Diagnosis of Critical Postperfusion Circulatory Disorders

    Directory of Open Access Journals (Sweden)

    L. A. Krichevsky

    2012-01-01

    Full Text Available Objective: to define the prognostic value of hemodynamic monitoring data and overall oxygen balance in the postperfusion period of cardiosurgical operations. Subjects and methods. Three hundred and fifty-three patients (317 men, 35 women aged 57±0.6 years, who had been operated on under extracorporeal circulation (78±6 min with a Swan-Ganz catheter being used, were retrospectively examined. Among the examined, 277 patients had undergone coronary bypass surgery (3.1±0.2 shunts; 18, mitral valve replacement; 42, aortic valve replacement; 9, mitral and aortic valve replacement; and 7 had one-two heart valve replacement with shunting of 2±1 coronary arteries. The left ventricular ejection fraction averaged 48±0.04%. The parameters of central hemodynamics and oxygen balance were recorded when the sternum was brought together. There was a group of those who had been discharged from hospital and a group of those who had died in hospital. The authors used an intergroup comparison of parameters and an analysis of ROC curves, by recording the cut off values. Results. The postperfusion risk factors of hospital mortality were a mean pulmonary artery pressure of more than 29 mm Hg; a pulmonary artery wedge pressure of greater than 16 mm Hg; a cardiac index of less than 2.35 l/min/m2; a stroke volume index of less than 22.7 ml/m2; an indexed oxygen transport of less than 315.6 ml/ml2; a blood lactate level of higher than 4.6 mmol/l; an adrenal dose need of more than 115/ng/kg/min. Left ventricular stroke work indicators, such as a stroke work index of less than 21.2 g”‘Xm”2 and, to the maximum extent, a pump coefficient of lower than 2.8 g”‘Xm”2/mm Hg, have a high degree of accuracy in suggesting the risk of mortality. Conclusion. The invasive monitoring of pulmonary pressure and cardiac efficiency in the postperfusion period permits an objective prediction of a risk for hospital mortality. Key words: cardiosurgery, Swan-Ganz catheter, heart

  19. Long-term results after lung transplantation using organs from circulatory death donors: a propensity score-matched analysis†.

    Science.gov (United States)

    Sabashnikov, Anton; Patil, Nikhil P; Popov, Aron-Frederik; Soresi, Simona; Zych, Bartlomiej; Weymann, Alexander; Mohite, Prashant N; García Sáez, Diana; Zeriouh, Mohamed; Wahlers, Thorsten; Choi, Yeong-Hoon; Wippermann, Jens; Wittwer, Thorsten; De Robertis, Fabio; Bahrami, Toufan; Amrani, Mohamed; Simon, André R

    2016-01-01

    Due to organ shortage in lung transplantation (LTx), donation after circulatory death (DCD) has been implemented in several countries, contributing to an increasing number of organs transplanted. We sought to assess long-term outcomes after LTx with organs procured following circulatory death in comparison with those obtained from donors after brain death (DBD). Between January 2007 and November 2013, 302 LTxs were performed in our institution, whereby 60 (19.9%) organs were retrieved from DCD donors. We performed propensity score matching (DCD:DBD = 1:2) based on preoperative donor and recipient factors that were significantly different in univariate analysis. After propensity matching, there were no statistically significant differences between the groups in terms of demographics and preoperative donor and recipient characteristics. There were no significant differences regarding intraoperative variables and total ischaemic time. Patients from the DCD group had significantly higher incidence of primary graft dysfunction grade 3 at the end of the procedure (P = 0.014), and significantly lower pO2/FiO2 ratio during the first 24 h after the procedure (P = 0.018). There was a trend towards higher incidence of the need for postoperative extracorporeal life support in the DCD group. Other postoperative characteristics were comparable. While the overall cumulative survival was not significantly different, the DCD group had significantly poorer results in terms of bronchiolitis obliterans syndrome (BOS)-free survival in the long-term follow-up. Long-term results after LTx with organs procured following DCD are in general comparable with those obtained after DBD LTx. However, patients transplanted using organs from DCD donors have a predisposition for development of BOS in the longer follow-up. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  20. Impact of Heart Transplantation on Survival in Patients on Venoarterial Extracorporeal Membrane Oxygenation at Listing in France.

    Science.gov (United States)

    Jasseron, Carine; Lebreton, Guillaume; Cantrelle, Christelle; Legeai, Camille; Leprince, Pascal; Flecher, Erwan; Sirinelli, Agnes; Bastien, Olivier; Dorent, Richard

    2016-09-01

    Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as a short-term circulatory support in patients with refractory cardiogenic shock providing a bridge to long-term mechanical circulatory support or transplantation. In France, a higher priority status is granted to transplant candidates on VA-ECMO than to those on long-term mechanical circulatory support. This study aimed to evaluate the impact of transplantation as primary therapy on survival in patients on VA-ECMO at listing. This was a retrospective analysis of data from the French national registry CRISTAL including all patients (n = 866) newly registered on the waiting list for heart transplantation between January 2010 and December 2011. We compared outcomes of 80 patients on VA-ECMO at listing to outcomes of the comparison group. In the VA-ECMO group, a Cox proportional hazard model with transplantation as a time dependent variable was used to evaluate the effect of transplantation on survival. Patients on VA-ECMO were more often on ventilator and dialysis and had a higher bilirubin level than other candidates. One-year overall survival rate was lower in candidates from the study group (52.2%) compared with comparison group (75.5%), (P < 0.01). One-year posttransplant survival was 70% in the VA-ECMO group and 81% in comparison group (P = 0.06). In the VA-ECMO group, transplantation was associated with a lower risk of mortality (hazard ratio, 0.44; 95% confidence interval, 0.2-0.9). Transplantation provides a survival benefit in listed patients on VA-ECMO even if posttransplant survival remains inferior than for patients without VA-ECMO. Transplantation may be considered to be an acceptable primary therapy in selected patients on VA-ECMO.

  1. MECHANISMS OF RIGHT VENTRICULAR FAILURE AND BIVENTRICULAR MECHANICAL CIRCULATORY SUPPORT

    Directory of Open Access Journals (Sweden)

    G. P. Itkin

    2013-01-01

    Full Text Available The paper presents a review of the problems of mechanical circulatory support with left ventricular bypass in total cardiac failure. Dysfunction of right ventricular defines the high mortality on left ventricular device. One of the effective methods for solving this problem is the use of right ventricular assisted devices. There are considered of the basic physiological mechanisms of interaction between the right and left ventricles of the heart, affecting on the function of the right heart. Shows the need to assess right ventricular function before deciding on mechanical circulatory support. Provides examples of the estimation the predictors of the right ventricular failure. The basic methods and devices of biventricular circulatory support were con- sidered. 

  2. Extracorporeal shock wave therapy (ESWT) in urology

    DEFF Research Database (Denmark)

    Fojecki, Grzegorz Lukasz; Thiessen, Stefan; Osther, Palle Jörn Sloth

    2017-01-01

    PURPOSE: The objective was to evaluate high-level evidence studies of extracorporeal shock wave therapy (ESWT) for urological disorders. METHODS: We included randomized controlled trials reporting outcomes of ESWT in urology. Literature search on trials published in English using EMBASE, Medline......i) responders in 2 of 4 trials and 3 of 4 trials, respectively. Three studies on chronic pelvic pain (CPP) engaging 200 men reported positive changes in National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). There was considerable heterogeneity between trials both with regard...

  3. A note on circulatory systems: Old and new results

    DEFF Research Database (Denmark)

    Kliem, Wolfhard; Pommer, Christian

    2017-01-01

    repeat this result in order to emphasize that the criterion is sufficient but not necessary for stability. Afterwards we concentrate on circulatory systems with purely imaginary eigenvalues and investigate the influence of indefinite damping. Finally the possibility of stabilizing circulatory systems......It is astonishing that after more than half a century intensive research in the area of non-conservative systems of second order differential equations still new interesting results appear, see [4]. In that paper an old stability criterion by Metelitsyn [8] and Frik [9] was reinvented. We shortly...

  4. Neurological injuries and extracorporeal membrane oxygenation: the challenge of the new ECMO era.

    Science.gov (United States)

    Martucci, Gennaro; Lo Re, Vincenzina; Arcadipane, Antonio

    2016-07-01

    Extracorporeal membrane oxygenation (ECMO) is a life-saving mechanical respiratory and/or circulatory support for potentially reversible severe heart or respiratory injury untreatable with conventional therapies. Thanks to the technical and management improvements the use of ECMO has increased dramatically in the last few years. Data in the literature show a progressive increase in the overall outcome. Considering the improving survival rate of patients on ECMO, and the catastrophic effect of neurological injuries in such patients, the topic of neurological damage during the ICU stay in ECMO is gaining importance. We present a case series of six neurological injuries that occurred in 1 year during the ECMO run or after the ECMO weaning. In each case the neurological complication had a dramatic effect: ranging from brain death to prolonged ICU stay and long term disability. This case series has an informative impact for the multidisciplinary teams treating ECMO patients because of its heterogeneity in pathogenesis and clinical manifestation: cerebral hemorrhage, ischemic stroke due to cerebral fat embolism, acute disseminated encephalomyelitis due to H1N1 Influenza. In our ECMO hub we started strict neurological monitoring involving intensivists, a neurologist and our radiology service, but neurological complications are still an insidious diagnosis and treatment. Considering several possible neurological injuries may help reduce delay in diagnosis and speed rehabilitation.

  5. Transcending Organization in Temporary Systems

    DEFF Research Database (Denmark)

    Stjerne, Iben Sandal

    Because of their temporary nature, work and employment in project based organizations are different from what we used to see in traditional organizational forms. Temporary employment, entailing less stability within the organization changes how employment and work are organized. Temporary systems...... are organized by transcending organization that go beyond the individual firm and replaces what used to be organized inside the firm. Following several calls for further research on these topics, this dissertation is a small step along the way as it investigates how work and employment are organized...... in temporary systems that lack stability and formal order. It advances our understanding of transcending organization in creative industries by adopting a practice based perspective. Empirically, the dissertation presents an in-depth study of the Danish film industry, which is an extreme case of a project...

  6. [Complex control of the source of infection in sepsis : Extracorporeal membrane oxygenation (ECMO) as a bridging concept for tracheal fistula repair in sepsis-associated ARDS].

    Science.gov (United States)

    Weiterer, S; Schmidt, K; Deininger, M; Ulrich, A; Tochtermann, U; Eberhardt, R; Hofer, S; Weigand, M A; Brenner, T

    2016-09-01

    Here, we present a case of a tracheal fistula due to an anastomotic insufficiency following abdominothoracic esophageal resection. Despite immediate discontinuity resection, the tracheal fistula could not be surgically closed, resulting in incomplete control of the source of infection and an alternative treatment concept in the form of interventional fistula closure using a Y-tracheal stent. However, owing to existing severe acute respiratory distress syndrome (ARDS), which is associated with a considerable risk of peri-interventional hypoxia, a temporary bridging concept using venovenous extracorporeal membrane oxygenation (ECMO) was implemented successfully.

  7. Belgian modified classification of Maastricht for donors after circulatory death.

    Science.gov (United States)

    Evrard, P

    2014-11-01

    "Non-heart-beating donors," or, in a more recent and international definition, "donors after circulatory death," are a potential and additional group of deceased persons who are able to add organs to the pool. A new classification is proposed on the basis of the result of a consensus of experts issued from all Belgian transplant centers. The first level of definition is simple and based on whether the situation is uncontrolled (categories I and II) or controlled (categories III, IV, and V). In category I, the patient is declared "dead on arrival" and, in category II, there is an "unsuccessful resuscitation" whether it occurred out or in the hospital for both situations. Category III is the most usual situation in which the treating physician and family are "awaiting cardiac arrest" to declare the death of the patient. Category IV is always characterized by "cardiac arrest during brain death." The special situation of the Belgian law allowing the euthanasia is elaborated in category V, "euthanasia," and includes patients who grant access to medically assisted circulatory death. Organ donation after euthanasia is allowed under the scope of donation after circulatory death. This classification conserves the skeleton of the Maastricht one, as it is simple and clear, but classifies easily the different donors after circulatory death types by processes for ethical issues and for the non-medical or non-specialized reader interested in the field. This is also an argument for public consideration and trust in the difficult field of organ donation.

  8. During studies on the circulatory system of the cuttlefish Sepia ...

    African Journals Online (AJOL)

    spamer

    During studies on the circulatory system of the cuttlefish Sepia officinalis L. in the autumn of 1989 and 1996, it was observed that many animals from the Bay of Arcachon (Atlantic Coast of France) showed an obvious malformation in the systemic heart complex. The malformation took the form of an atypical doubling in the ...

  9. The European Registry for Patients with Mechanical Circulatory Support (EUROMACS)

    DEFF Research Database (Denmark)

    de By, Theo M M H; Mohacsi, Paul; Gummert, Jan

    2015-01-01

    other founding international members. It aims to promote scientific research to improve care of end-stage heart failure patients with ventricular assist device or a total artificial heart as long-term mechanical circulatory support. Likewise, the organization aims to provide and maintain a registry...

  10. Biological evaluation of mechanical circulatory support systems in calves

    NARCIS (Netherlands)

    Rakhorst, G; VanDerMeer, J; Kik, C; Mihaylov, D; Havlik, P; Trinkl, J; Monties, [No Value

    Data from animal experiments with mechanical circulatory support systems (MCSS) performed in Groningen and Marseille over the past years were used to obtain normal values of hematological, coagulation, rheological and blood chemistry parameters in calves. These parameters were divided between two

  11. Recommendations for donation after circulatory death kidney transplantation in Europe

    NARCIS (Netherlands)

    van Heurn, L. W. Ernest; Talbot, David; Nicholson, Michael L.; Akhtar, Mohammed Z.; Sanchez-Fructuoso, Ana I.; Weekers, Laurent; Barrou, Benoit

    2016-01-01

    Donation after circulatory death (DCD) donors provides an invaluable source for kidneys for transplantation. Over the last decade, we have observed a substantial increase in the number of DCD kidneys, particularly within Europe. We provide an overview of risk factors associated with DCD kidney

  12. Biochemical and circulatory parameters during purely mental stress

    NARCIS (Netherlands)

    Danner, S. A.; Endert, E.; Koster, R. W.; Dunning, A. J.

    1981-01-01

    In order to evaluate biochemical and circulatory parameters during purely mental stress, 20 healthy medical students were studied before, during and at the end of an important written medical examination. Plasma catecholamines and diastolic blood pressure rose significantly during the examination,

  13. Extracorporeal Circulation Using an Extracorporeal Membrane Oxygenation System and an Autotransfusion System

    Directory of Open Access Journals (Sweden)

    Yu. A. Bakhareva

    2010-01-01

    Full Text Available The authors draw attention to the fact that complete cardiopulmonary bypass can be made in the emergency situation in order to perform an extracorporeal membrane oxygenation (ECMO procedure in a 5-year-old boy weighing 15 kg, diagnosed as having Fallot tetrad. By taking into account the technological features of the system for ECMO, there is an additional need for a blood cell separator to be applied.

  14. 42 CFR 488.415 - Temporary management.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Temporary management. 488.415 Section 488.415... Compliance for Long-Term Care Facilities with Deficiencies § 488.415 Temporary management. (a) Definition. Temporary management means the temporary appointment by CMS or the State of a substitute facility manager or...

  15. Cerebral aspects of neonatal extracorporeal membrane oxygenation: a review.

    NARCIS (Netherlands)

    Mol, A.C. de; Liem, K.D.; Heijst, A.F.J. van

    2013-01-01

    Background: Neonatal extracorporeal membrane oxygenation (ECMO) is a lifesaving therapeutic approach in newborns suffering from severe, but potentially reversible, respiratory insufficiency, mostly complicated by neonatal persistent pulmonary hypertension. However, cerebral damage, intracerebral

  16. Relationship of spontaneous retinal vein pulsation with ocular circulatory cycle.

    Directory of Open Access Journals (Sweden)

    Mijin Kim

    Full Text Available PURPOSE: To determine the timing of spontaneous venous pulsation (SVP relative to the ocular circulatory cycle by using the movie tool of confocal scanning laser ophthalmoloscope. METHODS: A video recording of the fundus was obtained using a confocal scanning laser ophthalmoscope (Spectralis HRA, Heidelberg Engineering, Heidelberg, Germany at 8 frames/s in 47 eyes (15 glaucoma patients and 32 glaucoma suspects with visible pulsation of both the central retinal artery (CRA and vein (CRV. The timing of the maximum and minimum diameters of the CRA (CRA(max and CRAmin, respectively and CRV (CRV(max and CRV(min, respectively was identified during four pulse cycles. The interval between CRV(min and CRA(min, and between CRV(max and CRA(max was expressed as the number of frames and as a percentage of the ocular circulatory cycle. RESULTS: The ocular circulatory cycle (from one CRA(max to the next lasted 7.7 ± 1.0 frames (958.8 ± 127.2 ms, mean ± SD, with a mean pulse rate of 62.6 beats/min. The diameter of the CRA was increased for 2.4 ± 0.5 frames (301.9 ± 58.8 ms and decreased for 5.3 ± 0.9 frames (656.9 ± 113.5 ms. CRV(max occurred 1.0 ± 0.2 frames after CRA(max (equivalent to 13.0% of the ocular circulatory cycle, while CRV(min occurred 1.1 ± 0.4 frames after CRA(min (equivalent to 14.6% of the ocular circulatory cycle. CONCLUSIONS: During SVP, the diameter of the CRV began to decrease at early diastole, and the reduction persisted until early systole. This finding supports that CRV collapse occurs during ocular diastole.

  17. In Vivo Quantification of Clot Formation in Extracorporeal Circuits

    OpenAIRE

    David, Omid; Gerrah, Rabin

    2012-01-01

    Clot formation is a common complication in extracorporeal circuits. In this paper we describe a novel method for clot formation analysis using image processing. We assembled a closed extracorporeal circuit and circulated blood at varying speeds. Blood filters were placed in downstream of the flow, and clotting agents were added to the circuit. Digital images of the filter were subsequently taken, and image analysis was applied to calculate the density of the clot. Our results show a significa...

  18. Transhepatic cholangiography in the jaundiced patient. Extracorporeal drainage and endoprosthesis

    Energy Technology Data Exchange (ETDEWEB)

    Olbert, F.; Schlegl, A.; Muzika, N. (Krankenhaus der Stadt Wien-Lainz (Austria). 1. Chirurgische Abt.)

    1984-01-01

    Percutaneous transhepatic cholangiographpy, as well as the therapeutic possibility of extracorporeal biliary tract drainage and insertion of an endoprosthesis are discussed in this paper. The results are presented of 19 patients treated by extracorporeal drainage and of 12 patients treated by insertion of an endoprosthesis, with a successful outcome in each group. The clinical parameters, the reduction in bilirubin values after treatment and improvement in the patient's condition and general well-being are discussed.

  19. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention).

    Science.gov (United States)

    Rihal, Charanjit S; Naidu, Srihari S; Givertz, Michael M; Szeto, Wilson Y; Burke, James A; Kapur, Navin K; Kern, Morton; Garratt, Kirk N; Goldstein, James A; Dimas, Vivian; Tu, Thomas

    2015-06-01

    Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines. Copyright © 2015. Published by Elsevier Inc.

  20. Extracorporeal membrane oxygenation-hemostatic complications.

    Science.gov (United States)

    Murphy, Deirdre A; Hockings, Lisen E; Andrews, Robert K; Aubron, Cecile; Gardiner, Elizabeth E; Pellegrino, Vincent A; Davis, Amanda K

    2015-04-01

    The use of extracorporeal membrane oxygenation (ECMO) support for cardiac and respiratory failure has increased in recent years. Improvements in ECMO oxygenator and pump technologies have aided this increase in utilization. Additionally, reports of successful outcomes in supporting patients with respiratory failure during the 2009 H1N1 pandemic and reports of ECMO during cardiopulmonary resuscitation have led to increased uptake of ECMO. Patients requiring ECMO are a heterogenous group of critically ill patients with cardiac and respiratory failure. Bleeding and thrombotic complications remain a leading cause of morbidity and mortality in patients on ECMO. In this review, we describe the mechanisms and management of hemostatic, thrombotic and hemolytic complications during ECMO support. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY (ESWL PADA BATU GINJAL

    Directory of Open Access Journals (Sweden)

    Anak Agung Sri Satyawati

    2014-09-01

    Full Text Available Latar Belakang. Extracorporeal shockwave lithotripsy (ESWL merupakan pilihan terapi yang paling cost effective pada kasus kasus batu ginjal, namun sayangnya modalitas terapi ini belum banyak dipilih karena dianggap mahal dan kurangnya informasi mengenai keuntungan penggunaannya. Kasus. Perempuan usia 65 tahun mengeluh nyeri pinggang yang dirasakan mendadak dan semakin memberat  sejak 2 bulan sebelum masuk rumah sakit, disertai mual dan penurunan nafsu makan. Berdasarkan pemeriksaan foto polos abdomen dan USG Urologi  didapatkan kesan adanya batu renal dekstra ukuran 16mm x 18mm, dengan hidronefrosis derajat I renal dekstra. Kemudian dilakukan tindakan ESWL. Hasil. Setelah dilakukan tindakan ESWL berupa penghantaran gelombang kejut pada permukaan ginjal  kanan selama 20-30 menit, keluar pecahan pecahan kecil batu kalsium. Berdasarkan pemeriksaan radiografi post ESWL tidak ditemukan gambaran radioopak pada kaliks ginjal, ureter maupun kandung kemih. Kesimpulan. Batu kalsium dengan ukuran 16mm x 18mm pada renal dekstra berhasil dikeluarkan total tanpa adanya komplikasi.

  2. Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism.

    Science.gov (United States)

    Dolmatova, Elena V; Moazzami, Kasra; Cocke, Thomas P; Elmann, Elie; Vaidya, Pranay; Ng, Arthur F; Satya, Kumar; Narayan, Rajeev L

    Extracorporeal Membrane Oxygenation (ECMO) has been suggested for cardiopulmonary support in patients with massive pulmonary embolism (PE) refractory to other treatment or as bridging to embolectomy. The survival benefit from ECMO in patients with massive PE remains unclear. Here, we describe 5 cases in which ECMO was used as cardiopulmonary support following massive near-fatal pulmonary embolism. The overall mortality in patients with massive PE that received ECMO support was 40%. Death occurred secondary to ECMO-related complication in one case and due to inability to maintain adequate cerebral perfusion despite ECMO support in the second case. ECMO can be considered as a treatment modality for patients with massive PE. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Temporary Clusters and Knowledge Creation

    DEFF Research Database (Denmark)

    Maskell, Peter; Bathelt, Harald; Malmberg, Anders

    2004-01-01

    to distant markets and technologies. Third, it compares such temporaryclusters with permanent territorial hubs within their respective sector or industry. If regularparticipation in temporary clusters could satisfy a firm's need to learn through interactionwith suppliers, customers, peers and rivals, why...... or participating in such events are means toidentify the current market frontier, take stock of relative competitive positions and formfuture plans. These events exhibit many of the characteristics ascribed to permanentclusters, albeit in a temporary, periodic and intensified form. The temporary clusters...... is the phenomenon of permanent clusteringso pervasive?The answer, it is claimed, lies in the restrictions imposed on economic activity whenknowledge and ideas are transformed into valuable products and services. The paper shedsnew light on how interaction among firms in current clusters coincides...

  4. [Caffeine and adaptive changes in the circulatory system during pregnancy].

    Science.gov (United States)

    Cendrowska-Pinkosz, Monika; Dworzański, Wojciech; Krauze, Magdalena; Burdan, Franciszek

    2017-01-23

    Adaptive physiological changes that occur in pregnant women can fluctuate with the intake of substances with proven, adverse biological effect on the body. Due to the fact that caffeine is one of the most chronically used xenobiotics, the impact of consuming caffeine on adaptive processes in the circulatory system of a pregnant women required a research. Many researchers emphasise its negative effect on the circulatory system of the mother and her offspring. However, in spite of years of observation, there is no clear answer to what extent dose or in what period of time the caffeine modulates the adaptive processes during pregnancy. Because of the potential risk the supply of caffeine during pregnancy should be subjected to considerable restrictions.

  5. Extracorporeal Membrane Oxygenation for Adult Community-Acquired Pneumonia: Outcomes and Predictors of Mortality.

    Science.gov (United States)

    Ramanathan, Kollengode; Tan, Chuen Seng; Rycus, Peter; MacLaren, Graeme

    2017-05-01

    Extracorporeal membrane oxygenation is a rescue therapy used to support severe cardiorespiratory failure. Data on outcomes from severe community-acquired pneumonia in adults receiving rescue extracorporeal membrane oxygenation are mainly confined to single-center experiences or specific pathogens. We examined data from the Extracorporeal Life Support Organisation registry to identify risk factors for poor outcomes in adult patients with community-acquired pneumonia. Retrospective data analysis. Extracorporeal Life Support Organization Registry database. We collected deidentified data on adult patients (> 18 yr) receiving extracorporeal membrane oxygenation for community-acquired pneumonia between 2002 and 2012. Patients with incomplete data or brain death were excluded. The primary outcome measure was in-hospital mortality. Other measurements included demographic information, pre-extracorporeal membrane oxygenation mechanical ventilation and biochemical variables, inotrope requirements, extracorporeal membrane oxygenation mode, duration, and complications. Initial univariate analysis assessed potential associations between survival and various pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation factors. Variables with p values of less than 0.1 were considered for logistic regression analysis to identify predictors of mortality. None. One thousand fifty-five patients, who satisfied inclusion criteria, were included in the final analysis. There was an increase in the number of patients cannulated per annum over the 10-year period studied. Univariate analysis identified pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation variables associated with high mortality. Further multiple regression analysis identified certain pre-extracorporeal membrane oxygenation factors as predictors of mortality, including duration of mechanical ventilation prior to extracorporeal membrane oxygenation, lower arterial pressure, fungal

  6. Singular divergence instability thresholds of kinematically constrained circulatory systems

    Energy Technology Data Exchange (ETDEWEB)

    Kirillov, O.N., E-mail: o.kirillov@hzdr.de [Magnetohydrodynamics Division, Helmholtz-Zentrum Dresden-Rossendorf, P.O. Box 510119, D-01314 Dresden (Germany); Challamel, N. [University of South Brittany, LIMATB, Lorient (France); Darve, F. [Laboratoire Sols Solides Structures, UJF-INPG-CNRS, Grenoble (France); Lerbet, J. [IBISC, Universite d' Evry Val d' Essone, 40 Rue Pelvoux, CE 1455 Courcouronnes, 91020 Evry Cedex (France); Nicot, F. [Cemagref, Unite de Recherche Erosion Torrentielle Neige et Avalanches, Grenoble (France)

    2014-01-10

    Static instability or divergence threshold of both potential and circulatory systems with kinematic constraints depends singularly on the constraints' coefficients. Particularly, the critical buckling load of the kinematically constrained Ziegler's pendulum as a function of two coefficients of the constraint is given by the Plücker conoid of degree n=2. This simple mechanical model exhibits a structural instability similar to that responsible for the Velikhov–Chandrasekhar paradox in the theory of magnetorotational instability.

  7. Thermal, circulatory, and neuromuscular responses to whole-body cryotherapy

    OpenAIRE

    Westerlund, T. (Tarja)

    2009-01-01

    Abstract The purpose of this study was to examine thermal (body temperature, thermal sensation and comfort ratings), circulatory (blood pressure, heart rate variability) and neuromuscular performance responses to whole-body cryotherapy (WBC, -110 °C). Altogether 66 healthy subjects were exposed to WBC for two minutes. The acute and long-term changes were examined, when the subjects were exposed to WBC three times a week during three months. Skin temperatures decreased very rapidl...

  8. Belgian modified classification of Maastricht for donors after circulatory death

    OpenAIRE

    Evrard, Patrick; Belgian Working Group on DCD National Protocol; Lois, Fernande; Darius, Tom; De Pauw, Luc; Hantson, Philippe; Jacquemin, Dominique; Schamps, Geneviève; Van Deynse, Dominique; Rondelet, Benoît; Verschuren, Franck

    2014-01-01

    BACKGROUND: "Non-heart-beating donors," or, in a more recent and international definition, "donors after circulatory death," are a potential and additional group of deceased persons who are able to add organs to the pool. METHODS: A new classification is proposed on the basis of the result of a consensus of experts issued from all Belgian transplant centers. RESULTS: The first level of definition is simple and based on whether the situation is uncontrolled (categories I and II) or contr...

  9. Circulatory Arrest: A Surgical Option for Adult Window Ductus Closure

    Directory of Open Access Journals (Sweden)

    Vithalkumar Malleshi Betigeri

    2012-03-01

    Full Text Available The window ductus , an atypical type of patent ductus arteriosus(PDA is a characteristically large in size(>2cm with no recognizable length, characteristic continuation of main pulmonary artery with aortic arch and absence of internal ductal tissue. Surgical safety and effectiveness of its closure can be increased by using cardiopulmonary bypass (CPB and hypothermic total circulatory arrest (HTCA via median sternotomy.

  10. Acute circulatory deficiency due to endocrinal tumoral manipulation: the pinealoblastoma.

    Science.gov (United States)

    Heithem, Chemchihik; Issaoui, Ghazi; Khadraoui, Mejdi; Ladib, Mohamed; Naija, Walid; Said, Rachid

    2014-01-01

    We rapport the case of a patient presenting intra-abdominal metastasis of a pinealoblastoma, via a ventriculo-peritoneal shunt, confirmed by an anatomo-pathologic exam. The patient presented an acute hydrocephalus secondary to DVP dysfunction. The surgical manipulation of this metastasis had caused an acute circulatory deficiency due to massive serotonin release. In this case we analyze pineal gland physiology and serotonin effect on different systems.

  11. Acute circulatory deficiency due to endocrinal tumoral manipulation: the pinealoblastoma

    OpenAIRE

    Heithem, Chemchihik; Issaoui, Ghazi; Khadraoui, Mejdi; Ladib, Mohamed; Naija, Walid; Said, Rachid

    2014-01-01

    We rapport the case of a patient presenting intra-abdominal metastasis of a pinealoblastoma, via a ventriculo-peritoneal shunt, confirmed by an anatomo-pathologic exam. The patient presented an acute hydrocephalus secondary to DVP dysfunction. The surgical manipulation of this metastasis had caused an acute circulatory deficiency due to massive serotonin release. In this case we analyze pineal gland physiology and serotonin effect on different systems.

  12. Antibiotics can ameliorate circulatory complications of liver cirrhosis

    DEFF Research Database (Denmark)

    Madsen, Bjørn Stæhr; Schaffalitzky de Muckadell, Ove B

    2011-01-01

    Livercirrhosis can be complicated by a hyperdynamic circulatory syndrome. This is due to translocation of bacteria and bacterial product (bacterial DNA and endotoxins), which stimulate the splanchnic nitric oxide synthase and leads to splanchnic vasodilatation and haemodynamic derangement....... This review focuses on how broad spectrum antibiotics can ameliorate the haemodynamic consequences of bacterial translocation. It is possible that the use of broad spectrum antibiotics in the future may be used to prevent other complications of liver cirrhosis than spontaneous bacterial peritonitis...

  13. Extracorporeal membrane oxygenation for critically ill adults.

    Science.gov (United States)

    Tramm, Ralph; Ilic, Dragan; Davies, Andrew R; Pellegrino, Vincent A; Romero, Lorena; Hodgson, Carol

    2015-01-22

    Extracorporeal membrane oxygenation (ECMO) is a form of life support that targets the heart and lungs. Extracorporeal membrane oxygenation for severe respiratory failure accesses and returns blood from the venous system and provides non-pulmonary gas exchange. Extracorporeal membrane oxygenation for severe cardiac failure or for refractory cardiac arrest (extracorporeal cardiopulmonary resuscitation (ECPR)) provides gas exchange and systemic circulation. The configuration of ECMO is variable, and several pump-driven and pump-free systems are in use. Use of ECMO is associated with several risks. Patient-related adverse events include haemorrhage or extremity ischaemia; circuit-related adverse effects may include pump failure, oxygenator failure and thrombus formation. Use of ECMO in newborns and infants is well established, yet its clinical effectiveness in adults remains uncertain. The primary objective of this systematic review was to determine whether use of veno-venous (VV) or venous-arterial (VA) ECMO in adults is more effective in improving survival compared with conventional respiratory and cardiac support. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and EMBASE (Ovid) on 18 August 2014. We searched conference proceedings, meeting abstracts, reference lists of retrieved articles and databases of ongoing trials and contacted experts in the field. We imposed no restrictions on language or location of publications. We included randomized controlled trials (RCTs), quasi-RCTs and cluster-RCTs that compared adult ECMO versus conventional support. Two review authors independently screened the titles and abstracts of all retrieved citations against the inclusion criteria. We independently reviewed full-text copies of studies that met the inclusion criteria. We entered all data extracted from the included studies into Review Manager. Two review authors independently performed risk of bias assessment. All included studies

  14. [Evaluation of non-invasive hemoglobin measurements using the Masimo Rainbow Radical-7® device in a patient with extracorporeal membrane oxygenation].

    Science.gov (United States)

    Moreno, I; Artieda, O; Vicente, R; Zarragoikoetxea, I; Vicente, J L; Barberá, M

    2014-01-01

    Circulatory assist devices such as extracorporeal membrane oxygenation are indicated in cases of cardiogenic shock refractory to optimal conventional treatment. Bleeding is a serious complication of such systems, mainly due to coagulation disorders caused by continuous administration of heparin, as well as platelet dysfunction. Serial coagulation and hemoglobin (Hb) measurements are essential. Hb measurements can be performed through repeated arterial blood gasometry, and more recently with a new spectrophotometric sensor, Masimo Rainbow Radical-7® device, which gives Hb values continuously and non-invasively. We report a case of a patient undergoing cardiac surgery who required extracorporeal membrane oxygenation for severe cardiogenic shock immediately after surgery. We compare the correlation and the level of agreement with Hb levels measured by 2 existing systems in clinical practice. Our results indicate that the Masimo® spectrophotometric monitor showed statistically comparable Hb values, in the correlation (r=.85; P<.01) and in agreement with those obtained by serial blood gas analyzer, ABL800 FLEX® (wavelength). In view of these results we consider the Masimo® device as a valid alternative for the continuous follow-up of the Hb and control of bleeding in these patients. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  15. Objects as Temporary Autonomous Zones

    Directory of Open Access Journals (Sweden)

    Tim Morton

    2011-09-01

    Full Text Available From Hakim Bey's instructions on creating temporary autonomous zones we see an oscillation "between performance art and politics, circus clowning and revolution." In this essay Tim Morton discusses anarchist politics as, "the creation of fresh objects in a reality without a top or a bottom object, or for that matter a middle object."

  16. Nursing Intervention During Temporary Care

    Science.gov (United States)

    Curry, Judith B.

    1974-01-01

    The role of the professional nurse in asseviating or minimizing the separation anxiety and traumatic impact on families during temporary placement of a retarded child in a residential facility is seen in two case studies of girls 3 and 12 years of age. (Author/MC)

  17. Temporary risk identification in urolithiasis.

    Science.gov (United States)

    Marickar, Y M Fazil; Salim, Abiya

    2009-12-01

    We have been using a risk index calculation for urolithiasis, which included most of the identifiable factors promoting calculogenesis. However, it was observed that the frequency of a patient getting stone problem was not uniform in spite of similarity of the risk index in the permanent setting. Also, many of the risk indices could be changed by dietary or lifestyle modifications. The objective of this paper was to calculate the temporary risk index of a patient at the time of each visit and correlate with stone activity during such periods, so that appropriate advice could be given on drugs, diet and lifestyle changes. The temporary risk index score was based on four symptoms, namely pain (0, nil; 1, vague pain; 2, mild; 3, moderate; 4, severe; 5, excruciating), haematuria (0, nil; 1, turbid; 2, cloudy; 3, reddish; 4, occasional frank blood; 5, continuous frank blood), burning sensation (0, nil; 1, minimal; 2, moderate; 3, terminal severe; 4, occasional excruciating; 5, continuous excruciating), and dysuria (0, nil; 1, minimal; 2, moderate; 3, terminal severe; 4, occasional excruciating, 5, continuous excruciating), ultrasonography for back pressure (0, nil; 1, mild; 2, moderate; 3, severe kidney and ureter; 4, unilateral total; 5, bilateral total anuria) and eight urine deposit findings (0, nil; 1, +; 2, 2+; 3, 3+; 4, 4+; 5, plenty), red blood cells, pus cells, whewellite crystals, weddellite crystals, phosphate crystals, uric acid/ammonium urate crystals, crystal clumping and crystal aggregation making a total of 13 parameters. Each parameter was given values ranging from 0 to 5. The total score was calculated and chemotherapeutic regimes were decided base on the score, which varied from 0 to 65. Hundred randomly selected patients who had been visiting the stone clinic for a minimum of five occasions were included in the study. The total scores of temporary risk were correlated with the permanent clinical risk score mentioned earlier. The temporary risk of the

  18. Bivalirudin in venovenous extracorporeal membrane oxygenation.

    Science.gov (United States)

    Jyoti, Aman; Maheshwari, Arun; Daniel, Elvin; Motihar, Amit; Bhathiwal, Rajpal Singh; Sharma, Deevakar

    2014-03-01

    Optimal anticoagulation plays a pivotal role in successful outcome of extracorporeal membrane oxygenation (ECMO). Heparin has been the anticoagulant of choice owing to its advantages like easy monitoring and reversibility. However, if heparin resistance is encountered, one has to decide whether to treat heparin resistance with fresh-frozen plasma or antithrombin concentrates or to choose one of the heparin alternatives for anticoagulation. We report a case of heparin resistance resulting from antithrombin III deficiency in a patient on venovenous ECMO, in which anticoagulation was managed with bivalirudin. The dose of bivalirudin for anticoagulation in ECMO has not been standardized and different authors have reported different doses. We found a bivalirudin dose of .1-.2 mg/kg/h to be adequate to maintain a target activated clotting time of 200-220 seconds. Platelet counts were stable throughout and no major bleeding or thrombotic complications took place. We found bivalirudin to be a feasible and effective anticoagulant and safe to use for long durations in ECMO without any major complications.

  19. Thigh compartment syndrome during extracorporeal life support.

    Science.gov (United States)

    Kreibich, Maximilian; Czerny, Martin; Benk, Christoph; Beyersdorf, Friedhelm; Rylski, Bartosz; Trummer, Georg

    2017-11-01

    The aim of this study was to report our experience with patients on the extracorporeal life support system (ECLS) who presented with thigh compartment syndrome, a yet unreported complication. A retrospective analysis was performed from April 2003 to April 2017 to identify patients who presented to our department for treatment of acute compartment syndrome of the thigh after cannulation of the ECLS through the femoral artery and vein. Five patients, aged 30 to 84 years, who developed thigh compartment syndrome during ECLS therapy were identified. In three patients, the cause was arterial malperfusion; in one patient, the cause was venous malfunction and arterial malperfusion due to malposition of the arterial distal leg perfusion cannula in the femoral vein. The fifth patient suffered impaired venous drainage. Patients were on ECLS for 4 ± 2 days, and decompressive fasciotomy was performed in all patients 1 ± 1 days after ECLS commencement. Thigh compartment syndrome was responsible for significant morbidity, including prolonged open wound therapy, hospitalization, and leg amputation in one patient. Compartment syndrome of the thigh is a limb- and life-threatening complication and may occur in patients on ECLS. Angiographic or duplex ultrasound control of adequate limb perfusion and correct placement of the perfusion cannulas is recommended. Also, awareness of and close clinical observation for thigh perfusion and compartment syndrome are essential in patients during ECLS therapy. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  20. Extracorporeal shockwave therapy in musculoskeletal disorders

    Directory of Open Access Journals (Sweden)

    Wang Ching-Jen

    2012-03-01

    Full Text Available Abstract The sources of shockwave generation include electrohydraulic, electromagnetic and piezoelectric principles. Electrohydraulic shockwaves are high-energy acoustic waves generated under water explosion with high voltage electrode. Shockwave in urology (lithotripsy is primarily used to disintegrate urolithiasis, whereas shockwave in orthopedics (orthotripsy is not used to disintegrate tissues, rather to induce tissue repair and regeneration. The application of extracorporeal shockwave therapy (ESWT in musculoskeletal disorders has been around for more than a decade and is primarily used in the treatment of sports related over-use tendinopathies such as proximal plantar fasciitis of the heel, lateral epicondylitis of the elbow, calcific or non-calcific tendonitis of the shoulder and patellar tendinopathy etc. The success rate ranged from 65% to 91%, and the complications were low and negligible. ESWT is also utilized in the treatment of non-union of long bone fracture, avascular necrosis of femoral head, chronic diabetic and non-diabetic ulcers and ischemic heart disease. The vast majority of the published papers showed positive and beneficial effects. FDA (USA first approved ESWT for the treatment of proximal plantar fasciitis in 2000 and lateral epicondylitis in 2002. ESWT is a novel non-invasive therapeutic modality without surgery or surgical risks, and the clinical application of ESWT steadily increases over the years. This article reviews the current status of ESWT in musculoskeletal disorders.

  1. Patient and personnel exposure during extracorporeal lithotripsy.

    Science.gov (United States)

    Glaze, S; LeBlanc, A D; Bushong, S C; Griffith, D P

    1987-12-01

    Extracorporeal shock wave lithotripsy (ESWL) has provided a nonsurgical approach to treatment of renal stones. The Dornier lithotripter uses dual image intensified x-ray systems to center the stone before treatment. Three imaging modes are offered: a fluoroscopic mode and two video spot filming modes. The average entrance exposure to the stone side of the typical patient at our facility is 2.6 X 10(-3) C kg-1 (10 R) [range: 0.5-7.7 X 10(-3) C kg-1 (2-30 R)] which is comparable and often much less than that reported for percutaneous lithotripsy. Recommendations are made for minimizing patient exposure. Scattered radiation levels in the lithotripter room are presented. We have determined that Pb protective apparel is not required during this procedure provided x-ray operation is temporarily halted should personnel be required to lean directly over the tub to attend to the patient. If the walls of the ESWL room are greater than 1.83 m (6 feet) from the tub, shielding in addition to conventional construction is not required.

  2. Active rehabilitation in a pediatric extracorporeal membrane oxygenation patient.

    Science.gov (United States)

    Zebuhr, Carleen; Sinha, Amit; Skillman, Heather; Buckvold, Shannon

    2014-05-01

    Decreased intensive care unit (ICU) mortality has led to an increase in ICU morbidity. ICU-induced immobilization plays a major role in this morbidity. Recently, ICU mobility has been shown to be safe and effective in adolescent and adult patients. We report the successful rehabilitation of an 8-year-old boy with severe acute respiratory distress syndrome on extracorporeal membrane oxygenation. A child who is critically ill may safely perform active rehabilitation while on venovenous extracorporeal membrane oxygenation. The gains achieved through active rehabilitation and optimal nutrition can facilitate recovery from severe acute respiratory distress syndrome in select pediatric patients on extracorporeal membrane oxygenation. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  3. Venoarterial extracorporeal membrane oxygenation support for neonatal and pediatric refractory septic shock.

    Science.gov (United States)

    Rambaud, Jerome; Guellec, Isabelle; Léger, Pierre-Louis; Renolleau, Sylvain; Guilbert, Julia

    2015-10-01

    To report our institutional experience of veno-arterial extracorporeal membrane oxygenation (VA ECMO) in children with refractory septic shock. We retrospectively reviewed our ECMO database to identify patients who received VA ECMO for septic shock from January 2004 to June 2013 at our Pediatric Intensive Care Unit in Armand-Trousseau Hospital. We included all neonates and children up to the age of 18 years who received VA ECMO for septic shock. For each patient, we collected the pre-ECMO inotrope score, clinical circulatory and ventilatory parameters, infecting organism, ECMO duration and complications, and length of hospital stay. The study included 14 neonates and 8 older children (the pediatric population, with a mean age of 30 months, range: 1-113 months). Survival was 64% among newborns and 50% among pediatric patients. Multiorgan failure or severity scores did not show any correlation with mortality (Pediatric Logistic Organ Dysfunction score, P = 0.94; the score for neonatal acute physiology-perinatal extension II, P = 0.34). In the pediatric population, the inotrope score was higher in the survivor group (127.5 vs. 332.5, P = 0.07). Blood samples taken shortly before cannulation showed that pH (P = 0.27), lactate level (P = 0.33), PaO2/FiO2 ratio (P = 0.49), or oxygenation index (P = 0.35) showed no correlation to success or failure of ECMO. ECMO can be safely used to resuscitate and support children with refractory septic shock. We recommend that patients with oliguria whose lactate level has not decreased within 6 h of starting maximum drug therapy be transferred to an ECMO referral center.

  4. In vivo quantification of clot formation in extracorporeal circuits.

    Science.gov (United States)

    Gerrah, Rabin; David, Omid

    2013-01-01

    Clot formation is a common complication in extracorporeal circuits. In this paper we describe a novel method for clot formation analysis using image processing. We assembled a closed extracorporeal circuit and circulated blood at varying speeds. Blood filters were placed in downstream of the flow, and clotting agents were added to the circuit. Digital images of the filter were subsequently taken, and image analysis was applied to calculate the density of the clot. Our results show a significant correlation between the cumulative size of the clots, the density measure of the clot based on image analysis, and flow duration in the system.

  5. Staffing, Equipment, Monitoring Considerations for Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Fitzgerald, David C; Darling, Edward M; Cardona, Monika F

    2017-10-01

    Although the reasons for the recent growth in adult extracorporeal membrane oxygenation (ECMO) are multifactorial, much of the success may be attributed to the development of well-trained staff and the technological innovations in equipment and monitoring devices used during extracorporeal support. In this article, the authors discuss general educational formats for the ECMO bedside provider, staffing support models, and devices designed to best meet the needs of the patient while simultaneously ensuring the proper delivery of ECMO-related care. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Extracorporeal Methods in Treatment of Inborn Errors of Metabolism

    Directory of Open Access Journals (Sweden)

    ilknur Tolunay

    2015-12-01

    Full Text Available Inborn errors of metabolism are hereditary disorders that are related to the accumulation of toxic substances or deficiency of proteins because of enzymatic blokage in the metabolic pathways. Treatment should be quick and aggressive as inborn errors of metabolism might lead to organ damage and even death. This article discusses extracorporeal methods like exchange transfusion, peritoneal dialysis, hemodialysis, plasmapheresis and extracorporeal membran oxygenation for acute management of inborn errors of metabolism apart from medical therapies. [Archives Medical Review Journal 2015; 24(4.000: 509-519

  7. Extracorporeal membrane oxygenation after protracted ventricular fibrillation cardiac arrest: case report and discussion.

    Science.gov (United States)

    Abu-Laban, Riyad B; Migneault, David; Grant, Meghan R; Dhingra, Vinay; Fung, Anthony; Cook, Richard C; Sweet, David

    2015-03-01

    Extracorporeal membrane oxygenation (ECMO) is a method to provide temporary cardiac and respiratory support to critically ill patients. In recent years, the role of ECMO in emergency departments (EDs) for select adults has increased. We present the dramatic case of a 29-year-old man who was placed on venoarterial ECMO for cardiogenic shock and respiratory failure following collapse and protracted ventricular fibrillation cardiac arrest in our ED. Resuscitation efforts prior to ECMO commencement included 49 minutes of virtually continuous cardiopulmonary resuscitation (CPR), 11 defibrillations, administration of numerous medications, including a thrombolytic agent, while CPR was ongoing, percutaneous coronary intervention and stenting for a mid-left anterior descending coronary artery dissection and thrombotic occlusion, inotropic support, and intra-aortic balloon pump counterpulsation. Over the next 48 hours following ECMO commencement, the patient's cardiorespiratory function rapidly improved, and he was discharged home 9 days after admission with no neurologic sequelae. The history, indications, and increasing role of ECMO in a range of conditions, including cardiac arrest, are reviewed.

  8. [Cerebral oximetry in pulmonary thromboendarterectomy with circulatory arrest].

    Science.gov (United States)

    Catalán Escudero, P; González Román, A; Serra Ruiz, C N; Barbero Mielgo, M; García Fernández, J

    2014-02-01

    Pulmonary thromboendarterectomy is an uncommon procedure and should be performed with circulatory arrest. One of the major concerns is the postoperative central neurological injuries. Perioperative brain oxygen monitoring is advisable in this surgical procedure for the early detection of brain hypoperfusion episodes and their intensity as well as any other postoperative episodes that can deteriorate the neurological outcome. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  9. Circulatory abnormalities in cirrhosis with focus on neurohumoral aspects

    DEFF Research Database (Denmark)

    Møller, Søren; Henriksen, Jens Henrik

    1997-01-01

    Patients with cirrhosis exhibit characteristic hemodynamic changes with a hyperkinetic circulation and an abnormal distribution of the blood volume and neurohumoral regulation. Their plasma and noncentral blood volumes are increased, and the central and arterial blood volume and systemic vascular......-angiotensin-aldosterone system, and elevated circulating vasopressin, endothelin-1 may also be implicated in the hemodynamic counter-regulation in cirrhosis. Recent research has focused on the assertion that the hemodynamic and neurohumoral abnormalities in cirrhosis are part of a general circulatory dysfunction influencing...

  10. Recommendations for donation after circulatory death kidney transplantation in Europe.

    Science.gov (United States)

    van Heurn, L W Ernest; Talbot, David; Nicholson, Michael L; Akhtar, Mohammed Z; Sanchez-Fructuoso, Ana I; Weekers, Laurent; Barrou, Benoit

    2016-07-01

    Donation after circulatory death (DCD) donors provides an invaluable source for kidneys for transplantation. Over the last decade, we have observed a substantial increase in the number of DCD kidneys, particularly within Europe. We provide an overview of risk factors associated with DCD kidney function and survival and formulate recommendations from the sixth international conference on organ donation in Paris, for best-practice guidelines. A systematic review of the literature was performed using Ovid Medline, Embase and Cochrane databases. Topics are discussed, including donor selection, organ procurement, organ preservation, recipient selection and transplant management. © 2015 Steunstichting ESOT.

  11. Temporary Residences: a becoming project

    Directory of Open Access Journals (Sweden)

    Luisa Ingaramo

    2012-04-01

    Full Text Available Among the experimental actions fostered so far by the Compagnia di San Paolo through its Housing Program, committed in handling the complex and fragmented housing discomfort issue, the Temporary Dwellings initiative represents a unique and innovative experience, as it actually offers the chance to activate a proper managerial direction around and about the real estate development processes. In particular, the Temporary Dwellings action is marked by two key aspects: a structured co-planning vision and projects selected through a requests for proposal system. The process in the whole aims on the one hand at reaching an high transparent level of decision making , while, on the other hand, at developing a continuous and mutual monitoring and matching activity between the Housing Program and the group of cross-curricular experts teamed up in the project: technicians, designers, managers, psychologists, contractors, and the other local stakeholders.

  12. Large capacity temporary visual memory

    Science.gov (United States)

    Endress, Ansgar D.; Potter, Mary C.

    2014-01-01

    Visual working memory (WM) capacity is thought to be limited to three or four items. However, many cognitive activities seem to require larger temporary memory stores. Here, we provide evidence for a temporary memory store with much larger capacity than past WM capacity estimates. Further, based on previous WM research, we show that a single factor — proactive interference — is sufficient to bring capacity estimates down to the range of previous WM capacity estimates. Participants saw a rapid serial visual presentation (RSVP) of 5 to 21 pictures of familiar objects or words presented at rates of 4/s or 8/s, respectively, and thus too fast for strategies such as rehearsal. Recognition memory was tested with a single probe item. When new items were used on all trials, no fixed memory capacities were observed, with estimates of up to 9.1 retained pictures for 21-item lists, and up to 30.0 retained pictures for 100-item lists, and no clear upper bound to how many items could be retained. Further, memory items were not stored in a temporally stable form of memory, but decayed almost completely after a few minutes. In contrast, when, as in most WM experiments, a small set of items was reused across all trials, thus creating proactive interference among items, capacity remained in the range reported in previous WM experiments. These results show that humans have a large-capacity temporary memory store in the absence of proactive interference, and raise the question of whether temporary memory in everyday cognitive processing is severely limited as in WM experiments, or has the much larger capacity found in the present experiments. PMID:23937181

  13. Mechanical ventilation during extracorporeal membrane oxygenation

    Science.gov (United States)

    2014-01-01

    The timing of extracorporeal membrane oxygenation (ECMO) initiation and its outcome in the management of respiratory and cardiac failure have received considerable attention, but very little attention has been given to mechanical ventilation during ECMO. Mechanical ventilation settings in non-ECMO studies have been shown to have an effect on survival and may also have contributed to a treatment effect in ECMO trials. Protective lung ventilation strategies established for non-ECMO-supported respiratory failure patients may not be optimal for more severe forms of respiratory failure requiring ECMO support. The influence of positive end-expiratory pressure on the reduction of the left ventricular compliance may be a matter of concern for patients receiving ECMO support for cardiac failure. The objectives of this review were to describe potential mechanisms for lung injury during ECMO for respiratory or cardiac failure, to assess the possible benefits from the use of ultra-protective lung ventilation strategies and to review published guidelines and expert opinions available on mechanical ventilation-specific management of patients requiring ECMO, including mode and ventilator settings. Articles were identified through a detailed search of PubMed, Ovid, Cochrane databases and Google Scholar. Additional references were retrieved from the selected studies. Growing evidence suggests that mechanical ventilation settings are important in ECMO patients to minimize further lung damage and improve outcomes. An ultra-protective ventilation strategy may be optimal for mechanical ventilation during ECMO for respiratory failure. The effects of airway pressure on right and left ventricular afterload should be considered during venoarterial ECMO support of cardiac failure. Future studies are needed to better understand the potential impact of invasive mechanical ventilation modes and settings on outcomes. PMID:24447458

  14. Simulation training for extracorporeal membrane oxygenation

    Directory of Open Access Journals (Sweden)

    Roberta Brum

    2015-01-01

    Full Text Available Background: Extracorporeal membrane oxygenation (ECMO is a complex treatment. Despite this, there are a lack of training programs designed to develop relevant clinical and nonclinical skills required for ECMO specialists. The aim of the current study was to describe the design, implementation and evaluation of a 1-day simulation course for delivering training in ECMO. Methods: A 1-day simulation course was developed with educational and intensive care experts. First, the delegates received a lecture on the principles of simulation training and the importance of human factors. This was, followed by a practical demonstration and discussion of the ECMO circuit, console components, circuit interactions effects and potential complications. There were then five ECMO simulation scenarios with debriefing that covered technical and nontechnical issues. The course culminated in a knowledge-based assessment. Course outcomes were assessed using purpose-designed questionnaires. Results: We held 3 courses with a total of 14 delegates (9 intensive care nurses, 3 adult intensive care consultants and 2 ECMO technicians. Following the course, 8 (57% gained familiarity in troubleshooting an ECMO circuit, 6 (43% increased their familiarity with the ECMO pump and circuit, 8 (57% perceived an improvement in their communication skills and 7 (50% perceived an improvement in their leadership skills. At the end of the course, 13 (93% delegates agreed that they felt more confident in dealing with ECMO. Conclusions: Simulation-training courses may increase knowledge and confidence in dealing with ECMO emergencies. Further studies are indicated to determine whether simulation training improves clinical outcomes and translates to reduced complication rates in patients receiving ECMO.

  15. Neonatal respiratory extracorporeal membrane oxygenation (ECMO) referrals.

    LENUS (Irish Health Repository)

    El-Khuffash, A

    2011-03-01

    Extracorporeal membrane oxygenation (ECMO) is a complex technique for providing life support in neonatal respiratory failure. T UK Collaborative ECMO trial demonstrated cost-effectiveness and substantial improvements in neurological morbidity and mortality. Currently, infants requiring ECMO in Ireland are referred to one of various centres in the UK and Scandinavia. We aimed to review the number of infants referred from Ireland for respiratory ECMO. All infants with a non-cardiac condition referred from Ireland for ECMO were reviewed for diagnosis and outcomes. Eleven infants required ECMO between June 2006 and January 2009 and were referred to the Scandinavian team for ECMO transport although one infant improved and did not require ECMO following the arrival of the team. Four infants died: one infant died prior to arrival of the ECMO team, 3 infants had fatal diagnoses and one infant with congenital diaphragmatic hernia received pre-op ECMO. The median (inter-quartile range) gestational age was 39.7 (38.3-40.7) weeks and birth weight of 3.7 (3.2-4.0) kg. The median age at the decision to transfer for ECMO was 13h (4-123) and the team arrived at 23 h (12-132). All infants had a normal cranial ultrasound and echo prior to ECMO and 2 infants had an abnormal MRI post-ECMO. The time on ECMO was 9 days (3-17) and total length of hospital stay was 32 d (23-36). There were no pre-ECMO clinical or biochemical

  16. Simulation training for extracorporeal membrane oxygenation

    Science.gov (United States)

    Brum, Roberta; Rajani, Ronak; Gelandt, Elton; Morgan, Lisa; Raguseelan, Nira; Butt, Salman; Nelmes, David; Auzinger, Georg; Broughton, Simon

    2015-01-01

    Background: Extracorporeal membrane oxygenation (ECMO) is a complex treatment. Despite this, there are a lack of training programs designed to develop relevant clinical and nonclinical skills required for ECMO specialists. The aim of the current study was to describe the design, implementation and evaluation of a 1-day simulation course for delivering training in ECMO. Methods: A 1-day simulation course was developed with educational and intensive care experts. First, the delegates received a lecture on the principles of simulation training and the importance of human factors. This was, followed by a practical demonstration and discussion of the ECMO circuit, console components, circuit interactions effects and potential complications. There were then five ECMO simulation scenarios with debriefing that covered technical and nontechnical issues. The course culminated in a knowledge-based assessment. Course outcomes were assessed using purpose-designed questionnaires. Results: We held 3 courses with a total of 14 delegates (9 intensive care nurses, 3 adult intensive care consultants and 2 ECMO technicians). Following the course, 8 (57%) gained familiarity in troubleshooting an ECMO circuit, 6 (43%) increased their familiarity with the ECMO pump and circuit, 8 (57%) perceived an improvement in their communication skills and 7 (50%) perceived an improvement in their leadership skills. At the end of the course, 13 (93%) delegates agreed that they felt more confident in dealing with ECMO. Conclusions: Simulation-training courses may increase knowledge and confidence in dealing with ECMO emergencies. Further studies are indicated to determine whether simulation training improves clinical outcomes and translates to reduced complication rates in patients receiving ECMO. PMID:25849687

  17. Antithrombotic therapy for the CardioWest temporary total artificial heart.

    Science.gov (United States)

    Ensor, Christopher R; Cahoon, William D; Crouch, Michael A; Katlaps, Gundars J; Hess, Michael L; Cooke, Richard H; Gunnerson, Kyle J; Kasirajan, Vigneshwar

    2010-01-01

    The CardioWest temporary total artificial heart serves as a viable bridge to orthotopic heart transplantation in patients who are experiencing end-stage refractory biventricular heart failure. This device is associated with a low, albeit still substantial, risk of thrombosis. Platelet interactions with artificial surfaces are complex and result in continuous activation of contact proteins despite therapeutic anticoagulation. We searched the medical literature (publication dates, January 1962-October 2009) in order to evaluate means of mitigating adverse events that have occurred after implantation of the CardioWest temporary total artificial heart.We conclude that the use of a multitargeted antithrombotic approach, involving anticoagulation (bivalirudin and warfarin) and antiplatelet therapy (dipyridamole and aspirin), can mitigate the procoagulative effects of mechanical circulatory assist devices, particularly those that are associated with the CardioWest temporary total artificial heart. Careful monitoring with use of a variant multisystem approach, involving efficacy tests (thrombelastography and light transmittance aggregometry), safety tests (laboratory analyses), and warfarin genomics, may maximize the therapeutic actions and minimize the bleeding risks that are associated with the multitargeted antithrombotic approach. The development and monitoring of individualized antithrombotic regimens require that informed health professionals appreciate the complexities and grasp the hazards that are associated with these therapies.

  18. Ethical controversies in organ donation after circulatory death.

    Science.gov (United States)

    2013-05-01

    The persistent mismatch between the supply of and need for transplantable organs has led to efforts to increase the supply, including controlled donation after circulatory death (DCD). Controlled DCD involves organ recovery after the planned withdrawal of life-sustaining treatment and the declaration of death according to the cardiorespiratory criteria. Two central ethical issues in DCD are when organ recovery can begin and how to manage conflicts of interests. The "dead donor rule" should be maintained, and donors in cases of DCD should only be declared dead after the permanent cessation of circulatory function. Permanence is generally established by a 2- to 5-minute waiting period. Given ongoing controversy over whether the cessation must also be irreversible, physicians should not be required to participate in DCD. Because the preparation for organ recovery in DCD begins before the declaration of death, there are potential conflicts between the donor's and recipient's interests. These conflicts can be managed in a variety of ways, including informed consent and separating the various participants' roles. For example, informed consent should be sought for premortem interventions to improve organ viability, and organ procurement organization personnel and members of the transplant team should not be involved in the discontinuation of life-sustaining treatment or the declaration of death. It is also important to emphasize that potential donors in cases of DCD should receive integrated interdisciplinary palliative care, including sedation and analgesia.

  19. Circulatory effects of noradrenaline and adrenaline before and after labetalol

    Science.gov (United States)

    Richards, D. A.; Prichard, B. N. C.; Hernández, R.

    1979-01-01

    1 Two studies were carried out in the same six normal healthy males to compare the circulatory effects of exogenously infused noradrenaline and adrenaline before and after intravenous labetalol. 2 Noradrenaline before and after labetalol produced a similar pattern of circulatory change, namely dose related systolic and diastolic pressor responses accompanied by profound bradycardia and reduced cardiac output. 3 Labetalol competitively antagonized both the systolic and diastolic pressor effects of noradrenaline. 4 Adrenaline at low doses produced a diastolic depressor response accompanied by increases in heart rate and cardiac output. The highest dose also produced smaller increases in heart rate and cardiac output and diastolic pressure increased slightly. All doses provoked increases in systolic pressure. 5 After labetalol all doses of adrenaline provoked a diastolic pressor response which was marked at high doses. The systolic response was attenuated compared with that before labetalol. At all doses, heart rate and cardiac output were reduced. 6 Since in the presence of labetalol both noradrenaline and adrenaline profoundly reduce heart rate and cardiac output whilst increasing blood pressure, it may be unwise to use either of these catecholamines alone if attempts are being made to reverse excessive hypotension from labetalol overdose. 7 Preliminary observations indicate that labetalol does not increase endogenous plasma catecholamines immediately after intravenous injection. Plasma concentrations of noradrenaline and adrenaline after exogenous infusion were increased after labetalol compared with those levels before labetalol. It appears that labetalol inhibits the clearance of catecholamines from the plasma possibly by inhibiting neuronal uptake mechanisms. PMID:444356

  20. Guidelines for reporting case studies on extracorporeal treatments in poisonings

    DEFF Research Database (Denmark)

    Lavergne, Valéry; Ouellet, Georges; Bouchard, Josée

    2014-01-01

    A literature review performed by the EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup highlighted deficiencies in the existing literature, especially the reporting of case studies. Although general reporting guidelines exist for case studies, there are none in the specific field of extra...

  1. Management of retained encrusted urethral catheter with extracorporeal shockwave lithotripsy

    Directory of Open Access Journals (Sweden)

    Sameh Anwar Kunzman

    2002-01-01

    Full Text Available We report a case of non-deflating heavily encrusted Foley catheter successfully removed by extracorporeal shockwave lithotripsy (ESWL. To our knowledge this is the first case of using ESWL to remove encrusted foley catheter retained in the bladder.

  2. Respiratory Syncytial Virus Associated Myocarditis Requiring Venoarterial Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Anamaria Milas

    2017-01-01

    Full Text Available Severe fulminant myocarditis causing cardiogenic shock can be a rapidly progressing, life threatening condition. Respiratory syncytial virus (RSV is a very rare infectious culprit infrequently described in medical literature as a cause of myocarditis, particularly in adults. We present a case of acute fulminant myocarditis in a patient with PCR positive RSV infection requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO.

  3. Complications of extracorporeal shockwave therapy in plantar fasciitis : Systematic review

    NARCIS (Netherlands)

    Roerdink, R. L.; Dietvorst, M.; van der Zwaard, B.; van der Worp, H.; Zwerver, J.

    2017-01-01

    Background: Extracorporeal shockwave therapy (ESWT) seems to be an effective treatment for plantar fasciitis (PF) and is assumed to be safe. No systematic reviews have been published that specifically studied the complications and side effects of ESWT in treating PF. Aim of this systematic review is

  4. Factors affecting lower calyceal stone clearance after Extracorporeal ...

    African Journals Online (AJOL)

    shanker

    Abstract. Objective: Extracorporeal shock wave lithotripsy (ESWL) is one of the most commonly used procedures to remove renal calculi from the lower calyces. The aim of this work is to study the impact of radiological, anatomical and demographic factors on stone clearance after ESWL of lower calyceal calculi. Patients and ...

  5. paediatric ureteric calculi: in-situ extracorporeal shock wave lithotripsy

    African Journals Online (AJOL)

    Objective To evaluate prospectively the efficacy of in-situ extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteric calculi in the paediatric age group. Patients and Methods Twenty children (aged 2.2 16 years) with 22 ureteric stones were evaluated and treated with in-situ ESWL using the Dornier S lithotripter ...

  6. Factors affecting lower calyceal stone clearance after Extracorporeal ...

    African Journals Online (AJOL)

    Objective: Extracorporeal shock wave lithotripsy (ESWL) is one of the most commonly used procedures to remove renal calculi from the lower calyces. The aim of this work is to study the impact of radiological, anatomical and demographic factors on stone clearance after ESWL of lower calyceal calculi. Patients and ...

  7. Changes in thyroid hormone concentrations during neonatal extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    Leeuwen, L.; Heijst, A.F.J. van; Rosmalen, J. van; Rijke, Y.B. de; Beurskens, L.; Tibboel, D.; Akker, E.L. van den; H, I.J.

    2017-01-01

    OBJECTIVE: Thyroid hormone concentrations can be disturbed during critical illness. Our aim was to determine changes in thyroid hormone concentrations during neonatal extracorporeal membrane oxygenation (ECMO). STUDY DESIGN: We included 21 ECMO-treated neonates. Age-specific s.d. scores (SDS) of

  8. A comparison between minimized extracorporeal circuits and conventional extracorporeal circuits in patients undergoing aortic valve surgery: is 'minimally invasive extracorporeal circulation' just low prime or closed loop perfusion ?

    OpenAIRE

    Starinieri, Pascal; Declercq, Peter E.; Robic, Boris; Yilmaz, Alaaddin; Van Tornout, Michiel; Dubois, Jasperina; Mees, Urbain; Hendrikx, Marc

    2017-01-01

    Introduction: Even though results have been encouraging, an unequivocal conclusion on the beneficial effect of minimally invasive extracorporeal circulation (MiECC) in patients undergoing aortic valve surgery cannot be derived from previous publications. Long-term outcomes are rarely reported and a significant decrease in operative mortality has not been shown. Most studies have a limited number of patients and are underpowered. They merely report on short-term results of a heterogeneous intr...

  9. Normothermal or Hypothermal Extracorporeal Circulation Regimens in Patients with Acquired Heart Disease

    Directory of Open Access Journals (Sweden)

    V. V. Lomivorotov

    2013-01-01

    Full Text Available Background. Hypothermal extracorporeal circulation has been used in cardiosurgery over 50 years. However, recent trials have not shown its predominant effect on the protection of the brain, lung, and myocardium in patients during surgery. We have presumed that when normothermal extracorporeal circulation used in patients with acquired heart disease, its pathophysiological effect on the body is comparable with that of hypothermal extracorporeal circulation. Subjects and methods. One hundred and forty patients who were to undergo acquired heart disease correction were randomized into two equal groups: that using hypothermal or normothermal extracorporeal circulation. Perioperative troponin I and NT-proBNP concentrations, postoperative clinical course, and hospital morbidity and mortality rates were estimated. Results. There were no significant differences in the concentrations of troponin I and NT-proBNP at the study stages. In the normothermal extracorporeal circulation group patients with isolated aortic stenosis, the concentration of troponin I was higher than that in the hypothermal extracorporeal circulation group. Analyzing the postoperative course indicated that the duration of mechanical ventilation was significantly lower in the hypothermal extracorporeal circulation group than in the normothermal extracorporeal circulation group. There were no differences in hospital complications and mortality rates. Conclusion. Hypothermal versus normothermal extracorporeal circulation in the correction of acquired heart diseases has no predominant effect on tro-ponin I and NT-proBNP concentrations, postoperative clinical course, and hospital complications and mortality rates. Key words: extracorporeal circulation, hypothermia, acquired heart disease, troponin I, NT-proBNP.

  10. Application of a user-friendly comprehensive circulatory model for estimation of hemodynamic and ventricular variables

    NARCIS (Netherlands)

    Ferrari, G.; Kozarski, M.; Gu, Y. J.; De Lazzari, C.; Di Molfetta, A.; Palko, K. J.; Zielinski, K.; Gorczynska, K.; Darowski, M.; Rakhorst, G.

    2008-01-01

    Purpose: Application of a comprehensive, user-friendly, digital computer circulatory model to estimate hemodynamic and ventricular variables. Methods: The closed-loop lumped parameter circulatory model represents the circulation at the level of large vessels. A variable elastance model reproduces

  11. Sizable variations in circulatory disease mortality by region and country of birth in six European countries

    DEFF Research Database (Denmark)

    Rafnsson, Snorri B; Bhopal, Raj S; Agyemang, Charles

    2013-01-01

    . RESULTS: South Asians in Denmark, England and Wales and France experienced excess circulatory disease mortality (MRRs 1.37-1.91). Similar results were seen for Eastern Europeans in these countries as well as in Sweden (MRRs 1.05-1.51), for those of Middle Eastern origin in Denmark (MRR = 1.49) and France......BACKGROUND: Circulatory disease mortality inequalities by country of birth (COB) have been demonstrated for some EU countries but pan-European analyses are lacking. We examine inequalities in circulatory mortality by geographical region/COB for six EU countries. METHODS: We obtained national death...... sizes. The pattern for IHD mortality was similar to that for circulatory disease mortality. Two- to three-fold excess cerebrovascular disease mortality was found for several foreign-born groups compared with the local-born populations in some countries. CONCLUSIONS: Circulatory disease mortality varies...

  12. Creating a Controlled Arterio-Venous Shunt by Reversing the Extracorporeal Membrane Oxygenation Blood Flow: A Strategy for Weaning Patients Off Veno-Arterial Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Mattke, Christian Adrian; Haisz, Emma; Pandya, Nischal; Black, Anthony; Venugopal, Prem

    2017-10-01

    To assess whether reversing the veno-arterial extracorporeal membrane oxygenation blood flow (thereby creating a controlled arterio-venous shunt) can be used to wean children off extracorporeal membrane oxygenation. The standard practice for weaning patients off VA extracorporeal membrane oxygenation is to gradually reduce the blood flows delivered through the extracorporeal membrane oxygenation pump to a minimum level followed by either insertion of an "arterio-venous bridge" and clamping of the blood flow to the patient or direct decannulation. "Pump controlled retrograde flow trial off" is a technique where the revolutions in the centrifugal pump are reduced to the point where the patient will drive the blood retrograde through the extracorporeal membrane oxygenation circuit, effectively turning the circuit into a controlled arterio-venous shunt. The revolutions per minute control the amount of shunt flow. This eliminates any cardiorespiratory support the extracorporeal membrane oxygenation circuit may provide to the patient. Feasibility study. Pediatric intensive care. Extracorporeal membrane oxygenation-dependent pediatric patients, who were ready for weaning, and possible separation from extracorporeal membrane oxygenation entered the trial. Pump controlled retrograde flow trial off. During 2016, pump controlled retrograde flow trial off was used in 17 patients, for a total of 23 episodes. One episode was unsuccessful in a patient with a body weight of 2.2 kg, where cardiac output was insufficient to provide blood flow to both body and extracorporeal membrane oxygenation circuit, though from 2.8 kg body weight upward, the technique was tolerated. The duration of pump controlled retrograde flow trial off was 15 minutes to 2.5 hours. Five cases led to a continuation of the extracorporeal membrane oxygenation run, as they were not ready to be decannulated. Fifteen patients were decannulated after the pump controlled retrograde flow trial off. No patient

  13. The effects of conventional extracorporeal circulation versus miniaturized extracorporeal circulation on microcirculation during cardiopulmonary bypass-assisted coronary artery bypass graft surgery.

    Science.gov (United States)

    Yuruk, Koray; Bezemer, Rick; Euser, Mariska; Milstein, Dan M J; de Geus, Hilde H R; Scholten, Evert W; de Mol, Bas A J M; Ince, Can

    2012-09-01

    OBJECTIVES To reduce the complications associated with cardiopulmonary bypass (CPB) during cardiac surgery, many modifications have been made to conventional extracorporeal circulation systems. This trend has led to the development of miniaturized extracorporeal circulation systems. Cardiac surgery using conventional extracorporeal circulation systems has been associated with significantly reduced microcirculatory perfusion, but it remains unknown whether this could be prevented by an mECC system. Here, we aimed to test the hypothesis that microcirculatory perfusion decreases with the use of a conventional extracorporeal circulation system and would be preserved with the use of an miniaturized extracorporeal circulation system. METHODS Microcirculatory density and perfusion were assessed using sublingual side stream dark-field imaging in patients undergoing on-pump coronary artery bypass graft (CABG) surgery before, during and after the use of either a conventional extracorporeal circulation system (n = 10) or a miniaturized extracorporeal circulation system (n = 10). In addition, plasma neutrophil gelatinase-associated lipocalin and creatinine levels and creatinine clearance were assessed up to 5 days post-surgery to monitor renal function. RESULTS At the end of the CPB, one patient in the miniaturized extracorporeal circulation-treated group and five patients in the conventional extracorporeal circulation-treated group received one bag of packed red blood cells (300 ml). During the CPB, the haematocrit and haemoglobin levels were slightly higher in the miniaturized extracorporeal circulation-treated patients compared with the conventional extracorporeal circulation-treated patients (27.7 ± 3.3 vs 24.7 ± 2.0%; P = 0.03; and 6.42 ± 0.75 vs 5.41 ± 0.64 mmol/l; P circulation-treated group from 16.4 ± 3.8 to 12.8 ± 3.3 mm/mm(2) (P circulation-treated group (16.3 ± 2.7 and 15.2 ± 2.9 mm/mm(2) before and during the pump, respectively). Plasma neutrophil

  14. The Role of Extracorporeal Membrane Oxygenation Simulation Training at Extracorporeal Life Support Organization Centers in the United States.

    Science.gov (United States)

    Weems, Mark F; Friedlich, Philippe S; Nelson, Lara P; Rake, Alyssa J; Klee, Laura; Stein, James E; Stavroudis, Theodora A

    2017-08-01

    Extracorporeal membrane oxygenation (ECMO) requires a multidisciplinary healthcare team. The Extracorporeal Life Support Organization publishes training guidelines but leaves specific requirements up to each institution. Simulation training has shown promise, but it is unclear how many institutions have incorporated simulation techniques into ECMO training to date. We sent an electronic survey to ECMO coordinators at Extracorporeal Life Support Organization sites in the United States. Participants were asked about training practices and the use of simulation for ECMO training. Descriptive results were reported as the percentage of total responses for each question. Logistic regression was used to identify characteristics associated with simulation use. Of 94 responses (62% response rate), 46% had an ECMO simulation program, whereas 26% report a program is in development. Most (61%) have been in operation for 2 to 5 years. Sixty-three percent use simulation for summative assessment, and 76% have multidisciplinary training. Access to a simulation center [odds ratio (OR) = 4.7, 95% confidence interval (CI) = 1.7-12.5], annual ECMO caseload of greater than 20 (OR = 2.5, 95% CI = 1.5-5.8), and having a pediatric cardiothoracic intensive care unit (OR = 2.8, 95% CI = 1.2-6.7) are each associated with increased likelihood of mannequin-based ECMO simulation. Common scenarios include pump failure (93%), oxygenator failure (90%), and circuit rupture (76%). Extracorporeal membrane oxygenation simulation is growing but remains in its infancy. Centers with access to a simulation center, higher caseloads, and pediatric cardiothoracic intensive care units are more likely to have ECMO simulation programs. Extracorporeal membrane oxygenation simulation is felt to be beneficial, and further work is needed to delineate best training practices for ECMO providers.

  15. On the Sharing of Temporary Parental Leave

    DEFF Research Database (Denmark)

    Amilon, Anna

    2007-01-01

    This paper views temporary parental leave (leave from work to take care of a sick child) as a household public good, produced with time inputs of the parents as the only input. Assuming equal productivities in the production of temporary parental leave and equal utility functions of the spouses......-point of the female is found to push the intra household allocation of temporary parental leave towards greater sharing between the spouses. In addition, an increase in the insurance ceiling will further sharing of temporary parental leave in some families, while reducing it in others....

  16. Circulatory abnormalities in cirrhosis with focus on neurohumoral aspects

    DEFF Research Database (Denmark)

    Møller, S; Henriksen, Jens Henrik Sahl

    1997-01-01

    -angiotensin-aldosterone system, and elevated circulating vasopressin, endothelin-1 may also be implicated in the hemodynamic counter-regulation in cirrhosis. Recent research has focused on the assertion that the hemodynamic and neurohumoral abnormalities in cirrhosis are part of a general circulatory dysfunction influencing......Patients with cirrhosis exhibit characteristic hemodynamic changes with a hyperkinetic circulation and an abnormal distribution of the blood volume and neurohumoral regulation. Their plasma and noncentral blood volumes are increased, and the central and arterial blood volume and systemic vascular...... resistance are decreased. A peripheral arterial vasodilatation may be of pathogenic importance to the low systemic vascular resistance as it directly correlates to the degree of central hypovolemia. It may therefore be an important element in the development of the low arterial blood pressure...

  17. Pathophysiology of cerebral circulatory disorders in idiopathic normal pressure hydrocephalus.

    Science.gov (United States)

    Takeuchi, Totaro; Goto, Hiromi; Izaki, Kenji; Tamura, Shinya; Tomii, Masato; Sasanuma, Jinichi; Maeno, Kazushige; Kikuchi, Yasuhiro; Koizumi, Jinichi; Watanabe, Zenichiro; Numazawa, Shinichi; Itoh, Yasunobu; Watanabe, Kazuo; Kojima, Masanori; Mishima, Masayuki; Onishi, Yuhki; Okada, Toshimitsu; Arai, Takashi

    2007-07-01

    This study was conducted to elucidate the pathologic conditions of cerebral circulatory disorders in idiopathic normal pressure hydrocephalus (iNPH). Among 44 possible iNPH patients, 40 patients underwent shunt surgery based on diagnostic flow charts plotted by the Southern Tohoku method and were evaluated to be shunt-effective at the end of the first post-surgical month. The cerebral blood flow (CBF) was measured by N-isopropyl-((123)I)-P-iodo-amphetamine single photon emission computed tomography (mean, mCBF; cortical region, cCBF; thalamus-basal ganglia region, tbCBF on autoradiography [ARG] method) and the perfusion patterns of the cerebral cortex were measured based on three-dimensional stereotactic surface projection (3D-SSP) Z-score images, before and 1 month after the surgery in all 40 subjects. The mCBF rose significantly from 32.1 +/- 2.74 ml/100 g/min before surgery to 39.8 +/- 3.02 ml/100 g/min after surgery (p < 0.03). Investigation of the change of CBF revealed reductions in the cCBF (3 cases), tbCBF (9 cases), and cCBF + tbCBF (28 cases), with the reduced-cCBF group totaling 31 cases and the reduced-tbCBF group totaling 37 cases. Investigation of cerebral cortex hypoperfusion by 3D-SSP Z-score revealed 31 cases with hypoperfusion (frontal lobe type [19 cases], occipitotemporal lobe type [5 cases], mixed type [7 cases]) and nine cases with cortical normoperfusion (N). The pattern of reduction of the cortical blood flow on ARG method was favorably correlated with the pattern of hypoperfusion of the cerebral cortex on 3D-SSP Z-score images before surgery. A reduction of blood flow was found in the thalamus-basal ganglia region of all N type cases. The blood flow improved in 19 of 31 (61.3%) cases of the reduced-cCBF group and in 32 of 37 (86.5%) cases of the reduced-tbCBF group. All of the cases without detectable improvement exhibited increased blood flow in non-reduction areas. Investigation of the hypoperfusion patterns of the cerebral cortex on 3D

  18. Donation after circulatory death: a national survey of current practice in England in 2012.

    Science.gov (United States)

    Patel, Sameer; Martin, Jonathan R; Marino, Philip S

    2014-10-01

    In recent years, England has seen renewed interest in donation after circulatory death. Many national and local initiatives have been implemented to encourage and support donation after circulatory death. To assess whether practice is in line with published guidance, we conducted a national survey with regard to current donation after circulatory death practices, local guidelines, and views on the need to further develop a national standardized protocol for donation after circulatory death. Online survey. Lead physicians for intensive care or organ donation for every acute National Health Service trust in England delivering adult care between April and June 2012. Physicians were e-mailed a link to a structured online questionnaire regarding their experience and practice of donation after circulatory death, including local protocols, use of organ optimization, and the need for a national protocol. We received replies from 119 of 156 eligible trusts (76.3%) in England. Of these, 112 trusts (94%) have performed donation after circulatory death. Ninety-three trusts (78.1%) have a local donation after circulatory death protocol, and 89 trusts (74.7%) felt there should be a national donation after circulatory death protocol. All responding transplant centers had performed donation after circulatory death, 14 of 17 (82.3%) had a donation after circulatory death protocol with 14 of 17 respondents (82.3%) supporting a national protocol. Regarding organ optimization, 92 institutions (77.3%) used vasoactive drugs to achieve a target mean arterial blood pressure with 82 centers (68.9%) employing positive end-expiratory pressure and FIO2 to optimize oxygenation. Eight centers (6.7%) used heparin premortem compared with two of 17 transplant centers (11.8%). Two centers have used phentolamine to facilitate organ retrieval, with another five centers (4.2%) cannulating vessels premortem. Our survey revealed varying approaches and views toward donation after circulatory death across

  19. The "Abdominal Circulatory Pump": An Auxiliary Heart during Exercise?

    Science.gov (United States)

    Uva, Barbara; Aliverti, Andrea; Bovio, Dario; Kayser, Bengt

    2015-01-01

    Apart from its role as a flow generator for ventilation the diaphragm has a circulatory role. The cyclical abdominal pressure variations from its contractions cause swings in venous return from the splanchnic venous circulation. During exercise the action of the abdominal muscles may enhance this circulatory function of the diaphragm. Eleven healthy subjects (25 ± 7 year, 70 ± 11 kg, 1.78 ± 0.1 m, 3 F) performed plantar flexion exercise at ~4 METs. Changes in body volume (ΔVb) and trunk volume (ΔVtr) were measured simultaneously by double body plethysmography. Volume of blood shifts between trunk and extremities (Vbs) was determined non-invasively as ΔVtr-ΔVb. Three types of breathing were studied: spontaneous (SE), rib cage (RCE, voluntary emphasized inspiratory rib cage breathing), and abdominal (ABE, voluntary active abdominal expiration breathing). During SE and RCE blood was displaced from the extremities into the trunk (on average 0.16 ± 0.33 L and 0.48 ± 0.55 L, p Vbs swings (maximum to minimum amplitude) were bimodal and averaged 0.13 ± 0.08 L. During exercise, Vbs swings consistently increased (0.42 ± 0.34 L, 0.40 ± 0.26 L, 0.46 ± 0.21 L, for SE, RCE and ABE respectively, all p < 0.01 vs. baseline). It follows that during leg exercise significant bi-directional blood shifting occurs between the trunk and the extremities. The dynamics and partitioning of these blood shifts strongly depend on the relative predominance of the action of the diaphragm, the rib cage and the abdominal muscles. Depending on the partitioning between respiratory muscles for the act of breathing, the distribution of blood between trunk and extremities can vary by up to 1 L. We conclude that during exercise the abdominal muscles and the diaphragm might play a role of an "auxiliary heart."

  20. Circulatory Responses to Operative Stress in Females with Gestosis

    Directory of Open Access Journals (Sweden)

    I. V. Mikhno

    2007-01-01

    Full Text Available Objective: to study the specific features of hemodynamic responses in females with gestosis in the perioperative period; to evaluate the impact of intensive care on the basis of co-administration of dalargin, dexamethasone, pen-toxifylline, and reamberin.Materials and methods. A Diamant KM-AP-01 rheograph (Saint Petersburg was used to study hemodynamic parameters in 142 patients in whom surgical delivery was made under spinal anesthesia. A control group comprised 30 patients with uncomplicated pregnancy; Group 1 included 26 females with moderate gestosis; Group 2 consisted of 27 females with moderate gestosis who received the developed intensive care regimen; Group 3 comprised 29 females with severe gestosis; Group 4 included 30 females to whom the developed intensive care regimen was applied on the basis of the concurrent use of dalargin, dexamethasone, pentoxifylline, and reamberin.Results: A neurogenic mechanism prevails in females with moderate gestosis. The decreased baseline cardiac index is mostly due to a high postload. Surgical stress does not deteriorate postoperative circulatory parameters, which suggests that females with moderate gestosis have adequate capacities for self-regulation. As gestosis progresses to a severe degree, a role of humoral mechanisms increases in the maintenance of arteriolar spasm. Arteriolar spasm and hypokinetic hemodynamics are retained within 5 postoperative days, which is indicative of the inadequacy of self-regulation and compensatory mechanisms in overcoming two stressors: severe gestosis and surgical aggression.Conclusion: the intensive care regimen developed on the basis of combined use of dalargin, dexamethasone, pentoxifylline, and reamberin favors a more intensive (the promptest normalization of circulatory parameters after surgical delivery in females with moderate and severe gestosis. 

  1. Circulatory Estrogen Level Protects Against Breast Cancer in Obese Women

    Science.gov (United States)

    Suba, Zsuzsanna

    2013-01-01

    Literary data suggest apparently ambiguous interaction between menopausal status and obesity-associated breast cancer risk based on the principle of the carcinogenic capacity of estrogen. Before menopause, breast cancer incidence is relatively low and adiposity is erroneously regarded as a protective factor against this tumor conferred by the obesity associated defective estrogen-synthesis. By contrast, in postmenopausal cases, obesity presents a strong risk factor for breast cancer being mistakenly attributed to the presumed excessive estrogen-production of their adipose-tissue mass. Obesity is associated with dysmetabolism and endangers the healthy equilibrium of sexual hormone-production and regular menstrual cycles in women, which are the prerequisites not only for reproductive capacity but also for somatic health. At the same time, literary data support that anovulatory infertility is a very strong risk for breast cancer in young women either with or without obesity. In the majority of premenopausal women, obesity associated insulin resistance is moderate and may be counteracted by their preserved circulatory estrogen level. Consequently, it is not obesity but rather the still sufficient estrogen-level, which may be protective against breast cancer in young adult females. In obese older women, never using hormone replacement therapy (HRT) the breast cancer risk is high, which is associated with their continuous estrogen loss and increasing insulin-resistance. By contrast, obese postmenopausal women using HRT, have a decreased risk for breast cancer as the protective effect of estrogen-substitution may counteract to their obesity associated systemic alterations. The revealed inverse correlation between circulatory estrogen-level and breast cancer risk in obese women should advance our understanding of breast cancer etiology and promotes primary prevention measures. New patents recommend various methods for the prevention and treatment of obesity

  2. 40 CFR 264.553 - Temporary Units (TU).

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Temporary Units (TU). 264.553 Section... Provisions for Cleanup § 264.553 Temporary Units (TU). (a) For temporary tanks and container storage areas... Administrator may designate a unit at the facility, as a temporary unit. A temporary unit must be located within...

  3. Lessons learnt from experimental temporary octopus fishing ...

    African Journals Online (AJOL)

    This paper presents evidence of the fisheries effect of experimental temporary fishing closures for Octopus in the then-emergent Velondriake Locally Managed Marine Area (LMMA) in south-west Madagascar during 2004–2006. We present an analysis of the O. cyanea catch data for the first two years of temporary closures ...

  4. Diversity patterns of temporary wetland macroinvertebrate ...

    African Journals Online (AJOL)

    Although macroinvertebrates are potentially useful for assessing the condition of temporary wetlands, little is yet known about them. Macroinvertebrate assemblages were assessed in 138 temporary wetlands in the south-western Cape, recording 126 taxa. However, predicted richness estimates were all higher than the ...

  5. Extracorporeal Membrane Oxygenation Applications in Cardiac Critical Care.

    Science.gov (United States)

    Raleigh, Lindsay; Ha, Rich; Hill, Charles

    2015-12-01

    The use of extracorporeal membrane oxygenation therapy (ECMO) in cardiac critical care has steadily increased over the past decade. Significant improvements in the technology associated with ECMO have propagated this recent resurgence and contributed to improved patient outcomes in the fields of cardiac and transplant (heart and lung) surgery. Specifically, ECMO is being increasingly utilized as a bridge to heart and lung transplantation, as well as to ventricular assist device placement. ECMO is also employed during the administration of cardiopulmonary resuscitation, known as extracorporeal life support. In this review, we examine the recent literature regarding the applications of ECMO and also describe emerging topics involving current ECMO management strategies. © The Author(s) 2015.

  6. Evaluation of cell death after treatment with extracorporeal photopheresis.

    Science.gov (United States)

    Daniele, Nicola; Del Proposto, Gianpaolo; Cerrone, Paola; Sinopoli, Silvia; Sansone, Lucia; Gadaleta, Deborah Ilaria; Lanti, Alessandro; Ferraro, Angelo Salvatore; Spurio, Stefano; Scerpa, Maria Cristina; Zinno, Francesco; Adorno, Gaspare; Isacchi, Giancarlo

    2012-02-01

    The aim of our study is to assess the mortality of leukocytes during extracorporeal photopheresis. Sixty-three photopheresis performed on 13 patients affected by chronic GvHD were evaluated. Samples were analyzed using a FACSCalibur flow cytometer. Apoptosis and necrosis of limphomononuclear cells dramatically increased after the apheretic procedure. We found a further increase of apoptotic and necrotic limphomononuclear cells after treatment with 8-MOP and UVA (p≤0.05). Our data suggested that the immunomodulatory effects of extracorporeal photopheresis, triggered by circulating apoptotic or necrotic cells, could play an important role in the treatment of GvHD with this procedure. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Extracorporeal Immunoglobulin Elimination for the Treatment of Severe Myasthenia Gravis

    Directory of Open Access Journals (Sweden)

    H. Langrova

    2010-01-01

    Full Text Available Myasthenia gravis (MG is a neuromuscular disorder leading to fluctuating muscle weakness and fatigue. Rarely, long-term stabilization is not possible through the use of thymectomy or any known drug therapy. We present our experience with extracorporeal immunoglobulin (Ig elimination by immunoadsorption (adsorbers with human Ig antibodies. Acetylcholine receptor antibodies (AChRAs were measured during long-term monitoring (4.7±2.9 years; range 1.1–8.0. A total of 474 samples (232 pairs were analyzed, and a drop in AChRA levels was observed (P=.025. The clinical status of patients improved and stabilized. Roughly 6.8% of patients experienced clinically irrelevant side effects. The method of Ig elimination by extracorporeal immunoadsorption (IA is a clinical application of the recent biotechnological advances. It offers an effective and safe therapy for severe MG even when the disease is resistant to standard therapy.

  8. Transportation of Critically Ill Patients on Extracorporeal Membrane Oxygenation

    OpenAIRE

    Broman, L. Mikael; Frenckner, Bj?rn

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) may be a life-saving procedure for patients with severe reversible pulmonary or cardiac failure or for patients in need for a bridge to transplantation. ECMO is provided by specialized centers, but patients in need of ECMO are frequently taken care of at other centers. Conventional transports to an ECMO center can be hazardous and deaths have been described. For this reason, many ECMO centers have developed transport programs with mobile ECMO. After ...

  9. Severe myocardial injury and extracorporeal membrane oxygenation following perinatal asphyxia

    Directory of Open Access Journals (Sweden)

    P. Benson Ham

    2015-05-01

    Full Text Available Perinatal asphyxia is a common cause of morbidity and mortality in the newborn and is associated with myocardial injury in a significant proportion of cases. Biomarkers, echocardiography, and rhythm disturbances are sensitive indicators of myocardial ischemia and may predict mortality. We present a case of severe myocardial dysfunction immediately after delivery managed with extracorporeal membrane oxygenation (ECMO and discuss the role of cardiac biomarkers, echocardiography, electrocardiography, and ECMO in the asphyxiated newborn.

  10. Pediatric extracorporeal shock wave lithotripsy: Predicting successful outcomes.

    Science.gov (United States)

    McAdams, Sean; Shukla, Aseem R

    2010-10-01

    Extracorporeal shock wave lithotripsy (ESWL) is currently a first-line procedure of most upper urinary tract stones ionizing radiation, perhaps utilizing advancements in ultrasound and magnetic resonance imaging. This report provides a review of the current literature evaluating the patient attributes and stone factors that may be predictive of successful ESWL outcomes along with reviewing the role of pre-operative imaging and considerations for patient safety.

  11. Automatic Control of Veno-Venous Extracorporeal Lung Assist.

    Science.gov (United States)

    Kopp, Ruedger; Bensberg, Ralf; Stollenwerk, Andre; Arens, Jutta; Grottke, Oliver; Walter, Marian; Rossaint, Rolf

    2016-10-01

    Veno-venous extracorporeal lung assist (ECLA) can provide sufficient gas exchange even in most severe cases of acute respiratory distress syndrome. Commercially available systems are manually controlled, although an automatically controlled ECLA could allow individualized and continuous adaption to clinical requirements. Therefore, we developed a demonstrator with an integrated control algorithm to keep continuously measured peripheral oxygen saturation and partial pressure of carbon dioxide constant by automatically adjusting extracorporeal blood and gas flow. The "SmartECLA" system was tested in six animal experiments with increasing pulmonary hypoventilation and hypoxic inspiratory gas mixture to simulate progressive acute respiratory failure. During a cumulative evaluation time of 32 h for all experiments, automatic ECLA control resulted in a peripheral oxygen saturation ≥90% for 98% of the time with the lowest value of 82% for 15 s. Partial pressure of venous carbon dioxide was between 40 and 49 mm Hg for 97% of the time with no value 49 mm Hg. With decreasing inspiratory oxygen concentration, extracorporeal oxygen uptake increased from 68 ± 25 to 154 ± 34 mL/min (P respiratory rate resulted in increasing extracorporeal carbon dioxide elimination from 71 ± 37 to 92 ± 37 mL/min (P concept could be demonstrated for this novel automatically controlled veno-venous ECLA circuit. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  12. Elective Thoracoscopic Maze with Venoarterial Extracorporeal Life Support.

    Science.gov (United States)

    Stein, Erica J; Elsenraat, Abram; Sirak, John H; Mast, David; Gerhardt, Mark

    2015-09-01

    This case report describes the intraoperative use of extracorporeal life support (ECLS) for an elective thoracoscopic maze procedure in which the patient could not tolerate one-lung ventilation because of hypoxia. Potential pitfalls associated with the anesthetic management of elective intraoperative ECLS include managing native cardiac ejection and ECLS flows to provide optimal oxygenation and cardiac output. Particular attention must be paid to cardiac and respiratory physiology when ECLS is used in a patient with normal cardiac function.

  13. Monitoring of the Adult Patient on Venoarterial Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Mabel Chung

    2014-01-01

    Full Text Available Venoarterial extracorporeal membrane oxygenation (VA ECMO provides mechanical support to the patient with cardiac or cardiopulmonary failure. This paper reviews the physiology of VA ECMO including the determinants of ECMO flow and gas exchange. The efficacy of this therapy may be determined by assessing patient hemodynamics and device flow, overall gas exchange support, markers of adequate oxygen delivery, and pulsatility of the arterial blood pressure waveform.

  14. After the sunset: the residual effect of temporary legislation

    NARCIS (Netherlands)

    F.J. Fagan (Frank)

    2013-01-01

    textabstractThe difference between permanent legislation and temporary legislation is the default rule of termination: permanent legislation governs perpetually, while temporary legislation governs for a limited time. Recent literature on legislative timing rules considers the effect of temporary

  15. Low-Intensity Extracorporeal Shockwave Therapy in Sexual Medicine

    DEFF Research Database (Denmark)

    Fode, Mikkel; Lowenstein, Lior; Reisman, Yacov

    2017-01-01

    INTRODUCTION: Low-intensity extracorporeal shockwave therapy (LI-ESWT) has emerged as a treatment option for male sexual dysfunction. However, results have been contradictory. AIM: To investigate the knowledge, practice patterns, and attitudes regarding LI-ESWT among experts in sexual medicine. M...... by urologists. Fode M, Lowenstein L, Reisman Y. Low-Intensity Extracorporeal Shockwave Therapy in Sexual Medicine: A Questionnaire-Based Assessment of Knowledge, Clinical Practice Patterns, and Attitudes in Sexual Medicine Practitioners. Sex Med 2017;X:XX-XX.......INTRODUCTION: Low-intensity extracorporeal shockwave therapy (LI-ESWT) has emerged as a treatment option for male sexual dysfunction. However, results have been contradictory. AIM: To investigate the knowledge, practice patterns, and attitudes regarding LI-ESWT among experts in sexual medicine....... METHODS: A study-specific questionnaire was handed out at the 18th Congress for the European Society for Sexual Medicine. Participants were queried on their knowledge about LI-ESWT and about their use of the equipment. MAIN OUTCOME MEASURES: Descriptive data on the knowledge of LI-ESWT and perception...

  16. Infection Necrosis After an Extracorporeal Reduction of a Condyle Fracture.

    Science.gov (United States)

    Hwang, Kun; Kim, Hyung Mook

    2016-05-01

    The authors experienced a patient of infection necrosis after an extracorporeal reduction of a condyle fracture and reconstructed it with an iliac bone graft.A 37-year-old man visited with a bilateral condyle fracture and a left para-symphyseal fracture. On the post-trauma third day, an intermaxillary fixation was applied using arch bars. On the post-trauma tenth day, an extracorporeal reduction was carried out. On postoperative day (POD) 7, the amount of the drain was 9 cc and the drain was removed. On POD 9, redness and a pus drain were observed on the operation site. On POD 18, growth of Streptococcus anginosus was observed in a thioglycolate broth. On POD 47, the infected condylar head was removed and reconstructed with an iliac bone graft. On the POD ninth week, the incisal opening was 24 mm.To prevent such infections, necrosis or absorption of reduced and a miniplate-fixed condyle head, the bony defect should be filled completely without exposing any medullary bone. Hematomas should be prevented using a large suction drain until the drain turns serous and eventually diminishes to zero. Finally, aseptic conditions are required in retrieving, assembling, and reinserting the extracorporeal reduced segment by changing the gloves and sufficient disinfectant irrigation. In case a pus discharge appears at the operation site, it would be wise to remove the fixed condyle, the infection source, and replace with healthy bone graft as soon as possible.

  17. Generation of Recombinant Human Ache Op-Scavengers With Extended Circulatory Longevity

    National Research Council Canada - National Science Library

    Shafferman, Avigdor

    2004-01-01

    .... We have demonstrated in the past that extension of the circulatory lifetime of AChE can be achieved either by optimizing post-translation-related enzyme processing or by chemical conjugation of polyethylene glycol (PEG...

  18. Brain ultrasonographic findings of late-onset circulatory dysfunction due to adrenal insufficiency in preterm infants

    OpenAIRE

    Su-Mi Shin; Jee Won Chai

    2016-01-01

    Purpose: The aim of this study was to characterize the brain ultrasonographic findings of late-onset circulatory dysfunction (LCD) due to adrenal insufficiency (AI) in preterm infants. Methods: Among the 257 preterm infants born at

  19. The Implications of the Shift Toward Donation After Circulatory Death in Australia

    Directory of Open Access Journals (Sweden)

    Janske Reiling, MD, PhD

    2017-12-01

    Discussion. This study shows that livers donated after circulatory death are an underused resource in Australia. Better use of these currently available organs would be a highly cost-effective way of reducing waiting list mortality in liver transplantation.

  20. Extracorporeal membrane oxygenation in a child with traumatic ventricular septal defect

    Directory of Open Access Journals (Sweden)

    Jennifer Y. Lam

    2018-01-01

    Full Text Available Traumatic ventricular septal defect is an uncommon event following blunt thoracic trauma. Within the pediatric trauma literature, extracorporeal membrane oxygenation is most commonly used for secondary acute respiratory distress syndrome. We present the first account of rescue extracorporeal membrane oxygenation to allow for safe transport and access to definitive operative repair in the setting of blunt cardiac injury.

  1. Mortality from Circulatory System Diseases and Malformations in Children in the State of Rio de Janeiro.

    Science.gov (United States)

    Salim, Thais Rocha; Soares, Gabriel Porto; Klein, Carlos Henrique; Oliveira, Glaucia Maria Moraes de

    2016-06-01

    The epidemiological profile of mortality in a population is important for the institution of measures to improve health care and reduce mortality Objective: To estimate mortality rates and the proportional mortality from cardiovascular diseases and malformations of the circulatory system in children and adolescents. This is a descriptive study of mortality from cardiovascular diseases, malformations of the circulatory system, from all causes, ill-defined causes and external causes in children and adolescents in the state of Rio de Janeiro from 1996 to 2012. Populations were obtained from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE) and deaths obtained from the Department of Informatics of the Unified Health System (DATASUS)/Ministry of Health. There were 115,728 deaths from all causes, 69,757 in males. The annual mortality from cardiovascular diseases was 2.7/100,000 in men and 2.6/100,000 in women. The annual mortality from malformations of the circulatory system was 7.5/100,000 in men and 6.6/100,000 in women. Among the specific causes of circulatory diseases, cardiomyopathies had the highest rates of annual proportional mortality, and from malformations of the circulatory system, it occurred due to unspecified malformations of the circulatory system, at all ages and in both genders. Mortality from malformations of the circulatory system was most striking in the first years of life, while cardiovascular diseases were more relevant in adolescents. Low access to prenatal diagnosis or at birth probably prevented the proper treatment of malformations of the circulatory system.

  2. Mortality from Circulatory System Diseases and Malformations in Children in the State of Rio de Janeiro

    OpenAIRE

    Salim, Thais Rocha; Soares,Gabriel Porto; Klein,Carlos Henrique; de Oliveira, Glaucia Maria Moraes

    2016-01-01

    Abstract Background: The epidemiological profile of mortality in a population is important for the institution of measures to improve health care and reduce mortality Objective: To estimate mortality rates and the proportional mortality from cardiovascular diseases and malformations of the circulatory system in children and adolescents. Methods: This is a descriptive study of mortality from cardiovascular diseases, malformations of the circulatory system, from all causes, ill-defined cause...

  3. LEFT VENTRICLE UNLOADING BY PERCUTANEOUS TRANSFEMORAL TRANSSEPTAL CANNULATION OF LEFT ATRIUM IN PATIENTS BRIDGED TO HEART TRANSPLANTATION WITH PERIPHERAL VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION

    Directory of Open Access Journals (Sweden)

    V. N. Poptsov

    2013-01-01

    Full Text Available Aim. Peripheral VA ECMO is effective method of circulatory support in heart transplant candidates with life th- reatening CHF. However this type of extracorporeal life support may be complicated by pulmonary congestion (“white lung” as a result of left ventricle (LV dilatation and volume overload. Difference approach proposed for LV unloading following VA ECMO circulatory support. We report our experience of LV unloading by percutaneous introduced of supplement drainage cannula in the left atrium (LA through the femoral vena and interatrial septum. Material and methods. In this study was included 33 heart transplant candidates (6/27 F/M, age 46.2 ± 3.7 yrs on peripheral VA ECMO support. For LV unloading we used supplement standard venous ECMO-cannula (15–19 F percutaneous introduced in LA through the femoral vena of conterlateral leg and connected to the venous line of ECMO circuit. Results. To 20 (60.6% from 33 patients needed of early (n = 10 or delayed (n = 10 LA drainage. After beginning of LV drainage we noted of significant (p < 0.05 decreasing of PAWP from 31 ± 3 to 14 ± 3 mm Hg and resolution of pulmonary edema. Mean blood flow on LA cannula was 1.5 ± 0.2 l/min. To 18 (90% from 20 patients was successfully bridged to heart transplantation. Duration VA ECMO before OHT was 8.6 ± 1.7 days. 16 (88.9% recipients were discharged from hospital. Conclusion. Active LA drainage is as effective tool of LV un- loading and protection of pulmonary congestion and edema in patients bridged to heart transplantation by peripheral VA ECMO. 

  4. Palatability of tastes is associated with facial circulatory responses.

    Science.gov (United States)

    Kashima, Hideaki; Hamada, Yuka; Hayashi, Naoyuki

    2014-03-01

    To examine whether various types of taste stimuli in the oral cavity elicit unique changes in facial skin blood flow (SkBF) according to the palatability perceived by an individual, the facial SkBF was observed by laser speckle flowgraphy in 15 healthy subjects (11 males and 4 females) before and during the ingestion of bitter tea, chilli sauce, coffee, orange juice, soup, and a water control. The heart rate, mean arterial pressure (MAP), and SkBF in the index finger were recorded continuously. Subjects reported their subjective palatability and taste intensity scores after each stimulus. The vascular conductance indexes (CIs) in the face and finger were calculated as ratios of SkBF to MAP. CI in the eyelid increased significantly in response to chilli sauce, orange juice, and soup, whereas CIs in the forehead, nose, and cheek decreased in response to bitter tea. There was a significant correlation between the palatability scores and CI values in the eyelid when changes induced by chilli sauce were excluded. These results suggest that the facial circulatory response reflects the degree of palatability of a foodstuff.

  5. Hemodynamic analysis in infants with late-onset circulatory collapse.

    Science.gov (United States)

    Washio, Yosuke; Uchiyama, Atsushi; Nakanishi, Hidehiko; Totsu, Satsuki; Masumoto, Kenichi; Kusuda, Satoshi

    2013-10-01

    Late-onset circulatory collapse (LCC) is a disorder in which blood pressure decreases and oliguria suddenly occurs in preterm infants who have survived the acute stage, leading to shock, without contributing underlying factors. In order to evaluate hemodynamic changes during LCC, the correlation between myocardial functions and organ blood flow was investigated with echography. Seven very-low-birthweight infants were given a diagnosis of LCC during the study period. Cardiovascular and organ flow parameters of the infants were recorded prospectively, once a week, and compared with eight control very-low-birthweight infants with matching gestational age. Echographic study was performed before LCC, at the onset of LCC, and after LCC among infants with LCC. A significant increase in ejection fraction and a significant decrease in end systolic wall stress were observed in infants with the LCC condition. At the same time, the mean blood flow velocity increased significantly in the superior mesenteric artery, while it decreased in the anterior cerebral artery. Systolic blood flow velocity increased and mean velocity was maintained in the renal artery during LCC. LCC is a distributive shock, characterized by a hyperdynamic state and decreased afterload. Echographic examination of organ flow during LCC is useful in understanding the pathophysiology of the disorder. © 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.

  6. Harms of unsuccessful donation after circulatory death: An exploratory study.

    Science.gov (United States)

    Taylor, Lauren J; Buffington, Anne; Scalea, Joseph R; Fost, Norman; Croes, Kenneth D; Mezrich, Joshua D; Schwarze, Margaret L

    2018-02-01

    While donation after circulatory death (DCD) has expanded options for organ donation, many who wish to donate are still unable to do so. We conducted face-to-face interviews with family members (N = 15) who had direct experience with unsuccessful DCD and 5 focus groups with professionals involved in the donation process. We used qualitative content analysis to characterize the harms of nondonation as perceived by participants. Participants reported a broad spectrum of harms affecting organ recipients, donors, and donor families. Harms included waste of precious life-giving organs and hospital resources, inability to honor the donor's memory and character, and impaired ability for families to make sense of tragedy and cope with loss. Donor families empathized with the initial hope and ultimate despair of potential recipients who must continue their wait on the transplant list. Focus group members reinforced these findings and highlighted the struggle of families to navigate the uncertainty regarding the timing of death during the donation process. While families reported significant harm, many appreciated the donation attempt. These findings highlight the importance of organ donation to donor families and the difficult experiences associated with current processes that could inform development of alternative donation strategies. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

  7. Neonatal circulatory failure due to acute hypertensive crisis: clinical and echocardiographic clues.

    Science.gov (United States)

    Louw, Jacoba; Brown, Stephen; Thewissen, Liesbeth; Smits, Anne; Eyskens, Benedicte; Heying, Ruth; Cools, Bjorn; Levtchenko, Elena; Allegaert, Karel; Gewillig, Marc

    2013-04-01

    Circulatory failure due to acute arterial hypertension in the neonatal period is rare. This study was undertaken to assess the clinical and echocardiographic manifestations of circulatory failure resulting from acute neonatal hypertensive crisis. Neonatal and cardiology databases from 2007 to 2010 were reviewed. An established diagnosis of circulatory failure due to neonatal hypertension before the age of 14 days was required for inclusion. Six patients were identified. Five patients presented with circulatory failure due to an acute hypertensive crisis. The median age at presentation was 8.5 days (range: 6.0-11.0) with a median body weight of 3.58 kg (range: 0.86-4.70). Echocardiography demonstrated mild left ventricular dysfunction [median shortening fraction (SF) 25%, range 10-30] and mild aortic regurgitation in 83% (5/6) of patients. One patient with left ventricular dysfunction (SF = 17%) had a large apical thrombus. Two patients were hypotensive, and hypertension only became evident after restoration of cardiac output. Administration of intravenous milrinone was successful, with rapid improvement of the clinical condition. Left ventricular function normalised in all survivors. Early neonatal circulatory collapse due to arterial hypertension is a rare but potentially life-threatening condition. At presentation, hypotension, especially in the presence of a dysfunctional left ventricle, does not exclude a hypertensive crisis being the cause of circulatory failure. The echocardiographic presence of mild aortic regurgitation combined with left ventricular hypocontractility in a structurally normal heart should alert the physician to the presence of underlying hypertension.

  8. Gut Bacteria and Hydrogen Sulfide: The New Old Players in Circulatory System Homeostasis.

    Science.gov (United States)

    Tomasova, Lenka; Konopelski, Piotr; Ufnal, Marcin

    2016-11-17

    Accumulating evidence suggests that gut bacteria play a role in homeostasis of the circulatory system in mammals. First, gut bacteria may affect the nervous control of the circulatory system via the sensory fibres of the enteric nervous system. Second, gut bacteria-derived metabolites may cross the gut-blood barrier and target blood vessels, the heart and other organs involved in the regulation of the circulatory system. A number of studies have shown that hydrogen sulfide (H₂S) is an important biological mediator in the circulatory system. Thus far, research has focused on the effects of H₂S enzymatically produced by cardiovascular tissues. However, some recent evidence indicates that H₂S released in the colon may also contribute to the control of arterial blood pressure. Incidentally, sulfate-reducing bacteria are ubiquitous in mammalian colon, and H₂S is just one among a number of molecules produced by the gut flora. Other gut bacteria-derived compounds that may affect the circulatory system include methane, nitric oxide, carbon monoxide, trimethylamine or indole. In this paper, we review studies that imply a role of gut microbiota and their metabolites, such as H₂S, in circulatory system homeostasis.

  9. [Therapeutic effect of extracorporeal shock wave combined with orthopaedic insole on plantar fasciitis].

    Science.gov (United States)

    Yan, Wenguang; Sun, Shaodan; Li, Xuhong

    2014-12-01

    To observe the therapeutic effect of extracorporeal shock wave combined with orthopaedic insole on plantar fasciitis. A total of 153 plantar with plantar fasciitis were randomly divided into a combined group (n=51), an extracorporeal shock wave group (n=53) and an orthopaedic group (n=49). The combined group received treatment of both extracorporeal shock wave and orthopaedic insole while the extracorporeal shock wave or the orthopaedic group only received the treatment of extracorporeal shock wave or orthopaedic insole. The therapeutic parameters such as visual analogue scale (VAS) scores, continued walking time and thickness of the plantar fascia were monitored before and aft er the treatment for 2 weeks, 1 month and 3 months, respectively. The VAS scores in the 3 groups were all reduced after the treatment compared with the corresponding scores before the therapy (Pplantar fascia was improved after the treatment (Pplantar fasciitis. It is recommended to spread in clinic.

  10. Minimal extracorporeal circulation (MECC) does not result in less hypertrophic scar formation as compared to conventional extracorporeal circulation (CECC) with dexamethasone

    NARCIS (Netherlands)

    Soykan, E.A.; Butzelaar, L.; de Kroon, T.L.; Beelen, R.H.J.; Ulrich, M.M.W.; van der Molens, A.B.M.; Niessen, F.B.

    2014-01-01

    Introduction: Cardiopulmonary bypass surgery is associated with a systemic inflammatory response through the interaction of air, blood and synthetic components in the bypass system and the physical trauma of surgery. An alternative cardiopulmonary bypass system, minimal extracorporeal circulation

  11. [Peripheral circulatory support in acute poisoning: 10 years' experience].

    Science.gov (United States)

    Baud, Frédéric; Lamhaut, Lionel; Jouffoy, Romain; Carli, Pierre

    2016-01-01

    Extracorporeal life support (ECLS) has become a common technique for treating refractory cardiogenic shock and cardiac arrest induced by drug overdose. The aim of this paper is to present our group's 10-year experience (2002-2012) using ECLS to treat drug-induced, refractory cardiogenic shock and cardiac arrest. We review 112 consecutive cases of acute poisoning requiring arteriovenous ECLS. We provided ECLS with a Rotaflow pump (Jostra-Maquette). In 71 cases (63%) the patient presented with refractory cardiac arrest; 41 (37%) presented with refractory cardiogenic shock. The dose ingested was very high in all cases. Survival was strongly related to presentation (cardiogenic shock vs cardiac arrest) and the type of drug taken. Survival was highest after overdoses of β-blockers and antiarrhythmic drugs and lowest after overdoses of chloroquine, colchicine, or verapamil. Survival rates were very low in the subgroup of patients presenting with cardiac arrest who had taken hypnotics or sedatives, suggesting that the heart stopped more because of anoxia than because of a direct cardiotoxic effect. In contrast, in cardiotoxic drug-induced cardiac arrest, the survival rate of 10% was significantly higher than the rate in non cardiotoxic arrests. Survival rates in drug-induced cardiogenic shock ranged from 45% to 100%. We conclude that ECLS should be considered for the management of cardiotoxic drug overdose. Close cardiovascular monitoring should be initiated if a patient has taken a particularly high dose of a cardiotoxic drug. Severe cardiotoxicity is rare but life threatening. The use of ECLS in these cases should be based on clinical criteria. Early use of ECLS in drug-induced cardiogenic shock significantly improves survival. Delays in applying ECLS in severe drug-induced cardiotoxicity-diagnosed based on type of drug, dose, and hemodynamic effects-can lead to cardiac arrest and a worse outcome.

  12. Temporary closure of the tunnel

    CERN Multimedia

    Relations with the Host States Service

    2005-01-01

    Owing to major maintenance work, the tunnel linking the various parts of the CERN site will be closed from Monday 4 July to Sunday 24 July 2005 The Host State authorities have given authorisation for persons employed by CERN or the Institutes to travel and for goods belonging to these entities to be transported between the various parts of the site via Gate E (Charles de Gaulle) while this work is being carried out, subject to strict compliance with the Rules for the Use of the Tunnel (see http://dsu.web.cern.ch/dsu/dsum/hsr/DOCUMENTS/8200980415.pdf). Gate E will thus be open between 7.00 a.m. and 7.00 p.m. from Monday to Friday during the period concerned. The rules governing the use of Gate E to enter the Meyrin site between 7.30 a.m. and 9.00 a.m. or to leave the site between 5.00 p.m. and 6.30 p.m. (see http://dsu.web.cern.ch/dsu/dsum/hsr/DOCUMENTS/12222_041027.pdf)) will remain unaffected by this temporary authorisation. Relations with the Host States Service and TS-FM Group

  13. A rationale for early extracorporeal membrane oxygenation in patients with postinfarction ventricular septal rupture complicated by cardiogenic shock.

    Science.gov (United States)

    Rob, Daniel; Špunda, Rudolf; Lindner, Jaroslav; Rohn, Vilém; Kunstýř, Jan; Balík, Martin; Rulíšek, Jan; Kopecký, Petr; Lipš, Michal; Šmíd, Ondřej; Kovárník, Tomáš; Mlejnský, František; Linhart, Aleš; Bělohlávek, Jan

    2017-05-01

    Ventricular septal rupture (VSR) became a rare mechanical complication of myocardial infarction in the era of percutaneous coronary interventions but is associated with extreme mortality in patients who present with cardiogenic shock (CS). Promising outcomes have been reported with the use of circulatory support allowing haemodynamic stabilization, followed by delayed repair. Therefore, we analysed our experience with an early use of Veno-Arterial Extracorporeal Membrane Oxygenation (V-A ECMO) for postinfarction VSR. We conducted a retrospective search of institutional database for patients presenting with postinfarction VSR from January 2007 to June 2016. Data from 31 consecutive patients (mean age 69.5 ± 9.1 years) who were admitted to hospital were analysed. Seven out of 31 patients with VSR who were in refractory CS received V-A ECMO support preoperatively. ECMO improved end-organ perfusion with decreased lactate levels 24 hours after implantation (7.9 mmol/L vs. 1.6 mmol/L, p = 0.01), normalized arterial pH (7.25 vs. 7.40, p < 0.04), improved mean arterial pressure (64 mmHg vs. 83 mmHg, p < 0.01) and lowered heart rate (115/min vs. 68/min, p < 0.01). Mean duration of ECMO support was 12 days, 5 out of 7 patients underwent surgical repair, 4 were weaned from ECMO, 3 survived 30 days and 2 survived more than 1 year. The most frequent complication (5 patients) and the cause of death (3 patients) was bleeding. Our experience suggests that early V-A ECMO in patients with VSR and refractory CS might prevent irreversible multiorgan failure by improved end-organ perfusion. Bleeding complications remain an important limitation of this approach. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

  14. PC based temporary shielding administrative procedure (TSAP)

    Energy Technology Data Exchange (ETDEWEB)

    Olsen, D.E.; Pederson, G.E. [Sargent & Lundy, Chicago, IL (United States); Hamby, P.N. [Commonwealth Edison Co., Downers Grove, IL (United States)

    1995-03-01

    A completely new Administrative Procedure for temporary shielding was developed for use at Commonwealth Edison`s six nuclear stations. This procedure promotes the use of shielding, and addresses industry requirements for the use and control of temporary shielding. The importance of an effective procedure has increased since more temporary shielding is being used as ALARA goals become more ambitious. To help implement the administrative procedure, a personal computer software program was written to incorporate the procedural requirements. This software incorporates the useability of a Windows graphical user interface with extensive help and database features. This combination of a comprehensive administrative procedure and user friendly software promotes the effective use and management of temporary shielding while ensuring that industry requirements are met.

  15. Temporary Authorizations at Permitted Waste Management Facilities

    Science.gov (United States)

    This rule under the Code of Federal Regulations (CFR) provides EPA with the authority to grant a permittee temporary authorization, without prior public notice and comment, to conduct activities necessary to respond promptly to changing conditions.

  16. Estimation of temporary emigration in male toads.

    Science.gov (United States)

    Muths, Erin; Scherer, Rick D; Corn, Paul Stephen; Lambert, Brad A

    2006-04-01

    Male boreal toads (Bufo boreas) are thought to return to the breeding site every year but, if absent in a particular year, will be more likely to return the following year. Using Pollock's robust design we estimated temporary emigration (the probability a male toad is absent from a breeding site in a given year) at three locations in Colorado, USA: two in Rocky Mountain National Park and one in Chaffee County. We present data that suggest that not all male toads return to the breeding site every year. Our analyses indicate that temporary emigration varies by site and time (for example, from 1992 to 1998, the probability of temporary emigration ranged from 10% to 29% and from 3% to 95% at Lost Lake and Kettle Tarn, respectively). Although the results provide weak evidence that males are more likely to return after a year's hiatus, a general pattern of state-dependent temporary emigration was not supported. We also hypothesized relationships between temporary emigration and a number of weather variables. While some competitive models included weather covariates, imprecise and variable estimates of the effects of these covariates precluded fully defining their impact on temporary emigration.

  17. A method for anticoagulation of children on mechanical circulatory support.

    Science.gov (United States)

    Copeland, Hannah; Nolan, Paul E; Covington, Diane; Gustafson, Monica; Smith, Richard; Copeland, Jack G

    2011-11-01

    Anticoagulation of children on mechanical circulatory support presents a challenge. We implanted 28 devices in children and infants using a consistent anticoagulation protocol. We performed a retrospective review of all children implanted in our program with mechanical assist devices since 1997. Heparin, dipyridamole, and aspirin were used for anticoagulation and antiaggregation. Coagulation monitoring included thromboelastography (TEG), platelet aggregration studies, international normalized ratio, partial thromboplastin time, and platelet count. Twenty-eight children, ages 1 month to 16 years (mean 5.3; median 2.4 years), were implanted for 3-107 days (mean 27; median 17). Eighteen received left ventricular assist devices, seven received biventricular assist devices, and three received total artificial hearts. Adverse events during the 720 days of device support included the following: six (21%) reoperations for bleeding; seven strokes (25%): two fatal, two with a mild residual deficit, and three without deficit; and three (11%) visceral emboli: two fatal and one nonfatal. There were eight deaths (29%). Causes of death were embolic (four), graft failure post-transplantation (one), preimplant anoxic brain damage (two), and postexplant heart failure (one). 24/28 (86%) survived to transplantation or weaning from device and 20/28 (71%) were discharged from the hospital, 10 after transplantation and 10 after native heart recovery. All 20 early survivors survived long term. We describe an anticoagulation protocol based upon TEG and platelet aggregation studies and using heparin, aspirin, and dipyridamole. Adequate anticoagulation is more difficult in children. However, 71% of the patients in our study survived long term. © 2011, Copyright the Authors. Artificial Organs © 2011, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  18. Organ donation after circulatory death in a university teaching hospital.

    Science.gov (United States)

    Sidiropoulos, S; Treasure, E; Silvester, W; Opdam, H; Warrillow, S J; Jones, D

    2016-07-01

    Although organ transplantation is well established for end-stage organ failure, many patients die on waiting lists due to insufficient donor numbers. Recently, there has been renewed interest in donation after circulatory death (DCD). In a retrospective observational study we reviewed the screening of patients considered for DCD between March 2007 and December 2012 in our hospital. Overall, 148 patients were screened, 17 of whom were transferred from other hospitals. Ninety-three patients were excluded (53 immediately and 40 after review by donation staff). The 55 DCD patients were younger than those excluded (P=0.007) and they died from hypoxic brain injury (43.6%), intraparenchymal haemorrhage (21.8%) and subarachnoid haemorrhage (14.5%). Antemortem heparin administration and bronchoscopy occurred in 50/53 (94.3%) and 22/55 (40%) of cases, respectively. Forty-eight patients died within 90 minutes and proceeded to donation surgery. Associations with not dying in 90 minutes included spontaneous ventilation mode (P=0.022), absence of noradrenaline infusion (P=0.051) and higher PaO2:FiO2 ratio (P=0.052). The number of brain dead donors did not decrease over the study period. The time interval between admission and death was longer for DCD than for the 45 brain dead donors (5 [3-11] versus 2 [2-3] days; Porgan transplants due to DCD. Introducing a DCD program can increase potential organ donors without reducing brain dead donors. Antemortem investigations appear to be acceptable to relatives when included in the consent process.

  19. Efficacy of extracorporeal shock wave treatment in calcaneal enthesophytosis

    OpenAIRE

    Cosentino, R.; Falsetti, P; Manca, S; Stefano, R.; Frati, E; Frediani, B; Baldi, F; Selvi, E; Marcolongo, R

    2001-01-01

    OBJECTIVE—To evaluate the efficacy of extracorporeal shock wave treatment (ESWT) in calcaneal enthesophytosis.
METHODS—60 patients (43 women, 17 men) were examined who had talalgia associated with heel spur. A single blind randomised study was performed in which 30 patients underwent a regular treatment (group 1) and 30 a simulated one (shocks of 0 mJ/mm2 energy were applied) (group 2). Variations in symptoms were evaluated by visual analogue scale (VAS). Variations in the dimension of enthes...

  20. Beriberi Induced Cardiomyopathy Requiring Salvage Venoarterial Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Aditya Shah

    2016-01-01

    Full Text Available Beriberi refers to a constellation of symptoms caused primarily by thiamine (vitamin B1 deficiency. An acute and fulminant presentation of this rare condition has been described in the literature as “Shoshin” beriberi which is characterized by catastrophic cardiovascular collapse. Early recognition and treatment lead to dramatic improvements of symptoms. We present a case of thiamine deficiency-induced acute heart failure in a malnourished patient leading to cardiac arrest necessitating VA-ECMO (venoarterial extracorporeal membrane oxygenation with improvement in heart function secondary to thiamine administration.

  1. [Antibiotic prophylaxis with enoxacin in extracorporeal shockwave lithotripsy].

    Science.gov (United States)

    Knipper, A; Böhle, A; Pensel, J; Hofstetter, A G

    1989-01-01

    According to literature, 16 to 35% of operatively removed renal stones harbour bacteria. The efficacy of antibiotic prophylaxis with enoxacin in reducing the rate of bacteriuria after extracorporeal shock wave lithotripsy (ESWL) was investigated in a prospective randomized study. Twenty-five patients received a single 400 mg dose of enoxacin one hour before ESWL, 25 patients did not receive an antibiotic. It was found that a single 400 mg dose of enoxacin one hour before ESWL can reduce the rate of bacteriuria significantly.

  2. Extracorporeal membrane oxygenation after intravenous injection of paraffin oil

    DEFF Research Database (Denmark)

    Pasgaard, Thomas; Huynh, Anh-Nhi Thi; Gjedsted, Jakob

    2016-01-01

    We present a rare cause of acute respiratory distress syndrome (ARDS) due to an accidental intravascular injection of paraffin oil. While there is no specific therapy, we decided to support the patient with veno-venous extracorporeal membrane oxygenation (V-V ECMO) to allow the ARDS to resolve....... A previously healthy 30-year-old man was admitted to the Emergency Department with acute onset respiratory distress following an injection with paraffin oil for cosmetic purposes. In 36 hours, the patient developed severe ARDS and respiratory support with V-V ECMO was initiated. The patient was successfully...

  3. Technological advances in extracorporeal membrane oxygenation for respiratory failure.

    Science.gov (United States)

    Rehder, Kyle J; Turner, David A; Bonadonna, Desiree; Walczak, Richard J; Rudder, Robert J; Cheifetz, Ira M

    2012-08-01

    Extracorporeal membrane oxygenation (ECMO) for neonatal and pediatric cardiac and/or respiratory failure is well established, and its use for adult respiratory failure is rapidly increasing. Management strategies developed over the past 30 years coupled with significant recent technological advances have led to improved ECMO survival. These new technologies are expanding the potential applications for ECMO in exciting ways, including new patient populations and the ability to make ECMO mobile for both intra- and inter-hospital transport. In this article, we highlight some of the recent technological advances and their impact on the utilization of ECMO in increasingly diverse patient populations.

  4. Transition of intestinal fatty acid-binding protein on hypothermic circulatory arrest with cardiopulmonary bypass.

    Science.gov (United States)

    Kano, Hiroya; Takahashi, Hiroaki; Inoue, Takeshi; Tanaka, Hiroshi; Okita, Yutaka

    2017-04-01

    Intestinal fatty acid-binding protein (I-FABP) is increasingly employed as a highly specific marker of intestinal necrosis. However, the value of this marker associated with cardiovascular surgery with hypothermic circulatory arrest is unclear. The aim of this study was to measure serum I-FABP levels and provide the transition of I-FABP levels with hypothermic circulatory arrest to help in the management of intestinal perfusion. From August 2011 to September 2013, 33 consecutive patients who had aortic arch surgery with hypothermic circulatory arrest or heart valve surgery performed were enrolled in the study. Twenty patients had aortic surgery with hypothermic (23-29°C) circulatory arrest and 13 patients had heart valve surgery with cardiopulmonary bypass (33°C). I-FABP levels increased, both in patients undergoing aortic surgery with hypothermic circulatory arrest and heart valve surgery with cardiopulmonary bypass, reaching peak levels shortly after the administration of protamine. I-FABP levels in patients with aortic surgery were significantly higher with circulatory arrest. They reached peak levels immediately after recirculation and there was a significant drop at the end of surgery (p<0.001). I-FABP levels in heart valve surgery were gradually increased, with the highest at the administration of protamine; they gradually decreased. Peak I-FABP levels were significantly higher in patients undergoing aortic surgery with hypothermic circulatory arrest than in patients with heart valve surgery. However, no postoperative reperfusion injury occurred in the intestinal tract due to the use of hypothermic organ protection. Plasma I-FABP monitoring could be a valuable method for finding an intestinal ischemia in patients with cardiovascular surgery.

  5. User's instructions for the Guyton circulatory dynamics model using the Univac 1110 batch and demand processing (with graphic capabilities)

    Science.gov (United States)

    Archer, G. T.

    1974-01-01

    The model presents a systems analysis of a human circulatory regulation based almost entirely on experimental data and cumulative present knowledge of the many facets of the circulatory system. The model itself consists of eighteen different major systems that enter into circulatory control. These systems are grouped into sixteen distinct subprograms that are melded together to form the total model. The model develops circulatory and fluid regulation in a simultaneous manner. Thus, the effects of hormonal and autonomic control, electrolyte regulation, and excretory dynamics are all important and are all included in the model.

  6. Device Strategies for Patients in INTERMACS Profiles 1 and 2 Cardiogenic Shock: Double Bridge With Extracorporeal Membrane Oxygenation and Initial Implant of More Durable Devices.

    Science.gov (United States)

    Cheng, Richard; Ramzy, Danny; Azarbal, Babak; Arabia, Francisco A; Esmailian, Fardad; Czer, Lawrence S; Kobashigawa, Jon A; Moriguchi, Jaime D

    2017-03-01

    For Interagency Registry for Mechanically Assisted Circulatory Support profiles 1 and 2 cardiogenic shock patients initially placed on extracorporeal membrane oxygenation (ECMO), whether crossover to more durable devices is associated with increased survival, and its optimal timing, are not established. Profiles 1 and 2 patients placed on mechanical support were prospectively registered. Survival and successful hospital discharge were compared between patients placed on ECMO only, ECMO with early crossover, and ECMO with delayed crossover. Survival of patients directly implanted with non-ECMO devices was also reported. One-hundred and sixty-two patients were included. Mean age was 52.2 ± 13.8 years. Seventy-three of 162 (45.1%) were initiated on ECMO. Of these, 43 were supported with ECMO only, 11 were crossed-over early ECMO devices, 30-day and 60-day survival was 90.9 ± 3.1% and 87.3 ± 3.8%, respectively, and survival to hospital discharge was 78.7%. Both initial implant of durable devices and double bridge strategy was associated with improved outcomes. If the double bridge strategy is chosen, early crossover is associated with improved survival and successful hospital discharge. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  7. Early Prediction Model for Successful Bridge to Recovery in Patients With Fulminant Myocarditis Supported With Percutaneous Venoarterial Extracorporeal Membrane Oxygenation - Insights From the CHANGE PUMP Study.

    Science.gov (United States)

    Sawamura, Akinori; Okumura, Takahiro; Hirakawa, Akihiro; Ito, Masaaki; Ozaki, Yukio; Ohte, Nobuyuki; Amano, Tetsuya; Murohara, Toyoaki

    2017-10-27

    Cardiac recovery and prevention of end-organ damage are the cornerstones of establishing successful bridge to recovery (BTR) in patients with fulminant myocarditis (FM) supported with percutaneous venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, the timing and method of successful BTR prediction still remain unclear. We aimed to develop a prediction model for successful BTR in patients with FM supported with percutaneous VA-ECMO.Methods and Results:This was a retrospective multicenter chart review enrolling 99 patients (52±16 years; female, 42%) with FM treated with percutaneous VA-ECMO. The S-group comprised patients who experienced percutaneous VA-ECMO decannulation and subsequent discharge (n=46), and the F-group comprised patients who either died in hospital or required conversion to other forms of mechanical circulatory support (n=53). At VA-ECMO initiation (0-h), the S-group had significantly higher left ventricular ejection fraction (LVEF) and lower aspartate aminotransferase (AST) concentration than the F-group. At 48 h, the LVEF, increase in the LVEF, and reduction of AST from 0-h were identified as independent predictors in the S-group. Finally, we developed an S-group prediction model comprising these 3 variables (area under the curve, 0.844; 95% confidence interval, 0.745-0.944). We developed a model for use 48 h after VA-ECMO initiation to predict successful BTR in patients with FM.

  8. Neonatal and pediatric extracorporeal membrane oxygenation in developing Latin American countries.

    Science.gov (United States)

    Kattan, Javier; González, Álvaro; Castillo, Andrés; Caneo, Luiz Fernando

    To review the principles of neonatal-pediatric extracorporeal membrane oxygenation therapy, prognosis, and its establishment in limited resource-limited countries in Latino America. The PubMed database was explored from 1985 up to the present, selecting from highly-indexed and leading Latin American journals, and Extracorporeal Life Support Organization reports. Extracorporeal membrane oxygenation provides "time" for pulmonary and cardiac rest and for recovery. It is used in the neonatal-pediatric field as a rescue therapy for more than 1300 patients with respiratory failure and around 1000 patients with cardiac diseases per year. The best results in short- and long-term survival are among patients with isolated respiratory diseases, currently established as a standard therapy in referral centers for high-risk patients. The first neonatal/pediatric extracorporeal membrane oxygenation Program in Latin America was established in Chile in 2003, which was also the first program in Latin America to affiliate with the Extracorporeal Life Support Organization. New extracorporeal membrane oxygenation programs have been developed in recent years in referral centers in Argentina, Colombia, Brazil, Mexico, Perú, Costa Rica, and Chile, which are currently funding the Latin American Extracorporeal Life Support Organization chapter. The best results in short- and long-term survival are in patients with isolated respiratory diseases. Today extracorporeal membrane oxygenation therapy is a standard therapy in some Latin American referral centers. It is hoped that these new extracorporeal membrane oxygenation centers will have a positive impact on the survival of newborns and children with respiratory or cardiac failure, and that they will be available for an increasing number of patients from this region in the near future. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  9. Neonatal and pediatric extracorporeal membrane oxygenation in developing Latin American countries

    Directory of Open Access Journals (Sweden)

    Javier Kattan

    Full Text Available Abstract Objective: To review the principles of neonatal-pediatric extracorporeal membrane oxygenation therapy, prognosis, and its establishment in limited resource-limited countries in Latino America. Sources: The PubMed database was explored from 1985 up to the present, selecting from highly-indexed and leading Latin American journals, and Extracorporeal Life Support Organization reports. Summary of the findings: Extracorporeal membrane oxygenation provides “time” for pulmonary and cardiac rest and for recovery. It is used in the neonatal-pediatric field as a rescue therapy for more than 1300 patients with respiratory failure and around 1000 patients with cardiac diseases per year. The best results in short- and long-term survival are among patients with isolated respiratory diseases, currently established as a standard therapy in referral centers for high-risk patients. The first neonatal/pediatric extracorporeal membrane oxygenation Program in Latin America was established in Chile in 2003, which was also the first program in Latin America to affiliate with the Extracorporeal Life Support Organization. New extracorporeal membrane oxygenation programs have been developed in recent years in referral centers in Argentina, Colombia, Brazil, Mexico, Perú, Costa Rica, and Chile, which are currently funding the Latin American Extracorporeal Life Support Organization chapter. Conclusions: The best results in short- and long-term survival are in patients with isolated respiratory diseases. Today extracorporeal membrane oxygenation therapy is a standard therapy in some Latin American referral centers. It is hoped that these new extracorporeal membrane oxygenation centers will have a positive impact on the survival of newborns and children with respiratory or cardiac failure, and that they will be available for an increasing number of patients from this region in the near future.

  10. Outcomes of intraoperative extracorporeal membrane oxygenation versus cardiopulmonary bypass for lung transplantation.

    Science.gov (United States)

    Machuca, Tiago N; Collaud, Stephane; Mercier, Olaf; Cheung, Maureen; Cunningham, Valerie; Kim, S Joseph; Azad, Sassan; Singer, Lianne; Yasufuku, Kazuhiro; de Perrot, Marc; Pierre, Andrew; McRae, Karen; Waddell, Thomas K; Keshavjee, Shaf; Cypel, Marcelo

    2015-04-01

    The study objective was to compare the outcomes of intraoperative extracorporeal membrane oxygenation versus cardiopulmonary bypass support in lung transplantation. We performed a retrospective cohort study from a prospective database of adult lung transplantations performed at the University of Toronto from 2007 to 2013. Among 673 lung transplantations performed in the study period, 267 (39.7%) required cardiopulmonary support. There were 39 cases of extracorporeal membrane oxygenation (2012-2013) and 228 cases of cardiopulmonary bypass (2007-2013). Patients who were bridged with extracorporeal life support, underwent a concomitant cardiac procedure, received a combined liver or heart transplant, were colonized with Burkholderia cenocepacia, or required emergency cannulation for cardiopulmonary support were excluded. Finally, 33 extracorporeal membrane oxygenation cases were matched with 66 cases of cardiopulmonary bypass according to age (±10 years), lung transplantation indication, and procedure type (bilateral vs single lung transplantation). Recipient factors such as body mass index and gender were not different between extracorporeal membrane oxygenation and cardiopulmonary bypass groups. Furthermore, donor variables were similar, including age, body mass index, last PaO2/FiO2 ratio, smoking history, positive airway cultures, and donor type (brain death and donation after cardiac death). Early outcomes, such as mechanical ventilation requirement, length of intensive care unit stay, and length of hospital stay, significantly favored extracorporeal membrane oxygenation (median 3 vs 7.5 days, P = .005; 5 vs 9.5 days, P = .026; 19 vs 27 days, P = .029, respectively). Perioperative blood product transfusion requirement was lower in the extracorporeal membrane oxygenation group. The 90-day mortality for the extracorporeal membrane oxygenation group was 6% versus 15% for cardiopulmonary bypass (P = .32). Extracorporeal membrane oxygenation may be

  11. Ultrasonic Doppler blood flow meter for extracorporeal circulation

    Science.gov (United States)

    Dantas, Ricardo G.; Costa, Eduardo T.; Maia, Joaquim M.; Nantes Button, Vera L. d. S.

    2000-04-01

    In cardiac surgeries it is frequently necessary to carry out interventions in internal heart structures, and where the blood circulation and oxygenation are made by artificial ways, out of the patient's body, in a procedure known as extracorporeal circulation (EC). During this procedure, one of the most important parameters, and that demands constant monitoring, is the blood flow. In this work, an ultrasonic pulsed Doppler blood flowmeter, to be used in an extracorporeal circulation system, was developed. It was used a 2 MHz ultrasonic transducer, measuring flows from 0 to 5 liters/min, coupled externally to the EC arterial line destined to adults perfusion (diameter of 9.53 mm). The experimental results using the developed flowmeter indicated a maximum deviation of 3.5% of full scale, while the blood flow estimator based in the rotation speed of the peristaltic pump presented deviations greater than 20% of full scale. This ultrasonic flowmeter supplies the results in a continuous and trustworthy way, and it does not present the limitations found in those flowmeters based in other transduction methods. Moreover, due to the fact of not being in contact with the blood, it is not disposable and it does not need sterilization, reducing operational costs and facilitating its use.

  12. Should Extracorporeal Membrane Oxygenation Be Offered? An International Survey.

    Science.gov (United States)

    Kuo, Kevin W; Barbaro, Ryan P; Gadepalli, Samir K; Davis, Matthew M; Bartlett, Robert H; Odetola, Folafoluwa O

    2017-03-01

    To assess the current attitudes of extracorporeal membrane oxygenation (ECMO) program directors regarding eligibility for ECMO among children with cardiopulmonary failure. Electronic cross-sectional survey of ECMO program directors at ECMO centers worldwide within the Extracorporeal Life Support Organization directory (October 2015-December 2015). Of 733 eligible respondents, 226 (31%) completed the survey, 65% of whom routinely cared for pediatric patients. There was wide variability in whether respondents would offer ECMO to any of the 5 scenario patients, ranging from 31% who would offer ECMO to a child with trisomy 18 to 76% who would offer ECMO to a child with prolonged cardiac arrest and indeterminate neurologic status. Even physicians practicing the same specialty sometimes held widely divergent opinions, with 50% of pediatric intensivists stating they would offer ECMO to a child with severe developmental delay and 50% stating they would not. Factors such as quality of life and neurologic status influenced decision making and were used to support decisions for and against offering ECMO. ECMO program directors vary widely in whether they would offer ECMO to various children with cardiopulmonary failure. This heterogeneity in physician decision making underscores the need for more evidence that could eventually inform interinstitutional guidelines regarding patient selection for ECMO. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Extracorporeal membrane oxygenation: a breakthrough for respiratory failure.

    Science.gov (United States)

    Frenckner, B

    2015-12-01

    Extracorporeal membrane oxygenation (ECMO) is a method for providing long-term treatment of a patient in a modified heart-lung machine. Desaturated blood is drained from the patient, oxygenated and pumped back to a major vein or artery. ECMO supports heart and lung function and may be used in severe heart and/or lung failure when conventional intensive care fails. The Stockholm programme started in 1987 with treatment of neonates. In 1995, the first adult patient was accepted onto the programme. Interhospital transportation during ECMO was started in 1996, which enabled retrieval of extremely unstable patients during ECMO. Today, the programme has an annual volume of about 80 patients. It has been characterized by, amongst other things, minimal patient sedation. By 31 December 2014, over 900 patients had been treated, the vast majority for respiratory failure, and over 650 patients had been transported during ECMO. The median ECMO duration was 5.3, 5.7 and 7.1 days for neonatal, paediatric and adult patients, respectively. The survival to hospital discharge rate for respiratory ECMO was 81%, 70% and 63% in the different age groups, respectively, which is significantly higher than the overall international experience as reported to the Extracorporeal Life Support Organization (ELSO) Registry (74%, 57% and 57%, respectively). The survival rate was significantly higher in the Stockholm programme compared to ELSO for meconium aspiration syndrome, congenital diaphragmatic hernia in neonates and pneumocystis pneumonia in paediatric patients. © 2015 The Association for the Publication of the Journal of Internal Medicine.

  14. Extracorporeal support for patients with acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Simon J. Finney

    2014-09-01

    Full Text Available Extracorporeal membrane oxygen (ECMO has been used for many years in patients with life-threatening hypoxaemia and/or hypercarbia. While early trials demonstrated that it was associated with poor outcomes and extensive haemorrhage, the technique has evolved. It now encompasses new technologies and understanding that the lung protective mechanical ventilation it can facilitate is inextricably linked to improving outcomes for patients. The positive results from the CESAR (Conventional ventilation or ECMO for Severe Adult Respiratory failure study and excellent outcomes in patients who suffered severe influenza A (H1N1/09 infection have established ECMO in the care of patients with severe acute respiratory distress syndrome. Controversy remains as to at what point in the clinical pathway ECMO should be employed; as a rescue therapy or more pro-actively to enable and ensure high-quality lung protective mechanical ventilation. The primary aims of this article are to discuss: 1 the types of extracorporeal support available; 2 the rationale for its use; 3 the relationship with lung protective ventilation; and 4 the current evidence for its use.

  15. Extracorporeal albumin dialysis in patients with Amanita phalloides poisoning.

    Science.gov (United States)

    Faybik, Peter; Hetz, Hubert; Baker, Amir; Bittermann, Clemens; Berlakovich, Gabriela; Werba, Alois; Krenn, Claus-Georg; Steltzer, Heinz

    2003-01-01

    Ingestion of Amanita phalloides is the most common cause of lethal mushroom poisoning. The relative late onset of symptoms is a distinct diagnostic feature of Amanita intoxication and also the main reason of failure for extracorporeal removal of Amanita-specific toxins from the gut and circulation. Extracorporeal albumin dialysis (ECAD) has been used on six consecutive patients admitted after A. phalloides poisoning with acute liver failure (ALF). Six patients, with mean age of 46 years (range: 9-70 years), underwent one to three ECAD treatments. The mean time from mushroom ingestion until the first ECAD treatment was 76 h. Two patients regenerated spontaneously under ECAD treatment and orthotopic liver transplantation (OLT) could be avoided. Two patients were successfully bridged to OLT and one patient died because of cerebral herniation. One patient was treated with ECAD immediately after OLT because of the graft dysfunction and survived without re-transplantation. ECAD appeared to be a successful treatment perspective in supporting liver regeneration or in sufficient bridging to OLT and also in treatment of graft dysfunction after OLT in patients with A. phalloides poisoning.

  16. 77 FR 66847 - Circulatory System Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting

    Science.gov (United States)

    2012-11-07

    ...: (1) Centrifugal type pumps utilize a rotor to impart energy to the blood in an extracorporeal circuit... cardiopulmonary blood pumps for use in cardiopulmonary bypass circuits for periods of up to six hours. Micro... blood pumps for use in cardiopulmonary bypass circuits for periods of up to six hours, but FDA did not...

  17. Significant social events and increasing use of life-sustaining treatment: trend analysis using extracorporeal membrane oxygenation as an example.

    Science.gov (United States)

    Chen, Yen-Yuan; Chen, Likwang; Huang, Tien-Shang; Ko, Wen-Je; Chu, Tzong-Shinn; Ni, Yen-Hsuan; Chang, Shan-Chwen

    2014-03-04

    Most studies have examined the outcomes of patients supported by extracorporeal membrane oxygenation as a life-sustaining treatment. It is unclear whether significant social events are associated with the use of life-sustaining treatment. This study aimed to compare the trend of extracorporeal membrane oxygenation use in Taiwan with that in the world, and to examine the influence of significant social events on the trend of extracorporeal membrane oxygenation use in Taiwan. Taiwan's extracorporeal membrane oxygenation uses from 2000 to 2009 were collected from National Health Insurance Research Dataset. The number of the worldwide extracorporeal membrane oxygenation cases was mainly estimated using Extracorporeal Life Support Registry Report International Summary July 2012. The trend of Taiwan's crude annual incidence rate of extracorporeal membrane oxygenation use was compared with that of the rest of the world. Each trend of extracorporeal membrane oxygenation use was examined using joinpoint regression. The measurement was the crude annual incidence rate of extracorporeal membrane oxygenation use. Each of the Taiwan's crude annual incidence rates was much higher than the worldwide one in the same year. Both the trends of Taiwan's and worldwide crude annual incidence rates have significantly increased since 2000. Joinpoint regression selected the model of the Taiwan's trend with one joinpoint in 2006 as the best-fitted model, implying that the significant social events in 2006 were significantly associated with the trend change of extracorporeal membrane oxygenation use following 2006. In addition, significantly social events highlighted by the media are more likely to be associated with the increase of extracorporeal membrane oxygenation use than being fully covered by National Health Insurance. Significant social events, such as a well-known person's successful extracorporeal membrane oxygenation use highlighted by the mass media, are associated with the use of

  18. Life style and the risk of development of circulatory system diseases.

    Science.gov (United States)

    Borzecki, Andrzej; Zółkowska, Dorota; Sieklucka-Dziuba, Maria

    2002-01-01

    Circulatory system diseases (c.s.d.) belong to the group of civilization diseases. The risk factors of circulatory system diseases are: stress, overuse of alcohol, smoking cigarettes, bad eating habits, sitting life style. Calorie overconsumption, animal fat rich diet, sitting life style result in the development of android obesity, hypercholesterolemia, that enhance atheromatosis. The most dangerous consequences of atheromatosis are: angina pectoris, hypertension, myocardial infarction, brain insult, type II diabetes. The aim of the work was to evaluate life style and its correlation with development of circulatory system diseases. The results obtained significantly indicate how important is health education about the danger of widely understood unhealthy life style. Propagation of staying healthy model with emphasizing real profit resulting from leading healthy life style is the only righteous way to improve it.

  19. The Diagnosis and Hemodynamic Monitoring of Circulatory Shock: Current and Future Trends

    Directory of Open Access Journals (Sweden)

    Hendy Adham

    2016-07-01

    Full Text Available Circulatory shock is a complex clinical syndrome encompassing a group of conditions that can arise from different etiologies and presented by several different hemodynamic patterns. If not corrected, cell dysfunction, irreversible multiple organ insufficiency, and death may occur. The four basic types of shock, hypovolemic, cardiogenic, obstructive and distributive, have features similar to that of hemodynamic shock. It is therefore essential, when monitoring hemodynamic shock, to making accurate clinical assessments which will guide and dictate appropriate management therapy. The European Society of Intensive Care has recently made recommendations for monitoring hemodynamic shock. The present paper discusses the issues raised in the new statements, including individualization of blood pressure targets, prediction of fluid responsiveness, and the use of echocardiography as the first means during the initial evaluation of circulatory shock. Also, the place of more invasive hemodynamic monitoring techniques and future trends in hemodynamic and metabolic monitoring in circulatory shock, will be debated.

  20. Need for adaptation: transformation of temporary houses.

    Science.gov (United States)

    Wagemann, Elizabeth

    2017-10-01

    Building permanent accommodation after a disaster takes time for reasons including the removal of debris, the lack of available land, and the procurement of resources. In the period in-between, affected communities find shelter in different ways. Temporary houses or transitional shelters are used when families cannot return to their pre-disaster homes and no other alternative can be provided. In practice, families stay in a standard interim solution for months or even years while trying to return to their routines. Consequently, they adapt their houses to meet their midterm needs. This study analysed temporary houses in Chile and Peru to illustrate how families modify them with or without external support. The paper underlines that guidance must be given on how to alter them safely and on how to incorporate the temporary solution into the permanent structure, because families adapt their houses whether or not they are so designed. © 2017 The Author(s). Disasters © Overseas Development Institute, 2017.

  1. Circulatory mitochondrial DNA is a pro-inflammatory agent in maintenance hemodialysis patients.

    Directory of Open Access Journals (Sweden)

    Hongdi Cao

    Full Text Available Chronic inflammation is highly prevalent in maintenance hemodialysis (MHD patients, and it has been shown to be a strong predictor of morbidity and mortality. Mitochondrial DNA (mtDNA released into circulation after cell damage can promote inflammation in patients and animal models. However, the role and mechanisms of circulatory mtDNA in chronic inflammation in MHD patients remain unknown. Sixty MHD patients and 20 health controls were enrolled in this study. The circulatory mtDNA was detected by quantitative real-time PCR assay. Plasma interleukin 6 (IL-6 and tumor necrosis factor α (TNF-α were quantitated by ELISA assay. Dialysis systems in MHD patients and in vitro were used to evaluate the effect of different dialysis patterns on circulatory mtDNA. Circulatory mtDNA was elevated in MHD patients comparing to that of health control. Regression analysis demonstrated that plasma mtDNA was positively associated with TNF-α and the product of serum calcium and phosphorus, while negatively associated with hemoglobin and serum albumin in MHD patients. MtDNA induced the secretion of IL-6 and TNF-α in the THP-1 cells. Single high-flux hemodialysis (HF-HD and on line hemodiafiltration (OL-HDF but not low-flux hemodialysis (LF-HD could partially reduce plasma mtDNA in MHD patients. In vitro, both HD and hemofiltration (HF could fractional remove mtDNA. Collectively, circulatory mtDNA is elevated and its level is closely correlated with chronic inflammation in MHD patients. HF-HD and HDF can partially reduce circulatory mtDNA in MHD patients.

  2. Closing a temporary ileostomy within two weeks.

    Science.gov (United States)

    Hindenburg, Tommy; Rosenberg, Jacob

    2010-06-01

    Temporary ileostomy is frequently constructed to relieve a rectal anastomosis and avoid peritonitis if the anastomosis is leaking. Ostomy is a burden for both the patient and society and early closure is therefore desirable to counteract increased morbidity. Several prospective studies and a single randomized controlled trial have shown that closure in less than two weeks was associated with lower or equal morbidity compared with later closure. Thus, current data support early closure of temporary ileostomy performed to cover rectal anastomosis in routine clinical practice.

  3. Nurses' perceptions of temporary nursing service agencies.

    Science.gov (United States)

    Sorrentino, E A; Simunek, L A

    1991-04-01

    Temporary staffing agencies have indeed carved out a role for themselves, and our free enterprise system lends itself to the perpetuation of the entrepreneurial spirit in all: nurses, agencies, and hospitals alike. It is wiser to learn to work with current structure realizing that supply and demand plays an important role in the survival and success of agencies. Although there are problems associated with temporary nursing staffing, they are surmountable. Orientation programs, performance monitoring, ensuring accountability of both nurse and agency are but a few that can enhance utilization and quality of service.

  4. Novel circulatory connection from the acupoint Zhong Wan(CV12 to pancreas

    Directory of Open Access Journals (Sweden)

    Minsoo Kim

    2008-03-01

    Full Text Available Objectives : Demonstrating a novel circulatory path from the acupoint(CV12 to the pancreas. Method : Alcian blue(1% solution, 20μl, pH 7.4 was injected into the acupoint(CV12. Two hours later the surfaces of internal organs were observed by using a stereomicroscope. Results : Alcian blue arrived and colored the omental fat band(OFB on the pancreas. The OFB connected the head and tail of the pancreas, the pancreas and the spleen, and the pancreas and the stomach. Conclusion : The existence of a novel circulatory path from the acupoint CV12 to the pancreas and its OFB was demonstrated.

  5. [Indications and strategies in mechanical circulatory support : Rise of the machines?

    Science.gov (United States)

    Dashkevich, A; Michel, S; Hagl, C

    2017-09-04

    Terminal heart failure is an emerging problem with a continuously growing number of diseased patients worldwide. Because of the limited number of donor hearts, mechanical circulatory support is increasingly becoming an integral part of surgical treatment for end-stage heart failure, especially in patients deemed for destination therapy. Accurate patient selection, appropriate indication, and the optimal implantation time point guarantee a good outcome for these patients. This review article gives a systematic overview of the possible indication settings and treatment strategies for various patient groups in need of mechanical circulatory support.

  6. Pharmacokinetics of cefotaxime and desacetylcefotaxime in infants during extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    M.J. Ahsman (Maurice); E.D. Wildschut (Enno); D. Tibboel (Dick); R.A. Mathot (Ron)

    2010-01-01

    textabstractExtracorporeal membrane oxygenation (ECMO) is used to temporarily sustain cardiac and respiratory function in critically ill infants but can cause pharmacokinetic changes necessitating dose modifications. Cefotaxime (CTX) is used to prevent and treat infections during ECMO, but the

  7. METHODS OF EXTRACORPOREAL HEMOCORRECTION IN COMPLEX TREATMENT OF BACTERIAL AND VIRAL INFECTIONS AFTER KIDNEY TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    A. V. Vatazin

    2013-01-01

    Full Text Available Scientific publications devoted to the contemporary prospective selected and combined extracorporeal modalities to treat complications after renal allotransplantation were analyzed involving pyoseptic processes and viral hepatites.

  8. Evaluation of furosemide regimens in neonates treated with extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    M.M.J. van der Vorst (Maria); E.D. Wildschut (Enno); R.J.M. Houmes (Robert Jan); S.J. Gischler (Saskia); J.E. Kist-Van Holthe (Joana); J. Burggraaf (Jacobus); A.J. van der Heijden (Bert); D. Tibboel (Dick)

    2006-01-01

    textabstractIntroduction: Loop diuretics are the most frequently used diuretics in patients treated with extracorporeal membrane oxygenation (ECMO). In patients after cardiopulmonary bypass (CPB) surgery, the use of continuous furosemide infusion is increasingly documented. Because ECMO and CPB are

  9. Recommendations for the role of extracorporeal treatments in the management of acute methanol poisoning

    DEFF Research Database (Denmark)

    Roberts, Darren M; Yates, Christopher; Megarbane, Bruno

    2015-01-01

    of biomarkers of exposure and toxicity. In the absence of severe poisoning, the decision to use extracorporeal treatment is determined by balancing the cost and complications of extracorporeal treatment to that of fomepizole or ethanol. Given regional differences in cost and availability of fomepizole......OBJECTIVE: Methanol poisoning can induce death and disability. Treatment includes the administration of antidotes (ethanol or fomepizole and folic/folinic acid) and consideration of extracorporeal treatment for correction of acidemia and/or enhanced elimination. The Extracorporeal Treatments...... of fomepizole therapy, 2) greater than 600 mg/L or 18.7 mmol/L in the context of ethanol treatment, 3) greater than 500 mg/L or 15.6 mmol/L in the absence of an alcohol dehydrogenase blocker; in the absence of a methanol concentration, the osmolal/osmolar gap may be informative; or, in the context of impaired...

  10. Nationwide Evaluation of Congenital Hypothyroidism Screening during Neonatal Extracorporeal Membrane Oxygenation

    NARCIS (Netherlands)

    Leeuwen, L.; Heijst, A.F.J. van; Vijfhuize, S.; Beurskens, L.W.; Weijman, G.; Tibboel, D.; Akker, E.L. van den; Ijsselstijn, H.

    2017-01-01

    BACKGROUND: Thyroid hormone concentrations may deviate from normal values during critical illness. This condition is known as nonthyroidal illness syndrome (NTIS), and it can influence the results of screening for congenital hypothyroidism (CH) during neonatal extracorporeal membrane oxygenation

  11. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care: Endorsed by the American Heart Assocation, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention.

    Science.gov (United States)

    Rihal, Charanjit S; Naidu, Srihari S; Givertz, Michael M; Szeto, Wilson Y; Burke, James A; Kapur, Navin K; Kern, Morton; Garratt, Kirk N; Goldstein, James A; Dimas, Vivian; Tu, Thomas

    2015-05-19

    Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines. Copyright © 2015 The Society for Cardiovascular Angiography and Interventions, The American College of Cardiology Foundation, The Heart Failure Society of America, and The Society for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  12. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie D'intervention).

    Science.gov (United States)

    Rihal, Charanjit S; Naidu, Srihari S; Givertz, Michael M; Szeto, Wilson Y; Burke, James A; Kapur, Navin K; Kern, Morton; Garratt, Kirk N; Goldstein, James A; Dimas, Vivian; Tu, Thomas

    2015-06-01

    Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella®; left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines. © 2015 by The Society for Cardiovascular Angiography and Interventions, The American College of Cardiology Foundation, The Heart Failure Society of America, and The Society for Thoracic Surgery.

  13. A Neutrophil Phenotype Model for Extracorporeal Treatment of Sepsis.

    Directory of Open Access Journals (Sweden)

    Alexander D Malkin

    2015-10-01

    Full Text Available Neutrophils play a central role in eliminating bacterial pathogens, but may also contribute to end-organ damage in sepsis. Interleukin-8 (IL-8, a key modulator of neutrophil function, signals through neutrophil specific surface receptors CXCR-1 and CXCR-2. In this study a mechanistic computational model was used to evaluate and deploy an extracorporeal sepsis treatment which modulates CXCR-1/2 levels. First, a simplified mechanistic computational model of IL-8 mediated activation of CXCR-1/2 receptors was developed, containing 16 ODEs and 43 parameters. Receptor level dynamics and systemic parameters were coupled with multiple neutrophil phenotypes to generate dynamic populations of activated neutrophils which reduce pathogen load, and/or primed neutrophils which cause adverse tissue damage when misdirected. The mathematical model was calibrated using experimental data from baboons administered a two-hour infusion of E coli and followed for a maximum of 28 days. Ensembles of parameters were generated using a Bayesian parallel tempering approach to produce model fits that could recreate experimental outcomes. Stepwise logistic regression identified seven model parameters as key determinants of mortality. Sensitivity analysis showed that parameters controlling the level of killer cell neutrophils affected the overall systemic damage of individuals. To evaluate rescue strategies and provide probabilistic predictions of their impact on mortality, time of onset, duration, and capture efficacy of an extracorporeal device that modulated neutrophil phenotype were explored. Our findings suggest that interventions aiming to modulate phenotypic composition are time sensitive. When introduced between 3-6 hours of infection for a 72 hour duration, the survivor population increased from 31% to 40-80%. Treatment efficacy quickly diminishes if not introduced within 15 hours of infection. Significant harm is possible with treatment durations ranging from 5

  14. Knee joint angle of intracerebral hemorrhage-induced rats after extracorporeal shock wave therapy

    OpenAIRE

    Lee, Jung-Ho

    2016-01-01

    [Purpose] The purpose of this study was to investigate the impact on rat knee joints of extracorporeal shock wave therapy after experimentally induced intracerebral hemorrhage. [Subjects and Methods] Sprague-Dawley (SD) rats were divided into an experimental group that received extracorporeal shock wave therapy after central nervous system injury (n=10) and a control group that did not receive any therapeutic intervention after central nervous system injury (n=10). The Dartfish program was us...

  15. Can cellulite be treated with low-energy extracorporeal shock wave therapy?

    OpenAIRE

    Angehrn, Fiorenzo; Kuhn, Christoph; Voss, Axel

    2007-01-01

    Fiorenzo Angehrn1, Christoph Kuhn1, Axel Voss21Klinik Piano, Gottstattstrasse 24, Biel, Switzerland; 2SwiTech Medical AG, Kreuzlingen, SwitzerlandAbstract: The present study investigates the effects of low-energy defocused extracorporeal generated shock waves on collagen structure of cellulite afflicted skin. Cellulite measurement using high-resolution ultrasound technology was performed before and after low-energy defocused extracorporeal shock wave therapy (ESWT) in 21 female subjects. ESWT...

  16. Respiratory Dialysis: Reduction in Dependence on Mechanical Ventilation by Venovenous Extracorporeal CO2 Removal

    Science.gov (United States)

    2011-06-01

    Respiratory dialysis : Reduction in dependence on mechanical ventilation by venovenous extracorporeal CO2 removal* Andriy I. Batchinsky, MD; Bryan S...clinical practice been implemented in a variable fashion (19–24). An alternate approach to treating acute respiratory insufficiency , for avoid- ing...ventilator-induced lung injury, and for achieving “lung rest,” is to perform gas exchange via an extracorporeal device (25–31). Such “respiratory dialysis

  17. Experience and needs of family members of patients treated with extracorporeal membrane oxygenation.

    Science.gov (United States)

    Tramm, Ralph; Ilic, Dragan; Murphy, Kerry; Sheldrake, Jayne; Pellegrino, Vincent; Hodgson, Carol

    2017-06-01

    To explore the experiences of family members of patients treated with extracorporeal membrane oxygenation. Sudden onset of an unexpected and severe illness is associated with an increased stress experience of family members. Only one study to date has explored the experience of family members of patients who are at high risk of dying and treated with extracorporeal membrane oxygenation. A qualitative descriptive research design was used. A total of 10 family members of patients treated with extracorporeal membrane oxygenation were recruited through a convenient sampling approach. Data were collected using open-ended semi-structured interviews. A six-step process was applied to analyse the data thematically. Four criteria were employed to evaluate methodological rigour. Family members of extracorporeal membrane oxygenation patients experienced psychological distress and strain during and after admission. Five main themes (Going Downhill, Intensive Care Unit Stress and Stressors, Carousel of Roles, Today and Advice) were identified. These themes were explored from the four roles of the Carousel of Roles theme (decision-maker, carer, manager and recorder) that participants experienced. Nurses and other staff involved in the care of extracorporeal membrane oxygenation patients must pay attention to individual needs of the family and activate all available support systems to help them cope with stress and strain. An information and recommendation guide for families and staff caring for extracorporeal membrane oxygenation patients was developed and needs to be applied cautiously to the individual clinical setting. © 2016 John Wiley & Sons Ltd.

  18. Combination of continuous renal replacement therapies (CRRT) and extracorporeal membrane oxygenation (ECMO) for advanced cardiac patients.

    Science.gov (United States)

    Yap, Hon-Jek; Chen, Yung-Chang; Fang, Ji-Tseng; Huang, Chiu-Ching

    2003-03-01

    The critically ill patients may require mechanical ventilation, cardiac mechanical support, and other types of critical support. Extracorporeal membrane oxygenation (ECMO) is a supportive therapy, which provides good cardiopulmonary and end-organ support. Continuous renal replacement therapies (CRRT) exhibit important advantages in terms of clinical tolerance and blood purification. This investigation aims to evaluate the acute renal failure in cardiac patients under ECMO, and assess the effect of combining these two technologies, ECMO and CRRT. Between December 1998 and June 2001, 10 adult cardiac patients were treated on ECMO. Five of them were treated with both ECMO and CRRT. The clinical outcomes were retrospectively analyzed. Of the 10 patients studied, five were men and five were women. The mean age of survivors and non-survivors was 37.00 +/- 14.54 years and 46.17 +/- 7.41 years, respectively. The overall mortality rate was 60%. Survivors did not differ significantly from non-survivors in age or gender. The APACHE II scores on the first day of ECMO support between survival and non-survival were 19.00 +/- 9.38 and 24.67 +/- 3.50 (P value = 0.392) (Table 2), which demonstrates no significant differences too. The cause of death in most patients was related to organ system failure during the 24 h immediately before ECMO started. Five patients with acute renal failure treated by CRRT were eventually died. The median and mean survival in this group on CRRT was 40.50 +/- 18.07 h and 92.60 +/- 60.50 h. We conclude that mortality rate for acute renal failure in cardiac patients under ECMO continues to be high. Our data suggest that acute renal failure is generally a part of multiorgan failure. This unique form of acute renal failure, causes generalized edema and fluid overload despite still low serum creatinine and azotemia, and deteriorates rapidly to death. From this study shows, advanced cardiac failure may need more aggressive and early initiation of ECMO support

  19. The effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis

    OpenAIRE

    Lee, Ji-Hyun; Lee, Sangyong; Choi, SeokJoo; Choi, Yoon-Hee; Lee, Kwansub

    2017-01-01

    [Purpose] The purpose of this study was to identify the effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis. [Subjects and Methods] Twenty patients with degenerative knee arthritis were divided into a conservative physical therapy group (n=10) and an extracorporeal shock wave therapy group (n=10). Both groups received general conservative physical therapy, and the extracorporeal shock wave therapy was additionally treated with ext...

  20. The use of extracorporeal life support in adolescent amlodipine overdose.

    Science.gov (United States)

    Persad, Elizabeth A; Raman, Lakshmi; Thompson, Marita T; Sheeran, Paul W

    2012-10-01

    Calcium channel blocker (CCB) toxicity is associated with refractory hypotension and can be fatal. A 13 year old young woman presented to the emergency department(ED) six hours after an intentional overdose of amlodipine, barbiturates, and alcohol. She remained extremely hypotensive despite the administration of normal saline and calcium chloride and despite infusions of norepinephrine, epinephrine, insulin, and dextrose. Due to increasing evidence of end organ dysfunction, Extracorporeal Life Support (ECLS) was initiated 9 hours after presentation to the ED. The patient's blood pressure and end organ function immediately improved after cannulation. She was successfully decannulated after 57 hours of ECLS and was neurologically intact. Patients with calcium channel blocker overdose who are resistant to medical interventions may respond favorably to early ECLS.

  1. Extracorporeal shock wave therapy in periodontics: A new paradigm

    Science.gov (United States)

    Venkatesh Prabhuji, Munivenkatappa Lakshmaiah; Khaleelahmed, Shaeesta; Vasudevalu, Sujatha; Vinodhini, K.

    2014-01-01

    The quest for exploring new frontiers in the field of medical science for efficient and improved treatment modalities has always been on a rise. Extracorporeal shock wave therapy (ESWT) has been enormously used in medical practice, principally, for the management of urolithiasis, cholelithiasis and also in various orthopedic and musculoskeletal disorders. The efficacy of ESWT in the stimulation of osteoblasts, fibroblasts, induction of neovascularization and increased expression of bone morphogenic proteins has been well documented in the literature. However, dentistry is no exception to this trend. The present article enlightens the various applications of ESWT in the field of dentistry and explores its prospective applications in the field of periodontics, and the possibility of incorporating the beneficial properties of shock waves in improving the treatment outcome. PMID:25024562

  2. Effect of extracorporeal ultraviolet blood irradiation on blood cholesterol level

    Science.gov (United States)

    Zalesskaya, G. A.; Laskina, O. V.; Mitkovskaya, N. P.; Kirkovsky, V. V.

    2012-07-01

    We have studied the effect of extracorporeal ultraviolet blood irradiation on cholesterol metabolism in patients with cardiovascular diseases. We have carried out a comprehensive analysis of the spectral characteristics of blood and plasma, gas-exchange and oximetry parameters, and the results of a complete blood count and chemistry panel before and after UV blood irradiation. We have assessed the changes in concentrations of cholesterols (total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides) in the blood of the patients in response to a five-day course of UV blood irradiation. The changes in the spectral characteristics of blood and plasma, the chemistry panel, the gas composition, and the fractional hemoglobin composition initiated by absorption of UV radiation are used to discuss the molecular mechanisms for the effect of therapeutic doses of UV radiation on blood cholesterols.

  3. The use of extracorporeal life support in adolescent amlodipine overdose

    Science.gov (United States)

    Persad, Elizabeth A.; Raman, Lakshmi; Thompson, Marita T.; Sheeran, Paul W.

    2012-01-01

    Calcium channel blocker (CCB) toxicity is associated with refractory hypotension and can be fatal. A 13 year old young woman presented to the emergency department(ED) six hours after an intentional overdose of amlodipine, barbiturates, and alcohol. She remained extremely hypotensive despite the administration of normal saline and calcium chloride and despite infusions of norepinephrine, epinephrine, insulin, and dextrose. Due to increasing evidence of end organ dysfunction, Extracorporeal Life Support (ECLS) was initiated 9 hours after presentation to the ED. The patient's blood pressure and end organ function immediately improved after cannulation. She was successfully decannulated after 57 hours of ECLS and was neurologically intact. Patients with calcium channel blocker overdose who are resistant to medical interventions may respond favorably to early ECLS. PMID:23559727

  4. Extracorporeal shock wave therapy in periodontics: A new paradigm

    Directory of Open Access Journals (Sweden)

    Munivenkatappa Lakshmaiah Venkatesh Prabhuji

    2014-01-01

    Full Text Available The quest for exploring new frontiers in the field of medical science for efficient and improved treatment modalities has always been on a rise. Extracorporeal shock wave therapy (ESWT has been enormously used in medical practice, principally, for the management of urolithiasis, cholelithiasis and also in various orthopedic and musculoskeletal disorders. The efficacy of ESWT in the stimulation of osteoblasts, fibroblasts, induction of neovascularization and increased expression of bone morphogenic proteins has been well documented in the literature. However, dentistry is no exception to this trend. The present article enlightens the various applications of ESWT in the field of dentistry and explores its prospective applications in the field of periodontics, and the possibility of incorporating the beneficial properties of shock waves in improving the treatment outcome.

  5. Stenting and extracorporeal shock wave lithotripsy in chronic pancreatitis

    DEFF Research Database (Denmark)

    Holm, M; Matzen, Peter

    2003-01-01

    BACKGROUND: Early observational studies of endoscopic treatment and extracorporeal shock wave lithotripsy (ESWL) reported considerable or complete relief of pain in 50%-80% of patients with chronic pancreatitis. There is no consensus on the measurement of pain, making comparison of observational...... studies difficult, and little attention has been paid to the type and amount of analgesics used by patients before and after decompressive treatment. METHODS: We performed a retrospective study of all patients with chronic pancreatitis and large-duct disease and receiving decompressing treatment between 1...... November 1994 and 31 July 1999. Primary parameters were type and amount of analgesics used. RESULTS: Forty-nine patients with chronic pancreatitis and large-duct disease received stenting of the pancreatic duct (28 patients), ESWL (6 patients) or both (15 patients). After a median follow-up of 21 months...

  6. Extracorporeal shockwave therapy for shoulder lameness in dogs.

    Science.gov (United States)

    Becker, Willem; Kowaleski, Michael P; McCarthy, Robert J; Blake, Cara A

    2015-01-01

    The purpose of this article was to describe the outcome of dogs with instability, calcifying, and inflammatory conditions of the shoulder treated with extracorporeal shockwave therapy (ESWT). Medical records for 15 dogs with lameness attributable to the shoulder that failed previous conservative management were retrospectively reviewed. ESWT was delivered to those dogs q 3-4 wk for a total of three treatments. Short-term, in-hospital subjective lameness evaluation revealed resolution of lameness in three of nine dogs and improved lameness in six of nine dogs available for evaluation 3-4 wk following the final treatment. Long-term lameness score via telephone interview was either improved or normal in 7 of 11 dogs (64%). ESWT may result in improved function based on subjective patient evaluation and did not have any negative side effects in dogs with lameness attributable to instability, calcifying, and inflammatory conditions of the shoulder.

  7. Extracorporal hemodialysis with acute or decompensated chronical hepatic failure

    Science.gov (United States)

    Hessel, Franz; Grabein, Kristin; Schnell-Inderst, Petra; Siebert, Uwe; Caspary, Wolfgang; Wasem, Jürgen

    2006-01-01

    Background Conventional diagnostic procedures and therapy of acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) focus on to identify triggering events of the acute deterioration of the liver function and to avoid them. Further objectives are to prevent the development respectively the progression of secondary organ dysfunctions or organ failure. Most of the times the endocrinological function of the liver can to a wide extent be compensated, but the removal of toxins can only marginally be substituted by conventional conservative therapy. To improve this component of the liver function is the main objective of extracorporal liver support systems. The following principles of liver support systems can be differentiated: Artificial systems, bioartifical systems and extracorporal liver perfusion systems. This HTA report focuses on artificial systems (e.g. BioLogic-DT/-DTPF, MARS, Prometheus), because only these approaches currently are relevant in the German health care system. In 2004 a category "Extracorporal liver assist device" was introduced in the list of "additional payments" in the German DRG-system, which makes reimbursement for hospitals using the technology in inpatient care possible, based on an hospital's individual contract with statutory sickness funds. Objectives To report the present evidence and future research need on medical efficacy and economic effectiveness of extracorporal liver support devices for treatment of patients with ALF or ACLF based on published literature data. Are artificial liver support systems efficient and effective in the treatment of ALF or ACLF? Methods An extensive, systematic literature search in medical, economic, and HTA literature data bases was performed. Relevant data were extracted and synthesised. Results Relevant controlled trials were detected for BioLogic-DT and MARS. No randomised controlled trial on Prometheus was found. None of the included studies on BioLogic-DT showed advantages of the

  8. 7 CFR 205.290 - Temporary variances.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false Temporary variances. 205.290 Section 205.290 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) ORGANIC FOODS PRODUCTION ACT PROVISIONS NATIONAL ORGANIC PROGRAM Organic...

  9. Temporary Tattoos and Henna/Mehndi

    Science.gov (United States)

    ... For example, we can issue Import Alerts and Warning Letters. An Import Alert allows FDA to detain products that violate or ... Awareness of Safety: FDA Webinar, May 13, 2014 Warning Letter Issued to Black Henna Ink, Inc. Import Alert #53-14: Intensified Coverage of Temporary Tattoos Containing ...

  10. Closing a temporary ileostomy within two weeks

    DEFF Research Database (Denmark)

    Hindenburg, Tommy; Rosenberg, J.

    2010-01-01

    Temporary ileostomy is frequently constructed to relieve a rectal anastomosis and avoid peritonitis if the anastomosis is leaking. Ostomy is a burden for both the patient and society and early closure is therefore desirable to counteract increased morbidity. Several prospective studies and a sing...

  11. Temporary tattoos: a novel OSCE assessment tool.

    Science.gov (United States)

    Gormley, Gerry; Menary, Allison; Layard, Brooke; Hart, Nigel; McCourt, Collette

    2013-08-01

    There are many issues regarding the use of real patients in objective structured clinical examinations (OSCEs). In dermatology OSCE stations, standardised patients (SPs) with clinical photographs are often used. Temporary transfer tattoos can potentially simulate skin lesions when applied to an SP. This study aims to appraise the use of temporary malignant melanoma tattoos within an OSCE framework. Within an 11-station OSCE, a temporary malignant melanoma tattoo was developed and applied to SPs in a 'skin lesion' OSCE station. A questionnaire captured the opinions of the candidate, SP and examiners, and the degree of perceived realism of each station was determined. Standard post hoc OSCE analysis determined the psychometric reliability of the stations. The response rates were 95.9 per cent of candidates and 100 per cent of the examiners and SPs. The 'skin lesion' station achieved the highest realism score compared with other stations: 89.0 per cent of candidates felt that the skin lesion appeared realistic; only 28 per cent of candidates had ever seen a melanoma before in training. The psychometric performance of the melanoma station was comparable with, and in many instances better than, other OSCE stations. Transfer tattoo technology facilitates a realistic dermatology OSCE station encounter. Temporary tattoos, alongside trained SPs, provide an authentic, standardised and reliable experience, allowing the assessment of integrated dermatology clinical skills. © 2013 John Wiley & Sons Ltd.

  12. Closing a temporary ileostomy within two weeks

    DEFF Research Database (Denmark)

    Hindenburg, Tommy; Rosenberg, J.

    2010-01-01

    Temporary ileostomy is frequently constructed to relieve a rectal anastomosis and avoid peritonitis if the anastomosis is leaking. Ostomy is a burden for both the patient and society and early closure is therefore desirable to counteract increased morbidity. Several prospective studies and a single...

  13. 40 CFR 180.31 - Temporary tolerances.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Temporary tolerances. 180.31 Section 180.31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS... period designed to allow the orderly marketing of the raw agricultural commodities produced while testing...

  14. Temporary Chinese Migration to Madagascar: Local Perceptions ...

    African Journals Online (AJOL)

    This article fills a knowledge-gap in the literature on China in Africa by exploring local perceptions of temporary Chinese migrants in Madagascar, the growth of small-scale Chinese-owned import and retail businesses in the capital, and their impacts on Malagasy producers, utilizing the country's blanket and paper industries ...

  15. Temporary Chinese Migration to Madagascar: Local Perceptions ...

    African Journals Online (AJOL)

    However, as public debate over their impact in Madagascar intensifies, the temporary Chinese migrant ... economic and political engagement of the continent. Following the .... all focus on either the earlier waves of migration or on the relations between the resident Chinese community and the new migrants. Notable ...

  16. 47 CFR 74.537 - Temporary authorizations.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 4 2010-10-01 2010-10-01 false Temporary authorizations. 74.537 Section 74.537 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES EXPERIMENTAL RADIO.... However, in the case of events of widespread interest and importance which cannot be transmitted...

  17. 47 CFR 74.633 - Temporary authorizations.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 4 2010-10-01 2010-10-01 false Temporary authorizations. 74.633 Section 74.633 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES EXPERIMENTAL RADIO... wide-spread interest and importance which cannot be transmitted successfully on these frequencies...

  18. 47 CFR 74.833 - Temporary authorizations.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 4 2010-10-01 2010-10-01 false Temporary authorizations. 74.833 Section 74.833 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES EXPERIMENTAL RADIO... interest and importance which cannot be transmitted successfully on these frequencies, frequencies assigned...

  19. 47 CFR 74.433 - Temporary authorizations.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 4 2010-10-01 2010-10-01 false Temporary authorizations. 74.433 Section 74.433 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES EXPERIMENTAL RADIO... of events of wide-spread interest and importance which cannot be transmitted successfully on these...

  20. Survival and neurocognitive outcomes in pediatric extracorporeal-cardiopulmonary resuscitation.

    Science.gov (United States)

    Garcia Guerra, Gonzalo; Zorzela, Liliane; Robertson, Charlene M T; Alton, Gwen Y; Joffe, Ari R; Moez, Elham Khodayari; Dinu, Irina A; Ross, David B; Rebeyka, Ivan M; Lequier, Laurance

    2015-11-01

    Extracorporeal Cardiopulmonary Resuscitation (E-CPR) is the initiation of extracorporeal life support during active chest compressions. There are no studies describing detailed neurocognitive outcomes of this population. We aim to describe the survival and neurocognitive outcomes of children who received E-CPR. Prospective cohort study. Children who received E-CPR at the Stollery Children's Hospital between 2000 and 2010 were included. Neurocognitive follow-up, including Wechsler Preschool and Primary Scales of Intelligence, was completed at the age of 4.5 years, and at a minimum of 6 months after the E-CPR admission. Fifty-five patients received E-CPR between 2000 and 2010. Children with cardiac disease had a 49% survival to hospital discharge and 43% survival at age 5-years, with no survivors (n=4) in those with non-cardiac disease. Pediatric E-CPR survivors had a mean (SD) Full Scale Intelligence quotient (FSIQ) score of 76.5 (15.9); with 4 children (24%) having intellectual disability (defined as FSIQ over 2 standard deviations below the population mean; i.e., CPR, open chest CPR, longer duration of CPR, low pH and more red blood cells given on the first day of ECMO, and longer time for lactate to normalize on ECMO were associated with higher mortality at age 5-years. Pediatric patients with cardiac disease who required E-CPR had 43% survival at age 5 years. Of concern, the intelligence quotient in E-CPR survivors was significantly lower than the population mean, with 24% having intellectual disability. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Branded prescription drug fee. Final regulations, temporary regulations, and removal of temporary regulations.

    Science.gov (United States)

    2014-07-28

    This document contains final regulations that provide guidance on the annual fee imposed on covered entities engaged in the business of manufacturing or importing branded prescription drugs. This fee was enacted by section 9008 of the Patient Protection and Affordable Care Act, as amended by section 1404 of the Health Care and Education Reconciliation Act of 2010. This document also withdraws the Branded Prescription Drug Fee temporary regulations and contains new temporary regulations regarding the definition of controlled group that apply beginning on January 1, 2015. The final regulations and the new temporary regulations affect persons engaged in the business of manufacturing or importing certain branded prescription drugs. The text of the temporary regulations in this document also serves as the text of proposed regulations set forth in a notice of proposed rulemaking (REG-123286-14) on this subject in the Proposed Rules section in this issue of the Federal Register.

  2. Fate of patients with extracorporeal lung assist as a bridge to lung transplantation versus patients without--a single-center experience.

    Science.gov (United States)

    Lehmann, S; Uhlemann, M; Leontyev, S; Meyer, A; Garbade, J; Seeburger, J; Laflamme, M; Bittner, H B; Mohr, F W

    2015-03-01

    Mechanical lung assist (MLA; extracorporeal membrane oxygenation (ECMO) or extracorporeal lung assist (ECLA)) is increasingly used as a temporary bridge to lung transplantation (LTx). This study was designed to evaluate the impact of preoperative MLA on the operative outcome, including longer-term survival, in comparison to patients undergoing LTx without preoperative MLA. A total of 143 patients underwent LTx at our institution from 2002 to 2011. Forty-three percent (n=62) of patients presented with idiopathic pulmonary fibrosis and 71% (n=102) presented with severely elevated pulmonary artery pressure. Thirteen patients (9.1%) required pre-LTx MLA support (age 44 ±13 years, double LTx 73.3%, female gender 53%) whereas 130 patients did not (age 52 ±11 years, double LTx 41.5%, female gender 36.9%). In one patient, MLA was successfully weaned and the patient underwent subsequent LTx. All patients in the MLA group were intraoperatively supported with continuous ECMO. One patient had to be supported with MLA after LTx for a period of 8 days. The short-term and mid-term postoperative survival of the MLA patient group was not significantly different from the non-MLA group (LogRank p=0.28). The 30-day, 90-day and 1-year survivals were 95%, 90% and 71%, respectively, in the patients without MLA compared to 85%, 77% and 68% in the MLA group. MLA has no impact on long-term survival rate in LTx patients, but has an influence in postoperative survival. MLA support is a valuable tool to bridge unstable patients to LTx. © The Author(s) 2014.

  3. Relationships between alumina and bauxite dust exposure and cancer, respiratory and circulatory disease

    NARCIS (Netherlands)

    Friesen, M. C.; Fritschi, L.; del Monaco, A.; Benke, G.; Dennekamp, M.; de Klerk, N.; Hoving, J. L.; MacFarlane, E.; Sim, M. R.

    2009-01-01

    OBJECTIVES: To examine the associations between alumina and bauxite dust exposure and cancer incidence and circulatory and respiratory disease mortality among bauxite miners and alumina refinery workers. METHODS: This cohort of 5770 males has previously been linked to national mortality and national

  4. Pulsatile iVAC 2L circulatory support in high-risk percutaneous coronary intervention

    NARCIS (Netherlands)

    Uil, C.A.D. (Corstiaan A. Den); J. Daemen (Joost); M.J. Lenzen (Mattie); A.M. Maugenest; Joziasse, L. (Linda); R.J.M. van Geuns (Robert Jan); N.M. van Mieghem (Nicolas)

    2017-01-01

    textabstractAims: Our aim was to test the feasibility and safety of the transfemoral PulseCath iVAC 2L (PulseCath, Amsterdam, The Netherlands). Methods and results: Circulatory support devices are helpful adjunctive tools to perform high-risk percutaneous coronary interventions (PCI). The PulseCath

  5. Long-term Effects of Pediatric Burns on the Circulatory System

    National Research Council Canada - National Science Library

    Duke, Janine M; Randall, Sean M; Fear, Mark W; Boyd, James H; Rea, Suzanne; Wood, Fiona M

    2015-01-01

    .... However, it is not clear if these changes lead to long-term effects on the heart. The aim of this study was to assess whether pediatric burn injury is associated with increased long-term hospital use for circulatory diseases...

  6. Long-term results after transplantation of pediatric liver grafts from donation after circulatory death donors

    NARCIS (Netherlands)

    van Rijn, Rianne; Hoogland, Pieter E. R.; Lehner, Frank; van Heurn, Ernest L. W.; Porte, Robert J.

    2017-01-01

    Background Liver grafts from donation after circulatory death (DCD) donors are increasingly accepted as an extension of the organ pool for transplantation. There is little data on the outcome of liver transplantation with DCD grafts from a pediatric donor. The objective of this study was to assess

  7. From Head to Toe: Respiratory, Circulatory, and Skeletal Systems. Book 3.

    Science.gov (United States)

    Wiebe, Arthur, Ed.; And Others

    Designed to supplement curricular programs dealing with the human body, this booklet offers an activity-based, student-oriented approach for middle school teachers and students. Twelve activities focus on principles and skills related to the respiratory, circulatory, and skeletal systems. Each activity consists of student sheets and a teacher's…

  8. Pancreas transplantation with grafts from donors deceased after circulatory death (DCD) : 5 years single center experience

    NARCIS (Netherlands)

    Kopp, Wouter H; Lam, Hwai-Ding; Schaapherder, Alexander F M; Huurman, Volkert A L; van der Boog, Paul; de Koning, Eelco; de Fijter, Johan W; Baranski, Andrzej; Braat, Andries E

    2017-01-01

    INTRODUCTION: Donation after circulatory death (DCD) pancreas transplantation has been shown to be an additional way to deal with donor organ shortages. The results of 5-year DCD pancreas transplantation are presented. METHODS: A retrospective, single center analysis (2011 - 2015) was performed to

  9. Dual hypothermic oxygenated machine perfusion in liver transplants donated after circulatory death

    NARCIS (Netherlands)

    van Rijn, R.; Karimian, N.; Matton, A. P. M.; Burlage, L. C.; Westerkamp, A. C.; van den Berg, A. P.; de Kleine, R. H. J.; de Boer, M. T.; Lisman, T.; Porte, R. J.

    Background: Experimental studies have suggested that end-ischaemic dual hypothermic oxygenated machine perfusion (DHOPE) may restore hepatocellular energy status and reduce reperfusion injury in donation after circulatory death (DCD) liver grafts. The aim of this prospective case-control study was

  10. Improved Outcome of Cardiac Extracorporeal Membrane Oxygenation in Infants and Children Using Magnetic Levitation Centrifugal Pumps.

    Science.gov (United States)

    Luciani, Giovanni Battista; Hoxha, Stiljan; Torre, Salvatore; Rungatscher, Alessio; Menon, Tiziano; Barozzi, Luca; Faggian, Giuseppe

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) has traditionally been and, for the most part, still is being performed using roller pumps. Use of first-generation centrifugal pumps has yielded controversial outcomes, perhaps due to mechanical properties of the same and the ensuing risk of hemolysis and renal morbidity. Latest-generation centrifugal pumps, using magnetic levitation (ML), exhibit mechanical properties which may have overcome limitations of first-generation devices. This retrospective study aimed to assess the safety and efficacy of veno-arterial (V-A) ECMO for cardiac indications in neonates, infants, and children, using standard (SP) and latest-generation ML centrifugal pumps. Between 2002 and 2014, 33 consecutive neonates, infants, and young children were supported using V-A ECMO for cardiac indications. There were 21 males and 12 females, with median age of 29 days (4 days-5 years) and a median body weight of 3.2 kg (1.9-18 kg). Indication for V-A ECMO were acute circulatory collapse in ICU or ward after cardiac repair in 16 (49%) patients, failure to wean after repair of complex congenital heart disease in 9 (27%), fulminant myocarditis in 4 (12%), preoperative sepsis in 2 (6%), and refractory tachy-arrhythmias in 2 (6%). Central cannulation was used in 27 (81%) patients and peripheral in 6. Seven (21%) patients were supported with SP and 26 (79%) with ML centrifugal pumps. Median duration of support was 82 h (range 24-672 h), with 26 (79%) patients weaned from support. Three patients required a second ECMO run but died on support. Seventeen (51%) patients required peritoneal dialysis for acute renal failure. Overall survival to discharge was 39% (13/33 patients). All patients with fulminant myocarditis and with refractory arrhythmias were weaned, and five (83%) survived, whereas no patient supported for sepsis survived. Risk factors for hospital mortality included lower (<2.5 kg) body weight (P = 0.02) and rescue ECMO after cardiac

  11. Canadian Guidelines for Controlled Pediatric Donation After Circulatory Determination of Death-Summary Report.

    Science.gov (United States)

    Weiss, Matthew J; Hornby, Laura; Rochwerg, Bram; van Manen, Michael; Dhanani, Sonny; Sivarajan, V Ben; Appleby, Amber; Bennett, Mary; Buchman, Daniel; Farrell, Catherine; Goldberg, Aviva; Greenberg, Rebecca; Singh, Ram; Nakagawa, Thomas A; Witteman, William; Barter, Jill; Beck, Allon; Coughlin, Kevin; Conradi, Alf; Cupido, Cynthia; Dawson, Rosanne; Dipchand, Anne; Freed, Darren; Hornby, Karen; Langlois, Valerie; Mack, Cheryl; Mahoney, Meagan; Manhas, Deepak; Tomlinson, Christopher; Zavalkoff, Samara; Shemie, Sam D

    2017-11-01

    Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada. We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions requiring recommendations were generated based on 1) 2006 Canadian donation after circulatory determination of death guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pediatric donation after circulatory determination of death leaders, and 3) a scoping review of the pediatric donation after circulatory determination of death literature. Input from these sources drove drafting of actionable questions and Good Practice Statements, as defined by the Grading of Recommendations Assessment, Development, and Evaluation group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using Grading of Recommendations Assessment, Development, and Evaluation and then formulated into evidence profiles that informed recommendations through the evidence-to-decision framework. Recommendations were revised through consensus among members of seven topic-specific working groups and finalized during meetings of working group leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies and patient partners. We generated 63 Good Practice Statements and seven Grading of Recommendations Assessment, Development, and Evaluation recommendations covering 1) ethics, consent, and withdrawal of life-sustaining therapy, 2) eligibility, 3) withdrawal of life-sustaining therapy practices, 4) ante and postmortem interventions, 5) death determination, 6) neonatal pediatric donation after circulatory

  12. Canadian Guidelines for Controlled Pediatric Donation After Circulatory Determination of Death—Summary Report*

    Science.gov (United States)

    Hornby, Laura; Rochwerg, Bram; van Manen, Michael; Dhanani, ; Sonny; Sivarajan, V. Ben; Appleby, Amber; Bennett, Mary; Buchman, Daniel; Farrell, Catherine; Goldberg, Aviva; Greenberg, Rebecca; Singh, Ram; Nakagawa, Thomas A.; Witteman, William; Barter, Jill; Beck, Allon; Coughlin, Kevin; Conradi, Alf; Cupido, Cynthia; Dawson, Rosanne; Dipchand, Anne; Freed, Darren; Hornby, Karen; Langlois, Valerie; Mack, Cheryl; Mahoney, Meagan; Manhas, Deepak; Tomlinson, Christopher; Zavalkoff, Samara; Shemie, Sam D.

    2017-01-01

    Objectives: Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada. Methods: We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions requiring recommendations were generated based on 1) 2006 Canadian donation after circulatory determination of death guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pediatric donation after circulatory determination of death leaders, and 3) a scoping review of the pediatric donation after circulatory determination of death literature. Input from these sources drove drafting of actionable questions and Good Practice Statements, as defined by the Grading of Recommendations Assessment, Development, and Evaluation group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using Grading of Recommendations Assessment, Development, and Evaluation and then formulated into evidence profiles that informed recommendations through the evidence-to-decision framework. Recommendations were revised through consensus among members of seven topic-specific working groups and finalized during meetings of working group leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies and patient partners. Results: We generated 63 Good Practice Statements and seven Grading of Recommendations Assessment, Development, and Evaluation recommendations covering 1) ethics, consent, and withdrawal of life-sustaining therapy, 2) eligibility, 3) withdrawal of life-sustaining therapy practices, 4) ante and postmortem interventions, 5) death determination, 6) neonatal pediatric donation

  13. Temporary Employment and Perceived Employability: Mediation by Impression Management

    Science.gov (United States)

    De Cuyper, Nele; De Witte, Hans

    2010-01-01

    Perceived employability (PE) has been advanced as the upcoming resource for career development, particularly for temporary workers. The question is how temporary workers become employable. Our hypothesis is that temporary workers more than permanent workers use impression management to become employable, both on the internal and the external labor…

  14. 30 CFR 47.44 - Temporary, portable containers.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Temporary, portable containers. 47.44 Section... TRAINING HAZARD COMMUNICATION (HazCom) Container Labels and Other Forms of Warning § 47.44 Temporary, portable containers. (a) The operator does not have to label a temporary, portable container if he or she...

  15. 21 CFR 872.3770 - Temporary crown and bridge resin.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Temporary crown and bridge resin. 872.3770 Section... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3770 Temporary crown and bridge resin. (a) Identification. A temporary crown and bridge resin is a device composed of a material, such as...

  16. Long-term Effects of Pediatric Burns on the Circulatory System.

    Science.gov (United States)

    Duke, Janine M; Randall, Sean M; Fear, Mark W; Boyd, James H; Rea, Suzanne; Wood, Fiona M

    2015-11-01

    The systemic responses to burns (in particular, elevated levels of catecholamines and stress hormones) have been shown to have an impact on cardiac function for at least 3 years in children with burns. However, it is not clear if these changes lead to long-term effects on the heart. The aim of this study was to assess whether pediatric burn injury is associated with increased long-term hospital use for circulatory diseases. A population-based longitudinal study was undertaken using linked hospital and death data from Western Australia for children younger than 15 years when hospitalized for a first burn injury (n = 10 436) in 1980-2012 and a frequency matched noninjury comparison cohort, randomly selected from Western Australia's birth registrations (n = 40 819). Crude admission rates and cumulative length of stay for circulatory diseases were calculated. Negative binomial and Cox proportional hazards regression modeling were used to generate incidence rate ratios and hazard ratios, respectively. After adjustment for demographic factors and preexisting health status, the burn cohort had 1.33 (incidence rate ratio) times (95% confidence interval [CI]: 1.08-1.64) as many circulatory system hospitalizations, 2.26 times the number of days in hospital with a diagnosis of a circulatory disease (2.26, 95% CI: 1.06-4.81), and were at a higher risk of incident admissions (hazard ratio 1.22, 95% CI: 1.03-1.46), compared with the uninjured cohort. Children who sustain burn injury experience elevated hospital admission rates and increased length of hospital stay for diseases of the circulatory system for a prolonged period of time after burn discharge. Copyright © 2015 by the American Academy of Pediatrics.

  17. Analysis of Dose Response for Circulatory Disease After Radiotherapy for Benign Disease

    Energy Technology Data Exchange (ETDEWEB)

    Little, Mark P., E-mail: mark.little@nih.gov [Radiation Epidemiology Branch, National Cancer Institute, Executive Plaza South, Rockville, Maryland (United States); Kleinerman, Ruth A. [Radiation Epidemiology Branch, National Cancer Institute, Executive Plaza South, Rockville, Maryland (United States); Stovall, Marilyn; Smith, Susan A. [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Mabuchi, Kiyohiko [Radiation Epidemiology Branch, National Cancer Institute, Executive Plaza South, Rockville, Maryland (United States)

    2012-12-01

    Purpose: To assess the shape of the dose-response for various circulatory disease endpoints, and modifiers by age and time since exposure. Methods and Materials: This was an analysis of the US peptic ulcer data testing for heterogeneity of radiogenic risk by circulatory disease endpoint (ischemic heart, cerebrovascular, other circulatory disease). Results: There were significant excess risks for all circulatory disease, with an excess relative risk Gy{sup -1} of 0.082 (95% CI 0.031-0.140), and ischemic heart disease, with an excess relative risk Gy{sup -1} of 0.102 (95% CI 0.039-0.174) (both p = 0.01), and indications of excess risk for stroke. There were no statistically significant (p > 0.2) differences between risks by endpoint, and few indications of curvature in the dose-response. There were significant (p < 0.001) modifications of relative risk by time since exposure, the magnitude of which did not vary between endpoints (p > 0.2). Risk modifications were similar if analysis was restricted to patients receiving radiation, although the relative risks were slightly larger and the risk of stroke failed to be significant. The slopes of the dose-response were generally consistent with those observed in the Japanese atomic bomb survivors and in occupationally and medically exposed groups. Conclusions: There were excess risks for a variety of circulatory diseases in this dataset, with significant modification of risk by time since exposure. The consistency of the dose-response slopes with those observed in radiotherapeutically treated groups at much higher dose, as well as in lower dose-exposed cohorts such as the Japanese atomic bomb survivors and nuclear workers, implies that there may be little sparing effect of fractionation of dose or low-dose-rate exposure.

  18. Prediction of potential for organ donation after circulatory death in neurocritical patients.

    Science.gov (United States)

    Xu, Guixing; Guo, Zhiyong; Liang, Wenhua; Xin, Erye; Liu, Bin; Xu, Ye; Luan, Zhongqin; Schroder, Paul Michael; Manyalich, Martí; Ko, Dicken Shiu-Chung; He, Xiaoshun

    2018-03-01

    The success or failure of donation after circulatory death depends largely on the functional warm ischemia time, which is closely related to the duration between withdrawal of life-sustaining treatment and circulatory arrest. However, a reliable predictive model for the duration is absent. We aimed to compare the performance of the Chinese Donation after Circulatory Death Nomogram (C-DCD-Nomogram) and 3 other tools in a cohort of potential donors. In this prospective, multicenter, observational study, data were obtained from 219 consecutive neurocritical patients in China. The patients were followed until circulatory death after withdrawal of life-sustaining treatment. The C-DCD-Nomogram performed well in predicting patient death within 30, 60, 120 and 240 minutes after withdrawal of life-sustaining treatment with c-statistics of 0.87, 0.88, 0.86 and 0.95, respectively. The DCD-N score was a poor predictor of death within 30, 60 and 240 minutes, with c-statistics of 0.63, 0.69 and 0.59, respectively, although it was able to predict patient death within 120 minutes, with a c-statistic of 0.73. Neither the University of Wisconsin DCD evaluation tool (UWDCD) nor the United Network for Organ Sharing (UNOS) criteria was able to predict patient death within 30, 60, 120 and 240 minutes after withdrawal of life-sustaining treatment (UWDCD tool: 0.48, 0.45, 0.49 and 0.57; UNOS criteria: 0.50, 0.53, 0.51 and 0.63). The C-DCD-Nomogram is superior to the other 3 tools for predicting death within a limited duration after withdrawal of life-sustaining treatment in Chinese neurocritical patients. Thus, it appears to be a reliable tool identifying potential donors after circulatory death. Copyright © 2018. Published by Elsevier Inc.

  19. An evolutionary treatment of the morphology and physiology of circulatory organs in insects.

    Science.gov (United States)

    Hertel, Wieland; Pass, Günther

    2002-11-01

    An overview from an evolutionary perspective is presented on the research of the past 2 decades on insect circulatory organs. Based on various functional morphology it is clear that the flow mode of the dorsal vessel ('heart') has changed during the evolution of hexapods. In all apterygotes and mayflies the flow is bidirectional. In most pterygote insects, however, it is unidirectional. In some endopterygote insects, the direction of the flow alternates. This is achieved by heartbeat reversal, which may have various physiological functions and is a derived condition that probably occurred several times during the course of insect evolution. Special attention is given to the hemolymph flow in body appendages. In ancestral hexapods, they are supplied by arteries, whereas circulation in appendages of higher insects is accomplished by accessory pulsatile organs. These auxiliary hearts are autonomous pumps and exhibit a great diversity in their functional morphology. They represent evolutionary innovations which evolved by recruitment of building blocks from various organ systems and were assembled into new functional units. Almost all pulsatile circulatory organs in insects investigated exhibit a myogenic automatism with a superimposed neuronal control. The neuroanatomy of insect circulatory organs has been investigated only in a small number of species but in considerable detail. Numerous potential peptidergic and a few aminergic mediators could be demonstrated by immunocytochemical and biochemical methods. The cardiotropic effectiveness of these mediators may vary among species and it can be stated that there is no uniform picture of the control of the various circulatory organs in insects. A possible explanation for the differences may lie in the different evolutionary origins of the muscular components. Furthermore, insect circulatory organs may represent important neurohemal releasing sites.

  20. 77 FR 71825 - Notice of Temporary Restriction of Vehicle Use and Temporary Closure to Tree Cutting and Wood...

    Science.gov (United States)

    2012-12-04

    ...: 14X1125] Notice of Temporary Restriction of Vehicle Use and Temporary Closure to Tree Cutting and Wood... harvesting and/or tree cutting on public land within the Topaz Ranch Estates (TRE) and Preacher fires burn... and a temporary closure to tree cutting and wood collecting on areas burned by the TRE and Preacher...

  1. Revised protocol of extracorporeal membrane oxygenation (ECMO) therapy in severe ARDS. Recommendations of the Veno-venous ECMO Expert Panel appointed in February 2016 by the national consultant on anesthesiology and intensive care.

    Science.gov (United States)

    Lango, Romuald; Szkulmowski, Zbigniew; Maciejewski, Dariusz; Sosnowski, Andrzej; Kusza, Krzysztof

    2017-01-01

    Extracorporeal Membrane Oxygenation (ECMO) has become well established technique of the treatment of severe acute respiratory failure (Veno-Venous ECMO) or circulatory failure (Veno-Arterial ECMO) which enables effective blood oxygenation and carbon dioxide removal for several weeks. Veno-Venous ECMO (V-V ECMO ) is a lifesaving treatment of patients in whom severe ARDS makes artificial lung ventilation unlikely to provide satisfactory blood oxygenation for preventing further vital organs damage and progression to death. The protocol below regards exclusively veno-venous ECMO treatment as a support for blood gas conditioning by means of extracorporeal circuit in adult patients with severe ARDS. V-V ECMO does not provide treatment for acutely and severely diseased lungs, but it enables patient to survive the critical phase of severe ARDS until recovery of lung function. Besides avoiding patients death from hypoxemia, this technique can also prevent further progression of the lung damage due to artificial ventilation. Recent experience of ECMO treatment since the outbreak of AH1N1 influenza pandemic in 2009, along with technical progress and advancement in understanding pathophysiology of ventilator-induced lung injury, have contributed to significant improvement of the results of ECMO treatment. Putative factors related to increased survival include patients retrieval after connecting them to ECMO, and less intensive anticoagulation protocols. The aim of presenting this revised protocol was to improve the effects of ECMO treatment in patients with severe ARDS, to enhance ECMO accessibility for patients who might possibly benefit from this treatment, to reduce time until patient's connection to ECMO, and to avoid ECMO treatment in futile cases. The authors believe that this protocol, based on recent papers and their own experience, can provide help and advice both for the centers which develop V-V ECMO program, and for doctors who will refer their patients for the

  2. National review of use of extracorporeal membrane oxygenation as respiratory support in thoracic surgery excluding lung transplantation.

    Science.gov (United States)

    Rinieri, Philippe; Peillon, Christophe; Bessou, Jean-Paul; Veber, Benoît; Falcoz, Pierre-Emmanuel; Melki, Jean; Baste, Jean-Marc

    2015-01-01

    Extracorporeal membrane oxygenation (ECMO) for respiratory support is increasingly used in intensive care units (ICU), but rarely during thoracic surgical procedures outside the transplantation setting. ECMO can be an alternative to cardiopulmonary bypass for major trachea-bronchial surgery and single-lung procedures without in-field ventilation. Our aim was to evaluate the intraoperative use of ECMO as respiratory support in thoracic surgery: benefits, indications and complications. This was a multicentre retrospective study (questionnaire) of use of ECMO as respiratory support during the thoracic surgical procedure. Lung transplantation and lung resection for tumour invading the great vessels and/or the left atrium were excluded, because they concern respiratory and circulatory support. From March 2009 to September 2012, 17 of the 34 centres in France applied ECMO within veno-venous (VV) (n=20) or veno-arterial (VA) (n=16) indications in 36 patients. Ten VA ECMO were performed with peripheral cannulation and 6 with central cannulation; all VV ECMO were achieved through peripheral cannulation. Group 1 (total respiratory support) was composed of 28 patients without mechanical ventilation, involving 23 tracheo-bronchial and 5 single-lung procedures. Group 2 (partial respiratory support) was made up of 5 patients with respiratory insufficiency. Group 3 was made up of 3 patients who underwent thoracic surgery in a setting of acute respiratory distress syndrome (ARDS) with preoperative ECMO. Mortality at 30 days in Groups 1, 2 and 3 was 7, 40 and 67%, respectively (PECMO was weaned intraoperatively or within 24 h in 75% of patients. In Group 2, ECMO was weaned in ICU over several days. In Group 1, 2 patients with VA support were converted to VV support for chronic respiratory indications. Bleeding was the major complication with 17% of patients requiring return to theatre for haemostasis. There were two cannulation-related complications (6%). VV or VA ECMO is a

  3. Benefit of extracorporeal membrane oxygenation in major burns after stun grenade explosion: Experience from a single military medical center.

    Science.gov (United States)

    Hsu, Po-Shun; Tsai, Yi-Ting; Lin, Chih-Yuan; Chen, Shyi-Gen; Dai, Niann-Tzyy; Chen, Cheng-Jung; Chen, Jia-Lin; Tsai, Chien-Sung

    2017-05-01

    Explosion injury is very common on the battlefield and is associated with major burn and inhalation injuries and subsequent high mortality and morbidity rates. Here we report six victims who suffered from explosion injuries caused by stun grenade; all were treated with extracorporeal membrane oxygenation (ECMO) as salvage therapy. This study was aimed to evaluate the indications and efficacy of ECMO in acute and critically ill major burn patients. This was a retrospective analysis of six patients from Tri-Service General Hospital, National Defense Medical Center in Taiwan. All suffered from major burns with 89.0±19.1% average of total body surface area over second degree (TBSA; range, 50-99%). ECMO was used due to inhalation injury in five patients and cardiogenic shock in one patient. The average interval to start ECMO was 26.5±19.0h (range, 14-63h). Venoarterial ECMO was used on in four patients due to unstable hemodynamic status, whereas venovenous ECMO was used in two patients for sustained hypoxemia. All patients had rhabdomyolysis with acute renal failure. The average duration of ECMO was 169.6±180.9h (range, 27-401h). All patients developed coagulopathy and needed debridement surgery during ECMO support, and five underwent torso escharotomy due to inspiratory compromise. Only one patient whose second and third degree burns covered 50% TBSA was successfully weaned from ECMO and survived; he was discharged after 221 hospital days. All patients who died had second and third degree burns covering over 90% of their TBSA. Three patients died of multiple organ failure, one died of septic shock, and the other died of cardiogenic shock. Overall survival rate was 16.7%. In acute and critically ill major burn patients, ECMO could be considered as a salvage therapy, particularly in those with inhalation injury and burn-related acute respiratory distress syndrome. However, ECMO does not seem to provide benefits for circulatory support in those with hemodynamic

  4. Fracture resistance of various temporary crown materials.

    Science.gov (United States)

    Yilmaz, Asude; Baydaş, Seyfettin

    2007-01-01

    The aim of this study was to evaluate the fracture resistance of various provisional crown materials using an in vitro model test system. In the present study polycarbonate crowns, prefabricated by the manufacturer (3M Polycarbonate Crown), and the temporary crowns, fabricated in the dental laboratory environment, were fabricated using bis-acryl composite (Protemp II), autopolymerizing PMMA resin (BISICO Temp S), and heat-polymerized PMMA resin (Major C&B-V Dentine). All temporary crowns were stored in distilled water for 24 hours at room temperature prior to testing. The crowns were seated on metal dies, fabricated from Cr-Co alloy (AZ Dental, Konstanz, Germany), and then tested using the indenter of a Hounsfield testing machine (Hounsfield Tensometer, Hounsfield Test Equipment, Raydon, England). The tip of the indenter was located at a position one-third of the way down the inciso-palatine surface at 135 masculine. The data were statistically analyzed for differences using one-way analysis of variance (ANOVA) and the Tukey HSD test (P polycarbonate crowns were significantly different from the BISICO Temp S, Protemp II, and Major C&B-V Dentine (P polycarbonate crowns may be preferable to the other types of temporary crowns used in this study.

  5. Nosocomial Infections During Extracorporeal Membrane Oxygenation: Incidence, Etiology, and Impact on Patients' Outcome.

    Science.gov (United States)

    Grasselli, Giacomo; Scaravilli, Vittorio; Di Bella, Stefano; Biffi, Stefano; Bombino, Michela; Patroniti, Nicolò; Bisi, Luca; Peri, Anna Maria; Pesenti, Antonio; Gori, Andrea; Alagna, Laura

    2017-10-01

    To study incidence, type, etiology, risk factors, and impact on outcome of nosocomial infections during extracorporeal membrane oxygenation. Retrospective analysis of prospectively collected data. Italian tertiary referral center medical-surgical ICU. One hundred five consecutive patients who were treated with extracorporeal membrane oxygenation from January 2010 to November 2015. None. Ninety-two patients were included in the analysis (48.5 [37-56] years old, simplified acute physiology score II 37 [32-47]) who underwent peripheral extracorporeal membrane oxygenation (87% veno-venous) for medical indications (78% acute respiratory distress syndrome). Fifty-two patients (55%) were infected (50.4 infections/1,000 person-days of extracorporeal membrane oxygenation). We identified 32 ventilator-associated pneumonia, eight urinary tract infections, five blood stream infections, three catheter-related blood stream infections, two colitis, one extracorporeal membrane oxygenation cannula infection, and one pulmonary-catheter infection. G+ infections (35%) occurred earlier compared with G- (48%) (4 [2-10] vs. 13 [7-23] days from extracorporeal membrane oxygenation initiation; p infections. Younger age (2-35 years old) was independently associated with higher risk for nosocomial infections. Twenty-nine patients (31.5%) died (13.0 deaths/1,000 person-days of extracorporeal membrane oxygenation). Infected patients had higher risk for death (18 vs. 8 deaths/1,000 person-days of extracorporeal membrane oxygenation; p = 0.037) and longer ICU stay (32.5 [19.5-78] vs. 19 [10.5-27.5] days; p = 0.003), mechanical ventilation (36.5 [20-80.5] vs. 16.5 [9-25.5] days; p 50 years old), reason for connection different from acute respiratory distress syndrome, higher simplified acute physiology score II, diagnosis of ventilator-associated pneumonia, and infection by multidrug-resistant bacteria were independently associated to increased death rate. Infections (especially ventilator

  6. Venovenous extracorporeal membrane oxygenation in adult respiratory failure

    Science.gov (United States)

    Hsin, Chun-Hsien; Wu, Meng-Yu; Huang, Chung-Chi; Kao, Kuo-Chin; Lin, Pyng-Jing

    2016-01-01

    Abstract Despite a potentially effective therapy for adult respiratory failure, a general agreement on venovenous extracorporeal membrane oxygenation (VV-ECMO) has not been reached among institutions due to its invasiveness and high resource usage. To establish consensus on the timing of intervention, large ECMO organizations have published the respiratory extracorporeal membrane oxygenation survival prediction (RESP) score and the ECMOnet score, which allow users to predict hospital mortality for candidates with their pre-ECMO presentations. This study was aimed to test the predictive powers of these published scores in a medium-sized cohort enrolling adults treated with VV-ECMO for acute respiratory failure, and develop an institutional prediction model under the framework of the 3 scores if a superior predictive power could be achieved. This retrospective study included 107 adults who received VV-ECMO for severe acute respiratory failure (a PaO2/FiO2 ratio ECMO. The predictive power of hospital mortality of each score was presented as the area under receiver-operating characteristic curve (AUROC). The multivariate logistic regression was used to develop an institutional prediction model. The surviving to discharge rate was 55% (n = 59). All of the 3 published scores had a real but poor predictive power of hospital mortality in this study. The AUROCs of RESP score, ECMOnet score, and SOFA score were 0.662 (P = 0.004), 0.616 (P = 0.04), and 0.667 (P = 0.003), respectively. An institutional prediction model was established from these score parameters and presented as follows: hospital mortality (Y) = −3.173 + 0.208 × (pre-ECMO SOFA score) + 0.148 × (pre-ECMO mechanical ventilation day) + 1.021 × (immunocompromised status). Compared with the 3 scores, the institutional model had a significantly higher AUROC (0.779; P ECMO. Among the score parameters, duration of mechanical ventilation, immunocompromised status, and

  7. Extracorporeal shockwave therapy: A systematic review of its use in fracture management

    Directory of Open Access Journals (Sweden)

    Petrisor B

    2009-01-01

    Full Text Available Extracorporeal shockwave therapy is increasingly used as an adjuvant therapy in the management of nonunions, delayed unions and more recently fresh fractures. This is in an effort to increase union rates or obtain unions when fractures have proven recalcitrant to healing. In this report we have systematically reviewed the English language literature to attempt to determine the potential clinical efficacy of extracorporeal shockwave therapy in fracture management. Of 32 potentially eligible studies identified, 10 were included that assessed the extracorporeal shockwave therapy use for healing nonunions or delayed unions, and one trial was included that assessed its use for acute high-energy fractures. From the included, studies′ overall union rates were in favor of extracorporeal shockwave therapy (72% union rate overall for nonunions or delayed unions, and a 46% relative risk reduction in nonunions when it is used for acute high-energy fractures. However, the methodologic quality of included studies was weak and any clinical inferences made from these data should be interpreted with caution. Further research in this area in the form of a large-scale randomized trial is necessary to better answer the question of the effectiveness of extracorporeal shockwave therapy on union rates for both nonunions and acute fractures.

  8. Survival after extracorporeal cardiopulmonary resuscitation in infants and children with heart disease.

    Science.gov (United States)

    Chan, Titus; Thiagarajan, Ravi R; Frank, Deborah; Bratton, Susan L

    2008-10-01

    We investigated survival and predictors of mortality for infants and children with heart disease treated with extracorporeal membrane oxygenation as an aid to cardiopulmonary resuscitation. Children (cardiopulmonary resuscitation and were reported to the Extracorporeal Life Support Organization database were evaluated. Patients were classified into one of 3 groups based on underlying cardiac physiology: single ventricle, 2 ventricles, and cardiac muscle disease. Patients with eligible procedure codes were assigned a Risk Adjustment for Congenital Heart Surgery-1 classification. Four hundred ninety-two patients were eligible for analysis, and 279 (57%) were assigned a Risk Adjustment for Congenital Heart Surgery-1 category. Overall survival was 42%. In a multivariable logistic regression analysis, significant pre-extracorporeal predictors for mortality included single-ventricle physiology (odds ratio, 1.6; 95% confidence interval, 1.05-2.4), a history of a stage 1-type procedure (odds ratio, 2.7; 95% confidence interval, 1.2-6.2), and extreme acidosis (arterial blood gas pH cardiopulmonary resuscitation resulted in hospital survival in 42% of infants and children with heart disease. Underlying cardiac physiology and associated cardiac surgical procedures influenced mortality, as did pre-extracorporeal resuscitation status and extracorporeal membrane oxygenation-associated complications.

  9. Extracorporeal shock wave lithotripsy in children: Results and short-term complications.

    Science.gov (United States)

    da Cunha Lima, João Paulo; Duarte, Ricardo Jordão; Cristofani, Lílian Maria; Srougi, Miguel

    2007-08-01

    The introduction of extracorporeal shock wave lithotripsy represented an important evolution in urinary tract lithiasis management. The aim of this study is to describe the results of extracorporeal shock wave lithotripsy for the treatment of urinary tract lithiasis in children, focusing on the index of elimination of the calculi and the complications occurring during the procedure and during the following three months. From September 1991 to July 2002, 135 children between one and 12 years, suffering from urinary tract lithiasis underwent extracorporeal shock wave lithotripsy. A retrospective analysis of these patients was carried out. One hundred and ninety-five calculi ranging in size from 5.0 mm to 20.0 mm were treated, out of which 147 were found in the kidneys and 48 in the ureter. Urinary tract dilation was presented by 30% of the children at the time of the procedure. After extracorporeal shock wave lithotripsy 75.8% of the calculi were eliminated: 64.1% were stone-free and 11.7% had pain. In children, extracorporeal shock wave lithotripsy proved to be able to eliminate 75.8% of the treated calculi and 83.7% of the patients presented a complete or partial response. Complications were observed in 23.7% of patients, and pain was the most frequent symptom.

  10. Do we need randomized clinical trials in extracorporeal respiratory support? Yes.

    Science.gov (United States)

    Combes, Alain; Pesenti, Antonio; Brodie, Daniel

    2017-09-15

    Extracorporeal respiratory support, also known as extracorporeal gas exchange, may be used to rescue the most severe forms of acute hypoxemic respiratory failure with high blood flow venovenous extracorporeal membrane oxygenation. Alternatively, lower flow extracorporeal carbon dioxide removal might be applied to reduce the intensity of mechanical ventilation in patients with less severe forms of the disease. However, critical reading of the results of the randomized trials and case series published to date reveals major methodological biases. Older trials are not relevant anymore since the ECMO circuitry was not heparin-coated leading to severe hemorrhagic complications due to high levels of anticoagulation, and because extracorporeal membrane oxygenation (ECMO) and control group patients did not receive lung-protective ventilation. Alternatively, in the more recent CESAR trial, many patients randomized to the ECMO arm did not receive ECMO and no standardized protocol for lung-protective mechanical ventilation existed in the control group. Since these techniques are costly and associated with potentially serious adverse events, there is an urgent need for high-quality data, for which the cornerstone remains randomized controlled trials.

  11. Incidence of infectious complications after extracorporeal shock wave lithotripsy in patients without associated risk factors.

    Science.gov (United States)

    Mira Moreno, Alejandra; Montoya Lirola, María Dolores; García Tabar, Pedro José; Galiano Baena, Juan Francisco; Tenza Tenza, José Antonio; Lobato Encinas, Juan José

    2014-11-01

    We determined the incidence of infectious complications (asymptomatic bacteriuria, urinary tract infection and urosepsis) in patients without associated risk factors treated with extracorporeal shock wave lithotripsy. We performed an observational, prospective cohort study between October 2010 and June 2013. We included all patients without risk factors who were treated with extracorporeal shock wave lithotripsy for kidney or ureteral lithiasis. All patients underwent urine culture 5 days before the procedure. Another urine culture was performed 7 days after lithotripsy. No patient received antibiotics. Initially 366 patients with a mean ± SD age of 53 ± 13 years were enrolled in the study. A total of 64 patients (17.5%) underwent extracorporeal shock wave lithotripsy with a previously placed Double-J® stent. After lithotripsy urine culture was positive in 20 patients (5.8%), of whom 4 (1.2%) presented with symptomatic urinary infection and the remaining 4.6% showed no symptoms. Urosepsis did not develop in any case. In our study patient age was an independent risk factor for bacteriuria after lithotripsy. The incidence of infectious complications after extracorporeal shock wave lithotripsy in patients without risk factors is low. This leads us to conclude that without defined risk factors antibiotic prophylaxis is not justified. Also, elderly patients were more at risk for bacteriuria after extracorporeal shock wave lithotripsy and, thus, for a possible infectious complication. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  12. Short-Term Neurodevelopmental Outcome in Congenital Diaphragmatic Hernia: The Impact of Extracorporeal Membrane Oxygenation and Timing of Repair.

    Science.gov (United States)

    Danzer, Enrico; Hoffman, Casey; D'Agostino, Jo Ann; Connelly, James T; Waqar, Lindsay N; Gerdes, Marsha; Bernbaum, Judy; Rintoul, Natalie E; Herkert, Lisa M; Peranteau, William H; Flake, Alan W; Adzick, N Scott; Hedrick, Holly L

    2018-01-01

    The purpose of this study was to assess the need and timing of extracorporeal membrane oxygenation in relation to congenital diaphragmatic hernia repair as modifiers of short-term neurodevelopmental outcomes. Retrospective study. A specialized tertiary care center. Between June 2004 and February 2016, a total of 212 congenital diaphragmatic hernia survivors enrolled in our follow-up program. Neurodevelopmental outcome was assessed at a median age of 22 months (range, 5-37) using the Bayley Scales of Infant Development, third edition. Fifty patients (24%) required extracorporeal membrane oxygenation support. Four patients (8%) were repaired prior to cannulation, 25 (50%) were repaired on extracorporeal membrane oxygenation, and 21 (42%) were repaired after decannulation. None. Children with congenital diaphragmatic hernia, who required extracorporeal membrane oxygenation scored on average 4.6 points lower on cognitive composite (p = 0.031) and 9.2 points lower on the motor composite (p < 0.001). Language scores were similar between groups. Mean scores for children with congenital diaphragmatic hernia repaired on extracorporeal membrane oxygenation were significantly lower for cognition (p = 0.021) and motor (p = 0.0005) outcome. Language scores were also lower, but did not reach significance. A total of 40% of children repaired on extracorporeal membrane oxygenation scored below average in all composites, whereas only 9% of the non-extracorporeal membrane oxygenation, 4% of the repaired post-extracorporeal membrane oxygenation, and 25% of the repaired pre-extracorporeal membrane oxygenation patients scored below average across all domains. Only 20% of congenital diaphragmatic hernia survivors repaired on extracorporeal membrane oxygenation support scored within the average range for all composite domains. Duration of extracorporeal membrane oxygenation support was not associated with a higher likelihood of adverse cognitive (p = 0.641), language (p = 0.147), or

  13. Ideal cardiovascular health and mortality from all causes and diseases of the circulatory system among adults in the United States

    National Research Council Canada - National Science Library

    Ford, Earl S; Greenlund, Kurt J; Hong, Yuling

    2012-01-01

    .... The objective of the present study was to examine how well these metrics predicted mortality from all causes and diseases of the circulatory system in a national sample of adults in the United States...

  14. Hypothermic Oxygenated Machine Perfusion Prevents Arteriolonecrosis of the Peribiliary Plexus in Pig Livers Donated after Circulatory Death

    NARCIS (Netherlands)

    den Dries, Sanna op; Sutton, Michael E.; Karimian, Negin; de Boer, Marieke T.; Wiersema-Buist, Janneke; Gouw, Annette S. H.; Leuvenink, Henri G. D.; Lisman, Ton; Porte, Robert J.

    2014-01-01

    Background: Livers derived from donation after circulatory death (DCD) are increasingly accepted for transplantation. However, DCD livers suffer additional donor warm ischemia, leading to biliary injury and more biliary complications after transplantation. It is unknown whether oxygenated machine

  15. Mechanical ventilation in patients subjected to extracorporeal membrane oxygenation (ECMO).

    Science.gov (United States)

    López Sanchez, M

    2017-11-01

    Mechanical ventilation (MV) is a crucial element in the management of acute respiratory distress syndrome (ARDS), because there is high level evidence that a low tidal volume of 6ml/kg (protective ventilation) improves survival. In these patients with refractory respiratory insufficiency, venovenous extracorporeal membrane oxygenation (ECMO) can be used. This salvage technique improves oxygenation, promotes CO2 clearance, and facilitates protective and ultraprotective MV, potentially minimizing ventilation-induced lung injury. Although numerous trials have investigated different ventilation strategies in patients with ARDS, consensus is lacking on the optimal MV settings during venovenous ECMO. Although the concept of "lung rest" was introduced years ago, there are no evidence-based guidelines on its use in application to MV in patients supported by ECMO. How MV in ECMO patients can promote lung recovery and weaning from ventilation is not clear. The purpose of this review is to describe the ventilation strategies used during venovenous ECMO in clinical practice. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  16. Pediatric extracorporeal shock wave lithotripsy: multi-institutional results.

    Science.gov (United States)

    Özgür, Berat Cem; Irkilata, Lokman; Ekici, Musa; Hoşcan, Mustafa Burak; Sarici, Haşmet; Yücetürk, Cem Nedim; Karakan, Tolga; Atilla, Mustafa Kemal; Hasçiçek, Ahmet Metin; Eroglu, Muzaffer

    2016-05-24

    To evaluate the efficacy, auxiliary procedures and complications of pediatric extracorporeal shock wave lithotripsy (ESWL) performed with electrohydraulic lithotripters. Children with urolithiasis, aged between 0 and 15, were retrospectively evaluated. ESWL was performed by using two different electrohydraulic lithotripters, Elmed Multimed Classic (Elmed Medical Systems, Ankara, Turkey) and E-1000 (EMD Medical Systems, Ankara, Turkey), between January 2008 and December 2012 in four different referral centers in Turkey. 85.5% of patients were stone-free at 3 months. Further ESWL treatment was needed in 33.7% of the cases (one session, n = 55; two sessions, n = 15; three sessions, n = 13). Steinstrasse occurred in 10 patients but 8 of them cleared completely during the follow-up period. Urinary tract infection was detected in 3 (3.9%), fever in 3 (3.9%) and a small subcapsular hematoma in one (1.3%) patient, respectively. When the stones were divided into two groups as those with diameters <10 mm and ≥10 mm, it was found that the stone-free rate was associated with stone diameter, and that the smaller diameters had higher but statistically insignificant stone-free rates (P = 0.196). ESWL yields favorable results with low rates of complication and auxiliary procedures in selected pediatric patients.

  17. [Individualised care plan during extracorporeal membrane oxygenation. A clinical case].

    Science.gov (United States)

    Call Mañosa, S; Pujol Garcia, A; Chacón Jordan, E; Martí Hereu, L; Pérez Tejero, G; Gómez Simón, V; Estruga Asbert, A; Gallardo Herrera, L; Vaquer Araujo, S; de Haro López, C

    2016-01-01

    An individualised care plan is described for a woman diagnosed with pneumonia, intubated, and on invasive mechanical ventilation, who was admitted to the Intensive Care Unit for extracorporeal membrane oxygenation (ECMO). A nursing care plan was designed based on Marjory Gordon functional patterns. The most important nursing diagnoses were prioritised, using a model of clinical reasoning model (Analysis of the current status) and NANDA taxonomy. A description is presented on, death anxiety, impaired gas exchange, decreased cardiac output, dysfunctional gastrointestinal motility, risk for disuse syndrome, infection risk, and bleeding risk. The principal objectives were: to reduce the fear of the family, achieve optimal respiratory and cardiovascular status, to maintain gastrointestinal function, to avoid immobility complications, and to reduce the risk of infection and bleeding. As regards activities performed: we gave family support; correct management of the mechanical ventilation airway, cardio-respiratory monitoring, skin and nutritional status; control of possible infections and bleeding (management of therapies, care of catheters…). A Likert's scale was used to evaluate the results, accomplishing all key performance indicators which were propose at the beginning. Individualised care plans with NNN taxonomy using the veno-venous ECMO have not been described. Other ECMO care plans have not used the same analysis model. This case can help nurses to take care of patients subjected to veno-venous ECMO treatment, although more cases are needed to standardise nursing care using NANDA taxonomy. Copyright © 2016. Published by Elsevier España, S.L.U.

  18. Clinical experiences with extracorporeal immunoperfusion of plasma from cancer patients.

    Science.gov (United States)

    Korec, S; Smith, F P; Schein, P S; Phillips, T M

    1984-01-01

    We have treated 11 patients having a variety of tumor types and three patients having mitomycin-C-associated thrombotic thrombocytopenic purpura (TTP) with extracorporeal plasma perfusion through filters containing immobilized protein A from Staphylococcus aureus. In performing more than 140 procedures we observed only minimal toxicity, of which fever, chills, nausea, and vomiting were the most common symptoms, occurring in 25% of the patients. Significant decrease in blood pressure and bronchospasm were rare complications. However, none of these side effects were severe enough to require therapeutic intervention. The antitumor effect of immunoperfusion was modest. In 10 adequately treated patients there was one measurable tumor reduction (40% decrease of original tumor mass). Two patients had correction of total small bowel obstruction, with return to normal food intake and restoration of normal bowel habits, lasting for 6 and 3 months; and two of the two adequately treated TTP patients had dramatic hematological improvement after four and five immunoperfusion treatments and are well at present. We found direct correlation between extent of complement activation and clinical toxicity. By temperature manipulation of the perfusion procedure we were able to control the above-mentioned side effects caused by complement activation.

  19. Continuous Renal Replacement Therapy Applications on Extracorporeal Membrane Oxygenation Circuit.

    Science.gov (United States)

    Yetimakman, Ayse Filiz; Tanyildiz, Murat; Kesici, Selman; Kockuzu, Esra; Bayrakci, Benan

    2017-06-01

    Continuous venovenous hemofiltration or hemodiafiltration is used frequently in pediatric patients, but experience of continuous renal replacement therapy (CRRT) application on extracorporeal membrane oxygenation (ECMO) circuit is still limited. Among several methods used for applying CRRT on ECMO patients, we aim to share our experience on inclusion of a CRRT device in the ECMO circuit which we believe is easier and safer to apply. The data were collected on demographics, outcomes, and details of the treatment of ECMO patients who had CRRT. During the study period of 3 years, venous cannula of ECMO circuit before pump was used for CRRT access for both the filter inlet and outlet of CRRT machine to minimize the thromboembolic complications. The common indication for CRRT was fluid overload. CRRT was used in 3.68% of a total number of patients admitted and 43% of patients on ECMO. The patients have undergone renal replacement therapy for periods of time ranging between 24 h and 25 days (260 h mean). The survival rate of this group of patients with multiorgan failure was 33%. Renal recovery occurred in all of the survivors. Complications such as electrolyte imbalance, hypothermia, and bradykinin syndrome were easily managed. Adding a CRRT device on ECMO circuit is a safe and effective technique. The major advantages of this technique are easy to access, applying CRRT without extra anticoagulation process, preventing potential hemodynamic disturbances, and increased clearance of solutes and fluid overload using larger hemofilter.

  20. Extracorporal hemodialysis with acute or decompensated chronical hepatic failure

    Directory of Open Access Journals (Sweden)

    Wasem, Jürgen

    2006-04-01

    Full Text Available Background: Conventional diagnostic procedures and therapy of acute liver failure (ALF and acute-on-chronic liver failure (ACLF focus on to identify triggering events of the acute deterioration of the liver function and to avoid them. Further objectives are to prevent the development respectively the progression of secondary organ dysfunctions or organ failure. Most of the times the endocrinological function of the liver can to a wide extent be compensated, but the removal of toxins can only marginally be substituted by conventional conservative therapy. To improve this component of the liver function is the main objective of extracorporal liver support systems. The following principles of liver support systems can be differentiated: Artificial systems, bioartifical systems and extracorporal liver perfusion systems. This HTA report focuses on artificial systems (e.g. BioLogic-DT/-DTPF, MARS, Prometheus, because only these approaches currently are relevant in the German health care system. In 2004 a category "Extracorporal liver assist device" was introduced in the list of "additional payments" in the German DRG-system, which makes reimbursement for hospitals using the technology in inpatient care possible, based on an hospital's individual contract with statutory sickness funds. Objectives: To report the present evidence and future research need on medical efficacy and economic effectiveness of extracorporal liver support devices for treatment of patients with ALF or ACLF based on published literature data. Are artificial liver support systems efficient and effective in the treatment of ALF or ACLF? Methods: An extensive, systematic literature search in medical, economic, and HTA literature data bases was performed. Relevant data were extracted and synthesised. Results: Relevant controlled trials were detected for BioLogic-DT and MARS. No randomised controlled trial on Prometheus was found. None of the included studies on BioLogic-DT showed

  1. Factors affecting urinary calculi treatment by extracorporeal shock wave lithotripsy

    Directory of Open Access Journals (Sweden)

    Tarawneh Emad

    2010-01-01

    Full Text Available Extracorporeal Shock Wave Lithotripsy (ESWL is still the treatment of choice for most renal and upper ureteric stones; however the outcome depends on multiple factors. The objective of this study was to investigate the effects of stone density, as measured by Hounsfield Units (H.U by non-contrast Computerized Tomography (CT, stone size and stone location on ESWL treatment outcome of urinary calculi in Jordanian patients. 65 patients underwent clinical, biochemical and radiological assessments followed by ESWL treatment. Statistical analyses including chi-square, analysis of variance (ANOVA, correlation, regression were performed for statistical significance between ESWL treatment, stone fragmentation and stone density, size and location in the renal pelvis. ESWL success rate was high (94% for low density stones (< 500 Hounsfield units. In general CT densities of 750 Hounsfield units or less were almost always successfully treated by ESWL. An inverse association between ESWL treatment outcome and stone size was also documented. CT stone density and stone size combined account for nearly 73% of the variation in the number of shock waves required to attain fragmentation. Stones located in lower calyceal area had less success rates. In conclusion, stones with higher density, large size and lower location may better be managed by percutaneous nephrolithotomy.

  2. Factors affecting urinary calculi treatment by extracorporeal shock wave lithotripsy.

    Science.gov (United States)

    Tarawneh, Emad; Awad, Zeyad; Hani, Audy; Haroun, Azmi Amin; Hadidy, Azmi; Mahafza, Waleed; Samarah, Osama

    2010-07-01

    Extracorporeal Shock Wave Lithotripsy (ESWL) is still the treatment of choice for most renal and upper ureteric stones; however the outcome depends on multiple factors. The objective of this study was to investigate the effects of stone density, as measured by Hounsfield Units (H.U) by non-contrast Computerized Tomography (CT), stone size and stone location on ESWL treatment outcome of urinary calculi in Jordanian patients. 65 patients underwent clinical, biochemical and radiological assessments followed by ESWL treatment. Statistical analyses including chi-square, analysis of variance (ANOVA), correlation, regression were performed for statistical significance between ESWL treatment, stone fragmentation and stone density, size and location in the renal pelvis. ESWL success rate was high (94%) for low density stones (< 500 Hounsfield units). In general CT densities of 750 Hounsfield units or less were almost always successfully treated by ESWL. An inverse association between ESWL treatment outcome and stone size was also documented. CT stone density and stone size combined account for nearly 73% of the variation in the number of shock waves required to attain fragmentation. Stones located in lower calyceal area had less success rates. In conclusion, stones with higher density, large size and lower location may better be managed by percutaneous nephrolithotomy.

  3. [Experience with infections in the use of extracorporeal membrane oxygenation].

    Science.gov (United States)

    Calderón Checa, Rosa María; Rojo Conejo, Pablo; González-Posada Flores, Aranzazu Flavia; Llorente de la Fuente, Ana María; Palacios Cuesta, Alba; Aguilar, Juan Miguel; Belda Hofheinz, Sylvia

    2017-10-11

    To identify risk factors associated with infectious complications acquired by paediatric patients during extracorporeal life support (ECLS). Patients under ECLS from January 2011 to December 2014 have been retrospectively reviewed and data on demographics, care and infectious complications were collected. There were 50 ECLS assistances in the study period, of which 20 patients had 23 infectious complications: 16 were bloodstream infections, with coagulase negative staphylococci being the predominant isolate (there were 2 cases of candidaemia). Age, site of cannulation procedure, cannulation site, severe coagulopathy, and surgical interventions during assistance were analysed as risk factors for infectious complications, but no significant differences were found. ECLS duration was significantly longer in patients with infectious complications (8.91 vs 5.91 days; P=.039). There were no significant differences as regards Paediatric Intensive Care Unit (PICU) stay, or in survival. Infectious complications during ECLS are very common, and ECLS duration is significantly longer in patients with infections. Measures should be put in place to prevent infectious complications and reduce time on ECLS. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  4. Quantification of Operational Learning in Minimal Invasive Extracorporeal Circulation.

    Science.gov (United States)

    Anastasiadis, Kyriakos; Antonitsis, Polychronis; Asteriou, Christos; Argiriadou, Helena; Deliopoulos, Apostolos; Konstantinou, Dimitrios; Grosomanidis, Vassilios; Tossios, Paschalis

    2017-07-01

    Minimal invasive extracorporeal circulation (MiECC) has initiated important new efforts within science and technology towards a more physiologic perfusion. In this study, we aim to investigate the learning curve of our center regarding MiECC. We studied a series of 150 consecutive patients who underwent elective coronary artery bypass grafting by the same surgical team during the initial phase of MiECC application. Patients were randomly assigned into two groups. Group A (n = 75) included patients operated on MiECC, while group B (n = 75) included patients operated with conventional cardiopulmonary bypass (cCPB). The primary end-point of the study was to identify whether there is a learning curve when operating on MiECC. The following parameters were unrelated with increasing experience, even though the results favored MiECC use: reduced CPB duration (102.9 ± 25 vs. 122.2 ± 33 min, P advantages of MiECC technology in terms of reduced hemodilution and improved end-organ protection and clinical outcome are evident from the first patient. Optimal results are obtained with 50 cases; this refers mainly to significant reduction in the need for intraoperative blood transfusion. Teamwork from surgeons, anesthesiologists, and perfusionists is of paramount importance in order to maximize the clinical benefits from this technology. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  5. Efficacy of extracorporeal shock wave treatment in calcaneal enthesophytosis.

    Science.gov (United States)

    Cosentino, R; Falsetti, P; Manca, S; De Stefano, R; Frati, E; Frediani, B; Baldi, F; Selvi, E; Marcolongo, R

    2001-11-01

    To evaluate the efficacy of extracorporeal shock wave treatment (ESWT) in calcaneal enthesophytosis. 60 patients (43 women, 17 men) were examined who had talalgia associated with heel spur. A single blind randomised study was performed in which 30 patients underwent a regular treatment (group 1) and 30 a simulated one (shocks of 0 mJ/mm(2) energy were applied) (group 2). Variations in symptoms were evaluated by visual analogue scale (VAS). Variations in the dimension of enthesophytosis were evaluated by x ray examination. Variations in the grade of enthesitis were evaluated by sonography. A significant decrease of VAS was seen in group 1. Examination by x ray showed morphological modifications (reduction of the larger diameter >1 mm) of the enthesophytosis in nine (30%) patients. Sonography did not show significant changes in the grade of enthesitis just after the end of the treatment, but a significant reduction was seen after one month. In the control group no significant decrease of VAS was seen. No modification was observed by x ray examination or sonography. ESWT is safe and improves the symptoms of most patients with a painful heel, it can also structurally modify enthesophytosis, and reduce inflammatory oedema.

  6. Radial extracorporeal shock wave treatment harms developing chicken embryos

    Science.gov (United States)

    Kiessling, Maren C.; Milz, Stefan; Frank, Hans-Georg; Korbel, Rüdiger; Schmitz, Christoph

    2015-01-01

    Radial extracorporeal shock wave treatment (rESWT) has became one of the best investigated treatment modalities for cellulite, including the abdomen as a treatment site. Notably, pregnancy is considered a contraindication for rESWT, and concerns have been raised about possible harm to the embryo when a woman treated with rESWT for cellulite is not aware of her pregnancy. Here we tested the hypothesis that rESWT may cause serious physical harm to embryos. To this end, chicken embryos were exposed in ovo to various doses of radial shock waves on either day 3 or day 4 of development, resembling the developmental stage of four- to six-week-old human embryos. We found a dose-dependent increase in the number of embryos that died after radial shock wave exposure on either day 3 or day 4 of development. Among the embryos that survived the shock wave exposure a few showed severe congenital defects such as missing eyes. Evidently, our data cannot directly be used to draw conclusions about potential harm to the embryo of a pregnant woman treated for cellulite with rESWT. However, to avoid any risks we strongly recommend applying radial shock waves in the treatment of cellulite only if a pregnancy is ruled out. PMID:25655309

  7. EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN TREATMENT OF PEDIATRIC UROLITHIASIS

    Directory of Open Access Journals (Sweden)

    Emilija Golubovic

    2006-04-01

    Full Text Available The paper presents the experiences in the treatment of urinary tract calculosis in 114 children aged 6 months to 14 years by means of extracorporeal shock wave lithotripsy (ESWL.The treatment was performed at the Institute of Radiology and the Clinic for Pediatric Surgery and Orthopedics in Nis, in the period 1988-2000 on Siemens Litostar lithotriptor. The children were treated after clinical, laboratory and radiological preparation, provided that the stone was not greater than 3 cm (measured in native urinary tract graph and that it was not located in the pelvic part of the ureter. In the present study, the success in application of ESWL for treating pediatric patients was 88%. The total clearance of fragments was found in 57% of patients, whereas retention of fragments smaller than 4 mm three months after the last treatment was present in 31% of patients. ESWL treatment failed in 12% of patients since they had retained fragments greater than 4 mm.The authors recommend this method as a method of choice in the treatment of renal and urethral calculi in children.

  8. Effects of low-dose extracorporeal shock waves on microcirculation

    Science.gov (United States)

    Khaled, Walaa; Goertz, Ole; Lauer, Henrik; Lehnhardt, Marcus; Hauser, Jörg

    2012-11-01

    The extended wounds of burn patients remain a challenge due to wound infection and following septicemia. The aim of this study was to analyze microcirculation, angiogenesis and leukocyte endothelium interaction after burn injury with and without extracorporeal shock wave application (ESWA). A novel shockwave system was developed based on a commercially available device for orthopedics (Dornier Aries®) that was equipped with a newly developed applicator. This system is based on the electromagnetic shock wave emitter (EMSE) technology and was introduced to accomplish a localized treatment for wound healing. The system includes a novel field of focus for new applications, with high precision and ease of use. In the animal study, full-thickness burns were inflicted on to the ears of hairless mice (n=51). Intravital fluorescent microscopy was used to assess microcirculatory parameters, angiogenesis and leukocyte behavior. ESWA was performed on day 1, 3 and 7. Values were obtained immediately after burn, as well as at days 1, 3, 7, and 12 post burn. All shockwave treated groups showed an accelerated angiogenesis with a less non-perfused area and an improved blood flow after burn injury compared to the placebo control group. After three treatments, the shock waves increased the number of rolling leukocytes significantly compared to the non-treated animals. Shock waves seem to have a positive effect on several parameters of wound healing after burn injury. However, further investigations are necessary to detect positive influence of shock waves on microcirculation after burn injuries.

  9. Pediatric extracorporeal shock wave lithotripsy: Predicting successful outcomes

    Directory of Open Access Journals (Sweden)

    Sean McAdams

    2010-01-01

    Full Text Available Extracorporeal shock wave lithotripsy (ESWL is currently a first-line procedure of most upper urinary tract stones <2 cm of size because of established success rates, its minimal invasiveness and long-term safety with minimal complications. Given that alternative surgical and endourological options exist for the management of stone disease and that ESWL failure often results in the need for repeat ESWL or secondary procedures, it is highly desirable to identify variables predicting successful outcomes of ESWL in the pediatric population. Despite numerous reports and growing experience, few prospective studies and guidelines for pediatric ESWL have been completed. Variation in the methods by which study parameters are measured and reported can make it difficult to compare individual studies or make definitive recommendations. There is ongoing work and a need for continuing improvement of imaging protocols in children with renal colic, with a current focus on minimizing exposure to ionizing radiation, perhaps utilizing advancements in ultrasound and magnetic resonance imaging. This report provides a review of the current literature evaluating the patient attributes and stone factors that may be predictive of successful ESWL outcomes along with reviewing the role of pre-operative imaging and considerations for patient safety.

  10. [Extracorporeal lithotripsy in experimental vesicular lithiasis in pigs].

    Science.gov (United States)

    Capdeville, R; André-Bougaran, J; Barrat, F; Moreaux, J

    1990-01-01

    Experimental extracorporeal shock wave lithotripsy of gallstones was performed with the EDAP LT 01 piezoelectric lithotripter. Fragmentation of biliary stones was evaluated after implantation of human stones inside the gallbladder in 10 pigs. Lithotripsy was performed with a firing frequency of 2.5 shots per second during a mean time of 50 min. Zero to 18 days after lithotripsy, complete fragment clearance was seen in 6 cases, fragments less than 2 mm were found in 2 cases and fragments larger than 2 mm with only 1 non fragmented stone in 2 cases. There were no stone fragments in the cystic and common ducts. Damage to gallbladder and adjacent organs was appreciated after lithotripsy to the empty gallbladder of pigs with firing frequencies from 40 to 1.25 shots per second. Perforation of the gallbladder was observed in both pigs treated with a firing frequency of 40 shots per second and in 1 pig out of 3 treated with a firing frequency of 20 shots per second. With 10 shots per second and lower firing frequencies, mild histological changes of the gallbladder walls were only observed in 3 cases reoperated on the 2nd day after lithotripsy. The gallbladder wall was normal in the 5 cases reoperated on the 15th day and there were no hepatic, duodenal and pancreatic lesions. These experimental results are consistent with utilization of this machine in the treatment of gallstones in man; low firing frequencies are effective for fragmentation of gallstones without any adverse effects.

  11. High-efficiency shock-wave generator for extracorporeal lithotripsy.

    Science.gov (United States)

    Broyer, P; Cathignol, D; Theillère, Y; Mestas, J L

    1996-09-01

    In extracorporeal lithotripsy, the electro-acoustic efficiency of electrohydraulic generators is limited by the inductance of the electrical discharge circuit. A new shock-wave generator is described that uses a coaxial discharge line enabling electro-acoustic efficiency to be greatly increased. The line is built using a para-electric ceramic with a relative dielectric constant of 1700, manufactured for use in high-voltage impulse mode. A coaxial spark gap, with minimal inductance, has been developed to obtain the triggered breakdown of the discharge line. Shock waves are created with a coaxial electrode plugged directly into the spark gap and immersed in an electrolyte of degassed saline. Electrode gap and electrolyte resistivity are adjusted to match the resistivity of the electrolyte volume between the underwater electrodes to the characteristic impedance of the line. The discharge line generates in the medium a rectangular current pulse with an amplitude of about 6000 A and a rise time of 50 ns. Compared with conventional generators, measurements of the expansive peak pressure pulse show an increase of 105% at 10 kV, 86.5% at 12 kV and 34.5% at 14 kV charging voltage. Electro-acoustic efficiency is found to be 11% instead of 5.5% for a conventional discharge circuit.

  12. Blood Transfusion Strategies in Patients Undergoing Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Hyoung Soo Kim

    2017-02-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO is frequently associated with bleeding and coagulopathy complications, which may lead to the need for transfusion of multiple blood products. However, blood transfusions are known to increase morbidity and mortality, as well as hospital cost, in critically ill patients. In current practice, patients on ECMO receive a transfusion, on average, of 1-5 packed red blood cells (RBCs/day, with platelet transfusion accounting for the largest portion of transfusion volume. Generally, adult patients require more transfusions than neonates or children, and patients receiving venovenous ECMO for respiratory failure tend to need smaller transfusion volumes compared to those receiving venoarterial ECMO for cardiac failure. Observation studies have reported that a higher transfusion volume was associated with increased mortality. To date, the evidence for transfusion in patients undergoing ECMO is limited; most knowledge on transfusion strategies was extrapolated from studies in critically ill patients. However, current data support a restrictive blood transfusion strategy for ECMO patients, and a low transfusion trigger seems to be safe and reasonable.

  13. Acute kidney injury in adults receiving extracorporeal membrane oxygenation

    Directory of Open Access Journals (Sweden)

    Yung-Chang Chen

    2014-11-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO has been utilized for critically ill patients such as patients with postcardiotomy cardiogenic shock or life-threatening respiratory failure. Acute kidney injury (AKI that develops during ECMO is associated with a very poor outcome, possibly because of accumulated extravascular water causing interstitial overload, impaired oxygen transport through tissues, and increased extravascular lung water volume with impaired O2 transport. Increased water is associated with subsequent organ dysfunction, particularly of the heart, lungs, and brain. Based on single-center studies, the incidence of AKI is 70–85% in ECMO patients. Therefore, renal replacement therapy is required in approximately 50% of these patients. This review summarizes three modalities that can be used to introduce renal replacement therapy to patients on ECMO, the pathophysiology of AKI in ECMO, and the impact of AKI on mortality. This review also identifies specific research-focused questions that need to be addressed to predict AKI early and to improve outcomes in this at-risk adult population.

  14. EXTRACORPOREAL SHOCKWAVE TERAPY TO TREAT CHRONIC MUSCLE INJURY.

    Science.gov (United States)

    Astur, Diego Costa; Santos, Bruno; de Moraes, Eduardo Ramalho; Arliani, Gustavo Gonçalves; Dos Santos, Paulo Roberto Dias; Pochini, Alberto de Castro

    2015-01-01

    To evaluate the low energy extracorporeal shock waves therapy (ESWT) associated with physical therapy in the treatment of chronic muscle injuries classified as grades 2 and 3 in the lower limbs of amateur athletes. Eight athletes presenting with lower limb muscle injury for more than three weeks were treated with physiotherapy and ESWT. We evaluated the following parameters during treatment: palpable gap, muscle strength, pain, and Tegner score, as well as ultrasound image features and the ability to return to sports practice. The average time of the first evaluation of the injury was 8.75 weeks. All patients presented muscle strength grade V after eight weeks. The pain score evolved from 5.75 to 0.5 points of the visual analogue scale (VAS), at the end of the treatment. The Tegner score after treatment was six points on average. Patients returned to sports practice after 8.14 weeks. ESWT associated with physical therapy proved to be effective to treat long-term muscle injury, with good performance and the ability to return to sport practice for all patients. Level of Evidence IV, Case Series, Prospective Study.

  15. Mechanical Circulatory Support Devices for Pediatric Patients With Congenital Heart Disease.

    Science.gov (United States)

    Chopski, Steven G; Moskowitz, William B; Stevens, Randy M; Throckmorton, Amy L

    2017-01-01

    The use of mechanical circulatory support (MCS) devices is a viable therapeutic treatment option for patients with congestive heart failure. Ventricular assist devices, cavopulmonary assist devices, and total artificial heart pumps continue to gain acceptance as viable treatment strategies for both adults and pediatric patients as bridge-to-transplant, bridge-to-recovery, and longer-term circulatory support alternatives. We present a review of the current and future MCS devices for patients having congenital heart disease (CHD) with biventricular or univentricular circulations. Several devices that are specifically designed for patients with complex CHD are in the development pipeline undergoing rigorous animal testing as readiness experiments in preparation for future clinical trials. These advances in the development of new blood pumps for patients with CHD will address a significant unmet clinical need, as well as generally improve innovation of the current state of the art in MCS technology. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  16. Summary of the British Transplantation Society guidelines for transplantation from donors after deceased circulatory death.

    Science.gov (United States)

    Andrews, Peter A; Burnapp, Lisa; Manas, Derek

    2014-02-15

    The second edition of the British Transplantation Society Guidelines for Transplantation from Donors after Deceased Circulatory Death was published in June 2013. The guideline has been extensively revised since the previous edition in 2004 and has used the GRADE system to rate the strength of evidence and recommendations. This article summarizes the Statements of Recommendation contained in the guideline, which provide a framework for transplantation after deceased circulatory death in the U.K. and may be of wide international interest. It is recommended that the full guideline document is consulted for details of the relevant references and evidence base. This may be accessed at: http://www.bts.org.uk/MBR/Clinical/Guidelines/Current/Member/Clinical/Current_Guidelines.aspx.

  17. Preparedness planning before mechanical circulatory support: a "how-to" guide for palliative medicine clinicians.

    Science.gov (United States)

    Swetz, Keith M; Kamal, Arif H; Matlock, Daniel D; Dose, Ann Marie; Borkenhagen, Lynn S; Kimeu, Ashley K; Dunlay, Shannon M; Feely, Molly A

    2014-05-01

    The role of palliative medicine in the care of patients with advanced heart failure, including those who receive mechanical circulatory support, has grown dramatically in the last decade. Previous literature has suggested that palliative medicine providers are well poised to assist cardiologists, cardiothoracic surgeons, and the multidisciplinary cardiovascular team with promotion of informed consent and initial and iterative discussions regarding goals of care. Although preparedness planning has been described previously, the actual methods that can be used to complete a preparedness plan have not been well defined. Herein, we outline several key aspects of this approach and detail strategies for engaging patients who are receiving mechanical circulatory support in preparedness planning. Published by Elsevier Inc.

  18. A cholinergic contribution to the circulatory responses evoked at the onset of handgrip exercise in humans

    DEFF Research Database (Denmark)

    Vianna, Lauro C; Fadel, Paul J; Secher, Niels H

    2015-01-01

    A cholinergic (muscarinic) contribution to the initial circulatory response to exercise in humans remains controversial. Herein, we posit that this may be due to exercise mode with a cholinergic contribution being important during isometric handgrip exercise, where the hyperemic response of the m......A cholinergic (muscarinic) contribution to the initial circulatory response to exercise in humans remains controversial. Herein, we posit that this may be due to exercise mode with a cholinergic contribution being important during isometric handgrip exercise, where the hyperemic response...... of the muscle is relatively small compared with the onset of leg cycling, where a marked increase in muscle blood flow rapidly occurs as a consequence of multiple redundant mechanisms. We recorded blood pressure (BP; brachial artery), stroke volume (pulse contour analysis), cardiac output, and systemic vascular...

  19. Mechanical circulatory support in cardiogenic shock - what every interventional cardiologist should know.

    Science.gov (United States)

    Pyka, Lukasz; Pres, Damian; Przybylski, Roman; Pacholewicz, Jerzy; Poloński, Lech; Zembala, Marian; Gąsior, Mariusz

    2014-01-01

    Cardiogenic shock (CS) remains the main cause of death in patients with myocardial infarction. Conservative treatment alone does not sufficiently improve prognosis. Mortality in CS can only be significantly reduced with revascularization, both surgical and percutaneous. However some patients present with haemodynamic instability despite optimal medical treatment and complete revascularization, resulting in very high mortality rates. These patients require the implementation of mechanical circulatory support in order to increase systemic blood flow, protect against organ hypoperfusion and protect the myocardium through a decrease in oxygen consumption. In contemporary interventional cardiology it seems that every operator should be aware of all available mechanical circulatory support methods for their patients. This article aims to present the current state of knowledge and technical possibilities in this area.

  20. Knee joint angle of intracerebral hemorrhage-induced rats after extracorporeal shock wave therapy

    Science.gov (United States)

    Lee, Jung-Ho

    2016-01-01

    [Purpose] The purpose of this study was to investigate the impact on rat knee joints of extracorporeal shock wave therapy after experimentally induced intracerebral hemorrhage. [Subjects and Methods] Sprague-Dawley (SD) rats were divided into an experimental group that received extracorporeal shock wave therapy after central nervous system injury (n=10) and a control group that did not receive any therapeutic intervention after central nervous system injury (n=10). The Dartfish program was used to evaluate the SD rats’ locomotion. [Results] There was a significant difference between the control group and the experimental group in the change of knee joint angle during midstance after the intervention. [Conclusion] In conclusion, at extracorporeal shock wave therapy for central nervous system injury was confirmed to be effective at reducing knee joint angle, confirming it is a good physical therapy intervention, based on its efficacy. PMID:27942132

  1. Novel Method for Exchange of Impella Circulatory Assist Catheter: The "Trojan Horse" Technique.

    Science.gov (United States)

    Phillips, Colin T; Tamez, Hector; Tu, Thomas M; Yeh, Robert W; Pinto, Duane S

    2017-07-01

    Patients with an indwelling Impella may require escalation of hemodynamic support or exchange to another circulatory assistance platform. As such, preservation of vascular access is preferable in cases where anticoagulation cannot be discontinued or to facilitate exchange to an alternative catheter or closure device. Challenges exist in avoiding bleeding and loss of wire access in these situations. We describe a single-access "Trojan Horse" technique that minimizes bleeding while maintaining arterial access for rapid exchange of this percutaneous ventricular assist device.

  2. Use of Short-term Circulatory Support as a Bridge in Pediatric Heart Transplantation

    Directory of Open Access Journals (Sweden)

    Luiz Fernando Canêo

    2015-01-01

    Full Text Available Background: Heart transplantation is considered the gold standard therapy for the advanced heart failure, but donor shortage, especially in pediatric patients, is the main limitation for this procedure, so most sick patients die while waiting for the procedure. Objective: To evaluate the use of short-term circulatory support as a bridge to transplantation in end-stage cardiomyopathy. Methods: Retrospective clinical study. Between January 2011 and December 2013, 40 patients with cardiomyopathy were admitted in our Pediatric Intensive Care Unit, with a mean age of 4.5 years. Twenty patients evolved during hospitalization with clinical deterioration and were classified as Intermacs 1 and 2. One patient died within 24 hours and 19 could be stabilized and were listed. They were divided into 2 groups: A, clinical support alone and B, implantation of short-term circulatory support as bridge to transplantation additionally to clinical therapy. Results: We used short-term mechanical circulatory support as a bridge to transplantation in 9. In group A (n=10, eight died waiting and 2 patients (20% were transplanted, but none was discharged. In group B (n=9, 6 patients (66.7% were transplanted and three were discharged.The mean support time was 21,8 days (6 to 984h. The mean transplant waiting list time was 33,8 days. Renal failure and sepsis were the main complication and causeof death in group A while neurologic complications were more prevalent en group B. Conclusion: Mechanical circulatory support increases survival on the pediatric heart transplantation waiting list in patients classified as Intermacs 1 and 2.

  3. FEATURES OF LONG-TERM MECHANICAL CIRCULATORY SUPPORT WITH CONTINUOUS-FLOW PUMP

    Directory of Open Access Journals (Sweden)

    G. P. Itkin

    2012-01-01

    Full Text Available In a review of the comparative analysis of methods and tools for long-term mechanical circulatory support with continuous flow and pulsatile flow implantable pumps. Particular attention is paid to the choice of the optimal modes of the operation of pumps based on the physical principles of the interaction between a the steady flow of blood to the pulsatile mechanics of the heart chambers. 

  4. A cause of circulatory collapse that should be considered following trauma

    Directory of Open Access Journals (Sweden)

    Omar Hesham R

    2010-08-01

    Full Text Available Abstract Management of poly-trauma patients presenting to the emergency room is usually a challenging and formidable task. Two of the common problems seen in those patients are shock and neurological dysfunction. A huge differential for post-traumatic circulatory collapse exist and timely identification of the etiology is of utmost importance to avoid complications. In this report we are describing 2 cases presenting with circulatory collapse following trauma. The first case was a 29 year old female who presented after a motor vehicle accident fully conscious with severe hypotension and bradycardia. The second case presented with severe hemodynamic instability after falling at home. Physical examination of both patients revealed weakness in all 4 limbs and CT cervical spine revealed complete anterior sublaxation of C5 over C6 cervical vertebrae in the first case and partial sublaxation of C5 over C6 cervical vertebrae in the second case confirming that spinal cord injury is the likely cause for these hemodynamic alterations. A high index of suspicion for spinal cord injuries is therefore mandatory when managing a trauma patient presenting with quadriparesis and hemodynamic instability that is otherwise unexplained especially when the ensuing hypotension is associated with bradycardia instead of reflex tachycardia. Awareness of this cause of circulatory collapse is particularly important in the unconscious patient where eliciting sensory and motor deficits looking for spinal cord injury is not always feasible. Both patients were transferred to the intensive care unit and were maintained on epinephrine till becoming hemodynamically stable. The report aims to sensitize readers to this cause of post-traumatic circulatory collapse.

  5. Occlusive ascending aorta and arch atheroma treated with deep hypothermic circulatory arrest and thromboendarterectomy.

    LENUS (Irish Health Repository)

    O' Sullivan, Katie E

    2013-12-01

    We describe an uncommon presentation of severely advanced aortic atherosclerosis in a 48-year old man with a history of hypertension and heavy smoking. Initial presentation with upper limb ischaemia led to the diagnosis of an aortic arch atheroma occluding 90% of the aortic lumen, managed with deep hypothermic circulatory arrest and aortic thromboendarterectomy. To our knowledge, this is the first reported case of atherosclerotic plaque resulting in aortic occlusion and requiring emergent operative intervention.

  6. Chronic low-dose exposure in the Techa River cohort. Risk of mortality from circulatory diseases

    Energy Technology Data Exchange (ETDEWEB)

    Krestinina, Lyudmila Yurievna; Epifanova, Svetlana; Silkin, Stanislav; Mikryukova, Lyudmila; Degteva, Marina; Shagina, Natalia; Akleyev, Alexander [Urals Research Center for Radiation Medicine, Chelyabinsk (Russian Federation)

    2013-03-15

    The aim of the present study was to analyze the mortality from circulatory diseases for about 30,000 members of the Techa River cohort over the period 1950-2003, and to investigate how these rates depend on radiation doses. This population received both external and internal exposures from {sup 90}Sr, {sup 89}Sr, {sup 137}Cs, and other uranium fission products as a result of waterborne releases from the Mayak nuclear facility in the Southern Urals region of the Russian Federation. The analysis included individualized estimates of the total (external plus internal) absorbed dose in muscle calculated based on the Techa River Dosimetry System 2009. The cohort-average dose to muscle tissue was 35 mGy, and the maximum dose was 510 mGy. Between 1950 and 2003, 7,595 deaths from circulatory diseases were registered among cohort members with 901,563 person years at risk. Mortality rates in the cohort were analyzed using a simple parametric excess relative risk (ERR) model. For all circulatory diseases, the estimated excess relative risk per 100 mGy with a 15-year lag period was 3.6 % with a 95 % confidence interval of 0.2-7.5 %, and for ischemic heart disease it was 5.6 % with a 95 % confidence interval of 0.1-11.9 %. A linear ERR model provided the best fit. Analyses with a lag period shorter than 15 years from the beginning of exposure did not reveal any significant risk of mortality from either all circulatory diseases or ischemic heart disease. There was no evidence of an increased mortality risk from cerebrovascular disease (p > 0.5). These results should be regarded as preliminary, since they will be updated after adjustment for smoking and alcohol consumption. (orig.)

  7. Fructose-1,6-bisphosphate for improved outcome after hypothermic circulatory arrest in pigs.

    Science.gov (United States)

    Romsi, Pekka; Kaakinen, Timo; Kiviluoma, Kai; Vainionpää, Vilho; Hirvonen, Jorma; Pokela, Matti; Ohtonen, Pasi; Biancari, Fausto; Nuutinen, Matti; Juvonen, Tatu

    2003-03-01

    Fructose-1,6-bisphosphate is a high-energy intermediate in the anaerobic metabolism. It enhances glycolysis, preserves cellular adenosine triphosphate, and prevents the increase of intracellular calcium during ischemia. The potential neuroprotective effect of fructose-1,6-bisphosphate during hypothermic circulatory arrest was evaluated in a surviving porcine model. Twenty-four pigs were randomly assigned to receive two intravenous infusions of either fructose-1,6-bisphosphate (500 mg/kg) or saline solution. The first infusion was given immediately before a 75-minute period of hypothermic circulatory arrest and the second was given immediately after hypothermic circulatory arrest. The 7-day survivals were 83.3% in the fructose-1,6-bisphosphate group and 41.7% in the control group (P =.09). The treated animals had significantly better postoperative behavioral scores. The administration of fructose-1,6-bisphosphate was associated with higher venous phosphate and sodium levels, lower venous ionized calcium levels, higher blood osmolarity, and a better fluid balance. Intracranial pressure and venous creatine kinase isoenzyme MB were significantly lower in the fructose-1,6-bisphosphate group during rewarming (P =.01 and P =.001, respectively). Among the treated animals, brain glucose, pyruvate and lactate levels tended to be higher, brain glycerol levels tended to be lower, and the histopathologic score of the brain was significantly lower (P =.04). Intravenous administration of fructose-1,6-bisphosphate at 500 mg/kg before and after hypothermic circulatory arrest in a surviving porcine model was associated with better survival, behavioral outcome, and histopathologic score. The observed lower blood creatine kinase isoenzyme MB and brain glycerol levels and the higher brain glucose, pyruvate, and lactate levels in the fructose-1,6-bisphosphate group suggest that this drug has supportive effects on myocardial and brain metabolisms.

  8. The Impact of Ionospheric and Geomagnetic Changes on Mortality from Diseases of the Circulatory System

    Czech Academy of Sciences Publication Activity Database

    Podolská, Kateřina

    2018-01-01

    Roč. 27, č. 2 (2018), s. 404-417 ISSN 1052-3057 Institutional support: RVO:68378289 Keywords : mortality * circulatory system diseases * solar indices * cluster analysis using time Subject RIV: DN - Health Impact of the Environment Quality OBOR OECD: Public and environmental health Impact factor: 1.517, year: 2016 http://www.strokejournal.org/article/S1052-3057(17)30488-3/fulltext

  9. Mechanical support with venoarterial extracorporeal membrane oxygenation (ECMO-VA): Short-term and long-term prognosis after a successful weaning.

    Science.gov (United States)

    García-Gigorro, R; Renes-Carreño, E; Pérez-Vela, J L; Marín-Mateos, H; Gutiérrez, J; Corrés-Peiretti, M A; Delgado, J F; Pérez-de la Sota, E; Cortina-Romero, J M; Montejo-González, J C

    2017-12-01

    Extracorporeal membrane oxygenation (ECMO) affords mechanical circulatory assistance associated to high mortality. However, weaning from such mechanical support may not imply improved short- or long-term survival. This study describes the characteristics and evolution of patients with refractory cardiogenic shock (RCS) subjected to venoarterial ECMO (VA-ECMO) in a hospital with a heart transplant program. A single-center, retrospective cohort study was carried out. The cardiovascular ICU of a tertiary hospital. Forty-six patients consecutively subjected to VA-ECMO over 6 years. Hospital mortality after weaning from ECMO and overall survival (OS) were analyzed. Fifteen patients (33%) died with VA-ECMO and 31 (67%) were weaned after 8 days of support (IQR: 5-15). Fourteen patients under went transplantation. Hospital mortality in these patients was 32% (10/31), and was associated to age (P=.001), SAPS II score (P=.009), cannulation bleeding (P=.01) and post-acute myocardial infarction RCS (P=.001). After a median follow-up of 27 months (IQR: 11-49), 91% of the patients discharged from hospital were still alive. Overall survival after weaning from assistance was associated to the type of cardiac disease (P=.002). Patients with RCS after acute myocardial infarction had a poorer prognosis. In our experience, VA-ECMO can be used as mechanical assistance in the management of RCS. The technique is associated to high early mortality, though the long-term survival rate after hospital discharge is good. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  10. Ten thousand kilometre transfer of cardiogenic shock patients on venoarterial extracorporeal membrane oxygenation for emergency heart transplantation: Cooperation between Reunion Island and Metropolitan France.

    Science.gov (United States)

    Charon, Clément; Allyn, Jérôme; Bouchet, Bruno; Nativel, Fréderic; Braunberger, Eric; Brulliard, Caroline; Martinet, Olivier; Allou, Nicolas

    2017-06-01

    There is no heart transplantation centre on the French overseas territory of Reunion Island (distance of 10,000 km). The aim of this study was to describe the characteristics of cardiogenic shock adult patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) who were transferred from Reunion Island to mainland France for emergency heart transplantation. This retrospective observational study was conducted between 2005 and 2015. The characteristics and outcome of cardiogenic shock patients on VA-ECMO were compared with those of cardiogenic shock patients not on VA-ECMO. Thirty-three cardiogenic shock adult patients were transferred from Reunion Island to Paris for emergency heart transplantation. Among them, 19 (57.6%) needed mechanical circulatory support in the form of VA-ECMO. Median age was 51 (33-57) years and 46% of the patients had ischaemic heart disease. Patients on VA-ECMO presented higher Sequential Organ Failure Assessment score ( p = 0.03). No death occurred during the medical transfer by long flight, while severe complications occurred in 10 patients (30.3%). Incidence of thromboembolic events, severe infectious complications and major haemorrhages was higher in the group of patients on VA-ECMO than in the group of patients not on VA-ECMO ( p <0.01). Seven patients from the VA-ECMO group (36.8%) and six patients from the non-VA-ECMO group (42.9%, p=0.7) underwent heart transplantation after a median delay of 10 (4-29) days on the emergency waiting list. After heart transplantation, one-year survival rates were 85.7% for patients on VA-ECMO and 83.3% for patients not on VA-ECMO ( p=0.91). This study suggests the feasibility of very long-distance medical evacuation of cardiogenic shock patients on VA-ECMO for emergency heart transplantation, with acceptable long-term results.

  11. Using the brain criterion in organ donation after the circulatory determination of death.

    Science.gov (United States)

    Dalle Ave, Anne L; Bernat, James L

    2016-06-01

    The UK, France, and Switzerland determine death using the brain criterion even in organ donation after the circulatory determination of death (DCDD), in which the United States and Canada use the circulatory-respiratory criterion. In our analysis of the scientific validity of the brain criterion in DCDD, we concluded that although it may be attractive in theory because it conceptualizes death as a unitary phenomenon, its use in practice is invalid. The preconditions (ie, the absence of reversible causes, such as toxic or metabolic disorders) for determining brain death cannot be met in DCDD. Thus, although brain death tests prove the cessation of tested brain functions, they do not prove that their cessation is irreversible. A stand-off period of 5 to 10 minutes is insufficient to achieve the irreversibility requirement of brain death. Because circulatory cessation inevitably leads to cessation of brain functions, first permanently and then irreversibly, the use of brain criterion is unnecessary to determine death in DCDD. Expanding brain death to permit it to be satisfied by permanent cessation of brain functions is controversial but has been considered as a possible means to declare death in uncontrolled DCDD. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Can cellulite be treated with low-energy extracorporeal shock wave therapy?

    Science.gov (United States)

    Angehrn, Fiorenzo; Kuhn, Christoph; Voss, Axel

    2007-01-01

    The present study investigates the effects of low-energy defocused extracorporeal generated shock waves on collagen structure of cellulite afflicted skin. Cellulite measurement using high-resolution ultrasound technology was performed before and after low-energy defocused extracorporeal shock wave therapy (ESWT) in 21 female subjects. ESWT was applied onto the skin at the lateral thigh twice a week for a period of six weeks. Results provide evidence that low-energy defocused ESWT caused remodeling of the collagen within the dermis of the tested region. Improving device-parameters and therapy regimes will be essential for future development of a scientific based approach to cellulite treatment. PMID:18225463

  13. Sedation Management in Children Supported on Extracorporeal Membrane Oxygenation for Acute Respiratory Failure.

    Science.gov (United States)

    Schneider, James B; Sweberg, Todd; Asaro, Lisa A; Kirby, Aileen; Wypij, David; Thiagarajan, Ravi R; Curley, Martha A Q

    2017-10-01

    To describe sedation management in children supported on extracorporeal membrane oxygenation for acute respiratory failure. Secondary analysis of prospectively collected data from a multicenter randomized trial of sedation (Randomized Evaluation of Sedation Titration for Respiratory Failure). Twenty-one U.S. PICUs. One thousand two hundred fifty-five children, 2 weeks to 17 years old, with moderate/severe pediatric acute respiratory distress syndrome. Sedation managed per usual care or Randomized Evaluation of Sedation Titration for Respiratory Failure protocol. Sixty-one Randomized Evaluation of Sedation Titration for Respiratory Failure patients (5%) with moderate/severe pediatric acute respiratory distress syndrome were supported on extracorporeal membrane oxygenation, including 29 managed per Randomized Evaluation of Sedation Titration for Respiratory Failure protocol. Most extracorporeal membrane oxygenation patients received neuromuscular blockade (46%) or were heavily sedated with State Behavioral Scale scores -3/-2 (34%) by extracorporeal membrane oxygenation day 3. Median opioid and benzodiazepine doses on the day of cannulation, 0.15 mg/kg/hr (3.7 mg/kg/d) and 0.11 mg/kg/hr (2.8 mg/kg/d), increased by 36% and 58%, respectively, by extracorporeal membrane oxygenation day 3. In the 41 patients successfully decannulated prior to study discharge, patients were receiving 0.40 mg/kg/hr opioids (9.7 mg/kg/d) and 0.39 mg/kg/hr benzodiazepines (9.4 mg/kg/d) at decannulation, an increase from cannulation of 108% and 192%, respectively (both p withdrawal than moderate/severe pediatric acute respiratory distress syndrome patients managed without extracorporeal membrane oxygenation support (p managed per Randomized Evaluation of Sedation Titration for Respiratory Failure protocol, usual care extracorporeal membrane oxygenation patients received more opioids during the study period (mean cumulative dose of 183.0 vs 89.8 mg/kg; p = 0.02), over 6

  14. Empirical correlation methods for temporary anions.

    Science.gov (United States)

    Sommerfeld, Thomas; Weber, Rebecca J

    2011-06-23

    A temporary anion is a short-lived radical anion that decays through electron autodetachment into a neutral molecule and a free electron. The energies of these metastable species are often predicted using empirical correlation methods because ab initio predictions are computationally very expensive. Empirical correlation methods can be justified in the framework of Weisskopf-Fano-Feshbach theory but tend to work well only within closely related families of molecules or within a restricted energy range. The reason for this behavior can be understood using an alternative theoretical justification in the framework of the Hazi-Taylor stabilization method, which suggests that the empirical parameters do not so much correct for the coupling of the computed state to the continuum but for electron correlation effects and that therefore empirical correlation methods can be improved by using more accurate electronic structure methods to compute the energy of the confined electron. This idea is tested by choosing a heterogeneous reference set of temporary states and comparing empirical correlation schemes based on Hartree-Fock orbital energies, Kohn-Sham orbital energies, and attachment energies computed with the equation-of-motion coupled-cluster method. The results show that using more reliable energies for the confined electron indeed enhances the predictive power of empirical correlation schemes and that useful correlations can be established beyond closely related families of molecules. Certain types of σ* states are still problematic, and the reasons for this behavior are analyzed. On the other hand, preliminary results suggest that the new scheme can even be useful for predicting energies of bound anions at a fraction of the computational cost of reliable ab initio calculations. It is then used to make predictions for bound and temporary states of the furantrione and croconic acid radical anions.

  15. Temporary new opening hours for Gate C

    CERN Multimedia

    GS Department

    2010-01-01

    Please note the new temporary opening hours for the gate C as from 22 September 2010 until 29 October 2010 (working days): Morning: between 7:00 a.m. and 9:00 a.m. Lunch: between 12:00 and 2:00 p.m. Evening: between 5:00 pm and 7:00 p.m. Traffic flow will be permitted in both directions during this period. Please minimize your speed accordingly and respect all road signs. GS-SEM Group General Infrastructure Services Department

  16. Criteria for diagnosis of temporary gluten intolerance.

    Science.gov (United States)

    McNeish, A S; Rolles, C J; Arthur, L J

    1976-04-01

    Strict criteria for the diagnosis of temporary gluten intolerance are formulated in the light of the case of an 8-week-old infant with severe diarrhoea and failure to thrive, who recovered on an elimination diet that was gluten-free. 8 weeks later an oral challenge with 2.5 g twice daily of powdered gluten for one day produced diarrhoea, weight loss, and impaired xylose absorption. Gluten was successfully reintroduced into the diet 9 months later without incident. Jejunal histology remains normal after 26 months of a daily diet that contains 5 to 10 g gluten.

  17. Temporary effects of alcohol on color vision

    Science.gov (United States)

    Geniusz, Maciej K.; Geniusz, Malwina; Szmigiel, Marta; Przeździecka-Dołyk, Joanna

    2017-09-01

    The color vision has been described as one to be very sensitive to the intake of several chemicals. The present research reviews the published literature that is concerned with color vision impairment due to alcohol. Most of this research considers people under long-term effects of alcohol. However, there is little information about temporary effects of alcohol on color vision. A group of ten volunteers aged 18-40 was studied. During the study levels of alcohol in the body were tested with a standard breathalyzer while color vision were studied using Farnsworth Munsell 100 Hue Color Vision Tests. Keywords: Col

  18. Local hypertrichosis: A rare complication of a temporary henna tattoo.

    Science.gov (United States)

    Akpolat, Nebahat Demet; Aras, Arzu

    2016-01-01

    Temporary henna tattoos have become increasingly widespread among children and young people, especially in holiday spots in recent years. Although reactions to henna tattoo are becoming progressively more common, only few cases of a henna pseudo-tattoo resulting in temporary hypertrichosis have been reported so far. Here, we have reported a 5-year-old girl who developed allergic contact dermatitis and localized hypertrichosis on her right arm after application of temporary henna tattoo during summer holiday.

  19. Mechanical Circulatory Support for the Failing Heart: Which Device to Choose

    Directory of Open Access Journals (Sweden)

    Mustafa Ahmed, MD

    2015-10-01

    Full Text Available Critical cardiogenic shock remains a problem with staggering mortality, with the best hope of survival depending on timely and aggressive intervention. This often requires the use of extracorporeal mechanical support in addition to vasoactive medications to manage patients through their initial insult. The decision to use such support must be made early in the clinical presentation, and is best done in a multidisciplinary fashion. In this article, we review the literature and provide an algorithm for the treatment of cardiogenic shock.

  20. A Donation After Circulatory Death Program Has the Potential to Increase the Number of Donors After Brain Death.

    Science.gov (United States)

    Broderick, Andrew R; Manara, Alex; Bramhall, Simon; Cartmill, Maria; Gardiner, Dale; Neuberger, James

    2016-02-01

    Donation after circulatory death has been responsible for 75% of the increase in the numbers of deceased organ donors in the United Kingdom. There has been concern that the success of the donation after circulatory death program has been at the expense of donation after brain death. The objective of the study was to ascertain the impact of the donation after circulatory death program on donation after brain death in the United Kingdom. Retrospective cohort study. A national organ procurement organization. Patients referred and assessed as donation after circulatory death donors in the United Kingdom between October and December 2013. None. A total of 257 patients were assessed for donation after circulatory death. Of these, 193 were eligible donors. Three patients were deemed medically unsuitable following surgical inspection, 56 patients did not proceed due to asystole, and 134 proceeded to donation. Four donors had insufficient data available for analysis. Therefore, 186 cases were analyzed in total. Organ donation would not have been possible in 79 of the 130 actual donors if donation after circulatory death was not available. Thirty-six donation after circulatory death donors (28% of actual donors) were judged to have the potential to progress to brain death if withdrawal of life-sustaining treatment had been delayed by up to a further 36 hours. A further 15 donation after circulatory death donors had brain death confirmed or had clinical indications of brain death with clear mitigating circumstances in all but three cases. We determined that the maximum potential donation after brain death to donation after circulatory death substitution rate observed was 8%; however due to mitigating circumstances, only three patients (2%) could have undergone brain death testing. The development of a national donation after circulatory death program has had minimal impact on the number of donation after brain death donors. The number of donation after brain death donors

  1. Logistics and safety of extracorporeal membrane oxygenation in medical retrieval.

    Science.gov (United States)

    Burns, Brian J; Habig, Karel; Reid, Cliff; Kernick, Paul; Wilkinson, Chris; Tall, Gary; Coombes, Sarah; Manning, Ron

    2011-01-01

    This article reviews the logistics and safety of extracorporeal membrane oxygenation (ECMO) medical retrieval in New South Wales, Australia. We describe the logistics involved in ECMO road and rotary-wing retrieval by a multidisciplinary team during the H1N1 influenza epidemic in winter 2009 (i.e., June 1 to August 31, 2009). Basic patient demographics and key retrieval time lines were analyzed. There were 17 patients retrieved on ECMO, with their ages ranging from 22 to 55 years. The median weight was 110 kg. Four critical events were recorded during retrieval, with no adverse outcomes. The retrieval distance varied from 20.8 to 430 km. There were delays in times from retrieval booking to both retrieval tasking and retrieval team departure in 88% of retrievals. The most common reasons cited were "patient not ready" 23.5% (4/17); "vehicle not available," 23.5% (4/17); and "complex retrieval," 41.2% (7/17). The median time (hours:minutes) from booking with the medical retrieval unit (MRU) to tasking was 4:35 (interquartile range [IQR] 3:27-6:15). The median time lag from tasking to departure was 1:00 (IQR 00:10-2:20). The median stabilization time was 1:30 (IQR 1:20-1:55). The median retrieval duration was 7:35 (IQR 5:50-10:15). The process of development of ECMO retrieval was enabled by the preexistence of a high-volume experienced medical retrieval service. Although ECMO retrieval is not a new concept, we describe an entire process for ECMO retrieval that we believe will benefit other retrieval service providers. The increased workload of ECMO retrieval during the swine flu pandemic has led to refinement in the system and process for the future.

  2. Liver support by extracorporeal blood purification: a clinical observation.

    Science.gov (United States)

    Stange, J; Mitzner, S R; Klammt, S; Freytag, J; Peszynski, P; Loock, J; Hickstein, H; Korten, G; Schmidt, R; Hentschel, J; Schulz, M; Löhr, M; Liebe, S; Schareck, W; Hopt, U T

    2000-09-01

    Liver failure associated with excretory insufficiency and jaundice results in an endogenous accumulation of toxins involved in the impairment of cardiovascular, kidney, and cerebral function. Moreover, these toxins have been shown to damage the liver itself by inducing hepatocellular apoptosis and necrosis, thus creating a vicious cycle of the disease. We report a retrospective cohort study of 26 patients with acute or chronic liver failure with intrahepatic cholestasis (bilirubin level > 20 mg/dL) who underwent a new extracorporeal blood purification treatment. A synthetic hydrophilic/hydrophobic domain-presenting semipermeable membrane (pore size MARS]). Bile acid and bilirubin levels, representing the previously described toxins, were reduced by 16% to 53% and 10% to 90% of the initial concentration by a single treatment of 6 to 8 hours, respectively. Toxicity testing of patient plasma onto primary rat hepatocytes by live/dead fluorescence microscopy showed cell-damaging effects of jaundiced plasma that were not observed after treatment. Patients with a worsening of Child-Turcotte-Pugh (CTP) index before the treatments showed a significant improvement of this index during a period of 2 to 14 single treatments with an average of 14 days. After withdrawal of MARS treatment, this improvement was sustained in all long-term survivors. Ten patients represented a clinical status equivalent to the United Network for Organ Sharing (UNOS) status 2b (group A1), and all survived. Sixteen patients represented a clinical status equivalent to UNOS status 2a, and 7 of these patients survived (group A2), whereas 9 patients (group B) died. We conclude that in acute excretory failure caused by a chronic liver disease, this treatment provides a therapy option to remove toxins involved in multiorgan dysfunction secondary to liver failure.

  3. Financial and clinical outcomes of extracorporeal mechanical support.

    Science.gov (United States)

    Chiu, Ryan; Pillado, Eric; Sareh, Sohail; De La Cruz, Kim; Shemin, Richard J; Benharash, Peyman

    2017-03-01

    Over the past decade, extracorporeal mechanical support (ECMO) has been increasingly utilized in respiratory failure and cardiogenic shock. There is a need for assessing clinical and financial outcomes of ECMO use. This study presents our institution's experience with veno-arterial ECMO (VA-ECMO) over a 9-year period. A retrospective review of our institution's ECMO database identified patients undergoing VA-ECMO between 2005 and 2013 (N = 150). Patients were assigned to four groups by indication: post-cardiotomy syndrome, cardiogenic shock requiring cardiopulmonary resuscitation (CPR), cardiogenic shock not requiring CPR, and respiratory failure. Hospital charges from administrative records were analyzed. Trend and correlation analyses were used to evaluate clinical and financial outcomes. Of the 150 patients meeting inclusion criteria, 28% required VA-ECMO for post-cardiotomy syndrome, 31.3% for cardiogenic shock with CPR, 35.3% for cadiogenic shock with no CPR, and 5.4% for respiratory failure. Mean duration on ECMO was 5.0 ± 3.4 days with a survival rate of 64% and no difference between the four groups (p = 0.40). ECMO-associated charges averaged $74,500 ± 61,400 per patient, 6% of total hospital charges. Subgroup analysis of cardiogenic shock patients revealed a nearly twofold increase in ECMO-related charges among patients who did not receive CPR (p = 0.04), as well as a trend toward improved survival (69.8% vs 51.1%, p = 0.06). In view of the variations in survival and costs in ECMO patients, further studies should aim to delineate patient populations that benefit from early initiation of ECMO. © 2017 Wiley Periodicals, Inc.

  4. Extracorporeal life support in the treatment of colchicine poisoning.

    Science.gov (United States)

    Boisramé-Helms, Julie; Rahmani, Hassène; Stiel, Laure; Tournoud, Christine; Sauder, Philippe

    2015-01-01

    Ingestions of Colchicum autumnale may lead to severe poisoning. It begins with gastrointestinal symptoms and leukocytosis, followed by multi-organ failure with shock and a possible late recovery phase. Mortality is highly dependent on the ingested dose. We report a case of accidental C. autumnale poisoning with refractory cardiogenic shock and eventual survival after extracorporeal life support (ECLS). A 68-year-old woman was admitted to the intensive care unit (ICU) on day 3 after ingestion of C. autumnale in a meal. She first suffered from nausea and vomiting leading to severe dehydration. She then developed multi-organ failure and refractory cardiogenic shock, with a mean arterial pressure nadir of 50 mmHg despite high doses of catecholamines and a left ventricular ejection fraction at 5-10%. Venous-arterial ECLS was therefore started at an initial rate of 3.5 L/min and 3,800 rev/min. Her symptoms also included pancytopenia on day 4 with diffuse bleeding requiring iterative blood product transfusion. Platelet and leukocyte count nadirs were 13 × 10(9)/L (normal range: 150-400 × 10(9)/L) and 0.77 × 10(9)/L (normal range: 4.2-10.7 × 10(9)/L), respectively. ECLS allowed good cardiac contractility recovery within a few days, with complications including bleeding made controllable. Indeed, because of hemostasis disorders, the patient presented hemoptysis and hematuria. She was treated with tranexamic acid and transfused with blood products. She received 15 erythrocyte concentrates, 13 platelet concentrates, and 7 fresh frozen plasma. ECLS was removed by day 10, with subsequent weaning from mechanical ventilation as well as from hemodialysis in the following days. This patient survives after the use of ECLS in Colchicum poisoning, with controllable complications. Thus, ECLS might be indicated to overcome the potentially refractory cardiogenic shock phase.

  5. Extracorporeal treatments in a dapsone overdose: a case report.

    Science.gov (United States)

    Ghannoum, Marc; Cormier, Monique; Bernier-Jean, Amélie; Brindamour, Dave; Déziel, Clément; Bouchard, Josée

    2016-11-01

    Intentional dapsone intoxication can be life-threatening. There is limited data on the clinical effect of extracorporeal treatments (ECTRs) on dapsone elimination. We describe a case of severe dapsone toxicity treated with different ECTRs. A 23-year-old woman was admitted 2.5 h after ingesting 2.2 g of dapsone. She developed methemoglobinemia (39.9%) and showed signs of toxicity (hemodynamic instability and altered mental status) despite multiple-activated charcoal, methylene blue, vasopressors and endotracheal intubation. Continuous venovenous hemofiltration (CVVH) was then initiated for 5 h, followed by intermittent hemodialysis with hemoperfusion (IHD-HP) for 4 h, and CVVH for another 48 h. The platelet count decreased to 32 × 10 9 /L 3 h after IHD-HP. The elimination half-life of dapsone was 2.0 h during IHD-HP, and 14.2 h during CVVH. Mean dapsone clearance with IHD was 62 mL/min versus 22 mL/min with CVVH. IHD removed 95.3 mg, and CVVH removed 67.8 mg over 3.8 h. No rebound occurred following ECTR cessation. The toxicokinetics of dapsone metabolites were also accelerated during ECTR. The patient was extubated after 3.5 days and discharged without sequelae after 7 days. Dapsone clearance was enhanced by ECTR, especially by IHD-HP. However, HP was associated with severe asymptomatic thrombocytopenia.

  6. Extracorporeal shock wave therapy in calcific tendinitis of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Peters, Jutta [Bethanien Krankenhaus, Department of Radiology, Frankfurt am Main (Germany); University Hospital Frankfurt, Department of Radiology, Frankfurt am Main (Germany); Luboldt, Wolfgang; Schwarz, Wolfram; Jacobi, Volkmar; Herzog, Christopher; Vogl, Thomas J. [University Hospital Frankfurt, Department of Radiology, Frankfurt am Main (Germany)

    2004-12-01

    To investigate clinical (pain, mobility) and radiological (resolution of calcium deposits) efficacy of different energy levels of extracorporeal shock wave therapy (ESWT) in calcific tendinitis of the shoulder. There were 90 study subjects with radiographically verified calcific tendinitis of one shoulder, mean age 52{+-}6 years (range 29 - 65 years; females:males=55:35), all of whom had had symptoms for at least 6 months and substantial restriction of shoulder mobility and pain that required taking anti-inflammatory drugs. Calcium deposits were of type I or type II (clearly circumscribed and dense) and ranged from 1 cm to 3 cm in diameter. Subjects were divided into three groups to receive ESWT at one of two energy levels (E{sub 1}=0.15 mJ/mm{sup 2}, E{sub 2}=0.44 mJ/mm{sup 2}) or sham treatment. Treatment was given at 6 weekly intervals until symptoms resolved, five treatments had been given or the subject dropped out of the programme. All subjects in groups E{sub 1} and E{sub 2} completed the programme. Those in group E{sub 1} had significantly less pain during treatment but more treatments than those in group E{sub 2}, and at 6 month follow-up had residual calcification and recurrence of pain (87%). Subjects in group E{sub 2} had no residual calcification or recurrence of pain. Sham treatment had no effect. There were no side effects except a small number of haematomas (2 in E{sub 1}, 6 in E{sub 2}; maximum size 2 cm). ESWT in calcific tendinitis of the shoulder is very effective. It does not have significant side effects at an energy level of E=0.44 mJ/mm{sup 2}, which can therefore be recommended. (orig.)

  7. Prolonged Extracorporeal Membrane Oxygenation Support for Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    Wen-Je Ko

    2006-01-01

    Full Text Available When all conventional treatments for respiratory failure in patients with acute respiratory distress syndrome (ARDS have failed, extracorporeal membrane oxygenation (ECMO can provide a chance of survival in these desperately ill patients. A 49-year-old male patient developed septic shock and progressive ARDS after liver abscess drainage. Venovenous ECMO was given due to refractory respiratory failure on postoperative day 6. Initially, two heparin-binding hollow-fiber microporous membrane oxygenators in parallel were used in the ECMO circuit. Twenty-two oxygenators were changed in the first 22 days of ECMO support because of plasma leak in the oxygenators. Each oxygenator had an average life of 48 hours. Thereafter, a single silicone membrane oxygenator was used in the ECMO circuit, which did not require change during the remaining 596 hours of ECMO. The patient's tidal volume was only 90 mL in the nadir and less than 300 mL for 26 days during the ECMO course. The patient required ECMO support for 48 days and survived despite complications, including septic shock, ARDS, acute renal failure, drug-induced leukopenia, and multiple internal bleeding. This patient received an unusually long duration of ECMO support. However, he survived, recovered well, and was in New York Heart Association functional class I-II, with a forced expiratory volume in 1 second of 81% of the predicted level 18 months later. In conclusion, ECMO can provide a chance of survival for patients with refractory ARDS. The reversibility of lung function is possible in ARDS patients regardless of the severity of lung dysfunction at the time of treatment.

  8. Management of Surge in Extracorporeal Membrane Oxygenation Transport.

    Science.gov (United States)

    Salna, Michael; Chicotka, Scott; Biscotti, Mauer; Agerstrand, Cara; Liou, Peter; Ginsburg, Mark; Oommen, Roy; Sonett, Joshua R; Brodie, Daniel; Bacchetta, Matthew

    2017-11-23

    Transporting patients receiving extracorporeal membrane oxygenation (ECMO) support is safe and reliable with a dedicated program and established management protocols. As our program has grown, our teams have had to adapt to manage surges in transport volume while maintaining patient safety. We assessed the outcomes at peak use of our ECMO transport services during surges. We conducted a single-center retrospective review of all patients transported to our institution while supported with ECMO from September 2008 to September 2016. Survival to discharge was the primary outcome. Surge patients were defined as those transported during months with at least 8 transports or patients transported within 24 hours of another patient in nonsurge months. From 2008 to 2016, 222 patients were transported to our institution while supported with ECMO. Baseline characteristics and indices of disease severity were comparable between surge and nonsurge patients. Of the 84 patients transported during surges, 59 surge patients (70%) survived to hospital discharge vs 86 (63%) of nonsurge patients (p = 0.31). Multivariable logistic regression showed that age and APACHE II (Acute Physiology and Chronic Health Evaluation) severity index score were predictors of in-hospital death (p surge was not (odds ratio, 0.91; 95% confidence interval, 0.46 to 1.80; p = 0.79). Patient safety and clinical outcomes can be maintained during surges in ECMO transport volume if the ECMO program has developed plans for handling transient increases in volume and considers staff fatigue and burnout. Standardizing interhospital communication, patient selection, and management protocols are critical to maintaining quality of care. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Remote effects of extracorporeal shock wave therapy on cutaneous microcirculation.

    Science.gov (United States)

    Kisch, Tobias; Sorg, Heiko; Forstmeier, Vinzent; Knobloch, Karsten; Liodaki, Eirini; Stang, Felix; Mailänder, Peter; Krämer, Robert

    2015-11-01

    Extracorporeal shock wave treatment (ESWT) has proven its clinical benefits in different fields of medicine. Tissue regeneration and healing is improved after shock wave treatment. Even in the case of burn wounds angiogenesis and re-epithelialization is accelerated, but ESWT in extensive burn wounds is impracticable. High energy ESWT influences cutaneous microcirculation at body regions remote from application site. Eighteen Sprague Dawley rats were randomly assigned to two groups and received either high energy ESWT (Group A: total 1000 impulses, 10 J) or placebo shock wave treatment (Group B: 0 impulses, 0 J), applied to the dorsal lower leg of the hind limb. Ten minutes later microcirculatory effects were assessed at the contralateral lower leg of the hind limb (remote body region) by combined Laser-Doppler-Imaging and Photospectrometry. In Group A cutaneous capillary blood velocity was significantly increased by 152.8% vs. placebo ESWT at the remote body location (p = 0.01). Postcapillary venous filling pressure remained statistically unchanged (p > 0.05), while cutaneous tissue oxygen saturation increased by 12.7% in Group A (p = 0.220). High energy ESWT affects cutaneous hemodynamics in body regions remote from application site in a standard rat model. The results of this preliminary study indicate that ESWT might be beneficial even in disseminated and extensive burn wounds by remote shock wave effects and should therefore be subject to further scientific evaluation. Copyright © 2015 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  10. The effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis

    Science.gov (United States)

    Lee, Ji-Hyun; Lee, Sangyong; Choi, SeokJoo; Choi, Yoon-Hee; Lee, Kwansub

    2017-01-01

    [Purpose] The purpose of this study was to identify the effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis. [Subjects and Methods] Twenty patients with degenerative knee arthritis were divided into a conservative physical therapy group (n=10) and an extracorporeal shock wave therapy group (n=10). Both groups received general conservative physical therapy, and the extracorporeal shock wave therapy was additionally treated with extracorporeal shock wave therapy after receiving conservative physical therapy. Both groups were treated three times a week over a four-week period. The visual analogue scale was used to evaluate pain in the knee joints of the subjects, and the Korean Western Ontario and McMaster Universities Osteoarthritis Index was used to evaluate the function of the subjects. [Results] The comparison of the visual analogue scale and Korean Western Ontario and McMaster Universities Osteoarthritis Index scores within each group before and after the treatment showed statistically significant declines in scores in both the conservative physical therapy group and extracorporeal shock wave therapy group. A group comparison after the treatment showed statistically significant differences in these scores in the extracorporeal shock wave therapy group and the conservative physical therapy group. [Conclusion] extracorporeal shock wave therapy may be a useful nonsurgical intervention for reducing the pain of patients with degenerative knee arthritis and improving these patients’ function. PMID:28356649

  11. Percutaneous extracorporeal membrane oxygenation in electrical storm: five case reports addressing efficacy, transferring allowance or radiofrequency ablation support.

    Science.gov (United States)

    Uribarri, Aitor; Bravo, Loreto; Jimenez-Candil, Javier; Martin-Moreiras, Javier; Villacorta, Eduardo; Sanchez, Pedro L

    2017-09-01

    Extracorporeal membrane oxygenation systems have undergone rapid technological improvements and are now feasible options for medium-term support of severe cardiac or pulmonary failure. We report five cases of electrical storm that was rescued by the insertion of peripheral veno-arterial extracorporeal membrane oxygenation systems. This device could help to restore systemic circulation as well as permitting organ perfusion in patients with cardiogenic shock in relation to electrical storm thus achieving greater electrical stability. Also, in some cases extracorporeal membrane oxygenation support could facilitate electrophysiology study.

  12. extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital refractory cardiac arrest

    DEFF Research Database (Denmark)

    Obling, Laust; Wiberg, Sebastian; Møller, Jacob Eifer

    2017-01-01

    Out-of-hospital cardiac arrest is associated with high mortality and morbidity. Treatment options remain few in refractory cases, but extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly applied to improve the outcome. This article summarizes the use, experience and outcome of e...

  13. Extracorporeal Membrane Oxygenation (ECMO): A Treatment for Neonates in Respiratory Failure.

    Science.gov (United States)

    Morris, Donna S.; Gonzalez, Lori S.; Stewart, Sharon R.; Sampers, Jackie

    2000-01-01

    A brief history is provided of extracorporeal membrane oxygenation (ECMO), a treatment option for infants that provides prolonged circulation and reoxgenation of blood outside the body to temporarily support a failing heart or lungs. The University of Kentucky ECMO program is described, along with the positive outcomes of 19 infants. (Contains…

  14. Feasibility of sedation and analgesia interruption following cannulation in neonates on extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    E.D. Wildschut (Enno); M.N. Hanekamp (Manon); N.J. Vet (Nienke); R.J.M. Houmes (Robert Jan); M.J. Ashman (Maurice); R.A.A. Mathôt (Ron); S.N. de Wildt (Saskia); D. Tibboel (Dick)

    2010-01-01

    textabstractPurpose: In most extracorporeal membrane oxygenation (ECMO) centers patients are heavily sedated to prevent accidental decannulation and bleeding complications. In ventilated adults not on ECMO, daily sedation interruption protocols improve short- and long-term outcome. This study aims

  15. Motor performance in five-year-old extracorporeal membrane oxygenation survivors: a population-based study.

    NARCIS (Netherlands)

    Nijhuis-Van der Sanden, M.W.G.; Cammen-van Zijp, M.H. van der; Janssen, A.J.M.; Reuser, J.J.C.M.; Mazer, P.; Heyst, A.F.J. van; Gischler, S.J.; Tibboel, D.; Kollee, L.A.A.

    2009-01-01

    INTRODUCTION: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a cardio-pulmonary bypass technique to provide life support in acute reversible cardio-respiratory failure when conventional management is not successful. Most neonates receiving ECMO suffer from meconium aspiration

  16. Gut hormone profiles in critically ill neonates on extracorporeal membrane oxygenation.

    NARCIS (Netherlands)

    Hanekamp, M.N.; Spoel, M.; Sharman-Koendjbiharie, M.; Hop, W.C.J.; Hopman, W.P.M.; Jansen, J.B.M.J.; Tibboel, D.

    2005-01-01

    OBJECTIVES: The objective of this study was to gain insight into the hormonal responses to enteral nutrition in critically ill newborns requiring venoarterial extracorporeal membrane oxygenation (ECMO) by analyzing plasma gut hormone levels of gastrin, cholecystokinin and peptide-YY in relation to

  17. The effect of epoprostenol on platelet activation and consumption during experimental extracorporeal perfusion

    DEFF Research Database (Denmark)

    Skogby, M; Adrian, K; Friberg, L

    1999-01-01

    Hemorrhages are major complications experienced in 10-35% of neonates treated with extracorporeal life support (ECLS). The increased bleeding tendency is partly due to an ECLS induced thrombocytopenia and impaired platelet function. In the present study, we evaluated the effect of epoprostenol...

  18. Motor performance in five-year-old extracorporeal membrane oxygenation survivors: A population-based study

    NARCIS (Netherlands)

    M.W.G. Nijhuis-van der Sanden (Maria); M.H.M. van der Cammen-van Zijp (Monique); A.J.W.M. Janssen (Anjo); J.J.C.M. Reuser (Jolanda); P. Mazer (Petra); A.F.J. van Heijst (Arno); S.J. Gischler (Saskia); D. Tibboel (Dick); L.A. Kollee

    2009-01-01

    textabstractIntroduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a cardio-pulmonary bypass technique to provide life support in acute reversible cardio-respiratory failure when conventional management is not successful. Most neonates receiving ECMO suffer from meconium

  19. Cytoflavin as an Additional Method for Myocardial Salvage During Operations Under Extracorporeal Circulation

    Directory of Open Access Journals (Sweden)

    Z. Z Nadiradze

    2006-01-01

    Full Text Available The paper presents the results of use of the combined antihypoxant Cytoflavin during operations under extracorporeal circulation. Twenty-nine patients operated on for rheumatic mitral valvular disease were examined. The examinations have shown that the use of Cytoflavin positively affects the restoration of cardiovascular performance and improved tissue oxygen transport in the postperfusion period.

  20. Pressure-Guided Positioning of Bicaval Dual-Lumen Catheters for Venovenous Extracorporeal Gas Exchange

    Science.gov (United States)

    2013-01-01

    Peterson-Carmichael S, Lin SS, Davis D, Zaas D (2011) Active rehabilitation and physical therapy during extracorporeal membrane oxygenation while...Defreyne L, Benoit DD, Decruyenaere J (2011) Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis

  1. Extracorporeal shockwave therapy in the treatment of chronic diabetic foot ulcers

    DEFF Research Database (Denmark)

    Jeppesen, S M; Yderstraede, K B; Rasmussen, B S B

    2016-01-01

    OBJECTIVE: To investigate the efficacy of extracorporeal shockwave therapy (ESWT) on healing chronic diabetic foot ulcers (DFU). METHOD: Patients with chronic DFUs were randomised (1:1) to receive a series of six ESWT treatments over 3 weeks in combination with standard care or standard care alone...

  2. Cyclosporine and Extracorporeal Photopheresis are Equipotent in Treating Severe Atopic Dermatitis

    DEFF Research Database (Denmark)

    Koppelhus, Uffe; Poulsen, Johan; Grunnet, Niels

    2014-01-01

    BACKGROUND: Severe atopic dermatitis (AD) is a recurrent and debilitating disease often requiring systemic immunosuppressive treatment. The efficacy of cyclosporine A (CsA) is well proven but potential side effects are concerning. Several reports point at extracorporeal photopheresis (ECP) as an ...

  3. Sensorineural hearing loss and language development following neonatal extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    D. van den Hondel (Desiree); M.J. Madderom (Marlous); A. Goedegebure (Andre); S.J. Gischler (Saskia); P. Mazer (Petra); D. Tibboel (Dick); H. IJsselstijn (Hanneke)

    2012-01-01

    textabstractOBJECTIVE: To determine the prevalence of hearing loss in school-age children who have undergone neonatal extracorporeal membrane oxygenation (ECMO) treatment and to identify any effects of hearing loss on speech- and language development. DESIGN: Prospective longitudinal follow-up

  4. Treatment of cutaneous calcinosis in CREST syndrome by extracorporeal shock wave lithotripsy.

    Science.gov (United States)

    Sparsa, Agnès; Lesaux, Nicolas; Kessler, Emmanuel; Bonnetblanc, Jean-Marie; Blaise, Sophie; Lebrun-Ly, Valérie; Colombeau, Pierre; Vidal, Elisabeth; Bédane, Christophe

    2005-11-01

    We describe the unusual case of a 78-year-old woman consulting for extensive and painful wound leg ulcerations and calcifications secondary to CREST syndrome that was treated by extracorporeal shock wave lithotripsy. This treatment was considered because of the severity of our patient's symptoms and her failure to respond to various medical and surgical treatment.

  5. Non-intubated recovery from refractory cardiogenic shock on percutaneous VA-extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    van Houte, J; Donker, D W; Wagenaar, L J; Slootweg, A P; Kirkels, J H; van Dijk, D

    We report on the use of percutaneous femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in a fully awake, non-intubated and spontaneously breathing patient suffering from acute, severe and refractory cardiogenic shock due to a (sub)acute anterior myocardial infarction. Intensified

  6. Extracorporeal shock waves lithotripsy of urinary organs in patients with one kidney

    Directory of Open Access Journals (Sweden)

    Zogović Jezdimir

    2002-01-01

    Full Text Available Extracorporeal Shock Waves Lithotripsy (ESWL is a method of choice in the treatment of lithiasis. Surgical treatment is reduced to minimum, which in our case means 1-2%. Contraindications for using this method are: blood coagulation disorders, manifest tuberculosis, pregnancy, over obesity. Thanks to appropriate indications and technique which is used in an adequate way as well as to various endurological manipulations, removal of a stone by this method is safe, trauma is minimised, which is very important for patients with one kidney. During the last three years, usually in hospital conditions, 57 patients were treated in this way. Removal of a stone was performed by Extracorporeal Shock Waves Lithotripsy as mono therapy in 30 (53% patients; Extracorporeal Shock Waves Lithotripsy by using Double-J catheter in 16 (28% patients; Extracorporeal Lithotripsy with urine derivation by percutaneous nephrostome in 11 (19% patients. Endurological methods were used in 27 patients. Disintegration of stone was performed in the proper way. Full success was reached. Two patients had incrustation of ureteral catheter which had to be removed by surgery. In two other patients with inferior function of one kidney, after brief obstruction, hemodialisis was performed. Our results confirm that this method is nonaggressive, tech nically perfect for disintegration of urineorgans stone on all levels followed by small complications which are often solved by endoscopie manipulations.

  7. CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure

    Directory of Open Access Journals (Sweden)

    Mugford Miranda

    2006-12-01

    Full Text Available Abstract Background An estimated 350 adults develop severe, but potentially reversible respiratory failure in the UK annually. Current management uses intermittent positive pressure ventilation, but barotrauma, volutrauma and oxygen toxicity can prevent lung recovery. An alternative treatment, extracorporeal membrane oxygenation, uses cardio-pulmonary bypass technology to temporarily provide gas exchange, allowing ventilator settings to be reduced. While extracorporeal membrane oxygenation is proven to result in improved outcome when compared to conventional ventilation in neonates with severe respiratory failure, there is currently no good evidence from randomised controlled trials to compare these managements for important clinical outcomes in adults, although evidence from case series is promising. Methods/Design The aim of the randomised controlled trial of Conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR is to assess whether, for patients with severe, but potentially reversible, respiratory failure, extracorporeal membrane oxygenation will increase the rate of survival without severe disability ('confined to bed' and 'unable to wash or dress' by six months post-randomisation, and be cost effective from the viewpoints of the NHS and society, compared to conventional ventilatory support. Following assent from a relative, adults (18–65 years with severe, but potentially reversible, respiratory failure (Murray score ≥ 3.0 or hypercapnea with pH Discussion Analysis will be based on intention to treat. A concurrent economic evaluation will also be performed to compare the costs and outcomes of both treatments.

  8. Congenital diaphragmatic hernia: To repair on or off extracorporeal membrane oxygenation?

    NARCIS (Netherlands)

    R. Keijzer (Richard); D.E. Wilschut (Dorien); R.J.M. Houmes (Robert Jan); K. van de Ven (Kees); L. de Jongste-van den Hout (Lieke); I. Sluijter (Ilona); P. Rycus (Peter); N.M.A. Bax (Klaas); D. Tibboel (Dick)

    2012-01-01

    textabstractBackground: Congenital diaphragmatic hernia (CDH) can be repaired on or off extracorporeal membrane oxygenation (ECMO). In many centers, operating off ECMO is advocated to prevent bleeding complications. We aimed to compare surgery-related bleeding complications between repair on or off

  9. [Influenza A H1N1v treated with extra-corporal membrane oxygenation.

    DEFF Research Database (Denmark)

    Jensen, Reinhold; Severinsen, Inge Krogh; Terp, Kim

    2010-01-01

    . Polymerase chain reaction test for H1N1v was positive until day ten. No mutations were found in the virus. The patient was given oseltamivir tablets and inhalable zanamivir as well as antibiotics. The patient was treated with extra-corporal membrane oxygenation (EcmO) for 12 days followed by ventilator...

  10. 8 CFR 245a.2 - Application for temporary residence.

    Science.gov (United States)

    2010-01-01

    ... (No. 76-C-4268 (N.D. ILL. March 22, 1977)); that is, an alien from an independent country of the... States was due merely to a brief temporary trip abroad due to emergent or extenuating circumstances... employment and travel abroad for temporary resident status applicants under section 245A(a) of the Act may...

  11. 14 CFR 47.16 - Temporary registration numbers.

    Science.gov (United States)

    2010-01-01

    ...) Temporary registration numbers may not be used to fly aircraft into the United States for the purpose of... for as many temporary registration numbers as are necessary for his business. The application must be... used on a flight outside the United States for delivery purposes, the holder shall record the...

  12. 23 CFR 1235.5 - Temporary removable windshield placards.

    Science.gov (United States)

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Temporary removable windshield placards. 1235.5 Section 1235.5 Highways NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION AND FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION GUIDELINES UNIFORM SYSTEM FOR PARKING FOR PERSONS WITH DISABILITIES § 1235.5 Temporary removable windshield placards. (a)...

  13. Temporary Employment Contracts in Academia: A Real Option View

    Science.gov (United States)

    Brady, Malcolm

    2017-01-01

    This paper examines the strategic use of temporary employment contracts in dealing with supply uncertainty in the form of employee ability that is slow to reveal itself, for example in academia where there exist significant time lags in demonstration of research ability. A temporary contract is modeled as a real option, specifically as a…

  14. 25 CFR 700.175 - Temporary emergency moves.

    Science.gov (United States)

    2010-04-01

    ... move not been made. (iv) The Commission will pay all costs in connection with the move to temporary... temporary move, based upon the criteria set forth by the Commission. (2) The estimated duration of the... Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES...

  15. 22 CFR 123.3 - Temporary import licenses.

    Science.gov (United States)

    2010-04-01

    ... articles, unless exempted from this requirement pursuant to § 123.4. This requirement applies to: (1) Temporary imports of unclassified defense articles that are to be returned directly to the country from... DEFENSE ARTICLES § 123.3 Temporary import licenses. (a) A license (DSP-61) issued by the Directorate of...

  16. 32 CFR Attachment 5 to Part 855 - Sample Temporary Agreement

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Sample Temporary Agreement 5 Attachment 5 to Part 855 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE AIRCRAFT CIVIL AIRCRAFT USE OF UNITED STATES AIR FORCE AIRFIELDS Pt. 855, Att. 5 Attachment 5 to Part 855—Sample Temporary...

  17. 29 CFR 1926.154 - Temporary heating devices.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 8 2010-07-01 2010-07-01 false Temporary heating devices. 1926.154 Section 1926.154 Labor... Temporary heating devices. (a) Ventilation. (1) Fresh air shall be supplied in sufficient quantities to... heating devices shall be installed to provide clearance to combustible material not less than the amount...

  18. Generalized derivation of the added-mass and circulatory forces for viscous flows

    Science.gov (United States)

    Limacher, Eric; Morton, Chris; Wood, David

    2018-01-01

    The concept of added mass arises from potential flow analysis and is associated with the acceleration of a body in an inviscid irrotational fluid. When shed vorticity is modeled as vortex singularities embedded in this irrotational flow, the associated force can be superimposed onto the added-mass force due to the linearity of the governing Laplace equation. This decomposition of force into added-mass and circulatory components remains common in modern aerodynamic models, but its applicability to viscous separated flows remains unclear. The present work addresses this knowledge gap by presenting a generalized derivation of the added-mass and circulatory force decomposition which is valid for a body of arbitrary shape in an unbounded, incompressible fluid domain, in both two and three dimensions, undergoing arbitrary motions amid continuous distributions of vorticity. From the general expression, the classical added-mass force is rederived for well-known canonical cases and is seen to be additive to the circulatory force for any flow. The formulation is shown to be equivalent to existing theoretical work under the specific conditions and assumptions of previous studies. It is also validated using a numerical simulation of a pitching plate in a steady freestream flow, conducted by Wang and Eldredge [Theor. Comput. Fluid Dyn. 27, 577 (2013), 10.1007/s00162-012-0279-5]. In response to persistent confusion in the literature, a discussion of the most appropriate physical interpretation of added mass is included, informed by inspection of the derived equations. The added-mass force is seen to account for the dynamic effect of near-body vorticity and is not (as is commonly claimed) associated with the acceleration of near-body fluid which "must" somehow move with the body. Various other consequences of the derivation are discussed, including a concept which has been labeled the conservation of image-vorticity impulse.

  19. Noninvasive optoacoustic system for rapid diagnosis and management of circulatory shock

    Science.gov (United States)

    Petrov, Irene Y.; Kinsky, Michael; Petrov, Yuriy; Petrov, Andrey; Henkel, S. N.; Seeton, Roger; Esenaliev, Rinat O.; Prough, Donald S.

    2013-03-01

    Circulatory shock can lead to death or severe complications, if not promptly diagnosed and effectively treated. Typically, diagnosis and management of circulatory shock are guided by blood pressure and heart rate. However, these variables have poor specificity, sensitivity, and predictive value. Early goal-directed therapy in septic shock patients, using central venous catheterization (CVC), reduced mortality from 46.5% to 30%. However, CVC is invasive and complication-prone. We proposed to use an optoacoustic technique for noninvasive, rapid assessment of peripheral and central venous oxygenation. In this work we used a medical grade optoacoustic system for noninvasive, ultrasound image-guided measurement of central and peripheral venous oxygenation. Venous oxygenation during shock declines more rapidly in the periphery than centrally. Ultrasound imaging of the axillary [peripheral] and internal jugular vein [central] was performed using the Vivid e (GE Healthcare). We built an optoacoustic interface incorporating an optoacoustic transducer and a standard ultrasound imaging probe. Central and peripheral venous oxygenations were measured continuously in healthy volunteers. To simulate shock-induced changes in central and peripheral oxygenation, we induced peripheral vasoconstriction in the upper extremity by using a cooling blanket. Central and peripheral venous oxygenations were measured before (baseline) and after cooling and after rewarming. During the entire experiment, central venous oxygenation was relatively stable, while peripheral venous oxygenation decreased by 5-10% due to cooling and recovered after rewarming. The obtained data indicate that noninvasive, optoacoustic measurements of central and peripheral venous oxygenation may be used for diagnosis and management of circulatory shock with high sensitivity and specificity.

  20. Delayed Referral Results in Missed Opportunities for Organ Donation After Circulatory Death.

    Science.gov (United States)

    Krmpotic, Kristina; Payne, Clare; Isenor, Cynthia; Dhanani, Sonny

    2017-06-01

    Rates of organ donation and transplantation have steadily increased in the United States and Canada over the past decade, largely attributable to a notable increase in donation after circulatory death. However, the number of patients awaiting solid organ transplantation continues to remain much higher than the number of organs transplanted each year. The objective of this study was to determine the potential to increase donation rates further by identifying gaps in the well-established donation after circulatory death process in Ontario. Retrospective cohort study. Provincial organ procurement organization. Patients who died in designated donation hospitals within the province of Ontario, Canada between April 1, 2013, and March 31, 2015. None. Of 1,407 patient deaths following planned withdrawal of life-sustaining therapy, 54.0% (n = 760) were medically suitable for donation after circulatory death. In 438 cases where next of kin was approached, consent rates reached 47.5%. A total of 119 patients became actual organ donors. Only 66.2% (n = 503) of suitable patients were appropriately referred, resulting in 251 missed potential donors whose next of kin could not be approached regarding organ donation because referral occurred after initiation of withdrawal of life-sustaining therapy or not at all. The number of medically suitable patients who die within 2 hours of planned withdrawal of life-sustaining therapy is nearly six times higher than the number of actual organ donors, with the greatest loss of potential due to delayed referral until at the time of or after planned withdrawal of life-sustaining therapy. Intensive care teams are not meeting their ethical responsibility to recognize impending death and appropriately refer potential organ donors to the local organ procurement organization. In cases where patients had previously registered their consent decision, they were denied a healthcare right.

  1. Temporary anchorage devices – Mini-implants

    Science.gov (United States)

    Singh, Kamlesh; Kumar, Deepak; Jaiswal, Raj Kumar; Bansal, Amol

    2010-01-01

    Orthodontists are accustomed to using teeth and auxiliary appliances, both intraoral and extraoral, to control anchorage. These methods are limited in that it is often difficult to achieve results commensurate with our idealistic goals. Recently, a number of case reports have appeared in the orthodontic literature documenting the possibility of overcoming anchorage limitations via the use of temporary anchorage devices—biocompatible devices fixed to bone for the purpose of moving teeth, with the devices being subsequently removed after treatment. Although skeletal anchorage is here to stay in orthodontics, there are still many unanswered questions. This article describes the development of skeletal anchorage and provides an overview of the use of implants for orthodontic anchorage. PMID:22442547

  2. [Temperature that modifies the effect of air pollution on emergency room visits for circulatory and respiratory diseases in Beijing, China].

    Science.gov (United States)

    Wang, L L; Zhang, Q; Bai, R H; Mi, B B; Yan, H

    2017-08-10

    Objective: To analyze the temperature modification effect on emergency room visits for circulatory and respiratory diseases caused by air pollution, in Beijing. Methods: Data on both circulatory and respiratory diseases in 2010 and 2011 were collected, Both meteorological and air pollutants related data were obtained from the National Scientific Data Sharing Platform for Population and Health. By using the stratified time-series models, we analyzed the effects of air pollution on emergency room visits for circulatory and respiratory diseases under different temperature zones, from 2010 to 2011, in Beijing. Results: Low temperature (daily average temperaturepollution index (API) on emergency room visits for circulatory diseases, Under 10 units of API, the relative risks and confidence interval appeared as 1.067 (1.054-1.080). However, high (daily average temperature between 24.4 ℃ and 28.5 ℃) and extra-high temperature (daily average temperature >28.5 ℃) could enhance the effect of API on emergency room visits for respiratory diseases, Under 10 units of API, the relative risks and confidence interval were 1.021 (1.015-1.028) and 1.006 (1.003-1.008), respectively. Conclusion: Temperature seemed to have modified the association between air pollution and both circulatory and respiratory diseases.

  3. Time to threshold as a new indicator of circulatory state and prognosis in patients with pulmonary embolism.

    Science.gov (United States)

    Bach, Andreas Gunter; Taute, Bettina-Maria; Surov, Alexey

    2018-01-01

    Bolus tracking is commonly applied in computed tomography pulmonary angiography. The time that it takes for contrast to reach a predefined threshold in the pulmonary artery is called time to threshold (TTT). TTT could be associated with the circulatory state, and ultimately with prognosis in patients with PE. The purpose of the present study was to examine the correlation of TTT with embolus burden, radiological and clinical parameters of circulatory state, and ultimately with 30-day mortality. In a single-center, retrospective study 50 patients with pulmonary embolism and contrast administration via central venous line were included. The Mastora score was used to quantify embolus burden. Radiological parameters of circulatory state were the ratio of the short axes of the right and left ventricle diameter and the reflux of contrast medium into the inferior vena cava. Clinical parameters of circulatory state were arterial pH, systolic blood pressure, heart rate, and the Acute Physiology and Chronic Health Evaluation II: APACHE II. Survival was defined as surviving the following 30days after the PE diagnosis. TTT was significantly correlated with all radiological and clinical parameters of circulatory state and with 30-day mortality. However, TTT is dependent on device specific and protocol specific factors. Higher TTT is associated with worse prognosis in patients with pulmonary embolism. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Schedules of Controlled Substances: Temporary Placement of 4-Fluoroisobutyryl Fentanyl into Schedule I. Temporary scheduling order.

    Science.gov (United States)

    2017-05-03

    The Administrator of the Drug Enforcement Administration is issuing this temporary scheduling order to schedule the synthetic opioid, N-(4-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)isobutyramide (4-fluoroisobutyryl fentanyl or para-fluoroisobutyryl fentanyl), and its isomers, esters, ethers, salts and salts of isomers, esters, and ethers, into schedule I pursuant to the temporary scheduling provisions of the Controlled Substances Act. This action is based on a finding by the Administrator that the placement of 4-fluoroisobutyryl fentanyl into schedule I of the Controlled Substances Act is necessary to avoid an imminent hazard to the public safety. As a result of this order, the regulatory controls and administrative, civil, and criminal sanctions applicable to schedule I controlled substances will be imposed on persons who handle (manufacture, distribute, reverse distribute, import, export, engage in research, conduct instructional activities or chemical analysis, or possess), or propose to handle, 4-fluoroisobutyryl fentanyl.

  5. Refractory pediatric cardiogenic shock: A case for mechanical support

    OpenAIRE

    Anil Sachdev; Bharat Mehra; Arun Mohanty; Dhiren Gupta; Neeraj Gupta

    2016-01-01

    Acute left ventricular dysfunction in children justifies aggressive treatment because of the high potential for complete recovery. The options for providing mechanical support to the failing heart in a child include extracorporeal membrane oxygenation, left ventricular assist devices, and the use of the intra-aortic balloon pump (IABP). The IABP is a commonly used method of temporary circulatory support in adults. However, despite the availability of pediatric size balloons, the usage of IABP...

  6. Burden of Circulatory System Diseases and Ignored Barriers ofKnowledge Translation

    Directory of Open Access Journals (Sweden)

    Hamed-Basir Ghafouri

    2012-10-01

    Full Text Available Circulatory system disease raise third highest disability-adjusted life years among Iranians and ischemic cardiac diseases are main causes for such burden. Despite available evidences on risk factors of the disease, no effective intervention was implemented to control and prevent the disease. This paper non-systematically reviews available literature on the problem, solutions, and barriers of implementation of knowledge translation in Iran. It seems that there are ignored factors such as cultural and motivational issues in knowledge translation interventions but there are hopes for implementation of started projects and preparation of students as next generation of knowledge transferors.

  7. Overcoming Hospital Resistance to Create a Successful Donation After Circulatory Death Program.

    Science.gov (United States)

    O'Meeghan, R; Pedral, L

    2016-09-01

    In the setting of an ever-increasing transplantation need, and a relatively static number of brain dead donors, donation after circulatory death (DCD) has heightened importance as a process to increase the number of organs available for transplantation. This article describes the barriers to the DCD process at a community hospital, what occurred to change the situation, and how data were used to overcome administrative and cultural barriers to create a successful DCD program. The program has become a role model in the local community. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Effects of fluid restriction on measures of circulatory efficacy in adults with septic shock

    DEFF Research Database (Denmark)

    Hjortrup, P. B.; Haase, Nicolai; Wetterslev, Jørn

    2017-01-01

    BACKGROUND: The haemodynamic consequences of fluid resuscitation in septic shock have not been fully elucidated. Therefore, we assessed circulatory effects in the first 24 h of restriction of resuscitation fluid as compared to standard care in intensive care unit (ICU) patients with septic shock....... METHODS: This was a post-hoc analysis of the multicentre CLASSIC randomised trial in which patients with septic shock, who had received the initial fluid resuscitation, were randomised to a protocol restricting resuscitation fluid or a standard care protocol in nine ICUs. The highest plasma lactate...... of restriction of resuscitation fluid as compared with standard care in adults with septic shock who had received initial resuscitation....

  9. [Current status of extracorporeal shock wave lithotripsy in urinary lithiasis.

    Science.gov (United States)

    Pereira-Arias, Jose Gregorio; Gamarra-Quintanilla, Mikel; Urdaneta-Salegui, Luis Felipe; Mora-Christian, Jorge Alberto; Sánchez-Vazquez, Andrea; Astobieta-Odriozola, Ander; Ibarluzea-González, Gaspar

    2017-03-01

    Over the last decade, urinary lithiasis' prevalence has dramatically increased due to diet and lifestyle changes, growing 10.6% and 7.1% in men and women respectively. Extracorporeal shock wave lithotripsy has lost relevance in current practice due to endoscopic device development and unpredictability of results. Instrument miniaturization is leading to an increase of the percutaneous approach of increasingly smaller stones, while most flexible ureteroscopes durability and digitalization has allowed urologists to address larger stones. So that, decision algorithm is now impossible to define, but what is clear is that ESWL has declined worldwide. Can it disappear as a urinary lithiasis treatment modality? If we don't improve appropriate candidate selection and optimize disintegration efficiency, guidelines are going to replace the more "boring" ESWL by popular and more attractive endoscopes. Shock wave technology has evolved in the last two decades, however lithotripsy fundamental principle has not changed. ESWL has passed the test of time and centers dedicated to stone treatment should have a lithotripter in order to offer an appropriate balance in different options for different clinical situations. New developments will be focused on improvements in location (in-line navigation systems; Vision track system) and automatic ultrasound location on a robotic arm; monitoring and stone fixation, implementation of different focal sizes with new acoustic lenses, multitask working stations that allow endourological approach, coupling control (avoiding microbubbles) and low cost devices for different applications. On the other hand, optimizing outcomes by: slower pulse rates, ramping strategies and patient selection with soft stones, short stone-skin distance, low BMI and favorable collecting system anatomy, allow us to achieve better outcomes in shock wave treatments. SWL still represents a unique non invasive method of stone disease treatment with no anesthesia and low

  10. Trough Concentrations of Vancomycin in Patients Undergoing Extracorporeal Membrane Oxygenation.

    Directory of Open Access Journals (Sweden)

    So Jin Park

    Full Text Available To investigate the appropriateness of the current vancomycin dosing strategy in adult patients with extracorporeal membrane oxygenation (ECMO, between March 2013 and November 2013, patients who were treated with vancomycin while on ECMO were enrolled. Control group consisted of 60 patients on vancomycin without ECMO, stayed in medical intensive care unit during the same study period and with the same exclusion criteria. Early trough levels were obtained within the fourth dosing, and maintenance levels were measured at steady state. A total of 20 patients were included in the analysis in ECMO group. Sixteen patients received an initial intravenous dose of 1.0 g vancomycin followed by 1.0 g every 12 hours. The non-steady state trough level of vancomycin after starting administration was subtherapeutic in 19 patients (95.00% in ECMO group as compared with 40 patients (66.67% in the control group (p = 0.013. Vancomycin clearance was 1.27±0.51 mL/min/kg, vancomycin clearance/creatinine clearance ratio was 0.90 ± 0.37, and elimination rate constant was 0.12 ± 0.04 h-1. Vancomycin dosingfrequency and total daily dose were significantly increased after clinical pharmacokinetic services of the pharmacist based on calculated pharmacokinetic parameters (from 2.10 ± 0.72 to 2.90 ± 0.97 times/day, p = 0.002 and from 32.54 ± 8.43 to 42.24 ± 14.62mg/kg, p = 0.014 in ECMO group in contrast with those (from 2.11 ± 0.69 to 2.37 ± 0.86 times/day, p = 0.071 and from 33.91 ± 11.85 to 31.61 ± 17.50 mg/kg, p = 0.350 in the control group.Although the elimination rate for vancomycin was similar with population parameter of non ECMO patients, the current dosing strategy of our institution for vancomycinin our ICU was not sufficient to achieve the target trough in the initial period in most patients receiving ECMO.

  11. 78 FR 44965 - Notice of Temporary Closure and Temporary Restrictions of Specific Uses on Public Lands for the...

    Science.gov (United States)

    2013-07-25

    ... human body a controlled substance in violation of any state or Federal law, or regulation issued... Desert playa. DATES: The temporary closure and temporary restrictions will be in effect from August 12... approved by the BLM authorized officer. B. Alcohol 1. Possession of an open container of an alcoholic...

  12. The Impact of Extracorporeal Life Support and Hypothermia on Drug Disposition in Critically Ill Infants and Children

    NARCIS (Netherlands)

    E.D. Wildschut (Enno); A. van Saet (Annewil); P. Pokorna (Pavla); M.J. Ahsman (Maurice); J.N. van den Anker (John); D. Tibboel (Dick)

    2012-01-01

    textabstractExtracorporeal membrane oxygenation (ECMO) support is an established lifesaving therapy for potentially reversible respiratory or cardiac failure. In 10% of all pediatric patients receiving ECMO, ECMO therapy is initiated during or after cardiopulmonary resuscitation. Therapeutic

  13. Does Extracorporeal Shock Wave Therapy Enhance Healing of Osteochondritis Dissecans of the Rabbit Knee?: A Pilot Study

    National Research Council Canada - National Science Library

    Lyon, Roger; Liu, Xue Cheng; Kubin, Martin; Schwab, Joseph

    2013-01-01

    ... (ie, drilling, excision, or débridement). Since extracorporeal shock wave therapy (ESWT) enhances healing of long-bone nonunion fractures, we speculated ESWT would reactivate the healing process in OCD...

  14. Novel temporary left ventricular assist system with hydrodynamically levitated bearing pump for bridge to decision: initial preclinical assessment in a goat model.

    Science.gov (United States)

    Kishimoto, Satoru; Takewa, Yoshiaki; Tsukiya, Tomonori; Mizuno, Toshihide; Date, Kazuma; Sumikura, Hirohito; Fujii, Yutaka; Ohnuma, Kentaro; Togo, Konomi; Katagiri, Nobumasa; Naito, Noritsugu; Kishimoto, Yuichiro; Nakamura, Yoshinobu; Nishimura, Motonobu; Tatsumi, Eisuke

    2017-09-12

    The management of heart failure patients presenting in a moribund state remains challenging, despite significant advances in the field of ventricular assist systems. Bridge to decision involves using temporary devices to stabilize the hemodynamic state of such patients while further assessment is performed and a decision can be made regarding patient management. We developed a new temporary left ventricular assist system employing a disposable centrifugal pump with a hydrodynamically levitated bearing. We used three adult goats (body weight, 58-68 kg) to investigate the 30-day performance and hemocompatibility of the newly developed left ventricular assist system, which included the pump, inflow and outflow cannulas, the extracorporeal circuit, and connectors. Hemodynamic, hematologic, and blood chemistry measurements were investigated as well as end-organ effect on necropsy. All goats survived for 30 days in good general condition. The blood pump was operated at a rotational speed of 3000-4500 rpm and a mean pump flow of 3.2 ± 0.6 L min. Excess hemolysis, observed in one goat, was due to the inadequate increase in pump rotational speed in response to drainage insufficiency caused by continuous contact of the inflow cannula tip with the left ventricular septal wall in the early days after surgery. At necropsy, no thrombus was noted in the pump, and no damage caused by mechanical contact was found on the bearing. The newly developed temporary left ventricular assist system using a disposable centrifugal pump with hydrodynamic bearing demonstrated consistent and satisfactory hemodynamic performance and hemocompatibility in the goat model.

  15. Veno-venous Extracorporeal CO2 Removal: Can We Reduce Dependence on Mechanical Ventilation During En-route Care?

    Science.gov (United States)

    2010-04-01

    ECMO ) has, to date, been too costly for routine use as a lung-rest strategy in adult ARDS patients. To this end, Zwischenberger and colleagues...natural lung. Extracorporeal membrane oxygenation ( ECMO ) gained acceptance for treatment of neonatal respiratory failure (37). But it is currently...40). Alpard and Zwischenberger developed an extracorporeal arterio-venous CO2 removal (AVCO2R) system using a low resistance ECMO oxygenator for gas

  16. Extracorporeal Gas Exchange and Spontaneous Breathing for the Treatment of Acute Respiratory Distress Syndrome: An Alternative to Mechanical Ventilation?

    Science.gov (United States)

    2014-03-01

    and the artificial lung (extracorporeal gas exchange) in this setting. Design: Laboratory investigation. Setting: Animal ICU of a governmental...Finally, in this sce- nario, a somewhat new player, namely spontaneous breathing, would enter in the arena of the ICUs . This study sheds light on some... rehabilitation during extracorporeal membrane oxygenation as a bridge to lung transplan- tation. Respir Care 2013; 58:1291–1298 12. Turner DA, Cheifetz IM

  17. Circulatory and respiratory effects of methoxyflurane in dogs: comparison of halothane.

    Science.gov (United States)

    Steffey, E P; Farver, T B; Woliner, M J

    1984-12-01

    Circulatory and respiratory effects of 3 alveolar concentrations (representing 1.0, 1.5, and 2.0 times the minimal alveolar concentration, MAC) of methoxyflurane in O2 were compared with similar MAC multiples of halothane in O2. Eight adult mixed breed dogs that were healthy and nonmedicated were studied in cross-over fashion with both agents during conditions of controlled ventilation (CV; PaCO2 averaged 34 to 38 mm of Hg) and spontaneous ventilation (SV). When ventilation was controlled, methoxyflurane similar to halothane caused dose-related cardiovascular depression. Except for a greater heart rate and lesser stroke volume with methoxyflurane, little difference was noticed between the anesthetics at equivalent doses during CV. There was less dose-related circulatory depression during SV with both agents but particularly with methoxyflurane. During SV, PaCO2 increased progressively with increases in alveolar concentrations of methoxyflurane and halothane. Methoxyflurane caused significantly greater (P less than 0.05) hypoventilation than halothane only at 2.0 MAC. Except for a greater respiratory gas flow and inspiratory-expiratory gas flow ratio and a lesser inspiratory-expiratory time ratio with methoxyflurane, there was no anesthetic- or dose-response effect on respiratory variables.

  18. Developing 7th grade students' systems thinking skills in the context of the human circulatory system

    Directory of Open Access Journals (Sweden)

    Lena eRaved

    2014-12-01

    Full Text Available Developing systems thinking skills in school can provide useful tools to deal with a vast amount of medical and health information that may help learners in decision making in their future lives as citizen. Thus, there is a need to develop effective tools that will allow learners to analyze biological systems and organize their knowledge. Here we examine junior high school students' systems thinking skills in the context of the human circulatory system. A model was formulated for developing teaching and learning materials and for characterizing students' systems thinking skills. Specifically we asked whether 7th grade students, who studied about the human circulatory system, acquired systems thinking skills and what are the characteristics of those skills? Concept maps were used to characterize students' systems thinking components and examine possible changes in the students' knowledge structure. These maps were composed by the students before and following the learning process. The study findings indicate a significant improvement in the students' ability to recognize the system components and the processes that occur within the system, as well as the relationships between different levels of organization of the system, following the learning process. Thus, following learning students were able to organize the systems’ components and its processes within a framework of relationships, namely the students' systems thinking skills were improved in the course of learning using the teaching and learning materials.

  19. Developing seventh grade students' systems thinking skills in the context of the human circulatory system.

    Science.gov (United States)

    Raved, Lena; Yarden, Anat

    2014-01-01

    Developing systems thinking skills in school can provide useful tools to deal with a vast amount of medical and health information that may help learners in decision making in their future lives as citizen. Thus, there is a need to develop effective tools that will allow learners to analyze biological systems and organize their knowledge. Here, we examine junior high school students' systems thinking skills in the context of the human circulatory system. A model was formulated for developing teaching and learning materials and for characterizing students' systems thinking skills. Specifically, we asked whether seventh grade students, who studied about the human circulatory system, acquired systems thinking skills, and what are the characteristics of those skills? Concept maps were used to characterize students' systems thinking components and examine possible changes in the students' knowledge structure. These maps were composed by the students before and following the learning process. The study findings indicate a significant improvement in the students' ability to recognize the system components and the processes that occur within the system, as well as the relationships between different levels of organization of the system, following the learning process. Thus, following learning students were able to organize the systems' components and its processes within a framework of relationships, namely the students' systems thinking skills were improved in the course of learning using the teaching and learning materials.

  20. Heart Transplant and Mechanical Circulatory Support in Patients With Advanced Heart Failure.

    Science.gov (United States)

    Sánchez-Enrique, Cristina; Jorde, Ulrich P; González-Costello, José

    2017-05-01

    Patients with advanced heart failure have a poor prognosis and heart transplant is still the best treatment option. However, the scarcity of donors, long waiting times, and an increasing number of unstable patients have favored the development of mechanical circulatory support. This review summarizes the indications for heart transplant, candidate evaluation, current immunosuppression strategies, the evaluation and treatment of rejection, infectious prophylaxis, and short and long-term outcomes. Regarding mechanical circulatory support, we distinguish between short- and long-term support and the distinct strategies that can be used: bridge to decision, recovery, candidacy, transplant, and destination therapy. We then discuss indications, risk assessment, management of complications, especially with long-term support, and outcomes. Finally, we discuss future challenges and how the widespread use of long-term support for patients with advanced heart failure will only be viable if their complications and costs are reduced. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  1. Colloids Versus Albumin in Large Volume Paracentesis to Prevent Circulatory Dysfunction: Evidence-based Case Report.

    Science.gov (United States)

    Widjaja, Felix F; Khairan, Paramita; Kamelia, Telly; Hasan, Irsan

    2016-04-01

    Large volume paracentesis may cause paracentesis induced circulatory dysfunction (PICD). Albumin is recommended to prevent this abnormality. Meanwhile, the price of albumin is too expensive and there should be another alternative that may prevent PICD. This report aimed to compare albumin to colloids in preventing PICD. Search strategy was done using PubMed, Scopus, Proquest, dan Academic Health Complete from EBSCO with keywords of "ascites", "albumin", "colloid", "dextran", "hydroxyethyl starch", "gelatin", and "paracentesis induced circulatory dysfunction". Articles was limited to randomized clinical trial and meta-analysis with clinical question of "In hepatic cirrhotic patient undergone large volume paracentesis, whether colloids were similar to albumin to prevent PICD". We found one meta-analysis and four randomized clinical trials (RCT). A meta analysis showed that albumin was still superior of which odds ratio 0.34 (0.23-0.51). Three RCTs showed the same results and one RCT showed albumin was not superior than colloids. We conclude that colloids could not constitute albumin to prevent PICD, but colloids still have a role in patient who undergone paracentesis less than five liters.

  2. Clinical experience with L-lysine escinate for acute and chronic cerebral circulatory disorders

    Directory of Open Access Journals (Sweden)

    N. V. Pizova

    2015-01-01

    Full Text Available Cerebrovascular diseases (CVD are major causes of disability and death in Russia. Stroke is the third significant cause of higher death rates after cardiovascular disease and cancer. The prevalence of circulatory diseases, such as atherosclerosis and hypertension, is on the rise. Therapy for CVD must be aimed at the underlying disease in which vascular catastrophe (atherosclerosis, hypertension, heart disease, etc. develops, at the regression of neurological and psychopathological syndromes, and at the improvement of cerebral blood flow and metabolic processes. Neuroprotective agents, whose efficacy has been established in uncontrolled and small placebo-controlled trials, are widely used in our country. The prescription of these medications is substantiated by the important role of the pathogenetic mechanisms underlying cerebral ischemia. This paper gives data on the clinical use of L-lysine escinate for ischemic stroke (IS, hypertensive crisis, and chronic cerebral circulatory disorders and discusses the mechanism of this drug's action and the pathogenetic mechanisms of cerebrovascular lesions. A number of investigations have shown it expedient to incorporate L-lysine escinate in the combined neuroprotective therapy of patients with IS, cerebral hypertensive crisis, and hypertensive encephalopathy, which is associated with its antiedematous effect, particularly in preventing vasogenic brain edema, in enhancing the tone of cerebral veins, and in improving venous outflow. It is stated that there is a need for an individualized approach to treating CVD, by taking into consideration the existing risk factors and somatic and neurological diseases. 

  3. Developing Seventh Grade Students’ Systems Thinking Skills in the Context of the Human Circulatory System

    Science.gov (United States)

    Raved, Lena; Yarden, Anat

    2014-01-01

    Developing systems thinking skills in school can provide useful tools to deal with a vast amount of medical and health information that may help learners in decision making in their future lives as citizen. Thus, there is a need to develop effective tools that will allow learners to analyze biological systems and organize their knowledge. Here, we examine junior high school students’ systems thinking skills in the context of the human circulatory system. A model was formulated for developing teaching and learning materials and for characterizing students’ systems thinking skills. Specifically, we asked whether seventh grade students, who studied about the human circulatory system, acquired systems thinking skills, and what are the characteristics of those skills? Concept maps were used to characterize students’ systems thinking components and examine possible changes in the students’ knowledge structure. These maps were composed by the students before and following the learning process. The study findings indicate a significant improvement in the students’ ability to recognize the system components and the processes that occur within the system, as well as the relationships between different levels of organization of the system, following the learning process. Thus, following learning students were able to organize the systems’ components and its processes within a framework of relationships, namely the students’ systems thinking skills were improved in the course of learning using the teaching and learning materials. PMID:25520948

  4. Permanent and temporary pacemaker implantation after orthotopic heart transplantation

    Directory of Open Access Journals (Sweden)

    Bacal Fernando

    2000-01-01

    Full Text Available PURPOSE:To determine the indication for and incidence and evolution of temporary and permanent pacemaker implantation in cardiac transplant recipients. METHODS: A retrospective review of 114 patients who underwent orthotopic heart transplantation InCor (Heart Institute USP BR between March 1985 and May 1993. We studied the incidence of and indication for temporary pacing, the relationship between pacing and rejection, the need for pemanent pacing and the clinical follow-up. RESULTS: Fourteen of 114 (12%heart transplant recipients required temporary pacing and 4 of 114 (3.5% patients required permanent pacing. The indication for temporary pacing was sinus node dysfunction in 11 patients (78.5% and atrioventricular (AV block in 3 patients (21.4%. The indication for permanent pacemaker implantation was sinus node dysfunction in 3 patients (75% and atrioventricular (AV block in 1 patient (25%. We observed rejection in 3 patients (21.4% who required temporary pacing and in 2 patients (50% who required permanent pacing. The previous use of amiodarone was observed in 10 patients (71.4% with temporary pacing. Seven of the 14 patients (50% died during follow-up. CONCLUSION: Sinus node dysfunction was the principal indication for temporary and permanent pacemaker implantation in cardiac transplant recipients. The need for pacing was related to worse prognosis after cardiac transplantation.

  5. Return to Work After Temporary Disability Pension in Finland.

    Science.gov (United States)

    Laaksonen, Mikko; Gould, Raija

    2015-09-01

    When it is possible that the employee's work ability can be restored through treatment or rehabilitation, disability pension in Finland is granted for a fixed period. We examined which factors are associated with return to work (RTW) after such temporary disability pension. The study included all Finnish residents whose temporary disability pension from the earnings-related pension system started in 2008 (N = 10,269). Competing risks regression analysis was applied to examine register-based determinants for RTW after temporary disability pension due to mental disorders, musculoskeletal diseases, other diseases, and injury over a 4-year follow-up period. The overall cumulative incidence of RTW was 25%. RTW was more probable after temporary disability pension due to injury and musculoskeletal diseases and less probable after temporary disability pension due to mental disorders. Younger age and higher education increased RTW but differences between genders, private and public sector employees, and occupational classes were relatively small. The probability of RTW was higher among those who were employed before their temporary disability pension (subhazard ratio in multivariate analysis 2.41 (95% CI 2.13-2.72) and among the 9% who participated in vocational rehabilitation during their pension [SHR 2.10 (95% CI 1.90-2.31)]. With some exceptions, the results were fairly similar for all diagnostic causes of temporary disability pension. Return to work after temporary disability pension was relatively uncommon. Nevertheless, in all diagnostic groups RTW continued for the whole follow-up period. The low educated and those not employed before temporary disability pension need more support in their RTW. The strong association between vocational rehabilitation and RTW suggests that increasing rehabilitation among those with impaired work ability may promote RTW.

  6. Early Activation of Children Operated on under Extracorporeal Circulation

    Directory of Open Access Journals (Sweden)

    P. R. Dudov

    2008-01-01

    Full Text Available Objective: to study the safety and clinical and economic efficiency of early activation of children operated on under extracorporeal circulation (EC. Subjects and methods. Sixty-eight children aged 4—14 years (8.6±0.4 years operated on under EC for congenital heart diseases (CHD were examined. In accordance with the time of switching to spontaneous respiration and tracheal extubation, 2 groups were identified: 1 those who received postoperative artificial ventilation (AV for 2.9±0.2 hours (a study group; 2 those who had AV for 8.7±0.7 hours (a control group. Both groups did not differ in age, cardiac diseases, their severity, anthropometric characteristics, EC duration, aortic ligation time, and abnormality pattern. In the study group, anesthesia was maintained with fentanyl (5.3±0.1 ^g/kg/hr, diazepam (0.15±0.01 mg/kg/hr, and inhaled ftorotan or enflurane. Diazepam was discontinued in the postperfusion period. The control group received fentanyl (7.6±0.4 ^Bg/kg/hr, diazepam (0.3±0.02 mg/kg/hr, droperidol (0.4±0.04 mg/kg/hr, and/or sodium oxybutyrate (81±5 mg/kg/hr. Myoplegia was provided by pancuronium or pipecuronium that was continuously infused until EC was completed in Group 1 and intermittently injected until the end of surgery in Group 2. Results. There were no indications for tracheal reintubation in both groups of patients. The early postoperative period was uncomplicated in 97.2% of the children in the study group and in 28.1% in the control group (p<0.05. The incidence of pulmonary complications was 2.8 and 46.9%, respectively (p<0.05. In the children from Groups 1 and 2, the duration of a resuscita-tive period was 44.2±1.7 and 77.3±4.9 hours, respectively (p<0.05, and that of the whole postoperative period was 12.6±0.3 and 18.0±1.1 days (p<0.05. In the study group, the total final expenditures, including the cost of anesthesia and treatment for postoperative complications, decreased by 127.5% as compared to the control

  7. Nosocomial infections in a cohort of extracorporeal life support patients.

    Science.gov (United States)

    Conrick-Martin, Ian; O'Gorman, Joanne; Lenehan, Deirdre; Oshodi, Daniel; Scanlon, Nuala; O'Brien, Serena; Hannan, Margaret; Lynch, Maureen; Carton, Edmund

    2012-09-01

    To examine nosocomial infections in a cohort of patients receiving extracorporeal life support (ECLS) at our institution and to identify the types of infections, impact of prophylaxis, and any apparent risk factors for infection. In a retrospective cohort study, we examined the records of all patients who received ECLS at our institution between August 2009 and March 2011. A prospective, daily, multidisciplinary assessment of all microbiological issues in these patients was carried out, including assessment of microbiological culture positivity and clinical evidence of infection. The results of these assessments were analysed in relation to HELICS (Hospital in Europe Link for Infection Control through Surveillance) and CDC (Centers for Disease Control and Prevention) diagnostic criteria. The use of antimicrobials in these patients was also assessed, as well as the overall bloodstream infection rate in ICU patients. Seventeen patients received ECLS during the study period, with a total of 445 ECLS days. Of these patients, 13 received respiratory (venovenous) ECLS and four received cardiac (venoarterial) ECLS. There were 17 infections in the cohort: 11 ventilator-associated pneumonias; four bloodstream infections (likely all catheter related, yielding a rate of 9.0 infections/1000 ECLS days); one skin and soft tissue infection; and one urinary tract infection. The bloodstream infection rate in the ICU population as a whole was 9.30/1000 bed-days in 2009 and 7.21/1000 bed-days in 2010. Resistant organisms were identified in 3/17 infections: one methicillin-resistant Staphylococcus aureus, one multidrug-resistant strain of Pseudomonas and one extended-spectrum Β-lactamase-producing Escherichia coli. The median time to acquiring nosocomial infection was 25 days (interquartile range, 13-33 days). The first four ECLS patients received antibacterial (vancomycin) and antifungal (caspofungin) prophylaxis for the duration of ECLS, whereas the later cohort of 13 did not. In

  8. Temporary tattoo for wireless human pulse measurement

    Science.gov (United States)

    Pepłowski, Andrzej; Janczak, Daniel; Krzemińska, Patrycja; Jakubowska, Małgorzata

    2016-09-01

    Screen-printed sensor for measuring human pulse was designed and first tests using a demonstrator device were conducted. Various materials and sensors' set ups were compared and the results are presented as the starting point for fabrication of fully functional device. As a screen printing substrate, commercially available temporary tattoo paper was used. Using previously developed nanomaterials-based pastes design of a pressure sensor was printed on the paper and attached to the epidermis. Measurements were aimed at determining sensors impedance constant component and its variability due to pressure wave caused by the human pulse. The constant component was ranging from 2kΩ to 6kΩ and the variations of the impedance were ranging from +/-200Ω to +/-2.5kΩ, depending on the materials used and the sensor's configuration. Calculated signal-to-noise ratio was 3.56:1 for the configuration yielding the highest signal level. As the device's net impedance influences the effectiveness of the wireless communication, the results presented allow for proper design of the sensor for future health-monitoring devices.

  9. Sealing of temporary cements in endodontics

    Directory of Open Access Journals (Sweden)

    Eduardo Gomes Ferraz

    2009-10-01

    Full Text Available Objective: The aim of this study was to assess the coronal leakage of three temporary cements in endodontics: Bioplic® (Biodinâmica, Londrina, Brazil, IRM® (Dentsply, Petrópolis, Brazil and Coltosol® (Vigodent, Bonsucesso, Brazil. Methods: Forty human pre-molars were divided into four groups: I (Bioplic® + adhesive system, II (Bioplic®, Biodinâmica, Londrina, Brasil, III (IRM®, Dentsply, Petrópolis, Brasil, and IV (Coltosol®, Vigodent, Bonsucesso, Brasil. The teeth were immersed in 1% Rodamine and kept at 37°C for 24h. They were then thermal cycled for seven days. Temperatures ranged between 5, 37 and 50°C. After longitudinal sectioning the leakage was measured in mm and statistical analysis was performed using the ANOVA and Tukey tests with a level of significance of 5%.Results: In the group in which Bioplic® was used with adhesive, a lower level of leakage was detected (0.37 ± 0.24. There was significant difference (p<0.05 between groups I and III, I and IV, II and III. Conclusion: It was concluded that all the tested material showed coronal leakage and that the use of the (Bioplic® Biodinâmica, Londrina, Brasilplus adhesive system showed the lowest level of leakage.

  10. Description, validation, and modification of the Guyton model for space-flight applications. Part A. Guyton model of circulatory, fluid and electrolyte control. Part B. Modification of the Guyton model for circulatory, fluid and electrolyte control

    Science.gov (United States)

    Leonard, J. I.

    1985-01-01

    The mathematical model that has been a cornerstone for the systems analysis of space-flight physiological studies is the Guyton model describing circulatory, fluid and electrolyte regulation. The model and the modifications that are made to permit simulation and analysis of the stress of weightlessness are described.

  11. The Liminality of Temporary Agency Work: Exploring the Dimensions of Temporary Agency Workers’ Liminal Experience

    DEFF Research Database (Denmark)

    Winkler, Ingo; Mahmood, Mustafa Khalil

    2015-01-01

    along which liminality can unfold in organizational and work-related contexts. We argue that future studies should explore the various dimensions in other contexts of passages from one relatively stable state to another. In doing so, similarities and differences between various liminal experiences...... on political anthropology we identify the dimensions of ‘types of subjects,’‘time,’ ‘space,’ and ‘scale’ in order to analytically unlock the liminal experience. Exemplifying our concept we present the findings from an own study of temporary agency workers in Denmark. Exploring the workers’ interpretations...

  12. Intermittent extracorporeal CO2 removal in chronic obstructive pulmonary disease patients: a fiction or an option.

    Science.gov (United States)

    Alessandri, Francesco; Pugliese, Francesco; Mascia, Luciana; Ranieri, Marco V

    2018-02-01

    Aim of this article is to review evidence recently generated on the application of extracorporeal carbon dioxide removal (ECCO2R) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation (invasive and non invasive) for hypercapnic respiratory failure. To date, the paucity of evidences on ECCO2R to decrease the rate of noninvasive ventilation (NIV) failure and to wean hypercapnic patients from invasive mechanical ventilation (IMV) precludes to systematically apply this technology to COPD patients. Although several efforts have been made to reduce invasiveness and to improve the efficiency of extracorporeal systems, further randomized studies are needed to assess the effects of this technique on both short-term and long-term clinical outcomes.

  13. Extracorporeal life support for a 5-week-old infant with idiopathic pulmonary hemosiderosis.

    Science.gov (United States)

    Gutierrez, Sherrill; Shaw, Susanna; Huseni, Shehlanoor; Sachdeva, Shagun; Costello, John P; Basu, Sonali; Nath, Dilip S; Klugman, Darren

    2014-12-01

    Idiopathic pulmonary hemosiderosis is a rare disease defined by the triad of iron deficiency anemia, hemoptysis, and diffuse pulmonary infiltrates on chest radiograph. Idiopathic pulmonary hemosiderosis is known to cause dyspnea and, in some cases, acute onset of massive pulmonary hemorrhage which is traditionally treated with conventional mechanical ventilation or high-frequency oscillation in conjunction with immunosuppressive therapy. In this case report, we describe a 5-week-old infant presenting with hemoptysis, massive pulmonary hemorrhage, and significant hypercapnic respiratory failure. The patient failed conventional ventilation but responded well to extracorporeal life support that was initiated early in his course. Idiopathic pulmonary hemosiderosis was suspected in light of his response to high-dose steroids and was confirmed by subsequent lung biopsies. Patients with severe pulmonary hemorrhage secondary to idiopathic pulmonary hemosiderosis can be safely supported with extracorporeal life support when conventional therapies have been exhausted.

  14. Role of Epinephrine and Extracorporeal Membrane Oxygenation in the Management of Ischemic Refractory Ventricular Fibrillation

    Directory of Open Access Journals (Sweden)

    Jason A. Bartos, MD, PhD

    2017-06-01

    Full Text Available Summary: Extracorporeal membrane oxygenation (ECMO is used in cardiopulmonary resuscitation (CPR of refractory cardiac arrest. The authors used a 2 × 2 study design to compare ECMO versus CPR and epinephrine versus placebo in a porcine model of ischemic refractory ventricular fibrillation (VF. Pigs underwent 5 min of untreated VF and 10 min of CPR, and were randomized to receive epinephrine versus placebo for another 35 min. Animals were further randomized to left anterior descending artery (LAD reperfusion at minute 45 with ongoing CPR versus venoarterial ECMO cannulation at minute 45 of CPR and subsequent LAD reperfusion. Four-hour survival was improved with ECMO whereas epinephrine showed no effect. Key Words: advanced cardiopulmonary life support, cardiac arrest, cardiopulmonary resuscitation, ECMO, extracorporeal membrane oxygenation, ischemic refractory ventricular fibrillation, ST-segment elevation myocardial infarction, ventricular fibrillation

  15. Capgras syndrome: a clinical manifestation of watershed cerebral infarct complicating the use of extracorporeal membrane oxygenation.

    Science.gov (United States)

    Dejode, J M; Antonini, F; Lagier, P; Martin, C

    2001-08-01

    Ischaemic cerebral accidents are frequent following extracorporeal membrane oxygenation (ECMO), especially after fixing the reinjection cannula in the right primitive carotid artery, which leads to an interruption in downstream flow. We describe a rare and unusual symptom of cerebral ischaemic accident that is known as Capgras syndrome. This feature is interesting because it may be documented by computed tomography (CT) scan and particular electroencephalography signals. It appears that our observation represents the first documented case of Capgras syndrome complicating ECMO. This incident emphasizes the potential hazards associated with right common artery ligature for venoarterial extracorporeal membrane oxygenation (VAECMO). In addition, it shows that this psychiatric symptom (that has been interpreted psychodynamically for many years) can have an organic basis, which should be studied.

  16. Transfusion Associated Hyperkalemia and Cardiac Arrest in an Infant after Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Do Wan Kim

    2015-05-01

    Full Text Available Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potassium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradiated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complications associated with transfusions during ECMO.

  17. 20 CFR 655.20 - Applications for temporary employment certification.

    Science.gov (United States)

    2010-04-01

    ... Nursing in the United States (H-2B Workers) § 655.20 Applications for temporary employment certification..., the employer will be required to conduct another labor market for the portion of time beyond 12 months. ...

  18. 20 CFR 655.21 - Supporting evidence for temporary need.

    Science.gov (United States)

    2010-04-01

    ... Attestations for Temporary Employment in Occupations Other Than Agriculture or Registered Nursing in the United... containing the following: (1) A description of the employer's business history and activities (i.e., primary...

  19. 44 CFR 9.13 - Particular types of temporary housing.

    Science.gov (United States)

    2010-10-01

    ... is the only practicable alternative. The following factors shall be substituted for the factors in... risk to the temporary housing occupant; (iii) Cost effectiveness; (iv) Social and neighborhood patterns...

  20. 7 CFR 160.41 - Issuance of temporary license.

    Science.gov (United States)

    2010-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) NAVAL STORES REGULATIONS AND... processor of the need therefor and the competency of the applicant for such temporary license. Such...

  1. Renovascular acute renal failure precipitated by extracorporeal shock wave lithotripsy for pancreatic stones

    Science.gov (United States)

    Cecere, Nicolas; Goffette, Pierre; Deprez, Pierre; Jadoul, Michel; Morelle, Johann

    2015-01-01

    Extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones is considered a safe and efficient method to facilitate fragmentation and stone removal. We describe the case of a 73-year-old woman with a solitary functioning kidney who presented an acute-onset anuria and renovascular renal failure the day after ESWL. We speculate that vascular calcifications in the area targeted by shock waves played a critical role in renal artery obstruction in the present case. PMID:26251710

  2. Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: a 5-year cohort study

    OpenAIRE

    Aubron, Cecile; Cheng, Allen C; Pilcher, David; Leong, Tim; Magrin, Geoff; Cooper, D Jamie; Scheinkestel, Carlos; Pellegrino, Vince

    2013-01-01

    Introduction Mortality of patients on extracorporeal membrane oxygenation (ECMO) remains high. The objectives of this study were to assess the factors associated with outcome of patients undergoing ECMO in a large ECMO referral centre and to compare veno-arterial ECMO (VA ECMO) with veno-venous ECMO (VV ECMO). Methods We reviewed a prospectively obtained ECMO database and patients' medical records between January 2005 and June 2011. Demographic characteristics, illness severity at admission, ...

  3. Extracorporeal membrane oxygenation following pediatric cardiac surgery: development and outcomes from a single-center experience

    OpenAIRE

    Itoh, Hideshi; Ichiba, Shingo; Ujike, Yoshihito; Kasahara, Shingo; Arai, Sadahiko; Sano, Shuji

    2012-01-01

     Extracorporeal membrane oxygenation (ECMO) has emerged as an effective mechanical support following cardiac surgery with respiratory and cardiac failure. However, there are no clear indications for ECMO use after pediatric cardiac surgery. We retrospectively reviewed medical records of 76 pediatric patients [mean age, 10.8 months (0-86); mean weight, 5.16 kg (1.16-16.5)] with congenital heart disease who received ECMO following cardiac surgery between January 1997 and October 2010. Forty-fiv...

  4. The Evaluation of Nosocomial Infections in Pediatric Patients with Extracorporeal Membrane Oxygenation Support

    OpenAIRE

    Ayyıldız, Pelin; Kasar, Taner; Ozturk, Erkut; Yildiz, Okan; Ozturk, Serpil; Ergul, Yakup; Haydin, Sertac; Guzeltas, Alper

    2017-01-01

    Introduction Extracorporeal membrane oxygenation (ECMO) has become a standard technique over the past few decades in intensive care unit (ICU). Objective A review of pediatric patients who received ECMO support in the pediatric cardiac ICU was conducted to determine the incidence, risk factors and causal organisms related to acquired infections and assess the survival rates of ECMO patients with nosocomial infections. Methods Sixty-six patients who received ECMO support in the pediatric cardi...

  5. Feasibility of sedation and analgesia interruption following cannulation in neonates on extracorporeal membrane oxygenation

    OpenAIRE

    Wildschut, Enno; Hanekamp, Manon; Vet, Nienke; Houmes, Robert Jan; Ashman, Maurice; Mathôt, Ron; de Wildt, Saskia; Tibboel, Dick

    2010-01-01

    textabstractPurpose: In most extracorporeal membrane oxygenation (ECMO) centers patients are heavily sedated to prevent accidental decannulation and bleeding complications. In ventilated adults not on ECMO, daily sedation interruption protocols improve short- and long-term outcome. This study aims to evaluate safety and feasibility of sedation interruption following cannulation in neonates on ECMO. Methods: Prospective observational study in 20 neonates (0.17-5.8 days of age) admitted for ECM...

  6. Postoperative cardiac arrest after heart surgery: does extracorporeal perfusion support a paradigm change in management?

    Science.gov (United States)

    Gologorsky, Edward; Macedo, Francisco Igor B; Carvalho, Enisa M; Gologorsky, Angela; Ricci, Marco; Salerno, Tomas A

    2010-01-01

    Early institution of extracorporeal perfusion support (ECPS) may improve survival after cardiac arrest. Two patients sustained unexpected cardiac arrest in the Intensive Care Unit (ICU) following cardiac interventions. ECPS was initiated due to failure to restore hemodynamics after prolonged (over 60 minutes) advanced cardiac life support (ACLS) protocol-guided cardiopulmonary resuscitation. Despite relatively late institution of ECPS, both patients survived with preserved neurological function. This communication focuses on the utility of ECPS in the ICU as a part of resuscitative efforts.

  7. Venovenous Extracorporeal Membrane Oxygenation as a Treatment for Obesity Hypoventilation Syndrome

    OpenAIRE

    Umei, Nao; Ichiba, Shingo

    2017-01-01

    The mortality rate for respiratory failure resulting from obesity hypoventilation syndrome is high if it requires ventilator management. We describe a case of severe acute respiratory failure resulting from obesity hypoventilation syndrome (BMI, 60.2 kg/m2) successfully treated with venovenous extracorporeal membrane oxygenation (VV-ECMO). During ECMO management, a mucus plug was removed by bronchoscopy daily and 18 L of water was removed using diuretics, resulting in weight loss of 24 kg. Th...

  8. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue

    OpenAIRE

    Notarnicola, Angela; Moretti, Biagio

    2012-01-01

    There is currently great interest in the use of Extracorporeal Shock Wave Therapy (ESWT) and in clarifying the mechanisms of action in tendon pathologies. The success rate ranges from 60% to 80% in epicondylitis, plantar fasciitis, cuff tendinitis, trocanteritis, Achilles tendinitis or jumper’s knee. In contrast to urological treatments (lithotripsy), where shockwaves are used to disintegrate renal stones, in musculoskeletal treatments (orthotripsy), shockwaves are not being used to disintegr...

  9. OPEN HEART OPERATIONS—Results in 100 Consecutive Cases, Using Extracorporeal Circulation

    Science.gov (United States)

    Shumway, Norman E.; Stofer, Raymond C.; Lower, Richard R.; Hurley, Edward J.; Dong, Eugene

    1962-01-01

    In one hundred consecutive cases in which operations were done on the heart with the surgical field exposed to view and circulation was shunted to extracorporeal apparatus, there were six deaths. None were attributable to the by-pass procedure. The lesions were of various kinds, congenital and acquired. In one case a fibromyxosarcoma that was obstructing the right ventricular outflow tract and invading the main pulmonary artery was successfully excised. PMID:13912412

  10. Effect of Radial Extracorporeal Shock Wave Therapy in Patients With Fabella Syndrome

    Science.gov (United States)

    2016-01-01

    The fabella is a small sesamoid bone generally located in the tendon of the lateral head of the gastrocnemius behind the lateral condyle of the femur. Fabella syndrome is the occurrence of posterolateral knee pain associated with the fabella. It is a rare cause of knee pain that is often misdiagnosed. Fabella syndrome can be managed with conservative or surgical treatment. We applied radial extracorporeal shock wave therapy as a new treatment strategy for fabella syndrome and achieved a successful outcome. PMID:28119844

  11. Effect of Radial Extracorporeal Shock Wave Therapy in Patients With Fabella Syndrome

    OpenAIRE

    Seol, Pyong-Hwa; Ha, Kang Wook; Kim, Yun Hee; Kwak, Ho-Jun; Park, Seung-Wan; Ryu, Byung-Ju

    2016-01-01

    The fabella is a small sesamoid bone generally located in the tendon of the lateral head of the gastrocnemius behind the lateral condyle of the femur. Fabella syndrome is the occurrence of posterolateral knee pain associated with the fabella. It is a rare cause of knee pain that is often misdiagnosed. Fabella syndrome can be managed with conservative or surgical treatment. We applied radial extracorporeal shock wave therapy as a new treatment strategy for fabella syndrome and achieved a succe...

  12. Herpes zoster reactivation after extracorporeal shock wave lithotripsy: A case report

    Directory of Open Access Journals (Sweden)

    Krishnamoorthy Hariharan

    2016-01-01

    Full Text Available Herpes zoster is a reactivated varicella-zoster virus (VZV infection of the sensory nerve ganglion, peripheral nerve, and its branches. Mechanical trauma to the nervous system can reactivate VZV. It is well known that extracorporeal shock wave lithotripsy (SWL can produce mechanical damage to the tissue. We report a rare case of herpes zoster reactivation after SWL for treatment of 1.2 cm size renal stone in a 63-year-old male patient.

  13. Evaluation of furosemide regimens in neonates treated with extracorporeal membrane oxygenation

    OpenAIRE

    Vorst, Maria; Wildschut, Enno; Houmes, Robert Jan; Gischler, Saskia; Kist-Van Holthe, Joana; Burggraaf, Jacobus; Heijden, Bert; Tibboel, Dick

    2006-01-01

    textabstractIntroduction: Loop diuretics are the most frequently used diuretics in patients treated with extracorporeal membrane oxygenation (ECMO). In patients after cardiopulmonary bypass (CPB) surgery, the use of continuous furosemide infusion is increasingly documented. Because ECMO and CPB are 'comparable' procedures, continuous furosemide infusion is used in newborns on ECMO. We report on the use of continuous intravenous furosemide in neonates treated with ECMO. Methods: This was a ret...

  14. Extracorporeal Membrane Oxygenation in Diffuse Alveolar Hemorrhage Secondary to Systemic Lupus Erythematosus

    OpenAIRE

    Claudio, Christine Pacheco; Charbonney, Emmanuel; Durand, Madeleine; Kolan, Christophe; Laskine, Mikhael

    2014-01-01

    Diffuse alveolar hemorrhage (DAH) is a rare and potentially deadly complication of systemic lupus erythematosus (SLE). We report two adult cases where extracorporeal membrane oxygenation (ECMO) was used as rescue therapy for severe respiratory failure in this setting. We discuss the risk related to coagulation disturbance and the need for the circuit anticoagulation in this particular setting. We also briefly discuss the clinical problem of lack of knowledge on the bioavailability of the immu...

  15. Left Atrial Decompression by Percutaneous Left Atrial Venting Cannula Insertion during Venoarterial Extracorporeal Membrane Oxygenation Support

    Directory of Open Access Journals (Sweden)

    Ha Eun Kim

    2016-06-01

    Full Text Available Patients with venoarterial extracorporeal membrane oxygenation (ECMO frequently suffer from pulmonary edema due to left ventricular dysfunction that accompanies left heart dilatation, which is caused by left atrial hypertension. The problem can be resolved by left atrium (LA decompression. We performed a successful percutaneous LA decompression with an atrial septostomy and placement of an LA venting cannula in a 38-month-old child treated with venoarterial ECMO for acute myocarditis.

  16. Drying firewood in a temporary solar kiln: a case study.

    Science.gov (United States)

    George R. Sampson; Anthony F. Gasbarro

    1986-01-01

    A pilot study was undertaken to determine drying rates for small diameter, unsplit paper birch firewood that was dried: (1) in a conventional top-covered pile; (2) in a simple, temporary solar kiln; and (3) in tree length. Drying rates were the same for firewood piles whether they were in the temporary solar kilns or only covered on top to keep rain or snow from...

  17. The savings behavior of temporary and permanent migrants in Germany

    OpenAIRE

    Bauer, Thomas K.; Sinning, Mathias

    2005-01-01

    This paper examines the relative savings position of migrant households in West Germany, paying particular attention to differences between temporary and permanent migrants. Utilizing household level data from the German Socio-Economic Panel (GSOEP), our findings reveal significant differences in the savings rates between foreign-born and German-born individuals. These differences disappear, however, for temporary migrants, if their remittances are taken into account. Fixed effects estimation...

  18. The impacts of temporary and anticipated tourism spending

    OpenAIRE

    Grant Allan; Patrizio Lecca; Kim Swales

    2014-01-01

    Part of the local economic impact of a major sporting event comes from the associated temporary tourism expenditures. Typically demand-driven Input-Output (IO) methods are used to quantify the impacts of such expenditures. However, IO modelling has specific weaknesses when measuring temporary tourism impacts; particular problems lie in its treatment of factor supplies and its lack of dynamics. Recent work argues that Computable General Equilibrium (CGE) analysis is more appropriate and this h...

  19. The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology.

    Science.gov (United States)

    Millar, Jonathan E; Fanning, Jonathon P; McDonald, Charles I; McAuley, Daniel F; Fraser, John F

    2016-11-28

    Extracorporeal membrane oxygenation (ECMO) is a technology capable of providing short-term mechanical support to the heart, lungs or both. Over the last decade, the number of centres offering ECMO has grown rapidly. At the same time, the indications for its use have also been broadened. In part, this trend has been supported by advances in circuit design and in cannulation techniques. Despite the widespread adoption of extracorporeal life support techniques, the use of ECMO remains associated with significant morbidity and mortality. A complication witnessed during ECMO is the inflammatory response to extracorporeal circulation. This reaction shares similarities with the systemic inflammatory response syndrome (SIRS) and has been well-documented in relation to cardiopulmonary bypass. The exposure of a patient's blood to the non-endothelialised surface of the ECMO circuit results in the widespread activation of the innate immune system; if unchecked this may result in inflammation and organ injury. Here, we review the pathophysiology of the inflammatory response to ECMO, highlighting the complex interactions between arms of the innate immune response, the endothelium and coagulation. An understanding of the processes involved may guide the design of therapies and strategies aimed at ameliorating inflammation during ECMO. Likewise, an appreciation of the potentially deleterious inflammatory effects of ECMO may assist those weighing the risks and benefits of therapy.

  20. A miniaturized extracorporeal membrane oxygenator with integrated rotary blood pump: preclinical in vivo testing.

    Science.gov (United States)

    Kopp, Ruedger; Bensberg, Ralf; Arens, Jutta; Steinseifer, Ulrich; Schmitz-Rode, Thomas; Rossaint, Rolf; Henzler, Dietrich

    2011-01-01

    Extracorporeal membrane oxygenation can achieve sufficient gas exchange in severe acute respiratory distress syndrome. A highly integrated extracorporeal membrane oxygenator (HEXMO) was developed to reduce filling volume and simplify management. Six female pigs were connected to venovenous HEXMO with a total priming volume of 125 ml for 4 hours during hypoxemia induced by a hypoxic inspired gas mixture. Animals were anticoagulated with intravenous heparin. Gas exchange, hemodynamics, hemolysis, and coagulation activation were examined. One device failed at the magnetic motor coupling of the integrated diagonal pump. In the remaining five experiments, the oxygenation increased significantly (arterial oxygen saturation [SaO2] from 79 ± 5% before HEXMO to 92% ± 11% after 4 hours) facilitated by a mean oxygen transfer of 66 ± 29 ml/dl through the oxygenator. The CO2 elimination by the HEXMO reduced arterial PaCO2 only marginal. Extracorporeal blood flow was maintained at 32% ± 6% of cardiac output. Hemodynamic instability or hemolysis was not observed. The plasmatic coagulation was only mildly activated without significant platelet consumption. The HEXMO prototype provided sufficient gas exchange to prevent hypoxemia. This proof of concept study supports further development and design modifications to increase performance and to reduce coagulation activation for potential long-term application.

  1. Can cellulite be treated with low-energy extracorporeal shock wave therapy?

    Directory of Open Access Journals (Sweden)

    Fiorenzo Angehrn

    2008-01-01

    Full Text Available Fiorenzo Angehrn1, Christoph Kuhn1, Axel Voss21Klinik Piano, Gottstattstrasse 24, Biel, Switzerland; 2SwiTech Medical AG, Kreuzlingen, SwitzerlandAbstract: The present study investigates the effects of low-energy defocused extracorporeal generated shock waves on collagen structure of cellulite afflicted skin. Cellulite measurement using high-resolution ultrasound technology was performed before and after low-energy defocused extracorporeal shock wave therapy (ESWT in 21 female subjects. ESWT was applied onto the skin at the lateral thigh twice a week for a period of six weeks. Results provide evidence that low-energy defocused ESWT caused remodeling of the collagen within the dermis of the tested region. Improving device-parameters and therapy regimes will be essential for future development of a scientific based approach to cellulite treatment.Keywords: cellulite (gynoid lipodystrophy, collagen structure of dermis, collagenometry high-resolution ultrasound of skin, low-energy defocused extracorporeal shock wave therapy (ESWT, septa of subcutaneous connective tissue

  2. Hemodynamic deterioration during extracorporeal membrane oxygenation weaning in a patient with a total artificial heart.

    Science.gov (United States)

    Hosseinian, Leila; Levin, Matthew A; Fischer, Gregory W; Anyanwu, Anelechi C; Torregrossa, Gianluca; Evans, Adam S

    2015-01-01

    The Total Artificial Heart (Syncardia, Tucson, AZ) is approved for use as a bridge-to-transplant or destination therapy in patients who have irreversible end-stage biventricular heart failure. We present a unique case, in which the inferior vena cava compression by a total artificial heart was initially masked for days by the concurrent placement of an extracorporeal membrane oxygenation cannula. This is the case of a 33-year-old man admitted to our institution with recurrent episodes of ventricular tachycardia requiring emergent total artificial heart and venovenous extracorporeal membrane oxygenation placement. This interesting scenario highlights the importance for critical care physicians to have an understanding of exact anatomical localization of a total artificial heart, extracorporeal membrane oxygenation, and their potential interactions. In total artificial heart patients with hemodynamic compromise or reduced device filling, consideration should always be given to venous inflow compression, particularly in those with smaller body surface area. Transesophageal echocardiogram is a readily available diagnostic tool that must be considered standard of care, not only in the operating room but also in the ICU, when dealing with this complex subpopulation of cardiac patients.

  3. [The influence of extracorporeal laser radiation on structural indices of erythrocytes].

    Science.gov (United States)

    Khetsuriani, R G; Aladashvili, L M; Arabuli, M B; Tophuria, D Z; Tchlikadze, N G

    2015-01-01

    Object of the research was to study the diffractometric indices of erythrocytes, while 1 ml of the blood of the experimental animals was irradiated extracorporally by helium-neon laser. For this purpose 1 ml blood was taken from normal weight, (1200 gr) grown up shinshila rabbits, that we divided into 7 groups and irradiated with 10 vat helium-neon laser during 0.5-1 minutes. After irradiation blood was injected back to the organism of rabbits. After 2-6 hours from irradiation blood was taken from veins, to study by electronic microscope and later to be processed by diffractometric analysis method. The examinations testify that after extracorporeal irradiation diffractometric characteristics of erythrocytes' membranes are lower than after general irradiation, which indicates to the different energetic possibilities of laser. The extracorporeal irradiation, performed by laser and input of radiated blood back to organism is considered to be a shock therapy from the side of erythrocytes, which promote the defense function of the organism itself. The base for the shock therapy should be important factors such as homeostasis, compensative-adaptive mechanisms and so on. Exactly this above mentioned should be manifested after the sensitized cells are led back to the body (1 ml of blood) and with their existence they should promote display of the defense mechanisms.

  4. Retroperitoneal approach for laparoscopic nephroureterectomy with stripping technique: extracorporeal ligation of ureter and ureteral catheter.

    Science.gov (United States)

    Nakamura, K; Nagata, D; Kajikawa, K; Kobayashi, I; Zennami, K; Nishikawa, G; Yoshizawa, T; Tobiume, M; Aoki, S; Yamada, Y; Sumitomo, M

    2012-02-01

    The pluck and stripping techniques are used for lower ureter management in renal pelvic cancer patients. Herein, we report our experience of extracorporeal ligation of the ureter and the ureteral catheter through the trocar port, which differs from conventional laparoscopic ligation in the retroperitoneal space. This technique was selected to reduce the time needed for ureter management using the stripping technique and to provide secure ligation. We performed this stripping technique in patients with T1 and T2 stage renal pelvic cancer without imaging-evident lymph node metastasis. After transurethrally placing a ureteral catheter, we resected the circumference of the ureteral orifice. After laparoscopic nephrectomy via a retroperitoneal approach, the ureteral catheter and distal ureter were ligated extracorporeally. The catheter was pulled to invaginate the ureter so it could then be pulled through the external urethral orifice. This technique of extracorporeal ligation ensures more a secure ligation of the ureter and ureteral catheter. This modified stripping technique does not require lower ureter management with laparotomy, and it is also useful in shortening the operative time. This method is effective for relatively early stage renal pelvic cancer. © 2012 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Blackwell Publishing Asia Pty Ltd.

  5. The effects of extracorporeal shock wave therapy on stroke patients with plantar fasciitis

    Science.gov (United States)

    Kim, Tae Gon; Bae, Sea Hyun; Kim, Gye Yeop; Kim, Kyung Yoon

    2015-01-01

    [Purpose] The purpose of this research was to analyze the efficacy of extracorporeal shock wave therapy for the treatment of stroke patients with plantar fasciitis. [Subjects and Methods] This study included 10 stroke patients diagnosed with plantar fasciitis who were administered 3 sessions of extracorporeal shock wave therapy per week. After the last session, they performed stretching exercises for their Achilles tendon and plantar fascia for 30 min/day, 5 times a week for 6 months. The following parameters were measured and compared prior to therapy, 6 weeks after therapy, and 6 months after therapy: thickness of the plantar fascia, using an ultrasonic imaging system; degree of spasticity, using a muscle tension measuring instrument; degree of pain, using the visual analogue scale; and gait ability, using the Functional Gait Assessment. [Results] Decreased plantar fascia thickness, spasticity, and pain and increased gait ability were noted after therapy. These changes were significantly greater at 6 months after therapy than at 6 weeks after therapy. [Conclusion] These results indicated that extracorporeal shock wave therapy reduced tension in the plantar fascia, relieving pain and improving gait ability in stroke patients. PMID:25729207

  6. Minimized extracorporeal circulation is improving outcome of coronary artery bypass surgery in the elderly.

    Science.gov (United States)

    Freundt, Miriam; Ried, Michael; Philipp, Alois; Diez, Claudius; Kolat, Philipp; Hirt, Stephan W; Schmid, Christof; Haneya, Assad

    2016-03-01

    Advanced age is a known risk factor for morbidity and mortality after coronary artery bypass grafting (CABG). Minimized extracorporeal circulation (MECC) has been shown to reduce the negative effects associated with conventional extracorporeal circulation (CECC). This trial assesses the impact of MECC on the outcome of elderly patients undergoing CABG. Eight hundred and seventy-five patients (mean age 78.35 years) underwent isolated CABG using CECC (n=345) or MECC (n=530). The MECC group had a significantly shorter extracorporeal circulation time (ECCT), cross-clamp time and reperfusion time and lower transfusion needs. Postoperatively, these patients required significantly less inotropic support, fewer blood transfusions, less postoperative hemodialysis and developed less delirium compared to CECC patients. In the MECC group, intensive care unit (ICU) stay was significantly shorter and 30-day mortality was significantly reduced [2.6% versus 7.8%; p<0.001]. In conclusion, MECC improves outcome in elderly patients undergoing CABG surgery. © The Author(s) 2015.

  7. Temporary worsening of kidney function following aortic reconstructive surgery.

    Science.gov (United States)

    Ghaheri, Hafez; Kazemzadeh, Gholam Hossein; Beigi, Ali Akbar

    2008-07-01

    Little is known about the incidence of temporary kidney dysfunction following major vascular surgeries. We aimed to assess the frequency of temporary decreased kidney function following aortic surgeries. In a retrospective study, we assessed 108 hospital records of the patients who had undergone elective open abdominal surgery of aortic aneurysm. Preoperative and postoperative (days 1, 2, and 3) data on estimated glomerular filtration rate (GFR) were collected and evaluated in relation to the patients' clinical characteristics and outcomes. A decline greater than 10% in GFR on day 1 or 2, and then, an increase of GFR to a level of maximum 10% below the baseline value on the third postoperative day was considered as temporary worsening of kidney function. Postoperative alterations of GFR not greater than 10% in relation to the baseline were considered as improved or unchanged kidney function. Two patients with persistent decrease in GFR were excluded. Temporary worsening of kidney function was seen in 25 patients (23.6%). Short-term mortality rate was 44.0% in this group of patients, while it was 17.3% in those without decreased GFR (P = .006). According to the regression analysis, the only predictor of mortality was temporary worsening of kidney function, with a hazard ratio of 4.03 (95% confidence interval, 1.44 to 11.31; P = .008). Nearly 1 out of 4 aortic surgeries results in kidney dysfunction. Albeit temporary in most cases, it seems to be associated with a higher short-term mortality rate.

  8. Effect of particulate matter, atmospheric gases, temperature, and humidity on respiratory and circulatory diseases’ trends in Lisbon, Portugal

    NARCIS (Netherlands)

    Freitas, M.C.; Pacheco, A.M.G.; Verburg, T.G.; Wolterbeek, H.T.

    2009-01-01

    This study addresses the significant effects of both well-known contaminants (particles, gases) and less-studied variables (temperature, humidity) on serious, if relatively common, respiratory and circulatory diseases. The area of study is Lisbon, Portugal, and time series of health outcome (daily

  9. The practice of diagnosing and reporting transfusion-associated circulatory overload: a national survey among physicians and haemovigilance officers

    NARCIS (Netherlands)

    Bosboom, J. J.; Klanderman, R. B.; Peters, A. L.; van de Weerdt, E. K.; Goudswaard, E. J.; Binnekade, J. M.; Zwaginga, J. J.; Beckers, E. A. M.; Geerts, B. F.; Hollmann, M. W.; Zeerleder, S. S.; van Kraaij, M.; Vlaar, A. P.

    2017-01-01

    This study aims at identifying factors that disciplines consider when diagnosing and reporting transfusion-associated circulatory overload ('TACO'). TACO is a clinical diagnosis based mainly on subjective factors. Therefore, TACO could be an underreported complication of blood transfusion. A survey

  10. Senescent Changes in Cerebrospinal Fluid Circulatory Physiology and Their Role in the Pathogenesis of Normal-tension Glaucoma

    NARCIS (Netherlands)

    Wostyn, Peter; De Groot, Veva; Van Dam, Debby; Audenaert, Kurt; De Deyn, Peter Paul

    PURPOSE: To evaluate the evidence supporting a role for senescent changes in cerebrospinal fluid (CSF) circulatory physiology in the pathogenesis of normal-tension glaucoma (NTG). DESIGN: Literature review and personal perspective of the authors. METHODS: Analysis of selected articles in the

  11. Predictors of Death and Transplant in Patients With a Mechanical Circulatory Support Device : A Multi-institutional Study

    NARCIS (Netherlands)

    Holman, William L.; Kormos, Robert L.; Naftel, David C.; Miller, Marissa A.; Pagani, Frank D.; Blume, Elizabeth; Cleeton, Timothy; Koenig, Steven C.; Edwards, Leah; Kirklin, James K.

    Background: INTERMACS is a registry of FDA-approved durable mechanical circulatory support (MCS) devices used for the strategies of destination therapy (DT) and bridge to transplantation (BTT) or recovery. This study identifies predictors for death and transplantation based on initial results from

  12. In situ lung perfusion is a valuable tool to assess lungs from donation after circulatory death donors category III

    NARCIS (Netherlands)

    Van de Wauwer, Caroline; Munneke, Anita J.; Engels, Gerwin E.; Berga, Foke M.; Rakhorst, Gerhard; Nijsten, Maarten W.; Mariani, Massimo A.; Erasmus, Michiel E.

    Donations after circulatory death (DCD) lung grafts are an alternative to extend the donor pool in lung transplantation. This study investigates the use of an in situ lung perfusion system (ISLP) in the donor to evaluate category III lungs. Pigs were sacrificed by ventricular fibrillation. All

  13. Students' Visualization of Diagrams Representing the Human Circulatory System: The Use of Spatial Isomorphism and Representational Conventions

    Science.gov (United States)

    Cheng, Maurice M. W.; Gilbert, John K.

    2015-01-01

    This study investigated students' interpretation of diagrams representing the human circulatory system. We conducted an interview study with three students aged 14-15 (Year 10) who were studying biology in a Hong Kong school. During the interviews, students were asked to interpret diagrams and relationships between diagrams that represented…

  14. The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) of the European Association for Cardio-Thoracic Surgery (EACTS)

    DEFF Research Database (Denmark)

    de By, Theo M M H; Mohacsi, Paul; Gahl, Brigitta

    2017-01-01

    OBJECTIVES: The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) was founded in Berlin, Germany. EUROMACS is supported fully by the European Association for Cardio-Thoracic Surgery (EACTS) and, since 2014, has functioned as a committee of the EACTS. The purpose...

  15. Diseases of the circulatory system among adult people diagnosed with infantile autism as children

    DEFF Research Database (Denmark)

    Mouridsen, Svend Erik; Rich, Bente; Isager, Torben

    2016-01-01

    adult people diagnosed with infantile autism (IA) as children with 336 sex and age matched controls from the general population. METHODS AND PROCEDURES: All participants were screened through the nationwide Danish National Hospital Register. The average observation time of both groups was 37.2 years...... that cardiovascular disease is the primary cause of death in most developed countries, it is suggested that to prevent disease and manage health conditions, health monitoring is essential in adult people with IA.......BACKGROUND: Research dealing with adult people with autism spectrum disorders (ASD) noticeably lags behind studies of children and young individuals with ASD. AIMS: The objective of this study was to compare the prevalence and types of diseases of the circulatory system in a clinical sample of 118...

  16. The prevention of circulatory collapse in left atrial myxoma or left atrail thrombus patients.

    Science.gov (United States)

    Sun, Jie; Ding, Zhengnian

    2016-05-01

    Some patients with myxoma or thrombus may develop to severe hypotension or sudden death. In this article, we hypothesize a clinical scenario that when the myxoma or thrombus blocks in the mitral valve and causes significant hypotension during anesthesia or surgery. Increasing cardiac preload will be an effective preventive method to increasing the mitral valve annulus and decreasing the severity of stenosis, as a result it will prevent circulatory collapse. Our hypothesis will decrease the possibility of lethal mitral valve stenosis induced by left atrial mass blocking the mitral valve area. In addition, we should also maintain a relative slow heart rate and a relative high systemic vascular resistance. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Long-term Mechanical Circulatory Support System reliability recommendation by the National Clinical Trial Initiative subcommittee.

    Science.gov (United States)

    Lee, James

    2009-01-01

    The Long-Term Mechanical Circulatory Support (MCS) System Reliability Recommendation was published in the American Society for Artificial Internal Organs (ASAIO) Journal and the Annals of Thoracic Surgery in 1998. At that time, it was stated that the document would be periodically reviewed to assess its timeliness and appropriateness within 5 years. Given the wealth of clinical experience in MCS systems, a new recommendation has been drafted by consensus of a group of representatives from the medical community, academia, industry, and government. The new recommendation describes a reliability test methodology and provides detailed reliability recommendations. In addition, the new recommendation provides additional information and clinical data in appendices that are intended to assist the reliability test engineer in the development of a reliability test that is expected to give improved predictions of clinical reliability compared with past test methods. The appendices are available for download at the ASAIO journal web site at www.asaiojournal.com.

  18. Outcomes of Kidney Transplantation from Circulatory Death Donors With Increased Terminal Creatinine Levels in Serum.

    Science.gov (United States)

    Tomita, Yusuke; Tojimbara, Tamotsu; Iwadoh, Kazuhiro; Nakajima, Ichiro; Fuchinoue, Shohei

    2016-07-01

    To alleviate chronic renal graft shortages in Japan, donation after circulatory death (DCD) is an increasingly used organ resource. Organs from DCD donors with progressively increased terminal creatinine (t-Cr) levels are frequently used, but the effects of this condition on kidney transplantation (KTx) remain unclear. Between 1996 and 2013, 99 KTx from DCD donors were conducted in our department. Recipients were grouped according to the t-Cr (in mg/dL) of donors: group 1, t-Cr less than history of hypertension were significantly associated with graft survival. Results suggest that, under certain conditions, kidneys from DCD donors with progressively increased t-Cr can be used safely with promising long-term outcomes.

  19. Energy transmission and power sources for mechanical circulatory support devices to achieve total implantability.

    Science.gov (United States)

    Wang, Jake X; Smith, Joshua R; Bonde, Pramod

    2014-04-01

    Left ventricular assist device therapy has radically improved congestive heart failure survival with smaller rotary pumps. The driveline used to power today's left ventricular assist devices, however, continues to be a source of infection, traumatic damage, and rehospitalization. Previous attempts to wirelessly power left ventricular assist devices using transcutaneous energy transfer systems have been limited by restrictions on separation distance and alignment between the transmit and receive coils. Resonant electrical energy transfer allows power delivery at larger distances without compromising safety and efficiency. This review covers the efforts to wirelessly power mechanical circulatory assist devices and the progress made in enhancing their energy sources. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Brain ultrasonographic findings of late-onset circulatory dysfunction due to adrenal insufficiency in preterm infants.

    Science.gov (United States)

    Shin, Su-Mi; Chai, Jee Won

    2016-07-01

    The aim of this study was to characterize the brain ultrasonographic findings of late-onset circulatory dysfunction (LCD) due to adrenal insufficiency (AI) in preterm infants. Among the 257 preterm infants born at cystic change in one patient. Ultrasonographic findings after LCD demonstrated no significant change in grade 1 PVE and no new lesions in eight (57%), grade 1 PVE with newly appearing GMH in three (21%), and increased PVE in three (21%) infants. Five infants (36%) showed new development (n=4) or increased size (n=1) of GMH. Two of three infants (14%) with increased PVE developed cystic periventricular leukomalacia (PVL) and rapid progression to macrocystic encephalomalacia. LCD due to AI may be associated with the late development of GMH, increased PVE after LCD, and cystic PVL with rapid progression to macrocystic encephalomalacia.

  1. New classification of donation after circulatory death donors definitions and terminology.

    Science.gov (United States)

    Thuong, Marie; Ruiz, Angel; Evrard, Patrick; Kuiper, Michael; Boffa, Catherine; Akhtar, Mohammed Z; Neuberger, James; Ploeg, Rutger

    2016-07-01

    In the face of a crisis in organ donation, the transplant community are increasingly utilizing donation after circulatory death (DCD) donors. Over the last 10 years, with the increasing usage of DCD donors, we have seen the introduction in a number of new terms and definitions. We report the results of the 6th International Conference in Organ Donation held in Paris in 2013 and report a consensus agreement of an established expert European Working Group on the definitions and terminology regarding DCD donation, including refinement of the Maastricht definitions. This document forms part of a special series where recommendations are presented for uncontrolled and controlled DCD donation and organ specific guidelines for kidney, pancreas, liver and lung transplantation. An expert panel formed a consensus on definitions and terms aiming to establish consistent usage of terms in DCD donation. © 2016 Steunstichting ESOT.

  2. Centrifugal pumps and hemolysis in pediatric extracorporeal membrane oxygenation (ECMO) patients: An analysis of Extracorporeal Life Support Organization (ELSO) registry data.

    Science.gov (United States)

    O'Brien, Ciaran; Monteagudo, Julie; Schad, Christine; Cheung, Eva; Middlesworth, William

    2017-06-01

    It is currently unclear whether centrifugal pumps cause more hemolysis than roller pumps in extracorporeal membrane oxygenation (ECMO) circuits. The aim of this study was to help answer that question in pediatric patients. A limited deidentified data set was extracted from the international multicenter Extracorporeal Life Support Organization (ELSO) registry comprising all reported ECMO runs for patients 18years or younger between 2010 and 2015. Logistic regression was used to evaluate a possible association between hemolysis and pump type, controlling for patient demographics, circuit factors, and complications. 14,776 ECMO runs for 14,026 patients had pump type recorded. Centrifugal pumps were employed in 60.4% of ECMO circuits. Hemolysis was a reported complication for 1272 (14%) centrifugal pump runs and for 291 (5%) roller pump runs. 1755 (20%) centrifugal pump runs reported kidney injury as compared to 797 (14%) roller pump runs. In the full logistic regression, the odds of hemolysis were significantly greater for runs using centrifugal pumps (OR 3.3, 95% CI 2.9-3.8, p<0.001). In this retrospective analysis of a large international data set, the use of centrifugal pumps was associated with increased rates of hemolysis, hyperbilirubinemia, and kidney injury. Retrospective cohort study. Level III. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Infection-Induced Interaction between the Mosquito Circulatory and Immune Systems

    Science.gov (United States)

    King, Jonas G.; Hillyer, Julián F.

    2012-01-01

    Insects counter infection with innate immune responses that rely on cells called hemocytes. Hemocytes exist in association with the insect's open circulatory system and this mode of existence has likely influenced the organization and control of anti-pathogen immune responses. Previous studies reported that pathogens in the mosquito body cavity (hemocoel) accumulate on the surface of the heart. Using novel cell staining, microdissection and intravital imaging techniques, we investigated the mechanism of pathogen accumulation in the pericardium of the malaria mosquito, Anopheles gambiae, and discovered a novel insect immune tissue, herein named periostial hemocytes, that sequesters pathogens as they flow with the hemolymph. Specifically, we show that there are two types of endocytic cells that flank the heart: periostial hemocytes and pericardial cells. Resident periostial hemocytes engage in the rapid phagocytosis of pathogens, and during the course of a bacterial or Plasmodium infection, circulating hemocytes migrate to the periostial regions where they bind the cardiac musculature and each other, and continue the phagocytosis of invaders. Periostial hemocyte aggregation occurs in a time- and infection dose-dependent manner, and once this immune process is triggered, the number of periostial hemocytes remains elevated for the lifetime of the mosquito. Finally, the soluble immune elicitors peptidoglycan and β-1,3-glucan also induce periostial hemocyte aggregation, indicating that this is a generalized and basal immune response that is induced by diverse immune stimuli. These data describe a novel insect cellular immune response that fundamentally relies on the physiological interaction between the insect circulatory and immune systems. PMID:23209421

  4. Infection-induced interaction between the mosquito circulatory and immune systems.

    Directory of Open Access Journals (Sweden)

    Jonas G King

    Full Text Available Insects counter infection with innate immune responses that rely on cells called hemocytes. Hemocytes exist in association with the insect's open circulatory system and this mode of existence has likely influenced the organization and control of anti-pathogen immune responses. Previous studies reported that pathogens in the mosquito body cavity (hemocoel accumulate on the surface of the heart. Using novel cell staining, microdissection and intravital imaging techniques, we investigated the mechanism of pathogen accumulation in the pericardium of the malaria mosquito, Anopheles gambiae, and discovered a novel insect immune tissue, herein named periostial hemocytes, that sequesters pathogens as they flow with the hemolymph. Specifically, we show that there are two types of endocytic cells that flank the heart: periostial hemocytes and pericardial cells. Resident periostial hemocytes engage in the rapid phagocytosis of pathogens, and during the course of a bacterial or Plasmodium infection, circulating hemocytes migrate to the periostial regions where they bind the cardiac musculature and each other, and continue the phagocytosis of invaders. Periostial hemocyte aggregation occurs in a time- and infection dose-dependent manner, and once this immune process is triggered, the number of periostial hemocytes remains elevated for the lifetime of the mosquito. Finally, the soluble immune elicitors peptidoglycan and β-1,3-glucan also induce periostial hemocyte aggregation, indicating that this is a generalized and basal immune response that is induced by diverse immune stimuli. These data describe a novel insect cellular immune response that fundamentally relies on the physiological interaction between the insect circulatory and immune systems.

  5. Changes of circulatory and nervous diseases mortality patterns during periods of exceptional solar events

    Science.gov (United States)

    Podolska, Katerina

    2017-04-01

    The paper contains a statistical analysis of exceptional solar events and daily numbers of deaths from diseases from ICD-10 group VI. Diseases of the nervous system, group IX. Diseases of the circulatory system, and overall daily numbers of deaths in the Czech Republic. It is demonstrated that neurological diseases exhibit greater instability during the period of rising and falling solar activity. Specifically, we study the daily number of deaths separately for both sexes at the age groups under 39 and 40+ during the Solar Cycles No. 23 and No. 24. We focus mainly on exceptional solar events such as a "Bastille Day event" on July 14, 2000 (class X5), "Halloween solar storm" on October 28, 2003 (class X17), and events on January 7, 1997, April 2, 2000 (class X20), or September 7, 2005 (class X15). Special attention is given to "St. Patrick's Day storm" on March 17, 2015, the strongest geomagnetic storm of the Solar Cycle No. 24 that occurred following a coronal mass ejection (CME). We investigate changes in daily numbers of deaths during 1 month before and 1 month after these exceptional solar events. We take specific storm dynamics of geophysical parameters into consideration, and we also apply the results of risky characteristics of expositions by ionospheric and geomagnetic parameters. It is verified that, for diseases of the nervous system, women are generally more sensitive than men. On the contrary, this differences between men and women are not found for diseases of the circulatory system. Our findings suggest that the impact of hazardous space weather conditions on human health depends on the specific course and strength of individual solar storm.

  6. Central Hemodynamics and Intracranial and Cerebral Perfusion Pressures in Acute Cerebral Circulatory Disorders

    Directory of Open Access Journals (Sweden)

    K. V. Lukashev

    2009-01-01

    Full Text Available Objective: to study the central hemodynamics (CH and intracranial and cerebral perfusion pressures (ICP and CPP in acute cerebral circulatory disorders (ACCD and their possible relationships for further development of intensive differential therapy for the detected disorders. Material and methods. Hemodynamic studies using the transpulmonary thermodilu-tion technique, measurements of ICP, calculations of CPP, and currently available X-ray studies were conducted in 18 patients on days 1, 3, 5, and 7 of ACCD. All the patients were found to have essential hypertension and coronary heart disease. Results. In the first 5 days of ACCD, there was a normodynamic type of circulation in hemorrhagic stroke (HS and a hypodynamic type in ischemic stroke (IS. ICP remained at the baseline elevated level in the IS group and increased over time in the HS group. CPP was significantly unchanged. Myocardial dysfunction was detected when there was a significant preload caused by a high postload. In IS, an inverse correlation was found between ICP and global ejection fraction (GEF, cardiac performance index (CPI and on day 7, the correlation was direct. In HS, ICP had a direct correlation with CPI and an inverse correlation with GEF. These changes during treatment failed to progress and were revealed in the presence of brain dislocation, as evidenced by spiral computed tomography. Conclusion. Thus, the pattern of CH disorders depends on the type of ACCD. In the first 5 days of ACCD, a hypokinetic circulatory type is registered in IS and a normokinetic type is in HS. Evolving dislocation of the brain with impaired function of its stem structures due to ICP elevation is one of the causes of central hemodynamic changes. The value of ICP in ACCD is a crucial indicator in the diagnosis of secondary brain damages and determines treatment policy. Key words: acute ischemic attack, intracranial pressure, cerebral perfusion pressure, central hemodynamics, myocardial depression.

  7. Acute resistance exercise modulates microRNA expression profiles: Combined tissue and circulatory targeted analyses.

    Directory of Open Access Journals (Sweden)

    Randall F D'Souza

    Full Text Available A subset of short non-coding RNAs, microRNAs (miRs, have been identified in the regulation of skeletal muscle hypertrophy and atrophy. Expressed within cells, miRs are also present in circulation (c-miR and have a putative role in cross-tissue signalling. The aim of this study was to examine the impact of a single bout of high intensity resistance exercise (RE on skeletal muscle and circulatory miRs harvested simultaneously. Resistance trained males (n = 9, 24.6 ± 4.9 years undertook a single bout of high volume RE with venous blood and muscle biopsies collected before, 2 and 4hr post-exercise. Real time polymerase chain reaction (Rt-PCR analyses was performed on 30 miRs that have previously been shown to be required for skeletal muscle function. Of these, 6 miRs were significantly altered within muscle following exercise; miR-23a, -133a, -146a, -206, -378b and 486. Analysis of these same miRs in circulation demonstrated minimal alterations with exercise, although c-miR-133a (~4 fold, p = 0.049 and c-miR-149 (~2.4 fold; p = 0.006 were increased 4hr post-exercise. Thus a single bout of RE results in the increased abundance of a subset of miRs within the skeletal muscle, which was not evident in plasma. The lack a qualitative agreement in the response pattern of intramuscular and circulating miR expression suggests the analysis of circulatory miRs is not reflective of the miR responses within skeletal muscle after exercise.

  8. Advancing the Science of Myocardial Recovery With Mechanical Circulatory Support

    Directory of Open Access Journals (Sweden)

    Stavros G. Drakos, MD, PhD

    2017-06-01

    Full Text Available Summary: The medical burden of heart failure (HF has spurred interest in clinicians and scientists to develop therapies to restore the function of a failing heart. To advance this agenda, the National Heart, Lung, and Blood Institute (NHLBI convened a Working Group of experts from June 2 to 3, 2016, in Bethesda, Maryland, to develop NHLBI recommendations aimed at advancing the science of cardiac recovery in the setting of mechanical circulatory support (MCS. MCS devices effectively reduce volume and pressure overload that drives the cycle of progressive myocardial dysfunction, thereby triggering structural and functional reverse remodeling. Research in this field could be innovative in many ways, and the Working Group specifically discussed opportunities associated with genome-phenome systems biology approaches; genetic epidemiology; bioinformatics and precision medicine at the population level; advanced imaging modalities, including molecular and metabolic imaging; and the development of minimally invasive surgical and percutaneous bioengineering approaches. These new avenues of investigations could lead to new treatments that target phylogenetically conserved pathways involved in cardiac reparative mechanisms. A central point that emerged from the NHLBI Working Group meeting was that the lessons learned from the MCS investigational setting can be extrapolated to the broader HF population. With the precedents set by the significant effect of studies of other well-controlled and tractable subsets on larger populations, such as the genetic work in both cancer and cardiovascular disease, the work to improve our understanding of cardiac recovery and resilience in MCS patients could be transformational for the greater HF population. Key Words: cardiac remodeling, mechanical circulatory support, myocardial recovery, ventricular assist devices

  9. Effects of 12 days exposure to simulated microgravity on central circulatory hemodynamics in the rhesus monkey

    Science.gov (United States)

    Convertino, V. A.; Koenig, S. C.; Krotov, V. P.; Fanton, J. W.; Korolkov, V. I.; Trambovetsky, E. V.; Ewert, D. L.; Truzhennikov, A.; Latham, R. D.

    Central circulatory hemodynamic responses were measured before and during the initial 9 days of a 12-day 10 ° head-down tilt (HDT) in 4 flight-sized juvenile rhesus monkeys who were surgically instrumented with a variety of intrathoracic catheters and blood flow sensors to assess the effects of simulated microgravity on central circulatory hemodynamics. Each subject underwent measurements of aortic and left ventricular pressures, and aortic flow before and during HDT as well as during a passive head-up postural test before and after HDT. Heart rate, stroke volume, cardiac output, and left ventricular end-diastolic pressure were measured, and dP/dt and left ventricular elastance was calculated from hemodynamic measurements. The postural test consisted of 5 min of supine baseline control followed by 5 minutes of 90 ° upright tilt (HUT). Heart rate, stroke volume, cardiac output, and left ventricular end-diastolic pressure showed no consistent alterations during HDT. Left ventricular elastance was reduced in all animals throughout HDT, indicating that cardiac compliance was increased. HDT did not consistently alter left ventricular +dP/dt, indicating no change in cardiac contractility. Heart rate during the post-HDT HUT postural test was elevated compared to pre-HDT while post-HDT cardiac output was decreased by 52% as a result of a 54% reduction in stroke volume throughout HUT. Results from this study using an instrumented rhesus monkey suggest that exposure to microgravity may increase ventricular compliance without alterating cardiac contractility. Our project supported the notion that an invasively-instrumented animal model should be viable for use in spaceflight cardiovascular experiments to assess potential changes in myocardial function and cardiac compliance.

  10. Increased Plasma Levels of Heparin-Binding Protein on Admission to Intensive Care Are Associated with Respiratory and Circulatory Failure.

    Directory of Open Access Journals (Sweden)

    Jonas Tydén

    Full Text Available Heparin-binding protein (HBP is released by granulocytes and has been shown to increase vascular permeability in experimental investigations. Increased vascular permeability in the lungs can lead to fluid accumulation in alveoli and respiratory failure. A generalized increase in vascular permeability leads to loss of circulating blood volume and circulatory failure. We hypothesized that plasma concentrations of HBP on admission to the intensive care unit (ICU would be associated with decreased oxygenation or circulatory failure.This is a prospective, observational study in a mixed 8-bed ICU. We investigated concentrations of HBP in plasma at admission to the ICU from 278 patients. Simplified acute physiology score (SAPS 3 was recorded on admission. Sequential organ failure assessment (SOFA scores were recorded daily for three days.Median SAPS 3 was 58.8 (48-70 and 30-day mortality 64/278 (23%. There was an association between high plasma concentrations of HBP on admission with decreased oxygenation (p<0.001 as well as with circulatory failure (p<0.001, after 48-72 hours in the ICU. There was an association between concentrations of HBP on admission and 30-day mortality (p = 0.002. ROC curves showed areas under the curve of 0,62 for decreased oxygenation, 0,65 for circulatory failure and 0,64 for mortality.A high concentration of HBP in plasma on admission to the ICU is associated with respiratory and circulatory failure later during the ICU care period. It is also associated with increased 30-day mortality. Despite being an interesting biomarker for the composite ICU population it's predictive value at the individual patient level is low.

  11. Cellulite and extracorporeal Shockwave therapy (CelluShock-2009 - a Randomized Trial

    Directory of Open Access Journals (Sweden)

    Joest Beatrice

    2010-10-01

    Full Text Available Abstract Background Cellulite is a widespread problem involving females' buttocks and thighs based on the female specific anatomy. Given the higher number of fat cells stored in female fatty tissue in contrast to males, and the aging process of connective tissue leads to an imbalance between lipogenesis and lipolysis with subsequent large fat cells bulging the skin. In addition, microcirculatory changes have been suggested, however remain largely unknown in a controlled clinical setting. We hypothesize that the combination of extracorporeal shockwave and a daily gluteal muscle strength program is superior to the gluteal muscle strength program alone in cellulite. Methods/Design Study design: Randomized-controlled trial. IRB approval was granted at Hannover Medical School, Germany on May 22, 2009. For allocation of participants, a 1:1 ratio randomization was performed using opaque envelopes for the concealment of allocation. Reporting: according to CONSORT 2010. Eligible patients were females aged 18 or over and 65 or younger with cellulite with documented cellulite 1°-4° according to the Nürnberger score. Exclusion criteria were suspected or evident pregnancy, no cellulite, no informed consent or age under 18 years or above 65 years. Patients were recruited by advertisements in local regional newspapers and via the Internet. Analysis: Intention-to-treat. Outcome parameters: a Photonumeric severity scale, b Nürnberger Score, c circumference measurements, d capillary blood flow, e tissue oxygen saturation, f postcapillary venous blood flow. Intervention group: Six sessions of extracorporeal focused shock wave for six sessions (2000 impulses, 0,25 mJ/m2 every 1-2 weeks at both gluteal and thigh regions plus a specific gluteal strength exercise training. Control group: Six sessions of sham extracorporeal focused shock wave for six sessions (2000 impulses, 0,01 mJ/m2 every 1-2 weeks at both gluteal and thigh regions plus a specific gluteal

  12. Cellulite and extracorporeal Shockwave therapy (CelluShock-2009) - a Randomized Trial

    Science.gov (United States)

    2010-01-01

    Background Cellulite is a widespread problem involving females' buttocks and thighs based on the female specific anatomy. Given the higher number of fat cells stored in female fatty tissue in contrast to males, and the aging process of connective tissue leads to an imbalance between lipogenesis and lipolysis with subsequent large fat cells bulging the skin. In addition, microcirculatory changes have been suggested, however remain largely unknown in a controlled clinical setting. We hypothesize that the combination of extracorporeal shockwave and a daily gluteal muscle strength program is superior to the gluteal muscle strength program alone in cellulite. Methods/Design Study design: Randomized-controlled trial. IRB approval was granted at Hannover Medical School, Germany on May 22, 2009. For allocation of participants, a 1:1 ratio randomization was performed using opaque envelopes for the concealment of allocation. Reporting: according to CONSORT 2010. Eligible patients were females aged 18 or over and 65 or younger with cellulite with documented cellulite 1°-4° according to the Nürnberger score. Exclusion criteria were suspected or evident pregnancy, no cellulite, no informed consent or age under 18 years or above 65 years. Patients were recruited by advertisements in local regional newspapers and via the Internet. Analysis: Intention-to-treat. Outcome parameters: a) Photonumeric severity scale, b) Nürnberger Score, c) circumference measurements, d) capillary blood flow, e) tissue oxygen saturation, f) postcapillary venous blood flow. Intervention group: Six sessions of extracorporeal focused shock wave for six sessions (2000 impulses, 0,25 mJ/m2 every 1-2 weeks) at both gluteal and thigh regions plus a specific gluteal strength exercise training. Control group: Six sessions of sham extracorporeal focused shock wave for six sessions (2000 impulses, 0,01 mJ/m2 every 1-2 weeks) at both gluteal and thigh regions plus a specific gluteal strength exercise training

  13. Cellulite and extracorporeal Shockwave therapy (CelluShock-2009)--a randomized trial.

    Science.gov (United States)

    Knobloch, Karsten; Joest, Beatrice; Vogt, Peter M

    2010-10-26

    Cellulite is a widespread problem involving females' buttocks and thighs based on the female specific anatomy. Given the higher number of fat cells stored in female fatty tissue in contrast to males, and the aging process of connective tissue leads to an imbalance between lipogenesis and lipolysis with subsequent large fat cells bulging the skin. In addition, microcirculatory changes have been suggested, however remain largely unknown in a controlled clinical setting. We hypothesize that the combination of extracorporeal shockwave and a daily gluteal muscle strength program is superior to the gluteal muscle strength program alone in cellulite. Randomized-controlled trial. IRB approval was granted at Hannover Medical School, Germany on May 22, 2009. For allocation of participants, a 1:1 ratio randomization was performed using opaque envelopes for the concealment of allocation. Reporting: according to CONSORT 2010. Eligible patients were females aged 18 or over and 65 or younger with cellulite with documented cellulite 1°-4° according to the Nürnberger score. Exclusion criteria were suspected or evident pregnancy, no cellulite, no informed consent or age under 18 years or above 65 years. Patients were recruited by advertisements in local regional newspapers and via the Internet. Intention-to-treat. a) Photonumeric severity scale, b) Nürnberger Score, c) circumference measurements, d) capillary blood flow, e) tissue oxygen saturation, f) postcapillary venous blood flow. Intervention group: Six sessions of extracorporeal focused shock wave for six sessions (2000 impulses, 0,25 mJ/m2 every 1-2 weeks) at both gluteal and thigh regions plus a specific gluteal strength exercise training. Six sessions of sham extracorporeal focused shock wave for six sessions (2000 impulses, 0,01 mJ/m2 every 1-2 weeks) at both gluteal and thigh regions plus a specific gluteal strength exercise training. 12 weeks. Blinding was achieved for all participants enrolled in the trial, the

  14. Capabilities of a mobile extracorporeal membrane oxygenation service for severe respiratory failure delivered by intensive care specialists.

    Science.gov (United States)

    Sherren, P B; Shepherd, S J; Glover, G W; Meadows, C I S; Langrish, C; Ioannou, N; Wyncoll, D; Daly, K; Gooby, N; Agnew, N; Barrett, N A

    2015-06-01

    We conducted a single-centre observational study of retrievals for severe respiratory failure over 12 months. Our intensivist-delivered retrieval service has mobile extracorporeal membrane oxygenation capabilities. Sixty patients were analysed: 34 (57%) were female and the mean (SD) age was 44.1 (13.6) years. The mean (SD) PaO2 /FI O2 ratio at referral was 10.2 (4.1) kPa and median (IQR [range]) Murray score was 3.25 (3.0-3.5 [1.5-4.0]). Forty-eight patients (80%) required veno-venous extracorporeal membrane oxygenation at the referring centre. There were no cannulation or extracorporeal membrane oxygenation-related complications. The median (IQR [range]) retrieval distance was 47.2 (14.9-77.0 [2.3-342.0]) miles. There were no major adverse events during retrieval. Thirty-seven patients (77%) who received extracorporeal membrane oxygenation survived to discharge from the intensive care unit and 36 patients (75%) were alive after six months. Senior intensivist-initiated and delivered mobile extracorporeal membrane oxygenation is safe and associated with a high incidence of survival. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

  15. Temporary jobs and the severity of workplace accidents.

    Science.gov (United States)

    Picchio, Matteo; van Ours, Jan C

    2017-06-01

    From the point of view of workplace safety, it is important to know whether having a temporary job has an effect on the severity of workplace accidents. We present an empirical analysis on the severity of workplace accidents by type of contract. We used microdata collected by the Italian national institute managing the mandatory insurance against work related accidents. We estimated linear models for a measure of the severity of the workplace accident. We controlled for time-invariant fixed effects at worker and firm levels to disentangle the impact of the type of contract from the spurious one induced by unobservables at worker and firm levels. Workers with a temporary contract, if subject to a workplace accident, were more likely to be confronted with severe injuries than permanent workers. When correcting the statistical analysis for injury under-reporting of temporary workers, we found that most of, but not all, the effect is driven by the under-reporting bias. The effect of temporary contracts on the injury severity survived the inclusion of worker and firm fixed effects and the correction for temporary workers' injury under-reporting. This, however, does not exclude the possibility that, within firms, the nature of the work may vary between different categories of workers. For example, temporary workers might be more likely to be assigned dangerous tasks because they might have less bargaining power. The findings will help in designing public policy effective in increasing temporary workers' safety at work and limiting their injury under-reporting. Copyright © 2017. Published by Elsevier Ltd.

  16. Refractory pediatric cardiogenic shock: A case for mechanical support.

    Science.gov (United States)

    Sachdev, Anil; Mehra, Bharat; Mohanty, Arun; Gupta, Dhiren; Gupta, Neeraj

    2016-11-01

    Acute left ventricular dysfunction in children justifies aggressive treatment because of the high potential for complete recovery. The options for providing mechanical support to the failing heart in a child include extracorporeal membrane oxygenation, left ventricular assist devices, and the use of the intra-aortic balloon pump (IABP). The IABP is a commonly used method of temporary circulatory support in adults. However, despite the availability of pediatric size balloons, the usage of IABP for temporary circulatory support in children has not been widespread. Current case report, first from India in pediatric age group, aims to aware the pediatric intensivist about the role of IABP in providing temporary mechanical cardiovascular support in managing patients with refractory low cardiac output state.

  17. Temporary henna tattoo is unsafe in atopic children.

    Science.gov (United States)

    Corrente, Stefania; Moschese, Viviana; Chianca, Marco; Graziani, Simona; Iannini, Roberta; La Rocca, Maria; Chini, Loredana

    2007-03-01

    Temporary henna tattoos have become increasingly popular as a safe alternative to permanent tattoos among American and European children and teenagers during the summer holidays. Currently, temporary henna tattoos contain not only henna, but also other additives such as para-phemylenediamine (PPD), which is considered to be the chemical agent that most frequently causes skin reactions associated with the use of commercial black henna. In this report, we describe an 11-year-old boy who applied a temporary black henna tattoo on his right arm during the summer holidays in Greece and developed a severe contact dermatitis at the tattoo site with residual hypopigmentation. He had no previous history of contact dermatitis, however he did suffer from seasonal allergic rhinitis and atopic dermatitis. Patch testing revealed a strong reaction to PPD, a substance commonly contained in temporary henna tattoo preparations. Henna tattoos are an increasing problem worldwide since they carry an increased risk of severe skin reactions; therefore we suggest that the use of temporary henna tattoos in children be discouraged.

  18. Mechanical circulatory support for right heart failure: current technology and future outlook.

    Science.gov (United States)

    Hsu, Po-Lin; Parker, Jack; Egger, Christina; Autschbach, Rüdiger; Schmitz-Rode, Thomas; Steinseifer, Ulrich

    2012-04-01

    The increasing global prevalence of congestive heart failure is a major healthcare concern, accounting for a high morbidity rate worldwide. In particular, isolated right heart dysfunction after cardiotomy has a poor prognosis and is associated with a high mortality rate. The occurrence of postoperative right heart failure may develop in more than 40% of patients undergoing implantation of a left ventricular assist device (LVAD) and cardiac transplantation. To date, mechanical cardiac assistance in the form of VADs has become accepted as a therapeutic solution for end-stage patients when a donor heart is not available. However, right ventricular (RV) assistance is still in the early phase of development when compared with LVAD technology. State-of-the-art RVADs, both in clinical use and under development, are reviewed in this manuscript. Clinical RVADs include the extracorporeal pulsatile Abiomed BVS 5000 and AB5000, Thoratec PVAD, MEDOS VAD, BerlinHeart Excor, the percutaneous continuous flow CentriMag and TandemHeart systems, and the implantable Thoratec IVAD. Devices on the horizon, including the wear-free implantable DexAide and the minimally invasive Impella RD, are additionally reviewed. In addition to the current status of RV assistance, as well as the device categorization, the outlook and considerations for successful development of future RVADs were discussed. © 2011, Copyright the Authors. Artificial Organs © 2011, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  19. Extracorporeal Membrane Oxygenation in Severe Acute Respiratory Failure in Postpartum Woman With Rheumatic Mitral Valve Disease: Benefit, Factors Furthering the Success of This Procedure, and Review of the Literature

    Science.gov (United States)

    Fayad, Georges; Larrue, Benoît; Modine, Thomas; Azzaoui, Richard; Regnault, Alexi; Koussa, Mohammad; Gourlay, Terry; Fourrier, François; Decoene, Christophe; Warembourg, Henri

    2007-01-01

    Abstract: Pregnancy is a common decompensation factor for women with post-rheumatic mitral disease. However, valvular heart diseases causing severe acute respiratory distress are rare. Use of extracorporeal membrane oxygenation (ECMO) early in the event of cardiorespiratory failure after cardiac surgery may be of benefit. Indeed, ECMO cardiopulmonary bypass (CPB) support could help pulmonary recovery if the mitral pathology is involved. A 31-year-old female patient at 30 weeks of amenorrhea was admitted to the obstetrics department with 40°C hyperthermia and New York Heart Association (NYHA) class 4 dyspnea. The patient’s medical history included a post-rheumatic mitral stenosis. Blood gases showed severe hypoxemia associated with hypocapnia. The patient needed to be rapidly intubated and was placed on ventilatory support because of acute respiratory failure. Transesophageal echocardiography showed a severe mitral stenosis, mild mitral insufficiency, and diminished left ventricular function, hypokinetic, dilated right ventricle, and a severe tricuspid regurgitation. An urgent cesarean section was performed. Because of the persistent hemodynamic instability, a mitral valvular replacement and tricuspid valve annuloplasty were performed. In view of the preoperative acute respiratory distress, we decided, at the beginning of the operation, to carry on circulatory support with oxygenation through an ECMO-type CPB at the end of the operation. This decision was totally justified by the unfeasible CPB weaning off. ECMO use led to an efficient hemodynamic state without inotropic drug support. The surgical post-operative course was uneventful. Early use of cardiorespiratory support with veno-arterial ECMO allows pulmonary and right heart recovery after cardiac surgery, thus avoiding the use of inotropic drugs and complex ventilatory support. PMID:17672195

  20. Circulatory shock in horses / Choque circulatório em equinos

    Directory of Open Access Journals (Sweden)

    José Monteira da Silva Filho

    2010-04-01

    Full Text Available Circulatory shock can be defined as an acute circulatory failure with an inadequate tissue delivery of oxygen and nutritive substrates to the tissues, resulting in generalised cellular hypoxia. Shock can be classified as cardiogenic, obstructive, hypovolaemic, or distributive. The pathophysiologic consequences of inadequate tissue perfusion are directly related to cell ischemia, inadequate O2 delivery, and the production of proinflammatory mediators. If abnormalities of tissue perfusion are allowed to persist, the function of vital organs will be impaired. The subsequent reperfusion will exacerbate organ dysfunction and, in severe cases, may culminate in multiple organ dysfunction syndrome. Early recognition of equine that are shocked and immediate provision of effective circulatory support is therefore essential. In all cases the objective is to restore oxygen delivery to the tissues while correcting the underlying cause. Delays in making the diagnosis and initiating treatment, as well as suboptimal resuscitation, contribute to the development of peripheral vascular failure and irreversible defects in oxygen use which can culminate in vital organ dysfunction.Choque circulatório pode ser definido como uma falha circulatória aguda com liberação inadequada de oxigênio e nutrientes aos tecidos, resultando em hipóxia celular. O choque pode ser classificado como cardiogênico, obstrutivo, hipovolêmico ou distributivo. As consequências fisiopatológicas da perfusão tecidual inadequada estão diretamente relacionadas à isquemia celular, liberação inadequada de O2 e produção de potentes mediadores inflamatórios. Caso as anormalidades de perfusão tecidual se perpetuem, a função de vários órgãos se torna inadequada. A consequente reperfusão poderá exacerbar a disfunção orgânica e, nos casos graves, culminar na síndrome da disfunção orgânica múltipla. O reconhecimento precoce de equinos em choque circulatório e o