Psychotropic Medication and Stroke Outcome ZHAO, CHUAN-SHENG; PUURUNEN, KIRSI; SIVENIUS, JUHANI ...
The American journal of psychiatry,
05/2005, Letnik:
162, Številka:
5
Journal Article
Aims: To illustrate the histopathological features of acute acalculous cholecystitis (AAC) of critically ill patients and to compare them with those of acute calculous cholecystitis (ACC) and normal ...gallbladders.
Methods and results: We studied 34 gallbladders with AAC and compared them with 28 cases of ACC and 14 normal gallbladders. Histological features were systematically evaluated. Typical features in AAC were bile infiltration, leucocyte margination of blood vessels and lymphatic dilation. Bile infiltration in the gallbladder wall was more common and extended wider and deeper into the muscle layer in AAC compared with ACC. Epithelial degeneration and defects and widespread occurrence of inflammatory cells were typical features in ACC. Necrosis in the muscle layer was also more common and extended wider and deeper in ACC. There were no differences in the occurrence of capillary thromboses, lymphatic follicles or Rokitansky–Aschoff sinuses between the AAC and ACC samples.
Conclusions: There are characteristic differences in histopathology between AAC and ACC, although due to overlap, none appeared to be specific as such for either condition. These results suggest that AAC is largely a manifestation of systemic critical illness, whereas ACC is a local disease of the gallbladder.
Objective
To evaluate the incidence, treatment, and outcome of influenza A(H1N1) in Finnish intensive care units (ICUs) with special reference to corticosteroid treatment.
Methods
During the H1N1 ...outbreak in Finland between 11 October and 31 December 2009, we prospectively evaluated all consecutive ICU patients with high suspicion of or confirmed pandemic influenza A(H1N1) infection. We assessed severity of acute disease and daily organ dysfunction. Ventilatory support and other concomitant treatments were evaluated and recorded daily throughout the ICU stay. The primary outcome was hospital mortality.
Results
During the 3‐month period altogether 132 ICU patients were tested polymerase chain reaction‐positive for influenza A(H1N1). Of these patients, 78% needed non‐invasive or invasive ventilatory support. The median (interquartile) length of ICU stay was 4 2–12 days. Hospital mortality was 10 of 132 8%, 95% confidence interval (CI) 3–12%. Corticosteroids were administered to 72 (55%) patients, but rescue therapies except prone positioning were infrequently used. Simplified Acute Physiology Score II and Sequential Organ Failure Assessment scores in patients with and without corticosteroid treatment were 31 24–36 and 6 2–8 vs. 22 5–30 and 3 2–6, respectively. The crude hospital mortality was not different in patients with corticosteroid treatment compared to those without: 8 of 72 (11%, 95% CI 4–19%) vs. 2 of 60 (3%, 95% CI 0–8%) (P = 0.11).
Conclusions
The majority of H1N1 patients in ICUs received ventilatory support. Corticosteroids were administered to more than half of the patients. Despite being more severely ill, patients given corticosteroids had comparable hospital outcome with patients not given corticosteroids.
Magnesium may be beneficial in the control of ventricular ectopy and supraventricular tachyarrhythmias after coronary artery bypass graft (CABG) surgery, but it is not known whether a high-dose ...magnesium regimen is superior to a regimen keeping the patient normomagnesemic. A prospective randomized and double-blind clinical comparison was performed in 81 elective CABG patients in order to assess the effects of two different magnesium infusion regimens on electrolyte balance and postoperative arrhythmias. Forty-one patients (high-dose group, H) received 4.2 ± 0.7 g (mean ± SD), of magnesium sulfate before cardiopulmonary bypass, followed by an infusion of 11.9 ± 2.8 g of magnesium chloride until the first postoperative (PO) morning, and a further 5.5 ± 1.0 g until the second PO morning. Forty patients (low-dose group, L) received magnesium sulfate only after bypass to a total of 2.9 ± 0.5 g at the first, and 1.4 ± 0.1 g at the second PO morning. A blood cardioplegia technique was used in both groups, including bolus doses of magnesium chloride to a total of 2.4 ± 0.6 g and 2.3 ± 0.6 g to H and L patients, respectively. Continuous Holter tape-recording was used for 12 to 15 hours preoperatively, and for 48 hours postoperatively. Serum magnesium peaked in H patients on the first PO morning at 1.60 ± 0.25 mmol/L, whereafter it declined to the normal level on the third PO morning. Patients in the L group were normomagnesemic, except after the start of bypass. Recovery to spontaneous rhythm after declamping of the aorta was better in the H patients; only one patient had ventricular fibrillation (VF), whereas in the L group, four patients had VF and five patients needed a temporary pacemaker (
p = 0.016). Atrial fibrillation (AF) was detected in 3 H (7.3%), and 10 L patients (25%) within the first 48 PO hours (
p = 0.037). Ten H (24.3%) and 18 L patients (45.0%) had a total of 19 and 41 episodes of AF during the first PO week (
p < 0.01). Paired ventricular ectopic beats were detected during the first 24 PO hours in 17 H (42.5%) and 27 L patients (71.1%) (
p = 0.013).
BACKGROUND:Acute acalculous cholecystitis (AAC) is a potentially fatal condition mainly affecting critically ill patients. Current experience from computed tomography (CT) findings in AAC is ...contradictory.
METHODS:CT images of 127 mixed medical-surgical intensive care unit patients were retrospectively reviewed for the following findingsbile density, thickness and enhancement of the gallbladder (GB) wall, subserosal edema, greatest perpendicular diameters of the GB, width of extrahepatic bile ducts, gas within the GB, ascites, peritoneal fat edema, and diffuse tissue edema. Forty-three of these patients underwent open cholecystectomy, and 8 patients revealed a normal GB, 26 an edematous GB, and 9 a necrotic AAC.
RESULTS:Abnormal CT findings were present in 96% of all the intensive care unit patients. Higher bile density in the GB body and subserosal edema was associated with an edematous GB (specificity, 93.6%; sensitivity, 23.1%). The most specific findings predicting necrotic AAC were gas in the GB wall or lumen, lack of GB wall enhancement, and edema around the GB (specificity, 99.2%, 94.9%, and 92.4%, respectively; and sensitivity, 11.1%, 37.5%, and 22.2%, respectively).
CONCLUSIONS:The frequency of nonspecific abnormal findings in the GB of critically ill patients limits the diagnostic value of CT scanning in detecting AAC. However, in the case of totally normal GB findings in CT, the probability of necrotic AAC is low.
