Subject(s)
Critical Care/methods , Life Support Care/methods , Quality of Life , Critical Care/psychology , Humans , PrognosisABSTRACT
The somatic functional capacity can be defined as an organ-specific functional reserve. Statistical studies have shown perioperative risks in reciprocal relationship to this limit. A stepwise (graduated) approach for the assessment of cardiac and pulmonary function is suggested, which depends on the estimated risk. Indications for surgical therapy and operability, especially in the treatment of tumors and for geriatric patients, are not only determined by the somatic functional capacity but also by multiple other conditions.
Subject(s)
Stress, Physiological/complications , Surgical Procedures, Operative , Hemodynamics , Humans , Myocardial Infarction/etiology , Neoplasms/surgery , RiskSubject(s)
Anaphylaxis , Shock, Cardiogenic , Shock , Anaphylaxis/diagnosis , Anaphylaxis/etiology , Anaphylaxis/therapy , Anti-Arrhythmia Agents/therapeutic use , Blood Transfusion , Cardiac Tamponade/etiology , Catecholamines/therapeutic use , Epinephrine/therapeutic use , Glucocorticoids/therapeutic use , Humans , Myocardial Infarction/complications , Myxoma/complications , Prognosis , Shock/diagnosis , Shock/etiology , Shock/therapy , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Thrombosis/complicationsABSTRACT
The alteration (delta Z0) of transthoracic electrical impedance (TEI) during extracorporeal hemodialysis (EHD) was investigated in two Groups of patients with acute renal and acute respiratory failure, that differed with respect to the severity of respiratory insufficiency. Group I had moderate respiratory failure (FiO2 0.31 +/- 0.10, PaO2 84 +/- 14 mmHg), and Group II had severe respiratory failure (FiO2 0.75 +/- 0.17, PaO2 77 +/- 14 mmHg). There was a significant correlation between increase in TEI (delta Z0) and decrease in body weight (delta BW) in each individual patient, but the slope of regression lines was remarkably flattened in Group II. In Group I, delta TEI was 1.9 +/- 0.9 omega, the calculated TEI for 500 gr decrease in BW (delta Z0-500 gr) was 0.59 +/- 0.21 omega, and a significant correlation existed between pooled data of delta Z0 and delta BW. In Group II TEI increased less significantly, delta TEI was 0.6 +/- 0.3 omega (P less than 0.001), delta Z0-500 gr was 0.26 +/- 0.27 omega (P less than 0.01), and there was no correlation between pooled data of delta Z0 and delta BW. Increase of TEI in Group II could be completely attributed to increase in hematocrit. It is concluded that patients of Group I with acute renal failure and moderate respiratory failure lost intrathoracic fluid during EHD, whereas patients of Group II with severe respiratory failure did not. TEI during EHD may serve as a test for detection of fixed fluid within the pulmonary interstitium indicating a poor prognosis of the acute respiratory failure.
Subject(s)
Cardiography, Impedance , Plethysmography, Impedance , Renal Dialysis , Respiratory Insufficiency/diagnosis , Acute Kidney Injury/therapy , Adult , Aged , Body Weight , Female , Hematocrit , Humans , Male , Middle Aged , Posture , Pulmonary Edema/diagnosis , Respiratory Insufficiency/therapy , Respiratory Therapy , UltrafiltrationSubject(s)
Amino Acids/metabolism , Parenteral Nutrition, Total/methods , Parenteral Nutrition/methods , Energy Intake , Glucose/metabolism , Hepatic Encephalopathy/metabolism , Humans , Kidney Diseases/metabolism , Liver Diseases/metabolism , Methionine/toxicity , Octopamine/toxicity , Phenols/toxicity , Phosphates/blood , Postoperative PeriodSubject(s)
Coma/therapy , Critical Care , Brain Diseases/therapy , Coma/etiology , Diabetic Coma/therapy , Humans , Hypoglycemia/therapy , Poisoning/therapyABSTRACT
Bradyarrhythmias are due to disturbance of impulse formation and conduction in the heart. The sick sinus syndrome consists of both forms, sinusbradycardia being the most common type of arrhythmia, followed by sinus arrest and sinuatrial block. There is a wide range of the reported frequency of concomitant intermittent supraventricular tachycardia. Most patients have additional atrioventricular conduction disturbances. Diagnostic methods include measurement of the sinus node recovery time and sinoatrial conduction time, but therapy, i.e. pacemaker implantation depends largely on documentation of significant reduction of heart rate with clinical symptoms. The largest group of bradycardias is due to high degree atrioventricular block. As the prognosis of Mobitz Type II block is unfavorable in regard to development of complete distal av-block, differentiation between type I and II is of clinical importance, particularly in patients with additional fascicular block. Although exact localization of conduction disturbance with the Hisbundle-electrogram is possible, proof or exclusion of block distal to the Hisbundle including high frequency testing with atrial stimulation does not give the sole indication for therapeutic measures as follow up studies of patients with intraventricular conduction disturbances with and without distal block have demonstrated, that progression to complete av-block is difficult to predict.
Subject(s)
Bradycardia , Arrhythmia, Sinus/diagnosis , Bradycardia/classification , Bradycardia/diagnosis , Bradycardia/therapy , Diagnosis, Differential , Electrocardiography , Humans , Sinoatrial Block/diagnosis , Tachycardia/diagnosisSubject(s)
Dehydration/diagnosis , Pulmonary Edema/diagnosis , Cardiography, Impedance , Critical Care , HumansSubject(s)
Pulmonary Embolism/surgery , Adult , Aged , Extracorporeal Circulation , Female , Humans , Hypertension, Pulmonary/etiology , Male , Middle Aged , PerfusionSubject(s)
Plethysmography, Impedance , Vascular Diseases/diagnosis , Adult , Female , Humans , Leg , Male , Middle Aged , PlethysmographyABSTRACT
The main problem of fluorescent antibody techniques is the elimination of "non-specific-staining (NSS)". To assure specificity of the reactions the following points have to be taken into account. The preparation of monospecific antisera, the coupling and purification of fluorescent conjugates to achieve optimal molar fluorescein-protein (F/P)-ratios and of appropriate specificity controls. Furthermore the testing of the optimal method for tissue preparation or the investigation of isolated cells is necessary. The paper shows that there is need for a standardization of the fluorescent antibody technique to achieve comparable results in different laboratories.
