68 research outputs found
Bronchoscopy in Rural Areas?
Quality of bronchoscopy performed by one single pulmonologist in a scarcely populated subarctic area was compared to the guidelines provided by the British Thoracic Society (BTS).
103 patients underwent bronchoscopy. Diagnostic yield was increased to 76.6% when the first bronchoscopy was supplemented by bronchial washing fluid and brush cytology and to 86.7% (BTS guidelines >80%) after a second bronchoscopy. Median time from referral to bronchoscopy was 10 days and 8 days from positive bronchoscopy to operative referral to another hospital. 1% of patients that underwent transbronchial lung biopsy had minor complications.
One pulmonologist had rate of correct diagnosis based on visible endobronchial tumors that was comparable to the rates of numerous pulmonologists at larger centers performing the same procedure. Time delay was short. Rate of complications was comparable. Bronchoscopy performed by one pulmonologist alone could, in organized settings, be carried out at local hospitals in areas of scattered settlement
How should tranexamic acid be administered in haemorrhagic shock? - continuous serum concentration measurements in a swine model
Background: Tranexamic acid (TXA) reduces mortality in trauma patients. Intramuscular (IM) administration
could be advantageous in low-resource and military settings. Achieving the same serum concentration as intravenous (IV) administration is important to achieve equal mortality reduction. Therefore, we aimed to investigate whether dividing an IM dose
of TXA between two injection sites and whether an increase in dose would lead to serum concentrations comparable to those
achieved by IV administration. Methods: Norwegian landrace pigs (n = 29) from a course in hemostatic emergency surgery were
given TXA 1 h after start of surgery. Blood samples were drawn at 0, 5, 10, 15, 20, 25, 35, 45, 60, and 85 min. The samples were
centrifuged and serum TXA concentrations quantified with liquid chromatography-tandem mass spectrometry. The use of two
injection sites was compared with distributing the dose on one injection site, and a dose of 15 mg/kg was compared with a dose
of 30 mg/kg. All IM groups were compared with IV administration. Results: The groups were in a similar degree of shock. Increasing the IM dose from the standard of 15 mg/kg to 30 mg/kg resulted in significantly higher serum concentrations of TXA,
comparable to those achieved by IV administration. Distributing the IM dose on two injection sites did not affect drug uptake,
as shown by equal serum concentrations. Conclusions: For IM administration of TXA, 30 mg/kg should be the standard dose.
With a short delay, IM administration will provide equal serum concentrations as IV administration, above what is considered necessary to inhibit fibrinolysis
Plasma Lipopolysaccharide Is Closely Associated With Glycemic Control and Abdominal Obesity: Evidence from bariatric surgery
publishedVersio
Open chest and pericardium facilitate transpulmonary passage of venous air emboli
Background: Transpulmonary passage of air emboli can lead to fatal brain- and myocardial infarctions. We studied whether pigs with open chest and pericardium had a greater transpulmonary passage of venous air emboli than pigs with closed thorax.
Methods: We allocated pigs with verified closed foramen ovale to venous air infusion with either open chest with sternotomy and opening of the pleura and pericardium (n = 8) or closed thorax (n = 16). All pigs received a five-hour intravenous infusion of ambient air, starting at 4-6 mL/kg/h and increased by 2 mL/kg/h each hour. We assessed transpulmonary air passage by transesophageal M-mode echocardiography and present the results as median with inter-quartile range (IQR).
Results: Transpulmonary air passage occurred in all pigs with open chest and pericardium and in nine pigs with closed thorax (56%). Compared to pigs with closed thorax, pigs with open chest and pericardium had a shorter to air passage (10 minutes (5-16) vs. 120 minutes (44-212), P < .0001), a smaller volume of infused air at the time of transpulmonary passage (12 mL (10-23) vs.170 mL (107-494), P < .0001), shorter time to death (122 minutes (48-185) vs 263 minutes (248-300, P = .0005) and a smaller volume of infused air at the time of death (264 mL (53-466) vs 727 mL (564-968), P = .001). In pigs with open chest and, infused air and time to death correlated strongly (r = 0.95, P = .001).
Conclusion: Open chest and pericardium facilitated the transpulmonary passage of intravenously infused air in pigs
Why does the provision of home mechanical ventilation vary so widely?
There is wide variation in the provision of home mechanical ventilation
(HMV) throughout Europe, but the provision of home
mechanical ventilation can also vary within countries. In 2008, the overall
prevalence of HMV in Norway was 19.9/100,000, and there were huge regional
differences in treatment prevalence. The aim of this study is to find
explanations for these differences. We gathered multidisciplinary respondents
involved in HMV treatment from five hospitals in five different counties to six
focus group conversations to explore respondents' views of their
experiences systematically. We based the analysis on grounded theory. We found
that uneven distribution of âenthusiasmâ between
hospitals seems to be an important factor in the geographical distribution of
HMV. Furthermore, we found that the three subcategories, âhigh
competence,â âspreading competence,â and
âmultidisciplinary collaboration,â are developed and
used systematically in counties with âenthusiasm.â This
culture is the main category, which might explain the differences, and is
described as âwise enthusiasm.â The last subcategory is
âindividual attitudesâ about HMV among decision-making
physicians. The most important factor is most likely the uneven distribution of
highly skilled enthusiasm between hospitals. Individual attitudes about HMV
among the decision makers may also explain why the provision of HMV
varies so widely. Data describing regional differences in the prevalence of HMV
within countries is lacking. Further research is needed to identify these
differences to ensure equality of provision of HMV
Dental and Periodontal Health in Acute Intermittent Porphyria
In the inherited metabolic disorder acute intermittent porphyria (AIP), high sugar intake
prevents porphyric attacks due to the glucose effect and the following high insulin levels that
may lower AIP disease activity. Insulin resistance is a known risk factor for periodontitis and
sugar changes diabetogenic hormones and affects dental health. We hypothesized differences in
homeostasis model assessment (HOMA) scores for insulin resistance in AIP cases vs. controls and in
those with periodontitis. Our aim was to systematically study dental health in AIP as poor dental
health was previously only described in case reports. Further, we aimed to examine if poor dental
health and kidney failure might worsen AIP as chronic inflammation and kidney failure might
increase disease activity. In 47 AIP cases and 47 matched controls, X-rays and physical examination
of clinical attachment loss (CAL), probing pocket depth (PPD), and decayed missing filled teeth
(DMFT) were performed. Dietary intake was evaluated through a diet logbook. Plasma cytokines
and diabetogenic hormones were measured using multiplex technology and urine porphobilinogen
and kidney and liver function by routine methods. An excel spreadsheet from the University of
Oxford was used to estimate HOMA scores; beta cell function, HOMA%B (%B), insulin sensitivity,
HOMA%S (%S), and insulin resistance HOMA-IR (IR), based on glucose and plasma (P) C-peptide.
The Wilcoxon matched-pairs signed rank test, the MannâWhitney U-test, and Spearmanâs nonparametric correlation were used. Insulin (p = 0.007) and C-peptide (p = 0.006) were higher in the AIP
cases with periodontitis versus those without. In AIP patients, the liver fibrosis index 4 correlated
with DMFT (p < 0.001) and CAL âĽ4 mm (p = 0.006); the estimated glomerular filtration rate correlated
with DMFT (p < 0.001) and CAL âĽ4 mm (p = 0.02). CAL âĽ4 mm was correlated with chemokine
ligand 11 and interleukin (IL)-13 (p = 0.04 for both), and PPD >5 mm was correlated with plasminogen
activator inhibitor-1 (p = 0.003) and complement component 3 (p = 0.02). In conclusion, dental health
in AIP cases was correlated with insulin resistance, inflammatory markers, and biomarkers of kidney
and liver function, demonstrating that organ damage in the kidney and liver are associated with
poorer dental health
Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies
Iatrogenic vascular air embolism is a relatively infrequent event but is associated with significant morbidity and mortality. These emboli can arise in many clinical settings such as neurosurgery, cardiac surgery, and liver transplantation, but more recently, endoscopy, hemodialysis, thoracentesis, tissue biopsy, angiography, and central and peripheral venous access and removal have overtaken surgery and trauma as significant causes of vascular air embolism. The true incidence may be greater since many of these air emboli are asymptomatic and frequently go undiagnosed or unreported. Due to the rarity of vascular air embolism and because of the many manifestations, diagnoses can be difficult and require immediate therapeutic intervention. An iatrogenic air embolism can result in both venous and arterial emboli whose anatomic locations dictate the clinical course. Most clinically significant iatrogenic air emboli are caused by arterial obstruction of small vessels because the pulmonary gas exchange filters the more frequent, smaller volume bubbles that gain access to the venous circulation. However, there is a subset of patients with venous air emboli caused by larger volumes of air who present with more protean manifestations. There have been significant gains in the understanding of the interactions of fluid dynamics, hemostasis, and inflammation caused by air emboli due to in vitro and in vivo studies on flow dynamics of bubbles in small vessels. Intensive research regarding the thromboinflammatory changes at the level of the endothelium has been described recently. The obstruction of vessels by air emboli causes immediate pathoanatomic and immunologic and thromboinflammatory responses at the level of the endothelium. In this review, we describe those immunologic and thromboinflammatory responses at the level of the endothelium as well as evaluate traditional and novel forms of therapy for this rare and often unrecognized clinical condition
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