Книги з теми "Pressure on tissue"
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1
Royle, Stephen Gordon. Tissue pressure, muscle oxygen and cutaneous circulation in the lower leg. Manchester: University of Manchester, 1993.
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2
(Editor), R. Huch, ed. Clinical Oxygen Pressure Measurement: Tissue Oxygen Pressure and Transcutaneous Oxygen Pressure. Springer-Verlag, 1987.
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3
Ehrly, Albrecht M. Clinical Oxygen Pressure Measurement: Tissue Oxygen Pressure and Transcutaneous Oxygen Pressure. Springer, 2011.
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4
M, Ehrly A., Frankfurt Symposium on Clinical Oxygen Pressure Measurement. (3rd : 1988), Symposium on Tissue Oxygen Pressure. (2nd : 1984 : Frankfurt am Main, Germany), and Workshop on Theory and Practice of Tissue p02 Measurement (1988 : Lübeck, Germany), eds. Clinical oxygen pressure measurement II: Tissue oxygen pressure and transcutaneous oxygen pressure. Berlin: Blackwell Ueberreuter Wissenschaft, 1990.
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5
Trent, NHS Executive, and Trent Regional Health Authority, eds. Tissue viability - pressure sores and leg ulcers: Opportunities for health gain. Sheffield: Trent Regional Health Authority, 1994.
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6
Kipnis, Eric, and Benoit Vallet. Tissue perfusion monitoring in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0138.
Повний текст джерелаАнотація:
Resuscitation endpoints have shifted away from restoring normal values of routinely assessed haemodynamic parameters (central venous pressure, mean arterial pressure, cardiac output) towards optimizing parameters that reflect adequate tissue perfusion. Tissue perfusion-based endpoints have changed outcomes, particularly in sepsis. Tissue perfusion can be explored by monitoring the end result of perfusion, namely tissue oxygenation, metabolic markers, and tissue blood flow. Tissue oxygenation can be directly monitored locally through invasive electrodes or non-invasively using light absorbance (pulse oximetry (SpO2) or tissue (StO2)). Global oxygenation may be monitored in blood, either intermittently through blood gas analysis, or continuously with specialized catheters. Central venous saturation (ScvO2) indirectly assesses tissue oxygenation as the net balance between global O2 delivery and uptake, decreasing when delivery does not meet demand. Lactate, a by-product of anaerobic glycolysis, increases when oxygenation is inadequate, and can be measured either globally in blood, or locally in tissues by microdialysis. Likewise, CO2 (a by-product of cellular respiration) and PCO2 can be measured globally in blood or locally in accessible mucosal tissues (sublingual, gastric) by capnography or tonometry. Increasing PCO2 gradients, either tissue-to-arterial or venous-to-arterial, are due to inadequate perfusion. Metabolically, the oxidoreductive status of mitochondria can be assessed locally through NADH fluorescence, which increases in situations of inadequate oxygenation/perfusion. Finally, local tissue blood flow may be measured by laser-Doppler or visualized through intravital microscopic imaging. These perfusion/oxygenation resuscitation endpoints are increasingly used and studied in critical care.
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Warwick, David, Roderick Dunn, Erman Melikyan, and Jane Vadher. Soft tissue injuries of the hand. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199227235.003.0006.
Повний текст джерелаАнотація:
Wound care 154Cold sensitivity 155Microvascular replantation 156Revascularization162Amputations164Nail injury170High-pressure injection injury174Extravasation injury176Gunshot wounds178Burns180Frostbite186Factitious injury (Secretans's)189• Thorough cleaning• Dressings• Splints:• Position of safe immobilization (POSI), joints with the collateral ligaments in the longest position preventing contractures....
8
Crawford, Laura, and Ruth Kleinpell. Principles and prevention of pressure sores in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0279.
Повний текст джерелаАнотація:
A pressure ulcer, defined by the National Pressure Advisory Panel and European Pressure Ulcer Advisory Panels as localized injury to the skin or tissue as the result of pressure or pressure in combination with shear, can be an adverse complication of a hospital stay, especially for acute and critically-ill patients. Factors that can contribute to pressure ulcer development include the intensity and duration of pressure, tissue tolerance, shear, and friction. Common anatomical sites for pressure ulcers development are over bony prominences. The National Pressure Advisory Panel and European Pressure Ulcer Advisory Panels define pressure ulcers in six stages according to the degree of tissue damage present in the wound. A risk assessment should be performed to identify the vulnerability of pressure ulcer development and provide guidance for the implementation of preventative interventions. For the critically-ill patient, several specific measures are advocated for preventing pressure ulcers.
9
Stephens, Paul, and Roderick Dunn. Soft tissue injuries of the hand. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198757689.003.0006.
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Soft tissue injuries of the hand are common and may present variously to therapists, general practice, emergency departments, or surgeons. Simple injuries can be treated without specialist input, but the majority of hand trauma should be referred to dedicated hand surgery centres. Diagnostic error and delayed specialist treatment may lead to poor outcomes and long-term disability. This chapter provides a detailed overview for non-specialists, as well as an aide memoire for hand surgeons and hand therapists. It includes the principles of general wound care, the management of nail injuries, the treatment of extravasation and high-pressure injection injuries, and gunshot wounds. We describe different levels of upper limb amputation, as well as microvascular reconstruction (both replantation and revascularization). We also cover thermal injuries (burns and frostbite), trauma-induced cold sensitivity, and factitious injury.
10
van den Bosch, Annemien E., Luigi P. Badano, and Julia Grapsa. Right ventricle and pulmonary arterial pressure. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0023.
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Right ventricular (RV) performance plays an important role in the morbidity and mortality of patients with left ventricular dysfunction, congenital heart disease, and pulmonary hypertension. Assessment of RV size, function, and haemodynamics has been challenging because of its complex geometry. Conventional two-dimensional echocardiography is the modality of choice for assessment of RV function in clinical practice. Recent developments in echocardiography have provided several new techniques for assessment of RV dimensions and function, include tissue Doppler imaging, speckle-tracking imaging, and volumetric three-dimensional imaging. However, specific training, expensive dedicated equipment, and extensive clinical validation are still required. Doppler methods interrogating tricuspid inflow and pulmonary artery flow velocities, which are influenced by changes in pre- and afterload conditions, may not provide robust prognostic information for clinical decision-making. This chapter addresses the role of the various echocardiographic modalities used to assess the RV and pulmonary circulation. Special emphasis has been placed on technical considerations, limitations, and pitfalls of image acquisition and analysis.
11
Wise, Matt, and Paul Frost. ICU treatment of cardiovascular failure. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0150.
Повний текст джерелаАнотація:
Cardiovascular failure or shock is best defined as inadequate delivery or utilization of oxygen for cellular metabolic needs. The majority of shock states are characterized by limitations in perfusion rather than extraction of oxygen by tissues. It is important to recognize that ineffectual tissue perfusion may occur in the absence of hypotension and, therefore, a normal blood pressure does not exclude shock. This chapter covers the etiology of shock, as well as symptoms, complications, diagnosis, prognosis, and treatment.
12
Lancellotti, Patrizio, and Bernard Cosyns. Assessment of Diastolic Function. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713623.003.0005.
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Diastole is the part of the cardiac cycle starting at aortic valve closure and ending at mitral valve closure. Evaluation of diastolic function by echocardiography is useful to diagnose heart failure with preserved ejection fraction, and regardless of ejection fraction, echocardiography can be used to estimate left ventricular filling pressure. Assessment of diastolic function includes analysis of left ventricular relaxation and compliance, left atrial and left ventricular filling pressures. This chapter describes the phases of diastole and covers the integrated approach of LV diastolic function through M-Mode and 2D/3D echocardiography, pulsed-wave Doppler echocardiography, and pulsed-wave tissue Doppler echocardiography.
13
Harrois, Anatole, and Jacques Duranteau. Pathophysiology of severe capillary leak. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0164.
Повний текст джерелаАнотація:
Severe capillary leak plays an important role in the pathogenesis of several inflammatory syndromes, including sepsis, acute lung injury, and shock syndromes. Microvascular leak is caused by an increase in endothelial permeability. This is due to a range of inflammatory mediators that destabilize endothelial junctions, thereby causing tissue oedema with potential harmful effects on tissue oxygenation and organ function. Tissue oedema can impair tissue oxygenation by increasing the distance required for the diffusion of oxygen to cells, and by decreasing microvascular perfusion due to an increase in interstitial pressure. Better understanding of the pathogenesis of microvascular permeability may lead to new therapies targeting the microvascular barrier in sepsis and the acute respiratory distress syndrome.
14
Staitieh, Bashar S., and Greg S. Martin. Therapeutic goals of fluid resuscitation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0070.
Повний текст джерелаАнотація:
Optimizing tissue perfusion by administering intravenous fluids presents a special challenge to the intensive care unit (ICU) clinician. Recent studies have drastically altered how we assess a patient’s fluid responsiveness, particularly with regard to upstream surrogates of tissue perfusion. Central venous pressure and pulmonary capillary wedge pressure have been found to be inaccurate markers of fluid responsiveness and have given way to methods such as cardiac output as assessed by echocardiography and the various forms of arterial waveform analysis. These newer techniques, such as stroke volume variation, systolic pressure variation, and pulse pressure variation, have been found to better delineate which patients will respond to a fluid challenge with an increase in cardiac output, and which will not. In addition, traditional methods of assessing the consequences of excessive fluid administration, such as pulmonary oedema and the non-anion gap acidosis of saline administration, have given way to more sophisticated measurements of extravascular lung water, now available at the bedside. Downstream markers of tissue perfusion, such as base deficit, central venous oxygen saturations, and lactic acid, continue to be useful in particular clinical settings, but are all relatively non-specific markers, and are therefore difficult to use as resuscitation targets for ICU patients in general. Finally, recent data on septic shock and ARDS have demonstrated the importance of conservative fluid strategies, while data in surgical populations have emphasized the need for judicious fluid administration and attention to the balance of blood products used in resuscitation efforts.
15
Klimek, Markus, Francisco A. Lobo, Luzius A. Steiner, and Cor J. Kalkman. Anaesthesia for neurosurgery and electroconvulsive therapy. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0059.
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Neuroanaesthesia is the subspecialty of anaesthesiology that deals with patients undergoing surgical procedures in or close to the brain and the spinal cord. Neuroanaesthesia can be challenging, because sometimes apparently contradictory demands must be managed, for example, achieving optimal conditions for neurophysiological monitoring while maintaining sufficient anaesthetic depth, or maintaining oxygen delivery to neuronal tissue and simultaneously preventing high blood pressures that might induce local bleeding. Atypical patient positioning, management of increased intracranial pressure, and the need for early postoperative neurological evaluation are other typical challenges. This chapter addresses the general principles of neuroanaesthesia and special aspects of the most relevant procedures. A section on anaesthesia for electroconvulsive therapy is also included.
16
Kiss, Thomas, and Paolo Pelosi. Lung recruitment techniques in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0120.
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Lung recruitment manoeuvres (RMs) have been suggested as a means of homogenizing the lung structure and distribution of the mechanical stress across the lungs. Such effects can be achieved provided enough pressure is applied for enough time at the airways, and maintained if adequate levels of positive end-expiratory pressure (PEEP) are used. When RMs effectively open atelectatic tissue, shear stress, and cyclic collapse/reopening are importantly reduced. The lung response to RMs is mainly determined by cause and severity of lung injury, and the position of the lungs with respect to the gravity gradient. RMs can be performed in several different ways, the most relevant RMs in terms of clinical applicability are sustained inflation manoeuvres, high pressure controlled ventilation, incremental PEEP, and intermittent sighs.
17
Kelleher, Clare. Diabetic Foot Infections. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0043.
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Diabetic foot infections (DFI) are diagnosed by two or more classic findings of inflammation (redness, swelling, warmth, and tenderness) or purulent drainage within an existing diabetic foot wound. Wounds without clinical evidence of soft tissue or bone infection often do not require antibiotic therapy. When infection is present, empiric antibiotic regimens must be based on the available clinical and local epidemiologic data, but definitive therapy should be based on cultures of infected tissues or clinical response. Consideration of methicillin-resistant Staphylococcus aureus (MRSA) coverage should be given when local prevalence is high, in patients with a prior history of MRSA infection, or when the systemic manifestations are severe. Surgical intervention and vascular assessment play key roles in the management of many DFI; deep DFI require incision, drainage, and debridement. Redistribution of pressure off of the wound is a tenet in the management of DFI.
18
Kreit, John W. Gas Exchange. Edited by John W. Kreit. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190670085.003.0002.
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Gas Exchange explains how four processes—delivery of oxygen, excretion of carbon dioxide, matching of ventilation and perfusion, and diffusion—allow the respiratory system to maintain normal partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2) in the arterial blood. Partial pressure is important because O2 and CO2 molecules diffuse between alveolar gas and pulmonary capillary blood and between systemic capillary blood and the tissues along their partial pressure gradients, and diffusion continues until the partial pressures are equal. Ventilation is an essential part of gas exchange because it delivers O2, eliminates CO2, and determines ventilation–perfusion ratios. This chapter also explains how and why abnormalities in each of these processes may reduce PaO2, increase PaCO2, or both.
19
Smiseth, Otto A., Maurizio Galderisi, and Jae K. Oh. Left ventricle: diastolic function. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0021.
Повний текст джерелаАнотація:
Evaluation of diastolic function by echocardiography is useful to diagnose heart failure with preserved ejection fraction by showing signs of diastolic dysfunction, and regardless of ejection fraction, echocardiography can be used to estimate left ventricular (LV) filling pressure. Diastolic dysfunction occurs in a number of cardiac diseases other than heart failure and mild diastolic dysfunction is part of the normal ageing process. The fundamental disturbances in diastolic dysfunction are slowing of myocardial relaxation, loss of restoring forces, and reduced LV chamber compliance. As a compensatory response there is elevated LV filling pressure. Slowing of relaxation and loss of restoring forces are reflected in reduction in LV early diastolic lengthening velocity (e?) by tissue Doppler. The reduced diastolic compliance is reflected in faster deceleration of early diastolic transmitral velocity by pulsed wave Doppler. Elevated LV filling pressure is reflected in a number of Doppler indices and in enlarged left atrium. This chapter reviews the physiology of diastolic function, the clinical methods and indices which are available, and how these should be applied.
20
De Backer, Daniel, and Patrick Biston. Vasopressors in critical illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0034.
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Vasopressors are used in various shock states to correct hypotension, aiming at restoring or improving organ and tissue perfusion. Vasopressor therapy may be associated with excessive vasoconstriction, but also metabolic and other side-effects. Hence, the ideal target for arterial pressure remains undetermined. Adrenergic agents remain the most commonly used vasopressor agents. Adrenergic agents increase arterial pressure through stimulation of alpha-adrenergic receptors. The effects of the different adrenergic agents differ mostly due to variable associated beta-adrenergic effects. Epinephrine and norepinephrine are strong and equipotent vasopressor agents. Their impact on outcome is as yet unanswered, but there is no sign that epinephrine might be associated with better outcomes. Accordingly, norepinephrine is the adrenergic agent of choice, especially in patients with cardiogenic shock. Vasopressin is a non-adrenergic vasopressor acting via V1 receptor stimulation, with weak vasopressor effects in normal conditions, but markedly increased vascular tone in shock states, especially in septic shock. Splanchnic vasoconstriction may occur. Arginine vasopressin at low doses appears to be a promising alternative to adrenergic agents, but its exact place is not yet well defined.
21
Boat, Anne C., and Senthilkumar Sadhasivam. Myelomeningocele Repair. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199764495.003.0056.
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Myelomeningocele (MMC) is a spinal birth defect that occurs due to failure in the closure of the embryologic neural tube. The meninges and/or neural structures are exposed, resulting in nerve damage. MMCs are associated with significant direct morbidity as well as with Chiari II malformations and hydrocephalus. The degree of sensory and motor deficits depends on the level of the defect, with bowel and bladder function often affected. Due to the risk of infection with an exposed spinal cord, surgical repair is usually performed in the first 24 to 48 hours of life. Anesthesia for MMC repair presents a unique challenge since positioning of these patients must prevent direct pressure on the exposed neural tissue.
22
Kreit, John W. Acute Respiratory Distress Syndrome (ARDS). Edited by John W. Kreit. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190670085.003.0012.
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Acute Respiratory Distress Syndrome reviews the definitions, causes, pathophysiology, and management of this relatively common, life-threatening disorder. This chapter describes how to ensure adequate tissue oxygen delivery while minimizing ventilator-induced lung injury and provides an in-depth review of how to determine the optimum level of positive end-expiratory pressure (PEEP). The first topic addressed is the precipitating factors and pathophysiology of acute respiratory distress syndrome. Next the chapter turns to mechanical ventilation, and covers the subjects of adequate oxygenation, ventilator-induced lung injury, ancillary therapies, ventilatory therapies, and high I:E ventilation. The topics addressed in the area of non-ventilatory therapies include: prone positioning of the patient, neuromuscular blockade, inhaled vasodilators, and extracorporeal membrane oxygenation (ECMO).
23
Longman, Susan Dawn. Cardiovascular studies with angiotensin converting enzyme inhibitors in the rat: Effects of arterial blood pressure and plasma and tissue angiotensin converting enzyme (ACE) activity of acute and chronic administration of ACE inhibitors in sodium deficient normotensive (NT) rats. Bradford, 1986.
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24
Stocchetti, Nino, and Andrew I. R. Maas. Causes and management of intracranial hypertension. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0233.
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Intracranial hypertension may damage the brain in two ways—it causes tissue distortion and herniation, and reduces cerebral perfusion. The many different pathologies that can result in intracranial hypertension include subarachnoid haemorrhage, spontaneous intra-parenchymal haemorrhage, malignant cerebral hemispheric infarction, and acute hydrocephalus. The pathophysiology and specific treatment of intracranial hypertension may be different and depend on aetiology. In patients with subarachnoid haemorrhage a specific focus is on treating secondary hydrocephalus and maintaining adequate cerebral perfusion pressure (CPP). Indications for surgery in patients with intracranial hypertension due to intracerebral haemorrhage (ICH) are not only related to the mass effect, but also to remove the toxic effect of extravasated blood on brain tissue. Decompressive surgery should be considered for patients with a malignant hemispheric infarction, but in order to benefit the patient this surgery should be performed within 48 hours of the onset of the stroke. Hydrocephalus may result from obstruction of cerebrospinal fluid (CSF) flow, from impaired CSF re-absorption and occasionally from overproduction of CSF. Emergency management of acute hydrocephalus can be accomplished by external ventricular drainage of CSF. More definitive treatment may be either by third ventriculostomy or implantation of a CSF shunt diverting CSF to the abdominal cavity (a ventriculoperitoneal shunt) or to the right atrium of the heart (ventriculo-atrial shunt).
25
Diehl, Peter. Disinfection of Human Tissues in Orthopedic Surgical Oncology by High Hydrostatic Pressure. INTECH Open Access Publisher, 2012.
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26
King, Steven Jay. Effects of angiotensin on central and peripheral tissues involved in blood pressure homeostasis. 1986.
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27
Donaghy, Michael. Focal peripheral neuropathy. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569381.003.0487.
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Some causes of focal peripheral nerve damage are self-evident, such as involvement at sites of trauma, tissue necrosis, infiltration by tumour, or damage by radiotherapy. Focal compressive and entrapment neuropathies are particularly valuable to identify in civilian practice, since recovery may follow relief of the compression. Leprosy is a common global cause of focal neuropathy, which involves prominent loss of pain sensation with secondary acromutilation, and requires early antibiotic treatment. Mononeuritis multiplex due to vasculitis requires prompt diagnosis and immunosuppressive treatment to limit the severity and extent of peripheral nerve damage. Various other medical conditions, both inherited and acquired, can present with focal neuropathy rather than polyneuropathy, the most common of which are diabetes mellitus and hereditary liability to pressure palsies. A purely motor focal presentation should raise the question of multifocal motor neuropathy with conduction block, which usually responds well to high-dose intravenous immunoglobulin infusions.
28
Reade, Michael C., and Peter D. Thomas. Pathophysiology of ballistic trauma. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0339.
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Bullets and other projectiles cause ballistic trauma. Explosions wound by the effect of a blast pressure wave, penetrating fragments propelled by the explosion, the mass movement of gas interacting with the casualty or the environment, and miscellaneous effects. Most blast casualties surviving to hospital care will not have significant pressure wave injury, but some will. Blast fragmentation most commonly resembles other types of low energy transfer ballistic trauma.. The effect of bullets depends on the kinetic energy transferred and the nature of the tissues struck, with energy transfer partly determined by bullet design. Low energy transfer bullets wound by crushing and laceration, limited to the tissues struck. High energy bullets may impart kinetic energy to surrounding tissues, causing a temporary cavity which sucks in debris and damages tissues sometimes well beyond the bullet track. Predicting the extent of devitalization can be difficult at the time of initial inspection. Wound contamination, particularly with soil, may modify the usual conservative approach to initial debridement.
29
Ho, Vanessa P., and Philip S. Barie. Acute acalculous cholecystitis in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0188.
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Acute acalculous cholecystitis (AAC) may occur in surgical or injured, critically-ill, and systemically-ill patients, with diabetes mellitus, malignant disease, abdominal vasculitis, congestive heart failure, cholesterol embolization, shock, and cardiac arrest. Children may also be affected, especially following a viral illness. The pathogenesis of AAC is complex and multifactorial. Ischaemia/reperfusion injury and the associated pro-inflammatory response and oxidative tissue stress, appear to be the central mechanisms, but bile stasis, opioid therapy, positive-pressure ventilation, and parenteral nutrition may all contribute to development of the disease. Ultrasound of the gallbladder is most accurate for the diagnosis of AAC in the critically-ill patient. Computed tomography is probably of comparable accuracy, but carries both advantages and disadvantages. Percutaneous cholecystostomy is now the treatment of choice, controlling AAC in about 85% of patients, despite the known high prevalence of gallbladder infarction (~50%) and perforation (~10%). Rapid improvement may be expected when AAC is diagnosed correctly and cholecystostomy is performed timely. The mortality (historically ~30%) of percutaneous and open cholecystostomy are similar, reflecting the severity of illness, but improved resuscitation and critical care may portend a decreased risk of death.
30
Sainz, Jorge G., and Bradley P. Fuhrman. Basic Pediatric Hemodynamic Monitoring. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199918027.003.0005.
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Physiological monitoring using a variety of technological advances supplements, but does not replace, our ability to distinguish normal from abnormal physiology traditionally gleaned from physical examination. Pulse oximetry uses the wavelengths of saturated and unsaturated hemoglobin to estimate arterial oxygenation noninvasively. Similar technology included on vascular catheters provides estimation of central or mixed venous oxygenation and helps assess the adequacy of oxygen delivered to tissues. End-tidal carbon dioxide measurements contribute to the assessment of ventilation. Systemic arterial blood pressure and central venous pressure measurements help evaluate cardiac performance, including the impact of ventilatory support. Intra-abdominal pressure may increase as a result of intraluminal air or fluid, abnormal fluid collections within the peritoneal cavity, or abnormal masses. Increased pressure may impede venous return to the heart and compromise intra-abdominal organ perfusion. Pressure measurement guides related management decisions.
31
Galderisi, Maurizio, and Sergio Mondillo. Assessment of diastolic function. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199599639.003.0009.
Повний текст джерелаАнотація:
Modern assessment of left ventricular (LV) diastolic function should be based on the estimation of degree of LV filling pressure (LVFP), which is the true determinant of symptoms/signs and prognosis in heart failure.In order to achieve this goal, standard Doppler assessment of mitral inflow pattern (E/A ratio, deceleration time, isovolumic relaxation time) should be combined with additional manoeuvres and/or ultrasound tools such as: ◆ Valsalva manoeuvre applied to mitral inflow pattern. ◆ Pulmonary venous flow pattern. ◆ Velocity flow propagation by colour M-mode. ◆ Pulsed wave tissue Doppler of mitral annuls (average of septal and lateral E′ velocity).In intermediate doubtful situations, the two-dimensional determination of left atrial (LA) volume can be diagnostic, since LA enlargement is associated with a chronic increase of LVFP in the absence of mitral valve disease and atrial fibrillation.Some new echocardiographic technologies, such as the speckle tracking-derived LV longitudinal strain and LV torsion, LA strain, and even the three-dimensional determination of LA volumes can be potentially useful to add further information. In particular, the reduction of LV longitudinal strain in patients with LV diastolic dysfunction and normal ejection fraction demonstrates that a subclinical impairment of LV systolic function already exists under these circumstances.
32
Timperley, Jonathan, and Sandeep Hothi. Peripheral oedema. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0014.
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Peripheral oedema is a palpable swelling caused by increased interstitial fluid in soft tissues, and can be due to local or systemic disease. Fluid distribution between capillaries and the interstitium is governed by Starling forces. The lymphatic system returns excess fluid and protein from the extracellular, interstitial space to the bloodstream. Thus, interstitial oedema may arise from factors that increase capillary pressure or permeability, factors that reduce plasma colloid osmotic pressure, factors that impede lymphatic drainage, or a combination of these causes. This topic addresses the diagnosis of peripheral oedema.
33
Leys, Didier, Charlotte Cordonnier, and Valeria Caso. Stroke. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0067.
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Stroke is a major public health issue. Many are treatable in the acute stage, provided patients are admitted soon enough. The overall incidence of stroke in Western countries is approximately 2400 per year per million inhabitants, and 80% are due to cerebral ischaemia. The prevalence is approximately 12 000 per million inhabitants. Stroke is associated with increased long-term mortality, handicap, cognitive and behavioural impairments, recurrence, and an increased risk of other types of vascular events. It is of major interest to take the heterogeneity of stroke into account, because of differences in the acute management, secondary prevention, and outcomes, according to the subtype and cause of stroke. In all types of stroke, early epileptic seizures, delirium, increased intracranial pressure, and non-specific complications are frequent. In ischaemic strokes, specific complications, such as malignant infarcts, spontaneous haemorrhagic transformation, early recurrence, and a new ischaemic event in another vascular territory, are frequent. In haemorrhagic strokes, the major complication is the subsequent increased volume of bleeding. There is strong evidence that stroke patients should be treated in dedicated stroke units; each time 24 patients are treated in a stroke unit, instead of a conventional ward, one death and one dependence are prevented. This effect does not depend on age, severity, and the stroke subtype. For this reason, stroke unit care is the cornerstone of the treatment of stroke, aiming at the detection and management of life-threatening emergencies, stabilization of most physiological parameters, and prevention of early complications. In ischaemic strokes, besides this general management, specific therapies include intravenous recombinant tissue plasminogen activator, given as soon as possible and before 4.5 hours, otherwise aspirin 300 mg, immediately or after 24 hours in case of thrombolysis, and, in a few patients, decompressive surgery. In intracerebral haemorrhages, blood pressure lowering and haemostatic therapy, when needed, are the two targets, but surgery does not seem effective to reduce death and disability.
34
Leys, Didier, Charlotte Cordonnier, and Valeria Caso. Stroke. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0067_update_001.
Повний текст джерелаАнотація:
Stroke is a major public health issue. Many are treatable in the acute stage, provided patients are admitted soon enough. The overall incidence of stroke in Western countries is approximately 2400 per year per million inhabitants, and 80% are due to cerebral ischaemia. The prevalence is approximately 12 000 per million inhabitants. Stroke is associated with increased long-term mortality, handicap, cognitive and behavioural impairments, recurrence, and an increased risk of other types of vascular events. It is of major interest to take the heterogeneity of stroke into account, because of differences in the acute management, secondary prevention, and outcomes, according to the subtype and cause of stroke. In all types of stroke, early epileptic seizures, delirium, increased intracranial pressure, and non-specific complications are frequent. In ischaemic strokes, specific complications, such as malignant infarcts, spontaneous haemorrhagic transformation, early recurrence, and a new ischaemic event in another vascular territory, are frequent. In haemorrhagic strokes, the major complication is the subsequent increased volume of bleeding. There is strong evidence that stroke patients should be treated in dedicated stroke units; each time 24 patients are treated in a stroke unit, instead of a conventional ward, one death and one dependence are prevented. This effect does not depend on age, severity, and the stroke subtype. For this reason, stroke unit care is the cornerstone of the treatment of stroke, aiming at the detection and management of life-threatening emergencies, stabilization of most physiological parameters, and prevention of early complications. In ischaemic strokes, besides this general management, specific therapies include intravenous recombinant tissue plasminogen activator, given as soon as possible and before 4.5 hours, otherwise aspirin 300 mg, immediately or after 24 hours in case of thrombolysis, and, in a few patients, decompressive surgery. In intracerebral haemorrhages, blood pressure lowering and haemostatic therapy, when needed, are the two targets, but surgery does not seem effective to reduce death and disability.
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Leys, Didier, Charlotte Cordonnier, and Valeria Caso. Stroke. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0067_update_002.
Повний текст джерелаАнотація:
Stroke is a major public health issue. Many are treatable in the acute stage, provided patients are admitted soon enough. The overall incidence of stroke in Western countries is approximately 2400 per year per million inhabitants, and 80% are due to cerebral ischaemia. The prevalence is approximately 12 000 per million inhabitants. Stroke is associated with increased long-term mortality, handicap, cognitive and behavioural impairments, recurrence, and an increased risk of other types of vascular events. It is of major interest to take the heterogeneity of stroke into account, because of differences in the acute management, secondary prevention, and outcomes, according to the subtype and cause of stroke. In all types of stroke, early epileptic seizures, delirium, increased intracranial pressure, and non-specific complications are frequent. In ischaemic strokes, specific complications, such as malignant infarcts, spontaneous haemorrhagic transformation, early recurrence, and a new ischaemic event in another vascular territory, are frequent. In haemorrhagic strokes, the major complication is the subsequent increased volume of bleeding. There is strong evidence that stroke patients should be treated in dedicated stroke units; each time 24 patients are treated in a stroke unit, instead of a conventional ward, one death and one dependence are prevented. This effect does not depend on age, severity, and the stroke subtype. For this reason, stroke unit care is the cornerstone of the treatment of stroke, aiming at the detection and management of life-threatening emergencies, stabilization of most physiological parameters, and prevention of early complications. In ischaemic strokes, besides this general management, specific therapies include intravenous recombinant tissue plasminogen activator, given as soon as possible and before 4.5 hours, mechanical thrombectomy in case of proximal occlusion (middle cerebral artery, intracranial internal carotid artery, basilar artery), on top of thrombolysis in the absence of contraindication or alone otherwise, aspirin 300 mg, immediately or after 24 hours in case of thrombolysis, and, in a few patients, decompressive surgery. In intracerebral haemorrhages, blood pressure lowering and haemostatic therapy, when needed, are the two targets, while surgery does not seem effective to reduce death and disability.
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Hoskin, Peter J. Radiotherapy in symptom management. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0123.
Повний текст джерелаАнотація:
Radiotherapy has a major role in symptom control and over 40% of all radiation treatments are given with palliative intent. In the palliative setting, radiotherapy will usually be delivered using high-energy external beam treatment from a linear accelerator. Bone metastases may be treated with intravenous systemic radioisotopes and dysphagia with endoluminal brachytherapy. A general principle of palliative radiotherapy is that it should be delivered in as few treatment visits as possible and be associated with minimal acute toxicity. The main indications for palliative radiotherapy are in the management of symptoms due to local tumour growth and infiltration. These include pain from bone metastases, visceral pain from soft tissue metastases, and neuropathic pain from spinal, pelvic, and axillary tumour. Local pressure symptoms are particularly onerous and potentially dangerous when they affect the nervous system; thus spinal canal compression remains one of the few true emergency situations in which radiotherapy is indicated. Similarly brain, meningeal, or skull base metastases require urgent assessment and can be helped with local radiotherapy. Obstruction of a hollow tube or drainage channels can lead to significant symptoms and again local radiotherapy can be valuable in addressing this scenario. Such indications would include dysphagia, bronchial obstruction, leg or arm oedema, vena cava obstruction, or hydrocephalus. Finally haemorrhage can be distressing if rarely life-threatening. Local radiotherapy to bleeding tumours in the lung, bronchus, bowel, genitourinary tract, and skin is very effective at control of bleeding.
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Ho, Kwok M. Kidney and acid–base physiology in anaesthetic practice. Edited by Jonathan G. Hardman. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0005.
Повний текст джерелаАнотація:
Anatomically the kidney consists of the cortex, medulla, and renal pelvis. The kidneys have approximately 2 million nephrons and receive 20% of the resting cardiac output making the kidneys the richest blood flow per gram of tissue in the body. A high blood and plasma flow to the kidneys is essential for the generation of a large amount of glomerular filtrate, up to 125 ml min−1, to regulate the fluid and electrolyte balance of the body. The kidneys also have many other important physiological functions, including excretion of metabolic wastes or toxins, regulation of blood volume and pressure, and also production and metabolism of many hormones. Although plasma creatinine concentration has been frequently used to estimate glomerular filtration rate by the Modification of Diet in Renal Disease (MDRD) equation in stable chronic kidney diseases, the MDRD equation has limitations and does not reflect glomerular filtration rate accurately in healthy individuals or patients with acute kidney injury. An optimal acid–base environment is essential for many body functions, including haemoglobin–oxygen dissociation, transcellular shift of electrolytes, membrane excitability, function of many enzymes, and energy production. Based on the concepts of electrochemical neutrality, law of conservation of mass, and law of mass action, according to Stewart’s approach, hydrogen ion concentration is determined by three independent variables: (1) carbon dioxide tension, (2) total concentrations of weak acids such as albumin and phosphate, and (3) strong ion difference, also known as SID. It is important to understand that the main advantage of Stewart over the bicarbonate-centred approach is in the interpretation of metabolic acidosis.
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van Hinsbergh, Victor W. M. Physiology of blood vessels. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198755777.003.0002.
Повний текст джерелаАнотація:
This chapter covers two major fields of the blood circulation: ‘distribution’ and ‘exchange’. After a short survey of the types of vessels, which form the circulation system together with the heart, the chapter describes how hydrostatic pressure derived from the heartbeat and vascular resistance determine the volume of blood that is locally delivered per time unit. The vascular resistance depends on the length of the vessel, blood viscosity, and, in particular, on the diameter of the vessel, as formulated in the Poiseuille-Hagen equation. Blood flow can be determined in vivo by different imaging modalities. A summary is provided of how smooth muscle cell contraction is regulated at the cellular level, and how neuronal, humoral, and paracrine factors affect smooth muscle contraction and thereby blood pressure and blood volume distribution among tissues. Subsequently the exchange of solutes and macromolecules over the capillary endothelium and the contribution of its surface layer, the glycocalyx, are discussed. After a description of the Starling equation for capillary exchange, new insights are summarized(in the so-called glycocalyx cleft model) that led to a new view on exchange along the capillary and on the contribution of oncotic pressure. Finally mechanisms are indicated in brief that play a role in keeping the blood volume constant, as a constant volume is a prerequisite for adequate functioning of the circulatory system.
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Vydyanathan, Amaresh, Allan L. Brook, Boleslav Kosharskyy, and Samer N. Narouze. Thoracic Nerve Root and Facet Injections: Computed Tomography. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199908004.003.0014.
Повний текст джерелаАнотація:
Thoracic back pain patients present with associated radiculopathy, degenerative disc disease, spondylosis, stenosis, scoliosis, rib fractures, tumors, or after undergoing thoracic surgery. Thoracic transforaminal or selective nerve root blocks (SNRBs) may be both therapeutic and diagnostic. Therapeutic injections may include either local anesthetics for pain relief or corticosteroids for anti-inflammatory effects. The two types of pain amenable to therapeutic SNRBs include pain caused by irritation or direct pressure on a spinal nerve and pain originating from anatomic structures that are innervated by the sinuvertebral nerve. Although these blocks are traditionally performed under fluoroscopic guidance, computed tomography (CT) and CT fluoroscopy have been increasingly used to direct needle placement and have been advocated by experts due to superior visualization of the needle tip and the ability to clearly define spinal anatomy and adjacent soft-tissues.
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Bochaton-Piallat, Marie-Luce, Carlie J. M. de Vries, and Guillaume J. van Eys. Vascular smooth muscle cells. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198755777.003.0007.
Повний текст джерелаАнотація:
To understand the function of arteries in the regulation of blood supply throughout the body it is essential to realize that the vessel wall is composed predominantly of smooth muscle cells (SMCs) with only one single layer of luminal endothelial cells. SMCs determine the structure of arteries and are decisive in the regulation of blood flow. This review describes the reason for the large variation of SMCs throughout the vascular tree. This depends on embryonic origin and local conditions. SMCs have the unique capacity to react to these conditions by modulating their phenotype. So, in one situation SMCs may be contractile in response to blood pressure, in another situation they may be synthetic, providing compounds to increase the strength of the vascular wall by reinforcing the extracellular matrix. This phenotypic plasticity is necessary to keep arteries functional in fulfilling the metabolic demands in the various tissues of the body.
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Alonso Salinas, Gonzalo Luis, Marina Pascual Izco, Covadonga Fernández-Golfín, Luigi P. Badano, and José Luis Zamorano. Ischaemic heart disease: acute coronary syndrome. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0029.
Повний текст джерелаАнотація:
Transthoracic echocardiography (TTE) is a non-invasive and accessible tool that should be widely used in the evaluation of patients with suspected or known acute coronary syndrome (ACS). Its role is crucial in the management of patients with suspected ACS without electrocardiographic changes or elevation of cardiac markers, allowing the formulation of differential diagnosis between cardiac and extracardiac aetiologies. If the ACS is confirmed, initial assessment of regional and global left and right ventricle contractile function is fundamental in establishing the management strategy and may help in the risk stratification of these patients. TTE can also characterize the ischaemic myocardium in the acute phase, exposing any myocardial regional wall motion abnormalities. Furthermore, TTE is an excellent tool for the initial assessment of the aetiology of cardiogenic shock. It provides additional information regarding the haemodynamic status of the patient, including filling pressures and stroke volume, and it may rule out other causes of shock; thus, immediate TTE, or transoesophageal echocardiography if necessary, should be performed when cardiogenic shock is suspected. In the chronic phase, TTE plays an important role in characterizing myocardial infarction scar and its extent. TTE can accurately differentiate viable myocardium from scar tissue, and may guide revascularization if needed, improving patient care.
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Gupta, Pawan, and Anurag Vats. Regional anaesthesia of the lower limb. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0055.
Повний текст джерелаАнотація:
Lower limb nerve blocks gained popularity with the introduction of better nerve localization techniques such as peripheral nerve stimulation and ultrasound. A combination of lower limb peripheral nerve blocks can provide anaesthesia and analgesia of the entire lower limb. Lower limb blocks, as compared to central neuraxial blocks, do not affect blood pressure, can be used in sick patients, provide longer-lasting analgesia, avoid the risk of epidural haematoma or urinary retention, provide better patient satisfaction, and have acceptable success rates in experienced hands. Detailed knowledge of the relevant anatomy is essential before performing any nerve blocks in the lower limb as the nerve plexuses and the peripheral nerves are deep and obscured by bony structures and large muscles. The lumbosacral plexus provides sensory and motor innervation to the superficial tissues, muscles, and bones of the lower limb. This chapter covers different approaches and techniques for lower limb blocks, that is, the lumbar plexus, femoral nerve, fascia iliaca, saphenous nerve, sciatic nerve, popliteal nerve, ankle block, forefoot block, and the intra-articular infusion of local anaesthetics. Both peripheral nerve stimulator- and ultrasound-guided approaches are discussed. The use of ultrasound guidance is suggested as it helps in reducing the dose of local anaesthetic required and can ensure circumferential spread of local anaesthetic around peripheral nerves, which hastens the onset of block and improves success rate.