1,721,148 research outputs found
Sudden Deafness
No full textIdiopathic sudden sensorineural hearing loss (ISSHL) or “sudden deafness” (SD) is a sudden or rapidly progressive hypoacusis
in which no known cause of sensorineural hearing loss can be identified. The hearing loss is due to pure damage of the cochlea;
and four main theories are proposed to explain this disturbance: vascular, viral, round window rupture and auto-immune disorders.
Although these hypotheses are controversial, the most likely cause involves impaired oxygen delivery to the organ of Corti.
Cochlear activity is dependent on energy supply which is itself directed by the oxygen metabolism; and it has been well demonstrated
that perilymphatic oxygen tension decreases significantly in patients with SD. According to these pathophysiological data,
various therapeutic agents (steroids, vasodilators, hemodilution, among others) supposed to enhance rheology and oxidative
metabolism have been proposed. In the same way, and due to its general and specific effects, hyperbaric oxygen therapy (HBO)
is able to increase perilymphatic oxygen pressure, by restoring the oxidative metabolism in the stria vascularis and by protecting
neurosensory cells. All these drugs and techniques have been tried singly or in combination for many years. Despite the results
of retrospective and prospective studies, their therapeutic efficacy is difficult to establish due partly to the high rate
of spontaneous recovery. Conventional therapies and HBO are extensively discussed in this chapter, together with evidence
from the literatur
Should we be aware of autonomic nervous system control before performing head-down laparoscopy?
No full textlaparoscopic surgery accounts for millionsof surgical procedures per year, and it has become the most-used elective procedure among radical prostatectomy surgeries.2, 3 De- spite the fact that the overall mortality from laparoscopic surgery is low 4 and that cardiac and cerebral complications related to laparoscopic prostatectomy are rare,5 head-down positioning and pneumoperitoneum exert their effects on the cardiovascular and respiratory systems. laparoscopic procedures generate hydrostatic and abdominal pressures,6 and in- volve the action of anesthetic drugs. the degree of cardiovascular involvement depends on a complex interaction of all mechanisms in volved in the control of arterial pressure such as the intrinsic myogenic response of vessels and the neuroendocrine and autonomic nervous systems
Dose of colistin. a work in progress?
Full text linkWe thank Rashid and colleagues [1] and Honoré and colleagues [2] for their comments regarding our article on risk factors for acute kidney injury in pa- tients receiving colistin or other nephrotoxic antimi- crobials [3].
It is correct that we did not specifically report urine output in the text, but it was obviously included in the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria reported in Table two [3]
Do hypooncotic fluids for shock increase the risk of late-onset acute respiratory distress syndrome?
No full textIn patients with shock, late-onset acute respiratory distress syndrome (ARDS) carries poor prognosis. Hypooncotic fluids may improve kidney function preservation, whereas hyperoncotic fluids may in theory decrease the risk of late-onset ARDS. Our objective was to determine whether predominant or exclusive use of crystalloids and/or hypooncotic colloids for shock resuscitation influenced the risk of late-onset ARDS.
International prospective cohort of consecutive adults who were free of ARDS on admission and who received fluid resuscitation for shock in 115 intensive care units (ICUs) during a 4-week period.
Severity scores, hemodynamic status, indication for fluids, risk factors for ARDS, plasma expander use, transfusions, and late-onset ARDS were recorded prospectively. Logistic regression models were tested to determine whether predominant or exclusive use of hypooncotic fluids was associated with higher incidence of late-onset ARDS. Of 905 patients, 81 [8.9%; 95% confidence interval (CI) 7.2-11.0] developed ARDS, with no difference between patients given only hypooncotic fluids (10.4%; 95% CI 7.6-13.7) and the other patients (7.7%; 95% CI 5.5-10.5; p = 0.16). Late-onset ARDS was significantly associated with sepsis [odds ratio (OR) 1.90; 95% CI 1.06-3.40], worse chest X-ray score at fluid initiation (1.55; 95% CI 1.27-1.91), positive fluid balance (1.06 per l; 95% CI 1.02-1.09), and greater transfusion volume (1.14 per l; 95% CI 1.01-1.29). The proportion of hypooncotic fluids in the plasma expander regimen was not associated with late-onset ARDS (1.01 per %; 95% CI 0.99-1.01).
Based on this observational study, there is no evidence that in patients with shock the use of hypooncotic fluids increases the risk of late-onset ARDS. This finding needs to be confirme
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