AIM To investigate the changes of hemodynamic and laboratory parameters during the course of acute liver failure following acetaminophen overdose.METHODS Eight pigs underwent a midline laparotomy following jejunal cat...AIM To investigate the changes of hemodynamic and laboratory parameters during the course of acute liver failure following acetaminophen overdose.METHODS Eight pigs underwent a midline laparotomy following jejunal catheter placement for further acetaminophen intoxication and positioning of a portal vein Doppler flow-probe. Acute liver failure was realized by intrajejunal acetaminophen administration in six animals, two animals were sham operated. All animals were invasively monitored and received standardized intensive care support throughout the study. Portal blood flow, hemodynamic and ventilation parameters were continuously recorded. Laboratory parameters were analysed every eight hours. Liver biopsies were sampled every 24 h following intoxication and upon autopsy.RESULTS Acute liver failure (ALF) occurred after 28 ± 5 h resulted in multiple organ failure and death despite maximal support after further 21 ± 1 h (study end). Portal blood flow (baseline 1100 ± 156 m L/min) increased to a maximum flow of 1873 ± 175 m L/min at manifestation of ALF, which was significantly elevated(P < 0.01). Immediately after peaking, portal flow declined rapidly to 283 ± 135 m L/min at study end. Thrombocyte values (baseline 307 × 103/μL± 34 × 103/μL) of intoxicated animals declined slowly to values of 145 × 103/μL± 46 × 103/μL when liver failure occurred. Subsequent appearance of severe thrombocytopenia in liver failure resulted in values of 11 × 103/μL± 3 × 103/μL preceding fatality within few hours which was significant(P > 0.01).CONCLUSION Declining portal blood flow and subsequent severe thrombocytopenia after acetaminophen intoxication precede fatality in a porcine acute liver failure model.展开更多
BACKGROUND Gastric tube formation and pull-up is the most common technique of reconstruction following esophagectomy for esophageal cancer.If previous treatment with radiotherapy for gastric mucosa-associated lymphoid...BACKGROUND Gastric tube formation and pull-up is the most common technique of reconstruction following esophagectomy for esophageal cancer.If previous treatment with radiotherapy for gastric mucosa-associated lymphoid tissue(MALT)-lymphoma restricts suitability of the stomach for anastomosis to the esophagus is unknown.CASE SUMMARY A 57-year-old man underwent sequential chemotherapy and radiotherapy for gastric MALT-lymphoma seven years prior to diagnosis of esophageal adenocarcinoma.Esophagectomy without neoadjuvant treatment was recommended by the multidisciplinary tumor board due to early tumor stage[uT1(sm2)uN+cM0 according to TNM-classification of malignant tumors,8^(th) edition]without lymph node involvement.Minimal invasive esophageal resection with esophagogastrostomy was performed.Due to gastric tube necrosis with anastomotic leakage on the twelfth postoperative day,diverting resection with construction of a cervical salivary fistula was necessary.Rapid recovery facilitated colonic interposition without any complications six months afterwards.CONCLUSION This case report may represent the start for further investigation to know if it is reasonable to refrain from esophagogastrostomy in patients with a long interval between gastric radiotherapy and surgery.展开更多
AIM To detect blood withdrawal for patients with arterial blood pressure monitoring to increase patient safety and provide better sample dating.METHODS Blood pressure information obtained from a patient monitor was fe...AIM To detect blood withdrawal for patients with arterial blood pressure monitoring to increase patient safety and provide better sample dating.METHODS Blood pressure information obtained from a patient monitor was fed as a real-time data stream to an experimental medical framework. This framework was connected to an analytical application which observes changes in systolic, diastolic and mean pressure to determine anomalies in the continuous data stream. Detection was based on an increased mean blood pressure caused by the closing of the withdrawal three-way tap and an absence of systolic and diastolic measurements during this manipulation. For evaluation of the proposed algorithm, measured data from animal studies in healthy pigs were used.RESULTS Using this novel approach for processing real-time measurement data of arterial pressure monitoring, the exact time of blood withdrawal could be successfully detected retrospectively and in real-time. The algorithm was able to detect 422 of 434(97%) blood withdrawals for blood gas analysis in the retrospective analysis of 7 study trials. Additionally, 64 sampling events for other procedures like laboratory and activated clotting time analyses were detected. The proposed algorithm achieved a sensitivity of 0.97, a precision of 0.96 and an F1 score of 0.97.CONCLUSION Arterial blood pressure monitoring data can be used toperform an accurate identification of individual blood samplings in order to reduce sample mix-ups and thereby increase patient safety.展开更多
文摘AIM To investigate the changes of hemodynamic and laboratory parameters during the course of acute liver failure following acetaminophen overdose.METHODS Eight pigs underwent a midline laparotomy following jejunal catheter placement for further acetaminophen intoxication and positioning of a portal vein Doppler flow-probe. Acute liver failure was realized by intrajejunal acetaminophen administration in six animals, two animals were sham operated. All animals were invasively monitored and received standardized intensive care support throughout the study. Portal blood flow, hemodynamic and ventilation parameters were continuously recorded. Laboratory parameters were analysed every eight hours. Liver biopsies were sampled every 24 h following intoxication and upon autopsy.RESULTS Acute liver failure (ALF) occurred after 28 ± 5 h resulted in multiple organ failure and death despite maximal support after further 21 ± 1 h (study end). Portal blood flow (baseline 1100 ± 156 m L/min) increased to a maximum flow of 1873 ± 175 m L/min at manifestation of ALF, which was significantly elevated(P < 0.01). Immediately after peaking, portal flow declined rapidly to 283 ± 135 m L/min at study end. Thrombocyte values (baseline 307 × 103/μL± 34 × 103/μL) of intoxicated animals declined slowly to values of 145 × 103/μL± 46 × 103/μL when liver failure occurred. Subsequent appearance of severe thrombocytopenia in liver failure resulted in values of 11 × 103/μL± 3 × 103/μL preceding fatality within few hours which was significant(P > 0.01).CONCLUSION Declining portal blood flow and subsequent severe thrombocytopenia after acetaminophen intoxication precede fatality in a porcine acute liver failure model.
文摘BACKGROUND Gastric tube formation and pull-up is the most common technique of reconstruction following esophagectomy for esophageal cancer.If previous treatment with radiotherapy for gastric mucosa-associated lymphoid tissue(MALT)-lymphoma restricts suitability of the stomach for anastomosis to the esophagus is unknown.CASE SUMMARY A 57-year-old man underwent sequential chemotherapy and radiotherapy for gastric MALT-lymphoma seven years prior to diagnosis of esophageal adenocarcinoma.Esophagectomy without neoadjuvant treatment was recommended by the multidisciplinary tumor board due to early tumor stage[uT1(sm2)uN+cM0 according to TNM-classification of malignant tumors,8^(th) edition]without lymph node involvement.Minimal invasive esophageal resection with esophagogastrostomy was performed.Due to gastric tube necrosis with anastomotic leakage on the twelfth postoperative day,diverting resection with construction of a cervical salivary fistula was necessary.Rapid recovery facilitated colonic interposition without any complications six months afterwards.CONCLUSION This case report may represent the start for further investigation to know if it is reasonable to refrain from esophagogastrostomy in patients with a long interval between gastric radiotherapy and surgery.
文摘AIM To detect blood withdrawal for patients with arterial blood pressure monitoring to increase patient safety and provide better sample dating.METHODS Blood pressure information obtained from a patient monitor was fed as a real-time data stream to an experimental medical framework. This framework was connected to an analytical application which observes changes in systolic, diastolic and mean pressure to determine anomalies in the continuous data stream. Detection was based on an increased mean blood pressure caused by the closing of the withdrawal three-way tap and an absence of systolic and diastolic measurements during this manipulation. For evaluation of the proposed algorithm, measured data from animal studies in healthy pigs were used.RESULTS Using this novel approach for processing real-time measurement data of arterial pressure monitoring, the exact time of blood withdrawal could be successfully detected retrospectively and in real-time. The algorithm was able to detect 422 of 434(97%) blood withdrawals for blood gas analysis in the retrospective analysis of 7 study trials. Additionally, 64 sampling events for other procedures like laboratory and activated clotting time analyses were detected. The proposed algorithm achieved a sensitivity of 0.97, a precision of 0.96 and an F1 score of 0.97.CONCLUSION Arterial blood pressure monitoring data can be used toperform an accurate identification of individual blood samplings in order to reduce sample mix-ups and thereby increase patient safety.