摘要:

Although the incidence is not high, pregnancy is complicated by a wide variety of gastrointestinal and hepatic disorders. Gastrointestinal and hepatic complications during pregnancy are associated with increased morbidity and mortality of the mother and fetus. Diagnosis and treatment are often difficult because of physiologic changes during gestation and limitations or reluctance in using invasive procedures. Recent literature is reviewed in regard to this issue. Early diagnosis and prompt management are mandatory to attain favorable maternal and fetal outcome.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Recent advances and perspectives in monitoring and selecting critically ill patients with cerebrovascular disease for specific treatment alternatives are reviewed. Current management for intracranial hypertension and respiratory failure in patients with severe strokes are disputed and the relationship of blood pressure, cerebral blood flow, and metabolism for cerebral ischemia is discussed. Furthermore, advances in techniques to continuously monitor brain tissue metabolism and new therapeutic approaches to ameliorate effects of cerebrocascular catastrophies are analyzed.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Cervical spine trauma is a frequent and expensive critical illness in the intensive care unit. Initial neurologic diagnosis before paralytics or sedatives are administered and before radiologic assessment is instrumental in determining the level of injury and possible early interventions. Neuroprotection using methylprednisolone within the first 8 hours is an accepted intervention but carries significant risk of comorbidity. Prognosis based on somatosensory evoked potential testing offers direction for neurorehabilitation after intensive care. An increased knowledge of the pathophysiology of spinal cord injury and brain injury is needed to provide future direction for spinal neurocritical care.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

There have been a number of recent developments in understanding the mechanisms and treatment of acute seizures and status epilepticus in the past year. Sudden unexplained death in epileptic patients is better understood, as is the role of associated illnesses in acute seizures. Several new drugs have been studied in chronic epilepsy and several more in the treatment of status epilepticus. Anatomy sites, changes in the extracellular space, and seizure-induced neuronal damage have all been studied in experimental models of status epilepticus, as has been th role of excitatory and inhibitory neurotransmitters. A newin vitromodel of status epilepticus has been developed. Advances in clinical knowledge of status epilepticus have included increased appreciation of the role of neuron-specific enolase as a marker of status epilepticus-induced neuronal damage, the role of blood-brain barrier compromise in the development of Rassmussen's encephalitis, and the role of genetics in febrile seizures and their consequences.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The prognosis of patients with severely altered neurologic status remains difficult to predict, complicated as it has been by unclear diagnoses in many past studies. Consequently, recovery of consciousness in patients in a “persistent” vegetative state may be more frequent than was previously reported, leading to questions about the reliability of this diagnosis. Brain death may be defined in a number of ways and may not be an acceptable concept within some cultures. Nonetheless, the current pressures of organ transplantation lead us to refine our efforts at diagnosing this neurologic state and to continue to evaluate physiologic changes that may affect the quality of donated organs. The field of organ transplantation ethics is actively examining the issues of allocation of resources, obtaining organs from non-heart-beating donors, and xenografting.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

In the past year numerous articles have been published expanding our knowledge of neurogenic respiratory failure. This review discusses the implications of this work. The areas addressed include neuromuscular disease and ventilator dependence, the role of vital capacity in treating patients with myasthenia gravis, the pathology in Guillain-Barré syndrome, and the relationship between Guillain-Barré syndrome andCampylobacter jejuni.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Experiments in animal models and cell culture systems have substantially improved our understanding of the complex pathophysiologic mechanisms of bacterial meningitis. Some studies have given new insights into the molecular mechanisms of the interactions of bacteria (Streptococcus pneumoniae, Escherichia coli) and cells making up the blood-brain barrier. There is increasing evidence that nitric oxide and excitatory amino acids are involved as mediators in the pathophysiology of bacterial meningitis, offering hope for new targets in adjunctive therapeutic strategies in this disease. Polymerase chain reaction on the cerebrospinal fluid is a rapid, specific method that has been shown to be useful for early diagnosis of tuberculous meningitis. Central nervous system toxoplasmosis is the most common cause of subacute focal encephalopathy in AIDS, which can be effectively treated with pyrimethamine-sulfadiazine.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Critically ill patients are often hypermetabolic; their nutritional requirements are best assessed using indirect calorimetry. Early feeding is recommended in order to avoid the negative consequences of a starved gut, which include sepsis, multiple organ failure, and death. Enteral delivery is preferred over the parenteral route, and the use of promotility agents and new feeding tube styles have improved tolerance and feasibility of placement. Although most patients' nutritional needs can be met with standard polymeric formulas, specialized formulas may be beneficial in some circumstances. Supplemental fish oil, arginine, and growth factors may have beneficial immunologic effects on intestinal health. Glutamine has gained increased recognition as being “conditionally essential” in critically ill patients. Further work may define the ideal candidates for the use of glutamine and other supplements.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Gastrointestinal and hepatic complications are common in bone marrow transplant recipients. These patients often present difficult diagnostic and therapeutic dilemmas. Toxicity related to chemoradiation and other drugs, graft-versus-host disease, and infections account for the major mechanisms of gastrointestinal and liver damage. The timing of symptom presentation after transplantation is especially important to differentiate between various possible etiologies. There continues to be a paucity of prospective data on the etiology and outcome of specific gastrointestinal symptoms. Despite major advances in this field, significant hurdles still remain. The ability to predict, prevent, and treat gastrointestinal and hepatic complications is crucial for long-term survival. However, new problems, such as secondary malignancies, continue to emerge as survival increases.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID