Kosowsky, J. M., Han, J. H., Collins, S. P., Mcafee, A. T. and Storrow, A. B. (2002), Assessment of stroke index using impedance cardiography: Comparison with




НазваниеKosowsky, J. M., Han, J. H., Collins, S. P., Mcafee, A. T. and Storrow, A. B. (2002), Assessment of stroke index using impedance cardiography: Comparison with
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References

Kosowsky, J.M., Han, J.H., Collins, S.P., Mcafee, A.T. and Storrow, A.B. (2002), Assessment of stroke index using impedance cardiography: Comparison with traditional vital signs for detection of moderate acute blood loss in healthy volunteers. Academic Emergency Medicine, 9 (8), 775-780.

Abstract: Objectives: Impedance cardiography has been used to detect early hemorrhagic shock, but, to the best of the authors' knowledge, no previous study has looked at the test characteristics of bioimpedance-derived hemodynamic parameters for the detection of a measured loss of blood volume. The authors set out to investigate the effect of controlled hemorrhage on stroke index (SI) using impedance cardiography, and to evaluate the performance of this test for moderate blood loss in comparison with the performance of traditional vital signs. Methods: Supine and standing measurements of SI were made using a thoracic electrical bioimpedance monitor in 197 healthy, adult volunteers before and after donation of a standard unit (500 mL) of whole blood. Pre- and post-donation means for supine SI, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP), and for the postural changes in each of these measurements (ASI, DeltaHR, DeltaSBP, DeltaDBP), were compared using a paired-sample, two-tailed t- test. For each term, receiver operating characteristic (ROC) curves were generated, treating pre- and post-donation populations as independent. Areas under the ROC curves were compared using a method for correlated test result data. Results: Mean +/- SD pre- and post-donation values for SI were 47.0 +/- 6.9 mL/m(2) and 43.9 +/- 7.3 mL/m(2), respectively (p < 0.0001). Mean pre- and post-donation values for ASI were -7.7 +/- 5.8 mL/m(2) and -9.0 +/- 8.2 mL/m(2), respectively (p = 0.02). For discriminating between pre- and post-donation status, the areas under the ROC curves for SI and DeltaSI were 0.62 and 0.58, respectively. In comparison, the areas under the ROC curves for HR, SBP, DBP, DeltaHR, DeltaSBP, and DeltaDBP were 0.49, 0.61, 0.56, 0.82, 0.53, and 0.50, respectively. The area under the ROC curve for DeltaHR was significantly greater than the area under any of the other curves (p < 0.0001). Conclusions: Moderate blood loss was associated with a decline in mean SI that was clearly detectable with impedance cardiography. However, as a test for moderate blood loss in this controlled setting, neither SI nor ASI performed better than traditional vital signs

Keywords: acute/acute blood loss/adult/bioimpedance/blood/blood loss/blood pressure/blood volume/CARDIAC-OUTPUT/cardiography/changes/comparison/decline/detection/diastolic/diastolic blood pressure/effect/EMERGENCY/healthy volunteers/heart/heart rate/hemodynamic/hemodynamic parameters/hemorrhage/hemorrhagic/hemorrhagic shock/impedance/impedance cardiography/index/knowledge/loss/METAANALYSIS/monitor/noninvasive monitoring/PA/performance/postural/PRESSURE/receiver operating characteristic/shock/SHOCK/SI/standard/status/stroke/stroke index/supine/systolic/systolic blood/systolic blood pressure/thoracic/THORACIC ELECTRICAL BIOIMPEDANCE/TILT TEST/TRAUMA/USA/VOLUME

Yamaguchi, K., Hori, S., Nogawa, S., Tanahashi, N., Fukuuchi, Y. and Aikawa, N. (2002), Thrombolysis candidates for the treatment of stroke at an emergency department in Japan. Academic Emergency Medicine , 9 (7), 754-758.

Abstract: Objectives: To study the proportion and characteristics of potential candidates for the intravenous administration of tissue plasminogen activator (IV-tPA) among patients with cerebral infarction in a Japanese emergency department (ED). Methods: A retrospective observational study was performed using patients who had been transported by ambulance between August 1988 and April 2000 to an urban ED of a university hospital located in the Tokyo metropolitan area. Potential candidates for IV-tPA were identified using the criteria of the National Institute of Neurological Disorders and Stroke (NINDS) study. Results: Of all 30,064 patients transported by ambulance, 526 were diagnosed as having cerebral infarction. Among them, 190 patients arrived at the ED within two hours of symptom onset (early ED arrivers). In comparison of their demographics with late ED arrivers (n = 319), atrial fibrillation, male gender, and consciousness disturbance were related with early ED arrivers, while aging and diabetes were related with late ED arrivers. As to the stroke subtype, patients with an embolic infarction accounted for 76.8%, among early ED arrivers. Application of exclusion criteria identified 114 patients, who were suitable for the thrombolysis treatment, indicating that the proportion of potential IV-tPA candidates was 217% among all cerebral infarction patients and 0.38%, among all ED patients. Conclusions: The number of potential IV- tPA candidates among patients transported to the ED by ambulance in Japan was substantial, where the proportion of embolic infarction cases was extremely high

Keywords: ACUTE ISCHEMIC STROKE/aging/ambulance/atrial/atrial fibrillation/cerebral/cerebral infarction/comparison/consciousness/criteria/diabetes/embolic/embolism/emergency/emergency department/emergency medical services/fibrillation/gender/hospital/infarction/intravenous/Japan/Japanese/male/observational study/PA/patients/plasminogen/plasminogen activator/stroke/stroke subtype/thrombolysis/thrombolytic therapy/tissue plasminogen activator/TISSUE-PLASMINOGEN ACTIVATOR/tPA/treatment/USA

Lafleur, J. and Stokes-Buzzelli, S. (2002), Clinicopathological conference: A 73-year-old man with shock, stroke, and cyanotic extremities. Academic Emergency Medicine, 9 (2), 161-168

Keywords: ACUTE MYOCARDIAL-INFARCTION/CARDIAC RUPTURE/cyanosis/DIAGNOSIS/diagnosis/extremities/HEART/myocardial infarction/PA/pericardial tamponade/PERICARDITIS/RELEVANCE/shock/stroke/USA/VENTRICULAR FREE-WALL

Aronen, H.J., Perkio, J., Karonen, J.O., Vanninen, R.L., Ostergaard, L., Liu, Y.W., Kononen, M., Vanninen, E.J., Soimakallio, S. and Kuikka, J.T. (2002), Perfusion-weighted MRI in human acute ischemic stroke: A comparison with the progression of the infarct on diffusion- weighted images. Academic Radiology, 9 S160-S164

Keywords: acute/acute ischemic/acute ischemic stroke/CEREBRAL BLOOD-FLOW/comparison/CONTRAST/diffusion/diffusion weighted/diffusion- weighted/ECASS/EXPERIENCE/Finland/GROWTH/HIGH-RESOLUTION MEASUREMENT/human/HYPERACUTE STROKE/infarct/ischemic/ischemic stroke/MRI/progression/stroke/TIME/TRACER BOLUS PASSAGES/USA/VOLUME

Yoshiura, T., Mihara, F., Kuwabara, Y., Ogomori, K., Kaneko, K., Tanaka, A., Sasaki, M., Nakagawa, M., Koga, H., Yamanaka, T. and Masuda, K. (2002), MR relative cerebral blood flow mapping of Alzheimer disease: Correlation with Tc-99m HMPAO SPECT. Academic Radiology, 9 (12), 1383-1387.

Abstract: Rationale and Objectives. To evaluate the value of magnetic resonance (MR) perfusion imaging for diagnosis of Alzheimer disease (AD), the authors compared relative cerebral blood flow (CBF) maps obtained with MR perfusion imaging and technetium- 99m hexamethyl-propyleneamine oxime (HMPAO) single photon emission computed tomography (SPECT) in patients with AD. Materials and Methods. Eight patients with AD were studied with MR perfusion imaging and HMPAO SPECT. The relative CBF maps from the two techniques were spatially coregistered, and relative CBF values in 13 cerebral gray matter regions (total, 26 regions of interest) were compared with regression analysis. To evaluate the degree of deviation of each brain region from the regression line, a P value for the residual was calculated for each region. Results. A significant overall correlation was seen between the relative CBF values produced by the two techniques (r.68, P<.0001). Smaller P values for the residuals were obtained in the anterior cingulate cortex (P=.05) and posterior cingulate cortex (P<.001), indicating larger deviations in these regions. When data from these two regions were eliminated, the correlation coefficient rose to 0.80 (P<.0001). Conclusion. Despite fairly large discrepancies in the anterior and posterior cingulate cortices, the relative CBF map obtained with MR imaging is generally in close agreement with the HMPAO SPECT map, suggesting that MR perfusion imaging can provide clinically useful information regarding CBF abnormalities in patients with AD

Keywords: abnormalities/AD/agreement/Alzheimer/Alzheimer disease/analysis/anterior cingulate cortex/blood/blood flow/brain/CBF/cerebral/cerebral blood flow/cerebral blood vessels/computed tomography/CONTRAST/correlation/cortex/dementia/diagnosis/disease/emission/emission computed/emission-computed/flow/flow dynamics/gray matter/HIGH-RESOLUTION MEASUREMENT/HMPAO/HMPAO SPECT/HMPAO-SPECT/HYPERACUTE STROKE/imaging/information/Japan/magnetic/magnetic resonance/mapping/MR/MR imaging/MR perfusion/MR perfusion imaging/patients/perfusion/PERFUSION/perfusion imaging/POSITRON-EMISSION-TOMOGRAPHY/radionuclide studies/regions of interest/regression/regression analysis/residual/single photon emission computed tomography/SPECT/techniques/tomography/TRACER BOLUS PASSAGES/USA/VOLUME

Hofer, C.K., Zalunardo, M.P., Klaghofer, R., Spahr, T., Pasch, T. and Zollinger, A. (2002), Changes in intrathoracic blood volume associated with pneumoperitoneum and positioning. Acta Anaesthesiologica Scandinavica, 46 (3), 303-308.

Abstract: Background: It is still controversial whether elevated cardiac filling pressures after the onset of pneumoperitoneum are the consequence of increased intrathoracic pressure or of increased venous return. The aim of this study was to assess the effects of pneumoperitoneum and body positioning on intrathoracic blood volume (ITBV). Methods: Thirty anesthetized patients were randomly assigned to have CO2-pneumoperitoneum (13 mmHg) either in a supine, in a 15degrees head-up tilt or in a 15degrees head-down tilt position. Measurements of ITBV and hemodynamics by the double indicator method were recorded after induction of anesthesia and application of a fluid bolus (Lactated Ringer's solution 10 ml/kg), after positioning and after induction of pneumoperitoneum. Results: Intrathoracic blood volume index (ITBVI) increased significantly after induction of pneumoperitoneum in all body positions (supine: from 18.5 +/- 3.3-20.2 +/- 5.2 ml/kg (+6%) head-up from 16.7 +/- 3.8-17.4 +/- 3.7 ml/kg (+16%) and head-down: from 19.8 +/- 5.6-20.5 +/- 5.9 ml/kg (+14%)). Heart rate did not change significantly in any of the groups. Cardiac index showed a statistically significant change in the head-down position with pneumoperitoneum (-11%). A good correlation was found for stroke volume (SV) with ITBV (r = 0.79), but not with central venous pressure (r = 0.26). Systemic vascular resistance index increased significantly in all three groups (supine +6%, head-up +16%, head-down position +14%). Conclusion: The present study indicates that the onset of pneumoperitoneum, even with moderate intra-abdominal pressures, is associated with an increased intrathoracic blood volume in ASA I/II patients

Keywords: anesthesia/ASA/blood/blood volume/bolus/CARBON-DIOXIDE/cardiac/cardiac filling pressures/cardiac index/CARDIAC-OUTPUT/central venous pressure/COPENHAGEN/correlation/DENMARK/effects/fluid/head down tilt/head up tilt/head-up tilt/HEMODYNAMIC- CHANGES/hemodynamics/HUMANS/index/indicator-dilution technique/INSUFFLATION/INTRAPERITONEAL/intrathoracic/intrathoracic blood volume/LAPAROSCOPIC CHOLECYSTECTOMY/laparoscopy/LUNG WATER/patients/pneumoperitoneum/position/positioning/PRESSURE/pressures/resistance/stroke/stroke volume/supine/Switzerland/tilt/vascular/vascular resistance/venous pressure/VENOUS RETURN/volume

Linstedt, U., Meyer, O., Kropp, P., Berkau, A., Tapp, E. and Zenz, M. (2002), Serum concentration of S-100 protein in assessment of cognitive dysfunction after general anesthesia in different types of surgery. Acta Anaesthesiologica Scandinavica, 46 (4), 384-389.

Abstract: Background: S-100 protein serum concentration (S-100) serves as a marker of cerebral ischemia in cardiac surgery head injury and stroke. In these circumstances S-100 corresponds well with the results of neuropsychological tests. The aim of the present study was to investigate the value of S-100 and neuron specific enolase (NSE) in reflecting postoperative cognitive deficit (POCD) after general surgical procedures. Methods: One hundred and twenty patients undergoing vascular, trauma, urological or abdominal surgery were investigated. Serum values of S-100 and NSE were determined preoperatively and 0.5, 4, 18 and 36 h postoperatively. Neuropsychological tests for detecting POCD were performed preoperatively and on day 1, 3, and 6 after the operation. A decline of more than 10% in neuropsychological test results was regarded as POCD. Furthermore, we retrospectively compared the S-100 in patients with and without POCD in different types of surgery. Results: According to our definition, forty-eight patients had POCD (95% confidence interval: 37.5-58.5). These patients showed higher serum concentrations of S-100 (median 024ng/ml; range 0.01-3.3ng/ml) compared with those without POCD (n=69; median 0.14ng/ml; range 0-1.34ng/ml) 30 min post-operatively (P=0.01). Neuron specific enolase was unchanged during the course of the study. Differences of S-100 in patients with and without POCD were found in abdominal and vascular surgery but not in urological surgery. Conclusion: When all patients are pooled, S-100 appears to be suitable in the assessment of incidence, course and outcome of cognitive deficits. We suspect that in some surgical procedures, such as urological surgery, S-100 appears to be of limited value in detecting POCD. Neuron specific enolase did not reflect neuropsychological dysfunction after noncardiac surgery. (C) Acta Anaesthesiologica Scandinavica 46 (2002)

Keywords: abdominal/anesthesia/assessment/BLOOD/cardiac/cardiac surgery/CARDIAC-SURGERY/cerebral/cerebral ischemia/CEREBRAL-ISCHEMIA/cognitive/cognitive deficit/cognitive deficits/cognitive dysfunction/COPENHAGEN/CORONARY-ARTERY BYPASS/DAMAGE/decline/deficits/definition/DENMARK/dysfunction/ELDERLY PATIENTS/FEMORAL-NECK FRACTURES/general/general anesthesia/Germany/head injury/incidence/injury/ischemia/marker/NEUROBIOCHEMICAL MARKERS/neuron/neuron specific enolase/NEURON-SPECIFIC ENOLASE/neuropsychological/neuropsychological test/neuropsychological tests/NSE/outcome/patients/postoperative/postoperative cognitive deficit/protein/range/results/S-100/S-100 protein/serum/serum markers/stroke/surgery/surgical/surgical procedures/tests/trauma/TRAUMATIC BRAIN INJURY/vascular/vascular surgery

Soderstrom, S., Sellgren, J., Aneman, A. and Ponten, J. (2002), Interpretation of radial pulse contour during fentanyl/nitrous oxide anesthesia and mechanical ventilation. Acta Anaesthesiologica Scandinavica, 46 (7), 866-874.

Abstract: Background: Peripheral arterial blood pressure is not a reliable substitute for proximal aortic pressure. Recognition of this phenomenon is important for correct appreciation of cardiac afterload. Our aim was to evaluate the utility of the radial pulse wave to better understand ventriculo-vascular coupling during anesthesia. Methods: We observed the differences between aortic systolic pressure (AoSAP, tipmanometry) and radial systolic pressure in 15 patients, (including two women) aged 53-78 years, before coronary artery bypass surgery. We studied the induction of anesthesia with fentanyl (20 mug kg(-1) ), moderate volume loading, and thereafter the addition of 70% nitrous oxide. The circulatory effects of mechanical ventilation were studied by doubling the tidal volumes. Pulse wave contours were assessed by calculation of radical and aortic augmentation indices (AI), which measure the second systolic pressure peak. Results: Radial systolic pressure was higher than AoSAP in the control situation (8+/-2 mmHg), and this SAP gradient increased further with fentanyl (12+/-2 mmHg). The gradient persisted throughout the study, but was partially reduced by volume loading and nitrous oxide, respectively. Radial augmentation index was the only parameter remaining in a stepwise multivariate model to explain the variance in the SAP gradient (r (2) =0.48). Radial augmentation index also correlated with aortic pulse pressure (r (2) =0.71). Mechanical ventilation had significant and similar effects on pulse wave augmentation both in the aorta and in the radial artery, and did not affect the radial to aortic SAP gradient. Conclusion: These elderly coronary patients had stiff vasculature (high aortic AI) and considerable pulse wave reflection, which was beneficially delayed by fentanyl. Changes in the radial pulse wave augmentation during mechanical ventilation were mainly a result of cyclic changes in the stroke volume, and were seldom associated with an increased systolic pressure gradient from the aorta to the radial artery

Keywords: addition/affect/afterload/AGE/aged/AI/anesthesia/aorta/aortic/aortic pressure/arterial/arterial blood pressure/artery/artificial respiration/AUGMENTATION INDEX/blood/blood pressure/blood pressure monitors/BLOOD-PRESSURE/bypass/bypass surgery/cardiac/CARDIAC-OUTPUT/CENTRAL ARTERIAL-PRESSURE/changes/circulatory/control/COPENHAGEN/coronary/coronary artery/coronary artery bypass/coronary artery bypass surgery/coronary disease/coupling/DENMARK/effects/elderly/fentanyl/HUMANS/index/loading/measure/mechanical/mechanical ventilation/model/NITROGLYCERIN/nitrous oxide/patients/pressure/pulse/pulse pressure/pulse wave/radial/radial artery/stroke/stroke volume/surgery/Sweden/systolic/thermodilution/UPPER-LIMB/utility/vasculature/ventilation/volume/volume loading/wave reflection/women

Zorbas, Y.G., Kakurin, V.J., Afonin, V.B. and Yarullin, V.L. (2002), Biochemical and hemodynamic changes in normal subjects during acute and rigorous bed rest and ambulation. Acta Astronautica,
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