OBJECTIVES: To study the value of functional echocardiographic parameters in predicting refractory septic shock in neonates. METHODS: A total of 72 neonates with septic shock were enrolled. According to the highest value of septic shock score, they were divided into two groups: refractory (n=30) and non-refractory (n=42). The two groups were compared in terms of clinical data, laboratory findings, and functional echocardiographic parameters. The receiver operating characteristic (ROC) curve was used to evaluate the performance of functional echocardiographic parameters in predicting refractory septic shock. RESULTS: Compared with the non-refractory group, the refractory group had significantly lower cardiac output and cardiac index (CI) and a significantly higher mean arterial pressure (MAP)/CI ratio (P<0.05). CI had a cut-off value of 2.6 L/(min·m²), a sensitivity of 79%, a specificity of 83%, and an area under the ROC curve (AUC) of 0.841 in predicting septic shock-related death (P<0.05), and MAP/CI ratio had a cut-off value of 11.4, a sensitivity of 83%, a specificity of 73%, and an AUC of 0.769 (P<0.05). CI had a cut-off value of 2.9 L/(min·m²), a sensitivity of 69%, a specificity of 69%, and an AUC of 0.717 in predicting all-cause death within 28 days (P<0.05). CONCLUSIONS CI and MAP/CI ratio can be useful for early prediction of septic shock-related death in neonates.
Infant, Newborn ; Humans ; Shock, Septic/diagnostic imaging* ; Echocardiography ; ROC Curve

Choristoma ; complications ; diagnosis ; diagnostic imaging ; Duodenal Diseases ; complications ; diagnosis ; diagnostic imaging ; Duodenoscopy ; Fatal Outcome ; Female ; Humans ; Middle Aged ; Pancreas ; Shock, Septic ; etiology ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: Isolated superior mesenteric artery dissection (SMA) is an uncommon event but is reported not infrequently recently because of the advancement of diagnostic imaging modalities. However, the etiology and therapeutic guideline are not yet established. The purpose of this study is to find a therapeutic guideline of isolated SMA dissection. METHOD: Between January 1997 and February 2007, we retrospectively reviewed 21 patients diagnosed with isolated SMA dissection. RESULT: All patients except one patient were male and mean age was 54 years old (39~68) at the time of the diagnosis. The most common symptom was diffuse abdominal pain (72.2%). Diagnosis was made by computed tomography and/or angiography. SMA thrombosis was noted in 16 patients (76.2%). Conservative treatments were performed in 14 patients (66.7%) and surgical treatments in 7 (33.3%). One of the patients who received conservative treatment underwent diagnostic laparotomy to assure viability of bowel. Of the 7 patients received surgical treatment, 2 patients (12.5%) with the preoperative diagnosis of bowel infarction received emergent laparotomy followed by resection of the small bowel, 4 thrombectomy with angioplasty, and 1 prosthetic graft bypass surgery. One patient who had short bowel disease died of septic shock. Otherwise, there was no recurrence of symptoms during the 15 months follow-up period. CONCLUSION: In patients with isolated SMA dissection, conservative treatment seems to be feasible if there is no evidence of bowel infarction.
Abdominal Pain ; Angiography ; Angioplasty ; Diagnosis ; Diagnostic Imaging ; Follow-Up Studies ; Humans ; Infarction ; Laparotomy ; Male ; Mesenteric Artery, Superior* ; Middle Aged ; Recurrence ; Retrospective Studies ; Shock, Septic ; Thrombectomy ; Thrombosis ; Transplants

OBJECTIVETo investigate the effect of different doses of ulinastatin (UTI) on the cardiac function and myocardial expression of p38 mitogen-activated protein kinase (p38MAPK) in septic rats.

METHODSForty male SD rats were randomized equally into 5 groups, namely the control group (group A), sham-operated group (group B), sepsis group (group C), low-dose UTI group (group D), and high-dose UTI group (group E). Rat models of sepsis were established by cecal ligation and puncture (CLP), At 24 h after successful modeling, the left ventricle ejection fraction (LVEF) and fractional shortening (LVFS) were evaluated, and the myocardium of the left ventricle was sampled to examine the expression of the expressions of p38MAPK and p-p38MAPK using Western blotting.

RESULTSIn groups A, B, C, D, and E, the LVEF was (77.13∓3.76)%, (76.88∓3.64)%, (56.13∓4.16)%, (55.00∓3.12)%, and (66.50∓3.46)%, and the LVFS was (43.50∓3.70)%, (44.00∓3.38)%, (28.13∓1.81)%, (26.13∓2.70)%, and (38.00∓2.07)%, respectively. Compared with group B at 24 h after CLP, LVEF and LVFS were markedly lowered in the groups C, D and E (P=0.000, 0.000 and 0.002), but showed no significant differences between groups C and D (P=0.541 and 0.166); LVEF and LVFS were significantly lower in group E than in groups C and D (P=0.000 and 0.000). The p-p38/p38 ratio was similar between groups C and D (0.79∓0.12 vs 0.75∓0.12, P=0.682), but both significantly higher than that in group B (0.28∓0.15, P=0.001); the ratio in group E was significantly lower than that in group C (P=0.001), but similar with that in group B (P=0.972).

CONCLUSIONHigh-dose UTI can inhibit p38 phosphorylation, which may be the mechanism for its effect of myocardial protection in septic rat.

Animals ; Glycoproteins ; pharmacology ; Heart ; drug effects ; physiopathology ; Male ; Myocardium ; metabolism ; Rats ; Rats, Sprague-Dawley ; Shock, Septic ; diagnostic imaging ; metabolism ; physiopathology ; Ultrasonography ; p38 Mitogen-Activated Protein Kinases ; metabolism

INTRODUCTIONHaemodynamic monitoring is an essential element in the management of critically ill patients in the intensive care unit (ICU). However, there have been increasing concerns about the clinical utility and safety profile of the invasive pulmonary artery catheter (PAC). Oesophageal Doppler (ED) monitoring has emerged recently as a safer and less invasive tool which can be used by the intensivist to estimate cardiac output in the critically ill patient. Validation studies have thus far only been performed in surgical patients perioperatively and in mixed surgical/medical ICU patients. Currently, minimal data are available in any sizeable Asian population or in patients with severe sepsis. The assumption that these normograms and data hold true for our local medical ICU patients may not be valid due to differences in body habitus.

MATERIALS AND METHODSOur primary aim is to validate the oesophageal Doppler as a reliable measure of cardiac index, systemic vascular resistance (SVR) and preload in our local Asian population of patients with severe sepsis and septic shock in the medical ICU. This was a prospective pilot study on 12 consecutive mechanically ventilated patients in our medical ICU with the diagnosis of septic shock as defined by SCCM/ESICM/ACCP/ATS/SIS International Sepsis definitions Conference-Critical Care Medicine 2003 and required PAC haemodynamic monitoring as indicated by Medical Intensive Care Unit attending.

RESULTSNinety-seven paired cardiac output measurements were made. Cardiac output ranged from 2.87 to 11.0 L/ min (calculated cardiac index ranging from 1.73 to 6.36 L/min/m2) when measured using the PAC with thermodilution technique and from 2.0 to 12.1 L/min (calculated cardiac index of 1.2 to 7.2 L/min/m2) using the trans-oesophageal Doppler. There was moderately good correlation between CIpac and CIed (correlation coefficient, r = 0.762 with PCA = 58%). The mean bias was 0.26 L/min/m2 (P <0.07), while the limit of agreement was +/- 1.44 L/min/m2.

CONCLUSIONED has good correlation with PAC in measuring cardiac index in Asians with septic shock but is an unreliable measure of both pre-load and SVR.

Cardiac Output ; Critical Care ; Critical Illness ; Echocardiography, Transesophageal ; Esophagus ; diagnostic imaging ; Female ; Hemodynamics ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pilot Projects ; Prospective Studies ; Pulmonary Artery ; Reproducibility of Results ; Shock, Septic ; diagnostic imaging ; Statistics as Topic ; Ultrasonography, Doppler

OBJECTIVES: To evaluate the clinical characteristics, diagnostic METHOD:s, serologic tests and treatment modalities of neuropsychiatric lupus (NPSLE). METHODS: Systemic lupus erythematosus(SLE) patients manifesting NPSLE at Severance Hospital, Yonsei University College of Medicine were retrospectively studied in the period of Jan 1994 to March 1996. RESULTS: The results were as follows; 1) Neuropsychiatric manifestations were observed in 24 patients of the total 144 SLE patients(16. 6%). 2) Of the 24 NPSLE patients, there was i male, 23 female and the mean age was 32 years(range 14 - 70). 3) Eight patients presented neuropsychiatric symptoms as an initial manifestation and the rest presented during the follow up period(mean: 25 months, range: 2 months - 10 years). 4) Preceding cause was identified in seven patients and was classified as secondary NPSLE: drug in 1 case, infection in 2 cases, reactive depression in 2 cases, and cerebral hemorrhage due to thrombocytopenia in 2 case. 5) NPSLE was classified into diffuse manifestation and focal manifestation. The diffuse manifestation was found in 22 cases and the focal manifestation was found in 6 cases. Patients with focal manifestation showed higher rate of anticardiolipin antibody or lupus anticoagu]ant test than patients with diffuse manifestation with of 100%(3/3) in the former and 30%(6/20) in the latter (p(0.01). 6) The sensitivity of diagnostic tests were as follows: cerebrospinal fluid study 7.l% (1/ll), electroencephalogram 62.5% (5/8), brain computed tomogram 52.9%(9/17), magnetic resonance imaging 66.7% (6/9), cerebral angiogram 100% (1/1), and myelogram 0%(0/1). 7) The treatment modalities were as follows; high dose steroid (lmg/kg/day) or steroid pulse therapy (intravenous methylprediniso]one lg/day for 3 days) alone in 13 cases, high dose steroid or steroid plus other drugs (anticonvulants, psychiatric medication, warfarin) in 5 cases, steroid pulse plus plasmapheresis in 3 cases, steroid pulse and plasmapheresis plus other drugs (intravenous cyclophosphamide, anticonvulsant) in 2 patients, low dose steroid (alone or with analgesics) in 2 patient, psychiatric treatment in 2 patients and no treatment in 1 patient. 26 patients responded to treatment. 8) The mortality rate was 12. 5~ (3/24) and the cause of death was pulmonary hemorrhage, septic shock, and status epilepticus. CONCLUSIONS: NPSLE is a frequent and morbid manifestation of SLE but diagnosis is difficult due to lack of specific test. Focal manifestation of NPSLE was associated with antiphospholipid antibody.
Adjustment Disorders ; Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid ; Brain ; Cause of Death ; Cerebral Hemorrhage ; Cerebrospinal Fluid ; Cyclophosphamide ; Diagnosis ; Diagnostic Tests, Routine ; Electroencephalography ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Male ; Mortality ; Plasmapheresis ; Retrospective Studies ; Serologic Tests ; Shock, Septic ; Status Epilepticus ; Thrombocytopenia