The concentration of oxygen, lactate and glucose in the central veins, right heart, and pulmonary artery: a study in patients with pulmonary hypertension.

Introduction: Decreases in oxygen saturation (SO2) and lactate concentration [Lac] from superior vena cava (SVC) to pulmonary artery have been reported. These gradients (Delta SO2 and Delta[Lac]) are probably created by diluting SVC blood with blood of lower SO2 and [Lac]. We tested the hypothesis that Delta SO2 and Delta[Lac] result from mixing SVC and inferior vena cava (IVC) blood streams.

Exosomal Fetuin-A identified by proteomics: a novel urinary biomarker for detecting acute kidney injury.

Urinary exosomes containing apical membrane and intracellular fluid are normally secreted into the urine from all nephron segments, and may carry protein markers of renal dysfunction and structural injury. We aimed to discover biomarkers in urinary exosomes to detect acute kidney injury (AKI), which has a high mortality and morbidity. Animals were injected with cisplatin.

Identifying critically ill patients at high risk for developing acute renal failure: a pilot study.

Background: Acute renal failure (ARF) occurs commonly in the intensive care unit (ICU), but predicting which patients will develop ARF is difficult. We set out to determine which risk factors would predict the development of ARF in critically ill patients who are admitted to the ICU without ARF.

Methods: From August 2002 to April 2003, we enrolled medical-surgical ICU admissions into a cohort using a sampling tool based on their risk factor (RF) profile.

Lactate concentration gradient from right atrium to pulmonary artery.

Introduction: We compared simultaneous measurements of blood lactate concentration ([Lac]) in the right atrium (RA) and in the pulmonary artery (PA). Our aim was to determine if the mixing of right atrial with coronary venous blood, having substantially lower [Lac], results in detectable decreases in [Lac] from the RA to the PA.

Methods: A prospective, sequential, observational study was conducted in a medical-surgical intensive care unit.

Modification of continuous venovenous hemodiafiltration with single-pass albumin dialysate allows for removal of serum bilirubin.

A 53-year-old woman was admitted to the hospital with ischemic colitis and underwent a subtotal colectomy. She developed acute renal failure, severe hyperbilirubinemia, and intense pruritus resistant to medical treatment. Extracorporeal albumin dialysis using a Molecular Adsorbent Recirculating System (MARS; Gambro Co, Lund, Sweden) has been used to treat liver failure and reduce total serum bilirubin (SB) levels.

Lack of equivalence between central and mixed venous oxygen saturation.

Study Objective: We compared paired samples of central venous O(2) saturation (Scvo(2)) and mixed venous O(2) saturation (Svo(2)) to test the hypothesis that Scvo(2) is equivalent to Svo(2). We also compared O(2) consumption (Vo(2)) computed with Scvo(2) (Vo(2)cv) to that computed with Svo(2) (Vo(2)v).

Design: Prospective, sequential, observational study.

Incomplete reversal of enoxaparin toxicity by protamine: implications of renal insufficiency, obesity, and low molecular weight heparin sulfate content.

The use of low molecular weight heparin (LMWH) is increasing throughout North America and Europe for a number of reasons: 1). ease of use; 2). predictable dose response; 3).

Anthropometric measures, cytokines and survival in haemodialysis patients.

Background: Lower serum albumin concentration (sAlb) and higher levels of pro-inflammatory cytokines have been reported to predict death in patients treated with haemodialysis (HD). SAlb, along with anthropometric measures, has been used as a surrogate marker for nutritional status in patients with chronic disease. Though adequate nutrition has been considered an important factor for patients treated with HD, it has not been established if any nutritional markers other than lower serum albumin and lower body mass index (BMI) predict death.

Emphysematous pyelitis presenting as an acute abdomen in an end-stage renal disease patient treated with peritoneal dialysis.

Emphysematous pyelitis is air in the renal collecting system in patients with urinary tract infections. This entity is uncommon and seen primarily in patients with diabetes mellitus. We report a case of a patient with end-stage renal disease treated with peritoneal dialysis who developed emphysematous pyelitis who presented with signs and symptoms that were more consistent with appendicitis.

Zinc nutritional status modifies renal osteodystrophy in uremic rats.

Background: Previous studies from our laboratories suggested that zinc depletion reduces the circulating level of 1,25-dihydroxycholecalciferol (1,25(OH)2D, calcitriol) in calcium- and phosphorus-depleted rats with normal renal function, and rats with uremia. Since calcitriol synthesis is in part dependent on renal function, we studied levels of circulating vitamin D metabolites, PTH response, mineral balance and bone histomorphometry in animals with different zinc nutritional and renal functional status.

Methods: Fifty-eight male Sprague-Dawley rats were pair-fed zinc-replete (+) or -deplete (-) diets for two weeks.

Hemodialysis central venous catheter tip fracture with embolization into the pulmonary artery.

We describe the first reported case of spontaneous hemodialysis catheter fracture and embolization. We also include a summary of similar cases not previously reported in the literature that appear in the Food and Drug Administration records as medical equipment malfunctions. Our patient presented with a cough and was initially treated for presumptive pneumonia.

Endoscopic techniques in the diagnosis of upper gastrointestinal tract malignancies. A comparison.

Objective: To perform a comparative evaluation of various endoscopic techniques in the diagnosis of upper gastrointestinal tract malignancies.

Study Design: Thirty cases of suspected malignancy involving the upper gastrointestinal tract were studied. In all 30 cases, four endoscopic cytology techniques (brushing before biopsy, brushing after biopsy, fine needle aspiration cytology [FNAC] and suction cytology) were evaluated and correlated with histology by forceps biopsy.

Endothelium-derived relaxing factor is important in mediating the high output state in chronic severe anemia.

Objectives: We evaluated the endothelial and vascular smooth muscle function in patients with chronic severe anemia to determine whether increased basal nitric oxide levels contribute to the systemic vasodilation and high cardiac output seen in these patients.

Background: Patients with chronic severe anemia have a high output state due to a low systemic vascular resistance. However, the cause of the low vascular resistance is unclear.

Esophageal candidiasis following omeprazole therapy: a report of two cases.

Esophageal candidiasis was diagnosed at endoscopy in two patients receiving omeprazole therapy. There was no clinical evidence of immunosuppression or any obstructive lesion in the esophagus. There was prompt response of oral ketoconazole.

Serum pepsinogen levels in patients with gastro-duodenal lesions.

Serum pepsinogen (SP) levels were studied in 100 patients with gastroduodenal lesions, and 100 healthy volunteers. SP levels were significantly elevated in patients with duodenal ulcer (DU) and duodenitis compared to the controls. SP values above 150 ug Tyr/ml/24 hr were highly suggestive of duodenal ulcer disease.

Ascitic fluid cholesterol in differential diagnosis of ascites.

Cholesterol was estimated in ascitic fluid of 89 patients (29 malignant and 60 non-malignant ascites). Mean ascitic cholesterol level was significantly higher in malignant ascites (89.52 mg/dl) as compared to non-malignant ascites (29.

Atrial fibrillation following electrical injury.

The development of atrial fibrillation in 2 patients, following an electrical shock is reported. One patient, with an underlying pre-excitation syndrome, had to be cardioverted due to rapid ventricular rate and hypotension. The other, with normal conduction, tolerated the arrhythmia well and atrial fibrillation reverted spontaneously after 24 hours.

Indolent gastric carcinoma.

A 55 year old woman presenting with epigastric pain and dyspeptic symptoms was diagnosed to have gastric carcinoma on endoscopic biopsy independently on two occasions. She was subsequently asymptomatic without any specific therapy till she developed gastric outlet obstruction and weight loss four years later. Histology of the resected specimen revealed an adenocarcinoma infiltrating the serosa without any evidence of metastasis.