Determinants of postprandial flow across the human ileocaecal junction: a combined manometric and scintigraphic study.

The relationships between ileocolonic motor patterns and flow have not been defined in humans. Utilizing simultaneous ileocolonic manometry and scintiscanning, we aimed to examine this relationship and test the hypotheses that ileal propagating sequences (PSs) underlie caecal filling, that caecal filling is a stimulus for proximal colonic PSs and that the ileocolonic junction (ICJ) regulates flow between the small and large bowel. In six healthy volunteers, a 5-m-long nasocolonic manometry catheter was positioned such that 16 recording sites, spaced at 7.

Twenty-four hour spatiotemporal mapping of colonic propagating sequences provides pathophysiological insight into constipation.

Colonic propagating sequences (PS)s are a major determinant of luminal propulsion. A global appreciation of spatiotemporal patterning of PSs requires evaluation of 24 h pan-colonic recordings, a difficult task given that PSs are relatively infrequent events that are not uniformly distributed throughout the colon. Here we developed a means of space-time-pressure 'mapping' in a condensed format, 24 h of colonic recording in such a manner that readily permits an overall view of colonic antegrade and retrograde colonic PSs within a single figure.

The basic science of tendinopathy.

Tendinopathy is a common clinical problem with athletes and in many occupational settings. Tendinopathy can occur in any tendon, often near its insertion or enthesis where there is an area of stress concentration, and is directly related to the volume of repetitive load to which the tendon is exposed. Recent studies indicate tendinopathy is more likely to occur in situations that increase the "dose" of load to the tendon enthesis - including increased activity, weight, advancing age, and genetic factors.

Comparison of two methods of pediatric resuscitation and critical care management.

Study Objective: We compare time to drug delivery and the incidence of dosage error between 2 different systems of medication administration: The Broselow Pediatric Emergency Tape and a standardized volume/weight-based dose reformulation of resuscitation and critical care medications (reformulated to 0.1 mL/kg).

Methods: This was a randomized crossover trial, in which volunteers (n=16) from emergency department (ED) pediatric resuscitation teams from the ED of a large, urban, teaching hospital in Australia were assigned to manage simulated (Advanced Pediatric Life Support scenario) patients.

Epidemiology and 12-month outcomes from traumatic brain injury in australia and new zealand.

Background: An epidemiologic profile of traumatic brain injury (TBI) in Australia and New Zealand was obtained following the publication of international evidence-based guidelines.

Methods: Adult patients with TBI admitted to the intensive care units (ICU) of major trauma centers were studied in a 6-month prospective inception cohort study. Data including mechanisms of injury, prehospital interventions, secondary insults, operative and intensive care management, and outcome assessments 12-months postinjury were collected.

Proximal colonic propagating pressure waves sequences and their relationship with movements of content in the proximal human colon.

Abnormal colonic motor patterns have been implicated in the pathogenesis of severe constipation. Yet in health, the mechanical link between movement of colonic content and regional pressures have only been partially defined. This is largely due to current methodological limitations.

A teaching hospital's experience applying the Pneumonia Severity Index and antibiotic guidelines in the management of community-acquired pneumonia.

Background And Objectives: The Pneumonia Severity Index (PSI) was developed to predict mortality in community-acquired pneumonia (CAP). It has been prospectively validated to identify patients who are at low risk of death and thereby aid in the selection of patients for outpatient management. This study assessed the compliance of medical staff at a university teaching hospital with the use of the PSI and the PSI-based local antibiotic guidelines in admitted patients.

Pulmonary hemorrhage during percutaneous radiofrequency ablation: a more frequent complication than assumed?

Objective: To alert clinicians of the underreported complication of intraparenchymal lung hemorrhage during percutaneous radiofrequency ablation (RFA) of primary and secondary pulmonary malignancies.

Methods: Of 101 RF ablations performed in 46 patients, 81 were retrospectively assessed for periprocedural intrapulmonary bleeding. The data was compared with the literature for this minimally invasive interventional treatment as well as with the reported frequency of lung hemorrhage during diagnostic lung biopsies.

Parenteral versus enteral nutrition: effect on serum cytokines and the hepatic expression of mRNA of suppressor of cytokine signaling proteins, insulin-like growth factor-1 and the growth hormone receptor in rodent sepsis.

Introduction: Early nutrition is recommended for patients with sepsis, but data are conflicting regarding the optimum route of delivery. Enteral nutrition (EN), compared with parenteral nutrition (PN), results in poorer achievement of nutritional goals but may be associated with fewer infections. Mechanisms underlying differential effects of the feeding route on patient outcomes are not understood, but probably involve the immune system and the anabolic response to nutrients.

Using nitric oxide to treat tendinopathy.

Nitric oxide (NO) is a small free radical generated by a family of enzymes, the nitric oxide synthases (NOSs). Following injury to a tendon, NO is induced by all three isoforms of NOS and NOS activity is also upregulated in tendinopathy. In animal models when NOS activity is inhibited by competitive inhibitors of NOS, tendon healing is reduced.

Intermittent dysphagia for solids associated with a multiringed esophagus: clinical features and response to dilatation.

The entity of the multiringed esophagus, generally presenting in adults as intermittent dysphagia for solids, is relatively uncommon and its pathogenesis is unknown. The goal of this study was to describe the demographic, clinical, and endoscopic features of patients presenting with this condition, their response to esophageal dilatation, and the relationship of multiple esophageal rings to eosinophilic esophagitis. Between 1989 and June 2004, 32 patients at this adult hospital fulfilled the following inclusion criteria: (1) intermittent dysphagia for solids, (2) multiple esophageal rings at endoscopy, and (3) esophageal dilatation(s) performed.

Early switch to oral antibiotics and early discharge guidelines in the management of community-acquired pneumonia.

Background And Objective: The major cost of managing community-acquired pneumonia (CAP) relates to the duration i.v. antibiotic use and length of hospital stay (LOS).

Progressive resistance training and nutrition in renal failure.

Nutrition and exercise are an integral part of the medical management of many chronic and complex conditions. They are interrelated and share many common metabolic pathways that may affect disease processes and their management. In nephrology, nutritional interventions have been relatively well studied and are recommended in many evidence-based clinical practice guidelines for managing people with chronic kidney disease (CKD).

Cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal carcinoma: non-mucinous tumour associated with an improved survival.

Aims: Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy has been reported as a treatment option for patients with peritoneal carcinomatosis from colorectal carcinoma.

Methods: Thirty patients with colorectal peritoneal carcinomatosis underwent cytoreductive surgery and perioperative intraperitoneal chemotherapy. All appendiceal cancers were excluded.

Validation of a semi-automated scintigraphic technique for detecting episodic, real-time colonic flow.

The relationships between the movement of colonic content and regional pressures have only been partially defined. During the analysis of a combined colonic scintigraphic and manometric study, a quantitative technique for determining discrete, episodic, real-time colonic flow was developed. Our aim was to validate this technique through the construction of a computer-generated phantom model of known antegrade and retrograde motility.

Recurrence after complete cryoablation of colorectal liver metastases: analysis of prognostic features.

This study critically evaluated the prognostic determinants for disease-free survival (DFS) after cryoablation for colorectal liver metastases. An observational cohort study of prospectively collected data on 135 patients who underwent cryoablation with or without resection for colorectal liver metastases was performed. Univariate and multivariate analyses were used to determine the prognostic factors for overall DFS, cryosite DFS, remaining liver DFS, and extrahepatic DFS.

Iodine induced thyrotoxicosis following povidine-iodine dressings: a case report.

A 40-year-old woman was admitted to the intensive care unit after a radical resection of a recurrent abdominal malignancy. Her postoperative course was complicated by sepsis requiring numerous abdominal operations with the abdomen being left open for drainage and dressings. Use of povidone-iodine soaked abdominal packs to reduce secondary infection led to development of thyrotoxicosis, which resolved following the cessation of the iodine dressings.

Antibiotic prophylaxis for external ventricular drains in neurosurgical patients: an audit of compliance with a clinical management protocol.

Objective: To examine the clinical impact of a management protocol for external ventricular drains (EVD).

Patients And Methods: All patients with EVDs over a six-month period were reviewed retrospectively. Data concerning the indications for EVD placement, antibiotics and cerebrospinal fluid (CSF) analyses were collected.

Cervical spine clearance in Australian intensive care units.

Objective: Rigid or semi-rigid collar and spine board related complications may be causes of significant morbidity in intubated polytraumatised patients. As the process quantifying cervical spine injuries is controversial, exclusion of cervical spinal injuries (cervical spine clearance) can be delayed, thereby increasing complications associated with spinal cord immobilisation. We examined current practices in Australian ICUs by survey.

Does neostigmine increase gastric emptying in the critically ill?--results of a pilot study.

Objective: Based on the successful use of neostigmine for the treatment of acute colonic pseudo-obstruction, we hypothesised that neostigmine would increase gastric emptying and improve tolerance to enteral feeding in the critically ill patient.

Methods: Eleven patients intolerant of enteral feeds due to high gastric aspirates, were randomised to receive a 'study infusion' consisting of either neostigmine (0.4 mg/hr) or 0.

Remember the side effects of haloperidol: a case report.

An eighteen-year-old man who had a laminectomy and subtotal excision of a lipomyelomeningocele, received a single dose of haloperidol for post-operative pain and agitation. The patient suffered an acute dystonic reaction and was extensively investigated before the correct diagnosis and treatment was instituted. This case illustrates the ease with which extrapyramidal side effects following treatment with haloperidol may be overlooked in complicated medical or surgical cases.

Quantifying cerebral autoregulation in health and disease.

Objective: To review methods of quantifying human cerebral autoregulation in health and disease.

Data Sources: Articles and published abstracts on methods to quantify cerebral autoregulation in health and disease.

Summary Of Review: Cerebral autoregulation is defined as the relationship between cerebral blood flow and cerebral perfusion pressure.

"Triple h" therapy for aneurysmal subarachnoid haemorrhage: real therapy or chasing numbers?

Despite technological and medical advances for the treatment of SAH that have had a positive impact on outcomes over the last 20 years, but the all-cause mortality for this often-catastrophic condition remains high at 12 - 15%. Survival will ultimately depend on the severity of the haemorrhage, the subsequent loss of functional neurones and the extracranial reserve of the patient. In this regard, advances in neuroradiology and operative techniques together with expert neurocritical care and rehabilitation provide the best chances of short- and long- term survival respectively.