In November, 2009, a 61-year-old man was admitted to our intensive therapy unit (ITU) after extensive abdominal surgery to treat multiple gunshot wounds. Two days into his stay in ITU, he developed septicaemia, which necessitated treatment with antibiotics and ventilatory and inotropic support.
Acute liver failure is a rare disorder with high mortality and resource cost. In the developing world, viral causes predominate, with hepatitis E infection recognised as a common cause in many countries.
2010 Jul 9 - Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants: a multicentre cohort study
There are few data on the epidemiology and outcomes of influenza infection in recipients of solid-organ transplants. We aimed to establish the outcomes of pandemic influenza A H1N1 and factors leading to severe disease in a cohort of patients who had received transplants.
The use of neuromuscular blocking agents (NMBAs) remains an essential part of general anaesthesia. The muscle relaxation they produce enables interventions both by the anaesthetist and the surgeon. However, an international survey confirmed that there is considerable variation in anaesthetists' understanding of the subject, in their use of objective monitoring of the drugs' effects, and in their use of antagonists to reverse them. 1 Research evidence and advances in monitoring technology and drug ...
Pre-eclampsia remains a leading cause of maternal and perinatal mortality and morbidity. It is a pregnancy-specific disease characterised by de-novo development of concurrent hypertension and proteinuria, sometimes progressing into a multiorgan cluster of varying clinical features.
2010 Jul 1 - Global operating theatre distribution and pulse oximetry supply: an estimation from reported data
Surgery is an essential part of health care, but resources to ensure the availability of surgical services are often inadequate. We estimated the global distribution of operating theatres and quantified the availability of pulse oximetry, which is an essential monitoring device during surgery and a potential measure of operating theatre resources.
Activation of the fibrinolytic system is an integral part of vascular haemostatic mechanisms to maintain vascular patency. The basis of fibrinolysis is the conversion of the inactive substrate plasminogen to plasmin, an enzyme that cleaves fibrin but also has pleiotropic effects. 1 , 2
2010 Jun 15 - Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial
Tranexamic acid can reduce bleeding in patients undergoing elective surgery. We assessed the effects of early administration of a short course of tranexamic acid on death, vascular occlusive events, and the receipt of blood transfusion in trauma patients.
2010 Jun 1 - Elective high-frequency oscillatory versus conventional ventilation in preterm infants: a systematic review and meta-analysis of individual patients' data
Population and study design heterogeneity has confounded previous meta-analyses, leading to uncertainty about effectiveness and safety of elective high-frequency oscillatory ventilation (HFOV) in preterm infants. We assessed effectiveness of elective HFOV versus conventional ventilation in this group.
Despite many randomised trials of high-frequency oscillatory ventilation (HFOV) versus conventional ventilation, 1 neonatologists remain unsure about the potential benefits and harms of HFOV for support of preterm infants with surfactant-deficient lungs.
Highly virulent strains of Clostridium difficile have emerged since 2003, causing large outbreaks of severe, often fatal, colitis in North America and Europe.
2010 May 15 - Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials
Early administration of intravenous recombinant tissue plasminogen activator (rt-PA) after ischaemic stroke improves outcome.
Atheroembolic renal disease develops when atheromatous aortic plaques rupture, releasing cholesterol crystals into the small renal arteries. Embolisation often affects other organs, such as the skin, gastrointestinal system, and brain.
Correpondence on the article of Strøm T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet 2010; 375: 475-480.
Inadequacies in current therapies for atrial fibrillation have made new drug development crucial. Conventional antiarrhythmic drugs increase the risk of ventricular proarrhythmia. In drug development, the focus has been on favourable multichannel-blocking profiles, atrial-specific ion-channels, and novel non-channel targets (upstream therapy).
The original international classifications of seizures and epilepsies began with proposals by Henri Gastaut in 1969. The accepted classifications were published in 1970. 1 , 2 They were last updated for seizures in 1981 3 and syndromes in 1989, 4 although changes were minimal.
Hereditary porphyrias are a group of eight metabolic disorders of the haem biosynthesis pathway that are characterised by acute neurovisceral symptoms, skin lesions, or both. Every porphyria is caused by abnormal function of a separate enzymatic step, resulting in a specific accumulation of haem precursors.
Meticillin-resistant Staphylococcus aureus (MRSA) is endemic in hospitals worldwide, and causes substantial morbidity and mortality. Health-care-associated MRSA infections arise in individuals with predisposing risk factors, such as surgery or presence of an indwelling medical device.
Tetsuhisa Kitamura and colleagues' study1 in The Lancet today is the largest that has analysed out-of-hospital cardiac arrest in children. Overall survival was 9% and only 3% of children had a good neurological outcome, as has been reported before.2—5 The prognosis does not seem to have improved much despite advances in cardiopulmonary resuscitation (CPR).
2010 Mar 3 - Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study
The American Heart Association recommends cardiopulmonary resuscitation (CPR) by bystanders with chest compression only for adults who have cardiac arrests, but not for children. We assessed the effect of CPR (conventional with rescue breathing or chest compression only) by bystanders on outcomes after out-of-hospital cardiac arrests in children.