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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The peritoneovenous shunt (PVS) is a safe procedure; all of its complications have been found to be preventable. Disseminated intravascular coagulopathy (DIC) can be a life threatening complication but has been completely eliminated by draining the ascitic fluid at the time of surgery, as it is caused by the introduction of excessive quantities of peritoneal fluid into the venous system. Peritoneal fluid is rich in tissue plasminogen activator (TPA), which is inhibited by epsilon aminocaproic acid. This substance has been successfully used to treat postshunt coagulopathy. The salt retention associated with ascites is related to a diminished plasma volume, a condition further aggravated by diuretic drugs. A PVS should be inserted if the patient does not respond to a salt restricted diet. Occult peritonitis occurs in 10% of cirrhotic ascites. The shunt does not prevent this, and a high percentage of late shunt failures are caused by fibrinopurulent debris in the valve. The valve system should not contain a pump, which disseminates infection and causes fatal emboli; pumping and flushing are seldom remedial and often dangerous. Because the complications of the shunt are all preventable, the indications for the shunt should be liberalized.
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PMID:The place of the peritoneovenous shunt in the treatment of ascites. 265 57

Group A streptococcus has emerged as a major cause of aggressive life-threatening deep-seated infections. In addition, toxic shock syndrome caused by Group A streptococcus was recognized in 1983. Group A streptococcus produces several potent exotoxins which explain the pathophysiology of these invasive infections. Other virulence factors such as M protein, which can impede phagocytosis, are associated with some Group A streptococcus. M protein and streptococcal pyrogenic exotoxins may act as super antigens. Host factors may influence the severity of infection. Blood purification techniques such as continuous renal replacement therapy and plasmapheresis can remove streptococcal exotoxins as well as inflammatory mediators. Replacement with fresh-frozen plasma corrects coagulopathy and may provide some antibody protection. Four patients with Group A streptococcus-toxic shock syndrome treated with continuous renal replacement therapy, plasmapheresis, or both showed dramatic, rapid improvement in cardiovascular dynamics and respiratory parameters. Two patients died. The mainstay of treatment for Group A streptococcus-toxic shock syndrome remains early diagnosis, aggressive surgical control of the infection, and appropriate antibiotics (i.e., penicillin and clindamycin). Flush resuscitation may rescue some patients from profound toxic shock. The mechanisms of action need to be delineated.
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PMID:Flush resuscitation for group A streptococcus toxic shock: a possible role for continuous renal replacement therapy and plasmapheresis. 970 9

In the Surveillance Report, bacteraemia was not defined specifically within the document. However, it was implied that bacteraemia was present if blood cultures were positive. No clinical information concerning the effect of bacteraemia on the patients or the degree of haemodynamic support required was described. Nor was the movement of patients between specialties indicated. This information would have been helpful to clinicians because it would demonstrate the increased severity of illness experienced by patients and the concomitant increase in services required to meet these needs, although of course prevention should be the key response to the data provided. It is evident from the two reports that infection of the bloodstream is described utilizing different terms, i.e. bacteraemia and catheter-related bloodstream infection. This is potentially confusing and efforts should be made to encourage the use of consistent terminology across specialties, e.g. infection control, critical care, oncology The potential for confusion also arises where evidence is pooled utilizing both CRI and CR-BSI as endpoints for the research reviewed. The recommendation associated with flushing the CVC with heparinized saline solution does not consider a patient's coagulopathy to be a contraindication, only the manufacturer's recommendations. This appears to be a limitation of the guidelines and may place the patient at risk. The recommendation also does not indicate if this is only to be performed when the catheter or lumen is not in use, or if heparin should be administered if it is in use. Finally, the categories used to denote the level of evidence are not defined in the document. It can be assumed that Category 1 relates to randomized controlled trials, which demonstrate homogeneity or/and narrow confidence intervals; whilst categories 2 and 3 relate to cohort studies and pooled data. It should be expected that a document of this nature should establish criteria or refer the reader to the primary source for categorization. Eggimann and Pittet (2000) have undertaken an excellent review of central venous catheter related infections in intensive care units. The evidence accrued and recommendations made mirrors the two reports outlined above. It is imperative we take action to reduce the incidence of CR-BSI and it is hoped that this Editorial has provided a basis for discussion and action; and will stimulate debate.
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PMID:Hospital-acquired bacteraemia--surveillance and guidelines for practice. 1186 13

In heart transplantation, pulmonary hypertension and increased pulmonary vascular resistance followed by donor right ventricular dysfunction remain a major cause of perioperative morbidity and mortality. In lung transplantation, primary graft dysfunction remains a major obstacle because it can cause bronchiolitis obliterans and mortality. Pulmonary vasodilators have been used as an adjunct therapy for heart or lung transplantation, mainly to treat pulmonary hypertension, right ventricular failure, and associated refractory hypoxemia. Among pulmonary vasodilators, inhaled nitric oxide is unique in that it is selective in pulmonary circulation and causes fewer systemic complications such as hypotension, flushing, or coagulopathy. Nitric oxide is expected to prevent or attenuate primary graft dysfunction by decreasing ischemia-reperfusion injury in lung transplantation. However, when considering the long-term benefit of these medications, little evidence supports their use in heart or lung transplantation. Current guidelines endorse inhaled vasodilators for managing immediate postoperative right ventricular failure in lung or heart transplantation, but no guidance is offered regarding agent selection, dosing, or administration. This review presents the current evidence of inhaled nitric oxide in lung or heart transplantation as well as comparisons with other pulmonary vasodilators including cost differences in consideration of economic pressures to contain rising pharmacy costs.
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PMID:Inhaled Pulmonary Vasodilators and Thoracic Organ Transplantation: Does Evidence Support Its Use and Cost Benefit? 3145 Oct 92