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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To determine the nature of neurologic dysfunction after deep hypothermic circulatory arrest during aortic arch surgery, we reconsidered the cases of 154 patients who had undergone aortic arch surgery (either of the ascending or transverse aorta, or both) between November 1993 and July 1999. Temporary postoperative neurologic dysfunction was seen in 9 patients (5.8%), and another 3 patients (1.9%) experienced stroke. Patients with temporary neurologic dysfunction had no new infarct and were discharged home with no residual symptoms. Computed tomographic scans revealed that 2 patients with stroke had multiple infarcts in the brainstem, and the 3rd had bilateral border-zone infarcts. The patients with brainstem infarcts died on postoperative days 7 and 15, and the patient with border-zone infarct was discharged home with no symptoms 3 months after surgery. Univariate analysis revealed that patients with neurologic deficits had significantly higher rates of history of hypertension, concomitant coronary artery bypass grafting, cardiac ischemia times longer than 90 minutes, and chronic renal failure. A multivariate logistic regression analysis revealed that the significant preoperative variables associated with neurologic deficits were a history of hypertension and a cardiac ischemia time longer than 90 minutes. Deep hypothermic circulatory arrest is a safe and useful technique for protection of the brain during surgery for complex aortic problems. In future, some patients at extreme risk for perioperative neurologic complications might be offered novel neuroprotective agents, in combination with deep hypothermia.
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PMID:Neurologic complications after deep hypothermic circulatory arrest: types, predictors, and timing. 1145 37

Professional phagocytes, comprising polymorphonuclear neutrophils and monocyte/macrophage cells, play an important role in the host defense. Any defect in their function exposes the organism to microbial intruders terminating in fatal diseases. The functional responses of the phagocytes to bacterial and fungal infections include chemotaxis, actin assembly, migration, adhesion, aggregation, phagocytosis, degranulation, and reactive oxygen species production. Superoxide generation by phagocytic NADPH oxidase is an imperative step toward bacterial killing. Phagocytes participate in inflammatory reactions and exert tumoricidal activity. They are supported by serum factors such as immunoglobulins, cytokines, complement, the acute phase reactant C-reactive protein, production of antibacterial proteins, and others. In addition to their principal task to eliminate bacteria, they are engaged in removing damaged, senescent, and apoptotic cells. Engulfed cell debris, large particles such as latex beads, fat, and oil droplets, are examples of phagocytic activity illustrated in the present review with transmission and scanning electron microscope micrographs. Numerous factors, such as diseases and stressful conditions, affect the engulfing activity of the professional phagocytes. Our experience regarding the impaired phagocytic capacity of cells in patients with diabetes and chronic renal failure is discussed. The results obtained in our laboratory from experiments detecting the effect of strenuous physical exercise, hypothermia, fasting, and abdominal photon irradiation on the phagocytic capacity of human polymorphonuclear neutrophils and rat peritoneal macrophages are hereby summarized and the reports on those subjects in the recent literature are reviewed. A variety of assays are applied for quantifying phagocytosis. Flow cytometry based on incubation of phagocytic cells with fluorescent conjugated particles and measuring the amount of fluorescence as an indicator of the engulfing capacity of the cells is a useful method. A direct visualization of the ingested particles using light or electron microscopy is a valuable tool for estimation of phagocytic function. In our hands, the use of semithin sections of embedded phagocytes following their incubation with latex particles provided satisfactory results for measuring the total number of phagocytic cells, as well as the internalizing capacity of each individual cell. Microbiological assays, the nitroblue tetrazolium test, quantitation of antibody- and antigen-mediated phagocytosis, as well as methods reviewed in detail in other reports are additional applications for determination of this intricate process.
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PMID:Phagocytosis--the mighty weapon of the silent warriors. 1211 25

Although recent operative outcome for aortic arch aneurysm has been improved by various newly-devised assistant measures, satisfactory results have not been obtained in cases with serious preoperative complications, such as chronic renal failure. We present here an operative case of a 67-year-old woman on chronic hemodialysis with a calcified aortic arch aneurysm and a right femur neck fracture. First, we performed femur head replacement under careful hemodynamic control. After her mobilization was achieved, total aortic arch replacement was performed in "arch-first technique" using deep hypothermia plus retrograde cerebral perfusion in consideration of her calcified vessels. Her postoperative course was uneventful. We believe that early mobilization was a key for her recovery, because it was useful to prevent postoperative complications such as pulmonary infection and atelectasis. Our experience suggested that meticulous management throughout the whole perioperative course is very important for total aortic arch replacement in such complicated cases.
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PMID:[Total aortic arch replacement with a right femur neck fracture on chronic renal dialysis; report of a successful case]. 1279 55

We report a case of star fruit intoxication in a 60-yr-old male patient with a past medical history of diabetes mellitus and chronic renal failure. Clinical effects included hiccups, hearing impairment, urine retention, and disturbed consciousness. Star fruit intoxication was also the suspected cause of hypothermia, an unusual symptom. The patient remained comatose after receiving two sessions of hemodialysis. However, after a 6 h session of charcoal hemoperfusion following the second hemodialysis treatment, his consciousness returned to normal within 1 day. While no previous study on hemoperfusion therapy in star fruit intoxication has been reported, in view of the fatal outcome of star fruit intoxication in uremic patients, hemoperfusion may be an alternative therapy if intensified hemodialysis fails.
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PMID:Chronic renal disease patients with severe star fruit poisoning: hemoperfusion may be an effective alternative therapy. 1590 95

The urocortin1 (Ucn1) neurons of the mid-brain-localized Edinger-Westphal nucleus (EW) are robustly responsive to ethanol (EtOH) administration, and send projections to the dorsal raphe nucleus (DRN), which contains corticotropin-releasing factor type 2 receptors (CRF2) that are responsive to Ucn1. In addition, the DRN has been shown to be involved in regulation of body temperature, a function greatly affected by EtOH administration. The goal of the present study was to identify the role that the urocortinergic projections from the EW to the DRN have in mediating EtOH-induced and lipopolysaccharide (LPS)-induced hypothermia. Male C57BL6/J mice were used. Groups of mice underwent cannulation of the DRN, and then received i.p. injections of EtOH (2g/kg) or LPS (600 microg/kg or 400 microg/kg), followed by intra-DRN injections of artificial cerebrospinal fluid (aCSF) or anti-sauvagine (aSVG) (55 pmol), a CRF2 antagonist. Separate groups of mice received single intra-DRN injections of Ucn1 (20 pmol), CRF (20 pmol) or aCSF. For all experiments, core temperatures were monitored rectally every 30 min for several hours post-injection. Both EtOH and LPS induced hypothermia, and aSVG significantly attenuated this effect after EtOH; however, there was no significant attenuation of hypothermia after either dose of LPS. Ucn1 injection also caused hypothermia, while CRF injection did not. These data demonstrate that EtOH-induced hypothermia, but not LPS-induced hypothermia, may involve Ucn1 from EW acting at CRF2 receptors in the DRN.
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PMID:Ethanol versus lipopolysaccharide-induced hypothermia: involvement of urocortin. 1596 90

In postmortem biochemistry, there is insufficient data available for the practical analysis of factors in the pericardial fluid. The aim of the present study was to examine postmortem pericardial fluid for urea nitrogen (UN), creatinine (Cr) and uric acid (UA) levels to investigate the pathophysiology of death in forensic autopsy cases (total, n = 409; within 48 h postmortem), which included blunt, sharp instrument injury, asphyxiation, drowning, fire fatalities, hyperthermia, hypothermia, methamphetamine-related fatalities, other poisoning, delayed death from trauma and natural diseases. There was a significant elevation in the three markers for chronic renal failure, gastrointestinal bleeding, hyperthermia, hypothermia, methamphetamine fatalities and delayed traumatic death, which was comparable with the clinical criteria for their serum levels. These postmortem findings showed azotemia due to renal failure, elevated protein catabolism and rhabdomyolysis. Although the pericardial levels were otherwise similar to the clinical serum reference ranges, only the drowning fatalities showed significantly lower levels for each marker. These observations suggested the stability of UN, Cr and UA in the pericardial fluid within 48 h postmortem and their usefulness for the pathophysiological investigation of death involving azotemia.
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PMID:Evaluation of postmortem urea nitrogen, creatinine and uric acid levels in pericardial fluid in forensic autopsy. 1604 40

Previous studies showed significant differences in postmortem urea nitrogen (UN), creatinine (Cr) and uric acid (UA) levels in heart blood depending on the causes of death, including acute death. In addition, the levels in pericardial fluid approximated the clinical serum reference ranges, and their elevations may be assessed based on clinical criteria. The present study investigated difference between blood and pericardial levels of these markers. Medicolegal autopsy cases (n=556, within 48h postmortem) of the following causes of death were examined: injury (n=136), asphyxiation (n=50), drowning (n=39), fire fatalities (n=99), hyperthermia (n=11), hypothermia (n=8), poisoning (n=26), delayed traumatic death (n=44) and natural diseases (n=143). When serum UN, Cr and UA levels were compared with the pericardial levels, there was an equivalency for delayed traumatic death and chronic renal failure, although each level was markedly elevated. Parallel increases in serum and pericardial UA and/or Cr levels were also observed for hypothermia and gastrointestinal bleeding. However, in drowning cases, the left cardiac and pericardial UN levels were lower than the right cardiac and peripheral levels, suggesting the influence of water aspiration. Significant elevations in serum and pericardial Cr and UA levels with a higher serum/pericardial UA ratio for fatal methamphetamine intoxication suggest progressive skeletal muscle damage due to advanced hypoxia/acidosis. Similar findings were often observed for other acute and subacute deaths. These findings suggest that a comparison between blood and pericardial nitrogenous compounds would be useful for investigating the cause and process of death.
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PMID:Differences in postmortem urea nitrogen, creatinine and uric acid levels between blood and pericardial fluid in acute death. 1719 25

Acute kidney injury (AKI) is encountered in a variety of settings (e.g., hospitalized and outpatient, non-intensive and intensive care unit patients, pediatric, adult, and elderly), with varied clinical manifestations ranging from a minimal elevation of serum creatinine (SCr) to anuric renal failure and/or multi organ failure (MOF), and a wide variation in causes, risk factors and comorbiditis. There is no hard and fast rule as to when renal replacement therapy (RRT) should be initiated, but is clearly not sensible to wait until an obvious uremic complication arises. Modern practice is to initiate RRT sooner rather than later, for example, when the SCr concentration reaches 500-700 micromol/L, perhaps even earlier, unless there is clear evidence that renal function is about to recover. The choice of the treatment will depend on the clinical practice, technical resources, and well-trained nurses of a given department, than on precise clinical indication. The ideal RRT should mimic the functions and physiological mechanisms of the native organ, ensuring qualitative and quantitative blood purification, be free of complications, have good clinical tolerance and restore and maintain homeostasis, thus favouring organ recovery. Now available RRT options /peritoneal dialysis (PD), 2. intermittent hemodialysis (IHD), 3. continuous therapies (CRRT), and 4. hybrid therapies/, differ in the method of delivery, efficiency, and their clinical tolerability. AKI without MOF is less complex, can be managed outside intensive care unit and the same RRT techniques used for the treatment of chronic renal failure may be applied. AKI associated with MOF is a more complex condition and requires more flexible RRT. Acute PD remains a viable option for the treatment of selected patients with AKI, particularly pediatric population, and those who are hemodynamically compromised, have severe coagulation abnormalities, difficulty in obtaining blood access, removal of high molecular weight toxins (> 10 kD), and clinically significant hypothermia and hyperthermia. Patients that are hemodynamically stable can be managed with IHD techniques. Maintaining hemodynamic stability is probably one of the most important aspects of dialysis technique as well as one of the most difficult challenges. With CRRT, the continuous regulation of volume homeostasis could lessen the hourly rate of required UF, thereby improving hemodynamic stability compared with IHD. Clinical data suggest that CRRT should be strongly considered for patients with severe hyperphosphatemia, elevated intracranial pressure, cerebral edema complicating acute liver failure, sepsis or septic shock, might be a useful component of therapy for lithium intoxication, and because of continuous nature of process prevents the post-dialytic "rebound" elevation of plasma concentration of uremic toxins typically seen with IHD. Hybrid therapies using a variety of machines are safe and convenient, providing excellent control of electrolytes and fluid balance, and offers several advantages over CRRT, including less cumbersome technique, patient mobility, and decreased requirements for anticoagulation, while providing similar hemodynamic stability and volume control. Currently, it has been found no difference in mortality or renal recovery between hybrid RRT, CRRT or IHD for critically ill patients with AKI. However, future investigations should collect detailed information on long-term costs and the relative likelihood of renal recovery associated with dialysis modality.
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PMID:New experiences with the therapy of acute kidney injury. 1925 43

The present study analyzed serum levels of urea nitrogen (UN), creatinine (Cr), and C-reactive protein (CRP), which are very stable during the early postmortem period, for investigation of the cause of death with special regard to hyperthermia (heat stroke) in serial medico-legal autopsy cases (n = 429), excluding fatal injury, intoxication, and fire fatality. In this series, mechanical asphyxiation, drowning, and sudden cardiac death cases (n = 56, n = 43, and n = 212, respectively) usually showed low levels within postmortem reference ranges for these serum markers, although UN and CRP levels were mildly elevated in cases of sudden cardiac death and cerebrovascular stroke. There were concomitant significant elevations in serum levels of UN (>50 mg/dL), Cr (>2 mg/dL), and CRP (>2 mg/dL) for chronic renal failure, gastrointestinal bleeding, pneumonia, and hypothermia (cold exposure). UN and CRP were especially high for chronic renal failure and pneumonia, respectively. However, hyperthermia cases showed an isolated elevation in the serum Cr level, suggesting an influence of systemic skeletal muscle damage. These serum markers may be practically useful for postmortem investigation of death due to hyperthermia (heat stroke), for which specific pathological and toxicological evidence may not be available.
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PMID:Postmortem serum nitrogen compounds and C-reactive protein levels with special regard to investigation of fatal hyperthermia. 1929 58

Signaling by the corticotropin-releasing factor receptor type 1 (CRFR1) plays an important role in mediating the autonomic response to stressful challenges. Multiple hypothalamic nuclei regulate sympathetic outflow. Although CRFR1 is highly expressed in the arcuate nucleus (Arc) of the hypothalamus, the identity of these neurons and the role of CRFR1 here are presently unknown. Our studies show that nearly half of Arc-CRFR1 neurons coexpress agouti-related peptide (AgRP), half of which originate from POMC precursors. Arc-CRFR1 neurons are innervated by CRF neurons in the hypothalamic paraventricular nucleus, and CRF application decreases AgRP(+)CRFR1(+) neurons' excitability. Despite similar anatomy in both sexes, only female mice selectively lacking CRFR1 in AgRP neurons showed a maladaptive thermogenic response to cold and reduced hepatic glucose production during fasting. Thus, CRFR1, in a subset of AgRP neurons, plays a regulatory role that enables appropriate sympathetic nervous system activation and consequently protects the organism from hypothermia and hypoglycemia.
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PMID:CRFR1 in AgRP Neurons Modulates Sympathetic Nervous System Activity to Adapt to Cold Stress and Fasting. 2721


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