The Mount Sinai journal of medicine, New York
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Comparative Study
Comparison of arterial systolic pressure variation with other clinical parameters to predict the response to fluid challenges during cardiac surgery.
Prophylactic optimization of stroke volume during surgery has been thought by some to reduce complications following surgery. Mechanical ventilation has been shown to induce variations in systolic systemic arterial blood pressure. Measuring such variations in systolic pressure (SPV) might serve as an attractive method for guiding fluid therapy intraoperatively. ⋯ Although significant intergroup differences in the extent of systolic pressure variations were observed, no appropriate threshold values could be determined that would accurately predict the response to a fluid bolus. There is a relationship between SPV and SPVdown values and intravascular volume status. SPV and echocardiographic-derived values did not predict the response to a fluid bolus as well as values obtained from the pulmonary artery catheter.
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The practice of neuroanesthesia at the Mount Sinai Medical Center focused initially on clinical practice, followed by specialization. This article presents a brief history of the division and a description of the areas of interest, presentations, and publications that have originated there.
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A case of subarachnoid hemorrhage following spinal anesthesia for prostate radioactive seed implantation is reported. The implications of the differential diagnosis of post-dural puncture headache are discussed.
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Case Reports
Pneumococcal vaccine failure in an HIV-infected patient with fatal pneumococcal sepsis and HCV-related cirrhosis.
Pneumoccocal vaccination of HIV-positive individuals is recommended to prevent pneumococcal infection. We present a case of a 44-year-old HIV-infected male who came to the emergency room with bacterial pneumonia and sepsis. The patient also had a history of HBV and HCV infection. ⋯ The patient had received Pneumovax two years before his death. The organism isolated from blood cultures was Streptococcus pneumoniae isotype 3, a strain included in Pneumovax. This is a case of pneumococcal vaccine failure with a fatal outcome in a person with an HIV infection and hepatitis C-related liver cirrhosis.
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Body fluid volume regulation is critically important in maintaining life. In this paper, we review our unifying hypothesis of body fluid volume regulation, which maintains arterial circulatory integrity in health and disease. The integrity of the arterial circulation, as determined by cardiac output and peripheral vascular resistance, is the predominant determinant of renal sodium and water retention. ⋯ However, over the long term, these adaptive responses may have detrimental effects, such as pulmonary congestion, increased myocardial demand, increased cardiac afterload, ascites and hyponatremia. The intensity of the neurohumoral responses correlates with the progression and severity of both cardiac failure and cirrhosis. The understanding of the pathogenesis of sodium and water retention in cardiac failure and cirrhosis has led to therapies that favorably affect the morbidity and mortality of these patients.