Articles: cations.
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A 33-year-old man presented with a 10-day history of fever, dry cough, and dyspnea. He reported small amounts of frank hemoptysis that occurred several times a day for the past 3 days and a reduction in urine volume. ⋯ He had a medical history of childhood asthma and untreated hypertension for the past 2 years. He had no history of smoking, recent travel, medication use, or occupational inhalation.
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Diffuse World Health Organization grade II glioma (GIIG) is a slow-growing brain cancer that migrates along the white matter (WM) tracts. Neuroplastic changes were described in reaction to GIIG progression, opening the window to extensive cerebral surgical resection in patients able to resume an active life with no functional consequences. However, atlases of cortico-subcortical neural plasticity emphasized the limited potential of axonal reorganization. ⋯ In this model, 2 parts of the WM tracts are considered: (1) the stem of the bundle that represents the actual limitation of plastic potential, as supported by reproducible behavioral disorders elicited by intraoperative axonal electrostimulation mapping (ESM) and (2) the terminations/origins of the bundle that may no longer be critical in case of functional reallocation of the cortex to/from which these WM fibers run-thus inducing no behavioral troubles during direct ESM. Understanding that a certain degree of axonal compensation in specific portions of the tracts is driven by cortical remodeling may enable to rethink the concept of WM plasticity and to refine the preoperative estimation of extent of resection for GIIG. Identifying eloquent fibers by ESM, especially their convergence in the depth, is essential to achieve an individualized connectome-based resection.
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Although admission to an intensive care unit during pregnancy is rare, pregnant women may become critically ill due to either obstetric or non-obstetric illness. Whilst critical illness due to obstetric reasons during the peripartum period (e.g. peripartum haemorrhage, HELLP-syndrome) is more common, it is also important to know how to care for critically ill pregnant women with non-obstetric illness (e.g. infection, cardiovascular diseases, neurological diseases, trauma). ⋯ The use of different drugs is inevitable in critical care, knowing which drugs are safe to use during the different stages of pregnancy is essential. Caring for mother and unborn child in the ICU is a challenge, open communication, ethical considerations and interdisciplinary as well as multiprofessional collaborations should be key points when caring for critically ill pregnant patients.
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Patient safety and reduction of possible complications are the top priorities for anesthesiologists in everyday clinical practice. Thus, interdisciplinary early assessment and optimization of patient specific medical conditions and risk factors are crucial. In obstetrics, regional anesthesia and general anesthesia are routinely being performed. ⋯ Spinal anesthesia, as well as epidural and combined spinal-epidural anesthesia (CSE) are widely used for caesarean section. In this context, special attention should be paid to possible bleeding disorders. The combination of risk stratification and strategies to improve the patient's preoperative medical status is capable to reduce maternal and fetal complications.