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HIV and AIDS
Published in Rae-Ellen W. Kavey, Allison B. Kavey, Viral Pandemics, 2020
Rae-Ellen W. Kavey, Allison B. Kavey
To this time, the general public had primarily seen AIDS as a mystery disease of gay men and drug addicts chased by epidemiologists in relative obscurity. With spread to women, babies and healthy people receiving routine blood transfusions, AIDS was suddenly a focus for the mainstream media and a cause of mounting public concern. At that time, the field of medicine was enjoying a genuine sense of accomplishment. In addition to the dramatic progress made in the development of antibiotics for treatment of infectious diseases, the twentieth century had seen major advances in almost every other area of medicine including development of vaccines against diphtheria, whooping cough, tetanus, yellow fever, and polio. Insulin therapy for diabetes was discovered, transforming this previously fatal disease. The heart–lung machine had been invented allowing routine open-heart surgery. Computed tomography (CT) scanning and magnetic resonance imaging (MRI) provided amazingly detailed views of the human body in health and disease. Kidney, liver, lung, and heart transplants were successfully performed. Against this backdrop, the emergence of a new, fatal epidemic was an unanticipated and unwelcome surprise, and a disease that was transmitted sexually and was especially common in promiscuous homosexuals was especially unwelcome at a time when the sexual revolution that began in the 1960s had only just started to make the possibility of sex outside of traditional heterosexual, married relationships acceptable.
Organic Chemicals
Published in William J. Rea, Kalpana D. Patel, Reversibility of Chronic Disease and Hypersensitivity, Volume 4, 2017
William J. Rea, Kalpana D. Patel
Ethylene (oxirane, methyl): Ethylene is one of the most common substances in breath analysis. Ethylene can be formed directly from crude oil (Figure 5.1). Ethylene oxide is used as a sterilizing solution for a number of types of medical equipment. Numerous adverse effects, including death, resulting from ethylene oxide exposure have been reported in the literature.97,98 One episode of contamination with resultant fatalities occurred during the sterilization of the heart lung machines used for babies. Ethylene gas is used to ripen bananas and other fruits artificially. Many chemically sensitive cannot tolerate fruit ripened artificially but have no problem with naturally ripened fruit. Ethylene at times has been used as a fungicide. Ethylene is also used as a dispersant in coating composition for silicone crucibles and also as a blending fuel for enhancement of cold start performance of gasoline and ethanol.
Lung transplantation for cystic fibrosis and bronchiectasis
Published in Wickii T. Vigneswaran, Edward R. Garrity, John A. Odell, LUNG Transplantation, 2016
As first described, the procedure was performed without cardiopulmonary bypass. However, a heart-lung machine is essential in some circumstances (e.g., during a lobar transplant); it can provide some advantage in all patients, and it has been the approach of choice in the author’s center since 1991.23 The approach developed at the center includes removal of both lungs, exclusion of the trachea, and simultaneous reperfusion. The first implanted lung is kept cool, but not reperfused, in the chest while the second lung is being implanted. The advantages of cardiopulmonary bypass are summarized in Table 22.1.
Preoperative circadian physical activity rhythm and postoperative delirium in cardiovascular surgery patients
Published in Chronobiology International, 2020
Chieko Tan, Nao Saito, Ikuko Miyawaki, Hideyuki Shiotani
Delirium is defined as an acute and variable impairment of consciousness and cognitive impairment (American Psychiatric Association 2013). Postoperative delirium (POD), a form of delirium, manifests in patients who have undergone surgical procedures and anesthesia, usually peaking in intensity between 1 and 3 days after the operation (Whitlock et al. 2011). POD is associated with an increased intensive care unit (ICU) length of stay and hospital length of stay, as well as functional decline in patients. Furthermore, POD has been found to be related to an increase in mortality rate, risk of dementia, and medical costs (Whitlock et al. 2011). Cardiovascular surgery requires the use of temporary aortic blockage, heart-lung machine, and extracorporeal circulation to prevent vital organ damage, depending on the surgical procedure; and it is extremely invasive. Recent studies have reported that the incidence of delirium after cardiovascular surgery is at least 3% and is great as 55% (Aitken et al. 2017; Djaiani et al. 2016; Gosselt et al. 2015; Lei et al. 2017; Liu et al. 2017). Therefore, patients who undergo cardiovascular surgery can have a high risk of delirium. In order to enhance the quality of life of such patients, it is essential to develop interventions for the prevention, symptoms reduction, and period shortening of delirium.
Intact coronary and myocardial functions after 24 hours of non-ischemic heart preservation
Published in Scandinavian Cardiovascular Journal, 2020
Guangqi Qin, Björn Wohlfart, Long Zuo, Jingfeng Hu, Trygve Sjöberg, Stig Steen
The heart preservation system has been developed in-house and can be described as a portable heart-lung machine [2]. The weight of the machine is 34 kg including gas containers and the sterile single-use part weighs 3.3 kg without preservation solution. The size of the machine is 70 × 41 × 46 cm which makes it suitable for easy transportation in cars and small aircrafts. The components of the preservation system include an automatic pressure and flow controlled perfusion-pump system, a leucocyte and arterial filter, an automatic gas exchange system, a heater-cooler unit, a programmable sequencer and heart preservation solution (for composition, see Table 1) The heart was mounted in the preservation system within 20 min after explantation and perfused at 8 °C in cycles of 15 min of perfusion with a pressure of 20 mmHg, 40 min of perfusion with a pressure of 10 mmHg and 5 min of non-perfusion for mixing the perfusate and calibrating the pressure sensor before the next cycle was started. With a perfusion pressure of 20 mmHg the perfusion flow was in the range of 150–200 mL/min, and with a perfusion pressure of 10 mmHg the perfusion flow was 50–100 mL/min.
The effect of dexmedetomidine on the inflammatory response in children undergoing repair of congenital heart disease: a randomized controlled clinical trial
Published in Egyptian Journal of Anaesthesia, 2020
Khaled A Abdelrahman, Shimaa A Hassan, Ahmed A Mohammed, Essam E Abdelhakeem, Sayed K. Abd-Elshafy, Ragaa H Salama, Esam M Abdalla
The routine strategy was performed by a non-pulsatile heart-lung machine (Stockert Centrifugal Pump S5 Console Roller pump 150- part No: 10–80-00, Ser No: 10E03400, Germany). Priming of the CPB circuit was done with mannitol, sodium bicarbonate, and packed red cells given to obtain a hematocrit of 22–26%. Heparin 400 IU/kg was given to the patient and once activated clotting time reached ≥450 seconds, CPB was initiated. The aorta was clamped and cold blood cardioplegia (15–20 ml/kg) was administered into the aortic root. The body (core) temperature was cooled to 30–32°C. The cardioplegia solution was repeated every 20 minutes. pH-stat blood gas strategy was used; partial pressure of carbon dioxide in arterial blood (PaCO2) was maintained between 35 and 45 mmHg. During CPB, mean systemic arterial pressure (MAP) was preserved between 30–60 mmHg, and anesthesia was conserved by sevoflurane 0.8–1.5%, fentanyl (1–2 mcg/kg/hr.) and cisatracurium (0.05 mg/kg per dose). Weaning from CPB was done at 37°C after completion of surgery. Ventilation was started, and patient hemodynamics and arterial blood gases were stabilized. Heparin was reversed by 1 mg protamine for every 100 IU heparin. The patients were transported to post-operative pediatric cardiac intensive care unit (PICU) post-surgery.