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Oxygen saturation post-gastroscopy and post-colonoscopy.

A standard of care for providing pulse oximetry monitoring for patients receiving conscious sedation during and after endoscopy has not been established. This study sought to clarify whether desaturation occurs after gastroscopy and colonoscopy and what characteristics are predictive of desaturation that does occur. The convenience sample consisted of 475 adult participants receiving meperidine and/or midazolam in a hospital-based outpatient setting. A baseline oxygen saturation level was obtained before the procedure. Assessment of the oxygen saturation continued in the recovery room for 1 hour, with readings recorded every 10 minutes. A saturation of 90% or less was used as the indicator to resume oxygen therapy. Data revealed that oxygen desaturation in the recovery phase is influenced by the preprocedure baseline oxygen saturation level, smoking history, and age. The incidence of oxygen desaturation was 24% in the recovery phase, with the majority of decreases occurring within the first 10 minutes.

Colonoscopy↗

PubMed1995

Transient hepatic fibrin-ring granulomas in a patient with acute hepatitis A.

A case of acute hepatitis A associated with fibrin-ring granulomas in the liver is presented. Because a relationship between acute hepatitis A infection and granuloma formation had not previously been established, liver specimens were examined from both the hepatitic and recovery phases. Numerous fibrin-ring granulomas were observed in the parenchyma during the hepatitic phase. The cellular components of the granulomas were largely macrophages and CD4-positive T-cells. Granulomas had disappeared completely by the recovery phase. These results suggest that fibrin-ring granulomas were caused by hepatitis A virus infection. This virus may activate macrophages and CD4-positive T-cells through an as-yet undetermined mechanism.

Acute Disease↗

PubMed1996

Hepatic response to the oxidative stress induced by E. coli endotoxin: glutathione as an index of the acute phase during the endotoxic shock.

Reactive oxygen species are important mediators of cellular damage during endotoxic shock. In order to investigate the hepatic response to the oxidative stress induced by endotoxin, hepatic and plasma glutathione (total, GSH and GSSG), GSSG/GSH ratio as well as Mn-superoxide dismutase and catalase activities were determined during the acute and recovery phases of reversible endotoxic shock in the rat. A significant increase in liver and plasma total glutathione content was observed 5 h after endotoxin treatment (acute phase), followed by a diminution of these parameters below control values at 48 h (recovery phase). The significant increases of GSSG levels and GSSG/GSH ratio are indicative of oxidative stress occurring during the acute phase. Liver Mn-SOD activity showed a similar time dependency as the GSSG/GSH ratio; however, a marked decrease in the liver catalase activity was observed during the process. These results indicate the participation of liver glutathione in the response to endotoxin and the possible use of plasma glutathione levels and GSSG/GSH ratio as indicators of the acute phase during the endotoxic process.

Acute Disease↗

PubMed2000

Metabolic cost and subjective assessment of palletizing and subsequent recovery.

Twenty-one male blue collar workers repeatedly lifted (palletized) a box weighing 22 kg six times min(-1) for 5 min to a shelf of fixed height. The experimental conditions included two planes of lifting (symmetries), two shelf clearances, and three headrooms. The metabolic (heart rate, caloric cost and ventilation volume) and psychophysical variables (rate of perceived exertion, RPE; visual analogue score, VAS; and body part discomfort ratings, BPDR) were measured during resting, palletization, and recovery phases. In palletization the heart rate and metabolic cost ranged between 25 to 35% of the maximal aerobic capacity. Of the three factors only headroom had a significant effect on metabolic cost (p<0.02) and the BPDR for low back (p<0.05). In the recovery phase only headroom had significantly effect (p<0.001) on metabolic cost. The metabolic recovery took 10 min; however, recovery measured through psychophysical indices appeared to continue for 20 min.

Adult↗

PubMed1996

A model of fatigue and recovery in paraplegic's quadriceps muscle subjected to intermittent FES.

The objective of this paper was to propose a mathematical model for the fatigue and recovery phases of a paraplegic's quadriceps muscle subjected to intermittent functional electrical stimulation (FES). The model is based on in vivo, noninvasive, recording of fatigue related metabolic parameters recorded during stimulation and recovery. Records of the time variations of the muscle's phosphorus metabolites, particularly the phosphocreatine (PCr) and inorganic phosphorus (Pi), obtained from 31P magnetic resonance spectroscopy (MRS), were used to calculate the intracellular pH level in the muscle and this latter parameter was incorporated in a musculo-tendon model. The fatigue-recovery model allows the transition from the fatiguing phase to the recovery phase as soon as the stimulation terminates and vice versa. This model was incorporated into a Huxley type muscle model expressing the dynamics of the muscle. Two ordinary differential equations describing the musculo-tendon dynamics and the dynamics of the activation were solved simultaneously and records of the force trajectory during intermittent stimulations were obtained. Study cases ranging from 5 to 30 s for each of the stimulation and recovery alternating phases were stimulated. The force and the total impulse in the modeled quadriceps muscle were computed. It was found that the greatest impulse was produced in intermittent stimulation of 40-50 s duty cycle, with a 50 percent ratio between the stimulation and recovery intervals. An additional series of six runs, including two contractions, one of 3 min and one of 1 min, separated by rest periods of 3, 6, 9, 12, 15, and 30 min was performed. From the predicted force trajectories obtained, the maximal force values served for comparison with measured values made on one patient.

Electric Stimulation↗

PubMed1994

Effects of macrophage colony-stimulating factor (M-CSF) on the mobilization of peripheral blood stem cells.

We studied the effects of human urinary macrophage colony-stimulating factor (huM-CSF) on the mobilization of peripheral blood stem cells (PBSC) following cytotoxic chemotherapy in 6 patients with acute leukemia. After complete remission (CR) was achieved, two courses of consolidation chemotherapy consisting of an intermediate dose of cytosine arabinoside were administered to the patients. During a recovery phase after each course of consolidation chemotherapy, two successive cycles of leukapheresis were performed every other day. M-CSF was administered intravenously at a dose of 8 x 10(6) U/day during a recovery phase after the second course of consolidation chemotherapy (cytotoxic plus M-CSF mobilization). There was no significant difference in white blood cell (WBC) or platelet recovery between the first and second cycles, regardless of the administration of M-CSF. Furthermore, between cytotoxic and cytotoxic/M-CSF mobilization, significant differences were not observed in the harvest of mononuclear cells (average 1.43 x 10(8)/kg vs 1.62 x 10(8)/kg), granulocyte/macrophage progenitor cells (CFU-GM) (1.82 x 10(4)/kg vs 3.07 x 10(4)/kg) or erythroid progenitor cells (BFU-E) (2.86 x 10(4)/kg vs 2.66 x 10(4)/kg). Thus M-CSF is not effective for expanding a pool of circulating hematopoietic stem cells when administered at a conventional dose during hematologic recovery following chemotherapy.

Acute Disease↗

PubMed1989

Blood responses under chronic low daily dose gamma irradiation: I. Differential preclinical responses of irradiated male dogs in progression to either aplastic anemia or myeloproliferative disease.

Male beagles chronically exposed to low daily doses of 60Co gamma rays (7.5 cGy/22h/day) show one of three hematopoietic patterns, which reflect three different distinctly responding subgroups: (1) low radioresistance with progressing aplastic anemia and shortened survival (-S-AA subgroup); (2) high radioresistance with a complex of progressing myeloproliferative disorders (+R-MPD group); or (3) high radioresistance with other nonMPD syndromes (+R-nonMPD group). Blood cell levels (granulocytes, monocytes, erythrocytes, lymphocytes, and platelets) were assessed and fitted to a flexible polynomial spline model, thus defining the (a) initial suppressive and (b) subsequent recovery phases for the subgroups. Results showed that relative to the overall magnitude of blood cell loss as well as to the maximum rate of suppression during the initial phase, the subgroups were generally ranked -S-AA much greater than +R-MPD greater than +R-nonMPD. Relative to the overall strength of the recovery response, the subgroups were generally ranked +R-MPD greater than +R-nonMPD much much greater than -S-AA. In terms of overall maintenance levels of circulating blood cells during the recovery phase, however, the +R-nonMPD subgroup consistently exhibited stronger responses than the +R-MPD subgroup. These results tend to support our contention that selected subgroups of dogs have strong propensities to specific hematopathologies (i.e. aplastic anemia and myeloid leukemia) under chronic irradiation and that these pathology-prone animals exhibit a series of marked differential hematopoietic responses during early preclinical phases, which serve effectively to prognosticate subsequent pathological progression.

Adaptation, Physiological↗

PubMed2000

Valproate metabolism during valproate-associated hepatotoxicity in a surviving adult patient.

The plasma profiles of valproate (VPA), its beta-oxidation metabolites E-2-en-VPA and 3-oxo-VPA and its terminal desaturation metabolite 4-en-VPA, have been measured in a patient receiving NaVPA 1000 mg twice per day from early in the course of serious hepatotoxicity and for 2 weeks after the drug was stopped. Concurrent profiles of liver, renal and haematological function parameters were available. Relative to concurrent plasma VPA concentrations, E-2-en-VPA concentrations were not different to those of the VPA-treated epileptic population at any stage of the illness, whereas 3-oxo-VPA concentrations relative to concurrent VPA concentrations were abnormally high early in the toxicity, abnormally low at its peak (3-5 days later), and comfortably within normal limits for the treated epileptic population late in the recovery phase (9-13 days from the onset). When measurable, plasma 4-en-VPA concentrations were not elevated. The elimination half-life of VPA during the recovery phase was 100 h, which is some 6-12 times greater than values reported for this parameter in normal patients. These data clearly define, in this patient, a link between idiosyncratic VPA-associated hepatotoxicity at its onset and peak and the later stages of VPA beta-oxidation. Whether the beta-oxidation abnormalities are causative or a consequence of an as yet undefined defect is unknown. In this patient, 4-en-VPA was unlikely to have been involved in the pathogenesis of the toxicity.

Adult↗

PubMed1971

Body water and electrolyte composition in acute renal failure.

Body water and electrolyte contents have been measured by means of muscle biopsy analysis in 11 patients with untreated acute renal failure and in one patient during the diuretic recovery phase of his illness. Patients with acute oliguric renal failure show two main types of imbalance. One group shows evidence of a reduction in extracellular sodium and chloride with normal intracellular water and electrolytes. These findings are thought to be due to a combination of excess urinary salt loss during the development of oliguric renal failure, and inadequate replacement of extrarenal electrolyte losses. A second group shows overhydration of both extra- and intracellular phases, associated with an excess of sodium and chloride. The intracellular potassium concentration is reduced, owing to the intracellular water excess. The patient studied during the diuretic recovery phase of acute renal failure showed a marked loss of sodium and chloride, which emphasizes the necessity to replace urinary electrolyte losses at this stage of the illness. It is often extremely difficult to assess fluid and electrolyte balance in patients presenting with acute renal failure, and muscle biopsy analysis or isotope dilution studies may be required before accurate replacement therapy is possible.

Acute Kidney Injury↗

PubMed1984

Left ventricular dysfunction after acute myocardial infarction: results of a prospective multicenter study.

In a multicenter prospective study of 866 patients who survived the coronary care unit phase of an acute myocardial infarction, variables reflecting left ventricular function were examined to assess their impact on 2 year survival. Single variables that reflected left ventricular dysfunction before infarction and in the acute and recovery phases were, respectively, history of prior myocardial infarction, rales in the coronary care unit dichotomized at greater than bibasilar and predischarge radionuclide ejection fraction dichotomized at less than 0.40. When combined in a stepwise fashion, patients lacking these three risk characteristics had a 2 year 4.2% mortality rate, whereas patients possessing all three characteristics had a 45% mortality rate. Rales in the coronary care unit and predischarge ejection fraction act independently, and each contributes to mortality. Fifty-two patients with advanced rales but an ejection fraction of 0.40 or greater had a 21% mortality rate. Similarly, 208 patients with few rales but an ejection fraction of less than 0.40 had a 15% mortality rate. These data suggest that the mortality risk imposed by those factors that assess permanent left ventricular damage is independent of and additive to the mortality risk contributed by dynamic, acute phase dysfunction. These data fit the hypothesis that acute phase dysfunction is, in part, due to transient ischemia that, on reversal, can restore function toward normal. The results suggest 1) that assessment of left ventricular function during the acute and recovery phases of myocardial infarction is necessary to define prognostic characteristics of an individual patient, and 2) that of particular importance is the identification of patients whose postinfarction course is consistent with reversible ischemia.

Cardiac Output↗

PubMed2007

X-ray noninterferometric phase imaging: a unified picture.

A unified theory of noninterferometric phase recovery based on the so-called ambiguity function is introduced. The theory is used to analyze previously published techniques and unify them with the methods of phase-space tomography applicable to partially coherent data. The theory is then used to propose some new approaches to noninterferometric phase recovery.

Journal Article↗

PubMed1993

Does treatment with haemopoietic growth factors affect the incidence of bacteraemia in adult lymphoma transplant recipients?

Eighty-six consecutive adult patients undergoing ABMT colony-stimulating factor for lymphoma in three (CSF) trials were studied retrospectively to investigate whether the administration of CSFs had a beneficial impact on the incidence of bacteraemia. Forty-nine patients did not receive CSFs and 51% of them developed bacteraemia during the recovery phase. Nineteen patients received M-CSF post-ABMT, 9 G-CSF and 9 GM-CSF; 40%, 33% and 22%, respectively, developed bacteraemia during the recovery phase. Ninety per cent of all infections (Gram +ve and Gram -ve) and 100% of the Gram -ve ones occurred when the absolute neutrophil count (ANC) was < or = 0.1 x 10(9)/l. This period of maximum risk, i.e. the total number of consecutive days with ANC < 0.1 x 10(9)/l, was not shortened by CSFs; however, a decrease in the incidence of bacteraemia was detected in the CSF-treated patients during the above period and this might be a result of enhanced phagocytic function. The incidence of bacteraemia appeared to be related to the type of lymphoma (p < 0.02) regardless of CSF administration: 28 of 59 patients with Hodgkin's disease developed bacteraemia (46.7%) versus 6 of 27 patients (22.2%) with non-Hodgkin's lymphoma.

Adult↗

PubMed1993

Beta-endorphin and adrenocorticotropic hormone production during marathon and incremental exercise.

To evaluate the increases in concentration of beta-endorphin and adrenocorticotropic hormone (ACTH) 16 healthy athletes, well-trained for endurance exercise, volunteered for an exhausting incremental graded treadmill exercise and a marathon run. Maximum oxygen uptake was determined during the treadmill exercise. Venous blood samples were drawn before and after exercise, and at 30, 60 and 120 min during the recovery phase. For the marathon race venous blood was collected before, after 1 and 2 h of running and at the end, as well as at 0.5, 1, 2 and 24 h during the recovery phase. Lactate concentration, heart rate and perceived exertion were also determined at all points of blood collection. Both types of exercise led to significant increases in concentration of beta-endorphin and ACTH of similar magnitude, with beta-endorphin tending to be higher after the marathon run. The decrease of both was slower during the recovery from the marathon than after the incremental test. Concentrations of both hormones increased exponentially during the marathon run. Positive correlations between beta-endorphin and ACTH concentrations were determined at the end of both runs. It was found that incremental exhausting and prolonged exhausting endurance exercise such as marathon running induced an increase of similar magnitude in both beta-endorphin and ACTH concentration.

Adrenocorticotropic Hormone↗

PubMed1988

The effects of different anesthetics on blood steroid concentrations in domestic tom-cats.

Testosterone and androstenedione were measured in the plasma of mature tom-cats before, during and after anesthesia with thiopentone, ketamine, xylazine and alphaxolone/alphadolone. Samples were collected via an indwelling jugular catheter at 30 min intervals before anesthesia (5 samples) and during the recovery phase (8 samples), and at intervals of 15 min during anesthesia (7 samples). Thiopentone and ketamine anesthesia significantly depressed testosterone and androstenedione concentrations during and after anesthesia. Xylazine significantly increased testosterone concentrations during anesthesia but they returned to pre-anesthetic concentrations during recovery. Androstenedione concentrations were significantly depressed during the recovery phase from xylazine anesthesia. Alphaxolone/alphadolone anesthesia had no significant effect of testosterone concentrations but significantly increased and androstenedione concentrations during anesthesia and recovery. Testosterone and androstenedione concentrations in cats were significantly altered by these 4 commonly used anesthetics and this must be taken into account if hormone concentrations are measured while cats are anesthetised.

Androstenedione↗

PubMed1982

[Exercise-induced asthma and arterial hypoxemia].

40 young asthmatic patients performed submaximal work on a treadmill ergometer for 6 minutes. In 20 cases the PaO2 was found to be below 77.5 mm Hg (arterial hypoxemia) at the 10th or the 20th minute of post-exercise recovery time. A first subgroup A of 9 asthmatics presented hypoxemia together with a fall of FEV1 below 90% of control at the first to the 20th minute post-exercise recovery phase. A second subgroup B of 11 asthmatics showed hypoxemia with FEV1's higher than 90%, often higher than 100% of the control value. The following features of the recovery period were observed: 1. 10 minutes delay of onset of hypoxemia in relation to the FEV1 drop in group A. 2. Progressive hypoxemia despite a clear return of FEV1 versus the control value during the late recovery phase of group A. 3. Appearance of arterial hypoxemia despite unchanged normal FEV1's in group B. These three observations suggest that there are 2 kinds of post-exercise bronchoconstrictions. The first may be situated in the large bronchi (FEV1-drop), the second in the small peripheral airways (PaO2-drop), from the first to the 20th and from the 20th to the 40th minute respectively after the end of submaximal work load. It is concluded that there must be 2 sequential bronchoconstrictions due to cooling of the airways and these constrictions may guarantee alveolar homeostasis for body temperature and full saturation with water vapour. However, the first barrier in the large airways can be abolished by high blood levels of adrenaline. In such cases the second barrier in the small airways becomes important and may protect the alveoli from cooling and dry air.

Adult↗

PubMed1992

Cardiac surgery in the elderly: the critical care phase.

A growing number of elderly patients (aged 70 years and older) are seen in critical care units after valve surgery or coronary artery bypass grafting. While studies show that the elderly demonstrate overall successful results after cardiac surgery, the mortality and morbidity risks are higher than in younger adults. The elderly patient is more likely to experience postoperative complications, prolonging the recovery phase. Commonly reported postoperative complications include dysrhythmias, pneumonia, cerebral vascular accidents, and infection. Elderly surgical candidates must be evaluated preoperatively to determine risk factors that may affect the critical care recovery phase. The length of stay tends to be longer in the intensive care unit, requiring nursing care that takes the aging process into consideration. The following article focuses on trends in cardiac surgery in the elderly, physiologic factors that affect outcome and recovery, and nursing interventions aimed at preventing or limiting postoperative complications.

Aged↗

PubMed1996

Functional, biochemical, and morphological hepatobiliary effects in rats chronically exposed to a steroidal antiandrogen.

Yellow-brown deposits in intrahepatic bile ducts and portal macrophages were observed for male, but not female, Sprague- Dawley rats fed zanoterone, a steroidal antiandrogen, for >=3 months. The lesion did not affect biliary canaliculi and was associated with changes of biliary epithelium, portal chronic inflammation, and bile duct proliferation. Deposit formation was assumed to be related to a gender-related anomaly in bile composition and/or flow. Therefore, the pathogenesis of the lesion was investigated in male, female, and orchiectomized rat. Hepatobiliary structure and function were evaluated after 3 months of treatment and 3 months of reversibility. Drug biliary disposition was evaluated at 3 months. Sulfobromophthalein clearance, bile flow, and plasma concentration and biliary excretion rate of cholesterol were increased at the end of the treatment phase without significant sex-related differences. These effects are consistent with the hepatic enzyme induction potential of the drug, were accompanied by perivenous hepatocellular hypertrophy and increased liver weights, and were no longer observed at the end of the recovery phase. Histomorphologic evidence of cholestasis was observed for most intact and orchiectomized males, the lesion being slightly less pronounced for the latter. Deposits were present at the end of the recovery phase, but were confined to macrophages in all but one case. The lesion differed from a protoporphyria, or precipitates of bile pigments, cholesterol, or proteins. The drug was extensively metabolized with major gender-related differences. Glucuronides of a 16- hydroxy- and another unidentified metabolite were the major metabolites found in bile of males, while a 15-hydroxy-glucuronide was the major metabolite for females. The concentration and biliary excretion of the 16-hydroxy- glucuronide markedly increased after chronic exposure. A possible explanation for pigment deposition in males is that the drug is converted to a metabolite(s) which is excreted at a rate beyond the solubilization potential of bile and, therefore, precipitates in bile ducts.

Androgen Antagonists↗

PubMed2006

A tactile cockpit instrument supports the control of self-motion during spatial disorientation.

OBJECTIVE: We investigated the effectiveness of a tactile torso display as a countermeasure to spatial disorientation (SD) and compared inside-out and outside-in codings. BACKGROUND: SD is a serious threat to military as well as civilian pilots and aircraft. Considerable effort has been put into SD countermeasures such as training programs and advanced cockpit displays. Tactile displays have been considered a promising technology. METHOD: Twenty-four participants were assigned to the two coding groups (12 per group and matched for age and gender). We used a rotating chair to build up a state of SD by rotating participants around their yaw axis followed by a sudden stop. During the following recovery phase a random disturbance signal was added to the chair's orientation. Participants actively controlled their orientation and were instructed to maintain a stable orientation. RESULTS: Statistical analyses revealed that recovery from SD was improved with support of the tactile instrument, but tracking performance was reduced. The effects were the same whether the instrument was available full time or during the recovery phase only. There were no differences between outside-in and inside-out coding. CONCLUSION: The present study demonstrates the potential of tactile cockpit instruments in controlling SD, even in the presence of strong but misleading self-motion information from the vestibular sense. APPLICATION: Actual or potential applications of this research include spatial disorientation countermeasures for pilots, divers, and astronauts.

Adult↗