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Jason N. Katz, MD

  • Medical Director, Cardiac Intensive Care Unit
  • Assistant Professor of Medicine
  • Divisions of Cardiology and Pulmonary/
  • Critical Care Medicine, University of North Carolina
  • Chapel Hill, North Carolina

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Renal replacement therapies for prevention of radiocontrast-induced nephropathy: a scientific review. Effects of noradrenalin and albumin in sufferers with kind I hepatorenal syndrome: a pilot examine. Vasopressin, not octreotide, may be helpful in the therapy of hepatorenal syndrome: a retrospective research. Terlipressin versus norepinephrine within the treatment of hepatorenal syndrome: a systematic evaluation and meta-analysis. Survival to discharge amongst patients treated with continuous renal alternative remedy. Urine output is associated with prognosis in patients with acute kidney harm requiring steady renal replacement therapy. Empirical relationships amongst oliguria, creatinine, mortality, and renal replacement therapy within the critically ill. Fenoldopam prophylaxis of postoperative acute renal failure in high-risk cardiac surgical procedure sufferers. A comparability between fenoldopam and low-dose dopamine in early renal dysfunction of critically sick patients. Fenoldopam reduces the incidence of renal alternative remedy after cardiac surgical procedure. Effect of fenoldopam on use of renal substitute therapy among sufferers with acute kidney injury after cardiac surgery: a randomized medical trial. Fenoldopam to prevent acute kidney damage after main surgery-a systematic review and meta-analysis. Renal-dose dopamine for the treatment of acute renal failure: scientific rationale, experimental studies and medical trials. The role of natriuretic peptide administration in cardiovascular surgery-associated renal dysfunction: a systematic review and meta-analysis of randomized managed trials. Atrial natriuretic peptide for administration of acute kidney injury: a scientific review and meta-analysis. Rates of hyperkalemia after publication of the randomized aldactone evaluation examine. Independent stimulation of glucose metabolism and Na+-K+ trade by insulin within the human forearm. Effect of bicarbonate administration on plasma potassium in dialysis patients: interactions with insulin and albuterol. Cellular mechanisms in proximal tubular Pi reabsorption: some answers and more questions. Effect of meals additives on hyperphosphatemia amongst sufferers with end-stage renal disease: a randomized managed trial. The results of nocturnal in contrast with typical hemodialysis on mineral metabolism: a randomized-controlled trial. Hyperuricemia increases the chance of acute kidney harm: a scientific evaluation and meta-analysis. Hyperuricemia and contrast-induced acute kidney injury: a scientific review and meta-analysis. Serum uric acid level as a risk issue for acute kidney injury in hospitalized patients: a retrospective database evaluation utilizing the integrated medical data system at kochi medical faculty hospital. Relationship between serum uric acid focus and acute kidney injury after coronary artery bypass surgical procedure. Impact of anemia on outcome in critically ill sufferers with extreme acute renal failure. A multicenter, randomized, controlled scientific trial of transfusion necessities in important care. Anemia is a threat issue for acute kidney injury and long-term mortality in critically ill patients. Aspirin prolongs bleeding time in uremia by a mechanism distinct from platelet cyclooxygenase inhibition. Dose-effect and pharmacokinetics of estrogens given to correct bleeding time in uremia. L-arginine, the precursor of nitric oxide, abolishes the impact of estrogens on bleeding time in experimental uremia.

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Tube thoracostomy for occult pneumothorax: a prospective randomized research of its use. Continuous venous air embolism in sufferers receiving positive endexpiratory strain. Incidence, threat elements and consequence of barotrauma in mechanically ventilated sufferers. Recruitment manoeuvers for adults with acute lung injury receiving mechanical ventilation. Higher vs lower positive endexpiratory strain in sufferers with acute lung damage and acute respiratory distress syndrome: systematic evaluate and metaanalysis. Ultrasound localization of central vein catheter and detection of post procedural pneumo thorax: a substitute for chest radiography. Relationship between ventilator settings and barotrauma in the acute respiratory distress syndrome. Mean airway pressure: physiologic determinants and clinical importance-part 2: clinical implications. Risk components for morbidity in mechanically ventilated sufferers with acute severe asthma. The relation of pneumothorax and different air leaks to mortality within the acute respiratory distress syndrome. Airway pressures and early barotrauma in sufferers with acute lung damage and acute respiratory distress syndrome. Comparison of excessive frequency jet air flow with typical mechanical ventilation for bronchopleural fistula. Pneumothorax following transbronchial biopsy: Low diagnostic yield with routine chest roentgenograms. The value of transbronchial needle aspiration in the prognosis of peripheral pulmonary lesions. Factors related to pneumothorax and pneumothorax requiring treatment after per cutaneous lung biopsy in 443 consecutive patients. Postbiopsy pneumothorax: estimating the chance by chest radiography and pulmonary operate checks. Incidence and risk factors of delayed pneumothorax after transthoracic needle biopsy of the lung. Iatrogenic pneumothorax; etiology and morbidity: results of a Department of Veterans Affairs cooperative study. Ultrasound steerage for placement of central venous catheters: a metaanalysis of the literature. Central vein catheteriza tion: failure and complication rates by three percutaneous approaches. Patient security: impact of institutional protocols on antagonistic events related to feeding tube placement in the critically ill. Inadvertent transbronchial insertion of narrow bore feeding tubes into the pleural space. Incorrect positioning of nasogastric feeding tubes and the development of pneumothorax. Elective percutaneous dilational tracheostomy: a brand new simple bedside process; preliminary report. Spontaneous pneu mothorax following partial decision of complete bronchial obstruction. Asymptomatic hydro pneumothorax after therapeutic thoracentesis for malignant pleural effusion. Alveolar hemorrhage as a manifestation of pulmonary barotrauma after scuba diving. British Thoracic Society Fitness to Dive Group (Subgroup of the British Thoracic Society Standards of Care Committee). Worsening oxygenation within the mechanically ventilated patient: causes, mechanisms, and early detection. Bilateral pneu mothoraces secondary to iatrogenic buffalo chest; an uncommon complication of median sternotomy and subclavian catheterization.

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The Adverse Experience Committee; and the Multicenter Diltiazem Postinfarction Research Group. Randomised trial of cholesterol decreasing in 4444 patients with coronary coronary heart illness: the Scandinavian Simvastatin Survival research (4S). The effect of pravastatin on coronary occasions after myocardial infarction in patients with average cholesterol levels. Prevention of cardiovascular events and death with pravastatin in sufferers with coronary heart illness and a broad vary of preliminary cholesterol levels. A prospective, randomized analysis of prophylactic intraaortic balloon counterpulsation in excessive threat sufferers with acute myocardial infarction treated with main angioplasty. Optimal timing of revascularization: transmural versus nontransmural acute myocardial infarction. Impact of clopidogrel in sufferers with acute coronary syndromes requiring coronary artery bypass surgery: a multicenter analysis. Outcomes following pre-operative clopidogrel administration in sufferers with acute coronary syndromes present process coronary artery bypass surgical procedure. Pericarditis in acute myocardial infarction: characterization and medical significance. Comparison of frequency, diagnostic and prognostic significance of pericardial involvement in acute myocardial infarction handled with and with out thrombolytics. Frequency and prognostic significance of pericarditis following acute myocardial infarction treated by primary percutaneous coronary intervention. Early and long-term medical outcomes associated with reinfarction following fibrinolytic administration within the Thrombolysis in Myocardial Infarction trials. Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes: an up to date and comprehensive meta-analysis of 25,307 patients. Warfarin plus aspirin after myocardial infarction or the acute coronary syndrome: meta-analysis with estimates of risk and profit. Randomised double-blind trial of fastened low-dose warfarin with aspirin after myocardial infarction. Beta blocker therapy after acute myocardial infarction in sufferers with heart failure and systolic dysfunction. Effect of propranolol after acute myocardial infarction in patients with congestive coronary heart failure. Heterogeneity in the management and outcomes of patients with acute myocardial infarction complicated by coronary heart failure: the National Registry of Myocardial Infarction. Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction. Right ventricular myocardial infarction with anterior wall left ventricular infarction: an post-mortem examine. Right ventricular infarction: frequency, measurement and topography in coronary coronary heart disease: a potential study comprising 107 consecutive autopsies from a coronary care unit. Patterns of coronary compromise resulting in acute right ventricular ischemic dysfunction. Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction. Combined effect of age and right ventricular involvement on acute inferior myocardial infarction prognosis. Physical examination for exclusion of hemodynamically necessary proper ventricular infarction. Clinical diagnosis and differentiation from cardiac tamponade and pericardial constriction. Hemodynamic results of inhaled nitric oxide in right ventricular myocardial infarction and cardiogenic shock. Initial report of percutaneous right ventricular assist for right ventricular shock secondary to right ventricular infarction. Reversibility of hypotension and shock by atrial or atrioventricular sequential pacing in sufferers with proper ventricular infarction.

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Risk of renal and colonic neoplasms and spontaneous pneumothorax in BirtHoggDube syndrome. Nonsense mutations in folliculin presenting as isolated familial spontaneous pneumothorax in adults. Surgical handle ment of spontaneous pneumothorax in sufferers with acquired immunodeficiency syndrome. Tissue invasion by Pneumocystis carinii: a potential explanation for cavitary pneumonia and pneumothorax. Necrotizing Pneumocystis carinii vasculitis associated with lung necrosis and cavitation in a affected person with acquired immunodeficiency syndrome. Aerosolized pent amidine: impact on prognosis and presentation of Pneumocystis carinii pneumonia. Occult traumatic pneumothorax: immediate tube thoracostomy versus expectant management. Communication between the two pleural cavities after major cardiothoracic surgical procedure: relevance to percutaneous intervention. Simultaneous bilateral spontaneous pneumothorax: report of 12 instances and review of literature. Electrocardiogram modifications suggestive of coronary artery disease in pneumothorax: their reversibility with upright posture. Left rigidity pneumothorax mimicking myocardial infarction after percutaneous central venous cannulation. Plain and computed radiography for detecting experimentally induced pneumothorax in cadavers: implications for detection in sufferers. Comparison of upright inspiratory and expiratory chest radiographs for detecting pneumo thoraces. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification 178. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Quantification of the size of major spontaneous pneumothorax: accuracy of the Light index. Study protocol for a randomised managed trial of invasive versus conservative management of major spontaneous pneumothorax. Outcomes of emergency division sufferers handled for primary spontaneous pneumothorax. A randomized managed trial comparing mini chest tube and needle aspiration in outpatient management of main pneumothorax. Outpatient management of major spontaneous pneumothorax in emergency division of a neighborhood hospital utilizing a smallbore catheter and Heimlich valve. Simple aspiration versus chest tube insertion within the management of main spontaneous pneumothorax: a scientific evaluate. Aspiration versus tube drainage in major spontaneous pneumothorax: a randomized study. Comparison of a giant and smallcaliber tube drain for managing spontaneous pneumothoraces. The thoracic vent: clinical expertise with a new device for treating easy pneumothorax. Videoassisted thoracoscopy surgical procedure for main spontaneous pneumothorax: analysis of indications and longterm consequence compared with conservative therapy and open thoracotomy. Axillary thoracotomy versus videothoracoscopy for the treatment of main spontaneous pneumothorax. Videothoracoscopic therapy of major spontaneous pneumothorax: a 6year experience. Longterm outcomes after videoassisted thoracoscopic surgery for firsttime and recurrent spontaneous pneumothorax. Primary spontaneous pneumothorax: onestage therapy by bilateral videothoracoscopy. Persistent pleuro pulmonary air leak handled with autologous blood: results from a university hospital and evaluate of literature. Autologous blood patch pleurodesis in spontaneous pneumothorax with persistent air leak. Fibrin glue software via the flexible fiberoptic bronchoscope: closure of broncho pleural fistulas.

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Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor lisinopril on morbidity and mortality in continual heart failure. Epideminology, pathophysiology, prognosis, and therapy of systolic and diastolic heart failure. Comparison of candesartan, enalapril, and their mixture in congestive heart failure. A randomized trial of the angiotensin receptor blocker valsartan in continual heart failure. Effects of candesartan in patients with persistent coronary heart failure and reduced left ventricular systolic perform intolerant to angiotensin-converting enzyme inhibitors. Effects of candesartan in sufferers with continual coronary heart failure and lowered left ventricular systolic perform taking angiotensin-converting enzyme inhibitors. Association of serum digoxin focus and outcomes in sufferers with coronary heart failure. Sex-based differences in the impact of digoxin for the therapy of coronary heart failure. Determinants and prognostic impact of coronary heart failure complicating acute coronary syndromes. Incidence, temporal developments, and prognostic influence of coronary heart failure complicating acute myocardial infarction. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical proof of coronary heart failure. The survival of patients with coronary heart failure with preserved or reduced left ventricular ejection fraction: an individual patient knowledge metaanalysis. Hospitalization for coronary heart failure in the presence of a standard left ventricular ejection fraction. Congestive heart failure regardless of regular left ventricular systolic operate in a population-based sample: the strong heart study. Systolic versus diastolic coronary heart failure in group apply: clinical options, outcomes, and using angiotensin-converting enzyme inhibitors. Clinical presentation, management, and in-hospital outcomes of sufferers admitted with acute decompensated coronary heart failure with preserved systolic operate. Clinical characteristics and predictors of in-hospital mortality in acute coronary heart failure with preserved left ventricular ejection fraction. Trends in prevalence and end result of heart failure with preserved ejection fraction. Outcome of coronary heart failure with preserved ejection fraction in a population-based research. Prevalence, medical options and prognosis of diastolic heart failure: an epidemiologic perspective. Elevations of cardiac troponin I related to myocarditis; experimental and clinical correlates. Inflammatory cardiomyopathy (myocarditis): which sufferers must be handled with anti-inflammatory therapy The position of endomyocardial biopsy in the management of heart problems: a press release from the American Heart Association, the American College of Cardiology and the European Society of Cardiology. Long-term end result of fulminant myocarditis as in contrast with acute (non-fulminant) myocarditis. Effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. A comparability of antiarrhythmic drug therapy with implantable defibrillators in sufferers resuscitated from near-fatal ventricular arrhythmias. Improved survival with an implanted defibrillator in patients with coronary disease at excessive danger for ventricular arrhythmia. A randomized research of the prevention of sudden death in patients with coronary artery illness. Implantable defibrillators for the prevention of mortality in patients with non-ischemic cardiomyopathy.

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Outcome after cardiopulmonary resuscitation in patients with pulmonary arterial hypertension. Changes in exercise haemodynamics throughout therapy in pulmonary arterial hypertension. Why defend the best ventricle in sufferers with acute respiratory misery syndrome Prevalence and prognosis of cor pulmonale during protecting air flow for acute respiratory distress syndrome. A 40-year-old moderately obese man is admitted for sameday cardiac catheterization after presenting with 6 months of worsening chest tightness, dyspnea on exertion, and cough. Echography was technically troublesome, precluding evaluation of the left ventricle, but the right ventricle appeared mildly dilated with vital elevation of the pulmonary artery systolic stress. A 27-year-old feminine with a previous medical history of scleroderma with related pulmonary hypertension identified 5 years in the past presents with syncope. Her present medical regimen includes inhaled prostacyclin, an endothelin receptor blocker, and a phosphodiesterase inhibitor. Her important signs present a blood pressure of 70/50 mm Hg and a coronary heart price of 88 beats/min. She is using chronic oxygen therapy and her oxygen saturation is 96% on three L (via nasal cannula). Owing to hypotension, she is transferred to the intensive care unit and a Swan-Ganz catheter is placed to help in administration. Her outpatient therapy wanted escalation over time such that now she is receiving treprostinil subcutaneous infusion of 100 �g/kg per minute, ambrisentan 10 mg every day, sildenafil 40 mg three times a day, spironolactone 50 mg 2 instances a day, digoxin 250 �g as quickly as a day, and torsemide 40 mg 2 occasions a day. Since presenting to the hospital, her respiratory worsened and he or she needed mechanical ventilation. Insert a pulmonary artery catheter to acquire correct hemodynamics and assist her with an inotrope; if that method fails, start mechanical support. Inotrope and mechanical support should be thought-about, as should be candidacy for lung transplantation in this younger patient with out overt contraindications. Massive hemoptysis is outlined as the expectoration of blood from the respiratory tract in lifethreatening portions. Clinical definitions of huge hemoptysis focus on selected quantities of coughed blood between 200 and a thousand mL over 24 hours or much less, with higher than 600 mL as the most typical criterion. The adverse scientific effects of hemoptysis, similar to impaired gas trade, airway obstruction, or hypotension, could additionally be more related for defining a life-threatening condition. Although mortality charges as high as 71%6 had been reported prior to now, mortality charges in latest research of huge hemoptysis vary from 0% to 38%. Pulmonary Circulation the pulmonary artery bifurcates into left and right major pulmonary arteries after it leaves the right aspect of the center. The pulmonary circulation is a low-pressure system, however pulmonary artery pressures may rise to strategy systemic pressures in pulmonary parenchymal and pulmonary vascular illnesses. Bleeding from the pulmonary arterial circulation accounts for less than 10% of large hemoptysis circumstances and has been famous in a wide selection of harmful pulmonary lesions, together with tuberculosis, lung abscess, and aspergillosis. Anatomic Considerations the lung is unique among the visceral organs in that it receives a twin blood provide from completely different circulations. Because hemoptysis 704 Bronchial Circulation Bleeding from the higher-pressure bronchial circulation has been estimated to trigger 88% of the circumstances of huge and submassive hemoptysis. The one or two bronchial arteries that provide each lung in the majority of individuals10 come up from the area close to the primary and second intercostal arteries. Particularly on the right facet, the bronchial arteries might arise instantly from the proximal first intercostal artery. The arteries course along the trachea, main bronchi, and bronchioles and have terminal communications with the pulmonary capillaries or pulmonary venules. The small-vessel bronchial provide to the trachea and major bronchi drains into the azygos vein with direct communication to the superior vena cava. Aneurysmal dilation of bronchial arteries (Dieulafoy vascular malformation) has been famous in some sufferers with hemoptysis, and it might possibly occasionally be visualized endobronchially and noted on bronchial arteriography. Anatomic studies have discovered that intermeshing of pulmonary and bronchial capillary networks is the most common anastomotic arrangement that stops pressurization of the pulmonary arterioles with systemic pressures.

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Note elevated filling pressures at a imply of 24 mm Hg with V waves at common top of 32 mm Hg. Mean pulmonary capillary wedge strain rose to 33 mm Hg with V waves to 48 mm Hg. The markedly thickened mitral valve (B) was excised from this affected person after being torn (arrow) during balloon mitral commissurotomy. Elimination of mitral stenosis gradient (area in A, crammed in red) is demonstrated. The first coronary heart sound may be gentle, reflecting lack of brisk apposition of the mitral valve leaflets. Thus the systolic murmur may decrease in intensity earlier than the onset of the aortic second heart sound. The V wave on the wedge tracings is roughly 28 mm Hg, however on direct left atrial stress the measurement obtained by transseptal puncture is 44 mm Hg. The gradients between the wedge stress and left atrial strain throughout systole (area filled in blue) and through diastole (area filled in red) represent artifact due to damping and section delay of pressure waveforms reflected throughout the pulmonary vascular mattress. A combination of an inotrope (typically dobutamine; a vasoconstrictor ought to be avoided) and nitroprusside can have related salutary results. The key to improved function and outcomes has typically included preserving the integrity of the submitral equipment,179 and comparability of profitable repair versus alternative has indicated that high-volume institutions (>140 mitral operations/year) have one of the best results with nearly twice the speed of successful restore as low-volume institutions. The most extensively studied relies on catheter-based edge-to-edge repair of the mitral leaflets designed to mimic the surgical process developed by Alfieri and colleagues. Although the distinction between surgical procedure and MitraClip endured at 5-year follow-up, the vast majority of occasions that favored surgical procedure have been noted early. Transcatheter mitral valve replacement is being carried out by way of a selection of access routes together with transapical, transjugular, and transseptal. There is an related danger of sudden dying, heart failure, and cerebral and systemic embolism. All besides the mitral valve clip used for leaflet restore are experimental within the United States. Because the obstruction begins after the initial brisk ejection of blood from the ventricle, the onset of murmur is late after the primary coronary heart sound. B, Systolic anterior motion of the anterior mitral leaflet with apposition in opposition to outflow tract (arrows). The severely hypertrophied septum on the two-dimensional view is proven on the high of every panel. Dramatic exaggeration of the resting gradient in the postextrasystolic beat, with lower systemic stress, and narrowed pulse strain (difference between femoral systolic and diastolic pressure) are demonstrated-all hallmarks of dynamic outflow obstruction. Typical thresholds for intervention are a resting peak instantaneous gradient of 50 mm Hg or extra, although relying on diploma of symptoms and provocability, a selection of different thresholds have been applied. Nevertheless, the disease remains prevalent in developing countries and a small however vital variety of sufferers continue to current in the important care setting all through the world. A proper ventricular carry may happen in sufferers with superior and continual pulmonary hypertension, and occasionally a palpable pulmonic second sound is felt. Both S1 and P2 are elevated early in the course of the disease; with progressive deformity of the subvalvular apparatus, S1 might turn into fairly soft as mitral valve closure velocity decreases. Presystolic accentuation is the end result of increased circulate in late diastole attributable to atrial contraction in patients in sinus rhythm. Other important traits of the mitral leaflets are diploma of thickening, mobility, and calcification, all of which, along with extent of subvalvular disease, help to handle suitability for balloon dilation or commissurotomy somewhat than valve alternative. The valve space is regularly instantly measured utilizing planimetry of a cross-sectional view. Cardiac catheterization can additionally be used to assess pulmonary artery pressures and response to exercise if the clinical and noninvasive footage are discordant. Cross-sectional views of the left atrial floor of the valve are shown in the inset. With mitral stenosis, the valve opening is restricted with a characteristic doming appearance, the commissures are fused, the leaflets are thickened, the subvalvular equipment is deformed, and a few calcification is noted. This is a vicious circle because the tachycardia could also be a response to insufficient stroke volume; the tachycardia then lowers the diastolic filling period and additional exacerbates the gradient.

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Iomar, 36 years: The advanced nature of discordant extreme calcified aortic valve disease grading: new insights from mixed Doppler echocardiographic and computed tomographic study. In sufferers with overt shock, thrombus fragmentation is often the first precedence of therapy with the aim to expedite discount in clot burden. Benign symptomatic premature ventricular complexes: short- and long-term efficacy of antiarrhythmic drugs and radiofrequency ablation. Ramipril and metoprolol consumption irritate human and murine anaphylaxis: proof for direct mast cell priming.

Goran, 33 years: Effects of acute and persistent interleukin-6 administration on thyroid hormone metabolism in humans. Rupture of the left ventricular free wall might manifest in any of several ways: pericardial tamponade with acute hemodynamic collapse and immediate dying, gradual onset of tamponade and hypotension, or subacute formation of a pseudoaneurysm. A preliminary, randomized, multicenter examine evaluating intravenous immunoglobulin, plasma change, and immune adsorption in Guillain-Barr� syndrome. Value of the medical pulmonary infection rating for the identification and administration of ventilatorassociated pneumonia.

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