Purpose of review Hospitalization and mortality rates associated with heart failure are persistently high. This is due partly to aging of the population but mostly to delayed progress in the pharmacological treatment of decompensated heart failure. We will review the current recommendations and most recent advancement in the pharmacological treatment of acute decompensated heart failure while providing a systematic approach to the management of this prevalent condition. Recent findings Loop diuretics, nitrates and inotropes such as dobutamine and milrinone are the current mainstay of acute heart failure management although their associated morbidity and possible mortality have raised serious concerns. Recent vasoactive agents such as xyzxyz軟體補給站
Nesiritide, Tolvaptan and more recently the inotropic agent Levosimedan could offer improved hemodynamics and congestive relief to patients in acute pulmonary edema.
摘要: xyz資訊工坊
Intra-abdominal infections are an important cause of morbidity and mortality in the intensive care unit(ICU). Peritonitis can be classified as primary, secondary, or tertiary, the unique pathologic features reflecting the complex nature of the endogenous gut flora and the gut-associated immune system, and the alterations of these that occur in critical illness. Outcome is dependent on timely and accurate diagnosisxyz軟體補給站, xyz
vigorous resuscitation and antibiotic support, and decisive implementation of optimal source control measures, specifically the drainage of abscessesand collections of infected fluid, the debridement of necrotic infected tissue, and the use of definitive measures to prevent further contamination and to restore anatomy and function.Conclusions: Optimal management of intra-abdominal infection in the critically ill patient is based on the synthesis of evidence, an understanding of biologic principles, and clinical experience. An algorithm outlining a clinical approach to the ICU patient with complex intra-abdominal infection is presented.
Guillain-Barre syndrome (GBS) is an important cause of acute neuromuscular paralysis. Molecular mimicry and across-reactive immune response play a crucial part in its pathogenesis, at least in those cases with a preceding.Campylobacter jejuni infection and with antibodies to gangliosides. The type of preceding infection and patient-related host factors seem to determine the form and severity of the disease. Intravenous immunoglobulin (IVIg) and plasma exchange are eff ective treatments in GBS; mainly for practical reasons, IVIg is the preferred treatment. Whether mildly aff ected patients or patients with Miller Fisher syndrome also benefi t from IVIg is unclear. Despite medical treatment, GBS often remains a severe disease; 3–10% of patients die and 20% are still unable to walk after 6 months.In addition, many patients have pain and fatigue that can persist for months or years. Advances in prognostic modelling have resulted in the development of a new and simple prognostic outcome scale that might also help to guide new treatment options, particularly in patients with GBS who have a poor prognosis. Guillain-Barre' 症候群是一種感染後多發性神經炎，發生率是每十萬人中有1 至1. 5人，好發年齡是16歲至25歲，其次是40歲至60歲，以4歲至10歲的兒蜜較易受感染。Guillain-Barre' 氏症候鮮是一種急性、單一病程，侵犯周邊神經與腦神經的疾病，又稱之為多發神經根炎。患者運動、感覺、自主、以及腦神經傳導路徑，被巨大吞噬細胞浸蝕破壞髓鞘，阻礙神經傳導 。臨床表徵首先出現跌倒、步態不穩，由下肢侵犯，漫延至上肢、軀幹、及頸部肌肉，最後腦神經受到侵犯，導致雙側臉部肌肉無力，吞嘸障礙、發音困難。若呼吸肌肉受侵犯，會導致呼吸肌無力，氣鶴交換不足，需利用人工呼吸器來輔助呼吸。
