1/77. Non-heart-beating donors: a case study in procurement.To help meet the increasing need for transplantable organs, especially kidneys, organ procurement organizations are recovering organs from non-heart-beating patients. This article outlines the successful recovery and transplantation of kidneys from such a donor. Consent issues and historical background are also discussed.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
2/77. Ventricular asystole during vagus nerve stimulation for epilepsy in humans.Electrical stimulation of the vagus nerve, a recently available option for patients with refractory epilepsy, has demonstrated safety and efficacy. We report four patients with refractory epilepsy who experienced ventricular asystole intraoperatively during initial testing for implantation of the vagus nerve stimulator. Acute intraoperative vagus nerve stimulation may create ventricular asystole in humans. Extracorporeal cervical vagus nerve stimulation testing with continuous EKG monitoring intraoperatively before generator implantation is warranted.- - - - - - - - - - ranking = 1.115211634414keywords = nerve (Clic here for more details about this article) |
3/77. Recurrent cardiocirculatory arrest after kidney transplantation related to intravenous methylprednisolone bolus therapy.BACKGROUND: Intravenous bolus therapy with steroids is often used in standard immunosuppression initially after organ transplantation and to treat acute graft rejection. Although this regimen in generally is safe, severe adverse effects can occur. methods: This letter gives a picture of the eventful clinical course of a patient with preexisting heard problems after renal transplantation. RESULTS: This case report proves lethal cardiopulmonary complications closely related to the recurrent intravenous administration of methylprednisolone in a risk patient. CONCLUSIONS: Severe side effects after the application of high-dose steroids are possible. If risk patients are identified, steroid bolus therapy should be avoided or, if not possible, should only be done under close monitoring.- - - - - - - - - - ranking = 0.25keywords = organ (Clic here for more details about this article) |
4/77. Hospital resuscitation of cardiac arrest patients.Resuscitation of collapsed cardiac patients is often a not-too-successful affair. It has been repeatedly emphasised that the most important aspect of cardiac resuscitation is early access, early recognition of ventricular fibrillation and early defibrillation in patients with ventricular fibrillation. However, the co-ordination of the various phases of cardiac resuscitation itself, which is often forgotten, would need a good organisation so that a systematic assessment of the patient can be done while resuscitation is in progress. In this report, we describe a case of successful prolonged cardiac resuscitation with emphasis on the organisation of resuscitation as well as early defibrillation. We would also like to emphasise that all procedures that were done were performed correctly and their effects on the monitored patient were assessed frequently so as to maximise efficiency, myocardial salvage and patient survival.- - - - - - - - - - ranking = 0.5keywords = organ (Clic here for more details about this article) |
5/77. bradycardia and asystole with the use of vagus nerve stimulation for the treatment of epilepsy: a rare complication of intraoperative device testing.PURPOSES: A 56-year-old man with mild mental retardation, right congenital hemiparesis, and refractory partial seizures was referred for vagus nerve stimulation (VNS). methods: Routine lead diagnostic testing during the surgical procedure (1.0 mA, 20 Hz, and 500 micros, for approximately 17 s) resulted, during the initial two stimulations, in a bradycardia of approximately 30 beats/min. A third attempt led to transient asystole that required atropine and brief cardiopulmonary resuscitation. RESULTS: The procedure was immediately terminated, the device removed, and the patient recovered completely. A postoperative cardiologic evaluation, including an ECG, 24-h Holter monitor, echocardiogram, and a tilt-table test, was normal. CONCLUSIONS: Possible mechanisms for the bradycardia/asystole include stimulation of cervical cardiac branches of the vagus nerve either by collateral current spread or directly by inadvertent placement of the electrodes on one of these branches; improper plugging of the electrodes into the pulse generator, resulting in erratic varying intensity of stimulation; reverse polarity; and idiosyncratic-type reaction in a hypersusceptible individual. The manufacturer reports the occurrence rate in approximately 3,500 implants for this intraoperative event to be approximately one in 875 cases or 0.1%.- - - - - - - - - - ranking = 0.83640872581053keywords = nerve (Clic here for more details about this article) |
6/77. Non-heart-beating organ donation: process and review.To combat the national shortage of donor organs and meet the needs of more than 60,000 patients awaiting transplant, many organ procurement organizations have reevaluated non-heart-beating organ donation (NHBD) as one solution. Non-heart-beating donation is the process by which organs are recovered from patients after the pronouncement of death by cardiopulmonary criteria. Recent media reports have misled health care providers to believe that this is a new donation procedure; however, NHBD provided the foundation for modern clinical transplantation. This article describes non-heart-beating donor evaluation criteria, the donation process, associated ethical considerations and the role of the advance practice nurse in assisting families with this end-of-life decision. A case study will be presented followed by a summary of transplant recipient patient and graft survival outcomes.- - - - - - - - - - ranking = 2.25keywords = organ (Clic here for more details about this article) |
7/77. Maximizing liver transplantation from non-heart-beating donors.In order to increase the supply of transplantable organs, an increasing number of organ procurement organizations are adopting policies regarding donations from non-heart-beating donors. Few centers, however, actually recover and transplant these organs. This article reviews a case in which kidneys and livers imported from out of state were successfully recovered from a non-heart-beating donor and transplanted. In addition, the article demonstrates how cooperation and flexibility in transplant personnel can increase the number of organs transplanted from a non-heart-beating donor.- - - - - - - - - - ranking = 1.25keywords = organ (Clic here for more details about this article) |
8/77. Fatal cardiac arrhythmia after infusion of dimethyl sulfoxide-cryopreserved hematopoietic stem cells in a patient with severe primary cardiac amyloidosis and end-stage renal failure.amyloidosis (AL) is a rapidly fatal plasma cell dyscrasia causing progressive multiorgan failure. Recently, substantial improvement of survival was reported following high-dose chemotherapy with peripheral blood stem cell (PBSC) rescue. We describe a patient with AL with severe cardiac and renal involvement who received high-dose melphalan followed by fractioned autologous PBSC transplantation (455 ml on day 1 and 350 ml on day 2). Immediately after the second infusion of the PBSCs, life-threatening cardiac arrhythmias occurred and, despite intensive treatment, the patient died less than 24 h later. The infusion of cryopreserved PBSCs may be associated with complications, including cardiac toxicity. dimethyl sulfoxide (DMSO) is the most frequently used cryopreservation agent. In the present case, we suggest that DMSO could have played an important role in causing the fatal cardiac arrhythmias. The mechanisms of the cardiovascular effects of DMSO and the possible preventive measures are discussed. Given the poor prognosis of AL and the promising results of dose-intensive chemotherapy with autologous PBSC transplantation, careful patient selection and intensive monitoring are mandatory in order to further pursue this therapeutic approach.- - - - - - - - - - ranking = 0.25keywords = organ (Clic here for more details about this article) |
9/77. The first non-heart-beating organ donor in hawaii--medical and ethical considerations.The shortage of organ donors remains a major obstacle in transplantation in hawaii. Some patients die while waiting for a life-saving organ. Across the nation, "marginal" donors, including non-heart-beating donors are used. The authors describe the first successful non-heart-beating organ donor transplant in hawaii, and include medical and ethical considerations.- - - - - - - - - - ranking = 1.75keywords = organ (Clic here for more details about this article) |
10/77. Vagal schwannoma of the cerebello-medullary cistern presenting with hoarseness and intractable tinnitus: a rare case of intra-operative bradycardia and cardiac asystole.Schwannomas arising from the lower cranial nerves (IX-XI) are rare, constituting only 3% of all intracranial schwannomas unassociated with neurofibromatosis. A great majority of these tumours present as jugular foramen lesions and less commonly they occur along the extracranial course of these nerves. An intracisternal location is extremely rare. We report a case of vagal schwannoma purely in the cerebello-medullary cistern causing distortion of the medulla oblongata. Total microsurgical excision of this tumor, arising from one of the rootlets of the vagus nerve, was achieved with preservation of the 9th, 10th and 11th cranial nerves.The intraoperative course was complicated by two episodes of complete cardiac asystole, each lasting for 4(s), and six episodes of severe bradycardia. The patient was relieved of his intractable tinnitus but continued to have a hoarse voice due to an ipsilateral partial vocal cord palsy.- - - - - - - - - - ranking = 0.55760581720702keywords = nerve (Clic here for more details about this article) |
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