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One approach to circulation and blood flow in the critical care unit

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World Journal of Critical Care Medicine 2019年第4期8卷 36-48页

作者： Camilo Pena-Hernandez kenneth nugent Department of Internal Medicine Division of Nephrology and HypertensionTexas Tech University Health Sciences CenterLubbockTX 79430United States Department of Internal Medicine Division of Pulmonary and Critical Care MedicineTexas Tech University Health Sciences CenterLubbockTX 79430United States

Evaluating and managing circulatory failure is one of the most challenging tasks for medical practitioners involved in critical care *** the applicability of some of the basic but,at the same time,complex physiological processes occurring during a state of illness is sometimes neglected and/or presented to the practitioners as point-of-care protocols to ***,managing hemodynamic shock has shown us that the human body is designed to fight to sustain life and that the compensatory mechanisms within organ systems are *** this review article,we have created a minimalistic guide to the clinical information relevant when assessing critically ill patients with failing *** such as organ blood flow,circulating volume,and hemodynamic biomarkers of shock are *** addition,we will describe historical scientific events that led to some of our current medical practices and its validation for clinical decision making,and we present clinical advice for patient care and medical training.

关键词： Shock Volume status Fluid Vasopressors Mean systemic pressure Pulse pressure Plethysmography variability index

Obstructive Sleep Apnea and Post-Operative Complications: Single Center Data, Review of Literature and Guidelines for Practicing Internists and Surgeons

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Surgical Science 2012年第2期3卷 65-71页

作者： kenneth M. nugent Michael Phy Rishi Raj Texas Tech University Health Sciences Center Lubbock USA

Obstructive sleep apnea has been linked to higher rates of post-operative complications in some studies. We examined the prevalence of obstructive sleep apnea and its impact on post-operative complications in 125 patients (21 prospective, 104 retrospective) undergoing various elective outpatient surgeries at our institution. Ten percent of these patients had OSA, and half of them were on continuous positive airway pressure therapy (CPAP). Patients who were on CPAP as outpatients received CPAP post-operatively as well. No patients died, and the prevalence of post-operative complications was low. There was no difference in complication rates between patients with and without OSA. We also review the existing literature on this subject and make practical recommendations regarding pre-operative evaluation and post-operative management of these patients for practicing internists and surgeons based on the current literature.

关键词： Obstructive Sleep Apnea Postoperative Complications Pre-Operative Evaluation

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静脉滴注高剂量甲氨蝶呤引发急性心脏毒性

中国处方药 2005年第12期4卷 54-57页

作者： Alejandro Perez-Verdia Freddy Angulo Fred L.Hardwicke kenneth M.nugent 林宝琴

甲氨蝶呤常用于治疗癌症和炎症(如风湿性关节炎)。甲氨蝶呤通过抑制叶酸还原,能够破坏DNA合成,从而抑制细胞增殖。然而,临床研究发现甲氨蝶呤除了有抑制细胞增殖作用外,还有直接的细胞毒作用。这些报道主要描述了该药物的中枢神经系统毒... 详细信息

甲氨蝶呤常用于治疗癌症和炎症(如风湿性关节炎)。甲氨蝶呤通过抑制叶酸还原,能够破坏DNA合成,从而抑制细胞增殖。然而,临床研究发现甲氨蝶呤除了有抑制细胞增殖作用外,还有直接的细胞毒作用。这些报道主要描述了该药物的中枢神经系统毒性,并提示对代谢通路的干扰可能是产生这一毒性的原因。本文主要描述了一位年轻的骨肉瘤患者在高剂量滴注甲氨蝶呤治疗过程中引发心律失常的案例。从以往健康成人使用甲氨蝶呤的病例中,临床医生应该意识到给病人使用高剂量甲氨蝶呤会引发心脏病症状和心律失常等并发症,同时也应该提高警惕和进行更多的临床调查。

关键词：心脏毒性静脉滴注高剂量甲氨蝶岭急性甲氨蝶呤治疗标准协议介入治疗多柔比星相关症状

Endoscopic removal of multiple duodenum foreign bodies:An unusual occurrence

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World Journal of Gastrointestinal Endoscopy 2010年第5期2卷 186-189页

作者： Sameer R Islam Ebtesam A Islam David Hodges kenneth nugent Sreerum Parupudi Department of Internal Medicine and Gastroenterology Texas Tech University Health Sciences Center3601 4th StreetLubbockTX 79430United States

Deliberate single foreign body ingestion is a scenario that many gastroenterologists commonly see in psychiatric units and ***,multiple foreign body ingestions,especially located in the duodenum,provide the endoscopist with unique challenges for management and *** most foreign objects pass spontaneously,one should have a low threshold of intervention for multiple objects,especially those that are wide,sharp and at risk of *** is typically made when there is a history of ingestion coupled with corresponding radiographic *** symptoms tend to be non-specific although some patients are able to delineate where the discomfort level is,correlating with the site of *** foreign bodies pass spontaneously;however when multiple sharp objects are ingested,the gastroenterologist should perform endoscopic procedures to minimize the risks of bowel *** describe here a successful case of multiple ingested foreign bodies retrieved across the C-loop of the duodenum and the pharynges-esophageal curve via endoscopy and review the literature of multiple foreign body ingestion.

关键词： Foreign bodies Multiple Duodenum Management Foreign body ingestions