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Fluid balance concepts in medicine:Principles and practice

World Journal of Nephrology 2018年第1期7卷 1-28页

作者： Maria-Eleni Roumelioti Robert H Glew zeid J Khitan Helbert Rondon-Berrios Christos P Argyropoulos Deepak Malhotra Dominic S Raj Emmanuel I Agaba Mark Rohrscheib Glen H Murata Joseph I Shapiro Antonios H Tzamaloukas Division of Nephrology Department of MedicineUniversity of New Mexico School of MedicineAlbuquerqueNM 87131United States Department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87131United States Division of Nephrology Department of MedicineJoan Edwards School of MedicineMarshall UniversityHuntingtonWV 25701United States Division of Renal and Electrolyte Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA 15260United States Division of Nephrology Department of MedicineUniversity of Toledo School of MedicineToledoOH 43614-5809United States Division of Renal Disease and Hypertension Department of MedicineGeorge Washington UniversityWashingtonDC 20037United States Division of Nephology Department of MedicineJos University Medical CenterJosPlateau State 930001Nigeria Research Service Raymond G Murphy VA Medical Center and University of New Mexico School of MedicineAlbuquerqueNM 87108United States 不详

The regulation of body fluid balance is a key concern in health and disease and comprises three concepts. The first concept pertains to the relationship between total body water(TBW) and total effective solute and is expressed in terms of the tonicity of the body fluids. Disturbances in tonicity are the main factor responsible for changes in cell volume, which can critically affect brain cell function and survival. Solutes distributed almost exclusively in the extracellular compartment(mainly sodium salts) and in the intracellular compartment(mainly potassium salts) contribute to tonicity, while solutes distributed in TBW have no effect on tonicity. The second body fluid balance concept relates to the regulation and measurement of abnormalities of sodium salt balance and extracellular volume. Estimation of extracellular volume is more complex and error prone than measurement of TBW. A key function of extracellular volume, which is defined as the effective arterial blood volume(EABV), is to ensure adequate perfusion of cells and organs. Other factors, including cardiac output, total and regional capacity of both arteries and veins, Starling forces in the capillaries, and gravity also affect the EABV. Collectively, these factors interact closely with extracellular volume and some of them undergo substantial changes in certain acute and chronic severe illnesses. Their changes result not only in extracellular volume expansion, but in the need for a larger extracellular volume compared with that of healthy individuals. Assessing extracellular volume in severe illness is challenging because the estimates of this volume by commonly used methods are prone to large errors in many illnesses. In addition, the optimal extracellular volume may vary from illness to illness, is only partially based on volume measurements by traditional methods, and has not been determined for each illness. Further research is needed to determine optimal extracellular volume levels in several illne

关键词： Body fluids Body water Extracellular volume Hypertonicity Hypotonicity Congestive heart failure Hepatic cirrhosis Sepsis Nephrotic syndrome

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Evaluation of Bilateral Mental Nerve Block as an Alternative to General Anesthesia for Resection of Lower Lip Tumors

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Surgical Science 2017年第8期8卷 319-325页

作者： Ashraf Khater Islam A. Elzahaby Mohamed Hamdy Mohammad Zuhdy Omar Hamdy Mohamed Ezzat Mahmoud Abdelaziz Ahmad M. Farid Mansour Elmoatasem Amr Hassan Khalid Atallah Mahmoud Mostafa Saleh Maha A. Abo-zeid Amr Yassin Ola Taha Abd Eldayem Mona Gad Department of Surgical Oncology Mansoura Oncology Center (OCMU) Faculty of Medicine Mansoura University Mansoura Egypt Anesthesia and Surgical Intensive Care Department Mansoura University Hospital Faculty of Medicine Mansoura University Mansoura Egypt

Objective: Nerve blockade is commonly used in oncosurgical procedures as an alternative to general anesthesia for older patients and those with significant medical problems. We report a single tertiary oncology center experience in performing various lip resections and reconstructive techniques using this technique. Patients and methods: sixty patients with lower lip tumors were enrolled into this study with exclusion of refusing, non-compliant and critically ill patients. A solution of 4 ml 2% Lidocaine and epinephrine was put in a 5 ml syringe. Half the solution (2 ml) was injected into each side with a 23 gauge needle and after 5 minutes the surgical resection was carried out after testing for anesthesia. Results: The mean age was 68 ± 6.2 years. The mean ASA score was 3 ± 0.75. There were 4 cases who expressed painful sensation and their operations were completed with fentanyl increments. Mean hospital stay was 1 ± 0.75 days. There were three cases of wound gaping who were treated with secondary closure in an outpatient basis. One patient expressed postoperative acute ischemic heart pain that was managed with anti-ischemic measurements. Conclusion: Bilateral mental nerve block is a safe and effective alternative to general anesthesia in lower lip tumors’ resection especially in older patients and those with poor tolerance for general anesthesia provided that there is no need for cervical nodal dissection.

关键词： Mental Nerve Block Lip Tumors Lidocaine

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