Bacterial filters in ventilation circuits neither reduce the prevalence of respiratory infections associated with MV nor decrease exogenous infectious events; thus, their usage is not necessary.
Adrenal insufficiency after cardiac surgery can easily be confused during the course of an immediate unstable postoperative period. If unrecognized, this condition may cause serious morbidity and can be fatal. We report on a 43-yr-old female patient with chronic known adrenal insufficiency, who, despite her adequate preoperative replacement therapy, presented with one episode of acute hypoadrenal crisis after elective open heart surgery, which could serve as a model to illustrate the salient clinical features and possible problems in this setting for diagnosing this problem to patients in whom chronic adrenal insufficiency remains unknown.
Introduction It has been previously shown that the two forms of acute cholecystitis, acute acalculous cholecystitis (AAC) and acute calculous cholecystitis (ACC), have significantly different histopathological features suggesting that AAC is a manifestation of systemic critical illness whereas ACC is a local disease of the gallbladder. A balance between cell proliferation and cell death is essential for cell homeostasis. The purpose of this study was to compare the markers of apoptosis, cell proliferation, and expression of hypoxic-inducible factor alpha (HIF-1α) in AAC, ACC and normal gallbladders. Methods The AAC group consisted of 30 patients who underwent open cholecystectomy due to acute acalculous cholecystitis during their ICU stay. The ACC group consisted of 21 hospitalized patients who underwent cholecystectomy due to acute calculous cholecystitis. The control group consisted of nine samples taken from normal gallbladders extirpated during pancreatic tumor surgery. The immunohistochemical analysis was done according to the manufacturer's recommendations and they consisted of Ki-67 (proliferation), M30 (apoptosis) and HIF-1α antibodies. Cell proliferation and degree of apoptosis were expressed as the percentage of positive cells. HIF-1α expression was expressed as absent or weak (Score 1) or strong (Score 2). Results Apoptosis (median, 25th, 75th percentiles) was significantly increased in AAC 1.3% (1.0%, 3.3%), P = 0.001 and ACC 0.93% (0.40%, 3.25%), P = 0.011 compared with controls 0.32% (0.20%, 0.40%). Proliferation rate was also significantly increased in AAC S2
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