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Idiopathic systemic capillary leak syndrome (ISCLS), also known as Clarkson's disease, is a rare and potentially life-threatening condition characterized by episodes of plasma leakage from blood vessels into tissues, leading to shock and organ failure. The underlying mechanisms of ISCLS are not well understood, but it is believed to involve hypersensitivity of capillaries to inflammatory or immune triggers. Recent research suggests that the endothelial nitric oxide synthase (eNOS) pathway may play a role in ISCLS, but further investigation is needed to fully understand its involvement. A study found that the reactive hyperemia response, which is modulated by nitric oxide synthesis, appeared unaffected in ISCLS patients during the intercritical period, suggesting that the role of the nitric oxide pathway may not be straightforward in vivo. More research is needed to explore the complex interplay of different pathways involved in ISCLS. [Extracted from the article]

Diastolic dysfunction is an underestimated feature in the context of the critically ill setting and perioperative medicine. Advances in echocardiography, its noninvasive, safe and easy use, have allowed Doppler echocardiography to become a cornerstone for diagnosing diastolic dysfunction in clinical practice. The diagnosis of diastolic dysfunction and increased filling pressures is nevertheless complex. Using an echocardiographic assessment and the routine application of preload stress maneuvers during echocardiographic examination can help identify early stages of diastolic dysfunction leading to better management of patients at risk of acute heart decompensation in the perioperative period or during ICU stay. [ABSTRACT FROM AUTHOR]

The Impella Recover left direct (LD) is a new intravascular microaxial blood pump, intended as a short-term mechanical support especially in case of acutely reduced left ventricular function. From September 2002 to October 2004, Impella was used to support 12 patients: six patients were supported as bridge-to-heart transplant (HTx); three patients were treated for fulminant acute myocarditis, and three patients for postcardiotomy low-output syndrome. Mean support time was 8.8 ± 2.3 days. Overall mortality was 50%. Four patients were successfully HTxed; two patients supported as bridge-to-HTx died on left ventricular assist device. Two patients with myocarditis died of septic shock; two patients in the group of postcardiotomy died of multiorgan failure. The latter two patients were slowly weaned from the device, and at 3-months follow-up showed good improvement of the left ventricular function. Our initial experience with Impella Recover LD as mechanical support for patients in cardiogenic shock of various etiology is promising, yielding a good survival in a population of particularly compromised patients. [ABSTRACT FROM AUTHOR]

Impella Recover 100 is an intravascular microaxial blood pump designed for short-term circulatory support in conditions of reduced left ventricular function. Two-dimensional echocardiography is a consolidated tool to study and monitor patients undergoing circulatory support. Three-dimensional (3D) echocardiography is emerging as a source of more accurate analysis in heart morphology and function. We described the use of 3D echocardiography in a patient who underwent Impella recover 100 support for postcardiotomy shock. 3D echocardiography allowed complete visualization of the pump and provided excellent intraoperative assessment of the complex spatial location into the left ventricle. (ECHOCARDIOGRAPHY, Volume 22, September 2005) [ABSTRACT FROM AUTHOR]