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The indwelling pleural catheter (IPC) is an established treatment for recurrent pleural effusion. Fluid leakage through the IPC insertion tract has been reported, but its occurrence is only limited to a short period after the procedure. Besides, the drainage efficacy of IPC may be limited by the presence of loculation in the pleural space, especially when intrapleural fibrinolytic is contraindicated. We report a case of fluid leakage through the healed entry site of IPC due to high pressure built from undrained pleural fluid locules, which was successfully treated with an additional drain targeting the largest undrained locule. [ABSTRACT FROM AUTHOR]

Aim To investigate the sealing quality of ProRoot Endo Sealer, a calcium silicate-based sealer and its morphologic characteristics after immersion in a phosphate-containing fluid (PCF). Methodology Single-rooted canals were filled with gutta-percha and either ProRoot Endo Sealer or two commercially available zinc oxide eugenol (ZOE)-based and epoxy resin-based sealers. The sealers were allowed to set for 6 days and the filled teeth were immersed in PCF for 24 h before fluid leakage evaluation. After initial leakage evaluation at the 7th day, each filled root was restored and reimmersed in PCF for 28 days before the second phase of leakage evaluation at 35 days. Cryofractured specimens of additional teeth filled with the three sealers were examined using scanning electron microscopy after immersion in PCF for the two periods. Results One-way repeated measuresanova and Tukey test revealed significant differences between the ZOE-based sealer at 35 days and the calcium silicate-based sealer at 35 days ( P < 0.001), and between the ZOE-based sealer at 7 days and the calcium silicate-based sealer at 35 days ( P = 0.001). No difference was found between the epoxy resin-based sealer and the calcium silicate-based sealer after both storage periods. Cryofractured calcium silicate-based sealer specimens demonstrated apatite-like crystalline deposits along the apical and middle thirds of the canal walls via transformation from amorphous calcium phosphate-like precursors. Conclusions ProRoot Endo Sealer is comparable in sealing quality to the epoxy resin-based sealer and seals better than the ZOE-based sealer after immersion in PCF. The calcium silicate-based sealer also demonstrates ex vivo bioactivity when it comes into contact with phosphate ions. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary bypass (CPB) is associated with increased fluid filtration occasionally leading to post-operative organ dysfunction. One of the factors determining fluid filtration is the capillary hydrostatic pressure which depends on arterial pressure, venous pressure and pre- to post-capillary resistance ratio. The purpose of this study was to assess whether lowering of the mean arterial pressure and/or the central venous pressure could reduce fluid extravasation during normothermic and hypothermic CPB. Methods: Seven piglets were given nitroprusside to a mean arterial pressure of 35–40 mmHg during 60 min of normothermic and 90 min of hypothermic CPB (LP group). They were compared with a control group (C group, n = 7) without blood pressure interventions. Blood chemistry, net fluid balance, plasma volume, colloid osmotic pressure in plasma and interstitial fluid, intravascular protein masses, fluid extravasation rate and total tissue water content were measured or calculated. Results: Mean arterial pressure was significantly lower in the LP group than in the C group during CPB. Plasma volume tended to increase in the LP group ( P > 0.05), but remained essentially unchanged in the C group. Net fluid balance in the LP group was more positive than in the C group 30 min after CPB start [1.02 (0.15) vs. 0.56 (0.13) ml/kg/min (Mean (SEM) P < 0.05)]. Fluid extravasation rate tended to be higher in the LP group and total tissue water content of the gastrointestinal tract, left myocardium and skin was significantly elevated compared with the C group. Conclusion: During CPB, lowering of the mean arterial pressure using nitroprusside did not reduce fluid extravasation. On the contrary, the data may implicate an increase in edema formation during low pressure CPB. [ABSTRACT FROM AUTHOR]

Background: Hypothermia, commonly used for organ protection during cardiopulmonary bypass (CPB), has been associated with changes in plasma volume, hemoconcentration and microvascular fluid shifts. Fluid pathophysiology secondary to hypothermia and the mechanisms behind these changes are still largely unknown. In a recent study we found increased fluid needs during hypothermic compared to normothermic CPB. The aim of the present study was to characterize the distribution of the fluid given to maintain normovolemia. In addition, we wanted to investigate the quantity and quality of the fluid extravasated during hypothermic compared to normothermic CPB. Methods: Two groups of anesthetized piglets were studied during 2 h of hypothermic (28 °C) (n=7) or normothermic (38 °C) (n=7) CPB. Net fluid balance (input-output) was recorded. Changes in colloid osmotic pressures of plasma (COPp) and interstitial fluid (COPi), plasma volume (PV), hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), s-osmolality, s-albumin and s-total protein was followed throughout the experiments. Fluid extravasation rate was calculated. In addition, total tissue water content was measured and compared with a control group (n=6) (no CPB). Results: During hypothermic compared with normothermic CPB, the average net positive fluid balance from 10–120 min of extracorporeal circulation was 1.35±0.06 ml · kg-1 · min-1 and 0.33±0.03 ml · kg-1 · min-1 respectively (P<0.0001). We found a marked increase in fluid extravasation during hypothermic CPB. The extravasation rate during hypothermia was 1.8±0.2 ml · kg-1 · min-1, (1st hour) and 1.1±0.2 ml · kg-1 · min-1 (2nd hour) compared with 0.8±0.2 ml · kg-1 · min-1, and 0.1±(0.1) ml · kg-1 · min-1 during normothermia, respectively (P<0.01). The total intravascular protein and albumin masses remained constant in both groups. Following hypothermic CPB, the water content increased significantly in all tissues and organs. Conclusion: During hypothermic CPB an increased extravasation of fluid from the intravascular to the interstitial space was found. As no leakage of proteins could be demonstrated, based on stable values for albumin and protein masses throughout the experiments, the extravasated fluid contained mainly water and small solutes. [ABSTRACT FROM AUTHOR]

This study used an airway model to compare the ability of a pediatric endotracheal tube with a taper-shaped cuff to prevent microaspiration relative to endotracheal tubes with conventional cuffs. Four different types of 5.0-mm inner diameter cuffed pediatric endotracheal tubes (taper-shaped cuff [ Taper], high-volume low-pressure [ Hi- Lo], middle-volume low-pressure [Intermediate], and low-volume low-profile [ Lo- Pro]) were fixed within vertically placed acrylic tubes. The cuffs were maintained at 10, 20, or 30 cmH2O pressure and 3 mL of simulated stomach contents was added to the top of the cuffs. The volume of leakage around the cuffs after 5 min and 4 h was measured. After 5 min, the volume of leakage was significantly lower with the Taper than with the Hi- Lo, Intermediate, or Lo- Pro at all pressure settings. After 4 h, leakage was significantly lower with the Taper than with the other three tubes regardless of initial cuff pressure ( P < 0.05). [ABSTRACT FROM AUTHOR]