Mechanical support therapy

Mechanical support therapy has been a significant addition to the armamentarium against refractory heart failure. However, surgically placed pumps are associated with significant morbidity and mortality, most related to the surgical implantation procedure... 

In 1996, the National Institute of Drug abuse discontinued clinical trials of ibogaine. Research is currently undertaken by researchers outside of the United States. Far more empirical research is needed to establish the antiaddictive effects of ibogaine. The neuropharmacological mechanisms support possible antiaddictive effects, and results of case studies suggest further investigation. If successful, it would still be necessary to complement it with psychosocial support and counseling, as with other addiction therapies. 

Patients who are critical and do not satisfactorily respond to supportive therapy should be administered specific cyanide antidotes as outlined in Table 19.5. Cyanide antidotes have been classified into three main groups based on their mechanism of action (1) methemoglobin inducers, (2) sulfur donors, and (3) cobalt compounds. The definitive treatment of cyanide poisoning differs in various countries due to different medical practices and guidelines. The safety... 

There is a data need to develop better chelation therapies, better ways to prevent absorption of mercury into the body of children, and better ways to interfere with the mechanism of action, especially for damage to the nervous system. The current literature continues to grow with case histories of poisonings where supportive therapy and passive observation of a progressively deteriorating health status are the best that can be done. 

Recently, treatment options for RDS have advanced significantly. Effective drug therapies include surfactant and perfluorocarbons (PECs). Nitric oxide and extracorporeal membrane oxygenation (ECMO) have been used as final resorts. Supportive therapies such as mechanical ventilation, management of acidosis, and diuresis are also important. An algorithm for prevention and treatment of neonatal RDS is presented in Fig. 28-2. 

Antivenoms (usually made by injecting a tolerant animal with the venom) are the best therapy with adrenaline required in cases of anaphylactic shock. Antibiotics, corticosteroids, ice-packs and rest can be used as supportive therapy while oxygen, mechanical ventilation and intravenous fluid support may be needed in severe cases and atropine may be useful in reducing salivation. Severe hypertension and tachycardia may respond to P-blockers most reports suggest that benzodiazepines are useful sedatives. 

Jaramillo-Botero A et al (2010) First-principles based approaches to nano-mechanical and biomimetic characterization of polymer-based hydrogel networks for cartilage scaffold-supported therapies. J Comput Theor Nanosci 7(7) 1238—1256... 

If there is dear evidence of worsening prompt hospital admission for intensive therapy is necessary. As the availability of a suitable donor heart is not predictable, hemodynamic deterioration is first treated with intravenous inotropic support. When the low-cardiac-output syndrome continues to be refractory, patients are put on a mechanical circulatory device for temporary mechanical support. This bridge to transplantation concept enables patient stabilization, withdrawal of intravenous medication (inotropic agents, catecholamines, calcium sensitizers) and rehabilitation (Antretter et al. 2002a). During chronic mechanical circulatory support a low level of exercise is possible and the patients are able to walk around, to leave hospital and sometimes they are followed up by heart failure specialists in an outpatient clinic. Nearly 25% of the most recent cohort transplanted from 1 January, 2001 to 30 June, 2003 were on some type of mechanical circulatory support (Taylor et al. 2004). 

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