Our arguments are the following: to start with, the criteria for any clinical diagnosis of BD were fulfilled ; 2nd, the electroencephalographic recording was isoelectric; and third, computed tomography angiography (CTA) showed signals of intracranial circulatory arrest (Figure?one). The sensitivity of CTA in detecting intracranial 14 Innovative Practices To Avoid PTC124 Problems circulatory arrest has been shown to get comparable to that of other established techniques .Figure 1Computed tomography angiography (CTA) demonstrates signals of intracranial circulatory arrest. (A) Axial-view CTA picture of the arterial phase. Extreme brain edema is shown. Both superficial temporal arteries are visualized. (B)Axial-view CTA picture of ...Nevertheless, we agree with Rady and Verheijde that a supraspinal origin of head-turning movements in our patient can't be ruled out.
In regard to your involved supply of such movements in BD, we advised in our prior report that additional research (including hispatological examination) are essential for this to become clarified.AbbreviationsBD: Brain death; CTA: Computed tomography angiography.Competing interestsThe authors declare that they have no competing interests.NotesSee connected letter by Wu and Orizaola Balaguer, http://ccforum.com/content/17/4/440AcknowledgementsYW and POB thank the Radiology Division of Hospital Universitario de Marqu��s de Valdecilla for technical and analytical support with all the CTA pictures. Written consent to publish was obtained from your patient��s upcoming of kin.We read through with interest the write-up by Pons and colleagues  in a current situation of Important Care and we'd like to ask them several concerns.
They excluded individuals ��for whom urine couldn't be collected based on the study protocol�� . What have been the good reasons for this - anuria, renal substitute therapy (RRT), ICU discharge or death? The authors stated that there was no patient getting RRT at the time with the review, but then they outlined 14 individuals requiring RRT within the initial 24?hrs. How many patients had been excluded as a result of less than 72?hours of follow-up? Considering the fact that acute kidney damage (AKI) diagnosis was mandatorily completed on admission in an effort to define AKI reversal from the very first three ICU days, what about patients who have been ��no-AKI�� on admission but developed AKI in these three?days?The authors evaluated urinary indices which are truly calculated variables, dependent on numerous measured parameters.
Within a pilot research , we demonstrated that urinary sodium (NaU) was reduced on admission in individuals who designed AKI from the 1st four ICU days. We believe that sequential NaU measurement is beneficial, specially while in the absence of diuretics, and that early AKI growth is characterized by decreases in NaU which might precede increases in creatinine, in both transient and persistent AKI (unpublished information).