This is the personal experience of David Luckenbach, diagnosed with brain and lung cancer in May 2009. Here is a spreadsheet of part of my "weekly" blood tests, we update it when I get another test.
For example, my first test showed a platelet count of 487, out of the normal 150-400 range which meant I don't bleed well but can clot well. I'd like to see RDW, random red blood cell width, come back near the normal range of 11-15. During acute illness or stress or when blood glucose levels are consistently elevated (e.g.
Glucose and Ketone Testing In One MeterThe same Nova meter used for hospital glucose testing also tests for ketones. Glucose and Ketone Testing From Capillary SamplesCapillary samples are not only preferred over urine samples to detect DKA,they are also easier to obtain and allow for immediate reflex testing of ketones.
StatStrip Blood Ketone Results in Only 10 Seconds StatStrip blood ketone results will quickly detect ketotic states for fast treatment decisions in DKA emergencies.
Multi-WellTM Technology Measures and Eliminates Interferences StatStrip Multi-Well technology measures and eliminates inferences such as hematocrit, asorbic acid, acetaminophen and uric acid. During the interval from the time she first began making suspension arrangements, until the diagnosis of her final illness in January of 1990, Mrs. Subsequently during her 1-12-90 admission the patient was diagnosed with metastatic adenocarcinoma of the upper lobe of the left lung.
Computerized Tomogram (CT) scan during this admission revealed a ring enhancing lesion of the right parietal lobe white matter consistent with metastatic disease. On 25 January, 1990 the patient was re-admitted with progressive swelling and discomfort of the right upper arm as well as absent radial, brachial and axillary pulses. On 6 February 1990 the patient was admitted with severe, intractable mid-back pain apparently secondary to her vertebral metastatic disease. Another hospitalization followed on 10 March, 1990 for severe, intractable nausea and vomiting with accompanying dehydration.
Following her discharge on 24 March the patient's condition improved to the point that she was briefly ambulatory and her nutritional status improved. It is significant to note that the patient experienced the complete loss of all hair on her head as a result of chemotherapy induced alopecia.
Throughout the period of the patient’s self-imposed dehydration the patient was repeatedly reassured that this was not a course of action she should feel compelled to continue and she was reassured that she could resume hydration at any time without any adverse impact on her cryopreservation arrangements. It is worth noting here that the patient developed several methods of coping with extreme thirst without resorting to increased doses of narcotic analgesics, or the use of anxieolytics or other sedating drugs. The patient remained conscious and appropriately responsive until the last 24 hours of life with the exception of a short period of agitation, delirium and confusion (~10 minutes duration) which occurred upon waking from a nap on 03 June.
Photo 1: As the patient becomes frankly agonal, transport medications are prepared for administration. Photo 2: The patient was a home hospice patient and experienced medico-legal death in her home. Immediately following the pronouncement of legal death the patient was moved from the reclining chair in which she arrested and was quickly carried to the portable ice bath (PIB) in an adjacent room.
Simultaneous with the start of CPS the patient was externally cooled with approximately 60 kg of water ice to which 5 gallons of room temperature water was added. Photo 3: The hospice nurse examines the ETCO2 detector (the disc-shaped plastic device under the nurse's left thumb).
Hi-impulse Thumper support terminated at 1802 due to blow-off of an internal gas line resulting in failure of the unit. Initial response to CPS was judged to be excellent as indicated by prompt return of agonal gasping, pinking-up of the skin, and an EtCO2 of 2-3% (5% is optimum). Evaluation of Baseline Blood Sample: A baseline blood sample drawn shortly after the start of CPS (but prior to the administration of any transport medications) is indicative of dehydration and emerging renal failure. At ~1838 SCCD augmented external cooling was temporarily discontinued due to lack of AC power during vehicular transport. Photo 4: The patient was transported to the mortuary for total body washout (TBW) without interruption in closed chest mechanical CPS.
Photo 5: The patient, with CPS continuing, is loaded into the van provided for transport to the mortuary which was located approximately 5 minutes drive from the patient's home. Photo 6: The H-cylinder of oxygen driving the Thumper is loaded next to the PIB in the transport vehicle. Photo 7: The patient in the PIB along with the oxygen bottle secured next to her is fully loaded into the vehicle and ready for transport to the mortuary for TBW. SCCD supported external cooling was re-initiated after arrival at the mortuary at approximately 1906. Comparison Of Cooling Methods: Above are actual cooling curves for three adult human cryopreservation patients on Thumper support, using ice bags, the Portable Ice Bath (PIB), and the PIB augmented by SCCD (squid) cooling. Photo 8: After arrival at the mortuary the PIB was placed atop the embalming table and preparations were made to carry out TBW. Thumper CPS was briefly interrupted between 1848 and 1849 when the H-oxygen cylinder supplying the unit became exhausted and was switched out for a fresh tank. At 2010 a small quantity (3cc-5 cc) of the blood-tinged foam characteristic of pulmonary edema was noted in the patient's oropharynx. There was no evidence of erosion of the gastric mucosa, as evidenced by lack of gastric bleeding; aspiration of the gastric tube in the EGTA disclosed yellow cream colored gastric contents, presumably Maalox and gastric juices tinged with bile. Note: 20 liters of SHP-1 flush solution was prepared using Dextran-40 as the colloid to minimize cold agglutination. The use of SHP-1 and ViaSpan, both intracellular perfusates, as a cold ischemic transport medium, is supported by both the clinical and experimental organ preservation literature (references) and in house research where SHP-1 has been used to successfully recover dogs without lasting neurological deficit following 4-hours of asanguineous perfusion with this solution at ~5°C. Femoral cut-down to connect the patient to the extracorporeal circuit for total body washout was begun at 1925. The femoral artery and vein were dissected free and #2 silk ties placed on the proximal and distal exposures of both vessels. Blood washout was carried out employing a custom-built, 2-head roller pump, a William Harvey 1500 bubble oxygenator, and a Shiley SAF-20, 20µ blood filter. The extracorporeal circuit was primed with 3 liters of washout solution, the composition of which is given in Table I.
Perfusion of six liters of Viaspan was begun at 2034 at a pressure of 60 mmHg and was concluded at 2040. Photo 12: The arterial cannula is being aspirated to remove any trapped air bubbles prior to connecting it to the extracorporeal circuit.
Photo 13: The arterial and venous lines are connected to the arterial and venous cannula immediately prior to the start of extracorporeal support and TBW.
Remarkably, no cold agglutination was observed during either TBW or subsequent cryoprotective perfusion of this patient.
Air transport was by private, prop-driven aircraft which arrived at Riverside Municipal Airport at approximately 0145 on 10 June, 1990. Photo 14: The fibderglass insulated air transport case is prepared to received the patient. Photo 15: The patient, atop the bed of ice bags, is covered over with additional ice bags prior to closure of the air transport container.
Photo 16: The patient loaded aboard a prop-driven aircraft for transport to Alcor's facilities in Riverside, CA. The patient was free of any signs of rigor mortis and there was no evidence of post-mortem lividity.
The composition of the perfusate employed to carry out cryoprotective perfusion is given in Table III. Median sternotomy was begun at 0500 on 10 June with an incision over the midline of the sternum with a #10 scalpel blade.
The left subclavian artery was identified and followed to locate the left vertebral and mammary arteries. A third small purse-string suture of 5-0 silk was placed in the left lateral aspect of the ascending aorta and an aortotomy made with a #11 scalpel blade.
The sterile perfusion tubing was then brought up to the surgical field and secured in a Travenol tubing holder towel-clamped to the drapes. The circuit consisted of two parts: a recirculating system to which the patient was connected, and a cryoprotectant addition system which was connected to the recirculating system. Arterial and venous samples for evaluation of chemistries and glycerol concentration were drawn at 15-minute intervals during cryoprotective perfusion. The perfusion circuit was prepared in advance of need and was sterilized with ethylene oxide using an appropriate protocol of post-sterilization out-gassing and aeration. Pulsatile flow was initiated at 0810 using a Tamari-Kaplitt pulsator at a rate of 60 pulses per minute. At 0820 glycerolization of the face and scalp was noted to be very uniform with no patchy non-perfused areas noted. The initial response to the start of the cryoprotective ramp was good, with cerebral cortical volume rapidly decreasing to 2-3 mm below the margin of the burr hole. The final venous cryoprotectant concentration was 4.5 M as measured by freezing point depression osmometery using a Precision Systems Osmette A osmometer. Photo 18: The cryoprotective (CPA) perfusion circuit has been primed and readied for the start of CPA perfusion. Photo 19: Median sternotomy and surgery to connect the patient to the CPA perfusion circuit is underway.
Photo 20: CPA concentration, arterial and venous blood gases and pH are analyzed in real time in the operating room. At 0945, the silastic-coated tip of a 15' long, 30 gauge, Kapton-wrapped copper-constantan (type T) thermocouple probe (Instrument Laboratory #53-30-513) was threaded into the burr-hole and placed on the cortical surface. Surgery for cephalic isolation was begun at 1003 with a circumferential skin incision made at the base of the neck and extended anteriorly and posteriorly to just below the margins of the clavicle. The cervical skin and musculature were observed to be dark in color, evenly stiff, and waxy in texture, consistent with uniform glycerolization.
Temperature descent to -77°C was monitored with probes in the frontal sinus, the brain surface, and head surface (placed temporally) and an additional probe was used to monitor bath temperature. An esophageal TC probe was not placed in the patient and as a consequence true surface to core temperature differential could not be measured. On 23 March, at 2256 the patient was removed from the Silcool bath, the outer Silcool-wetted plastic bag was stripped off, and the patient was placed inside a polyester pillow case resting on a bed of Dacron wool at the bottom of an aluminum neurocan.
As can be seen from the graphs above, control of cooling using this method was unsatisfactory.
Allowing fracturing to be delayed until the solution is cooled far below Tg results in a very large number of small fractures distributed throughout the solution. At 0036 on 12 June, 1990 the cooling assembly containing the patient was lowered into a Bigfoot dewar to which approximately 300 liters of liquid nitrogen had been added.
During the course of cryoprotective perfusion the patient's abdomen remained packed in ice in order to maintain the temperature of the abdominal viscera at 1-2°C. Laboratory evaluations of samples taken during cryoprotective perfusion are presented in full in both graphic and tabular form as an addendum to this document below.
This case demonstrates the importance of a thorough assessment of the patient’s medical condition at the time of terminal diagnosis and any associated risks of sudden death with appropriate mitigating medical intervention.
This cryopreservation patient’s decision to voluntarily end her life via dehydration was not the first [23] and will probably not be the last.
In the absence of a Foley catheter perhaps the next best way to determine the patient’s fluid status and possible time course to cardiac arrest is to measure serum osmolality. When using serum osmolality (or specific gravity) to evaluate a patient it is important to understand that it is primarily a marker for life threatening or lethal levels of dehydration and not likely to be the direct mechanism responsible for cardiopulmonary arrest. In the event blood samples cannot be obtained due to lack of vascular access or for medicolegal reasons, urine osmolality may serve as a rough guide in assessing the degree of dehydration. In the absence of a refractometer a Squibb Urinometer (a small, low volume hydrometer) may be used to measure urine specific gravity. In the future, daily measurement of the patient’s weight may prove valuable even if it cannot be continued for long. This case also demonstrates the importance of regular charting and graphing of vital signs in predicting the patient’s agonal course. Minaturization and reduction in the cost for pulse oximetery equipment in the near future should allow for economical in-field measurement of patient SpO2 during the agonal period as well as during CPS.
Not surprisingly the patient was markedly dehydrated at the time of cardiac arrest as evidenced by a baseline serum osmolality of 358 mOsm and a BUN of 47. Arguably, the most critical initial protective strategy against ischemic injury in the human cryopatient during transport is the rapid induction of profound cerebral and systemic hypothermia [29-31]. The PIB was developed by the author to allow for direct contact of ice water with essentially the entire surface area of the patient to simulate rates of heat exchange presumably encountered in cold water drowning where recovery of adults without neurological deficit after 20-40 minutes or more of submersion in ice water has been repeatedly clinically documented [37-40]. Determining the rate of cooling likely to be achieved with the PIB, particularly with the addition of convection cooling by stirring or circulating the PIB water around the patient was important prior to expending the considerable resources required and logistic difficulties to be overcome if these techniques were to be implemented routinely during Transports. Unfortunately, the only published data were those of the SS (Schutzstaffel) Nazi physicians Holzloehner, Finke, and Rascher, et al., conducted in 1942 on prisoners in the German concentration camp Dachau as part of an effort to understand the mechanisms and time course of hypothermia (as well as methods of safe re-warming) in Luftwaffe pilots downed in cold North Sea water. At this time, the citation and use of this data are extremely controversial and their relevance, integrity, and scientific usefulness have been called into question [42].
The author, and others in authority at Alcor (principally Alcor Directors and staff scientists Jerry Leaf and Hugh Hixon), had the difficult task of determining whether it was both ethical and scientifically valid to use these data. Data from the Alexander Report must be interpreted with caution and within the context of both the typical conditions under which human cryopreservation takes place and more recent data on the effects of cold water immersion on human subjects which is unquestionably both ethically and scientifically sound [43,44].
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Ex-model christina estrada sets astonishing demands , The extraordinary demands supermodel locked britain' biggest divorce battles billionaire saudi sheikh emerged court today.. The HbA1c Testing is a fully automated boronate affinity assay for the determination of the percentage of hemoglobin A1c (HbA1c %) in human whole blood. The CLOVER A1c Test Cartridge is composed of a Cartridge and a Reagent Pack containing the reagents necessary for the determination of hemoglobin A1c, with a collection leg for blood sample collection.


Then, the assembled Cartridge is rotated so that the washing solution washes out non-glycated hemoglobin from the blood sample, thus the amount of glycated hemoglobin can be photometrically measured. The ratio of glycated hemoglobin with respect to total hemoglobin in the blood sample is calculated. Where 'D' is the signal obtained from the HbA1c Testing, and 'C' and 'F' are the slope and intercept factor to correct the value for DCCT calibration. A 60-year-old man presented with dysuria and obstructive urinary symptoms of 2 months′ duration.
Urethral hemangioma is a benign disease, believed to be of congenital origin, arising from the embryonic rest of unipotent angioblastic cells that fail to develop into normal blood vessels.
Fibro-epithelial polyps, foreign body granulomas and urethral warts should be considered in the differential diagnosis. Advantage to using capillary blood B-hydroxybutyrate determination for the detection and treatment of diabetic ketosis. Point-of-care blood ketone testing: screening for diabetic ketoacidosis at the emergency department. The direct measurement of 3-beta-hydroxy butyrate enhances the management of diabetic ketoacidosis in children and reduces time and costs of treatment.
Fried first became aware of cryonics as a result of the involvement of her daughter Linda Chamberlain who, with her husband Fred Chamberlain, founded the Alcor Life Extension Foundation in 1972 (all dates are CE, all clock times 24-hour).
Fried's attitude vis-à-vis her cryopreservation arrangements was her unsolicited and spontaneous request that the non-cryopreserved portion of her body be used in any way that might advance the state of the art of either human cryopreservation for future medical rescue, or organ cryopreservation for transplantation. Fried's long acquaintance with both cryonics and Alcor, as well as her aggressive involvement in her own care, particularly as it related to her impending cryopreservation, establish her informed consent. Fried is a 68-year-old female who enjoyed good health until early December of 1989 at which time she developed a flu-like illness while on a vacation cruise in the Atlantic.
A bone scan and spot X-ray films revealed evidence of metastatic disease at T-3 thru T-5 and at T-11.
Subsequent ultrasound evaluation disclosed deep vein thrombi of the veins of the left upper arm extending to the internal jugular vein with accompanying marked stenosis of the subclavian artery on the left side, most probably at its origin. At this time a decision was made to begin a course of palliative radiotherapy to the spine between T-3 and T-5. Management of the patient's nausea proved difficult and she was not discharged until 19 March, 1990 at which time her nausea had resolved and it was noted that her response to radiotherapy had been good with no further occurrence of pain in her thoracic spine.
However, throughout May the patient's condition steadily worsened with weakness, anorexia and cachexia largely confining the patient to a reclining chair in her kitchen. The patient repeatedly declined these offers to resume eating and drinking stating that her quality of life was unacceptable. The patient recovered from this episode with verbal reassurance from her daughter and son-in-law, and repeated statements from them helping her to become oriented as to persons present, as well as to time and place. Because it was impossible to assess the patient well remotely and because the hospice nurse was unavailable to give a clinical assessment of the patient’s likely agonal course and time to cardiac arrest, a decision was made to deploy the Standby Team Leader and one other skilled team member and this was done on 03 June. Preparation of these medications just prior to cardiopulmonary arrest saves a considerable amount of time and facilitates their administration at the start of reperfusion when cardiopulmonary support (CPS) is initiated.
It was her desire that assets to provide for immediate post-arrest CPS, medication, and exterrnal cooling be deployed in her home.
An array of tubing driven by a Sears Model # 563-269500 submersible utility pump (36 GPM 10' head) and terminating in sprinkler heads was used to circulate ice-cold water in the PIB over the patient, particularly over the head and anatomical areas with large, high flow vessels near the surface of the skin: the groin, neck, and axilla. Note the surface convection cooling device (SCCD) tubing with with two cold water discharge heads over each carotid artery.
Manual CPR was immediately begun per AHA Guidelines [7] and a conventional Michigan Instruments Life-Aid Model 1004 Thumper was installed at 1806. A venous blood sample drawn at 1825 via the Port-A-Cath was bright red, indicating good ventilation and perfusion. Sorenson thin-wall dialysis needle to puncture the Port A Cath® septum and facilitate rapid IV administration of transport medications. Continuous IV infusion of 500 cc of 0.3 M tromethamine (THAM) and 500 cc of 20% mannitol in water were begun at 1756 and 1758, respectively. At1840 the patient was loaded into a mortuary van which departed at 1845 to Duggan's Mission Chapel Mortuary for femoral cutdown and TBW. In this photo personnel are preparing to lift the PIB into the back of the mortuary transport vehicle.
Thereafter there is a ~3 minute rebound of rectal temperature to 35°C, followed by a slight plateau in the cooling rate.
Pulmonary edema is known to develop rapidly (~10 minutes) during CPR with the severity increasing with the duration of CPR [8-11]. Dry chemical perfusate components were prepared from reagent or medical grade chemicals weighed out using an Ohaus Centogram model 311, or an Ohaus Triple Beam 2610 g balance.
A final flush of 6 liters of ViaSpan organ preservation solution (composition given in Table II) was used for air transport, to minimize the potentially damaging effects to the vascular endothelium of prolonged exposure to Dextran-40. Upon opening the femoral artery, it was noted that the arterial blood appeared bright red with oxygen saturation estimated visually at >80%.
Perfusion pressure was measured at the Shiley SF-20 filter, anterior to the arterial cannula, employing an aneroid manometer with a sterile Tri-Med Isolator flexible membrane barrier to protect the aneroid from fluid contamination. At the start of blood washout, chest compressions were discontinued and the mask of the Esophageal Gastric Tube Airway (EGTA) was removed (the obturator was left in place to guard against aspiration of gastric contents and water from the PIB). Note the bright red arterial blood which has backed up into the arterial line as a result of systemic blood pressure generated by the Thumper.
The patient was cleaned up on the mortuary prep table and transferred to a heavy-duty (8 mil) vinyl body bag. At 0423 the patient was transferred from the air shipment container to the weighing surface of an Acme model SRD-2S in-bed where scale the patient's weight was determined to be 32.8 kg.
Dry chemical perfusate components were prepared from reagent or medical grade chemicals weighed out using an Ohaus Centogram model 311, and Ohaus Triple Beam 2610 g balances. The sternal operative site was defined by draping with sterile towels and an adhesive operative drape (3M) was placed over the sternum. Fascia and connective tissue were cleared down to the sternum with an electrosurgical knife. Number 2 silk ties were placed on the mammary artery and on the subclavian, just distal to the vertebral, and secured to exclude these vessels. A Cobe 3-way stopcock was fitted to an Aloe arterial pressure monitoring catheter, and the catheter was flushed with normal saline and introduced through the aortotomy into the ascending aorta. The vertex of the scalp approximately 3 cm to the right of midline over the right frontal lobe was incised with a #10 scalpel blade and an incision approximately 4 cm long was made down to the periosteum. The recirculating system was a 20 liter high density polyethylene reservoir sitting atop a magnetic stirring table, an arterial (recirculating) roller pump, a Sci-Med 1.82 meter oxygenator, a Sarns Torpedo heat exchanger and a Pall EC1440 40 micron blood filter. Arterial samples were drawn from a 3-way stopcock interposed between the arterial filter and the filter vent line. Nitrogen gas delivered to the oxygenator at a flow rate of 15 liters per minute was used throughout cryoprotective perfusion to reduce the possibility of oxygen-mediated reperfusion injury following prolonged cold ischemia.
The problem was resolved by advancing and rotating the venous cannula in the superior vena cava.
Circulation through the scalp and dura was judged to be excellent with the only exception being the skin at the margins of the craniotomy incision where it was compressed by the prongs of the Weitlaner retractor. The brain continued to shrink until the cortical surface was estimated as being 6 mm below the calvarium. Above the perfusionist's extended right arm is a Tektronix invasive pressure monitor and a Physiotemp multiple channel thermocouple temperature monitor. The skin was dissected free from the underlying connective tissue up to the level of the 5th cervical vertebra to form skin flaps. The pillow case was then closed with a white cotton shoe lace to which was affixed a stainless steel tag identifying the patient. Temperature descent occurred more rapidly and far less uniformly than desired with one excursion in sinus to brain surface temperature differential of 10 °C occurring between 60 and 80 hours post arrest. In the absence of this, a return to the use of a heavily insulated container to hold the neurocan as been done in previous cases, would seem to be indicated. The patient was lowered to a stratum in the dewar where the ambient temperature was approximately -130°C. At the conclusion of cryoprotectant perfusion the patient's left kidney was removed via a mid-ventral laparotomy and transferred to a screw-cap, liquid-tight polypropylene laboratory bottle containing ~300 cc of ViaSpan pre-chilled to 2°C. This patient’s history of coronary atherosclerotic disease coupled with neoplasia associated hypercoagulability resulted in potentially life threatening arterial and venous thromboembolic disease.
In both this case and the previous case the clinical course was much the same with the patient experiencing one or two short periods of agitation, confusion and delirium after the first few days of reduced hydration. The primary etiologic mechanism in death by dehydration in the hospice setting is hypovolemic shock.
In fact, inability of the patient to stand due to orthostatic hypotension is a valuable indicator that dehydration is progressing and beginning to have the anticipated negative hemodynamic effects.
Real-time graphic charting of these parameters is critical as it shows trends which are more important than any single reading. This should allow for more reliable prediction of the time course to cardiopulmonary arrest as well as for more definitive evaluation of the effectiveness of CPS in the field in real time.
SGOT, SGPT, LDH and GGT were all elevated at the time of cardiac arrest presumably as a result of both the malignancy and the ante-mortem agonal period with its associated lengthy and profound shock. From a theoretical standpoint the most effective means of achieving rapid and profound reduction of core temperature would be via extracorporeal cooling [32]. A careful examination of the literature was undertaken by the author circa 1987 to determine if there were any published data on the rate(s) of core cooling likely to be feasible with these modalities. After extensive discussion and consideration it was decided that it was both ethically and scientifically justified. Until either or both of these events happen core temperature will either transiently increase or will not decrease appreciably. The reaction solution contains agents that lyse erythrocytes and bind hemoglobin specifically, as well as a boronate resin that binds cis-diols of glycated hemoglobin.
The illness consisted of bronchitis-like symptoms; slight malaise without fever, slight hemoptysis, and occasional yellow sputum. The patient was informed she was terminally ill and decided, in consultation with her oncologist Dr. The patient was treated with IV heparin infusion with good results (resolution of edema and restoration of axillary, brachial and radial arterial pulses). A course of whole-brain radiation (4,000 rads) and palliative chemotherapy with cisplatin was also scheduled. This is significant because the absence of any hair on the head might reasonably be expected to materially improve heat exchange during external cooling at the start of post-arrest cardiopulmonary support and transport. Fluid intake was typically in the range of 200 cc to 300 cc per day until the last three days of life when it dropped to 20 cc to 30 cc per day.
The patient’s recovery from this episode of altered sensorium was remarkable and she continued to frequently reminisce about her life and converse at a high level of function until the last 48 hours of life. Capillary refill time was 2-3 seconds and the extremities were dusky and mottled with marked pedal cyanosis. Once MAP declines to ~50 mmHg, or below, coronary perfusion becomes inadequate, MAP begins to rapidly deteriorate, HR falls precipitously, and cardiac arrest occurs. To this end, her living room was set up as the emergency response area several weeks prior to medico-legal death.
A similar line is under the patient with two discharge heads delivering 0-2° C water to the patient's cranial vault.
Carotid and femoral pulses, as evaluated by palpation, were noted to be strong and in synchrony with the Thumper throughout CPS; the last assessment was done during vehicular transport to the mortuary for Total Body Washout (TBW). Mechanical cardiopulmonary support and infusion of THAM and mannitol were continued en route to the mortuary and the infusions were completed at approximately 1857. The rebound and plateau appear to correspond with failure of the High-impulse Thumper and substitution of manual CPS which occurred from 1802 to 1806; between 12 and 16 minutes into CPS and external cooling. As this data indicates PIB cooling is approximately two times as efficient as ice bag cooling.
Dry components were mixed with sterile water for injection USP, or sterile water for irrigation USP.
There was a vigorous arterial pulse with each chest compression from the Thumper, and the capillary blood (ooze from skin and fascia) appeared well-oxygenated. A calibration curve of measured back-pressure versus measured flow was generated in advance to account for the pressure increase resulting from cannula-induced flow restriction.
The presence of visibly agglutinated masses of red blood cells has been an almost uniform finding in prior cases where ultra-profound hypothermia has been induced with red blood cells (RBCs) present. The patient was collected from the aircraft and transported to the Alcor facility by Cryovita van, arriving at approximately 0212.
The patient was then transferred to the operating table, the surface of which had been previously prepared with a cooling blanket (connected to a Cincinnati Subzero BlanketrolTM Hypothermia unit) placed atop a 2"-thick egg-crate foam mattress. This directed flow to the left vertebral artery, supplying the brain, and excluded the brachial and thoracic wall circulation.
Silk ties were placed, as was done over the left side, to direct flow to the vertebral artery. A periosteal elevator was used to expose the bone approximately 3 cm to the right of the midline.
The recirculating (mixing) reservoir was continuously stirred with a 2" Teflon-coated magnetic stirring bar driven by a Thermolyne type 7200 magnetic stirrer. Venous samples were drawn from an 8' Cobe monitoring line connected to a Cobe 3-way stopcock attached to the venous connector connecting the venous cannula and the venous return line. The brain appeared caramel colored and shrunken within the burr hole at the conclusion of cryoprotective perfusion. Barely visible in the foreground behind the red biohazard bag is the Tamari-Kaplitt pulsatile flow device. The suture line was protected with Parke-Davis spray-on bandage and the probe wire was anchored to the scalp with surgical staples.


The cervical musculature and other anatomical structures were then severed with a #10 scalpel blade down to the junction of the 5th and 6th cervical vertebrae.
The neurocan was then nested inside a 5 gallon plastic pail on a bed of crushed dry ice and then surrounded with crushed dry ice on all sides to the top of the open neurocan.
However, the patient cooled more rapidly than expected and had a reached a temperature of -150°C before fracture initiation could be carried out. Thermocouple probes were led out of the Bigfoot dewar and connected to an Omega 2165A thermocouple thermometer.
This container was then placed inside a Zip-Loc plastic bag which was in turn placed inside an insulated container which was filled with flaked water ice. The high incidence of hypercoagulable states associated with malignant disease, particularly in the elderly, and the accompanying increased incidence of sudden death from deep vein thrombosis, pulmonary embolism, heart attack and stroke should be given careful consideration in the future [16-21]. This alteration of sensorium in combination with no urine output triggered anxiety in the family and the hospice personnel that the patient’s cardiopulmonary arrest was imminent. Disturbances in electrolytes, metabolic derangements directly as a result of hyperosmolality, and blood hyperviscosity can be expected to contribute to, and occasionally directly result in cardiopulmonary arrest. The ratio of mean maximal urine osmolality to mean serum osmolality at the time of peak urine concentration was 7.3 [26]. At this time there seems little alternative to this problem due to the unavailability of in-field arterial blood gas measurement equipment and the inevitable deterioration of the patient’s gas exchange status as a result of CPR-mediated pulmonary edema.
However, due limitations of cost, logistics and surgical time required to achieve vascular access the use of extracorporeal cooling as a first-line modality is likely to remain un-achievable for the foreseeable future.
One of the principal criticisms of the scientific validity of this work has been the observation that many of the more than 300 victims of this research were cachectic and weakened from malnutrition and frank starvation making their physiological responses non-representative of that of the healthy German aviator. Blood sample (4µL) is collected at the collection leg of the Reagent Pack, then the Reagent Pack is inserted into the Cartridge, where the blood is instantly lysed releasing the hemoglobin and the boronate resin binding the glycated hemoglobin. Young age at presentation is expected; however, it is reported even at the age of 68 years. Hydroxybutyrate near-patient testing to evaluate a new end-point for intravenous insulin therapy in the treatment of diabetic ketoacidosis in children. Mark Bosdick, M.D, to forego what she was advised would likely be futile and quality of life eroding attempts at curative or possibly life-extending chemotherapy and radiotherapy.
The patient was discharged home on 2 February, 1990 with 7.5 mg per day of Coumadin added her to regimen to control what was thought to be a coagulopathy secondary to her adenocarcinoma. Urine output varied between 200 cc and 50 cc per day with the patient voiding 250 cc of extremely concentrated molasses-colored urine on 9 June, 1990, the day of her cardiac arrest. Forty-eight hours before cardiac arrest the patient began to sleep most of the day and became increasingly difficult to rouse but remained oriented x 3. In the young patient or the well-conditioned older patient peak HR will typically be higher, the tolerable period of MAP at or below 50 mmHg will be far longer, and the agonal course may be prolonged by a long period of bradycardia before cardiac arrest occurs. The dining room table in the foreground was used to lay out airway management supplies and was used to organize and prepare transport medications for administration. This was in sharp contrast to the duskiness and cyanosis observed during the hours of ante mortem shock which preceded cardiac arrest.
It is possible that the anomaly in the rectal cooling curve observed 20 minutes into CPS is indicative of greatly reduced cardiac output as a result of the switch to manual CPS.
The SCCD appears to increase the rate of cooling by an additional 50%over that of the PIB (roughly adjusting for the difference in the patients’ body mass). The anatomical position of the right femoral artery and vein were located by reference to the pubic tubercle and the anterior superior iliac spine.
Even after TBW, agglutinated RBCs are typically observed following air transport when cryoprotective perfusion is subsequently initiated [12].
The body bag containing the patient was then placed atop a bed of Zip-Loc bags containing crushed ice which had been laid down inside an insulated air transport box.
The top of the scalp was draped with a fenestrated adhesive drape over the right frontal lobe. The edges of the sternotomy were padded with laparotomy sponges, a self-retaining retractor placed, and the sternotomy retracted open. This drainage of perfusate from the burr hole is presumably as a result of leakage from the scalp wound, cranial bone, and incised dura and increases in severity as tissue cryoprotectant concentration rises. This is an appropriate response to high molarity glycerol perfusion indicative of both cellular and interstitial dehydration and more importantly the absence of edema in either tissue compartment. A Gigli saw was then passed under the vertebral column and the cut was made at approximately the level of the 5th cervical vertebra, which freed the head from the body. 53-20-507 TC probe placed in the frontal sinus was used to replace the clinical TC probe employed to monitor pharyngeal temperature during perfusion.) TC probes were anchored into place with surgical staples. The neurocan and packaging had been pre-cooled to ~-90°C by spraying with liquid nitrogen. The purpose of this maneuver was to hopefully induce fracturing events at relatively high temperatures below Tg on theoretical grounds that a smaller number of comparatively large fractures is preferable to a large number of small fractures.
A decision was made not to rewarm the patient, but rather to attempt to initiate fracturing before the patient’s temperature decreased further. It also virtually eliminates the danger of rapid and extreme temperature excursions during both cooling and subsequent transfer of the patient to long term storage.
The neurocan was then raised or lowered as needed to obtain the desired rate of temperature descent. Further, the response of the patient’s renal cortex to cryoprotectant toxicity studies closely paralleled studies conducted with fresh rabbit renal cortex in the same laboratory. Where feasible and economically possible, it would seem advisable to perform laboratory studies for hypercoagulability at the time of terminal diagnosis and at intervals during the antemortem period. Anuria is a very real indicator of imminent cardiac arrest in critically ill and dying patients and may be used as guide, in combination with other clinical findings, for when to initiate a Standby. Blood hyperviscosity (and accompanying increased risk of throembolic disease) will be of special concern in patients with an elevated hematocrit. Graphic charting of a daily weight (where possible) will also be particularly important in patients undergoing dehydration and in patients with renal failure who are experiencing fluid gains. Future Thumpers may better employ incorporated time and volume cycled ventilators in place of the fixed-time ventilators currently in use. This means that other methods such as external cooling via the application of ice, core cooling utilizing peritoneal lavage with fluids nears 0°C (reference), or a combination of the two are likely to remain the methods of choice for initial induction of hypothermia following cardiopulmonary arrest. Ironically, it is just this criticism that makes the data obtained in this study uniquely valuable to human cryopreservation. The assembled Cartridge is inserted into the CLOVER A1c Analyzer and rotated so that the blood sample mixture is placed at the measurement zone of the Cartridge, where the amount of total hemoglobin in the blood sample is measured by the reflectance of the photo sensor LED (Light Emitting Diode) and PD (Photo Diode).
She was feeling slightly improved until the evening of 1-11-90 at which time she experienced numbness of her right nare.
She was enrolled in a hospice program with Valley of the Moon Hospice shortly after her diagnosis was established.
This may result in many hours of inadequate systemic and cerebral perfusion (shock) before legal death occurs. Administration of large volume parenteral medications required pressure infusion due to elevated central venous pressure from CPS which precluded gravity infusion. 8528-20) thermocouple thermometer employing a copper-constantan vinyl coated TC probe to measure esophageal temperature (Cole-Parmer Instrument Co. A total of 20 liters of washout perfusate was prepared consisting of SHP-1 with Dextran-40 as the colloid.
An incision with a #10 scalpel blade was made at the midpoint between these two structures, beginning with the inguinal ligament and running parallel to the longitudinal axis of the leg for approximately 5 cm. USCI type 1967 venous catheter, and it was advanced through the atriotomy (with concurrent release of the Satinsky clamp) into the right atrium to the superior vena cava. The dura mater was opened and trimmed away with iris scissors to expose approximately 6 to 8 mm of the cortical surface. This phenomenon is commonly observed in patients with beating hearts during neurosurgical procedures but had not been previously observed in a human cryopreservation patient subjected to pulsatile flow. The neurocan lid was then placed on top of the neurocan and the neurocan was covered over with additional crushed dry ice. Fracturing is known to occur at some point in human cryopatients cooled to below the glass transition point Tg of the patient [15]. As this case demonstrates it is not possible to determine true anuria (cessation of renal urine output) unless the bladder is catheterized and urine output is continuously monitored. If these data are applicable to humans a urine specific gravity of 1.050 or greater should be prognostic of terminal dehydration (~24 to 72 hours time course to cardiopulmonary arrest). It is strongly recommended that standardized, pre-printed, data collection sheets for use during the agonal period of Standby be prepared for use in future cases and be deployed with personnel whom are thoroughly trained in their use. The ability to adjust tidal and minute volume by titrating ventilation to the patient’s measured EtCO2 is highly desirable.
Urethrocystoscopy revealed a 32-mm solitary pedunculate lesion arising from the ventral aspect of the glanular urethra.
Frank hematuria and urinary retention are also noted, depending on the site and number of lesions.
Symptomatic and large lesions require complete excision, along with fulguration of the base either by diathermy or laser. During this period she asked many questions about cryonics in general and Alcor's procedures in particular and stated repeatedly that she felt that cryonics offered her real hope. On the morning of 1-12-90 she experienced Jacksonian seizures involving the right side of her face and right upper arm. NOTE: Cuff pressures may not be accurate (or even obtainable) in many patients in profound agonal shock.
Personnel not in scrubs were relatives and Alcor volunteers who helped with various supportive tasks such as monitoring oxygen supplies, assisting with icing, taking photographs, and scribing temperature readings at predeternmined intervals. This may be as a result of decreasing ∆T between the patient and the bath, a reduction in cardiac output due to a decay in the efficacy of CPS, or a combination of the two. Perfusion with SHP-1 washout solution was followed with 6 liters of ViaSpan (Belzer UW) Cold Storage Solution.
The ascending aorta was freed from the pulmonary artery by blunt dissection with Metzenbaum scissors. The burr hole was opened at 0550; the pial vessels, including a large pial vein directly under the burr hole were noted to be free of blood and the cortical surface appeared pearly white. The pail was then suspended by a nylon cord attached to a pulley and lowered into a Bigfoot whole body dewar (see accompanying diagram). In aqueous cryoprotectant-water solutions the closer fracturing is initiated to Tg the fewer the number of fractures.
The patient was placed into long-term cryogenic storage at 0044 on 20 June by submersion in liquid nitrogen in an MVE A-2600 cryogenic dewar. Over-ventilation causes depletion of pCO2 with accompanying cerebral vasoconstriction and reduced cerebral blood flow [27,28]. Urethral bleeding is common when hemangioma occurs in the distal urethra, while hematuria is common in the membranous or proximal urethra. She also took a very active role in arranging her terminal care in ways that would increase her chances of a quality cryopreservation. Thus a MAP of <50 mmHg obtained via brachial sphygmomanometery may be 30 to 40 mmHg lower than true central (vital organ) MAP. Further discussion of these results is present in the section on Evaluation of Serum Chemistries near the end of this report.
An aortic cross-clamp was placed just above the aortic valve to exclude the coronary circulation. In order to prevent contamination of the recirculating system with venous circulation from the extremities, silk ties were placed on the left and right innominate veins just distal to the left and right internal jugular veins. The cortical surface was 2 mm below the cranial bone, indicating slight cerebral dehydration, probably secondary to the patient's dehydrated state at the time of cardiopulmonary arrest and subsequent perfusion of hyperosmolar solutions during TBW. Temperature descent was controlled by lowering (or, if necessary, raising) the pail with the neurocan (and dry ice thermal ballast) towards a pool of approximately 300 liters of liquid nitrogen in the bottom of the whole body dewar. To our knowledge, this is the largest pedunculate pure capillary hemangioma reported till date. Fried stated at that time that her primary purpose in making suspension arrangements was to please her daughter and son-in-law.
She was transported by paramedic ambulance to the Emergency Department (ED) of Sonoma Valley Hospital where she experienced additional focal seizures of the right arm and face without loss of consciousness. The lenses of the eyes were opaque due to the reversible, thermally-driven precipitation of the gamma crystallins (-III and -IV) [13]. A second aortic cross-clamp was applied to the descending aorta just distal to the left subclavian artery in order to exclude any arterial circulation to the body.
Urethral hemangioma can be localized in a small or extensive area and can occur as single or multiple lesions. Even though it is a benign lesion, because of its high incidence of recurrence regular follow-up is essential.
She was medicated with intravenous (IV) diazepam which was effective in halting the seizures. Unlike in our patient, cavernous hemangioma is the commonest variety in the distal urethra. The patient's final hospitalization occurred on 21 March, 1990 as a result of multiple focal motor seizures which progressed to status epilepticus. The extent of lesion is much more than what is seen, and this should be borne in mind while managing these cases.



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