摘要:

Cytochrome P450 (CYP) from the CYP1, CYP2, and CYP3 families are monoxygenases expressed mainly in the liver. They are able to oxidize a number of compounds and may generate cytotoxic or genotoxic metabolites. Their expression and activity can be affected by genetic defects, inhibitors and inducers present in the environment, oxygen, cytokines, and growth factors, as well as cell-cell contacts. These factors account for the wide interindividual variability exhibited by humans in response to drugs. Hypoxia, cytokines, and growth factors could decrease the metabolism of drugs in intensive care unit patients.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Although there are only a handful of second messengers, they are activated by a multiplicity of ligands, receptors, G proteins, and generating or terminating enzymes. The intricacies of the systems are gradually being elucidated, increasing our understanding of both normal and abnormal physiologic function and offering new targets of drug therapy. Papers published in the past year show gradual progress but only a minority contain information of direct clinical relevance. The most interesting observation was made in the study of chronic lymphocytic leukemia, in which defects were found in the β2-adrenoceptor cAMP signaling system.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Albumin is the protein in the blood with the largest concentration. It is easy to measure, purify, and give to patients. Until recently, there has been little research on its role in the critically ill. Serum concentrations decrease rapidly with illness. Although it has several functions in healthy humans (maintenance of colloid oncotic pressure, drug transport, and free radical scavenging), how these functions change with illness is unknown. Indeed, how albumin itself changes is also unknown. To add to these difficulties in understanding the role of albumin there are relatively normal humans and also rats that lack the genes to make albumin in significant amounts. As well as the expected effects of albumin there are important other effects on blood clotting and the effects of diuretics that need to be evaluated.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Because timely decompression of the abdomen is currently the only viable treatment of the abdominal compartment syndrome, current approaches focus on the investigation of the physiologic alterations induced by this entity and on its prevention. Many questions remain, including identification of the pathophysiologic sequences, recognition of objective diagnostic indicators, choice of the most adequate surgical management, and prospective evaluation of the surgical outcome. Although the answers should be sought in the analysis of the physiologic alterations induced by intra-abdominal hypertension and in the results obtained with the different therapeutic strategies, without doubt they remain controversial. In this review we 1) outline the current knowledge concerning the abdominal compartment syndrome, and 2) explore the goals toward which clinical and experimental research has been oriented during the past few years.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Staged laparotomy has evolved into the standard approach to critically injured patients who are at risk of developing the triad of hypothermia, metabolic acidosis, and coagulopathy. This vicious cycle is rapidly fatal if not prevented or interrupted. The damage control approach emphasizes initial control of bleeding and contamination with rapid closure of the abdomen. Physiologic restoration is pursued in the intensive care unit and is followed by definitive reexploration. Although most commonly used in the postinjury setting, this technique is applicable to a variety of emergency and elective procedures in the chest, pelvis, and extremities.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

There is no evidence that planned reoperation yields superior results when compared with conventional treatment. Until larger randomized studies are available, the indication for planned relaparotomy should be made with caution. However, there may be subgroups of patients that benefit from the procedure.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Ample evidence suggests that early fixation of femoral fractures (within 24 hours of injury) in polytrauma patients using intramedullary nailing (IMN) techniques is the optimal timing and method of fracture management. However, recent data suggest that in patients with concomitant thoracic injuries, early fixation using IMN techniques may contribute to the development of fat embolism and increase pulmonary morbidity. Although IMN techniques clearly induce the intravasation of marrow emboli both in animals and humans there is very little experimental or clinical evidence to suggest that this phenomenon has any impact on the development or severity of acute lung injury. Thus, on the basis of current data, there is no reason to deny patients with thoracic injury the optimal method and timing of femur fracture fixation.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Gastric tonometry allows detection of abnormalities of metabolism that cause an elevated pCO2, such as tissue dysoxia or shock states. This may allow greater sensitivity in detecting insufficient resuscitation from known shock states, such as hypovolemic shock, or earlier detection of occult shock states, such as sepsis. This approach has been validated in several patient populations including hypovolemic trauma patients. There remains a population, however, in which the gastric intramucosal pCO2can not be normalized by increases in global oxygen delivery. This may be due to ischemia-reperfu-sion injury. We developed a resuscitation algorithm to limit both hypovolemia or dysoxia and reperfusion injury. We postulate that a more aggressive approach to limiting reperfusion injury will allow further advances in decreasing morbidity and mortality of the critically injured trauma patient.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID