摘要:

Background.Arteriovenous carbon dioxide (AVCO2R) removal is a technique of pumpless extracorporeal carbon dioxide removal. This system has been used successively to control pH and PaCO2in patients with acute lung injury who could not be adequately ventilated. This report describes the use of this technology in an organ donor awaiting harvesting.Methods.AVCO2R was implanted using a hollow-fiber oxygenator attached to 12 F and 14 F vascular cannulas that were inserted into the femoral artery and vein, respectively. Oxygen was attached to the oxygenator to provide the sweep gas.Results.The PaCO2and arterial pH promptly corrected after support was initiated (from 83–42 mm Hg and 7.18–7.38, respectively).Conclusion.This case describes the successful use of pumpless arteriovenous extracorporeal removal of CO2in a heart-beating donor awaiting organ harvest.

ISSN:0041-1337    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background.Invasive fungal infections (IFI), particularly those caused byAspergillusand other angioinvasive molds, are associated with an excessive mortality despite therapy.Methods.Voriconazole was prescribed on a compassionate basis to patients with IFI who were intolerant to or who had progressed despite standard therapy. Outcome was determined by protocol-based criteria as established by the consensus definitions (complete response [CR], partial response [PR], stable disease, failure, and intolerance).Results.Forty-five patients were enrolled in a compassionate release program (29 [64%] because of failure of response to standard therapy), between 1998 and 2002. Of the 45 patients enrolled, 35 (78%) had invasiveAspergillus, 3 (7%) hadFusarium, and 2 (4%) hadScedosporiuminfections. Underlying illnesses were as follows: 13 (29%) solid-organ transplant (SOT), 11 (24%) BMT, and 7 (13%) hematologic malignancy. Site of infection was as follows: 26 (58%) pulmonary, 9 (20%) disseminated, 5 (11%) central nervous system (CNS), and 3 (7%) sinus. Overall response rates were as follows: 9 (20%) CR, 17 (38%) PR, 15 (33%) failure, and 4 (9%) intolerant. Seven of the eight (88%) patients with sinus or CNS disease demonstrated stabilization of the IFI. The median duration of voriconazole therapy was 79 days with 9 (20%) patients receiving over 1 year of therapy. Nine thousand one hundred twenty-eight days of therapy were given with only four serious adverse events in two cases considered possibly or probably drug related.Conclusions.In this population of severely immunocompromised patients with life-threatening IFI who have failed or were intolerant to standard antifungal therapy, voriconazole demonstrated substantial efficacy and an acceptable level of toxicity.

ISSN:0041-1337    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0041-1337    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0041-1337    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

In renal transplant recipients, hypertension is common and associated with increased cardiovascular and allograft rejection risks. Ambulatory blood pressure monitoring is required for its accurate diagnosis and adequate treatment, as it clearly offers several advantages over office or casual blood pressure measurements. First, it correlates better with target-organ damage and with cardiovascular mortality. Second, ambulatory blood pressure monitoring can eliminate “white coat” hypertension. Most important is the identification of nocturnal hypertension, an independent cardiovascular risk factor. A circadian nondipping pattern is often found in renal transplant recipients, most probably resulting from cyclosporine A and persistent fluid overload in the early posttransplant phase (approximately 70% prevalence), but reflecting an underlying renal (parenchymal or vascular) allograft disease when persistent (approximately 25% prevalence) beyond the first year posttransplant.

ISSN:0041-1337    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Adequate control of hypertension is among the most important aims of medical management of the kidney transplant recipient, with the aim of reducing the risk of premature cardiovascular disease and preserving graft function. Antihypertensive therapy should be adjusted according to the best available estimates of usual resting blood pressure. If clinic measurements are used, care should be taken to ensure that these measurements are taken under optimal conditions. Home blood pressure monitoring is a useful adjunct in many patients. Ambulatory blood pressure monitoring gives valuable additional data; mean ambulatory blood pressure correlates better with markers of target organ damage such as left ventricular hypertrophy. However, current treatment thresholds and targets are based on clinic measurements. Ambulatory blood pressure monitoring is certainly a useful adjunct to clinic and home blood pressure measurement, but its role in routine clinical practice in the transplant clinic remains to be defined.

ISSN:0041-1337    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0041-1337    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0041-1337    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0041-1337    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0041-1337    

出版商:OVID    

年代:2003

数据来源: OVID