摘要:

Macrophages activated at sites of tissue injury produce interleukin-1, which induces hepatocytes to synthesize acute phase proteins (APP). Daily serum levels of C-reactive protein (CRP), haptoglobin (HPT), transferrin (TRF), alpha-1 antitrypsin, and ceruloplasmin (CER) were measured in 60 patients, 30 having inguinal herniorrhaphy (H), 18 cholecystectomy (C), and 12 major abdominal trauma (MAT). APP response was proportional to the level of tissue injury. CRP rose in all groups, MAT greater than C, which was greater than H. HPT levels were depressed in MAT, presumably due to removal of hemoglobin-HPT complexes from the serum. TRF was severely depressed in MAT and may be implicated in the higher infection susceptibility in this group. CER was elevated in C, suggesting a stimulating mechanism in this group as opposed to H and MAT. Explanation for this is unknown. APP changes, especially CRP, may be useful as markers of the amount of tissue damage.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Central diabetes insipidus (DI) occurs in patients suffering from overwhelming CNS injuries leading to brain death. The purpose of this study was to describe the clinical presentation of DI in children with brain death. The medical records of 34 patients with a diagnosis of brain death were reviewed. Diuresis was present in 76% of patients; however, DI was only present in 38% of patients. On autopsy, the pituitary gland in six patients revealed varying degrees of edema, congestion, hemorrhage, and coagulative necrosis. We concluded that DI is present in many, but not all, patients who experience brain death and therefore, cannot be relied on solely as a marker of brain death.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Defibillation after prolonged ventricular fibrillation (VF) is frequently followed by asystole or electromechanical dissociation (EMD) which are usually fatal. We studied the effects of glucagon, a known inotropic and chronotropic agent, during 19 episodes of postcountershock asystole/EMD in nine dogs. Systolic and diastolic aortic (Ao), left ventricular, pulmonary arterial, and right atrial (RA) pressures were recorded as was the instantaneous Ao-RA difference (coronary perfusion pressure) and coronary sinus blood flow (CSF) during closed-chest CPR. VF was induced electrically; 2 min later, a 400-J transthoracic shock was given. Countershock was always followed by asystole (n = 12) or EMD (n = 7). Conventional closed-chest CPR with a mechanical device was begun 30 to 60 sec after countershock and continued for 2 to 3 min. If a perfusing rhythm did not occur, glucagon (1 mg) was given iv and CPR continued for 2 to 3 min more.Glucagon had no significant effect on intravascular pressures, the coronary perfusion gradient, or CSF when compared to CPR alone. However, in 14 or 19 postcountershock episodes unresponsive to CPR alone, glucagon restored effective spontaneous circulation, i.e., successful cardiac resuscitation, due to its effects on the intrinsic pacemaker discharge rate. Glucagon has been previously shown to stimulate myocardial adenyl cyclase via nonadrenergic mechanisms. We conclude that when postcountershock asystole/EMD occurs, glucagon has a direct and favorable effect on cardiac resuscitation outcome due to its effects on pacemaker discharge rate which is not mediated by changes in myocardial blood flow or coronary perfusion pressure.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We compared Ringer's acetate-gluconate solution with 6% dextran-70 infused during rewarming after coronary bypass surgery. In a randomized study, 18 patients received 56 ± 15 ml/kg of crystalloid (group 1), and 14 patients received 16 ± 6 ml/kg of dextran (group 2). Data were taken at the following intervals: 4 to 5 h after terminating the cardiopulmonary bypass, after rewarming, the next morning on controlled ventilation and continuous positive airway pressure (CPAP) breathing, and after extubation. The patients were followed for 14 days.Prophylactic nitroglycerin infusion may have increased the need for plasma expansion. After volume loading, the stroke index increased in both groups, but the left ventricular stroke work index increased in group 2 only. After transition to the CPAP mode, hydrostatic pressures increased, more in group 2, doubling the pulmonary shunt flow. Pulmonary extravascular thermal volume did not change in either group. We conclude that hemodynamic stability occurred faster with dextran, and ventilatory weaning was somewhat easier with crystalloid.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

To test the hypothesis that angiotensin II could be a mediator of acute lung injury, we studied the effects of perindopril diacid, a new angiotensin-converting enzyme inhibitor, on hemodynamics, blood gases, lung mechanics, and extravascular lung water (EVLW). Twenty-four dogs were anesthetized, paralyzed and ventilated with a fraction of inspired oxygen of 0.4 in which pulmonary edema was induced by 0.1 ml/kg iv oleic acid. Perindopril diacid (1 mg/kg) was administered iv either before (eight dogs) or 100 min after (eight dogs) oleic acid injection. In the control group (eight dogs) not treated with perindopril diacid, 150 min after oleic acid injection, Pao2changed from 193 ± 7 (mean ± SEM) to 55 ± 4 torr, venous admixture from 3 ± 1% to 52 ± 5%, cardiac index from 4.1 ± 0.3 to 3.1 ± 0.3 L/min·m2, mean pulmonary artery pressure from 13± l to 17± 1 mm Hg, dynamic compliance from 90 ± 8 to 46 ± 7 ml/cm H2O, and EVLW from 165 ± 25 to 750 ± 92 ml/m2. Administration of perindopril diacid reduced systemic BP by 20% but did not affect other hemodynamic variables, blood gases, or dynamic compliance. Maximum increases in EVLW were from 169 ± 16 to 615 ± 54 ml/m2in the pretreated group and from 188 ± 23 to 675 ± 56 ml/m2in the treated group (no significant difference from the control group). However, pretreatment with perindopril diacid significantly (p < .05) slowed the rise in EVLW, which was lower 60 and 90 min after oleic acid injection compared to untreated dogs. Plasma renin activity and angiotensin I concentration increased after oleic acid injection. Perindopril diacid administration almost completely abolished serum angiotensin-converting enzyme activity and resulted in a further rise in plasma renin activity and angiotensin I levels. These results suggest that angiotensin II might contribute to increased pulmonary vascular permeability in the earliest stage of experimental lung injury. However, blockade of its synthesis does not modify the overall evolution of pulmonary edema.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We tested the hypothesis that thyrotropin releasing hormone (TRH) would improve cardiovascular function and survival in circulatory shock by opposing the adverse effects of endogenous opioids and other pathophysiologic mediators. Cynomolgus monkeys and mongrel dogs were anesthetized and catheterized to measure mean arterial pressure (MAP) and left ventricular contractility (LV dp/dtmax). Hemorrhagic shock was induced by bleeding into a reservoir to achieve and maintain MAP at 45 mm Hg for one hour. Endotoxic shock was produced by the iv injection of an LD80dose ofEscherichia colilipopolysaccharide endotoxin (3 mg/kg in dogs and 5 mg/kg in monkeys). Animals were treated iv with either TRH (2 mg/kg plus 2 mg/kgh) or equivolume saline. TRH significantly increased MAP and LV dp/dtmaxin primate hemorrhagic and endotoxic shock. In primate hemorrhagic shock, TRH significantly (p=.02) improved survival (alive/total = 4/5 vs. 0/5). However, TRH had no effect on survival in endotoxemic primates. In contrast, TRH treatment in dogs produced only a transient hemodynamic response after endotoxemia and no significant hemodynamic effect after acute hemorrhage (even at twice the TRH dose). TRH did not affect survival in either dog model of circulatory shock. Based on extensive evidence with the opiate receptor antagonist naloxone in other studies, endogenous opioids play a role in the cardiovascular depression in primate and canine circulatory shock. From these studies with TRH, we conclude that 1) TRH is relatively ineffective in canine circulatory shock, and 2) physiologic antagonism of the adverse effects of opioids and other cardiodepressant substances by TRH administration may prove to be a useful alternative treatment of primate hemorrhagic shock.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

This study was designed to examine whether pressure transducer systems prepared hours or days before actual use represent an infection potential. Twenty-one nondisposable transducers assembled with sterile plastic disposable domes and extension tubing were utilized. The systems were prefilled with heparinized flush solution (2 U sodium heparin per ml normal saline). Flush solution samples were cultured from the distal end of the equipment immediately after set-up (time 0) and 24, 48, and 72 h after set-up in all 21 transducers. In 11 of 21 transducers, cultures were also taken at 168 h (1 wk) and 336 h (2 wk) after set-up. Out of the total 106 cultures, only two showed growth, both of which proved to be external skin or mouth contaminants. Binomial distribution testing indicated that if a .05 probability level was used, the chance was 1.3% that one or more transducers in 100 could become contaminated by 72 h. Using the same statistical analyses for the 66 cultures involving the 11 transducers cultured for 2 wk, the chance of contamination in 100 cultures is 2.7% at 2 wk. We conclude from these data that nondisposable transducer systems, when preassembled using standard aseptic precautions and sterile disposable plastics, show no evidence of significant contamination when allowed to stand in readiness after assembly but not connected to a patient. We feel it is safe to preassemble transducers for at least a 72-h period before use. Longer intervals from set-up to use may also be justified.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Although gastroduodenal ulcers rarely perforate during critical illness, this occurrence causes specific and difficult problems of diagnosis and management. In our review of the records of 19 critically ill patients whose ulcers perforated, we found that classical symptoms were frequently absent. The perforations often were manifested by nonspecific clinical events, such as unexplained ileus or hypotension. Diagnosis was typically delayed and on occasion was first suspected after observing pneumoperitoneum on a routine x-ray. While the ulcers were characteristically very large (greater than 2 cm), minimal inflammation surrounded them. Mortality was 56% in the 16 patients whose perforations were diagnosed before death or discharge. Fifteen patients were treated with simple patching of the ulcer. Perforated ulcers in critically ill patients differ in several important ways from those occurring in otherwise healthy individuals.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The cardiovascular effects of a patent ductus arteriosus (PDA) in a premature baboon model of hyaline membrane disease treated with conventional positive-pressure ventilation (CPPV) or high-frequency ventilation (HFV) were studied. Twenty-seven (84%) of 32 infant baboons delivered at 75% gestation had positive retrograde aortograms at one hour of life. Eleven (34%) of these infant baboons had persisting evidence for retrograde flow over the first 24 h by Doppler examination. Significantly higher fluid requirements and bicarbonate requirements were present in the animals with a persisting PDA. Mean aortic BP values were significantly lower in these same animals. No significant differences were found between groups when mean airway pressure, heart rate, urine output, or form of ventilation were compared. The only significant differences found between the conventional and high-frequency ventilated animals with PDA were higher peak airway pressures and lower PEEP levels in the conventionally ventilated infants. The premature baboons can be a useful primate model to study the PDA. There appears to be no significant difference regarding the clinical effects of HFV and CPPV on PDA.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Multifocal atrial tachycardia (MAT) is a difficult arrhythmia to treat. Pharmacologic treatment is generally disappointing, and successful conversion in a predictable manner is uncommon. To assess the efficacy of metoprolol, a relatively selective beta 1-adrenergic blocking agent, we administered this agent to 11 patients (aged 71.8 ± 8.3 yr). All patients had serious pulmonary disease. Hypoxia, hypercarbia, acidosis, and electrolyte abnormalities were corrected before the study. Nine patients were receiving theophylline derivatives and six digoxin. Serum levels for both drugs were in the therapeutic range. Four patients had received verapamil without control of MAT. Mean atrial rate before administration of metoprolol was 142.3 ± 17.2 beat/min and mean ventricular rate was 131.4 ± 24.3 beat/min. One to 3 h after metoprolol (25 or 50 mg orally), all patients were restored to sinus rhythm, with a mean ventricular rate of 86.9 ± 6.8 beat/min (p < .01). Six patients had 3 to 6 premature atrial contractions per minute. No adverse effects were noted, and arterial blood gases before and after therapy were comparable. Five patients expired from their underlying disease and four were continued on metoprolol to maintain sinus rhythm. Metoprolol is effective in the acute and chronic treatment of MAT and may be given to patients with MAT and respiratory failure without serious adverse effects.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID