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Udo Kaisers Dirk Pappert Jan M. Langrehr Horst Undi Peter Neuhaus Rolf Rossaint 《Transplant international》1996,9(3):214-220
The purpose of this study was to determine the effects of vasoactive treatment with dopamine (DO), dopexamine (DX), and dobutamine (DOB) on hemodynamics, oxygen transport and hepatic venous oxygen saturation (SvhO2) after orthotopic liver transplantation (OLT). A pulmonary artery catheter was inserted into the right hepatic vein of 17 OLT patients. Timed infusion of DO, DX, and DOB was performed at the following rates: DO at 4 and 8 g/kg per minute, and DOB at 5 and 10 g/kg per minute. Hemodynamics, oxygen transport variables, and SvhO2 were assessed. Each catecholamine induced a significant increase in cardiac index, oxygen delivery, and SvhO2. Mean arterial pressure was increased during DO and DOB, but significantly reduced during DX. Each inotrope increased oxygen delivery in parallel with SvhO2, suggesting a corresponding increase in hepatic oxygen supply. Therefore, it appears that each vasoactive drug may be utilized in OLT patients to provide oxgen delivery without impairment of splanchnic oxygenation. 相似文献
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Ann Martin MDa Elsa Gutierrez MDa Jennie Muglia MDb Charles J. McDonald MDb Cynthia Guzzo MDc Alice Gottlieb MD PhDd Amy Pappert MDd W.Thomas Garland MDe Jerry Bagel MDf Patricia Bacha PhDg 《Journal of the American Academy of Dermatology》2001,45(6):871
Background: Denileukin diftitox, a fusion protein targeting both malignant and normal activated lymphocytes, has been shown previously to have antipsoriatic activity. However, the ideal dosing regimen for treating psoriasis was not established. Objective: We examined the safety and efficacy of denileukin diftitox in patients with severe plaque-type psoriasis. Methods: This was a cohort dose-escalation trial. Patients were administered denileukin diftitox on 3 consecutive days every other week. Patients were evaluated for toxicity, improvement in psoriasis, immunogenicity, and serum levels. Results: Thirty-five patients were treated at 3 dose levels. Eight patients had a 50% decrease or more in Psoriasis Area and Severity Index score from baseline (0/10 at 0.5 μg/kg per day, 1/10 at 1.5 μg/kg per day, and 7/15 at 5 μg/kg per day). Adverse events primarily consisted of constitutional events and skin reactions. Conclusions: The potential antipsoriatic activity of denileukin diftitox demonstrated in this study was comparable to that observed in other psoriasis studies with this agent. However, this dosing regimen was better tolerated than the dosing regimen used in the last study with denileukin diftitox in psoriasis patients. (J Am Acad Dermatol 2001;45:871-81.) 相似文献
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Effects of inhaled nitric oxide on right ventricular function in severe acute respiratory distress syndrome 总被引:6,自引:0,他引:6
R. Rossaint K. Slama W. Steudel H. Gerlach D. Pappert S. Veit K. Falke 《Intensive care medicine》1995,21(3):197-203
Objective To compare the effects of inhaled nitric oxide (NO) and an infusion of prostacyclin (PGI2) on right ventricular function in patients with severe acute respiratory distress syndrome (ARDS).Design Randomized prospective short-term study.Setting: Post-surgical ICU in an university hospital.Patients 10 patients with severe ARDS referred to our hospital for intensive care.Interventions In random sequence the patients inhaled NO at a concentration of 18 parts per million (ppm) followed by 36 ppm, and received an intravenous infusion of PGI2 (4 ng·kg–1·min–1).Measurement and results Inhalation of 18 ppm NO reduced the means (±SE) pulmonary artery pressure (PAP) from 33±2 to 28±1 mmHg (p=0.008), increased right ventricular ejection fraction (RVEF), as assessed by thermodilution technique, from 28±2 to 32±2% (p=0.005), decreased right ventricular end-diastolic volume index from 114±6 to 103±8 ml·m–2 (p=0.005) and right ventricular end-systolic volume index from 82±4 to 70±5 ml·m–2 (p=0.009). Mean arterial pressure (MAP) and cardiac index (CI) did not change significantly. The effects of 36 ppm NO were not different from the effects of 18 ppm NO. Infusion of PGI2 reduced PAP from 34±2 to 30±2 mmHg (p=0.02), increased RVEF from 29±2 to 32±2% (p=0.02). Right ventricular end-diastolic and end-systolic volume indices did not change significantly. MAP decreased from 80±4 to 70±5 mmHg (p=0.03), and CI increased from 4.0±0.5 to 4.5±0.5 l·min–1·m–2 (p=0.02).Conclusions Using a new approach to selective pulmonary vasodilation by inhalation of NO, we demonstrate in this groups of ARDS patients that an increase in RVEF is not necessarily associated with a rise in CI. The increase in CI during PGI2 infusion is probably related to the systemic effect of this substance.Supported by DFG Fa 139/1-2/2-2 相似文献
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J. Mäurer A. Kendzia H. Gerlach D. Pappert J. Hierholzer K. J. Falke R. Felix 《Intensive care medicine》1998,24(11):1152-1156
Objective: To determine whether the quality of infiltrations in chest radiographs can accurately predict the histological extent of
fibrotic change in patients with acute respiratory distress syndrome (ARDS). Design: Retrospective clinical investigation. Setting: Intensive care unit (ICU) of a university teaching hospital. Patients and methods: Of 47 patients treated with extracorporeal membrane oxygenation (ECMO) for severe ARDS over a 5-year period, 23 patients
underwent open lung biopsy at thoracotomy for treatment, mostly of pneumothorax. Chest films obtained by portable chest roentgenography
preceding the operation were reviewed retrospectively and compared to the histomorphological results of the lung specimen.
Results: Chest radiographs displayed mixed alveolar-reticular opacification in 60.2 %, alveolar patterns in 22.9 % and reticular
opacities in 10.5 %. In 0.4 % there were no infiltrates, 6 % could not be evaluated because of insufficient quality. There
was no relevant difference between the right and left lungs. Subdividing patients into two groups according to the histological
results of either absent or mild (1) or severe (2) lung fibrosis, we found an alveolar haziness in 12.3 % in group 1 compared
with 28.2 % in group 2, while reticular characteristics were identified in 13 % and 11 %, respectively. Conclusions: The most common opacity in chest radiographs of patients with severe ARDS treated with ECMO is mixed alveolar-reticular
opacification. Severe lung fibrosis is not positively correlated with a reticular radiographic pattern. ECMO does not lead
to specific radiological changes in conventional radiograms, contrary to clinical findings that treatment with ECMO might
induce pleural or pulmonic haemorrhage, especially in the earlier days when systemic heparinization had to be used instead
of the heparin-coated tube-surfacing.
Received: 24 November 1997 Accepted: 20 July 1998 相似文献