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Management of patients with acute respiratory distress syndrome.

Critical care nursing clinics of North America 1999年第2期11卷 233-247页

作者： Phillips, J.K. Surgical Critical Care Unit Hospital of the University of Pennsylvania Philadelphia United States

Acute respiratory distress syndrome is a complex clinical syndrome of respiratory failure that presents a challenge to every critical care team. Since the first clear description by Ashbaugh et al more than 30 years ago, much has been learned about the pathophysiologic process that occurs within the lungs after they suffer either a direct or indirect injury. Unfortunately, little success has been achieved in improving outcomes;however, hope is on the horizon. Current research evaluating optimal ventilator management, ECMO, the use of inhaled nitric oxide, and other experimental management strategies will hopefully combine to produce improved outcomes.

关键词：危重病人医疗/方法循证医学体外膜氧合作用/护理体液转移一氧化氮/治疗应用护理估计/方法呼吸人工/护理呼吸窘迫综合征成人/代谢呼吸窘迫综合征成人/病理生理学呼吸窘迫综合征成人/治疗血管舒张药/治疗应用人类

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Treatment strategies for microvascular dysfunction following acute myocardial infarction

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Current Cardiology Reports 2000年第5期2卷 405-410页

作者： Roe, Matthew T. Duke Clinical Research Institute Durham NC 27715 PO Box 17969 United States

Successful reperfusion following acute myocardial infarction is considered to be restoration of epicardial infarct vessel patency, but recent studies suggest that disrupted microvascular function and inadequate myocardial tissue perfusion are often present despite epicardial patency. New angiographic techniques, including the corrected Thrombolysis in Myocardial Infarction (TIMI) frame count and myocardial blush grade, have been used to demonstrate that restoration of downstream coronary flow and tissue perfusion may be the key links to improved clinical outcomes. Additionally, other diagnostic techniques, including infarct size measurement with cardiac marker release patterns, or 99m Tc-sestamibi single photon emission computed tomography imaging, and analysis of ST-segment resolution have also been used to assess microvascular function and tissue perfusion. Promising adjunctive therapies that target microvascular dysfunction, including platelet glycoprotein IIb/IIIa inhibitors, anti-inflammatory agents, vasodilators, glucose-insulin-potassium, and embolization protection devices, may ameliorate microvascular dysfunction following epicardial reperfusion. However, these therapies have not yet been shown to improve clinical outcomes and are thus currently being studied together with fibrinolytics and primary angioplasty in clinical trials. Therefore, shifting the focus of reperfusion therapy to the microcirculation offers the potential to further improve myocardial salvage and clinical outcomes following acute myocardial infarction. Copyright © 2000 by Current Science Inc.

关键词：冠状血管造影术微循环心肌梗死/药物疗法心肌梗死/病理生理学心肌再灌注心肌/代谢血小板聚集抑制剂/治疗应用血管未闭/药物作用血管舒张药/治疗应用人类

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Current management of patients with pulmonary hypertension and right ventricular insufficiency

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Current Cardiology Reports 2000年第3期2卷 244-251页

作者： Hankins, Shelley R. Horn, Evelyn M. Albert Einstein College of Medicine Bronx NY 10461 1300 Morris Park Avenue United States Heart Failure Research Center New York Presbyterian Hospital Columbia-Presbyterian Campus New York NY 10032 177 Fort Washington Avenue United States

Pulmonary hypertension is a pathologic condition characterized by elevated pulmonary artery pressures and an associated vasculopathy. Primary pulmonary hypertension (PPH) is a rare condition with a sporadic occurrence and a familial form of the disorder. Abnormal vasomotor tone in the pulmonary vasculature results from an imbalance of the action of various vasoconstrictors/vascular proliferative agents (endothelin and thromboxane) versus vasodilators /anti-proliferative agents (prostacyclin and nitric oxide). The mainstay of outpatient therapy has been the use of digitalis, diuretics, oxygen, and coumadin and the judicious use of vasodilator therapy. Calcium channel blockers in a select group and intravenous prostacyclin have dramatically improved survival for those with primary pulmonary hypertension. Use of prostaglandin I2 (PGI2) in other forms of chronic pulmonary arterial hypertension is not as clear, although evidence of initial beneficial response is promising. Importantly, over the next few years both pharmacologic and nonpharmacologic treatment modalities for pulmonary hypertension may rapidly change as we focus more on the abnormal pulmonary vascular biology and concomitant hemodynamic and neurohormonal milieu. Copyright © 2000 by Current Science Inc.

关键词：抗高血压药/治疗应用强心药/治疗应用内皮血管/病理生理学依前列醇/治疗应用高血压肺性/药物疗法高血压肺性/病理生理学血管舒张药/治疗应用血管舒缩系统/病理生理学心室功能障碍右/药物疗法心室功能障碍右/病理生理学人类

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扩血管药治疗肾实质性高血压100例

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中华肾脏病杂志 1991年第2期7卷 88-88页

作者：杨维今江西省人民医院肾内科

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Measurement of troponin T to detect cardioprotective effect of trimetazidine during coronary artery bypass grafting

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ANNALS OF THORACIC SURGERY 1999年第6期68卷 2173-2176页

作者： Tünerir, B Çolak, Ö Alatas, Ö Besogul, Y Kural, T Aslan, R Osmangazi Univ Sch Med Dept Cardiovasc & Thorac Surg Eskisehir Turkey Osmangazi Univ Sch Med Dept Biochem Eskisehir Turkey Res Hosp Eskisehir Turkey

Background. The aim of the present study was to evaluate potential myocardial protection by trimetazidine by measurement of the cardiac marker protein troponin T (TnT) during coronary bypass operations. Methods. We conducted a double-blind, placebo-controlled study on 30 randomized patients who had aorta-coronary artery bypass operations. The TMZ group was composed of 15 patients and the placebo group of 15 patients in New York Heart Association class III or IV. Pretreatment was started 3 weeks preoperatively with trimetazidine (60 mg orally per day) or the placebo. In the trimetazidine TMZ group, there were 2 women and 13 men with a mean age of 57.1 +/- 2.2 years and mean cross-clamp time of 44 +/- 1.8 minutes. In the placebo group, there were 5 women and 10 men with a mean age of 58.4 +/- 1.2 years and a mean cross-clamp time of 42 +/- 2.4 minutes. Serial blood samples were collected before and after the operation, and serum concentrations of cardiac TnT were measured. Results. The preoperative serum concentration of TnT was 0 to 0.39 ng/mL in all patients. The mean TnT levels were measured 5 minutes after completion of cardiopulmonary bypass (1.5 +/- 0.3 ng/mL) and 12 (1.4 +/- 0.1 ng/mL), 24 (0.9 +/- 0.1 ng/mL), and 48 hours postoperatively (0.1 +/- 0.1 ng/mL) in the trimetazidine group. Troponin T levels in the placebo group measured at the same time periods were 4.4 +/- 0.4, 4.8 +/- 0.7, 2.8 +/- 0.4, and 0.7 +/- 0.1 ng/mL. In the trimetazidine group, TnT levels were significantly less than those of the placebo group (p < 0.001). The levels of TnT were tested by creatine kinase-MB levels of both groups. Mean cardiac index was evaluated in all patients preoperatively and postoperatively. There was no significant difference in perioperative hemodynamics (blood pressure and cardiac index) between groups. Conclusions. These results obtained by measurement of cardiac TnT suggested that pretreatment with trimetazidine reduces ischemic-reperfusion damage during coronar

关键词：心肺转流术冠状动脉分流术双盲法心肌再灌注损伤/病理生理学心肌再灌注损伤/预防和控制曲美他嗪/治疗应用肌钙蛋白T/血液血管舒张药/治疗应用女(雌)性人类男(雄)性中年人

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PGE₁ treatment of severe intermittent claudication (short-term versus long-term, associated with exercise) -: Efficacy and costs in a 20-week, randomized trial

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ANGIOLOGY 2000年第8期51卷 S15-S26页

作者： Belcaro, G Nicolaides, AN Agus, G Cesarone, MR Geroulakos, G Pellegrini, L De Sanctis, MT Incandela, L Ricci, A Mondani, P De Angelis, R Ippolito, E Barsotti, A Vasdekis, S Ledda, A Christopoulos, D Errichi, BM Helmis, H Cornelli, U Ramaswami, G Dugall, M Bucci, M Martines, G Ferrari, PG Corsi, M Di Francescantonio, D Pomante, P Mezzanotte, L Petrucci, M Ciccarelli, R San Valentino PAP PEA Project I-65020 San Valentino Pe Italy St Marys Hosp Imperial Coll Irvine Lab London England Univ G dAnnunzio Dept Biomed Sci Chieti Italy

The efficacy, safety, and cost of prostaglandin E-1 (PGE(1)) in the treatment of severe intermittent claudication was studied comparing a long-term treatment protocol (LTP) with a short-term treatment protocol (STP) in a randomized 20-week study. The study included 980 patients (883 completed the study) with an average total walking distance of 85.5 +/- 10 m (range 22-119). Phase 1 was a 2-week run-in phase (no treatment) for both protocols. In LTP, phase 2 was the main treatment phase. In the LTP, treatment was performed with 2-hour infusions (60 mu g PGE(1), 5 days each week for 4 weeks. In phase 3 (4-week interval period) PGE(1) was administered twice a week (same dosage). In phase 4 (monitoring lasting 3 months, from week 9 to 20) no drugs were used. In STP phase 2 treatment was performed in 2 days by a 2-hour infusion (first day: morning 20 mu g, afternoon 40 mu g;second day morning and afternoon 60 mu g). The reduced dosage was used only at the first cycle (week 0) to evaluate tolerability or side effects. Full dosage (60 mu g bid) was used for all other cycles. The same cycle was repeated at the beginning of weeks 4, 8, and 12. The observation period was between weeks 12 and 20. A treadmill test was performed at inclusion, at the beginning of each phase, and at the end of 20th week. A similar progressive physical training plan (based on walking) and a reduction in risk factors levels plan was used in both groups. Intention-to-treat analysis indicated an increase in walking distance, which improved at 4 weeks and at 20 weeks in the STP more than in the LTP group. At 4 weeks the variation (increase) in pain-free walking (PFWD) was 167.8% (of the initial value) in the LTP group and 185% in the STP group (p < 0.05). At 4 weeks the variation (increase) in total walking distance (TWD) was 227.6% of the initial value in the LTP group and 289% in the STP group (p < 0.05). At 20 weeks the increase in PFWD was 496% of the initial value in the LTP group vs 643% in the S

关键词：前列地尔/投药和剂量前列地尔/经济学前列地尔/治疗应用综合疗法费用效益分析药费支出运动疗法间歇性跛行/药物疗法间歇性跛行/病理学间歇性跛行/康复腿/血液供给疼痛/药物疗法疼痛/病因学治疗结果血管舒张药/投药和剂量血管舒张药/经济学血管舒张药/治疗应用老年人女(雌)性人类男(雄)性中年人

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Cilostazol approved for use in intermittent claudication

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AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY 1999年第5期56卷 404-404页

作者： [Anonymous]

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Minoxidil and male-pattern alopecia: a potential role for a local regulator of sebum secretion with vasoconstrictive effects?

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MEDICAL HYPOTHESES 1999年第5期53卷 402-406页

作者： Kurbel, S Kurbel, B Zanic-Matanic, D Osijek Clin Hosp Dept Physiol Osijek Croatia Univ Zagreb Univ Hosp Rebro Dept Anaesthesiol Surg Clin Zagreb Croatia

Regulation of the hair cycle takes place at the pilo-sebaceous unit with the sebaceous gland as a sex hormone-dependent part Although minoxidil stimulates proliferation of follicular cells and activation of prostaglandin endoperoxide synthase-l, it was suggested that other mechanisms, such as an increase in the local blood flow, might mediate the drug effect on hair growth. If that is the case, it is possible that minoxidil counteracts some vasoconstrictive mediator of male-pattern alopecia. This hypothetical vasoconstrictive media for X would have to meet some criteria: (I) vasoconstriction both in the general circulation and in the hair-growing skin;(II) local vasoconstrictive activity in the hair growing skin should be related to the circulating testosterone level;(III) only an increase in the local mediator X activity causes male-pattern alopecia, since hypertensive patients are not balder than expected. The sebaceous gland is a possible place of the mediator X secretion since it is a sex-hormone-dependent part of the pilo-sebaceous unit. ET-1 might be a suitable candidate for the media for X, since male hormones raise ET-1 plasma levels and female hormones lower them. The speculation presented here is that ET-1, beside vasoconstriction in the general circulation, might also regulate the sebum secretion, by triggering contractions of the myoepithelial cells. This hypothetical mechanism would normally remain confined to the sebaceous gland. During puberty, sex hormones stimulate growth of sebaceous glands in both sexes. In women hypertrophied sebaceous glands under estrogen control would not increase its ET-1 content, while in men, testosterone would increase ET-1 secretion that might affect the neighboring arterioles. Induced vasoconstriction might reduce the hair growth and promote hair loss. If ET-I plays the described role, then an ET-1 antagonist, i.e. bosentane, should also have some hair-growing properties. (C) 1999 Harcourt Publishers Ltd.

关键词：秃发/血液秃发/药物疗法内皮缩血管肽1/药理学雌激素类/血液米诺地尔/药理学米诺地尔/治疗应用模型理论皮脂/分泌睾酮/血液血管收缩/药物作用血管舒张药/药理学血管舒张药/治疗应用人类男(雄)性

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Preoperative management of right ventricular dysfunction in aortic origin of the right pulmonary artery

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PEDIATRIC CARDIOLOGY 2000年第4期21卷 388-388页

作者： Wong, JA Cheng, W Cedars Sinai Med Ctr Div Pediat Cardiol Los Angeles CA 90048 USA Cedars Sinai Med Ctr Div Cardiovasc Surg Los Angeles CA 90048 USA

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Transitory left ventricular outflow tract obstruction after mitral valve reconstruction

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DEUTSCHE MEDIZINISCHE WOCHENSCHRIFT 1999年第38期124卷 1095-1098页

作者： Hauber, J Rein, JG Sigel, H Klin Eichert Med Klin 1 D-73006 Goppingen Germany SANA Herzchirurg Klin Stuttgart Germany

History and admission findings:a few days after uneventful surgical reconstruction of the mitral valve a 43-year-old man was found to have a systolic murmur due to prolapse of the posterior leaflet, suggesting renewed mitral regurgitation. Investigations: Echocardiography revealed haemodynamically significant left ventricular outflow tract obstruction (LVOT) with a left ventricle to aorta systolic gradient of 83 mm Hg. In addition there was moderately severe mitral regurgitation as well as a pericardial effusion but no signs of tamponade. Treatment and course: The obstruction was at first treated with verapamil, later with sotalol. The pericardial effusion was interpreted as part of a postcardiotomy syndrome. The effusion regressed under steroid administration, and the LVOT and mitral regurgitation also decreased. A provocation test five months postoperatively no longer brought about an outflow gradient. The good results were still present 12 months postoperatively. Conclusion: The described, rarely seen form of LVOT was probably caused by a combination of a very large anterior mitral leaflet, postoperative pericardial effusion and pharmacological effects. If the obstruction first occurs postoperatively, appropriate medication may improve the cardiac status and reoperation may be avoided. Echocardiography is an important method of diagnosis and serial monitoring.

关键词：肾上腺素能β受体拮抗剂/治疗应用超声心动描记术随访研究二尖瓣/外科学二尖瓣闭锁不全/病因学二尖瓣脱垂/诊断二尖瓣脱垂/病因学心包积液/诊断心包积液/药物疗法心包积液/病因学索他洛尔/治疗应用时间因素血管舒张药/治疗应用室性流出道阻塞/诊断室性流出道阻塞/药物疗法室性流出道阻塞/病因学维拉帕米/治疗应用成年人人类男(雄)性

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