Medical science monitor : international medical journal of experimental and clinical research
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The aim of the study was to compare autopsy findings with antemortem findings in children who died in a pediatric intensive care unit. ⋯ Our findings support the importance of autopsy assessment in the pediatric intensive care setup. We believe that postmortem examination is also essential for improving the quality of pediatric patient care.
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The activation of various cytokines, e.g. TNFalpha, IL-1 and/or IL-6, may play an important role in the pathogenesis of renal vasculitis and lupus nephritis (LN). The systemic effect of these cytokines may be modulated by their circulating soluble receptors. The plasma levels of cytokine receptors may thus also be markers of the activation of these cytokines. ⋯ While increased plasma levels of TNFalpha may be a nonspecific marker of the activity of ANCA-positive renal vasculitis and LN, plasma levels of sTNF-RII are also increased in patients with ANCA-positive renal vasculitis in remission. Increased plasma levels of sTNF-RII may inhibit the systemic effects of TNFalpha, but may also prolong the half-life of its active form. Plasma levels of sIL-6R are increased both in ANCA-A and in LN, but their increase is much less pronounced than that of sTNF-RII and cannot effectively block the systemic effects of IL-6.
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Continuous determination of cardiac output (CO) by transpulmonary thermodilution calibrated pulse-contour analysis is gaining clinicical acceptance. However there is doubt, whether this method is reliable in hemodynamic instable patients. We compared pulse-contour analysis to thermodilution in patients with profound changes of CO. ⋯ CO measurement by arterial pulse-contour analysis is reliable even in patients with profound changes of CO or during hemodynamic instability.
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The purpose of the present study was to evaluate the influence of infiltration anesthesia of the projected line of incision in the skin of head on the hemodynamic response of the circulatory system, and the essential dose of opioids in 100 patients who underwent craniotomy. ⋯ Infiltration anesthesia of the projected line of skin incision in the head enabled maintenance of stability in the circulatory system and lower doses of opioids administered before commencing surgery.
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Randomized Controlled Trial Clinical Trial
Low doses of aprotinin in aortocoronary bypass surgery--advantages and disadvantages.
Excessive blood loss, as a result of augmented postoperative drainage, is considered one of the most serious cardiosurgical complications. The compounding constitutive anemia seems particularly harmful for patients with coronary artery disease. Aprotinin (Trasylol), a non-specific serine protease inhibitor, is successfully used to reduce excessive postoperative bleeding in such patients. The aim of our study was to verify the hypothesis whether aprotinin used during cardiopulmonary bypass procedure affects hemostatic parameters, which might be crucial for the elevated risk of thromboembolic complications. ⋯ In this study we confirmed the essential advantage of the use of aprotinin: both the postoperative blood drainage and the blood units to be transfused postoperatively to cardiosurgical patients were vastly reduced in the aprotinin-treated subjects. The enhanced overall frequency of perioperative myocardial infarction events was not attributed to this group of patients, nor the non Q-wave infarctions were observed more often in patients treated with aprotinin. In these patients, fibrinolysis parameters tended to be depressed (with increased PAI-1 dominating over elevated t-PA) on the first day after the operation, and no significant differences with regard to fibrinogen, prothrombin fragment F1 + 2, troponin I and platelet count. There was a continuous rise in D-dimers in all the postoperative patients, which lasted until the third day and tended to reach plateau at the 5th day after the operation. We failed to reveal the preventive effects of aprotinin on platelet function: both platelet activation and reactivity remained apparently unchanged. Overall, our results rather support the reasoning on the advantageous effects of low doses of aprotinin. The use of this inhibitor reduces the risk of postoperative undesirable bleeding and results in a decreased postoperative drainage and reduced transfused blood units. On the other hand, however, a higher incidence of perioperative Q-wave infarction in the aprotinin-treated patients, although purely apparent and not statistically significant, might question the unlimited safety of the use of aprotinin in cardiovascular operations.