26 research outputs found

    Short term effects of milrinone on biomarkers of necrosis, apoptosis, and inflammation in patients with severe heart failure

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    <p>Abstract</p> <p>Introduction</p> <p>Inotropes are associated with adverse outcomes in heart failure (HF), raising concern they may accelerate myocardial injury. Whether biomarkers of myocardial necrosis, inflammation and apoptosis change in response to acute milrinone administration is not well established.</p> <p>Methods</p> <p>Ten patients with severe HF and reduced cardiac output who were to receive milrinone were studied. Blood samples were taken just before initiation of milrinone and after 24 hours of infusion. Dosing was at the discretion of the patient's attending physician (range 0.25–0.5 mcg/kg/min). Plasma measurements of troponin, myoglobin, N-terminal-pro-BNP, interleukin-6, tumor necrosis factor-α, soluble Fas, and soluble Fas-ligand were performed at both time points.</p> <p>Results</p> <p>Troponin was elevated at baseline in all patients (mean 0.1259 ± 0.17 ng/ml), but there was no significant change after 24 hours of milrinone (mean 0.1345 ± 0.16 ng/ml, p = 0.44). There were significant improvements in interleukin-6, tumor necrosis factor-α, soluble Fas, and soluble Fas-ligand (all p < 0.05) indicative of reduced inflammatory and apoptotic signaling compared to baseline.</p> <p>Conclusion</p> <p>In conclusion, among patients with severe HF and low cardiac output, ongoing myocardial injury is common, and initiation of milrinone did not result in exacerbation of myocardial injury but instead was associated with salutary effects on other biomarkers.</p

    Levels and sources of PCDDs, PCDFs and dl-PCBs in the water ecosystems of central Poland — A mini review

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    Polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs) are unwanted by-products in a variety of industrial and thermal processes. They have been present on Earth long before the human era, since they may be also formed as a result of forest fires or volcanic explosions. Polychlorinated biphenyls (PCBs) in turn, have been intentionally produced by humans. Poland was a minor producer of PCB mixtures (Chlorofen and Tarnol), which were a source of direct and indirect environmental diffusion with PCB and less with PCDDs/PCDFs. Industrial accidents with PCDDs/PCDFs were absent in Poland. Their stability and resistance to thermal breakdown made them very dangerous for environment and, in consequence, due to their environmental persistence, bioaccumulation and biomagnification in the terrestrial and aquatic food chains, to humans. Humans may become affected by PCDDs/PCDFs and PCBs through environmental (soil and water contamination, fish and food), occupational (incinerators; pulp, paper and metallurgy industry; copper production), or accidental (Seveso accident) exposure. The aim of this review was to evaluate environmental hazard caused by PCDDs, PCDFs and dioxin-like-PCBs in the central region of Poland based on the accessible data on diffusion of those compounds in sediments and riverine, reservoir and storm water from our previous studies and discussed in the context of other achievements in Poland and elsewhere

    "Dobro, zło i medycyna. Filozoficzne podstawy bioetyki kulturowej" (Kazimierz Szewczyk)

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    &#8222;Wspomnienia onkologa. Porażki i sukcesy&#8221; (Marek Pawlicki)

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    Continuous aortic flow augmentation - A pilot study of hemodynamic and renal responses to a novel percutaneous intervention in decompensated heart failure

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    Background - Diminished aortic flow may induce adverse downstream vascular and renal signals. Investigations in a heart failure animal model have shown that continuous aortic flow augmentation ( CAFA) achieves hemodynamic improvement and ventricular unloading, which suggests a novel therapeutic approach to patients with heart failure exacerbation that is inadequately responsive to medical therapy. Methods and Results - We studied 24 patients ( 12 in Europe and 12 in the United States) with heart failure exacerbation and persistent hemodynamic derangement despite intravenous diuretic and inotropic and/or vasodilator treatment. CAFA ( mean +/- SD 1.34 +/- 0.12 L/min) was achieved through percutaneous ( n = 19) or surgical ( n = 5) insertion of the Cancion system, which consists of inflow and outflow cannulas and a magnetically levitated and driven centrifugal pump. Hemodynamic improvement was observed within 1 hour. Systemic vascular resistance decreased from 1413 +/- 453 to 1136 +/- 381 dyne (.) s (.) cm(-5) at 72 hours ( P = 0.0008). Pulmonary capillary wedge pressure decreased from 28.5 +/- 4.9 to 19.8 +/- 7.0 mm Hg ( P < 0.0001), and cardiac index ( excluding augmented aortic flow) increased from 1.97 +/- 0.44 to 2.27 +/- 0.43 L (.) min(-1) (.) m(-2) ( P = 0.0013). Serum creatinine trended downward during treatment ( overall P = 0.095). There were 8 complications during treatment, 7 of which were self-limited. Hemodynamics remained improved 24 hours after CAFA discontinuation. Conclusions - In patients with heart failure and persistent hemodynamic derangement despite intravenous inotropic and/or vasodilator therapy, CAFA improved hemodynamics, with a reduction in serum creatinine. CAFA represents a promising, novel mode of treatment for patients who are inadequately responsive to medical therapy. The clinical impact of the observed hemodynamic improvement is currently being explored in a prospective, randomized, controlled trial

    Evaluation of the stability profile of anticancer drugs: a review of Ifosfamide and Mesna regimen for the treatment of metastatic soft tissue sarcoma

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    Purpose: This paper aims to summarise and critically review the existing published literature with regard to clinical considerations as well as stability testing studies of Ifosfamide and Mesna. It also aims to highlight the factors that should be considered when designing and conducting stability testing experiments. Summary: Ifosfamide and Mesna are currently given to patients for 14 days continuous home-based infusion for the treatment of soft tissue sarcoma. No previous work has evaluated their stability for more than 7 days under real-life conditions so the current regimen involves patients visiting hospital twice during the 14-day treatment. This may create extra disruption to patients’ life style as well as increasing the workload for cancer services. Conclusion: There is a need to conduct stability testing experiments for Ifosfamide and Mesna taking into consideration all of the highlighted factors to mimic standard clinical practice
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