[Comparison between dopamine and dobutamine in the treatment of low cardiac output syndrome].
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Biomedical subjects
Publications and source records attributed to M Bertolissi.
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The effects of various doses of caffeine and of chlor-desmethyldiazepam on footshock-induced aggressive behavior were examined in mice with different baselines of aggressiveness. Caffeine significantly increased the number of fighting episodes with all the doses tested. This was more evident in mice with low rather than in those with high basal rates of agonistic response. Caffeine caused the appearance of minimal convulsive signs in mice subjected to a threshold electroshock which did not produce any seizure in the controls; it also increased metrazol toxicity. Chlor-desmethyldiazepam enhanced fighting behavior at doses of 0.04 and 0.08 mg/kg, but decreased it at 1.25 mg/kg. The first two doses produced the same effects as caffeine on electroshock test, but did not influence metrazol toxicity.
Three series of behavioral experiments, i.e. hole-board, open-field and spontaneous motor activity test, were carried out on mice with the goal of determining the effects of the interaction between caffeine and two peculiar benzodiazepines (BDZ). The drugs, desmethyldiazepam (DMDZ) and chlor-desmethyldiazepam (Cl-DMDZ), were administered acutely by the intraperitoneal route. In preliminary experiments, the effects of several doses of caffeine were examined in the three in order to obtain some indication of the doses to use for interaction experiments. Therefore, stimulant doses of caffeine (5, 10 and 20 mg/kg) were associated with the two benzodiazepines. It was found that BDZ counteracted the effect of caffeine in the hole-board and in the spontaneous motor activity tests. By contrast, in the open-field situation, the association always gave rise to an increase in exploration activity. Furthermore, the present investigations showed, once again, that chlor-desmethyldiazepam is more active than the other benzodiazepine.
The immunological profile was evaluated in 12 adults affected by Down's syndrome. Our findings showed: increase of serum IgG, IgA and Gammaglobulins, decrease of IgM, presence of auto-antibodies and increased antibodies response after antigenic stimulation (typhoid vaccination). Some tests, connected with T lymphocytes functions, were also abnormal: percentage of E-active rosettes, cutaneous sensibilization with DNCB and lymphocyte stimulation index with PHA. Our findings suggest a T lymphocyte deficit, with loss of immunological surveillance and therefore of the control over antibody mediated immunological reactions. The immunological alterations observed in our adult patients with Down's syndrome were more extensive and severe than those found in young subjects. The possible relevance of these findings is discussed as well as the incidence of Alzheimer's dementia in adult patients with Down's syndrome.
A 48-year-old woman who underwent emergency cardiac surgery for removal of a thrombus partially occluding the mitral valve, developed pulmonary hypertension right ventricular failure and systemic hypotension, in the immediate postoperative period, a clinical condition not well controlled by high doses of epinephrine and dobutamine. The addition of a continuous infusion of norepinephrine in incremental dosages, caused the rise in cardiac index accompanied before by the reduction in the pulmonary pressure and the stability in the systemic pressure, than by the further reduction in the pulmonary pressure and the increase in the systemic pressure. The conclusion is drawn that norepinephrine is useful in the treatment of right ventricular failure which follows a condition of acute pulmonary hypertension, because the improvement of cardiac performance established without adverse effects on the pulmonary pressures whose values on the contrary progressively declined.
The authors present the epidemiological data concerning nosocomial infections in their Intensive Care Unit, and discuss an antibiotic strategy statistically oriented by these data. In their experience, treatment based on statistical criteria, brought to a reduction in antibiotic consumption with particular regard to broad-spectrum antibiotics, and to a decrease in individual budget.
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BACKGROUND: The present study was designed to compare the hemodynamic effects of nifedipine and sodium nitroprusside, intravenously administered to control acute systemic hypertension in the immediate postoperative period after open heart surgery. METHODS: The study was carried out on 16 patients who developed acute systemic hypertension, defined as mean systemic arterial pressure (MAP) values above 90 mmHg, within the first hour after ICU admission, which followed cardiac surgery for valvular and coronary disease. After control measurements during the hypertensive status, each patient was treated by alternating infusions of sodium nitroprusside and nifedipine in order to obtain MAP values of about 80 mmHg with each administration. All patients had preoperative left ventricular ejection fraction above 45%. RESULTS: Nifedipine produced a superior and significant increase in cardiac index (CI) (+28%) and stroke volume index (SVI) (+30%), and a greater decrease in systemic vascular resistance index (SVRI) (-39%), when compared with sodium nitroprusside [CI (+5%), SVI (no change), SVRI (-27%)]. On the contrary the right and left ventricular filling pressures were reduced significantly by sodium nitroprusside [pulmonary capillary wedge pressure (-30%), central venous pressure (-20%)], while nifedipine induced small and not significant changes in the preload values. No ECG changes suggesting ischemic myocardial events were observed in any patient. CONCLUSIONS: On the basis of these results it has been concluded that nifedipine affects primarily the arteriolar resistance vessels without significant changes in venous tone, which is on the contrary markedly reduced by sodium nitroprusside. The better improvement in cardiac index and stroke volume index obtained with the administration of nifedipine, makes this drug a good alternative to sodium nitroprusside for treatment of acute hypertension after cardiac surgery in patients with a good preoperative left ventricular function.