PubMed Health⌕ Search

Biomedical subjects

M Wysocki

Publications and source records attributed to M Wysocki.

At least 19 recordsLinked to original sources
PubMed1995

Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease.

BACKGROUND: In patients with acute exacerbations of chronic obstructive pulmonary disease, noninvasive ventilation may be used in an attempt to avoid endotracheal intubation and complications associated with mechanical ventilation. METHODS: We conducted a prospective, randomized study comparing noninvasive pressure-support ventilation delivered through a face mask with standard treatment in patients admitted to five intensive care units over a 15-month period. RESULTS: A total of 85 patients were recruited from a larger group of 275 patients with chronic obstructive pulmonary disease admitted to the intensive care units in the same period. A total of 42 were randomly assigned to standard therapy and 43 to noninvasive ventilation. The two groups had similar clinical characteristics on admission to the hospital. The use of noninvasive ventilation significantly reduced the need for endotracheal intubation (which was dictated by objective criteria): 11 of 43 patients (26 percent) in the noninvasive-ventilation group were intubated, as compared with 31 of 42 (74 percent) in the standard-treatment group (P < 0.001). In addition, the frequency of complications was significantly lower in the noninvasive-ventilation group (16 percent vs. 48 percent, P = 0.001), and the mean (+/- SD) hospital stay was significantly shorter for patients receiving noninvasive ventilation (23 +/- 17 days vs. 35 +/- 33 days, P = 0.005). The in-hospital mortality rate was also significantly reduced with noninvasive ventilation (4 of 43 patients, or 9 percent, in the noninvasive-ventilation group died in the hospital, as compared with 12 of 42, or 29 percent, in the standard-treatment group; P = 0.02). CONCLUSIONS: In selected patients with acute exacerbations of chronic obstructive pulmonary disease, noninvasive ventilation can reduce the need for endotracheal intubation, the length of the hospital stay, and the in-hospital mortality rate.

Acute Disease↗
PubMed1995

Noninvasive pressure support ventilation in patients with acute respiratory failure. A randomized comparison with conventional therapy.

The benefit of noninvasive pressure support ventilation (NIPSV) in avoiding the need for endotracheal intubation and reducing morbidity and mortality associated with endotracheal intubation was evaluated in 41 patients who presented with acute respiratory failure not related to chronic obstructive pulmonary disease (COPD). Patients were randomly assigned to receive conventional therapy (n = 20) or conventional therapy plus NIPSV (n = 21). NIPSV was delivered to the patient by a face mask connected to a ventilator (Puritan-Bennett 7200a) set in inspiratory pressure support (IPS) mode. The mean levels of IPS, positive end-expiratory pressure (PEEP), and fraction of inspired oxygen (FIO2) were respectively 15 +/- 3 cm H2O, 4 +/- 2 cm H2O, and 57 +/- 22%. The rate of endotracheal intubation (62 vs 70%, p = 0.88), the length of ICU stay (17 +/- 19 days vs 25 +/- 23 days, p = 0.16), and the mortality rate (33 vs 50%, p = 0.46) were not different between patients treated with NIPSV and those treated conventionally. Post hoc analysis suggested that in patients with PaCO2 > 45 mm Hg (n = 17), NIPSV was associated with a reduction in the rate of endotracheal intubation (36 vs 100%, p = 0.02), in the length of ICU stay (13 +/- 15 days vs 32 +/- 30 days, p = 0.04), and in the mortality rate (9 vs 66%, p = 0.06). We conclude that NIPSV is of no benefit when used systematically in all forms of acute respiratory failure not related to COPD. A subgroup of patients, characterized by acute ventilatory failure and hypercapnia, may potentially benefit from this therapy and further studies are needed to focus on this aspect.

Acute Disease↗
PubMed1994

Additive effect on gas exchange of inhaled nitric oxide and intravenous almitrine bismesylate in the adult respiratory distress syndrome.

OBJECTIVE: To assess the additive effect of inhaled nitric oxide (NO) and intravenous almitrine bismesylate (ALM) on gas exchange. DESIGN: Prospective self-controlled study. SETTING: 3 medico-surgical intensive care units. PATIENTS: 17 patients with severe hypoxemia (PaO2/FIO2 ratio: 88 +/- 30 mmHg, venous admixture: 47 +/- 7%) and elevated mean pulmonary artery pressure (MPAP: 30 +/- 5 mmHg) due to adult respiratory distress syndrome (ARDS). INTERVENTIONS: 5 conditions were studied: 1) baseline, 2) 5 to 10 ppm of NO during 30 min, 3) discontinuation of NO during 30 min, 4) ALM infusion (0.5 mg/kg) during 30 min, 5) ALM infusion (0.5 mg/kg) during 30 min in combination with 5 to 10 ppm of NO. MEASUREMENT AND RESULTS: The PaO2/FIO2 ratio rose from 88 +/- 30 to 98 +/- 37 mmHg (NS) with NO alone, and from 92 +/- 25 to 130 +/- 56 mmHg (p < 0.01) with NO + ALM (p < 0.05 vs NO alone). Seven patients were considered as "NO-responders" (rise in PaO2/FIO2 ratio of 10 mmHg or more with NO); in this subgroup the PaO2/FIO2 ratio rose from 87 +/- 30 to 128 +/- 39 mmHg (p < 0.05) with NO alone, and from 93 +/- 20 to 169 +/- 51 mmHg (p < 0.01) with NO + ALM (p < 0.05 versus NO alone). MPAP decreased from 30 +/- 5 to 26 +/- 5 mmHg (p < 0.01) with NO alone, increased slightly from 28 +/- 5 to 31 +/- 5 mmHg (NS) with ALM alone and decreased to 27 +/- 5 mmHg (p < 0.05) with NO + ALM. CONCLUSIONS: NO + ALM had additive effects on gas exchange while decreasing MPAP in patients with ARDS. The effects of NO alone were small and non significant, except in a subgroup of 7 patients in whom the combination of both therapies had the more pronounced results.

Administration, Inhalation↗
PubMed1994

Rapid isolation and serum-free expansion of human CD34+ cells.

Human CD34+ cells were isolated from bone marrow from normal volunteers and expanded under serum-free culture conditions. CD34+ cells were cultured with interleukin-3 (IL-3), IL-1, and stem cell factor and expanded in granulocyte-macrophage colony-forming units, erythroid blast-forming units, and CD34+ cell number during the first 7-14 days of incubation. By contrast, cultures maintained in fetal calf serum under identical conditions showed much reduced expansion, as measured by all of the above parameters. The level of expansion of the CD34+ cells was dependent on the combination of growth factors used during culture. The data establish the feasibility of serum-free expansion of progenitors and suggest the clinical use of this procedure for the generation of expanded progenitor cell products for transfusion after chemotherapy to minimize treatment-related cytopenias.

Adult↗
PubMed1994

[Congenital spherocytosis in children].

The clinical course and effects of treatment of congenital spherocytosis (CS) were analyzed in 28 children. In 10 cases the disease ran a severe clinical course. Jaundice, anaemia, and splenomegaly were the most frequent clinical signs which were significantly intensified during haemolytic crises. In 14 cases splenectomy was performed, obtaining in all children a regression of jaundice and anaemia. Before the operation two children were vaccinated with Pneumo 23. In asplenic children Debecillin was prophylactically used. Serious infectious complications were observed only in one patient.

Adolescent↗
PubMed1994

Is carbohydrate-deficient transferrin in serum useful for detecting excessive alcohol consumption in hypertensive patients?

The aim of this study was to examine the diagnostic usefulness of carbohydrate-deficient transferrin (CDT) in serum in a cross-sectional study of 439 treated hypertensive men. We related the results to alcohol intake by questionnaire and to biochemical and hemodynamic measurements known to reflect excessive alcohol consumption. The diagnostic sensitivity and the specificity for high alcohol intake (> or = 24 g/day of ethanol) were 44% and 87%, respectively. The group with reported high alcohol intake (n = 32) was characterized by hemodynamic and biochemical changes typical of alcohol abuse. The corresponding profile for the patients with increased serum CDT concentrations (n = 70) was different in several respects, indicating a considerable number of false-positive tests. We conclude that serum CDT determination had low sensitivity and specificity for excessive alcohol consumption in this group of hypertensive patients. The results illustrate the importance of evaluating new laboratory methods in unselected patient populations before drawing any conclusions about their clinical value.

Aged↗
PubMed1994

[Preliminary evaluation of adverse effects after administration of arabinoside cytosine (Ara-C) in high doses to children with acute myelogenous leukemia].

Five children with AML were treated with high-doses of Ara-C (2 g/m2) during consolidation. After 17 cycles the toxicity was evaluated. Granulocytopenia (< 0.5 x 10(9)/l) and thrombocytopenia (< 25 x 10(9)/l) were stated after 15/17 and 13/17 cycles respectively. The nadir of bone marrow suppression appeared between day 10 and 14. In one case treatment related death during severe myelosuppression was noted. In individual cases jaundice with elevated activity of aminotransferases, paralytic ileus and pulmonary oedema were observed. All these adverse reactions were reversible. Other toxicities such as nausea/vomiting, stomatitis, diarrhea, infections and drug related fever were transient. No neurologic toxicity was seen. There is a need for developing a new way of the administration of high-dose Ara-C which could substantially reduce toxicity of the drug.

Adolescent↗
PubMed1993

Ectopic ACTH syndrome due to bilateral ovarian androblastoma with double, gynandroblastic differentiation in one ovary.

A case of fulminant Cushing's syndrome due to an ectopic ACTH secretion in a patient with bilateral ovarian sex-cord stromal tumour is reported. Surgical resection of the ovaries as well as the inhibitors of steroid synthesis and cytostatics caused only transient improvement because the widespread neoplastic dissemination progressed very quickly.

ACTH Syndrome, Ectopic↗
PubMed1992

Flow resistance and its components in hypertensive men treated with the calcium antagonist isradipine.

The components of blood flow resistance were investigated in 14 men with essential hypertension (diastolic blood pressure higher or equal to 100 mm Hg) before and after treatment with the dihydropyridine calcium antagonist-isradipine. Isradipine reduced intraarterial blood pressure by decreasing the total (placebo 5.1 U.mPa-1.s-1; isradipine 3.9 U.mPa-1.s-1), and renal (placebo 48.9 U.mPa-1.s-1, isradipine 35.4 U.mPa-1.s-1) vascular hindrance, the blood viscosity being unchanged. Arterial compliance was increased by isradipine (placebo 1.03 ml.mmHg-1; isradipine 1,25 ml.mmHg-1). The pressor response to adrenergic alpha stimulation with phenylephrine was decreased during treatment with the calcium antagonist. The compliance of the venous system was not changed by the treatment with isradipine. Haemorheological parameters were stable throughout the study but some changes in the correlations between the different rheological parameters were observed. The present study indicates that the antihypertensive effect of the dihydropyridine calcium antagonist isradipine was the result of functional modulation of the small and large arteries, the venous system and the flow properties of blood being unaffected.

Adult↗
PubMed1992

Calcium antagonism in essential hypertension: effect on renal haemodynamics and microalbuminuria.

Sixteen middle-aged men with primary hypertension were treated with the calcium antagonist isradipine over a 9-week period in a randomized, placebo-controlled, double-blind cross-over manner. At the end of the intervention period the urinary albumin excretion rate, systemic and renal haemodynamics, haemorheological properties of blood and plasma concentrations of atrial natriuretic peptide, noradrenaline and peripheral renin activity were determined. Treatment with isradipine resulted in a substantial reduction in blood pressure due to a reduction in peripheral resistance. The mean albumin excretion rate was not influenced by the isradipine treatment. In a multivariate analysis, changes in the urinary albumin excretion rate were only related to changes in blood pressure.

Albuminuria↗
PubMed1992

Modification of oxygen extraction ratio by change in oxygen transport in septic shock.

To help clarify the oxygen uptake/transport (VO2/TO2) relationship and because the oxygen extraction ratio (OER) and TO2 share no common variable such as cardiac index, we examined the changes in OER when TO2 was decreased in 12 patients with sepsis in whom a PEEP trial was performed. From zero end-expiratory pressure (ZEEP) to PEEP (12 +/- 3 cm H2O), a significant increase in OER from 30 +/- 10 percent to 38 +/- 12 percent (p less than 0.005) was observed, and individual percentage changes in OER were well correlated with individual percentage changes in TO2. The VO2 measured (VO2m) by respiratory gas analysis was unchanged, while VO2 calculated by the Fick equation (VO2f) decreased, suggesting a mathematical coupling between VO2f and TO2. Patients with hyperlactacidemia (n = 5) exhibited the same relationships between OER, VO2m, and TO2 as those without hyperlactacidemia. Our results suggest an adaptive response in the OER when TO2 is decreased in patients with established septic shock.

Adult↗
PubMed1992

[Allergic reactions to teniposide (VM-26) in children with neoplasms].

Allergic reactions of dramatic intensity were observed in 5 children treated with Teniposide (VM-26) for acute lymphoblastic leukaemia and histiocytosis X. In the further treatment this drug was replaced with epoxide, a cytostatic agent which is also a podophyllin derivative but in other chemical formulation. In none of these patients the allergic reaction returned.

Adolescent↗
PubMed1992

[Burgdorf's reaction (painful acral erythema) in patients with acute lymphoblastic leukemia following medium-dose methotrexate therapy].

Erythematous changes of the palms with associated oedema, blistering and desquamation were observed in two children during chemotherapy for acute lymphoblastic leukaemia, after methotrexate in doses of 1,000 mg/m2. These changes correspondent to those described in the literature as Burgdorf's reaction. In Poland it was never reported as yet.

Child, Preschool↗
PubMed1992

[Studies of methotrexate pharmacokinetics in children with neoplasms of the hematopoietic system after administration of different doses of the drug].

Concentration of MTX was determined in the serum after the infusion of MTX in a dose of 0.5 g/m2, 1.0 g/m2 and 5.0 g/m2 to 24 children with ALL/NHL. The mean value of steady-state concentrations of MTX was two-fold greater after the infusion of a dose of 1.0 g/m2 and ten-fold greater after the infusion of a dose 5.0 g/m2 than at dose 0.5 g/m2. Great inpatient and interpatient variations of serum MTX concentrations were observed. Pharmacokinetic analysis of the data revealed biphasic model of the elimination. Statistically significant differences were found between the half-life MTX values (ti/2 alpha) in the first postinfusion day: the higher the dose, the shorter ti/2 was observed. The ti/2 of MTX during the second postinfusion day was significantly longer than that of the first day after infusion, but values for the higher doses were not significantly shorter than those for 0.5 g/m2. Systemic clearance (Cl) of MTX showed inpatient and interpatient variations of the values. However, no statistically significant difference was found between Cl values at doses of 0.5 g/m2, 1.0 g/m2 and 5.0 g/m2.

Administration, Oral↗