[Rational use of hyperosmolar solutions].
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Acidosis↗
Biomedical subjects
A Carli
Publications and source records attributed to A Carli.
[Severe diarrhea disclosing toxic adenoma of the thyroid].
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Adenoma↗
Early released lipid-soluble cardiodepressant factor and elevated oestrogenic substances in human septic shock.
A cardiodepressant factor (CDF) able to decrease contractile activity of cultured rat heart cells was determined to be located in the lipid-soluble fraction of sera from men in septic shock. This heat-stable CDF has a molecular weight under 1000. Repeated fractionations of sera gave evidence of an oestrone-like chromatographic behaviour. Oestrone, oestradiol and cortisol were immunologically quantified in two groups (recovery and death) of men in septic shock. All of them were elevated in sera from patients with shock. Highest levels of oestrone 4330 pmol 1(-1), (SEM +/- 851, n = 15), oestradiol 1030 pmol 1(-1), (SEM +/- 220, n = 15) and cortisol 1096 pmol 1(-1), (SEM +/- 94, n = 15), were found in patients who failed to recover from shock. However, oestrone levels were the most striking, especially in the male. This study gives evidence for a polarity relationship between the CDF and oestrone, but natural oestrone does not appear to be a direct CDF. Moreover, this study shows that radioimmunoassay of oestrone could be an important index evaluating the severeness of septic shock.
Adult↗
Oxygen consumption during septic shock. Effects of inotropic drugs.
Septic shock may be defined as a clinical entity wherein a patient has an inadequate peripheral metabolism in the presence of circulating bacteria. The demands for metabolic requirements of the tissues and hence for oxygen transport to these tissues are then markedly high. The average response to increased metabolism in such patients is a percentage increase in cardiac output that is comparable to the percentage increase in oxygen consumption while oxygen extraction rate does not change or even decreases in severe or/and advanced septic shock. This emphasizes the high priority placed by the body on the ability to increase blood flow from the heart in the presence of increased metabolic demands due to sepsis. Concerning the myocardium, oxygen consumption is low in hyper- and hypodynamic states of septic shock, probably and partially due to marked arterial vasodilatation. However, in hypodynamic states, the lower value of perfusion pressure may account for a decrease in myocardial oxygen supply, especially in subendocardial areas and may be responsible for myocardial ischaemia, more especially as myocardial oxygen extraction as well as systemic oxygen extraction is impaired. The goal of therapeutics is to improve oxygen availability through: (1) maintenance of haemoglobin levels and (2) increases in stroke volume using inotropic drugs since these drugs may produce a rise in myocardial oxygen supply higher than their drug-induced increase in oxygen requirements in hypodynamic states of septic shock.
Blood Pressure↗
Oral route administration of medroxyprogesterone acetate (MAP) at high doses in the treatment of advanced breast cancer: clinical results.
Twenty-six patients with metastatic breast cancer were treated with high dose medroxyprogesterone acetate (MAP) p.o. according to currently available pharmacokinetic data (2000 mg/day b.i.d. for 30 days, 1000 mg/day for the following 60 days). Objective response (WHO criteria) was obtained in seven patients (CR + PR = 27%), with good results on visceral and soft tissue localizations; performance status improvement and/or pain relief was obtained in twenty-three (88%). Oral high dose MPA seems to be an effective and well tolerated palliative treatment in advanced breast cancer.
Administration, Oral↗
Depressed isoprenaline vascular response in endotoxic rats.
The injection of a sublethal dose of E. coli endotoxin (0127 B8) to intact rats (2 mg/kg i.v) or adrenalectomized rats (0.01 mg/kg i.v.) depressed hypotensive responses to isoprenaline (0.2, 0.4, 0.8 microgram/kg i.v.) for at least 4 h following endotoxin injection. These findings evidence an early (under 1 h after administration) and long-lasting (over 4 h) depression of the vascular response to isoprenaline in endotoxic rats. This depression was not related to catecholamine adrenal discharge or to the hypotensive and lethal effects of endotoxin.
Adrenalectomy↗
Indomethacin suppresses the early cardiodepressant factor released by endotoxin in the rat: possible involvement of a prostacyclin-related material.
UNLABELLED: The aim of this study was to determine if a prostaglandin-related material--in particular prostacyclinlike substance--could explain our previous findings showing that a sublethal dose of endotoxin caused the early release of a serum lipid-soluble factor able to decrease various activities of cultured rat heart cells (CRHC) through an intracellular calcium dysregulation. Sera were sampled from rats 4 h after administration of 2 mg/kg E coli endotoxin (E) and their cardiodepressant effect on CRHC determined by an electrooptical technique. E-treated rat serum (ETRS) cardiodepressant effect was compared to that of 0.1 ng/ml prostacyclin (PGI2) and of 0.029 ng/ml nifedipine, a calcium antagonist. The reversal effect of caffeine, a substance known for its positive inotropic effect by increasing intracellular calcium availability at the sarcoplasmic reticulum site, has been tested against the depressant effect of ETRS, PGI2, and nifedipine. RESULTS: 1) Compared to control, serum from endotoxin-treated rats with or without imidazole pretreatment depressed contractility of CRHC in a similar fashion, whereas pretreatment with indomethacin had a much less marked effect; 2) PGI2, nifedipine, and ETRS depressed CRHC contractility in much the same way; 3) caffeine reversed the depressant effect of PGI2 and ETRS, but was much less effective against nifedipine effect. These results suggest that the cardiodepressant effect of ETRS is mediated by a prostaglandinlike substance, other than thromboxane, acting through reduced intracellular calcium availability. PGI2 or PGI2-related material is consistent with such a depressant effect and such a mechanism.
Animals↗
Acute myocardial failure during Yersinia enterocolitica infection.
A case of severe cardiac failure during generalized Yersinia enterocolitica infection, in a previously healthy woman is described. It was possible to demonstrate the important role of coronary hypoperfusion in the late stages of septic shock. When beta stimulant drugs became ineffective, IABP improved cardiac function.
Adult↗
Left ventricular contractility using isovolumic phase indices during PEEP in ARDS patients.
The effects of incremental increases in PEEP during mechanical ventilation on left ventricular (LV) contractility before and after intravascular volume expansion (IVE) were studied in 10 patients treated for ARDS. A pulmonary artery (PA) catheter, a LV catheter-tip micromanometer, and an esophageal balloon catheter were inserted in these patients. We measured transmural right atrial and PA pressures, transmural LV end-diastolic and systemic arterial pressures, the first derivative of LV pressure (LV dP/dt), the ratio of LV dP/dt at transmural developed LV pressure (dP/dt/DPt) with DPt = 5, 10, 40 mm Hg, cardiac index (CI) at every level of PEEP and after IVE at the highest PEEP. Stepwise increases in PEEP (from 0-20 cm H2O) were associated with progressive fall in CI whereas heart rate remained unchanged. Transmural right atrial and PA pressures did not change; transmural LV end-diastolic and systemic arterial pressures and peak dP/dt decreased significantly with PEEP, except for dT/dt/dPt. IVE reversed this fall in CI and peak dP/dt. Whereas transmural LV end-diastolic pressure rose markedly. We conclude that the observed fall in LV performance during PEEP is not the result of a depressed LV contractility because PEEP does not induce a decrease in dP/dt/DPt, the least sensitive to change in preload isovolumic phase indices of contractility.
Adult↗
Laboratory culture of Palaemon elegans (Rathke, 1837). (Crustacea decapoda) (third contribution).
A certain amount of Palaemon elegans larvae is bred in the laboratory under controlled conditions (at four different salty concentration rates). They were hatched from a number of egg laying females, which had previously been gathered along the Ligurian littoral. The larval development carried on for 25 to 30 days at an average temperature of ambient of 20 degree C during the seasonal period from May 23rd to June 23rd, 1980. Two hundreds out of the five hundreds larvae hatched from the eggs have been insulated and held for an adaptation period of about ten hours at the salinity of their home environment. Thus, the resistance of these froms to the salinity variations is evident. The results are confirmed by the biostatistical control.
Animals↗
Serum depletion of corticosteroid binding activities, an early marker of human septic shock.
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Corticosterone↗
[Management of unilateral or asymmetrical lung disease (author's transl)].
To determine the indications of body position, continuous positive airway pressure and independent lung ventilation in unilateral lung disease, we turned 10 patients with overwhelming unilateral lung disease from supine to lateral position. All patients were breathing spontaneously with a mask, then associated with continuous airway pressure (10 cm H2O PEEP) in five cases. During these spontaneous ventilation methods, hemodynamic parameters did not change, but arterial blood oxygen tension increased and intra-pulmonary shunting decreased significantly. Final recovery was obtained in 7 cases. In the 3 others, mechanical ventilation was needed because spontaneous breathing methods were ineffective in improving blood gases. Lateral position and conventional ventilation with positive airway pressure were also ineffective. Only independent ventilation enhanced arterial blood oxygen tension. But only one patient survived. We conclude that spontaneous breathing methods are able to provide successful treatment in most of patients with unilateral lung disease. In other patients, only independent lung ventilation is effective.
Adult↗
Evidence for an early lipid soluble cardiodepressant factor in rat serum after a sublethal dose of endotoxin.
The administration of a sublethal dose of E coli endotoxin (2 mg/kg) has been found to induce in the intact rat a slight decrease in mean carotid arterial pressure only 16 hours later. No death occurred whereas the same dose injected in the adrenalectomized rat caused lethality, and so did the higher dose (3 mg/kg) in the intact rat. Sera sampled two, four and 16 hours after administration of endotoxin (2 mg/kg) depressed contractile activity and the chronotropic response of isoproterenol in cultured rat heart cells. Such properties were not noted with sera sampled one or 24 hours after endotoxin administration. These cardiodepressant effects were localized in the lipid soluble fraction of endotoxin serum and absent in the fat-free portion. And yet neither endotoxin nor nonesterified fatty acid (NEFA) serum fraction was involved, since they did not alter cell culture activity. Moreover, though total or individual NEFA levels in endotoxic serum were higher than those of control rat serum four hours after endotoxin injection, they were not significantly different from control 16 hours later. It is concluded that the administration of a sublethal dose of endotoxin to the intact rat induces early and prolonged (up to 14-16 hours) release of one or more humoral lipid soluble cardiodepressant factor(s), even in the absence of systemic hypotension.
Adrenalectomy↗
[Are nitro derivatives always beneficial in the acute stage of myocardial infarction or preinfarction syndrome?].
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Coronary Disease↗
[Reduction of isoprenaline induced tachycardia in pregnant rats. Role of a serum factor].
The in vivo isoprenaline (50 microgram/kg) induced tachycardia (beta 1 adrenergic stimulant effect) was decreased in pregnant (20th day) Rats compared to non pregnant Rats. The in vitro positive chronotropic effect of isoprenaline (10 ng/ml) on cultured Rat heart cells was abolished by pregnant Rat serum whereas progesterone (0.10 to 5 microgram/ml) or oestradiol (0.1 to 25 microgram/ml) were ineffective. The decreased beta 1 adrenergic responsiveness in pregnant Rats could be related to a seric factor, different from these two hormones.
Animals↗
[Biological determination of the beta blocking activity of human serum].
A method of biological assessment of the Beta blocking activity of human serum is reported. It is based on the catecholamine response of rat myocardial cells in culture, incubated in the serum to be tested. Its advantage is that it takes into account all block-blocking substances present in the serum, not only the drug itself but also its possible active metabolites. The results obtained by this method in 10 healthy subjects after 60 mg penbutolol were compared with those given by chemical dosage and ergometry. The ergometric and biological changes were parallel from the 2nd and the 8th hour while the serum levels of the drug rapidly. This discordance could be due to the presence of an active metabolite, 4-hydroxy-penbutolol.
Adrenergic beta-Antagonists↗
Reversal by calcium of rat heart cell dysfunction induced by human sera in septic shock.
Twenty human sera obtained during the first 24 hours following clinical onset of different septic shocks were evaluated for their effects on electric an mechanical activities of rat heart cell cultures. Possible antagonistic action of calcium was tested on these effects. The results showed that septic shock sera, when compared to normal sera, increased action potential duration and depressed contractility of beating cardiac cells. Addition of calcium reversed these two actions, though markedly higher concentration was needed for depressed contractility. The in vitro deleterious effects of septic shock sera on cell cultures were related neither to decrease in extracellular calcium, since total calcium level was moderately below normal values, nor to inhibition of low calcium channel, since the action potential was not suppressed in presence of K+ excess. This study suggests the involvement of humoral factors mimicking the cardiac effects of low calcium concentration. If calcium is involved in in vitro cardiac dysfunction, it could result only from a decrease of available calcium in cytosol.
Action Potentials↗