Biomedical subjects

J Takala

Publications and source records attributed to J Takala.

At least 37 records · Page 2Linked to original sources

PubMed2001

Good continuity of care may improve quality of life in Type 2 diabetes.

Some features of diabetes care and diabetes treatment regimen which may have an impact on health-related quality of life (HRQOL) in people with diabetes were studied cross-sectionally using the SF-20 questionnaire. Of the 381 subjects with Type 2 diabetes aged under 65 years, 260 (68%) participated in the study. On univariate analysis, HRQOL was associated with regular clinical review (check-up at least twice a year) and continuity of care (the same GP for at least 2 years), education by a diabetes nurse, and satisfaction with diabetes education. No associations were found between the HRQOL dimensions and home glucose monitoring, participation in educational courses, or satisfaction with care. On logistic regression analysis only good continuity of care was significantly associated with the better well-being dimensions of the SF 20 (ORs 2.5-6.0). However, good continuity of care was also associated with less satisfactory glucose control (HbA(1c) 8.9 +/- 2.0 (+/- SD) vs 8.3 +/- 2.0%, P=0.04). It is concluded that a permanent physician-patient relationship may improve HRQOL in subjects with Type 2 diabetes, but further prospective studies are needed to confirm this finding.

Blood Glucose Self-Monitoring↗

PubMed2001

Pain as a reason to visit the doctor: a study in Finnish primary health care.

This study aims to demonstrate the prevalence of pain as a reason for seeing a physician in primary care. We also performed an analysis of the localization, duration and frequency of pains, as well as the diagnoses of patients having pain. A total of 28 physicians at 25 health centers in Finland collected the data, comprising 5646 patient visits. Pain was identified as the reason for 2237 (40%) of the visits. The most common localizations were in the lower back, abdomen and head. One-fifth of the pain patients had experienced pain for over six months. Analysis of the diagnoses revealed half of the pains to be musculoskeletal. Patients experienced considerable limitations in various activities of life due to pain. A quarter of the pain patients of active working age received sick leave. Our results confirm that pain is a major primary health care problem, which has an enormous impact on public health.

Activities of Daily Living↗

PubMed2001

General practitioners' willingness to request plain lumbar spine radiographic examinations.

OBJECTIVES: To examine general practitioners' attitudes to plain lumbar spine radiographic examinations. DESIGN: A postal questionnaire consisting of questions on background data and doctors' opinions about plain lumbar spine radiographic examinations, as well as eight vignettes (imaginary patient cases) presenting indications for lumbar radiography, and five vignettes focusing on the doctors' willingness to request lumbar radiography on the basis of patients' age and duration of symptoms. The data were analysed according to the doctor's age, sex, workplace and the medical school of graduation. SETTING: Finland. SUBJECTS: Six hundred and fifteen randomly selected physicians working in primary health care (64% of original target group). RESULTS: The vignettes revealed that the use of plain lumbar radiographic examination varied between 26 and 88%. Patient's age and radiation protection were the most prominent factors influencing doctors' decisions to request lumbar radiographies. Only slight differences were observed between the attitudes of male and female doctors, as well as between young and older doctors. Doctors' willingness to request lumbar radiographies increased with the patient's age in most vignettes. The duration of patients' symptoms had a dramatic effect on the doctor's decision: in all vignettes, doctors were more likely to request lumbar radiography when patient's symptoms had exceeded 4 weeks. CONCLUSIONS: General practitioners commonly use plain lumbar spine radiographic examinations, despite its limited value in the diagnosis of low back pain. Further consensus and medical education is needed to clarify the indications for plain lumbar radiographic examination.

Adult↗

PubMed2001

Variability in prescribing for musculoskeletal pain in Finnish primary health care.

OBJECTIVE: To assess primary care physicians' prescribing patterns for musculoskeletal pain in different diagnostic categories. METHODS: The data were collected in 25 randomly selected health centres, in which a total of 28 physicians took part in the four-week study. Physicians recorded all the medicines they prescribed for patients visiting due to pain. Visits resulting in a diagnosis of musculoskeletal disease or injury were included in this study. RESULTS: Analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs), were prescribed for 61% of the patients. NSAIDs were prescribed for 46%, topical analgesics for 15% and opioids for 4% of the patients. In general, ibuprofen was the most frequently prescribed drug but back and neck pains were most commonly treated with naproxen. No difference between patients' genders was observed in analgesic prescriptions. Prescribing was associated with patient's age, physician's view on priority of visit, diagnosis and intensity of pain. There was a large variation in prescribing patterns between individual physicians and between different areas of the country. CONCLUSION: NSAIDs are the prevailing treatment for musculoskeletal pain in Finnish primary health care. Different drugs are favoured according to the diagnosis. The large variability in prescribing patterns cannot be explained solely by the characteristics of pain or patients.

Administration, Topical↗

PubMed2001

Validation of a new respiratory inductive plethysmograph.

BACKGROUND: The respiratory inductive plethysmograph (RIP) can be used to monitor changes in end-expiratory lung volume (deltaEELV), and thus, used in intensive care when evaluating positive end-expiratory pressure (PEEP)-induced changes in lung volumes in order to optimise the ventilator settings. We validated the newest model of RIP (Respitrace Plus), both under laboratory and clinical conditions, and made a comparison with a previously validated RIP (Respigraph) in the measurement of tidal volume (V(T)), long-term EELV and PEEP-induced acute deltaEELV. METHODS: The in vitro validation was performed using a lung model and the in vivo evaluation in five spontaneously breathing normal subjects, four patients with acute lung injury (ALI) and eight anaesthetised patients. RESULTS: The difference in V(T) values during PEEP manipulations between pneumotachometer (PNT) and RIP in spontaneously breathing volunteers and mechanically ventilated ALI patients was 0.1-0.9% (mean+/-SEM) and -5.2+/-0.6, respectively (effect of device NS). In anaesthetised patients, the difference between the new RIP and spirometer in the measurement of PEEP-induced acute deltaEELV was -2.6+/-1.5% (PEEP-device interaction, P<0.05). In ALI patients, the difference between PNT and RIP in the measurement of PEEP-induced acute deltaEELV was 1.0+/-9.7% (NS). The new RIP had a baseline drift over 50-fold when cold and over 10-fold when warm compared to the old RIP in vitro. CONCLUSION: The new RIP is accurate enough for clinical and research purposes in the measurement of V(T). Semiquantitative measurements of acute deltaEELV can be done with accuracy sufficient for clinical use, but long-term deltaEELV monitoring is not possible. The new RIP should be kept on for several hours before measurements to minimise the drift.

Adult↗

PubMed2001

Prevalence of left ventricular hypertrophy in Finnish primary health care hypertensive patients.

BACKGROUND: Hypertensive patients who present left ventricular hypertrophy (LVH) are at considerable risk of developing cardiovascular complications. Echocardiography, being the best method for assessing of LVH, is too expensive for routine daily practice particularly in primary health care. Therefore, electrocardiogram (ECG) still remains the most feasible method to assess LVH in these settings. OBJECTIVES: The aim of this study was to determine the prevalence of ECG-LVH in Finnish hypertensive primary health care patients and evaluate the quality of their blood pressure control. METHODS: A total of 255 general practitioners in 26 primary health care centres identified all of their hypertensive patients visiting during a 1-week period. A health examination was carried out on these patients by health nurses and laboratory tests, including ECG, were taken. The ECG's were analysed by using the Minnesota Code. Altogether, 1746 hypertensive patients were examined. RESULTS: The prevalence of ECG-LVH when using Sokolow-Lyon criterion was 9.8% for males and 5.7% for females. The corresponding figures, when using the sex-specific Cornell product, were 14.9% for males and 18.8% for females. Only 17% of LVH patients had their blood pressure under good control (BP <140/90 mm Hg) as compared to 25% of non-LVH patients (P < 0.01). CONCLUSION: The prevalence of ECG-LVH in Finnish hypertensive primary health care patients is high. Despite this warning signal, the treatment situation for LVH patients was even worse than that of other hypertensives.

Aged↗

PubMed2001

Patients' perceived problems with hypertension and attitudes towards medical treatment.

OBJECTIVE: To study perceived problems and attitudes in hypertension treatment in primary health care. STUDY POPULATION AND METHODS: A cross-sectional survey of 2219 hypertensive patients, identified by general practitioners, in 26 health centres was carried out during 1 week in 1996. A total of 1782 patients (80%) returned two questionnaires and participated in a health examination. The final study population consisted of 1561 patients currently being medically treated for hypertension and 220 patients not currently on medical treatment. The questionnaires contained 82 questions on different aspects of hypertension care and treatment, which were further elaborated using factor analysis. On the basis of reliability and internal validity analyses, 14 problem indices related to medical treatment of hypertension were formed. RESULTS: The most common perceived problem was related to lack of motivation for follow-up of hypertension (72%). Many patients had difficulties to accept being hypertensive (66%). A careless attitude towards hypertension was also common (63%). Lack of information was experienced by 56% of the patients. About 33% felt hopeless about their hypertension, reported adverse effects of hypertension treatment on sexual functions and lack of support by health care personnel. The least frequent problems were reimbursement problems and modification of dosage instructions. The number of problems identified per person varied between zero and 14 with a mean of 4.9 +/- 2.6 (s.d.). CONCLUSION: Perceived problems concerning hypertension, negative attitudes and experiences are very common among hypertensive patients in primary health care.

Age Factors↗

PubMed2001

Outcome and resource utilization in gastroenterological surgery.

BACKGROUND: A small minority of patients undergoing gastroenterological surgery are at high risk for postoperative complications, which may lead to prolonged hospital stay, disproportionate use of resources and increased mortality. The nature and frequency of, and predictive factors for, postoperative complications were studied and the impact of complications on resource utilization was assessed. METHODS: A prospective observational study was undertaken of 503 patients undergoing gastroenterological surgery in a tertiary care centre. The incidence of cardiorespiratory, infective and surgical complications was assessed. The need for reoperation, intensive care and length of hospital stay, readmission, death at 6 months and costs were evaluated. RESULTS: Some 235 patients (47 per cent) had at least one complication, most commonly delayed oral intake (n = 70). Complications were associated with cardiovascular disease, prolonged operation, high Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity, and increased number of Shoemaker's criteria. The length of hospital stay of patients with complications was longer than that of those without complications (11 versus 6 days). Morbidity resulted in a twofold increase in median costs. CONCLUSION: High-risk patients could be identified by simple clinical criteria, although the commonly used risk criteria were not very sensitive. A reduction in postoperative complication rates would result in marked cost savings.

Adolescent↗

PubMed2001

Nitrogen sparing effect of structured triglycerides containing both medium-and long-chain fatty acids in critically ill patients; a double blind randomized controlled trial.

BACKGROUND AND AIMS: Patients with sepsis and trauma are characterised by hypermetabolism, insulin resistance and protein catabolism. Fat emulsions containing medium chain triglycerides have been suggested to be beneficial for these patients since medium chain fatty acids are a more readily available source of energy when compared to long chain fatty acids. The aim of this study was to compare a medium and long chain triglyceride emulsion consisting of structured triglycerides (ST) with a long chain triglyceride (LCT) emulsion in terms of effects on nitrogen balance, energy metabolism and safety. METHODS: 30 ICU patients with sepsis or multiple injury received a fat emulsion with ST or 20% LCT (1.5 g triglycerides/kg body weight/day) as a component of total parenteral nutrition (TPN), for 5 days in a double blind randomised parallel group design. The main analysis was made on the 3 day per protocol population due to lack of patients at day 5. RESULTS: There were no differences in baseline characteristics of the two groups receiving either the LCT or the ST emulsion. The efficacy analysis was performed on the per protocol population (n=9 ST, n=11 LCT). There was a significant difference between the two treatments regarding daily nitrogen balances when the first 3 days were analysed P=0.0038). This resulted in an amelioration of the nitrogen balance on day 3 in the group on ST as compared to those on LCT (0.1+/-2.4 g vs -9.9+/-2.1 g P=0.01). The 3 day cumulative nitrogen balance was significantly better in the group receiving ST compared to those on LCT (-0.7+/-6.0 vs -16.7+/-3.9 P=0.03). This better cumulative nitrogen balance on day 3 was also preserved as a tendency (P=0.061) in the analysis of the intention to treat population, but on day 5 there was no significant difference (P=0.08). The ST emulsion was well tolerated and no difference was found compared to the LCT emulsion regarding respiratory quotient, energy expenditure, glucose or triglyceride levels during infusion. CONCLUSION: Administration of a structured triglyceride emulsion resulted in an amelioration of nitrogen balance despite no effect on energy expenditure in short term administration over 3 days to ICU patients when compared to a long chain triglyceride emulsion. No side effects linked to medium chain triglycerides were noted.

Adult↗

PubMed2001

Splanchnic perfusion during hemodialysis: evidence for marginal tissue perfusion.

OBJECTIVE: Splanchnic perfusion may be compromised during hemodialysis because of hypovolemia, inflammatory response, and blood flow redistribution. The aim of this study was to assess the response of splanchnic blood flow and oxygen transport to hemodialysis. DESIGN: A prospective clinical study. SETTING: A mixed medical-surgical intensive care unit in a university hospital. PATIENTS: Nine patients with acute renal failure. INTERVENTIONS: A 4-hr period of hemodialysis. MEASUREMENTS AND MAIN RESULTS: Systemic (via a pulmonary artery catheter), hepatosplanchnic, and femoral (via dye dilution) blood flow and gastric mucosal Pco2 were measured before, during, and 2 hrs after hemodialysis. During hemodialysis, despite unchanged arterial blood pressure, cardiac output and stroke volume decreased from 3.0 +/- 1.0 L/m2/min (mean +/- sd) to 2.3 +/- 0.7 L/m2/min (p =.02), and from 38 +/- 16 mL/m2/min to 28 +/- 12 mL/m2/min (p =.01), respectively. Splanchnic but not femoral blood flow decreased from 0.9 +/- 0.3 L/m2/min to 0.7 +/- 0.2 L/m2/min (p =.02). The blood flows returned to baseline values after dialysis without need for therapeutic interventions. Gastric mucosal-arterial Pco2 gradients were high before dialysis (35 +/- 23 torr [4.6 +/- 3.1 kPa]) and did not change. Renin but not atrial natriuretic peptide concentration increased during hemodialysis from 13 +/- 13 microg/L to 35 +/- 40 microg/L and decreased afterward to baseline values (13 +/- 13 microg/L; p =.01). Whereas interleukin 6 tended to decrease, tumor necrosis factor alpha increased during hemodialysis from 74 +/- 24 pg/mL to 86 +/- 31 pg/mL and continued to increase after hemodialysis to 108 +/- 66 pg/mL (p =.022). CONCLUSION: Hemodialysis and fluid removal in normotensive patients with acute renal failure may result in a reduction of systemic and splanchnic blood flow that is undetectable using traditional clinical signs. In contrast to what is observed in hypovolemia, the changes in regional blood flow are rapidly reversible after hemodialysis.

Acute Kidney Injury↗

PubMed2001

Metabolic changes after cardiac surgery.

The metabolic changes that occur after cardiac surgery result from a complex interaction between the effects of surgery and extracorporeal circulation per se, the inflammatory response to surgical trauma and extracorporeal circulation, perioperative use of hypothermia, the cardiovascular and neuroendocrine responses characteristic to cardiac surgery, and the drugs and blood products used to support circulation during and after operation. These changes include among others increased oxygen consumption and energy expenditure and increased secretion of insulin, growth hormone, adrenocorticotrophic hormone, cortisol, epinephrine and norepinephrine. Other changes include decreased total-Trijodthyronine levels, hyperglycemia, hyperlactatemia, increased glutamate, aspartate and free fatty acid concentrations, hypokalemia, an increased production of inflammatory cytokines and increased consumption of complement and adhesion molecules. There is evidence that better control of metabolic abnormalities improves the patients' outcome.

Cardiac Surgical Procedures↗

PubMed2001

Effects of systemic arterial hypoperfusion on splanchnic hemodynamics and hepatic arterial buffer response in pigs.

The hepatic arterial buffer response (HABR) tends to maintain liver blood flow under conditions of low mesenteric perfusion. We hypothesized that systemic hypoperfusion impairs the HABR. In 12 pigs, aortic blood flow was reduced by cardiac tamponade to 50 ml. kg(-1). min(-1) for 1 h (short-term tamponade) and further to 30 ml. kg(-1). min(-1) for another hour (prolonged tamponade). Twelve pigs without tamponade served as controls. Portal venous blood flow decreased from 17 +/- 3 (baseline) to 6 +/- 4 ml. kg(-1). min(-1) (prolonged tamponade; P = 0.012) and did not change in controls, whereas hepatic arterial blood flow decreased from 2 +/- 1 (baseline) to 1 +/- 1 ml. kg(-1). min(-1) (prolonged tamponade; P = 0.050) and increased from 2 +/- 1 to 4 +/- 2 ml. kg(-1). min(-1) in controls (P = 0.002). The change in hepatic arterial conductance (DeltaC(ha)) during acute portal vein occlusion decreased from 0.1 +/- 0.05 (baseline) to 0 +/- 0.01 ml. kg(-1). min(-1). mmHg(-1) (prolonged tamponade; P = 0.043). In controls, DeltaC(ha) did not change. Hepatic lactate extraction decreased, but hepatic release of glutathione S-transferase A did not change during cardiac tamponade. In conclusion, during low systemic perfusion, the HABR is exhausted and hepatic function is impaired without signs of cellular damage.

Animals↗

PubMed2001

Patients' versus general practitioners' assessments of pain intensity in primary care patients with non-cancer pain.

Pain is a major cause for visiting a primary care physician. There are, however, few studies on the assessment of pain patients at the primary care level. The aim of this cross-sectional study was to investigate the concordance between general practitioners' (GPs') and patients' assessments of pain intensity and whether this assessment is influenced by the duration or intensity of pain. Seven hundred and thirty-eight patients aged 16 to 75 years, who were visiting a GP because of pain, participated. Both the patients and the GPs rated pain intensity using the horizontal 100 mm Visual Analogue Scale (VAS). Means and correlations were calculated using non-parametric tests. The VAS scales were arbitrarily divided into five grades (one unit = 20 mm) to investigate the concordance between GPs' and patients' assessments of pain intensity. Spearman 's correlation coefficient between GPs' and patients' assessments was 0.31 for non-chronic pain (of duration less than six months) and 0.20 for chronic pain. GPs evaluated graded pain intensity at least one unit lower than patients in 37% of the visits. In one-fifth of the visits (20.5%), the GP's rating was at least two units lower than the patient's rating. The more severe the pain as assessed by patients, the greater the non-concordance between patients' and GPs' assessments. There was considerable non-concordance between GPs' and patients' assessments of pain intensity. GPs tended to estimate their patients' pain intensity as clinically significantly lower than the patients themselves, particularly in chronic and severe pain.

Adolescent↗

PubMed2000

Non-conventional vasopressors in septic shock: effects on hepatosplanchnic blood flow.

Vasopressors are necessary to treat the vasodilation characteristic of hypotension in septic shock. In addition to noradrenaline, the reference vasopressor, various drugs, including dopamine, adrenalin, phenylephrine, L-NMMA (a nitric oxide synthase inhibitor), and vasopressin have been used in clinical septic shock. The available clinically relevant data on the effects of "non-conventional" vasopressors on splanchnic circulation is very limited or nonexistent, and their safety has not been demonstrated. All these drugs can modify the perfusion and metabolism of splanchnic organs, changes which cannot be predicted from changes in systemic circulation or metabolism. Due to the complexity of actions and the high potential for severe adverse effects, "compassionate" use of unconventional vasopressors to treat hypotension in septic shock should be abandoned outside the scope of controlled clinical trials.

Humans↗

PubMed2000

Pre-operative tonometry is predictive for mortality and morbidity in high-risk surgical patients.

OBJECTIVE: To determine whether a) pre-operative measurement of gastric intramucosal pHi is predictive for mortality and morbidity in high-risk surgical patients and b) peri-operative improvement of global oxygen delivery (DO2) with fluids and dopexamine leads to increased gastric pHi and c) either improved global perfusion or improved splanchnic perfusion is related to the prevention of multiple organ failure (MOF). DESIGN: Retrospective analysis of a double-blind, placebo-controlled, randomised study. SETTING: General intensive care units from 14 hospitals. PATIENTS: Two hundred eighty-six high-risk surgical patients. INTERVENTIONS: Swan-Ganz and tonometer catheter placement; patients were stabilised pre-operatively using fluids, blood and/or oxygen to preset goals before receiving placebo or two doses of dopexamine (0.5 or 2.0 microg.kg.min) peri-operatively. MEASUREMENTS AND RESULTS: Haemodynamic assessment (including DO2 and oxygen consumption (VO2)) was performed together with measurement of gastric mucosal pHi pre-operatively and directly, 2, 6, 12, 24 and 36 h post-operatively. Retrospectively, patients were divided pre-operatively into two sub-groups based on the optimal cut-off value for mortality of the first pHi measurement after induction of anaesthesia as calculated by a receiver operator characteristic (ROC) curve analysis --low pHi group (< 7.35) and normal pHi (> or =7.35). Mortality in the low pHi, was higher than in the normal pHi, group (16.8 vs 2.3%; p = 0.0001). In the normal pHi group dopexamine, which was given prior to the first pHi measurement, had no effect on pHi, while DO2 increased significantly. In this group MOF score and number of patients with MOF remained similar for the treatment sub-groups. In the low pHi group gastric pHi increased significantly during dopexamine infusion (p = 0.008), despite the lack of an increase in DO2 and VO2. In this group the MOF score and the number of patients developing MOF decreased significantly with the use of dopexamine (p = 0.04). In both groups bicarbonate levels remained similar for the treatment subgroups. CONCLUSIONS: In high-risk surgical patients pre-operative measurement of pHi was predictive for mortality. The peri-operative response of pHi to dopexamine seemed to be dependent on pre-operative gastric pHi.

Analysis of Variance↗

PubMed2000

Sampling rate causes bias in APACHE II and SAPS II scores.

OBJECTIVE: To study the effect of sampling rate of laboratory and haemodynamic data on severity scorings and predicted risk of hospital death. DESIGN: Prospective study. SETTING: Medical-surgical intensive care unit (ICU) with 23 beds in a university hospital. PATIENTS: Sixty-nine consecutive emergency admission patients. INTERVENTIONS: Blood samples were drawn from indwelling arterial lines for the laboratory tests of all variables contained in the APACHE II and SAPS II scores at 2-hourly intervals from the time of admission up to 24 h or earlier discharge or death of the patient. Haemodynamic data and temperature were collected either manually by the attending nurse once an hour or as 2-min median values automatically using a Clinical Information Management System (CIMS, Clinisoft, Datex-Ohmeda, Helsinki, Finland). Three sets of severity scores were obtained. (1) "Traditional" scores (haemodynamic data from manual records and laboratory values from tests taken at admission and subsequently on clinical basis only). (2) "CIMS" scores (haemodynamic data from 2-min median values and laboratory values prescribed on clinical indication) and (3) "High rate" scores (haemodynamic data from 2-min median values and laboratory values at 2-hourly intervals). Probability of hospital death was calculated using the SAPS II and APACHE II scores, respectively. RESULTS: Increasing the sampling rate of haemodynamic monitoring interval to 2-min from once per hour resulted in 7.8 % and 11.5 % increases (p < 0.001) in the APACHE II and SAPS II scores, respectively. The combined effect of increased sampling rate of haemodynamic and laboratory tests on the APACHE II and SAPS II scores was 14.4 % and 14.5 % compared to traditional scores (p < 0.001), respectively. The probability of hospital death increased from 0.23 and 0.21 ("traditional" SAPS II and APACHE II) to 0.31 and 0.25 ("high rate" SAPS II and APACHE II), respectively, and, because eight patients died, standardised mortality ratio (SMR) decreased from 0.53 to 0.41 (SAPS II) and from 0.60 to 0.50 (APACHE II). CONCLUSIONS: Increased sampling rate results in higher scores and lower SMR. Comparisons between hospitals using severity scores are biased due to differences in the sampling rates.

APACHE↗

PubMed2000

Costs of care, long-term prognosis and quality of life in patients requiring renal replacement therapy during intensive care.

OBJECTIVE: To assess (1) the long-term outcome of patients requiring renal replacement therapy (RRT) in terms of 6-month and 5-year mortality, (2) quality of life and (3) costs of the intensive care. DESIGN: A retrospective observational cohort study. SETTING: Twenty-three-bed multidisciplinary intensive care unit (ICU) in a tertiary care center. PATIENTS AND PARTICIPANTS: Out of 3,447 intensive care patients admitted, 62 patients with no end-stage renal failure required RRT. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The incidence rate of acute renal failure (ARF) was 8/100,000 inhabitants/ year. The majority of patients (71%) had ARF in conjunction with multiple organ failure. The mortality in the ICU and in the hospital was 34 % and 45%, respectively. Mortality was 55% at 6 months and 65 % at 5 years. Renal function recovered in 82 % of the survivors during hospitalization. Loss of energy and limitations of physical mobility assessed by Nottingham Health Profile were the most frequently reported complaints at 6 months. Functional ability, as assessed by the Activities of Daily Living score was fairly good at 6 months. The cost per ARF 6-month survivor was $80,000. CONCLUSIONS: There was only a minor increase in mortality after discharge from hospital among patients treated for ARF in intensive care. The costs related to ARF in intensive care are high, but the almost complete physical and functional recovery seen in ARF survivors should be noted in cost-effective analyses.

ADP-Ribosylation Factor 6↗

PubMed2000

Ranitidine or dobutamine alone or combined has no effect on gastric intramucosal-arterial PCO(2) difference after cardiac surgery.

OBJECTIVE: To test the hypothesis that ranitidine, either alone or in combination with dobutamine, modifies the gastric intramucosal-arterial PCO(2) difference. DESIGN: Full factorial design (double-blinded for ranitidine). SETTING: Intensive Care Unit of a university hospital. PATIENTS: Sixty-four haemodynamically stable coronary artery bypass surgery patients. INTERVENTIONS: Ranitidine (150 mg preoperatively per os and 50 mg intravenously postoperatively) and dobutamine (4 micro g. kg(-1). min(-1) for 3 h postoperatively) were administered in four randomised groups of patients: preoperative and postoperative ranitidine, either alone (n = 15) or in combination with dobutamine (n = 17), dobutamine alone (n = 15) or neither ranitidine nor dobutamine (n = 17). MEASUREMENTS AND RESULTS: Gastric intramucosal-arterial PCO(2) difference was measured during the first 5 postoperative hours. No differences in the postoperative pattern of gastric intramucosal-arterial PCO(2) difference were found among the groups. CONCLUSIONS: Ranitidine and dobutamine have no effect on the gastric tonometry results on intramucosal-arterial PCO(2) difference after uncomplicated cardiac surgery. Hence, the routine use of H(2)-antagonists for gastrointestinal tonometry is not warranted. Our results must be limited to results obtained by tonometry; they do not allow any conclusions on the effects of these drugs on splanchnic blood flow or its distribution.

Adrenergic beta-Agonists↗