Biomedical subjects

M Bertrand

Publications and source records attributed to M Bertrand.

At least 73 records · Page 4Linked to original sources

PubMed1998

Predictors of restenosis after coronary stent implantation.

OBJECTIVES: We sought to determine predictors of restenosis after coronary stenting (CS) in a consecutive series of patients. BACKGROUND: Although stenting in highly selected patient groups reduces restenosis, the results of stenting in a heterogeneous patient group and the effects of clinical and procedural factors on stent restenosis are currently unclear. METHODS: We analyzed the 6-month angiographic outcome of 500 lesions in 463 consecutive patients undergoing successful CS. Clinical, qualitative and quantitative angiographic variables were correlated with restenosis assessed as both a binary and a continuous variable. RESULTS: Restenosis, defined as the presence of >50% diameter stenosis in the dilated segment, was present in 105 (26%) of the 405 lesions with angiographic follow-up. The mean late lumen loss during the follow-up period was 0.79+/-0.64 mm. Implantation of multiple stents (p < 0.0001) and a high acute gain (p < 0.0002) were independently associated with a higher late lumen loss. In contrast, the use of high inflation pressure (p < 0.02) and Palmaz-Schatz stents (p < 0.005) was independently associated with a lower late lumen loss. When restenosis was defined as a qualitative variable, implantation of multiple stents (p < 0.001), stenosis length (p < 0.01), small reference diameter (p < 0.02) and stent type other than Palmaz-Schatz (p < 0.01) were independent predictors of restenosis. None of the clinical variables tested was associated with restenosis. CONCLUSIONS: Coronary stenting in an unselected patient group is associated with an acceptable restenosis rate. Although some risk factors were identified, the risk of restenosis was not related to most of the variables tested. This suggests that the superiority of CS over balloon angioplasty, in terms of restenosis, might also apply to subgroups of patients that were not included in the recent randomized studies.

Aged↗

PubMed1998

Treating anesthesia-induced hypotension by angiotensin II in patients chronically treated with angiotensin-converting enzyme inhibitors.

UNLABELLED: Although angiotensin II bolus administration may be used to increase blood pressure in patients chronically treated with angiotensin-converting enzyme inhibitors (ACEI) who have severe hypotension on anesthetic induction, no data are available describing its time course and its effects on the left ventricular function. Fourteen patients chronically treated with ACEI for hypertension and scheduled for vascular surgery were prospectively studied. Patients with cardiac insufficiency were excluded. A transesophageal echocardiography probe was inserted to assess systolic left ventricular function. When hypotension was observed (systolic arterial pressure [SAP] <85 mm Hg), an I.V. bolus of 2.5 microg of angiotensin II (AII) was given, and hemodynamic variables were recorded each 30 s over 5.5 min. Results are expressed as mean +/- SEM. Sixty seconds after the AII bolus injection, the SAP increased from 78 +/- 3 to 152 +/- 6 mm Hg. SAP remained higher than control until the 5th min. This was associated with significant increases in end-diastolic area (from 15.1 +/- 0.6 to 19.3 +/- 1.0 cm2, P < or = 0.001), end-systolic area (from 6.6 +/- 0.4 to 10.7 +/- 0.7 cm2, P < or = 0.001), end-systolic wall stress (from 32 +/- 0.05 to 82 +/- 7 kdynes/cm2, P < or = 0.001). In addition, a decrease in fiber-shortening velocity (from 1.1 +/- 0.05 to 0.76 +/- 0.04 circ/s, P < or = 0.05) and in fractional area change (from 0.57 +/- 0.02 to 0.44 +/- 0.02, P < or = 0.05) was observed. Heart rate did not significantly change during the study. Increases in preload and afterload were observed. However, the administration of AII causes a transient impairment in left ventricular function. We conclude that AII, given as an I.V. bolus of 2.5 microg, is effective in restoring arterial blood pressure within 60 s in patients chronically treated with ACEI. IMPLICATIONS: Severe hypotension on anesthetic induction in patients chronically treated with angiotensin-converting enzyme inhibitors for hypertension could be treated with an I.V. bolus of 2.5 microg of angiotensin II.

Aged↗

PubMed1998

Intramural injection of biodegradable microspheres as a local drug-delivery system to inhibit neointimal thickening in a rabbit model of balloon angioplasty.

Restenosis remains the major limitation of coronary angioplasty. The objective of this study was to develop microspheres able to be delivered at the angioplasty site for long-term drug release and to test their effects in a model of balloon angioplasty. Polylactic-co-glycolide acid microspheres (5-10 microm in diameter) were prepared by using an oil-in-water emulsion-solvent evaporation method. In vitro experiments with hydrocortisone-loaded microspheres revealed a hydrocortisone release for 4 weeks. We studied the in vivo effect of injection of microspheres into the arterial wall of New Zealand White rabbits by using a perforated balloon. Deep penetration of microspheres in the arterial wall was documented immediately after angioplasty. Intimal hyperplasia was assessed in iliac arteries 4 weeks after angioplasty. The morphometric analysis was performed in four groups of animals; the first group was subjected only to conventional angioplasty (control, n = 10), whereas the other three groups after conventional angioplasty were received perforated balloon angioplasty with saline (n = 10), microspheres (n = 10), or hydrocortisone-loaded microspheres (n = 7). Intramural injection of saline did not induce greater intimal hyperplasia compared with control (0.17 +/- 0.03 vs. 0.18 +/- 0.03 mm2, respectively). Microspheres injection was associated with a trend toward a greater degree of intimal hyperplasia that did not reach statistical significance. Hydrocortisone-loaded microspheres were associated with a significant reduction in intimal hyperplasia compared with unloaded microspheres (0.16 +/- 0.02 vs. 0.26 +/- 0.03 mm2, respectively). The polylactic-co-glycolide acid microspheres are well tolerated, easily injected into the arterial wall, and the increase of intimal hyperplasia is easily inhibited by release of hydrocortisone for 4 weeks after initial injury.

Angioplasty, Balloon↗

PubMed1998

Delivery of extraterrestrial amino acids to the primitive Earth. Exposure experiments in Earth orbit.

A large collection of micrometeorites has been recently extracted from Antarctic old blue ice. In the 50 to 100 micrometers size range, the carbonaceous micrometeorites represent 80% of the samples and contain 2% of carbon. They might have brought more carbon to the surface of the primitive Earth than that involved in the present surficial biomass. Amino acids such as "-amino isobutyric acid have been identified in these Antarctic micrometeorites. Enantiomeric excesses of L-amino acids have been detected in the Murchison meteorite. A large fraction of homochiral amino acids might have been delivered to the primitive Earth via meteorites and micrometeorites. Space technology in Earth orbit offers a unique opportunity to study the behaviour of amino acids required for the development of primitive life when they are exposed to space conditions, either free or associated with tiny mineral grains mimicking the micrometeorites. Our objectives are to demonstrate that porous mineral material protects amino acids in space from photolysis and racemization (the conversion of L-amino acids into a mixture of L- and D-molecules) and to test whether photosensitive amino acids derivatives can polymerize in mineral grains under space conditions. The results obtained in BIOPAN-1 and BIOPAN-2 exposure experiments on board unmanned satellite FOTON are presented.

Aluminum Silicates↗

PubMed1998

[Current data on atheromatous plaques and their evolution].

The modes of evolution of atheromatous plaques are now better understood. The process may start very early and continue for several decades. The severity of atherosclerosis lies in the results of phases of rapid progression involving a thrombotic mechanism. An initial mechanical accident (rupture or erosion of the plaque) is followed by a phenomenon of arterial thrombosis of variable severity. The vulnerability of an atheromatous plaque (defined as its potential for acute complication) is related to: 1) the risk of rupture, 2) the risk of thrombosis in case of rupture. A number of intrinsic properties influence the degree of plaque vulnerability. A thorough understanding of these mechanisms is essential for the development of new treatments to improve the prognosis of coronary patients.

Arteriosclerosis↗

PubMed1997

Evaluation of the effects of mivacurium chloride on hemodynamics and left ventricular function in patients with coronary artery disease undergoing abdominal aortic surgery.

OBJECTIVE: To determine the effects of two doses of mivacurium chloride on hemodynamics and left ventricular function in patients with documented coronary artery disease undergoing aortic surgery. DESIGN: A prospective study with the dose of mivacurium determined by randomization. SETTING: Induction area at a university hospital. PARTICIPANTS: Twenty consecutive patients undergoing aortic surgery with clinically and/or angiographically documented coronary artery disease. INTERVENTIONS: Intravenous administration of mivacurium chloride. MEASUREMENTS AND MAIN RESULTS: Induction of anesthesia was performed with midazolam and fentanyl. Two different doses of mivacurium chloride, 0.15 mg/kg (n = 10) and 0.2 mg/kg (n = 10; 2 and 2.5 ED95; respectively), were administered as a single bolus injection over a 60-second period in the absence of any surgical stimulation. In addition to standard hemodynamic monitoring, pulmonary artery catheterization and transesophageal echocardiography were used. The occurrence of myocardial ischemia was monitored using both a computerized three-lead ST-segment analysis system and the echocardiographic assessment of regional wall motion. No change in heart rate, mean arterial pressure, pulmonary capillary wedge pressure, cardiac output, and global left ventricular function was noted after administration of mivacurium with the two doses studied. No ST-segment change or new segmental wall motion abnormality was noted in either group. CONCLUSION: Mivacurium chloride, when injected over a 60-second period, preserves global and regional myocardial function in patients with documented coronary artery disease undergoing noncardiac surgery.

Adult↗

PubMed1997

Conformational variety of polyanionic peptides at low salt concentrations.

Sequential oligo- and polypeptides based on glutamic acid and leucine residues have been synthesized. In pure water, they exhibit a random coil conformation. Addition of very small amounts of divalent metallic cations induces the formation of ordered structure in the peptides which remain in solution. Higher salt concentrations precipitate the peptides. Polypeptides with alternating glutamic acid and leucine residues undergo a coil to beta-sheet transition in the presence of Ca2+, Ba2+, Mn2+, Co2+, Zn2+ and Hg2+. Addition of Cu2+ or Fe3+ induces the formation of an alpha-helix. Solid amorphous CdS generates water soluble beta-sheets, as well. Sequential poly(Leu-Glu-Glu-Leu) adopts an alpha-helix in the presence of divalent cations. The sequence-dependent conformational diversity was extended to poly(Asp-Leu) and poly(Leu-Asp-Asp-Leu).

Amino Acid Sequence↗

PubMed1997

Subclasses of LpA-I in coronary artery disease: distribution and cholesterol efflux ability.

We analysed the distribution of LpA-I particles according to their molecular weight in 34 men with symptomatic coronary artery disease (CAD) and 11 men with no symptoms of CAD (control group). Using an original rapid and reproducible gradient gel electrophoresis technique, three LpA-I subclasses were defined: large (L-LpA-I), intermediate (I-LpA-I) and small LpA-I (S-LpA-I). The proportion of L-LpA-I was significantly lower in the CAD group (37.5 +/- 18.5%) than in the control group (58.9 +/- 15.0%) (P < 0.01). Conversely, a significantly (P < 0.05) higher proportion of I-LpA-I (31.9 +/- 20.7%) was observed in the CAD group compared with the control group (14.2 +/- 8.2%). Also, in the CAD group, the proportion of L-LpA-I was positively associated with the plasma level of LpA-I (P < 0.05) and, conversely, the proportion of S-LpA-I was negatively associated with LpA-I levels (P < 0.01). L-LpA-I and I-LpA-I from CAD patients and from control subjects were most effective in promoting cholesterol efflux from Fu5AH rat hepatoma cells, whereas S-LpA-I was ineffective in this regard. In conclusion, the decreased ratio in CAD patients of L-LpA-I, lipoprotein subspecies that are required for cholesterol efflux from cells, suggests a potential anti-atherogenic effect of these particles associated with the larger LpA-I subfractions.

Aged↗

PubMed1997

A seroepidemiological study on toxoplasmosis.

Using the microparticle capture enzyme-immunoassay (MEIA) based on IMx technology (Abbott), we determined the current prevalence of toxoplasmosis in 784 pregnant women followed up during 1990, and in 1,839 randomly selected blood donors. They all came from the Brabant Wallon area and the South-East of Brussels. Specimens yielding low IgG immunity (6-15 units) [corrected], were further tested with a sensitive direct agglutination assay (Toxo-Screen DA, bioMerieux). Overall, the prevalence was 67% among blood donors and 50% in pregnant women. In blood donors, the prevalence in women was not statistically different from the prevalence in men: X2 = 2.95 NS. In the two populations, a progressive age-related increasing prevalence of up to 60% for pregnant women and 77% for blood donors was observed. In females, the prevalence was higher among female blood donors than among pregnant women: 63% versus 50%, X2 = 16, P < 0.001. However, when the prevalences were compared within three age subgroups of women (< or = 33 yrs, 34 to 41 yrs, > or = 42 yrs), there were no statistically significant differences between pregnant women and blood donors. Thus, the overall observed difference was due to an age effect. Therefore, the distribution of IgG titers was established in each of the six age and sex subgroups. The 25th, 50th and 75th percentiles of those distributions ranged between 14 IU and 20 IU, 24 IU and 35 IU, and 40 IU and 64 IU, respectively. The annual seroconversion rate was 0.8% in pregnant women, against 0.2% amongst non-immune blood donors over 3 months. In conclusion, our findings confirm the general prevalence of 50% of toxoplasmosis and an annual seroconversion rate of 0.8% in these two populations.

Adult↗

PubMed1997

Lumbar muscle rhabdomyolysis after abdominal aortic surgery.

Lumbar muscle rhabdomyolysis has been very rarely reported after surgery. The aim of this study was to determine its incidence and main characteristics in a large population undergoing abdominal aortic surgery. Over a 21-mo period, 224 consecutive patients, 209 male and 15 female, mean age 65 +/- 10 yr, underwent abdominal aortic surgery (aortic aneurysm in 142 patients and occlusive aortic degenerative disease in 82 patients). Surgical incision was a midline incision with exaggerated hyperlordosis in 173 patients and a flank incision with a retroperitoneal approach in 51 patients. Postoperative rhabdomyolysis was diagnosed in 20 patients. In these patients, 9 (4%) experienced severe low back pain, and lumbar muscle rhabdomyolysis was confirmed by tomodensitometry (n = 6) or muscle biopsy (n = 3). The remaining 11 patients had lower limb muscle rhabdomyolysis. Rhabdomyolysis occurred after surgery of longer duration, which involved more frequent visceral artery reimplantation, with longer duration of aortic clamping and greater intraoperative bleeding. Lumbar rhabdomyolysis occurred in younger patients who were more frequently obese. On first postoperative day, the mean creatine kinase (CK) value was greater in lumbar rhabdomyolysis than in lower limb rhabdomyolysis (17,082 +/- 15,003 vs 3,313 +/- 3,120 IU/L, P < 0.05). Acute renal failure and postoperative death did not occur in patients with lumbar muscle rhabdomyolysis. Lumbar rhabdomyolysis was not a rare event after abdominal aortic surgery (4%). This syndrome was characterized by postoperative low back pain of unusual severity, which required analgesic therapy, and induced a very high increase in CK with typical findings at tomodensitometry or muscle biopsy but was not associated with postoperative renal failure.

Acute Kidney Injury↗

PubMed1997

Risk factors for acute postoperative renal failure in thoracic or thoracoabdominal aortic surgery: a prospective study.

UNLABELLED: Acute postoperative renal failure is a common complication of thoracic aorta, thoracoabdominal aorta, or aortic arch surgery. To identify variables associated with acute postoperative renal failure, we prospectively studied 475 consecutive patients undergoing thoracoabdominal aortic surgery over a 12-yr period, including those requiring emergent surgery. One hundred twenty-one (25%) patients developed acute postoperative renal failure, and 39 (8%) required hemodialysis. Using multivariate analysis, acute postoperative renal failure was significantly associated with the following variables: age >50 yr (odds ratio [OR] 2.90 [95% confidence interval 1.52-5.53]), preoperative serum creatinine >120 micromol/L (OR 2.76 [1.70-4.48]), duration of left kidney ischemia >30 min (OR 2.01 [1.27-3.17]), packed red cells administration >5 units (OR 2.04 [1.24-3.37]), and Cell-Saver administration >5 units (OR 2.31 [1.34-1.96]). Reimplantation of visceral, renal arteries and the Adamkievicz artery; duration of visceral, spinal, and right kidney ischemia; requirement for fresh frozen plasma; administration of aprotinin; extracorporeal circulation; and procedures with circulatory arrest and profound hypothermia were not predictive of postoperative renal failure. In addition, age >50 yr (OR 5.59 [1.31-23.91]), requirement for packed red blood cells >5 unit (OR 3.91 [1.58-9.67]), and preoperative serum creatinine concentration >120 micromol/L (OR 2.26 [1.13-4.53]) were independent factors for acute renal failure requiring hemodialysis. In conclusion, acute renal failure is often observed after thoracic aortic surgery. Numerous predictive factors must be considered when evaluating the etiology of this complication. IMPLICATIONS: Acute postoperative renal insufficiency is a common complication of thoracic aortic surgery. This study found that age >50 yr, preoperative renal dysfunction, duration of renal ischemia, and amount of blood transfusion are significant predictors of this complication.

Acute Kidney Injury↗

PubMed1997

Salt-dependent conformational diversity of alternating poly (Glu-Leu).

Alternating poly(Glu-Leu) was synthesized by the condensation of the corresponding dipeptide p-nitrophenyl ester at high concentration. It exhibits a random coil structure in pure water at neutral pH. Addition of monovalent cations, such as NH4+ to a final 0.1 M solution, induces a transition to a water soluble beta-structure. The salt effect is quite selective since no transition was observed with Li+, Na+ or Cs+ ions. Addition of 0.5 equiv of calcium, cobalt or manganese chlorides per glutamyl residue induces similar coil to beta-sheet transitions. No polymer precipitation was observed at these very low salt concentrations. Addition of 0.5 equiv. of Cu2+ or 0.15 equiv. of Fe3- induces a coil to alpha-helix transition. Molecular modeling has been used to understand tentatively the main factors controlling the different conformations observed with the various metal ions.

Ammonia↗

PubMed1997

Association of angiotensin converting enzyme and angiotensin II type 1 receptor genotypes with left ventricular function and mass in patients with angiographically normal coronary arteries.

OBJECTIVE: To analyse the potential association of the angiotensin converting enzyme (ACE) and angiotensin II type 1 receptor (AT1R) gene polymorphisms on left ventricular function and mass in patients with normal coronary arteries. DESIGN: Consecutive sample. SETTING: University hospital. SUBJECTS: 141 consecutive white patients referred for coronary angiography and with angiographically normal coronary arteries. Patients with valvar diseases, cardiomyopathies, or a history of myocardial infarction were excluded. MAIN OUTCOME MEASURES: Left ventricular variables were measured for all patients. The ACE and AT1R genotypes were determined with a polymerase chain reaction based protocol using DNA prepared from white blood cells. A general linear model was used to compare data according to the ACE and to the AT1R genotypes. RESULTS: A strong association was observed between left ventricular mass and systemic hypertension (mean (SD) hypertension: 114 (31) g/m2; no hypertension 98 (23) g/m2; P < 0.003). However, no influence of ACE and AT1R polymorphisms on left ventricular mass was found, regardless of systemic hypertension. The subjects homozygous for the AT1R CC mutation had a significantly lower ejection fraction than those with allele A (AC+AA) (mean (SD) 62(12)% and 68(10)%, respectively, P < 0.05). No synergistic interaction of ACE and AT1R gene polymorphisms on left ventricular function and mass was found. CONCLUSIONS: These data do not support an association of the ACE and AT1R genotypes on left ventricular hypertrophy in white patients with normal coronary arteries.

Angiotensin II↗

PubMed1997

Multicenter retrospective study on the utilization of FEIBA in France in patients with factor VIII and factor IX inhibitors. French FEIBA Study Group. Factor Eight Bypassing Activity.

Factor VIII or factor IX replacement is frequently impossible in inhibitor-developing hemophiliacs, because of the level of the inhibitor titer. Activated prothrombin complex concentrates are one of the available options to treat the bleeding episodes in such patients. However, the efficacy of these products and the associated thrombogenic risk, particularly in prolonged administration such as employed during surgeries, are important concerns for hemophilia care providers. We performed a multicenter retrospective study to evaluate the use of FEIBA (Factor Eight Bypassing Activity) in France, and data is presented on 433 bleeding episodes, including surgical procedures, concerning 60 patients from 15 hemophilia centers. The efficacy was judged as good or excellent in 352 episodes (81.3%), poor in 73 episodes (16.9%) and non-existent in 8 episodes (1.8%). Minor and major surgical procedures were successfully performed using FEIBA as a second-line therapy after human or porcine factor VIII, and in some occasions FEIBA was utilized as the only substitution product. The tolerance was assessed as good in 428 episodes (98.8%), but in 5 cases adverse effects were reported. Only 3 patients out of 52 regularly evaluated (5.8%) were HIV-seropositive, and for two of them the seroconversion occurred prior to the first use of FEIBA. In contrast, 80.4% of the patients were HCV-seropositive. An anamnestic response after the administration of FEIBA was noted in 31.5% of cases. This study points out the main features of the use of FEIBA in France, and particularly the low HIV seroprevalence in the patients treated. The good efficacy and the excellent tolerance still confer to this product a place to consider in the therapeutic options for the treatment of inhibitor-developing hemophiliacs or in acquired hemophilia.

Adolescent↗

PubMed1997

[Coronary angioscopy].

Coronary angioscopy evaluates the composition of the atherosclerotic plaque by direct examination of the arterial wall. The angioscope is fitted with a balloon which prevents assessment of the proximal segment of the vessels. The fibre optic system provides and excellent view of the mid and distal segments of the coronary arteries. The coronary arteries appear smooth and white on angioscopy. The atherosclerotic plaque is a white or yellowish incursion. Unstable plaques are characterised by the presence of thrombus. In unstable angina, thrombus is observed in 64% of cases and in 75% of cases during the first month after myocardial infarction. The colour of the plaque seems to be related to its fragility: the yellow plaque is much more common during myocardial infarction than in unstable angina (75% versus 47% of cases). Finally, after coronary angioplasty restenosis is more commonly white, covered by neo-intimal proliferation. Angioscopy has been shown to be feasible and safe and it is a better method of identifying thrombus. At present, it is a tool for clinical research in coronary thrombosis and interventional cardiology.

Angioplasty, Balloon, Coronary↗

PubMed1996

ACE polymorphism, a genetic predictor of occlusion after coronary angioplasty.

In this study, restenosis after coronary angioplasty is evaluated in a series of 291 consecutive patients according to ACE genotypes. The authors conclude that the ACE 2ID polymorphism has no effect on progressive restenosis after balloon angioplasty, but it is implicated in a distinct mechanism of restenosis (thrombosis and occlusion) that could explain discrepancies among previously published studies.

Angioplasty, Balloon, Coronary↗

PubMed1996

Fundamental limitations on the contrast-transfer efficiency in elastography: an analytic study.

Elastography is a new ultrasonic imaging technique introduced to produce images of the Young's modulus distribution of compliant tissue. This Young's modulus distribution is derived from the ultrasonically estimated longitudinal internal strains induced by an external compression of the tissue. The displayed two-dimensional images are called elastograms. Recently, contrast-transfer efficiency, defined as the ratio of elasticity contrast as measured from elastogram to the true contrast, was used to illustrate by simulation the fundamental limitation of elastography in displaying the elastic modulus contrast of soft inclusion in a hard background and vice versa. In this paper, using a classical analytic solution of the elasticity equations derived for an infinite medium subjected to a uniaxial compression, we confirm such earlier simulations results. For this purpose we derive an analytic expression predicting the observed contrast in elastograms.

Animals↗

PubMed1996

Effects of pentoxifylline on circulating cytokine concentrations and hemodynamics in patients with septic shock: results from a double-blind, randomized, placebo-controlled study.

OBJECTIVE: To determine whether a continuous intravenous infusion of pentoxifylline, a methylxanthine derivative, alters the serum cytokine concentrations and/or hemodynamic measurements in patients with septic shock. DESIGN: A prospective, randomized, double-blind, placebo-controlled study. SETTING: Medical intensive care unit in a university hospital. PATIENTS: Sixteen patients with septic shock. INTERVENTIONS: Patients were randomly assigned to receive either pentoxifylline (1 mg/kg) followed by an infusion of 1.5 mg/kg/hr for 24 hrs (n = 8), or placebo (n = 8). MEASUREMENTS AND MAIN RESULTS: Tumor necrosis factor (TNF) and interleukin (IL)-6 concentrations were measured by radioimmunoassays; IL-8 concentrations by an enzyme-linked immunosorbent assay (ELISA) and pentoxifylline concentrations by high-performance liquid chromatography at 0, 3, 6, 12, 18, 24 and 48 hrs after study entry. Pulmonary artery catheter-derived hemodynamics were measured at 0, 0.75, 3, 6, 12, 18, and 24 hrs. In pentoxifylline-treated patients, at 24 hrs, serum concentrations of TNF were significantly lower compared with controls (12 +/- 2 vs. 42 +/- 12 pg/mL, respectively, p = .04). Serum concentrations of IL-6 and IL-8 did not differ between the two treatment groups. There were also no significant differences in any hemodynamic and oxygenation measurements comparing the two treatment groups. Pentoxifylline concentrations were 1,544 +/- 241 ng/mL after the initial dose, and 5,776 +/- 1,781 ng/mL at the end of the 24-hr infusion. Five patients in the pentoxifylline group and four patients in the placebo group died. CONCLUSIONS: Pentoxifylline is able to decrease serum TNF but not IL-6 or IL-8 serum concentrations during septic shock. Pentoxifylline was well tolerated by all eight patients with no adverse effect. Further studies are needed to determine if pentoxifylline's ability to lower circulating TNF concentration without altering hemodynamics will improve outcome in septic shock.

Adult↗