Sepsis and the heart.

Septic shock, the most severe complication of sepsis, accounts for approximately 10% of all admissions to intensive care. Our understanding of its complex pathophysiology remains incomplete but clearly involves stimulation of the immune system with subsequent inflammation and microvascular dysfunction. Cardiovascular dysfunction is pronounced and characterized by elements of hypovolaemic, cytotoxic, and distributive shock. In addition, significant myocardial depression is commonly observed. This septic cardiomyopathy is characterized by biventricular impairment of intrinsic myocardial contractility, with a subsequent reduction in left ventricular (LV) ejection fraction and LV stroke work index. This review details the myocardial dysfunction observed in adult septic shock, and discusses the underlying pathophysiology. The utility of using the regulatory protein troponin for the detection of myocardial dysfunction is also considered. Finally, options for the management of sepsis-induced LV hypokinesia are discussed, including the use of levosimendan.

Virtual angioscopy by means of three-dimensional rotational angiography of the aortoiliac arteries.

PURPOSE: The aim of this study was to report the different findings that can be visualised with virtual angioscopy starting from rotational angiography (RA) and three-dimensional (3D) image processing (3DRA) in the evaluation of the abdominal aorta and iliac arteries. MATERIALS AND METHODS: Fifty-seven patients showing an occlusive or aneurysmal disease of the abdominal aorta and iliac arteries underwent intraarterial digital subtraction angiography (DSA) equipped with the RA function and a 3D workstation. We found that 3DRA is able to generate images of the examined vessels with a very effective 3D appearance; furthermore, it is able to create images of the lumen and wall of the vessel through two different modalities: endoviews and cross sections. The possibility of matching high-density structures (i.e. calcified plaques and stents) to standard 3D reconstructions of the examined arteries was applied. RESULTS: Different aspects of the arteries can be demonstrated in the angioscopic elaborations: the normal and stenotic lumen, artery bifurcations, the collateral vessel origins and the severity and extensions of atheromatous calcifications and their relationships to the vessel wall. Virtual angioscopy is able to visualise some devices (catheters, stents) introduced during diagnostic and interventional procedures. CONCLUSIONS: The constant technological evolution of diagnostic imaging is offering new image-processing techniques, providing new types of previously unexplored information. We present a summary of the different radiological findings that can be demonstrated with this new imaging technique.

Endovascular treatment of endoleaks after endovascular abdominal aortic aneurysm repair: personal experience.

PURPOSE: This paper describes the different endovascular treatments (cuffs, endografts and embolisation) available for types I, II and III endoleaks occurring after endovascular abdominal aortic aneurysm repair (EVAR). MATERIALS AND METHODS: From January 2000 to June 2006, 134 patients (118 men, 16 women; mean age 75.1 years) underwent EVAR. Ten patients (7%) developed significant endoleaks requiring endovascular treatment. RESULTS: Five endoleaks were type I, two were type II and three were type III. Of the five type I endoleaks, four were proximal and one was distal. The proximal endoleaks were treated by cuff deployment, whereas the distal endoleak was treated with a bifurcated graft. Of the two patients with type II endoleak, one was treated by translumbar puncture and coil embolisation, and the other was treated by superselective embolisation of the lumbar feeding vessel with nonresorbable particles. Of the three patients with type III endoleak, two were treated by deploying an aortouniiliac endograft inside the bifurcated graft and the other by implanting a cuff to restore continuity between the graft body and the contralateral limb. Endovascular treatment was successful in 6/10 cases, whereas three cases required surgical conversion. One patient did not undergo surgery owing to poor general condition. CONCLUSIONS: The reported incidence of endoleaks after EVAR is 10%-20%. Significant endoleaks should be treated promptly. Endovascular treatment can be done with different techniques, but success in not constant due to adverse anatomical conditions and technical difficulties.

9-[3-(2-Nitro-1-imidazolyl)propylamino]-1,2,3,4-tetrahydroacridine hydrochloride. A novel DNA-affinic hypoxic cell cytotoxin and radiosensitizer. Comparison with NLA-1.

Electron-affinic compounds with strong DNA intercalating properties have demonstrated less than the expected radiosensitization due to restriction of their mobility along the DNA backbone and their lower extravascular diffusion in tumors. A 2-nitroimidazole linked 1,2,3,4-tetrahydroacridine derivative (THNLA-1) has been synthesized as a hypoxia-selective cytotoxin and radiosensitizer with presumably lower DNA-binding affinity due to the perturbation of the planarity in the acridine ring. THNLA-1 is a good hypoxia-selective cytotoxin with a differential toxicity of approximately equal to 11 in V79 cells, but it is approximately equal to 2 times less potent on a concentration basis than NLA-1 (the 2-nitroimidazole linked acridine analog). However, THNLA-1 is a very efficient radiosensitizer, showing a sensitization enhancement ratio (SER) of 3.04 +/- 0.05 at 100 microM at 25 degrees C, and the concentration giving an SER of 1.6(C1.6) is 19.0 +/- 0.5 microM. The therapeutic index, defined as the ratio of the clonogenic IC50 under aerobic conditions for 1-h exposure (IC50A,1h) to the C1.6 value, is 20 for THNLA-1 vs. 11 for NLA-1. THNLA-1's partition coefficient in octanol/water is 0.14 +/- 0.02. Topoisomerase I and II interaction studies with THNLA-1 showed that topoisomerase I-mediated relaxation of supercoiled DNA was inhibited at relatively high THNLA-1 concentrations (> or = 1000 microM), while topoisomerase II-mediated decatenation of kinetoplast DNA remained unaffected even in concentrations toxic in vitro under aerobic conditions. Uptake studies under aerobic conditions showed high intracellular drug concentrations, compatible with the required ones for topoisomerase I inhibition.

[Ciprofloxacin in the treatment of respiratory infections]. / La ciprofloxacina nel trattamento delle infezioni respiratorie.

The authors evaluate the clinical efficacy and tolerability of the new wide-spectrum fluoroquinolone ciprofloxacin for management of respiratory tract infections. Of the 20 patients enrolled and treated with 500 mg ciprofloxacin tablets twice daily, 17 (85%) were completely cured, and tolerance was excellent in 19 (95%).