Measurements of cardiac output obtained with transesophageal echocardiography and pulmonary artery thermodilution are not interchangeable.

BACKGROUND: Echocardiography is increasingly becoming an integrated tool for circulatory evaluation in the intensive care unit and the operating room. Therefore, it is imperative to know the reproducibility of measurements obtained by echocardiography. In this study, a comparison of cardiac output (CO) measurements obtained with transesophageal echocardiography (TEE) and pulmonary artery catheter (PAC) thermodilution (TD) was carried out to test the precision, accuracy and trending ability of CO measurements obtained with TEE. METHODS: Twenty-five patients completed the study. Each patient was placed in the following successive positions: supine, head-down tilt, head-up tilt, supine, supine with phenylephrine administration, pace heart rate 80 beats per minute (bpm), pace heart rate 110 bpm. TEE CO and PAC CO were measured simultaneously. The agreement was analysed by Bland-Altman plots, and to assess trending ability, a polar plot was constructed. RESULTS: Both methods showed an acceptable precision 8% (PAC TD) and 16% (TEE). In comparison with PAC TD, the TEE was associated with a bias of -0.22 l/minute [95% confidence interval: -0.54; 0.10], wide limits of agreement (-1.73 l/minute; 1.29 l/minute), a percentage error of 38.6% and a trending ability with a radial degree of 53.6°, corresponding to a poor trending ability. CONCLUSION: In comparison, CO measurements obtained with TEE and PAC TD had wide limits of agreement, a larger percentage error than would be expected from the precision of the two methods, and a poor trending ability. Thus, TEE is not interchangeable with PAC TD for measuring CO.

Investigations on the effect of different cooling rates on the stability of amorphous indomethacin.

Amorphous forms of indomethacin have previously been prepared using various preparation techniques and it could be demonstrated that the way the material was prepared influenced the physicochemical properties of the amorphous form of the drug. The aim of this study was to use one preparation technique (transformation via the melt) to prepare amorphous indomethacin and to investigate the influence of the cooling rate (as a processing parameter) on the physical stability of the resulting amorphous form. The amorphous materials obtained were analysed for their structural characteristics using Raman spectroscopy in combination with multivariate data analysis. The onset of crystallisation was determined as an indicator of the physical stability of the materials using differential scanning calorimetry (DSC) and polarising light microscopy. The Johnson-Mehl-Avrami (JMA) model and Sestak-Berggren (SB) model were used in this study to describe the non-isothermal crystallisation behaviour. All differently cooled samples were completely X-ray amorphous. Principal component analysis of the Raman spectra of the various amorphous forms revealed that the samples clustered in the scores plot according to the cooling rate, suggesting structural differences between the differently cooled samples. The minimum cooling rate required to obtain amorphous indomethacin was 1.2 K min(-1), as assessed from the time-temperature-transformation (TTT) diagram. The physical stability of the samples was found to increase as a function of cooling rate in the order of 30 K min(-1) > 20 K min(-1) > 10 K min(-1) > 5 K min(-1) > 3 K min(-1) ≈ 1.2 K min(-1) and was in agreement with calculated descriptors for the glass forming ability (GFA), including the reduced glass transition temperature (T(rg)) and the reduced temperature (T(red)). The JMA model could not be applied to describe the crystallisation process for the differently cooled melts of indomethacin in this study. The kinetic exponent M from the autocatalytic SB model however, showed a positive correlation with glass stability.

[Results of protein-sparing modified fasting in hyperlipoproteinemias]. / Ergebnisse des proteinsparenden modifizierten Fastens bei Hyperlipoproteinämien.

We investigated the influence of a PSMF on body weight, body composition, blood lipids, physical working capacity, and nitrogen balance in obese HLP patients. During 4 weeks, 12 patients were treated by PSMF (approximately 340 kcal/d) under health resort conditions. At the same time, they daily exercised on a bicycle with an intensity of 80% of their physical working capacity estimated by an exercise load. The therapeutic regimen induced a significant weight loss (10.1 kg in the mean). Evidently, the patients diminished their body fat only as could be shown by estimations of total body water. Triglycerides, total cholesterol, and LDL-cholesterol also decreased significantly, while HDL-cholesterol remained unchanged. In spite of the weight reduction, the physical working capacity significantly increased from 57.8 to 93.2 kgm. Measurements of total nitrogen excretion with urine gave evidence of the protein saving effect of the therapy. Thus, PSMF--representing an effective therapeutic procedure--can be recommended to be used in obese HLP patients, proceeded that contraindications have been taken into consideration carefully.