ABSTRACT
A higher mean arterial pressure (MAP) achieved by norepinephrine up-titration may improve organ blood flow in critically ill, whereas norepinephrine-induced afterload rise might worsen myocardial function. Our aim was to assess the effects of norepinephrine dose titration on global hemodynamics in cardiogenic shock. We prospectively evaluated 12 mechanically ventilated euvolemic patients (aged 67 +/- 12 years) in cardiogenic shock (10 patients acute myocardial infarction, 1 patient dilated cardiomyopathy, 1 patient decompensated aortic stenosis). Hemodynamic monitoring included arterial and Swan-Ganz catheters. The first data were obtained at MAP of 65 mm Hg, then the norepinephrine dose was increased over 40 min to achieve MAP of 85 mm Hg. Finally, the norepinephrine-dose was tapered over 40 min to achieve MAP of 65 mm Hg. Norepinephrine up-titration increased MAP to the predefined values in all patients with concomitant mild increase in filling pressures and heart rate. Systemic vascular resistance increased, whereas cardiac output remained unchanged. During norepinephrine down-titration, all hemodynamic parameters returned to baseline values. We observed no changes in lactate levels and mixed venous oxygen saturation. Our data suggest that short-term norepinephrine dose up-titration in cardiogenic shock patients treated or pretreated with inotropes was tolerated well by the diseased heart.
Subject(s)
Adrenergic alpha-Agonists/administration & dosage , Hemodynamics/drug effects , Norepinephrine/administration & dosage , Shock, Cardiogenic/drug therapy , Adult , Aged , Blood Pressure/drug effects , Cardiac Output/drug effects , Critical Care , Female , Heart Rate/drug effects , Humans , Male , Middle Aged , Monitoring, Physiologic , Prospective Studies , Respiration, Artificial , Shock, Cardiogenic/physiopathology , Time Factors , Treatment Outcome , Vascular Resistance/drug effectsABSTRACT
Microfilariae were found in blood samples of a 32 year-old-student from Guinea-Bissau (Africa). Based on parasite morphology as well as some other features the microfilariae were identified as Mansonella perstans. The course of infection was asymptomatic (except for slight urticarial skin lesions). The microfilariae disappeared from peripheral blood after mebendazole treatment (200 mg daily for 1 month).
Subject(s)
Mansonella/isolation & purification , Mansonelliasis/parasitology , Adult , Animals , Humans , Larva , Male , Mansonelliasis/blood , Mansonelliasis/diagnosisSubject(s)
Campylobacter Infections , Diarrhea/etiology , Acute Disease , Adolescent , Campylobacter fetus , Child , Child, Preschool , Humans , InfantSubject(s)
Campylobacter Infections/diagnosis , Colitis/diagnosis , Enteritis/diagnosis , Adult , Child , Child, Preschool , Colitis/etiology , Enteritis/etiology , Female , Humans , MaleABSTRACT
Hundred-and-two samples of four kinds of mild replacers for calves, produced in Czechoslovakia, were examined and evaluated. None of the studied pathogenic germs was detected in the samples. More than a half of the samples contained 1000 and 10000 mesophilous germs per 1 g. More than a third contained 1 to 1000 coliform germs per 1 g. On the basis of the results it is recommended--within microbiological requirements for the product--to propose that the maximum total number of microorganisms should be 100000 per 1 g of product.
