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41.
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Schweizer A Khatchatourian G Höhn L Spiliopoulos A Romand J Licker M 《Journal of clinical anesthesia》2002,14(7):486-493
STUDY OBJECTIVES: To assess the impact of a new postanesthesia care unit (PACU) on intensive care unit (ICU) utilization, hospital length of stay, and complications following major noncardiac surgery. DESIGN: Observational study. SETTING: University hospital. PATIENTS AND MEASUREMENTS: From 1992 to 1999, 915 patients underwent either abdominal aortic reconstruction (n = 448) or lung resection for cancer (n = 467). Demographic, clinical, surgical, and anesthetic data, as well as perioperative complications, were abstracted from two institutional databases. INTERVENTIONS: Patients were divided in two study periods, before and after the opening of a new PACU (period 1992-1995 and period 1996-1999). MAIN RESULTS: Utilization of ICU decreased from 35% to 16% for vascular patients and from 57% to less than 4% for thoracic patients during the second period. Readmission to the ICU, perioperative mortality, and respiratory complications were comparable between the two periods. Patients with congestive heart failure, chronic obstructive pulmonary disease, or renal insufficiency were more likely to be admitted to the ICU than the PACU. Following vascular surgery the frequency of cardiac complications decreased from 10.6% in 1992-1995 to 5.2% in 1996-1999 (p < 0.005), as well as the need for postoperative mechanical ventilation (25% vs. 12%; P < 0.05). CONCLUSIONS: Increased availability of PACU beds resulted in reduced utilization of ICU resources without compromising patient care after major noncardiac surgery. 相似文献
43.
Neuroendocrine carcinoma (carcinoid) of the thymus associated with Cushing's syndrome 总被引:7,自引:0,他引:7
de Perrot M Spiliopoulos A Fischer S Totsch M Keshavjee S 《The Annals of thoracic surgery》2002,73(2):675-681
Neuroendocrine carcinoma (carcinoid) of the thymus associated with Cushing's syndrome is a rare disease. Recent evidence suggests that these tumors form part of a continuous spectrum ranging from well-differentiated carcinomas to small cell carcinomas. We report two new cases and review the 23 cases reported in the literature since 1972. The different diagnostic modalities are discussed, and an algorithm for the diagnosis of ectopic secretion of adrenocorticotropin (ACTH) is presented. In the future, the advent of radiologic and nuclear imaging as well as more accurate workup should help to diagnose these tumors at an earlier stage and improve the long-term outcome. 相似文献
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45.
Richard I. Shader David J. Greenblatt Domenic A. Ciraulo Marcia Divoll Jerold S. Harmatz Anastase Georgotas 《Psychopharmacology》1981,75(2):193-197
Desmethyldiazepam (DMDZ) disposition was evaluated in 32 healthy male and female volunteers who ingested single 15-mg doses of the precursor compound, clorazepate dipotassium. DMDZ concentrations were measured in multiple plasma samples obtained between 7 and 9 days after dosage. Appearance of DMDZ in blood was rapid, with peak concentrations attained on average 1.5 h after dosage. Absorption half-life (t
1/2 a) averaged 24 min. Neither peak time nor t
1/2 a were influenced by age or sex. After a rapid phase of distribution, DMDZ elimination was slow, with a mean elimination half-life (t
1/2 ) of 82 h (range 27–219 h). t
1/2 became prolonged with age in men but not in women Likewise, clearance of total (free plus bound) DMDZ declined with age in male subjects (r=–0.47, P<0.1), but was unrelated to age in women. DMDZ was extensively bound to protein in all subjects. The mean free fraction (FF) was 3.1% (range 2.0–4.3%), and increased significantly with declining plasma albumin concentrations (r=–0.57, P<0.001). Partly due to a decline in plasma albumin with age (r=–0.47, P<0.01), FF tended to increase with age (r=0.23). After correction for individual differences in FF, clearance of pharmacologically active unbound DMDZ declined significantly with age in men (r=–0.62, P<0.01), but actually was slightly higher, in elderly as opposed to young women. Thus, the age-related decline in the capacity for hepatic hydroxylation of DMDZ is highly sex-specific. 相似文献
46.
47.
Risk factors for reperfusion injury after lung transplantation 总被引:1,自引:1,他引:0
Cottini SR Lerch N de Perrot M Treggiari MM Spiliopoulos A Nicod L Ricou B 《Intensive care medicine》2006,32(4):557-563
Objective To assess the influence of recipient's and donor's factors as well as surgical events on the occurrence of reperfusion injury
after lung transplantation.
Design and setting Retrospective study in the surgical intensive care unit (ICU) of a university hospital.
Methods We collected data on 60 lung transplantation donor/recipient pairs from June 1993 to May 2001, and compared the demographic,
peri- and postoperative variables of patients who experienced reperfusion injury (35%) and those who did not.
Results The occurrence of high systolic pulmonary pressure immediately after transplantation and/or its persistence during the first
48 h after surgery was associated with reperfusion injury, independently of preoperative values. Reperfusion injury was associated
with difficult hemostasis during transplantation (p = 0.03). Patients with reperfusion injury were more likely to require the administration of catecholamine during the first
48 h after surgery (p = 0.014). The extubation was delayed (p = 0.03) and the relative odds of ICU mortality were significantly greater (OR 4.8, 95% CI: 1.06, 21.8) in patients with reperfusion
injury. Our analysis confirmed that preexisting pulmonary hypertension increased the incidence of reperfusion injury (p < 0.01).
Conclusions Difficulties in perioperative hemostasis were associated with reperfusion injury. Occurrence of reperfusion injury was associated
with postoperative systolic pulmonary hypertension, longer mechanical ventilation and higher mortality. Whether early recognition
and treatment of pulmonary hypertension during transplantation can prevent the occurrence of reperfusion injury needs to be
investigated.
The preliminary results of the present study were presented at the 14th Annual Meeting of the European Society of Intensive
Care Medicine, September 2001, Geneva, Switzerland 相似文献
48.
Margaret W Gerbase Marc Fathi Anastase Spiliopoulos Thierry Rochat Laurent P Nicod 《The Journal of heart and lung transplantation》2003,22(5):587-590
Pharmacologic interactions and absorption disturbances after transplantation may induce serologic fluctuation of immunosuppression and adversely affect outcome. We present data showing that trough levels of mycophenolic acid decreased by 50% during combined mycophenolate mofetil (MMF) and cyclosporine therapy compared with levels during combined MMF and tacrolimus therapy. In addition, cystic fibrosis patients required 30% higher doses of MMF to achieve the therapeutic levels of recipients without cystic fibrosis. 相似文献
49.
50.
Matthew L. Romo Ellen Brazier Dominique MahambouNsond Rene De Waal Christine SekaggyaWiltshire Cleophas Chimbetete Winnie R. Muyindike Gad Murenzi Cordelia Kunzekwenyika Thierry Tiendrebeogo Josephine A. Muhairwe Patricia Lelo Anastase Dzudie Christelle Twizere Idiovino Rafael Oliver C. Ezechi Lameck Diero Marcel Yotebieng Lukas Fenner Kara K. WoolsKaloustian N. Sarita Shah Denis Nash International epidemiology Databases to Evaluate AIDS 《Journal of the International AIDS Society》2022,25(7)
IntroductionDolutegravir is being scaled up globally as part of antiretroviral therapy (ART), but for people with HIV and tuberculosis co‐infection, its use is complicated by a drug–drug interaction with rifampicin requiring an additional daily dose of dolutegravir. This represents a disadvantage over efavirenz, which does not have a major drug–drug interaction with rifampicin. We sought to describe HIV clinic practices for prescribing concomitant dolutegravir and rifampicin, and characterize virologic outcomes among patients with tuberculosis co‐infection receiving dolutegravir or efavirenz.MethodsWithin the four sub‐Saharan Africa regions of the International epidemiology Databases to Evaluate AIDS consortium, we conducted a site survey (2021) and a cohort study (2015–2021). The cohort study used routine clinical data and included patients newly initiating or already receiving dolutegravir or efavirenz at the time of tuberculosis diagnosis. Patients were followed from tuberculosis diagnosis until viral suppression (<1000 copies/ml), a competing event (switching ART regimen; loss to program/death) or administrative censoring at 12 months.ResultsIn the survey, 86 of 90 (96%) HIV clinics in 18 countries reported prescribing dolutegravir to patients who were receiving rifampicin as part of tuberculosis treatment, with 77 (90%) reporting that they use twice‐daily dosing of dolutegravir, of which 74 (96%) reported having 50 mg tablets available to accommodate twice‐daily dosing. The cohort study included 3563 patients in 11 countries, with 67% newly or recently initiating ART. Among patients receiving dolutegravir (n = 465), the cumulative incidence of viral suppression was 58.9% (95% confidence interval [CI]: 54.3–63.3%), switching ART regimen was 4.1% (95% CI: 2.6–6.2%) and loss to program/death was 23.4% (95% CI: 19.7–27.4%). Patients receiving dolutegravir had improved viral suppression compared with patients receiving efavirenz who had a tuberculosis diagnosis before site dolutegravir availability (adjusted subdistribution hazard ratio [aSHR]: 1.47, 95% CI: 1.28–1.68) and after site dolutegravir availability (aSHR 1.28, 95% CI: 1.08–1.51).ConclusionsAt a programmatic level, dolutegravir was being widely prescribed in sub‐Saharan Africa for people with HIV and tuberculosis co‐infection with a dose adjustment for the drug–drug interaction with rifampicin. Despite this more complex regimen, our cohort study revealed that dolutegravir did not negatively impact viral suppression. 相似文献