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Robert K.P Chow MD Vincent C Ho MD FRCPC 《Journal of the American Academy of Dermatology》1996,34(6):1047-1060
Critical to the proper management of pyoderma gangrenosum are correct diagnosis, identification and treatment of any underlying disorder, and the proper choice of topical and systemic therapy. Many agents are available for the treatment of pyoderma gangrenosum. We review the current therapeutic options, their efficacy and side effects, and we offer some guidelines for their proper selection. 相似文献
13.
Toe temperature versus transcutaneous oxygen tension monitoring during acute circulatory failure 总被引:1,自引:0,他引:1
Measurements of toe temperature and transcutaneous PO2 (PtcO2) have been both suggested for non-invasive assessment of peripheral blood flow in acute circulatory failure. The underlying
principle of the two methods is that cutaneous vasoconstriction occurs early when tissue perfusion is altered. In 15 patients,
we compared the two measurements during cardiogenic shock (27 measurements) or septic shock (29 measurements). Toe-ambiant
temperature gradient and PtcO2 correlated well together (r=0.66, p(0.001) especially in hyperkinetic septic shock (r=0.79, p(0.001). In cardiogenic shock, toe-ambiant temperature correlated well with cardiac index (r=0.63), stroke index (r=0.64) and oxygen transport (r=0.65), and these correlations were stronger than for PtcO2. In septic shock, both techniques were poor indicators of blood flow indexes but PtcO2 rather correlated with arterial pressure (r=0.66) and left ventricular work (r=0.66). Trend evaluation of data revealed in cardiogenic shock that the increase in toe temperature usually preceded the increase
in PtcO2. Since measurement of PtcO2 is technically more complicated, correlates less well with standard hemodynamic parameters and later reflects cardiovascular
improvement, it has no advantage over measurement of toe temperature in circulatory shock. In cardiogenic shock, measurements
of toe temperature can reliably track cardiac output changes. In septic states, however, non-invasive assessment of skin perfusion
is of limited interest. 相似文献
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J L Vincent P Van der Linden M Domb S Blecic G Azimi A Bernard 《Anesthesia and analgesia》1987,66(6):565-571
The hemodynamic effects of dopamine and dobutamine (at doses of 6 micrograms X kg-1 X min-1) were compared during fluid resuscitation from septic shock induced by endotoxin (3 mg/kg) in the dog. In the first part of the study, when a standard amount of saline solution was infused (in 24 dogs), dopamine infusion resulted in higher cardiac filling pressures than did dobutamine infusion, whereas dobutamine infusion resulted in higher cardiac output. In the second part of the study, when fluid infusion was titrated to maintain pulmonary artery balloon-occluded pressure at constant level (in 24 dogs), the total amount of fluids was significantly greater with dobutamine than when dopamine was used (109 +/- 13 vs 71 +/- 10 ml/kg). The combination of dobutamine with fluids resulted in significantly greater stroke volume (39.6 +/- 3.8 vs 21.0 +/- 4.0 ml, P less than 0.05) and oxygen consumption (194 +/- 18 vs 144 +/- 8 ml/min, P less than 0.05). The different effects of dopamine and dobutamine on cardiac filling pressures can be due to differences in effects on myocardial contractility, ventricular afterload, and cardiac compliance. This experimental study indicates that when fluid therapy is combined with adrenergic agents in resuscitation from septic shock, dobutamine can be associated with higher cardiac output and oxygen transport and can result in higher tissue oxygen consumption than dopamine. 相似文献
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Leonardo Bonilha MD PhD Paulien M. de Vries Diana J. Vincent MD PhD Chris Rorden MD PhD Paul S. Morgan Mark W. Hurd PhD Nada Besenski MD Kenneth J. Bergmann MD Vanessa K. Hinson MD PhD 《Movement disorders》2007,22(8):1110-1116
We investigated whether structural white matter abnormalities, in the form of disruption of axonal coherence and integrity as measured with diffusion tensor imaging (DTI), constitute an underlying pathological mechanism of idiopathic dystonia (ID), independent of genotype status. We studied seven subjects with ID: all had cervical dystonia as their main symptom (one patient also had spasmodic dysphonia and two patients had concurrent generalized dystonia, both DYT1‐negative). We compared DTI MR images of patients with 10 controls, evaluating differences in mean diffusivity (MD) and fractional anisotropy (FA). ID was associated with increased FA values in the thalamus and adjacent white matter, and in the white matter underlying the middle frontal gyrus. ID was also associated with increase in MD in adjacent white matter to the pallidum and putamen bilaterally, left caudate, and in subcortical hemispheric regions, including the postcentral gyrus. Abnormal FA and MD in patients with ID indicate that abnormal axonal coherence and integrity contribute to the pathophysiology of dystonia. These findings suggest that ID is not only a functional disorder, but also associated with structural brain changes. Impaired connectivity and disrupted flow of information may contribute to the impairment of motor planning and regulation in dystonia. © 2006 Movement Disorder Society 相似文献
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Mary Steidl Matsui Isabella Illarda Nianci Wang Vincent A. DeLeo 《Experimental dermatology》1993,2(6):247-256
Abstract Several lines of evidence implicate protein kinase C (PKC) in the development of basal cell and squamous cell carcinomas, tumors which originate from epidermal keratinocytes. To examine PKC in a model relevant to human skin, we exposed normal human epidermal keratinocytes (NHEK) in serum-free media to a variety of PKC agonists and antagonists. NHEK PKC activity increased up to 10-fold within the 1st hour of exposure to tetradecanoyl phorbol acetate (TPA), and gradually returned to control values within 72 h. TPA-induced PKC activity was enhanced by pretreatment of cultures with protein and RNA synthesis inhibitors. TPA-induced growth arrest and differentiation was antagonized by staurosporine. Down-regulation by bryostatin pretreatment blocked TPA-stimulated differentiation. Our overall conclusion is that activation of PKC in cultured human keratinocytes is required for differentiation. These results are crucial to the analysis of compounds suspected of promoting or inhibiting epidermal tumors. 相似文献