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51.
Oren I. Feder David Yeroushalmi Charles C. Lin Matthew S. Galetta Moretza Meftah Claudette M. Lajam James D. Slover Ran Schwarzkopf Joseph A. Bosco William B. Macaulay 《The Journal of arthroplasty》2021,36(8):2951-2956
BackgroundVancomycin is often used as antimicrobial prophylaxis in patients undergoing total hip or knee arthroplasty. Vancomycin requires longer infusion times to avoid associated side effects. We hypothesized that vancomycin infusion is often started too late and that delayed infusion may predispose patients to increased rates of surgical site infections and prosthetic joint infections.MethodsWe reviewed clinical data for all primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients at our institution between 2013 and 2020 who received intravenous vancomycin as primary perioperative gram-positive antibiotic prophylaxis. We calculated duration of infusion before incision or tourniquet inflation, with a cutoff of 30 minutes defining adequate administration. Patients were divided into two groups: 1) appropriate administration and 2) incomplete administration. Surgical factors and quality outcomes were compared between groups.ResultsWe reviewed 1047 primary THA and TKA patients (524 THAs and 523 TKAs). The indication for intravenous vancomycin usage was allergy (61%), methicillin-resistant staphylococcus aureus colonization (17%), both allergy and colonization (14%), and other (8%). 50.4% of patients began infusion >30 minutes preoperatively (group A), and 49.6% began infusion <30 minutes preoperatively (group B). Group B had significantly higher rates of readmissions for infectious causes (3.6 vs 1.3%, P = .017). This included a statistically significant increase in confirmed prosthetic joint infections (2.2% vs 0.6%, P = .023). Regression analysis confirmed <30 minutes of vancomycin infusion as an independent risk factor for PJI when controlling for comorbidities (OR 5.22, P = .012).ConclusionLate infusion of vancomycin is common and associated with increased rates of infectious causes for readmission and PJI. Preoperative protocols should be created to ensure appropriate vancomycin administration when indicated. 相似文献
52.
53.
温热清对小鼠腹腔巨噬细胞吞噬功能的影响 总被引:1,自引:0,他引:1
本文对温热清冲剂(柴胡、黄芩、生石膏、重楼、公英、连翘、厚朴、甘草)对小鼠腹腔巨噬细胞吞噬功能的影响进行实验观察,结果表明:温热清对巨噬细胞的各噬功能有显著的促进作用,与对照组相比较,有显著差别(P<0.01)。由此说明中药祛邪亦可实现扶正。 相似文献
54.
F. Terzi B. M. Assael A. Claris-Appiani G. Marra C. A. Dell'Agnola B. Tadini V. Tomaselli 《Pediatric nephrology (Berlin, Germany)》1990,4(6):581-584
Serum electrolyte equilibrium and plasma aldosterone concentrations were monitored in 19 infants who had severe obstructive uropathy or grade 5 vesico-ureteral reflux and were undergoing surgical correction in the first 2 months of life. Before surgery high plasma aldosterone levels were observed in 8 patients, but serum sodium and potassium concentrations were normal. Plasma concentrations of aldosterone were elevated in all patients during the week following surgery and 7 patients developed severe hyponatraemia, hyperkalaemia and weight loss despite very high plasma aldosterone concentrations. As a consequence 5 infants were infused with sodium chloride (4 mEq/kg per day) before and for 36h after surgery; this prevented metabolic imbalance. We conclude that infants undergoing surgical correction of uropathies may require a high sodium intake to maintain electrolyte balance and adequate growth. 相似文献
55.
通过57例原发性不孕症病人在B超引导下行输卵管通液术,术后随访观察,输卵管不通畅治愈率达89.5%(51/57);妊娠率达63。2%(36/57)。因此,B超引导下行输卵管通液术不仅是诊断和治疗输卵管不通所致原发性不孕症的一条好途径,而且是对传统输卵管通液术的进一步发展。 相似文献
56.
57.
Bernd Mühlbauer Erik Hartenburg Hartmut Osswald 《Naunyn-Schmiedeberg's archives of pharmacology》1994,349(3):244-249
Previously, we have found that feeding is a dominant factor controlling urinary dopamine excretion (UDA) in conscious rats (Mühlbauer and Osswald 1992). Since the renal response to feeding is also characterized by an increase in glomerular filtration rate (GFR), we wanted to investigate in a first step whether the feeding-induced elevations of GFR and UDA could be causally related phenomena. Therefore, we studied the influence of dopamine synthesis and dopamine receptor blockade on the renal response to amino acid infusion (AA) in thiopental anesthetized rats. AA infusion (n = 7) increased GFR by 33±7% (P<0.001) and UDA by 87±19% (P<0.001). In the presence of benserazide (BZD, n = 5), an inhibitor of dopamine synthesis, infused i.v. at a dose of 30 g/min/kg, UDA was suppressed to values below detection limit and the AA-induced GFR increase was abolished. Continuous intravenous infusion of the DA1 receptor antagonist SCH 23390 (SCH, n = 7) in a dose of 4.0 g/kg/min did not prevent the AA-induced increase in GFR (33±3%, P<0.001) and UDA (97±12%, P< 0.001). In contrast, S-sulpiride (SUL), a specific DA2 receptor antagonist, infused continuously i.v. in a dose of 5 g/kg/min, completely abolished the AA-induced GFR increase, while UDA was increased 1.6-fold (P<0.01). Like BZD, both dopamine receptor antagonists did not affect renal sodium excretion substantially.Our results suggest, that endogenous dopamine could act as a mediator in the renal response to amino acid infusion in the rat, most likely by activation of DA2 receptors.
Correspondence to:B. Mühlbauer at the above address 相似文献
58.
Holliday MA 《Pediatric nephrology (Berlin, Germany)》1999,13(9):989-995
This review highlights characteristics of extracellular fluid (ECF) that are often overlooked. ECF has, in addition to plasma
and interstitial fluid (ISF) surrounding cells, a third large compartment, the ISF of skin and connective tissue. This acts
as a reservoir that gives up ECF to plasma volume (PV) in order to sustain circulation in the event of either shock or dehydration.
While Starling forces drive filtration, ECF is returned to PV more by lymph and less by Starling forces than previously appreciated.
Lymph return to PV is dependent on physical activity and muscle contraction to overcome gravity. Regional change in metabolic
rate alters the need for oxygen and nutrients that is met by a regional increase in capillary blood flow. Blood flow is controlled
by vasoactive compounds released in response to a drop in PO2; these relax capillary smooth muscle to increase blood flow and delivery of oxygen and nutrients. Plasma proteins, including
albumin, are filtered into the interstitium through larger pores than those filtering ECF. The rate of protein filtration
is set by size and charge of these larger endothelial pores and by size and charge of proteins. Charge of these pores, hence
albumin permeability, is regulated by many of the same vasoactive compounds that control capillary flow. As a consequence,
in response to gravitational stress and other forms of shock that reduce effective circulation, albumin as well as ECF is
rapidly shifted from plasma and sequestered in ISF. When this has occurred, as in burn shock, restoration is better effected
by generous expansion of ECF with Ringer’s solution alone, rather than with Ringer’s solution supplemented with human serum
albumin or other colloid. Restoring both PV and ISF volume restores lymph circulation and returns sequestered albumin to PV.
Received: 12 November 1998 / Revised: 30 March 1999 / Accepted: 2 April 1999 相似文献
59.
冠脉搭桥术:8例经验体会 总被引:1,自引:0,他引:1
目的 总结冠脉搭桥术( C A B G) 的临床经验和体会、寻找最佳的围术期处理方法。方法 分析8 例 C A B G 患者完整的临床资料。心绞痛7 例,陈旧性心肌梗塞伴左室室壁瘤形成及发作性心绞痛1 例。并发高血压病者6 例,糖尿病3 例。 N Y H A 心功能Ⅱ级1 例,Ⅲ级4 例,Ⅳ级3 例。内乳动脉替代7 例,共用大隐静脉桥15 支。结果 1 例,术后因对角支静脉桥出血,行第2 次开胸修补止血。次2 日又因胸骨裂开,第3 次开胸行胸骨再固定术。全组无手术死亡病例,出院时心绞痛症状完全缓解。结论 C A B G 成功的关键除病变部位的准确诊断外,桥的获取及良好的心肌保护至关重要。 相似文献
60.
Andrew P. Cheung Yali F. Hallock B. Rao Vishnuvajjala Thuylinh Nguyenle Euphemia Wang 《Investigational new drugs》1999,16(3):227-236
Bryostatin 1 is currently in phase II clinical trial sponsored by the National Cancer Institute as an anticancer chemotherapeutic agent. Bryostatin 1 for injection was supplied in a dual pack containing a drug vial and a diluent vial and was manufactured by Ben Venue Laboratories, Inc (Bedford, OH). The stability and compatibility of the bryostatin 1-PET formulation, diluted to 1 and 10 ug/mL in saline and benzyl alcohol preserved saline, with polypropylene (PP) and polyvinyl chloride (PVC) bags at room temperature (27°C) were studied. All experiments were conducted in triplicate and analyses were performed using a validated, stability-indicating, high performance liquid chromatography (HPLC) assay.Bryostatin 1 solutions were compatible with PP bags. At both concentrations and with both salines, the bryostatin content remained unchanged during the 28-day storage period, benzyl alcohol concentration in the preserved saline solutions also remained relatively constant. In PVC bags, however, a decrease in bryostatin 1 concentrations without generation of decomposition products was observed at both dilutions and with both salines during the 28-day storage. A decrease in benzyl alcohol concentration in the preserved saline was also observed. While no diethylhexylphthalate (DEHP) leakage into the solution was observed in PP bags, DEHP leakage in PVC infusion bags was observed on day 2 of storage which increased with storage time and leveled off on day 6. The amount of DEHP leached into drug solution is dependent on the drug concentration. This study suggests bryostatin-PET formulation diluted with preserved saline can be used for long-term (4 week) intravenous administration using PP infusion bags, but not with PVC bags. 相似文献