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Yosuke Homma Takashi Shiga Hiraku Funakoshi Dai Miyazaki Atsushi Sakurai Yoshio Tahara Ken Nagao Naohiro Yonemoto Arino Yaguchi Naoto Morimura 《The American journal of emergency medicine》2019,37(2):241-248
Objective
This study assessed the association between the timing of first epinephrine administration (EA) and the neurological outcomes following out-of-hospital cardiac arrests (OHCAs) with both initial shockable and non-shockable rhythms.Methods
This was a post-hoc analysis of a multicenter prospective cohort study (SOS-KANTO 2012), which registered OHCA patients in the Kanto region of Japan from January 2012 to March 2013. We included consecutive adult OHCA patients who received epinephrine. The primary result included 1-month favorable neurological outcomes defined as cerebral performance category (CPC) 1 or 2. Secondary results included 1-month survival and return of spontaneous circulation (ROSC) after arrival at the hospital. Multivariable logistic regression analysis determined the association between delay per minute of the time from call to first EA in both pre- or in-hospital settings and outcomes.Results
Of the 16,452 patients, 9344 were eligible for our analyses. In univariable analysis, the delay in EA was associated with decreased favorable neurological outcomes only when the initial rhythm was a non-shockable rhythm. In multivariable analyses, delay in EA was associated with decreased ROSC (adjusted odds ratio [OR] for one minute delay, 0.97; 95% confidence interval [CI], 0.96–0.98) and 1-month survival (adjusted OR, 0.95; 95% CI, 0.92–0.97) when the initial rhythm was a non-shockable rhythm, whereas during a shockable rhythm, delay in EA was not associated with decreased ROSC and 1-month survival.Conclusions
While assessing the effectiveness of epinephrine for OHCA, we should consider the time-limited effects of epinephrine. Additionally, consideration of early EA based on the pathophysiology is needed. 相似文献6.
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Kayoko Minakata Masako Suzuki Hideki Nozawa Kunio Gonmori Kanako Watanabe Osamu Suzuki 《Forensic Toxicology》2006,24(2):83-87
Platinum (Pt) levels were determined in various tissues and body fluids obtained from a patient who died 181 days after cisplatin
overdosing. The symptoms of cisplatin overdose, however, might have almost disappeared by day 40, and the patient’s death
was ascribed to the recurrence of malignant lymphoma. Determination of Pt derived from cisplatin was performed by electrospray
ionization mass spectrometry (ESI-MS) using silver (Ag) as internal standard. Pt and Ag complexed with diethyldithiocarbamate
(DDC) in wetashed blood, and tissue solutions were extracted into isoamyl alcohol, and then acidified with oxalic acid. By
injecting an aliquot of the isoamyl alcohol layer into a mass spectrometer in the direct flow injection mode, the quantitation
was performed using the signals of Pt(DDC)3
+ and Ag(DDC)2
+ at m/z 639 and 403, respectively. The Pt levels ranged from 25ng/ml in blood to 2050ng/g wet weight in the liver of the patient,
indicating that Pt remained at high levels in tissues, even after a period as long as 181 days after cisplatin overdosing. 相似文献
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Takao Itoi Atsushi Sofuni Fumihide Itokawa Yasushi Shinohara Kazuya Takeda Kazuto Nakamura Toshio Kurihara Takayoshi Tsuchiya Fuminori Moriyasu 《Digestive endoscopy》2006,18(3):232-238
We describe our methods and outcomes of multidisciplinary treatments in patients with unresectable hilar cholangiocarcinoma. Fifty‐seven patients with a known outcome were enrolled. Thirty‐four of 57 patients were treated and evaluated by salvage therapy. For salvage therapy, we used internal and external radiotherapy, photodynamic therapy, YAG laser therapy and microwave coagulation therapy. The median survival time was 548 days for the group receiving salvage therapy and 198 days for the group not receiving this treatment. In conclusion, although no randomization of the patients was performed in this retrospective study, our present data provide convincing evidence that salvage therapy is a useful therapeutic approach for unresectable hilar cholangiocarcinomas. 相似文献
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Kazunori Aizawa Takeshi Hanaoka Hiroki Kasai Kaoru Kogashi Setsuo Kumazaki Jun Koyama Hiroshi Tsutsui Yoshikazu Yazaki Noboru Watanabe Osamu Kinoshita Uichi Ikeda 《Hypertension research》2006,29(2):123-128
The phosphodiesterase-5 (PDE-5) inhibitor, sildenafil, has been reported to produce sustained pulmonary vasodilatation in patients with pulmonary hypertension (PH). Recently, vardenafil, a more potent and selective PDE-5 inhibitor than sildenafil, has been approved for the treatment of erectile dysfunction. However, the long-term effects of oral vardenafil in patients with PH are unknown. We studied five consecutive patients with PH; one with primary pulmonary hypertension, two with chronic pulmonary thromboembolism, one with Eisenmenger syndrome (ventricular septal defect) and one with secondary pulmonary hypertension after a ventricular septal defect closure operation. In an acute hemodynamic trial, vardenafil (5 mg) significantly decreased both the pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR) with an increase in cardiac output. In a chronic hemodynamic trial, the maintenance dose of vardenafil (10 to 15 mg) for 3 months significantly decreased the PVR, but not the SVR, with a 20.7% reduction of the PVR/ SVR ratio. Plasma brain natriuretic peptide (BNP) levels were also significantly decreased after 3 months. This pilot study demonstrates that long-term oral vardenafil therapy may be a safe and effective treatment for patients with PH. 相似文献