Photodynamic therapy (PDT) is a recently approved treatment modality that involves the sequential administration of a photosensitizer or its precursor and light to generate singlet oxygen for treating diseased tissue. The use of topical aminolevulinic acid (ALA) and blue light for nonhypertrophic actinic keratoses currently represents the only approved dermatologic application for PDT in the U.S.A. ALA is a photosensitizer precursor that is metabolized by cells into protoporphyrin IX (PpIX), which can be subsequently activated by visible light. PDT with topical ALA has been shown to improve psoriasis, but post-treatment hyperpigmentation as well as inconsistent clinical responses despite repeated PDT sessions have limited the development of this treatment approach for psoriasis. Furthermore the use of topical PDT photosensitizers becomes somewhat impractical for treating larger body surface areas in patients with extensive psoriasis. We have recently shown that oral administration of ALA induces preferential accumulation of PpIX in psoriatic plaques. The objectives of this study were to evaluate the effects of PDT with blue light on psoriatic plaques after systemic ALA administration as well as to determine whether systemic ALA-PDT induces apoptosis in lesional T lymphocytes. It has been suggested that induction of apoptosis in lesional T lymphocytes may be indicative of longer remission time following treatment of psoriasis.

This article describes 2 patients with severe acute right ventricular failure causing circulatory shock. Portal vein pulsatility assessed by bedside ultrasonography suggested clinically relevant venous congestion. Management included cardiac preload reduction and combined inhalation of milrinone and epoprostenol to reduce right ventricular afterload. Portal vein ultrasonography may be useful in assessing right ventricular function in the acutely ill patient.

Background Persistent hypotension is a frequent complication after cardiac surgery with cardiopulmonary bypass (CPB). Midodrine, an orally administered alpha agonist, could potentially reduce intravenous vasopressor use and accelerate ICU discharge of otherwise stable patients. The main objective of this study was to explore the clinical impacts of administering midodrine in patients with persistent hypotension after CPB. Our hypothesis was that midodrine would safely accelerate ICU discharge and be associated with more days free from ICU at 30 days. Results We performed a retrospective cohort study that included all consecutive patients having received midodrine while being on vasopressor support in the ICU within the first week after cardiac surgery with CPB, between January 2014 and January 2018 at the Montreal Heart Institute. A contemporary propensity score matched control group that included patients who presented similarly prolonged hypotension after cardiac surgery was formed. After matching, 74 pairs of patients (1:1) fulfilled inclusion criteria for the study and control groups. Midodrine use was associated with fewer days free from ICU (25.8 [23.7–27.1] vs 27.2 [25.9–28] days, p = 0.002), higher mortality (10 (13.5%) vs 1 (1.4%), p = 0.036) and longer ICU length of stay (99 [68–146] vs 68 [48–99] hours, p = 0.001). There was no difference in length of intravenous vasopressors (63 [40–87] vs 44 [26–66] hours, p = 0.052), rate of ICU readmission (6 (8.1%) vs 2 (2.7%), p = 0.092) and occurrence of severe kidney injury (11 (14.9%) vs 10 (13.5%) patients, p = 0.462) between groups. Conclusion The administration of midodrine for sustained hypotension after cardiac surgery with CPB was associated with fewer days free from ICU and higher mortality. Routine prescription of midodrine to hasten ICU discharge after cardiac surgery should be used with caution until further prospective studies are conducted.

We describe the cases of 2 patients free from mechanical ventilation after a cardiac surgery with systemic venous congestion from right ventricular (RV) failure. Management of these patients included RV preload reduction with diuretics and RV afterload reduction with inhaled pulmonary vasodilators. Noninvasive combination of inhaled epoprostenol and inhaled milrinone through the AirLife filtered nebulizer system (CareFusion) was used. Reduction of splanchnic venous congestion was assessed by Doppler portal flow pulsatility.

SUMMARY The tail-cuff methods for measuring systolic blood pressure in the rat usually require preheating of the animal to obtain recordable pulse signals. To find a more sensitive method, we applied the principle of differentiated impedance (dZ/dt) to the tail-cuff measurement of systolic blood pressure. We obtained clear pulse signals from the tail in awake rats without preheating the animals, and the systolic blood pressure obtained by this method had an excellent correlation with the directly measured femoral artery pressure (correlation coefficient = 0.98). Heating the animals at 40°C for 5 minutes increased systolic blood pressure by a mean of 6 mm Hg as compared with that determined at the ambient temperature of 21 to 24°C. Mean systolic blood pressure in young female diabetic rats was 122 ± 3 mm Hg, which was significantly higher than the 111 ± 2 mm Hg of normal rats. It is concluded that the technique of electrical impedance as applied to the tail-cuff method is simple and highly sensitive and is suitable for measurement of tail systolic blood pressure in awake rats without preheating. (Hypertension 11: 371-375, 1988) KEY WORDS • tail-cuff method • temperature effect • hypertension • diabetes mellitus N ONINVASFVE measurement of arterial pressure in small animals such as rats is hampered by the small size of the accessible peripheral arteries, which provide relatively weak pulse signals for detection. Thus, the commonly used tailcuff methods for measuring systolic blood pressure (SBP) in the rat, which employ plethysmography 13 or Doppler ultrasonic flowmeter, 4 require preheating of the animals to enhance the amplitude of pulsation in order to record the pulse signals. Such a maneuver can artificially increase SBP 3 ' 6 and, therefore, can lead to less accurate determination of SBP. The photoelectric sensor technique, 7 "" as described by Yen et al. 10 and studied by Bunag and Butterfield," does not require preheating, but a high ambient temperature is needed for reliable measurements of SBP. In the present study, we developed a relatively simple method for the

Revascularization of the anterolateral territory using the LIMA-SVB is a promising approach considering its clinical safety and favourable patency rate results. A prospective randomized clinical trial is underway to compare this technique to conventional CABG.

No abstract

No abstract