Fenoldopam, a newly developed intravenous dopaminergic DA1 receptor agonist, was used in an open, prospective study for blood pressure control in 12 patients presenting with hypertensive crisis. At a dose of 0.2-0.5 microgram kg-1 min-1 fenoldopam decreased systolic blood pressure from 209 +/- 13 to 151 +/- 17 mmHg and diastolic blood pressure from 114 +/- 10 to 78 +/- 10 mmHg. Blood pressure was controlled in all 12 patients within 5-50 min. In none of the patients did rebound hypertension occur upon termination of the study medication, nor was any adverse event reported. Major hemodynamic changes induced by fenoldopam were a decrease in total peripheral resistance from 1853 +/- 611 to 1193 +/- 368 and in pulmonary vascular resistance from 252 +/- 170 to 180 +/- 74 dyne s-1 cm-5. In patients with high left ventricular filling pressure at study pulmonary capillary wedge pressure decreased while the stroke volume index and mixed venous oxygen saturation increased under fenoldopam. Thus, fenoldopam appears to be a rapid-acting, well-tolerated, and highly effective intravenous substance for the treatment of severe hypertension.
Based on the histological findings of 23 patients who had received implants of the bovine hydroxyapatite ceramic Endobon for a period of up to 16 months, the biocompatibility, nature and extent of osseointegration as well as the resorption and degradation behaviour of the ceramic were investigated. The investigation material consisted mainly of small fragments that had been retrieved during revision operations that were indicated for other reasons. The results confirm the good tolerability and suitability that have been systematically investigated in experimental studies and described for hydroxyapatite ceramic as bone substitute in a vital cancellous bone bed that is not exposed to excessive strain (due to its brittle character). The importance of fulfilling certain requirements in order to achieve a successful result, such as stable implantation in a well vascularized, infection-free bone bed also with a minimization of the contact with local connective tissue has been further substantiated. Good success has been achieved by simultaneous loading with autogenous bone marrow as is practised by many ceramic users. In some cases a widening of intergrain boundaries as well as partial dissociation of superficial hydroxyapatite crystallites were observed in the implant surface.
Ziel: In der vorliegenden Untersuchung wird das Verhalten der Stickstoffbilanz und der Plasmaproteine ohne und mit Infusion von Aminosäuren bei Patienten mit akutem Myokardinfarkt untersucht. Design und Patienten: Wir untersuchten in einer offenen, nicht randomisierten Studie 30 konsekutive Patienten, die mit einem akuten Myokardinfarkt auf die internistische Intensivstation aufgenommen wurden. Rahmen und Interventionen: Die ersten 10 Patienten (Gruppe I) erhielten 10% Intrafusin 10 ml/kg KG/24 h als kontinuierliche intravenöse Infusion über insgesamt 96 h, die Patienten Nr. 11-20 (Gruppe II) erhielten Aminosteril® 10% 10 ml/kg KG/24 h über ebenfalls 96 h, und die Patienten Nr. 21-30 (Gruppe III) bekamen Jonosteril® 10 ml/kg KG/24 h intravenös über 96 h infundiert. Ergebnisse: Die Stickstoffbilanzen zeigten einen statistisch signifikanten Abfall in alien Gruppen (Gruppe I 9,1 auf 6,1 g/Tag, Gruppe II 9,8 auf 4,8 g/Tag, Gruppe III 1,3 auf-1,1 g/Tag), wobei jedoch in den Gruppen I und II die Stickstoffbilanzen positiv blieben. Die Konzentrationen vom Gesamteiweiß, Transferrin, retinolbindendem Protein und Präalbumin sanken signifikant ab, wobei diese Abnahme bei Aminosäureinfusion signifikant geringer war. Schlußfolgerungen: Durch Aminosäureinfusion beim akuten Myokardinfarkt können Stickstoffbilanzen positiv gehalten und der Abfall der Plasmaproteine signifikant vermindert werden. Es bedarf weiterer Untersuchungen zu entscheiden, inwieweit dieser günstige nutritive Effekt den Verlauf des Infarktes positiv beeinflußt und damit therapeutisch nutzbar ist.
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