Abstract
An intact endothelium releases nitric oxide (NO), which acts through cyclic GMP to mediate coronary dilatation, whereas a diseased endothelium releases less NO and more endothelin and poorly reduces the vasomotor tone. Release of NO is indirectly assessed by the measurement of NO synthase and the end product metabolites of NO (i.e. nitrites and nitrates). Diabetic patients (patients) with the potential of diabetic microangiopathy and endothelial dysfunction are theoretically expected to be poor secretors of NO. The aim of the present study is to correlate the serum level of NO in patients with acute coronary syndromes (ACS) (i.e. unstable angina, nonST segment elevation myocardial ischemia [NSTEMI], and ST segment elevation myocardial ischemia) in correlation with the extent of the total ischemic burden in relation to the presence or absence of diabetes mellitus. To achieve this aim we studied 59 patients, 20 diabetics and 39 nondiabetics (53 males, six females), with ACS (unstable angina in 20 patients, NSTEMI in five patients and acute myocardial ischemia in 34 patients). Before any therapeutic intervention, arterial blood samples were withdrawn to assess the serum NO metabolites level by the Griess reaction. Acute myocardial perfusion imaging with gated SPECT study was carried out by injecting 10 mci 99mTC SestaMIBI IV during chest pain with acquisition of the first set of SPECT images to asses the area of myocardium at risk (MAR), and to estimate of the initial ejection fraction. The second set was acquired 72 hours later to assess the extent of myocardial salvage achieved by different therapeutic modalities (PTCA, SK, etc.). A twenty-segment scoring system was applied for both sets of images to estimate the salvage index (SI): SI = [(MAR - second score) / MAR] × 100. A control group of 20 patients matched for age and sex were also studied.
Highlights
In contrast to conventional surgical tracheostomy, percutaneous dilational tracheostomy (PDT) in different variants is spreading rapidly in intensive care units today
Summary Our study demonstrated that LS is a good alternative to restore cardiac contractile function when combined with NE
The use of AVP may lead to further deteriorate sepsis-related myocardial dysfunction even when combined with a positive inotropic agent
Summary
In contrast to conventional surgical tracheostomy, percutaneous dilational tracheostomy (PDT) in different variants is spreading rapidly in intensive care units today. The objectives of the current study were (1) to assess the prognostic significance of plasma concentrations of NSE for early prediction of outcome in patients at risk for anoxic encephalopathy after cardiopulmonary resuscitation (CPR), and (2) to compare the prognostic information provided by NSE measurements with that provided by conventional risk indicators (clinical neurological examination and computerised tomography [CT] scan of the brain). Independent pulmonary ventilation was introduced in the 1930s and allows the utilization of different ventilatory strategies for each lung to improve gas exchange, respiratory mechanics or both in patients with heterogeneous lung diseases It is not clear whether the lower inflection point (LIP) on the inspiratory limb or the point of maximum curvature (PMC) on the deflation limb of the pressure–volume (PV) curve should be used for the positive end-expiratory pressure (PEEP) setting in acute lung injury (ALI). The long-term outcome, health-related quality of life (HRQL), and ICU and hospital costs of medical ICU patients were assessed
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