Dan Med Bull
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Randomized Controlled Trial Clinical Trial
Albumin administration and acute phase proteins in abdominal vascular surgery. A randomised study.
Previous studies suggest that supplementary exogenous albumin may adversely affect hepatic protein synthesis. To test this, 18 patients undergoing elective abdominal aortic surgery were studied. Based on randomisation, nine patients received an average of 53.3 g albumin as part of blood replacement therapy, followed by 20 g albumin daily for the first three postoperative days. ⋯ All protein fractions other than albumin showed identical curve sequences and peak concentrations. The significant decrease (p less than 0.01) in concentration of all proteins except albumin of the albumin group was quantitatively explained by unreplaced plasma loss. The study rules out consequences of clinical importance of albumin supplementation on hepatic protein synthesis.
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The correlation between in vitro activity, pharmacokinetic properties and effect in vivo of antibiotics has so far received relatively little attention, and the optimal dosing strategy for most antibiotics is still a matter of dispute. A review on this subject is presented based on observations from an experimental pneumococcus infection model in mice. The pneumococcus is particularly suitable as pathogen in experimental infection models for antibiotic research, since it is clinically relevant, susceptible to a range of antibiotics, and naturally virulent to most laboratory animals without the need for potentiating factors. ⋯ The role of the time greater than MIC in context with other factors such as extravascular penetration of antibiotics, serum protein binding and the post-antibiotic effect is discussed. Most other experimental studies concerning dosing strategy for the beta-lactam antibiotics, including the few clinical studies available, confirm the importance of the time factor. The clinical implication for this group of antibiotics therefore is to strive for a constant, not necessarily high, concentration above the MIC.(ABSTRACT TRUNCATED AT 400 WORDS)
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The primary aim of the haemostatic mechanism is to protect the vascular system and to keep it intact after injury in order to secure the function of tissues and organs. A second aim is to provide a matrix in wound healing and tissue repair. The regulation of this physiological mechanism is effected by a dynamic haemostatic balance comprising interactions between endothelial cells, thrombocytes, coagulation, and fibrinolysis. ⋯ Effects of disturbances in the balance are illustrated by description of cases of haemorrhagic disorders or thrombosis, and the pathophysiological aspects are surveyed. The regulation of coagulation and fibrinolysis follows in both systems the same pattern. The active enzymes (thrombin and plasmin, respectively) are formed by activation of circulating proenzymes, and inhibitors (circulating or localized) exert their modifying influences at various stages of the total process.(ABSTRACT TRUNCATED AT 400 WORDS)