Systemic capillary leak syndrome (SCLS) is a condition that's caused by the shift of fluid and protein from the intravascular space to the interstitial space as a result of repetitive episodes of capillary hyperpermeability. The pathogenesis of SCLS is still unclear, but there's recently been a report showing this syndrome in association with monoclonal gammopathy. This syndrome can be a fatal disease because cardiovascular collapse can occur in the initial capillary leak phase. Although theophylline, diuretics, terbutaline, steroids, calcium antagonist, Ginkgo biloba extracts and plasmapheresis have been suggested as medication, none of them have been proven to be effective. Considering that this disease is self-limiting, conservative treatment in the acute phase is believed to be very important. Because hypoalbuminemia is very a common manifestation of SCLS, Pentastarch, which has a higher molecular weight than albumin, could be efficient to prevent cardiovascular collapse. We used 10% Pentastarch during the acute SCLS attacks of 2 patients and the patients both showed a dramatic response. Pentastarch may be helpful to treat SCLS in its initial capillary leak phase by the elevating blood pressure, and this might contribute to somewhat decreasing the acute mortality of SCLS.
Adult ; Capillary Leak Syndrome/diagnosis/*drug therapy/etiology ; Capillary Permeability ; Female ; Hetastarch/*therapeutic use ; Humans ; Plasma Substitutes/*therapeutic use

Humans ; Liver Failure ; therapy ; Liver, Artificial ; Membranes, Artificial ; Plasma ; Plasma Exchange ; methods ; Plasma Substitutes ; therapeutic use ; Renal Dialysis ; methods ; Serum Albumin ; therapeutic use

OBJECTIVETo observe the effect of hypertonic sodium chloride hydroxyethyl starch 40 injection (HSH) in treatment of acute intracranial hypertension complicated by hemorrhagic shock in dogs, and explore the mechanism of the effects of HSH.

METHODSTwenty dogs were randomized into 4 equal groups, namely the 7.5% NaCl (HS) group, Ringer-Lactates solution (RL) group, hydroxyethyl strarch (HES) group, and HSH group. Canine models of acute intracranial hypertension complicated by hemorrhagic shock were established by epidural balloon inflation with saline and rapid discharge of the arterial blood. One hour after the induced shock, the dogs were given HS (6 ml/kg), RL of 3-fold volume of blood loss, HES of equivalent volume of blood loss, and HSH 8 ml/kg in the 4 groups, respectively. During the shock and resuscitationperiod, the intracranial pressure (ICP), mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) of the dogs were monitored, and the serum sodium level and plasma osmolality were measured at 30 min, 1 h and 4 h after the resuscitation.

RESULTSAll dogs had similar MAP, CPP, and ICP before resuscitation (P>0.05). After resuscitation, the MAP was significantly improved (P<0.01), but the dogs in HSH group exhibited the fastest response; with the exception of the dogs in HS group to have significantly decreased MAP 2 h after resuscitation (P<0.01), all the other dogs maintained the MAP for 4 h. The CPP was also significantly increased after resuscitation (P<0.01), and in HS group, CPP decreased significantly after 2 h (P<0.01), and HSH group maintained the high CPP after 4 h. The ICP was increased significantly in RL and HES groups after resuscitation (P<0.01), reaching the peak level at 1 and 3 h, respectively, but in HS and HSH groups, the ICP decreased significantly to the lowest level at 1 h (P<0.01) which was maintained for 4 h. After resuscitation, the plasma sodium and plasma osmolality were significantly increased in HSH and HS groups.

CONCLUSIONIn dogs with acute intracranial hypertension and hemorrhagic shock, HSH can effectively resuscitate hemorrhagic shock and decrease ICP, and the effect is longer-lasting than that of HS.

Acute Disease ; Animals ; Dogs ; Female ; Hydroxyethyl Starch Derivatives ; administration & dosage ; therapeutic use ; Intracranial Hypertension ; drug therapy ; etiology ; Male ; Plasma Substitutes ; administration & dosage ; therapeutic use ; Random Allocation ; Saline Solution, Hypertonic ; administration & dosage ; therapeutic use ; Shock, Hemorrhagic ; complications ; drug therapy ; Treatment Outcome

Injection pain of propofol remains a common clinical problem. Previous studies demonstrated that propofol injection pain was alleviated by applying nitroglycerin ointment to the skin of injection site, which inspires us to test whether venous vasodilation induced by fluid preload could alleviate the pain. Different types or volumes of fluid preload were compared. 200 ASA I-II adult patients were randomly assigned to five groups of 40 each. A 20 G cannula was established on the dorsum or wrist of the hand. When fluid preload given with Plasma-Lyte A 100 mL (P100 group), 250 mL (P250 group), 500 mL (P500 group), 0.9% saline 500 mL (N500 group) or Gelofusine 500 mL (G500 group) was completed within 30 min, respectively, Propofol (0.5 mg/kg, 1%) was injected at a rate of 0.5 mL/s. A blind investigator assessed the pain using a four-point scale. Incidence of pain in P100, P250, and P500 groups was 87.5%, 57.5% and 35%, respectively (P<0.05). The median pain intensity score was significantly lower in P500 group than that in P250 and P100 groups (P<0.05 and P<0.01, respectively). Comparison of the effect of different types of solution preload indicated that the highest incidence of pain was in N500 group (62.5%) (N500 vs. P500, P=0.014; N500 vs. G500, P=0.007). The median pain intensity score in N500 group was higher than that in P500 group (P<0.05) and G500 group (P<0.05). There was no significant difference between P500 and G500 groups. It is suggested that Plasma-Lyte A or Gelofusine preload with 500 mL before propofol injection is effective in alleviating propofol-induced pain.
Adolescent ; Adult ; Aged ; Electrolytes ; administration & dosage ; therapeutic use ; Female ; Humans ; Injections, Intravenous ; adverse effects ; methods ; Male ; Middle Aged ; Pain ; drug therapy ; etiology ; prevention & control ; Plasma Substitutes ; administration & dosage ; therapeutic use ; Polygeline ; administration & dosage ; therapeutic use ; Propofol ; administration & dosage ; adverse effects

OBJECTIVETo evaluate the combination of surgical grade calcium sulfate hemihydrate (SGCS) and platelet-rich plasma (PRP) for alveolar ridge preservation prior to implant placement.

METHODSChanges of bone quantity and quality in extraction sites following the SGCS/PRP and SGCS implantations were investigated by spiral computer tomography scan, bone scintigraphy, radiographic, histological and histomorphometric examinations.

RESULTSThe placement of SGCS/PRP reduced the resorption of the alveolar ridge. It also promoted bone metabolism and bone-to-implant contact. The addition of PRP to SGCS achieved the enhancement of the bone metabolism only at the early healing phase.

CONCLUSIONSIn this animal experiment, SGCS/PRP may be used as fresh extraction sockets graft for alveolar ridge preservation prior to implant placement.

Alveolar Bone Loss ; prevention & control ; Alveolar Process ; pathology ; surgery ; Animals ; Bone Substitutes ; therapeutic use ; Calcium Sulfate ; therapeutic use ; Dental Implants ; Dogs ; Male ; Mandible ; pathology ; surgery ; Osseointegration ; physiology ; Osteogenesis ; physiology ; Platelet-Rich Plasma ; Radiopharmaceuticals ; Tomography, X-Ray Computed

No abstract available.
Aged ; Anti-Inflammatory Agents/therapeutic use ; Carotid Artery Diseases/*complications/diagnosis/therapy ; Cerebral Angiography/methods ; Diagnosis, Differential ; Female ; Glucocorticoids/therapeutic use ; Humans ; Hydrocortisone/therapeutic use ; Hypopituitarism/diagnosis/*etiology/therapy ; Intracranial Aneurysm/*complications/diagnosis/therapy ; Magnetic Resonance Imaging ; Plasma Substitutes/administration & dosage ; Predictive Value of Tests ; Prednisolone/therapeutic use ; Sella Turcica ; Thyroid Hormones/therapeutic use ; Tomography, X-Ray Computed ; Treatment Outcome

BACKGROUNDPlatelet-rich plasma (PRP) is a kind of natural source of autologous growth factors, and has been used successfully in medical community. However, the effect of PRP in periodontal regeneration is not clear yet. This study was designed to evaluate the effectiveness of PRP as an adjunct to bovine porous bone mineral (BPBM) graft in the treatment of human intrabony defects.

METHODSSeventeen intrabony defects in 10 periodontitis patients were randomly treated either with PRP and BPBM (test group, n = 9) or with BPBM alone (control group, n = 8). Clinical parameters were evaluated including changes in probing depth, relative attachment level (measured by Florida Probe and a stent), and bone probing level between baseline and 1 year postoperatively. Standardized periapical radiographs of each defect were taken at baseline, 2 weeks, and 1 year postoperatively, and analyzed by digital subtraction radiography (DSR).

RESULTSBoth treatment modalities resulted in significant attachment gain, reduction of probing depth, and bone probing level at 1-year post-surgery compared to baseline. The test group exhibited statistically significant improvement compared to the control sites in probing depth reduction: (4.78 +/- 0.95) mm versus (3.48 +/- 0.41) mm (P < 0.01); clinical attachment gain: (4.52 +/- 1.14) mm versus (2.85 +/- 0.80) mm (P < 0.01); bone probing reduction: (4.56 +/- 1.04) mm versus (2.88 +/- 0.79) mm (P < 0.01); and defect bone fill: (73.41 +/- 14.78)% versus (47.32 +/- 11.47)% (P < 0.01). DSR analysis of baseline and 1 year postoperatively also showed greater radiographic gains in alveolar bone mass in the test group than in the control group: gray increase (580 +/- 50) grays versus (220 +/- 32) grays (P = 0.0001); area with increased gray were (5.21 +/- 1.25) mm(2) versus (3.02 +/- 1.22) mm(2) (P = 0.0001).

CONCLUSIONSThe treatment with a combination of PRP and BPBM led to a significantly favorable clinical improvement in periodontal intrabony defects compared to using BPBM alone. Further studies are necessary to assess the long-term effectiveness of PRP, and a larger sample size is needed.

Adult ; Alveolar Bone Loss ; diagnostic imaging ; surgery ; Animals ; Blood Platelets ; physiology ; Bone Regeneration ; drug effects ; Bone Substitutes ; therapeutic use ; Bone Transplantation ; methods ; Cattle ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Growth Substances ; therapeutic use ; Guided Tissue Regeneration, Periodontal ; methods ; Humans ; Male ; Middle Aged ; Minerals ; therapeutic use ; Plasma ; chemistry ; cytology ; Platelet Transfusion ; Radiography ; Transplantation, Heterologous ; Treatment Outcome