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Clopidogrel (Plavix) given before the operation increases bleeding complications following coronary artery bypass grafting (CABG). High perioperative doses of aprotinin (Trasylol) are known to reduce bleeding and transfusions after cardiac surgery, but may increase the risk of thrombosis, renal impairment, and mortality. The aim of the study was to evaluate the clinical effects of aprotinin given in high doses intra- and postoperatively vs. a low postoperative dose in patients on clopidogrel. Patients admitted for first-time CABG and receiving clopidogrel with or without aspirin, were prospectively randomized either to receive a total of 75,000 kallikrein inhibitor unit (KIU)/kg aprotinin given intra- and postoperatively or 25,000 KIU/kg aprotinin after the operation. Three hundred and ninety-nine patients aged 32-87 years (median 67 years) were included. Postoperative bleeding was slightly different, but moderate in both groups. The transfusion rate was similar, as were the incidences of postoperative neurological disturbances and myocardial infarction. Renal impairment and need for inotropic drugs were more frequent in the high dose group. Thirty-day mortality was similar (high dose 2%, low dose 0.5%, P=0.22). A low postoperative dose of aprotinin in patients receiving clopidogrel is safe and has comparable effects regarding postoperative bleeding complications as a high dose.

We hypothesized that lipids and bile acids in meconium may induce pulmonary insufficiency in newborns. Because albumin may bind these components we studied the effect of albumin on meconium-induced lung injury in piglets. We measured concentration of FFA in the meconium (110 mg dry weight/mL) and added albumin to provide a molar FFA to albumin ratio of 11. Newborn piglets, 0–2 d of age, artificially ventilated and exposed to hypoxemia by ventilation with 8 O2, were randomized to group A receiving meconium (n12) or group B receiving meconium albumin (n12), 3 mL/kg intratracheally. The animals were reoxygenated for 8 h. Reoxygenation was started when mean blood pressure was <20 mm Hg or base excess was <−20 mM. Pulmonary function was assessed in parallel with pulmonary hemodynamics. From the start of reoxygenation and the next 8 h we found a significant difference (by ANOVA) between the two groups in oxygenation index (p0.005), with an increase from 1.6 ± 0.2 to 6.1 ± 6.8 (p0.04) in the meconium group and from 1.8 ± 0.3 to 3.1 ± 3.1 (NS) in meconium albumin group. There were also significant differences (by ANOVA) between the groups in favor of the treatment group concerning need of inspired fraction of O2, mean airway pressure, dynamic compliance of the respiratory system, time constant, ventilation index, and pulmonary vascular resistance. In conclusion, albumin given concurrently with meconium significantly reduced detrimental effects of meconium aspiration in the lungs of newborn piglets.

We investigated whether newborn piglets exposed to hypoxemia and severe meconium aspiration could be reoxygenated with room air as efficiently as with 100% O2. Twenty-one 2- to 5-d-old piglets were randomly divided into three groups: 1) the room air group: hypoxemia, meconium aspiration, and reoxygenation with room air (n = 8); 2) the O2group: hypoxemia, meconium aspiration, and reoxygenation with 100% O2(n = 8); and 3) the control group: meconium aspiration, and reoxygenation with room air (n = 5). Hypoxemia was induced by ventilation with 8% O2until the mean blood pressure reached <20 mm Hg or the base excess reached <-20 mM. At this point, reoxygenation was started with either room air or 100% O2. Three milliliters per kilogram of meconium 110 mg/mL was instilled into the trachea immediately before the start of reoxygenation. The O2tension in arterial blood was significantly lower in the room air group; at 5 min of reoxygenation it was 9.1 ± 0.5 kPa versus 43.5 ± 6 kPa in the O2group (p < 0.05). At 5 min of reoxygenation the tidal volume per kilogram was 12.1 ± 0.7 mL/kg in the room air group and 13.1 ± 0.9 mL/kg in the O2group (NS). There were no significant differences between the room air and the O2groups during 120 min of reoxygenation in mean arterial blood pressure, pulmonary arterial pressure, cardiac index, base excess, or plasma hypoxanthine. In conclusion, hypoxic newborn piglets with meconium aspiration were found to be reoxygenated as efficiently with room air as with 100% O2.

In an open investigation on 50 patients with various dermatological lesions 17 (81%) out of 21 psoriatics and 28 out of 29 other patients improved considerably or were clinically cured after three weeks' treatment with an ointment containing 0·05% betamethasone dipropionate and 3·0% chinoform. Among the patients chosen for the study 34 had previously tried topical corticosteroids without success. Of these 31 improved markedly during the steroid trial.

The effects on fluid balance, pulmonary tunctions and economics were evaluated in a randomized comparison of one colloid free and three colloid containing fluid regimens, for 48 hours during and after coronary artery‐bypass (CAB) surgery. A standard regimen for anaesthesia, extracorporeal circulation and monitoring was used. Only Ringer's acetate (RAc) was used as priming solution for extracorporeal circulation. Forty patients were randomized to receive either RAc, polygeline 35 mg‐ml‐1(Haemaccel®), dextran 70 (Macrodex®) 60 mg ml‐14, or albumin 40 mg‐ml‐1in saline whenever fluid volume was needed to stabilize haemodynamics. At the end of the operation, fluid retention was significantly lower in patients receiving polygeline and dextran 70, compared with patients receiving RAc. At 48 hours, however, there were no differences in cumulative fluid balance. Patients in the colloid groups postoperatively had a higher serum colloid osmotic pressure (s‐COP), bui a higher net lung capillary filtration pressure (AP) only on the second postoperative day than the RAc group. However, this did not adversely atfect intrapulmonary venous admixture, arterial oxygen tension, or time on respirator in the RAc group compared with the colloid groups. The most expensive colloid fluid regimen (albumin) cost about 230 USS more per patient than the RAc fluid regimen. We conclude that Ringer's acetate for volume replacement to stabilize haemodynamics during and after CAB surgery is associated with increased fluid retention only during the intraoperative period, compared with dextran 70 or polygeline, and with a lower serum colloid osmotic pressure and net lung capillary filtration pressure postoperatively, compared with all three colloid groups. This does not affect pulmonary functions adversely. Thus, the RAc regimen is clinically fully acceptable and economically more favourable than the polygeline, dextran 70, and albumin‐containing fluid regimens.

Previous studies have demonstrated that continuous infusion of furosemide results in increased diuresis and natriuresis compared with bolus administration of the drug in patients with severe heart failure. We reasoned that continuous infusion of furosemide caused less activation of neurohumoral mechanisms, since other studies have shown that bolus administration of furosemide may activate this system. We therefore tested the hypothesis that continuous administration of furosemide would increase water and sodium excretion due to less activation of neurohormones. Eight patients with severe heart failure were studied during continuous infusion over 24 h and bolus injections of furosemide twice daily in a randomized cross-over study. Bolus administration of furosemide increased diuresis and natriuresis significantly in the first 4 h after administration compared with continuous administration, but this was later reversed, resulting in similar 24 h total output. The neurohormones measured at baseline were all markedly elevated. Neither regimens of furosemide caused any further significant changes in neurohumoral response except that pro-ANF decreased more during the first 8 h after bolus administration compared to continuous infusion. This study has demonstrated that bolus administration of furosemide in conventional doses is equally effective as continuous intravenous infusion in patients with severe heart failure. This may be due to maximal neurohormonal activation in severe heart failure (NYHA III-IV) which could not be further activated by bolus administration.

Forty patients undergoing CPB for coronary artery surgery, using a standardized technical setting, were randomized to receive either Ringer's acetate, dextran 70 (Macrodex), polygeline (Haemaccel) or albumin 4% for volume replacement during and after surgery. The choice of fluid did not affect early complement activation (C3 activation products). Higher values of the terminal complement complex (TCC) were found only at the end of the operation in patients receiving polygeline. There were no differences between any two of the four groups during the postoperative course. The use of blood transfusion or autotransfusion and the degree of haemodilution and hypothermia did not affect complement activation.We conclude that complement activation in association with open-heart surgery is only marginally affected by the choice of fluid for volume replacement.

Background: Extracorporeal circulation induces increased capillary permeability with fluid leakage into the interstitial space, resulting in positive fluid balance and intravascular hypovolaemia. Hypertonic saline 75 mg . ml‐1in dextran 70, 60 mg . ml‐1(HSD) seems to be of benefit in patients with impaired perfusion. The purpose of the study was to investigate the effects of HSD infusion on fluid balance and cardiorespiratory functions just after the end of cardiac surgery.

Background: Hypertonic saline (HS) is increasingly used for fluid resuscitation in hypovolaemic patients. Although the effects of HS have been investigated in animal models, controlled studies in healthy human individuals are few. Aim: The effects of iv. hypertonic saline 75 mg . ml‐1in dextran 70, 60 mg . ml‐1(HSD) infusion on fluid shifts between the interstitial and intravascular fluid spaces, diuresis and haemodynamics were studied in normovolaemic and moderately hypovolaemic healthy volunteers.

The effects of blocking endothelin (ET) receptors in pulmonary circulation during hypoxemia and reoxygenation were studied in five groups of piglets. Ten minutes before hypoxemia, the Hyp group (n10) was given saline and the 1-mg (n9) and 5-mg group (n9), respectively, were given 1 and 5 mg/kg i.v. SB 217242 (an ET receptor antagonist). Two groups served as normoxic controls. The piglets were ventilated with 8 O2until base excess was <−20 mmol/L or mean arterial blood pressure was <20 mm Hg. Reoxygenation was performed with air. The increase of mean pulmonary artery pressure was significantly attenuated during hypoxemia and reoxygenation in the 1-mg group (p0.006). The pulmonary vascular resistance index increased significantly at the end of hypoxemia in the Hyp and 5-mg groups but was comparable to baseline in the 1-mg group. During the study period, the changes in pulmonary vascular resistance index were significantly attenuated in the 1-mg group compared with the 5-mg group. Stroke volume index was significantly attenuated compared with baseline in the 5-mg group during both hypoxemia and reoxygenation, whereas, in the Hyp and 1-mg group, stroke volume index was attenuated only at the end of hypoxemia. During hypoxemia, plasma ET-1 decreased from 1.9 ± 0.2 to 1.3 ± 0.3 ng/L (p0.008) in the Hyp group, remained unchanged in the 1-mg group, and increased from 1.6 ± 0.2 to 6.6 ± 1.6 ng/L (p0.008) in the 5-mg group. We conclude that blocking ET receptors attenuates pulmonary vasoconstriction during hypoxemia and reoxygenation in piglets.