Effect of endotoxin on hypoxic pulmonary vasoconstriction--the role of prostaglandins and leukotrienes

High altitude headache: efficacy of acetaminophen vs. ibuprofen in a randomized, controlled trial

Ibuprofen has been shown to be more effective than placebo in the treatment of high altitude headache (HAH), but nonsteroidal anti-inflammatory agents have been linked to increased incidence of gastrointestinal (GI) side effects and high-altitude pulmonary edema (HAPE). We postulated that acetaminophen, which does not share ibuprofen's theorized causal link to GI side effects or HAPE, could provide effective HAH therapy. We conducted a prospective, randomized, double-blind, clinical trial of ibuprofen vs. acetaminophen in the Solu Khumbu, Nepal: Mt. Everest Base Camp, Pheriche, Dingboche (4240 m to 5315 m). Seventy-four consecutive patients (ages 13 to 61 years) were randomized, were assessed with the Lake Louise Acute Mountain Sickness (AMS) criteria, and received a physical examination (which included vital signs, oxygen saturation as measured by pulse oximetry (SpO(2)), and assessment of clinical Lake Louise AMS criteria). Patients then received either 400 mg of ibuprofen (IBU) or 1000 mg of acetaminophen (ACET), and were asked to rate their cephalgia using a 10-cm visual analog scale (VAS). Thirty-nine patients received IBU, and 35 received ACET. Baseline Lake Louise AMS scores were identical in the two groups (mean = 5.9). No differences in mean VAS scores between IBU and ACET groups were noted at time 0 (presentation), 30, 60, or 120 min. No cases of HAPE or high altitude cerebral edema were noted during the study period. In this study population, acetaminophen was as effective as ibuprofen in relieving the pain of HAH.

Effect of hemocarboperfusion on organ blood flow and survival in porcine endotoxic shock

OBJECTIVE

To evaluate the effects of hemocarboperfusion on hemodynamics, organ blood flow, and survival in endotoxin shock.

DESIGN

Prospective, placebo-controlled, animal trial.

SETTING

Research laboratory in a major university teaching hospital.

SUBJECTS

Pentobarbital-anesthetized pigs.

INTERVENTIONS

Twenty-eight pentobarbital-anesthetized pigs (18.5 to 22.3 kg) received 100 micrograms/kg of Escherichia coli endotoxin (lipopolysaccharide 0127) over 30 mins. Group 1 animals (n = 14) were controls and had blood diverted through an extracorporeal circuit without activated charcoal for 60 mins after lipopolysaccharide infusion. Group 2 animals (n = 14) underwent nonpulsatile hemocarboperfusion (activated charcoal SCN-1K).

MEASUREMENTS AND MAIN RESULTS

Mean arterial pressure, cardiac output, systemic vascular resistance, mean pulmonary arterial pressure, pulmonary vascular resistance, oxygen delivery, and regional blood flow (radiolabeled microsphere technique) were determined at baseline and every 30 mins for 150 mins. Results are presented as mean +/- SD. Parameters in the two groups were compared by two-way analysis of variance. A p < .05 was considered significant. The survival rate was ten (71%) of 14 animals in group 1 compared with 14 (100%) of 14 animals in group 2 (p < .05, Fisher's exact test). The mean cardiac output at the end of hemocarboperfusion was 1.6 +/- 0.6 L/min in group 1 compared with 3.0 +/- 0.9 L/min in group 2, and remained lower in group 1 animals throughout the experiment. Pulmonary arterial pressure and pulmonary vascular resistance were lower in the hemocarboperfusion-treated animals during and after hemocarboperfusion. Systemic vascular resistance increased by 70% after lipopolysaccharide infusion and returned to baseline values in the hemocarboperfusion group but remained increased in controls. Oxygen delivery was lower in group 1 at 90 and 150 mins (287 +/- 34 vs. 478 +/- 48 mL/min and 251 +/- 24 vs. 356 +/- 21 mL/min, respectively). Blood flow rates to the brain (38.5 +/- 7.5 vs. 27.1 +/- 5.4 mL/min/100 g), large intestine (26.6 +/- 1.1 vs. 17.7 +/- 2.5 mL/ min/100 g), and adrenal cortex (200 +/- 45 vs. 139 +/- 41 mL/min/100 g) were higher in the hemocarboperfusion group at the completion of carboperfusion but not at later time points.

CONCLUSION

These data suggest that hemocarboperfusion may be of value in the treatment of septic shock.

Effects of 3,4-dihydroxyacetophenone (3,4-DHAP) on hypoxic pulmonary and systemic vascular response in dogs

The effects of 3,4-DHAP on hypoxic pulmonary and systemic vascular responses were studied in anaesthetized dogs. The percentage change in pulmonary vascular resistance (delta PVR %) and that in systemic vascular resistance (delta SVR %) induced by 5 min hypoxia decreased significantly. 3,4-DHAP in doses of 1 mg/kg, 3 mg/kg, and 10 mg/kg i.v. caused a decrease in delta PVR% from the control value of 47.27 +/- 22.27% to 24.62 +/- 21.76%, 18.15 +/- 18.73%, and 24.10 +/- 19.76% respectively, and a decrease in delta SVR % from the control value of 12.91 +/- 7.39 % to -0.34 +/- 12.70%, -2.11 +/- 12.76%, and -2.37 +/- 15.52 % respectively. The results showed that 3,4-DHAP could decrease the hypoxic responses of pulmonary and systemic blood vessels. But it did not change delta PVR % or delta SVR % in dose of 30 mg/kg, neither did it influence the heart rate, cardiac output or cerebral blood flow during hypoxia in all the doses used.