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Abstract
BACKGROUND We identified the need to modernize frostbite management in our northern centre and implemented a treatment protocol in 2015. Our aim was to describe the clinical course of patients presenting to the hospital since the implementation of the protocol. METHODS This was a retrospective case series from Whitehorse General Hospital, Whitehorse, Yukon Territory, Canada. We reviewed the charts of patients who presented to the hospital with grade 2-4 frostbite and were treated as per our protocol between Feb. 9, 2015, and Feb. 8, 2020. Patients with grade 2-4 frostbite received iloprost; in addition, those with grade 4 frostbite received alteplase and heparin. We determined the number of digits affected and salvaged, and the time from presentation to the emergency department to treatment initiation. We also examined patients' demographic characteristics, predisposing events, frostbite severity and adverse drug reactions. RESULTS In 22 patients treated for grade 2-4 frostbite, 142 digits were affected: 59 with grade 2 frostbite, 25 with grade 3 frostbite and 58 with grade 4 frostbite; of the 142, 113 (79.6%) were salvaged. All 29 digits amputated had grade 4 frostbite. The mean time from presentation to iloprost initiation was reduced from 32.9 hours in 2015 to 3.0 hours in 2020. Sports (10 cases [45%]) and alcohol use (6 [27%]) were the most common precipitating events, with alcohol use tending to result in more severe injury (grade 4 in 5 of 6 cases). Adverse reactions with iloprost (e.g., headache) were common but mild. Adverse reactions with alteplase (e.g., bleeding) were less common but of greater clinical significance. INTERPRETATION Over the study period, our protocol contributed to improvement in frostbite care at our institution, resulting in a digit salvage rate comparable to other published results. Our 5-year experience shows that advanced medical care of frostbite can be achieved, even at a rural centre.
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Affiliation(s)
- Alexander Poole
- Whitehorse General Hospital (Poole), Whitehorse, Yukon; Department of Surgery (Poole), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Whitehorse General Hospital (Gauthier), Yukon Hospital Corporation, Whitehorse, Yukon; University of Saskatchewan (Gauthier), Saskatoon, Sask.; Department of Surgery (MacLennan), McMaster University, Hamilton, Ont.; Harvard T.H. Chan School of Public Health (MacLennan), Boston, Mass.
| | - Josianne Gauthier
- Whitehorse General Hospital (Poole), Whitehorse, Yukon; Department of Surgery (Poole), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Whitehorse General Hospital (Gauthier), Yukon Hospital Corporation, Whitehorse, Yukon; University of Saskatchewan (Gauthier), Saskatoon, Sask.; Department of Surgery (MacLennan), McMaster University, Hamilton, Ont.; Harvard T.H. Chan School of Public Health (MacLennan), Boston, Mass
| | - Mira MacLennan
- Whitehorse General Hospital (Poole), Whitehorse, Yukon; Department of Surgery (Poole), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Whitehorse General Hospital (Gauthier), Yukon Hospital Corporation, Whitehorse, Yukon; University of Saskatchewan (Gauthier), Saskatoon, Sask.; Department of Surgery (MacLennan), McMaster University, Hamilton, Ont.; Harvard T.H. Chan School of Public Health (MacLennan), Boston, Mass
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2
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Abstract
BACKGROUND Frostbite is a thermal injury caused when tissue is exposed to sub-zero temperatures (in degrees Celsius) long enough for ice crystals to form in the affected tissue. Depending on the degree of tissue damage, thrombosis, ischaemia, necrosis (tissue death), gangrene and ultimately amputation may occur. Several interventions for frostbite injuries have been proposed, such as hyperbaric oxygen therapy, sympathectomy (nerve block), thrombolytic (blood-thinning) therapy and vasodilating agents such as iloprost, reserpine, pentoxifylline and buflomedil, but the benefits and harms of these interventions are unclear. OBJECTIVES To assess the benefits and harms of the different management options for frostbite injuries. SEARCH METHODS On 25 February 2020, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), Embase (OvidSP), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), Conference Proceedings Citation Index-Science (CPCI-S), as well as trials registers. Shortly before publication, we searched Clinicaltrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform, OpenGrey and GreyLit (9 November 2020) again. We investigated references from relevant articles, and corresponded with a trial author. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared any medical intervention, e.g. pharmacological therapy, topical treatments or rewarming techniques, for frostbite injuries to another treatment, placebo or no treatment. DATA COLLECTION AND ANALYSIS Two authors independently extracted data. We used Review Manager 5 for statistical analysis of dichotomous data with risk ratio (RR) with 95% confidence intervals (CIs). We used the Cochrane 'Risk of bias' tool to assess bias in the included trial. We assessed incidence of amputations, rates of serious and non-serious adverse events, acute pain, chronic pain, ability to perform activities of daily living, quality of life, withdrawal rate from medical therapy due to adverse events, occupational effects and mortality. We used GRADE to assess the quality of the evidence. MAIN RESULTS We included one, open-label randomised trial involving 47 participants with severe frostbite injuries. We judged this trial to be at high risk of bias for performance bias, and uncertain risk for attrition bias; all other risk of bias domains we judged as low. All participants underwent rapid rewarming, received 250 mg of aspirin and 400 mg intravascular (IV) buflomedil (since withdrawn from practice), and were then randomised to one of three treatment groups for the following eight days. Group 1 received additional IV buflomedil 400 mg for one hour per day. Group 2 received the prostacyclin, iloprost, 0.5 ng to 2 ng/kg/min IV for six hours per day. Group 3 received IV iloprost 2 ng/kg/min for six hours per day plus fibrinolysis with 100 mg recombinant tissue plasminogen activator (rtPA) for the first day only. The results suggest that iloprost and iloprost plus rtPA may reduce the rate of amputations in people with severe frostbite compared to buflomedil alone, RR 0.05 (95% CI 0.00 to 0.78; P = 0.03; very low-quality evidence) and RR 0.31 (95% CI 0.10 to 0.94; P = 0.04; very low-quality evidence), respectively. Iloprost may be as effective as iloprost plus rtPA at reducing the amputation rate, RR 0.14 (95% CI 0.01 to 2.56; P = 0.19; very low-quality evidence). There were no reported deaths or withdrawals due to adverse events in any of the groups; we assessed evidence for both outcomes as being of very low quality. Adverse events (including flushing, nausea, palpitations and vomiting) were common, but not reported separately by comparator arm (very low-quality evidence). The included study did not measure the outcomes of acute pain, chronic pain, ability to perform activities of daily living, quality of life or occupational effects. AUTHORS' CONCLUSIONS There is a paucity of evidence regarding interventions for frostbite injuries. Very low-quality evidence from a single small trial indicates that iloprost, and iloprost plus rtPA, in combination with buflomedil may reduce the need for amputation in people with severe frostbite compared to buflomedil alone. However, buflomedil has been withdrawn from use. High quality randomised trials are needed to establish firm evidence for the treatment of frostbite injuries.
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Affiliation(s)
| | - Christopher Davis
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, USA
| | - Luit Penninga
- Department of Surgery and Transplantation C2122, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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3
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Legrand M, Oufella HA, De Backer D, Duranteau J, Leone M, Levy B, Rossignol P, Vicaut E, Dépret F. The I-MICRO trial, Ilomedin for treatment of septic shock with persistent microperfusion defects: a double-blind, randomized controlled trial-study protocol for a randomized controlled trial. Trials 2020; 21:601. [PMID: 32611377 PMCID: PMC7329442 DOI: 10.1186/s13063-020-04549-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/22/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Septic shock remains a significant cause of death in critically ill patients. During septic shock, some patients will retain microcirculatory disorders despite optimal hemodynamic support (i.e., fluid resuscitation, vasopressors, inotropes). Alterations in the microcirculation are a key pathophysiological factor of organ dysfunction and death in septic shock patients. Ilomedin is a prostacyclin analog with vasodilatory effect and anti-thrombotic properties (i.e., inhibition of platelet aggregation) preferentially at the microcirculatory level. We hypothesize that early utilization of intravenous Ilomedin in septic shock patients with clinical persistence of microperfusion disorders would improve the recovery of organ dysfunction. METHODS The I-MICRO trial is a multicenter, prospective, randomized, double-blinded, placebo-controlled study. We plan to recruit 236 adult patients with septic shock and persistent microcirculatory disorders (i.e., skin mottling or increased capillary refill time) despite hemodynamic support. Participants will be randomized to receive a 48-h intravenous infusion of either Ilomedin or placebo starting at the earliest 6 h and later 24 h after septic shock. The primary outcome will be the change (delta) of sequential organ failure assessment (SOFA) score between randomization and day 7. Secondary outcomes will include mean SOFA score during the first 7 days after randomization, mortality at day 28 post-randomization, number of ventilation-free survival days in the 28 days post-randomization, number of renal replacement therapy-free survival days in the 28 days post-randomization, number of vasopressor-free survival days in the 28 days post-randomization, and mottling score at day 1 after randomization. DISCUSSION The trial aims to provide evidence on the efficacy and safety of Ilomedin in patients with septic shock and persistent microcirculatory disorders. TRIAL REGISTRATION NCT NCT03788837 . Registered on 28 December 2018.
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Affiliation(s)
- Matthieu Legrand
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 rue A. Paré, 75010, Paris, France.
- INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, Paris, France.
- Univ Paris Diderot, F-75475, Paris, France.
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, 500 Parnassus Avenue MUE416, Box 0648, San Francisco, CA, 94143, USA.
| | - Hafid Ait Oufella
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, 75571, Paris Cedex 12, France
- Sorbonne Université, Université Pierre-et-Marie Curie, Paris 6, France
| | - Daniel De Backer
- Intensive Care Department, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques Duranteau
- Department of Anesthesia and Intensive Care, Hôpitaux Universitaires Paris Sud, Université Paris Sud XI, Le Kremlin Bicêtre, France
| | - Marc Leone
- Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Service d'Anesthésie et de Réanimation, Hôpital Nord, Marseille, France
| | - Bruno Levy
- Service de Réanimation Médicale, Centre Hospitalo-Universitaire de Nancy, F-54511, Vandœuvre-Lès-Nancy, France
- Université de Lorraine, F-54000, Nancy, France
| | - Patrick Rossignol
- Centre d'Investigation Clinique Plurithématique Pierre Drouin-INSERM CHU de Nancy, Nancy, France
- FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Université de Lorraine, Nancy, France
| | - Eric Vicaut
- APHP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, Paris, France
| | - François Dépret
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 rue A. Paré, 75010, Paris, France
- INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, Paris, France
- Univ Paris Diderot, F-75475, Paris, France
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Hirsch K, Säemann M, Walter C, Taher F, Edda S, Mlekusch I, Jäger H, Assadian A, Falkensammer J. Decrease of peripheral resistance after intraoperative administration of iloprost in patients with and without type 2 diabetes mellitus and with peripheral arterial occlusive disease. Diab Vasc Dis Res 2020; 17:1479164120930589. [PMID: 32589047 PMCID: PMC7510379 DOI: 10.1177/1479164120930589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In many cases, Ilomedin® infusions are applied as part of a perioperative measure in patients with peripheral arterial occlusive disease because it makes a relevant vasodilatatory effect in patients with type 2 diabetes mellitus and with/without peripheral neuropathy. AIMS A prospective case-control study was performed to investigate the effect of prostanoids on peripheral resistance in patients with type 2 diabetes mellitus and patients without type 2 diabetes mellitus, as well as the role of peripheral neuropathy in patients undergoing arterial reconstruction. METHODS Sixty patients undergoing arterial reconstruction were enrolled. Sufficient data were collected on 38 patients. Prior to surgery, peripheral nerve conduction velocity was measured. Blood flow volume at the common femoral artery was assessed intraoperatively using a Doppler flowmeter at four time points: at baseline before arterial reconstruction (T0), after reconstruction (T1), after 5 (T2) and 10 min (T3) after intra-arterial application of 3000 ng of Ilomedin. Peripheral resistance units were calculated as a function of mean arterial pressure and flow volume using the following formula: peripheral resistance unit = mean arterial pressure (mm Hg) / flow volume (mL/min). RESULTS Ilomedin produced an immediate and significant drop of peripheral resistance in patients without type 2 diabetes mellitus as well as in patients with type 2 diabetes mellitus. Patients with peripheral neuropathy showed a less pronounced effect to Ilomedin compared to individuals with normal nerve conduction velocity.
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Affiliation(s)
- Kornelia Hirsch
- Department of Surgery, Vascular and Endovascular Surgery, Wilhelminenspital, Vienna, Austria
- Kornelia Hirsch, Department of Vascular and Endovascular Surgery, Wilhelminenspital, Montleartstrasse 37, 1160 Vienna, Austria.
| | - Marcus Säemann
- Department of Nephrology, Wilhelminenspital, Vienna, Austria
| | - Corinna Walter
- Department of Surgery, Vascular and Endovascular Surgery, Wilhelminenspital, Vienna, Austria
| | - Fadi Taher
- Department of Surgery, Vascular and Endovascular Surgery, Wilhelminenspital, Vienna, Austria
| | - Skrinjar Edda
- Department of Surgery, Vascular and Endovascular Surgery, Wilhelminenspital, Vienna, Austria
| | - Irene Mlekusch
- Department of Surgery, Vascular and Endovascular Surgery, Wilhelminenspital, Vienna, Austria
| | - Heidrun Jäger
- Department of Physical Medicine, Wilhelminenspital, Vienna, Austria
| | - Afshin Assadian
- Department of Surgery, Vascular and Endovascular Surgery, Wilhelminenspital, Vienna, Austria
| | - Jürgen Falkensammer
- Department of Surgery, Vascular and Endovascular Surgery, Wilhelminenspital, Vienna, Austria
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5
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Affiliation(s)
- Philipp Jud
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
| | - Franz Hafner
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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6
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Affiliation(s)
- Xin Jiang
- Key Laboratory of Pulmonary Vascular Medicine & FuWai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, and Chinese Academy Medical Sciences & Peking Union Medical College
| | - Xi-Qi Xu
- Key Laboratory of Pulmonary Vascular Medicine & FuWai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, and Chinese Academy Medical Sciences & Peking Union Medical College
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7
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Abstract
BACKGROUND This systematic review and meta-analysis was conducted to investigate the efficacy and safety of the chronic administration of aerosolized iloprost for pulmonary arterial hypertension (PAH). METHODS All the relevant studies were obtained from three databases, namely, PubMed, Web of Science and the Cochrane Library, from the inception of each database to June 1, 2018. In our study, chronic treatment was defined as a period lasting at least 3 months. The rate of each event was analyzed by SPSS as a percentage with 95% confidence intervals (CIs). For the meta-analysis, a randomized effect model or a fixed effect model was applied according to the results of the heterogeneity test. RESULTS Ten studies were included in this study, with a total of 370 patients treated with inhaled iloprost, including 214 in five randomized controlled trials and 156 in five prospective clinical trials. Among the patients who received inhaled iloprost, there was a significant improvement in the 6-min walk distance (6MWD) in the short-medium and prolonged treatment groups. Notably, the functionality improved by at least 1 class in 48.7% of the treated patients. In all the pooled studies, the estimated 3-month, 6-month, 1-year and 2-year event-free survival rates were 96.6%, 92.3%, 62.6% and 39.6%, respectively. In addition, there were eight adverse drug responses. CONCLUSION In this systematic review and meta-analysis, inhaled iloprost has been shown to be a safe and well-tolerated agent for PAH in the first 3 months after diagnosis. If used for a prolonged period, aerosol iloprost monotherapy could contribute to an unsatisfactory improvement in vascular remodeling and even a decreased event-free survival rate.
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Affiliation(s)
- Hongyu Kuang
- Department of Cardiology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China
- China International Science and Technology Cooperation Base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Qiang Li
- Department of Cardiology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China
- China International Science and Technology Cooperation Base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Qijian Yi
- Department of Cardiology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China
- China International Science and Technology Cooperation Base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Tiewei Lu
- Department of Cardiology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.
- China International Science and Technology Cooperation Base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.
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Emanuel AL, de Clercq NC, Koopen AM, van Poelgeest E, Serlie MJM, van Raalte DH, Kramer MHH, Nieuwdorp M, Eringa EC, Serné EH. Iloprost infusion prevents the insulin-induced reduction in skeletal muscle microvascular blood volume but does not enhance peripheral glucose uptake in type 2 diabetic patients. Diabetes Obes Metab 2018; 20:2523-2531. [PMID: 29885045 DOI: 10.1111/dom.13410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/22/2018] [Accepted: 06/05/2018] [Indexed: 01/26/2023]
Abstract
AIMS In type 2 diabetes impaired insulin-induced muscle perfusion is thought to contribute to reduced whole-body glucose uptake. In this study, we examined the effects of iloprost, a stable prostacyclin analogue, on insulin-induced muscle capillary recruitment and whole-body glucose uptake. MATERIALS AND METHODS In a randomized cross-over design, 12 type 2 diabetes patients (age, 55 [46-69] years; BMI, 33.1 [31.0-39] kg/m2 ) underwent two hyperinsulinaemic-euglycaemic clamps, one with and one without simultaneous low-dose iloprost infusion. Contrast-enhanced ultrasonography of the vastus lateralis muscle was performed before and during the clamp. Muscle capillary recruitment was calculated as percentage change in microvascular blood volume (MBV) before and during the clamp. RESULTS Insulin infusion reduced skeletal muscle MBV by ~50% compared to the fasting state (fasting, 1.77·10-4 [1.54·10-5 -2.44·10-3 ] arbitrary units (AU); hyperinsulinaemia, 6.69·10-5 [2.68·10-6 -5.72·10-4 ] AU; P = 0.050). Infusion of iloprost prevented this insulin-induced skeletal muscle capillary derecruitment, from (-49.5 [-89.5 to 55.3] %) to (8.0 [-68.8 to 306.6] %), for conditions without and with iloprost, respectively. The rate of glucose disappearance (Rd ) did not change significantly during iloprost infusion (17.3 [10.0-40.8] μmol/kg/min) compared with insulin infusion alone (17.6 [9.9-68.7] μmol/kg/min). CONCLUSIONS Our data suggest that acute improvement in insulin-stimulated muscle perfusion is not an attractive therapeutic approach to bypass cellular resistance to glucose uptake in type 2 diabetes. Whether long-term improvements in insulin-induced muscle perfusion may prove beneficial for glucose disposal remains to be determined.
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Affiliation(s)
- Anna L Emanuel
- Department of Internal Medicine, VU University Medical Centre, Diabetes Centre, Amsterdam, Netherlands
| | - Nicolien C de Clercq
- Department of Internal Medicine, Academic Medical Centre, Amsterdam, Netherlands
| | - Annefleur M Koopen
- Department of Internal Medicine, Academic Medical Centre, Amsterdam, Netherlands
| | - Erik van Poelgeest
- Department of Internal Medicine, VU University Medical Centre, Diabetes Centre, Amsterdam, Netherlands
| | - Mireille J M Serlie
- Department of Internal Medicine, Academic Medical Centre, Amsterdam, Netherlands
| | - Daniel H van Raalte
- Department of Internal Medicine, VU University Medical Centre, Diabetes Centre, Amsterdam, Netherlands
| | - Mark H H Kramer
- Department of Internal Medicine, VU University Medical Centre, Diabetes Centre, Amsterdam, Netherlands
| | - Max Nieuwdorp
- Department of Internal Medicine, VU University Medical Centre, Diabetes Centre, Amsterdam, Netherlands
- Department of Internal Medicine, Academic Medical Centre, Amsterdam, Netherlands
| | - Etto C Eringa
- Department of Physiology, VU University Medical Centre, Amsterdam, Netherlands
| | - Erik H Serné
- Department of Internal Medicine, VU University Medical Centre, Diabetes Centre, Amsterdam, Netherlands
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Fiori G, Marzi T, Bartoli F, Bruni C, Ciceroni C, Palomba M, Zolferino M, Corsi E, Galimberti M, Moggi Pignone A, Viggiano MP, Guiducci S, Calamai M, Matucci-Cerinic M. The challenge of pet therapy in systemic sclerosis: evidence for an impact on pain, anxiety, neuroticism and social interaction. Clin Exp Rheumatol 2018; 36 Suppl 113:135-141. [PMID: 30277859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 01/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The aim of our study was to evaluate the effect of animal-assisted intervention (AAI), a complementary support to traditional therapies focused on the interaction between animals and human beings, in improving psychological trait, anxiety and pain in a cohort of systemic sclerosis (SSc) patients. METHODS 42 SSc patients, undergoing iloprost intravenous infusion, were divided in three groups: 1) 14 patients submitted to 20 AAI sessions; 2) 14 patients engaged in alternative social activity (control group 1 - C1); and 3) 14 patients without any alternative activity (control group 2 - C2). All patients underwent Visual Analog Scale (VAS), the State-anxiety (STAI-S) and emotional faces at the beginning (s0) and at the end (s1) of each single session, while General Anxiety State-Trait Anxiety Inventory (STAI-T), Beck Depression Inventory (BDI), Social Interaction Anxiety Scale (SIAS), Eysenck Personality Questionnaire-Revised (EPQ-R), the Social Phobia Scale (SPS), the Toronto Alexythymia Scale (TAS-20), the Thought Control Questionnaire (TCQ) were administered at baseline (t0) and at the end of the project (t1). RESULTS AAI group showed a significant decrease of the anxiety state level in respect to the two control groups (p<0.001). VAS scale resulted lower both in AAI (p < 0.001) and C1 group (p<0.01). Moreover, STAI-T and TAS scores were significantly reduced in AAI group (p<0.001). TCQ scale showed that patients treated with AAI, compared to control group C2, had greater capacity to avoid unpleasant and unwanted thoughts (p<0.05). In AAI group, the EPQ-R test revealed an enhancement of extroversion trait compared to both control groups (p<0.05). CONCLUSIONS Our data show that AAI significantly reduces pain perception, anxiety, neuroticism and ameliorates patients' social interaction, therefore it may be a useful to allow a better compliance to traditional therapies.
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Affiliation(s)
- Ginevra Fiori
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology & Scleroderma Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
| | - Tessa Marzi
- Department of Neuroscience, Psychology, Drug Research and Child's Health, University of Florence, Italy
| | - Francesca Bartoli
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology & Scleroderma Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology & Scleroderma Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Carlo Ciceroni
- Veterinary Service of Azienda Sanitaria Locale 10, Florence, Italy
| | - Michela Palomba
- Italian Association "Utilizzo Cani D'Assistenza" (AIUCA society), Italy
| | - Michela Zolferino
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology & Scleroderma Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Elena Corsi
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology & Scleroderma Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | | | - Alberto Moggi Pignone
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Emergency Medicine, Division of Medicine, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Maria Pia Viggiano
- Department of Neuroscience, Psychology, Drug Research and Child's Health, University of Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology & Scleroderma Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Monica Calamai
- General Director of the Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology & Scleroderma Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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Duarte AC, Barbosa L, Santos MJ, Cordeiro A. Iloprost infusion through elastomeric pump for the outpatient treatment of severe Raynaud's phenomenon and digital ulcers - a single centre experience. Acta Reumatol Port 2018; 43:237-238. [PMID: 30414374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Raynaud's phenomenon (RP) and digital ulcers (DU) are the main clinical features of vasculopathy that occurs in several systemic rheumatic diseases. Intravenous iloprost is recommended for the treatment of severe RP and DU in patients with systemic sclerosis and portable devices for iloprost infusion have been recently designed, allowing outpatient treatment. This new alternative for drug administration not only avoids absenteeism, with the patient having the opportunity to continue his own family and work life, but also reduces the costs associated with hospitalization. We describe our protocol and report our experience with 12 patients, for a total of 25 infusions, who have received domiciliary iloprost through elastomeric pump. Patients could easily manage the device and the treatment outcomes were promising, with all patients having DU healing, without any special safety concerns.
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Ingegnoli F, Schioppo T, Allanore Y, Caporali R, Colaci M, Distler O, Furst DE, Hunzelmann N, Iannone F, Khanna D, Matucci-Cerinic M. Practical suggestions on intravenous iloprost in Raynaud's phenomenon and digital ulcer secondary to systemic sclerosis: Systematic literature review and expert consensus. Semin Arthritis Rheum 2018; 48:686-693. [PMID: 29706243 DOI: 10.1016/j.semarthrit.2018.03.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/27/2018] [Accepted: 03/29/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Systemic sclerosis (SSc) is an autoimmune chronic disease characterized by vascular impairment, immune dysfunction and collagen deposition. Raynaud's phenomenon (RP) and digital ulcers (DU) are prominent features of SSc. Intravenous (IV) iloprost (ILO), according to the recently updated EULAR recommendations, is indicated for RP after failure of oral therapy. Moreover, IV ILO could be useful in DU healing. IV ILO is currently available mainly on the European market approved for RP secondary to SSc with 3-5 days infusion cycle. Unfortunately, data published varies regarding regimen (dosage, duration and frequency). Up to now, ILO has been studied in small cohorts of patients and in few randomized controlled trials. METHODS A systematic review of studies on IV ILO in patients with SSc complicated by DU and RP was performed. Insufficient data were available to perform a meta-analysis according to the GRADE system. We performed a three-stage internet-based Delphi consensus exercise. RESULTS Three major indications were identified for IV ILO usage in SSc: RP non-responsive to oral therapy, DU healing, and DU prevention. IV ILO should be administered between 0.5 and 2.0ng/kg/min according to patient tolerability with a frequency depending on the indication. CONCLUSIONS Although these suggestions are supported by this expert group to be used in clinical setting, it will be necessary to formally validate the present suggestions in future clinical trials.
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Affiliation(s)
- Francesca Ingegnoli
- Division of Clinical Rheumatology, ASST Pini-CTO, Milano, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy.
| | | | - Yannick Allanore
- Paris Descartes University, Cochin Hospital, Rheumatology A department, INSERM U1016, Paris, France
| | - Roberto Caporali
- Division of Rheumatology, University of Pavia, IRCCS S. Matteo Foundation, Pavia, Italy
| | - Michele Colaci
- Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Switzerland
| | - Daniel E Furst
- Los Angeles, USA UCLA (emeritus); University of Washington, Seattle Wash; University of Florence, Florence, Italy
| | | | | | - Dinesh Khanna
- Ann Arbor, University of Michigan, Ann Arbor, Michigan
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence & Department of Geriatric Medicine, Division of Rheumatology AOUC, Florence, Italy
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Zippelius T, Matziolis G, Perka C, Putzier M, Strube P, Röhner E. Long-Term Effects of Intravenous Iloprost Therapy in Patients with Bone Marrow Oedema of the Knee Joint. Acta Chir Orthop Traumatol Cech 2018; 85:17-21. [PMID: 30257764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE OF THE STUDY Bone marrow oedema (BMO) syndrome is a multifactorial condition. Various conservative treatment options include analgesic therapy, immobilisation of the affected joint and/or systemic intravenous iloprost therapy. Many studies have confirmed the positive effect of iloprost therapy, but only after short-term follow-up. The purpose of this study was to show that treatment with iloprost leads to positive long-term functional and radiological outcomes for BMO of the knee. MATERIAL AND METHODS Fifteen patients with BMO of the knee joint, ARCO stage 1-2, were included in this study. Various questionnaires, the Lysholm Score, the SF-36, WOMAC, Knee Society Score, and a visual analogue pain scale (VAS), were evaluated before and after iloprost therapy. All patients underwent MRI for radiological follow-up three months after treatment. RESULTS Significant improvements were found in the Lysholm Score, SF-36, WOMAC and KSS. In 80% of patients, follow-up MRI after three months showed complete regression of the oedema. Three patients received additional surgery after a follow-up period of 33 ± 7 months. CONCLUSIONS Based on the positive results of our study, we recommend treatment with iloprost for BMO of the knee in ARCO stage 1-2 patients. Key words:iloprost, bone marrow oedema, knee joint.
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Affiliation(s)
- T Zippelius
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg,Germany
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13
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Rose F, Hattar K, Gakisch S, Grimminger F, Olschewski H, Seeger W, Tschuschner A, Schermuly RT, Weissmann N, Hanze J, Sibelius U, Ghofrani HA. Increased neutrophil mediator release in patients with pulmonary hypertension – suppression by inhaled iloprost. Thromb Haemost 2017; 90:1141-9. [PMID: 14652649 DOI: 10.1160/th03-03-0173] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryPolymorphonuclear neutrophils (PMN) have been implicated in various vascular inflammatory processes. We isolated PMN from venous blood samples of 10 patients with severe primary pulmonary arterial hypertension (PPH), 7 patients with pulmonary hypertension secondary to chronic thromboembolism (CTEPH), and 12 healthy controls. When stimulated with the calcium-ionophore A23187, platelet activating factor (PAF) or the microbial agent n-formyl-Methionyl-Leucyl-Phenylalanine (fMLP), significantly increased release of elastase and super-oxide anion was noted in both groups with pulmonary hyper-tension. Moreover, the neutrophils of CTEPH patients responded with an enhanced liberation of leukotriene (LT) B4 and 5-hydroxyeicosatetraenoic acid (5-HETE). Inhalation of aerosolized iloprost (5 µg) caused a rapid decline in pulmonary vascular resistance, in both PPH and CTEPH. This hemodynamic response was paralleled by a significant suppression of ionophore- and ligand-induced elastase and superoxide release, as well as LTB4 and 5-HETE formation. The neutrophil inhibitory effect of the inhalation maneuver was fully reproduced by in vitro incubation of neutrophils with 1-10 pg/ml iloprost for 2 hours. This is the first study to demonstrate that circulating neutrophils from patients with PPH and CTEPH possess an enhanced readiness to respond with inflammatory mediator generation to different stimulatory agents ex-vivo, and that PMN respiratory burst, elastase secretion and leukotriene generation are promptly reduced by an iloprost inhalation maneuver. Neutrophils might participate in the inflammatory processes in pulmonary arterial hypertension.
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Affiliation(s)
- Frank Rose
- Department of Internal Medicine, Justus-Leipzig-University, Klinikstrasse 36, 35392 Giessen, Germany.
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14
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Fraticelli P, Martino GP, Murri M, Mattioli M, Gabrielli A. A novel iloprost administration method with portable syringe pump for the treatment of acral ulcers and Raynaud's phenomenon in systemic sclerosis patients. A pilot study (ILOPORTA). Clin Exp Rheumatol 2017; 35 Suppl 106:173-178. [PMID: 28869415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The objective of the study is to evaluate the feasibility, safety and efficacy of home infusion of iloprost with the new portable syringe pump Infonde®, for the treatment of scleroderma-related Raynaud's phenomenon and digital ulcers. METHODS 12 scleroderma patients were treated with iloprost at home, using the pump, with infusion cycles of 2 days per month (24 hours a day), for 6 months. RESULTS The home treatment proved feasible since ten patients (83%) completed the entire infusion cycle, thus satisfying the feasibility target imposed by the protocol (75%). Side effects related to the device or venous access occurred in 3 out of 65 total 48-hour infusions (4.6%). They mostly consisted in phlebitis. No adverse events related to the device management were reported. Among the ten patients who completed the infusions, three showed a reduction in the number of ulcers, three maintained the same number, and four had no ulcers throughout the observation period. Patient's perception of their quality of life and wellness during home infusions, expressed with the Visual Analogue Scale (VAS) improved from 79/100 at the first infusion to 91/100 at the end of the study. All patients expressed a positive global judgment regarding this innovative method of iloprost infusion. CONCLUSIONS The infusion of iloprost at home with Infonde® is feasible, safe and effective. Moreover, this approach presents potential advantages from the economic and organisational point of view. Because of the pilot design of our study, these results need to be confirmed in larger randomised trials.
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Affiliation(s)
- Paolo Fraticelli
- Clinica Medica, Department of Internal Medicine, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy.
| | - Giuseppe Pio Martino
- Clinica Medica, Department of Internal Medicine, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Marta Murri
- Clinica Medica, Department of Internal Medicine, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Massimo Mattioli
- Clinica Medica, Department of Internal Medicine, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Armando Gabrielli
- Clinica Medica, Department of Internal Medicine, Ospedali Riuniti University Hospital, Ancona; and Department of Clinical and Molecular Sciences, Section of Clinical Medicine, Università Politecnica delle Marche, School of Medicine, Ancona, Italy
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15
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Unal S, Aktas S, Aksu M, Hirfanoglu IM, Atalay Y, Turkyilmaz C. Iloprost Instillation in Two Neonates with Pulmonary Hypertension. J Coll Physicians Surg Pak 2017; 27:257-259. [PMID: 28492159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 01/16/2017] [Indexed: 06/07/2023]
Abstract
Pulmonary hypertension may coexist with certain diseases in neonates. Iloprost inhalation is one of the treatments which cause selective pulmonary vasodilatation. Inhalation is not an easy way of drug administration in mechanically ventilated infants; as some exhibit desaturations during inhalation. Moreover, inhalation of drug requires cessation of mechanical ventilation, if patient is on high frequency oscillatory ventilation. We presented two patients with pulmonary hypertension; term baby with congenital diaphragmatic hernia and preterm baby with respiratory distress syndrome; who had iloprost instillation during mechanical ventilation treatment. Iloprost instillation was well tolerated with no side effects in the term patient with diaphragmatic hernia; whereas severe blood pressure fluctuations were observed in the preterm infant. This report may courage administration of iloprost in term neonates with resistant pulmonary hypertension.
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MESH Headings
- Administration, Inhalation
- Female
- Humans
- Hypertension, Pulmonary/drug therapy
- Hypertension, Pulmonary/etiology
- Iloprost/administration & dosage
- Iloprost/therapeutic use
- Infant
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/drug therapy
- Infant, Premature, Diseases/etiology
- Infant, Very Low Birth Weight
- Male
- Respiratory Distress Syndrome, Newborn/complications
- Respiratory Distress Syndrome, Newborn/therapy
- Treatment Outcome
- Vasodilator Agents/administration & dosage
- Vasodilator Agents/therapeutic use
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Affiliation(s)
- Sezin Unal
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
- Department of Neonatology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Selma Aktas
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
| | - Meltem Aksu
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
| | - Ibrahim M Hirfanoglu
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
| | - Yildiz Atalay
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
| | - Canan Turkyilmaz
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
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16
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Melillo E, Lucaccini E, Berchiolli R, Adami D, Nuti M, Dell'Omo G, Farina A, Panigada G, Roberts AT, Meini S. Long-term survival of patients with critical limb ischemia treated with iloprost: response rate and predictive criteria. A retrospective analysis of 102 patients. Eur Rev Med Pharmacol Sci 2016; 20:5233-5241. [PMID: 28051243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Critical limb ischemia (CLI) patients have poor long-term prognosis. We showed that iloprost improves outcomes (major amputation and survival) up a 5-year follow-up, but it is not known if in this length of time the survival curves, of clinical responders and non-responders, differ. PATIENTS AND METHODS A retrospective study enrolling 102 consecutive patients between 2004-2008, with clinical and instrumental (ultrasound, angiography, transcutaneous tensiometry of oxygen TcpO2 and carbon dioxide TcpCO2 in the affected and contralateral limbs) diagnosis of critical ischemia. All patients received the best medical therapy. Iloprost was administered (0.5-2 ng/kg/min 6 hours/day for 2-4 weeks) in all patients initially considered unsuitable for revascularization, repeating it regularly in time every six-twelve months in the case of positive response. The minimum expected follow-up was 4 years. RESULTS 71.5% of patients were treated with iloprost and the responder rate was 71.2%. Most of the patients were regularly retreated with repeated cycles. Initial median supine TcpCO2 in symptomatic limb was higher in untreated patients than those treated (58 vs. 49 mmHg; p < 0.05) and in non-responders compared to responders (60 vs. 49 mmHg; p < 0.05). TcpCO2 directly and significantly correlated with the highest risk of mortality and seems to represent a new accurate prognostic criterion of unfavourable short and long-term response to prostanoid. In iloprost group, major amputations were significantly reduced. Revascularization was significantly higher in non-responders (57.1% vs. 11.5%; p < 0.05). There was a significantly higher prevalence of subsequent myocardial infarction in the non-iloprost group (27.6% vs. 9.6%; p < 0.05). The survival rate of non-responders was higher than untreated up until the second year (76.2% vs. 62%; p < 0.05). At 4 years we found higher survival in patients treated with iloprost (64.3% vs. 41% in untreated; p < 0.05) and in responders (75% vs. 38.1% in non-responders; p < 0.05). CONCLUSIONS Our results confirm the favourable role of iloprost on the long-term outcome in patients with CLI. In particular, the maximum benefit is obtained in responder patients treated with multiple cycles of infusion.
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Affiliation(s)
- E Melillo
- Cardiothoracic and Vascular Department, Angiology Unit, University of Pisa, Pisa, Italy.
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17
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Karaman S, Ozkan B, Yazir Y, Yardimoglu M, Gok M, Kara O, Vural C, Rencber S, Emek SK. Comparison of hyperbaric oxygen versus iloprost treatment in an experimental rat central retinal artery occlusion model. Graefes Arch Clin Exp Ophthalmol 2016; 254:2209-2215. [PMID: 27480178 DOI: 10.1007/s00417-016-3444-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/18/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Central retinal artery occlusion (CRAO) is one of the serious ophthalmological emergencies with poor visual prognosis. Iloprost is a stable prostacyclin analogue and has prominent anti-edema, anti-inflammatory, vasodilatory, and antiagregant effects. The main objective of this work was to investigate iloprost as an alternative agent versus hyperbaric oxygen (HBO) in the treatment of CRAO. METHODS Twenty-eight healthy Wistar albino male rats were randomly assigned into control (n = 7, sham operation), HBO (n = 7), iloprost (n = 7), and sham groups (n = 7). CRAO model was created through optic nerve exploration and ligation. Full-thickness retina (FTR), outer nuclear layer (ONL), inner nuclear layer (INL) and ganglion cell layer (GCL) thickness were measured on Hematoxylin/Eosin (H&E) stained retinal sections and immunohistochemical analysis including terminal deoxynucleotidyl transferase-mediated biotindeoxyuridine triphosphate nick-end labeling (TUNEL) assay was performed to determine the apoptotic index (AI). RESULTS AI values of HBO (0.204 ± 0.067) and iloprost (0.197 ± 0.052) groups were significantly lower than sham (0.487 ± 0.046) group (p < 0.001). Any significant difference was found between the HBO and iloprost groups in terms of AI (p = 0.514). A statistically significant increase in thickness of FTR, ONL, INL and GCL was detected in HBO, iloprost and sham groups compared to the control group (p = 0.002). FTR, ONL, INL and GCL thickness were significantly thinner in HBO and iloprost groups than in the sham group (p = 0.002). A significant lesser increase was observed in all the retinal layers thickness in iloprost group versus HBO group (p = 0.002) except for INL (p = 0.665). CONCLUSIONS The study results demonstrated anti-edema, neuroprotective, and anti-apoptotic effects of iloprost quantitatively; thus, iloprost may be a beneficial alternative agent in the treatment of CRAO.
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Affiliation(s)
| | - Berna Ozkan
- Department of Ophthalmology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Yusufhan Yazir
- Department of Histology and Embryology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Melda Yardimoglu
- Department of Histology and Embryology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Mustafa Gok
- Department of Ophthalmology, Ministry of Health, Ordu University Research and Training Hospital, Ordu, 52200, Turkey.
| | - Ozgur Kara
- Department of Ophthalmology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Cigdem Vural
- Department of Pathology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Selenay Rencber
- Department of Histology and Embryology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Salih K Emek
- Oksimed Hyperbaric Oxygen Clinic, Kocaeli, Turkey
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18
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Lee SH, Lee JG, Lee CY, Kim N, Chang MY, You YC, Kim HJ, Paik HC, Oh YJ. Effects of intraoperative inhaled iloprost on primary graft dysfunction after lung transplantation: A retrospective single center study. Medicine (Baltimore) 2016; 95:e3975. [PMID: 27399072 PMCID: PMC5058801 DOI: 10.1097/md.0000000000003975] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
DESIGN Inhaled iloprost was known to alleviate ischemic-reperfusion lung injury. We investigated whether intraoperative inhaled iloprost can prevent the development of primary graft dysfunction after lung transplantation. Data for a consecutive series of patients who underwent lung transplantation with extracorporeal membrane oxygenation were retrieved. By propensity score matching, 2 comparable groups of 30 patients were obtained: patients who inhaled iloprost immediately after reperfusion of the grafted lung (ILO group); patients who did not receive iloprost (non-ILO group). RESULTS The severity of pulmonary infiltration on postoperative days (PODs) 1 to 3 was significantly lower in the ILO group compared to the non-ILO group. The PaO2/FiO2 ratio was significantly higher in the ILO group compared to the non-ILO group (318.2 ± 74.2 vs 275.9 ± 65.3 mm Hg, P = 0.022 on POD 1; 351.4 ± 58.2 vs 295.8 ± 53.7 mm Hg, P = 0.017 on POD 2; and 378.8 ± 51.9 vs 320.2 ± 66.2 mm Hg, P = 0.013 on POD 3, respectively). The prevalence of the primary graft dysfunction grade 3 was lower in the ILO group compared to the non-ILO group (P = 0.042 on POD 1; P = 0.026 on POD 2; P = 0.024 on POD 3, respectively). The duration of ventilator use and intensive care unit were significantly reduced in the ILO group (P = 0.041 and 0.038). CONCLUSIONS Intraoperative inhaled iloprost could prevent primary graft dysfunction and preserve allograft function, thus reducing the length of ventilator care and intensive care unit stay, and improving the overall early post-transplant morbidity in patients undergoing lung transplantation.
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Affiliation(s)
- Su Hyun Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery
| | | | - Namo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute
| | - Min-Yung Chang
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Chul You
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute
| | - Hyun Joo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery
- Correspondence: Hyo Chae Paik, Department of Thoracic and Cardiovascular Surgery, Seodaemun-gu, Seoul, Korea (e-mail: ); Young Jun Oh, Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (e-mail: )
| | - Young Jun Oh
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute
- Correspondence: Hyo Chae Paik, Department of Thoracic and Cardiovascular Surgery, Seodaemun-gu, Seoul, Korea (e-mail: ); Young Jun Oh, Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (e-mail: )
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Segreto F, Tosi D, Marangi GF, Pendolino AL, Santoro S, Gigliofiorito P, Persichetti P. Iloprost administration in acrodermatitis of Hallopeau complicated by acquired toes syndactyly: a case report and review of the literature. Eur Rev Med Pharmacol Sci 2015; 19:2945-2948. [PMID: 26367710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Acrodermatitis Continua of Hallopeau (ACH) is a variant of pustular psoriasis often very difficult to treat. Secondary syndactyly, also called "pseudosyndactyly", is rare and can be a complication of burns, dystrophic epidermolysis bullosa or trauma. If left untreated, joint complications and definitive functional impairments may occur. CASE REPORT We report a case of a 74-year-old man with acrodermatitis continua of Hallopeau involving the toes and complicated by syndactyly. ACH regression following Iloprost administration was also observed. DISCUSSION Published studies are mainly limited to case reports only, due to the rarity of the disease. Therefore, there are no clear-cut therapeutic management guidelines available for this chronic and sometimes debilitating disease. ACH is often recalcitrant to the available therapies. Topical and systemic treatments have been described in literature with no long-lasting results. CONCLUSIONS To our knowledge, this is the first report of foot syndactyly associated to ACH. In our patient, ACH symptoms regressed with Iloprost administration: this finding has never been previously described in literature. If confirmed by other clinical experiences, Iloprost could be a further therapeutic option in ACH.
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Affiliation(s)
- F Segreto
- Plastic and Reconstructive Surgery Unit, Università Campus Bio-Medico di Roma, Rome, Italy.
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20
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Bautin AE, Iakovlev AS, Tashkhanov DM, Datsenko SV, Marichev AO, Popov MA, Fedotov PA. [SPECIFICS OF INHALED ILOPROST PHARMACODYNAMICS IN PATIENTS WITH SEVERE LEFT VENTRICULAR SYSTOLIC DYSFUNCTION]. Anesteziol Reanimatol 2015; 60:4-7. [PMID: 26148353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To determine the specifics of inhaled iloprost effect on pulmonary and systemic hemodynamics in patients with pulmonary hypertension (PH) associated with left ventricular systolic dysfunction. MATERIALS AND METHODS 47 vasore- activity tests (VRT) with 20 micrograms inhaled iloprost (Ventavis, Bayer) were performed in 39 candidates on heart transplantation. All patients had heart failure III-IV NYHA and PH with pulmonary vascular resistance (PVR) more than 2.5 Wood units. Hemodynamic parameters were evaluated at baseline and 15 minutes after inhalation of iloprost. RESULTS Iloprost significant decreased PAPmean: from 36.8 ± 8.5 mm Hg to 29.9 ± 9.4 mm Hg (p < 0.001). There was a significant decrease in PVR:from 4.5 1.6 Wood units to 3 ± 1 Wood units (p < 0.001). PVR dropped more than 20% in 34 cases (72.3%). Iloprost inhalation caused significant changes in systemic hemodynamic. There were decrease in sys- temic vascular resistance (SVR)from 1820 ± 527 dynes·sec·cm(-5) to 1423 ± 427 dynes·sec·cm(-5) (p < 0.001), increase in stroke volume index (SVI) from 26.1 ± 8.7 ml/m2 to 30.5 ± 9.5 ml/m2 (p < 0.001) and decrease in PCWP from 20.6 ± 5.9 mm Hg to 18.4 ± 6.6 mm Hg. (p = 0.016). We found significant negative correlation between systemic effects of iloprost and initial cardiac index (r = -0.63). CONCLUSIONS Inhaled iloprost caused significant changes in systemic hemodynamic when was used in patients with severe LV systolic dysfunction. Favorable changes in the left ventricle preload and after- load naturally increased its performance and decreased PCWP.
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21
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Jiang X, Wang YF, Zhao QH, Jiang R, Wu Y, Peng FH, Xu XQ, Wang L, He J, Jing ZC. Acute hemodynamic response of infused fasudil in patients with pulmonary arterial hypertension: a randomized, controlled, crossover study. Int J Cardiol 2014; 177:61-5. [PMID: 25499341 DOI: 10.1016/j.ijcard.2014.09.101] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/18/2014] [Accepted: 09/20/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Rho-kinase pathway has been shown to be involved in the pathogenesis of PAH. As yet, however, the acute effects of the Rho-kinase inhibitor fasudil have not been compared with established pulmonary selective vasodilators in patients with PAH. We compared the acute effects of intravenous fasudil with inhaled iloprost in patients with pulmonary arterial hypertension (PAH). METHODS Using a crossover design, 50 patients with PAH (idiopathic PAH, PAH associated with repaired left-to-right cardiac shunts, or connective tissue disease) were randomized to iloprost inhalation (5 μg) and intravenous fasudil (30 mg over 30 min). Hemodynamic data were collected at baseline and during acute drug exposure. RESULTS Comparable decreases were observed in mean pulmonary artery pressure (-4.6 ± 4.3 mmHg vs. -4.8 ± 4.2 mmHg) and pulmonary vascular resistance (-3.0 ± 3.0 Wood U vs. -2.2 ± 2.7 Wood U) with fasudil infusion and iloprost inhalation, respectively, during acute challenge. However, fasudil infusion resulted in a more pronounced increase in mean cardiac output and mixed venous oxygen saturation compared with iloprost inhalation (13.7 ± 17.1% vs. 6.9 ± 15.0%; p=0.044 and 4.5 ± 5.3% vs. 2.7 ± 8.2%; p=0.044, respectively). Whereas inhaled iloprost resulted in a non-significant increase in mean systemic arterial oxygen saturation (0.8 ± 3.6%), infused fasudil resulted in a non-significant reduction (-0.6 ± 1.1%). CONCLUSION Infused fasudil improved pulmonary hemodynamics in patients with PAH without significant toxicity.
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Affiliation(s)
- Xin Jiang
- Thrombosis Medicine Center, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, Peking Union Medical College and Chinese Academy Medical Science, Beijing, China
| | - Yue-Fu Wang
- Department of Anesthesiology, Fu Wai Hospital, Peking Union Medical College and Chinese Academy Medical Science, Beijing, China
| | - Qin-Hua Zhao
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rong Jiang
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan Wu
- Thrombosis Medicine Center, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, Peking Union Medical College and Chinese Academy Medical Science, Beijing, China
| | - Fu-Hua Peng
- Thrombosis Medicine Center, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, Peking Union Medical College and Chinese Academy Medical Science, Beijing, China
| | - Xi-Qi Xu
- Thrombosis Medicine Center, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, Peking Union Medical College and Chinese Academy Medical Science, Beijing, China
| | - Lan Wang
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing He
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhi-Cheng Jing
- Thrombosis Medicine Center, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, Peking Union Medical College and Chinese Academy Medical Science, Beijing, China.
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Avila-Alvarez A, Bravo-Laguna MC, Bronte LD, Del Cerro MJ. Inhaled iloprost as a rescue therapy for transposition of the great arteries with persistent pulmonary hypertension of the newborn. Pediatr Cardiol 2014; 34:2027-9. [PMID: 23143352 DOI: 10.1007/s00246-012-0575-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 10/11/2012] [Indexed: 11/27/2022]
Abstract
Transposition of the great arteries (TGA) in the newborn combined with persistent pulmonary hypertension was reported previously to occur in 3-12 % of full-term neonates with TGA. Right-to-left shunting at the ductal level causes severe hypoxemia despite prostaglandin infusion and balloon atrial septostomy. Although the introduction of inhaled nitric oxide (iNO) has improved the prognosis, this condition still is associated with high preoperative mortality. This report describes the case of a newborn with TGA and persistent pulmonary hypertension, which was managed successfully with oral sildenafil, iNO, and inhaled iloprost during life-threatening acute pulmonary hypertension, thus preventing the use of extracorporeal membrane oxygenation.
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Affiliation(s)
- Alejandro Avila-Alvarez
- Neonatal Intensive Care Unit, Department of Neonatology, Hospital Infantil Universitario La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain,
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Chotigeat U, Champrasert M, Khorana M, Sangtaweesin V, Kanjanapattanakul W. Iloprost inhalation for the treatment of severe persistent pulmonary hypertension of the newborn, experience at QSNICH. J Med Assoc Thai 2014; 97 Suppl 6:S89-S94. [PMID: 25391178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Persistent pulmonary hypertension of the newborn (PPHN) is the most serious condition that causes high mortality in term and post term infants. The authors have an experience of using high frequency oscillatory ventilation (HFOV) and inhaled nitric oxide (iNO) for treatment of this condition with a good result. However, due to high cost of iNo, other pulmonary vasodilators have been use. Sildenafil had some side effects of systemic hypotension. Thus, inhaled iloprost was introduced for treatment of PPHN at our institute. OBJECTIVE To evaluate the outcome of inhaled iloprost for the treatment of PPHN. MATERIAL AND METHOD This was a retrospective study. The data from medical records of newborns, diagnosed as persistent pulmonary hypertension of the newborn and had received inhaled iloprost from October 1st, 2008-October 31st, 2012, were reviewed. RESULTS Nineteen cases of PPHN treated with inhaled iloprost were reviewed. Male to female ratio was 1.3 7:1 (11:8). Mean birth weight and gestational age of these patients were 2,997 ± 531.63 grams and 37.9 ± 2.51 weeks, respectively. Meconium aspiration syndrome was the leading underlying cause of this condition. The mortality rate in this study was 21% (4 from 19 cases). After the addition of inhaled iloprost, the oxygen index (OI) in the survivor group decreased significantly at one hour after treatment (from 32.89 to 22.06, 18.76, 13. 76 at 1, 6, 12 hours, respectively). Oxygen saturation (SpO2) continued increasing after treatment in the survivor group (from 82.40% to 92.20%, 95.00%, 95.80% at 1, 6, 12 hours, respectively) with significant difference at one hour. There was a significant difference of OI and SpO2 between the survivor and non-survivor groups after treatment. Low Apgar score at 5 minutes and early diagnosis of PPHN were found statistically significant different in the non-survivor compared to the survivor groups. CONCLUSION Inhaled iloprost could be used as an alternative treatment of PPHN without side effects of systemic hypotension.
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Zhang C, Li Q, Liu T, Gu H. [Cardiac catheterization and pulmonary vasoreactivity testing in children with idiopathic pulmonary arterial hypertension]. Zhonghua Er Ke Za Zhi 2014; 52:468-472. [PMID: 25190170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE As an important method of hemodynamic assessment in idiopathic pulmonary arterial hypertension (IPAH), cardiac catheterization combined with pulmonary vasoreactivity testing remains with limited experience in children, and the acute pulmonary vasodilator agents as well as response criteria for vasoreactivity testing remain controversial. The aim of this study was to investigate the clinical importance, agent selection, and responder definition of cardiac catheterization combined with pulmonary vasoreactivity testing in pediatric IPAH. METHOD The patients admitted to Department of Pediatric Cardiology of Beijing Anzhen Hospital between April 2009 and September 2013 with suspected IPAH, under 18 years of age, with WHO functional class II or III, were enrolled. All the patients were arranged to receive left and right heart catheterization and pulmonary vasoreactivity testing with inhalation of pure oxygen and iloprost (PGI2) respectively. Hemodynamic changes were analyzed, and two criteria, the European Society of Cardiology recommendation criteria (Sitbon criteria) and traditional application criteria (Barst criteria), were used to evaluate the test results. RESULT Thirty-nine cases of children with suspected IPAH underwent cardiac catheterization. In 4 patients IPAH was excluded; 4 patients developed pulmonary hypertension crisis. The other 31 patients received standard cardiac catheterization and pulmonary vasoreactivity testing. Baseline mean pulmonary artery pressure (mPAP) was (66 ± 16) mmHg (1 mmHg = 0.133 kPa), and pulmonary vascular resistance index (PVRI) (17 ± 8) Wood U · m². After inhalation of pure oxygen, mPAP fell to (59 ± 16) mmHg, and PVRI to (14 ± 8) Wood U · m² (t = 4.88 and 4.56, both P < 0.001) . After inhalation of PGI2, mPAP fell to (49 ± 21) mmHg, and PVRI to (12 ± 9) Wood U · m² (t = 7.04 and 6.33, both P < 0.001). According to the Sitbon criteria, the proportion of pure oxygen responders was 6.5% (3/31) , while PGI2 responders was 35.5%, and the difference was significant (P = 0.004). According to the Barst criteria, the proportion of pure oxygen responders was 16.1% (5/31), while PGI2 responders was 51.6% (16/31), and the difference was significant (χ² = 0.09, P = 0.001). CONCLUSION For children with IPAH, cardiac catheterization combined with pulmonary vasoreactivity testing has important value in differential diagnosis, severity estimation, and treatment (including the emergency treatment) choices. Pulmonary hypertension crisis is an important complication of cardiac catheterization in pediatric IPAH. Younger age, general anesthesia, crisis history, and poor heart function are important risk factors for pulmonary hypertension crisis. PGI2 is a relatively ideal agent for vasoreactivity testing in children with IPAH, which has more responders than traditionally used pure oxygen. RESULTS of responders are not completely consistent using different criteria, and comprehensive evaluation should be done according to the goals of treatment in clinical practice.
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Affiliation(s)
- Chen Zhang
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Qiangqiang Li
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Tianyang Liu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Hong Gu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
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Elkiran O, Karakurt C, Koçak G. Combined effect of aerosolized iloprost and oxygen on assessment of pulmonary vasoreactivity in children with pulmonary hypertension. Anadolu Kardiyol Derg 2014; 14:383-388. [PMID: 24818629 DOI: 10.5152/akd.2013.4650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The evaluation of pulmonary vascular reactivity plays a significant role in the management of patients with pulmonary hypertension. Inhaled nitric oxide in combination with oxygen (O2) has become widely used as an agent for pulmonary vasodilator testing. However, inhaled nitric oxide is not available in many developing countries. Recently, aerosolized iloprost was suggested as an alternative to nitric oxide for this purpose. In the present study, aerosolized iloprost was used together with O2 in the pulmonary vasoreactivity test of children with severe pulmonary hypertension. Thus, the synergistic effect of both vasodilators was utilized without extending the duration of cardiac catheterization. METHODS The prospective cohort study registered a total of 16 children with severe pulmonary hypertension whose median age was 4.5 years. Hemodynamic parameters were quantified before and after the vasoreactivity test. Increased left-to-right shunt, pulmonary vascular resistance of <6 Woods units (WU)/m(2) and a pulmonary-systemic resistance ratio of <0.3, as well as a decrease >10% in the pulmonary vascular resistance and pulmonary-systemic vascular resistance ratio after the vasoreactivity test were accepted as a positive response. The data were analyzed using Wilcoxon signed-rank and the Mann-Whitney U tests. RESULTS Eleven children gave a positive response to the vasoreactivity test, while 5 children did not respond. Pulmonary vascular resistance dropped from 9.98 ± 1.39 WU/m(2) to 5.08 ± 1.05 WU/m(2) (p=0.013) and the pulmonary-systemic vascular resistance ratio fell from 0.68 ± 0.08 to 0.32 ± 0.05 (p=0.003) in the children who were responsive. No side effects were observed related to iloprost administration. CONCLUSION Administration of inhaled iloprost in combination with O2 for pulmonary vasoreactivity testing can be useful for correctly identifying pulmonary vasoreactivity without extending the duration of cardiac catheterization.
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Affiliation(s)
- Ozlem Elkiran
- Department of Pediatric Cardiology, Faculty of Medicine, İnönü University; Malatya-Turkey.
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Gaĭsin IR, Bagautdinova ZR, Trukhina AA, Burlaeva NA, Gibadullina LR, Timonin DV, Smirnov IA, maksimov NI. [Efficacy of intravenous iloprost (Ilomedin®) in salvage of the only extremity in a patient with thrombangiitis obliterans]. Angiol Sosud Khir 2014; 20:150-156. [PMID: 24961337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Buerger s disease, or thromboangiitis obliterans, is a severe invalidating systemic vascular disease. The present article deals with a clinical case report concerning treatment of a patient suffering from thromboangiitis obliterans with three limbs amputated (on the background of therapy with alprostadil, Karavanov s mixture, rheopolyglukin, pentoxyphyllin). The course intravenous administration of the stable analogue of prostacyclin - iloprost (IlomedinR) made it possible to save the only extremity.
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Zhang C, Huang Y, Huang T, Xia C, Huang X, Zhang G, Chen J, Chen J, Zhuang J. Effects of low doses of aerosolized iloprost combined with tadalafil in treatment of adult congenital heart disease with severe pulmonary arterial hypertension. Chin Med J (Engl) 2014; 127:975-977. [PMID: 24571899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- Caojin Zhang
- Department of Cardiology, Guangdong General Hospital & Guangdong Cardiovascular Institute, Guangzhou, Guangdong 510100, China
| | - Yigao Huang
- Department of Cardiology, Guangdong General Hospital & Guangdong Cardiovascular Institute, Guangzhou, Guangdong 510100, China
| | - Tao Huang
- Department of Cardiology, Guangdong General Hospital & Guangdong Cardiovascular Institute, Guangzhou, Guangdong 510100, China
| | - Chunli Xia
- Department of Cardiology, Guangdong General Hospital & Guangdong Cardiovascular Institute, Guangzhou, Guangdong 510100, China
| | - Xinsheng Huang
- Department of Cardiology, Guangdong General Hospital & Guangdong Cardiovascular Institute, Guangzhou, Guangdong 510100, China
| | - Guolin Zhang
- Department of Cardiology, Guangdong General Hospital & Guangdong Cardiovascular Institute, Guangzhou, Guangdong 510100, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong General Hospital & Guangdong Cardiovascular Institute, Guangzhou, Guangdong 510100, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong General Hospital & Guangdong Cardiovascular Institute, Guangzhou, Guangdong 510100, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong General Hospital & Guangdong Cardiovascular Institute, Guangzhou, Guangdong 510100, China.
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Karaagaç AT, Yildirim AI. Is it safe to use inhaled iloprost in infants with pulmonary hypertension? Indian Pediatr 2013; 50:1064-1065. [PMID: 24382910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Aysu Türkmen Karaagaç
- *Pediatric Cardiology, Kartal Kobuyolu Research and Training Hospital, Denizer cad. Cevizli kavsagy, No:2 34846 Kartal/Istanbul
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Pitsiou G, Paspala A, Bagalas V, Boutou AK, Stanopoulos I. Inhaled iloprost plus levosimendan to decompensate right heart failure due to chronic thromboembolic pulmonary hypertension. Anaesth Intensive Care 2013; 41:554-556. [PMID: 23808522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Auriemma M, Vianale G, Reale M, Costantini E, Di Nicola M, Romani GL, Merla A, Muraro R, Amerio P. Iloprost treatment summer-suspension: effects on skin thermal properties and cytokine profile in systemic sclerosis patients. GIORN ITAL DERMAT V 2013; 148:209-216. [PMID: 23588147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM Aim of the study was to assess whether Iloprost treatment summer suspension modifies systemic cytokines levels, cutaneous thermal properties and functional response to a cold-induced stress in patients affected by systemic sclerosis (SSc). METHODS Twenty-eight patients fulfilling the American College of Rheumatology (ACR) criteria for SSc were included in the study. Patients recorded number, duration and pain-severity of Raynaud phenomenon (RP). Pain-severity was determined by a visual analog scale. Cytokines expression and production in peripheral blood mononuclear cells and serum were evaluated by RT-PCR and ELISA assay. Basal finger temperature (Tb), distal-dorsal difference temperature (DTdd) and thermal recovery time (tr) from cold stress were measured by means of functional infrared imaging (fIR). Measurements were performed in late spring, during routine Iloprost therapy (1-3 days infusion of 0.5-2 ng/kg every month), and in late summer after a therapy-withdrawal period. RESULTS Deterioration of SSc patients' skin thermal properties was observed in the period of therapy withdrawal (Tb reduction and tr enhancement; no DTdd differences) despite the improvement in symptoms of RP. A reduction in IL-12/23p40 gene expression was recorded after therapy withdrawal and a direct correlation between IL-12/23p40 and IL-23p19 gene expression was observed, stronger after therapy suspension. CONCLUSION Our data suggest that Iloprost treatment summer suspension may induce the loss of the therapy beneficial effect on microcirculation despite the objective reduction of RP, thus favouring a continuous use of Iloprost in absence of severe side effects. Iloprost showed to modulate only IL-23 expression corroborating the idea that this cytokine is crucial for SSc development and progression.
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Affiliation(s)
- M Auriemma
- Department of Experimental and Clinical Sciences University "G. D'Annunzio" Chieti-Pescara, Italy.
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Mascaux C, Feser WJ, Lewis MT, Barón AE, Coldren CD, Merrick DT, Kennedy TC, Eckelberger JI, Rozeboom LM, Franklin WA, Minna JD, Bunn PA, Miller YE, Keith RL, Hirsch FR. Endobronchial miRNAs as biomarkers in lung cancer chemoprevention. Cancer Prev Res (Phila) 2013; 6:100-8. [PMID: 23268837 PMCID: PMC4159305 DOI: 10.1158/1940-6207.capr-12-0382] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Lung cancers express lower levels of prostacyclin than normal lung tissues. Prostacyclin prevents lung cancer in a variety of mouse models. A randomized phase II trial comparing oral iloprost (a prostacyclin analog) with placebo in high-risk subjects showed improvement in bronchial histology in former, but not current, smokers. This placebo-controlled study offered the opportunity for investigation of other potential intermediate endpoint and predictive biomarkers to incorporate into chemoprevention trials. Matched bronchial biopsies were obtained at baseline and at 6-month follow-up from 125 high-risk individuals who completed the trial: 31/29 and 37/28 current/former smokers in the iloprost and placebo arm, respectively. We analyzed the expression of 14 selected miRNAs by Real Time PCR in 496 biopsies. The expression of seven miRNAs was significantly correlated with histology at baseline. The expression of miR-34c was inversely correlated with histology at baseline (P < 0.0001) and with change in histology at follow-up (P = 0.0003), independent of treatment or smoking status. Several miRNAs were also found to be differentially expressed in current smokers as compared with former smokers. In current smokers, miR-375 was upregulated at baseline (P < 0.0001) and downregulated after treatment with iloprost (P = 0.0023). No miRNA at baseline reliably predicted a response to iloprost. No biomarker predictive of response to iloprost was found. MiR-34c was inversely correlated with baseline histology and with histology changes. Mir-34c changes at follow-up could be used as a quantitative biomarker that parallels histologic response in formalin-fixed bronchial biopsies in future lung cancer chemoprevention studies.
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Affiliation(s)
- Celine Mascaux
- Department of Medicine, Division of Medical Oncology, Colorado School of Public Health, Aurora, 80045, USA.
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Boeck L, Tamm M, Grendelmeier P, Stolz D. Acute effects of aerosolized iloprost in COPD related pulmonary hypertension - a randomized controlled crossover trial. PLoS One 2012; 7:e52248. [PMID: 23300624 PMCID: PMC3531427 DOI: 10.1371/journal.pone.0052248] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 11/16/2012] [Indexed: 12/02/2022] Open
Abstract
Background Inhaled iloprost potentially improves hemodynamics and gas exchange in patients with chronic obstructive pulmonary disease (COPD) and secondary pulmonary hypertension (PH). Objectives To evaluate acute effects of aerosolized iloprost in patients with COPD-associated PH. Methods A randomized, double blind, crossover study was conducted in 16 COPD patients with invasively confirmed PH in a single tertiary care center. Each patient received a single dose of 10 µg iloprost (low dose), 20 µg iloprost (high dose) and placebo during distinct study-visits. The primary end-point of the study was exercise capacity as assessed by the six minute walking distance. Results Both iloprost doses failed to improve six-minute walking distance (p = 0.36). Low dose iloprost (estimated difference of the means −1.0%, p = 0.035) as well as high dose iloprost (−2.2%, p<0.001) significantly impaired oxygenation at rest. Peak oxygen consumption and carbon dioxide production differed significantly over the three study days (p = 0.002 and p = 0.003, accordingly). As compared to placebo, low dose iloprost was associated with reduced peak oxygen consumption (−76 ml/min, p = 0.002), elevated partial pressure of carbon dioxide (0.27 kPa, p = 0.040) and impaired ventilation during exercise (−3.0l/min, p<0.001). Conclusions Improvement of the exercise capacity after iloprost inhalation in patients with COPD-associated mild to moderate PH is very unlikely. Trial Registration Controlled-Trials.com ISRCTN61661881
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Affiliation(s)
- Lucas Boeck
- Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland
| | - Michael Tamm
- Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland
| | - Peter Grendelmeier
- Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland
| | - Daiana Stolz
- Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland
- * E-mail:
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Deng KW, Zhou YJ, Xu XQ, Wu MY, Wang GH, Bian H, Chen B, Wang CB. [Aerosolized iloprost therapy for pulmonary hypertensive crisis in 4 patients with idiopathic pulmonary arterial hypertension]. Zhonghua Xin Xue Guan Bing Za Zhi 2012; 40:854-857. [PMID: 23302674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To summary the efficacy and safety of aerosolized iloprost in patients with pulmonary hypertensive crisis. METHODS On the basis of conventional therapy, aerosolized iloprost (10 µg per time for 10 - 15 min in 2 hours interval, 8 times per day) was administered to four patients with idiopathic pulmonary arterial hypertension and pulmonary hypertensive crisis. Blood pressure, heart rate, systemic artery oxygen saturation, systolic pulmonary arterial pressure (sPAP) measured by echocardiography and the adverse events were analyzed. RESULTS After aerosolized iloprost therapy, sPAP was significantly decreased and systemic artery oxygen saturation was improved. Adverse events (nausea, vomiting, diarrhea, dry cough) were observed in two patients, and the iloprost use was stopped in one patient due to severe vomiting and diarrhea. CONCLUSION Aerosolized iloprost could significantly reduce the sPAP and improve the systemic artery oxygen saturation in patients with pulmonary hypertension crisis.
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Affiliation(s)
- Ke-wu Deng
- The Affiliated Tongren Hospital of the Capital Medical University, Beijing, China
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35
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Senturk E, Cakar N, Ozcan PE, Basel A, Sengul T, Telci L, Esen F, Nahum A, Strang CM, Winterhalter M. No additive effects of inhaled iloprost and prone positioning on pulmonary hypertension and oxygenation in acute respiratory distress syndrome. Minerva Anestesiol 2012; 78:1005-1012. [PMID: 22475807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND In acute respiratory distress syndrome (ARDS), pulmonary hypertension is associated with a poor prognosis. Prone position is effective to improve oxygenation whereas inhaled iloprost can treat pulmonary hypertension. However, combination of these interventions has not been examined before. The hypothesis was that this combination had additive effects on oxygenation and pulmonary hemodynamics as compared with each intervention alone. METHODS In a prospective, randomized cross-over study, ten pigs were anesthetized, intubated and ventilated with volume controlled ventilation. Carotid, jugular venous and pulmonary artery catheters were inserted. ARDS was induced with oleic acid (0.20 mL/kg). Measurements were repeated in randomized different sequences of prone or supine positions with or without iloprost inhalation (220 ng/kg/min) (four combinations). Systemic and pulmonary arterial pressures; arterial and mixed venous blood gases; and Qs/Qt and the resistances were recorded. RESULTS Iloprost decreased pulmonary artery pressures (for MPAP: P=0.034) in both supine (37±10 vs. 31±8 mmHg; P<0.05) and prone positions (38±9 vs. 29±8 mmHg; P<0.05); but did not obtain a significant improvement in oxygenation in both positions. Prone position improved the oxygenation (p<0.0001) compared to supine position in both with (361±140 vs. 183±158 mmHg, P<0.05) or without iloprost application (331±112 vs. 167±117 mmHg, P<0.05); but did not achieve a significant decrease in MPAP. CONCLUSION Although iloprost reduced pulmonary arterial pressures, and prone positioning improved oxygenation; there are no additive effects of the combination of both interventions on both parameters. To treat both pulmonary hypertension and hypoxemia, application of iloprost in prone position is suggested.
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Affiliation(s)
- E Senturk
- Department of Anaesthesiology, Istanbul University, Istanbul Medical Faculty, Turkey.
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Zhang HL, Liu ZH, Wang Y, Xiong CM, Ni XH, He JG, Luo Q, Zhao ZH, Zhao Q, Sun XG. Acute responses to inhalation of Iloprost in patients with pulmonary hypertension. Chin Med J (Engl) 2012; 125:2826-2831. [PMID: 22932074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Iloprost has been used to test acute pulmonary vasoreactivity in idiopathic pulmonary arterial hypertension (PAH). We aimed to investigate the acute hemodynamic and oxygenation responses and tolerability to 20 µg aerosolized Iloprost in Chinese patients with pulmonary hypertension. METHODS Between March 2005 and May 2010, 212 pulmonary hypertension patients inhaled a single dose of 20 µg Iloprost over 10 - 15 minutes for vasoreactivity testing. The acute hemodynamic and oxygenation responses and adverse events were recorded. RESULTS Iloprost decreased total pulmonary resistance ((1747 ± 918) dyn×s×cm(-5) vs. (1581 ± 937) dyn×s×cm(-5), P < 0.001), increased stroke volume ((45.0 ± 22.1) ml vs. (47.0 ± 24.2) ml, P = 0.002), and cardiac output ((3.7 ± 1.7) L/ml vs. (3.9 ± 1.9) L/min, P = 0.009). Heart rate and systemic vascular resistance remained stable during inhalation. However, systemic arterial blood oxygen saturation fell slightly ((91.0 ± 6.8)% vs. (90.3 ± 6.7)%, P = 0.002). Pulmonary and systemic arterial blood pressures declined within 1 - 3 minutes after inhalation initiation and reached their lowest levels within 10 - 15 minutes. Idiopathic PAH responded more favorably than pulmonary hypertension due to other causes (P £0.001) and patients with less severe pulmonary hypertension have better responses to Iloprost. No adverse events requiring medical care or leading to termination of inhalation occurred. CONCLUSIONS Inhalation of 20 µg Iloprost showed potent and selective pulmonary hemodynamic effects and was well tolerated in the Chinese pulmonary hypertension patients. Patients with idiopathic PAH and less severe pulmonary hypertension responded more favorably to inhalation of Iloprost.
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Affiliation(s)
- Hong-Liang Zhang
- Center for Pulmonary Vascular Diseases, State Key Laboratory of Cardiovascalar Disease, Fuwai Hospital, National Center for Cardiovascalar Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Gokce I, Kahveci H, Turkyilmaz Z, Adakli B, Zeybek C. Inhaled iloprost in the treatment of pulmonary hypertension in very low birth weight infants: a report of two cases. J PAK MED ASSOC 2012; 62:388-391. [PMID: 22755287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We treated 2 very low birth weight (VLBW) infants with respiratory distress syndrome suffering from refractory hypoxic respiratory failure complicated with severe pulmonary hypertension with inhaled iloprost. The first infant was an 800 gram male and the second case was a 920 gram female. Echocardiography revealed a right to left shunt through patent duct in the first case; suprasystemic pulmonary arterial pressure was estimated by using tricuspid regurgitation of moderate severity in the second case. Inhaled iloprost was started in those infants when conventional therapies including the administration of exogenous surfactant and high-frequency oscillatory ventilation failed. After the commencement of therapy, the clinical condition of the infants improved dramatically. Pulmonary arterial pressure returned to normal levels within five days. We suggest that inhaled iloprost may be helpful by improving oxygenation and reducing the need for aggressive mechanical ventilation in some cases of severe hypoxaemic respiratory failure in VLBW infants.
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MESH Headings
- Administration, Inhalation
- Female
- Humans
- Hypertension, Pulmonary/drug therapy
- Hypertension, Pulmonary/etiology
- Iloprost/administration & dosage
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/drug therapy
- Infant, Premature, Diseases/etiology
- Infant, Very Low Birth Weight
- Male
- Respiratory Distress Syndrome, Newborn/complications
- Respiratory Distress Syndrome, Newborn/therapy
- Vasodilator Agents/administration & dosage
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Affiliation(s)
- Ibrahim Gokce
- Department of Paediatrics, Erzurum District Training and Research Hospital, Erzurum, Turkey
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Rabanal Llevot JM, Cimadevilla Calvo B, Cifrian Martinez JM, Ruisanchez Villar C, Mons Lera R. [Effect of nebulised iloprost combined with inhaled nitric oxide and oral sildenafil on lung transplant patients. Therapeutic efficacy in pulmonary hypertension during surgery]. Rev Esp Anestesiol Reanim 2012; 59:142-149. [PMID: 22985755 DOI: 10.1016/j.redar.2012.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 02/10/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES There is a high incidence of pulmonary hypertension during the lung transplant peri-operative period, and could lead to a haemodynamic deterioration that may require the need of extracorporeal circulation. Our aim was to study the haemodynamic effects on the pulmonary and systemic circulation of the combination of inhaled nitric oxide and iloprost and oral sildenafil in patients with severe pulmonary hypertension during lung transplant surgery. PATIENTS AND METHODS Seventeen patients received 10μg of nebulised iloprost during the peri-operative period of the lung transplant when their mean pulmonary pressure exceeded 50mmHg. AU the patients received 50mg of oral sildenafil 30min before anaesthetic induction, 20ppm of inhaled nitric oxide after tracheal intubation. The haemodynamic and respiratory variables were recorded at baseline (after anaesthetic induction), prior to the administering of iloprost, and at 5 and 30min after it was given. RESULTS The administering of iloprost significantly reduced the pulmonary arterial pressure and significantly increases the cardiac Índex and the right ventrícular ejection fractíon. There were no signíficant changes occurred in the systemic arterial pressure. CONCLUSIONS The triple combination significantly reduces the pulmonary pressures in the lung transplant peri-operative and should be considered when there is severe pulmonary hypertension during the surgery or during the immediate post-operative period of lung transplantation.
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Affiliation(s)
- J M Rabanal Llevot
- Servicio de Anestesiología y Reanimación, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
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Caojin Z, Yigao H, Tao H, Wenhui H, Chunli X, Xinsheng H. Comparison of acute hemodynamic effects of aerosolized iloprost and inhaled nitric oxide in adult congenital heart disease with severe pulmonary arterial hypertension. Intern Med 2012; 51:2857-62. [PMID: 23064558 DOI: 10.2169/internalmedicine.51.7927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To compare the acute hemodynamic effects of aerosolized iloprost and inhaled nitric oxide (NO) in adult congenital heart disease (CHD) patients with severe pulmonary arterial hypertension (PAH). METHODS One hundred and eighty five adult CHDs with severe PAH were nonrandomized into two groups (iloprost, n=127; NO, n=58). Various hemodynamic parameters were measured before and after iloprost or NO inhalation. RESULTS Iloprost and NO inhalation resulted in significant reductions in pulmonary arterial pressure (from 110.6±21.8 mmHg to 105.5±22.3 mmHg, p<0.05; from 113.1±18.7 mmHg to 107.2±19.9 mmHg, p<0.05, respectively) and pulmonary vascular resistance (PVR) (from 13.4±8.3 Wood units to 9.6±6.4 Wood units, p<0.01; from 13.7±7.1 Wood units to 9.3±4.9 Wood units, p<0.01, respectively) and increases in pulmonary blood flow (from 6.7±3.3 L/min to 9.4±5.8 L/min, p<0.05; from 6.6±3.1 L/min to 9.6±5.9 L/min, p<0.01, respectively) and the Qp/Qs ratio (from 1.5±0.8 to 2.1±1.4, p<0.01; from 1.5±0.8 to 2.0±1.3, p<0.01, respectively). When the effects of inhaled iloprost and NO were compared, similar reductions in pulmonary arterial pressure and pulmonary vascular resistance were observed. Aerosolized iloprost and inhaled nitric oxide (iNO) were generally well tolerated and no patient experienced any side effects during inhalation. CONCLUSION Aerosolized iloprost can be effectively and safely used and might be an alternative to NO for testing pulmonary vascular reactivity and treating severe PAH in adult CHD patients.
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Affiliation(s)
- Zhang Caojin
- Department of Cardiology, Guangdong General Hospital & Guangdong Cardiovascular Institute, China.
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Guo XX, Tian Z, Liu YT, Wang Q, Li MT, Zeng XF, Zhu WL, Fang Q. [Effects of inhaled aerosolized iloprost in adult patients with pulmonary arterial hypertension on right heart functions]. Zhonghua Yi Xue Za Zhi 2011; 91:2832-2836. [PMID: 22333544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To explore the immediate effects of inhaled aerosolized iloprost on right heart function in adult patients with pulmonary arterial hypertension (PAH). METHODS A total of 30 PAH patients were recruited. Right heart catheterization and echocardiography were performed before and immediately after the inhalation of iloprost (20 µg). RESULTS After inhalation, the values of mean pulmonary artery pressure (PAPm) and pulmonary vascular resistances (PVR) decreased markedly (42.5 ± 9.6 to 34.4 ± 11.9 mm Hg, P < 0.001; 9.6 ± 5.7 Wood unit to 7.1 ± 4.8 Wood unit, P < 0.001). And the value of tricuspid annular systolic motion peak velocity (TASm) increased markedly [(10.7 ± 2.1) cm/s vs (11.9 ± 2.5) cm/s, P < 0.01]. The baseline level of TASm was higher in acute responders than non-responders [(12.0 ± 2.2) cm/s vs (10.1 ± 1.8) cm/s, P = 0.01] and TASm increased markedly after inhalation in non-responders [(10.1 ± 1.8) cm/s vs (11.6 ± 2.3) cm/s, P < 0.01]. CONCLUSION The inhalation of iloprost decreases the levels of PAPm and PVR and improve right heart functions in adult PAH patients. For non-responders, right heart function is worse and more benefits may be achieved after the inhalation of iloprost.
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Affiliation(s)
- Xiao-xiao Guo
- Department of Cardiology & Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Hafner F, Thomas G, Froehlich H, Steidl K, Brodmann M. Effect of a sequential therapy of bosentan and iloprost versus a monotherapy with bosentan in the treatment of scleroderma related digital ulcers. INT ANGIOL 2011; 30:493-495. [PMID: 21804491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Caravita S, Wu SC, Secchi MB, Dadone V, Bencini C, Pierini S. Long-term effects of intermittent Iloprost infusion on pulmonary arterial pressure in connective tissue disease. Eur J Intern Med 2011; 22:518-21. [PMID: 21925064 DOI: 10.1016/j.ejim.2011.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 01/16/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Intravenous periodic Iloprost is proven effective in the treatment of Raynaud phenomenon (RP) related to connective tissue disorder (CTD). It's well known that synthetic prostaglandins are effective drugs for the treatment of pulmonary arterial hypertension (PAH), and that PAH is frequently associated with CTD. OBJECTIVE The aim of the study is to evaluate in the chronic effect of cyclic intravenous Iloprost on pulmonary arterial pressure. METHODS We studied 17 consecutive patients with CTD (14 systemic sclerosis, 3 mixed CTD) and RP, at the entry and after at least 6months of treatment of RP with cyclic Iloprost. On both occasions, in all patients we performed transthoracic Doppler echocardiography and we determined NT-proBNP plasma levels, NYHA functional class, 6 Minute-Walk Distance (6MWD). RESULTS At follow-up (8.2±1.9months; range 6-12) mean values of pulmonary arterial systolic pressure (PASP) significantly decreased (from 32.2±9.2 to 29.2±7.6mmHg, p<0.04) and mean values of 6MWD significantly increased (from 407.5±101.5 to 448.3±89.9m, p<0.01). Moreover, we observed a significant direct correlation between PASP and NT-proBNP values and a significant inverse correlation both between NT-proBNP and 6MWD values and between PASP and 6MWD values. CONCLUSION Our results suggest that cyclic intravenous Iloprost may protect against the development or worsening of PAH in patients with CTD and RP.
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Affiliation(s)
- Sergio Caravita
- U.O.C. Medicina Interna, Ospedale Bassini, Azienda Ospedaliera Istituti Clinici di Perfezionamento, Milano, Italy
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Fiori G, Amanzi L, Moggi Pignone A, Braschi F, Matucci-Cerinic M. The treatment of skin ulcers in patients with systemic sclerosis. Reumatismo 2011; 56:225-34. [PMID: 15643477 DOI: 10.4081/reumatismo.2004.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Systemic Sclerosis (Ssc) is a complex disease of the connective tissue, characterized by progressive thickening and fibrosis of the skin and the internal organs and by diffused damage of the microvascular system. The fibrosis ones of the skin associated to the characteristic vascular alterations lead to the genesis of ulcers, more or less extended, often multiple, peripheral localization, chronic course, painful, able to influence patient's quality of life. Indeed, immunity reactivity, the thinning and the loss of elasticity of the skin, the peripheral neurological damage and the eventual drug assumption that can reduce regenerative/reparative abilities, can easily make an ulcer chronic and become infected complicating still more the patient disease, rendering more difficult the cure often, ulcer evolves to gangrene, and in some cases, in amputation too. For all these reasons, we have begun to study ulcers therapy (local and systemic), considering this activity it leave integrating of the charitable distance of the sclerodermic patient, putting to point on strategy both diagnostic and therapeutic, but above all with the primary scope, if possible, is to prevent ulcers, in contrary case, to alleviate the pain and to render the quality of the life of the patient better.
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Affiliation(s)
- G Fiori
- Università degli studi di Firenze, Medicina Interna I e II, Sezione di Reumatologia, 50139 Firenze.
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Martischnig AM, Tichy A, Nikfardjam M, Heinz G, Lang IM, Bonderman D. Inhaled iloprost for patients with precapillary pulmonary hypertension and right-side heart failure. J Card Fail 2011; 17:813-8. [PMID: 21962419 PMCID: PMC3190128 DOI: 10.1016/j.cardfail.2011.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 04/21/2011] [Accepted: 05/25/2011] [Indexed: 11/17/2022]
Abstract
Background Pulmonary hypertension (PH) can lead to right-side heart failure (RHF) and death. There are no therapeutic recommendations for patients experiencing acute RHF in the course of PH. This study aimed to examine the safety and efficacy of inhaled iloprost in patients with precapillary PH and RHF. Methods and Results Between October 2007 and December 2008, 7 patients with precapillary PH and RHF were enrolled. Per protocol, iloprost was inhaled hourly for a minimum of 12 hours during a 24-hour period. The starting dose of 2.5 μg was increased hourly by 2.5 μg as long as the increases were tolerated. Safety and efficacy were determined by continuous invasive monitoring of systemic and pulmonary hemodynamic parameters. Systemic pressures remained stable during inhalation (66.1 ± 6.9 mm Hg at baseline and 69.1 ± 6.4 mm Hg immediately after inhalation therapy, P = 0.48). Cardiac index increased from 2.4 ± 0.7 L/min/m2 to 2.9 ± 0.9 L/min/m2 (P = .008). Pulmonary vascular resistance decreased from 634.6 ± 218.3 dyn·s·cm−5 to 489.6 ± 173.8 dyn·s·cm−5 (P = .044), and N-terminal B-type natriuretic peptide levels decreased from 13,591 ± 10,939 pg/mL to 9,944 ± 8,569 pg/mL (P = .051). Conclusion Blood pressure-guided hourly inhalation of iloprost may offer a safe and effective strategy for the treatment of PH patients with RHF.
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Affiliation(s)
- Amadea M. Martischnig
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Alexander Tichy
- Core Unit for Medical Statistics and Informatics, University of Veterinary Medicine, Vienna, Austria
| | - Mariam Nikfardjam
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Gottfried Heinz
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Irene M. Lang
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Diana Bonderman
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
- Reprint requests: Diana Bonderman, MD, Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, 1090 Vienna, Austria. Tel: +43 1 40 400 4614; Fax: +43 1 40 400 4216.
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Abstract
Aerosolised drugs are prescribed for use in a range of inhaler devices and systems. Delivering drugs by inhalation requires a formulation that can be successfully aerosolised and a delivery system that produces a useful aerosol of the drug; the particles or droplets need to be of sufficient size and mass to be carried to the distal lung or deposited on proximal airways to give rise to a therapeutic effect. Patients and caregivers must use and maintain these aerosol drug delivery devices correctly. In recent years, several technical innovations have led to aerosol drug delivery devices with efficient drug delivery and with novel features that take into account factors such as dose tracking, portability, materials of manufacture, breath actuation, the interface with the patient, combination therapies, and systemic delivery. These changes have improved performance in all four categories of devices: metered dose inhalers, spacers and holding chambers, dry powder inhalers, and nebulisers. Additionally, several therapies usually given by injection are now prescribed as aerosols for use in a range of drug delivery devices. In this Review, we discuss recent developments in the design and clinical use of aerosol devices over the past 10-15 years with an emphasis on the treatment of respiratory disorders.
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Affiliation(s)
- Myrna B Dolovich
- Firestone Institute of Respiratory Health, St Joseph's Healthcare, Department of Medicine, McMaster University, Hamilton, ON, Canada.
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Zhang DZ, Zhu XY, Meng J, Xue HM, Sheng XT, Han XM, Cui CS, Wang QG, Zhang P. Acute hemodynamic responses to adenosine and iloprost in patients with congenital heart defects and severe pulmonary arterial hypertension. Int J Cardiol 2011; 147:433-7. [PMID: 20537740 DOI: 10.1016/j.ijcard.2010.04.093] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Revised: 04/18/2010] [Accepted: 04/28/2010] [Indexed: 11/29/2022]
Affiliation(s)
- Duan-zhen Zhang
- Department of Congenital Heart Disease, Shenyang Northern Hospital, Shenyang 110016, PR China
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Bali G, Schwantzer G, Aberer F, Kraenke B, Aberer E. Discontinuing long-term Iloprost treatment for Raynaud's Phenomenon and systemic sclerosis: a single-center, randomized, placebo-controlled, double-blind study. Acta Dermatovenerol Alp Pannonica Adriat 2011; 20:13-21. [PMID: 21879200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Iloprost has been reported to reduce Raynaud`s phenomenon (RP) and to inhibit progression of systemic sclerosis (SSc). OBJECTIVE The aim of our study was to compare monthly iloprost infusions with placebo in patients treated long-term. METHODS Seventeen patients, six with RP and 11 with SSc on monthly treatment with iloprost, received either a 3-hour intravenous infusion of iloprost or an equal volume of placebo once per month for 4 months in a monocentric, randomized, placebo-controlled, double-blind study. Raynaud attacks as measured by diary entries, skin temperature, skin sclerosis, fist closure, mouth opening, and digital ulcers were recorded during the observation period. RESULTS Whereas mouth opening improved significantly (p = 0.043) in the iloprost-treated group, RS improved in both patient groups. However, no significant differences were found in the outcome measures. CONCLUSION Although iloprost influences the inflammatory cascade in SSc, no statistical differences were seen in our study, indicating that treatment strategies with iloprost should be modified.
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Affiliation(s)
- G Bali
- MVZ Attendorn GmbH, Ostwall 94, D-57439 Attendorn.
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Pavone C, Melloni C, Oxenius I, Napoli G, Usala M, Abbadessa D. [Safety and tolerability of local treatment with Iloprost in patients with Peyronie's disease. A phase 1 pilot study and proposal of a new symptom questionnaire]. Urologia 2010; 77:172-179. [PMID: 20931546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE Intralesional therapy is a less invasive method for the treatment of Peyronie's disease. The objective of this study was to evaluate safety and tolerability of intralesional injections of Iloprost (I2 Prostacyclin analogue) for its property to suppress in fibroblasts CTFG (Connective tissue growth factor) production, which acts in concert with TGF-ß to stimulate the fibrotic process. METHODS Nineteen patients with Peyronie's disease were preliminarily evaluated by considering the degree of penile curvature, plaque size and local and systemic symptoms. Each patient then received weekly intralesional injections of 200 ng of Iloprost in 1 ml of normal saline for 4-5 weeks. If tolerated, the single dose increased weekly to the maximum of 400 ng (2 mL). RESULTS The treatment has shown that all patients seem to well tolerate a 200 ng Iloprost dose; 7 of them reached a 300 ng dose and 6 tolerate a 400 ng dose without showing side effects. There was no placebo control group in this study. To evaluate the efficacy of the treatment, the absence of objective parameters (except for the auto-photograph of penis in erection) led us to develop a subjective questionnaire that was given to all patients to assess sexual function, pain reduction, ecc. CONCLUSIONS Due to the relatively small size of the sample, the efficacy evaluation has been restricted to check the questionnaire reliability. Iloprost is well tolerated to a dose of 400 ng in the local treatment of Peyronie's disease.
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Affiliation(s)
- Carlo Pavone
- UO Urologia, Azienda Ospedaliera Universitaria Paolo Giaccone, Università degli Studi di Palermo, Palermo, Italy.
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Koschel DS, Kolditz M, Höeffken G, Halank M. Combined vasomodulatory therapy for severe pulmonary hypertension in chronic hypersensitivity pneumonitis. Med Sci Monit 2010; 16:CS55-CS57. [PMID: 20424556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND There are only a few reports of pulmonary hypertension (PH) in hypersensitivity pneumonitis (HP) and an approved vasomodulatory therapy for PH does not exist at all for interstitial lung disease (ILD), particularly for HP. CASE REPORT The case of a 53-year-old woman with chronic HP and severe life-threatening PH treated with a combined specific vasomodulatory therapy is reported. Sustained clinical and hemodynamic improvement was achieved. CONCLUSIONS Further investigation of PH in HP and specific vasomodulatory therapy is necessary.
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Affiliation(s)
- Dirk Steffen Koschel
- Department of Pulmonary Diseases, Fachkrankenhaus Coswig, Centre for Pulmonary Diseases and Thoracic Surgery, Coswig, Germany.
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Rimeika D, Sanchez-Crespo A, Nyren S, Lindahl SGE, Wiklund CU. Iloprost inhalation redistributes pulmonary perfusion and decreases arterial oxygenation in healthy volunteers. Acta Anaesthesiol Scand 2009; 53:1158-66. [PMID: 19650810 DOI: 10.1111/j.1399-6576.2009.02018.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies have shown that ventilation-perfusion matching is improved in the prone as compared with that in the supine position. Regional differences in the regulation of vascular tone may explain this. We have recently demonstrated higher production of nitric oxide in dorsal compared with ventral human lung tissue. The purpose of the present study was to investigate regional differences in actions by another vasoactive mediator, namely prostacyclin. The effects on gas exchange and regional pulmonary perfusion in different body positions were investigated at increased prostacyclin levels by inhalation of a synthetic prostacyclin analogue and decreased prostacyclin levels by unselective cyclooxygenase (COX) inhibition. METHODS In 19 volunteers, regional pulmonary perfusion in the prone and supine position was assessed by single photon emission computed tomography using (99m)Tc macro-aggregated albumin before and after inhalation of iloprost, a stable prostacyclin analogue, or an intravenous infusion of a non-selective COX inhibitor, diclofenac. In addition, gas distribution was assessed in seven subjects using (99m)Tc-labelled ultra-fine carbon particles before and after iloprost inhalation in the supine position. RESULTS Iloprost inhalation decreased arterial PaO(2) in both prone (from 14.2+/-0.5 to 11.7+/-1.7 kPa, P<0.01) and supine (from 13.7+/-1.4 to 10.9+/-2.1 kPa, P<0.01) positions. Iloprost inhalation redistributed lung perfusion from non-dependent to dependent lung regions in both prone and supine positions, while ventilation in the supine position was distributed in the opposite direction. No significant effects of non-selective COX inhibition were found in this study. CONCLUSIONS Iloprost inhalation decreases arterial oxygenation and results in a more gravity-dependent pulmonary perfusion in both supine and prone positions in healthy humans.
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Affiliation(s)
- D Rimeika
- Department of Cardiothoracic Surgery and Anaesthesiology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
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