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  • 1995-1999  (4)
  • Prognosis  (2)
  • Anxiety PTSD  (1)
  • Cell & Developmental Biology  (1)
  • 1
    Electronic Resource
    Electronic Resource
    Limitation of life support: Frequency and practice in a London and a Cape Town intensive care unit (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1020-1025 
    Details
    ISSN: 1432-1238
    Keywords: Critical care ; Ethics ; Resuscitation orders ; Advance directives ; Life support withdrawal ; Prognosis ; Severity of illness index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives To examine the frequency of limiting (withdrawing and withholding) therapy in the intensive care unit (ICU), the grounds for limiting therapy, the people involved in the decisions, the way the decisions are implemented and the patient outcome. Design Prospective survey. Ethical approval was obtained. Setting ICUs in tertiary centres in London and Cape Town. Patients All patients who died or had life support limited. Interventions Data collection only. Results There were 65 deaths out of 945 ICU discharges in London and 45 deaths out of 354 ICU discharges in Cape Town. Therapy was limited in 81.5% and 86.7% respectively (p=0.6) of patients who died. The mean ages of patients whose therapy was limited were 60.2 years and 51.9 years (p=0.014) and mean APACHE II scores 18.5 and 22.6 (p=0.19) respectively. The most common reason for limiting therapy in both centres was multiple organ failure. Both medical and nursing staff were involved in most decisions, which were only implemented once wide consensus had been reached and the families had accepted the situation. Inotropes, ventilation, blood products, and antibiotics were most commonly withdrawn. The mean time from admission to the decision to limit therapy was 11.2 days in London and 9.6 days in Cape Twon. The times to outcome (death in all patients) were 13.2 h and 8.1 h respectively. Conclusions Withdrawal of therapy occurred commonly, most often because of multiple organ failure. Wide consensus was reached before a decision was made, and the time to death was generally short.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01699222
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Limitation of life support: frequency and practice in a London and a Cape Town intensive care unit (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1020-1025 
    Details
    ISSN: 1432-1238
    Keywords: Key words Critical care ; Ethics ; Resuscitation orders ; Advance directives ; Life support withdrawal ; Prognosis ; Severity of illness index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To examine the frequency of limiting (withdrawing and withholding) therapy in the intensive care unit (ICU), the grounds for limiting therapy, the people involved in the decisions, the way the decisions are implemented and the patient outcome. Design: Prospective survey. Ethical approval was obtained. Setting: ICUs in tertiary centres in London and Cape Town. Patients: All patients who died or had life support limited. Interventions: Data collection only. Results: There were 65 deaths out of 945 ICU discharges in London and 45 deaths out of 354 ICU discharges in Cape Town. Therapy was limited in 81.5% and 86.7% respectively (p=0.6) of patients who died. The mean ages of patients whose therapy was limited were 60.2 years and 51.9 years (p=0.014) and mean APACHE II scores 18.5 and 22.6 (p=0.19) respectively. The most common reason for limiting therapy in both centres was multiple organ failure. Both medical and nursing staff were involved in most decisions, which were only implemented once wide consensus had been reached and the families had accepted the situation. Inotropes, ventilation, blood products, and antibiotics were most commonly withdrawn. The mean time from admission to the decision to limit therapy was 11.2 days in London and 9.6 days in Cape Town. The times to outcome (death in all patients) were 13.2 h and 8.1 h respectively. Conclusions: Withdrawal of therapy occurred commonly, most often because of multiple organ failure. Wide consensus was reached before a decision was made, and the time to death was generally short.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01699222
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 3
    Electronic Resource
    Electronic Resource
    Yohimbine facilitated acoustic startle in combat veterans with post-traumatic stress disorder (1995)
    Springer
    Psychopharmacology 117 (1995), S. 466-471 
    Details
    ISSN: 1432-2072
    Keywords: Yohimbine ; Noradrenergic ; Anxiety PTSD
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Preclinical and clinical studies have suggested that the acoustic startle reflex (ASR) is a useful model to investigate the neurochemical basis of anxiety and fear states. This work has revealed that the anxiogenic alpha-2 receptor antagonist, yohimbine, increases the amplitude of the ASR in laboratory animals and in healthy human controls. Because of the growing body of data that support the hypothesis that severe stress results in substantial alterations in noradrenergic neuronal reactivity, the present investigation evaluated the effects of yohimbine on the ASR of 18 patients with PTSD and 11 healthy combat controls. Subjects received IV yohimbine (0.4 mg/kg) or saline placebo on 2 separate days in a randomized double blind placebo control design. A trial of two tone frequencies with varied intensity (90, 96, 102, 108, 114 dB) white noise and instantaneous rise time, was delivered binaurally through headphones. Tones were delivered every 25–60 s, for a 40-ms duration. Startle testing was performed 80 min post-infusion and lasted 15–20 min. Yohimbine significantly increased the amplitude, magnitude and probability of the ASR in combat veterans with PTSD, but did not do so in combat controls. Overall startle was significantly larger in the PTSD subjects; however, this did not account for the differential effect of yohimbine, since yohimbine had no significant effect in the control group. This study demonstrates an excitatory effect of yohimbine on the amplitude, magnitude and probability of the ASR in PTSD patients that is not seen in combat controls. In the context of the key role of this reflex in the alarm response, this finding adds to the array of documented behavioral, biochemical and cardiovascular effects of yohimbine in humans which support the relationship between increased noradrenergic function and exaggerated startle symptomatology of PTSD.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02246220
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Bone morphogenetic proteins inhibit adipocyte differentiation by bone marrow stromal cells (1995)
    New York, N.Y. : Wiley-Blackwell
    Journal of Cellular Biochemistry 58 (1995), S. 393-402 
    Details
    ISSN: 0730-2312
    Keywords: adipocytes ; bone morphogenetic proteins ; differentiation ; bone marrow stromal cells ; transforming growth factor β ; Life and Medical Sciences ; Cell & Developmental Biology
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Biology , Chemistry and Pharmacology , Medicine
    Notes: The bone morphogenetic proteins were originally identified based on their ability to induce ectopic bone formation in vivo and have since been identified as members of the transforming growth factor-β gene superfamily. It has been well established that the bone morphogenetic cytokines enhance osteogenic activity in bone marrow stromal cells in vitro. Recent reports have described how bone morphogenetic proteins inhibited myogenic differentiation of bone marrow stromal cells in vitro. In vivo, bone marrow stromal cells differentiate along the related adipogenic pathway with advancing age. The current work reports the inhibitory effects of the bone morphorphogenetic proteins on adipogenesis in a multipotent murine bone marrow stromal cell line, BMS2. When exposed to bone morphogenetic protein-2, the pre-adipocyte BMS2 cells exhibited the expected induction of the osteogenic-related enzyme, alkaline phosphatase. Following induction of the BMS2 cells with adipogenic agonists, adipocyte differentiation was assessed by morphologic, enzymatic, and mRNA markers. Flow cytometric analysis combined with staining by the lipophilic fluorescent dye, Nile red, was used to quantitate the extent of lipid accumulation within the BMS2 cells. By this morphologic criteria, the bone morphogenetic proteins inhibited adipogenesis at concentrations of 50 to 500 ng/ml. This correlated with decreased levels of adipocyte specific enzymes and mRNAs. The BMS2 pre-adipocytes constitutively expressed mRNA encoding bone morphogenetic protein-4 and this was inhibited by adipogenic agonists. Together, these findings demonstrate that bone morphogenetic proteins act as adipogenic antagonists. This supports the hypothesis that adipogenesis and osteogenesis in the bone marrow microenvironment are reciprocally regulated.
    Additional Material: 4 Ill.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/jcb.240580312
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    Paper (German National Licenses)
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