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  • 11
    Electronic Resource
    Electronic Resource
    The influence of antithrombin III (AT III) substitution to supranormal activities on systemic procoagulant turnover in patients with end-stage chronic liver disease (1997)
    Springer
    Intensive care medicine 23 (1997), S. 1150-1158 
    Details
    ISSN: 1432-1238
    Keywords: Key words Antithrombin III ; Coagulation ; Disseminated intravascular coagulation ; Disseminated intravascular coagulation ; Liver failure ; Liver cirrhosis ; Liver transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Since antithrombin III (AT III) substitution to normal activities could not be shown to have major beneficial effects in patients with end-stage chronic liver disease in a variety of clinical settings, we tested the hypothesis that substitution to supranormal activities decreases systemic procoagulant turnover better in this patient group. Design: Controlled prospective clinical study. Setting: Operating rooms at a University Hospital. Patients: Twenty-four patients with histologically verified liver cirrhosis consecutively scheduled for liver transplantation. Interventions: Nineteen patients were given an antithrombin III concentrate to achieve either 100 % (n = 10) or 175 % (n = 9) AT III activity. Control patients (n = 5) received saline 0.9 % instead. Measurements and results: Molecular markers of coagulation activation, platelet count and aggregability, and global coagulation variables were measured prior to AT III infusion and 60 min thereafter. In both AT III-treated groups thrombin-antithrombin III-complex increased significantly (p 〈 0.005), whereas prothrombin fragment F1 + 2, soluble fibrin and D-dimer concentrations, as well as other variables, did not show major changes. Conclusions: Despite thrombin inhibition by AT III in patients with end-stage chronic liver disease, systemic procoagulant turnover was not significantly decreased 60 min after AT III application even to supranormal activities. Replenishment of the inhibitory antithrombin III pool, decreased in chronic liver disease, should not be expected to slow down the baseline consumptive component of the haemostatic disorder in this patient group.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050472
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  • 12
    Electronic Resource
    Electronic Resource
    Interaction between haematocrit and pulmonary blood volume on pulmonary vascular flow resistance and pressure-flow relationships (1997)
    Springer
    Intensive care medicine 23 (1997), S. 1285-1285 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050501
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  • 13
    Electronic Resource
    Electronic Resource
    Hemofiltration increases IL-6 clearance in early systemic inflammatory response syndrome but does not alter IL-6 and TNFα plasma concentrations (1997)
    Springer
    Intensive care medicine 23 (1997), S. 878-884 
    Details
    ISSN: 1432-1238
    Keywords: Key words Hemofiltration ; Systemic inflammatory response syndrome ; Tumor necrosis factor α ; Interleukin-6 ; Clearance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To test the hypothesis that continuous hemofiltration increases interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFα) clearances and results in decreased cytokine plasma concentrations independent of renal function in patients with early SIRS. Design: Prospective, controlled, randomized study. Setting: Intensive care units at a university hospital. Patients: 28 consecutive patients who fulfilled the criteria of the systemic inflammatory response syndrome (SIRS). Interventions: Patients with SIRS were randomly assigned to either a hemofiltration or a control group irrespective of renal function. In patients of the hemofiltration group an isovolemic hemofiltration was initiated directly after the diagnosis of SIRS and maintained for at least 48 h. Measurements and results: A significant (p 〈 0.001) increase in total IL-6 clearance (hemofiltrate + urine), but not in TNFα clearance, was observed with hemofiltration. However, the plasma concentrations of both cytokines remained unchanged. Hemodynamic variables did not change significantly. Conclusions: Continuous hemofiltration increases IL-6 plasma clearance but not TNFα clearance. However, hemofiltration failed to decrease plasma concentrations of TNFα and IL-6 and, therefore, cannot be used effectively for cytokine elimination in SIRS. Accordingly, beneficial effects occasionally reported with hemofiltration are unlikely to be expected due to elimination of IL-6 or TNFα.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050425
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  • 14
    Electronic Resource
    Electronic Resource
    Interaction between haematocrit and pulmonary blood volume on pulmonary vascular flow resistance and pressure-flow relationships (1997)
    Springer
    Intensive care medicine 23 (1997), S. 1082-1088 
    Details
    ISSN: 1432-1238
    Keywords: Key words Haemoconcentration ; Haemodilution ; Pressure-flow relationship ; Pulmonary circulation ; Pulmonary vascular flow resistance ; Pulmonary vascular hypertension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Pulmonary vascular flow resistance depends on blood viscosity, mainly due to haematocrit, and on vessel dimensions determining blood volume in this highly compliant vascular bed. We, therefore, evaluated the interaction between haematocrit, blood flow, and transpulmonary vascular pressure gradient under conditions of controlled pulmonary blood volume. Design: Experimental study in isolated zone-III rabbit lungs perfused with autologous blood. Setting: Laboratory for experimental studies. Interventions: Stepwise and independent variation of flow (50, 100, and 200 ml/min), pulmonary blood volume (increments of 2.5 ml and 5 ml imposed by changes of left atrial pressure), and haematocrit (0–50 %) varied by haemodilution (Krebs-Henseleit/albumin) or haemoconcentration (centrifugation). Measurements: Pulmonary arterial, left atrial, and airway pressures as well as reservoir volume (reflecting reciprocal changes of lung blood volume) and lung weight. Results: Haemodilution from the normal haematocrit (32 %) to 10 % at constant pulmonary blood volume and flow decreased flow resistance only slightly, whereas haemoconcentration (50 %) increased flow resistance up to 130 %. At the same time increments of in pulmonary blood volume of 2.5 and 5 ml (approx. 15 and 30 % of normal pulmonary blood volume) at constant haematocrit significantly shifted downwards pressure-flow relationships for all investigated haematocrits (0–50 %). Conclusions: Because of the multiple interrelationships between haematocrit, blood flow and pulmonary blood volume, haematocrit effects on pulmonary flow resistance and pressure-flow relationships in the pulmonary vasculature should be studied at controlled blood volume. While haemodilution only has minor effects, haemoconcentration changes pressure-flow relationships markedly. Pulmonary blood volume has a major impact on slope and position of pressure-flow relationships for all haematocrits investigated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050460
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  • 15
    Electronic Resource
    Electronic Resource
    Mechanical ventilation with PEEP – a unique therapy for failing hearts (1999)
    Springer
    Intensive care medicine 25 (1999), S. 778-780 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050952
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  • 16
    Electronic Resource
    Electronic Resource
    Ureaplasma urealyticum colonization and bronchopulmonary dysplasia: a comparative prospective multicentre study (1998)
    Springer
    European journal of pediatrics 157 (1998), S. 1004-1011 
    Details
    ISSN: 1432-1076
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To determine the role of tracheal colonization at birth with Ureaplasma urealyticum and other pathogenic bacteria with regard to the development of bronchopulmonary dysplasia (BPD), 97 premature infants with very low birth weight (〈1500 g) were followed prospectively over 30 days in a multicentre study. Of those infants, 35 were colonized with Ureaplasma urealyticum (group Ia), 22 with other pathogenic bacteria (group Ib) and 40 infants with sterile tracheal aspirates served as controls (group II). Colonization with Ureaplasma urealyticum or with pathogenic bacteria independently increased the risk of developing BPD as compared to the controls (OR 2.55; 95% CI [1.11, 5.87]). Among Ureaplasma urealyticum and bacterial colonized infants, duration of mechanical ventilation and oxygen requirement were significantly longer than among controls (P 〈 0.05); during the interval of 11 to 35 days of life, every additional day of ventilation significantly increased the risk of BPD (OR 1.22; CI [1.12, 1.32]). The rate of oxygen supplementation, which was similar in both groups during the first 2 weeks of life, was significantly higher among the colonized infants at day 21 (0.38 ± 0.18 and 0.39 ± 0.16 vs 0.31 ± 0.13, P 〈 0.05) and at day 28 (0.38 ± 0.21 and 0.34 ± 0.15 vs 0.28 ± 0.12, P 〈 0.05). For infants still ventilated at age of 28 days, Ureaplasma urealyticum and bacterial colonization were associated with a significant higher risk for BPD than for uncolonized controls (OR 5.53; [1.27, 24.02]. Association of Ureaplasma urealyticum and of bacterial colonization and BPD was not weakened after adjustments were made in a multivariate analysis for other significant risk factors. Conclusion Ureaplasma urealyticum colonization is as an important risk factor in the development of bronchopulmonary dysplasia as bacterial colonization even after treatment with surfactant.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310050987
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  • 17
    Electronic Resource
    Electronic Resource
    Immune-complex disease: A link between viral infection and sudden infant death? (1995)
    Springer
    European journal of pediatrics 154 (1995), S. 500-501 
    Details
    ISSN: 1432-1076
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02029368
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  • 18
    Electronic Resource
    Electronic Resource
    Individual assessment of visual perception by surgeons observing the same laparoscopic organs with various imaging systems (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 967-973 
    Details
    ISSN: 1432-2218
    Keywords: Video laparoscopy ; Imaging systems ; Visual perception
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Laparoscopic surgery necessitates that operations be performed via a television screen; therefore, image quality is crucial in determining the final outcome. Electronic imaging systems are constantly undergoing revisions and incorporating new ideas. Recently, we have been confronted with a variety of systems, and we, as operators, have no idea what the differences are between the old and the newer systems. As clinicians, we have no electronic yardstick available to compare the options presented or to check the specifications. This study examines critical aspects of image perception. General surgeons, gynecologists, operating-room nurses, as well as allied health personnel all experienced in laparoscopic surgery participated as test subjects. A blinded study was performed in which various camera systems (single chip, three-chip, digitized and nondigitized) were displayed in random fashion. Porcine abdominal areas were displayed using the various imaging units. Participants graded image perception based on the following characteristics: sharpness, color, contrast, and depth of field. The audience were blinded to the types, brand, and number of cameras utilized. A significant preference was shown for digitized systems (P〈0.0001). Also, digitized single-chip cameras scored higher than three-chip cameras (P〈0.05). We propose thorough testing by surgeons and nursing personnel before deciding what type of equipment to purchase.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00188452
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  • 19
    Electronic Resource
    Electronic Resource
    Laparoscopic fundoplication 1 month prior to lung transplantation (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 668-670 
    Details
    ISSN: 1432-2218
    Keywords: Lung transplantation ; Laparoscopic fundoplication ; Laparoscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Upper midline laparotomy in the presence of pulmonary failure is often complicated by a prolonged period of mechanical ventilation postoperatively. We report the successfull performance of laparoscopic fundoplication, without ventilatory suport, in a woman with end stage pulmonary disease and resting hypercarbia, one month prior to lung transplantation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00188526
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  • 20
    Electronic Resource
    Electronic Resource
    Endoscopic grading of the gastroesophageal valve in patients with symptoms of gastroesophageal reflux disease (GERD) (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 1184-1188 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Endoscopy — Gastroesophageal valve — Gastroesophageal reflux disease — GERD — Esophagus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: It has been suggested that endoscopic grading of the gastroesophageal flap valve is a good predictor of the reflux status. Methods: To test this hypothesis, 268 symptomatic patients underwent endoscopic grading of the gastroesophageal valve using Hill's classification, with grades I through IV. Esophageal acid exposure, lower esophageal sphincter characteristics, and the degree of esophageal mucosal injury were compared among the groups. Results: The prevalence of a mechanically defective sphincter, abnormal esophageal acid exposure, erosive esophagitis, and Barrett's esophagus increased with increasing alteration of the gastroesophageal valve. The presence of a grade IV valve indicated increased esophageal acid exposure in 75% of patients. As a predictor, this is similar to lower esophageal sphincter pressure but not as good as the presence of esophageal mucosal injury. Conclusions: Endoscopic grading of the gastroesophageal valve provides useful information about the reflux status but is less useful as an indicator of gastroesophageal reflux disease (GERD) than the presence of esophageal mucosal injury.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00009617
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