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  • 1
    Electronic Resource
    Electronic Resource
    Is endotoxin and cytokine release related to a decrease in gastric intramucosal pH after hemorrhagic shock? (1997)
    Springer
    Intensive care medicine 23 (1997), S. 1040-1048 
    Details
    ISSN: 1432-1238
    Keywords: Key words Trauma ; Hemorrhagic shock ; Cytokines ; Tumor necrosis factor-α ; Interleukin-6 ; Endotoxins ; Tonometry ; Intestinal mucosa
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: (a) To investigate the relationship between gut ischemia parameters (gastric intramucosal pH [pHi], mucosal–arterial carbon dioxide difference [PCO2-gap]), and endotoxin or cytokine release during hemorrhagic shock; (b) to compare the predictive value of pHi, PCO2-gap and arterial lactate concentrations. Design: Prospective study. Setting: Surgical intensive care unit of a university hospital. Patients: 20 multiple trauma patients with severe hemorrhagic shock. Interventions: Intramucosal measurements and blood samples were obtained on admission to the emergency room and repeatedly over 48 h. Measurements and results: Endotoxin was measured using a chromogenic limulus amoebocyte assay. Cytokine [tumor necrosis factor-α (TNFα) and interleukin-6 (IL-6)] values were evaluated by immunoradiometric assays. Only 3 patients had positive blood cultures but endotoxins were detected at least once in all patients. Endotoxin levels were similar in survivors and nonsurvivors over the study period and were not related to pHi or PCO2-gap. Initially, high levels of IL-6 were observed in both nonsurvivors and survivors [median 1778 pg/ml (range 435–44 540) vs 2068 pg/ml (range 996–92 300)]. IL-6 levels progressively decreased in the survivors but not significantly. On admission, TNFα concentrations were similar in nonsurvivors and survivors (42 ± 35 vs 46 ± 27 pg/ml). From the 24th h, TNFα values were higher in the nonsurvivors than in the survivors (24 h: 72 ± 38 vs 34 ± 17 pg/ml, p 〈 0.05). The greatest IL-6 levels were found for a pHi 〈 7.20 (28.5 ± 36.5 vs 1.8 ± 1.3 ng/ml, p 〈 0.05) or a PCO2-gap 〉 7.5 mmHg (1 kPa) (32.5 ± 37.5 vs 1.7 ± 1.3 ng/ml, p 〈 0.01). With the same pHi threshold, no difference was found in endotoxin levels. The lactate concentrations were predictive for outcome from the 12th h (9.5 ± 5.9 vs 3.6 ± 2.3 mmol/l, p 〈 0.05). Conclusions: During severe hemorrhagic shock, endotoxin translocation from the gut was a common phenomenon that seemed independent of both pHi values and outcome. It could not explain IL-6 and TNFα release. In severe hemorrhagic shock, neither pHi nor PCO2-gap provides additional information to the lactate measurements.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050454
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  • 2
    Electronic Resource
    Electronic Resource
    Comparison of norepinephrine and dobutamine to epinephrine for hemodynamics, lactate metabolism, and gastric tonometric variables in septic shock: a prospective, randomized study (1997)
    Springer
    Intensive care medicine 23 (1997), S. 282-287 
    Details
    ISSN: 1432-1238
    Keywords: Key words Septic shock ; Catecholamines ; Intramucosal pH ; Lactic acidosis ; Splanchnic circulation ; Tonometry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To compare the effects of norepinephrine and dobutamine to epinephrine on hemodynamics, lactate metabolism, and gastric tonometric variables in hyperdynamic dopamine-resistant septic shock. Design: A prospective, intervention, randomized clinical trial. Setting: Adult medical/surgical intensive care unit in a university hospital. Patients: 30 patients with a cardiac index (CI) 〉 3.5 l · min–1· m–2 and a mean arterial pressure (MAP) ≤ 60 mmHg after volume loading and dopamine 20 μg/kg per min and either oliguria or hyperlactatemia. Interventions: Patients were randomized to receive an infusion of either norepinephrine-dobutamine or epinephrine titrated to obtain an MAP greater than 80 mmHg with a stable or increased CI. Measurements and main results: Baseline measurements included: hemodynamic and tonometric parameters, arterial and mixed venous gases, and lactate and pyruvate blood levels. These measurements were repeated after 1, 6, 12, and 24 h. All the patients fulfilled the therapeutic goals. No statistical difference was found between epinephrine and norepinephrine-dobutamine for systemic hemodynamic measurements. Considering metabolic and tonometric measurements and compared to baseline values, after 6 h, epinephrine infusion was associated with an increase in lactate levels (from 3.1 ± 1.5 to 5.9 ± 1.0 mmol/l; p 〈 0.01), while lactate levels decreased in the norepinephrine-dobutamine group (from 3.1 ± 1.5 to 2.7 ± 1.0 mmol/l). The lactate/pyruvate ratio increased in the epinephrine group (from 15.5 ± 5.4 to 21 ± 5.8; p 〈 0.01) and did not change in the norepinephrine-dobutamine group (13.8 ± 5 to 14 ± 5.0). Gastric mucosal pH (pHi) decreased (from 7.29 ± 0.11 to 7.16 ± 0.07; p 〈 0.01) and the partial pressure of carbon dioxide (PCO2) gap (tonometer PCO2– arterial PCO2) increased (from 10 ± 2.7 to 14 ± 2.7 mmHg; p 〈 0.01) in the epinephrine group. In the norepinephrine-dobutamine group pHi (from 7.30 ± 0.11 to 7.35 ± 0.07) and the PCO2 gap (from 10 ± 3.0 to 4 ± 2.0 mmHg) were normalized within 6 h (p 〈 0.01). The decrease in pHi and the increase in the lactate/pyruvate ratio in the epinephrine group was transient, since it returned to normal within 24 h. Conclusions: Considering the global hemodynamic effects, epinephrine is as effective as norepinephrine-dobutamine. Nevertheless, gastric mucosal acidosis and global metabolic changes observed in epinephrine-treated patients are consistent with a markedly inadequate, although transient, splanchnic oxygen utilization. The metabolic and splanchnic effects of the combination of norepinephrine and dobutamine in hyperdynamic dopamine-resistant septic shock appeared to be more predictable and more appropriate to the current goals of septic shock therapy than those of epinephrine alone.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050329
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  • 3
    Electronic Resource
    Electronic Resource
    Assessment of deep vein thrombosis prophylaxis in surgical patients: a study conducted at Nancy University Hospital, France (1998)
    Springer
    European journal of clinical pharmacology 54 (1998), S. 671-676 
    Details
    ISSN: 1432-1041
    Keywords: Key words Deep vein thrombosis prophylaxis ; Clinical audit ; Low molecular weight heparin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract Objective: This retrospective evaluation aimed to assess the adequacy of prophylaxis against thromboembolism prescribed to surgical patients at the authors' institution, and to compare it with generally accepted published guidelines. Aspects considered were indications for prophylaxis, regimens used and monitoring. Methods: Eleven units (nine surgical and two surgical intensive care) took part in the survey on a voluntary basis. The clinical audit system used involved developing a set of criteria based on existing guidelines, comparing observed practice with those recommendations, analysing the factors underlying any deviation and developing corrective measures. Results: When the medical records of 117 patients hospitalized in October 1995 were examined, prophylaxis against deep vein thrombosis was documented in 86 (low molecular weight heparin in 85, dextran in one). No associated physical preventative measures were recorded. Indications and dosage were appropriately handled in 90.7% and 75.2% of patients, respectively. Ninety-five cases were outside the reference criteria: 74 for excluded surgical indications, 13 which involved laparoscopy, and eight in which spinal or epidural anaesthesia was administered. Platelet count was performed in 73.8% of cases before prophylactic treatment, and in 23.1% during its course. Anti-Xa activity was measured in 0.4% of cases. Analysis of causes showed that guidelines were not complied with either because of lack of organization, or because of disagreement with them. Discussion: In this study, indications for prophylaxis were well established and heparin dosages used were not fundamentally flawed. The weak point in practice was a failure to carry out platelet counts, particularly during the course of treatment. Appropriate corrective action consists of disseminating guidelines and relevant information, and using a preoperative checklist to assess thromboembolic risk. Conclusion: Physicians agree that opportunities to improve preventative practices exist, and that the quality improvement programme should be pursued.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002280050533
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  • 4
    Electronic Resource
    Electronic Resource
    L-carnitine: a way to decrease cellular toxicity of ifosfamide? (1995)
    Springer
    European journal of pediatrics 154 (1995), S. 686-687 
    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/s004310050373
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  • 5
    Electronic Resource
    Electronic Resource
    Clinical outcome and long-term management of 17 patients with propionic acidaemia (1996)
    Springer
    European journal of pediatrics 155 (1996), S. 205-210 
    Details
    ISSN: 1432-1076
    Keywords: Propionic acidaemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A retrospective study was performed on the clinical outcome and long-term treatment of 17 patients with propionic acidaemia diagnosed during the last 20 years in our hospital. The study group consisted of 12 patients with early onset type of disease and 5 patients with late onset. Seven (41%) patients died, five with early onset and two with late onset. The deceased early onset patients had a median survival of 0.4 years while the deceased late onset patients died at the age of 2.8 and 4 years respectively. Median age of the living early onset patients was 5.2 (1–9.25) years, the late onset patients were 4,7 and 23 years old. Patients were all treated with natural protein restriction and in most cases carnitine and metronidazole were added. The early onset patients were almost all treated with daily home tube feeding. The mean natural protein intake of early onset patients (6.3±1.5 g/day) was significantly lower than the natural protein intake of late onset patients (17.6±5.3 g/day). Supplemental protein intake was higher in early onset patients. The general neurological outcome of our study group was satisfactory with a better outcome for early onset patients. As to growth, many patients showed a failure to thrive, this was particularly for height. The strong protein restriction during the first years of life probably contributed to this. Conclusion The prognosis for patients with propionic acidaemia appeared to be satisfactory in terms of survival and outcome characteristics such as neurological and mental development. Despite these results the authors feel that the prognosis and quality of life of these patients might be improved with liver transplantation or possibly somatic gene therapy in the future.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01953939
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  • 6
    Electronic Resource
    Electronic Resource
    L-carnitine: a way to decrease cellular toxicity of ifosfamide? (1995)
    Springer
    European journal of pediatrics 154 (1995), S. 686-687 
    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/BF02079081
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  • 7
    Electronic Resource
    Electronic Resource
    Diffuse leukodystrophy in an infant with cytochrome-c oxidase deficiency (1998)
    Springer
    Journal of inherited metabolic disease 21 (1998), S. 748-752 
    Details
    ISSN: 1573-2665
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A 25-month-old boy, born to consanguineous parents, had progressive spastic tetraplegia, and increased signal of the white matter on cerebral T2-weighted magnetic resonance imaging indicative of diffuse leukodystrophy. Elevated blood and cerebrospinal fluid lactate levels pointed to a respiratory chain defect. Cytochrome-c oxidase deficiency was demonstrated in cultured skin fibroblasts and skeletal muscle. This report extends the phenotype of COX deficiency in infancy. Systematic study of blood and CSF lactate should be carried out in every infant with leukodystrophy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1005497116398
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  • 8
    Electronic Resource
    Electronic Resource
    Biochemical aspects of stuck and sluggish fermentation in grape must (1998)
    Springer
    Journal of industrial microbiology and biotechnology 20 (1998), S. 20-27 
    Details
    ISSN: 1476-5535
    Keywords: Keywords: stuck and sluggish fermentation; must; wine; yeast; enology; Saccharomyces cerevisiae
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Process Engineering, Biotechnology, Nutrition Technology
    Notes: Recently a number of studies have focused on the factors responsible for the occurrence of stuck and sluggish fermentations. Results from these studies indicate that together with nutritional deficiencies and inhibitory substances, technological practices could lead to such situations. This review explains, from a biochemical point of view, the influence of nutritional deficiencies, inhibitory substances and technological practices on yeast cell development and physiology and the fermentation process.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1038/sj.jim.2900442
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  • 9
    Electronic Resource
    Electronic Resource
    Metabolic intermediates in lactic acidosis: compounds, samples and interpretation (1996)
    Springer
    Journal of inherited metabolic disease 19 (1996), S. 478-488 
    Details
    ISSN: 1573-2665
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A number of acquired conditions including infections, severe catabolic states, tissue anoxia, severe dehydration and poisoning can give rise to hyperlactacidaemia. All these causes should be ruled out before considering inborn errors of metabolism. Carefully collected samples are necessary if artefacts that results in spuriously increased lactate/pyruvate (L/P) and 3-hydroxybutyrate/acetoacetate (B/A) ratios are to be avoided. When properly performed, 24-h studies of L/P and B/A ratios provide a useful tool in making a diagnosis. A few metabolic profiles when present are specific or highly suggestive of a given disorder. When the L/P ratio is normal or low, pyruvate dehydrogenase (PDH) deficiency is highly probable whatever the lactate concentration, which is often only moderately elevated after meal, may be. When the L/P ratio is very high in association with post-prandial hyperketonaemia and in contrast to a normal or low B/A ratio, pyruvate carboxylase (PC) deficiency andα-ketoglutarate dehydrogenase (KGDH) deficiency are the most likely diagnoses. The distinction between the two disorders relies upon amino acid and organic acid profiles (glutamate andα-ketoglutarate accumulations in KGDH deficiency and hyperammonaemia and hypercitrullinaemia in PC deficiency). When both L/P and B/A ratios are elevated and associated with significant post-prandial hyperketonaemia, respiratory-chain disorders should first be suspected. All other profiles, especially a high L/P ratio without hyperketonaemia, are compatible with respiratory-chain disorders but are not specific; all acquired anoxic conditions should also be ruled out. Clearly, the clinical utility of these profiles needs to be interpreted cautiously in very ill patients in relation to the cardiocirculatory condition and to therapy. Finally, a normal profile, even after stress and loading, does not rule out an inborn error of lactate/pyruvate oxidation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01799109
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