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  • 1
    Electronic Resource
    Electronic Resource
    Meningokokkensepsis und Purpura fulminans Erfolgreiche Lysetherapie mit rekombinantem Gewebeplasminogenaktivator (1999)
    Springer
    Monatsschrift Kinderheilkunde 147 (1999), S. 1010-1013 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Meningokokkensepsis ; Purpura fulminans ; Fibrinolyse ; Gewebeplasminogenaktivator ; Key words Meningococcemia ; Purpura fulminans ; Fibrinolysis ; Tissue plasminogen activator
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A case of a 16 years old young man with meningococcemia, septic shock and purpura fulminans is presented. The clinical course was complicated by ischemia of both lower legs and feet as well as both cheeks. After successful restoration of circulation, the lower legs remained ischemic and loss was imminent. Therefore, fibrinolytic therapy with recombinant tissue plasminogen activator (rt-PA) was started: Both lower legs and feet could be preserved. All of the toes of the right foot, however, had to be amputated. Discussion: Fibrinolytic therapy with rt-PA should be considered as a therapeutic option in patients with meningococcemia and purpura fulminans with imminent loss of extremities. Optimal perfusion pressure and control of coagulation seems to be a prerequisite for successful fibrinolytic therapy. Care should be taken to avoid complications, especially intracerebral hemorrhage.
    Notes: Zusammenfassung Berichtet wird über den Krankheitsverlauf eines 16jährigen Jugendlichen, der akut an einer Meningokokkensepsis mit septischem Schock und Purpura fulminans erkrankte. Nach Stabilisierung des Herz-Kreislauf- Systems blieben die Wangen sowie die Unterschenkel und Füße beidseits ischämisch, so daß mit einem Verlust beider Unterschenkel und Füße gerechnet werden mußte. In dieser Situation wurde eine Fibrinolyse mit rekombinantem Gewebeplasminogenaktivator (rt-PA) durchgeführt: Beide Unterschenkel und Füße konnten erhalten werden, jedoch mußten alle Zehen des rechten Fußes amputiert werden. Diskussion: Bei Meningokokkensepsis mit Purpura fulminans erscheint eine Fibrinolyse bei ischämischen Extremitäten sinnvoll. Diese sollte allerdings u.E. erst nach Stabilisierung des Herz-Kreislauf-Systems und der Gerinnung erfolgen, da ansonsten weder der Effekt der Lyse noch mögliche Komplikationen, insbesondere Blutungen in das Zentralnervensystem, richtig erkannt werden können.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050532
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  • 2
    Electronic Resource
    Electronic Resource
    A new side effect of inhaled nitric oxide in neonates and infants with pulmonary hypertension: functional impairment of the neutrophil respiratory burst (1996)
    Springer
    Intensive care medicine 22 (1996), S. 252-258 
    Details
    ISSN: 1432-1238
    Keywords: Key words Inhaled nitric oxide ; Pulmonary hypertension ; Respiratory burst of neutrophils
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract   Introduction: Inhaled nitric oxide (NO) may be beneficial in the treatment of pulmonary hypertension, both of the newborn and in the adult respiratory distress syndrome. Up to now, serious systemic side effects have not been reported. Objective: The effect of inhaled NO on superoxide anion production by neutrophils. Design: Prospective study of a consecutive series of 15 neonates and infants. Setting: Neonatal and paediatric ICUs with a total of 17 beds (university hospital). Measurements and results: Superoxide anion production was determined by a flow cytometric method using dihydrorhodamine 123 (DHR) as an oxidative probe after the priming of neutrophils with N-formyl-methionyl-leucyl-phenylalanine (fMLP) or with Escherichia coli. The generated fluorescence was expressed as relative fluorescence intensity (RFI). Inhalation of NO for more than 24 h reduced the superoxide anion production by neutrophils stimulated with E. coli to below baseline values before NO inhalation (mRFI=158±25 vs 222±24; P=0.03). This decrease was more pronounced after more than 72 h (mRFI=133±17). At this time, superoxide anion production by fMLP-stimulated neutrophils was also decreased (mRFI=40±3, vs 57±5; P=0.03). The reduced capacity of superoxide production persisted throughout therapy with NO and lasted up to more than 4 days after the end of NO inhalation. Conclusion: The results suggest that inhalation of NO in patients with pulmonary hypertension causes reduced superoxide anion production by neutrophils stimulated with E. coli or with fMLP. To determine the clinical importance of this systemic side effect with respect to bacterial infections, a randomized controlled study is necessary.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01712246
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    Paper (German National Licenses)
    Fulltext
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