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  • 1
    Electronic Resource
    Electronic Resource
    Fractalkine is Not a Major Chemoattractant for the Migration of Neutrophils Across Microvascular Endothelium (2003)
    Oxford, UK : Blackwell Science Ltd
    Scandinavian journal of immunology 58 (2003), S. 0 
    Details
    ISSN: 1365-3083
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Inflammatory responses during sepsis are determined by leucocyte recruitment into inflamed tissues. Both chemokines and adhesion molecules are believed to be involved in this process. As fractalkine exists as transmembrane protein with cell adhesion properties and as soluble chemotactic factor, the present study was conducted to study the role of fractalkine, produced by microvascular and macrovascular endothelial cells, in neutrophil recruitment. Lung microvascular endothelial cells (LMVECs) stimulated with lipopolysaccharide, tumour necrosis factor-α or interleukin-1 (IL-1) produced much more fractalkine compared with the macrovascular human umbilical vein endothelial cells (HUVECs). No differences were found between microvascular endothelial cells of different organs. Chemotactic activity in supernatants was significantly stronger in stimulated LMVEC when compared with HUVEC. Although recombinant fractalkine induced migration of neutrophils, IL-8 and monocyte chemoattractant protein-1 were found to be more strictly required. In vivo fractalkine was strongly upregulated in septic lung and kidney. Our data suggest that fractalkine production per se does not explain the preference for inflammation in the lung of septic patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-3083.2003.01298.x
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  • 2
    Electronic Resource
    Electronic Resource
    A comparison of sevoflurane to halothane in paediatric surgical patients: results of a multicentre international study (1996)
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 6 (1996), S. 0 
    Details
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Induction, emergence and recovery characteristics were compared during sevoflurane or halothane anaesthetic in a large (428) multicentre, international study of children undergoing elective inpatient surgical procedures. Two hundred and fourteen children in each group underwent inhalation induction with nitrous oxide/oxygen and sevoflurane or halothane. Incremental doses of either study drug were added until loss of eyelash reflex was achieved. Steady state concentrations of anaesthesia were maintained until the end of surgery when anaesthetic agents were terminated simultaneously. Time variables were recorded for induction, emergence and the first need for analgesia in the recovery room. In addition, in 86 of the children in both groups, venous blood samples were drawn for plasma fluoride levels during and after surgery. There was a trend toward smoother induction (induction of anaesthesia without coughing, breath holding, excitement laryngospasm, bronchospasm, increased secretion, and vomiting) in the sevoflurane group with faster induction (2.1 min vs 2.9 min, P= 0.037) and rapid emergence times (10.3 min vs 13.9 min, P= 0.003). Among the children given sevoflurane, 2% developed bradycardia compared with 11% in the halothane group. Postoperatively, 46% of the children in the halothane group developed nausea and or vomiting versus 31% in the sevoflurane group (P= 0.002). Two children in the halothane group developed cardiac dysrhythmia and were dropped from the study. In addition, a child in the halothane group developed malignant hyperthermia, received dantrolene, and had an uneventful recovery. Mean maximum inorganic fluoride concentration was 18.3 μM˙l−1. The fluoride concentrations peaked within one h of termination of sevoflurane anaesthetic and returned rapidly to baseline within 48 h. This study suggests that sevoflurane may be the drug of choice for the anaesthetic management of children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1460-9592.1996.tb00452.x
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  • 3
    Electronic Resource
    Electronic Resource
    Tödlicher Schock durch Nor-Adrenalin-Infusion im Tierexperiment (1974)
    Springer
    Langenbeck's archives of surgery 336 (1974), S. 115-123 
    Details
    ISSN: 1435-2451
    Keywords: Irreversible Shock ; Infusion of Norepinephrine ; Hemorrhagic Shock
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung 2 Gruppen normovolämischer Hunde erhalten je eine Dauer-infusion von 7,5 μg/kg. min Nor-Adrenalin maschinell intravenös. Eine Serie (n = 5) wird einem standardisierten hämorrhagischen Schock unterworfen; 20 min nach Reinfusion der entzogenen Blutmenge beginnt die Infusion. In der 2. Gruppe erhalten 6 Hunde lediglich eine Dauerinfusion von NA. Allein durch die NA-Dauerinfusion wird stets ein tödlicher Schock hervorgerufen, der sich im Verlauf von der Gruppe mit vorausgegangener Hypotonie nur unwesentlich unterscheidet. Auslösende Ursache ist die erhebliche Verminderung des Herz-Zeit-Volumens unter einen kritischen Wert. Der stark gestiegene periphere Strömungswiderstand halt den Blutdruck im Normbereich, bis kurz vor dem Tod der Tiere. Die Minderdurchblutung führt zu einer Gewebshypoxidose mit konsekutiver generalisierter Acidose.
    Notes: Summary In 2 groups of normovolemic dogs norepinephrine (7.5 μg/kg . min) is infused i.v. by an infusion pump. One group (n = 5) is subjected to a standardized hemorrhagic shock; the infusion of norepinephrine starts 20 min after reinfusion of the withdrawn blood. In the second group of 6 dogs norepinephrine is infused without a preceding hemorrhagic shock. Continuous infusion of norepinephrine alone always results in fatal shock, the course of which does not differ significantly from that of the group with preceding hypotony. The cause of shock is a critical reduction of cardiac output. Due to the considerable increase in peripheral resistance arterial blood pressure remains normal until shortly before death. The impaired microcirculation results in tissue hypoxidosis and consequently in generalized acidosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01257435
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  • 4
    Electronic Resource
    Electronic Resource
    Akute Änderungen der Fraktion der adhäsiven und nichtadhäsiven Blutplättchen und der pulmonalen Hämodynamik im Tourniquet-Schock des Hundes (1972)
    Springer
    Research in experimental medicine 157 (1972), S. 275-278 
    Details
    ISSN: 1433-8580
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01851167
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  • 5
    Electronic Resource
    Electronic Resource
    Regional heterogeneity of cerebral blood flow response to graded volume-controlled hemorrhage (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1026-1033 
    Details
    ISSN: 1432-1238
    Keywords: Local cerebral blood flow ; Autoradiography ; Hemorrhagic hypovolemia ; Hemorrhagic shock
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective Of the animal models of human hemorrhagic shock, the volume-controlled hemorrhage model appears to come closer to the clinical situation than the commonly used pressure-controlled model, since the volumecontrolled model allows regulatory adjustment of blood pressure. The effects of volume-controlled hemorrhage on local cerebral blood flow (LCBF) of conscious animasl are not known. The present study investigates specific reaction patterns of LCBF in comparison to mean cerebral blood flow (CBF) during graded volume-controlled hemorrhagic shock in conscious rats. Methods Conscious, spontaneously breathing, and minimally restrained rats were subjected to different degrees of volume-controlled hemorrhage (taking either 25, 30, 35, or 40 ml arterial blood/kg body weight (b.w.). Thirty minutes after the completion of blood taking, LCBF was determined during hemorrhagic hypovolemia using the autoradiographic iodo (14C) antipyrine method. A group of untreated rats (no hemorrhage) served as controls. LCBF was determined in 34 defined brain structures and mean CBF was calculated. Results During less severe hemorrhage (25 and 30 ml/kg b.w.) mean CBF was significantly higher than in the control group (+19% and +25%). During severe hemorrhage (35 and 40 ml/kg b.w.) mean CBF remained unchanged compared to the control values, although significant increases in LCBF could be detected in many of the brain structures analyzed (maximum +44%). The mean coefficient of variation of CBF was increased, indicating a larger heterogeneity of LCBF values at shed blood volumes of 35 and 40 ml/kg b.w. Conclusions A comprehensive and novel description of the local distribution of CBF during graded volume-controlled hemorrhage in conscious rats shows unexpected increases in LCBF and mean CBF. This “hypovolemic cerebral hyperemia” might be caused by endogenous hemodilution, thus maintaining the blood supply to the brain during hypovolemic shock.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01699223
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  • 6
    Electronic Resource
    Electronic Resource
    Coronardurchblutung und Coronarreserve im hämorrhagischen Schock (1972)
    Springer
    Research in experimental medicine 157 (1972), S. 271-273 
    Details
    ISSN: 1433-8580
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01851165
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  • 7
    Electronic Resource
    Electronic Resource
    Qualitätsmanagement in der Anästhesie (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 65-73 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter ; Qualitätsmanagement ; Kosteneffektivität ; Zertifizierung ; ISO 9001 ; EFQM ; Key words ; Quality management ; Cost effectiveness ; Certification ; ISO 9001 ; EFQM
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Quality of care and costs are getting closer together. Whereas costs and quality management did not play a substantial role 30 years ago, the consumption of resources nowadays is part of the outcome of quality of care. The definition of quality must be seen in the dimensions of structure, process and result. Resulting from newly developed clinical practice, guidelines are planned as instruments for cost containment in near future. Those guidelines may end up in a quality management system. The most wellknown european basic of such a quality management system are the DIN EN ISO 9000 f and the EFQM. The ISO 9001 and the European Quality Award became the most common base of evaluation for certification of quality management systems in Organisations europeanwide. Whereas the ISO 9001 does not give any information about the real achieved quality, the European Quality Award reflects the process. Guidelines are necessary to prove the cost effectiveness of measures of quality control and quality assurance since too much quality control and assurance may result in increased overall consumption of resources, leading to a reduction in the quality of care when ensuring that the overall budget is covered.
    Notes: Zusammenfassung Versorgungsqualität und Kosten rücken immer näher zusammen. Während noch vor 30 Jahren weder die Kostenfrage noch ein Qualitätsmanagement eine Rolle spielten, ist inzwischen der Ressourcenverbrauch sogar zu einem Bestandteil der Ergebnisqualität geworden. Der Qualitätsbegriff wird in seinen Dimensionen Struktur-, Prozeß- und Ergebnisqualität beleuchtet. Hieraus abgeleitete Empfehlungen und Leitlinien für die ärztliche Versorgung sollen in Zukunft als Instrumente zur Kostensenkung eingesetzt werden. Diese können in Qualitätsmanagementsystemen münden, deren bekannteste Grundlage derzeit die DIN EN ISO 9000 f. darstellt. Die ISO 9001 sowie die Selbstbewertung nach EFQM haben sich europaweit als Prüfungsgrundlage für die Zertifizierung von Qualitätsmanagementsystemen in Organisationen durchgesetzt. Organisationen können ganze Kliniken oder einzelne Abteilungen wie die Anästhesie sein. Dabei werden in 20 Kapiteln der ISO 9001 organisatorische Verfahren beschrieben, die innerhalb der Organisation die Aufrechterhaltung eines bestimmten Qualitätsniveaus sicherstellen sollen. Im EFQM-Modell steht die Prozeßbeherrschung im Vordergrund, die zugrundegelegten Kriterien gliedern sich in Befähiger- und Ergebniskriterien. Der Nachweis der Kosteneffektivität von Qualitätskontroll- und -sicherungsmaßnahmen ist wichtig, denn ein Zuviel an Qualitätskontrolle und -sicherung läßt den Ressourcenverbrauch zusätzlich ansteigen. Dies führt bei einem gedeckelten Gesamtbudget zu einer Senkung der Versorgungsqualität.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050011
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  • 8
    Electronic Resource
    Electronic Resource
    Neue Airbag-assoziierte Verletzungsmuster nach Verkehrsunfällen (1996)
    Springer
    Der Anaesthesist 45 (1996), S. 359-362 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Airbag ; Verletzungsmuster ; Stumpfes Thoraxtrauma ; Latenzzeit ; Dezelerationstrauma ; Key words Airbag ; Pattern of injuries ; Blunt thorax trauma ; Latency ; Deceleration trauma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Experimental studies have shown that in traffic accidents with frontal impact the new airbag system can significantly reduce the incidence of severe injuries and fatal outcome. The question of whether the airbag itself induces specific patterns of injury needs further investigation. Two cases of traffic accidents with airbag protection are presented here. The first case report clearly shows the life-saving and injury-reducing effect of the airbag system in a traffic accident with frontal impact at 100 km/h. In the second case only minor injuries of the face were diagnosed initially. Hemodynamic instability occurred after 3 h of hospitalization due to rupture of the azygos vein. Analysis of the presented cases shows that, besides the well-known benefits, there are certain injury patterns that seem to be related to the use of airbags. These have not been described before. It is concluded that patients who were involved in traffic accidents with airbag deployment have to be hospitalized and followed up carefully over time, even though they are initially stable, as potentially fatal sequelae of deceleration trauma can occur later. In our opinion it is not possible to estimate the severity of airbag-associated injuries with conventional methods.
    Notes: Zusammenfassung Experimentelle Untersuchungen haben gezeigt, daß bei Verkehrsunfällen mit Frontalaufprall neue Rückhaltesysteme wie der Airbag das Auftreten vital bedrohlicher Verletzungen signifikant reduzieren. Ob der Airbag mit besonderen Verletzungsmustern in Verbindung gebracht werden kann, ist bislang noch nicht eindeutig belegt. Systematisch sind nach Aufarbeitung von Verkehrsunfällen mit Airbagbeteiligung, die Verletzungsmuster und der jeweilige klinische Verlauf von zwei Verkehrsunfällen mit Airbag untersucht worden. In einem Fall verhinderte das Aigbagsystem bei Frontalkollision bei einer Aufprallgeschwindigkeit von 100 km/h vital bedrohlich Verletzungen. In einem anderen Fall wurden zunächst nur geringgradige Gesichtsverletzungen nach dem Verkehrsunfall diagnostiziert; mit einer zeitlichen Verzögerung von 3 h trat hämodynamische Instabilität auf, die durch einen traumatischen Abriß der V. azygos bedingt war. Die Analyse der dargestellten Fälle zeigt neben den offensichtlichen Vorteilen des Airbagsystems Verletzungsmuster, die mit diesem Rückhaltesystem in Verbindung gebracht werden können. Das Airbag-assoziierte Verletzungsausmaß kann nach unseren dargestellten Ergebnissen nicht mit den üblichen klinischen Kriterien abgeschätzt werden. Es wird empfohlen, daß zunächst jeder Airbag-Verunfallte besonders aufmerksam untersucht und einer klinischen Überwachung zugeführt wird.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050272
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  • 9
    Electronic Resource
    Electronic Resource
    Anästhesie bei geriatrischen Patienten Die Bedeutung physiologischer Variablen für die kognitive Leistungsfähigkeit geriatrischer Patienten nach Regional- oder Allgemeinanästhesie (1999)
    Springer
    Der Anaesthesist 48 (1999), S. 379-386 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Geriatrische Patienten ; Anästhesie ; Kognitive Funktionen ; Physiologische Parameter ; Hüft-Totalendoprothese ; Key words Geriatric patients ; Anaesthesia ; Cognitive functions ; Physiological parameters ; Hip arthroplasty
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Objective: The aim of the present study was to show the influence of the parameters of gas exchange (arterial oxygen pressure paO2, arterial oxygen saturation SatO2) and haemodynamics (arterial systolic and mean blood pressure RRs and MAP) on the restitution of cognitive functions in geriatric patients scheduled for elective hip arthroplasty. Methods: A total of 30 patients (70 years, ASA II) were randomized to be operated either in regional anaesthesia (n=15) or general anaesthesia (n=15). PaO2 (by capillary blood gas analysis), RRs and MAP (by oscillometry) were measured 15 and 90 minutes after arrival in the recovery unit (t1 and t2), 24 and 72 hours postoperatively (t3 and t4), and cognitive functions were tested. Intraoperatively, throughout the day and the first night after surgery we measured satO2 by continous pulse oximetry. We recorded MAP and RRs by oscillometry every 3 minutes during the operation and every15 minutes for the rest of that day and night. Results: The parameters of gas exchange and haemodynamics did not differ among the groups. PaO2 was significantly reduced in both groups compared to baseline 24 hours postoperatively (t3) and remained low until 72 hours postoperatively (t4). Nearly all cognitive functions were significantly reduced in both groups compared to baseline 15 and 90 minutes after arrival in the recovery unit (t1 and t2), but recovered on the first postoperative day (t3). Both groups kept deficits in verbal memory and reading capacity up to the third postoperative day (t4). There was no correlation between the physiological parameters and the restitution of the tested cognitive functions. Conclusion: The restitution of cognitive functions during the first three postoperative days in geriatric patients scheduled for elective hip surgery does not depend on the anaesthetic technique. According to our results regional anaesthesia does not show any advantage for geriatric patients undergoing elective hip arthroplasty.
    Notes: Zusammenfassung Fragestellung: Ziel unserer Untersuchung war es, mögliche kognitive Funktionsdefizite geriatrischer Patienten nach Allgemein- und rückenmarknaher Regionalanästhesie mit Parametern des Gasaustauschs (Sauerstoffpartialdruck paO2, Sauerstoffsättigung SatO2) und der Hämodynamik (arterieller systolischer und mittlerer Blutdruck RRs und MAP) in Beziehung zu setzen. Methodik: 30 Patienten (70 Jahre, ASA II), die sich der elektiven Implantation einer Hüft-Totalendoprothese unterzogen, wurden randomisiert entweder in rückenmarknaher Regionalanästhesie (n=15) oder Allgemeinanästhesie (n=15) operiert. 15 bzw. 90 min nach Ankunft im Aufwachraum (AWR – t1 bzw. t2), 24 bzw. 72 h postoperativ (t3 bzw. t4) wurden der paO2 (kapilläre Blutgasanalyse), RRs und MAP (oszillometrische Messung) dokumentiert sowie die kognitive Leistungsfähigkeit testpsychologisch untersucht. Intraoperativ, während des Operationstags und der ersten Nacht wurden im AWR die SatO2 pulsoxymetrisch kontinuierlich aufgezeichnet, der MAP und RRs oszillometrisch intraoperativ alle 3 min, im AWR alle 15 min gemessen. Ergebnisse: Die Parameter des Gasaustauschs und der Hämodynamik unterschieden sich in beiden Gruppen nicht. Der paO2 war in beiden Gruppen 24 h postoperativ (t3) zum präoperativen Ausgangswert (t0) signifikant erniedrigt und blieb auch 72 h postoperativ (t4) deutlich unter der Baseline. Bei beiden Narkoseverfahren erwiesen sich 15 und 90 min nach Ankunft im AWR (t1 und t2) nahezu alle untersuchten kognitiven Funktionen gegenüber dem Ausgangswert als signifikant verschlechtert. Beide Gruppen blieben bis zum 3. postoperativen Tag (t4) in der mittelfristigen verbalen Merkfähigkeit und in der Lesegeschwindigkeit beeinträchtigt. Zwischen den physiologischen Parametern und der postoperativen kognitiven Leistungsfähigkeit bestand in beiden Gruppen keine Korrelation. Schlußfolgerung: Bei geriatrischen Patienten, die sich elektiven hüftgelenknahen orthopädischen Eingriffen unterziehen, erfolgt die Restitution kognitiver Funktionen in den ersten drei postoperativen Tagen unabhängig vom angewandten Anästhesieverfahren. Anhand unserer Daten bietet eine Regionalanästhesie bei hüftchirurgischen Eingriffen für geriatrische Patienten keine nachweisbaren Vorteile gegenüber der Allgemeinanästhesie.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050716
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  • 10
    Electronic Resource
    Electronic Resource
    Influence of B2 receptor antagonists on bradykinin-induced vasodilation and edema formation in isolated rabbit hindlimbs (1995)
    Springer
    Inflammation research 44 (1995), S. 212-216 
    Details
    ISSN: 1420-908X
    Keywords: Bradykinin ; BK2 receptor antagonists ; Rabbit hindlimbs preparation ; Edema formation ; Peripheral vasodilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In search of new possibilities to prevent acute inflammatory vascular reaction, we examined the effect of two selective B2 receptor antagonists, CP 0127 ([Bissuccimidohexane (L-Cys6)−1] and HOE 140 (D-Arg[Hyp3, Thi5, D-Tic7, Oic8]BK), on changes in perfusion pressure and on edema formation caused by bradykinin (BK) in the isolated perfused rabbit hindlimbs. CP 0127 and HOE 140 were added to the perfusion fluid 2 min prior to the first BK-administration (5 × 10−9 mol/l). A second BK-stimulation was performed after 30 minutes. The antagonists were tested in groups of 6 experiments each at concentrations of 10−6 mol/l, 5 × 10−9 mol/l and 10−10 mol/l. CP 0127 was also tested in a concentration of 10−8 mol/l. The application of BK resulted in an acute decrease of the mean arterial pressure and in a continual edema formation, reflected by an increase of organ weight (controls,n=6). Pretreatment with CP 0127 as well as with HOE 140 attenuated dose-dependently the BK-induced vasodilation (p 〈 0.005) and edema formation. The current results indicate that CP 0127 and HOE 140 are able to reduce BK-induced effects on vascular tone and edema formation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01782261
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