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  • 1
    Electronic Resource
    Electronic Resource
    Effects of inhibitors of enzymatic and cellular pH-regulating systems on central sympathetic chemosensitivity (1995)
    Springer
    Pflügers Archiv 430 (1995), S. 690-696 
    Details
    ISSN: 1432-2013
    Keywords: Isolated brainstem perfusion ; Acetazolamide ; 4,4′-Diisothiocyanatostilbene-2,2′-disulphonic acid ; Diethylpyrocarbonate ; Ethylisopropylamiloride ; CO2
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Previous studies in cats using isolated NaClCO2 perfusion of the lower brainstem demonstrated an intrinsic chemosensitivity of sympathoexcitatory bulbospinal neurones within the rostroventrolateral medulla (RVLM). In the present experiments, the effects of inhibitors of enzymatic and cellular systems, known to be involved in pH regulation, were investigated. Isolated perfusion of the lower brainstem with CO2-enriched solutions was performed and preganglionic sympathetic nerve activity (SNA) was recorded. Drugs were locally injected into the left RVLM with glass micropipettes. Perfusion of the RVLM with CO2enriched solutions over a period of 15 s induced a marked increase in SNA. The magnitude of absolute changes in SNA during perfusion depended on the level of basal SNA before perfusion. Microinjections of 4,4′-diisothiocyanatostilbene-2,2′-disulphonic acid (DIDS) and acetazolamide (ACZ) induced a marked rise in basal SNA, whereas diethylpyrocarbonate (DEPC) and ethylisopropylamiloride (EIPA) had no significant effect on basal SNA. After application of DIDS and DEPC, the peak change in SNA due to perfusion of the RVLM with CO2-enriched solutions was slightly diminished. Furthermore, neither ACZ nor EIPA produced any significant influence on the slope, peak change and time course of the increase in SNA compared with control perfusions. We conclude that the enzymatic and cellular carrier systems tested in this study are not or only slightly involved in central sympathetic chemosensitivity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00386163
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  • 2
    Electronic Resource
    Electronic Resource
    Inhaled nitric oxide for avoidance of extracorporeal membrane oxygenation in the treatment of severe persistent pulmonary hypertension of the newborn (1996)
    Springer
    Intensive care medicine 22 (1996), S. 71-76 
    Details
    ISSN: 1432-1238
    Keywords: Nitric oxide ; Persistent pulmonary hypertension ; Extracorporeal membrane oxygenation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Inhaled nitric oxide (NO) is thought to provide a noninvasive therapeutic alternative to extracorporeal membrane oxygenation (ECMO) in the treatment of persistent pulmonary hypertension of the newborn (PPHN). Objective Since January 1993, we have studied inhalation of NO in PPHN patients meeting the ECMO criteria of our institution. We focused on the questions of whether or not the need for ECMO could be obviated and whether differences could be found between NO responders and nonresponders. Design NO gas was delivered via conventional IPPV ventilation in incrementally increasing concentrations from 20 to 80 ppm. Patients NO therapy was attempted in ten ECMO candidates with clinical and echocardiographical evidence of PPHN (mean OI 51.9, SD 10.4). Results At various NO levels (30–60 ppm), five patients showed a significant increase in meanPaO2 (range 32.9–85.9 mmHg). Improvement was transient in three patients (6–10 h) and prolonged in two others (54–80 h); in the latter cases, ECMO was avoided. Five patients did not respond at all to treatment. Responders and nonresponders differed in their mean respiratory tidal volume (8.9 vs 4.18 ml/kg,P〈0.05). Conclusions In our study, inhalation of NO obviated the necessity of ECMO therapy in only two out of ten PPHN patients. Thus, we would discourage any overoptimistic expectations about the effectiveness of NO therapy in PPHN until larger clinical trials have been performed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01728335
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  • 3
    Electronic Resource
    Electronic Resource
    Empfehlungen zu Blutuntersuchungen und klinischer Überwachung zur Früherkennung des Valproat-assoziierten Leberversagens Ergebnisse einer Konsensus-Konferenz vom 9.5.–11.5. 1997 in Berlin (1998)
    Springer
    Der Nervenarzt 69 (1998), S. 835-840 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Valproat ; Leberversagen ; Laborparameter ; Carnitintherapie ; Kontraindikationen ; Key words Valproate ; Hepatic failure ; Laboratory tests ; Carnitin therapy ; Contraindications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Valproate is a frequently used antiepileptic drug. It is associated with rare but serious adverse effects like liver failure. The first symptom is impairment of the patient’s well being. Isolated changes of standard laboratory liver parameters are not reliable early indicators. Thus, according to the knowledge of today, prophylactic blood screening cannot predict complications. On the contrary, clinical symptoms are the most relevant indicators of impending complications, eventually supported by laboratory findings. An abrupt withdrawl of valproate and administering carnitin in parallel can interrupt the otherwise fatal course of the complication and induce a subsequent recovery. At a Consensus Conference the current knowledge about early detection and therapy of the valproate-induced serious hepatotoxicity was discussed. The results regarding recommended laboratory screening, as well as diagnostic and therapeutic strategies are reported.
    Notes: Zusammenfassung Valproat ist ein weitverbreitetes Antiepileptikum mit einem breiten Indikationsspektrum, bei dessen Anwendung seltene, aber schwere Nebenwirkungen wie das Valproat-assoziierte Leberversagen auftreten können. Erstes Symptom ist dabei eine Befindlichkeitsstörung des Patienten. Isolierte Veränderungen von Standardlaborparametern der Leber sind kein Frühindikator. Eine frühzeitige Diagnostik der Komplikation ist daher nach heutigem Wissensstand durch prophylaktische Laborkontrollen nicht möglich. Entscheidend ist die rechtzeitige Erkennung der beginnenden Komplikation auf der Basis klinischer Kriterien, u.U. bei gleichzeitig veränderten Laborparametern. Ein sofortiges Absetzen der Valproinsäure und die gleichzeitige Gabe von Carnitin kann zu einer Unterbrechung des sonst fatalen Ablaufs der Komplikation mit anschließender Erholung führen. Im Rahmen einer Konsensuskonferenz wurden der aktuelle Wissensstand über Früherkennung und Therapie der VPA-induzierten Hepatotoxizität diskutiert. Die Ergebnisse des Konsensus wurden mit dem Ziel einer Verbessung der Arzneimittelsicherheit in einer Empfehlung über Laborkontrollen, Frühdiagnostik und Therapie zusammengefaßt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050351
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  • 4
    Electronic Resource
    Electronic Resource
    Probleme der Wachstumshormonbehandlung bei kleinwüchsigen Kindern mit normaler Wachstumshormonsekretion (1997)
    Springer
    Monatsschrift Kinderheilkunde 145 (1997), S. 1194-1196 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Wachstumshormonmangel ; Wachstumshormontherapie ; Kleinwuchs ; Key words Growth hormone deficiency ; Growth hormone therapy ; Growth disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Since 1985, some studies have tested the efficiency of treatment with recombinant DNA-derived growth hormone (GH) in children without laboratory evidence of classic growth hormone deficiency. Until now, it remained uncertain whether or not GH-therapy can improve the final adult height in non-GH deficient children. Besides, some major concerns must be critically discussed in order to evaluate the indication of GH-therapy in these children with short stature for various reasons. These concerns include psychological and sociomedical aspects of unrestricted growth promoting therapy.
    Notes: Zusammenfassung In mehreren klinischen Studien und Behandlungsversuchen wurde und wird biosynthetisches Wachstumshormon (GH) auch bei Kindern eingesetzt, bei denen gemäß den aktuellen Definitionen (z.B. der Arbeitsgemeinschaft für Pädiatrische Endokrinologie) kein Wachstumshormonmangel vorliegt. Bislang ist nicht gesichert, daß die Endgröße solcher Patienten nach Abschluß des Wachstums durch die aufwendige GH-Therapie signifikant verbessert wird. Unabhängig davon sollen im folgenden Beitrag einige ernsthafte individualmedizinische (v.a. psychologische) und sozialmedizinische Probleme diskutiert werden, die zum restriktiven Umgang mit der Indikation einer Wachstumshormontherapie bei Kindern ohne GH-Mangel mahnen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050219
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