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  • 1
    ISSN: 1420-908X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The hypothesis of a causal relationship between a progressive and unrestrained increase of tissue histamine formation by activation of an inducible histidine decarboxylase (HDC) and lethality in endotoxic shock (Schayer's ‘induced histamine concept’) was tested in a standardized rat endotoxic shock model. Initial enzyme identification studies in the rat shock liver (8 hrs after endotoxin challenge) clearly demonstrate that the ‘induced’ histidine decarboxylase is an acid (specific) HDC. The succeeding randomized, controlled study with appropriate inhibitors of the enzyme, α-methyl-histidine (competitive inhibitor) and α-fluoromethyl-histidine (irreversible inhibitor) using doses of 2, 20 or 100 mg/kg showedno significant effect on the survival rate of rats in endotoxin shock. The survival rate of the non-treated endotoxin control group (NaCl) was 25%; all methylprednisolone treated rats (50 mg/kg) survived. Thus, the ‘induced’ histamine isnot a predominant factor (necessary or sufficient determinant) for the lethal outcome in rat endotoxic shock. The protective effect of MP isnot predominantly due to the inhibition of the ‘induced’ histidine decarboxylase. The use of HDC-inhibitors as the appropriate instruments for evaluation of the significance of this mechanism is discussed.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1435-2451
    Keywords: Hip alloarthroplasty ; Infection ; Exchange operation ; Alloarthroplastik der Hüfte ; Infekt ; Austauschoperation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In einer retrospektiven Untersuchung wurden 207 Patienten (121 Frauen, 86 Männer, Durchschn. Alter 69,2 Jahre) mit infiziertem alloarthroplastischem Hüftgelenksersatz hinsichtlich therapeutischem Erfolg sowie funktioneller Spätergebnisse analysiert. Die Beurteilung der Hüftfunktion —ausgenommen Patienten mit Girdlestonehüfte — ergab überwiegend gute und zufriedenstellende Resultate ohne wesentliche Differenz zwischen den einzelnen Operationsverfahren. Während die einzeitige Austauschoperation eine hohe Reinfektionsrate (33%) zeigte, konnte diese beim zweizeitigen Vorgehen auf 10% reduziert werden. Der verzögerte zweizeitige Prothesenwechsel war jedoch mit einer hohen Krankenhausmortalität (lange Immobilisation) behaftet, so dass unser bevorzugtes Vorgehen der zweizeitige Prothesenwechsel mit frühzeitiger Reimplantation (〈4 Wochen nach Prothesenentfernung) darstellt.
    Notes: Summary In a retrospective study in 207 patients (121 females, 86 males; average age 69.2 years) with infected alloarthroplastic hip replacements, therapeutic success as well as functional long-term results were analyzed. In a majority of cases — except for those patients with Girdlestone operations — satisfactory or even good hip function was found regardless of the operative technique. While one-stage operations led to a reoccurrence of infection in 33% of cases, this could be reduced to 10% by use of the two-stage technique. Delayed two-stage exchanges, on the other hand, led to high hospital mortality (extended immobilization!). Thus, our procedure of choice is the two-stage exchange operation with early (i.e., less than 4 weeks after removal of infected material) reimplantation.
    Type of Medium: Electronic Resource
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