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  • 1
    Electronic Resource
    Electronic Resource
    ARDS und Wegener-Granulomatose (1997)
    Springer
    Der Anaesthesist 46 (1997), S. 969-973 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Wegener-Granulomatose ; Glomerulonephritis ; ARDS ; Extrakorporale Membranoxygenation ; ECMO ; Key words Wegener’s granulomatosis ; Glomerulonephritis ; Respiratory distress syndrom ; Adult ; Extracorporeal membrane oxygenation ; ECMO
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Wegener’s granulomatosis is a distinct clinicopathologic entity characterized by granulomatous vasculitis of the upper and lower respiratory tract and glomerulonephritis. This disease can present as a clinical picture which resembles sepsis and adult respiratory distress syndrome (ARDS). Wegener’s disease requires immunosuppression which can have detrimental consequences when used in sepsis. The following case report illustrates the diagnostic difficulties encountered by intensiv care physicians treating severe pulmonary failure and multiple organ dysfunction in Wegener’s granulomatosis appearing as ARDS with sepsis. Case report: A 19-year-old female patient had developed acute respiratory and renal failure after a prolonged period (many months) of antibiotic resistant otitis, sinusitis and mastoiditis. The patient had required intubation at another hospital and there was a history of tension pneumothorax and cardiopulmonary resuscitation during mechanical ventilation. Emergency extracorporeal membrane oxygenation (ECMO) for acute hypercapnic and hypoxic respiratory failure was instituted and the patient was transported to our institution while on ECMO. The patient was treated empirically for suspected pulmonary and systemic infection and received hydrocortisone (0,18 mg/kg/h) as part of a protocol-driven treatment of septic shock in addition to antibiotic and antimycotic regime. The use of ECMO was required for 10 and mechanical ventilation for another 50 days after admission. After successfull extubation, central nervous system dysfunction became evident with a somnolent and generally unresponsive patient. When the hydrocortisone dose was gradually tapered, the clinical status of the patient further deteriorated, pulmonary gas exchange worsened and she developed renal failure with proteinura and hematuria. A renal biopsy was performed demonstrating vasculitis and focal segmental glomerulonephritis, a systemic granulomatous vasculitis was suspected; the serum was tested for anti-proteinase 3 antibodies (PR3-ANCA) and turned out to be positive (17.5 U/ml; normal range 〈7 U/ml). The morphologic findings from renal biopsy, the positive test for antiproteinase 3 antibodies and the pulmonary-renal involvement with evidence of multisystem disease established the diagnosis of Wegener’s granulomatosis. Immunosuppressive therapy with cyclophosphamide and prednisolon was instituted resulting in rapid improvement with recovery of pulmonary, renal and central nervous system function within two weeks. The use of ECMO in this patient served as a life – saving immediate measure usefull to ”buy time” until a definite diagnosis could be established. ARDS represents an uniform pulmonary reaction to a large number of different noxious stimuli and disease entities. This case demonstrates that intensiv care physicians caring for critically ill patients with ARDS should include even rare causes of pulmonary injury into their differential diagnosis.
    Notes: Zusammenfassung Wir berichten über eine 19jährige Patientin, bei der unter dem typischen Bild eines schweren ARDS mit Multiorganversagen für insgesamt 10 Tage der Einsatz einer extrakorporalen Lungenersatztherapie (ECMO) erforderlich war. Therapieverlauf: Unter einer kalkulierten antibiotischen und antimykotischen Therapie sowie einer Behandlung mit Hydrocortison als adjuvanter Therapie bei septischem Schock besserte sich erst nach wochenlangem und kompliziertem klinischen Verlauf die Lungenfunktion soweit, daß eine Extubation möglich war. Die Patientin zeigte jedoch unverändert eine Mehrorgandysfunktion von Niere, Lunge und ZNS. In den folgenden Wochen nach Beendigung der Hydrocortisontherapie verschlechterten sich Nierenfunktion, pulmonaler Gasaustausch und Vigilanz wieder. Diagnostik: Der histologische Befund der Nierenbiopsie mit Arteriitis und Glomerulonephritis bei beidseitiger Vergrößerung der Nieren im CT und der Nachweis von Proteinase 3-ANCA im Serum ermöglichten letztlich bei Würdigung des gesamten klinischen Bildes und seiner genauen Vorgeschichte eine Diagnose: Wegener-Granulomatose. Durch immunsuppressive Therapie kam es innerhalb kurzer Zeit zu einer Remission mit vollständiger Erholung insbesondere der ZNS-Funktion. Schlußfolgerung: Dieser Fallbericht zeigt, daß im Einzelfall auch seltene Krankheitsbilder mit pulmonaler Beteiligung wie die Wegener-Granulomatose in die Differentialdiagnose des ARDS einbezogen werden müssen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050494
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  • 2
    Electronic Resource
    Electronic Resource
    COMMON STRATEGIES OF GERMAN PUBLIC FINANCIAL INSTITUTIONS IN THE SINGLE MARKET 1993 (1993)
    Oxford, UK : Blackwell Publishing Ltd
    Annals of public and cooperative economics 64 (1993), S. 0 
    Details
    ISSN: 1467-8292
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Economics
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1467-8292.1993.tb01388.x
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  • 3
    Electronic Resource
    Electronic Resource
    Effect of acute exposure to carbon bisulfide vapour upon some components of the hepatic-microsomal enzyme system in rats (1974)
    Springer
    Archives of toxicology 32 (1974), S. 233-240 
    Details
    ISSN: 1432-0738
    Keywords: Carbon Disulfide ; Microsomal Enzymes ; Microsomal Lipids ; Microsomal Protein ; Schwefelkohlenstoff ; Mikrosomenenzyme ; Mikrosomales Lipid ; Mikrosomales Protein
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Erwachsene weibliche Ratten wurden 8 Std lang abgestuften Schwefelkohlenstoff (CS2)-Konzentrationen zwischen 20 und 400 ppm exponiert. Danach war der Lipidgehalt der Mikrosomenfraktion in der Leber signifikant erhöht. Der Anstieg betraf die folgenden Lipidkomponenten: Phosphatidyläthanolamin, Phosphatidylcholin, Phosphatidylinosit, Phosphatidylserin, Sphingomyelin, Lysophosphatidylcholin, Cholesterin, Triglyceride, Diglyceride und freie Fettsäuren. Die Veränderungen waren nach der Exposition schnell und teilweise vollständig reversibel. Da der Gehalt an Cytochrom P-450 sowie die Aktivität der NADPH Cytochrom c-Reduktase in den Mikrosomen nach gleichen CS2-Expositionen normal blieben, wird angenommen, daß die Änderung im Lipidmuster des endoplasmatischen Retikulums für die durch gleiche inhalatorische CS2-Dosen verursachte Hemmung des mikrosomalen oxidativen Fremdstoffumsatzes ursächlich mitverantwortlich ist. Es wird vermutet, daß die Änderung des Lipidmusters eine Änderung der mikrosomalen Membranen bewirkt, wodurch der Elektronentransport gestört wird und eine Dysfunktion der Oxidationskette resultiert. 8-Std-Exponierungen in den genannten CS2-Konzentrationen waren außerdem gefolgt von einer leichten Vermehrung des mikrosomalen Proteins bei gleichzeitig erhöhtem RNS-Gehalt der Mikrosomen und gesteigertem Einbau von [2,4-3H]-L-Phenylalanin in die Mikrosomenfraktion. Diese Beobachtung wird als eine unspezifische stimulatorische Reaktion gewertet.
    Notes: Abstract Adult female rats were exposed for 8 h to graded carbon-disulfide (CS2) concentrations between 20 and 400 ppm. It was found that the lipid content of the hepatic microsomal fraction rose significantly due to an increase in phosphatidylethanolamine, phosphatidylcholine, phosphatidylinositol, phosphatidylserine, sphingomyeline, lysophosphatidylcholine, cholesterol, triglycerides, diglycerides, and free fatty acids. The alterations occurred quickly and were completely reversible after exposure. Since the microsomal cytochrome P-450 content, as well as the activity of the microsomal NADPH cytochrome c-reductase, remained within the normal range following identical CS2 exposures, it is assumed that the alteration in the lipid pattern of the endoplasmic reticulum is a causal factor in inhibition of the microsomal-oxidative drug metabolism, induced by identical inhalatory CS2 doses. It is suggested that the altered lipid pattern impairs the microsomal membranes, thus affecting electron transport and resulting in a dysfunction of the oxidation chain. A slight elevation of the microsomal total protein was observed in relation both to a rise of the microsomal RNA content and an enhanced incorporation of [2,4 -3H]-L-phenylalanine into the liver microsomes after identical CS2 exposures. It is considered that this finding might represent an unspecific stimulatory reaction.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00318438
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  • 4
    Electronic Resource
    Electronic Resource
    Neutron interferometer at NPI řež (1987)
    Springer
    Czechoslovak journal of physics 37 (1987), S. 993-996 
    Details
    ISSN: 1572-9486
    Source: Springer Online Journal Archives 1860-2000
    Topics: Physics
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01596996
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  • 5
    Electronic Resource
    Electronic Resource
    On the thermal decomposition of [Fe2NiO(CH3COO)6(H2O)3]·2H2O (1991)
    Springer
    Journal of thermal analysis and calorimetry 37 (1991), S. 993-1003 
    Details
    ISSN: 1572-8943
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Description / Table of Contents: Zusammenfassung HeteronukleareΜ-Oxoazetate der Zusammensetzung [Fe2NiO(CH3COO)6(H2O)3]·2H2O werden durch Erhitzen zersetzt, wobei Nickelferrite NiFe2O4 und — in AbhÄngigkeit von den Bedingungen der Zersetzung — mit einem Teil anderer fester Phasen gebildet wird. In der Zersetzungsreaktion werden auch H2O, CH3COOH, Azeton und CO2 gebildet. Es wird ein Reaktionsschema für die Zersetzung angegeben. Die Produkte sind poröse Pulver mit einem Korndurchmesser zwischen 3 und 10 m. Wird die Zersetzungstemperatur von 300 auf 800
    Notes: Abstract The heteronuclearΜ-oxoacetate with the composition [Fe2NiO(CH2COO)6(H2O)3]·2H2O decomposed on heating, forming nickel ferrite NiFe2O4 and (depending on the decomposition conditions) in part other solid phases. H2O, CH3COOH, acetone and CO2 were also formed in the decomposition. A reaction scheme is given for the decomposition. The products were porous powders with grain diameters between 3 and 10Μm. On increase of the temperature of decomposition from 300 to 800
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01932797
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