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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 60 (1982), S. 1006-1009 
    ISSN: 1432-1440
    Keywords: Anaphylactoid reactions ; Anaphylaxis ; Anaesthetics ; Epidemiology ; Mechanisms ; Anaphylaktoide Reaktionen ; Anaphylaxie ; Anästhetika ; Epidemiologie ; Mechanismen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Hundert schwere Anästhesiezwischenfälle, die in den Jahren 1975–1980 an Krankenhäusern im Osten Frankreichs beobachtet wurden, sind in der immunologischen Einheit des Universitätskrankenhauses in Nancy untersucht worden. Die Tests wurden „a posteriori“ durchgeführt; mittlere Zeit: drei Wochen nach dem Zwischenfall (Spannweite: eine Woche bis ein Jahr). Eine zweite Serie von Tests wurde bei 35% der Patienten und eine dritte Serie bei 8% der Patineten durchgeführt. Mit Hilfe der Tests wurde zwischen Anaphylaxie und anaphylaktoiden Reaktionen differenziert. In Frage kommende Arzneimittel wurden durch intradermale Testung, durch Degranulierungstests an menschlichen Basophilen und P.K.-Tests bestimmt. An prädisponierenden Faktoren wurde untersucht: Atopie (IgE Dosis), Anstieg der Histaminfreisetzung (intradermaler Test mit 48/80), abnormale Aufnahmefähigkeit für Histamin (intradermales Histamin), Spasmophilie (elektromyographische Aufzeichnungen). Die Ergebnisse zeigten, daß 42 Zwischenfälle einer echten Anaphylaxie entsprachen (einer von ihnen IgG mediiert); 48% der untersuchten Zwischenfälle wurden durch Succinylcholin hervorgerufen. Einige der prädisponierenden Faktoren wurden im untersuchten Patientengut in höherer Inzidenz als in der gesamten französischen Bevölkerung gefunden; Atopie, Hypersensitivität auf Histamin, vorherige Arzneimittelallergie, Spasmophilie.
    Notes: Summary One hundred severe peranesthetic accidents occuring in hospitals in the eastern part of France were tested between 1975 and 1980 at the Immunological Unit of the University Hospital in Nancy. Tests were carried out “a posteriori”; mean time: three weeks after the accident (extremes: one week to one year). A second battery of tests was carried out in 35%, and a third one in 8% of the patients. Anaphylaxis was differentiated from anaphylactoid reactions be means of the tests. Responsible drugs were determined by intradermal testing, by the human basophil degranulation test and P.K. tests. Predisposing factors were studied: atopy (IgE dosage), increase of histamine release (intradermal testing with 48/80), abnormal receptivity to histamine (intradermal histamine), spasmophilia (electromyography recordings). The results show that 42 accidents were due to true anaphylaxis (one of them due to IgG); 48% of the reported accidents were due to succinylcholine. Some of the predisposing factors, in the tested population, are found in a higher proportion than in the French population as a whole; atopy, hypersensitivity to histamine, previous drug allergy, spasmophilia.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1238
    Keywords: Key words Trauma ; Hemorrhagic shock ; Cytokines ; Tumor necrosis factor-α ; Interleukin-6 ; Endotoxins ; Tonometry ; Intestinal mucosa
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: (a) To investigate the relationship between gut ischemia parameters (gastric intramucosal pH [pHi], mucosal–arterial carbon dioxide difference [PCO2-gap]), and endotoxin or cytokine release during hemorrhagic shock; (b) to compare the predictive value of pHi, PCO2-gap and arterial lactate concentrations. Design: Prospective study. Setting: Surgical intensive care unit of a university hospital. Patients: 20 multiple trauma patients with severe hemorrhagic shock. Interventions: Intramucosal measurements and blood samples were obtained on admission to the emergency room and repeatedly over 48 h. Measurements and results: Endotoxin was measured using a chromogenic limulus amoebocyte assay. Cytokine [tumor necrosis factor-α (TNFα) and interleukin-6 (IL-6)] values were evaluated by immunoradiometric assays. Only 3 patients had positive blood cultures but endotoxins were detected at least once in all patients. Endotoxin levels were similar in survivors and nonsurvivors over the study period and were not related to pHi or PCO2-gap. Initially, high levels of IL-6 were observed in both nonsurvivors and survivors [median 1778 pg/ml (range 435–44 540) vs 2068 pg/ml (range 996–92 300)]. IL-6 levels progressively decreased in the survivors but not significantly. On admission, TNFα concentrations were similar in nonsurvivors and survivors (42 ± 35 vs 46 ± 27 pg/ml). From the 24th h, TNFα values were higher in the nonsurvivors than in the survivors (24 h: 72 ± 38 vs 34 ± 17 pg/ml, p 〈 0.05). The greatest IL-6 levels were found for a pHi 〈 7.20 (28.5 ± 36.5 vs 1.8 ± 1.3 ng/ml, p 〈 0.05) or a PCO2-gap 〉 7.5 mmHg (1 kPa) (32.5 ± 37.5 vs 1.7 ± 1.3 ng/ml, p 〈 0.01). With the same pHi threshold, no difference was found in endotoxin levels. The lactate concentrations were predictive for outcome from the 12th h (9.5 ± 5.9 vs 3.6 ± 2.3 mmol/l, p 〈 0.05). Conclusions: During severe hemorrhagic shock, endotoxin translocation from the gut was a common phenomenon that seemed independent of both pHi values and outcome. It could not explain IL-6 and TNFα release. In severe hemorrhagic shock, neither pHi nor PCO2-gap provides additional information to the lactate measurements.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 38 (1983), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Adverse, anaphylactoid, reactions to the intravenous drugs and other substances used in anaesthesia and surgery pose a major problem in many countries. The scope of the problem is somewhat difficult to judge since agreement can rarely be reached as to what is, or as to what is not, an adverse reaction. While the death of a fit young patient undergoing minor investigative surgery is an obvious candidate for inclusion, many of the very minor incidents of urticaria, mild hypotension and mild bronchospasm are less easy to classify since they may arise from theatre techniques, from underlying pathology, known or unsuspected, as well as from complex psychosomatic and psychosocial stimuli. Minor manifestations may not hinder the immediate procedure, but their incorrect interpretation may lead to a disaster during a general anaesthetic procedure weeks, or even years, later.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Clinical & experimental allergy 23 (1993), S. 0 
    ISSN: 1365-2222
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Clinical & experimental allergy 11 (1981), S. 0 
    ISSN: 1365-2222
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The antigen non-specific release of histamine by synthetic neuromuscular blocking agents is well known, though our review of thirty-two cases reported in the literature of anaphylactoid reactions to succinylcholine, shows that there is insufficient evidence to determine whether the signs are due to anaphylactic or to anaphylactoid reactions.We have examined thirteen cases in whom evidence of anaphylactic sensitization was examined by direct skin tests (in eleven cases) Prausnitz-Küstner tests (in five), rabbit basophil degranulation, Shelley test (in twelve) and human basophil degranulation (in seven). These tests were done on two to four occasions, and the optimal period for the first test ascertained to be 6 to 12 weeks after the episode. All eleven patients examined by direct skin tests showed evidence of anaphylactic sensitivity, and in three of five cases the sensitivity could be transferred by the Prausnitz-Küstner procedure. In one of these P-K tests there was evidence of both IgE and of IgG S-TS antibodies (heat-stable antibody conferring sensitivity for 2 hr).Particular susceptibilities to adverse reactions to this drug appear to be prior drug allergy (in 50% of cases), several previous anaesthetics, and atopy.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 57 (2002), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Respiration Physiology 90 (1992), S. 261-269 
    ISSN: 0034-5687
    Keywords: Airways, resistance, O"2, CO"2 ; Bronchospasm ; Mammals, rabbit ; Mechanics of breathing ; Resistance, airways
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1398-9995
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1398-9995
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We have evaluated the in vitro leukocyte histamine release tests for the diagnosis of allergy to muscle relaxant drugs in 40 patients (Group A) and a control group of 44 subjects with negative leukocyte histamine release (Group B). Non-IgE dependent histamine release, expressed as a percentage of the total blood histamine, was 3.94%± 0.49 in Group B. The upper limit of positivity was estimated to be 5% (mean + 2 SD). Leukocyte histamine release tests were positive in 65 % of the patients from Group A. The concordance between LHR and QAS-RIA was 64%. The maximal histamine release was observed at dilutions of 10−2–10−4 in 20 of the 26 positive cases. The maximal histamine release was 43.8%± 23.3. The spontaneous histamine release was as low as 1.7%± 1.1. Cross-reactivity among the 5 different muscle relaxant drugs has been investigated and compared by intradermal testing. The muscle relaxant drugs which gave the lower skin reaction (M2) and the drug responsible for shock (M1) were selected for the study of in vitro leukocyte histamine release. Of 20 patients, 10 had, simultaneously, a positive test to Ml and a negative to M2. All of the 10 cases had negative ID tests with M2. Three of these patients subsequently underwent general anesthesia with the muscle relaxant chosen as harmless (M2) without any clinical reaction.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1398-9995
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Until now, immunoassays for detection of anti-muscle relaxant IgE in serum have been performed with the drug coupled to epoxy-activated Sepharose or to RAST papers dics. In the present work we have used a quaternary ammonium-Sepharose in which the quaternary ammonium reactive group (choline chloride) was directly coupled to Sepharose via an ether linkage. 50 μl of the quaternary ammonium solid phase (QAS) was incubated with 50 μl of serum for 3 h, washed, incubated 18 h with 125I-anti-IgE and washed again. The results were expressed as the percentage of 125I-anti-IgE adsorbed onto the solid phase. The results were at 1.30.5% for 20 control sera, with an upper normal limit estimated to 2.3%. The within-run reproducibility ranged from 3.2% to 10.0%. The results were significantly correlated with those obtained with either alcuroniumepoxy-Sepharose, choline-epoxy-Sepharose, the RAST-alcuronium or with the RAST-succinyl choline (respectively, r = 0.66, r = 0.80, r = 0.81, r = 0.40 and r = 0.85). The values obtained with the sera of 83 patients ranged from 0.3 to 38.5%. The sensitivity was estimated at 87.9%, 66.7% and 40.7% with the QAS-RIA, the RAST-succinyl choline and the RAST-alcuronium, respectively. The inhibition of adsorption of specific IgE onto the gel ranged from 13.0 to 90.6% in presence of 130 nmol of soluble muscle relaxants. In 83.3% of 30 cases, the highest inhibition was obtained with the muscle relaxant which was clinically incriminated. In conclusion, the reactive-solid phase which was used in the present work significantly increased the sensitivity of detection of anti-muscle relaxant IgE in serum.
    Type of Medium: Electronic Resource
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