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  • 1
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Gesamteiweiß ; Albumin ; Hypoalbuminämie ; Intensivpatienten ; Key words Total protein ; Hypoalbuminaemia ; Critically ill patients
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract In clinical practice, the administration of supplementary albumin often depends on the measured plasma concentration of total protein (TPC). A TPC of less than 5 g/dl is generally accepted as an indication for albumin therapy, assuming an albumin concentration of less than 2.5 g/dl. However, a physiological relation between TPC and albumin cannot be expected in critically ill patients, and thus, measurement of TPC may be misleading as an indicator for the use of albumin. Therefore, we investigated the sensitivity and specificity of TPC testing for diagnosing hypoalbuminaemia requiring treatment. Methods. In this prospective study, 210 consecutive patients were included. Protein electrophoresis was performed three times a week; the second electrophoresis was selected for evaluation. Applied statistical analysis revealed the number of positive total protein tests indicating hypalbuminaemia requiring treatment (sensitivity) and the number of negative with tolerably reduced albumin concentrations (specificity). Results. Of the investigated patients, 27.6% had normal TPCs between 6.2 and 8.0 g/dl. In 81.9% of cases an albumin concentration below 3.5 g/dl was found, while 43 patients had a concentration below 2.5 g/dl. The sensitivity and specificity of TPC measurement for the diagnosis of clinically relevant hypoalbuminaemia (albumin concentration 〈2.5 g/dl) was calculated at different cutoff points for total protein. With a TPC of 6.0 g/dl, the sensitivity was 0.96 and the specificity 0.44. With a cutoff point of 5.0 g/dl, the sensitivity was reduced to 0.65 and specificity increased to 0.86. Finally, with a TPC of 4.0 g/dl sensitivity was 0.25 and specificity almost 1. Conclusions. Depending on the cutoff point for TPC, a relevant albumin requirement would frequently not be detected. In other cases, a need for albumin would be assumed from a reduced TPC even though the albumin concentration still exceeded 2.5 g/dl. Therefore, determination of TPC is not a suitable indicator of the need for albumin replacement. As a result, we suggest routine determination of albumin concentrations instead of TPC.
    Notes: Zusammenfassung In der klinischen Routine wird die Substitution von Humanalbumin häufig von der Gesamteiweißkonzentration abhängig gemacht, obwohl ein konstantes Verhältnis beider Variablen nicht immer zu erwarten ist. In der vorliegenden Untersuchung wurde die Sensitivität und Spezifität der Gesamteiweißbestimmung im Hinblick auf einen therapiebedürftigen Albuminmangel bei Intensivpatienten untersucht. Als Ergebnis zeigte sich, daß die Bestimmung der Gesamteiweißkonzentration mit erheblichen Fehleinschätzungen der Albuminkonzentration verbunden ist. Bei einer Interventionsschwelle von 5,00 g/dl Gesamteiweiß betrug die Sensitivität 0,64 und die Spezifität 0,86. Dagegen betrug bei einer Gesamteiweißkonzentration von 4,00 g/dl die Sensitivität nur noch 0,25, die Spezifität jedoch annähernd 1. Abhängig von der variablen Interventionsschwelle bezüglich der Gesamteiweißkonzentration wird einerseits ein relevanter Albuminbedarf häufig nicht erkannt. Andererseits kann in einigen Fällen eine unnötige Substitution erfolgen. Daher ist der Gesmteiweißtest zur Indikationsstellung der Albuminsubstitution nicht geeignet. Die direkte Bestimmung der Albuminkonzentration ist kostengünstig und routinemäßig durchführbar und sollte im Sinne einer rationalen Diagnostik und Therapie den Gesamteiweißtest ersetzen.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1440
    Keywords: Haemoperfusion ; Carbromal ; Diazepam ; Phenobarbital ; Hämoperfusion ; Carbromal ; Diazepam ; Phenobarbital
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In der vorliegenden Arbeit werden die Adsorptionseigenschaften von 6 verschiedenen Materialien, die bei der Hämoperfusion eingesetzt werden in vitro geprüft: Amberlite XAD-2 und XAD-4, Haemocol, Collodium verkapselte Aktivkohle, Collodium verkapselte und Albumin beschichtete Aktivkohle und Aktivkohle-Hohlfaser. Carbromal wird am schnellsten eliminiert von Amberlite XAD-2 und XAD-4, ebenso Diazepam. Beim Vergleich der verschiedenen Kohlepräparate werden Carbromal und Diazepam am schnellsten von Haemocol aus der Lösung entfernt, Phenobarbital von Aktivkohle-Hohlfaser, wenn man eine 5-stündige Perfusion zu Grunde legt. Die gerinnungsphysiologischen und klinisch-chemischen Untersuchungen mit Hilfe von heparinisiertem Frischblut lassen schwerwiegende Nebenwirkungen erkennen. Die Abnahme der Thrombozyten ist am ausgeprägtesten bei Amberlite XAD-2 und XAD-4, sie ist aber auch bei den Kohlepräparationen nachweisbar: Nach 5stündiger Hämoperfusion ist ihre Zahl auf bis zu 10% des Ausgangswertes abgefallen. Die Hämolyse ist besonders stark bei Amberlite XAD-2 und XAD-4, sowie Haemocol. Die je nach Giftstoff unterschiedlich große Adsorption der geprüften Materialien und ihre verschieden stark ausgeprägten Nebenwirkungen erfordern nach unseren Ergebnissen einen der individuellen Situation des Patienten angepaßten Einsatz.
    Notes: Summary The properties of six adsorbents for Haemoperfusion were investigated in vitro: Amberlite XAD-2; Amberlite XAD-4; Haemocol; collodion coated charcoal; albumine-collodion encapsulated charcoal and activated carbon fibers. Carbromal and diazepam are most quickly removed from aqueous solutions by Amberlite XAD-2 and XAD-4. Of the charcoal containing materials, Haemocol eliminates most rapidly carbromal and diazepam; while activated carbon fibers remove phenobarbital faster. When heparinized blood is perfused, a remarkable reduction in platelet count is observed. The drop is most pronounced with Amberlite XAD-2 and XAD-4, but even when using charcoal preparations the platelet depletion can reach 10% of the original number over 5 hours. Haemolysis is most pronounced with Amberlite XAD-2, XAD-4 and Haemocol. As the efficiency of the adsorbents towards the various drugs differ and as their adverse effects also vary, the decision for a particular material will have to be made according to the individual case.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1076
    Keywords: Liver transplantation ; Liver function tests ; Prognostic tests
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The pre-operative risk of paediatric liver transplantation candidates (n=41) was assessed in a prospective study by means of clinical symptoms, conventional static and liver blood flow dependent dynamic liver function tests. Nine patients died during the 365-day waiting period. The data were subjected as covariates to a survival analysis in the Cox proportional hazards model. There was a significant relationsship between the results of mono-ethylglycinexylidide (MEGX) formation and ICG test and the 365-day survival rate. In the stepwise analysis, none of the remaining parameters improved the predictive ability when added to the dynamic liver function test results. The assessment of post-transplantation liver function was studied in 27 patients during the first 28 postoperative-day period. In addition, liver function was studied in a cross-sectional study 1–7 years after successful liver transplantation in children with complete or partial rehabilitation. In the early postoperative period severe organ damage was indicated by both static and dynamic liver function tests. In the later course after transplantation no deterioration of liver function measured with MEGX formation was to be observed. These findings demonstrate the usefulness of dynamic liver function tests in the pre- and post-transplant assessment of liver function.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1041
    Keywords: enprofylline ; theophylline ; bronchial reactivity ; histamine inhalation test ; healthy volunteers ; pharmacokinetics ; bronchodilatation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary In a double blind, placebo controlled, crossover study the pharmacokinetics and acute effects of enprofylline and theophylline on airway reactivity during histamine challenge were investigated in 10 healthy volunteers. The pharmacokinetic parameters of enprofylline were (mean): elimination half-life 1.9 h, total body clearance 191.1 ml · kg−1 · h−1, volume of distribution 0.48 l · kg−1, and protein binding 49%. Bronchial reactivity in the histamine inhalation test was expressed as the concentration causing a 20% fall in FEV1.0 (PC20). Mean PC20 values were lowest after placebo and highest after theophylline with the enprofylline values in between. Only the difference in PC20 Safter placebo and theophylline was statistically significant (p〈0.05). At the time of determination of the PC20, the serum concentration of enprofylline was between 16.5 and 11.8 µmol/l, and that of theophylline was between 78.3 and 61.1 µmol/l. Adverse actions of enprofylline were nausea (3/10) and cardiovascular reactions (2/10), whereas theophylline mainly caused restlessness (3/10) and tremor (2/10). Thus enprofylline, in one-fifth of the serum concentration of theophylline cannot be regarded as equipotent in terms of bronchoprotection.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    European journal of clinical pharmacology 26 (1984), S. 491-498 
    ISSN: 1432-1041
    Keywords: theophylline ; computer simulation ; pharmacokinetics ; single-point dose prediction ; nomogram
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary A dosage prediction method to estimate theophylline clearance and dose requirement was evaluated in 22 outpatients with partly reversible obstructive airways disease. The steady state theophylline dose required to achieve a target concentration (Css) was predicted using a single serum theophylline determination 8 h after a single oral test dose. In 17 nonsmoking patients a mean absolute deviation of 8.2% (range 0.0–21.7%) between predicted and observed Css was found, and in 5 smoking patients the mean deviation was 34.0% (range 2.2–53.8%). In 17 healthy smokers the single-point method was found to predict theophylline clearance at a sampling time of 8 h with a prediction error of 11.3 (range 0.8–25.3%) compared to the clearance determination using the area under the curve. In addition, a numerical simulation program to assess the influence of absorption, elimination and sampling time on predictive accuracy showed that the method could be successfully applied to a patient population with elimination rate constants between 0.07 1/h and 0.25 1/h, allowing a mean prediction error of 15%.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Analytica Chimica Acta 221 (1989), S. 374 
    ISSN: 0003-2670
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Chemistry and Pharmacology
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Journal of cancer research and clinical oncology 119 (1993), S. 249-252 
    ISSN: 1432-1335
    Keywords: Breast cancer ; c-erbB-2 oncogene ; ICA ; p185 fragment ; Serum determination
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Concentrations of a fragment of the c-erbB-2 translational product (p185 fragment) were measured in serum of 70 breast cancer patients, 19 healthy blood donors, and 18 pregnant women using a heterogenic enzyme immunoassay. The serum concentrations of blood donors and pregnant women were below 30 kU/l. Breast cancer patients showed serum concentrations up to 578 kU/l. All 9/70 patients with serum concentrations higher than 30 kU/l had clinical evidence of metastatic disease and the serum levels of all 35/70 patients without metastasis lay within the normal range. From 9/37 patients with p185 overexpression of the primary tumor in immunohistochemical analysis 3/9 patients with metastatic disease had elevated serum levels higher than 30 kU/l. In all, 6/9 patients without metastasis serum levels were below 30 kU/l. The data of the present study suggest that determination of serum p185 fragment concentrations may be useful as a diagnostic tool in postoperative follow-up of breast cancer patients with c-erbB-2 overexpression of the primary tumor.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-2277
    Keywords: Liver transplantation ; graft prognosis test — Prognosis ; liver transplantation ; ketone body ratio — Arterial ketone body ratio ; prognosis liver graft
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To evaluate the ability of arterial ketone body ratio (AKBR; acetoacetate/3-hydroxybutyrate) to predict graft prognosis after liver transplantation, the diagnostic value as a predictive index was compared between AKBR and conventional liver function tests using receiver operating characteristic (ROC) analysis. The ROC curves were determined for AKBR, GOT, GPT, total bilirubin, serum lactate level, and prothrombin time, all of which were measured on the 1st and 2nd postoperative days in 88 cases of liver transplantation. Comparisons of the areas under the ROC curves between AKBR and other tests revealed the significant superiority of AKBR to other tests in predicting graft death within 1 month after transplantation. The present study suggests that AKBR can be used as an accurate index to predict graft prognosis after liver transplantation.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1432-2277
    Keywords: Liver graft viability ; Ketone body ratio, in brain-dead patients
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Hepatic energy metabolism was assessed by measuring the blood ketone body ratio (KBR), that is, the ratio of acetoacetate to β-hydroxybutyrate in the arterial blood, in 31 brain-dead patients in an intensive care unit (ICU) in Japan and in 25 donors just before procurement of the liver for transplantation in Germany. In the study in Japan, 7 of the 12 brain-dead patients treated with highdose catecholamine showed significantly decreased KBRs, revealing the detrimental effect of catecholamine on livermmetabolism. In contrast, 8 of the 9 untreated patients with blood pressure below 80 mm Hg showed almost normal KBRs. In the 25 donors in Germany, KBR was maintained within the normal range. Based upon conventional criteria, 21 livers were selected for use and the other 4 were discarded. Nineteen of the grafts were able to normalize KBR within 24 h after reperfusion, while 2 failed to function and required a second transplantation. It was suggested that a KBR in the normal range in donors is a prerequisite to immediate recovery of metabolic function of the liver graft after transplantation, and that hypotensive donors as a potential source of liver grafts may warrant further study.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1432-2277
    Keywords: Liver preservation, UW solution ; Mitochondrial function, in liver preservation ; Preservation, liver UW solution ; Ketone body ratio, liver
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Changes in arterial blood ketone body ratio (KBR) were investigated in 47 human liver transplantations. Of the 20 grafts preserved with University of Wisconsin (UW) solution, 10 had a cold preservation period of less than 10 h (UWS group) and 10 of more than 10 h (UWL group). In 27 other cases, grafts were preserved with EuroCollins (EC) solution for less than 10 h (EC group). In the EC group, KBR increased over 0.7 within 6 h after reperfusion of the graft in 17 cases (63%) and within 24 h in 7 cases (26%). In the 3 other cases, KBR failed to recover, and these patients underwent retransplantation. In the UW group, KBR recovered within 6 h in 13 cases (65%) and within 24 h in 7 cases (35%). There were no significant differences between the UWS and UWL groups. It is shown that the mitochondrial function of liver grafts preserved with UW solution can be well maintained even after extended preservation periods of more than 10 h.
    Type of Medium: Electronic Resource
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