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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 21 (1995), S. 235-237 
    ISSN: 1432-1238
    Keywords: Hypokalemia ; Potassium shift ; Catecholamine release ; Head trauma ; Beta-2-stimulation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A sudden decrease of serum potassium below 2.5 mmol/l carries the risk of dangerous arrhythmias and requires immediate replacement therapy [6]. We refer to a patient with a brain stem compression after head injury, who developed a profound hypokalemia (K+=1.2 mmol/l) with life-threatening arrhythmias, probably due to a catecholamine induced intracellular potassium shift (beta-2-stimulation). Only by aggressive potassium replacement up to 80 mmol/h (610 mmol/16h) could potassium levels be increased and cardiac arrhythmias terminated. Although replacement therapy was stopped when the serum K+-level increased to 2.4 mmol/l, 3.5 h later the patient became hyperkalemic (8.1 mmol/l). This was probably due to a secondary shift of potassium from intra-to extracellular space. In patients with severe head trauma and the potential risk of excessive catecholamine release special attention must be paid to changes in potassium balance.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 0942-0940
    Keywords: Neuroanaesthesia ; sitting position ; complications ; paradoxical air embolism monitoring ; transoesophageal echocardiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This prospective study investigates the frequency of patent foramen ovale (PFO), venous air embolism (VAE) and paradoxical air embolism (PAE) by transoesophageal echocardiography (TOE) in neurosurgical patients operated on in the sitting position. The risk of PAE after exclusion of PFO is assessed. A PFO was identified by pre-operative TOE and VAE and PAE by continuous intra-operative TOE. Sixty-two patients were divided into two groups, 22 patients were studied in group 1 (posterior fossa surgery) and group 2 (cervical surgery) contained 40 patients. Pre-operative TOE demonstrated a PFO in 5 of the 22 patients in group 1 (23%). Patients with proven PFO were excluded from the sitting position. Two further patients of this group (12% of 17 patients), in whom a PFO had been excluded pre-operatively, nevertheless had PAE, air occurring in all cavities of the heart. In group 2 the incidence of PFO was 4 out of 40 patients (10%). No PAE was observed in this group. Three morphological types of VAE with different haemodynamic and ventilation changes were demonstrated. VAE was observed in 76% of all posterior fossa operations and in 25% of cervical laminectomies. We conclude that a pre-operative search for PFO is mandatory considering its incidence of 23% in group 1 and of 10% in group 2, and the risk of PAE. If a PFO is detected, the sitting position should be avoided. A residual risk for PAE remains despite exclusion of PFO because the reliability of TOE is limited. TOE is the method of choice for detecting VAE and PAE.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-2013
    Keywords: Smooth muscle ; Creep ; Rheology ; Elasticity ; Osmotic pressure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 1. Experiments to investigate the creep phenomena of the taenia coli were performed in hypotonic (207 mosm) and hypertonic (447 or 463 mosm) media, in the relaxed (Ca2+-depletion+verapamil) as well as in the contracted (K2SO4-depolarized) state. They were compared with earlier results in isotonic media. The samples were standardized with respect to their volume (weight) before the beginning of the experiment. 2. Neither in the relaxed, nor in the contracted state was there a statistically significant difference in mean total length observed within each test series after loading with 9928 dyn for 2000 s (about 33 min) in the different osmotic media. We define total length as unloaded initial lengthl o+initial pure elastic extensionl E+creep N. 3. In the contracted state the mean total lengths attained by elastic extension and creep are significantly greater than in the relaxed state in both hypotonic and isotonic media. The greater variance in the data for hypertonic solutions makes any statistical decision of this kind impossible. 4. The typical time course of creep (N) and particularly the hyperbolic dependance of N anddN/dt stated in an earlier paper could also be observed here under varied osmotic conditions. 5. The results suggest that the viscosity of the cell plasma is not significant for the time course and extent of creep in smooth muscles of vertebrates. Creep probably takes place in the solid structures of the cells: most particularly the contractile proteins may be involved.
    Type of Medium: Electronic Resource
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