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  • 1
    Electronic Resource
    Electronic Resource
    Die Wirkung von Aprotinin Blutverlust und Gerinnungsparameter bei orthotoper Lebertransplantation: Eine klinisch-experimentelle, prospektive und randomisierte Doppelblindstudie (1997)
    Springer
    Der Anaesthesist 46 (1997), S. 294-302 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Lebertransplantation ; Aprotinin ; Transfusionsbedarf ; Gerinnungsparameter ; Key words Liver transplantation ; Aprotinin ; Transfusion requirements ; Coagulation parameters
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The effect of aprotinin (2000000 IU as a bolus +500000 JU/h until the end of the operation) on transfusion requirements and coagulation parameters in orthotopic liver transplantation (study group: n=9; placebo group: n=9) was investigated in a randomised, double-blind study. Coagulation parameters were monitored intraoperatively using a mobile laboratory. In contrast to the published results, no effect on transfusion requirements could be demonstrated. However, aprotinin showed a positive effect on some coagulation parameters in the reperfusion phase. The mechanism appeared to be inhibition of the contact activation of the intrinsic system with less thrombin generation in the study group.
    Notes: Zusammenfassung In einer randomisierten Doppelblindstudie wurde der Effekt von Aprotinin (2000000 KIE als Bolus+500000 KIE/h bis zum Ende der Operation, Verumgruppe n=9; Plazebogruppe n=9) auf Gerinnungsparameter und Transfusionsbedarf bei orthotoper Lebertransplantation untersucht. Alle Patienten wurden mit Hilfe eines fahrbaren Gerinnungslabors intraoperativ optimal überwacht. Im Gegensatz zu anderen Arbeitsgruppen fand sich unter diesen Bedingungen für den Transfusionsbedarf kein signifikanter Unterschied zwischen Verum- und Plazebogruppe. Dagegen beobachteten wir einen günstigen Effekt des Proteinaseninhibitors auf verschiedene Gerinnungsparameter, besonders in der Reperfusionsphase. Offensichtlich wird die Kontaktaktivierung des intrinsischen Gerinnungssystems, die durch geschädigte Gefäße des transplantierten Organs eingeleitet wird, durch Aprotinin gehemmt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050404
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  • 2
    Electronic Resource
    Electronic Resource
    The predictive value of four scoring systems in liver transplant recipients (1995)
    Springer
    Intensive care medicine 21 (1995), S. 32-37 
    Details
    ISSN: 1432-1238
    Keywords: Scoring systems ; Orthotopic liver transplantation ; Intensive care medicine ; Prognosis of outcome ; Apache II score ; MPM score ; SAPS score ; Hospital mortality
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To compare 4 general severity classification scoring systems concerning prognosis of outcome in 123 liver transplant recipients. The compared scoring systems were: the mortality prediction model (admission model and 24 h model); the simplified acute physiology score; the acute physiology and chronic health evaluation (Apache II) and the acute organ systems failre score. Design Retrospective, consecutive sample. Setting Adult intensive care unit in a university hospital. Patients 123 adult liver allograft recipients after admission to the intensive care unit. Measurements and main results The scoring systems were calculated as described by the authors to classify the severity of illness after admission of the allograft recipients to the intensive care unit. The mean and median values of survivors and the group of patients, that died during hospital stay were compared. Receiver-operating characteristics were plotted for all scoring systems and the areas under the curves of receiver-operating characteristics were calculated. The predictive value of the 4 scoring systems was tested using a variety of sensitivity analyses. The mortality prediction model (24 h model) was found to have a high significance (p〈0.001) in predicting mortality and showed the greatest area under the curve (0.829). Simplified acute physiology score (p〈0.001) and acute physiology and chronic health evaluation (Apache II) (p〈0.01) had a high significance as well, but did not hit the level of prognosis of mortality prediction model, as shown in the area under the curves. Accordingly, sensitivity was highest in MPM-24 h (83%), followed by SAPS (72%) and Apache II (71%). MPM-24h had a total misclassification rate of 22% (SAPS=32%, Apache II=33%). MPM-admission failed in predicting mortality (sensitivity=52%). Organ systems failure score seemed not to be useful in liver transplant recipients. Conclusion General disease classification systems, such as the mortality prediction model, simplified acute physiology score or acute physiology and chronic health evaluation are good mortality prediction models in patients after liver transplantation. We suggest that there is no need for improvement of a special scoring system.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02425151
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    Paper (German National Licenses)
    Fulltext
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