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  • 1
    Electronic Resource
    Electronic Resource
    Niedermolekulares Heparin (Fragmin®) in der Therapie der Sepsis mit Gerinnungsstörungen – vergleichende Untersuchung zweier Dosierungsschemata (1997)
    Springer
    Intensivmedizin und Notfallmedizin 34 (1997), S. 124-130 
    Details
    ISSN: 1435-1420
    Keywords: Key words Low moleculare weight heparin ; sepsis ; coagulation parameters ; Schlüsselwörter Niedermolekulares Heparin ; Septikämien ; Gerinnungsmarker
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung 30 Patienten einer internistischen Intensivstation mit dem Krankheitsbild einer Sepsis und einer beginnenden Verbrauchskoagulopathie wurden über 7 Tage mit dem niedermolekularen Heparin Fragmin behandelt: 15 Patienten erhielten nach randomisierter Gruppenzuteilung niedermolekulares Heparin in einer Dosis von 1,5–5 E pro Kilogramm Körpergewicht/h (Low dose-Gruppe). 15 Patienten der High dose-Gruppe wurden 8–15 E niedermolekularen Heparins pro Kilogramm Körpergewicht/h infundiert. Ein Vergleich der beiden Dosierungsschemata wurde anhand verschiedener Laborparameter durchgeführt, wobei besonders das Prothrombinfragment 1 + 2, das D-Dimer und der Thrombin-Antithrombin III-Komplex berücksichtigt wurden. Bei allen Patienten, die in die Studie aufgenommen wurden, zeigten die drei molekularen Marker bei Therapiebeginn eine Aktivierung des Gerinnung- und Fibrinolysesystems an. Keine Gruppenunterschiede waren zu erheben für die Indikatoren einer Entzündungsreaktion wie Temperatur, Leukozyten-Zahlen, CRP und Elastase. Auch hinsichtlich der (bei allen Patienten eingeschränkten) Nieren- oder Leberfunktion waren die beiden Gruppen gleich. In der High dose-Gruppe stellte sich ein schnellerer und stärkerer Konzentrationsabfall von primär erhöhtem Prothrombinfragment 1 + 2, D-Dimer und Thrombin-Antithrombin III ein. Blutungskomplikationen beobachteten wir in keinem Fall. Nach unseren Ergebnissen ist insbesondere die hochdosierte Therapie mit niedermolekularem Heparin geeignet, die im Rahmen einer Sepsis aktivierte Gerinnung zu inhibieren, ohne Blutungskomplikationen herbeizuführen.
    Notes: Summary Shock secondary to sepsis is a serious common disease with a substantial mortality. Coagulation abnormalities, ranging from a rapid fulminant state of disseminated intravascular coagulation (DIC) to a slight elevation in the level of fibrin(ogen) degradation products, are well recognized in patients with bacterial septicemia. Therefore, the inhibition of the activated coagulation is one of the first therapeutic steps. We investigated 30 intensive care patients with septic disease and comparable signs of abnomalities in coagulation at the beginning. Fifteen patients were treated with 1.5–5 E/kg body weight (Low dose group), the others received 8–15 E/kg (high dose group). Our study demonstrated a significant stronger and faster decline of coagulation parameters – such as d-dimer, TAT and PTF 1 + 2 – in the High dose group without any bleeding disorder. Thus, we support in cases of coagulation disease except fulminant ones the high dose therapy with LMWH as shown above.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003900050028
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  • 2
    Electronic Resource
    Electronic Resource
    Long-term metabolic effects in patients with urinary diversion (1998)
    Springer
    World journal of urology 16 (1998), S. 292-297 
    Details
    ISSN: 1433-8726
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The use of intestinal segments in genitourinary reconstruction could influence vitamin metabolism and affect the skeletal bone and its mineral content in the long term. In 137 patients, serum levels of the vitamins A, B1, B2, B6, B12, D, and E and of folic acid, bile acid, and ammonia as well as levels of intracorpuscular vitamin B12 and folic acid were examined and a red blood cell count was performed. The patients were divided into three groups (≤2 years, 〉2 to ≤4 years, and 〉4 years after surgery) as well as into children and adults. In addition, bone mineral density (dual-photon absorptiometry) was measured in 25 patients. Of these, 16 patients were ≈16.8 years s/p rectal reservoir, 6 were ≈20.5 years s/p colonic conduit, two were 6 and 8 years s/p ileocecal pouch, and one adolescent was 5 years s/p ileal bladder augmentation. In all patients the levels of vitamins A, B1, B2, B6, D, and E and of folic acid, bile acid, and ammonia as well as the red blood cell count were within normal ranges. In children (n= 51) there was no significant drop in vitamin B12 levels after the operation. In adults (n= 86), serum vitamin B12 levels dropped significantly from 402 ± 182 ng/l during the first 2 years after the operation to 292 ± 204 ng/l after the 4th year (normal range 240–1,100 ng/l). No significant increase in the intracorpuscular vitamin B12 level was observed during the same period. The bone mineral density was normal in all 25 patients with different types of urinary diversion. In addition to regular examination (sonography, creatinine levels, and base excess), vitamin B12 levels should be determined at 4 years after urinary diversion. It remains unclear whether substitution is necessary. However, substitution is easy to achieve and cheaper than the regular determination of vitamin B12. No decrease in bone mineral content was seen in the long-term follow-up with early correction of the base excess (below −2.5).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003450050069
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  • 3
    Electronic Resource
    Electronic Resource
    Stellenwert des Tumormarkers CA 19–9 in der Differentialdiagnose von Raumforderungen im Pankreaskopf (1996)
    Springer
    Der Chirurg 67 (1996), S. 1007-1011 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Pancreatic cancer ; CA 19 ; 9.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Bei 96 Patienten (duktales Pankreascarcinom, n = 34; periampulläres Carcinom, n = 43; chronische Pankreatitis, n = 19) wurde der Stellenwert des Tumormarkers CA 19–9 in der Differentialdiagnose bei Raumforderungen im Pankreaskopf retrospektiv überprüft. Die Sensitivität betrug für das duktale Carcinom 73,5 % und für den periampullären Tumor 48,8 % bei einer Spezifität von 63,2 %. Das carcinoembryonale Antigen war nur bei jedem 5. Patienten erhöht. Durch Kombination beider Tumormarker ließ sich die Sensitivität serologischer Tests nicht steigern. Die schlechte Spezifität von 63 %, die beim Vorliegen eines Verschlußikterus bis auf 33 % sinkt, erlaubt keine zuverlässige präoperative Differenzierung zwischen einem Carcinom und einer chronischen Pankreatitis. Ein postoperativ erhöhter CA-19–9-Serumspiegel weist auf persistierendes Tumorgewebe hin und ist mit einer statistisch signifikant schlechteren Prognose als bei normalen Marker verbunden.
    Abstract: Schlüsselwörter: Pankreascarcinom – CA 19–9.
    Notes: Summary. In 96 patients (ductal pancreatic carcinoma, n = 34; periampullary carcinoma, n = 43; chronic pancreatitis, n = 19) the role of CA 19–9 in the diagnosis of lesions of the head of the pancreas were evaluated. The sensitivity for ductal pancreatic carcinoma was 73.3 %, for periampullary carcinoma 48.8 %, and specificity was 63.2 %. Carcinoembryonic antigen was elevated only in every fifth patient. Even when combining the two tumor markers no increase in sensitivity could be observed. The low specificity of 63 %, which decreased to 33 % in the case of obstructive jaundice, does not allow adequate preoperative differentiation between cancer patients and those with chronic pancreatitis. In cases of postoperatively elevated CA 19–9 level the prognosis is worse than in patients with normal tumor markers.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00002512
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  • 4
    Electronic Resource
    Electronic Resource
    Biochemical bone markers compared with bone density measurement by dual energy X-ray absorptiometry (1995)
    Springer
    Calcified tissue international 57 (1995), S. 253-257 
    Details
    ISSN: 1432-0827
    Keywords: Bone density measurement ; Dual energy X-ray absorptiometry ; Collagen type I ; Biochemical bone markers ; b-quotient
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine , Physics
    Notes: Abstract In contrast to medical imaging, the biochemical markers allow a more frequent determination and are not as invasive as histomorphometric methods. We investigated biochemical markers of type I collagen compared with bone density measurements in 85 females between 41 and 89 years of age (median: 57 years). The bone density measurements were performed by dual-energy X-ray absorptiometry (DXA) on the lumbar spine (L1–4). The bone density measurements were stated as percentage of the norm. All patients were divided into three groups: I=〈80%; II=80–120%; III=〉120%. Based on this classification the median concentration of the I-carboxyterminal propeptide of type I procollagen in serum (S-PICP) as an anabolic marker of type I collagen increased significantly with rising bone density: I 65.0* μg/liter (interquartile range: 52.1–78.0 μg/liter); II 85.9* μg/liter (52.1–115.5 μg/liter); III 81.4 μg/liter (62.0–101.0 μg/liter); * P〈0.05. The concentration of urinary pyridinolines (U-PYR) as a marker for degradation of type I collagen decreased. The I-carboxyterminal telopeptide (S-ICTP) and osteocalcin (S-BGP) did not change. The multivariate regression analysis showed no relationship between bone density measurement and biochemical bone markers. Only the age significantly correlated negatively with bone density measurement. For a better assessment of type I collagen metabolism we created a “b-quotient” by dividing the sum of S-PICP and S-BGP by U-PYR. The median b-quotient increased significantly: I 1.55*+ (0.97–2.04); II 2.09* (1.57–2.86); III 2.46+ (1.58–3.22);*+ P〈0.05. Changes in bone metabolism cannot be identified by the determination of a single marker. However, the improved biochemical diagnostic measurement using the b-quotient may provide early information about the progression of a metabolic disorder within the interval of imaging.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00298879
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  • 5
    Electronic Resource
    Electronic Resource
    Collagen type I metabolism after bone surgery (1999)
    Springer
    Archives of orthopaedic and trauma surgery 119 (1999), S. 212-216 
    Details
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study follows the postoperative course of serum collagen type I metabolites in patients after uncomplicated implantation of a cemented total hip endoprothesis (TEP; n = 12, mean age: 69.3 years), a cemented hemiendoprothesis (HEP; n = 13, mean age 79.7 years), a dynamic condylar or hip screw (DCS/DHS; n = 12, mean age 75.1 years) and osteosynthetic treatment of a Weber B or C fracture (OS; n = 17, mean age 54.3 years). The course of the propeptide of human type I procollagen (PICP) as an anabolic marker as well as of I-carboxyterminal telopeptide (ICTP) as a catabolic marker of bone metabolism was characterized. Measurements were done preoperatively and weekly for 3 weeks after surgery. The concentrations of both markers increased and reached a maximum in the 2nd or 3rd week after surgery. However, the PICP values differed, depending on the kind of surgical intervention and the type of bone healing. Secondary fracture healing with formation of callus occurred in the DCS/DHS group, which developed the highest median PICP concentrations (initial 83 μ g/l, second week 337 μg/l; P 〈 0.001). In contrast, the primary bone healing in the OS group showed increasing ICTP but unchanged PICP concentrations. Patients in the cemented TEP and HEP groups as a kind of artificial bone healing had comparable concentrations. To consider the effective metabolism of collagen type I, the PICP/ICTP ratio was calculated. Although the median PICP and ICTP concentrations of the studied groups differed, the PICP/ICTP ratios were similar. In comparison to 54 young and healthy volunteers (median PICP/ICTP ratio: 37), the ratios of the studied groups were still normal but low (median ratios: 〈 20). This could be an effect of decreasing collagen type I metabolism with age. Although the results are in agreement with animal studies and histomorphometric investigations, the clinical use of PICP and ICTP determination as a tool for the detection of complicated bone healing is limited by the marked interindividual variability and the uncertain bone specificity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004020050393
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