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  • 1
    ISSN: 1432-055X
    Keywords: Schlüsselwörter TIVA ; Propofol/Remifentanil ; Balancierte Anästhesie ; Sevofluran/Fentanyl ; Laparoskopie ; Gynäkologie ; Key words TIVA ; Propofol/Remifentanil ; Balanced anaesthesia ; Sevoflurane/Fentanyl ; Laparoskopy ; Gynaecology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Objective: This study was designed to investigate the differences between TIVA with propofol/remifentanil (P/R) and balanced anaesthesia with sevoflurane/fentanyl (S/F) in gynaecological laparoscopic surgery. Emphasis was put on haemodynamic reaction, recovery profile, postoperative side effects and patient satisfaction. Methods: Sixty patients were randomly assigned to receive either total intravenous anaesthesia with propofol/remifentanil or anaesthesia with sevoflurane/fentanyl. After premedication (midazolam) and induction of anesthesia (propofol, atracurium) in both groups, either 1 µg/kg fentanyl (S/F) or 1 µg/kg remifentanil (P/R) was injected. Anaesthesia was maintained with 0.5 µg/kg/min remifentanil (reduced to 50% after 5 min) and 0.06 µg/kg/min propofol (P/R) or 1.7 vol % sevoflurane (S/F). Both groups were mechanically ventilated with 30% oxygen in air. The administration of sevoflurane and the infusion of the anaesthetics were adjusted to maintain a surgical depth of anaesthesia. For postoperative analgesia 1 g paracetamol was administered rectally prior to surgery. After recovery 20 mg/kg metamizol was given intravenously. At the end of surgery the anaesthetics were discontinued and haemodynamics, early emergence from anaesthesia, pain level, frequency of analgesic demand, incidence of PONV, shivering and patient satisfaction were assessed. Parameters were recorded for 24 h postoperatively. Results: Recovery time after propofol-remifentanil anaesthesia was significantly shorter than after administration of sevoflurane and fentanyl (spontaneous ventilation 4.1 vs. 6.3 min, extubation 4.3 vs. 9.3 min, eye opening 4.4 vs 8.2 min, stating name 5.3 vs. 13.2 min, stating date of birth 5.4 vs. 13.3 min). There were no significant differences between the groups in shivering, pain score, analgesic demand and PONV. The S/F group responded to tracheal intubation with significantly higher blood pressure than the P/R group. During maintenance of anaesthesia heart rate in patients with S/F was significantly higher (P/R: HR max +16/–10; S/F: HR max +24/–0.). Measured on a scale from very satisfied to very dissatisfied, 73% of the patients in the P/R group were ”very satisfied” (S/F 23%) and 23% were ”satisfied” (S/F 62%). Conclusion: Compared with patients given balanced anaesthesia with sevoflurane and fentanyl, TIVA with propofol and remifentanil proved to be particularly suited for gynaecological laparoscopic surgery. Its major advantages are haemodynamic stability, significantly shorter times of emergence, and the exceptional acceptance by the patients.
    Notes: Zusammenfassung Fragestellung: Unterscheidet sich eine TIVA mit Remifentanil/Propofol (P/R) von einer balancierten Anästhesie mit Sevofluran/Fentanyl (S/F) hinsichtlich der Hämodynamik, des Aufwachverhaltens, postoperativer Nebenwirkungen und der Patientenzufriedenheit? Methodik: 60 Patientinnen wurden randomisiert einer Anästhesie mit (P/R) oder (S/F) zugeteilt. Nach oraler Prämedikation mit Midazolam wurde die Narkose mit Propofol eingeleitet, die Relaxierung erfolgte mit Atracurium. Gemäß randomisierter Gruppenzuteilung wurde 1 µg/kg Fentanyl oder 1 µg/kg Remifentanil i.v. injiziert und die Narkose bis zum OP-Ende entweder mit 0,5 µg/kg/h Remifentanil (Reduktion auf 50% nach 5 min) und mit 0,06 mg/kg/min Propofol oder mit 1,7 Vol.-% Sevofluran aufrechterhalten. Beide Gruppen wurden mit 30% O2 in Luft beatmet. Die Dosierung von Sevofluran, Propofol und Remifentanil wurden bei Bedarf der jeweiligen Intensität chirurgischer Stimuli angepaßt. Zur postoperativen Analgesie erhielten alle Patientinnen zu OP-Beginn 1 g Paracetamol rektal, nach Erwachen Metamizol 20 mg/kg i.v.. Bei OP-Ende wurde die Anästhetikazufuhr unterbrochen und folgende Parameter erfaßt: mittlerer arterieller Blutdruck, Herzfrequenz, Aufwachverhalten, Schmerzintensität, Analgetikabedarf, PONV, Muskelzittern und die Patientenzufriedenheit mit dem Anästhesieverfahren. Der Beobachtungszeitraum betrug 24 h. Ergebnisse: Die Patientinnen waren nach einer P/R Narkose signifikant eher wach und orientiert als nach einer Anästhesie mit S/F (Spontanatmung 4,1 vs. 6,3 min, Extubation 4,3 vs. 9,3 min, Augenöffnen 4,4 vs. 8,2 min, Namen nennen 5,3 vs. 13,2 min, Geburtsdatum 5,4 vs. 13,3 min). Die Inzidenz von PONV (43% vs. 43%) und Muskelzittern (56% vs. 37%) sowie die Schmerzintensität und die Anzahl der Schmerzmittelanforderungen (67 vs. 52) waren in beiden Gruppen vergleichbar. Der MAP war in der S/F-Gruppe nach der Intubation signifikant höher, die HF im gesamten Verlauf signifikant höher als in der P/R Gruppe (P/R: HF max. +16/–10; S/F: HF max. +24/–0). Auf einer Skala von „sehr zufrieden–sehr unzufrieden” waren 73% (P/R) der Patientinnen mit dem Anästhesieverfahren „sehr zufrieden” (S/F 23%), 23% „zufrieden” (S/F 62%). Schlußfolgerung: Verglichen mit einer balancierten Anästhesie mit Sevofluran und Fentanyl erwies sich die TIVA mit Remifentanil und Propofol als besonders vorteilhaft für laparoskopische Operationen in der Gynäkologie. Wesentliche Vorteile waren signifikant schnellere Aufwachzeiten, die hämodynamische Stabilität und die große Akzeptanz des Anästhesieverfahrens durch die Patientinnen.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    The journal of membrane biology 145 (1995), S. 233-244 
    ISSN: 1432-1424
    Keywords: Ca2+ current ; Arachidonic acid ; Myristic acid ; Tetradecyltrimethylammonium ; Sphingosine ; Neuroblastoma x glioma hybrid cells
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Chemistry and Pharmacology
    Notes: Abstract Low-voltage-activated (1-v-a) and high-voltage-activated (h-v-a) Ca2+ currents I Ca were recorded in whole-cell voltage clamped NG108-15 neuroblastoma x glioma hybrid cells. We studied the effects of arachidonic acid (AA), oleic acid, myristic acid and of the positively charged compounds tetradecyltrimethyl-ammonium (C14TMA) and sphingosine. At pulse potentials 〉−20 mV, AA (25-100 μm) decreased 1-v-a and h-v-a I Ca equally. The decrease developed slowly and became continually stronger with increasing time of application. It was accompanied by a small negative shift and a slight flattening of the activation and inactivation curves of the 1-v-a I Ca. The shift of the activation curve manifested itself in a small increase of 1-v-a I Ca at pulse potentials 〈−30 mV. The effects were only partly reversible. The AA effect was not prevented by 50 μm 5, 8, 11, 14-eicosatetraynoic acid, an inhibitor of the AA metabolism, and not mimicked by 0.1–1 μm phorbol 12, 13-dibutyrate, an activator of protein kinase C. Probably, AA directly affects the channel protein or its lipid environment. Oleic and myristic acid acted similarly to AA but were much less effective. The positively charged compounds C14TMA and sphingosine had a different effect: They shifted the activation curve of 1-v-a I Ca in the positive direction and suppressed 1-v-a more than h-v-a I Ca; their effect reached a steady-state within 5–10 min and was readily reversible. C14TMA blocked 1-v-a I Ca with an IC50 of 4.2 μm while sphingosine was less potent.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1076
    Keywords: Key wordsHaemophilus influenzae type b ; Acellular pertussis ; Vaccination ; PRP-tetanus ; Diphtheria
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract With an increasing number of new vaccines available for routine childhood immunization, combination vaccines are needed in order to maintain or achieve a high compliance with recommended immunization programmes. In a prospective, randomized, comparative, multi-centre study, 822 healthy infants were enrolled to receive three doses of either a candidate or a commercially available Haemophilus influenzae type b (Hib) vaccine concomitantly with diphtheria-, tetanus- acellular pertussis (DTaP) vaccine. Study subjects were randomly allocated to one of the following groups: (1) separate, or (2) mixed injection of DTaP and candidate Hib vaccine, or (3) separate injection of DTaP and commercial Hib vaccine. One year later the first 189 study subjects received either separate or mixed injections of the same Hib and DTaP vaccines as booster doses. Evaluation of reactogenicity was based on diary cards completed by parents. Immunogenicity was documented by measuring IgG antibody concentrations in serum samples taken before and 4 weeks after primary and booster vaccination. No serious adverse events occurred and most local and systemic reactions were mild to moderate. Booster doses were more reactogenic than primary doses with all groups. Antibody concentrations against pertussis antigens were similar to those seen with DTaP alone. All but one subject had protective antibody concentrations against diphtheria and tetanus. Primary immune response to the Hib vaccine was significantly lower in the group receiving the mixed Hib-DTaP vaccine, however, ≥95% of vaccinees had anti-Hib antibody concentrations ≥0.15 μg/ml and there was a marked booster response (〉100-fold) in all groups. Conclusions Mixing DTaP and Hib vaccines for primary immunization caused a decrease in anti-Hib antibody response, although after primary immunization as after booster doses, all subjects showed antibody concentrations considered to be protective for invasive Hib disease. Mixing of the vaccines did not result in increased reactogenicity.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1076
    Keywords: Key words pertussis ; attack rate ; household ; adult ; erythromycin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The objective of this study was to compare the spread of pertussis in children and adults being secondary contacts after household exposure. The study was nested in an efficacy trial of an acellular pertussis vaccine. The spread of the disease was also monitored with respect to gender and antibiotic therapy. A total of 453 index cases, of which 133 were monitored for adult disease, fulfilled the WHO definition of pertussis. They had contacts to 173 unvaccinated children aged 6–47 months, and a total of 101 adults with pertussis were followed. Detection of the bacteria, or a significant increase of specific antibodies confirmed the diagnosis. Secondary spread of the disease was assumed, when a household member coughed for 7 days or more and had laboratory evidence for pertussis. Crude attack rates (AR) were 69% in children and 31% in adults (P 〈 0.05). AR in children were independent of gender but more women than men (P = 0.02) were affected in those households where the index case was a child. Erythromycin treatment of the index case reduced the AR in exposed toddlers from 80% to 57% (P = 0.06), and in exposed adults from 40% to 21% (P= 0.2). Erythromycin therapy in contacts did not alter the clinical course of the disease significantly. Conclusions In a household study of pertussis, 69% of children and 31% of adults (more women than men) contracted the disease. Erythromycin reduced the number of infections in household contacts, but did not alter the clinical course in those who contracted pertussis.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 155 (1996), S. 74-76 
    ISSN: 1432-1076
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 157 (1998), S. 395-401 
    ISSN: 1432-1076
    Keywords: Key words Pertussis ; Cost-effectiveness ; Acellular pertussis vaccine ; Whole-cell pertussis vaccine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Acellular pertussis vaccines are less reactogenic than whole cell pertussis vaccines, but they are also more expensive. Based on simulation models, we compared the costs and effects of three alternative pertussis vaccination strategies in German children to ”no prevention”: (1) vaccination with whole-cell vaccine at 45% coverage (vaccine efficacy 90%), (2) vaccination with acellular vaccine at 45% coverage (vaccine efficacy 85%), and (3) vaccination with acellular vaccine at 90% coverage. In the two low coverage scenarios expected annual savings in direct medical costs through prevention of disease were larger for whole-cell than for acellular vaccination (252 vs 216 million DM, respectively). Direct costs for treating the more important adverse events induced by whole-cell vaccination (16.9 million DM annually) did not outweigh the higher direct costs of pertussis infections not prevented with the acellular vaccine and the higher price of the acellular vaccine. However, vaccination with acellular pertussis vaccine rapidly becomes as cost saving as vaccination with whole-cell vaccine as soon as vaccination coverage can be raised from 45% to 52.5% with acellular vaccine. Acellular vaccination is also the superior alternative when considering indirect cost savings resulting from reduction in work-loss due to adverse events. Conclusion In our simulations, the most cost-effective pertussis prevention strategy was the use of an effective whole-cell vaccine with a high coverage rate. Introduction of the more expensive acellular pertussis vaccines becomes cost saving if at least a 7.5% increase in coverage is achieved. If also non-medical indirect costs to parents resulting from vaccine associated side-effects are accounted for, acellular vaccines may be more cost-effective also in countries with already high whole-cell vaccine coverage.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1432-1076
    Keywords: Key words Haemophilus influenzae type b  ;   Combination vaccine  ;  Immunological memory
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The lack of an adequate immune response to the major polysaccharide of the Haemophilus influenzae type b (Hib) capsule (polyribosyl ribitol phosphate) (PRP) in very young infants (〈 18 months) can be overcome by conjugating PRP to a T-cell dependent carrier protein. We studied whether administration of a tetanus-PRP conjugate vaccine reconstituted with a diphtheria-tetanus-acellular pertussis-hepatitis B (DTPa-HBV) vaccine as a three dose primary course at 3, 4 and 5 months of age induced PRP-specific immunological memory, by examining the anti-PRP response to a dose of unconjugated PRP given with the DTPa-HBV booster approximately 1 year later. The unconjugated PRP elicited protective anti-PRP antibody levels (≥ 0.15 μg/ml) in all but 3 of the 369 vaccinees, including 13 infants who failed to demonstrate a measurable immune response after the primary course. In a sub-cohort of 54 subjects all had anti-PRP levels ≥ 0.5 μg/ml within 7–14 days of the booster showing a rapid anamnestic type response. Both primary and booster responses were predominantly IgG1 indicating a T-cell dependent response. The DTPa-HBV components elicited protective anti-diphtheria, anti-tetanus and anti-HBs antibody levels in ≥ 98.5% of vaccinees, and immune responses to each of the acellular pertussis vaccine components in 92.3%–97.3% of subjects. Conclusion The tetanus-PRP conjugate vaccine not only elicited a good primary humoral response, but also induced immunological memory so that the infants were able to mount a large and rapid immune response to subsequent exposure to plain PRP, indicating that protection against circulating wild-type Hib had been generated. Successful induction of immunological memory occurred even when there was no measurable humoral anti-PRP response to the primary course. Tetanus-PRP conjugate vaccine can be used in combination with DTPa-HBV vaccine, when administered separately or as a single injection in the same syringe, in primary immunisation schedules at 3, 4 and 5 months of age.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    College Park, Md. : American Institute of Physics (AIP)
    The Journal of Chemical Physics 104 (1996), S. 4198-4203 
    ISSN: 1089-7690
    Source: AIP Digital Archive
    Topics: Physics , Chemistry and Pharmacology
    Notes: The deuterated dicyanoquinonediimine salt Cu(2-CD3,5-CD3-DCNQI)2, (d6), a highly conductive organic metal, exhibits a phase transition from the metallic to the insulating state at Tc≈60 K. In a wide temperature range we observe an anticoincidence of high conductivity and electron spin resonance (ESR). These experiments were performed simultaneously in our ESR apparatus equipped for application of He pressure up to 200 bar. Near Tc there is a coexistence of conducting (ESR-silent) and insulating (ESR-detectable) domains. This correlation of ESR and conductivity σ points to a percolation limited conductivity. Upper and lower limits of the size of the domains are given. Light shifts Tc to lower temperatures, pressure to higher ones. This could be due to shrinking of the lattice which induces the phase transition when critical structural parameters are approached. This is most probably explained by a simultaneous development of a charge density wave (CDW) and a spin pairing within the DCNQI stack together with the trimerization of the lattice. Systematic measurements by variation of temperature, pressure, and light led to phase diagrams of (d6) and to the understanding of the mechanism of the phase transitions. © 1996 American Institute of Physics.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To evaluate the reactogenicity and immunogenicity of aHaemophilus influenzae type b conjugate vaccine (HbOC) and of a tricomponent acellular pertussis vaccine (DTaP) when injected simultaneously into either contralateral arms or into contralateral thighs, 110 infants were enrolled to receive three doses of DTaP at 3, 4, and 5 months and two HbOC doses at 3 and 5 months of age. Administration of either of the two vaccines into arms was associated with significantly more local side effects than administration into thighs. There was no difference in geometric mean concentration (GMC) values for any of the four vaccine antigens between subjects who had been vaccinated into arms or thighs. After immunization, all children had protective antibody titers to diphtheria toxin. While post vaccination the mean anti-tetanus toxoid GMC was ≥ 1.25 IU/ml, there was no significant rise as compared to the GMC before vaccination. GMCs of antibodies against the various pertussis antigens were similar to those observed before with the same DTaP vaccine. The simultaneous administration of DTaP and HbOC was safe and immunogenic irrespective of the site of vaccine administration, but significantly more local reactions occurred when vaccines were injected into arms.
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  • 10
    ISSN: 1435-1420
    Keywords: Key words Tetanus ; autonomic dysfunction ; magnesium sulfate ; Schlüsselwörter Tetanus-infektion ; autonome Störungen ; Magnesiumsulfat
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Hintergrund: Für die hohe Letalität bei generalisiertem Tetanus sind häufig autonome Störungen infolge Sympathikusüberaktivierung verantwortlich. Anhand einer Kasuistik wird auf das therapeutische Potential einer adjuvanten Magnesiumtherapie hingewiesen. Fallbericht: Ein 54jähriger Patient entwickelte zwei Wochen nach einer oberflächlichen Hautverletzung zunächst eine Kau-, Schluck- und Sprechstörung und schließlich generalisierte Muskelkrämpfe mit Befall der Atemmuskulatur. Impfschutz gegen Tetanus bestand nicht. Die Basistherapie bestand in Antitoxingabe, Antibiose und hochdosierter Analgosedierung (Midazolam, Sufentanil) und Relaxierung (Cisatracurium) bei künstlicher Beatmung. Zur Beherrschung massiv auftretender autonomer Störungen wurde adjuvant Magnesiumsulfat 10% verabreicht. Hierunter verbesserten sich die enormen Blutdruckschwankungen, verringerte sich die Herzfrequenz und milderten sich die Muskelspasmen. Nach 10wöchiger intensivmedizinischer Therapie und 8wöchiger Rehabilitationsbehandlung war der Patient klinisch unauffällig. Schlußfolgerung: Magnesiumsulfat erwies sich bei einer schweren generalisierten Tetanuserkrankung als adjuvante Therapie zur Kupierung autonomer Störungen und zur Minderung der Muskelspasmen als nützlich.
    Notes: Summary Background: The high mortality rate in severe tetanus frequently is due to sympathetic overactivity. We present a case that demonstrates the usefulness of adjuvant magnesium. Case report: Two weeks after a superficial skin injury a 54-year old patient was admitted because of difficulties in chewing, swallowing, and speech. A few days later generalized muscle spasms occurred involving breathing muscles. He had not been immunized against tetanus by vaccination. Basic therapy included tetanusantitoxin, antibiotics, analgesia (sufentanil), sedation (midazolam) and relaxation (cisatracurium), and mechanical ventilation. There was pronounced autonomic nervous system instability. We used 10% magnesium sulfate to control sympathetic crisis, which resulted in normalization of blood pressure, slight depression of heart rate, and reduction of the muscle spasms. After ten weeks ICU treatment and eight weeks of rehabilitation the patient was in good clinical condition. Conclusion: This experience suggests that adjuvant magnesium is useful in the treatment of sympathetic overactivity and muscle spasms in severe tetanus.
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