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  • 1
    Electronic Resource
    Electronic Resource
    31. Interdisziplinäre Zusammenarbeit in der Intensivmedizin —Gemeinsamkeiten und Abgrenzungen aus der Sicht des Internisten (1974)
    Springer
    Langenbeck's archives of surgery 337 (1974), S. 223-228 
    Details
    ISSN: 1435-2451
    Keywords: Vital Basal Function ; Trend Analysis ; Interdisciplinary Collaboration ; Vitale Grundfunktion ; Trendanalyse ; Interdisziplinäre Zusammenarbeit
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die interdisziplinäre Zusammenarbeit zwischen Chirurg, Anaesthesist und Internist hat drei Perspektiven. Die erste stellt die operative Optimierung interner Grundtherapie dar. Die zweite bezieht sich auf postoperative Inanspruchnahme des Internisten bei Komplikationen wie Herzinsuffizienz, Nierenversagen oder Hypoventilation, wobei häufig mehrere Störungen vitaler Grundfunktionen gleichzeitig bestehen. Die dritte beinhaltet die Indikation zu konservativem oder operativem Vorgehen, Zeitpunkt der Intervention und die diagnostische Strategie. Es liegt nahe, standardisierte Empfehlungen zu entwickeln, die unter Verwendung statistischer Methoden abstrahiert werden.
    Notes: Summary There are three aspects to interdisciplinary collaboration of surgeon, anesthetist and internist. The first is the surgical optimalization of basic internal treatment. The second involves postoperative care by the internist in the case of such complications as cardiac insufficiency, renal failure, or hypoventilation; frequently several such disorders of vital functions occur together. The third aspect is concerned with decision-making; collaboration is necessary for correct decisions as to whether conservative or surgical treatment is necessary, when any surgical intervention should be performed, and what diagnostic techniques should be used. It is suggested that standardized recommendations be developed and abstracted by statistical methods.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01278663
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  • 2
    Electronic Resource
    Electronic Resource
    Inflammatory mediators in chronic inflammatory bowel diseases (1991)
    Springer
    Journal of molecular medicine 69 (1991), S. 981-987 
    Details
    ISSN: 1432-1440
    Keywords: Inflammatory bowel diseases ; Inflammatory mediators ; Crohn's disease ; Ulcerativecolitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Crohn's disease and ulcerative colitis are chronic inflammatory bowel diseases (IBD) of unknown etiology. They are characterized by an activation of intestinal mononuclear cells. Cytokines play a crucial role in the regulation of the functions of these cells. An increased synthesis of the cytokines interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factorα (TNFα), which are primarily synthesized by activated monocytes/macrophages has been described in patients with IBD. The synthesis of interleukin-2 (IL-2) and of interferonγ (IFNγ), which are produced by lymphocytes, on the other hand, has been found to be decreased. The published data are, however, not quite consistent. In patients with IBD there is not only a stimulation of the local cytokine production in the gut. The blood levels and the synthesis of the cytokines IL-1, IL-6 and TNFα by peripheral blood mononuclear cells are also increased, in particular in patients with Crohn's disease. Drugs, which are commonly used for the treatment of IBD impair the synthesis of these cytokines in monocytes/macrophages.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01645143
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  • 3
    Electronic Resource
    Electronic Resource
    Prediction of diuretic mobilization of cirrhotic ascites by pretreatment fractional sodium excretion (1990)
    Springer
    Journal of molecular medicine 68 (1990), S. 545-551 
    Details
    ISSN: 1432-1440
    Keywords: Ascites ; Liver cirrhosis ; Xipamide ; Spironolactone ; Furosemide ; Resistance to diuretics ; Fractional sodium excretion ; Side effects
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a randomized prospective study the efficacy and side effects of xipamide versus the combination spironolactone/furosemide in the treatment of cirrhotic ascites were studied. Out of 27 patients four responded to a basic treatment consisting of salt and water restriction and one had to be excluded because of deterioration of kidney function. The remaining 22 patients were randomized to additional treatment with either 20 mg xipamide/day (group I) or 200 mg spironolactone/ day combined with 40 mg of furosemide every other day (group II). A response to treatment during the first 4 days was seen in 7 of 11 patients of group I versus only 3 of 11 patients in group II. In the latter group 7 of 11 patients finally responded after 8 days of treatment. Responsiveness to either diuretic treatment strongly depended on pretreatment fractional Na excretion, FENa. The resistance to diuretic treatment can be predicted by a FENa〈0.2%, and could be overcome by additional strategies known to reduce avid proximal Na reabsorption. Xipamide frequently induced hypokalemia, whereas hyperkalemia was seen following treatment with spironolactone/furosemide. Kidney function remained stable during either diuretic treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01667146
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  • 4
    Electronic Resource
    Electronic Resource
    Valid parameters for investigation of the pupillary light reflex in normal and diabetic subjects shown by factor analysis and partial correlation (1994)
    Springer
    Diabetologia 37 (1994), S. 414-419 
    Details
    ISSN: 1432-0428
    Keywords: Key words Pupillary autonomic function, pupillary parameters, factor analysis, pupillary unrest.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Pupillary test data of 103 normal and 119 diabetic subjects (47 IDDM, 72 NIDDM) were evaluated by factor analysis. From a total of nine pupillary parameters three factors were extracted in the analysis. Factor 1 represents maximal pupillary area, contraction velocity at 1 s, dilation velocity at 6 s and minimal pupillary area – static and simple dynamic parameters; factor 2 amplitude of pupillary unrest, area under the detrended curve of pupillary unrest and period of pupillary unrest – parameters of pupillary unrest; factor 3 fusion frequency of pupillary response following flicker stimuli and latency time of pupillary light reflex – second order dynamic parameters. Factor analysis was then applied to investigate diabetic patients with a high percentage of autonomic neuropathic participants (about 39 % had pupillary and about 35 % had cardiorespiratory function disorders), which revealed the same three factors as those identified in normal subjects. Furthermore, an age-related database of parameters of pupillary unrest is given. It demonstrates that normal subjects and diabetic patients did not differ in the period of pupillary unrest (normal vs diabetic (mean ± SEM): 1550±29 vs 1536±27 ms; 2p〉0.5). The difference in amplitude (47.8±2.8 vs 41.0±2.6 % percentile; 2p =0.071) and area under the detrended curve of pupillary unrest (47.9±2.8 vs 40.8±2.6 % percentile, 2p =0.062) seems to show a trend but was not significant. In conclusion, factor analysis revealed three different pupillary test factors. From the comparison of normal and diabetic subjects factor 1 which accounts for the highest percentage of variance (≅ 43 %) and factor 3 (≅12 %) appear to be useful for investigating the pupillary light reflex. Factor 2 is not useful because of the insignificant differences between the normal and diabetic group. From factor analysis and partial correlation we believe that pupillary autonomic function in diabetic patients can be best assessed by using only two parameters, maximal pupillary area and latency time. [Diabetologia (1994) 37: 414–419]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00408480
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  • 5
    Electronic Resource
    Electronic Resource
    Valid parameters for investigation of the pupillary light reflex in normal and diabetic subjects shown by factor analysis and partial correlation (1994)
    Springer
    Diabetologia 37 (1994), S. 414-419 
    Details
    ISSN: 1432-0428
    Keywords: Pupillary autonomic function ; pupillary parameters ; factor analysis ; pupillary unrest
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Pupillary test data of 103 normal and 119 diabetic subjects (47 IDDM, 72 NIDDM) were evaluated by factor analysis. From a total of nine pupillary parameters three factors were extracted in the analysis. Factor 1 represents maximal pupillary area, contraction velocity at 1 s, dilation velocity at 6 s and minimal pupillary area — static and simple dynamic parameters; factor 2 amplitude of pupillary unrest, area under the detrended curve of pupillary unrest and period of pupillary unrest — parameters of pupillary unrest; factor 3 fusion frequency of pupillary response following flicker stimuli and latency time of pupillary light reflex — second order dynamic parameters. Factor analysis was then applied to investigate diabetic patients with a high percentage of autonomic neuropathic participants (about 39 % had pupillary and about 35 % had cardio-respiratory function disorders), which revealed the same three factors as those identified in normal subjects. Furthermore, an age-related database of parameters of pupillary unrest is given. It demonstrates that normal subjects and diabetic patients did not differ in the period of pupillary unrest (normal vs diabetic (mean±SEM): 1550±29 vs 1536±27 ms; 2p〉0.5). The difference in amplitude (47.8±2.8 vs 41.0±2.6 % percentile; 2p=0.071) and area under the detrended curve of pupillary unrest (47.9±2.8 vs 40.8±2.6 % percentile, 2p=0.062) seems to show a trend but was not significant. In conclusion, factor analysis revealed three different pupillary test factors. From the comparison of normal and diabetic subjects factor 1 which accounts for the highest percentage of variance (≅43 %) and factor 3(≅12 %) appear to be useful for investigating the pupillary light reflex. Factor 2 is not useful because of the insignificant differences between the normal and diabetic group. From factor analysis and partial correlation we believe that pupillary autonomic function in diabetic patients can be best assessed by using only two parameters, maximal pupillary area and latency time.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00408480
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  • 6
    Electronic Resource
    Electronic Resource
    Buchbesprechungen (1970)
    Springer
    Journal of molecular medicine 48 (1970), S. 506-511 
    Details
    ISSN: 1432-1440
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01485110
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  • 7
    Electronic Resource
    Electronic Resource
    Hämodynamische Veränderungen bei kontrollierter Herzfrequenzsteigerung mittels Vorhofschrittmacher. Untersuchungen bei Herzgesunden und bei Coronarkranken (1971)
    Springer
    Journal of molecular medicine 49 (1971), S. 1022-1029 
    Details
    ISSN: 1432-1440
    Keywords: Atrial pacing ; coronary artery disease ; ECG ; hemodynamics ; stress testing ; Angina pectoris ; Coronarinsuffizienz ; Belastungstest ; EKG ; Kreislaufphysiologie ; Vorhofschrittmacher
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Vergleichende hämodynamische Untersuchungen wurden bei 38 Coronarkranken und ebensoviclen Herzgesunden aus einer Gruppe von 143 Untersuchungen mittels kontrollierter Herzfrequenzsteigerung angestellt. Schon bei Ruhe zeigten die Coronarkranken im Durchschnitt eine niedrigere Förderleistung des Herzens bei gleichem oder gar niedrigerem Füllungsdruck des Herzens und vergleichbarem arteriellem und pulmonal-arteriellem Druck. Das hypokinetische Syndrom war außerdem durch einen erhöhten peripheren Gefäßwiderstand gekennzeichnet. Bei der stufenweisen Erhöhung der Herzfrequenz sank der Füllungsdruck des rechten und des linken Herzens, um erst bei höheren Frequenzen wieder anzusteigen. Diese Drucksenkung war bei Coronarkranken weniger ausgeprägt. Während SVI und MSERI sanken, blieben Herzindex und TPR bei allen geprüften Herzfrequenzen unverändert, ebenso die arteriellen und pulmonal-arteriellen Drucke. Die Herzarbeit stieg bei den Coronarkranken etwas an. Die sonst eine Sinustachykardie begleitende Sympathicusaktivierung blieb aus. Infolgedessen wurde die AV-Überleitungszeit zunehmend länger. Dadurch entwickelte sich sehr rasch eine Vorhofpfropfung, in deren Verlauf die Überhöhung dera-Welle besonners bei den Coronarkranken auffiel. — Die Dauer der mechanischen Systole nahm mit steigender Herzfrequenz ab. Bei Coronarkranken war diese Verkürzung weniger ausgeprägt. Das Phänomen der relativ zu langen Systole wird auf eine gestörte Kontraktionsmechanik zurückgeführt. Bei 18 von 38 Patienten wurde ein pectanginöser Anfall durch die „Belastung“ ausgelöst. Die eintretenden hämodynamischen Veränderungen waren denjenigen im ergometrisch induzierten Anfall ähnlich, wahrscheinlich bedingt durch sekundäre Sympathicusaktivierung. Das Verfahren der kontrollierten Herzfrequenzsteigerung erlaubt eine präzise und reproduzierbare Bestimmung der „Angina pectoris-Schwelle“. Die Methode ist sehr schonend und birgt sicher mancherlei noch ungenutzte, diagnostische und therapeutische Vorteile.
    Notes: Summary 38 patients with coronary artery disease and 38 control subjects out of a group of 143 patients examined with the atrial pacing technique underwent a hemodynamic study. Even at rest coronary patients exhibited lower cardiac output, while filling pressures and arterial as well as pulmonary arterial pressures were identical. The hypokinetic syndrome was furthermore characterized by elevated total peripheral resistance in the coronary patients. Atrial pacing initially led to a fall of right and left heart filling pressures. At higher rates this pressure rose definitely above normal in the coronary group, and particularly so if angina pectoris was present, or after sudden cessation of pacing. While cardiac index and TPR remained unchanged within the range of heart rates tested, cardiac work increased slightly in the coronary group. These cases required higher ventricular filling pressures to maintain cardiac output. Progressive prolongation of the PR-interval led to the development of gianta-waves in the right and probably also the left atrial pressure pulse. The height of thea-wave was conspicously exaggerated in the coronary disease group. Left ventricular ejection time shortened progessively with rising heart rate. However, this was not observed in the diseased group. Here, a relative prolongation of the duration of mechanical systole was observed and interpreted as evidence of altered contractile properties of the ischemic myocardium. 18 of 38 patients developed angina pectoris during atrial pacing. Hemodynamic changes in this group resmbled those in exercise-induced angina, the reason being most likely a secondary activation of the sympathetic system. Atrial pacing provides a precise and reproducible means for determination of the angina threshold. The hemodynamic alterations, however, appear to be fundamentally different of those occuring in spontaneous or exercise-induced angina. Diagnostic and therapeutic potentials of the atrial pacing method appear considerable, yet they are largely unexplored.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01487733
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  • 8
    Electronic Resource
    Electronic Resource
    Granulocyte elastase in assessment of severity of acute pancreatitis (1990)
    Springer
    Digestive diseases and sciences 35 (1990), S. 97-105 
    Details
    ISSN: 1573-2568
    Keywords: acute pancreatitis ; granulocyte elastase ; C-reactive protein ; α1-antitrypsin, α2-macroglobulin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Complexes of granulocyte elastase and α1-antitrypsin are markers for granulocyte activation. In 75 patients with acute pancreatitis these complexes were immunologically determined daily in plasma during the first week of hospitalization. Patients were classified into three groups: mild pancreatitis (I, ≤1 complication, N=34), severe pancreatitis (II, ≥2 complications, N= 29), lethal outcome (III, N=12). Initially, granulocyte elastase (mean±sem) was lower in group I (348±39 μg/liter) as compared to groups II (897±183 μg/l) and III (799±244 μg/liter), P〈0.001 for I vs II + III. Initial elastase concentrations 〉400 μg/liter were consistent with a severe or fatal course of the disease but did not distinguish between severe and lethal pancreatitis. In patients with mild or severe disease, mean elastase concentrations decreased continuously during the following days (197±15 μg/liter in mild cases, 325±30 μg/liter in severe cases at day 7). In patients with lethal disease, however, mean elastase concentrations even increased at day 2 and remained higher than 700 μg/liter during the observation period. At days 1 and 2 the predictive value for severe or lethal disease of raised (〉400 μg/liter) elastase concentrations [positive predictive value (PPV) 82%, negative predictive value (NPV) 81%] was better than that of elevated (〉100 mg/liter) C-reactive protein (PPV 73%, NPV 73%), elevated (〉4.0 g/liter) α1-antitrypsin (PPV 59%, NPV 50%), or decreased (〈1.5 g/liter) α2-macroglobulin (PPV 82%, NPV 67%). When the time course of the concentrations of the acute-phase proteins was studied, it was found that rises of granulocyte elastase were followed by elevated C-reactive protein levels after one day, by elevated α1-antitrypsin levels after two days and by decreased α2-macroglobulin levels after three to four days. We conclude that granulocyte elastase is a good early marker for the severity of acute pancreatitis. Compared with elevated levels of C-reactive protein and α1-antitrypsin release of granulocyte elastase reflects an event that precedes acute-phase protein induction.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01537230
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  • 9
    Electronic Resource
    Electronic Resource
    Scintigraphic assessment of leukocyte infiltration in acute pancreatitis using technetium-99m-hexamethyl propylene amine oxine as leukocyte label (1991)
    Springer
    Digestive diseases and sciences 36 (1991), S. 65-70 
    Details
    ISSN: 1573-2568
    Keywords: leukocyte scintigraphy ; technetium-99m-hexamethyl propylene amine oxine ; acute pancreatitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The infiltration of leukocytes has been linked to the pathophysiology of complicated or severe pancreatitis. We have tested the ability of leukocyte scintigraphy using technetium-99m-hexamethyl propylene amine oxine (HM-PAO) as label to demonstrate the localization of leukocytes in the pancreas during acute pancreatitis. Twenty-eight patients with acute pancreatitis (eight with biliary, 13 with alcoholic, and seven with unknown origin) were studied with leukocyte scintigraphy using planar imaging and single photon emission computed tomography (SPECT). Fourteen patients had a mild (group I), 11 a severe (group II), and three a lethal outcome (group III) of pancreatitis. All patients of group III, six of group II, and two of group I had a positive leukocyte scan. Thus, the sensitivity of leukocyte scintigraphy for the detection of a lethal course, of acute pancreatitis was 100%, of a severe course 54%, and of a severe or lethal course 64%. The specificity of a negative scan for a mild pancreatitis was 86%. Comparison of the results of leukocyte scintigraphy with those of contrast enhanced CT showed that six of eight patients with pancreatic necrosis in CT had a positive leukocyte scan, but only five of 20 patients without detectable pancreatic necrosis in CT. In summary, leukocyte infiltration into the pancreas during pancreatitis can be demonstrated by noninvasive leukocyte scintigraphy using technetium-99m-HM-PAO as label. A correlation between the severity of the disease and leukocyte infiltration exists.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01300089
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  • 10
    Electronic Resource
    Electronic Resource
    PMN-elastase in assessment of patients with inflammatory bowel disease (1993)
    Springer
    Digestive diseases and sciences 38 (1993), S. 1638-1644 
    Details
    ISSN: 1573-2568
    Keywords: inflammatory bowel disease ; Crohn's disease ; ulcerative colitis ; PMN-elastase
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PMN-elastase is a proteinase released by activated neutrophils. PMN-elastase was determined in two independent populations with inflammatory bowel disease. In an unselected population of 70 consecutive patients with Crohn's disease and 24 patients with ulcerative colitis with different degrees of disease activity plasma PMN-elastase levels were statistically significantly higher in patients with active than in patients with inactive disease [Crohn's disease: 80.5±33.2 ng/ml vs 60.1±24.6 ng/ml (means±sd),P=0.0017; ulcerative colitis: 98.2±54.9 ng/ml vs 59.2±16.8 ng/ml,P=0.026]. PMN-elastase levels in feces were also higher in patients with active Crohn's disease (23.6±15.3 ng/g vs 13.6±12.5 ng/g,P=0.0021) and active ulcerative colitis (46.5±60.5 ng/g vs 20.2±25.0 ng/g,P=0.46), but the difference reached significance only in Crohn's disease. Correlation of disease activity and PMN-elastase in individual patients showed a statistically significant correlation between plasma and fecal elastase concentrations and disease activity in ulcerative colitis (plasma:r=0.72,P〈0.001; feces:r=0.423,P〈0.001) but not fecal elastase concentrations (r=0.0083,P=0.485) correlated significantly with disease activity. Plasma PMN-elastase correlated weakly with fecal PMN-elastase levels in Crohn's disease (r=0.431,P〈0.01) and in ulcerative colitis (r=0.515,P=0.05). In 28 patients with highly active Crohn's disease [median severity activity index (SAI) 203] and 11 patients with highly active ulcerative colitis [median Rachmilewitz index (RI) 14] studied before and four weeks after steroid therapy, treatment lowered the median SAI to 140 and the median RI to 4.5. Mean plasma elastase concentrations decreased concomitantly from 83±44.9 ng/ml to 61.8±25.8 (P=0.0035) in patients with Crohn's disease and from 110±49.5 to 71.6±28.8 ng/ml (P=0.0069) in patients with ulcerative colitis. In conclusion, there is a release of PMN-elastase in active IBD, which can be detected in plasma as well as in feces. Plasma elastase levels reflect disease activity in patients with IBD. The variation of the data and the large overlap between different groups, however, strongly reduce the clinical value.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01303172
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