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Biomedical subjects

H Burgmann

Publications and source records attributed to H Burgmann.

At least 55 records · Page 3Linked to original sources
PubMed1997

Prostaglandin E1 inhibits platelet decrease after massive blood transfusions during major surgery: influence on coagulation cascade?

BACKGROUND: A plunge in platelet count if often observed after massive blood transfusions during major surgery. This study was designed to assess whether the prophylactic administration of prostaglandin E1 (PGE1) might prevent this drop in platelet count. METHODS: Forty-five patients receiving massive transfusions of packed red blood cells (> 10 units) during major orthopedic surgery were enrolled in a prospective, randomized, double-blind, placebo-controlled study and divided into two groups: group 1 (therapy group) received intravenous PGE1 up to 30 ng/kg/min for 72 hours after surgery, and group 2 (placebo group) received a placebo during the same time period. RESULTS: The patients in group 1 suffered no reduction in platelet count and thus required no platelet concentrate transfusions. In contrast, a significant postoperative drop in platelet count (p < 0.05) was observed in the placebo group between days 3 and 5 after surgery when compared to the therapy group, necessitating transfusions of platelet concentrates in this group. Similarly, red blood cell count and hemoglobin were far more stable in the therapy group, which required fewer transfusions of red blood cells than did the placebo group (p < 0.05). There seemed to be a tendency toward a consumptive coagulation disorder in the placebo group as indicated by a decrease of fibrinogen levels, prothrombin time, and antithrombin III activity, and an increase of partial thromboplastin time. The incidence of adult respiratory distress syndrome was slightly lower in the therapy group. Last but not least, the length of intensive care unit stay was significantly shorter in the therapy group (p < 0.05). CONCLUSION: In our study, the administration of PGE1 prevented a reduction in platelet count. Furthermore, measurements of clotting activity furnished the possibility that PGE1 might inhibit transfusion-induced coagulation disturbances. We recommend that PGE1 should be considered in patients requiring massive transfusion during major surgery.

Adult↗
PubMed1997

Levels of stem cell factor and interleukin-3 in serum in acute Plasmodium falciparum malaria.

The purpose of the present study was to measure serum concentrations of stem cell factor (SCF) and interleukin-3 (IL-3) in patients with acute Plasmodium falciparum malaria. Serum samples from 15 patients were taken on day of admission and days 7, 14, 21, and 28. Anemia developed in 80% of patients. A transient increase in IL-3 could be observed at the beginning of the disease. It remains controversial whether the measured concentrations of IL-3 and SCF correlate with the grade of anemia. The possibly suppressed IL-3 and SCF production may contribute to the prolonged anemia in P. falciparum malaria, as has been shown for erythropoietin.

Adolescent↗
PubMed1997

Cytokine profile and correlation to the APACHE III and MPM II scores in patients with sepsis.

In 35 patients fulfilling the criteria of systemic inflammatory response syndrome (SIRS) of infectious origin, tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), tumor necrosis factor-soluble receptor (TNF-sR), and interleukin-12 (IL-12), C-reactive protein (CRP) levels and the Acute Physiology, and Chronic Health Evaluation III score (APACHE III) were determined on days 1 to 7, 14, 21, and 28. The Mortality Probability Models (MPM) II sepsis score was assessed at the time of admission into the study. The MPM II sepsis score correlated with IL-6 plasma levels on day 1. The APACHE III scores correlated with plasma levels of TNF-sR on days 2-7, with IL-6 levels on days 3-7, and with CRP levels on days 4-7 (p < 0.01). The MPM II sepsis score, the APACHE III score, and the IL-6, TNF-sR, and CRP levels were significantly different between survivors and nonsurvivors and between patients with and without shock (p < 0.05). A significant decrease of the APACHE III scores, IL-6, and CRP levels was observed over the study period in the survivor group only (p < 0.05), while neither the dynamics of TNF-alpha nor IL-12 plasma levels contributed to the risk estimation of mortality.

APACHE↗
PubMed1996

Tissue concentration of clindamycin and gentamicin near ischaemic ulcers with transvenous injection in Bier's arterial arrest.

BACKGROUND: In the treatment of patients with inflamed ischaemic ulcers in peripheral arterial occlusive disease, high tissue concentrations of antibiotics (TCA) are important. With local transvenous pressure injection in Biers' arterial arrest (TVA-Bier) higher TCAs are assumed to be obtained but they have not been measured. METHODS: Two groups of 16 patients each with ischaemic foot ulcers were studied. In one group, patients received a mean of 284 (SD 116) mg gentamicin and in the other, 1200 mg clindamycin. The antibiotics were given intravenously, intra-arterially, and by TVA-Bier in a randomised order at intervals of 48 hours. Biopsy samples were taken from the edge of the ulcers 20 minutes and 3 hours after TVA-Bier, and 1 hour and 3 hours after intravenous and intra-arterial injection. At the same times blood samples were taken. FINDINGS: TCAs of gentamicin and clindamycin with TVA-Bier were significantly higher compared with intravenous or intra-arterial injection. Median TCA-enhancing factor of clindamycin achieved by TVA-Bier at 20 min 1 hour was 18.3 and 14.1 versus intravenous and intra-arterial infusion, respectively, and at 3 hours 7.3 and 5.6, respectively. The median TCA-enhancing factor for gentamicin by TVA-Bier versus intravenous and intra-arterial application was, at 1 hour 20 min, 9.4 and 9.7, respectively, and at 3 hours 1.2 and 1.7, respectively. INTERPRETATION: Higher TCAs could be achieved with TVA-Bier than with intravenous or intra-arterial infusion. TCAs were lower when using gentamicin and higher with clindamycin.

Aged↗
PubMed1996

Increased serum concentration of soluble CD14 is a prognostic marker in gram-positive sepsis.

Increased serum sCD14 concentrations are associated with poor outcome in Gram-negative sepsis and trauma patients. In the present study serum sCD14 concentrations were measured in patients with Gram-positive sepsis and compared with Gram-negative septic and nonseptic intensive care unit patients. Furthermore, serum sCD14 concentration was correlated with patient's outcome. Serum samples of 28 Gram-positive (8 nonsurvivors/20 survivors) and 10 Gram-negative bacteriemic patients (3 nonsurvivors/7 survivors) were obtained at the day they met the sepsis criteria defined by Bone et al. (Day 0) and at Days 4 and 7 and compared with 10 nonseptic ICU patients and 10 healthy volunteers. Serum concentrations of sCD14 were measured by ELISA. Significantly higher sCD14 serum concentrations were found on Days 4 and 7 in Gram-positive nonsurvivors than in Gram-positive survivors (Day 4: 5.85 +/- 0.48 vs 4.07 +/- 0.43 microgram/ml, P < 0.05; Day 7: 6.12 +/- 0.46 vs 3.53 +/- 0.33 microgram/ml, P < 0.01). In addition, sCD14 concentrations of Gram-positive nonsurvivors were significantly higher than those of nonseptic ICU patients and healthy volunteers at any time of observation. However, no significant difference was calculated between Gram-positive and Gram-negative patients. Summarizing our results, the serum level of sCD14 could be proven to be a good prognostic marker in the course of Gram-positive sepsis. Increased levels are associated with a high mortality.

Adult↗
PubMed1996

Serum laminin and basic fibroblast growth factor concentrations in patients with complicated Plasmodium falciparum malaria.

Serum concentrations of laminin and basic fibroblast growth factor (FGF) were measured in 20 patients suffering from complicated Plasmodium falciparum malaria in Bangkok. Significant higher mean serum concentrations of laminin were determined prior to treatment (1973 ng/ml) and 7 days after starting medication (1025 ng/ml) in comparison to the control (412 ng/ml). The values remained numerically higher for at least 21 days. With regard to serum basic FGF concentrations, a peak was found 7 day after starting treatment (35.61 pg/ml). In addition, a significant correlation was found for parasite clearance time and basic FGF concentration on day 7 (P < 0.01). These increased values of laminin and basic FGF may be the consequence of endothelial and basement membrane damage induced by sequestration of the parasites. Furthermore, basic FGF might play a role in endothelial repair mechanisms after the clearance of the parasites.

Adolescent↗
PubMed1996

Multiple-dose pharmacokinetics of cefpirome in long-term hemodialysis with high-flux membranes.

Cefpirome is a cephalosporin eliminated primarily by kidneys that requires dosage reduction in patients with renal failure. The pharmacokinetic parameters were studied in 10 patients with end-stage renal disease who were receiving hemodialysis. Repeated intravenous administration of 2 gm cefpirome three times a week resulted in trough levels of 12.2 +/- 5.4 micrograms/ml and peak serum concentrations of 99.6 +/- 82.1 micrograms/ml. After 3 1/2 hours of hemodialysis with polysulfone high-flux membranes, 62.3% +/- 23.3% of cefpirome was removed. The interdialytic half-life was 9.35 +/- 0.99 hours, and the intradialytic half-life was 2.02 +/- 0.7 hours.

Adult↗
PubMed1996

Elevated levels of soluble CD14 in serum of patients with acute Plasmodium falciparum malaria.

Serum sCD14, tumour necrosis factor-alpha (TNF-alpha), IL-6, and endotoxin were analysed in 45 patients with complicated malaria, in 14 patients with Gram-negative septicaemia and in 24 healthy subjects by ELISA. Malaria patients with renal failure (n = 16) had higher levels than patients without renal failure (n = 29) (8116 + 1440 micrograms/l versus 9453 + 1017 micrograms/l; P < 0.05) and both had higher levels than patients with septicaemia (6155 + 1635 micrograms/l) and normal subjects (2776 + 747 micrograms/l). A significant correlation between sCD14 and IL-6 (r = 0.756) and TNF (r = 0.822) existed. However, no relation between sCD14 and serum endotoxin or indices of clinical disease severity (parasitaemia, fever, parasite or fever clearance time) was seen. Although the role of sCD14 in malaria remains to be determined, elevated levels may participate in the inflammatory response in complicated malaria.

Acute Disease↗
PubMed1996

Increased serum laminin and angiogenin concentrations in patients with peripheral arterial occlusive disease.

AIM: To measure serum laminin and angiogenin concentrations in patients with peripheral arterial occlusive disease (PAOD) Fontaine stages IIb, III, and IV. METHODS: The study population comprised 38 patients (20 men and 18 women) with stage IV PAOD, 11 patients (six men and five women) with stage III PAOD, 18 patients (10 men and eight women) with stage IIb PAOD, and 23 patients (10 men and 13 women) with deep vein thrombosis. Fifteen normal subjects (matched for risk factors) and 10 patients (five men and five women) without PAOD served as controls. Serum samples were obtained at admission and serum laminin and angiogenin concentrations were measured using an enzyme linked immunosorbent assay. RESULTS: Patients with stage IV PAOD had higher serum laminin (mean +/- SEM; 826 +/- 97 ng/ml) and angiogenin concentrations (467 +/- 26 pg/ml) than normal subjects (laminin: 379 +/- 21 ng/ml; angiogenin: 358 +/- 16 pg/ml) and patients without PAOD (laminin: 277 +/- 34 ng/ml; angiogenin: 406 +/- 25 pg/ml). A significant correlation was found between angiogenin and laminin and between serum laminin and fibrinogen concentrations in patients with stage IV disease. CONCLUSIONS: Raised laminin and angiogenin concentrations may be indicators of endothelial damage caused by reduced vascular perfusion or compensatory revascularisation, or both.

Angiogenesis Inducing Agents↗
PubMed1996

Quinolones in gastrointestinal infections.

Fluoroquinolones are efficient antimicrobial drugs for the treatment of enteric fever, shigellosis, Escherichia coli diarrhea, cholera, and traveler's diarrhea. They also play a role in the therapy of yersiniosis, campylobacteriosis, and intestinal salmonellosis. A single dose of quinolones has been effective in the treatment of traveler's diarrhea and cholera. Uncomplicated typhoid fever was cured by norfloxacin, pefloxacin, and ofloxacin 400 mg twice daily (b.i.d.) for 7-14 days or ciprofloxacin 500 mg b.i.d. for 10 days. A single daily dose of 400 mg fleroxacin for 3 days has been shown to be effective in this indication. A few reports suggest that the newer quinolones can eliminate the carrier state. The efficacy of quinolones in the prophylaxis and treatment of intra-abdominal infections following abdominal surgery requires further investigation.

Anti-Infective Agents↗
PubMed1996

Serum levels of erythropoietin in acute Plasmodium falciparum malaria.

The pathophysiologic backgrounds of anemia in malaria are complex and multifactorial. The purpose of the present study was to measure serum concentrations of erythropoietin (EPO) and to evaluate the adequacy of EPO production in patients suffering from acute Plasmodium falciparum malaria. Fifteen patients with complicated malaria were included in the study. Serum samples were taken on the day of admission, and days 7, 14, 21 and 28. Serum EPO concentrations were measured using an enzyme-linked immunosorbent assay. The median serum EPO concentration was 15.6 mU/ml on the day of admission (range 0.5-567) mU/ml, 10.6 mU/ml (1.2-863) on day 7, 11.8 mU/ml (0.5-72.8) on day 14, 10 mU/ml (0.5-74.6) on day 21, and 8.3 mU/ml (2.2-61.6) on day 28. Inadequate EPO production was found in 46.6% of the patients on the day of admission, which increased to 67% and 68% on days 7 and 14, and reached a maximum of 80% on day 21. Almost 54% of patients had inadequate EPO production on day 28. Our data indicate inadequate EPO production in patients suffering from acute P. falciparum malaria, which might contribute to the prolonged anemia observed in these patients.

Acute Disease↗
PubMed1996

Influence of stress ulcer prophylaxis on translocation of bacteria from the intestinal tract in rats.

Clinical studies in critically ill patients suggest an increased rate of septicemia during stress ulcer prophylaxis with H2-blockers when compared with sucralfate, a topically active compound. In the present study we examined the effect of stress ulcer prophylaxis with sucralfate as compared with ranitidine versus untreated animals in a rat model on intestinal flora and on the translocation of bacteria from the intestinal tract. The translocation of bacteria was also determined after induction of hemorrhagic shock and, in addition, we examined bacterial translocation in animals infected with a multiple resistant Escherichia coli and following antibiotic therapy with vancomycin and gentamicin during stress ulcer prophylaxis with and without hemorrhagic shock. Male Wistar rats, which received standard meals either without stress ulcer prophylaxis or with ranitidine/sucralfate were investigated. After induction of hemorrhagic shock we analysed qualitatively and quantitatively the bacterial flora in the gastrointestinal tract, blood, mesenteric lymph nodes and visceral organs (liver, spleen). In the absence of shock no changes of the intestinal flora and no translocation of bacteria from the gut were observed in control animals nor during stress ulcer prophylaxis. However, after induction of hemorrhagic shock there was a pronounced bacterial translocation in control animals and during ranitidine, whereas the translocation rate was reduced in animals treated with sucralfate (p < 0.05). During massive E. coli challenge both without and with shock a significantly higher rate of translocation was found in all three experimental groups there were no significant differences between the three groups. We conclude that a) bacterial translocation is low or absent in healthy animals, b) hemorrhagic shock induces a massive increase in bacterial translocation, c) stress ulcer prophylaxis with sucralfate reduces translocation of bacteria during the shock state and c) during massive bacterial overgrowth and/or concomitant shock none of the treatments can reduce the massively elevated rate of bacterial translocation.

Animals↗
PubMed1996

[Infectious complications of cardioverter/defibrillators--case report and review of the literature].

Implantable cardioverters/defibrillators have greatly improved survival in patients with malignant ventricular arrhythmias. As modern devices and technical skill and experience reduce surgical complications attention is focussed on the potentially lethal infections of these devices. Staphylococcus spp. can be isolated as the predominant causative organisms. Devices that require thoracotomy (as opposed to transvene systems) and generator replacement (as opposed to primary implantation) carry a higher risk of infections. Although there are sporadic reports on successful conservative management of ICD infection, explantation of the generator, leads and patches followed by reimplantation of a new device after no less than 2 weeks is still the recommended procedure. Concomitant intravenous antibiotic therapy should be continued for 4 to 6 weeks.

Aged↗
PubMed1995

[African eye worm as initial manifestation of loaiasis].

HISTORY AND CLINICAL FINDINGS: A 23-year-old woman suddenly had the sensation of a foreign body in her right eye. On looking into the mirror she saw what looked like a moving worm-like structure in the lateral angle of the eye. The patient had visited Cameroon 2 years previously. TESTS: On ophthalmological examination with a slit-lamp a transparent worm, 6-7 cm long, was seen. Laboratory tests showed an eosinophilia of 13%, C-reactive protein slightly raised to 1.25 mg/dl and IgG of 2100 mg/dl (IgE was normal at 33 U/ml). Giemsa staining of a whole-blood drop contained numerous microfilaria typical of Loa loa (2000/ml). Filaria serology with antigen of Dipetalonema vitae (Acanthocheilonema) gave a positive response. TREATMENT AND COURSE: The worm was removed surgically and, after a test dose, diethylcarbamazine, 6 mg/kg daily), was administered. Although methylprednisolone (initially 20 mg daily) was given concurrently, a fever of 38,5 degrees C developed on the 4th day. At the same time, streaky cutaneous eruptions were noted over the left lower arm and left knee bond. These two signs, which were due to two adult worms, disappeared within 2 days. On the 5th day the patient complained of headache, nausea and sensitivity to light, and she had meningism. The symptoms were treated with paracetamol and diazepam and quickly improved. The patient was discharged after 3 weeks. Further treatment cycles with diethylcarbamazine are planned.

Acetaminophen↗