Management of the beard problem.
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Anesthesia, General↗
Biomedical subjects
J Heine
Publications and source records attributed to J Heine.
Tracheal injury as a sequence of multiple attempts of endotracheal intubation in the course of a preclinical cardiopulmonary resuscitation.
Management of the difficult airway requires an appropriate approach based on personal clinical experiences. For every physician involved in rescue and emergency medicine, it is important to know the difficult airway algorithm and be familiar with alternative techniques of managing the difficult airway. We report a case of tracheal injury caused by multiple attempts at intubating the trachea. Based on current knowledge, apart from surgical equipment for cricothyroidotomy the laryngeal mask airway (LMA) and the Combitube (ETC) should be available on any ambulance vehicle staffed by an emergency physician. In future, blind intubation through the intubating laryngeal mask airway (ILMA) could offer a new opportunity.
Cardiopulmonary Resuscitation↗
Low-dose dopexamine in patients undergoing hemihepatectomy: an evaluation of effects on reduction of hepatic dysfunction and ischaemic liver injury.
BACKGROUND: Hepatic dysfunction is a common problem in patients after hemihepatectomy. Treatment with low-dose dopamine has been shown to be beneficial in hemihepatectomy patients. We hypothesized that dopexamine, a synthetic vasoactive catecholamine, due to its specific pharmocodynamic profile may be more effective in reducing hidden ischaemic episodes in the hepato-splanchnic region during and after temporary total cross-clamping of hepatic inflow in these patients. METHODS: The effects of low-dose dopexamine on hepatic venous haemoglobin oxygen saturation (ShvO2), hepatic venous lactate level, monoethylglycinxylid (MEGX) formation, hepatic synthetic function and indicators for hepatic cell damage were studied during hemihepatectomy and for 16 h postoperatively in hemihepatectomy patients and compared to those of low-dose dopamine. In a prospective, double-blind clinical study 20 patients received randomly either dopexamine (DPX) 0.5 microg kg(-1) min(-1) (n=10) or dopamine (DO) 2.5 microg kg(-1) min(-1) (n= 10). Infusions were started after induction of anaesthesia and continued 16 h postoperatively. Hepatic vein, radial and pulmonary artery were catheterized. Measurements were carried out after induction of anaesthesia, after total cross-clamping of hepatic inflow, and at 2 h and 16 h postoperatively. RESULTS: There were no differences in systemic haemodynamics, oxygenation, ShvO2, serum aminotransferases or MEGX levels between the groups. At 16 h postoperatively prothrombin and antithrombin III levels were significantly lower while hepatic venous lactate was significantly higher in the DPX group compared to the DO group. CONCLUSION: In patients undergoing hemihepatectomy, we could not reveal superior hepatoprotective effects of low-dose dopexamine compared to low-dose dopamine.
Adult↗
[In Process Citation]
Early post-operative infections remain the most important cause of morbidity and mortality in patients following orthotopic liver transplantation (OLTx). Since polymorphonuclear neutrophils (PMNs) are one of the major determinants of antimicrobial defence, the alteration of their functions may influence the outcome of infection in these patients. Ciclosporin predominantly used as immunosuppressive drug following organ transplantation inhibits superoxide anion production during respiratory burst (RB) of PMNs. Growth factors have been shown to modulate the RB of PMNs in healthy volunteers. It has been examined whether PMNs from patients under immunosuppression following OLTx can be primed by in vitro administration of interleukin-3 (IL-3), granulocyte-macrophage colony stimulating factor (GM-CSF), and granulocyte colony stimulating factor (G-CSF). For flow-cytometric evaluation, leukocytes were obtained as supernatant following sedimentation and were incubated with IL-3 (500 U ml-1), IL-3 and GM-CSF (500 U ml-1), or IL-3 and G-CSF (500 U ml-1). The RB was measured by intracellular oxidation of non-fluorescent dihydrorhodamine to green fluorescent rhodamine after induction of phorbol 12-myristate 13-acetate (PMA) or a combination of tumour necrosis factor alpha (TNF-alpha) and N-formyl-methionyl-leucyl-phenylalanine (FMLP). Following stimulation with PMA, the RB of patients following OLTx could be increased significantly after priming with the combination of IL-3/G-CSF (p < 0.03); following stimulation with TNF-alpha/FMLP the RB could be increased significantly by IL-3 (p < 0.01), IL-3/G-CSF (p < 0.002), and IL-3/GM-CSF (p < 0.002). Regarding the clinical administration of IL-3, GM-CSF and G-CSF following OLTx, the role of these cytokines for prophylaxis or treatment of early postoperative infections should be further investigated.
Journal Article↗
[Effect of enucleation on the biomechanical behavior of the lumbar motion segment].
OBJECTIVES: The purpose of the present investigation was to determine the influence of nucleotomy for the biomechanical properties of the lumbar motion segment. METHODS: From 11 human cadavers the lumbar-vertebral segment L3/4 was taken. The segment was tested by an 3D testing device. Measurements were taken under physiological loads up to 7 Nm. Load application was performed in flexion/extension, lateral bending and rotation direction. For each step translation and rotation were measured in three axis of space. Next measurement was performed after a nucleotomy simulated by rectangular excision of the anulus and total nucleotomy on an average of 6 g tissue. RESULTS: There was a significant relation (p < 0.05) between removed disc material and flexibility of the lumbar motion segment. CONCLUSION: The nucleotomy plays a crucial role in the segmental mobility.
Biomechanical Phenomena↗
Anaesthesiological and criterial care aspects regarding the treatment of patients with arteriovenous malformations in interventional neuroradiology.
In recent years, the neuroradiological treatment of cerebral and spinal arteriovenous malformations (AVMs) has undergone significant evolution and improvement. Endovascular embolisation procedures of AVMs are mainly performed under general anaesthesia. Different pathophysiological characteristics of patients with AMVs must be considered for the choice of the anaesthetic procedures. Anaesthesiological management must aim at maintaining stable intracranial haemodynamics; thus, the drugs used must be evaluated according to their effects on brain perfusion, brain metabolism, and intracranial pressure. Rapid recovery to normal central nervous functions should be obtained postoperatively. Close-meshed neurological surveillance should be exercised in order to detect immediately any alteration of neurological state. In summary, anaesthesiological management of interventional neuroradiology is based on the same well-established principles as anaesthesia in neurosurgery.
Anesthesia, General↗
Anaesthesia with propofol decreases FMLP-induced neutrophil respiratory burst but not phagocytosis compared with isoflurane.
Propofol has been reported to produce a dose-dependent inhibition of phagocytosis and superoxide anion production during the respiratory burst (RB) of polymorphonuclear cells (PMNs) in vitro. In this randomized, blinded study, these two parameters were compared during propofol or isoflurane anaesthesia in patients undergoing elective interventional embolization of cerebral arterio-venous malformations. Anaesthesia was performed with continuous intravenous propofol 6-8 mg kg-1 h-1 (n = 15) or isoflurane 0.8-1.0% end tidal (n = 15). Heparinized blood was drawn before, and 2 and 4 h after induction of anaesthesia. The RB in isolated leucocytes was measured with the fluorescent dye rhodamine after ex vivo induction by Escherichia coli or tumour necrosis factor alpha/N-formyl-methionyl-leucylphenylalanine (TNF-alpha/FMLP). Phagocytosis was carried out in whole blood after incubation with fluorescein isothiocyanate (FITC)-labelled, opsonized E. coli and also measured with a flow cytometer. The two groups were similar in terms of biometric data and haemodynamic responsiveness. After 4 h of propofol or isoflurane anesthesia, the mean (SD) phagocytosis of E. coli was 93.2% (7.0%) and 94.3% (9.2%), respectively, of that before anaesthesia. The percentage of PMN with RB activity following TNF-alpha/FMLP stimulation was significantly reduced after 2 h (80.9% (24.2%); P < 0.05) and 4 h (53.7% (27.3); P < 0.05) of anaesthesia with propofol compared with the values before induction. This effect of propofol anaesthesia was significantly different from the effect of isoflurane anaesthesia. In contrast to published in vitro results, 4 h of anaesthesia with propofol did not reduce the phagocytotic capacity of human blood PMN more than isoflurane anaesthesia.
Adolescent↗
Cardiac output measurement by arterial thermodilution in piglets.
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Animals↗
[Carbon monoxide poisoning].
Carbon monoxide (CO) is a product of incomplete burning of coals and carbon compounds and is a gas without any typical taste, colour or smell. Defective radiators or gas pipes, open fireplaces, fires and explosions are sources of unintended CO production and inhalation. CO bonds with haemoglobin much more readily than oxygen does. CO toxicity causes impaired oxygen delivery and utilisation at cellular level. It affects different sites within the body, but has its most profound impact on the organs with the highest oxygen requirement. CO concentration and the intensity and duration of inhalation determine the extent of intoxication. Following basic life support, assisted or controlled ventilation with 100% oxygen is essential during emergency care. Hyperbaric oxygenation (HBO) is the preferred therapeutic option for releasing CO from its binding to haemoglobin. It has been shown that CO may cause lipid peroxidation and leukocyte-mediated inflammatory changes in the brain, a process that may be inhibited by HBO. Patients with neurological symptoms including loss of consciousness and expectant mothers should undergo HBO treatment, no matter how high their CO levels are. Neonates and in-utero fetuses are more vulnerable due to the natural leftward shift of the dissociation curve of fetal haemoglobin, a lower baseline pO2 and carboxyhaemoglobin levels at equilibration that are 10-15% higher than maternal levels. Physicians need to be aware of the potential occurrence of this life threatening hazard so that appropriate emergency treatment can be administered and fatalities prevented.
Brain↗
Effect of magnetic resonance imaging on human respiratory burst of neutrophils.
It is known that low intensity magnetic fields increase superoxide anion production during the respiratory burst of rat peritoneal neutrophils in vitro. We investigated whether the high intensity magnetic fields (1.5 T) during magnetic resonance imaging can influence the human neutrophil function under in vivo conditions. Blood samples were obtained from 12 patients immediately before and after magnetic resonance imaging (mean time 27.6(+/-11.4 min)). The induced respiratory burst was investigated by the intracellular oxidative transformation of dihydrorhodamine 123 to the fluorescent dye rhodamine 123 via flow cytometry. The respiratory burst was induced either with phorbol 12-myristate 13-acetate, Escherichia coli, N-formyl-methionyl-leucylphenylalanine or priming with tumor necrosis factor followed by FMLP stimulation. There was no significant difference between the respiratory burst before and after magnetic resonance imaging, irrespective of the stimulating agent. Short time exposure to a high intensity magnetic field during magnetic resonance imaging seems not to influence the production of radical species in living neutrophils.
Adult↗
GM-CSF increases in vitro the respiratory burst of human neutrophils after liver transplantation.
OBJECTIVE: Superoxide production by polymorphonuclear neutrophils (PMNs) under cyclosporin A (CsA) therapy following kidney transplantation is impaired. We investigated if the respiratory burst of PMNs is similarly depressed in patients undergoing CsA treatment following orthotopic liver transplantation (OLTx). Additionally, the in vitro influence of granulocyte-macrophage colony-stimulating factor (GM-CSF) on the superoxide anion production was examined during the respiratory burst. PATIENTS: 10 patients after OLTx and 10 healthy blood donors (control group). MEASUREMENTS AND RESULTS: PMNs were stimulated with bacteria (Escherichia coli) or a combination of tumour necrosis factor alpha (TNFalpha) and N-formyl-methionyl-leucyl-phenylalanine (FMLP). The respiratory burst was measured by oxidation of non-fluorescent dihydrorhodamine to the fluorescent rhodamine by means of flow cytometry. No differences in respiratory bursts from OLTx patients compared to those from healthy blood donors could be seen. Under TNFalpha/FMLP stimulation, the respiratory burst was significantly increased after in vitro incubation with GM-CSF (500 U ml(-1)) in patients following OLTx (from 58.2 to 74.5 %) as well as in the control group (from 47.4 to 61.9%). CONCLUSIONS: Our results demonstrate that superoxide production is not impaired under CsA treatment following OLTx. The respiratory burst of these patients' PMNs can even be augmented by GM-CSF in vitro.
Cyclosporine↗
Periprosthetic bone remodelling after total knee arthroplasty: early assessment by dual energy X-ray absorptiometry.
The present investigation aims to evaluate periprosthetic bone remodelling after total knee arthroplasty by the use of dual-energy X-ray absorptiometry (DXA). Twelve patients affected by osteoarthrosis of the knee joint underwent primary total knee arthroplasty at an average age of 70.5 years. None of them had received a knee prosthesis before on the contralateral side. Anteroposterior and lateral DXA measurements of the femur, tibia and total knee (both sides) were taken 2 weeks, 3 and 9 months postoperatively. The 2-week measurement was used as an individual reference value to be compared with the 3- and 9-month findings. In addition, the contralateral knee was investigated also in order to estimate how far bone mineral loss was due to implantation or to an individual decline in bone mineral density (BMD). The comparison of BMD values after knee arthroplasty revealed a conspicuous decrease of bone density within 9 months. Bone mineral loss amounted to an average of 9.2% in anteroposterior and 17.8% in lateral DXA measurements. Lateral femur shots showed an average decrease of density of even 21.5%. In contrast, the BMD values of the contralateral knees remained almost unchanged. DXA, especially lateral shots of the femur, promises to be a suitable method for early assessment of periprosthetic bone remodelling after total knee arthroplasty.
Absorptiometry, Photon↗
Prognostic criteria for work resumption after standard lumbar discectomy.
The purpose of this study was to determine prognostic criteria for return to work 9-12 years after standard nucleotomy for herniated nucleus pulposus confirmed by CT. From 1985 until 1988, 182 patients (102 male, 80 female, mean age 45 years) with a single-level herniated nucleus pulposus were operated on for the first time. In summer 1997, an average of 10.2 years after the operation, 101 of 182 patients (55.5%) returned a standardised questionnaire. Eighteen patients (9.8%) had died during the intervening years, while 63 patients (34.6%) were lost to follow-up because of moving to other cities. Two groups could then be distinguished: group I worked full time in their usual job; group II did not. The influence of the degree of the paresis, time elapsed since the occurrence, intraoperative findings, age, sex, weight, type of work and re-operations were analysed statistically. Group I consisted of 44 patients who still worked full time in their usual job. Group II contained 57 patients, of whom 18 worked only part of the time, 9 had changed to a lighter full-time job, 23 had taken early retirement, and 7 were receiving a pension. Patients in group I were significantly younger (38 vs. 51 years), had a smaller proportion of patients with more than 20% overweight (27% vs. 44%), had a smaller proportion of severe, grade 0 and 1, motor dysfunction (0% vs. 16.3%), had been operated sooner (within 3 days: 52.3% vs. 19.3%), had undergone fewer re-operations for recurrence of the herniation (4.5% vs. 21.1%), and had worked less frequently in physically demanding jobs (6.7% vs. 22.8%). We concluded that when there is a relative indication for herniated nucleus pulposus surgery, it should be limited to patients aged below 40 years, with slight motor dysfunction, who work in physically undemanding jobs, so as to make a satisfactory long-term result more likely.
Adult↗
Sagittal static imbalance in myelomeningocele patients: improvement in sitting ability by partial and total gibbus resection.
The progression of kyphosis in myelomeningocele is independent of skeletal growth and requires early operative correction and stabilization to prevent a loss of sitting ability. In severe cases, only vertebrectomy makes it possible to achieve correction, stability and skin-closure without tension. In 14 patients with myelomeningocele gibbus, kyphectomy was performed, removing two vertebral bodies on average. The average kyphosis angle decreased from 128 degrees to 81 degrees, enabling most of the patients to participate again in social life by restoring wheelchair mobility. Nevertheless, a significantly higher complication rate was found compared to other correctional operations, lengthening the average hospital stay to 41 days. Special problems arose from trophic disorders of the skin and soft tissue and from the dystrophic muscles below the level of neural malfunction. In three cases, kyphosis reappeared cranial to the fused segments, requiring ventral stabilization. With respect to increasing kyphosis angle, an early intervention should be aimed at. A secondary operation can be necessary, if surgery is performed without taking care of the growth potential.
Child↗
Degenerative lumbar spinal stenosis. Long-term results after undercutting decompression compared with decompressive laminectomy alone or with instrumented fusion.
The aim of the study was to evaluate the long-term outcome of various surgical procedures for lumbar spinal stenosis. Operations were performed on 117 consecutive patients for lumbar spinal stenosis between 1987 and 1992. Pre- and intraoperative data were recorded in a standardized manner. Three treatment groups were distinguished: group I consisting of 39 patients submitted to undercutting decompression; group II, 51 patients, submitted to laminectomy and foraminal decompression alone; and group III, 27 patients, who underwent foraminal decompression and laminectomy with instrumented fusion. Eight years (5-10 years) after surgery a questionnaire was mailed to the patients containing the outcome scales according to Greenough and Fraser [6] and Turner et al. [22] together with questions about residual pain, necessity of treatment and satisfaction with the operative outcome. A total of 72 questionnaires (61.6%) gave enough information for analysis. After a mean follow-up of 8 years, walking capacity had increased significantly in all groups (P < 0.001). Compared to preoperative values, pain had decreased significantly in all groups (P < 0.01). In group I 36% had good-to-excellent outcomes, and 30.8% and 23.8% in groups II and III (P > 0.05). Forty percent of group I patients were unsatisfied with the result, compared to 38.4% and 33.3% in the other groups (P > 0.05). Overall, 25 of 72 patients (34.7%) had severe constant back and/or leg pain requiring daily administration of analgesics. We conclude that the long-term outcome of decompressive surgery of the lumbar spinal canal, without and with instrumented fusion, is less favourable than was previously reported.
Aged↗
Effects of fentanyl on cellular immune functions in man.
In order to analyze the effects of the opioid agonist fentanyl on cells of the innate immune system, seven healthy individuals were treated intravenously with the opioid fentanyl and five subjects received a placebo. Respiratory burst of polymorphonuclear cells (PMNC) and phenotypes of peripheral blood lymphocytes (PBL) were analyzed from blood samples drawn before, 15 and 30 min after fentanyl or placebo application. In addition, in vitro effects of fentanyl on natural killer (NK) activity was assessed. Fentanyl administration affected neither superoxide production of PMNC nor circulating numbers of B-and T-lymphocytes. In contrast, NK cell (CD16+/CD56+) numbers significantly increased in response to fentanyl. However, no direct influence of fentanyl on NK cell function in vitro could be detected. These results suggest a transient effect of fentanyl on NK cell circulation which seemed to be centrally mediated rather than a direct effect of this opioid on NK cells.
Adult↗
Neutrophil respiratory burst following liver transplantation: in vitro effects of granulocyte colony-stimulating factor.
Early postoperative infections and septic complications are predominant causes of morbidity and mortality in patients following orthotopic liver transplantation (OLTx). Prophylactic granulocyte colony-stimulating factor (G-CSF) administration after OLTx was found to decrease the number of sepsis episodes and sepsis-related mortality. Since polymorphonuclear neutrophils (PMNs) are one of the major determinants of antimicrobial defense, alteration of their functions may influence the development of sepsis in these patients. Therefore, we investigated in vitro whether or not priming with G-CSF affects the neutrophils' respiratory burst (RB) in immunosuppressed liver-transplanted patients. Venous blood was drawn from liver allograft recipients (n=12) between the 5th and 15th day postoperatively. Patients without clinical signs of infection or rejection were included in this study. Leukocytes were obtained as supernatant following sedimentation and incubated with 1000 IE ml-1 G-CSF. The RB was measured by the intracellular oxidation of non-fluorescent dihydrorhodamine to the fluorescent rhodamine by flow cytometry. The results were expressed as a percentage of increasing stimulation compared to the control responses, which are made up of the percentage of cells with RB reaction after stimulation with phorbol ester (PMA), bacteria (E. coli), or the combination of a cytokine (TNF-alpha) and a bacterial peptide (FMLP) in the absence of G-CSF. In vitro priming with G-CSF resulted in significantly increased activity of the RB after PMA (from 71.7% to 85.6%) and TNF-alpha/FMLP (from 58.4% to 72.7%) stimulation. These data demonstrate that G-CSF in vitro augments the RB of PMNs, thereby suggesting a possible therapeutic role for G-CSF as immunomodulating agent during bacterial and fungal infections following OLTx.
Flow Cytometry↗
[Value of the laryngeal mask in emergency care--a survey of North German emergency physicians].
In clinical routine, the laryngeal mask airway (LMA) has proved an alternative to both endotracheal intubation and mask ventilation. In a survey among North German emergency physicians, aspects such as doctors' acquaintance with the LMA, the degree of ist distribution, its use and its potential benefits under non-hospital emergency conditions were evaluated. Seventeen per cent (n = 162) of physicians responded to the questionnaire, 75% of them (n = 122) anaesthetists. Although 73% (n = 119) were familiar with the use of the LMA from clinical experience, and again 73% would welcome having LMA use and application as part of the training of non-academic members of ambulance teams, only 24% (n = 37) of the responding doctors have an LMA on their emergency ambulances and merely twelve (7.4%) physicians reported actually using the LMA, one of them unsuccessfully. Sixty-three per cent considered the LMA the first-choice alternative in an unexpected "can't-ventilate-can't-intubate" situation. Use of the LMA should be extended in emergency medicine especially as its application is relatively easy to learn in clinical routine.
Attitude of Health Personnel↗