Detection of cutaneous metastatic melanoma with TI-201 scintigraphy.
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Aged↗
Biomedical subjects
J Koller
Publications and source records attributed to J Koller.
Cardiac troponin T release in multiply injured patients.
Cardiac troponin T (cTnT), a new marker of myocardial tissue damage, was investigated in 32 consecutive multiply injured patients. cTnT, creatine kinase (CK) and CK isoenzyme MB (CK-MB) mass concentrations were measured immediately after admission, 12 and 24 h later and daily thereafter for 4 days. We found a moderate increase in cTnT in 22 patients (72 per cent; peaks: 0.6-5.1 micrograms/l). In only four of these 22 patients did the CK-MB mass/CK index indicate myocardial injury. ST-T alterations and arrhythmias did not occur significantly more frequently in patients with increased cTnT plasma concentrations or positive CK-MB mass/CK index. We found a moderate increase in cTnT in 72 per cent of all patients with multiple injuries, but we found no association between an increase in cTnT and the occurrence of electrocardiographic changes and arrhythmias.
Adolescent↗
Modification of layered atelocollagen: enzymatic degradation and cytotoxicity evaluation.
Two kinds of layered atelocollagen materials cross-linked with hexamethylene diisocyanate (HMDIC), starch dialdehyde and glyoxal were enzymatically treated by bacterial collagenase. Evaluating collagenase digestion assay for these material showed progressive differences, particularly in the group of samples cross-linked with HMDIC. This should offer the possibility of programmed enzymatic degradation. These materials may be toxicologically acceptable as proven by the short-term test used for cytotoxicity evaluation.
Amino Acid Sequence↗
Considerations and problems in the development of the mini-spindle pump.
The premise for the development of the mini-spindle pump, planned as an implantable device for assisted circulation, was to transport 4 L of water/min in mock circulation with a speed of 12-15,000 rpm against an afterload of 90 mm Hg. After calculations, the resulting first prototype had a spindle rotor with 3 threads (outer diameter, 18 mm; inner diameter, 6.2 mm; length, 45 mm) in a U-shaped housing, driven by an electric motor with a cooling system. In mock circulation, this pump moved 7.8 L of water/min at 18,000 rpm. To avoid animal experiments, its influence on the blood was tested in a Maxima oxygenator. The device circulated 4.2 L of blood/min with the same speed. Because of its high traumatic hemolysis rate (> 250 mg% of free hemoglobin after 7 h of pumping), the rotor was modified, first without effect at 2.5 threads and then at 4 threads. In addition, in this third prototype, the flow direction was reversed. This prototype was more effective (4.3 L of blood/min at 12,000 rpm in the oxygenator) and the hemolysis rate, after a pumping duration of 8 h, could only be reduced to 180 mg% of free hemoglobin. As a result, a fourth prototype was developed (i.e., the U-shape of the housing was abandoned). This device functioned better than the third prototype (4.5 L of blood/min at 12,000 rpm in the oxygenator), but the blood trauma increased (220 mg% of free hemoglobin after 7 h of pumping).(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Effect of lung transplantation on right and left ventricular volumes and function measured by magnetic resonance imaging.
To evaluate the effect of lung transplantation on right ventricular (RV) and left ventricular (LV) volumes and function, magnetic resonance imaging (MRI) was performed in 11 patients before and 6 to 24 months after single (n = 7) or double (n = 4) lung transplantation as well as in 15 healthy control subjects. Prior to transplantation, RV end-diastolic (RVEDVI, ml/m2) and end-systolic (RVESVI, ml/m2) volume indices were significantly increased in patients compared with those in control subjects. RV ejection fraction (RVEF, %), although within the lower normal range, was significantly reduced. In contrast, LV volume indices (ml/m2) were significantly smaller in patients than in control subjects, whereas LV ejection fraction (LVEF, %) was not different from that in normal subjects. After lung transplantation, MRI revealed a significant reduction in RVEDVI from 73 +/- 29 to 54 +/- 14 (p = 0.03) and RVESVI from 38 +/- 23 to 20 +/- 6 (p = 0.01) with a concomitant significant increase in RVEF from 48 +/- 14 to 63 +/- 6 (p = 0.01). Consecutively, the LV expanded to normal (LVEDVI from 49 +/- 12 to 65 +/- 14, p = 0.01; LVESVI from 23 +/- 9 to 28 +/- 7, p = 0.05), whereas LVEF remained unchanged (55 +/- 9 versus 56 +/- 8).
Adult↗
Early enteral nutrition in severe burns.
The method of early enteral nutrition (EEN) in extensively burned patients was started at the Bratislava Burns Department in January 1992. EEN was instituted in all patients with burns exceeding 20% of the BSA who were admitted to the department not later than 6 hours post burn. The nutrition itself was started with administration of milk, and later on, if good tolerance was observed, the milk was replaced by standard tube feeding formulas. The feeding was adjusted to the actual needs of the individual patients according to nutritional balance calculations and regular control of the patients' weights. During a period of 18 months 20 patients met the criteria for EEN. Twelve of them survived and 8 died due to complications of extensive burns. The overall tolerance of EEN was very good in both the survivors and nonsurvivors groups of patients. EEN proved to be safe and effective in maintaining nutritional balance of the patients and eliminating particularly the occurrence of Curling's ulcers.
Adult↗
Analysis of 1119 burn injuries treated at the Bratislava Burn Department during a five-year period.
The Bratislava Burn Department was founded and started its activity 5 years ago. The department serves an area with 2.5 million of inhabitants with mixed both urban and rural population. We tried to analyze epidemiological data of 1119 acute burn injuries treated at the Department during a five-year period. All the data were compiled from statistical burn charts of in-patients. The average annual number of acute burn admissions including referrals was approximately 200 patients. We could see a distinct male predominance in almost all of the age groups with an average male to female ratio of 2.1:1. Children represented 38.1% of all the treated burn patients. The age group with the highest number of patients was in children 0-3 years with 237 patients (21.1%), and in adults 16-30 years with 197 patients (17.6%). The extent of burns varied between 1 and 99% of the BSA. The mean burn size was 15.7% of the BSA. The majority of the accidents were caused by hot liquids, followed closely by flame and/or explosion--they represented 43% and 36%, respectively. Concerning the place and/or cause of the accidents, the majority of burns occurred at homes, they represent 81.5% of the cases. Only 18.5% occurred at work, mostly in industry. Almost all of the injuries were caused by negligence. The rate of suicides by our patients was very low, less than 1%. 83 patients died, only 3 of them were children. The overall mortality rate was 7.3%. The mortality rate in children was as low as 0.7%. We compared our data with similar studies done in Kosice (Slovakia), Spain, and Brazil.(ABSTRACT TRUNCATED AT 250 WORDS)
Accidents, Home↗
The use of rocuronium (ORG 9426) in patients with chronic renal failure.
The pharmacodynamics of an initial dose of 0.6 mg.kg-1 rocuronium followed by three maintenance doses of 0.15 mg.kg-1 were studied during nitrous oxide/oxygen/isoflurane anaesthesia in patients with normal renal function (n = 12) and chronic renal failure (n = 12). The mean (SD) duration (min) of block after the initial dose was 28.0 (5.5) and 25.6 (11.7) respectively. The mean (SD) duration (min) of the effect of the three maintenance doses was 15.3 (4.0) and 14.2 (7.0); 17.3 (3.2) and 17.4 (8.7); 18.1 (2.8) and 19.1 (10.1) for the normal and renal failure patients respectively. The induced and spontaneous recovery indices were 3.7 (0.7) and 17.1 (6.9) in the normal group compared with 3.9 (0.5) and 19.0 (12.5) in the renal failure group and these values did not differ between the two groups. In this small study rocuronium appears to be suitable for patients with chronic renal failure. There is no evidence of prolonged block even when the drug is given in repeated doses for maintenance.
Adolescent↗
Evaluation of the time course of action of maintenance doses of rocuronium (ORG 9426) under halothane anaesthesia.
The time course of action of rocuronium was compared using three different sizes of maintenance doses after at least three subsequent administrations of the same repeat dose in each patients under halothane anaesthesia. Following endotracheal intubation facilitated with 0.6 mg.kg-1 rocuronium (ORG 9426), muscle relaxation was maintained in three groups each consisting of ten patients, using increments of equal repeat doses of either 75 micrograms.kg-1, 150 micrograms.kg-1 or 225 micrograms.kg-1 equivalent to 1/4, 1/2 and 3/4 of the ED95 of this new compound, respectively. Maintenance doses were administered when the twitch height depression induced by the previous dose returned to 25% of its control value. The clinical duration of the intubating dose averaged 27 +/- 7.5 min (mean +/- s.d.). The time course of action of the various maintenance doses depended on their size, but not on the number of administrations. The durations of repeat doses averaged 8-9 min, 14-16 min and 19-23 min after the low, medium and high maintenance doses, respectively. No overt cumulative effects were observed.
Adolescent↗
[The effect of various donor factors on primary and long-term function of the transplanted kidney].
Various factors such as cause of brain death, duration of intensive care, single or multiple organ procurement, renal function, heart rate, mean arterial blood pressure, requirement of catecholamines and metabolic derangement were investigated in 86 consecutive organ donors with respect to the possible influence on initial graft function in 86 kidney recipients. Donor conditioning and perioperative recipient management were standardized. Donors of kidneys with initial graft function (group I) showed a significantly higher incidence (80%) of brain death as a consequence of an isolated cerebral incident than donors of kidneys without initial graft function (group II), whereas the incidence of polytrauma (including cerebral) was much higher in donors of group II kidneys (42.9%). The donor requirement of catecholamines was higher in group II donors and the frequency of multiple organ donors was also higher in this group. Five-year graft survival was 80% for group I kidneys but only 62% for group II kidneys. The other factors had no influence on initial graft function. These data demonstrate that multiple injuries and multiple organ procurement have a negative impact on the initial function of the transplanted kidney, possibly due to prolonged ischemic insult.
Acid-Base Equilibrium↗
Antagonism of vecuronium by one of its metabolites in vitro.
The neuromuscular-blocking agent vecuronium bromide undergoes hydrolysis to three pharmacologically active metabolites (3-desacetyl, 17-desacetyl and 3,17-desacetyl vecuronium) which might modify the neuromuscular-blocking action of their parent compound. In order to elucidate the possible role of the interaction between vecuronium and its metabolites in the complications reported after long-term use of vecuronium in intensive care unit (ICU) patients, the relative potency of vecuronium, 3-desacetyl and 3,17-desacetyl vecuronium was determined in the rat hemidiaphragm in vitro and the mode of interaction of the above-mentioned compounds investigated. Dose-response relationships were established for each substance alone and for combinations of vecuronium with its metabolites. The relative potency at the EDmax50 levels (% maximal effect) were in the order of 1:1.2:27 for vecuronium, the 3-desacetyl derivative and the 3,17-desacetyl derivative, respectively. The mode of interaction characterized by isobolographic and algebraic (functional) analysis showed vecuronium and 3-desacetyl vecuronium to interact in an additive fashion while the combined effect of the parent compound and its 3,17-desacetyl derivative was less than additive, indicating antagonism.
Animals↗
Atrial natriuretic peptide (ANP), aldosterone, angiotensin II and renin in the 'low T3 syndrome' in organ donors.
The present prospective study was conducted in order to investigate the effect of an acute decrease in serum T3 levels on ANP, aldosterone, angiotensin II, renin and ADH. All patients showed a pathologic TRH stimulation test prior to organ harvesting. Our patients developed secondary T3 hypothyroidism of different severity dependent on intensive care unit (ICU) stay. T3 values in group 1 (ICU stay > or = 77 h) were smaller than 70 ng/dl, those of group 2 (ICU stay < or = 53 h) were greater than 70 ng/dl. In both groups a severe elevation of plasma renin activity was measured, with almost high-normal values for ANP in group 1 and slightly elevated values in group 2 [not significant (n.s.)]. Results demonstrate that, contrary to patients who are not critically ill, brain-dead patients develop a dissociation of the renin-angiotensin-aldosterone mechanism. No statistical significant difference was found between the groups in serum levels of ADH and aldosterone. This endocrine dissociation, however, seems to have no clinical significance with regard to organ function after transplantation in kidney recipients.
Aldosterone↗
Successful multivisceral transplantation.
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Adenocarcinoma↗
Evaluation of the endotracheal intubating conditions of rocuronium (ORG 9426) and succinylcholine in outpatient surgery.
The time-course of action and tracheal intubating conditions of rocuronium and succinylcholine under intravenous anesthesia with propofol, alfentanil, and nitrous oxide were studied in 30 patients undergoing outpatient surgery. The neuromuscular effects of both drugs were quantified by recording the indirectly evoked twitch response of the adductor pollicis muscle after ulnar nerve stimulation (0.1 Hz, 0.2 ms supramaximal stimuli). Patients were given either 0.6 mg/kg rocuronium (n = 20) or 1 mg/kg succinylcholine (n = 10) intravenously. Sixty seconds after the administration of the muscle relaxant, the trachea was intubated and the intubating conditions were scored by a "blinded" assessor. Intubating conditions were not different (P = 0.34) between the rocuronium and succinylcholine groups. The onset and duration of neuromuscular blockade were shorter with succinylcholine than with rocuronium. The depression of the twitch response to 5% of control value occurred in 0.8 +/- 0.1 min with 1 mg/kg succinylcholine and 1.2 +/- 0.5 min with 0.6 mg/kg rocuronium (P less than 0.01). The recovery of the twitch response to 25%, 75%, and 90% of its control value was shorter after succinylcholine (P less than 0.001) and occurred at 8.1 +/- 2.6, 10.3 +/- 3.9, 11.3 +/- 4.6 and 25.3 +/- 5.0, 33.1 +/- 5.9, 36.1 +/- 6.3 min after succinylcholine and rocuronium, respectively. Also the time required for spontaneous recovery from 25% to 75% of the control twitch response was significantly shorter (P less than 0.001) after succinylcholine (2.2 +/- 1.4 min) than after rocuronium (7.8 +/- 2.1 min). It is concluded that in spite of the pharmacodynamic differences between succinylcholine and rocuronium, the intubating conditions after administration of both compounds are similar and develop at the same rate.
Adult↗
Endothelin and big endothelin concentrations in injured patients.
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Adolescent↗
Cardiac troponin T in the diagnosis of heart contusion.
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Adolescent↗
High-tension electrical-arc-induced thermal burns caused by railway overhead cables.
Eleven patients with high-tension electrical-arc-induced thermal burns due to railway overhead cables were treated at the Bratislava Burn Department during a relatively short period of 18 months. All the injuries occurred by the same mechanism, that is persons climbing on top of railway carriages and approaching the 25,000 V a.c. overhead cables. All the burns were the result of an electrical arc passing externally to the body, with subsequent ignition of the victim's clothes. The cutaneous burns, ranging from 24 to 79 per cent of the BSA, were mostly deep partial to full skin thickness injuries. One patient died on day 5 postburn, the other survived. In spite of high-tension aetiology, no true electrical injuries appear to have occurred and no amputations were necessary. The pathophysiology and possible preventive measures are discussed. It must be stressed that arcing can be induced by an earthed object approaching, but not touching, a cable carrying a high voltage.
Adolescent↗