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Biomedical subjects

K Lenz

Publications and source records attributed to K Lenz.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Effect of prostaglandin E1 on extravascular lung water in patients with severe heart failure].

Prostaglandin E1 (PGE1) is a physiologic vasodilator, which is broadly used in the therapy of peripheral arterial occlusive disease. In addition, the successful use of PGE1 in patients with severe heart failure has been described in several studies, where a decrease in pulmonary artery pressure and an increase in cardiac output were observed. In contrast to these positive effects, the development of lung edema was reported in individual cases after the infusion of PGE1 in patients with heart disease. We therefore conducted a double-blind study to evaluate the effect of PGE1 on extravascular lung water (EVLW) in patients with heart failure (NYHA III-IV) and borderline increased EVLW. Seven patients received an infusion of PGE1 (Prostavasin) at a dosage of 60 micrograms over 2 hours, while in 6 patients (control group) isotonic saline was given as placebo. EVLW was measured using a double indicator method at time points -15 h, -9 h before and at the start of the infusion, 1 h and 2 h during infusion, as well as +1 h, +4 h, +7 h, and +22 h after termination of the infusion. Infusion of PGE1 did not alter EVLW both in comparison to pre-study values (9.8 +/- 4.3 ml/kg bw preinfusion. 9.3 +/- 3.2 ml/kg bw after 1 hour and 9.4 +/- 3.5 ml/kg bw after 2 hours) or to the control group (6.5 +/- 3.3 ml/kg bw preinfusion, 7.1 +/- 2.7 ml/kg bw after 1 hour and 7.0 +/- 3.2 ml/kg bw after 2 hours). We conclude that there is no evidence that PGE1 might contribute to the development, or worsening of lung edema by inducing extravascular lung water accumulation and can, thus, be savely given to patients with even a severe degree of heart failure (NYHA III-IV).

Alprostadil↗
PubMed1995

Aerosol amphotericin B inhalations for prevention of invasive pulmonary aspergillosis in neutropenic cancer patients.

To determine the value of aerosol amphotericin B inhalations for prevention of invasive pulmonary aspergillosis (IPA), we initiated a prospective randomized multicenter trial. The scheduled intent-to-treat interim analysis included 115 patients (30%) with prolonged neutropenia after chemotherapy for acute myeloid leukemia, acute lymphoblastic leukemia/high-grade non-Hodgkin's lymphoma, or solid tumors undergoing autologous stem cell transplantation. Sixty-five patients had been randomized to receive prophylactic aerosol amphotericin B inhalations at a dose of 10 mg twice daily (group A); for the remaining 50 patients no aerosol amphotericin B prophylaxis was used (group B). No serious side effects from amphotericin B inhalations occurred, but coughing (54%), bad taste (51%), and nausea (37%) caused early cessation of aerosol amphotericin B prophylaxis in 23% (15/65) of courses. In group A, the incidence of proven, probably, or possible IPA was 5% (3/65) as compared with 12% (6/50) in group B (p > 0.05). Microbiologically documented bacterial pneumonias were observed in 5/65 (8%) patients in group A and in 1/50 (2%) patients in group B (p > 0.05). Thus, no reduction in incidence of IPA from use of prophylactic aerosol amphotericin B inhalations was found in this interim analysis. As there were no serious side effects from aerosol amphotericin B prophylaxis, accrual in the study will continue for a total of 380 patients.

Administration, Inhalation↗
PubMed1995

Patient data management systems in intensive care--the situation in Europe.

OBJECTIVE: Computerized Patient Data Management Systems (PDMS) have been developed for handling the enormous increase in data collection in ICUs. This study tries to evaluate the functionality of such systems installed in Europe. DESIGN: Criteria reflecting usefulness and practicality formed the basis of a questionnaire to be answered accurately by the vendors. We then examined functions provided and their implementation in European ICUs. Next, an "Information Delivery Test" evaluated variations in performance, taking questions arising from daily routine work and measured time of information delivery. SETTING: ICUs located in Vienna (Austria), Antwerp (Belgium), Dortmund (Germany), Kuopio (Finland). PARTICIPANTS: 5 PDMS were selected on the basis of our inclusion criteria: commercial availability with at least one installation in Europe, bedside-based design, realization of international standards and a prescribed minimum of functionality. RESULTS: The "Table of Functions" shows an overview of functions and their implementation. "System analyses" indicates predominant differences in properties and functions found between the systems. Results of the "Information Delivery Tests" are shown in the graphic charts. CONCLUSIONS: Systems with graphical data presentation have advantages over systems presenting data mainly in numerical format. Time has come to form a medical establishment powerful enough to set standards and thus communicate with industrial partners as well as with hospital management responsible for planning, purchasing and implementing PDMS. Overall, communication between clinicians, nurses, computer scientists and PDMS vendors must be enhanced to achieve the common goal: useful and practical data management systems at ICUs.

Database Management Systems↗
PubMed1995

Computer assisted data analysis in intensive care: the ICDEV project--development of a scientific database system for intensive care (Intensive Care Data Evaluation Project).

INTRODUCTION: Patient Data Management Systems (PDMS) for ICUs collect, present and store clinical data. Various intentions make analysis of those digitally stored data desirable, such as quality control or scientific purposes. The aim of the Intensive Care Data Evaluation project (ICDEV), was to provide a database tool for the analysis of data recorded at various ICUs at the University Clinics of Vienna. SETTINGS: General Hospital of Vienna, with two different PDMSs used: CareVue 9000 (Hewlett Packard, Andover, USA) at two ICUs (one medical ICU and one neonatal ICU) and PICIS Chart+ (PICIS, Paris, France) at one Cardiothoracic ICU. CONCEPT AND METHODS: Clinically oriented analysis of the data collected in a PDMS at an ICU was the beginning of the development. After defining the database structure we established a client-server based database system under Microsoft Windows NI and developed a user friendly data quering application using Microsoft Visual C++ and Visual Basic; RESULTS: ICDEV was successfully installed at three different ICUs, adjustment to the different PDMS configurations were done within a few days. The database structure developed by us enables a powerful query concept representing an 'EXPERT QUESTION COMPILER' which may help to answer almost any clinical questions. Several program modules facilitate queries at the patient, group and unit level. Results from ICDEV-queries are automatically transferred to Microsoft Excel for display (in form of configurable tables and graphs) and further processing. CONCLUSIONS: The ICDEV concept is configurable for adjustment to different intensive care information systems and can be used to support computerized quality control. However, as long as there exists no sufficient artifact recognition or data validation software for automatically recorded patient data, the reliability of these data and their usage for computer assisted quality control remain unclear and should be further studied.

Austria↗
PubMed1995

Fat elimination in chronic hepatic failure: long-chain vs medium-chain triglycerides.

Elimination and hydrolysis of fat emulsions containing long-chain (LCT) or long- and medium-chain triglycerides (MCT, 50:50) were compared in eight patients with advanced chronic hepatic failure (CHF) and six healthy control subjects by using a two-stage constant infusion protocol. In control subjects clearance of MCT was slightly higher than that of LCT (1.93 +/- 0.34 vs 1.55 +/- 0.3 mL.kg-1.min-1, P < 0.05). The rise in plasma triglycerides was similar and the release of free fatty acids was higher during MCT (P < 0.02). In CHF patients, clearance of both LCT and MCT was comparable with that in healthy subjects and the rise in plasma triglycerides and release of free fatty acids was identical. We conclude that a clinically relevant infusion rates the elimination of lipid emulsions containing LCT or LCT and MCT and the release of free fatty acids thereof is not altered in patients with CHF and that intravenous lipids are a suitable source of energy and essential fatty acids (and phospholipids) for parenteral nutrition.

Blood Glucose↗
PubMed1995

Laparoscopy in 100 consecutive patients with 128 impalpable testes.

OBJECTIVE: To investigate the value of laparoscopy in boys with impalpable testes, to carry out a histological examination of testicular biopsies or orchidectomy specimens, and to present a clinical description of boys with impalpable testes. PATIENTS AND METHODS: One hundred consecutive patients underwent laparoscopy for 128 impalpable testes. They ranged in age from 2.7 to 19.3 years (median 10.8). Histological examination was performed on 39 testicular biopsies, nine primarily orchidectomized testes and 13 tissue samples from the end of blind-ending vessels and vasa deferentia. Any additional diagnoses to that of impalpable testes were recorded. RESULTS: There were no complications associated with laparoscopy and the procedure clarified the situation in all patients. In 50% of patients either blind-ending cord structures above the internal inguinal ring or intra-abdominal testes were identified; in the remainder, cord structures could be seen passing through the ring, indicating an intracanalicular testis. The impalpable testis was absent in 77% of patients with a contralateral scrotal testis. A seminoma was found in one 18.6-year-old patient with bilateral cryptorchidism. No intratubular germ cell neoplasia (carcinoma in situ) was found. Germ cell hypoplasia or aplasia was demonstrated in 95% of patients with testicular parenchyma. Additional diagnoses were made in 49% of patients with bilaterally undescended testes (one or both of which were impalpable). CONCLUSION: We recommend laparoscopy as a safe procedure which leads to a diagnosis in patients with impalpable testes; the advent of laparoscopic procedures makes definitive treatment possible in about 50% of such patients. Open procedures will be indicated only to ascertain the quality and treatment of intracanalicular testes.

Adolescent↗
PubMed1995

[Evaluation and analysis of social relationships of children in clinical practice and research: "Social Relationship Scale for Children"].

The Social Relationship Procedure for Children (Soziales Beziehungsverfahren f¿ur Kinder, SOBEKI), a technique employing figure tasks and interviewing, is a new clinical psychology assessment instrument for use with children. With this instrument it is possible to (a) determine the significant others (social network) of 6- to 12-year-old children, (b) measure how specific functions are divided among members of a child's social networks, and (c) visualizing cohesion and hierarchical structures of the children's networks within and outside their families. In the present paper the theoretical foundations, administration and assessment of the procedure are outlined. In addition, the results of a comparison of children with psychiatric disorders and a healthy control group are presented.

Child↗
PubMed1994

Elimination of amino acids in renal failure.

The elimination of intravenously infused amino acids was evaluated in six patients with acute renal failure (ARF), 6 with conservatively treated chronic renal failure (CRF), 6 subjects receiving regular hemodialysis treatment (RDT), and 5 healthy control subjects. In ARF, CRF, and RDT groups, whole-body clearance (Cltot) of the 10 amino acids was elevated (113.5 +/- 1.5; 94.2 +/- 1.5 and 127.6 +/- 12.4, respectively, vs 85.2 +/- 4.8 mL.kg-1.min-1 in control subjects, P < 0.001). In ARF, Cltot of histidine, lysine, and methionine was higher and Cltot of phenylalanine and valine was lower as compared with control subjects. In CRF, Cltot of tryptophan and histidine was elevated and Cltot of phenylalanine was reduced; in RDT, Cltot of histidine, methionine, tryptophan, lysine, isoleucine, and leucine was raised. In all groups the relative clearance (% of total clearance) of phenylalanine and valine was reduced, and relative clearance of histidine and tryptophan was elevated. We conclude that in renal failure the elimination of amino acids from the intravascular space is profoundly altered and that the pattern of metabolic aberrations is similar in ARF, CRF, and RDT groups.

ADP-Ribosylation Factor 6↗
PubMed1994

[Psychiatric disorders in children of alcoholic parents].

The role of parental alcohol abuse was investigated in children and adolescents seen as inpatients or outpatients at our child psychiatry unit in 1992. Data were obtained from our clinical documentation system, which is based on WHO recommendations. The control group consisted of patients in whose families there was neither substance abuse nor another serious medical problem. The groups differed significantly on axis V of the Multi-axial Classification Scheme (associated abnormal psychosocial situations) but not in psychopathology or psychiatric diagnosis.

Adaptation, Psychological↗
PubMed1994

Acute renal failure in the elderly 1975-1990.

Two hundred and forty-two elderly patients (> 65 years) with acute renal failure (ARF) treated at a predominantly medical intensive care unit between 1975 and 1990 were retrospectively analyzed for underlying diseases, severity of disease (as evaluated by the rate of ventilated patients, septicemia and APACHE II score, respectively), causes of ARF, acute and chronic risk factors for the development of ARF, complications during treatment and outcome. Overall mortality was 61%; 28 patients (12%) died in spite of resolution of ARF so actually, 49% of the patients died in ARF. Outcome was comparable to other age groups with overall mortality being 57% in patients < 18 years and 59% in those 19-65 years. Moreover, within the group of elderlies mortality did not increase with age and was 60% in those aged 65-68 and 54% in those aged > 80 years, respectively. The need for renal replacement therapy, plasma creatinine > 6 mg/dl, anuria, BUN > 120 mg/dl, ventilator dependency and the presence of septicemia all negatively affected outcome. During the years 1975 to 1990 mortality decreased from > 70% to < 50% (p < 0.02). This improvement of survival was seen in spite of an increase in the severity of disease (1975-1982: 20% ventilated patients, 24% with septicemia, 1983-1990 51% and 40%, respectively, p < 0.01). We conclude that age per se is not an important determinant of survival in patients with ARF and that prognosis has improved considerably during the last 15 years and this was seen in spite of an increase in the severity of disease. It is not justified to withhold therapy in elderly patients acquiring ARF.

Acute Kidney Injury↗
PubMed1994

Oropharyngeal decontamination with gentamicin for long-term ventilated patients on stress ulcer prophylaxis with sucralfate?

The incidence of nosocomial pneumonia in long-term ventilated patients has been reduced by stress ulcer prophylaxis with sucralfate. In a double-blind trial we studied whether gentamicin administered topically to the oropharynx (OPG) had additional clinical benefits in these patients. 67 critically ill adult patients fulfilled entry criteria for > or = 5 days on ventilation. The OPG group received 40 mg gentamicin, the control group received 5% dextrose topically administered to the oropharynx 4 times a day. During OPG, pharyngeal colonization rate (21 vs 44%) and tracheal secretion colonization rate (12 vs 41%) were significantly lower than during placebo (p < 0.05). Despite these differences nosocomial pneumonia rate (3 vs 12%), duration of mechanical ventilation [15.8 +/- 11.1 vs 19.9 +/- 37.5 days (means +/- SD)] and mortality (27 vs 41%) were not significantly affected by OPG. Moreover, 13 of 15 bacteria (87%) that occurred during OPG were resistant to gentamicin. Despite its reduction of bacterial colonization rates of pharyngeal and tracheal secretions, OPG did not seem to offer additional clinical benefits in long-term mechanically ventilated patients on stress ulcer prophylaxis with sucralfate.

Administration, Topical↗
PubMed1993

Early prediction of individual outcome after cardiopulmonary resuscitation.

Prediction of individual outcome after cardiopulmonary resuscitation is of major medical, ethical, and socioeconomic interest but uncertain. We studied the early predictive potency of evoked potential recording after cardiac arrest in 66 resuscitated patients who returned to spontaneous circulation but were unconscious and mechanically ventilated. Detailed long-latency and short-latency sensory evoked potentials were recorded and neurological evaluations were done 4-48 h after admission to intensive care. In all 17 patients with favourable outcome (cerebral performance categories 1 and 2) the cortical evoked potential N70 peak, a reliable measure of cortical function, was detected between 74 and 116 ms. In 49 patients with bad outcome (categories 4 and 5) the N70 peak was absent in 35 or found with a delay between 121 and 171 ms in 14 (p < 0.05 vs favourable outcome). Thus the predictive ability was 100% with cutoff of 118 ms. To confirm reproducibility and validity, repeated tracings, and linked-earlobe referenced techniques were done and gave similar results. Early recording of long-latency evoked potentials after cardiopulmonary resuscitation is highly predictive of outcome.

Adolescent↗
PubMed1993

Lactic acidosis in thiamine deficiency.

Two chronically ill patients with limited nutritional intake during several weeks developed prolonged lactic acidosis. As no other causes of hyperlactaemia could be identified, thiamine deficiency was suspected. Supplementation of 600 mg thiamine resulted in a rapid normalisation of serum lactate levels (in patient 1 from 10.9-2.4 mmol/l; in patient 2 from 11.8-2.0 mmol/l) and acid base status (patient 1: pH from 7.11-7.30, bicarbonate from 8.6-21.2 mmol/l; patient 2: pH from 7.24-7.46, bicarbonate from 16-28 mmol/l; before and after treatment, respectively). Thiamine deficiency was confirmed by the degree of stimulation of erythrocyte transketolase activation by adding thiamine pyrophosphate, evaluated before and after thiamine replacement therapy. Stimulation decreased in patient 1 from 170% to 17% and in patient 2 from 20% to 0%, respectively. In addition to the metabolic derangement right ventricular heart failure was confirmed by echocardiography in both patients and again this was rapidly reversible by thiamine supplementation. We conclude that in malnourished patients unexplained prolonged lactic acidosis may result from thiamine deficiency, which is rapidly reversible by thiamine replacement therapy.

Journal Article↗
PubMed1993

GM-CSF in the treatment of a patient with severe methotrexate intoxication.

This case report describes the successful treatment of severe methotrexate intoxication in a 72-year-old female patient. Following two prior uneventful courses of a polychemotherapy regimen including low-dose intravenous (i.v.) methotrexate, the patient presented with fever, polymucositis, incipient pyodermia, acute renal failure and pancytopenia 9 days after the third application. Severe methotrexate overdose was confirmed by serum levels. Using a polypragmatic treatment approach focusing on renal function and including granulocyte-macrophage-colony-stimulating factor (GM-CSF) this life threatening and nearly fatal intoxication was successfully treated. This case report demonstrates that GM-CSF might contribute to rapid reconstitution of leukopoiesis once methotrexate serum levels are in the subtoxic range.

Acute Disease↗
PubMed1993

Endothelin-1 in adult respiratory distress syndrome.

Endothelin-1 (ET-1), a potent vasoconstrictor peptide produced by endothelial cells and degraded predominantly in the pulmonary vasculature, has been implicated in the development of various organ dysfunctions. To determine the pathophysiologic role of ET-1 in adult respiratory distress syndrome (ARDS) and the impact of impaired lung function on transpulmonary peptide handling, we compared plasma levels and pulmonary ET-1 balance in 14 patients with ARDS and in seven healthy control subjects. To obtain comparable conditions in both groups, the ET-1 level was raised in the control group by exogenous infusion (0.4 pmol/kg/min) to 9.4 +/- 0.8 pmol/L. ARDS was accompanied by a hyperdynamic circulatory pattern with increased cardiac output and depressed total vascular resistance but, simultaneously, pulmonary hypertension. Venous ET-1 concentration was massively increased in ARDS (9.8 +/- 1.2 versus 2.1 +/- 0.2 pmol/L, p < 0.001). In control subjects, the lung cleared the major fraction of ET-1 (fractional extraction 43 +/- 8.8%, uptake 12.5 +/- 2.5 pmol/min). In contrast, in ARDS there was a pronounced pulmonary releases into the circulation (32.8 +/- 10.3 pmol/min). We conclude that ET-1 concentrations are elevated in ARDS as the result of both increased formation and decreased disposal. Lung failure affects not only gas exchange but also nonrespiratory, metabolic pulmonary functions.

Adolescent↗
PubMed1993

Effect of immunoglobulin administration on blood rheology in patients with septic shock.

The hemorrheological determinants plasma fibrinogen, plasma viscosity, red cell aggregation, and hematocrit were studied in 11 patients before and 4 and 24 hr after a 15 g immunoglobulin infusion to assess the effect of intravenous immunoglobulin administration on blood rheology in septic shock. Four hr after the immunoglobulin administration, plasma fibrinogen decreased significantly [472 (175-950) vs. 522 (182-1,050) mg/dl before administration; median (range); P < 0.01]; after 24 hr, plasma fibrinogen tended to increase again [501 (185-980); n.s.]. No changes were seen in plasma viscosity, red cell aggregation, hematocrit, and coagulation status 4 and 24 hr after immunoglobulin administration. In patients with septic shock, intravenous immunoglobulin administration leads to a decrease in plasma fibrinogen, whereas plasma viscosity and red cell aggregation remain unaffected. The explanation for the decrease in fibrinogen remains speculative.

Adult↗
PubMed1992

Diagnosis of gallbladder perforation in acute acalculous cholecystitis in critically ill patients.

In the presence of ascites ultrasound is not appropriate to distinguish between gallbladder perforation and acute acalculous cholecystitis. However, the correct and early diagnosis of gallbladder perforation is important for the treatment and prognosis. We report 4 critically ill patients with ascites. All patients had evidence of gallbladder perforation by ultrasound and underwent cholecystectomy: 2 patients had gallbladder perforation, but 2 had acalculous cholecystitis without perforation. Markedly elevated serum alkaline phosphatase was the only discriminating finding indicating gallbladder perforation.

Adult↗