Multiple organ failure in generalized disseminated tuberculosis.
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Aged↗
Biomedical subjects
M Sydow
Publications and source records attributed to M Sydow.
[Polytrauma following a fall from a great height. The injury pattern and the intensive medicine aspects].
We report on 10 polytraumatised patients who were treated in an ICU after a free-fall injury. The injury pattern of these patients proved to be relatively uniform. Brain oedema occurred in many victims. Remarkable was the fact that 8 out of 10 patients developed a pneumothorax, but only three of them had rib fractures on the same side. All patients suffered from fractures of the extremities with the lower extremities being affected more often. Abdominal injuries were not of importance.
Abdominal Injuries↗
[Extreme duration of action of diazepam as a cause of respiratory insufficiency in a female geriatric patient].
A 77-year-old woman who had undergone surgery of a non-malignant extracerebral retro-orbital tumor suffered postoperatively from respiratory failure due to impaired respiratory drive and unconsciousness of unknown origin and required artificial ventilation for 14 days. After cerebral and endocrinological causes had been excluded, the residual effects of diazepam were taken into consideration, since the patient had received this substance for premedication and during 3 days postoperatively (total 165 mg). After the application of flumazenil (Anexate), a specific benzodiazepine receptor antagonist, she awoke immediately and was extubated with sufficient spontaneous breathing. The hypothesis that diazepam was the causative agent for the respiratory failure and impaired consciousness was supported by the detection of high serum concentrations of diazepam and its active metabolite desmethyldiazepam. During the following 3 days repetitive injections of flumazenil were necessary to counteract recurring depression of respiration and vigilance. Thereafter further application of flumazenil was not necessary.
Aged↗
Postoperative pulmonary complication rate and long-term changes in respiratory function following esophagectomy with esophagogastrostomy.
Upper abdominal surgery has a high incidence of postoperative respiratory complications. Although operations involving a thoracic as well as an upper abdominal incision as encountered in esophageal surgery are likely to be associated with an even higher complication rate and perhaps permanent alterations of respiratory function, only a few studies have addressed this problem. We evaluated the postoperative course of patients undergoing thoracoabdominal esophagectomy with esophagogastrostomy. Twenty patients were evaluated, of whom 10 (50%) developed respiratory complications as defined by our criteria, which were the simultaneous occurrence of rectal temperature over 38 degrees C on the first postoperative day and radiographic evidence of pulmonary infiltration. Although there is no general consensus regarding the diagnostic criteria of a postoperative pulmonary complication, we were able to validate the clinical relevance of our definition by showing that these patients suffered from a more severe and more prolonged impairment of global oxygen exchange than those who did not fulfill the criteria. They also required a longer period of respiratory support (median duration of intubation 12 vs. 3 days, P less than 0.005). A comparison of the preoperative pulmonary function with that determined at least 6 months after the operation showed that only vital capacity (VC) and total lung capacity (TLC) were significantly (P less than 0.05) reduced following the operation, but not to a clinically relevant degree (VC-6%, TLC-7%).
Adolescent↗
The influence of isoflurane on peri-operative endocrine and metabolic stress responses.
Trauma and surgery profoundly affect the circulating concentrations of metabolites and so-called stress hormones, and may thereby directly or indirectly influence recovery. This stress response on the other hand is subject to modification by the anaesthetics employed. We investigated the effects of isoflurane on selected stress parameters in 10 patients undergoing major abdominal surgery and compared them to those in 10 patients receiving halothane. Plasma levels of adrenaline, noradrenaline, cortisol, ACTH, and beta-endorphin, as well as glucose, non-esterified fatty acids (NEFA), and lactate were determined during a pre-operative anaesthesia period as well as intra- and post-operatively. The levels of all parameters remained stable or decreased during the pre-operative anaesthesia period. They increased intra- and/or post-operatively, reaching peak values in the recovery period. Although the changes in both groups were basically similar, we observed lower serum concentrations of cortisol and lactate in the isoflurane group. We conclude that isoflurane and halothane have similar effects on peri-operative changes of endocrine and metabolic parameters, and that neither can effectively block the stress response to major surgery. We found no firm evidence for a stimulatory effect of isoflurane on the parameters studied.
Adrenocorticotropic Hormone↗
[Endotracheal suctioning using a 24-hour continuous system. Can costs and waste products be reduced?].
Suctioning of the airways is often required in critically ill, intubated, or tracheotomised patients. In addition to the primary cost of these disposable materials, expenditures for waste disposal and environmental problems due to plastics should also be considered. In this study, the primary costs and amount of waste products of the closed suction system "Trach Care" were compared with a conventional disposable system. Other advantages and disadvantages of a closed suction system are discussed. METHODS. In this prospective, randomised investigation, both the open disposable suction system and the closed Trach Care system were used, in 60 patients (30 in each group) who were intubated for 1 week or more. During the first 7 days, we counted the number of times endotracheal suctioning was performed and measured the time it took. The costs of purchasing the systems, amounts of waste products, and costs of disposal were compared. RESULTS. The frequency of endotracheal suctioning was quite different from patient to patient and varied from 6 to 41 times per day. On average it was necessary 15 times per day per patient in both groups. Using the disposable system, a mean time of 3.5 min was measured in contrast to 2.5 min with the closed system. The costs of purchase were much lower with the disposable system taking into account all materials needed (17.36 DM vs 53.36 DM per day), whereas the weight of litter produced by the closed system was lower (429 g vs 745 g per day), the costs of disposal being accordingly different. During endotracheal suctioning O2 desaturation was not observed with the closed system, whereas in patients with acute respiratory failure O2 saturation fell rapidly from 90% to as far as 70% when a disposable system was used. CONCLUSION. The closed Trach Care suction system is more expensive to acquire, but may reduce the risk of exogenous nosocomial pneumonias as disconnections from the ventilator are minimised. The workload, weight of waste products, and costs of disposal are lower using the Trach Care system. From the physician's viewpoint, the main advantage of the Trach Care system becomes evident in patients with acute respiratory failure and patients with elevated intracranial pressure. In these cases, we now favor the Trach Care system as a matter of principle.
Anesthesiology↗
Improved determination of static compliance by automated single volume steps in ventilated patients.
A new method for determination the static compliance of the respiratory system is described ("static compliance by automated single steps"--SCASS). In 12 ventilated patients pressure/volume (P/V) curves were determined by automated repetitive occlusion (6 s) at single volume steps and compared to the conventional syringe method (SM). All measurements were corrected for effects of temperature, humidity and pressure (THP). SM was found to be significantly influenced by intrapulmonary gas exchange causing an effective mean volume deficit of 217.4 +/- 65.7 ml (BTPS) at the end of the deflation. In contrast to that, the short duration of occlusion in SCASS minimize the gas exchange effects. The methodical differences between both methods result in overestimation of the inflation compliance in the uncorrected SM (SMuncorr: 83.4 +/- 12.6; SCASS: 76.0 +/- 11.9 ml/cmH2O. p less than 0.01) and underestimation of the deflation compliance resp. (SMuncorr: 58.3 +/- 7.5; SCASS: 79.1 +/- 15.0 ml/cmH2O. p less than 0.005). In contrast to the P/V curves by SM no significant hysteresis was found by SCASS. Gas exchange seems to be the main reason for the hysteresis. Even after correcting gas exchange and THP effects a significant hysteresis remained. The SCASS method avoids these problems and allows furthermore an accurate checking of leaks.
Adult↗
[Gas embolism with cardiac arrest during hysteroscopy. A case report on 3 patients].
Hysteroscopy and laparoscopy are relatively non-invasive methods routinely employed in the investigation of infertility. The danger of air embolism during these procedures was recognized early, and carbon dioxide was substituted for air since it is more readily soluble in blood. In this report we describe 3 cases of circulatory collapse and cardiac arrest in healthy young women during routine hysteroscopy (out of a total of 62 patients during the period 1989-1990) which were most probably caused by massive carbon dioxide embolism. Premedication was with oral diazepam 10 mg. Anesthesia was induced with 0.1 mg fentanyl, 2.5 mg droperidol and 100 mg methohexital (100 mg propofol in one case). Intubation was facilitated with 2 mg pancuronium and 50-100mg succinylcholine. Anesthesia was maintained with nitrous oxide 66% and halothane. Ventilation was controlled with a tidal volume of 10 ml per kilogram body weight at a rate of 10 per minute. Monitoring included ECG, automated non-invasive blood pressure, capnometry, pulse oximetry and body temperature. Anesthesia was uneventful prior to insufflation. In each case the signs and symptoms began approximately 5-8 minutes after the start of insufflation and consisted of an initial tachycardia rapidly followed by ventricular dysrhythmias, bradycardia and cardiac arrest. The end-tidal CO2 decreased during the tachycardic phase and prior to asystole. The patients were cyanotic with engorged jugular veins. Resuscitation with closed chest heart massage and intravenous epinephrine or orciprenaline was successful in every case. The typical "mill wheel phenomenon" of gas embolism was audible on auscultation after heart activity had returned, but disappeared after about 5 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Haemodynamic and endocrine effects of deliberate hypotension with magnesium sulphate for cerebral-aneurysm surgery.
Deliberate hypotension is widely used during cerebral-artery aneurysm surgery to facilitate clipping and to prevent rupture. A large number of drugs are commonly employed to achieve hypotension, but all have their specific drawbacks. We investigated the effects of magnesium-sulphate-induced hypotension on haemodynamics, as well as on plasma catecholamine and renin concentrations in 11 patients undergoing cerebral-aneurysm surgery. Magnesium sulphate lowered blood pressure by reducing systemic vascular resistance. There was no reflex tachycardia or rebound hypertension, and cardiac output was not decreased. Plasma renin activity increased during hypotension but the inhibitory effects of magnesium on angiotensin converting enzyme prevented angiotensin-II-associated hypertension. Plasma catecholamine concentrations increased moderately during hypotension. Renal perfusion was not impaired since diuresis remained constant or even improved during and after hypotension. Magnesium sulphate in high doses has major drawbacks, however, among which are enhanced neuromuscular blockade and delayed return of consciousness. Although the haemodynamic effects of magnesium sulphate during hypotension appear to be beneficial, these side-effects might limits its usefulness, particularly in neurosurgery. More research must be conducted before magnesium sulphate can be considered a routine method.
Adult↗
[Management of acute respiratory insufficiency in chronic obstructive lung diseases].
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Acute Disease↗
Production and characterization of a fragment containing the HIV-gp120 binding region of CD4 using a bovine papilloma virus (BPV) vector.
We have used a bovine papilloma virus (BPV) based mammalian cell expression vector consisting of the complete BPV genome and a human cytomegalovirus transcription unit for the production of soluble CD4. Mouse C-127 cells were transfected with vector DNA together with a selectable G418 resistance plasmid. Surviving clones were selected for high production using a solid phase ELISA based on the immobilization of supernatant-derived CD4 onto nitrocellulose paper and subsequent detection with anti-CD4 antibodies. The expressed protein was shown to bind HIV-gp120 and efficiently block HIV-1 infection in vitro. The possibility to use the above system for rapid production of defined glycoprotein fragments harboring defined functional regions, for the further elucidation of the functional role of CD4 in antigen presentation and cell to cell contact, and for possible intervention during HIV infection is discussed.
Bovine papillomavirus 1↗
[The effect of selective decontamination on nosocomial infections, their causative agents and antibiotic resistance in long-term intubated intensive care patients].
During a 12-month period 45 long-term intubated patients were treated by topical application of non-absorbable antibiotics (tobramycin, polymyxin, amphotericin B) together with an initial short-term intravenous application of an antibiotic with only minimal activity against anaerobic intestinal flora. These patients were compared to 48 patients in the previous 12-month period who had only interventional antibiotic therapy in case of established infections. This selective decontamination of the digestive tract (SDD) reduced the colonisation of the respiratory tract, thus also decreasing incidence of nosocomial pneumonia. There were fewer urinary tract infections, while the incidence of wound infections and septicaemia was influenced to microorganism a lesser degree. The number of gram-negative isolated microorganism was reduced, leading to a shift towards gram-positive organisms, especially S. epidermidis. During the 12-month study period there was no change of antibiotic sensitivity of the isolated microorganisms. Although we encountered no problems associated with multiresistant pathogens, routine microbiological surveillance is strongly recommended to detect changes in antibiotic resistance at an early stage.
Administration, Topical↗
[Organ failure in patients with multiple trauma. The effect of early osteosynthesis of fractures on complications].
The course of 225 multiple traumatized patients in our ICU with a mean age of 35 +/- 16.8 years, a mean ISS of 30 +/- 8.3 and an overall mortality of 18.2% was evaluated retrospectively. For comparable ISS the mortality was higher in patients over 65 years, and increased further with age. The most common causes of death were MOF (41.5%), severe head injury (34.1%), and acute respiratory failure (ARF) (19.5%). The mortality increased when two or more organ failures were present. 105 patients had fractures of the long bones; in 28 of these all fractures were stabilized primarily (during the first 24 hours). Organ failure was seen less frequently in these patients compared to those with secondary stabilization: ARF 10.7% vs. 51.9% (p less than 0.0004), acute renal failure 3.6% vs. 11.7%, liver failure 3.6% vs. 11.7%, sepsis 14.3% vs. 29.9%. Mortality was significantly lower in the patient with primarily stabilized fractures (7.1% vs. 24.7%, p less than 0.05). The study demonstrates that early stabilization of long bone fractures results in a more favourable course, and that this should be carried out whenever feasible.
Adolescent↗
[Hemodynamic effects of the benzodiazepine antagonist flumazenil following laparotomy under total intravenous anesthesia using midazolam].
Inhalational anesthetic agents, particularly nitrous oxide, are potentially hazardous to both the patient and operating room personnel. Recent efforts have been directed towards the development of intravenous anesthetic techniques using combinations of a hypnotic with an analgesic. The hypnotic used in such a combination should have a short elimination half-life, little or no influence on hemodynamics, and no side effects. Benzodiazepines are likely candidates for total intravenous anesthesia (TIVA) since they combine hemodynamic stability and paucity of unwanted effects with the ability to induce amnesia for the entire perioperative period. They do have long elimination half-lives; even midazolam, the shortest-acting benzodiazepine, has a half-life of 2 to 3 h. This disadvantage might be counteracted by the use of flumazenil, the recently introduced, specifically acting benzodiazepine antagonist. The aim of this study was to determine the effects of rapid awakening following flumazenil after major abdominal surgery with benzodiazepine-fentanyl TIVA. Six patients (4 male, 2 female) scheduled for elective laparotomies participated in this pilot study. The average duration of surgery was 2.2 +/- 0.9 h. The patients were given 2 mg flunitrazepam p.o. the evening before surgery and 1 h before being brought to the operating room. Baseline pre-induction values were obtained 15 min after inserting catheters and attaching the EEG electrodes. Fentanyl (0.005 mg/kg) was given as a bolus injection followed by a rapid midazolam infusion. The infusion rate was calculated using the method of Wagner et. al. from the data of Lauven et al. to give plasma concentrations of 500 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[A case of bronchospasm under isoflurane anesthesia].
Isoflurane is generally considered to have little effect on bronchomotor tone. The following case report shows that isoflurane anesthesia can be associated with severe bronchospasm. A 9-year-old girl (35 kg, 140 cm) with no history of asthma or drug sensitivity was scheduled for emergency appendectomy. Anesthesia was induced with fentanyl, methohexital, and vecuronium. Breath sounds were normal prior to induction and after endotracheal intubation. Isoflurane was added to the gas mixture 5 min after the last injection. Almost immediately after isoflurane was added the mean inspiratory pressure increased from 15 to ca. 35 cm H2O, expiration was prolonged, and wheezing was heard on auscultation. End-expiratory CO2 increased from 5.1% to more than 8% (pCO2 ca. 60 mmHg). Halothane was substituted for isoflurane and theophylline was injected, i.v. shortly after which the inspiratory pressure decreased, the wheezing improved, and the end-expiratory CO2 returned to normal. The remaining course and postoperative period were uneventful. Isoflurane is considered to be the causative agent in this case. Other possible mechanisms are discussed and pertinent literature is reviewed.
Anesthesia↗
Surface properties of lactobacilli isolated from the small intestine of pigs.
One hundred wild-type strains of the genus Lactobacillus were isolated from the small intestine of newly-slaughtered pigs up to 6 months of age. Cell surface hydrophobicity and capsule formation were studied on a number of strains. Strains showing high surface hydrophobicity as measured by the salt-aggregation test and hydrophobic interaction chromatography on Octyl Sepharose were commonly found to adhere in high numbers to isolated pig intestinal epithelial cells. Heat and protease treatment of bacteria of high surface hydrophobicity, including autoaggregating strains in phosphate-buffered saline, showed a drastic decline in this surface property. Three hydrophilic strains (LBp 1044, 1068 and 1073) also showed binding to intestinal cells but at a lower level (approx. 5 bacteria/cell) as compared with the best binding hydrophobic strain (LBp 1063, approx. 11 bacteria/cell). These findings suggest that different or multiple adhesion mechanisms may be involved in the colonization of the small intestinal mucosa of pigs. Cultures of selected strains grown in liquid media rich in carbohydrates did not affect their hydrophobic cell surface character. Therefore it seems less likely that carbohydrate capsule polymers are the major determinants of intestinal colonization of lactobacilli in pigs.
Animals↗
The effect of olfactory bulb lesions on agonistic, locomotory and social behavior in mice housed in aggregate.
Eleven Dublin ICR mice sustaining nearly complete bilateral aspiration lesions of the olfactory bulbs were compared to 16 sham-operated mice on the frequency of agonistic, locomotory, social, and maintenance behaviors. The animals were housed in aggregate with two cages of bulbectomized mice and two cages of shams. A time sampling technique was used to quantify the frequency of the various behaviors three times per week during one preoperative and four postoperative weeks. During the first two postoperative weeks the bulbectomized mice were observed to make frequent single bites of the head incision and tail of mice passing directly in front of them, with the bites resulting in mild to severe lesions. Following surgery, the bulbectomized mice also showed a temporary increase in locomotory responses and permanent suppression of social responses.
Aggression↗
Influence of isolation and training on fighting in mice with olfactory bulb lesions.
Isolation-induced aggressive mice receiving total bilateral bulbectomy failed to fight after chronic training. Animals receiving sub-total olfactory bulbectomy were capable of being trained to attack but the latency to attack was increased. When mice were bulbectomized before being isolated they were incapable of attack regardless of training or completeness of the lesion. These results indicated that isolation influences aggressive behavior in bilaterally bulbectomized mice.
Aggression↗