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P Sporn

Publications and source records attributed to P Sporn.

At least 37 records · Page 2Linked to original sources
PubMed1989

[Preoperative plasma exchange in treatment of plasma-related coagulation disorders before liver transplantation].

PATIENTS AND METHODS: Seventy-two consecutive patients undergoing orthotopic liver transplantation at the Department of Surgery I, University of Vienna Medical School (OLT nos. 1 to 72), were evaluated. Their mean age was 47 years (range: 18-63 years). The indications for liver transplantation are listed in Table 1. All transplant procedures were performed without using a bypass technique. The intraoperative management and surgical procedure have been described elsewhere [7]. Patients were categorized in two groups, each of which was divided in two subgroups. Group I consisted of 18 patients transplanted before the introduction of preoperative plasma exchange. These were retrospectively allocated to two subgroups on basis of their preoperative prothrombin times (PT): A (n = 9): preoperative PT less than 40%; B (n = 9): preoperative PT greater than 40%. The two subgroups of group 2, which contained 54 patients, were compared on a prospective basis: C (n = 32): preoperative PT above 40%; D (n = 22): PT on admission below 40%, preoperative plasma exchange. Comparison of the two subgroups was based on the following parameters: (1) pre-exchange PT (subgroup D); (2) preoperative PT (= PT post-plasma exchange in subgroup D; (3) intraoperative infusion volumes (balanced electrolyte solutions and human albumin to maintain an intravascular colloid osmotic pressure greater than 16 mm Hg); (4) transfusion volumes (whole blood stored for no more than 72 h or packed red cells and fresh plasma, as available; and (5) intraoperative sodium bicarbonate requirements to maintain an arterial pH greater than 7.20. RESULTS: (Table 2) . Prothrombin time (PT): Group 1: Patients in subgroup A had a mean preoperative PT of 34% (range: 15%-40%). This was significantly lower than in subgroup B (74%; 52%-100%; P less than 0.001). Group 2: The pre-exchange mean PT in subgroup D was 27% (12%-39%) vs. 68% in subgroup C (45%-104%), the difference being highly significant (P less than 0.0001). In patients in subgroup D a mean plasma volume of 3638 ml was exchanged by plasmapheresis. This resulted in a significant increase in PT to 55% (Table 3). As a result, the preoperative post-exchange PT in subgroup D was slightly but significantly (P less than 0.005) less than in subgroup C. Transfusion volumes: Group 1: Patients in subgroup A needed significantly more blood units than those in subgroup B (55.3 units [19-110] vs. 18.7 [3-33]).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1989

[Liver transplantation--anesthesiology aspects].

Based on our experience in 82 liver transplant procedures performed without using a bypass-technique, we report on our current perioperative anaesthetic management. Preoperative plasma exchange with fresh frozen plasma proved very effective in 16 patients with severe coagulation defects, leading to a significant increase in prothrombin time from 27 to 55%. Intra- and postoperative haemodynamic profiles of 48 patients are presented. Baseline measurements revealed a hyperdynamic circulatory state with elevated cardiac index (CI) and heart rate in all patients. During the anhepatic phase CI and mean arterial pressure (MAP) were persistently lowered. Immediately after reperfusion of the graft, reflux of the stagnant venous content induced a significant increase in CI and led to a moderate elevation of pulmonary artery pressure. MAP showed a rather slow recovery, but was within the normal range at the end of surgery. Oxygen consumption index, which was significantly lowered during the anhepatic period, excessively increased after reperfusion of the graft.

Adult↗
PubMed1989

[Evoked potentials in the follow-up and prognosis of patients with craniocerebral trauma].

The aims of this study were to find a reliable way of establishing the prognosis for the final outcome in the first week after head injury, to show the correlation between abnormalities in evoked potentials (EP) and clinical coma score, and finally, to document EP results in patients with the clinical diagnosis of brain death. We examined 46 patients, 23 in different states of coma and 23 with bulbar syndrome (complete absence of cortical and brain stem function). In the group of comatose patients brain stem auditory EP (BAEP) and somatosensory EP (SEP) were recorded in the first 48 h, 3-5 days, 1 week and 4 weeks after the head injury. The depth of coma was scaled with a scoring system devised by the authors and with the Innsbruck coma scale. Outcome was evaluated with the Glasgow outcome scale after 3, 6, and 9 months. BAEP were recorded bilaterally after stimulation with clicks; SEP were recorded from the neck (C2) and the contralateral cortex (C3', C4') after electrical stimulation of the median nerve. Evoked potentials were scored according to a four-point scale from grade 1 (normal) to grade 4 (only component I present in BAEP or absence of cortical responses on both sides in SEP). We found a significant correlation between the mean SEP score of the first week and the Glasgow outcome of the 3rd month, but no significant correlation between the BAEP score of the first week and the Glasgow outcome. There was a significant correlation between SEP (BAEP) scores and the corresponding clinical score.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Malignant hyperthermia susceptibility confirmed in both parents of probands. A report of three Austrian families.

From 1976 to 1986, 79 cases of suspected malignant hyperthermia (MH) were reported to the authors' institution. A total of 233 muscle biopsies was done in 66 families. The mother and father of the proband were investigated in 44 families; in three of these, both parents of probands gave positive test results. These three families, all from Vorarlberg, a secluded mountain area, represent 4.5% of all our MH-positive families (n = 61) and 7.3% of all MH-positive families where both parents had been tested (n = 41). This observation might be explained by: 1) a much higher incidence of MH in this part of Austria, and 2) a different test policy, as at the authors' institution, if possible, both parents are investigated, even if there is a positive test result in one of them. It is concluded that family investigations of MH susceptibility should always include both parents of a proband.

Adult↗
PubMed1988

[Hemodynamic and metabolic changes during orthotopic liver transplantation].

Hemodynamic and metabolic profiles were obtained on 48 adult patients (mean age 46 years) undergoing orthotopic liver transplantation without using a bypass technique during the anhepatic period. Baseline measurements after induction of anesthesia (A) revealed a high-output circulatory state. During hepatic dissection (B, preclamping control), mean arterial pressure (MAP), mean pulmonary artery pressure (MPAP), pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), and elevated cardiac index (CI) were well maintained. Preoperative plasma exchange with fresh frozen plasma in the presence of severe coagulation defects and liberal use of platelet concentrates limited the need for massive blood transfusion, and thus contributed to stable hemodynamics during this stage. Significant cardiovascular changes occurred immediately after clamping of the inferior vena cava and the portal vein (C): there was a marked fall in MAP (-30%), MPAP (-45%), PCWP (-48%), RAP (-40%), and CI (-60%) reflecting the hemodynamic adaptation to the impeded venous return. At the end of the anhepatic period (D), MAP (-21%), MPAP (-38%), PCWP (-39%), RAP (-24%), and CI (-56%) were persistently lowered because no attempts were made to attenuate the clamping response by vigorous volume expansion or infusion of inotropic drugs. The reduction in oxygen availability index (O2AVI) was compensated by enhanced oxygen extraction. Oxygen consumption index (VO2I) fell secondary to the removal of the liver and the decrease in body temperature (BT). Potassium levels and acid-base balance were well controlled; no hypoglycemic episode was observed during the anhepatic period.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Equilibrium↗
PubMed1988

[Malignant hyperthermia in Austria. III. Anesthesia in susceptible patients].

Anesthesia in patients susceptible to malignant hyperthermia (MH) is generally considered to be very risky, although - with one notable exception - there are no prospective studies about anesthetic management in a large number of such patients. The prophylactic use of dantrolene has been recommended in MH patients, although there is no strong evidence supporting this - despite the fact that dantrolene may have serious side effects. We therefore decided to report the results of our own anesthetic technique for MH patients, as our technique does not include the prophylactic use of dantrolene. From 1981 to 1988, 19 operations on 16 MH-susceptible patients were performed. Patients 1-4 were pediatric survivors of an MH episode, where MH susceptibility was confirmed by muscle biopsy and in vitro contracture tests in at least one parent; patients 5-7 were survivors of an MH crisis, and they later underwent diagnostic muscle biopsies themselves; all other patients (nos. 8-16) were relatives of MH survivors with positive in vitro contracture tests. Diazepam, pentobarbital, pethidine, and chlorprothixene were used for premedication; no prophylactic dantrolene was given. Anesthesia was induced by thiopentone and was continued by nitrous oxide/oxygen, fentanyl, and droperidol; alcuronium, atracurium, and vecuronium were administered as necessary. Pyridostigmine, atropine, and naloxone were used if appropriate. New or disposable tubings were used for ventilation, and the vaporizers were removed from the anesthesia machines. ECG and body temperature were recorded in all patients; blood pressure was monitored invasively if indicated; end tidal CO2 was monitored whenever possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Malignant hyperthermia in Austria. II. A comparison of the results of diagnostic test procedures].

During the last 4 years different diagnostic procedures for the detection of malignant hyperthermia (MH) susceptibility have been used at the authors' clinical unit; this study was designed to compare the results of these tests. PATIENTS AND METHODS. Since March 1983, 158 patients have been referred for the following reasons: group A: probands (n = 17) who had had symptoms of MH during anesthesia; group B: patients of probands (n = 48) if the latter were not tested because of age (n = 24) or death (n = 2); group C: relatives from MH families (n = 86); group D: patients (n = 5) who developed fever during stress and/or physical activity (n = 3), had myotonia (n = 1), or developed rhabdomyolysis during intensive care (n = 1); group E: controls (n = 2). Two static halothane and two static caffeine tests according to the European protocol were performed in all patients (n = 158). Histological examinations of skeletal muscle (fixed in glutaraldehyde, stained with hematoxylin-eosin, Gieson, and toluidine blue) were done in the first 100 patients; all specimens were scored by the same investigator (E.S.). Score 0: normal; 1: increased number of sarcolemma cores; 2: 1+cores forming groups; 3: 1+2+fiber degeneration; 4: specific changes-myopathies. Plasma levels of creatine kinase (CK) were determined in the first 50 patients. Complete neurological examinations, including electromyography (EMG), were done in ten patients who had increased CK levels as well as histological scores of 3 or 4 (Table 1).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Results of cardiopulmonary and cerebral resuscitation in the area of surgical intensive care].

In intensive care units specially trained staff and sophisticated technical equipment are confronted with extremely critically ill patients. In this patient population multiple organ failure is mostly established thus requiring application of all therapeutic facilities. During a study period of 40 months in 203 (86.4%) out of 235 patients with cardiac arrest a decision not to resuscitate ("DNR order") was made. In 32 patients cardiopulmonary resuscitation was attempted. Although spontaneous circulation could be maintained for at least 12 hours in 40.6% (13 patients), 6 died within the first day and 3 other patients died during the first week. Only 4 patients resuscitated could be discharged. Our data suggest that, despite further development of technical and therapeutic methods, the underlying disease has to be considered as the limitation of long-term survival.

Adolescent↗
PubMed1986

Metabolic changes of patients with acute necrotizing pancreatitis.

We carried out metabolic investigations of 26 patients with severe forms of acute pancreatitis which were evaluated by an organ score. We formed six groups from this data: survivors and deceased in the first week, the second week, and after a further two weeks of illness. The amino acid patterns in plasma and muscles deviated considerably from normal at all times in both the surviving and the deceased patients. In particular, changes in the concentrations of branched-chain amino acids and glutamine in the muscle tissue have a prognostic value. In the range two to four (normal range: above 20), the factor glutamine/VAL+LEU+ILE characterizes a prefinal condition in non-survivors. This factor increased in patients recovering from the illness from 6 to values over 20. Non-survivors (NS) had higher plasma levels of glucose and glucagon compared to surviving patients. Plasma glucagon concentrations in NS reached levels up to 4,000 pg/mL at admission, which declined gradually to normal range during the course of the illness.

Acute Disease↗
PubMed1986

[Glucose-potassium-insulin in hypodynamic septic shock].

Haemodynamic and metabolic effects of glucose-potassium-insulin (GKI) were studied in 14 patients with peritonitis. Study entry criteria were: hypodynamic septic shock (mean arterial pressure less than 50 mmHg and cardiac index less than 3.5 l/min) despite a highly positive fluid balance (greater than +2,000 ml during the last 12 h) and use of catecholamines (greater than 15 mcg/kg/min Dobutamine). GKI (glucose 70% 1 g/kg + potassium 10 mval + insulin 1.5 U/kg) was infused within 15 min via a central venous catheter. Before and 10 min after GKI haemodynamic and metabolic measurements were performed. GKI led to significant increases in systolic (+53%) and mean (+61%) arterial pressures, cardiac index (+50%), right (+60%) and left (+109%) ventricular stroke work indices, and oxygen consumption index (+18%). Heart rate remained unchanged, pulmonary shunt fraction increased slightly, systemic and pulmonary vascular resistances showed an insignificant decline. Serum glucose (p less than 0.01) and pCO2 (p less than 0.1) increased. The haemodynamic improvement lasted from 30 min or less (n = 3; 21%) to several hours. Nine patients (64%) survived more than 2 days, and two patients (14%) were eventually discharged from the hospital. We conclude, that in hypodynamic septic shock refractory to volume loading and catecholamine treatment GKI may be beneficial, although the mechanism of action remains unclear.

Adult↗
PubMed1986

[Malignant hyperthermia in Austria. I. Epidemiology and clinical aspects].

Investigation of malignant hyperthermia (MH) was started in 1975; by March 1986, 79 suspected cases had been reported. In vitro contracture tests were performed in 66 probands or their parents; in 61 of these (92%), MH was confirmed and 5 (8%) proved negative. In 4 lethal crises, the parents refused biopsy, but because of well-documented clinical histories these were also included as confirmed MH reactions. We were able to analyse 65 cases of documented MH, and 9 patients are still to be investigated. About 18% of all Austrian hospitals (29 of 158) had reported 1-14 MH reactions (mean 2.7/hospital); it must therefore be assumed that a high number of crises are either not detected or not reported, and the total incidence of MH cannot be estimated. In our hospital (the University Hospital of Vienna), the incidence was 1:23,600 (including children and adults), whereas in Bludenz (Vorarlberg), the incidence was as low as 1:1,300 (in children only). This might partly be explained by genetic factors (such as inbreeding); we identified 3 families, all from Vorarlberg (which is a small, secluded mountain area), in which both parents were carriers of the MH trait. Fulminant crises (of which three times as many were rigid as were non-rigid) accounted for 58%, and masseter spasm for 26%, of all MH reactions. There was a significant influence of sex (72% males) and age (71% less than 20 years) on incidence. Neuromuscular symptoms or other signs reported to be associated with MH were found in only 5 patients (8%). During crises, cardiac symptoms (81%) and cyanosis (71%) were frequently observed; rigidity (45%) and body temperature above 39 degrees C (27%) showed remarkably low incidences. The overall mortality was 17% (11 of 65); it was significantly increased if the maximum temperature exceeded 39 degrees C, after acute surgery or anaesthesia lasting greater than 60 min, and in patients aged over 20 y. Most crises required no specific therapy; dantrolene was administered to only 10 patients. In the future, earlier detection via better monitoring, improved documentation, and mandatory reporting of suspected MH reactions should allow a more detailed description of MH and could further decrease the mortality associated with this condition.

Austria↗