Ventricular fibrillation due to hypocalcemia after parathyroidectomy with autotransplantation of parathyroid tissue in a dialysis patient.
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Adult↗
Biomedical subjects
T Marx
Publications and source records attributed to T Marx.
[The effect of different anesthetic procedures on hormone levels in women. Studies during an in vitro fertilization-embryo transfer (IVF-ET) program].
Different anaesthetic procedures that were used during an in vitro fertilisation and embryo transfer (IVF-ET) program have been analysed in order to determine their influence on plasma levels of estradiol, progesterone, prolactin, and beta-endorphin and results of IVF-ET. METHODS. Fifty-four patients awaiting transvaginal oocyte aspiration were randomised into three groups: (1) anaesthesia with ketamine as an induction agent and analgesic (n = 20); (2) general intubation anaesthesia using thiopentone for induction and enflurane for maintenance (n = 18); and (3) no anaesthesia (n = 16). Estradiol, progesterone, prolactin, and beta-endorphin were measured from day 3 to 14 referring to follicle aspiration. Differences between preoperative hormone levels and their intra- and postoperative peaks were analysed using the Kruskal-Wallis test (P < 0.03). The results were corrected using the Holms method (alpha = 0.05). RESULTS. No differences were observed in estradiol and progesterone levels (Figs. 1, 2). Prolactin levels were 1.4 times higher (P < 0.001) when ketamine was used and 2.2 times higher (P < 0.001) after short general anaesthesia than in the control group (Fig.3). Similar results were observed with respect to beta-endorphin: in comparison with the control group we found significant elevation by a factor of 2.1 when ketamine was used (P < 0.001). The discrepancy became even more marked with general anaesthesia: beta-endorphin was 3.9 times higher compared to the controls (P < 0.001) (Fig.4). Comparing the two groups who were given anaesthetics, prolactin and beta-endorphin levels were also significantly different (P < 0.001). The IVF procedure itself did not appear to be affected by different anaesthetic procedures during oocyte aspiration (Table 2). CONCLUSIONS. The increased prolactin and beta-endorphin plasma levels associated with ketamine and general anaesthesia reflect a significant alteration of the observed hormone levels. When anaesthesia is indicated, we try to avoid general intubation anaesthesia in favor of ketamine.
Adult↗
[Modification of ventilation and length of stay of traumatized intensive care patients by quality and duration of preclinical management].
AIM: The study aimed at detecting relations between the quality and duration of prehospital care in the case of traumatic patients and the duration of artificial respiration and ICU stay times. DESIGN: 94 traumatic patients, admitted to the intensive care unit, were subdivided into groups according to the type of trauma. The mean time of prehospital care, injury severity score, the Apache II at the admission to the clinic and the discharge to the ICU, intraoperative replacement of blood and clinical care times were calculated. RESULT: In the group of all patients, times of the ICU-stay were correlated to the ISS and the Apache II of the hospital admission. In the group with multiple fractures, a positive correlation to the prehospital care times was found. DISCUSSION: Quality and duration of the prehospital care were identified as factors, influencing the time of the ICU stay. Optimizing these factors will be helpful in respect of economic considerations.
APACHE↗
[Effect of different follicle puncture methods on hormone homeostasis in the woman. Studies within the scope of an in vitro fertilization-embryo transfer program].
Different methods for follicular puncture which were used in an in vitro fertilization-embryo transfer program have been analyzed in order to determine their influence on plasma levels of estradiol, progesterone, prolactin and beta-endorphins. Thirty-eight patients awaiting oocyte aspiration were randomized into a laparoscopic (n = 20) and an ultrasound-guided oocyte aspiration group (n = 18). No differences were observed as far as estradiol and progesterone levels and embryo transfer rates were concerned. When using the laparoscopic technique, prolactin levels were found to be elevated 1.5 times in comparison with the ultrasound-guided aspiration procedure, which is highly significant (p < 0.001). Also, beta-endorphins peaked at a significantly higher level during laparoscopy (27.8 vs. 20.7 mol/l, p < 0.001). The enhanced prolactin and beta-endorphin levels reflect an increased stress response during laparoscopy. With respect to less trauma and shorter duration of the procedure, we now perform the sonographically guided transvaginal aspiration technique in our program almost exclusively.
Adult↗
Interleukin-6 in synovial fluid is closely associated with chronic synovitis in rheumatoid arthritis.
Interleukin-6 (IL-6) was detected at low levels in plasma [0.014 +/- 0.006 ng/ml (mean +/- SEM] and in high amounts in synovial fluid [SF; 2.6 +/- 2.2 ng/ml (mean +/- SEM)] of patients with rheumatoid arthritis. No correlation of IL-6 levels in plasma or SF with the ESR (n = 15) or with histological parameters of acute local synovitis (n = 10) was observed. In contrast, SF IL-6 was positively correlated with histological characteristics of chronic synovitis (n = 10; P < or = 0.01) and elevated plasma IgG concentrations (n = 15; P < or = 0.05). In vitro concentrations of IL-6 comparable to those detected in SF increased the production of both IgG and IgM by synovial membrane mononuclear cells. The present results contribute to the view that high local IL-6 concentrations in SF promote chronic synovitis in RA.
Adult↗
Concomitant loss of conformation and superantigenic activity of staphylococcal enterotoxin B deletion mutant proteins.
The T-cell-stimulating activity of staphylococcal enterotoxin B (SEB) is an important factor in the pathogenesis of certain staphylococcal diseases. To investigate the immunologically active domains of the SEB molecule, we have produced truncated fragments of recombinant SEB by C-terminal and N-terminal deletions. The fragments were expressed as fusion proteins with protein A, including a cleavage site to remove the protein A part. Mutant proteins were tested for the ability to stimulate human resting T cells and SEB-reactive T-cell clones. Deletion of only 9 amino acids from the C terminus leads to complete loss of T-cell-stimulating activity. Removing further amino acids from the SEB molecule did not lead to a reexpression of T-cell-mitogenic activity. A mutant protein, however, in which the 9 C-terminal amino acids were replaced with a tail of 68 amino acids encoded by the vector was fully active. Two mutant proteins with N-terminal deletions of 60 and 81 amino acids were inactive as well. A neutralizing monoclonal antibody against a conformational epitope lost binding with all the inactive mutant proteins only, whereas a monoclonal antibody recognizing an epitope involved in emetic activity reacted with all mutant proteins. These results suggest that even small deletions at the C terminus affect the three-dimensional conformation of the SEB molecule.
Amino Acid Sequence↗
Can a clinician predict the technical equipment a patient will need during intensive care unit treatment? An approach to standardize and redesign the intensive care unit workstation.
The technical equipment of today's intensive care unit (ICU) workstation has been characterized by a gradual, incremental accumulation of individual devices, whose presence is dictated by patient needs. These devices usually present differently designed controls, operate under different alarm philosophies, and cannot communicate with each other. By contrast, ICU workstations could be equipped permanently and in a standardized manner with electronically linked modules if the attending physicians could reliably predict, at the time of admission, the patient's equipment needs. Over a period of 3 1/2 months, the doctors working in our 20-bed surgical ICU made 1,000 predictions concerning outcome, equipment need, duration of artificial ventilation, and duration of hospitalization for 300 recently admitted patients. The interviews were made within the first 24 hours after admission. The doctors being interviewed were usually (i.e., in over 90% of cases) unfamiliar with the patient. Information concerning the patient's general state of health, special pre-ICU events, and complications was offered to the interviewed clinician because this information represents standard admission data. It was found that the equipment need (represented by two different setups, "high tech" and "low tech") could be predicted most reliably (96.4% correct predictions) compared with a prediction on outcome of ICU treatment (94.5%), on duration of artificial ventilation (75.4%), and on duration of stay (43.4%). There was no significant (p greater than 0.05) difference in the reliability of predictions between residents and consultants. Factors influencing the postoperative equipment need varied with surgical specialty.(ABSTRACT TRUNCATED AT 250 WORDS)
Anesthesia Department, Hospital↗
[Experimental studies on the recovery of anesthetic gases].
The volatile anesthetic agents halothane, enflurane, and isoflurane are chlorofluorocarbons (CFC) and contribute to ozone depletion. Although the contribution is small, its importance is rising, as technical CFCs will be phased out according to the Montreal protocol (1987) and the London conference (1990) by the year 2000. Alternative procedures and CFC-free volatile agents such as des- and sevoflurane do not contribute to depletion of the ozone layer, but will not replace standard methods using volatile anesthetic agents in the near future. METHODS. In an experimental setup, we filtered anesthetic waste gases from scavenging systems of rebreathing circles by activated carbon filters. The filtered substances were desorbed by a heat chamber and condensed in a cold trap. RESULTS. By this method, it was possible to retrieve 50%-60% of the applied gases. Gas chromatographic analysis showed halothane containing traces of pollutants and isoflurane and enflurane as pure substances. DISCUSSION. The retrieval of anesthetic waste gases is easy; no sophisticated technical equipment is necessary. Purity of substances could make recycling possible and offer a method to avoid environmental pollution by volatile anesthetics.
Anesthetics↗
[The "preoxygenation" special function in mechanical ventilators. Medically necessary and an ergonomic plus?].
Hypoxia-related cardiovascular complications and unnecessary monitor and ventilator alarms are well-known problems during tracheobronchial suctioning. Preoxygenation together with temporary muting of acoustic alarms for tracheobronchial suctioning are provided by a single operational control of the ventilator "Evita", software release 9 (Drägerwerk AG). This integrated function was evaluated in medical and ergonomic respects. METHODS. Thirty tracheobronchial suctioning procedures each, with or without preoxygenation, were evaluated. The subjects were patients in our anesthesiological intensive care unit who were under continuous positive-pressure ventilation with FIO2 between 0.25 and 0.6. They ranged in age from 18 months to 72 years. Each patient served as her/his own control after about 1-h delays. Depending on the preference of the nurse, the procedures were either both on-ventilator (via the catheter port) or both off-ventilator suctionings. Arterial samples for blood gas analyses as well as arterial oxygen saturation (SaO2) determinations were taken before preoxygenation, at the moment of disconnection or opening of the catheter port, at reconnection or closure of the port, and 5 min later. Moreover, the number of changes in position of the performing nurse, the number of acoustic ventilator alarms, and the duration of the procedure were recorded. Finally, assessments of the integrated ventilator feature by the 28 participating nurses were collected both as a score from 1 ("most useful and innovative") to 5 ("completely superfluous and distracting") and as detailed statements. RESULTS. Arterial blood gas results and SaO2 courses differentiated as to procedures with or without preoxygenation as well as on-ventilator and off-ventilator suctioning are shown in Table 1 (values are mean +/- standard deviation). Without preoxygenation, most patients did not exhibit threatening drops in SaO2 (values fell from 98.2%) to 97.0% on the average). Nevertheless, preoxygenation provided an additional safety margin (100% saturation throughout the procedure in all patients). Under certain conditions, e.g., low functional residual capacity as in small children or patients with adult respiratory distress syndrome (in 1 of these cases we observed a SaO2 drop to 87%), it is mandatory. Although occurring far less frequently, unnecessary acoustic alarms were not completely excluded by the integrated function because the ventilator would not recognize the insertion of the suction catheter via the catheter port as the expected disconnection. Thus, coughing was able to trigger the "high airway pressure" alarm. As expressed by an average score of 2.8, approval of the integrated ventilator function prevailed among the involved nursing staff.
Adolescent↗
[Blood sugar in patients with vegetativ dysfunction and neurotic tendencies (author's transl)].
There are multiple relations between neurotic abnormal behavior and the incidence of functional vegetativ disorders and there are also correlations between such dysfunctions and blood sugar homoiostasis. In patients with functional vegetative dysorders and neurotic behavior we performed a glucose tolerance test and compared the results to a control group. In the group of patients with vegetative dysfunction and neurotic tendencies the oral glucose tolerance test was abnormal in 68.4 p.c. as compared to 21.3 p.c. in the control group. Several insulin antagonists which play a role in stress responses are discussed in the interpretation of these surprising results.
Autonomic Nervous System↗
[Proceedings: Changes of serum glycoproteins in arterial vascular diseases].
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Arteries↗
Molecular cloning of a putative voltage- and cyclic nucleotide-gated ion channel present in the antennae and eyes of Drosophila melanogaster.
The amino acid sequence BCNG-1 (brain cyclic nucleotide gated 1, of the mouse), the first member of mamalian I(h) channels, was used to construct a set of polymerase chain reaction (PCR) primers from possibly conserved regions. Reverse transcription-PCR with Drosophila melanogaster mRNA yielded in a PCR product, which exhibited a high homology to BCNG-1. Using these PCR products to screen a D. melanogaster head cDNA library we isolated a cDNA encoding a member of a new class of putative voltage- and cyclic nucleotide-gated potassium channels from D. melanogaster. The most important features of the amino acid sequence predicted from the cDNA were a C-terminal cyclic nucleotide-binding region, an S4-voltage sensor and a putative potassium-selective pore-forming motif. The high homology of 51% to the sea urchin I(h) channel, which belongs to the same class of ion channels as BCNG-1, leads us to suggest that the Drosophila cDNA is the first insect member of a new class of hyperpolarization-activated and cyclic nucleotide-gated channels. As shown by in situ hybridization, a pronounced mRNA expression was detected in neuronal tissue, including sensory tissue like the compound eyes, and the olfactory and the auditory organs.
Amino Acid Sequence↗
Tumor inhibition by titanocene complexes: activity against sarcoma 180.
The antitumor activity of various titanocene derivatives was examined against ascitic and solid, subcutaneously growing sarcoma 180. The complexes investigated were two dihalide compounds, (C5H5)2TiCl2 (I) and (C5H5)2TiBr2 (II), two carboxylato complexes, (C5H5)2Ti (cis-OOCCH = CHCOOH)2(III) and (C5H5)2Ti(OOCCCl3)2(IV), and the p-aminothiophenolate hydrochloride (C5H5)2Ti(p-SC6H4NH3+Cl-)2(V). Against ascitic sarcoma 180, best results were obtained for I; an injection of 50 mg/kg resulted in the survival of 40-50% of the animals (ILS, 161-184%). A similar result was recorded for cis-diamminedichloroplatinum(II), whereas the compounds II-IV induced a maximum cure rate of 20% (ILS, 95-139%). Against solid sarcoma 180, triple injections of I-V caused reduction of mean tumor weight to 23-53% of control values, the dichloro complex I exhibiting most pronounced activity. These results clearly underline antitumor potency for titanocene complexes (C5H5)2TiX2 modified at the acido ligand X.
Animals↗