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  • 1
    ISSN: 1433-044X
    Keywords: Key words Enteral nutrition • Immunonutrition • Multiple trauma • Injury • Systemic inflammatory response syndrome • Sepsis • Multiple organ failure ; Schlüsselwörter Enterale Ernährung • Immunonutrition • Polytrauma • Ganzkörperinflammationssyndrom • SIRS • Sepsis • Multiorganversagen • MOV
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In dieser prospektiven randomisierten, doppelblinden, placebokontrollierten Studie wurde der Einfluß einer mit Arginin, Ω-3-Fettsäuren und Nukleotiden supplementierten Nährlösung auf Akutphase- und immunologische Parameter, auf das Auftreten eines SIRS (systemic inflammatory response syndrome) und eines Multiorganversagens (MOV) bei schwerstpolytraumatisierten Patienten untersucht; 29 Patienten mit einem PTS und einem ISS um 40 Punkte wurden randomisiert, die Testnahrung (Impact) oder eine isokalorische und isonitrogene Kontrolldiät (Kontrolle) zu erhalten. Hinsichtlich der Verletzungsschwere und der demographischen Daten waren die beiden Gruppen vergleichbar. Unter den untersuchten Parametern der Immunfunktion war die HLA-DR-Antigenpräsentation als Zeichen einer Monozytenstimulation gemessen an der Fluoreszenzintensität in der Testgruppe an Tag 7 signifikant höher als in der Kontrollgruppe (p 〈 0,05). Bei den Akutphaseparametern zeigten sich für das C-reaktive Protein (CRP) tendenziell niedrigere Werte in der Testgruppe, an Tag 4 (131 ± 67 vs. 221 ± 110 mg/l) mit signifikantem Unterschied (p 〈 0,05). Auch für das Fibrinogen konnte an Tag 12 (6,6 ± 1,4 vs. 7,5 ± 1,4 g/l) und 14 (7,1 ± 1,3 vs. 7,8 ± 0,8 g/l) in der Testgruppe ein signifikant geringerer Wert festgestellt werden (p 〈 0,05). Die Inzidenz des SIRS war bei den Patienten mit der supplementierten Kost zwischen dem 8. und 14. Tag hochsignifikant geringer (p 〈 0,001) als in der Kontrollgruppe. Die Multiorganversagenscores nach Goris [23] und Sauaia [43] zeigten ebenfalls an einzelnen Tagen signifikante Unterschiede zugunsten der Testgruppe. Beim schwersten Polytrauma bewirkt eine frühzeitige enterale Zufuhr einer mit Arginin, Ω-3-Fettsäuren und Nukleotiden supplementierten Sondenkost wahrscheinlich eine günstige Beeinflussung der Akutphasereaktionen sowie eine Monozytenstimulation. Außerdem führt sie zur Verringerung des Auftretens von SIRS und MOV und stellt damit einen wichtigen Beitrag in der Intensivtherapie dieser Patienten dar.
    Notes: Summary Previous studies in critically ill patients have shown the beneficial effects of early enteral nutrition supplemented with arginine, omega-3 fatty acids and nucleotides (Impact) on immunological response, infection rate and length of stay in hospital. No specific data exist for patients with severe multiple injury, who represent a high risk group for systemic inflammatory response syndrome (SIRS), septic complications and multiple organ failure (MOF). In this prospective, randomized, double-blind controlled clinical study on patients after severe trauma (ISS ca. 40) the primary study endpoints were incidence of SIRS and MOF [definitions according to Am Soc Crit Care Med (5) and Goris (23), Sauaia (43)]. Thirty-two patients enrolled in the study, and 29 were eligible for analysis: test (Impact) (n = 16), control (n = 13). Both groups were comparable according to age, body mass index and severity of trauma (PTS-test: 38.8 ± 12.5, PTS-control: 40.8 ± 15.5, ISS-test: 39.6 ± 11.4, ISS-control: 40.5 ± 9.2). Patients were randomized to receive either Impact (test) or an isonitrogenous isocaloric diet (control). Feeding was started on the 2nd day after trauma via endoscopically placed nasoduodenal or -jejunal feeding tubes. The experimental diet was safe and well tolerated. During the 1st week the enteral feeding amount was about 2000 ml without significant difference. Test-fed patients developed SIRS significantly less frequently between day 1 and day 28 (8 vs 13.3; P 〈 0.05) and especially between day 8 and day 14 (3 vs 6.2; P 〈 0.001). In the control group the Goris score was significantly worse (P 〈 0.05) on days 3, 4, 6, 7, 10, 11, 16 and 17 and the Sauaia score on days 8, 9, 10 and 11 (P 〈 0.05; P 〈 0.01). Mortality rate did not significantly differ (test 2/16, control 4/13), nor did length of ICU or hospital stay. With regard to the acute-phase response, C-reactive protein was significantly lower on day 4 in the test group (test: 131 ± 67 mg/l, control: 221 ± 110 mg/l) as was fibrinogen on day 12 (6.6 ± 1.4 vs 7.5 ± 1,4 g/l) and day 14 (7.1 ± 1.3 vs 7.8 ± 0,8 g/l). No significant difference could be observed for CD4/CD8 ratio, CD45 isotope on activated T-cells and lymphocytic interleukin (Il)-2- receptor- and Il-6 level. However, HLA-DR antigen presentation on peripheral monocytes was significantly elevated on day 7 in the test group (P 〈 0.05). According to the results, arginine, omega-3 fatty acids and nucleotides-enriched diet during early enteral feeding leads to reduction of SIRS after severe multiple injury. There is evidence for improvement of post-traumatic immunological response which helps to overcome the immunological depression after trauma.
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  • 2
    ISSN: 1432-0738
    Keywords: Bromisovalerianylcarbamide ; Methaqualone-Meprobamate-Poisoning ; Gastric/Intestinal Lavage ; Forced Diuresis ; Extracorporeal Dialysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Eine schwere Bromisovalerianylcarbamid-, Methaqualonund Meprobamatvergiftung (Nyktogen®), die mit tiefer Bewußtlosigkeit, Axeflexie, Atemstörungen, klonisch-tonischen Krampfanfall, tiefgreifenden EEG-Veränderungen und toxischer Leberschädigung einherging, konnte bei einem 12 Jahre alten Knaben durch intensive Behandlung mit fortlaufenden Magen- und Darmspülungen, forcierter Diurese und extracorporaler Dialyse beherrscht werden. Auf Grund der Bromiduntersuchungen im Serum und Mageninhalt zeigte sich, daß forcierte Magenspülungen und Darmspülungen als die wesentlichen Maßnahmen in der Therapie
    Notes: Abstract A 12-year-old boy who had ingested large amounts of bromisovalerianyl-carbamide-methaqualone-meprobamate (Nyctogen®) and was suffering from coma, respiratory distress, convulsions, areflexia, dysrhythmias in the EEG, and toxic liver damage was successfully treated by means of prolonged and repeated gastric and intestinal lavage, forced diuresis and extracorporeal dialysis. On the basis of the bromide analysis in the serum and the gastric lavage fluid, it seems that forced gastric and intestinal lavage are the essential therapeutic measures in case of Bromural poisoning. This conclusion was drawn from observation of the present case. The conditions of absorption and reabsorption of the toxic substances were especially unfavorable, because of a paralytic ileus. The fact that extracorporeal hemodialysis had no effect in our case is partly due to the low blood-concentration of bromide and possibly partly to the low dialysability of Meprobamate.
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  • 3
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To investigate the expectation of general insufficiency of osteoblasts with increasing age, we studied autotopsy material from 105 deceased persons of both sexes who had died between 16 and 91 years and in whom clinically manifest diseases of the bone had been excluded. Quantitative morphometric examination of the structure of the spongy bone of the 3rd–5th lumbar vertebral bodies (LVBs) and of the 5th–7th cervical vertebral bodies (CVBs) was carried out in frontal and saggital planes, the parameters analysed being volumetric density (Vv), surface density (Sv) and specific surface area (S/V), and the results were subjected to statistical evaluation. The results showed that in the three LVBs, Vv, Sv and S/V behave in a similar manner, Vv and Sv decreasing after the age of 50 years by more than one-third while S/V remains constant throughout life. The three lower CVBs had higher values than the LVBs for all three structural parameters. In the 7th CVB somewhat lower Vv and Sv values and higher S/V values were found than in the 5th and 6th. The age-related changes, by contrast, were very small. This differing behavior of the spongy bone in the two regions of the spinal column is an expression of the different characteristic loading forces in each regions: LVB loading is predominantly static, CVB loading mainly dynamic. Thus, from the functional point of view, what is known as “physiological osteoporosis due to ageing” is nothing more than adaptation by an ageing bone to physical activity, reflecting —like the bone of the young adult — the current loading of the cancellous bone by the actions of the musculoskeletal system. Since such physical activity is often age-related, the performance of the osteoblasts does not depend upon age per se, but merely on the remaining functional adaptive capacities of the ageing organism as whole.
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  • 4
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To investigate the etiopathogenesis of the common clinical symptoms of the lower lumbar spine (LS) and cervical spine (CS) (lower back pain and local cervical spine syndrome), the dimensions of the third to fifth lumbar vertebral bodies (LVB) and the fifth to seventh cervical vertebral bodies (CVB) were studied quantitatively and morphometrically in frontal and sagittal planes, as a function of sex and age, in 105 human cadavers of both sexes aged between 16 and 91 years. The evaluation was done in X-ray pictures of 100-μm-thick polished bone sections with the aid of the Macro Facility of the Leitz Texture Analysis System. In each case, the maximum and minimum heights and widths and depths and the computed differences in heights, widths, and depths were determined. The results were evaluated statistically and compared within and between the two regions of the spine, using regression-correlation analyses. The heights, widths, and depths of the VB are all greater in men than in women; their behavior during ageing is, however, identical for both sexes. The heights of all the VB examined remain constant throughout life after termination of growth. The maximun widths and the width differences reveal an increase in both LVB and CVB in old age. All depth parameters reveal constancy in the case of the LVB but an increase in the case of the CVB in old age. The correlation coefficients of the maximum width of the VB within the spinal regions are very high in the LVB, but lower in the CVB. Between the two regions, in contrast, they are very low. This behavior suggests a superordinate action principle within each of the spinal regions which is based on characteristic anatomical construction and functional stressing. The static stressing of the LVB leads, laterally to disc protrusions. As a result of this, traction forces acting on the weak lateral elements of the anterior longitudinal ligament, stimulate the accretion of spondylotic osteophytes at the point of insertion of the ligament on the vertebral body. Anteriorly, in contrast, the particular strong anterior longitudinal ligament prevents such a remodelling process. Posteriorly, the longitudinal ligament is attached to the intervertebral discs, and can thus not stimulate the vertebral body to produce osteophytes. The dynamic stressing of the CVB leads laterally to friction between the VB in the region of the uncovertebral joints and to the formation of arthrotic osteophytes. Anteriorly, owing to the weak configuration of the anterior longitudinal ligament in this aspect, disc protrusion occur and, subsequently, spondylotic osteophytes accrete. Posteriorly, the (posterior) longitudinal ligament is also attached to the intervertebral discs, and can thus provide no ossification stimulus. Lateral arthrotic and anterior spondylotic osteophytes at the CVB are thus the result of etiopathogenetically different processes, and can occur independently of each other. The also differing etiopathogenesis of lateral osteophytes in the case of the LVB and CVB, presenting as spondylosis or arthrosis, also finds statistical expression in a very small correlation of the maximum widths of the VB in both regions of the spine. Spondylotic osteophytes occurring laterally at the LVB and anteriorly at the CVB do not of themselves cause clinical symptoms. These are rather a sequela of motion segment instability, where overloading of the supporting structures can give rise to a local chronic spinal syndrome. Arthrotic osteophytes occurring laterally on the CVB, in contrast, can, as a result of the pressure twenty-three consecutive patients aged 33–80 years with a presumed Sudeck's syndrome of one hand or one foot were seen. A fracture initiated the syndrome in three-quarters of them, and the median duration of suffering was 3.5 months in the hand and 7 months in the foot. Osteoporosis and marked 99mTc-labeled methylene diphosphonate uptake were seen in radiographs and scintigrams respectively. Thirteen of the patients were operatively treated; distal fasciotomy on the volar aspect of the forearm or the ventral aspect of the lower leg gave rapid relief from pain at rest in nine of ten patients thus affected. All the patients became symptom-free, except two who underwent closed treatment. At follow-up 2–8 years later radiographic and scintigraphic findings were usually normal.
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  • 5
    ISSN: 1618-2650
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
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  • 6
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary 120 women suffering from acute uncomplicated bacterial cystitis were treated in an open randomized study either with 1 × 400 mg enoxacin or 1 × 3 g amoxicillin per os. Analysis of midstream urine and bacteriological urine cultures were examined before, two and seven days as well as six weeks after therapy. Treatment with enoxacin resulted in 97.5% (second day), respectively 92.5% (seventh day) bacteriologically sterile urine cultures, whereas the rate of sterile urines following amoxicillin reached only 72.5% (second day), and 65% (seventh day), respectively. Side effects (gastrointestinal, allergic, cardiovascular) were noted in one case in the enoxacin group and in ten cases in the amoxicillin group. The highly active antibiotic derivatives of the 4-quinolone-group (e.g. enoxacin) administered as a single dose achieve high cure rates in carefully selected female patients with acute uncomplicated bacterial cystitis.
    Notes: Zusammenfassung 120 Frauen mit unkomplizierter akuter bakterieller Zystitis wurden in einer offenen randomisierten Studie entweder mit 1 × 400 mg Enoxacin oder 1 × 3 g Amoxicillinper os behandelt. Analysen von Mittelstrahlurin und bakteriologische Urinkulturen wurden vor sowie zwei und sieben Tage und sechs Wochen nach Therapie durchgeführt. Der derzeitigen Auswertung liegen die Daten von 80 Patienten zugrunde. Die Enoxacin-Behandlung führte zu einem sterilen Urin in 97,5% (zweiter Tag) bzw. 92,5% (siebter Tag) der Fälle, während die Rate steriler Urine mit Amoxicillin bei 72,5% (zweiter Tag) und 65% (siebter Tag) lag. Gastrointestinale, allergische oder kreislaufbedingte Nebenwirkungen traten bei Enoxacin in einem Fall, bei Amoxicillin in zehn Fällen auf. Die hochaktiven Antibiotika der 4-Chinolon-Gruppe (u. a. Enoxacin) ergaben bei geringer Medikamentenbelastung eine hohe Heilungsrate in der Einzeldosistherapie bei sorgfältig ausgewählten Patientinnen mit akuter bakterieller Zystitis.
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Infection 14 (1986), S. S316 
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Chlamydia trachomatis-Infektionen stellen eine zunehmende Ursache der sexuell übertragenen Urogenitalinfektionen dar, wobei sie zahlenmäßig schon häufiger als Gonokokkeninfektionen auftreten.Chlamydia trachomatis kann schwerwiegende und komplizierte Erkrankungen verursachen, die jedoch nicht mit den klinischen Beschwerden korrelieren müssen. Für den Nachweis derC. trachomatis wird der MicroTrakTM-Test eingesetzt, der auf dem direkten Nachweis fluoreszenzmarkierter monoklonaler Antikörper unter dem Fluoreszenzmikroskop beruht. 20 Patienten (15 Männer, fünf Frauen) mitC. trachomatis-Urethritis wurden fünf Tage mit 2 × 200 mg Ofloxacin per os behandelt. Die initiale Heilungsrate betrug 90% (18 von 20 Patienten), bei verlängerter Behandlungsdauer von insgesamt zehn Tagen zusätzlich 10%. Nebenwirkungen traten unter der Therapie nicht auf. Zusammenfassend kann Ofloxacin als wirksames Chemotherapeutikum — auch beiC. trachomatis-Urethritis — angesehen werden.
    Notes: Summary Sexually transmittedChlamydia trachomatis infection of the genito-urinary tract is becoming recognized as a disease which has reached a higher incidence than gonococcal infections, and caused severe and complicated infections in males and females even without major complaints. The MicroTrakTM test is used to demonstrateC. trachomatis by direct identification under the fluorescence microscope using fluorescein-labelled monoclonal antibodies. 20 patients (15 males, five females) with provenC. trachomatis urethritis were treated for five days with 2 × 200 mg ofloxacin. The initial cure rate was 90% (18 of 20 patients) with an additional 10% being cured after extended therapy over ten days. No side-effects occurred during ofloxacin therapy. Thus ofloxacin can be regarded as an effective and safe drug for the treatment of the genitourinary infections caused byC. trachomatis.
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Marine biology 23 (1973), S. 343-346 
    ISSN: 1432-1793
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology
    Notes: Abstract A biopsy dart, that can be shot from a gun or crossbow, was developed to obtain skin of whales at sea. Determination of sex was found possible by staining and locating sex chromatin bodies in the nuclei of female skin cells. This procedure will be useful in many types of field studies on whales.
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