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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  17. Grazer Konferenz - Qualität der Lehre 2013: Teaching medical skills; 20130404-20130406; Wien, Österreich; DOCP18 /20131129/
    Publication Date: 2013-11-30
    Keywords: ddc: 610
    Language: English
    Type: conferenceObject
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  • 2
    ISSN: 1432-1238
    Keywords: Pentoxifylline ; Septic shock ; Cytokines
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate the influence of pentoxifylline (PTX), a phosphodiesterase inhibitor, on cytokines and inflammatory proteins in patients suffering from septic shock. Design Prospective study comparing a therapy group to a matched control group. Setting Medical intensive care unit at a university hospital. Patients Twenty four patients fulfilling the criteria of septic shock were included in this study. Twelve patients received PTX (therapy group) and 12 patients matched for diagnosis, age and gender served as the control group. Interventions Pentoxifylline at 1 mg/kg per hour over 24 h in the therapy group. Measurements ad results Cytokine levels [tumor necrosis factor-α (TNF)], soluble TNF receptor [TNF-R], and interleukin-6 [IL-6] and inflammatory proteins [C-reactive protein, α-1-antitrypsin (AAT), fibronectin, and haptoglobin], as well as hemodynamic parameters and the APACHE III score were evaluated before initiation of therapy and 24 h later. After 24 h, TNF levels were significantly lower in the therapy group (p=0.013), while IL-6 levels were significantly higher in the therapy group (p=0.030). Within the 24 h TNF declined significantly in the therapy group (p=0.006), while IL-6 showed a significant increase (p=0.043). AAT and the APACHE III score tended to differ significantly after 24 h between the groups [AAT levels higher in the therapy group (p=0.05), APACHE III score lower (p=0.05)]. In the therapy group, the systemic vascular resistance index was significantly higher after 24 h (p=0.0026) whereas the cardiac index declined (p=0.035). Conclusions PTX does influence TNF levels in septic shock patients. Nevertheless, inhibiting a single mediator in severe septic shock cannot stop the inflammatory overreaction.
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  • 3
    ISSN: 1432-1238
    Keywords: Key words Pentoxifylline ; Septic shock ; Cytokines
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To evaluate the influence of pentoxifylline (PTX), a phosphodiesterase inhibitor, on cytokines and inflammatory proteins in patients suffering from septic shock. Design: Prospective study comparing a therapy group to a matched control group. Setting: Medical intensive care unit at a university hospital. Patients: Twenty four patients fulfilling the criteria of septic shock were included in this study. Twelve patients received PTX (therapy group) and 12 patients matched for diagnosis, age and gender served as the control group. Interventions: Pentoxifylline at 1 mg/kg per hour over 24 h in the therapy group. Measurements ad results: Cytokine levels [tumor necrosis factor-α (TNF)], soluble TNF receptor [TNF-R], and interleukin-6 [IL-6] and inflammatory proteins [C-reactive protein, α-1-antitrypsin (AAT), fibronectin, and haptoglobin], as well as hemodynamic parameters and the APACHE III score were evaluated before initiation of therapy and 24 h later. After 24 h, TNF levels were significantly lower in the therapy group (p=0.013), while IL-6 levels were significantly higher in the therapy group (p=0.030). Within the 24 h TNF declined significantly in the therapy group (p=0.006), while IL-6 showed a significant increase (p=0.043). AAT and the APACHE III score tended to differ significantly after 24 h between the groups [AAT levels higher in the therapy group (p=0.05), APACHE III score lower (p=0.05)]. In the therapy group, the systemic vascular resistance index was significantly higher after 24 h (p=0.0026) whereas the cardiac index declined (p=0.035). Conclusions: PTX does influence TNF levels in septic shock patients. Nevertheless, inhibiting a single mediator in severe septic shock cannot stop the inflammatory overreaction.
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  • 4
    ISSN: 1432-1238
    Keywords: Key words Thrombotic ; thrombocytopenic purpura ; Thrombotic microangiopathy ; Hemolytic uremic syndrome ; Intensive Care Unit ; Critical illness ; Plasma exchange
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Description of diagnostic procedures, treatment modalities and intensive care management of patients with thrombotic thrombocytopenic purpura (TTP). Design: Descriptive study. Setting: Internal medicine Intensive Care Unit (University Hospital of Vienna). Patients: Six patients (two after allogeneic bone marrow transplantation), treated for 12 episodes of TTP. Interventions: Treatment with plasma exchange (fresh frozen plasma, 50–80 ml/kg per day), prednisone (0.75 mg/kg b.i.d.) and, in some cases, vincristine. Supportive therapy as needed. Measurements and results: Patients were admitted to the ICU because of neurological symptoms with acute onset (42% mild, 58% severe), hemolysis and thrombocytopenia. Additional symptoms were fever (50%), bleeding tendency (50%), acute renal failure (42%) and metabolic derangement (8%). Initial laboratory values showed thrombocytopenia (median 17 G/l), hemolysis (median hemoglobin 10.0 g/dl, lactate dehydrogenase 635 U/l, reticulocyte count 175 G/l) with red cell fragmentation. Coagulation tests were normal. Respiratory assist was needed in six episodes (severe seizures, cardiopulmonary resuscitation). In patients without preexisting hematological abnormality the platelet counts exceeded 100 G/l after 3–8 cycles of plasma exchange. In patients after bone marrow transplantation, the platelet counts never exceeded 40 G/l, but the lactate dehydrogenase levels dropped significantly. The neurological symptoms disappeared in all patients and renal function normalized. One patient died before the initiation of therapy. Three patients relapsed 1–3 times between 2 weeks and 5 months after the last episode. The relapses were associated with symptoms similar to the first episode and responded promptly to plasma therapy. Conclusions: TTP is a rare, but life-threatening disorder. It needs immediate diagnosis and has a good prognosis after adequate treatment with plasma exchange.
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  • 5
    ISSN: 1432-1238
    Keywords: Key words Thiopental ; Endothelial cells ; Neutrophils ; Migration ; In vitro assay ; PMNL
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: The interactions between blood and vascular wall cells are essential for the understanding of pathophysiologic processes, e. g. inflammation. The influence of the anesthetic drug thiopental on leukocyte function is well documented. Recently, an inhibitory effect of thiopental on leukocyte chemotaxis in a Boyden chamber assay (i. e. endothelial cells were not included) was demonstrated. In vivo, leukocytes have to interact with endothelial cell monolayers to invade the tissue. The influence of thiopental on a monolayer of endothelial cells has not yet been investigated. The aim of the current study was to investigate the influence of thiopental on the migration of leukocytes through endothelial cell monolayers (ECM). Material and methods: Human umbilical vein endothelial cells (HUVEC) were isolated and cultured on microporous membrane filters to achieve a monolayer. Isolated polymorphonuclear leukocytes (PMNL) as well as ECM were preincubated with different concentrations of thiopental. The rate of leukocyte migration against the chemotactic protein formyl-methyl-leucyl-phenylalanine was measured (n = 7). Thiopental was able to reduce the amount of leukocyte migration through ECM significantly. Conclusion: In conclusion, we could show that thiopental is able to reduce the migration of PMNL through ECM significantly.
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  • 6
    ISSN: 1434-4726
    Keywords: Esophageal-tracheal Combitube ; Airway obstruction ; Cervical hematoma ; Intubation difficulty
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The esophageal-tracheal Combitube (Sheridan, Argyle, NY) is a new device for emergency intubation, which can be inserted blindly without the use of a laryngoscope. Ventilation is independent of the position of the Combitube in either the esophagus or the trachea, since ventilation is always provided by the tube's double channel. The “tracheal” channel acts as a conventional endotracheal airway and has an open distal end. The “esophageal” channel has a blocked distal end, so that together with the inflated distal cuff it acts as an esophageal obturator in cases of esophageal intubation. Perforations at the pharyngeal section direct the airflow to the trachea. At the oropharyngeal section a large elastic balloon is positioned in order to obturate the oral cavity and the nasopharynx. Two patients are described to exemplify the Combitube's clinical use. Both had rapidly enlarging cervical hematomas causing upper airway obstruction and thus requiring immediate intubation. Endotracheal intubation failed because the glottis could not be visualized with a laryngoscope. In both cases the Combitube was applied successfully and adequate ventilation was provided via the Combitube placed esophageally. To better secure each patient's airway, tracheotomy was performed during ventilation without any complications.
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  • 7
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-1459
    Keywords: Myotonic dystrophy ; Erythrocytes ; Adenine and adenosine uptake ; Adenine nucleotide formation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Aufnahme und der Stoffwechsel von Adenin und Adenosin in Erythrocyten von Patienten mit myotoner Dystrophie (MD) wurde untersucht. Zur Charakterisierung des Aufnahmevorganges wurden gewaschene Erythrocyten von Kontrollpersonen bzw. Patienten mit 14C-markiertem Adenin oder Adenosin bei 20° C für 5 bis 120s inkubiert. Zwischen den Kontrollen und den Patienten waren keine Unterschiede nachweisbar. Nach 30 min Inkubation bei 37° C wurden die gebildeten Adeninnukleotide bestimmt. Im Vergleich zu den Kontroll-Erythrocyten wurde in den Erythrocyten der MD-Patienten Adenin um den Faktor 2.6 vermehrt in Adeninnukleotide eingebaut, wobei es zu einem Anstieg des Quotienten aus ATP: ADP+AMP von durchschnittlich 0,92 auf 1,39 kam. Adenosin wurde hingegen in den Erythrocyten beider Kollektive in gleicher Weise metabolisiert. Die Ergebnisse weisen auf keine Störung der Purintransportsysteme an Erythrocyten von MD-Patienten, lassen aber trotz normaler intraerythrocytärer ATP-Konzentration auf einen größeren Bedarf an ATP schließen, der auf einen vermehrten Austritt der Adeninnukeotide aus dem MD-Erythrocyten zurückzuführen sein könnte.
    Notes: Summary The uptake and subsequent metabolism of adenine and adenosine was studied with the intact erythrocytes of patients with myotonic dystrophy (MD). Washed erythrocytes of both controls and patients were incubated with 14C-labeled adenine or adenosine at 20°C for 5 to 120s to characterize the uptake process. No differences in the uptake process of adenine or adenosine were observed between normal and MD erythrocytes. Formation of adenine nucleotides was determined at 37° C after incubation for 30 min. Compared to controls, the incorporation of adenine into adenine nucleotides was 2.6 times higher in MD erythrocytes. This depends mainly on an increase of ATP formation. The mean ratios of ATP: ADP+AMP for normal red cells and MD erythrocytes were 0.92 and 1.39 respectively. No difference was found in the conversion of adenosine to adenine nucleotides. In spite of a normal amount of intracellular ATP a greater demand for ATP exists. This might be due to leakage of adenine nucleotides out of MD erythrocytes.
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  • 9
    ISSN: 1432-1335
    Keywords: Acute myeloid leukaemia ; Drug resistance ; MDR1 gene ; Dexverapamil ; Daunorubicin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In order to evaluate dexverapamil as a resistance modifier in acute myeloid leukaemia, we have added dexverapamil (4×300 mg/d orally) to DA chemotherapy (daunorubicin, cytosine arabinoside) in six patients with acute myeloid leukaemia. Two patients (1 first and 1 second relapse) achieved complete remission and two patients (1 refractory disease, 1 third relapse) showed some improvement. One patient in first relapse died due to disease progression and one drug-refractory patient remained refractory. The peak plasma levels of dexverapamil and nordexverapamil ranged from about 600 to 4100 ng/ml and from 450 to 1130 ng/ml, respectively. Major sideeffects were hypotension and sinus bradycardia. These results show the need for further evaluation of dexverapamil as a resistance modifier in acute myeloid leukaemia.
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  • 10
    ISSN: 1432-1238
    Keywords: Key words Prothrombin complex concentrates ; Thrombogenicity ; Intensive care ; Disseminated intravascular coagulation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To evaluate thrombogenicity of prothrombin complex concentrates (PCCs) in critically ill patients.¶Design: Prospective clinical study.¶Setting: Medical intensive care unit at a university hospital.¶Patients: 16 consecutive patients suffering from acquired deficiencies of coagulation factors and with either overt bleeding from any site or a planned invasive procedure.¶Interventions: 2000 factor IX units of PCCs intravenously.¶Measurements and results: Prothrombin time (PT), activated partial prothrombin time, fibrinogen, platelet count, plasma levels of coagulation factors II, V, VII, VIII, IX, X, antithrombin, protein C, thrombin-antithrombin complex (TAT), prothrombin fragment F1+2, and the fibrin degradation product D-dimer were measured prior to and 1, 3, and 24 h after administration of PCCs. PT as well as coagulation factors II, VII, IX, and X, TAT, and F1+2 showed a significant increase after administration of PCCs. All other parameters remained unchanged.¶Conclusions: Administration of PCCs induces thrombin generation. No evidence for induction of disseminated intravascular coagulation in biochemical terms could be found. When rapid correction of acquired coagulation factor disturbances is warranted, the use of PCCs seems reasonable, but the elevated risk of intravascular thrombus formation should be kept in mind.
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