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  • 1
    ISSN: 1432-1440
    Keywords: Catecholamines ; Octopamine ; Hepatic coma ; Sympathetic nervous system ; Katecholamine ; Octopamin ; Coma hepaticum ; Sympathisches Nervensystem
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Plasmaspiegel von Adrenalin, Noradrenalin und Octopamin wurden mit Hilfe radioenzymatischer Methoden bei neun ambulanten Zirrhose-Patienten mit Enzephalopathie und bei zehn Patienten im Coma hepaticum (Comagrad III–IV) bestimmt. Bei den Zirrhose-Patienten wurden sowohl normale als auch erhöhte Plasmaspiegel von Noradrenalin gemessen. Octopamin war im Plasma dieser Patienten sowie bei zehn gesunden Kontrollpersonen nicht nachweisbar. Erhöhte Noradrenalinspiegel im Plasma waren bei allen Patienten im Coma hepaticum vorhanden. Die Noradrenalinkonzentration im Plasma blieb auch während des Comaverlaufes erhöht oder stieg weiter an. Der Adrenalinplasmaspiegel war hingegen nicht regelmäßig erhöht. In acht der zehn Patienten war Octopamin wiederum nicht nachweisbar. Nur bei zwei Coma-Patienten konnten Octopaminspiegel bis zu 59,5 ng/ml bei gleichzeitiger Erhöhung der Noradrenalinkonzentration gefunden werden. Die Infusion der verzweigtkettigen Aminosäure L-Valin beeinflußte weder den Noradrenalin- noch den Octopaminspiegel. Die Ergebnisse sprechen dafür, daß die Aktivität des sympathischen Nervensystems im Coma hepaticum erhöht ist. Eine Akkumulierung von Octopamin ist kein charakteristischer Befund bei chronischer Lebererkrankung und hepatischem Coma. Nachdem bei zwei Coma-Patienten die Akkumulierung von Octopamin bei einer gleichzeitigen Erhöhung des Noradrenalinspiegels auftrat, erscheint eine Verdrängung von Noradrenalin durch den falschen Neurotransmitter Octopamin im noradrenergen Neuron des peripheren Sympathikus unwahrscheinlich. Die Resultate sprechen dafür, daß die Entwicklung einer Hypotension im Rahmen der Leberzirrhose und des Coma hepaticum nicht auf einen Mangel an Noradrenalin zurückzuführen ist.
    Notes: Summary Plasma levels of adrenaline, noradrenaline and octopamine were estimated by a radioenzymatic method in nine cirrhotic outpatients with encephalopathy and in ten patients with hepatic coma (coma grade III–IV). In the cirrhotic outpatients normal as well as elevated plasma levels of noradrenaline were found. Octopamine could not be detected in the plasma of these patients as well as of ten healthy volunteers. Elevated noradrenaline levels were present in all patients with hepatic coma. Plasma noradrenaline remained elevated or even further increased during the course of hepatic coma, whereas adrenaline was elevated less frequently. In eight of the ten patients with hepatic coma octopamine was again not detectable in plasma. Only in two patients high levels of octopamine up to 59.5 ng/ml could be found in addition to increased noradrenaline concentrations. The infusion of the branched chain amino acid L-valine had no influence on the plasma level of either noradrenaline or octopamine. The data indicate that the sympathetic nervous system is activated during the course of hepatic coma. An accumulation of octopamine is not a common finding in chronic liver disease and hepatic coma. Since in the two patients with elevated octopamine levels the rise in octopamine occured concomitantly with a rise in noradrenaline, a displacement of noradrenaline by the false neurotransmitter octopamine in the noradrenergic neuron of the peripheral sympathetic nervous system seems unlikely. The results indicate that the development of hypotension in the course of liver cirrhosis and hepatic coma cannot be related to a deficiency of noradrenaline.
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  • 2
    ISSN: 1432-1440
    Keywords: Tetanus ; Sympathisches Nervensystem ; Katecholamine ; Herzkreislaufsystem ; Adrenerge Beta-Rezeptorenblocker ; Tetanus ; Sympathetic nervous system ; Catecholamines ; Cardiovascular system ; Adrenergic beta receptor blockers
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Besides the characteristic disturbances of the motor nervous system symptoms indicating an overactivity of the sympathetic nervous system can complicate the course of severe cases of tetanus. These symptoms include fluctuating tachycardia and hypertension, electrocardiographic changes, sweating, constipation with development of paralytic ileus and metabolic disorders. These symptoms are comparable to these developing in patients with phaeochromocytoma. Elevated catecholamine levels in plasma and urine have been found in several patients with tetanus who developed these symptoms. The prolonged overactivity of the sympathetic nervous system is thought to contribute to the still considerably high mortality rate. Myocardial lesions observed at necropsy are comparable to those found in patients dying of phaeochromocytoma. These lesions are suggested to be associated with sudden death from arrhythmias or cardiac failure in patients with tetanus. For the protection of the organism against the overactivity of the sympathetic nervous system a treatment using the combination of β-adrenergic receptor blocking agents and adrenergic neuron blocking agents has been introduced. A reduction of the mortality rate was achievable by this treatment. Experimental evidence is accumulating that the tetanus toxin affects not only the motor, but also the sympathetic and sensory neurons.
    Notes: Zusammenfassung Neben den charakteristischen Störungen des motorischen Nervensystems können Symptome, die eine erhöhte Aktivität des sympathischen Nervensystems andeuten, den Verlauf von schweren Tetanusfällen komplizieren. Zu diesen Symptomen gehören fluktuierende Tachykardie und Hypertension, elektrokardiographische Veränderungen, Schwitzen, Konstipation bis zum paralytischen Ileus und Störungen des Metabolismus. Diese Symptome können auch bei Patienten mit Phaeochromocytom beobachtet werden. Erhöhte Katecholaminspiegel im Plasma und Harn waren bei verschiedenen Tetanus-Patienten, die diese Symptomatik entwickelten, nachweisbar. Die langanhaltende Überaktivität des sympathischen Nervensystems wird als beitragender Faktor für die noch immer beträchtlich hohe Mortalitätsrate bei Tetanus angesehen. Myokardläsionen, die bei der Autopsie immer wieder beobachtet werden, sind mit Läsionen vergleichbar, die bei Patienten mit Phaeochromocytom gefunden werden. Diese Läsionen werden mit dem plötzlichen Tod durch Arrhythmien oder Herzinsuffizienz bei Tetanuspatienten in Zusammenhang gebracht. Um den Organismus vor der Überaktivität des sympathischen Nervensystems zu schützen, wurde eine Kombinationstherapie mit β-adrenergen Rezeptorenblockern und adrenergen Neuronenblockern eingeführt. Durch diese Behandlung konnte eine Senkung der Mortalitätsrate erzielt werden. Es konnten zunehmend mehr tierexperimentelle Hinweise gewonnen werden, daß das Tetanustoxin nicht nur motorische, sondern auch sympathische und sensorische Neuronen beeinflußt.
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  • 3
    ISSN: 1432-1440
    Keywords: Tetanus ; Sympathisches Nervensystem ; Katecholamine ; Adrenerge beta-Rezeptoren Blocker ; Tetanus ; Sympathetic nervous system ; Catecholamines ; Adrenergic beta receptor blockers
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary In severe cases of tetanus an overactivity of the sympathetic nervous system has been postulated because of the clinical symptoms including hypertension, fluctuating blood pressure, tachycardia, tachyarrhythmia and peripheral vasoconstriction. In the present study the involvement of the sympathetic nervous system in tetanus was investigated by serial determinations of plasma adrenaline (A) and noradrenaline (NA) in 2 patients who developed severe symptoms of tetanus and the characteristic cardiovascular disturbances. Sustained high circulating levels of NA and A could be observed indicating a prolonged overactivity of the sympathetic nervous system. In one case, the elevation of the NA level in plasma persisted until the disturbances of the motor nervous system ceased. In a third case of tetanus whithout cardiovascular abnormalities, the plasma NA and A only increased slightly on a few occasions. The results demonstrate that an overactivity of the sympathetic nervous system can complicate the course of severe tetanus.
    Notes: Zusammenfassung Aufgrund der klinischen Symptomatik wurde bei schweren Fällen von Tetanus eine erhöhte Aktivität des sympathischen Nervensystems postuliert. Die Symptomatik setzt sich zusammen aus Hypertension mit starken Schwankungen der Blutdruckwerte, Tachykardien, Tachyarrhythmien, peripherer Vasokonstriktion. Um die Rolle des sympathischen Nervensystems im Rahmen der Tetanuserkrankung näher zu beleuchten, wurden Serienbestimmungen von Adrenalin (A) und Noradrenalin (NA) im Plasma bei 2 Tetanus-Patienten durchgeführt, die die charakteristische Herzkreislaufsymptomatik entwikkelten. Eine über Wochen anhaltende Erhöhung des NA und A als Ausdruck einer langdauernden Überaktivität des sympathischen Nervensystems konnte festgestellt werden. In einem der Fälle konnte demonstriert werden, daß die Erhöhung des Plasma NA Spiegels so lange anhielt, bis die Störungen des motorischen Nervensystems verschwanden. Die Untersuchung bei einem 3. Tetanus-Patienten, bei dem eine Störung des Herzkreislaufsystems nicht auftrat, ergab nur gelegentlich einen geringgradigen Anstieg der Plasmakatecholamine. Die Ergebnisse demonstrieren, daß eine Überaktivität des sympathischen Nervensystems eine Komplikation im Verlauf von Tetanus darstellen kann.
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  • 4
    ISSN: 1432-1238
    Keywords: Burn ; Fluid replacement ; Sodium input ; Plasma osmolarity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In 12 severely burned patients the input of fluid and sodium, as well as sodium concentration in plasma and urine, was studied. The osmolarity in plasma and 24-h urine was measured. The high initial sodium input is noted. Plasma sodium levels stay within the normal range when the amount of sodium given during the further treatment is reduced. The importance of urea production in affecting plasma osmolarity is demonstrated.
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  • 5
    ISSN: 1432-1238
    Keywords: Cranio-cerebral trauma ; Thyroid stimulating hormone ; Human growth hormone ; Endocrine failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Patients suffering from severe cranio-cerebral trauma show alterations of the secretory patterns of thyroid stimulating hormone (TSH) and human growth hormone (HGH) which may be of prognostic significance. We studied 10 patients following severe brain injury and prospectively compared a new synthetic human growth hormone releasing factor (HGHRF) test with the thyrotropin releasing hormone (TRH) test. On admission, all patients had a Glasgow Coma Scale score of 3 or 4. All patients had a low T3 syndrome. In the patients who died the TSH response after stimulation with TRH was also absent. In the patients who survived a significant TSH increase was observed (p〈0.05). In comparison to the patients who died those who survived showed a significant (p〈0.001) HGH increase after HGHRF stimulation. This test might be useful as an additional tool in establishing early prognosis in patients with severe brain injury.
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  • 6
    ISSN: 1432-1238
    Keywords: Severe craniocerebral trauma ; Adrenal system ; Gonadal system ; Thyroidal system ; Human growth hormone ; Insulin system
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Patients with severe craniocerebral trauma (sCCT) display metabolic and endocrine changes. The question is raised whether hormonal patterns give cues to the prognosis of outcome or not. In 21 patients the function of the adrenocortical, gonadal, thyroid and human growth hormone (hGH)-insulin system was assessed. LH, FSH, TSH, prolactin and hGH were stimulated. 3 groups of patients were formed. Group I: patients in acute phase with a Glasgow Coma Score (GCS) more than 6 (group Ia) and less than 6 (group Ib). Group II: patients in transition to traumatic apallic syndrome (TAS). Group III: patients with full-blown or resolving TAS. The values of group Ia comprised low T3, T4 and testosterone, elevated insulin, normal hGH. Group Ib had hypothyroid T3 and T4 and an attenuated response of LH, TSH, prolactin and hGH to stimulation. Group III: there was seen an endocrine normalisation with elevated T4 and TBG and an altered response of hGH and prolactin to stimulation. Endocrine abnormalities were not helpful in predicting which course, either to better or to worse, a given patient would follow.
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  • 7
    ISSN: 1432-1238
    Keywords: Transcutaneous PO2 ; Transcutaneous PCO2 ; Hemodynamics ; Oxygen dissociation curve ; Blood gases ; Intensive care patients
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Transcutaneus PO2 (PtcO2) is suggested to reflect tissue oxygenation in intensive care patients, whereas transcutaneous PCO2 (PtcCO2) is advocated as a noninvasive method for assessing PaCO2. In 24 critically ill adult patients (mean Apache II score 14.2, SD 4.7) we investigated the impact of variables that are commonly thought to determine PtcO2 and PtcCO2 measurements. A linear correlation was found between PtcO2 and PaO2 (r=0.6;p≤0.0001) and between PtcO2 and mean arterial blood pressure (MAP;r=0.42;p≤0.003). Cardiac index (CI) correlated with tc-index (PtcO2/PaO2;r=0.31;p≤0.03). There was no relationship between PtcO2 and hemoglobin concentration (Hb) and the position of the oxygen dissociation curve (ODC). Stepwise multiple regression analysis demonstrated a significant influence of PaO2 and MAP on PtcO2. The contribution of CI, Hb and the ODC was not significant. Only 40% of the variability of a single PtcO2 measurement could be explained by PaO2 and MAP. A significant linear correlation was demonstrated between PtcCO2 and PaCO2 (r=0.76;p≤0.0001) but not between PtcCO2 and CI, MAP and arterial base excess (BEa). Stepwise multiple regression analysis revealed an influence of PaCO2 and of CI on PtcCO2; 66% of the variability of a single PtcCO2-value could be explained by PaCO2 and CI. Our data demonstrate that transcutaneous derived gas tensions result from complex interaction between hemodynamic, respiratory and local factors, which can hardly be defined in ICU-patients.
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  • 8
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    Intensive care medicine 19 (1993), S. 343-346 
    ISSN: 1432-1238
    Keywords: Noise ; Alarms ; ICU
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective The growing number of technical devices in ICUs makes noise exposure a major stressor. The purpose of this study was to assess noise levels during routine operation in our ICU. Design Our ICU is an open ward with four rooms, constructed in the 1960s. During the study period, 4 patients were in the controlled room and were treated by 4 nurses during the day and by 2 at night. A-weighted sound pressure levels (SPL) were measured continuously for 2 days and nights. Also measured were the alarms of various appliances. For gross overall evaluation it is customary to state the Leq, i.e. the energy-averaged level during measurement. The annoyance caused by noise depends more on rare events of high intensity. Therefore, the distribution of SPL values (Ln) over time was also analysed. Results SPL was roughly the same during the day and at night, with Leq between 60–65 dB(A) and peaks up to 96 dB(A). Most alarms reach an SPL of 60–70 dB(A), but some exceed 80 dB(A). During teaching rounds Leq exceeds 65 dB(A). Conclusion During the day and at night SPL always surpasses the permissible noise exposure for 24 h of 45 db(A) recommended by the US Environmental Protection Agency. Alarms cause the most irritating noise. Hospital management should pay attention to internal noise, and SPL should be measured routinely.
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  • 9
    ISSN: 1432-1912
    Keywords: Dopamine β-hydroxylase ; Sympathetic nervous system ; Catecholamines ; Head injury
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The activity of dopamine β-hydroxylase in plasma was studied in 10 patients with various diseases accompanied by a prolonged overactivity of the sympathetic nervous system. Eight of these patients were suffering from head injury, one from tetanus and one from multiple injuries complicated by fat embolism syndrome. Plasma noradrenaline and adrenaline levels were measured concomitantly by a radioenzymatic method. It could be demonstrated that sustained increases of noradrenaline and/or adrenaline levels, which were present for several days or even weeks, were associated with a gradual decline of dopamine β-hydroxylase activity. The decrease of dopamine β-hydroxylase activity was more pronounced in those patients with especially high plasma catecholamine levels. In 3 patients only 13–16% of the initial dopamine β-hydroxylase activity remained after an increase in the activity of the sympathetic nervous system lasting 3–4 weeks. In one of these 3 patients it could be shown that the dopamine β-hydroxylase activity and the noradrenaline and adrenaline levels in plasma returned to the initial levels after complete recovery. An initial increase followed by a decline was present in these patients with the highest increases in adrenaline levels. The decline in dopamine β-hydroxylase activity was not due to an increase in endogenous inhibitors, since the activity of a known amount of dopamine β-hydroxylase was not reduced by adding it to a plasma in which the dopamine β-hydroxylase activity was decreased. Four patients suffering from head injury without signs of an overactivity of the sympathetic nervous system served as controls. No comparable decline of the dopamine β-hydroxylase activity in plasma was observable and noradrenaline and adrenaline levels were within the normal range. The results indicate that dopamine β-hydroxylase activity in plasma does not provide an useful parameter of the sympatho-adrenal activity in a state of prolonged overactivity in humans. It is suggested that the decline in the plasma concentration of dopamine β-hydroxylase in the latter condition may be caused by the depletion of releasable stores of this enzyme in the sympathetic nerve endings.
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  • 10
    ISSN: 1432-1459
    Keywords: Plasma exchange ; Guillain-Barré syndrome ; Artificial respiration ; Recovery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Wirksamkeit einer Plasmaaustausch-Behandlung wurde bei 8 Patienten mit einem Guillain-Barré-Syndrom geprüft. Alle Patienten hatten einen schweren Krankheitsverlauf gezeigt, mit schlaffen Tetraparesen und multiplem Hirnnervenbefall. Fünf Patienten mußten assistiert beatmet werden. Auch bei den anderen Patienten zeigten sich Hinweise für eine drohende respiratorische Insuffizienz. Nach den ersten Plasmapheresebehandlungen konnte eine abrupt einsetzende und deutliche Besserung der Ausfälle beobachtet werden. Die klinische Besserung verlief besonders eindrücklich, wenn der Plasmaaustausch an drei aufeinanderfolgenden Tagen mit einer Austauschmenge von jeweils 2,0–3,01 und in der initialen progressiven Phase der Erkrankung erfolgte. Ein großer Vorteil dieser Therapie dürfte in der Vermeidung langzeitiger künstlicher Beatmung und Ernährung und den damit verbundenen Komplikationen liegen.
    Notes: Summary Plasma exchange has been used for therapy in eight patients with the Guillain-Barré syndrome. All patients were severely ill. They became tetraplegic and showed cranial nerve involvement. Five patients received assisted respiration, but the others were also at risk of ventilatory insufficiency. Recovery was abrupt in all cases after the first plasma exchanges. Improvement was more marked when plasmapheresis was done on three successive days with plasma exchanges of 2.0–3.01 each in the initial progressive stage of the disease. A considerable advantage of this therapy is the avoidance of continued artificial respiration and nutrition, which both carry the risk of further complications.
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