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  • 1
    ISSN: 1573-2568
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 1. Twenty patients withE. vermicularis infection received 200 mg. of dithiazanine three times a day after meals for 5 days.E. vermicularis eggs were not demonstrable on 7 consecutive daily Scotch-tape swabs beginning one day after the completion of therapy in 19 of the 20 patients. Only one egg shell on a single swab was demonstrated in the remaining patient and it was considered a contaminant. 2. Fifteen patients withE. vermicularis infections received 100 mg. of dithiazanine three times a day after meals for 5 days. In all cases,E. vermicularis eggs were not demonstrable on 7 consecutive daily Scotch-tape swabs beginning one day after the completion of therapy. The cure rate of enterobiasis for this series was 100 per cent. 3. The drug in 100 mg. enteric-coated tablets was well tolerated except for occasional single episodes of vomiting.
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  • 2
    ISSN: 1573-2568
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The principle of effective broad-spectrum anthelmintic activity against human intestinal nematode infections has been demonstrated by the therapeutic results obtained with dithiazanine. In proper dosage, this polyvermicide is therapeutic for trichuriasis, strongyloidiasis, ascariasis and enterobiasis. The drug has only moderate anthelmintic activity against the hookworm,Necator americanus. It fills a need for a therapeutic for trichuriasis and strongyloidiasis. Dithiazanine is useful for the treatment of patients with either single or multiple intestinal helminthic infections. The indications for use of dithiazanine iodide are: 1. Trishuriasis 2. Strongyloidiasis 3. Mixed infections with trichuriasis and ascariasis 4. Other mixed infections with intestinal nematodes when either trichuriasis or strongyloidiasis is present.
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  • 3
    ISSN: 1435-1420
    Keywords: Schlüsselwörter Tonometrie – lebervenöse Oxymetrie – lebervenöse Sauerstoffsättigung – Hepatosplanchikusregion ; Key words Tonometry – hepatovenous oximetry – liver venous oxygen saturation – hepatosplanchnic region
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Tonometry and hepatovenous oximetry monitor the O2 supply of the gastrointestinal region from different points of view. While tonometry estimates tissue oxygenation of gut mucosa, hepatovenous oximetry measures the global ratio of O2-demand and -consumption of the hepatosplanchnic region without direct relation to the oxygen supply of the mucosa at the cellular level. The reliability of tonometry was evaluated in animal studies. Its prognostic value was identified in clinical investigations. Before routine employment of tonometry for monitoring of gut-related therapy in the intensive care unit, some methodical problems need to be solved. In the near future the development of fiberoptic catheters for on-line measurement of mucosal PCO2 or of semicontinuous air tonometry will reduce the time interval between measurements of valid tonometric data. Changes of mucosal PCO2 will then be more closly related to therapeutic maneuvers. Hepatovenous oximetry requires invasive catheterization of a liver vein. This method allows an on-line monitoring of changes in O2 supply of the hepatosplanchnic region. Theoretically it might support a gut-related therapy. Some investigations indicate a good prognostic value of ShvO2. Unfortunately, an increase of ShvO2 cannot always be interpreted as an improvement in the oxygen supply-demand ratio in the splanchnic region. Complications related to the hepatovenous catheter are possible but have not been published up to now. Due to the small number of recently published investigations this method cannot be considered to be sufficiently evaluated. So far recommendations concerning the indication and the moment for starting the monitoring of ShvO2 cannot be given. Consequently, hepatovenous oximetry cannot be recommended for routine monitoring in the ICU up to now. Additional controlled studies are necessary to carry out a safe analysis of advantages and risks of tonometry and hepatovenous oximetry.
    Notes: Zusammenfassung Tonometrie und hepatovenöse Oxymetrie sind Verfahren zur Überwachung der O2-Versorgung des Gastrointestinaltrakts. Während die Tonometrie die Gewebesauerstoffversorgung eines definierten Abschnittes der gastrointestinalen Mukosa erfaßt, präsentiert die hepatovenöse Oxymetrie mit der Angebot-Verbrauch-Relation des Splanchnikusgebietes einen Globalparameter ohne direkten Bezug zur Oxygenierung auf zellulärer Ebene. Die Aussagekraft der wenig invasiven Tonometrie wurde im Tierversuch evaluiert, ihre prognostische Wertigkeit konnte in klinischen Untersuchungen nachgewiesen werden. Um das Verfahren erfolgreich zur teilkreislaufbezogenen Therapiesteuerung bei Intensivpatienten einsetzen zu können, bedarf es noch der Klärung einiger methodischer Probleme. Die Entwicklung von Fiberoptikkathetern zur kontinuierlichen Erfassung des mukosalen pCO2, bzw. der semikontinuierlichen Gastonometrie kann in naher Zukunft helfen, das Zeitintervall zur Bestimmung valider Daten zu verkürzen und die Interpretation der Dynamik des Parameters in Relation zu therapeutischen Manövern zu erleichtern. Die hepatovenöse Oxymetrie setzt die Anlage eines Lebervenenkatheters und damit eine hochinvasive Vorgehensweise voraus. Die schnelle Erfassung von Veränderungen der O2-Versorgung des Gastrointestinaltrakts ermöglicht eine zeitnahe Anpassung der Intensivtherapie. Auch gibt es Hinweise auf eine gute prognostische Aussagekraft der lebervenösen Sauerstoffsättigung (ShvO2). Als Nachteil ist die nicht eindeutige Interpretationsmöglichkeit eines lebervenösen Sättigungsanstieges zu betrachten, der nicht zwingend einer Verbesserung des O2-Angebot-Verbrauch-Verhältnisses zuzuordnen ist. Katheterbezogene Komplikationen sind theoretisch möglich, wurden aber noch nicht beschrieben. Das Verfahren gilt aufgrund der geringen Publikationszahlen als noch nicht evaluiert. Fragen zur Indikationsstellung und zum Zeitpunkt eines Überwachungsbeginns wurden bislang nicht geklärt. Für den klinischen Routineeinsatz ist die hepatovenöse Oxymetrie z.Zt. nicht zu empfehlen. Weitere kontrollierte Studien sind notwendig, um eine definitive Nutzen-Risiko-Analyse der Tonometrie und der hepatovenösen Oxymetrie durchführen zu können.
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  • 4
    ISSN: 0538-8066
    Keywords: Chemistry ; Physical Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: An iterative method has been devised for the simulation of chemiluminescence data during the oxidative decomposition of αα′ azobisisobutyronitrile in the presence of ethylbenzene. From this simulation the cross termination rate constant of the two types of peroxy radicals present has been estimated.
    Additional Material: 2 Ill.
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  • 5
    ISSN: 1432-1238
    Keywords: Key words Plasmapheresis ; Hemofiltration ; Sepsis ; Mortality ; Surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To examine the effect of continuous venovenous hemofiltration (CVVHF) combined with plasmapheresis (TPE) in critically ill surgical patients after treatment of the septic focus. Design: Observational pilot study. Setting: University teaching hospital intensive care unit. Interventions: TPE and CVVHF were administered 24 h after surgical and/or interventional treatment of septic focus. Arterial blood pressure, cardiac output, and systemic vascular resistance values were monitored. We examined the effect of the combined extracorporeal detoxification on outcome related to age, morbidity, organic failure rate, and initial APACHE II score. Measurements and results: Forty-three patients with sepsis were treated; 19 received TPE in combination with CVVHF, and 24 did not receive extracorporeal therapy. Overall mortality was 44.2 %. In the therapy group mortality was lower (42.1 vs. 45.8 %), but the primary organic failure rate was higher. The relationship between mortality and age was similar in the two groups. There was also no difference between the groups in the course of scores on APACHE II, multiple-organ failure, and sepsis severity. Only patients with an initial APACHE II score of 21–25 had a significant reduction in mortality after combined extracorporeal detoxification. Mortality of 17 % in TPE/CVVHF patients with single- (pulmonary) and double-organ failure (renal/pulmonary) was significantly lower (P 〈 0.0001) than in untreated patients. Conclusions: Reduction in mortality in single- and double-organ failure was as high as 28 % in septic patients with combined extracorporeal detoxification. A prospective randomized trial in sepsis and double-organ failure should be projected.
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  • 6
    ISSN: 0047-2670
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Chemistry and Pharmacology
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  • 7
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Oxymetrie ; Lebervenöse Sauerstoffsättigung ; Splanchnicus-Durchblutung ; Key words Oximetry ; Hepatovenous O2 saturation ; Splanchnic circulation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract As it is the driving force in the development of a multiorgan dysfunction syndrome (MODS), the gastro-intestinal region is at the centre of current discussion. Recently, hepatovenous oximetry has been used increasingly to monitor the relationship between oxygen supply and consumption in the splanchnic system. In the present paper we report an exclusively oximetrically controlled catheterisation procedure that can be carried out at the bedside without the use of imaging procedures. In the inferior vena cava a typical venous oxygen saturation profile can be expected. Near the opening of renal veins there is a peak in venous saturation due to the large extent to which the kidneys partake in the cardiac output and their relatively low oxygen consumption. Correspondingly there is a significant drop in saturation in the area around the opening of the hepatic veins. At the right atrium the oxygen saturation increases again due to admixing of more highly saturated blood from the superior vena cava. Taking these physiological facts into consideration it was attempted to find the opening of the hepatic veins into the inferior vena cava using only continuous in vivo oximetry and to insert a hepatovenous catheter. Material and methods. In 14 patients with postoperative MODS (Apache II score ≥20) a fibreoptic pulmonary catheter for the continuous evaluation of oxygen saturation was inserted via the inferior vena cava (entrance through the femoral vein). First the catheter was pushed forward into the wedge position in the usual way. Subsequently it was pulled back up to the region of high renal venous saturation. At this point the catheter, now unblocked, was pushed forward again with gentle twisting motions until a distinct decrease in saturation was reached well below the value of the mixed-venous saturation which can be taken as an indication for having entered the hepatic vein. Using a CO oximeter a slowly aspirated blood specimen was taken from the distal line of the catheter and analysed. The placement of the hepatovenous catheter was verified by radiograph of the abdomen. In most cases the catheter had to be readjusted several times before it reached its final position. Results. Of the 14 patients, 13 showed the saturation course in the inferior vena cava that could theoretically be expected. In 12 patients (85.7%) we succeeded in placing the hepatovenous catheter correctly by applying this procedure. The average depth of insertion of the catheter after final positioning was 57±4 cm. Initial values of hepatovenous saturation (S hvO2) amounted to an average of 35.1±9.4%. The minimum value was 19%; the maximum S hvO2 came to 59%. Discussion. With the procedure presented it was possible in 12 of 14 patients to position a hepatovenous catheter oximetrically controlled without further means. A precondition for this is a typical saturation profile of the inferior vena cava, which, however, was not found in one of the patients. A possible explanation for this could be an increased shunt volume in the hepatosplanchnicus area, which can lead to high S hvO2 values. For this reason the opening of the hepatic veins could not be recognized by a decrease in saturation using the oximetric procedure. Placement of a catheter was not possible. Future studies on larger groups of patients will be required to show to what extent monitoring of S hvO2 can lead to an efficient therapy specific for this part of the cardiovascular system in patients with sepsis and MODS.
    Notes: Zusammenfassung Der Gastrointestinaltrakt steht als Motor der Entwicklung eines Multiorgandysfunktionssyndroms (MODS) im Mittelpunkt der aktuellen Diskussion. Zur Überwachung des Sauerstoff-Angebot-Verbrauchs-Verhältnisses in diesem Teilkreislaufgebiet wird in jüngster Vergangenheit vermehrt die lebervenöse Oxymetrie eingesetzt. In der vorliegenden Arbeit wird eine ausschließlich oxymetrisch gesteuerte Katheterisierung einer Lebervene beschrieben, die bettseitig ohne Einsatz bildgebender Diagnostik-Verfahren möglich ist. In der V. cava inferior ist ein typisches venöses Sauerstoffsättigungsprofil zu erwarten. In Höhe der Einmündung der Nierenvenen kommt es zu einem sprunghaften Anstieg der venösen Sättigung aufgrund des hohen Anteils der Organe am Herzzeitvolumen und dem, in Relation dazu, geringen Sauerstoffverbrauch. Im Bereich des Zuflusses der Lebervenen zeigt sich meist ein ebenso deutlicher Abfall der Sättigung. Nach Erreichen des rechten Vorhof steigt die O 2 -Sättigung auf Grund der Zumischung höher gesättigten V. cava superior Blutes wieder an. Unter Berücksichtigung dieser physiologischen Gegebenheiten gelang es bei 12 von 14 Patienten mit postoperativem MODS (Apache II-Score ≧20) mit alleiniger Hilfe der kontinuierlichen in-vivo Oxymetrie die Leberveneneinmündung in die V. cava inferior aufzufinden und einen Katheter hepatovenös zu plazieren. Die Ausgangswerte der lebervenösen Sauerstoffsättigung (shvO 2 ) wurden im Mittel mit 35,1±9,4% bestimmt. Der minimale Wert betrug 19%, die höchste shvO 2 lag bei 59%. Inwieweit das Monitoring der shvO 2 zu einer effizienten, teilkreislaufspezifischen Therapie bei Patienten mit Sepsis und MODS führen kann, werden erst zukünftige Studien mit größeren Patientenkollektiven zeigen können.
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  • 8
    ISSN: 1432-055X
    Keywords: Schlüsselwörter SIRS ; Sepsis ; MODS ; Hämodynamik ; Interleukin-2 ; Interferon-α ; Key words SIRS ; Sepsis ; MODS ; Haemodynamics ; Interleukin-2 ; Interferon-alpha
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Human recombinant interleukin 2 (IL-2), alone or in combination with other cytokines, is currently under investigation for the immunotherapy of metastatic tumours. Objective responses of 20%–35% have been reported in patients with disseminated melanoma and renal cell carcinoma who received high-dose intravenous IL-2 in combination with interferon-α (IFNα). However, treatment with IL-2 is complicated by a syndrome of life-threatening adverse reactions such as disseminated vascular leakage, fluid retention, severe hypotension, and (reversible) multiple organ dysfunction (MODS). A systemic inflammatory reaction (SIRS)/sepsis sepsis-like haemodynamic pattern has been described in patients after IL-2 bolus application alone. Our purpose was to study the haemodynamic changes in patients treated with high-dose IL-2 administered as a constant infusion and in combination with IFNα. Patients and Methods. Haemodynamic variables were obtained during therapy courses of 11 patients (aged 48 to 71 years, median 61) with metastatic renal cell carcinoma receiving immunotherapy with IL-2/IFNα. Therapy consisted in (Fig. 1): IFNα 10·1010 IU/m2 body surface area (BSA) once daily on days 1–5 i.m. on a regular ward, followed by IL-2 as a constant infusion of 18·106 IU/m2 BSA on days 6–11 in an intensive care unit (ICU). Haemodynamics were first measured after 5 days of IFNα application and transfer to the ICU on day 6, a further 24 h after the beginning of IL-2 infusion (day 7), and at the end of the therapy course (days 10 and 11). Mean arterial pressure (MAP) was measured noninvasively using an oscillometric device (Dinamap®, Critikon). Mixed-venous oxygen saturation (sv¯¯ O2) was measured using an CO-oxymeter (OSM 3®, Radiometer) and peripheral arterial oxygen saturation (psaO2) was recorded continuously with a pulse oximeter (Oxyshuttle®, Critikon). In case of haemodynamic instability, stabilisation had priority over invasive haemodynamic measurements, so that nadir values of blood pressure (BP) did not influence mean MAP and are reported separately. Lactate values and criteria for SIRS were obtained before and during IL-2 infusion. Lactate measurements were performed using an enzymatic essay (Abbot FLx®). The mean effect size of the haemodynamic values, SIRS criteria, and lactate concentrations during IL-2 infusion (days 6–11) were calculated, and 95% confidence intervals for the effect sizes are indicated in Table 1. Results. After their daily i.m. injections of IFNα, patients had short episodes of fever and tachycardia without significant drops in BP. A few hours after transfer to the ICU and continuous infusion of IL-2, they developed a syndrome of fever, tachycardia and tachypnoea. The haemodynamic values after 5 days of IFNα therapy remained in the normal range, whereas those during IL-2 infusion strongly resembled SIRS and sepsis, with a decrease in MAP (98 to 82 mm Hg) and systemic vascular resistance (SVR, 1477 to 805 dyn·s·cm−5) and an increase in cardiac output (cardiac index 2.8 to 4.3 l·min−1·m−2) (Fig. 2, Table 1). MAP often had to be stabilised with colloids during the last 48 h of therapy; 5 patients had nadir values below 60 mm Hg, or 30% below basic values in hypertensive patients. Catecholamine therapy became mandatory in 1 patient and therapy had to be discontinued. Surprisingly, some patients already had elevated plasma lactate concentrations after IFNα therapy. During IL-2 infusion mean plasma lactate levels increased from 2.3 to 3.2 mmol·l−1 and all patients had lactate concentrations above 2.0 mmol·l−1 at the end of therapy (Fig. 3, Table 1). During the last 48 to 72 h of IL-2 infusion, patients suffered from MODS with altered mental state (7 patients), oligoanuria (all patients), cardiac dysrhythmias (4 patients), congestive heart failure (1 patient, which led to a second case of therapy interruption), elevated bilirubin (4 patients), and pulmonary dysfunction. In 9 patients supplementary oxygen was necessary when psaO2 fell below 92%. Chest X-rays showed signs of pulmonary interstitial oedema. All patients developed significant generalised oedema due to a vascular leak syndrome, with fluid retention and weight gains of 6.3% during IL-2 infusion (Tables 1 and 2). Leukocyte counts dropped to 3670 μl−1 after 5 days of IFNα injection and rose to 9970 μl−1 at the and of IL-2 infusion. After discontinuation of IL-2 (day 11) the body temperature, heart rate, BP, and criteria of impaired organ function rapidly returned to the normal range, but leukocyte counts rose to 15360-μl−1 on day 12 (Table 1). Conclusion. High-dose IL-2 administered as a constant infusion and in combination with IFNα results in similar haemodynamic changes to those seen during high-dose IL-2 bolus application alone. The observed haemodynamic pattern strongly resembles SIRS and sepsis. MODS, fluid retention, and increases in plasma lactate indicate microcircular disorders. Elevated levels of sepsis mediators such as tumor necrosis factor and interleukin-1, activation of the complement cascade, activated neutrophil granulocytes and endothelial cells have been reported in patients receiving high-dose IL-2 bolus treatment. Our results and data of other investigators lead us to conclude that not only the (macro)haemodynamic pattern of IL-2/IFNα therapy, but also its pathogenetic pathways parallel SIRS and sepsis. IL-2/IFNα immunotherapy may therefore be used as a clinical “model” for sepsis research.
    Notes: Zusammenfassung Die Zytokine Interleukin-2 (IL-2) und Interferon-α (IFNα) werden zur Immuntherapie metastasierender Malignome eingesetzt. In der vorliegenden Studie wurde bei 11 Patienten mit Nierenzellkarzinom die Hämodynamik während einer fünftägigen, hochdosierten, kontinuierlichen IL-2 Infusion in Kombination mit der i.m.-Applikation von IFNα mit einem Pulmonalarterienkatheter invasiv überwacht. Die Patienten entwickelten wenige Stunden nach Beginn der kontinuierlichen IL-2 Infusion ein Syndrom aus Fieber, Tachykardie, Tachypnoe und im weiteren Verlauf Leukozytose (SIRS). Die Hämodynamik ähnelte den hyperdynamen Kreislaufverhältnissen bei SIRS und Sepsis. Hinweise auf eine Mikrozirkulationsstörung ergaben sich aus einem Anstieg der Plasma-Laktatkonzentrationen, muliplen Organfunktionsstörungen und einer erheblichen interstitiellen Flüssigkeitsretention aufgrund eines „vascular leak“-Syndroms. Hieraus und aus der von anderen Autoren beschriebenen Aktivierung von Sepsis-typischen Mediatoren unter IL-2-Applikation schließen wir auf eine weitgehende Parallelität in der Pathogenese von hochdosierter IL-2-/IFNα Therapie und SIRS bzw. Sepsis. Die IL-2-/IFNα Therapie bietet sich daher als klinisches Modell der Sepsis an.
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  • 9
    ISSN: 1432-055X
    Keywords: Schlüsselwörter: Kompartmentsyndrom – Rhabdomyolyse – Creatin-Kinase-Aktivität – Steinschnittlage ; Key words: Compartment syndrome – Rhabdomyolysis – Creatine kinase-activity – Lithotomy position
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract. We report two cases of compartment syndrome of the lower leg that occurred in male patients aged 62 and 57 years, respectively, after 10- and 12-h urological surgery in the lithotomy position. During sedation and mechanical ventilation creatine kinase (CK) activity of more than 8,000 U/l was found in both patients. After extubation, clinical symptoms of the compartment syndrome were found. On the 1st day after surgery patient 2 underwent fasciotomy of both lower legs (Fig. 2). No lasting neurologic defects were observed. Patient 1 was treated by fasciotomy on the 4th postoperative day after paresis of the peroneal nerve had developed in the left lower leg. This paresis had shown no tendency to regression when the patient left hospital. On phlebography, both patients showed blockage of the deep lower leg veins up to the knee. Discussion. The compartment syndrome is a rare but serious complication resulting from prolonged surgery in the lithotomy position. Symptoms are neuromuscular lesions of the affected limb. Severe complications of the compartment syndrome are acute renal failure resulting from myoglobin residues in the tubules, electrolyte disturbances, and disorders of acid-base balance. A decrease in perfusion due to the elevated position of the legs, on the one hand, and the impeded venous back-flow due to the positioning on the other are discussed. While positioning the legs, it is important to ensure that the lower legs are lifted only slightly above left atrial level. When rhabdomyolysis occurs, serum CK activity increases. CK values of over 2,000 U/l after surgery may be considered a warning sign in ventilated and sedated patients, in whom early clinical symptoms of the compartment syndrome such as pain and paresthesias cannot be ascertained. Frequent and regular checks of these parameters starting shortly after surgery are recommended. A thorough examination of the lower legs and, if necessary, measurement of the tissue pressure in the compartment should follow. The deep veins of the legs should be checked by phlebography. In cases of verified compartment syndrome, early fasciotomy is the best choice of therapy, because neuromuscular defects are known to be irreversible after 12 to 24 h. Enforced diuresis is recommended in order to avoid renal complications.
    Notes: Zusammenfassung. Es werden die Fälle zweier männlicher Patienten im Alter von 62 Jahren (G. R.) und 57 Jahren (A. T.) dargestellt, bei denen im Anschluß an einen 10- bzw. 12stündigen urologischen Eingriff in Steinschnittlage ein Kompartmentsyndrom (KS) der Unterschenkel auftrat. Bei beiden Patienten fiel unter Analgosedierung und Beatmung eine Serum-Creatin-Kinase-Aktivität von über 8000 U/l auf. Erst nach der Extubation wurden die klinischen Symptome eines KS erkannt. Patient A. T. wurde am 1. postoperativen Tag an beiden Unterschenkeln fasziotomiert, bleibende neurologische Schädigungen traten nicht auf. Patient G. R. wurde am 4. postoperativen Tag nach Auftreten einer Peroneusparese am linken Unterschenkel fasziotomiert. Bis zur Entlassung zeigte die Parese keine Rückbildungstendenz. Beide Patienten zeigten phlebographisch einen Verschluß der tiefen Unterschenkelvenen bis zum Kniegelenkspalt. Als Ursache des KS wird die protrahierte Steinschnittlagerung diskutiert, die einerseits eine Perfusionsminderung der unteren Extremität verursacht und andererseits den venösen Abstrom behindert. Die postoperativ erhöhten CK-Werte werden bei analgosedierten Beatmungspatienten, bei denen die klinischen Frühsymptome des KS, wie Schmerzen und Parästhesien, nur schwierig zu erheben sind, als ein Warnsignal gewertet. Bei entsprechender Lagerungsanamnese und erhöhten CK-Werten sollte dann zum Ausschluß eines KS eine genaue Untersuchung der unteren Extremitäten und ggf. eine Gewebedruckmessung in den Faszienlogen der Unterschenkel erfolgen.
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  • 10
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Pulsoxymetrie ; Methämoglobin ; Prilocain ; Plexusanästhesie ; Key words Pulsoximetry ; Methaemoglobinaemia ; Prilocaine ; Plexus block
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract During the last 15 years pulse oximetry has become a widely accepted method of monitoring during general and local anaesthesia. Pulse oximeters measuring with two wavelengths are considerably affected by dyshaemoglobin. At concentrations up to 30%, CO-Hb cannot be distinguished from O2-Hb. Met-Hb, even in low concentrations, leads to a constant error of measurement; some authors recommended exploiting this for estimation of the Met-Hb concentration. To prove the aim of the present study was to test whether this error in measurement can be defined with one formula for different pulse oximeters. Patients and methods. In a prospective, randomized, double-blind study, 171 non-smoking patients with healthy lungs (ASA 1–3) who had received a plexus block for hand surgery were investigated. After premedication with 3.75–15 mg medazolam p.o. each patient received a total of 6 lO2 via a Hudson mask during the investigation. After 10 min the following pulse oximeters were put on the index finger: (1) Ohmeda BIOX 3700e, (2) Critikon Oxyshuttle, (3) Nellcor N 180. Simultaneously a venous blood sample was taken and analysed immediately with a Radiometer OSM3. The procedure was repeated 15, 30, 60 and 120 min after the plexus block. In 41 patients the plexus block was carried out with lidocaine (6 mg/kg body weight) and in 130 patients, with prilocaine (7 mg/kg body weight). Results. There were no significant differences in age, sex and risk groups between the lidocaine and the prilocaine group. In the lidocaine group we were able to show that hyperoxic conditions can be maintained for 2 h with the method described. In the lidocaine group none of the pulse oximeters showed a psO2 less than 99%. Our results show significant differences between the three pulse oximeters. Therefore, in contrast to the convention followed in the literatur, the relation between Met-Hb and psO2 under hyperoxic conditions must be described with different formulas for each pulse oximeter as follows: (1) Ohmeda BIOX 3700e: Met-Hb=(101-psO2)·0.6 (r=0.94); (2) Critikon Oxyshuttle: Met-Hb=(101-psO2)·0.7 (r=0.83); (3) Nellcor N 180: Met-Hb=(101-psO2) ·0.9 (r=0.92). Discussion. Our results show that it is not possible to describe the connection between Met-Hb and psO2 for all pulse oximeters with only one formula, but it is possible to set up different formulas with good correlations for each of the three pulse oximeters. The reasons for the different sensitivity are probably the different algorithms used by the manufacturers. In spite of the good correlations we can not recommend Met-Hb estimation by pulse oximetry measurement with two wavelengths, because the distinction of hypoxia and Met-Hb its not possible when hyperoxic conditions are not stable as they were in our controlled study. A low psO2 measured in patients with normal arterial blood gases can be an indication of Met-Hb, but the exact measurement of dyshaemoglobin is only possibly by using a co-oximeter.
    Notes: Zusammenfassung In einer prospektiven, randomisierten Doppelblindstudie wurde die Beeinflussung der Meßgenauigkeit dreier verschiedener Pulsoxymeter durch Methämoglobin untersucht. 171 Patienten, die sich einem handchirurgischen Eingriff in Plexusanästhesie unterzogen, erhielten während des gesamten Untersuchungszeitraums 6 l O 2 über eine Hudson-Maske. Bei 41 Patienten wurde die Plexusblockade mit Lidocain und bei 130 Patienten mit Prilocain durchgeführt. Vor Anlage der Plexusanästhesie sowie 15, 30, 60 und 120 min danach wurden folgende Pulsoxymeter angelegt: 1. Ohmeda BIOX 3700e, 2. Critikon Oxyshuttle, 3. Nellcor Pulsoxymeter N180. Gleichzeitig wurde eine periphervenöse Blutprobe auf Dyshämoglobine untersucht. Mit der Lidocaingruppe konnte gezeigt werden, daß es mit der beschriebenen Methodik möglich ist hyperoxische Bedingungen aufrechtzuerhalten. In der Prilocaingruppe ergaben sich erhebliche psO 2 -Abfälle, die sich zwischen den drei Pulsoxymetern signifikant unterschieden. Ein Zusammenhang zwischen Met-Hb und psO 2 -Abfall für alle Pulsoxymeter gleich konnte nicht gefunden werden, sondern müßte individuell wie folgt definiert werden: 1. Ohmeda BIOX 3700e: Met-Hb= (101-psO 2 )·0,6 (r=0,94), 2. Critikon Oxyshuttle: Met-Hb= (101-psO 2 )·0,7 (r=0,83), 3. Nellcor Pulsoxymeter N180: Met-Hb=(101-psO 2 )· 0,9 (r=0,92). Obwohl dieser Meßfehler für jeden Gerätetyp gut reproduzierbar ist, halten wir es dennoch nicht für zulässig, aus dem Abfall der psO 2 auf das Ausmaß der Methämoglobinämie zu schließen. Die Bestimmung von Dyshämoglobinen muß daher immer in vitro, d.h. mit einem Co-Oxymeter erfolgen.
    Type of Medium: Electronic Resource
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