0000000000053321
AUTHOR
Matthias Rothmund
Perioperative nonspecific histamine release : a new classification by aetiological mechanisms and evaluation of their clinical relevance
As a consequence of the performance of a randomized controlled clinical trial on perioperative histamine release and cardiovascular and respiratory disturbances, several types of increases in plasma histamine had to be distinguished instead of only two which existed at the beginning of the study: drug-induced allergic and pseudoallergic reactions. First of all, the new classification by aetiology (clinical epidemiology) was derived from a meta-analysis (secondary analysis) of the most recent literature. According to that histamine release in the perioperative period has several, different causes and is involved in several, different disease manifestations. A clear distinction (classificatio…
Problem solving strategies with biomedical and clinimetric components: The case of perioperative H1-+H2-prophylaxis
A formal (objective) problem solving strategy was developed for the question whether a perioperative histamine H1-+H2-prophylaxis should be applied to patients at risk for a histamine release reaction or for a special severity of such a reaction even in the case of a minor histamine release.
Incidence and clinical importance of perioperative histamine release: randomised study of volume loading and antihistamines after induction of anaesthesia
Although histamine release is recognised as a common event during anaesthesia and surgery, few clinicians judge the resultant cardiorespiratory disturbances serious enough to warrant prophylaxis with antihistamines. We have assessed the incidence and importance of histamine release in a randomised 2 x 2 factorial study. 240 patients representing a routine throughput of major general surgery were studied during a standardised induction of anaesthesia and preoperative loading of the circulation with either Ringer solution or Haemaccel-35, with or without antihistamine prophylaxis with dimetindene (H1) plus cimetidine (H2). Cardiorespiratory disturbances were graded as detectable, clinically r…
The Effect of High Parathyroid Hormone Concentration on Calcitonin in Patients with Primary Hyperparathyroidism2)
Serum calcitonin (CT), parathyroid hormone (PTH), and calcium levels were measured in 23 patients with primary hyperparathyroidism. PTH was determined by a midregion (M-RIA) and a carboxyl-terminal (C-RIA) specific PTH-RIA. Only 2 patients had elevated CT levels. In contrast to the findings in 46 healthy controls, the CT levels did not correlate with calcium levels. Patients who had the highest iPTH values showed a negative correlation between CT and iPTH (M-RIA (n = 7): R = -1.0000, p less than 0.001; C-RIA (n = 13): R = -0.5604, p less than 0.05). The results of the C-RIA were subtracted from those of the M-RIA. In 12 patients with the highest levels of intact PTH (M-RIA - C-RIA), serum P…
Einfluß relevanter hämodynamischer Störungen in der Posteinleitungsphase auf die postoperative Wiederherstellung in der Allgemeinchirurgie
Pra- und intraoperative kardiovaskulare Storungen sind haufige Ereignisse des klinischen Alltages. In der Auswertung und Publikation des ersten Teiles der hier vorgestellten Studie konnte nachgewiesen werden, das deren Inzidenz unmittelbar nach Einleitung der Anasthesie und vor Beginn der Operation deutlich hoher liegt, als dieses bisher allgemein angenommen wurde. Dabei sind diese Storungen uberwiegend histaminabhangig, erfullen aber nicht die klassischen Paradigmen der Histaminfreisetzungsreaktion und sind somit im klinischen Alltag schwer als solche zu identifizieren [1]. Obwohl des in der Literatur deutliche Hinweise zumindest fur den Zusammenhang schwerer postoperativer kardialer Probl…
Erfolgreiche Xenotransplantation von mikroenkapsuliertem Nebenschilddrüsengewebe: Nachweis der Langzeitfunktion ohne Immunsuppression im Tierversuch
Ein permanenter Hypoparathyreoidismus liegt vor, wenn die Calciumkonzentration im Serum uber einen Zeitraum von 6 Monaten hinaus unter 2,2 mmol/1 erniedrigt ist. Haufigste Ursache ist die iatrogene irreversible Schadigung oder Exstirpation der Nebenschilddrusen im Rahmen von Schilddrusenoperationen. Die Angaben uber die Inzi-denz persistierender Hypocalcamie schwanken nach subtotaler Schilddrusenresektion zwischen 0,2 und 1,9% und reichen nach Thyreoidektomie von 0,4–13,8% [1, 2, 3, 4]. Persistierender Hypoparathyreoidismus fuhrt zunachst zu gesteigerter neuromuskularer Erregbarkeit, die sich vor allem in Form von rezidivierenden Tetanien, Konvulsionen und Parasthesien ausert. Die organisch…
Szintigraphie adrenerger Tumoren mit 131J-meta-Benzylguanidin
Pheochromocytoma scanning using 131J-meta-benzylguanidine was done in one patient with metastasizing paraganglioma, one patient with multiple endocrine neoplasia type IIb. No activity of tumour tissue could be demonstrated in the patient with metastasizing paraganglioma, whereas the pheochromocytoma could be clearly defined in the patient with multiple endocrine neoplasia type IIa. The female with multiple endocrine neoplasia type IIb showed a suspect space-occupying lesion of the left adrenal using computed tomography. Pheochromocytoma could be excluded by 131J-benzylguanidine scanning, selective estimation of catecholamines in adrenal venous blood as well as the glucagon stimulation and c…