Akute exogene Intoxikationen in der Intensivmedizin ? Wissen und Erfahrung

Acute dialysis: PMN-elastase as a new parameter for controlling individual anticoagulation with low molecular weight heparin (Fragmin).

Despite the improvements in the development of dialyzer membranes with greater hemocompatibility, an activation of the coagulation system occurs when blood comes into contact with exogenous surfaces. The large number of heparin dosage regimens demonstrate the difficulty to adapt general therapeutic guidelines. Low molecular weight heparin (Fragmin®) was administered as a single bolus dose for anticoagulation during 58 acute dialyses. Anti-Xa-activity, the plasma levels of the lysosomal elastase of the polymorphnuclear granulocytes (“PMN-elastase”) and of the thrombin-antithrombin III-complex (TAT) were measured at hourly intervals. Therapeutic anti-Xa-levels did not show evidence of suffici…

Experiences of a Poison Center Network with Renal Insufficiency in Acetaminophen Overdose: An Analysis of 17 Cases

Renal insufficiency is less common than liver failure in acetaminophen overdose but renal tubular damage occurs even in the absence of hepatotoxicity. Data published on this topic are rare consisting mostly of case reports or reports in a small number of patients. Presently, a larger number of patients with renal insufficiency associated with acetaminophen overdose should be analyzed using a multicenter approach.Retrospective analysis of patients with acetaminophen-related nephrotoxicity reported to a poison center network from 1995 to 2003. Renal insufficiency was defined as elevated serum creatinine of more than double of the normal range (2.4 mg/dL [212 micromol/L]). Patients were classi…

Psychogene Amphetamine (,,Ecstasy``)

Unter dem Oberbegriff ,,Ecstasy`` werden zur Zeit viele verschiedene halluzinogene Amphetaminderivate zusammengefast, deren wohl gangigste Vertreter MDMA (3,4-methylendioxymethamphetamin) und MDEA (3,4-methylendioxyethamphetamin) sind. Neben diesen und verwandten Wirkstoffen sind jedoch oft auch noch andere Substanzen in den angebotenen Praparaten enthalten (Amphetamin, Ephedrin, Selegilin, Paracetamol u. a.), welche die Wirkung und das Symptombild von Ecstasy erheblich modifizieren konnen. Der Gebrauch von Ecstasy und damit auch die Haufigkeit von Komplikationen nach Ecstasyingestion hat in den letzten Jahren in Deutschland stark zugenommen. Daraus ergibt sich derzeit ein wachsender Bedarf…

In Vitro Cultured Islet‐Derived Progenitor Cells of Human Origin Express Human Albumin in Severe Combined Immunodeficiency Mouse Liver In Vivo

Studies in rodents suggest the presence of a hepatopancreatic stem cell in adult pancreas that may give rise to liver cells in vivo. The aim of the present study was to determine the ability of human islet-derived cells to adopt a hepatic phenotype in vivo. Cultured human islet-derived progenitor cells that did not express albumin in vitro were stained with the red fluorescent dye PKH26 and injected into the liver of severe combined immunodeficiency mice. After 3 or 12 weeks, red fluorescent cells were detected in 11 of 15 livers and were mostly single cells that were well integrated into the liver tissue. Human albumin was found in 8 of 11 animals by immunohistochemistry, and human albumin…

Evidence for Impaired Hepatic Vitamin K1 Metabolism in Patients Treated with N-Methyl-Thiotetrazole Cephalosporins

SummaryIn 8 patients on no oral intake and with parenteral alimentation, administration of cephalosporins with N-methyl-thiotetrazole side chain (moxalactam, cefamandole), was associated with prolongation of prothrombin time, appearance in the circulation of descarboxy-prothrombin (counter immunoelectrophoresis and echis carinatus assay) and diminution of protein C. Acute administration of 10 mg vitamin Ki was followed by the transient appearance of vitamin K1 2,3-epoxide, indicating an impaired hepatocellular regeneration of vitamin K1 from the epoxide. Impaired hepatic vitamin K1 metabolism, tentatively ascribed to the N-methyl-thiotetrazole group, is one (but possibly not the only) cause…

Significance of hyperlactatemia in acute hypnotic drug poisoning

Lactate concentration, fibrinogen and fibrin(ogen) -- degradation-products in central venous blood were analysed in 35 unconscious patient with acute hypnotic drug poisoning (HDP) and compared with the results in 13 healthy control persons undergoing the same degree of forced diuresis via central venous catheters. Blood samples were taken on admission and at 12 h intervals up to 36 h after admission. Patients with HDP were attributed to the categories of moderate intoxications (n = 17) and severe intoxications (n = 18) according to their clinical condition. On admission, blood lactate was significantly higher in severe intoxication (3.90 +/- 2.94 mmol/l) as compared to the control group (1.…

Akute Vergiftungen Aktuelle Literatur der klinischen Toxikologie (1993?1995)

In den Jahren 1993 bis 1995 sind zahlreiche Originalarbeiten zu klinisch toxikologischen Themen erschienen. In dem folgenden Artikel werden solche mit klinischer Relevanz herausgearbeitet: Bei primaren Entgiftungsmasnahmen zeigt sich ein deutlicher Trend zur Kohle-Diarrhoe-Therapie ohne Magenspulung oder Emesis. Sekundare Masnahmen wie kontinuierliche arteriovenose Hamoperfusion (CAVHP) sind effektiv bei Vergiftungen mit Phenobarbital und Theophyllin. Als gesicherte Indication fur Cyanidintoxikationen gilt Hydroxycobalamin als ein wirksames Antidot. Die Effektivitat einer N-Acetylcystein-Antidottherapie kann durch Verlangerung der Applikationsdauer optimiert werden. Durch eine zeitliche Aus…

Aktuelle Diagnostik von Intoxikationen

Qualit�tssicherung und Kosten-Nutzen-Analyse in der internen Intensivmedizin M�glichkeiten ? Probleme ? Effizienz

Qualitatssicherungskonzepte stellen eine Basis fur Vergleiche zwischen Intensiveinheiten dar. Eine Einteilung in Strukturqualitat, Prozesqualitat und Ergebnisqualitat erlaubt eine Systematisierung der Qualitatssicherung. Patienten ,,data management systems`` inklusive verschiedener Scoresysteme sind hilfreich bei der Entwicklung therapeutischer-, diagnostischer und wissenschaftlicher Standards.

Akute Medikamenten-Vergiftungen - Neue Ergebnisse und Trends (1996-1998)

In der folgenden Arbeit wird ein update uber die aktuelle klinisch toxikologische Literatur der Jahre 1996–1998 gegeben. Magenspulung und induziertes Erbrechen werden zunehmend zuruckhaltender eingesetzt. Die Indikation wird auf Vergiftungen mit potentiell lebensbedrohlichen Mengen an Substanz beschrankt, wenn die Masnahme innerhalb eines Zeitfensters von 60 Minuten durchfuhrbar ist. In verstarktem Mase kommt die Kohle-Diarrhoe-Therapie zum Einsatz. Die repetitive Gabe von Kohle scheint bei Praparaten mit verzogert freisetzendem Wirkstoff Vorteile zu bieten, insgesamt ist die Bewertung noch uneinheitlich.

Systemische fibrinolytische Therapie mit Urokinase bei Zentralarterienverschluss der Netzhaut

BACKGROUND AND OBJECTIVE Systemic fibrinolysis has become an important therapeutical option in patients with thrombotic occlusion of coronary or pulmonary arteries. In view of the hemorrhagic risk systemic fibrinolytic therapy for retinal vessel occlusion has been discussed controversial. In the present case study results and complications of systemic fibrinolysis should be investigated in patients with central retinal artery occlusion. PATIENTS AND METHODS From 1995 to 2002 a case series of 19 consecutive patients (8 female, 11 male, age: 63.2+/-14,3 years) with central retinal artery occlusion were treated by systemic application of urokinase using a standardized scheme. The latency from …

Suizidale und parasuizidale Intoxikationen mit Paracetamol

BACKGROUND AND OBJECTIVE: Paracetamol is frequently used in deliberate self-poisoning resulting in a major risk for the patients due to its dose-dependent hepatotoxicity. In the present study the cases of intoxications consulting our Poison Center should be analysed illustrating recent results and trends. PATIENTS AND METHODS: From 38 065 patients (25 098 female, 12447 male, 520 sex unknown, average age 36.8 years) registered during the study period from 1.1.1995 until 31.5.2002 4021 with paracetamol intoxication were analysed with respect to the ingested dose, concomitant substances, the degree of observed symptoms and the length of hospital stay. RESULTS: The use of paracetamol in deliber…

Pseudocholinesterase Activity in Organophosphate Poisoning after Storage of Unseparated Blood Samples at Room Temperature for 3 Weeks

Suppressed pseudocholinesterase activity is a well-established laboratory finding in patients with serious organophosphate poisoning (1). Recently, a 48-year-old man with suspected ingestion of methyl parathion died, and the postmortem examination was not indicative. After 3 weeks, an overlooked specimen was discovered that had been collected from the patient ∼1 h after the suspected poisoning. The determination of pseudocholinesterase activity was requested. The blood sample, which showed complete hemolysis, was separated by centrifugation, and the pseudocholinesterase activity was determined. The result of 4.21 kU/L indicated the presence of only minor organophosphate poisoning without su…

Influence of blood sampling from venipunctures and catheter systems on serial determinations of prothrombin activation fragment 1 + 2 and thrombin-antithrombin III complex

To evaluate the influence of different blood sampling techniques on test results of thrombin-antithrombin III complex (TAT) and prothrombin fragment 1 + 2 (F1 + 2) serial determinations were performed. In six groups of nonrandomized patients (ten patients each) the concentrations of the coagulation markers of blood samples from central catheters (internal jugular, caval, Shaldon, pulmonary artery) and peripheral cannulas (17G and 18G) were compared with those of blood samples obtained simultaneously from direct venipunctures of the contralateral arm. Medians and 25th-75th percentiles of TAT and F1 + 2 concentrations of plasmas obtained from central catheters were not different from those ta…

Differences in pharmacokinetics and pharmacodynamics of insulin lispro and aspart in healthy volunteers.

Pharmacokinetic and pharmacodynamic profiles of the rapid-acting insulin analogues lispro and aspart were compared in a randomized, double-blind crossover study of 20 fasting healthy men following a single subcutaneous injection. Either insulin lispro or aspart, 0.05 U/kg-body-weight, was injected subcutaneously and followed by determination of 5-h profiles of plasma glucose, serum C-peptide and insulin concentrations. Lowest glucose concentrations were observed after 50 min in the aspart group (3.2 +/- 0.1 mmol/l versus lispro 3.5 +/- 0.1 mmol/l; p = 0.026) and after 60 min in the lispro group (3.4 +/- 0.1 mmol/l). For blood glucose t min was 59.3 +/- 3.4 min in the aspart and 63.5 +/- 5.3…

Anti-Inflammatory Treatment with Standardized Human Serum Protein Solution Reduces Local and Systemic Inflammatory Response after Hemorrhagic Shock

<i>Objective:</i> Reperfusion after hemorrhagic shock leads to local and systemic inflammatory response. This study evaluates the effect of a short-term treatment with standardized human serum protein solution (SPS) on the local and systemic inflammatory response in the mesenteric microcirculation in the rat. <i>Methods:</i> Spontaneously breathing animals underwent median laparotomy and exteriorization of an ileal loop for intravital microscopy of the mesenteric microcirculation. Volume-controlled hemorrhagic shock was set by arterial blood withdrawal (2.5 ml/100 g body weight for 60 min), followed by reperfusion for 4 h. SPS (n = 10) or saline 0.9% (controls, n = 1…

Einsatz von niedermolekularem Heparin zur Antikoagulation in der Schwangerschaft

A 26-year-old woman, on bedrest since the 6th week of pregnancy because of threatened abortion, developed thrombosis in the left iliac, superficial femoral and common femoral veins with small pulmonary emboli in the 11th week. Inhibitor deficiency was excluded. The thrombosis was only partially recanalized by unfractionated heparin at therapeutic dosage (38,400 IU per 24 h). As thrombolysis treatment and oral anticoagulation were contraindicated because of the threatened abortion, coagulation with low molecular weight heparin (LMWH) was started in the 18th week (5000 anti-Xa units daily subcutaneously). Maximal anti-Xa activity in plasma never exceeded 0.3 U/ml and there were no complicatio…

Diagnostik von Pleuraergüssen bei intensivpflichtigen Patienten: Sonographie und Radiologie im Vergleich

Die Sonographie hat als unbelastende und leicht durchzufuhrende Untersuchungsmethode ihren festen Platz auch auf der Intensivstation. Hier konnen u. a. Pleuraergusse beim liegenden Patienten mit hoher Sensitivitat nachgewiesen werden [1–5] und zusatzlich, wie wir zeigen konnten, sicher volumetriert werden [2].

Comparison of Urinary On-Site Immunoassay Screening and Gas Chromatography-Mass Spectrometry Results of 111 Patients With Suspected Poisoning Presenting at an Emergency Department

On-site tests based on immunoassay techniques are widely used for toxicologic screening analysis in patients with suspected poisoning. However, such assays usually have been validated using urine samples with known concentrations of the investigated substances. In the present investigation, on-site screening results were evaluated in a clinical setting. This was a retrospective study of patients with suspected poisoning from January to December 2003 in the emergency department of a tertiary urban hospital. Urine samples were analyzed using the Triage 8 panel and gas chromatography-mass spectrometry (GC-MS). A total of 111 patients were included (54 female, 57 male; average age 37.8 +/- 19.7…

Suizidversuch mit einem klinischen Desinfektionsmittel

Die orale Aufnahme von 50 – 300 ml Lysoformin 3000, einem glutaral-, glyoxal- und didecyldimethylammoniumchloridhaltigen Desinfektionsmittels, verursachte bei einer 31jahrigen Frau schwere Koagulationsnekrosen im oberen Gastrointestinal- und gesamten Respirationstrakt. Im Verlauf von 86 Tagen waren die Schaden in Osophagus und Magen fast vollstandig reversibel, wahrend in Lunge und Bronchialsystem weiterhin Ventilations- und Perfusionsstorungen fortbestehen. Die Schleimhautschaden sollten zur Anderung der toxikologischen Bewertung des Praparates fuhren. Lysoformin 3000 sollte als „Atzend an Haut und Schleimhauten“ eingestuft werden.

Efficacy of obidoxime in human organophosphorus poisoning: determination by neuromuscular transmission studies.

Six patients with organophosphorus compound intoxications developed an intermediate syndrome (weakness and fasciculations) and obidoxime was given on eight occasions. The efficacy of the acetylcholinesterase (AChE) reactivator was monitored electrophysiologically by neuromuscular transmission studies using single and repetitive nerve stimulation (20 and 50 Hz) and the activity of the serum (butyryl) cholinesterase (ChE). Dramatic electrophysiologic improvement was seen when obidoxime was given early within 12 h in 3 patients, although evidence of AChE inhibition did not subside completely. When administration of obidoxime was delayed 26 h or more after intoxication on five occasions, electr…

End-plate dysfunction in acute organophosphate intoxication.

Acute organophosphate intoxication resulting from suicide attempts in 14 patients produced a series of electrophysiologic abnormalities that correlated with the clinical course. Spontaneous repetitive firing of single evoked compound muscle action potentials (CMAP) was the earliest and most sensitive indicator of the acetylcholinesterase inhibition. A decrement of evoked CMAP following repetitive nerve stimulation was the most severe abnormality. At the height of the intoxication no CMAP was evoked after the first few stimuli. The decrement-increment phenomenon occurred only at milder stages of intoxication and its features are characteristic of acetylcholinesterase inhibition. These electr…

Katabolismus und künstliche Ernährung des internistischen Intensivpatienten

Zahlreiche Untersuchungen beschaftigen sich mit dem Katabolismus nach Trauma und chirurgischen Eingriffen. Vergleichbare Untersuchungen im internistischen Intensivbereich sind eher selten. Diese Patienten weisen jedoch ahnliche Veranderungen auf mit einer Verlaufsdynamik und Zunahme des Muskelabbaus am 5. Tag.

Shunting of the Microcirculation After Mesenteric Ischemia and Reperfusion Is a Function of Ischemia Time and Increases Mortality

Shunting of the microcirculation contributes to the pathology of sepsis and septic shock. The authors address the hypothesis that shunting of the microcirculation occurs after superior mesenteric artery occlusion (SMAO) and reperfusion, and explore functional consequences.Spontaneously breathing animals (rats) (n = 30) underwent SMAO for 0 (controls), 30 (SMAO_30) or 60 min (SMAO_60) followed by reperfusion (4 h) with normal saline. Leukocyte-endothelial interactions in mesenteric venules were quantified in an exteriorized ileal loop using intravital microscopy. Abdominal blood flow was recorded continuously, and arterial blood gases were analyzed at intervals. The above groups were matched…

Fulminantes Lungenödembei Malaria tropica

HISTORY AND ADMISSION FINDINGS A 54-year-old man was admitted because of intermittent fever for 2 days. Ten days earlier he had returned from Kenya. He had not taken any antimalarial drugs prophylactically. INVESTIGATIONS Initial blood smears showed Plasmodium falciparum in 10.4% of erythrocytes. Laboratory tests indicated hyponatremia and disseminated intravascular coagulation. Also, laboratory markers of infection and hemolysis were clearly positive and accompanied by a low-grade normocyticanaemia. Chest radiograph showed the heart size to be at the upper limit of normal and no signs of congestion, pleural effusion or inflammatory infiltrates. Sonography demonstrated hepatosplenomegaly wi…

Anticoagulation with low-molecular-weight heparin (dalteparin) in plasmapheresis therapy: initial experience

BACKGROUND:  In contrast to other extracorporeal treatments no established regime exists for anticoagulation with low-molecular-weight heparin (LMWH) in plasmapheresis therapy. A study was conducted to investigate whether LMWH (dalteparin-Na) is suitable as an effective anticoagulant in plasmapheresis therapy. STUDY DESIGN AND METHODS:  Eleven patients with autoimmune neurological diseases and the necessity for a plasmapheresis therapy were enrolled. A capillary membrane filter was used. A total of 2000 mL of human plasma was isovolumetrically exchanged per plasmapheresis cycle. The anticoagulation was accomplished with a single bolus of LMWH (dalteparin) of 80 to 90 IU per kg of body weigh…

Aktuelle Therapie von Intoxikationen

Akute Ingestionsvergiftungen bei Erwachsenen: Kritische Analyse prim�rer Eliminationsmethoden

In der vorliegenden Arbeit werden Publikationen zur Effektivitat von primaren Entgiftungsmasnahmen kritisch analysiert. Die induzierte Emesis erbringt gegenuber der Therapie mit aktivierter Kohle keine Vorteile und scheint verzichtbar zu sein. Die Darmspulung konnte eine interessante Alternative darstellen, wenn deren Bedeutung noch evaluiert werden kann. Die vorliegenden Untersuchungen unterstreichen den hohen Stellenwert einer fruhzeitigen Kohletherapie (unter Berucksichtigung der Kontraindikationen). Auch wenn eine Magenspulung geplant ist, sollte im Vorfeld aktivierte Kohle zugefuhrt werden, da diese innerhalb von Sekunden ihre adsorbierende Wirksamkeit entfaltet. Die entgiftende Kapazi…

Intoxikationen mit Medikamenten im Kindesalter bei einem regionalen Giftinformationszentrum

BACKGROUND: Drug poisonings in childhood account with about one fourth for the most important group of poisonings in this age group. METHOD: From 1995 to 2004 the inquiries to a poison centre regarding drug poisonings of children

Analyse von Kosten und Nebenwirkungen der Membranplasmaseparationsbehandlung

In der aktuellen Diskussion um das adaquate Therapieverfahren (intravenose Immunglobulintherapie vs. Plasmaseparation) beim akuten Guillain-Barre-Syndrom (GBS) besteht derzeit kein allgemeingultiger Konsens. Die vorliegende Untersuchung uber Komplikationshaufigkeit resp.-schwere von 155 Plasmaseparationen und die Kostenevaluierung beider Verfahren leistet hierzu einen Beitrag.

Possible coumarin-like mechanism of action for cephalosporins.

In three patients treated with cephalosporins (one patient with latamoxef, two patients with cefazedone) vitamin K1 was injected to investigate whether this was followed by an increase in vitamin K1 2,3-epoxide plasma concentrations as compared to controls. Such a rise in K1-epoxide concentrations in the plasma can be demonstrated following treatment with coumarins. This reflects an inhibition of the vitamin K1-epoxide reductase in the liver. Coumarins are thought to induce hypoprothrombinaemia by such a mechanism. In all three patients we found a considerable increase in the vitamin K1-epoxide plasma concentrations following injection of 10 mg vitamin K1, whereas in normal subjects only tr…

Verbesserung der Prognose bei Langzeitbeatmung durch frühzeitigen Einsatz von PEEP

Bei 127 Patienten mit beatmungsbedurftiger akuter respiratorischer Insuffizienz wurde der Zusammenhang zwischen Zeitpunkt des Einsatzes der PEEP Beatmung und Behandlungergebnis untersucht. Bei 61 Patienten wurde in konventioneller Weise zunachst mit ZEEP beatmet und auf PEEP ubergegangen, wenn die inspiratorisch-arterielle O2-Differenz sich vergroserte, PaO2 bei FiO2≧0,5 unter 60 mm Hg lag, die radiologischen Lungenveranderungen zunahmen, oder eine Verschlechterung des Allgemeinzustandes offenkundig war (Gruppe I=sekundarer PEEP, zeitliche Latenz zwischen Intubation und PEEP im Mittel 46±47 Std., Medianwert 33 h). 66 Patienten wurden bei gegebener Indikation zur Beatmung unabhangig von dies…

Intermittierende Fieberschübe Lyme-Erkrankung ohne Erythema chronicum migrans

Zunehmende Bedeutung von Antidepressiva bei suizidalen und parasuizidalen Intoxikationen

BACKGROUND AND OBJECTIVE: Antidepressant drugs are frequently used in deliberate self-poisoning resulting in a major risk for the patients due to their cardiac and central-nervous toxicity. In the present study the cases of intoxications consulting our Poison Center should be analysed illustrating recent results and trends about self-poisoning with antidepressants. PATIENTS AND METHODS: During the study period from 1995 to 2001 35 394 inquiries concerning deliberate self-poisoning were registered in our Poison Center. The substance used, age and gender of the patient as well as the degree of the observed symptoms were documented. Thereby, antidepressant drugs were grouped in tricyclic antid…

Perorale Intoxikationen mit Betablockern Eine klinisch-epidemiologische Studie und Stand der Therapie

Vergiftungen mit Betablockern sind intensivmedizinisch relevant und imponieren vorwiegend mit Bradykardie, Hypotonie und neurologischen Symptomen. Vorliegende Arbeit untersucht 244 Intoxikationen mit Betablockern aus den Jahren 1986 bis 1996. Die Auswertung wurde anhand des speziellen follow up-Systems der Beratungsstelle bei Vergiftungen der Universitatsklinik Mainz vorgenommen. Im Kindesalter ist bei akzidentell eingenommenen Mengen von 1–2 Einzeldosen (insg. 320 mg) eines Betablockers nur mit geringen oder keinen Symptomen zu rechnen und hinsichtlich primarer Giftentfernung (Erbrechen, Magenspulung) Zuruckhaltung zu empfehlen. Eine eindeutige Beziehung zwischen Menge der aufgenommenen Su…

Aktueller Stand der Hirntoddiagnostik in Deutschland

□ Der Hirntod kann grundsatzlich nur dann diagnostiziert werden, wenn eine schwere akute Hirnschadigung vorliegt und andere Storungen sicher auszuschliesen sind. Primare Hirnschadigungen betreffen das Gehirn direkt (zum Beispiel intrakranielle Blutungen, Raumforderungen, schweres Schadel-Hirn-Trauma), sekundare Hirnschadigungen indirekt (zum Beispiel Hypoxie nach kardiopulmonaler Reanimation). Supratentorielle Hirnschadigungen betreffen das Groshirn, infratentorielle Hirnschadigungen den Hirnstamm und/oder das Kleinhirn. □ Koma, Hirnstammareflexie und Ausfall der Spontanatmung sind die obligaten klinischen Hirntodzeichen. Wenn diese Zeichen im Verlauf unverandert fortbestehen, ist der irrev…

Diagnostik von Pleuraergüssen und Atelektasen: Sonographie und Radiologie im Vergleich

In a prospective study it was shown that chest ultrasonography is superior to conventional x-ray diagnosis of recumbent patients in diagnosing pleural effusion and lung atelectasis. In 110 supine radiographs we found a sensitivity of 47% and a specificity of 71% for right pleural effusions and a sensitivity of 55% and a specificity of 93% for left pleural effusions in comparison to 110 sonographic examinations. The results of supine radiographs in detection of atelectasis were less efficient: sensitivity for the right side: 7%; sensitivity for the left side: 13.5%. Hence, the knowledge of chest ultrasonographic diagnosis can improve the interpretation of supine radiographs.

The control of anti-coagulation in acute dialyses with sensitive laboratory parameters.

In seven patients who had to be dialysed between four and 13 times due to acute renal failure, low molecular weight heparin (LMWH) Fragmin was used for anticoagulation. According to dose-finding studies, 80-90 U kg-1 body weight of LMWH as a single bolus were administered initially, producing dose-related levels of 0.3-1.5 anti-factor Xa U ml-1 in plasma. Apart from the anti-Xa activity in the plasma, the thrombin anti-thrombin III complex (TAT complex) and a fibrin degradation product (D-dimer) were measured as parameters of a coagulation activation. A sufficient anti-coagulation during dialysis was supposed to exist at a normal range (5.0 micrograms l-1 or below) of TAT complex. Pathologi…

C1-ESTERASE INHIBITOR REVERSES FUNCTIONAL CONSEQUENCES OF SUPERIOR MESENTERIC ARTERY ISCHEMIA/REPERFUSION BY LIMITING REPERFUSION INJURY AND RESTORING MICROCIRCULATORY PERFUSION

Activated complement contributes significantly to reperfusion injury after ischemia. This study explores functional consequences of C1-esterase inhibitor (C1-INH) treatment after superior mesenteric artery occlusion (SMAO)/ reperfusion using intravital microscopy. Thirty anesthetized, spontaneously breathing, male Sprague-Dawley rats underwent SMAO for 60 min followed by reperfusion (4 h). C1-esterase inhibitor (100 and 200 IU/kg body weight) or saline (0.9%) was given as a single bolus before reperfusion. Sham-operated animals (n = 10) without SMAO served as controls.Systemichemodynamicsweremonitoredcontinuously,arterial bloodgasesanalyzedintermittently, andleukocyte/ endothelial interacti…

Klinische Pharmakologie II

1963 beschrieb Ommaya ein subkutanes Plastikreservoir, das nach Implantation unter die Kopfhaut einen direkten, sterilen, wiederholbaren Zugang zum Ventrikelliquor ermoglichte. Nach okzipitaler Bohrlochtrepanation des Schadels wurde ein Siliconkatheter in das Hinterhorn des Seitenventrikels eingefuhrt und an das Reservoir angeschlossen.

Successful treatment of paraquat poisoning: activated charcoal per os and "continuous hemoperfusion".

AbstractIngestion of paraquat results in an extremely dangerous poisoning. The first aim is to clear the gastrointestinal tract by inducing emesis and performing gastric/gut lavage; as much activated charcoal as possible should be administered per os and as quickly as possible. The best measure to eliminate paraquat from blood and tissue is hemoperfusion with coated activated charcoal; it has to be performed in the sense of “continuous hemoperfusion” about 8 h/d over a period of 2–3 weeks. These measures give a chance to lower the lethality of paraquat poisoning.