0000000000400310
AUTHOR
I. Tzanova
Neurogenic pulmonary oedema after generalized epileptic seizure
The diagnosis 'tonic clonic seizure' is frequently established by emergency physicians on scene. In patients with epilepsy mortality due to accidents, asphyxia, cardiac arrhythmias or postictal neurogenic pulmonary oedema (NPO) is twice as high as in the general population. We report a case of acute pulmonary oedema after a tonic clonic seizure. Following this event, the patient developed respiratory insufficiency and evidence of pulmonary oedema not associated with the classic aetiologies of congestive heart failure, aspiration or toxic exposure. The patient survived the incident after aggressive prehospital treatment, long-term intensive care and subsequent rehabilitation. A systematic ca…
An�sthesie zur endovaskul�ren Therapie aortaler Aneurysmen Verfahren und perioperative Risiken
Die transvaskulare Plazierung endoluminaler Gefasprothesen mittels interventionell-radiologischer Methoden ist ein neues, minimal invasives Verfahren zur Therapie von Aortenaneurysmen. Wir analysierten retrospektiv die Praktikabilitat verschiedener Anasthesieverfahren, die pathophysiologischen Auswirkungen des Eingriffs und typische Risiken. Bei 19 Patienten mit Aneurysmen der infrarenalen (n=18) oder der thorakalen Aorta (n=1) wurden in 23 Eingriffen aortale Stentprothesen implantiert. Die Eingriffe erfolgten in Allgemeinanasthesie (AA: n=9), in Periduralanasthesie (PDA: n=8) oder Lokalanasthesie (LA: n=6) mit Analgosedierung. Trotz erhohten Uberwachungsaufwands in der Gruppe AA ergaben si…
Simulation of Metabolism for The Calculation of Enzyme Activities in Stress Metabolism
Abstract Using data of indirect calorimetry, total energy turnover as well as the rate of combustion of carbohydrates, fat and amino acids can be calculated. For the evaluation, simple standard procedures (4) are used. These procedures presume, that several assumptions are satisfied, e.g. a complete degradation of the energy delivering substrates and undisturbed enzyme activities. To be able to interprete also measurements, which are performed in the post-traumatic state as well as for estimation of the extent and consequences of reduced enzyme activities, a new method for the simulation of metabolism was developed. Hie underlying model considers a reduced activity of key enzymes and a swit…
Patterns and diagnostic value of cardiac troponin I vs. troponin T and CKMB after OPCAB surgery.
Cardiac troponin I (cTnI) has been shown to be a specific marker for myocardial injury in cardiac surgery. The object of this prospective study was to determine the patterns and kinetic and diagnostic value of cTnI, cardiac troponin T (cTnT), and creatine kinase MB (CKMB) activity after minimally invasive coronary revascularization using an octopus device on the beating heart (OPCAB).48 patients (33 male/15 female, mean age 68.3 +/- 8.7 years) underwent their first elective OPCAB surgery with median sternotomy without mortality. The mean number of grafts was 2.0 +/- 0.8 per patient. Preoperative mean ejection fraction was 56.6 % +/- 14.9%. CTnI and T levels, total creatine kinase (CK) and C…
Checking the carotid pulse check: diagnostic accuracy of first responders in patients with and without a pulse.
International guidelines for cardiopulmonary resuscitation (CPR) in adults advocate that cardiac arrest be recognized within 5-10 s, by the absence of a pulse in the carotid arteries. However, validation of first responders' assessment of the carotid pulse has begun only recently. We aimed (1) to develop a methodology to study diagnostic accuracy in detecting the presence or absence of the carotid pulse in unresponsive patients, and (2) to evaluate diagnostic accuracy and time required by first responders to assess the carotid pulse. In 16 patients undergoing coronary artery bypass grafting, four groups of first responders (EMT-1: 107 laypersons with basic life support (BLS) training; EMT-2…
Multicentre evaluation of in vitro contracture testing with bolus administration of 4-chloro-m-cresol for diagnosis of malignant hyperthermia susceptibility
Background and objective The in vitro contracture test with halothane and caffeine is the gold standard for the diagnosis of susceptibility to malignant hyperthermia (MH). However, the sensitivity of the in vitro contracture test is between 97 and 99% and its specificity is 78-94% with the consequence that false-negative as well as false-positive test results are possible. 4-Chloro-m-cresol is potentially a more specific test drug for the in vitro contracture test than halothane or caffeine. This multicentre study was designed to investigate whether an in vitro contracture test with bolus administration of 4-chloro-m-cresol can improve the accuracy of the diagnosis of susceptibility to MH. …
Investigation of Inspiratory Pressure-Volume Curves on Mechanically Ventilated Patients Using Least Square Polynomial Fit
Abstract An on-line method for the registration of pressure volume 1 oops TrT mechanically ventilated patients was developed using a personal computer with analog/digital interface. A third order polynomial function was fitted to the measured inspiratory pressure volume pairs. The significance of the fitting procedure was calculated using regression ANOVA. The inflection point of the pressure-volume curve was determinated by calculating the root of the second derivative of the polynomial. The method was teseted on 20 patients without major pulmonary dysfunction and on 6 patients with severe ARDS.