European journal of medical research
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Clinical Trial
Response to inhaled nitric oxide (NO) is not associated with changes of plasma cGMP levels in patients with acute lung injury.
A clinically relevant increase of PaO subset2 or decrease of pulmonary vascular resistance (PVR) upon inhalation of NO (iNO) does occur in only 60 to 80% of patients with acute lung injury. The mechanisms for divergent responses of different patients have not yet been fully elucidated. Since NO mediates its pulmonary effects by stimulating soluble guanylate cyclase, thereby increasing levels of cyclic guanosinemonophosphate (cGMP), we hypothesized that pulmonary cGMP production upon iNO might be suppressed in patients not responding to iNO treatment. ⋯ Inhalation of NO significantly stimulates soluble guanylate cyclase within the lungs in patients with acute lung injury. However, neither baseline cGMP nor its rise during treatment with inhaled NO can predict the clinical efficacy of iNO in humans. Furthermore, the fact that increased cGMP concentrations were detected during administration of iNO in mixed venous blood (i.e. pulmonary inflow) strongly suggest that the pharmacological effects of iNO are not fully selective for the lungs, but may also affect extrapulmonary organs.
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In the German emergency medical service system (EMSS) medical treatment can be improved in most of mass casualty incidents (MCI). Currently, the incident commander who is responsible for classification of the victims (depending on their urgency and condition, the so called triage) and ordered transportation uses paper-based documentation. Triage tags are used to identify and classify patients and gather treatment information. ⋯ Safety and security aspects can be guaranteed. The complete medical treatment workflow can be supported by telemedicine. Therefore, in case of MCI, telemedicine can optimise medical treatment and exonerate the paramedics from unnecessary documentation.
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We studied if injections of botulinum toxin into multiple pericranial muscles reduce pain of patients with tension-type headache. Nine patients with tension-type headache not sufficiently responding to physical therapy or to amitriptyline were studied. Patients kept a headache diary that was used to calculate the area under the headache curve (AUC) of 4 weeks before and after treatment. ⋯ No major side effects were reported by the patients. These results justify further studies of botulinum toxin therapy in patients with tension type headache. The presented scheme for injections of botulinum toxin into multiple pericranial muscles is a rational basis for the design of such studies.
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Small and large vessel occlusive disease leading to chronic cerebral ischemia and brain atrophy is a concept originating in the last century. The modern notion of acute brain infarct, however, appears to have eclipsed the idea of chronic hypoperfusion as an important factor in ischemic cerebral damage. ⋯ Findings indicating causes of cerebellar atrophy other than ischemia could not be elicited. We offer the hypothesis that basilar artery occlusion, inducing subsequent chronic ischemia, is the most likely cause of the cerebellar atrophy observed in our case.
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Several challenge procedures have been developed to characterize the cough reflex in patients with airway diseases. This study was performed to compare the interindividual range of cough sensitivity in asthmatic and normal subjects as well as smokers using an identical method. Sixteen normal subjects, 20 patients with mild bronchial asthma, 6 patients with moderate to severe bronchial asthma, 9 current smokers, and 7 occasional smokers were included. ⋯ There was no significant correlation between cough threshold, baseline FEV subset1 , and methacholine responsiveness. Our data indicate that (1) subjects with mild asthma showed on average similar cough thresholds as normal subjects, (2) there was a large variation in cough thresholds within groups, (3) the reproducibility of cough thresholds was within one doubling concentration, (4) cough thresholds did not correlate with methacholine responsiveness or baseline airway tone. In view of the prevalence of cough as a symptom of bronchial asthma, it appears that the determination of citric acid-induced cough thresholds does not yield additional diagnostic information in these subjects.