Klinische Wochenschrift
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Klinische Wochenschrift · Dec 1991
ReviewOxygen radicals--an important mediator of sepsis and septic shock.
There is considerable evidence to implicate aggressive species of oxygen in the pathogenesis of organ dysfunction consequent to sepsis and septic shock. The inflammatory process appears to participate ubiquitously in this setting. A characteristic of inflammation is the involvement of activated neutrophils and their generation of aggressive oxygen species. ⋯ For those reasons, the potential for antioxidants as therapy should include consideration of the volume of distribution of such substances. It is probably important that antioxidants access excluded spaces including cell interiors in order to have their maximum effect in this setting. We have studied ina preliminary way the effects of n-acetyl-cysteine, a highly permeable free radical scavenger and anti-oxidant, in patients with established ARDS.(ABSTRACT TRUNCATED AT 250 WORDS)
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This contribution focuses on the role of iron as a critical component in the genesis of oxygen radical mediated tissue injury occurring after global ischemia associated with severe hypovolemic shock. Conventional colloid or crystalloid fluid resuscitation does not adequately protect organs susceptible to reperfusion injury. One approach aimed at attenuating such post-trauma reperfusion injury is systemic, high dose, iron chelation used in combination with colloid fluid replacement.
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Klinische Wochenschrift · Dec 1991
Value of a modified continuity equation method to quantify mitral valve area in patients with mitral stenosis and sinus rhythm.
To quantify valve area in mitral stenosis, a modified continuity equation method using continuous wave Doppler and thermodilution measurements was applied. In 14 patients with mitral stenosis and sinus rhythm (age: 49 +/- 11 years), transmitral flow velocity was recorded by continuous wave Doppler during right and left heart catheterization. Mitral valve area was calculated by three different methods: 1. ⋯ In contrast, the correlation between mitral valve area determined by pressure half-time (y) and the Gorlin formula (x) was not as good: y = 0.77x + 0.11, SEE = 0.26 cm2, r = 0.65, P less than 0.05. Thus, the continuity equation method using combined continuous wave Doppler and thermodilution technique allows a valid determination of mitral valve area. In patients with mitral stenosis and sinus rhythm, this technique is superior to the noninvasive determination of mitral valve area by the conventional pressure half-time method.
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Klinische Wochenschrift · Jul 1991
Case ReportsExcessive hypernatremia in a patient with renal amyloid disease.
A 24-year-old Italian male presented with a nephrotic syndrome in September 1984. In February 1985 renal biopsy showed amyloid disease with tubular atrophy and interstitial fibrosis. Edema was treated with furosemide, and cholchicine was started. ⋯ The fluid deficit was slowly corrected. He was discharged three weeks later with normal serum electrolytes. This case demonstrates that (1) severe hypernatremia can present with mild neurological symptoms and (2) it can be survived provided that it develops slowly and is corrected cautiously.
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In 63 patients undergoing heart operations with extracorporeal circulation (47 males, 16 females, mean age 54 years; coronary artery bypass in 38 cases, valvular surgery in the rest) postoperative neurological and psychiatric complications were evaluated. 18 patients (29%) had no complications, whereas 35 patients (56%) showed minor or transient neurological symptoms, and 9 patients (14%) exhibited severe symptoms. Nine of the patients had slight psychiatric disturbances (affective disturbances, disorientation). No correlation was found between risk factors (age, nicotine abuse, hypertension, hypercholesteremia, neurologic and cardiac history), intraoperative parameters (duration of extracorporeal bypass, aortic clamp time, deviation of mean arterial pressure), postoperative parameters (internal complications) and the complication rate. Therefore no predisposing factors could be identified.