Klinische Wochenschrift
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Klinische Wochenschrift · Jan 1991
Case Reports[Diagnosis of suspected acute myocardial infarct in acute regional myocarditis].
We report on 4 patients in whom acute myocardial infarction was suspected due to acute onset of chest pain and elevation of the ST-segment. Furthermore in 2 patients the echocardiography revealed regional abnormal wall motion on admission, the others later. Coronary angiography showed normal coronary arteries in all cases. ⋯ Sometimes regional myocarditis might imitate an acute myocardial infarction. Both, the exact anamnesis and coronary angiography are necessary. The performance of an endomyocardial biopsy is desirable.
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The type of fluid that should be infused in the critically ill patient remains controversial. In the presence of normal lungs, maintenance of the colloid osmotic pressure (COP) can limit the development of pulmonary edema when the hydrostatic pressure is raised. ⋯ The larger increase obtained in extravascular fluids by the use of crystalloids could limit the availability of cellular oxygen. Nevertheless, differences in morbidity and mortality have not been related to the type of fluid infused, suggesting that the amount of fluid is a more important factor.
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Klinische Wochenschrift · Jan 1991
Review[Disorders of blood coagulation in the intensive care unit: what is important for diagnosis and therapy?].
In the haemostatic system there is normally a stable balance between its components (vessel wall, platelets, coagulation, fibrinolysis), which are in continuously close interaction. Disturbances of this balance may lead to bleeding, thrombosis, or thrombohaemorrhagic consumptive disorders. The task of haemostaseologic diagnostics is to discover eventual preexisting but as yet undiagnosed disturbances in any patient entering an intensive care unit and, in cases of acute bleeding, to provide useful information that facilitates therapeutic decisions. ⋯ Promising attempts to overcome DIC via substitution of antithrombin III and fresh frozen plasma are discussed. Optimal management of complications and monitoring of therapy requires the close teamwork of attending surgeons or physicians and haemostaseologists. The purpose of any therapy is to preserve or regain the balance of haemostasis.
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Klinische Wochenschrift · Jan 1991
Comparative Study[Supplemental infection therapy with i.v. immunoglobulins (polyvalent IgG and Pseudomonas IgG)--results of an observational case study with 163 patients].
The impact of i.v. immunoglobulin (IVIG) therapy on the survival of adult septic patients cannot yet be considered either proved or disproved. To define optimal criteria for a large multicenter placebo-controlled trial, a multicenter observational study was carried out in 163 medical and surgical patients exhibiting a total of 173 episodes of sepsis and septic shock [Elebute (El) sepsis score; 19 +/- 0.5). ⋯ This improvement, associated with an improved prognosis (mortality, 24% vs 55%), was found in all subgroups, most importantly, polyvalent IgG vs Pseudomonas IgG treatment; medical vs surgical patients; moderate vs severe MOF; and gram-positive vs gram-negative septicemia. Thus, all of these patients should be included in future placebo-controlled, randomized IVIG trials.(ABSTRACT TRUNCATED AT 250 WORDS)
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Klinische Wochenschrift · Jan 1991
[The role of antibiotic therapy for postoperative infectious complications].
Prospective analysis of the postoperative course of 1461 patients following major visceral surgery showed that postoperative complications scurred in 17.3% (253) of cases; 81% of the complications were related to the surgical procedure (surgical complications), whereas in 18.2% (46) of the patients, they complications were not related to surgery (non-surgical complications). Among septic cases, the relationship between surgical vs non-surgical complications was 141 to 29 patients, or 5:1. Early surgical reintervention was performed in all 141 patients exhibiting abdominal sepsis. ⋯ Early surgical reintervention is always the treatment of choice for these complications. Antibiotics are regarded only as an adjuvant measure. For the rather rare septic complications that are not related to surgery, antibiotic therapy is used.