Klinische Wochenschrift
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Klinische Wochenschrift · Oct 1986
Comparative investigation of the microcirculation in patients with hypertension and healthy adults.
A total of 51 patients with arterial hypertension, 29 of which have renal dysfunction, were examined with regard to patient history, clinically, laboratory analysis and capillary microscopy. Compared to healthy adult patients with hypertension demonstrated a significant increase in the number of capillaries per millimeter of epidermis, while at the same time showing a significantly decreased erythrocyte column diameter. This observation was more pronounced the greater the degree of retinal vascular alteration (fundus hypertonicus). ⋯ The plasma viscosity as well as the erythrocyte aggregation were significantly elevated. Patients suffering from additional kidney dysfunction had even higher viscosities. There also appeared to be a correlation to the degree of fundus hypertonicus in which the plasma viscosity increased in relation to an increasing degree of retinal vascular alteration.
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Klinische Wochenschrift · Mar 1985
Blood transfusion requirements in coronary artery surgery with and without the activated clotting time (ACT) technique.
Control of anticoagulation during cardiopulmonary bypass (CPB) with the automated activated whole blood clotting time (ACT) and reversal of heparin after CPB using a computerized ACT dose-response curve method resulted in significant reductions of blood transfusion requirements, surgical time, and protamine doses in 150 patients undergoing coronary artery bypass grafting procedures (ACT group) as compared to 200 patients for whom a standard fixed dose protocol for heparin and protamine was used (control patients). Mean transfusion requirements were 1,938 +/- 60 SEM ml whole blood and 853 +/- 48.3 SEM ml red blood cells for control patients and 1,397 +/- 59 SEM ml whole blood (P less than 0.001) and 695 +/- 34 SEM ml red blood cells (P less than 0.01) in the ACT group. ⋯ U. (P less than 0.001). Surgical time decreased from 321 +/- 5.5 SEM min for control patients to 289 +/- 5.4 SEM min for ACT group patients (P less than 0.001).
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Epidural opiates were administered to 139 patients with pain due to malignant diseases via a chronic indwelling catheter inserted percutaneously. So far, 9,716 days of treatment can be evaluated. In 87% of the patients whose pain previously could not be controlled with conventional analgesic approaches, epidural opiates resulted in remarkable pain relief. ⋯ Two severe side-effects (meningitis) were observed, both patients being free of symptoms after catheter removal and antibiotic therapy. Epidural opiates proved to be a valuable method of pain control in terminal illness. The method should be reserved for those patients, for whom oral opiates fail to produce effective pain relief.
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Several line of evidence suggest that bile acids may be implicated in the pathogenesis of colonic cancer. A high consumption of fat and animal protein and a low dietary intake of fiber have been shown to be related to the incidence of colonic cancer. From these epidemiologic observations the hypothesis was proposed that the correlation between diet and colon cancer might be explained by the involvement of bile acids. ⋯ Furthermore, microbial in vitro tests showed a comutagenic activity of secondary bile acids. However, case control studies comparing the fecal bile acid excretion pattern in colonic cancer patients and control subjects failed to show such a clear relationship, which might be explained by rather similar dietary habits within one population and individual differences in sensitivity to environmental factors contributing to the tumor development. Cholecystectomy, leading to an increased exposure of bile acids to the intestinal microflora, has been suggested as a predisposing factor for the development of colonic cancer, but the results of experimental and epidemiologic studies so far are rather inconsistent.(ABSTRACT TRUNCATED AT 250 WORDS)
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Klinische Wochenschrift · Nov 1984
Randomized Controlled Trial Comparative Study Clinical TrialAdrenocortical suppression by a single induction dose of etomidate.
In a prospective controlled trial we studied the effect of a single induction dose of etomidate or thiopentone on the adrenocortical function in 29 patients undergoing elective surgery. During anesthesia and in the recovery period serum cortisol rose significantly in the thiopentone group only. ⋯ Moreover, plasma ACTH increased significantly more after etomidate than after thiopentone (p less than 0.02) indicating relative unresponsiveness of the adrenal cortex to stimulation by endogenous ACTH. We conclude that a single i.v. bolus of etomidate (0.26 mg/kg) leads to significant adrenal insufficiency in patients without preexisting endocrine abnormalities.