Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Dec 1987
Randomized Controlled Trial Clinical Trial[Combination autotransfusion in heart surgery. Use of acute normovolemic hemodilution in coronary heart disease].
Normovolemic hemodilution (15 mg/kg body-weight: group I) was undertaken in 100 patients immediately before the start of coronary-artery surgery. In addition, a Cell-Saver (Haemonetics, Munich) was used for intra-operative autotransfusion. Another group of 100 patients (group II) was similarly operated on without autotransfusion (the study was conducted on 200 consecutive patients undergoing aorto-coronary bypass). ⋯ Acute normovolemic hemodilution increased cardiac output and oxygen transport capacity, while other hemodynamic parameters remained unchanged, and there was no effect on extravascular lung water. Autotransfusion reduced the need for homologous blood derivatives by 71% (fresh blood, fresh plasma, RBC concentrates). No clinically significant disadvantages occurred.
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Dtsch. Med. Wochenschr. · Aug 1987
[Effect of glycylpressin on pressure in esophageal varices in patients with liver cirrhosis and previous hemorrhaging varices].
In 15 patients with the history of bleeding from esophageal varices, confirmed cirrhosis of the liver (Child A) and esophageal varices (grade II, 2; grade III, 11; and grade IV, 2 patients) esophageal intravariceal pressures were endoscopically measured before and 10 min after intravenous administration of 1 mg glycylpressin. Pressures fell in the patients without previous sclerotherapy from 21.8 +/- 2.8 to 19.0 +/- 1.9 mm Hg (not significant), in those previously sclerosed from 18.0 +/- 1.4 to 14.5 +/- 1.0 mm Hg (p less than 0.05). ⋯ The results indicate that glycylpressin has a relatively minor and uncertain effect on esophageal intravariceal pressure. In view of the possible side effects of the drug the indications for its use should be carefully weighed.
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Dtsch. Med. Wochenschr. · Jun 1987
[Hypokalemia as the principal symptom of covert vomiting. Clinical and diagnostic aspects].
In ten adults (nine females), referred for hypokalemia as the cardinal symptom of uncertain etiology and normal blood pressure, surreptitious self-induced vomiting was demonstrated as the main cause. In the majority of such patients, the pathognomonic pattern of serum and urine electrolytes (in the unstable phase--loss of gastric juice) allows diagnosis without hospitalization. If there are atypical urinary electrolyte values or the patients deny vomiting, hospitalization or part-hospitalization is recommended, with parenteral administration of 1 litre physiological saline daily under weight control, and (if necessary) toxicological urine tests for diuretics if there is a high urinary chloride level. In this manner a sufficiently accurate diagnosis is possible.
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Dtsch. Med. Wochenschr. · May 1987
Case Reports[The heparin-induced thrombosis-thrombocytopenia syndrome].
Severe thrombocytopenia, acute coronary artery thrombosis with myocardial infarction and thrombotic occlusion of both popliteal arteries occurred simultaneously in a 54-year-old man within 11 days of starting an intravenous heparin regimen as prophylaxis against deep-vein thrombosis. Popliteal artery thrombectomy was performed 12 days later and re-administration of heparin again induced thrombocytopenia with recurrent thromboses in the area of the leg arteries.