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Biomedical subjects

A Hammerle

Publications and source records attributed to A Hammerle.

13 recordsLinked to original sources
PubMed1997

Effects of pentoxifylline on hemodynamics and oxygenation in septic and nonseptic patients.

OBJECTIVE: To evaluate the effects of pentoxifylline on hemodynamics and systemic oxygenation in septic and nonseptic critically ill patients. DESIGN: Prospective clinical investigation. SETTING: Intensive care unit (ICU) of a university hospital. PATIENTS: Nineteen critically ill patients were included in the study 1 to 4 days after their admission to the ICU. A systemic inflammatory response syndrome was present in 12 patients, fulfilling at least two of the American College of Chest Physicians/ Society of Critical Care Medicine Consensus Conference criteria. The other seven patients did not fulfill these criteria and were classified as nonseptic. INTERVENTIONS: All patients were mechanically ventilated. The dosage of catecholamines was kept constant during the entire study period and at least during 15 mins before the start of the study. In both study groups, pulmonary and radial artery catheters were inserted and 5 mg/kg of pentoxifylline (diluted in 300 mL of physiologic saline) was intravenously administered over a period of 180 mins at a rate of 100 mL/hr. MEASUREMENTS AND MAIN RESULTS: Hemodynamic variables, oxygen transport (DO2), oxygen uptake (VO2), and oxygen extraction ratio were determined before pentoxifylline, after 2.5 mg/kg of pentoxifylline, after 5 mg/kg of pentoxifylline, and 60 mins after the termination of pentoxifylline. Repeated-measures analysis of variance and Mann-Whitney test were used for statistical analysis. At baseline, there were significant differences between the septic and the nonseptic groups in mean pulmonary arterial pressure (septic: 31 +/- 5 mm Hg; nonseptic: 26 +/- 7 mm Hg, p < .05), and pulmonary vascular resistance index (PVRI) (septic: 344 +/- 121 dyne.sec/ cm5.m2; nonseptic: 233 +/- 100 dyne.sec/cm5.m2, p < .05). In the septic group, significant increases in heart rate and cardiac index were observed. Systemic vascular resistance index and PVRI decreased. No significant changes in hemodynamic variables occurred in the nonseptic group. In both groups, DO2 and VO2 increased significantly, while oxygen extraction ratio remained unchanged. CONCLUSIONS: The administration of pentoxifylline to septic patients results in a significant improvement in hemodynamic performance compared with critically ill nonseptic patients. The better hemodynamic state is accompanied by an increase in DO2 and VO2 with unchanged oxygen extraction ratio.

Adult↗
PubMed1996

The clinical application of two newly developed lipid emulsions (Solipid 20% S&E) in critically ill patients.

OBJECTIVE: The clinical compatibility of two newly developed lipid emulsions based on soy oil (20%) emulsified with egg lecithin (12 g/l) or soy lecithin (15 g/l) (Solipid 20% E&S) has been compared. DESIGN: Double-blind prospective randomized study. SETTING: Intensive care unit of a university hospital. PATIENTS: 20 patients (16 men, 4 women, age 20-59 years) were entered into the study. INTERVENTIONS: One g of lipids/kg body weight per day was administered on day 1 and subsequently 2 g/kg/day on days 2-5. Blood was drawn once a day, lipids, lipoproteins, apoproteins and other routine clinical chemistry parameters were determined. RESULTS: No significant increase of total triglycerides could be observed. Total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoproteins A I and B usually remained below the reference ranges. Electrolytes, uric acid and glucose, blood cells, parameters of liver and kidney function, coagulation and protein metabolism did not show relevant changes; only the activity of gamma-GT in both groups--independent of the sort of lecithin--increased significantly. CONCLUSION: The results indicate adequate elimination of both tested lipid emulsions from the plasma at usual clinical conditions. Therefore Solipid 20% S&E can be used in critically ill patients.

Adult↗
PubMed1995

Resistance of nitrogen metabolism to growth hormone treatment in the early phase after injury of patients with multiple injuries.

OBJECTIVES AND DESIGN: Several studies have shown an anticatabolic effect of recombinant human growth hormone (rhGH) in surgical patients. We investigated, in a prospective, randomized, double blind, and placebo-controlled study, the effect of r-hGH on hormone and nitrogen metabolism in 14 patients with multiple injuries in the early phase of injury. MATERIALS AND METHODS: All patients were treated in the intensive care unit, had mechanical ventilation, and were highly catabolic, with a mean daily nitrogen loss of 13.2 +/- 1.8 g. r-hGH was given subcutaneously (once a day, at 8 PM) in a dosage of 0.2 IU/kg.d for seven days, starting on the second day after injury. RESULTS: Administration of r-hGH evoked a significant increase in plasma concentrations of GH, insulin-like growth factor-I (IGF-I), and insulin-like growth factor binding-protein-3 (IGFBP-3). No significant differences were found for either daily or cumulative nitrogen balances (-103.1 +/- 14 g for patients receiving r-hGH and -92.1 +/- 18.1 for those with placebo). r-hGH therapy did not affect skeletal muscle extracellular water, nor did it affect plasma or muscle concentrations of total free amino acids or glutamine. Plasma albumin, prealbumin, and retinol-binding protein concentrations were also unchanged by r-hGH therapy, as were the urinary excretion of potassium and urea. CONCLUSIONS: We conclude that elevated plasma levels of GH, insulin, and IGF-I are unable to effect a protein anabolic drive in patients with multiple injuries during the early postinjury phase and assume that this r-hGH resistance to nitrogen metabolism takes place at the level distal to IGF-I.

Adult↗
PubMed1993

Right ventricular function in early septic shock states.

OBJECTIVES: To define a variable which could reliably predict when fluid resuscitation as monotherapy is not expected to improve organ perfusion pressure, owing to limitations in cardiac output responsiveness in patients with severe sepsis. DESIGN: Prospective controlled trial. SETTING: Anesthesiological ICU in a university hospital. PATIENTS: Twenty seven patients in early septic shock states (MAP < 60 mmHg). INTERVENTIONS: Infusion therapy was titrated until no further increase in cardiac index and mean arterial pressure could be achieved. Fluid resuscitation as monotherapy was deemed unsuccessful at the end of 2 h if inotropic or vasoactive pharmacologic support was required to maintain a mean arterial pressure > 60 mmHg. MEASUREMENTS AND RESULTS: We investigated the hemodynamic course during fluid resuscitation (2850 +/- 210 ml crystalloids) with special emphasis on right heart function using the thermodilution technique. Eleven patients (group A) had a right ventricular (RV) ejection fraction below 45%. In this group positive inotropic and/or vasoactive drugs were obligatory to achieve and maintain a sufficient perfusion pressure (MAP > 60 mmHg) after fluid challenge. CONCLUSIONS: In 27 septic shock patients investigated, we diagnosed right ventricular dysfunction in 41%. In this specific patient population fluid replacement alone did not succeed in stabilizing hemodynamic variables, therefore necessitating catecholamine therapy.

Adult↗
PubMed1993

Endothelin-1 in adult respiratory distress syndrome.

Endothelin-1 (ET-1), a potent vasoconstrictor peptide produced by endothelial cells and degraded predominantly in the pulmonary vasculature, has been implicated in the development of various organ dysfunctions. To determine the pathophysiologic role of ET-1 in adult respiratory distress syndrome (ARDS) and the impact of impaired lung function on transpulmonary peptide handling, we compared plasma levels and pulmonary ET-1 balance in 14 patients with ARDS and in seven healthy control subjects. To obtain comparable conditions in both groups, the ET-1 level was raised in the control group by exogenous infusion (0.4 pmol/kg/min) to 9.4 +/- 0.8 pmol/L. ARDS was accompanied by a hyperdynamic circulatory pattern with increased cardiac output and depressed total vascular resistance but, simultaneously, pulmonary hypertension. Venous ET-1 concentration was massively increased in ARDS (9.8 +/- 1.2 versus 2.1 +/- 0.2 pmol/L, p < 0.001). In control subjects, the lung cleared the major fraction of ET-1 (fractional extraction 43 +/- 8.8%, uptake 12.5 +/- 2.5 pmol/min). In contrast, in ARDS there was a pronounced pulmonary releases into the circulation (32.8 +/- 10.3 pmol/min). We conclude that ET-1 concentrations are elevated in ARDS as the result of both increased formation and decreased disposal. Lung failure affects not only gas exchange but also nonrespiratory, metabolic pulmonary functions.

Adolescent↗
PubMed1993

Continuous spinal anesthesia with a microcatheter and low-dose bupivacaine decreases the hemodynamic effects of centroneuraxis blocks in elderly patients.

This prospective randomized study was designed to investigate the hemodynamic effects and quality of continuous spinal anesthesia (CSA) after rapid injection of a low dose of 0.5% bupivacaine through a 32-gauge microcatheter. The method was compared with continuous epidural (CEA) and single-dose spinal anesthesia (SSA). Seventy-seven elderly patients (ASA II-III) ranging from 57 to 94 yr old and undergoing lower limb surgery were assigned to CSA (n = 26), CEA (n = 26), and SSA groups (n = 25). In all three groups, mean arterial pressure (MAP) and heart rate (HR) were assessed continuously for 30 min after initial injection, as well as after every reinjection of local anesthetic in the CSA and CEA groups. Bupivacaine (0.5%) was used as a local anesthetic. The initial doses were 1 mL of CSA, 10 mL of CEA, and 3 mL of SSA. The reinjection doses were 1 mL of CSA and 5 mL of CEA. In the CSA group, MAP did not decrease, whereas in the CEA group, the maximum decrease was 15% +/- 3% (mean +/- SEM) for the initial injection, 12% +/- 2% for the first repetition, and 13% +/- 2% for the second repetition. In the SSA group, the largest decrease of MAP was 19% +/- 2%. All changes of MAP in the CEA and SSA groups were significantly larger compared with CSA group (P < 0.05). A total of seven patients in these two groups needed vasopressors due to a decrease of MAP of more than 30% from baseline values. Heart rate did not change.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Whole blood aggregometry and platelet adenine nucleotides during cardiac surgery.

The influence of extracorporeal circulation (ECC) on human platelet adenine nucleotides has been studied in 28 coronary bypass patients before, during and after operation. An oscillating pattern of transient increases and decreases in total platelet ATP was observed following the sternotomy until the end of the operation. A highly significant increase in platelet ATP (20% +/- 14 of the pre-anaesthesia values) occurred during the first 24 h after surgery. Total platelet ADP however, did not show this oscillation nor was there any significant release of ADP from the platelets during ECC. Following collagen activation, increased amounts of 'releaseable ATP' were found after protaminization (124% +/- 38 of pre-anaesthesia values) (p less than 0.05), although whole blood aggregability was slightly reduced (89% +/- 18 of pre-anaesthesia values). This study indicates that 1) the metabolic ATP pool of circulating platelets underwent rapid changes during open heart surgery; 2) the majority of platelets did not release inert ADP during ECC; 3) there may be a compensatory enhancement of platelet function by other blood cells, which could explain the discrepancy between our aggregatory results in whole blood and those reported in platelet rich plasma (PRP) aggregometry.

Adenosine Diphosphate↗
PubMed1987

Endothelial cell seeding of polytetrafluoroethylene vascular grafts in humans: a preliminary report.

The importance of initial human trials with autologous endothelial seeding lies not only in the implementation of a promising idea but also in the fact that canine data are only partially applicable to humans. The surface area of jugular veins in humans is much smaller than in dogs and considerably longer grafts are needed. Moreover, the reproductive capacity of adult human endothelial cells under in vivo conditions, which probably determines the success of seeding more than the seeding density, is also uncertain. Therefore the efficiency of autologous endothelial seeding in humans was investigated in 18 patients undergoing distal femoropopliteal bypass surgery. The average surface area of the jugular veins was 4.9 +/- 1.7 cm2 with an average cell yield of 32.6 +/- 18.0 x 10(4). The mean number of seeded cells per square centimeter of graft surface was 3.1 x 10(3). In a follow-up extending for 14 weeks, plasma levels of platelet factor 4 and beta-thromboglobulin as well as the platelet function in the whole blood aggregometer showed significantly better results in the seeded group. Plasma thromboxane B2, uptake and survival of indium 111-labeled platelets, and Doppler ultrasound investigations also favored the seeded group, but the results were statistically insignificant. No difference at all was found for the platelet dense granule compounds, releasable adenosine triphosphate and platelet serotonin. Thus our findings did not indicate the development of a closed endothelialized surface after 14 weeks, which is a period three times as long as the one required for confluent endothelial cell coverage in dogs.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Scanning electron microscopy of circulating platelets reveals new aspects of platelet alteration during cardiopulmonary bypass operations.

Seventeen male patients undergoing cardiopulmonary bypass (CPBP) surgery for aorto-coronary bypass grafting were investigated by scanning electron microscopy (SEM) for alterations of the surface morphology of circulating platelets. An initial decline in the percentage of unactivated smooth discocytes (SD) to 87 +/- 12% was found after thoracotomy. Three minutes after the onset of CPBP, the percentage of SD had dropped drastically to 59 +/- 13%, and by the 8th minute of CPBP it had dropped to its lowest point (49 +/- 19%). On the other hand, the percentage of shape-changed platelets (SC) increased to 17 +/- 9% after 3 minutes, and the percentage of pseudopod discocytes (PD) to 25 +/- 13% after 8 minutes. Surprisingly, a remarkable recovery of platelet morphology could be observed after even 15 minutes of CPBP, and by the end of bypass 78 +/- 15% of the circulating platelets had regained the smooth discoid (SD) appearance of unactivated platelets. We conclude that this recovery of platelet morphology is due to an increasing insensitivity of the platelets to activating stimuli during the course of CPBP. Our study provides evidence that the only major platelet activation occurs during the first minutes of CPBP, and that CPBP-caused platelet activation is much less pronounced than generally believed.

Journal Article↗
PubMed1986

Role of beta-endorphins in silent myocardial ischemia.

The reason for the absence of pain perception in silent myocardial ischemia is unknown. A role of increased endorphinic activity in patients with silent ischemia has been postulated. To further investigate this hypothesis, 10 men with documented coronary artery disease and previous positive electrocardiographic findings during exercise without anginal pain were studied. Six healthy volunteers served as control subjects. The protocol included 2 bicycle exercise tests, the first test serving as baseline and the second performed after administration of naloxone, a specific opiate antagonist. Plasma beta-endorphin levels were measured by radioimmunoassay in both tests at rest, at peak exercise level and after recovery. All patients underwent thallium-201 scintigraphy after coronary vasodilation to provide an additional independent marker of ischemia. All patients showed stress-induced reversible perfusion abnormalities. No patient reported pain after naloxone application. Exercise duration, blood pressure and heart rate were not significantly altered by naloxone. Plasma beta-endorphin levels ranged from 18 +/- 6 pg/100 microliters (mean +/- standard deviation) at rest to 22 +/- 6 pg/100 microliters during exercise in the patient group and from 20 +/- 5 to 27 +/- 9 pg/100 microliters in the control subjects. Thus, there was no significant increase of plasma beta-endorphins during exercise or after naloxone administration, nor was there any difference observed between patients and control group. These data support the view that endorphinic activity does not play an essential role in the pathophysiology of silent myocardial ischemia.

Blood Pressure↗
PubMed1983

Hemodynamic and hormonal response to induced hypotension with isosorbide dinitrate and nitroglycerin during anesthesia.

Changes in hemodynamics, plasma catecholamines, and PRA in response to controlled hypotension induced with ISDN (n = 10, mean dose 15.5 micrograms kg-1 min-1) and NTG (n = 7, mean dose 5.5 micrograms kg-1 min-1) were studied during neuroleptanesthesia in patients undergoing facial and neck surgery. Before the commencement of vasodilator infusion the patients were pretreated with metoprolol 0.1 mg kg-1. In addition, enflurane was used to obtain the desired hypotensive level. During ISDN induced hypotension, MAP was reduced from 83 to 63 mm Hg (p less than 0.001). Continuous infusion of NTG resulted in a decrease of MAP from 81 to 53 mm Hg (p less than 0.01). In both groups, HR decreased by 10% (p less than 0.05). For both vasodilators the reduction of MAP was associated with a marked decrease in SVRI (p less than 0.01), while Cl remained largely unchanged. The hemodynamic responses to the two vasodilators were similar, except that NTG reduced PAMP (p less than 0.01) and increased intrapulmonary shunt volume (p less than 0.01). The anesthetic technique attenuated catecholamine and renin release, suppressed reflex tachycardia, and prevented rebound hypertension.

Adolescent↗
PubMedDate not supplied

[Obstetric management of patients with HELLP syndrome].

The syndrome of haemolysis, elevated liver enzymes and low platelet count (HELLP-Syndrome) is a severe form of preeclampsia and eclampsia. The clinical course is characterized by right upper quadrant and epigastric pain, hypertension, proteinuria and edema. Maternal and neonatal morbidity are high. The underlying cause for this pregnancy-related syndrome is still unclear. As soon as a reliable diagnosis is established handling of patients suffering from HELLP-Syndrome is ambivalent: Immediate termination of pregnancy, however, poses a problem at early gestational age. Therefore some authors have advocated a conservative management. At our department active management and delivery by Caesarean section as soon as possible has gained acceptance in the past 5 years. We report our experience with 23 patients over a 12 year period, and with 4 patients from the intensive care unit (N = 27). Mean gestational age was 33.5 weeks (+/- 4.8) and the mean birthweight was 1922.5 g (+/- 971.5). 19 patients were delivered by Caesarean section. Most complications were based on a delayed delivery and subsequent deterioration of maternal condition. Reduction of the time interval between establishment of diagnosis and termination of pregnancy (1980-1985-3 days; 1986-1992-12 hours) resulted in a better outcome. We recommend intensive laboratory screening and exact clinical examination since missed or delayed diagnosis as well as delayed delivery are life threatening for mother and child. Only prompt delivery yields an improvement of prognosis.

Adult↗