Biomedical subjects

A Kübler

Publications and source records attributed to A Kübler.

51 records · Page 3Linked to original sources

PubMed1997

[Cannulation of the internal jugular vein under control of USG imaging].

The internal jugular vein cannulation is a commonly used route for access to the central venous system for therapeutic and diagnostic purposes. Although the great majority of this venous puncture are successfully performed using anatomic landmark technique, serious complication such as pneumothorax, arterial puncture or hemothorax can occur during this procedure, particularly under difficult clinical condition. A simple, ultrasound-guided technique has been developed using a portable scanner with transducer optimized for venous access. The authors experience in over 100 cases of ultrasound-guided central venous cannulations has been described. Ultrasound guidance reduces the number of passes needed to puncture the vein, increases the success rate of venous puncture, and minimizes complications. Ultrasound guidance is usually successful in allowing performance of internal jugular vein cannulation when landmark technique fail.

Catheterization, Central Venous↗

PubMed1997

Immunological status of septic and trauma patients. II. Proliferative response and production of interleukin 6 and tumor necrosis factor alpha by peripheral blood mononuclear cells from septic survivor, nonsurvivor and trauma patients: a correlation with the survival rate.

We have studied proliferative response to phytohemagglutinin (PHA) and bacterial lipopolysaccharide (LPS) of peripheral blood mononuclear cells (PBMC) and their ability to produce IL-6 and TNF-alpha in vitro in: septic survivors, nonsurvivors and with multiple injury patients. Blood samples for determination of PBMC reactivity were taken upon admission and after 1, 2 and 5 days later. The proliferative response of lymphocytes, both spontaneous as well as PHA- and LPS-induced, was generally higher in septic nonsurvivor patients comparing to other groups. Markedly elevated LPS-induced proliferation (particularly on day 3) was a bad prognostic sign for survival. The ability of PBMC from the patients to produce IL-6 in culture was depressed in nonsurvivor septic patients and elevated in trauma patients, comparing to control donors. More profound differences were found with respect to TNF-alpha production which was deeply depressed (both spontaneous and induced) in septic nonsurvivors. In contrast, TNF-alpha production in septic survivors was significantly higher with a peak response on day 3. Trauma patients, on the other hand, had significantly increased ability to produce TNF-alpha on day 1 and 2, declining thereafter. The data presented in this report reveal that low production (or even anergy) with respect to synthesis of proinflammatory cytokines in vitro, as well as increased spontaneous proliferation of PBMC and proliferation in response to LPS, are significantly correlated with the fatal outcome of the septic shock.

Adolescent↗

PubMed1997

Immunological status of septic and trauma patients. I. High tumor necrosis factor alpha serum levels in septic and trauma patients are not responsible for increased mortality; a prognostic value of serum interleukin 6.

The aim of this study was to monitor plasma interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-alpha), levels in patients with sepsis, septic shock and multiple organ dysfunction syndrome admitted to the intensive care unit. The patients obtained adequate supportive therapy. Plasma samples were taken upon admission, then on days 1, 2, and 5 following admission. IL-6 and TNF-alpha levels were determined using bioassays (7TD1 and WEHI-164.13 indicator cell lines, respectively). The results showed that the kinetics of the cytokine release in septic patients differed significantly between survivors and nonsurvivors. In survivors IL-6 concentrations were initially high, fell down rapidly on day 1 after admission, and persisted very low throughout the monitoring time. In contrast, relatively low IL-6 levels in the nonsurvivors, registered upon admission, rose significantly with peak values on day 3 of observation, declining thereafter. TNF-alpha levels were initially higher in survivors than in nonsurvivors, declined on day 1 following admission, and on day 5 they were higher than the initial values. In nonsurvivors, on the other hand, the starting concentrations of TNF-alpha were much lower than in survivors with a peak on day 3 with a tendency to fall on day 7. The profiles of cytokine production by traumatic patients (90% survivors) revealed low and progressively diminishing levels of IL-6, contrasting with constantly increasing concentrations of TNF-alpha within the monitoring period. We conclude that high IL-6 levels in septic patients accompanied by high TNF-alpha levels may indicate bad prognosis. In contrast, rapidly diminishing serum IL-6 levels, even in the presence of high TNF-alpha levels, could indicate a very good chance for survival. Similar conclusion can be drawn from the monitoring of cytokine production in traumatic, nonseptic patients since almost all of them recovered. We also speculate that TNF-alpha presence in circulating blood is essential for regeneration of tissues and wound healing.

Adolescent↗

PubMed1997

Immunological status of patients subjected to cardiac surgery: effect of lactoferrin on proliferation and production of interleukin 6 and tumor necrosis factor alpha by peripheral blood mononuclear cells in vitro.

The aim of this investigation was to monitor proliferation and cytokine production by peripheral blood mononuclear cells (PBMC) of patients subjected to cardiac surgery. Another goal was to establish regulatory effects of lactoferrin (LF) on these immune reactions in vitro. PBMC were tested before, during surgery and on day 1 and day 8-10 following operation. In control donors, low spontaneous and phytohemagglutinin (PHA)-induced proliferation of PBMC, as well as lipopolysaccharide (LPS)-induced TNF-alpha secretion was stimulated by LF, but high production of this cytokine was inhibited. In patients, the proliferation of PBMC and the ability to produce IL-6 TNF-alpha by these cells underwent characteristic changes depending on preoperative immune reactivity of patients. In general, low, preoperative reactivity of PBMC showed a tendency to increase within the monitoring period whereas moderate/high responsiveness was diminishing. LF had, in majority of cases, a down-regulatory effect on the proliferative response, best pronounced in patients of high/moderate preoperative response. Similarly, LF exhibited, in general, an inhibitory effect on LPS-induced IL-6 production. In terms of TNF-alpha production, a considerable up-regulatory effect of LF, particularly in low responding patients was of a special interest. In summary, we suggest that LF may play a role in lowering the immune response of patients to surgery and promoting tissue regeneration.

Adult↗

PubMed1996

Effect of photodynamic therapy on the healing of a rat skin flap and its implication for head and neck reconstructive surgery.

BACKGROUND AND OBJECTIVE: Photodynamic therapy (PDT) may as adjuvant therapy by used to reduce tumor recurrence in the head and neck with surgery, given intraoperatively after resection. A concern with the use of intraoperative PDT is the possible effect on wound healing, especially on the healing of myocutaneous skin flaps, which are widely used to reconstruct defects following resections for head and neck cancer. STUDY DESIGN/ MATERIALS AND METHODS: A flap, based on the inferior epigastric artery, was prepared in thirty male Lewis rats. Group I did not receive any further treatment but the wound was left open for 20 minutes. Group II was injected with 5mg/kg Photofrin, 48 hours prior to the operation and also did not receive any further treatment. The wound bed and wound borders of group III were treated with 630nm light of different dosages, delivered by an argon dye laser. Animals in group IV received 5mg/kg Photofrin 48 hours prior to the operation and their wound beds were treated with the same light dosages as group III. After the treatment all flaps were replaced into the wound bed and the incisions were closed. Biopsies for histological analysis were taken at several time points; and on day 21, biopsies for wound tensile strength measurements were taken. RESULTS: The wound healing in group I, II, and III appeared normal and there were no differences seen between these groups. Also, the tensile strength did not differ significantly. The flaps of group IV showed serous effusion, epidermal necrosis, and weaker tensile strength (P = .04 and .02 for the light doses of 50 J/sq cm and 75 J/sq cm respectively) at a specific time point. CONCLUSION: The results of this study demonstrate that PDT given immediately before flap reconstruction will result in delayed wound healing. These results should be considered when contemplating the use of PDT as adjuvant intraoperative therapy for tumor surgery requiring flap reconstruction after ablative surgery.

Animals↗

PubMed1996

Immunological status of patients subjected to cardiac surgery: serum levels of interleukin 6 and tumor necrosis factor alpha and the ability of peripheral blood mononuclear cells to proliferate and produce these cytokines in vitro.

The aim of this study was to monitor plasma interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) levels in patients subjected to cardiac surgery under general anesthesia. In addition, proliferation of peripheral blood mononuclear cells (PBMC) to phytohemagglutinin (PHA) and the ability of these cells to secrete lipopolysaccharide-induced IL-6 and TNF-alpha during the observation period was investigated. IL-6 and TNF-alpha levels were measured using bioassays. We found that despite high variability in the postoperative response of the patients, characteristic kinetics in the appearance of the cytokines in plasma could be demonstrated. Most significant phenomenon was an increase of IL-6 level 1 day after operation associated with an inhibition of TNF-alpha concentration. Relatively high, preoperative concentrations of these cytokines were probably elicited by stress. Control, healthy donors, did not exhibit measurable levels of these cytokines. In terms of proliferative response of PBMC to PHA and of cytokine production in vitro, the patients could be classified into low and high responding. The proliferative response of PBMC from low responders was progressively increasing and the response of high responders did not exhibit meaningful changes throughout the observation period. PBMC from low producers of IL-6 showed also an increased ability to secrete this cytokine during the monitoring time while the cells from high producers yielded less IL-6 on the last day of the follow up. Regarding TNF-alpha production, PBMC from low responders reacted strongly by secretion of this cytokine on day 1 after surgery in contrast to high responders whose cells yielded less TNF-alpha after surgery. In majority of cases TNF-alpha production had a tendency to diminish on the last day of observation. We conclude that the changes in cytokine levels as well as an altered reactivity of PBMC in vitro reflect the immune response to the postoperative trauma and are desirable for a normal course of the immune response and wound healing.

Acute-Phase Reaction↗

PubMed1996

[A case of HELLP syndrome complicated by acute renal failure and acute respiratory failure].

We present a case of HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome that developed post partum in 31 year old woman. It was initially misdiagnosed as acute cholecystitis. The disease was complicated with acute renal failure and acute respiratory failure. Admission to the intensive therapy unit became necessary; patient required haemodialysis and short lasting mechanical ventilation. The outcome of described case was nevertheless good.

Acute Kidney Injury↗

PubMed1994

Intra- and extracerebral blood flow changes and flushing after intravenous injection of human corticotropin-releasing hormone.

To study facial flush after systemic administration of human corticotropin-releasing hormone (hCRH) we injected 100 micrograms hCRH intravenously to ten healthy young men. The increase in facial temperature was measured by infrared camera. A significant increase in facial temperature of 1.39 degrees C +/- 0.3 was found within 7 min in all patients, which lasted up to 60 min, although facial flushing was visible in only 50% (5/10) of the probands. In a second experiment 100 micrograms hCRH was then administered to seven other healthy young men. Intra- and extracerebral blood flow velocity changes in the medial cerebral artery (MCA) and external carotid artery (ECA) were measured after hCRH administration by use of Doppler sonography. We found a decrease of intracerebral blood flow which was caused by hyperventilation and was reversible following 6% CO2 hyperventilation during a second injection of 100 micrograms hCRH. Blood flow velocity in the ECA increased by 111.5 +/- 32.9% (compared to baseline level), lasted up to 60 min after hCRH injection, and was not reversible by 6% end-tidal CO2 ventilation. We thus demonstrated that the direct vasodilatory effect of hCRH involves the ECA-supplied vascular territory only. The intracerebral vasoconstrictory effect represents the result of hyperventilation following hCRH injection. The data thus clearly suggest an interaction of hCRH and the vascular endothelium of the ECA, causing a marked blood flow velocity increase and facial flushing.

Adult↗

PubMed1994

Control for carbon dioxide-related changes in flow velocity by transcranial Doppler monitoring.

Transcranial Doppler ultrasonography can monitor changes in intracranial blood flow velocity over time in a variety of experimental and clinical settings with excellent temporal resolution. Alterations in arterial carbon dioxide pressure exert a profound influence on blood flow velocity. Such changes exhibit important individual fluctuation depending on respiratory status. This limits the ability of transcranial Doppler to accurately study subtle changes in blood flow velocity, independent of the respiratory state of the subject. Suggested here is a method to control for the respiration artifact on blood flow velocity. The middle cerebral artery of 7 healthy male volunteers was studied with transcranial Doppler under resting conditions, monitoring end-tidal carbon dioxide concentration and blood flow velocity. Hyperventilation was performed both voluntarily and with pharmacological induction by human corticotropin-releasing hormone. These studies were carried out both with and without the use of counterregulation of the end-tidal carbon dioxide concentration via a respiration unit, with an adjustable carbon dioxide-oxygen gas supply preventing significant changes in end-tidal carbon dioxide. The blood flow velocity in the middle cerebral artery during maximal voluntary hyperventilation decreased from baseline values of 100% to 44.4 +/- 4.3% (a 55.6% decrease), and with human corticotropin-releasing hormone-induced involuntary hyperventilation, to 65.1 +/- 5.3% (a 34.9% decrease). With the control method, blood flow velocities during voluntary and pharmacological hyperventilation were 100 +/- 1.6% and 100 +/- 2.8%, respectively. This method allows for control of respiration-induced artifacts during transcranial Doppler monitoring, and can be used to assess the effect of direct or indirect blood flow velocity stimuli independent of respiratory status.

Adult↗

PubMed1992

The influence of testosterone substitution on bone mineral density in patients with Klinefelter's syndrome.

The aim of this study was to clarify the extent of bone mineral deficiency in patients with Klinefelter's syndrome on the premise that testosterone substitution could prevent this deficiency. Bone mineral density was measured by single-photon absorptiometry in 42 patients with Klinefelter's syndrome, (21 patients without therapy, 10 with testosterone substitution before the age of 20 and 11 patients with testosterone substitution beginning after the age of 20). We found significantly lower bone mineral density in patients without therapy and in patients when the therapy began later compared to normal individuals. Patients with early therapy showed a high proportion of normal values of bone mineral density. We found a positive correlation between bone mineral density and plasma testosterone and a negative correlation between plasma testosterone and age for patients without therapy. These findings suggest that low testosterone levels before or during puberty cause inadequate bone development and low bone mineral density in Klinefelter's syndrome. Only early testosterone substitution may prevent bone mineral deficiency. Later substitution no longer affects bone mineral density.

Adult↗

PubMed1978

[The use of dopamin in shock and heart failure (author's transl)].

The action of dopamine was evaluated in 18 patients with cardiogenic shock after myocardial infarction, in 14 patients with heart failure and in 18 patients with low-output syndrome after cardiac surgery. In the patients with shock, dopamine increased significantly systolic arterial blood pressure, myocardial contractility, diuresis and sodium excretion. In patients with heart failure a great increase in diuresis and sodium excretion with decrease of CVP was observed. In patients after cardiac surgery dopamine produced a significant increase of arterial blood pressure and diuresis with decrease of CVP. The clinical application of dopamine and the advantages of the use of dopamine combined with other catecholamines were discussed.

Blood Pressure↗

PubMed1978

Monitoring pulmonary artery pressures in critically ill patients.

A flow-directed Swan-Ganz catheter was used for the catheterisation of the pulmonary artery in critically ill patients. The monitoring of pulmonary artery pressures provided reliable information regarding left ventricular function and pulmonary vascular resistance. Moreover, the pulmonary artery catheter can be used for mixed venous blood sampling. Experiences with pulmonary pressure monitoring for the assessment of left ventricular performance in patients with myocardial infarction and left ventricular failure, for the estimation of lung function in patients with respiratory failure and for the selection of the optimal level of positive end-expiratory ventilation are presented. The advantages of pulmonary artery pressure monitoring for the assessment of the circulatory and respiratory status of critically ill patients are stressed, and technical problems and complications are discussed.

Blood Pressure↗

PubMed1977

[A study on the action of naloxone (author's transl)].

The action of naloxone was evaluated in two separate investigations. In the first study the action of naloxone, nalorphine and placebo was compared in 5 healthy volunteers using a double-blind, cross-over trial. After the administration of nalorphine changes in psychical state and respiratory depression were observed in all subjects, whereas naloxone caused no changes even after very high doses. It is concluded, that naloxone has no agonism or intrinsic narcotic activity as opposed to nalorphine. In the second investigation, the efficacy of naloxone in antagonising large doses of fentanyl was evaluated in 25 surgical patients. The administration of naloxone caused a significant increase of respiratory rate and minute volume, a decrease of arteriell pCO2 and an increase of pO2. The results obtained confirmed that naloxone has a fast and potent anti-narcotic action.

Adult↗

PubMedDate not supplied

Changes in the phases of left ventricular contraction during induction of general anaesthesia.

By means of polycardiographic tracings the authors assessed the effects of althesin, ketamine and fentanyl on the dynamics of left ventricular contraction when these agents were applied for induction of anaesthesia. A depressing action of althesin was found while fentanyl and ketamine were without effect on the dynamics of left ventricular contraction. Polycardiographic tracings are a useful method for the assessment of the action of pharmacological agents on the cardiovascular system during operations.

Adult↗

PubMedDate not supplied

Comparative study of the action of naloxone (Narcan) and nalorphine in man.

The comparative study of 2 narcotic antagonists, naloxone and nalorphine, was performed in healthy volunteers. The influence of these drugs on the respiratory and cicularoty systems and on the psychical state was compared. The study was carried out in a double-blind, cross-over manner. Increasing doses of naloxone and placebo or nalorphine and placebo, were administered intravenously. Naloxone, even in very high doses, caused no changes in cardivascular system, acid-base balance, sensitivity of respiratory centre to carbon dioxide and psychical state of volunteers. After the administration of nalorphine, even in very small doses, changes in psychical state in all examined subjects were observed. Nalorphine caused the significant change in the ventilatory response to CO2. Based on their results, the authors conclude that naloxone has no agonist or intrinsic narcotic activity, as opposed to nalorphine possessing strong narcotic action.

Attention↗