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Biomedical subjects

A N Laggner

Publications and source records attributed to A N Laggner.

At least 109 records · Page 6Linked to original sources
PubMed1996

Cardiorespiratory response to free suspension simulating the situation between fall and rescue in a rock climbing accident.

Many factors contribute to the risk of late death after successful rescue in a rock climbing accident. One factor may be hemodynamic and respiratory compromise by free suspension in a rope between fall and rescue. The risk probably results from using a chest harness alone or the combination of a chest harness and a sit harness. No trials on the acute cardiorespiratory response to free suspension in rock climbing have been reported so far. The effect of 3 min free suspension in a chest harness or in a sit harness on cardiopulmonary parameters was investigated in a randomized, cross-over trial in six healthy volunteers in a simulated rock climbing accident. Measurements were performed before and during the suspension at an altitude of 171 m. No statistical change in cardiopulmonary parameters was observed after free suspension in the sit harness. After free suspension in the chest harness, mean forced vital capacity decreased by 34.3% and mean forced expiratory volume decreased by 30.6%. No statistical change of arterial oxygen saturation occurred and mean end-tidal carbon dioxide increased by 11.5%. Mean heart rate decreased by 11.7%, mean systolic blood pressure decreased by 27.6%, mean diastolic blood pressure decreased by 13.1%, and mean cardiac output decreased by 36.4%. The p value for all reported changes was <0.05. We conclude that free suspension in a chest harness leads to a dramatic impairment of hemodynamics and respiration. This may contribute to the risk of a fatal outcome if rescue is not timely.

Accidental Falls↗
PubMed1996

Effect of desmopressin substitution during organ procurement on early renal allograft function.

BACKGROUND: As diabetes insipidus in brain-dead organ donors leads to hypovolaemia, hyponatraemia, and hypotension, desmopressin is recommended for treatment of diabetes insipidus. As its effect on early renal allograft function remains unclear, we conducted a study to evaluate the effect of desmopressin on renal-graft survival. METHODS: We report the results of a prospective study in 41 brain-dead organ donors (mean age 45 +/- 12 years) with diabetes insipidus, who were treated either with adequate fluid substitution and bolus application of desmopressin (desmopressin group; n = 22) or with volume substitution along (control group; n = 19). Donors as well as recipients of both groups were well matched with respect to age, sex, dopamine dosage, serum electrolytes, cold ischaemic time, HLA match, number of prior transplantations, and current cytotoxic antibodies. Early renal allograft function was evaluated in 71 recipients (mean age 48 +/- 4 years within 3 days after transplantation. RESULTS: Overall, primary non-function was observed in 26 (36.6%) of 71 recipients. The rate of primary non-function was significantly higher in the desmopressin group compared to the control group (desmopressin group 48.6%; control group 23.5%; P = 0.28). CONCLUSION: The use of desmopressin during organ procurement is associated with a higher rate of primary non-function of renal allografts.

Adolescent↗
PubMed1996

Conservative management of foreign bodies in the gastrointestinal tract.

There are at present no clear guidelines whether foreign body ingestion in the gastrointestinal tract should be managed conservatively, endoscopically or surgically. Retrospectively we have, therefore, analyzed 78 foreign body ingestion's in 42 patients (age 15-72 years) admitted to the Emergency Department of the University Hospital in Vienna. Our intention was to assess the value of a conservative management, defined as daily follow-up visits until the foreign body spontaneously appeared in the feces and to find criteria when endoscopic or surgical management is required. Of 78 foreign bodies, 67 (86%) passed the gastrointestinal tract spontaneously without complications, 9 (11%) were removed endoscopically, and only 2 (3%) required surgery. There were no gastrointestinal perforations. Even foreign bodies with a maximal length of 13.5 cm appeared in the feces spontaneously within a few days. Our data suggests that more than 80% of adults with foreign body ingestion can be managed safely as outpatients by means of conservative treatment. Endoscopic or surgical removal is only indicated in very rare circumstances.

Adolescent↗
PubMed1996

Influence of stress ulcer prophylaxis on translocation of bacteria from the intestinal tract in rats.

Clinical studies in critically ill patients suggest an increased rate of septicemia during stress ulcer prophylaxis with H2-blockers when compared with sucralfate, a topically active compound. In the present study we examined the effect of stress ulcer prophylaxis with sucralfate as compared with ranitidine versus untreated animals in a rat model on intestinal flora and on the translocation of bacteria from the intestinal tract. The translocation of bacteria was also determined after induction of hemorrhagic shock and, in addition, we examined bacterial translocation in animals infected with a multiple resistant Escherichia coli and following antibiotic therapy with vancomycin and gentamicin during stress ulcer prophylaxis with and without hemorrhagic shock. Male Wistar rats, which received standard meals either without stress ulcer prophylaxis or with ranitidine/sucralfate were investigated. After induction of hemorrhagic shock we analysed qualitatively and quantitatively the bacterial flora in the gastrointestinal tract, blood, mesenteric lymph nodes and visceral organs (liver, spleen). In the absence of shock no changes of the intestinal flora and no translocation of bacteria from the gut were observed in control animals nor during stress ulcer prophylaxis. However, after induction of hemorrhagic shock there was a pronounced bacterial translocation in control animals and during ranitidine, whereas the translocation rate was reduced in animals treated with sucralfate (p < 0.05). During massive E. coli challenge both without and with shock a significantly higher rate of translocation was found in all three experimental groups there were no significant differences between the three groups. We conclude that a) bacterial translocation is low or absent in healthy animals, b) hemorrhagic shock induces a massive increase in bacterial translocation, c) stress ulcer prophylaxis with sucralfate reduces translocation of bacteria during the shock state and c) during massive bacterial overgrowth and/or concomitant shock none of the treatments can reduce the massively elevated rate of bacterial translocation.

Animals↗
PubMed1996

Efficacy of different antihypertensive drugs in the emergency department.

Hypertensive crises are a commonly observed problem in an emergency department. The aim of the study was to evaluate the efficacy and safety of different antihypertensive agents in the treatment of patients with hypertensive crises. 168 patients (mean age: 52 +/- 12 years) admitted to the emergency department with a hypertensive urgency (systolic (SBP) blood pressure > 210 mm Hg and/or diastolic (DBP) blood pressure > 110 mm Hg) or a hypertensive emergency (DBP > 100 mm Hg and evidence of end-organ damage) were included into the study protocol. Blood pressure (BP) was measured every 5 min automatically using a noninvasive BP measurement unit. After a resting period of 30 min the patients received the following drugs: 5 mg enalaprilat intravenous (n = 43) or 25 mg urapidil intravenous (n = 48) or 10 mg nifedipine-capsule sublingual (n = 47) or 2 x 5 mg nifedipine-spray sublingual (n = 30). The aim of treatment was to reduce SBP below 180 mm Hg and DBP below 95 mm Hg within 45 min after start of treatment. When evaluating the response rates the highest rate was observed in the urapidil group (96%). The response rate of enalaprilat and both preparations of nifedipine were similar (70-72%). The rate of major side effects was higher in the urapidil compared to the other drugs (4% vs 2% in the nifedipine-group or 0% in the enalaprilat-group). All four drugs are suitable in the treatment of patients with hypertensive crisis in the emergency department. Urapidil should be used as a first choice drug in critically ill patients with hypertensive crisis due to its higher response rate.

Adult↗
PubMed1996

Suicidal chloroquine poisoning: clinical course, autopsy findings, and chemical analysis.

Suicidal overdose of chloroquine is rare. We present a 14-year-old girl who was admitted to our Emergency Department after intentional ingestion of 7.5 g of chloroquine base followed by cardiac and respiratory arrest. Despite early mechanical ventilation, cardiac support, and treatment with high doses of diazepam, the patient died. Laboratory investigation indicated disseminated intravascular coagulation confirmed by petechial hemorrhages in the leptomeninges at autopsy, a finding that has not previously been described. Postmortem tissue analysis demonstrated early drug distribution to the medulla oblongata and cerebellum.

Adolescent↗
PubMed1995

Clinical evaluation of different doses of intravenous enalaprilat in patients with hypertensive crises.

BACKGROUND: The appropriate dose of intravenous enalaprilat to be used in the treatment of hypertensive crisis is controversial. There has been no comparative study of the efficacy and safety of different dosages of enalaprilat in hypertensive patients. METHODS: Sixty-five consecutive patients with hypertensive urgencies (systolic blood pressure > 210 mm Hg and/or diastolic blood pressure > 110 mm Hg) or emergencies (diastolic blood pressure > 100 mm Hg and evidence of end-organ damage, ie, angina pectoris, hypertensive encephalopathy, or congestive heart failure) admitted to an emergency department from January 1, 1994, to September 30, 1994, were identified. The patients were randomized to receive different doses of enalaprilat (0.625, 1.25, 2.5, and 5 mg). Response to treatment was defined as a stable reduction of systolic blood pressure to below 180 mm Hg and diastolic blood pressure to below 95 mm Hg within 45 minutes after the start of treatment and relief of symptoms in patients with hypertensive emergencies. RESULTS: In 41 (63%) of 65 patients, the treatment goal was reached. Twenty-four patients (37%) failed to achieve the goal of treatment within 45 minutes after administration of enalaprilat. The response rates in the 0.625-mg, 1.25-mg, 2.5-mg, and 5-mg groups were 67%, 65%, 59%, and 62%, respectively. The proportion of patients initially randomized who responded to treatment was not different between any of the four groups of enalaprilat doses. There were no significant differences according to enalaprilat dose with respect to changes in systolic, diastolic, and mean arterial blood pressure. No severe side effects were observed. CONCLUSION: Enalaprilat is a safe antihypertensive drug with moderate efficacy in the treatment of hypertensive crisis. As doses above 0.625 mg alter neither response rates nor the magnitude of blood pressure reduction, we recommend 0.625 mg as the initial dose in the treatment of hypertensive crisis.

Aged↗
PubMed1995

Effect of alcohol on acute ventilatory adaptation to mild hypoxia at moderate altitude.

OBJECTIVE: To evaluate the influence of alcohol on acute adaptation to mild hypoxia at moderate altitude. DESIGN: Randomized, double-blind, placebo-controlled crossover trial. SETTING: University clinic and mountaineering resort at altitudes of 171 m and 3000 m, respectively, in the Austrian Alps. PARTICIPANTS: 10 healthy male alpinists, 22 to 24 years of age. INTERVENTION: Single dose of 50 g of alcohol or placebo at altitudes of 171 m and 3000 m. MAIN OUTCOME MEASURES: Arterial oxygen pressure (Pao2) and arterial carbon dioxide pressure (Paco2) before and 1 hour after consumption of alcohol or placebo. RESULTS: At an altitude of 171 m, 50 g of alcohol caused no statistical change in Pao2 and Paco2 (median Pao2, 91.5 compared with 90.5 mm Hg [P = 0.89]; median Paco2, 37.5 compared with 36.0 mm Hg [P = 0.41]). At an altitude of 3000 m, the median Pao2 decreased from 69.0 to 64.0 mm Hg, a median decrease in the paired difference of 4.0 mm Hg (95.1% CI, 1.5 to 6.5 mm Hg; P < 0.01), and the median Paco2 increased from 32.5 to 34.0 mm Hg, a median increase in the paired difference of 3.0 mm Hg (95.1% CI, 2.0 to 4.0 mm Hg; P < 0.01) 1 hour after drinking 50 g of alcohol. Placebo did not influence Pao2 or Paco2 at either altitude. CONCLUSION: Alcohol inhibits the initial stages of adequate acute ventilatory adaptation to mild hypoxia at moderate altitude. Caution in the use of alcoholic beverages at moderate altitude is therefore necessary.

Adaptation, Physiological↗
PubMed1995

Factitious hyperthyroidism causing acute myocardial infarction.

Myocardial ischemia is a rare but severe and possibly life threatening manifestation of hyperthyroidism, but does not usually result in persistent ischemia. We report on a 71-year-old woman who had undergone total thyroidectomy with subsequent irradiation because of follicular carcinoma 3 years ago. Since then, she had been maintained on oral levothyroxine replacement therapy at a dose of 0.15 mg alternating with 0.2 mg daily. When latent hypothyroidism became evident despite replacement therapy, the dose of levothyroxine was increased to 0.3 mg a day. Three weeks later, the patient suffered from an acute posterior myocardial infarction, although she had no previous history of coronary artery disease. Subsequent coronary arteriograms revealed no evidence of disease of the major vessels. Myocardial scintigraphy 3 weeks after infarction still revealed a persistent perfusion defect. Since it is known that thyroid hormones increase oxygen demand, the rapid elevation of oxygen utilization caused by thyrotoxicosis factitia is likely to be responsible for this patient's myocardial infarction. The case illustrates that a sudden increase in levothyroxine replacement dose should be avoided.

Acute Disease↗
PubMed1995

Poor ventilatory response to mild hypoxia may inhibit acclimatization at moderate altitude in elderly patients after carotid surgery.

Peripheral chemoreceptors (carotid bodies) are the main sensing organs for hypoxaemia. During carotid surgery, the carotic body in the bifurcation of the common carotid artery is often involved and damaged or destroyed. Animals lose their ability to adapt to high altitude after experimental denervation of the carotid bodies. The objective of our study was to evaluate the ability of human patients to adapt to moderate altitude after single side carotid surgery. Blood gas analysis at rest at 171 m and after car and cable car transport to 1600 m before and after carotid surgery was performed. Mean(s.d.) paO2 decreased insignificantly from 74.8(3.56) at 171 m altitude to 71.6(2.07) at 1600 m (P = n.s.), means(s.d.) paCO2 decreased significantly from 36.2(2.86) to 31.4(2.7) mmHg (P < 0.05) before carotid surgery. Months after surgery, a significant drop in paO2 occurred after identical passive exposure to moderate altitude: mean(s.d.) paCO2 at 171 m 74.4(3.65) mmHg, at 1600 m 65.8(3.70) mmHg (P < 0.01), paCO2 did not change significantly. Mean(s.d.) paCO2 at 171 m: 36.0(2.35), at 1600 m 36.2(2.86) mmHg (P = n.s.). Although the sample investigated was small, after single side carotid surgery patients seem to lose their ability for satisfactory ventilatory response to acute exposure to moderate altitude. This is of possible alpine medical importance.

Acclimatization↗
PubMed1995

Emergency mechanical ventilation at moderate altitude.

Portable emergency ventilators are commonly used in the prehospital setting in the transport of critically ill patients in hypobaric environments. The aim of our trial was to evaluate the influence on minute ventilation and blood gas analysis of moderate altitude (3000 m) compared to 171 m in healthy volunteers during mechanical ventilation with the Draeger Oxylog ventilator. At 3000 m, the delivered minute volume increased by 9.8% in the air mix mode and by 14.6% in the no air mix mode. PaO2 at 3000 m altitude decreased by 33.3% in the air mix mode, and no statistical change was observed in the no air mix mode. PaCO2 at 3000 m altitude decreased by 9.0% in the air mix mode and by 12.8% in the no air mix mode. These changes are of sufficient magnitude and importance to require monitoring of minute volume to prevent barotrauma or volume-related trauma and to monitor oxygenation by pulse oximetry during emergency mechanical ventilation at moderate altitude.

Adult↗
PubMed1995

Near infrared spectroscopy during and after cardiac arrest--preliminary results.

OBJECTIVE: To evaluate if regional cerebrovascular oxygen saturation (rSO2) is linked to systemic oxygenation and if impaired regional cerebral oxygenation affects outcome in cardiac arrest patients. DESIGN: Prospective, observational study. SETTING: Emergency department of a University Hospital. SUBJECTS: Patients during cardiac arrest or after restoration of spontaneous circulation. INTERVENTIONS: To measure rSO2 an infrared light-emitting probe was applied to the patient's forehead after arrival in the emergency department. Data were collected continuously together with blood pressure and pulse oximetry. Each variable measured immediately after arrival was used for calculation. ENDPOINTS: Best outcome (cerebral performance category) or death within one week. MEASUREMENTS AND MAIN RESULTS: Regional SO2 was measured in 18 consecutive patients. Six patients presented with cardiac arrest on arrival and rSO2 was measured during chest compression. Twelve patients had achieved restoration of spontaneous circulation before they arrived in the emergency department. No association was found between rSO2 and pulse oximetry or rSO2 and blood pressure. All patients surviving for one week (n = 9) achieved a significantly higher median rSO2 on arrival than nonsurvivors (n = 9) (63% and 46%, respectively; p = 0.003). Median rSO2 was lower in the group arriving without spontaneous circulation (n = 6) than in patients after restoration of spontaneous circulation (n = 12) (44% and 63%, respectively; p = 0.009). This difference was not found in pulse oximetry readings. Patients with restoration of spontaneous circulation surviving the first week after cardiac arrest (n = 8) had a higher rSO2 than patients with restoration of spontaneous circulation who did not survive (n = 4) (65% and 48%, respectively). Time from restoration of spontaneous circulation to arrival was not different between the two groups. CONCLUSION: By showing that low rSO2 readings after cardiac arrest are associated with a higher mortality, this new, non-invasive and easily applicable technique might help to prognosticate outcome and offers new insights into monitoring cerebral oxygenation after cardiac arrest.

Adolescent↗
PubMed1994

Sudden cardiac death of a teenage girl.

Anomalies of coronary artery origin can be of little clinical significance and only an incidental autopsy finding. However recent case reports have shown that a wide range of potential pathologic alterations of congenital coronary anomalies are associated with clinical symptoms and exercise related sudden death. We describe the case of a 16-year-old girl who sustained a cardiac arrest and died after cardiopulmonary resuscitation (CPR) of intractable cardiogenic shock. The sporty and previously healthy girl suddenly fainted after swimming in a tributary of the Danube. Autopsy revealed an anomalous origin of the left coronary artery from the anterior sinus of Valsalva and its course between aorta and pulmonary artery. The cause of this anomalous origin and possible mechanism for sudden death is discussed. We conclude that this congenital anomaly should be considered in cases of major cardiac events in young people.

Adolescent↗
PubMed1994

Adenosine for the management of patients with tachycardias--a new protocol.

We developed a new protocol for diagnosis and treatment of patients with sustained tachycardias (heart rate > 150 beats.min-1). The patients first underwent vagal manoeuvres; if those remained unsuccessful, i.v. adenosine in increasing doses of 6, 12, and 18 mg was administered until sinus rhythm (SR) or transient atrioventricular (AV) block, unmasking the underlying rhythm, was recorded. In the latter and in the non-responding cases other antiarrhythmics were applied. Ninety-three episodes of tachycardia in 46 patients were treated according to this protocol. Six episodes (6%) were terminated by carotid massage, 64 of the remaining 87 episodes (74%) responded to adenosine with return to SR. Conversion to SR occurred more often in episodes with narrow- than in wide-complex tachycardia (81 vs. 59%, P < 0.05). To achieve SR, the mean adenosine dose was lower in narrow- than in wide-complex tachycardia (13 +/- 8 vs 21 +/- 10 mg; P < 0.01). The duration of asystole after adenosine did not differ between these two groups, whereas the duration of arrhythmia after adenosine differed significantly (8.5 +/- 5.8 vs 18.6 +/- 22.9 s; P < 0.05). Side effects of adenosine such as flush, dyspnoea, and chest pain did not seem to be dose dependent and occurred in about 20%. According to our protocol, in more than 75% SR was achieved in patients with sustained tachycardias after vagal manoeuvres and adenosine.

Adenosine↗
PubMed1994

Action of ATP on ventricular automaticity.

ATP is an effective treatment of supraventricular tachycardia when the atrioventricular (AV) node is part of the reentrant circuit. However, the lower a pace-maker in the pacemaker hierarchy, the more sensitive it is to adenosine. Therefore, we investigated the effects of ATP on ventricular automaticity in in vivo and in vitro conditions. Wide and narrow QRS complex tachycardia in 46 patients was treated with 6, 12, and 18 mg ATP as sequential intravenous (i.v.) bolus. ATP terminated tachycardias in 67%. Bolus infusion ATP caused < or = 6.4-s asystole that was self-limited. Perfusion of isolated spontaneously beating guinea pig heart with 100 microM ATP completely suppressed ventricular automaticity. After ATP-infusion was discontinued, the first ventricular beat was evident after 3.1 +/- 0.9 s and sinus node activity recovered with a time constant of 3.0 +/- 1.1 s. Because sinus node and ventricular automaticity recovered within seconds after ATP infusion was discontinued in vitro, recovery in vivo is also likely to be determined by the short half-life (+1/2) of ATP.

Adenosine Triphosphate↗
PubMed1994

Estimated glucose requirement following massive insulin overdose in a patient with type 1 diabetes.

A well-documented case of a 35-year-old male Type 1 diabetic patient who was admitted as an emergency after having injected 1500 international units (IU) of insulin (750 IU regular insulin,750 IU NPH-insulin) subcutaneously as a suicidal attempt is reported. Computing disappearance rates of glucose from its infused amounts necessary to maintain euglycaemia during 65 h after the insulin injection in analogy to experimental hyperinsulinaemic euglycaemic clamp examinations, a glucose consumption of 55.6 mumol kg-1 min-1 was found at peak serum insulin concentrations of about 14,400 pmol l-1. The insulin-induced glucose dynamics resemble closely those seen in healthy persons and Type 1 diabetic subjects during a 10 mU kg-1 min-1 euglycaemic clamp. This information may be useful in the handling of similar cases of insulin intoxication.

Adult↗
PubMed1994

Hormonal derangements in patients with severe alcohol intoxication.

Controversial results of fluid and electrolyte derangements in patients with moderate alcohol intoxication have been described. However, no information is available about severe alcohol intoxication. We investigated differences of hormonal disorders between alcohol-habituated and alcohol-naive subjects with severe ethanol intoxication. The hormonal derangements and recommendations on therapy of these patients are discussed. Thirty-three patients [10 alcohol-naive (group A) and 23 alcohol-habituated (group B) subjects] with severe alcohol intoxication (blood ethanol > 200 mg/dl) were selected for the study. Electrolytes and osmolarity of serum and urine, blood ethanol, vasopressin, renin, and aldosterone were determined on admission 2, 4, and 6 hr later. Fluid balance was calculated for each hour. All patients received isotonic saline solution according to urine production. Group A: On admission, serum osmolarity was increased (308 mOsmol/kg). Concomitantly, vasopressin level was elevated on admission (9.12 pg/ml). Increased serum osmolarity was correlated with elevated vasopressin levels (r = 0.8211; p < 0.005). Serum electrolytes, renin, and aldosterone values were within normal ranges. Group B: On admission, vasopressin level was significantly decreased (0.9 pg/ml), despite an elevated serum osmolarity (309 mOsmol/kg). Serum osmolarity remained high despite a sufficient fluid substitution. In addition, vasopressin level remained suppressed over the observation period. Aldosterone level was significantly increased on admission (319 ng/ml). Accordingly, serum sodium was increased from 142 to 148 mM/liter, and serum potassium was decreased from 3.9 to 3.4 mM/liter. Response to hyperosmolarity due to severe alcohol intoxication is different in alcohol-naive and alcohol-habituated subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗