Biomedical subjects

Barbara Steinlechner

Publications and source records attributed to Barbara Steinlechner.

8 recordsLinked to original sources

PubMed2007

TENS relieves acute posttraumatic hip pain during emergency transport.

BACKGROUND: In Central Europe, ambulances for patients suffering from pain caused by nonlife-threatening trauma, such as hip fractures are staffed by medical personnel (medics) without physicians. Thus, there is an urgent need for nonpharmacological interventions that can be applied during the transport by basic life-support (BLS) medical personnel. METHODS: In all, 101 patients were screened for participation in this randomized placebo-controlled double-blind study, and randomly assigned to two groups (verum and sham transcutaneous electrical nerve stimulation [TENS]). First, medic A recorded all baseline parameters and measurements, then medic B performed TENS in absence of medic A. At the end of transportation, medic A performed data collection. Each patient was asked to grade his/her pain and anxiety level on visual analog scales (VAS, 0 to 100 mm). RESULTS: From 101 screened patients fulfilling the entry criteria, 29 declined consent and 9 had to be excluded from the analysis because of their final diagnosis. Therefore, the data from 30 patients (group 1, verum TENS) as well as from 33 patients (group 2 [control], sham TENS) were analyzed. No significant differences in potentially influencing factors were found before treatment. Pain scores upon arrival at the hospital differed significantly between group 1 and group 2 (p < 0.01). In group 1, pain reduction was observed between departure from the site of emergency and arrival at the hospital (VAS: 89 +/- 9 to 59 +/- 6 mm), whereas pain scores remained nearly unchanged in group 2 (VAS: 86 +/- 12 to 79 +/- 11 mm). CONCLUSION: Our findings show that TENS is a valuable and fast-acting pain treatment under the difficult circumstances of "out-of-hospital rescue". Because of its lack of side effects, it could also be a valuable tool in the hospital.

Aged↗

PubMed2006

Recombinant human antithrombin inhibits thrombin formation and interleukin 6 release in human endotoxemia.

We hypothesized that infusion of recombinant human antithrombin without concomitant heparin would have dose-dependent anticoagulant properties and potentially decrease endotoxin (lipopolysaccharide [LPS])-induced cytokine production. This was a randomized, double-blind, placebo-controlled study in parallel groups enrolling 30 healthy male volunteers. The active treatment groups received infusions of recombinant human antithrombin to increase antithrombin levels to 200% and 500% before infusion of 2 ng/kg endotoxin (LPS). Infusion of antithrombin dose-dependently decreased coagulation (P < .01 by repeated-measures ANOVA): peak levels of prothrombin fragment (1.8 nmol/L [95% confidence interval (CI), 1.3-2.3 nmol/L] in the 500% antithrombin group and 4.4 nmol/L [95% CI, 2.7-6.2 nmol/L] in the placebo group at 4 hours), thrombin antithrombin complexes (12 microg/L [95% CI, 8-16 microg/L] in the 500% antithrombin group and 34 microg/L [95% CI, 20-48 microg/L] in the placebo group at 4 hours), and D-dimer (0.2 microg/L [95% CI, 0.1-0.2 microg/L] in the 500% antithrombin group and 0.5 microg/L [95% CI, 0.4-0.7 microg/L] in the placebo group). Recombinant human antithrombin decreased peak interleukin-6 levels by 40% (222 pg/mL [95% CI, 148-295 pg/mL] and 216 pg/mL [95% CI, 112-320 pg/mL] in the 500% and 200% antithrombin groups, respectively, versus 357 pg/mL [95% CI, 241-474 pg/mL] in the placebo group; P < .001 by ANOVA). Finally, infusion of recombinant human antithrombin rapidly and transiently decreased neutrophil counts (by 19% [95% CI, 8%-30%] in the 500% antithrombin group versus 6% [95% CI, 1%-10%] in the placebo group, P = .002 by Kruskal-Wallis ANOVA) and monocyte counts (by 30% [95% CI, 16%-44%] in the 500% antithrombin group and 18% [95% CI, 9%-28%] in the 200% antithrombin group versus 8% [95% CI, 5%-20%] in the placebo group, P = .04) before LPS challenge, indicating that recombinant human antithrombin directly interacts with these leukocyte subsets. In summary, recombinant human antithrombin dose-dependently inhibited tissue factor-triggered coagulation. Effects on leukocytes and inhibition of interleukin-6 release seem to represent specific pharmacodynamic properties of recombinant human antithrombin.

Adult↗

PubMed2006

Neuronal injury after repeated brief cardiac arrests during internal cardioverter defibrillator implantation is associated with deterioration of cognitive function.

To determine the degree of neurocognitive dysfunction after placement of internal cardioverter defibrillators (ICD) and its relationship to the extent of neuronal injury, we studied 42 patients undergoing ICD (n = 21) or pacemaker (PM) insertion (control patients, n = 21). The Mini Mental State Examination, the Trailmaking A test and the forward and backward Digit Span tests were used and P300 latencies were determined preoperatively and postoperatively. Serum neuron-specific enolase (NSE) was determined before and at the end of, as well as 2, 6, and 24 h after surgery. Preoperatively, PM patients scored worse in the Digit Span backward and the Trailmaking tests and showed prolonged P300 latencies. Postoperatively, the Digit Span backward scores declined and NSE levels increased only in the ICD group (P < or = 0.05). The difference between preoperative and postoperative Digit Span backward scores correlated with the increase in serum NSE levels (r2 = 0.3, P < or = 0.05). Moreover, P300 latencies increased in 13 of 17 ICD patients, but decreased in 7 of 10 PM patients (P < or = 0.05). PM patients even improved in the Trailmaking test (P < or = 0.05). Neuronal injury from even brief periods of global brain ischemia seems to be associated with deteriorating neurocognitive function.

Aged↗

PubMed2006

Apoptosis-specific activation markers in on- versus off-pump coronary artery bypass graft (CABG) patients.

BACKGROUND: The relation of epithelial/endothelial apoptosis and secretion of death-inducing receptors (DIR) in comparison to vascular adhesion molecules is not known in patients undergoing the On- versus Off-pump coronary artery bypass graft (CABG) procedure. METHODS: 30 patients were prospectively included in the study (On- vs. Off-pump CABG, each n = 15). Serum samples were obtained prior to, and 30 minutes, 60 minutes and 24 hours after CABG operation. ELISA was utilized to detect caspase-cleaved cytokeratin-18 (CK18) by means of M30 antibody, soluble VCAM-1, soluble ICAM-1, and soluble DIR TNFR-1 and CD95. RESULTS: Soluble caspase-cleaved CK18 was increased and leveled to initial values at 24 hrs. sICAM-1 showed a significant decrease at 30 minutes and 60 minutes in comparison to preoperative values. sTNFR-1/sCD95 showed a rise that was not significant to preoperative values. CONCLUSION: These results indicate for the first time that epithelial/endothelial apoptosis is occurring in patients undergoing bypass operation, irrespective of the CABG procedure selected.

Apoptosis↗

PubMed2005

A systematic review of currently available pharmacological neuroprotective agents as a sole intervention before anticipated or induced cardiac arrest.

We conducted a Medline search for controlled studies evaluating currently available drugs for pharmacological neuroprotection. They had to be administered prior to transient global cerebral ischaemia without further non-pharmacological measures. We deliberately excluded focal ischaemia since its pathophysiology is substantially different from global ischaemia. A total of 45 articles conducted exclusively in laboratory animals met these criteria. The following classes of agents were evaluated: anaesthetics, GABAergic drugs, calcium-antagonists, anticonvulsives, sodium-channel blockers, potassium-channel activators, NMDA-receptor antagonists, hormones, vasodilators, dopamine- and alpha2-agonists, magnesium, xanthine oxidase- and cyclooxygenase inhibitors, a nootropic, a protease inhibitor, and immunosuppressants. Some of them were applied chronically and others administered via clinically impracticable routes. The available literature favours isoflurane, phenytoin, lamotrigine, magnesium, and potentially, nimodipine, and flunarizine. If factors like costs, toxicity, side effects, route and mode of application are considered, isoflurane and MgSO4 that have also been safely applied to patients with compromised left ventricular pump function are advantageous but their true role in human neuroprotection remains unclear.

Animals↗

PubMed2005

Postoperative analgesia with remifentanil in patients undergoing cardiac surgery.

Remifentanil, a short-acting opioid, is commonly used in cardiac anesthesia. In this study we sought to demonstrate the feasibility of pain treatment and to determine the remifentanil dose necessary for adequate analgesia in tracheally extubated patients after cardiac surgery. Thirty patients undergoing elective cardiac surgery were included in this study. After surgery, the intraoperatively administered remifentanil was initially continued at 0.05 microg . kg(-1) . min(-1). Before tracheal extubation, a nonsteroidal antiinflammatory drug was administered and remifentanil was reduced to 0.035 microg . kg(-1) . min(-1). Pain assessment using a visual analog scale (VAS) was performed after tracheal extubation, in 2-min intervals for 10 min, every 10 min until the end of the first hour and every 30 min during the ensuing 5 h. A VAS score > or =30 or a respiratory rate <10 breaths/min was followed by an increase or decrease in the remifentanil dose by 0.005 microg . kg(-1) . min(-1), respectively. For rapid dose adaptation during the first 10 min, remifentanil was increased twice by 0.005 microg. kg(-1) . min(-1) and then 3 times by 0.01 microg . kg(-1) . min(-1). With a mean remifentanil dose of 0.051 microg . kg(-1) . min(-1) VAS decreased to 26 +/- 14 after 30 min. Sufficient analgesia was achieved with remifentanil doses ranging from 0.03 to 0.09 microg. kg(-1) . min(-1). A maximum mean remifentanil dose of 0.057microg. kg(-1) . min(-1) was reached after 4 h. The combination of remifentanil with a nonsteroidal antiinflammatory drug provided adequate analgesia in 73% of patients 30 min after tracheal extubation. Rapid dose titration was necessary during the first 10 min in 50% of patients. Increasing the initial remifentanil dose could shorten the titration period but may be associated with respiratory complications.

Adult↗

PubMed2005

Soluble ST2 protein in cardiac surgery: a possible negative feedback loop to prevent uncontrolled inflammatory reactions.

BACKGROUND: Recent reports have demonstrated that cardiopulmonary bypass (CBP) utilization leads to a TH2 cytokine bias in patients undergoing coronary artery bypass grafting (CABG) operation. The relation of soluble ST2 and secretion of IL-10, markers of TH2 T-cell activation, and IL-13 in relation to immunoglobulin isotope production is not known in patients undergoing On- versus Off-pump (CABG) procedure. METHODS: 30 patients were prospectively included in the study (On- vs Off-pump CABG, each n = 15). Serum samples were obtained prior to, and 30 min, 60 min and 24hrs after operation. ELISA was utilized to detect sST2 and IL-10, IL-13 and immunoglobulin isotype production. RESULTS: In both cohorts we could demonstrate a significant rise of ST2 24 hours after the CABG procedure. In the On-pump group ST2 levels (pg/ml) before the operation, at 30 and 60 minutes and after 24 hours were 115.3 +/- 25, 71.2 +/- 15, 114.1 +/- 26 and 4231.9 +/- 520, respectively. In the Off-pump group they were 200.3 +/- 109, 91.2 +/- 20, 137 +/- 29 and 4144.9 +/- 488 (both, p < 0.0001, p < 0.0001, respectively). IL-10 (pg/ml) levels rose from preoperative values of 6.2 +/- 1.6 in the On-pump group and 7.91 +/- 1.8 in the Off-pump group to 33.14 +/- 8.7 and 13.72 +/- 3 after 60 minutes (p 0.0189, p 0.0397, respectively). IL-13 levels and immunoglobulin production did not change significantly within the study period irrespective of the operation procedure used. CONCLUSION: In conclusion, our results demonstrate that sST2 and IL-10, markers of TH2 cytokine producing cells, are increased in CABG operation, irrespective of the procedure selected, and settles a longstanding controversy concerning the shift from Th1 to Th2 cells.

Cardiopulmonary Bypass↗

PubMed2004

The oxygen dissociation curve: quantifying the shift.

An oxyhaemoglobin dissociation curve (ODC) quantifies the most important function of red blood cells and that is the affinity for oxygen and its delivery to the tissues. Oxygen affinity for haemoglobin plays a critical role in the delivery of oxygen to the tissues and is changed by shifting to the left or right. A shift to the left implies an increased oxygen affinity and, hence, tighter binding due to the higher oxygen saturation in relation to the pO2. On the other hand, a shift to the right corresponds to a decreased oxygen affinity and easier release of oxygen to the tissues. It is well known that the ODC shifts in response to changes in pH, pCO2 and 2,3 diphosphoglycerate. However, how much the ODC shifts has never been quantified. Arterial and venous blood gases were taken during cardiopulmonary bypass and two indices were used to quantify the shift of the ODC; the p50 shift and the SO2 difference. Arterial blood shifted to the right by 4 +/- 0.1 mmHg at a pH of 7.24 and shifted to the left by -3.5 +/- 0.05 mmHg at a pH of 7.51. The change in arterial saturation was minimal, rising by 0.8% and dropping by -5% and did not correlate to p50 shifting and changes in pH, but demonstrated changes dependent on the concentration of dyshaemoglobins. The venous blood exhibited a greater range of p50 shifting at each pH value. At a pH of 7.24, the p50 shifted to the right by 4.8 +/- 2 mmHg and at a pH of 7.51 the p50 shifted to the left by -4 +/- 1.8 mmHg. Unlike the arterial blood, the change in saturation correlated well to p50 shifting. It is shown here for the first time how much the curve shifts with changes in pH and how this may be used to evaluate treatment strategies.

Arteries↗