Antibiotics change contractility of guinea pig aorta and trachea to histamine after a short exposure to LPS.
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Animals↗
Biomedical subjects
C Hasse
Publications and source records attributed to C Hasse.
Effect of accessory pathway location on the efficiency of heating during radiofrequency catheter ablation.
During radiofrequency catheter ablation of accessory pathways there is a poor correlation between applied power and temperature at target sites for catheter ablation. This study was designed to examine the relation between power and temperature during radiofrequency catheter ablation in patients with accessory pathways and to identify the factors that affect the efficiency of heating, defined as the ratio of applied power and temperature. Twenty-nine patients underwent radiofrequency catheter ablation of an accessory pathway. Among 257 energy applications, 108 were applied for ablation of a right-sided accessory pathway, 105 for a left-sided accessory pathway, and 44 for a posteroseptal accessory pathway. During each application of radiofrequency energy, temperature was continually monitored by use of an ablation catheter with a thermistor embedded in the tip of the distal electrode. During some applications of energy, fluctuations in temperature were observed. The average power, impedance, temperature, and efficiency of heating for all applications of radiofrequency energy was 37 +/- 11 W, 100 +/- 9 ohms, 53 +/- 9 degrees C, and 1.7 +/- 0.8 degrees C/W (range 0.9 degrees to 6.6 degrees C/W), respectively. The efficiency of heating varied by location (p < 0.0001), with the greatest efficiency of heating for posteroseptal energy applications (2.3 +/- 1.2 degrees C/W, which were significantly greater than for left-sided (1.8 +/- 0.8 degrees C/W; p < 0.01) or right-sided (1.2 +/- 0.4 degrees C/W; p < 0.0001) applications. Phasic fluctuation in temperature was observed during 127 (49%) energy applications, and the efficiency of heating was 1.5 +/- 0.7 degrees C/W.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Influence of somatostatin to biochemical parameters in patients with primary hyperparathyroidism.
Somatostatin (SRIF) is effective in the nonoperative management of a variety endocrine tumors. A potential role of SRIF for treatment of patients with primary hyperparathyroidism (pHPT) has been suggested. In a controlled, prospective, triple-blinded, randomized clinical trial, the somatostatin analogue octreotide (SMS 201-995, Sandostatin) was evaluated in 40 patients with well documented pHPT. Amongst other biochemical parameters, serum calcium and-phosphate and levels of parathyroid hormone, calcitonin, and osteocalcin as well as octreotide were assessed before and for 4 hours after a single iv. application of 200 micrograms ocreotide or placebo. SRIF-receptor autoradiography was performed in parathyroid tissue samples. Baseline values revealed a constellation of biochemical parameters typically found in pHPT. Following 200 micrograms octreotide, no significant changes in any of the biochemical parameters investigated for were observed. Multivariate analysis was performed to identify patient subpopulations in which any given combination of laboratory parameters changed in response to either drug or placebo. However, no 'responders' to octreotide were identified. 45% of patients receiving octreotide, reported side effects. Parathyroid tissue samples were negative for SRIF-receptor expression. It is concluded that a single dose iv. application of octreotide does not result in appreciable changes of biochemical parameters relevant in pHPT and carries a high rate of side effects. Furthermore, absence of SRIF-receptors in parathyroid tissue from patients with pHPT, together with lack of octreotide effects, suggests that somatostatin-analogues may not be effective in the non-operative therapy of pHPT.
Adolescent↗
Influence of ceruletid on gallbladder contraction: a possible prophylaxis of acute acalculous cholecystitis in intensive care patients?
The purpose of this study was to investigate the utility of repeated applications of ceruletid to reduce gallbladder volume and its feasibility as a means of prophylaxis of acute acalculous cholecystitis in intensive care patients. First, a dose-response curve of ceruletid was obtained in 20 mechanically ventilated patients of a surgical intensive care unit (SICU) not receiving enteral nutrition. An effective dose of ceruletid, defined by a 50% reduction of gallbladder volume was established and subsequently studied in 40 mechanically ventilated SICU patients on total parenteral nutrition in a prospective, randomized, controlled, triple-blind trial. Gallbladder volume, sludge formation and side effects were evaluated. A dose of 1.5 micrograms/kg body weight ceruletid was established as the effective dose, causing 50% reduction of gallbladder volume in all patients studied and reduction of gallbladder sludge in 95%. In 67.5% of patients side effects were observed, requiring therapeutic intervention in 68%. It is concluded that ceruletid is effective in stimulating gallbladder contraction and reducing sludge formation in severely ill patients on intensive care units. Its routine use as prophylaxis of acute acalculous cholecystitis, however, may be limited by the nature, severity and frequency of side effects.
Acute Disease↗
[Pancreatitis in primary hyperparathyroidism (pHPT) is a complication of advanced pHPT].
Pancreatitis occurred in 13 (5.6%) of 234 patients (76 men, 158 women; mean age 63 [2-83] years) who were operated on for primary hyperparathyroidism (pHPT) between 1987 and 1992. The pancreatitis patients had a significantly higher median level of parathormone (340 pg/ml), of serum calcium (3.2 mmol/l) and of thyroid weight (1.7 g) than the remaining 221 patients (135 pg/ml; 2.9 mmol/l; 1.0 g, respectively: P < 0.05 for each). In ten patients pHPT had been diagnosed during an attack of pancreatitis: pancreatitis had been the diagnostic clue to pHPT. After conservative treatment of the pancreatitis and parathyroidectomy seven of the ten patients were free of symptoms during the follow-up. In one patient pancreatitis recurred postoperatively and two patients died of the consequences of haemorrhagic necrotizing pancreatitis. Cholelithiasis, as another possible causative factor for pancreatitis, was present in five of the 13 patients (38%). None of the patients was an alcoholic. These data indicate that there is a positive correlation between advanced pHPT and pancreatitis. Pancreatitis may be the expression of much advanced hyperparathyroidism which has been diagnosed too late.
Acute Disease↗
Relation between impedance and endocardial contact during radiofrequency catheter ablation.
Lesion size during radiofrequency catheter ablation in patients with paroxysmal supraventricular tachycardia (PSVT) is thought to be related to multiple factors, including contact pressure at the catheter-endocardial interface. Therefore a predictor of contact pressure at a potential target site for ablation might be useful. In this study 25 patients underwent duplicate 2 W applications of radiofrequency energy with the catheter in poor and firm contact with the right ventricular endocardium after successful ablation treatment for PSVT. The mean age of the patients was 44 +/- 15 years. Fifteen patients underwent slow pathway ablation for atrioventricular nodal reentrant tachycardia, and 10 patients underwent ablation for an accessory pathway. The mean impedance for low-energy applications in firm contact (139 +/- 24 ohms) was 22% +/- 13% greater (p 0.0001) than in poor contact with the right ventricle (113 +/- 16 ohms). The maximum impedance was 27% greater when the catheter was in firm (147 +/- 28 ohms) rather than poor contact (116 +/- 16 ohms), with the endocardium (p 0.0001). These results suggest that higher impedance measurements may be obtained with low-energy applications of 2 W when the ablation catheter is in firm contact with the endocardium.
Adult↗
[Atony of the gallbladder as a risk factor for acalculous cholecystitis. What is the effect of intensive care?].
The incidence of acute acalculous cholecystitis (AAC) is increasing and associated mortality is high. Biliary stasis and sludge formation are probably important factors in the pathogenesis of this disease. No data concerning the dynamics of these changes in the early phase of intensive care therapy are available. The gallbladders of 20 patients treated after major abdominal surgery in the surgical intensive care unit (SICU) with mechanical ventilation and without enteral feedings were therefore observed sonographically during the first 5 postoperative days in a prospective observational study. 20 patients treated on a regular ward after major abdominal surgery also not receiving any enteral nutrition served as control group. 24 hours after admission to the intensive care unit and on all subsequent days of observation the gallbladders of the patients in the SICU-group were significantly larger than in the control group. Sludge also appeared earlier and more frequently in the gallbladders of the SICU-patients. Lack of enteral feedings alone cannot explain these results. Positive-pressure ventilation and medications used in SICU are most likely responsible for the observed differences. Besides the necessity to make the diagnosis of AAC as early as possible, it appears to be worthwhile to investigate measures of prophylaxis. Since gallbladder distension in patients treated in SICU can be already observed on the first postoperative day it seems to be reasonable to initiate a regimen of prophylactic measures (e.g. with cholecystokinin or ceruletide) early in the course of ICU-therapy.
Abdomen↗
Prospective, randomized comparison of conventional and high dose loading regimens of amiodarone in the treatment of ventricular tachycardia.
OBJECTIVES: The purpose of this prospective randomized study was to compare the electrophysiologic effects of conventional and high dose loading regimens of amiodarone in patients with sustained ventricular tachycardia. BACKGROUND: Uncontrolled studies in which patients have been treated with an oral loading dose of 2 to 4 g/day of amiodarone have suggested that, compared with a conventional loading dose, this dosing regimen results in more rapid control of spontaneous ventricular tachycardia and ventricular tachycardia induced by programmed stimulation. METHODS: Patients in whom sustained monomorphic ventricular tachycardia was inducible by programmed stimulation and who were refractory to class I antiarrhythmic medications were randomly assigned to receive either a conventional (n = 15) or a high (n = 17) loading dose of amiodarone. The conventional dose consisted of 600 mg twice a day for 10 days. The high dose regimen consisted of 50 mg/kg body weight per day on days 1 to 3, 30 mg/kg per day on days 4 and 5 and 600 mg twice a day on days 6 to 10. An electrophysiologic test was performed in the baseline state and after 3 and 10 days of therapy. An adequate response to amiodarone was defined as the inability to induce ventricular tachycardia or the ability to induce only relatively slow (cycle length > or = 350 ms) hemodynamically stable ventricular tachycardia. RESULTS: After 3 days of therapy, 2 of 14 patients who received the conventional loading dose and 6 of 15 patients who received the high dose loading regimen had an adequate response to amiodarone (p = 0.08). After 10 days of therapy, four patients in each group had an adequate response to amiodarone (p = NS). Three patients who received the high dose and one patient who received the conventional dose of amiodarone had an adequate response after 3 days of therapy but not after 10 days of therapy. There were significant increases in the sinus cycle length, atrioventricular block cycle length, ventricular effective refractory period and ventricular tachycardia cycle length after 3 and 10 days of therapy compared with baseline values regardless of the dosing regimen. The extent of the effects of amiodarone on these variables after 3 and 10 days of therapy was similar with both dosing regimens. CONCLUSIONS: The therapeutic and electrophysiologic effects of conventional and high dose loading regimens of amiodarone do not differ significantly after 3 or 10 days of therapy. High oral loading doses of amiodarone do not offer any significant clinical advantage over a conventional loading dose of amiodarone for controlling ventricular tachycardia induced by programmed stimulation.
Aged↗
Perioperative nonspecific histamine release: a new classification by aetiological mechanisms and evaluation of their clinical relevance.
As a consequence of the performance of a randomized controlled clinical trial on perioperative histamine release and cardiovascular and respiratory disturbances, several types of increases in plasma histamine had to be distinguished instead of only two which existed at the beginning of the study: drug-induced allergic and pseudoallergic reactions. First of all, the new classification by aetiology (clinical epidemiology) was derived from a meta-analysis (secondary analysis) of the most recent literature. According to that histamine release in the perioperative period has several, different causes and is involved in several, different disease manifestations. A clear distinction (classification), however, is necessary if histamine release as an unwanted (adverse) effect has to be recognized, value judged according to its clinical relevance and therefore also prevented by histamine antagonists. Histamine release by neuro-endocrine and neuro-inflammatory mechanisms, cytotoxic histamine release and local, cytokine induced histamine release have been distinguished from pseudoallergic histamine release, but its functions are not yet clear. It has been analysed in prospective trials which used special clinical situations as models: patients on a normal ward or before and during upper GI endoscopy without premedication, but also in specific phases of laparoscopic cholecystectomy (trocar phase and dissection phase). Their existence in the clinical reality is now very likely, but new trials must investigate the pathophysiological effects such as in metabolism, coagulation, pulmonary haemodynamics (shunt volume) and gastric acid secretion. Histamine release by pseudoallergic mechanisms, however, was identified in the very vulnerable post-induction phase of anaesthesia up to skin incision. Its incidence was much higher than ever expected and its clinical relevance was demonstrated by the severity of reactions and the intervention strategies of the anaesthetists who were blinded concerning the type of the plasma substitute given and the prophylaxis with antihistamines. Pseudoallergic histamine release was clearly unwanted (adverse). Its occurrence in the other phases of anaesthesia has to be further evaluated in the tedious procedure of data analysis of the Mainz-Marburg-trial. The overall incidence of histamine release in the trial was so incredible high (72% of all patients, some of them with up to 4 episodes of histamine release) that a distinction between pseudoallergic (unwanted) and other types of histamine release (possibly less unwanted or even beneficial) is urgently needed. In the phase of steady state (maintenance) of anaesthesia the H1-(+)H2-prophylaxis was highly effective. Further analysis must show whether this is also the case during the phases of induction of anesthesia.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
Immobilization and light-dark cycle-induced modulation of serotonin metabolism in rat brain and of lymphocyte subpopulations: in vivo voltammetric and FACS analyses.
The effect of immobilization and light-dark cycle on the serotoninergic system of the n. raphe dorsalis and on the distribution of blood lymphocyte subpopulations was studied in the rat. As was shown by in vivo voltammetry, 10 min immobilization enhanced serotonin metabolism with a maximum 15 min after immobilization. The distribution of the blood lymphocytes into subpopulations was also affected: pan-T and T helper lymphocytes were reduced during immobilization and reached minimum values after 20 min recovery. The circadian rhythms of serotonin metabolism and the distribution of pan-T and T helper cells exhibited a slight phase shift if compared with each other.
Animals↗
[Parathyroid gland cancer. Problems in diagnosis and therapy].
Parathyroid carcinoma occurs in 0.1 to 5% as the cause of primary hyperparathyroidism (HPT). It is difficult to determine the true incidence, because parathyroid carcinoma is diagnosed too often due to unreliable histologic criteria. It is only justified to make the diagnosis, when a local recurrence or metastases with the clinical picture of a recurrent or persistent HPT occurred. Treatment of choice is the initial en-bloc resection, which may result in long disease-free intervals. Pharmacological treatment, chemotherapy, and radiation are mostly ineffective in the treatment of parathyroid carcinoma. A satisfactory long-term palliation can only be achieved with repeated resections of the local recurrences and metastases. Diagnostic efforts should be made to localize the recurrent tumor before every reoperation, whereby ultrasonography of the neck is the most sensitive procedure. Occasionally the parathyroid tissue cannot be identified in spite of preoperative diagnostic studies or hypercalcemia persists after surgery. In these cases forced diuresis and medical treatment with calcitonin, diphosphonates or mithramycine can briefly control hypercalcemia. The clinical courses of 3 patients with metastasizing parathyroid carcinoma are presented and discussed. In these patients 3 to 11 surgical interventions were performed in combination with an intermittent medical treatment. By this regimen we achieved long-term palliations up to 13 years.
Adenoma↗
[Cystic parathyroid gland adenomas: pathologic-anatomic variants of parathyroid gland adenomas or a separate disease entity?].
Between 01.01.1987 and 31.12.1990 a primary operation was performed on 126 patients in the Dept. of General Surgery, University of Marburg Hospital for primary hyperparathyroidism due to a parathyroid adenoma. Their clinically relevant data were prospectively documented. In 6 patients (4.8%) a total of 7 cystic parathyroid adenomas was found. While there was no difference in age- and sex-distribution, patients with cystic adenomas were found to have markedly higher serum parathormone and alkaline phosphatase levels than patients with solid adenomas. Calcium levels were similar in both groups. Cystic adenomas were much heavier than solid adenomas. A significant number of cystic adenomas was found to be displaced into the posterior mediastinum. The property of cystic parathyroid adenomas to be frequently located away from their usual anatomical position can make the intraoperative search for them difficult.
Adenoma↗
Carcinoid tumors of Meckel's diverticula. Report of two cases and review of the literature.
Two cases of carcinoid tumors in Meckel's diverticula are reported. Additionally, data of 104 published cases of carcinoids in this rare location are analyzed. The average age of the patients is 56.6 years and corresponds to the age of patients with ileal carcinoids. Carcinoids in Meckel's diverticula also resemble ileal carcinoids in their biological behavior more than they do appendiceal carcinoids. Tumors larger than 5 mm have a marked risk to metastasize. By the time symptoms are present, 77 percent of these tumors have already metastasized. Men are affected by this tumor 2.5 times more often than women. Carcinoids in Meckel's diverticula metastasize twice as often in female as in male patients. More than 70 percent of carcinoids in Meckel's diverticula are found at the tips of the diverticula. An aggressive surgical management of tumors larger than 5 mm is recommended.
Adult↗
Intraoperative ultrasonography in surgery for chronic pancreatitis.
We report our experience with intraoperative ultrasonography in 49 patients undergoing surgery for chronic pancreatitis. Among drainage procedures, there were 14 laterolateral pancreaticojejunostomies, 15 pseudocystojejunostomies, and 2 pseudocystoduodenostomies. Under the guidance of intraoperative ultrasonography, left sided partial resection of the pancreas was performed in 7 patients, whereas a Whipple-type procedure was necessary in 6 cases. All preoperatively diagnosed pseudocysts, abscess formations, and dilated pancreatic ductal systems could be easily localized with the assistance of intraoperative ultrasound. Additionally to diagnoses already made preoperatively, intraoperative ultrasonography revealed a second, smaller pseudocyst in one patient and pancreaticolithiasis in another case. However, significant assistance and comfort to the operating surgeon was provided in all cases by intraoperative ultrasound imaging. This technique, which is cost effective and minimally invasive, proved to be extremely helpful in localizing pancreatic fluid collections and the course of the pancreatic duct. It facilitates the operation by reducing tissue traumatization and operative time. In experienced hands, intraoperative ultrasonography is a reliable method and a useful adjunct to the surgeon.
Adult↗
[Sterile disposable packaging of ultrasound transducers for intraoperative use].
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Disposable Equipment↗
Hypoxemia during outpatient general anesthesia.
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Adult↗
Successful allotransplantation of microencapsulated parathyroids in rats.
Allotransplantation of parathyroid tissue in humans is desirable for treating long-term hypoparathyroidism (e.g., after inadvertent removal of parathyroid glands during thyroid surgery). Until now, parathyroid allotransplantation was not used clinically because its advantages were outweighted by the need of immunosuppression. To overcome the immunogenicity of the tissue to be transplanted, we employed the method of microencapsulation; first tried in islet cell transplantation for experimental allotransplantation of parathyroid tissue. We have been able to achieve long-term success in a rat model. After isolation and tissue culture, tissue pieces from parathyroid glands of 280 Lewis rats were encapsulated in barium alginate and grafted into hypocalcemic DA rats. From the 7th to the 90th day after transplantation the recipient rats (DA rats) showed a normal serum calcium concentration. This is the first report of successful long-term survival and function of microencapsulated allotransplanted parathyroid tissue.
Animals↗
First successful xenotransplantation of microencapsulated human parathyroid tissue in experimental hypoparathyroidism: long-term function without immunosuppression.
Owing to the complexity of the parathyroid hormone's metabolic interactions, clinical hypoparathyroidism is one of the most difficult of all endocrine disorders to treat. Therefore, causative treatment of this disorder by transplantation of parathyroid glands is highly desirable. We have recently documented the long-term in vivo function of iso- and allotransplanted rat parathyroid tissue without systemic immunosuppression in an animal model. In view of the potential clinical use of this method, human parathyroid tissue has been microencapsulated and transplanted over the highest immunological barrier. In a controlled, long-term animal study in the parathyroidectomized rat, the effect of microencapsulation on xenotransplanted human parathyroid tissue was evaluated over 30 weeks (native and microencapsulated parathyroid tissue = 40 rats respectively). Functionally, human parathyroid tissue was able to replace that of the rat. All animals that had received microencapsulated parathyroid tissue were normocalcemic for 16 weeks; 27/40 at the end of the study. In contrast, serum calcium concentrations dropped to post-parathyroidectomy levels within 4 weeks in those animals that had received native tissue only. Histologic evaluation of the explanted, functionally successful xenografts showed vital parathyroid tissue inside intact microcapsules surrounded by a small rim of fibroblasts. Avital fibrotic remnants were demonstrated in animals with non-encapsulated parathyroid tissue. Thus, we have established the feasibility of microencapsulation of human parathyroid tissue, preserving its viability over long periods in vivo even if xenotransplanted. In combination with an improved tissue culture method, transplantation of human parathyroid tissue and maintenance of its physiological function is reproducibly achieved without postoperative systemic immunosuppression over the highest transplantation barrier. This may be a crucial step towards the first clinical application of this method.
Animals↗