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C Sprung

Publications and source records attributed to C Sprung.

29 records · Page 2Linked to original sources
PubMed1992

Predictors of bacteremia and gram-negative bacteremia in patients with sepsis. The Veterans Affairs Systemic Sepsis Cooperative Study Group.

BACKGROUND: We analyzed data from the Department of Veterans Affairs trial of steroid therapy for systemic sepsis to identify predictors of bacteremia and gram-negative bacteremia. METHODS: Of the 2568 patients screened for entry in the trial, 465 met the following criteria: presence of four of seven clinical signs of sepsis; blood cultures at the time of screening; and complete data on nine clinical parameters. The multivariate logistic regression model was used to identify predictors of bacteremia and gram-negative bacteremia. Predicted probabilities of having these types of infections were calculated using the identified predictors. Patients were then classified into groups with and without bacteremia (and gram-negative bacteremia) based on the predicted probability. Misclassification error rates were calculated for each method of categorization by comparing the true with the predicted grouping of patients. RESULTS: Three factors were independently predictive of bacteremia and gram-negative bacteremia: elevated temperature, low systolic blood pressure, and low platelet count. Using these three factors, classification methods were identified that predicted blood infection better than chance, but misclassification was also high. For predicting bacteremia, the maximum predicted positive rate was 83%, with a specificity of nearly 100% and a sensitivity of only 5%. For predicting gram-negative bacteremia, the maximum predicted positive accuracy was 100%, with a specificity also of 100% and a sensitivity of almost 0%. CONCLUSIONS: Using simple clinical parameters, we could not predict either bacteremia or gram-negative bacteremia with sufficient accuracy to be clinically meaningful; however, our approach represents a step in the direction of forecasting the bacterial organism responsible for sepsis in advance of culture results.

Adrenal Cortex Hormones↗
PubMed1990

MR-imaging findings in children with Sturge-Weber syndrome.

Intracranial extent and distribution of leptomeningeal angiomatosis, visualized by magnetic resonance imaging (MRI) with Gadolinium-DTPA (Gd-DTPA) enhancement, is demonstrated in four children with Sturge-Weber syndrome (SWS). Aged 7, 9, 11 and 19 months, they presented with cutaneous, neurologic and ocular symptoms at the time of MRI examination. Angiomatous alteration of the skull, atypically located and congested intracerebral and basal veins as well as intracerebral changes secondary to the leptomeningeal angiomatosis are demonstrated with T2 weighted images. Gd-DTPA enhanced T1 weighted images exhibit clearly the regional distribution of angiomatosis in the skull, meninges and within the brain. Before calcifications in children with SWS are detectable by CT, MRI is the method of choice to detect intracranial involvement. Enhancement with Gd-DTPA improves the diagnostic value of MRI, before neurological symptoms appear. Follow-up studies with Gd-DTPA enhanced MRI can be applied to recognize thrombotic changes of leptomeningeal angiomatosis as well as subsequent intracerebral impairment.

Atrophy↗
PubMed1989

A comparative study of CT and MRI in midline tumors of childhood and adolescence.

In order to compare the validity of CT and MRI, we evaluated results of these studies in 40 children and adolescents suffering from supratentorial and infratentorial midline tumors. Plain and enhanced CT scans were compared with MRI for sensitivity, specificity and capacity to delineate the tumor. These parameters were evaluated by three independent investigators on a scale with four grades of accuracy. The results demonstrate greater sensitivity and better delineation of the tumor with MRI, but greater specificity in diagnosis of tumors with CT studies.

Adolescent↗
PubMed1988

Structural changes of plasma high molecular weight kininogen after in vitro activation and in sepsis.

High molecular weight kininogen (HMWK) is a multifunctional protein that is a parent molecule for bradykinin, a cofactor for coagulation, and an inhibitor of cysteine proteases. On immunoblot, nonreduced plasma HMWK is usually two bands at 140 kd and 120 kd; reduced plasma HMWK is a single band at 120 kd. In both concentration-dependent and time-dependent experiments kaolin-activated normal plasma HMWK becomes cleaved in an ordered sequence. When nonreduced, HMWK on immunoblot in kaolin-activated plasma changes in size from a 140 kd band through a 120 kd intermediate to result in a stable 100 kd protein. When reduced, HMWK on immunoblot in kaolin-activated plasma changes from a single 120 kd band through a 56 kd intermediate to result in a stable 46 kd protein. A similar sequence of cleavage of plasma HMWK occurs when the soluble activator dextran sulfate is used to stimulate the system. Cleavage of plasma HMWK after kaolin activation occurs similarly in factor XI-deficient plasma as in normal plasma but is decreased in prekallikrein-deficient plasma. Prolonged kaolin activation of prekallikrein-deficient plasma results in HMWK cleavage to bands below 120 kd. No band of plasma HMWK below 120 kd appears in prolonged kaolin-activated factor XII-deficient plasma. In some patients with sepsis, detectable cleavage of plasma HMWK to bands below 120 kd may not be seen, even though the patient has other evidence for contact system activation. In conclusion, these studies indicate that certain cleaved patterns of plasma HMWK on immunoblot indicate prior activation of the contact system. However, the absence of these cleaved forms of plasma HMWK in a single plasma does not exclude the occurrence of contact activation.

Bacterial Infections↗
PubMed1985

Supratentorial intraventricular tumors in childhood.

We report on a series of 21 infants and children with tumors of the supratentorial ventricular system, all of whom were assessed by computed tomography and underwent operation using microsurgical techniques. In 7 cases the tumor was found in the 3rd ventricle, whereas the lateral ventricles were involved in the others. Surgical access to the lateral ventricles and the anterior portion of the 3rd ventricle was gained by standard intergyral cortical incision in the precentral or postcentral regions and via the foramen of Monro. The posterior portions of the lateral ventricle of the dominant hemisphere as well as the posterior part of the 3rd ventricle were exposed with minimal risk, using the occipital midsagittal supratentorial route. Following this technique, total removal of the tumors was possible in all cases without substantial postoperative morbidity. After a follow-up period of 6 months to 9 years all patients are in good or excellent neurological condition. Tumor recurrences were not encountered, although a definitive statement cannot be made in some patients with malignant lesions.

Adolescent↗
PubMed1985

Clinical experience with nimodipine in the prophylaxis of neurological deficits after subarachnoid hemorrhage.

The efficacy and tolerability of the dihydropyridine calcium antagonist nimodipine (BAY e 9736) in the prophylaxis of ischemic neurological deficits after subarachnoid hemorrhage were investigated in 171 patients in an open, prospective, multicenter study. 68 of the patients had to be excluded from the efficacy assessment as they had failed to satisfy important inclusion criteria. The efficacy assessment was based on 104 patients of Hunt and Hess grades I-III. In 86 patients the ruptured aneurysm was clipped before or during the nimodipine therapy, while 18 patients did not undergo surgery owing to failure to detect an aneurysm, continuous deterioration of the clinical condition, or for other reasons. At the end of the nimodipine treatment 74 of the patients (71%) were completely free from symptoms or had only very slight neurological deficits. There were 10 patients (10%) with moderate and 10 with a severe disablement, 4 patients were apallic, and 6 (6%) died during the nimodipine treatment. In 4 patients (3.8%) cerebral vasospasm was the sole cause of severe neurological deficits or death, while in a further 3 patients (2.7%) vasospasm and other serious complications were responsible for poor outcome. 22 of the 171 patients (12.9%) died during or shortly after nimodipine therapy. Rebleeding occurred during nimodipine therapy in 7 of the 143 preoperatively treated cases (4.9%).

Adult↗
PubMed1984

Magnetic resonance tomography (MRT) of intracranial tumours: initial experience with the use of the contrast medium Gadolinium-DTPA.

The present study provides an introduction to the clinical diagnosis of intracranial lesions by means of magnetic resonance tomography (MRT). The demonstration of different tissue qualities (bone and bone marrow, cerebral cortex and medulla, ventricular system (CSF), blood, tumour and perifocal oedema) in the MR tomogram is explained. The principles of specific MRT contrast media and their clinical application in brain tumours are discussed in detail.

Adult↗
PubMed1981

Left fascicular blocks during right-heart catheterization using the Swan-Ganz catheter.

During insertion of Swan-Ganz catheters, mechanical right bundle branch block occurred in association with left posterior fascicular block in two patients and with left anterior fascicular block in two. None of the four patients had acute myocardial infarction or acute (spontaneous or iatrogenic) pulmonary disease. In two cases, electrophysiologic studies demonstrated the coexistence of intra- and infra-Hisian conduction delays and blocks. Although the right bundle branch block may have resulted from injury to the central or peripheral right branch, the left fascicular blocks could not be explained by direct trauma to these left-sided structures. Our findings support the recent clinical and experimental reports that show that left fascicular block (as well as right bundle branch block) may be due to lesions involving the His bundle; presumably because of longitudinal dissociation of this structure affecting the transverse interconnections. In one patient, 2:1 intra-Hisian block may have coexisted with bradycardia-dependent (phase 4) right bundle branch block. More studies are required to determine the implications of catheter-induced conduction disturbances in other clinical settings, such as acute myocardial infarction.

Bundle of His↗
PubMed1979

Value of computed tomography for the diagnosis of arachnoid cysts and assessment of surgical treatment.

The clinical and radiological findings in 18 patients suffering from arachnoid cysts of the middle fossa (ACMF) are reported. The importance of computed tomography in diagnosis and in the assessment of surgical therapy in 15 cases is emphasized. The indication to operate upon ACMF and criteria of adequate surgical treatment are discussed. We want to point out the superiority of simple shunting procedures over craniotomies and removal of membranes.

Adolescent↗
PubMed1978

Uremic pulmonary edema.

Pulmonary edema fluid analyses and hemodynamic evaluations were performed in two uremic patients with acute pulmonary edema. The colloid osmotic pressure of the pulmonary edema fluid ranged from 57 per cent to 93 per cent that of the serum. Although cardiac function was normal in both patients, the serum colloid osmotic pressure--pulmonary artery wedge pressure gradients were markedly reduced. Uremic pulmonary edema is the result of alterations of pulmonary intravascular Starling forces and increases in pulmonary capillary membrane permeability, allowing for the efflux of protein-rich fluid from the capillaries into the lung.

Adult↗