Biomedical subjects

D Rixen

Publications and source records attributed to D Rixen.

31 records · Page 2Linked to original sources

PubMed1996

Histamine release in sepsis: a prospective, controlled, clinical study.

OBJECTIVE: To determine if histamine release occurs in clinical sepsis. DESIGN: Prospective, controlled, clinical study. SETTING: Interdisciplinary intensive care unit and trauma ward. PATIENTS: Sepsis was confirmed in 20 patients (test group) by the criteria of the Veterans Administration Systemic Sepsis Cooperative Study Group (1987) and was verified by positive blood culture. In addition, patients were scored by the Elebute and Stoner Sepsis Score (1983), as modified by Dionigi et al (1985). A concomitant control group consisted of 20 postoperative patients with non-life-threatening trauma to the extremities and without signs of local or systemic infection. INTERVENTIONS: Observational study. Blood samples were collected for determination of plasma histamine concentrations in both groups at the time of study entry and on five succeeding days. MEASUREMENTS AND MAIN RESULTS: The patients were well matched, and the groups were not significantly different for all criteria known to influence histamine release. Comparison of the median values of each group on days 1 through 5 demonstrated significantly higher plasma histamine values in the test group on days 1 through 4, but these values were no longer significantly higher on day 5. While none of the nonseptic control patients achieved a plasma histamine concentration of > 1 ng/mL (the concentration of which was considered to be the pathologic cutoff point representing histamine release), these values (i.e., > 1 ng/ mL) were found in nine of 20 test group patients. In the test group, nonsurvivors (n = 9) had significantly higher plasma histamine concentrations than survivors (n = 11) throughout the whole study and eight of nine nonsurvivors showed a plasma histamine concentration of > 1 ng/mL. Correlation of plasma histamine concentrations on day 1 to sepsis severity (initial Sepsis Score) showed that all but one patient with a combined low Sepsis Score (< 20 points) and histamine concentration of < 1 ng/mL survived, while all patients with a Sepsis Score of > 20 points and histamine release (plasma histamine concentration of > 1 ng/mL) died. CONCLUSION: Increased histamine concentrations were shown to be causally associated (contributory determinant) with sepsis.

Adult↗

PubMed1996

Ranitidine improves lymphocyte function after severe head injury: results of a randomized, double-blind study.

OBJECTIVE: To study the immunomodulatory effect of the histamine receptor antagonist, ranitidine, in patients admitted to the intensive care unit after severe head injury. DESIGN: Randomized, prospective, double-blind study. SETTING: Surgical intensive care unit of a university Level I trauma center. PATIENTS: Twenty patients admitted with a Glasgow Coma Scale score of < 10 who were enrolled as part of a prospective, multicenter trial to assess the impact of multiple risk factors and ranitidine prophylaxis on the development of stress-related upper gastrointestinal bleeding. INTERVENTIONS: Continuous infusion of ranitidine at 6.25 mg/hr (n = 9) or placebo (n = 11) for a maximum of 5 days. MEASUREMENTS AND MAIN RESULTS: Before the patients were enrolled in the study and on completion of treatment, lymphocyte cell-surface antigen expression was determined by flow cytometry (n = 14 patients); mitogen-stimulated interferon-gamma and interleukin-2 production were measured by enzyme-linked immunosorbent assay (n = 19 patients). Treatment with ranitidine, but not placebo, was associated with a significant increase in CD4+ lymphocytes (33% to 49%; p < .05) and a significant decrease in CD8+ lymphocytes (41% to 27%; p < .05). Also, the mitogen-stimulated interferon-gamma production increased from 121 to 269 pg/mL (p < .05) in patients treated with ranitidine, but not in patients treated with placebo. There were no significant differences in interleukin-2 production or circulating B-cell concentrations between both groups. CONCLUSION: This study demonstrates an immunostimulatory effect of the histamine-2-receptor antagonist, ranitidine, both at the cellular and mediator levels in patients after head injury.

Adult↗

PubMed1996

"Sepsis/SIRS," physiologic classification, severity stratification, relation to cytokine elaboration and outcome prediction in posttrauma critical illness.

OBJECTIVE: To develop a quantitative severity stratification within the framework of a Physiologic State Classification (PSSC) system that can be applied to critically ill post-trauma patients with "sepsis/SIRS" and to relate PSSC to the nature of the plasma cytokine response. MATERIALS AND METHODS: At each study time period, a patient was classified into one of seven physiologic States previously derived from clustering 17 cardiopulmonary and metabolic variables from 338 critically ill patients: R = reference, A = normal stress response, B = metabolic insufficiency, C1 (early) and C2 (late) = respiratory insufficiency, D = cardiogenic insufficiency, H = nonshock hypovolemia. MAIN RESULTS: The PSSC used State data from a developmental set of 159 trauma patients in a logistic model (L2PDEATH) to provide a quantitative index of severity. This severity index was tested on 80 new trauma patients (mean injury Severity Score (ISS) = 27.6, 64% survivors). Using PSSC State distributions for evaluation of enzyme-linked immunosorbent assay (ELISA) measured cytokines interleukin (IL)-1, IL-6, IL-8, tumor necrosis factor (TNF) showed the multicytokine score to be greatest in those C2- and B-State regions associated with a higher severity as measured by L2PDEATH. Compared with ARDEATH of the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system, L2PDEATH provided a better indicator of severity of sepsis/systemic inflammatory response syndrome (SIRS) for posttrauma patients. CONCLUSIONS: PSSC allows classification of the physiologic and cytokine mediator response to trauma and permits stratification of severity in posttrauma critical illness.

APACHE↗

PubMed1996

Airbag protection versus compartment intrusion effect determines the pattern of injuries in multiple trauma motor vehicle crashes.

OBJECTIVE: A prospective study of the interaction between airbag (AB) and seat-belt (Bt) protection versus vehicular compartment (VC) intrusion effects on injury patterns in motor vehicle crash (MVC) trauma patients. METHODS: Two hundred MVC patients, nonejected drivers or front seat passengers with multiple trauma or severe lower extremity (LE) trauma admitted to two Level I trauma centers. RESULTS: In frontal crashes, airbags (AB) more than Bt reduced Glasgow Coma Scale severity in brain injury, face fracture, shock, and the need for MVC extrication (all p < 0.05). Frontal AB also had a protective effect on LE fractures (41% vs. 66%, p < 0.01), but had no significant protective effect on pelvic fractures. When AB protection was present, it prevented brain and face fracture injuries caused by impact contacts and reduced the incidence of these injuries resulting from VC intrusions (p < 0.05). Thoracoabdominal injuries resulting from steering wheel intrusion showed AB protection against intrusions of twice the magnitude of those seen in non-AB vehicles (p < 0.05). In frontal MVCs, AB reduced LE fracture contact injuries but did not prevent LE fractures resulting from intrusions of instrument panel, toepan, or floor pedal structures. In lateral MVCs, Bt did not protect against brain, face, thorax, or pelvic injuries. CONCLUSIONS: Safety measures beyond frontal airbags must address frontal crash LE injuries induced by steering wheel, instrument panel, and toepan passenger compartment structure intrusions. Lateral crash injuries may profit from side AB supplemental restraint protection.

Accidents, Traffic↗

PubMed1996

[Value of clinical scoring systems for evaluation of injury severity and as an instrument for quality management of severely injured patients].

Trauma Score Systems attempt to summarize the severity of injury in a single value. They provide a better classification of trauma patients and translate different severities of injury in a common language. They enable thereby comparisons between hospitals or trauma systems. Young doctors can control their clinical judgement with scoring systems and will gain experience. Scoring systems therefore increase safety and can help in decision making. As accuracy of scoring systems is never 100% individual decisions can never rely on scores only. Glasgow Coma Scale, Revised Trauma Score, Injury Severity Score and TRISS are the most often used international scores for severely injured patients. Their sensitivity and specificity, validity, reliability and practicability have been studied and proved in many trials. The role of these scoring systems for quality management purposes in the treatment of severe trauma is actually studied with the Trauma Registry of the German Society for Trauma Surgery.

Cause of Death↗

PubMed1995

Physiologic state severity classification as an indicator of posttrauma cytokine response.

A Physiologic State Severity Classification (PSSC) derived from clustering of 17 cardiorespiratory variables was used to predict cytokine response in critically ill posttrauma patients. The PSSC defined physiologic states: A-State (A), normal stress response; B-State (B), metabolic insufficiency; C2-State (C), respiratory insufficiency. Bayesian analysis of these states defined a probability of death (Pdeath). 416 studies from 60 newly studied multiple trauma patients (70% males, Injury Severity Score = 27.5) were analyzed; 45 (75%) had sepsis (s), 28 (47%) had sepsis-adult respiratory distress syndrome (s-ARDS). Of 35 survivors (66% s, 37% s-ARDS, mean Pdeath = .42) 23% were predominantly A, 66% B, and 11% C. Of 25 deaths (88% s, 60% s-ARDS, mean Pdeath = .64) 0% were A, 44% B, and 56% C. PSSC States were correlated with incidence and mean plasma levels (pl) in picograms/mL of cytokines. 23 samples from recovering nonseptic trauma patients were used as controls.

Adolescent↗

PubMed1994

Randomized trial of modified Bassini versus Shouldice inguinal hernia repair. The Cologne Hernia Study Group.

Between 1986 and 1992, 265 men of mean age 51 (range 16-75) years with a primary inguinal hernia were randomized to undergo surgery by staff surgeon or surgical resident and further randomized to receive a modified Bassini operation (transversalis fascia not divided but included in the repair) or Shouldice procedure. The follow-up rate was 92.1 per cent with a mean follow-up of 3.3 years. Recurrence developed in 12 of 125 patients with a Bassini procedure and two of 119 after a Shouldice repair (9.6 versus 1.7 per cent, P = 0.006). The recurrence rate was no different for staff surgeons and trainees (5.9 versus 5.6 per cent, P not significant). Multivariate analysis identified the presence of a direct hernia (P = 0.003) as the additional main factor for the development of recurrence.

Adolescent↗

PubMed1994

Time sequence of histamine release and formation in rat endotoxic shock.

Increased histamine release and formation (induced histamine) are two hypotheses considered in the pathogenesis of endotoxic shock development. To prove both hypotheses a sequence of four randomized controlled studies in rats was performed. Histamine release was measured indirectly as a decrease in tissue-histamine contents (lung, liver, spleen, stomach); histamine formation was estimated directly as an increase in histidine decarboxylase (HDC) activity in the same organs. Changes in contents and enzymatic activities were determined 4 and 8 h after shock induction; in addition, at the time of death, the activity of HDC was measured in heart, kidney, and small intestine. 4 h after shock induction, there was a significant decrease in the tissue-histamine content as measured only in the liver, with the same trend in lung and spleen. 8 h after endotoxin application, however, histamine concentration increased in the liver (significantly p < .05) and lung compared to the NaCl control group. The manifestation of changes in HDC activity in various organs was selective (i.e., not all organs showed alterations), not uniform (decreased as well as increased activities were measured), and time-dependent (no increase in HDC activity in animals dying at > 20 h). At 4 and 8 h, only the liver showed a strong increase in HDC activity which can explain the increase in histamine content. In lung, spleen, and stomach, a significant decrease occurred. The results on histamine release and formation let us conclude that histamine is involved in the pathogenesis of endotoxic shock development.

Animals↗

PubMed1994

Beneficial effect of H2-agonism and H1-antagonism in rat endotoxic shock.

Although histamine release is generally considered harmful in endotoxic shock, several data exist to doubt this view. Own previous studies in rats let us assume a possible beneficial effect only with H1-antagonists, however a detrimental effect on survival with H2-antagonists. Consequently H1- and H2-agonists and antagonists were studied to prove the hypothesis of a beneficial H2-agonistic and H1-antagonistic effect. Two randomized studies were performed in a standardized rat endotoxic shock model (45 mg of Escherichia coli endotoxin/kg body weight (b.w.)). In both, methylprednisolone (50 mg/kg b.w.) and saline were used as positive and negative controls, respectively. Study I compared the effects of H1- and H2-agonists (betahistine, .1 mg/kg/h, and impromidine, 100 micrograms/kg/h) with H1- and H2-antagonists (astemizole and famotidine both 1 mg/kg b.w.; 20 rats/dose). Study II was performed to estimate the dose-response relationship of a new, highly potent H2-agonist with additional H1-antagonistic features (BU-E 75: .01, .1, 1.0, 10, and 100 micrograms/kg/h; 20 rats/dose). Animals receiving impromidine or BU-E 75 all received omeprazole (1 mumol/kg b.w.) to suppress gastric acid secretion. In study I impromidine significantly increased the survival-time and -course compared to famotidine treated animals (p = .01 and p < .05). Study II showed a positive dose-response relationship of BU-E 75 with an increase in survival rates from 30% (.01 microgram/kg/h) to 70% (100 micrograms/kg/h). These data strongly support the hypothesis of a beneficial effect of H2-agonism and H1-antagonism on survival parameters in rat endotoxic shock.

Animals↗

PubMed1993

[Reliability of clinical examination of the shoulder in comparison with arthroscopy. A prospective study].

The results of clinical shoulder examination including 20 special tests were compared with subsequent arthroscopic findings in 45 patients. The sensitivity of the clinical diagnosis was 73%. Impingement syndrome was correctly diagnosed in 19 of 22 cases (86%), rotator cuff tears in 7 of 9 cases (78%). The highest sensitivity for stage II impingement was found for the supraspinatus test (85%) and the lift-up test (92%); the sensitivity of these tests for rotator cuff tears was 100% and 89% respectively. Differentiation between impingement syndrome with and without rotator cuff tear by one of these tests alone was not possible because of their low positive predictive values (26% and 56%). In contrast, in 90% of patients with negative rotator tests the rotator cuff was complete, while the negative predictive value of the supraspinatus test was 100%. Instability was confirmed in only 53% of cases; the Leffert test had the highest positive predictive value (73%). In conclusion, the clinical diagnosis of a shoulder lesion cannot reliably be achieved by single tests; rather overall evaluation by an experienced clinician is necessary.

Adolescent↗

PubMed1992

Arthroscopy of the knee in children and adolescents.

Arthroscopy of the knee was performed in 104 patients under 18 years of age, 41 in children (aged 8 to 15) and 63 in adolescents (aged 16 to 18). Most frequently lesions of the patella were found (in 45% of all diagnoses in children and 29% in adolescents), in most cases because of acute or recurrent dislocation of the patella. The incidence of meniscal lesions increased with age. The most frequent therapeutic procedure performed in children was a lateral release (34%), in adolescents a partial meniscal resection (31%). In children 43% of arthroscopies were diagnostic, in adolescents 21%. Preoperative diagnosis was shown to be incorrect or incomplete arthroscopy in 41% of children and 24% of adolescents taking arthroscopic findings as a golden standard. Preoperative diagnosis had highest accuracy for dislocation of the patella, 90% of dislocations were diagnosed correctly before arthroscopy. The lowest accuracy of clinical diagnosis was found for meniscal lesions; only 36% of meniscal tears were suspected preoperatively. In 35 of 38 patients with hemarthrosis a relevant knee lesion was found, in 23 of these patients arthroscopic therapy was performed. This justifies our concept for arthroscopy of every knee hemarthrosis. Besides superficial chondral lesions in 8 patients there were no complications associated with the procedure. It is concluded that arthroscopy of the knee in children and adolescents is a safe procedure with high diagnostic and therapeutic value.

Adolescent↗

PubMed1991

[Mediators and their antagonists in shock therapy].

The list of shock mediators currently comprises more than 150 candidates. A careful analysis using the criteria of Koch-Dale together with decision trees for exclusion of bias revealed that only histamine, C5a, beta-endorphin, tumor necrosis factor (TNF) thromboxane B2, platelet-activating factor (PAF), and oxygen free radicals are shown to be causally associated with shock symptoms. Although experimental studies with inhibitors of these mediators were convincing, there is still a lack of evidence under clinical conditions (exception histamine: anaphylactic shock). Combinations of antagonists against different causal mediators are the most promising future approaches.

Acute-Phase Proteins↗

PubMed1991

[Functional versus plaster cast treatment of acute rupture of the fibular ligament of the upper ankle joint. A randomized clinical study].

From November 1987 to December 1988, 60 patients with recent ruptures of the fibular ligament were enrolled in a randomized trial. After randomization patients were treated with a pneumatic leg brace (Aircast) or with cast immobilization for 6 weeks. Follow-up examination was carried out 15 months after cessation of therapy and was possible in 90% of the patients studied. Clinical criteria were evaluated according to a validated questionnaire including a 120-point scoring scale. In 42 patients stress tenography was carried out. The functionally treated group had significantly better score values than the immobilized group (functional treatment group 46.4 points; immobilization group 37.2 points). There was no significant difference between the treatment groups in radiological stability after the injury or at follow-up. On the basis of this study and the literature we recommend a primary functional treatment for recent ruptures of the fibular ligaments of the ankle in adults.

Adolescent↗