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Biomedical subjects

E Kilger

Publications and source records attributed to E Kilger.

42 records · Page 3Linked to original sources
PubMed1995

[Noninvasive ventilation after lung transplantation].

BACKGROUND: Non-invasive mechanical ventilation (NIPPV) is an accepted choice of treatment in patients with chronic pulmonary disease and/or acute respiratory failure. Recently NIPPV was also proposed in the postoperative weaning period. PATIENTS AND METHODS: Six of 30 patients after lung transplantation were were extubated despite a weaning failure was predicted using well accepted weaning criteria. Therefore, the 6 patients were treated with intermittent-noninvasive ventilation using assisted modes of mechanical ventilation (PSV/CPAP). RESULTS: Both, oxygenation (increase in paO2: 18 mm Hg during PSV, 11 mm Hg during CPAP) and pulmonary mechanics (decrease in respiratory rate: 14/min during PSV, 10/min during CPAP; increase in tidal volume: 5 ml/kg during PSV, 3 ml/kg KG during CPAP) improved and the energy expenditure decreased (19% during PSV, 12% during CPAP). CONCLUSION: Non-invasive ventilation after lung transplantation enables earlier extubation and prevents weaning failure.

Humans↗
PubMed1994

[Continuous intravascular blood gas analysis. Clinical evaluation of a new fiber optic monitor].

Continuous monitoring of blood gases and pH could add substantially to patient safety. During the last decade, efforts have been made to develop continuous optochemical blood gas sensors. The initial evaluation of such fibreoptic-based systems showed major patient-interface problems [11]. We evaluated a new intra-arterial blood gas monitoring system (PB3300, Puritan-Bennett, Carlsbad CA) under routine clinical conditions. METHODS. After institutional review board approval and with written informed consent, 38 sensors were tested in 25 patients with acute respiratory failure (e.g., the acute respiratory distress syndrome, complications after lung transplantation). Two conventional bench-top blood gas analysers (ABL 520 and ABL 300, Radiometer, Copenhagen) served as criterion standards. The mean differences (bias) and standard deviations (SD) of the differences (precision) were calculated according to the method of Bland and Altman [2]. In addition, linear regression analysis and correlation coefficients were calculated. The quality of blood pressure tracings was assessed using a grading system. RESULTS. The median sensor lifetime was 81.3 h; 869 blood samples (median 14 per sensor) were analysed for the comparison of continuous and conventional blood gas analysis. The ranges for measured parameters were: pH: 6.92 to 7.55; PCO2: 20 to 83 torr; PO2: 31 to 518 torr. The mean differences (SD) were: pH: -0.03 (0.03) or -0.4 (0.4)%; PCO2: -2.6 (4.1) torr or -6.9 (10.9)%; PO2: -3.4 (10.5) torr or -2.9 (7.0)%. The results of linear regression analysis and the correlation coefficients are depicted in Table 2. The mean grade of blood pressure tracings was satisfactory for the clinical setting. CONCLUSIONS. The continuous blood gas monitor is sufficiently accurate and precise for clinical use. Bias and precision are better than those known from former studies evaluating fibreoptic blood gas monitors under experimental conditions [7]. Cost-effectiveness was not an issue of this study.

Blood Gas Analysis↗
PubMed1994

Continuous intra-arterial blood gas and pH monitoring in critically ill patients with severe respiratory failure: a prospective, criterion standard study.

OBJECTIVE: To evaluate the routine clinical performance of a new intra-arterial fiberoptic blood gas sensor that provides continuous PO2, PCO2, and pH monitoring. DESIGN: Criterion standard study under routine clinical conditions. SETTING: Intensive care unit (ICU) in a university hospital. PATIENTS: Twenty-two sensors were tested in 13 patients with acute respiratory failure, including two patients receiving veno-venous extracorporeal lung assist. Patient selection was based on the necessity of frequent blood gas monitoring. MEASUREMENTS: Sensor-deprived PO2, PCO2, and pH values were compared with values obtained using two different conventional laboratory blood gas analyzers located in the ICU. The median study period was 72 hrs per sensor (range 8 to 170 hrs). The quality of blood pressure readings with the sensor introduced through the arterial catheter was assessed by a grading system. RESULTS: Mean differences between sensor-derived values and the average values of the two conventional blood gas analyzers were as follows: PO2 -2.4 +/- 6.5 (SD) torr (-0.3 +/- 0.9 kPa), PCO2 -2.9 +/- 3.9 torr (-0.4 +/- 0.5 kPa), and pH -0.04 +/- 0.03. Correlation coefficients were 0.99 (PO2), 0.94 (PCO2), and 0.89 (pH), respectively. The agreement between the two methods for PO2 measurement was better for the clinically important range of values (PO2 < 150 torr [< 20 kPa]) than for all measured PO2 values (range 30 to 522 torr [4 to 69.6 kPa]). Blood withdrawal and pressure readings were not adversely affected by the sensor. No side effects due to the insertion of the sensor were observed. CONCLUSIONS: The degree of agreement of intra-arterial blood gas sensor values with conventional blood gas analysis is within an acceptable range for routine clinical purposes. Acute changes in measured values are detected reliably. Continuous intra-arterial blood gas analysis can add substantially to the safety of patients with acute respiratory failure and can reduce blood sampling requirements for blood gas analysis.

Adolescent↗
PubMed1993

[Fulminant pulmonary embolism in the 35th gestational week. Sonographic detection of a thrombus in the inferior vena cava with normal cavography].

Pulmonary embolism is the most common cause of maternal death during pregnancy. CASE REPORT. We report a 28-year-old obstetric patient (35th gestational week) who was admitted to the hospital because of intermittent vaginal bleeding caused by placenta totalis et accreta. Eleven days after admission she suffered a cardiac arrest. After cardiopulmonary resuscitation, an emergency caesarian section was performed and a healthy child was delivered. Abdominal sonography (B-mode) showed a floating thrombus in the inferior vena cava. Perfusion scintigraphy and cavography were normal; a computed tomography i.v. contrast medium study confirmed the presence of the thrombus. An open thrombectomy was performed to protect the patient from further pulmonary emboli. After 8 days she left the intensive care unit without residual complications. CONCLUSION. This case emphasises the importance of bedside sonography as a diagnostic method of identifying the source of a thrombus in patients with suspected pulmonary embolism.

Adult↗
PubMedDate not supplied

Expression of mucin (MUC-1) from a mini-Epstein-Barr virus in immortalized B-cells to generate tumor antigen specific cytotoxic T cells.

BACKGROUND: EBV immortalized B-cells can be used as antigen presenting cells (APC) to stimulate specific T-cell responses. Mini-Epstein-Barr virus (mini-EBV) plasmids contain all functional elements of Epstein-Barr virus (EBV) necessary to immortalize B-cells in vitro. These immortalized B-cells are incapable of releasing infectious virus in contrast to cells immortalized by wildtype EBV. In addition, mini-EBVs can be modified in E. coli to alter their genetic composition or adopt new genes. METHODS: We constructed a mini-EBV plasmid carrying an expression cassette for the human tumor antigen mucin encoded by the gene MUC-1. Primary human B-cells were infected with the MUC-1 carrying mini-EBV plasmid packaged into an EBV coat and immortalized B-cell clones were expanded in vitro. These B-cells were analyzed by FACS analyses for the expression of mucin and co-stimulatory molecules and were subsequently used as antigen presenting cells (APC) to stimulate peripheral blood mononuclear cells from healthy donors. RESULTS: Several B-cell lines were established that were shown to be free of helper virus or wildtype EBV. These B-cells expressed the relevant tumor-specific epitopes of mucin and the co-stimulatory ligands B7.1 and B7.2 necessary for efficient T-cell activation. Using the mucin expressing B-cells as antigen presenting cells (APC) mucin-epitope specific cytotoxic T-cells were established. CONCLUSIONS: Virus-free B-cell lines expressing tumor-associated epitopes such as mucin or other antigens of interest provide an unlimited and safe source of APC to generate antigen specific T-cells which could be used for clinical trials in adoptive immune therapy or cancer vaccines.

Antigen Presentation↗