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Biomedical subjects

I Pénzes

Publications and source records attributed to I Pénzes.

At least 19 recordsLinked to original sources
PubMed2001

Caring for the critically ill patient. High-dose antithrombin III in severe sepsis: a randomized controlled trial.

CONTEXT: Activation of the coagulation system and depletion of endogenous anticoagulants are frequently found in patients with severe sepsis and septic shock. Diffuse microthrombus formation may induce organ dysfunction and lead to excess mortality in septic shock. Antithrombin III may provide protection from multiorgan failure and improve survival in severely ill patients. OBJECTIVE: To determine if high-dose antithrombin III (administered within 6 hours of onset) would provide a survival advantage in patients with severe sepsis and septic shock. DESIGN AND SETTING: Double-blind, placebo-controlled, multicenter phase 3 clinical trial in patients with severe sepsis (the KyberSept Trial) was conducted from March 1997 through January 2000. PATIENTS: A total of 2314 adult patients were randomized into 2 equal groups of 1157 to receive either intravenous antithrombin III (30 000 IU in total over 4 days) or a placebo (1% human albumin). MAIN OUTCOME MEASURE: All-cause mortality 28 days after initiation of study medication. RESULTS: Overall mortality at 28 days in the antithrombin III treatment group was 38.9% vs 38.7% in the placebo group (P =.94). Secondary end points, including mortality at 56 and 90 days and survival time in the intensive care unit, did not differ between the antithrombin III and placebo groups. In the subgroup of patients who did not receive concomitant heparin during the 4-day treatment phase (n = 698), the 28-day mortality was nonsignificantly lower in the antithrombin III group (37.8%) than in the placebo group (43.6%) (P =.08). This trend became significant after 90 days (n = 686; 44.9% for antithrombin III group vs 52.5% for placebo group; P =.03). In patients receiving antithrombin III and concomitant heparin, a significantly increased bleeding incidence was observed (23.8% for antithrombin III group vs 13.5% for placebo group; P<.001). CONCLUSIONS: High-dose antithrombin III therapy had no effect on 28-day all-cause mortality in adult patients with severe sepsis and septic shock when administered within 6 hours after the onset. High-dose antithrombin III was associated with an increased risk of hemorrhage when administered with heparin. There was some evidence to suggest a treatment benefit of antithrombin III in the subgroup of patients not receiving concomitant heparin.

Adult↗
PubMed2001

[Flesh-eating bacteria infection of an immunocompromised patient].

After years of steadily declining morbidity and mortality due to group A streptococcal infections, a resurgence of severe, invasive disease has been ongoing since 1980, leading to the recognition of streptococcal shock syndrome (STSS), necrotizing fasciitis, the most severe form of invasive infection. The patients suffer from rapid local deep soft tissue destruction, severe septic shock and multi organ failure. The increased incidence of these infections has been accompanied by remarkable vigor in virulence and severity of the disease. The reason for this impressive change in the epidemiology and clinical manifestation of group A streptococcal infections remains unknown. The possible etiological factor is changing in virulence factor or the lack of protective immunity of the population (immunocompromise) against the invasive strains. We describe a severe necrotizing fasciitis of a 41-year-old previously immunocompromised woman. The patient developed severe septic shock, multi organ failure and perineal and lower abdominal skin, fat and fascia necrosis due to mixed GAS (aerob, anaerob) infection of the perineum and the Bartholini glands. After an aggressive surgical debridement, antibiotic and supportive therapy the generalised and local infection was treated.

Adult↗
PubMed2000

[Use of positive suggestions in medical practice: experiences in the intensive care unit].

The stressful states (e.g. the state of illness, sickness, acute or chronic pain, comatose and perioperative states) can be considered as psychological states in which we are more susceptible to all suggestions, including the deliberate or involuntary, direct or implicit ones. Under these conditions whether conscious of unconscious, peoples' thinking processes change, become literal, direct and somewhat paranoid, overly sensitive for not only to the direct, but to the implicit, inner meanings of communicative messages, as well. Research evidence shows that even the comatose people may maintain contact with the environment, therefore the conversation around and other communicative effects may serve as a special suggestion. These messages can be (unconsciously) interpreted by the patients following different logic than it would have been processed in the waking state. Treating people who are in these special stressful states one should carefully analyze all of the meaning layers of his/her communication, to make the helpful, positive suggestions more effective, and avoid the negative, destructive ones. The possible negative suggestions are those words, labels, and actions, that may be proper from practical, economical or organisational point of view, but we do not take their implicit suggestive meanings into considerations. The paper gives a detailed overview about the role of suggestions used during the management of a patient in intensive care situations, and some guidelines are outlined to make our (possible) negative suggestions to be helpful and positive.

Critical Care↗
PubMed1999

[Effective demeclocycline therapy in a patient with over-secretion of antidiuretic hormone following head trauma].

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a common cause of hyponatremia. In this study a case of SIADH caused by head trauma is reported, in which severe hyponatraemia, escorted by life-threatening neurological symptoms was observed that could only be managed by parenteral sodium chloride infusions. Severe hyponatraemia was accompanied by elevated urinary sodium excretion, a characteristic sign of SIADH. After introducing the therapy with demeclocycline, a tetracycline type antibiotic that inhibits the renal action of antidiuretic hormone, serum sodium levels began to rise gradually, and the urinary sodium excretion slowly decreased. These observations show the effectiveness of demeclocycline in the treatment of SIADH.

Craniocerebral Trauma↗
PubMed1999

[Critical illness polyneuropathy--report of two cases].

The authors describe the cases of two mechanically ventilated septic patients, in whom developed during their illness with the signs of severe tetraparesis critical illness neuropathy. In both cases the first sign of the neuropathy was the respirator dependency despite the improving neurological status. The severe general condition of the patients and the administered sedatives obscured the neurological signs for a long time, and only the development of a severe tetraparesis raised the suspicion of the critical illness neuropathy. In the first case the diagnosis was made by exclusion, but in the second case it was proved with the help of EMG and the histological examination of the m. biceps brachii. The authors discuss the clinical relevance, neurological and electrophysiological signs and the problems of the differential diagnosis of this disease, which is quite common among the critically ill, septic patients.

Aged↗
PubMed1995

[HELLP syndrome, an unusual form of pregnancy toxicosis].

The high maternal and perinatal morbidity and mortality associated with severe preeclampsia--eclampsia still have a remarkable significance. An unique form of preeclampsia--eclampsia is called HELLP syndrome which means hemolysis (H), elevated liver enzymes (EL), and low platelet count (LP). Authors demonstrate a patient treated in the intensive care unit and recovered completely from HELLP syndrome, and give a summary of the clinical findings and management principles of this life threatening complication. Authors emphasize the importance of the knowledge of HELLP syndrome for all physicians dealing with pregnant patients, considering that the fast established diagnosis and proper management can be life-saving.

Adult↗
PubMed1995

Chronic overcrowding decreases cytoplasmic free calcium levels in T lymphocytes of aged CBA/CA mice.

Intracellular calcium concentration is a sensitive marker of the homeostasis of living cells, and its increase is an essential step of T lymphocyte activation. Changes in the environment provoke an adaptive stress-response of the organism. In our present work we have investigated the effect of chronic overcrowding on resting and lectin-stimulated cytoplasmic free calcium concentration of splenic T lymphocytes from young and aged CBA/CA mice (50 animals total). The animals were kept under 'normal' (68 cm2/animal) or 'overcrowded' (22 cm2/animal) conditions for 3 months. Young animals showed no change in resting and stimulated calcium after overcrowding. T cells from aged mice, however, displayed significantly smaller levels of both resting and lectin-stimulated intracellular calcium concentration (p < 0.01 each), as compared to those of the non-stressed, aged animals. This inadequate adaptation in the calcium metabolism of T lymphocytes may significantly contribute to the diminished immune response of the aged in stress.

Aging↗
PubMed1991

Outcome prediction in adult respiratory distress syndrome using discriminant analysis of cardiorespiratory data.

In order to examine the prognostic value of different cardiopulmonary variables in adult respiratory distress syndrome the data of 30 patients with this illness were studied retrospectively. The patients were divided into 3 groups: Group A: survivors (9 cases, 40 examinations), Group B: early stage nonsurvivors (8 cases, 37 examinations), Group C: late stage nonsurvivors (19 cases, 89 examinations). In 6 nonsurvivor patients a few measurements were done in the early and late stage, too. There were highly significant differences between Groups A and C (mean pulmonary arterial pressure, pulmonary arterial diastolic pressure minus pulmonary capillary wedge pressure, left ventricular stroke work index, systemic and pulmonary vascular resistance, inspired oxygen fraction, arterial oxygen tension per inspired oxygen fraction, mixed venous oxygen saturation, pulmonary shunt fraction, and oxygen delivery, but the differences in relation to other groups were less prominent. Using a step-wise discriminant analysis, it was found that the oxygenation parameters alone determined the outcome correctly in 68-75%. Extending the analysis to haemodynamic variables the result improved (72-80%). Similar prediction was obtained when parameters potentionally measurable by noninvasive methods were analysed (69-80%). These results suggest that it is possible to predict the outcome of ARDS correctly without any invasive monitoring technique.

Blood Pressure↗
PubMed1991

Estimation of the optimal tissue oxygenation parameters in adult respiratory distress syndrome (ARDS).

We hypothesised earlier that the simultaneous examination of the basic tissue oxygenation parameters (O2 delivery-DO2, O2 extraction ratio-O2ER, O2 consumption-VO2) results in a more adequate relationship to characterize the oxidative metabolism of tissues than a separate evaluation. The aim of present study was to prove this hypothesis. That is for while the results of these oxygenation measurements were examined simultaneously in a 3-dimensional analysis in 30 patients with ARDS. It was found that all measured values distributed on a 3-dimensional space net. An optimal range on the tissue oxygenation surface could be separated where 64% of the data of survivors were inside this range, while 77% of the data of "late stage" nonsurvivors--patients, where the measurement were done on the last 5 days of their life--were outside this range. The therapeutic goal in the treatment of ARDS patients is to change the oxygenation parameters to be inside this optimal range.

Adolescent↗
PubMed1987

Tissue oxygenation in septic respiratory failure.

The relationships between tissue oxygenation and the different haemodynamic and respiratory parameters were studied in 20 patients with ARDS of septic origin. Good regressions were found between O2 delivery and cardiac index (r = 0.8507), O2 delivery and systemic vascular resistance (r = -0.7051), O2 extraction ratio and mixed venous O2 saturation (r = 0.8978), O2 consumption and cardiac index (r = 0.6593), O2 consumption and systemic vascular resistance (r = -0.6548), and O2 consumption and mixed venous O2 saturation (r = -0.7068). The correlation among the parameters of tissue oxygenation was more expressed between O2 extraction ratio and O2 consumption (r = 0.7285), than between O2 delivery and O2 consumption (r = 0.6095). A better result was achieved by multiple regression analysis, where the multiple r was 0.9748 between O2 consumption and O2 delivery + O2 extraction ratio, whereas the other variables did not increase the multiple r significantly. These regressions also proved the relationship following from the Fick equation, that is O2 consumption is the result of O2 delivery multiplied with the O2 extraction ratio.

Adolescent↗
PubMed1986

Tissue oxygenation: another aspect of the Fick equation.

Substituting the formulas of O2 delivery (DO2) and O2 extraction ratio (O2ER) into the Fick equation, a new equation representing tissue oxygenation is obtained: VO2 = DO2 X O2ER. This aspect of the Fick equation is important in clinical practice as it provides a reliable picture of tissue oxygenation if all related variables are examined together.

Cardiac Output↗
PubMed1981

Pulmonary and systemic circulatory responses elicited by hyperosmotic solutions injected into the bronchial artery.

In open chest anaesthetized dogs the haemodynamic effects of solutions of equal hyperosmolarity (viz. NaHCO3 8%, NaCl k.6%, and glucose 34.3%, solutions) given into the bronchial artery were studied. Administration of any of these solutions directly into the bronchial artery resulted in increased cardiac output, stroke volume, bronchial blood flow, and bronchial fraction of the cardiac output, and decreased heart rate and bronchial as well as pulmonary vascular resistances. When given into the pulmonary circulation, the same solutions evoked similar reactions of smaller magnitude. To exclude the effect of major surgical trauma and the open-chest condition, another experimental model closer to the physiological situation was also developed. In this preparation NaHCO3 failed to produce the above haemodynamic response even when given into the bronchial artery. After a one-hour bleeding period resulting in a drop of arterial blood pressure to 40 mmHg, while using the same preparation, the administration f NaHCO3 solution into the bronchial artery caused a significant rise in blood pressure in both the systemic and pulmonary arteries. In these experiments a correlation was found between arterial oxygen tension and the extent of change in blood pressure. The exact mechanism of action of the observed haemodynamic changes is still not clear. However, it is likely that receptors localized in the area of the bronchial circulation and sensitive to hypoxia might have played a role in the development of the haemodynamic effects described.

Animals↗
PubMed1979

Role of the arterial bronchial system in the pathomechanism of the shock lung.

Experimental results suggested that in normovolaemia 0.5% of the total pulmonary circulation flows through the bronchial arteries. In haemorrhagic shock bronchial flow dropped to 0.04% of the total pulmonary circulation and ceased completely below 40 mmHg. The authors claim that a hypoperfusion of both circulatory systems (pulmonary and bronchial) is an important pathogenetic factor in the first step of the development of the shock lung. A two-hour abolishment of the nutritive circulation of the lung caused already hypotension, hypoxaemia and metabolic acidosis. Tissue hypoxia was confirmed by the rise in the enzymatic activity of the lung tissue. An abolishment of bronchial circulation in the described manner was enough to induce the development of the shock lung, as confirmed by the visible changes (changed colour, greater weight, development of congestive atelectasis and oedema) of the lung and by the haemodynamic and respiratory changes. Here too the increase in pulmonary vascular resistance is attributed an important role due perhaps in the beginning to an enhancement of the sympathetic tone and later to hypoxia and metabolic acidosis. If the effect of haemorrhage alone is compared to the effect of simultaneous haemorrhage and elimination of the bronchial artery, it appears that the functional lesion of the lung becomes considerably more pronounced with the abolishment of the nutritive circulation. Severe hypoxia and metabolic acidosis cause an extreme rise of the pulmonary vascular resistance. The severity of metabolic acidosis, the degree to which pulmonary vascular resistance has increased and its duration seem decisive from the aspect of both the development and outcome of the shock lung.

Animals↗
PubMed1978

[Experimental model for the study of the vascular system of the bronchial artery].

An experimental model was worked out for the isolated study of the vasculal system of the bronchial artery. The model allowed to study 1) the role of bronchiar circulation in the pathomechanism of the shock lung; 2) the effect of charges in fusion of the isolated circulation of the microstructure of the lungs; 3) the effect of changes in pH, CO2 level and O2 tension on the greater and lesser circulation, on ventilation, CO2 loss, and O2 uptake were studied.

Animals↗
PubMed1977

Haemodynamic and respiratory changes accompanying haemorrhagic shock in thoracotomized dogs.

Haemorrhagic shock was induced after thoracotomy by bleeding into a reservoir and the reduction of systemic blood pressure to 40 mm Hg. After two hours the blood was retransfused. The haemodynamic and respiratory changes due to the haemorrhage and retransfusion were noted during the two hour shock period and one hour after transfusion. The results were as follows: 1. Pulmonary mean and systemic mean pressure during haemorrhage and retransfusion do not change in parallel; 2. there is a rapid rise in pulmonary arterial [PA] and pulmonary capillary [PC] pressure during retransfusion; 3. cardiac output and its pulmonary fraction decrease during shock and cardiac output failed to normalise on retransfusion of the lost blood; 4. pulmonary vascular resistance, pulmonary total resistance increase significantly at the end of the shock period and after retransfusion; 5. shunt volume, alveolo-arterial O2 difference, the difference in arterio-alveolar co2 tension and dead space ventilation increase; while 6. o2 consumption and CO2 production decrease; 7. arterial blood gas values alone do not indicate those serious metabolic; circulatory and respiratory changes which develop in the lung during shock; 8. effective pulmonary compliance and the plasma oncotic pressure decrease, indicating interstitial oedema; 9. the primary mechanism responsible for the disorder during shock is not entirely clear but beside a number of other factors, the importance of the hypoperfusion of the bronchial circulation is stressed; 10. the conclusions permit a certain insight into the pathogenesis and therapeutic possibilities of the adult respiratory distress syndrome.

Animals↗