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Biomedical subjects

M Knoch

Publications and source records attributed to M Knoch.

At least 37 records · Page 2Linked to original sources
PubMed1991

[The importance of Pneumocystis carinii infection in patients with acute respiratory distress syndrome].

Each year we treated approximately 40 patients with adult respiratory distress syndrome (ARDS) in our department of anaesthesiology. In these cases we found with bronchoalveolar lavage followed by microbiological examination, a high incidence (40 per cent) of pneumocystis carinii contamination. An infection with Pneumocystis carinii deteriorates the clinical course of ARDS. Effective drugs were the combination of trimethoprim and sulfamethoxazole. Under this therapy we always saw a decrease of infiltrations in the chest-x-ray as well as an improved gas exchange. No relapse was seen in any case.

Adolescent↗
PubMed1991

The prognostic value of extracellular matrix component concentrations in serum during treatment of adult respiratory distress syndrome with extracorporeal CO2 removal.

The time-dependent concentrations of hyaluronan, aminoterminal propeptide of type III procollagen, and laminin were determined in sera of 16 patients with severe adult respiratory distress syndrome during treatment with an extracorporeal CO2 removal device. Patients were classified according to lung parameters as responders (n = 10) and non-responders (n = 6) to extracorporeal CO2 removal. At the beginning of treatment strongly elevated serum concentrations of all studied extracellular matrix components were found. During the first 6-11 days of treatment the concentrations of aminoterminal propeptide of type III procollagen and hyaluronan increased further in non-responders but decreased in the majority of responders, while laminin decreased in both groups. No significant correlations were found between the serum concentrations of connective tissue components and the parameters of lung function. By non-parametric analysis of variance, significant differences between responders and non-responders according to treatment time could be established. By analysing the time course of the serum concentrations of hyaluronan and aminoterminal propeptide of type III procollagen, a total differentiation between responders and nonresponders was made possible by the trends of these analytes as early as three days after the start of treatment. The determination of aminoterminal propeptide of type III procollagen and hyaluronan in serum of patients with adult respiratory distress syndrome might therefore have prognostic significance in extracorporeal CO2 removal.

Adolescent↗
PubMed1990

Extracorporeal gas exchange in adult respiratory distress syndrome: associated morbidity and its surgical treatment.

Extracorporeal carbon dioxide removal (ECCO2-R) over a membrane lung is a new therapy for patients with adult respiratory distress syndrome (ARDS) who frequently suffer from lung complications caused by long-term artificial ventilation and who may require major thoracic surgery. This is a report of 76 patients with severe ARDS who were treated by ECCO2-R. Twenty-six of these 76 patients required thoracotomy: 19 for pneumothorax and pneumatocele, and seven for haemothorax, infected lung necrosis or oesophagotracheal fistula. Most pneumothoraces were bilateral. Ten of these 26 patients required reoperation, usually for extensive persisting alveolar air leaks. Sixteen (62 per cent) of the 26 patients who had a thoracotomy and 22 (44 per cent) of the 50 patients without surgery survived. These results demonstrate that performing a thoracotomy, if necessary, does not diminish the survival chance of high-risk patients with severe ARDS.

Adolescent↗
PubMed1990

Marburger concept for computer-aided acquisition, processing and documentation of patient data in the intensive care unit.

The authors report on their experience with the computer-aided acquisition, processing and documentation of patient data in an intensive care unit. The goal of an effective data and information collection system in the intensive care unit is to make therapy, and the patients respond to it, recognizable and understandable through the clear and complete representation of the patients conditions. The focal point of the data documentation is the medical record. In the implementation of a computer-aided data documentation and processing system the application of one central PC is unpractical. Each bed will be equipped with its own PC, and all the individual PCs will be connected to one central PC, which functions as server, and to connected to another PC in the doctors room. The data will be managed in a powerful database-management-system and be stored on an optical-disk. The development of an effective man/machine interface is especially important. In addition we can promote the user acceptance in other ways, so as to ensure a concrete benefit for each user group.

Electronic Data Processing↗
PubMed1990

[The measurement of extravascular lung water--significant in the follow-up of ARDS?].

In 40 adult patients suffering from severe ARDS stage III and IV (Morel) we examined the course of the extravascular lung water (EVLW) measured by the double indicator dilution method with 858 single measurements, during mechanical ventilation with PEEP, or extracorporeal CO2 elimination (ECCO2 R). No correlation could be found between EVLW and the values of alveolar arterial oxygen difference (AaDO2) and intrapulmonary right-left shunt (Qs/Qt) or haemodynamic values such as CVP, PCWP, mean pulmonary arterial pressure, or the 24 h fluid balance. It was, therefore, not possible to estimate a prognostic trend based on a single measurement of EVLW. However, the course EVLW was more appropriate to perceive the prognostic trend of ARDS because a rapid decrease of very high EVLW was correlated with a decrease of AaDO2 (r = 0.87); whereas lethal ARDS (fibrosis) was associated with moderately increased, unchanged EVLW. However, during the ECCO2-R treatment the repeated estimation of EVLW and AaDO2 is a useful tool to assess recovery because other parameters such as Qs/Qt and chest computer tomography during long-term bypass are very difficult or impossible to employ for this purpose. A change of EVLW with increasing PEEP level could not be found. The reproducibility of 858 EVLW values was excellent with a coefficient of variation of 4.9 +/- 3.5%.

Adolescent↗
PubMed1990

[Surgical therapy of lung complications of long-term ventilation for severe adult respiratory distress syndrome].

Long-term respiratory therapy with high pressure levels in case of ARDS can lead to several symptoms requiring surgical treatment. Various forms of manifesting barotrauma predominate (bronchopleural fistula, pneumothorax, pneumatocele and soft tissue emphysema), while hematothorax, infected necrosis of parenchyma or esophagotracheal fistula are rare. Most of the operations became necessary because of bronchopleural fistula resp. pneumothorax, and with this indication the number of reoperations was especially high. Of 21 patients 13 (62%) survived.

Adolescent↗
PubMed1989

Purification, properties and immunological detection of a bromoperoxidase-catalase from Streptomyces venezuelae and from a chloramphenicol-nonproducing mutant.

A new bromoperoxidase-catalase was purified from the chloramphenicol-producing actinomycete Streptomyces venezuelae ISP 5230. The homogeneous enzyme showed brominating activity, catalase activity and a very low peroxidase activity. The spectral properties and pH dependence of the catalase activity showed similarities to conventional catalases. In contrast to other haem-bromoperoxidases, the bromoperoxidase-catalase was stable when treated with an ethanol/chloroform mixture. Gel filtration gave an estimated Mr of 127,000-136,000. SDS-PAGE showed a single band corresponding in mobility to a species with an Mr of 61,000. The pI was estimated to be 4.5. The bromoperoxidase-catalase was not present in active form in a mutant of S. venezuelae ISP 5230, blocked in the chlorination step of chloramphenicol biosynthesis. However, an inactive species of the enzyme was detected in crude extracts of the mutant by using antibodies. From these results it is concluded that this bromoperoxidase participates in the chlorination step during chloramphenicol biosynthesis.

Catalase↗
PubMed1989

[Adult respiratory distress syndrome in legionella pneumonia--successful treatment with extracorporeal CO2 elimination procedures].

We report on successful treatment of an 46-year-old patient with ARDS (Adult Respiratory Distress Syndrome), caused by legionella-pneumophilia-pneumonia. The treatment with conventional artifical mechanical ventilation had failed. The new method of extracorporeal CO2-Elimination and low frequency positive pressure ventilation (ECCO2-R-LFPPV), introduced by L. Gattinoni (2) was in that case of severest ARDS very helpful. Supported by antimicrobial therapy with Erythromycin and Rifampicin the lung function could be improved to "restitutio ad integrum". Changes in chest radiographs, clinical parameters of ventilation, gas exchange and haemodynamics as well as the results of sequential pulmonary studies are demonstrated and discussed.

Carbon Dioxide↗
PubMed1989

[Personal experiences with extracorporeal CO2 elimination in patients with severe ARDS--a current review].

The method of extracorporeal CO2 elimination (ECCO2-R) as described by Luiciano Gattinoni and Theodor Kolobow is compared with earlier extra corporeal methods such as extracorporeal membrane oxygenation. The physiological fundamentals of the method, as well as indications and contraindications are explained. - The results of more than 100 patients treated worldwide are discussed together with the present problems of the method. In cases of severe ARDS stage IV, ECCO2-R definitely reduces mortality.

Carbon Dioxide↗
PubMed1988

Model studies at mechanical aortic heart valve prostheses--Part I: Steady-state flow fields and pressure loss coefficients.

In a 3:1 scaled model of the human aorta models of the Omniscience, Björk-Shiley Convexo-Concave, Björk-Shiley Monostrut, Medtronic-Hall, Duromedics (Hemex) and the Saint Jude Medical heart valve prostheses are studied in steady flow representing the systolic peak flow phase. Detailed flow visualization experiments show flow separations at all inner ring surfaces as well as at most of the occluders. The resulting stagnation areas increase the risk of thrombus accumulation. Flow separations also stimulate vortex formation and turbulent mixing at the downstream jet boundaries and thus may intensify blood damage by turbulent shear stresses. The different influences of struts and occluder guides on the flow around the occluders are discussed. The effects of the individual valve components on the flow fields are analyzed and correlated with the resulting pressure losses.

Aortic Valve↗
PubMed1988

In vitro comparison of aortic heart valve prostheses. Part 1: Mechanical valves.

The hydrodynamic performance of a series of mechanical heart valve prostheses is measured in the aortic position. All experiments are performed in an electrohydraulic, computer-controlled pulse duplicator simulating the left side of the human circulatory system. Testing conditions are set according to a Food and Drug Administration interlaboratory comparison protocol with cardiac outputs of 3.0, 4.5, 6.5, and 8.0 L/min at a constant heart rate of 70 beats/min. Mean systolic pressure differences, volume losses, and energy losses, as well as dimensionless pressure losses and energy loss coefficients, are calculated from the recorded pressure, volume, and flow tracings. The results of 10 mechanical heart valve prostheses (eight tilting disc valves and two bileaflet valves) are presented and their clinical relevance is discussed.

Aortic Valve↗
PubMed1987

[Experience with extracorporeal CO2 elimination].

The method of extracorporeal CO2-elimination (ECCO2-R) as described by L. Gattinoni [2] and Kolobow [5] is reported in ten patients with severe ARDS in whom conventional respirator therapy had failed. The method itself as well as important pulmonary function parameters, e.g. changes in gas exchange (Fig. 3), extravascular lung fluid (Fig. 6), and chest radiographs are explained. After 7-17 day treatment with the Life-Support System (LSS), seven patients were in satisfactory condition to allowing weaning from the ventilator (Responder). In three cases the lung mechanics and gas exchange were unchanged by the therapy with CO2 removal and high PEEP (Nonresponders). In the responders, oxygenation improved and the intrapulmonary shunt Qs/Qt (Fig. 4) decreased, followed by extravascular lung water and mean pulmonary arterial pressure (Fig. 5). Towards the end of the therapy we could find normalization of the compliance (Fig. 7) and chest X-rays, which may be interpreted as a cure. The results confirm our theory that ECCO2-R in combination with high PEEP and low-frequency ventilation seems to be an important method for future therapy of acute pulmonary failure.

Acute Disease↗
PubMed1987

[ARDS in Mycoplasma pneumonia].

In this paper we describe a case of bilateral broncho-pneumonia due to invasion by mycoplasma pneumoniae, leading to ARDS. A high serum level of cold agglutinins, a mild haemolysis and a rash resembling that of an erythema multiforme were noted. The initial treatment was non-specific. After pathogen identification tetracycline therapy was initiated. Bacterial superinfections were treated with appropriate antibiotic schemas. The observed biphasic clinical course could be explained as an immunological phenomenon.

Adult↗
PubMed1986

[Hemodynamic effects of nalbuphine in patients with acute respiratory insufficiency].

Examination of haemodynamic changes, after 20 mg nalbuphine had been administered IV to 11 ventilated patients with acute respiratory failure, showed that on average pulmonary arterial mean pressure increased by 8% of the initial value. This increase was reversed after the test dosage was doubled from 20 mg to 40 mg nalbuphine. Regression analysis of the correlation between changes in pulmonary arterial mean pressure and patient age resulted in an increase in mean pressure by 0.1 mmHg per year after 20 mg nalbuphine. These findings suggest that nalbuphine must be carefully monitored in elderly and pulmonary risk patients.

Adolescent↗