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M Sold

Publications and source records attributed to M Sold.

At least 19 recordsLinked to original sources
PubMed1995

P300-mapping--a neurophysiological tool to quantify cerebral dysfunction after coronary artery bypass grafting.

Objective parameters are needed to quantify cerebral dysfunction following cardiac surgery in outcome and comparative studies. In this investigation we assessed the value of the late auditory evoked potentials N100 and P300 to measure the neuropsychological deficit after coronary artery bypass grafting (CABG). N100, an exogenous potential is influenced by the stimulus pattern (frequency, intensity and stimulus presentation rate). P300, an endogenous potential, depends on the cognitive processing invoked by the stimulus. With approval of the Human Investigation Committee and the patients' consents, 52 subjects undergoing elective CABG were enrolled. Operation, extracorporal circulation, anesthesia and postoperative intensive care were standardized. Twenty-channel recordings of N100 and P300 were obtained for off-line analysis. P300 was elicited using an oddball paradigm with rare target tones interspersed among frequent non-target tones. Additionally, neuropsychological tests (syndrome short test SKT and letter cancellation test) were carried out. Neurological examination and all tests were compared preoperatively and one week postoperatively. A significant deterioration in cerebral function was documented by the SKT score (P = 0.04), an increase in P300 latency (P = 0.004) and an increase of mistake rate in counting the P300 target tone (P = 0.02). No differences between preoperative and postoperative testing were found for letter cancellation, P300 amplitude and any N100 parameter. No correlation was found between the preoperative/postoperative changes in SKT score and P300 latency. P300 was proved to be an objective neurophysiological parameter that allows for the quantification of cerebral function after CABG.

Aged↗
PubMed1992

EEG and auditory evoked potential P300 compared with psychometric tests in assessing vigilance after benzodiazepine sedation and antagonism.

We have compared the EEG and auditory evoked wave P300 with psychometric tests in assessing vigilance after flumazenil antagonism of midazolam sedation in 12 healthy volunteers. Measurements were made before and after midazolam 0.1 and 0.2 mg kg-1 i.v., and immediately and 30, 60, 120 and 240 min after administration of flumazenil 1 mg. The sedative effects of midazolam and antagonism by flumazenil resulted in alterations in EEG, P300 and psychometric tests (syndrome short test, letter cancellation, choice reaction and recognition). However, 60 and 120 min after flumazenil a decrease in test performance indicating rebound sedation was seen only in P300 mapping. Thus P300 mapping was a sensitive method of detecting subtle differences in vigilance. Rebound sedation occurred even when midazolam 0.2 mg kg-1 was antagonized with an adequate dose of flumazenil. We suggest that it is advisable to supervise patients for at least 240 min after flumazenil antagonism of midazolam 0.2 mg kg-1.

Adult↗
PubMed1992

[Postspinal headache. A comparison of the 24G Sprotte syringe and a 29G Quincke needle].

PATIENTS AND METHODS: A randomised study was performed to compare the frequency of postdural puncture headache in 56 patients who underwent spinal anaesthesia for extra-corporeal shockwave lithotripsy using either a Sprotte 24 G (n = 28) or Vygon 29 G or Quincke type needle (n = 28). Frequency of headache was recorded in a similar group of 28 patients who received general anaesthesia. RESULTS: Dural puncture was easier with the Sprotte 24 G cannula than with the less stable Quincke needle, as documented by a significantly shortened time for insertion of the cannula (4.6 +/- 2.6 vs 8.6 +/- 6.3 min, P less than 0.005). The total frequency of post-operative headache was 57% in the Vygon 29 G group and 25% in the Sprotte 24 G group; 21% of patients in the general anaesthesia group complained of headache. Frequency of postdural puncture headache, classified as being posture-related, was 25% in the 29 G Vygon group, compared with 11% in the 24 G Sprotte group (P = 0.148). When only moderate and severe postdural puncture headache was considered, there was a significant difference (25% vs. 4%; P = 0.026) in favour of the Sprotte cannula. DISCUSSION AND CONCLUSIONS: Thus, the 24 G Sprotte needle was at least as effective as the 29 G Vygon needle, and there is a suggestion that the former is more effective in minimising the incidence of moderate or severe postdural puncture headache.

Adolescent↗
PubMed1992

[Suppression of the adrenal cortex by enoximone. A proband study with documentation of the hemodynamic course].

In contrast to the bipyridine derivatives amrinone and milrinone, the phosphodiesterase III/IV inhibitor enoximone is an imidazolone that creates the possibility of inhibiting adrenal steroid synthesis, as has already been demonstrated for other imidazoles, e.g. ketoconazole and etomidate. To clarify this point we carried out a double-blind sequential study in seven healthy volunteers. METHODS. After obtaining the approval of the ethics committee and the written consent of the volunteers, 1.25 mg/kg enoximone or saline was infused intravenously over a period of 20 min using a randomized crossover design with an interval of at least 5 days between the two trials. Twenty minutes after administration of the drug, 250 micrograms ACTH was injected. Plasma cortisol was measured prior to stimulation of the adrenal cortex and 30, 60 and 120 min afterwards; levels of aldosterone and 11-desoxy-cortisol were determined after 60 min. Standard radioimmunoassays were used. Haemodynamic parameters were measured non-invasively. RESULTS. In contrast to the placebo, enoximone resulted in a significant (P < 0.01) increase in the cardiac index (from 3.2 +/- 0.7 to 3.9 +/- 0.9 l min-1 m-2) and heart rate (from 69 +/- 11 to 81 +/- 8 min-1) and a decrease in peripheral resistance (from 1120 +/- 202 to 894 +/- 183 dyn s cm-5); blood pressure fell only slightly. Following injection of ACTH there were significant increases in cortisol (from 63 +/- 29 to 274 +/- 58 micrograms/l), aldosterone (from 86 +/- 37 to 300 +/- 105 ng/l) (both P < 0.001) and 11-desoxycortisol (from 5.3 +/- 1.2 to 9.8 +/- 4.6 micrograms/l; P < 0.05). There was no difference between enoximone and placebo at any time (P > 0.2). CONCLUSIONS. This study confirms the inodilation caused by enoximone. The normal response to ACTH rules out a direct inhibitory effect of a loading dose of 1.25 mg enoximone on the adrenal cortex. As the concentration of the major metabolite of enoximone, the sulphoxide, has been shown to surmount that of the parent drug after 40 min, this also holds true for the metabolite. We conclude that in contrast to etomidate, which causes a substantial reversible adrenal suppression after a single dose of 0.2 mg/kg, enoximone 1.25 mg/kg did not interfere with corticosteroid synthesis or release. Taking into account the metabolism and pharmacokinetics of this inodilator, there is no reason to expect an inhibitory effect even after repeated dosage.

Adrenal Cortex↗
PubMed1991

[Atraumatic Clostridium septicum infection in granulocytopenia].

A fatal Clostridium septicum infection occurred in three patients. Case 1. A 55-year-old man died of septicaemia resulting from granulocytopenia of uncertain aetiology; it was associated with perforation of ileal mucosal ulcers. Autopsy revealed neutropenic enterocolitis and diffuse gas formation, especially in the brain, caused by Clostridium septicum. Case 2. A 18-year-old boy developed a caecal invagination during imipenem-induced granulocytopenia. A fulminant postoperative Clostridium septicum infection ended fatally. At autopsy many ulcers were found at the site of invagination with gas formation involving all organs. Case 3. Myonecrosis of the left arm, caused by Clostridium septicum, developed without external cause in a 12-year-old girl with congenital neutropenia. Despite aggressive surgical intervention she died of toxic shock. Autopsy revealed caecal mucosal ulcers as the portal of entry of Clostridium septicum.

Adolescent↗
PubMed1990

[The estimation of blood circulation parameters using imaging techniques--comparison with measurements made using the Swan-Ganz catheter].

Circulation can be evaluated by means of measuring parameters in X-ray-thorax and ultrasonography. Changes in haemodynamics can be estimated by measured changes in width of vena azygos. Additional sonography of systemic veins of thoracic inlet (V. jugularis interna, V. cava inferior) improves multiple correlation to circulating blood volume up to r = 0.81. Supine or erect position and type of ventilation are influencing factors. Diaphragm motility was measured by means of ultrasonography: patients with assisted ventilation showed significantly decreased motility compared to patients with spontaneous breathing.

Adult↗
PubMed1990

[Extrarenal elimination procedures in acute kidney failure].

In spite of continuous progress in intensive care during the past two decades, there is no definite proof that the prognosis of critically ill patients with acute renal failure has actually improved. Nevertheless, the development of hemofiltration and hemodiafiltration and of the continuous methods has extended the therapeutic spectrum and allows therapy to be adapted to the specific cardiovascular and metabolic situation of the individual patient. Detoxification is carried out intracorporeally in peritoneal dialysis or extracorporeally by means of filters and membranes with different filtration properties. Peritoneal dialysis is seldom indicated in operative patients, because of its low efficiency and the hypercatabolism that is often observed, except in situations where continuous abdominal lavage is desired, as in peritonitis or necrotizing pancreatitis. The standard detoxification method is hemodialysis in which the filter is perfused in the opposite direction to blood flow. Solute transport is the result of diffusion, osmosis and, to a minor extent, convection, and the elimination of small molecules is favored. As huge amounts of dialysate have to be used, a central water regeneration unit is the technical prerequisite for hemodialysis. In critically ill patients bicarbonate dialysis should be preferred, because it is hemodynamically better tolerated. Hemofiltration relies on convection rather than diffusion through a membrane with a cut-off between 20,000 and 50,000 daltons. The ultrafiltrate largely resembles plasma water. Fluid loss is substituted by appropriate electrolyte solutions allowing space for negative balances and hypercaloric parenteral nutrition. Hemofiltration is better tolerated than hemodialysis and was introduced to improve the elimination of toxic middle molecules. In intensive care units without access to hemodialysis or intermittent hemofiltration continuous arteriovenous hemofiltration (CAVH), first proposed by P. Kramer, has become an alternative, mainly because of its simplicity and the absence of hemodynamic side effects. The drawback of this method is its limited efficiency. In hypercatabolic patients daily ultrafiltration rates of 10-15 l will not reduce blood urea sufficiently. The same holds true for severe hyperkalemia. One attempt to increase efficiency is predilution, which involves adding part of the substitution fluid before the filter, to enhance blood flow and to increase the effective filtration pressure by lowering the oncotic pressure of the plasma. Predilution will increase the net urea clearance by some 20%. Another way to enhance filtration is to apply negative pressure to the membrane with the aid of an infusion pump at the filtrate side. The development of better filters with smaller resistances may further increase filtration rates.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute Kidney Injury↗
PubMed1989

[Acute pregnancy fatty liver with survival of the mother and child].

A case of acute fatty liver as a rare cause of pregnancy-induced jaundice is reported. Near term the 25-year-old patient became rapidly jaundiced. On admission laboratory tests showed signs of incipient coagulopathy and impaired renal function. When fetal vital signs deteriorated cesarean section was performed. After surgery the fullblown picture of disseminated intravascular coagulation developed, with profuse bleeding only controllable by rigorous substitution of plasma factors. Acute hepatic insufficiency with ascites followed. Despite the marked bilirubin elevation the hepatic enzymes were only slightly raised. In addition, acute renal insufficiency, pancreatitis and hyperuricemia developed. Under intensive care the patient recovered slowly and was discharged after 4 weeks with a healthy baby.

Adult↗
PubMed1989

[Pulmonary segmental artery angiography in intensive care patients].

The indication for wedge angiograms in intensive-care patients within the scope of X-ray chest examination is outlined. The obligatory wedge angiogram in patients with Swan-Ganz catheter is redundant. 4 indications for this special examination are specified. As a new possibility for differentiating between the ventral or dorsal course of pulmonary vessels, an inverse ratio of arborization angles is outlined for the first time.

Catheterization, Swan-Ganz↗
PubMed1989

[ECG-controlled placement of central venous catheters in patients with atrial fibrillation].

Some workers state that sinus rhythm is essential for electrocardiographic placement of central venous catheters. We performed a prospective study to compare location control by ECG and by chest X-ray in 40 patients with absolute arrhythmia and atrial fibrillation. The criteria accepted as allowing the assumption of an intracardiac position of the catheter tip were: (1) Abrupt appearance of high-voltage P-waves when the right atrium (RA) was entered and their brisk disappearance when pulling the catheter back into the vena cava superior (VCS) and/or (2) a change in configuration and voltage of the QRS complex on withdrawal of the catheter from the right ventricle (RV). After establishment of an intracardiac position, the catheter was withdrawn until the ECG changed to show a trace identical to that seen before it had entered the heart. Then, in this study, the correct central venous position was confirmed by chest X-ray. The intravascular ECG revealed a correct placement of the catheter tip in the VCS in all patients but one. In this patient who had severe dysrhythmia, an intracardiac ECG could not be obtained, although the chest X-ray showed a correct position of the catheter in the VCS. While false-negative results (where an intracardiac catheter position cannot be documented although the catheter is in a central venous position) occasionally do occur, false-positive results (with ECG suggesting an intracardiac location read, though the catheter tip is actually in a peripheral vein) are virtually impossible.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Fibrillation↗
PubMed1989

[A successful procedure in mitral valve rupture accompanied by rupture of the papillary muscle and the chordae tendinae following multiple injuries and blunt thoracic trauma].

In a considerable number of cases, blunt chest trauma also involves cardiac lesions including myocardial contusion or disruption pericardial effusion, or valve rupture. Definite cardiac trauma poses a challenge to everyone involved in intensive care, as early diagnosis and prompt treatment may be necessary to prevent a fatal outcome. We report a 32-year-old patient with fractures of the humerus, forearm, left clavicle and 2nd rib, and right ribs 4-6 after an 8 m fall. He was intubated in the emergency room because of arterial hypoxemia. Despite fluid administration the blood pressure deteriorated and the patient rapidly developed congestive heart failure that required huge doses of catecholamines. A systolic murmur was heard in the apex and left axilla. Conventional transthoracic echocardiography showed mitral valve prolapse and was suggestive of a flail mitral valve. Transesophageal echocardiography confirmed the diagnosis of mitral valve rupture, which proved to be grade IV by angiography. Because of continuous deterioration with low cardiac output and critical blood pressures and heart rates, surgery was carried out on the day of admission. Complete rupture of the anterolateral papillary muscle was found with laceration of the ventricular muscle, rupture of the secondary chordae tendineae, partial rupture of the valve base and partial dissection of the valve leaflets from the base. As expected from the echocardiography, there was no pericardial effusion. The destroyed valve was replaced by a Duromedics prosthesis. Operative stabilization of the subcapital humeral fracture followed 3 days later.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗