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T Bein

Publications and source records attributed to T Bein.

53 records · Page 3Linked to original sources
PubMed1995

[Severe legionellosis after abuse of anti-inflammatory drugs--diagnostic and intensive care aspects based on a case report].

Legionella infections are getting increasingly important as causes of severe pneumonias or of acute respiratory insufficiency. Consumptive or immunosuppressive underlying diseases such as diabetes mellitus, cardiac insufficiency, alcohol-induced liver damage, malignant tumours or drug-induced immunosuppression after organ transplantation, are among the risk factors. Diagnosis is based on direct identification of the pathogen from body secretions by means of direct immunofluorescence. The serological immunoresponse often takes place long after outbreak of the disease or fails entirely to appear and is therefore only suitable for retrospective confirmation. Therapy of choice is an intravenous administration of erythromycin. There are now increasing pointers to the efficiency of fluoroquinolone antibiotics, such as ciprofloxacin. We report on the course of a severe case of legionnaire's disease with multiple organ failure occurring in a patient after bone marrow depression induced by anti-inflammatory drugs. Treatment erythromycin resulted in a marked cholestasis, so that antibiotic treatment was changed to ciprofloxacin. This therapy as well as the supportive intensive-care treatment eventually led to the patient's complete recovery. Based on the case report, fundamental aspects of diagnostics, antibiotic treatment, intensive-care treatment and prognosis of severe cases of legionellosis are discussed.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1995

Is the transfusion requirement predictable in critically ill patients after admission to the intensive care unit?

OBJECTIVE: In intensive care medicine the clinical decision to order and transfuse red blood cells (RBC) is usually based on hematocrit or hemoglobin levels. The intention of this study was to investigate whether clinical or laboratory variables, taken after the admission of patients to the intensive care unit (ICU), are able to predict the transfusion requirement of the following 72 h. DESIGN: The values of initially measured systolic blood pressure, hematocrit level, and the values of 2 scores of severity of disease (Acute Physiology And Chronic Health Evaluation [APACHE-II], Mortality Prediction Model [MPM]) were calculated after the admission of patients to the ICU. The decision for transfusion was based on specific criteria. The median values of the scores, those of the variables, and the median number of transfused RBC units of the surviving group were compared to the values of the group of patients who died during hospital stay. The quantity of RBC transfusions was compared to the variables and score values by linear regression analysis. Additionally, the values of the patients who did not receive blood transfusion were compared to those of patients who required RBC. Furthermore, the patient group with neurosurgical diseases was compared to the group without neurosurgical diseases. PATIENTS: 117 patients were prospectively and consecutively investigated in an 8-bed ICU of a university hospital. RESULTS: Nonsurvivors required significantly more units of RBC during the first 72 h (p < 0.05). Patients who did not require transfusion had a higher hematocrit and a lower APACHE-II value at admission (p < 0.001). In the MPM values no differences were found. Patients with neurosurgical diseases had a higher initial hematocrit value, and they required less units of RBC in comparison to patients without neurosurgical diseases. In the analysis of linear regression neither in the initially measured systolic blood pressure nor in the APACHE-II and MPM we found a strong linear correlation to the quantity of blood transfusion. CONCLUSIONS: A hematocrit value < or = 20% and a APACHE-II score > or = 20 at the time of admission to the ICU referred to a demand for blood transfusion. We believe that these parameters are useful as predictive instruments. The initially measured systolic blood pressure had no prognostic capacity. In the individual patient a number of factors should be taken into account to decide whether to transfuse or not.

APACHE↗
PubMed1995

Right ventricular function and plasma atrial natriuretic peptide levels during fiberbronchoscopic alveolar lavage in critically ill, mechanically ventilated patients.

STUDY OBJECTIVE: To assess the influence of fiberbronchoscopic alveolar lavage on hemodynamics, right ventricular function, and plasma atrial natriuretic peptide (ANP) concentrations in critically ill, mechanically ventilated patients. DESIGN: Prospective investigation. SETTING: Eight-bed ICU of a university hospital. PATIENTS: Fourteen patients with cardiovascular instability due to a systemic inflammatory response syndrome who were mechanically ventilated. INTERVENTIONS: Fiberbronchoscopic alveolar lavage after fluid replacement, deep sedation, and paralyzation. Intervention time: 10 min. After inspection of the endobronchial system, one lavage of 40 mL sterile saline solution was instilled in each lung and recovered. MEASUREMENTS AND RESULTS: The fiberbronchoscopic procedure induced a prompt increase in mean pulmonary arterial pressure after 3 min (median[range]: 25 [13 to 39] to 30 [19 to 45] mm Hg, p < 0.05), which increased further after 6 min (34 [17 to 46] mm Hg, p < 0.01). Cardiac index increased simultaneously (4.25 [3.1 to 5.7] to 4.85 [4.3 to 6.9] L/min.m2 after 6 min, p < 0.01), whereas mean arterial pressure and heart rate remained unchanged. Central venous pressure rose from 12 (3 to 18) mm Hg before procedure to 14 (4 to 20) mm Hg after 6 min (p < 0.01). The right ventricular function was measured using a "fast response" ejection fraction thermodilution catheter: end-diastolic volume increased (238 [137 to 358] to 280 [150 to 4ll] mL after 9 min, p < 0.05), as well as stroke volume (88 [54 to 113] to 103 [67 to 153] mL after 9 min, p < 0.01). Right ventricular ejection fraction (37 [25 to 50] %) did not change significantly during the procedure, but the stroke work index was reinforced (8.2 [4.7 to 15.7] to 13.3 [2.4 to 41.3] gm.M/M2 after 6 min, p < 0.01). Plasma c-ANP concentration rose from 135 (24 to 350) to 196.5 (44 to 830 pg/ml after 20 min (p < 0.05). Systemic vascular resistance decreased from 533 (390 to 1,042) to 429 (281 to 684) dynes.s/cm5 after removal of the bronchoscope (p < 0.01). CONCLUSIONS: Although acute pulmonary hypertension was observed during the fiberbronchoscopic procedure, the right ventricular performance did not deteriorate in hemodynamically unstable patients. To maintain a "hyperdynamic cardiovascular state," the right ventricular stroke work was reinforced, presumably by the "Frank-Starling mechanism." We assume that the acute distention of the right side of the heart resulted in elevated ANP concentrations. The marked decrease in systemic vascular resistance might be due to high ANP levels.

Adult↗
PubMed1994

[Acute pulmonary and cardiovascular effects of continuous axial rotation (kinetic therapy) in respiratory failure].

AIM: Continuous lateral rotational therapy (kinetic therapy) is advocated to improve pulmonary gas exchange in patients with severe respiratory failure, by promoting mobilization of secretions and reducing mismatch of ventilation and perfusion. We analyzed the acute pulmonary and hemodynamic changes before and after beginning kinetic therapy in critically ill patients with inotropic support. PATIENTS AND METHODS: Due to severe respiratory failure, 18 patients with "systemic inflammatory response syndrome" had been placed in a kinetic bed (Rotorest, KCI Mediscus). Retrospective analysis included several indices of arterial oxygenation, intrapulmonary "shunt fraction", cardiac index, arterial and pulmonary arterial pressure, systemic vascular resistance and systemic oxygen consumption. RESULTS: After the start of kinetic therapy, we found a statistically significant improvement of pulmonary gas exchange and a reduction of shunt fraction 12 hours later. Cardiac index and arterial and pulmonary arterial pressure remained unchanged. Systemic oxygen consumption was increased. CONCLUSION: The continuous axial rotation of patients with severe respiratory failure results in a prompt improvement of arterial oxygenation. Even in hemodynamically unstable patients we did not observe harmful effects.

Adult↗
PubMed1993

[Atrial septum aneurysm as the cause of a thromboembolic infarction of the brain stem and cerebellum?].

A 32-year-old woman with migraine for several years again had a migraine attack with headache, nausea, vomiting and eye-muscle disorder, 14 days after an uncomplicated delivery. Within 24 hours a left-dominant hemiparesis developed, followed 12 hours later by tonic-clonic seizure and deep unconsciousness (Glasgow score: 3); the patient could not be aroused. Cranial computed tomography revealed extensive infarction of the brainstem and cerebellum. Angiography demonstrated occlusion of the basilar artery but not other abnormalities of other vessels. There was no evidence for vascular anomalies and the clotting tests were normal. Transoesophageal echocardiography demonstrated an atrial septal aneurysm. But any interatrial shunt (e.g. through a patent foramen ovale) was excluded by colour Doppler sonography, making it highly unlikely that a paradoxical embolus was the cause of the infarction. The brainstem infarction resulting from the basilar artery occlusion did not respond to treatment and the patient died 10 days after the initial seizure.

Adult↗
PubMed1993

[Score systems in emergency medicine].

Trauma scores are used in emergency medicine to classify the severity of injuries. Score systems are applied in science and epidemiological investigations in emergency and intensive care. Moreover, trauma scores are intended to support the decisions in triage and predict the prognosis of mortality. Scores are based on anatomicmorphological or physiological parameters by which the intensity of injury is graded and valued. Commonly used scores are the Injury Severity Score (ISS) and the Revised Trauma Score (RTS). The Glasgow Coma Scale (GCS) is a system that is used worldwide to classify neurologic deficiencies after injury of the brain. Trauma scores have a good prognostic potential by comparing large data bases of different patient groups. Individual prognosis of mortality by trauma scores in the routine of emergency medicine are rapid classification of the injury after trauma and early identification of critically ill patients. Score systems can support decisions and the training of emergency staff. Future studies should go into the grade of rehabilitation and the quality of life after trauma as a -possibly score-aided-prognostic parameter.

Emergencies↗
PubMed1993

[Potentialities and limitations of the score system in intensive medicine].

In intensive-care medicine, score systems serve to quantify the severity of diseases and to characterise patient groups on the basis of objective criteria. The principle is to describe the severity by adding up points. Objectives are to assess the prognosis, to establish the amount of treatment required and assist in clinical decision making. The most important examples of general scores covering more than one disease are Acute Physiology And Chronic Health Evaluation (APACHE-II, APACHE-III), Simplified Acute Physiology Score (SAPS) and Mortality Prediction Model (MPM). General scores assess the deviation of physiological parameters from the normal assuming that the degree of deviation reflects the severity of the disease. The Therapeutic Intervention Scoring System (TISS) constitutes a particular form which evaluates exclusively the amount of therapy required. Disease-specific scores (trauma scores, sepsis scores) take into account the fact that the nature and stage of specific disease determine the outcome in a typical way. Scores are adequately validated and suitable for evaluation of clinical studies or cost-benefit analyses by characterisation of patient populations. The use of score systems for individual prognosis is at present controversial. Their clinical significance might increase in that scores help to make medical decisions by contributing to early identification of endangered patients by systematic establishment and evaluation of investigation results. Scores are likely to be used increasingly in intensive-care medicine.

Critical Care↗
PubMed1992

[The determination of plasma volume using indocyanine green in man].

The importance of circulating blood (BV) and plasma volume (PV) in critically ill patients and physiological research is unchallenged. Recently, Evans blue (EB) [8, 25] and radioactively labelled serum albumin (RIHSA) [20] have mostly been used as tracers for PV determination. However, the disadvantages of radioactive contamination (RIHSA) and dye accumulation (EB), especially in repeated measurements, are obvious. In addition, recent reports show a possible carcinogenic potential for EB [15, 21]. This has prompted us to examine the feasibility of indocyanine green (ICG), a tricarbocyanine dye currently used for cardiac output and liver blood flow measurements, for the determination of PV. The volume of distribution of ICG has been reported to represent PV [5, 26]. METHODS. In 23 healthy volunteers (19 men and 4 women), PV was determined in duplicate (PV1, PV2) with an interval of 30 min. Before injection a tourniquet was put around the arm and a pressure above the systolic arterial pressure was applied for 2 min. During recirculation, ICG (2.5 mg/ml) was administered in a dose of 0.25 mg/kg as a bolus injection over 5 s via an antecubital vein. Blood was drawn from an antecubital vein of the contralateral arm at 1 min intervals. After centrifugation, the optical density (corrected for blank) was read in a densitometer. Third- to ninth-minute plasma samples were used to calculate monoexponential plasma decay curves. The ICG concentration at injection time was achieved by extrapolation. A calibration curve was generated using 5 different known ICG concentrations. PV was calculated from injected ICG dose divided by ICG concentration at injection time. BV and red cell volumes (EV) were derived from measured PV and hematocrit (hct). RESULTS. Between minutes 3 and 9, tracer decay was monoexponential in all but 1 subject. From minute 10 on the plasma decay of ICG represented another, slower compartment (Fig. 1). The plasma half-life of ICG was 3.2 +/- 0.6 min (mean +/- SD). Mean PVs per body weight and body surface area (BSA) were 44 +/- 5 ml/kg and 1662 +/- 176 ml/m2, respectively. Linear regression revealed PV2 = 0.92.PV1 + 226 (r = 0.92) (Fig. 2). The mean percentage of difference (D) was -0.6%, the methodologic error (SD) +/- 5.7% [27]. Linear regression of PV and BSA revealed PV = 1885.BSA -416 (r = 0.71, P less than 0.0001) (Fig. 3). BV and EV estimates (Table 2) obtained from PV and hct showed reproducibility in the range of the PV determination because of excellent reproducibility of hct measurements. DISCUSSION. ICG plasma half-life times in our experiments were comparable to those reported by other authors [18, 19, 24]. Reproducibility of PV determination was good and was well within the limits of other tracer methods (EB, RIHSA) [17, 27]. Using exclusively peripheral veins for ICG injection and blood withdrawal did not seem to affect the accuracy of PV determination. PV estimates obtained by the ICG method showed good agreement with those known from the literature [7, 10, 25]. Our results correspond especially well with the data reported by Hurley [14] obtained from 481 healthy men using different methods (Evans blue, RIHSA, or labelled red cells).

Adult↗
PubMed1991

[Rupture of the trachea during difficult intubation].

Serious injuries of the larynx or trachea during tracheal intubation are rare but potentially life-threatening complications. This case report describes the diagnostic procedures and therapeutic management of an intubation-induced tracheal rupture in a young female patient with a musculoskeletal disorder (rigid spine syndrome). Interdisciplinary treatment requires precise documentation of the extent of the injuries, including advanced imaging techniques. Removal of the endotracheal tube prior to accurate diagnosis can result in immediate airway obstruction. Because of the risk of infection, as a rule surgical treatment is indicated.

Adult↗
PubMed1991

[A life-threatening arrhythmia (ventricular tachycardia) triggered by a Swan-Ganz catheter in a patient with the WPW syndrome].

The induction of dysrhythmias during or after pulmonary artery catheterization is a serious complication in critically ill patients. The following case presentation reports the incidence of life-threatening ventricular tachycardia after catheterisation in a patient known to have Wolff-Parkinson-White (WPW)-Syndrome. The dysrhythmia began during repositioning of the patient 10 h after placement of the catheter. Attempted inversion by administration of Ajmalin was unsuccessful. Removal of the catheter resulted in prompt cessation of the dysrhythmia.

Adult↗
PubMed1989

[Perioperative anxiety behavior of IVF patients and a suitable simplified analgo-sedation procedure in transvaginal follicle puncture].

In the present prospective study, perioperative anxiety was investigated in 52 patients, who underwent transvaginal follicular centesis for IVF treatment. Also the surgical and anaesthesiological procedures are described. The mean age of the patients was 32.2 years, and the mean period of desire for children 9.1 years. On average, six stimulation cycles were carried out. In an operation with a duration of approx. 20 minutes, an average of six oocytes were collected. As an alternative to general anaesthesia, an analgosedation, given intravenously with midazolam (0.1 mg/kg) and fentanyl (2 micrograms/kg) has been described. This necessitates continuous anaesthesiological monitoring due to respiratory depression, induced by the risk of medication. In our study, IVF patients who had a long history of desire for children, in some cases with several previous operations, show a low to moderate anxiety level before the operation. "Hospital routine" has evidently led to this low anxiety level, which is maintained after the operation.

Adult↗
PubMed1989

[Analgosedation with midazolam and fentanyl as an alternative to general anesthesia in transvaginal follicle puncture within the scope of in vitro fertilization].

The technique of in vitro fertilization (IVF) was simplified by the development of ultrasound-supported transvaginal follicular centesis. This makes it possible to dispense with general anesthesia. As an alternative, an intravenous analgosedation with midazolam (0.1 mg/kg) and fentanyl (2 micrograms/kg) is presented. Besides a good analgesic and anxiolytic action, an incipient respiratory depression was observed, so that insufflation of oxygen-enriched air is to be recommended. The operation is felt to be comfortable by almost all patients. A high degree of anterograde amnesia is attained. Meticulous intraoperative and postoperative anesthesiological monitoring is a prerequisite for application of this procedure.

Adult↗
PubMed1988

[Midazolam in combination with piritramid versus Thalamonal in premedication in ambulatory ENT interventions in childhood].

70 children aged between 15 months and 8 years who had to undergo outpatient surgery (adenotomy) were divided into two groups and given different premedication. Group A received Midazolam (0.15 mg/kg) combined with Piritramid (0.1 mg/kg), group B Thalamonal (0.04 ml/kg). Based on vigilance schemes, the degree of sedation and the mood tone were rated during initiation of anaesthesia, in the awakening phase and on discharge of the patient. Cooperation during initiation (via a mask) was definitely higher in group A (72%) than in group B (44%). During the awakening phase the children in group A showed a more balanced mood tone combined with improved vigilance. For example, 3 hours postoperatively 65% of the children in group A had got up and participated in getting dressed, whereas in group B only 11% of the children did so. Intramuscular premedication with Midazolam/Piritramid must be considered as especially advantageous in outpatient ENT treatment requiring a large number of small surgical interventions in children in respect of effective preparation and with a minimum of problems regarding postoperative follow-up.

Adenoidectomy↗
PubMedDate not supplied

Disruption of classical conditioning in patients with Alzheimer's disease.

One of the primary features of Alzheimer's disease (AD) is a disorder of memory. Although considerable effort has been devoted to characterizing this memory disorder, simple forms of memory such as classical (Pavlovian) conditioning have not been studied. The prevailing view has been that these simple forms of memory are not affected in AD. These forms of memory, however, may be of particular interest because they are beginning to be well understood at the neurobiological level. Because of this, when memory disorders are detected, it may be possible to specify their neurobiological substrate. We now report that classical conditioning of the eyeblink response is disrupted in AD patients compared to age-matched controls. This deficit in conditioning is not due to nonassociative factors such as changes in sensitivity to stimuli or disruption of the motor response. The results are considered in terms of using simple forms of memory to help generate hypotheses regarding the neurobiology of age-related memory disorders.

Aged↗