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W Mauritz

Publications and source records attributed to W Mauritz.

At least 19 recordsLinked to original sources
PubMed1992

Septic focus localized by determination of arterio-venous difference in neopterin blood levels.

We describe a case of a 38-year-old female accident victim who was admitted to the trauma hospital with an ISS of 66. Successful emergency treatment (including amputation of the left leg) and 4 weeks of intensive care led to an overall improvement so that the patient was extubated on day 29. Throughout this period neopterin was measured routinely 3 times a week and correlated well with the clinical course. At the end of the fifth week massive lung impairment and all clinical signs of sepsis appeared. Neopterin values increased dramatically up to 200 nmol/L. However, no abnormal findings were revealed by X-ray, contrast fluoroscopy, or sonographic imaging. To examine the amputation site more closely, simultaneous determination of neopterin in samples from the vena and arteria femoralis was performed. We found a 50% higher level in the venous blood (300 vs. 200 nmol/L). This was regarded as evidence for a hidden focus. Immediate surgical intervention revealed an abscess, which proved to be Pseudomonas aeruginosa positive. After adequate treatment the patient recovered quickly. In this case neopterin was not only helpful in monitoring the septic episodes of the patient, but proved essential for the detection of a septic focus and the risk of explorative relaparotomy could be omitted.

Abscess↗
PubMed1992

Bed-side infection screening of ICU patients using gram stained smears.

Bronchial, abdominal or pleural aspirates (n = 364) collected from 165 ICU patients were both cultivated and evaluated microscopically using Gram stained smears, and the results were compared: 331 aspirates (91%) were classified correctly. Fungi were confirmed in all cases (21/21, sensitivity and specificity 100%). Gram-negative findings (n = 66) had a specificity of 97% (2/66 reclassified as Gram positive by culture): 21/85 Gram-negative cultures were overlooked by the Gram method (sensitivity 75%). Of 106 Gram-positive results, culture was negative in 10/106 and 7/106 were diagnosed as Gram-negative (specificity 84%). Sensitivity was 98% (only 2/91 not detected by the Gram technique). In 171 cases, no organisms were seen; specificity was 92% (Gram-negative bacteria cultivated in 14/171). Sensitivity was 94% (10/167 misdiagnosed as Gram-positive). Gram diagnoses were available 63 +/- 14 h prior to the culture test results. Treatment decisions based upon the Gram results were correct in 90% (326/364). It is concluded that Gram stained smears are a valuable tool for bed-side infection screening in ICU patients.

Adolescent↗
PubMed1992

Effects of nimodipine administration during cardiopulmonary resuscitation in pigs.

The haemodynamic effects of nimodipine during cardiopulmonary resuscitation (CPR) were investigated in 25 anaesthetized pigs. After 5 min of ventricular fibrillation (VF) and 5 min of closed-chest CPR, adrenaline (50 micrograms kg-1), either nimodipine (10 micrograms kg-1 as a bolus followed by 1 microgram kg-1 min-1 continuously) or the equivalent volume of placebo (solvent for nimodipine) were administered followed by the first countershock. If this failed to restore spontaneous circulation, adrenaline and countershocks were repeated for a maximum of 30 min. CPR was successful in nine out of 10 nimodipine-treated animals, but only in six out of 15 placebo-treated animals (P less than 0.02). In resuscitated pigs there were no significant differences in the number of countershocks, the number of seconds required for restoration of spontaneous circulation and the total doses of adrenaline required for both nimodipine and placebo pigs. After restoration of spontaneous circulation haemodynamic responses to nimodipine were characterized by decreases in systemic vascular resistance and mean arterial pressure with consequent increases in heart rate and cardiac output, but they were not significantly different from those of the placebo-treated animals. We therefore conclude that high doses of nimodipine are well tolerated during and after CPR; nimodipine administration may even result in higher initial CPR success rates. The underlying mechanisms need further investigation.

Animals↗
PubMed1991

Muscle biopsy for diagnosis of malignant hyperthermia susceptibility in two patients with severe exercise-induced myolysis.

Muscle biopsy and in vitro contracture tests for diagnosis of susceptibility to malignant hyperthermia (MH) were performed in two patients who had developed fever and severe myolysis during exercise. MH susceptibility was confirmed in one patient, but in the other, exercise-induced heat stroke proved to be the correct diagnosis. Clinical presentation and epidemiology of exercise-induced MH and its relation to the heat stroke syndrome are discussed.

Adult↗
PubMed1990

Serum vasopressin (AVP) levels in polyuric brain-dead organ donors.

Hydromineral metabolism and serum arginine-vasopressin (AVP) levels were investigated in 11 patients who sustained brain death. They showed various degrees of polyuria with low osmolality and low fractional sodium excretion. Urine osmolality was always below that of serum, and AVP levels were between 1.3 and 50.0 pg/ml vs 0.7-8.0 pg/ml in ten normal subjects. Thus central diabetes insipidus was excluded. A renal mechanism inducing water diuresis has to be assumed. The type of renal lesion, however, remains unclear.

Adolescent↗
PubMed1990

[Pneumothorax in intensive care patients. The value of tangential views].

In 55 intensive-care patients an additional tangential view of the chest was taken to demonstrate or exclude a pneumothorax in patients with sudden deterioration of gas exchange and negative ap-chest x-ray, if there was a suspicion of pneumothorax or a confirmed small pneumothorax in the ap-view. In 14 of 42 cases (33.3%) with negative or suspected ap-chest x-ray the tangential view revealed a pneumothorax. 6 of these 14 pneumothoraces were under tension. In 7 out of 11 patients (63.6%) with small pneumothorax, the tangential view showed additionally a tension pneumothorax.

Adult↗
PubMed1990

Prediction of malignant hyperthermia susceptibility: statistical evaluation of clinical signs.

The anaesthetic records of 61 patients who had experienced adverse reactions thought to be malignant hyperthermia (MH) were reviewed retrospectively to evaluate the diagnostic importance of clinical symptoms. Using the in vitro contracture test, 38 (62%) patients were identified as MH susceptible (MHS), the remainder showing normal test results (MHN). Generalized rigidity, ventricular arrhythmias, cyanosis and postoperative myoglobinuria were observed significantly more often in MHS patients. Median values of body temperature and creatine kinase serum concentrations were significantly greater in the MHS group. Masseter spasm and sinus tachycardia were as common in MHS as in MHN individuals. Statistical models using generalized rigidity, ventricular arrhythmias, cyanosis and fever exceeding 38 degrees C for prediction of MH showed a maximum sensitivity and specificity of 78% and thus are not acceptable for clinical use. For definitive diagnosis of MH, the well established in vitro contracture test remains essential.

Adolescent↗
PubMed1990

Anaesthesia in malignant hyperthermia-susceptible patients without dantrolene prophylaxis: a report of 30 cases.

The intra- and postoperative course of 30 anaesthetics in 24 MH-carriers verified by in vitro contracture tests is reported. None of the patients received dantrolene prophylactically and only agents known to be nontriggers were used for anaesthesia. Neither MH-related changes in perioperative heart rates, body temperatures, and CK levels nor any other symptoms of MH were observed. We conclude that the prophylactic use of dantrolene is not necessary in patients suspected to be prone to MH if triggering agents are avoided and the patients are closely monitored.

Adolescent↗
PubMed1990

Echocardiographic assessment of mitral valve function during mechanical cardiopulmonary resuscitation in pigs.

Using two-dimensional and M-mode echocardiography, mitral valve function was assessed during mechanical cardiopulmonary resuscitation (CPR). In 10 anesthetized pigs CPR began 1 min after induction of ventricular fibrillation; in all pigs three different compressive forces (200, 350, and 500 Newton [N]) were applied in randomized sequence for 3 min each, thus resulting in a reduction of anterior-posterior chest diameter by 15%, 20%, and 25%, respectively. Echocardiographic recordings of adequate technical quality were obtained from seven animals. During ventricular fibrillation, mitral valve leaflets showed fibrillatory movements without closure. During CPR systole with a compressive force of 200 N, the mitral valve closed in 114 of 700 CPR cycles (16%). This rate increased significantly (P less than 0.001) to 399 of 584 cycles (68%) with 350 N, and further to 470 of 494 cycles (95%) with 500 N. The higher mitral valve closure incidence was linked to statistically significant increases in systolic cerebral (+125%) and diastolic myocardial perfusion pressures (+136%) and cardiac output. We thus conclude that with low compressive force blood flow during mechanical CPR is due mainly to the chest pump mechanism, whereas the cardiac pump mechanism is effective with high compressive forces.

Animals↗
PubMed1990

Anesthesia in malignant hyperthermia susceptible patients.

The intra- and postoperative course of 30 general and 3 regional anesthetics in 27 MH-carriers verified by in vitro contracture tests is reported. None of the patients received dantrolene prophylactically. Disposable tubings were used for ventilation, vaporizers and soda lime were removed. ECG, esophageal temperature, blood pressure, oxygen saturation, and end tidal pCO2 were monitored. Minor tranquilizers were offered for premedication. Fentanyl, thiopentone, nitrous oxide, non depolarizing relaxants, neuromuscular antagonists and naloxone were used. In three patients, surgery was performed during epidural or spinal anesthesia with the use of amide local anesthetics. Neither MH-related changes in perioperative heart rates, body temperatures, and CK levels nor any other symptoms of MH were observed in any patient. The anesthetic techniques used seem to be safe and reliable; the anesthetic management of known MHS patients is discussed in detail.

Adult↗
PubMed1989

[Preoperative plasma exchange in treatment of plasma-related coagulation disorders before liver transplantation].

PATIENTS AND METHODS: Seventy-two consecutive patients undergoing orthotopic liver transplantation at the Department of Surgery I, University of Vienna Medical School (OLT nos. 1 to 72), were evaluated. Their mean age was 47 years (range: 18-63 years). The indications for liver transplantation are listed in Table 1. All transplant procedures were performed without using a bypass technique. The intraoperative management and surgical procedure have been described elsewhere [7]. Patients were categorized in two groups, each of which was divided in two subgroups. Group I consisted of 18 patients transplanted before the introduction of preoperative plasma exchange. These were retrospectively allocated to two subgroups on basis of their preoperative prothrombin times (PT): A (n = 9): preoperative PT less than 40%; B (n = 9): preoperative PT greater than 40%. The two subgroups of group 2, which contained 54 patients, were compared on a prospective basis: C (n = 32): preoperative PT above 40%; D (n = 22): PT on admission below 40%, preoperative plasma exchange. Comparison of the two subgroups was based on the following parameters: (1) pre-exchange PT (subgroup D); (2) preoperative PT (= PT post-plasma exchange in subgroup D; (3) intraoperative infusion volumes (balanced electrolyte solutions and human albumin to maintain an intravascular colloid osmotic pressure greater than 16 mm Hg); (4) transfusion volumes (whole blood stored for no more than 72 h or packed red cells and fresh plasma, as available; and (5) intraoperative sodium bicarbonate requirements to maintain an arterial pH greater than 7.20. RESULTS: (Table 2) . Prothrombin time (PT): Group 1: Patients in subgroup A had a mean preoperative PT of 34% (range: 15%-40%). This was significantly lower than in subgroup B (74%; 52%-100%; P less than 0.001). Group 2: The pre-exchange mean PT in subgroup D was 27% (12%-39%) vs. 68% in subgroup C (45%-104%), the difference being highly significant (P less than 0.0001). In patients in subgroup D a mean plasma volume of 3638 ml was exchanged by plasmapheresis. This resulted in a significant increase in PT to 55% (Table 3). As a result, the preoperative post-exchange PT in subgroup D was slightly but significantly (P less than 0.005) less than in subgroup C. Transfusion volumes: Group 1: Patients in subgroup A needed significantly more blood units than those in subgroup B (55.3 units [19-110] vs. 18.7 [3-33]).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1989

[The action of ketamine on muscle contractile behavior. In vitro studies on the musculature of subjects susceptible to malignant hyperthermia].

Since ketamine has been incriminated as triggering malignant hyperthermia (MH) [3, 9, 13, 14, 18], but has still been used uneventfully in MH susceptible patients, we performed an in vitro study to examine the safety of ketamine for use in human MH. METHODS. Muscle specimens of 20 patients who had muscle biopsies to diagnose MH were investigated. In every patient diagnostic contracture tests (2 halothane (Hal) and 2 caffeine (Caf) were done according to the protocol established by the European MH group (EMHG). In addition, one test unit for investigating the effect of stepwise increased bath-concentrations of ketamine (5, 10, 20, 60, 120, 240 and 960 mumol/l) and a further one serving as control (no drugs added to the bath) were used. Combined Hal (2 vol%) and Ket (960 mumol/l) tests were performed in 9 patients (4 MHS, 4 MHN, 1 MHEh). Changes in baseline contractures and mechanical twitch tension were evaluated. RESULTS. The diagnostic test showed MHS in 8, MHN in 8 and MHEh in 4 patients. Ketamine did not induce baseline contractures in any of the tests performed. Contractures induced by 2 vol% of halothane in 4 MHS muscles did not change significantly when ketamine was added to the bath (concentration 960 mumol/l). A significant, dose-related decrease in mechanical twitch tension occurred, when ketamine was added to the test. At the highest concentration (960 mumol) twitch tension was reduced by 55%. Twitch tension remained stable in untreated muscles. No significant differences were found between the specimens from MHS, MHN and MHE patients. This reduction in twitch tension was more pronounced in specimens exposed to both halothane (2 vol%) and ketamine (960 mumol/l), resulting in an average decrease of 71%. CONCLUSION. In accordance with Fletcher et al., our results indicate that ketamine - at least in vitro - does not trigger MH. In MHS muscles, ketamine does not augment halothane-induced baseline contractures. The ketamine-induced reduction of mechanical twitch tension in directly stimulated human muscles has not been described before. Analogous findings in frog sartorius muscles can be found in the literature. Whereas the effect of ketamine on indirectly stimulated muscle has been investigated by several authors, the underlying mechanism of ketamine-induced twitch suppression in directly stimulated muscles is not known. Inhibition of calcium release from or accelerated uptake into the sarcoplasmatic reticulum have been reported.

Caffeine↗
PubMed1989

[Liver transplantation--anesthesiology aspects].

Based on our experience in 82 liver transplant procedures performed without using a bypass-technique, we report on our current perioperative anaesthetic management. Preoperative plasma exchange with fresh frozen plasma proved very effective in 16 patients with severe coagulation defects, leading to a significant increase in prothrombin time from 27 to 55%. Intra- and postoperative haemodynamic profiles of 48 patients are presented. Baseline measurements revealed a hyperdynamic circulatory state with elevated cardiac index (CI) and heart rate in all patients. During the anhepatic phase CI and mean arterial pressure (MAP) were persistently lowered. Immediately after reperfusion of the graft, reflux of the stagnant venous content induced a significant increase in CI and led to a moderate elevation of pulmonary artery pressure. MAP showed a rather slow recovery, but was within the normal range at the end of surgery. Oxygen consumption index, which was significantly lowered during the anhepatic period, excessively increased after reperfusion of the graft.

Adult↗
PubMed1988

Malignant hyperthermia susceptibility confirmed in both parents of probands. A report of three Austrian families.

From 1976 to 1986, 79 cases of suspected malignant hyperthermia (MH) were reported to the authors' institution. A total of 233 muscle biopsies was done in 66 families. The mother and father of the proband were investigated in 44 families; in three of these, both parents of probands gave positive test results. These three families, all from Vorarlberg, a secluded mountain area, represent 4.5% of all our MH-positive families (n = 61) and 7.3% of all MH-positive families where both parents had been tested (n = 41). This observation might be explained by: 1) a much higher incidence of MH in this part of Austria, and 2) a different test policy, as at the authors' institution, if possible, both parents are investigated, even if there is a positive test result in one of them. It is concluded that family investigations of MH susceptibility should always include both parents of a proband.

Adult↗
PubMed1988

[Protracted action of vecuronium in a patient with chronic renal insufficiency treated by dialysis].

Although the pharmacokinetics of vecuronium are altered by the loss of kidney function, they do not differ significantly between patients with normal renal function and patients with renal failure. Therefore, the drug has become a preferred neuromuscular blocking agent in anuric patients. The author observed complete relaxation--verified by nerve stimulation--for more than 3 h following a single dose of 0.09 mg/kg vecuronium in a patient with chronic renal failure. Liver function was normal, and no drugs known to interact with vecuronium were used. The authors conclude that the altered pharmacokinetics of vecuronium in anuric patients might cause clinically significant effects in some patients.

Adult↗