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51.
Changes in serum creatinine in the first 24 hours after cardiac arrest indicate prognosis: an observational cohort study 总被引:1,自引:0,他引:1
Dietrich Hasper Stephan von Haehling Christian Storm Achim Jörres Joerg C Schefold 《Critical care (London, England)》2009,13(5):R168-7
Introduction
As patients after cardiac arrest suffer from the consequences of global ischemia reperfusion, we aimed to establish the incidence of acute kidney injury (AKI) in these patients, and to investigate its possible association to severe hypoxic brain damage. 相似文献52.
Christina Fotopoulou Konstantinos Savvatis Robert Kraetschell Joerg C. Schefold Werner Lichtenegger Jalid Sehouli 《European journal of obstetrics, gynecology, and reproductive biology》2010
Objective
To systematically assess the metastatic pattern of intermediate- and high-risk endometrial cancer in pelvic and para-aortic lymph-nodes and to evaluate risk factors for lymph-node metastases.Study Design
Between 01/2005 and 01/2009 62 consecutive patients with intermediate- and high-risk endometrial cancer who underwent a systematic surgical staging including pelvic and para-aortic lymphadenectomy were enrolled into this study. Patients’ characteristics, histological findings, lymph-node localization and involvement, surgical morbidity and relapse data were analyzed. Univariate analysis was performed to define risk factors for lymph-node metastasis.Results
Of the 13 patients (21%) with positive lymph-nodes (N1), 8 (61.5%) had both pelvic and para-aortic lymph-nodes affected, 2 (15.4%) only para-aortic and 3 (23%) only pelvic lymph-node metastases. Overall, 54% of the N1-patients had positive lymph-nodes above the inferior mesenteric artery (IMA) to the level of the renal veins. Univariate analysis revealed lymph vascular space invasion (p-value: <0.001), vascular-space-invasion (p-value: <0.001) and incomplete tumor resection (p-value: 0.008) as significant risk factors for N1-status. Overall and progression-free survival was not significantly different between N1- and N0-patients.Conclusions
Since the proportion of N1-endometrial cancer patients with positive para-aortic lymph-nodes is, at 76%, considerably high, and more than half of them have affected lymph-nodes above the IMA-level, lymphadenectomy for endometrial cancer should be extended up to the renal veins, when indicated. The therapeutic impact of systematic lymphadenectomy on overall and progression-free survival has still to be evaluated in future prospective randomized studies. 相似文献53.
54.
Meier Christoph Schefold Joerg C. Hug Urs Trentz Otmar Platz Andreas 《European journal of trauma and emergency surgery》2004,30(6):371-377
European Journal of Trauma and Emergency Surgery - Immediate ORIF (open reduction and internal fixation) is the treatment of choice for displaced ankle fractures. However, definitive treatment may... 相似文献
55.
Joerg C Schefold Stephan von Haehling Rene Pschowski Thorsten Onno Bender Cathrin Berkmann Sophie Briegel Dietrich Hasper Achim J?rres 《Critical care (London, England)》2014,18(1):R11
Introduction
Acute renal failure (ARF) requiring renal replacement therapy (RRT) occurs frequently in ICU patients and significantly affects mortality rates. Previously, few large clinical trials investigated the impact of RRT modalities on patient outcomes. Here we investigated the effect of two major RRT strategies (intermittent hemodialysis (IHD) and continuous veno-venous hemofiltration (CVVH)) on mortality and renal-related outcome measures.Methods
This single-center prospective randomized controlled trial (“CONVINT”) included 252 critically ill patients (159 male; mean age, 61.5 ± 13.9 years; Acute Physiology and Chronic Health Evaluation (APACHE) II score, 28.6 ± 8.8) with dialysis-dependent ARF treated in the ICUs of a tertiary care academic center. Patients were randomized to receive either daily IHD or CVVH. The primary outcome measure was survival at 14 days after the end of RRT. Secondary outcome measures included 30-day-, intensive care unit-, and intrahospital mortality, as well as course of disease severity/biomarkers and need for organ-support therapy.Results
At baseline, no differences in disease severity, distributions of age and gender, or suspected reasons for acute renal failure were observed. Survival rates at 14 days after RRT were 39.5% (IHD) versus 43.9% (CVVH) (odds ratio (OR), 0.84; 95% confidence interval (CI), 0.49 to 1.41; P = 0.50). 14-day-, 30-day, and all-cause intrahospital mortality rates were not different between the two groups (all P > 0.5). No differences were observed in days on RRT, vasopressor days, days on ventilator, or ICU-/intrahospital length of stay.Conclusions
In a monocentric RCT, we observed no statistically significant differences between the investigated treatment modalities regarding mortality, renal-related outcome measures, or survival at 14 days after RRT. Our findings add to mounting data demonstrating that intermittent and continuous RRTs may be considered equivalent approaches for critically ill patients with dialysis-dependent acute renal failure.Trial registration
, clinicaltrials.gov NCT01228123相似文献56.
Boldt LH Fraszl W Röcker L Schefold JC Steinach M Noack T Gunga HC 《European journal of applied physiology》2008,102(5):547-554
Warm water bathing is a popular recreational activity and is frequently used in rehabilitation medicine. Although well tolerated
in most cases, there are reports indicating an increased risk of thrombotic events after hot tub bathing. The effects of a
45 min thermoneutral bath followed by a 50 min bath with increasing water temperature (maximum 41°C) until reaching a body
core temperature of 39°C on factors of blood coagulation and fibrinolysis were studied in eight healthy male volunteers. Blood
was obtained after a 45-min resting period as control and after the thermoneutral and hyperthermic bath as well as after another
45 min recovery period at the end of the study. Hyperthermic immersion (HI) lead to a shortening of activated partial thromboplastin
time (aPTT) (P < 0.05). Fibrinogen concentration decreased immediately after HI (P < 0.05) but increased during recovery (P < 0.05). Plasminogen activator inhibitor (PAI) activity decreased during HI (P < 0.05), D-dimer concentration was not found to change. Thrombocyte count increased (P < 0.05) during HI. The increases in tissue-type plasminogen activator concentration as well as leucocyte count during HI
were due to haemoconcentration. Prothrombin time, PAI-activity and granulocyte count decreased during thermoneutral immersion
(P < 0.05). Warm water bathing leads to haemoconcentration and minimal activation of coagulation. The PAI-1 activity is decreased.
A marked risk for thrombotic or bleeding complications during warm water bathing in healthy males could not be ascertained. 相似文献