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11.
Prof. Dr. W. Lorenz B. Stinner M. Rothmund D. Duda W. Dick H. Menke Th. Junginger 《European Surgery》1992,24(3):128-134
Zusammenfassung Probleml?sungsstrategien zu perioperativen Prophylaxema?nahmen umfassen mehr Studienarten als Tierexperimente und kontrollierte
klinische Studien. Dabei verhelfen Methoden der kognitiven Psychologie und künstlichen Intelligenz zu neuen Verfahren, um
kontroverse Standpunkte in der klinischen Versorgung zu formalisieren. Der Weg vom Tierexperiment zur klinischen Indikation,
mag mühevoll und beschwerlich sein, aber die Strategie hat sich bei der perioperativen Antihistaminikaprophylaxe als eine
neue Form der Prophylaxe schon bew?hrt. Gerade wurde im Refresher Course der ASA, der amerikanischen Gesellschaft für An?sthesie
und Intensivmedizin, diese Prophylaxe für alle US-An?sthesisten empfohlen.
Mit Unterstützung durch die Deutsche Forschungsgemeinschaft (Lo 199/16-2). 相似文献
12.
F.?W. Ahnefeld J. Barth W. Dick A. Doenicke T. Fuchs H. Gervais H. Laubenthal H. L?llgen W. Lorenz H.?H. Mehrkens G.?H. Meuret H. M?llmann S. Piepenbrock B. Przybilla R. Ring W. Schmutzler G. Schultze-Werninghaus J. Schüttler H.?P. Schuster P. Sefrin M. Tryba J. Zander M. Zenz 《Der Anaesthesist》1994,43(4):211-222
13.
U. Lehmann G. Regel B. Ellendorf E. Rickels M. Lorenz H. Becker H. Tscherne 《Der Unfallchirurg》1997,100(9):705-710
Summary
A total of 208 multiple trauma patients with head injury (HI) were investigated who had been treated in the period from 1990
to 1995. The average age was 35.2 ± 17.7 years; the injury severity according to ISS was 30.2 ± 8.6 points; 20.5 % died as
a result of the HI; the mortality of all patients was 26.5 %. The Glasgow Coma Scale (GCS) was determined at an average of
22 min after trauma (8.0 ± 4.3 points) at the scene of accident. The patients were classified according to GCS into minor
HI (group 1: 14–15 points), moderate HI (group 2: 9–13 points) and severe HI (group 3: 3–8 points). Patient outcome was assessed
by the Glasgow Outcome Scale (GOS) and was classified as good (GOS 4 and 5) and poor (GOS 1, 2 and 3) outcome. At the latest,
2 h after trauma, a CT scan of the head (CCT) was done. The HI groups are compared regarding frequency of types of injury.
In all HI groups the fractures of the bony face occurred at the same frequency (36.0–38.9 %). The frequency of calotte fractures
(Kal-Fx) increased from group 1 (8.0 %) to 2 (19.2 %) and 3 (25.6 %); fractures of the skull base significantly differed between
group 1 (16.0 %), 2 (7.8 %) and 3 (33.4 %). Epidural hemorrhage (EDB) appeared only in group 2 (7.8 %) and 3 (6.7); subdural
hemorrhage was found in group 1 (2.7 %), 2 (7.8 %) and 3 (10.0 %). Subarachnoid hemorrhage (SAB) was significantly more frequently
seen, dependent on HI severity, in group 3 (26.7 %) compared to group 2 (11.7 %) and 1 (8.0 %). Intracerebral contusion (ICK)
significantly increased from group 1 (12.0 %) to 2 (27.3) and 3 (45.6 %). Brain swelling (BS) also significantly increased
from group 1 (8.0 %) to 2 (19.5 %) and 3 (49.0 %) and lesions of ventricles (VL) from group 1 (2.7 %) to 2 (11.7 %) and 3
(20.0 %). Midline shift (13.4 %) and signs of herniation (4.5 %) only occurred in group 3. The analysis of correlation/regression
and receiver operating characteristics was able to predict 79 % of patients' outcome accurately using GCS (r 0.54; P < 0.0001) alone, using CCT (r 0.65; P < 0.0001) 87 % were correctly predicted with significant variables Cal-Fx, EDB, SAB and BS. CCT with GCS (r 0.74; P < 0.0001) were able to predict 88 % accurately with significant variables Cal-Fx, EDB, BS and GCS. The combination of CCT
with GCS, age and ISS (r 0.78; P < 0.0001) was able to predict only 87 % correctly, although the r value was the highest; significant variables were Kal-Fx, EDB, BS, VL, GCS, age and ISS.
相似文献
14.
15.
Routine clinical use of radiographic contrast media (RCM) causes adverse reactions in some patients. To elucidate the mechanisms of these reactions both in vitro and in vivo studies are necessary. In this study, RCM-induced histamine release from isolated mast cells was compared with the in vivo release of histamine and cardiovascular symptoms using a porcine model. The 2 non-ionic preparations examined (Solutrast and Ultravist) released little or no histamine from the 4 cell types tested (porcine pulmonary, cardiac, hepatic, and renal mast cells). The 4 ionic preparations (Angiographin, Hexabrix Rayvist, and Telebrix) caused histamine release from most of the cell suspensions. In almost all cases, the cardiac mast cells were the most sensitive followed by the hepatic mast cells. All 4 RCM tested in vivo produced elevated plasma histamine levels in some animals. The highest incidence was observed using the ionic, high osmolal Rayvist (6 of 12 animals), followed by the non-ionic RCM with the lowest osmolality Ultravist (4 of 12 animals). In vivo, mechanisms in addition to direct histamine release may also be involved in RCM-induced adverse reactions, since low osmolal, non-ionic RCM can cause elevated plasma histamine levels without in vitro release. The susceptibility of cardiac mast cells to RCM-induced histamine release suggests that patients undergoing e.g. coronary angiography may be especially at risk for an adverse reaction. 相似文献
16.
PURPOSE: To evaluate whether prolonged postoperative stenting may reduce the risk of obstruction of the neourethra after TIP repair with deep glanular incision. METHODS: In a 1-year period 27 patients were operated for penile hypospadias using the TIP technique described by Snodgrass. In contrast to a previous study with 8 - 10 days of postoperative catheter drainage, the indwelling transurethral catheter was kept in place for 12 - 14 days. Deep incision of the urethral plate up to the tip of the glans is the most remarkable surgical detail, resulting in a meatus on top of the glans but in a defect on the dorsal rim of the neomeatus as well. After 3 - 6 months 22 patients were re-investigated during an outpatient visit using a scheme to describe the position of the neomeatus. Uroflowmetry was also performed. Information in three toddlers was gained by phone and 2 patients were lost to follow-up. RESULTS: Two patients returned with significant obstruction including an urethrocutaneous fistula in one. In contrast to the good assessment by parents and compared to the early appearance after catheter removal a change in meatal position was observed in the majority of patients. Only 6 patients presented with an unchanged meatal position whereas in 16 patients the meatus lost its oval or slit-like shape as well as its position on the tip of the glans. However, despite one obstructive meatus in the coronal position 15 patients showed a sufficient size and position of the meatus underneath the tip of the glans. Uroflowmetry revealed reduced peak-flow values (mean: 8.1 ml/s) in some of the 9 patients evaluated. CONCLUSIONS: Our data indicate that prolonged stenting does not give better results in those TIP repairs, in whom the urethral plate was incised across the rim of the neomeatus. The early excellent aspect of the glans after stent removal is often impaired by partial closure of the glans incision with a short-term change in size and position of the meatus. To prevent this, the rim of the meatus during reconstruction should be kept completely epithelialised. 相似文献
17.
Outpatient or short-stay thyroid and parathyroid surgery is still uncommon in Germany. Although a substantial number of these operations are performed with low morbidity, nearly zero mortality, and short operation time, some potentially lethal complications, especially postoperative hemorrhage, are strong arguments against liberal shortening of hospital stay. Symptomatic hematomas after thyroid and parathyroid surgery are observed in about 1-2% of cases. They frequently occur during the first 8 h after operation (40%). However, two thirds of these major complications occur later, about 20% of them more than 24 h postoperatively. Therefore, an outpatient procedure cannot be generally recommended. Short-stay (<23 h, overnight) thyroid and parathyroid surgery may be attractive, but this concept requires clear release-criteria and professional outpatient structures. Compared to general anesthesia, local and regional anesthesia did not emerge as helpful to shorten hospital stay. Also, prophylactic calcium supplementation is not recommended to enhance early hospital discharge after bilateral thyroid or parathyroid surgery. 相似文献
18.
Depressed pathological gamblers 总被引:1,自引:0,他引:1
Depressed gamblers (n = 14) were compared with normal controls (n = 41) for antecedent life events. The depressed gamblers had experienced significantly more life events, and undesirable or exit life events, during the 6 months before the onset of depression. 相似文献
19.
20.
Claus Neurohr Patrick Huppmann Hanno Leuchte Martin Schwaiblmair Iris Bittmann Gundula Jaeger Rudolf Hatz Lorenz Frey Peter Überfuhr Bruno Reichart Jürgen Behr for the Munich Lung Transplant Group 《American journal of transplantation》2005,5(12):2982-2991
Bronchiolitis obliterans syndrome (BOS) is the limiting factor to long-term survival after lung transplantation. Previous studies suggested respiratory viral tract infections are associated with the development of BOS. To identify the impact of virus detection in bronchoalveolar lavage (BAL) fluid, we analyzed BAL samples from 87 consecutive lung transplant recipients for human herpesvirus (HHV)-6, Epstein-Barr virus, Herpes simplex virus 1/2, Cytomegalovirus, respiratory syncytical virus and adenovirus by PCR. Acute rejection, BOS and death were recorded for a mean follow-up time of 3.27 +/- 0.47 years. Results of PCR analysis and other potential risk factors were entered into a Cox regression analysis of BOS predictors and death. Only acute rejection was a distinct risk factor for BOS of all stages, death and death from BOS. HHV-6 was detected in 20 patients. Univariate and multivariate analysis revealed that HHV-6 was associated with an increased risk to develop BOS > orb = stage 1 and death, separate from the risk attributable to acute rejection. Identification of HHV-6 DNA in BAL fluid is a potential risk factor for BOS. Our results warrant further studies to elucidate a possible causal link between HHV-6 and BOS. 相似文献