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21.
Claudia M. Dillier Daniel Trachsel Werner Baulig Claudine Gysin Andreas C. Gerber Markus Weiss 《Journal canadien d'anesthésie》2004,51(1):72-75
PURPOSE: To present a case of laryngeal damage in an infant caused by a too large and inappropriately designed cuffed tracheal tube. CLINICAL FEATURES: A 13-month-old child undergoing cardiac surgery was intubated with an uncuffed endotracheal tube with an internal diameter (ID) of 4.0 mm. Because of an important air leak around the tracheal tube during mechanical ventilation, a cuffed endotracheal tube ID 4.0 mm was inserted. The air leak with the tube cuff not inflated was acceptable at 25 cm H2O airway pressure. After extubation on the third postoperative day, the patient showed increasing stridor and respiratory deterioration. Fibreoptic laryngoscopy of the spontaneously breathing patient showed a large intra-laryngeal web. After surgical removal of the web, the child rapidly recovered and was discharged from the hospital on the 12th postoperative day. Inspection of the 4.0 mm (ID) cuffed tracheal tube revealed a cuff positioned inappropriately high and an increase of 0.7 mm in outer tube diameter compared to the 4.0 mm (ID) uncuffed tracheal tube from the same manufacturer. The tube cuff is likely to be situated within the larynx when placed in accordance to insertion depth formulas or radiological criteria, as used for uncuffed tracheal tubes in children. CONCLUSION: The larger than expected tracheal tube with its intra-laryngeal cuff position in a 13-month-old child likely caused mucosal damage and an inflammatory reaction within the larynx resulting in granulation tissue formation and fibrous healing around the tracheal tube. 相似文献
22.
23.
Andreas Blana Stefan Denzinger Markus Lenhart Wolf F Wieland Roman Ganzer 《International journal of urology》2007,14(5):450-451
We report a case of recurrent inguinal lymphocele formation after inguinal lymphadenectomy treated by lymphographic mapping and selective ligation of the lymphatic vessels. Lymphographic mapping was performed by puncturing a lymphatic vessel at the dorsum of the foot. After isolating the vessels that drained into the lymphocele, they were clipped and divided through a small skin incision. The described technique showed an instant and complete suspension of the lymph secretion with subsequent complete healing. Lymphatic mapping and selective ligation of afferent lymphatic vessels proved to be an effective treatment of a recurrent inguinal lymphocele. 相似文献
24.
Claus D. Eisenbach Andreas Gldel Monika Terskan-Reinold Ulrich S. Schubert 《Macromolecular chemistry and physics.》1995,196(4):1077-1091
The synthesis and properties of segmented ABA triblock and (AB)n multiblock copolymer systems with 6,6′-disubstituted 2,2′-bipyridine (bpy) building blocks B and poly(oxytetramethylene) soft segments A are described. The access to the disubstituted bipyridines in large scale quantities was achieved by modification of conventional synthetic routes. In the presence of copper(I) ions these polymers formed mononuclear [Cu(I)(bpy)2] complexes in solution through self-assembly. The complexed copolymers were microphase separated systems in bulk with nano to mesoscopic superstructures consisting of copper-bpy complex aggregates in a polyether matrix. The thermal, mechanical and elastomer properties of the block copolymers varied with composition. 相似文献
25.
Effects of enteral feedback inhibition on motility,luminal flow,and absorption of nutrients in proximal gut of minipigs 总被引:2,自引:0,他引:2
Andreas Huge Eckhard Weber Prof. Dr. Hans-Jörg Ehrlein 《Digestive diseases and sciences》1995,40(5):1024-1034
We wanted to clarify whether the postprandial intestinal feedback control activated by nutrients in the distal gut exerts different effects on motility, transit of digesta, and absorption of nutrients in the proximal gut. Additionally, interrelationships among motility, transit, and absorption were to be elucidated because these relationships have only been investigated in the fasted state. In five minipigs, a 150-cm segment of the proximal jejunum was isolated by two cannulas. Motility of the jejunal segment was recorded by multiple strain gauges and analyzed by computerized methods. Markers (Cr- and Cu-EDTA) were used for the measurement of the flow rate, transit time, and absorption of nutrients. After a meal, the test segment was perfused with 2 kcal/min of an elemental diet over a period of 90 min. A feedback inhibition was activated by infusion of nutrients into the midgut at rates of 1–4 kcal/min. Saline was infused as control. With increasing energy loads infused into the midgut, the motility index and the length of contraction waves decreased, whereas the incidence of stationary contractions increased, ie, the motility changed from a propulsive to a segmenting pattern. These modulations of motility were associated with a linear decrease in the flow rate and a linear increase in transit time. Flow and transit were linearly correlated with each other. Additionally, the reduction in flow rate and the delay in luminal transit were associated with a linear increase in the absorption of nutrients. However, the increase in absorption induced by the feedback mechanism was small (7.3–13.4%) compared to the marked inhibition of the motility parameters (54–64%), the flow rate (59%), and the delay of transit (5.8-fold). Feedback control primarily modulated motor patterns and luminal flow, whereas the small increase in absorption was only a side effect due to the longer contact time of the nutrients with the mucosa.The study was supported by the Deutsche Forschungsgemeinschaft, grant Eh 64/6-3. 相似文献
26.
Ernst P. Leumann Andreas Dietl Ana Matasovic 《Pediatric nephrology (Berlin, Germany)》1990,4(5):493-497
The molar ratios of oxalate and glycolate over creatinine were determined in single urine samples of 26 infants and 27 children aged 1–5 years. In 135 children aged 5–16 years, two urine specimens were collected, one before breakfast and one at noon. Oxalate was determined by oxalate oxidase, and glycolate was measured by a colorimetric method (improved chromatotropic acid-sulphuric acid assay after prior purification by cation and anion exchanger). Both ratios (expressed in mmol/mol creatinine and analysed on a log-normal basis) were highest in infants 0–6 months old [mean oxalate 147 (95% confidence interval: 60–360), mean glycolate 175 (72–425)]. The mean oxalate ratio was 72 mmol/mol (29–174) at the age of 7–24 months, 44 (19–101) at the age of 2–5 years and 22 (12–40) in adolescents aged 16 years. Molar glycolate ratios were higher, but disclosed the same pattern. Oxalate and glycolate ratios in fasting urines did not differ significantly from those in noon samples (except glycolate in the oldest age group). Oxalate ratios correlated well with glycolate ratios in children up to 5 years of age only. Random urine samples are thus suitable for screening. However, interpretation of data requires use of age-specific reference values that are based on comparable methods. 相似文献
27.
Abstract
Purpose:
Evaluation of the therapeutic usefulness of
the “pelvic C–clamp” (PCC) during emergency treatment
of multiply injured patients with unstable disruption
of the posterior pelvic ring.
Patients and Methods:
The data of 28 patients with
polytrauma in combination with an unstable fracture
of the posterior pelvic ring (average Injury Severity
Score [ISS]: 49 points; average Polytrauma Score [PTS]:
41 points) were retrospectively analyzed from the
moment they were admitted to the emergency room
until 48 h after admittance. The PCC was used immediately
for primary stabilization of the pelvis after
clinical diagnosis of the unstable pelvic fracture. Main
outcome measurements: development of mean blood
pressure, development of oxygenation level, period of
time until the PCC was placed, number of blood units
needed, period of time until circulatory stabilization
occurred.
Results:
The PCC was applied in all cases within an average
of 64.7 min after trauma. Seven patients (25%) died
within the first 45 min after admission. The surviving
patients showed:• an increase in mean blood pressure of 25% 20 min after
application of the PCC,• a hemodynamic stabilization 6 h after application of
the PCC,• a stabilization of the oxygenation level 6 h after application
of the PCC,• a decrease in the number of required blood units 6 h
after application of the PCC.
Conclusion:
The present study shows, that the application
of the PCC to critically injured patients with unstable
pelvic fractures leads to stabilization of the vital parameters
within a short period of time. 相似文献
28.
Andreas Bremerich 《Mund-, Kiefer- und Gesichtschirurgie》2007,11(3):129-130
Ohne Zusammenfassung 相似文献
29.
30.
Kathrin Scherer Wolfgang Studer Verena Figueiredo Andreas J Bircher 《Annals of allergy, asthma & immunology》2006,96(3):497-500
BACKGROUND: Blue dyes used for lymphatic mapping in sentinel lymph node biopsy cause intraoperative anaphylactic reactions in up to 2.7% of patients. With increasing implementation of this technique, the incidence of anaphylaxis to these dyes can be expected to increase. In the literature, the chemically often unrelated and inconsistently designated dyes have been confused, adding to other inconsistencies in the nomenclature. OBJECTIVE: To demonstrate the nomenclature, chemical and physiologic differences, and allergenicity of the various blue dyes used in a medical context. METHODS: We describe a patient with an intraoperative grade IV anaphylactic reaction to isosulfan blue. Immediate-type hypersensitivity was proved by positive skin test reactions and CD63 expression to isosulfan blue and cross-reactivity to patent blue V. RESULTS: A review of the literature clarified the exact nomenclature of the blue dyes and the possible pitfalls of confusing nomenclature in the context of structurally closely related dyes with different allergenic properties. For the detection of type I hypersensitivity, intracutaneous tests are valuable tools. An IgE-mediated mechanism has been shown recently. In most cases, sensitization exists without known previous exposure in a medical context. This may be due to the widespread use of such dyes in objects of everyday life. Preoperative antiallergic medication use does not prevent anaphylactic reactions but apparently reduces their severity. CONCLUSION: For better comparison and precision, the Chemical Abstracts Service number of the respective dye should always be given. 相似文献