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71.
Summary In 47 medical and postoperative ICU patients with 57 episodes of sepsis and septic shock, cardiovascular parameters including systemic vascular resistance (SVR), cardiac index (CI), stroke volume index (SVI), left ventricular stroke work index (LVSWI) as well as six scoring systems (APACHE II, Elebute, Goris, HIS, SAPS and SSS) were studied regarding their usefulness in the assessment of disease progression and evaluation of response to supplemental sepsis therapy (immunoglobulins, plasmapheresis). Among the hemodynamic parameters, only a prompt SVR improvement significantly discriminated between ultimate survivors and nonsurvivors. Thus, an increase in SVR (>160 dyn*cm–5*sec, within days 0 to 4, persisting for >24 hours) can serve as a prognostically validated response criterion (responders/non-responders: 26/31; mortality: 27% vs. 77%). Non-invasively, the APACHE II score was best suited (specificity: 88%, sensitivity: 67%) to classify hemodynamically defined responders to supplemental sepsis treatment (score-reduction 4 on day 4 after onset of therapy).
Herz-Kreislauf-Parameter und Score-Systeme in der Beurteilung des Therapieerfolges bei Sepsis und septischem Schock
Zusammenfassung Bei 47 internistischen sowie postoperativen Intensivpatienten mit insgesamt 57 Episoden von Sepsis und septischem Schock wurden Herz-Kreislauf-Parameter inklusive systemischer Gefäßwiderstand (SGW), Herzindex, Schlagvolumenindex und linksventrikulärer Schlagarbeitsindex sowie sechs Score-Systeme (APACHE II, Elebute, Goris, HIS, SAPS und SSS) in ihrer Wertigkeit zur Beurteilung des Krankheitsverlaufes sowie des Ansprechens auf additive Sepsistherapie (Immunglobuline, Plasmapherese) untersucht. Von den hämodynamischen Parametern diskriminierte nur der — prompt nachweisbare — Anstieg des SGW signifikant zwischen letztlich überlebenden und nicht überlebenden Patienten. Ein Anstieg des SGW (>160 dyn*cm–5*s innerhalb von vier Tagen, länger als 24 Stunden anhaltend) kann somit als prognostisch validiertes Responder-Kriterium dienen (Responder/Non-Responder: 26/31; Letalität: 27% vs. 77%). Nichtinvasiv erwies sich der APACHE II Score (Kriterium: Score-Abfall 4 bis zum Tag 4 nach Therapiebeginn) zur Klassifizierung der hämodynamisch definierten Therapie-Responder bei additiver Sepsistherapie am besten geeignet (Spezifität: 88%, Sensitivität 67%).相似文献
72.
Interrater and internal consistency reliabilities were computed for the Boston Qualitative Scoring System, a newly developed system for scoring the Rey-Osterrieth Complex Figure. Subjects (N = 108) included males with right hemisphere stroke (n = 46), left hemisphere stroke (n = 20), dementia (n = 21), and normal controls (n = 21). Interrater reliability coefficients for all scales except asymmetry, which had a reliability coefficient of .2013, ranged from .6342 to .9919, with most in the good to excellent range. Internal consistency reliabilities ranged from .7774 to .9128, also with most in the good to excellent range. Discriminant indices of visuospatial accuracy scales found the scoring system to be useful in distinguishing between individuals based on visuospatial scores. 相似文献
73.
PD Dr. J. Süss Dr. med. vet. Patrizia Béziat Dr. med. H. P. Rohr Dr. med. J. Treib Prof. Dr. med. A. Haass 《Infection》1996,24(5):403-404
Summary The aim of the present study was to analyse the current epidemiological situation with respect to TBE in the new federal Länder of Germany and in Saarland through detection of the TBEV genome in unengorged ticks using an RT-PCR technique. 22,273 ticks (Ixodes ricinus) were collected in the five new Länder (and some in Bavaria and Baden-Württemberg) and divided into 294 pools. It was possible to detect TBEV RNA in six pools of ticks from Mecklenburg Western-Pomerania [4], Brandenburg [1], Thuringia [1] (and in three pools from Bavaria and Baden-Württemberg). The nucleotide sequence data of the PCR products were analysed and compared. In Saarland 8,780 ticks were collected in 70 habitats from all the geographic regions and analysed using the PCR in 21 pools; two pools produced positive PCR signals (Saarlouis, Perl). We cannot as a result make a general recommendation that TBE-immunization be introduced in Saarland and in the new federal Länder of Germany. In Germany, however, TBE immunoprophylaxis in Bavaria and Baden-Württemberg is very important.
Nachweis des Virus der Frühsommer-Meningoenzephalitis in Zecken einiger Bundesländer mittels Polymerase-Kettenreaktion und nähere Charakterisierung des Virus
Zusammenfassung Das Ziel der vorgelegten Studie ist die Einschätzung der aktuellen epidemiologischen Situation der Frühsommer-Meningoenzephalitis in den fünf neuen Bundesländern und im Saarland mit Hilfe des Nachweises von FSMEV-RNA in ungesogenen Zecken (Ixodes ricinus) durch eine RT-PCR-Technik. 22 273 Zecken wurden in den fünf neuen Ländern (einige auch in Bayern und Baden-Württemberg) gesammelt und in 294 Pools untersucht. Der spezifische RNA-Nachweis gelang viermal in Zecken aus Mecklenburg-Vorpommern, einmal in solchen aus Brandenburg und einmal aus Thüringen. In Bayern und Baden-Württemberg gelang der Virus-RNA-Nachweis dreimal. Die Sequenzdaten der PCR-Amplifikate zeigten, auch im Vergleich mit denen des Prototypstammes Neudoerfl, den hohen Grad der Konservierung im Bereich der 5 NCR. 8780 saarländische Zecken aus allen Gebieten des Bundeslandes wurden in 21 Pools untersucht, positive PCR-Signale konnten in zwei Pools aus Saarlouis und Perl und Umgebung gefunden werden. Der relativ seltene FSMEV-RNA-Nachweis in den neuen Ländern und im Saarland berechtigt nicht, eine generelle Impfempfehlung für diese Gebiete zu geben. Ein Impfschutz sollte jedoch vor Einreise in die Endemiegebiete Bayerns und Baden-Württembergs bestehen.相似文献
74.
RAL Dampney Y. Hirooka PD Potts GA Head 《Clinical and experimental pharmacology & physiology》1996,23(Z3):105-111
- 1 It was first shown several years ago that the rostral part of the ventrolateral medulla (VLM) contains a high density of receptor binding sites for angiotensin II (AngII). In the present paper we briefly review recent studies aimed at determining the actions of both exogenous and endogenous angiotensin peptides in the rostral VLM, as well as their specific sites of action.
- 2 The results of these studies have shown that angiotensin peptides can excite pressor and sympathoexcitatory neurons in the rostral VLM, but do not appear to affect non-cardiovascular neurons in this region.
- 3 It is known that pressor neurons in the rostral VLM include both catecholamine and non-catecholamine neurons. There is evidence that, at least in conscious rabbits, both of these types of neurons are activated by AngII. The specific endogenous angiotensin peptide or peptides that affect pressor neurons in the rostral VLM have not yet been definitively identified.
- 4 It is also possible that different angiotensin peptides may have different effects on pressor neurons in the rostral VLM, mediated by different receptors. Further studies will be needed to define these different functions as well as the specific receptors and cellular mechanisms that subserve them.
75.
T L Walden 《Radiology》1991,181(3):635-639
On February 22, 1890, Dr Arthur Goodspeed and William Jennings made the first x-ray photograph, in the physical lecture room of the University of Pennsylvania. On that evening, Goodspeed and Jennings had been making brush electrographs of coins and brass weights. After they finished their experiments, Jennings stacked all of the photographic plates; two coins--either left from the experiments or Jennings' trolley fare--were placed on top of the plates. Goodspeed then demonstrated to Jennings the university's collection of Crookes tubes, with the idea of photographing the glow from the tube. While the two men were talking, however, the Crookes tube was emitting x radiation that affected the nearby plates. After the plates were developed, Jennings noted that one had the shawdow(s) of a disk(s) on it; neither man could explain the image. On hearing of Roentgen's work in 1896, Goodspeed and Jennigns retrieved the original plate and reproduced their "accident." The glass plate was subsequently lost among library archives. 相似文献
76.
J Walden 《Primary care》1991,18(1):53-74
Trichuriasis may be asymptomatic or, in heavy infection, lead to profuse, bloody diarrhea and rectal prolapse. Diagnosis is made by finding the distinctive barrel shaped eggs in the stool or in the heavily infested patient, by anoscopy and identification of worms attached to reddened and ulcerated rectal mucosa. Mebendazole is the drug of choice in treatment. Capillariasis, a parasitic infection encountered mainly in the Philippine Islands, is of interest in that the eggs may be confused with the eggs of trichuris. Hookworm disease is generally asymptomatic, but in heavy infection, leads to iron deficiency and hypochromic, microcytic anemia. Diagnosis is made by finding the characteristic hookworm eggs on a examination of a direct fecal film. Accidental invasion of humans by dog and cat hookworm leads to cutaneous larva migrans, also known as "creeping eruption." Human hookworm is treated most effectively with mebendazole, while the rash produced by creeping eruption responds to topical thiabendazole. Strongyloides is fairly common in rural areas of the southeastern United States and may be seen in the urban setting among inmates of mental institutions, prisons, and in immigrants who formerly resided in endemic tropical regions. Because of its remarkable capacity for dissemination of larvae throughout the body, this parasite is now recognized as a serious problem for the patient who is immunocompromised. Diagnosis is made by finding larvae in the stool or by the Enterotest. All infected patients should be treated with thiabendazole. I consider the issue on Drugs For Parasitic Infections, published annually or biannually by The Medical Letter on Drugs and Therapeutics, to be the single best source of information on the treatment of parasitic diseases for primary care physicians. 相似文献
77.
Prof. Dr. A. A. Fauser Prof. Dr. G. Dölken Prof. Dr. K. J. Bross Dr. J. Schmid Dr. med. Eva Lang PD Dr. F. Sörgel 《Infection》1991,19(3):195-200
Summary We evaluated teicoplanin for suspected gram-positive infections after inadequate response to initial empiric beta-lactam and aminoglycoside combination therapy. All 20 patients included in this study received either an allogeneic (8 patients) or an autologous (12 patients) bone marrow transplant for acute myeloid leucaemia (AML), non-Hodgkin's-lymphoma (NHL, high grade) or other malignant diseases. All patients developing primary septicaemia of unknown origin (18 patients) or catheter-related septicaemia (2 patients) were treated with 400 mg teicoplanin, administered i.v. once daily in combination with a cephalosporin and an aminoglycoside (ceftazidime 2 g i.v., t.i.d.; netilmicin 400 mg once daily). All patients responded to therapy, 19 patients were clinically cured and one patient improved under therapy. The therapeutic regimen was well tolerated; only one adverse drug reaction was observed. We did not observe any delayed take or prolonged neutropenia or thrombocytopenia with this therapeutic regimen when our patients were compared to other bone marrow transplant patients (who did not receive this antimicrobial therapy). Our results suggest that teicoplanin is a potentially effective and well tolerated antimicrobial agent in bone marrow transplant patients with infections not responding primarily to beta-lactams and aminoglycosides.
Teicoplanin in Kombination mit -Laktamen und Aminoglykosiden bei Knochenmarktransplantatempfängern mit schwerer Sepsis
Zusammenfassung Wir untersuchten Teicoplanin bei vermuteten grampositiven Infektionen nach ungenügendem Ansprechen auf die anfängliche Kombinationstherapie von -Laktam-Antibiotika und Aminoglykosiden. Alle 20 in dieser Studie erfaßten Patienten wurden entweder allogen (8 Patienten) oder autolog (12 Patienten) transplantiert mit folgenden Grundkrankheiten: akute myeloische Leukämie (AML), Non-Hodgkin-Lymphom (NHL) oder andere maligne Erkrankungen. Alle Patienten, die eine primäre Septikämie unbekannten Ursprungs entwickelten (18 Patienten) oder unter einer Katheter-bedingten Septikämie (2 Patienten) litten, wurden mit 400 mg Teicoplanin behandelt. Die Verabreichung von Teicoplanin erfolgte einmal täglich intravenös in Kombination mit einem Cephalosporin und einem Aminoglykosid (Ceftazidim 2 g i.v., 3 ×/die, Netilmicin 400 mg, 1 ×/die). Alle behandelten Patienten sprachen auf diese Therapie an. 19 Patienten wurden klinische geheilt, ein Patient besserte sich unter dieser Therapie. Die Kombinationstherapie wurde gut vertragen, unerwünschte Arzneimittelwirkungen traten während der Studie nicht auf. Wir beobachteten kein verzögertes Angehen des Knochenmarks oder eine Verlängerung der Thrombozytopenie unter dieser Behandlung im Vergleich zu anderen knochenmarktransplantierten Patienten, die diese antimikrobielle Behandlung nicht erhielten. Unsere Ergebnisse zeigen, daß Teicoplanin ein wirksames und gut verträgliches Antibiotikum für knochenmarktransplantierte Patienten ist, die primär nicht auf die Kombinationstherapie mit -Laktam-Antibiotika und Aminoglykosiden ansprechen.相似文献
78.
MJ Stevens PD Stricker J Saalfeld PC Brenner R Kooner GFA O'Neill PJ Duval RS Jagavkar P Cross J Martland 《Journal of Medical Imaging and Radiation Oncology》2003,47(2):152-160
Combination high dose rate brachytherapy (HDRB) and external beam radiation therapy is technically and clinically feasible as definitive treatment for localized prostate cancer. We report the first large Australian experience using this technique of radiation dose escalation in 82 patients with intermediate‐ and high‐risk disease. With a median follow up of 3 years (156 weeks), complications were low and overall prostate‐specific antigen progression‐free survival was 91% using the American Society for Therapeutic Radiology and Oncology consensus definition. The delivery of hypofractionated radiation through the HDRB component shortens overall treatment time and is both biologically and logistically advantageous. As a radiation boost strategy, HDRB is easy to learn and could be introduced into most facilities with brachytherapy capability. 相似文献
79.
80.