Massive Beinschwellung und prätibiale Ulzerationen nach Hüftgelenksoperation

Compression ultrasound is nowadays a standard procedure and an indispensable tool in the diagnostics of lower extremity deep vein thrombosis (DVT). If DVT has been ruled out an arteriovenous fistula is an important differential diagnosis of unilateral leg swelling and should be considered especially in cases of preceding major joint surgery. An arteriovenous fistula can be easily detected using colour-coded duplex sonography.     

In Vitro Selection of Neisseria gonorrhoeae Mutants with Elevated MIC Values and Increased Resistance to Cephalosporins

Strains of Neisseria gonorrhoeae with mosaic penA genes bearing novel point mutations in penA have been isolated from ceftriaxone treatment failures. Such isolates exhibit significantly higher MIC values to third-generation cephalosporins. Here we report the in vitro isolation of two mutants with elevated MICs to cephalosporins. The first possesses a point mutation in the transpeptidase region of the mosaic penA gene, and the second contains an insertion mutation in pilQ.     

Absence of correlation between graft-versus-host associated immunosuppression and cytotoxic T cell activity in response to major histocompatibility antigens

Studies in mice suggest that the T cell subset involved in graft-versus-host-reaction (GvHR) across the major histocompatibility complex (MHC) depends on the class of MHC antigens recognized by the donor cells. However, the correlation between phenotype and function is not absolute. Using a functional approach, we investigated in a parent →>F₁ hybrid model differing at the whole MHC, whether graft-versus-host (GvH) associated immunosuppression was correlated with donor cytotoxic T cell activity. The immunodeficiency was tested by the ability of the F₁ mice to generate a cytotoxic T cell response against trinitrophenyl-modified syngeic cells (TNF-self) or an alloantigen. F₁ specific parental cytotoxic T cells, generated in vitro, induced less immunosuppression than naive parental cells. Specific in vivo priming increased the cytotoxicity of parental spleen cells, but decreased their capacity to induce GvH-associated immunosuppression. In contrast, nonspecific priming resulted in the usual immunodeficiency. In conclusion, there was no correlation between GvH-associated immunosuppression and cytotoxic T cell activity of the parental cells.     

End tidal carbon dioxide as an haemodynamic determinant of cardiopulmonary resuscitation in the rat

End tidal PCO2 (PETCO2) has been found to be a good prognostic indicator of successful resuscitation from cardiac arrest. To explore the value of this measurement further, we carried out a series of experiments during cardiac arrest and closed chest resuscitation in 14 mechanically ventilated Sprague-Dawley rats. Ventricular fibrillation (VF) was induced by a 10 mA current delivered to the right ventricular endocardium. After 4 min of VF, precordial compression was begun with a mechanical thumper and defibrillation was attempted 2 min later. PETCO2 decreased abruptly during cardiac arrest to 0.3 mm Hg (0.04 kPa). With precordial compression, it increased to 11 mm Hg (1.5 kPa). Within 3 min of successful defibrillation, there was an overshoot in the PETCO2 to 44 mm Hg (5.8 kPa) with return to baseline levels approximating those of the pre-arrest control measurements over the 60 min that followed restoration of spontaneous circulation. The PETCO2 measurement during precordial compression predicted the success of defibrillation with return of spontaneous circulation. When PETCO2 exceeded 9 mm Hg (1.2 kpA), 7 of 8 animals were successfully resuscitated. When PETCO2 was less than 9 mm Hg during precordial compression, none of six animals were successfully resuscitated. The PETCO2 correlated with the mean aortic (r = 0.71) and coronary perfusion pressure (r = 0.80) generated during precordial compression. In corroboration of previously reported observations on pigs, dogs, and human patients, PETCO2 served as a non-invasive monitor of the effectiveness of precordial compression for maintaining coronary perfusion and therefore cardiac viability during CPR. The PETCO2 was also useful in that it promptly signalled restoration of spontaneous circulation.     

Computer systems for facilitating management of the critically ill

The Shock Research Unit has applied computer technology to the care of the critically ill and injured patient since 1961. The requirements for patient monitoring were initially explored with a process control computer (IBM 1710). In the current system, a Xerox Sigma-5 computer is utilized for monitoring EKG, hemodynamic, respiratory, and biochemical signals. Electronic preprocessing increases the efficiency and speed of data acquisition and signal analysis. Provisions are made for recording narrative data as part of a commitment to evolve an automated patient record. Bedside displays include both tabular and graphic summaries of patient status and trends. A computer accessible archive of patient files is maintained.Clinical operation of the system has been facilitated by automation of afferent and efferent functions including flushing of catheters, servo-calibration of pressure measuring systems, automated urine collection and disposal, and computer controlled infusion of fluids and medications. We anticipate the continuing development of automated afferent and efferent components for feedback control of ventilators by automated sampling and measurement of arterial blood gases and infusion of fluids and medications in response to changes in monitored hemodynamic variables. Such automation, together with medical intelligence for priority alarms and interpretive displays, hold promise of increasingly potent and cost-effective systems to facilitate and improve care of the critically ill or injured patient.     

An "oncometer" of clinical measurement of colloid osmotic pressure of plasma.

Measurement of colloid osmotic pressure complements measurements of pulmonary artery wedge pressure for assessing the risks of pulmonary edema and constitutes an increasingly important reference for purposes of guiding selection of colloid or crystalloid fluids in patients with acute cardiac disease. We describe a simple device for its routine clinical measurement. A membrane, selectively impermeable to molecules of relative molecular mass (Mr) greater than 30000, is rigidly mounted between a sample chamber and a reference chamber filled with isotonic saline. A pressure transducer measures the negative pressure developed in the reference chamber and displays it on a digital panel meter. The sensor chamber accommodates samples of 50 to 300 microliter. Equilibration is completed within 2 min. A control solution of human serum albumin (50 g/liter) is measured to confirm the accuracy of calibration of the system, with reproducible readings of 25.9 g/cm2 within one SD (equivalent to 0.4 g/cm2). Technical simplicity of operation and modest costs of disposables have made feasible the routine measurement of colloid osmotic pressure.     

End-tidal CO2 as a guide to successful cardiopulmonary resuscitation: a preliminary report

Utilizing a well-established porcine model of cardiac arrest, we found that end-tidal CO2 concentration (ETCO2) strikingly decreased to approximately 24% of control levels, immediately after cardiac arrest and before precordial compression. During precordial compression, ETCO2 progressively increased to 46% of control values in successfully resuscitated animals but only to 26% in animals which failed to respond to resuscitation efforts. After successful resuscitation, ETCO2 rapidly returned to baseline values. These data indicate that ETCO2 may be a useful monitor for assessing the adequacy of CPR.     

Monitoring of intracranial pressure in 2 severe cases of Reye's syndrome

The intracranial pressure (PIC) of two children with Reye's sundrome aged 9 years 7 months and 4 years 7 months was monitored for 9 and 5 days respectively with a subdural device. This provided a useful guide to the treatment that was necessary to reduce the very high intracranial pressure. One of the patients died of uncontrollable raised intracranial pressure (HIC). This monitoring technique should be used in all cases of HIC.