Wirbelsäulenstabilisierung bei extraduraler Metastasenkrankheit Indikation und Verläufe bei 32 Patienten

Zweiunddrei?ig Patienten mit Metastasenkrankheit der Wirbels?ule, überwiegend von Mammakarzinomen und Plasmozytomen wurden über 41/2 Jahre operativ dekomprimiert und stabilisiert. Unter Einbeziehung von 5 früh Verstorbenen, betr?gt die mittlere überlebenszeit 9,5 Monate. Bei Entlassung der überlebenden aus station?rer Behandlung waren mit einer Ausnahme alle Patienten gehf?hig. In der Regel kamen Verbundosteosynthesen, bevorzugt der ventrale Zugang, zur Anwendung. Die pr?operative Embolisation war ein unverzichtbarer Bestandteil des Managements. Die operative Behandlung der Wirbels?ulenmetastasen ist eine segensreiche Methode, die in das gesamte Behandlungskonzept der bedauernswerten Patienten frühzeitig integriert werden sollte. Hochgradige Paresen oder Paralysen, insbesondere nach fudroyantem Verlauf, nicht kontrollierte Prim?rtumoren und spezielle Tumoren, z. B. das Bronchialkarzinom sowie gastrointestinale Karzinome, sind auch in der eigenen Serie indikatorisch eher kritisch zu sehen.      

Metabolic effects of i.v. propacetamol, metamizol or external cooling in critically ill febrile sedated patients

We have measured the metabolic response to sequential administration of propacetamol, metamizol and/or external cooling in 20 febrile patients under sedation and analgesia and during mechanical ventilation. There was no change in temperature (T degree) after propacetamol therapy, whereas after metamizol only a small decrease was noted (from 38.9 (SEM 0.2) to 38.5 (0.3) degrees C; P = 0.02). External cooling produced a significant decrease in T degree (39.1 (0.2) to 37.1 (0.2) degrees C; P < 0.0001) accompanied by a decrease in energy expenditure (EE) (2034 (73) to 1791 (88) kcal day-1; P < 0.004). Heart rate and minute ventilation decreased significantly in parallel. There were no other changes in haemodynamics or pulmonary gas exchanges. We conclude that propacetamol and metamizol did not produce a clinically significant decrease in T degree in febrile ICU patients whereas external cooling decreased both T degree and EE. The parallel decrease in body temperature and EE seemed to be related to opioid administration or sedation, or both.      

Traumatic or septic aortic regurgitation: diagnosis by oesophageal echocardiography

Severe aortic regurgitation was discovered in a young man 21 days after blunt chest trauma and after a prolonged febrile state with positive blood cultures. Using transoesophageal echocardiography (TEE), it was possible to make the differential diagnosis between traumatic rupture and endocarditis as the cause of valvular insufficiency. The use of TEE in the initial evaluation of severe thoracic trauma with an unclear clinical picture is recommended. This method is easy to use at the bedside and gives precise information on the aortic valve and the ascending aorta.     

Intracerebral haemorrhage as a manifestation of Lyme Neuroborreliosis?

Lyme Neuroborreliosis (LNB) has repeatedly been reported to cause cerebral vasculitis. However, there is no reliable information about the incidence of cerebral vessel affection. The majority of reports deal with ischaemic consequences, and there are a few reports of subarachnoid haemorrhage (SAH). We report a case of otherwise unexplained intracerebral haemorrhage (ICH) where clinical and laboratory tests have shown LNB. Late stage LNB might not only cause ischaemic, but haemorrhagic stroke as well.     

Pulmonary sequelae of long-term ventilation of very low birth weight premature infants. Results of a follow-up study of 6-to-9-year-old children

Fifty six children with a birth weight of less than 1500 g and gestational age less than 34 weeks were studied at a mean age of 7.7 years. All had required mechanical ventilation, 36 suffered from hyaline membrane disease, 17 from atelectasis and three from pneumonia. Of these patients 37 developed broncho-pulmonary dysplasia (BPD). The study included skin prick test, measurement of ciliary beat frequency, chest X-ray, whole-body plethysmography and histamine challenge. Eight patients suffered from recurrent pulmonary infections up to the age of 4 years. Eleven children had a positive skin prick test. Three suffered from allergic asthma and six from hay-fever. The family history of atopy in these premature infants was no different from that of the general population. Ciliary beat frequency was normal in all cases (frequency: 11.8 +/- 1.8 Hz). In 34 patients X-rays showed minimal changes (peribronchial thickening n = 6, mild emphysema n = 28). Pulmonary function was normal except for an increase of thoracic gas volume which was correlated to grade of BPD according to Northway. There was a significant correlation between oxygen-score and radiological stage of BPD (r = 0.7). Histamine challenge showed hyperresponsiveness in 53% of the children. Eight patients showed a threshold similar of mild asthma (less than 1000 micrograms histamine per ml). The degree of airway hyperreactivity was correlated to the grade of BPD (r = 0.7; p less than 0.01) and the oxygen-score (r = -0.63; p less than 0.05). The oxygen-score may be considered a predictor of hyperresponsiveness and pulmonary outcome in later childhood.     

Antitumor effect of synthetic derivatives of lipid A in an experimental model of colon cancer in the rat

Colon carcinoma is one of the most frequent causes of cancer death in industrialized countries. The patients generally die of the metastases. In a colon cancer rat model, the authors have shown that lipopolysaccharides from Escherichia coli induced the regression of carcinomatosis and cured 20%-30% of the rats. Some synthetic derivatives of lipid A, which are less toxic than lipopolysaccharides, were injected 14 days after the tumor cells. They induced the complete regression of peritoneal carcinomatosis consisting of numerous nodules measuring 1-5 mm in 20%-30% of rats. Only compounds with three or more hydroxymyristic acid residues were effective. In vivo effects were correlated with the capacity to induce the production of interleukin 1 and tumor necrosis factor but not with the capacity to induce macrophage-mediated cytolysis. It is therefore possible to synthesize weakly toxic derivatives of lipopolysaccharides retaining their antitumoral property in vivo.     

Cisplatinum Dose Dependent Response in Germ Cell Cancer Evaluated by Tumour Marker Modelling

This study presents an analysis on longitudinal tumour marker series in twenty-two patients with non-seminomatous germ cell cancers treated with cisplatinum (DDP) based combination chemotherapy. Series of alphafoetoprotein (AFP), human chorionic gonadotropin (HCG) and lactate dehydrogenase (LDH) were analyzed applying a dynamic mathematical marker model. The model analysis provided quantitated values for growth rate and treatment response in the marker producing cells. The analysis showed that LDH had to be above 2 000 U/l to be a trustworthy tumour marker. HCG producing cells tended to grow faster than AFP producing cells, and were 3-5-fold more sensitive to the chemotherapy given than AFP producing cells. Treatment response versus DDP dose appeared to be bi-phasic, but with no significant change in treatment efficiency within the given range of DDP doses.     

体外循环术后低钾血症370例的护理

1临床资料我院1996-01/2004-12体外循环下行心内直视手术370例,其中先心病240例,冠状动脉搭桥术55例,风心病瓣膜置换术75例,年龄1.5～74.0岁.