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1.
Hans D de Boer Jan van Egmond Jacques J Driessen Leo HD Booij 《Neuropsychiatric Disease and Treatment》2007,3(5):539-544
Steroidal neuromuscular blocking agents (NMBAs), such as rocuronium, are widely used in clinical anesthesia and emergency medicine to facilitate endotracheal intubation and artificial ventilation and to allow surgical access to body cavities. Reversal of neuromuscular blockade is important for the acceleration of patient recovery and prevention of postoperative residual neuromuscular blockade and reduces the incidence of severe morbidity and mortality associated with anesthesia management. Sugammadex is the first selective relaxant binding agent (SRBA) and has been designed to reverse the steroidal neuromuscular blocking drug rocuronium. Encapsulation of the rocuronium molecule by sugammadex results in a rapid decrease in free rocuronium in the plasma and subsequently at the nicotinic receptor at the motor endplate. After encapsulation, rocuronium is not available to bind to the nicotinic receptor in the neuromuscular junction. This promotes the liberation of acetylcholine receptors, and muscle activity reappears. This new concept of reversal of neuromuscular block induced by rocuronium (or vecuronium) led to impressive results in animal and phase 1 and 2 studies. Sugammadex is currently in phase 3 clinical studies and may be commercially available by 2008. 相似文献
2.
Christoph R?cken Jutta Ernst Ernst Hund Hartmut Michels Jolanta Perz Wolfgang Saeger Orhan Sezer Simone Spuler Friedrich Willig und Hartmut H.-J. Schmidt 《Medizinische Klinik》2006,101(10):825-829
Ohne Zusammenfassung 相似文献
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In vitro and in vivo precipitation of iodinated contrast agents when ioxaglate and papaverine are given together has been reported. To verify these reports and to investigate other medications not previously tested, the authors analyzed mixtures of contrast agents and medications in vitro with a light spectrophotometer and observed them for visible precipitates for up to 120 minutes. Previously reported incompatibilities between ionic or low-osmolality contrast media and medications were verified, and several new incompatibilities were discovered. No incompatibilities were found when the drugs tested were mixed with the new nonionic contrast media. 相似文献
5.
Zusammenfassung. Die Umsetzung radikaler onkologischer Grunds?tze der Tumorchirurgie mit laparoskopischen Operationsmethoden ist zur Zeit
nicht gesichert. Minimal-invasive Techniken für die R0-Resektion maligner Tumoren stehen noch in der Phase der kritischen
Evaluation. Dagegen sind laparoskopische, palliative Eingriffe zur Minimierung des Operationstraumas durchaus indiziert. Eine
Vielzahl von Publikationen belegt die technische Durchführbarkeit bei vertretbarem Operationsrisiko und verkürztem Krankenhausaufenthalt.
Trotzdem wird aus verschiedenen Gründen (Voroperationen, unsichere Resektabilit?t, Einsatz interventioneller Methoden etc.)
das laparoskopische Vorgehen zur Palliation maligner Tumoren offenbar nur in kleinen Patientenserien realisiert. Am h?ufigsten
wird über die palliative Anlage von Gastro- oder Jejunostomien zur enteralen Ern?hrung berichtet. Bei pr?operativ gesicherter
Palliativsituation lie?e sich der Anteil laparoskopischer Operationen sehr wahrscheinlich steigern, wenn das minimal-invasive
Vorgehen im differentialtherapeutischen Spektrum fester verankert wird. Für den laparoskopisch erfahrenen Chirurgen sind die
Methoden in der Regel technisch einfach durchführbar. Der unmittelbare Nutzen für den Patienten nach palliativ-laparoskopischer
Resektion tumortragender Abschnitte des Gastrointestinaltrakts ist derzeit noch nicht gesichert. Wenn die Inkurabilit?t w?hrend
einer diagnostischen Laparoskopie festgestellt wird, bietet sich die unmittelbar anschlie?ende, laparoskopische Palliation
in gleicher Sitzung an.
相似文献
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Frank Makowiec Stefan Post Hans-Detlev Saeger Norbert Senninger Heinz Becker Michael Betzler Heinz J. Buhr Ulrich T. Hopt German Advanced Surgical Treatment Study Group 《Journal of gastrointestinal surgery》2005,9(8):1080-1087
Despite decreasing mortality rates, morbidity is still high after pancreatic head resection. Comparative data in the United
States and Europe show a relationship between hospital volume and mortality. Treatment strategies vary frequently, partially
because of the lack of evidence-based data. We performed a multi-institutional analysis in Germany evaluating current numbers,
indications, techniques, and complication rates of pancreatic head resection. Questionnaires were completed by seven high-volume
surgical departments regarding quantitative and qualitative aspects of pancreatic head resections in the period from 1999
to 2004 (five prospective and two retrospective institutional databases). A total of 1454 pancreatic head resections (944
for malignancy) were reported. Mean annual hospital volume ranged from 14 to 52 (10 to 43 in malignancy). Mortality was between
1.1% and 4.8%, morbidity was between 24% and 46%, and pancreatic leakage was between 9% and 20%. In malignant disease, all
centers perform standard lymphadenectomy and regard arterial infiltration as a contraindication for resection. However, the
rate of portal vein resection varied from 0% to 28%. No consensus is seen on the type of surgery for malignancy and chronic
pancreatitis. After resection for pancreatic cancer less than one fourth of the patients receive adjuvant therapy. The results
of our analysis in Germany confirm that pancreatic head resection can be performed with low mortality in specialized units.
Variations in indications, operative technique, and perioperative care may demonstrate the lack of evidence-based data and/or
personal and institutional experience. The low number of patients receiving adjuvant therapy after resection of pancreatic
cancer suggests that more efforts must be made to establish novel adjuvant therapies under randomized study conditions.
Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–18,
2005 (oral presentation). 相似文献
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Parental and professional responses to questionnaires evaluating a paediatric disability service are reported and the viability of auditing structural, process, and outcome aspects of clinical practice are discussed. Expectations of waiting time to first appointment (met for only 52% of consumers) illustrate structural issues. Process issues are reflected in consumer reactions to outreach work (for example, 94% of parents and 84% of professionals found this supportive). Outcome measures such as consumer satisfaction with the service (76% of consumers reported being 'very satisfied' and 20% 'fairly satisfied') suggest that service aims are being met. Good concurrence of service aims with consumer needs is indicated by parental reasons for referral (for example, 75% for diagnostic help, 73% for a better understanding of the disorder, 88% for practical help), referrers' reasons (for example, 55% for a second diagnostic opinion, 45% due to lack of local expertise), and reports from most other professionals involved with the case that a similar service was not provided locally. 相似文献