Sichere Lagekontrolle von Magensonden: ein oft unterschätztes Thema zur Vermeidung potenziell schwerwiegender Komplikationen

Die Anaesthesiologie - Die Anlage einer Magensonde im OP oder auf einer Intensivstation (ITS) stellt eine alltäglich durchgeführte Prozedur dar. Obwohl die Sonde häufig durch...     

Allergic contact dermatitis from phenylephrine in eyedrops.

Phenylephrine is widely used as an ophthalmic drug. However, there are only very few reports on allergic contact dermatitis induced by phenylephrine. In addition, little is known on cross reactivity patterns between the sympathomimetics phenylephrine, epinephrine and ephedrine which share a similar chemical structure. We report on a man who developed allergic contact dermatitis to Neosynerphin POS eyedrops containing phenylephrine hydrochloride. Cross reactivity between phenylephrine, epinephrine and ephedrine was studied by patch testing. Patch tests were performed with the European standard, an ophthalmics and preservatives series, Neosynerphin POS eyedrops, phenylephrine hydrochloride 10% aq., epinephrine and ephedrine (both 1.0 % aq.). Test sites were read after 48, 72 and 168 hours according to the recommendations of the ICDRG. Neosynerphin POS and phenylephrine hydrochloride 10 % aq. gave positive reactions, whereas epinephrine and ephedrine tested negative. Although phenylephrine is an epinephrine analog delayed type hypersensitivity to phenylephrine did not result in cross reactivity with chemically related epinephrine and ephedrine.     

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123I-amphetamine-SPECT in classical migraine and migraine accompagnée

Migraine is considered to be a functional neurological disorder. In classical migraine (headache associated with prodromal visual field disturbances) and migraine accompagnée (headache associated with transient neurological symptoms), disturbances of cerebral blood flow and amine metabolism are thought to be pathogenetic factors. However, conventional methods of neuroimaging (CAT, NMR) usually do not yield any pathological findings in patients. Since 123I-iodoamphetamine (123I-IMP) crosses the intact blood brain barrier, 123I-IMP-SPECT is used for the assessment of cerebral perfusion in various neurological diseases, including functional disorders. 123I-IMP-SPECT was performed on 5 patients with classical migraine and 18 patients with migraine accompagnée. At the time of investigation, all patients were symptom-free. Cerebral blood flow was decreased in all patients with migraine accompagnée, and often corresponded to the site of headache as well as to the topography of transient neurological symptoms. This reduction was most obvious in a patient with persisting neurological symptoms. Most patients with classical migraine, however, did not show any alteration of cerebral perfusion. It appears that migraine--and in particular migraine accompagnée--is characterized by a permanent alteration not only of cerebral blood flow but also of neuronal activity. Migraine attacks may occur in connection with exacerbations of preexisting metabolic alterations.     

In vivo effects of nifedipine and BAY 1 8201 on ceruletide induced gallbladder contraction

Studies in animals suggest that calcium channel blockers may influence gallbladder contraction. In order to study possible actions in man we examined by ultrasonography the effects of two dihydropyridine derivatives, i.e. nifedipine (20 mg p. o.) and BAY 1 8201 (100 mg p.o.) on ceruletide induced human gallbladder contraction in 9 healthy male volunteers in a randomized, double-blind, three fold crossover study (latin square design). Blood samples for the measurement of plasma drug concentrations were drawn before and at regular intervals up to 8 h after drug ingestion. Ceruletide decreased gallbladder volumes by 52.1 +/- 8.2% (mean +/- 1 SEM) after nifedipine, 53.1 +/- 8.1% after BAY 1 8201 and by 59.3 +/- 10.1% after placebo (NS). Peak plasma concentrations of 53.7 x/: 2.3 ng/ml (geometric mean x/: geometric standard deviation) and of 35.5 x/: 1.5 ng/ml were reached after oral application of nifedipine and BAY 1 8201, respectively. We conclude that human gallbladder contraction in response to ceruletide is not markedly influenced by dihydropyridine derivates in the dosages used in this study. The results reported here stress the importance of calcium released from intracellular stores for the contractility of smooth muscle in the human gallbladder.     

Ueber apoplectiforme (und epileptiforme) Anfälle in frühen Stadien oder im Verlauf der Tabes

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Accidental Occupational Farm Fatalities in North Carolina: 1984 to 1988

Development of interventions to prevent accidental occupational fatalities requires the prior identification of those at risk and the circumstances surrounding the injuries. A survey of unintentional farm fatalities was conducted using medical examiner reports (RIME) and death certificates (MECD) to identify deaths due to agricultural occupational injuries in North Carolina from 1984 through 1988. Of 393 cases, 123 met the criteria "farmer" listed as occupation on the RIME/MECD and/or "victim" in a rural area performing a farming task when injured. A second aim of this study was to use an existing data base to achieve maximum accuracy in identifying true cases of work-related farm fatalities.
A fatality rate of 41/100,000 agricultural workers was found; the National Institutes of Occupational Safety and Health's National Traumatic Occupational Fatality study criteria would have identified only 57 percent of these. Victims were characterized as middle age (53 years), white (76%), male (100%), full-time farmers (65%). Injury occurred during harvest season on Monday or Tuesday (47%) between 2 and 6 p.m. (54%). Death was pronounced at the scene (74%), with probable cause listed as tractor (62%). Injury location and land elevation were also related, with the mountain region having twice the fatality rate as the coastal plains region.