Thoracoabdominal aortic aneurysm (TAAA) is a highly lethal disorder requiring open or endovascula... more Thoracoabdominal aortic aneurysm (TAAA) is a highly lethal disorder requiring open or endovascular TAAA repair, both of which are rare, but extensive and complex surgical procedures associated with a significant systemic inflammatory response and high post-operative morbidity and mortality. Heparanase is a β-d-endoglucuronidase that remodels the endothelial glycocalyx by degrading heparan sulfate in many diseases/conditions associated with systemic inflammation including sepsis, trauma, and major surgery. We hypothesized that (a) perioperative serum levels of heparanase and heparan sulfate are associated with the clinical course after open or endovascular TAAA repair and (b) induce a systemic inflammatory response and renal injury/dysfunction in mice. Using a reverse-translational approach, we assessed (a) the serum levels of heparanase, heparan sulfate, and the heparan sulfate proteoglycan syndecan-1 preoperatively as well as 6 and 72 h after intensive care unit (ICU) admission in ...
; for the SepNet-Critical Care Trials Group IMPORTANCE Adjunctive hydrocortisone therapy is sugge... more ; for the SepNet-Critical Care Trials Group IMPORTANCE Adjunctive hydrocortisone therapy is suggested by the Surviving Sepsis Campaign in refractory septic shock only. The efficacy of hydrocortisone in patients with severe sepsis without shock remains controversial. OBJECTIVE To determine whether hydrocortisone therapy in patients with severe sepsis prevents the development of septic shock.
Septic cardiomyopathy affects up to 70% of patients with septic shock and the derangement of card... more Septic cardiomyopathy affects up to 70% of patients with septic shock and the derangement of cardiac mitochondrial function contributes to the likelihood of death. However, at present, there is no specific therapeutic drug available. The peroxisome proliferator-activated receptor (PPAR)-γ coactivator-1α (PGC-1α) and coactivator-1β (PGC-1β) modulate members of the PPARs, which regulate mitochondrial energy metabolism and the production of mitochondrial reactive oxygen species in the heart. This study investigated the potential of the newly developed synthetic antimicrobial peptide 19-2.5 (Pep2.5) to attenuate mitochondrial dysfunction in murine cardiomyocytes stimulated with serum from septic shock patients. Pep2.5 treatment attenuated the suppression of PPAR-α, PPAR-γ (P = 0.0004 and P = 0.0001, respectively) and PGC-1α/β (P = 0.0008 and P = 0.0147, respectively) in cardiomyocytes stimulated with serum from septic shock patients compared with untreated cells. Pep2.5 treatment enhanc...
Acetaminophen (APAP, paracetamol) poisoning is a leading cause of acute liver failure (ALF) in hu... more Acetaminophen (APAP, paracetamol) poisoning is a leading cause of acute liver failure (ALF) in humans and induces hepatocyte necrosis, followed by the activation of the innate immune system further aggravating liver injury. The role of infiltrating monocytes during the early phase of ALF is still ambiguous. Upon experimental APAP overdose in mice, monocyte-derived macrophages (MoMF) massively accumulate in injured liver within 12-24h, while the number of tissue-resident macrophages (Kupffer cells) decreases. The influx of MoMF is dependent on the chemokine receptor CCR2, since Ccr2(-/-) mice display reduced infiltration of monocytes and attenuated liver injury after APAP overdose at early time-points. As evidenced by intravital multiphoton microscopy of Ccr2-reporter mice, CCR2(+) monocytes infiltrate liver as early as 8-12h after APAP overdose and form dense cellular clusters around necrotic areas. The CCR2(+) MoMF express a distinct pattern of inflammatory but also repair-associat...
Background: In this observational study near infrared spectroscopy (NIRS) was evaluated as a non-... more Background: In this observational study near infrared spectroscopy (NIRS) was evaluated as a non-invasive monitor of impaired tissue oxygenation (StO 2) after cardiac surgery. StO 2 , cardiac output, mixed venous oxygen saturation and mean arterial pressure were compared with lactate clearance as established measure for sufficient tissue perfusion and oxygen metabolism. Methods: Forty patients after cardiac surgery (24 aortocoronary bypass grafting, 5 heart valve, 3 ascending aorta and 8 combined procedures) were monitored until postoperative day 1 with NIRS of the thenar muscle (InSpectra™ StO 2-monitor, Hutchinson Technology), a pulmonary-artery catheter and intermittent blood gas analyses for the assessment of lactate clearance. Results: StO 2 was reduced 4 h after surgery (75 ± 6 %), but recovered at day 1 (84 ± 5 %), while lactate concentration remained increased. Using uni-and multivariate regression analysis, minimum StO 2 (r = 0.46, p <0.01) and cardiac index (r = 0.40, p <0.05) correlated with lactate clearance at day 1, while minimum mixed venous saturation and mean arterial pressure did not. In a receiver-operating characteristics (ROC) analysis, minimum StO 2 (with a threshold of 75 %) predicted a lactate clearance <10 % at day 1 with an area under the ROC-curve of 0.83, a sensitivity of 78 % and a specificity of 88 %. In the subgroup with StO 2 <75 %, troponin and creatine kinase MB were significantly increased at day 1. Conclusions: StO 2 below 75 % in the first hours after surgery was a better early indicator of persistent impaired lactate clearance at day 1 than cardiac index, mixed venous oxygen saturation or mean arterial pressure.
Mixed venous and central venous oxygen saturations reflect the balance between oxygen requirement... more Mixed venous and central venous oxygen saturations reflect the balance between oxygen requirement and oxygen delivery, and thus may be used to assess the adequacy of tissue oxygenation. This review discusses recent data on the impact of using venous oximetry by obtaining mixed venous oxygen saturation or central venous oxygen saturation as useful monitoring parameters in critically ill patients. Monitoring of changes in the central venous oxygen saturation after major surgery has been shown to be associated with outcome. Furthermore, early goal-directed therapy for patients with severe sepsis or septic shock, which includes treatment goals for mean arterial pressure, central venous pressure, and central venous oxygen saturation, was able to increase survival in these patients. In contrast, pulmonary artery catheter usage does not affect outcome in critically ill patients. Early goal-directed therapy should be implemented in the initial resuscitation of septic patients. Central venou...
Macrophage activation by bacterial lipopolysaccharides (LPS) is induced through Toll-like recepto... more Macrophage activation by bacterial lipopolysaccharides (LPS) is induced through Toll-like receptor 4 (TLR4). The synthesis and activity of TLR4 downstream signaling molecules modulates the expression of pro- and anti-inflammatory cytokines. To address the impact of post-transcriptional regulation on that process, we performed RIP-Chip analysis. Differential association of mRNAs with heterogeneous nuclear ribonucleoprotein K (hnRNP K), an mRNA-specific translational regulator in differentiating hematopoietic cells, was studied in noninduced and LPS-activated macrophages. Analysis of interactions affected by LPS revealed several mRNAs encoding TLR4 downstream kinases and their modulators. We focused on transforming growth factor-β-activated kinase 1 (TAK1) a central player in TLR4 signaling. HnRNP K interacts specifically with a sequence in the TAK1 mRNA 3′ UTR in vitro. Silencing of hnRNP K does not affect TAK1 mRNA synthesis or stability but enhances TAK1 mRNA translation, resulting...
Introduction The aim of the study was to evaluate some of the underlying pathomechanisms of hydro... more Introduction The aim of the study was to evaluate some of the underlying pathomechanisms of hydroxyethylstarch (HES) induced adverse effects on renal function using 24 porcine kidneys in an isolated perfusion model over six hours. Methods Infusion of either 10% HES 200/0.5, 6% HES 130/ 0.42 or Ringer's lactate (RL) was performed to achieve an haematocrit of 20% in eight kidneys from four animals per group. Physiological and pathophysiological parameters were determined (including N-acetyl-beta-aminoglucosidase as a marker for lysosomal tubular damage). Histological investigations and immunohistological stainings of the kidneys were performed.
In order to find out the frequency rates of domestic and wild animal bites as well as the evaluat... more In order to find out the frequency rates of domestic and wild animal bites as well as the evaluation of the prevalence rates of rabies disease in the human population in the Province of Kerman, a retrospective study was designed to analyze statistically the collected recorded data related to this project. Methods This study was conducted within the framework of MPVM student research projects by means of collaboration
In order to find out the frequency rates of domestic and wild animal bites as well as the evaluat... more In order to find out the frequency rates of domestic and wild animal bites as well as the evaluation of the prevalence rates of rabies disease in the human population in the Province of Kerman, a retrospective study was designed to analyze statistically the collected recorded data related to this project. Methods This study was conducted within the framework of MPVM student research projects by means of collaboration
In order to find out the frequency rates of domestic and wild animal bites as well as the evaluat... more In order to find out the frequency rates of domestic and wild animal bites as well as the evaluation of the prevalence rates of rabies disease in the human population in the Province of Kerman, a retrospective study was designed to analyze statistically the collected recorded data related to this project. Methods This study was conducted within the framework of MPVM student research projects by means of collaboration
Crit Care 1999, 3 3 ((s su up pp pl l 1 1)):P1 I In nt tr ro od du uc ct ti io on n: : Critically... more Crit Care 1999, 3 3 ((s su up pp pl l 1 1)):P1 I In nt tr ro od du uc ct ti io on n: : Critically ill patients requiring intensive care are at risk of iatrogenic ocular damage. Studies have reported an incidence of eye problems of up to 40% in critically ill ventilated patients. We conducted this study to assess the incidence of ocular complications in our intensive care unit where all patients are cared for according to an eye care standard. M Me et th ho od ds s: : All ventilated patients over a 2 month period were included. Ophthalmic assessment was performed on admission and repeated every other day during the period of ventilation. At each assessment the average Ramsey sedation score over the previous 24 h, the presence of tracheal secretions and the presence of ventilation associated pneumonia was noted. Eye care performed was recorded. R Re es su ul lt ts s: : Sixty patients were included. One patient developed corneal exposure keratopathy. No patient developed conjunctivitis or corneal ulceration. Further advice on appropriate measures of eye care was given in five cases (8%). Nine patients (15%) had large amounts of respiratory secretions with positive microbiological results. C Co on nc cl lu us si io on n: : This study confirms that the use of an eye care standard is associated with a low incidence of ocular surface complications. The incidence of ocular complications in this group of patients is far lower than previously described.
Crit Care 1999, 3 3 ((s su up pp pl l 1 1)):P1 I In nt tr ro od du uc ct ti io on n: : Critically... more Crit Care 1999, 3 3 ((s su up pp pl l 1 1)):P1 I In nt tr ro od du uc ct ti io on n: : Critically ill patients requiring intensive care are at risk of iatrogenic ocular damage. Studies have reported an incidence of eye problems of up to 40% in critically ill ventilated patients. We conducted this study to assess the incidence of ocular complications in our intensive care unit where all patients are cared for according to an eye care standard. M Me et th ho od ds s: : All ventilated patients over a 2 month period were included. Ophthalmic assessment was performed on admission and repeated every other day during the period of ventilation. At each assessment the average Ramsey sedation score over the previous 24 h, the presence of tracheal secretions and the presence of ventilation associated pneumonia was noted. Eye care performed was recorded. R Re es su ul lt ts s: : Sixty patients were included. One patient developed corneal exposure keratopathy. No patient developed conjunctivitis or corneal ulceration. Further advice on appropriate measures of eye care was given in five cases (8%). Nine patients (15%) had large amounts of respiratory secretions with positive microbiological results. C Co on nc cl lu us si io on n: : This study confirms that the use of an eye care standard is associated with a low incidence of ocular surface complications. The incidence of ocular complications in this group of patients is far lower than previously described.
Background: Whole body hyperthermia induced by radiative systems has been used in therapy of mali... more Background: Whole body hyperthermia induced by radiative systems has been used in therapy of malignant diseases for more than ten years. Von Ardenne and co-workers have developed the 'systemiche Krebs-Mehrschritt-Therapic' (sKMT), a combined regime including whole body hyperthermia of 42°C, induced hyperglycaemia and relative hyperoxaemia with additional application of chemotherapy. This concept has been employed in a phase I/II clinical study for patients with metastatic colorectal carcinoma at the Virchow-Klinikum since January 1997. Methods: The sKMT concept was performed eleven times under intravenous general anaesthesia, avoiding volatile anaesthetics. Core temperatures of up to 42°C were reached stepwise by warming with infrared-A-radiation (IRATHERM 2000®). During the whole procedure blood glucose levels of 380-450 mg/dl were maintained as well as PaO 2 levels above 200 mmHg. Extensive invasive monitoring was performed in all patients including measurements with the REF-Ox-Pulmonary artery catheter with continuous measuring of mixed venous saturation (Baxter Explorer®) and invasive monitoring of arterial blood pressure. Data for calculation of hemodynamic and gas exchange parameters were collected four times, at temperatures of 37°C, 40°C, 41.8-42°C and 39°C, during measurements FiO 2 was 1.0 at all times. Fluids were given in order to keep central-venous and Wedge pressure within normal range during the whole procedure. Statistics were performed using the Wilcoxon Test. Results: Statistically significant differences were found between heart rate, cardiac index and systemic vascular resistance comparing data at 37°C and 42°C. Heart rate and cardiac index increased to a maximum at 42°C (P < 0.0001) whereas systemic vascular resistance had its minimum at 42°C (P < 0.0001). Mean arterial pressure dropped with increasing temperature, differences were not significant. Calculation of stroke volume index and ventricular volumes showed only a slight decrease in endsystolic volumes with increasing temperature, the resulting differences in right ventricular ejection fraction were marginally significant (P = 0.038) comparing 42°C to baseline. Right ventricular stroke work index as well as mean pulmonary arterial pressure increased at 42°C (P = 0.0115 and P = 0.0037), pulmonary vascular resistance only dropped little compared to systemic vascular resistance, left ventricular stroke work index even dropped with increasing temperature, though showing no significant difference. Values for mixed venous oxygen saturation did not vary during therapy, pulmonary right-left shunt showed a temperature associated increase (P = 0.0323) to a maximum at 42°C. Conclusion: Under the procedure of sKMT cardiac function in patients, who do not have any pre-existing cardiac impairment, can be maintained almost unchanged, ie with normal right and left ventricular pressure, despite an increase in right ventricular stroke work Acknowledegment: Supported by Deutsche Krebshilfe.
In order to find out the frequency rates of domestic and wild animal bites as well as the evaluat... more In order to find out the frequency rates of domestic and wild animal bites as well as the evaluation of the prevalence rates of rabies disease in the human population in the Province of Kerman, a retrospective study was designed to analyze statistically the collected recorded data related to this project. Methods This study was conducted within the framework of MPVM student research projects by means of collaboration
Thoracoabdominal aortic aneurysm (TAAA) is a highly lethal disorder requiring open or endovascula... more Thoracoabdominal aortic aneurysm (TAAA) is a highly lethal disorder requiring open or endovascular TAAA repair, both of which are rare, but extensive and complex surgical procedures associated with a significant systemic inflammatory response and high post-operative morbidity and mortality. Heparanase is a β-d-endoglucuronidase that remodels the endothelial glycocalyx by degrading heparan sulfate in many diseases/conditions associated with systemic inflammation including sepsis, trauma, and major surgery. We hypothesized that (a) perioperative serum levels of heparanase and heparan sulfate are associated with the clinical course after open or endovascular TAAA repair and (b) induce a systemic inflammatory response and renal injury/dysfunction in mice. Using a reverse-translational approach, we assessed (a) the serum levels of heparanase, heparan sulfate, and the heparan sulfate proteoglycan syndecan-1 preoperatively as well as 6 and 72 h after intensive care unit (ICU) admission in ...
; for the SepNet-Critical Care Trials Group IMPORTANCE Adjunctive hydrocortisone therapy is sugge... more ; for the SepNet-Critical Care Trials Group IMPORTANCE Adjunctive hydrocortisone therapy is suggested by the Surviving Sepsis Campaign in refractory septic shock only. The efficacy of hydrocortisone in patients with severe sepsis without shock remains controversial. OBJECTIVE To determine whether hydrocortisone therapy in patients with severe sepsis prevents the development of septic shock.
Septic cardiomyopathy affects up to 70% of patients with septic shock and the derangement of card... more Septic cardiomyopathy affects up to 70% of patients with septic shock and the derangement of cardiac mitochondrial function contributes to the likelihood of death. However, at present, there is no specific therapeutic drug available. The peroxisome proliferator-activated receptor (PPAR)-γ coactivator-1α (PGC-1α) and coactivator-1β (PGC-1β) modulate members of the PPARs, which regulate mitochondrial energy metabolism and the production of mitochondrial reactive oxygen species in the heart. This study investigated the potential of the newly developed synthetic antimicrobial peptide 19-2.5 (Pep2.5) to attenuate mitochondrial dysfunction in murine cardiomyocytes stimulated with serum from septic shock patients. Pep2.5 treatment attenuated the suppression of PPAR-α, PPAR-γ (P = 0.0004 and P = 0.0001, respectively) and PGC-1α/β (P = 0.0008 and P = 0.0147, respectively) in cardiomyocytes stimulated with serum from septic shock patients compared with untreated cells. Pep2.5 treatment enhanc...
Acetaminophen (APAP, paracetamol) poisoning is a leading cause of acute liver failure (ALF) in hu... more Acetaminophen (APAP, paracetamol) poisoning is a leading cause of acute liver failure (ALF) in humans and induces hepatocyte necrosis, followed by the activation of the innate immune system further aggravating liver injury. The role of infiltrating monocytes during the early phase of ALF is still ambiguous. Upon experimental APAP overdose in mice, monocyte-derived macrophages (MoMF) massively accumulate in injured liver within 12-24h, while the number of tissue-resident macrophages (Kupffer cells) decreases. The influx of MoMF is dependent on the chemokine receptor CCR2, since Ccr2(-/-) mice display reduced infiltration of monocytes and attenuated liver injury after APAP overdose at early time-points. As evidenced by intravital multiphoton microscopy of Ccr2-reporter mice, CCR2(+) monocytes infiltrate liver as early as 8-12h after APAP overdose and form dense cellular clusters around necrotic areas. The CCR2(+) MoMF express a distinct pattern of inflammatory but also repair-associat...
Background: In this observational study near infrared spectroscopy (NIRS) was evaluated as a non-... more Background: In this observational study near infrared spectroscopy (NIRS) was evaluated as a non-invasive monitor of impaired tissue oxygenation (StO 2) after cardiac surgery. StO 2 , cardiac output, mixed venous oxygen saturation and mean arterial pressure were compared with lactate clearance as established measure for sufficient tissue perfusion and oxygen metabolism. Methods: Forty patients after cardiac surgery (24 aortocoronary bypass grafting, 5 heart valve, 3 ascending aorta and 8 combined procedures) were monitored until postoperative day 1 with NIRS of the thenar muscle (InSpectra™ StO 2-monitor, Hutchinson Technology), a pulmonary-artery catheter and intermittent blood gas analyses for the assessment of lactate clearance. Results: StO 2 was reduced 4 h after surgery (75 ± 6 %), but recovered at day 1 (84 ± 5 %), while lactate concentration remained increased. Using uni-and multivariate regression analysis, minimum StO 2 (r = 0.46, p <0.01) and cardiac index (r = 0.40, p <0.05) correlated with lactate clearance at day 1, while minimum mixed venous saturation and mean arterial pressure did not. In a receiver-operating characteristics (ROC) analysis, minimum StO 2 (with a threshold of 75 %) predicted a lactate clearance <10 % at day 1 with an area under the ROC-curve of 0.83, a sensitivity of 78 % and a specificity of 88 %. In the subgroup with StO 2 <75 %, troponin and creatine kinase MB were significantly increased at day 1. Conclusions: StO 2 below 75 % in the first hours after surgery was a better early indicator of persistent impaired lactate clearance at day 1 than cardiac index, mixed venous oxygen saturation or mean arterial pressure.
Mixed venous and central venous oxygen saturations reflect the balance between oxygen requirement... more Mixed venous and central venous oxygen saturations reflect the balance between oxygen requirement and oxygen delivery, and thus may be used to assess the adequacy of tissue oxygenation. This review discusses recent data on the impact of using venous oximetry by obtaining mixed venous oxygen saturation or central venous oxygen saturation as useful monitoring parameters in critically ill patients. Monitoring of changes in the central venous oxygen saturation after major surgery has been shown to be associated with outcome. Furthermore, early goal-directed therapy for patients with severe sepsis or septic shock, which includes treatment goals for mean arterial pressure, central venous pressure, and central venous oxygen saturation, was able to increase survival in these patients. In contrast, pulmonary artery catheter usage does not affect outcome in critically ill patients. Early goal-directed therapy should be implemented in the initial resuscitation of septic patients. Central venou...
Macrophage activation by bacterial lipopolysaccharides (LPS) is induced through Toll-like recepto... more Macrophage activation by bacterial lipopolysaccharides (LPS) is induced through Toll-like receptor 4 (TLR4). The synthesis and activity of TLR4 downstream signaling molecules modulates the expression of pro- and anti-inflammatory cytokines. To address the impact of post-transcriptional regulation on that process, we performed RIP-Chip analysis. Differential association of mRNAs with heterogeneous nuclear ribonucleoprotein K (hnRNP K), an mRNA-specific translational regulator in differentiating hematopoietic cells, was studied in noninduced and LPS-activated macrophages. Analysis of interactions affected by LPS revealed several mRNAs encoding TLR4 downstream kinases and their modulators. We focused on transforming growth factor-β-activated kinase 1 (TAK1) a central player in TLR4 signaling. HnRNP K interacts specifically with a sequence in the TAK1 mRNA 3′ UTR in vitro. Silencing of hnRNP K does not affect TAK1 mRNA synthesis or stability but enhances TAK1 mRNA translation, resulting...
Introduction The aim of the study was to evaluate some of the underlying pathomechanisms of hydro... more Introduction The aim of the study was to evaluate some of the underlying pathomechanisms of hydroxyethylstarch (HES) induced adverse effects on renal function using 24 porcine kidneys in an isolated perfusion model over six hours. Methods Infusion of either 10% HES 200/0.5, 6% HES 130/ 0.42 or Ringer's lactate (RL) was performed to achieve an haematocrit of 20% in eight kidneys from four animals per group. Physiological and pathophysiological parameters were determined (including N-acetyl-beta-aminoglucosidase as a marker for lysosomal tubular damage). Histological investigations and immunohistological stainings of the kidneys were performed.
In order to find out the frequency rates of domestic and wild animal bites as well as the evaluat... more In order to find out the frequency rates of domestic and wild animal bites as well as the evaluation of the prevalence rates of rabies disease in the human population in the Province of Kerman, a retrospective study was designed to analyze statistically the collected recorded data related to this project. Methods This study was conducted within the framework of MPVM student research projects by means of collaboration
In order to find out the frequency rates of domestic and wild animal bites as well as the evaluat... more In order to find out the frequency rates of domestic and wild animal bites as well as the evaluation of the prevalence rates of rabies disease in the human population in the Province of Kerman, a retrospective study was designed to analyze statistically the collected recorded data related to this project. Methods This study was conducted within the framework of MPVM student research projects by means of collaboration
In order to find out the frequency rates of domestic and wild animal bites as well as the evaluat... more In order to find out the frequency rates of domestic and wild animal bites as well as the evaluation of the prevalence rates of rabies disease in the human population in the Province of Kerman, a retrospective study was designed to analyze statistically the collected recorded data related to this project. Methods This study was conducted within the framework of MPVM student research projects by means of collaboration
Crit Care 1999, 3 3 ((s su up pp pl l 1 1)):P1 I In nt tr ro od du uc ct ti io on n: : Critically... more Crit Care 1999, 3 3 ((s su up pp pl l 1 1)):P1 I In nt tr ro od du uc ct ti io on n: : Critically ill patients requiring intensive care are at risk of iatrogenic ocular damage. Studies have reported an incidence of eye problems of up to 40% in critically ill ventilated patients. We conducted this study to assess the incidence of ocular complications in our intensive care unit where all patients are cared for according to an eye care standard. M Me et th ho od ds s: : All ventilated patients over a 2 month period were included. Ophthalmic assessment was performed on admission and repeated every other day during the period of ventilation. At each assessment the average Ramsey sedation score over the previous 24 h, the presence of tracheal secretions and the presence of ventilation associated pneumonia was noted. Eye care performed was recorded. R Re es su ul lt ts s: : Sixty patients were included. One patient developed corneal exposure keratopathy. No patient developed conjunctivitis or corneal ulceration. Further advice on appropriate measures of eye care was given in five cases (8%). Nine patients (15%) had large amounts of respiratory secretions with positive microbiological results. C Co on nc cl lu us si io on n: : This study confirms that the use of an eye care standard is associated with a low incidence of ocular surface complications. The incidence of ocular complications in this group of patients is far lower than previously described.
Crit Care 1999, 3 3 ((s su up pp pl l 1 1)):P1 I In nt tr ro od du uc ct ti io on n: : Critically... more Crit Care 1999, 3 3 ((s su up pp pl l 1 1)):P1 I In nt tr ro od du uc ct ti io on n: : Critically ill patients requiring intensive care are at risk of iatrogenic ocular damage. Studies have reported an incidence of eye problems of up to 40% in critically ill ventilated patients. We conducted this study to assess the incidence of ocular complications in our intensive care unit where all patients are cared for according to an eye care standard. M Me et th ho od ds s: : All ventilated patients over a 2 month period were included. Ophthalmic assessment was performed on admission and repeated every other day during the period of ventilation. At each assessment the average Ramsey sedation score over the previous 24 h, the presence of tracheal secretions and the presence of ventilation associated pneumonia was noted. Eye care performed was recorded. R Re es su ul lt ts s: : Sixty patients were included. One patient developed corneal exposure keratopathy. No patient developed conjunctivitis or corneal ulceration. Further advice on appropriate measures of eye care was given in five cases (8%). Nine patients (15%) had large amounts of respiratory secretions with positive microbiological results. C Co on nc cl lu us si io on n: : This study confirms that the use of an eye care standard is associated with a low incidence of ocular surface complications. The incidence of ocular complications in this group of patients is far lower than previously described.
Background: Whole body hyperthermia induced by radiative systems has been used in therapy of mali... more Background: Whole body hyperthermia induced by radiative systems has been used in therapy of malignant diseases for more than ten years. Von Ardenne and co-workers have developed the 'systemiche Krebs-Mehrschritt-Therapic' (sKMT), a combined regime including whole body hyperthermia of 42°C, induced hyperglycaemia and relative hyperoxaemia with additional application of chemotherapy. This concept has been employed in a phase I/II clinical study for patients with metastatic colorectal carcinoma at the Virchow-Klinikum since January 1997. Methods: The sKMT concept was performed eleven times under intravenous general anaesthesia, avoiding volatile anaesthetics. Core temperatures of up to 42°C were reached stepwise by warming with infrared-A-radiation (IRATHERM 2000®). During the whole procedure blood glucose levels of 380-450 mg/dl were maintained as well as PaO 2 levels above 200 mmHg. Extensive invasive monitoring was performed in all patients including measurements with the REF-Ox-Pulmonary artery catheter with continuous measuring of mixed venous saturation (Baxter Explorer®) and invasive monitoring of arterial blood pressure. Data for calculation of hemodynamic and gas exchange parameters were collected four times, at temperatures of 37°C, 40°C, 41.8-42°C and 39°C, during measurements FiO 2 was 1.0 at all times. Fluids were given in order to keep central-venous and Wedge pressure within normal range during the whole procedure. Statistics were performed using the Wilcoxon Test. Results: Statistically significant differences were found between heart rate, cardiac index and systemic vascular resistance comparing data at 37°C and 42°C. Heart rate and cardiac index increased to a maximum at 42°C (P < 0.0001) whereas systemic vascular resistance had its minimum at 42°C (P < 0.0001). Mean arterial pressure dropped with increasing temperature, differences were not significant. Calculation of stroke volume index and ventricular volumes showed only a slight decrease in endsystolic volumes with increasing temperature, the resulting differences in right ventricular ejection fraction were marginally significant (P = 0.038) comparing 42°C to baseline. Right ventricular stroke work index as well as mean pulmonary arterial pressure increased at 42°C (P = 0.0115 and P = 0.0037), pulmonary vascular resistance only dropped little compared to systemic vascular resistance, left ventricular stroke work index even dropped with increasing temperature, though showing no significant difference. Values for mixed venous oxygen saturation did not vary during therapy, pulmonary right-left shunt showed a temperature associated increase (P = 0.0323) to a maximum at 42°C. Conclusion: Under the procedure of sKMT cardiac function in patients, who do not have any pre-existing cardiac impairment, can be maintained almost unchanged, ie with normal right and left ventricular pressure, despite an increase in right ventricular stroke work Acknowledegment: Supported by Deutsche Krebshilfe.
In order to find out the frequency rates of domestic and wild animal bites as well as the evaluat... more In order to find out the frequency rates of domestic and wild animal bites as well as the evaluation of the prevalence rates of rabies disease in the human population in the Province of Kerman, a retrospective study was designed to analyze statistically the collected recorded data related to this project. Methods This study was conducted within the framework of MPVM student research projects by means of collaboration
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