RESUMEN
Recurrent fever lasting for nine months up to ten years occurred in seven women and three men, with fever of up to 39 degrees C lasting from two to seven days. All patients had travelled outside of Germany at least one year previously. Micro-Widal reaction revealed antibodies against Yersinia enterocolitica (serotype 0:3 or 0:9), with a titre of between 1:80 and 1:1280. Antibiotic treatment (doxycycline or cotrimoxazole) brought cure in all ten. The antibody titres fell in seven of nine patients; titres could not be followed in one.
Asunto(s)
Fiebre/etiología , Yersiniosis/diagnóstico , Adulto , Anticuerpos Antibacterianos/análisis , Doxiciclina/uso terapéutico , Combinación de Medicamentos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Sulfametoxazol/uso terapéutico , Trimetoprim/uso terapéutico , Combinación Trimetoprim y Sulfametoxazol , Yersiniosis/complicaciones , Yersiniosis/tratamiento farmacológico , Yersinia enterocolitica/inmunologíaRESUMEN
In a primigravida of 25 years of age who had an attack of eclampsia seven hours after Caesarean section we found an abnormally low oncotic pressure (i.e. colloid osmotic pressure, COP) in the plasma, namely, 14.5 mm Hg instead of the normal value which is greater than 20mm Hg. In EPH-gestosis there is a pathogenetic dependence of the oedemas, hypovolaemia, haemoconcentration and insufficient perfusion of parenchymatous organs, on the transcapillary colloid osmotic pressure gradient. As a result of colloid substitution with human albumin (20-40 g per day) effected with oncometric control, the COP increased stepwise to 18.3 mm Hg within one week and the distribution of fluid between the intravascular and extravascular space normalised. Repeated direct measurement of the colloid osmotic pressure (in our case by Onkometer BMT 921, Thomae) proved extremely helpful especially as a means of therapy control.
Asunto(s)
Eclampsia , Trastornos Puerperales , Adulto , Albúminas/administración & dosificación , Cesárea , Coloides , Eclampsia/fisiopatología , Eclampsia/terapia , Femenino , Humanos , Recién Nacido , Presión Osmótica , Embarazo , Trastornos Puerperales/fisiopatología , Trastornos Puerperales/terapiaRESUMEN
On isolated normothermic and constant-pressure perfused rat-hearts cardioplegic haemoglobin-perfusion was compared with conventional cardioplegic perfusion without haemoglobin. The addition of 4% haemoglobin to the cardioplegic solution guarantees oxygen demand of the pharmacologically arrested heart at physiological PO2 (about 100 mm Hg) of the perfusion-solution, while conventional cardioplegic perfusion without haemoglobin needs arterial PO2 > 600 mm Hg and guarantees oxygen demand of the arrested normotherm rat-heart only under condition of sufficient coronary flow. The coronary flow during constant-pressure cardioplegic haemoglobin-perfusion was about 58% higher than during cardioplegic perfusion without haemoglobin. Interstitial oedema after perfusion for 1 hour was more intense after perfusion with the conventional cardioplegic solution than after cardioplegic haemoglobin-perfusion. Normothermic ischaemia of 20 minutes after perfusion with cardioplegic haemoglobin-solution was connected with a smaller drop of creatinephosphate and adenosinetriphosphate than after conventional cardioplegic perfusion, electron-optical preparations showed smaller changes of the structure. The use of cardioplegic haemoglobin-solutions in heart-surgery and the advantages of cardioplegic haemoglobinperfusion are discussed.
Asunto(s)
Paro Cardíaco Inducido , Hemoglobinas , Perfusión/métodos , Adenosina Trifosfato/análisis , Animales , Gasto Cardíaco/efectos de los fármacos , Corazón/efectos de los fármacos , Miocardio/metabolismo , Miocardio/ultraestructura , Oxígeno/metabolismo , Fosfocreatina/análisis , RatasRESUMEN
The concentrations of adrenaline and noradrenaline, and dopamine-beta-hydroxylase in the plasma, and certain haemodynamic parameters, were determined in 14 children undergoing surgical correction of congenital cardiac defects under hypothermia at 30 degrees C and methoxyflurane anaesthesia. During the pre-operative phase of hypothermia at 30 degrees C, the adrenaline levels rose to about 300% of the inital levels, and the noradrenaline levels to about 200%. During the postoperative phase of re-warming at 34 degrees C, a further dysregulative release of catecholamines led to an increase in adrenaline levels to a critical concentration of about 800% of the norm, and in noradrenaline levels of about 400% of the norm. No change was seen in dopamine-beta-hydroxylase activity. Hypothermia thus results in a massive activation of the sympatho-neuronal and sympatho-adrenal systems, which is not prevented by methoxyflurane anaesthesia, and which may endanger the recently operated heart, particularly during the early post-operative period, because of the increased oxygen requirements imposed on the myocardium. In normothermia, on the other hand, methoxyflurane anaesthesia results in only a slight degree of activation of the sympathetic nervous system, which increased only slightly during the post-operative period. Under these conditions, the plasma dopamine-beta-hydroxylase activity remains unchanged. Unlike the changes in plasma catecholamine levels, dopamine-beta-hydroxylase activity cannot be regarded as an index of changes in sympatho-neuronal activity.
Asunto(s)
Cardiopatías Congénitas/cirugía , Adolescente , Adulto , Anciano , Anestesia General , Niño , Dopamina beta-Hidroxilasa/metabolismo , Epinefrina/sangre , Humanos , Hipotermia , Metoxiflurano , Persona de Mediana Edad , Miocardio/metabolismo , Norepinefrina/sangre , Consumo de OxígenoRESUMEN
Ethrane permits a very smooth and quick introduction of anaesthesia per inhalationem without signs of any excitation due to its physical properties. Because of its low analgesic property it was necessary to administer nitrous oxide. After the interruption of Tthrane--administration our patients awoke without any nausea or vomiting. In our study we measured stroke-volume and cardiac output during and after Ethrane anaesthesia using the IFM-Minnesota Impedance Cardiograph 304 A. In the first ten minutes of anaesthesia we found a 23 per cent-decrease of strokevolume, a 19 per cent cardiac output-decrease whereas the heartrate rose slightly. Any further significant changes of these parameters up to the end of anaesthesia were not detectable. Already two minutes after the end of Ethrane-administration all parameters had reached their initial values.