Standardisierte Kontrastmittelsonographie (CEUS) in der klinischen Akut- und Notfallmedizin sowie Intensivmedizin (CEUS-Akut)

Die Anaesthesiologie -     

Fever and infection early after ischemic stroke

Previous studies showed that elevated body temperature early after ischemic stroke is associated with severe neurological deficit and a poor outcome. The aim of this study was to analyse the prevalence and putative etiology of febrile body temperature (>/=38.0 degrees C) early after stroke and to investigate the association between body temperature, stroke severity and outcome. We investigated 119 consecutive patients who were admitted within 24 h after ischemic stroke. Patients were examined for infection before ischemia using a standardized questionnaire and received daily clinical examination after stroke. In case of fever, standardized radiological and microbiological examinations were performed. Fever within 48 h after stroke was observed in 30 (25.2%) patients. The probable cause of fever was infective or chemical aspiration pneumonia (n=12), other respiratory tract infection (n=7), urinary tract infection (n=4), viral infections (n=3) or insufficiently defined (n=5). (One patient had two potential causes of fever.) In thirteen of these patients, infection was most probably acquired before stroke. Fever newly developed more often during day 1 to 2 than day 3 to 7 after stroke (P=0.016). Fever was associated with a more severe deficit on admission independent from age, vascular diseases and risk factors (odds ratio 9.6; 95% confidence interval 3.1-29). Fever is a frequent complication early after stroke and in the majority of cases, it can be explained by infection or chemical aspiration pneumonia. In about half of the infected patients, infection was most probably acquired before stroke. Fever was associated with a more severe neurological deficit on admission.     

Method for computation of cardiac output in mitral stenosis independent of left ventricular dimensions and kinetic state: correlation with cardiac catheterization via the Fick method

An hydraulic orifice formula offering the possibility of quantifying cardiac output in conditions of mitral stenosis is tested using potentially noninvasive portions of catheterization data from patients evaluated for obstructive mitral valve disease. The equation studied is V = (1/21) R A T2, where V is the cardiac output (ml/min), R is the heart frequency, A is the mitral valve area (cm2), and T is the diastolic filling interval (sec/min). The mitral valve area was determined by the Gorlin formula, and R and T were measured from the pressure tracings recorded at cardiac catheterization. The degree of correspondence between the equation tested and the measured cardiac output as determined by the Fick principle technique is characterized by r = 0.87, SE = 450 ml/min, N = 10. The results suggest that the new formulation may offer a noninvasive method for estimating the cardiac output status of patients with mitral valve disease once mitral valve area is measured either at catheterization or by two-dimensional echocardiography.     

Implementing Intervention Research into Public Policy—the “I<Superscript>3</Superscript>-Approach”

Evidence-based intervention programs have become highly important in recent years, especially in educational contexts. However, transferring these programs into practice and into the wider field of public policy often fails. As a consequence, the field of implementation research has emerged, several implementation frameworks have been developed, and implementation studies conducted. However, intervention research and implementation research have not yet been connected systematically and different traditions and research groups are involved. Implementation researchers are mostly given mandates by politicians to take on the implementation of already existing interventions. This might be one of the key reasons why there are still many problems in translating programs into widespread community practice. In this paper, we argue for a systematic integration of intervention and implementation research (“I³-Approach”) and recommend a six-step procedure (PASCIT). This requires researchers to design and develop intervention programs using a field-oriented and participative approach. In particular, the perspective of policymakers has to be included as well as an analysis of which factors support or hinder evidence-based policy in contrast to opinion-based policy. How this systematic connection between intervention and implementation research can be realized, is illustrated by means of the development and implementation of the ViSC school program, which intends to reduce aggressive behavior and bullying and to foster social and intercultural competencies.     

Regulation of protease-activated receptor 1 (PAR1) on platelets and responsiveness to thrombin receptor activating peptide (TRAP) during systemic inflammation in humans

Thrombin is a coagulation protease that activates platelets, endothelial cells, leukocytes and mesenchymal cells. Thrombin signaling is mediated at least in part by protease-activated receptors (PARs). As little is known about the in vivo regulation of PAR1, this study aimed to characterize the effects of systemic thrombin formation during human endotoxemia on the regulation of PAR1 and the associated responsiveness of human platelets to thrombin receptor activating peptide (TRAP). Endotoxin (2 ng/kg) was infused into 40 healthy men to study the regulation of PAR1 in systemic human inflammation. The SPAN12 antibody was used to determine the in vivo regulation of PAR1. To measure whether modulation of the PAR1 receptor may be associated with altered platelet reactivity, whole blood was stimulated with TRAP ex vivo. Thrombin generation was determined by prothrombin (F(1+2)) fragment. F(1+2) levels increased almost 9-fold from 0.5+/-0.1 nmol/L to 4.5+/-1.9 nmol/L at 4 h (p<0.001). PAR1 decreased by approximately 8% (p<0.001) within 2 h after endotoxin infusion and stayed at those levels until 6 h. Concomitantly, TRAP induced P-selectin expression maximally decreased by 18% (p<0.001) at 6 h. In conclusion, PAR1 expression is down-regulated on platelets during systemic thrombin formation induced by inflammation in humans which results in decreased responsiveness to subsequent stimulation of the PAR1 receptor.     

Carbamazepine (Tegretol) monotherapy in epilepsies with partial and/or secondary generalized seizures in childhood and adolescence

The effectiveness and side effects of a carbamazepine monotherapy were evaluated in 40 children and adolescents (22 boys and 18 girls with an age distribution between 1 and 16 years) over a period of 6 years. In addition the attempt has been made, to find correlations between sex, age of seizure onset, aetiology of the disease, types of seizures, and EEG-abnormalities on the one hand, and the clinical response to the drug on the other. Selection criteria were, that the patients were under continuous follow-up, that they suffered from partial or/and secondarily generalized seizures and that Tegretol was the first and only drug at the beginning of the examination. The treatment with the Carbamazepine-monotherapy was successful in 63% of the patients, 37% remained resistant to the treatment. Carbamazepine proved to be effective against partial seizures as well as secondarily generalized grand-mal-seizures. The therapeutic range of the serum carbamazepine levels during monotherapy varied between 15-35 mu Mol/l. 40 patients entered, 38 completed the study. In two cases the drug had to be stopped owing to allergic skin rash due to the drug. No other serious side effects were observed in any of the remaining 38 patients. The most frequent laboratory changes were an increase of Gamma-GT and leucopenia. All the cases who became seizure-free (Responder) were compared with the remaining cases with unfavourable treatment results (Nonresponder) in order to find out whether there are significant differences between the two groups, as far as sex, age ... etc. (see above) are concerned.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ethnic differences in plasma levels of interleukin-8 (IL-8) and granulocyte colony stimulating factor (G-CSF)

Ethnic neutropenia is common in people of African descent. As interleukin-8 (IL-8) and granulocyte colony stimulating factor (G-CSF) bind to receptors on neutrophils, ethnic differences in neutrophil counts are hypothesized to result in different plasma levels of these cytokines. A prospective study was conducted in 72 healthy young volunteers. Neutrophil counts were 60% higher in Caucasians (P<0.00001). Average IL-8 and G-CSF levels were about 50% and 70% higher in African volunteers compared with Caucasian volunteers (P=0.0008 and P=0.00005, respectively). Additionally, oxidative burst capacity in stimulated neutrophils was significantly lower in volunteers of African descent (P=0.03 between both groups). In sum, lower neutrophil counts are associated with higher levels of IL-8 and G-CSF in Africans.     

Die Epilepsie des Kindes- und Jugendalters

Zusammenfassung Es wird ein Patientenmaterial von 212 ambulanten und 44 stationär beobachteten kindlichen Epilepsien besprochen. Eingehend wird auf die 2 Seiten der Erkrankung eingegangen, die organische und die psychische. Es wird versucht, die sogenannten atypischen Anfälle zu rubrizieren und es werden Aufschlüsselungen von verschiedenem Anfallsgeschehen im Krankengeschichtsverlauf besprochen, vor allem hinsichtlich der Zuordnung bestimmter Syndrome zu bestimmten Altersgruppen.Es wird ferner versucht, das Problem der epileptischen Wesensveränderung aus komplexeren Faktoren abzuleiten. Schließlich wird auf die Therapieversager bei neurotischen und debilen Kindern eingegangen und es werden Beziehungen zwischen Neurose und allergischen Erscheinungen aufgewiesen.Zusammenfassend möchten wir sagen, daß die Bedeutung der Fraisen im allgemeinen unterschätzt wird, daß man aber andererseits der manifesten Anfallskrankheit selbst derzeit meist noch zu pessimistisch gegenübersteht.Erweiterter Vortrag von H. Strotzka bei der österreichischen Nervenärztetagung in Kreuzstein am Mondsee, 1952.     

Reparixin, a specific interleukin-8 inhibitor, has no effects on inflammation during endotoxemia

Reparixin antagonizes interleukin-8 (IL-8) on the level of signal transduction in vitro. We hypothesized that IL-8 mediates some of the reactions occurring during acute inflammation and specifically that IL-8 may be a mediator of endotoxin induced neutrophilia. We therefore tested the effects of reparixin on humoral and cellular parameters in LPS-induced acute systemic inflammation. The study is a randomized (3:2 active:placebo), double-blind, placebo-controlled parallel group trial. Twenty healthy male volunteers randomly received either reparixin (12) or placebo (8) intravenously. One hour after the start of reparixin/placebo infusion a bolus of 2 ng/kg endotoxin was infused over 1-2 min. Blood samples were obtained over 24 h. Reparixin, being metabolized to ibuprofen, suppressed serum thromboxane B2 levels by 78 percent compared to baseline and control at 8 h. LPS-induced neutrophilia was not significantly affected by reparixin in human volunteers. Consistently, reparixin did not alter the lymphocyte or monocyte counts and had no effect on LPS-induced systemic inflammation as measured by tumor necrosis factor alpha (TNF-alpha) or interleukin-6 (IL-6) release. Regulation of IL-8 receptors CXCR1 and 2 and the degranulation marker CD11b showed the expected kinetics. Reparixin had no effect on thrombin formation as measured by prothrombin fragment (F1+2). In conclusion, our study showed that reparixin was safe but had no impact on endotoxin induced inflammation. In contrast to previous studies with its metabolite ibuprofen, reparixin does not enhance inflammation in this model.