1,583 results on '"G. Hempelmann"'
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2. Retraction Note: Does continuous heparinization influence platelet function in the intensive care patient?
- Author
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J. Boldt, M. Müller, A. Rothe, P. Lenzen, and G. Hempelmann
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Critical Care and Intensive Care Medicine - Published
- 2023
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Catalog
3. Retraction Note: Circulating adhesion molecules in the critically ill: A comparison between trauma and sepsis patients
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J. Boldt, M. Müller, D. Kuhn, L. C. Linke, and G. Hempelmann
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Critical Care and Intensive Care Medicine - Published
- 2023
- Full Text
- View/download PDF
4. Retraction to 'Does the technique of cardiopulmonary bypass affect lung water content?' [Eur J Cardiothorac Surg 1991;5(1):22-6]
- Author
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J Boldt, B Zickmann, F Dapper, and G Hempelmann
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Pulmonary and Respiratory Medicine ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2022
5. Dosis-Wirkungsbeziehung von Clonidin zu epidural appliziertem Ropivacain bei orthopädischen Eingriffen der unteren Extremität
- Author
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G. Hempelmann, R. Hussmann, K.-H. Gürtler, Thilo Menges, and J. Engel
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Gynecology ,medicine.medical_specialty ,Anesthesiology and Pain Medicine ,Chirurgie orthopedique ,business.industry ,Regional anesthesia ,medicine ,General Medicine ,business ,Lower limb - Abstract
Fragestellung: Es sollte bei elektiven orthopadischen Eingriffen an der unteren Extremitat eine erste Dosis-Wirkungsbeziehung von Clonidin zu epidural appliziertem Ropivacain untersucht werden in einem Bereich, in dem am wenigsten mit kardiovaskuklaren Nebenwirkungen zu rechnen ist. Methodik: Es wurden sechs Gruppen a 10 Patienten gebildet. Gruppe 1 bekam 1 mg/cm Korpergrose Ropivacain mit einem Zusatz von 25 µg Clonidin, die zweite Gruppe 50 µg Clonidin, die dritte Gruppe 75 µg Clonidin, die vierte Gruppe 100 µg Clonidin und die funfte Gruppe 150 µg Clonidin als Zusatz. Als Kontrolle diente eine Gruppe mit NaCl 0,9% als Adjuvans. Der sensible und motorische Wirkungseintritt wurde ab der 5. min im Abstand von 5 min bis zur 20. min und dann in der 30. min bestimmt. Weiterhin wurde das Kreislaufverhalten dokumentiert und die Sedierung nach 45 min anhand eines Scores beurteilt. Nach Operationsende untersuchten wir die Ruckkehr des „Spitz-Stumpf-Empfindens” bis zur 2-Segment-Regression und den Zeitpunkt des Einsetzens von Schmerzen. Ergebnisse: Die Gruppen waren hinsichtlich demographischer Daten und der Anschlagzeit vergleichbar. Die Analgesiezeit war mit dem Zusatz von 150 µg Clonidin auf 513 ± 92 min (p = 0,002) verlangert, mit 100 µg Clonidin auf 460 ± 148 min (p = 0,073), mit 75 µg Clonidin auf 440 ± 86 min (p = 0,057) gegenuber 347 ± 114 min in der Kontrollgruppe. Die 2-Segment-Regression betrug mit 150 µg Clonidin 251 ± 47 min (p = 0,018), mit 100 µg Clonidin 238 ± 33 min (p = 0,034), mit 75 µg Clonidin 229 ± 29 min (p = 0,027) und ohne Zusatz 178 ± 43 min. Die Herzfrequenz fiel in allen Gruppen ohne Gruppenunterschiede innerhalb von 60 min signifikant zum Ausgangswert ab. Der mittlere arterielle Druck (MAP) sank in allen Gruppen mit Ausnahme der Kontrollgruppe signifikant zwischen der 20. und der 40. min zum Ausgangswert. Im Gruppenvergleich zur reinen Substanz fanden sich mit 75 µg Clonidin signifikante Unterschiede des MAP von der 20. min an, mit 100 µg Clonidin von der 50. min an und mit 150 µg Clonidin in der 40. min. Der mittlere Sedationsscore lag nach 45 min in der Kontrollgruppe bei 0,6 ± 0,5, mit 75 µg Clonidin bei 1,3 ± 1,0, mit 100 µg Clonidin bei 1,7 ± 0,8 (p = 0,022) und mit 150 µg Clonidin bei 1,8 ± 0,8 (p = 0,007). Schlusfolgerung: Wir konnten in dieser Untersuchung zeigen, das 150 µg Clonidin die analgetische Wirkung des Ropivacains signifikant steigert. Das schmerzfreie Intervall lag bei einer mittleren Ropivacainmenge von 171 mg mit Clonidin deutlich uber den Zeiten, die mit 200 mg Lokalanasthetikum gefunden wurden. Parallel fanden sich signifikante Blutdruckunterschiede. Ein engmaschiges Herz-Kreislauf-Monitoring des Patienten ist dazu in jedem Fall notwendig. Durch den Clonidinzusatz konnen die Nachspritzintervalle verlangert werden. more...
- Published
- 2020
6. Retraction notice to 'Endothelial-related coagulation in cardiac surgery' [Br J Anaesth 74 (1995) 174-9]
- Author
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Joachim Boldt, Ehrenfried Schindler, W.A. Stertmann, G. Hempelmann, M. Welters, and C. Knothe
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medicine.medical_specialty ,Anesthesiology and Pain Medicine ,Notice ,business.industry ,Anesthesia ,Medicine ,Coagulation (water treatment) ,business ,Cardiac surgery - Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editor-in-Chief, Professor Hugh Hemmings, based on the recommendations of Justus-Liebig-University Giessen following an internal review of research conducted by Joachim Boldt at the University. This is further described in 'Further Retractions of Articles by Joachim Boldt', https://doi.org/10.1016/j.bja.2020.02.024. more...
- Published
- 2020
7. Retraction notice to 'Influence of different anticoagulation regimens on platelet function during cardiac surgery' [Br J Anaesth 73 (1994) 639-44]
- Author
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Christoph Osmer, Ehrenfried Schindler, Joachim Boldt, M. Wittstock, G. Hempelmann, and W.A. Stertmann
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medicine.medical_specialty ,Anesthesiology and Pain Medicine ,Notice ,business.industry ,Anesthesia ,Medicine ,Platelet ,business ,Cardiac surgery - Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editor-in-Chief, Professor Hugh Hemmings, based on the recommendations of Justus-Liebig-University Giessen following an internal review of research conducted by Joachim Boldt at the University. This is further described in 'Further Retractions of Articles by Joachim Boldt', https://doi.org/10.1016/j.bja.2020.02.024. more...
- Published
- 2020
8. Retraction notice to 'The role of enoximone in cardiac surgery' [Br J Anaesth 69 (1992) 45-50]
- Author
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W. Russ, Bernfried Zickmann, C. Knothe, M. Ballesteros, F. Dapper, Joachim Boldt, and G. Hempelmann
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medicine.medical_specialty ,Anesthesiology and Pain Medicine ,Notice ,business.industry ,Anesthesia ,MEDLINE ,medicine ,Enoximone ,business ,medicine.drug ,Cardiac surgery - Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editor-in-Chief, Professor Hugh Hemmings, based on the recommendations of Justus-Liebig-University Giessen following an internal review of research conducted by Joachim Boldt at the University. This is further described in 'Further Retractions of Articles by Joachim Boldt', https://doi.org/10.1016/j.bja.2020.02.024. more...
- Published
- 2020
9. Retraction notice to 'Does the type of volume therapy influence endothelial-related coagulation in the critically ill?' [Br J Anaesth 75 (1995) 740-6]
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W. Padberg, Ingeborg Welters, Joachim Boldt, G. Hempelmann, K. Martin, and M. Heesen
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Anesthesiology and Pain Medicine ,Notice ,Volume (thermodynamics) ,business.industry ,Critically ill ,Anesthesia ,Coagulation (water treatment) ,Medicine ,business - Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editor-in-Chief, Professor Hugh Hemmings, based on the recommendations of Justus-Liebig-University Giessen following an internal review of research conducted by Joachim Boldt at the University. This is further described in 'Further Retractions of Articles by Joachim Boldt', https://doi.org/10.1016/j.bja.2020.02.024. more...
- Published
- 2020
10. Retraction to ‘The effects of preoperative aspirin therapy on platelet function in cardiac surgery’ [Eur J Cardiothorac Surg 1992;6:598–602]
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J, Boldt, C, Knothe, B, Zickmann, C, Herold, F, Dapper, and G, Hempelmann
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Pulmonary and Respiratory Medicine ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2022
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11. Retraction notice to 'Volume replacement with hydroxyethyl starch solution in children' [Br J Anaesth 70 (1993) 661–5]
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Joachim Boldt, F. Dapper, G. Hempelmann, H. Hammermann, C. Knothe, and Ehrenfried Schindler
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Anesthesiology and Pain Medicine ,Notice ,business.industry ,Anesthesia ,Volume replacement ,Medicine ,Hydroxyethyl starch ,business ,medicine.drug - Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editor-in-Chief, Professor Hugh Hemmings, based on the recommendations of Justus-Liebig-University Giessen following an internal review of research conducted by Joachim Boldt at the University. This is further described in 'Further Retractions of Articles by Joachim Boldt', https://doi.org/10.1016/j.bja.2020.02.024. more...
- Published
- 2020
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12. Retraction notice to 'Influence of hypertonic volume replacement on the microcirculation in cardiac surgery' [Br J Anaesth 67 (1991) 595–602]
- Author
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C. Herold, F. Dapper, M. Ballesteros, Bernfried Zickmann, Joachim Boldt, and G. Hempelmann
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medicine.medical_specialty ,Anesthesiology and Pain Medicine ,Notice ,business.industry ,Anesthesia ,Volume replacement ,Medicine ,Tonicity ,business ,Microcirculation ,Cardiac surgery - Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editor-in-Chief, Professor Hugh Hemmings, based on the recommendations of Justus-Liebig-University Giessen following an internal review of research conducted by Joachim Boldt at the University. This is further described in 'Further Retractions of Articles by Joachim Boldt', https://doi.org/10.1016/j.bja.2020.02.024. more...
- Published
- 2020
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13. Anästhesie bei Herztransplantationen im Neugeborenenund Säuglingsalter: Spezielle Aspekte beim Syndrom des hypoplastischen linken Herzens
- Author
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Zickmann, B., Boldt, J., Knothe, Ch., Bauer, J., Dapper, F., Hempelmann, G., and and G. Hempelmann
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- 1995
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14. Retraction notice to 'Cardiorespiratory responses to hypertonic saline solution in cardiac operations' [Ann Thorac Surg 51 (1991) 610-615]
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Joachim Boldt, Bernfried Zickmann, G. Hempelmann, F. Dapper, Ch. Herold, and M. Ballesteros
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Pulmonary and Respiratory Medicine ,Cardiac operations ,Notice ,business.industry ,Hypertonic Saline Solution ,Anesthesia ,Medicine ,Surgery ,Cardiorespiratory fitness ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
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15. Retraction notice to 'Does correction of acidosis influence microcirculatory blood flow during cardiopulmonary bypass?' [Br J Anaesth 71 (1993) 277–81]
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G. Hempelmann, H. Hammermann, C. Knothe, Bernfried Zickmann, Joachim Boldt, and W.A. Stertmann
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Anesthesiology and Pain Medicine ,Notice ,business.industry ,law ,Anesthesia ,Cardiopulmonary bypass ,Medicine ,Blood flow ,medicine.symptom ,business ,Acidosis ,law.invention - Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editor-in-Chief, Professor Hugh Hemmings, based on the recommendations of Justus-Liebig-University Giessen following an internal review of research conducted by Joachim Boldt at the University. This is further described in 'Further Retractions of Articles by Joachim Boldt', https://doi.org/10.1016/j.bja.2020.02.024. more...
- Published
- 2020
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16. Retraction notice to 'Haemodynamic effects of the phosphodiesterase inhibitor enoximone in comparison with dobutamine in esmolol-treated cardiac surgery patients' [Br J Anaesth 64 (1990) 611–6]
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D. Kling, Bernfried Zickmann, Joachim Boldt, G. Hempelmann, and F. Dapper
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medicine.medical_specialty ,business.industry ,Hemodynamics ,Esmolol ,Cardiac surgery ,Anesthesiology and Pain Medicine ,Internal medicine ,medicine ,Cardiology ,Enoximone ,Dobutamine ,Phosphodiesterase inhibitor ,business ,medicine.drug - Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editor-in-Chief, Professor Hugh Hemmings, based on the recommendations of Justus-Liebig-University Giessen following an internal review of research conducted by Joachim Boldt at the University. This is further described in 'Further Retractions of Articles by Joachim Boldt', https://doi.org/10.1016/j.bja.2020.02.024. more...
- Published
- 2020
- Full Text
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17. Retraction notice to 'Changes in regulators of the circulation in patients undergoing lung surgery' [Br J Anaesth 79 (1997) 733–9]
- Author
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Matthias J. Müller, Joachim Boldt, G. Hempelmann, D. Uphus, and Michael Papsdorf
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Anesthesiology and Pain Medicine ,Notice ,business.industry ,Anesthesia ,Medicine ,In patient ,Circulation (currency) ,Lung surgery ,business - Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editor-in-Chief, Professor Hugh Hemmings, based on the recommendations of Justus-Liebig-University Giessen following an internal review of research conducted by Joachim Boldt at the University. This is further described in 'Further Retractions of Articles by Joachim Boldt', https://doi.org/10.1016/j.bja.2020.02.024. more...
- Published
- 2020
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18. Retraction Notice to 'Six Different Hemofiltration Devices for Blood Conservation in Cardiac Surgery' [Ann Thorac Surg 1991;51(5):747-753]
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F. Dapper, Joachim Boldt, C. Herold, Bernfried Zickmann, G. Hempelmann, and B. Fedderson
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Blood conservation ,Notice ,business.industry ,medicine.medical_treatment ,MEDLINE ,Cardiac surgery ,Hemofiltration ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine - Published
- 2017
19. Remote intracranial parenchymal haematomas as complications of spinal surgery: presentation of three cases with minor or untypical symptoms
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Eckhardt Mater and Ralf G. Hempelmann
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medicine.medical_specialty ,medicine.medical_treatment ,Case Report ,Hematoma ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,Cerebral Hemorrhage ,business.industry ,Laminectomy ,Postoperative complication ,Middle Aged ,medicine.disease ,Spine ,Spinal surgery ,Surgery ,Spinal Fusion ,Spinal fusion ,Female ,Neurosurgery ,Presentation (obstetrics) ,business ,Complication - Abstract
Intracranial haemorrhage is a rare complication of spinal surgery. Three cases of cerebral or cerebellar haemorrhages following spinal operations with CSF loss are reported, and the literature was reviewed.One patient suffered from melancholy after the operation, one patient had moderate headache and nausea, and the third patient suffered from mental confusion and anxiety. The intracranial haemorrhages were treated conservatively. All patients recovered from the bleedings.The cases show that cerebral or cerebellar haemorrhage after spinal CSF loss may be accompanied by minor or rather untypical clinical symptoms.The dangerous complication of intracranial haemorrhage has to be kept in mind when patients have moderate cerebral symptoms after CSF loss due to spinal operations. more...
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- 2012
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20. Function of the adrenal cortex during therapy with fluconazole in intensive care patients
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D. Zeiler, Roswitha Füssle, J. Biscoping, G. Michaelis, and G. Hempelmann
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endocrine system ,medicine.medical_specialty ,Adrenal cortex ,business.industry ,Dermatology ,General Medicine ,Adrenocorticotropic hormone ,Flucytosine ,Basal (phylogenetics) ,Infectious Diseases ,medicine.anatomical_structure ,Endocrinology ,Internal medicine ,Intensive care ,medicine ,business ,hormones, hormone substitutes, and hormone antagonists ,Fluconazole ,Glucocorticoid ,Hydrocortisone ,medicine.drug - Abstract
An impairment of cortisol synthesis can be assumed for the new antimycotic fluconazole based on its chemical structure (triazole derivative) and mechanism of action (inhibition of ergosterol synthesis). In healthy volunteers, however, no influence on steroid hormone production could be found. The present study was undertaken to clarify whether this is also true for critically ill, long-term patients in an intensive care unit. The basal cortisol and adrenocorticotropic hormone (ACTH) levels were determined by means of radioimmunoassay in 11 patients being treated with antimycotics at fixed times. Antimycotic treatment was carried out using either fluconazole (n = 6) or a combination of amphotericin B and flucytosine (n = 5) for 14 days. Seven days after cessation of the treatment the above-mentioned hormones were again determined. Patients with the same baseline criteria who did not require antimycotic treatment (n = 8) served as controls. During the entire study period adequate cortisol synthesis was found after ACTH stimulation in all three patient groups. They all presented with relatively raised basal cortisol levels (range 16.4-31.0 micrograms dl-1) and an increase in ACTH-stimulated cortisol synthesis from 31% (group ampho B/flucytosine) to 78% (group fluconazole). The basal ACTH values were always within the normal range (9.2-16.4 pg ml-1). Neither the basal ACTH levels nor the basal cortisol levels as well as the cortisol levels determined after the ACTH test showed adrenocortical suppression in the patients of all three groups. Thus, according to the present results clinically relevant impairment of cortisol synthesis after treatment with fluconazole can be excluded. more...
- Published
- 2009
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21. Kombinierte Autotransfusion in der Herzchirurgie: Anwendung der akuten normovolämischen Hämodilution bei koronarer Herzkrankheit
- Author
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Scheld Hh, Joachim Boldt, Weidler B, D. Kling, B. von Bormann, and G. Hempelmann
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medicine.medical_specialty ,Cardiac output ,Blood transfusion ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Extracorporeal circulation ,Oxygen transport ,Hemodynamics ,General Medicine ,Hematocrit ,Surgery ,Anesthesia ,medicine ,Hemoglobin ,business ,Autotransfusion - Abstract
Normovolemic hemodilution (15 mg/kg body-weight: group I) was undertaken in 100 patients immediately before the start of coronary-artery surgery. In addition, a Cell-Saver (Haemonetics, Munich) was used for intra-operative autotransfusion. Another group of 100 patients (group II) was similarly operated on without autotransfusion (the study was conducted on 200 consecutive patients undergoing aorto-coronary bypass). Before blood (autologous or homologous) was administered a reduction of hemoglobin to 9 g/100 ml and hematocrit to 0.28 was well tolerated (during extracorporeal circulation: 6.5 g/100 ml and 0.16, respectively). Due to intra- and postoperative complications, such as infarct bleeding (including reoperation) or septicemia, the number of patients placed in group I fell to 94, that in group II to 90. Acute normovolemic hemodilution increased cardiac output and oxygen transport capacity, while other hemodynamic parameters remained unchanged, and there was no effect on extravascular lung water. Autotransfusion reduced the need for homologous blood derivatives by 71% (fresh blood, fresh plasma, RBC concentrates). No clinically significant disadvantages occurred. more...
- Published
- 2008
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22. Metabolische Veränderungen durch das Extremitäten-Tourniquet und ihre Beeinflussung durch das Narkoseverfahren*
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G. Hempelmann, J. Biscoping, G. Michaelis, and B. Bachmann
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Tourniquet ,business.industry ,Metabolic acidosis ,medicine.disease ,Respiratory compensation ,Anesthesia ,Hyperventilation ,Respiration ,Anesthetic ,medicine ,Orthopedics and Sports Medicine ,Surgery ,medicine.symptom ,business ,Respiratory minute volume ,Acidosis ,medicine.drug - Abstract
In 3 groups of 15 patients, respectively, we studied metabolic changes following tourniquet-release after operations of lower extremity. The influence of different anesthetic methods was evaluated by blood-gas-analyses up to 30 minutes after blood-circulation of the lower limb had been reinstalled. Our results demonstrate, that the patients under regional anesthesia with spontaneous respiration (group 1) could preserve their metabolic equilibrium with minor changes within the physiologic range. The intubated patients with controlled respiration (group 2) revealed a marked metabolic acidosis after tourniquet-release with insufficient respiratory compensation. Initial values were not reached within 30 minutes. The patients of group 3 (controlled respiration with a 25% increase of the normal minute volume for a period of 5 minutes after release of the tourniquet) had a less severe acidosis than those of group 2. The beneficial influence of spontaneous respiration in compensating metabolic acidosis--even in aged patients--following an ischemic tourniquet has been demonstrated by this investigation. Short-term hyperventilation seems to be the therapeutic tool in patients with controlled respiration to compensate for metabolic acidosis up to a certain extent. more...
- Published
- 2008
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23. Untersuchung zur Häufigkeit von Luftembolien bei der Implantation von Hüftprothesen*
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W. Krumholz, B. Bachmann, G. Hempelmann, J. Biscoping, and K. Ratthey
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musculoskeletal diseases ,Lung embolism ,medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Total hip replacement ,Venous air embolism ,medicine.disease ,Air embolism ,Surgery ,Embolism ,medicine ,Orthopedics and Sports Medicine ,General anaesthesia ,business ,Venous Embolism - Abstract
The prosthetic supply of the hip-joint may be accompanied by the problem of venous air embolism. By including 53 orthopaedic patients having undergone total hip replacement, the influence of bone-cement as well as of the different anaesthetic techniques on the frequency of embolic phenomenons was investigated. Embolism was determined as an abrupt decrease (greater than 5 mmHg) in the end-tidal pCO2. Venous embolism often occurred with cemented endoprostheses in contrast to non-cement implantations. Patients with general anaesthesia presented more often with venous air embolism than patients with epidural anaesthesia. This might be explained by an expanding effect of nitrous oxide on air bubbles entering the vascular bed under the implantation of the shaft-prostheses. Our data stress the importance of continuous monitoring of end-tidal pCO2 for early discovery of lung embolism. more...
- Published
- 2008
- Full Text
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24. Perioperative concentrations of catecholamines in the cerebrospinal fluid and plasma during spinal anesthesia
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N. Frickey, T. Podranski, G. Hempelmann, M. J. Oehmke, D. F. M. Kuhn, and M. Mann
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Mean arterial pressure ,medicine.medical_specialty ,business.industry ,General Medicine ,Norepinephrine (medication) ,chemistry.chemical_compound ,Anesthesiology and Pain Medicine ,Endocrinology ,Cerebrospinal fluid ,Epinephrine ,chemistry ,Dopamine ,Internal medicine ,Anesthesia ,Heart rate ,medicine ,Catecholamine ,Neurotransmitter ,business ,medicine.drug - Abstract
Background: Catecholamine release is a physiological response to stress. The extent to which perioperative stress provokes the central release of catecholamines, which modulate pain perception in the spinal cord, still remains unknown. The perioperative course of catecholamine concentrations in the cerebrospinal fluid (CSF) and plasma was examined. Methods: A prospective study was performed in 25 patients (ASA III, 60–84 years) undergoing elective hip joint replacement in spinal catheter anesthesia. The concentrations of dopamine, epinephrine and norepinephrine in the CSF and plasma were measured before anesthesia, immediately after surgery, and 6 and 24 h post-operatively. Results: In most patients, dopamine and epinephrine were not detectable in CSF. CSF–norepinephrine concentrations decreased from median [interquartile-range] 159 [124;216] pre-anesthesia to 116 [79;152] pmol/l immediately post-operatively and were slightly elevated 24 h post-operatively (180 [134;302] pmol/l) (P=0.05). Dopamine plasma concentrations were not detectable or were barely above the detection threshold. Plasma epinephrine increased from 61 [28;77] pmol/l pre-anesthesia to 112 [69;138] pmol/l 6 h post-operatively and returned to baseline 24 h post-operatively (P=0.001). Plasma norepinephrine concentrations increased intra-operatively from 298 [249;422] to 556 [423;649] pmol/l and remained elevated 24 h after surgery (P=0.009). There was no association between changes in CSF or plasma norepinephrine or epinephrine concentrations and changes in heart rate (HR) or mean arterial pressure (MAP). Conclusion: During spinal anesthesia for elective hip joint replacement, norepinephrine concentrations were greater in plasma than in CSF. CSF dopamine and epinephrine concentrations were essentially undetectable. The changes in CSF-norepinephrine concentrations and the changes of plasma norepinephrine concentrations showed no association with each other; nor were there correlations between clinical stress parameters (HR, MAP) or visual analog scale pain, and the changes in CSF norepinephrine concentrations. more...
- Published
- 2008
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25. β-Adrenozeptoren in Anästhesie und Intensivmedizin
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M. Heesen and G. Hempelmann
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Chronotropic ,Inotrope ,medicine.medical_specialty ,business.industry ,Extracorporeal circulation ,Proteolytic enzymes ,General Medicine ,Critical Care and Intensive Care Medicine ,Adenylyl cyclase ,chemistry.chemical_compound ,Anesthesiology and Pain Medicine ,Endocrinology ,chemistry ,Intensive care ,Internal medicine ,Anesthesia ,Emergency Medicine ,Medicine ,Signal transduction ,business ,Receptor - Abstract
beta-Adrenoceptors (beta-AR) are divided into a beta 1-, a beta 1-, and a recently cloned beta 3-subtype. beta-AR belong to the group of 7-transmembrane spanners which are coupled via GS-proteins to the enzyme adenylyl cyclase. Instead of being static entities, beta-AR undergo dynamic regulation upon repeated or prolonged exposure to agonists (down-regulation) or antagonists (up-regulation). After exposure to agonists, an early desensitisation caused by phosphorylation of amino acid residues can be distinguished from receptor sequestration. Finally, the internalised receptor is digested by proteolytic enzymes. The present article describes the basic patterns of molecular biology of beta-AR, signal transduction, and receptor desensitisation. In the human heart, beta-AR are the most important receptor system to provide positive inotropic and chronotropic effects. The alterations of the beta-adrenergic system in cardiac insufficiency, after heart transplantation, and after extracorporeal circulation, as well as changes induced by surgery and single anaesthetic agents, are reviewed. more...
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- 2008
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26. Topographische Änderungen der hirnelektrischen Aktivität nach Prämedikation mit Flunitrazepam
- Author
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K. Wulf, A Thiel, Joachim Boldt, H. C. Hofmann, Bernfried Zickmann, and G. Hempelmann
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Benzodiazepine ,medicine.diagnostic_test ,medicine.drug_class ,Chemistry ,General Medicine ,Electroencephalography ,Critical Care and Intensive Care Medicine ,Hypnotic ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Anesthesia ,Cortex (anatomy) ,Sedative ,Emergency Medicine ,medicine ,Morphine ,Premedication ,Flunitrazepam ,medicine.drug - Abstract
AIM The effects on cerebral function of premedication with the benzodiazepine flunitrazepam and with morphine were studied on the evening of the preoperative day (2 mg flunitrazepam p.o.) and 90 minutes before induction of anaesthesia (2 mg flunitrazepam plus 15 mg morphine i.m.). DESIGN The EEG was analysed topographically (17 electrodes) and quantitatively. RESULTS As a typical effect of benzodiazepines, increases in electrical activity in the frequency band beta-1 of the power spectrum were observed, and could be demonstrated 10 minutes after oral application, mainly in the frontal and central parts of the cortex. Increases in the powerbands delta and theta indicated induction of sleep approximately 15-20 minutes after application and were not looked upon as an effect of the benzodiazepine exclusively. These increases were noticed first in the central, occipital and temporal areas and after 30 minutes in the frontal parts of the cortex. Flunitrazepam plus morphine showed qualitatively similar but quantitatively less pronounced results. Topographical differences were similar to the results of an application of flunitrazepam alone. DISCUSSION The results demonstrate the importance of a topographical as well as quantitative evaluation in studies on complex interactions of sedative or narcotic drugs and their clinical effects on cerebral function. more...
- Published
- 2008
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27. Minimal immunoreactive plasma β-endorphin and decrease of cortisol at standard analgesia or different acupuncture techniques
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B. Moll, Joerg Muehling, G. Hempelmann, Philipp Markart, H. Otto, Rolf-Hasso Boedeker, Heinz Harbach, and U. Vigelius-Rauch
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Adult ,Male ,endocrine system ,medicine.medical_specialty ,Hydrocortisone ,Electroacupuncture ,medicine.medical_treatment ,Analgesic ,Internal medicine ,medicine ,Acupuncture ,Humans ,Acupuncture Analgesia ,Prospective Studies ,business.industry ,beta-Endorphin ,Repeated measures design ,Middle Aged ,Low back pain ,Anesthesiology and Pain Medicine ,Endocrinology ,Nociception ,Opioid ,Anesthesia ,Analysis of variance ,Analgesia ,medicine.symptom ,business ,hormones, hormone substitutes, and hormone antagonists ,medicine.drug - Abstract
BACKGROUND AND OBJECTIVE Acupuncture has been claimed to be associated with activation of the endogenous antinociceptive system. The analgesic effects of acupuncture have been ascribed to beta-endorphin interacting with opioid receptors. However, firstly, the release of beta-endorphin into the blood has been proven to be induced by stress, i.e. under dysphoric conditions, and, secondly, if released under stress, beta-endorphin has been shown not to be analgesic. Our aim was to test whether beta-endorphin immunoreactive material is released into the cardiovascular compartment during acupuncture comparing the most frequently used types of acupuncture with standard pain treatment under apparently low stress conditions. METHODS This prospective study included 15 male patients suffering from chronic low back pain. beta-Endorphin immunoreactive material and cortisol were measured in the plasma of patients who underwent, in random order, therapy according to a standard pain treatment, traditional Chinese acupuncture, sham acupuncture, electro acupuncture and electro acupuncture at non-acupuncture points before, at and after the treatment. Statistical analysis was performed using two-way ANOVA with repeated measures. RESULTS A decrease in plasma cortisol concentration measured over the five treatment protocols was highly significant (P < 0.001). The beta-endorphin immunoreactive material concentrations in plasma were minimal at all times and in all treatment conditions. The influence of treatments by various acupuncture procedures on cortisol and beta-endorphin immunoreactive material plasma concentrations over the three time points was not significantly different. CONCLUSIONS beta-endorphin immunoreactive material in blood is not released by any type of acupuncture as tested under low stress conditions. more...
- Published
- 2007
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28. Which mechanisms are involved in taurine-dependent granulocytic immune response or amino- and α-keto acid homeostasis?
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G. Hempelmann, Ingeborg Welters, Reginald Matejec, H. Harbach, Matthias Krüll, K. A. Nickolaus, Matthias Wolff, T. W. Langefeld, K. Weismüller, J. Mühling, M. Fuchs, J. Engel, and M. C. Heidt
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Adult ,Male ,Taurine ,Eflornithine ,Neutrophils ,Diazooxonorleucine ,Clinical Biochemistry ,S-Nitroso-N-Acetylpenicillamine ,Biology ,Biochemistry ,Nitric oxide ,chemistry.chemical_compound ,Immune system ,Superoxides ,Homeostasis ,Humans ,Amino Acids ,Taurine transport ,Peroxidase ,chemistry.chemical_classification ,Organic Chemistry ,Hydrogen Peroxide ,Metabolism ,Keto Acids ,Amino acid ,Glutamine ,NG-Nitroarginine Methyl Ester ,chemistry ,beta-Alanine - Abstract
We examined the effects of beta-alanine (taurine analogue and taurine transport antagonist), taurine (regarding its role in neutrophil (PMN) immunonutrition) and taurine combined either with L-NAME (inhibitor of *NO-synthase), SNAP (*NO donor), DON (glutamine-analogue and inhibitor of glutamine-requiring enzymes), DFMO (inhibitor of ornithine-decarboxylase) and beta-alanine on neutrophil amino- and alpha-keto acid profiles or important PMN immune functions in order to establish whether taurine transport-, nitric oxide-, glutamine- or ornithine-dependent mechanisms are involved in any of the taurine-induced effects. According to the present findings, the taurine-mediated effect appears to be based primarily on a modulation of important transmembraneous transport mechanisms and only secondarily on directly or indirectly induced modifications in intragranulocytic amino- and alpha-keto acid homoeostasis or metabolism. Although a direct relation to the parallel observed immunological modifications can only be presumed, these results show very clearly that compositional modifications in the free intragranulocytic amino- and alpha keto-acid pools coinciding with changes in intragranulocytic taurine levels are relevant metabolic determinants that can significantly influence the magnitude and quality of the granulocytic immune response. more...
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- 2007
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29. Retraction Statement
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J, Boldt, B, von Bormann, D, Kling, U, Börner, J, Mulch, and G, Hempelmann
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Extracorporeal Circulation ,Pulmonary Circulation ,Blood Volume ,Dose-Response Relationship, Drug ,Pulmonary Gas Exchange ,Hemodynamics ,Coronary Disease ,Starch ,Middle Aged ,Water-Electrolyte Balance ,Retraction ,Hydroxyethyl Starch Derivatives ,Humans ,Coronary Artery Bypass - Abstract
In a randomized study including 55 patients undergoing elective aorto-coronary bypass surgery efficacy of a low concentrated hydroxyethylstarch (3% HES 200/0.5) was tested after extracorporeal circulation (ECC). All patients received 1,000 ml autologous washed erythrocytes (cell saver) and 400 ml fresh frozen plasma (FFP). Thereafter patients were randomized into 4 groups. Hemodynamic parameters, laboratory parameters as well as extravascular lung water (EVLW - double indicator dilution technique) were measured before ECC as well as before and after infusion therapy. With regard to hemodynamic efficiency and the change in laboratory data no relevant differences between group I, II and III could be seen. EVLW-measurement demonstrated the lowest increase in lung water after infusion of HES; simultaneously pulmonary gas exchange was less compromised in comparison to the other infusion groups. 3% HES 200/0.5 solution can be considered as an effective volume substitute with short intravascular retention time, which seems to be of advantage in patients coming off extracorporeal circulation. more...
- Published
- 2015
30. Hyperosmolarer Volumenersatz
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J. Boldt, Ch. Herold, and G. Hempelmann
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- 2015
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31. Therapieeskalation bei progredienten neuropathischen Tumorschmerzen
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K. Diehlmann, H. Otto, G. Hempelmann, D. Heinrichs, T. Fritz, and R. Matejec
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Gynecology ,medicine.medical_specialty ,Anesthesiology and Pain Medicine ,business.industry ,medicine ,Neurology (clinical) ,business - Abstract
Die Behandlung von Tumorschmerzen, insbesondere neuropathischen Ursprungs, stellt in vielen Fallen eine therapeutische Herausforderung dar. Nach den WHO-Empfehlungen sind Opioide die Mittel der ersten Wahl bei der Behandlung starker bis starkster Tumorschmerzen. Die Progredienz der Tumorerkrankung kann jedoch zu einer ausgepragten Dosissteigerung des Opioids fuhren, sodass eine Therapieerweiterung durch interventionelle Strategien oder ein Wechsel des Opioids bzw. des Applikationswegs erforderlich werden. Der vorgestellte Fall demonstriert die Therapieeskalation bei einer trotz exzessiver Analgetikadosen fast nicht beherrschbaren Schmerzentwicklung im Rahmen einer progredienten Tumorerkrankung. more...
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- 2006
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32. Nitric oxide and polyamine pathway-dependent modulation of neutrophil free amino- and α-keto acid profiles or host defense capability
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J. Mühling, G. Hempelmann, Matthias Krüll, H. Harbach, M. Müller, Thilo Menges, Reginald Matejec, M. Fuchs, Ingeborg Welters, J. Engel, M. Halabi, Matthias Wolff, and T. W. Langefeld
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Adult ,Male ,Eflornithine ,Arginine ,Neutrophils ,Clinical Biochemistry ,Nitric Oxide ,Biochemistry ,Neutrophil Activation ,Ornithine decarboxylase ,Nitric oxide ,chemistry.chemical_compound ,Superoxides ,Polyamines ,Humans ,Amino Acids ,Peroxidase ,chemistry.chemical_classification ,biology ,Superoxide ,Penicillamine ,Organic Chemistry ,Hydrogen Peroxide ,Ornithine ,Keto Acids ,Amino acid ,Enzyme Activation ,Nitric oxide synthase ,NG-Nitroarginine Methyl Ester ,chemistry ,biology.protein ,Polyamine - Abstract
We have examined the effects of N(omega)-nitro-L-arginine-methylester-hydrochloride [L-NAME; inhibitor of nitric oxide synthase], S-nitroso-N-acetyl-penicillamine [SNAP; nitric oxide donor], alpha-difluoro-methyl-ornithine [DFMO; inhibitor of ornithine decarboxylase] arginine or ornithine as well as the combination of arginine or ornithine with L-NAME, SNAP or DFMO on intracellular free amino- and alpha-keto acid profiles and the immune function markers superoxide anion and hydrogen peroxide generation as well as released myeloperoxidase activity in neutrophils (PMN). Although the underlying mechanisms still remain unclear, we believe from our results that nitric oxide as well as polyamine-dependent pathways are involved in the signal transmission of free radical molecule, beneficial nutritional therapy or maleficient pharmacological stress-induced alterations in PMN nutrient composition. Relevant changes in intragranulocyte free amino- and alpha-keto acid homeostasis and metabolism, especially, may be one of the determinants in PMN nutrition that positively or negatively influences and modulate neutrophil host defence capability and immunocompetence. more...
- Published
- 2006
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33. Novel Therapeutic Options due to Autologous Blood Components – Exemplified by Autologous Platelet Gel
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G. Hempelmann, B. Fengler, D.F.M. Kuhn, H. Braun, and U. Taborski
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Pathology ,medicine.medical_specialty ,biology ,business.industry ,Autologous blood ,Hematology ,Pharmacology ,Fibrin ,Apheresis ,biology.protein ,Immunology and Allergy ,Medicine ,Platelet ,Autologous platelet ,business - Abstract
Autologous platelet gel (APG) was developed in the early 1970s as a byproduct of the so-called multi-component apheresis. APG is a matrix composed of fibrin and platelets, and was initially used as
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- 2006
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34. Der Einfluss des kontinuierlich positiven Atemwegsdruckes (CPAP) auf die Blutflussgeschwindigkeit im venösen Leberstromgebiet - duplexsonographische Untersuchungen
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C. Pistofidou, M. Born, M. Scheffler, V. Klingmüller, and G. Hempelmann
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Artificial ventilation ,Duplex ultrasonography ,business.industry ,medicine.medical_treatment ,General Medicine ,Blood flow ,Critical Care and Intensive Care Medicine ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Blood pressure ,Anesthesia ,Heart rate ,Emergency Medicine ,medicine ,Breathing ,Continuous positive airway pressure ,Vein ,business - Abstract
OBJECTIVE In the last years, noninvasive techniques of artificial ventilation like continuous positive airway pressure (CPAP) have become more and more important. However, the effects of such procedures on the circulation of the hepatosplanchnic area are, except for the indocyanine green plasma clearance, not yet representative by means of noninvasive investigation methods. METHODS We studied maximum blood flow velocity in defined areas of hepatic and portal veins by duplex ultrasonography in 20 healthy volunteers (12 male, 8 female; age: 24,7 +/- 4,7 years [mean +/- SD]) before, during and after application of CPAP (10 cm H(2)O). As many measurements as possible were taken in both vascular systems. After division into five minute intervals arithmetical mean values were calculated for each interval. The experiment was divided into a control interval ("before CPAP"), three "CPAP" intervals and finally two "after CPAP" intervals. Heart rate and blood pressure were taken at the beginning of these intervals. RESULTS Compared with the control interval, maximum blood flow velocity in the area of the hepatic vein decreased significantly by 13,2 %, 16,8 % and 15,7 % (p < or = 0,001 in each case) during each of the three "CPAP" periods. In the portal venous area blood flow velocity decreased by 4,3 %, 8,8 % and 7,0 %, respectively, with a significant decrease only in the second "CPAP" interval (p < or = 0,005). After CPAP, changes returned to baseline within a few minutes. Heart rate and blood pressure showed no significant differences during the whole experiment. CONCLUSION Parameters taken in both venous vascular areas of the liver show clear correspondence with the results of former studies, which have been determined by means of more invasive investigation methods. Maximum blood flow velocity seems to be useful for monitoring liver blood flow and its individual time course during CPAP, noninvasively and semiquantitatively. Further trials under conditions of controlled mechanical ventilation should be performed to optimize ventilation strategies for the critically ill. more...
- Published
- 2005
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35. Relationship of taurine and other amino acids in plasma and in neutrophils of septic trauma patients
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G. Hempelmann, T. Löhr, B. Kärcher, Thilo Menges, J. Mühling, S. Little, S. Weiss, and J. Engel
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Adult ,medicine.medical_specialty ,Taurine ,Neutrophils ,Clinical Biochemistry ,Glutamic Acid ,Biology ,Biochemistry ,Sepsis ,chemistry.chemical_compound ,Internal medicine ,medicine ,Humans ,Amino Acids ,Retrospective Studies ,chemistry.chemical_classification ,Aspartic Acid ,Organic Chemistry ,Glutamate receptor ,Middle Aged ,medicine.disease ,Pathophysiology ,Amino acid ,Endocrinology ,chemistry ,Osmolyte ,Immunology ,Osmoregulation ,Wounds and Injuries ,Intracellular - Abstract
Recently, an interdependency of plasma taurine and other amino acids as well as metabolic and clinical variables implicating therapeutic options was reported. This result may be an indication that plasma taurine levels are directly related to intracellular levels. Therefore, the aim of this study was to analyse the possible relationship between taurine levels in plasma and in neutrophils, the relationship to other amino acids, and variables quantifying metabolic impairment and severity of sepsis in multiple trauma patients developing sepsis. After multiple trauma taurine decreased significantly in plasma in thirty-two patients as well as within the neutrophil and does not recover in sepsis. Lower individual levels in the neutrophil did not follow lower individual levels in plasma and no correlation of taurine in plasma and in the neutrophils could be observed. In sepsis, only plasma showed an interdependency of taurine, aspartate, and glutamate. No association between taurine plasma or intracellular levels and SOFA score as indicator for severity of sepsis or metabolic variables was observed. After multiple trauma and in sepsis, taurine uptake in cells (which is regulated in different ways), and intracellular taurine (which serves e.g. as an osmolyte) can be influenced. Therefore a prediction of the neutrophil taurine pool seems not fully possible from taurine plasma levels. Intracellular taurine has some unique properties explaining the missing interdependency despite some similarities in osmoregulation and metabolic interactions to other amino acids. The association of taurine, aspartate, and glutamate in plasma cannot be simply transferred to the neutrophils intracellular level. The clinical meaning of the plasma correlation remains unclear. A dependency of plasma and neutrophil taurine to severity of sepsis and to metabolic variables seems not possible because of the multifactorial pathophysiology of sepsis. more...
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- 2005
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36. Perioperatives Management der pulmonalen Hypertonie bei Kindern mit angeborenen Herzfehlern
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Matthias J. Müller, G. Hempelmann, Hakan Akintürk, R. Zimmermann, Myron M. Kwapisz, and St. Scholz
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Emergency Medicine ,Critical Care and Intensive Care Medicine - Published
- 2005
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37. Aktivierung von Granulozyten und Antiproteasen bei herzchirurgischen Eingriffen mit extrakorporaler Zirkulation
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A. Menzebach, Matthias J. Müller, Jan Hirsch, Ingeborg Welters, and G. Hempelmann
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Granulocyte activation ,Proteases ,medicine.medical_specialty ,medicine.diagnostic_test ,biology ,business.industry ,Extracorporeal circulation ,Elastase ,General Medicine ,Critical Care and Intensive Care Medicine ,Flow cytometry ,Respiratory burst ,Surgery ,Anesthesiology and Pain Medicine ,Neutrophil elastase ,Emergency Medicine ,medicine ,biology.protein ,business ,SLPI - Abstract
OBJECTIVE Cardiovascular surgical procedures with extracorporeal circulation (ECC) lead to neutrophil activation followed by the release of proteases such as neutrophil elastase (NE) and oxidants. The mis-balance between proteases and their physiological inhibitors may contribute to morbidity in the postoperative period. In this study, the effects of cardiac surgery on neutrophil mediators were evaluated. Release of neutrophil elastase and plasma levels of the natural NE antagonists alpha (1)-proteinase inhibitor (API) and secretory leukocyte proteinase inhibitor (SLPI) were measured. The oxidative burst and the phagocytic activity were also evaluated. Tissue destruction was quantified by measuring the serum concentration of fibronectin. METHODS Blood samples were obtained from 30 patients undergoing elective coronary artery bypass grafting (n = 30). NE and SLPI concentrations were measured by ELISA, API and fibronectin plasma levels were determined by nephelometry. Neutrophil phagocytic activity and oxidative burst were evaluated by flow cytometry. RESULTS Neutrophil elastase plasma concentrations rose during ECC (245 +/- 107 microg/ml versus 44 +/- 14 microg/ml after induction, p < 0.001), whereas SLPI and API were decreased after onset of ECC. 24 h after ECC SLPI (54 +/- 17 ng/ml versus 41 +/- 10 ng/ml, p < 0.05) and API (3 +/- 0.5 g/l versus 1.6 +/- 0.3 g/l, p < 0.05) increased significantly compared to baseline values. A minor increase in phagocytic activity was observed after the onset of ECC. There were no significant changes in the oxidative burst. CONCLUSION Cardiac surgery with ECC leads to neutrophil activation and elastase release. The imbalance between NE and the NE inhibitors API and SLPI may increase the risk for tissue damage due to granulocyte activation after cardiac surgery. more...
- Published
- 2005
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38. Impact on postoperative pain of long-lasting pre-emptive epidural analgesia before total hip replacement: a prospective, randomised, double-blind study
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Joachim Klasen, G. Hempelmann, S. Graf, I. Jürgensen, M. Haas, H. Harbach, and L. Quinzio
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Adult ,Male ,Long lasting ,medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,Postoperative pain ,medicine.medical_treatment ,Total hip replacement ,Drug Administration Schedule ,Clinical study ,Double blind study ,Bolus (medicine) ,Double-Blind Method ,Humans ,Medicine ,Ropivacaine ,Prospective Studies ,Anesthetics, Local ,Saline ,Aged ,Pain Measurement ,Pain, Postoperative ,business.industry ,Analgesia, Patient-Controlled ,Middle Aged ,Amides ,Surgery ,Analgesia, Epidural ,Anesthesiology and Pain Medicine ,Anesthesia ,Female ,business ,Preanesthetic Medication ,medicine.drug - Abstract
Summary Clinical studies on pre-emptive analgesia have produced inconsistent results. We conducted a clinical study investigating the effect of long-lasting pre-emptive epidural analgesia on consumption of analgesics and acute pain. Forty-two patients scheduled for elective hip replacement for osteo-arthritis were randomly assigned to receive, on the day before operation, either 5 ml.h )1 ropivacaine 0.2% (study group, n = 21) or 5 ml.h )1 saline (control group, n = 21). Postoperative analgesia was achieved in both groups by patient-controlled epidural analgesia (PCEA) with ropivacaine 0.2%. The main outcome measure was consumption of local anaesthetics. Additional parameters included visual analogue pain scale (VAS) scores, consumption of rescue analgesics, requests for PCEA boluses, and side-effects. The pre-operative parameters and pain scores were similar in the two groups. Epidural blocks provided sufficient operative analgesia in all patients. Pre-emptive analgesia was continued for 11‐20 h and led to significantly decreased pain scores before surgery. The consumption of local anaesthetics was decreased postoperatively in the study group (194 mg vs. 284 mg in the postoperative period). Furthermore, bolus requests occurred more frequently in the control group. VAS scores did not differ significantly between groups. Long-lasting ‘pre-emptive’ epidural analgesia decreases postoperative pain with improved pain control. more...
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- 2005
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39. Morphin hemmt die Expression von Komplementrezeptoren sowie Phagozytose und Oxidativen Burst in Monozyten über einen NO-abhängigen Mechanismus
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A. Menzebach, M Mogk, G. Hempelmann, Jan Hirsch, Ingeborg Welters, and R Nöst
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Superoxide ,Monocyte ,Receptor expression ,Phagocytosis ,General Medicine ,Complement receptor ,(+)-Naloxone ,Pharmacology ,Critical Care and Intensive Care Medicine ,Respiratory burst ,chemistry.chemical_compound ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,chemistry ,Immunology ,Emergency Medicine ,medicine ,Receptor - Abstract
Objective Monocytes play a crucial role in the immune response by recognition, ingestion, and intracellular killing of microorganisms. We investigated whether morphine and fentanyl influence CD 11b and CD35 surface receptor expression, phagocytic activity and superoxide anion generation of monocytes in a whole blood flow cytometric assay. Methods Whole blood of 13 healthy volunteers was incubated with different morphine and fentanyl concentrations. Expression of surface receptors CD 11b and CD35 was determined by fluorochrome-labelled antibodies. Phagocytic activity was assessed by ingestion of fluorescent bacteria. Conversion of dihydrorhodamin served for oxidative burst measurements. Results Morphine inhibited monocyte function in a concentration and time dependent manner. Morphine-induced changes were abolished by preincubation with the NO synthase inhibitor N-nitro-l-arginine as well as naloxone. Fentanyl failed to inhibit receptor expression, phagocytosis and reactive oxygen production by monocytes in clinically relevant as well as supraclinical concentrations. Conclusion Our results suggest that these monocyte functions are inhibited by a morphine-stimulated NO release mediated by a mu opiate receptor subtype expressed on the surface of monocytes. In contrast, fentanyl did not share morphine's inhibitory effects on monocyte activity. more...
- Published
- 2004
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40. Vollautomatische Kalkulation des Pflegeaufwandes auf einer Operativen Intensivstation
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Bernd Hartmann, L. Quinzio, G. Hempelmann, A. Junger, Dominik Brammen, Rainer Röhrig, F. Brenck, and Matthias Benson
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Gynecology ,medicine.medical_specialty ,business.industry ,Emergency Medicine ,Medicine ,Emergency Nursing ,Critical Care and Intensive Care Medicine ,business - Abstract
Ziel dieser prospektiven Untersuchung war es zu prufen, inwieweit der TISS-28 (Therapeutic Intervention Scoring System) und der Nine Equivalents of Nursing Manpower Use Score (NEMS) den Pflegeaufwand von Patienten einer Operativen Intensivstation vergleichbar abbilden. In die Studie wurden alle Patienten eines Kalenderjahres eingeschlossen, die alter als 18 Jahre waren und langer als 24 Stunden auf einer Operativen Intensivstation behandelt wurden. Die Dokumentation der Stationsaufenthalte erfolgte mit einem Patient-Daten-Management-System. Fur jeden Patienten und jeden Behandlungstag wurde der TISS-28 und der NEMS automatisch berechnet und mit Hilfe der Bland-Altman-Analyse der Grad der Ubereinstimmung beurteilt. In die Untersuchung konnten 687 Patienten (Uberlebende = 604, Verstorbene = 83) mit insgesamt 3238 Behandlungstagen eingeschlossen werden. Der durchschnittliche TISS-28 (bzw. NEMS) betrug 23,8 ± 4,6 (22,6 ± 5,6) fur die Uberlebenden und 28,5 ± 6,7 (28,3 ± 7,5) fur die Verstorbenen. Der TISS-28 wertet um durchschnittlich 1,6 Punkte hoher als der NEMS-Score (p < 0,05) mit einem R2 = 0,125 und einer linearen Regressionsgeraden von y = –0,227x + 7,394. In dieser Untersuchung konnte gezeigt werden, dass der TISS-28 und der NEMS vergleichbare Scorewerte liefern. Somit konnen beide Scoring-Systeme in Qualitatssicherungsprojekten parallel eingesetzt werden und erlauben den Vergleich des Pflegeaufwandes. more...
- Published
- 2004
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41. Perioperative changes in cerebral ischemic markers in the cerebrospinal fluid after preoperative nimodipine treatment
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G. Hempelmann, M. J. Oehmke, D. F. M. Kuhn, J. Engel, T. Fritz, and D. Schirrmeister
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Male ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Enolase ,Placebo ,Anesthesia, Spinal ,Brain Ischemia ,Cerebrospinal fluid ,Double-Blind Method ,Preoperative Care ,medicine ,Humans ,Lactic Acid ,Prospective Studies ,Infusions, Intravenous ,Intraoperative Complications ,Creatine Kinase ,Nimodipine ,Saline ,Aged ,Cerebrospinal Fluid ,Acidosis ,Aged, 80 and over ,Hypoxanthine ,business.industry ,General Medicine ,Perioperative ,Hydrogen-Ion Concentration ,Calcium Channel Blockers ,Catheter ,Neuroprotective Agents ,Anesthesiology and Pain Medicine ,Phosphopyruvate Hydratase ,Anesthesia ,Female ,medicine.symptom ,business ,Biomarkers ,medicine.drug - Abstract
BACKGROUND Elderly patients with previous organ damage are at risk for minor neurologic deficits after major surgery. Spinal catheter analgesia is used whenever possible in this group and enables regular cerebrospinal fluid (CSF) sampling. Nimodipine, a calcium blocker, may have neuroprotective effects. We examined whether preoperative treatment with nimodipine affects ischemic markers in the CSF during extracranial surgery. METHODS We performed a prospective, randomized, placebo-controlled, double-blind study in patients (ASA III or IV, 65-85 years) that underwent elective implantation surgery of the hip joint with intrathecal catheter anesthesia. Starting 15 h before surgery, patients received either 30 microg x kg(-1) h(-1) of nimodipine (n = 20) or 0.9% saline solution (placebo, n = 23) as a central venous infusion. The concentrations of neuron-specific enolase, hypoxanthine, creatine-kinase, lactate and pH in the CSF were determined before and immediately after surgery as well as 6 and 24 h after surgery. RESULTS Before surgery, the baseline CSF pH was normal in all patients. Immediately after surgery it fell significantly to 7.08 +/- 0.29 in the placebo group and non-significantly to 7.27 +/- 0.38 in the treatment group; all values were normalized at 6 and 24 h after surgery in both groups. In the placebo group, lactate levels rose significantly from 1.48 +/- 0.28 mmol l(-1) before surgery to 1.77 +/- 0.27 mmol l(-1) immediately after surgery, and to 2.03 +/- 0.32 mmol l(-1) 24 h after surgery. In the treatment group, lactate concentrations remained stable up to 6 h after surgery (1.55-1.62 mmol l-1), while an increase to 2.10 +/- 0.48 mmol l(-1) was observed 24 h after the operation. Neuron-specific enolase, hypo-xanthine and creatine-kinase showed no change in either group. CONCLUSION In conclusion, preoperative nimodipine treatment reduced intraoperative CSF acidosis and delayed surgery-related increases in lactate concentration in the CSF by several hours in elderly, comorbid patients at risk for minor postoperative neurologic deficits. more...
- Published
- 2003
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42. Effects of endogenous and synthetic opioid peptides on neutrophil function in vitro
- Author
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Jan Hirsch, Ingeborg Welters, A. Menzebach, and G. Hempelmann
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Male ,medicine.medical_specialty ,Enkephalin ,Neutrophils ,medicine.drug_class ,Enkephalin, Methionine ,Receptor expression ,(+)-Naloxone ,Neutrophil Activation ,Antigens, CD ,Superoxides ,Opioid receptor ,Naltrindole ,Internal medicine ,medicine ,Humans ,Opioid peptide ,business.industry ,beta-Endorphin ,Enkephalin, Leucine-2-Alanine ,Flow Cytometry ,Peptide Fragments ,Anesthesiology and Pain Medicine ,Endocrinology ,Opioid Peptides ,Opioid ,Enkephalin, D-Penicillamine (2,5) ,Somatostatin ,business ,Opioid antagonist ,medicine.drug - Abstract
Opioid peptides released from immunocytes during inflammation and stress in critically ill patients are associated with an altered immune response. Moreover, concentrations of opioid peptides are increased in peripheral blood and at the sites of inflammatory reactions.Using flow cytometric assay of whole human blood, we investigated direct effects of endogenous and synthetic opioid peptides on surface expression of complement receptors CD35 and CD11b/CD18 and Fcã receptor III CD16, and superoxide anion generation of neutrophils.The endogenous opioid peptides beta-endorphin(1-31) and met-enkephalin, representing the N-terminal fragment of beta-endorphin(1-31), and the synthetic delta opioid receptor agonists D-Ala(2)-D-Leu(5)-enkephalin and D-Pen(2)-enkephalin produced concentration-dependent stimulation of neutrophil activity. Incubation with met-enkephalin 10(-7) M or beta-endorphin(1-31) 10(-7) M led to an increase in receptor expression of up to 10% (met-enkephalin) and 15% (beta-endorphin(1-31)). After incubation with D-Ala(2)-D-Leu(5)-enkephalin or D-Pen(2/5)-enkephalin, receptor expression was increased by up to 30%. This correlated with concentration-dependent stimulation of the production of reactive oxygen intermediates, as shown by an increase of up to 40% in oxidative burst activity. All effects were abolished after preincubation with naloxone or with the selective delta opioid antagonist naltrindole, whereas the selective micro receptor antagonist d-Phe-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr-NH(2) showed only partial inhibitory effects.Our data suggest a delta opioid receptor-mediated stimulatory effect on neutrophil function. beta-Endorphin(27-31), the C-terminal fragment of beta-endorphin(1-31), did not alter neutrophil function, indicating that beta-endorphin(1-31) mediates its effect on neutrophils via the N-terminal fragment. This study may contribute to a better understanding of neuroimmune interaction. more...
- Published
- 2003
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43. Pocken - Klinik, Therapie und anästhesiologische Aspekte (Teil 1)
- Author
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T. W. Langefeld, G. Hempelmann, J. Engel, and Thilo Menges
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medicine.medical_specialty ,business.industry ,viruses ,virus diseases ,Outbreak ,General Medicine ,Disease ,Critical Care and Intensive Care Medicine ,medicine.disease ,complex mixtures ,Virology ,law.invention ,Vaccination ,Anesthesiology and Pain Medicine ,Infectious disease (medical specialty) ,law ,Case fatality rate ,Quarantine ,Emergency Medicine ,medicine ,Smallpox ,Intensive care medicine ,business ,Smallpox vaccine - Abstract
Smallpox is an acute contagious and sometimes fatal infectious disease. It is caused by the variola-virus. Smallpox is characterized by a typical disease form with a progressive distinctive skin rash, especially at face, arms and legs. Smallpox has a fatality rate of about 30 % and the therapy of infected patients is only symptomatically. As prevention the WHO initiated worldwide vaccination programs in the year 1967. The last naturally occurring case of smallpox in the world was in Somalia in 1977. Since then the only known cases of smallpox happened from an outbreak in Birmingham, England caused by a laboratory accident in the year of 1979. On May the 8 th 1980 the disease was declared as eliminated from the world by the WHO (WHO-Resolution 33.33). A natural occurrence of the variola-virus seems to be not given. Nevertheless the virus exists for research in two laboratories, the American Centers of Disease Control and Prevention in Atlanta, Georgia and in the Russian Research Center for Virology and Biotechnics in Kolzowo, Sibiria. Threatening infections with smallpox or other microorganisms, used as bioweapons, get a new dimension through global terrorism. The variola-virus represents an optimal candidate for bioweapons. It is easy to replicate, it is highly contagious and the transmission over aerosol or direct contact from man to man is easy to handle. After the disease was eliminated from the world, routine vaccination among general public was stopped. Therefore younger people don't possess any vaccination protection. Older formerly vaccinated people probably have only a non-sufficient protection. Because of the smallpox elimination a lot of physicians have no experience with this disease. An outbreak of this smallpox isn't only controlled by new vaccination. In our times we need adapted prevention-standards, pox-alarm plans and quarantine standards. more...
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- 2003
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44. Low plasma glutamine after multiple trauma: relationship with intracellular glutamine in polymorphonuclear neutrophils during prolonged ICU stay
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S. Weiss, J. Engel, Y. Simonis, G. Hempelmann, T. Löhr, Thilo Menges, and J. Mühling
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medicine.medical_specialty ,business.industry ,Neutrophile ,Reference range ,General Medicine ,Granulocyte ,Intensive care unit ,law.invention ,Glutamine ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Endocrinology ,law ,Internal medicine ,Mole ,Blood plasma ,Immunology ,medicine ,business ,Intracellular - Abstract
BACKGROUND Aim of the study was to evaluate whether low plasma glutamine (GLN) is related to low intracellular GLN in stress-affected cells such as polymorphonuclear neutrophil (PMN). We hypothesized, that because low plasma GLN is assumed to have an impact on clinical outcome, stress-affected cells may also show low GLN contents. METHODS Thirty-nine consecutive severely injured trauma patients staying at least 10 days at a surgical intensive care unit (ICU) of a university hospital were separated into two groups: group one (n = 16) with low plasma GLN (< 420 micromol/l in average during ICU stay), and group two (n = 23) with normal plasma GLN. Initial blood samples for GLN analyses were collected within 24 h of admission at ICU. Further blood samples were taken on days 5 and 10 at 08:00 hours. RESULTS Patients in both groups showed no differences regarding demographic data, surgical interventions or infections. Acute physiology and chronic health evaluation (APACHE) II and the sequential organ failure assessment (SOFA) score and mortality rate were also comparable. During the study period, intracellular PMN GLN contents and concentrations did not differ between both groups. On the first day, intracellular PMN GLN content in the low plasma GLN group peaked at 5.01 +/- 3.06 x 10(-16) mol and in normal plasma GLN group at 4.73 +/- 2.57 x 10(-16) mol above the level of healthy individuals. In both groups, content decreased significantly towards the end of the observation period (group one: 2.79 +/- 1.59 x 10(-16) mol and group two: 2.63 +/- 1.71 x 10(-16) mol). A correspondent course could be observed for cell volumes. In contrast, variation of intracellular GLN concentrations remained within the reference range throughout the observation period: group one 836 +/- 510 micromol/l on day 1 and 582 +/- 331 micromol/l on day 10, and group two 788 +/- 428 micromol/l on day 1 and 548 +/- 356 micromol/l on day 10. No correlation between plasma GLN and intracellular GLN was found in either group. CONCLUSION No association between low plasma GLN and low intracellular GLN in PMN was found in a cohort of severely injured trauma patients with a minimum stay of 10 days at ICU. more...
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- 2003
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45. Korrelation eines automatisch generierten SOFA-Scores und seiner abgeleiteten Größen mit der Liegedauer auf einer operativen Intensivstation
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A. Banzhaf, M. Benson, G. Hempelmann, B. Hartmann, A. Junger, J. M. Engel, Rainer Röhrig, and M. Zimmer
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medicine.medical_specialty ,business.industry ,health care facilities, manpower, and services ,Organ dysfunction ,Glasgow Coma Scale ,Retrospective cohort study ,General Medicine ,Critical Care and Intensive Care Medicine ,Intensive care unit ,respiratory tract diseases ,law.invention ,Anesthesiology and Pain Medicine ,law ,health services administration ,Intensive care ,Severity of illness ,Emergency medicine ,Emergency Medicine ,medicine ,SOFA score ,medicine.symptom ,Intensive care medicine ,business ,Blood coagulation test - Abstract
Objective The purpose of this study was to assess whether or not the information on progression of illness and therapeutic interventions included in a computerized SOFA (Sequential Organ Failure Assessment) score and derived measures (maximum SOFA, total maximum SOFA and delta SOFA) influences the correlation with length of stay (LOS) at an operative intensive care unit (ICU). Methods During a period of one year 524 patients aging over 18 years who stayed more than 24 hours at an operative ICU were included into this study. Based on SQL scripts (Structured Query Language), a computerized SOFA score and the derived measures "maximum-SOFA", "total-maximum-SOFA" and "delta-SOFA" of all patients were retrospectively calculated for each day at ICU using routine data recorded with the patient data management system ICUData (IMESO GmbH, Huttenberg, Germany). "Maximum-SOFA" and "total-maximum-SOFA" are measures for the severity of illness or cumulative organ dysfunction. "Delta-SOFA" measures the magnitude of organ dysfunction developing during ICU stay and is therefore potentially influenced by therapeutic measures. Analysis was based on exact LOS in hours. Results Mean LOS of the whole collective was 5.2 +/- 6.8 days (median 2.8, range 1 - 51). Correlation of LOS depending on score results increased from "admission-SOFA" (r = 0.280), to "maximum-SOFA" (r = 0.444), "total-maximum-SOFA" (r = 0.503), and "delta-SOFA" (r = 0.576). Conclusion Therefore, the sum of information on progression of illness and therapeutic interventions included in derived measures improves the correlation with LOS at an ICU compared to the "admission-SOFA". more...
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- 2003
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46. Temperature course and distribution during plasma heating with a microwave device
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G. Hempelmann, R. Bach, G. V. Dietrich, Jan Hirsch, A. Menzebach, and Ingeborg Welters
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medicine.medical_specialty ,Plasma heating ,business.industry ,Analytical chemistry ,Plasma ,Surgery ,Anesthesiology and Pain Medicine ,Thermometer ,medicine ,Fresh frozen plasma ,Temperature difference ,business ,Heating time ,Microwave ,Overheating (electricity) - Abstract
Summary In spite of the much shorter thawing times, the use of microwave devices for heating units of fresh frozen plasma is still being discussed. Concerns about general and localised overheating are the main arguments against the use of microwave devices. We evaluated the warming of fresh frozen plasma using the recently introduced Transfusio-therm 2000® microwave blood warmer. Units of fresh frozen plasma were weighed and the heating times were recorded. The surface temperature of the fresh frozen plasma bags during heating was recorded every 10 s. Temperature variation on the surface was examined by measuring the difference between peripheral and centrally placed temperature sensors. After heating, plasma temperature was determined using a calibrated thermometer. There were no signs of overheating during the heating process. The surface temperature of three units of fresh frozen plasma heated simultaneously (n = 45) was 34.0°C (SD, 1.5°C) after a mean heating time of 23.2 min (SD, 1.1 min). The mean (SD) temperature difference was −0.6 (0.5)°C and the mean (SD) plasma temperature was 33.6 (0.8)°C. Heating one fresh frozen plasma unit at a time (n = 20), the mean (SD) heating time was 6.3 (0.4) min. The surface temperature after heating was 34.3 (0.2)°C, the mean (SD) temperature difference was −0.6 (0.4)°C and the mean (SD) plasma temperature after heating 33.1 (0.6)°C. We conclude that no general or localised overheating of fresh frozen plasma occurs during or after heating with the microwave blood warmer. more...
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- 2003
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47. Comparison of Blood Loss using Fluorescein Flow Cytometry during Total Hip Replacement under General or Spinal Anesthesia
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S. Lorson, A. Jost, M. Benson, A. Junger, B. Hartmann, G. Hempelmann, T. Klein, and T. Langefeld
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Hip surgery ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Total hip replacement ,Spinal anesthesia ,Hematology ,Perioperative ,Surgery ,Flow cytometry ,chemistry.chemical_compound ,Blood loss ,chemistry ,Anesthesia ,Circulatory system ,medicine ,Immunology and Allergy ,Fluorescein ,business - Abstract
Objective: In this study we assessed differences in intraoperative blood loss using flow cytometry in patients undergoing total hip replacement under general (GA) or spinal anesthesia (SA). Patients and Methods: After approval of the ethics committee and written informed consent, 42 patients (ASA I–III) undergoing elective total hip replacement were included in this study. All perioperative data were recorded with an anesthesia information management system. Therefore, standardized electronic anesthesia record charts were configured according to the study protocol. Red cell volume was measured with sodium fluorescein using flow cytometry before induction of anesthesia and at the end of the surgical procedure. Surgical blood loss was determined with the calculated loss of red blood cells and the mean of all intraoperatively measured hematocrit levels. Results: Data of all 42 patients (18 GA, 24 SA) were evaluated. The electronic charts contained complete data sets of the patients’ biometric data, laboratory parameters, and surgery times. The study revealed no significant differences (p Conclusions: The controversially discussed influence of anesthesia technique on intraoperative blood loss in total hip replacement could not be confirmed by this study. GA as well as SA are equivalent techniques in hip surgery regarding circulatory parameters and body temperature. more...
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- 2003
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48. Risikoindizes, Scoring-Systeme und prognostische Modelle in der Anästhesie und Intensivmedizin
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B. Hartmann, M. Benson, J. M. Engel, Rainer Röhrig, G. Hempelmann, and A. Junger
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medicine.medical_specialty ,Quality management ,business.industry ,Psychological intervention ,General Medicine ,Critical Care and Intensive Care Medicine ,Anesthesiology and Pain Medicine ,Anesthesiology ,Intensive care ,Severity of illness ,Emergency Medicine ,medicine ,Simplified Acute Physiology Score ,Risk assessment ,Intensive care medicine ,business ,Prospective cohort study - Abstract
The aim of the second part of this review article was to describe common scoring systems in intensive care, and to point out their possible benefits and limitations. Intensive care medicine multipurpose scoring-systems are currently used to estimate severity of illness, mortality and the amount of treatment required. Costs (only commercial available scores e.g. Acute Physiology and Chronic Health Evaluation [APACHE]III) and time needed for calculation have to be taken into consideration. Prognostic models of the third generation (APACHE III, Simplified Acute Physiology Score [SAPS] II, Mortality Prediction Model [MPM] II) should be preferred having better prognostic performance compared to scoring systems of prior generations. Although no prospective study exists comparing these three common scoring systems, it appears that all three systems are able to provide useful information to the clinician and researcher. These scoring systems were designed to classify severity of illness or the course of diagnostic and therapeutic interventions and to perform a risk stratification for scientific studies in a standardized way. In quality management and cost control, scoring systems and predictors are used for risk adjustment and evaluation of care performance. more...
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- 2002
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49. Risikoindizes, Scoring-Systeme und prognostische Modelle in der Anästhesie und Intensivmedizin. Teil I: Anästhesie
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A. Junger, A. Jost, L. Quinzio, J. M. Engel, G. Hempelmann, and A. Banzhaf
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medicine.medical_specialty ,business.industry ,MEDLINE ,General Medicine ,Perioperative ,Critical Care and Intensive Care Medicine ,Surgery ,Anesthesiology and Pain Medicine ,Intensive care ,Anesthesiology ,Severity of illness ,Emergency Medicine ,medicine ,Risk factor ,business ,Adverse effect ,Intensive care medicine ,Risk assessment - Abstract
Risk predictors and scoring systems are commonly used in medicine to provide a reliable and objective estimation of disease prognoses, probability of adverse events and outcome. Furthermore, they were designed to classify severity of illness or the course of diagnostic and therapeutic interventions and to perform a risk stratification for scientific studies in a standardized way. In quality management and cost control, scoring systems and predictors are used for risk adjustment and evaluation of care performance. The aim of this review article was to describe common risk indices and scoring systems in anesthesia (part I) and intensive care (part II), and to point out their possible benefits and limitations. Different scoring systems and classifications are available to stratify perioperative risk and adverse events in anesthesia. Especially in cardiac surgery, an increasing interest in risk-adjusted outcome studies led to the modeling and validation of different prognostic systems for postoperative morbidity, mortality and length of stay. Furthermore, there are scoring-systems for special events, such as difficult laryngoscopy or postoperative nausea and vomiting (PONV). Risk check lists and risk indices are superior to the ASA classification of physical status in providing more exact results and the possibility of statistic risk calculation. Nevertheless, they are not frequently used in clinical routine. Because of its simplicity and easy handling the ASA classification has worldwide popularity and recent studies demonstrated at least equal prognostic performance. more...
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- 2002
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50. Incidence and risk calculation of inotropic support in patients undergoing cardiac surgery with cardiopulmonary bypass using an automated anaesthesia record-keeping system
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M Benson, Matthias J. Müller, Myron M. Kwapisz, Hakan Akintürk, G. Hempelmann, Michael E. Bräu, A. Junger, and Ehrenfried Schindler
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Male ,Inotrope ,medicine.medical_specialty ,Cardiotonic Agents ,Time Factors ,Epinephrine ,Medical Records Systems, Computerized ,Myocardial Infarction ,Preoperative care ,law.invention ,Coronary artery bypass surgery ,Risk Factors ,law ,Dobutamine ,Preoperative Care ,medicine ,Cardiopulmonary bypass ,Humans ,Anesthesia ,Myocardial infarction ,Enoximone ,Aged ,Retrospective Studies ,Heart Failure ,Cardiopulmonary Bypass ,business.industry ,Middle Aged ,medicine.disease ,Cardiac surgery ,Anesthesiology and Pain Medicine ,Heart failure ,Female ,business ,medicine.drug - Abstract
This retrospective study analysed the effects of preoperative and intraoperative factors on the occurrence of inotropic support after cardiopulmonary bypass (CPB).The data sets of 1471 adult patients having received elective cardiac surgery with CPB were recorded using an online anaesthesia record-keeping system. Patients were judged to have required inotropic drug support if they had received one or a combination of the positive inotropic drugs, epinephrine, dobutamine and enoximone. The effects of age, height, weight, body mass index, gender, chronic heart failure, documented preoperative myocardial infarction, left main coronary artery disease, preoperative history of hypertension, chronic renal failure, diabetes mellitus, chronic obstructive pulmonary disease (COPD), preoperative medical treatment, type of surgical procedure, duration of CPB, duration of aortic clamping and reperfusion time were analysed by logistic regression for predictive power of the need for positive inotropic drugs.Of the patients, 32.4% received positive inotropic drugs in the operating theatre after weaning from CPB. The overall 30-day mortality was 2.2%. Of non-survivors, 81.8% received inotropes compared with 18.2% of survivors (P0.01). The numbers of previous myocardial infarctions (odds ratio (OR), 2.01), congestive heart failures New York Heart Association class2 (OR, 1.85), COPD (OR, 1.85) and age65 yr (OR, 1.62), aortic cross clamping time of90 min (OR, 2.32) and coronary artery bypass surgery (OR, 0.43) all represented influential factors within the logistic regression model.The knowledge of these risk factors should be useful in increasing the anaesthetist's vigilance in those patients most at risk for inotropic support and in providing for more timely therapeutic intervention and optimizing anaesthesia management. more...
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- 2002
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