Accuracy of Point-of-Care B-Line Lung Ultrasound in Comparison to NT-ProBNP for Screening Acute Heart Failure.

AIM: The objective of this pilot study was to determine the accuracy of point-of-care B-line lung ultrasound in comparison to NT Pro-BNP for screening acute heart failure. MATERIALS AND METHODS: An 8-zone lung ultrasound was performed by experienced sonographers in patients presenting with acute dyspnea in the ED. AHF was determined as the final diagnosis by 2 independent reviewers. RESULTS: Contrary to prior studies, B-line ultrasound in our study was highly specific, but moderately sensitive for identifying patients with AHF. There was a strong association between elevated NT-proBNP levels and an increased number of B-lines. CONCLUSION: In conclusion, point-of-care lung ultrasound is a helpful tool for ruling in or ruling out important differential diagnoses in ED patients with acute dyspnea.

[Health care situation of patients with suspected sepsis in a German emergency department]. / Versorgungsprozesse von Patienten mit Verdacht auf Sepsis in einer deutschen Notaufnahme.

BACKGROUND: The in-hospital mortality of patients with severe sepsis and septic shock (ssss) is high. Of note, little is known about the health care situation of patients with sepsis in German emergency departments. The aim of the study was to analyze whether sepsis patients are treated according to current guidelines, to identify the treatment sites within the hospital and to evaluate the death rate of affected patients during index hospitalization. PATIENTS AND METHODS: In this single-centre, prospective and observational trial we analyzed consecutive patients with complaints of sepsis during August and September 2012. RESULTS: During the study period 151 patients presented with complaints of sepsis (age 68.3 ± 18 years, 54.3% men, 45% with ssss, in-hospital mortality of the overall cohort: 14.6%). The Surviving Sepsis Campaign three hour bundle (lactate, blood cultures, broad spectrum antibiotics, and volume) was carried out in 54.2% of patients with ssss. In case of ssss, broad spectrum antibiotics were initiated in the emergency department in 85.4%. Patients with ssss were admitted to wards with usual care in 67.2%, in 32.8% they were admitted to an intensive or intermediate care unit. The in-hospital mortality of patients with ssss during their index hospitalization was 27.8%. CONCLUSION: Despite the high in-hospital mortality rate, more than two thirds of the patients with ssss were admitted to wards with usual care. We call for action 1) to early identify affected patients, 2) to provide adequate risk stratification tools and 3) to realize an early disposition of patients to the appropriate care units.

Indication and results of insulin therapy for gestational diabetes mellitus.

The aim of this study was to determine whether amniotic fluid insulin concentration (AFI) is a better parameter than mean maternal blood glucose values (MBG) for deciding about insulin therapy in patients with gestational diabetes. MBG's were calculated on the base of 9 blood glucose levels during a 24 hour period after one week of diet therapy. In a prospective trial between 1987 and 1989 in Karlsburg, 123 gestational diabetic patients were randomized into two groups. Treatment was either based on the concentration of AFI or MBG levels. In a second series in Berlin, 103 patients were offered amniocentesis. 81 patients agreed and 22 refused. Treatment was then analogous to that in Karlsburg. In both groups of the randomized population, strict metabolic control was achieved. There was no difference regarding pregnancy complications. Earlier labor induction and higher cesarean section rates were seen in the non-invasive group (p < 0.05). The incidence of diabetic fetopathy and neonatal hypoglycemia was significantly lower in the invasive group (p < 0.01), even though the metabolic control parameters did not differ between the two groups. The results in Berlin correspond to these findings. In conclusion, AFI enables the recognition of any hyperinsulinism reaction to the maternal metabolic situation. We recommend the additional measurement of the AFI concentration between 28 and 36 weeks as the direct fetal parameter for deciding about insulin treatment.

[Diabetic retinopathy and nephropathy--complications in pregnancy and labor]. / Diabetische Retinopathie und Nephropathie--Komplikationen während Schwangerschaft und Geburt.

The purpose of this retrospective study was to determine the risk factors for the morbidity of the mothers and their fetus in patients with diabetic retinopathy and/or nephropathy with an open family planning. We compared the course of pregnancies, complications as well as the maternal and neonatal morbidity in 76 patients with diabetic retinopathy or nephropathy (White R F) with 85 patients without severe microangiopathy (White C D). We found a correlation between retinopathy progression and hyperglycaemia during the first trimester (p < 0.05). There was an increase in the deterioration of visual acuity up to blindness due to the progression of this microangiopathy in cases of proliferative retinopathy. There was a significant increase of the mean diastolic blood pressure (mdp) and preeclamptic symptoms occurred in 71% of the cases with severe microangiopathy (p < 0.05). Deterioration of the diabetic nephropathy with excessive proteinuria (> 10 g/d) and unmanageable hypertension or a progression of the retinopathy led to an earlier delivery in 80% of the patients (p < 0.05). A high rate of preterm deliveries (39%) and a frequent occurrence of intrauterine growth retardation's (9%) characterised the fetal outcome. The following examinations for a patient with an open family planning, if diabetes is diagnosed during childhood or the course of the disease is between 10 and 15 years, should be done: Ophthalmological evaluation, control of the renal function, contraceptive advice and an improvement of the metabolic situation. In case of a diabetic nephropathy in combination with hypertonus the patients shoud be warned against pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Placental function test, clinical and biochemical parameters in diabetic pregnancy complicated by retinopathy.

The pregnancy in specific-beta 1-glycoprotein (SP1) has been characterized as a beta 1 electrophoretic mobile glycoprotein with a molecular weight of 90,000 daltons. SP1 is known to be synthesized by the trophoblast. The measurement of this protein has been shown to be useful as a placental function test. At present, we have compared maternal SP1 serum levels in diabetic pregnancies between White classes A to D on the one hand and R, F on the other. A total of 37 uncomplicated pregnancies in healthy women and 32 of insulin-dependent pregnant diabetic women were examined between completed gestational weeks 8 and 41. In the diabetic group there were eleven women with diabetic retinopathy. Maternal SP1 serum levels were estimated by single radial immunodiffusion using a monospecific antiserum. In the results were integrated maternal and neonatal data such as glycemic control, glycosylated hemoglobin and insulin requirements. In each group there was a significant rise in maternal SP1 serum values in the second and the third trimester, when compared with values in the first trimester (p less than 0.01). Between the 34th and the 37th gestational week we found significantly lower SP1 values (p less than 0.05) in the retinopathic group (104.2 +/- 28.7 mg/l) in comparison with the control group (149.9 +/- 61.0 mg/l) and non-retinopathic group (139.1 +/- 41.7 mg/l).

Serum concentrations of pregnancy-associated alpha-2-glycoprotein in diabetic pregnancy complicated by nonfulminant and fulminant proliferative retinopathy.

The pregnancy zone protein serum concentration in normal pregnancy reaches its peak at about the 24th week. High serum PZ concentrations are significantly more frequent among pregnant diabetic patients without proliferative retinopathy. In contrast, the mean values in mothers with diabetes mellitus complicated by proliferative retinopathy continue to decrease. A very low limit of 150 mg/l was achieved more frequently in diabetic pregnancy complicated by fulminant proliferative retinopathy. Measurement of serum PZ levels in diabetic pregnancy might help to predict the risk of progressive retinopathy.

Circulating levels of placental protein 10 (PP 10) in diabetic pregnancy complicated by retinopathy.

Placental protein 10 (PP 10) is a soluble tissue antigen of the placenta. PP 10, a glycoprotein, was tested in diabetic pregnancy complicated by retinopathy. A continuous increase in PP 10 serum levels until weeks 35-36 is followed by a fall thereafter up to term. The mean of the healthy control group between 32 and 39 weeks gestation was 22 +/- 10 micrograms/l. In diabetic pregnancies complicated by retinopathy there were measured 69 +/- 24 micrograms/l in benign form and 77 +/- 26 micrograms/l in proliferative form. Both of these values are significantly (p less than 0.05) above the control values. Increased PP 10 levels in diabetic pregnancy complicated by retinopathy are probably caused by placental and amniotic leakages.

[Placental protein 12 (PP 12)/insulin-like growth factor binding protein (IGF-bp) in pregnancy in metabolically healthy patients and diabetic patients with retinopathy]. / Plazentaprotein 12 (PP 12)/Insulin like growth-factor binding protein (IGF-bp) in der Schwangerschaft von Stoffwechselgesunden und Diabetikerinnen mit Retinopathie.

The placental protein 12 (PP 12) was found to be identical with the insulin like growth-factor binding protein (IGF-bp). In present investigations serum samples of 420 healthy pregnant women between 7th and 40th weeks of gestation were proved regarding to their IGF-bp concentrations by means of a radioimmunoassay. For each pregnancy week means and standard deviations were estimated. IGF-bp serum concentrations continuously increased up to the 18th week (140 +/- 40 micrograms/l); followed by decreasing of the values up to the 30th week (102 +/- 44 micrograms/l) and then slightly increased up to term (121 +/- 46 micrograms/l). In addition the IGF-bp estimations were performed in maternal serum samples of 45 diabetic pregnant women complicated by retinopathia diabetica benigna as well as proliferativa; sum total 101 serum samples. In patients with benign retinopathy 82% (12/68) and in patients of proliferative retinopathy 85% (5/33) of the IGF-bp values were increased above the two times standard deviation.

Placental protein 12 (PP 12), a decidual protein, in pregnancy complicated by diabetes with retinopathy.

Placental protein 12 (IGF-bp/PP 12) is a soluble tissue antigen produced in the decidua. PP 12 was measured in the 3rd trimester of diabetic pregnancy complicated by retinopathy. The mean values of the healthy control group between 28 and 34 and between 35 and 39 weeks gestation were 108 +/- 39 micrograms/l and 124 +/- 47 micrograms/l, respectively. The equivalent values in diabetic pregnancies complicated by retinopathy were 200 +/- 80 micrograms/l and 204 +/- 81 micrograms/l, respectively; both these PP 12 values were significantly (P less than 0.05) above the values in the control group. There was no significant difference between benign and proliferative retinopathy. The increased PP 12 levels in the presence of diabetic retinopathy are probably caused by decidual degeneration.

The effect of intensified conventional insulin therapy before and during pregnancy on the malformation rate in offspring of diabetic mothers.

56 out of the 200 pregnant diabetic women admitted to our clinic between July 1981 and June 1983 had followed a pre-pregnancy metabolic intensive treatment programme. Most of these patients achieved near-normoglycemia: 87% or more of all their blood glucose readings before conception and in the early weeks of gestation were normoglycemic. The 56 patients were delivered of 57 babies, one of them suffering from fatal heart malformation. The 144 pregnant diabetics who were admitted to hospital only after eight weeks of pregnancy and had not had any special preconceptional metabolic control gave birth to 145 children, 9 of which presented congenital malformations: 3 of these were fatal another 3 were severe, and 3 were minor. These data are in line with our previously reported results on the years 1977-81. They stress the importance of a reasonably strict metabolic control, started well before conception, to prevent excess rates of congenital malformation.

Prevention of congenital malformations in infants of insulin-dependent diabetic mothers.

From April 1977 to April 1981, 420 deliveries of infants of insulin-dependent diabetic women were performed in our department. Of the infants delivered, 23 had congenital malformations (5.5%). The malformation rate was 1.4% for infants of 420 nondiabetic women. Strict metabolic control was begun after 8 wk gestation in 292 of the diabetic women who delivered 22 infants with congenital malformations (7.5%). Intensive treatment was begun before conception in 128 diabetic women planning pregnancy. There was only one malformation in infants of this group (0.8%), a significant reduction from the anomaly rate in the late registrants (X2 = 7.84; P less than 0.01). These observations indicate that reasonable metabolic control started before conception and continued during the first weeks of pregnancy can prevent malformations in infants of diabetic mothers.

Immunochemical investigations on the problem of the pregnancy zone protein. XII. Serum concentrations of pregnancy-associated alpha-2-glycoprotein in diabetic pregnancy.

The concentration in serum of the pregnancy zone protein (PZ), a high molecular pregnancy-associated alpha 2-glycoprotein, increases during pregnancy, when oral contraceptives are taken and under certain pathological conditions. PZ is probably part of a multifactorial immunological defence system which prevents the premature rejection of the fetus and placenta which together may be regarded as an allograft. Normally, the PZ serum concentration begins to rise during the 6th-12th week of pregnancy and reaches its peak at about the 24th week. The mean values then remain stable and afterwards diminish slightly toward the end of the pregnancy. In contrast, the mean values in mothers with insulin-dependent diabetes mellitus continue to rise. Excessively high serum PZ concentrations are significantly more frequent among pregnant diabetic patients, especially where there is also rhesus D antigen incompatibility. No correlation was found between excessively high values and the risk features used for the Priscilla White classification. A few patients with progressive proliferative retinopathy even had unusually low values.

[Modification of a radioimmunological double-antibody method for human chorionic somatomammotropin (HCS) as a rapid test suitable for high concentrations in the late pregnancy]. / Modifikation einer radioimmunologischen Doppelantikörpermethode für Human Chorionic Somatomammotropin (HCS) als Schnelltest--geeignet für hohe Konzentrationen in der Spätschwangerschaft

A rapid and reproducible double antibody radioimmunoassay for plasma human chorionic somatomammotropin is described. The assay can routinely be performed by incubation for three hours (37 degrees C). The different steps of this method and precision of test modifications were evaluated. Levels of HCS of 222 normal pregnant women between the 24th and 40th week of pregnancy were investigated in order to determine the normal range of HCS levels during pregnancy.