[Level of immunoglobulins A, G and M in the postoperative period]. / Verhalten der Immunglobuline A, G und M in der postoperativen Phase.

There are very different points of view in the literature concerning the application of immunoglobulin preparations in the prophylaxis of septic complications or in the therapy of the sepsis syndrome. Indication for immunoglobulin substitution therapy with commercial products requires a critical new approach. Daily measurement of the immunoglobulin A, G and M serum levels may help in cases of deficiency. The high expectations placed in immunoglobulin therapy in cases of septic syndrome have not been fulfilled because of its complexity. Our own examinations were done to look for defects in the immunological system in the postoperative period and to make targeted substitutions. We compared the immunoglobulin levels in patients with and without postoperative septic complications. If there was a deficiency, we added 30-35 g Venimmun, but the immunological situation was not better than before, with regard to the serum levels. According to the literature, prophylaxis with immunoglobulin preparations is not useful to reduce the therapeutic period in an intensive care unit. The further development of septic complications, especially with regard to mortality, could not be influenced.

[The value of blood lactate determination in the postoperative phase]. / Die Bedeutung der Lactatbestimmung im Blut in der postoperativen Phase.

The aim of this study was to investigate whether the measurement of blood lactate in the early postoperative period would be useful for an assessment of the postoperative course. For the determination of a reference curve, the lactate concentration was measured in 10 patients (control group) with uncomplicated courses of the operation which lasted for up to two hours. The investigation group included 111 patients with complicated courses of the operation and/or a duration of the operation of more than 2 hours. The reference value of lactate was 1.3 mmol/l on the average. Lactate values above 2.5 mmol/l were considered as pathological values. In spite of the high physiological range of variations of the blood lactate concentration and many factors which influenced this value, it could be shown that the blood lactate concentration enabled a good prognostic assessment of the course of the early postoperative period in intensive care patients. Intraoperative complications were followed by significantly higher lactate concentrations in the first two postoperative hours (p < 0.001). Increased lactate concentrations during the first two postoperative hours were also a significant parameter for the occurrence of postoperative complications (p < 0.001). Patients with lethal courses already showed intraoperatively increased lactate values in comparison to those patients who could be transferred to a normal ward for further recovery (p < 0.05). From the statistical point of view, patients with lactate concentrations of more than 4.0 mmol/l lasting for more than two hours after an operation had bad prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[The characteristics of colloid osmotic pressure and hematocrit following human albumin substitution as an indication of permeability disorders in septic complications]. / Das Verhalten des kolloidosmotischen Druckes und des Hämatokrits nach Humanalbumin-Substitution als Hinweis auf das Vorliegen von Permeabilitätsstörungen bei septischen Komplikationen.

Out of a pool of the postoperative intensive care patients in Anaesthesiological and Intensive Care Clinic, Berlin-Friedrichshain, 26 patients with hypoalbuminaemia after major abdominal surgery were selected. Septic complications occurred in 13 patients. In a comparative study we analysed colloid osmotic pressure and haematocrit after substitution of human serum albumin. In cases of septic complications, human serum albumin substitution did not lead to an increase of colloid osmotic pressure and in all cases the haematocrit persisted at the initial value or rose. It is discussed that both parameters can be early references to permeability disturbances. Uncritical use of human serum albumin in septic patients can be the cause of disturbances of organ functions, especially of the lungs. An alternative for improving the oncotic situation is the use of high molecular weight hydroxy-ethyl-starch (molecular weight 200,000).

Changes in ceruloplasmin activity and lactate concentration in patients at high risk of acute organ system failure.

In 241 critically ill patients at a high risk of acute organ system failure (OSF) the activity of ceruloplasmin (CPL) and the concentration of lactate in blood was measured. In patients with acute OSF the lactate concentration is high, and the CPL activity is lower in comparison with patients without OSF. These changes are particularly distinct in nonsurviving patients with OSF. The results are discussed in connection with the development of a tissue oxygen debt and the decrease of antioxidative capacity of blood.

Changes of neuron-specific enolase concentration in plasma after cardiac arrest and resuscitation.

The concentration of neuron-specific enolase (NSE) was measured in plasma of 18 patients after cardiac arrest and resuscitation (14 nonsurvivors and 4 survivors). In all patients, the NSE concentration was significantly higher in comparison to reference values. The highest concentration was measured in nonsurvivors. Time-course investigation in the first 24 h after cardiac arrest was performed in five patients. Two nonsurvivors and one survivor of the five patients showed a significant rise, and a NSE peak concentration of 42.7 micrograms/L, 13.6 micrograms/L, and 10.5 micrograms/L, respectively, was found 10-19 h after cardiac arrest.

Physiological profiles and therapeutic goals--graphical aids support quick orientation in intensive care.

Although present-day technical facilities and modern patient monitoring produce an overwhelming number of measured parameters in intensive care medicine, there is a great need to develop decision aids to enable ICU personnel to become quickly orientated in the pathophysiological state of the patients under their care. One possible way for the representation of a multidimensional pattern of physiological values is the graphical display of a physiological profile of a patient's state. A combination of this display and the concept of 'therapeutic goals' is well suited for reducing the complexity of the computer output and for aiding in the necessary decisions in a twofold manner: substantial deviations of a single parameter are instantly visible and may be checked for their causes, the physician obtains an impression of the most serious deviations from the intended therapeutic goal for his patient. So she/he can act to support the patient in achieving the most likely course for recovery.

[Growth chart for ages 0 to 3 years]. / Somatogramme für das Alter von 0 bis 3 Jahren.

The body mass and body length of 84 boys and 91 girls were investigated from birth up to the age of three years. From these data growth charts were drawn up. The development of body mass and body length related to chronological age, on the one hand, and the development of body mass related to body length, on the other hand. were set out. The growth charts are recommended as standards for reference purposes.

The influence of sex hormones on the development of sex-specific cholesterol serum levels in rats.

1. The development of sex-specific cholesterol serum levels (under a fat-enriched diet) depends on the sex hormone status during the postpuberal activation phase. 2. The efficiency of postpuberal sex hormones seems to be influenced by the presence of definite sex hormone levels during the prepuberal/puberal maturation phase. 3. An influence of the perinatal sex-specific brain differentiation on the development of sex-typical cholesterol biosynthesis as reported by Carlson et al. was not demonstrable, possibly because of our special diet regimes (fat-enriched diet).

[Errors in the determination of oxygen consumption using the analysis of respiratory gases]. / Fehler bei der Ermittlung des Sauerstoffverbrauches mittels Atemgasanalyse.

Analytical investigation of errors showed that the noninvasive determination of oxygen consumption (VO2) from the analysis of respiratory gases fails in giving as reliable results as expected in view of the small measuring uncertainties of internationally available analyzers. Absolute errors of delta FO2 = +/- 0.002 for oxygen fractions and delta FCO2 = +/- 0.001 for carbon dioxide fractions already cause the clinically just tolerated error limits of +/- 20% deviation from the true VO2 value to be exceeded under normal conditions. The approximation formula VO2 = VE (FIO2 - FEO2) gives the most reliable results for low inspiratory oxygen fractions (FIO2). It leads, however, systematically rising with FIO2, to an underestimation of VO2. Assuming 0.7 less than or equal to R less than or equal to 0.9 (R = respiratory quotient), the maximum relative error of VO2 can be limited to 21% for air (FIO2 = 0.21) and 30% for FIO2 = 1 by an appropriate correction factor K using the equation VO2 = VE (K.FIO2 - FEO2). For VO2 greater than or equal to 250 ml/min with VE = 10 l/min, K = 1.006 is suggested.

Individually disparate anti-inflammatory in-vivo susceptibility to corticosteroids in renal transplant recipients.

We used the strength of suppression of the interleukin-1-induced peak CRP response (CRPmax) post-transplant as a measure for the individual steroid susceptibility in vivo. This suppressive effect proved to be fully reversible after abrogation of steroid therapy following graft removal. The standardized suppressive therapy immediately post-transplant led to extremely different results in individual patients ranging from no suppression (26.1% of the patients) to a strong or practically absolute suppression of CRP synthesis in 20.7% of the patients studied. This behaviour is also reflected in anti-rejection bolus therapy whereby the percentage of prednisolone resistant patients strongly correlated with increasing (unsuppressed) CRPmax values. From our data we conclude that the disparate anti-inflammatory susceptibility for corticosteroids seems to be an individual feature of patients under high-dose steroid treatment.

The influence of cod-liver oil diet on various lipid metabolism parameters, the thromboxane formation capacity, platelet function and the serum MDA level in patients suffering from myocardial infarction.

The influence of an eicosapentaenoic-acid-rich diet, containing 8.1 g cod-liver oil, given daily for two weeks on various parameters of lipid metabolism, the thromboxane formation capacity, platelet function and the serum MDA level was studied in 16 patients with myocardial infarction. The 18:2, 20:3 and 20:4 fatty acid portions of serum phospholipids were significantly decreased, whereas the 20:5 and 22:6 portions were significantly elevated. Serum total cholesterol, LDL cholesterol and the thromboxane formation capacity were significantly increased. Serum triglycerides, HDL cholesterol, the prostacyclin blocking activity of LDL, and several parameters of platelet function were unchanged, the platelet count was significantly depressed. As compared to those of healthy persons, the serum MDA levels in myocardial infarction patients were significantly increased both before and after cod-liver oil ingestion. A possible correlation between the elevated serum levels of MDA and total cholesterol, LDL cholesterol as well as thromboxane formation capacity and the cod-liver oil treatment in patients with myocardial infarction is discussed.

Synergistic effect of donor pretreatment with 8-methoxypsoralen and ultraviolet irradiation of the graft plus azathioprine and prednisolone therapy in prolonging rat renal allograft survival.

Pretreatment of the kidney donor with 8-methoxy-psoralen (8-MOP) and direct longwave ultraviolet (UVA) irradiation of the kidney graft (PUVA therapy) significantly prolonged survival in allogeneic recipients. 40% of the recipients survived more than 100 days with normal transplant function. The addition of standard clinical immunosuppressive agents azathioprine and prednisolone (both at dosages of 15 mg/kg body weight/day for 21 days) to the PUVA therapy further improved graft survival rate, with a recipient survival rate of 62.5%. The two drugs alone were less effective in prolonging graft survival rate (28.5%). A synergistic effect of PUVA therapy and standard immunosuppressive treatment with azathioprine and prednisolone was demonstrated. This suggested a possible clinical application of this type of immunosuppression and immunoregulation.

Fatty acid patterns of the serum phospholipids, cholesterolesters and triglycerides in patients with myocardial infarction (MI) during the acute phase and a follow-up of one year.

We examined the fatty acid patterns of serum phospholipids, cholesterolesters, triglycerides and serum testosterone, estradiol, total cholesterol, triglycerides and HDL-cholesterol levels in the acute phase and after one, 6 and 12 months in a group of 27 male patients with myocardial infarction. These results were compared with the corresponding values of 19 healthy controls. Significant differences were discussed as the consequence of disturbed metabolism in patients with ischaemic heart diseases.

C-reactive protein and clinical kidney transplantation.

50 patients were serially monitored for C-reactive protein (CRP) in serum after kidney transplantation. Compared with a control group the post-operative peak at days 1 and 3 was strongly depressed in the immunosuppressive-treated transplant group (p less than 0.01). In 29 out of 30 patients CRP concentration showed an average rise from 9.4 to 30.0 micrograms/ml between the 5th and 2nd day before onset of the rejection episodes (p less than 0.01). The dynamics of CRP concentration before, during and after prednisolone anti-rejection bolus therapy was considered in 22 cases. The first bolus led to a greater or smaller decrease in CRP concentration in almost all patients. After the second bolus treatment CRP dropped to zero already in more than half of the patients with reversible rejection episodes (p less than 0.01). In case of irreversible rejection crises CRP never reached zero.