The influence of anthracycline therapy on cardiac function during anesthesia.

Unlabelled: Cardiotoxicity is a well recognized complication of anthracycline (AC) therapy. Subtle abnormalities in myocardial function that become apparent only after exercise may exist in survivors of childhood cancer who have previously received AC, yet have normal resting cardiac function. To evaluate if anesthesia-induced changes in cardiac function differ in pediatric patients with previous AC therapy from healthy children and adolescents, we evaluated in a prospective study 43 patients, of whom 42 were analyzed.

[Acute respiratory failure and mediastinal mass syndrome].

A 46-year-old female with a history of a chronic obstructive lung disease was intubated by the emergency physician for acute respiratory failure. However, after intubation she developed circulatory failure and required cardio-pulmonary resuscitation. The reason for the circulatory failure following muscle relaxation and intubation was identified as a mediastinal mass syndrome.

Measurement of indocyanine green plasma disappearance rate by two different dosages.

Objective: While using a transcutaneous system for assessment of liver function by indocyanine green plasma disappearance rate (ICG-PDR) in critically ill patients, we compared the agreement between ICG-PDR obtained by the recommended standard ICG dosage (0.5 mg/kg) and a reduced dosage (0.25 mg/kg).

[Ischemia brain infarct and rupture of an infrarenal anortic aneurysm].

An 86-year old lady with aphasia, left sided hemiparesis, a heart rate of 110 bpm and a blood pressure of 110/60 mmHg was intubated by the emergency physician. She was given 1000 ml crystalloid fluid IV and brought to our department with suspected stroke. Clinical examination revealed a pulsatile abdominal mass, while immediate CT-scan excluded an intracranial hemorrhage.

[Seizure as a possible symptom of septic encephalopathy following transrectal prostate needle biopsy].

A 47-year-old male patient developed a seizure and was admitted to our institution by the emergency physician after tracheal intubation due to suspected primary intracerebral lesion. A primary neurological disorder could be excluded. Urosepsis with positive blood cultures for E.

Left ventricular regional wall motion abnormalities during pneumoperitoneum in children.

Background: In adult patients, certain levels of PEEP (16 and 20 cm H(2)O) have been associated with left ventricular (LV) regional wall motion abnormalities. Since any increase in intra-abdominal pressure (IAP) exerted by a pneumoperitoneum is transmitted to the intrathoracic cavity, similar effects on LV regional wall motion cannot be ruled out.

Methods: To investigate the effects of pneumoperitoneum on LV regional wall motion, we performed a post hoc analysis of a transoesophageal echocardiography study in eight small children (mean age 3 yr, range 15-63 months) undergoing laparoscopic herniorrhaphy under anaesthesia with sevoflurane in nitrous oxide/oxygen and a PEEP of 5 cm H(2)O.

Prognostic value of extravascular lung water in critically ill patients.

Objective: Measurement of extravascular lung water (EVLW) as a clinical tool for the assessment of pulmonary function has been found to be more appropriate than oxygenation parameters or radiographic techniques. In this study, we analyzed the prognostic value of EVLW in critically ill patients.

Design: Retrospective analysis.

Prognostic value of the indocyanine green plasma disappearance rate in critically ill patients.

Objective: Measurement of the indocyanine green plasma disappearance rate (ICG-PDR) has been proposed as a clinical tool for the assessment of liver perfusion and function in transplant donors as well as a prognostic marker. In this study, we analyzed the prognostic value of the ICG-PDR in critically ill patients.

Design: Retrospective analysis.

Comparison of cardiac output and circulatory blood volumes by transpulmonary thermo-dye dilution and transcutaneous indocyanine green measurement in critically ill patients.

Objective: We prospectively studied the agreement between transpulmonary aortic fiberoptic-based and pulse dye densitometry (PDD) measurements of cardiac output and circulatory blood volumes.

Design: Prospective clinical study.

Setting: Operative ICU of a university hospital.

Preserved CO(2) reactivity and increase in middle cerebral arterial blood flow velocity during laparoscopic surgery in children.

Unlabelled: In adult patients, the creation of pneumoperitoneum (PP) by means of carbon dioxide (CO(2)) insufflation leads to an increase in cerebral blood flow velocity (CBFV), which is thought to be caused by hypercapnia. We evaluated whether PP leads to an increase of CBFV in children, and whether this increase is directly related to PP. The effects of PP on middle cerebral artery blood flow velocity were investigated in 12 children (mean age 3 yr, range 15-63 mo) undergoing laparoscopic herniorrhaphy under general anesthesia with sevoflurane and nitrous oxide/oxygen.

In vitro hepatotoxicity of alachlor and its by-products.

During water treatment, potentially hazardous chemical by-products may be formed. Alachlor (2-chloro-N-(2, 6-diethylphenyl)-N-(methoxymethyl) acetamide) is a widely used pre-emergence herbicide. The present study investigated the toxicity of alachlor and its disinfection by-products on freshly isolated rat hepatocytes.

Does the optimization of cardiac output by fluid loading increase splanchnic blood flow?

We studied the effects of increasing cardiac output by fluid loading on splanchnic blood flow in patients with haemodynamically stabilized septic shock. Eight patients (five female, 39-86 yr) were assessed using a transpulmonary thermo-dye-dilution technique for the measurement of cardiac index (CI) intrathoracic blood volume (ITBV) as a marker of cardiac preload and total blood volume (TBV). Splanchnic blood flow was measured by the steady state indocyanine-green technique using a hepatic venous catheter.

Variability of splanchnic blood flow in patients with sepsis.

Objectives: Previous studies on therapeutic interventions in sepsis have assumed stability of the measure of splanchnic blood flow throughout the study. We assessed the variability of splanchnic blood flow during stable global hemodynamics in eight patients with sepsis requiring treatment with dobutamine and/or norepinephrine.

Design And Setting: Prospective clinical study in an intensive care unit of a university hospital.

Therapeutic options for the treatment of impaired gut function.

Tissue hypoxia, especially in the splanchnic area, is still considered to be an important cofactor in the pathogenesis of multiple organ failure. Therefore, the specific effects of the various therapeutic interventions on splanchnic perfusion and oxygenation are of particular interest. Restoring and maintaining oxygen transport and tissue oxygenation is the most important step in the supportive treatment of patients with sepsis and impaired gut perfusion.

Catecholamines and splanchnic perfusion.

For supportive therapy in sepsis adequate volume loading is probably the first, and possibly the most important step in the treatment of patients with septic shock. An elevated global O2-supply (DO2) may be necessary and beneficial in most of these patients, but the increase in DO2 should be guided by measurement of parameters assessing global and regional oxygenation. Routine strategies for elevating DO2 by the use of very high dosages of catecholamines cannot be recommended.

Comparison of invasive and noninvasive measurements of indocyanine green plasma disappearance rate in critically ill patients with mechanical ventilation and stable hemodynamics.

Objectives: We studied the correlation between invasive (aortic fiberoptic) and noninvasive (transcutaneous sensor) measurements of indocyanine green (ICG) plasma disappearance rate (PDR) in critically ill patients.

Design And Setting: Prospective clinical study in a surgical intensive care unit of a university hospital.

Patients: 16 critically ill patients with adult respiratory distress syndrome (n = 8), sepsis/septic shock (n = 6), subarachnoid hemorrhage (n = 1), or severe head injury (n = 1).

Late cardiac arrhythmias after blunt chest trauma.

Objective: Case reports of two patients who developed fatal cardiac arrhythmias several days after blunt chest trauma.

Design: Case reports.

Setting: Surgical intensive care unit of a university hospital.

[Left ventricular aneurysm after myocardial contusion caused by blunt chest trauma].

A 30-year old male car-driver was polytraumatized after a frontal collision with another motor vehicle (left-sided rib fractures, right-sided pneumothorax, multiple lung contusions, anterior and posterior pelvic ring fracture, femoral shaft fracture, traumatic subarachnoid hemorrhage. After intubation and hemodynamic stabilization on the scene of accident, he was transported to our institution. Transesophageal echocardiography revealed a left-ventricular anteroseptal akinesia and patchy intramyocardial hyperdensities as indicator of myocardial contusion which was confirmed later by autopsy.