Wiener klinische Wochenschrift
-
Wien. Klin. Wochenschr. · Jan 2005
Review[Influence of new dialysis solutions on clinical results in patients treated with peritoneal dialysis].
Long-term peritoneal dialysis is associated with changes in the peritoneal membrane. Conventional dialysate solutions are bioincompatible because of their low pH, high glucose content, hyperosmolality and increased concentration of glucose degradation products. The development of double-compartment systems has made it possible to separate glucose from the buffer during heat sterilization, resulting in a higher or even physiologic pH of the solution with reduced concentration of glucose degradation products. ⋯ Icodextrin may induce a fall of sodium plasma levels. Because of cross-reaction with elevated plasma levels of maltose, serum amylase is determined falsely low and glucose (using the glucose-dehydrogenase method) is measured falsely high, but high plasma levels of maltose do not affect measurement of lipase or measurement of glucose using the glucose-oxidase method. New dialysate solutions will have a positive influence on both survival and technical drop-out rates in patients receiving peritoneal dialysis treatment.
-
Wien. Klin. Wochenschr. · Dec 2004
Comparative StudyProcalcitonin in patients with acute and chronic renal insufficiency.
Bacterial infections are associated with a high morbidity and mortality rate in patients with acute and chronic renal failure. Because C-reactive-protein (CRP) is elevated in many patients with renal failure, even in the absence of infection, procalcitonin (PCT) might be useful for the detection of systemic bacterial infections. This cross-sectional observation study measured PCT and CRP in several groups of patients with various types, degrees and treatments of kidney diseases, including patients with sepsis treated with renal replacement therapy. ⋯ With the exception of CAPD patients, PCT levels were not significantly affected by renal diseases or treatments but were markedly elevated in the presence of infections. Thus PCT is a valuable marker for early diagnosis of systemic bacterial infections in patients with CRF or patients undergoing HD. In contrast, CRP is elevated in several groups with renal diseases and has low specificity for the diagnosis of bacterial infections.
-
Wien. Klin. Wochenschr. · Nov 2004
Intravenous amiodarone bolus for treatment of atrial fibrillation in patients with advanced congestive heart failure or cardiogenic shock.
The clinical course of patients with advanced organic heart disease is often complicated by the occurrence of atrial fibrillation. Slowing the ventricular rate and, if possible, restoration of normal sinus rhythm is crucial but difficult in the state of decreased ventricular function. ⋯ Amiodarone, given as a single intravenous bolus through a peripheral vein rapidly reduced ventricular rate and was well tolerated in patients with atrial fibrillation, even in the presence of congestive heart failure and cardiogenic shock.
-
Wien. Klin. Wochenschr. · Nov 2004
Case ReportsSuccessful treatment of ARDS and severe pulmonary hypertension in a child with Bordetella pertussis infection.
Infection with Bordetella pertussis can cause severe illness with neurological and pulmonary complications in children. Pulmonary hypertension is an early sign of potentially fatal disease and can cause failure of conventional respiratory therapy in severe acute respiratory distress syndrome (ARDS). We report a 4 1/2-year-old boy with B. pertussis infection who developed severe ARDS and pulmonary hypertension. ⋯ After conventional ventilation, surfactant and high frequency oscillation ventilation (HFOV) failed, treatment with nitric oxide (NO) improved oxygenation, allowing recovery without the need for ECMO. The patient survived with few sequelae. Thus, this treatment may be an option in high-risk children who meet the criteria for ECMO but are excluded because of poor neurological status, as in our patient.
-
Wien. Klin. Wochenschr. · Sep 2004
Review Comparative StudyHydroxyethyl starch--can the safety problems be ignored?
Hydroxyethyl starch (HES) has come into widespread use for fluid management of acutely ill patients. Certain characteristic complications of HES, notably renal impairment, hemorrhage and pruritus, have been well documented with all types of HES solutions. The use of HES solutions with lower molecular weight and substitution has been claimed to minimize these safety risks. ⋯ Typically presenting as pruritic crises of delayed onset, this complication is often severe, protracted and refractory to treatment. An additional risk of HES infusion is the occurrence of potentially life-threatening anaphylactoid reactions, which are 4.5 times as frequent after HES as albumin exposure. Limiting the dose and duration of HES therapy may be helpful in lessening the risk of undesired side effects; at present however, reliance on particular HES solutions does not appear sufficient to ensure safety.