Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Jan 1996
Review[Glutamine: effects on the immune system, protein balance and intestinal functions].
Glutamine is the most abundant free amino acid of the human body. In catabolic stress situations such as after operations, trauma and during sepsis the enhanced transport of glutamine to splanchnic organs and to blood cells results in an intracellular depletion of glutamine in skeletal muscle. Glutamine is an important metabolic substrate for cells cultivated under in vitro conditions and is a precursor for purines, pyrimidines and phospholipids. ⋯ Moreover, glutamine exerted a trophic effect on the intestinal mucosa, decreased the intestinal permeability and thus may prevent the translocation of bacteria. In conclusion, glutamine is an important metabolic substrate of rapidly proliferating cells, influences the cellular hydration state and has multiple effects on the immune system, on intestinal function and on protein metabolism. In several disease states glutamine may consequently, become an indispensable nutrient, which should be provided exogenously during artificial nutrition.
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During the past years perinatal mortality in diabetic pregnancy has been lowered significantly, in special collections with highly motivated diabetic women even below 2%. In case of optimal metabolic control and absence of diabetic angiopathy the perinatal survival rate is identical to that in normal pregnancy. But adequate metabolic control cannot be reached in all pregnant women during the whole period of gestation, and pre-existing diabetic angiopathy exists frequently; therefore diabetic pregnancy will be associated with elevated perinatal mortality and morbidity also in the future. ⋯ Diabetic women with macroangiopathy, especially with coronary artery disease show a high risk for cardiovascular events during pregnancy. The occurrence of acute myocardial infarction in pregnant diabetic women is associated with elevated fetal and maternal mortality. Though there are case reports in the literature describing a successful fetal and maternal outcome after myocardial infarction during pregnancy.
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Wien. Klin. Wochenschr. · Jan 1994
Review["Small volume resuscitation"--does it open new possibilities in the treatment of hypovolemic shock?].
Hypertonic-hyperoncotic solutions are a supplementation to conventional fluid regimens in the management of hypovolemia due to trauma, hemorrhage and shock. In this review the possible modes of action of these solutions are discussed and their efficacy both in experimental and clinical settings is presented. Possible side effects, such as hypernatremia and possible problems in the presence of increased intracranial pressure, following administration of hypertonic-hyperoncotic solutions are discussed, as well as the reaction of normovolemic patients to such infusions.
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Wien. Klin. Wochenschr. · Jan 1994
Review[Bronchial cancer--development, diagnosis, therapy, prognosis].
Lung cancer is the most frequent cause of death from cancer in men. In addition its prevalence among women is currently rapidly increasing. Main risk factors are smoking, exposure to asbestos and genetic factors. ⋯ In small cell lung cancer the probability of 5-year survival is about 10% for patients with limited disease and less than 1% for patients with extended disease. Although surgery plays a role in stage I to stage IIIA, chemotherapy remains the most important mode of therapy in small cell lung cancer. In stages I to IIIA, however, combined treatment modalities might improve outcome of the patients with small cell lung cancer.
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In spontaneous breathing intrathoracic pressure alternates between positive and negative in a biphasic sequential pattern. By contrast, during mechanical ventilation (IPPV, CPPV) the intrathoracic pressure remains above atmospheric all the time. ⋯ In order to minimize these deleterious effects of positive pressure ventilation it is essential to keep the procedure as short and little invasive as possible. The following strategy enables this goal to be brought closer: 1) early commencement of ventilation; 2) optimal adjustment of artificial ventilation to the individual needs of the patient, 3) early weaning from assisted ventilation through augmented rather than controlled modes of ventilation: 4) kinetic therapy (systematic changing of the patient's position) with the back up of the requisite thoracic CT scan findings; 5) reduction of the invasiveness of the procedure in order to ensure early commencement of spontaneous respiration.