Infusionstherapie (Basel, Switzerland)最新文献

Enteral nutrition is becoming more convenient because of a lot of available different techniques. Tubes can be placed nasogastrically, nasoduodenally or nasojejunally, as bedside method controlled by X-ray or with the aid of an endoscope. If there is a risk of spontaneous removal, fixing with a stabilisation system is helpful. In cases where the tube should be hidden, a specially prepared plastic olive placed in the nostril can be used. All these methods are of interest for short and medium term enteral nutrition. For long term enteral nutrition, the percutaneous endoscopic gastrostomy, especially the so-called 'thread-pass-through' method is increasingly in use. All attempts to arrange a simpler method using direct punction techniques have failed up to now. The following paper gives a survey of different technical possibilities.

In addition to measuring the routine blood coagulation parameters (Quick, PTT, TT, AT III, Fibrinogen, PLT), the Thrombin-Antithrombin III Complex (TAT) Test was performed preoperatively on 20 patients treated because of nodular goiter in the euthyreoid state and ten patients with symptomatic cholecystolithiasis. While there were no changes in the routine blood coagulation parameters, significant alterations of the TAT occurred in both patient groups. This indicates that TAT makes operation-induced activation of the blood coagulation system, which is impossible by just measuring the routine blood coagulation parameters alone, detectable.

The COBE Spectra was evaluated in 71 plateletpheresis procedures. Using the collection and anticoagulant algorithms of the system (n = 57) we collected 4.3 +/- 1.2 x 10(11) platelets with a mean separation efficiency of 70.2 +/- 12.1%. The cell contamination was very low (leukocytes 0.5 +/- 1.0 x 10(7), red cells 1.5 +/- 2.2 x 10(7]. In four different modifications of the standard separation protocols, we tried to reduce the ACD consumption in order to shorten the donation time and to improve donor safety. A constant ACD/blood ratio of 1:9 and increase of the blood flow to 50 ml/min (n = 14) caused significantly lower yields (3.1 +/- 0.7, p less than 0.01) and visible spontaneous platelet aggregates in the collection line in 50% and in the PC's in 29% of the runs. In order to prevent platelet activation the ACD algorithm had to be maintained, but a reduction of the ACD/blood ratio to about 15% was acceptable.

Total nitrogen excretion was studied prospectively in 54 surgical patients during the first and second postoperative day by the Chemiluminescence method. The results were compared to three different methods for approximation of the total nitrogen excretion. Daily total nitrogen excretion was 13.13 +/- 5.7 g after peripheral vascular procedures, 15.97 +/- 8.1 g after major surgical procedures and 20.42 +/- 5.2 g in septic patients. The assessment of total nitrogen excretion by the three other methods underestimated real nitrogen losses by 20-52%. The nitrogen concentration in various secretions was relatively constant. We conclude that measuring the urine nitrogen losses only and adjusting them for the calculation of the total nitrogen excretion by several factors in incorrect. Direct measurement of total nitrogen excretion is too costly for the use in daily clinical practice.

The transfusion of leukocyte-containing blood products causes a number of side reactions, which among others induces alterations of the immune system of the recipient leading to alloimmunization or immunosuppression. Antibodies against antigenic determinants of the major histocompatibility complex-proteins of class I are the major cause of alloimmunization. Though platelets are easy targets for HLA antibodies, they cannot induce the antibody production themselves. This requires leukocytes, carrying the MHC-proteins of the class II. Standard platelet concentrates for the clinical routine have more than 10(6) leukocytes. Leukocyte filters with a special surface modification reduce the number of leukocytes in platelet concentrates underneath this CILL-value (critical immunogenic load of leukocytes), thus reducing the antigenic, immunogenic effects of leukocyte contamination considerably.

The knowledge of circulating blood volume extends the possibility of judgement of the circulation status and is a valuable help for the management of volume therapy. Blood volume measurements are rarely done in clinical practice in underestimation of their value for the therapy because of their high technical expense, long duration of examination, bad repeatability and radiation exposure. A method for blood volume determination which possesses more favorable abilities than known radioactive methods has been developed by staining red cells with fluorescein sodium. This paper presents an insight into the method and examines the reliability of measurement by means of repeated determinations in vivo.