OPUS 4 | Universitätspublikationen

Reference values and physiological characterization of a specific isolated pig kidney perfusion model (2007)

Volker Unger Christian Grosse-Siestrup Claudia Fehrenberg Axel Fischer Michael Meissler Jan David Alexander Groneberg

BACKGROUND: Models of isolated and perfused kidneys are used to study the effects of drugs, hazardous or toxic substances on renal functions. Since physiological and morphological parameters of small laboratory animal kidneys are difficult to compare to human renal parameters, porcine kidney perfusion models have been developed to simulate closer conditions to the human situation, but exact values of renal parameters for different collection and perfusion conditions have not been reported so far. If the organs could be used out of regular slaughtering processes animal experiments may be avoided. METHODS: To assess renal perfusion quality, we analyzed different perfusion settings in a standardized model of porcine kidney hemoperfusion with organs collected in the operating theatre (OP: groups A-D) or in a public abattoir (SLA: group E) and compared the data to in vivo measurements in living animals (CON). Experimental groups had defined preservation periods (0, 2 and 24 hrs), one with additional albumin in the perfusate (C) for edema reduction. RESULTS: Varying perfusion settings resulted in different functional values (mean +/- SD): blood flow (RBF [ml/min*100 g]: (A) 339.9 +/- 61.1; (C) 244.5 +/- 53.5; (D) 92.8 +/- 25.8; (E) 153.8 +/- 41.5); glomerular filtration (GFR [ml/min*100 g]: (CON) 76.1 +/- 6.2; (A) 59.2 +/- 13.9; (C) 25.0 +/- 10.6; (D) 1.6 +/- 1.3; (E) 16.3 +/- 8.2); fractional sodium reabsorption (RFNa [%] (CON) 99.8 +/- 0.1; (A) 82.3 +/- 8.1; (C) 86.8 +/- 10.3; (D) 38.4 +/- 24.5; (E) 88.7 +/- 5.8). Additionally the tubular coupling-ratio of Na-reabsorption/O2-consumption was determined (TNa/O2-cons [mmol-Na/mmol- O2] (CON) 30.1; (A) 42.0, (C) 80.6; (D) 17.4; (E) 23.8), exhibiting OP and SLA organs with comparable results. CONCLUSION: In the present study functional values for isolated kidneys with different perfusion settings were determined to assess organ perfusion quality. It can be summarized that the hemoperfused porcine kidney can serve as a biological model with acceptable approximation to in vivo renal physiology, also if the organs originate from usual slaughtering processes.

Acute management of poor condition subarachnoid hemorrhage patients (2007)

Eleftherios Archavlis Mario N. Carvi y Nievas

Poor condition subarachnoid hemorrhage (SAH) patients present a high mortality and morbidity. In this study, we reviewed the acute interventional (surgical and endovascular) management of 109 SAH-poor condition patients, who were treated as early as logistically possible after confirming stable circulation parameters. Patients over the age of 70 years, without clinical response to painful stimulation were excluded. We recognized at least 3 different postinterventional therapeutic approaches: (1) Norm- or hypovolemic, normotensive hemodilution in 30 patients with space-occupying intracranial hematomas as well as in 31 cases with acute cerebro-spinal-fluid obstruction. (2) Normovolemic, hypertensive hemodilution after unilateral decompressive craniotomy in 23 surgical- and 2 endovascular-treated patients with focalized space occupying lesions and reduced cerebral perfusion. (3) Hypovolemic, normo-, or hypertensive hemodilution after bilateral decompressive craniotomy in 23 cases with massive brain-swelling. We observed a reduced mortality (21%). The overall late outcome was favorable in 56% and unfavorable in 23%. Selective aggressive treatment adapted to increase the cerebral perfusion, seems to be an effective therapy to improve the survival and outcome of several poor condition SAH-patients.

Causes of metabolic acidosis in canine hemorrhagic shock: role of unmeasured ions (2007)

Dirk Steffen Brügger Gregor I. Kemming Matthias Jacob Franz Georg Meisner Christoph J. Wojtczyk Kristian Packert Peter E. Keipert N Simon Faithfull Oliver Habler Bernhard F. Becker Markus Rehm

INTRODUCTION: Metabolic acidosis during hemorrhagic shock is common and conventionally considered to be due to hyperlactatemia. There is increasing awareness, however, that other nonlactate, unmeasured anions contribute to this type of acidosis. METHODS: Eleven anesthetized dogs were hemorrhaged to a mean arterial pressure of 45 mm Hg and were kept at this level until a metabolic oxygen debt of 120 mLO2/kg body weight had evolved. Blood pH, partial pressure of carbon dioxide, and concentrations of sodium, potassium, magnesium, calcium, chloride, lactate, albumin, and phosphate were measured at baseline, in shock, and during 3 hours post-therapy. Strong ion difference and the amount of weak plasma acid were calculated. To detect the presence of unmeasured anions, anion gap and strong ion gap were determined. Capillary electrophoresis was used to identify potential contributors to unmeasured anions. RESULTS: During induction of shock, pH decreased significantly from 7.41 to 7.19. The transient increase in lactate concentration from 1.5 to 5.5 mEq/L during shock was not sufficient to explain the transient increases in anion gap (+11.0 mEq/L) and strong ion gap (+7.1 mEq/L), suggesting that substantial amounts of unmeasured anions must have been generated. Capillary electrophoresis revealed increases in serum concentration of acetate (2.2 mEq/L), citrate (2.2 mEq/L), alpha-ketoglutarate (35.3 microEq/L), fumarate (6.2 microEq/L), sulfate (0.1 mEq/L), and urate (55.9 microEq/L) after shock induction. CONCLUSION: Large amounts of unmeasured anions were generated after hemorrhage in this highly standardized model of hemorrhagic shock. Capillary electrophoresis suggested that the hitherto unmeasured anions citrate and acetate, but not sulfate, contributed significantly to the changes in strong ion gap associated with induction of shock.

kurz und kn@pp news : Nr. 8 (2007)

* Vorankündigung: 1. Frankfurter Tag der Allgemeinmedizin * Tipps zur Fehlervermeidung * STERN-Titel zu Bluthochdruck unter Mitarbeit des Instituts * 2. Teil DEGAM-Leitlinie "Herzinsuffizienz", Langfassung * Start des anonymen Fehlerzirkels! * Über 1000 Studierende in Evidenzbasierter Medizin ausgebildet * Wissenschaftliche/r Mitarbeiter/in gesucht

kurz und kn@pp news : Nr. 9 (2007)

* Terminänderung: 1. Frankfurter Tag der Allgemeinmedizin * Sommersymposium der Stiftung Praxissiegel e.V. am 6. Juli 2007 * Neukonzeption des Kurses "Einführung in die Klinische Medizin" * Sommerfest für Praxen des PRoMPT-Forschungsprojektes

kurz und kn@pp news : Nr. 10 (2007)

* Prof. Gerlach in den Sachverständigenrat Gesundheit berufen * Zusätzliche Professur im Institut für Allgemeinmedizin * Jeder-Fehler-zaehlt in neuem Design * Betreuung von Menschen mit chronischen Erkrankungen * Fehlerforschung: Studie zur Sicherheitskultur geplant * Online-Eintragung für Studierende jetzt möglich * BMBF fördert PRoMPT-Folgestudie

kurz und kn@pp news : Nr. 8 [engl. Fassung] (2007)

* Advance Notice: 1st Frankfurt Ge-neral Practice Day * Tips on how to avoid errors * STERN-Leading article on high blood pressure in cooperation with the Institute * 2nd part of DEGAM chronic heart failure guideline - long version * Launch of the anonymous error circle! * Over 1,000 students trained in evidence based medicine * Research assistant wanted

short @nd sweet news : Nr. 9 (2007)

* Change the Date: 1st Frankfurt General Practice Day * Summer Symposium of the Praxissiegel Foundation on July 6, 2007 * Revamp of the course "Introduction to Clinical Medicine" * Summer celebration for practice participants in the PRoMPTresearch project

short @nd sweet news : Nr. 10 (2007)

* Prof. Gerlach appointed to the Health Advisory Council * New professorship at the Institute for General Practice * Every-Error-Counts website revamped * Taking care of patients with chronic diseases * Error research: Study on safety culture planned * Online registration now possible for students * BMBF sponsors PRoMPT follow-up study

Speech perception in noise in CI systems with different microphones (2007)

Juliane Wechtenbruch Uwe Baumann Tobias Rader John Martin Hempel

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