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The purpose of this phase III clinical trial was to compare two different extracellular contrast agents, 1.0 M gadobutrol and 0.5 M gadopentate dimeglumine, for magnetic resonance imaging (MRI) in patients with known or suspected focal renal lesions. Using a multicenter, single-blind, interindividual, randomized study design, both contrast agents were compared in a total of 471 patients regarding their diagnostic accuracy, sensitivity, and specificity to correctly classify focal lesions of the kidney. To test for noninferiority the diagnostic accuracy rates for both contrast agents were compared with CT results based on a blinded reading. The average diagnostic accuracy across the three blinded readers (‘average reader’) was 83.7% for gadobutrol and 87.3% for gadopentate dimeglumine. The increase in accuracy from precontrast to combined precontrast and postcontrast MRI was 8.0% for gadobutrol and 6.9% for gadopentate dimeglumine. Sensitivity of the average reader was 85.2% for gadobutrol and 88.7% for gadopentate dimeglumine. Specificity of the average reader was 82.1% for gadobutrol and 86.1% for gadopentate dimeglumine. In conclusion, this study documents evidence for the noninferiority of a single i.v. bolus injection of 1.0 M gadobutrol compared with 0.5 M gadopentate dimeglumine in the diagnostic assessment of renal lesions with CE-MRI.
Defluran ist ein volatiles Inhalationsästhetikum aus der Gruppe der halogenierten Methyl-Äthyl-Äther. Eines seiner Nebenwirkungen ist die Verstärkung eines kompetitiven neuromuskulären Blocks. Die vorliegende Dissertation untersucht den Einfluss von Desfluran auf die Wirkstärke der nichtdepolarisierenden Muskelrelaxan zien Vecuronium, Atracurium und Pancuronium. Patienten der ASA-Klassifikation I und II wurden randomisiert in fünf Untersuchungsgruppen aufgeteilt. Die Wirkstärke-Untersuchungen der verschiedenen Muskelrelaxanzien wurden jeweils unter Desfluran-Narkose und als Kontrollgruppe unter modifizierter Neuroleptanästhesie durchgeführt. Die Messung der neuromuskulären Funktion wurde mechanographisch durchgeführt. Mit Hilfe der gefundenen kumulativen Effekte und der gegebenen kumulativen Dosen wurden für jeden Patienten durch semilogarithmische Regressionsanalysen eine kumulative Dosis-Wirkungskurve berechnet und individuelle 50-%- bzw. 95-%- Blockadedosen (ED50, ED95) ermittelt. Die resultierenden ED50- (ED95-)Werte wurden nach Untersuchungsgruppen zusammengestellt und mit Hilfe eines nicht-parametrischen Tests auf statistisch signifikante Unterschiede zwischen den Gruppen untersucht. Signifikanzniveau war die Irrtumswahrscheinlichkeit von 5%. Desfluran potenziert die relaxierende Wirkung der nichtdepolarisierenden Muskelrelaxanzien Vecuronium, Atracurium und auch Pancuronium. Bezogen auf die ED50 von Vecuronium liegt die potenzierende Wirkung von Desfluran bei 33% und für Atracurium bei 36%. Bezogen auf die ED95 von Vecuronium liegt die potenzierende Wirkung von Desfluran bei 34% und für Atracurium bei 38%. Vecuronium und Atracurium werden durch Desfluran in geringfügigem Masse unterschiedlich potenziert. Zusammenfassend lässt sich sagen, dass Desfluran die Wirkung der nichtdepolarisierenden Muskelrelaxanzien Vecuronium, Atracurium und Pancuronium um ein Drittel ihrer Wirkstärke potenziert, das heisst, um die gleiche Wirkung zu erhalten, ist eine Dosisreduktion der Muskelrelaxanzien um ca. ein Drittel vorzunehmen. Zudem lässt sich anhand von vergleichenden Daten aus der Literatur nachweisen, dass die Potenzierung kompetitiver Muskelrelaxanzien durch die Ätherderivate Desfluran/Isofluran substanz unabhängig ist, wobei sich die Substanzunabhängigkeit sowohl auf die verwendeten Muskelrelaxanzien als auch auf die applizierten Ätherderivate bezieht.
Introduction: Aim of this study was to reduce blood loss caused by diagnostic blood sampling and to minimize the development of anemia in a high-risk group of mechanically ventilated medical intensive care patients. We therefore implemented a “blood-saving bundle” (BSB) combining a closed-loop arterial blood sampling system, smaller sampling tubes, reduced frequency of blood drawings, and reduced sample numbers.
Methods: The study included all patients from our medical ICU who were ventilated for more than 72 hours. Exclusion criteria were: acute or chronic anemia on admission, bleeding episode(s) during the ICU stay, or end-of-life therapy. The BSB was introduced in 2009 with training and educational support. Patients treated in 2008, before the introduction of the BSB, served as a control group (n = 41, 617 observation days), and were compared with patients treated in 2010 after the introduction of the BSB (BSB group, n = 50, 559 observation days). Primary endpoints were blood loss per day, and development of anemia. Secondary endpoints were numbers of blood transfusions, number of days on mechanical ventilation, and length of the ICU stay.
Results: Mean blood loss per ICU day was decreased from 43.3 ml (95% CI: 41.2 to 45.3 ml) in the controls to 15.0 ml (14.3 to 15.7 ml) in the BSB group (P < 0.001). The introduction of a closed-loop arterial blood sampling system was the major contributor to this effect. Mean hemoglobin concentrations showed no significant differences in both groups during the ICU stay. Hemoglobin values <9 g/dl, however, were recorded in 21.2% of observation days in the controls versus 15.4% in the BSB group (P = 0.01). Units of transfused red blood cells per 100 observation days decreased from 7 to 2.3 (P < 0.001). The mean number of ventilation days was 7.1 days (6.1 to 8.3 days) in the controls and 7.5 days (6.6 to 8.5 days) in the BSB group (P = NS). In total, patients in the BSB group stayed in ICU for a mean of 9.9 days (8.6 to 11.3 days), compared to a mean ICU stay of 13.0 days (10.9 to 15.4 days) in the control group (P = 0.014). Due to the longitudinal study design, however, we cannot exclude uncontrolled confounders affecting the transfusion frequency and mean ICU stay.
Conclusion: Our BSB could be easily implemented and was able to reduce diagnostic blood loss.
Es wurden 34 polyvalente Immunoglobulinpräparate zur i.m. und i.v. Anwendung verschiedener Hersteller und verschiedener Chargen sowie 9 spezifische Tetanus-Immunglobulinpräparate auf das Vorhandensein von HBsAg-Immunkomplexen untersucht. Möglicherweise vorhandene Immunkomplexe wurden vorher mit der sauren Dissoziationsmethode gespalten. Der anschließende Nachweis von HBsAg erfolgte mit dem von uns modifizierten AUSRIA* II-725-Test der Firma Abbot. Von den polyvalenten Immunglobulinen wurden 22 positiv für HBsAg gefunden. Von den spezifischen Immunglobulinen waren 3 positiv.
The microwave spectrum of several symmetric and asymmetric top isotopic species of CH3CCl3 has been studied in the region from 8 to 40 GHz. A least squares analysis of the rotational con-stants gave the following structural parameters : dC-C =(1.541 ±0.001) A, dC-Cl = (1,7712 ± 0.0008) A, dC-H = (1.090 ± 0.002) A, ∢H—C—H= (110.04±0.25) ° , ∢Cl—C—Cl= (109.39 ±0.25) °. A dipole moment of μ = (1.755 ± 0.015) D has been derived from the investigation of the Stark effect of the transition J=4→5 of CH3CCl3335. From intensity measurements the barrier to internal rotation is estimated to be (1740 ± 300) cal/mol. An analysis of the spectrum of CH2DCCl2Cl37 shows conclusively that methylchloroform in its equilibrium configuration has the methyl group staggered with respect to the CCl3-group. It could be shown that there exist two torsional isomers gauche and anti with specific microwave spectra.
The rotational spectrum of several isotopic species of HSiCl3 and CH3SiCl3 was studied in the region from 8 to 40 Gc. From the derived rotational constants the following structural parameters were obtained using KRAITCHMAN'S equations: dSi-H= (1.4655±0.0002) A, dSi-Cl= (2.0118±0.0009) A, ∢ Cl—Si—Cl= (110,60±0.25)°. Furthermore the constants for centrifugal distortion DJ= (1.2 ± 0.4) kc for HSiCl3 and DJ= (0.19 ± 0.04) kc for CH3SiCl3, for the quadrupole coupling e Q Vzz= + 12.8 Mc and the dipole moment μ= (0.86 ± 0.01) D for HSiCl3 and μ= (1.91 ± 0.01) D for CH3SiCl3 were determined. The interaction of the overall-rotation with the internal rotation is discussed for CH3SiCl3, and the hindering barrier is estimated to be less than 200 cm-1.
The microwave spectra of SiHBr3 and SiDBr3 have been investigated in the region from 28 to 40 GHz. From the rotational constants the following structural parameters were derived by a least square method: dSi-H = (1,494 ± 0,009) A, dSi-Br = (2,170 ± 0,001) Å, ∢Br-Si-Br = (111,36 ± 0,25)0. The results are compared with those obtained for other Si-halogen-compounds.
The microwave spectrum of CF3CCl3 has been investigated in the region from 15 to 40 GHz. A least squares analysis of the rotational constants gave the following structural parameters: dC–C= (1,5394 ± 0,001) A, dC–F= (1,330 ±0,001) A, dC-Cl = (1,7710 ± 0,0009) A, ∢ C—C—F = (109,55 ± 0,25) °, ∢ C—C—Cl= (109,55 ± 0,25) °. The splitting of the torsional satellite may be explained by the theory of KOEHLER and DENNISON.
