ABSTRACT
BACKGROUND: Increasingly more patients reaching our hospitals as an emergency are chronically ill or are in advanced stages of infaust, e.g., malignant, diseases. On the other hand, the treatment options for malignant diseases are improving. In an emergency, a decision must be made between life-sustaining treatment (in the context of a potentially poor prognosis) versus palliation. DEVELOPMENT OF A DECISION-MAKING MODEL: The current literature about this topic is heterogeneous. The aim of the present article is to present a method using four case reports to decide either for life-sustaining treatment or for palliation with the help of the following: (1) the prognosis of the chronic disease and (2) the association of the acute situation with the chronic disease. CONCLUSION: This method has an advisory role and cannot be taken as a guideline. Its usefulness can only be proven in practice.
Subject(s)
Chronic Disease/therapy , Critical Care , Decision Support Techniques , Emergency Medical Services , Palliative Care , Acute Kidney Injury/diagnosis , Acute Kidney Injury/therapy , Aged , Combined Modality Therapy , Comorbidity , Female , Granulomatosis with Polyangiitis/diagnosis , Granulomatosis with Polyangiitis/therapy , Heart Failure/diagnosis , Heart Failure/therapy , Humans , Life Support Care , Lymphatic Metastasis , Lymphoma, Follicular/diagnosis , Lymphoma, Follicular/therapy , Male , Neoplasms, Unknown Primary/diagnosis , Neoplasms, Unknown Primary/therapy , Pleural Effusion, Malignant/diagnosis , Pleural Effusion, Malignant/therapy , Polyneuropathies/diagnosis , Polyneuropathies/therapy , Prognosis , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/therapy , Sigmoid Neoplasms/diagnosis , Sigmoid Neoplasms/therapy , Tachycardia, Supraventricular/diagnosis , Tachycardia, Supraventricular/therapy , Treatment OutcomeABSTRACT
The present study examines the influence of kinins on the migratory capacity of human polymorphonuclear leukocytes under in vitro conditions using the Boyden chamber technique. By means of checkerboard analysis the migration of neutrophils induced by bradykinin could be characterized as true chemotaxis. The stimulation of human neutrophils with bradykinin, with the nonpeptide B(2) receptor agonist FR190997 as well as with des-Arg(9)-bradykinin and des-Arg(10)-kallidin results in a concentration-dependent migration. Pretreatment of the neutrophils with the B(2) receptor antagonist HOE-140 (icatibant) inhibited the bradykinin-induced migration but not that induced by B(1) receptor agonists, whereas the B(1 )receptor antagonist des-Arg(10)HOE-140 abolished the migration elicited by des-Arg(9)-bradykinin or des-Arg(10)-kallidin but not that evoked by bradykinin. Pretreatment of the neutrophils with the leukotriene B(4) (LTB(4)) antagonist ZK158252 inhibited the LTB(4)-induced chemotaxis as well as the chemotaxis produced by bradykinin and des-Arg(10)-kallidin. An involvement of interleukin-1beta and of the chemokine IL-8 in the bradykinin-induced migration in vitro could be excluded during the migration time of the neutrophils. In conclusion, the present study provides pharmacological evidence showing that B(1) and B(2) kinin receptors are involved in the migration of human neutrophils in vitro, that LTB(4) participates in the downstream pathway and that the B(1) kinin receptor seems to be expressed already under physiological conditions.
Subject(s)
Cell Movement/drug effects , Kinins/pharmacology , Neutrophils/drug effects , Cell Movement/physiology , Dose-Response Relationship, Drug , Humans , Kinins/physiology , Neutrophils/cytology , Receptor, Bradykinin B1 , Receptor, Bradykinin B2 , Receptors, Bradykinin/agonists , Receptors, Bradykinin/physiologyABSTRACT
AIM: Description of the indications, surgical technique and postoperative complications of distal pancreatic resection. METHODS: We analyzed the prospectively documented perioperative data of 41 patients undergoing distal pancreatectomy between 1994 and 2001. Indications for resection were chronic pancreatitis (n = 21), malignant or benign tumors (n = 19) and others (n = 1). RESULTS: Median operation time was 4.5 hours, a Y-Roux-pancreaticojejunostomy was performed in 66 %. Further organs were resected in 93 %, most frequently in form of splenectomy. A malignant vascular invasion led to positive resection margins in three patients. Mortality was 2 %. Postoperative complications occurred in 41 % with 15 % revealing pancreatic leakage. A relaparotomy was carried out in 20 %. Pancreatic leakage was more frequently seen in the first part of the study period and after oversewing of the pancreatic stump. A new onset diabetes occurred postoperatively in 6 % of the patients. CONCLUSIONS: Distal pancreatectomy can be carried out with low mortality, despite a high complication rate. The probability of postoperative diabetes is low. The frequency of pancreatic leakage may be reduced significantly by increasing hospital experience. The management of the pancreatic stump by pancreatojejunostomy should be considered in patients with a high risk of pancreatic leakage.
