[Hemodynamic effect of 6% hydroxyethyl starch (HES 200,000/0.62)]. / Hämodynamische Effekte von 6% Hydroxyäthylstärke (HAES 200,000/0.62).

The hemodynamic effects of 6% hydroxyethyl starch (HES) 200,000/0.62 were investigated in 20 patients (7 female, 13 male) who required invasive (Swan-Ganz/radial artery catheter) monitoring during major surgery. In 8 patients infrarenal aneurysmectomy and implantation of a bifurcation prosthesis was carried out, in 10 patients with arteriosclerotic vessel disease a bifurcation prosthesis was implanted, in 1 patient a renal artery aneurysm was repaired, and in another abdominosacral rectum amputation was performed. After induction of general anesthesia with alcuronium 2 mg, fentanyl 0.25-0.5 mg, droperidol 2.5-7.5 mg, thiopental 250-375 mg, succinylcholine 100 mg, and alcuronium 8 mg, the patients were ventilated with an O2-N2O ratio of 1.4:3 and halothane 0.4-0.6 vol%; the left radial artery was cannulated and a Swan-Ganz catheter was introduced percutaneously via the right internal jugular vein. According to clinical needs, repetitive doses of alcuronium, droperidol, and fentanyl were administered. At pulmonary capillary wedge pressures (PCWP) of 8-10 mm Hg arterial and mixed-venous samples were drawn for blood gas analysis and saturations; arterial blood pressure (systolic, diastolic), pulmonary artery pressure (systolic and diastolic), and central venous pressure were measured. Five measurements of cardiac output were carried out with cold saline solution, the highest and lowest values discarded, and the hemodynamic variables calculated based on the average of the remaining three values. All hemodynamic data were measured with the Siemens SIRECUST 400/404 monitoring system. Measurement of injectate temperature was done by on-line thermistor GOULD SP 5045. (ABSTRACT TRUNCATED AT 250 WORDS)

Determination of urinary free cortisol by "on-line" liquid chromatography.

This is a fully automated method for the specific assessment of urinary free cortisol. A 1-mL urine sample is concentrated and prepurified on a reversed-phase precolumn with alkaline, acid, and organic washes. After selective elution, the cortisol-containing organic eluate is "polarized" by admixing water in such a way that cortisol is focused on the top of a second reversed-phase precolumn. From this precolumn, cortisol is desorbed by backflush, separated from the still-remaining related compounds on an analytical column, and finally detected by ultraviolet absorbance. Losses of cortisol throughout the total procedure are negligible and thus external calibration is feasible for quantification. CVs were 4.1% for interassay variability, 2.6% for intra-assay variability. Cortisol concentrations down to 15 nmol/L are assayable, we estimated the median amount of free cortisol excreted daily by normal students, outpatients, hospitalized patients, and patients under intensive care. After stimulation with corticotropin1-24, the median concentration of free cortisol in urine increased from 99 nmol/L to 1238 nmol/L (n = 6). Results by radioimmunoassay for normal persons and hospitalized patients were about fourfold those by this technique. The same method can also be used for free cortisone in urine.

Meningococcal pneumonia. A source of nosocomial infection.

Pneumonia apparently resulting from aspiration became clinically apparent in an elderly man two days after admission to a private room on a general medical ward. Pneumonia developed in a patient in an adjacent room three days later. Both patients had group B Neisseria meningitidis isolated from a percutaneous transtracheal aspirate. A prevalence survey failed to identify meningococcal carriers among other ward patients. The index patient required frequent nasotracheal suctioning during the first two hospital days prior to penicillin G potassium therapy. The second patient was simultaneously receiving continuous oxygen therapy administered by nasal cannula. Events suggested that the organism may have been transmitted by direct contact, probably on the hands of hospital personnel.