Prophylaxis of Contrast Material-induced Nephropathy in Patients in Intensive Care: Acetylcysteine, Theophylline, or Both? A Randomized Study

Purpose: To prospectively compare the protective effect of acetylcysteine, theophylline, and both agents combined in patients who are admitted to the intensive care unit with at least one risk factor for contrast material-induced nephropathy and who receive at least 100 mL of iodinated contrast medium. Materials and Methods: Institutional ethics review board approval and informed consent were obtained. A total of 91 patients (mean age, 58.5 years +/- 14.8 [standard deviation]; 31 women, 60 men; 150 examinations) were admitted to the intensive care unit with at least one risk factor for contrast-induced nephropathy and received either (a) 200 mg theophylline 30 minutes before contrast medium administration (group T), (b) 600 mg acetylcysteine twice daily on the day of and (if possible) the day before the examination (group A), or (c) both agents combined (group AT). The primary end-point for this study was the incidence of contrast-induced nephropathy (x(2) test). Results: Groups T, A, and AT were comparable with regard to baseline creatinine levels and the amount of contrast medium administered. The incidence of contrast-induced nephropathy in groups T, A, and AT was 2%, 12%, and 4%, respectively, and was significantly lower in group T than in group A (P=.047). There was no significant difference in the incidence of contrast-induced nephropathy between groups A and AT (P=.148) or between groups T and AT (P=.53). For group A, serum creatinine did not change after 12, 24, or 48 hours compared with baseline. Creatinine levels in group T decreased 12 hours (1.19 mg/dL +/- 0.58; P=.008) and 48 hours (1.16 mg/dL +/- 0.55; P=.034) after contrast material injection compared with baseline (1.25 mg/dL +/- 0.61). In group AT, creatinine significantly decreased 24 hours (1.21 mg/dL +/- 0.74; P=.003) and 48 hours (1.17 mg/dL +/- 0.69; P=.001) after contrast material injection compared with baseline (1.28 mg/dL +/- 0.74). Group A had significantly higher maximal increases in creatinine than groups T and AT (P <.014). Conclusion: For prophylaxis of contrast-induced nephropathy in patients who are admitted to the intensive care unit and who receive 100 mL or more of contrast medium, theophylline is superior to acetylcysteine

Studies on patients with atopic diseases at the Environmental Research Station Schneefernerhaus (UFS).

Mountain climate therapy takes advantage of specific climatic conditions to treat chronic allergic diseases. The aim of the study was to investigate effects of a 5-day observation period on atopic diseases at the Environmental Research Station Schneefernerhaus (UFS; Umweltforschungsstation). 18 patients with grass pollen-induced rhinoconjunctivitis, atopic ezcema or asthma and 11 non-allergic controls were included in this study. Skin physiology parameters, changes of the respiratory and nasal functions, subjective symptoms and blood parameters were measured during a 5-day observation period in the Environmental Research Station Schneefernerhaus at the moderate altitude mountain region (Zugspitze; 2650 m alt.) compared to a low altitude area (Munich; 519 m alt.). Histamine induced itch decreased significantly. Several of the skin physiology parameters changed significantly during the observation period (decrease of skin hydration, increase of skin smoothness, skin roughness, skin scaliness and pH-value). In patients with atopic eczema, the SCORAD (Severity Scoring of Atopic Dermatitis) and the scores of the DIELH (Deutsches Instrument zur Erfassung der Lebensqualität bei Hauterkrankungen) did not change significantly. Parameters of nasal function (rhinomanometry, eosinophil cationic protein (ECP) in nasal secretions) did not change significantly. The vital capacity (VC) decreased significantly, several other parameters of lung function (FEV1/VC, PEF, MEF 50, MMFEF 25/75) showed a slight, but statistically significant improvement. ECP (eosinophil cationic protein) and IL-33 in the serum and parameters of blood count changed significantly. In dependence on the atopic disease the benefit of a moderate altitude mountain climate sojourn over a period of 5 days differed – especially itching of the skin and asthma parameters improved. Assessing the parameters during a longer observation periods in alpine climate would be useful. The methodology used can serve as a suitable template for qualified studies on the effect of climate therapy

Influence of alpine mountain climate of Bavaria on patients with atopic diseases: Studies at the environmental research station Schneefernerhaus (UFS - Zugspitze) - a pilot study.

Mountain and maritime climate therapy takes advantage of specific climatic conditions to treat chronic allergic diseases. It was the aim of the study to investigate effects of a 5 day sojourn on atopic diseases at the highest German mountain. In this pilot study 18 patients with grass pollen-induced rhinoconjunctivitis, atopic ezcema or asthma and 11 non-allergic controls were included. Skin physiology parameters, changes of the respiratory and nasal functions, subjective symptoms and blood parameters were measured during a 5-day observation period in the Environmental Research Station Schneefernerhaus (UFS) at the moderate altitude mountain region (Zugspitze; 2650 m alt.) compared to a low altitude area (Munich; 519 m alt.). Several of the skin physiology parameters changed significantly during the observation period (decrease of skin hydration, increase of skin smoothness, skin roughness, skin scaliness and pH-value). In patients with atopic eczema, the SCORAD (Severity Scoring of Atopic Dermatitis) and the scores of the DIELH (Deutsches Instrument zur Erfassung der Lebensqualit&auml;t bei Hauterkrankungen) did not change significantly. Histamine induced itch decreased significantly. Parameters of nasal function did not change significantly. Several lung parameters showed a slight, but statistically significant improvement (forced expiratory volume in one second/volume capacity [FEV1/VC], peak expiratory flow [PEF], maximum expiratory flow at 50% of vital capacity [MEF 50], maximal mid-expiratory flow between 25% and 75% of vital capacity [MMFEF 25/75]), whereas the vital capacity (VC) decreased significantly. ECP (eosinophil cationic protein) in the serum and parameters of blood count changed significantly. These results show that the benefit of a moderate altitude mountain climate sojourn over a period of 5 days differs in depending on the atopic disease. Especially asthma parameters and itching of the skin improved. It would be interesting to assess the parameters during longer observation periods in alpine climate