Efficacy and safety of argatroban in patients with acute respiratory distress syndrome and extracorporeal lung support

Background Extracorporeal membrane oxygenation (ECMO) or pumpless extracorporeal lung assist (pECLA) requires effective anticoagulation. Knowledge on the use of argatroban in patients with acute respiratory distress syndrome (ARDS) undergoing ECMO or pECLA is limited. Therefore, this study assessed the feasibility, efficacy and safety of argatroban in critically ill ARDS patients undergoing extracorporeal lung support. Methods This retrospective analysis included ARDS patients on extracorporeal lung support who received argatroban between 2007 and 2014 in a single ARDS referral center. As controls, patients who received heparin were matched for age, sex, body mass index and severity of illness scores. Major and minor bleeding complications, thromboembolic events, administered number of erythrocyte concentrates, thrombocytes and fresh-frozen plasmas were assessed. The number of extracorporeal circuit systems and extracorporeal lung support cannulas needed due to clotting was recorded. Also assessed was the efficacy to reach the targeted activated partial thromboplastin time (aPTT) in the first consecutive 14 days of therapy, and the controllability of aPTT values is within a therapeutic range of 50–75 s. Fisher’s exact test, Mann–Whitney U tests, Friedman tests and multivariate nonparametric analyses for longitudinal data (MANOVA; Brunner’s analysis) were applied where appropriate. Results Of the 535 patients who met the inclusion criteria, 39 receiving argatroban and 39 matched patients receiving heparin (controls) were included. Baseline characteristics were similar between the two groups, including severity of illness and organ failure scores. There were no significant differences in major and minor bleeding complications. Rates of thromboembolic events were generally low and were similar between the two groups, as were the rates of transfusions required and device-associated complications. The controllability of both argatroban and heparin improved over time, with a significantly increasing probability to reach the targeted aPTT corridor over the first days (p < 0.001). Over time, there were significantly fewer aPTT values below the targeted aPTT goal in the argatroban group than in the heparin group (p < 0.05). Both argatroban and heparin reached therapeutic aPTT values for adequate application of extracorporeal lung support. Conclusions Argatroban appears to be a feasible, effective and safe anticoagulant for critically ill ARDS patients undergoing extracorporeal lung support

Pleomorphe Sarkome der Extremitäten

In der vorliegenden Arbeit wurde der Krankheitsverlauf von 140 Patienten mit einem pleomorphen Sarkom der Extremitäten analysiert. Es wurden die Überlebenszeiten und Rezidivraten zwischen erstmals aufgetretenen pleomorphen Sarkomen und Rezidivpräsentationen verglichen. Ein Rezidiv entwickelte sich im Nachuntersuchungszeitraum (median 52 Monate) bei 36 Patienten. Von diesen handelte es sich bei 11 Patienten (18%) um in einem Schwerpunktzentrum therapierte Primärtumore, die restlichen 25 Patienten (32%) waren bereits auswärtig operiert worden und stellten sich mit mindestens dem ersten Rezidiv vor. Die 5-Jahres-Überlebensrate betrug für das gesamte Patientenkollektiv 72%. Signifikante Unterschiede zeigten sich sowohl prognostisch für die Gruppe der Primärtumore (5-JÜLR: 84%, p<0,05), als auch für Rezidivtumore (5-JÜLR: 62%, p<0,05). Die Ergebnisse zeigen, dass die R0-Resektion eine der wichtigsten Maßnahmen im multidisziplinären Behandlungskonzept der pleomorphen Sarkome ist

Lieder zum Gesange mit Begleitung des Forte piano

zur Tonkunst gebracht vom Franz SchwaibergerAuf der Titelseite unten rechts: "in Kup. gest. von J.H. Walder"Seitenzählung: Titelblatt, 3, 2, 4-13Enthält: Daphne am Bach ; An Lyda ; Nachruf des Jünglings (Stolberg) -- Einsamkeit ; Geduld (Lavater) -- Unmöglicher Besuch (L.F.G. von Goeckingk) -- Traumbild (J.M. Armbruster) -- An ein Mädchen ; An Karolinens Bildnis ; Klagen eines Mädchens (Hölty) -- Arete zu ihren Gespielinnen (Overbeck) -- Glück der Liebe (J.M. Miller