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At the Sixth Wiggers Bernard Conference, a group of scientists from
various disciplines discussed new findings relating to nitric oxide
synthase inhibitor in shock, sepsis, and organ failure. Dedicated
to the presentation and discussion of both positive and negative
findings related to the use of NOS inhibitors, the meeting served
as a forum for issues relating to specific and non-specific
inhibitors, as well as the role of nitric oxide-oxygen radical
interactions. Both experimental and clinical data were presented in
the trauma and sepsis field.
New findings involving the brain in traumatic and septic shock and
after brain injury are reported in this book, including
pathophysiological and pathohistological results. An experimental
and clinical approach to treatment is presented together with
specific results obtained from the encephalogram and from
histopathological study with regard to the immunohistochemistry of
toxic lipid peroxidant products. The latest results of clinical and
experimental pathophysiology in inflammatory processes after
traumatic brain injury and the therapeutic effects of hypertonic
fluid therapy are also discussed.
International experts examine the role of nitric oxide in various
metabolic events such as septic shock, cardiovascular dysfunction,
and trauma and hemorrhagic shock. The nitric oxide pathway and
nitric oxide synthesis regulation are also discussed.
The decisive factor in trauma is that many processes first occur at
the cellular level before they can be determined in laboratory
tests, and recognition of them has only recently found its way into
intensive care practice. Yet knowledge of the pathophysiology of
these processes is essential for an early diagnosis of multiple
organ failure and the implementation of adequate therapy, which
ultimately make the patient's survival possible. Professor Schlag,
an internationally renowned scientist and clinician, has been
concerned with the basic pathophysiological principles of shock for
many years. In this book he has brought together for the first time
an international team of authors primarily from the USA and Europe,
who present their collective findings of trauma, shock, development
of the organ in shock and early failure and of sepsis-like
syndrome, and development of septic multiple organ failure.
Patienten mit Multiorganversagen haben immer noch eine schlechte
Prognose in der intensivmedizinischen Behandlung, insbesondere wenn
sie noch zusatzlich in einen septischen Schock geraten. Hier hilft
auch oft eine breite Abdeckung mit modernsten Antibiotika nicht
weiter. Neue Ansatze fur eine Therapie dieser problempatienten
haben sich in den letzten Jahren durch Erkenntnisse der
pathophysiologischeen Vorgange die zum Schock fuhren ergeben. Herr
Professor Schlag hat als anerkannte Kapazitat auf dem Gebiet der
Traumatologie und Schockforschung fur dieses erste umfassende Werk
zu den Grundlagen des Multiorganversagens eine beeindruckende Liste
von mehr als 50 international renommierten Autoren
zusammenbekommen. Das Buch ist nicht nur eine Aufarbeitung aller
Grundlagen des Schocks und Multiorganversagens sondern zudem ein
ausgezeichnetes Nachschlagewerk fur jeden intensivmedizinisch
tatigen Klinikarzt, egal ob er aus der Anasthesie, der Inneren
Medizin oder der Unfallchirurgie kommt."
At the Sixth Wiggers Bernard Conference, a group of scientists from
various disciplines discussed new findings relating to nitric oxide
synthase inhibitor in shock, sepsis, and organ failure. Dedicated
to the presentation and discussion of both positive and negative
findings related to the use of NOS inhibitors, the meeting served
as a forum for issues relating to specific and non-specific
inhibitors, as well as the role of nitric oxide-oxygen radical
interactions. Both experimental and clinical data were presented in
the trauma and sepsis field.
These eight volumes, which developed out of the international con
gress "Update and Future Trends in Fibrin Sealing in Surgical and
Nonsurgical Fields" held in November 1992, attempt to present the
state of the art concerning fibrin sealing. Initially fibrin
sealant played an important role in surgery. During the past few
years, however, it has been increasingly used in nonsurgical
applications, and we can now say that it has become a component of
medicine in general. The doubts about the efficacy of fibrin
sealant, which had been raised by nonusers, are no longer valid.
The correct indication and method ology continue to be basic
prerequisites, and even today - after 20 years of fibrin sealant
renaissance - the three most prominent effects of fibrin sealant
still retain their validity: hemostasis, sealing and sup port of
wound healing. The problems posed by the transmission of viral
infections have gained substantially in importance because of the
potential transmission of AIDS via fibrin sealant. Fortunately the
transmission of AIDS via fi brin sealant is today so unlikely that
it no longer poses a cause for con cern. This does not mean,
however, that research in this field can be discontinued.
This book is the result of the 3rd Wiggers Bernard Conference. The
Wiggers Bernard Conferences, named after two great physiologists of
the past, are biannual gatherings of the leaders in the field of
shock. The meetings focus on specific areas of interest, where a
lot of new informations is available, but needs to be focused.
There are informal presentations during which the seminarian can be
intenupted in order to clarify a pat1icular point; formal
discussions follow each presentation; these are followed by
infOlmal gatherings in which these discussion continue in a very
relaxed environment. The 1992 meeting took place in Obermayerhofen,
a small but charming castle in the soft green hills of Eastern
Styria in the South-Eastern part of Austria. The castle was built
in 1130, restored and turned into a hotel in 1977. The renaissance
court yard and the generous and exclusive decors make it one of the
most beautiful castles in Austria. The frank beauty and hospitality
of this area acted as a catalyst to crystalize the thoughts of this
interdisciplinary group of scientists as they discussed new
findings in the cytokine area.
The Wiggers Bernard Conferences, named after two great
physiologists of the past, are an nual gatherings of the leaders in
the field of shock. The meetings focus on specific areas of which
appears to be showing the most advancement during the previous
year. There are se veral types of sessions; informal presentations
during which the seminarian can be intenup ted in order to clarify
a particular point; formal discussions follow each presentation;
these are followed by informal gatherings in which these
discussions continue during meals and libation in a very relaxed
environment. The 1990 meeting took place in Durnstein, Austria. A
small hamlet in the wine growing area of the Wachau valley, on the
Danube above Vien na. This was the site of a former citadel where
the English King Richard the Lion-Heart (Coeur de Uon) was held for
ransom during the middle ages. The frank beauty and hospi tality of
this area in addition to the ancient Roman adage "in vino veritas"
acted as a catalyst to crystalize the thoughts of this
interdisciplinary group of scientists as they discussed the
following areas: 1. Gut as a Source of Organ Failure 2. Metabolic
Aspects of the Liver in Sepsis 3. Endothelium as a Target'in Sepsis
We would like to thank the participants of the conference for
taking time away from their very productive and busy schedules to
participate in the conference and for the prompt pre sentation of
their manuscripts and editions of their discussions.
The First Wiggers Bernard Conference on Shock, Sepsis, and Organ
Failure was envisaged as a meeting of American and European
Scientists. It was named after two researchers, one from the "Old"
and one from the "New World," who are wellknown for their
outstanding achievements in shock research and experimental
medicine. This meeting was a point of de parture for a series of
workshops that will focus on two to three main topics dealt with in
detail by experts in their respective fields. The First Wiggers
Bernard Conference addressed three main questions: 1.
Multi-organ-failure - is it a sequence of organ failures or a
systemic disease? 2. Cellular events in trauma and sepsis - are
they due to suppression, activation or both? 3. Mediators of organ
failure - are LPS or sepsis necessary? Although many answers were
given in this first session, numerous issues remain to be clarified
due to the enormous complexity of the subject. How ever, the stage
was set for encounters between clinicians and basic medical
researchers, since theoretical knowledge will be useful to the
clinician ex ploring new approaches to diagnosis, prophylaxis, and
therapy. The conference could not have been organized without the
generous sup port of the Immuno Company, Vienna, Austria. May we
express our special thanks to Dr. Eibl, managing director and head
of the research division of Immuno AG, not only for granting
financial support but also for his valuable advice, encouragement,
and scientific expertise."
1. 1 Ubersicht der Probleme und der klinischen Fragestellungen Das
Krankheitsbild einer stumpfen Kontusionsverletzung der Lunge ist in
der Medi zin seit Jahrhunderten bekannt. ledoch erst seit dem 2.
Weltkrieg setzt sich die Auf fassung durch, daB es sich bei der
Lungenkontusion urn eine eigene klinische Entitat handelt. Ihre
pathophysiologischen Auswirkungen treten unabhangig von den nahezu
immer vorhandenen Begleitverletzungen auf und bedfirfen der
Behandlung. Die Lun genkontusion als Parenchymschadigung wird heute
nicht mehr nur als bloBe "Er weiterung" einer Thoraxwandverletzung
angesehen. Sie ist hinsichtlich ihrer Ursache, ihren
pathophysiologischen Folgen und ihren funktionellen Auswirkungen
von dem oft mit ihr zusammen auftretenden und zu beurteilenden
Syndrom der instabilen Tho raxwand abgrenzbar. Trotz dieser
Fortschritte kann heute das gesicherte Wissen urn die Lungenkon-
sion wie 1955 durch Lohr 19] - mit Einschrankungen - zusammengefaBt
werden: "Immer wieder wird die Beurteilung einer Thoraxverletzung
ernster ausfallen, wenn die Diagnose Kontusionspneurnonie gestellt
wurde. Urn so auffallender ist es, daB eine gewisse Unsicherheit
der atioiogischen Vorstellung besteht, daB kiare therapeutische
Richtlinien nirgends zu finden sind, und daB iiber Spatfoigen keine
Mitteilungen vorliegen. " Auf den heutigen Kontext bezogen, wfirde
man die bestehenden Probleme so formu lieren: Die Diagnose der
Lungenkontusion ist oftmals unmittelbar nach dem Unfall nicht
eindeutig zu stellen und erst nach einem unterschiedlich langen
zeitlichen Intervall zu sichem."
This reference work presents the basic principles of angiogenesis
induction, including the roles of signaling factors such as
hypoxia-inducible factors, biophysical stimulation and angiogenic
cells. The book also covers lymphogenesis induction. Both the
established fundamentals in the field as well as new trends in the
vascularization of engineered tissues are discussed. These include
pre-vascularization strategies using preparation of channeled
scaffolds and preparation of decellularized blood vessel trees,
approaches to inducing formation of microvasculature and approaches
to inducing the growth of vascular networks. The authors expand on
these concepts with current studies of dual-level approaches to
engineer vascularized tissue composites. The book concludes with a
discussion of current clinical approaches and the use of vascular
grafts in the context of providing clinical practice with new
tissue engineering strategies.
This reference work presents the origins of cells for tissue
engineering and regeneration, including primary cells,
tissue-specific stem cells, pluripotent stem cells and
trans-differentiated or reprogrammed cells. There is particular
emphasis on current understanding of tissue regeneration based on
embryology and evolution studies, including mechanisms of amphibian
regeneration. The book covers the use of autologous versus
allogeneic cell sources, as well as various procedures used for
cell isolation and cell pre-conditioning , such as cell sorting,
biochemical and biophysical pre-conditioning, transfection and
aggregation. It also presents cell modulation using growth factors,
molecular factors, epigenetic approaches, changes in biophysical
environment, cellular co-culture and other elements of the cellular
microenvironment. The pathways of cell delivery are discussed with
respect to specific clinical situations, including delivery of ex
vivo manipulated cells via local and systemic routes, as well as
activation and migration of endogenous reservoirs of reparative
cells. The volume concludes with an in-depth discussion of the
tracking of cells in vivo and their various regenerative activities
inside the body, including differentiation, new tissue formation
and actions on other cells by direct cell-to-cell communication and
by secretion of biomolecules.
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