Session 1: Histamine and the Stomach: Chemical Histamine Assays

Lorenz, W.; Thon, K.; Stöltzing, H.; Neugebauer, E.; Lindlar, R.; Sattler, J.; Weber, D.

doi:10.3109/00365529109093173

Cited by 8 publications

(2 citation statements)

References 27 publications

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“…Im Bereich der Notfallmedizin liegt hierzu mittlerweile ein Studienbeispiel vor. Ein Beispiel für die Anwendung dieser Methodik zur Überprüfung der zeitabhängigen Genauigkeit von Histaminbestimmungen (Vergleich Ulkuspatienten versus gesunde Kontrollgruppe) findet sich in Referenz [49]. Die Testgruppe bestand aus Polytraumapatienten, bei denen der Plasmahistaminspiegel am Unfallort gemessen wurde.…”

Section: Beobachtungsstudienunclassified

Klinische Studien in der Notfallmedizin

et al. 1998

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Clinical studies are usually conceived of as controlled randomized trials, as retrospective patient statistics or as single case reports. However, such a classification is too narrow and overlooks many other forms of study designs. This review, therefore, offers a more encompassing and practical classification of clinical studies for the field of emergency medicine. Randomized controlled trials fulfill scientific criteria at the highest level (gold standard): comparison, repeatability, objective measurement. At the same time, randomized trials also have to comply with demanding ethical criteria and must be justifiable in the individual patient. Therefore, comparable uncertainty with regard to the superiority of the treatment options under investigation is a sine qua non. In addition to randomized trials, six other groups of clinical trials have the potential to solve scientific questions in emergency medicine: observational studies, decision analysis, meta analysis, public health care studies, case reports and descriptive summary statistics and studies on ethical problems. This variability in trial designs calls for a clinically oriented methodologist; the concept and institutionalization of theoretical surgery has been a response to this demand. All study types in this review are illustrated by examples in emergency medicine. Literature for advanced reading in particular trial methodologies can be found in the reference list. A checklist summarizes all elements for designing and conducting randomized trials in emergency medicine. All clinical trials striving for a high standard of quality--whether randomized or not--depend on the following prerequisites:professional organization, time effort, a supportive social environment and a scientific culture.

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Section: Beobachtungsstudienunclassified

Klinische Studien in der Notfallmedizin

et al. 1998

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“…The cross-sectional study [102] was designed and conducted according to LORENZ et al [76] with features of well-designed observational studies (similar to randomized trials). They included com~ plete protocol before start (including approval by ethical committee), elimination of Berkson bias (only hospitalized, surgical patients), defined entrance criteria for cases and controls, assignment to groups not predictable, balanced assignment (10subjects in each group), prognostic factors (e.g.…”

Section: Trialmentioning

confidence: 99%

Perioperative nonspecific histamine release : a new classification by aetiological mechanisms and evaluation of their clinical relevance

Duda¹,

Lorenz

Menke

et al. 1993

Annales Françaises d'Anesthésie et de Réanimation

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RI~SUM#: Les auteurs ont r6alis6 quatre 6tudes prospectives dans le but d'6tudier les diff6rents facteurs responsables de la lib6ration d'histamine dans la p6riode p6dop6ratoire. Les r6actions allergiques vraies et les r6actions pseudo-allergiques ne sont pas seules en cause. De nombreux autres m6canismes d'histaminolib6ration sont sugg6r6s : m6canismes neuroendocriniens, lib6ration cons6cutive ,~ des stimuli nociceptifs, facteurs cytotoxiques cons6cutifs au traumatisme tissulaire de l'acte chirurgical et lib6ration induite par les cytokines. Ces mdcanismes ont 6t6 mis en 6vidence darts deux 6tudes prospectives 6tudiant, l'une des patients lors d'une gastroscopie r6alis6e sans pr6m6dication et l'autre, des patients b6n6ficiant d'une chol6cystectomie perccelioscopique. Darts une autre 6tude, une histaminolib6ration par mdcanisme pseudoallergique a 6t6 not6e imm6diatement apr~s l'induction anesth6sique chez un hombre important de patients op6r6s pour divers acres de chirurgie g6n6rale. Dans ces deux cas, I'histaminolib6ration est ind6sirable car elle est ~a l'origine de sympt6mes de gravit6 variable. Les signes cliniques sont surtout cardiovasculaires et respiratoires alors que les signes cutan6s sont souvent absents. Les auteurs consid~-rent que dans la pdriode p6riop6ratoire la lib6ration d'histamine est ind6sirable dans certains cas mais darts d'autres elle n'a pas de cons6quences n6fastes, pouvant m6me 6tre b6n6fique. Une r66valuation des signes cliniques d'histaminolib6ration est n6cessaire puisque les 6tudes ont montr6 que des concentrations plasmatiques de 12 ng. ml -~ d'histamine souvent ne s'accompagnaient d'aucun signe cutan6. Ainsi une histaminolib6ration non sp6cifique n'est, le plus souvent, pas reconnue comme cause d'une hypotension art6rielle p6riop6ratoire en raison du manque de sp6cificit6 de ce sympt6me. Des 6tudes ult6rieures doivent pr6ciser le r61e des m6dicaments antihistaminiques (anti-H1 et anti-H2, doses, choix des patients, moment de Fadministration) darts la pr6vention de l'histaminolib6ration p6riop6ratoire. CLASSIFICATION OF PERIOPERATIVE HISTAMINE RELEASEIn the last conference on prevention of perianaesthetic anaphylactoid reactions, Nancy, 1984 [52], a whole series of mechanisms for nonspecific histamine release was not mentioned at all [62]. Surgical trauma was included, but only one reference could be given at this time [93] and did not challenge the general opinion over 50 years that ,~ histamine does not play an important role in major injury or traumatic shock, [1, 311In this conference [54], however, a considerable increase of knowledge has to b~ reported which creates new hypotheses on functions of histamine in clinical epidemiology ( fig. 1). A new classification has to be found which does not only alter aetiology, but also pathogenesis and disease manifestations, especially in the perioperative and postoperativ e period.

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