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C Puchstein

Publications and source records attributed to C Puchstein.

At least 19 recordsLinked to original sources
PubMed2000

Cysteinyl-leukotriene generation as a biomarker for survival in the critically ill.

OBJECTIVE: To evaluate the capacity of cysteinyl-leukotriene generation in the progression of critical illness compared with that in healthy volunteers and to clarify interrelationships between the rate of leukotriene generation, severity of the disease, and clinical outcome. DESIGN: Prospective, observational study. SETTING: Surgical intensive care unit (ICU) in a German university hospital. PATIENTS: We studied 14 ICU patients (nine men, five women; aged 42-82 yrs) suffering from systemic inflammatory response syndrome, sepsis, or sepsis syndrome, with a calculated sepsis severity score of 17.7+/-4.2 and a Simplified Acute Physiology score of 17.6+/-3.0. In addition, five healthy volunteers (three men, two women; aged 34-38 yrs) were included in the study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Blood samples were obtained every second day from septic patients until discharge from the ICU or death. Leukotriene C4 (LTC4) synthesizing capacity was assessed in isolated and stimulated leukocytes (Ca-ionophore) by using combined reversed-phase, high-pressure liquid chromatography and radioimmunoassay methods. Initially, all patients synthesized less LTC4 than the healthy subjects. In patients who did not survive, the low LTC4 generation persisted throughout the observation period, whereas in surviving patients, its formation was normalized during convalescence. In surviving patients, LTC4 concentrations correlated with sepsis severity score. CONCLUSIONS: LTC4 generation is impaired in sepsis and may serve as a biomarker for survival in the critical ill.

Aged↗
PubMed1999

Influence of bolus size on efficacy of postoperative patient-controlled analgesia with piritramide.

We have examined the influence of bolus size on efficacy, opioid consumption, side effects and patient satisfaction during i.v. patient-controlled analgesia (PCA) in 60 patients (ASA I-II, aged 32-82 yr) after abdominal surgery. Patients were allocated randomly, in a double-blind manner, to receive PCA with a bolus dose of either piritramide 0.75 mg or 1.5 mg (lockout 5 min) for postoperative pain control. Mean 24 h piritramide consumption differed significantly between groups (11.4 (SD 5.8) mg vs 22.5 (18.3) mg; P = 0.001). There were no significant differences in the number of applied bolus doses, pain scores, pain relief (VAS), sedation, nausea, pruritus and patient satisfaction. We conclude that a PCA regimen with a bolus dose of piritramide 0.75 mg and a lockout time of 5 min was effective in the treatment of postoperative pain, but did not reduce the occurrence of side effects.

Adult↗
PubMed1998

Total parenteral nutrition with glutamine dipeptide after major abdominal surgery: a randomized, double-blind, controlled study.

OBJECTIVE: To assess the efficacy of glutamine (Gln) dipeptide-enriched total parenteral nutrition (TPN) on selected metabolic, immunologic, and clinical variables in surgical patients. SUMMARY BACKGROUND DATA: Depletion of Gln stores might lead to severe clinical complications. Recent studies indicate that the parenteral provision of Gln or Gln-containing dipeptides improves nitrogen balance, maintains the intracellular Gln pool, preserves intestinal permeability and absorption, and shortens hospital stay. METHODS: Twenty-eight patients (age range, 42-86 years, mean 68 years) undergoing elective abdominal surgery were allocated, after randomization, to two groups to receive isonitrogenous (0.24 g nitrogen kg(-1) day(-1)) and isoenergetic (29 kcal/122 kJ kg(-1) day(-1)) TPN over 5 days. Controls received 1.5 g of amino acids kg(-1) day(-1), and the test group received 1.2 g of amino acids and 0.3 g of L-alanyl-L-glutamine (Ala-Gln) kg(-1) day(-1). Venous heparinized blood samples were obtained before surgery and on days 1, 3, and 6 after surgery for routine clinical chemistry and for the measurement of plasma free amino acids. Lymphocytes were counted and the generation of cysteinyl-leukotrienes from polymorphonuclear neutrophil granulocytes was analyzed before surgery and on days 1 and 6 after surgery. Nitrogen balances were calculated postoperatively on days 2, 3, 4, and 5. RESULTS: No side effects or complaints were noted. Patients receiving Gln dipeptide revealed improved nitrogen balances (cumulative balance over 5 days: -7.9 +/- 3.6 vs. -23.0 +/- 2.6 g nitrogen), improved lymphocyte recovery on day 6 (2.41 +/- 0.27 vs. 1.52 +/- 0.17 lymphocytes/nL) and improved generation of cysteinyl-leukotrienes from polymorphonuclear neutrophil granulocytes (25.7 +/- 4.89 vs. 5.03 +/- 3.11 ng/mL). Postoperative hospital stay was 6.2 days shorter in the dipeptide-supplemented group. CONCLUSION: We confirm the beneficial effects of Gln dipeptide-supplemented TPN on nitrogen economy, maintenance of plasma Gln concentration, lymphocyte recovery, cysteinyl-leukotriene generation, and shortened hospital stay in surgical patients.

Adult↗
PubMed1996

The effect of parenteral fish oil on leukocyte membrane fatty acid composition and leukotriene-synthesizing capacity in patients with postoperative trauma.

The incorporation of omega-3 and omega-6 fatty acids (FAs) into leukocyte membranes and the leukotriene (LT)B4-, LTB5 -, LTC4-, and LTCs-synthesizing capacity in stimulated leukocytes were measured following parenteral omega-3 FA nutrition in 20 postoperative patients. Total parenteral nutrition (TPN) over 5 days postoperatively was isonitrogenous (0.24 g N x kg-1 x d1) and isoenergetic (92 kJ/22 kcal x kg-1 x d-1), containing 0.15 g fish oil and 0.85 g soybean oil per kg-1 x d-1 (FO) or 1.0 g soybean oil x kg-1 x d-1 (SO). Following 5 days' FO administration, the content of eicosapentaenoic acid (EPA) was increased 2.5-fold, LTB5 1.5-fold, and LTC5 sevenfold. With SO nutrition, EPA and LTB5 generation remained unaltered, whereas LTC5 doubled. The production of LTB4 and LTC4 was not affected in any of the groups. We conclude that a 5-day parenteral fish oil supplementation has an immunomodulatory effect on lipid-mediator generation in human leukocytes in postoperative trauma.

Adult↗
PubMed1996

[Immunomodulation after parenteral glutamine administration in colorectal surgery].

The influence of parenteral L-alanyl-L-glutamine dipeptide on the cysteinyl-leukotriene (cys-LT) synthesizing capacity from neutrophils was studied in patients undergoing colonic surgery. The decrease in cys-LT, observed postoperatively, could be normalized with parenteral glutamine, while the cys-LT decrease persisted in controls. We conclude that the provision of glutamine in the postoperative state improves normalization of neutrophil functions (e.g., generation of cys-LT), which is an essential prerequisite for host defences.

Adult↗
PubMed1991

[Hemodynamic effects of a combination of general and peridural anesthesia during anesthesia induction in geriatric patients].

For major operative procedures in the lower abdomen and many orthopedic procedures such as total hip replacement, a combination of general and epidural anesthesia is used. In order to investigate the hemodynamic effects of such a combination in 14 geriatric patients aged 63-80 years who were undergoing total hip replacement, cardiovascular monitoring was established by an arterial line and a pulmonary artery catheter. The epidural anesthesia was achieved with bupivacaine 0.5% in a dose calculated to obtain a block up to Th 6. General anesthesia was then induced and maintained with midazolam, fentanyl, pancuronium bromide, and a 2:1 nitrous oxide-oxygen mixture. Hemodynamic measurements were established before and 30 min after induction of the epidural anesthesia and 20 min after the induction of general anesthesia. After bupivacaine was injected the loss of sympathetic tone produced a systolic arterial blood pressure decrease from 174 +/- 22 to 136 +/- 28 mmHg (p less than 0.05) and a decrease in heart rate from 73 +/- 12 to 66 +/- 10 min-1 (p less than 0.05). The cardiac index did not change, but the peripheral vascular resistance decreased significantly. Because intravenous fluids were given simultaneously, preload could be maintained. Oxygen delivery and oxygen extraction did not change. During general anesthesia a significant drop in cardiac output was observed from 3.0 +/- 0.6 l/min.m2 to 2.3 +/- 0.4 l/min.m2 (p less than 0.05). The systolic arterial blood pressure decreased to as low as 95 +/- 17 mmHg (p less than 0.05) and oxygen delivery decreased from 500 +/- 125 ml/min.m2 to 323 +/- 84 ml/min.m2 (p less than 0.05).

Aged↗
PubMed1990

[Pharmacokinetic studies of a new 20% fat emulsion containing 70% medium-chain triglycerides].

The aim of the study was to acquire basic knowledge on pharmacokinetic, metabolism and tolerance of a new 20% fatty emulsion with a 70% proportion of medium-chain triglycerides (MCT) and a 30% proportion of long-chain triglycerides (LCT) in the postoperative phase after a trauma of medium severity. - 12 female patients who had an elective rectal amputation and who needed parenteral nutrition postoperatively, were studied. The nutritional regime consisted of 4.8 g/kg/day of glucose and 1 g/kg/day of amino acids. On the second postoperative day the patients were given 0.06 g/kg body weight/h and on the third day 0.12 g/kg body weight/h of new 20% fatty emulsion during a time period of eight hours. Blood samples for the evaluation of triglycerides, free fatty acids, phospholipids, beta-hydroxybutyrate (beta-OHB), acetoacetate, cholesterol, glucose, pyruvate and lactate were taken before and after the fat application. Ketone were measured semiquantitatively. Side effects and complications were not observed. Simultaneously to the administrated triglycerides an increase in serum triglycerides was observed. After four hours fat emulsion was infused under steady state conditions. Under the graphically measured half-life of 17 minutes for the MCT/LCT emulsion, rapid and complete elimination could be seen after the infusion had been stopped. Simultaneously with the high clearance of the infused triglycerides, free fatty acids increased significantly in the plasma without reaching a plateau; 30 minutes after the fat application the laboratory results returned to the initial levels.(ABSTRACT TRUNCATED AT 250 WORDS)

3-Hydroxybutyric Acid↗
PubMed1989

Effect of parenteral glutamine peptide supplements on muscle glutamine loss and nitrogen balance after major surgery.

Twelve patients admitted for elective resection of carcinoma of colon or rectum were allocated at random to experimental and control groups (six in each) and received a total parenteral nutrition regimen providing 230 mg N/kg and 166 KJ/kg daily over the first 5 postoperative days. In the experimental group the parenteral fluid was supplemented with a synthetic glutamine-containing dipeptide, L-alanyl-L-glutamine (54 mg peptide-N/kg per day) and the control group received corresponding amounts of alanine-N and glycine-N. On each postoperative day nitrogen balance was better in the experimental group; mean daily nitrogen balance with alanyl-glutamine was -1.5 (SE 0.4) g N/day and with the control solution -3.6 (0.2) g N/day. The cumulative nitrogen balances on the fifth postoperative day were -7.1 (2.2) and -18.1 (1.7) g N, respectively. With the peptide-containing solution intramuscular glutamine concentration remained close to the preoperative value whereas with the control solution it decreased from 19.7 (SE 0.9) to 12.0 (0.6) mmol/l intracellular water.

Clinical Trials as Topic↗
PubMed1989

Treatment of intraoperative hypertensive emergencies in patients with intracranial disease.

In patients with neuropathologic processes leading to disturbed cerebrovascular autoregulation, sudden increases in arterial blood pressure may lead to a sudden elevation in cerebral blood flow and intracranial pressure. Therefore, sudden increases in arterial pressure should be assiduously avoided in the perioperative period. Hypertensive episodes may occur at any time during anesthesia, but are more likely to occur (1) during laryngoscopy and intubation, (2) at the time of skin incision, (3) at extubation, and (4) during awakening. In patients with cardiovascular disease, such hypertensive episodes may also cause deterioration of the cardiovascular situation. Catecholamines are the principal mediators of such intraoperative hypertensive reactions. There are 2 options available to the anesthesiologist: (1) attempt to suppress this response after it has occurred, or (2) prevent its occurrence at the outset. Treatment of hypertension often relies on agents that relax vascular smooth muscle. In patients with compromised intracranial compliance, however, cerebral vasodilation must be avoided because it leads to an increase in cerebral blood volume. This, in turn, may raise intracranial pressure and result either in herniation of brain contents or a decrease in cerebral perfusion pressure leading to brain ischemia. Different pharmacologic means of preventing or suppressing such intraoperative hypertensive reactions are reviewed. Many of the drugs reviewed resulted in adverse effects that could preclude their use in patients with reduced intracranial compliance. Alpha- and beta-adrenergic receptor blockers can safely be administered to such patients.

Antihypertensive Agents↗
PubMed1989

[Protein oriented peripheral venous nutrition following surgical trauma].

In the postoperative state, hypercaloric parenteral nutrition is not indicated in every patient where enteral nutrition is not feasible. Low caloric protein oriented peripheral venous parenteral feeding might be an alternative nutritional regimen in moderate catabolic postoperative states. In a prospective study, 18 females received a completed nutritional solution during 4 days postoperatively following major colon surgery. The solution contained 80 g Sorbitol, 40 g Xylitol, 70 g amino acids and electrolytes (700 kcal/day). A slightly negative nitrogen balance with daily losses of about 4 g of N were observed. Routine biochemical data did not change compared to preoperative values. Plasma free amino acid homeostasis has been maintained so that conditions for optimal utilisation of the infused nutrients were given. No general side effects could be observed. This protein oriented nutritional solution may be recommended for hypocaloric peripheral venous nutrition in moderate catabolic states.

Amino Acids↗
PubMed1989

Caloric requirements in burned patients.

Adequate nutritional support is an important goal for the management of burn patients. Caloric requirements are higher than in any other major trauma or disease. The development of hypermetabolism and hypercatabolism leads to an increase in resting energy expenditure which depends on the severity of the injury. Therefore, with the intent to counteract these developments and their complications, a balanced carbohydrate, fat and protein intake should be adjusted to the actual needs. This paper gives a survey of the metabolic consequences of burns, reviews the underlying pathophysiology and tries to give practical guidelines for the nutritional support of the burn patient.

Burns↗
PubMed1989

[Metabolic problems and therapeutic approaches in multiple organ failure].

Multiple-system organ failure is associated with progressive defects of cellular metabolism involving several organ systems. The metabolic failure is caused by a neural-hormonal reaction to trauma and sepsis and by humoral mediators damaging cell metabolism. Involved are catabolic hormones like catecholamines, cortisol and glucagon as well as the humoral mediators interleukin and arachidonic acid metabolites. There is an increase in resting energy expenditure and a derangement of utilization and production of adenine nucleotides. Severe injury, sepsis and multiple-system organ failure are associated with a 30-40% decreased content of energy rich phosphates in different tissues. The low energy charge potential is caused by the inability to use nutritional substrates adequately. Relative clearance and oxidation of glucose will advance fatty infiltration of the liver. Clearance and oxidation of fat is normal or often increased. If illness is progredient fat utilization will be disturbed. Although protein synthesis is increased in critical ill patients, due to excessive proteolyses net protein loss occur. In preterminal patients the ability of the liver to synthetize protein decreases, concentrations of several free amino acids in plasma increase, while the clearance for amino acids decreases.

Critical Care↗
PubMed1989

[Experiences with a new fat emulsion in surgical intensive care medicine].

As far as energy availability is concerned, it is advantageous to give lipid emulsions to severely catabolic patients, in comparison to lipid-free TPN. It is important to administer essential fatty acids, especially linoleic and linolenic acid, which play a major part in synthesis of membrane phospholipids and prostaglandin metabolism. Lipid emulsions with linoleic acid content and high linoleic-linolenic ratio might be of great value in posttraumatic situations, where the need for linoleic acid might be increased up to 50 g/day. We have examined the safety of a new lipid emulsion with a linoleic-linolenic acid ratio of 16:1 in 14 severely catabolic surgical ICU patients. As a result, neither liver enzyme elevation nor allergic reactions occurred. The limited elevation of triglycerides under lipid infusion and the rapid fall of these values to normal levels account for the satisfactory utilization of the examined lipid emulsion in critically ill patients.

Adult↗
PubMed1989

[Assessing nutritional status].

Malnutrition is associated with a delayed recovery from illness and an increased rate of complications. Heart failure, respiratory diseases, impaired immune function and postoperative wound healing are influenced by the nutritional status. Nutritional assessment includes patients history, physical examination, anthropometric measurements, laboratory dates and changes of immunocompetence. Anthropometric assessment, like skinfold and muscle area measurements, is not an extremely accurate method predicting nutritional status of an individual patient. Multifactorial influence on the concentration of the serum proteins, albumine, transferrin and retinolbinding protein caused a wide range of normal values. Therefore the validity and sensitivity of these parameters to assess nutritional status are diminished for the individual patient. The concentration of serum albumin seems to be of some value as a marker for nutritional status. The influence of malnutrition on immunity is complex. There are no sensitive markers available to assess the influence of malnutrition on the immuno competence of an individual patient for the clinical routine. Malnutrition may be assessed and the resulting clinical complications may be predicted by calculating a prognostic nutritional index, which include several nutritional parameters.

Anthropometry↗