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Biomedical subjects

G Goeckenjan

Publications and source records attributed to G Goeckenjan.

At least 37 records · Page 2Linked to original sources
PubMed1984

[Suicide and weather].

In 151 patients, admitted to an intensive care unit after attempted suicide, the possible influence of weather at the time of the attempt was analysed retrospectively. The "biosynoptic daily analysis" of the German Weather Service provided the weather data. There was a 5% and 1%, respectively, significant level for the positive correlation between the time of the attempted suicide and the weather parameters "stable upslide, labile upslide, fog and thunderstorm" and the summarized parameters "warm air, upslide and weather drier than on the two preceding days". Significantly fewer attempts than expected occurred when the weather description was "low pressure and trough situation, labile ground layer--upslide above" and the summarized parameters "subsidence or downslide motion". Besides the individual factors such as the reaction to conflicts and the spectrum of reactions, exogenous factors like weather must be considered as important for the time of suicidal attempt.

Adult↗
PubMed1984

[Acute respiratory failure in a medical intensive care unit. Incidence and prognosis].

Acute respiratory failure had occurred in 89 of 1594 patients in a medical intensive care unit (5.6%), 26.8% of all patients (332) on long-term mechanical ventilation. Compared with the other chronically ventilated patients those with acute respiratory failure averaged a lower age, the proportion of women was higher and the duration of ventilation longer. The death rate was significantly higher (78.7% compared with 58.3%). The important prognostic factors included the underlying disease, additional abnormal organ function, severity of pulmonary gas exchange abnormality, and advanced age. If there was septicaemia, peritonitis, liver cirrhosis with bleeding oesophageal varices or polytrauma with acute renal failure the death rate was over 80%; after hypovolaemic shock, pancreatitis or postoperative pulmonary failure it was less than 65%. Patients who had abnormal function of at most one other organ in addition and an inspiratory arterial pO2 difference below 250 mm Hg, measured 12 hours after onset of mechanical ventilation, had a relatively favourable prognosis with a death rate of 33%, while in the other groups of patients it was 86-100%.

Acute Disease↗
PubMed1984

[Electromyographic determination of the fatigability of respiratory and leg muscles before and after aortocoronary bypass operation].

To study the effect of postoperative confinement to bed on respiratory muscle fatigue, 31 male subjects (age, 34-66 years) undergoing coronary artery revascularization were examined. Fatigue of both respiratory muscles (musculi intercostales externi) and leg muscles (musculus gastrocnemius) was determined by electromyography prior to and 7 and 12 days after operation. Additionally, oscillatory resistance to breathing and phase angle were measured. Pre- and postoperative routine lung function tests were performed. A comparison between preoperative and postoperative measurements reveals that respiratory as well as leg muscle fatigue occurred at higher loads during the preoperative and the second postoperative than during the first postoperative determination. After surgery vital capacity, total lung capacity, 1-second capacity, and, to a lower extent, thoracic gas volume were diminished, while specific airway conductance, oscillatory resistance to breathing, phase angle, residual volume, and relative 1-second capacity remained unchanged. The constancy of the latter parameters indicates that neither airway obstruction nor a significant restriction of the lung and/or thorax occurred due to surgery. Therefore, the increase of respiratory muscle fatigue after surgery may more probably be attributed to a lack of training of respiratory muscles which may contribute to limitation of ventilation in bedridden patients.

Adult↗
PubMed1984

[Fibrinolysis in right ventricular thrombus].

After fracture of his toes, a 34-year-old male patient developed deep leg vein thrombosis and subsequent pulmonary embolism. Because of progressive heart enlargement, 2D-echocardiography was performed. A floating mass measuring 4.5 cm X 3.5 cm was found in the right ventricle. On account of the deep leg vein thrombosis and the lung perfusion deficits detected by scintigraphy, the floating mass was thought to be a thrombus. Because of the severity of the patient's state and the lack of success of a heparin therapy with 32,000 IU/d, fibrinolytic treatment with streptokinase was started. After initial improvement in pulmonary gas exchange the patient died about 7 hours later from progressive cardiopulmonary insufficiency. Necropsy revealed a smaller right ventricular thrombus than that seen by echocardiography. There were typical surface erosions caused by the fibrinolytic treatment. Many younger and older emboli which in part were fragmented could be shown in the pulmonary vessels. A fragmentation of the right ventricular thrombus and subsequent lethal occlusion of pulmonary vessels had to be considered. With respect to the course of the described case and some case reports in the literature we think fibrinolysis is more dangerous than surgical thrombectomy in right ventricular thrombosis.

Adult↗
PubMed1984

[Calculated and measured oxygen saturation. A valid comparison of the Kelman, Severinghaus, and Siggaard-Anderson formulas for calculating oxygen saturation of patients in intensive care].

The validity of calculation of oxygen saturation by means of Kelman's, Severinghaus ' and Siggaard -Andersen's formulas was investigated in 329 arterial and 26 mixed venous blood samples of intensive-care patients. The spectrophotometric measurement of oxygen saturation with Radiometer's Hemoximeter OSM2 served as reference. In spite of good coefficients of correlation regarding the total number of samples (r 0,963/ Kelman's formula; r = 0,964/ Severinghaus and Siggaard -Andersen's formula) there were not as satisfactory correlations in some individual patients. The study shows that there was a decrease in conformity between measured and calculated oxygen saturation with decreasing oxygen tension in the blood. Sufficient accuracy of calculation of saturation can be expected only with pO2 greater than 80 mmHg. Siggaard -Andersen's formula was slightly superior to the other tested algorithms.

Adult↗
PubMed1982

[Effects of long-term ventilation on the bronchial system. Bronchoscopic, cytologic and microbiological findings].

UNLABELLED: The effects of longterm ventilation were evaluated in 50 patients from a medical intensive care unit. The bronchial tract was investigated using repeated bronchoscopy and assessed by semiquantitative scoring. Prior to each endoscopy tracheal secretions were obtained for microbiological and cytological evaluation, in 20 patients histological analysis of the bronchial mucosa was done in addition. RESULTS: 1. Within 24-48 hours after initiation of respirator ventilation alterations of the bronchial mucosa occur. The extent progresses rapidly, however no further increase of progression is to be observed after ventilation of approximately 150-200 hours. 2. Endoscopic assessment of the severity of mucosal changes correlates well with cytological and histologic results. 3. In 34 patients microbial agents could be demonstrated. In 8 of them mucosal changes preceded demonstration of microbial organisms. The extent of mucosal changes is independent of category or count of pathogen. Endoscopic follow-up investigations of the bronchial tract affected by long-term ventilation serve both direct bronchial clearing and control of position of the intubation tube as well as assessment of mucosal alterations and control of treatment of bronchial infection.

Adolescent↗
PubMed1982

[The large heart].

Explore the source record for details and available documents.

Cardiomegaly↗
PubMed1982

[Abnormal findings of cardiac function in patients with systemic lupus erythematosus (author's transl)].

To find out the rate of cardiac involvement among patients with systemic lupus erythematosus (SLE), 34 patients with SLE were examined by ECG, x-ray of the chest, body plethysmography, one- and two-dimensional echocardiography In addition, in 23 patients with SLE a microcatheterization of the right heart side was undertaken with measuring of the mean pulmonary artery pressure and cardiac index during exercise. Echocardiography revealed moderate abnormal findings in 62% of the patients. In particular, there was a thickening of the interventricular septum (31%), an enlargement of the right ventricle (23%), a diminution of the left ventricular fractional shortening (16%), an augmentation of the left atrium (10%) and of the left ventricle (6%). A small pericardial effusion was observed in 6% and a thickening of the left ventricular posterior wall in 3%. At micro-catheterization in 19 out of 23 patients with SLE, there was an increase of the mean pulmonary artery pressure up to abnormal values. In 5 patients, mean pulmonary pressure rose over 40 mm Hg. Most of the patients also showed an increase of the arterial pressure up to pathological values. Furthermore, most of the patients finished exercise because of muscular insufficiency or dyspnoea. Only 4 of 23 patients with SLE reached 90% of the age-corresponding maximal heart rate. The results indicate that with about 80% of all patients with SLE the cardiac capacity is reduced. In about 20% of the patients with SLE, this diminution of cardiac capacity is severe, and the necessity of medical treatment has to be discussed.

Adolescent↗
PubMed1980

[Pulmonary oedema as a complication of tocolytic therapy (author's transl)].

Tocolytic treatment with fenoterol and additional administration of betamethasone and acetyl salicylic acid to a 19-year-old girl caused irreversible and finally fatal pulmonary changes. The clinical course in this and that of other published cases indicates a causal relationship between the tocolytic treatment and the onset of pulmonary oedema. The pulmonary arterial pressures in this patient, the poor therapeutic response and the shock-lung picture without corresponding myocardial changes suggest a non-cardiogenic cause of pulmonary oedema. Any of the three drugs administered could have been responsible.

Adult↗
PubMed1979

[Scanning electron microscopic examination of intra-arterial PO2 electrodes (author's transl)].

Continuous blood gas measurement by means of indwelling intraarterial electrodes facilitates and contributes to considerably improve the monitoring of pulmonary gas exchange in intensive care and anaesthesiology. Knowledge of the behaviour of the electrode surface in the blood stream is necessary to assess the characteristics of the measuring and the possible risks or complications. Scanning electron microscopic examinations were performed in a commercial-type polarographic PO2 electrode after in vitro and in vivo application. 14 electrodes were examined after continuous intra-arterial measurements in patients with chronic obstructive pulmonary disease and in intensive care patients. Duration of intra-arterial measurements was 2-109 h. Already after a measuring period of 2 h in nearly all cases a protein film was discovered on the electrode surface. Microthrombotic deposits were seen in 2 cases, in one of these despite of treatment with heparin. The electrode membrane showed a network ofmicro-cracks, small bubbles and dents. The membrane changes were probably the result of the drying process during the electron microscopic preparation, because the membrane material (Hydron) is hydrophil and swells during the measurement. Yet it cannot be excluded that these changes occur, in part, during the measurements. From these and other studies we conclude that the intra-arterial application of this electrode has a low risk of thromboembolic complications. The deposits on the electrode surface and the membrane changes may probably affect the response time and possibly also the stability of the electrode.

Blood Gas Analysis↗
PubMed1979

[A simple method for pleural drainage (author's transl)].

21 patients had pleural drainage with a rubber valve (Heimlich) on account of pneumothorax (15) and massive pleural effusion (6). The method succeeded in every case. It has the advantage that it dispenses with suction and bottles, that it needs no turning-off when the patient gets up, but maintains its draining action, and that in cases of persisting broncho-pleural fistula there is no additional suction. The technique represents a simplified alternative to the customy methods of pleural drainage.

Humans↗
PubMed1979

Continuous measurement of arterial PO2. Significance and indications in intensive care.

The use of continuous arterial PO2 monitoring with the aid of intra-arterial electrodes is discussed with reference to 50 patients in an intensive care unit specializing in internal medicine. Monitoring time ranged from 2 h to 15 days. There were no serious complications which could, with certainty, be attributed to the intravascular measurement of PO2. The advantages of this method lie particularly in the early detection of hypoxemias, in the uninterrupted monitoring of artificial respiration and in the immediate indication of favorable and unfavorable response to therapy. Finally, a list is given of possible indications in which this method can be used in intensive medicine.

Aged↗
PubMed1979

[Evaluation of lung function tests by means of a programmed minicomputer (author's transl)].

A computer programme for a small programmable electronic calculator is introduced which considerably facilitates the offline evaluation of tests of the ventilatory lung function and mechanics of breathing, including the establishment of individuel ideal values. This favourably priced computer reduces the time required for calculation by about one-third compared with the conventional method. The process of assessment is rendered strikingly simple and hence safer by this highly versatile computer.

Computers↗
PubMed1979

Use of the continuous transcutaneous PO2 measurement in lung function tests.

Continuous measurements of transcutaneous PO2 are of interest in pulmonary function tests by which dynamic processes of pulmonary gas exchange are examined. The aim of the present study is to clarify the question of whether the transition function of transcutaneous PO2 after a step change of inspiratory oxygen concentration could give information about pulmonary gas exchange. In 8 healthy volunteers and 31 patients with chronic obstructive pulmonary disease of various degrees the half-value mixing times of transcutaneous PO2 were correlated with parameters of respiratory mechanics and pulmonary gas exchange. In spite of a damping of rapid changes of arterial PO2 by the transcutaneous measurement, there were significant correlations of the mixing times with physiologic right-to-left shunt; with physiologic dead space, alveolar ventilation, and blood gases; and with the parameters of lung overinflation and airway obstruction. There was a significant correlation with the age of the subjects, too. This had to be attributed mainly to an increase in severity of lung function disturbances with advancing age. Aging of the skin seemed to have a minor influence. According to these results, the transition function of transcutaneous PO2 after a step change of inspiratory oxygen concentration is determined mainly by the alveolar ventilation and the ventilation-perfusion inhomogeneity. This paper describes a short test that only takes some minutes of oxygen breathing and that has nearly the same diagnostic value as the measurement of the half-value mixing time.

Adult↗