[Nursing care in pregnancy, puerperium and for healthy newborn infants. Overall learning goal and content. 10].
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Biomedical subjects
Publications and source records attributed to G Herold.
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In 24 patients who had undergone cholecystectomy or abdominal hysterectomy the serum levels of prealbumin, transferrin, retinol-binding protein and immunoglobulin G were determined up to the 5th day after operation. Intra- and immediately postoperatively the patients received only isotonic infusion, beginning on the 3rd day after operation, they were fed increasingly orally. The observed serum levels decreased postoperatively.
Between January 1975 and March 1978, 15 cases of sudden death or hospitalized medical emergencies occurred during cross-country skiing in the Engadine region, comprising 3 sudden deaths, 9 myocardial infarctions, and 3 neurovascular accidents. The total number is small as compared to the number of people practising this sport. Among participants of the Engadine Ski Marathon, the incidence was 1 emergency per 40,000 skiing hours and 1 death per 120,000 skiing hours. Patients suffering from myocardial infarctions were all vacationers from lower altitudes, in most whom several risk factors were present. Two cases of cerebrovascular accident demonstrate that competitive cross-country skiing may impose enormous stress on the cerebrosvascular system even in well-trained individuals.
The frequency of side effects occurring when administering carbohydrates in postoperative parenteral nutrition has been examined in 72 adult intensive-care patients. By keeping the dosage of 0.5 carbohydrate/kg body-weight/h at a relation of 2:1:1 (G:F:X), no significant deviations from the usual pattern were observed.
In 20 patients, the serum level and urinary output of zinc, magnesium, copper, calcium and anorganic phosphate were examined during postoperative parenteral feeding. The parenteral feeding was standardized. In addition, the above mentioned bioelements were systematically substituted. Effects of this substitution therapy on serum level and urinary output are discussed.
In 52 adult patients, serum levels and renal loss of zinc, magnesium, calcium, copper and anorganic phosphate were examined during the period of parenteral postoperative nutrition. Simultaneously performed analyses of applied infusion and protein solutions, as well as of conserved blood, yielded a markedly differing content of these bioelements. Particularly pronounced are the differences in zinc concentrations of individual infusion solutions. A random substitution of zinc and anorganic phosphate is insufficient since it does not correspond with the demand. For this reason, anorganic phosphate and zinc should only be purposively substituted.
In 45 patients serum levels and urinary excretion of zinc, magnesium, calcium and phosphate were examined during postoperative parenteral nutrition. The patients received the same parenteral nutrition and were divided in groups according to different types of operations. Serum levels of calcium and magnesium were found to be normal in all groups at highly varying degrees of urinary excretion. Zinc and phosphate serum levels, as well as urinary excretion, show a markedly different behavior.
Clinical observations during postoperative feeding (observation period 10 to 30 days) are reported. We compared glucose and fructose intake at different intake rates to glucose and fructose urinary output. Insulin admixture per 100 g of glucose is not constant. It can be progressively reduced following operation.
The death rate of 6662 major gynaecological operations on women of 60 years or more in 17 West-Berlin Gynaecological Departments (1960--1969) was 7,7% (512 cases). Of these, 89 women (16,8%) died either during operation or within 3 days after the operation. In all cases there was an adequate indications for surgical intervention. With few exceptions the procedures of the operations could not be criticized. Only a very small part of the intra- and postoperative mortality could be attributed to the anesthesia. In some cases medication was insulfficient (e.g. lack of preoperative treatment with digitalis or postoperative replacement with substitutes or blood). This may partly be explained by the fact that during the period under investigation in many cases the anesthesia had to be done by the gynaecologists. Publications on early postoperative mortailty supply better information on the quality of medical care given to the gynaecological patients, than surveys of so called "Anaesthetic dealths".
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Bibliographic data on pathophysiology, therapeutic methods and mortality rate of burn disease are compared with own clinical experiences with a standardized therapy. Within a period of 18 month 35 patients with burn disease of special therapeutic problems were treated besides the overall number of patients in the operative intensive care unit of the Klinikum Steglitz. As special devices for patients with burns still do not exist provisional solutions had to be developed. It is referred to the close connexion between prognosis and mortality, on the one hand, and the age of the patients and the degree of burns, on the other hand. Whereas shock treatment, medicamentous therapy and nutrition are largely standardized, there are strongly differing opinions on local treatment and surgical wound care. The routine application of gammaglobulines, antibiotics and heparin controversial, too.
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An increasing number of old on senile patients now submit to major surgery and intensive therapy for these patients is often indicated. The development in medicine has led to very good results being obtained in many of these cases. Patients this age-group may have pre-existing injuries, organ changes and restricted abilities to compensate, which means that when certain complications follow one must examine carefully the indication for continuing intensive therapy, in order to avoid needless and painful life-prolonging measures. Our own experiences with 54 patients are discussed.
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