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Biomedical subjects

J Rieger

Publications and source records attributed to J Rieger.

At least 91 records · Page 5Linked to original sources
PubMed1980

[First observations with continuous ambulatory peritoneal dialysis (author's transl)].

Continuous ambulatory peritoneal diaglysis (CAPD) represents a new method for treatment of chronic renal failure whereby patients carry two litres of dialysate with them permanently and are freely mobile. Dialysis is only interrupted by exchange of dialysate in approximately 6-hourly intervals. Due to the long presence of the dialysate in the peritoneal cavity clearance values are superior to intermittent peritoneal dialysis for small-molecular substances and reach elimination values of haemofiltration for medium-molecular substances. The main technical requirements consist of a permanent peritoneal dialysis catheter linked to a plastic dialysate bag by way of a connecting tube. In order to avoid frequent change of bag and thus increased risk of peritonitis bags are folded and carried on the body of the patient during the interval. Thereafter the bag is unfolded, filled with used dialysate and exchanged for a new bag. Six patients were thus treated for over 34 patient-months so far. Changes of chemical pathology were readily acceptable. Even though CAPD has several advantages over conventional dialysis as they are mainly founded on the high degree of rehabilitation of patients, risk of peritonitis is still a considerable factor of uncertainty.

Abdomen↗
PubMed1980

Management of anuric intensive-care patients with arteriovenous hemofiltration.

It may be concluded from our results to date, that arteriovenous hemofiltration is an accurate and reliable method for the management of fluid balance in patients resistant to diuretics. Early use of this method may improve the prognosis of intensive-care patients by decongestion or dehydration of lungs, reduction of cardiac pre-and after-load and unrestricted infusion therapy for prevention of catabolism. In addition, the method has been shown to be useful for compensation of uremia and particularly for hypernatremia. The fact that this method requires no investment costs might be of particular interest to many intensive-care units which cannot afford expensive hemodialysis or hemofiltration machines.

Adolescent↗
PubMed1980

Biochemical investigations of CAPD: plasma levels of trace elements and amino acids and impaired glucose tolerance during the course of treatment.

Investigations have been initiated into the effect of CAPD on the plasma concentrations of trace elements and amino acids, and in particular the response of patients to an oral glucose tolerance test (OGTT) during the course of treatment. Six months CAPD had no effect on the plasma concentrations of aluminium, fluoride, zinc and copper. Levels of aluminium and fluoride were above the normal range. Loss of amino acids in the dialysate correlated with their plasma concentrations. No changes were observed in the E/NE, Val/Gly or Tyr/Phe ratios during nine months treatment. Five CAPD patients demonstrated an impaired glucose tolerance in response to an OGTT after one month of treatment and a further deterioration occurred in the glucose tolerance of three patients after another six months CAPD. In a preliminary investigation with fructose substituted for glucose in the dialysate of one patient, an improvement in the OGTT and rate of insulin secretion was observed after 3 days dialysis against fructose.

Adolescent↗
PubMed1979

Capabilities of the Redy cartridge for regeneration of hemofiltrate.

Capabilities of the Redy cartridge for hemofiltrate regeneration were tested. Electrolytes, creatinine, BUN, uric acid, acid-base, glucose, heparin, fluoride and amino acids were measured in the cartridge inflow and outflow (V = 70 ml/min) over a four-hour period. There was complete adsorption of potassium, calcium, magnesium, creatinine, BUN, uric acid, phosphate and heparin. Sodium ions, hydrogen ions, fluoride ions and possibly other trace elements are released by the cartridge. Amino acid absorption is almost complete if the amino acids are aromatic, have two or more N-atoms or if they have S-atoms. When using hemofiltrate after sorbent regeneration for reinfusion to the patient, one has to consider electrolyte substitution (i.e., K, Ca, Mg), sodium balance, trace element metabolism, acid-base problems, amino-acid profiles and ammonia overload.

Adsorption↗
PubMed1979

Intestinal recycling and substitution of haemofiltrate in dogs.

Haemofiltrate was administered into the duodenum of 5 ambulatory dogs through an implanted silastic catheter at a rate of 5-10 ml/min. None of the dogs presented signs of discomfort or suffered from regurgitation or diarrhoea. All 5 dogs had solid stools, enhanced diuresis and no change in body weight over a time period of 8 hours. Filtration rates between 5 and 10 ml/min were obtained in 7 dogs after connecting an Amicon in-line Ultrafilter with an external a.v. shunt. The intestinal recycling rate via the duodenal tube as a rule was 2 ml/min lower than the free flow ultrafiltration. Recirculation of autologous haemofiltrate in 5 uraemic dogs indicated unselective reabsorption of all electrolytes and small molecules. In 5 experiments with intestinal substitution of ultrafiltrate by a potassium-free Ringer's lactate solution, correction of acidosis and decrease in plasma potassium, creatinine and BUN was achieved.

Animals↗
PubMed1978

Clinical experience with continuously monitored fluid balance in automatic hemofiltration.

Automatic fluid balancing, as obtained with the hemofiltration machines from Sartorius (Göttingen, West Germany) and Dialysetechnik (Karlsruhe, West Germany), is accurate enough to replace bed scales, which have been necessary in conventional hemodialysis for patients who are confined to beds. Side effects such as hypotension, nausea and muscle cramps during treatment may be reduced with these new machines, compared to conventional methods, provided that the rate of effective fluid withdrawal does not exceed 0.5 L/hr. In particular, the constant weight loss associated with automatic hemofiltration seems to be well tolerated by the patients with fewer side effects.

Body Weight↗
PubMed1977

[Arteriovenous haemofiltration: a new and simple method for treatment of over-hydrated patients resistant to diuretics].

Fluid withdrawal in over-hydrated patients resistant to diuretics was obtained by means of a capillary haemofilter, using the arterio-venous pressure gradient for blood perfusion at a rate of 100 ml/min. The ultrafiltration rate was 200-600 ml/h and could be maintained as long as 48 h without changing the haemofilter. This method, which needs no technical investment, is easy and simple to handle for the physician, bears only a very low risk for the patient, and ensures a negative fluid balance even at a mean blood pressure of only 60 mm Hg.

Edema↗
PubMed1977

Drug elimination by hemofiltration.

Elimination by hemofiltration of gentamicin, doxycylin, ampicillin, sulfamethoxazole and clofibrate was measured in patients with chronic renal insufficiency. Clearance values of ampicillin and clofibrate were roughly in the range that might be expected according to the reported protein binding values of these drugs, whereas doxycyclin and sulfamethoxazole were eliminated to a much higher degree. Gentamicin clearances during a 6-hour hemofiltration treatment were lower than should be expected from reported protein binding values. For gentamicin and doxycyclin the filtered fraction linearly increased with time, a phenomenon which may be explained by membrane polarization.

Ampicillin↗
PubMedDate not supplied

Transcatheter coil embolization of an aneurysm of the pancreatico-duodenal artery with occluded celiac trunk.

We report on a case of a wide-necked aneurysm of the pancreatico-duodenal artery with occlusion of the celiac trunk in an asymptomatic patient. The aneurysm was considered to be at high risk of rupture. Successful embolization after interdisciplinary consultation was followed with color-coded duplex ultrasound (CCDS) demonstrating significant flow reduction. Three weeks later CCDS and angiography demonstrated exclusion of the aneurysm and a patent arterial supply of the liver and spleen fed by superior mesenteric artery (SMA) collaterals. The patient has done well so far, without major adverse clinical events or evidence for tissue necrosis of the liver, pancreas or spleen. Discussion of the case and review of the literature indicate that transcatheter embolization is the therapy of choice even in complicated cases.

Aged↗
PubMedDate not supplied

Indications, management, and complications of temporary inferior vena cava filters.

PURPOSE: We describe the results of a preliminary prospective study using different recently developed temporary and retrievable inferior vena cava (IVC) filters. METHODS: Fifty temporary IVC filters (Günther, Günther Tulip, Anthéor) were inserted in 47 patients when the required period of protection against pulmonary embolism (PE) was estimated to be less than 2 weeks. The indications were documented deep vein thrombosis (DVT) and temporary contraindications for anticoagulation, a high risk for PE, and PE despite DVT prophylaxis. RESULTS: Filters were removed 1-12 days after placement and nine (18%) had captured thrombi. Complications were one PE during and after removal of a filter, two minor filter migrations, and one IVC thrombosis. CONCLUSION: Temporary filters are effective in trapping clots and protecting against PE, and the complication rate does not exceed that of permanent filters. They are an alternative when protection from PE is required temporarily, and should be considered in patients with a normal life expectancy.

Adult↗
PubMedDate not supplied

Elastic deformation properties of implanted endobronchial wire stents in benign and malignant bronchial disease: A radiographic in vivo evaluation.

PURPOSE: To evaluate the long-term mechanical behavior in vivo of expandable endobronchial wire stents, we imaged three different prostheses in the treatment of tracheobronchial disease. METHODS: Six patients with bronchial stenoses (three benign, three malignant) underwent insertion of metallic stents. Two self-expandable Wallstents, two balloon-expandable tantalum Strecker stents and two self-expandable nitinol Accuflex stents were used. Measurements of deformation properties were performed during voluntary cough by means of fluoroscopy, at 1 month and 7-10 months after implantation. The procedures were videotaped, their images digitized and the narrowing of stent diameters calculated at intervals of 20 msec. RESULTS: After stent implantation all patients improved with respect to ventilatory function. Radial stent narrowing during cough reached 53% (Wallstent), 59% (tantalum Strecker stent), and 52% (nitinol Accuflex stent) of the relaxed post-implantation diameter. Stent compression was more marked in benign compared with malignant stenoses. In the long term permanent deformation occurred with the tantalum Strecker stents; the other stents were unchanged. CONCLUSION: Endobronchial wire stents can be helpful in the treatment of major airway collapse and obstructing bronchial lesions. However, evidence of material fatigue as a possible effect of exposure to recurrent mechanical stress on the flexible mesh tube may limit their long-term use. This seems to be predominantly important in benign bronchial collapse.

Airway Obstruction↗