Search PubMed⌕ Search

Biomedical subjects

K H Vestweber

Publications and source records attributed to K H Vestweber.

At least 19 recordsLinked to original sources
PubMed1991

[Laser Doppler in angiology: clinical relevance or expensive game?].

The analysis of 55 articles about the Laser-Doppler in Angiology with a total of 2425 patients and controls shows very promising results concerning the applicability in daily clinical medicine. However, to establish the method as a basic-test in angiology and vascular surgery, standardized procedures and provocation-tests should be developed in future prospective trials.

Arterial Occlusive Diseases↗
PubMed1991

[The role of nutrition in the intensive care unit].

Clinical (artificial) nutrition in patients in a surgical intensive care unit (ICU) is a supportive, and not a therapeutic, measure. However, it is as necessary as medical or surgical treatment, because nutrition can prolong life, so that time is bought during which the clinician can start adequate treatment. Studies on the effectiveness of clinical nutrition are rare and difficult, but there is a huge amount of indirect evidence supporting the following basic concept. The caloric requirement of an ICU patient is clearly higher than that of a normal person. However, it seldom exceeds 2500 kcal (about 35 kcal kg-1 day-1) and can be satisfied with a standardized regimen. Fat and carbohydrates should be given, with fat amounting to 10% at least and 50% at most of total calories. Glucose administration should be limited to about 500 g day-1. As with calories, the demand for amino acids (100-150 g day-1) is increased in ICU patients due to catabolic illness and nitrogen loss, e.g., via drains, wound. The successful creation of different kinds of a stable and safe access to the gastrointestinal tract for enteral nutrition has opened a true alternative to the well-known practice of parenteral delivery of food to a critically ill patient. Today it is possible to nourish nearly all patients enterally via the stomach or small bowel with commercially available fluid diets. This kind of clinical nutrition obviates the need for concern about the optimal substrate composition. Moreover, enteral nutrition appears to be much simpler and more logical than parenteral nutrition. There is evidence suggesting that there are even clinical advantages of enteral nutrition.

Critical Care↗
PubMed1991

[Perioperative use of antibiotics for preventive indications].

The prevention of infections in surgical patients undergoing an operation is a major challenge. One of the several possibilities is the administration of appropriate antibiotics during the perioperative period. For this type of prophylactic use the agent selected should be given before contamination--a single dose is very often sufficient. Common indications for antibiotic prophylaxis are: operations involving a high chance of contamination and those that have hither to be clean but in which the implications of infections would be highly threatening.

Anti-Bacterial Agents↗
PubMed1990

Whole gut irrigation and Prepacol laxative preparation for colonoscopy: a comparison.

Two techniques for preparation of the colon for colonoscopy were compared in a controlled trial. Fifty patients given a low residue diet and the laxative Prepacol were compared with 50 patients given whole gut irrigation. Significantly more patients suffered from vomiting (P = 0.0005), shivering (P = 0.0062) and nausea (P = 0.031) following irrigation; in two cases the procedure had to be abandoned because of profuse vomiting. Irrigation was less well tolerated by the patients (P = 0.00002) than preparation with Prepacol. On the other hand, the quality of bowel preparation was found to be better (P = 0.0005) after irrigation. On two occasions colonoscopy was not possible following Prepacol preparation because of faecal residue. Patients with a previous colorectal resection showed a similar quality of cleansing to those patients prepared with irrigation. We conclude that Prepacol is as efficient as irrigation for patients who have had a previous colorectal resection because the quality of bowel preparation is as good and the associated patient discomfort is small.

Adolescent↗
PubMed1990

[Percutaneous endoscopic tracheostomy].

Between 6/88 and 8/89 61 critically ill patients (sepsis, ARDS, pneumonia, multiple trauma, etc.) underwent elective percutaneous endoscopic tracheostomy (PET). Following dilation up to 36 Fr. a number 6-10 tracheostomy tube was introduced. The patients were ventilated 17 (2-68 days) before and 28 (4-160) days after PET. One patient died from cardiac arrest, and in 4 patients, because of tube obstruction or cuff defect, reintubation was necessary. Additionally 2 significant infections and a minor bleeding and a emphysema occurred. Elective percutaneous tracheostomy performed in the ICU seems to be a simple and cost-effective procedure.

Coma↗
PubMed1990

Endoscopic guided percutaneous tracheostomy: early results of a consecutive trial.

Percutaneous tracheostomy is increasingly being used for patients needing prolonged ventilatory support. The purpose of this study was to assess the feasibility of widespread application of endoscopic guided percutaneous tracheostomy. Sixty-one consecutive ICU patients requiring prolonged mechanical ventilation underwent bedside endoscopic guided percutaneous tracheostomy. Using a modified Ciaglia technique, a #6-10 tracheostomy tube was introduced between the second and third tracheal rings. Bronchoscopic transillumination facilitated identification of the appropriate tracheostomy site, and verified satisfactory placement of dilators and tracheostomy tube. There was one procedure-related death due to arrhythmia. Procedure-related complications included (n = 7): bleeding (controlled with local pressure), two infections, two cuff tears, and two obstructions of the tracheal tube. The tracheostomy was eventually removed in 13 patients. Bronchoscopic evaluation of three patients at 4 months post-tracheostomy removal was normal and there has been no clinical evidence suggestive of tracheal stenosis in the remaining ten extubated patients. There was a 50% reduction in cost when compared to operative tracheostomy. Percutaneous tracheostomy is a simple, safe, cost-effective bedside procedure for critically ill ventilator-dependent patients. Endoscopic guidance appears to increase the safety of this procedure and may prevent complications of pneumothorax, subcutaneous emphysema, and paratracheal false passage previously reported with blinded percutaneous methods.

Adult↗
PubMed1989

Percutaneous endoscopic tracheostomy.

Bedside percutaneous tracheostomies are increasingly performed. This avoids patient transport to the operating room. Complications of this procedure are largely related to the blind nature of the technique. After laboratory studies, 4 patients underwent percutaneous endoscopic guided tracheostomy in a selective clinical trial. There were no procedure-related complications. Endoscopic guidance ensures precise low tracheostomy position, prevents paratracheal tube misplacement, and avoids inadvertent injuries.

Endoscopy↗
PubMed1989

[Quality of life as a justification for high risk therapeutic concepts--pouch or simple reconstruction].

The classic endpoints of mortality and morbidity are no longer sufficient to evaluate new therapeutic concepts. Since significant differences are rarely found between the different patient groups, e.g. pouch vs simple reconstructions in the intestinal tract. Patients undergoing total gastrectomy have a better quality of life after receiving a Hunt-Lawrence-Rodino-pouch than after simple esophagojejunostomy. Similarly ileoanal pouch reconstruction in the pelvis after total colectomy impairs a patient's well-being less than classic enterostomas. Colonic pouch after following very low anterior resections could provide a new approach by substituting for rectum capacity.

Activities of Daily Living↗
PubMed1989

[Indications for construction of stoma pouches].

Despite the advances of reconstructive surgical techniques, there are still indications for enterostoma constructions. Terminal colostomies are constructed after abdominoperineal rectal amputations. The terminal ileostomy is the procedure of choice after total colectomies for Crohn's disease. Loop colostomies are still a possibility for stool diversion procedures and for decompression in acute colonic obstruction. Loop ileostomies reduce load before ileal anastomoses and are increasingly used as diverting stomas in cases of colonic anastomoses. The cecal tube fistula, which does not divert the fecal stream completely, has the special advantage of easy, spontaneous closure.

Colostomy↗
PubMed1989

[Score systems, their importance for the intensive care patient].

Scoring systems are a technique for defining patients for scientific and management purposes. A hypothetical, severely ill patient with cirrhosis, peritonitis, renal insufficiency and coagulation problems can be precisely classified: Child C, Mannheim-Peritonitis-Index 34 and APACHE II score 27 which results in a mortality of at least 70% of patients. At our own hospital, the continuous APACHE score (CAPS) has been developed and tested. The CAPS performed better than daily APACHE scores and provided useful trend information for the individual patient.

Critical Care↗
PubMed1987

Percutaneous endoscopic duodenostomy (PED). Case report.

Surgeons are increasingly using endoscopy to place transabdominal feeding tubes for enteral nutrition or gastric decompression. A possible extension for the application of this new technique is the direct placement of the feeding tube into the duodenal bulb. Two patients are presented in whom percutaneous endoscopic duodenostomy was successfully performed, although percutaneous endoscopic gastrostomy was not possible. It shows that this new method is technically possible. In both patients the positive influence of this technique on the patient's quality of life could be shown using the Spitzer Quality of Life Index and the Karnofsky Performance Status. Enteral nutrition was maintained for more than 6 weeks.

Aged↗