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Biomedical subjects

K Rommelsheim

Publications and source records attributed to K Rommelsheim.

At least 37 records · Page 2Linked to original sources
PubMed1985

Combined enteral-parenteral nutrition versus total parenteral nutrition in brain-injured patients. A comparative study.

A comparative nutritional study in brain-injured patients (BIP) was performed to assess the influence of a combined enteral-parenteral nutrition (CN) and a total parenteral nutrition (TPN) on protein catabolism in the early posttraumatic period. 20 male BIP (Glasgow coma scale 5-7) were randomized to one of the two feeding regimes. Nutritional support was based on 150-175% basic energy expenditure. Amino acid intake was 1.4 g/kg/day in the TPN and 2.4 g/kg/day in the CN group. Negative nitrogen balance (NNB) averaged means = 11.3 g/m2/day (SEM = 3.06 g/m2/day) in the TPN group and means = 10.2 g/m2/day (SEM = 2.33 g/m2/day) in the CN group. Between both feeding regimes not statistically significant differences could be observed concerning mortality, N-balance, creatinine and 3-methylhistidine excretions. Protein concentration of the regurgitated gastric fluid was significantly higher in the CN than in the TPN study group. Data imply that both alimentary regimes are of similar value, but BIP with impaired gastric function, such as high tube reflux, are better treated by TPN.

Adolescent↗
PubMed1985

[Pharyngeal flora as a reference spectrum for infection pathogens in intensive care patients].

Differentiation according to species, phage type and enterocinogenotype shows that isolates of enterococci obtained from throat swabs and simultaneously from other localisations can mostly be considered as isotypical. However, it is also possible to demonstrate with other pathogens that there is an isotypicality between the spectra of other pathogens in the throat swab and in other pathological material including blood cultures, the agreement increasing with the severity of the disease. For example, in patients with multiple injuries 61% of the facultatively pathogenic opportunistic germs in the oropharynx correspond with the germs localised elsewhere; in septic patients, this agreement amounts to 96%. This means that especially with most severely ill patients the daily throat swab can yield early hints to the spectrum of pathogens responsible for an infection.

Bacteriophage Typing↗
PubMed1985

[Principles of the prevention of pneumonia by the intratracheal instillation of aminoglycoside antibiotics].

In long-term respiration the descension of the pharyngeal contents into the tracheobronchial system appears as unavoidable as the colonisation of the oropharynx with pathogens. On the other hand, elimination of the descended pathogens from the trachea and the bronchi by setting up an antibiotic barrier represented by the aminoglycoside antibiotics, can prevent colonisation of the lower respiratory passages. As a matter of fact, the aminoglycoside antibiotics exercise, first of all, rapid and bactericidal action, and secondly a spectrum of pathogens. Intratracheal application of 4 X 40 mg tobramycin daily, distributed over 24 hours, leads in the case of persons with healthy kidneys to serum levels between 0.4 and 0.7 micrograms/ml. Side effects are mainly seen in patients with restricted renal function in the form of cumulative serum concentrations. At present there are no alternative possibilities of prophylaxis against the sequels of descension.

Aminoglycosides↗
PubMed1985

[A new double-lumen tracheostomy tube for long-term use].

A new double-lumen tracheostomy tube supplied by Rüsch meets all demands made on long-term application with laterally separated ventilation. In view of the difficulties encountered in the preparation of flexible double-lumen tubes that are variable in length, it appears to be feasible to have a range of tubes at one's disposal the shapes of which are determined by clinical experience.

Adolescent↗
PubMed1984

[Prolongation of ischemic tolerance time of donor livers by alkaline preservation solutions].

Intracellular enzyme activities can be greatly influenced by alterations of pH, and non-physiologic pH may inhibit cell metabolism. The study was undertaken to examine the influence of pH values in preservation solution on ischemic tolerance time of the liver. BDE rat livers were used. Livers were preserved for 20 min or 2 h in warm ischemia after an initial perfusion with Ringer's solution at pH 9.0, 7.4, and 6.0. The values of total adenine nucleotide (TAN) and energy reserve (ER) in the livers were determined at the end of the preservation. After 20 min of warm ischemia, TAN values at pH 9.0 and 7.4 fell to 2.727 +/- 0.255 and 2.410 +/- 0.164 mumol/g, respectively (normal values: 3.414 +/- 0.270 mumol/g) and ER values to 0.786 +/- 0.186 mumol/g at pH 9.0 and to 0.446 +/- 0.095 mumol/g at pH 7.4 (normal values: 2.962 +/- 0.214 mumol/g). A similar trend was also observed after 2 h of warm ischemia. The preservation with a solution at pH 6.0 did not present any difference as compared to that at pH 7.4. Four-hour preservation in cold ischemia with Ringer's solution at pH 9.0 rendered higher values of TAN (2.635 +/- 0.085 mumol/g) and ER (0.336 +/- 0.026 mumol/g) than those in preservation at pH 7.4. No significant difference between TAN and ER values was found when 4-h preservation at pH 7.4 and 6.0 was compared. In another group an intermittent liver perfusion at 1-h interval was performed with chilled Ringer's solution; afterwards GOT, GPT, beta-glucuronidase, and acid phosphatase values in the effluents were evaluated. All of these enzymes showed higher concentration in the effluent with solution at pH 7.4 than that at 9.0. These results suggested that better intracellular energy reserve and organ viability can be maintained by preservation with alkaline solution. Furthermore, ER values seemed to be an excellent indicator of the organ viability during preservation. These were also confirmed by orthotopic hepatic transplantation in pigs. Livers were successfully preserved with alkaline Ringer's solution for up to 12 h. However, without change of pH, livers could not be preserved for more than 4.5 h.

Acid Phosphatase↗
PubMed1983

[Possibilities and limits of temporary liver substitution by hemoperfusion with biological material].

For temporary hepatic assistance we used 200 g porcine liver pieces (5 X 5 X 5 mm3) which were perfused for 6 h with 11 swine blood. ATP and energy reserve values reached their maxima 30 min after starting perfusion, remained unchanged for 120 min, and decreased thereafter. Following 30 min of perfusion energy charge values increased from 0.260 +/- 0.110 mumol/g to 0.560 +/- 0.093 mumol/g (normal value; 0.854 +/- 0.022 mumol/g) and thereafter remained unchanged for 6 h. These results suggest that good energy regulation was maintained in the liver pieces. The small liver cubes showed excellent ammonia and phenol detoxication. However, the liver pieces were not found to be able to conjugate serum bilirubin, which might have been caused by a lack of this anatomic pathway in our model. Levels of hepatic and lytic enzymes in the perfusate increased with the time of perfusion, though they were relatively low as compared to levels in patients with acute hepatic failure. The concentration of free fatty acids in the perfusate, which are known to potentiate hepatic coma, increased slightly. However, methyl mercaptane remained constant during perfusion. Concentrations of nearly all amino acids rose during 6-h perfusion due to damage of hepatic tissues, but the molar ratio of the branched chain amino acid to aromatic amino acid was not changed. These results suggest that liberated substances from the damaged liver would not potentiate hepatic encephalopathy. We feel that hemoperfusion over small liver pieces could be a useful method for hepatic assistance.

Adenine Nucleotides↗
PubMed1983

[Biochemical findings in gestosis patients with pulmonary complications].

Lysosomal proteases from the granula of polymorphonuclear leucocytes play an important part in the development of the shock lung syndrome and its preliminary stages. If there is a local imbalance between the neutral proteinases (e.g. elastase) and its inhibitors, the interstitium consisting of collagenous fibres and glycosaminoglycanes is damaged. In 4 patients with gestosis and pulmonary complications it became evident that the plasma levels of the elastase-alpha 1-proteinase inhibitor complex correlate well with the clinical status and the x-ray findings. Significantly increased values are seen already prepartally; maximum values represent a severe interstitial oedema, and the drop of the values occurs parallel with the improvement of the clinical pattern. The increased consumption of inhibitors is expressed by the absence of the reactive increase of alpha 1-antitrypsin. By determining the elastase-alpha 1-PI complex it becomes possible to recognize the possible risk of development of an interstitial pulmonary oedema well in time, and the success of therapeutic measures is easily ascertained and controlled.

Adult↗
PubMed1983

[Respiratory distress syndrome of the adult in the computer tomograph].

Pulmonary changes due to the adult respiratory distress syndrome, which are visualized in the roentgenogram as spreading from the hilus to the periphery, often show a distribution in dorsocentral direction in the computer tomogram, a phenomenon which occurs especially during the oedema phase under the influence of gravity. In addition, there are ARDS developments involving the expected spread from the root of the lung, particularly so with patients of advanced age and with septic-toxic diseases. The causes and significance of these differences are discussed.

Adult↗
PubMed1983

[Automatic non-invasive blood pressure determination--comparative determinations and experiences with the DINAMAP Vital Data 845 XT Monitor in the intensive care station].

An improved version of a well-established monitor for the noninvasive measurement of blood pressure and heart rate was tested in critically ill patients in an operative intensive care-unit. The device utilizing the oscillometric method and a microprocessor proved to be safe, reliable and sufficiently precise for long-term monitoring. Data were shown clearly on a lighted digital display. Individual factors had much influence on the measurement. Deviations from intraarterial measurement occurred in the same patient almost permanently in one direction, but alterations of blood pressure were read out precisely. Irrespective of the individual influence, mean arterial pressure (MAP) and diastolic blood pressure were indicated too high, and the systolic pressure was recorded to low above 150 mmHg (= 20 kPa) and too high below 100 mmHg (= 13.3 kPa) obtained by the invasive method.

Blood Pressure Determination↗
PubMed1982

Kinetics of high-dose i.v. diazepam.

The pharmacokinetics of high-dose i.v. diazepam were studied in two patients in an intensive care unit. The first patient received up to 240 mg of diazepam daily for 21 days while the second received 60 mg daily for 30 days. Plasma concentrations of diazepam and its major metabolite, desmethyldiazepam, were very large but, despite severe underlying disease and simultaneous administration of several other drugs, the half-lives of diazepam and desmethyldiazepam washout were consistent with those found in healthy persons. Washout half-lives in the first patient were, if anything, shorter than expected, possibly caused by simultaneous administration of phenobarbitone. Thus the kinetics of diazepam are apparently not altered by administration of large doses.

Adult↗
PubMed1982

[Lung function in pregnant patients and its significance for anesthetic ventilation in cesarean section].

Spirometry was conducted preoperatively in a group of 10 women subjected to cesarean section. The measured minute ventilation served as basis for ventilation under anaesthesia. The acid-base and blood gas parameters of the newborns from this group of patients were compared to the corresponding data obtained from babies of 11 women who underwent caesarean section under epidural analgesia. It was found that part of the data were significantly better under general anaesthesia with controlled respiration than under epidural analgesia with spontaneous respiration. The maternal carbon dioxide level assumes the significance of a guiding value for the choice of the ventilation parameters. If the spirometric initial data and the actual pCO2 value under anaesthesia are not known, it is recommended to employ a minute ventilation of 11.5 l/min.

Anesthesia, Epidural↗
PubMed1980

[Dantrolen solution of high active substance concentration. Preliminary communication (author's transl)].

The effectivity of treatment of a dramatically progressing malignant hyperthermia with Dantrolen depends, inter alia, on the easy production and applicability of the preparation. The modification described in this article, of an intravenously injectable Dantrolen solution which contains 10.0 mg active substance in 1.0 ml of a mixture of ethanol, glycerin and water, seems to meet these conditions, as established by experimental investigation.

Animals↗
PubMed1980

[Stress-induced haemorrhages in intensive care patients (author's transl)].

An analysis of the case material of the intensive care unit of the Department of Surgery showed haemorrhages from acute gastro-duodenal lesions in 8% of the cases. Control of the bleeding by therapeutic lavage with suspensions of antacids was the more effective the higher the frequency of application. Prophylactic lavage with antiacids in patients liable to develop gastric bleeding succeeded in reducing the incidence of this complication to 1%. Prophylactic administration of Cimetidine had the same effect.

Antacids↗
PubMed1980

[Changes in the secretion of growth hormone in severely injured persons (author's transl)].

The secretion of growth hormone was studied in 25 severely injured persons during the adaptive and convalescent stage. The ages of the patients varied between 9--65 years. During the first few days after the trauma hormone concentrations rose to up to 7--15 times their normal upper limits (about 10 mU/l). In some cases the hormone levels subsequently fell to the lower limits of normal. No attempt was made to calculate average values and the reasons for the omission are stated. The results are discussed with reference to the metabolic condition of the severely injured persons.

Adolescent↗
PubMed1979

[Indications and value of chest radiography in patients with respiratory insufficiency (author's transl)].

Chest X-rays of patients with respiratory insufficiency provide different information depending on the stage of the disease. The indications for chest radiography should, therefore, be determined by whether the examination is intended to establish the diagnosis and causes of the respiratory disease, to arrive at the differential diagnosis or test the efficacy of treatment.

Adolescent↗