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Biomedical subjects

K Unertl

Publications and source records attributed to K Unertl.

53 records · Page 3Linked to original sources
PubMed1993

[Potentialities and limitations of the score system in intensive medicine].

In intensive-care medicine, score systems serve to quantify the severity of diseases and to characterise patient groups on the basis of objective criteria. The principle is to describe the severity by adding up points. Objectives are to assess the prognosis, to establish the amount of treatment required and assist in clinical decision making. The most important examples of general scores covering more than one disease are Acute Physiology And Chronic Health Evaluation (APACHE-II, APACHE-III), Simplified Acute Physiology Score (SAPS) and Mortality Prediction Model (MPM). General scores assess the deviation of physiological parameters from the normal assuming that the degree of deviation reflects the severity of the disease. The Therapeutic Intervention Scoring System (TISS) constitutes a particular form which evaluates exclusively the amount of therapy required. Disease-specific scores (trauma scores, sepsis scores) take into account the fact that the nature and stage of specific disease determine the outcome in a typical way. Scores are adequately validated and suitable for evaluation of clinical studies or cost-benefit analyses by characterisation of patient populations. The use of score systems for individual prognosis is at present controversial. Their clinical significance might increase in that scores help to make medical decisions by contributing to early identification of endangered patients by systematic establishment and evaluation of investigation results. Scores are likely to be used increasingly in intensive-care medicine.

Critical Care↗
PubMed1989

[Pulmonary complications within the scope of multiple organ failure].

The adult respiratory distress syndrome (ARDS) is the pulmonary manifestation of multiple organ failure. Respiratory distress, alveolar consolidation and hypoxemia refractory to oxygen are the result of uniform and unspecific morphological reactions of the alveolo capillary membrane. The development of ARDS is most commonly associated with risk factors such as sepsis, trauma, shock or pneumonia. A causal therapy for ARDS is not known. Treatment of the underlying disease, maintenance of arterial oxygenation and prevention of secondary complications are the most important therapeutic measures.

Combined Modality Therapy↗
PubMed1989

Lung tissue concentrations of ciprofloxacin following intravenous administration in patients.

Serum and corresponding lung tissue concentrations of ciprofloxacin (Ciprobay) were investigated in 25 patients undergoing open lung surgery for pulmonary malignancies. Drug levels were measured at various times (50-240 min) after completion of a single i.v. dose of 200 mg by bioassay and HPLC. Lung tissue concentrations peaked within one hour after dosing (bioassay: 3.2 micrograms/g, HPLC: 4.5 micrograms/g). Tissue levels exceeded corresponding serum level 3- to 4fold throughout the observation period. The results demonstrate excellent penetration properties of this new antimicrobial compound into lung tissue. Ciprofloxacin was concentrated in the lung and thus by far exceeded known minimum inhibitory concentrations for most nosocomial respiratory pathogens.

Adult↗
PubMed1988

[The equilibrium of nitrogen, potassium and phosphate and renal excretion of creatinine and creatinine over the course of 3 weeks following severe trauma].

In 19 patients after accidental trauma and with intact renal function during an observation time of 21 days we found a cumulated negative balance of nitrogen (N), phosphate (P) and potassium (K) amounting to a mean of 214g, 357 and 447 mmol, respectively. Median daily potassium balance was positive on day 2 to 5 and this was interpreted as an increased extrarenal potassium deposition due to increased levels of circulating catecholamines. Median renal creatinine excretion was about 120% of predicted normal till day 10 and continuously decreased thereafter to values lower than predicted normal. Three patients did not show creatinuria (greater than 200 mg/day) during the whole observation time. In 15 patients after a "free interval" with a mean duration of 7 days creatinuria frequently developed rather quickly and maximal excretion of creatine was as high as 4 g/day. In 7 patients creatinuria persisted to the end of the 21 days observation time. During the phase of creatinuria the median cumulated excretion of creatine amounted to 14.4 g. The "free interval" of creatinuria after severe trauma is remarkable. Most of the N, K and P, which is lost from the body during this time obviously stems from tissues other than sceletal muscle. During the phase of creatinuria, however, the negative balance of N, K and P seems to be mainly due to muscle wasting. Hypophosphatemia was prominent during the first 5 days after trauma and obviously was caused by a decrease in renal phosphate threshold (TmPO4/GFR). The underlying mechanism of this primary change in renal function after severe trauma could not yet be identified.

Adolescent↗
PubMed1988

[Water-electrolyte balance and kidney function for 3 weeks following severe trauma].

A study on water-electrolyte metabolism and renal function was performed in 32 patients (mainly young to middle-aged males) over three weeks after severe accidental trauma (mainly brain trauma), who did not suffer from acute renal failure. With a mean water input of 4 l/day the difference of water input and urine volume was positive over the whole observation time. Patients had a mean osmolar excretion of 1800 mosm/day which was twice normal and was mainly caused by a high urea excretion. They were almost invariably in the state of antidiuresis and achieved unusually high values for negative free-water clearance around 2 ml/min. This, however, was adequate in terms of normotonicity of body water. Cumulated sodium balance over 21 days was negative and, on the average, amounted to minus 440 mmol. The median value for creatinine clearance was in the range of predicted normal (156 ml/min.) between day 5 and 10 and a little less before and thereafter. We frequently observed an elevation of creatinine clearance to 120-150% of normal. Renal clearance of urea was around 100 ml/min. during the phase of maximal protein catabolism. Therefore the reasonable increases in urea production up to a mean of 60 g/day resulted only in moderately elevated levels of plasma urea (40-50 mg/100 ml). In 14 patients we performed a total of 83 measurements of plasma volume (Evans-Blue). In patients with intact renal function mean plasma volume amounted to 110% normal. This, in combination with a reduced red all volume on the average, resulted in mild hypovolaemia (blood volume about 90% of predicted normal).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1987

Prevention of colonization and respiratory infections in long-term ventilated patients by local antimicrobial prophylaxis.

In a randomized clinical trial the prophylactic effects of locally administered antimicrobials on quantitative colonization and respiratory infections were studied in intubated patients with an expected period of mechanical ventilation of greater than 6 days. Nineteen patients received 50 mg of polymyxin B and 80 mg of gentamicin distributed among nose, oropharynx and stomach at 6-h intervals, as well as 300 mg of amphotericin B in the oropharynx. Twenty untreated patients served as controls. In the control group colonization by respiratory pathogens was more common (oropharynx 19 vs 6 patients (p less than 0.001); trachea 19 vs 11 (p less than 0.01)), and the number as well as the count of the colonizing species was usually higher. Fourteen patients of the control group developed respiratory infections, including nine cases of pneumonia, as compared to four patients with prophylaxis, including one case of pneumonia (p less than 0.01). Pneumonia-associated deaths were prevented with prophylaxis; however, the overall mortality remained unchanged. Respiratory infections in the prophylaxis group were associated with organisms resistant to the agents used, but the overall occurrence of resistance was not increased, as compared to the control group. We conclude that unrestrained upper airway colonization by respiratory pathogens and respiratory tract infection were causally related. Local antimicrobial prophylaxis proved to be a highly effective strategy for the prevention of potentially life-threatening pneumonias in critically ill patients, but in the present study the host setting appeared to be the major determinant of outcome.

Administration, Intranasal↗
PubMed1986

[Work of breathing in spontaneous respiration with continuous positive airway pressure].

In postoperative respiratory failure continuous positive airway pressure (CPAP), besides improving pulmonary gas exchange, influences respiratory mechanics. Elastic and flowresistive components of respiratory work were measured in intensive care patients being weaned from the respirator. Measured values during breathing with a continuous-flow CPAP system with elastic reservoir were compared with those for O2 breathing via T-tube. Under CPAP total breathing work and resistance were reduced. Compliance, tidal volume and respiratory frequency did not change significantly. The reduction in respiratory work was primarily due to decreased nonelastic work associated with a decrease in resistance. Thus, on weaning from mechanical ventilation using a reservoir-CPAP system, the respiratory work was reduced in comparison to O2 breathing via T-tube.

Airway Resistance↗
PubMed1986

[Treatment of respiratory tract infections with imipenem/cilastatin in critical patients with respiratory insufficiency].

In an open prospective study the efficacy and tolerance of imipenem/cilastatin was investigated in 24 critically ill patients on mechanical ventilation with nosocomial respiratory tract infection. Nine patients had previously received antibiotic therapy, eight of them with various other beta-lactam antibiotics which had failed. Imipenem was given in a dose of 1-3 g/24 h over 5-37 (mean 11) days. Seven patients were additionally treated with aminoglycosides, one patient with erythromycin. Pseudomonas aeruginosa (n = 14), Staphylococcus aureus (n = 4), Haemophilus influenzae (n = 4) and Escherichia coli (n = 3) were the potential pathogens most frequently isolated from tracheo-bronchial secretions. All of the isolates were susceptible to imipenem. 91% of the infections without and 77% with involvement of P. aeruginosa were successfully treated. Two patients who had not responded to previous treatment succumbed to the consequences of progressive respiratory distress syndrome. All of the gram-positive and 85% of the gram-negative pathogens (Pseudomonas not included) were eliminated in the course of therapy. By contrast, 64% of the isolates of P. aeruginosa persisted; half of these became imipenem-resistant. Nine patients showed adverse reactions including one case of pseudomembranous colitis or laboratory abnormalities which were all reversible. Imipenem/cilastatin proved highly effective and was relatively well tolerated; it is suitable as a single agent for the initial treatment of nosocomial respiratory tract infections in ventilated patients, although only with limitations in cases of infection due to P. aeruginosa.

Adolescent↗
PubMed1986

[Treatment of bronchopulmonary infections in patients during artificial respiration with imipenem/cilastatin].

In an open prospective study the efficacy and tolerance of imipenem/cilastatin was investigated in 24 critically ill patients on mechanical ventilation with nosocomial respiratory tract infection. Nine patients had previously received antibiotic therapy which had failed. Imipenem was given in a dose of 1-3g/24 h over 5-37 (mean 11) days. Seven patients were additionally treated with aminoglycosides, one patient with erythromycin. Pseudomonas aeruginosa, Staphylococcus aureus, Hemophilus influenzae and Escherichia coli were the most frequently isolated pathogens from tracheobronchial secretions. 91% of the infections without and 77% with involvement of Pseudomonas aeruginosa were successfully treated. All of the gram-positive and 85% of the gram-negative pathogens (Pseudomonas not included) were eliminated in the course of therapy. By contrast, 64% of the isolates of Pseudomonas aeruginosa persisted; half of these became imipenem-resistant. Nine patients showed adverse reactions including one case of pseudomembranous colitis which were reversible. Imipenem/cilastatin proved highly effective and was relatively well tolerated; limitations in the efficacy were seen in cases of infection due to Pseudomonas aeruginosa.

Adolescent↗
PubMed1982

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH)--treatment with lithium.

Two patients with SIADH after brain trauma are described. Features of SIADH are "inappropriate" antidiuresis and excessive natriuresis with negative sodium balance resulting in hyponatremia and plasma hypoosmolality which may lead to cerebral dysfunction. Oral lithium carbonate was beneficial in both patients. With plasma levels of lithium around 1 mmol/l a temporary impairment of renal concentrating ability and antinatriuresis with normalization of plasma sodium and plasma osmolality was observed. The SIADH subsided about 4 months after the original trauma, long after gross neurological symptoms had resolved.

Accidents, Traffic↗
PubMed1981

[Pancreas grafts. Nuclear medical perfusion to exclude vascular complications and rejection crises (author's transl)].

Perfusion studies with 99m Tc-DTPA, which has hitherto been used routinely to investigate renal grafts, have also proved useful for monitoring the perfusion of pancreas grafts. A total perfusion failure is equally reliably demonstrable as in renal grafts. Quantitatively smaller perfusion alterations can be demonstrated by monitoring the course. It seems possible to differentiate the salivary edema of a rejection reaction, well known from animal experiments, with the help of other parameters (e. g. creatinine). Further clinical studies are however necessary to confirm these results.

Adult↗
PubMedDate not supplied

Elimination of fecal Enterobacteriaceae by intravenous ciprofloxacin is not inhibited by concomitant sucralfate--a microbiological and pharmacokinetic study in patients.

Intravenously administered ciprofloxacin is partially secreted into the intestinal lumen and thereby eliminates fecal Enterobacteriaceae. Sucralfate inhibits the antimicrobial activity of ciprofloxacin by chelate binding. In a prospective study, we investigated the impact of intravenous ciprofloxacin on the intestinal microflora during oral administration of sucralfate. A total of 45 stool specimens were analyzed in 20 hospitalized patients who were treated with 200 mg of ciprofloxacin i.v. bid. Ten patients concomitantly received 1 g sucralfate p.o. tid (group A). After more than 3 days of i.v. ciprofloxacin, the mean fecal ciprofloxacin concentration was 185.3 +/- 158.7 micrograms/g in patients of group A and 108.7 +/- 76.9 micrograms/g in patients without concurrent sucralfate (group B). There was no significant difference in mean fecal ciprofloxacin levels between both groups (Wilcoxon's test). Enterobacteriaceae were below the threshold of detection (10(2) cfu/g) in all patients of group B after 3 days of treatment whereas small numbers were found in only 2 samples of patients of group A (10(4) cfu/g). Intravenous ciprofloxacin eliminates or largely reduces intestinal Enterobacteriaceae irrespective of concurrent administration of sucralfate.

Administration, Oral↗