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L S Weilemann

Publications and source records attributed to L S Weilemann.

At least 19 recordsLinked to original sources
PubMed1992

[The value of the x-ray findings in the follow-up of the adult respiratory distress syndrome. A retrospective analysis].

Serial chest x-rays of 23 ARDS patients, taken in an 24 hour interval, were retrospectively analysed. Radiographic patterns of ARDS were divided into five stages and were related to corresponding parameters of respiratory status. Characteristic findings on chest x-ray films occurred after a short latency period following the clinical onset of ARDS. There was a close relationship between the time of maximum radiographic changes and maximum loss of lung function. The progression through successive radiologic stages was in many cases accompanied by a significant deterioration of functional parameters. Distinction between survivors and non-survivors was achieved while considering maximum radiographic abnormalities. The results suggest significance of serial chest x-rays in diagnosis and course estimation of ARDS.

Follow-Up Studies↗
PubMed1992

The control of anti-coagulation in acute dialyses with sensitive laboratory parameters.

In seven patients who had to be dialysed between four and 13 times due to acute renal failure, low molecular weight heparin (LMWH) Fragmin was used for anticoagulation. According to dose-finding studies, 80-90 U kg-1 body weight of LMWH as a single bolus were administered initially, producing dose-related levels of 0.3-1.5 anti-factor Xa U ml-1 in plasma. Apart from the anti-Xa activity in the plasma, the thrombin anti-thrombin III complex (TAT complex) and a fibrin degradation product (D-dimer) were measured as parameters of a coagulation activation. A sufficient anti-coagulation during dialysis was supposed to exist at a normal range (5.0 micrograms l-1 or below) of TAT complex. Pathological TAT concentrations at the end of dialysis indicated the requirement of an increased dose for the next dialysis. These concentrations reflected a need for more heparin if, for example, inflammation, indicated by increasing C-reactive protein levels (CRP), occurred. The increase of TAT complex and D-dimer during dialysis showed a good agreement (p less than 0.001). Due to a single bolus application before dialysis, one measurement of TAT at the end of the dialysis was sufficient. The determination of the TAT complex concentration enabled a heparinization better adapted to the clinical situation of intensive-care patients undergoing acute dialyses, so that the coagulation system was not additionally activated by the extracorporeal circulation.

Acute Kidney Injury↗
PubMed1991

[Heart involvement in mixed connective tissue disease (MCTD)].

The incidence of cardial involvement in mixed connective tissue disease (MCTD) was investigated by two-dimensional echocardiography. Pericardial manifestation was found in two patients. Mitral valve prolapse was detected in 61% of the patients, which may indicate a specific cardial involvement in MCTD. Myocardial changes were rare.

Adult↗
PubMed1991

[Chemical burns caused by hydrofluoric acid. Incidence, frequency and current status of therapy].

Reasons and frequencies of hydrofluoric acid burns have been investigated during our work in the toxicological information centre (1987/88) and by means of the patients treated in the last five years in our ICU: Almost all of the cases are due to accidental hurts (29/30). About 3/4 of the accidents (22/30) happened during occupational exposure. One third of the patients (10/30) have been exposed to hydrofluoric acid fume and 18/30 suffered from percutaneous burns especially of the distal parts of the upper limbs. Oral intoxications are rare (2/30). The observed quotes of the information centre are equivalent to those of our own patients (eight cases from 1984 to 1989). Hydrofluoric acid burns are treated with calcium. Concerning the frequent burns of the limbs, the intraarterial therapy proved good and prevailed during the last years over the classical infiltration therapy. Only early treatment avoids necroses. Unfortunately the particularity of this percutaneous intoxication is often misunderstood.

Anesthetics, Local↗
PubMed1991

Acute dialysis: PMN-elastase as a new parameter for controlling individual anticoagulation with low molecular weight heparin (Fragmin).

Despite the improvements in the development of dialyzer membranes with greater hemocompatibility, an activation of the coagulation system occurs when blood comes into contact with exogenous surfaces. The large number of heparin dosage regimens demonstrated the difficulty to adapt general therapeutic guidelines. Low molecular weight heparin (Fragmin) was administered as a single bolus dose for anticoagulation during 58 acute dialyses. Anti-Xa-activity, the plasma levels of the lysosomal elastase of the polymorphonuclear granulocytes ("PMN-elastase") and of the thrombin-antithrombin III-complex (TAT) were measured at hourly intervals. Therapeutic anti-Xa-levels did not show evidence of sufficient inhibition of thrombin formation. The PMN-elastase increased by 180 ng/ml 3 h after administration of the bolus dose, with no further increase occurring (plateau phase). This was considered to reflect adequate anticoagulative activity. Where anticoagulation was inadequate, the elastase values rose consistently. After 2 h the increase of the PMN-elastase showed that--and to what extent--coagulation had been activated. The determination of PMN-elastase, using the IMAC-principle, is a method which can be performed quickly with any conventional autoanalyzer. It makes it possible to monitor adequate anticoagulation, but PMN-elastase results must be proven during routine use before recommendation as a routine test.

Acute Kidney Injury↗
PubMed1991

[Diagnosis of pleural effusions and atelectases: sonography and radiology compared].

In a prospective study it was shown that chest ultrasonography is superior to conventional x-ray diagnosis of recumbent patients in diagnosing pleural effusion and lung atelectasis. In 110 supine radiographs we found a sensitivity of 47% and a specificity of 71% for right pleural effusions and a sensitivity of 55% and a specificity of 93% for left pleural effusions in comparison to 110 sonographic examinations. The results of supine radiographs in detection of atelectasis were less efficient: sensitivity for the right side: 7%; sensitivity for the left side: 13.5%. Hence, the knowledge of chest ultrasonographic diagnosis can improve the interpretation of supine radiographs.

Critical Care↗
PubMed1991

[Food poisoning].

Explore the source record for details and available documents.

Emergencies↗
PubMed1990

[Acute emphysematous cholecystitis as a cause of pneumoperitoneum].

A 48-year-old man developed progressively more severe epigastric pain, pain on pressure in the right upper abdomen and fever up to 38.6 degrees C so that acute cholecystitis was suspected. Ultrasound did not demonstrate a gall-bladder but a sickle shaped, dense echo with a distal adjoining echo-free zone. Computed tomography revealed air in the gall-bladder lumen as well as intramural and pericholecystic air pockets, findings pathognomonic for emphysematous cholecystitis. In addition pneumoperitoneum was diagnosed. Subsequent cholecystectomy intraoperatively revealed a gangrenous, nonperforating gall-bladder in which E. coli was demonstrated. During the first postoperative week, there were no complications under transitory antibiotic treatment with tobramycin and ticarcillin with clavulanic acid. Then, an abscess developed in the residual gall bladder bed; this abscess was cured after drainage, local irrigation and re-initiation of antibiotic treatment. The patient was finally discharged well.

Abscess↗
PubMed1990

Comparative clinical trial of ceftazidime and imipenem/cilastatin in patients with severe nosocomial pneumonias and septicaemias.

The efficacy and safety of ceftazidime and imipenem in patients with severe infections was compared in a randomized multi-centre trial. Patients on assisted respiration with clinical signs of pneumonia or septicaemia who had been in hospital for at least 3 days were studied. Twenty-one patients were treated with ceftazidime, 24 with imipenem. The mean duration of treatment was 9 days in both groups. At the end of the trial 17 patients (81%) of the ceftazidime group and 16 patients (67%) in the imipenem group were clinically cured or showed marked improvement. The bacteriological results showed an eradication of the causative pathogens in 17 of 21 cases in the ceftazidime group and 13 of 19 in the imipenem group.

Ceftazidime↗
PubMed1990

Hemodynamics during PEEP ventilation in patients with severe left ventricular failure studied by transesophageal echocardiography.

The effects of mechanical ventilation with PEEP were investigated in five patients with normal cardiopulmonary function (group A) and in 11 patients with severe left ventricular failure (group B). Cross-sectional area of the right and left atrium (RA/LA), left ventricle (LV), and right ventricle (RV) was determined at EDA/ESA using transesophageal echocardiography. Hemodynamic parameters and transesophageal pressure were measured simultaneously at PEEP levels 0, 4, 8, 12, and 16 cm H2O. End-diastolic area of the right atrium decreased significantly in both groups. The RA pressure increased, while transmural pressure remained unaltered. The CI decreased in both groups. The decrease in cardiac output by PEEP ventilation was related to the decrease in RV filling volume by external compression. In patients with congestive heart failure, PEEP ventilation with 8 to 10 cm H2O did not worsen LV function.

Adult↗
PubMed1989

Inactivation of end-plate acetylcholinesterase during the course of organophosphate intoxications.

Blood organophosphate (OP) levels, serum butyrylcholinesterase (BChE) activity and electrophysiological neuromuscular transmission following repetitive nerve stimulation at 10 Hz and 50 Hz were studied serially in five patients with severe acute organophosphate intoxication following suicide attempts. Eight to 45 hours after oral ingestion, blood OP levels were elevated, BChE activity was markedly reduced, while repetitive nerve stimulation studies showed no or only mild abnormalities. The latter attained the maximal abnormality 32-69 h after ingestion, when BChE was inactivated further but elevated OP levels had fallen. Recovery from these abnormalities at 10 Hz nerve stimulation occurred within 100-237 h after the intoxication and it was still incomplete at 50 Hz stimulation 48-80 h later. BChE activity varied within a wide range and showed even normal values at both times. Neuromuscular transmission studies proved to be the most useful indicator for determining the severity and time course of organophosphate intoxication.

Acetylcholinesterase↗
PubMed1989

[Catabolism and artificial nutrition of the internal medicine intensive care patient].

Numerous investigations have been performed on catabolism in polytrauma and surgery. Comparable studies on the internal medical intensive-care patient are not available. Such patients have an increasing metabolism with a maximum attained on day 5, and the catabolic condition is associated with an increased muscle protein breakdown. Objective measurements of catabolism and nutritional status are important but difficult. The recovery of a patient after acute illness depends on the provision of sufficient and adequate nutrition in three steps: 1. quantity and quality of calories; 2. quantity and quality of protein; 3. vitamins and electrolytes. Glucose is one source of calories as are fructose, xylit, and fat. Quantity and quality of amino acids are relative to organ failure and disturbance of amino acid metabolism. Branched-chain amino acids may be helpful in hepatic failure and severe sepsis.

Critical Care↗
PubMed1989

End-plate dysfunction in acute organophosphate intoxication.

Acute organophosphate intoxication resulting from suicide attempts in 14 patients produced a series of electrophysiologic abnormalities that correlated with the clinical course. Spontaneous repetitive firing of single evoked compound muscle action potentials (CMAP) was the earliest and most sensitive indicator of the acetylcholinesterase inhibition. A decrement of evoked CMAP following repetitive nerve stimulation was the most severe abnormality. At the height of the intoxication no CMAP was evoked after the first few stimuli. The decrement-increment phenomenon occurred only at milder stages of intoxication and its features are characteristic of acetylcholinesterase inhibition. These electrophysiologic features proved to be the most useful for determining initial severity and clinical course of the acute organophosphate intoxication and differentiated this syndrome from those of myasthenia gravis, Eaton-Lambert syndrome, and botulism.

Adult↗
PubMed1988

[Ultrasound scanning of thickening of the gallbladder wall and its diagnostic significance in critical care patients].

In a prospective study including 398 intensive-care patients, we analysed the ultrasonographic relevance of a gallbladder wall thickening. In 24 of 398 (6%) cases a wall thickening was found that could be differentiated into two types of walls. In 20.8% (5/24) the gallbladder wall thickening was an expression of an acute cholecystitis. In further differential diagnosis of a gallbladder wall thickening pathological states with hypoalbuminaemia occupy the prime position. The pathological mechanism has not yet been completely clarified. Hypoalbuminaemia without inflammatory alterations of the organ was found in 37.5% of the cases with gallbladder wall thickening. In 41.6% of the patients the wall thickening had to be taken as a non-specific ultrasonographic sign. On the whole, therefore, gallbladder wall thickening has thus to be valued primarily as non-specific sign. In a few cases only, it implies an autonomous affection of the gallbladder.

Adult↗