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Biomedical subjects

P Lawin

Publications and source records attributed to P Lawin.

At least 19 recordsLinked to original sources
PubMed1996

[Treatment reduction in intensive care. "Allowing the patient to die" by conscious withdrawal of medical procedures].

The conversion of an "attempt to treat" to "prolongation of dying" represents an important problem in modern intensive care. If the actual or presumed will of the patient is unknown, the physician has to decide about the extent of treatment in a paternalistic manner. In these difficult decisions the physician has to consider prognosis, and certainty of prognosis and has to carefully balance between the right to live and the right to die. This decision about the extent of therapy is a very personal medical activity and can be taken off the physician's shoulders by nobody. Consultation with other physicians involved, relatives, nurses and clergy, however, is mandatory, as a joint decision should be sought. If the situation is hopeless and further medical interventions are futile, then allowing the patient to die by therapy reductions is not only a possibility but a mandatory act of humanity. In that case it does not matter whether new treatment modalities are abandoned or whether already instituted medical measures are withdrawn. In clinical practice, however, the "fine tuning" of therapy reduction has to be tailored to the individual case and largely depends on prognostic certainty.

Child↗
PubMed1995

Repeated administration of recombinant human insulin-like growth factor-I in patients after gastric surgery. Effect on metabolic and hormonal patterns.

OBJECTIVE: The primary objective of this investigation was to evaluate the anticatabolic effects of repeated subcutaneous administration of recombinant human insulin-like growth factor-I (rhlGF-I) in patients after gastric surgery. SUMMARY BACKGROUND DATA: The anabolic and protein-sparing effects of growth hormone are primarily mediated by IGF-I. Malnutrition and catabolic states result in increasing blood levels of growth hormone and decreasing levels of IGF-I. Experimental data showed that exogenous IGF-I could attenuate or reverse catabolism. METHODS: After giving their written informed consent, 38 male and female patients undergoing gastrectomy (age 40-75 years, body mass index 17-30 kg/m2) were treated with 80 micrograms/kg body weight rhlGF-I or placebo in a prospective, randomized, double-blind study for 5 consecutive days. Patients received a standardized total parenteral nutritional regimen with 3 g/kg body weight glucose and 0.1 g/kg body weight nitrogen. Nitrogen balance and 3-methylhistidine excretion were measured daily. Hormone profiles (IGF-I, IGFBP1, IGFBP3, cortisol, insulin, glucagon, triiodothyronine [T3], levothyroxine [T4], and thyroxine-binding globulin) were taken.

Adult↗
PubMed1994

[Glucose-xylitol 35% (1:1) versus glucose 40%. Effectiveness and metabolic effects after major surgery].

Injury and stress are accompanied by a characteristic hormonal response and altered energy utilisation. Hyperglycaemia and negative nitrogen (N) balance are the leading symptoms of the metabolic changes in the post-operative state. In a prospective, randomised study the efficacy and metabolic effects of glucose-xylitol (GX) 35% (1:1) versus glucose (G) 40% were investigated in patients undergoing major surgery. METHOD. Twenty-four patients undergoing abdomino-thoracic oesophageal cancer surgery were treated in a standardised manner. Total parenteral nutrition was administered over 6 days (kg body wt.-1/day): day of surgery 1-1.25 g carbohydrate (CH); 1st postoperative day (POD) 1.5 g CH, 1 g amino acids (AA); 2nd POD 3 g CH, 1.5 g AA, 1.0 g fat; from 3rd POD 3 g CH, 1.5 g AA, 1.5 g fat (CH GX35% (n = 12) or G40% (n = 12), AA Intrafusin 15%, fat Intralipid 20%). Daily and cumulative N balances, blood-G profiles, blood chemistry, and physical parameters were determined. Glucagon and insulin profiles, CH losses, and oxalic acid secretion were measured. RESULTS. Both groups were comparable for age, body mass index, clinical and physical parameters, and blood chemistry. Mean cumulative N balances after 6 days were -12.0 +/- 16.3 g N for GX35% and -5.6 +/- 19.4 g N for G40% (n.s.; Wilcoxon, P < 0.05). Blood G was similar for both groups with values ranging from 130 to 240 mg/dl on the day of surgery and below 150 mg/dl on the consecutive days. In each group 1 patient needed additional insulin therapy. Glucagon and insulin levels did not show a significant difference between the groups. CONCLUSION. No difference in tolerance and efficacy of nutritional support by GX versus G at a dose of 3 g.kg body wt.-1.d in oesophagectomised patients could be observed. Similar blood G profiles were in accordance with comparable glucagon and insulin levels. Because of the high standard deviations of N balances, differences in efficacy could not be proven. A significantly lower level of pseudocholinesterase (PCHE) for G40% on day 7 might indicate enhanced hepatic protein synthesis in the GX group.

Adult↗
PubMed1994

[Safety and tolerance of a new dipeptide-containing amino acid solution DP-Gln 20 versus a conventional amino acid solution Vamin 18EF in patients after elective colon surgery].

OBJECTIVE AND METHODS: Recent studies have demonstrated the important role of glutamine in postoperative metabolism. Using dipeptide-containing amino acid solutions it is possible to enhance glutamine supply. Safety and tolerance of DP-Gln 20 (gly-gln, gly-tyr) and Vamin 18EF were investigated in an open, prospective, randomised study. 16 patients received isonitrogenous parenteral nutrition over 4 days. RESULTS: There was no difference in clinical and biochemical patterns between both groups. Complications and adverse events due to the infused amino acid solutions were not observed.

Adolescent↗
PubMed1993

Mechanical ventilation in the prone position for acute respiratory failure after cardiac surgery.

Ten patients with acute respiratory failure (ARF) after coronary artery bypass grafting were studied during conventional mechanical ventilation in the supine and in the prone position. Impaired gas exchange was defined as an inspired oxygen fraction (FIO2) greater than 0.5 to maintain an arterial oxygen tension (PaO2) > or = 70 mmHg, an alveolar-arterial PaO2 gradient (PA-aO2) > 200 mmHg and a venous admixture (QVA/QT) > 15% during mechanical ventilation with a tidal volume (VT) = 10 to 12 mL/kg, frequency (f) = 10 to 15 VT/min, inspiratory-expiratory (I:E) ratio = 0.5, and positive end-expiratory pressure (PEEP) of 5 to 7.5 cm H2O. In the supine position, systemic and pulmonary hemodynamics were in the normal range, but oxygenation was severely impaired. In all patients thoracic computed tomography scans were obtained and revealed crest-shaped bilateral densities in the dependent lung regions. FIO2 of 0.67 +/- 0.22 was required to maintain a PaO2 greater than 70 mmHg during mechanical ventilation in the supine position. Under these conditions PA-aO2 and QVA/QT were 362 +/- 153 mmHg and 32.5 +/- 8.3%, respectively. CO2 elimination was not severely affected. The patients were turned into the prone position after an average of 30.6 +/- 5.4 hours postoperatively and ventilated with unchanged VT, f, PEEP, and inspiratory-expiratory ratio for 26.7 +/- 11.7 hours (range, 10 to 42 hours). A second cardiopulmonary status was obtained within 2 to 5 hours of ventilation in the prone position.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗