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Biomedical subjects

R Ritz

Publications and source records attributed to R Ritz.

At least 91 records · Page 5Linked to original sources
PubMed1988

[Initial experiences with thrombolysis in Swiss hospitals. Synopsis of a round-table discussion].

Thrombolytic therapy of acute myocardial infarction (AMI) has resulted in significant reduction of mortality, limitation of infarct size and preservation of left ventricular function. Among the panelists there was consensus with respect to the following recommendations for efficient thrombolytic therapy of AMI: the prehospital phase should be considerably shortened, especially by reducing patient delay. This can be achieved by rendering patients aware of symptoms of AMI and the need for immediate hospitalization on their occurrence. After contraindications have been ruled out, intravenous thrombolysis should be started in every case where the time elapsed since the onset of pain is not greater than 3 hours. In patients with large infarctions intravenous thrombolysis is indicated up to 6 hours after onset of pain. Accompanying medication should include heparinization and administration of aspirin. When reperfusion is achieved the patient should be monitored for recurrence of ischemia. Regardless of symptoms recurrence of ischemia requires immediate coronary arteriography with a view to revascularization by PTCA or bypass surgery. Patients without recurrence of spontaneous ischemia should undergo ergometric stress testing before leaving the hospital. Exercise-induced angina or ST segment depression are strong indications for coronary arteriography.

Acute Disease↗
PubMed1988

[MTBE litholysis and extracorporeal shock wave lithotripsy of gallstones].

Two new therapies for cholesterol gallstones, MTBE litholysis and extracorporeal shock-wave lithotripsy, have been developed and clinically tested in the last five years. In principle MTBE litholysis is applicable in 50-80% of gallstone patients and shock-wave lithotripsy in 25-30%. In MTBE litholysis a pigtail catheter is placed in the gallbladder by the percutaneous-transhepatic route using ultrasound-guidance. The gallstones can than be dissolved with the cholesterol contact solvent MTBE (methyl tert-butyl ether). With appropriate selection criteria the successful dissolution rate is 80-90%. Over 99% of radiolucent gallstones (1-3 stones per gallbladder) can be fragmented by extracorporeal shockwaves. Bile acids must be administered as adjuvant litholytic therapy, and thus the remaining fragments can be dissolved in 91% of cases within 2-18 months. In view of the limited experience with these procedures at the present time they are mainly indicated for symptomatic surgical high-risk patients and for those who strongly wish to avoid surgery. With careful evaluation of study data a broader indication policy may be possible in the future. The new methods and the essential study data are presented.

Cholelithiasis↗
PubMed1988

[Pharmacotherapy of cardiogenic shock].

The definition and classification of the various forms of circulatory shock are outlined, together with the causes and management of cardiogenic shock. The pharmacotherapeutic possibilities in patients with shock following myocardial infarction are discussed: over the last 15 years several alpha and beta adrenergic stimulants, as well as alpha-blocking agents, have been included in the treatment of this severe circulatory failure; today the most commonly used drugs in cardiogenic shock are dopamine and dobutamine, sometimes in combination with vasodilators. Dopamine appears to be indicated when low cardiac output, arterial hypotension and oliguria are present; dobutamine, a positive inotropic acting drug, should be used when arterial hypotension is only moderate but combined with elevated filling pressures. Despite the various therapeutic approaches the mortality of cardiogenic shock, which reaches 10-15% of patients with acute myocardial infarction, is still high (70-90%); an improvement may be expected with newer forms of therapy (fibrinolysis, dilatation). Finally, a concept for the management of cardiogenic shock following myocardial infarction is presented.

Adrenergic Agonists↗
PubMed1988

[Model of a prospective follow-up study of patients managed in intensive care].

For ethical and economic reasons, follow-up--especially after intensive care--is important as a form of quality control which could serve as a basis for more differentiated indications for patient admission. A follow-up model, involving questionnaires 3 months, 1 year and 3 years after intensive care, and preliminary results of patients in 1985 are presented. Only a few patients described their present health situation as bad, but unstable situations showed little improvement between 3 months and 1 year after intensive care. There was a rather high percentage of rehospitalization and/or need for continued medical care. Only 10% of respondent patients were unable to work 1 year after intensive care, and 12% still depended on help from others. 15-35% described their quality of life as restricted; only 4% had negative memories of intensive care (fear, pain), and only 0.6% of respondent patients thought their previous admission to the intensive care unit had been a wrong decision.

Adolescent↗
PubMed1988

Reduction in early recurrence of variceal bleeding by propranolol.

Survival after variceal bleeding depends greatly on the outcome of the immediate posthaemorrhagic period. This may in turn depend on the recurrence of bleeding. We therefore prospectively evaluated the influence of propranolol on the recurrence of variceal haemorrhage during the early period after the acute bleeding episode. Twenty consecutive patients with acute variceal haemorrhage and liver disease were randomly assigned to treatment either with propranolol or placebo orally for 14 days. Propranolol significantly decreased the rate of recurrence of variceal haemorrhage during this early period (p = 0.0028; 95% confidence interval in the placebo group, 90 +/- 20%; in the beta blocker group, 20 +/- 26%). Whereas a recurrence of variceal bleeding occurred in 9 of 10 patients in the placebo group, only 2 of 10 rebled during treatment with propranolol. These results suggest that propranolol may prevent rebleeding in the crucial early period after acute haemorrhage from oesophageal varices.

Acute Disease↗
PubMed1988

[Analgesic effect and side-effects of buprenorphine in acute coronary heart disease. A randomized double-blind comparison with morphine].

The analgetic effect and the side effects of buprenorphine (Temgesic) and morphine were compared in a double blind randomised study in 76 patients with suspected acute coronary heart disease. In 68 patients the acute coronary heart disease could be proven, in 61 patients the protocols could be entirely analysed. In 7 of 30 patients on buprenorphine and in 10 of 31 on morphine the analgetic effect was not sufficient (n.s.). The observed side effects were hypotension, bradycardia, nausea, vomiting, vertigo, reduction in respiratory rate and sedation. There were no significant differences in the rate of these side effects in the two groups. The average reduction in respiratory rate was more prominent in the buprenorphine group (-8 vs. -3/min. p less than 0.001) but we found no significant difference in both groups in the number of patient with a respiratory rate less than 12/min. We conclude that buprenorphine is safe for use in the pain therapy of patients with acute coronary heart disease and has a similar analgetic effect and profile of side effects as morphine. It can be used as an alternative to morphine in acute coronary heart disease.

Aged↗
PubMed1987

[Massive and small pulmonary embolisms in intensive care units].

Over one fifth of patients hospitalized for massive pulmonary embolism die within the first few hours. The threatening load on the right ventricle can be reduced by early detection of embolism and immediate start to treatment. 53 patients treated for pulmonary embolism in our intensive care unit from 1982-1984 were divided into groups of 34 patients with massive embolism (occlusion 50% and/or circulatory shock) and 16 patients with small embolism. In 3 additional patients the embolism was detected only at autopsy. Patient's history and first clinical workup, together with special investigations and hemodynamics, allowed differentiation between massive and small embolism. Regarding treatment, patients with pulmonary embolism and circulatory shock were immediately embolectomized surgically. The other patients with massive embolism were treated by early fibrinolysis, with strict attention to any contraindications. These fibrinolyzed patients had fewer complications during the subsequent hospital course. A total of 8 patients with massive embolism and 2 patients with small embolism died during the same hospital stay. Where history and clinical findings prompt suspicion of massive pulmonary embolism a rather aggressive diagnostic procedure is indicated, since rapid reopening of the pulmonary circuit, to reduce the load on the right ventricle, may be life-saving.

Adolescent↗
PubMed1987

[Prognostic factors in bacterial meningitis in adults. Retrospective analysis of 46 patients].

Clinical and laboratory data on 46 patients with acute bacterial meningitis were analyzed in a retrospective survey. The incidence of bacterial meningitis in hospital admissions was 1.3% and the mortality 33%. Streptococcus pneumoniae was the most frequent etiologic agent. Mortality was highest for pneumococcal meningitis and was higher in patients over 50 years of age (83% vs 25%, p less than 0.05). The initial stage of consciousness was prognostically important. All awake patients survived, while the more impaired the consciousness (from lethargy to coma), the higher the mortality (19%, 25%, and 78% respectively). Seizures and paresis of the third cranial nerve were significantly higher in lethal cases. Brain edema was the leading cause of death (60%). The interval between hospital admission and start of antibiotic treatment was crucial for prognosis. Patients who received the first dose of antibiotics within 3 hours after admission had a mortality of 13%, while a delay of 6-24 hours increased the mortality to 3/3.

Acute Disease↗
PubMed1987

Computer-assisted individualized lidocaine dosage: clinical evaluation and comparison with physician performance.

The performance of a computerized dosing aid in achieving a target serum concentration of lidocaine in the middle of the recommended therapeutic range (3.5 mg/L) was evaluated in 63 patients treated for acute ventricular arrhythmias. In all patients a serum concentration measurement was obtained shortly after starting lidocaine infusion. In 22 patients a microcomputer program based on a Bayesian forecasting technique was used for dosing recommendations, whereas in 41 the serum concentration was interpreted and the dose was adjusted by the unaided physician. Both groups were similar with respect to the average concentration achieved (control: 3.8 +/- 1.13 [SD] mg/L, computer-aided: 3.5 +/- 0.59 mg/L). However, the interindividual variability was significantly larger in the control group (95% confidence interval: 1.5 to 6.1 mg/L vs 2.3 to 4.7 mg/L [p less than 0.01]). Nine of the 41 patients in the control group had a lidocaine concentration outside the recommended therapeutic range of 2 to 5 mg/L compared to only 1 of 22 in the computer-aided group. Lidocaine concentrations greater than 2 mg/L were associated with significantly more effective suppression of ventricular arrhythmias (p less than 0.05). The results show that Bayesian forecasting outperforms the physician in early adjustment of lidocaine dosage based on serum concentration measurements.

Aged↗
PubMed1987

The vasodilator potency of atrial natriuretic peptide in man.

The vasodilating potency of alpha-human atrial natriuretic peptide (alpha-hANP) was investigated in the forearms of 16 normotensive subjects, 22 to 48 (mean 28) years old, with the use of venous occlusion plethysmography. alpha-hANP, 0.005 to 1.5 micrograms/min/100 ml forearm volume (FAV), infused in nine dose steps into the brachial artery increased forearm blood flow (FAF; ml/min/100 ml FAV) from 2.8 +/- 0.4 (SEM) to a maximum of 9.6 +/- 1.1. Forearm vascular resistance (mean arterial pressure/FAF) decreased by 72%. The alpha-hANP dose that produced a 50% vasodilator response was 0.093 +/- 0.016 microgram/min/100 ml FAV (n = 11) and it resulted in a venous plasma concentration of ANP (pANP) of 115 +/- 7 pmol/liter (normal 2 to 80; radioreceptor assay). Intraindividually, the maximum dose of alpha-hANP induced an increase in FAF that was 60% of the maximum response to sodium nitroprusside (14.1 +/- 1.8). Combined infusions (n = 9) of maximum forearm vasodilator doses of alpha-hANP and nitroprusside increased FAF to 22.7 +/- 3.4; this additive vasodilator effect of alpha-hANP and nitroprusside is consistent with their different actions on the guanylate cyclase system. In man, the direct vasorelaxant effect of alpha-hANP occurs at concentrations within the upper normal range of pANP, suggesting a physiologic vasodilator role for alpha-hANP.

Adult↗
PubMed1986

[Long-term course over three years in a patient with unstable angina pectoris].

The long-term follow up in 48 patients with unstable angina pectoris was analyzed retrospectively. All patients were hospitalized in a coronary care unit during the acute phase and responded favourably to a medical regimen consisting of nitrates in 45 patients, betablockers in 23, calcium channel blocking agents in 22 and i.v. nitroglycerin in 12. 30 patients (group 1) responded promptly to oral medication with one or a combination of two drugs, whereas in 18 patients a combination of at least three drugs or intravenous nitroglycerin were necessary. After 42 +/- 6 months 21 patients remained asymptomatic, with 8 still on antianginal therapy. In 27 patients (56%) complications had occurred. These complications were severe limiting angina pectoris in 16, of whom 11 were treated surgically after 3.5 +/- 3 months, and myocardial infarction in 11 patients after 16 +/- 9 months, of whom 4 patients died. Complications occurred in 10 of the 30 patients in group 1 and in 16 of the 18 patients in group 2 (33% vs. 89%, p less than 0.01). This study confirms that the long-term course in patients with unstable angina is often complicated by severe angina pectoris or myocardial infarction. The late response to initial therapy and the need for the combination of more than two antianginal drugs or of i.v. medications identifies a subgroup of patients with a high complication rate.

Adrenergic beta-Antagonists↗
PubMed1986

Contamination of a multiple-use suction catheter in a closed-circuit system compared to contamination of a disposable, single-use suction catheter.

UNLABELLED: Multiple-use (M-U) closed-system endotracheal suction catheters are effective in preventing arterial oxygen desaturation in patients on positive end-expiratory pressure (PEEP) and may lessen the frequency of bradycardia and hypotension in unstable patients who are prone to these complications of suctioning. However, because M-U catheters remain attached to the ventilator circuit and are reintroduced repeatedly into the patient's airway over 24 hours or longer, they could become heavily contaminated with pathogens. We hypothesized a risk of autocontamination to the patient by re-inoculation of the respiratory tract with organisms that flourished on the M-U catheter while it was isolated from the patient's immune defenses or antibiotic therapy. METHODS: We tested this hypothesis in 30 mechanically ventilated adult patients with positive sputum cultures. We measured and compared the amount of bacteria present on an M-U catheter at the end of a 24-hour use period, the amount of bacteria present in the patient's sputum at that time, and the amount of bacteria present on a single-use (S-U) catheter at that time, after it had made one pass into the patient's airway. Organisms recovered and colony counts were also compared to results of a sputum culture obtained before the study began. RESULTS: Fourteen different pathogens or potential pathogens were recovered, in numbers of 2 x 10(1) to 2 x 10(7)colony-forming units. The greatest number of colonies was most often recovered from the sputum specimen, and statistical analysis showed no differences in rate or magnitude of contamination between M-U and S-U catheters.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Design and evaluation of a nitrous oxide scavenging system for use in nontraditional hospital settings.

Analgesic use of nitrous oxide (N2O) in nontraditional settings requires safe and effective scavenging systems to rid the work area of hazardous waste gas. Significant health risks to health care workers are associated with repetitive exposure to excessive levels of N2O. Regulations limit the exposure level to 25 parts per million and also require the use of effective scavenging systems. We tested the existing room ventilation and a suction-powered scavenging system in our burn unit's hydrotherapy room and found them to be inadequate in maintaining safe room air levels. We therefore developed a fan-powered scavenging system using a ceiling-mounted hood, under which N2O is administered, and found it to maintain safe levels while requiring little patient cooperation and allowing complete access to the patient.

Burn Units↗