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Biomedical subjects

S Horsch

Publications and source records attributed to S Horsch.

98 records · Page 6Linked to original sources
PubMedDate not supplied

[Small premature infants do not tolerate axillary temperature measurement any better than rectal measurement. Study of the effect of axillary and rectal temperature measurement on vital parameters and cerebral hemodynamics and oxygenation].

BACKGROUND: Aim of this study was to assess, by use of monitoring parameters and near infrared spectroscopy (NIRS), whether premature infants tolerate axillary temperature measurement better than rectal. METHODS: Twenty-one infants were studied. Birth weight was 540-1680 g (median 840 g), weight at the time of investigation 470-1500 g (Median 920 g), gestational age 24-31 weeks (median 29 weeks), age at time of investigation 4-25 days (median 11 days). Four pairs of axillary/rectal temperatures were taken in every infant. Heart rate and oxygen saturation were monitored. Using NIRS cerebral oxygenated and deoxygenated hemoglobin were measured and total cerebral hemoglobin and the cerebral oxygenation index were calculated. RESULTS: Mean heart rate increased slightly but significantly from baseline during axillary and rectal temperature measurement (axillary: +6/min (+/- 7); p < 0.0001; rectal: +4/min (+/- 6); p < 0.0001). Peak increase in heart rate was significantly higher during axillary than during rectal temperature measurement (axillary: +18/min (+/- 10); rectal: +14/min (+/- 8); axillary versus rectal: p = 0.02). There was no difference in the number of measurements during which oxygen saturation dropped intermittently below 88% (rectal: 21% of measurements; axillary: 20% of measurements). NIRS parameters were not significantly different between axillary and rectal measurements: cerebral oxygenated hemoglobin and the oxygenation index showed a decrease in cerebral oxygenation during both, axillary and rectal measurement. CONCLUSIONS: Axillary temperature measurement is not better tolerated than rectal in premature infants.

Axilla↗
PubMedDate not supplied

[Comparison of effects of endotracheal suction and surfactant administration on hemodynamics and oxygenation of premature infants--a near infrared spectroscopy study].

BACKGROUND: Aim of this study was to assess whether the decrease in heart rate and oxygen saturation occurring acutely after bolus administration of surfactant is different from the effect of endotracheal suctioning and whether there are effects on cerebral haemodynamics and oxygenation. METHODS: Twelve premature infants, birth weight 720-1560 g (Median 935 g), gestational age 25-30 weeks (Median 28 weeks), were investigated during surfactant administration (Curosurf) as a single bolus and a preceding endotracheal suctioning procedure. Using near infrared spectroscopy changes in cerebral blood volume and cerebral oxygenation index were assessed. Heart rate, arterial oxygen saturation, PCO2, and arterial blood pressure were registered continuously. Data were compared at 30, 60 and 120 seconds after the beginning of suctioning and surfactant administration. RESULTS: Endotracheal suctioning and surfactant administration induced a similar decrease in heart rate (-29/min, SD 25, p < 0.01 and -30/min, SD 23, p < 0.001) during the first 30 seconds and in oxygen saturation at the 30 seconds datapoint (-3%, SD 2, p < 0.01 and -3%, SD 6, p < 0.05). The decrease in oxygen saturation persisted at 60 seconds after the start of suctioning (-4%, SD 5, p < 0.05). In contrast, oxygen saturation was no longer different from baseline levels 60 seconds after surfactant administration (+1%, SD 6, p = 0.5). After suctioning, cerebral oxygenation index had decreased significantly from baseline levels at 30, 60, and 120 seconds. In contrast, after surfactant administration, no significant difference from baseline was noted at 30 and 60 seconds and a significant increase occurred at 120 seconds. Mean arterial blood pressure, PCO2, and cerebral blood volume did not change significantly during endotracheal suctioning and during surfactant administration. CONCLUSIONS: Acute decreases in heart rate and oxygen saturation during bolus administration of surfactant are equal to effects occurring during endotracheal suctioning. However, the decrease in oxygen saturation is shorter and more importantly, no decrease in cerebral oxygenation occurs.

Biological Products↗
PubMedDate not supplied

Intraoperative assessment of cerebral ischemia during carotid surgery.

One of the problems in carotid surgery is the intraoperative detection of brain ischemia. None of the methods (EEG; stump pressure) applied so far have been successful. Branston et al. (1974) found a threshold relationship between cortical cerebral blood flow and cortical somatosensory evoked potential (SEP). As the local blood flow fell below about 16 ml/100 g/min a progressive reduction occurred in the amplitude of the cortical evoked potential (N20/P25), implying a fundamental failure of neuronal function in the somatosensory cortex. We have monitored cortical SEP (somatosensory evoked potential) during 734 CEA's (carotid endarterectomies) in order to find an index of risk of incipient cerebral ischemia during carotid cross-clamping, to determine the need for shunting and the causes of early irreversible neurologic deficits. In 59 cases evaluation of SEP was not possible because of technical difficulties. During 586 CEA's no alteration of SEP occurred. However, 4 patients had an immediate postoperative neurologic deficit, while the SEP remained normal. Abnormal SEP occurred in 89 cases and in 6 of these an irreversible loss of SEP was seen. These patients awoke with a new neurologic deficit. We found a reversible abnormal SEP in 83 cases. Reversible changes of SEP occurred mainly during carotid clamping. The diagnostic sensitivity of intraoperative SEP monitoring in predicting neurologic outcome was 60% with a specificity of 100%.

Brain Ischemia↗
PubMedDate not supplied

Is venous patch grafting after carotid endarterectomy able to reduce the rate of restenosis? Prospective randomized pilot study with stratification.

Many studies have already demonstrated that the restenosis rate after carotid endarterectomy is greater as expected since ultrasound examination has become a routine procedure after endarterectomy. The purpose of our randomized study is to compare the rates of restenosis with two methods of carotid endarterectomy--direct suturing and autologous vein grafting. Sofar restenosis are found after endarterectomy and direct suturing. Different possible causes for restenosis are discussed. We hope to inform soon if patching with the autologous vein is the best method in order to prevent early restenosis after CEA.

Aged↗
PubMedDate not supplied

The use of somatosensory evoked responses in carotid surgery for monitoring brain function.

One of the problems in carotid surgery is the intra-operative detection of brain ischemia. None of the methods applied so far have been successful. Experience has shown that the results were unsatisfactory. Experimental studies have detected a strong correlation between regional cerebral blood flow and somatosensory evoked potentials. At the Surgical Clinic of the University of Cologne, 60 patients had continuous intraoperative monitoring of somatosensory evoked responses during carotid endarterectomy. Our previous experiences suggest that monitoring of somatosensory evoked responses during carotid endarterectomy provides a suitable method for the registration of brain function. Furthermore it is possible to pinpoint the causes of ischemia and to immediately begin treatment based on the causes of ischemia.

Aged↗
PubMedDate not supplied

[Carotid stenosis surgery: results after 10 years' experience].

From 1973 to July 1983 220 patients at the University clinic of Cologne, Germany, had carotid endarterectomies for carotid stenosis. A shunt has always been used. The procedure mortality and morbidity were 3,4% and 6,3% respectively. We do not see any indication to operate in acute stroke.

Arterial Occlusive Diseases↗
PubMedDate not supplied

[Venous thrombectomy].

The aim of surgical treatment of acute deep venous thrombosis is to prevent lethal pulmonary emboli, the venous desobstruction and the maintenance of the valvular mechanism. From 1972 to 1982, 161 patients have been operated at the surgical clinic of Cologne. In 41.4% of the cases the long term result was excellent. The clinical examination, the complaints of the patients, the phlebography were judgement criteria.

Catheterization↗