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Biomedical subjects

U Braun

Publications and source records attributed to U Braun.

At least 235 records · Page 13Linked to original sources
PubMed1993

Clinical signs, diagnosis and treatment of duodenal ileus in cattle.

The clinical signs, changes in blood and rumen fluid, findings at laparotomy, therapy and course of disease of 23 cows with obstruction or compression of the duodenum are described. The duodenum was obstructed by a phytobezoar in 14 cows and by a blood clot in one cow. In eight cows, the duodenum was compressed by and adhered to a liver abscess. The most important clinical findings included moderate to severe disturbance in the general behaviour and attitude, markedly reduced gastrointestinal activity, no or greatly reduced defaecation and abomasal reflux with metabolic alkalosis. Ten cows were slaughtered after clinical examination or exploratory laparotomy. In 13 cows, the phytobezoar was compressed manually to facilitate normal elimination, and if this was not possible, the phytobezoar was removed by enterotomy. Postoperative therapy consisted of intravenous administration of a solution containing sodium chloride and glucose, potassium chloride and intramuscular administration of metoclopramide, procaine penicillin and flunixin meglumine for three to five days. Two of the treated cows were slaughtered a few days postoperatively. There was a rapid improvement in the remaining 11 cows, and general condition, appetite and defaecation returned to normal within a short time.

Animals↗
PubMed1993

[Emesis and the oculocardiac reflex. Drug prophylaxis with droperidol and atropine in children undergoing strabismus surgery].

Although droperidol is often used to prevent emesis, vomiting is still common in children undergoing strabismus surgery. METHODS. One hundred children aged 3 to 12 years admitted for strabismus surgery were enrolled in a randomised, double-blind study to investigate the influence of the timing of the administration of droperidol (75 micrograms/kg i.v.) and the effect of atropine (10 micrograms/kg i.v.) on postoperative vomiting and the occurrence of the oculocardiac reflex (OCR). Each child was prospectively assigned to one of the following groups: Group A: atropine and droperidol before the beginning of surgery (n = 25); Group B: atropine before the beginning, droperidol after completion of surgery (n = 25); Group C: no atropine, droperidol before the beginning of surgery (n = 25); Group D: no atropine, droperidol after completion of surgery (n = 25). After oral premedication with 0.4 mg/kg midazolam, anaesthesia was induced via a face mask by inhalation of halothane, nitrous oxide, and oxygen and 1 mg/kg succinylcholine was given to facilitate tracheal intubation. Gastric contents were aspirated by a gastric tube at the end of the operation. Vomiting and retching were recorded for 24 h; recovery from anaesthesia was assessed by a modified Steward score. RESULTS. The four groups were comparable regarding age, sex, body weight, duration of anaesthesia, and number of repaired eye muscles. Patients receiving droperidol before and after the end of surgery had a similar incidence of vomiting (groups A and C 60% vs. groups B and D 50%). There was no significant difference in the number of patients vomiting between groups A and B (58%) and groups C and D (52%). The incidence of the OCR was lower in the patients premedicated with atropine (18% vs. 60%, P < 0.01). There was no statistical relationship between the occurrence of the OCR and post-operative emesis. Younger children (3 to 6 years) vomited more often than older ones (7 to 12 years). The incidence of the OCR was higher in patients with more than two eye muscles repaired than in others. Recovery scores were slightly lower in patients with droperidol after completion of surgery; postoperative recovery times did not differ significantly between the study groups. CONCLUSIONS. The timing of the administration of droperidol (75 micrograms/kg) had no influence on postoperative vomiting. The application of atropine (10 micrograms/kg) prior to surgery did not influence vomiting after strabismus surgery. Atropine (10 micrograms/kg) reduced the incidence of the OCR significantly. There was no statistical relationship between the occurrence of the OCR and postoperative vomiting.

Atropine↗
PubMed1993

[The effect of sedation on oxygen uptake during spontaneous breathing].

Sedation may be used in intensive care and emergency medicine to improve the oxygen demand/delivery ratio. The influence of sedation has most frequently been investigated in a dose-related manner. The aim of the present study was to determine the effect-related influence of different sedatives on oxygen uptake (VO2) in relation to defined resting conditions. METHODS. Forty ASA I patients who had to undergo a minor surgical procedure were investigated 1.5 h before surgery at basal energy-expenditure measurement conditions. One of the following substances was given with a preset bolus rate in a double-blind, randomised order until a defined level of sleep or side effects was encountered: propofol (n = 8), midazolam (n = 8), thiopentone (n = 8), sodium chloride (n = 8), and fentanyl (n = 8). The sleep level was defined as sluggish response to a loud voice or tapping on the forearm. The variables VO2, carbon dioxide elimination (VCO2), end tidal CO2 (p(et)CO2), oxygen saturation (SaO2), heart rate, systemic blood pressure, skin temperature, and skin resistance on the sole of the foot were documented on-line on a computer. All variables were compared using differences of averages from 10-min periods before and after sedation during which the VO2 was minimal. RESULTS. The mean VO2 before sedation was 264 +/- 60 ml/min, and the measured energy expenditure did differ by -0.2% (+/- 14%) from mean predicted values using the Harris-Benedict equation. The VO2 was reduced by 15 +/- 2% with propofol, by 12 +/- 8% with midazolam, and by 10 +/- 5% with thiopentone. This was statistically significant compared to placebo treatment, as was the difference between propofol and thiopentone effects. All patients in these groups reached the defined sleep level, which was not achieved by the placebo and fentanyl groups. Placebo treatment changed the VO2 by 0.1% (+/- 2%). Fentanyl increased the VO2 by 5% (+/- 8%), which did not reach significance. In the fentanyl group the bolus application had to be stopped at a p(et)CO2 of 50 mm Hg in all patients. In the propofol, midazolam, and thiopentone groups the phasic changes of skin resistance were reduced to zero and the skin temperature increased from 27 +/- 2 degrees C to 32 +/- 2 degrees C. The fentanyl group showed an increase in changes of skin resistance without changes in temperature. CONCLUSIONS. Sleep induced by propofol, midazolam, or thiopentone to a clinically maximal desirable level in spontaneously breathing patients reduced VO2 by 10% to 15%. This level of sedation did not induce a relevant change in P(et)CO2 or SaO2. The effect of propofol appeared to be the most pronounced and least variable. This may be attributable to a more pronounced reduction in single-organ VO2 or to an undetected difference in level of sedation. Fentanyl did, in contrast to most publications on opioid effects, seem to increase VO2. Underlying mechanisms may be sought in an increased rate-pressure product and sympathetic activity on the basis of hypercapnia and changes in muscle tension.

Adolescent↗
PubMed1993

The influence of plasma glucose levels on fluorine-18-fluorodeoxyglucose uptake in bronchial carcinomas.

PET studies with 2-18F-fluorodeoxyglucose (FDG) were carried out in 15 patients with bronchial carcinomas, first under fasting conditions and then 2 days later during intravenous infusion of a 20% glucose solution which raised the plasma glucose level from 84.6 +/- 14.7 to 168.3 +/- 23.6 mg/100 ml (n = 15, p < 0.001). Tumor metabolism was quantified by the dose absorption ratio (DAR) of FDG uptake [DAR = tissue concentration/(injected dose/body weight)] and also by the rate of glucose consumption (MR) as measured by the Patlak graphical approach in 12 patients. The DAR decreased from 5.07 +/- 1.89 under fasting conditions to 2.84 +/- 0.97 (-41.8% +/- 15%, n = 15, p < 0.001) during glucose infusion, while the MR remained constant (4.71 +/- 2.38 mg/100 ml/min versus 4.96 +/- 2.46 mg/100 ml/min, n = 12, ns). Correction of the DAR data by plasma glucose level eliminated the significant difference between the fasting and glucose load [4.24 +/- 1.59 versus 4.70 +/- 1.45 (n = 15, ns)], but considerable changes in individual patients remained. These data indicate that the DAR of FDG uptake in bronchial carcinomas is influenced significantly by plasma glucose levels. Dynamic quantification of glucose metabolism using the Patlak approach is less dependent on the plasma glucose level and appears advantageous when high reproducibility is needed.

Blood Glucose↗
PubMed1993

[General anesthesia in two patients with mitochondrial myopathy].

Two patients with mitochondrial myopathy (Kearns-Sayre syndrome) received general anaesthesia. In the first case propofol-alfentanil anaesthesia was carried out; the second patient received propofol-fentanyl anaesthesia. Muscle relaxation was provided with vecuronium. In both cases we observed a short episode of bradycardia (heart rate < 50.min-1), which was successfully treated with atropine. After the propofol infusion had been stopped, both patients rapidly gained consciousness and were extubated after prompt spontaneous ventilation had returned. Reversal of neuromuscular blockade in the second patient was achieved within 5 min by neostigmine. Special anaesthetic problems in patients with mitochondrial myopathies such as myocardial conduction disturbances, postoperative muscle hypotonia, and possible increased susceptibility to malignant hyperthermia can be overcome by the described anaesthetic management.

Adult↗
PubMed1993

[Laterosubmental tracheal intubation. An alternative method to nasal-oral intubation or tracheostomy in single-step treatment of panfacial multiple fractures or osteotomies].

In single-step surgery of panfacial fractures or conversion osteotomies of the visceral cranium, nasal as well as oral intubation or tracheal intubation via tracheostomy is necessary. If complicated tracheostomy is not done, intraoperative nasal-oral repositioning of the tube is required. In order to avoid the risks of repositioning the endotracheal tube or tracheostomy, we suggest a new alternative method called laterosubmental tracheal intubation. After a laterosubmental fistula is created at the base of the mouth, directly behind the anterior mandibular dentition, the tube is guided through the oral floor, lateral to the muscles and the salivary duct, and fixed extraorally. The advantages of this method are: no more intraoperative repositioning of the endotracheal tube and no need for tracheostomy, thus eliminating the risks and side effects, as well as tracheal scarring, and free accessibility of the operative field.

Facial Bones↗
PubMed1992

Ruminal lactic acidosis in sheep and goats.

The clinical findings in 37 sheep and goats with acute ruminal lactic acidosis included a disturbed general condition characterised by anorexia, apathy, teeth grinding and muscle twitching, ruminal stasis, and the excretion of soupy or watery faeces. The ruminal fluid of affected animals was milky, had a sour odour and a low pH. There was a predominance of Gram-positive bacteria in smears of ruminal fluid. In comparison with 10 control animals, the rumen fluid of 23 sheep with ruminal lactic acidosis had higher lactic acid and lower volatile fatty acid concentrations. In addition, the affected animals often had haemoconcentration and metabolic acidosis. Treatment included single or repeated transfer of ruminal fluid from healthy cows and, depending on the severity, the administration of antacids, yeast and chlortetracycline, and the intravenous infusion of isotonic sodium chloride and 5 per cent sodium bicarbonate solutions. Of the 37 treated sheep and goats, four died within 24 hours, and three others were euthanased after one, two and three days because their condition rapidly deteriorated. Thirty animals were discharged one to nine days after treatment. Twenty-nine of them (78.4 per cent) recovered completely but one was euthanased later.

Acetates↗
PubMed1992

Postoperative pulmonary complication rate and long-term changes in respiratory function following esophagectomy with esophagogastrostomy.

Upper abdominal surgery has a high incidence of postoperative respiratory complications. Although operations involving a thoracic as well as an upper abdominal incision as encountered in esophageal surgery are likely to be associated with an even higher complication rate and perhaps permanent alterations of respiratory function, only a few studies have addressed this problem. We evaluated the postoperative course of patients undergoing thoracoabdominal esophagectomy with esophagogastrostomy. Twenty patients were evaluated, of whom 10 (50%) developed respiratory complications as defined by our criteria, which were the simultaneous occurrence of rectal temperature over 38 degrees C on the first postoperative day and radiographic evidence of pulmonary infiltration. Although there is no general consensus regarding the diagnostic criteria of a postoperative pulmonary complication, we were able to validate the clinical relevance of our definition by showing that these patients suffered from a more severe and more prolonged impairment of global oxygen exchange than those who did not fulfill the criteria. They also required a longer period of respiratory support (median duration of intubation 12 vs. 3 days, P less than 0.005). A comparison of the preoperative pulmonary function with that determined at least 6 months after the operation showed that only vital capacity (VC) and total lung capacity (TLC) were significantly (P less than 0.05) reduced following the operation, but not to a clinically relevant degree (VC-6%, TLC-7%).

Adolescent↗
PubMed1992

Comparison of staple and suture techniques for partial typhlectomy in the cow: a prospective clinical study of 40 cases.

Two techniques for partial typhlectomy were evaluated on 20 cows each suffering from dilatation/torsion of the cecum. In a preliminary study on two cows the suitability of a stainless steel staple pattern using two TA 90 cartridges of 4.8 mm and 3.5 mm staples respectively was examined and the technique standardized. In the main clinical study the stapling pattern (group I) was compared with a simple continuous full thickness appositional suture oversewn with a continuous Cushing suture (group II). The cartridges with the 4.8 mm staples were used in 7 clinical cases, with intestinal wall edema and the 3.5 mm staples were used in 13 cases. Arterial bleeding from the cecal stump occurred in 20 out of 22 cases (including the results of the preliminary study). The number of arteries that had to be ligated was statistically significantly higher (p less than 0.05) with the 4.8 mm staples than with the 3.5 mm staples. The additional ligation of bleeding vessels prolonged the surgical procedure. Seventeen out of 20 cows (85%) of each group were discharged from the clinic. The duration of the hospital stay was 6 days for both groups. Fourteen cows (70%) of each group were still alive upon inquiry. One cow of the stapling group was slaughtered because of a severe fibrinous peritonitis at the resection site. In the other 11 cows there was no evidence of a connection between the surgery and the slaughtering.

Animals↗
PubMed1992

Ultrasonography of the urinary tract of female sheep.

We determined the position, dimensions, and structure of the kidneys, ureters, bladder, and urethra of 62 female sheep by use of ultrasonography. A 5.0-MHz convex transducer was placed over the right flank to examine the kidneys, and a 5.0 MHz-linear transducer was used to examine the bladder and urethra transrectally. All examinations were performed on sheep in standing position. The left kidney was 7.1 to 8.9 cm long, 3.4 to 5.5 cm wide, and 3.3 to 4.7 cm deep. Diameter of the parenchyma and renal sinus of the left kidney ranged between 1.1 and 1.9 cm and 1.1 and 2.0 cm, respectively. Circumference of the medullary pyramids varied between 2.1 and 3.3 cm. Similar ultrasonographic measurements were obtained for the right kidney. The diameter of the bladder varied between 0.3 and 6.9 cm in 96.8% of the sheep. The diameter of the bladder could not be determined in 32% of the sheep because it was > 10 cm, and, therefore, was beyond the penetration depth of the scanner. The only part of the urethra that could be ultrasonographically visualized was the internal urethral orifice. It had diameter between 0.1 and 0.2 cm. The ureters could not be ultrasonographically visualized in any of the sheep examined. The urinary tract of 8 sheep was examined 10 times within 2 weeks to examine whether measurements were reproducible. The interassay variation coefficient determined ranged from 3.1 to 31.8%, although for most variables, it ranged between 5 and 11%.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed1992

[The refusal to consent to blood transfusion. Legal and medical aspects using Jehovah's Witnesses as an example].

The limited understanding of a patient, such as a Jehovah's Witness, who has consented to an operation but refuses a blood transfusion for personal or religious reasons, places the physician in a moral dilemma. According to Article 2 II of the German Constitution, the fact that the patient has withheld or expressly refused his consent, i.e., in writing, mandates that the legal right of physical integrity be upheld with final legal effect, even in the case of an emergency. If this right to self-determination is abused, the person giving treatment is guilty of bodily harm in the sense of section 223 of the German Penal Code. Intraoperative haemodilution, the cell-save procedure, and colloidal and crystalloid volume replacement represent alternative methods of blood transfusion for Jehovah's Witnesses.

Blood Transfusion↗
PubMed1992

Percutaneous ultrasound-guided cholecystocentesis in cows.

A method was developed for percutaneous ultrasound-guided cholecystocentesis in cattle. The procedure was performed on the right side in the 9th, 10th, or 11th intercostal space of 30 cows. Of the 30 cows, 20 were slaughtered 24 hours after cholecystocentesis and the remaining 10 cows were slaughtered after a 10-day observation period. Changes in the peritoneum and gallbladder wall, observed at slaughter, were minimal. During the 10-day observation period, general behavior, attitude, and appetite of the 10 cows were normal. A transient, slight increase in rectal temperature was observed in 6 cows at 4, 5, or 8 days after cholecystocentesis. Total and differential WBC counts and total protein and fibrinogen concentrations, determined daily, were all within normal ranges. Bile samples from 20 cows were examined microscopically and biochemically. Fasciola hepatica and Dicrocoelium dendriticum eggs were observed in bile from 7 and 12 cows, respectively. Fecal examination revealed F hepatica eggs in 4 cows; D dendriticum eggs were not identified in any of the fecal samples. In 1 cow, F hepatica eggs were observed in the feces, but not in the bile. Bile acids concentration in bile varied from 12.5 to 68.5 mmol/L (mean +/- SD, 45.3 +/- 3.05 mmol/L) and in serum from 3.8 to 281.0 mumol/L (41.6 +/- 17.24 mumol/L). Negative correlation was obtained between bile acids concentration in bile and that in serum (r = -0.60, P less than 0.01). It was concluded that percutaneous ultrasound-guided cholecystocentesis in cows is a safe procedure and that microscopic and biochemical examinations of obtained bile can be useful diagnostic aids.

Animals↗
PubMed1992

Ultrasonographic examination of the liver in sheep.

The purpose of the study reported here was to get detailed information about the normal size and texture of the liver in sheep by means of ultrasonographic examinations. Structure, location, and shape of the liver, gallbladder, portal vein, and caudal vena cava were examined ultrasonographically in 100 sheep. Furthermore, 10 sheep were scanned 10 times within 2 weeks to determine reproducibility of findings. Examinations were performed on the right side of the abdomen in the seventh through twelfth intercostal spaces. In each intercostal space, the dimensions of the liver, and, if visible, the location and diameter of the caudal vena cava and portal vein were determined. The angle of the liver, and location and size of the gallbladder also were determined. Ultrasonographic measurements of liver size and location in healthy sheep can be used as references for changes in liver size attributable to illness.

Animals↗
PubMed1992

[Validation of the gas exchange monitoring function of the Engström Elvira respirator].

Gas exchange monitoring (GEM) has only recently become available for routine use on ventilated patients. Engström has introduced a new concept of integrated gas exchange monitoring within the Elvira respirator, optionally combined with an external CO2 monitor. The following paper describes a laboratory validation of a prototype of this device with regard to the influence of respiratory variables within their specified ranges: FIO2 0.2-0.6, FIO2-FEO2 (DFO2) 0.02-0.05, FECO2 0.02-0.05, VI 5-20 l/min, p 10-60 mbar, respiratory rate 7-29, VT 500-2,000 ml, inspiratory flow 25-90 l/min, relative humidity 5% and 55%. VO2 and VCO2 (100-700 ml/min) were simulated by gas dilution at a respiratory quotient of 1 using a 'bag-in-the-bottle' test lung for 48 test situations. Two reference measurements per test situation were carried out by mass spectrometry and wet-gas spirometry. The Elvira GEM function uses a self-calibrating fuel cell for FO2 detection, an external infrared CO2 monitor (Eliza) for FECO2 measurement, and differential pressure detection on a venturi principle for inspiratory flow measurement. VI measurement necessitates the use of the Haldane transformation for VO2 and VCO2 calculation. The VO2 (VCO2) repeatability coefficient (2 s) for the reference method was 5.6 (5.5) ml/min compared to 10.3 (10.35) ml/min for the GEM function. The mean relative methodical difference for VO2 (VCO2) was +19% (+4.1%) with limits of agreement (+/- 2 s) of +/- 13% (+/- 8.7%). The systematical difference for VCO2 as well as the variability within different test situations was in an acceptable range for clinical measurement.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation Studies as Topic↗
PubMed1992

[Droperidol versus metoclopramide. Prevention of emesis following strabismus surgery in children].

Vomiting after strabismus surgery is a major problem that remains as yet unsolved, especially in children. Droperidol and metoclopramide, both known as powerful antiemetic drugs, were compared in this study. METHODS. One hundred ASA class I and II children ranging from 3 to 10 years of age were studied in a double-blind, randomised fashion. They were assigned to three groups: group D (n = 33) received 0.075 mg/kg droperidol, group M (n = 33) 0.15 mg/kg metoclopramide, and group N (n = 34) 0.1 ml/kg NaCl i.v. upon arrival in the post-anaesthesia recovery room (PARR). After oral premedication with 0.4 mg/kg midazolam, anaesthesia was induced via a face mask by inhalation of halothane, nitrous oxide, and oxygen. Barbiturates, atropine, and succinylcholine were not used; 0.05 mg/kg vecuronium was given to facilitate intubation. Gastric contents were aspirated by a gastric tube at the end of the operation. Vomiting and retching were recorded for 24 h; recovery from anaesthesia was assessed by a modified Steward score. RESULTS. The three groups were comparable regarding age, body weight, duration of anaesthesia, number of repaired eye muscles, and occurrence of the oculocardiac reflex (OCR). During the first 24 h postoperatively 21/33 (64%) patients of group D vomited, 24/33 (73%) of group M, and 33/34 (97%) of group N. The differences between groups D and N and between M and N were significant (P less than 0.01); comparison of groups D and M showed no statistical significance. Droperidol was more effective in reducing severe vomiting. Of the group N children, 47% vomited more than 6 times in 24 h compared to 18% of group M and 0% of group D. Age, sex, duration of anaesthesia, number of repaired eye muscles, and occurrence of the OCR had no influence on postoperative vomiting. Despite being administered at the end of the operation, droperidol did not prolong the patients' stay in the PARR. The post-anaesthetic scores for group D children were only slightly lower compared to groups M and N. CONCLUSIONS. Droperidol (0.075 mg/kg) and metoclopramide (0.15 mg/kg) both reduce postoperative vomiting after strabismus surgery. Droperidol seems to be more effective in reducing severe vomiting. Postoperative sedation after droperidol was not a major problem in our experience.

Child↗
PubMed1992

Ultrasonographic findings in a cow with ascites due to thrombosis of the caudal vena cava.

This case report describes a three-year-old Swiss Braunvieh cow with ascites due to thrombosis of the caudal vena cava. Ultrasonography verified the ascites and revealed dilatation of the abdominal portion of the caudal vena cava (4.8 cm). It was presumed that the caudal vena cava was occluded by a thrombus or by perivenous compression cranial to the dilatation. Post mortem findings included: a massive accumulation of fluid in the abdominal cavity; a 15 cm long thrombus in the subphrenic region of the caudal vena cava; multiple pulmonary abscesses; severe thrombosis of the pulmonary vasculature; hepatic congestion; oedematous abomasal folds; and severe thrombophlebitis of the left jugular vein and both udder veins, due to poor intravenous injection technique. Ascites caused by thrombosis of the caudal vena cava is rare because collateral routes of venous return, including the udder veins, are usually established. It was therefore concluded that the ascites was attributable to bilateral thrombosis of the udder veins.

Animals↗
PubMed1991

Bleeding abomasal ulcers in dairy cows.

The clinical signs and changes in blood and rumen fluid, and the results of therapy are described in 35 cows suffering from bleeding abomasal ulcer. The most important pathological findings were moderate to severe anaemia with pale mucous membranes and tachycardia, dark coloured to black faeces, a disturbed general condition and anorexia. Two of the cows were slaughtered immediately. The others were treated by the transfusion of several litres of blood and the intravenous administration of a solution containing sodium chloride and glucose and other drugs such as calcium solution, vitamin K, vitamin C and metoclopramide. Two animals died in spite of the treatment and three had to be slaughtered because of the deterioration in their condition. The other 28 cows recovered within a few days and their general condition, appetite and defecation returned to normal.

Abomasum↗