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  • 1
    Electronic Resource
    Electronic Resource
    Course and prognosis of 86 episodes of diabetic coma (1975)
    Springer
    Diabetologia 11 (1975), S. 93-100 
    Details
    ISSN: 1432-0428
    Keywords: Diabetic coma ; ketoacidosis ; non-ketotic hyperosmolar coma ; acidosis ; mortality ; blood urea
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The admission data and the course of 58 episodes of severe diabetic ketoacidotic coma and of 28 episodes of non-ketotic coma are compared. The non-ketotic patients were older; initial blood glucose, osmolarity, blood urea and serum sodium concentration were higher than in the ketotic patients. Treatment in the first 24 hrs consisted of similar amounts of insulin in both coma forms, the presence of acidaemia did not increase the insulin needs. Acidaemia was corrected only when pH was below 7.20. The disadvantages of alkali therapy are emphasized. A comparison of the age groups of survivors and those patients who died within 72 hrs showed an increase in mortality with age. However, the mortality rates from ketotic and non-ketotic coma were similar in the age groups above 50 years. On admission, blood glucose, osmolarity and blood urea were higher in the fatal cases. Blood urea was the most important indicator of a fatal outcome. The response of blood glucose to insulin was impaired in the subsequently fatal cases. Insulin was given in “moderate” doses by constant infusion. The use of “small” doses is discussed. Early mortality was 14% in the ketotic and 29% in the non-ketotic cases. The most frequent causes of death were circulatory failure of undetermined origin, infections and thromboembolic complications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00429830
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  • 2
    Electronic Resource
    Electronic Resource
    Treatment of fulminant hepatic failure with infusions of Co-factors and mannitol and charcoal-hemoperfusions during fourty-one days (1979)
    Springer
    Journal of molecular medicine 57 (1979), S. 949-956 
    Details
    ISSN: 1432-1440
    Keywords: Fulminante Lebernekrose ; Hirnödem ; Mannitol ; Kohlehämoperfusion ; Leberzellregeneration ; Fulminant liver necrosis ; Brain edema ; Mannitol ; Charcoal hemoperfusion ; Liver cell regeneration
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The clinical course of a 26 year old female patient with acute liver necrosis and coma due to hepatitis B is reported. The disturbances of conciousness had improved. The patient survived 41 days after the beginning of the coma and developped livercell regeneration and an acute post-hepatitic liver cirrhosis. As a grave complication a septicemia with aspergillus was observed. The patient died because of gastro-intestinal hemorrhage. At autopsy there were no signs of brain edema. The treatment consisted in: daily infusions with coenzyme A, nicotinamid-adenin-dinucleotide, alpha lipoic acid and cocarboxylase to improve the metabolic disorders and the clinical picture; mannitol intravenously to prevent and to treat cerebral edema; 33 charcoal-hemoperfusions to remove toxic substances of acute liver failure. Treatment of the aspergillus infection with 5-fluorocytosine and amphotericine B and infusion of concentrated ascites led to a decompensation of liver functions. From this observation the following conclusions can be drawn: after an acute viral hepatic necrosis, new synthetic functions and improvements of the disturbed intermediary metabolism in regenerated liver-cells can eventually be seen only after twenty-four to thirty days. With systematically applicated mannitol infusions it is possible to treat cerebral edema effectively.
    Notes: Zusammenfassung Es wird der Verlauf einer durch Hepatitis B bedingten, akuten Lebernekrose mit Coma bei einer 26jährigen Patientin beschrieben. Die Bewußtseinsstörung besserte sich. Die Patientin überlebte 41 Tage und entwickelte Leberzellregenerate und eine akute posthepatitische Leberzirrhose. Im Verlauf trat als schwere Komplikation eine Pilzsepsis auf. Die Patientin starb an einer Magendarmblutung. Bei der Autopsie fand sich kein Hirnödem. Die Behandlung beständ in täglichen Infusionen von Coenzym A, Nikotinamid-adenin-dinukleotid, alpha-Liponsäure und Cocarboxylase zur Besserung von metabolischen Störungen und klinischem Bild; Mannitol intravenös, zur Verhinderung und Behandlung des Hirnödems; 33 Kohlehämoperfusionen, zur Entfernung toxischer Substanzen. Behandlung der Aspergillus-Infektion mit 5-Fluorocytosin und Amphotericin B und Infusion des konzentrierten Ascites führten zu einer Dekompensation der Leberfunktionen. Aus dieser Beobachtung können folgende Schlüsse gezogen werden: Nach einer akuten viralen Lebernekrose kann es erst nach 24–30 Tagen zur Wiederaufnahme synthetischer Funktionen und zur Besserung des gestörten Intermediärstoffwechsels in regenerierten Leberzellen kommen. Mit systematischer Mannitol-Therapie ist es möglich, das Hirnödem wirksam zu bekämpfen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01478552
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  • 3
    Electronic Resource
    Electronic Resource
    Assessment of depth of midazolam sedation using objective parameters (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1385-1390 
    Details
    ISSN: 1432-1238
    Keywords: Key words Midazolam ; Sedation ; Weaning ; Heart rate variability ; Prediction model
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To determine the relationship between the clinically evaluated depth of midazolam-induced sedation and the cardiac beat-to-beat variability (RR variability) in ICU patients in the intensive care unit (ICU). Design: Prospective study. Setting: ICU of a university hospital. Patients: 20 consecutive patients studied during weaning from mechanical ventilation and withdrawal of midazolam-induced sedation. Measurements and results: After clinical evaluation of depth of sedation according to the Ramsay sedation score, the RR variability over 512 RR intervals and predominant respiratory rate were measured. The power spectrum of RR variability was calculated by a fast Fourier transformation and the resulting total frequency band (0.016–0.35 Hz) was subdivided into a very low, a low, and a high frequency band. Stepwise multiple regression analysis in the first 10 patients (group 1) showed a significant relationship between depth of sedation and measures of RR variability combined with respiratory rate (r 2=0.59; F=12.1; p〈0.001).The more effective sedation was, the more depressed were both RR variability and predominant respiratory rate. Mean heart rate, mean respiratory rate, median deviation of RR intervals from the mean, and the ratio between spectral power density in the high and the low frequency bands proved to be the most important predictors of the Ramsay score (±1 level accuracy: 87%, p〈0.001). Using this regression equation, the Ramsay score was predicted in the remaining 10 patients (group 2) with a ±1 level of accuracy of 81% (p〈0.001). Conclusion: In ICU patients, a significant correlation is found between the depth of midazolam-induced sedation as assessed by the Ramsay sedation score and RR variability, with a clinically sufficient prediction accuracy. RR variability can serve as an objective, continuously available, and non-invasive measurement to monitor midazolam-induced sedation in intubated and mechanically ventilated patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709555
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  • 4
    Electronic Resource
    Electronic Resource
    Assessment of depth of midazolam sedation using objective parameters (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1385-1390 
    Details
    ISSN: 1432-1238
    Keywords: Midazolam ; Sedation ; Weaning ; Heart rate variability ; Prediction model
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To determine the relationship between the clinically evaluated depth of midazolaminduced sedation and the cardiac beat-to-beat variability (RR variability) in ICU patients in the intensive care unit (ICU). Design Prospective study. Setting ICU of a university hospital. Patients 20 consecutive patients studied during weaning from mechanical ventilation and withdrawal of midazolam-induced sedation. Measurements and results After clinical evaluation of depth of sedation according to the Ramsay sedation score, the RR variability over 512 RR intervals and predominant respiratory rate were measured. The power spectrum of RR variability was calculated by a fast Fourier transformation and the resulting total frequency band (0.016–0.35 Hz) was subdivided into a very low, a low, and a high frequency band. Stepwise multiple regression analysis in the first 10 patients (group 1) showed a significant relationship between depth of sedation and measures of RR variability combined with respiratory rate (r 2=0.59;F=12.1;p〈0.001). The more effective sedation was, the more depressed were both RR variability and predominant respiratory rate. Mean heart rate, mean respiratory rate, median deviation of RR intervals from the mean, and the ratio between spectral power density in the high and the low frequency bands proved to be the most important predictors of the Ramsay score (±1 level accuracy: 87%,p〈0.001). Using this regression equation, the Ramsay score was predicted in the remaining 10 patients (group 2) with a ±1 level of accuracy of 81% (p〈0.001). Conclusion In ICU patients, a significant correlation is found between the depth of midazolam-induced sedation as assessed by the Ramsay sedation score and RR variability, with a clinically sufficient prediction accuracy. RR variability can serve as an objective, continuously available, and non-invasive measurement to monitor midazolam-induced sedation in intubated and mechanically ventilated patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709555
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  • 5
    Electronic Resource
    Electronic Resource
    Gunther Wolff, M.D. (1996)
    Springer
    Intensive care medicine 22 (1996), S. 721-721 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709510
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  • 6
    Electronic Resource
    Electronic Resource
    Additional inspiratory work of breathing imposed by tracheostomy tubes and non-ideal ventilator properties in critically ill patients (1999)
    Springer
    Intensive care medicine 25 (1999), S. 514-519 
    Details
    ISSN: 1432-1238
    Keywords: Key words Work of breathing ; Tracheostomy tube ; Ventilator weaning ; ATC ; Upper airway resistance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To determine the tracheostomy tube-related additional work of breathing (WOBadd) in critically ill patients and to show its reduction by different ventilatory modes. Design: Prospective, clinical study. Setting: Medical ICU of a university teaching hospital. Intervention: Standard tracheostomy due to prolonged respiratory failure. Measurements and results: Ten tracheostomized, spontaneously breathing patients were investigated. As the tube resistance depends on gas flow, patients were subdivided according to minute ventilation into a low ventilation group ( = 10 l/min; n = 5) and a high ventilation group ( 〉 10 l/min; n = 5). The WOBadd due to tube resistance and non-ideal ventilator properties was calculated on the basis of the tracheal pressure measured. Ventilatory modes investigated were: continuous positive airway pressure (CPAP), inspiratory pressure support (IPS) of 5, 10, and 15 cm H2O above PEEP, and automatic tube compensation (ATC). In the low ventilation group, WOBadd during CPAP was 0.382 ± 0.106 J/l. It was reduced to below 15 % of that value by ATC or IPS more than 5 cm H2O. In the high ventilation group WOBadd during CPAP increased to 0.908 ± 0.142 J/l. In this group, however, only ATC was able to reduce WOBadd below 15 % of the value observed in the CPAP mode. Conclusions: The results indicate that, depending on respiratory flow rate, (1) tracheostomy tubes can cause a considerable amount of WOBadd, and (2) ATC, in contrast to IPS, is a suitable mode to compensate for WOBadd at any ventilatory effort of the patient.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050890
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  • 7
    Electronic Resource
    Electronic Resource
    Influence of carbon monoxide (CO) on the early course of acute myocardial infarction (1995)
    Springer
    Intensive care medicine 21 (1995), S. 716-722 
    Details
    ISSN: 1432-1238
    Keywords: Carboxyhemoglobin ; Acute myocardial infarction ; Complications ; Ventricular arrhythmias
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To clarify the influence of an elevated carboxyhemoglobin (COHb) blood level on the course of acute myocardial infarction and to evaluate the administration of supplemental oxygen on the COHb level and the incidence of complications. Design Prospective clinical study with randomized, unblinded intervention. Setting Coronary Care Unit of a university hospital. Patients 78 consecutive patients with acute myocardial infarction. Excluded were patients with severe dyspnea, pulmonary edema or any other medical indication for supplemental oxygen therapy. Interventions Randomized therapy with 4l/min oxygen in 35 patients.Measurements and results: COHb was measured at admission and 4 h later. The incidence of serious arrhythmias and the maximal creatine kinase (CK) values were recorded. In patients with initial COHb≧5%, there were significantly more arrhythmias and significantly higher maximal CK values than in those with normal COHb at admission (89 vs 33%,p〈0.001; and 1897±1602 u/l vs 960±1097 u/l,p=0.05). This effect was seen only in patients with Q-wave infarction, not in those with non-Q-wave infarction. Supplemental oxygen had no effect on the incidence of arrhythmias. Conclusions We conclude that myocardial infarction patients with acute Q-wave infarction and increased COHb levels at admission suffer a more severe course of the disease. This outcome was not influenced by oxygen therapy. Whether this finding indicates a causal relationship and whether higher oxygen concentrations would favorably alter the course of acute myocardial infarction remain to be determined.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01704738
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  • 8
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    Unknown
    R. W. BEVIS: "English Drama: Restoration and Eighteenth Century, 1660-1789" (Book Review) (1990)
    Paris : Periodicals Archive Online (PAO)
    Etudes anglaises. 43:1 (1990:janv./mars) 120 
    Details
    ISSN: 0014-195X
    Topics: English, American Studies
    Notes: COMPTES RENDUS
    URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pao:&rft_dat=xri:pao:article:0132-1990-043-01-000013
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  • 9
    Electronic Resource
    Electronic Resource
    Die ,,Lidocain-Story`` (1997)
    Springer
    Intensivmedizin und Notfallmedizin 34 (1997), S. 329-332 
    Details
    ISSN: 1435-1420
    Keywords: Key words Lidocaine-prophylaxis ; individualized lidocaine dosage ; warning arrhythmias ; computerized arrhythmia monitoring ; life threatening arrhythmias ; Schlüsselwörter Lidocain-Prophylaxe ; individualisierte Lidocain-Dosierung ; warnende Arrhythmien ; computerisierte Arrhythmie-Überwachung ; lebensbedrohliche Rhythmusstörungen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Im Rahmen der Qualitätssicherung müssen auch in der Intensivmedizin sogenannte bewährte Behandlungskonzepte überprüft werden. Anhand der retrospektiven Betrachtung der ,,Lidocain-Story`` wird dies hier beispielhaft vorgenommen: Lidocain wurde in den 70er und 80er Jahren weltweit bei Patienten mit akuter koronarer Herzkrankheit (KHK) nach Auftreten sogenannter ,,warning arrhythmias`` (Vorläufer lebensbedrohlicher Rhythmusstörungen) prophylaktisch verabreicht; der Erfolg war umstritten. Später wurden die Konzentrationsmessungen von Lidocain im Plasma und Vorausberechnungen zur exakteren individuellen Dosierung eingeführt. Dennoch blieb der Wert einer solchen Lidocain-Prophylaxe umstritten, insbesondere seit lebensbedrohliche Rhythmusstörungen bei Patienten mit akuter KHK seltener beobachtet werden, möglicherweise als Folge neuer Reperfusions-Therapien. In einer kontrollierten Studie wollten wir 1. die Folge der Bedeutung von ,,warning arrhythmias'' und 2. den Wert einer Lidocain-Prophylaxe weiter klären, um möglicherweise künftig auf das gesamte Prophylaxe-Konzept, einschließlich der aufwendigen differenzierten Rhythmus-Erkennung, verzichten zu können.
    Notes: Summary Longstanding diagnostic and therapeutic management concepts in critical care medicine have to be reevaluated in the context of quality control. The following presentation of the ``Lidocaine-Story'' could serve as an example: in the seventies and eighties Lidocaine was prophylactically administered to patients with acute coronary heart disease (CHD), when so-called ``warning arrhythmias'' (precursors of life threatening rhythm disturbances) appeared; the value of such a prophylaxis remained uncertain although in worldwide use. Later, the measurement of the lidocaine concentration in plasma and the forecasting of individualized dosage became available. However, the significance of this form of managing ventricular arrhythmias was difficult to prove, especially, because of the decrease in the frequency of life threatening arrhythmias during the years of up-coming reperfusion therapies. In a controlled study we intended to further clarify: 1) the question of the significance of ``warning arrhythmias'' and 2) the value of the concept of lidocaine prophylaxis in the future, including the expending form of differentiated arrhythmia monitoring.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003900050059
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  • 10
    Electronic Resource
    Electronic Resource
    Benzodiazepine sedation in adult ICU patients (1991)
    Springer
    Intensive care medicine 17 (1991), S. S11 
    Details
    ISSN: 1432-1238
    Keywords: Longterm sedation ; Ventilated patients ; Benzodiazepines
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01731148
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