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D Fröhlich

Publications and source records attributed to D Fröhlich.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Nitrous oxide exposure to personnel in a recovery room with modern climate control].

Epidemiologic studies have shown that trace concentrations of inhalation anaesthetics polluting the air of operating theatres could have deleterious effects on the personnel's health. Nitrous oxide (N2O) oxidises vitamin B12 and thus decreases DNA production by inactivation of methionine synthase. Therefore, the United States and most European health authorities recommend threshold values to protect against potential health risks. These values range from 25 to 100 ppm, expressed as time-weighted averages (TWA). There is a lack of data concerning measurements of trace concentrations under defined conditions. The aim of this study was to quantify levels of N2O in a recovery room (RR) with an air conditioning system. METHODS. Trace concentrations of N2O were determined in the main RR of the University Hospital of Regensburg (Germany). Measurements were taken for 5 days from 8:00 a.m. to 8:00 p.m. Trace concentrations of N2O were measured directly by means of a highly sensitive photoacoustic infrared spectrometry analyser. The lower detection limit was 0.03 ppm. Samples of room air were taken continuously from six different places in the recovery room, five of which had a distance of 50 cm to the patients' heads. One point represented the nurses' desk 5 m away from the patients. TWAs were calculated for each day and location. RESULTS. All values were below 5 ppm TWA at each location. Typical TWA (range) values recorded at day 2 were for point 1:3.5 ppm (0.4-8.9), point 2:3.2 (0.5-7.3), point 3:3.0 (0.5-5.4), point 4:3.7 (0.5-21.2), point 5:3.2 (0.6-6.6), and at the nurses' desk 3.3 (0.5-6.3). Peak concentrations of nearly 25 ppm were reached for at least 10 min. Significant differences between the days and locations could not be found (P < 0.05, Wilcoxon test). CONCLUSION. Exposure to N2O in a climatised RR is determined by several factors: (1) efficacy of air conditioning, with 10.7 changes per hour without recirculation; (2) recovery room size; (3) transport of the patients takes about 15 min, during which some quantities of N2O leave the patient; and (4) high numbers of patients staying 2 and more hours in the recovery room and exhaling smaller concentrations of N2O into the room air. Because of these factors, all measured values are significantly below the standard international threshold values. Under other conditions of room design, such as ventilation and size, measured values may be higher.

Air Conditioning↗
PubMed1995

Is the transfusion requirement predictable in critically ill patients after admission to the intensive care unit?

OBJECTIVE: In intensive care medicine the clinical decision to order and transfuse red blood cells (RBC) is usually based on hematocrit or hemoglobin levels. The intention of this study was to investigate whether clinical or laboratory variables, taken after the admission of patients to the intensive care unit (ICU), are able to predict the transfusion requirement of the following 72 h. DESIGN: The values of initially measured systolic blood pressure, hematocrit level, and the values of 2 scores of severity of disease (Acute Physiology And Chronic Health Evaluation [APACHE-II], Mortality Prediction Model [MPM]) were calculated after the admission of patients to the ICU. The decision for transfusion was based on specific criteria. The median values of the scores, those of the variables, and the median number of transfused RBC units of the surviving group were compared to the values of the group of patients who died during hospital stay. The quantity of RBC transfusions was compared to the variables and score values by linear regression analysis. Additionally, the values of the patients who did not receive blood transfusion were compared to those of patients who required RBC. Furthermore, the patient group with neurosurgical diseases was compared to the group without neurosurgical diseases. PATIENTS: 117 patients were prospectively and consecutively investigated in an 8-bed ICU of a university hospital. RESULTS: Nonsurvivors required significantly more units of RBC during the first 72 h (p < 0.05). Patients who did not require transfusion had a higher hematocrit and a lower APACHE-II value at admission (p < 0.001). In the MPM values no differences were found. Patients with neurosurgical diseases had a higher initial hematocrit value, and they required less units of RBC in comparison to patients without neurosurgical diseases. In the analysis of linear regression neither in the initially measured systolic blood pressure nor in the APACHE-II and MPM we found a strong linear correlation to the quantity of blood transfusion. CONCLUSIONS: A hematocrit value < or = 20% and a APACHE-II score > or = 20 at the time of admission to the ICU referred to a demand for blood transfusion. We believe that these parameters are useful as predictive instruments. The initially measured systolic blood pressure had no prognostic capacity. In the individual patient a number of factors should be taken into account to decide whether to transfuse or not.

APACHE↗
PubMed1995

[Therapy trends in the prevention of radiation-induced diarrhea after pelvic and abdominal irradiation. Results of a tricenter study].

PURPOSE: Radiotherapy induced diarrhea and convulsive pain are severe side-effects of irradiation of the pelvis and the abdomen leading often to an interruption of the treatment. Up to now these side-effects were only treated symptomatically, prophylactic therapies are not known. PATIENTS AND METHODS: During the years 1992 and 1993 174 patients who obtained radiotherapy in the pelvis or the abdomen because of different malignancies were observed referring to the diarrhea-prophylactic effect of Smectite (= Skilpin). 80 patients received Smectite at the beginning of radiotherapy, 94 patients of the control group were treated with motility modifying drugs when diarrhea appeared. The following parameters were compared: Frequency, consistence and incontinence of stool, tenesmus and the onset of diarrhea. RESULTS: 67.0% (n = 63) of the patients in the control group developed diarrhea, whereas in the pretreated Smectite-group only 37.5% of the cases (n = 30) developed diarrhea. The first appearance of diarrhea was at day 17 in the pretreated group and averagely at day 11 in the control group. 44% of the patients in the control group suffered from tenesmus versus 25% in the Smectite-group. CONCLUSION: In comparison to the symptomatic treatment of radiation enteritis the prophylactic application of Smectite is able to reduce the diarrhea from the beginning of radiotherapy or at least to reduce the pathological frequency of stool and therefore to increase the quality of life.

Abdomen↗
PubMed1994

Prediction of outcome using the Mannheim peritonitis index in 2003 patients. Peritonitis Study Group.

Early prognostic evaluation of abdominal sepsis is desirable to select high-risk patients for more aggressive therapeutic procedures and to provide objective classification of the severity of disease. The reliability of the Mannheim peritonitis index was assessed and its predictive power for different populations examined in a study of 2003 patients from seven centres in three European countries. The prevalence of risk factors varied considerably between the groups. For a threshold index score of 26, the sensitivity was 86 (range 54-98) per cent, specificity 74 (range 58-97) per cent and accuracy 83 (range 70-94) per cent in predicting death. For patients with a score less than 21 the mean mortality rate was 2.3 (range 0-11) per cent, for score 21-29 22.5 (range 10.6-50) per cent and for score greater than 29 59.1 (range 41-87) per cent. The mean index score and mean mortality rate correlated in the different groups, reflecting a homogeneous standard of therapy for peritonitis. The Mannheim peritonitis index provides an easy and reliable means of risk evaluation and classification for patients with peritoneal inflammation.

Aged↗
PubMed1994

Local serum application: restoration of sufficient host defense in human peritonitis.

Intra-abdominal host defense in human peritonitis is hampered by a severe dysfunction of phagocytosis due to an almost complete breakdown of bacteria opsonization. This defect relates to some opsonin consumption, but mainly to proteolytic and oxidative opsonin destruction. To restore and protect intact opsonins we have developed a clinical approach of intra-operative peritoneal serum application. In a prospective, controlled, and randomized study of 30 patients with generalized peritonitis we have investigated the impact of this adjuvant therapy on biochemical parameters and clinical features. Serum application induced a rise in opsonin concentration and, even more pronounced, opsonin function (P < 0.01) of several hours' duration, leading to a distinct improvement of bacteria elimination. In addition, alpha 1-proteinase inhibitor (alpha 1-P)I levels were significantly increased after 1 h (P < 0.05) in the treatment group. The follow-up by APACHE II scoring indicated an improvement in the therapy group over the whole observation period of 14 days. Lethality in the therapy group was 33% compared to 53% in controls. These results indicate that the intra-operative restoration of physiologic intra-abdominal milieu can improve bacteria opsonization and elimination, thus contributing to a favourable clinical course in abdominal sepsis.

Adult↗
PubMed1992

The role of the kininogens as cysteine proteinase inhibitors in local and systemic inflammation.

The contribution of the kininogens and cystatin C to the functional inhibitory capacity for cysteine proteinases of blood plasma and inflammatory secretions was estimated from ex vivo experiments. 98.5% of the inhibitory capacity of blood plasma for cathepsin L (4-5 microM) is provided by the kininogens ensuring a complete control of this enzyme even at a lowered kininogen concentration. Control of cathepsin B activity by the kininogens is incomplete and depends critically on the active concentration of cystatin C (70 nM in normal plasma), which is reduced in blood plasma of polytraumatized and septic patients and very low in epithelial lining fluid of the shock lung.

Cathepsin B↗
PubMed1992

[The effect of taurolin on endogenous immunity and pathogen elimination in human peritonitis].

The influence of taurolin on phagocytosis-related defense functions and on the elimination of bacteria has been investigated in a controlled study. Particle opsonisation, a prerequisite for sufficient phagocytosis, was undisturbed in presence of up to 0.1% taurolin. Intraabdominal taurolin application did not diminish the leukocyte influx into the abdominal cavity. Opsonic capacity of peritoneal exudate was low in the taurolin group. These exudates contained more severe bacterial contamination, suggesting that this deficit was due to enhanced specific consumption of opsonins. Taurolin treatment resulted in a marked reduction of bacterial growth. Thus the substance provides antiseptic capacities without afflicting the physiological defense systems.

Aged↗
PubMed1992

[Treatment of peritonitis with staged lavage: prognostic criteria and course of treatment].

In order to define rational criteria for "planned relaparotomies" (PR) in the treatment of critical intra-abdominal infections we have analysed characteristics and the clinical course of 377 patients with diffuse peritonitis 152 of whom were treated by PR. More detailed prognostic aspects and data of the clinical course were prospectively investigated in 111 cases. Patient's age and an underlying malignoma revealed to be of prognostic significance in both univariate and multivariate analysis. The number of organs involved in septic organ failure during the treatment was a further indicator of risk. 40% of our patients, however, survived even an impairment of 5 organ-systems. The successful eradication of the source of peritonitis either with the 1st operation or only with consecutive operations resulted in a crucial difference of the mortality rate with 14% and 64% respectively. The failure to accomplish a definite operative resolution was accompanied by a mortality rate of 90%. The systematical application of PR facilitated control and completion of the eradication of the source of peritonitis. In one third of the patients treated by PR this technique led to early detection of relevant complications and adequate operative treatment. Patients in whom primarily a definitive eradication of the source of peritonitis had been accomplished did not benefit from PR. In patients with persisting or relapsing peritonitis, however, PR was accompanied by a 27% reduction of mortality.

Adult↗
PubMed1992

On-line coupled liquid chromatography-gas chromatography (LC-GC) and LC-LC-GC for detecting irradiation of fat-containing foods.

On-line coupled liquid chromatography-gas chromatography-flame ionisation detection (LC-GC-FID) enables efficient and unambiguous determination of irradiation for some fat-containing foods (e.g. meat). Other products, however, contain interfering components or are contaminated, e.g., with mineral oil. Since more selective detection by mass spectrometry has limited success, the determination was improved by a more selective isolation of some key components among the fat degradation products, e.g. the dienes or trienes, by LC-LC-GC-FID. Applications are shown for soup mixes, some spices, fish, and shrimps.

Alkanes↗
PubMed1991

Proteolysis of defensive proteins in peritonitis exudate: pathobiochemical aspects and therapeutical approach.

Peritonitis exudate reveals strong proteolytic activity which is paralleled by deficient opsonic capacity and high concentrations of lysosomal proteinases (elastase and cathepsin B). Lysosomal serine and cysteine proteinases (elastase, cathepsins B, L) were shown to degrade immunoglobulin G(IgG) and seem to be at least partially responsible for the observed proteolytic inactivation of IgG in peritonitis exudates. Intraabdominal serum application seems to restore opsonic activity by substitution of opsonins and proteinase inhibitors.

Ascitic Fluid↗