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Biomedical subjects

G Tempel

Publications and source records attributed to G Tempel.

At least 19 recordsLinked to original sources
PubMed2005

[Senior migrants in Bremen: demographic structure, social condition and health status].

In the coming years, the number of migrants of 60 and older will rise considerably in Germany. There are indications that their health problems are more severe than those of the native population, and that much can be done to supplement health care offers for them. The authors suggest to put this statement on a more objective basis and bridge the gaps of empirical research, focussing both on health relevant aspects of the general situation of senior migrants (differences in the cultural background, migration biography, accommodation, integration/segregation etc.) and on the health status itself. At the same time preconditions and possibilities of an intercultural opening of care structures and culture-sensitive nursing should be utilised and further developed.

Adolescent↗
PubMed2000

[Metformin-induced lactic acidosis].

HISTORY AND ADMISSION FINDINGS: A 62-year-old woman had been found unconscious on her bed. She had to be resuscitated several times in the ambulance on the way to hospital. On admission her pupils were dilated and fixed, the cardiovascular system was unstable. Her rectal temperature was 28 degrees C. She was a diabetic being treated with metformin and glimepiride and was in incipient renal failure (serum creatinine 1.5 mg/dl). She was also in heart failure due to coronary heart disease and was in a debilitated state. INVESTIGATIONS: She had marked lactic acidosis (lactate 45.3 mmol/l; pH 6.6). Toxicological screening tests were negative. TREATMENT AND COURSE: In the absence of a history she was at first treated symptomatically. Conventional management of the lactic acidosis neither corrected the acidosis nor stabilized the circulatory system. Continuous veno-venous haemodialysis with bicarbonate-buffered solutions succeeded in reducing the need for catecholamines. Neurological examination was supplemented by recording acoustic and sensory evoked potentials. Suspected metformin-induced lactic acidosis was confirmed by appropriate tests. Three weeks after admission she was well enough to be transferred to a normal medical ward and ultimately discharged without further complications. CONCLUSION: Metformin should only be prescribed if the contraindications, in particular renal failure are carefully monitored. Severe lactic acidosis should be treated early with continuous veno-venous haemodialysis with bicarbonate-buffered substituting fluids. The good neurological results in this case are probably largely due to the marked hypothermia.

Acidosis, Lactic↗
PubMed1996

The opiate-sparing effect of dipyrone in post-operative pain therapy with morphine using a patient-controlled analgesic system.

OBJECTIVE: To determine whether dipyrone has an opiate-sparing effect in post-operative pain therapy compared with placebo during patient-controlled morphine therapy (PCA) and to compare the effects on analgesia and respiratory and coagulation parameters. DESIGN: Randomized, observer-blind, parallel-group, placebo-controlled study. SETTING: Surgical intensive care unit of a university hospital. PATIENTS: 106 adult patients who were to undergo abdominal or urological surgery under 90-min standardized inhalational anaesthesia were entered and 103 were included in the efficacy analysis (53 on dipyrone, 50 on placebo). INTERVENTIONS: Preprogrammed PCA (0.03 mg morphine/kg per bolus) with either dipyrone (initially 2.0 g i.v. and 1.0 g/2 ml i.v. at 4, 8 and 16 h) or placebo (saline). MEASUREMENTS AND RESULTS: Cumulative morphine consumption was calculated automatically during PCA. Pain intensity and pain relief and the investigator's global assessments of efficacy and tolerability were recorded on five-point verbal rating scales. Vital signs, standard laboratory parameters, respiratory rate, partial pressure of carbon dioxide (PCO2) and of oxygen, partial thromboplastin time (PTT) and Quick values were recorded. Total consumption of opiates in the dipyrone group (median 31.6 mg) was significantly less (p = 0.00015) than in the placebo group (median 50.3 mg), while pain relief (area under the curve) AUC was the same for both PCA+dipyrone (median 4.1) and PCA+placebo (median 3.9). Global assessment of efficacy was good to excellent in more than 90% of cases in both groups. Vital signs, respiratory rate, PCO2, PTT and Quick did not differ between groups. Adverse events were mainly nausea and/or vomiting (dipyrone, n = 4; placebo, n = 1); 1 patient in the placebo group had bradycardia. Three serious adverse events were unrelated to study medication. In 1 patient, the PCA programme malfunctioned and had to be changed. CONCLUSIONS: Concomitant administration of dipyrone with on-demand morphine (PCA) reduces opiate consumption while maintaining post-operative pain relief with a low incidence of side-effects.

Adult↗
PubMed1994

[Electroencephalographic demonstration of central nervous system effects of different premedication regimens].

INTRODUCTION: For many years, the main goal of premedication was prevention of the dangerous side effects sometimes encountered in anesthetics with anticholinergics, antiemetic antihistaminics, and opioids. Because the rules were always preoperative fasting, premedication was administered i.m. Thus, the onset of action was within 15-30 min from administration. In recent years, with the introduction of newer anesthetics with fewer side effects, anxiolysis became the main aim in premedication. Moreover, the oral route became popular since it obviously did not increase the acidity or volume of the gastric content. However, the uptake and thus onset of action of orally administered drugs may take longer and can differ considerably between individual patients. Therefore, the optimum interval between administration and induction of anesthesia remains controversial. The present study was carried out to examine the time course of drug action and the effects of different premedication regimens on the electroencephalogram (EEG). PATIENTS AND METHODS: After obtaining informed consent, in 38 unselected adult patients (ASA I and II, < 65 years) scheduled for elective surgery, the EEG was recorded continuously before and after premedication. The patients were randomly assigned to four groups: M: midazolam, 0.2 mg/kg BW orally; N: nordazepam, 0.2 mg/kg BW orally; AP: atropine, 0.5 mg, plus promethazine, 50 mg i.m.; APP: atropine, 0.5 mg, plus promethazine, 50 mg, plus pethidine, 0.7 mg/kg BW i.m. The EEG was recorded for a reference period of 10 min before and a study period of 30 min after premedication. Automated EEG processing was performed with CATEEM (computer-aided topographical electroencephalometry). Surface electrodes were placed according to the 10-20 system. Date were collected via an amplifier (resistance 10 M omega) and a digitalization unit (filter 0.2-35 Hz, sampling rate 512 Hz, 12 bit A/D convertor). The original EEG signals were used in an interpolation algorythm to produce an additional 82 virtual recording points, allowing for high topographical resolution. After spectral analysis (fast Fourier transformation), the different frequency ranges of the EEG power spectrum are displayed in different colors. The screen displays the on-line map with color-based topographical power distribution. In order to achieve a pharmacodynamic time profile, the study period was subdivided into three periods of 10 min each. For clinical evaluation of vigilance, a 6-grade scoring system was used 1 = awake, 6 = not arousable). RESULTS: All data are presented with respect to reference period. The power density of each frequency range for each electrode is integrated over the selected period and mean values are shown. Changes in power density with time are expressed as percentage change from reference period. Biometrical data showed no significant differences between groups. The median vigilance score 30 min after premedication (end of study period) was 4 in groups M, AP, and APP, and 3 in group N. In both benzodiazepine groups, a distinct increase in power density was found in the beta-bands, while in groups AP and APP the increase was most pronounced in the delta and theta bands. In group M, there was a linear increase in beta 1 power up to 310%, while in the beta 2 range there was a 170% maximum within the second period of 10 min. In group N, there was a similar course with a lower increase in beta 1 (220%) and beta 2 (130%). Increases in both beta-bands were most pronounced with frontal electrodes. While group M showed an increase in delta power (150%), together with moderate suppression in alpha (alpha 1 50%, alpha 2 40%), nordazepam caused only a slight increase in delta (124%) and a distinct increase in alpha 2 to 150%, predominantly in the frontal areas. Group APP showed a linear increase in both delta up to 210% and theta power to 190%. (ABSTRACT TRUNCATED)

Adult↗
PubMed1994

[Left heart failure in anesthesia in a child pretreated with propranolol--case report].

A 13-year-old girl suffering from nephrogenic hypertension, treated with high-dose propranolol and other antihypertensive medication, developed acute hypoxaemia (oxygen saturation at 60% at 100% oxygen ventilation) shortly after induction of anaesthesia. The auscultatory findings first suggested bronchospasm; however, specific measures failed to improve pulmonary function. The planned procedure was delayed and further investigations showed acute left heart failure due to beta-blockade combining with general anaesthesia.

Adolescent↗
PubMed1991

[Socially selective degree of achievement in community-oriented intervention--analysis of participation in health actions of the German Cardiovascular Prevention Study].

The subject of this article is an analysis of participation in campaigns of the German Cardio-Vascular-Prevention Study (GCP). In 1988 two representative surveys were carried out in the City of Bremen. Altogether, 2360 persons were questioned. Of these, 149 stated that they had participated in campaigns of the GCP. A multivariate analysis shows that the probability of participation was highest for people with an interest in health-related issues and for members of higher social classes. The discussion of these result emphasizes some problem areas in the use of such community-based intervention concepts.

Adult↗
PubMed1988

[Pharmacologic modification of vigilance in the postnarcotic phase-- naloxone or physostigmine?].

The usefulness of physostigmine in reversing post-narcotic depression after general anaesthesia is well proven; so is that of naloxone, a specific opioid analgetics antagonist, in reversing neuroleptic anaesthesia effects. Morphine-like analgetics are widely used as premedication agents, too; on the other hand, physostigmine reverses opioids as well as other psychotropic and narcotic agents. For that reason, positive post-narcotic physostigmine effects could be due to its anti-opioid potency as well. In a double-blind, randomised study, physostigmine and naloxone were evaluated using a clinically based vigilance protocol, and compared with saline solution. Naloxone did not have remarkable advantages as compared with placebo, while physostigmine led to a significantly higher level of vigilance; moreover, that level was reached sooner. The positive effects of physostigmine in restoring a sufficient level of vigilance after general anaesthesia are, in respect of our findings, unrelated to its antagonism to morphine-like analgetics.

Adult↗
PubMed1987

Cooperative Group of Additional Immunoglobulin Therapy in Severe Bacterial Infections: results of a multicenter randomized controlled trial in cases of diffuse fibrinopurulent peritonitis.

A multicenter randomized controlled clinical trial, which was carried out in 10 hospitals in the Federal Republic of Germany between 1979 and 1983, studied the influence of i.v. immunoglobulin G on the mortality in patients with diffuse acute fibrinopurulent peritonitis. Altogether 288 patients were enrolled in the trial. There was no statistically significant difference in the mortality rates within the treated group (46%) vs the control group (41%). The power of the statistical test to detect a decrease of the mortality by 20% was calculated to be 0.93. This result did not change when we eliminated 50 patients not strictly obeying the entrance criteria of the analysis, or when we focused on a subgroup of patients with initial deficiency of immunoglobulin G. Factors influencing mortality were a preceding laparotomy, serum creatinine level above 2 mg/100 ml, and necessity for artificial respiration. These factors, reflecting the surgical situation and the severity of shock, essentially explain the mortality differences observed between the participating hospitals.

Bacterial Infections↗
PubMed1987

[Anesthesia for nuclear magnetic resonance tomography (NMR)].

The NMR-Tomography as a new imaging device is still in the experimental stage for clinical use. It has distinct advantages in comparison to other conventional methods especially when considering special indications and clinical considerations. In some cases NMR-Tomography can only be carried out when a patient is under general anesthesia. This anesthesia must be performed in accordance with the basic nature of this imaging method, i.e. one always has to remember that no ferromagnetic material can be used in the vicinity of the apparatus. With our described method a certain and safe performance of general anesthesia for NMR-Tomography is possible.

Anesthesia, General↗
PubMed1986

[Significance of upper gastrointestinal hemorrhage in patients with multiple injuries].

The incidence, time of onset and course of clinically manifest upper gastrointestinal bleeding was analysed in 265 polytraumatized patients with an average "injury severity score" (ISS) of 31.5. Under standardized intensive-care treatment - including appropriate artificial ventilation; maintenance of a stable circulation; complete parenteral and earliest possible enteral nutrition; low-dose heparinization; sedation and analgesia as required; and intragastric administration of antacids - only two patients (0.8%) had clinically manifest upper intestinal bleeding and then only preterminally in the course of incurable multi-organ involvement, the bleeding being a component of multiple organ failure. The focus of stress-ulcer prevention should lie in a decrease of factors precipitating multiple organ failure, as well as in the carefully selective use of general intensive-care measures. The need of general systemic prevention with H2-receptor blockers and (or) pirenzepine is questionable.

Adult↗
PubMed1986

[Maxillary sinusitis in intensive care patients].

Fever of unknown origin is a major diagnostic problem in traumatologic postoperative intensive care medicine. Even when other causes of fever (wound infection, pneumonia, intravenous catheter contamination) have been ruled out, purulent maxillary sinusitis is rarely considered as the initial focus. The maxillary sinuses of 46 patients admitted to a postoperative intensive care unit were examined using a mobile "A-Scan" ultrasonic scanner. Follow-up examinations were performed on a regular basis. As early as on the 5th day of treatment, the initially, most often nasotracheally intubated and artificially ventilated patients exhibited a high frequency of pathological ultrasonic results, whereas only 10 of the 46 patients within the study demonstrated normal findings throughout the follow-up examinations. As a rule, bilateral involvement was observed. When findings were initially unilateral, the nasally intubated side was most often affected. Early extubation, partial mobilisation and/or administration of antibiotics from the first day of treatment onwards did not prevent the occurrence of pathologic ultrasonic results. Fever and leucocyte count were found to be elevated to a higher level in patients with purulent sinusitis. Thus, affection of the maxillary sinuses appears to be a frequent accompanying disease in intensive care patients, and should therefore always be taken into consideration as the initial focus of fever of unknown origin.

Adolescent↗
PubMed1986

[Injury severity score (ISS) in the classification of polytrauma patients].

Differentiated classification of overall severity of a multiple injury is essential to proper assessment of therapeutic success in cases of polytraumatisation. The injury severity score (ISS) is a classification system primarily based on anatomic findings and has proved to be highly practicable and suitable for investigations of larger groups of traumatised patients and their verifiable comparability. Its use is described by examples. The informative potential of the ISS was verified by traumatic patterns and pathological courses of 1,017 patients with injuries from accidents. ISS was found to be well correlated with final courses of diseases, length of treatment and artificial ventilation of survivors as well as with the amount of banked blood required for preoperative management. Effects of age on prognosis are not considered in ISS. Conclusive information on individual prognosis cannot be derived from ISS.

Accidents↗
PubMed1985

[Value of the injury severity score (ISS)].

The injury severity score (ISS) has been most widely accepted as a practicable method of classifying traumatised patients (ie., patients with accident injuries) according to the severity of their injuries, and has become more popular than all other comparable classification systems. By allocating the patients to different severity groups, it facilitates their classification in respect of prognosis. Over and above this, it enables comparison of patient groups of different hospitals. The authors investigated the validity of ISS classification by studying the case records of 432 patients in a traumatological intensive-care ward. They found good correlation between ISS score on the one hand, and lethality, requirements of banked blood during first-aid care and duration of treatment and artificial respiration of survivors on the other. However, the mean survival time of those patients who had died, did not reveal any connection with the severity of the injury. It is definitely impossible to arrive at any prognosis for an individual patient on the basis of his ISS classification. With increasing age, lethality after an accident increases even if the injury is less severe. The validity of ISS could be increased further if the age of the patients could be taken into account as well.

Adolescent↗
PubMed1985

[Modification of vigilance in the postanesthetic phase using physostigmine].

Physostigmine is an approved antidote in the treatment of intoxication as well as in the management of overdoses of numerous medications--many of which are used in the course of pre-medication or anesthesia induction or maintenance. In order to clarify whether or not physostigmine can accelerate the restoration of normal vigilance, a randomised, double-blind study of 60 patients was performed on the basis of 14 pre-determined vigilance criteria. The patients who received physostigmine demonstrated a significantly superior and more rapid restoration of consciousness as compared to the control group. Side-effects following administration were not observed. The results of our study indicate that post-anaesthesia administration of physostigmine appears useful in the treatment of certain types of patients.

Adult↗
PubMed1985

[Open wound treatment in diffuse fibrinous-purulent peritonitis].

Diffuse fibrinous-purulent peritonitis is an acute life threatening disease. Intensive care will at least for some time help to support vital functions even in patients with severe course, general intoxication, and multiple organ failure. A cure, however, can only be achieved if the cause for the intoxication syndrome can be eliminated by appropriate surgical procedures. The surgical procedures have to follow the general principles of septic surgery, including in certain cases air dressing, open treatment of wounds.

Abdomen↗
PubMed1984

[Behavior of immunoglobulins following traumatologically indicated splenectomy].

Blood levels of the immunoglobulins A, G and M were determined in a group of thirty patients, who had been splenectomized subsequent to splenal trauma, as part of a series of follow-up studies on polytrauma patients. These levels were compared with the corresponding values of an otherwise similar group of patients who had not been splenectomized. With few exceptions the majority of globulin levels in both groups were with the norm. The levels of IgG and IgA were significantly higher in the group of splenectomized patients, the IgM level was significantly lower than that of the comparison group of non-splenectomized patients. The medical history of the splenectomized patients showed no increase in susceptibility to infections and the average globulin levels were also well within the norm. Therefore, the clinical significance of these findings seems doubtful.

Adolescent↗