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Biomedical subjects

J Piek

Publications and source records attributed to J Piek.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Total parenteral nutrition of neurosurgical patients following elective midline surgery].

The authors report on their results of total parenteral nutrition (TPN) which was performed in a group of 11 comatose patients following elective neuro-surgery of different midline lesions (e.g. tumours, aneurysms of the anterior communicating artery). Carbohydrates were administered from day 1 postoperatively in a dose of 18-24 kcal/kg BW/day. Amino acids were given as a commercially available 12.5% solution (1.4-1.83 g/kg BW/day). Daily routine laboratory values were measured as well as levels of total serum protein, albumin, prealbumin, and retinol-binding protein. Free amino acids in plasma were measured on the day of operation and on day 3, 5, and 7 postoperatively. Renal nitrogen loss was high with maximal values up to 30 gm/day. By TPN cumulative nitrogen balance remained positive until day 2 and was reduced to -61.8 g at the end of the study period. Short-lived serum proteins remained normal. Free FAA's in plasma increased steadily with their highest levels on day 5 and 7 (twice the normal range). Besides slight elevation of liver enzymes and mild hyperglycaemia, no severe changes were observed in routine laboratory parameters. The authors conclude that severe catabolism is a common feature in comatose patients after elective midline surgery and is comparable to catabolism following brain injuries. TPN is well indicated in this group as it preserves visceral protein levels and reduces nitrogen loss without severe side effects.

Adult↗
PubMed1990

Continuous monitoring of cerebral tissue pressure in neurosurgical practice--experiences with 100 patients.

The authors present their experience with the use of continuous monitoring of cerebral tissue pressure (CTP) in a neurosurgical intensive care unit. The CTP was monitored in 100 patients with a variety of neurosurgical diseases. In 13 patients simultaneous recording of the ventricular fluid pressure (VFP) was carried out for up to 134 h. In 21 patients intrahemispheric gradients of CTP were recorded and in 66 patients CTP alone was recorded (59 supratentorial, 7 infratentorial). In general CTP monitoring gave excellent results with no additional risk to the patient and low costs for the monitoring system. The behaviour of CTP in various clinical conditions and the indications and limitations of CTP monitoring compared with VFP or epidural pressure monitoring are outlined. The authors recommend monitoring of VFP as the method of choice in ICP supervision. Continuous monitoring of CTP is the preferred method in the posterior fossa, after large craniectomies, for postoperative supervision following open surgery and in cases of narrowed ventricles.

Catheters, Indwelling↗
PubMed1989

Resting energy expenditure in patients with isolated head injuries and spontaneous intracranial haemorrhages.

Indirect calorimetry was performed during the first seven days in 39 neurosurgical patients with isolated head injuries (N = 20) and with spontaneous intracranial haemorrhage (N = 19). All patients were artificially ventilated and received total parenteral nutrition during the whole study period. In the trauma group resting energy expenditure (REE) varied from 473-2172 kcal/m(2)/day and in patients with spontaneous haematomas from 552-1591 kcal/m/day. These were 56-265% (trauma) and 61-192% (spontaneous haemorrhages) of predicted basal metabolic rates (BMR). Patients with head injuries showed higher REE values than patients with spontaneous haemorrhage, which was significant (p < 0.001) for the differences between the two study groups and for coma grade II patients. Deeper coma resulted in lower energy expenditure in patients with head injuries but the decrease was significant only from coma grade I to II. The authors conclude that REE rarely exceeds 30% of predicted BMR in patients with spontaneous haemorrhage and 50% in trauma patients. However, the effect of coma on REE should be taken into account when devising nutritional support in this group of patients.

Journal Article↗
PubMed1989

[Preoperative nutritional status of neurosurgery patients].

In a prospective trial anthropometric and biochemical data of 24 neurosurgical patients with primary intracranial tumors were measured to assess preoperative malnutrition in this special group of patients. In spite of starving because of invasive diagnostic procedures, high-dose dexamethasone therapy of peritumoral edema, and changes in food intake because of psychical alterations and repeated vomiting resulting from elevated intracranial pressure no abnormalities were found in the data measured. The authors conclude that in general preoperative malnutrition is absent in neurosurgical patients and preoperative nutrition to improve postoperative outcome is not indicated in this group.

Adult↗
PubMed1988

Intrahemispheric gradients of brain tissue pressure in patients with brain tumours.

The authors report on 14 patients in whom cerebral tissue pressure was recorded after operation for brain tumours. Cerebral tissue pressure was recorded by a 5 French catheter with two microtransducers. The transducers were placed intraoperatively in the wall of the tumour cavity and in a distance of approximately 2.5 cm. Differences between both pressures from 4 to 28 mmHg were observed. They were higher in patients with glioblastomas and meningiomas than in patients with intracranial metastases. In 7 patients proximal tissue pressure was higher than distal. In 4 patients the contrary was observed. Discussing the literature the authors think intrahemispheric changes of brain water content, blood flow, and brain tissue elastance to be responsible for this phenomenon.

Adult↗
PubMed1988

[The energy consumption of patients with craniocerebral trauma and spontaneous intracranial hemorrhage in the early postoperative post-traumatic phase].

Indirect calorimetry was performed during the first five days after admission in 18 neurosurgical patients with isolated head - injuries (N = 7) and spontaneous intracranial hemorrhages (N = 11) to determine basal metabolic rates (BMR). In the study group each day BMR varied from 2143 +/- 636 kcal/day to 3371 +/- 1140 kcal/day. Most patients however showed BMR values between 2000 and 2500 kcal/day. Individually BMR values ranged from 60 to 340 percent of normal healthy individuals. Patients with isolated head - injuries showed significant higher metabolic rates than patients with spontaneous intracranial hemorrhages. The authors conclude that an caloric intake of 2000 to 2500 kcal/day is sufficient for parenteral nutrition and usually helps to avoid negative effects of hyperalimentation by overestimation of BMR in this special patient group.

Adult↗
PubMed1987

A practical technique for continuous monitoring of cerebral tissue pressure in neurosurgical patients. Preliminary results.

A new technique for continuous monitoring of cerebral tissue pressure is presented. It is based on a new type of piecoresistive microtransducer with low baseline and temperature drifts. In 7 patients cerebral tissue pressure and ventricular fluid pressure were recorded simultaneously. Comparison of these two different pressures showed extremely good correlation with coefficients always better than 0.95. Due to another type of pulsewave cerebral tissue pressure was constantly 4 to 12 mm Hg lower than ventricular fluid pressure. Routine use of cerebral tissue monitoring in 12 neurosurgical patients with brain tumours postoperatively showed good clinical correlation of cerebral tissue pressure without any additional complications. The authors recommend continuous monitoring of cerebral tissue pressure as a safe and simple method of intracranial pressure monitoring in neurosurgery.

Brain Diseases↗
PubMed1987

[Continuous registration of intracranial pressure using disposable transducers].

The authors report the results of physical tests (baseline drift, temperature drift, absolute accuracy) and clinical experiences in intraventricular intracranial pressure monitoring with disposable transducers. Physical tests gave excellent results concerning baseline drift (less than 1%), temperature drift (0.35 mmHg/degrees C), and absolute accuracy (+/- 2 mmHg) in the range of intracranial pressure of both transducers tested (Gould DTX and Cobe 41-500). Clinical testing gave corresponding values compared with routine methods of ventricular pressure monitoring via a Bentley-Trantec-Transducer. As a result of the study disposable pressure transducers are recommended for routine use in clinical practice of intraventricular intracranial pressure monitoring.

Brain Injuries↗
PubMed1987

[Cerebrospinal fluid and plasma aminograms in patients with primary and secondary tumors of the CNS].

16 different free amino acids were determined in cerebrospinal fluid and plasma of each 5 patients with glioblastomas, meningiomas, and low grade gliomas as well as in 21 patients with lumbar disk herniations (control group). The values from the control group were in good accordance with those previously observed in normal adults of 5 studies of the literature. Significant changes were seen only in 6 of 16 amino acids. Absolute values of free CSF amino acids showed significant lower levels of valine, leucine and asparagine in the 3 subgroups whereas serine remained constantly high. The greatest changes were observed in glioblastoma and meningioma patients. Relative values gave similar results. No significant changes were found in CSF-plasma free amino acid relations. The authors conclude that changes of free CSF amino acids are due to a non-specific reaction of the brain itself to tumor growth. The different histology of the tumor does not give specific results. Determination of free CSF amino acids may help in early diagnosis of brain tumor recurrence after operation and to watch the effect of chemotherapy and radiation on brain tumor growth.

Adult↗
PubMed1986

Secondary intraventricular haemorrhage in blunt head trauma.

Intraventricular haemorrhage (IVH) has been detected by computed tomography (CT) in 225 patients admitted to our clinic from 1977 to 1985. In 9 patients IVH was caused by trauma. We report two cases in whom IVH occurred after a lucid interval of about 10 hours postinjury. The pathogenesis of traumatic IVH is discussed comparing these cases with a review of the literature.

Adult↗
PubMed1985

Protein and amino acid metabolism after severe cerebral trauma.

Fourteen patients (20-48 years) suffering from severe head injury were followed for changes in amino acid and protein metabolism during the first 8 days after trauma. All patients received a standardized intravenous nutrition containing 15.7 g of nitrogen per day and additional carbohydrates. Electrolytes, free water, and blood constituents were given as needed. Additional treatment included surgical decompression of space-occupying hematomas, high dose dexamethasone therapy, and controlled hyperventilation for at least 5 days. Gross changes of protein metabolism were observed particularly on the days 5 and 6. The duration and chronological sequence of these changes are different from those usually found in patients with multiple injuries.

Adult↗
PubMed1985

Cerebrospinal fluid free amino acids in patients with spinal space-occupying lesions. A preliminary report.

18 different free amino acids were determined in the cerebrospinal fluid of 28 patients with various spinal space--occupying lesions. The study group included 15 patients with lumbar disc lesions (control group), 8 patients with cervical radiculopathy, 4 patients with cervical myelopathy, and 1 patient with a thoracic spinal angioma. The values from the control group were in general accord with those previously observed in normal adults of 5 studies of the literature. Comparison of the values in the different subgroups showed normal values of all amino acids in patients with cervical myelopathy, and significantly higher levels of glutamic acid in patients with cervical radiculopathy. In the case of a thoracic spinal angioma however most free amino acids were extremely high. The authors conclude that this may be due to alterations of the spinal metabolism and that determination of free amino acids in CSF of patients with intradural spinal lesions may help to improve preoperative diagnosis in addition to neuroradiological methods.

Adult↗
PubMed1985

[Monitoring of auditory function in comatose patients in therapy with potentially ototoxic substances using acoustically evoked brain stem potentials].

Brain-stem auditory evoked potentials were measured in 14 comatose patients treated with aminoglycosides in cases of bronchopulmonary infection. Patients treated with tobramycin showed little influences on the latencies of wave 1, whereas treatment with amikacin resulted in enhanced wave 1 latencies even after completion of therapy. These changes were observed with therapeutic plasma levels of the aminoglycosides in all cases. As a method of bedside monitoring of auditory function with no additional stress to the patient with immediate results monitoring brain-stem auditory evoked potentials is recommended as a routine method to control auditory function in comatose patients under administration of aminoglycosides.

Adult↗
PubMed1984

[A physical model on the problem of the slipped clip].

The authors present their physical concept of determining the blade pressure of various aneurysm clips. On the basis of this concept, the consequences for the practical use of such clips are discussed. A new clip for aneurysm surgery is presented.

Biomechanical Phenomena↗