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Biomedical subjects

L Wild

Publications and source records attributed to L Wild.

At least 37 records · Page 2Linked to original sources
PubMed1990

Spinal opioids: a nursing perspective.

Nursing care of the patient receiving spinal opioids for pain control is reviewed in a comprehensive manner. Selection of patients, nursing management and patient outcomes are discussed. Three pain control techniques are described: epidural opioid injection for cancer pain, epidural opioid infusion for acute postoperative pain, and single dose spinal opioids for postcesarean section pain. Monitoring and pharmacologic aspects common to all three forms of spinal opioid treatment are given, and specific nursing interventions for each therapy are delineated.

Analgesia, Epidural↗
PubMed1990

Pain management.

Postoperative pain management in the critically ill patient is a challenge for nurses. Knowing the basis of pain transmission and mechanisms of action of interventions can assist the critical care nurse in making clinical decisions regarding pain control for individual patients. There are a number of modalities available to treat postoperative pain including both pharmacologic and nonpharmacologic interventions. Techniques such as PCA not only can provide good analgesia, but allow the critically ill patient at least one aspect of control in the otherwise highly controlled environment of the critical care unit. Epidural or intrathecal analgesia, using either opioids or LAAs alone or in combination, provides excellent analgesic effect (with minimal side effects) and may improve patient outcomes. Nonpharmacologic techniques, unfortunately, are commonly overlooked as adjuncts to traditional analgesia routines because of the nature of the illness in the critically ill patient. Nonpharmacologic techniques of pain management have a place in the care of the critically ill when applied based on the assessment of an individual patient's needs and abilities to participate in his or her care. Ensuring optimal patient comfort can benefit critically ill patients and improve clinical outcomes.

Analgesics↗
PubMed1990

[Bronchologic examination techniques for verifying abnormalities of the respiratory tract in early childhood].

With appropriate technique of endoscopy and contrast radiography adapted to the age and the respective problem, specific bronchological examinations in all age groups are feasible. Of all endoscopic techniques for the diagnosis of abnormalities in the upper respiratory tract, the most suitable method is laryngotracheoscopy only with the optic under halothane insufflation anaesthesia with spontaneous respiration maintained. For combined malformations of the septum that are considered problematic in diagnosis, sounding is suggested to determine the location of the tracheoesophageal fistula and color scanning is recommended to prove patency, as well as simultaneous contrast radiography of the two systems. In bronchography the insertion of contrast medium via the elevated orotracheal tube has proved suitable for documentation and for a differentiated demonstration of the abnormality type. In the case of skeleton malformations of the respiratory tract and vessel abnormalities stenosing the bronchial tree, biplanar radiographs in both respiratory phases are imperative.

Bronchography↗
PubMed1990

[Are there new aspects in thoracic surgery in children?].

A comparison was made between the operations of the respiratory tract in childhood and their associated bronchological examinations were analyzed and also there were other kinds of indication for examination and operation. The surgical therapy of abnormalities has the priority.

Child↗
PubMed1990

[Bronchopulmonary foregut malformations with communication to the esophagus].

Congenital abnormal communications between separated pulmonary tissue and the oesophagus are rarities. Only about 50 cases have been reported in the literature. For all different forms the term of bronchopulmonary foregut malformation (BPFM) was first applied by Gerle and his coworkers in 1968. Major symptoms of this condition involved respiratory distress, cough, dyspnea, vomiting and repeated pneumonia. This paper presents reports of two own patients. In both cases was confirmed a bronchopulmonary foregut malformation in the lower right thorax with ectopic main bronchus communicating into the distal oesophagus. According to the literature we describe our own experience and discuss embryologic pathogenesis and surgical consequences for children.

Bronchial Fistula↗
PubMed1990

[A change in substitution therapy in patients with congenital adrenogenital syndrome within the scope of surgical interventions].

Stress response during genital surgery was investigated in 18 female patients with CAH. Changes were studied in blood pH and base excess, in serum concentrations of sodium- and potassium ions, in concentrations of 17 OHP in serum and saliva. The following conclusions may be drawn: On the day of operation patients should receive 100 mg Prednisolut per square metre of body surface area i.v., divided in three doses. On postoperative days 1 and 2 the 4 to 6 fold, on postoperative days 3 and 4 the 2 to 3 fold amounts of supplementary doses of hydrocortisone should be administered. Fludrocortisone is substituted with 3-5 mg DCA i.m. only on the day of operation. It is convenient to use a half-isotonic solution of electrolytes with 5% glucose for the infusion therapy. A dose of 25-50 mg Prednisolut i.v. can be added to the substitution therapy before short diagnostic and therapeutic procedures with or without anaesthesia such as endoscopy or change of bandage. Radenarcon (etomidate), used for induction of anesthesia, is contraindicated in patients with CAH.

17-alpha-Hydroxyprogesterone↗
PubMed1989

[Treatment of otherwise incurable tumor diseases in childhood using whole-body hyperthermia and chemotherapy].

Conventional methods of treatment having failed in 17 children (aged 9/12 to 16 5/12 years) with incurable solid malignant tumours underwent whole-body hyperthermia (41.8-42.0 degrees C, for 2-3 h), hyperglycaemia (20-25 mmol/l) and polychemotherapy. Five children had neuroblastoma (stage 4), three Wilm's tumour (stage 4 or 5, unfavourable histology), five skeletal sarcoma with metastases, three inoperable malignant liver tumour, and one brainstem tumour of unknown histology. Whole-body hyperthermia was induced by extracorporeal blood warming in an haemodialysis apparatus under neuroleptic analgesia, thermistors measuring the temperature in the oesophagus, rectum, trachea and skin. There were on average four treatment sessions (between one and ten, total 58), a week apart. The result could be assessed in 12 children: one persisting complete remission (19 months-metastasising renal rhabdoid tumour), eight partial or incomplete remissions, and three nonresponders (osteogenic sarcoma; Ewing sarcoma; brainstem tumour). If the risk can be satisfactorily judged the method is useful and of bearable toxicity. The results point to a high antitumour effectiveness of combined hyperthermia and chemotherapy.

Adolescent↗
PubMed1989

Nursing management of patients receiving epidural narcotics.

Epidural analgesia is an important intervention in patients with pain after surgery. This article presents a brief overview of the anatomy of the epidural space and the physiology of pain transmission, including the action of narcotics in pain relief. The importance of written nursing protocols and in-service education for nursing staff members is discussed as being a necessary prerequisite for the safe use of epidural analgesia. A flow diagram with rationale illustrates the epidural injection technique. Nursing care of patients receiving epidural narcotics is detailed. The discussion emphasizes the management of potential side effects from epidural narcotics (respiratory depression, urinary retention, pruritus, pain on injection, dizziness, nausea, and vomiting) and includes information on the use of a narcotic antagonist. Recommendations are made for preoperative and postoperative teaching of the patient and family. A variety of tools for assessing patients' pain levels are described, and a comprehensive nursing care plan with nursing diagnoses and nursing interventions is provided.

Analgesia, Epidural↗
PubMed1988

[Scintigraphic search for metastases in patients with neoplasms of the head and neck].

Pretherapeutic staging is essential for the management of head and neck cancer. The diagnostic value of liver, brain and bone scanning was estimated by a retrospective study of 281 patients. Bone and liver scans are useful for detecting distant metastases from head and neck cancer. Brain scanning should be replaced by computed tomography, if there is clinical suspicion of intracerebral metastases. Nowadays ultrasound examination of the liver is more useful than liver scans. Thus, bone scanning remains the only radioisotope method used in the routine pretherapeutic staging of head and neck cancer. Chest X-ray, abdominal ultrasound examination and bone scans are adequate methods for the detection of metastases. The management of malignant lymphoma needs a special and more detailed diagnostic approach.

Adenocarcinoma↗
PubMed1987

[Infections caused by RS virus in young infants].

We saw 5 young infants with severe pneumonias due to RS virus (diagnosed serologically). Three of these infants were born as premature babies. Artificial ventilation was necessary in two cases. After the case reports follows a discussion of the most important problems of epidemiology, diagnostics and therapy of RS virus infections in young infants.

Anti-Bacterial Agents↗
PubMed1986

Effects of hyperoxia on alveolar permeability of neutropenic rabbits.

We investigated whether neutrophil suppression would prevent the early hyperoxic injury to the rabbit alveolar epithelium. Rabbits received a single intravenous injection of either nitrogen mustard (2 mg/kg) or saline and were exposed to 100% C2 for 64 h. At the end of the hyperoxic exposure, there were 20 +/- 7 neutrophils/ml blood in the nitrogen mustard group vs. 5,935 +/- 1,174 in the control group (means +/- SE; P less than 0.05). The corresponding numbers in lung extravascular tissue, expressed per high-power field, were 0.37 +/- 7 and 5.9 +/- 0.35, respectively (P less than 0.05). At this time, the rate constants of solute flux for 57Co-vitamin B12 (r = 6.5 A) and 131I-cytochrome c (r = 17 A), across the alveolar epithelium, were 33 +/- 5 (min-1) and 7 +/- 2 for the nitrogen mustard and 29 +/- 5 and 6 +/- 1 for the saline group, respectively. These variables were ninefold higher than their corresponding values in animals breathing air. We concluded that neutrophils do not play a significant role during the early stages of sublethal hyperoxic injury to rabbit alveolar epithelium.

Agranulocytosis↗