Effect of low-molecular-weight heparin on serum potassium.
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Anticoagulants↗
Biomedical subjects
M P Fischler
Publications and source records attributed to M P Fischler.
[Fever: friend or enemy?].
Normal body temperature values are distributed in a Gaussian manner and are subject to circadian variation. Therefore, the usually accepted upper limit of 37 degrees C for normal body temperature should be replaced by a value of 37.1 degrees C in the morning and 37.4 degrees C in the afternoon. Fever develops when cytokines increase the thermostatic set point in the hypothalamus, which in turn results in increased body temperature via increased heat production and decreased heat dissipation. Hyperthermia is a distinct entity in which the thermostatic set point is normal but the heat control mechanism fails. Increased body temperature has positive effects (e.g. decreased bacterial growth, stimulation of host defence mechanisms) as well as negative effects (e.g. increased heart rate, oxygen consumption and metabolism). Whether fever is a friend or foe depends on the actual clinical circumstances. Antipyretic treatment should, therefore, not be applied routinely. In the case of pure hyperthermia (e.g. heat stroke), physical cooling is appropriate, while in the case of fever the thermostatic set point must first be normalized with drugs before cooling can be applied.
Body Temperature Regulation↗
Late outcome of percutaneous dilatational tracheostomy in intensive care patients.
OBJECTIVE: Percutaneous dilatational tracheostomy is increasingly practiced in intensive care units and has a low incidence of early complications. The late effects of this procedure are still poorly known and were the focus of this study. DESIGN: Prospective descriptive clinical study. SETTING: Interdisciplinary intensive care unit in a 300-bed teaching hospital. PATIENTS: A consecutive group of critically ill patients who underwent percutaneous tracheostomy between Nov. 90 and March 93, surviving at least 2 months after decannulation. MEASUREMENTS AND RESULTS: There were 17 patients fulfilling the inclusion criteria and 16 of them were seen and examined. The follow-up protocol required a formal standardized patient interview, a physical examination of the stoma site and a fiberoptic laryngotracheoscopy. Results of these sub-tests and overall outcome rating were standardized and expressed as good, moderate or poor. Subjective rating was good in all patients. All denied suffering from any side effects of their tracheostomy. Clinical examination revealed neither stridor nor hoarseness in any of the patients. Most of the scars were whitish and less than 1 cm in length, a few were sunken in, none had adhesions. In 15 patients the clinical result was good and in one, moderate (whitish, sunken-in scar, longer than 2 cm). Ten patients underwent tracheoscopy, while 6 did not. There were no signs of significant stenosis or tracheomalacia. In 8 patients with minor findings results were scored as good, while 2 were classified as moderate (combination of swelling and scar formation of a string-like membrane). The overall rating was good in 13 patients (81%) and moderate in 3 patients (19%). There were no poor outcomes. CONCLUSIONS: Late outcome of percutaneous dilatational tracheostomy in critically ill patients is mostly good. Pending further studies, the use of this technique in intensive care units appears justified.
Adult↗