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Biomedical subjects

N Mertes

Publications and source records attributed to N Mertes.

14 recordsLinked to original sources
PubMed1991

[Intraoperative anaphylactic shock due to a latex allergy].

Delayed hypersensitivity to rubber chemicals is well known, but there has been an increasing number of reports of immediate-type hypersensitivity due to latex causing contact urticaria, angioedema, bronchial asthma, and anaphylactic shock in adults. We report a 10-year-old boy who developed anaphylactic shock during surgery due to surgical gloves containing latex. The patient was atopic and had a history of neurodermatitis and localized angioedema on exposure to rubber. There had been two previous uneventful surgical procedures. Thirty-five minutes after induction of anesthesia and 5 min after laparotomy for appendectomy there was an acute onset of increased airway pressure, oxygen desaturation, and profound hypotension. The circulation and gas exchange stabilized after treatment with oxygen, intravenous fluids, epinephrine, H1 and H2 blockers, aminophylline, and methylprednisolone. A positive skin test and RAST revealed a latex allergy. Latex can cause life-threatening allergic reactions in patients with a history of rubber allergy or frequent exposure to latex products.

Anaphylaxis↗
PubMed1990

Percutaneous venous cannulation and central venous line placement by means of ultrasonography and ultrasonic Doppler.

Ultrasonography is being increasingly used in the field of anesthesiology. One major indication is visualization of central venous vessels, in particular the internal jugular vein before and during cannulation by means of ultrasonography or ultrasonic Doppler. This should facilitate puncture with a higher rate of successful cannulations and decreased rate of complications related to needle probing during catheterization attempts. Furthermore, by using ultrasonography central venous catheters can be located in the vessels. The picture quality of various central venous catheters currently used in anesthesia and intensive care does not show any noticeable difference.

Catheterization, Central Venous↗
PubMed1990

[Pharmacokinetic studies of a new 20% fat emulsion containing 70% medium-chain triglycerides].

The aim of the study was to acquire basic knowledge on pharmacokinetic, metabolism and tolerance of a new 20% fatty emulsion with a 70% proportion of medium-chain triglycerides (MCT) and a 30% proportion of long-chain triglycerides (LCT) in the postoperative phase after a trauma of medium severity. - 12 female patients who had an elective rectal amputation and who needed parenteral nutrition postoperatively, were studied. The nutritional regime consisted of 4.8 g/kg/day of glucose and 1 g/kg/day of amino acids. On the second postoperative day the patients were given 0.06 g/kg body weight/h and on the third day 0.12 g/kg body weight/h of new 20% fatty emulsion during a time period of eight hours. Blood samples for the evaluation of triglycerides, free fatty acids, phospholipids, beta-hydroxybutyrate (beta-OHB), acetoacetate, cholesterol, glucose, pyruvate and lactate were taken before and after the fat application. Ketone were measured semiquantitatively. Side effects and complications were not observed. Simultaneously to the administrated triglycerides an increase in serum triglycerides was observed. After four hours fat emulsion was infused under steady state conditions. Under the graphically measured half-life of 17 minutes for the MCT/LCT emulsion, rapid and complete elimination could be seen after the infusion had been stopped. Simultaneously with the high clearance of the infused triglycerides, free fatty acids increased significantly in the plasma without reaching a plateau; 30 minutes after the fat application the laboratory results returned to the initial levels.(ABSTRACT TRUNCATED AT 250 WORDS)

3-Hydroxybutyric Acid↗
PubMed1989

Effect of parenteral glutamine peptide supplements on muscle glutamine loss and nitrogen balance after major surgery.

Twelve patients admitted for elective resection of carcinoma of colon or rectum were allocated at random to experimental and control groups (six in each) and received a total parenteral nutrition regimen providing 230 mg N/kg and 166 KJ/kg daily over the first 5 postoperative days. In the experimental group the parenteral fluid was supplemented with a synthetic glutamine-containing dipeptide, L-alanyl-L-glutamine (54 mg peptide-N/kg per day) and the control group received corresponding amounts of alanine-N and glycine-N. On each postoperative day nitrogen balance was better in the experimental group; mean daily nitrogen balance with alanyl-glutamine was -1.5 (SE 0.4) g N/day and with the control solution -3.6 (0.2) g N/day. The cumulative nitrogen balances on the fifth postoperative day were -7.1 (2.2) and -18.1 (1.7) g N, respectively. With the peptide-containing solution intramuscular glutamine concentration remained close to the preoperative value whereas with the control solution it decreased from 19.7 (SE 0.9) to 12.0 (0.6) mmol/l intracellular water.

Clinical Trials as Topic↗
PubMed1989

[Protein oriented peripheral venous nutrition following surgical trauma].

In the postoperative state, hypercaloric parenteral nutrition is not indicated in every patient where enteral nutrition is not feasible. Low caloric protein oriented peripheral venous parenteral feeding might be an alternative nutritional regimen in moderate catabolic postoperative states. In a prospective study, 18 females received a completed nutritional solution during 4 days postoperatively following major colon surgery. The solution contained 80 g Sorbitol, 40 g Xylitol, 70 g amino acids and electrolytes (700 kcal/day). A slightly negative nitrogen balance with daily losses of about 4 g of N were observed. Routine biochemical data did not change compared to preoperative values. Plasma free amino acid homeostasis has been maintained so that conditions for optimal utilisation of the infused nutrients were given. No general side effects could be observed. This protein oriented nutritional solution may be recommended for hypocaloric peripheral venous nutrition in moderate catabolic states.

Amino Acids↗
PubMed1989

[Experiences with a new fat emulsion in surgical intensive care medicine].

As far as energy availability is concerned, it is advantageous to give lipid emulsions to severely catabolic patients, in comparison to lipid-free TPN. It is important to administer essential fatty acids, especially linoleic and linolenic acid, which play a major part in synthesis of membrane phospholipids and prostaglandin metabolism. Lipid emulsions with linoleic acid content and high linoleic-linolenic ratio might be of great value in posttraumatic situations, where the need for linoleic acid might be increased up to 50 g/day. We have examined the safety of a new lipid emulsion with a linoleic-linolenic acid ratio of 16:1 in 14 severely catabolic surgical ICU patients. As a result, neither liver enzyme elevation nor allergic reactions occurred. The limited elevation of triglycerides under lipid infusion and the rapid fall of these values to normal levels account for the satisfactory utilization of the examined lipid emulsion in critically ill patients.

Adult↗
PubMed1989

[Assessing nutritional status].

Malnutrition is associated with a delayed recovery from illness and an increased rate of complications. Heart failure, respiratory diseases, impaired immune function and postoperative wound healing are influenced by the nutritional status. Nutritional assessment includes patients history, physical examination, anthropometric measurements, laboratory dates and changes of immunocompetence. Anthropometric assessment, like skinfold and muscle area measurements, is not an extremely accurate method predicting nutritional status of an individual patient. Multifactorial influence on the concentration of the serum proteins, albumine, transferrin and retinolbinding protein caused a wide range of normal values. Therefore the validity and sensitivity of these parameters to assess nutritional status are diminished for the individual patient. The concentration of serum albumin seems to be of some value as a marker for nutritional status. The influence of malnutrition on immunity is complex. There are no sensitive markers available to assess the influence of malnutrition on the immuno competence of an individual patient for the clinical routine. Malnutrition may be assessed and the resulting clinical complications may be predicted by calculating a prognostic nutritional index, which include several nutritional parameters.

Anthropometry↗
PubMed1986

Pretreatment technique for fast intubation with vecuronium: intubation conditions and unwanted effects.

In eighty patients 15 micrograms kg-1 of vecuronium was given 3 minutes before induction of anesthesia and 50 micrograms kg-1 was given at the time of induction. The trachea was intubated 60 seconds after the second dose. A wide spread of twitch depression was found. The 80 patients were divided into 4 groups retrospectively with respect to the degree of neuromuscular blockade during intubation. Tracheal intubation was performed when the mean twitch depression was 48.8 +/- 11.8 (SD)% and the conditions were satisfactory in 89% of the cases. Intubating conditions were different significantly between the four sub-groups (p less than 0.01). Ptosis occurred in 77 patients, diplopia in 13 patients and dyspnea in 2 patients between the first injection of vecuronium and induction of anesthesia. The administration of vecuronium in divided doses gives satisfactory intubating conditions in the majority of the patients, but close observation between the priming dose and the induction of anesthesia is mandatory. The method is not considered suitable for obese and is probably not indicated in severely ill patients.

Adolescent↗