Biomedical subjects

Peter E Ballmer

Publications and source records attributed to Peter E Ballmer.

5 recordsLinked to original sources

PubMed2006

Serumalbumin--a qualified parameter to determine the nutritional status?

OBJECTIVES: The primary objective of the study was to evaluate the relationship between serum albumin concentration and nutritional status. As a secondary objective, correlations between nutritional status, the length of hospital stay, the number of drugs taken and patients' age were assessed. METHODS: In a mono-centre non-interventional trial hospitalised patients were screened for undernutrition. Length of hospital stay, number of drug prescriptions, number of diagnoses, age and serum albumin concentration were recorded. Undernutrition was defined using the criteria of Edington et al. RESULTS: Of 232 screened patients, 102 entered the study, 52 men and 50 women with a mean age of 62.5 (SD+/-19.5) years. Twenty-nine (28.4%) patients were classified as undernourished and 73 as well-nourished. Nineteen of 25 (76%) undernourished patients showed a hypoalbuminaemia (30.5+/-6.5 g/l) compared with 74.5% (44/59) well-nourished patients (32.0+/-5.8 g/l, p 0.093). On average the length of hospital stay in undernourished patients was three days longer, which was statistically significant (p=0.009). CONCLUSIONS: Prevalence of undernutrition in the present pilot study was high and compared well with results from former studies. Serum albumin concentration could not discriminate between well and undernourished patients. Undernourished patients indicated longer length of hospital stay.

Female↗

PubMed2006

Skeletal muscle protein synthesis after active or passive ascent to high altitude.

INTRODUCTION: The effects of acute exposure to high altitude on muscle protein synthesis rates in human volunteers were examined after active and passive ascent. METHODS: Measurements were made initially at low altitude (550 m) and again after ascent to high altitude (4,559 m). To be able to separate the contribution of physical exercise, one group was flown by helicopter (air group, N=8), whereas the other group climbed to high altitude (foot group, N=9). Fractional rates of muscle protein synthesis rates (FSR) were determined from the incorporation of isotope into protein after injection of [H5ring] phenylalanine. RESULTS: In the air group, there was no change in FSR at high altitude, whereas in the foot group, there was a 35% increase in FSR (P<0.05 for interaction) measured 19-23 h after the end of climbing. At high altitude, the degree of hypoxia and alkalosis were not different between the groups. The plasma concentration of insulin-like growth factor-1, free thyroxin, free triiodothyronine, and thyroid-stimulating hormone were not different between the groups. Urinary 24-h cortisol excretion increased significantly in both groups after ascent, but the increase in the foot group was significantly higher compared with the air group. CONCLUSION: Physical exercise appeared to be responsible for the observed increase in muscle FSR. The significantly higher increase of 24-h cortisol excretion in the foot group suggests that the increase in FSR occurred despite higher levels of glucocorticoids, which generally affect muscle protein turnover by inhibiting protein synthesis.

Adult↗

PubMed2004

Hospital readmissions--are they predictable and avoidable?

QUESTIONS UNDER STUDY: In the context of limited resources in the healthcare system, factors that can be used as indicators for the effective use of diagnostic and therapeutic management of patients are of interest. The rate of hospital readmission (RA) is a potentially important parameter of quality in hospital care. In the present preliminary study, our aim was to measure the rate of readmissions, and to qualify the readmissions as avoidable or not. PRINCIPLES/METHODS: We performed this pilot study at the Department of Internal Medicine (DIM) of the Kantonsspital Winterthur (KSW). Between March 1st. and May 31st 1998 all patients admitted to our hospital were included in the study. Each patient was followed up for a period of 90 days after discharge. RA was classified as planned, unplanned, avoidable or unavoidable. Only the first RA of a patient was investigated. RAs were divided into those occurring within 30 and those occurring within 90 days of discharge. RESULTS: 884 index admissions (IA) were recorded. 83 patients (9.4%) died and 28 (3.2%) were referred to another clinic in the KSW. These 111 patients were excluded from the analysis. 773 (87.4%) patients were discharged from the DIM and are taken as 100% for the sake of calculation of the rates of RA. 95 (12.3%) RAs occurred within 30 days, 68 (8.8%, 95%-CI 6.8-10.8) of these being RAs related to the IA. 27 (3.5%) had no relation to the IA. 36 (4.7%) of these 68 RAs were planned and 32 (4.1%) were unplanned. Three unplanned RAs (0.4%) were considered to have been avoidable. When the observation period was extended to 90 days, 151 (19.5%) RAs occurred. 100 (12.9%) of the RAs were related to the IA. Of these 100 RAs 46 (5.9%) were planned and 54 (7.0%) were unplanned. Of these 54 RAs 10 (1.3%) were considered to have been avoidable. The highest rate of RAs occurred within the first 10 days of discharge, followed by a substantial decrease in RAs over the next 20 days and a constant low rate over the next 60 days. Unplanned RAs occurred in 59.3% within the first 30 days. Patients admitted on a Friday had the longest length of stay (LOS) in hospital and those admitted on a Sunday, the shortest. CONCLUSIONS: The present pilot study indicates that RA should be monitored regularly. Most RAs occurred within 30 days of discharge. Extension of the observation period to 90 days did not change the overall conclusions.

Disease↗

PubMed2003

Pathophysiological significance of peroxidative stress, neuronal damage, and membrane permeability in acute mountain sickness.

Free radical-mediated changes in vascular permeability and subsequent inflammatory response may be a contributory pathogenetic cofactor responsible for the development of neurological sequelae associated with acute mountain sickness (AMS). To investigate this, 49 subjects were examined at sea level and serially after rapid ascent to 4,559 m. Although the venous concentration of total creatine phosphokinase activity was measured in all subjects, a complementary examination of lipid peroxidation (F(2)-isoprostanes), inflammatory (TNF-alpha, IL-1beta, IL-2, IL-6, IL-8, C-reactive protein), and cerebrovascular tissue damage (neuron-specific enolase) biomarkers was confined to a subcohort of 24 subjects. A selective increase (P < 0.05) in total creatine phosphokinase was observed in subjects diagnosed with AMS at high altitude (n = 25) compared with apparently healthy controls (n = 24). However, despite a marked increase in IL-6 and C-reactive protein attributable primarily to subjects developing high-altitude pulmonary edema, subcohort analyses demonstrated no selective differences in F(2)-isoprostanes, neuron-specific enolase, or remaining proinflammatory cytokines due to AMS (n = 14). The present findings are the first to demonstrate that free radical-mediated neuronal damage of sufficient degree to be detected in the peripheral circulation does not occur and is, therefore, unlikely to be an important, initiating event that is critical for the development of AMS. The pathophysiological significance of increased sarcolemmal membrane permeability and inflammatory response, either as a cause or epiphenomenon of AMS and/or high-altitude pulmonary edema, remains to be elucidated.

Acute Disease↗

PubMed2002

Acute epiglottis in adults.

Acute epiglottitis can be a serious life-threatening disease because of its potential for sudden upper airway obstruction. It is a well-recognised entity in children but it is uncommon in adults and therefore is often misdiagnosed. In this retrospective study we present twelve cases of acute epiglottitis in adults. The diagnosis was made by visualisation of the epiglottis using fibreoptic laryngoscopy. The illness was managed using a standardised management protocol (see Appendix). The most frequent symptoms were odynophagia (100%), inability to swallow secretions (83%), sore throat (67%), dyspnoea (58%) and hoarseness (50%). Body temperature was elevated (>37.2 degrees C) in 75% and 50% of the patients had tachycardia (>100 bpm). The supposedly typical sign of stridor was found in only 42% of the cases. A routine oropharyngeal examination does not exclude epiglottitis, 44% of our patients had a normal oropharynx and the diagnosis could only be made following fibreoptic laryngoscopy. Nasotracheal intubation was necessary in four patients. A 40-year-old man with sore throat, hoarseness, cough and odynophagia was initially seen by a physician. With the suspected diagnosis of an infection - induced exacerbation of bronchial asthma, he was treated with antibiotics, paracetamol und corticosteroids. On admission six hours later the patient was in coma. The diagnosis was not made until conventional oral endotracheal intubation (without a tracheotomy set placed at the bedside) was attempted. Unfortunately the intubation failed and the patient died. Medical management of epiglottitis in adults includes an antibiotics, NSAIDs and possibly inhalation with adrenaline. The maintenance of an adequate open airway is the main concern in adults as well as in children. Although most adults have no signs of airway obstruction, the clinical threshold for insertion of an airway should remain low, as it is the only way of preventing death. A high index of suspicion is needed to recognise this rare disease correctly and patients must be admitted to a hospital with intensive care facilities, where the diagnosis can be confirmed and intubation performed if necessary and thus reduce the mortality rate.

Acute Disease↗