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Biomedical subjects

U Jost

Publications and source records attributed to U Jost.

At least 19 recordsLinked to original sources
PubMed2004

[Repeated improper intravenous injection of fentanyl from a transdermal system].

We report on a 30 year-old male who misused transdermal fentanyl. He injected the contents of transdermal patches intravenously. Suffering from chronic pain following total hip replacement, he had received a prescription for this drug formulation from his general practitioner. During his stay in a pain clinic he was able to obtain a total of 13 fentanyl patches from other patients or local pharmacies. He became seriously ill with multiple organ dysfunction in the course of an infection of his thigh. After surgical and intensive care treatment he recovered soon, but the hip prosthesis had to be explanted. There are some reports in the literature of misuse of fentanyl patches. The contents may be ingested orally, or they can be inhaled. Aspirated with a syringe the content of fentanyl patches can also be injected intravenously, sometimes resulting in exit-us. Prescribers must be aware of the potential for abuse of fentanyl patches which can be stolen, sold or even removed from dead bodies.

Administration, Cutaneous↗
PubMed2004

[Spinal anaesthesia in 50 patients with previous lumbar spinal surgery].

In anaesthesia textbooks, spinal anaesthesia is described as relatively contraindicated in patients with a history of lumbar spinal surgery. In order to assess the feasibility of spinal anaesthesia in these patients, we performed 56 spinal anaesthetics in 50 consecutive patients with previous lumbar spinal surgery. Our success rate of spinal anaesthesia was 100 %. Side effects were only minor and had a low incidence. We conclude that spinal anaesthesia is a viable technique in these patients.

Adult↗
PubMed2004

[Is the preoperative removal of dentures reasonable in every case?].

Traditionally, dentures are removed prior to anaesthesia. Modern techniques in dentistry and the widespread use of regional anaesthesia should lead to a more individual approach to this problem. From a legal standpoint, the information about advantages and disadvantages concerning the removal of dentures can be explained without problems to the patient without medical background.

Anesthesia↗
PubMed2002

[Complete brachial plexus paralysis caused by compartment syndrome in heroin intoxication].

We report the case of a young man with heroin intoxication. While deeply unconscious, he sustained a compartment syndrome of the arm and shoulder region leading to a lesion of the upper plexus. Immediate surgical decompression by fasciotomy incisions, intensive care treatment including hemofiltration to treat myoglobinemia, intense physical exercise, and mesh-grafting closure of the wounds soon led to unexpected recovery. The function of the arm was restored in such a way that the patient was able to intoxicate himself again. He needed intubation and ventilation but recovered uneventfully.

Adult↗
PubMed2000

[Experience with G27 Whitacre needle in in-patient and out-patient settings--incidence of post dural puncture headaches and other side effects].

OBJECTIVE: The aim of the study was to evaluate the incidence of side-effects in patients bearing a high risk of post dural puncture headache (PDPH) when a spinal anaesthesia was performed. This included outpatients, patients for sectio caesarea and patients younger than 40 years who were mobilized as soon as the surgeon agreed. METHODS: Quality control without randomization. Spinal anaesthesia for sectio caesarea was applied with a G27 Whitacre needle with the patient in the right lateral decubitus position. Hyperbaric Bupivacain 2-2.2 ml (10-12 mg) was injected when spontaneous flow of spinal fluid occurred through the needle. The preparations for the surgery then started immediately with the patient in a left lateral position. Intravenous Ephedrin (10-20 mg) was given simultaneously. All the other spinal anaesthesias were performed in a similar manner with the patient lying on the side of the scheduled surgery. For outpatients Articain was used instead of Bupivacain. In those outpatients older than 60 years a 26 G Quincke needle was used for spinal anaesthesia. Interviews: All in-hospital patients were visited once or more during the first 48 hours and asked about side-effects e.g. PDPH. Outpatients older than 60 years were interviewed by a telephone call on the third day after surgery. The younger ones were asked to send back a questionnaire free of charge. RESULTS: None of the 206 patients (mean age 30.7 years) who underwent caesarian sectio suffered from headache. Lower back pain was seldom [8] and moderate. They all had the bladder drained as a routine measure of the obstetrician. 547 of 600 in hospital patients were mobilized as soon as the block disappeared. 11 complained of headache. (1.8%) 2 females needed oral non-opioid analgesics, one 17-year-old woman an epidural blood patch (0.17%). 150 of the outpatients younger than 60 years sent back the questionnaire spontaneously. 75 had to be reminded by a telephone call. 10 of these 225 had PDPH but only 2 females needed oral non-opioids for one day. One 34-year-old woman needed conservative treatment with oral fluid intake more than 3 liters a day, analgesics and bed rest. None of the outpatients older than 60 years complained of headache. Two suffered from vomiting on the way home. Three males had disturbed bladder function, but did not need catheterism. CONCLUSIONS: The use of a thin pencil point needle (Whitacre G27) enables the application of a spinal anaesthesia to young people with a low risk of moderate PDPH. Pregnancy is not a contraindication. Early mobilisation does not increase the risk of PDPH even in young patients nor is this the case in outpatients. In outpatients older than 60 years a G26 Quinke needle, which is easier to handle and cheaper, is suitable for spinal anaesthesia without a risk of PDPH. Better post-operative vigilance may be a further benefit of the method. Young people especially appreciated the option to pursue their own video-endoscopic surgery. In a comparable group where an epidural was performed we found more side-effects.

Adult↗
PubMed1998

[Quality assurance in a psychiatric day clinic. A catamnestic study with goal attainment scaling].

PURPOSE: For the second time after 1990, a community mental health service questioned the outcome quality of its day hospital in rehabilitating primarily psychotic patients. METHODS: In addition to the assessment of 66 persons at the beginning and at the end of an average of six months' treatment in the years 1990-95, a psychologist who had not been involved in the treatment interviewed 49 persons one year after discharge with the use of goal attainment scaling in five relevant fields. RESULTS: Due to the economic recession the goal attainment decreased with regard to the job situation in the sense that it was difficult to find unsheltered jobs. By defining the goals in accordance with the needs of the patients, an improvement in the lodging situation was observed. As a result of the first study, quality monitoring led to an improvement of the structures that promote spare time interests. Social contacts and coping with everyday life showed sustainable achievements. CONCLUSIONS: These achievements can be interpreted as a result of the comparably long time of exposure to social learning within the therapeutic milieu of the day hospital. This hypothesis of a positive correlation between the sustainability of the outcome and the length of treatment must be validated by another study.

Adult↗
PubMed1997

[Propofol and postoperative nausea and/or vomiting].

UNLABELLED: The objective of this prospective, randomised study was to investigate the incidence of postoperative nausea and/or vomiting (PONV) during the first 24 h postoperatively. For a quality assurance study on PONV, we compared two established general anaesthetic procedures in 239 patients undergoing four different types of surgery (subtotal thyroidectomy, laparotomy for gynaecological procedures, laparoscopy, and surgery for extra-abdominal procedures). METHODS: All eligible patients provided informed consent. For premedication temazepam 10-20 mg was administered orally. We used propofol (1.5-2 mg/kg) for induction of anaesthesia in all patients, followed by 0.1-0.3 mg fentanyl, 2.5-5 mg droperidol, and for muscular relaxation atracurium or pancuronium according to body weight. Maintenance of general anaesthesia in group A was by administration of isoflurane in a maximum concentration of 0.6 vol.% in 70% nitrous oxide and 30% oxygen and in group B by continuous infusion of propofol (5-8 mg/kg.h) and normoventilation with oxygen in air (Fi02 = 0.3). In both groups additional analgesia was provided intraoperatively by equal dosages of fentanyl up to a maximum of 0.6 mg and clonidine up to 200 micrograms. Episodes of PONV were registered following extubation, during the first 4 h postoperatively, during the period 4-24 h postoperatively, and after the first mobilisation. Pain scores were recorded with the aid of a visual analogues scale. The statistical evaluation was performed using the chi-square or Wilcoxon test. RESULTS AND DISCUSSION: In patients undergoing thyroidectomy or laparotomy, continuous infusion of propofol drastically reduced the incidence of PONV in the first 24 h postoperatively, particularly during the first 4 h (25/41 vs 10/41, resp. 20/32 vs 11/31). The overall incidence of PONV was higher in the first half of the menstrual cycles decreased with patient age, increased with the duration of anaesthesia, and was higher in patients with a history of motion sickness. With the same level of analgesia in both groups, the differences disappeared in the further postoperative course. The use of similar dosages of opioids for pain control in these groups might explain this observation. PONV occurred extremely rarely in patients undergoing laparoscopy (1 resp. 2 of 34), and in those undergoing surgery for extra-abdominal procedures did not occur at all. The explanation may be that the induction of anaesthesia with propofol was followed only by a relatively short duration of general anaesthesia for these surgical procedures, and postoperative pain control was performed solely with non-opioids. CONCLUSIONS: We found that the antiemetic effect of propofol was considerable in the early postoperative period. The higher cost of propofol as compared to other induction agents can be covered by not using nitrous oxide for maintenance of anaesthesia and by the decreased need for antiemetic drugs postoperatively. According to the calculations of our clinical pharmacy, the costs of the propofol infusion regimen exceeded those of balanced anaesthesia by 8.50 DM/h; the need for antiemetics was one-half that of the non-propofol group. Considering a cost of 16 DM for cleaning the bed after vomiting, improvement of the patient's condition during the postoperative period can be achieved without additional expense.

Adult↗
PubMed1993

Conversion from cyclosporin to FK 506 after liver transplantation.

Thirty-seven liver-grafted patients with steroid-resistant acute or chronic graft rejection or with cyclosporin-related complications were converted from CyA to FK 506. The clinical outcome of the patients primarily depended on the degree of liver dysfunction present at initiation of FK 506 treatment. In patients switched to FK 506 for treatment of acute or early chronic graft rejection, CyA nephrotoxicity, or CyA malabsorption, the FK 506 therapy was associated with a clear improvement in the clinical course. In contrast, in patients with advanced chronic graft rejection, a lower response rate to the conversion in immunosuppression was observed. The lower response rate was associated with a higher patient mortality. These studies demonstrate that FK 506 represents a valuable alternative immunosuppressant for liver-grafted patients. The conversion from CyA to FK 506 should take place before serious--and potentially irreversible--disturbances in liver function are observed.

Acute Disease↗
PubMed1990

Evidence for a preglomerular oxygen diffusion shunt in rat renal cortex.

Although blood flow to the renal cortex is high and oxygen extraction is low, the renal cortex is remarkably susceptible to hypoxia. Because erythropoietin production has been localized mainly to the renal cortex, the aim of this study was to find a common denominator for both the high susceptibility to hypoxia and oxygen sensing within the renal cortex. By direct measurement of oxygen pressure with microcoaxial needle sensors at superficial glomeruli of the in situ kidney of anesthetized Munich-Wistar-Frömter rats, we obtained mean partial pressure of O2 (PO2) values of 46 +/- 13 (SD) mmHg (n = 71). The simultaneously measured systemic PO2 in arterial blood was 90 +/- 8 mmHg (n = 54). Changing the respirator gas from air to pure oxygen enhanced systemic arterial PO2 to 593 +/- 27 mmHg, whereas PO2 at the superficial glomeruli increased only to a mean of 80 +/- 28 mmHg (n = 71). These data suggest significant preglomerular shunting of oxygen within the cortical vasculature, most likely between interlobular vessels, which are arranged in a countercurrent fashion and represent quantitatively the largest contact area between arteries and veins within the renal cortex.

Air↗