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1.
Br J Anaesth ; 102(4): 523-7, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19244264

RESUMO

BACKGROUND: The purpose of our study was to evaluate the maternal cardiopulmonary function and lung water content during percutaneous fetoscopic interventions under general maternal-fetal anaesthesia and continuous tocolytic medication. METHODS: We prospectively studied 13 women between 19 and 30 weeks of gestation undergoing percutaneous fetoscopic procedures that were performed under general maternal-fetal anaesthesia and tocolysis using indomethacin. Invasive haemodynamic monitoring using pulmonary artery catheters and the transpulmonary indicator dilution technique was applied to determine intrathoracic blood volume (ITBV), cardiac output, and extravascular lung water (EVLW). Pulmonary vascular permeability was estimated as the ratio of EVLW/ITBV. Measurements were performed during and for 24 h after the interventions. RESULTS: Respective mean (SD) maternal ITBV and cardiac output were 894 (191) ml min(-1) m(-2) and 3.29 (0.51) litre(-1) min(-1) m(-2) intraoperatively, and 843 (169) ml min(-1) m(-2) and 4.47 (0.55) litre min(-1) m(-2) during the first postoperative day. EVLW was 7.9 (2.7) ml kg(-1) during the interventions and 7.7 (1.8) ml kg(-1) during the first postoperative day. The pulmonary vascular permeability index was calculated as 0.35 (0.06) during the interventions and 0.38 (0.14) for the first postoperative day. Clinically overt pulmonary oedema was not detected in any woman while pulmonary gas exchange remained normal. CONCLUSIONS: In mid-gestational women undergoing percutaneous fetoscopic interventions under general maternal-fetal anaesthesia, cardiopulmonary function remained stable. However, a moderate increase in EVLW and pulmonary vascular permeability indicates an increased risk for maternal pulmonary oedema.


Assuntos
Anestesia Geral/métodos , Água Extravascular Pulmonar/metabolismo , Fetoscopia , Hemodinâmica/fisiologia , Adulto , Volume Sanguíneo/fisiologia , Permeabilidade Capilar/fisiologia , Débito Cardíaco/fisiologia , Feminino , Humanos , Técnicas de Diluição do Indicador , Monitorização Intraoperatória/métodos , Consumo de Oxigênio/fisiologia , Gravidez , Complicações na Gravidez/fisiopatologia , Estudos Prospectivos , Circulação Pulmonar , Edema Pulmonar/etiologia , Edema Pulmonar/fisiopatologia , Tocólise , Adulto Jovem
2.
Surg Endosc ; 20(7): 1134-43, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16763924

RESUMO

BACKGROUND: This study assessed the feasibility and safety of surgical techniques developed in sheep for fetoscopic fetal cardiac interventions during three selected less complex procedures for noncardiac fetal conditions in humans. On the basis of this assessment, the implications for the clinical introduction of minimally invasive fetoscopic fetal cardiac interventions in the near future are discussed. METHODS: The authors performed 16 percutaneous fetoscopic procedures in 13 human fetuses at between 19 + 2 and 34 + 6 weeks of gestation, then analyzed various parameters of surgical relevance for minimally invasive fetoscopic fetal cardiac interventions. Each of the three noncardiac malformations posed typical surgical challenges that will be critical for the technical success of minimally invasive fetoscopic cardiac interventions. RESULTS: Overall technical success was achieved in 14 of the 16 procedures. Percutaneous fetoscopic surgery did not result in any untoward effects and was well tolerated by all but two pregnant women: one with bleeding complication and one with mild postoperative pulmonary edema. No fetal complications or injuries from the various percutaneous fetoscopic surgical approaches were observed. CONCLUSIONS: The author's experience with surgical techniques introduced for percutaneous fetoscopic fetal cardiac intervention in selected noncardiac fetal lesions has led them to believe the time has come for the clinical introduction of fetoscopic fetal cardiac interventions. After an adequate learning curve supervised by committees of human research, the overall outcome and quality of postnatal life for the unborn patients ultimately will determine whether fetoscopic or other fetal cardiac interventions will be better therapeutic alternatives to currently available postnatal procedures.


Assuntos
Doenças Fetais/cirurgia , Fetoscopia/métodos , Cardiopatias/cirurgia , Feminino , Fetoscopia/efeitos adversos , Fetoscopia/normas , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Gravidez
3.
Ultrasound Obstet Gynecol ; 27(1): 84-88, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16308883

RESUMO

Congenital high airway obstruction syndrome (CHAOS) from laryngeal atresia bears a poor prognosis for hydropic fetuses owing to cardiac failure. We attempted percutaneous fetoscopic and ultrasound-guided tracheal decompression in a hydropic human fetus with CHAOS associated with Fraser syndrome. Percutaneous fetoscopic and ultrasound-guided tracheal decompression was performed using three trocars under general materno-fetal anesthesia at 19 + 5 weeks of gestation. Abnormal fetoplacental blood flow normalized within hours as a result of the intervention. Furthermore, a normalization of lung : heart size and lung echogenicity was observed within days. Resolution of hydrops was complete within 3 weeks. Premature rupture of membranes and premature contractions prompted emergency delivery of the fetus by ex-utero intrapartum treatment (EXIT) at 28 + 2 weeks of gestation. Following delivery, the lungs could be ventilated at low pressures and ambient oxygen concentration. Weaning from ventilation was achieved at 18 days of postnatal life. Our experience indicated that percutaneous fetoscopic and ultrasound-guided decompression of the fetal trachea is feasible and may permit normalization of hemodynamics in hydropic human fetuses with CHAOS from laryngeal atresia. The procedure may also result in normalization of heart : lung size and provide the time needed to regain the function of the overstretched diaphragm in this grave fetal condition.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Doenças Fetais/cirurgia , Laringe/anormalidades , Ultrassonografia Pré-Natal/métodos , Descompressão Cirúrgica , Feminino , Fetoscopia/métodos , Humanos , Gravidez , Síndrome , Ultrassonografia de Intervenção/métodos
4.
Neurology ; 62(3): 389-94, 2004 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-14872018

RESUMO

BACKGROUND: Mutations in the Parkin gene (PARK2) are the most commonly identified cause of recessively inherited early-onset Parkinson disease (EOPD) but account for only a portion of cases. DJ-1 (PARK7) was recently reported as a second gene associated with recessively inherited PD with a homozygous exon deletion and a homozygous point mutation in two families. METHODS: To investigate the frequency of DJ-1 mutations, the authors performed mutational analysis of all six coding exons of DJ-1 in 100 EOPD patients. For the detection of exon rearrangements, the authors developed a quantitative duplex PCR assay. Denaturing high performance liquid chromatography analysis was used to screen for point mutations and small deletions. Further, Parkin analysis was performed as previously described. RESULTS: The authors identified two carriers of single heterozygous loss-of-function DJ-1 mutations, including a heterozygous deletion of exons 5 to 7 and an 11-base pair deletion, removing the invariant donor splice site in intron 5. Interestingly, both DJ-1 mutations identified in this study were found in the heterozygous state only. The authors also detected a polymorphism (R98Q) in 1.5% of the chromosomes in both the patient and control group. In the same patient sample, 17 cases were detected with mutations in the Parkin gene. CONCLUSIONS: Mutations in DJ-1 are less frequent than mutations in Parkin in EOPD patients but should be considered as a possible cause of EOPD. The effect of single heterozygous mutations in DJ-1 on the nigrostriatal system, as described for heterozygous changes in Parkin and PARK6, remains to be elucidated.


Assuntos
Proteínas Oncogênicas/genética , Doença de Parkinson/genética , Adolescente , Adulto , Idade de Início , Estudos de Coortes , Análise Mutacional de DNA , Progressão da Doença , Predisposição Genética para Doença , Genótipo , Heterozigoto , Humanos , Peptídeos e Proteínas de Sinalização Intracelular , Íntrons/genética , Doença de Parkinson/epidemiologia , Polimorfismo Genético , Proteína Desglicase DJ-1 , Sítios de Splice de RNA/genética , Deleção de Sequência
5.
Dtsch Med Wochenschr ; 129(1-2): 27-30, 2004 Jan 02.
Artigo em Alemão | MEDLINE | ID: mdl-14703578

RESUMO

The foramen ovale which is the fetal connection between the right and left atrium persists in about 30 % of the adult population. In the presence of a persistent foramen ovale (PFO) shunting of blood may occur from the right to the left atrium, and bubbles can reach the systemic circulation during or after the decompression phase of a dive with compressed air. Therefore, divers with PFO may have an increased risk to develop ischemic cerebral lesions and neurologic decompression sickness (DCS). Significant right-to-left shunting may be diagnosed using transcranial doppler ultrasound of the medial cerebral artery and echocardiography with echo contrast media and Valsalva provocation. However, there are no official guidelines concerning PFO screening in medical fitness exams for professional or recreational divers in Germany. Therefore, it remains in the diver's choice to be screened for PFO. Divers with a history of DCS should be monitored for PFO, especially when diving strictly adhered to decompression tables. Divers with PFO who refuse to stop diving after DCS should be advised to adhere to very save dive profiles.


Assuntos
Doença da Descompressão/etiologia , Mergulho , Comunicação Interatrial/fisiopatologia , Ecocardiografia Doppler , Ecocardiografia Transesofagiana , Comunicação Interatrial/complicações , Comunicação Interatrial/diagnóstico , Humanos , Programas de Rastreamento , Fatores de Risco
6.
Anaesthesist ; 52(3): 224-8, 2003 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-12666004

RESUMO

A case of failed spinal analgesia with a combined spinal epidural anaesthesia (CSE) for Caesarean section is described. The lack of desired effect following an inconspicuous spinal, epidural or combined regional anaesthesia by an experienced anaesthetist is a rare and unexpected event. Especially when repeatedly observed in one patient,one should consider modified anatomical conditions of the affected spinal regions. We discuss the differential diagnosis which consists of inherent and acquired modification of tissue, neoplasia and vascular or infectious diseases. This case also confirms that not every adverse event after spinal or extradural anaesthesia is necessarily caused by the puncture.


Assuntos
Anestesia Epidural , Anestesia Obstétrica , Raquianestesia , Cesárea , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Gravidez , Medula Espinal/anatomia & histologia , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/patologia , Coluna Vertebral/anatomia & histologia
7.
Anaesthesist ; 51(5): 359-66, 2002 May.
Artigo em Inglês | MEDLINE | ID: mdl-12125306

RESUMO

INTRODUCTION: Indocyanine green (ICG) elimination tests have been repeatedly suggested as an early predictor of graft function in patients with liver transplantation. Conventionally, ICG clearance (ClICG) is measured by a series of blood samples with subsequent laboratory analysis. More recently bedside techniques have become available to measure ICG concentrations in vivo and in addition to ClICG, the plasma disappearance rate of ICG (PDRICG) is increasingly being used. The aim of this study was to assess and to compare the normal time courses of ClICG and PDRICG in liver transplant recipients. METHODS: ClICG and PDRICG were measured perioperatively and at various times up to 24 h after liver transplantation. The bedside transpulmonary indicator dilution technique with an arterial fiberoptic-thermistor catheter was used to assess the ICG concentration time curve together with total circulating blood volume (Vd circ). RESULTS: Similar patterns of the time courses of ClICG and PDRICG with a fast recovery of ICG elimination in the early reperfusion period were observed. Compared to healthy subjects, ClICG was supranormal and PDRICG was slightly subnormal. In this study, Vd circ was increased at baseline and remained increased during surgery. CONCLUSIONS: PDRICG and ClICG are well suited to monitor onset and maintenance of graft function in patients undergoing liver transplantation. The PDRICG values measured tend to be relatively lower than ClICG because of an increased blood volume in these patients. By knowing these differences it is justified to monitor liver function in a very simple manner with PDRICG.


Assuntos
Verde de Indocianina/farmacocinética , Testes de Função Hepática/métodos , Transplante de Fígado/fisiologia , Monitorização Intraoperatória/métodos , Adulto , Algoritmos , Anestesia , Volume Sanguíneo/fisiologia , Débito Cardíaco/fisiologia , Corantes , Hemodinâmica/fisiologia , Humanos , Período Intraoperatório , Masculino , Período Pós-Operatório
8.
Anesthesiology ; 95(2): 382-9, 2001 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11506110

RESUMO

BACKGROUND: Spontaneous breaths during airway pressure release ventilation (APRV) have to overcome the resistance of the artificial airway. Automatic tube compensation provides ventilatory assistance by increasing airway pressure during inspiration and lowering airway pressure during expiration, thereby compensating for resistance of the artificial airway. The authors studied if APRV with automatic tube compensation reduces the inspiratory effort without compromising cardiovascular function, end-expiratory lung volume, and gas exchange in patients with acute lung injury. METHODS: Fourteen patients with acute lung injury were breathing spontaneously during APRV with or without automatic tube compensation in random order. Airway pressure, esophageal and abdominal pressure, and gas flow were continuously measured, and tracheal pressure was estimated. Transdiaphragmatic pressure time product was calculated. End-expiratory lung volume was determined by nitrogen washout. The validity of the tracheal pressure calculation was investigated in seven healthy ventilated pigs. RESULTS: Automatic tube compensation during APRV increased airway pressure amplitude from 7.7+/-1.9 to 11.3+/-3.1 cm H2O (mean +/- SD; P < 0.05) while decreasing trans-diaphragmatic pressure time product from 45+/-27 to 27+/-15 cm H2O x s(-1) x min(-1) (P < 0.05), whereas tracheal pressure amplitude remained essentially unchanged (10.3+/-3.5 vs. 10.1+/-3.5 cm H2O). Minute ventilation increased from 10.4+/-1.6 to 11.4+/-1.5 l/min (P < 0.001), decreasing arterial carbon dioxide tension from 52+/-9 to 47+/-6 mmHg (P < 0.05) without affecting arterial blood oxygenation or cardiovascular function. End-expiratory lung volume increased from 2,806+/-991 to 3,009+/-994 ml (P < 0.05). Analysis of tracheal pressure-time curves indicated nonideal regulation of the dynamic pressure support during automatic tube compensation as provided by a standard ventilator. CONCLUSION: In the studied patients with acute lung injury, automatic tube compensation markedly unloaded the inspiratory muscles and increased alveolar ventilation without compromising cardiorespiratory function and end-expiratory lung volume.


Assuntos
Hemodinâmica/fisiologia , Lesão Pulmonar , Respiração Artificial/métodos , Mecânica Respiratória/fisiologia , Adulto , Idoso , Animais , Gasometria , Eletrocardiografia , Feminino , Humanos , Medidas de Volume Pulmonar , Masculino , Pessoa de Meia-Idade , Respiração com Pressão Positiva , Suínos , Ventiladores Mecânicos
9.
Langenbecks Arch Surg ; 386(1): 42-6, 2001 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11405088

RESUMO

BACKGROUND AND AIMS: Lymphocyte apoptosis may influence immune responsiveness in systemic inflammation. Therefore, we investigated whether early signs of apoptosis (i.e., annexin-V binding and cell shrinkage) in peripheral lymphocytes were different among patients with severe sepsis, critically ill, nonseptic patients after major surgery, and healthy individuals. PATIENTS/METHODS: Ten patients with severe sepsis and ten critically ill, nonseptic patients after major surgery admitted to a surgical intensive care unit in a university hospital were included in the study. In addition, ten healthy blood donors were included for comparison. We investigated early signs of apoptosis using flow cytometric measurement of annexin-V binding to the cell surface and cell shrinkage of peripheral lymphocytes. RESULTS: The percentage of apoptotic lymphocytes determined as annexin-V positive and propidium iodide negative cells was increased in freshly prepared cells of patients with severe sepsis (11.4 +/- 0.5%) and critically ill, nonseptic patients after major surgery (18.5 +/- 2.0%) relative to healthy blood donors (4.4 +/- 0.5%) (P < 0.05). No significant difference between patients with severe sepsis and patients after major surgery were found. Annexin-V binding increased significantly after OKT-3 stimulation of lymphocytes in patients with severe sepsis (34.4 +/- 1.6%), patients after major surgery (33.8 +/- 3.4%), and healthy blood donors (21.1 +/- 2.8%). No significant difference among groups was detected following OKT-3 stimulation. Furthermore, freshly isolated peripheral lymphocytes of patients with severe sepsis and critically ill, nonseptic patients after major surgery revealed a significantly higher proportion of cell shrinkage than in healthy blood donors (55.0 +/- 2.2%, 21.5 +/- 2.4% vs 3.6 +/- 0.7%; P < 0.05). CONCLUSION: Circulating lymphocytes of critically ill patients show a high degree of early signs of cellular apoptosis. This may contribute to hyporesponsiveness of immune cells in systemic inflammation.


Assuntos
Apoptose , Estado Terminal , Linfócitos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
10.
Crit Care Med ; 29(2): 310-6, 2001 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11246311

RESUMO

OBJECTIVE: To investigate the functional integrity of the hypothalamic-pituitary-adrenal (HPA) axis in patients with severe sepsis by stimulating with corticotropin-releasing hormone (CRH). DESIGN: Prospective observational study in consecutive intensive care unit patients with severe sepsis. SETTING: Surgical intensive care unit and outpatient department of endocrinology in a university hospital. PATIENTS: The study included 20 patients with the diagnosis of severe sepsis; six critically ill, nonseptic patients after major surgery; ten patients with primary adrenal insufficiency; ten patients with anterior pituitary insufficiency; and ten individuals without clinical signs of HPA axis disturbance. INTERVENTIONS: CRH tests were performed with an intravenous bolus injection of 100 microg of human CRH. MEASUREMENTS AND MAIN RESULTS: We studied the functional integrity of the HPA axis in patients with severe sepsis by performing the CRH test. In addition, during the period of severe sepsis, we repeatedly measured basal plasma concentrations of adrenocorticotropin hormone (ACTH) and cortisol. The mean basal plasma cortisol concentration was decreased significantly in nonsurvivors with severe sepsis (288.8 +/- 29.1 [sem] nmol/L) compared with survivors (468.1+/- 18.6 nmol/L; p <.01). By calculating the ACTH/cortisol indices, we found no evidence for adrenal insufficiency in patients with severe sepsis. The mean ACTH/cortisol indices of nonsurvivors with severe sepsis (0.02 +/- 0.008) and survivors (0.01 +/- 0.002) were significantly lower compared with the index of patients with primary adrenal insufficiency (6.8 +/- 1.0; p <.001). In contrast, in nonsurvivors with severe sepsis, the plasma cortisol response to CRH stimulation was impaired compared with survivors: The mean basal cortisol concentration within the CRH test was 269.4 +/- 39.8 nmol/L in nonsurvivors compared with 470.8 +/- 48.4 nmol/L in survivors and increased to a peak value of 421.6 +/- 72.6 nmol/L in nonsurvivors and 680.7 +/- 43.8 nmol/L in survivors (p <.02). However, the change in plasma cortisol, expressed as mean +/- sem and calculated by subtracting the basal cortisol from the peak cortisol after CRH stimulation, was not significantly different in survivors with severe sepsis (243.5 +/- 36.1, range 111.0-524.0 nmol/L, n = 15) compared with nonsurvivors (161.0 +/- 38.9, range 42.0-245.0 nmol/L, n = 5; p >.05). CONCLUSIONS: We found lower basal plasma cortisol concentrations in nonsurvivors compared with survivors of severe sepsis. In addition, the plasma cortisol response to a single CRH stimulation was impaired in nonsurvivors compared with survivors. Reduced responses to CRH stimulation may reflect a state of endocrinologic organ dysfunction in severe sepsis.


Assuntos
Hormônio Adrenocorticotrópico/sangue , Infecções Bacterianas/metabolismo , Infecções Bacterianas/fisiopatologia , Hormônio Liberador da Corticotropina/fisiologia , Hidrocortisona/sangue , Sistema Hipotálamo-Hipofisário/fisiopatologia , Sistema Hipófise-Suprarrenal/fisiopatologia , Sepse/metabolismo , Sepse/fisiopatologia , Adolescente , Insuficiência Adrenal/sangue , Adulto , Idoso , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/mortalidade , Estudos de Casos e Controles , Cuidados Críticos , Feminino , Humanos , Hipopituitarismo/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sepse/diagnóstico , Sepse/mortalidade , Índice de Gravidade de Doença , Análise de Sobrevida
11.
Anesthesiology ; 93(6): 1413-7, 2000 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11149435

RESUMO

BACKGROUND: Mechanical ventilation with high tidal volumes (V(T)) in contrast to mechanical ventilation with low V(T) has been shown to increase plasma levels of proinflammatory and antiinflammatory mediators in patients with acute lung injury. The authors hypothesized that, in patients without previous lung injury, a conventional potentially injurious ventilatory strategy with high V(T) and zero end-expiratory pressure (ZEEP) will not cause a cytokine release into systemic circulation. METHODS: A total of 39 patients with American Society of Anesthesiologists physical status I-II and without signs of systemic infection scheduled for elective surgery with general anesthesia were randomized to receive mechanical ventilation with either (1) V(T) = 15 ml/kg ideal body weight on ZEEP, (2) V(T) = 6 ml/kg ideal body weight on ZEEP, or (3) V(T) = 6 ml/kg ideal body weight on positive end-expiratory pressure of 10 cm H2O. Plasma levels of proinflammatory and antiinflammatory mediators tumor necrosis factor, interleukin (IL)-6, IL-10, and IL-1 receptor antagonist were determined before and 1 h after the initiation of mechanical ventilation. RESULTS: Plasma levels of all cytokines remained low in all settings. IL-6, tumor necrosis factor, and IL-1 receptor antagonist did not change significantly after 1 h of mechanical ventilation. IL-10 was below the detection limit (10 pg/ml) in 35 of 39 patients. There were no differences between groups. CONCLUSIONS: Initiation of mechanical ventilation for 1 h in patients without previous lung injury caused no consistent changes in plasma levels of studied mediators. Mechanical ventilation with high V(T) on ZEEP did not result in higher cytokine levels compared with lung-protective ventilatory strategies. Previous lunge damage seems to be mandatory to cause an increase in plasma cytokines after 1 h of high V(T) mechanical ventilation.


Assuntos
Citocinas/sangue , Ventilação de Alta Frequência , Adulto , Análise de Variância , Biomarcadores/sangue , Peso Corporal , Dióxido de Carbono , Feminino , Ventilação de Alta Frequência/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Pressão Parcial , Respiração com Pressão Positiva/efeitos adversos , Fatores de Tempo
14.
Artigo em Alemão | MEDLINE | ID: mdl-9498885

RESUMO

UNLABELLED: The purpose of our study was to find out whether patient-controlled epidural administration (PCEA) of a mixture containing a low-dose local anaesthetic, opioid and alpha 2-agonist provides as good or better postoperative analgesia as continuous epidural administration of the same analgetic solution. METHODS: 30 patients (ASA I-III), scheduled for major abdominal surgery, were randomly divided into 2 groups. 90 minutes after induction of general anaesthesia all patients received a continuous epidural infusion of 5 ml/h of the analgetic solution (50 micrograms sufentanil + 150 micrograms clonidine in 50 ml 0.125% bupivacaine) until the end of surgery. Immediately postoperatively the patients of group A received a continuous infusion of the study solution (5-8 ml/h), the patients of group B received a baseline continuous epidural infusion (3 ml/h), additionally they could self-administer 5 ml boli via a PCEA device. Measurements included the total dose of infused drug solution, pain at rest and on exercise by a visual analogue scale, cardiorespiratory data and side effects within the first 24 hours postoperatively. A standardised interview on analgesia and side effects was held 2 days after surgery. RESULTS: The PCEA group demanded less epidural analgesics (gr. B: 112 +/- 33 ml vs. gr. A: 135 +/- 20 ml) p < 0.01). Both continuous epidural infusion and patient-controlled administration provided very good analgesia at rest (gr. A: VAS 0.4 +/- 0.4 and gr. B: VAS 0.4 +/- 0.5) (n.s.). On exercise continuous epidural infusion of analgesics resulted in significantly lower pain scores (gr. A: 1.9 +/- 1.1) than patient-controlled application (gr. B: 3.4 +/- 1.1) (p < 0.01). We did not notice severe side effects such as respiratory depression or drop of heart rate or blood pressure. CONCLUSION: In patients at rest both continuous and patient-controlled epidural administration of analgesics provides excellent analgesia after major abdominal surgery. Contrariwise, patients on exercise who could use a PCA-device experienced more pain compared to those with a continuous epidural infusion technique. On the other hand the patients of the PCA-group consumed less epidural analgesics. We did not notice any severe side effects such as respiratory depression or cardiovascular instability during the study.


Assuntos
Analgesia Epidural/métodos , Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/administração & dosagem , Anestésicos Combinados/administração & dosagem , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Clonidina/administração & dosagem , Cuidados Pós-Operatórios/métodos , Sufentanil/administração & dosagem , Simpatolíticos/administração & dosagem , Idoso , Analgesia Epidural/efeitos adversos , Analgesia Epidural/estatística & dados numéricos , Analgesia Controlada pelo Paciente/efeitos adversos , Analgesia Controlada pelo Paciente/estatística & dados numéricos , Analgésicos Opioides/efeitos adversos , Anestésicos Combinados/efeitos adversos , Anestésicos Locais/efeitos adversos , Bupivacaína/efeitos adversos , Clonidina/efeitos adversos , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pós-Operatórios/estatística & dados numéricos , Estatísticas não Paramétricas , Sufentanil/efeitos adversos , Simpatolíticos/efeitos adversos , Fatores de Tempo
15.
Artigo em Alemão | MEDLINE | ID: mdl-9063919

RESUMO

OBJECTIVE: The purpose of this study was to investigate whether continuous epidural administration of combined low dose local anaesthetic, opioid and clonidine can provide sufficient postoperative analgesia after major abdominal surgery. METHODS: 45 patients (ASA I-III), scheduled for major abdominal surgery, were randomly divided into three groups. Prior to surgery all patients received an epidural catheter before induction of general anaesthesia. After 90 minutes a 10 ml bolus of the study solution was given via the epidural catheter followed by a continuous infusion of 5 ml/h until the end of surgery and further on 5-8 ml/h for 24 hours postoperatively. The solutions consisted of 50 micrograms sufentanil in 50 ml 0.125% bupivacaine (group 1), 150 micrograms clonidine in 50 ml 0.125% bupivacaine (group 2) and 50 micrograms sufentanil + 150 micrograms clonidine in 50 ml 0.125% bupivacaine (group 3). Measurements included the total dose of infused drug solution, pain at rest and on exercise by a visual analogue scale, cardiorespiratory data and side-effects within the first 24 hours postoperatively. A standardised interview on analgesia and side-effects was held two days after surgery. RESULTS: At rest excellent analgesia could be provided by all of the tested drug solutions. On exercise we evaluated lower pain scores in group 3 (1.9 +/- 1.1) compared to group 1 (2.8 +/- 1.6) or group 2 (3.8 +/- 2.1) (2 vs 3 p < 0.05). Severe side effects such as respiratory depression or drop of heart rate or blood pressure did not occur. CONCLUSIONS: Epidural administration of drug solutions containing a low dose local anaesthetic, opioid and alpha 2-agonist, provides excellent analgesia after major abdominal surgery. Patients at rest can be treated very effectively with both a combination of only two or with all of the tested drugs. On exercise the mixture containing all analgesics was more efficient than the solutions with only two of the tested drugs. Severe side effects such as respiratory depression or cardiovascular instability were not seen.


Assuntos
Analgesia Epidural , Bupivacaína/administração & dosagem , Clonidina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Sufentanil/administração & dosagem , Abdome/cirurgia , Adulto , Idoso , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Resultado do Tratamento
16.
Headache ; 33(4): 198-200, 1993 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-8388370

RESUMO

Cyclic AMP (CAMP) accumulation induced by isoproterenol (IP) and forskolin in intact lymphocytes was determined in 12 patients with migraine and 12 healthy controls. Our data showed that IP CAMP accumulation (8.20 + 1.08 Pmol/million cells) was significantly (P = 0.033) lower than accumulation in the controls (14.39 + 2.44 Pmol/million cells). Forskolin-induced CAMP did not differ in the two groups. These findings support the association of migraine and a reduced lymphocyte beta-adrenergic receptor sensitivity. An alteration in lymphocyte beta-adrenergic receptor may reflect similar changes in central beta-adrenergic function and may be used as a probe to evaluate its activity.


Assuntos
Linfócitos/metabolismo , Transtornos de Enxaqueca/sangue , Receptores Adrenérgicos beta/metabolismo , Adulto , Colforsina/farmacologia , AMP Cíclico/sangue , Feminino , Humanos , Isoproterenol/farmacologia , Linfócitos/efeitos dos fármacos , Masculino
17.
Dtsch Med Wochenschr ; 113(11): 409-13, 1988 Mar 18.
Artigo em Alemão | MEDLINE | ID: mdl-2965004

RESUMO

During a four-year period (1983-1986) percutaneous transluminal coronary angioplasty (PTCA) was performed on 930 patients with stable or unstable angina with a mortality rate of 0.4%. A transmural myocardial infarct developed in 1.1% and 1.0% of patients required an urgent aorto-coronary bypass. Thus the total rate of severe cardiac complications was 2.5%. Compared with the years 1983-1985, there was in 1986 a significant fall in the number of deaths and of myocardial infarcts from 2.2% to 0.5% (P less than 0.05), while there was a nonsignificant increase in emergency coronary bypass surgery from 0.7 to 1.3%. Patients with unstable angina compared with those with stable angina had a significantly higher mortality rate (1.0% vs. 0.2%; P less than 0.05), incidence of infarction (2.0% vs. 0.6%; P less than 0.05), and emergency operations (2.0% vs. 0.5%; P less than 0.05). The total risk of a severe cardiac complication was 1.2% for stable and 5.2% for unstable angina (P less than 0.001).


Assuntos
Angina Pectoris/terapia , Angioplastia com Balão/efeitos adversos , Aneurisma/etiologia , Angina Instável/terapia , Angioplastia com Balão/mortalidade , Arritmias Cardíacas/etiologia , Fístula Arteriovenosa/etiologia , Vasos Coronários , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Tromboembolia/etiologia
18.
Chirurg ; 58(10): 668-74, 1987 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-3677884

RESUMO

In a prospective non-randomised trial 1642 patients were included. After a mean time of 10 years a follow-up analysis was performed. The importance of the radicality of the primary operative therapy of breast cancer should be evaluated. The mean 5 years survival rate was 67.3%, the 10 year survival rate 51.6%. Tumor stage and age had a highly significant influence on the survival rate. Patients with simple mastectomy had a lower survival rate as patients with radical mastectomy. This apparent difference was caused by a different age distribution in the therapy groups. Accordingly the mean life deficiency was the lowest in the simple mastectomy group. In a multiple hazard statistical analysis tumor stage and age showed a highly significant influence on the survival rate. The intraoperative radicality classification showed a significant correlation to the prognoses of the patients. The operative therapy itself had no significant influence on the survival rate of the patients.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia , Complicações Pós-Operatórias/mortalidade , Adulto , Idoso , Neoplasias da Mama/patologia , Terapia Combinada , Feminino , Seguimentos , Alemanha Ocidental , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos
19.
Arch Intern Med ; 144(4): 742-4, 1984 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-6143540

RESUMO

We assessed the prevalence of Raynaud's phenomenon (RP) in 111 migrainous patients and 111 controls matched for age and sex. While 29 (26%) of the 111 migrainous patients suffered from RP, its prevalence among the controls was seven (6%) of 111. Raynaud's phenomenon was diagnosed among 13 (33%) of 39 patients with classic migraine and 16 (22%) of 72 patients with common migraine. Drug treatment did not account for the different prevalence in the two groups. We conclude that RP occurs more frequently in patients suffering from migraine than in the non-migrainous population.


Assuntos
Transtornos de Enxaqueca/complicações , Doença de Raynaud/complicações , Adolescente , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Idoso , Criança , Ergotamina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/tratamento farmacológico , Propranolol/uso terapêutico , Doença de Raynaud/epidemiologia , Fumar , Fatores de Tempo
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