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Biomedical subjects

A Francke

Publications and source records attributed to A Francke.

At least 19 recordsLinked to original sources
PubMed2002

Sonography-guided injection of botulinum toxin A in children with cerebral palsy.

Visual identification of muscles and depth control of needle placement are the key features of sonography-guided injection that lead to improved targeting and safety of BoNT/A injections. This method may be especially helpful to validate already established injection techniques or when learning the correct injection technique. We recommend sonography-guided injection as a simple and painless "add-on" to the currently used standard procedure of palpation. The additional expenditure for sonography-guided injection is more than offset by the improved reliability in correct needle placement.

Age Factors↗
PubMed2002

[Accidental hypothermia--a challenge for rescue service and intensive care].

Accidental hypothermia is a rare clinical picture with different causes. Specific features are shown by patients who have accidents in water, due to rapid cooling. The SARRRAH project (Search and Rescue, Resuscitation and Rewarming in Accidental Hypothermia) was launched to secure fast and professional medical care right up to rewarming by extracorporal circulation. The University of Rostock takes part in this project. Based on the course of accidental hypothermia in fifteen patients, the authors report on the treatment of this life-threatening situation with special regard to the use of extracorporal circulation and present their first results. The core temperature of these patients lay between 16.0 and 34.0 degrees C. Eight of the patients had cardiac arrest at the scene of the accident. Seven of the patients with cardiac arrest were treated with extracorporal circulation in addition to cardiopulmonary resuscitation, which was started pre-clinically and continued in hospital. In one patient, extracorporal circulation was used at an initial temperature of 25.4 degrees C without previous cardiopulmonary resuscitation. Six of these fifteen patients with accidental hypothermia died. Five of the non-survivors belonged to the group of eight patients who were rewarmed by extracorporal circulation. With one exception, they also had the lowest core temperatures. Only a homogeneous and up-to-date documentation will allow further conclusions to be made for improving the concept of therapy.

Adolescent↗
PubMed2001

Changes in canine skeletal muscles during experimental tibial lengthening.

In 24 beagles, lengthening of the right tibia was performed by callus distraction after osteotomy and application of a ring fixator. Distraction was started at the fifth postoperative day, with a distraction rate of 0.5 mm twice per day, and ended after 25 days. A control group of six additional dogs underwent tibial osteotomy and external fixation without distraction. Twelve animals with and three animals without leg lengthening were euthanized immediately after the distraction period of 25 days (Group A); the remaining 15 dogs were euthanized after an additional consolidation phase of another 25 days (Group B). From the distracted right leg and from the left control leg the tibialis anterior muscle, extensor digitorum longus muscle, peroneus longus muscle, and gastrocnemius muscle were removed and studied by means of routine histologic, histochemical, and immunohistochemical analyses, and electron microscopic examination. The muscles of the control group showed no differences between the right and left sides. However, in the other 24 dogs of Groups A and B, the authors saw marked alterations affecting only the lengthened muscles but not the muscles of the control limbs. These changes were highly significant and included muscle fiber degeneration and regeneration, target fibers, central cores, minicores, marked endomysial and perimysial fibrosis, and atrophy of Type 1 and Type 2 fibers. In the consolidation period (Group B) fiber type grouping indicated that reinnervation had occurred. In addition, an increase in satellite cells and myoblasts and proliferation of nuclei were observed. The findings of the current study indicate that leg lengthening results not only in muscle fiber degeneration followed by regeneration and reinnervation but also in formation of new muscle tissue.

Animals↗
PubMed2000

Changes in canine peripheral nerves during experimental callus distraction.

In 24 beagles, lengthening of the right tibia was performed by callus distraction after osteotomy and application of a ring fixator. Distraction was started the fifth day after surgery with a distraction rate of 0.5 mm twice per day and ended after 25 days. A control group of six additional dogs underwent tibial osteotomy and external fixation without distraction. Twelve animals with leg lengthening and three animals without leg lengthening were sacrificed immediately after the distraction period of 25 days (Group A), the remaining 15 dogs were sacrificed after an additional consolidation phase of another 25 days (Group B). From the distracted right leg and from the left control side of each animal, the tibial and peroneal nerves were removed and studied by means of morphometric analysis of semithin sections and electron microscopic study. The authors reported only minor alterations of the myelinated nerve fibers consisting in relatively thin myelinated remyelinating nerve fibers, single axon degeneration, or macrophages. There was no axonal sprouting. In contrast, electron microscopic study disclosed signs of late Wallerian degeneration and axonal regeneration of the nonmyelinated axons. Morphometric analysis of the peroneal nerves revealed a significant increase of fiber density and a reduced mean axon and fiber diameter in the consolidation period (Group B). Similar changes were found in the tibial nerves in Group A and disappeared in the consolidation phase (Group B). These features indicate that callus distraction leads to moderate degenerative changes, followed by repair mechanisms, almost complete recovery, and some nerve fiber growth.

Animals↗
PubMed2000

[How accurate is invasive blood pressure determination with fluid-filled pressure line systems?].

It has been discussed by other authors that clinically relevant mistakes can occur in the measurement of invasive blood pressure. For this reason, we investigated all pressure lines used in our hospital. Our studies showed that exact measurement of invasive blood pressure using fluid-filled pressure measuring systems is not possible in the arterial, venous or pulmonal-arterial areas. Iatrogen mistakes should be excluded by working carefully. Exact knowledge of the physical qualities and the dynamic response of the fluid-filled pressure line used is required for judging the measuring accuracy. In clinical practice, measurement errors can amount to 40%. An acknowledged method to verifying errors is the Gabarith system developed by Billiet and Colardyn, which can determine the extent of the biggest-possible error after investigating the pressure line. A reduction of measurement error to below 2% can be achieved by carefully combining the individual components of the measuring system and, if necessary, by using an industrially-produced damping device (resonance overshoot eliminator [R.O.S.E.]). In this way, standardized measuring systems can be made available for clinical practice.

Blood Pressure Monitors↗
PubMed1996

[The high risk cardiac patient in anesthesia].

As a result of more offensive therapeutic measures and the given abilities of modern medicine and the increasing number of geriatric patients who are characterized by multimorbidity, more perioperative complications, in particular those of cardiac origin, can be expected. As in any other medical discipline, the safety of anaesthesiological care of the patient very much depends on the individual professional qualification and competence of the physician. For the field of anaesthesiology it can be concluded that it is necessary to tackle the specific problems of this risk group in order to reduce the rate of complications to a minimum. In line with a number of studies showing equal manifestation of cardiac risk factors during the pre-, intra- and postoperative periods, we should concentrate on the consistent use of all preventive and therapeutic measures available during these three periods. Besides evaluation of the cardiac risk factors and planning of the intra- and postoperative management, premedication is of particular importance in the preoperative period. To avoid sympathicoadrenergic contraregulations, benzodiazepines are particularly recommended because of their anxiolytic and sedative effects. The selection of a special anaesthetic method suitable for the patient with high cardiac risk should be influenced not only by anaesthesiological aspects but also by the complex effects of anaesthetic drugs on the determinants of the myocardial oxygen balance. In this connection, an increased sympathicoadrenergic tonus is of particular importance, i.e. extreme changes in blood pressure or heart rate--compared to preanaesthetic values--and an increase in diastolic wall tension should be avoided. An anaesthetic regime comprising gentle general anaesthesia combined with epidural block and small doses of opioids or local anaesthetics meets these requirements, as does a combination of opioids with low doses of volatile anaesthetics or intravenous hypnotics. The quality of perioperative management is also strongly determined by careful haemodynamic monitoring and early correction of circulatory disturbances. Since cardiac patients remain at risk up to three days after surgery, a level of haemodynamic monitoring appropriate to the level of cardiac risk must be maintained. Three main symptoms--increasing oxygen uptake (as a product of pain or shivering), hypoventilation and hypoxaemia--should be avoided in the postoperative period. Therefore, respiratory insufficiency should be diagnosed without fail by respiratory monitoring. If required, artificial ventilation must be continued, with particular attention being given to circulatory effects during artificial ventilation and weaning from the ventilator.

Aged↗
PubMed1996

[Enoximone--clinical experiences in heart surgery].

In 1991 and 1992, we introduced the new phosphodiesterase-III-inhibitor, enoximone, in the treatment of cardiac low-output-syndromes in the early phase after valve replacement or coronary bypass grafting. We introduced enoximone in cases which met the following criteria: cardiac index < or = 2.4 l/min/m2; systolic arterial pressure < or = 90 mmHg; left ventricular filling pressure > or = 20 mmHg despite the use of dopamine (> or = 12 micrograms/kg/ min); epinephrine (> or = 0.12 microgram/kg/min) and glyceroltrinitrate (1 microgram/kg/min). After clarification of preoperative risk factors and postoperative complications, retrospective evaluation of complete haemodynamic monitoring in patients after valve replacement (14 out of 86) and patients after coronary bypass grafting (22 out of 228) led to the following conclusions. Enoximone is of essential importance for the treatment of cardiac low-output at the end of extracorporeal circulation, particularly in cases complicated by preoperative myocardial deterioration. The use of enoximone is especially effective combined with beta-sympathomimetics as a result of elevation of cAMP-levels in two ways: by stimulation of beta-adrenoceptors directly and by inhibition of phosphodiesterase. Cardiac indices early after bypass, compared with measurements taken before bypass, reveal a clear rise indeed caused by increase in heart rate. Only in patients who underwent coronary bypass grafting did we observe a moderate increase in stroke volume indices. The therapeutic principle of using vasodilators--to lower peripheral resistance for improving stroke volume --appears to be effective immediately after extracorporeal circulation only in part. The vasodilating effect of enoximone has to be constantly compensated for by volume supplementation and alpha-mimetic stimulation, especially after valve replacement surgery. In contrast to this, we continued the application of glyceroltrinitrate in about 25% of the cases. Coronary surgery patients tolerated the vasodilating action particularly well; consequently, despite inotropic stimulation to a high degree, these patients showed no additional signs of ischaemia. Based on our therapeutic measures, the therapy led to very good short-term results. However, this therapeutic regime failed in patients suffering from extended myocardial infarction or irreversible pulmonary hypertension.

Adult↗
PubMed1993

[Intra- and postpartum cortisol concentrations during fentanyl anesthesia].

In a clinical study the course of cortisol concentration in serum was investigated at the following points: under labour, directly post partum simultaneously in the mother, the umbilical artery and vein and on the first and second day after birth in the mother and on the second third days in the newborn. Two groups of patients were investigated: 51 first and multiple parturients with peridural fentanyl analgesia for labour pain relief (PFA) and 42 first and multiple parturients as control group. The reduction of stress under PFA could be confirmed by measurement of cortisol concentrations in serum. The cortisol concentrations listed according to the time of day showed significantly lower values for the multiple parturients compared with the control group. Circadian peaks of the intrapartal cortisol in serum are generally absent in the multiple parturients. In the first parturients of the PFA group a more differentiated course of the cortisol levels listed according to the time of the day was observed. Up to about noon, the cortisol values are markedly lower than those of the control group, but after decreasing tendency in the early afternoon, they show another peak around 4.00 p.m. This means there is still a circadian rhythm under the influence of PFA for the first parturients. In contrast to the multiple parturients, the reaction of the cortisol level of the first parturients after PFA is only of short duration. At the other measuring points there are possibly different stress factors such as permanent expectation under labour and the absence of labour experience, superposing the fentanyl effect seen in the cortisol levels of the multiple parturients.

Analgesia, Epidural↗
PubMed1993

[Coronary artery fistula--surgical or percutaneous embolization treatment?].

Three children aged 4 months, 2.7 and 7 years with the unusual fistula of the left coronary artery to the right atrium were observed over a 2-year period. The two younger children underwent emergency surgery although they showed no clinical symptoms. The reasons for surgical intervention were an aneurysm in the right atrium with obstruction of the vena cava superior and a considerably enlarged fistula, respectively. In the older child, we percutaneously embolized a terminate fistula of the ramus circumflexus with two platinum microcoils without complications. Two-dimensional-echocardiography and color flow mapping were used to confirm the diagnosis. After such diagnosis we recommend a coronary angiography in every case. The transcatheter-coil-embolization is an alternative method to surgical closure in selected cases. We recommend an early onset intervention in case of congenital coronary artery fistula.

Aortography↗
PubMed1989

[Adaptive behavior of mature newborn infants following obstetric pain control with peridural fentanyl].

Obstetric pain relief using fentanyl epidurally is a safe and efficient method. In this study the effects of this obstetric analgesia on the adaptation pattern of 26 eutrophic newborns in the first hour of live have been estimated with cardiorespirograph in comparison with a normal groups. We did also determinations of acid-base-balance in arterial blood of umbilical artery and in hyperemic capillary blood of newborns. There were significant differences in basal frequency and the duration till the beginning of resting phase in the cardiorespirogramm. The differences to normal newborns may be correlated to the slight increase of partial pressure of carbon dioxide in the newborns following obstetrical analgesia. During the first hour of life newborns can good compensate. There is no sedation of newborns by fentanyl.

Acid-Base Equilibrium↗
PubMed1988

[Peridural analgesia with fentanyl--an alternative to control of labor pain].

Modern obstetrics should include not only an optimal labour monitoring but also an adequate pain relief during delivery. Due to the discovery of specific opiate receptors, for example in the substantia gelatinosa of the posterior horn in the spinal cord and the proof of direct pain-modifying effects on spinal level, new ways of the therapy of pain have been developed. The analysis was made with 40 parturients, who had decided for an epidural analgesia. They were given 0.1 mg fentanyl epidurally at a cervical dilatation of 3 to 5 cm and regular uterine contractions. The registrated onset time of fentanyl was between 6 and 15 minutes. A fentanyl dose of 0.1 mg applied epidurally proved to be sufficient for all parturients for the alleviation of pain in the period of dilatation. The interval without pain amounted to 130 mins. The motoricity was not impaired by the peridural application of fentanyl, because the parturient was able to be mobilized under continuous telemetric monitoring including telemetric management of the profile of the uterine activity. The period of the active and latent phases as well as the total delivery time was within the desirable ranges. An impairment of the general condition, e.g. vomiting, nausea or pruritus, was not noticed. There were no circulatory disturbances either. After the application of fentanyl the cardiotocograms remained uninfluenced in all parameters. All parturients declared that they had a positive birth experience under this kind of obstetric analgesia and that they would decide for this method again in case of a further delivery.

Anesthesia, Epidural↗