[Comments on the contribution by K. Sterzik et al. The effect of different anesthesia procedures on hormone regulation in the woman].
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
A Thiel
Publications and source records attributed to A Thiel.
[Changes in somatosensory evoked potentials after sevoflurane and isoflurane. A randomized phase III study].
Monitoring of somatosensory evoked potentials (SEP) is used to identify critical phases of cerebral ischaemia by means of characteristic changes in the signal patterns. A correct interpretation of the results is possible, however, only if the influence of drugs that act on the central nervous system is known. We were able to show that volatile anaesthetics have an impact on latencies and stimulus amplitudes. In this study, we examined the influence of sevoflurane as compared with isoflurane on the conduction of SEP by the median nerve at various concentrations. In addition, we determined how the addition of nitrous oxide (N2O) influenced the stimulus response of median-nerve SEP. Both isoflurane and sevoflurane caused a dose-dependent increase in latency of the primary cortical complex, while the influence on the cervical components of the SEP with respect to increased latency was only slight. No significant difference was found between both study groups. Under the influence of N2O, there were marked reductions in amplitude of the cortical stimulus response. Thus, it can be recommended that supplementation with N2O should be avoided in the presence of low initial amplitudes. Based on our results, the use of isoflurane and sevoflurane concentrations up to 1.0 MAC seems to be compatible with intraoperative monitoring of SEP.
Anesthetics, Inhalation↗
Effects of pipecuronium and pancuronium on cerebrospinal fluid pressure in neurosurgical patients.
Arterial hypertension and/or tachycardia may alter intracranial pressure in neurosurgical patients. We compared the effects of pancuronium 0.1 mg/kg and pipecuronium 0.1 mg/kg given as i.v. bolus on cerebrospinal fluid (CSF) pressure in 2 groups of 10 patients each scheduled for intracranial surgery in the supine position. Before surgery, no patient presented clinical symptoms of elevated intracranial pressure (ICP). Anesthesia was induced and maintained with fentanyl and midazolam. Ventilation with 50% nitrous oxide in oxygen was adjusted to maintain arterial pCO2 at 30-35 mmHg. After induction of anesthesia, CSF pressure was registered via a lumbar subarachnoid catheter before and 3, 5, 10, and 30 min after pipecuronium or pancuronium administration. Hemodynamics were monitored using radial and pulmonary artery catheters. All variables underwent analyses of variance for repeated measures with p < 0.05 considered significant. Mean CSF pressure decreased insignificantly from 15 +/- 5 mmHg (before injection) to 14 +/- 4 mmHg in patients given pipecuronium and from 13 +/- 4 mmHg to 10 +/- 3 mmHg in the pancuronium group without significant differences between the study groups. Heart rate and arterial pressure increased significantly (p < 0.001) in patients given pancuronium but remained stable after pipecuronium. Onset and duration of neuromuscular blockade were comparable between groups. Based on our results, pipecuronium is a safe alternative to pancuronium during neurosurgical procedures in patients without abnormally high intracranial pressure.
Adult↗
F-Dopa as an amino acid tracer to detect brain tumors.
A 57-yr-old woman suffering from light movement disorder of the left arm and hand was referred for 18F-Dopa PET. The PET study not only proved asymmetrically reduced dopamine uptake in the putamen (influx constant Ki right 0.0064/min, left 0.0086) but also revealed pathologically increased 18F-Dopa accumulation in the right frontal lobe. Further PET examinations demonstrated increased 11C-methionine uptake and low glucose metabolism in this right frontal region. MRI and 1H-MRSI showed a heterogeneous lesion with reduced N-acetyl-aspartate and increased choline and lactate, suggesting a mixed, low-grade glioma. In 15O-water studies, during intentional movements of one hand the respective motor areas were identified, indicating asymmetries due to the mass occupying lesion. The tumor could be removed in open surgery, thus sparing the motor areas; a mild postoperative motor deficit resolved to the presurgical state. Histology confirmed the diagnosis of a grade 2 oligo-astrocytoma. This case impressively demonstrates that 18F-Dopa can be used as an amino acid tracer for brain tumor detection in addition to its established application to assess aromatic acid decarboxylase activity.
Brain↗
Effects of intravenous anesthetic agents on middle cerebral artery blood flow velocity during induction of general anesthesia.
OBJECTIVE: Our objective was to quantify the effects of intravenous anesthetics on values measured by or derived from transcranial Doppler sonography (TCD) during induction of general anesthesia. METHODS: We recorded blood flow velocity in the middle cerebral artery (V-MCA) before, during, and after induction of general anesthesia in six groups of young patients without intracranial pathology (n = 10 each) using TCD. Patients were randomized to receive either 2 mg/kg propofol, 1.5 mg/kg methohexital, 5 mg/kg thiopental, 0.3 mg/kg etomidate, 2 micrograms/kg fentanyl and 0.15 mg/kg midazolam, or 1.5 mg/kg ketamine and 0.15 mg/kg midazolam intravenously. At 2 min after injection, each patient was intubated and given isoflurane 0.8% and nitrous oxide 66% in oxygen. Ventilation was set to achieve an end-tidal PCO2 of 40 mm Hg. V-MCA, arterial blood pressure, heart rate, hematocrit, and PCO2 (venous samples) were measured before and 1, 3, 5, 10, and 30 min after induction of anesthesia. RESULTS: The preinduction data were not different between groups. At 1 min after injection, propofol, thiopental, methohexital, and etomidate significantly decreased V-MCA. TCD values were only slightly affected following fentanyl/midazolam. Ketamine/midazolam induced a modest rise in V-MCA. After endotracheal intubation, V-MCA increased in all groups, and slowly declined thereafter. CONCLUSIONS: Under the circumstances of our study, values derived from TCD measurements responded differently to the agents used to induce general anesthesia in nonneurosurgical patients.
Adult↗
The effects of epidural and intravenous lidocaine on somatosensory evoked potentials after stimulation of the posterior tibial nerve.
The measurement of somatosensory evoked potentials (SEPs) after stimulation of the posterior tibial nerve (PTN-SEPs) has been proposed as an objective indicator of the quality of lumbar epidural block. It is unclear whether peak latency increases after epidural application of local anesthetics may be due in part to systemic effects of the drug absorbed from the epidural space. In this clinical study, we compared PTN-SEPs after intravenous and epidural administration of lidocaine to those of a control group who did not receive lidocaine. Plasma concentrations of lidocaine remained within expected ranges for epidural and intravenous administration. No subjects developed signs for overdose or toxicity. After epidural application of 2% lidocaine, mean latencies of peaks P1, N1, and P2 increased significantly in comparison to baseline values. In 3 of 10 patients, latency changes were not observed. Intravenous lidocaine did not produce statistically significant changes in latencies, although a trend toward increasing latencies appeared to be present. In the control group without lidocaine, no statistically significant changes occurred during the 1-h study period. No correlation was found between peak latency changes and plasma concentrations of lidocaine. We conclude that latency increases observed after epidural application of lidocaine are due primarily to local, not systemic, effects of the local anesthetic.
Absorption↗
Cerebrovascular carbon dioxide reactivity in carotid artery disease. Relation to intraoperative cerebral monitoring results in 100 carotid endarterectomies.
BACKGROUND: In patients with carotid artery disease, poor intracerebral collateralization is reflected by impaired cerebrovascular reactivity to carbon dioxide inhalation, which will improve after endarterectomy. The relationship between preoperative reactivity to carbon dioxide using transcranial Doppler sonography (TCD) and intraoperative changes of somatosensory evoked potentials (SEP) and TCD parameters were investigated. METHODS: In 94 patients, preoperative carbon dioxide reactivity was examined and defined impaired if mean blood flow velocity in the middle cerebral artery (Vm-MCA) increased less than 1.5% mmHg during carbon dioxide challenge. Patients then underwent 100 carotid operations under general anesthesia with both SEP and TCD monitoring. Shunts were placed if SEP amplitude decreased to less then 50% of control or central conduction time increased by 20% after clamping (critical SEP changes). TCD changes were defined as critical in case of a postclamping/preclamping Vm-MCA ratio < or = 0.4. The incidence of critical SEP and TCD changes was compared to preoperative carbon dioxide testing using Fisher's exact test with P < 0.05 considered significant. Postoperatively, neurologic state and carbon dioxide responsiveness were re-examined. RESULTS: Twelve patients showed impaired preoperative carbon dioxide reactivity on the side of operation, which improved markedly after surgery. The incidence of critical SEP changes in these cases (8.3%) was not significantly different from that in the remaining patients (14.8%). Critical SEP changes were significantly correlated with critical TCD changes (P < 0.0001). CONCLUSIONS: Patients with poor carbon dioxide reactivity (preoperative TCD testing) did not have an increased risk of cerebral ischemia during carotid surgery, as assessed by intraoperative SEP recording.
Blood Flow Velocity↗
CD34+ human hemopoietic progenitor cells of the bone marrow differ from those of the peripheral blood: an immunocytochemical and morphometric study.
CD34+ progenitor cells were harvested from bone marrow and peripheral blood from 10 healthy donors by immunomagnetic isolation and enrichment procedures. The CD34+ cell population was investigated using a battery of enzyme reactions and monoclonal antibodies on cytospin preparations. Additionally, morphometric measurements were carried out and also liquid suspension culture studies were performed to ascertain vitality and stem cell character. More than 95% of the total yield of medullary CD34 progenitors expressed CD45 (LCA), CD43 (MT1) and beta-glucuronidase. Reactivity with CD33 (My9), CD15 (LeuM1), CD38 (Leu17), CD20 (L26) and Ret40f (glycophorin C) was assumed to be in keeping with a transition into more differentiated elements of the various hemopoietic lineages. Morphometric analysis revealed conspicuous heterogeneity of the CD34+ cell population considering size measurements. This finding was in line with the diversities of antigen expression, indicating the more committed nature of CD34+ stem cells derived from the bone marrow in comparison with those progenitors isolated from the peripheral blood. Moreover, proliferation marker staining by PCNA disclosed a positivity in a considerable number of progenitors in contrast to the findings in CD34+ cells that are found in the peripheral blood.
Antibodies, Monoclonal↗
Obsessive-compulsive disorder among patients with anorexia nervosa and bulimia nervosa.
OBJECTIVE: The present study sought to determine the prevalence of obsessive-compulsive disorder among patients with eating disorders. METHOD: Ninety-three women who met DSM-III-R criteria for anorexia nervosa or bulimia nervosa were investigated by using a semistructured diagnostic interview, the Yale-Brown Obsessive Compulsive Scale, and the Eating Disorder Inventory. RESULTS: Thirty-four patients (37%) met the DSM-III-R criteria for obsessive-compulsive disorder and also had a clinically significant score of 16 or higher on the Yale-Brown scale. These patients also had significantly higher, and hence pathological, mean scores on five of eight Eating Disorder Inventory scales than patients with eating disorders without concomitant obsessive-compulsive disorder. CONCLUSIONS: These results suggest that there is a high prevalence of obsessive-compulsive disorder among patients with anorexia and bulimia nervosa and that this prevalence may be correlated with the severity of the eating disorder.
Adolescent↗
Characterization of CD34+ human hemopoietic progenitor cells from the peripheral blood: enzyme-, carbohydrate- and immunocytochemistry, morphometry, and ultrastructure.
Following an immunomagnetic isolation and enrichment procedure, CD34+ cells were harvested from the peripheral blood of about 50 healthy donors. A battery of cytochemical staining reactions, monoclonal and carbohydrate-specific antibodies, proliferation markers and lectins was applied on smears and sections from paraffin-embedded pellets. Additionally, a morphometric analysis and ultrastructural investigation was carried out. More than 95% of the total yield of progenitor cells expressed CD34 and CD43 (MT1) and of these about 90% CD45 (LCA) and 25% CD45A (MT2). The CD34+/CD45RA-population was thought to represent very primitive, probably not lineage-restricted stem cells. On the other hand, reactivity with ANAE, CD11c, CD15, CD20, Ret40f, KiM1P, and CD61 (ranging between 1 to 20%) was considered to indicate a transition into more differentiated elements of hemopoiesis. The failure to detect any staining with proliferation markers (Ki-67/MIB 1, PCNA, KiS1) was in keeping with a quiescent status. Carbohydrate antigens revealed a pattern which underlines the fact that the CD34 and CD43 antigens belong to the family of heavily O-glycosylated sialomucins. Blood group antigens which are located at the peripheral regions of mucin-oligosaccharides (H type 2, Lewis, Lewis) could be demonstrated, but not A, B, Sialyl-Lewis and Lewis. Morphometric analysis revealed that CD34+ progenitors were larger than small lymphocytes. Electron microscopy showed a relatively primitive cytoplasmic organization and numerous tiny magnetic beads clustered at the plasma membrane.
Adult↗
[Obsessive-compulsive symptoms in structural ego defects--a study exemplified by anorexia and bulimia nervosa].
The present study reports findings concerning the hypothesis whether patients with narcissistic self-system disturbances show more obsessive-compulsive (OC) symptoms as compared to patients without such disturbances. Ninety-one patients meeting DSM-III-R criteria for anorexia nervosa (AN) or bulimia nervosa (BN) were investigated using the Narzissmusinventar (NI), the Hamburger-Zwangsinventar (HZI), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Eating Disorder Inventory (EDI). The NI-data demonstrated a great variance of self-system disturbances in AN and BN; a cluster analysis identified two different clinical features. In comparison to eating disorder patients without concomitant disturbances of the self-system (n = 34) the patient group with such narcissistic deficits (n = 57) showed significantly higher Y-BOCS and HZI-scores indicating more and severer OC symptoms. These patients also had significantly higher and hence pathologic means on seven of eight EDI scales. The results suggest that OC behaviour may be an unconscious attempt to stabilize the self-system equilibrium, i.e. counteracting narcisstic desintegration. Regulatory processes of the self-system and OC symptoms may present additional prognostic factors and lead to new approaches in psychotherapy research.
Adolescent↗
[Compulsive symptoms in anorexia and bulimia nervosa].
The present study reports findings concerning the prevalence of obsessive-compulsive symptoms in eating disorders. Ninety-three women meeting DSM-III-R criteria for anorexia nervosa (AN) or bulimia nervosa (BN) were investigated using the Hamburg Obsession Compulsion Inventory HZI-K (Klepsch et al. 1993). Forty-six patients (49.5%) met the criteria for obsessive-compulsive disorder (OCD). This subgroup showed significant pathologically elevated scores on several scales of the Eating Disorder Inventory (Garner et al. 1983), and two different personality questionnaires (Freiburger Persönlichkeitsinventar, Fahrenberg et al. 1984; Giessen-Tests, Beckmann et al. 1983). The results demonstrate a high rate of OCD in AN and BN. The relationship between eating disorders and OCD and the question of clinical relevance is discussed.
Adolescent↗
[Initial clinical experiences with TIPS (transjugular intrahepatic portasystemic stent-shunt)].
15 patients with predominantly alcoholtoxic liver cirrhosis (mean age 50 years; 8 men and 7 women) were treated by the technically successful implantation of a transjugular portosystemic stent-shunt (TIPS) within a period of 1 year. The indications for TIPS implantation were the following: gastroesophageal bleedings in 12 cases (10 patients with recurrent variceal bleeding including 2 emergency cases with severe bleeding resistant to conventional therapy and 2 patients with exclusively gastral bleeding due to severe hypertensive gastropathy) and ascites resistant to conventional therapy in 3 cases. Portovenous pressure could be effectively reduced by mean of 37%. Within a mean observation period of 8 months 13 patients including the emergency cases remained without recurrent bleeding. Duplexsonography showed patent stents. 1 patient suffered from an early recurrent bleeding due to occlusion of the stent-shunt. The estimation of liver function according to the Child-Pugh-classification showed only minor changes. Before TIPS 9 patients were in class A, 4 in B, 2 in C; after TIPS 8 patients in A, 5 in B and 2 in C. Ascites resolved completely. Following TIPS all patients appeared to abstain from alcohol. After TIPS 5 from 14 surviving patients (36%) developed clinically manifest encephalopathy within the first 4-8 weeks (2 patients with previous episodes of encephalopathy, 2 other patients after withdrawal of lactulose). By enhanced conservative treatment (lactulose, paromomycine and protein restriction) encephalopathy could be overcome. 8 from 11 surviving patients investigated displayed characteristic MRI changes with an increased signal intensity in the basal ganglia (T1 weighted images). According to our preliminary results TIPS represents a new successful interventional regimen for the treatment of portal hypertension in selected cases.
Adult↗
Induction of interleukin 4 (IL-4) expression in T helper (Th) cells is not dependent on IL-4 from non-Th cells.
Interleukin 4 (IL-4) is essential for the induction of immunoglobulin E (IgE) responses in mice. Recent in vitro studies have suggested that IL-4 derived from non T helper (Th) cells, in particular from mast cells and basophils, may be essential for triggering of IL-4 expression in Th cells and may directly contribute to IgE isotype switch induction. Here, we have generated mice carrying a functional IL-4 gene only in Th cells or non-Th cells, respectively, by reconstitution of IL-4-deficient mice (IL-4T mice) with CD4+ or CD4- spleen cells from congenic wild-type animals. In mice in which only CD4+ cells are able to express IL-4, antigen-specific IgE is produced in a T cell-dependent immune response. Thus, induction of IL-4 expression in Th cells can occur in the absence of IL-4 from non-Th cells, which suggests that at least some Th cells can express IL-4 in response to another signal which has yet to be identified. No IgE is detectable, however, in mice in which only CD4- cells can express IL-4, suggesting that Th cells are the primary, if not the only source of IL-4 for initial induction of IgE synthesis.
Animals↗
Dyskinesias possibly induced by norpseudoephedrine.
We report two case histories of previously healthy patients who both developed persistent dyskinetic syndromes (spasmodic torticollis and cranial dystonia, respectively) following the intake of norpseudoephedrine (NPE) as an appetite suppressant. The symptoms took a chronic course even after NPE intake was discontinued. Similar drug-induced dyskinesias have been described for amphetamine and neuroleptic drugs. This side effect has, however, not yet been reported for NPE, which is pharmacologically related to amphetamine. One of the patients may also have had multiple sclerosis. Structural lesions in the basal ganglia area might predispose the development of such a movement disorder. The potential relationship between NPE intake and the development of dyskinesia is discussed. Appetite suppressants, often taken without the neurologist's knowledge, may be the cause of dyskinetic syndromes.
Adult↗
Effects of clozapine on CSF homovanillic acid in spasmodic torticollis.
We studied the effect of the atypical neuroleptic clozapine (CLO) on homovanillic acid (HVA) in cerebrospinal fluid (CSF) in five patients with spasmocid torticollis. Lumbar puncture was performed before and on the seventh day of CLO treatment. Although an HVA elevation was to be expected because of the antidopaminergic action of CLO, statistical analysis failed to reveal any significant increase of HVA under CLO treatment. Thus significance of CSF HVA may be less important for the description of antidopaminergic action of neuroleptics than previously assumed.
Adult↗
High-gradient magnetic cell sorting.
Explore the source record for details and available documents.
Animals↗
[Protection for the heart and brain: anesthesia in carotid artery operations].
Explore the source record for details and available documents.
Anesthesia, General↗