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Biomedical subjects

A Thiel

Publications and source records attributed to A Thiel.

At least 127 records · Page 7Linked to original sources
PubMed1994

[Topographic changes in cerebral electric activity after premedication with flunitrazepam].

AIM: The effects on cerebral function of premedication with the benzodiazepine flunitrazepam and with morphine were studied on the evening of the preoperative day (2 mg flunitrazepam p.o.) and 90 minutes before induction of anaesthesia (2 mg flunitrazepam plus 15 mg morphine i.m.). DESIGN: The EEG was analysed topographically (17 electrodes) and quantitatively. RESULTS: As a typical effect of benzodiazepines, increases in electrical activity in the frequency band beta-1 of the power spectrum were observed, and could be demonstrated 10 minutes after oral application, mainly in the frontal and central parts of the cortex. Increases in the powerbands delta and theta indicated induction of sleep approximately 15-20 minutes after application and were not looked upon as an effect of the benzodiazepine exclusively. These increases were noticed first in the central, occipital and temporal areas and after 30 minutes in the frontal parts of the cortex. Flunitrazepam plus morphine showed qualitatively similar but quantitatively less pronounced results. Topographical differences were similar to the results of an application of flunitrazepam alone. DISCUSSION: The results demonstrate the importance of a topographical as well as quantitative evaluation in studies on complex interactions of sedative or narcotic drugs and their clinical effects on cerebral function.

Administration, Oral↗
PubMed1994

Clozapine treatment of spasmodic torticollis.

We report a trial of clozapine (CLO) in patients with spasmodic torticollis (ST). In an open-design trial we treated five patients with adult-onset ST with CLO (300 mg/d) over 12 weeks and one patient over 3 weeks. We videotaped the patients three times (before and at the end of CLO treatment, and 2 weeks after CLO withdrawal) according to a standardized protocol. At the end of the treatment period, CLO plasma concentrations ranged from 67 to 371 ng/ml. In all six patients, analysis of the video ratings and patients' self-assessments failed to reveal any improvement of ST. These preliminary results fail to confirm any therapeutic benefit of CLO in the treatment of ST.

Adult↗
PubMed1994

[Life threatening embolism caused by central venous catheter fragments in psychiatric patients].

Central venous catheters are sometimes the cause of life-threatening complications. In two patients with underlying psychiatric disorders we observed an embolism as a result of catheter fragments. The first patient was a 30-year-old woman with a borderline personality disorder and several previous episodes of self-mutilation, psychogenic seizures and disturbances of consciousness. She cut her central venous line positioned in the external jugular vein when she was unattended. The intravasal fragment dislocated into the right ventricle and had to be removed by a forceps used for myocardial biopsies. The second patients was a 34-year-old mentally retarded male with a history of psychomotoric and grand mal seizures who suffered from a prolonged disturbance of consciousness with uncontrolled motor activity after four grand mal seizures. Despite physical restraint, the tip of his central venous catheter inserted through the subclavian vein broke and embolized in the right atrium. The embolus was removed by thoracotomy. To avoid these complications central venous lines should be used only when critically needed in uncooperative patients or those who display disturbance of consciousness and uncontrolled motor activity.

Adult↗
PubMed1994

[Intensive care treatment of psychiatric patients].

In a retrospective analysis we studied the frequency and cause of intensive care measures for psychiatric patients. All inpatients seen in the Department of Psychiatry, University of Göttingen, between 1985 and 1990 who either were treated in an intensive care unit (ICU) or died during treatment were included. 218 patients fulfilled these criteria, representing 2.4% of all psychiatric inpatients. In the sample as a whole, addiction (29%) and neurotic disorder (27%) were the largest diagnostic groups, followed by organic psychoses (15%). In comparison with other psychiatric diagnoses, addictive and organic disorders were overrepresented. The patients originally seen in the Department of Psychiatry (n = 70) were admitted to the ICU for various reasons (24% alcoholic delirium, 17% electrolyte disturbances and dehydration, 16% pneumonia, 11% suicide attempts, 7% thrombosis, etc.). Reasons for admission directly to the ICU (n = 138) with subsequent referral to the Department of Psychiatry were generally either suicide attempts (53%) or complications of addiction (32%). Thirty-six per cent of all patients required tracheal intubation. Patients with endogenous psychoses required mechanical ventilation more often than patients with other psychiatric diagnoses. Sixteen deaths occurred in this period of time, most often in patients with organic psychoses (n = 6). These results illustrate a high incidence of severe medical disorders in psychiatric inpatients. They emphasize the necessity of intensive collaboration between psychiatrists and intensive care physicians.

Adult↗
PubMed1993

Pharmacokinetic quantification of the exchange of drugs between blood and cerebrospinal fluid in man.

Various parameters which may be useful in quantification of drug transit from blood into CSF and vice versa after a short duration infusion are compared here by recalculating previously published data from our group. Due to the slower entry into and elimination from the CSF compartment as compared to the central compartment, the ratio of drug concentrations in CSF and serum sampled at the same time increase with time after an infusion. Therefore, concentration quotients of simultaneously drawn blood and CSF are inadequate to characterise CSF penetration. The ratio of the areas under the concentration-time curves in a body fluid and serum (AUCbody fluid/AUCs) is an established measure to quantify overall penetration from the central into a peripheral compartment. AUCCSF/AUCs is closely correlated with the quotient of the maximum CSF and serum concentrations (CmaxCSF/CmaxS) (rs = 0.87, n = 42, P < 0.001) and with the rate constant of distribution in CSF (CLin/VCSF) (rs = 0.80, n = 42, P < 0.001). Since CmaxCSF/CmaxS depends on the mode of drug administration, it is suggested that AUCCSF/AUCs be used to quantify overall drug transit into CSF. CLin/VCSF is of use when CSF can only be sampled once, or when the velocity of the transit of a drug into CSF is to be described. The CSF exit rate constant (CLout/VCSF) characterises elimination from CSF independent of the elimination from serum and may be applied to estimate the formation rate of CSF; in the present study it averaged 20 ml/h.

Blood↗
PubMed1993

[Anesthesia in familial hyperkalemic periodic paralysis].

A 53-year-old woman was scheduled for elective surgery of a L4-L5 lumbar disc prolapse. Preoperatively, she reported of a hereditary muscle disease in her family which could be identified as familial hyperkalaemic periodic paralysis. In patients with familial periodic paralysis, only limited information is available in the current anaesthesiological literature. This is especially true of the hyperkalaemic form which was separated from the hypokalaemic form in 1957. Most patients suffering from periodic paralysis will develop myotonic symptoms in time, but evidence is lacking that the incidence of malignant hyperthermia (MH) is higher than in normals. However, abnormalities of the electrocardiogram (ECG) due to changes in the potassium serum levels are not unusual, and the anaesthesiologist must be aware of cardiac arrhythmias. In the present case, the patient was anaesthetized using fentanyl, midazolam, and vecuronium, and ventilated with 66% nitrous oxide in oxygen. Radial artery blood pressure, end-tidal CO2, and nasopharyngeal temperature were monitored continuously. Surgery was completed after 2 hours with no abnormalities in the intraoperative course. Recovery from anaesthesia was uneventful. During the postoperative follow-up for 1 week, further attacks of paralysis, intermittent sodium-potassium imbalance of the muscle cell membrane appears to be the primary pathogenetic factor. In this special disease, prevention of carbohydrate depletion and the avoidance of muscle relaxants are recommended in the anaesthesiological literature. However, a specified regimen of general anaesthesia has not yet been outlined. In our special case, the use of anaesthetics deemed to be safe in MH susceptible patients produced an uneventful perioperative course.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMed1993

Subclinical eating disorders in male athletes. A study of the low weight category in rowers and wrestlers.

This study investigated the possibility that male athletes who, owing to the rules of their sport, are pressured to maintain a low weight show an elevated prevalence of subclinical eating disorders. Twenty-five wrestlers and 59 rowers in the lower weight categories were investigated using the Eating Disorder Inventory (EDI). Fifty-two percent of the athletes reported the occurrence of binging. The EDI profiles of 11% of the athletes suggested the presence of a subclinical eating disorder. These figures are clearly elevated compared with the normal male population. Low-weight wrestlers and rowers should be considered a high-risk male population for subclinical eating disorders. These findings are comparable to high-risk groups consisting mainly of women (such as ballet and modelling students). The causal relationship between the specific sport and the development of a psychogenic eating disorder is discussed.

Adolescent↗
PubMed1993

Intoxication in manic patients following chaotic self-administration of lithium.

Intoxication is a serious complication of lithium therapy. Suicides attempted by depressive patients or excessive serum levels due to reduced renal elimination are typical causes of these intoxications. So far, lithium intoxications following excessive intake by patients with manic disorders have not been reported. We present 4 case histories of manic patients in whom the diagnosis of lithium intoxication was delayed, even though their affective disorders and medication were known. Lithium should be determined immediately on a routine basis in all patients who, on the basis of their history, are known to receive or who, considering the underlying mental illness, possibly receive lithium therapy.

Adult↗
PubMed1993

[Body image of the male athlete. A study of the psychological health of wrestlers and rowers of the lower weight class].

The present study reports findings concerning the body-experience of male athletes. 25 wrestlers and 59 rowers in the lower weight categories were investigated using the questionnaire for evaluation of body-experience "Fragebogen zur Beurteilung des eigenen Körpers--FBK" (Strauss u. Appelt, 1983). Due to nature of their sports, these men are particularly subject to a constant pressure to maintain a low body weight. In 31% of the subjects the FBK profiles were indicative of disturbances of body-image and body-experience. This subgroup also demonstrated multiple pathologically elevated scores in the personality questionnaire "Freiburger Persönlichkeitsinventar" (Fahrenberger et al. 1984) and the Eating-Disorder-Inventory (Garner et al. 1983). Low-weight wrestlers and rowers should be considered a high-risk male population for body-image disturbances and other psychological disorders. The casual relationship between the specific sport and the development of an body-image disorder is discussed.

Adolescent↗
PubMed1993

["Psychologic marital unfitness" in cyclothymia? A case report on the topic of the annullment procedure in canon law].

According to the Canon Law (CIC) of the catholic church a marriage can be annulled because of psychological inability under certain conditions. We present the case report of a married woman, who fell ill with cyclothymia after her first childbirth. Her marriage was annulled under canon 1095 (n.3 CIC) because of psychological inability to fulfill martial obligations. The authors believe that this represents a clear cut case of discrimination against patients with mental disorders: on the one hand the catholic church claims that every martial bond is principally indissoluble; on the other hand they do not eschew invalidating a marriage due to an affective psychosis. This poses special problems which are also discussed.

Adult↗
PubMed1993

[Dementia and psychotic symptoms in amyotrophic lateral sclerosis].

We present 2 case histories of patients, treated in psychiatric clinics because of psychotic disorders, in whom further investigation revealed the presence of amyotrophic lateral sclerosis (ALS) and dementia. The causal relationship between psychotic symptoms and dementia on the one hand and ALS on the other hand is discussed. Probably in ALS other functional systems besides motor-neuron pathways are involved.

Amyotrophic Lateral Sclerosis↗
PubMed1992

Transcranial Doppler sonography: effects of halothane, enflurane and isoflurane on blood flow velocity in the middle cerebral artery.

Systolic, diastolic, and mean blood flow velocity in the middle cerebral artery (Vs,mca; Vd,mca; Vm,mca) and pulsatility (Vs-Vd)/Vm of the waveform obtained were recorded in 51 patients before, during and after general anaesthesia. Transcranial Doppler (TCD) sonographic variables were measured in the awake patient and after induction of anaesthesia with thiopentone 5-6 mg kg-1. After tracheal intubation, 17 patients received 0.8% halothane and 66% nitrous oxide in oxygen for 30 min (15 min normoventilation; 15 min hyperventilation). The inspired halothane concentration was then increased to 1.6% for 45 min (15 min normoventilation; 15 min hyperventilation; 15 min normoventilation with nitrous oxide replaced by oxygen). Enflurane (1.7% for 30 min and 3.4% for 45 min) was given to another 17 patients; 17 other patients received isoflurane (1.2% and 2.4%). Mean arterial pressure (MAP), nasopharyngeal temperature, end-tidal carbon dioxide concentration, inspired and end-tidal anaesthetic agent concentrations, haemoglobin concentration, PVC and TCD variables were measured at the end of each 15 min period. After recovery from anaesthesia, TCD variables were measured again. There were no intergroup differences in changes in MAP, nasopharyngeal temperature, haemoglobin concentration and PCV. Halothane, enflurane and isoflurane at low doses and normoventilation had little influence on TCD variables compared with awake values. In large concentrations with nitrous oxide in oxygen and normoventilation, there were differences between the volatile agents. Halothane increased blood flow velocities, but enflurane and isoflurane caused little change. Hyperventilation always decreased blood flow velocities and increased pulsatility.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Studies using S-(+)-ketamine on probands. Endocrine and circulatory reactions, recovery and dream experiences].

UNLABELLED: Clinically used ketamine is a racemic mixture of two isomers, S(+)- and R(-)-ketamine. The anaesthetic potency of S(+)-ketamine was found to be three times higher than that of R(-)-ketamine. It was the aim of this study to compare the effects of racemic ketamine and S(+)-ketamine on endocrine and cardiovascular parameters, recovery and psychomimetic reactions in young healthy volunteers. METHODS: 6 women and 4 men between 23 and 38 years were investigated twice in a randomized double blind cross-over design receiving injections of 2 mg/kg BW racemic ketamine or 1 mg/kg BW S(+)-ketamine at an interval of at least 7 days. Samples were taken from a central venous catheter before and 1, 3, 5, 10, 15, 30, 60 and 120 min after injection for analysis of adrenaline, noradrenaline (by high pressure liquid chromatography with electrochemical detection), ADH, ACTH, cortisol (by radio immuno assay), glucose, lactate and free glycerol. In addition, SAP, HR, and arterial oxygen saturation were measured, and return of consciousness and orientation were protocoled. Incidence and assessment of dreams were reported by the volunteers. RESULTS: Adrenaline, noradrenaline, ACTH, cortisol, lactate and free glycerol in plasma as well as SAP and HR increased significantly after injection of both racemic ketamine and S(+)-ketamine. The influence on ADH and glucose was not significant. There were no differences between racemic ketamine and S(+)-ketamine in these parameters. Recovery was significantly improved after administration of S(+)-ketamine. Simple orders were followed after 7.9 +/- 1.1 vs. 9.2 +/- 1.2 min (P = 0.004). Orientation with respect to the person returned after 9.0 +/- 1.8 vs. 11.5 +/- 2.5 min (P = 0.004); with respect to time and location after 10.1 +/- 2.1 min vs. 13.4 +/- 4.0 min (P = 0.007). 18 dreams were reported; assessment was positive in 13 cases and indifferent in 5 cases, none was negative. In 7 of 10 cases, the investigators were able to identify that S(+)-ketamine had been injected. CONCLUSION: With respect to endocrine and cardiovascular parameters, the pharmacodynamic effects of racemic and S(+)-ketamine were comparable. Because of the significant improvement in recovery and the reduced quantitative drug load, S(+)-ketamine offers a clear clinical advantage compared with currently used racemic ketamine.

Adrenocorticotropic Hormone↗
PubMed1992

[Studies using S-(+)-ketamine on probands. Computerized EEG-analysis and transcranial Doppler ultrasonography].

It has been shown in the recent literature that the anaesthetic potency of the ketamine isomer S(+)-ketamine is twice that of the racemic mixture used in clinical practice. METHODS. With approval of the local ethics committee, we investigated the effects of a bolus injection of 2 mg/kg racemic ketamine or 1 mg/kg S(+)-ketamine, respectively, on the electroencephalogram (EEG) and transcranial Doppler sonography (TCD) of the middle cerebral artery in ten healthy volunteers by means of a randomised, double-blind, cross-over design. Spectral edge frequency, total activity and activity of the alpha, beta, delta, and theta bands were assessed by bihemispheric leads using the Neurotrac system before (MZP 1) and 1, 3, 5, 10, 15, 30, 60, and 120 min after injection (MZP 2-9). Simultaneously, systolic (Vs-MCA), diastolic (Vd-MCA), and mean (Vm-MCA) blood flow velocities in the middle cerebral artery and pulsatility (Vs-Vd)/Vm were recorded. Statistics consisted of two-dimensional analysis of variance with P < 0.05 considered as significant. RESULTS. Racemic ketamine and S(+)-ketamine produced comparable effects on the EEG. Theta- and beta-activities increased between the 1st and 10th min after injection and returned to near baseline values thereafter. 120 min after injection, the absolute delta- and theta-activities were higher following racemic ketamine when compared to the S(+)-ketamine group. However, significant differences between the groups could not be confirmed statistically. TCD variables changed considerably in the course of the study without intergroup differences. Compared to the baseline values, Vs-MCA, Vd-MCA, and Vm-MCA increased significantly for the first 15 min after injection with a maximum at MZP 3. The pulsatility of the obtained Doppler waveform (Vs-Vd)/Vm showed significant decreases at MZP 2-4. CONCLUSIONS. In our study, both racemic ketamine and its isomer S(+)-ketamine produced similar EEG changes consistent with the data from earlier studies. However, the relative lower proportion of slow EEG activity at the end of the study might indicate a better recovery of cortical function following S(+)-ketamine than after racemic ketamine. Assuming a close relationship between cerebral blood flow velocity and cerebral blood flow, our TCD results suggest that both racemic ketamine and S(+)-ketamine will considerably increase cerebral blood flow in spontaneously breathing volunteers. Such an effect has been observed by others and, at least partly, can be explained by a concomitant increase in arterial carbon dioxide partial pressure.

Adult↗
PubMed1991

Treatment of advanced chronic lymphocytic leukemia by fludarabine. Results of a clinical phase-II study.

In a clinical phase-II study fludarabine phosphate was given to 20 patients with advanced chronic lymphocytic leukemia who had failed on prior conventional therapy. Fludarabine was administered at a dose of 25 mg/m2/d for 5 days. Treatment cycles were repeated every 4 weeks until maximal response, followed by two cycles for consolidation. Four of the 20 patients achieved complete remission and seven patients partial remission, resulting in an overall response rate of 55% (11/20). Fludarabine therapy was well tolerated, with mild myelosuppression and secondary infections comprising the predominant side effects. These data warrant further confirmation and a randomized comparison of fludarabine with established regimens, which is currently underway.

Adult↗