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Biomedical subjects

C Maier

Publications and source records attributed to C Maier.

At least 73 records · Page 4Linked to original sources
PubMed1998

Does prolonged oral treatment with sustained-release morphine tablets influence immune function?

UNLABELLED: Opioids such as morphine are the mainstay of acute and chronic pain treatment. The purpose of this study was to investigate the immunosuppressive effects of morphine in patients with pain syndromes. We investigated 10 patients with chronic pain syndromes undergoing treatment with oral sustained-release morphine (30-240 mg/d) before and after 1,4, and 12 wk of treatment compared with healthy control subjects without morphine treatment. Immunological variables of the cellular and humoral immune axis showed that 1) total lymphocyte counts and the distribution of lymphocyte subpopulations, including helper T-cell/suppressor cytotoxic T-cell ratios (CD4/CD8 ratios), did not change compared with baseline or healthy control subjects; 2) proliferation of peripheral mononuclear cells (PMC) was not impaired by morphine treatment; 3) interleukin 2 production increased after 4 wk of treatment with morphine; and 4) immunoglobulin (Ig) production was reduced before initiation of therapy in pain patients and decreased further during morphine treatment, whereas Ig concentrations in the circulation remained at normal levels. These results indicate that treatment with oral, sustained-release morphine does not have a suppressive effect on overall PMC function. On the other hand, Ig production was impaired in patients with chronic pain and was further suppressed by morphine. Whether this suppression of humoral immune function has a clinical impact on the immune system as a whole remains to be determined. IMPLICATIONS: Treatment of patients with chronic pain with oral, sustained-release morphine does not influence cellular immune function, but it suppresses the already attenuated production of immunoglobulins.

Administration, Oral↗
PubMed1998

Exacerbated pain in cervical radiculopathy at axial rotation, flexion, extension, and coupled motions of the cervical spine: evaluation by kinematic magnetic resonance imaging.

RATIONALE AND OBJECTIVES: The authors evaluate the functional changes in patients with cervical radiculopathy and increasing symptoms after provocative maneuvers at flexion, extension, axial rotation, and coupled motions of the cervical spine. METHODS: Twenty-one patients with cervical disc herniation (n = 17) or cervical spondylosis (n = 4) in whom symptoms were elicited at flexion, extension, axial rotation, and coupled motions of the cervical spine were studied. The patients were examined inside a positioning device by using a circular surface coil for signal reception. At neutral position (0 degrees) and at provocative positions sagittal T2-weighted turbo spin-echo, axial T2-weighted two-dimensional flash sequence, sagittal three-dimensional (3D) fast imaging with steady state precision sequence and coronal 3D double-echo-in-the-steady-state sequences were obtained. The 3D sequences were reformatted in the axial and oblique coronal planes perpendicular to the exiting nerve roots. The images were evaluated for the size of disc herniations, the foraminal size and cervical cord rotation or displacement at provocative position compared with neutral position (0 degrees). RESULTS: Compared with neutral position (0 degrees), change in size of disc herniation was not found in any (0%) of the provocative positions. In five (24%) patients cervical cord rotation or displacement was noted at axial rotation. The foraminal size increased at flexion, axial rotation to the opposite side of pain and flexion combined with axial rotation to the opposite side of the pain. The foraminal size decreased at extension combined with axial rotation to the side of the pain. A decrease or no change in foraminal size was observed at either extension or axial rotation to the side of the pain. CONCLUSIONS: In patients with cervical disc herniation or cervical spondylosis, exacerbated pain at defined provocative maneuvers is related more to changes in the foraminal size and to nerve root motion with, in some cases, cervical cord rotation or displacement than to changes in the size of herniated discs.

Adult↗
PubMed1998

Intraoperative monitoring with somatosensory evoked potentials in carotid artery surgery--less reliable in patients with preoperative neurologic deficiency?

BACKGROUND: In a retrospective analysis of intraoperative somatosensory evoked potential (SEP) results during carotid artery surgery we found some cases with postoperative neurologic deficits, surprisingly without significant SEP changes. METHODS: Median nerve SEP were monitored as usual. Indication for selective shunting was a complete loss of amplitude N20/P25 in the first period of the investigation, later on a 50% reduction, or a prolongation of the central conduction time (CCT) of about 1.5 ms after cross-clamping. Anaesthesia was maintained with isoflurane in N2O/O2, fentanyl and atracurium. RESULTS: Over a 3-year period 146 patients were monitored. Indications were: transient ischaemic attacks (TIA) (n=51), stroke (n=23), stroke with residuals (n=39), asymptomatical stenosis (n=29), subclavian steal syndrome (n=4). Twenty-four patients received an intraluminal shunt following SEP alterations. Postoperatively, 5 patients (3.4%) had symptoms of intraoperative brain ischaemia (stroke n=2, TIA n=3), 4 of them showing only minor intraoperative SEP alterations; 1 received a shunt because of CCT prolongation. Four of these 5 patients had cerebral neurologic deficiency preoperatively. CONCLUSION: Since some authors have found a 100% sensitivity of intraoperative SEP, it is remarkable, that 1 patient with postoperative stroke and 3 patients with TIA had no significant SEP changes intraoperatively. We suppose there was an association with preoperative neurological deficits resulting from previous strokes. In such cases, regional critical ischaemia may apparently occur outside the sensory pathway monitored with SEP.

Aged↗
PubMed1997

One-year prophylactic efficacy and safety of pantoprazole in controlling gastro-oesophageal reflux symptoms in patients with healed reflux oesophagitis.

BACKGROUND: Pantoprazole is a benzimidazole derivative which selectively inhibits the proton pump H+. K+-ATPase necessary for the final step in gastric acid secretion. AIM: To investigate the tolerability and the prophylactic effect of pantoprazole 40 mg once daily on relapse in patients whose reflux oesophagitis had been healed. METHODS: The safety of pantoprazole 40 mg once daily was assessed in an open 1-year trial on 222 patients whose reflux oesophagitis had been healed with omeprazole or pantoprazole. Relapse was defined as endoscopically-confirmed reflux oesophagitis (at least Grade I), with endoscopies being performed for patients experiencing 3 consecutive days of disease-specific symptoms. RESULTS: Kaplan-Meier survival analysis at 6 and 12 months gave estimated treatment failure rates of 2% and 6% from confirmed relapses (per-protocol), and of 9% and 30% for a worst-case group (all withdrawals counted as failures). The only population shift in laboratory variables was a doubling of the median serum gastrin level over the first 6 months; thereafter it stabilized. Fifty-four (24%) patients experienced adverse events; 15 of these withdrew. Serious adverse events were reported for 12 patients. CONCLUSIONS: Pantoprazole appears to be highly effective and to have a good safety profile for long-term prophylaxis of reflux oesophagitis.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1997

Tramadol in the management of post-operative pain: a double-blind, placebo- and active drug-controlled study.

A double-blind, randomized, placebo- and drug-controlled study in which the analgesic efficacy and safety of intravenous (i.v.) tramadol in patients with post-operative pain is reported. One hundred and eighty patients recovering from gynaecological or abdominal surgery were assigned to one of three treatment groups. After titration of an individual loading dose, patients could self-administer tramadol 20 mg, morphine 2 mg or placebo using a patient-controlled analgesia (PCA) device throughout a 48-h period. Criteria of efficacy were a decrease in pain intensity within the first 30 min of at least 20 on a visual analogue scale (VAS) (0 denotes no pain, 100 worst pain imaginable) and satisfactory analgesia in the patient's opinion during the study period. Patients treated with tramadol, morphine and placebo were assessed as responders at 66.7%, 75.0% and 18.3% (P < 0.0001). VAS after the initial bolus were 39.2 +/- 22.1, 35.9 +/- 21.6 and 50.0 +/- 24.2 (P = 0.002), the initial loading dose amounted to tramadol 144.9 +/- 51.2 mg, morphine 12.3 +/- 5.1 mg and placebo 17.2 +/- 4.9 mL. No serious opioid-related adverse events occurred in the patients given tramadol while two patients given morphine developed an impaired respiratory rate and a decreased oxygen saturation to 80% or less. Tramadol proved to be efficacious for PCA treatment of post-operative pain following gynaecological and abdominal surgery.

Adult↗
PubMed1997

Baroreflex sensitivity and heart rate variability in conscious rats with myocardial infarction.

The baroreflex sensitivity (BRS) and the heart rate variability (HRV) were studied in conscious rats after myocardial infarction (MI; induced by coronary artery ligation) and after sham operation (SH). BRS was determined by linear regression of R-R interval vs. arterial pressure changes induced by nitroprusside or methoxamine (intravenous bolus). HRV was calculated from 3-min electrocardiogram recordings. Left ventricular end-diastolic pressure and plasma atrial natriuretic peptide were increased after MI; plasma norepinephrine and basal heart rate (HR) remained unchanged. At 3 and 28 days after MI, BRS was reduced as indicated by decreased reflex bradycardia (RB) (MI, 0.66 +/- 0.13 and 0.78 +/- 0.07 ms/mmHg; SH, 1.27 +/- 0.16 and 1.48 +/- 0.14 ms/mmHg, respectively; P < 0.05 MI vs. SH). At 56 days after MI, BRS was normalized. RB was unaffected by atropine 3 and 28 days after MI but reduced in all other groups. The increase of basal HR by atropine 3 and 28 days after MI was less than in all other groups. HRV (SD of mean N-N interval, coefficient of variance, low- and high-frequency power; studied at 28 and 56 days) was similar in all groups. It is concluded that BRS is transiently depressed in rats with left ventricular dysfunction after MI probably due to a reduced reflex vagal activity. Even though basal HR and HRV are unchanged after MI, a temporary attenuation of tonic vagal activity is unmasked after autonomic blockade.

Analysis of Variance↗
PubMed1997

Effects of oral treatment with sustained release morphine tablets on hypothalamic-pituitary-adrenal axis.

Morphine is suggested to influence immune function by activation of hypothalamic-pituitary-adrenal axis. Thus, we investigated 8 pain patients prior to and during prolonged oral treatment with 30-240 mg of sustained release morphine for plasma concentrations of adrenocorticotropic hormone and serum concentrations of cortisol. Results revealed that pain patients at basal status had elevated cortisol concentrations. Hormone concentrations measured after 1, 4 and 12 weeks of morphine treatment were significantly decreased, not normalized, but at very low values. Since these data, even in the absence of clinical symptoms, might have been indicative for adrenal insufficiency, a corticotropin-releasing hormone test was performed in 2 patients. After injection of 100 micrograms of human corticotropin-releasing hormone. ACTH and cortisol concentrations increased sufficiently. In conclusion, even though low hormonal concentrations were observed in pain patients during morphine treatment, pituitary and adrenal stimulation of the endocrine axis remained intact.

Administration, Oral↗
PubMed1996

Gallstone recurrence after successful dissolution therapy.

After successful dissolution therapy of cholesterol gallbladder stones bile again becomes supersaturated and recurrent gallstones may develop. Three different postdissolution treatments [500 mg ursodeoxycholic acid (UDCA) per day (N = 14, group I), 100 mg aspirin per day (N = 14, group II) and diet (N = 15, group III) versus a control group (no treatment, N = 15, group IV) aimed at preventing recurrence of gallstones were investigated in a prospective, randomized study in 58 gallstone patients (33 female, 25 male) after complete stone clearance. Bile samples (prior to dissolution therapy and at stone recurrence) were investigated for biliary cholesterol (C), phospholipids (PL), total bile acid concentration (BA), cholesterol saturation index (CSI), total lipid concentration (TLC), total biliary protein concentration (TP), and nucleation time (NT). In group IV multiple gallstones tended to recur more often than solitary stones (66.7% vs 16.7%) whereas in groups I-III only solitary stones recurred. Recurrent gallbladder stones were detectable in 10 patients (eight patients in group IV and one each in groups I and II, respectively) within one year after dissolution and in two patients (one each in groups III and IV, respectively) after 15 months. Furthermore, the probability of stone recurrence was significantly higher in untreated patients as compared to treated patients. In nine (group IV) of 12 patients with recurrent stones NT, C, CSI, PL, BA, TLC, TP, and bile acid spectrum remained nearly unchanged as compared to their pretreatment values, whereas in three (groups I-III) of 12 cases a decrease in C, CSI, and TP was observed during therapy. However, in each of these three patients, initial and after-treatment TP was significantly higher and NT shorter as compared to groups I-IV. Furthermore, in these cases (N = 3) NT was prolonged, whereas no significant changes were found in PL, BA, TLC, and bile acid spectrum. Recurrence of gallstones, which seems to occur more likely in patients with multiple stones as compared to solitary stones, will happen in the early stage after stone clearance, again causing biliary pain. UDCA, aspirin or diet will reduce the probability for recurrent stones after complete gallstone dissolution.

Adult↗
PubMed1996

Reflex sympathetic dystrophy: skin blood flow, sympathetic vasoconstrictor reflexes and pain before and after surgical sympathectomy.

To examine the pathophysiological mechanisms of vascular disturbances and to assess the role of the sympathetic nervous system, 12 patients with reflex sympathetic dystrophy (RSD) of the hand were studied using laser Doppler flowmetry. Cutaneous blood flow, skin resistance and skin temperature were measured at the affected and contralateral hands. Sympathetic vasoconstrictor reflexes were induced bilaterally by deep inspiration. Four patients were treated with unilateral surgical sympathectomy and pain and vascular changes were documented in follow-up investigations. (1) After acclimatization in cold environment (< or = 18 degrees C) blood flow and skin temperature were considerably lower on the affected side in 10 patients. No additional vasoconstrictor reflexes could be elicited. (2) After acclimatization in warm environment (22-24 degrees C) blood flow and skin temperature demonstrated no side differences in all cases. Vasoconstrictor responses were the same on both sides. (3) After sympathectomy vasoconstrictor reflexes were absent. Skin resistance was considerably higher on the affected side. In the first 4 weeks the affected hand was warmer and blood flow was higher compared with the healthy side. Thereafter, skin temperature and perfusion slowly decreased and the affected hand turned from warm to cold. Very regular high amplitude vasomotion waves occurred unilaterally. There were no signs of reinnervation. Two patients had long-term pain relief. We conclude as follows. (1) Side differences in skin temperature and blood flow are no static descriptors in RSD. They are dynamic values depending critically on environmental temperature. Therefore, they have to be interpreted with care when defining reliable diagnostic criteria. (2) Vascular disturbances in RSD are not due to constant overactivity of sympathetic vasoconstrictor neurons. Changes in vascular sensitivity to cold temperature and circulating catecholamines may be responsible for vascular abnormalities. Alternatively, RSD may be associated with an abnormal (side different) reflex pattern of sympathetic vasoconstrictor neurons due to thermoregulatory and emotional stimuli generated in the central nervous system. (3) After sympathectomy, denervation supersensitivity of blood vessels and intense vasomotion may be associated with recurrence of pain in some patients.

Adult↗
PubMed1996

Phytohemagglutinin-dependent T-cell proliferation is not impaired by morphine.

Opioids have been reported in the literature to have immunosuppressive properties. Thus, we investigated the influence of morphine, morphine-3-glucuronide and morphine-6-glucuronide in vitro on phytohemagglutinin-stimulated proliferation of peripheral mononuclear cells from healthy humans. Furthermore, the effects of a 1-week treatment with morphine in a range of 30-240 mg/day on proliferation of lymphocytes from patients with chronic pain syndromes were evaluated. In addition, human peripheral mononuclear cell membranes were tested for specific opioid radioligand binding. The results show that i) morphine and its main metabolites do not influence mitogen-induced T-cell proliferation, ii) treatment of patients with sustained release morphine for 1 week did not impair the lymphocyte proliferative response, and iii) no specific binding of mu-, delta- and kappa-radioligands could be demonstrated to membranes of peripheral lymphocytes obtained from healthy humans. These results do not indicate an impairment of phytohemagglutinin-induced T-cell proliferation during pain treatment with sustained release morphine.

Analgesics, Opioid↗
PubMed1995

Effect of extracorporeal shock-wave lithotripsy on gallbladder emptying in patients with solitary and multiple gallbladder stones.

In a prospective study, we investigated the effect of extracorporeal shock-wave lithotripsy (ESWL) on gallbladder contractility and on fasting and residual gallbladder volume in patients with solitary and multiple gallbladder stones with stone densities < 100 Hounsfield units (HU) and adequate gallbladder function. Twenty-five patients (seven males and 18 females, mean age 48.5 +/- 11.7 years) treated with ESWL were assigned to either group I, consisting of 13 patients with solitary stones < 20 mm diameter, or group II, including patients with two to three stones and maximum stone diameter of 30 mm. ESWL was performed with the MPL 9000 lithotripter. Gallbladder ejection fraction was determined using the method of Dodds after a 12-hr fast and following application of a standard stimulative meal. Gallbladder volume was measured by ultrasound over 90 min at 10-min intervals before ESWL, then at 1, 30, 120, and 210 days after ESWL. At 24 hr after ESWL, residual gallbladder volume increased in group I from 7.4 ml to 13.9 ml (P = 0.0567) and in group II from 6.5 ml to 20.2 ml (P = 0.0076). Thereafter, residual volumes returned to pre-ESWL levels. In group II, post-ESWL fasting volumes were significantly increased over initial values at all time intervals. Correspondingly, only at 24 hr after ESWL, ejection fractions decreased from 73.1% to 64.9% in group I and from 76.5% to 62.7% in group II. No statistically significant differences in gallbladder contractility between the two groups were observed at any point of the follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

A double-blind study of pantoprazole and ranitidine in treatment of acute duodenal ulcer. A multicenter trial. European Pantoprazole Study Group.

Pantoprazole is a new substituted benzimidazole, which is a potent inhibitor of gastric acid secretion by its inhibition of H+,K(+)-ATPase. Pantoprazole, 40 mg, was compared with the H2-receptor antagonist ranitidine, 300 mg, in the healing of acute duodenal ulcer. Two hundred seventy-six patients with endoscopically diagnosed duodenal ulcer were studied in this multicenter double-blind study. Patients were reendoscopied after two weeks of treatment, and those patients whose ulcers remained unhealed were also endoscoped after an additional two weeks of treatment. The primary end point was the complete healing of the ulcer. Demographic characteristics were comparable in both treatment groups. After two weeks of treatment, 90/124 (73%) patients in the pantoprazole group had healed ulcers compared with 57/126 (45%) patients in the ranitidine group (P < 0.001, per-protocol analysis). After four weeks, the cumulative healing rates were 92% and 84% in the pantoprazole and ranitidine groups, respectively (P = 0.073). Symptoms were also improved at week 2, with 84% and 72% of patients in the pantoprazole and ranitidine groups, respectively, reporting no ulcer pain (P < 0.05, per-protocol analysis). Both treatments were well tolerated. This study has confirmed the superiority of pantoprazole compared with ranitidine in the healing of duodenal ulcers and pain relief after two weeks of treatment and has shown pantoprazole to be well tolerated in this indication.

2-Pyridinylmethylsulfinylbenzimidazoles↗