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C Maier

Publications and source records attributed to C Maier.

At least 109 records · Page 6Linked to original sources
PubMed1994

[Relations between intrapsychic and familial structures in schizophrenic patients].

The authors present the results of a research project that points out the connections of the clinical signs of schizophrenia with the intrapsychic space referring to the repertory-grid test and with the circumplex model of family dimensions (Olson-Faces II). The acute psychotic episode was connected with characteristic arrangements of the representational elements in groups and with disintegration of the family rules system. Also the postpsychotic phase displayed a characteristic constellation of the representational elements in the repertory-grid test. The results of the research project underline the important role of the affects during both the acute and the postpsychotic phase of schizophrenia as organizing and integrating factors of the affective-cognitive reference system described by Ciompi.

Adolescent↗
PubMed1994

The effect of ursodeoxycholic acid on nucleation time in patients with solitary or multiple gallbladder stones.

OBJECTIVE: The objective of this study was to determine the effect of ursodeoxycholic acid (UDCA), 1000 mg/day, on nucleation time and cholesterol saturation index (CSI) in human gallbladder bile. METHODS AND RESULTS: In 48 patients with cholesterol gallbladder stones undergoing extracorporeal shockwave lithotripsy, bile samples exhibited a significant longer median nucleation time in the case of solitary stones (7.9 +/- 5.1 days) than in patients with multiple stones (1.7 +/- 1.0 days; p < 0.0001). Stone number and nucleation time were correlated inversely (r = -0.79). UDCA led to a significant prolongation of nucleation time (solitary stones 17.9 +/- 5.8 days, multiple stones 18.0 +/- 5.7 days; p < 0.01) with a concomitant disappearance of cholesterol liquid crystals and cholesterol monohydrate crystals in gallbladder bile. Initially, there was no difference in the CSI between patients with solitary stones or multiple gallbladder stones (1.4 +/- 0.3 vs. 1.4 +/- 0.4, respectively). UDCA caused a significant decrease in CSI by 64.3% (p < 0.01). CONCLUSIONS: We conclude that UDCA prolongs the nucleation time by decreasing the cholesterol saturation index, as well as by diminishing cholesterol liquid crystals and cholesterol monohydrate crystals in gallbladder bile from patients with cholesterol gallstones. Second, recurrent stones essentially occur in patients with multiple cholesterol gallstones, reflected by a concomitant short nucleation time.

Bile↗
PubMed1994

Does adequate patient selection reduce the risk of gallstone recurrence after successful extracorporeal shockwave lithotripsy?

To determine the risk of gallbladder stone recurrence in these patients, 58 of the first consecutive 61 patients with solitary stones achieving complete stone clearance after ESWL and adjuvant bile acid therapy were included in a prospective study. All patients were observed for at least 12 months following discontinuation of oral bile acids. Twenty-one patients fulfilled our postulated ideal criteria (solitary radiolucent stones between 10-20 mm initial diameter, initial stone density < 50 HU, gallbladder ejection fraction > 70%). The remaining patients (n = 37) fulfilled the criteria of the Munich study group. In patients fulfilling our ideal criteria, stone recurrence was not observed in any patient, while in those fulfilling solely the criteria of the Munich group, five instances of stone recurrence were observed (13.5% [n = 37], p < 0.1). Initial stone count is only one factor influencing the probability of gallstone recurrence following ESWL and discontinuation of oral bile acids. Our data suggest that factors such as low initial stone density at gallbladder CT and good gallbladder function not only accelerate initial stone clearance but also reduce the risk of stone recurrence after ESWL once oral bile acids have been discontinued.

Adult↗
PubMed1993

Neuroprotection by the alpha 2-adrenoreceptor agonist dexmedetomidine in a focal model of cerebral ischemia.

BACKGROUND: Dexmedetomidine, a highly selective alpha 2-adrenoreceptor agonist, decreases central sympathetic activity and reduces the anesthetic requirement of halothane. Preliminary studies show that dexmedetomidine improves the outcome from ischemic injury and, therefore, may have potential therapeutic value. METHODS: The authors studied 14 rabbits that underwent a 2-h occlusion of the left internal carotid, anterior cerebral, and middle cerebral arteries, followed by 4 h of reperfusion. Ten minutes after occlusion, the animals were treated with either normal saline (n = 7) or dexmedetomidine (n = 7) using a computer-controlled infusion rate calculated to maintain a steady state plasma concentration. Halothane concentration was reduced by 50% for dexmedetomidine-treated animals to maintain a comparable level of anesthesia. Somatosensory evoked potentials were used to confirm adequate ischemia, and injury was assessed by histopathology. RESULTS: There were significant differences in the area of ischemic neuronal damage between the groups in the cortex (halothane alone, 38.2 +/- 6.0% SEM vs. halothane plus dexmedetomidine, 20.0 +/- 2.7% SEM, P = 0.018), but not in the striatum (halothane alone, 68.7 +/- 12.6% SEM vs. halothane plus dexmedetomidine, 43.5 +/- 15.9% SEM, P = 0.24), nor in physiologic parameters. Dexmedetomidine plasma levels obtained every 90 min showed a mean of 4.0 +/- 0.15 ng/ml. CONCLUSIONS: Results from this study indicate that postischemic administration of dexmedetomidine, in a dose that reduces the anesthetic requirements by 50%, has a neuroprotective effect in this model of focal cerebral ischemia.

Adrenergic alpha-Agonists↗
PubMed1993

[Radiologic position control of epidural catheters (epidurography). An instrument of quality assurance for regional analgesia].

Epidural analgesia is a very efficient method of postoperative pain management. Nevertheless, problems such as unilateral analgesia, sensory loss and inadequate pain relief are often difficult to handle. Radiologic evaluation of the position of the catheter and the spread of radiopaque dye (epidurography) is an important advance toward a solution of these problems. METHODS. The findings of 110 consecutive epidurographies from the acute pain service of the Department of Anaesthesiology of the University Hospital of Kiel, Germany, were analysed. Radiograms were obtained following the injection of 2 ml and an additional 8 ml of radiopaque dye (iopamidol) in the anterior-posterior and lateral plane. In addition, typical and instructive examples of epidurographies from the past 8 years are presented. RESULTS. In 99 of 110 patients the epidurography revealed a proper position of the catheter. Seven cases of partial displacement (e.g. paravertebral spread of radiopaque dye) and two cases of complete misplacement were documented. Allergic reactions or other side effects were not observed. The radiologic criteria for a proper epidural position of the catheter are discussed (Fig. 2a). Furthermore, examples of the following malpositions of epidural catheters are presented: intravascular misplacement (Fig. 2b), paravertebral misplacement (Fig. 2c), paravertebral escape of radiopaque dye (Fig. 2e) and correct distribution after the catheter had been withdrawn 2 cm (Fig. 2f), intrathecal misplacement (Fig. 2g), and simultaneous spread of dye in the subarachnoid and epidural space in a patient with preceding dural tap (Fig. 2h). In some cases unexpected reasons for problems in postoperative pain management were revealed by epidurography (e.g. disc prolapse, (Fig. 2d). CONCLUSION. In our view epidurography is a valuable way of improving the quality and safety of postoperative epidural analgesia. It is an important tool for decision-making in the event of clinical problems. The benefits for the patients have to be weighed against the radiation exposure.

Aged↗
PubMed1993

[Morphine tablets for chronic non-tumor-induced pain. Which factors modify the success or failure of a long-term therapy?].

In a prospective study 60 patients receiving morphine for treatment of mostly neuropathic and musculoskeletal pain of non-malignant origin were investigated. The aim of the study was to determine the characteristics of responders to morphine therapy and the frequency and severity of side effects. METHODS. Eligible patients suffered from chronic pain that had not been relieved despite all current therapy. All of them received controlled-release morphine tablets. Dose was increased in case of insufficient pain relief. Before morphine treatment and at the follow-ups pain intensity was rated on a numeric analogous scale, analgesia and side effects on a four-stage verbal rating scale. Intake of the prescribed and other drugs was randomly controlled by urine analysis. The patients were divided in three groups retrospectively: group I, non-responders who ceased the morphine therapy within 1 month due to weak analgesia or severe side effects; group II, patients in whom the therapy was stopped within the following months despite persisting pain; group III, patients who continued therapy. STATISTICS. ANOVA, chi-squared test, non-parametric tests (Kruskal-Wallis, Wilcoxon). Results were accepted as significant at p < 0.05. RESULTS. Twenty-three patients were non-responders. Fourteen other patients stopped the therapy after initial response because the side effects exceeded the benefit of analgesia (group II). Only 10 of the remaining 23 responders had good analgesia and minor side effects during the observation time. Constipation, despite prophylactic laxatives, and nausea were the most frequently reported events causing cessation of therapy. Analgesia and side effects in groups II and III were constant during the observation time of 241 (36-1486) days. In groups II and III, 43% of the patients needed an increase of the morphine dosage during therapy. The initially sufficient morphine dosage was significantly higher in group II than in group III; only one patient needed more than 90 mg/day in group III. Urine screening tests in 45 patients disclosed that 18 patients concealed the intake of other opioids or psychotropic drugs, mostly benzodiazepines. CONCLUSIONS. The study showed many problems with the patients' compliance and acceptance of oral morphine due to side effects and lack of analgesia. The discrepancy from other, positive reports might be explained by the extremely selected patients of this study and by the fact that not only responders were included for evaluation. Patients' compliance seems to have been overestimated in previous studies because no urinary controls were taken.

Administration, Oral↗
PubMed1992

Primary structure differences of human surfactant-associated proteins isolated from normal and proteinosis lung.

The primary structures of human pulmonary surfactant-associated proteins SP-A, SP-B and SP-C isolated from lung lavage of patients with alveolar proteinosis exhibit significant differences from lung surfactant proteins isolated from lungs of healthy individuals. In contrast to SP-A from normal lungs, proteinosis SP-A was shown by SDS gel electrophoresis to contain large amounts of unreducibly cross-linked beta chains. Specific primary structure modifications of SP-C and SP-B proteins were established by direct molecular weight and structural analysis, using [252Cf]plasma desorption mass spectrometry (PD/MS) as the principal method. In comparison to normal lung surfactant SP-B, proteinosis SP-B showed a significantly increased molecular weight by approx. 500 Da for the unreduced protein dimer. SP-C proteins from normal lungs were identified to possess a bis-cysteinyl-5,6-(thioester)palmitoylated structure, and to contain a frayed N-terminus resulting in two sequences of 34 and 35 amino acid residues. In contrast, SP-C from proteinosis patients was modified by (i) partial or even complete removal of palmitate residues and (ii) additional N-terminal proteolytic degradation. These results indicate the presence of pathophysiological structure modifications, which are likely to occur in the alveolar space, and may lead to a reduced surfactant function.

Amino Acid Sequence↗
PubMed1992

[In vivo 31-phosphorus MR spectroscopy of the calf musculature in arterial occlusive diseases].

Muscle metabolism was measured in 7 patients with arterial occlusive disease and symptoms of intermittent claudication both before and after percutaneous vascular neurolysis by means of dynamic 31P-MR spectroscopy. Phosphorus spectra of the involved calf muscles were determined before, during and after defined treadmill exercise. In addition to pH values the phosphocreatine content was measured during activity and recovery phases. There was close correlation in these patients between the increase in claudication distance and more rapid regeneration of phosphocreatine following neurolysis. However, none of the patients achieved normal values of phosphate metabolism. By means of the non-invasive 31P-MR spectroscopy it was possible for the first time to demonstrate the biochemical changes associated with neurolytic lumbar sympathetic blockade.

Adult↗
PubMed1992

Increased gallbladder residual volume in nonresponders to extracorporeal shock wave lithotripsy of gallbladder stones.

In a prospective study of 63 patients, we purposed to determine whether gallbladder contractility or gallbladder volume before biliary lithotripsy are predictors of fragment disappearance. Percentage gallbladder contraction was calculated from the fractional difference in the sonographically measured gallbladder volume after a standard fatty meal. Statistical analysis showed no significant differences in gallbladder contractility between the fragment-free group and the residual-fragment group before (77.2 +/- 12.7% vs. 71.9 +/- 19.3%; p = 0.1044) biliary lithotripsy and after the termination of adjuvant cholelitholysis therapy (76.4 +/- 12.9% vs. 72.2 +/- 17.1%; p = 0.1341). Before treatment, there was no significant difference in fasting gallbladder volume in either group (29.9 +/- 15.4 ml vs. 36.6 +/- 18.8; p = 0.0682), but postprandial gallbladder volume was greater in nonresponders (10.4 +/- 9.4 ml vs. 6.5 +/- 3.8; p = 0.0164). After termination of the therapy, both the fasting gallbladder volume (41.2 +/- 24.2 ml vs. 29.8 +/- 10.3 ml; p = 0.0093) and the postprandial gallbladder volume (11.9 +/- 11.7 ml vs. 7.3 +/- 5.3 ml; p = 0.0267) were greater in the residual-fragment group. The increase of the fasting gallbladder volume in the residual-fragment group was statistically not significant. Our results indicate that the increased residual volume is a significant cause of therapeutic failure in nonresponders.

Chenodeoxycholic Acid↗
PubMed1992

[Complications and side effects of stellate ganglion blockade. Results of a questionnaire survey].

Stellate ganglion blockade (SGB) is an established method in the therapy of chronic pain syndromes. Complications are rare but can be life-threatening (inadvertant subarachnoid or intra-arterial injection). Since no data are currently available as to the incidence of complications, we sent questionnaires to 76 departments of anaesthesiology in West Germany to evaluate this issue. RESULTS. Thirty-nine questionnaires (51%) were returned, representing approximately 45,000 SGBs; 82% of the departments prefer bupivacaine for SGB. The incidence of severe complications was 1.7 in 1000 blockades. Most of these were CNS complications (i.e., convulsions). A high subarachnoid block was reported in 6 cases, high epidural blockade in 3, pneumothorax in 9, and allergic reactions in 2. All departments conduct aspiration tests before injection; 94% take precautionary measures in case of respiratory failure (oxygen, ventilating devices); 73% do not perform SGB without an assistant and an anticonvulsant drug at hand; 72% place an intravenous line before SGB; 28% use ECG monitoring routinely; and 53% administer a test dose of 0.5-2 ml local anaesthetic. DISCUSSION. Severe complications following SGB are rare. Potentially life-threatening complications usually arise from inadvertant subarachnoid or intra-arterial injection. Aspiration tests and test doses obviously do not guarantee proper administration. Placement of an intravenous line, ECG monitoring, and the presence of an assistant are strongly recommended. Anticonvulsant drugs as well as drugs and equipment for intubation and resuscitation should be immediately available. The administration of very low doses of opioids to the stellate ganglion has been shown to have similar therapeutic results to local anaesthetic blocks, whereas the incidence of side effects and complications is lower. Therefore, the administration of opioids to sympathetic ganglia could provide an alternative therapeutic regimen for the future.

Adult↗
PubMed1992

[Ambulatory epidural analgesia in patients with tumors. An outmoded technique?].

In 35 of 316 patients suffering from severe cancer pain, an epidural catheter was placed for continuous morphine application. Indications for epidural opiates included failure of pain relief with oral morphine, severe side effects with oral administration, and contraindications for oral morphine, e.g., ileus. METHODS. The epidural catheter was inserted in the lumbar, thoracic or cervical region, according to the main localization of pain. A silicon catheter with a Dacron cuff (4.2 F Broviac Davol, Cranston, R.I.) was connected and tunneled subcutaneously to a distant exit on the lateral chest wall (Fig. 2). A portable morphine pump (CADD-PCA Pharmacia Deltec) was connected to the externalized catheter. The morphine was infused continuously at a basic rate. It could be increased to a programmed limit by additional boli determined by the patients themselves. Thirty patients were treated as outpatients. RESULTS. The mean duration of treatment was 101 (10-333) days. The daily dose of morphine ranged from 9 to 200 (33) mg at the beginning of therapy, and from 20 to 288 (88) mg at the end of treatment. In 27 patients (77%) epidural morphine administration proved to be a valuable method of pain control (Fig. 3). Even in most cases of tolerance to oral morphine, especially in patients suffering from pain of neuropathic origin, pain control was adequate. There were no cases of continuous loss of effectiveness of continuous loss of effectiveness or development of tolerance (Fig. 5). The epidural morphine dosage depended on the character and intensity of pain and its responsiveness to epidural opiates. Technical complications were noticed in 6 patients (17%), and fairly mild side effects of epidural morphine occurred in 20% of the patients for a limited time. CONCLUSIONS. The technique described is a simple and convenient method for long-term treatment of cancer patients with epidural morphine. There was no need for more invasive procedures, such as intrathecal or intraventricular morphine administration, in this group of patients in whom no pain relief had been achieved with oral morphine administration.

Adult↗
PubMed1991

Plasma protein binding of bupivacaine in pregnant women at term.

The increased toxicity of bupivacaine in parturients is a well-known phenomenon. The reduced plasma protein binding of bupivacaine is one of the possible reasons. Therefore, we measured the free fraction of bupivacaine in plasma samples of parturients and non-pregnant volunteers. The free fraction was significantly higher in parturients (8.2% vs 5.4%) associated with a lower concentration of the alpha-1-acid glycoprotein (0.42 vs 1.01 g/l) and a higher concentration of progesterone (156 vs 0.4 ng/ml). The addition of progesterone to plasma samples of non-pregnant volunteers did not influence the free fraction of bupivacaine, whereas the addition of alpha-1-acid glycoprotein to the plasma of parturients decreased the free fraction significantly. Therefore, the lower concentration of this protein is the principal reason for the higher free fraction of bupivacaine in pregnancy and possibly one of the causes of the higher incidence of toxic side effects of bupivacaine in obstetric use.

Adolescent↗
PubMed1991

[The treatment of zoster neuralgia].

Neuralgic pain during or following herpes zoster infection is a common problem in pain therapy. The current management of neuralgias due to zoster is discussed with reference to patients in a chronic pain clinic within an anesthesiology department. The courses of 80 patients followed up for at least 3 months from the pain clinic at the University Hospital in Kiel were analyzed. The mean age was 69 years. The predominant locations for zoster lesions were the thoracic segments (65%) and the first branch of the trigeminal nerve (19%). Diabetes mellitus was present in 20% of the patients and malignant disease in 18%. In 2 patients recurrent postherpetic neuralgia was the first symptom of HIV infection. Despite pretreatment, the mean initial pain score was 8 on an analog scale (range 0-10). Acute herpes zoster pain during the infection was treated with virustatic agents, corticosteroids and sympathetic blocks. Postherpetic neuralgias required a more sophisticated approach, depending on the stage of the disease and the type of pain involved: sympathetic blockade with local anesthetic agents or injections of very low dose opioids to sympathetic ganglia, transcutaneous electrical nerve stimulation, and antidepressants or anticonvulsants. The success of the therapy is correlated with the duration of pain. If the history of zoster pain was less than 1 month, the majority of patients showed good or excellent results. On the other hand, only one-third of patients with a history longer than 6 months had adequate pain relief. Therefore, early and appropriate treatment is desirable for patients suffering from zoster neuralgias.

Aged↗