[The pilot project "Soteria Bern" in treatment of acute schizophrenic patients. I. Conceptual principles, practical realization, clinical experiences].
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Adolescent↗
Biomedical subjects
C Maier
Publications and source records attributed to C Maier.
[Results of a questionnaire survey of the practice and organization of postoperative peridural analgesia at 461 anesthesia departments].
In 1988, questionnaires were sent to 1225 departments of anesthesiology to evaluate the practice of postoperative epidural analgesia (EA) in the Federal Republic of Germany. The following problems were investigated. To what extent are anesthesiologists concerned with postoperative pain therapy? Does EA play a major role in this, in particular outside the intensive care setting? Who is allowed to administer epidural injections: anesthesiologists, other physicians or nurses? What kind of monitoring is used? What agents are used for epidural injections and what problems and complications have arisen? In all, 461 (38%) evaluable forms were returned. Most anesthesiologists said they were responsible for postoperative pain control. In 75.3% of the responding departments EA was used as a method of postoperative pain therapy, while in 24.7% the catheter was removed immediately after the operation, in most cases for fear of complications resulting from insufficient monitoring. In clinical practice, however, EA was the only major alternative to routine intermittent injections of opioids as needed. Some departments reported that they restricted postoperative EA to patients in the intensive care unit or in the recovery room because adequate monitoring was not feasible on the ordinary wards. EA was administered in 62.4% on ordinary wards. But in only 25.7% were trained nurses allowed to give epidural injections. Most responding departments (77%) preferred epidural use of opioids during intensive care, in most cases morphine or buprenorphine in combination with low-dose local anesthetics, and 66.7% also favored epidural opioids on ordinary wards.
Analgesia, Epidural↗
[Intrapleural catheter analgesia in patients with multiple rib fractures].
Patients with multiple rib fractures often suffer from severe pain that impairs their respiratory performance. The effect of interpleural administration of bupivacaine (20 ml 0.25% every 4 h) for pain management was evaluated in ten patients. The initial interpleural injection resulted in significant pain relief and improvement of arterial oxygen tension. Two patients needed additional i.v. injections of opioids (piritramide 15-22.5 mg/24 h). In one patient a small asymptomatic pneumothorax was observed following placement of the catheter, which resolved spontaneously. No other complications were reported. In an intraindividual comparison, bupivacaine alone and bupivacaine plus epinephrine 1:200,000 were compared with regard to pharmacokinetics of bupivacaine, analgesic effect, side effects, and respiratory performance. The addition of epinephrine yielded only minor advantages from a pharmacokinetic point of view (median peak concentration of bupivacaine 1.8 micrograms/ml vs 2.0 micrograms/ml for bupivacaine alone). The quality and duration of analgesia and the effects on respiration were not influenced by epinephrine. The heart rate was significantly higher and the blood pressure significantly lower when epinephrine was added to the solution. Nevertheless, these differences were too small to be of clinical importance. Even though maximum total plasma concentrations of bupivacaine above 2 micrograms/ml were found in some patients, there were no signs of CNS toxicity, most probably because of the increased protein binding of bupivacaine following trauma. Accordingly, the maximum free plasma concentrations in all patients were below the threshold level of 0.24 micron/ml. We therefore conclude tht interpleural administration of bupivacaine could be a valuable means of pain relief in patients with multiple rib fractures, providing no severe pulmonary contusions or concomitant injuries are present.
Adult↗
[Hemostatic requirements for the implementation of regional anesthesia].
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Anesthesia, Conduction↗
Analysis of a mutated phage T6 receptor protein of Escherichia coli K 12.
The tsx-206 allele encodes an altered Tsx protein, Tsx-206, that can no longer function as the T6 receptor. We show here that this allele also confers resistance to the Tsx-specific phages H1, H3, H8, K9, K18 and Ox1 but not to colicin K. The Tsx-206 protein still mediates the efficient permeation of deoxyadenosine across the outer membrane at low substrate concentration. A host-range mutant of phage T6, T6h3.1, was isolated which can use both the Tsx-206 and the Tsx wild-type protein as its receptor. Cloning and DNA sequence analysis of the tsx-206 allele showed that the phage resistant phenotype was associated with an Asn to Tyr substitution at position 254 of the 272-residue Tsx protein.
Amino Acid Sequence↗
Activation of polyubiquitin gene expression during developmentally programmed cell death.
Ubiquitin, a highly conserved 76 amino acid protein, plays a role in targeting intracellular proteins for degradation. Ubiquitin expression was examined during the developmentally programmed atrophy and degeneration of the intersegmental muscles (ISMs) in the hawk-moth, Manduca sexta. A clone containing nine repeats of the ubiquitin coding sequence was isolated from an ISM cDNA library and was used as a probe to examine polyubiquitin expression during development. When the ISMs became committed to degenerate, polyubiquitin gene expression increased dramatically. Injection of 20-hydroxyecdysone, which delays degeneration in this system, prevented the increase in polyubiquitin mRNA. The expression of polyubiquitin occurred without apparent activation of the cell's heat shock response. These data suggest that ubiquitin plays a role in programmed cell death.
Animals↗
[Treatment concept of tumor-induced maxillofacial pain].
From 1987 to 1989 forty-six patients with primary or recurrent maxillofacial tumors which could not be treated curatively came to our clinic because they suffered for facial pain. Their treatment was carried out in cooperation with the pain clinic of the department of anesthesiology. In 8 patients causal therapy with palliative chemotherapy primarily carried out on an outpatient basis was successful. In the other patients oral application of opiates was the therapy of choice. In only few cases invasive techniques were required to relieve facial pain.
Facial Pain↗
[The modification of injection pain and the incidence of thrombophlebitis following etomidate].
A prospective study with 161 patients was performed to investigate the effects of intravenous local anaesthetics on the pain of injection following etomidate injection. After placebo injection 56.6% of the patients reported on pain after etomidate, but only 29% after 20 mg lidocaine i.v. Lidocaine combined with venous congestives significantly reduced the incidence of pain to 3.35%. A dilution of etomidate with water (ratio 1:1) had a lower effect (17.6% incidence of pain). The rate of postoperative thrombophlebitis was lowest in the group with combined lidocaine with venous congestives at 7.4%, in opposition to a rate of 18% in the remaining groups. In comparison to a second contralateral venous cannula without applied etomidate the venous sequelae did not increase significantly.
Adult↗
[Subdural spread of a local anesthetic following installation of a peridural catheter].
We report 4 cases of inadvertent subdural injection of local anesthetics among 640 patients receiving epidural anesthesia. In contrast to subarachnoid injection a typical sign was the development of patchy anesthesia in cervical segments and with late onset of symptoms. The case of a 63 year old woman scheduled for aortofemoral bypass surgery in epidural anesthesia is reported. She developed paresthesia, paresis and signs of sympatholysis in both arms 30 min after the injection of 10 ml bupivacaine 0.5% at T10-11. These symptoms lasted for 7 h. Subdural injection was documented using radiopaque dye. Two other cases of probable subdural injection leading to paresthesia and paresis in cervical segments after lumbar injection of 50 or 75 mg bupivacaine are reported. The symptoms began 15-30 min after injection and lasted for 60 min. The fourth case was that of a 26-year-old woman scheduled for cesarean section under epidural anesthesia. Following the injection of 75 mg bupivacaine 0.5% patchy anesthesia extending to T10 developed. By 10 min after an additional injection of 25 mg bupivacaine 0.5% she had paresis and paresthesia in both arms and was unable to cough. Her trachea was therefore intubated; 30 min later the level of anesthesia was below T5 and she could be extubated. Uneventful cesarean section was then performed. These cases demonstrate that as well as subarachnoid injection, inadvertent subdural injection of local anesthetic agents is a potential hazard of epidural anesthesia, not only in patients in an advanced state of pregnancy but also in nonpregnant patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Alpha-1-acid glycoprotein and protein-binding of bupivacaine in the plasma of pregnant women at term.
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Adult↗
[Management and treatment of patients with atypical facial pain].
The term "atypical facial pain" refers to a pain disease and should not be used for pain of peripheral origin. As a rule atypical facial pain is induced by a peripheral tissue trauma not necessarily associated with nerve lesions. The intensity of pain does not correlate with the measurable magnitude of the trauma. If treatment is possible, it will be the more successful the earlier it is started. Therapy comprises transcutaneous electric nerve stimulation, sympathetic nerve block, drug therapy and psychotherapy.
Adult↗
[Schizophrenic puerperal psychoses. A psychodynamic approach].
The author describes the psychodynamics of schizophrenic childbirth psychoses and criticizes attempts to explain these on a one-sided somatogenic basis. Referring to ethnographic material on childbirth customs, he develops therapeutic approaches are intended to bring about a better social integration of the woman as well as a deflection from her uncontrollable aggression against the child.
Adult↗
Characterization of the nucleoside-binding site inside the Tsx channel of Escherichia coli outer membrane. Reconstitution experiments with lipid bilayer membranes.
Reconstitution of purified Tsx protein from Escherichia coli into lipid bilayer membranes showed that Tsx formed small ion-permeable channels with a single-channel conductance of 10 pS in 1 M KCl. The dependence of conductance versus salt concentration was linear, suggesting that Tsx has no binding site for ions. Conductance was inhibited by the addition of 20 mM adenosine. Titration of the Tsx-mediated membrane conductance with different solutes including free bases, nucleosides, and deoxynucleosides suggested that the channel contains a binding site for nucleosides but not for sugars or amino acids, and binding increased in the following order: free base, nucleoside, and deoxynucleoside. Among the five nucleosides the stability constant for the binding increased in the order of cytidine, guanosine, uridine, adenosine, and thymidine. Control experiments revealed that the binding of the nucleosides is independent of ion concentration in the aqueous phase, i.e. there was no competition between nucleosides and ions for the binding site inside the channel. The binding of the solutes to the channel interior can be explained by a one-site two-barrier model for the Tsx channel. The advantage of a binding site inside a specific porin for the permeation of solutes is discussed with respect to the properties of a general diffusion pore.
Adenosine↗
Pore-forming activity of the Tsx protein from the outer membrane of Escherichia coli. Demonstration of a nucleoside-specific binding site.
The Tsx protein from the outer membrane of Escherichia coli is known to be involved in the permeation of nucleosides across the outer membrane under limiting substrate conditions. We purified Tsx from an E. coli strain that overproduces Tsx. The purified protein was still functional since it could neutralize the Tsx-specific bacteriophage T6 in vitro. When the purified Tsx was reconstituted into a lipid bilayer, there was a large increase of the membrane conductance, indicating pore-forming activity of Tsx in vitro. This increase could be strongly blocked with adenosine and to a much lesser extent with cytidine. Titration of the pore conductance with adenosine or cytidine suggested the presence of a binding site for nucleosides in the Tsx pore, with a Ks of 6 X 10(-4) and 2 X 10(-2) M for adenosine and cytidine, respectively. We propose that the Tsx protein functions in vivo as a pore that specifically facilitates the permeation of nucleosides across the outer membrane due to its binding site for nucleosides.
Adenosine↗
Pharmacokinetics and protein binding of bupivacaine in postoperative epidural analgesia.
We describe a method, which is both specific and rapid, for the measurement of bupivacaine concentrations in plasma using high-performance liquid chromatography. Bupivacaine plasma concentrations, pharmacokinetics and protein binding in the postoperative period were investigated in seven patients (58-77 years old) following hip surgery. Postoperative analgesia was achieved by epidural bolus injections of 25 mg bupivacaine 0.25% every 6 h. Sufficient pain relief without side-effects was obtained. Total (maximum 1.13 micrograms/ml) as well as free (maximum 0.1 microgram/ml) bupivacaine plasma concentrations remained below toxic threshold levels and no cumulation occurred. Increased protein binding in the postoperative period is reported, emphasizing the importance of measuring the free fraction in addition to the total plasma concentration. The free fraction decreased from 5.4% preoperatively to 2.7% in the postoperative period (P less than 0.05). Changes in plasma protein binding of bupivacaine and changes in plasma levels of the acute phase reactant alpha-1-acid glycoprotein were correlated (r = 0.8, P less than 0.05). Difficulties in interpreting the elimination parameters following epidural administration are discussed, leading to the conclusion that the derivation of dosage regimens from kinetic parameters following epidural administration is not warranted.
Aged↗
[Epidural hematoma following epidural catheter anesthesia in thrombocytopenia].
We report a 21-year-old male patient suffering from acute myeloid leukemia and concomitant thrombocytopenia. Following a diagnostic thoracotomy-which revealed Aspergillus pneumonia-he developed respiratory insufficiency and dyspnea. A thoracic epidural catheter was inserted and epidural morphine treatment led to improved ventilation. No clinical signs of pathological epidural processes were noticed during the treatment. The patient died of Aspergillus sepsis 26 days after catheter insertion. Autopsy revealed bacterial growth in the epidural space with slight infectious tissue reactions as well as an epidural hematoma. No evidence of spinal cord compression was found at autopsy. The development of epidural infection or hematoma seems to be a possible complication of epidural analgesia in patients suffering from impaired defense mechanisms or thrombocytopenia. These risk factors should be taken into account when epidural analgesia is considered. We suggest that the platelet count should be determined beforehand in patients suspected of having thrombocytopenia (e.g. cancer, pre-eclampsia).
Adult↗
[Postoperative treatment of phantom pain and causalgias with calcitonin].
Results of IV calcitonin treatment in patients suffering from postoperative phantom limb pain (n = 12) or causalgia following peripheral nerve lesions (n = 4) are reported. All patients were complained of severe pain after a traumatic event or amputation, with disturbed sleep in many cases. After only 1-2 infusions 10 patients with phantom limb pain (83%) were discharged from hospital pain-free. Pain was effectively reduced by up to 5 infusions in 2 patients (17%). A follow-up for maximally 24 months showed a recurrence of pain in only 4 patients with obvious stump problems or reamputations. Three patients with causalgia also profited from a remarkable but transitory pain reduction; in 1 patient therapy was ineffective. Recurrent pain due to causalgia could not be improved by repeated calcitonin infusion, although this was effective for phantom limb pain. The administration of calcitonin IV can be recommended as a valuable treatment for phantom limb pain and causalgias in the early postoperative period. Therapy was effective with negligible side-effects, and long-term follow-up revealed a long-lasting effect.
Arm↗
Contraceptive progestins and gonadotropin secretion in vitro.
In an in vitro bioassay using rat pituitary cell cultures the effect of contraceptive progestins was tested on basal and gonadotropin-releasing hormone (GnRH)-induced luteinizing hormone (LH) and follicle-stimulating hormone (FSH) secretion in vitro. Progestins diminished gonadotropin release in pituitary cells stimulated with GnRH, but did not alter basal values. This inhibitory effect was dose dependent in a range of 10(-10)-10(-5) M tested and the inhibitory action of most of the progestins examined was more potent than that of progesterone. The maximal reduction of LH and FSH values was by 60% of GnRH-induced control levels. Progestins also caused a shift in sensitivity of cells to GnRh (10(-12)-10(-6) M). When time dependence was investigated, some progestins potentiated GnRH effect on gonadotropins in pituitary cell cultures pre-incubated for a short time (4 h) with steroids. More prolonged pre-incubations from 23 to 71 h resulted in a progressive suppression of LH and FSH response to GnRH (10(-7) M). In order to examine intracellular effects, cells were pretreated with progestins and inositol phosphate metabolism was investigated. The data obtained in pituitary cells give evidence that polyphosphoinositide breakdown is potentially an early step in the action of GnRH on gonadotropin secretion by providing diacylglycerol and inositol phosphates. Addition of gonadotropin-releasing hormone to myo-2[3H]inositol-prelabeled rat pituitary cells in primary culture evoked a dose-dependent increase of the accumulation of [3H]inositol phosphates with a rise of inositol triphosphate, inositol diphosphate and inositol monophosphate within 1 min. Using one contraceptive progestin, gestoden, inositol phosphate production was inhibited by 80% compared to controls of GnRH-treated cells without the addition of steroids. The data obtained in this study suggest that this in vitro bioassay using rat pituitary cells is a useful tool in testing progestational compounds regarding their potency on gonadotropin release. In addition, these results show that one possible site of interference of progestins with GnRH-induced gonadotropin secretion may involve polyphosphoinositide breakdown.
Animals↗