Search PubMed⌕ Search

Biomedical subjects

C Winckler

Publications and source records attributed to C Winckler.

At least 55 records · Page 3Linked to original sources
PubMed1987

[Disclosure of a fatal pheochromocytoma during general anesthesia].

A case is reported of a phaeochromocytoma revealed during a general anaesthesia by a sudden hypertensive crisis associated with acute pulmonary oedema and signs of extreme sympathetic stimulation (bilateral mydriasis, piloerection, peripheral vasoconstriction). Aortic angiography revealed the tumour lying in an ectopic retroperitoneal situation and spasm in the superior mesenteric arterial territory. The patient died at the thirtieth hour from septic shock due to necrotizing colitis.

Adrenal Gland Neoplasms↗
PubMed1987

[Effects of intravenous naloxone on the secondary effects and analgesia after epidural injection of fentanyl].

On demand intravenous naloxone reverses respiratory depression following epidural morphine but does not have any effect on analgesia. This study aimed to assess the action of a preventive naloxone infusion on the side-effects and analgesia induced by epidural fentanyl. Sixteen patients were studied. Three had isolated uncomplicated flail chest. The thirteen others had undergone thoracotomy, and were included in the protocol at least 6 h after extubation. All patients had two epidural injections, they received an intravenous infusion of either 10 micrograms.kg-1.h-1 naloxone after a 400 micrograms bolus (group F + N) or 5% dextrose (group F), which was randomly allocated. In group F, but not in group F + N PaCO2 increased from the 15th min to the 4th, and sedation occurred from the 15th min to the 6th h. A significant and similar pain relief was noted in both groups. Duration of analgesia was not statistically different in the two groups. This preventive action of intravenous naloxone on the supraspinal adverse effects of epidural fentanyl was not accompanied by a reduction in analgesia. This could lead to widespread use of this analgesic technique.

Adult↗
PubMed1987

[Controlled obturator nerve block using electrostimulation: prevention of the stimulation of the obturator nerve during resection of the lateral walls of the bladder].

An adductor contraction secondary to obturator nerve stimulation can occur during transurethral resection of a lateral bladder lesion and then can induce bladder perforation or hamper complete resection. Many technique have been advocated but they are ineffective or unreliable. Obturator nerve blockade in the obturator canal by local anesthesia with control by nerve stimulator can prevent these complications. The technique described, has been used in 12 patients it is reliable, fast and easy to perform.

Anesthesia, Local↗
PubMed1986

[Pneumothorax after ventriculoperitoneal shunt procedure].

A respiratory distress syndrome is reported in a four month old girl, after placement of a ventriculo-peritoneal shunt for hydrocephalus. This complication was related to a surgical pneumothorax. It was an early and spontaneously resolving complication, which one should have in mind after shunting procedures.

Cerebrospinal Fluid Shunts↗
PubMed1984

[Immune disorders during postoperative peritonitis].

Despite major diagnostic and therapeutic advances, postoperative peritonitis appeared to be still associated with a severe prognosis. The failure to react to delayed hypersensitivity skin tests was recently shown to identify patients at increased risk for sepsis. In an attempt to clarify the mechanisms of this anergy, cellular and humoral immunity was studied with in vitro tests in 12 patients treated for postoperative peritonitis. Complement was decreased in 33.3% of cases and normal in the others. No significant change was found in IgG and IgM titres, but IgA concentrations were increased in 80% of cases. A decrease in the total number of lymphocytes was observed in 41.7% of patients, related to the reduction in the total T lymphocyte count. Mitogen-induced lymphocyte transformation was studied with phytohaemagglutinin, concanavalin A, pokeweed-mitogen, and tuberculin purified protein derivative. Six patients had decreased or negative response to at least three mitogens; 91,7% had no response to tuberculin. The leukocyte migration inhibition test was negative in all cases. These abnormalities in cell mediated immunity may have been related to underlying diseases (severe nutrition depletion in 7 cases), to sepsis (septic shock in 10 cases), to repeated anaesthesias and surgical procedures, and even to drugs (e.g. antibiotics). The presence of serum inhibitors may have been the cause of the anergy and further studies are required.

Adult↗
PubMed1984

[Withdrawal syndrome during epidural administration of morphine after stopping treatment with clonidine].

A 70 year old hypertensive patient who had undergone a gastrectomy experienced withdrawal symptoms 10 h after a second epidural injection of morphine (150 micrograms X kg-1) for postoperative analgesia. A clonidine treatment had been stopped 129 h earlier. These symptoms disappeared shortly after a third epidural injection of morphine. Clonidine was then reintroduced. The later progressive interruption of epidural morphine analgesia did not introduce any further symptoms of withdrawal. Since physical dependence on a drug is related to repeated and prolonged administration of that drug, opiate withdrawal symptoms were highly unlikely after epidural morphine used to relieve immediate postoperative pain. Abrupt discontinuation of a long-term treatment by clonidine may produce a withdrawal syndrome, but clinical and biological signs usually occur earlier than noted in this case. Recent experimental and clinical data has provided support for the existence of a complex presynaptic regulation of noradrenergic transmission in the central nervous system, both alpha 2 and opiate receptors being implicated. The activation of such presynaptic receptors inhibits further transmitter release. Suddenly stopping the chronic administration of alpha 2 or opiate agonists was responsible for a rebound excitation of these noradrenergic neurons, inducing a withdrawal syndrome. The related withdrawal symptoms may have resulted from an interaction between the discontinuation of clonidine and the decrease in morphine activity. Practitioners should be warned of this possible side-effects.

Aged↗
PubMed1983

[Prevention of the thromboembolic risk during the operative period in a patient with a congenital antithrombin III deficiency].

The case of a woman with congenital antithrombin III (AT III) deficiency undergoing elective hysterectomy is reported. AT III deficient patients have high risks of thromboembolic disease, especially developing during and after surgery. It is usual practice to discontinue oral anticoagulants with antivitamin K activity and to obtain effective AT III activity by the transfusion of freeze-dried concentrates of AT III and/or fresh frozen plasma (FFP). Heparin is prescribed as soon as AT III activity reaches 70%. The oral anticoagulant regimen is reinstituted in the late postoperative period. In our case, transfusion of FFP, in the pre- and postoperative periods, results in an AT III activity of 63%. Heparin was not used because oral anticoagulants were readministered early, 12 h after operation. No clinical thrombo-embolic complication was observed.

Adult↗
PubMed1981

[Use of new internal jugular vein catheterization modified by using of a "catheter around the needle" (author's transl)].

Although widely used, subclavian catheterization has lost popularity to the benefit of internal jugular vein judged more secure. Numerous technics have been described. Since two years we use internal jugular vein catheterization according to the description of Boulanger et al. modified by using a "Catheter around the needle" type device 13 cm long and 1.65 mm wide. 122 patients have experienced 125 catheterizations which were performed on the right side in 96.8 p. cent of the cases. More than 50 p. cent of the patients was conscious at the time of venepuncture. 118 attempts were successful. In 7 cases failure was due either to impossibility of puncture (4 times) or catheterization (3 times). The sole complication was accidental arterial puncture (5 times, 4 p. cent). 4 of them at the time of failure of venepuncture. Training has an important role in the occurrence of failures and complications. They were much more frequent during the twenty first attempts. According to us this technic can reduce incidence of accidental arterial puncture. The risk of pneumothorax is low in spite of the length of the needle. But because of the length and relative stiffness of the catheter the tip is always located in the superior vena cava when the right side has been chosen.

Adolescent↗
PubMed1979

[Acute dyspnoea by acute thyroid abscess (author's transl)].

Infection is extremely rare in the pathology of the thyroid gland. One case is reported, and a review of the literature has helped to emphasize some specific points. Acute thyroiditis can be misdiagnosed in its initial phase because a fever by itself may not lead to a through examination of the neck, even if a goitre is present; the latter being the site of infection in the case reported. Dyspnoea of laryngeal origin proves to be a dangerous complication of thyroid abscesses. Treatment is always surgical, linked with appropriate antibiotic therapy. In the long run, thyroid function is unaffected.

Abscess↗