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Biomedical subjects

G Hack

Publications and source records attributed to G Hack.

At least 19 recordsLinked to original sources
PubMed1994

[Diagnostic and intensive care problems in hemolytic uremic syndrome].

We observed a young man with apparently septic appendicitis who finally could be diagnosed as suffering from haemolytic uraemic syndrome (HUS) when spuriously normalising platelet counts were identified as a cell counter artifact. This case stresses the fact that automatically counted abnormal thrombocyte numbers should be examined by microscopy. Therapy is empirically based on corticosteroids, plasmapheresis and fresh frozen plasma. The application of thrombocyte concentrates should be avoided because of the risk of aggravating the disease process.

Adult↗
PubMed1990

[Anesthesiologic implications in the Shy-Drager syndrome--a case report].

Based on a case report with vaginal hysterectomy, the anaesthetic implications are discussed in a patient with Shy-Drager syndrome, which is a degenerative disease in middle-aged to elderly patients, resulting in autonomic dysfunction. The syndrome is reviewed and the anaesthetic management is described. Adequate cardiovascular monitoring and maintenance of haemodynamic stability are important. The response to sympathomimetic drugs is unpredictable and may be extreme due to denervation hypersensitivity. In the postoperative period, signs of postural hypotension may be severe and require training by elevation of the upper part of the body, fluid therapy, sympathomimetics and fludrocortisone.

Anesthesia↗
PubMed1985

[Anesthesiologic peculiarities in bilateral pheochromocytoma and suspected multiple endocrine neoplasia].

Based on a case report with surgical removal of bilateral giant phaeochromocytomas with heredofamilial affliction and suspicion of multiple endocrine neoplasia type II (MEN-II syndrome) and of malignancy, the anaesthetic implications are discussed in a patient inadvertently not prepared by antiadrenergic treatment. It is pointed out that in MEN II syndrome, a combination of phaeochromocytoma and medullary carcinoma of the thyroid, surgical removal of the phaeochromocytoma merits utmost priority before thyreoidectomy. The most important laboratory parameters in the diagnosis of MEN II syndrome are pre- and postoperative determinations of calcitonin and carcinoembryonal antigen (CEA).

Adrenal Gland Neoplasms↗
PubMed1985

[Hemodynamic effects of an etomidate-flunitrazepam or midazolam- fentanyl combination for induction of anesthesia in patients with heart valve diseases].

A comparison of the haemodynamic effects of 3 anaesthetic techniques, the combinations etomidate + fentanyl (I), flunitrazepam + fentanyl (II) or midazolam + fentanyl (III), respectively was carried out in 45 patients undergoing various types of cardiac valve replacement surgery. Haemodynamics were assessed by continuously measuring the heart rate as well as the blood pressure in the systemic and pulmonary circulations whereas the cardiac output was measured intermittently. In the first 30 minutes after induction of anaesthesia, a mean arterial blood pressure drop of 10% (I), 20% (II) or 15% (III) respectively, was observed; at the same time, the rate did not change significantly. Cardiac index, however, fell significantly in all 3 groups by 33% (I) 30% (II) or 28% (III), respectively. Pulmonary pressure, wedge pressure and systemic vascular resistance rose only in groups I and III and decreased in group II (flunitrazepam + fentanyl). On the other hand, pulmonary vascular resistance as well as left ventricular work index were significantly decreased in all 3 groups. We conclude that all 3 anaesthetic techniques investigated here may be effectively applied for safe induction of anaesthesia in patients with valvular lesions of the heart. On account of the effect of the combination flunitrazepam + fentanyl on decreasing pulmonary artery pressure and wedge pressure, this technique seems to be preferable in patients with pulmonary hypertension.

Adolescent↗
PubMed1985

[Anesthesia in aortocoronary bypass surgery: comparison of effects on hemodynamics of recent technics of total intravenous anesthesia].

20 patients electively scheduled for operation were enrolled in the study and anaesthetized randomly with one of the two techniques etomidate + fentanyl (I) or flunitrazepam + fentanyl (II). Haemodynamics were assessed by continuously measuring blood pressure in the systemic and pulmonary circulations, as well as the heart rate, and intermittently determining the cardiac output. It could be shown that systemic arterial blood pressure, in spite of an initial drop after induction of anaesthesia, remained within an acceptable safety margin throughout the investigation period. Whereas heart rate remained almost constant in both groups, the rate-pressure product which may serve as a measure of myocardial oxygen consumption in the clinical setting, decreased considerably in both groups, although more appreciably under the influence of the anaesthetic technique flunitrazepam + fentanyl. Although the diastolic blood pressure as the most significant individual factor determining coronary blood flow was not changed appreciably in both groups, it remained at a higher level under the influence of the anaesthetic technique etomidate + fentanyl (I). We conclude that both anaesthetic regimes described here may be safely applied for the anaesthesia of patients with reduced coronary perfusion and cardio-haemodynamic reserve potential.

Adult↗
PubMed1983

[Renin-angiotensin system under extracorporeal circulation during heart valve surgery].

Angiotensin I (A I), angiotensin II (A II) and the activity of angiotensin-converting enzyme (ACE) were measured in 15 patients undergoing cardiopulmonary bypass for mitral or aortic valve replacement. During cardiopulmonary bypass A I, A II, A I/II ratio and arteriovenous A II--difference decreased markedly, whereas the activity of ACE fell only during a small 15 min period after start of extracorporeal circulation. Possible reasons for these effects are discussed.

Angiotensin I↗
PubMed1981

[Suspension cultures of Ehrlich ascites tumor cells as a test system for the study of cytotoxic effects of anaesthetics (author's transl)].

Cultures of a permanently in suspension growing line of Ehrlich ascites tumor cells (EATC) were studied regarding their use as a test system for the determination of cytotoxic effects of anaesthetics. These cells, having a comparatively high reduplication rate, are cultured at 37 degrees C in vitro in a chemically defined liquid medium supplemented by 15% horse serum without agitation in a closed system. In order to detect drug effects on the cultures various cellular parameters can be determined due to the suspension character of the cultures without complicated preparatory measures, e.g. cell number or multiplication rate, cell volume, cell volume distribution. Moreover biochemical parameters, such as protein or nucleic acid content, may be estimated after centrifugation of the cultures separately in the cell sediment and the medium supernatant. Applying drugs of various pharmacological groups (cytostatic and anti-inflammatory drugs, local and general anaesthetics) the usefulness of some of these parameters for the detection of cytotoxic effects was studied.

Anesthetics↗
PubMed1981

[In vitro studies on the influence of volatile anaesthetics on cell number, cell volume, and cellular protein, DNA, and RNA content (author's transl)].

The aim of the present investigations was to see, if halothane (h), enflurane (e), isoflurane (i), and methoxyflurane (m) exert cytostatic or cytotoxic effects. The experiments were performed on suspension cultures of an established line of Ehrlich ascites tumor cells, which were gased by a mixture of N2 (78%), O2 (20%), and CO2 (2%) to which the volatile anaesthetics in 5 different concentrations were added by vaporizers. Under standardized conditions (incubation time: 24 or 48 hrs; initial cell density: 2 X 10(5) cells/ml culture medium) the following results were obtained: 1. All anaesthetics exerted dose dependent cytostatic effects, which were reversible up to concentrations of 2.0 vol% (m), 3.0 vol% (h), and 5.0 vol% (e, i). The cytostatic ID50 values (mmol/l) were found to be 0.50 (h), 1.00 (e), 0.72 (i), 1.25 (m). 2. In cell cultures, which were exposed to anaesthetics for 48 hrs cytotoxic effects were observed after doses of 2.0 vol% (m), 3.0 and 4.0 vol% (h), 4.0 and 5.0 vol% (e and i). 3. In contrast to colchicine, which was studied in comparison to the volatile anaesthetics, the mean cell volume of anaesthetic treated cultures showed only minimal deviations from control values. 4. With exception of m, which produced a significant decrease of the cellular protein content in the dose range 1.5-2.0 vol% and of the cellular DNA content in all concentrations applied the 3 other anaesthetics caused an increase of the cellular protein content and a somewhat smaller increase of the cellular nucleic acids content. The obtained results indicate that the effect of anaesthetic agents on dividing cells is not due to the same mode or site of action, but to an influence on different stage of the cell cycle, particularly the interphase. Colchicine-like c-mitosis were not obtained.

Anesthesia, Inhalation↗
PubMed1980

[Regional anaesthesia in haemophiliacs (author's transl)].

Since the middle of 1976 spinal and peridural anaesthesia are also being used for orthopaedic surgery of the lower extremities in haemophilic persons, the most important pre-requisites for the use of these techniques are: that it is a case of genuine haemophilia, that the deficiency is fully made up before and during anaesthesia and that the most important coagulation parameters are closely watched in co-operation with the Hemophilia Centre during the entire period. 46 haemophiliacs were given spinal and epidural anaesthesia via a catheter. A great advantage of these long-acting techniques is that less analgesics are needed during the postoperative period. Continuous peridural anaesthesia ensures freedom from pain without interfering with motoricity. The treatment of contractures of the joint by active and passive exercises has thus a better chance of success. Provided factors VIII/IX were kept normal there have so far not been any haemophilia-related haemorrhages into the spinal canal or cord or neurological disturbances that could be attributed to these anaesthetic techniques.

Adolescent↗
PubMed1979

[Gas chromatographic determination of the solubility coefficient for volatile anaesthetics (author's transl)].

For the determination of the solubility coefficient of volatile anaesthetics in Schindler's liquid culture, modified by Karzel, a gas-chromatographic analysis with direct-injection-method was used. A well defined volume with a known concentration of the anaesthetic was added to a vessel with known volume. After equilibration the concentration of the inhalational anaesthetics was determined in the liquid at various temperatures. The solubility coefficient and the temperature coefficient were then calculated from these data. We obtained the following solubility coefficients at -4 degrees C (37 degrees): for halothane 1,07 (0,77), for enflurane 1,14 (0,70), for methoxyflurane 4,92 (3,23) and for isoflurane 1,13 (0,82). In Schindler's liquid culture modified by Karzel the values at 24 degrees (37 degrees) were: for halothane 1,33 (0,92), for enflurane 1,32 (0,87), for methoxyflurane 6,61 (4,48) and for isoflurane 1,19 (0,98). The temperature coefficient for this temperature range were in water (in Schindler's liquid culture) for halothane: -2,31 . 10(-2) K(-1) (-3,15 . 10(-2) K(-1)), for methoxyflurane: -13,0 . 10(-2) K(-1) (-16,48 . 10(-2) K(-1)), for enflurane: -3,38 . 10(-2) K(-1) (-3,46 . 10(-2) K(-1)) and for isoflurane: -2,38 . 10(-2) K(-1) (-1,62 . 10(-2) K(-1)).

Anesthetics↗
PubMed1977

[Effects of premedication, narcosis and surgery on the coagulation and fibrinolysis systems and the platelets. The influence of dextran and hydroxyethyl starch (hes) during and after operation (author's transl)].

Patients who had undergone orthopaedic surgery were investigated. The changes attributable to premedication and narcosis were characterized by a primary fibrinolysis which was accompanied by a slight hypercoagulability. This increased fibrinolytic activity was more pronounced immediately after the beginning of the operation. The post operative changes are characterized by increased ADP-induced aggregation, increased release of platelet factors 3 and 4 and hypercoagulability with reduced fibrinolysis. The reduction in platelets during the operation could be prevented due to the influence of dextran and hydroxyethyl starch (HES). It came further to a slight increase in the activity of factor VII, to an increased fibrinogen polymerization and also to an increased release of platelet factor 4.

Adenosine Diphosphate↗